Wirana Angthong1, Kran Jiarakoop2, Kaan Tangtiang2. 1. Department of Radiology, Thammasat University Hospital, 95 Moo 8, Phahon Yothin Road, Khlong Luang, Pathum Thani, 12110, Thailand. angthongw@gmail.com. 2. Department of Radiology, Thammasat University Hospital, 95 Moo 8, Phahon Yothin Road, Khlong Luang, Pathum Thani, 12110, Thailand.
Abstract
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. Statistically significant CT parameters were identified through univariate and multivariate analyses. RESULTS: In univariate analysis, the presence of ampullary mass, asymmetric, abrupt narrowing of distal common bile duct (CBD), dilated intrahepatic bile duct (IHD), dilated pancreatic duct (PD), peripancreatic lymphadenopathy, duodenal wall thickening, and delayed enhancement were more frequently in ampullary carcinomas observed (P < 0.05). Multivariate logistic regression analysis using significant CT parameters and clinical data from univariate analysis, and clinical symptom with jaundice (P = 0.005) was an independent predictor of ampullary carcinomas. For multivariate analysis using only significant CT parameters, abrupt narrowing of distal CBD was an independent predictor of ampullary carcinomas (P = 0.019). Among various CT criteria, abrupt narrowing of distal CBD and dilated IHD had highest sensitivity (77.4%) and highest accuracy (90.3%). CONCLUSION: The abrupt narrowing of distal CBD and dilated IHD is useful for differentiation of ampullary carcinomas from benign entity in patients without the presence of mass.
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. Statistically significant CT parameters were identified through univariate and multivariate analyses. RESULTS: In univariate analysis, the presence of ampullary mass, asymmetric, abrupt narrowing of distal common bile duct (CBD), dilated intrahepatic bile duct (IHD), dilated pancreatic duct (PD), peripancreatic lymphadenopathy, duodenal wall thickening, and delayed enhancement were more frequently in ampullary carcinomas observed (P < 0.05). Multivariate logistic regression analysis using significant CT parameters and clinical data from univariate analysis, and clinical symptom with jaundice (P = 0.005) was an independent predictor of ampullary carcinomas. For multivariate analysis using only significant CT parameters, abrupt narrowing of distal CBD was an independent predictor of ampullary carcinomas (P = 0.019). Among various CT criteria, abrupt narrowing of distal CBD and dilated IHD had highest sensitivity (77.4%) and highest accuracy (90.3%). CONCLUSION: The abrupt narrowing of distal CBD and dilated IHD is useful for differentiation of ampullary carcinomas from benign entity in patients without the presence of mass.
Entities:
Keywords:
Ampulla of Vater; Ampullary carcinoma; Ampullary obstruction; CT
Authors: Se Woo Kim; Se Hyung Kim; Dong Ho Lee; Sang Min Lee; Yeon Soo Kim; Jin Young Jang; Joon Koo Han Journal: AJR Am J Roentgenol Date: 2017-08-31 Impact factor: 3.959