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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.

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.