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Purpose <p>To evaluate the value of hybrid <sup>18</sup>F-FDG PET/MRI in assessing the biological aggressiveness of intraductal papillary neoplasms of the bile duct (IPNBs).</p> Methods <p>This retrospective study included patients with pathologically confirmed IPNB who underwent <sup>18</sup>F-FDG PET/MRI. Imaging features analyzed included <sup>18</sup>F-FDG uptake, enhancement, diffusion restriction, duct walls infiltration, lesion size, SUVmax and lesion-to-liver SUVmax ratio. Final lesion classification was based on a composite reference standard integrating pathology with imaging follow-up, to account for potential biopsy sampling error. Spearman’s correlation assessed associations between SUV parameters and histological grade. Group comparisons used the Mann–Whitney U test and Fisher’s exact test. ROC analysis evaluated SUV parameters in diagnosing IPNBs with associated invasive adenocarcinoma.</p> Results <p>Eight patients (5 M, 3 F; median age: 65.5) with 10 lesions were included: five IPNBs with associated invasive adenocarcinoma, four dysplastic, and one non-dysplastic lesion. SUVmax and lesion-to-liver SUVmax ratio positively correlated with histological grade (ρ = 0.784, p = 0.007 and ρ = 0.844, p = 0.002, respectively). SUVmax ratio was higher in IPNBs with associated invasive adenocarcinoma versus both non-adenocarcinoma (p = 0.016) and dysplastic lesions (p = 0.032). Lesion SUVmax was higher in IPNBs with associated invasive adenocarcinoma only versus non-adenocarcinoma (p = 0.032) without reaching significance against dysplastic lesions (p = 0.063). ROC analysis yielded AUC values of 0.90–0.96 (95% CI 0.674–1.000) for SUV parameters. Cut-offs of 8.04 for SUVmax and 3.00 for SUVmax ratio achieved 80% sensitivity and 100% specificity.</p> Conclusion <p>Hybrid <sup>18</sup>F-FDG PET/MRI shows promising potential for preoperative assessment and risk stratification of IPNBs, warranting validation in larger prospective studies.</p> Key points <p>• Preoperative differentiation between dysplastic and IPNBs with invasive adenocarcinoma remains challenging, yet critical for surgical planning and prognosis.</p> <p>• <sup>18</sup>F-FDG PET/MRI SUV parameters correlate with histological grade, with the lesion-to-liver SUVmax ratio showing the strongest and most robust association.</p> <p>• <sup>18</sup>F-FDG PET/MRI may support non-invasive risk stratification of IPNBs, potentially overcoming the limitations associated with biopsy sampling.</p>

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18F-FDG PET/MRI for non-invasive risk stratification of Intraductal Papillary Neoplasms of the Bile Duct (IPNB)

  • 期刊论文

  • 发表日期：

    2026年7月8日

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  • Antonino Andrea Blandino,
  • Elio Quiros,
  • Luigi Asmundo,
  • M. Lisa Zhang,
  • Mario V. Russo,
  • Amirkasra Mojtahed,
  • Mark A. Anderson,
  • Pedram Heidari,
  • Onofrio Antonio Catalano

摘要

Purpose

To evaluate the value of hybrid 18F-FDG PET/MRI in assessing the biological aggressiveness of intraductal papillary neoplasms of the bile duct (IPNBs).

Methods

This retrospective study included patients with pathologically confirmed IPNB who underwent 18F-FDG PET/MRI. Imaging features analyzed included 18F-FDG uptake, enhancement, diffusion restriction, duct walls infiltration, lesion size, SUVmax and lesion-to-liver SUVmax ratio. Final lesion classification was based on a composite reference standard integrating pathology with imaging follow-up, to account for potential biopsy sampling error. Spearman’s correlation assessed associations between SUV parameters and histological grade. Group comparisons used the Mann–Whitney U test and Fisher’s exact test. ROC analysis evaluated SUV parameters in diagnosing IPNBs with associated invasive adenocarcinoma.

Results

Eight patients (5 M, 3 F; median age: 65.5) with 10 lesions were included: five IPNBs with associated invasive adenocarcinoma, four dysplastic, and one non-dysplastic lesion. SUVmax and lesion-to-liver SUVmax ratio positively correlated with histological grade (ρ = 0.784, p = 0.007 and ρ = 0.844, p = 0.002, respectively). SUVmax ratio was higher in IPNBs with associated invasive adenocarcinoma versus both non-adenocarcinoma (p = 0.016) and dysplastic lesions (p = 0.032). Lesion SUVmax was higher in IPNBs with associated invasive adenocarcinoma only versus non-adenocarcinoma (p = 0.032) without reaching significance against dysplastic lesions (p = 0.063). ROC analysis yielded AUC values of 0.90–0.96 (95% CI 0.674–1.000) for SUV parameters. Cut-offs of 8.04 for SUVmax and 3.00 for SUVmax ratio achieved 80% sensitivity and 100% specificity.

Conclusion

Hybrid 18F-FDG PET/MRI shows promising potential for preoperative assessment and risk stratification of IPNBs, warranting validation in larger prospective studies.

Key points

• Preoperative differentiation between dysplastic and IPNBs with invasive adenocarcinoma remains challenging, yet critical for surgical planning and prognosis.

• 18F-FDG PET/MRI SUV parameters correlate with histological grade, with the lesion-to-liver SUVmax ratio showing the strongest and most robust association.

• 18F-FDG PET/MRI may support non-invasive risk stratification of IPNBs, potentially overcoming the limitations associated with biopsy sampling.