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Yin JJ, Hu X, Hu S, Sheng GH. Efficacy of multi-slice spiral computed tomography in evaluating gastric cancer recurrence after endoscopic submucosal dissection. World J Gastrointest Oncol 2023; 15:1636-1643. [PMID: 37746651 PMCID: PMC10514731 DOI: 10.4251/wjgo.v15.i9.1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/25/2023] [Accepted: 08/08/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Recurrence is the major challenge facing endoscopic submucosal dissection (ESD)-based treatment therapies for early gastric cancer (EGC). Urgent development of simple and easy surveillance approaches will enhance clinical treatment of the disease. AIM To explore the role of computed tomography (CT) recurrence in evaluating EGC after ESD treatment. METHODS We retrospectively recruited patients from our endoscopy department, between January 2002 and December 2015, and analyzed their basic characteristics, including symptoms, CT results, and results of endoscopy with biopsy, among others. RESULTS Among a total of 2150 patients EGC patients surveyed, 1362 met our inclusion and exclusion criteria and were therefore enrolled in our study. The cohort's sensitivity of CT for recurrent GC and specificity were 44.22% and 43.86%, respectively, with negative and positive predictive values of 40.15% (275/685) and 48.01% (325/677), respectively. The area under the curve of arterial and venous CT values for recurrent EGC were 0.545, and 0.604, respectively. Receiver operating characteristic curve revealed no statistically significant differences between arterial and venous CT values for recurrent EGC. CONCLUSION Enhanced CT has superior diagnostic efficacy, but less accuracy, compared to gold standard techniques in patients with recurrent EGC.
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Affiliation(s)
- Jian-Jun Yin
- Department of Radiology, Huangshi Maternity and Children's health Hospital, Affiliated Maternity and Children's Health Hospital of Hubei Polytechnic University, Huangshi 435000, Hubei Province, China
| | - Xiao Hu
- Department of Geriatrics, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi 435000, Hubei Province, China
| | - Sen Hu
- Department of Radiology, Huangshi Maternity and Children's health Hospital, Affiliated Maternity and Children's Health Hospital of Hubei Polytechnic University, Huangshi 435000, Hubei Province, China
| | - Guo-Hong Sheng
- Department of Radiology, Huangshi Maternity and Children's health Hospital, Affiliated Maternity and Children's Health Hospital of Hubei Polytechnic University, Huangshi 435000, Hubei Province, China
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Kiyokawa T, Fukagawa T, Kaneshiro S, Igarashi Y, Soeda N, Kumata Y, Horikawa M, Sasajima Y, Matsuda K, Fukushima R. Accuracy of preoperative staging of gastric stump cancer. Jpn J Clin Oncol 2022; 52:571-574. [PMID: 35296901 DOI: 10.1093/jjco/hyac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 02/25/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In this study, the accuracy of preoperative staging for gastric stump cancer, which has not been thoroughly investigated since the condition is rare, was investigated using computed tomography and gastroscopic imaging. METHODS Between February 1994 and April 2018, 49 patients with gastric stump cancer, following subtotal or total gastrectomy, were reviewed retrospectively. Preoperative diagnoses of clinical T and clinical N categories were compared with post-operative pathological diagnoses (pT and pN categories). Positive predictive values, accuracy, sensitivity and specificity were also evaluated. RESULTS The overall accuracy of T staging was 40.8%. The positive predictive value for cT3/T4 was 96.3%, whereas the positive predictive value for cT1/T2 was 72.7%. The overall accuracy for N staging was 61.2%. The positive predictive value of lymph node positive patients was 73.3%. The positive predictive value and sensitivity of over stage II were 96.6% and 84.8%, respectively. CONCLUSIONS The accuracy of preoperative diagnosis using both computed tomography and gastroscopy imaging may be feasible for T3/T4 advanced gastric stump cancer, whereas diagnosing T1/2 gastric stump cancer must be carefully considered due to high misdiagnosis rates, relating to depth.
