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Evaluation of Imaging Findings of Pancreatobiliary and Intestinal Type Periampullary Carcinomas with 3.0T MRI

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    # All of the authors declare that they have all participated in the design, execution, and analysis of the paper and that they have approved the final version. Written informed consent was waived by the Institutional Review Board.
    Mustafa Orhan Nalbant
    Correspondence
    Address correspondence to: M.O. N.
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    # All of the authors declare that they have all participated in the design, execution, and analysis of the paper and that they have approved the final version. Written informed consent was waived by the Institutional Review Board.
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    Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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    Ercan Inci
    Footnotes
    # All of the authors declare that they have all participated in the design, execution, and analysis of the paper and that they have approved the final version. Written informed consent was waived by the Institutional Review Board.
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    Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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    # All of the authors declare that they have all participated in the design, execution, and analysis of the paper and that they have approved the final version. Written informed consent was waived by the Institutional Review Board.
    Ozlem Akinci
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    Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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    # All of the authors declare that they have all participated in the design, execution, and analysis of the paper and that they have approved the final version. Written informed consent was waived by the Institutional Review Board.
    Sinan Aygan
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    Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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    # All of the authors declare that they have all participated in the design, execution, and analysis of the paper and that they have approved the final version. Written informed consent was waived by the Institutional Review Board.
    Ulas Gulturk
    Footnotes
    # All of the authors declare that they have all participated in the design, execution, and analysis of the paper and that they have approved the final version. Written informed consent was waived by the Institutional Review Board.
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    Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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    # All of the authors declare that they have all participated in the design, execution, and analysis of the paper and that they have approved the final version. Written informed consent was waived by the Institutional Review Board.
    Aycan Boluk Gulsever
    Footnotes
    # All of the authors declare that they have all participated in the design, execution, and analysis of the paper and that they have approved the final version. Written informed consent was waived by the Institutional Review Board.
    Affiliations
    Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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    # All of the authors declare that they have all participated in the design, execution, and analysis of the paper and that they have approved the final version. Written informed consent was waived by the Institutional Review Board.
Published:December 28, 2022DOI:https://doi.org/10.1016/j.acra.2022.12.028

      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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