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Terra C, Ramos-Andrade D, Sá-Marques I, Brito J, Caseiro-Alves F, Curvo-Semedo L. Duodenal imaging on the spotlight: from A to Z. Insights Imaging 2021; 12:94. [PMID: 34232417 PMCID: PMC8263847 DOI: 10.1186/s13244-021-01045-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/18/2021] [Indexed: 12/14/2022] Open
Abstract
Abdominal computed tomography (CT) is frequently performed to evaluate gastrointestinal pathologic conditions. The majority of the gastrointestinal radiology literature has concentrated on the colon, stomach, and distal small bowel. The duodenum is often overlooked on imaging, namely on CT, but its anatomy (intra and retroperitoneal) and location in such close proximity to other viscera results in involvement by a multitude of primary and secondary processes, some of them exclusive to this bowel segment. While some conditions, like duplications, lipomas, and diverticula, are usually asymptomatic and are incidentalomas that have no pathologic significance, others are symptomatic and very relevant and should be recognized by every general radiologist: development conditions such as annular pancreas and gut malrotation; inflammatory processes such as ulcers and secondary involvement from pancreatitis; neoplastic conditions such as adenocarcinoma, lymphoma, or local extension from adjacent malignancies. They all can be reliably diagnosed with CT. In this article, we demonstrate the typical imaging features of various diseases involving the duodenum, such as developmental, traumatic, inflammatory, infectious, neoplastic, and postsurgical pathologic conditions in alphabetical order, focusing mainly on upper gastrointestinal series (UGIS) and CT but also some radiography, ultrasound, and magnetic resonance (MR) imaging.
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Affiliation(s)
- Carolina Terra
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal.
| | - Daniel Ramos-Andrade
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Ivo Sá-Marques
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Jorge Brito
- Centro Hospitalar do Algarve, Faro, Portugal
| | - Filipe Caseiro-Alves
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
| | - Luís Curvo-Semedo
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561, Coimbra, Portugal
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Wang XJ, Ke JL, Xu JX, Zhou JP, Lu YF, Zhou QM, Shi D, Yu RS. Radiographic Features and Clinical Factor for Preoperative Prediction in the Bulging Duodenal Papilla With Malignancy. Front Oncol 2021; 11:627482. [PMID: 33869010 PMCID: PMC8047452 DOI: 10.3389/fonc.2021.627482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background To investigate characteristic clinical and imaging features and establish a scoring system for preoperative prediction of malignancy in the bulging duodenal papilla. Methods A total of 147 patients with bulging duodenal papilla (Benign enlargement n = 67; malignant enlargement n = 80) from our hospital between 2010 and 2020 were retrospectively analyzed. We investigated meaningful clinical and CT imaging features and established the score model through logistic regression and weighted. The calibration test, the ROC, AUC, and cut-off points were performed in score model. The model was also divided into three score ranges for convenient clinical evaluation. Results Three clinical and CT imaging features were finally included in the score model including direct bilirubin (DBil) increase >7 umol/L (3 points), pancreatic duct (PD) dilation >5 mm (2 points), and irregular shape (2 points). The AUCs of the primary predictive model and score model were 0.896 (95% CI, 0.835-0.940) and 0.896 (95% CI, 0.835-0.940), respectively. This scoring system presented with a sensitivity of 78.8% and a specificity of 88.1% when using 2.5 points as cutoff value. Three score ranges were also proposed for convenient clinical use as follows: 0-2 points; 3-4 points; 5-7 points. The number of patients with malignant duodenal papillary enlargement increased with the increasing scores. Conclusions We proposed a convenient scoring system to preoperative predict malignancy in the bulging duodenal papilla.
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Affiliation(s)
- Xiao-Jie Wang
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun-Li Ke
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian-Xia Xu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jia-Ping Zhou
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan-Fei Lu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiao-Mei Zhou
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Shi
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ri-Sheng Yu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Endoscopic Ultrasound in Guiding Local Resection and Ampullary Preservation of a High-Risk Periampullary GIST. Case Rep Gastrointest Med 2020; 2020:8418905. [PMID: 32082652 PMCID: PMC7013300 DOI: 10.1155/2020/8418905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/04/2020] [Accepted: 01/09/2020] [Indexed: 12/18/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) typically develop in the stomach or small intestine and rarely involve the ampulla of Vater, with only 13 cases reported in the world literature since 2004. Most authors advocate performing pancreaticoduodenectomy for such lesions. However, this operation can carry higher rates of morbidity and mortality compared to local resection. We present a case of a high-risk, invasive periampullary GIST and the multidisciplinary management approach to local resection with the aid of endoscopic ultrasound. In addition, this case shows no local recurrence at 3 months and a favorable clinical outcome at 1 year.