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Affiliation(s)
- Takashi Kiyokawa
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Takeo Fukagawa
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Shinya Kaneshiro
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Yuuichi Igarashi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Naruyoshi Soeda
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Yoshimasa Kumata
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Masahiro Horikawa
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Yuko Sasajima
- Department of Pathology, Teikyo University Hospital, Tokyo , Japan
| | - Keiji Matsuda
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Ryoji Fukushima
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Teikyo University, Tokyo, Japan
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Liu H, Liu Y, Zhao L, Li X, Zhang W. Preprocedural fasting for contrast-enhanced CT: when experience meets evidence. Insights Imaging 2021; 12:180. [PMID: 34865183 PMCID: PMC8643287 DOI: 10.1186/s13244-021-01131-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022] Open
Abstract
Traditional preparatory fasting policy prior to iodinated contrast media (ICM) assisted contrast-enhanced CT (CECT) examinations lacks methodologically acceptable evidence. Considering the possible negative effects of preprocedural fasting, the latest European Society of Urogenital Radiology guidelines V10.0 and American Committee of Radiology 2021 guidelines clearly state that preprocedural fasting is not recommended prior to routine intravenous ICM administration. This comprehensive and detailed Review presents the current global dietary preparation policies, potential harm of excessive fasting, and a systematical and well-bedded description of practice advancements of dietary preparation. The evidences revealed that there has been no single instance of vomiting-associated aspiration pneumonia due to the undemanding implementation of preparatory fasting prior to CECT yet. Non-fasting would not increase the incidence of emetic symptoms and the risk of aspiration pneumonia. Not every patient should undergo all CECT examinations without preparatory fasting. There is still much more refinement to be done on the preparatory fasting policy. Changes in traditional preparatory fasting policy will make positive and significant implications on clinical practice. This Review aims to provide operational guidance and suggestions for practitioners and policymakers, motivate efficient, reasonable, safe and normative ICM usage, and achieve optimal patient clinical benefits and high-quality radiological care practices.
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Affiliation(s)
- Heng Liu
- Department of Radiology, PLA Rocket Force Characteristic Medical Center, No. 16 Xinjiekou Outer Street, Beijing, 100088, China.,Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China
| | - Yu Liu
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Li Zhao
- Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China
| | - Xue Li
- Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China.
| | - Weiguo Zhang
- Department of Radiology, Daping Hospital, Army Medical University, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, China. .,Chongqing Clinical Research Center for Imaging and Nuclear Medicine, Chongqing, 400042, China.
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Onoda H, Tanabe M, Higashi M, Kawano Y, Ihara K, Miyoshi K, Ito K. Assessment of gastric wall structure using ultra-high-resolution computed tomography. Eur J Radiol 2021; 146:110067. [PMID: 34847396 DOI: 10.1016/j.ejrad.2021.110067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/14/2021] [Accepted: 11/21/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the image quality of ultra-high-resolution CT (U-HRCT) in the comparison among four different reconstruction methods, focusing on the gastric wall structure, and to compare the conspicuity of a three-layered structure of the gastric wall between conventional HRCT (C-HRCT) and U-HRCT. METHOD Our retrospective study included 48 patients who underwent contrast-enhanced U-HRCT. Quantitative analyses were performed to compare image noise of U-HRCT between deep-learning reconstruction (DLR) and other three methods (filtered back projection: FBP, hybrid iterative reconstruction: Hybrid-IR, and Model-based iterative reconstruction: MBIR). The mean overall image quality scores were also compared between the DLR and other three methods. In addition, the mean conspicuity scores for the three-layered structure of the gastric wall at five regions were compared between C-HRCT and U-HRCT. RESULTS The mean noise of U-HRCT with DLR was significantly lower than that with the other three methods (P < 0.001). The mean overall image quality scores with DLR images were significantly higher than those with the other three methods (P < 0.001). Regarding the comparison between C-HRCT and U-HRCT, the mean conspicuity scores for the three-layered structure of the gastric wall on U-HRCT were significantly better than those on C-HRCT in the fornix (5 [5-5] vs. 3.5 [3-4], P < 0.001), body (4 [3.25-5] vs. 4 [3-4], P = 0.039), angle (5 [4-5] vs. 3 [2-4], P < 0.001), and antral posterior (4 [3.25-5] vs. 2 [2-4], P < 0.001), except for antral anterior (4 [3-5] vs. 3 [3-4], P = 0.230) CONCLUSION: U-HRCT using DLR improved the image noise and overall image quality of the gastric wall as well as the conspicuity of the three-layered structure, suggesting its utility for the evaluation of the anatomical details of the gastric wall structure.
