Ampulla of Vater: Comprehensive anatomy, MR imaging of pathologic conditions, and correlation with endoscopy

Kim, Tae Un; Kim, Suk; Lee, Jun Woo; Woo, Sung Koo; Lee, Tae Hong; Choo, Ki Seok; Kim, Chang Won; Kim, Gwang Ha; Kang, Dae Hwan

doi:10.1016/j.ejrad.2007.04.005

Cited by 50 publications

(23 citation statements)

References 19 publications

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“…Our retrospective study was approved by the institutional review board of Severance Hospital (Seoul, Republic of Korea), T he ampulla of Vater includes the ampullary bile duct, ampullary pancreatic duct, ampullary common channel, and the duodenal papilla ( 1 ). The duodenal papilla is lined by intestinal mucosa that is similar to colonic epithelium, and the ampullary portions are covered by simple mucinous epithelium, as in the normal bile duct ( 2 ).…”

Section: Patientsmentioning

confidence: 99%

Differential Features of Pancreatobiliary- and Intestinal-type Ampullary Carcinomas at MR Imaging

et al. 2010

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Purpose:To defi ne the differential imaging features of pancreatobiliaryand intestinal-type ampullary carcinomas at magnetic resonance (MR) imaging and to correlate these features with pathologic fi ndings. Materials and Methods:This retrospective study was approved by the institutional review board; informed consent was waived. Fifty patients with surgically confi rmed ampullary carcinoma and preoperative MR results were included. Two radiologists, blinded to histologic type of cancer, evaluated imaging fi ndings in consensus. Univariate and multiple logistic regression analysis were performed to defi ne imaging fi ndings that were useful for differentiation of the two types of carcinomas. Results:On 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 fi lling defect at the distal end of the bile duct was the only independent fi nding for differentiating intestinal from pancreatobiliary carcinoma ( P = .027). Conclusion:An oval fi lling 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.q RSNA, 2010 Supplemental material: http://radiology.rsna.org/lookup /suppl

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Section: Patientsmentioning

confidence: 99%

Differential Features of Pancreatobiliary- and Intestinal-type Ampullary Carcinomas at MR Imaging

et al. 2010

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“…Owing to the confusing and overlapping findings in periampullary obstruction, it is not always easy to differentiate benign from malignant lesions, especially to exclude patients with choledocholithiasis [4,16]. MRI with MRCP represents one of the most comprehensive imaging examinations currently available for evaluating periampullary obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Malignant periampullary obstruction was considered on CT and MRI if there was: (1) direct visualization of a hypodense or hypointense mass relative to the normal pancreatic or hepatic parenchyma at the obstructive level [8,16,17], (2) an irregular thickened ductal wall that obliterated the lumen and demonstrated contrast enhancement [14,18], or (3) a thickened duodenal wall with relatively narrowed duodenal lumen or irregular overhanging edges in the periampullary regions with an abrupt and asymmetric obstruction of bile duct with proportional dilated duct [17].…”

Section: Image Analysismentioning

confidence: 99%

“…PHC was demonstrated when a relatively hypodense or hypointense mass in the region of pancreatic head parenchyma was seen directly on the enhanced CT or T1-weighted MR images [1,19]. If no discernible mass was observed, indirect signs including focal contour changes in the pancreas with abrupt termination of the bile duct, pancreatic duct, or both, or presentation of a foursegment sign were suggestive of PHC on both modalities [1,16]. Once the reviewers identified a mass in a patient, they were also recorded the size (maximal diameter) and enhancement pattern of the mass on each image set.…”

Section: Image Analysismentioning

confidence: 99%

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Differentiation of noncalculous periampullary obstruction: comparison of CT with negative-contrast CT cholangiopancreatography versus MRI with MR cholangiopancreatography

Zhang

et al. 2014

Eur Radiol

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“…Its borders may be lobulated or infiltrating (Fig 2). At MR imaging, a visible ampullary tumor will enhance after gadolinium-based contrast agent administration (7). The addition of diffusionweighted imaging sequences to conventional MR imaging has more recently been shown to improve detection of ampullary carcinoma (5).…”

Section: Sa-cme Learning Objectivesmentioning

confidence: 99%

Imaging Features of Benign and Malignant Ampullary and Periampullary Lesions

Nikolaidis¹,

Hammond²,

Day³

et al. 2014

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The ampulla of Vater is an important anatomic landmark where the common bile duct and main pancreatic duct converge in the major duodenal papilla. Imaging evaluation of the ampulla and periampullary region poses a unique diagnostic challenge to radiologists because of the region's complex and variable anatomy and the variety of lesions that can occur. Lesions intrinsic to the ampulla and involved segment of the biliary tree can be neoplastic, inflammatory, or congenital. Neoplastic lesions include ampullary adenocarcinomas and adenomas, which often are difficult to differentiate, as well as pancreatic or duodenal adenocarcinomas, pancreatic neuroendocrine tumors, and cholangiocarcinomas. Ultrasonography (US), computed tomography, magnetic resonance (MR) imaging, and MR cholangiopancreatography are commonly used to evaluate this region. Endoscopic retrograde cholangiopancreatography or endoscopic US examination may be necessary for more definitive evaluation. Periampullary conditions in the duodenum that may secondarily involve the ampulla include neoplasms, duodenitis, duodenal diverticula, and Brunner's gland hyperplasia or hamartomas. Because these lesions can exhibit a wide overlap of imaging features and subtle or nonspecific imaging findings, diagnosis is made on the basis of patient age, clinical history, and imaging and laboratory findings. Given the complexity of imaging evaluation of the ampulla and periampullary region, it is essential for radiologists to understand the variety of lesions that can occur and recognize their imaging characteristics.

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Ampulla of Vater: Comprehensive anatomy, MR imaging of pathologic conditions, and correlation with endoscopy

Cited by 50 publications

References 19 publications

Differential Features of Pancreatobiliary- and Intestinal-type Ampullary Carcinomas at MR Imaging

Differential Features of Pancreatobiliary- and Intestinal-type Ampullary Carcinomas at MR Imaging

Differentiation of noncalculous periampullary obstruction: comparison of CT with negative-contrast CT cholangiopancreatography versus MRI with MR cholangiopancreatography

Imaging Features of Benign and Malignant Ampullary and Periampullary Lesions

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