title: Diffuse-type gastric cancer: specific enhancement pattern on multiphasic contrast-enhanced computed tomography.
abstract: OBJECTIVE
  To evaluate the enhancement pattern of diffuse-type gastric cancers (DGCs) on multiphasic contrast-enhanced computed tomography gastrography (CECTG).
  
  
  METHODS
  We studied 21 consecutive clinically diagnosed DGC patients who underwent CECTG. Gastric distension was obtained using effervescent granules. CT images were obtained 40 s (arterial phase) and 240 s (delayed phase) after injection of a nonionic contrast material. Two radiologists reviewed the CT images and analyzed layers and enhancement patterns. The readers evaluated the enhancement degree (mild, moderate, or marked) and calculated CT attenuation values by placing circular regions of interest (ROIs) within each layer of the lesion. The CT findings of 11 operated cases were correlated with pathological results.
  
  
  RESULTS
  Most lesions were double-layered in the arterial phase, with a moderately enhanced inner layer and a mildly enhanced outer layer, and single-layered in the delayed phase. The mean attenuation value of the inner layer (146 ± 32.8 HU) was significantly higher than that of the outer layer (80.4 ± 15.5 HU) in the arterial phase (p = 0.0001). In the pathological analysis, wall stratification was preserved in nine cases and not preserved in two cases.
  
  
  CONCLUSIONS
  Most DGCs showed a double-layered pattern in the arterial phase and a single-layered pattern with moderate enhancement in the delayed phase.
authors.affiliation: Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan. tsuru-d@radiol.med.kyushu-u.ac.jp.
authors.forename: Daisuke
authors.identifier: http://orcid.org/0000-0002-0443-7205
authors.initials: D
authors.lastname: Tsurumaru
authors.affiliation: Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Miyasaka
authors.affiliation: Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Muraki
authors.affiliation: Advanced Imaging and Interventional Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Asayama
authors.affiliation: Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nishie
authors.affiliation: Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Oki
authors.affiliation: Anatomic Pathology and Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
authors.forename: Minako
authors.initials: M
authors.lastname: Hirahashi
authors.affiliation: Anatomic Pathology and Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Hida
authors.affiliation: Departments of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Honda
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D007479:Iopamidol; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007479:Iopamidol
keywords: Enhancement pattern; Gastric cancer; Multiphasic contrast-enhanced computed tomography