Imaging features of benign and malignant ampullary and periampullary lesions

Paul Nikolaidis*, Nancy A. Hammond, Kevin Day, Yaghmai Vahid, Cecil G. Wood, David S. Mosbach, Carla B. Harmath, Myles T. Taffel, Jeanne M. Horowitz, Senta M. Berggruen, Frank H. Miller

*Corresponding author for this work

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)624-641
Number of pages18
JournalRadiographics
Volume34
Issue number3
DOIs
StatePublished - Jan 1 2014

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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