RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0041-1726663
Imaging of Ampullary and Periampullary Conditions
![](https://www.thieme-connect.de/media/10.1055-s-00043197/202103/lookinside/thumbnails/10-1055-s-0041-1726663-1.jpg)
Abstract
The ampulla of Vater is formed by the union of the pancreatic duct and the common bile duct and is also known as hepatopancreatic ampulla or hepatopancreatic duct. The ampulla is surrounded by a muscular valve known as the sphincter of Oddi, which controls the flow of bile and pancreatic juices into the duodenum in response to food. The ampulla is also an important embryological landmark as it marks the anatomical transition from foregut to the midgut. Because of this, it is a watershed zone where the blood supply changes from the celiac axis to the superior mesenteric artery. Radiologic evaluation of the ampulla and the periampullary region is challenging because it requires an understanding of the embryology, the normal appearance, and different anatomic variants. Also, a wide variety of pathologies can occur in this region. The purpose of this review is to present the normal anatomy of the ampulla and the periampullary region on different imaging modalities and to summarize the imaging features of the common variants, and benign and malignant ampullary and periampullary conditions. Understanding of the normal anatomical appearance and variants along with the knowledge of common pathologic conditions affecting the ampulla and periampullary conditions can help radiologists in making accurate diagnosis resulting in optimum patient care.
Publikationsverlauf
Artikel online veröffentlicht:
05. Mai 2021
© 2021. Indian Society of Gastrointestinal and Abdominal Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Nikolaidis P, Hammond NA, Day K. et al Imaging features of benign and malignant ampullary and periampullary lesions. Radiographics 2014; 34 (03) 624-641
- 2 Frierson Jr HF. The gross anatomy and histology of the gallbladder, extrahepatic bile ducts, Vaterian system, and minor papilla. Am J Surg Pathol 1989; 13 (02) 146-162
- 3 Russu IG, Vaida A. [New findings on the development of the pancreas]. Acta Anat (Basel) 1959; 38: 114-125
- 4 Tadokoro H, Takase M, Nobukawa B. Development and congenital anomalies of the pancreas. Anat Res Int 2011; 2011: 351217
- 5 Rizzo RJ, Szucs RA, Turner MA. Congenital abnormalities of the pancreas and biliary tree in adults. Radiographics 1995; 15 (01) 49-68 , quiz 147–148
- 6 Henry BM, Skinningsrud B, Saganiak K, Pękala PA, Walocha JA, Tomaszewski KA. Development of the human pancreas and its vasculature - an integrated review covering anatomical, embryological, histological, and molecular aspects. Ann Anat 2019; 221: 115-124
- 7 Horiguchi S, Kamisawa T. Major duodenal papilla and its normal anatomy. Dig Surg 2010; 27 (02) 90-93
- 8 Alessandrino F, Ivanovic AM, Yee EU, Radulovic D, Souza D, Mortele KJ. MDCT and MRI of the ampulla of Vater. Part I: technique optimization, normal anatomy, and epithelial neoplasms. Abdom Imaging 2015; 40 (08) 3274-3291
- 9 Mirilas P, Colborn GL, Skandalakis LJ, Skandalakis PN, Zoras O, Skandalakis JE. Benign anatomical mistakes: “ampulla of Vater” and “papilla of Vater”. Am Surg 2005; 71 (03) 269-274
- 10 Sun CH, Li X, Chan T. et al Multidetector computed tomography (MDCT) manifestations of the normal duodenal papilla. Eur J Radiol 2013; 82 (06) 918-922
- 11 Suda K. Histopathology of the minor duodenal papilla. Dig Surg 2010; 27 (02) 137-139
- 12 Kim TU, Kim S, Lee JW. et al Ampulla of Vater: comprehensive anatomy, MR imaging of pathologic conditions, and correlation with endoscopy. Eur J Radiol 2008; 66 (01) 48-64
- 13 Quencer K, Kambadakone A, Sahani D, Guimaraes AS. Imaging of the pancreas: part 1. Appl Radiol 2013; 42 (09) 14-20
