Assessment of anomalous pancreaticobiliary ductal junction with high-resolution multiplanar reformatted images in MDCT.
OBJECTIVE
The objective of our study was to assess the capabilities of MDCT for the diagnosis of an anomalous pancreaticobiliary ductal junction using high-resolution multiplanar reformatted (multiplanar reconstruction) images.


METHODS
This study included nine patients with and 54 without an anomalous pancreaticobiliary ductal junction confirmed on direct cholangiopancreatography. Multiplanar reconstruction images with 0.5-mm continuous slices were generated from isotropic or nearly isotropic pancreatic phase images. By mainly interpreting the multiplanar reconstruction images using the Scrolling mode, two blinded reviewers independently determined whether the confluence of the pancreatic and biliary ducts joined in the pancreatic parenchyma (in other words, outside the duodenal wall). The results were correlated with the findings of direct cholangiopancreatography. The diagnostic capabilities of CT for revealing associated pancreatobiliary diseases were assessed in patients with this anomaly.


RESULTS
Interobserver agreement in the classification of the duct confluence was high (kappa = 0.804). The duct confluence was identified in all patients except four without an anomalous pancreaticobiliary ductal junction. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT for diagnosing an anomalous pancreaticobiliary ductal junction were 100% (9 of 9 patients), 87% (47 of 54 patients), 89% (56 of 63 patients), 75% (9 of 12 patients), and 100% (47 of 47 patients) in the final decisions, respectively. CT showed all associated pancreatobiliary diseases except bile duct stones in two patients.


CONCLUSIONS
MDCT enabled the diagnosis of an anomalous pancreaticobiliary ductal junction by showing whether the pancreatic and biliary ducts join within the pancreatic parenchyma on high-resolution multiplanar reconstruction images.
Itoh
Shigeki
S
Department of Technical Radiology, Nagoya University School of Health Sciences, Nagoya, Aichi 461-8673, Japan. shigeito@met.nagoya-u.ac.jp
Fukushima
Hiromichi
H
Takada
Akira
A
Suzuki
Kojiro
K
Satake
Hiroko
H
Ishigaki
Takeo
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010183:Pancreatic Ducts / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods