Computed Tomographic Findings of the Carcinoma of the Ampulla of Vater

ABSTRACT

OBJECTIVE:The purpose of this study is to evaluate the CT findings of the carcinoma of the ampulla of Vater and to differentiate from other periampullary carcinoma including the carcinoma of the distal common bile duct and pancreas head. MATERIALS AND METHODS: We retrospectively reviewed the CT findings of 13 cases of the carcinoma of the ampulla of Vater, 20 cases of the carcinoma of the distal common bile duct and 20 cases of the carcinoma of the pancreas head confirmed by pathology. Five millimeter consecutive settings of CT scan were performed in all cases on ampulla level with supine position. The CT findings were retrospectively evaluated in view of common bile duct dilatation, pattern of termination of bile duct, pancreatic duct dilatation, protruding mass in duodenal lumen, and regional lymph node metastasis. RESULTS: All case of the carcinoma of the ampulla of Vater(13/13) and distal common bile duct(20/20) showed common bile duct dilatation with abrupt termination. Among the 10 cases of the carcinoma of the pancreas head with common bile duct dilatation, five cases each had is abrupt termination(5/20) and gradual stenosis of bile duct(5/20). Five cases of the carcinoma of the ampulla of Vater(5/13) and four cases of the carcinoma of distal common bile duct(4/20) showed pancreatic duct dilatation and all cases of the carcinoma of pancreas head show pancreatic duct dialtation(20/20). Twenty cases of the carcinoma of the ampulla of Vater showed protruding mass in the medial wall of the second portion of the duodenum(12/13) but only one case of the carcinoma of the distal common bile duct(I/20) and five cases of the carcinoma of the pancreas head (5/20) had protruding mass in the duodenal lumen. Only one case of the carcinoma of the ampulla of Vater showed(1/13) regional lymph node metastasis but three cases of the carcinoma of the distal common bile duct(3/20) and 18 cases of the carcinoma of the pancreas head(18/20) showed regional lymph node metastasis. CONCLUSION: Common bile duct dilatation with abrupt termination, protruding mass in the duodenal lumen and rare lymph node metastasis in CT may suggest the carcinoma of the ampulla of Vater.