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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

Residual food mimicking true gastric lesion.A. Residual food (arrows) in gastric antrum mimics focal mucosal lesion. Note tiny ulcer (arrowheads) in vicinity of residual food. B. Axial CT image demonstrates residual food (arrows) in gastric antrum and upper body. C. Conventional endoscopy reveals residual food (arrows) and tiny ulcer (arrowheads) in gastric antrum.
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Figure 9: Residual food mimicking true gastric lesion.A. Residual food (arrows) in gastric antrum mimics focal mucosal lesion. Note tiny ulcer (arrowheads) in vicinity of residual food. B. Axial CT image demonstrates residual food (arrows) in gastric antrum and upper body. C. Conventional endoscopy reveals residual food (arrows) and tiny ulcer (arrowheads) in gastric antrum.

Mentions: Three-dimensional CTG has several limitations in preoperative imaging of gastric cancer. First, although recent advances in computer technology have enabled 3D reconstruction processing to be faster and easier, it is still timeconsuming to prepare and interpret 3D CTG images. Also, a certain amount of learning time is necessary to get accustomed to the interpretation of 3D CTG images. Second, the fact that CTG images cannot detect color changes of the mucosa may be disadvantageous. In some cases of EGC type IIb (superficial flat lesion), only color change on conventional endoscopy implies the presence of the tumor without significant mucosal fold changes. Thus, in this case, if abnormal mural thickening and enhancement related to EGC is not seen on 2D images, 3D CTG cannot detect the tumor. Third, gastric secretion or residual food can mask a gastric cancer and may be confused with a true lesion. Thus, when a focal lesion is suspected on VE images, this lesion should be checked again using 2D images to rule out pseudo-lesions such as fluid collection, air bubbles, metallic clips, and food remaining in the stomach (Fig. 9).


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)

Residual food mimicking true gastric lesion.A. Residual food (arrows) in gastric antrum mimics focal mucosal lesion. Note tiny ulcer (arrowheads) in vicinity of residual food. B. Axial CT image demonstrates residual food (arrows) in gastric antrum and upper body. C. Conventional endoscopy reveals residual food (arrows) and tiny ulcer (arrowheads) in gastric antrum.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 9: Residual food mimicking true gastric lesion.A. Residual food (arrows) in gastric antrum mimics focal mucosal lesion. Note tiny ulcer (arrowheads) in vicinity of residual food. B. Axial CT image demonstrates residual food (arrows) in gastric antrum and upper body. C. Conventional endoscopy reveals residual food (arrows) and tiny ulcer (arrowheads) in gastric antrum.
Mentions: Three-dimensional CTG has several limitations in preoperative imaging of gastric cancer. First, although recent advances in computer technology have enabled 3D reconstruction processing to be faster and easier, it is still timeconsuming to prepare and interpret 3D CTG images. Also, a certain amount of learning time is necessary to get accustomed to the interpretation of 3D CTG images. Second, the fact that CTG images cannot detect color changes of the mucosa may be disadvantageous. In some cases of EGC type IIb (superficial flat lesion), only color change on conventional endoscopy implies the presence of the tumor without significant mucosal fold changes. Thus, in this case, if abnormal mural thickening and enhancement related to EGC is not seen on 2D images, 3D CTG cannot detect the tumor. Third, gastric secretion or residual food can mask a gastric cancer and may be confused with a true lesion. Thus, when a focal lesion is suspected on VE images, this lesion should be checked again using 2D images to rule out pseudo-lesions such as fluid collection, air bubbles, metallic clips, and food remaining in the stomach (Fig. 9).

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