64 Sllce Spiral CT Evaluation Of The Anatomy And Pathology Of The Duodenal Papilla.

Objective: to evaluate 64 slice spiral CT of normal duodenal papilla and its lesions.Materials and methods: a retrospective analysis of 53 cases of normal human papilla and 29 cases of lesions of the duodenal papilla imaged by 64 slice spiral CT was done and the size and shape and the enhancement of normal and abnormal duodenal papilla were compared and analysed.Results:1. The maximum diameter of the duodenal papilla was 5.67±1.60 mm, the maximum Anteroposterior diameter was 7.54±1.84 mm;the maximum anteroposterior diameter of normal duodenal papilla between male group and female group had no significant difference (P>0.05).2. With reference to endoscopic morphology and CT imaging the duodenal anatomy shape is divided into semicircular (58.3%), oval (13.3%), flat type (8%) and unclassified (20%).3.According to the CT-attenuation value of contrast enhancement in the normal duodenal papilla every phase, the enhancement pattern of the normal duodenal papilla is divided into crescendo, peak, decrescendo, unclassified. Statistical evaluation of contrast enhancement studies ( including crescendo, peak and decrescendo type ) showed that in the normal duodenal papilla arterial phase statistically significant difference was seen in the enhancement and the peak values between the various groups(P = 0.04,P < 0.05); significant difference was seen amongst various groups during the delayed phase of contrast enhancement(P = 0.012,P < 0.05);4.The duodenal anatomy shape is divided into semicircular , oval and flat type, Statistical evaluation of contrast enhancement studies showed that during the venous phase of contrast enhancement of the normal duodenal papilla significant difference was seen between the semicircular shape and flat shape groups(P = 0.038);. 5. There was a significant difference between the maximal diameters of duodenal papilla of the normal group and the diseased group (P<0.05). The maximum diameter of duodenal papilla carcinomas and the maximum diameter of duodenal papilla adenomas had no significant difference (P =0.43,P>0.05).6. The papilla shape of the duodenal papilla carcinomas (11 cases) and the duodenal papilla adenomas(4 cases) display circular, the papilla shape of the duodenal papilla carcinomas (7cases) and the duodenal papilla adenomas(1 cases) display difform.;7. Statistical evaluation of contrast enhancement studies ( including duodenal papilla carcinomas, duodenal papilla adenomas, duodenal papillitis , duodenal papilla polypus) showed that various groups had no significant difference amongst various groups(P =0.103) ; Statistical evaluation of contrast enhancement studies of the duodenal papilla affection and the normal duodenal papilla had no significant difference(P = 0.073,F=2.251).8. The enhancement pattern of papillary mass was homogeneous in 15 patients with duodenal papilla carcinomas and homogeneous in 3 patients with duodenal papilla adenomas。Conclusion(1) The measured maximum diameter of normal duodenal papilla was 5.67±1.60 mm, the maximum anteroposterior diameter was 7.54±1.84 mm.(2) With reference to endoscopic morphology and CT imaging the duodenal anatomy shape is divided into semicircular (58.3%), oval (13.3%), flat type (8%) and unclassified (20%);(3) According to the CT-attenuation value of contrast enhancement in the normal duodenal papilla every phase, the enhancement pattern of the normal duodenal papilla is divided into crescendo, peak, decrescendo; the benign and the malignant of duodenum papilla lesions could not be judge only according to the diameter of the duodenal papilla ; (4) The crescendo, the peak and the decrescendo are relevant to the structure of the normal duodenal papilla ; The enhancement pattern of the normal duodenal papilla could not be pretest only according to shape of duodenal papilla ;(5) the diameter of the duodenal papilla exceeds the upper limit of normal could be indicative of abnormalities; the benign and the malignant of duodenum papilla lesions could not be judge only according to the diameter of the duodenal papilla ;(6) The papillary carcinomas and duodenal papillary adenomas could not be judge only according to the shape of the duodenal papilla ;(7) the benign and the malignant of duodenal papilla could not be judge only according to of the enhancement pattern ;(8) Duodenal papilla mass was homogeneous during contrast enhancement, the malignant of duodenal papilla could not be excluable.