Computed tomography of gastrocolic ligament: involvement in malignant tumors of the stomach

Analysis of computed tomography and pathological observations of non-Hodgkin lymphomas with peritoneal, omental and mesenteric involvement

The aim of the present study was to evaluate the association between computed tomography (CT) images and the pathological observations of non-Hodgkin lymphoma (NHL) patients with peritoneal, omental and mesenteric involvement. In total, 26 patients suffering from an NHL with peritoneal, omental or mesenteric involvement were reviewed retrospectively, and the observed CT scan characteristics were analyzed. In addition, associations among the CT scan characteristics and the NHL subtypes, including diffuse large B-cell, mantle cell, follicular cell and T-cell lymphoma, were evaluated. The CT scan characteristics of the NHLs with peritoneal, omental and mesenteric involvement included peritoneal cord-like thickening, peritoneal omental nodular and swelling thickening, omental cake-like thickening and mesenteric mass. The probability of peritoneal linear, omental nodular and swelling thickening was found to be higher in diffuse large B-cell lymphoma cases compared with cases of other NHL subtypes (P<0.05). However, the probability of omental cake-like thickening and mesenteric mass was not found to be significantly different among the NHL subtypes (P>0.05). Signs of peritoneal, omental and mesenteric involvement were observed in the CT scans of all the NHL subtypes, particularly in diffuse large B-cell lymphoma cases. Therefore, linear, omental nodular and swelling thickening were characteristic of diffuse large B-cell lymphoma, while omental cake-like thickening and mesenteric mass were observed in all NHL subtypes.

Computed tomography of gastrohepatic ligament involvement by gastric carcinoma

PURPOSE

This study was aimed to analyze the contrast-enhanced CT features of gastrohepatic ligament (GHL) involvement in gastric carcinoma (GC) and to evaluate the influence of GHL on the spread of GC correlating with the anatomic bases.

METHODS

CT scans of 41 patients known to have GC and GHL involvement were reviewed retrospectively for the primary tumor and the GHL abnormalities, as well as the role GHL played in the spread of GC. Emphasis was placed on direct invasion, lymph node metastasis, and GHL seeding. The relationship between the accompanying ascites and the different pattern of the GHL involvement were also evaluated statistically.

RESULTS

CT features of the GHL abnormalities caused by GC could be summarized as follows: (a) direct invasion (34.1%, 14 of 41), which was visualized as a regional (nine of 14) or diffuse mass (five of 14) in the GHL; (b) GHL seeding (26.8%, 11 of 41), which consists of ''smudged'' appearance (eight of 11), nodular infiltration (two of 11) and "GHL caking" (one of 11); (c) lymph node metastasis (63.4%, 26 of 41), including enlargement of lymph nodes (22 of 26) and cystic lesion (four of 26). We also found direct extension of GC into the transverse fissure and/or the liver via the GHL in three patients. Ascites, which was found in ten patients, seemed to be associated with the pattern of seeding involvement.

CONCLUSIONS

GHL can be invaded by GC through several patterns and contrast-enhanced CT scan plays an important role in detecting GHL involvement in GC, which has a variety of CT manifestations. GHL may also serve as a potential conduit for the predictable spread of GC into the neighboring organs such as the liver.

Uneven haustra on CT colonography: a clue for the detection of transperitoneal invasion from gastric cancer

Two patients with gastric carcinoma underwent CT colonography (CTC) for preoperative work-up. Although no obvious peritoneal nodules were seen on axial CT images, colonic wall deformities were noted on three-dimensional (3D) air images. Multiplanar-reformatted images revealed corresponding colonic wall thickening at the deformities, and in addition, dense cordlike structures connecting the primary gastric cancer and colonic wall thickening were also observed. In one patient, cordlike indurations consistent with peritoneal invasion were found to connect the primary gastric cancer, gastrocolic ligament, and transverse mesocolon during exploratory surgery, and in the other, colonic scars consistent with peritoneal invasion after chemotherapy were observed. These observations suggest that CTC could be of potential use for the differentiation of transperitoneal colonic invasion and gastric cancer.

[X-ray and CT presentation of advanced gastric carcinomas of different locations]

We presented the X-ray and CT findings characteristic for gastric cancers of different localizations (localized in different parts of the stomach). Particularly, esophagogastric junction (EGJ) carcinomas and antral carcinomas are singled out, as two localizations of gastric cancer that we usually meet in everyday clinical and radiological practice, and which have completely different radiological presentation. Advanced carcinomas of esophago-gastric junction, whose incidence is on the rise, usually affect the distal segment of the esophagus, cardia, and proximal part of the stomach, in different proportions. Siewert's, and the Japanese classification of these tumors are listed. Due to the involvement of the distal esophagus, scanning region, besides the abdomen, should be expanded to the chest. Advanced cancer of the antral part of the stomach is presented by the X-ray as a fungating, infiltrative, or combined form, often capturing the entire wall circumference. Possible infiltration of the left liver, the body and neck of the pancreas, colon and anterior abdominal wall should be estimated by CT.

A study of multi-detector row CT scan on greater omentum in 50 individuals: correlating with anatomical basis and clinical application

BACKGROUND

In view of the descriptions of the CT manifestations on the greater omentum (GO) were not precise and detailed enough in the previous literature, we tried to evaluate the radiologic-anatomical features of the GO and to address the related clinical implications for the radiologic diagnosis and surgical application.

METHODS

We evaluated the GO by using multi-detector row CT (MDCT) scanning in 50 individuals correlating with anatomical basis and clinical application. Emphasis was placed on the following items: the anatomical distribution and location of the GO; the CT manifestations of the vasculature, fatty tissue and lymph nodes.

RESULTS

The gastro-epiploic vessel, the landmark for delineating the GO, was visualized in 50/50 cases (100%). The gastro-colic vein was detected in 34/50 cases (68%). The free-hanging portion, 48 cases revealed, seemed to have the capability of 'migration': it is located in the subphrenic spaces in 9/48 cases (19%) and distributed in the right lower quadrant predominantly in 10/48 cases (21%). Three-dimensional reformatted images, obtained in five cases, demonstrated the return of the gastro-epiploic vein distinctly. Lymph nodes were rarely detected within the GO.

CONCLUSION

The depicted omental vessels, visualized by using multi-planar reconstruction images together with three-dimensional reformatted images, played a crucial role in delineating the GO comprehensively. It can provide the valuable data for the radiologic diagnosis and surgical therapy planning including surgery of reconstruction, pancreas, portal hypertension as well as infections and neoplastic diseases.