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Diagnostic Performance of Virtual Gastroscopy Using MDCT in Early Gastric Cancer Compared with 2D Axial CT: Focusing on Interobserver Variation

Jung Hoon Kim1, Hyo Won Eun2, Jae Ho Choi1, Seong Sook Hong1, Weechang Kang3 and Yong Ho Auh4

1 Department of Radiology, Soonchunhyang University Hospital, 657 Hannam-Dong, Youngsan-Ku, Seoul 140-743, Korea.
2 Department of Radiology, College of Medicine, Ewha Womans University, Tongdaemun Hospital, Jongro-Ku, Seoul, Korea.
3 Department of Applied Statistics, Daejeon University, Daejeon, Korea.
4 Department of Radiology, Cornell University Weill Medical College, New York, NY.


Figure 1
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  		Fig. 1A —Early gastric cancer (EGC) type I lesion in 51-year-old man. Gastroscopy image shows polypoid lesion in prepyloric antrum of stomach (arrows).

 

Figure 2
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  		Fig. 1B —Early gastric cancer (EGC) type I lesion in 51-year-old man. Two-dimensional axial CT image shows focal polypoid enhanced lesion in prepyloric antrum (arrow).

 

Figure 3
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  		Fig. 1C —Early gastric cancer (EGC) type I lesion in 51-year-old man. Virtual gastroscopy image shows similar polypoid lesion located in prepyloric antrum (arrows). This finding closely corresponds with findings on conventional gastroscopic image. All observers interpreted this case as EGC on both 2D axial CT and virtual gastroscopy.

 

Figure 4
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  		Fig. 2A —Early gastric cancer (EGC) type IIc lesion in 49-year-old woman. Gastroscopy image shows superficially elevated lesion (arrows) with central depression (arrowhead) in gastric antrum.

 

Figure 5
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  		Fig. 2B —Early gastric cancer (EGC) type IIc lesion in 49-year-old woman. Two-dimensional axial CT image shows no abnormal wall thickening of stomach. All observers interpreted this image as showing normal findings.

 

Figure 6
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  		Fig. 2C —Early gastric cancer (EGC) type IIc lesion in 49-year-old woman. Virtual gastroscopy image shows superficially elevated lesion (arrows) with central depression (arrowhead) in gastric antrum similar to conventional gastroscopy image (A). It was not shown on axial CT. EGC was diagnosed by all three observers.

 

Figure 7
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  		Fig. 3A —Early gastric cancer (EGC) type IIb lesion in 70-year-old man. Gastroscopy image shows superficially flat lesion (arrows) with whitish color change in gastric angle.

 

Figure 8
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  		Fig. 3B —Early gastric cancer (EGC) type IIb lesion in 70-year-old man. Two-dimensional axial CT image shows no abnormal wall thickening of stomach.

 

Figure 9
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  		Fig. 3C —Early gastric cancer (EGC) type IIb lesion in 70-year-old man. Virtual gastroscopy image shows no abnormal mucosal lesion. All observers interpreted both 2D axial CT and virtual gastroscopy as showing normal findings.

 

Figure 10
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  		Fig. 4A —Misdiagnosis of early gastric cancer (EGC) in 47-year-old man without gastric cancer. Two-dimensional axial CT image shows focal enhanced wall thickening in gastric body (arrow). Strong enhancement of mucosal layer is seen. This finding suggests EGC, and all three observers diagnosed finding as EGC.

 

Figure 11
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  		Fig. 4B —Misdiagnosis of early gastric cancer (EGC) in 47-year-old man without gastric cancer. Virtual gastroscopy image shows similar superficially elevated (arrows) and depressed (arrowhead) lesion located in greater curvature side of gastric mid body. Virtual gastroscopy also shows converging fold changes. This finding suggests EGC; all three observers diagnosed as EGC, but gastroscopy showed no abnormal mucosal change. All observers might have confused giant fold in greater curvature of stomach with enhanced tumor mass.

 

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