RSNA 2003 

Abstract Archives of the RSNA, 2003


C06-273

Bare Area Invasion by Gastric Carcinoma: Multi-detector Helical CT Evaluation of Surgical Prognostic Factors

Scientific Papers

Presented on December 1, 2003
Presented as part of C06: Gastrointestinal (Gastric Cancer: Multi-Detector Row CT)

Participants

Bing Wu MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: The cause of the poor prognosis of the patients with proximal-third gastric carcinoma (PGC) when compared with that of patients with more distally located gastric carcinoma (DGC) must consist in an anatomical characteristic, the fact that the posterior wall of the fundus and subcardial portion (gastric bare area, GBA) is not covered by the visceral peritoneum. To date there has been very little radiologic literature looking at the CT evaluation of surgical prognostic factors in gastric carcinoma with GBA invasion. Methods and Materials: We assessed thin slice images in 68 consecutive patients with biopsy proven PGC using a multi-detector helical CT system (Sensation 4, Siemens). We evaluate the accuracy of multi-detector helical CT in identifying the following prognostic factors: the site of the tumor in relation to the GBA and the peritoneal reflection, the maximum depth of tumor extramural spread into subphrenic fat, the presence of adenopathy in GBA or subphrenic retroperitoneal space. All 68 patients underwent surgical resection and each surgical specimen was axially sectioned. Multi-detector Helical CT findings were compared with the pathology examination of each tumor bearing slice. Results: Multi-detector Helical CT correctly identified all 32 tumors with GBA invasion and correctly identified all 5 patients with tumor extension within 2.0cm of the edge of the gastric wall. Multi-detector Helical CT correctly predicted the relationship of the tumor to the peritoneal reflection (gastrophrenic ligament) in 60 of 68 patients and identified 25 patients with gastrophrenic ligament invasion by tumor. The maximum depth of tumor infiltration was correct to within 1cm of the histology measurements in 20 of the 28 patients with tumor infiltration into subphrenic fat. Multi-detector Helical CT correctly identified 12 of the 16 patients with metastatic lymph node greater than 1cm in GBA or subphrenic retroperitoneal space. Conclusion: Multi-detector Helical CT may be of value in assessing the important surgical prognostic risk factors of GBA invasion by PGC. Preoperative identification of patients at risk of incomplete surgical resection and lymph node metastasis may allow targeting of such patients for the most appropriate preoperative adjuvant therapy. (B.W., P.M. received financial support for this study from National Science Foundation.)

Cite This Abstract

Wu MD, B, Bare Area Invasion by Gastric Carcinoma: Multi-detector Helical CT Evaluation of Surgical Prognostic Factors.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3103316.html