DOI: 10.1148/rg.264055089
Imaging of Various Gastric Lesions with 2D MPR and CT Gastrography Performed with Multidetector CT1
Jung Hoon Kim, MD,
Hyo Won Eun, MD,
Dong Erk Goo, MD,
Chan Sup Shim, MD and
Yong Ho Auh, MD
1 From the Department of Radiology (J.H.K., D.E.G.) and Digestive Disease Center (C.S.S.), Soonchunhyang University Hospital, 657 Hannam-Dong, Youngsan-Ku, Seoul 140-743, Korea; the Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (H.W.E.); and the Department of Radiology, Cornell University Weill Medical College, New York, NY (Y.H.A.). Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received April 8, 2005; revision requested June 23; final revision received October 6; accepted October 7. All authors have no financial relationships to disclose.
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Figure 1a. Early gastric cancer (type I). (a) Image from conventional gastroscopy shows a polypoid mass in the lower body of the stomach along the greater curvature. (b) Oblique coronal 2D MPR image shows the uniformly enhanced mass (arrows) in the lower body of the stomach. (c) Image from virtual gastroscopy shows the polypoid mass. The volume rendering technique with an opacity of 100% was applied to create virtual gastroscopic images. These images correspond to conventional gastroscopic images. (d) Transparency-rendered image shows the mass (arrows) in the lower body of the stomach. The volume rendering technique with an opacity of 30%–50% was applied to create transparency-rendered images. These images correspond to double-contrast UGIS images.
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Figure 1b. Early gastric cancer (type I). (a) Image from conventional gastroscopy shows a polypoid mass in the lower body of the stomach along the greater curvature. (b) Oblique coronal 2D MPR image shows the uniformly enhanced mass (arrows) in the lower body of the stomach. (c) Image from virtual gastroscopy shows the polypoid mass. The volume rendering technique with an opacity of 100% was applied to create virtual gastroscopic images. These images correspond to conventional gastroscopic images. (d) Transparency-rendered image shows the mass (arrows) in the lower body of the stomach. The volume rendering technique with an opacity of 30%–50% was applied to create transparency-rendered images. These images correspond to double-contrast UGIS images.
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Figure 1c. Early gastric cancer (type I). (a) Image from conventional gastroscopy shows a polypoid mass in the lower body of the stomach along the greater curvature. (b) Oblique coronal 2D MPR image shows the uniformly enhanced mass (arrows) in the lower body of the stomach. (c) Image from virtual gastroscopy shows the polypoid mass. The volume rendering technique with an opacity of 100% was applied to create virtual gastroscopic images. These images correspond to conventional gastroscopic images. (d) Transparency-rendered image shows the mass (arrows) in the lower body of the stomach. The volume rendering technique with an opacity of 30%–50% was applied to create transparency-rendered images. These images correspond to double-contrast UGIS images.
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Figure 1d. Early gastric cancer (type I). (a) Image from conventional gastroscopy shows a polypoid mass in the lower body of the stomach along the greater curvature. (b) Oblique coronal 2D MPR image shows the uniformly enhanced mass (arrows) in the lower body of the stomach. (c) Image from virtual gastroscopy shows the polypoid mass. The volume rendering technique with an opacity of 100% was applied to create virtual gastroscopic images. These images correspond to conventional gastroscopic images. (d) Transparency-rendered image shows the mass (arrows) in the lower body of the stomach. The volume rendering technique with an opacity of 30%–50% was applied to create transparency-rendered images. These images correspond to double-contrast UGIS images.
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Figure 2a. (a) Endoscopic US image shows the normal appearance of the stomach. (b) Magnified view of a shows the normal gastric wall. A standard endoscopic US image demonstrates five layers of the gastrointestinal wall. The alternating hypoechoic and hyperechoic bands correspond to the following anatomic wall layers: the hyperechoic superficial mucosa or inner interface, hypoechoic deep mucosa (arrows), hyperechoic submucosa, hypoechoic muscularis propria (arrowheads), and hyperechoic serosa or outer interface.
