Gastric cancer staging at multi-detector row CT gastrography: comparison of transverse and volumetric CT scanning.
OBJECTIVE
To prospectively evaluate the accuracy of multi-detector row computed tomography (CT) gastrography for preoperative staging of gastric cancer, with pathologic and surgical results as the reference standard.


METHODS
This study was approved by the institutional review board, and patients gave written informed consent. One hundred six patients (72 male, 34 female; mean age, 56 years) with endoscopically proved gastric cancer underwent unenhanced and contrast material-enhanced multi-detector row CT gastrography, with effervescent granules used as oral contrast material. Two experienced radiologists independently evaluated the depth of tumor invasion into the gastric wall (tumor staging), the involvement of regional lymph nodes (nodal staging), and the presence or absence of metastasis (metastatic staging) on transverse and volumetric CT images, which included images produced with multiplanar reformation and a virtual endoscopic technique. TNM staging of each tumor was compared with the pathologic and surgical results. Diagnostic accuracy in TNM staging was analyzed.


RESULTS
Gastric cancer was detected in 92 (87%) of 106 study patients with transverse CT imaging and in 104 (98%) with volumetric CT imaging. The overall accuracy of the tumor staging was 77% with transverse CT imaging and 84% with volumetric CT imaging (P < .001). The overall accuracy for lymph node staging was 62% with transverse CT imaging and 64% with volumetric CT imaging (P = .057). For staging of metastases, there was no difference between transverse and volumetric CT imaging (86% for both) (P > .99).


CONCLUSIONS
Multi-detector row CT gastrography with multiplanar reformation and virtual endoscopy, compared with transverse CT imaging, can improve the accuracy of preoperative staging of gastric cancer. This difference was significant for tumor staging but not for the staging of lymph nodes and metastases.
Kim
Hye Jin
HJ
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-dong, Songpa-ku, Seoul 138-736, Korea.
Kim
Ah Young
AY
Oh
Seong Tae
ST
Kim
Jung-Sun
JS
Kim
Kyoung Won
KW
Kim
Pyo Nyun
PN
Lee
Moon-Gue
MG
Ha
Hyun Kwon
HK
D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007472:Iohexol / Q000031:analogs & derivatives; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011300:Preoperative Care; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide