Objective: The purpose of this study was to evaluate the utility of ampullary MDCT in the noninvasive, preoperative differentiation of pancreatobiliary and intestinal subtypes of ampullary adenocarcinoma.
Materials And Methods: This retrospective study included 32 patients (20 men, 12 women; age range, 41-81 years) with resected ampullary adenocarcinoma who underwent preoperative contrast-enhanced ampullary MDCT. Two radiologists, blinded to pathologic diagnosis of adenocarcinoma subtype, evaluated the presence of seven MDCT features independently. MDCT findings and ampullary adenocarcinoma subtypes were correlated using chi-square and Fisher exact tests. Interobserver agreement was evaluated using the Cohen kappa statistic.
Results: When evaluated with ampullary MDCT, the intestinal and pancreatobiliary subtypes were significantly different in terms of lesion morphology (p < 0.0001), papillary shape (p < 0.0001), common bile duct (CBD) infiltration and dilatation (p = 0.003 and p = 0.0004, respectively), duodenopancreatic groove infiltration (p = 0.0009), and pancreaticoduodenal artery involvement (p = 0.004). Pancreatobiliary subtype tumors were more often infiltrative in morphology (18/18) and showed retracted papilla (14/18), CBD (18/18) and main pancreatic duct (MPD) infiltration (12/18), dilated CBD (18/18) and MPD (13/18), fixed duodenopancreatic groove appearance (15/18), and pancreaticoduodenal artery involvement (12/18). Intestinal subtype carcinomas were more frequently nodular (14/14) and had a bulging papilla (13/14), a free duodenopancreatic groove appearance (11/14), and no pancreaticoduodenal artery involvement (2/14). When all features were taken into account, MDCT showed sensitivity of 85.7% and specificity of 83.3% in differentiating intestinal and pancreatobiliary subtype tumors. Accuracy, positive predictive value, and negative predictive value of MDCT were 84.4%, 80%, and 88.2%, respectively. Interobserver agreement was almost perfect for the presence of each imaging feature (κ > 0.8).
Conclusion: Ampullary MDCT can be useful to differentiate pancreatobiliary and intestinal subtypes of ampullary adenocarcinoma preoperatively, provided the duodenum is optimally distended at imaging.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.2214/AJR.16.16723 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized in a previous coronary artery bypass grafting: A case report and review of literature.
Medicine (Baltimore)
December 2021
Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan.
Rationale: Pancreaticoduodenectomy (PD) is a technically demanding procedure with high rates of morbidity and mortality. Therefore, preoperative evaluation of anatomy is indispensable. Multi-detector row computed tomography (CT) enables us to precisely understand arterial anatomy.
View Article and Find Full Text PDFAssessment of Duodenal Diverticula: Computed Tomography Findings.
Curr Med Imaging Rev
October 2020
Department of Radiology, School of Medicine, Trakya University, Edirne, Turkey.
Aims: To demonstrate the prevalence, accompanying pathologies, imaging and follow up findings of Duodenal Diverticula (DD) with Multidetector Computed Tomography (MDCT).
Materials And Methods: Consecutive 2910 abdominal MDCTs were retrospectively reviewed on axial, coronal and sagittal planes. DD were evaluated for prevalence, location, number, size, contents, diverticular neck, accompanying pancreaticobiliary pathologies, jejunal and colonic diverticula, respectively.
Chronic Pancreatitis or Pancreatic Tumor? A Problem-solving Approach.
Radiographics
July 2020
From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.).
Certain inflammatory pancreatic abnormalities may mimic pancreatic ductal adenocarcinoma at imaging, which precludes accurate preoperative diagnosis and may lead to unnecessary surgery. Inflammatory conditions that may appear masslike include mass-forming chronic pancreatitis, focal autoimmune pancreatitis, and paraduodenal pancreatitis or "groove pancreatitis." In addition, obstructive chronic pancreatitis can mimic an obstructing ampullary mass or main duct intraductal papillary mucinous neoplasm.
View Article and Find Full Text PDFDifferentiation of benign and malignant ampullary obstruction by multi-row detector CT.
Jpn J Radiol
August 2018
Department of Radiology, Thammasat University Hospital, 95 Moo 8, Phahon Yothin Road, Khlong Luang, Pathum Thani, 12110, Thailand.
Purpose: To determine useful CT parameters to differentiate ampullary carcinomas from benign ampullary obstruction.
Materials And Methods: This study included 93 patients who underwent abdominal CT, 31 patients with ampullary carcinomas, and 62 patients with benign ampullary obstruction. Two radiologists independently evaluated CT parameters then reached consensus decisions.
Multi-detector spiral CT diagnosis of common bile duct ampullary carcinoma.
Eur Rev Med Pharmacol Sci
August 2017
Department of Medical Imaging Center, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, P.R. China.
Objective: The aim of this project was to study the imaging characteristics of multi-detector CT (MDCT) in different types of malignant tumor in the common bile duct ampulla.
Patients And Methods: We examined 30 cases of pancreatic head cancer, 35 of terminal cholangiocarcinoma, 26 of ampullary carcinoma, and 40 of benign lesions, all confirmed by pathology. We used 64-slice spiral CT plain scan and multi-phase enhanced scan with multi-planar reconstruction (MPR) and curved planar reconstruction (CPR) post-processing to obtain three-dimensional images.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!