MRI in staging of gastric cancer

Motohara, Tomofumi; Semelka, Richard C.

doi:10.1007/s00261-001-0118-4

Cited by 35 publications

(21 citation statements)

References 23 publications

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“…MRI has not been shown to provide higher diagnostic accuracy than CT for tumor staging or detection of lymph node metastases. Advances in MRI techniques, including the development of breath-hold sequences and the use of intravenous contrast agents, have also made MRI feasible for abdominal imaging, including imaging of the stomach [13,14]; however, MRI is subject to artifacts secondary to respiratory and cardiac movement, and peristalsis in the thorax and abdomen; thus, the role of MRI for staging of gastric cancer is limited [15]. These imaging modalities have similar results with respect to diagnostic accuracy in T staging and a moderate degree of sensitivity and specificity in detecting lymph node metastases [16,17].…”

Section: Introductionmentioning

confidence: 99%

Gastric cancer: Imaging and staging with MDCT based on the 7th AJCC guidelines

et al. 2011

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Gastric cancer is a common deadly cancer worldwide. The tumor-node-metastasis (TNM) staging system is one of the most commonly used staging systems, and is accepted and maintained by the International Union against Cancer (UICC) and the American Joint Committee on Cancer (AJCC). The TNM system is well known to effectively predict the prognosis of gastric cancer patients. The latest revision of TNM staging was presented in the 7th edition of the AJCC in 2009. Multi-detector row CT (MDCT) is a powerful test for non-invasive evaluation and can assess metastatic and locoregional staging simultaneously. Current MDCT with isotropic imaging and 3D images has increased the accuracy of T and N staging in patients with gastric cancer. Multi-planar reformatted images permit the radiologist to select the optimal imaging plane to accurately evaluate tumor invasion depth of the gastric wall and perigastric infiltration to identify a fat plane between a tumor and adjacent organs, to avoid partial volume averaging effects, and to differentiate lymph nodes from small perigastric vessels. Thus, MDCT provides a useful all-in-one diagnostic method for the pre-operative evaluation of patients with known, or strongly suspected, gastric cancer according to the 7th AJCC TNM staging system.

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Section: Introductionmentioning

confidence: 99%

Gastric cancer: Imaging and staging with MDCT based on the 7th AJCC guidelines

et al. 2011

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“…Importantly, the ability of the CT scan to detect nodal involvement is determined primarily by the size of the nodes. In a recent study of 23 patients with equivocal findings of para-aortic LN involvement on CT scan (0.7-1 cm or nodes >1 cm with a fatty marrow) treated with an aggressive LN dissection, including paraaortic LN dissection, 43.5% of cases had positive para-aortic nodes on final pathology [16].The accuracy of magnetic resonance imaging (MRI) is considered to be inferior to CT for examining LN involvement, but may be more accurate than CT for metastatic disease [17,18]. However, recent evaluations of post-contrast MRI show this technique may hold a new key to detecting metastatic LNs reliably for gastric cancer.…”

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confidence: 99%

“…The accuracy of magnetic resonance imaging (MRI) is considered to be inferior to CT for examining LN involvement, but may be more accurate than CT for metastatic disease [17,18]. However, recent evaluations of post-contrast MRI show this technique may hold a new key to detecting metastatic LNs reliably for gastric cancer.…”

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confidence: 99%

“…Further diagnostic imaging via 18 F-fluoro-deoxy-D-glucose (FDG) positron emission tomography (PET) is not a replacement for CT in gastric cancer cases, but can add layers of staging and prognostic information. FDG PET sensitivity for gastric tumors is typically reported to be the same or poorer than CT (45-95% for PET), but depends greatly on the tumor stage (T1 poorer than T2-T4) [14,20], histological type (mucinous worse than non-mucinous) [14,15,21,22], and appears to be directly related to the expression of the glucose transporter-1 (GLUT-1) [22].…”

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Lymph nodes and gastric cancer

