Differentiating malignant from benign wall thickening in postoperative stomach using helical computed tomography: results of multivariate analysis.
OBJECTIVE
To determine significant computed tomography (CT) predictors for differentiating malignant from benign wall thickening in postoperative stomach.


METHODS
Sixty-nine patients with perianastomotic wall thickening (25 malignant, 44 benign) after gastric surgery were identified. All patients underwent contrast-enhanced CT with the administration of oral contrast agents such as air, diluted barium, or water. Two radiologists analyzed CT images regarding enhancement of thickened wall, obliteration of wall layering, heterogeneity, asymmetry, perigastric infiltration, proximity to metallic suture material, lymphadenopathy, adjacent bowel thickening, and periceliac soft-tissue density. Another radiologist measured the wall thickness and the mean CT value of the lesion and normal mucosa. Individual CT findings relevant as predictors were determined using the univariate test. Multivariate analysis was used to determine the most predictable factors.


RESULTS
Malignant wall thickening was significantly thicker than benign one. Isoattenuation and high attenuation of thickened wall were more frequently seen in malignant than in benign cases. Multivariate analysis showed that isoattenuation or high attenuation of thickened wall, proximity to suture material, and perigastric infiltration were only 3 variables that independently differentiated malignant from benign thickening in postoperative stomach.


CONCLUSIONS
Isoattenuation or high attenuation of thickened wall, perigastric infiltration, and wall thickening without metallic suture material are the 3 main factors distinguishing malignant from benign thickening in postoperative stomach.
Kim
Ji-Yang
JY
Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
Kim
Se Hyung
SH
Lee
Jeong Min
JM
Han
Joon Koo
JK
Lee
Jae Young
JY
Choi
Byung Ihn
BI
D000328:Adult; D000368:Aged; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D011230:Precancerous Conditions / Q000000981:diagnostic imaging / Q000473:pathology; D011857:Radiographic Image Interpretation, Computer-Assisted; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D036542:Tomography, Spiral Computed
D003287:Contrast Media