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Differentiation of early gastric cancer with ulceration and resectable advanced gastric cancer using multiphasic dynamic multidetector CT

  • Gastrointestinal
  • Published:
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Abstract

Objectives

Early gastric cancer with ulceration (EGC-U) mimics advanced gastric cancer (AGC), as EGC-Us and ACGs often have similar endoscopic appearance to ulceration. The purpose of this retrospective study was to determine whether multiphasic dynamic multidetector CT (MDCT) can help differentiate EGC-Us from AGCs.

Methods

Patients with EGC-Us with ulcer stages Ul-III or IV and AGCs with tumour stages T2 to T4a were enrolled. MDCT images were obtained 40 s (arterial phase), 70 s (portal phase) and 240 s (delayed phase) after injection of non-ionic contrast material. Two readers independently measured the attenuation values of the lesions by placing regions of interest. We compared the EGC-Us and AGCs using the mean attenuation values in each phase and peak enhancement phase. We analysed the diagnostic performance of CT for differentiating EGC-Us from AGCs.

Results

Forty cases (16 EGC-Us and 24 AGCs) were analysed. The mean attenuation values of the EGC-Us were significantly lower than those of the AGCs in both the arterial and portal phases (all p < 0.0001 for each reader). The peak enhancement was significantly different between the EGC-Us and AGCs for both readers (Reader 1, p = 0.0131; Reader 2, p = 0.0006).

Conclusion

Multiphasic dynamic contrast-enhanced MDCT can help differentiate EGC-Us from AGCs.

Key Points

• Early gastric cancer with ulceration and advanced gastric cancer have similar endoscopic appearances.

• EGC-U shows significantly lower attenuation values in both arterial and portal phases.

• Multiphasic dynamic contrast-enhanced MDCT differentiates EGC-U from AGC.

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Abbreviations

3D:

Three-dimensional

AGC:

Advanced gastric cancer

EGC-U:

Early gastric cancer with ulceration

EUS:

Endoscopic ultrasound

FOV:

Field of view

MDCT:

Multidetector computed tomography

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver operator characteristics

ROI:

Region of interest

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Acknowledgments

This paper was presented at ECR 2014, entitled “Differentiation of Early Gastric Cancer with Ulceration and Advanced Gastric Cancer Using Multiphasic Dynamic Multidetector CT” (Scientific Session, B-0637).The scientific guarantor of this publication is Hiroshi Honda. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Study subjects or cohorts have not been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan

    Daisuke Tsurumaru, Mitsutoshi Miyasaka, Yusuke Nishimuta, Yoshiki Asayama, Akihiro Nishie & Hiroshi Honda

  2. Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan

    Satoshi Kawanami

  3. Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan

    Eiji Oki

  4. Department of Anatomic Pathology and Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan

    Minako Hirahashi

Authors
  1. Daisuke Tsurumaru
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  2. Mitsutoshi Miyasaka
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  6. Satoshi Kawanami
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  9. Hiroshi Honda
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Correspondence to Daisuke Tsurumaru.

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Tsurumaru, D., Miyasaka, M., Nishimuta, Y. et al. Differentiation of early gastric cancer with ulceration and resectable advanced gastric cancer using multiphasic dynamic multidetector CT. Eur Radiol 26, 1330–1337 (2016). https://doi.org/10.1007/s00330-015-3938-2

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  • DOI: https://doi.org/10.1007/s00330-015-3938-2

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