Carcinoma of the pancreatic head area. Diagnostic imaging. Direct cholangiography: PTC.

The use of Chiba needle and a carefully performed procedure make percutaneous transhepatic cholangiography (PTC) highly diagnostic, with a low incidence of complications. However, because of their anatomy, visualization of pancreatic ducts, mandatory for an accurate diagnostic approach to the carcinomas of the pancreatic head area is impossible and thus this limits the diagnostic indications for PTC. At present it is performed in case of failure of endoscopic retrograde cholangiography (ERCP) or in view of interventional maneuvers. In carcinomas of the pancreatic head area PTC pattern is characterized by a more or less tight stenosis of the distal common bile duct with upward dilatation of biliary tree. The morphological features, the site and extent of stenosis usually permit a differential diagnosis between malignancies and benign forms (pancreatitis) while for definitive differentiation of cholangiocarcinoma from carcinoma of the pancreatic head infiltrating the common bile duct or from ampullary carcinoma, PTC should be combined with other imaging procedures.