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Figure 2b. (a) Endoscopic US image shows the normal appearance of the stomach. (b) Magnified view of a shows the normal gastric wall. A standard endoscopic US image demonstrates five layers of the gastrointestinal wall. The alternating hypoechoic and hyperechoic bands correspond to the following anatomic wall layers: the hyperechoic superficial mucosa or inner interface, hypoechoic deep mucosa (arrows), hyperechoic submucosa, hypoechoic muscularis propria (arrowheads), and hyperechoic serosa or outer interface.
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Figure 3a. Early gastric cancer (type II a+c). (a) Image from conventional gastroscopy shows a superficially elevated and depressed lesion in the midbody of the stomach on the greater curvature side. (b) Image from virtual gastroscopy shows the superficially elevated and depressed lesion. (c) Endoscopic US image shows thickening of the gastric mucosa with superficial infiltration of the submucosa (arrows). The central depressed lesion is also evident (arrowhead).
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Figure 3b. Early gastric cancer (type II a+c). (a) Image from conventional gastroscopy shows a superficially elevated and depressed lesion in the midbody of the stomach on the greater curvature side. (b) Image from virtual gastroscopy shows the superficially elevated and depressed lesion. (c) Endoscopic US image shows thickening of the gastric mucosa with superficial infiltration of the submucosa (arrows). The central depressed lesion is also evident (arrowhead).
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Figure 3c. Early gastric cancer (type II a+c). (a) Image from conventional gastroscopy shows a superficially elevated and depressed lesion in the midbody of the stomach on the greater curvature side. (b) Image from virtual gastroscopy shows the superficially elevated and depressed lesion. (c) Endoscopic US image shows thickening of the gastric mucosa with superficial infiltration of the submucosa (arrows). The central depressed lesion is also evident (arrowhead).
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Figure 4a. Early gastric cancer (type IIb). (a) Image from conventional gastroscopy shows a superficial flat lesion (arrows) in the lower body of the stomach on the lesser curvature side. (b) Image from virtual gastroscopy does not show the lesion. The flat nature of the tumor is the reason why it was overlooked at virtual gastroscopy. (c) Endoscopic US image shows mucosal thickening (arrows) in the lower body of the stomach.
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Figure 4b. Early gastric cancer (type IIb). (a) Image from conventional gastroscopy shows a superficial flat lesion (arrows) in the lower body of the stomach on the lesser curvature side. (b) Image from virtual gastroscopy does not show the lesion. The flat nature of the tumor is the reason why it was overlooked at virtual gastroscopy. (c) Endoscopic US image shows mucosal thickening (arrows) in the lower body of the stomach.
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Figure 4c. Early gastric cancer (type IIb). (a) Image from conventional gastroscopy shows a superficial flat lesion (arrows) in the lower body of the stomach on the lesser curvature side. (b) Image from virtual gastroscopy does not show the lesion. The flat nature of the tumor is the reason why it was overlooked at virtual gastroscopy. (c) Endoscopic US image shows mucosal thickening (arrows) in the lower body of the stomach.
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Figure 5a. Advanced gastric cancer (Borrmann type 2). (a) Image from conventional gastroscopy shows a mass with a central ulcer in the gastric antrum. (b) Oblique coronal 2D MPR image shows the enhanced mass in the antrum with adjacent gastric wall thickening (arrows). (c) Image from virtual gastroscopy shows the mass with a central ulcer. (d) Transparency-rendered image shows the well-defined mass (arrows) with a central ulcer in the antrum. (e) Endoscopic US image shows thickening of the entire gastric wall (arrows) with serosal interruption.
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Figure 5b. Advanced gastric cancer (Borrmann type 2). (a) Image from conventional gastroscopy shows a mass with a central ulcer in the gastric antrum. (b) Oblique coronal 2D MPR image shows the enhanced mass in the antrum with adjacent gastric wall thickening (arrows). (c) Image from virtual gastroscopy shows the mass with a central ulcer. (d) Transparency-rendered image shows the well-defined mass (arrows) with a central ulcer in the antrum. (e) Endoscopic US image shows thickening of the entire gastric wall (arrows) with serosal interruption.
