title: Differentiation of early gastric cancer with ulceration and resectable advanced gastric cancer using multiphasic dynamic multidetector CT.
abstract: OBJECTIVE
  Early gastric cancer with ulceration (EGC-U) mimics advanced gastric cancer (AGC), as EGC-Us and ACGs often have similar endoscopic appearance to ulceration. The purpose of this retrospective study was to determine whether multiphasic dynamic multidetector CT (MDCT) can help differentiate EGC-Us from AGCs.
  
  
  METHODS
  Patients with EGC-Us with ulcer stages Ul-III or IV and AGCs with tumour stages T2 to T4a were enrolled. MDCT images were obtained 40 s (arterial phase), 70 s (portal phase) and 240 s (delayed phase) after injection of non-ionic contrast material. Two readers independently measured the attenuation values of the lesions by placing regions of interest. We compared the EGC-Us and AGCs using the mean attenuation values in each phase and peak enhancement phase. We analysed the diagnostic performance of CT for differentiating EGC-Us from AGCs.
  
  
  RESULTS
  Forty cases (16 EGC-Us and 24 AGCs) were analysed. The mean attenuation values of the EGC-Us were significantly lower than those of the AGCs in both the arterial and portal phases (all p < 0.0001 for each reader). The peak enhancement was significantly different between the EGC-Us and AGCs for both readers (Reader 1, p = 0.0131; Reader 2, p = 0.0006).
  
  
  CONCLUSIONS
  Multiphasic dynamic contrast-enhanced MDCT can help differentiate EGC-Us from AGCs.
  
  
  CONCLUSIONS
  • Early gastric cancer with ulceration and advanced gastric cancer have similar endoscopic appearances. • EGC-U shows significantly lower attenuation values in both arterial and portal phases. • Multiphasic dynamic contrast-enhanced MDCT differentiates EGC-U from AGC.
authors.affiliation: Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan. tsuru-d@radiol.med.kyushu-u.ac.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tsurumaru
authors.affiliation: Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Miyasaka
authors.affiliation: Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Nishimuta
authors.affiliation: Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Asayama
authors.affiliation: Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nishie
authors.affiliation: Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kawanami
authors.affiliation: Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Oki
authors.affiliation: Department of Anatomic Pathology and Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Minako
authors.initials: M
authors.lastname: Hirahashi
authors.affiliation: Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Honda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012189:Retrospective Studies; D013270:Stomach / Q000000981:diagnostic imaging; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging*
keywords: Computed tomography; Gastric cancer; Gastric ulcer; Gastroscopy; Three-dimensional image