| Differential features of pancreatobiliary- and intestinal-type ampullary carcinomas at MR imaging. | |
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MedLine Citation:
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PMID: 20829529 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To define the differential imaging features of pancreatobiliary- and intestinal-type ampullary carcinomas at magnetic resonance (MR) imaging and to correlate these features with pathologic findings. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board; informed consent was waived. Fifty patients with surgically confirmed ampullary carcinoma and preoperative MR results were included. Two radiologists, blinded to histologic type of cancer, evaluated imaging findings in consensus. Univariate and multiple logistic regression analysis were performed to define imaging findings that were useful for differentiation of the two types of carcinomas. RESULTS: On the basis of hematoxylin-eosin and immunohistochemical staining, 35 patients were classified as having pancreatobiliary type; and 15 patients, intestinal type. At MR, all of 15 intestinal carcinomas were nodular, whereas 16 (46%) of 35 pancreatobiliary carcinomas were infiltrative. Intestinal carcinomas were isointense (13 [87%] of 15) to hyperintense (two [13%] of 15), whereas 34% (12 of 35) of pancreatobiliary carcinomas manifested as hypointense compared with the duodenum on T2-weighted MR images (P = .034). Intestinal carcinoma commonly manifested with an oval filling defect at the distal end of the bile duct on MR cholangiopancreatographic (MRCP) images (11 [73%] of 15 vs four [11%] of 35 in pancreatobiliary type) (P < .001). At endoscopy, intestinal carcinoma manifested with an extramural protruding mass (n = 15, 100%) with a papillary surface (n = 11, 73%), whereas pancreatobiliary carcinoma manifested with intramural protruding (n = 5, 28%) or ulcerating (n = 1, 6%) gross morphologic features (P = .047) with a nonpapillary surface (n = 17, 94%) (P < .001). Multiple logistic regression analysis showed that an oval filling defect at the distal end of the bile duct was the only independent finding for differentiating intestinal from pancreatobiliary carcinoma (P = .027). CONCLUSION: An oval filling defect at the distal end of the bile duct on MRCP images and an extramural protruding appearance with a papillary surface at endoscopy are likely to suggest intestinal ampullary carcinoma. |
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Authors:
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Yong Eun Chung; Myeong-Jin Kim; Mi-Suk Park; Jin Young Choi; Hoguen Kim; Sang Kyum Kim; Myungsu Lee; Hee Jin Kim; Jin-Sub Choi; Si Young Song; Ki Whang Kim |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-09-09 |
Journal Detail:
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Title: Radiology Volume: 257 ISSN: 1527-1315 ISO Abbreviation: Radiology Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-20 Completed Date: 2010-12-02 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0401260 Medline TA: Radiology Country: United States |
Other Details:
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Languages: eng Pagination: 384-93 Citation Subset: AIM; IM |
Copyright Information:
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© RSNA, 2010. |
Affiliation:
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Department of Radiology, Institute of Gastroenterology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, South Korea. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Ampulla of Vater / pathology* Bile Ducts, Intrahepatic / pathology* Chi-Square Distribution Cholangiopancreatography, Magnetic Resonance / methods* Common Bile Duct Neoplasms / diagnosis*, pathology Diagnosis, Differential Duodenal Neoplasms / diagnosis*, pathology Female Humans Image Interpretation, Computer-Assisted Immunohistochemistry Logistic Models Male Middle Aged Neoplasm Staging Pancreatic Neoplasms / diagnosis*, pathology Prognosis Retrospective Studies Survival Rate |
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