Gong Jun-Wei, Luo Tian-You, Zhang Jiao, Zhang Zhu, Wang Xin-Mei, Li Qi
Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Radiology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Quant Imaging Med Surg. 2025 Sep 1;15(9):8239-8249. doi: 10.21037/qims-2024-2501. Epub 2025 Aug 11.
Periampullary diverticulum (PAD) is a common acquired extraluminal outpouching of duodenal mucosa and is often clinically overlooked. When complicated by biliary-pancreatic stones or inflammation, PAD may lead to severe biliary-pancreatic complications. Although endoscopic retrograde cholangiopancreatography (ERCP) is currently regarded as the gold standard for PAD diagnosis, its invasive nature and other limitations have led to computed tomography (CT) being increasingly preferred as the first-line imaging modality. However, the correlation between imaging features and clinical manifestations remains unclear for high-risk PAD (HRPAD), defined as PAD associated with cholelithiasis and biliary-pancreatic inflammation. Therefore, this study aimed to examine the clinical and CT characteristics of HRPAD.
The data of 260 patients with HRPAD and 288 patients with non-high-risk PAD (N-HRPAD) who underwent contrast-enhanced abdominal CT scans between January 2018 and May 2024 were retrospectively analyzed. The clinical and CT features were compared between the groups. Independent factors for diagnosing HRPAD were identified through binary logistic regression analysis. Additionally, an external validation cohort comprising 150 patients from another center was used to test the predictive efficiency of the model.
Patients with HRPAD were significantly older than those with N-HRPAD, with an average age of 72±10 and 68±11 years, respectively (P<0.001). Additionally, they exhibited a higher proportion of larger diverticula (>1.95 cm: 65.38% . 22.57%), larger common bile duct (CBD) size (>0.69 cm: 72.31% . 20.83%), and greater pancreatic duct (PD) dilation (>0.20 cm: 86.92% . 60.42%) (all P values <0.001). Furthermore, there was a greater prevalence of diverticular neck swelling in the HRPAD group than in the control group (23.08% . 4.86%; P<0.001). Binary logistic regression analysis indicated that a diverticulum size >1.95 cm, CBD size >0.69 cm, PD size >0.20 cm, and the presence of diverticular neck swelling were predictors significantly associated with HRPAD, yielding an area under the curve (AUC) of 0.848; meanwhile, the AUC of the external validation cohort was 0.829.
Patients with HRPAD and those with N-HRPAD exhibited different clinical and imaging characteristics. A thorough understanding of these differences may facilitate early identification of HRPAD and timely treatment interventions, which would reduce complications related to biliary-pancreatic diseases.
壶腹周围憩室（PAD）是十二指肠黏膜常见的后天性腔外膨出，临床常被忽视。当并发胆胰结石或炎症时，PAD可能导致严重的胆胰并发症。尽管目前内镜逆行胰胆管造影（ERCP）被视为PAD诊断的金标准，但其侵入性及其他局限性使得计算机断层扫描（CT）越来越被优先用作一线成像方式。然而，对于定义为与胆石症和胆胰炎症相关的高危PAD（HRPAD），其影像学特征与临床表现之间的相关性仍不明确。因此，本研究旨在探讨HRPAD的临床和CT特征。
回顾性分析2018年1月至2024年5月期间接受腹部增强CT扫描的260例HRPAD患者和288例非高危PAD（N-HRPAD）患者的数据。比较两组的临床和CT特征。通过二元逻辑回归分析确定诊断HRPAD的独立因素。此外，使用来自另一个中心的150例患者组成的外部验证队列来测试该模型的预测效率。
HRPAD患者的年龄显著高于N-HRPAD患者，平均年龄分别为72±10岁和68±11岁（P<0.001）。此外，他们表现出较大憩室（>1.95 cm：65.38% 对22.57%）、较大胆总管（CBD）尺寸（>0.69 cm：72.31% 对20.83%）和较大胰管（PD）扩张（>0.20 cm：86.92% 对60.42%）的比例更高（所有P值<0.001）。此外，HRPAD组憩室颈部肿胀的患病率高于对照组（23.08% 对4.86%；P<0.001）。二元逻辑回归分析表明，憩室大小>1.95 cm、CBD大小>0.69 cm、PD大小>0.20 cm以及憩室颈部肿胀的存在是与HRPAD显著相关的预测因素，曲线下面积（AUC）为0.848；同时，外部验证队列的AUC为0.829。
HRPAD患者和N-HRPAD患者表现出不同的临床和影像学特征。深入了解这些差异可能有助于早期识别HRPAD并及时进行治疗干预，从而减少与胆胰疾病相关的并发症。
