Rationale and Objectives
The aim of this study was to differentiate pancreatobiliary and intestinal type periampullary
carcinomas using dynamic contrast MRI and MRCP (Magnetic Resonance Cholangiopancreatography)
with diffusion-weighted imaging (DWI)
Materials and Methods
MRI and MRCP images of 70 patients with pathologically proven periampullary adenocarcinoma
were included. MRCP image features, extra-ampullary features, enhancement patterns,
and apparent diffusion coefficient (ADC) values derived from b-values of 1000 s/mm²
were evaluated by two radiologists independently. The interclass correlation coefficient
(ICC) or Cohen's kappa statistic was used to evaluate the interobserver agreement.
Results
51 patients were diagnosed with pancreatobiliary type carcinomas, and 19 with intestinal
type. In the pancreatobiliary subtype, the distal wall of the common bile duct was
usually irregular (p = 0.047). Although the progressive enhancement pattern was evident in the pancreatobiliary
type, an oval filling defect in the distal common bile duct was found to be more common
in the intestinal type (p<0.001). The pancreatic duct cut-off sign (p<0.001), gastroduodenal
artery involvement (p <0,001), and lymphadenopathy (p<0.05) were mostly observed in pancreatobiliary carcinomas.
The ADCmin, ADCmean, and ADCmax values of the pancreatobiliary type carcinomas were
all lower compared to the intestinal type carcinomas (p <0.05).
Conclusion
The oval filling defect seen in MRI and MRCP examinations suggests intestinal type,
whereas the progressive contrasting pattern of the masses with irregular narrowing
in the distal margin of the common bile duct, the pancreatic duct cut-off sign, gastroduodenal
artery involvement, lymphadenopathy, and low ADC values indicate pancreatobiliary
type carcinomas.
Keywords
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Article info
Publication history
Published online: December 28, 2022
Accepted:
December 16,
2022
Received in revised form:
December 13,
2022
Received:
October 23,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
