The efficacy of MDCT imaging in the evaluation of periampullary tumors with histopathological correlation

Background: The ampulla of Vater is an important anatomic landmark where the common bile duct (CBD) and main pancreatic duct (MPD) converge in the major duodenal papilla. Periampullary lesions arise within 2 cm of the ampulla in the duodenum and include lesions from pancreatic head, lower common bile duct, periampullary duodenum and from within ampulla itself. The lesions can be neoplastic or inflammatory. The visualization of the normal structures, differentiation periampullary tumors and evaluation of the extent of ampullary and periampullary tumors are important in treatment planning. (1) Imaging of the periampullary region poses a unique diagnostic challenge to radiologists because of the region’s complex and variable. There are several imaging modalities available to evaluate patients with suspected periampullary tumors which include endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreaticography (ERCP), magnetic resonance imaging (MRI) and computed tomography (CT). Computed tomography has evolved as a predominant modality for diagnosis and preoperative staging. (2) Currently, when biliary obstructive diseases are suspected, there is an emphasis on the combination of imaging approaches, such as conventional magnetic resonance imaging (MRI) with MRCP for the improvement of diagnostic accuracy. However, MR examinations are not suitable for all patients, as some contraindications (incompatible cardiac pacemaker, aneurysm clips, severely ill, etc.) limit their clinical use. As MDCT is easily available in most secondary and tertiary care centres, it is accessible for the general population. Our study aims was to evaluate periampullary tumor by MDCT and correlate with histopathological findings. Objectives: 1. To determine the efficacy of MDCT imaging in evaluation of periampullary tumors and to correlate with histopathological findings. 2. To differentiate between benign and malignant tumors. Materials and methods: Source of data All patients with clinical suspicion of periampullary tumor referred to the Department of Radio-Diagnosis at Vydehi Institute of Medical Sciences & Research Centre, Bangalore for CT evaluation. Method of collection of data A comparative analytical study was conducted on 44 patients who came to Department of Radiodiagnosis and Imaging in Vydehi Institute of Medical Sciences and Research Centre, Bangalore for Radiography and Computed Tomography with clinical suspicion of periampullary tumors in a period of 1.5 years ranging from January 2017 to June 2019.