Stomach cancer CT: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 6: | Line 6: | ||
==Overview== | ==Overview== | ||
Abdominal CT scan may be helpful in the diagnosis of stomach cancer. | [[Abdomen|Abdominal]] [[Computed tomography|CT]] scan may be helpful in the diagnosis of stomach cancer. It is used to evaluate [[Metastasis|metastatic]] disease, especially [[hepatic]] or [[adnexa]]<nowiki/>l [[metastases]], [[ascites]], or distant nodal [[Spread of the cancer|spread]]. Integrated [[Positron emission tomography|PET/CT]] imaging can be useful to confirm [[malignant]] involvement of [[Computed tomography|CT]]-detected [[lymphadenopathy]]. A negative [[Positron emission tomography|PET CT]] is not helpful since even large tumors with a diameter of several centimeters can be falsely negative if the [[Tumor cell|tumor cells]] have a fairly low [[Metabolic rate|metabolic activity]]. | ||
==CT== | ==CT== | ||
* CT is | * [[Computed tomography|CT]] is procedure of choice used to assess the T [[Cancer staging|stage]] of the primary [[tumor]].<ref name="pmid3357941">{{cite journal| author=Sussman SK, Halvorsen RA, Illescas FF, Cohan RH, Saeed M, Silverman PM et al.| title=Gastric adenocarcinoma: CT versus surgical staging. | journal=Radiology | year= 1988 | volume= 167 | issue= 2 | pages= 335-40 | pmid=3357941 | doi=10.1148/radiology.167.2.3357941 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3357941 }}</ref> | ||
* It is | * It is used to evaluate [[Metastasis|metastatic]] disease, especially [[hepatic]] or [[adnexa]]<nowiki/>l [[metastases]], [[ascites]], or distant nodal spread. | ||
* Peritoneal metastases and hematogenous metastases smaller than 5 mm are frequently missed by CT in 20 percent of patients.<ref name="pmid19789243">{{cite journal| author=Kim SJ, Kim HH, Kim YH, Hwang SH, Lee HS, Park DJ et al.| title=Peritoneal metastasis: detection with 16- or 64-detector row CT in patients undergoing surgery for gastric cancer. | journal=Radiology | year= 2009 | volume= 253 | issue= 2 | pages= 407-15 | pmid=19789243 | doi=10.1148/radiol.2532082272 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19789243 }}</ref> | * [[Peritoneum|Peritoneal]] [[Metastasis|metastases]] and hematogenous [[Metastasis|metastases]] smaller than 5 mm are frequently missed by CT in 20 percent of patients.<ref name="pmid19789243">{{cite journal| author=Kim SJ, Kim HH, Kim YH, Hwang SH, Lee HS, Park DJ et al.| title=Peritoneal metastasis: detection with 16- or 64-detector row CT in patients undergoing surgery for gastric cancer. | journal=Radiology | year= 2009 | volume= 253 | issue= 2 | pages= 407-15 | pmid=19789243 | doi=10.1148/radiol.2532082272 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19789243 }}</ref> | ||
* | * [[Sensitivity (tests)|Sensitivity]] rates are from 65 to 97% and [[Specificity (tests)|specificity]] rates for regional [[Metastasis|metastases]] 49 to 90%.<ref name="pmid12592099">{{cite journal| author=Kienle P, Buhl K, Kuntz C, Düx M, Hartmann C, Axel B et al.| title=Prospective comparison of endoscopy, endosonography and computed tomography for staging of tumours of the oesophagus and gastric cardia. | journal=Digestion | year= 2002 | volume= 66 | issue= 4 | pages= 230-6 | pmid=12592099 | doi=10.1159/000068360 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12592099 }}</ref> | ||
Demonstration of lesions facilitated by negative [[Contrast agents|contrast agents:]]<ref>http://radiopaedia.org/articles/gastric-carcinoma</ref> | |||
Demonstration of lesions facilitated by negative contrast agents:<ref>http://radiopaedia.org/articles/gastric-carcinoma</ref> | |||
*A polypoid mass with or without ulceration | *A [[Polypoidy|polypoid]] [[mass]] with or without [[ulceration]] | ||
*Focal wall thickening with mucosal irregularity or focal infiltration of wall | *Focal wall thickening with mucosal irregularity or focal infiltration of wall | ||
*Ulceration: gas-filled ulcer crater within mass | *[[Ulceration]]: gas-filled [[ulcer]] crater within [[mass]] | ||
*Infiltrating carcinoma: wall thickening and loss of normal rugal fold pattern | *Infiltrating carcinoma: wall thickening and loss of normal rugal fold pattern | ||
[[File:CT gastric cancer.gif|300px|center|thumb|CT shows gastric cancer, source: Case courtesy of Dr Hani Salam, Radiopaedia.org, rID: 10722]] | [[File:CT gastric cancer.gif|300px|center|thumb|CT shows gastric cancer, source: Case courtesy of Dr Hani Salam, Radiopaedia.org, rID: 10722]] | ||
Revision as of 20:17, 21 November 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
|
Stomach cancer Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Stomach cancer CT On the Web |
|
American Roentgen Ray Society Images of Stomach cancer CT |
Overview
Abdominal CT scan may be helpful in the diagnosis of stomach cancer. It is used to evaluate metastatic disease, especially hepatic or adnexal metastases, ascites, or distant nodal spread. Integrated PET/CT imaging can be useful to confirm malignant involvement of CT-detected lymphadenopathy. A negative PET CT is not helpful since even large tumors with a diameter of several centimeters can be falsely negative if the tumor cells have a fairly low metabolic activity.
