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Evaluation of juxtapapillary duodenal diverticula using multiplanar reformation in MDCT: correlation with ERCP
Christopher Silman1, Shunro Matsumoto2, Yasunari Yamada2
1Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan. silmanchristopher@gmail.com.
Objective:
To determine the ability of multidetector computed tomography (MPR-MDCT) to identify and classify the juxtapapillary duodenal diverticulum (JPDD), with ERCP findings as the gold standard.
Methods:
We retrospectively reviewed all ERCP examinations (n: 455) performed between January 2010 to December 2018 and selected 105 patients with JPDD as the inclusion criteria. Of those, 28 patients were excluded because of advanced pancreatic carcinoma, incomplete MDCT examinations and biliary catheter insertion. Finally, MDCT examinations of 77 patients with JPDD were assessed for the presence and type of JPDD.
Results:
MPR-MDCT was able to identify 71 (92.2%) JPDD in 77 cases with 88.9% accuracy, 83.3% sensitivity, and 91.6% specificity in classifying the type of JPDD. MPR-MDCT performed best in determining type 1 JPDD, with accuracy of 95.4% compared with type 2 (83.3%) and type 3 (87.8%). There was no significant difference between age, gender, incidence of biliary stones and pancreatitis between each type of JPDD. No correlation of sizes with types of JPDD was found.
Conclusions:
MPR-MDCT can accurately identify and classify JPDD. This information will be useful in determining the difficulty of ERCP.
Insights
Multidetector computed tomography (MDCT) accurately identifies and classifies juxtapapillary duodenal diverticula (JPDD). This imaging technique aids in predicting the complexity of endoscopic retrograde cholangiopancreatography (ERCP) procedures.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Juxtapapillary duodenal diverticula (JPDD) are common but can complicate endoscopic retrograde cholangiopancreatography (ERCP).
- Accurate pre-procedural identification and classification of JPDD are crucial for planning ERCP.
Purpose of the Study:
- To evaluate the diagnostic performance of multidetector computed tomography (MDCT) in identifying and classifying JPDD.
- To compare MDCT findings with endoscopic retrograde cholangiopancreatography (ERCP) as the gold standard.
Main Methods:
- Retrospective review of 77 patients with JPDD who underwent MDCT and ERCP.
- Assessment of MDCT examinations for JPDD presence and classification.
Main Results:
- MDCT identified 92.2% of JPDD with high accuracy (88.9%), sensitivity (83.3%), and specificity (91.6%).
- MDCT demonstrated superior accuracy in classifying type 1 JPDD (95.4%) compared to types 2 (83.3%) and 3 (87.8%).
- No significant correlation was found between JPDD types, age, gender, or associated biliary/pancreatic conditions.
Conclusions:
- MDCT is a reliable tool for accurate identification and classification of JPDD.
- MDCT findings can assist in predicting ERCP procedural difficulty.
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