Uneven haustra on CT colonography: a clue for the detection of transperitoneal invasion from gastric cancer

Assessment of the use of computed tomography colonography in early detection of peritoneal metastasis in patients with gastric cancer: A prospective cohort study

Peritoneal metastasis (PM) is one of the most frequent forms of gastric cancer recurrence. In this study, we aimed to use computed tomography (CT) colonography (CTC) to detect signs of PM earlier in patients in whom PM was suspected but not yet diagnosed. CTC was used to evaluate patients with clinical symptoms or general CT findings that were suspicious but not sufficient to confirm PM. In total, 18 patients with suspected PM were enrolled. Ten patients (55.6%) had PM on CTC. Abnormal colonic deformities were identified at locations other than those of the lesions detected by general CT in seven patients. The sensitivity and specificity of CTC for the detection of PM were 83.3% and 100%, respectively. The median overall survival after CTC was 201 days in the CTC-positive group, which was significantly shorter than that in the CTC-negative group (945 days, p = 0.01). In the multivariate analysis, a positive CTC finding was the only factor independently associated with survival (p = 0.005). According to our experience with 18 patients, CTC can be an alternative to conventional imaging for early detection of PM. Further prospective studies with larger sample sizes are warranted to confirm and validate these findings. University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR): Registration number: UMIN000044167.

CT Colonography: an update on current and future indications

Computed tomographic colonography (CTC) is a minimally invasive, patient-friendly, safe and robust colonic imaging modality. The technique is standardized and consolidated evidence from the literature shows that the diagnostic performances for the detection of colorectal cancer and large polyps are similar to colonoscopy (CS) and largely superior to alternative radiological exams, like barium enema. A clear understanding of the exact role of CTC will be beneficial to maximize the benefits and minimize the potential sources of frustration or disappointment for both referring clinicians and patients. Incomplete, failed, or unfeasible CS; investigation of elderly, and frail patients and assessment of diverticular disease are major indications supported by evidence-based data and agreed by the endoscopists. The use of CTC for symptomatic patients, colorectal cancer screening and colonic surveillance is still under debate and, thus, recommended only if CS is unfeasible or refused by patients.

Computed tomography of gastrohepatic ligament involvement by gastric carcinoma

PURPOSE

This study was aimed to analyze the contrast-enhanced CT features of gastrohepatic ligament (GHL) involvement in gastric carcinoma (GC) and to evaluate the influence of GHL on the spread of GC correlating with the anatomic bases.

METHODS

CT scans of 41 patients known to have GC and GHL involvement were reviewed retrospectively for the primary tumor and the GHL abnormalities, as well as the role GHL played in the spread of GC. Emphasis was placed on direct invasion, lymph node metastasis, and GHL seeding. The relationship between the accompanying ascites and the different pattern of the GHL involvement were also evaluated statistically.

RESULTS

CT features of the GHL abnormalities caused by GC could be summarized as follows: (a) direct invasion (34.1%, 14 of 41), which was visualized as a regional (nine of 14) or diffuse mass (five of 14) in the GHL; (b) GHL seeding (26.8%, 11 of 41), which consists of ''smudged'' appearance (eight of 11), nodular infiltration (two of 11) and "GHL caking" (one of 11); (c) lymph node metastasis (63.4%, 26 of 41), including enlargement of lymph nodes (22 of 26) and cystic lesion (four of 26). We also found direct extension of GC into the transverse fissure and/or the liver via the GHL in three patients. Ascites, which was found in ten patients, seemed to be associated with the pattern of seeding involvement.

CONCLUSIONS

GHL can be invaded by GC through several patterns and contrast-enhanced CT scan plays an important role in detecting GHL involvement in GC, which has a variety of CT manifestations. GHL may also serve as a potential conduit for the predictable spread of GC into the neighboring organs such as the liver.