Comparing MR Imaging and CT in the Staging of Gastric Carcinoma

Sohn, Kyung-Myung; Lee, Jae Mun; Lee, Sung-Yong; Ahn, Bo Young; Park, Seungman; Kim, Kyoung‐Mee

doi:10.2214/ajr.174.6.1741551

Cited by 156 publications

(105 citation statements)

References 11 publications

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“…The reported accuracy rate is approximately 51%-59% (Dux et al 1999;Sohn et al 2000), and the staging of early gastric cancer is far from satisfactory. Newly developed PET-CT technology using computer software can fuse the PET metabolic-change image with the 3D image of the corresponding anatomical location in the CT image, thus achieving both qualitative and positioning diagnosis in one examination (Townsend and Beyer 2002).…”

Section: Discussionmentioning

confidence: 99%

Accurate Preoperative Staging of Gastric Cancer with Combined Endoscopic Ultrasonography and PET-CT

Zheng

Zhu

et al. 2012

Tohoku J. Exp. Med.

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Accurate staging of gastric cancer is helpful to determine the most appropriate therapy, but no staging modality has been accepted as the standard. Objective is to evaluate the usefulness of endoscopic ultrasonograph (EUS) combined with position emission tomography and computed tomograph (PET-CT) in gastric cancer staging. A total of 124 patients confirmed with gastric cancer were subjected to staging with EUS and PET-CT scanning. The detection rate of primary tumor was 99.2% by combination use of two modalities and 97.6% by EUS alone ( p = 0.6219), but the detection rate was 90.3% (112 of 124) by PET-CT alone (compared with the combination, p = 0.0027; compared with EUS alone, p = 0.0299). The locoregional lymph node invasion was identified in 84/124 (67.7%) by combined PET-CT and EUS, which was obviously higher than that with EUS (52.4%) or PET-CT (43.5%) alone ( p = 0.0194 and p = 0.0002, respectively). There was no statistical difference in identification of celiac axis lymph node metastasis among three methods, but the combined examination or PET-CT alone was more effective than EUS alone in the detection of distant metastases (all p < 0.01). Furthermore, the combined EUS and PET-CT was more optimal than using EUS or PET-CT alone in the accurate T and N staging and the effect on change of treatment. The present study indicates that the combination of EUS and PET-CT is an ideal modality in the preoperative staging of gastric cancer and it provides beneficial guidance for the treatment of gastric cancer.

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Section: Discussionmentioning

confidence: 99%

Accurate Preoperative Staging of Gastric Cancer with Combined Endoscopic Ultrasonography and PET-CT

Zheng

Zhu

et al. 2012

Tohoku J. Exp. Med.

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“…In the evaluation of regional lymph nodes in gastric cancer, various imaging modalities, such as computed tomography (CT), endoscopic ultrasonography (EUS), and conventional magnetic resonance imaging (MRI) have been used, with lymph nodes assessed according to size or morphologic criteria. The reported accuracy of CT, EUS, and conventional MRI for the N-staging of gastric cancer was 43%-80%, 65%-87%, and 34%-65%, respectively, and this level of diagnostic perfor- mance was not suffi cient for making a decision among treatment strategies for gastric cancer [4][5][6][7][8][9][10][11][12][13]. Recently, a lymphographic contrast medium of iron-containing nanoparticles, referred to as ultrasmall superparamagnetic iron oxide (USPIO), has received attention in the evaluation of lymph nodes in various types of malignancy, such as neck, prostatic, rectal esophageal, breast, and gastric cancers [14][15][16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, precise lymph-node staging greatly infl uences the decision on the mode of treatment. For the evaluation of regional lymph nodes in gastric cancer, the nodes have generally been defi ned according to size or morphologic criteria in several imaging modalities, such as computed tomography (CT), endoscopic ultrasonography (EUS), and conventional magnetic resonance imaging (MRI), but these methods have not been confi rmed as suffi ciently effective [4][5][6][7][8][9][10][11][12][13]. Recently, the use of ultrasmall superparamagnetic iron oxide (USPIO), which is a lympho-graphic contrast medium for MR imaging, has been of interest in the evaluation of lymph nodes in patients with neck, prostatic, rectal, esophageal, breast, and gastric cancers [14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of lymph node metastases in gastric cancer using magnetic resonance imaging with ultrasmall superparamagnetic iron oxide (USPIO): diagnostic performance in post-contrast images using new diagnostic criteria

et al. 2008

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“…Therefore, while the pre-operative T staging ability of MRI is highly accurate, a publication bias may be present, as all 3 studies reported excellent results (compared to the literature found on CT scans which included publication of poor results), which may have caused an overestimation of its performance abilities. Furthermore, current MRI protocols are breath-hold-dependent [12,13,36,49,51]; as such, it is possible that the patient cohorts included in these studies were better able to comply than the gastric cancer population as a whole.…”

Section: Evaluation Of T Stagingmentioning

confidence: 99%

How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis

et al. 2011

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Background Surgery is the fundamental curative option for gastric cancer patients. Imaging scans are routinely prescribed in an attempt to stage the disease prior to surgery. Consequently, the correlation between radiology exams and pathology is crucial for appropriate treatment planning. Methods Systematic searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 1, 2009. We calculated the accuracy, overstaging rate, understaging rate, Kappa statistic, sensitivity, and specificity for abdominal ultrasound (AUS), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) with respect to the gold standard (pathology). We also compared the performance of CT by detector number and image type. A meta-analysis was performed. Results For pre-operative T staging MRI scans had better performance accuracy than CT and AUS; CT scanners using C4 detectors and multi-planar reformatted (MPR) images had higher staging performances than scanners with \4 detectors and axial images only. For pre-operative N staging PET had the lowest sensitivity, but the highest specificity among modalities; CT performance did not significantly differ by detector number or addition of MPR images. For pre-operative M staging performance did not significantly differ by modality, detector number, or MPR images. Conclusions The agreement between pre-operative TNM staging by imaging scans and post-operative staging by pathology is not perfect and may affect treatment decisions. Operator dependence and heterogeneity of data may Electronic supplementary material The online version of this article

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Comparing MR Imaging and CT in the Staging of Gastric Carcinoma

Abstract: MR imaging was comparable to helical CT in the T and N staging of gastric cancer.

Cited by 156 publications

References 11 publications

Accurate Preoperative Staging of Gastric Cancer with Combined Endoscopic Ultrasonography and PET-CT

Accurate Preoperative Staging of Gastric Cancer with Combined Endoscopic Ultrasonography and PET-CT

Evaluation of lymph node metastases in gastric cancer using magnetic resonance imaging with ultrasmall superparamagnetic iron oxide (USPIO): diagnostic performance in post-contrast images using new diagnostic criteria

How useful is preoperative imaging for tumor, node, metastasis (TNM) staging of gastric cancer? A meta-analysis

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