|
1
|
He P, Miao LY, Ge HY, Wang TL, Ye JX, Meng LM, Xue H, Zhang F, Zhao B. Preoperative Tumor Staging of Gastric Cancer: Comparison of Double Contrast-Enhanced Ultrasound and Multidetector Computed Tomography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3203-3209. [PMID: 31115090 DOI: 10.1002/jum.15028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/28/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The purpose of this study was to compare the sensitivity and specificity of double contrast-enhanced ultrasound (CEUS) and multidetector computed tomography (MDCT) in the preoperative tumor staging of gastric cancer (GC) to stratify patients for suitable treatment. METHODS Fifty-four patients with GC proved by histologic findings were included. The sensitivity and specificity of double CEUS and MDCT for tumor staging were calculated and compared. The differences between these methods were evaluated by using the area under the curve (AUC) from a receiver operating characteristic curve analysis. RESULTS There were no significant differences in AUC values for T1 and T2 stages between double CEUS and MDCT (P = .190 and .256, respectively). However, the sensitivity of double CEUS in the detection of the T1 stage was higher than that of MDCT (88% versus 75%). The AUC values of MDCT for T3 and T4 stages were 0.833 and 0.905, which were both significantly higher than those of double CEUS (0.759 and 0.696; P < .05). The sensitivities of double CEUS and MDCT for the T3 stage were both 89%, but the accuracy and specificity of double CEUS were lower than those of MDCT (76% versus 83% and 63% versus 78%). The specificities of double CEUS and MDCT for the T4 stage were both 98%, but the accuracy and sensitivity of double CEUS were lower than those of MDCT (85% versus 94% and 42% versus 83%). CONCLUSIONS Multidetector CT is superior to double CEUS for T3 and T4 GC, and double CEUS may be regarded as an important complementary method to MDCT.
Collapse
Affiliation(s)
- Ping He
- Departments of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Li-Ying Miao
- Departments of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Hui-Yu Ge
- Departments of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Tian-Li Wang
- Departments of Radiology, Peking University Third Hospital, Beijing, China
| | - Ju-Xiang Ye
- Departments of Pathology, Peking University Third Hospital, Beijing, China
| | - Ling-Mei Meng
- Departments of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Heng Xue
- Departments of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Fan Zhang
- Departments of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Bo Zhao
- Departments of Ultrasound, Peking University Third Hospital, Beijing, China
| |
Collapse
|
|
2
|
Kishi T, Shimizu K, Hashimoto S, Onoda H, Washida Y, Sakaida I, Matsunaga N. CT enteroclysis/enterography findings in drug-induced small-bowel damage. Br J Radiol 2014; 87:20140367. [PMID: 25348282 DOI: 10.1259/bjr.20140367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To evaluate the CT enteroclysis (CTE)/enterography findings of patients with small-bowel mucosal damage induced by aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) and to compare these findings with the duration of drug use and endoscopic findings. METHODS CTE findings of 11 patients (22 lesions) with drug-induced small-bowel damage were reviewed, including 8 NSAID users and 3 aspirin users. Three patients were short-term users (6 months or shorter) and eight were long-term users (3 years or longer). Nine patients also underwent videocapsule endoscopy (VCE) or double-balloon enteroscopy (DBE). RESULTS Small-bowel abnormalities were visible in 8 of 11 patients (73%) on CTE. Multiple lesions were seen in five patients, including all short-term users. Lesions were classified into three types. Type 1 (mucosal patchy enhancement) was found in four of eight patients (50%, 12 lesions) all were short-term users. Small erosions with mild oedema/redness were shown by DBE. Type 2 (homogeneous hyperenhancement) was found in two of eight patients (25%, four lesions) who were long-term users. Large ulcers with marked oedema/redness were shown by DBE. Type 3 (stratification enhancement) was found in four of eight patients (50%, six lesions), both short-term and long-term users. Annular or large ulcers with strictures were shown by VCE or DBE. CONCLUSION On CTE, Type 1 lesions in patients with mostly short-term aspirin or NSAID use, Type 2 lesions in patients with long-term use and Type 3 lesions in both types of patients were detected. CTE may have usefulness for the detection of mild damage. ADVANCES IN KNOWLEDGE Small-bowel abnormalities owing to aspirin or NSAID present with three different patterns on CTE.
Collapse
Affiliation(s)
- T Kishi
- 1 Department of Radiology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | | | | | | | | | | | | |
Collapse
|
|
3
|
Shen Y, Kang HK, Jeong YY, Heo SH, Han SM, Chen K, Liu Y. Evaluation of early gastric cancer at multidetector CT with multiplanar reformation and virtual endoscopy. Radiographics 2011; 31:189-99. [PMID: 21257941 DOI: 10.1148/rg.311105502] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Early gastric cancer (EGC) is defined as a carcinoma in which invasion is limited to the mucosa and submucosa, regardless of lymph node status and distant metastasis. Recent advances in multidetector computed tomography (CT) with multiplanar reformation (MPR) provide a powerful tool for identifying gastric wall invasion and the perigastric extent of gastric cancer. In addition, MPR images confer advantages in the assessment of both intra- and extraluminal processes of the gastric wall and the evaluation of more distant regions, such as the paraaortic lymph nodes and other abdominal organs. Virtual endoscopy performed after air distention of the stomach can aid in the evaluation of gastric endoluminal morphologic features and the extent of EGC. Moreover, virtual endoscopy helps in detecting subtle mucosal changes and differentiating them from submucosal lesions in the same way as conventional endoscopy. Virtual endoscopy can depict abnormal endoluminal lesions within a wider field of view than can conventional endoscopy, and there are no "blind spots" because retrospective image reformation is available, which provides useful information for preoperative mapping. Multidetector CT with MPR and virtual endoscopy is a powerful, noninvasive tool for the early detection and accurate preoperative staging of EGC.
Collapse
Affiliation(s)
- Yulan Shen
- Department of Diagnostic Radiology, Shanghai Jiao Tong University Medical School, Rui Jin Hospital, China
| | | | | | | | | | | | | |
Collapse
|
|
4
|
Three-dimensional MDCT for preoperative local staging of gastric cancer using gas and water distention methods: a retrospective cohort study. AJR Am J Roentgenol 2011; 195:1316-23. [PMID: 21098189 DOI: 10.2214/ajr.10.4320] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The purpose of this article is to compare the T-staging accuracy and lesion detectability of MDCT with gas distention versus water distention according to the surgical and histopathologic findings, for the preoperative evaluation of gastric cancer. MATERIALS AND METHODS For a 3-month period, 113 consecutive patients (72 men and 41 women; age range, 23-85 years; mean age, 58 years) with 116 surgically confirmed gastric cancers from a single institution were included in our study. All patients had undergone preoperative MDCT with either effervescent granules taken orally (n = 55) or after having drunk 1,000 mL of tap water (n = 58) to create gastric distention. In addition to transverse images, multiplanar reformation images and 3D surface shaded display images were also obtained with gas distention CT, and multiplanar reformation images were obtained with water distention CT. The CT images were retrospectively reviewed by two abdominal radiologists separately with regard to T staging and lesion detectability. The accuracy values were compared between the two methods using Fisher's exact test. RESULTS The T-staging accuracy for gastric cancer did not differ significantly between gas distention and water distention CT scans, according to both radiologists (p > 0.05). Furthermore, the staging accuracy values for T1a cancers on gas distention CT scans for radiologists 1 and 2 were also comparable with those of water distention CT scans (91.1% vs 85% for radiologist 1 and 89.3% vs 85% for radiologist 2; p > 0.05). However, the tumor detection rate was significantly higher on gas distention CT scans using 2D and surface shaded display images for both radiologists (94.6% for radiologist 1 and 91.1% for radiologist 2), compared with the rates for water distention CT scans (78.3% and 73.3%) or gas distention CT scans using only 2D images (75.0% and 67.9%) (p < 0.05). CONCLUSION MDCT using the gas distention technique showed performance comparable to that of the water distention technique for the T staging of preoperative gastric cancer with better lesion detectability.
