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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

T1a cancer (type IIc) in 62-year-old man that is not seen on two-dimensional CT image despite being detected on both virtual endoscopy (VE) and tissue transition projection (TTP) images.A. Oblique, axial, contrast-enhanced CT image shows no discernible lesion at corresponding site (arrow) where early gastric cancer (EGC) is detected on three-dimensional images. B. VE image demonstrates shallow depressed lesion (arrows) with converging folds and uneven margins. C. Conventional endoscopic image shows malignant ulcer (arrows) with converging folds and uneven margin, which are similar morphologic features with B. D. TTP image depicts location of EGC (arrow) that is seen on VE (B).
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Figure 5: T1a cancer (type IIc) in 62-year-old man that is not seen on two-dimensional CT image despite being detected on both virtual endoscopy (VE) and tissue transition projection (TTP) images.A. Oblique, axial, contrast-enhanced CT image shows no discernible lesion at corresponding site (arrow) where early gastric cancer (EGC) is detected on three-dimensional images. B. VE image demonstrates shallow depressed lesion (arrows) with converging folds and uneven margins. C. Conventional endoscopic image shows malignant ulcer (arrows) with converging folds and uneven margin, which are similar morphologic features with B. D. TTP image depicts location of EGC (arrow) that is seen on VE (B).

Mentions: Most previous studies (4, 6, 11, 12, 21, 22) evaluated T staging using CT criteria based on the concepts of Minami et al. (23), that a normal gastric wall was typically seen as three separate layers on the contrast-enhanced CT images. These three layers consisted of an inner mucosal layer with marked enhancement, a submucosal layer with low attenuation, and an outer muscular-serosal layer with slightly higher attenuation. On MDCT images, T1a tumors show enhancement without thickening of the inner mucosal layer, as compared to the adjacent normal mucosal layer. Now that T1a gastric cancer is frequently detected only on 3D endoluminal images, any gastric cancer that is not depicted on 2D CT images may be interpreted as T1a cancer (Fig. 5) (24). T1b tumors show enhancing mucosal thickening with intact a low-density-stripe layer. Both T2 and T3 tumors destroy the low-density-stripe layer, but are confined to the gastric wall. However, T3 tumors can have a few small linear strandings in the perigastric fat plane. T4a tumors are usually accompanied by an irregular or nodular outer margin of the outer layer and a dense band-like perigastric fat infiltration. Stage T4b tumors show obliteration of the fat plane between the gastric lesion and the adjacent organs or direct invasion of the adjacent organs.


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)

T1a cancer (type IIc) in 62-year-old man that is not seen on two-dimensional CT image despite being detected on both virtual endoscopy (VE) and tissue transition projection (TTP) images.A. Oblique, axial, contrast-enhanced CT image shows no discernible lesion at corresponding site (arrow) where early gastric cancer (EGC) is detected on three-dimensional images. B. VE image demonstrates shallow depressed lesion (arrows) with converging folds and uneven margins. C. Conventional endoscopic image shows malignant ulcer (arrows) with converging folds and uneven margin, which are similar morphologic features with B. D. TTP image depicts location of EGC (arrow) that is seen on VE (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: T1a cancer (type IIc) in 62-year-old man that is not seen on two-dimensional CT image despite being detected on both virtual endoscopy (VE) and tissue transition projection (TTP) images.A. Oblique, axial, contrast-enhanced CT image shows no discernible lesion at corresponding site (arrow) where early gastric cancer (EGC) is detected on three-dimensional images. B. VE image demonstrates shallow depressed lesion (arrows) with converging folds and uneven margins. C. Conventional endoscopic image shows malignant ulcer (arrows) with converging folds and uneven margin, which are similar morphologic features with B. D. TTP image depicts location of EGC (arrow) that is seen on VE (B).
Mentions: Most previous studies (4, 6, 11, 12, 21, 22) evaluated T staging using CT criteria based on the concepts of Minami et al. (23), that a normal gastric wall was typically seen as three separate layers on the contrast-enhanced CT images. These three layers consisted of an inner mucosal layer with marked enhancement, a submucosal layer with low attenuation, and an outer muscular-serosal layer with slightly higher attenuation. On MDCT images, T1a tumors show enhancement without thickening of the inner mucosal layer, as compared to the adjacent normal mucosal layer. Now that T1a gastric cancer is frequently detected only on 3D endoluminal images, any gastric cancer that is not depicted on 2D CT images may be interpreted as T1a cancer (Fig. 5) (24). T1b tumors show enhancing mucosal thickening with intact a low-density-stripe layer. Both T2 and T3 tumors destroy the low-density-stripe layer, but are confined to the gastric wall. However, T3 tumors can have a few small linear strandings in the perigastric fat plane. T4a tumors are usually accompanied by an irregular or nodular outer margin of the outer layer and a dense band-like perigastric fat infiltration. Stage T4b tumors show obliteration of the fat plane between the gastric lesion and the adjacent organs or direct invasion of the adjacent organs.

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