BACKGROUND
The ampulla of Vater is an important anatomic landmark where the common bile duct (CBD) and main pancreatic duct (MPD) converge in the major duodenal papilla. Periampullary lesions arise within 2 cm of the ampulla in the duodenum and include lesions from pancreatic head, lower common bile duct, periampullary duodenum and from within ampulla itself. The lesions can be neoplastic or inflammatory. The visualization of the normal structures, differentiation periampullary tumors and evaluation of the extent of ampullary and periampullary tumors are important in treatment planning1.
Imaging of the periampullary region poses a unique diagnostic challenge to radiologists because of the region’s complex and variable. There are several imaging modalities available to evaluate patients with suspected periampullary tumors which include endoscopic ultrasound (EUS) , endoscopic retrograde cholangiopancreaticography (ERCP) , magnetic resonance imaging (MRI) and computed tomography (CT). Computed tomography has evolved as dominant modality for diagnosis and preoperative staging.2 Currently, when biliary obstructive diseases are suspected, there is an emphasis on the combination of imaging approaches, such as conventional MRI with Magnetic resonance cholangiopancreatography (MRCP) for the improvement of diagnostic accuracy. However, MR examinations are not suitable for all patients, as some contraindications ( incompatible cardiac pacemaker, aneurysm clips, severely ill, etc.) limit their clinical use .
As MDCT is easily available in most secondary and tertiary care centres, it is accessible for the general population.
The aim of our study was to evaluate periampullary tumor by MDCT and correlate with histopathologicalfindings.
OBJECTIVES
1. To determine the efficacy of MDCT imaging in evaluation of periampullary tumors and to correlate with histopathologicalfindings .
2. To differentiate between benign and malignant tumors.
MATERIALS AND METHODS Source of data :All patients with clinical suspicion of periampullary tumor referred to the Department of Radio-Diagnosis at Vydehi Institute of Medical Sciences & Research Centre, Bangalore for CT evaluation.
Method of collection of data :A comparative analytical study was conducted on 44 patients who came to Department of Radiodiagnosis and Imaging in Vydehi Institute of Medical Sciences and Research Centre, Bangalore for Radiography and Computed Tomography with clinical suspicion of periampullary tumors in a period of 1.5 years ranging from January 2017 to June 2019.
Inclusion criteria –
i. Patients who have given informed consent for the study.
ii. Patients having a clinical suspicion of periampullary pathology.
iii. Histologically proven cases of periampullary tumors by endoscopic or image guided biopsy.
Exclusion criteria –
1. Patients allergic to contrast.
2. Pregnant women.
3. Patients in end stage renal failure and hepatic failure.
Written informed consent was taken from all the patients included in the study. The study was conducted after approval by the ethics committee.
RESULT AND CONCLUSION :In our study maximum number of cases were observed in male patients in the 4thto 6th decade of life. 33 patients had malignant lesions and 11 had benign lesions in which cholangiocarcinoma was most common (11 cases 25%), followed by ampullary carcinoma (8 cases 18.2%), carcinoma of head of pancreas (7 cases 15.9%), carcinoma duodenum (5 cases 11.4%), mass forming pancreatitis (3 cases 6.8%), ampullary stricture (2 cases 4.5%), CBD stricture (2 cases 4.5%), groove pancreatitis (2 cases 4.5%), chronic pancreatitis (1 case 2.3%), focal pancreatitis (1 case 2.3%), metastatic lymph nodes (1 case 2.3%) and neuroendocrine tumour (1 case 2.5%).
Totally 44 cases were correlated with histopathology. With the sensitivity of 93.75%, specificity of 75%, Positive Predictive Value of 90.91%, Negative Predictive Value of 81.82%, Diagnostic Accuracy of 88.64% and Kappa agreement was 0.7059 for benign and malignant ampullary and periampullary lesions on MDCT.
Out of 32 subjects with malignant lesions in HPE, 93.8% were picked up by CT scan, and 6.2% were false negative. Out of 12 subjects with benign lesions in HPE, 25% were malignant and 75% were benign in CT.
So we conclude that there is significant association between CT scan diagnosis and HPE diagnosis in periampullarytumours.
MDCT is to be considered a promising imaging modality for the evaluation of ampullary and periampullarytumours and characterization as benign and malignant.
Impact Factor
2022: 6.012
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