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Figure 5c. Advanced gastric cancer (Borrmann type 2). (a) Image from conventional gastroscopy shows a mass with a central ulcer in the gastric antrum. (b) Oblique coronal 2D MPR image shows the enhanced mass in the antrum with adjacent gastric wall thickening (arrows). (c) Image from virtual gastroscopy shows the mass with a central ulcer. (d) Transparency-rendered image shows the well-defined mass (arrows) with a central ulcer in the antrum. (e) Endoscopic US image shows thickening of the entire gastric wall (arrows) with serosal interruption.
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Figure 5d. Advanced gastric cancer (Borrmann type 2). (a) Image from conventional gastroscopy shows a mass with a central ulcer in the gastric antrum. (b) Oblique coronal 2D MPR image shows the enhanced mass in the antrum with adjacent gastric wall thickening (arrows). (c) Image from virtual gastroscopy shows the mass with a central ulcer. (d) Transparency-rendered image shows the well-defined mass (arrows) with a central ulcer in the antrum. (e) Endoscopic US image shows thickening of the entire gastric wall (arrows) with serosal interruption.
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Figure 5e. Advanced gastric cancer (Borrmann type 2). (a) Image from conventional gastroscopy shows a mass with a central ulcer in the gastric antrum. (b) Oblique coronal 2D MPR image shows the enhanced mass in the antrum with adjacent gastric wall thickening (arrows). (c) Image from virtual gastroscopy shows the mass with a central ulcer. (d) Transparency-rendered image shows the well-defined mass (arrows) with a central ulcer in the antrum. (e) Endoscopic US image shows thickening of the entire gastric wall (arrows) with serosal interruption.
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Figure 6a. Advanced gastric cancer (Borrmann type 3). (a) Image from conventional gastroscopy shows an ulcerated and infiltrative lesion at the gastric angle. Clubbing and fusion of the converging folds are seen at the margin of the ulcer. (b) Oblique coronal 2D MPR image shows an area of enhanced wall thickening (arrows) at the gastric angle. (c) Image from virtual gastroscopy shows the irregularly marginated mass (arrows) with a central ulcer. Clubbing and fusion of the converging folds are seen at the margin of the ulcer. (d) Transparency-rendered image shows the mass (arrows) with luminal narrowing of the gastric angle. Transparency rendering provides excellent anatomic information for the surgeon. (e) Endoscopic US image shows the gastric wall thickening (arrows) without serosal interruption.
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Figure 6b. Advanced gastric cancer (Borrmann type 3). (a) Image from conventional gastroscopy shows an ulcerated and infiltrative lesion at the gastric angle. Clubbing and fusion of the converging folds are seen at the margin of the ulcer. (b) Oblique coronal 2D MPR image shows an area of enhanced wall thickening (arrows) at the gastric angle. (c) Image from virtual gastroscopy shows the irregularly marginated mass (arrows) with a central ulcer. Clubbing and fusion of the converging folds are seen at the margin of the ulcer. (d) Transparency-rendered image shows the mass (arrows) with luminal narrowing of the gastric angle. Transparency rendering provides excellent anatomic information for the surgeon. (e) Endoscopic US image shows the gastric wall thickening (arrows) without serosal interruption.
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Figure 6c. Advanced gastric cancer (Borrmann type 3). (a) Image from conventional gastroscopy shows an ulcerated and infiltrative lesion at the gastric angle. Clubbing and fusion of the converging folds are seen at the margin of the ulcer. (b) Oblique coronal 2D MPR image shows an area of enhanced wall thickening (arrows) at the gastric angle. (c) Image from virtual gastroscopy shows the irregularly marginated mass (arrows) with a central ulcer. Clubbing and fusion of the converging folds are seen at the margin of the ulcer. (d) Transparency-rendered image shows the mass (arrows) with luminal narrowing of the gastric angle. Transparency rendering provides excellent anatomic information for the surgeon. (e) Endoscopic US image shows the gastric wall thickening (arrows) without serosal interruption.
