Three Phase Dynamic CT with Double Spiral CT: Utility of Determination of Stomach Cancer Stage

ABSTRACT

PURPOSE: To evaluate the utillity of three phases of spiral CT in the diagnosis of stomach cancer. MATERIALS AND METHODS: Between August 1994 and March 1995, thirty eight patients with stomach cancer, demonstrated on spiral CT, underwent surgery. Twenty-eight cases were advanced and ten were early. There were 27 men, and 11 women, and their average age was 52.8 years old (33-77). After ingestion of 600 - 700ml of water, 120 - 140ml of nonionic contrast material was injected intravenously. Spiral CT scanning was performed in 10mm slice thickness and of 10 mm/sec table speed. Three phase images were obtained at 25 sec (arterial phase), 60-65 sec (venous phase) and 4min (equilibrium phase) after the start of bolus injection. On each phase, CT findings were compared with pathologic results, and tumor detectibility, depth of tumor invasion and lymph node metastasis was analysed. RESULTS: Thirty of the 38 carcinomas (79%) were detected on the arterial phase, 33 (81%) on the venous phase and 30 (79%) on the equilibrium phase. Depth of tumor invasion was measured accurately in 27 of 38 cases (71%) T1 -4/10 (40%), T2 - 8/11 (73%), T3 - 13/15 ( 87% ), T4 - 2/2 ( 100% ). We overstaged one case of T1 as T2 and two cases of T2 as T3, and understaged one case of T2 as T1 and two cases of T3 as T2. Among the 16 enlarged lymph nodes larger than 8mm, 13 cases were positive on pathologic examination and the sensitivity was 65%. CONCLUSION: With three-phase spiral CT scanning, we obtained 71% accuracy of depth of tumor invasion. The venous phase is most useful for tumor detection and for determining depth of tumor invasion and lymph node metastasis.