title: Two-phase helical CT for detection of early gastric carcinoma: importance of the mucosal phase for analysis of the abnormal mucosal layer.
abstract: OBJECTIVE
  To evaluate the efficacy of two-phase dynamic helical computed tomography (CT), including the gastric mucosal phase, for detection of early gastric carcinoma with typical hyperattenuating and atypical nonhyperattenuating enhancement patterns.
  
  
  METHODS
  Two-phase helical CT scanning was performed using the water-filling method as negative oral contrast material for 212 patients with proven adenocarcinoma on endoscopic biopsy. Two gastrointestinal radiologists prospectively analyzed the focal alterations of the inner hyperattenuating mucosal layer and the outer hypoattenuating layer before the information obtained at barium study and pathologic examination was available. The first, so-called mucosal phase was obtained at 38-45 seconds after the start of intravenous injection of contrast material for a total of 150 ml/sec at a rate of 4 ml/sec to obtain maximum enhancement of the inner mucosal layer. The second delayed phase was obtained at 3 minutes.
  
  
  RESULTS
  Fifty-four cases of early gastric cancer were suspected on two-phase helical CT preoperatively. Postoperatively, 49 cases of early gastric cancer were pathologically confirmed. The detection rate for the typical hyperattenuating early gastric cancer, that is the type I enhancement pattern defined as the localized thickening of the inner hyperattenuating layer, using two-phase helical CT was 18% (9/49 patients). The type 2 enhancement pattern, defined as the focal interruption of the inner hyperattenuating mucosal layer without abnormal enhancement of the outer hypoattenuating layer on the mucosal phase, was seen in 15 cases. These were pathologically confirmed as early gastric cancer IIb + IIc (three patients), IIc (four patients), IIc + IIa (one patient), IIc + III (three patients), IIb + IIc (one patient), and advanced cancer (T2) lesions (three patients). The type 3 enhancement pattern was defined as the focal polypoid protrusion of the inner hyperattenuating layer without abnormal enhancement of the outer thickened hypoattenuating layer on the mucosal phase, and was seen in seven patients who were pathologically confirmed with early gastric cancer IIb + IIc (three patients), IIc + IIa (one patient), and IIc + lIb (three patients). The lesions became less distinct on the delayed phase. Five T2 advanced gastric cancers were falsely interpreted as early gastric cancer. The detection rate for early gastric cancer after considering type 2 and 3 atypical enhancement patterns was increased to 57% (28/49 patients).
  
  
  CONCLUSIONS
  Helical CT with two-phase scan including the mucosal phase was efficient for identifying the enhancement patterns of early gastric cancer.
authors.affiliation: Department of Diagnostic Radiology, Ulsan University Hospital, Korea. jhlee@uuh.ulsan.kr
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: Y K
authors.initials: YK
authors.lastname: Jeong
authors.forename: D H
authors.initials: DH
authors.lastname: Kim
authors.forename: B K
authors.initials: BK
authors.lastname: Go
authors.forename: Y J
authors.initials: YJ
authors.lastname: Woo
authors.forename: S Y
authors.initials: SY
authors.lastname: Ham
authors.forename: S O
authors.initials: SO
authors.lastname: Yang
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D005753:Gastric Mucosa / Q000000981:diagnostic imaging*; D006801:Humans; D007479:Iopamidol; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007479:Iopamidol