Ting Ting Zhang1, Timothy J Sadler2, Siobhan Whitley3, Rebecca Brais4, Edmund Godfrey5. 1. Department of Radiology, Brighton and Sussex University Hospitals, Brighton, United Kingdom. 2. Department of Radiology, Royal Papworth Hospital, Cambridge, United Kingdom. 3. Department of Radiology, West Suffolk Hospital, Bury St Edmunds, United Kingdom. 4. Department of Pathology, Cambridge University Hospitals, Cambridge, United Kingdom. 5. Department of Radiology, Cambridge University Hospitals, Cambridge, United Kingdom.
Abstract
OBJECTIVE: Main duct and mixed intraductal papillary mucinous neoplasms (IPMN) are pre-malignant cystic pancreatic neoplasms associated with pancreatic duct dilatation. Distinguishing these from benign causes of pancreatic duct dilatation is important in order to allow appropriate surveillance or surgery. A patulous duodenal papilla with extrusion of mucus at endoscopic evaluation, the endoscopic fish mouth ampulla (E-FMA) sign, is reported in main duct and mixed IPMN. We aimed to establish whether a CT correlate (CT-FMA) of this sign exists and whether this was associated with the presence of invasion or high-grade dysplasia. We defined the CT-FMA sign as an uninterrupted column of water attenuation material running from the pancreatic duct to the duodenal lumen. METHODS: A retrospective, blinded review of 44 patients with histologically confirmed IPMN and 87 age-matched controls with pancreatic duct dilatation on CT was undertaken. A case-control series matched for the degree of pancreatic duct dilatation was used to compare the rates of invasion or high-grade dysplasia between main duct and mixed IPMN patients, with and without a CT-FMA sign. RESULTS: The CT-FMA sign could be identified in 18.5% patients with main duct/mixed IPMN with specificity 100%, positive predictive value 100% and negative predictive value 79.8%. A significant association was found between CT-FMA in main duct/mixed IPMN compared to controls, but not with the presence of high-grade dysplasia or invasion. CONCLUSIONS: The CT-FMA sign is a newly reported, highly specific sign of MD and mixed IPMN. ADVANCES IN KNOWLEDGE: If a fish mouth ampulla is identified at CT, a diagnosis of main duct or mixed IPMN is highly likely.
OBJECTIVE: Main duct and mixed intraductal papillary mucinous neoplasms (IPMN) are pre-malignant cystic pancreatic neoplasms associated with pancreatic duct dilatation. Distinguishing these from benign causes of pancreatic duct dilatation is important in order to allow appropriate surveillance or surgery. A patulous duodenal papilla with extrusion of mucus at endoscopic evaluation, the endoscopic fish mouth ampulla (E-FMA) sign, is reported in main duct and mixed IPMN. We aimed to establish whether a CT correlate (CT-FMA) of this sign exists and whether this was associated with the presence of invasion or high-grade dysplasia. We defined the CT-FMA sign as an uninterrupted column of water attenuation material running from the pancreatic duct to the duodenal lumen. METHODS: A retrospective, blinded review of 44 patients with histologically confirmed IPMN and 87 age-matched controls with pancreatic duct dilatation on CT was undertaken. A case-control series matched for the degree of pancreatic duct dilatation was used to compare the rates of invasion or high-grade dysplasia between main duct and mixed IPMN patients, with and without a CT-FMA sign. RESULTS: The CT-FMA sign could be identified in 18.5% patients with main duct/mixed IPMN with specificity 100%, positive predictive value 100% and negative predictive value 79.8%. A significant association was found between CT-FMA in main duct/mixed IPMN compared to controls, but not with the presence of high-grade dysplasia or invasion. CONCLUSIONS: The CT-FMA sign is a newly reported, highly specific sign of MD and mixed IPMN. ADVANCES IN KNOWLEDGE: If a fish mouth ampulla is identified at CT, a diagnosis of main duct or mixed IPMN is highly likely.
Authors: Masao Tanaka; Carlos Fernández-Del Castillo; Terumi Kamisawa; Jin Young Jang; Philippe Levy; Takao Ohtsuka; Roberto Salvia; Yasuhiro Shimizu; Minoru Tada; Christopher L Wolfgang Journal: Pancreatology Date: 2017-07-13 Impact factor: 3.996
Authors: C Procacci; A J Megibow; G Carbognin; A Guarise; E Spoto; C Biasiutti; G F Pistolesi Journal: Radiographics Date: 1999 Nov-Dec Impact factor: 5.333
Authors: C Max Schmidt; Patrick B White; Joshua A Waters; Constantin T Yiannoutsos; Oscar W Cummings; Marshall Baker; Thomas J Howard; Nicholas J Zyromski; Atilla Nakeeb; John M DeWitt; Fatih M Akisik; Stuart Sherman; Henry A Pitt; Keith D Lillemoe Journal: Ann Surg Date: 2007-10 Impact factor: 12.969