Coburn

2009

Journal of Surgical Oncology

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Worldwide, gastric cancer is one of the top three leading causes of cancer mortality, but incidence and presentation vary geographically. Currently, surgery is the only possible cure. Nodal status is an important prognostic indicator for gastric cancer, and despite results of randomized controlled trials, debate continues over the importance of aggressive lymphadenectomy.J. Surg. Oncol. 2009;99:199-206. ß 2009 Wiley-Liss, Inc. KEY WORDS: gastric neoplasm; lymph nodes; surgery Despite a decrease in incidence in recent decades, gastric cancer is still one of the most common causes of cancer death worldwide [1]. In areas without screening for gastric cancer, it presents late, and has a high frequency of nodal involvement [1]. Surgery is the only effective intervention for cure or long-term survival. Nodal status is an important prognostic indicator for gastric cancer, and debate continues over the importance of aggressive lymphadenectomy for gastric cancer.Historically, gastric lymph node (LN) metastases were detected as distant disease due to advanced presentation, with resultant poor prognosis. Sister Mary Joseph, surgical assistant to Dr. William Mayo, first described the relationship between advanced intra-abdominal malignancy and an umbilical nodule, now known as the Sister Mary Joseph's nodule [2], while Virchow's node (supra-clavicular) [3] and an Irish node (axillary) are used to describe other distant metastatic LN disease for gastric cancer. The idea of an extended lymphadenectomy for gastric cancer was first advanced by Mikulicz in 1889, who stated that the distal pancreas should be removed if necessary [4,5]. ASSESSING LYMPH NODE INVOLVEMENT IN GASTRIC CANCERStudies estimate that LNs will be involved with tumors for 3-5% of cases of gastric adenocarcinoma limited to the mucosa; 11-25% of cases for those limited to the sub-mucosa; 50% for T2; and 83% for T3 tumors [6,7]. Nodal status is one of the most important independent predictors of patient survival [8,9]. For example, for 288 T4 gastric cancers, the 1 and 3-year survivals were 76% and 21.9% for node negative cases, versus 40% and 10% for node positive cases, respectively [10].Pre-operative examinations to study the extent of the cancer may include esophagogastro-duodenoscopy (EGD), radiological imaging, and laparoscopy. A computed tomography (CT) scan of the abdomen and pelvis is the most widely recommended method for pre-operative staging of gastric cancer [11,12]. The sensitivity and specificity of CT scan for determining nodal involvement ranges from 50 to 95% and 40 to 99%, respectively; typically, specificity is higher than sensitivity for nodal involvement, but this is not consistent between studies [13][14][15]. Importantly, the ability of the CT scan to detect nodal involvement is determined primarily by the size of the nodes. In a recent study of 23 patients with equivocal findings of para-aortic LN involvement on CT scan (0.7-1 cm or nodes >1 cm with a fatty marrow) treated with an aggressive LN dissection, including paraaortic LN diss...

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“…Although continuous technical improvements obtain better image quality, especially in the study of soft tissues, magnetic resonance imaging (MRI) is not a popular diagnostic study for the evaluation of the gastric wall because of some relative limitations such as motion artifacts, longer examination time and high cost. Its accuracy with regard to the T parameter is reported to be between 73.3% and 88% [19][20][21]. EUS is the most common technique for the staging of primary lesions because it can depict the internal structure of the gastric wall, and the tumor penetration can be evaluated with excellent detail [22].…”

Section: Discussionmentioning

confidence: 99%

Preoperative T staging of gastric carcinoma obtained by MDCT vessel probe reconstructions and correlations with histological findings

et al. 2009

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This study aims to evaluate the diagnostic accuracy of 16-row multidetector CT (MDCT) and vessel probe reconstructions in the T staging of gastric carcinoma. Fifty-three patients (39 men, 14 women, mean age 57.5) with an endoscopic diagnosis of gastric adenocarcinoma underwent CT examination. A hypotonic drug was administered, and the gastric walls were distended by the ingestion of 400-600 ml of water. A biphasic technique with 40-s and 70-s delay was used after endovenous contrast material injection. All patients underwent surgery, and preoperative and histological stagings were compared. The diagnostic accuracy of T staging was 68% for axial images and 94% for VP reconstructions. In the T1, T2, T3 and T4 parameter evaluation, diagnostic accuracy values were 87%, 73.5%, 81% and 96%, respectively, for axial images and 96%, 96%, 98% and 100%, respectively for VP reconstructions. MDCT is an accurate technique for the preoperative staging of gastric cancer. The VP reconstructions obtained by isotropic data can evaluate the T parameter with a higher accuracy.

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MRI in staging of gastric cancer

Cited by 35 publications

References 23 publications

Gastric cancer: Imaging and staging with MDCT based on the 7th AJCC guidelines

Gastric cancer: Imaging and staging with MDCT based on the 7th AJCC guidelines

Lymph nodes and gastric cancer

Preoperative T staging of gastric carcinoma obtained by MDCT vessel probe reconstructions and correlations with histological findings

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