Objectives

1. To assess the capability of dedicated gastric MDCT protocols in localization and staging of early and advanced gastric cancer.

2. To establish dedicated MDCT criteria for operability or other treatment options of GC, thus facilitating crucial treatment strategy

3. To assess pathways of disease spread by dedicated MDCT.

Background

Gastric carcinoma (GC) is one of the most common and fatal cancers worldwide. Prognosis and treatment depend strongly on disease stage, thus accurate pre-treatment staging is essential. Early GC may be treated by endoscopical resection or surgery, whereas advanced GC requires previous adjuvant chemotherapy. Dedicated gastric MDCT protocols aim to define important steps in treatment algorithm, providing crucial information regarding depth of invasion, lymph node status, perigastric or peritoneal spread.

Imaging findings OR Procedure findings

Dedicated techniques are performed with adequate stomach distention, with negative contrast agents and/or induction of gastric hypotonia. Thin pre- and post contrast image acquisitions in late arterial and portal venous phases with high resolution multiplanar reformations allow evaluation of gastric wall layers and thickness, evidence of multilayer wall disruption, marked transmural or non-trasmural focal wall enhancement, regularity of outer border, obliteration of perigastric fat, lymph node involvement, submucosal, subperitoneal and peritoneal spread, adjacent organ invasion. These findings may serve as criteria for operablility of GC or other treatment options.

Conclusion

Dedicated MDCT gastric protocols apply for accurate staging of both early and advanced GC. MDCT is a widely available modality and dedicated protocols may improve tumor localization and staging. Awareness of MDCT imaging criteria is mandatory in planning therapeutic strategy.