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Figure 6d. Advanced gastric cancer (Borrmann type 3). (a) Image from conventional gastroscopy shows an ulcerated and infiltrative lesion at the gastric angle. Clubbing and fusion of the converging folds are seen at the margin of the ulcer. (b) Oblique coronal 2D MPR image shows an area of enhanced wall thickening (arrows) at the gastric angle. (c) Image from virtual gastroscopy shows the irregularly marginated mass (arrows) with a central ulcer. Clubbing and fusion of the converging folds are seen at the margin of the ulcer. (d) Transparency-rendered image shows the mass (arrows) with luminal narrowing of the gastric angle. Transparency rendering provides excellent anatomic information for the surgeon. (e) Endoscopic US image shows the gastric wall thickening (arrows) without serosal interruption.
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Figure 6e. Advanced gastric cancer (Borrmann type 3). (a) Image from conventional gastroscopy shows an ulcerated and infiltrative lesion at the gastric angle. Clubbing and fusion of the converging folds are seen at the margin of the ulcer. (b) Oblique coronal 2D MPR image shows an area of enhanced wall thickening (arrows) at the gastric angle. (c) Image from virtual gastroscopy shows the irregularly marginated mass (arrows) with a central ulcer. Clubbing and fusion of the converging folds are seen at the margin of the ulcer. (d) Transparency-rendered image shows the mass (arrows) with luminal narrowing of the gastric angle. Transparency rendering provides excellent anatomic information for the surgeon. (e) Endoscopic US image shows the gastric wall thickening (arrows) without serosal interruption.
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Figure 7a. Gastric GIST. (a) Image from conventional gastroscopy shows a smooth well-defined mass in the lower body of the stomach. There is a normal overlying mucosal fold. (b) Oblique coronal 2D MPR image shows the well-defined mass (arrows). (c) Image from virtual gastroscopy shows the smooth well-defined mass (arrows) and the normal overlying mucosal fold. (d) Transparency-rendered image shows the smooth well-defined submucosal mass and the bridging fold (arrows). (e) Endoscopic US image shows the well-defined hypoechoic mass in the submucosa.
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Figure 7b. Gastric GIST. (a) Image from conventional gastroscopy shows a smooth well-defined mass in the lower body of the stomach. There is a normal overlying mucosal fold. (b) Oblique coronal 2D MPR image shows the well-defined mass (arrows). (c) Image from virtual gastroscopy shows the smooth well-defined mass (arrows) and the normal overlying mucosal fold. (d) Transparency-rendered image shows the smooth well-defined submucosal mass and the bridging fold (arrows). (e) Endoscopic US image shows the well-defined hypoechoic mass in the submucosa.
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Figure 7c. Gastric GIST. (a) Image from conventional gastroscopy shows a smooth well-defined mass in the lower body of the stomach. There is a normal overlying mucosal fold. (b) Oblique coronal 2D MPR image shows the well-defined mass (arrows). (c) Image from virtual gastroscopy shows the smooth well-defined mass (arrows) and the normal overlying mucosal fold. (d) Transparency-rendered image shows the smooth well-defined submucosal mass and the bridging fold (arrows). (e) Endoscopic US image shows the well-defined hypoechoic mass in the submucosa.
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Figure 7d. Gastric GIST. (a) Image from conventional gastroscopy shows a smooth well-defined mass in the lower body of the stomach. There is a normal overlying mucosal fold. (b) Oblique coronal 2D MPR image shows the well-defined mass (arrows). (c) Image from virtual gastroscopy shows the smooth well-defined mass (arrows) and the normal overlying mucosal fold. (d) Transparency-rendered image shows the smooth well-defined submucosal mass and the bridging fold (arrows). (e) Endoscopic US image shows the well-defined hypoechoic mass in the submucosa.
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Figure 7e. Gastric GIST. (a) Image from conventional gastroscopy shows a smooth well-defined mass in the lower body of the stomach. There is a normal overlying mucosal fold. (b) Oblique coronal 2D MPR image shows the well-defined mass (arrows). (c) Image from virtual gastroscopy shows the smooth well-defined mass (arrows) and the normal overlying mucosal fold. (d) Transparency-rendered image shows the smooth well-defined submucosal mass and the bridging fold (arrows). (e) Endoscopic US image shows the well-defined hypoechoic mass in the submucosa.
