title: Preoperative locoregional staging of gastric cancer: is there a place for magnetic resonance imaging? Prospective comparison with EUS and multidetector computed tomography.
abstract: BACKGROUND
  The aim of this study was to prospectively compare the diagnostic performance of magnetic resonance imaging (MRI), multidetector computed tomography (MDCT) and endoscopic ultrasonography (EUS) in the preoperative locoregional staging of gastric cancer.
  
  
  METHODS
  This study had Institutional Review Board approval, and informed consent was obtained from all patients. Fifty-two patients with biopsy-proven gastric cancer underwent preoperative 1.5-T MRI, 64-channel MDCT and EUS. All images were analysed blind, and the results were compared with histopathological findings according to the seventh edition of the TNM classification. After the population had been divided on the basis of the local invasion (T1-3 vs T4a-b) and nodal involvement (N0 vs N+), sensitivity, specificity, positive and negative predictive value, and accuracy were calculated and diagnostic performance measures were assessed using the McNemar test.
  
  
  RESULTS
  For T staging, EUS showed higher sensitivity (94%) than MDCT and MRI (65 and 76%; p = 0.02 and p = 0.08). MDCT and MRI had significantly higher specificity (91 and 89%) than EUS (60%) (p = 0.0009 and p = 0.003). Adding MRI to MDCT or EUS did not result in significant differences for sensitivity. For N staging, EUS showed higher sensitivity (92%) than MRI and MDCT (69 and 73%; p = 0.01 and p = 0.02). MDCT showed better specificity (81%) than EUS and MRI (58 and 73%; p = 0.03 and p = 0.15).
  
  
  CONCLUSIONS
  Our prospective study confirmed the leading role of EUS and MDCT in the staging of gastric cancer and did not prove, at present, the value of the clinical use of MRI.
authors.affiliation: Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy. giganti.fra@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Giganti
authors.affiliation: Department of Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Orsenigo
authors.affiliation: Department of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Paolo Giorgio
authors.initials: PG
authors.lastname: Arcidiacono
authors.affiliation: Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Nicoletti
authors.affiliation: Pathology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Albarello
authors.affiliation: Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ambrosi
authors.affiliation: Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Annalaura
authors.initials: A
authors.lastname: Salerno
authors.affiliation: Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Esposito
authors.affiliation: Department of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Petrone
authors.affiliation: Department of Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Damiano
authors.initials: D
authors.lastname: Chiari
authors.affiliation: Department of Surgery, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Staudacher
authors.affiliation: Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Maschio
authors.affiliation: Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Cobelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D064847:Multimodal Imaging / Q000379:methods; D009367:Neoplasm Staging; D011300:Preoperative Care; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery
keywords: Endoscopic ultrasonography; Gastric cancer; Magnetic resonance imaging; Multidetector computed tomography; TNM staging