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Lubner MG, Menias CO, Johnson RJ, Gaballah AH, Shaaban A, Elsayes KM. Villous Gastrointestinal Tumors: Multimodality Imaging with Histopathologic Correlation. Radiographics 2018; 38:1370-1384. [PMID: 30059275 DOI: 10.1148/rg.2018170159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Villous lesions are advanced adenomas that manifest most commonly in the colon; however, they can develop throughout the gastrointestinal tract. The duodenum is the most common small-bowel site of these lesions. Although in most cases these are isolated lesions that occur sporadically, patients with certain specific colorectal cancer syndromes, including familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, may develop multiple advanced adenomas. Villous lesions are important because although they are histologically benign, they may harbor dysplasia and have potential for malignancy. These characteristics make them a primary target for colorectal cancer screening with optical and virtual colonoscopy. However, these lesions can also be symptomatic and detected at diagnostic imaging when patients present for examination. They have characteristic features at a variety of imaging examinations, including barium fluoroscopy, CT, MRI, and endoscopic US. It is important for radiologists to be aware of these lesions, their potential morphologies, and their typical appearances at multimodality imaging. Although villous tumors can be detected at imaging and confirmed with biopsy, owing to limitations in identifying dysplasia and foci of malignancy with the above modalities alone and the potential for malignancy, referral for surgical resection of these lesions ultimately is required. ©RSNA, 2018.
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Affiliation(s)
- Meghan G Lubner
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Christine O Menias
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Rashad J Johnson
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Ayman H Gaballah
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Akram Shaaban
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Khaled M Elsayes
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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Barat M, Dohan A, Dautry R, Barral M, Boudiaf M, Hoeffel C, Soyer P. Mass-forming lesions of the duodenum: A pictorial review. Diagn Interv Imaging 2017; 98:663-675. [PMID: 28185840 DOI: 10.1016/j.diii.2017.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 02/07/2023]
Abstract
Recent advances in imaging have resulted in marked changes in the investigation of the duodenum, which still remains primarily evaluated with videoendoscopy. However, improvements in computed tomography (CT) and magnetic resonance (MR) imaging have made detection and characterization of duodenal mass-forming abnormalities easier. The goal of this pictorial review was to illustrate the most common conditions of the duodenum that present as mass-forming lesions with a specific emphasis on CT and MR imaging. MR imaging used in conjunction with duodenal distension appears as a second line imaging modality for the characterization of duodenal mass-forming lesions. CT remains the first line imaging modality for the detection and characterization of a wide range of duodenal mass-forming lesions.
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Affiliation(s)
- M Barat
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - A Dohan
- Department of Radiology, McGill University Health Centre, Montreal General and Royal Victoria Hospitals, Montreal, Canada.
| | - R Dautry
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Barral
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Boudiaf
- Pôle santé du plateau, 3/5, avenue de Villacoublay, 92360 Meudon-La-Forêt, France.
| | - C Hoeffel
- Department of Radiology, hôpital Robert-Debré, 11, boulevard Pasteur, 51092 Reims, France.
| | - P Soyer
- Medicine department, Université Paris-Diderot, Sorbonne Paris Cité, 10, avenue de Verdun, 75010 Paris, France.
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Duodenal neuroendocrine tumors: retrospective evaluation of CT imaging features and pattern of metastatic disease on dual-phase MDCT with pathologic correlation. ACTA ACUST UNITED AC 2016; 40:1121-30. [PMID: 25504375 DOI: 10.1007/s00261-014-0322-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of the study is to evaluate the CT appearance and pattern of metastatic disease of patients with surgically resected well-differentiated duodenal neuroendocrine tumors who underwent pre-operative dual-phase CT. METHODS Clinical and pathologic records and CT images of 28 patients (average age 58.0 years) following Whipple procedure were retrospectively reviewed. The size, morphology (polypoid, intraluminal mass or wall thickening, intramural mass), location, CT attenuation in the arterial and venous phases, and the presence of lymph node or liver metastases were recorded. RESULTS On CT, 19 patients (67.8%) had neuroendocrine tumors manifested as polypoid or intraluminal masses (38 lesions, multiple tumors in 3 patients), 4 patients (14.3%) had tumors manifested as wall thickening or intramural masses, and in 5 patients (17.9%), the primary tumor was not visualized. Lesions not seen at CT were less than 0.8 cm on pathologic diagnosis. The mean size of polypoid tumors on CT was 1.2 cm (range 0.3-3.8 cm); 24 tumors were 1.0 cm or smaller, and 14 tumors were larger than 1.0 cm. Most lesions were hypervascular in the arterial phase (19/23 patients) with an increase in tumor enhancement in the venous phase in 14 patients (60.9%), decrease in enhancement in 7 patients (30.4%), and no change in enhancement in 2 patients (8.7%). Thirteen patients (46.4%) had metastatic disease from carcinoid tumor, most commonly regional enhancing lymphadenopathy. CONCLUSION Duodenal carcinoid tumors commonly appear as an enhancing mass in either the arterial or venous phases. If a primary tumor is not seen in the duodenum, adjacent enhancing lymphadenopathy can be a clue to the presence of a duodenal carcinoid tumor.
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Yamauchi H, Sakurai S, Hagiwara K, Yoshida T, Tabe Y, Fukasawa T, Kiriyama S, Fukuchi M, Naitoh H, Kuwano H. Poorly cohesive adenocarcinoma of the ampulla of Vater: a case report. Surg Case Rep 2016; 2:15. [PMID: 26943691 PMCID: PMC4754237 DOI: 10.1186/s40792-016-0142-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 02/11/2016] [Indexed: 11/23/2022] Open
Abstract
A 47-year-old Japanese male was submitted to pancreaticoduodenectomy for an ampullary cancer. Pathologically, the ampullary cancer was poorly cohesive adenocarcinoma without tubular structure. Moreover, locoregional lymph nodes were swollen with hypervascularity, plasmacytes infiltration, and hemorrhage. Our case seems to be different from usual poorly differentiated adenocarcinoma.
