| Purpose:To evaluate the role of multi-slice spiral computed tomography(MSCT), magnetic resonance imaging(MRI), ultrasonography(US), and endoscopic ultrasonography(EUS) in the diagnosis of periampullary carcinoma. Material and Methods:We respectively studied the preoperative imaging data on 92 patients with periampullar carcinoma, including MSCT of 76 cases, MRI of 33 cases, US of 80 cases and EUS of 30 cases. All patients were confirmed by pathological diagnosis after operation. Results:There were 18 cases of cancer of pancreatic head,25 cases of cancer of common bile duct,38 cases of ampullary cancer and 11 cases of duodenal cancer.37 cases were pathologically confirmed with lymph node metastasis.79 patients presented with low bile duct obstruction, the incidence of obstructive jaundice caused by duodenal cancer was significantly less than other tumors (χ2=20.923, P=0.000).79 cases preseted with expansion of common bile duct. The diameters were of 8-25mm, with an average of 16.10mm. Dilation of common bile duct caused by different tumors was statistically significant (χ2=152.916, P=0.021).68 cases presented with pancreatic duct dilation. The diameters were of 1-13mm, with an average of 4.37mm. Dilation of pancreatic duct between different tumors was not significant (χ2=25.677, P=0.188). There is no association between common bile duct dilatation and pancreatic duct dilation (P=0.324). "Double-duct-sign" were found in 66 cases, of which intersects of pancreatic and biliary ducts in 21 cases, isolated pancreatic and biliary ducts in 33 cases, unclassified in 12 cases. The types of "double-duct-sign" among different tumors were significantly different(χ2=26.593, P=0.000). There were 79 patients with biliary duct obstruction,23 cases in the upper pancreas,22 cases in pancreatic segment, and 34 cases in ampullary segment. The types of biliary duct obstruction among different tumors were significantly different (χ2=135.387, P=0.000). The shapes of obstructive segements were termination type (39 cases), funnel-shaped or beak-type (23 cases), rat tail type (17 cases). The shapes of obstructive segements of different tumors were significantly different (χ2=23.005, P=0.001). On MSCT scan,82.9%(63/76) cases were cleary shown with mass. All of lesions showed different degrees of contrast enhancement, according to different origins of cancers. The sensitivity, specificity and accuracy of MSCT for diagnosis of lymph node metastasis was 31.0%,97.9% and 72.4%, respectively. The sensitivity of MRI for detection of tumor was 93.4%(31/33).26 of 28 cases with enhanced scanning showed varying degrees of enhancement. The sensitivity, specificity and accuracy of MRI for diagnosis of lymph node metastasis was 13.3%, 94.4% and 57.6%, respectively.47.5%(38/80) of cases were shown with mass by US. The sensitivity, specificity and accuracy of US for diagnosis of lymph node metastasis was 8.6%,95.6% and 57.5%, respectively.90.0%(27/30) of cases were shown with mass by EUS. The sensitivity, specificity and accuracy of EUS for diagnosis of lymph node metastasis was 16.7%,72.2% and 50%. The sensitivity, specificity and accuracy of MSCT, MRI and EUS for diagnosis of tumor invasion to adjacent organs were quite different. Conclusions:US is reliable for the detection of biliary obstruction, common bile duct dilation, while there are some restrictions for detection of pancreatic duct expansion. MSCT or MRI should be the preferred method to detect obstructive jaundice, while MPR, MRCP can clearly show the biliary tract lesions. Different tumors with enhanced scanning showed varying degrees of enhancement. MSCT multi-phase scanning and LAVA dynamic scans of MRI were useful to detect lesions. EUS is the most sensitive examination for detection of periampullary cancers. The level and shape of luminal obstruction can help to diagnosis of periampullary cancers. Masses with termination and rat tail types of obstructive shape can be diagnosed as cancer. The isolated pancreatic and biliary ducts of "double-duct-sign" is very accurate signs for the differential diagnosis of pancreatic head cancer. Imaging for the diagnosis of tumor invasion of the adjacent structures and for lymph node metastasis has only suggestive significance. Imaging diagnosis of periampullary cancer require a combination of modern technology, integrated application of various inspection methods. |
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