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Wall Thickening of the Gastric Antrum as a Normal Finding: Multidetector CT with Cadaveric Comparison

¹ Department of Radiology, National Naval Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889-5600.
² Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20889.

View larger version (161K): [in a new window]   Fig. 1. —Contrast-enhanced axial multidetector CT (MDCT) image in 36-year-old man without gastric disease shows mild to moderate uniform concentric wall thickening involving well-distended gastric antrum (arrowheads). Pylorus and duodenal bulb are well depicted on this image. This appearance of gastric antrum was most common on MDCT.

View larger version (145K): [in a new window]   Fig. 2. —Contrast-enhanced axial multidetector CT image in 45-year-old woman without gastric disease shows prominent short-segment circumferential wall thickening (arrowheads) of distal gastric antrum. Note thin-walled gastric body (arrows).

View larger version (145K): [in a new window]   Fig. 3. —Contrast-enhanced axial multidetector CT image in 65-year-old man without gastric disease shows moderate antral wall thickening (arrowheads) relative to gastric body. Note linear submucosal fat attenuation in area of antral thickening.

View larger version (144K): [in a new window]   Fig. 4A. —Transient asymmetric antral wall thickening in 34-year-old man without gastric disease. Contrast-enhanced axial multidetector CT (MDCT) image during dynamic phase shows asymmetric antral wall thickening (arrowhead). Subtle submucosal low attenuation is present focally at or near pylorus. Note thin wall of more proximal gastric body (arrow).

View larger version (161K): [in a new window]   Fig. 4B. —Transient asymmetric antral wall thickening in 34-year-old man without gastric disease. Contrast-enhanced axial MDCT image during delayed phase shows resolution of asymmetric antral thickening (short arrows), leaving only mild uniform thickening relative to proximal gastric body (long arrow).

View larger version (18K): [in a new window]   Fig. 5. —Bar graph shows distribution of measurements of anterior (white bars) and posterior (black bars) antral wall thicknesses on multidetector CT in 153 consecutive patients without gastric disease.

View larger version (148K): [in a new window]   Fig. 6A. —Images show effect of degree of luminal distention on appearance of concentric long-segment antral thickening in 62-year-old woman without gastric disease. Contrast-enhanced axial multidetector CT (MDCT) image during dynamic phase shows concentric antral thickening (arrowheads) with moderate luminal distention. Note conspicuity of bright mucosal enhancement using water as oral contrast material, which would be obscured by positive oral contrast material.

View larger version (141K): [in a new window]   Fig. 6B. —Images show effect of degree of luminal distention on appearance of concentric long-segment antral thickening in 62-year-old woman without gastric disease. Contrast-enhanced axial MDCT image during delayed phase shows decreased luminal distention and further increase in antral thickening (arrowheads).

View larger version (148K): [in a new window]   Fig. 6C. —Images show effect of degree of luminal distention on appearance of concentric long-segment antral thickening in 62-year-old woman without gastric disease. Delayed axial MDCT image with optimal distention and patient in decubitus position after ingesting effervescent crystals shows decreased but persistent antral wall thickening (arrowheads).

View larger version (9K): [in a new window]   Fig. 7. —Graph shows mean antral wall thickness on multidetector CT in relation to degree of luminal distention. Distention was characterized as grade 1 (least), 2, 3, or 4 (most). Bars indicate 95% confidence intervals. • = grade 1, = grade 2, = grade 3, = grade 4.

View larger version (122K): [in a new window]   Fig. 8A. —Gastric evaluation from dissection of cadaver of 85-year-old woman who died of cardiopulmonary cause and who did not have history of gastric disease. Photograph of distal gastric antrum and pylorus after longitudinal incision shows mild wall thickening of distal gastric antrum (arrowheads) leading to pylorus (arrows). Wall of gastric body was perceptibly thinner (not shown).

View larger version (124K): [in a new window]   Fig. 8B. —Gastric evaluation from dissection of cadaver of 85-year-old woman who died of cardiopulmonary cause and who did not have history of gastric disease. Low-power photomicrographs of histologic sections through anterior wall of distal gastric antrum (B) and proximal gastric body (C) at same magnification show that relative antral thickening is primarily caused by differences in circular smooth muscle layer (asterisks). (H and E, x20)

View larger version (149K): [in a new window]   Fig. 8C. —Gastric evaluation from dissection of cadaver of 85-year-old woman who died of cardiopulmonary cause and who did not have history of gastric disease. Low-power photomicrographs of histologic sections through anterior wall of distal gastric antrum (B) and proximal gastric body (C) at same magnification show that relative antral thickening is primarily caused by differences in circular smooth muscle layer (asterisks). (H and E, x20)

View larger version (120K): [in a new window]   Fig. 9A. —Sonographic appearance of contraction of normal gastric antrum in 34-year-old man without gastric disease. Initial transverse sonographic image of water-filled stomach shows good luminal distention of distal gastric antrum (asterisk) and mild associated wall thickening (arrows). Note similarity of this image to Figure 1.

View larger version (119K): [in a new window]   Fig. 9B. —Sonographic appearance of contraction of normal gastric antrum in 34-year-old man without gastric disease. Sequential sonographic images show progressive luminal narrowing and wall thickening of distal gastric antrum (arrowheads, C) from active contraction. Note similarity of C to Figure 2.

View larger version (126K): [in a new window]   Fig. 9C. —Sonographic appearance of contraction of normal gastric antrum in 34-year-old man without gastric disease. Sequential sonographic images show progressive luminal narrowing and wall thickening of distal gastric antrum (arrowheads, C) from active contraction. Note similarity of C to Figure 2.

View larger version (164K): [in a new window]   Fig. 10. —Abnormal antral wall thickening in 44-year-old man with gastric adenocarcinoma. Contrast-enhanced axial MDCT image shows irregular, eccentric antral wall thickening (arrowheads) with shouldering. Gastric adenocarcinoma was subsequently proven.

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