- 14 Saran S, Malik S, Kharbanda A, Sharma Y. Pneumobilia with multiple air-fluid levels on abdominal radiography: a clincher. Ann Afr Med 2019; 18 (02) 115-116
- 15 Hope JW, Gibbons JF. Duodenal obstruction due to annular pancreas; with a differential diagnosis of other congenital lesions producing duodenal obstruction. Radiology 1954; 63 (04) 473-490
- 16 Ashida R, Tanaka S, Yamanaka H. et al The role of transabdominal ultrasound in the diagnosis of early stage pancreatic cancer: review and single-center experience. Diagnostics (Basel) 2018; 9 (01) 2
- 17 Kanno A, Masamune A, Hanada K. et al Japan Study Group on the Early Detection of Pancreatic Cancer (JEDPAC). Multicenter study of early pancreatic cancer in Japan. Pancreatology 2018; 18 (01) 61-67
- 18 Gandolfi L, Torresan F, Solmi L, Puccetti A. The role of ultrasound in biliary and pancreatic diseases. Eur J Ultrasound 2003; 16 (03) 141-159
- 19 Tse F, Barkun JS, Romagnuolo J, Friedman G, Bornstein JD, Barkun AN. Nonoperative imaging techniques in suspected biliary tract obstruction. HPB (Oxford) 2006; 8 (06) 409-425
- 20 Albrecht T, Hohmann J, Oldenburg A, Skrok J, Wolf KJ. Detection and characterisation of liver metastases. Eur Radiol 2004; 14 (Suppl. 08) 25-33
- 21 Patel NB, Oto A, Thomas S. Multidetector CT of emergent biliary pathologic conditions. Radiographics 2013; 33 (07) 1867-1888
- 22 Nino-Murcia M, Jeffrey Jr RB, Beaulieu CF, Li KCP, Rubin GD. Multidetector CT of the pancreas and bile duct system: value of curved planar reformations. AJR Am J Roentgenol 2001; 176 (03) 689-693
- 23 Zaky AM, Wolfgang CL, Weiss MJ, Javed AA, Fishman EK, Zaheer A. Tumor-vessel relationships in pancreatic ductal adenocarcinoma at multidetector CT: different classification systems and their influence on treatment planning. Radiographics 2017; 37 (01) 93-112
- 24 Luna A, Pahwa S, Bonini C, Alcalá-Mata L, Wright KL, Gulani V. Multiparametric MR imaging in abdominal malignancies. Magn Reson Imaging Clin N Am 2016; 24 (01) 157-186
- 25 Yeh BM, Liu PS, Soto JA, Corvera CA, Hussain HKMR. MR imaging and CT of the biliary tract. Radiographics 2009; 29 (06) 1669-1688
- 26 Zhang J, Israel GM, Hecht EM, Krinsky GA, Babb JS, Lee VS. Isotropic 3D T2-weighted MR cholangiopancreatography with parallel imaging: feasibility study. AJR Am J Roentgenol 2006; 187 (06) 1564-1570
- 27 Riff BP, Chandrasekhara V. The role of endoscopic retrograde cholangiopancreatography in management of pancreatic diseases. Gastroenterol Clin North Am 2016; 45 (01) 45-65
- 28 Canlas KR, Branch MS. Role of endoscopic retrograde cholangiopancreatography in acute pancreatitis. World J Gastroenterol 2007; 13 (47) 6314-6320
- 29 Săftoiu A, Vilmann P. Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer. J Clin Ultrasound 2009; 37 (01) 1-17
- 30 Yoshida T, Yamashita Y, Kitano M. Endoscopic ultrasound for early diagnosis of pancreatic cancer. Diagnostics (Basel) 2019; 9 (03) 81
- 31 Harima H, Kaino S, Shinoda S, Kawano M, Suenaga S, Sakaida I. Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrast-enhanced endoscopic ultrasonography. World J Gastroenterol 2015; 21 (20) 6252-6260
- 32 Alessandrino F, Souza D, Ivanovic AM, Radulovic D, Yee EU, Mortele KJ. MDCT and MRI of the ampulla of Vater. Part II: non-epithelial neoplasms, benign ampullary disorders, and pitfalls. Abdom Imaging 2015; 40 (08) 3292-3312
- 33 Karayiannakis AJ, Bolanaki H, Courcoutsakis N. et al Common bile duct obstruction secondary to a periampullary diverticulum. Case Rep Gastroenterol 2012; 6 (02) 523-529
- 34 Buse PE, Edmundowicz SA. Proximal common bile duct obstruction secondary to a periampullary duodenal diverticulum: successful treatment with endoscopic stenting. Gastrointest Endosc 1991; 37 (06) 635-637
