Computed tomography of gastrohepatic ligament involvement by gastric carcinoma.

PURPOSE: This study was aimed to analyze the contrast-enhanced CT features of gastrohepatic ligament (GHL) involvement in gastric carcinoma (GC) and to evaluate the influence of GHL on the spread of GC correlating with the anatomic bases.

METHODS: CT scans of 41 patients known to have GC and GHL involvement were reviewed retrospectively for the primary tumor and the GHL abnormalities, as well as the role GHL played in the spread of GC. Emphasis was placed on direct invasion, lymph node metastasis, and GHL seeding. The relationship between the accompanying ascites and the different pattern of the GHL involvement were also evaluated statistically.

RESULTS: CT features of the GHL abnormalities caused by GC could be summarized as follows: (a) direct invasion (34.1%, 14 of 41), which was visualized as a regional (nine of 14) or diffuse mass (five of 14) in the GHL; (b) GHL seeding (26.8%, 11 of 41), which consists of ''smudged'' appearance (eight of 11), nodular infiltration (two of 11) and "GHL caking" (one of 11); (c) lymph node metastasis (63.4%, 26 of 41), including enlargement of lymph nodes (22 of 26) and cystic lesion (four of 26). We also found direct extension of GC into the transverse fissure and/or the liver via the GHL in three patients. Ascites, which was found in ten patients, seemed to be associated with the pattern of seeding involvement.

CONCLUSIONS: GHL can be invaded by GC through several patterns and contrast-enhanced CT scan plays an important role in detecting GHL involvement in GC, which has a variety of CT manifestations. GHL may also serve as a potential conduit for the predictable spread of GC into the neighboring organs such as the liver.