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Dedicated Multidetector CT of the Stomach: Spectrum of Diseases¹

¹ From the Departments of Radiology (A.B.S., M.P., M.U., P.P., G.L.) and Surgery (B.T.), University of Vienna, Währinger Gürtel 18–20, A-1090 Vienna, Austria. Recipient of a Certificate of Merit award for an education exhibit at the 2001 RSNA scientific assembly. Received July 15, 2002; revision requested September 6; final revision received January 3, 2003; accepted January 15. Address correspondence to A.B.S. (e-mail: ahmed.ba-ssalamah@univie.ac.at).

View larger version (19K): [in a new window]   Figure 1a.  Types of early gastric cancer. Thin straight line = mucosa, jagged line = muscularis mucosae, thick straight line = muscularis propria. (a) Type I lesions are elevated and protrude more than 5 mm into the lumen. (b) Type IIa lesions are elevated but protrude less than 5 mm into the lumen. (c) Type IIb lesions are essentially flat. (d) Type IIc lesions are slightly depressed but do not penetrate the muscularis mucosae. (e) Type III lesions are true mucosal ulcers that penetrate the muscularis mucosae but not the muscularis propria. (Adapted and reprinted, with permission, from reference 10.)

View larger version (13K): [in a new window]   Figure 1b.  Types of early gastric cancer. Thin straight line = mucosa, jagged line = muscularis mucosae, thick straight line = muscularis propria. (a) Type I lesions are elevated and protrude more than 5 mm into the lumen. (b) Type IIa lesions are elevated but protrude less than 5 mm into the lumen. (c) Type IIb lesions are essentially flat. (d) Type IIc lesions are slightly depressed but do not penetrate the muscularis mucosae. (e) Type III lesions are true mucosal ulcers that penetrate the muscularis mucosae but not the muscularis propria. (Adapted and reprinted, with permission, from reference 10.)

View larger version (12K): [in a new window]   Figure 1c.  Types of early gastric cancer. Thin straight line = mucosa, jagged line = muscularis mucosae, thick straight line = muscularis propria. (a) Type I lesions are elevated and protrude more than 5 mm into the lumen. (b) Type IIa lesions are elevated but protrude less than 5 mm into the lumen. (c) Type IIb lesions are essentially flat. (d) Type IIc lesions are slightly depressed but do not penetrate the muscularis mucosae. (e) Type III lesions are true mucosal ulcers that penetrate the muscularis mucosae but not the muscularis propria. (Adapted and reprinted, with permission, from reference 10.)

View larger version (12K): [in a new window]   Figure 1d.  Types of early gastric cancer. Thin straight line = mucosa, jagged line = muscularis mucosae, thick straight line = muscularis propria. (a) Type I lesions are elevated and protrude more than 5 mm into the lumen. (b) Type IIa lesions are elevated but protrude less than 5 mm into the lumen. (c) Type IIb lesions are essentially flat. (d) Type IIc lesions are slightly depressed but do not penetrate the muscularis mucosae. (e) Type III lesions are true mucosal ulcers that penetrate the muscularis mucosae but not the muscularis propria. (Adapted and reprinted, with permission, from reference 10.)

View larger version (13K): [in a new window]   Figure 1e.  Types of early gastric cancer. Thin straight line = mucosa, jagged line = muscularis mucosae, thick straight line = muscularis propria. (a) Type I lesions are elevated and protrude more than 5 mm into the lumen. (b) Type IIa lesions are elevated but protrude less than 5 mm into the lumen. (c) Type IIb lesions are essentially flat. (d) Type IIc lesions are slightly depressed but do not penetrate the muscularis mucosae. (e) Type III lesions are true mucosal ulcers that penetrate the muscularis mucosae but not the muscularis propria. (Adapted and reprinted, with permission, from reference 10.)

