Evaluation of Early Gastric Cancer at Multidetector CT with Multiplanar Reformation and Virtual Endoscopy

Abstract

Early gastric cancer (EGC) is defined as a carcinoma in which invasion is limited to the mucosa and submucosa, regardless of lymph node status and distant metastasis. Recent advances in multidetector computed tomography (CT) with multiplanar reformation (MPR) provide a powerful tool for identifying gastric wall invasion and the perigastric extent of gastric cancer. In addition, MPR images confer advantages in the assessment of both intra- and extraluminal processes of the gastric wall and the evaluation of more distant regions, such as the paraaortic lymph nodes and other abdominal organs. Virtual endoscopy performed after air distention of the stomach can aid in the evaluation of gastric endoluminal morphologic features and the extent of EGC. Moreover, virtual endoscopy helps in detecting subtle mucosal changes and differentiating them from submucosal lesions in the same way as conventional endoscopy. Virtual endoscopy can depict abnormal endoluminal lesions within a wider field of view than can conventional endoscopy, and there are no "blind spots" because retrospective image reformation is available, which provides useful information for preoperative mapping. Multidetector CT with MPR and virtual endoscopy is a powerful, noninvasive tool for the early detection and accurate preoperative staging of EGC.

Comparison of18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography, Hydro-Stomach Computed Tomography, and Their Combination for Detecting Primary Gastric Cancer

“…3 tion and staging patients with gastric cancer. However, its use for detecting gastric cancer is limited because CT has a primary tumor detection rate of 85-95% in patients with AGC (1,11,12) cal staging, and optimal surgical procedures are essential to improve prognosis (10).…”

“…EGC. Studies in which dynamic or multiphase scanning was used to evaluate EGC achieved detection rates of 44-93.5% (1,3,(13)(14)(15)(16)). In our study, sensitivities of 40.2% and 97.7% were observed in patients with EGC and AGC, respectively, using S-CT alone.…”

MDCT imaging of the stomach: advances and applications

“…10 The patient prognosis is based on the stage at which cancer is detected with 5-year survival of EGC ranging between 85 and 100% and AGC having 5-year survival of only 20%. 11 Hence, accurate pre-operative staging is very important for treatment planning and patient prognosis.…”

“…8 The Bormann classification that divides the tumour on the basis of relative exophytic and endophytic components ( Figure 2) is also used to describe EGC lesions on CT (and VE). 11 Based on the depth of wall involvement, gastric cancer is classified as early and advanced, with EGC signifying tumour limited to the mucosa and submucosa irrespective of lymph node involvement or distant metastases. As highlighted earlier, the patient prognosis with EGC is significantly better than that with AGC.…”

“…The Bormann classification is typically used to describe the lesion based on its morphologic characteristics. 11 It has been shown that Virtual Endoscopy (VE) is as good as conventional endoscopy for differentiation of benign and malignant gastric ulcers. 21,22 On conventional CT, the EGC appears as an elevated or depressed lesion that may show abnormal enhancement when the stomach is distended by the intraluminal negative contrast.…”