Collapse
|
|
5
|
Alva S, Eisenberg D, Duffy A, Roberts K, Israel G, Bell R. A new modality to evaluate the gastric remnant after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2007; 4:46-9; discussion 49. [PMID: 17980677 DOI: 10.1016/j.soard.2007.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 07/19/2007] [Accepted: 09/06/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gastric bypass surgery has become one of the most common operations performed in the United States. Exclusion of the gastric remnant has raised concerns about the difficulty for future evaluation of mucosal-based lesions. Current methods include retrograde endoscopy, which is technically challenging, or a surgically created gastrotomy. Both procedures are invasive. Virtual colonoscopy is becoming an accepted means of colonic mucosal evaluation. Hence, we used virtual three-dimensional computed tomograpy (3D-CT), also referred to as virtual gastroscopy, to evaluate the gastric mucosa in patients who have undergone laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS After institutional review board approval, 3 patients who had undergone LRYGB were consented for evaluation. Virtual gastroscopy was performed using a 16-channel multidetector CT scan, and 3D images were rendered using proprietary software (Vital Images, Inc.). RESULTS Endoluminal views of the gastric remnant were generated using perspective volume rendering. Virtual fly-through images were obtained by manipulating data acquired from the 3D-CT. Out of the 3 patients evaluated, we were able to achieve remnant gastric distension in 2 patients with no adverse effects. CONCLUSION This is the first report of performing virtual gastroscopy to evaluate the remnant stomach after LRYGB. Variations of this technique may minimize the need for invasive and technically challenging studies in this patient population.
Collapse
Affiliation(s)
- Suraj Alva
- Department of Surgery, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | | | | | | | | | | |
Collapse
|
|
6
|
Chen CY, Hsu JS, Wu DC, Kang WY, Hsieh JS, Jaw TS, Wu MT, Liu GC. Gastric cancer: preoperative local staging with 3D multi-detector row CT--correlation with surgical and histopathologic results. Radiology 2007; 242:472-82. [PMID: 17255419 DOI: 10.1148/radiol.2422051557] [Citation(s) in RCA: 192] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To prospectively evaluate accuracy of multi-detector row computed tomographic (CT) images for preoperative staging of gastric cancer by using surgical and histopathologic results as reference standards. MATERIALS AND METHODS This study had institutional review board approval; informed consent was obtained from all patients. Multi-detector row CT included acquisition of virtual gastroscopy images after air distention and contrast material-enhanced dynamic transverse and multiplanar reformation (MPR) images after water distention. Fifty-five consecutive patients with gastric cancer (38 men, 17 women; age range, 37-84 years; mean age, 63 years) underwent preoperative CT. All received 6 g of gas-producing crystals before unenhanced CT scanning for gastric distention and virtual gastroscopy. Patients drank 800-1000 mL of tap water to establish a background for dynamic contrast-enhanced CT scans. Images were obtained in late arterial, portal venous, and delayed phases with start delays of 40, 70, and 150 seconds, respectively. All patients underwent surgery. CT findings were compared with surgical and histopathologic results. Differences in accuracy of transverse and MPR images for T and N staging were assessed with the McNemar exact test. Statistical significance was inferred at P < .05. RESULTS Detection rates of primary tumors with transverse images, MPRs, and combinations of MPR and virtual gastroscopy images were 91% (50 of 55), 96% (53 of 55), and 98% (54 of 55), respectively. Overall accuracy in assessment of tumor invasion of the gastric wall (T stage) was significantly better with MPR images (89% [49 of 55]) than with transverse images (73% [40 of 55]) (P < .01). Overall accuracy for lymph node (N) staging was 78% (43 of 55) with MPR images and 71% (39 of 55) with transverse images. This difference was not significant (P = .103). CONCLUSION Multi-detector row CT with combined water and air distention can improve the accuracy of preoperative staging of gastric cancer. MPRs yield significantly better overall accuracy than transverse images for tumor staging but not for lymph node staging.
Collapse
Affiliation(s)
- Chiao-Yun Chen
- Department of Medical Imaging, Kaohsiung Medical University, Chung-Ho Memorial Hospital, 100 Tz-You 1st Road, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
|
7
|
Kim JH, Eun HW, Goo DE, Shim CS, Auh YH. Imaging of various gastric lesions with 2D MPR and CT gastrography performed with multidetector CT. Radiographics 2006; 26:1101-16; discussion 1117-8. [PMID: 16844934 DOI: 10.1148/rg.264055089] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Recent advances in computed tomographic (CT) technology, three-dimensional imaging software, and cheaper data storage capacity have made faster, simpler, and more accurate gastric imaging available. Two-dimensional multiplanar reformation and CT gastrography including virtual gastroscopy and transparency rendering allow multiplanar cross-sectional imaging, gastroscopic viewing, and upper gastrointestinal series imaging in the same data acquisition. Multi-detector row CT allows noninvasive assessment of the gastric wall and the perigastric extent of disease. It is also helpful in detection and evaluation of gastric malignancies and a variety of inflammatory conditions that affect the stomach. Conventional gastroscopy provides the most useful information about the exact location of the lesion and also allows performance of biopsy. Endoscopic ultrasonography (US) provides the most useful information about horizontal extension of the tumor, the depth of mural invasion, and perigastric lymphadenopathy. However, endoscopic US has not been able to replace CT for tumor staging because of its limitations in demonstrating distant lymphadenopathy or metastatic deposits.
Collapse
Affiliation(s)
- Jung Hoon Kim
- Department of Radiology, Soonchunhyang University Hospital, 657 Hannam-Dong, Youngsan-Ku, Seoul 140-743, Korea.
| | | | | | | | | |
Collapse
|
|
8
|
Abstract
The rapid dissemination of multidetector-row computed tomographic (CT) technology will make faster and more accurate gastric imagining available. Two-dimensional multiplanar reconstruction and CT gastrography including virtual gastroscopy and transparency rendering using volume rendering are types of interactive two- and three-dimensional medical imaging tools. It provides multiplanar cross-sectional imaging, gastroscopic viewing, and upper gastrointestinal series imaging in the same data acquisition. Two-dimensional multiplanar reconstruction provides accurate staging of gastric cancer and extraluminal information such as lymphadenopathy and distant metastasis. Virtual gastroscopy detects subtle mucosal changes and differentiates them from submucosal lesions in the same way as gastroscopy. Transparency rendering provides global orientation of the focal findings in the stomach in the same way as upper gastrointestinal series findings and provides useful information for preoperative mapping. Thus, CT gastrography is a promising method for evaluating gastric lesion despite its limitations.
Collapse
Affiliation(s)
- J H Kim
- Department of Radiology, Soonchunhyang University Hospital, 657 Hannam-Dong, Youngsan-Ku, Seoul 140-743, Korea.
| | | | | | | |
Collapse
|
|
9
|
Shimizu K, Ito K, Matsunaga N, Shimizu A, Kawakami Y. Diagnosis of gastric cancer with MDCT using the water-filling method and multiplanar reconstruction: CT-histologic correlation. AJR Am J Roentgenol 2006; 185:1152-8. [PMID: 16247125 DOI: 10.2214/ajr.04.0651] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the utility of MDCT with a thin-sliced multiplanar reconstruction (MPR) technique and water-filling method for the diagnosis of gastric cancers. MATERIALS AND METHODS Sixty-five patients with gastric cancers were preoperatively examined with MDCT using the water-filling method. The abdomen was dynamically scanned at 30 and 80 sec after the start of contrast medium administration. MPR images were reconstructed with a slice width of 1.25 mm and a slice interval of 1 mm. The detection rate and accuracy of T staging for gastric cancer were evaluated on MPR images and compared with 5-mm-slice axial images. In addition, MDCT images were correlated with pathologic findings. RESULTS The detection rate of all gastric cancers using the MPR technique was 65%. The detection rate of advanced gastric cancers was 96.2% (25 of 26), whereas that of early gastric cancers was 41.2% (14 of 34). There was a statistically significant difference (p < 0.05) in the detection rate of early gastric cancers between MPR and 5-mm-slice axial images. The MDCT appearances of gastric cancers were well correlated with pathologic findings such as mucinous component or differences in infiltration of cancer cells. The overall accuracy of CT staging was 85%. MPR images were superior to axial images for the evaluation of the z-axis extent of tumor. CONCLUSION MDCT with the water-filling method has advantages in acceptable evaluation of depth invasion of gastric carcinomas and in visualization of histologic changes in the tumors. MPR images may be a useful guide for the evaluation of the z-axis extent of tumor.