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Affiliation(s)
- Hayato Yamauchi
- Department of Surgery, Japan Community Health Care Organization, Gunma Chuo Hospital, 1-7-13 Kouun-cho, Maebashi, Gunma, 371-0025, Japan.
| | - Shinji Sakurai
- Department of Diagnostic Pathology, Japan Community Health Care Organization, Gunma Chuo Hospital, Gunma, Japan.
| | - Kei Hagiwara
- Department of Surgery, Japan Community Health Care Organization, Gunma Chuo Hospital, 1-7-13 Kouun-cho, Maebashi, Gunma, 371-0025, Japan.
| | - Tomonori Yoshida
- Department of Surgery, Japan Community Health Care Organization, Gunma Chuo Hospital, 1-7-13 Kouun-cho, Maebashi, Gunma, 371-0025, Japan.
| | - Yuichi Tabe
- Department of Surgery, Japan Community Health Care Organization, Gunma Chuo Hospital, 1-7-13 Kouun-cho, Maebashi, Gunma, 371-0025, Japan.
| | - Takaharu Fukasawa
- Department of Surgery, Japan Community Health Care Organization, Gunma Chuo Hospital, 1-7-13 Kouun-cho, Maebashi, Gunma, 371-0025, Japan.
| | - Shinsuke Kiriyama
- Department of Surgery, Japan Community Health Care Organization, Gunma Chuo Hospital, 1-7-13 Kouun-cho, Maebashi, Gunma, 371-0025, Japan.
| | - Minoru Fukuchi
- Department of Surgery, Japan Community Health Care Organization, Gunma Chuo Hospital, 1-7-13 Kouun-cho, Maebashi, Gunma, 371-0025, Japan.
| | - Hiroshi Naitoh
- Department of Surgery, Japan Community Health Care Organization, Gunma Chuo Hospital, 1-7-13 Kouun-cho, Maebashi, Gunma, 371-0025, Japan.
| | - Hiroyuki Kuwano
- Department of General Surgical Science (Surgery I), Gunma University, Graduate School of Medicine, Gunma, Japan.
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Abstract
The duodenum is a unique segment of intestine, occupying both intra and extra-peritoneal locations. There is a wide spectrum of abnormalities of the duodenum that range from congenital anomalies to traumatic, inflammatory, and neoplastic entities. The duodenum may be overlooked on cross-sectional imaging due to its location and small size. Duodenal pathologies may, therefore, be missed or wrongly diagnosed. Knowledge about duodenal pathologies and optimal imaging techniques can increase diagnostic yield and permit optimal patient management. Conventionally, the duodenum was evaluated with upper GI studies on fluoroscopy; however, endoluminal evaluation is better performed with endoscopy. Additionally, a broad array of cross-sectional imaging modalities permits comprehensive assessment of the duodenum and surrounding viscera. While endoscopic sonography is increasingly used to locally stage duodenal malignancies, MDCT remains the primary modality widely used in the detection and characterization of duodenal abnormalities. MRI is used as a "problem solving" modality in select conditions. We present a comprehensive review of duodenal abnormalities with an emphasis on accurate diagnosis and management.
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Differentiation of noncalculous periampullary obstruction: comparison of CT with negative-contrast CT cholangiopancreatography versus MRI with MR cholangiopancreatography. Eur Radiol 2014; 25:391-401. [DOI: 10.1007/s00330-014-3430-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/18/2014] [Accepted: 09/03/2014] [Indexed: 01/16/2023]
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Guo ZJ, Chen YF, Zhang YH, Meng FJ, Lin Q, Cao B, Zi XR, Lu JY, An MH, Wang YJ. CT virtual endoscopy of the ampulla of Vater: preliminary report. ACTA ACUST UNITED AC 2012; 36:514-9. [PMID: 20981423 DOI: 10.1007/s00261-010-9644-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIM To explore multi-slice spiral CT (MSCT) virtual endoscopy (CTVE) in the detection of Vater's ampulla lesions. METHODS In addition to 30 healthy volunteers, 18 cases of common bile duct stones, and 7 cases of ampullary carcinoma were scanned with MSCT including virtual endoscopy (VE) reconstruction. Patterns of the duodenal papilla were then observed, and its size was measured. RESULTS Reconstructed images of CTVE in the volunteers showed that the normal type of the duodenal papilla was nodular in 16 cases, V-shaped in 8 cases, and Y-shaped in 6 cases. Its mean diameter was 0.84 ± 0.17 cm in the healthy volunteers; in patients with common bile duct stones of nodular type, mean diameter was 1.72 ± 0.32 cm. In ampullary cancer patients with an irregular protruded type, its diameter was 2.30 ± 0.85 cm, Overall the mean differences between the groups were statistically significant (P < 0.001). CONCLUSION CTVE is a convenience, no-wound, and precise clinical examination mode utilizing which the shape of duodenal papilla can be observed, and size of the latter can be measured.
