Rosario Francesco Grasso, Abstract Co-Author: Nothing to Disclose

Viola Valentini MD, Abstract Co-Author: Nothing to Disclose

Francesco Di Matteo MD, Abstract Co-Author: Nothing to Disclose

Matteo Sammarra MD, Abstract Co-Author: Nothing to Disclose

Pasquale D'Alessio MD, Abstract Co-Author: Nothing to Disclose

Bruno Beomonte Zobel MD, Presenter: Nothing to Disclose

The aim of the study was to assess the accuracy of 16 row MDCT (Somatom Sensation, Siemens) in the preoperative evaluation of gastric cancer in comparison with conventional endoscopy and endoscopic ultrasound (EUS)(FG3830UT Pentax Europe GmbH). We considered the role of MDCT and EUS in the detection, localization and staging of gastric cancer.

Between September 2003 and February 2005, 48 Pts, 31 male and 17 female, mean age 64.9 (range 37-82) were evaluated with conventional endoscopy with biopsies, EUS and MDCT;8 Pts studied were not included in the study due to the advanced disease requiring radiotherapy. We considered only patients with gastric adenocarcinoma. All the CT examinations were performed after the oral administration of 700/900 ml of water for gastric wall distension; each examination was performed with triphasic technique (basal, arterial and portal phase), following automatic injection of 2ml/Kg of non-ionic uroangiografic contrast agent (Xenetix 350 mg I/ml, Guerbet) at a flow rate of 4-3,5 cc/sec. The images were then post-processed using Multi-Planar Reformatting (MPR). The lesion morphology and thickness, the degree of gastric wall infiltration, locoregional lymph nodes and systemic metastases were evaluated by two radiologists blinded to the EUS findings. All the patients enrolled in the study underwent surgery; than the preoperative EUS and MDCT staging was evaluated against the pathology findings.

Gastric cancer was confirmed in all patients. Overall accuracy, sensitivity, and specificity in the evaluation of T stage for EUS and three-dimensional MDCT was respectively 87%, 85% and 92%; and 85%, 78% and 93,5%. For the evaluation of N factor for EUS and three-dimensional MDCT was respectively 78%, 68% and 79%;and 73%, 56% and 88,2%.

Although EUS seem to be superior to MDCT in the evaluation of T1 and T3 tumors, three-dimensional multidetector row CT still remains the cross sectional imaging technique of choice in the preoperative evaluation of gastric cancer. EUS play a major role in the evaluation of the degree of tumor wall invasion and in the differential diagnosis of T1 tumors, when local submucosal excision can be performed.

Grasso, R, Valentini, V, Di Matteo, F, Sammarra, M, D'Alessio, P, Beomonte Zobel, B, Multidetector Computed Tomography and Endoscopic Ultrasound in the Preoperative Assessment of Gastric Cancer.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4415376.html