Usefulness of the non-distension of the stomach in the evaluation of perigastric invasion in advanced gastric cancer by CT

The purpose of this study was to evaluate by CT the usefulness of the non-d istension of the stomach in determining invasion of the gastric cancer into perigastric space and adjacent organs. Forty-eight patients with pathologi cally proved gastric cancer were studied by conventional CT. Patients were examined using two techniques: (a) non-distension of the stomach in the sup ine position and 34 patients additionally in prone position; and (b) disten sion of the stomach with water or air in the supine and/or prone position. CT findings by both techniques were separately analysed preoperatively and compared to surgical findings. Invasion of perigastric fat was better demon strated by the non-distension technique in 15 of the 36 patients with patho logically proven fat infiltration. Non-distension technique was more accura te than distension in detecting: (a) involvement of gastric ligaments (80 v ersus 67% for gastrohepatic, 85 versus 73% for gastrocolic and 80% by both techniques for gastrosplenic ligament); (b) perigastric lymphadenopathy (86 % by both techniques for lymph nodes sited at the gastrohepatic ligament, 8 5 versus 75% for gastrocolic and 85 versus 80% for gastrosplenic ligament l ymph nodes, respectively); and (c) pancreatic invasion (86 versus 80%). The prone position with non-distended stomach was particularly helpful in excl uding pancreatic invasion in five patients with carcinoma of the gastric bo dy. The distension technique was more accurate in demonstrating perigastric extension in gastroesophageal junction tumors in two patients. In conclusi on, additional CT of the non-distended stomach with the patient in prone po sition can provide further evidence about infiltration of the perigastric f at, ligaments, lymph nodes and pancreas, in patients with gastric carcinoma , with the exception of gastroesophageal junction tumors. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.