- 35 Wu SD, Su Y, Fan Y. et al Relationship between intraduodenal peri-ampullary diverticulum and biliary disease in 178 patients undergoing ERCP. Hepatobiliary Pancreat Dis Int 2007; 6 (03) 299-302
- 36 Zoepf T, Zoepf DS, Arnold JC, Benz C, Riemann JF. The relationship between juxtapapillary duodenal diverticula and disorders of the biliopancreatic system: analysis of 350 patients. Gastrointest Endosc 2001; 54 (01) 56-61
- 37 Yoneyama F, Miyata K, Ohta H, Takeuchi E, Yamada T, Kobayashi Y. Excision of a juxtapapillary duodenal diverticulum causing biliary obstruction: report of three cases. J Hepatobiliary Pancreat Surg 2004; 11 (01) 69-72
- 38 Anand V, Provost J, Bakr M. et al Two cases of intraluminal “windsock” diverticula resulting in partial duodenal obstruction. ACG Case Rep J 2016; 3 (04) e135
- 39 Fidler JL, Saigh JA, Thompson JS, Habbe TG. Demonstration of intraluminal duodenal diverticulum by computed tomography. Abdom Imaging 1998; 23 (01) 38-39
- 40 Jayaraman MV, Mayo-Smith WW, Movson JS, Dupuy DE, Wallach MT. CT of the duodenum: an overlooked segment gets its due. Radiographics 2001; 21 (Spec No) S147-S160
- 41 Veldkamp MC, Rauws EA, Dijkgraaf MG, Fockens P, Bruno MJ. Iatrogenic ampullary stenosis: history, endoscopic management, and outcome in a series of 49 patients. Gastrointest Endosc 2007; 66 (04) 708-716 , quiz 768, 770
- 42 Aisen AM, Sherman S, Jennings SG. et al Comparison of secretin-stimulated magnetic resonance pancreatography and manometry results in patients with suspected sphincter of Oddi dysfunction. Acad Radiol 2008; 15 (05) 601-609
- 43 Urushihara N, Hamada Y, Kamisawa T. et al Classification of pancreaticobiliary maljunction and clinical features in children. J Hepatobiliary Pancreat Sci 2017; 24 (08) 449-455
- 44 Kamisawa T, Kuruma S, Chiba K, Tabata T, Koizumi S, Kikuyama M. Biliary carcinogenesis in pancreaticobiliary maljunction. J Gastroenterol 2017; 52 (02) 158-163
- 45 Law R, Topazian M. Diagnosis and treatment of choledochoceles. Clin Gastroenterol Hepatol 2014; 12 (02) 196-203
- 46 Kamisawa T, Ando H, Suyama M, Shimada M, Morine Y, Shimada H. Working Committee of Clinical Practice Guidelines for Pancreaticobiliary Maljunction, Japanese Study Group on Pancreaticobiliary Maljunction. Japanese clinical practice guidelines for pancreaticobiliary maljunction. J Gastroenterol 2012; 47 (07) 731-759
- 47 Kamisawa T, Ando H, Hamada Y. et al Japanese Study Group on Pancreaticobiliary Maljunction. Diagnostic criteria for pancreaticobiliary maljunction 2013. J Hepatobiliary Pancreat Sci 2014; 21 (03) 159-161
- 48 Kamisawa T, Amemiya K, Tu Y. et al Clinical significance of a long common channel. Pancreatology 2002; 2 (02) 122-128
- 49 Ono A, Arizono S, Isoda H, Togashi K. Imaging of pancreaticobiliary maljunction. Radiographics 2020; 40 (02) 378-392
- 50 Yeom SK, Lee SW, Cha SH. et al Biliary reflux detection in anomalous union of the pancreatico-biliary duct patients. World J Gastroenterol 2012; 18 (09) 952-959
- 51 Morine Y, Shimada M, Takamatsu H. et al Clinical features of pancreaticobiliary maljunction: update analysis of 2nd Japan-nationwide survey. J Hepatobiliary Pancreat Sci 2013; 20 (05) 472-480
- 52 Kobayashi M, Hirata N, Nakaji S, Shiratori T, Fujii H, Ishii E. Gastrointestinal stromal tumor of the ampulla of Vater: a case report. World J Gastroenterol 2014; 20 (16) 4817-4821
- 53 Chang S, Lim JH, Choi D, Kim SK, Lee WJ. Differentiation of ampullary tumor from benign papillary stricture by thin-section multidetector CT. Abdom Imaging 2008; 33 (04) 457-462
- 54 Hernandez-Jover D, Pernas JC, Gonzalez-Ceballos S, Lupu I, Monill JM, Pérez C. Pancreatoduodenal junction: review of anatomy and pathologic conditions. J Gastrointest Surg 2011; 15 (07) 1269-1281