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Figure 8a. Gastric lymphoma. (a) Image from conventional gastroscopy shows severe fold thickening from the fundus to the body of the stomach. (b) Oblique axial 2D MPR image shows the gastric wall thickening (arrows). There are multiple enlarged lymph nodes in the perigastric area. (c) Image from virtual gastroscopy shows the fold thickening. (d) Transparency-rendered image shows the severe fold thickening without luminal narrowing from the gastric fundus to the body. (e) Endoscopic US image shows a polypoid mass in the submucosa without interruption of the hypoechoic muscularis propria (arrowheads).
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Figure 8b. Gastric lymphoma. (a) Image from conventional gastroscopy shows severe fold thickening from the fundus to the body of the stomach. (b) Oblique axial 2D MPR image shows the gastric wall thickening (arrows). There are multiple enlarged lymph nodes in the perigastric area. (c) Image from virtual gastroscopy shows the fold thickening. (d) Transparency-rendered image shows the severe fold thickening without luminal narrowing from the gastric fundus to the body. (e) Endoscopic US image shows a polypoid mass in the submucosa without interruption of the hypoechoic muscularis propria (arrowheads).
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Figure 8c. Gastric lymphoma. (a) Image from conventional gastroscopy shows severe fold thickening from the fundus to the body of the stomach. (b) Oblique axial 2D MPR image shows the gastric wall thickening (arrows). There are multiple enlarged lymph nodes in the perigastric area. (c) Image from virtual gastroscopy shows the fold thickening. (d) Transparency-rendered image shows the severe fold thickening without luminal narrowing from the gastric fundus to the body. (e) Endoscopic US image shows a polypoid mass in the submucosa without interruption of the hypoechoic muscularis propria (arrowheads).
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Figure 8d. Gastric lymphoma. (a) Image from conventional gastroscopy shows severe fold thickening from the fundus to the body of the stomach. (b) Oblique axial 2D MPR image shows the gastric wall thickening (arrows). There are multiple enlarged lymph nodes in the perigastric area. (c) Image from virtual gastroscopy shows the fold thickening. (d) Transparency-rendered image shows the severe fold thickening without luminal narrowing from the gastric fundus to the body. (e) Endoscopic US image shows a polypoid mass in the submucosa without interruption of the hypoechoic muscularis propria (arrowheads).
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Figure 8e. Gastric lymphoma. (a) Image from conventional gastroscopy shows severe fold thickening from the fundus to the body of the stomach. (b) Oblique axial 2D MPR image shows the gastric wall thickening (arrows). There are multiple enlarged lymph nodes in the perigastric area. (c) Image from virtual gastroscopy shows the fold thickening. (d) Transparency-rendered image shows the severe fold thickening without luminal narrowing from the gastric fundus to the body. (e) Endoscopic US image shows a polypoid mass in the submucosa without interruption of the hypoechoic muscularis propria (arrowheads).
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Figure 9a. Gastric MALT lymphoma. (a) Image from conventional gastroscopy shows multiple small nodular lesions along the greater curvature of the gastric body. (b) Image from virtual gastroscopy shows the multiple small nodular lesions. (c) Endoscopic US image shows gastric mucosal thickening (arrows) with superficial infiltration of the submucosa.
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Figure 9b. Gastric MALT lymphoma. (a) Image from conventional gastroscopy shows multiple small nodular lesions along the greater curvature of the gastric body. (b) Image from virtual gastroscopy shows the multiple small nodular lesions. (c) Endoscopic US image shows gastric mucosal thickening (arrows) with superficial infiltration of the submucosa.
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Figure 9c. Gastric MALT lymphoma. (a) Image from conventional gastroscopy shows multiple small nodular lesions along the greater curvature of the gastric body. (b) Image from virtual gastroscopy shows the multiple small nodular lesions. (c) Endoscopic US image shows gastric mucosal thickening (arrows) with superficial infiltration of the submucosa.
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Figure 10a. Gastric varices due to portal hypertension. (a) Image from conventional gastroscopy shows tortuous folds and multiple grapelike nodules in the gastric fundus. (b) Oblique coronal 2D MPR image shows tortuous well-enhanced vascular structures (arrows) in the perigastric area along the fundus. (c) Image from virtual gastroscopy shows the tortuous folds.
