Ivanovic Aleksandar M, Gore Richard M, Saxena Shreya, Pavlovic Aleksandar, Bracanovic Milos, Djuric-Stefanovic Aleksandra, Alessandrino Francesco
University Clinical Center of Serbia, Center for Radiology, Belgrade, Serbia.
Endeavor Health, Department of Radiology, University of Chicago, Chicago, IL, USA.
Eur Radiol. 2025 May 14. doi: 10.1007/s00330-025-11677-z.
To evaluate the diagnostic accuracy of four imaging criteria obtained with a tailored duodenal MDCT to differentiate non-ampullary duodenal carcinoma (NADC) and intestinal-type ampullary carcinoma (ITAC).
In this retrospective single-center study, patients with resected ITAC and NADC who underwent preoperative contrast-enhanced MDCT using a tailored duodenal protocol were included. Three radiologists independently reviewed each MDCT, using four imaging criteria to differentiate the two cancer types: lesion shape, ductal cutoff, duodenopancreatic groove fixation and pancreatico-duodenal artery infiltration. Sensitivity, specificity, positive and negative predictive values of the imaging criteria were calculated using histopathologic analysis as the reference standard. Interobserver agreements were assessed using kappa statistics.
57 patients (mean age 55 years ± 18.2 (standard deviation); 25 women) were included in the study. ITAC was significantly different in terms of lesion shape (p < 0.0001) and duodenopancreatic groove fixation (p < 0.0007). Sensitivity and specificity of the lesion shape for the three readers were 47-66%, 83-92% (κ = 0.72); of the ductal cutoff were 24-52%, 61-71% (κ = 0.52); of the duodenopancreatic groove fixation were 54-73%, 86-93% (κ = 0.81); of the pancreatico-duodenal artery infiltration were 19-28%, 48-52% (κ = 0.44). When all features were taken into account, sensitivity and specificity in differentiating between ITAC vs NADC were 85.7% and 83.3%.
The lesion shape and duodenopancreatic groove fixation have high specificity and moderate/strong interreader agreement for preoperative differentiation of ITAC and NADC on tailored duodenal MDCT.
Question Preoperative differentiation of non-ampullary duodenal carcinoma and intestinal-type ampullary carcinoma has potential implications on patients' management. Findings Two imaging criteria acquired on a tailored duodenal CT allowed to differentiate between intestinal-type ampullary carcinoma non-ampullary duodenal carcinoma with > 80% sensitivity and specificity. Clinical relevance A tailored duodenal CT is a reliable tool to differentiate between intestinal-type ampullary carcinoma and non-ampullary duodenal carcinoma, with potential treatment implications.
评估采用定制十二指肠MDCT获得的四种影像标准对非壶腹十二指肠癌（NADC）和肠型壶腹癌（ITAC）进行鉴别的诊断准确性。
在这项回顾性单中心研究中，纳入了接受了使用定制十二指肠方案的术前对比增强MDCT检查且ITAC和NADC已切除的患者。三名放射科医生独立审查每例MDCT，使用四种影像标准来区分这两种癌症类型：病变形态、导管截断、十二指肠胰沟固定和胰十二指肠动脉浸润。以组织病理学分析作为参考标准，计算影像标准的敏感性、特异性、阳性和阴性预测值。使用kappa统计量评估观察者间的一致性。
57例患者（平均年龄55岁±18.2（标准差）；25名女性）纳入研究。ITAC在病变形态（p＜0.0001）和十二指肠胰沟固定（p＜0.0007）方面有显著差异。三位阅片者对于病变形态的敏感性和特异性分别为47% - 66%、83% - 92%（κ = 0.72）；对于导管截断的敏感性和特异性分别为24% - 52%、61% - 71%（κ = 0.52）；对于十二指肠胰沟固定的敏感性和特异性分别为54% - 73%、86% - 93%（κ = 0.81）；对于胰十二指肠动脉浸润的敏感性和特异性分别为19% - 28%、48% - 52%（κ = 0.44）。当综合考虑所有特征时，鉴别ITAC与NADC的敏感性和特异性分别为85.7%和83.3%。
病变形态和十二指肠胰沟固定对于在定制十二指肠MDCT上术前鉴别ITAC和NADC具有高特异性和中等/强的阅片者间一致性。
问题 非壶腹十二指肠癌和肠型壶腹癌的术前鉴别对患者的管理有潜在影响。发现 定制十二指肠CT上获得的两种影像标准能够以＞80%的敏感性和特异性区分肠型壶腹癌和非壶腹十二指肠癌。临床意义 定制十二指肠CT是区分肠型壶腹癌和非壶腹十二指肠癌的可靠工具，对治疗有潜在影响。
