title: Can computed tomographic gastrography and multiplanar reformatting aid the laparoscopic surgeon in planning a gastric resection? A pictorial essay.
abstract: OBJECTIVE
  To assess the value and feasibility of computed tomographic gastrography and multiplanar reformatting in the preoperative evaluation of patients undergoing laparoscopic gastric resection.
  
  
  METHODS
  Fourteen patients with gastric lesions were included in the study. A supine scan was performed after a hypotonic drug, an effervescent agent, and intravenous contrast. This was followed by delayed prone and decubitus scans. We created multiplanar reformats, transparency rendered images, and endoluminal images. The tumours were localized, and distances were measured to the esophagogastric junction and the pylorus.
  
  
  RESULTS
  Eleven patients underwent resections. Seven had laparoscopic wedge resections for aberrant pancreas (1 patient), carcinoid (1), Castleman disease (1), and gastrointestinal stromal tumours (GISTs) (4). One patient had an open subtotal gastrectomy for carcinoma due to adhesions. One had a hand-assisted sleeve resection for a gastrointestinal stromal tumour. Two had hand-assisted total gastrectomies for carcinoma and a GIST. For surgical planning, the surgeon rated the imaging extremely useful in 7 and useful in 4. Imaging was extremely useful or useful to localize laparoscopically invisible tumours in 6 patients and to relate tumours to the esophagogastric junction or pylorus and to assess localized vs extensive resection in 8. Correlation was excellent between the preoperative imaging and the intraoperative findings.
  
  
  CONCLUSIONS
  Computed tomographic gastrography and multiplanar reformatting are useful aids in preoperative planning of laparoscopic gastric resections.
authors.affiliation: Department of Medical Imaging, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. zaleva@smh.toronto.on.ca
authors.forename: Arthur H
authors.initials: AH
authors.lastname: Zalev
authors.forename: Teodor
authors.initials: T
authors.lastname: Grantcharov
authors.forename: Wayne
authors.initials: W
authors.lastname: Deitel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000002:abnormalities / Q000000981:diagnostic imaging; D010347:Patient Care Planning; D056888:Patient Positioning; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D013272:Stomach Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014283:Triiodobenzoic Acids
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol