Intraductal Papillary Neoplasm of the Bile Duct: Multimodality Imaging Appearances and Pathological Correlation Csilla Egri, BSc, MSc, Wan Wan Yap, MBChB,

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Intraductal Papillary Neoplasm of the Bile Duct: Multimodality Imaging Appearances and Pathological Correlation Csilla Egri, BSc, MSc, Wan Wan Yap, MBChB, MRCS (Ed), FRCR (UK), FRCPC, Charles H. Scudamore, BSc, MSc, MD, FACS, FRCSC, FRCS, Douglas Webber, MD, FRCPC, Alison Harris, BSc (Hons), MBChB, MRCP, FRCR (UK), FRCPC Canadian Association of Radiologists Journal Volume 68, Issue 1, Pages 77-83 (February 2017) DOI: 10.1016/j.carj.2016.07.005 Copyright © 2016 Canadian Association of Radiologists Terms and Conditions

Figure 1 (A, B) Endoscopic retrograde cholangeopancreatography and magnetic resonance cholangeopancreatography show severe extra and intrahepatic duct dilatation with mucin seen during the procedure with filling defects along its wall (B, white arrow). (C) Axial portal venous phase computed tomography shows marked intrahepatic duct dilatation with mildly enhancing solid material along the side wall (arrow). No parenchymal mass seen in the liver and no capsular retraction. (D) Magnetic resonance imaging axial T1 volumetric interpolated breath-hold exam (VIBE) postcontrast sequences through the liver showing intrahepatic duct dilatation and soft tissue along the wall. (E) Corresponding photomicrograph with hematoxylin and eosin at 20× magnification showing intrahepatic duct filled with intraductal papillary neoplasm of the bile duct (arrow) and liver to the left (asterisk). This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2017 68, 77-83DOI: (10.1016/j.carj.2016.07.005) Copyright © 2016 Canadian Association of Radiologists Terms and Conditions

Figure 2 (A) Endoscopic retrograde cholangeopancreatography shows intrahepatic duct dilatation and filling defect at the cystic and hepatic duct confluence. (B, C) Coronal and axial portal venous phase computed tomography shows a small enhancing nodule at the cystic duct. (D) Corresponding photomicrograph at the same level shows intraductal papillary neoplasm of the bile duct (IPNB) (asterisk) and duodenum (D). (E) Photomicrograph of the resection shows the cystic duct filled with IPNB, intestinal type 100×, with perineural invasion (N) of a minute 2 mm locus of moderately differentiated adenocarcinoma (arrow) 100×. Hematoxylin and eosin (asterisk) shows IPNB. This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2017 68, 77-83DOI: (10.1016/j.carj.2016.07.005) Copyright © 2016 Canadian Association of Radiologists Terms and Conditions

Figure 3 (A, B) Transabdominal ultrasound with echogenic filling defect with dilatation of the proximal duct (red arrows). (C–E) Axial triple-phase computed tomography showing arterial, portal venous, and delayed phases, respectively, with intrahepatic duct dilatation, focally affecting the left hepatic ducts. (F, G) Endoscopic retrograde cholangeopancreatography with smooth filling defect. (H) Triphasic contrast magnetic resonance imaging shows 5-minute delayed phase enhancement of the mural nodule. This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2017 68, 77-83DOI: (10.1016/j.carj.2016.07.005) Copyright © 2016 Canadian Association of Radiologists Terms and Conditions

Figure 3 (A, B) Transabdominal ultrasound with echogenic filling defect with dilatation of the proximal duct (red arrows). (C–E) Axial triple-phase computed tomography showing arterial, portal venous, and delayed phases, respectively, with intrahepatic duct dilatation, focally affecting the left hepatic ducts. (F, G) Endoscopic retrograde cholangeopancreatography with smooth filling defect. (H) Triphasic contrast magnetic resonance imaging shows 5-minute delayed phase enhancement of the mural nodule. This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2017 68, 77-83DOI: (10.1016/j.carj.2016.07.005) Copyright © 2016 Canadian Association of Radiologists Terms and Conditions

Figure 4 (A) Transabdominal ultrasound shows echogenic soft tissue in the common hepatic duct extending to distal common bile duct. (B) Endoscopic retrograde cholangeopancreatography with smooth filling defects in the hilar extrahepatic bile duct. Canadian Association of Radiologists Journal 2017 68, 77-83DOI: (10.1016/j.carj.2016.07.005) Copyright © 2016 Canadian Association of Radiologists Terms and Conditions

Figure 5 (A) Preoperative T1-weighted magnetic resonance imaging postcontrast showing a mass (arrow). (B) Preoperative magnetic resonance cholangeopancreatography showing long segment of filling defect (arrow). (C) Preoperative endoscopic retrograde cholangeopancreatography showing filling defect (arrow). (D) Post right hepatectomy for intraductal papillary neoplasm of the bile duct, recurring at the hilar region showing a mass with similar appearances to the preoperative magnetic resonance images (red arrows). (E) Axial computed tomography showing dilated intrahepatic ducts with circumferential mass (arrow). This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2017 68, 77-83DOI: (10.1016/j.carj.2016.07.005) Copyright © 2016 Canadian Association of Radiologists Terms and Conditions