1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea 2Department of Diagnostic Radiology, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
Corresponding author:
Jae Bock Chung,
ABSTRACT
Endoscopic retrograde cholangiopancreatography(ERCP) is the most useful method of diagnosis in duodenal papillary cancer. There are two morphological features in duodenal papillary cancer. Exophytic tumors can be diagnosed with the use of forceps or snare biopsies, and intra-papillary tumors can be detected by ERCP and confirmed by intraductal brush cytology. ERCP has diagnostic limitations when cannulation of the bile duct is not possible or when confirmation of duodenal papillary cancer is difficult in cases of normal duodenal mucosa. Although ERCP is generally considered a safe procedure, it has a morbidity and mortality of 7% and 1%, respectively. This is why a noninvasive method is needed in order to substitute the role of diagnostic ERCP. Magnetic resonance cholangiopancreatography (MRCP) is a relatively new imaging technique for the evaluation of the pancreaticobiliary tract. Projectional images, similar in appearance to ERCP, are obtained without administration of any oral or intravenous contrast agents. MRCP has a diagnostic accuracy comparable to that of ERCP for most of the pancreaticobiliary diseases, but duodenal papillary cancer remains a challenge for this imaging tool. Previous study on the diagnostic accuracy of MRCP in duodenal papillary cancer reported that it confirmed only 2 out of 6 cases, but recent technical advances have optimized the image. Therefore, further studies on the advanced quality is needed in the future. We report 2 cases of duodenal papillary cancer with polypoid protrusion correctly diagnosed as MRCP.
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