Intraductal papillary neoplasm of the bile duct (IPNB): CT and MRI appearance with radiology-pathology correlation


      • IPNB, a precursor to invasive adenocarcinoma is analogous to pancreatic IPMN, albeit with a higher rate of malignant transformation compared to the latter
      • IPNB's most commonly present as an extrahepatic intraluminal polypoid mass with upstream biliary ductal dilatation, can present as a stricture with plaque like thickening and upstream biliary ductal dilatation and rarely as ductal dilatation without an associated mass
      • IPNB remains a challenging diagnosis as most cases overlap with imaging appearance of Cholangiocarcinoma, hence requiring a multidisciplinary approach for treatment and surveillance



      Intraductal papillary neoplasm of the bile duct (IPNB) is a precursor to invasive carcinoma and is a distinct pathologic diagnosis. The purpose of this study was to evaluate imaging features of IPNB on cross-sectional imaging studies with histopathologic correlation.

      Materials and methods

      In this IRB approved, HIPAA compliant retrospective observational analysis of 23 pathology proven IPNB tumors 22 imaging studies were reviewed, 14 CT and 8 MRI scans. Features evaluated in consensus by two subspecialty-trained abdominal radiologists included: presence of specific lesion/mass within the bile duct, location within the biliary tree, size, morphology, enhancement characteristics, and bile duct caliber.


      Majority of the subjects (16/18, 90%) had definite intraluminal mass, of which 7 (39%) had a polypoid mass with upstream diffuse biliary ductal dilation and 5 (28%) had a plaque-like mass with focal stricture and upstream biliary ductal dilatation. 6/18 (33%) subjects had low grade dysplasia, most commonly intestinal subtype, 7/18 (39%) subjects presented with invasive component, commonly pancreaticobiliary subtype, and 5/18 (28%) presented with high grade dysplasia.


      IPNB has increased predilection for extrahepatic bile ducts, commonly presenting as either an intraluminal polypoidal mass with associated upstream biliary ductal dilation or a focal plaque like mass with associated ductal stricture at the site of the tumor.


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