title: MDCT features in the differentiation of T4a gastric cancer from less-advanced gastric cancer: significance of the hyperattenuating serosa sign.
abstract: OBJECTIVE
  The purpose of our study was to evaluate CT findings to differentiate between T4a and less advanced gastric cancers.
  
  
  METHODS
  The institutional review board approved this study and waived informed consent. This study included 228 retrospectively identified patients with surgically confirmed gastric cancer (138 T1, 25 T2, 24 T3 and 41 T4a) and who had also undergone pre-operative CT scan. Transverse and multiplanar reconstruction scans were reviewed in consensus by two other blinded radiologists. The following CT findings that differentiate T4a from less advanced cancers were evaluated: nodular or an irregular outer layer of the gastric wall, haziness of the perigastric fat and a hyperattenuating serosa sign. The CT features of T4a and less advanced gastric cancers were compared by means of univariate and multivariate analyses.
  
  
  RESULTS
  In univariate analysis, nodular or an irregular outer layer of the gastric wall, haziness of the perigastric fat and the hyperattenuating serosa sign were significant in differentiation between T4a and less advanced gastric cancers. In addition, nodular or an irregular outer layer of the gastric wall and the hyperattenuating serosa sign were significant in differentiation between T3 and T4a. In multivariate logistic analysis, the hyperattenuating serosa sign was the most significant finding in differentiation between T3 and T4a (odds ratio, 4.210; 95% confidence intervals, 1.581-11.214; p=0.004).
  
  
  CONCLUSIONS
  The hyperattenuating serosa sign may be a useful CT finding in differentiation between T4a and less-advanced gastric cancers.
  
  
  CONCLUSIONS
  The hyperattenuating serosa sign is associated with gastric cancer with invading the serosa and can facilitate planning of the optimal pre-operative evaluation and treatment.
authors.affiliation: Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
authors.forename: T U
authors.initials: TU
authors.lastname: Kim
authors.forename: S
authors.initials: S
authors.lastname: Kim
authors.forename: J W
authors.initials: JW
authors.lastname: Lee
authors.forename: N K
authors.initials: NK
authors.lastname: Lee
authors.forename: T Y
authors.initials: TY
authors.lastname: Jeon
authors.forename: D Y
authors.initials: DY
authors.lastname: Park
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012704:Serous Membrane / Q000000981:diagnostic imaging; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery