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Benign and Malignant Lesions of the Stomach: Evaluation of CT Criteria for Differentiation¹

¹ From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104. Received May 28, 2002; revision requested July 26; revision received September 19; accepted November 18. Address correspondence to E.K.I. (e-mail: insko@rad.upenn.edu).

View larger version (124K): [in a new window]   Figure 1a. Antral gastritis in a 73-year-old woman. (a) Transverse contrast material-enhanced CT image shows focal symmetric thickening (arrow) of the wall of the gastric antrum and no evidence of enhancement. The antral wall has a thickness of 1.2 cm in this region. (b) Left posterior oblique double-contrast UGI image shows slightly thickened folds (arrow) in the gastric antrum that are compatible with mild antral gastritis. Endoscopic biopsy specimens (not shown) revealed chronic inflammatory changes in the antrum and no evidence of tumor.

View larger version (150K): [in a new window]   Figure 1b. Antral gastritis in a 73-year-old woman. (a) Transverse contrast material-enhanced CT image shows focal symmetric thickening (arrow) of the wall of the gastric antrum and no evidence of enhancement. The antral wall has a thickness of 1.2 cm in this region. (b) Left posterior oblique double-contrast UGI image shows slightly thickened folds (arrow) in the gastric antrum that are compatible with mild antral gastritis. Endoscopic biopsy specimens (not shown) revealed chronic inflammatory changes in the antrum and no evidence of tumor.

View larger version (159K): [in a new window]   Figure 2. Transverse contrast-enhanced CT image obtained in a 59-year-old woman with antral gastritis shows focal asymmetric thickening (arrow) of the anterior wall of the gastric antrum and no evidence of enhancement. The antral wall has a thickness of 1.0 cm in this region. Subsequently obtained double-contrast UGI tract image (not shown) revealed antral gastritis with thickened antral folds but no evidence of tumor.

View larger version (146K): [in a new window]   Figure 3a. Hiatal hernia in a 77-year-old woman. (a) Transverse contrast-enhanced CT image shows focal asymmetric thickening (arrow) of the posteromedial wall of the gastric fundus in the region of the cardia and no evidence of enhancement. The fundal wall has a thickness of 2.0 cm in this region. (b) Right lateral double-contrast UGI tract image shows a hiatal hernia (arrow) and no evidence of tumor in the gastric fundus. In retrospect, the focal wall thickening of the stomach that was depicted at CT probably resulted from incomplete distention of the hiatal hernia, with prolapse of the hernia into the fundus.

View larger version (181K): [in a new window]   Figure 3b. Hiatal hernia in a 77-year-old woman. (a) Transverse contrast-enhanced CT image shows focal asymmetric thickening (arrow) of the posteromedial wall of the gastric fundus in the region of the cardia and no evidence of enhancement. The fundal wall has a thickness of 2.0 cm in this region. (b) Right lateral double-contrast UGI tract image shows a hiatal hernia (arrow) and no evidence of tumor in the gastric fundus. In retrospect, the focal wall thickening of the stomach that was depicted at CT probably resulted from incomplete distention of the hiatal hernia, with prolapse of the hernia into the fundus.

View larger version (143K): [in a new window]   Figure 4a. Benign gastric ulcer in a 72-year-old man. (a) Transverse contrast-enhanced CT image shows focal asymmetric thickening (arrow) of the wall of the gastric antrum and no evidence of enhancement. The antral wall has a thickness of 1.3 cm in this region. In retrospect, barium was probably trapped in an antral ulcer (arrowhead). (b) Frontal double-contrast UGI tract image shows an ulcer (black arrow) in the distal antrum with a large surrounding mound of edema (white arrows). Endoscopic biopsy specimens (not shown) confirmed the presence of a benign gastric ulcer with Helicobacter pylori gastritis.

