Department of Radiology, Sisli Etfal Training and Research Hospital, Sisli 34360, Istanbul, Turkey. halefoglu@hotmail.com.
AIM: To compare the diagnostic accuracy of pelvic phased-array magnetic resonance imaging (MRI) and endorectal ultrasonography (ERUS) in the preoperative staging of rectal carcinoma. METHODS: Thirty-four patients (15 males, 19 females) with ages ranging between 29 and 75 who have biopsy proven rectal tumor underwent both MRI and ERUS examinations before surgery. All patients were evaluated to determine the diagnostic accuracy of depth of transmural tumor invasion and lymph node metastases. Imaging results were correlated with histopathological findings regarded as the gold standard and both modalities were compared in terms of predicting preoperative local staging of rectal carcinoma. RESULTS: The pathological T stage of the tumors was: pT1 in 1 patient, pT2 in 9 patients, pT3 in 21 patients and pT4 in 3 patients. The pathological N stage of the tumors was: pN0 in 19 patients, pN1 in 9 patients and pN2 in 6 patients. The accuracy of T staging for MRI was 89.70%(27 out of 34). The sensitivity was 79.41% and the specificity was 93.14%. The accuracy of T staging for ERUS was 85.29%(24 out of 34). The sensitivity was 70.59% and the specificity was 90.20%. Detection of lymph node metastases using phased-array MRI gave an accuracy of 74.50%(21 out of 34). The sensitivity and specificity was found to be 61.76% and 80.88%, respectively. By using ERUS in the detection of lymph node metastases, an accuracy of 76.47%(18 out of 34) was obtained. The sensitivity and specificity were found to be 52.94% and 84.31%, respectively. CONCLUSION: ERUS and phased-array MRI are complementary methods in the accurate preoperative staging of rectal cancer. In conclusion, we can state that phased-array MRI was observed to be slightly superior in determining the depth of transmural invasion (T stage) and has same value in detecting lymph node metastases (N stage) as compared to ERUS.
Keywords: eru; phased-array; rectal; endorectal; endorectal ultrasonography; rectal cancer; stage; mry; preoperative stage; preoperative; node metastase; metastase; node; patient;
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INTRODUCTION: Invagination is a rare cause of mechanical intestinal obstruction in adults, but half of their causes are malignant. A diagnosis of invagination in an adult patient strongly suggests presence of a malignant pathology. Moreover some benign conditions may resemble malignant disorders like inflammatory fibroid polyp. Inflammatory fibroid polyps are rare benign lesions of uncertain origin that may occur in various parts of the gastrointestinal tract, with gastric antrum being the most common site, followed by the small intestine. CASE PRESENTATION: A 31-year old male patient was admitted to our emergency department few hours after complaints of nausea and vomiting. Abdominal examination revealed distension and clanging intestinal sounds. Computed tomography showed intestinal obstruction without an obvious cause. The patient underwent diagnostic laparotomy. In this process, approximately 10 cm of invaginated mid-jejunal segment was seen. The pathologic segment was resected and end-to-end anastomosis was performed. The patient was discharged without any complication. CONCLUSION: Although IFP is seen very rarely in adults, it is one of the probable diagnoses that should be considered in obstructive tumors of the small intestine causing invagination.
Hakan Köksal,
Sadik Yildirim,
Fevzi Celayir,
Gökhan Cipe,
Adil Baykan,
Mehmet Mihmanli,
Ismail Akgün
Sişli Etfal Research and Training Hospital Surgical Clinic, Istanbul. hakanmkoksal@hotmail.com
BACKGROUND: There is still ongoing debate on therapeutic results of traumatic colorectal perforations. The aim of this study was to evaluate and compare the incidence, management, and outcome of patients with traumatic colonic perforations. METHODS: From January 1997 to December 2002, 85 surgical patients underwent emergency operation for traumatic colonic perforations. Patients were reevaluated by analyzing the relationship between the overall morbidity and mortality and the surgical treatment options. We took into consideration the time interval between perforation and treatment as well as the nature, the site, and the cause of perforation, patients' age, and additional organ injuries. RESULTS: Mean age was 32,1. The most injured segment was transverse segment of the colon. Hartmann's procedure was performed in 3 patients (3.5%); resection, and primary anastomosis in 11 patients (12%); primary repair in 57(67%); primary repair and proximal diverting colostomy in 11(%12); colostomy in 5(5.8%); and appendectomy in 1 patient. Four postoperative death and one fecal fistula occurred. Deaths were not related to the surgical therapy applied. CONCLUSION: Our early postoperative results after primary repair, and resection anastomosis were good. We conclude that either primary repair or resection and anastomosis can be performed with acceptable morbidity for perforations of the colon and rectum.
