RESUMEN
The purpose of this two-part article is to review the cross-sectional anatomy of the ampulla and periampullary region, to propose novel and optimized MDCT and MRI techniques that allow accurate evaluation of the ampulla of Vater, and to summarize the cross-sectional imaging features of benign and malignant ampullary conditions. In this first part, we will review the normal anatomy of the ampullary region, provide suggestions on how to optimize evaluation of the ampullary region by MDCT and MRI, and review the imaging features of select epithelial neoplasms of the ampulla. Familiarity with the normal ampullary anatomy and the pathologic conditions involving the ampulla, as well as the use of optimized MDCT and MRI techniques, may improve the diagnostic accuracy of radiologists facing ampullary abnormalities.
Asunto(s)
Ampolla Hepatopancreática/diagnóstico por imagen , Ampolla Hepatopancreática/patología , Enfermedades del Conducto Colédoco/diagnóstico por imagen , Enfermedades del Conducto Colédoco/patología , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Ampolla Hepatopancreática/anatomía & histología , Neoplasias del Conducto Colédoco/diagnóstico por imagen , Neoplasias del Conducto Colédoco/patología , HumanosRESUMEN
The purpose of this two-part article is to review the cross-sectional imaging features of benign and malignant ampullary conditions with endoscopic and histopathologic correlation and to present the most common pitfalls in the evaluation of the ampulla. In this part, we will review the mesenchymal and secondary neoplasms of the ampulla, a vast array of benign ampullary conditions, causes of bulging papilla, and pitfalls. Familiarity with ampullary pathologic conditions and pitfalls, as well as the use of optimized MDCT and MRI techniques, may improve the diagnostic accuracy of radiologists facing ampullary abnormalities.
Asunto(s)
Ampolla Hepatopancreática/diagnóstico por imagen , Ampolla Hepatopancreática/patología , Enfermedades del Conducto Colédoco/diagnóstico por imagen , Enfermedades del Conducto Colédoco/patología , Imagen por Resonancia Magnética , Tomografía Computarizada Multidetector , Neoplasias del Conducto Colédoco/diagnóstico por imagen , Neoplasias del Conducto Colédoco/patología , Diagnóstico Diferencial , HumanosRESUMEN
OBJECTIVE: To determine if gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) cholangiography can detect and localize bile duct leaks in postcholecystectomy patients. MATERIAL AND METHODS: Four blinded independent radiologists performed a retrospective review of 16 consecutive patients who underwent MR cholangiography with intravenous Gd-EOB-DTPA for the evaluation of possible biliary leak. Image quality, ductal opacification, and presence and location of any bile leak were evaluated. An independent observer determined the criterion standard using a consensus of all chart, clinical, and imaging findings. RESULTS: All 6 bile leaks confirmed at endoscopic retrograde cholangiopancreatography were diagnosed by all reviewers (sensitivity, 100%). Of the 10 patients with no leak, only one reader incorrectly diagnosed a bile leak in a single case (specificity, 98%). The accuracy for detection of the site of leak with Gd-EOB-DTPA-enhanced MR cholangiography was 80%. CONCLUSION: Gadolinium-EOB-DTPA-enhanced MR can detect bile leaks with a high sensitivity and specificity.