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Affiliation(s)
- Hideko Onoda
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Mayumi Higashi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Yosuke Kawano
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Kenichiro Ihara
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Keisuke Miyoshi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
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Performance of a machine learning-based decision model to help clinicians decide the extent of lymphadenectomy (D1 vs. D2) in gastric cancer before surgical resection. Abdom Radiol (NY) 2019; 44:3019-3029. [PMID: 31201432 DOI: 10.1007/s00261-019-02098-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Controversy still exists on the optimal surgical resection for potentially curable gastric cancer (GC). Use of radiologic evaluation and machine learning algorithms might predict extent of lymphadenectomy to limit unnecessary surgical treatment. We purposed to design a machine learning-based clinical decision-support model for predicting extent of lymphadenectomy (D1 vs. D2) in local advanced GC. METHODS Clinicoradiologic features available from routine clinical assignments in 557 patients with GCs were retrospectively interpreted by an expert panel blinded to all histopathologic information. All patients underwent surgery using standard D2 resection. Decision models were developed with a logistic regression (LR), support vector machine (SVM) and auto-encoder (AE) algorithm in 371 training and tested in 186 test data, respectively. The primary end point was to measure diagnostic performance of decision model and a Japanese gastric cancer treatment guideline version 4th (JPN 4th) criteria for discriminate D1 (pT1 + pN0) versus D2 (≥ pT1 + ≥ pN1) lymphadenectomy. RESULTS The decision model with AE analysis produced highest area under ROC curve (train: 0.965, 95% confidence interval (CI) 0.948-0.978; test: 0.946, 95% CI 0.925-0.978), followed by SVM (train: 0.925, 95% CI 0.902-0.944; test: 0.942, 95% CI 0.922-0.973) and LR (train: 0.886, 95% CI 0.858-0.910; test: 0.891, 95% CI 0.891-0.952). By this improvement, overtreatment was reduced from 21.7% (121/557) by treat-all pattern, to 15.1% (84/557) by JPN 4th criteria, and to 0.7-0.9% (4-5/557) by the new approach. CONCLUSIONS The decision model with machine learning analysis demonstrates high accuracy for identifying patients who are candidates for D1 versus D2 resection. Its approximate 14-20% improvements in overtreatment compared to treat-all pattern and JPN 4th criteria potentially increase the number of patients with local advanced GCs who can safely avoid unnecessary lymphadenectomy.
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Li CF, Zheng J, Xue YW. The value of contrast-enhanced computed tomography in predicting gastric cancer recurrence and metastasis. Cancer Biomark 2017; 19:327-333. [PMID: 28482620 DOI: 10.3233/cbm-160528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Chun-Feng Li
- A Gastrointestinal Surgical Ward, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang, China
- A Gastrointestinal Surgical Ward, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang, China
| | - Jian Zheng
- A Gastrointestinal Surgical Ward, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang, China
- A Gastrointestinal Surgical Ward, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang, China
| | - Ying-Wei Xue
- Department of Diagnostic Radiology, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang, China
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Yan C, Bao X, Shentu W, Chen J, Liu C, Ye Q, Wang L, Tan Y, Huang P. Preoperative Gross Classification of Gastric Adenocarcinoma: Comparison of Double Contrast-Enhanced Ultrasound and Multi-Detector Row CT. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1431-1440. [PMID: 27072076 DOI: 10.1016/j.ultrasmedbio.2016.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/25/2015] [Accepted: 01/23/2016] [Indexed: 06/05/2023]
Abstract
The aim of this study was to compare the accuracy of multi-detector computed tomography (MDCT) with double contrast-enhanced ultrasound (DCEUS), in which intravenous microbubbles are used alongside oral contrast-enhanced ultrasound, in determining the gross classification of patients with gastric carcinoma (GC). Altogether, 239 patients with GC proved by histology after endoscopic biopsy were included in this study. DCEUS and MDCT were performed pre-operatively. The diagnostic accuracies of DCEUS and MDCT in determining the gross classification were calculated and compared. The overall accuracy of DCEUS in determining the gross appearance of GC was higher than that of MDCT (84.9% vs. 79.9%, p < 0.001). There was no significant difference in accuracy between DCEUS and MDCT for Borrmann I and IV classifications of advanced gastric cancer (χ(2), p = 0.323 for Borrmann type I, p = 0.141 for Borrmann type IV). The accuracy of DCEUS for early GC and Borrmann II and III classifications of GC was higher than that of MDCT (χ(2), p = 0.000 for all). DCEUS may be regarded as a valuable complementary tool to MDCT in determining the gross appearance of gastric adenocarcinoma pre-operatively.
