title: Extent of arterial tumor enhancement measured with preoperative MDCT gastrography is a prognostic factor in advanced gastric cancer after curative resection.
abstract: OBJECTIVE
  The objective of this study was to investigate the correlation between pathologic findings and arterial tumor enhancement at MDCT gastrography of patients with a prognosis of advanced gastric cancer after curative resection.
  
  
  METHODS
  The cases of 41 patients with advanced gastric cancer (23 men, 18 women; age range, 35-92 years; median, 60 years) who underwent MDCT gastrography and optical endoscopy before surgery were retrospectively evaluated. Two radiologists reviewed virtual endoscopic and multiplanar reconstruction images to measure arterial phase CT values of the inner tumor margin and healthy gastric wall. They used consensus regions of interest on a cross-sectional image of the largest tumor diameter and then calculated tumor-to-normal wall enhancement ratio (TNR). Advanced gastric cancers were divided into high- and low-TNR groups with mean TNR as the cutoff. The correlations between groups and pathologic factors, patient survival, and mode of recurrence were studied.
  
  
  RESULTS
  Multivariate logistic regression analysis showed that the arterial tumor enhancement ratio correlated with both microvessel density and lymphatic vessel invasion. The survival rate after curative resection was worse for the high-TNR group than for the low-TNR group. The rate of lymphatic and hematogenous recurrences was also higher in the high-TNR group. Multivariate survival analysis revealed that TNR was an independent prognostic factor.
  
  
  CONCLUSIONS
  The extent of arterial tumor enhancement correlated with tumor angiogenesis and lymphatic vessel invasion and was a useful prognostic indicator after curative resection in patients with advanced gastric cancer.
authors.affiliation: Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan. masakomori2002@gmail.com
authors.forename: Masahiro
authors.initials: M
authors.lastname: Komori
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Asayama
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Fujita
authors.forename: Kiyohisa
authors.initials: K
authors.lastname: Hiraka
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tsurumaru
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Honda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003287:Contrast Media; D005260:Female; D005743:Gastrectomy; D005773:Gastroscopy; D006801:Humans; D007479:Iopamidol; D016015:Logistic Models; D008197:Lymph Node Excision; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging* / Q000473:pathology; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate
chemical_list: D003287:Contrast Media; D007479:Iopamidol