View larger version (161K): [in a new window]   Figure 2a.  Early gastric cancer (pathologic stage T1). (a) Sagittal reformatted image shows a type I tumor as an enhancing polypoid lesion (arrow) that protrudes more than 5 mm into the lumen. (b) Coronal reformatted image shows a type IIa tumor as an elevated lesion in the greater curvature that protrudes less than 5 mm into the lumen. There is marked focal enhancement of the inner layer of the gastric wall (arrows). (c) Coronal reformatted image shows a type IIb tumor as focal thickening of the gastric wall with marked enhancement but an essentially flat surface (arrows). The other nodular protrusions of the gastric wall correspond to normal folds, which are stretched out because of gastric dilatation. (d) Oblique sagittal reformatted image shows a type III tumor as focal thickening of the gastric wall with a central ulcer (arrow).

View larger version (149K): [in a new window]   Figure 2b.  Early gastric cancer (pathologic stage T1). (a) Sagittal reformatted image shows a type I tumor as an enhancing polypoid lesion (arrow) that protrudes more than 5 mm into the lumen. (b) Coronal reformatted image shows a type IIa tumor as an elevated lesion in the greater curvature that protrudes less than 5 mm into the lumen. There is marked focal enhancement of the inner layer of the gastric wall (arrows). (c) Coronal reformatted image shows a type IIb tumor as focal thickening of the gastric wall with marked enhancement but an essentially flat surface (arrows). The other nodular protrusions of the gastric wall correspond to normal folds, which are stretched out because of gastric dilatation. (d) Oblique sagittal reformatted image shows a type III tumor as focal thickening of the gastric wall with a central ulcer (arrow).

View larger version (151K): [in a new window]   Figure 2c.  Early gastric cancer (pathologic stage T1). (a) Sagittal reformatted image shows a type I tumor as an enhancing polypoid lesion (arrow) that protrudes more than 5 mm into the lumen. (b) Coronal reformatted image shows a type IIa tumor as an elevated lesion in the greater curvature that protrudes less than 5 mm into the lumen. There is marked focal enhancement of the inner layer of the gastric wall (arrows). (c) Coronal reformatted image shows a type IIb tumor as focal thickening of the gastric wall with marked enhancement but an essentially flat surface (arrows). The other nodular protrusions of the gastric wall correspond to normal folds, which are stretched out because of gastric dilatation. (d) Oblique sagittal reformatted image shows a type III tumor as focal thickening of the gastric wall with a central ulcer (arrow).

View larger version (153K): [in a new window]   Figure 2d.  Early gastric cancer (pathologic stage T1). (a) Sagittal reformatted image shows a type I tumor as an enhancing polypoid lesion (arrow) that protrudes more than 5 mm into the lumen. (b) Coronal reformatted image shows a type IIa tumor as an elevated lesion in the greater curvature that protrudes less than 5 mm into the lumen. There is marked focal enhancement of the inner layer of the gastric wall (arrows). (c) Coronal reformatted image shows a type IIb tumor as focal thickening of the gastric wall with marked enhancement but an essentially flat surface (arrows). The other nodular protrusions of the gastric wall correspond to normal folds, which are stretched out because of gastric dilatation. (d) Oblique sagittal reformatted image shows a type III tumor as focal thickening of the gastric wall with a central ulcer (arrow).

View larger version (138K): [in a new window]   Figure 3a.  Advanced gastric cancer (pathologic stage T2). (a) Coronal reformatted image shows focal wall thickening in the antrum with marked enhancement of the mucosal layer (arrows). At histologic analysis, the outer layers of the muscularis propria were intact, whereas the inner layers were infiltrated. The subtle irregularities of the mucosal surface corresponded to ulcers at histologic analysis. Note the clear fat plane around the tumor. (b) Axial CT scan shows a large carcinoma at the lesser curvature. Note that there is an area of irregular distinction of the tumor from the surrounding fat (arrowhead), which corresponded to a desmoplastic reaction at histologic analysis. There are two slightly hyperenhancing lymph nodes adjacent to each other (arrow). Both proved to be metastasis positive at histologic analysis. (c) Sagittal reformatted image shows diffuse thickening of the gastric wall in the fundus and body regions due to linitis plastica. Note the lack of gastric folds and the decreased distention in the affected region.

View larger version (141K): [in a new window]   Figure 3b.  Advanced gastric cancer (pathologic stage T2). (a) Coronal reformatted image shows focal wall thickening in the antrum with marked enhancement of the mucosal layer (arrows). At histologic analysis, the outer layers of the muscularis propria were intact, whereas the inner layers were infiltrated. The subtle irregularities of the mucosal surface corresponded to ulcers at histologic analysis. Note the clear fat plane around the tumor. (b) Axial CT scan shows a large carcinoma at the lesser curvature. Note that there is an area of irregular distinction of the tumor from the surrounding fat (arrowhead), which corresponded to a desmoplastic reaction at histologic analysis. There are two slightly hyperenhancing lymph nodes adjacent to each other (arrow). Both proved to be metastasis positive at histologic analysis. (c) Sagittal reformatted image shows diffuse thickening of the gastric wall in the fundus and body regions due to linitis plastica. Note the lack of gastric folds and the decreased distention in the affected region.

View larger version (124K): [in a new window]   Figure 3c.  Advanced gastric cancer (pathologic stage T2). (a) Coronal reformatted image shows focal wall thickening in the antrum with marked enhancement of the mucosal layer (arrows). At histologic analysis, the outer layers of the muscularis propria were intact, whereas the inner layers were infiltrated. The subtle irregularities of the mucosal surface corresponded to ulcers at histologic analysis. Note the clear fat plane around the tumor. (b) Axial CT scan shows a large carcinoma at the lesser curvature. Note that there is an area of irregular distinction of the tumor from the surrounding fat (arrowhead), which corresponded to a desmoplastic reaction at histologic analysis. There are two slightly hyperenhancing lymph nodes adjacent to each other (arrow). Both proved to be metastasis positive at histologic analysis. (c) Sagittal reformatted image shows diffuse thickening of the gastric wall in the fundus and body regions due to linitis plastica. Note the lack of gastric folds and the decreased distention in the affected region.

View larger version (137K): [in a new window]   Figure 4a.  Advanced gastric cancer (pathologic stage T3). (a) Axial CT scan shows a large, polypoid carcinoma with gross infiltration of the perigastric fatty tissue (arrows). (b) Oblique coronal reformatted image, tilted posteriorly to display the body and fundus of the stomach and the distal esophagus, shows a large tumor (T) that protrudes from the posterior wall into the lumen and appears as a filling defect within the water-filled stomach. Note the high-attenuation stranding in the perigastric fat (arrow) and the oval lymph node (arrowhead), which was hyperplastic at histologic analysis.

View larger version (130K): [in a new window]   Figure 4b.  Advanced gastric cancer (pathologic stage T3). (a) Axial CT scan shows a large, polypoid carcinoma with gross infiltration of the perigastric fatty tissue (arrows). (b) Oblique coronal reformatted image, tilted posteriorly to display the body and fundus of the stomach and the distal esophagus, shows a large tumor (T) that protrudes from the posterior wall into the lumen and appears as a filling defect within the water-filled stomach. Note the high-attenuation stranding in the perigastric fat (arrow) and the oval lymph node (arrowhead), which was hyperplastic at histologic analysis.

View larger version (148K): [in a new window]   Figure 5a.  Advanced gastric cancer (pathologic stage T4). (a) Axial CT scan shows an advanced cancer of the posterior wall of the gastric body that infiltrates the pancreatic tail (arrow). (b) Coronal reformatted image of the posterior portions of the abdomen shows a large gastric cancer with obliteration of the fat plane and thickening of the colonic wall (arrow). At histologic analysis, the transverse colon was infiltrated. (c) Oblique coronal reformatted image obtained through the esophagus and the fundus and body of the stomach shows circumferential thickening of the gastric wall with loss of gastric folds due to linitis plastica. The tumor extends into the distal esophagus (arrow).

View larger version (142K): [in a new window]   Figure 5b.  Advanced gastric cancer (pathologic stage T4). (a) Axial CT scan shows an advanced cancer of the posterior wall of the gastric body that infiltrates the pancreatic tail (arrow). (b) Coronal reformatted image of the posterior portions of the abdomen shows a large gastric cancer with obliteration of the fat plane and thickening of the colonic wall (arrow). At histologic analysis, the transverse colon was infiltrated. (c) Oblique coronal reformatted image obtained through the esophagus and the fundus and body of the stomach shows circumferential thickening of the gastric wall with loss of gastric folds due to linitis plastica. The tumor extends into the distal esophagus (arrow).

