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The role of three-dimensional multidetector CT gastrography in the preoperative imaging of stomach cancer: emphasis on detection and localization of the tumor.

Kim JW, Shin SS, Heo SH, Lim HS, Lim NY, Park YK, Jeong YY, Kang HK - Korean J Radiol (2015)

Bottom Line: It has the ability to produce various three-dimensional (3D) images.Because 3D reconstruction images are more effective and intuitive for recognizing abnormal changes in the gastric folds and subtle mucosal nodularity than two-dimensional images, 3D MDCT gastrography can enhance the detection rate of early gastric cancer, which, in turn, contributes to the improvement of the accuracy of preoperative tumor (T) staging.In addition, shaded surface display and tissue transition projection images provide a global view of the stomach, with the exact location of gastric cancer, which may replace the need for barium studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chonnam National University Medical School, Gwangju 501-757, Korea.

ABSTRACT
Multidetector CT (MDCT) gastrography has been regarded as a promising technique for the preoperative imaging of gastric cancer. It has the ability to produce various three-dimensional (3D) images. Because 3D reconstruction images are more effective and intuitive for recognizing abnormal changes in the gastric folds and subtle mucosal nodularity than two-dimensional images, 3D MDCT gastrography can enhance the detection rate of early gastric cancer, which, in turn, contributes to the improvement of the accuracy of preoperative tumor (T) staging. In addition, shaded surface display and tissue transition projection images provide a global view of the stomach, with the exact location of gastric cancer, which may replace the need for barium studies. In this article, we discuss technical factors in producing high-quality MDCT gastrographic images and present cases demonstrating the usefulness of MDCT gastrography for the detection and T staging of gastric cancer while emphasizing the significance of preoperative localization of gastric cancer in terms of surgical margin.

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Related in: MedlinePlus

Diagrams showing possibility of re-operation due to location difference for gastric cancer between preoperative conventional endoscopy and surgery.A. Illustration shows location of gastric cancer at gastric angle, as is determined using preoperative conventional endoscopy. Black dotted lines indicate proximal and distal resection lines of planned laparoscopic subtotal gastrectomy with sufficient proximal resection margin (blue arrow). B. Illustration shows different location of gastric cancer between preoperative conventional endoscopy and surgery. If gastric cancer is located more proximally (green arrow) along lesser curvature at surgery than conventional endoscopy, planned proximal and distal resection lines (black dotted lines) would not secure sufficient proximal resected margin. Thus, in this case, additional total gastrectomy (red dotted line) may be required for sufficient proximal resected margin (blue arrow) after primary subtotal gastrectomy.
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Figure 3: Diagrams showing possibility of re-operation due to location difference for gastric cancer between preoperative conventional endoscopy and surgery.A. Illustration shows location of gastric cancer at gastric angle, as is determined using preoperative conventional endoscopy. Black dotted lines indicate proximal and distal resection lines of planned laparoscopic subtotal gastrectomy with sufficient proximal resection margin (blue arrow). B. Illustration shows different location of gastric cancer between preoperative conventional endoscopy and surgery. If gastric cancer is located more proximally (green arrow) along lesser curvature at surgery than conventional endoscopy, planned proximal and distal resection lines (black dotted lines) would not secure sufficient proximal resected margin. Thus, in this case, additional total gastrectomy (red dotted line) may be required for sufficient proximal resected margin (blue arrow) after primary subtotal gastrectomy.

Mentions: However, according to a recent study by Jeong et al. (19), preoperative conventional endoscopy appears to be inaccurate in localizing the tumor, especially when the gastric cancer is located along the lesser curvature, or in the upper or middle portion of the gastric body. This can be explained by the fact that, during conventional endoscopy, the stomach is usually over-distended, nearly twice as much as at surgery. The discrepancy in the location of gastric cancer between preoperative conventional endoscopy and surgery could be especially problematic during laparoscopic surgery. Indeed, in this situation, there is a possibility that the surgical strategy may change during the operation or may even require re-operation after the primary gastric resection because of an insufficient resection margin (Fig. 3).


