Preoperative assessment of gastric carcinoma: value of two-phase dynamic CT with mechanical iv. injection of contrast material.

Abstract

The purpose of this study was to evaluate the utility of two-phase dynamic CT performed with mechanical IV injection of a bolus of contrast medium after oral intake of water in the preoperative staging of gastric cancers. We performed incremental dynamic CT in 52 patients with pathologically proved gastric cancers. Dynamic CT findings were prospectively analyzed and correlated with surgical and histopathologic findings. A total of 150 ml of nonionic contrast medium was administered IV with a power injector at a flow rate of 5 ml/sec for 30 sec, and two-phase images were obtained at 30 sec (early phase) and 2 min (equilibrium phase) after the start of bolus injection. Forty-one advanced gastric carcinomas showed a moderate to marked degree of heterogeneous enhancement in the early phase and homogeneous enhancement of the entire lesion in the equilibrium phase of dynamic CT. The primary tumors were correctly detected with dynamic CT in five (56%) of the nine early gastric cancers and in 41 (95%) of the 43 advanced gastric cancers. The overall detection rate of gastric cancers was 88% (46 of 52 cases). The accuracies of dynamic CT according to TNM staging in determining the depth of tumor invasion, the degree of serosal invasion, and regional lymph node metastasis were 65% (34 of 52 cases), 83% (38 of 46 cases), and 70% (32 of 46 cases), respectively. Our findings show that two-phase incremental dynamic CT with mechanical IV injection of a bolus of contrast medium after oral intake of water improves the diagnostic accuracy of CT over that provided by conventional CT in the preoperative staging of gastric cancers.