Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Differentiation of Adenomyoma from Localized Adenocarcinoma of the Ampulla of Vater Using Multidetector CT

다중 검출 전산화단층촬영 영상에서 바터 팽대부의 샘근종과 국소적 샘암종의 감별

  • Yeongtae Park (Department of Radiology, Chungbuk National University Hospital) ;
  • Jisun Lee (Department of Radiology, Chungbuk National University Hospital) ;
  • Yook Kim (Department of Radiology, Chungbuk National University Hospital) ;
  • Bum Sang Cho (Department of Radiology, Chungbuk National University Hospital) ;
  • Kil Sun Park (Department of Radiology, Chungbuk National University Hospital) ;
  • Chang Gok Woo (Department of Pathology, Chungbuk National University Hospital)
  • 박영태 (충북대학교병원 영상의학과) ;
  • 이지선 (충북대학교병원 영상의학과) ;
  • 김육 (충북대학교병원 영상의학과) ;
  • 조범상 (충북대학교병원 영상의학과) ;
  • 박길선 (충북대학교병원 영상의학과) ;
  • 우창곡 (충북대학교병원 병리과)
  • Received : 2020.03.30
  • Accepted : 2020.06.11
  • Published : 2021.03.01
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Abstract

Purpose To determine the multidetector CT (MDCT) findings that differentiate adenomyoma of the ampulla of Vater (AOV) from localized adenocarcinoma of the AOV. Materials and Methods Sixteen and 30 patients with adenomyoma and localized adenocarcinoma of the AOV, respectively, were evaluated using MDCT. We analyzed the size and attenuation value and presence of uniform enhancement of the lesions, diameters of the extrahepatic bile duct (EHD) and main pancreatic duct, presence of regional lymph node enlargement, and laboratory findings. We determined the independent findings for differentiating adenomyoma from localized adenocarcinoma of the AOV using multivariate analysis. Results The size of the lesion and diameter of the EHD were significantly smaller for adenomyoma than those for localized adenocarcinoma of the AOV (all p < 0.001). In multivariate analyses, a lesion size of ≤ 1.3 cm, an EHD diameter of ≤ 1.3 cm, and an alanine transaminase level of ≤ 31 IU/L significantly differentiated adenomyoma from localized adenocarcinoma of the AOV. When all of these three findings were met, the specificity for adenomyoma of the AOV was 93.3%. Conclusion MDCT imaging may facilitate the differential diagnosis of adenomyoma and localized adenocarcinoma of the AOV based on the size of the lesion and diameter of the EHD.

목적 다중 검출 전산화단층촬영(multidetector CT; 이하 MDCT) 영상에서 바터 팽대부의 샘근종과 국소 샘암종을 감별할 수 있는 영상 소견을 알아보고자 하였다. 대상과 방법 MDCT 영상을 이용하여 바터 팽대부의 샘근종이 있는 16명의 환자와 국소 샘암종이 있는 30명의 환자를 평가하였다. 우리는 병변의 크기와 감쇠정도, 병변의 균일한 조영 증강의 여부, 간외담관과 주췌관의 직경, 국소 림프절 종대 유무를 측정하였고, 혈액검사 결과도 분석하였다. 바터 팽대부의 국소 샘암종과 비교하여 샘근종을 시사하는 독립적 소견을 확인하기 위해 다변량 분석을 수행하였다. 결과 병변의 크기와 간외담관의 직경은 샘근종에서 국소 샘암종군보다 유의하게 작았다(all p < 0.001). 다변량 분석에서 병변의 크기가 1.3 cm보다 작은 것, 간외담관의 작경이 1.3 cm 보다 작은 것, alanine transaminase level이 31보다 낮은 소견은 바터 팽대부의 국소 샘암종과 비교하여 샘근종을 시사하는 통계적으로 의미 있는 독립적 소견으로 나타났다. 이러한 세 소견을 모두 만족하는 경우 바터 팽대부에 생긴 샘근종의 진단적 특이도는 93.3%였다. 결론 MDCT 영상에서 병변의 크기와 간외담관의 직경을 측정하여 바터 팽대부의 샘근종과 국소 샘암종의 감별에 도움을 받을 수 있다.

Keywords

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