title: Differential diagnosis of gastric cancer and gastritis: the role of contrast-enhanced ultrasound (CEUS).
abstract: To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in differential diagnosis of gastric cancer and gastritis, with histological results as reference standard.
  
  
  
  From September 2011 to August 2014, 82 patients (50 males and 32 females; mean age ± SD, 59.5 ± 15.0 years; range 19-91 years) with gastric cancer or gastritis were included in this Ethics Committee-approved prospective study. Conventional ultrasonography (US) and CEUS were applied to distinguish the two lesions, and both qualitative and quantitative features were evaluated.
  
  
  
  Of the 82 histopathologic-proven lesions, 58 were cancer and 24 were gastritis. For US, the gastric wall stratification was not preserved in about one-third of cancer (21/58, 36.2%) compared with gastritis (0/24, 0%) (p < 0.001). Blurred, angular, or spiculated serosa margin and increased echogenicity in perigastric fat appeared only in cancer (10/58, 17.2%), and all of them proved to be pathologic T3 or T4 stage. On CEUS, gastric cancer usually manifested as diffused enhancement without comb-teeth-like vessels (parallel curvilinear structures representing arterial branching within the gastric wall) (56/58, 96.6%), while these vessels presented in most gastritis (19/24, 79.2%, p < 0.001). For quantitative analysis, the malignant lesions showed later and lower enhancement (p < 0.001), and they also had slower speed to reach the peak intensity (p < 0.001). On CEUS, the absence of comb-teeth-like vessel is most reliable for diagnosing malignancy, and the sensitivity, specificity, and accuracy were 96.5%, 79.2%, and 91.5%, respectively.
  
  
  
  Our results demonstrated the usefulness and accuracy of US and CEUS in differential diagnosis of gastric cancer and gastritis. CEUS has the potential to make the diagnosis more accurate.
authors.affiliation: Ultrasound Department of Peking University Third Hospital, Beijing, 100083, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Xue
authors.affiliation: Ultrasound Department of Peking University Third Hospital, Beijing, 100083, China. Ghyzmw@163.com.
authors.forename: Hui-Yu
authors.initials: HY
authors.lastname: Ge
authors.affiliation: Ultrasound Department of Peking University Third Hospital, Beijing, 100083, China.
authors.forename: Li-Ying
authors.initials: LY
authors.lastname: Miao
authors.affiliation: Ultrasound Department of Peking University Third Hospital, Beijing, 100083, China.
authors.forename: Shu-Min
authors.initials: SM
authors.lastname: Wang
authors.affiliation: Ultrasound Department of Peking University Third Hospital, Beijing, 100083, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhao
authors.affiliation: Ultrasound Department of Peking University Third Hospital, Beijing, 100083, China.
authors.forename: Jin-Rui
authors.initials: JR
authors.lastname: Wang
authors.affiliation: Ultrasound Department of Peking University Third Hospital, Beijing, 100083, China.
authors.forename: Li-Gang
authors.initials: LG
authors.lastname: Cui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D005756:Gastritis / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging*; D013459:Sulfur Hexafluoride; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Contrast-enhanced ultrasound; Gastritis; Stomach neoplasms; Ultrasonography