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Affiliation(s)
- Zhi-Jun Guo
- Department of Radiology, North China Petroleum Bureau General Hospital, Renqiu, Hebei, China.
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Lee M, Kim MJ, Park MS, Choi JY, Chung YE. Using multi-detector-row CT to diagnose ampullary adenoma or adenocarcinoma in situ. Eur J Radiol 2010; 80:e340-5. [PMID: 21093190 DOI: 10.1016/j.ejrad.2010.10.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 10/11/2010] [Accepted: 10/20/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the diagnostic accuracy of multi-detector-row computed tomography (MDCT) for the detection of ampullary adenomas or adenocarcinomas in situ. MATERIALS AND METHODS We retrospectively reviewed 21 computed tomography (CT) images from 20 patients with ampullary tumors, and 22 CT images from 22 patients without periampullary tumor. Three radiologists blindly and independently reviewed CT images. The sensitivities and specificities for identification of ampullary masses were calculated in all cases and in cases with adequate duodenal distension. The sensitivities and specificities for the diagnosis of ampullary tumors were calculated using the following criteria: identification of mass alone; presence of extrahepatic bile duct (EBD) dilation or identification of mass; presence of pancreatic duct (PD) dilation or identification of mass. Paired t-tests were performed to assess differences in mean values. RESULTS The mean sensitivity and specificity of MDCT for the detection of an ampullary mass in all cases were 47.6% and 86.4%, and in cases with adequate duodenal distension, 66.7% (p=0.07) and 80.5% (p=0.32), respectively. When the presence of EBD dilation or identification of mass were used as criteria, the mean sensitivity and specificity were 73.0% (p=0.03) and 60.6% (p=0.03), respectively. When presence of PD dilation or identification of mass were used as criteria, the mean sensitivity and specificity were 47.6% and 81.8% (p=0.23). CONCLUSIONS MDCT is moderately accurate for the diagnosis of ampullary adenoma or adenocarcinoma in situ. When EBD dilation or identification of mass were used as criteria, the sensitivity can be improved.
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Affiliation(s)
- Myungsu Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Chung YE, Kim MJ, Park MS, Choi JY, Kim H, Kim SK, Lee M, Kim HJ, Choi JS, Song SY, Kim KW. Differential features of pancreatobiliary- and intestinal-type ampullary carcinomas at MR imaging. Radiology 2010; 257:384-93. [PMID: 20829529 DOI: 10.1148/radiol.10100200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To define the differential imaging features of pancreatobiliary- and intestinal-type ampullary carcinomas at magnetic resonance (MR) imaging and to correlate these features with pathologic findings. MATERIALS AND METHODS This retrospective study was approved by the institutional review board; informed consent was waived. Fifty patients with surgically confirmed ampullary carcinoma and preoperative MR results were included. Two radiologists, blinded to histologic type of cancer, evaluated imaging findings in consensus. Univariate and multiple logistic regression analysis were performed to define imaging findings that were useful for differentiation of the two types of carcinomas. RESULTS On the basis of hematoxylin-eosin and immunohistochemical staining, 35 patients were classified as having pancreatobiliary type; and 15 patients, intestinal type. At MR, all of 15 intestinal carcinomas were nodular, whereas 16 (46%) of 35 pancreatobiliary carcinomas were infiltrative. Intestinal carcinomas were isointense (13 [87%] of 15) to hyperintense (two [13%] of 15), whereas 34% (12 of 35) of pancreatobiliary carcinomas manifested as hypointense compared with the duodenum on T2-weighted MR images (P = .034). Intestinal carcinoma commonly manifested with an oval filling defect at the distal end of the bile duct on MR cholangiopancreatographic (MRCP) images (11 [73%] of 15 vs four [11%] of 35 in pancreatobiliary type) (P < .001). At endoscopy, intestinal carcinoma manifested with an extramural protruding mass (n = 15, 100%) with a papillary surface (n = 11, 73%), whereas pancreatobiliary carcinoma manifested with intramural protruding (n = 5, 28%) or ulcerating (n = 1, 6%) gross morphologic features (P = .047) with a nonpapillary surface (n = 17, 94%) (P < .001). Multiple logistic regression analysis showed that an oval filling defect at the distal end of the bile duct was the only independent finding for differentiating intestinal from pancreatobiliary carcinoma (P = .027). CONCLUSION An oval filling defect at the distal end of the bile duct on MRCP images and an extramural protruding appearance with a papillary surface at endoscopy are likely to suggest intestinal ampullary carcinoma.
