Differentiation of noncalculous periampullary obstruction: comparison of CT with negative-contrast CT cholangiopancreatography versus MRI with MR cholangiopancreatography
Abstract:• nCTCP with subvolume MinIP is a practical tool in evaluating biliary obstruction • Two image sets have a comparable performance in differentiating noncalculous periampullary obstruction • MDCT could serve as an alternative in patients not eligible for MRI.
“…Previous studies have provided the observation that overall survival was highest for patients with ampullary and duodenal cancers, intermediate for patients with bile duct cancers, and lowest for those with pancreatic cancers . Therefore, many investigators tried to differentiate the four types of tumor using different imaging techniques in order to predict patients' prognosis . However, due to the anatomical complexity of the periampullary region, correct classification with respect to location remains challenging, particularly if the tumor is large and involves more than one potential site of origin .…”
“…Previous studies have provided the observation that overall survival was highest for patients with ampullary and duodenal cancers, intermediate for patients with bile duct cancers, and lowest for those with pancreatic cancers . Therefore, many investigators tried to differentiate the four types of tumor using different imaging techniques in order to predict patients' prognosis . However, due to the anatomical complexity of the periampullary region, correct classification with respect to location remains challenging, particularly if the tumor is large and involves more than one potential site of origin .…”
“…The imaging principle is based on the dilated bile ducts as a negative contrast agent for differentiation from the surrounding enhanced hepatic and pancreatic parenchyma without additional biliary contrast agent [12] . This technique was useful for identifying obstructive level, depicting complex biliary tree anatomy, and providing entire pancreatobiliary system in one image similar to of 3D MR cholangiopancreatography [13] ( Fig. 1 , Fig.…”
“…But its value is still unsatisfying in the diagnosis in periampullary lesions. Previous studies have reported that the specificity was 75.68-100%, sensitivity was 60-100%, and accuracy was 91.17-92.92% in the diagnosis of periampullary space-occupying lesions [11][12][13][14]. Then, MRCP examination requires a magnetic field, which is contradicted for patients with metal implanted material, such as cardiac pacemaker, metal stent, etc.…”
Objective This study was performed to assess the diagnostic performance of endoscopic ultrasonography (EUS) in patients with extrahepatic bile duct (EBD) dilatation and develop a novel model incorporating EUS-based signature with clinical parameters for distinguishing the malignant dilation of EBD. Methods The EUS data and clinical parameters of the patients were collected and analyzed retrospectively. First, we evaluated the diagnostic performance of EUS in detecting the cause of EBD dilatation. Then, we performed univariate and multivariate binary logistic regression analyses based on clinical and EUS features. Finally, a nomogram was established to aid in distinguishing between malignant dilation and noncalculous benign dilatation of EBD in patients.Results A total of 184 patients were enrolled. For the diagnosis of malignant dilation, EUS achieved an accuracy of 90.76%, sensitivity of 85.96%, and specificity of 92.91%. For the diagnosis of calculous dilation, EUS achieved an accuracy of 100%, sensitivity of 100%, and specificity of 100%. For the diagnosis of noncalculous benign dilatation, EUS achieved an accuracy of 90.76%, sensitivity of 90.90%, and specificity of 90.58%. Multivariable logistic regression analyses indicated that abnormal liver function test, elevated tumor markers, and EUS findings were the well-diagnostic factors of malignant EBD dilation. The nomogram established by these factors showed good calibration and discrimination. Conclusion EUS is a useful examinational modality in the work-up of EBD dilatation. In combination with abnormal liver function test and elevated tumor markers, EUS may provide additional information for the detection of malignant dilation of EBD and should be further investigated.
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