View larger version (115K): [in a new window]   Figure 5c.  Advanced gastric cancer (pathologic stage T4). (a) Axial CT scan shows an advanced cancer of the posterior wall of the gastric body that infiltrates the pancreatic tail (arrow). (b) Coronal reformatted image of the posterior portions of the abdomen shows a large gastric cancer with obliteration of the fat plane and thickening of the colonic wall (arrow). At histologic analysis, the transverse colon was infiltrated. (c) Oblique coronal reformatted image obtained through the esophagus and the fundus and body of the stomach shows circumferential thickening of the gastric wall with loss of gastric folds due to linitis plastica. The tumor extends into the distal esophagus (arrow).

View larger version (145K): [in a new window]   Figure 6a.  Normal lymph nodes in gastric cancer. (a) Axial CT scan shows a small, slightly oval lymph node 4 mm in diameter without significant enhancement (arrow). (b) Coronal reformatted image obtained through the gastric fundus shows a large gastric cancer of the cardia (pathologic stage T2) with multiple lymph nodes. Note the two inhomogeneous enhancing nodes greater than or equal to 8 mm in diameter (arrows), as well as the multiple nodes less than 6 mm in diameter (arrowheads). At histologic analysis, all of the nodes were metastasis negative.

View larger version (136K): [in a new window]   Figure 6b.  Normal lymph nodes in gastric cancer. (a) Axial CT scan shows a small, slightly oval lymph node 4 mm in diameter without significant enhancement (arrow). (b) Coronal reformatted image obtained through the gastric fundus shows a large gastric cancer of the cardia (pathologic stage T2) with multiple lymph nodes. Note the two inhomogeneous enhancing nodes greater than or equal to 8 mm in diameter (arrows), as well as the multiple nodes less than 6 mm in diameter (arrowheads). At histologic analysis, all of the nodes were metastasis negative.

View larger version (149K): [in a new window]   Figure 7a.  Lymph node metastases in gastric cancer (pathologic stages N1-N3). (a) Axial CT scan shows an ulcerated gastric cancer of the antrum with multiple hepatic metastases (pT2 pN1 pM1). Compare the metastasis-positive lymph node (diameter, 8 mm) (small arrow) with the metastasis-negative lymph node (diameter, 6 mm) (arrowhead). The hemiazygos vein (large arrow) may mimic a hyperenhancing lymph node in the retrocrural position. (b) Axial CT scan shows a moderately large ulcerated carcinoma of the lesser curvature that extends into the antrum (pT2). There are multiple round, hyperattenuating, metastasis-positive lymph nodes (pN2) (arrows) in the perigastric fat close to the left gastric artery. Note the group of hyperplastic lymph nodes smaller than 6 mm in diameter (arrowhead). (c) Coronal reformatted image shows multiple round and enlarged perigastric and paraaortic lymph nodes (pN3) (arrows) and multiple hepatic metastases (pM1) (arrowheads). Note the irregular contours of the organ borders due to continuous breathing in this dyspneic patient.

View larger version (144K): [in a new window]   Figure 7b.  Lymph node metastases in gastric cancer (pathologic stages N1-N3). (a) Axial CT scan shows an ulcerated gastric cancer of the antrum with multiple hepatic metastases (pT2 pN1 pM1). Compare the metastasis-positive lymph node (diameter, 8 mm) (small arrow) with the metastasis-negative lymph node (diameter, 6 mm) (arrowhead). The hemiazygos vein (large arrow) may mimic a hyperenhancing lymph node in the retrocrural position. (b) Axial CT scan shows a moderately large ulcerated carcinoma of the lesser curvature that extends into the antrum (pT2). There are multiple round, hyperattenuating, metastasis-positive lymph nodes (pN2) (arrows) in the perigastric fat close to the left gastric artery. Note the group of hyperplastic lymph nodes smaller than 6 mm in diameter (arrowhead). (c) Coronal reformatted image shows multiple round and enlarged perigastric and paraaortic lymph nodes (pN3) (arrows) and multiple hepatic metastases (pM1) (arrowheads). Note the irregular contours of the organ borders due to continuous breathing in this dyspneic patient.

