Purpose To investigate the added value of right down decubitus (RDD) CT when determining adjacent organ invasion in cases of advanced gastric cancer (AGC). Materials and Methods A total of 728 patients with pathologically confirmed T4a (pT4a), surgically confirmed T4b (sT4b), or pathologically confirmed T4b (pT4b) AGCs who underwent dedicated stomach-protocol CT, including imaging of the left posterior oblique (LPO) and RDD positions, were included in this study. Two radiologists scored the T stage of AGCs using a 5-point scale on LPO CT with and without RDD CT at 2-week intervals and recorded the presence of “sliding sign” in the tumors and adjacent organs and compared its incidence of appearance. Results A total of 564 patients (77.4%) were diagnosed with pT4a, whereas 65 (8.9%) and 99 (13.6%) patients were diagnosed with pT4b and sT4b, respectively. When RDD CT was performed additionally, both reviewers deemed that the area under the curve (AUC) for differentiating T4b from T4a increased ( p < 0.001). According to both reviewers, the AUC for differentiating T4b with pancreatic invasion from T4a increased in the subgroup analysis ( p < 0.050). Interobserver agreement improved from fair to moderate (weighted kappa value, 0.296–0.444). Conclusion RDD CT provides additional value compared to LPO CT images alone for determining adjacent organ invasion in patients with AGC due to their increased AUC values and improved interobserver agreement.
Purpose: To evaluate the diagnostic performance of perfusion computed tomography (PCT) parameters for differentiating gastrointestinal stromal tumors (GISTs) from other benign subepithelial tumors (SETs) in the stomach.Materials and Methods: Thirty-one patients with gastric SETs subsequently confirmed via surgery underwent PCT using a multidetector computed tomography (CT) scanner at 80 kVp. Two radiologists analyzed key CT features including homogeneity and degree of enhancement. PCT parameters including blood flow, blood volume, mean transit time, and permeability surface value (PS) were independently calculated by two other radiologists. Comparative analysis of the CT features and perfusion parameters of GISTs and other benign SETs was then performed. Diagnostic performances of the perfusion parameters were also evaluated using receiver operating characteristic (ROC) analysis.Results: Twenty-four patients were proven to have GISTs via histologic examination, while the remaining non-GISTs included 3 leiomyomas, 3 schwannomas, and 1 totally necrotic nodule. Among the conventional CT features, lymphadenopathy was more frequent in non-GISTs (2/7, 28.6%) than in GISTs (0/24, 0%) (p = 0.045). Among the PCT parameters, the mean PS in the areas of strongest enhancement of GISTs (25.3 ± 23.9 mL/100 g/min) was significantly higher than that of other SETs (8.8 ± 8.8 mL/100 g/min) (p = 0.029). In ROC analysis, an area under the curve of 0.774 (p = 0.03), sensitivity of 91.7%, and specificity of 57.1% were achieved when the PS cut-off was set at 7.17 mL/100 g/min.Conclusions: Perfusion parameters were helpful for differentiating GISTs from other benign SETs, as GISTs exhibited significantly higher PS than non-GISTs.
위장관 출혈은 단일 질환이 아니라 광범위한 위장 질환의 증상 및 임상적 발현이다. 임상적 양상에 따라 명백한 출혈, 잠재 출혈, 원인 불명 출혈로 나눌 수 있으며, 출혈 위치에 따라 Treiz 인대를 기준으로 상부 또는 하부 위장관 출혈로 분류할 수 있다. 혈관 질환, 용종, 종양, 크론병, 이소성 췌장 및 이소성 위조직 등 다양 한 질환이 위장관 출혈을 일으킬 수 있다. 명백한 출혈을 위한 영상 검사기법은 CT 혈관조영술, 고식적 혈관조영술 및 핵의학적 검사 등이 사용된다. 잠재 위장관 출혈을 평가하기 위한 영상검사로는 CT 소장조영술이 주로 사용되며, 위장관을 적절히 팽창해서 영상을 획득해야 위음성 혹은 위양성을 최소화하여 진단능을 높일 수 있다. CT 소장조영술에서 진단이 확실하지 않은 경우, Meckel scan이 보완적으로 사용될 수 있다. 원인 불명 위장관 출혈에 대한 검사는 임상 양상과 임상의 혹은 영상의학과 의사의 선호도에 따라 다양한 검사가 시행될 수 있으며, 이에 대한 추가적인 연구가 필요하다.
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