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Title: [Magnetic resonance imaging features and classification of intraductal papillary neoplasm of the bile duct].
Author: Liu LC, Chen YF, Shan YQ, Chen LL, Zeng MS, Wang ML.
Journal: Zhonghua Gan Zang Bing Za Zhi; 2024 May 20; 32(5):461-468. PubMed ID: 38858196.
Abstract:
Objective: To explore the magnetic resonance imaging (MRI) features and classification of intraductal papillary neoplasm of the bile duct (IPNB). Methods: Data from 90 patients with intraductal papillary neoplasm of the bile duct confirmed pathologically between June 2010 and January 2023 were retrospectively analyzed. The image analysis included the shape and location of the tumor, whether bile ducts had dilatation and the degree of dilation, whether there was a history of liver disease, whether there was a history of schistosomiasis, whether there was cancerous transformation, whether there were concurrent bile duct stones, whether there was hepatic lobe atrophy, whether there was hilar or abdominal lymph node enlargement, whether there was invasion of the bile duct wall, whether there was invasion of surrounding blood vessels, whether the tumor appears on T1-and T2 weighted imaging (T(1)WI and T(2)WI), whether the diffusion was limited, whether there was concurrent bleeding, enhancement rate, and whether there was abdominal fluid accumulation. Intraductal papillary neoplasms of the bile duct were divided into four types according to the morphological classification standards: type I (local bile duct dilation), type II (cystic), type III (free tumor), and type IV (dilated bile duct). The differences in the clinical and MRI features of the four groups of lesions were analyzed. Statistical analysis was performed with a t-test, an analysis of variance, and an χ(2)-test according to the different data. Results: Among the 90 cases with hepatic IPNB, there were 31 cases of type I, 15 cases of type II, 16 cases of type III, and 28 cases of type IV, 41 cases of liver left lobe, 11 cases of right and left lobe liver span, 7 cases of liver right lobes, 2 cases of liver caudate lobe, and 13 cases of hepatic hilar. There were statistically significant differences between the four groups (P < 0.05) in terms of age, clinical symptoms, direct bilirubin, γ-glutamyltransferase, whether they were cancerous, whether they were combined with bile duct stones, whether the liver lobes were atrophying, whether there was limited diffusion, intrahepatic bile duct diameter, and common bile duct diameter. However, there were no statistically significant differences among the four groups in gender, location, carbohydrate antigen 19-9, history of liver disease, history of schistosomiasis, carcinoembryonic antigen, alanine aminotransferase, aspartate aminotransferase, total bilirubin, whether hemorrhage was associated, lesion enhancement rate, whether the hilar/retroperitoneal lymph node was enlarged, whether the bile duct wall was invaded, whether blood vessels were invaded, and whether abdominal fluid was accumulated (P > 0.05). Conclusion: MRI manifestations have certain features for different types of intraductal papillary neoplasm of the bile duct tumors; hence, MRI aids in the diagnosis and differential diagnosis of this disease. 目的： 探讨肝内胆管内乳头状肿瘤（IPNB）的磁共振成像（MRI）特征及其分型。 方法： 回顾性分析2010年6月至2023年1月经病理证实的90例IPNB患者的资料，图像分析包括肿瘤的形态、位置、胆管有无扩张及扩张程度、有无肝病史、有无血吸虫病史、是否癌变、是否合并胆管结石、是否存在肝叶萎缩、有无肝门或腹腔淋巴结肿大、是否侵犯胆管壁、是否侵犯周围血管、肿瘤在T(1)加权成像（WI）、T(2)WI图像上的信号特征、是否扩散受限、是否合并出血、强化率、有无腹腔积液，根据形态学分类标准将IPNB分为4型，I型（局部胆管扩张型）、II型（囊肿型）、III型（无肿瘤型）、IV型(胆管扩张型)，分析4组病灶的临床及MRI特征差异。据资料不同采用t检验或方差分析、χ(2)检验进行统计学分析。 结果： 90例肝脏IPNB患者中I型31例，II型15例，III型16例，IV型28例；肝左叶41例，肝右叶11例，跨越肝左、右叶7例，肝尾状叶2例，肝门部13例；4组间在年龄、有无临床症状、直接胆红素、γ-谷氨酰转移酶、是否癌变、是否合并胆管结石、肝叶是否萎缩、是否扩散受限、肝内胆管直径、胆总管直径的比较差异有统计学意义（P<0.05）；4组间在性别、位置、糖类抗原19-9、有无肝病史、有无血吸虫病史、癌胚抗原、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、是否合并出血、病灶强化率、肝门/腹膜后有无肿大淋巴结、是否侵犯胆管壁、是否侵犯血管、有无腹腔积液的比较差异无统计学意义（P>0.05）。 结论： 不同类型的IPNB的MRI表现有一定的特征，MRI有助于该病的诊断与鉴别诊断。.

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