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Differentiating between benign and malignant ampullary strictures: a prediction model using a nomogram based on CT imaging and clinical findings

  • Gastrointestinal
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Abstract

Objectives

To construct a predictive nomogram for differentiating malignant from benign ampullary strictures using contrast-enhanced computed tomography (CT) findings combined with clinical findings.

Methods

In this retrospective study, 152 patients with ampullary stricture (98 benign and 54 malignant) who underwent contrast-enhanced CT were included. Various imaging findings of the ampulla, bile duct, main pancreatic duct, and periampullary area were evaluated and clinical findings including the presence of jaundice, carbohydrate antigen 19-9 level, and history of cholecystectomy were collected. Among them, statistically significant findings were identified using univariable and multivariable logistic regression analyses. A nomogram was constructed to differentiate benign and malignant ampullary strictures and was internally validated.

Results

Multivariable analysis revealed that jaundice (odds ratio [OR]: 17.33, p < 0.001), presence of an ampullary mass (OR: 24.40, p < 0.001), non-similar enhancement of the ampulla to the duodenum (OR: 31.96, p = 0.003), and proportional dilatation of the bile duct (OR: 7.98, p = 0.001) were independent significant factors for predicting the malignant ampullary stricture, and were used to construct a nomogram. Among them, non-similar enhancement of the ampulla to the duodenum showed the highest OR and predictor point on the nomogram. The calibration plots showed excellent agreement between the predicted probabilities and the actual rates of malignant ampullary strictures, on internal validation.

Conclusions

Combination of clinical and imaging findings could aid in predicting malignant ampullary strictures using significant findings of jaundice, presence of ampullary mass, non-similar enhancement of the ampulla to the duodenum, and proportional dilatation of the bile duct.

Key Points

• The presence of jaundice, ampullary mass, non-similar enhancement of the ampulla, and proportional bile duct dilatation were significant findings for predicting malignant ampullary strictures.

• Non-similar enhancement of the ampulla to the duodenum was a significant feature with the highest odds ratio for differentiating benign and malignant ampullary strictures.

• The nomogram constructed using contrast-enhanced computed tomography imaging and clinical findings could aid in predicting malignant ampullary strictures.

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Abbreviations

CA 19-9:

Carbohydrate antigen 19-9

CBD:

Common bile duct

CT:

Computed tomography

EHD:

Extrahepatic bile duct

IHD:

Intrahepatic bile duct

MPD:

Main pancreatic duct

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

OR:

Odds ratio

PPV:

Positive predictive value

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Acknowledgements

This work was supported by the Soonchunhyang University Research Fund. We thank Ji Eun Moon, MS (Department of Biostatistics, Clinical Trial Center, Soonchunhyang University College of Medicine, Bucheon Hospital) for the statistical analysis of this study.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon-Si, Gyeonggi-do, 14584, Republic of Korea

    Ji Eun Lee, Seo-Youn Choi, Min Hee Lee & Sanghyeok Lim

  2. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    Ji Hye Min & Jeong Ah Hwang

  3. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Sunyoung Lee

  4. Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehang-no, Chongno-gu, Seoul, 110-744, Republic of Korea

    Jung Hoon Kim

Authors
  1. Ji Eun Lee
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  2. Seo-Youn Choi
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  3. Min Hee Lee
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  4. Sanghyeok Lim
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  5. Ji Hye Min
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  7. Sunyoung Lee
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Corresponding author

Correspondence to Seo-Youn Choi.

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Guarantor

The scientific guarantor of this publication is Seo-Youn Choi, M.D.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

This work was supported by the Department of Biostatistics of our institusion.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational study

• Performed at one institution

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Lee, J.E., Choi, SY., Lee, M.H. et al. Differentiating between benign and malignant ampullary strictures: a prediction model using a nomogram based on CT imaging and clinical findings. Eur Radiol 32, 7566–7577 (2022). https://doi.org/10.1007/s00330-022-08856-7

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  • DOI: https://doi.org/10.1007/s00330-022-08856-7

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