J Korean Soc Radiol.  2010 Jan;62(1):47-55. 10.3348/jksr.2010.62.1.47.

Multidetector CT of Locally Invasive Advanced Gastric Cancer: Value of Oblique Coronal Reconstructed Images for the Assessment of Local Invasion

• Jung JH
• Kim AY
• Kim HJ
• Yook JH
• Yu ES
• Jang YJ
• Park SH
• Shin YM
• Ha HK

• KMID: 2208994
• DOI: http://doi.org/10.3348/jksr.2010.62.1.47

Abstract

PURPOSE
To evaluate the diagnostic value of oblique coronal reconstructed CT images to determine the local invasion of advanced gastric cancer (AGC).
MATERIALS AND METHODS
Thirty-four consecutive patients, who were suspected to have locally invasive advanced gastric cancer (more than T3 stage) on a preoperative MDCT scan and underwent a diagnostic or curative laparotomy, were enrolled in this study. Two reviewers performed an independent blind review of three series of MDCT images in random order; axial (AXI), conventional coronal (CCI), and oblique coronal (OCI) (parallel to long axis of gastric body and pancreas) images. In assessing the local invasion, the reader's confidence for the local invasion of AGC was graded using a five point scale (1 = definitely negative, 5 = definitely positive: T4). With surgical findings and histopathological proofs as reference standards, the diagnostic performance of the three different plans of CT images was employed for the verification of local invasion of AGC on a preoperative CT scan using the receiver operating characteristic (ROC) method. Agreements between the two reviewers were analyzed using weighted kappa statistics.
RESULTS
In 19 out of 34 patients, local invasion was confirmed surgically or histopathologically (13 pancreas invasion, 6 liver invasion, 4 major vascular invasion, 3 colon and mesocolon invasion, and 2 spleen invasion). The diagnostic performance of OCI was superior to AXI or CCI in the local invasion of AGC. The differences in the area under the curve of AXI (0.770 +/- 0.087, 0.700 +/- 0.094), CCI (0.884 +/- 0.058, 0.958 +/- 0.038), and OCI (0.954 +/- 0.050, 0.956 +/- 0.049), were statistically significant for both reviewers. Inter-observer agreement was excellent for OCI (kappa= .973), which was greater than CCI (kappa= .839), and AXI (kappa= .763).
CONCLUSION
On a CT scan, OCI might be a useful imaging technique in evaluating locally invasive advanced gastric cancer.

MeSH Terms

Axis, Cervical Vertebra
Colon
Humans
Laparotomy
Liver
Mesocolon
Neoplasm Staging
Pancreas
ROC Curve
Spleen
Stomach Neoplasms
Tomography, X-Ray Computed

Figure

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  Fig. 1 Oblique coronal image. Oblique coronal images were obtained by images parallel to the long axis of the gastric body and the pancreas

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  Fig. 2 MDCT of Advanced Gastric Cancer without Local Invasion in 43-year-old female. A, B. Irregular gastric wall-thickened mass (M), suggestive of advance gastric tumor, is in contact (arrows) with pancreas on axial (A) and coronal (B) images. C. On oblique coronal image, mass is separated from pancreas by intact fat plane (narrow arrows). At surgical field, there was no direct invasion into the pancreas.

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  Fig. 3 MDCT of Advanced Gastric Cancer without Local Invasion in 39-year-old female. A. Axial image shows fat plane was effaced with subtle irregular interface (arrowheads) between gastric tumor(M) and pancreas on axial image. B, C. Coronal (B) and oblique coronal (C) images show distinct and smooth interface (arrows) between gastric tumor (M) and pancreas, without compression. At surgery, there was no direct invasion into the pancreas.

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  Fig. 4 MDCT of Advanced Gastric Cancer with Local Invasion in 66-year-old male. A, B. Irregular gastric wall-thickened mass, suggestive of advance gastric tumor, shows subtle irregular interface (arrows) between the tumor mass (M) and the left hepatic lobe on axial (A) and coronal (B) images. But, direct invasion of the liver by the tumor is not clear on given CT images. C. On oblique coronal image, however, hepatic invasion (arrows) is shown more clearly.

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