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Published online before print December 18, 2008, 10.1148/radiol.2502071872

(Radiology 2009;250:767.)

A more recent version of this article appeared on March 1, 2009
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© RSNA, 2008

Gastrointestinal Imaging

Staging of T3 and T4 Gastric Carcinoma with Multidetector CT: Added Value of Multiplanar Reformations for Prediction of Adjacent Organ Invasion1

Young Hoon Kim, MD, Kyoung Ho Lee, MD, Seong Ho Park, MD, Hyung-Ho Kim, MD, Seokyung Hahn, PhD, Do Joong Park, MD, and Hye Seung Lee, MD

1 From the Departments of Radiology (Y.H.K., K.H.L.), Surgery (H.H.K., D.J.P.), and Pathology (H.S.L.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (Y.H.K., K.H.L.); Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (S.H.P.); and Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (S.H.). From the 2007 RSNA Annual Meeting. Received December 17, 2007; revision requested February 13, 2008; revision received April 24; accepted June 11; final version accepted August 14. Supported by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A060151). Address correspondence to K.H.L. (e-mail: kholee{at}snubhrad.snu.ac.kr).

Purpose: To determine the added value of multiplanar reformation (MPR) images combined with computed tomographic (CT) images in staging of T4 gastric cancers.

Materials and Methods: The institutional review board approved this retrospective study and waived informed consent. One hundred forty-nine consecutive patients (99 men [age range, 33–85 years; mean age, 63.1 years] and 50 women [age range, 30–85 years; mean age, 57.1 years]; age range, 30–85 years; mean age, 61.1 years) with pathologically and/or surgically confirmed T3 (n = 110) or T4 tumors (n = 39), with invasion of the transverse colon or mesocolon (n = 23), pancreas (n = 16), diaphragm (n = 4), liver (n = 3), and/or spleen (n = 1) were included. Two experienced radiologists independently reviewed 4-mm-thick transverse CT images and, 10 weeks later, reviewed both transverse CT and additional coronal and sagittal MPR images to assess tumor invasion in each of the aforementioned five adjacent organs. Receiver operating characteristic (ROC) analyses and weighted {kappa} statistics were obtained to evaluate reader performance and agreement in identifying tumor invasion.

Results: With addition of MPR images, the area under the ROC curve (AUC) led to a significant increase in the prediction of adjacent organ invasion in per-organ analyses (0.88 vs 0.95 for reader 1 [P = .01], 0.88 vs 0.98 for reader 2 [P < .001]) and identification of T4 tumors in per-patient analyses (0.79 vs 0.91 for reader 1 [P = .006], 0.78 vs 0.96 for reader 2 [P < .001]). In the five analyzed organs, AUC was significantly increased in regard to invasion of the transverse colon or mesocolon and pancreas; separate analysis was not performed for the diaphragm, liver, and spleen because of the small number of true invasions. Interobserver agreement increased in per-organ ({kappa} = 0.43 vs 0.67) and per-patient ({kappa} = 0.42 vs 0.62) analyses.

Conclusion: Adding MPR images to transverse CT images improves the capability for distinguishing T3 from T4 gastric cancer and prediction of adjacent organ invasion.

Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/2502071872/DC1

© RSNA, 2008