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Affiliation(s)
- Yong Eun Chung
- Department of Radiology, Institute of Gastroenterology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, South Korea
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Chung YE, Kim MJ, Kim HM, Park MS, Choi JY, Hong HS, Kim KW. Differentiation of benign and malignant ampullary obstructions on MR imaging. Eur J Radiol 2010; 80:198-203. [PMID: 20494539 DOI: 10.1016/j.ejrad.2010.04.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 04/09/2010] [Accepted: 04/14/2010] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To define diagnostic criteria for differentiating malignant ampullary carcinoma from benign ampullary obstruction on MR imaging. MATERIALS AND METHODS Nineteen patients with ampullary carcinoma and 22 patients with benign ampullary obstruction were enrolled. At the first session, two radiologists independently evaluated specific imaging findings, and then reached consensus decisions. At the second session, another two radiologists, who were informed about useful differentiation criteria based on the results from the first session, reviewed images and determined the causes of ampullary obstruction. Sensitivity and specificity were calculated for each interpretation session, and the Cohen κ statistic was used to evaluate interobserver agreement. RESULTS Findings of the presence of an ampullary mass (P<0.001), papillary bulging (P<0.001), irregular (P=0.021) and asymmetric (P<0.001) common bile duct (CBD) narrowing, and proportional biliary dilatation (P<0.001) were more commonly seen in patients with an ampullary carcinoma. The sensitivity and specificity of the first session were 84.2% and 86.4% after consensus. The sensitivity increased to 100% for both the readers at the second session, while the specificity decreased to 63.6% and 59.1%, respectively. CONCLUSIONS Identification of an ampullary mass, papillary bulging, irregular and asymmetric narrowing of the CBD, or proportional biliary dilatation may improve the diagnosis of ampullary carcinoma in patients with ampullary obstruction.
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Affiliation(s)
- Yong Eun Chung
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Nacif MS, Vabo KAD, Vabo TPD, Gouvêa RMDP, Ebecken R, Santos AASMDD. Qual o seu diagnóstico? Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000600004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marcelo Souto Nacif
- Centro Universitário Serra dos Órgãos; Hospital de Clínicas de Niterói, Brasil
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15
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Kim YK, Han YM, Kim CS. Usefulness of fat-suppressed T1-weighted MRI using orally administered superparamagnetic iron oxide for revealing ampullary carcinomas. J Comput Assist Tomogr 2007; 31:519-25. [PMID: 17882025 DOI: 10.1097/01.rct.0000250106.01047.4b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the value of adding fat-suppressed (FS) T1-weighted magnetic resonance imaging (MRI) with orally administered superparamagnetic iron oxide (SPIO) to the 3-dimensional dynamic MRI for revealing ampullary carcinomas. MATERIALS Twenty-five patients with ampullary carcinoma who underwent MRI with orally administered SPIO, including a FS T1-weighted fast low-angle shot (FLASH) sequence, a respiratory-triggered turbo spin-echo (RT-TSE) sequence, and the 3-phasic 3-dimensional dynamic images, were enrolled in this study. About 5 min before the examination, a mixture of 8.4 mg of SPIO and 300 mL water was administered orally to all patients. The images were compared quantitatively by measuring the tumor-pancreas (duodenum) contrast-to-noise ratio and, qualitatively, by evaluating tumor conspicuity. Three separate sets of images, that is, the dynamic set, the combination of the dynamic set, and the RT-TSE, and the combination of the dynamic set and the FLASH were analyzed by 2 observers in consensus. RESULTS For the tumor-pancreas (duodenum) contrast-to-noise ratio, the FLASH was significantly higher than those of the dynamic set and RT-TSE (P < 0.05). The tumor conspicuity with the combination of the dynamic set and the FLASH was also significantly better than those of the dynamic set, and the combination of the dynamic set and RT-TSE (P = 0.001). For 15 tumors that were surgically confirmed, the combined reading of the FLASH imaging and dynamic set allowed more accurate surgical staging (14/15, 93.3%) than did the dynamic imaging set or the combined reading of the dynamic set and RT-TSE (11/15, 73.3%). CONCLUSIONS Addition of the FS FLASH image using orally administered SPIO to the dynamic MRI is useful for revealing ampullary carcinoma.
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Affiliation(s)
- Young Kon Kim
- Department of Diagnostic Radiology, Chonbuk National University Hospital and Medical School JeonJu, South Korea.
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16
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Kim S, Lee NK, Lee JW, Kim CW, Lee SH, Kim GH, Kang DH. CT evaluation of the bulging papilla with endoscopic correlation. Radiographics 2007; 27:1023-38. [PMID: 17620465 DOI: 10.1148/rg.274065047] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A variety of pathologic conditions can cause abnormalities of the ampulla of Vater. A bulging papilla is frequently encountered at computed tomography (CT) and can be seen in healthy individuals as well as in patients with various pathologic conditions such as papillitis, ampullary cancer, and intraductal papillary mucinous tumor. Mural thickening and certain attenuation patterns seen at contrast material-enhanced CT can help differentiate pathologic papilla from normal papilla. Increased targetlike enhancement of the papilla is likely to represent a benign condition such as papillitis, whereas an enhancing polypoid mass or focal asymmetric or irregular thickening with prolonged enhancement in the ampulla of Vater indicates a malignant condition such as ampullary or periampullary carcinoma. Although CT often does not clarify the exact cause of bulging, adequate duodenal distention may allow detection of an abnormal papilla, thereby providing additional information about other abnormalities in the pancreaticobiliary system. Thus, CT findings may prove useful for subsequent imaging studies such as magnetic resonance (MR) cholangiography or endoscopy. MR cholangiography may be equivalent to CT for identifying a bulging papilla and superior for distinguishing the underlying cause. However, endoscopy with or without biopsy is the best method for making a definitive diagnosis in patients with a bulging papilla. Familiarity with the normal imaging anatomy of the periampullary region and with the imaging features of the various pathologic causes of a bulging papilla may be useful in making the diagnosis.