View larger version (145K): [in a new window]   Figure 7c.  Lymph node metastases in gastric cancer (pathologic stages N1-N3). (a) Axial CT scan shows an ulcerated gastric cancer of the antrum with multiple hepatic metastases (pT2 pN1 pM1). Compare the metastasis-positive lymph node (diameter, 8 mm) (small arrow) with the metastasis-negative lymph node (diameter, 6 mm) (arrowhead). The hemiazygos vein (large arrow) may mimic a hyperenhancing lymph node in the retrocrural position. (b) Axial CT scan shows a moderately large ulcerated carcinoma of the lesser curvature that extends into the antrum (pT2). There are multiple round, hyperattenuating, metastasis-positive lymph nodes (pN2) (arrows) in the perigastric fat close to the left gastric artery. Note the group of hyperplastic lymph nodes smaller than 6 mm in diameter (arrowhead). (c) Coronal reformatted image shows multiple round and enlarged perigastric and paraaortic lymph nodes (pN3) (arrows) and multiple hepatic metastases (pM1) (arrowheads). Note the irregular contours of the organ borders due to continuous breathing in this dyspneic patient.

View larger version (158K): [in a new window]   Figure 8.  Spread of gastric cancer. Oblique coronal reformatted image obtained to display the fundus, body, and antrum of the stomach shows an advanced cancer in the gastric body with ascites and peritoneal carcinomatosis (arrowheads). The cancer was surgically proved.

View larger version (114K): [in a new window]   Figure 9a.  Postoperative findings. (a) Oblique coronal reformatted image, obtained to display the gastroesophageal junction as well as the gastroenterostomy after partial gastrectomy for adenocarcinoma of the stomach, shows a large recurrent tumor (arrows) in the region of the anastomosis that infiltrates the remaining portions of the lesser curvature up to the gastroesophageal junction. The tumor was histologically proved. (b) Oblique axial image, tilted laterally to display the gastrojejunostomy after a Billroth II resection, shows substantial thickening of the anastomotic region (arrow). However, there was no evidence of malignancy in multiple biopsy specimens. (c) Axial CT scan obtained after fundoplication shows marked fold thickening at the gastroesophageal junction (arrows). (d) Coronal reformatted image, obtained through the gastric fundus after a Billroth II resection, shows a round, homogeneous seroma (arrow) adjacent to the lesser curvature. The seroma was biopsy proved.

View larger version (154K): [in a new window]   Figure 9b.  Postoperative findings. (a) Oblique coronal reformatted image, obtained to display the gastroesophageal junction as well as the gastroenterostomy after partial gastrectomy for adenocarcinoma of the stomach, shows a large recurrent tumor (arrows) in the region of the anastomosis that infiltrates the remaining portions of the lesser curvature up to the gastroesophageal junction. The tumor was histologically proved. (b) Oblique axial image, tilted laterally to display the gastrojejunostomy after a Billroth II resection, shows substantial thickening of the anastomotic region (arrow). However, there was no evidence of malignancy in multiple biopsy specimens. (c) Axial CT scan obtained after fundoplication shows marked fold thickening at the gastroesophageal junction (arrows). (d) Coronal reformatted image, obtained through the gastric fundus after a Billroth II resection, shows a round, homogeneous seroma (arrow) adjacent to the lesser curvature. The seroma was biopsy proved.

View larger version (132K): [in a new window]   Figure 9c.  Postoperative findings. (a) Oblique coronal reformatted image, obtained to display the gastroesophageal junction as well as the gastroenterostomy after partial gastrectomy for adenocarcinoma of the stomach, shows a large recurrent tumor (arrows) in the region of the anastomosis that infiltrates the remaining portions of the lesser curvature up to the gastroesophageal junction. The tumor was histologically proved. (b) Oblique axial image, tilted laterally to display the gastrojejunostomy after a Billroth II resection, shows substantial thickening of the anastomotic region (arrow). However, there was no evidence of malignancy in multiple biopsy specimens. (c) Axial CT scan obtained after fundoplication shows marked fold thickening at the gastroesophageal junction (arrows). (d) Coronal reformatted image, obtained through the gastric fundus after a Billroth II resection, shows a round, homogeneous seroma (arrow) adjacent to the lesser curvature. The seroma was biopsy proved.

