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Computed tomography features of gastrointestinal linitis plastica: spectrum of findings in early and delayed phase imaging

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Abstract

Purpose

To analyze the features of gastrointestinal linitis plastica obtained by computed tomography (CT).

Materials and methods

We conducted a single-center, retrospective analysis of 45 cases of gastrointestinal tract linitis plastica collected over a 10-year period. “Linitis plastica” was defined based on histological characteristics. Primary and secondary linitis plastica were included. Two readers independently assessed the radiological findings (i.e., number of lesions, mass, wall thickening, and enhancement).

Results

The patient cohort comprised 23 men and 22 women with an average age of 63.2 years. The main presenting signs and symptoms were impaired general health and ascites (22/45 patients, 48.8%). The stomach was the affected organ in 68.3% of the cases, while the rectum was affected in 11.7% of the cases. Primary linitis was found in 73.3% of the cases, and solitary lesions were found in 77.8% of the cases. The most common CT finding was wall thickening (91.7%) with a complete disappearance of folds and enhancement of the entire wall at 2 min. Four lesions (6.6%) were described as masses, and only one (1.7%) was described as a wall atrophy.

Conclusion

Linitis plastica can affect the entire digestive system. Its potentially secondary nature necessitates a systematic search for a primary tumor. An appropriate CT protocol is required to detect the specific radiological features of this fibrous cancer. CT can help confirm the diagnosis of linitis plastica, rule out differential diagnoses, and indicate the need for deep biopsies where possible.

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Author information

Authors and Affiliations

  1. Department of Radiology Adults, Brabois Hospital, University of Nancy, 11 allée du Morvan, 54 511, Vandoeuvre-lès-Nancy, France

    Clemence Burgain, Xavier Orry, Michel Claudon & Valérie Laurent

  2. Department of HBP Surgery, Brabois Hospital, University of Nancy, 11 allée du Morvan, 54 511, Vandoeuvre-lès-Nancy, France

    Adeline Germain

  3. Department of Pathology, Brabois Hospital, University of Nancy, 11 allée du Morvan, 54 511, Vandoeuvre-lès-Nancy, France

    Claire Bastien

  4. Department of Gastroenterology, Brabois Hospital, University of Nancy, 11 allée du Morvan, 54 511, Vandoeuvre-lès-Nancy, France

    Laurence Choné

Authors
  1. Clemence Burgain
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  2. Adeline Germain
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  3. Claire Bastien
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  4. Xavier Orry
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  5. Laurence Choné
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  6. Michel Claudon
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  7. Valérie Laurent
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Corresponding author

Correspondence to Clemence Burgain.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

The Institutional review board approved the study and did not require additional informed consent for reviewing the patients’ medical records and images.

Appendix: The form used for CT interpretation

Appendix: The form used for CT interpretation

Qualitative analysis

Presence of individual features (Y/N):

A. Positive diagnosis: lesion features

  1. a.

    Mass syndrome,

  2. b.

    Gut wall thickening (stomach, >5 mm; small intestine, colon, or anus, >3 mm):

    1. i.

      Segmental (<100-mm-long) or diffuse,

    2. ii.

      Circumferential,

    3. iii.

      Stenotic,

    4. iv.

      Beyond the serous, and

    5. v.

      Disappearance of folds; and

  3. c.

    Wall atrophy (<1 mm).

B. Qualitative analysis of lesion enhancement:

  1. a.

    No enhancement,

  2. b.

    Early arterial enhancement (A) of the mucosal-submucosal complex (two innermost layers of the gastrointestinal wall), and

  3. c.

    Delayed enhancement (T) of the whole lesion suggesting “fibrous” type tissue.

Quantitative analysis

Where possible

  1. A.

    Masses: two maximal orthogonal dimensions in the axial plane (mm);

  2. B.

    Wall thickening: maximum thickness (mm);

  3. C.

    Segmental thickening: maximum length (in mm);

  4. D.

    Density before injection (HU); and

  5. E.

    Density in the delayed portal, post-equilibrium phase (HU).

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Burgain, C., Germain, A., Bastien, C. et al. Computed tomography features of gastrointestinal linitis plastica: spectrum of findings in early and delayed phase imaging. Abdom Radiol 41, 1370–1377 (2016). https://doi.org/10.1007/s00261-016-0652-8

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  • DOI: https://doi.org/10.1007/s00261-016-0652-8

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