Evaluation of preoperative staging in advanced gastric cancer with MRI

Tang, Guoping; Guo, Qing-lu; Xin, Ping-Ping

doi:10.3748/wjg.v3.i2.95

Cited by 3 publications

(4 citation statements)

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“…The data were available in 8 US studies [ 21 - 27 , 29 ], 2 EUS studies [ 27 , 31 ], 18 CT studies [ 21 - 23 , 27 , 29 , 36 , 39 , 41 , 43 - 51 , 53 ], 2 MRI studies [ 37 , 38 ], and 4 18 F-FDG PET studies [ 35 , 36 , 41 , 42 ]. Meta-analysis was based on the bivariate model in the presence of significant heterogeneity.…”

Section: Resultsmentioning

confidence: 99%

“…Advantages of MRI over CT include the ability of generating significantly greater soft tissue contrast resolution, and the ability of removing the risk of iodinated contrast-induced nephropathy or ionizing radiation [ 64 ]. However only two eligible MRI studies [ 37 , 38 ] were identified in our review, and all from China, therefore the data were not combined. The two studies found that MRI had both high sensitivity and specificity in detecting liver metastasis.…”

Section: Discussionmentioning

confidence: 99%

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Imaging in assessing hepatic and peritoneal metastases of gastric cancer: a systematic review

2011

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BackgroundHepatic and peritoneal metastases of gastric cancer are operation contraindications. Systematic review to provide an overview of imaging in predicting the status of liver and peritoneum pre-therapeuticly is essential.MethodsA systematic review of relevant literatures was performed in Pubmed/Medline, Embase, The Cochrane Library and the China Biological Medicine Databases. QUADAS was used for assessing the methodological quality of included studies and the bivariate model was used for this meta-analysis.ResultsTotally 33 studies were included (8 US studies, 5 EUS studies, 22 CT studies, 2 MRI studies and 5 18F-FDG PET studies) and the methodological quality of included studies was moderate. The result of meta-analysis showed that CT is the most sensitive imaging method [0.74 (95% CI: 0.59-0.85)] with a high rate of specificity [0.99 (95% CI: 0.97-1.00)] in detecting hepatic metastasis, and EUS is the most sensitive imaging modality [0.34 (95% CI: 0.10-0.69) ] with a specificity of 0.96 (95% CI: 0.87-0.99) in detecting peritoneal metastasis. Only two eligible MRI studies were identified and the data were not combined. The two studies found that MRI had both high sensitivity and specificity in detecting liver metastasis.ConclusionUS, EUS, CT and 18F-FDG PET did not obtain consistently high sensitivity and specificity in assessing liver and peritoneal metastases of gastric cancer. The value of laparoscopy, PET/CT, DW-MRI, and new PET tracers such as 18F-FLT needs to be studied in future.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Imaging in assessing hepatic and peritoneal metastases of gastric cancer: a systematic review

2011

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“…Lymph node size and enhancing lymph node status were used by all studies included in the review as the criteria to define malignancy. 29,30 The inability to identify metastatic lymph node status with normal size may explain the insufficient diagnostic accuracy of MRI. Although the diagnostic performance of MRI for N staging is not better than T staging, this imaging modality can also help clinicians to consider the risk of patients with lymph node metastatic disease to select suitable pre-operative treatments.…”

Section: Discussionmentioning

confidence: 99%

“…We compared the pooled T (T3-4 vs T1-2) performance characteristics of MRI with DWI 9,22,24,25 to those without DWI 23,[26][27][28][29][30] to determine whether DWI could have helped preoperative staging performances (Table 4). However, we found that the summary results for T staging of GC (Table 4) showed no statistically significant difference between MRI with DWI and without DWI in sensitivity (p 5 0.279) and specificity (p 5 0.283).…”

Section: Subgroup Analysesmentioning

confidence: 99%

The utility of MRI for pre-operative T and N staging of gastric carcinoma: a systematic review and meta-analysis