- 55 Klein SD, Affronti JP. Pancreas divisum, an evidence-based review: part I, pathophysiology. Gastrointest Endosc 2004; 60 (03) 419-425
- 56 DiMagno MJ, Wamsteker EJ. Pancreas divisum. Curr Gastroenterol Rep 2011; 13 (02) 150-156
- 57 Sandrasegaran K, Patel A, Fogel EL, Zyromski NJ, Pitt HA. Annular pancreas in adults. AJR Am J Roentgenol 2009; 193 (02) 455-460
- 58 Zyromski NJ, Sandoval JA, Pitt HA. et al Annular pancreas: dramatic differences between children and adults. J Am Coll Surg 2008; 206 (05) 1019-1025 , discussion 1025–1027
- 59 Ziegler KM, Zyromski NJ. Choledochoceles: are they choledochal cysts?. Adv Surg 2011; 45: 211-224
- 60 Lee HK, Park SJ, Yi BH, Lee AL, Moon JH, Chang YW. Imaging features of adult choledochal cysts: a pictorial review. Korean J Radiol 2009; 10 (01) 71-80
- 61 Kim S, Lee NK, Lee JW. et al CT evaluation of the bulging papilla with endoscopic correlation. Radiographics 2007; 27 (04) 1023-1038
- 62 Miller FH, Hwang CM, Gabriel H. Goodhartz LA, Omar AJ, Parsons WG III. Contrast-enhanced helical CT of choledocholithiasis. AJR Am J Roentgenol 2003; 181 (01) 125-130
- 63 Raman SP, Salaria SN, Hruban RH, Fishman EK. Groove pancreatitis: spectrum of imaging findings and radiology-pathology correlation. AJR Am J Roentgenol 2013; 201 (01) W29-39
- 64 Triantopoulou C, Dervenis C, Giannakou N, Papailiou J, Prassopoulos P. Groove pancreatitis: a diagnostic challenge. Eur Radiol 2009; 19 (07) 1736-1743
- 65 Kwak SW, Kim S, Lee JW. et al Evaluation of unusual causes of pancreatitis: role of cross-sectional imaging. Eur J Radiol 2009; 71 (02) 296-312
- 66 Castell-Monsalve FJ, Sousa-Martin JM, Carranza-Carranza A. Groove pancreatitis: MRI and pathologic findings. Abdom Imaging 2008; 33 (03) 342-348
- 67 Kim AL, Choi YI. Safety of duodenal ampullectomy for benign periampullary tumors. Ann Hepatobiliary Pancreat Surg 2017; 21 (03) 146-150
- 68 Raman SP, Fishman EK. Abnormalities of the distal common bile duct and ampulla: diagnostic approach and differential diagnosis using multiplanar reformations and 3D imaging. AJR Am J Roentgenol 2014; 203 (01) 17-28
- 69 Chini P, Draganov PV. Diagnosis and management of ampullary adenoma: the expanding role of endoscopy. World J Gastrointest Endosc 2011; 3 (12) 241-247
- 70 Lim JH. Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. AJR Am J Roentgenol 2003; 181 (03) 819-827
- 71 Hennedige TP, Neo WT, Venkatesh SK. Imaging of malignancies of the biliary tract- an update. Cancer Imaging 2014; 14: 14
- 72 Yano F, Hama Y, Abe K, Iwasaki Y, Hatsuse K, Kusano S. Carcinoid tumor of the ampulla of Vater. Magnetic resonance imaging findings. Clin Imaging 2005; 29 (03) 207-210
- 73 Barat M, Dohan A, Dautry R. et al Mass-forming lesions of the duodenum: a pictorial review. Diagn Interv Imaging 2017; 98 (10) 663-675
- 74 Suthar M, Purohit S, Bhargav V, Goyal P. Role of MRCP in differentiation of benign and malignant causes of biliary obstruction. J Clin Diagn Res 2015; 9 (11) TC08-TC12
- 75 Saluja SS, Sharma R, Pal S, Sahni P, Chattopadhyay TK. Differentiation between benign and malignant hilar obstructions using laboratory and radiological investigations: a prospective study. HPB (Oxford) 2007; 9 (05) 373-382
- 76 Katabathina VS, Dasyam AK, Dasyam N, Hosseinzadeh K. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics 2014; 34 (03) 565-586
- 77 Yu X-R, Huang W-Y, Zhang B-Y, Li H-Q, Geng D-Y. Differentiation of infiltrative cholangiocarcinoma from benign common bile duct stricture using three-dimensional dynamic contrast-enhanced MRI with MRCP. Clin Radiol 2014; 69 (06) 567-573
- 78 Kim JY, Lee JM, Han JK. et al Contrast-enhanced MRI combined with MR cholangiopancreatography for the evaluation of patients with biliary strictures: differentiation of malignant from benign bile duct strictures. J Magn Reson Imaging 2007; 26 (02) 304-312