{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T06:36:06Z","timestamp":1772606166702,"version":"3.50.1"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"1103","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BJR"],"published-print":{"date-parts":[[2019,11]]},"abstract":"Objective:<\/jats:title> Main duct and mixed intraductal papillary mucinous neoplasms (IPMN) are pre-malignant cystic pancreatic neoplasms associated with pancreatic duct dilatation. Distinguishing these from benign causes of pancreatic duct dilatation is important in order to allow appropriate surveillance or surgery. A patulous duodenal papilla with extrusion of mucus at endoscopic evaluation, the endoscopic fish mouth ampulla (E-FMA) sign, is reported in main duct and mixed IPMN. We aimed to establish whether a CT correlate (CT-FMA) of this sign exists and whether this was associated with the presence of invasion or high-grade dysplasia. We defined the CT-FMA sign as an uninterrupted column of water attenuation material running from the pancreatic duct to the duodenal lumen. <\/jats:p><\/jats:sec>Methods:<\/jats:title> A retrospective, blinded review of 44 patients with histologically confirmed IPMN and 87 age-matched controls with pancreatic duct dilatation on CT was undertaken. A case\u2013control series matched for the degree of pancreatic duct dilatation was used to compare the rates of invasion or high-grade dysplasia between main duct and mixed IPMN patients, with and without a CT-FMA sign. <\/jats:p><\/jats:sec>Results:<\/jats:title> The CT-FMA sign could be identified in 18.5% patients with main duct\/mixed IPMN with specificity 100%, positive predictive value 100% and negative predictive value 79.8%. A significant association was found between CT-FMA in main duct\/mixed IPMN compared to controls, but not with the presence of high-grade dysplasia or invasion. <\/jats:p><\/jats:sec>Conclusions:<\/jats:title> The CT-FMA sign is a newly reported, highly specific sign of MD and mixed IPMN. <\/jats:p><\/jats:sec>Advances in knowledge:<\/jats:title> If a fish mouth ampulla is identified at CT, a diagnosis of main duct or mixed IPMN is highly likely. <\/jats:p><\/jats:sec>","DOI":"10.1259\/bjr.20190461","type":"journal-article","created":{"date-parts":[[2019,8,20]],"date-time":"2019-08-20T17:07:22Z","timestamp":1566320842000},"page":"20190461","source":"Crossref","is-referenced-by-count":9,"title":["The CT fish mouth ampulla sign: a highly specific finding in main duct and mixed intraductal papillary mucinous neoplasms"],"prefix":"10.1093","volume":"92","author":[{"given":"Ting Ting","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Radiology, Brighton and Sussex University Hospitals, Brighton, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy J","family":"Sadler","sequence":"additional","affiliation":[{"name":"Department of Radiology, Royal Papworth Hospital, Cambridge, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siobhan","family":"Whitley","sequence":"additional","affiliation":[{"name":"Department of Radiology, West Suffolk Hospital, Bury St Edmunds, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Brais","sequence":"additional","affiliation":[{"name":"Department of Pathology, Cambridge University Hospitals, Cambridge, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edmund","family":"Godfrey","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cambridge University Hospitals, Cambridge, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","reference":[{"key":"b1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-61024-0"},{"key":"b2","doi-asserted-by":"publisher","DOI":"10.5009\/gnl15063"},{"key":"b3","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2013.02.010"},{"key":"b4","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318155a9e5"},{"key":"b5","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2017.07.007"},{"key":"b6","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v13.i11.1701"},{"key":"b7","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000124386.54496.15"},{"key":"b8","first-page":"73","volume":"26","author":"Beintaris I","year":"2013","journal-title":"Ann Gastroenterol"},{"key":"b9","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.165.1.3306789"},{"key":"b10","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.174.2.1740441"},{"key":"b11","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2012.03.682"},{"key":"b12","doi-asserted-by":"publisher","DOI":"10.1148\/radiographics.19.6.g99no011447"},{"key":"b13","doi-asserted-by":"publisher","DOI":"10.1148\/radiographics.21.2.g01mr01323"},{"key":"b14","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.17.17963"},{"key":"b15","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2012.04.004"}],"container-title":["The British Journal of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.birpublications.org\/doi\/pdf\/10.1259\/bjr.20190461","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T16:36:11Z","timestamp":1705077371000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjr\/article\/7477742"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11]]},"references-count":15,"journal-issue":{"issue":"1103","published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1259\/bjr.20190461"],"URL":"https:\/\/doi.org\/10.1259\/bjr.20190461","relation":{},"ISSN":["0007-1285","1748-880X"],"issn-type":[{"value":"0007-1285","type":"print"},{"value":"1748-880X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11]]}}}