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Affiliation(s)
- Caoxin Yan
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Xiaofeng Bao
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Weihui Shentu
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Jian Chen
- Department of Surgery, The 2nd Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Chunmei Liu
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Qin Ye
- Department of Pathology, The 2nd Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Liuhong Wang
- Department of Radiology, The 2nd Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Yangbin Tan
- Department of Radiology, The 2nd Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Pintong Huang
- Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China.
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Liu S, He J, Guan W, Li Q, Yu H, Zhou Z, Bao S, Zhou Z. Added value of diffusion-weighted MR imaging to T2-weighted and dynamic contrast-enhanced MR imaging in T staging of gastric cancer. Clin Imaging 2013; 38:122-8. [PMID: 24411204 DOI: 10.1016/j.clinimag.2013.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/22/2013] [Accepted: 12/04/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the utilization of diffusion-weighted (DW) magnetic resonance (MR) imaging in T staging of gastric cancer prospectively. METHODS Fifty-one patients underwent T2-weighted (T2W), contrast-enhanced (CE) and DW MR imaging. Two radiologists independently interpreted the images for T staging of the tumors. RESULTS The overall accuracy of T staging in pT1-4 gastric cancers by T2W+CE+DW (88.2%) was significantly higher than that by T2W+CE and T2W+DW (both 76.5%, P=.031). CONCLUSION DW adds useful information to T2W and CE MR imaging in T staging of gastric cancer.
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Affiliation(s)
- Song Liu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Wenxian Guan
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Qiang Li
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Haiping Yu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Zhuping Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Shanhua Bao
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008.
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Lee BY, Ok JJ, Abdelaziz Elsayed AA, Kim Y, Han DH. Preparative Fasting for Contrast-enhanced CT: Reconsideration. Radiology 2012; 263:444-50. [DOI: 10.1148/radiol.12111605] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lin JW, Huang SR, Wu DB, Xu S, Zhong XG, Zhou XY. Value of 64-slice spiral CT triple-phase enhanced scanning for preoperative evaluation of lymph node dissection in patients with gastric cancer. Shijie Huaren Xiaohua Zazhi 2012; 20:596-600. [DOI: 10.11569/wcjd.v20.i7.596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the value of 64-slice spiral computed tomography (CT) triple-phase enhanced scanning for preoperative evaluation of lymph node dissection in patients with gastric cancer.
METHODS: Thirty-eight patients with gastric cancer underwent preoperative 64-slice spiral CT triple-phase enhanced scanning to comprehend the anatomic distribution of the celiac trunk, its three branches and their tributaries (common hepatic artery, right hepatic artery, left hepatic artery, splenic artery, and left gastric artery) through volume rendering and three dimensional vascular imaging. The lymph nodes were detected using group orientation method, and N staging was performed to compare with postoperative pathological results.
RESULTS: Surgical results verified that 64-slice spiral CT triple-phase enhanced scanning through volume rendering and three dimensional vascular imaging had an accuracy rate of 100% in preoperative evaluation of the distribution of the celiac trunk, its three branches and their tributaries. Compared to postoperative pathological results, the accuracy rate was 92.1% (35/38) in evaluating perigastric lymph node metastasis, and 71.4% (5/7), 62.5% (5/8), 81.82% (9/11), 75% (6/8), 25% (1/4) and 68.42% (26/38) in preoperatively evaluating stages N0-N3b and N gastric cancer, respectively.
CONCLUSION: Preoperative 64-slice spiral CT triple-phase enhanced scanning is an objective way to assess the distribution of the celiac artery trunk and related tributaries in patients with gastric cancer, and it allows to reliably judge whether there is perigastric lymph node metastasis and can guide intraoperative lymph node dissection and reduce intraoperative injury to the artery.
