Accuracy of whole-body diffusion-weighted MRI (WB-DWI/MRI) in diagnosis, staging and follow-up of gastric cancer, in comparison to CT: a pilot study

Abstract

Background Accurate staging of patients with gastric cancer is necessary for selection of the most appropriate and personalized therapy. Computed tomography (CT) is currently used as primary staging tool, being widely available with a relatively high accuracy for the detection of parenchymal metastases, but with low sensitivity for the detection of peritoneal metastases. Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) has a very high contrast resolution, suggesting a higher diagnostic performance in the detection of small peritoneal lesions. The aim of this study was to retrospectively evaluate the added value of whole-body diffusion-weighted MRI (WB-DWI/MRI) to CT for detection of peritoneal carcinomatosis (PC) and distant metastases in the preoperative staging of gastric cancer. Methods This retrospective study included thirty-two patients with a suspicion of gastric cancer/recurrence, who underwent WB-DWI/MRI at 1.5 T, in addition to CT of thorax and abdomen. Images were evaluated by two experienced abdominal radiologists in consensus. Histopathology, laparoscopy and/or 1-year follow-up were used as reference standard. Results For overall tumour detection (n = 32), CT sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was 83.3%, 100%, 100% and 82.4% respectively. For WB-DWI/MRI these values were 100%, 92.9%, 94.7% and 100%, respectively. For staging (n = 18) malignant lymph nodes and metastases, CT had a sensitivity, specificity/PPV/NPV of 50%/100%/100%/71.4%, and 15.4%/100%/100%/31.3% respectively. For WB-DWI/MRI, all values were 100%, for both malignant lymph nodes and metastases. WB-DWI/MRI was significantly better than CT in detecting tumour infiltration of the mesenteric root, serosal involvement of the small bowel and peritoneal metastases for which WB-DWI/MRI was correct in 100% of these cases, CT 0%. Conclusions WB-DWI/MRI is highly accurate for diagnosis, staging and follow-up of patients with suspected gastric cancer.

Imaging of Gastric Carcinomatosis

“…In patients with PC from ovarian origin, inter-reader agreement was good to excellent for the positive diagnostic of PM (k = 0.75-0.91), while it dropped significantly when considering small bowel locations (k = 0.12-0.29) [7]. The same results were confirmed in PC from gastric cancer [8]. CT sensitivity for PC is low to moderate, with wild variations, ranging from 23% to 76% [9,10].…”

“…Moreover, the use of T2-weighted imaging (T2WI) is of great interest when considering mucinous tumour subtypes, as PC typically appear with T2WI hyper-intensity, making this sequence very sensitive. It is of particular interest in the context of GC, as PM are frequently a small size lesion or infiltrative disease, with limited sensitivity to CT, as shown by De Vuysere et al [8]. Their work showed evidence of a CT sensitivity for overall gastric tumour detection that was 83.3% vs. 100% for MRI, with a significant difference when considering tumour infiltration of the mesentery, small bowel, and PM (0% vs. 100% for CT vs. MRI, respectively).…”

“…Their work showed evidence of a CT sensitivity for overall gastric tumour detection that was 83.3% vs. 100% for MRI, with a significant difference when considering tumour infiltration of the mesentery, small bowel, and PM (0% vs. 100% for CT vs. MRI, respectively). Realization of whole-body MRI has been proposed to allow for the assessment of primary tumour and lymph node involvement and distant metastasis for GC [8]. Nonetheless, MRI is not currently recommended as a first-line imaging modality for PM from GC but rather for the staging before surgery or as a problem-solving tool.…”

Endoscopic diagnosis and treatment of gastric dysplasia and early cancer: Current evidence and what the future may hold

“…Concurrent to these improvements in EUS, the addition of technologies such as CT with multiplanar reformations and virtual gastroscopy has led to overall accuracy as high as 94% for the diagnosis of EGC[ 79 ]. In addition, high-speed magnetic resonance imaging (MRI) and diffusion-weighted imaging have also addressed many of the limitations of MRI for the assessment of T-stage, though this remains infrequently used in the assessment of EGCs[ 80 , 81 ].…”

The Value of Predicting Human Epidermal Growth Factor Receptor 2 Status in Adenocarcinoma of the Esophagogastric Junction on CT-Based Radiomics Nomogram

“…At present, the research of non-invasive CT scanning methods to predict pathological or histological characteristics has gradually become a hot topic in clinical research. Conventional abdominal CT is widely used for preoperative examination of gastric cancer, but it is mostly used for the evaluation of gastric cancer staging and lymph node metastasis, and the evaluation of histology and genetic status of gastric cancer is limited ( 11 , 12 ). Therefore, this study used radiomics to explore a new non-invasive inspection method to evaluate the HER2 gene expression status of AEG.…”