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Thread sign in biliary intraductal papillary mucinous neoplasm: a novel specific finding for MRI

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate thread sign of biliary intraductal papillary mucinous neoplasm (B-IPMN) on magnetic resonance imaging (MRI).

Methods

Thread sign was defined as intraductal linear or curvilinear hypointense striations. Two radiologists independently evaluated the presence and location of thread sign on MR cholangiography (thin-slice, thick-slab and 3D MRC) and axial MR images (T2 TSE, T2 HASTE and DWI) in patients with B-IPMN (n = 38) and in matched control groups with benign (n = 36) or malignant (n = 35) biliary diseases. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of thread sign for diagnosing B-IPMN were evaluated.

Results

Thread sign was observed only in patients with B-IPMN on MRC (44.7–52.6 % [17/38–20/38], P < 0.001) and axial MR images (31.6 % [12/38], P < 0.001), except in one patient with recurrent pyogenic cholangitis on MRC (2.8 %, 1/36). The sensitivity, specificity, accuracy, PPV and NPV of thread sign for diagnosing B-IPMN on MRC were 0.53, 0.99, 0.83, 0.95 and 0.80, respectively (reader 1) and 0.45, 1.0, 0.81, 1.0 and 0.77, respectively (reader 2). Thread sign was detected mainly at the extrahepatic bile duct (52.6 %, 20/38).

Conclusion

B-IPMN can manifest thread sign, a novel specific MR finding, mainly at the extrahepatic bile duct on MRI, especially on MRC.

Key Points

• Some B-IPMNs manifest thread sign within the bile ducts on MRI.

• Thread sign is a highly specific finding for B-IPMN on MRI.

• MRC is superior to axial T2WI and DWI for detecting thread sign.

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Acknowledgments

The scientific guarantor of this publication is Jae Ho Byun, MD, PhD. 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. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Gil-Sun Hong, Jae Ho Byun, Jin Hee Kim, Hyoung Jung Kim, Seung Soo Lee & Moon-Gyu Lee

  2. Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Seung-Mo Hong

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  1. Gil-Sun Hong
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Correspondence to Jae Ho Byun.

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Hong, GS., Byun, J.H., Kim, J.H. et al. Thread sign in biliary intraductal papillary mucinous neoplasm: a novel specific finding for MRI. Eur Radiol 26, 3112–3120 (2016). https://doi.org/10.1007/s00330-015-4158-5

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  • DOI: https://doi.org/10.1007/s00330-015-4158-5

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