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Diagnosis of Gastric Cancer with MDCT Using the Water-Filling Method and Multiplanar Reconstruction: CT–Histologic Correlation

¹ All authors: Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.

View larger version (138K): [in a new window]   Fig. 1A —69-year-old man with protruding type of early gastric cancer. Coronal multiplanar reconstruction shows gastric wall as three-layer structure on CT. High-attenuating tumor (arrows) is adjacent to third layer. * = inner layer with high attenuation, ** = middle layer with low attenuation, *** = outer layer with isoattenuation.

View larger version (108K): [in a new window]   Fig. 1B —69-year-old man with protruding type of early gastric cancer. Photomicrograph shows inner layer corresponds to mucosa (*), middle layer to submucosa (**), and outer layer to proper muscle with serosa (***). Tumor is adjacent to proper muscle (arrows), as shown on multiplanar reconstruction (A).

View larger version (185K): [in a new window]   Fig. 2A —Early gastric cancers. 69-year-old man with protruding type of early gastric cancer. Oblique multiplanar reconstruction perpendicular to gastric wall shows protruding mass (arrow) of gastric cardia.

View larger version (179K): [in a new window]   Fig. 2B —Early gastric cancers. 77-year-old man with superficial and depressed type of early gastric cancer. Coronal multiplanar reconstruction shows irregularly enhanced lesion (arrows) at lesser curvature of lower gastric body.

View larger version (138K): [in a new window]   Fig. 3A —63-year-old woman with protruding type of early gastric cancer. Axial CT scan shows polypoid mass with thick vessels (arrows) at basement of tumor.

View larger version (125K): [in a new window]   Fig. 3B —63-year-old woman with protruding type of early gastric cancer. Photomicrograph also shows thick vessels (arrows) at basement of tumor.

View larger version (153K): [in a new window]   Fig. 4A —58-year-old man with protruding type of advanced gastric cancer. Sagittal multiplanar reconstruction shows low-attenuating area (*) in tumor.

View larger version (155K): [in a new window]   Fig. 4B —58-year-old man with protruding type of advanced gastric cancer. Photomicrograph reveals that low-attenuating area histologically corresponds to mucinous component (*) in tumor.

View larger version (159K): [in a new window]   Fig. 5A —70-year-old man with diffusely infiltrative type of advanced gastric cancer (pT3). Coronal multiplanar reconstruction shows thickened gastric wall with abnormal three-layer structure: high-attenuating first layer (*), low-attenuating second layer (**), and high-attenuating third layer (arrow).

View larger version (168K): [in a new window]   Fig. 5B —70-year-old man with diffusely infiltrative type of advanced gastric cancer (pT3). Photomicrograph shows that high-attenuating first layer pathologically corresponds to where cancer cells are more closely linked, mainly at mucosal and submucosal layers (*), and that low-attenuating second layer (**) corresponds to where tumor cells are diffusely scattered, mainly at proper muscle layer. In addition, high-attenuating third layer of outer line of gastric wall corresponds to closely linked proliferation of cancer cells from subserosal layer to serosa (arrow).

View larger version (155K): [in a new window]   Fig. 6A —56-year-old man with diffusely infiltrative type of advanced gastric cancer (pT4). Coronal multiplanar reconstruction shows inhomogeneous mass (arrows) invading pancreas.

View larger version (147K): [in a new window]   Fig. 6B —56-year-old man with diffusely infiltrative type of advanced gastric cancer (pT4). Pancreatic invasion is not clearly evident on axial CT scan.

View larger version (189K): [in a new window]   Fig. 7A —66-year-old man with protruding type of advanced gastric cancer (pT2). Axial CT scan shows large protruding mass with nodular deformation (arrow) of outer surface of gastric wall.

View larger version (128K): [in a new window]   Fig. 7B —66-year-old man with protruding type of advanced gastric cancer (pT2). Photomicrograph shows extraprotrusion of serosa by mucinous lake (arrow), but serosal infiltration by cancer cells is not histologically revealed.

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