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CT features and quantification of the characteristics of adrenocortical carcinomas on unenhanced and contrast-enhanced studies. Clin Radiol 2011; 67:38-46. [PMID: 21783181 DOI: 10.1016/j.crad.2011.03.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 03/02/2011] [Accepted: 03/08/2011] [Indexed: 01/11/2023]
Abstract
AIM To describe the morphological and contrast-agent washout characteristics of adrenocortical carcinomas (ACCs) on computed tomography (CT). MATERIALS AND METHODS Forty-one patients with histopathologically proven ACCs were retrospectively evaluated. The morphological characteristics of the ACCs were documented and compared with surgical and histopathological findings. The percentage of contrast agent enhancement washout (PEW) and relative PEW (RPEW) were calculated for 17 patients who had the combination of unenhanced, portal venous, and 15 min delayed phase images. RESULTS Characteristic imaging findings of ACCs included large size (38 of 41 tumours were >6 cm), well-defined margin with a thin enhancing rim (25 patients), and central stellate area of low attenuation on contrast-enhanced CT images (21 patients). Tumour extension into the inferior vena cava (IVC) with associated thrombus was identified on CT in six (14.6%) patients. Of 17 tumours evaluated, 12 (71%) had a PEW value of ≤60%, and 14 (82%) had an RPEW value of ≤40%. CONCLUSION Large size, a well-defined margin with a thin enhancing rim, central low attenuation, and a predilection for extension into the IVC are typical morphological characteristics of ACC on CT. The contrast-washout characteristics of ACCs, in concordance with their malignant nature, share those of non-adenomas rather than adenomas.
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Huang P, Li S, Aronow WS, Wang Z, Nair CK, Xue N, Shen X, Chen C, Cosgrove D. Double contrast-enhanced ultrasonography evaluation of preoperative Lauren classification of advanced gastric carcinoma. Arch Med Sci 2011; 7:287-93. [PMID: 22291769 PMCID: PMC3258721 DOI: 10.5114/aoms.2011.22080] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 03/28/2010] [Accepted: 05/16/2010] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The clinical value of double contrast-enhanced ultrasonography (DCUS) in determining the Lauren classification of advanced gastric carcinoma needed investigation. MATERIAL AND METHODS Fifty-eight patients with gastric cancer proved by endoscopic biopsy underwent preoperative DCUS examination in which an oral contrast agent was combined with an intravenous agent, and the findings were compared with the postoperative pathological findings using haematoxylin-eosin and Alcian Blue-Periodic Acid Schiff (AB-PAS) staining. RESULTS Of 58 patients, 34 (59%) were the intestinal type and 24 (41%) the diffuse type on pathological examination of resected specimens. Among intestinal type patients, 30 (88%) showed homogeneous vascular enhancement and 4 (12%) heterogeneous enhancement with the "sandwich" pattern in 2 patients (50%) and "barrier" pattern in 2 patients (50%). In the diffuse type, 22 of 24 patients (92%) enhanced heterogeneously, with stippled and peripheral enhancement in 9 (41%), the "sandwich" pattern in 8 (36%) and "barrier" pattern in 5 (23%). Two of 24 patients (8%) with the diffuse type enhanced homogeneously. The proportion of heterogeneous enhancement was significantly different between the 2 subtypes of tumour (p = 0.0001). The sensitivity and specificity of heterogeneous enhancement in diagnosing the diffuse type of advanced gastric cancer were 92% and 88%, respectively. Youden's index was 0.8. CONCLUSIONS Double contrast-enhanced ultrasonography is a new and useful method to determine Lauren classification in patients with gastric carcinoma.
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Affiliation(s)
- Pintong Huang
- Department of Ultrasonography, the 2 Affiliated Hospital of Zhejiang University, Zhejiang, China
| | - Shiyan Li
- Department of Ultrasonography, the 2 Affiliated Hospital of Zhejiang University, Zhejiang, China
| | | | - Zongmin Wang
- Department of Ultrasonography, the 2 Affiliated Hospital of Zhejiang University, Zhejiang, China
| | | | - Nianyu Xue
- Department of Ultrasonography, the 2 Affiliated Hospital of Zhejiang University, Zhejiang, China
| | - Xuedong Shen
- Cardiac Center of Creighton University, Omaha, USA
| | - Chengchun Chen
- Department of Ultrasonography, the 2 Affiliated Hospital of Zhejiang University, Zhejiang, China
| | - David Cosgrove
- Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, United Kingdom
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Hypervascular gastric masses: CT findings and clinical correlates. AJR Am J Roentgenol 2011; 195:W415-20. [PMID: 21098173 DOI: 10.2214/ajr.10.4575] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This article focuses on masses that are hypervascular on IV contrast-enhanced CT. CONCLUSION The rising use of dual-phase IV contrast-enhanced CT will result in an increase in incidental detection of hypervascular gastric masses. Radiologists must be aware of the range of abnormalities that may appear as a hyperenhancing gastric mass because the differential diagnosis includes both benign and malignant lesions.