View larger version (145K): [in a new window]   Figure 9d.  Postoperative findings. (a) Oblique coronal reformatted image, obtained to display the gastroesophageal junction as well as the gastroenterostomy after partial gastrectomy for adenocarcinoma of the stomach, shows a large recurrent tumor (arrows) in the region of the anastomosis that infiltrates the remaining portions of the lesser curvature up to the gastroesophageal junction. The tumor was histologically proved. (b) Oblique axial image, tilted laterally to display the gastrojejunostomy after a Billroth II resection, shows substantial thickening of the anastomotic region (arrow). However, there was no evidence of malignancy in multiple biopsy specimens. (c) Axial CT scan obtained after fundoplication shows marked fold thickening at the gastroesophageal junction (arrows). (d) Coronal reformatted image, obtained through the gastric fundus after a Billroth II resection, shows a round, homogeneous seroma (arrow) adjacent to the lesser curvature. The seroma was biopsy proved.

View larger version (141K): [in a new window]   Figure 10a.  Gastric lymphoma (biopsy proved). (a) Coronal reformatted image shows an early gastric lymphoma as focal thickening of the antral wall (arrows). (b) Sagittal reformatted image shows an advanced B-cell lymphoma as bulky disease.

View larger version (149K): [in a new window]   Figure 10b.  Gastric lymphoma (biopsy proved). (a) Coronal reformatted image shows an early gastric lymphoma as focal thickening of the antral wall (arrows). (b) Sagittal reformatted image shows an advanced B-cell lymphoma as bulky disease.

View larger version (157K): [in a new window]   Figure 11a.  Morphologic types of gastric lymphoma (biopsy proved). (a) Axial CT scan shows an infiltrative gastric lymphoma as large areas of gastric wall thickening (arrows) with enlarged lymph nodes (arrowhead). (b) Coronal reformatted image shows a polypoid advanced gastric lymphoma with ulceration (arrow) and extensive extension into the mesenteric root (arrowhead). (c) Coronal reformatted image shows a polypoid advanced gastric lymphoma as segmental thickening (arrowhead) and a large polypoid filling defect arising from the posterior wall of the stomach (arrow). (d) Coronal reformatted image shows a nodular gastric lymphoma as nodular thickening of the gastric wall.

View larger version (141K): [in a new window]   Figure 11b.  Morphologic types of gastric lymphoma (biopsy proved). (a) Axial CT scan shows an infiltrative gastric lymphoma as large areas of gastric wall thickening (arrows) with enlarged lymph nodes (arrowhead). (b) Coronal reformatted image shows a polypoid advanced gastric lymphoma with ulceration (arrow) and extensive extension into the mesenteric root (arrowhead). (c) Coronal reformatted image shows a polypoid advanced gastric lymphoma as segmental thickening (arrowhead) and a large polypoid filling defect arising from the posterior wall of the stomach (arrow). (d) Coronal reformatted image shows a nodular gastric lymphoma as nodular thickening of the gastric wall.

View larger version (143K): [in a new window]   Figure 11c.  Morphologic types of gastric lymphoma (biopsy proved). (a) Axial CT scan shows an infiltrative gastric lymphoma as large areas of gastric wall thickening (arrows) with enlarged lymph nodes (arrowhead). (b) Coronal reformatted image shows a polypoid advanced gastric lymphoma with ulceration (arrow) and extensive extension into the mesenteric root (arrowhead). (c) Coronal reformatted image shows a polypoid advanced gastric lymphoma as segmental thickening (arrowhead) and a large polypoid filling defect arising from the posterior wall of the stomach (arrow). (d) Coronal reformatted image shows a nodular gastric lymphoma as nodular thickening of the gastric wall.

View larger version (116K): [in a new window]   Figure 11d.  Morphologic types of gastric lymphoma (biopsy proved). (a) Axial CT scan shows an infiltrative gastric lymphoma as large areas of gastric wall thickening (arrows) with enlarged lymph nodes (arrowhead). (b) Coronal reformatted image shows a polypoid advanced gastric lymphoma with ulceration (arrow) and extensive extension into the mesenteric root (arrowhead). (c) Coronal reformatted image shows a polypoid advanced gastric lymphoma as segmental thickening (arrowhead) and a large polypoid filling defect arising from the posterior wall of the stomach (arrow). (d) Coronal reformatted image shows a nodular gastric lymphoma as nodular thickening of the gastric wall.