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Affiliation(s)
- Suk Kim
- Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine, 1-10 Ami-Dong, Seo-gu, Busan 602-739, Republic of Korea
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17
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From the archives of the AFIP: abdominal neoplasms in patients with neurofibromatosis type 1: radiologic-pathologic correlation. Radiographics 2006; 25:455-80. [PMID: 15798063 DOI: 10.1148/rg.252045176] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neurofibromatosis type 1 (NF1) is one of the most common genetic disorders. NF1 is a complex disease resulting from a spectrum of mutations that may occur at many locations along the large, complex NF1 gene, which is located on chromosome 17. Mutations of the NF1 gene lead to abnormal tumor suppression. Consequently, patients with NF1 have an increased prevalence of benign and malignant neoplasms throughout the body. There are five categories of NF1 tumors that occur in the abdomen: neurogenic, neuroendocrine, nonneurogenic gastrointestinal mesenchymal, embryonal, and miscellaneous. Many of these tumors are age related, occur at specific anatomic locations, and have unique imaging features. Notably, many patients have a variety of organs affected because there is a high prevalence of multiple tumors occurring in the same patient. Neurofibromas are the most common benign neoplasms and may occur in the retroperitoneum or visceral organs. Malignant peripheral nerve sheath tumor is an aggressive malignancy that is the most common malignant tumor of the abdomen in patients with NF1. Interpreting abdominal imaging studies in patients with NF1 can be challenging because of the wide spectrum and diverse nature of tumors that occur in this disease.
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18
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19
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Eickhoff A, Jakobs R, Riemann JF. Papillenadenom/Papillenkarzinom: Endoskopisch-interventionelle Möglichkeiten. Visc Med 2005. [DOI: 10.1159/000083360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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20
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Smith TR, Berkowitz D, Frost A. Prolapse of the common bile duct with small ampullary villous adenocarcinoma into third part of the duodenum. AJR Am J Roentgenol 2003; 181:599-600. [PMID: 12876062 DOI: 10.2214/ajr.181.2.1810599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Theodore R Smith
- J. D. Weiler Hospital of the Albert Einstein College of Medicine and Montefiore Medical Center Bronx, NY 10461,USA
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21
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Singh VV, Bhutani MS, Draganov P. Carcinoid of the minor papilla in incomplete pancreas divisum presenting as acute relapsing pancreatitis. Pancreas 2003; 27:96-7. [PMID: 12826909 DOI: 10.1097/00006676-200307000-00013] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Virmeet V Singh
- Division of Gastroenterology, Hepatology and Nutrition; University of Florida; Gainesville, Florida, USA
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22
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Kim JH, Kim MJ, Chung JJ, Lee WJ, Yoo HS, Lee JT. Differential diagnosis of periampullary carcinomas at MR imaging. Radiographics 2002; 22:1335-52. [PMID: 12432106 DOI: 10.1148/rg.226025060] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Periampullary carcinomas arise within 2 cm of the major duodenal papilla and comprise carcinomas of the ampulla, distal common bile duct, pancreas, and duodenum. Their clinical features and anatomic locations are similar, as are the therapeutic approaches; however, their long-term outcomes vary. Magnetic resonance (MR) images of 89 pathologically proved periampullary carcinomas (29 ampullary carcinomas, 27 distal common bile duct carcinomas, 21 pancreatic carcinomas, six duodenal carcinomas, and six unclassified carcinomas) were reviewed. Ampullary carcinoma manifests as a small mass, periductal thickening, or bulging of the duodenal papilla. Pancreatic carcinoma is characterized by a discrete parenchymal mass, which enhances poorly on dynamic gadolinium-enhanced images. Sometimes, two proximal and two distal pancreatic and biliary ducts appear as four separate ducts (the four-segment sign). Dilatation of side branches of the pancreatic ducts is frequently seen in pancreatic carcinoma but not in other periampullary carcinomas. Distal bile duct carcinoma manifests as luminal obliteration and wall thickening or as an intraductal polypoid mass. A dilated proximal bile duct, a nondilated distal bile duct, and a dilated or nondilated pancreatic duct may form the three-segment sign. MR cholangiopancreatography and sectional MR imaging are useful in determining the origins of periampullary carcinomas.