View larger version (152K): [in a new window]   Figure 4b. Benign gastric ulcer in a 72-year-old man. (a) Transverse contrast-enhanced CT image shows focal asymmetric thickening (arrow) of the wall of the gastric antrum and no evidence of enhancement. The antral wall has a thickness of 1.3 cm in this region. In retrospect, barium was probably trapped in an antral ulcer (arrowhead). (b) Frontal double-contrast UGI tract image shows an ulcer (black arrow) in the distal antrum with a large surrounding mound of edema (white arrows). Endoscopic biopsy specimens (not shown) confirmed the presence of a benign gastric ulcer with Helicobacter pylori gastritis.

View larger version (137K): [in a new window]   Figure 5a. Ulcerated carcinoma of the stomach in an 82-year-old man. (a) Transverse contrast-enhanced CT image shows focal asymmetric thickening (arrow) of the medial wall of the proximal gastric body and heterogeneous enhancement. The antral wall has a thickness of 1.6 cm in this region. (b) Left posterior oblique double-contrast UGI tract image shows a polypoid mass (black arrows) with a flat central ulcer (white arrow) in the lesser curvature of the proximal gastric body. Endoscopic results (not shown) confirmed the presence of an ulcerated mass in the stomach, and biopsy specimens (not shown) revealed gastric adenocarcinoma. The lesion was surgically resected.

View larger version (166K): [in a new window]   Figure 5b. Ulcerated carcinoma of the stomach in an 82-year-old man. (a) Transverse contrast-enhanced CT image shows focal asymmetric thickening (arrow) of the medial wall of the proximal gastric body and heterogeneous enhancement. The antral wall has a thickness of 1.6 cm in this region. (b) Left posterior oblique double-contrast UGI tract image shows a polypoid mass (black arrows) with a flat central ulcer (white arrow) in the lesser curvature of the proximal gastric body. Endoscopic results (not shown) confirmed the presence of an ulcerated mass in the stomach, and biopsy specimens (not shown) revealed gastric adenocarcinoma. The lesion was surgically resected.

View larger version (125K): [in a new window]   Figure 6a. Scirrhous carcinoma of the stomach in a 61-year-old man. (a) Transverse contrast-enhanced CT image shows focal circumferential thickening (arrow) of the wall of the gastric antrum and heterogeneous enhancement. The antral wall has a thickness of 2.0 cm in this region. (b) Left posterior oblique double-contrast UGI tract image shows irregular narrowing of the gastric antrum (arrows). Endoscopic biopsy specimens (not shown) revealed scirrhous adenocarcinoma of the stomach.

View larger version (165K): [in a new window]   Figure 6b. Scirrhous carcinoma of the stomach in a 61-year-old man. (a) Transverse contrast-enhanced CT image shows focal circumferential thickening (arrow) of the wall of the gastric antrum and heterogeneous enhancement. The antral wall has a thickness of 2.0 cm in this region. (b) Left posterior oblique double-contrast UGI tract image shows irregular narrowing of the gastric antrum (arrows). Endoscopic biopsy specimens (not shown) revealed scirrhous adenocarcinoma of the stomach.

View larger version (158K): [in a new window]   Figure 7a. Gastrointestinal stromal tumor in a 52-year-old man. (a) Transverse contrast-enhanced CT image shows focal masslike thickening (arrow) of the posterior wall of the fundus. This wall has lower attenuation than the adjacent wall and no evidence of enhancement. The lesion has a thickness of 2.2 cm. (b) Right lateral double-contrast UGI tract image shows a smooth submucosal-appearing mass (arrow) on the posterior wall of the gastric fundus. Endoscopic biopsy specimens (not shown) revealed a gastrointestinal stromal tumor in the gastric fundus. The lesion was surgically resected.

View larger version (115K): [in a new window]   Figure 7b. Gastrointestinal stromal tumor in a 52-year-old man. (a) Transverse contrast-enhanced CT image shows focal masslike thickening (arrow) of the posterior wall of the fundus. This wall has lower attenuation than the adjacent wall and no evidence of enhancement. The lesion has a thickness of 2.2 cm. (b) Right lateral double-contrast UGI tract image shows a smooth submucosal-appearing mass (arrow) on the posterior wall of the gastric fundus. Endoscopic biopsy specimens (not shown) revealed a gastrointestinal stromal tumor in the gastric fundus. The lesion was surgically resected.