Using multi-detector-row CT to diagnose ampullary adenoma or adenocarcinoma in situ
Myungsu Lee1, Myeong-Jin Kim, Mi-Suk Park
1Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Objective:
To assess the diagnostic accuracy of multi-detector-row computed tomography (MDCT) for the detection of ampullary adenomas or adenocarcinomas in situ.
Materials And Methods:
We retrospectively reviewed 21 computed tomography (CT) images from 20 patients with ampullary tumors, and 22 CT images from 22 patients without periampullary tumor. Three radiologists blindly and independently reviewed CT images. The sensitivities and specificities for identification of ampullary masses were calculated in all cases and in cases with adequate duodenal distension. The sensitivities and specificities for the diagnosis of ampullary tumors were calculated using the following criteria: identification of mass alone; presence of extrahepatic bile duct (EBD) dilation or identification of mass; presence of pancreatic duct (PD) dilation or identification of mass. Paired t-tests were performed to assess differences in mean values.
Results:
The mean sensitivity and specificity of MDCT for the detection of an ampullary mass in all cases were 47.6% and 86.4%, and in cases with adequate duodenal distension, 66.7% (p=0.07) and 80.5% (p=0.32), respectively. When the presence of EBD dilation or identification of mass were used as criteria, the mean sensitivity and specificity were 73.0% (p=0.03) and 60.6% (p=0.03), respectively. When presence of PD dilation or identification of mass were used as criteria, the mean sensitivity and specificity were 47.6% and 81.8% (p=0.23).
Conclusions:
MDCT is moderately accurate for the diagnosis of ampullary adenoma or adenocarcinoma in situ. When EBD dilation or identification of mass were used as criteria, the sensitivity can be improved.