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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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T2 cancer in 69-year-old man.A. Axial contrast-enhanced CT image shows well-enhancing mucosal thickening (arrow) and disruption of low-density-stripe layer (> 50% of thickness) at greater curvature of gastric body, without abutting outer, slightly higher-attenuating layer. This lesion was correctly classified as T2 cancer in preoperative imaging. B. Virtual endoscopy image shows ulceroinfiltrative mass (arrows). C. Conventional endoscopic image reveals poorly demarcated ulceroinfiltrative lesion (arrows), suggestive of advanced gastric cancer.
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Figure 7: T2 cancer in 69-year-old man.A. Axial contrast-enhanced CT image shows well-enhancing mucosal thickening (arrow) and disruption of low-density-stripe layer (> 50% of thickness) at greater curvature of gastric body, without abutting outer, slightly higher-attenuating layer. This lesion was correctly classified as T2 cancer in preoperative imaging. B. Virtual endoscopy image shows ulceroinfiltrative mass (arrows). C. Conventional endoscopic image reveals poorly demarcated ulceroinfiltrative lesion (arrows), suggestive of advanced gastric cancer.

Mentions: Meanwhile, a recent study by Kim et al. (3) postulated that the inner and the outer halves of the low-density-stripe layer on contrast-enhanced CT images might represent the submucosal and the proper muscle layer, respectively, according to the radiologic-pathologic correlation. They suggested different MDCT criteria based on their own speculation regarding the gastric mural layering, in which there are major differences in MDCT criteria for T1b and T2 cancers (3). When the low-density-stripe layer is disrupted to a degree of less than 50% of the thickness, the tumor is staged as T1b (Fig. 6). T2 tumors show disruption of the low-density-stripe layer (greater than 50% of the thickness) without abutting on the outer, slightly higher-attenuating layer (Fig. 7).


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)

T2 cancer in 69-year-old man.A. Axial contrast-enhanced CT image shows well-enhancing mucosal thickening (arrow) and disruption of low-density-stripe layer (> 50% of thickness) at greater curvature of gastric body, without abutting outer, slightly higher-attenuating layer. This lesion was correctly classified as T2 cancer in preoperative imaging. B. Virtual endoscopy image shows ulceroinfiltrative mass (arrows). C. Conventional endoscopic image reveals poorly demarcated ulceroinfiltrative lesion (arrows), suggestive of advanced gastric cancer.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: T2 cancer in 69-year-old man.A. Axial contrast-enhanced CT image shows well-enhancing mucosal thickening (arrow) and disruption of low-density-stripe layer (> 50% of thickness) at greater curvature of gastric body, without abutting outer, slightly higher-attenuating layer. This lesion was correctly classified as T2 cancer in preoperative imaging. B. Virtual endoscopy image shows ulceroinfiltrative mass (arrows). C. Conventional endoscopic image reveals poorly demarcated ulceroinfiltrative lesion (arrows), suggestive of advanced gastric cancer.
Mentions: Meanwhile, a recent study by Kim et al. (3) postulated that the inner and the outer halves of the low-density-stripe layer on contrast-enhanced CT images might represent the submucosal and the proper muscle layer, respectively, according to the radiologic-pathologic correlation. They suggested different MDCT criteria based on their own speculation regarding the gastric mural layering, in which there are major differences in MDCT criteria for T1b and T2 cancers (3). When the low-density-stripe layer is disrupted to a degree of less than 50% of the thickness, the tumor is staged as T1b (Fig. 6). T2 tumors show disruption of the low-density-stripe layer (greater than 50% of the thickness) without abutting on the outer, slightly higher-attenuating layer (Fig. 7).

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