Greyscale and contrast enhanced ultrasonography for characterization of gastric malignant tumors

Abstract

Aims: To evaluate the utility of grey scale ultrasonography (US) and contrast enhanced ultrasonography (CEUS) for characterization of malignant gastric tumors.Material and methods: The study was conducted prospectively and it included a number of 30 patients with malignant gastric tumors diagnosed through upper tract endoscopy and biopsy: 25 adenocarcinomas, 3 lymphomas, and 2 stromal tumors. All the patients were examined by US, followed immediately by CEUS, using both oral and intravenous contrast agents. CEUS assessed the dynamics of the contrast agent during the arterial phase and the venous phase. The distribution characteristics of the contrast agent inside the region of interest (ROI) were also evaluated. Twenty four patients underwent surgery.Results: Adenocarcinomas presented heterogeneous enhancement with variable pattern, followed by a delayed wash-out in almost all of the situations. Lymphomas presented a variable pattern, intensity and homogeneity of the enhancement, followed by delayed wash-out. Stromal tumors showed early arterial intense and homogenous enhancement followed by moderate wash-out in venous phase.Conclusions: Grey scale US and CEUS are useful methods in characterizing gastric tumors and contribute to a more adequate evaluation of the lesions. The dynamics of the contrast agent may be suggestive for the anatomopathological nature of the tumor. Larger studies will be necessary in order to determine thepractical value of the method.

B-Mode and Contrast Enhanced Ultrasonography Features of Gastric Inflammatory and Neoplastic Diseases in Cats

“…However, the study performed by Xue et al (2016) did not include any cases of gastric lymphoma, only adenocarcinomas, and this could explain the different vascular kinetics observed [ 34 ]. Furthermore, the study published by Neciu et al (2019), performed on 30 patients, included three cases of gastric lymphoma in which, however, only a qualitative analysis of the CEUS examinations was performed [ 35 ].…”

“…Furthermore, lymphomas of this group were more likely to have a homogeneous enhancement (7/10) and the presence of comb teeth-like vessels (7/10). In human medicine, enhancement patterns described for gastric lymphomas reported that these tumours are characterized by a variable uptake pattern, intense and heterogeneous enhancement, and a delayed washout [ 35 ]. However, in the mentioned study, the presence of comb teeth-like vessels was not considered, which was instead described by Xue et al as typical of gastritis and not of gastric cancers [ 34 ]: this finding seems to further support, as already highlighted for the increased quantitative contrast uptake values (PE and WiR), that the vascular component of the neoplastic gastric wall, during feline HGAL, maintains increased and aberrant perfusion patterns.…”

“…The qualitative assessment of enhancement patterns on CEUS clips was performed by the same operator in cases of a thickened gastric wall ≥6 mm only, since a thickness of less than 6 mm is too thin to perform an accurate analysis of the perfusion pattern. Moreover, even in human medicine, this type of analysis, performed in cases of gastritis and gastric neoplasia, has been reported only in ≥6-mm-thick gastric walls [ 34 , 35 ]. The enhancement patterns of thickened gastric walls considered are the same as those reported by Xue et al in the human medicine literature [ 34 ]: (1) enhancement degree, considering visible normal liver parenchyma as the reference.…”

“…In human medicine, the CEUS technique has been used to perform qualitative and quantitative assessments of gastric wall perfusion in patients affected by gastritis and neoplastic disease [ 34 , 35 ]. One study reported that gastric cancer showed a diffuse enhancement without “comb teeth-like” vessels (parallel curvilinear structures representing arterial branching within the gastric wall), while this pattern was visible in most cases of gastritis; furthermore, the neoplastic wall showed delayed and lower peak enhancement compared to gastritis [ 34 ].…”

“…One study reported that gastric cancer showed a diffuse enhancement without “comb teeth-like” vessels (parallel curvilinear structures representing arterial branching within the gastric wall), while this pattern was visible in most cases of gastritis; furthermore, the neoplastic wall showed delayed and lower peak enhancement compared to gastritis [ 34 ]. Another recent study evaluated standard B-mode US and CEUS in the characterization of malignant gastric tumours, reporting that the dynamics of the CM may be suggestive of the anatomopathological nature of the tumour: both adenocarcinomas and lymphomas showed a variable enhancement pattern followed by a delayed washout, while they differed in enhancement homogeneity; stromal tumours showed early arterial intense and homogenous enhancement followed by moderate washout in the venous phase [ 35 ].…”