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MR imaging and MR Cholangiopancreatography of multiple biliary hamartomas
Jingshan Gong1, Wenyan Kang, Jianmin Xu
1Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China.
Abstract:
Multiple biliary hamartomas (MBH), also known as von Meyenberg complexes, are rare benign malformations of the intrahepatic bile ducts. It is thought that MBH result from ductal plate malformations involving the small interlobular bile ducts. Proliferation of bile ducts' cuboidal epithelium in fibrous stroma subsequently leads to duct dilation. Macroscopically, MBH appear as well-defined subcapsular or parenchymal grayish-white nodules less than 0.5 cm in diameter without true capsulation in an abundant fibrous stroma. MR imaging is considered the best imaging modality for demonstrating MBH. We herein reported MR imaging and MR cholangiopancreatography of a patient with typical MBH appearance. Multiple tiny T1 hypointense and T2 hyperintense lesions of uniform distribution in the hepatic parenchyma were revealed. At MR cholangiopancreatography, the lesions were also hyperintense. Maximum intense projection (MIP) of MR cholangiopancreatography showed uniformly distributed hyperintense lesions appearing as ''starry sky'' configuration.
Insights
Multiple biliary hamartomas (MBH), rare benign liver malformations, are best visualized with MR imaging. This case highlights their characteristic "starry sky" appearance on MR cholangiopancreatography.
Area of Science:
- Hepatology
- Radiology
- Pathology
Background:
- Multiple biliary hamartomas (MBH), also known as von Meyenberg complexes, are rare benign malformations of intrahepatic bile ducts.
- They are believed to arise from ductal plate malformations affecting small interlobular bile ducts, leading to duct dilation.
- Macroscopically, MBH present as small, well-defined, non-encapsulated nodules within the liver parenchyma.
Observation:
- This report details the MR imaging and MR cholangiopancreatography findings in a patient with typical MBH.
- MR imaging revealed multiple, uniformly distributed, small lesions in the hepatic parenchyma.
- These lesions were hypointense on T1-weighted images and hyperintense on T2-weighted images.
Findings:
- MR cholangiopancreatography demonstrated hyperintense lesions within the hepatic parenchyma.
- Maximum intensity projection (MIP) imaging of MR cholangiopancreatography revealed a characteristic "starry sky" configuration.
- This appearance is attributed to the uniform distribution of hyperintense lesions.
Implications:
- MR imaging, particularly MR cholangiopancreatography, is the optimal modality for diagnosing MBH.
- The "starry sky" pattern on MRCP is a key diagnostic feature for MBH.
- Accurate imaging diagnosis can prevent unnecessary invasive procedures for these benign lesions.
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