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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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T1b early gastric cancer (type IIc) in 74-year-old woman that was overestimated as T2 cancer at multidetector CT gastrography.A, B. Conventional endoscopic (A) and virtual endoscopy (VE) (B) images clearly show focal ulcerative lesion (arrow). C. Oblique axial contrast-enhanced CT image shows focal ulcerative lesion with enhancing thickened mucosa (arrow) and uneven gastric layers in thickness. Because of relatively thin low-density-stripe layer (curved arrow) of proximal antrum, compared to distal antrum (arrowhead), disruption degree of low-density-stripe layer was estimated as greater than 50% of thickness. This lesion was judged preoperatively as T2 cancer. However, gastric cancer was confirmed pathologically as SM3 T1b cancer.
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Figure 8: T1b early gastric cancer (type IIc) in 74-year-old woman that was overestimated as T2 cancer at multidetector CT gastrography.A, B. Conventional endoscopic (A) and virtual endoscopy (VE) (B) images clearly show focal ulcerative lesion (arrow). C. Oblique axial contrast-enhanced CT image shows focal ulcerative lesion with enhancing thickened mucosa (arrow) and uneven gastric layers in thickness. Because of relatively thin low-density-stripe layer (curved arrow) of proximal antrum, compared to distal antrum (arrowhead), disruption degree of low-density-stripe layer was estimated as greater than 50% of thickness. This lesion was judged preoperatively as T2 cancer. However, gastric cancer was confirmed pathologically as SM3 T1b cancer.

Mentions: Although MDCT with MPR and 3D CTG images is believed to enhance the diagnostic accuracy of preoperative T staging of gastric cancer (12), it is still challenging to evaluate T staging in some cases. There is a tendency that EGC type IIc (excavated lesion) at gastric angle and EGC type I (protruded lesion) are over-staged. Also, in some cases, it is not easy to distinguish between T1b and T2 cancers due to the irregular contour of the tumor, uneven thickness of the gastric layer, and the presence of massive submucosal fibrosis (Fig. 8). Given that the visual discrimination among the subserosa, and the outer serosal layer is almost impossible on MDCT images, it is not a straightforward issue to differentiate among T2, T3, and T4a tumors using MDCT.


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)

T1b early gastric cancer (type IIc) in 74-year-old woman that was overestimated as T2 cancer at multidetector CT gastrography.A, B. Conventional endoscopic (A) and virtual endoscopy (VE) (B) images clearly show focal ulcerative lesion (arrow). C. Oblique axial contrast-enhanced CT image shows focal ulcerative lesion with enhancing thickened mucosa (arrow) and uneven gastric layers in thickness. Because of relatively thin low-density-stripe layer (curved arrow) of proximal antrum, compared to distal antrum (arrowhead), disruption degree of low-density-stripe layer was estimated as greater than 50% of thickness. This lesion was judged preoperatively as T2 cancer. However, gastric cancer was confirmed pathologically as SM3 T1b cancer.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 8: T1b early gastric cancer (type IIc) in 74-year-old woman that was overestimated as T2 cancer at multidetector CT gastrography.A, B. Conventional endoscopic (A) and virtual endoscopy (VE) (B) images clearly show focal ulcerative lesion (arrow). C. Oblique axial contrast-enhanced CT image shows focal ulcerative lesion with enhancing thickened mucosa (arrow) and uneven gastric layers in thickness. Because of relatively thin low-density-stripe layer (curved arrow) of proximal antrum, compared to distal antrum (arrowhead), disruption degree of low-density-stripe layer was estimated as greater than 50% of thickness. This lesion was judged preoperatively as T2 cancer. However, gastric cancer was confirmed pathologically as SM3 T1b cancer.
Mentions: Although MDCT with MPR and 3D CTG images is believed to enhance the diagnostic accuracy of preoperative T staging of gastric cancer (12), it is still challenging to evaluate T staging in some cases. There is a tendency that EGC type IIc (excavated lesion) at gastric angle and EGC type I (protruded lesion) are over-staged. Also, in some cases, it is not easy to distinguish between T1b and T2 cancers due to the irregular contour of the tumor, uneven thickness of the gastric layer, and the presence of massive submucosal fibrosis (Fig. 8). Given that the visual discrimination among the subserosa, and the outer serosal layer is almost impossible on MDCT images, it is not a straightforward issue to differentiate among T2, T3, and T4a tumors using MDCT.

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