title: Can lymphovascular invasion be predicted by preoperative multiphasic dynamic CT in patients with advanced gastric cancer?
abstract: OBJECTIVE
  To determine whether multiphasic dynamic CT can preoperatively predict lymphovascular invasion (LVI) in advanced gastric cancer (AGC).
  
  
  METHODS
  278 patients with AGC who underwent preoperative multiphasic dynamic CT were retrospectively recruited. Tumour CT attenuation difference between non-contrast and arterial (ΔAP), portal (ΔPP) and delayed phase (ΔDP), tumour-spleen attenuation difference in the portal phase (ΔT-S), tumour contrast enhancement ratios (CERs), tumour-to-spleen ratio (TSR) and tumour volumes were obtained. All CT-derived parameters and clinicopathological variables associated with LVI were analysed by univariate analysis, followed by multivariate and receiver operator characteristics (ROC) analysis. Associations between CT predictors for LVI and histopathological characteristics were evaluated by the chi-square test.
  
  
  RESULTS
  ΔPP(OR, 1.056; 95% CI: 1.032-1.080) and ΔT-S(OR, 1.043; 95% CI: 1.020-1.066) are independent predictors for LVI in AGC. ΔPP, ΔT-Sand their combination correctly predicted LVI in 74.8% (AUC, 0.775; sensitivity, 88.6%; specificity, 54.1%), 68.7% (AUC, 0.747; sensitivity, 68.3%; specificity, 69.4%) and 71.7% (AUC, 0.800; sensitivity, 67.6%; specificity, 77.8%), respectively. There were significant associations between CT predictors for LVI with tumour histological differentiation and Lauren classification.
  
  
  CONCLUSIONS
  Multiphasic dynamic CT provides a non-invasive method to predict LVI in AGC through quantitative enhancement measurement.
  
  
  CONCLUSIONS
  • Lymphovascular invasion rarely can be evaluated preoperatively in advanced gastric cancer (AGC). • ΔPPand ΔT-Swere independent predictors for LVI in patients with AGC. • ΔPPand ΔT-Sshowed acceptable predictive performance for LVI. • Combination of ΔPPand ΔT-Simproved predictive performance for LVI. • Multiphasic dynamic CT may be a useful adjunct for detecting LVI preoperatively.
authors.affiliation: Southern Medical University, Guangzhou, Guangdong, 510515, China.|Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhong Shan Er Lu, Guangzhou, Guangdong Province, 510080, China.
authors.forename: Zelan
authors.initials: Z
authors.lastname: Ma
authors.affiliation: Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhong Shan Er Lu, Guangzhou, Guangdong Province, 510080, China.
authors.forename: Changhong
authors.initials: C
authors.lastname: Liang
authors.affiliation: Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhong Shan Er Lu, Guangzhou, Guangdong Province, 510080, China.
authors.forename: Yanqi
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhong Shan Er Lu, Guangzhou, Guangdong Province, 510080, China.|School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510006, China.
authors.forename: Lan
authors.initials: L
authors.lastname: He
authors.affiliation: Southern Medical University, Guangzhou, Guangdong, 510515, China.|Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhong Shan Er Lu, Guangzhou, Guangdong Province, 510080, China.
authors.forename: Cuishan
authors.initials: C
authors.lastname: Liang
authors.affiliation: Department of Radiology, The Affiliated Guangzhou First People' Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510180, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Chen
authors.affiliation: Southern Medical University, Guangzhou, Guangdong, 510515, China.|Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhong Shan Er Lu, Guangzhou, Guangdong Province, 510080, China.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Huang
authors.affiliation: Southern Medical University, Guangzhou, Guangdong, 510515, China.
authors.forename: Yabing
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: Southern Medical University, Guangzhou, Guangdong, 510515, China. zyliu@163.com.|Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhong Shan Er Lu, Guangzhou, Guangdong Province, 510080, China. zyliu@163.com.
authors.forename: Zaiyi
authors.initials: Z
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D001808:Blood Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D015588:Observer Variation; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Advanced gastric cancer; CT attenuation; Lymphovascular invasion; Multiphasic dynamic CT; Predictor