Preoperative evaluation of gastric cancer: value of spiral CT during gastric arteriography (CTGA)

Background: To evaluate the utility of dual-phase spiral computed tomograph y during gastric arteriography (CTGA) in the preoperative staging of gastri c cancers. Methods: We performed CTGA in 21 patients with pathologically pr oven gastric cancers. CTGA findings were prospectively analyzed and correla ted with surgical and pathologic findings. Dual-phase scans were performed at 10 s (early) and 60-100 s (delayed) after injection of 120 mt of contras t medium at an injection rate of 6 mL/s through a preset 5-Fr catheter posi tioned in the celiac trunk. Spiral CT scans were assessed for enhancing pat tern of the normal gastric wall, tumor detectability, and accuracy of tumo r staging. Results: Normal gastric mucosa was clearly visible as two or three layers i n all patients on early-phase scans and in eight patients on delayed-phase scans. The primary tumors were correctly detected with CTGA in seven (88%) of the eight early gastric cancers and in all 13 (100%) advanced gastric ca ncers. The accuracy of CTGA for T staging was 50% and 77% in early and adva nced gastric cancers, respectively. The overall accuracy for tumor detectio n and T staging was 95% and 67%, respectively. The accuracy of CTGA for the degree of serosal invasion and regional lymph node metastasis was 77% and 76%. respectively. Conclusion: The CTGA technique improved tumor detection rate and accuracy o f tumor staging, especially in early gastric cancer, and may be very useful in the preoperative staging of gastric cancer.