Gastroduodenal ulcers on CT: forgotten, but not gone

Allen, Brian C.; Tirman, Philippe; Tobben, John P.; Evans, John A.; Leyendecker, John R.

doi:10.1007/s00261-014-0190-1

Cited by 15 publications

(12 citation statements)

References 20 publications

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“…After fasting for at least 6 h, the patient is instructed to drink 500 to 750 ml of tap water as negative oral contrast during 15–20 min before examination and is then placed on the scanner table in either supine or prone (when antropyloric abnormalities are suspected) position. After hypotonisation using 20 mg of N-butylscopolamine intravenously, contrast-enhanced CT is obtained in pancreatic-dominant and portal venous phases [ 5 – 7 , 9 ].…”

Section: Multidetector Ct Technique and Interpretationmentioning

confidence: 99%

“…Literature from the multidetector CT era reported sensitivities of CT for ulcers of 29.6% to 54%, with an average size of 25 mm for visible ulcers compared to 16 mm of missed ones. Whereas even large ulcers may not be visible on CT with poor luminal distension, deep or penetrating ulcers may be identified with careful multiplanar scrutiny and paying attention to secondary findings [ 5 – 7 ].…”

Section: Ct Appearances Of Uncomplicated Peptic Diseasementioning

confidence: 99%

“…Albeit deep ulcerations which protrude into a solid mass strongly suggest cancer, to overlapping CT appearances (Fig. 6 e, f) endoscopy is generally required for diagnostic confirmation [ 5 – 7 ].

Fig.…”

Section: Ct Appearances Of Uncomplicated Peptic Diseasementioning

confidence: 99%

“…Albeit superficial ulcers are generally inconspicuous, careful multiplanar CT interpretation and attention to subtle mural and extraluminal signs may allow diagnosing non-perforated PUD prospectively. Suggesting the possibility of unexpected PUD may allow planning early endoscopy for diagnostic confirmation and timely start of appropriate treatment with nasogastric tube aspiration, intravenous fluids, and HP “triple therapy” eradication [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis

Tonolini

Ierardi²,

Bracchi

et al. 2017

Insights Imaging

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Despite availability of effective therapies, peptic ulcer disease (PUD) remains a major global disease, resulting from a combination of persistent Helicobacter pylori infection and widespread use of nonsteroidal anti-inflammatory drugs. Albeit endoscopy definitely represents the mainstay diagnostic technique, patients presenting to emergency departments with unexplained abdominal pain generally undergo multidetector CT as an initial investigation. Although superficial ulcers generally remain inconspicuous, careful multiplanar CT interpretation may allow to detect deep ulcers, secondary mural and extraluminal signs of peptic gastroduodenitis, thereby allowing timely endoscopic verification and appropriate treatment. This pictorial essay aims to provide radiologists with an increased familiarity with CT diagnosis of non-perforated PUD, with emphasis on differential diagnosis. Following an overview of current disease epidemiology and complications, it explains the appropriate CT acquisition and interpretation techniques, and reviews with several examples the cross-sectional findings of uncomplicated PUD. Afterwards, the CT features of PUD complications such as ulcer haemorrhage, gastric outlet obstruction, biliary and pancreatic fistulisation are presented.Teaching points• Gastric and duodenal peptic ulcers are increasingly caused by nonsteroidal anti-inflammatory drugs • Multiplanar CT interpretation allows detecting deep ulcers and secondary signs of gastroduodenitis • CT diagnosis of uncomplicated peptic disease relies on direct and indirect signs • Currently the commonest complication, haemorrhage may be treated with transarterial embolisation • Other uncommon complications include gastric outlet obstruction and biliopancreatic fistulisation

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Section: Multidetector Ct Technique and Interpretationmentioning

confidence: 99%

Section: Ct Appearances Of Uncomplicated Peptic Diseasementioning

confidence: 99%

Fig.…”

Section: Ct Appearances Of Uncomplicated Peptic Diseasementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis

Tonolini

Ierardi²,

Bracchi

et al. 2017

Insights Imaging

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“…1A and B) (8). Gastric wall thickening may be observed as a symptom of gastric ulcer (18); however, irregularity of the edge of the thickened wall is a hallmark of gastric cancer (8). All of the present patients with gastric wall thickening were diagnosed with gastric cancer using upper gastrointestinal endoscopy.…”

Section: Us Findingsmentioning

confidence: 99%

Detection of gastric cancer using transabdominal ultrasonography is associated with tumor diameter and depth of invasion

Tomizawa

Shinozaki

Fugo

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Gastric cancer is occasionally diagnosed using transabdominal ultrasonography (US) during screening or investigation of patients with abdominal symptoms. Therefore, the present study analyzed the association of the tumor diameter, pathological T (pT) staging and depth of invasion with the detection of gastric cancer using US. Patient records were analyzed retrospectively and 13 patients were enrolled, who underwent US screening prior to endoscopic mucosal resection, endoscopic submucosal dissection or surgery. In total, 5 patients were diagnosed with gastric cancer using US (positive detection group), while US was unable to detect the gastric cancer in 8 patients (negative detection group). The tumor diameter and depth of invasion were determined by pathologists. One-way analysis of variance or the χ 2 test was performed. Wall thickness in gastric cancer cases ranged between 7 and 20 mm (mean, 12.2±5.9 mm), as measured using abdominal US. The hemoglobin level was significantly lower in the positive detection patients compared with the negative detection patients (P=0.0455). In addition, the diameters of the gastric wall in the negative and positive detection patients were 24.5±16.4 and 54.4±26.2 mm, respectively (P=0.0266). These results indicate that gastric cancer in the positive detection patients were at a more advanced-stage compared with that in the negative detection patients. Furthermore, gastric cancer with a stage over pT2 was diagnosed using abdominal US (P=0.0242), whereas stage pT1a gastric cancer was not detected by abdominal US. Gastric tumors invading deeper than the submucosa were diagnosed using US (P=0.0242). However, the gastric cancer cases limited to the mucosa remained undetected. In conclusion, the detection of gastric cancer correlated well with the tumor diameter, pT staging and depth of invasion.

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Distinguishing gastric anisakiasis from non-anisakiasis using unenhanced computed tomography

et al. 2017

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Gastroduodenal ulcers on CT: forgotten, but not gone

Abstract: Although CT has low sensitivity for peptic ulcer disease, the miss rate for visible peptic ulcers is high. Increased awareness, multiplanar imaging review, and identification of ancillary findings may improve sensitivity for gastroduodenal ulcers.

Cited by 15 publications

References 20 publications

Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis

Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis

Detection of gastric cancer using transabdominal ultrasonography is associated with tumor diameter and depth of invasion

Distinguishing gastric anisakiasis from non-anisakiasis using unenhanced computed tomography

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