**4. Differential diagnosis**

The vaterian ampulloma is a neoplastic entity with precise diagnostic elements, which reduces the list of possible differential diagnoses.

By anatomical topography, the only possible differential diagnoses are pancreatic neoplasm and duodenal malignancy.

For both diagnoses the role of CT and MRI is defined.

Pancreatic head neoplasm:

With the help of CT, but especially MRI, it is established from the beginning the location of the tumor mass, the size, the changes in structure, and the contrast of the pancreatic cephalic tumor mass. MRCP contributes to the analysis of changes in the biliary tree and duct of Wirsung, specific to pancreatic cephalic neoplasm.

Diagnostic elements from conventional radiological examination are not practically discussed.

**97**

**Author details**

Bucharest, Romania

Ana Magdalena Bratu1,2 and Constantin Zaharia1,2\*

\*Address all correspondence to<EMAIL_ADDRESS>
provided the original work is properly cited.

1 Department of Radiology and Medical Imaging, "Colţea" Clinical Hospital,

2 "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Radioimaging Diagnosis of Vaterian Ampulloma: Technique, Semiology, and Differential…*

Historically, there were conventional radiological signs, most of them indirect,

Basically, the real differential diagnosis is made using CT/MRI examination.

CT computed tomography

D2 descending duodenum

IV intravenous

MRI magnetic resonance imaging

MRCP magnetic resonance cholangiopancreatography

ERCP endoscopic retrograde cholangiopancreatography

Malignant duodenal tumors:

duodenal malignancy.

**Abbreviations**

*Radioimaging Diagnosis of Vaterian Ampulloma: Technique, Semiology, and Differential… DOI: http://dx.doi.org/10.5772/intechopen.89948*

Malignant duodenal tumors:

Historically, there were conventional radiological signs, most of them indirect, to suspect a malignant duodenal tumor.

Basically, the real differential diagnosis is made using CT/MRI examination.

Duodenal parietal changes, luminal stenosis, localization, structural analysis, and contrast enhancement are defining elements in establishing the diagnosis of duodenal malignancy.