November 21, 2008

Gastric Cancer on CT

Figure: Axial CT shows thickening (arrows) and mucosal enhancement of the lesser curvature of the stomach in a patient with known gastric carcinoma. The fat plane is preserved. No lymphadenopathy is seen.

Gastric Carcinoma

  • Etiology: atrophic gastritis, adenomatous polyp, Lynch syndromes, gastric stump cancer, Menetrier's disease
  • Usually present in advanced stage
  • Major determination of staging of gastric carcinoma = extent of tumor beyond gastric wall and lymph node involvement
  • CT usually used to determine presence and extent of perigastric spread
Gastric Carcinoma on CT
  • Wall thickening, soft tissue mass (polypoid or ulcerated mass), perigastric fat stranding, lymphadenopathy
  • Differentiation from lymphoma: lymphoma usually has a very thick wall, no perigastric stranding, and bulky lymph nodes
  • CT accuracy for staging is better with multiplanar reformations (coronal and sagittal), better for T staging than N staging
T Staging by CT
  • T1 lesion = focal thickening of the inner layer of the wall
  • T2 lesion = transmural thickening of the wall without or with minimal perigastric stranding
  • T3 lesion = blurring of at least 1/3 of tumor extent or wide reticular stranding around tumor border
  • T4 lesion = invasion of adjancent organ or fat plane obliteration between tumor and adjacent organ
  • Accuracy based on this description was 77% in one study, when axial + MPR images were used
Hur J, et al. Diagnostic accuracy of multidetector row computed tomography in T- and N staging of gastric adenocarcinoma with histopathologic correlation. J Comput Assist Tomogr 2006 (May/June)

1 comment:

Anonymous said...

great post!

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