title: Systematic evaluation of radiological findings in the assessment of resectability of peri-ampullary cancer by CT using different contrast phase protocols.
abstract: OBJECTIVE
  To determine the relative significance of radiological signs in determining the resectability of peri-ampullary cancer (PC) and to assess the value of multi-phase imaging in detecting these findings.
  
  
  METHODS
  Blinded, double re-reporting of preoperative imaging from five hospitals was undertaken of 411 patients undergoing surgery for PC over an 8-year period, of whom 119 patients were found to be inoperable at the time of surgery.
  
  
  RESULTS
  The median tumour size was 26.7 mm and the proportion of patients reported to have regional lymphadenopathy (RL), venous (VI) and arterial involvement (AI) was 24.7%, 11.5%, and 3.9%, respectively and was similar regardless of the number of contrast phases undertaken. Significant associations were, however, noted between individual risk factors: VI was closely associated with tumour size (p=0.002) and AI (p<0.0001). In multivariate analysis AI, VI, and RL were independently associated with resectability (relative risk of resection=0.05, 0.31, and 0.51, respectively). Tumour size, however, was not associated with resectability when VI was included in the multivariate model.
  
  
  CONCLUSIONS
  The use of multiple vascular contrast phases has no measureable impact on the rate of determination of tumour resectability of PC. In preoperative staging, AI is the most significant adverse finding for resectability. Large tumour diameter is not an adverse finding in isolation from other risk factors.
authors.affiliation: Peninsula HPB Unit, Derriford Hospital, Plymouth PL6 8DH, UK; Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth PL6 8BU, UK.
authors.forename: B
authors.initials: B
authors.lastname: Amr
authors.affiliation: Peninsula Radiology Academy, Plymouth International Business Park, Plymouth PL6 5WR, UK.
authors.forename: G
authors.initials: G
authors.lastname: Miles
authors.affiliation: School of Science and Technology, Nottingham Trent University, Nottingham NG1 4BU, UK.
authors.forename: G
authors.initials: G
authors.lastname: Shahtahmassebi
authors.affiliation: Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth PL6 8BU, UK; Peninsula Radiology Academy, Plymouth International Business Park, Plymouth PL6 5WR, UK. Electronic address: Carl.roobottom@nhs.net.
authors.forename: C
authors.initials: C
authors.lastname: Roobottom
authors.affiliation: Peninsula HPB Unit, Derriford Hospital, Plymouth PL6 8DH, UK; Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth PL6 8BU, UK.
authors.forename: D A
authors.initials: DA
authors.lastname: Stell
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D002985:Clinical Protocols; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*