Skip to main content

Advertisement

SpringerLink
Log in

Differential diagnosis of gastric cancer and gastritis: the role of contrast-enhanced ultrasound (CEUS)

  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in differential diagnosis of gastric cancer and gastritis, with histological results as reference standard.

Methods

From September 2011 to August 2014, 82 patients (50 males and 32 females; mean age ± SD, 59.5 ± 15.0 years; range 19–91 years) with gastric cancer or gastritis were included in this Ethics Committee-approved prospective study. Conventional ultrasonography (US) and CEUS were applied to distinguish the two lesions, and both qualitative and quantitative features were evaluated.

Results

Of the 82 histopathologic-proven lesions, 58 were cancer and 24 were gastritis. For US, the gastric wall stratification was not preserved in about one-third of cancer (21/58, 36.2%) compared with gastritis (0/24, 0%) (p < 0.001). Blurred, angular, or spiculated serosa margin and increased echogenicity in perigastric fat appeared only in cancer (10/58, 17.2%), and all of them proved to be pathologic T3 or T4 stage. On CEUS, gastric cancer usually manifested as diffused enhancement without comb-teeth-like vessels (parallel curvilinear structures representing arterial branching within the gastric wall) (56/58, 96.6%), while these vessels presented in most gastritis (19/24, 79.2%, p < 0.001). For quantitative analysis, the malignant lesions showed later and lower enhancement (p < 0.001), and they also had slower speed to reach the peak intensity (p < 0.001). On CEUS, the absence of comb-teeth-like vessel is most reliable for diagnosing malignancy, and the sensitivity, specificity, and accuracy were 96.5%, 79.2%, and 91.5%, respectively.

Conclusions

Our results demonstrated the usefulness and accuracy of US and CEUS in differential diagnosis of gastric cancer and gastritis. CEUS has the potential to make the diagnosis more accurate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Torre LA, Bray F, Siegel RL, et al. (2015) Global cancer statistics, 2012. CA: Cancer J Clin 65(2):87–108

    Google Scholar 

  2. Sporea I, Popescu A (2010) Ultrasound examination of the normal gastrointestinal tract. Med Ultrason 12(4):349–352

    PubMed  Google Scholar 

  3. Nielsen MB, Bang N (2004) Contrast enhanced ultrasound in liver imaging. Eur J Radiol 51(Suppl):S3–S8

    Article  PubMed  Google Scholar 

  4. Barr RG, Peterson C, Hindi A (2014) Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology 271(1):133–142

    Article  PubMed  Google Scholar 

  5. Wan C, Du J, Fang H, Li F, Wang L (2012) Evaluation of breast lesions by contrast enhanced ultrasound: qualitative and quantitative analysis. Eur J Radiol 81(4):e444–e450

    Article  PubMed  Google Scholar 

  6. Badea R, Neciu C, Iancu C, et al. (2012) The role of i.v. and oral contrast enhanced ultrasonography in the characterization of gastric tumors. A preliminary study. Med Ultrason 14(3):197–203

    PubMed  Google Scholar 

  7. Wei F, Huang P, Li S, et al. (2013) Enhancement patterns of gastric carcinoma on contrast-enhanced ultrasonography: relationship with clinicopathological features. PloS One 8(9):e73050

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Wang LA, Wei X, Li Q, Chen L (2016) The prediction of survival of patients with gastric cancer with PD-L1 expression using contrast-enhanced ultrasonography. Tumour Biol 37(6):7327–7332

    Article  CAS  PubMed  Google Scholar 

  9. Ohashi A, Niwa Y, Ohmiya N, et al. (2005) Quantitative analysis of the microvascular architecture observed on magnification endoscopy in cancerous and benign gastric lesions. Endoscopy 37(12):1215–1219

    Article  CAS  PubMed  Google Scholar 

  10. Ding S, Li C, Lin S, et al. (2006) Comparative evaluation of microvessel density determined by CD34 or CD105 in benign and malignant gastric lesions. Human Pathol 37(7):861–866

    Article  CAS  Google Scholar 

  11. Okanobu H, Hata J, Haruma K, et al. (2003) Giant gastric folds: differential diagnosis at US. Radiology 226(3):686–690

    Article  PubMed  Google Scholar 

  12. Kong WT, Wang WP, Zhang WW, et al. (2014) Contribution of contrast-enhanced sonography in the detection of intrahepatic cholangiocarcinoma. J Ultrasound Med 33(2):215–220

    Article  PubMed  Google Scholar 

  13. Washington K (2010) 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 17(12):3077–3079

    Article  PubMed  Google Scholar 

  14. Habermann CR, Weiss F, Riecken R, et al. (2004) Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US. Radiology 230(2):465–471

    Article  PubMed  Google Scholar 

  15. Chen CY, Hsu JS, Wu DC, et al. (2007) Gastric cancer: preoperative local staging with 3D multi-detector row CT–correlation with surgical and histopathologic results. Radiology 242(2):472–482

    Article  PubMed  Google Scholar 

  16. Cao Z, Bao M, Miele L, et al. (2013) Tumour vasculogenic mimicry is associated with poor prognosis of human cancer patients: a systemic review and meta-analysis. Eur J Cancer 49(18):3914–3923

    Article  PubMed  Google Scholar 

  17. Zetter BR (1998) Angiogenesis and tumor metastasis. Annu Rev Med 49:407–424

    Article  CAS  PubMed  Google Scholar 

  18. Yao K, Oishi T, Matsui T, Yao T, Iwashita A (2002) Novel magnified endoscopic findings of microvascular architecture in intramucosal gastric cancer. Gastrointest Endosc 56(2):279–284

    Article  PubMed  Google Scholar 

  19. Adachi Y, Mori M, Enjoji M, Sugimachi K (1993) Microvascular architecture of early gastric carcinoma. Microvascular-histopathologic correlates. Cancer 72(1):32–36

    Article  CAS  PubMed  Google Scholar 

  20. Carmeliet P, Jain RK (2000) Angiogenesis in cancer and other diseases. Nature 407(6801):249–257

    Article  CAS  PubMed  Google Scholar 

  21. Leinonen MR, Raekallio MR, Vainio OM, Ruohoniemi MO, O’Brien RT (2011) The effect of the sample size and location on contrast ultrasound measurement of perfusion parameters. Vet Radiol Ultrasound 52(1):82–87

    PubMed  Google Scholar 

Download references

Funding

This work was financially supported by National Key Research and Development Program of China (No. 2016YFA0201400).

Author information

Authors and Affiliations

  1. Ultrasound Department of Peking University Third Hospital, Beijing, 100083, China

    Heng Xue, Hui-yu Ge, Li-ying Miao, Shu-min Wang, Bo Zhao, Jin-rui Wang & Li-gang Cui

Authors
  1. Heng Xue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hui-yu Ge
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Li-ying Miao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shu-min Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bo Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jin-rui Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Li-gang Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hui-yu Ge.

Ethics declarations

Conflict of interest

Heng Xue, Hui-yu Ge, Li-ying Miao, Shu-min Wang, Bo Zhao, Jin-rui Wang, and Li-gang Cui declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies 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.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Li-ying Miao is first co-author.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xue, H., Ge, Hy., Miao, Ly. et al. Differential diagnosis of gastric cancer and gastritis: the role of contrast-enhanced ultrasound (CEUS). Abdom Radiol 42, 802–809 (2017). https://doi.org/10.1007/s00261-016-0952-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-016-0952-z

Keywords

Search

Navigation