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Affiliation(s)
- Joo Hee Kim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, Korea
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23
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Irie H, Honda H, Shinozaki K, Yoshimitsu K, Aibe H, Nishie A, Nakayama T, Masuda K. MR imaging of ampullary carcinomas. J Comput Assist Tomogr 2002; 26:711-7. [PMID: 12439303 DOI: 10.1097/00004728-200209000-00008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The purpose of this study was to demonstrate the appearance of ampullary carcinomas on MR images. METHODS Sixteen patients with ampullary carcinomas underwent MR imaging. Tumor detectability, signal intensity of the tumor, and enhancement pattern on dynamic study were analyzed. MR cholangiopancreatography (MRCP) findings were assessed and were compared with the endoscopic retrograde cholangiopancreatography (ERCP) findings. RESULTS Signal intensities of the tumor on each image were various. Dynamic study detected all tumors except one, and all detected tumors showed delayed enhancement. MRCP delineated more than half of the tumors as a filling defect within the duodenal fluid and clearly demonstrated pancreaticobiliary ductal. CONCLUSIONS Dynamic study is mandatory in diagnosing ampullary carcinoma, because it can depict most of the tumors, and delayed enhancement of such tumors is characteristic in case of ampullary carcinoma. MRCP can provide reliable information about pancreaticobiliary duct and it can replace diagnostic ERCP.
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Affiliation(s)
- Hiroyuki Irie
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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24
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Levy MJ, Vazquez-Sequeiros E, Wiersema MJ. Evaluation of the pancreaticobiliary ductal systems by intraductal US. Gastrointest Endosc 2002; 55:397-408. [PMID: 11868016 DOI: 10.1067/mge.2002.121878] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Michael J Levy
- Mayo Clinic Foundation, Division of Gastroenterology and Hepatology, 200 First Street SW, Rochester, MN 55905, USA
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25
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Mendes Ribeiro HK, Woodham C. CT demonstration of an unusual cause of biliary obstruction in a patient with peripheral neurofibromatosis. Clin Radiol 2000; 55:796-8. [PMID: 11052883 DOI: 10.1053/crad.2000.0111] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- H K Mendes Ribeiro
- Department of Radiology, John Radcliffe Hospital, Headley Way, Headington, Oxon OX3 9DU, UK
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26
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Sumi Y, Ozaki Y, Shindoh N, Kyogoku S, Katayama H. Hypotonic duodenograms of postbulbar duodenal lesions: pictorial essay. AUSTRALASIAN RADIOLOGY 2000; 44:266-74. [PMID: 10974718 DOI: 10.1046/j.1440-1673.2000.00811.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
General features are described and examples are provided of the radiological manifestations of postbulbar duodenal lesions, particularly the findings on hypotonic duodenograms. Hypotonic duodenography does not always reveal the characteristic findings of postbulbar duodenal lesions, but it helps to evaluate luminal stenosis and diagnose disease entities even in lesions that show non-specific findings. Radiologists should be familiar with the radiological findings of postbulbar duodenal lesions and know which kinds of lesions can affect the postbulbar duodenum. This is important in making a differential diagnosis and in preventing delays in diagnosis.
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Affiliation(s)
- Y Sumi
- Department of Radiology, Juntendo University Urayasu Hospital, Chiba, Japan.
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27
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de Bree E, Tsiftsis DD, Santos RM, Lavelle SM, Cuervas-Mons V, Gauthier A, Gips C, Malchow-Moeller A, Molino G, Rohr G, Theodossi A, Tsantoulas D. Objective assessment of the contribution of each diagnostic test and of the ordering sequence in jaundice caused by pancreatobiliary carcinoma. Scand J Gastroenterol 2000; 35:438-45. [PMID: 10831270 DOI: 10.1080/003655200750024038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Computer-assisted diagnostic systems are not substantially more accurate than the clinician in the differential diagnosis of jaundice but may help in optimal selection and sequencing of tests. The present study aimed to assess with an electronic diagnostic tool the pattern of ordering tests and the diagnostic contribution and related financial cost of each test in jaundiced patients with pancreatobiliary carcinoma, in an effort to make the clinician's diagnostic behaviour more efficient and economical. METHODS Clinical and diagnostic test data were prospectively gathered from 356 jaundiced patients with pancreatobiliary carcinoma and entered in a Bayesian diagnostic programme. The test results were added to the existing diagnostic evidence, and the programme calculated the diagnostic contribution of each test. RESULTS A total of 1804 diagnostic tests were ordered. Quantitative assessment of the diagnostic contribution of each test showed that percutaneous transhepatic cholangiography and computed tomography were associated with the highest provision of information. The most cost-effective tests were ultrasonography and liver function tests. CONCLUSIONS It is possible to determine objectively the diagnostic contribution of each test in establishing the diagnosis of pancreatobiliary carcinoma. The observed physician behaviour in ordering the various diagnostic tests might be improved with regard to its efficacy and its cost-effectiveness profile.