CT
- CT is procedure of choice used to assess the T stage of the primary tumor.[1]
- It is used to evaluate metastatic disease, especially hepatic or adnexal metastases, ascites, or distant nodal spread.
- Peritoneal metastases and hematogenous metastases smaller than 5 mm are frequently missed by CT in 20 percent of patients.[2]
- Sensitivity rates are from 65 to 97% and specificity rates for regional metastases 49 to 90%.[3]
Demonstration of lesions facilitated by negative contrast agents:[4]
- A polypoid mass with or without ulceration
- Focal wall thickening with mucosal irregularity or focal infiltration of wall
- Ulceration: gas-filled ulcer crater within mass
- Infiltrating carcinoma: wall thickening and loss of normal rugal fold pattern
PET/CT scan
- Integrated PET/CT imaging can be useful to confirm malignant involvement of CT-detected lymphadenopathy.[5]
- It directly visualizing the liver surface, the peritoneum, and local lymph nodes.
- A negative PET CT is not helpful since even large tumors with a diameter of several centimeters can be falsely negative if the tumor cells have a fairly low metabolic activity. Signet ring carcinomas are not FDG avid.[6]
- The main benefit of PET is that it is more sensitive than CT for the detection of distant metastases.[7]
- PET CT is not an adequate replacement for staging laparoscopy.[8]
References
- ↑ Sussman SK, Halvorsen RA, Illescas FF, Cohan RH, Saeed M, Silverman PM; et al. (1988). "Gastric adenocarcinoma: CT versus surgical staging". Radiology. 167 (2): 335–40. doi:10.1148/radiology.167.2.3357941. PMID 3357941.
- ↑ Kim SJ, Kim HH, Kim YH, Hwang SH, Lee HS, Park DJ; et al. (2009). "Peritoneal metastasis: detection with 16- or 64-detector row CT in patients undergoing surgery for gastric cancer". Radiology. 253 (2): 407–15. doi:10.1148/radiol.2532082272. PMID 19789243.
- ↑ Kienle P, Buhl K, Kuntz C, Düx M, Hartmann C, Axel B; et al. (2002). "Prospective comparison of endoscopy, endosonography and computed tomography for staging of tumours of the oesophagus and gastric cardia". Digestion. 66 (4): 230–6. doi:10.1159/000068360. PMID 12592099.
- ↑ http://radiopaedia.org/articles/gastric-carcinoma
- ↑ Yun M, Lim JS, Noh SH, Hyung WJ, Cheong JH, Bong JK; et al. (2005). "Lymph node staging of gastric cancer using (18)F-FDG PET: a comparison study with CT". J Nucl Med. 46 (10): 1582–8. PMID 16204706.
- ↑ Stahl A, Ott K, Weber WA, Becker K, Link T, Siewert JR; et al. (2003). "FDG PET imaging of locally advanced gastric carcinomas: correlation with endoscopic and histopathological findings". Eur J Nucl Med Mol Imaging. 30 (2): 288–95. doi:10.1007/s00259-002-1029-5. PMID 12552348.
- ↑ Kinkel K, Lu Y, Both M, Warren RS, Thoeni RF (2002). "Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis". Radiology. 224 (3): 748–56. doi:10.1148/radiol.2243011362. PMID 12202709.
- ↑ Yoshioka T, Yamaguchi K, Kubota K, Saginoya T, Yamazaki T, Ido T; et al. (2003). "Evaluation of 18F-FDG PET in patients with advanced, metastatic, or recurrent gastric cancer". J Nucl Med. 44 (5): 690–9. PMID 12732669.