Gin Chung Liu MD, Presenter: Nothing to Disclose

Chiao Yun Chen MD, Abstract Co-Author: Nothing to Disclose

Twei-Shiun Jaw MD, Abstract Co-Author: Nothing to Disclose

Jui-Sheng Hsu MD, PhD, Abstract Co-Author: Nothing to Disclose

Chien-Kuo Wang, Abstract Co-Author: Nothing to Disclose

To differentiate malignant and benign gastric ulcers using multiplanar reformations (MPRs ) and virtual gastroscopy (VG).

During a 24-month period, we prospectively performed CT examinations using a 16-row MDCT scanner in consecutive 65 patients with intractable gastric ulcer or suspicious malignant gastric ulcer. All patients were given 6g gas-producing crystals (B.G. Fuji) before unenhanced CT scan for gastric distension and VG. All patients subsequently drank 800-1000 ml tap water. Enhanced CT scans were performed after IV administration of 100 ml nonionic iodine contrast agent at a rate of 3 ml/sec. MPRs and VG were processed on a workstation. The criterions for malignant ulcers are :1) uneven ulcer base, 2) marginal elevation of the ulcer, 3)gastric fold changes (bulbous enlarged, fusion or abrupt termination) in VG; and 4) focal well enhanced hyperdense (>100 HU) tumoral part around the ulcers and 5) focal wall thickening around the ulcer in MPRs. We excluded 30 patients who were confirmed T3 or T4 gastric carcinoma. The final study population consisted of 16 men and 19 women (age range, 37-76 years; mean age, 59 years) who were 10 T1 gastric cancers ,13 T2 gastric cancers and 12 benign ulcers. MDCT images were analyzed by two radiologists who were blind to the clinical information. Evaluation was focused on malignant ulcer criterions. We used Fisher’s Exact test for statistical significance.

The percentages of malignant ulcers ( under stage T2 cancer) presenting with criterion 1 to 5 are 43%(10/23),100%(23/23), 43%(10/23),74%(17/23) and 70%(16/23) respectively; however , the percentages of benign ulcers presenting with criterion 1 to 5 are 0%( 0/12),50%(6/12), 0%( 0/12),8%(1/12) and 50%(6/12) respectively. All signet ring cell carcinomas(4) show negative in criterion 4. Significant differences exist between malignant and benign gastric ulcers in criterion 1 to 4 ,but not in criterion 5.

Combined hydro- and air-distension 3D MDCT using MPR and VG offers improved morphologic details of gastric ulcers, and is thus a valuable tool for differentiate malignant and benign gastric ulcer

Liu, G, Chen, C, Jaw, T, Hsu, J, Wang, C, Differentiation of Malignant and Benign Gastric Ulcers with Multi-Detector Row CT.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4416187.html