Department of General Surgery, Sisli Etfal Teaching and Research Hospital, Istanbul, Turkey. sadikyildirim@yahoo.com
Gastric pull-up is the most frequent reconstruction after esophagectomy. In this report we aimed to compare gastric pull-up with colonic interposition in terms of graft function and patient satisfaction. Of 62 patients undergoing esophagectomy, reconstruction was performed by colonic interposition in 11 and gastric pull-up in 51 (without pyloric drainage in 44 and with pyloric drainage in 7). All esophagectomies were performed transhiatally. Patient follow-up ranged from 6 to 132 months (median 14 months). Follow-up examinations were performed 1, 9, 15, and 24 months postoperatively. The following factors were evaluated: time to the start of oral liquid and solid nutrients without vomiting, frequency of regurgitation, presence of pillow staining (night regurgitation), postprandial fullness, and degree of satisfaction during and after eating compared between groups undergoing colonic interposition and gastric pull-up with or without pyloric drainage. Among patients undergoing gastric pull-up, regurgitation was observed in 22% to 27% during follow-up. None of the patients with colonic interposition had reflux or regurgitation. Twenty-five percent of patients with gastric pull-up without drainage and 66% of patients with gastric pull-up plus drainage had reflux esophagitis at 15 months. No esophagitis was observed in patients with colonic interposition during the same period. Overall satisfaction was superior in patients undergoing colonic interposition followed by gastric pull-up with no drainage. Colonic interposition after esophageal resection is a viable option. Our study suggests that function of the replacement is better in this group of patients.
Sisli Etfal Teaching and Research State Hospital, General Surgery, Istanbul, Turkey.
Sişli Etfal Teaching State Hospital, Istanbul, Turkey. sadikyildirim@yahoo.com
OBJECTIVES: Ischaemia/reperfusion injury of the liver is the major cause of liver dysfunction and cellular death in transplantation and in liver resection with hepatic pedicle clamping. Many agents are used to prevent this phenomenon, which occurs following interaction of different mediators during both ischaemia and reperfusion. In this study, we aimed to assess the effects of allopurinol, a xanthine oxidase inhibitor, and pentoxifilline, on liver ischaemia/reperfusion injury when used together and to compare these with the effects of using these agents singly. METHODS: Thirty-two rats were divided into four groups consisting of eight rats: Group C, control; Group P, pentoxifilline; Group A, allopurinol; and Group PA, pentoxifilline + allopurinol. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) levels were measured before hepatic pedicle clamping, on the 45th minute of ischaemia and 15 and 45 minutes after reperfusion. Group P rats were injected with 50 mg/kg pentoxifilline, Group A rats 50 mg/kg allopurinol and Group PA rats were injected with both agents 15 minutes before hepatic pedicle clamping. RESULTS: Ischaemia/reperfusion injury was produced by hepatic pedicle clamping, as demonstrated by AST, ALT and LDH increase. Injury prevention occurred in Groups P, A and PA. No significantly different (better) prevention was provided by giving allopurinol plus pentoxifilline to the rats. Furthermore, no difference was observed between the allopurinol and pentoxifilline injected groups in terms of preventing ischaemia/reperfusion injury. CONCLUSIONS: Pretreatment with allopurinol or pentoxifilline resulted in significantly lower hepatic enzyme elevation than that in controls in the rat liver ischaemia/reperfusion model. Using both agents does not provide better protection than using either agent alone.
Sisli Etfal Education and Research Hospital, Department of Pathology, Istanbul, Turkey.
p53 is a well-known tumor suppressor gene, and its mutation is a common event in intraepidermal and invasive neoplasms of the skin. p63 is a homologue of the tumor suppressor gene p53, which is expressed in human basal squamous epithelium, and despite its homology to p53, it is considered to act as an oncogene. We evaluated p63 and p53 expression in usual skin cancers, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), keratoacanthoma (KA), and intraepidermal neoplasms, including Bowen's disease (BD), actinic keratosis (AK), malignant melanoma in situ (MM in situ), and Paget's disease (PD) to clarify the putative role of p63 and p53 in the development and differential diagnosis of these lesions. Seventeen SCC, 23 BCC, 16 KA, 26 AK, 22 BD, 7 MM in situ, and 6 PD were included in this study. We determined decreasing p63 staining in BD, AK, BCC, SCC, and KA, respectively. None of the MM in situ and PD was positive for p63. The mean p53 staining was highest in BD, followed by AK, SCC, PD, KA, BCC, and normal skin. There was no correlation between the groups in terms of p63 and p53 staining. Based on our findings, analysis of p63 expression may be helpful in the differential diagnosis of BD and AK versus MM in situ and PD, particularly in small biopsies.
