Differentiation of benign and malignant ampullary obstructions on MR imaging |
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Authors: | Yong Eun ChungMyeong-Jin Kim Hye Mi KimMi-Suk Park Jin-Young ChoiHye-Suk Hong Ki Whang Kim |
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Affiliation: | a Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea b Institute of Gastroenterology and Brain Korea 21 Project, Yonsei University College of Medicine, Republic of Korea |
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Abstract: | ObjectiveTo define diagnostic criteria for differentiating malignant ampullary carcinoma from benign ampullary obstruction on MR imaging.Materials and methodsNineteen 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.ResultsFindings 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.ConclusionsIdentification 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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Keywords: | Ampulla of Vater Ampullary obstruction Ampullary carcinoma Magnetic resonance imaging Magnetic resonance cholangiopancreatography |
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