Radiologic Reevaluation of the ampulla of Vater cancer

To evaluate the radiographic characteristics of the ampulla of Vater cancer. The authors analyzed retrospectively the US(n=25) and CT(n=15) findings in 25 cases of ampulla of Vater cancer, with emphasis on the potential of CT and US in regard to the detectability of the mass. ERCP(n=15) and hypotonic duodenography(n=5) were also evaluated for the configuration of obstructed duct. The tumor was detected on sonography in only 12 cases(48%) as a small, relatively well delineated mass with slightly low echogenicity to the pancreas. The tumor was shown by CT in 8 cases(53%) as a well delineated mass protruding into the second portion of duodenal lumen with slightly low attenuation to the pancreas. CBD was dilated in 25 cases(100%), but pancreatic duct was dilated in 15 cases(60%). Obstructed end of CBD was nipple shaped in 7 cases(47%), clubbed in 3, flat in 3, and indistrict in 2 by ERCP. Hypotonic duodenogram showed irregular filling defect in the medial wall of second portion of the duodenum in 5 cases(100%). Mass detection rate cursing US or CT were not high in ampulla of Vater cancer. Except for a CT finding of small mass protruding into the regional duodenal lumen, other findings were nonspecific. Therefore, additional studies or more aggressive approach should be attempted for a correct diagnosis