Differentiation of benign and malignant ampullary obstruction by multi-row detector CT.
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.
['Angthong|Wirana|W|', 'Jiarakoop|Kran|K|', 'Tangtiang|Kaan|K|']
D000368:Aged D014670:Ampulla of Vater D003137:Common Bile Duct Diseases D003138:Common Bile Duct Neoplasms D003937:Diagnosis, Differential D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D061330:Multidetector Computed Tomography D012189:Retrospective Studies
Ampullary obstruction CT Ampullary carcinoma Ampulla of Vater