Department of Dermatology, University of Marmara, School of Medicine, Istanbul, Turkey. goncagokdemir@hotmail.com
Department of Pathology, Sisli Etfal Training and Research Hospital, M. Ismail Hakki Sk. No:10/1 Uskudar, Istanbul, 34672, Turkey, fkabukcuoglu@hotmail.com.
Tumor to tumor metastasis is a rare, but well recognized entity, most commonly involving a carcinoma metastasis to a benign or low grade mesenchymal tumor. A case of breast carcinoma metastasis in a recurrent myxoid liposarcoma is presented in this study. A 52-year-old female patient with a history of breast carcinoma (70% invasive lobular carcinoma and 30% invasive ductal carcinoma) presented with a mass in the right lumbar region. The excised mass was diagnosed as myxoid liposarcoma. The tumor recurred twice and was reexcised. Microscopic examination of the second recurrence revealed multiple foci of breast carcinoma metastases in myxoid liposarcoma. Immunohistochemical study showed staining for CK19, GCDFP-15, estrogen and progesterone in metastases. Both breast carcinoma metastasis and myxoid liposarcoma were immunoreactive for E-cadherin and beta-catenin. To our knowledge, this is the first reported case of breast carcinoma metastasis in myxoid liposarcoma, and the first occurrence of metastasis in a liposarcoma.
Levent Erdem,
Sadik Yildirim,
Nihat Akbayir,
Banu Yilmaz,
Necati Yenice,
Orhan-Sami Gultekin,
Onder Peker
Department of Gastroenterology, Sisli Etfal Teaching and Research Hospital, Abide-i Hurriyet cad. Sen ap. No. 103/1 Sen Ap. K:1 D:2 Sisli, Istanbul 34381, Turkey. leventerdem2003@yahoo.com.
AIM: To investigate the prevalence and demography of microscopic colitis in patients with diarrhea of unknown etiology and normal colonoscopy in Turkey. METHODS: Between March, 1998 to July, 2005, 129 patients with chronic non-bloody diarrhea of unexplained etiology who had undergone full colonoscopy with no obvious abnormalities were included in the study. Two biopsies were obtained from all colonic segments and terminal ileum for diagnosis of microscopic colitis. On histopathologic examination, criteria for lymphocytic colitis (intraepithelial lymphocyte >= 20 per 100 intercryptal epithelial cells, change in surface epithelium, mononuclear infiltration of the lamina propria) and collagenous colitis (subepithelial collagen band thickness >= 10 mum) were explored. RESULTS: Lymphocytic colitis was diagnosed in 12 (9%) patients (Female/Male: 7/5, mean age: 45 year, range: 27-63) and collagenous colitis was diagnosed in only 3 (2.5%) patients (all female, mean age: 60 years, range: 54-65). CONCLUSION: Biopsy of Turkish patients with the diagnosis of chronic non-bloody diarrhea of unexplained etiology and normal colonoscopic findings will reveal microscopic colitis in approximately 10% of the patients. Lymphocytic colitis is 4 times more frequent than collagenous colitis in these patients.
Kamil Ozdil,
Mehmet Sokmen,
Ozdal Ersoy,
Huseyin Demirsoy,
Besir Kesici,
Cetin Karaca,
Nihat Akbayir,
Levent Erdem,
Canan Alkim,
Damlanur Sakiz
Gastroenterology, Sisli etfal educatıon and research hospital, Istanbul, 80260, Turkey.
