Stomach cancer CT
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
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Overview
Abdominal CT scan may be helpful in the diagnosis of stomach cancer.
CT
- CT is currently the staging modality of choice because it can help identify the primary tumor.[1]
- It is best suited to evaluating widely metastatic disease, especially hepatic or adnexal metastases, ascites, or distant nodal spread, although biopsy confirmation is recommended because of the risk of false-positive findings.
- Peritoneal metastases and hematogenous metastases smaller than 5 mm are frequently missed by CT in 20 percent of patients.[2]
- CT accurately assesses the T stage of the primary tumor in 50 to 70 percent of cases.
- Sensitivity and specificity rates for regional nodal metastases range from 65 to 97, and 49 to 90 percent, respectively.[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.