MDCT, virtual gastroscopy, MPR efficacious in malignant gastric ulcer diagnosis

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Multidetector CT using virtual gastroscopy and post contrast-enhanced multiplanar reformation (MPR) images can be useful in differentiating between malignant and benign gastric ulcers, according to a study in the June issue of the American Journal of Roentgenology.

"Conventional gastroscopy can diagnose patients with gastric ulcers; however the procedure is invasive and occasionally may miss early stage disease. Our study was designed to determine if MDCT's multiplanar reformation images plus virtual gastroscopy can help radiologists differentiate cancerous lesions from benign ulcer lesions," said Chiao-Yun Chen, MD, lead author of the study. The research was conducted at the Kaohsiung Medical University Hospital in Kaohsiung, Taiwan.

The study included 26 patients with gastric cancer (11 with T1 lesions and 15 with T2 lesions) and 26 patients with a benign gastric ulcer. MDCT and virtual gastroscopic findings were analyzed according to four qualitative criteria: ulcer shape, base, and margin and changes in adjacent folds. The quantitative criteria ulcer size, thickness of the gastric wall around an ulcer, thickness of the enhanced ulcer base and enhancement around an ulcer were measured on MPR images.

Researchers calculated the sensitivity and specificity of each quantitative criterion and used receiver operator characteristic analysis to identify cutoff points yielding optimal sensitivity and specificity for the diagnosis of gastric cancer.

"MDCT had a higher specificity in the diagnosis of malignant gastric ulcers with 77.8 percent in virtual gastroscopy and 100 percent in multiplanar reformation images,” Chen concluded. "High specificity may help avoid delay in the treatment of patients with gastric cancer and thus may improve their survival rate.