There is a broad spectrum of biliary disease in adults that demonstrate characteristic radiologic patterns and histopathologic features. WHO classified biliary tumor into benign (bile duct adenoma, microcystic adenoma, and bilary adenofibroma), premalignant lesion (Biliary intraepithelial neoplasia, grade 3 (BilIN-3), Intraductal papillary neoplasm with low- to intermediate-grade, Intraductal papillary neoplasm with high-grade, Mucinous cystic neoplasm with low- to intermediate-grade, Mucinous cystic neoplasm with high-grade), and malignant tumors (Intrahepatic cholangiocaricnoma, Intraductal papillary neoplasm with invasive carcinoma, and Mucinous cystic neoplasm with invasive carcinoma). In clinical practice, we should differentiate them from various benign conditions and each other. For the differential diagnosis of biliary disease, a pattern approach could be helpful. Radiologic patterns of biliary disease may be classified into mass-forming, periductal infiltrative, intraductal, cystic, or miscellaneous. In this talk, I will present differential diagnosis of biliary lesions based on imaging phenotypes with pathologic and clinical correlation.

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