Abstract:
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Purpose: To evaluate the value of 3D multidetector row CT (MDCT) images using multiplanar reconstructive (MPR)- and virtual endoscopic (VE)- techniques in preoperative staging of gastric cancer by comparison with that of 2D images
Methods and Materials: Over a six-month period, consecutive 145 patients with pathologically proven gastric cancer underwent preoperative CT scan. Unenhanced and contrast-enhanced CT scans were obtained using MDCT, with a HQ mode after injection of anti-peristaltic agent and gaseous distention of the stomach. And then, MPR images and VE images were reconstructed on a commercial workstation. Thirty-nine patients were excluded due to failure of 3D reconstruction (n = 2), lack of surgical confirm (n = 18), and discrepancy between the surgical and pathologic reports (n = 19). Final study population consisted of 106 patients who underwent surgery (EGC in 46 patients; AGC in 60 patients). Two blinded readers analyzed only 2D images first and then 3D reconstructed images using MPR and VE, focusing on TNM staging of gastric cancer. Each TNM staging with 2D or 3D images was compared with pathologic and surgical results.
Results: On CT, gastric cancer was detected in 92 out of 106 cases with 2D images (87%) and in 104 with 3D images (98%). Overall accuracy of T-staging was 77% with 2D images and 92% with 3D images, respectively (p < .05). Superiority of 3D images in accuracy of T-staging was prominent in pathologic T1/2 than T3 stage (T-staging using 3D versus 2D images; 97% vs. 82% for T1/2 and 81% vs. 70% for T3, p < .05). Overall accuracy for N-staging with 2D and 3D images was 62% and 64%, respectively. Only in advanced cancer, the N staging of 3D images was more accurate than 2D, but it was not significant (p > .05). In M-staging, there was no difference between results of 2D and 3D images (98%, both).
Conclusion: In preoperative staging of gastric cancer, 3D reconstructed images using MPR and VE techniques markedly improved the accuracy for T staging of gastric cancer (92% with 3D versus (vs.) 77% with 2D images, p < .05). However, there was no significant difference in N- or M- staging between 3D and 2D images.
Kim MD, H,
Preoperative Staging of Gastric Cancer: Comparison of Two-dimensional and Three-dimensional Images with Multidetector Row CT. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3106802.html
