CT imaging comparison between intraductal papillary neoplasms of the bile duct and papillary cholangiocarcinomas

  • Takahiro Komori
  • Dai InoueEmail author
  • Yoh Zen
  • Norihide Yoneda
  • Azusa Kitao
  • Kazuto Kozaka
  • Akira Yokka
  • Fumihito Toshima
  • Takashi Matsubara
  • Satoshi Kobayashi
  • Toshifumi Gabata



To identify imaging features that assist in discriminating intraductal papillary neoplasms of the bile duct (IPNBs) from papillary cholangiocarcinomas (PCCs).


This study was approved by the institutional review board. Using the recently proposed histological diagnostic criteria for biliary papillary neoplasms, IPNBs and PCCs were selected from 537 biliary neoplasms consecutively resected in a 12.5-year period. Clinical and imaging features were compared between the two groups.


The histology review identified 19 IPNBs and 48 PCCs, representing an estimated prevalence of IPNBs among biliary neoplasms of 4%. Approximately one half of IPNBs were incidentally found on imaging conducted for other purposes. In terms of tumor location, 15/19 IPNBs (79%) developed in intrahepatic bile ducts, and 41/48 PCCs (85%) in the distal bile duct. Cystic appearance was highly suggestive for IPNBs (p < 0.001). Using these two parameters, 78% of papillary bile duct neoplasms could be classified into IPNBs or PCCs. Other imaging findings favoring IPNBs included frond-like mural nodule, downstream bile duct dilatation, and the lack of abnormal enhancement in the adjacent bile duct. Interestingly, two patients with non-invasive or microinvasive IPNB had undergone abdominal imaging studies > 3 years before, and a retrospective review of the previous images identified small nodular or cystic lesions, suggesting a less progressive nature of IPNBs than currently thought.


Imaging findings useful for discriminating IPNBs from PCCs appear to be tumor location, shape of tumor, appearance of mural nodules, duct dilatation at unaffected duct, and abnormal enhancement of the adjacent bile duct.

Key Points

• Intrahepatic location and cystic dilatation of the affected bile duct are the strong discriminators between IPNBs and PCCs.

• The shape of the mural nodule and appearance of the neighboring bile duct are helpful for distinguishing IPNBs and PCCs.

• The less aggressive behavior of IPNBs compared with PCCs may facilitate less invasive management in patients with IPNB.


Bile ducts Tomography, X-ray computed Cholangiocarcinoma 



Computed tomography


Delayed phase


Early phase


Hounsfield unit


Intraductal papillary mucinous neoplasm


Intraductal papillary neoplasm of the bile duct


Magnetic resonance imaging


Region of interest



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Dai Inoue.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Case-control study

• Multicenter study


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Takahiro Komori
    • 1
  • Dai Inoue
    • 1
    Email author
  • Yoh Zen
    • 2
  • Norihide Yoneda
    • 1
  • Azusa Kitao
    • 1
  • Kazuto Kozaka
    • 1
  • Akira Yokka
    • 1
  • Fumihito Toshima
    • 1
  • Takashi Matsubara
    • 1
  • Satoshi Kobayashi
    • 1
    • 3
  • Toshifumi Gabata
    • 1
  1. 1.Department of RadiologyKanazawa University Graduate School of Medical ScienceKanazawaJapan
  2. 2.Department of Diagnostic PathologyKobe University HospitalKobeJapan
  3. 3.Department of Quantum Medical ImagingKanazawa University Graduate School of Medical SciencesKanazawaJapan

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