MDCT for Differentiation of Category T1 and T2 Malignant Lesions from Benign Gastric Ulcers
Chiao-Yun Chen1,2,
Deng-Chyang Wu3,
Yu-Ting Kuo1,2,
Chien-Hung Lee4,
Twei-Shiun Jaw1,2,
Wan-Yi Kang5 and
Jui-Sheng Hsu1,6
1 Department of Medical Imaging, Kaohsiung Medical University Hospital,
Kaohsiung, Taiwan.
2 Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung
Medical University, Kaohsiung, Taiwan.
3 Division of Gastroenterology, Department of Internal Medicine, Kaohsiung
Medical University Hospital, and Faculty of Medicine, College of Medicine,
Kaohsiung Medical University, Kaohsiung, Taiwan.
4 Graduate Institute of Public Health, Kaohsiung Medical University, Kaohsiung,
Taiwan.
5 Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung,
Taiwan.
6 Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical
University, 100 Tz-You 1st Rd., Kaohsiung, 807 Taiwan, Province of
China.
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Fig. 1 —57-year-old woman with T1 malignant gastric ulcer
(circle) in gastric body. En face virtual gastroscopic view
shows uneven ulcer base, geographic ulcer shape, irregular ulcer margin,
associated gastric folds with interruption of rugae (black arrows),
and bulbous enlargement and fusion (white arrow).
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Fig. 2 —72-year-old woman with T2 malignant gastric ulcer
(arrows) in gastric angle. En face virtual gastroscopic view
shows even ulcer base, oval ulcer shape, irregular ulcer margin, and no
associated gastric folds around ulcer.
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Fig. 3 —68-year-old man with benign gastric ulcer (circle)
in gastric body. En face virtual gastroscopic view shows even ulcer
base, regular triangular ulcer shape, regular ulcer margin, and associated
regular gastric folds terminating at ulcer margin (arrows). N =
nasogastric tube.
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Fig. 4 —58-year-old man with benign gastric ulcer (arrows)
in gastric antrum. En face virtual gastroscopic view shows even ulcer
base, oval ulcer shape, regular ulcer margin, and no associated gastric folds
around ulcer.
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Fig. 5B —56-year-old man with T1 malignant gastric ulcer. Reformatted
paraaxial image in plane of line 1 (A) shows ulcer (circle) in
gastric antrum with periulcer gastric wall thickening, marked periulcer
enhancement, high attenuation at ulcer base, and preserved low attenuation of
outer submucosal layer.
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Fig. 6A —66-year-old woman with benign gastric ulcer. Paracoronal
reformatted image shows gastric ulcer (arrows) in gastric body with
mild periulcer gastric wall thickening, no increased periulcer enhancement,
and only linear sharp high attenuation at ulcer base.
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Fig. 7 —43-year-old woman with malignant gastric ulcer. Multiplanar
reformation shows maximum diameter of ulcer (line D), periulcer wall
thickening (line T), and thickening of enhanced ulcer base (line
B).
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Fig. 8 —66-year-old woman with benign gastric ulcer. Multiplanar
reformation shows maximum diameter of ulcer (line D), periulcer wall
thickening (line T), and discernible thickness of enhanced ulcer base
(line B).
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Fig. 9 —48-year-old man with malignant gastric ulcer. Multiplanar
reformation shows three optimally sized regions of interest (circles)
placed on right, left, and inferior portions of ulcer to measure attenuation
around ulcer.
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Fig. 10A —51-year-old man with signet ring cell carcinoma. En
face (A) and profile (B) virtual gastroscopic images of
gastric ulcer (circle) in gastric angle show even ulcer base,
irregular ulcer shape, and irregular ulcer margin but no associated periulcer
gastric folds. Findings indicate typical malignant gastric ulcer.
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Fig. 10B —51-year-old man with signet ring cell carcinoma. En
face (A) and profile (B) virtual gastroscopic images of
gastric ulcer (circle) in gastric angle show even ulcer base,
irregular ulcer shape, and irregular ulcer margin but no associated periulcer
gastric folds. Findings indicate typical malignant gastric ulcer.
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Fig. 10C —51-year-old man with signet ring cell carcinoma. Axial
multiplanar reformatted CT image shows ulcer (arrow) with periulcer
gastric wall thickening, no increased periulcer enhancement, and only linear
sharp high attenuation of ulcer base.
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