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Differentiation of benign and malignant ampullary obstruction by multi-row detector CT

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Abstract

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.

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Authors and Affiliations

  1. Department of Radiology, Thammasat University Hospital, 95 Moo 8, Phahon Yothin Road, Khlong Luang, Pathum Thani, 12110, Thailand

    Wirana Angthong, Kran Jiarakoop & Kaan Tangtiang

Authors
  1. Wirana Angthong
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  2. Kran Jiarakoop
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  3. Kaan Tangtiang
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Corresponding author

Correspondence to Wirana Angthong.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study. In addition, a statement affirming approval of the appropriate institutional review boards in accordance with the ethical standards laid down in the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Angthong, W., Jiarakoop, K. & Tangtiang, K. Differentiation of benign and malignant ampullary obstruction by multi-row detector CT. Jpn J Radiol 36, 477–488 (2018). https://doi.org/10.1007/s11604-018-0746-z

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  • DOI: https://doi.org/10.1007/s11604-018-0746-z

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