Collapse
Affiliation(s)
- Kensaku Shimizu
- Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | | | | | | | | |
Collapse
|
|
10
|
Kim JH, Eun HW, Hong SS, Auh YH. Early gastric cancer: virtual gastroscopy. ACTA ACUST UNITED AC 2006; 31:507-13. [PMID: 16465579 DOI: 10.1007/s00261-005-0183-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Accepted: 06/08/2005] [Indexed: 12/12/2022]
Abstract
Gastric cancer is one of the most common cancers and one of the most frequent causes of cancer-related deaths worldwide. Early detection and accurate preoperative staging of early gastric cancer (ECG) offers the best prognosis and is essential for planning optimal therapy such as endoscopic mucosal resection or gastric resection. Recent advances in computed tomographic technology and three-dimensional imaging software have enabled more accurate gastric imaging. Virtual gastroscopy (VG) is helpful in the detection and evaluation of EGC in the same way as gastroscopy. VG has a wider field of view than conventional gastroscopy, the angle of the virtual cancer can be adjusted omnidirectionally, and it has no blind point because retrospective reconstruction is available. Thus, VG is a promising method for evaluating gastric lesions despite its limitations. This report describes the clinical usefulness of VG with multidetector row computed tomography for EGC and axial computed tomography.
Collapse
Affiliation(s)
- J H Kim
- Department of Radiology, Soon Chun Hyang University Hospital, 657, Hannam-Dong, Yongsan-Ku, Seoul 140-743, Korea.
| | | | | | | |
Collapse
|
|
11
|
Chen CY, Wu DC, Kang WY, Hsu JS. Staging of gastric cancer with 16-channel MDCT. ACTA ACUST UNITED AC 2006; 31:514-20. [PMID: 16465577 DOI: 10.1007/s00261-005-0218-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Accepted: 07/14/2005] [Indexed: 12/17/2022]
Abstract
Early detection and accurate preoperative staging of gastric cancer are clinically important because the prognosis and choice of an optimal therapeutic approach are directly related to the stage of a neoplasm at time of presentation. Multidetector row computed tomography is a potentially powerful tool for noninvasive gastric evaluation. When thin collimation is used, near-isotropic imaging of the stomach is possible. Proper air distention of the stomach is used with virtual gastroscopic images; the technique is able to evaluate endoluminal lesions of the stomach and assist in early detection of gastric cancer. Adequate water-filled dynamic multiplanar reformatted images allow the radiologist to choose the optimal imaging plane to accurately evaluate depth of tumor invasion of the gastric wall and perigastric fat plane infiltration, identify a thin fat plane between a tumor and adjacent organs, avoid partial volume averaging effects, and better differentiate lymph nodes from small perigaskric vessels. Thus, the combination of air distention and hydrodistention of the stomach and dynamic contrast-enhanced multidetector row computed tomography with near-isotropic imaging offer improved diagnosis and staging of gastric cancers.