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Affiliation(s)
- E de Bree
- Dept. of Surgical Oncology, University Hospital, Herakleion, Crete, Greece
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28
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Menzel J, Hoepffner N, Sulkowski U, Reimer P, Heinecke A, Poremba C, Domschke W. Polypoid tumors of the major duodenal papilla: preoperative staging with intraductal US, EUS, and CT--a prospective, histopathologically controlled study. Gastrointest Endosc 1999; 49:349-57. [PMID: 10049419 DOI: 10.1016/s0016-5107(99)70012-x] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND An adenoma-carcinoma sequence also applies to adenomas of the major duodenal papilla. Therefore accurate preoperative diagnosis and tumor staging are essential to select the appropriate patients for adequate treatment. In a prospective, histopathologically controlled study of tumors of the main duodenal papilla, the preoperative diagnostic value of ultrasound (US) catheter probes applied during endoscopic retrograde cholangiopancreatography (ERCP) was investigated. METHODS Intraductal US was compared with conventional endoscopic ultrasonography (EUS) and computed tomography (CT). In 27 consecutive patients with benign polypoid tumors of the major duodenal papilla (n = 12) and carcinomas of the papilla (n = 15), respectively, the value of these imaging procedures in determining tumor visualization, tumor diagnosis and tumor staging according to the TNM classification was assessed. Every patient underwent surgical resection; histopathologic evaluation of resected specimens served as the reference standard. RESULTS Intraductal US was significantly superior to EUS and CT in terms of tumor visualization (100% vs 59.3% vs 29.6%, respectively). Sensitivity and specificity rates for intraductal US and EUS were 100% versus 62.5% and 75% versus 50%, respectively. Overall accuracy rate in tumor diagnosis for intraductal US (88.9%; 24 of 27) was significantly (p = 0.05) superior to EUS (56.3%; 9 of 16). The latter did not depict 4 adenomas and 7 carcinomas. Neither intraductal US nor EUS is suitable for detection of distant metastases. CONCLUSION Intraductal US appears to be the most effective imaging method in visualizing, diagnosing and staging tumors of the major duodenal papilla. Combining ERCP with catheter probe sonography offers a new diagnostic modality that has some potential advantages for local staging of small tumors of the main duodenal papilla. Consequently, minimally invasive techniques for resection of seemingly benign tumors of the papilla or, even more so, of small carcinomas should preferably be based on intraductal US.
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Affiliation(s)
- J Menzel
- Department of Medicine B, University of Muenster, Muenster, Germany
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29
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Affiliation(s)
- C A Mittelstaedt
- Department of Radiology, University of North Carolina Hospitals, University of North Carolina School of Medicine, Chapel Hill 27599, USA
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30
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Semelka RC, Kelekis NL, John G, Ascher SM, Burdeny D, Siegelman ES. Ampullary carcinoma: demonstration by current MR techniques. J Magn Reson Imaging 1997; 7:153-6. [PMID: 9039607 DOI: 10.1002/jmri.1880070122] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The objective of this study was to demonstrate the appearance of ampullary carcinoma using current MR techniques, including fat suppression, gadolinium enhancement, and MR cholangiography. Nine patients with ampullary carcinoma were examined by MRI at 1.5 T. MR examinations included T1-weighted spoiled gradient echo, T1-weighted fat-suppressed, and immediate postgadolinium spoiled gradient echo images for all patients and MR cholangiography for three patients. The imaging features of ampullary carcinomas, including tumor size and morphology, signal intensity, and enhancement characteristics, were determined. Ampullary carcinomas shown on MR images ranged in size from 1.5 to 5.5 cm. Tumors were low in signal intensity on precontrast T1-weighted spoiled gradient echo and T1-weighted fat-suppressed images relative to normal pancreatic tissue and enhanced less than normal pancreas on immediate postgadolinium spoiled gradient echo images. Tumor conspicuity was greatest on immediate postgadolinium spoiled gradient echo images. MR cholangiography demonstrated high grade obstruction of the common bile duct and mild dilatation of the pancreatic duct at the level of the ampulla with abrupt termination of the ducts in two untreated patients and moderate dilatation of the common bile duct in one patient who had a biliary stent. Ampullary carcinomas can be demonstrated on MR images as small masses arising at the ampulla. Tumors are well defined on immediate postgadolinium spoiled gradient echo images.
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Affiliation(s)
- R C Semelka
- Department of Radiology, University of North Carolina Chapel Hill 27599-7510, USA
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31
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Abstract
OBJECTIVE The authors report on indications and results of local excision of tumors of the ampulla of Vater. SUMMARY BACKGROUND DATA Local excision of ampullary tumors has been performed for nearly a century but remains controversial. The use of this procedure for benign conditions is clear, but its place, if any, in the management of ampullary malignancy is debated. METHODS The presentation, evaluation, and treatment of 26 patients who underwent local resection of ampullary tumors between January 1987 and November 1994 are reviewed. RESULTS There were 16 men and 10 women, with a median age of 58 years. Eighteen patients had adenomas, whereas 8 patients had adenocarcinomas. Patients presented predominantly with jaundice (50%), pain (35%), and pancreatitis (27%) and were evaluated with endoscopic retrograde cholangiopancreatography and biopsy. All patients with benign lesions had accurate preoperative biopsies. Two of eight patients shown intraoperatively to have malignant lesions had preoperative biopsies read as benign. There were no deaths. Postoperative complications included two wound infections and one episode each of cholangitis, lower gastrointestinal bleeding, and adhesive gastrointestinal obstruction. All patients had prompt resolution of jaundice if present before surgery, and the mean postoperative stay was 7.5 days. Six of eight patients with malignant lesions have had recurrent disease. CONCLUSIONS Local excision of malignant ampullary tumors is effective palliative therapy when the patient is unfit for the Whipple procedure. Ampullary resection usually is curative for patients with benign lesions without a polyposis syndrome. In this series, intraoperative frozen section routinely was accurate.
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Affiliation(s)
- G D Branum
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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