Purpose Irritable bowel syndrome is generally diagnosed according to the symptoms of the patient, and gluten enteropathy can also be presented with similar symptoms (diarrhea and/or constipation) of irritable bowel syndrome. Aimed to assess the association and the frequency of gluten enteropathy in a group of Turkish patients diagnosed as irritable bowel syndrome. Results Found anti-gliadin IgA positivity only in four patients among patients with irritable bowel syndrome. However, none of these four patients had anti-endomycium positivity or any histopathological findings specific for gluten enteropathy. All these four patients had normal histology in their small bowel biopsies. Conclusion Irritable bowel syndrome is a common problem in the population, but gluten enteropathy is not associated with the vast majority of subjects with irritable bowel syndrome as expected. The need for screening gluten enteropathy among these patients is still unclear, and screening with serology only without small bowel biopsy may lead to false positive results.
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D Fischerová,
D Cibula,
H Stenhová,
H Vondrichová,
M Zikán,
P Freitag,
J Sláma,
D Pavlsta,
I Pinkavová,
P Dundr
Onkogynekologické centrum, Gynekologicko-porodnická klinika VFN a 1. LF UK, Praha. daniela.fischerova@seznam.cz
OBJECTIVE: The goal of this study was to compare the accuracy of magnetic resonance imaging (MRI)--a standard method--and transrectal ultrasound (TRUS) in the staging and determination of significant prognostic parameters in early-stage cervical cancer. The following prognostic parameters were evaluated: identification of residual tumor in the cervix after cone-biopsy, tumor volume, and early parametrial infiltration. DESIGN: Prospective study. SETTING: Oncogynecological Center, Department of Obstetrics and Gynecology, General Faculty Hospital of Charles University, Prague. METHODS: Patients referred to Oncogynecological Center from January 2004 to February 2006, in whom early-stage cervical cancer (T1a1-T2a) was diagnosed by clinical examination, were prospectivelly enrolled in the study. Only those patients who were examined by both MRI and TRUS with following surgical treatment were included. Imaging results were compared with pathology findings. RESULTS: Data from 95 patients were evaluated. The accuracy of tumor detection in 95 patients was 93.7% for TRUS and 83.2% for MRI (P < or = 0.006). In small tumors (< or = 1 cm3), the accuracy of tumor detection by TRUS was 90.5% and 81.1% by MRI (P < or = 0.049). The accuracy of parametrial infiltration detection by TRUS and MRI was 98.9% and 94.7%, respectively (P < or = 0.219). The accuracy was not influenced by body mass index values. CONCLUSION: Our results show TRUS achieving comparable or even higher accuracy than the more commonly used MRI in staging of early-stage cervical cancer.
Colombo South Teaching Hospital, University Surgical Unit, Kalubowila, Sri Lanka, pulathis_ns@yahoo.co.uk.
Colonoscopic ultrasound (CUS) enables total colonoscopic examination combined with staging of tumor. Rigid probe transrectal ultrasound (TRUS) is reliable in assessing rectal cancer. Both the modalities are associated with an initial learning curve. We evaluated the predictability CUS in preoperative staging of rectal cancer during the learning curve, despite experience with TRUS. Forty-four patients with non-obstructing rectal cancer were assessed by colonoscopy and colonic ultrasound using a 7.5 MHz rotating transducer. Accuracy of ultrasound staging was compared with pathological staging. Tumor staging and nodal staging at pathology and ultrasound were named pT, pN and uT, uN, respectively. The pathological staging was pT1 in two (4.5%), pT2 in 16 (36%), pT3 in 21 (48%) and pT4 in five (11.5%) rectal cancer specimens. CUS understaged the tumor in 11 cases and overstaged it in 10 cases. Overall, the positive predictive value was 61%, negative predictive value 73%, sensitivity 61%, and specificity 73%. Lymph nodes were not visualized in 14. The overall un-weighted kappa of CUS staging of RC was 0.18 (poor). The predictive value in tumor staging of CUS is suboptimal in the learning phase, despite previous experience with TRUS.
Colorectal Fellow, Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
Preoperative staging is now an essential factor in the multidisciplinary management of rectal cancer because tumor stage is the strongest predictive factor for recurrence. Preoperative staging of rectal cancer can be divided into either local or distant staging. Local staging incorporates the assessment of mural wall invasion, circumferential resection margin involvement, as well as the nodal status for metastasis. Distant staging assesses for evidence of metastatic disease. The aim of this review is to consider the indications and limitations of the current preoperative imaging modalities for rectal cancer staging including clinical examination, endorectal ultrasound, magnetic resonance imaging, computed tomography and positron emission tomography-computed tomography, with respect to local and distant disease.
University of British Columbia, Vancouver, Canada.
