Diagnostic Performance of Multidetector Computed
Tomography (MDCT) to Differentiate Malignant
from Benign Ampullary Lesions Causing Distal
Common Bile Duct Obstruction
Sopa Pongpornsup MD*,
Parisut Pawananunt MD*, Wanwarang Teerasamit MD*
Affiliation :
* Department of Diagnostic Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To evaluate diagnostic performance of 64-slice multidetector computed tomography (MDCT) for differentiating
the benign from malignant ampullary lesion.
Material and Method: A retrospective study was performed in 55 patients with obstructive jaundice from distal common
bile duct (CBD) obstruction as a result of ampullary lesion underwent 64-slice MDCT. The patients were enrolled between
February 2007 and August 2014. The patients’ MDCT scans of abdomen were retrospectively evaluated by two gastrointestinal
radiologists without knowledge of patient’s history, clinical data, and final diagnosis. Readers recorded the presence or
absence of ampullary mass, size, shape, margin, enhancing pattern of ampullary lesion, diameter of CBD, and additional
finding.
Results : CBD dilatation in malignancy and benign groups were 1.9±0.7 cm and 1.5±0.5 cm, respectively (p<0.05).
Intrahepatic duct dilatation was more present in malignant ampullary lesion. Target pattern of ampullary lesion were found
in only benign group (p<0.05) and pancreatic divisum were found in only malignant group (p>0.05). As compared pathological
results and CT findings of benign and malignant lesions represent 95.4% sensitivity and 58.3% specificity.
Conclusion : MDCT is helpful to differentiate benign and malignant nature of ampullary lesion that causes distal CBD
obstruction. Benign and malignant ampullary lesion that cause distal CBD obstruction could not be definite differentiated
by size, density, and enhancement pattern on CT image but degree of CBD, intrahepatic duct dilatation, pancreatic divisum,
and target pattern may be distinguished.
Keywords : Ampullary tumor, Common bile duct obstruction, Multidetector computed tomography
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