View larger version (141K): [in a new window]   Figure 12.  Carcinoid tumor. Coronal reformatted image shows a gastric carcinoid tumor as an ulcerated mass. The tumor was biopsy proved. Note the thickened rim of the ulcer (arrows). Also note the presence of two hepatic metastases.

View larger version (141K): [in a new window]   Figure 13a.  Metastases to the stomach. (a) Coronal reformatted image of the gastric antrum and body shows rounded, calcified metastases from ovarian cancer in the antrum. At histologic analysis, all layers of the gastric wall were infiltrated and psammoma bodies were found. (b) Coronal reformatted image shows gastric metastases from esophageal carcinoma, which were biopsy proved. Note the submucosal location. (c) Coronal reformatted image of a patient with cholangiocellular carcinoma shows two subserosal metastases to the stomach. The metastases were histologically proved.

View larger version (121K): [in a new window]   Figure 13b.  Metastases to the stomach. (a) Coronal reformatted image of the gastric antrum and body shows rounded, calcified metastases from ovarian cancer in the antrum. At histologic analysis, all layers of the gastric wall were infiltrated and psammoma bodies were found. (b) Coronal reformatted image shows gastric metastases from esophageal carcinoma, which were biopsy proved. Note the submucosal location. (c) Coronal reformatted image of a patient with cholangiocellular carcinoma shows two subserosal metastases to the stomach. The metastases were histologically proved.

View larger version (138K): [in a new window]   Figure 13c.  Metastases to the stomach. (a) Coronal reformatted image of the gastric antrum and body shows rounded, calcified metastases from ovarian cancer in the antrum. At histologic analysis, all layers of the gastric wall were infiltrated and psammoma bodies were found. (b) Coronal reformatted image shows gastric metastases from esophageal carcinoma, which were biopsy proved. Note the submucosal location. (c) Coronal reformatted image of a patient with cholangiocellular carcinoma shows two subserosal metastases to the stomach. The metastases were histologically proved.

View larger version (147K): [in a new window]   Figure 14a.  Direct invasion of the stomach by a neighboring tumor. (a) Oblique coronal reformatted image obtained through the pancreas shows direct invasion of the stomach by an adenocarcinoma of the pancreatic tail (arrow). There is a splenic infarct (white arrowhead) and splenic malperfusion (black arrowhead) due to obstruction of the splenic artery and splenic vein by the tumor. (b) Parasagittal reformatted image obtained through the gastroesophageal junction shows direct infiltration of the stomach by an esophageal carcinoma (arrows). The tumor invasion was surgically proved.

View larger version (132K): [in a new window]   Figure 14b.  Direct invasion of the stomach by a neighboring tumor. (a) Oblique coronal reformatted image obtained through the pancreas shows direct invasion of the stomach by an adenocarcinoma of the pancreatic tail (arrow). There is a splenic infarct (white arrowhead) and splenic malperfusion (black arrowhead) due to obstruction of the splenic artery and splenic vein by the tumor. (b) Parasagittal reformatted image obtained through the gastroesophageal junction shows direct infiltration of the stomach by an esophageal carcinoma (arrows). The tumor invasion was surgically proved.

View larger version (138K): [in a new window]   Figure 15a.  GIST of the stomach. (a) Oblique coronal reformatted image shows a large, inhomogeneous, round mass that compresses the fundus of the stomach. Note the obtuse angle on the medial side and the rounded angle on the lateral side, which are compatible with the subserosal location seen at histologic analysis. (b) Coronal reformatted image shows a GIST that arises from the lesser curvature with endogastric and exogastric extension. The tumor was biopsy proved.

View larger version (150K): [in a new window]   Figure 15b.  GIST of the stomach. (a) Oblique coronal reformatted image shows a large, inhomogeneous, round mass that compresses the fundus of the stomach. Note the obtuse angle on the medial side and the rounded angle on the lateral side, which are compatible with the subserosal location seen at histologic analysis. (b) Coronal reformatted image shows a GIST that arises from the lesser curvature with endogastric and exogastric extension. The tumor was biopsy proved.

