From the Department of Radiology, Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (P.N., N.A.H., K.D., V.Y., C.G.W., D.S.M., C.B.H., J.M.H., S.M.B., F.H.M.); and Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC (M.T.T.).
Radiographics. 2014 May-Jun;34(3):624-41. doi: 10.1148/rg.343125191.
The ampulla of Vater is an important anatomic landmark where the common bile duct and main pancreatic duct converge in the major duodenal papilla. Imaging evaluation of the ampulla and periampullary region poses a unique diagnostic challenge to radiologists because of the region's complex and variable anatomy and the variety of lesions that can occur. Lesions intrinsic to the ampulla and involved segment of the biliary tree can be neoplastic, inflammatory, or congenital. Neoplastic lesions include ampullary adenocarcinomas and adenomas, which often are difficult to differentiate, as well as pancreatic or duodenal adenocarcinomas, pancreatic neuroendocrine tumors, and cholangiocarcinomas. Ultrasonography (US), computed tomography, magnetic resonance (MR) imaging, and MR cholangiopancreatography are commonly used to evaluate this region. Endoscopic retrograde cholangiopancreatography or endoscopic US examination may be necessary for more definitive evaluation. Periampullary conditions in the duodenum that may secondarily involve the ampulla include neoplasms, duodenitis, duodenal diverticula, and Brunner's gland hyperplasia or hamartomas. Because these lesions can exhibit a wide overlap of imaging features and subtle or nonspecific imaging findings, diagnosis is made on the basis of patient age, clinical history, and imaging and laboratory findings. Given the complexity of imaging evaluation of the ampulla and periampullary region, it is essential for radiologists to understand the variety of lesions that can occur and recognize their imaging characteristics.
Vater 壶腹是一个重要的解剖学标志，胆总管和主胰管在此汇聚于十二指肠大乳头。由于该区域的解剖结构复杂且多变，并且可能发生多种病变，因此对放射科医生来说，对壶腹和壶腹周围区域进行影像学评估具有独特的诊断挑战。壶腹和胆道树受累节段的固有病变可为肿瘤性、炎症性或先天性。肿瘤性病变包括壶腹腺癌和腺瘤，这些病变通常难以区分，此外还包括胰腺或十二指肠腺癌、胰腺神经内分泌肿瘤和胆管癌。超声检查 (US)、计算机断层扫描 (CT)、磁共振成像 (MR) 和 MR 胰胆管成像常用于评估该区域。对于更明确的评估，可能需要进行内镜逆行胰胆管造影或内镜超声检查。十二指肠中可能继发性累及壶腹的壶腹周围病变包括肿瘤、胰腺炎、十二指肠憩室和 Brunner 腺增生或错构瘤。由于这些病变在影像学特征上可能存在广泛重叠，且影像学表现细微或非特异性，因此诊断基于患者年龄、临床病史以及影像学和实验室检查结果。鉴于对壶腹和壶腹周围区域进行影像学评估的复杂性，放射科医生必须了解可能发生的各种病变，并识别其影像学特征。