Collapse
Affiliation(s)
- C-Y Chen
- Department of Medical Imaging, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | | | | | | |
Collapse
|
|
12
|
Inamoto K, Kouzai K, Ueeda T, Marukawa T. CT virtual endoscopy of the stomach: comparison study with gastric fiberscopy. ACTA ACUST UNITED AC 2005; 30:473-9. [PMID: 15688107 DOI: 10.1007/s00261-004-0278-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND We evaluated the value of computed tomographic (CT) gastric virtual endoscopy (VE) by comparing it with real gastric fiberscopy (GF). METHODS Sixty-six VE findings in 63 patients were compared with lesions found with GF. After a GF examination, the examinees were given bubble-making granules for the stomach and placed in a supine position on the CT table. Abdominal CT slices of 1 mm thickness were obtained by multidetector row CT (Siemens Sensation 16) and reconstructed to VE images with volume and surface rendering on the same day. RESULTS VE images were successful in showing subtle alterations in the gastric mucosal folds. Gastric cancer, polyps, ulcers, erosions, and gastritis were clearly visualized. Comparison studies between VE and GF (as the gold standard) showed a sensitivity of 92.7% and a specificity of 90.9%. Original CT images were also useful in detecting lesions in other abdominal organs such as the liver, adrenal gland, and kidney. CONCLUSION Because VE is a good noninvasive screening method, except for minimal radiation exposure, it is expected to become a new technique for stomach examinations.
Collapse
Affiliation(s)
- K Inamoto
- Iseikai Hospital, Sophia Health Improvement Center, 6-2-25, Sugahara, Higashiyodogawa-ku, Osaka 533-0022, Japan.
| | | | | | | |
Collapse
|
|
13
|
Abstract
AIM: To discuss the helical computed tomography (CT) characteristics of gastric cancer and evaluate the diagnostic value of contrast-enhanced helical hydro-CT (HHCT) in staging gastric cancer.
METHODS: A total of 50 patients with gastric cancer were included in this study. The CT findings in them were retros-pectively analyzed and correlated with pathologic findings at surgery. All patients were preoperatively imaged by plain and contrast-enhanced helical CT after orally ingesting 1 000-1 500 mL water. Peristalsis was minimized by intra-venous administration of spasmolytics.
RESULTS: The foci of gastric cancer became more prominent in all the 50 patients and showed strong enhancement in contrast-enhanced HHCT. The tumor was located at the gastric cardia in 14 cases, at the gastric fundus in 3 cases, at the gastric body in 8 cases, at the gastric antrum in 4 cases, at the gastric fundus and the body in 8 cases, at the gastric body and antrum in 11 cases, and at three segments of the stomach in 2 cases. The CT features of gastric cancer were focal or diffuse mural thickening, soft tissue mass, cancerous ulcer, stenosis of stomach, infiltration to adjacent tissues, lymph node and distant metastases. Strong contrast enhancement of the gastric wall was closely related to gastric cancer. The accuracy rate of contrast-enhanced HHCT in staging gastric cancer was 86% (43/50). The detection rate of lymph node metastases by CT was 60% (12/20).
CONCLUSION: Contrast-enhanced HHCT is a reliable method to diagnose and stage gastric cancer.
Collapse
Affiliation(s)
- Wen-Zhou Wei
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China.
| | | | | | | | | |
Collapse
|
|
14
|
Kim HJ, Kim AY, Oh ST, Kim JS, Kim KW, Kim PN, Lee MG, Ha HK. Gastric cancer staging at multi-detector row CT gastrography: comparison of transverse and volumetric CT scanning. Radiology 2005; 236:879-85. [PMID: 16020558 DOI: 10.1148/radiol.2363041101] [Citation(s) in RCA: 187] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To prospectively evaluate the accuracy of multi-detector row computed tomography (CT) gastrography for preoperative staging of gastric cancer, with pathologic and surgical results as the reference standard. MATERIALS AND METHODS This study was approved by the institutional review board, and patients gave written informed consent. One hundred six patients (72 male, 34 female; mean age, 56 years) with endoscopically proved gastric cancer underwent unenhanced and contrast material-enhanced multi-detector row CT gastrography, with effervescent granules used as oral contrast material. Two experienced radiologists independently evaluated the depth of tumor invasion into the gastric wall (tumor staging), the involvement of regional lymph nodes (nodal staging), and the presence or absence of metastasis (metastatic staging) on transverse and volumetric CT images, which included images produced with multiplanar reformation and a virtual endoscopic technique. TNM staging of each tumor was compared with the pathologic and surgical results. Diagnostic accuracy in TNM staging was analyzed. RESULTS Gastric cancer was detected in 92 (87%) of 106 study patients with transverse CT imaging and in 104 (98%) with volumetric CT imaging. The overall accuracy of the tumor staging was 77% with transverse CT imaging and 84% with volumetric CT imaging (P < .001). The overall accuracy for lymph node staging was 62% with transverse CT imaging and 64% with volumetric CT imaging (P = .057). For staging of metastases, there was no difference between transverse and volumetric CT imaging (86% for both) (P > .99). CONCLUSION Multi-detector row CT gastrography with multiplanar reformation and virtual endoscopy, compared with transverse CT imaging, can improve the accuracy of preoperative staging of gastric cancer. This difference was significant for tumor staging but not for the staging of lymph nodes and metastases.