Huang¹,

Xie²,

Guo³

et al. 2015

BJR

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Objective: To perform a meta-analysis and literature review regarding the diagnostic accuracy of MRI for pre-operative tumour depth invasion (T) and regional lymph node invasion (N) staging of gastric carcinoma (GC). Methods: Articles were identified through systematic search of Medline, PubMed, Cochrane Library, Web of Science, Springerlink and several Chinese databases. The study quality was assessed by the quality assessment for studies of diagnostic accuracy. 2 reviewers independently extracted and assessed the data from 11 eligible studies. A meta-analysis was then carried out. Subgroup and sensitivity analyses were also performed. Results: 11 studies (439 patients) were finally included in the current review. Among these studies, the significant evidence of heterogeneity was only discovered for Subgroup analyses showed that diffusion-weighted imaging was more helpful for T staging. Conclusion:The present systematic review suggests that MRI has a good diagnostic accuracy for pre-operative T staging of GC and should be widely used in clinical work. However, the ability for N staging is relatively poor on MRI. Advances in knowledge:In the pre-operative staging of GC, MRI was a useful tool and may enhance accuracy for the T staging of advanced GC.Gastric carcinoma (GC) is the fourth most common cancer and the second leading cause of cancer-related death with a 5-year survival rate of ,20% around the world. 1 The disease is more common in Asian countries, especially China, Japan and Republic of Korea.2,3 Accurate assessment of local tumour depth invasion (T) and regional lymph node invasion (N) plays an essential role in predicting prognosis and determining the most appropriate treatment planning. 4,5The pre-operative staging of GC has been based on a multimodality approach, such as endoscopic ultrasonography (EUS), CT, MRI and positron emission tomography (PET).6,7 EUS and CT have been widely used for GC staging in previous years.8 Of course, different imaging modalities have themselves relative merits. CT with ionized radiation requires the injection of iodine contrast medium.9 EUS is an invasive technique requiring sedation 1 and is highly operator dependent.10 PET highly depends upon the standardized uptake value and the pathological subtype of the cancer. 11MRI is a powerful imaging method with high soft-tissue contrast, with technical versatility for sequence selection and modification, and without ionizing radiation. However, it was unsuitable for the staging of GC owing to its long acquisition time and susceptibility to motion artefacts in previous years. With technology improved and shorter imaging time, these limitations have recently been partially overcome. 12Recently, there has been much research using MRI to assess pre-operative staging of GC. Nevertheless, the number of patients in each study has been insufficient, and the results varied among the articles. Also, the limited imaging field of view of MRI in a single session makes it difficult to stage the distant metastasis (M). 13Therefore, the o...

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Sclerotherapy Of Esophageal Varices In Severe Hemophilia A Patient And High Titer Inhibitor – Case Report

Szczepanik¹,

Dąbrowski²,

Szczepanik³

et al. 2015

Polish Journal of Surgery

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In cirrhotic hemophilia patients bleeding from esophageal varices is a serious clinical condition due to congenital deficiency of clotting factors VIII or IX, decreased prothrombin synthesis and hypersplenic thrombocytopenia. In hemophiliac with high-titer inhibitor bypassing therapy is required with activated prothrombin complex concentrates (aPCC) or recombinant activated coagulation factor VII (rFVIIa). Doses and duration treatment with these agents following endoscopic treatment of esophageal varices have not been yet established. Authors report the first case of a severe hemophilia A patient with high titer inhibitor (40 BU) treated with repeated injection sclerotherapy. The patient was admitted with symptoms of massive esophageal variceal hemorrhage ceased with emergency sclerotherapy. Bypassing therapy was administered with aPCC at initial dose of 72.5 U/kg and then with average daily dose of 162 U/kg through 5 days. To achieved a total eradication of esophageal varices the patient was then subjected to four elective sclerotherapy procedures. Two were covered by aPCC with daily dose of 120 U/kg and 145 U/kg for 4 and 3 days respectively and the following two procedures were covered by rFVIIa with the initial dose of 116 µg/kg and the next doses of 87 µg/kg administered every 3 hours in procedure day and every 4 hours on the next two days. During all procedures excellent hemostasis was achieved and no hemorrhagic or thromboembolic complications were observed. Bypassing regimen therapy with aPCC and rFVIIa we applied have been shown to be safe and effective in this patient subjected to sclerotherapy procedures.

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Evaluation of preoperative staging in advanced gastric cancer with MRI

Cited by 3 publications

References 6 publications

Imaging in assessing hepatic and peritoneal metastases of gastric cancer: a systematic review

Imaging in assessing hepatic and peritoneal metastases of gastric cancer: a systematic review

The utility of MRI for pre-operative T and N staging of gastric carcinoma: a systematic review and meta-analysis

Sclerotherapy Of Esophageal Varices In Severe Hemophilia A Patient And High Titer Inhibitor – Case Report

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