View larger version (144K): [in a new window]   Figure 16a.  Benign GIST of the stomach (histologically proved). (a) Sagittal reformatted image obtained with the patient prone shows a round, hyperenhancing, submucosal soft-tissue mass with a small central ulcer (arrow). (b) Axial CT scan shows a hypervascular mass with eccentric inhomogeneity in the gastric antrum. The large hepatic lesion is an abscess.

View larger version (153K): [in a new window]   Figure 16b.  Benign GIST of the stomach (histologically proved). (a) Sagittal reformatted image obtained with the patient prone shows a round, hyperenhancing, submucosal soft-tissue mass with a small central ulcer (arrow). (b) Axial CT scan shows a hypervascular mass with eccentric inhomogeneity in the gastric antrum. The large hepatic lesion is an abscess.

View larger version (153K): [in a new window]   Figure 17.  Gastric schwannoma. Axial CT scan shows a submucosal soft-tissue mass with only minor enhancement but with markedly enhancing intact mucosa (arrow). Note that the perigastric fat plane around the tumor is clear. The tumor was biopsy proved.

View larger version (146K): [in a new window]   Figure 18a.  Gastric polyps (biopsy proved). (a) Coronal reformatted image shows multiple hyperplastic polyps of the gastric wall (arrows). (b) Axial CT scan shows an adenomatous polyp in the gastric antrum (arrow).

View larger version (149K): [in a new window]   Figure 18b.  Gastric polyps (biopsy proved). (a) Coronal reformatted image shows multiple hyperplastic polyps of the gastric wall (arrows). (b) Axial CT scan shows an adenomatous polyp in the gastric antrum (arrow).

View larger version (124K): [in a new window]   Figure 19a.  Gastritis. (a) Oblique coronal reformatted image, obtained through the esophagus and the fundus, body, and antrum of the stomach, shows marked thickening of the antrum in a pattern that is difficult to distinguish from that of carcinoma. Note the enhancing mucosal lining and irregular folds (straight arrows). Endoscopy did not demonstrate an ulcer; multiple biopsy specimens demonstrated only acute gastritis. Note the small axial hernia (curved arrow). Owing to the oblique orientation of the section, the inferior vena cava appears as a round, hypervascular lesion in the liver (arrowhead). (b) Axial CT scan shows gastritis of the antrum as focal thickening and enhancement of the wall (arrows). Note the preserved mucosal lining. Biopsy demonstrated H pylori-induced gastritis.

View larger version (129K): [in a new window]   Figure 19b.  Gastritis. (a) Oblique coronal reformatted image, obtained through the esophagus and the fundus, body, and antrum of the stomach, shows marked thickening of the antrum in a pattern that is difficult to distinguish from that of carcinoma. Note the enhancing mucosal lining and irregular folds (straight arrows). Endoscopy did not demonstrate an ulcer; multiple biopsy specimens demonstrated only acute gastritis. Note the small axial hernia (curved arrow). Owing to the oblique orientation of the section, the inferior vena cava appears as a round, hypervascular lesion in the liver (arrowhead). (b) Axial CT scan shows gastritis of the antrum as focal thickening and enhancement of the wall (arrows). Note the preserved mucosal lining. Biopsy demonstrated H pylori-induced gastritis.

View larger version (133K): [in a new window]   Figure 20.  Gastric ulcer. Coronal reformatted image shows mucosal hyperemia and wall thickening in the antrum with a central ulcer (arrow). The ulcer was biopsy proved.

View larger version (156K): [in a new window]   Figure 21.  Ménétrier disease. Axial reformatted image shows large, lobulated folds and preserved gastric mucosa in the fundus. Biopsy demonstrated Ménétrier disease.

View larger version (160K): [in a new window]   Figure 22.  Gastric outlet obstruction. Coronal reformatted image shows gastric outlet obstruction due to infiltration by a cholangiocarcinoma (arrow), which was surgically proved. Note the dilated intrahepatic bile ducts (arrowheads).

View larger version (119K): [in a new window]   Figure 23.  Gastric varices in a patient with chronic pancreatitis and obstruction of the splenic vein. Coronal reformatted image shows varices of the small gastric veins.