Collapse
Affiliation(s)
- Hye Jin Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-dong, Songpa-ku, Seoul 138-736, Korea
| | | | | | | | | | | | | | | |
Collapse
|
|
15
|
Callaway MP, Bailey D. Staging computed tomography in upper GI malignancy. A survey of the 5 cancer networks covered by the South West Cancer Intelligence Service. Clin Radiol 2005; 60:794-800. [PMID: 16127832 DOI: 10.1016/j.crad.2005.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
|
16
|
Bhandari S, Shim CS, Kim JH, Jung IS, Cho JY, Lee JS, Lee MS, Kim BS. Usefulness of three-dimensional, multidetector row CT (virtual gastroscopy and multiplanar reconstruction) in the evaluation of gastric cancer: a comparison with conventional endoscopy, EUS, and histopathology. Gastrointest Endosc 2004; 59:619-626. [PMID: 15114303 DOI: 10.1016/s0016-5107(04)00169-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to assess the role of three-dimensional multidetector row CT for detection, precise localization, and staging of gastric cancer by comparison with conventional endoscopy, EUS, and histopathology. METHODS Sixty-three patients with gastric cancer (31 early stage, 32 advanced) were evaluated by EGD with biopsies, EUS, and three-dimensional multidetector row CT between January 2003 to August 2003. Three-dimensional multidetector row CT findings were analyzed by a single radiologist blinded to the endoscopic findings. Among 63 patients, the findings were confirmed in 48 at surgery or by EMR. In the remaining cases, the findings were confirmed by EGD and biopsy specimen. The accuracy of three-dimensional multidetector row CT for detection, localization, and staging of gastric cancer was determined, compared with endoscopy, EUS, and histopathology. RESULTS Among the 63 patients, there were 67 gastric cancers. The overall accuracy of three-dimensional multidetector row CT for detection of gastric lesions was 94% (63/67), with accuracies of 96.7% (30/31) and 100% (32/32) for detection of, respectively, early and advanced stage gastric cancer. The overall accuracy, sensitivity, and specificity for EUS and three-dimensional multidetector row CT in the pre-operative determination of depth of invasion (T stage) were, respectively, 87.5%, 82.4%, and 96%; and 83.3%, 69.1%, and 94.4%. The accuracy, sensitivity, and specificity of EUS and three-dimensional multidetector row CT for lymph node staging was, respectively, 79.1%, 57%, and 89.5%; and 75%, 57.4%, and 89.3%. CONCLUSIONS Three-dimensional multidetector row CT, along with virtual gastroscopy is a promising method for pre-operative evaluation of gastric cancer.
Collapse
Affiliation(s)
- Suryaprakash Bhandari
- Institute for Digestive Research and Department of Radiology, Soon Chun Hyang University College of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | |
Collapse
|
|
17
|
Lawler LP, Horton KM, Fishman EK. Peripancreatic masses that simulate pancreatic disease: spectrum of disease and role of CT. Radiographics 2003; 23:1117-31. [PMID: 12975504 DOI: 10.1148/rg.235035013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A number of entities can simulate pancreatic disease at computed tomography (CT), which may lead to misdiagnosis. Common pitfalls include peripancreatic lesions of the foregut, adrenal gland, and kidney as well as disease of the mesentery and neurovascular structures. Optimal design and application of multi-detector row CT protocols with multiplanar reformation and maximum-intensity-projection and volume-rendering postprocessing improves the specificity of image interpretation. In most cases, helical CT is highly accurate for distinguishing primary disease of the pancreas from adjacent disease, although there are cases in which the differential diagnosis is more challenging and the potential for misdiagnosis still exists. Familiarity with some of the entities that can simulate pancreatic disease, careful attention to scanning protocol and contrast material administration, use of the full potential of multi-detector row CT data sets, and judicious application of postprocessing tools may help avoid some of the pitfalls caused by peripancreatic lesions.
