The rapid dissemination of multidetector-row computed tomographic (CT) technology will make faster and more accurate gastric imagining available. Two-dimensional multiplanar reconstruction and CT gastrography including virtual gastroscopy and transparency rendering using volume rendering are types of interactive two- and three-dimensional medical imaging tools. It provides multiplanar cross-sectional imaging, gastroscopic viewing, and upper gastrointestinal series imaging in the same data acquisition. Two-dimensional multiplanar reconstruction provides accurate staging of gastric cancer and extraluminal information such as lymphadenopathy and distant metastasis. Virtual gastroscopy detects subtle mucosal changes and differentiates them from submucosal lesions in the same way as gastroscopy. Transparency rendering provides global orientation of the focal findings in the stomach in the same way as upper gastrointestinal series findings and provides useful information for preoperative mapping. Thus, CT gastrography is a promising method for evaluating gastric lesion despite its limitations.
"However, the ability of CT to predict the location of early gastric cancer is limited, particularly if the cancer is located on the horizontally oriented portion of the gastric wall, such as the lesser or greater curvature; this is because of poor z-axis resolution and a partial volume averaging effect [17,18]. In addition, CT detects flat and depressed or excavated tumors with more difficulty than protruding-type tumors, and it rarely detects tumors that are located in the gastric angle [15,19]. "
[Show abstract][Hide abstract] ABSTRACT: Before laparoscopic gastrectomy for gastric cancer can be planned, it is very important to know the precise location of the tumor. The aim of this study was to evaluate 3 methods of predicting the exact location of the tumor: preoperative gastrofibroscopy (GFS), preoperative computed tomography gastroscopy (CT), and intraoperative gastroscopy-guided laparoscopy (Lap).
In this study, 15 patients were prospectively identified, and endoscopic clips were preoperatively placed on the proximal 1 cm of the tumor, at the angle on the greater curvature and opposite the angle on the greater curvature. The distances between the pylorus and the proximal tumor clip (PT), the angle clip (PA), the greater curvature clip (PG), and the gastroesophageal junction were measured by preoperative GFS, preoperative CT, intraoperative Lap, and visual inspection (Vis).
PT, PA, and PG values measured by preoperative GFS differed significantly from the Vis values (P < 0.01). However, preoperative CT measurements of PT, PA, and PG did not differ from the Vis values (P = 0.78, P = 0.48, and P = 0.53, respectively). Intraoperative Lap and Vis PT values differed by only 1.1 cm on an average (P = 0.10), but PA and PG values varied by 1.9 and 3.4 cm, respectively (P = 0.01 for both).
Endoscopic clipping combined with preoperative CT gastroscopy is more useful than preoperative GFS for preoperatively predicting the location of early gastric cancers and will be helpful for planning laparoscopic gastrectomy.
Journal of the Korean Surgical Society 02/2013; 84(2):80-7. DOI:10.4174/jkss.2013.84.2.80 · 0.73 Impact Factor
"When evaluating advanced gastric cancer, accurately determining the extent of tumor is one of the most important tasks for the presurgical planning. Volume rendering techniques such as transparent or surface-shaded imaging can display the extent of advanced gastric cancer (6, 13). Therefore, in our study, the lesion conspicuity of early gastric cancer according to the scanning positions and the gastric portions was graded on the virtual gastroscopic images and that of advanced gastric cancer was graded on the surface-shaded display images. "
[Show abstract][Hide abstract] ABSTRACT: We wanted to prospectively evaluate the effect of various positions of the patient on gastric distension and lesion conspicuity during performance of CT gastrography (CTG).
One hundred thirteen consecutive patients with gastric cancer underwent CTG in the 30 degrees left posterior oblique (LPO), supine, and prone positions. Two radiologists scored (a grade from 1-4) the degree of gastric distension and the lesion conspicuity according to the three scanning positions and the three gastric portions. Two- (2D) and three-dimensional (3D) images were used for analysis. Finally, these data were compared with the endoscopic findings and surgical results.
The mean scores of gastric distension and lesion conspicuity for the LPO and supine positions were higher than those for the prone position (p < 0.001) in the gastric middle and lower portions. However, there was no significant difference between the LPO and supine positions (p > or = 0.21). As for the gastric upper portion, the mean scores of gastric distension in the prone position were higher than those in the two other positions (p < 0.001). The prone position showed better lesion conspicuity than the two other positions for only one of two cases of gastric cancer in the upper portion of the stomach.
CTG performed in the LPO position or the supine position combined with CTG performed in the prone position is optimal for achieving good gastric distension and evaluating the lesion conspicuity of gastric cancer.
Korean journal of radiology: official journal of the Korean Radiological Society 04/2009; 10(3):252-9. DOI:10.3348/kjr.2009.10.3.252 · 1.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Advances in imaging techniques are changing the way radiologists undertake imaging of the gastrointestinal tract and their ability to answer questions posed by surgeons. In this paper we discuss the technological improvements of imaging studies that have occurred in the last few years and how these help to better diagnosing alimentary tract disease.
World Journal of Gastroenterology 06/2006; 12(20):3139-45. · 2.37 Impact Factor
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