title: Imaging features of benign and malignant ampullary and periampullary lesions.
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.
authors.affiliation: From the Department of Radiology, Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine, 676 N Saint Clair St, Suite 800, Chicago, IL 60611 (P.N., N.A.H., K.D., V.Y., C.G.W., D.S.M., C.B.H., J.M.H., S.M.B., F.H.M.); and Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC (M.T.T.).
authors.forename: Paul
authors.initials: P
authors.lastname: Nikolaidis
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Hammond
authors.forename: Kevin
authors.initials: K
authors.lastname: Day
authors.forename: Vahid
authors.initials: V
authors.lastname: Yaghmai
authors.forename: Cecil G
authors.initials: CG
authors.lastname: Wood
authors.forename: David S
authors.initials: DS
authors.lastname: Mosbach
authors.forename: Carla B
authors.initials: CB
authors.lastname: Harmath
authors.forename: Myles T
authors.initials: MT
authors.lastname: Taffel
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Horowitz
authors.forename: Senta M
authors.initials: SM
authors.lastname: Berggruen
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
mesh_terms: D014670:Ampulla of Vater / Q000000981:diagnostic imaging / Q000473:pathology*; D001650:Bile Duct Neoplasms / Q000175:diagnosis*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000473:pathology; D003137:Common Bile Duct Diseases / Q000175:diagnosis*; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging; D014463:Ultrasonography