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Imaging Studies of Intraductal Tubulopapillary Neoplasms of the Pancreas: 2-Tone Duct Sign and Cork-of-Wine-Bottle Sign as Indicators of Intraductal Tumor Growth

Motosugi, Utaroh MD, PhD*†; Yamaguchi, Hiroshi MD, PhD*; Furukawa, Toru MD, PhD; Ichikawa, Tomoaki MD, PhD; Hatori, Takashi MD, PhD§; Fujita, Izumi MD§; Yamamoto, Masakazu MD, PhD§; Motoi, Fuyuhiko MD, PhD; Kanno, Atsushi MD, PhD; Watanabe, Tomoo MD, PhD#; Koike, Naoto MD, PhD**; Koyama, Isamu MD, PhD††; Kobayashi, Junya MD, PhD‡‡; Shimizu, Michio MD, PhD*

Journal of Computer Assisted Tomography: November/December 2012 - Volume 36 - Issue 6 - p 710–717
doi: 10.1097/RCT.0b013e31826d1fc8

Objective: The objective of this study was to describe the imaging findings for intraductal tubulopapillary neoplasms of the pancreas.

Methods: Eleven pancreatic tumors pathologically confirmed as intraductal tubulopapillary neoplasm were retrospectively collected. The dynamic contrast-enhanced computed tomography (CT), magnetic resonance (MR) imaging including MR cholangiopancreatography (MRCP), ultrasound, and endoscopic retrograde cholangiopancreatography (ERCP) results were reviewed. The 2-tone duct sign and cork-of-wine-bottle sign were reviewed as indicators of intraductal tumor growth on CT/MR and MRCP/ERCP images, respectively.

Results: A 2-tone duct sign was noted on the dynamic CT images (7/10, 70%) and on the MR imaging (5/8, 63%). The distal main pancreatic duct was dilated in all the patients except one, who had a branch duct lesion. A cork-of-wine-bottle sign was observed on the MRCP image (3/8, 38%) and on the ERCP image (3/6, 50%).

Conclusions: Intraductal tubulopapillary neoplasms are rare tumors showing characteristic imaging findings such as the 2-tone duct sign and the cork-of-wine-bottle sign that represent their intraductal growth.

From the *Department of Pathology, Saitama Medical University, International Medical Center, Hidaka; †Department of Radiology, University of Yamanashi, Chuo; ‡Institute for Integrated Medical Sciences and §Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo; ∥Hepato-Biliary Pancreatic Surgery, Tohoku University Hospital, and ¶Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai; #Department of Surgery, Tobu Chiiki Hospital, Tokyo; **Department of Surgery, Seirei Sakura Citizen Hospital, Sakura; ††Department of Surgery, Saitama Medical University, International Medical Center, Hidaka; and ‡‡Department of Surgery, Fujiyoshida Municipal Medical Center, Fujiyoshida, Japan.

Received for publication June 4, 2012; accepted August 2, 2012.

Reprints: Utaroh Motosugi, MD, PhD, Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan (e-mail:

The authors declare no conflict of interest.

© 2012 Lippincott Williams & Wilkins, Inc.