MDCT Using Virtual Gastroscopy and Multiplanar Reformation Image Technology Differentiates between Malignant and Benign Gastric Ulcers

Multidetector computed tomography (MDCT) using virtual gastroscopy and post-contrast enhanced multiplanar reformation image technology can be useful in differentiating between malignant and benign gastric ulcers, according to a recent study.

"Conventional gastroscopy can diagnose patients with gastric ulcers; however, the procedure is invasive and occasionally may miss early stage disease. Our study was designed to determine if MDCT's multiplanar reformation images plus virtual gastroscopy can help radiologists differentiate cancerous lesions from benign ulcer lesions,” said Chiao-Yun Chen, M.D., from Kaohsiung Medical University Hospital (Kaohsiung, Taiwan) and lead author of the study.

"For virtual gastroscopy, we need to inflate the stomach to perform a CT scan then send all of the raw data to the workstation for post-processing. We can visualize the mucosal surface of the stomach, which traditionally needs to be done by optical gastroscopy,” said Dr. Chen. "However, with virtual gastroscopy alone, no information about the depth of the lesion can be obtained. Therefore, multiplanar reformatted images following intravenous contrast administration play an important role. We are able to detect each lesion's depth with CT this way. We can detect enlarged lymph nodes located in the space between the parietal peritoneum and the muscles and bones of the posterior abdominal wall, liver metastasis, etc., that can't be easily detected using conventional endoscopy,” she continued.

The study included 26 patients with gastric cancer (11 with T1 lesions and 15 with T2 lesions) and 26 patients with a benign gastric ulcer. "MDCT had a higher specificity in the diagnosis of malignant gastric ulcers with 77.8% in virtual gastroscopy and 100% in multiplanar reformation images,” concluded Dr. Chen. "High specificity may help avoid delay in the treatment of patients with gastric cancer and thus may improve their survival rate.”

The study appeared in the July 2008, issue of the American Journal of Roentgenology (AJR).

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Kaohsiung Medical University Hospital