Role of Multidetector CT in Preoperative Evaluation of Periampullary Neoplasms

Abstract

Background: The phrase "periampullary tumours" refers to tumours that arise in the periampullary area, which is 2cm around the   ampulla of Vater and comprises the pancreas, duodenum, common bile duct distal section and ampulla of Vater. Using the proper  staging procedures is critical for properly identifying patients who may benefit from major surgical interventions. One useful test is Multi- Detector Computed Tomography (MDCT), which provides precise diagnosis, staging, operability evaluation and postoperative follow-up.  The most significant surgical step is the first assessment of tumours to identify resectable masses from those with growing vascular  encasement.

Objective: This study aimed to evaluate the preoperative resectability of periampullary tumors using MDCT accuracy in  comparison to operative data.

Materials and Methods: A cross sectional study comprised 40 individuals with suspected periampullary malignancies (27 men and 13 women). Using a contrast-enhanced pancreatic protocol, we performed 128-slice MDCT of abdomen on the  patients. The intraoperative results and the preoperative CT were evaluated for diagnostic accuracy regarding the vascular involvement  of the tumor and the resectability of masses.

Results: Forty individuals with periampullary cancer were enrolled in the research between  January 2022 and June 2023. Five of them were deemed incurable as follows three cases of substantial vascular invasion shown on the CT scans, one case of invasion of surrounding organs and hepatic metastasis, and one case of hepatic metastasis. Following the surgical  procedure, 70% of the cases were resectable overall. With a 75% diagnostic accuracy, the sensitivity and specificity of MDCT for tumor  resectability were 90% and 22% respectively. By using MDCT, vascular invasion could be identified with a sensitivity of 56% and specificity  of 100%.

Conclusion: When evaluating periampullary carcinomas preoperatively, MDCT has a high sensitivity but a low specificity. The  low precision of the CT scan in identifying vascular invasion is the cause of the poor specificity.