CT gastrography for volumetric measurement of remnant stomach after distal gastrectomy: a feasibility study.

Abstract

To evaluate the feasibility of post-operative CT gastrography for volumetry of the remnant stomach in gastric cancer patients treated with distal gastrectomy. CT gastrography was performed with oral administration of effervescent granules in 35 gastric cancer patients who underwent distal gastrectomy. Two readers independently rated the degree of gastric distension on a four-point scale, one (near-total collapse) to four (well distended) and measured the volume of remnant stomach using either 3D or 2D volumetry. The inter-volumetry agreements between the 2D and 3D methods and the interobserver agreements between readers 1 and 2 were assessed by intraclass correlation coefficients (ICCs) and Bland-Altman plots. The mean score of gastric distension was 3.4±0.6 points and 3.4±0.7 points from readers 1 and 2, respectively. We regarded CT images scored with 3-4 points as a technical success for reliable CT volumetry, which achieved a rate of 91.4% (32/35). For the inter-volumetry agreements between 3D and 2D volumetry, the ICCs were 0.9778 and 0.9814 from readers 1 and 2, respectively. The interobserver agreement between readers 1 and 2 was also excellent, with ICCs of 0.9961 and 0.9876 for 2D and 3D volumetry, respectively. On Bland-Altman plots, the means of differences between any pairs of volumetry measurements ranged from -31.1 to 3.2cm(3), which may be an acceptable range of measurement variability. Post-operative CT gastrography is feasible in patients treated with distal gastrectomy. Both 2D and 3D volumetry methods are comparable in measuring the remnant stomach volume.