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Ultraschall Med 2015; 36(06): 594-602
DOI: 10.1055/s-0034-1366672
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Ultrasound Findings of Intraductal Papillary Neoplasm in Bile Duct and the Added Value of Contrast-Enhanced Ultrasound

Ultraschallbefunde bei intraduktalen papillärer Neoplasien der Gallenwege und Zusatzwert der kontrastverstärkten Sonografie
L. N. Liu   1
1   Department of Medical Ultrasound, Shanghai Tenth People’s Hospital of Tongji University, Shanghai, China
2   Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
,
H. X. Xu
1   Department of Medical Ultrasound, Shanghai Tenth People’s Hospital of Tongji University, Shanghai, China
2   Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
,
S. G. Zheng
1   Department of Medical Ultrasound, Shanghai Tenth People’s Hospital of Tongji University, Shanghai, China
2   Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
,
L. P. Sun   1
1   Department of Medical Ultrasound, Shanghai Tenth People’s Hospital of Tongji University, Shanghai, China
,
L. H. Guo
1   Department of Medical Ultrasound, Shanghai Tenth People’s Hospital of Tongji University, Shanghai, China
,
Y. F. Zhang
1   Department of Medical Ultrasound, Shanghai Tenth People’s Hospital of Tongji University, Shanghai, China
,
J. M. Xu
1   Department of Medical Ultrasound, Shanghai Tenth People’s Hospital of Tongji University, Shanghai, China
,
C. Liu
1   Department of Medical Ultrasound, Shanghai Tenth People’s Hospital of Tongji University, Shanghai, China
,
X. H. Xu
3   Department of Ultrasound, Guangdong Medical College Affiliated Hospital, Zhanjiang, China
› Author Affiliations
Further Information

Publication History

03 December 2013

22 May 2014

Publication Date:
04 September 2014 (online)

Also available at
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Abstract

Purpose: To investigate the imaging features of intraductal papillary neoplasm in bile duct (IPNB) on baseline ultrasound and contrast-enhanced ultrasound (CEUS).

Materials and Methods: The imaging features on baseline ultrasound and CEUS in 16 pathologically proven IPNB lesions in 15 patients were retrospectively analyzed. Real-time contrast specific modes and contrast agent of SonoVue were used for CEUS.

Results: Bile duct dilation was present in all patients. The mean lengths for the intraductal papillary adenomas and adenocarcinomas were 2.5 ± 1.1 (range, 1.2 – 4.2 cm) and 5.6 ± 2.0 cm (range, 3.3 – 9.8 cm) (P = 0.004). Three imaging types of IPNB on ultrasound were depicted: bile duct dilation with intraductal mass (n = 8), bile duct dilation without intraductal mass (n = 3), and cystic-solid mixed type (n = 5). On CEUS, solid components of 13 lesions appeared hyper- (n = 12) or iso-enhancement (n = 1) in the arterial phase whereas all showed hypo-enhancement in the portal and late phases. For 3 lesions of bile duct dilation without intraductal mass, CEUS showed non-enhancement during all phases. Pre-surgical CEUS and conventional ultrasound made correct diagnoses in 12 (75.0 %) and 5(31.3 %) of 16 IPNBs respectively (P = 0.04). For CECT, correct diagnosis was also achieved in 12 (75.0 %) of 16 lesions (P = 1.00, in comparison with CEUS).

Conclusions: IPNB should be taken into consideration when intraductal mass or cystic-solid mass with bile duct dilation, or remarkable bile duct dilation without intraductal mass, are found on US. Intraductal mass length > 3.0 cm is more commonly found in malignant IPNB. CEUS might facilitate the diagnosis of IPNB by easily excluding the possibility of commonly found sludge, nonshadowing stones, or blood clots.

Zusammenfassung

Ziel: Untersuchung der Bildcharakteristika von intraduktalen papillären Neoplasien der Gallenwege (IPNB, „intraductal papillary neoplasms of the bile duct“) im Basis-Ultraschall und der kontrastverstärkten Sonografie (CEUS).

Material und Methoden: Die Bildcharakteristika von Basis-Ultraschall und CEUS bei 16 pathologisch bestätigten IPNB-Läsionen von 15 Patienten wurden retrospektiv ausgewertet. Im CEUS kamen kontrastspezifische Modi in Echtzeit und das Kontrastmittel SonoVue zum Einsatz.

Ergebnisse: Alle Patienten hatten eine Erweiterung der Gallengänge. Die mittlere Größe der papillären Adenome betrug 2,5 ± 1,1 (Bereich 1,2 – 4,2 cm) und die der Adenokarzinome 5,6 ± 2,0 cm (Bereich 3,3 – 9,8 cm) (p = 0,004). Drei Bildtypen der IPNB wurden im Ultraschall beschrieben: Gallengangsdilatation mit intraduktaler Raumforderung (n = 8), Gallengangsdilatation ohne intraduktale Raumforderung (n = 3) und der zystisch-solide gemischte Typ (n = 5). Im CEUS erschienen die soliden Komponenten von 13 Läsionen als hyperechogene (n = 12) oder isoechogene Kontrastaufnahme (n = 1) in der arteriellen Phase, während alle Läsionen eine hypoechogene Kontrastaufnahme in den portalen und späten Phasen zeigten. Bei 3 Läsionen mit Gallengangdilatation ohne intraduktale Raumforderung zeigte sich im CEUS über alle Phasen hinweg keine Kontrastaufnahme. Durch CEUS vor der Operation wurde die richtige Diagnose in 12 (75,0 %) der 16 IPNBs ermöglicht und im herkömmlichen Ultraschall in 5 (31,3 %) davon (p = 0,04). Durch CECT konnte in 12 (75,0 %) der 16 Läsionen die richtige Diagnose gestellt werden (p = 1,00 im Vergleich mit CEUS).

Schlussfolgerung: IPNB sollten bei intraduktalen oder zystisch-soliden Raumforderungen mit Gallengangserweiterung, aber auch bei auffallenden Gallengangsdilatation ohne intraduktale Raumforderung im Ultraschall, in Betracht gezogen werden. Intraduktale Raumforderungen mit einer Größe von > 3,0 cm werden häufiger bei malignen IPNB gefunden. CEUS kann die Diagnose von IPNB unterstützen, da häufig vorkommender Gallengries, wenig schattenwerfende Steine oder Blutgerinnsel problemlos ausgeschlossen werden können.

Key words

abdomen - ultrasound 2 D - contrast agents

1 both authors contributed equally to this article.


 

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