Contribution of DECT in detecting serosal invasion of gastric cancer

Abstract

Purpose: To investigate the relationship between the iodine concentration (IC) of perigastric fat tissue as assessed by dual-energy computed tomography (DECT) and serosal invasion of gastric cancer. Materials and methods: A total of 41 patients underwent preoperative staging evaluation for gastric cancer using DECT between July 2015 and March 2018. Patients were divided into two groups based on pathology results: serosal invasion (stage T4a) and intact serosa (stage T1?T3). Cut-off values, the diagnostic efficacy of IC in the perigastric fat tissue, and the perigastric fat tissue/tumor (P/T) ratio were determined. Results: Among the 41 patients, 22 had stage T4a gastric cancer, and 19 patients had gastric cancer with a stage lower than T4a. The mean IC of perigastric fat tissue and the P/T ratio were significantly higher in patients with serosal invasion than in those with intact serosa (p<0.001). During the arterial phase, the area under the curve (AUC) was 0.915 and 0.854 for the IC of perigastric fat tissue and the P/T ratio, respectively. During the venous phase, the AUC was 0.890 and 0.876 for the IC of perigastric fat tissue and the P/T ratio, respectively. Conclusion: The IC in the perigastric fat tissue seems to be a reliable indicator for serosal invasion of gastric cancer.

Assessment of a single‐pass venous phase CT chest, abdomen and pelvis and dual‐energy CT in general oncology outpatients

“…The use of DECT in a subset of patients showed a statistically significant increase in the conspicuity of sub‐centimetre and larger liver lesions by both readers. Most prior publications have assessed the benefit of DECT in a single primary diagnosis 24–30 and this study demonstrates the benefit of twin beam DECT across a range of primary cancers. The most frequent benefit was in hypovascular colorectal metastases, but increased conspicuity was also seen across a range of primaries including pancreas, breast, melanoma and hypervascular hepatocellular and neuroendocrine tumours.…”

Gastrointestinal Applications of Iodine Quantification Using Dual-Energy CT: A Systematic Review

“…Among these four studies, there seemed to be no correlation with TNM classification of malignant tumors. However, studies investigating IC in perigastric adipose tissue among gastric cancer patients [ 40 , 41 , 42 , 43 ] found a significant difference between patients with (T4) and without serosal invasion (T1-T3). Additionally, a study by Cheng et al [ 44 ] noted a significant difference between early (confined to mucosa/submucosa) vs. advanced gastric cancer (invasion of the submucosa) in nIC-V and nIC in delayed phase (nIC-D) with ROI placement on the gastric mass.…”

“…One of the most convincing DECT applications for gastrointestinal imaging is probably related to the differentiation of T1–3 vs. T4 stage gastric cancer based on IC measurements in the perigastric adipose tissue as seen in Table 1 [ 40 , 41 , 42 , 43 ]. An additional finding was the correlation between IC and varying degrees of cell differentiation in adenocarcinoma.…”

Effect of visceral adipose tissue on the accuracy of preoperative T-staging of gastric cancer

“…For the stomach, colorectal and other hollow organs, the accuracy of CT in the diagnosis of serous invasion of stomach wall and intestinal wall is not high, mainly because the imaging manifestations of tumor invasion, carcinomatous lymphangitis and inflammatory reaction around the tumor are not easy to distinguish. At present, the main basis for judging serosal involvement is the abnormal enhancement of serosal area and the turbidity of peristomach fatty tissue [21,22]. The content of visceral fat in patients is decreased, which is directly reflected in the reduction of low-density fat areas around the stomach cavity in CT images.…”