Preoperative staging of gastric carcinoma with multidetector spiral CT.

PURPOSE: To assess the accuracy of Multidetector computed tomography (MDCT) in the preoperative staging of gastric cancer.

MATERIALS AND METHODS: Between March 2002 and October 2002, 27 patents with histologically proven gastric adenocarcinoma underwent MDCT. Unenhanced and contrast-enhanced CT scans were obtained after the oral administration of 400-600 ml of water for gastric wall distension. Biphasic enhanced scans were performed after the automatic injection of 2ml/kg of contrast agent at a flow rate of 3.5 ml/sec with a scan delay of 35 and 70 sec. The images were evaluated for: lesion morphology, degree of wall infiltration, presence of locoregional lymphadenopathies and distant metastases. Based on the findings, a TCMD staging system was established according to the criteria reported in the literature. All the patients underwent surgery, and the preoperative MDCT staging was evaluated against the pathology findings.

RESULTS: MDCT staging was correct in 17/27 patients (62.9%). The T parameter was correctly assessed in 24/27 cases (88.9%), whereas it was understaged in 1 case (3.7%) (T1 stage at CT vs T2 at surgery) and overstaged in 2 cases (7.4%) (T3 vs T2). The N parameter was correctly evaluated in 19/27 patients (70.4%), understaged in 6/27 (22.2%) and overstaged in 2/27 (7.4%).

CONCLUSIONS: MDCT may be proposed for the staging of gastric carcinomas and, although accuracy in N staging remains low in comparison to single-detector spiral CT, it provides a larger amount of diagnostic information.