A case of a 60-year-old man with recurrent rectal villous adenoma is described. Preoperative staging with endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) revealed very discordant results. EUS showed a tumour present in the mucosa with no submucosal invasion, while MRI revealed invasion of the muscularis propria consistent with an invasive stage T2 carcinoma. Based on the MRI findings, the patient underwent a low anterior resection of the tumour. The surgical pathology specimen revealed a villous adenoma with lowgrade dysplasia but no carcinoma and no extension into the muscularis propria. The present case highlights the uncertainty that currently exists as to which imaging modality provides the greatest accuracy in the staging of rectal cancer and in guiding the type of surgical procedure performed. Two recent meta-analyses and a systematic review of the literature point to EUS as the imaging modality of choice for determining muscularis propria and perirectal tissue invasion, as well as nodal involvement.
Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, 80, Guro-dong, Guro-gu, Seoul 152-703, South Korea. jh36640@hanmail.net
AIMS: To evaluate the value of magnetic resonance imaging (MRI) for the detection of deep myometrial invasion. METHODS: The patient group consisted of 53 women with endometrial cancer who underwent preoperative workup, including MRI, and surgical staging between August 1999 and August 2008 at Korea University Medical Center, Seoul, South Korea. The pathological data from surgical staging were compared with the preoperative MRI results. RESULTS: The mean age of the patients was 51 years and most patients had endometrioid cancer. On pathological evaluation of the myometrium, 20.8% had a deep myometrial invasion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI in detecting deep myometrial invasion were 50.0%, 89.7%, 79.2%, 63.6% and 83.3%, respectively. Evaluation of MRI findings and tumour grades by preoperative biopsy had a sensitivity and specificity of 88.9% and 87.5%, respectively, with a kappa of 0.764. CONCLUSION: In patients with endometrial cancer, MRI is limited in its ability to detect deep myometrial invasion. The combination of MRI findings and tumour histology or grade can be helpful in determining if lymphadenectomy is necessary.
Department of Radiology, Aga Khan University Hospital, Karachi.
OBJECTIVE: To evaluate the accuracy of MRI in staging of endometrial carcinoma, and comparison with surgery and histopathological findings. METHODS: A one year prospective cross-sectional study was conducted from 10/3/2005 to 31/5/2006, at the Radiology department, Aga Khan University Hospital (AKUH) Karachi. Fifty two patients with diagnosis of endometrial carcinoma, referred to radiology department for preoperative staging by MRI and had undergone surgery were included. RESULTS: MRI was found to be 79% sensitive, 85% specific and 80% accurate for staging endometrial carcinoma while PPV and NPV were 97% and 66% respectively. CONCLUSION: Magnetic resonance imaging is a good, safe, accurate and non invasive imaging modality in staging of endometrial carcinoma. It can be used as a first line radiological investigation in patients with endometrial carcinoma for treatment planning.
Gastroenheden, Kirurgisk Sektion 435, Hvidovre Hospital, DK-2650 Hvidovre. line.aas.mortensen@hotmail.com
INTRODUCTION: The treatment of rectum cancer depends on the tumour stage, and until 2005 treatment included preoperative radiation therapy for the T3 and T4 cancer stages. An exact preoperative assessment of the cancer stage is therefore essential. In Denmark rectal Magnetic Resonance Imaging (MRI) is used as a standard procedure in preoperative evaluation, sometimes supplemented by transrectal ultrasound (TRUS). The purpose of this study was to determine the accuracy of preoperative MRI in tumour stage evaluation in order to correctly select the patients who will benefit from preoperative radiation therapy. MATERIAL AND METHODS: The MRI reports from 173 patients (98 male, 75 female, mean age 71 years) who underwent surgery for rectum cancer at Hvidovre Hospital, Copenhagen during the 2002-2005-period were evaluated. The T-stage of the MRI report was compared to the histological T-stage of the resected tumour. RESULTS: The overall accuracy of T-staging was 58%(n = 100) of which 41% T2 tumours (n = 18), 78% T3 tumours (n = 78) and 33% T4 tumours (n = 4) were correctly staged. In all, 29% of cancers were overstaged (n = 50)(100% of T1 tumours, 59% of T2 tumours, 7% of T3 tumours). A total of 13% of the cancers were understaged (15% of T3 tumours, 67% of T4 tumours). The selection of patients for preoperative radiation therapy had a sensitivity and specificity of 83% and 48%, respectively. CONCLUSION: The overall accuracy of 58% indicates that MR imaging in the early learning phases was not an optimal method for the preoperative T-staging of rectal cancer. In particular, the low specificity of MRI in selecting the patients who will benefit from preoperative radiation can result in overtreatment and increased morbidity.
Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Jeollanam-do, Korea.
BACKGROUND: The aim of this study was to evaluate the accuracy of surgical diagnosis of early gastric cancer (EGC) and lymph node metastasis, and elucidate its role in determining limited surgery for EGC. STUDY DESIGN: We reviewed 369 patients undergoing gastrectomy for primary gastric carcinoma. Surgical diagnosis was evaluated by determining its sensitivity, specificity, and accuracy, and was compared with preoperative examinations. RESULTS: Sensitivity, specificity, and accuracy of intraoperative diagnosis for EGC were 74.5%, 95.7%, and 83.7%, respectively. The predictive value for EGC by intraoperative diagnosis was 95.7%. Surgical diagnosis of EGC showed higher specificity and predictive value than preoperative examinations did, which significantly reduced the risk of underestimating advanced gastric cancer (AGC) to EGC. The sensitivity, specificity, and accuracy for lymph node metastasis by surgical diagnosis were 73.2%, 78.1%, and 76.4%, respectively. In 70 patients with a discrepancy in the diagnosis of EGC between pre- and intraoperative diagnoses, surgical diagnosis was correct in 63 (90%) patients, but preoperative examination was correct in only 7 (10%) patients. CONCLUSIONS: Surgical diagnosis shows better accuracy than preoperative examinations do in detecting EGC and lymph node metastasis. Our results suggest that the decision to perform limited surgery based on surgical diagnosis might reduce the risk of undertreatment of AGC to EGC better than preoperative examinations.
Zilai Pan,
Huan Zhang,
Chao Yan,
Lianjun Du,
Bei Ding,
Qi Song,
Huawei Ling,
Baisong Huang,
Kemin Chen
Department of Radiology, Ruijin Hospital affiliated to Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
PURPOSE: Multi-detector row CT (MDCT) has been widely used to detect primary lesions and to evaluate TNM staging. In this study we evaluated the accuracy of dynamic MDCT in the preoperative determination of the resectability of gastric cancer. METHODS: MDCT was used to image 350 cases of gastric cancer diagnosed by biopsy before surgery. MDCT findings regarding TNM staging and resectability were correlated with surgical and pathological findings. RESULTS: The accuracy of MDCT for staging gastric cancer was high, especially for tumour stage T1 (94.3%), lymph node stage N2 (87.3%), and for predicting distant metastases (>96.6%). When resectability was considered to be the outcome, the total accuracy of MDCT was 87.4%, sensitivity was 89.7% and specificity was 76.7%. Results showed high sensitivity for identifying peritoneal seeding (90.0%) and for predicting liver metastasis (80.0%). CONCLUSION: Dynamic enhanced MDCT is useful for TNM staging of gastric cancers and for predicting tumour respectability preoperatively.
Il Young Kim,
Sang Won Kim,
Hyeong Cheol Shin,
Moon Soo Lee,
Dong Jun Jeong,
Chang Jin Kim,
Young Tong Kim
Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Choongnam 330-720, South Korea. ilykim@schca.ac.kr
AIM: To determine the accuracy of 1.5-T magnetic resonance imaging (MRI) in the evaluation of gastric wall invasion and perigastric lymph node metastasis in gastric adenocarcinoma. METHODS: Twenty resected gastric specimens containing 20 tumors were studied with a 1.5-T MR system using a commercial head surface coil. MR scanning was performed with a T1 weighted image (TR/TE = 500/20), and a T2 weighted image (TR/TE = 2500/90). MR findings were compared with pathologic findings. RESULTS: A T1-weighted image demonstrated three layers in the normal gastric wall. All of the gastric tumors were well demonstrated by lesions and location. In a MRI findings of gastric wall invasion, there was 1 case of T1, 7 of T2, 11 of T3. Pathologic results of resected specimens included 3 cases of pT1, 4 of pT2, and 12 of pT3. The accuracy of T staging with MRI was 74%(14 of 19). MRI findings of lymph node metastasis included 6 cases of N0, 13 cases of N1. The accuracy of the N staging with MRI was 47%(9 of 19). CONCLUSION: MRI has a high diagnostic accuracy in the evaluation of the T staging of gastric cancer in vitro and thus potentially enables preoperative histopathologic staging.