Abstract
Purpose
This study aims to assess the diagnostic accuracy of virtual gastroscopy obtained by 320-row computed tomography (CT) examination in differentiating benign from malignant gastric ulcers (GUs).
Materials and methods
49 patients (30 M, 19 F, mean age 58.6) with endoscopic and histological diagnosis of GU underwent CT examination. A hypotonizing drug was administered and gastric walls were distended by air in order to perform virtual endoscopy. Based on morphological features, GUs were subdivided into benign or malignant forms by two blinded radiologists. Interobserver agreement was evaluated using Cohen’s kappa (k) test. CT results were then compared with endoscopic and histological findings, having the latter as the reference standard.
Results
Thirty-five out of 49 patients (71%) were affected by malignant ulcers, while in the remaining 14 cases diagnosis of benign GU was made. Virtual gastroscopy showed diagnostic accuracy, sensitivity, and specificity values of 94%, 91%, and 100%, respectively, in differentiating benign from malignant ulcers. Almost perfect agreement between the two readers was found (k = 0.86).
Conclusion
CT virtual gastroscopy improves the identification of GUs and allows differentiating benign from malignant forms.
Similar content being viewed by others
References
Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108
Crew KD, Neugut AI (2006) Epidemiology of gastric cancer. World J Gastroenterol 12:354–362
Chen CY, Kuo YT, Lee CH, et al. (2009) Differentiation between malignant and benign gastric ulcers: CT virtual gastroscopy versus optical gastroendoscopy. Radiology 252:410–417
Kim JH, Eun HW, Goo DE, et al. (2006) Imaging of various gastric lesions with 2D MPR and CT gastrography performed with multidetector CT. RadioGraphics 26:1101–1118
Fishman EK, Urban BA, Hruban RH (1996) CT of the stomach: spectrum of disease. Radiographics 16:1035–1054
Angelelli G, Ianora AA, Scardapane A, et al. (2001) Role of computerized tomography in the staging of gastrointestinal neoplasms. Semin Surg Oncol 20:109–121
Moschetta M, Stabile Ianora AA, Cazzato F, et al. (2011) The role of computed tomography in the imaging of gastric carcinoma. In: Ismaili N (ed) Management of gastric cancer. Rijeka: Intech Ed, pp 3–18
Moschetta M, Stabile Ianora AA, Anglani A, et al. (2010) Preoperative T staging of gastric carcinoma obtained by MDCT vessel probe reconstructions and correlations with histological findings. Eur Radiol 20:138–145
Hansson LE, Nyren O, Hsing AW, et al. (1996) The risk of stomach cancer in patients with gastric or duodenal ulcer disease. N Engl J Med 335:242–249
Andrade MH, Silva E, Mares-Guia M (1990) A plausible identification of the secondary binding site in trypsin and trypsinogen. Braz J Med Biol Res 23:1223–1231
Chen CY, Jaw TS, Kuo YT, et al. (2007) Differentiation of gastric ulcers with MDCT. Abdom Imaging 32:688–693
Rollag A, Jacobsen CD (1984) Gastric ulcer and risk of cancer: a five-year follow-up study. Acta Med Scand 216:105–109
Haukland HH, Johnson JA, Eide JT (1981) Carcinoma diagnosed in excised gastric ulcers. Acta Chir Scand 147:439–443
Chen CY, Wu DC, Kuo YT, et al. (2008) MDCT for differentiation of category T1 and T2 malignant lesions from benign gastric ulcers. AJR Am J Roentgenol 190:1505–1511
Graham DY, Schwartz JT, Cain GD, Gyorkey F (1982) Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. Gastroenterology 82:228–231
Stabile Ianora AA, Wolowiec A, Francioso G, et al. (2001) Benign and malignant gastric ulcer: CT findings. Radiol Med 102:32–36
Longo WE, Zucker KA, Zdon MJ, Modlin IM (1989) Detection of early gastric cancer in an aggressive endoscopy unit. Am Surg 55:100–104
D’Elia F, Zingarelli A, Palli D, Grani M (2000) Hydro-dynamic CT preoperative staging of gastric cancer: correlation with pathological findings. A prospective study of 107 cases. Eur Radiol 10:1877–1885
Bhandari S, Shim CS, Kim JH, et al. (2004) Usefulness of three-dimensional, multidetector row CT (virtual gastroscopy and multiplanar reconstruction) in the evaluation of gastric cancer: a comparison with conventional endoscopy, EUS, and histopathology. Gastrointest Endosc 59:619–626
Kim JH, Park SH, Hong SH, Auh YH (2005) CT gastrography. Abdom Imaging 30:509–517
Hori S, Tsuda K, Murayama S, et al. (1992) CT of gastric carcinoma: preliminary results with a new scanning technique. Radiographics 12:257–268
Tsuda K, Hori S, Murakami T, et al. (1995) Intramural invasion of gastric cancer: evaluation by CT with water-filling method. J Comput Assist Tomogr 19:941–947
Cho JS, Kim JK, Rho SM, et al. (1994) Preoperative assessment of gastric carcinoma: value of two-phase dynamic CT with mechanical iv. injection of contrast material. AJR Am J Roentgenol 163:69–75
Mani NB, Suri S, Gupta S, Wig JD (2001) Two-phase dynamic contrast-enhanced computed tomography with water-filling method for staging of gastric carcinoma. Clin Imaging 25:38–43
Minami M, Kawauchi N, Itai Y, et al. (1992) Gastric tumors: radiologic-pathologic correlation and accuracy of T staging with dynamic CT. Radiology 185:173–178
Fukuya T, Honda H, Kaneko K, et al. (1997) Efficacy of helical CT in T-staging of gastric cancer. J Comput Assist Tomogr 21:73–81
Kim JW, Shin SS, Heo SH, et al. (2011) Diagnostic performance of 64-section CT using CT gastrography in preoperative T staging of gastric cancer according to 7th edition of AJCC cancer staging manual. Eur Radiol . doi:10.1007/s00330-011-2283-3
Lee IJ, Lee JM, Kim SH, et al. (2010) Diagnostic performance of 64-channel multidetector ct in the evaluation of gastric cancer: differentiation of mucosal cancer (T1a) from submucosal involvement (T1b and T2). Radiology 255:805–814
Inamoto K, Kouzai K, Ueeda T, Marukawa T (2005) CT virtual endoscopy of the stomach: comparison study with gastric fiberscopy. Abdom Imaging 30:473–479
Kim JH, Eun HW, Hong SS, Auh YH (2006) Early gastric cancer: virtual gastroscopy. Abdom Imaging 31:507–513
Gurin NN, Logunov KV (1998) Effectiveness of differential diagnosis of benign and malignant ulcers at endoscopy. Ter Arkh 70:37–40
Bustamante M, Devesa F, Borghol A, et al. (2002) Accuracy of the initial endoscopic diagnosis in the discrimination of gastric ulcers: is endoscopic follow-up study always needed? J Clin Gastroenterol 35:25–28
Honmyo U, Misumi A, Murakami A, et al. (1997) Mechanisms producing color change in flat early gastric cancers. Endoscopy 29:366–371
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Moschetta, M., Scardapane, A., Telegrafo, M. et al. Differential diagnosis between benign and malignant ulcers: 320-row CT virtual gastroscopy. Abdom Imaging 37, 1066–1073 (2012). https://doi.org/10.1007/s00261-012-9849-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-012-9849-7