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Lee IJ, Lee JM, Kim SH, Shin CI, Lee JY, Kim SH, Han JK, Choi BI. Diagnostic performance of 64-channel multidetector CT in the evaluation of gastric cancer: differentiation of mucosal cancer (T1a) from submucosal involvement (T1b and T2). Radiology 2010; 255:805-14. [PMID: 20501718 DOI: 10.1148/radiol.10091313] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To identify the computed tomographic (CT) findings in T1a and T1b cancers and to evaluate the diagnostic performance of multidetector CT with two-dimensional multiplanar reconstruction and three-dimensional CT gastrography for evaluating the preoperative staging of gastric cancer, with special emphasis on the differentiation between T1a and T1b cancers. MATERIALS AND METHODS The institutional review board approved this retrospective study. A total of 148 patients with gastric cancer (64 T1a, 36 T1b, and 48 T2) were included. To identify CT findings in T1a and T1b cancers, two radiologists in consensus interpreted the preoperative CT images of the 100 T1 cancers to determine the morphologic characteristics to be used as staging criteria on CT images. By using univariate and multiple logistic regression analyses, the diagnostic criteria to identify T1a and T1b cancers were developed. To evaluate the diagnostic performance of multidetector CT by using the criteria, two other blinded reviewers independently analyzed the CT images of all 148 patients to assess the T (classifying the depth of invasion as T1a, T1b, or T2) and N (classifying nodal involvement as absent or present) stage. CT staging was correlated with histopathologic results. Interobserver agreement was assessed by using weighted kappa statistics. RESULTS The detectability of T1b cancer was significantly higher than that of T1a cancer (P = .003). T1b cancer showed well-enhancing mucosal thickening more frequently than did T1a cancer (P = .002). By using the modified CT criteria, the overall accuracy values of T staging and N staging were 64.9% (96/148) and 79.1% (117/148) for reviewer 1 and 63.5% (94/148) and 83.8% (124/148) for reviewer 2, respectively. Weighted kappa values of T and N staging were 0.795 and 0.641, respectively. CONCLUSION On multidetector CT images, T1a cancer shows different imaging features than does T1b cancer regarding enhancing characteristics and detectability. Multidetector CT provides relatively valuable results of T and N staging, including differentiation between T1a, T1b, and T2 gastric cancers.
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Affiliation(s)
- In Joon Lee
- Department of Radiology, Seoul National University Hospital, 28 Yeongon-dong, Jongno-gu, Seoul 110-744, Korea
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Cidón EU, Cuenca IJ. Gastric Adenocarcinoma: Is Computed Tomography (CT) Useful in Preoperative Staging? Clin Med Oncol 2009; 3:91-7. [PMID: 20689615 PMCID: PMC2872601 DOI: 10.4137/cmo.s2641] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Although multiple studies testing the accuracy of CT in the preoperative staging of gastric adenocarcinoma have been carried out, their results are controversial. Whilst some authors claim that CT is an accurate method for preoperatively staging gastric cancer, others have advocated the contrary. Because of this discrepancy we have retrospectively reviewed preoperative CT findings compared with histopathological results in patients with gastric adenocarcinoma. PATIENTS AND METHODS Seventy-two patients diagnosed with gastric cancer who underwent potentially curative surgery and preoperative staging CT of quality were included in the study. The size, gastric wall thickening, presence of lymphadenopathy, adjacent organ invasion and location of the gastric mass was recorded. Early tumors (T1 and T2) and more advanced tumors (T3 and T4) were grouped together. CT staging was correlated with the final histopathological stage (TNM). The global results were expressed as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS Seventy-two cases were included with fifty-five being male and a median age of 67 years (range 33-91). CT correctly identified the location of the tumor in 56 (53% antropyloric, 18% subcardial). Median time from CT scan to surgery was fourteen days (range 2-49). In T detection: T1/T2 and T3/T4 with sensitivity of 70% and 61%. Lymph node involvement: Sensitivity 49%. Overstaged in 47% Understaged in 75%. Specificity of 53%. Nine patients with colon-mesocolon (5 patients) and pancreas (4 patients) invasion. Sensitivity 44% and specificity 96%. CONCLUSION Spiral CT is not an accurate method in predicting preoperative stages in gastric cancer.
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Affiliation(s)
- Esther Uña Cidón
- Department of Medical Oncology, Clinical University Hospital, s/n C/Ramón y Cajal, 47005 Valladolid, Spain
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