Collapse
Affiliation(s)
- Leo P Lawler
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N Caroline St, Rm 3254, Baltimore, MD 21287-0801, USA
| | | | | |
Collapse
|
|
18
|
Chen F, Ni YC, Zheng KE, Ju SH, Sun J, Ou XL, Xu MH, Zhang H, Marchal G. Spiral CT in gastric carcinoma: Comparison with barium study, fiberoptic gastroscopy and histopathology. World J Gastroenterol 2003; 9:1404-8. [PMID: 12854130 PMCID: PMC4615472 DOI: 10.3748/wjg.v9.i7.1404] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate spiral computed tomography (CT) including virtual gastroscopy for diagnosis of gastric carcinoma in comparison with upper gastrointestinal series (UGI), fiberoptic gastroscopy (FG) and histopathology.
METHODS: Sixty patients with histologically proven gastric carcinoma (54 advanced and 6 early) were included in this study. The results of spiral CT were compared with those of UGI and FG. Two observers blindly evaluated images of spiral CT and UGI and video recording of FG with consensus in terms of diagnostic confidence with a five-point scale. Sensitivities of lesion detection, Borrmann's classification of spiral CT, UGI and FG, as well as the accuracy of TNM staging of spiral CT were determined by comparing them to surgical and histological findings.
RESULTS: The lesion detection rate was 98% (59/60), 95% (57/60) and 98% (59/60) for spiral CT, UGI and FG, respectively. There were no statistical differences in the detection sensitivity among the three techniques (P > 0.05). For the sensitivity in Borrmann's classification, spiral CT was higher than that of UGI (P = 0.025) and similar to that of FG (P > 0.05). The accuracy of spiral CT in staging the gastric carcinoma was 76.7%. Six cases of early gastric carcinoma were all detected by spiral CT as well as FG.
CONCLUSION: Spiral CT is equivalent to UGI and FG in the detection of gastric carcinoma, and superior to UGI but similar to FG in the Borrmann's classification of advanced gastric carcinoma. Spiral CT is more valuable than FG in the staging of gastric carcinoma.
Collapse
Affiliation(s)
- Feng Chen
- Department of Radiology, Zhongda Hospital, Nanjing, Jiangsu Province, China
| | | | | | | | | | | | | | | | | |
Collapse
|
|
19
|
Abstract
Recent advances in computed tomographic (CT) technology and three-dimensional (3D) imaging software have sparked renewed interest in using CT to evaluate gastric disease. Multidetector row CT scanners allow thinner collimation, which improves the visualization of subtle tumors as well as the quality of the 3D data sets. When water is used as an oral contrast agent, subtle disease is easier to visualize, especially when a rapid contrast material bolus is intravenously administered. Adenocarcinoma is the most common gastric malignancy and typically appears as focal or segmental wall thickening or a discrete mass. Gastric lymphoma can have a CT appearance similar to that of adenocarcinoma. Both gastric adenocarcinoma and lymphoma may be associated with adenopathy. Gastrointestinal stromal tumors (GISTs) tend to appear as well-defined masses that arise from the gastric wall and may be exophytic when large. GISTs are usually not associated with significant adenopathy. In addition to gastric malignancies, CT can also help detect inflammatory conditions of the stomach, including gastritis and peptic ulcer disease. CT angiography is especially helpful for depicting the gastric vasculature, which may be affected by a variety of disease conditions.
Collapse
Affiliation(s)
- Karen M Horton
- Department of Radiology, Johns Hopkins Medical Institutions, 601 N Caroline St, Rm 3251, Baltimore, MD 21287, USA
| | | |
Collapse
|