Das Magenkarzinom - Stellenwert der bildgebenden Verfahren für Primärdiagnose und präoperatives Tumorstaging -

Abstract

The aim of imaging of gastric carcinoma has to be to diagnose the carcinoma as early as possible and to sort out the tumors that are resectable. At the same time imaging of gastric carcinoma should reduce the number of futile laparotomies in patients with advanced, non-resectable tumors to a minimum. Today, endoscopy is the method of choice to diagnose gastric carcinoma. Endosonography is advantageous if small carcinomas have to be judged for depth of tumor infiltration (early gastric carcinoma vs. advanced gastric carcinoma) because high resolution images of the gastric wall are obtained. Staging of large carcinomas that have grown beyond the gastric wall is best performed by hydro-CT because CT scans most accurately delineate infiltrations of surrounding organs/structures and help to plan surgery. Nowadays MRI is not suited for gastric imaging. MRI, however, has the highest potential to fundamentally improve staging of gastric carcinoma if high resolution imaging of the gastric wall is combined with screening for metastases in one examination.

CT/MRI accuracy in detecting and determining preoperative stage of gastric adenocarcinoma in Albania

“…Some studies [ 48 – 50 ] suggested that CT had a higher accuracy in detecting metastases. Our study agrees with those authors [ 35 , 42 , 48 ] that concluded that MRI has a higher accuracy in detecting metastases. One author concluded that while MRI was a good method for detecting hepatic metastases while EUS was more suitable to detect peritoneal metastases.…”

“…Our study concluded that there are no differences in the accuracy of detecting the N classification between CT and MRI. This conclusion is the same as what is reported by several authors [ 39 , 42 – 44 ]. So far, no other publication that we could identify suggested that CT is more accurate, and only one author [ 45 ] suggested that MRI was better for identification of the N classification.…”

Clinical value of magnetic resonance imaging in preoperative T staging of gastric cancer and postoperative pathological diagnosis

“…These were the necessary methods to confirm the identification, location and characteristic diagnosis of gastric cancer. These methods were unable to directly reveal the stomach structure, were limited in identifying the invasion depth of the gastric wall, extra-stomach infiltration and metastasis, however, they aided to a certain extent with the qualitative diagnosis of cavity lesions (1). Recently, diagnosis has been improved by the application of the endoscopic ultrasound (EUS) and multislice computed tomography (MSCT), which clearly exhibit the location, size and shape of stomach tumors, and determine the extent of tumor invasion, lymph node metastasis and distant organ metastasis.…”