The role of three-dimensional multidetector CT gastrography in the preoperative imaging of stomach cancer: emphasis on detection and localization of the tumor.

Kim JW, Shin SS, Heo SH, Lim HS, Lim NY, Park YK, Jeong YY, Kang HK - Korean J Radiol (2015)

Diagrams showing possibility of re-operation due to location difference for gastric cancer between preoperative conventional endoscopy and surgery.A. Illustration shows location of gastric cancer at gastric angle, as is determined using preoperative conventional endoscopy. Black dotted lines indicate proximal and distal resection lines of planned laparoscopic subtotal gastrectomy with sufficient proximal resection margin (blue arrow). B. Illustration shows different location of gastric cancer between preoperative conventional endoscopy and surgery. If gastric cancer is located more proximally (green arrow) along lesser curvature at surgery than conventional endoscopy, planned proximal and distal resection lines (black dotted lines) would not secure sufficient proximal resected margin. Thus, in this case, additional total gastrectomy (red dotted line) may be required for sufficient proximal resected margin (blue arrow) after primary subtotal gastrectomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296280&req=5

Figure 3: Diagrams showing possibility of re-operation due to location difference for gastric cancer between preoperative conventional endoscopy and surgery.A. Illustration shows location of gastric cancer at gastric angle, as is determined using preoperative conventional endoscopy. Black dotted lines indicate proximal and distal resection lines of planned laparoscopic subtotal gastrectomy with sufficient proximal resection margin (blue arrow). B. Illustration shows different location of gastric cancer between preoperative conventional endoscopy and surgery. If gastric cancer is located more proximally (green arrow) along lesser curvature at surgery than conventional endoscopy, planned proximal and distal resection lines (black dotted lines) would not secure sufficient proximal resected margin. Thus, in this case, additional total gastrectomy (red dotted line) may be required for sufficient proximal resected margin (blue arrow) after primary subtotal gastrectomy.
Mentions: However, according to a recent study by Jeong et al. (19), preoperative conventional endoscopy appears to be inaccurate in localizing the tumor, especially when the gastric cancer is located along the lesser curvature, or in the upper or middle portion of the gastric body. This can be explained by the fact that, during conventional endoscopy, the stomach is usually over-distended, nearly twice as much as at surgery. The discrepancy in the location of gastric cancer between preoperative conventional endoscopy and surgery could be especially problematic during laparoscopic surgery. Indeed, in this situation, there is a possibility that the surgical strategy may change during the operation or may even require re-operation after the primary gastric resection because of an insufficient resection margin (Fig. 3).

Bottom Line: It has the ability to produce various three-dimensional (3D) images.Because 3D reconstruction images are more effective and intuitive for recognizing abnormal changes in the gastric folds and subtle mucosal nodularity than two-dimensional images, 3D MDCT gastrography can enhance the detection rate of early gastric cancer, which, in turn, contributes to the improvement of the accuracy of preoperative tumor (T) staging.In addition, shaded surface display and tissue transition projection images provide a global view of the stomach, with the exact location of gastric cancer, which may replace the need for barium studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chonnam National University Medical School, Gwangju 501-757, Korea.

ABSTRACT
Multidetector CT (MDCT) gastrography has been regarded as a promising technique for the preoperative imaging of gastric cancer. It has the ability to produce various three-dimensional (3D) images. Because 3D reconstruction images are more effective and intuitive for recognizing abnormal changes in the gastric folds and subtle mucosal nodularity than two-dimensional images, 3D MDCT gastrography can enhance the detection rate of early gastric cancer, which, in turn, contributes to the improvement of the accuracy of preoperative tumor (T) staging. In addition, shaded surface display and tissue transition projection images provide a global view of the stomach, with the exact location of gastric cancer, which may replace the need for barium studies. In this article, we discuss technical factors in producing high-quality MDCT gastrographic images and present cases demonstrating the usefulness of MDCT gastrography for the detection and T staging of gastric cancer while emphasizing the significance of preoperative localization of gastric cancer in terms of surgical margin.

Show MeSH
Related in: MedlinePlus