Benign and Malignant Lesions of the Stomach: Evaluation of CT Criteria for Differentiation

Abstract

Gastric wall thickness of 1 cm or greater at CT had a sensitivity of 100% but a specificity of less than 50% for detection of malignant or potentially malignant stomach lesions that necessitated further diagnostic evaluation.

Multidetector CT evaluation in Gastro-Intestinal Bleeding

“…In 1 of them, CT was also able to demonstrate gastric outlet obstruction as a complication due to the diffuse wall thickening and pre-pyloric large lymph nodes. A confirmed diagnosis of malignant wall thickening could be given due to the presence of thickening measuring greater than 1 cm, which was also confirmed by associated findings such as large necrotic and heterogeneously enhancing lymph nodes and fat stranding which were in in concordance with a study ofInsko et al 2003 (6) which also shows the upper cut off for malignant wall thickening to be 1 cm. 1 patient had shown diffuse extra-luminal wall thickening involving the 2 nd and 3 rd part of duodenum which was associated with large retro-peritoneal lymphadenopathies together which were encasing the superior mesenteric axis favoring small bowel lymphoma (Fig.-2).…”

Evaluation of Bowel Wall Thickening by Computed Tomography to Differentiate Benign from Malignant Lesions

“…Bowel wall thickness of 2 cm and less than 2 cm was considered as mild while thickness of more than 2 cm was considered as marked [Table/ Fig 8].It was observed that in our study, 14 (93.3%) out of total 15 cases were correctly diagnosed as benign on CT. Also, out of the total 35 malignant cases, 33 (94.3%) cases were correctly diagnosed on CT. Out of these, one case whose probable diagnosis was kept as lymphoma turned out to be adenocarcinoma [Table/ Fig-8] and another case of abnormal thickening of pyloric region of stomach, thought to be malignant, turned out to be hypertrophic gastritis. Erik K. Insko et al, [11] in their study of 38 patients of abnormal bowel wall thickening had taken into account 14 malignant and 24 benign cases. Like in our study where bowel wall thickness of more than 2cms had sensitivity and specificity of 69% and 93% respectively; the sensitivity and specificity in the study conducted by Erik K. Insko et al, were 50% and 88% respectively [11].…”

“…Erik K. Insko et al, [11] in their study of 38 patients of abnormal bowel wall thickening had taken into account 14 malignant and 24 benign cases. Like in our study where bowel wall thickness of more than 2cms had sensitivity and specificity of 69% and 93% respectively; the sensitivity and specificity in the study conducted by Erik K. Insko et al, were 50% and 88% respectively [11]. However, in our study we had divided the lesions into three categories taking into account focal, segmental and diffuse involvement of the bowel wall.…”

Síndrome Febril en Paciente Sometido a Quimioterapia

“…El uso de agentes efervescentes, antiespasmódicos y adecuada cantidad de contraste oral (neutro o positivo) favorecen su evaluación (1) . Se considera que el grosor normal de la pared del estómago debidamente distendido en TC es 7-10 mm.…”

“…Sin embargo, este hallazgo es altamente sensible pero poco específico (50%) en la detección de lesiones malignas o potencialmente malignas, por lo que para evaluar adecuadamente una lesión deben tomarse en cuenta otros parámetros como: simetría, distribución y refuerzo con el medio de contraste intravascular. El análisis de estas características en conjunto aumenta la sensibilidad y especificidad diagnósticas por lo que la pesquisa de un engrosamiento parietal focal excéntrico que refuerza con contraste tiene elevada sensibilidad (92%) y especificidad en la detección de lesiones malignas (1) . Debido a que sólo un 36% de los pacientes con neoplasias gástricas tienen engrosamiento parietal, la TC no debe utilizarse para la detección de neoplasias gástricas y, las alteraciones que se pesquisan a la TC deben ser confirmadas con endoscopía.…”