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- “ In our experience, both the distal CBD and ampulla are common sites of missed diagnoses for radiologists. Avoiding mistakes in interpreting imaging findings in this location requires a systematic approach especially in the setting of unexplained biliary ductal dilatation. Rather than simply suggesting that MRCP or ERCP be performed for the ultimate diagnosis, radiologists can perform a careful CT evaluation using multiplanar reformations and 3D imaging to determine the correct diagnosis prospectively. A timely and correct diagnosis is imperative because lesions in the ampulla and CBD can be very aggressive despite their small size.”
Abnormalities of the Distal Common Bile Duct and Ampulla: Diagnostic Approach and Differential Diagnosis Using Multiplanar Reformations and 3D Imaging.
Raman SP,Fishman EK.
AJR Am J Roentgenol. 2014 Jul;203(1):17-28. - “The distal common bile duct (CBD) and ampulla are extremely difficult sites to evaluate on CT. This article seeks to provide the reader with a framework and algorithmic approach to the evaluation of abnormalities involving the distal CBD and ampulla, including an emphasis on the use of multiplanar reformations and 3D imaging, the morphologic features on CT that suggest the presence of malignancy, and a differential diagnosis for abnormalities in this location.”
Abnormalities of the Distal Common Bile Duct and Ampulla: Diagnostic Approach and Differential Diagnosis Using Multiplanar Reformations and 3D Imaging.
Raman SP,Fishman EK.
AJR Am J Roentgenol. 2014 Jul;203(1):17-28. - “In general, the CBD should measure 7 mm or less in healthy patients, although the normal duct may be dilated in older patients and those who have undergone cholecystectomy.”
Abnormalities of the Distal Common Bile Duct and Ampulla: Diagnostic Approach and Differential Diagnosis Using Multiplanar Reformations and 3D Imaging.
Raman SP,Fishman EK.
AJR Am J Roentgenol. 2014 Jul;203(1):17-28. - “The duodenum and proximal jejunum are the most common sites for the development of small- bowel adenocarcinoma, accounting for 50– 70% of lesions. When these tumors arise in close proximity to the ampulla, ultimately resulting in biliary and pancreatic ductal obstruction, the distinction between a primary periampullary duodenal adenocarcinoma and a primary ampullary carcinoma is impossible to make based on imaging alone.”
Abnormalities of the Distal Common Bile Duct and Ampulla: Diagnostic Approach and Differential Diagnosis Using Multiplanar Reformations and 3D Imaging.
Raman SP,Fishman EK.
AJR Am J Roentgenol. 2014 Jul;203(1):17-28.
- Biliary Cystadenoma/Cystadenocarcinoma
- Cystic lesion with multiple internal loculations
- Encapsulated and well circumscribed
- Even if benign, can have malignant potential
- Very difficult to completely resect
- Female predominance
- Biliary Stent Occlusion: Etiology
Tumor growth into stent
Stent occlusion due to non-malignant causes- Biliary sludge
- Hemobilia
- Retained mucus
- Refluxed food matter from duodenum
"The sensitivity and specificity of MDCT for the diagnosis of tissue growth were 86.7% and 85.7% respectively. The overall accuracy of curved planar reformation images of MDCT for diagnosing the causes of stent occlusion was 86.2%"
Curved Planar Reformatted Images of MDCT for Differentiation of Biliary Stent Occlusion in Patients with Malignant Biliary Obstruction
Bang BW et al.
AJR 2010; 194:1509-1514"The difference in attenuation value inside the biliary stent between the contrast-enhanced and unenhanced phases of CT in the tissue growth group was 27.7 ± 21.7 HU and 4.2 ± 10.6 HU in the stent clogging group.The sensitivity and specificity of MDCT for the diagnosis of tissue growth were 86.7% and 85.7% respectively. The overall accuracy of curved planar reformation images of MDCT for diagnosing the causes of stent occlusion was 86.2%"
Curved Planar Reformatted Images of MDCT for Differentiation of Biliary Stent Occlusion in Patients with Malignant Biliary Obstruction
Bang BW et al.
AJR 2010; 194:1509-1514"The difference in attenuation value inside the biliary stent between the contrast-enhanced and unenhanced phases of CT in the tissue growth group was 27.7 ± 21.7 HU and 4.2 ± 10.6 HU in the stent clogging group."
Curved Planar Reformatted Images of MDCT for Differentiation of Biliary Stent Occlusion in Patients with Malignant Biliary Obstruction
Bang BW et al.
AJR 2010; 194:1509-1514"Curved planar reformation MDCT is a useful noninvasive technique that is relatively accurate for diagnosing the cause of biliary stent occlusion and is helpful in planning the therapeutic management of such patients."
Curved Planar Reformatted Images of MDCT for Differentiation of Biliary Stent Occlusion in Patients with Malignant Biliary Obstruction
Bang BW et al.
AJR 2010; 194:1509-1514- "Inhomogeneous enhancement in the early phase on dynamic CT is frequently seen in patients with acute cholangitis; this finding usually disappears after treatment."
Dynamic CT of Acute Cholangitis: Early Inhomogeneous Enhancement of the LiverArai K et al.AJR 2003; 1881:115-118