Utility of multi-modality imaging in the evaluation of periampullary lesions

Abstract

Background: The radiological evaluation of periampullary area poses a diagnostic challenge to radiologists owing to its complex anatomy. We performed this study to evaluate the role of imaging modalities in evaluation of periampullary lesions and correlation with operative and histopathological findings.

Objective: To evaluate role of imaging modalities in establishing the nature of perimapullary lesions, stage and determine the resectability of perimapullary cancers.

Study design: prospective observational.

Participants: 86 patients consisting of 44 males and 42 females with mean age of 51.6 years.

Materials and methods: 86 patients with obstructive jaundice with preliminary ultrasound pointing to the possibility of terminal CBD and/or MPD block were subsequently evaluated with either CT, MRI or both. Imaging features were assessed to differentiate benign and malignant lesions on a 5-point confidence scale. Cancers arising within 2 cm of major papilla were included and distinguished into 4 different types-periampullary pancreatic, ampullary, distal CBD and duodenum. Resectability, nodal disease and distant metastasis of malignant lesions were assessed.

Results: 71 patients had malignant lesions which included 30 pancreatic cancers, 25 ampullary cancers, 7 distal CBD cancers and 6 duodenal carcinomas. In differentiation of benign and malignant lesions, CT ahd sensitivity and specificity rates of 91.9% and 90% while MRI had 97% and 82% respectively. In the assessment of resectability, CT showed sensitivity and specificity of 91 % and 86% while MRI had rates of 90% and 83% respectively. CT was 75% sensitive and 95% specific while MRI was 83.3% sensitive and 95.4% specific in assessment of distant metastasis. For nodal disease, CT showed sensitivity of 22.7% while MRI showed sensitivity of 15.3%.

Conclusion: Both CT and MRI perform well in evaluation of nature of periampullary lesions and assessment of resectability of malignant cancers. CT can be used single most important test in evaluation of periampullary lesions. Imaging modalities perform poorly In pre operative evaluation of nodal metastasis.

Implications: CT and MRI are invaluable imaging modalities in the evaluation of periampullary lesions.