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Figure 10b. Gastric varices due to portal hypertension. (a) Image from conventional gastroscopy shows tortuous folds and multiple grapelike nodules in the gastric fundus. (b) Oblique coronal 2D MPR image shows tortuous well-enhanced vascular structures (arrows) in the perigastric area along the fundus. (c) Image from virtual gastroscopy shows the tortuous folds.
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Figure 10c. Gastric varices due to portal hypertension. (a) Image from conventional gastroscopy shows tortuous folds and multiple grapelike nodules in the gastric fundus. (b) Oblique coronal 2D MPR image shows tortuous well-enhanced vascular structures (arrows) in the perigastric area along the fundus. (c) Image from virtual gastroscopy shows the tortuous folds.
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Figure 11a. Heterotopic pancreas. (a) Image from conventional gastroscopy shows a smooth, broad-based submucosal mass with a central umbilication (arrow) in the gastric antrum. (b) Image from virtual gastroscopy shows the mass with its central umbilication (arrow). (c) Endoscopic US image shows submucosal thickening with a central duct (arrow).
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Figure 11b. Heterotopic pancreas. (a) Image from conventional gastroscopy shows a smooth, broad-based submucosal mass with a central umbilication (arrow) in the gastric antrum. (b) Image from virtual gastroscopy shows the mass with its central umbilication (arrow). (c) Endoscopic US image shows submucosal thickening with a central duct (arrow).
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Figure 11c. Heterotopic pancreas. (a) Image from conventional gastroscopy shows a smooth, broad-based submucosal mass with a central umbilication (arrow) in the gastric antrum. (b) Image from virtual gastroscopy shows the mass with its central umbilication (arrow). (c) Endoscopic US image shows submucosal thickening with a central duct (arrow).
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Figure 12a. Pancreatic mucinous cystic adenocarcinoma with gastric invasion. (a) Image from conventional gastroscopy shows a smooth masslike lesion in the gastric body. The lesion has the appearance of a normal mucosal fold. (b) Oblique coronal 2D MPR image shows a large pancreatic cystic mass with invasion of the gastric body (arrows). Splenic infarction is also noted (arrowheads). (c) Image from virtual gastroscopy shows the smooth masslike lesion of the gastric body. (d) Transparency-rendered image shows indentation of the gastric body (arrows).
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Figure 12b. Pancreatic mucinous cystic adenocarcinoma with gastric invasion. (a) Image from conventional gastroscopy shows a smooth masslike lesion in the gastric body. The lesion has the appearance of a normal mucosal fold. (b) Oblique coronal 2D MPR image shows a large pancreatic cystic mass with invasion of the gastric body (arrows). Splenic infarction is also noted (arrowheads). (c) Image from virtual gastroscopy shows the smooth masslike lesion of the gastric body. (d) Transparency-rendered image shows indentation of the gastric body (arrows).
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Figure 12c. Pancreatic mucinous cystic adenocarcinoma with gastric invasion. (a) Image from conventional gastroscopy shows a smooth masslike lesion in the gastric body. The lesion has the appearance of a normal mucosal fold. (b) Oblique coronal 2D MPR image shows a large pancreatic cystic mass with invasion of the gastric body (arrows). Splenic infarction is also noted (arrowheads). (c) Image from virtual gastroscopy shows the smooth masslike lesion of the gastric body. (d) Transparency-rendered image shows indentation of the gastric body (arrows).
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Figure 12d. Pancreatic mucinous cystic adenocarcinoma with gastric invasion. (a) Image from conventional gastroscopy shows a smooth masslike lesion in the gastric body. The lesion has the appearance of a normal mucosal fold. (b) Oblique coronal 2D MPR image shows a large pancreatic cystic mass with invasion of the gastric body (arrows). Splenic infarction is also noted (arrowheads). (c) Image from virtual gastroscopy shows the smooth masslike lesion of the gastric body. (d) Transparency-rendered image shows indentation of the gastric body (arrows).
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Figure 13. Primary achalasia. Oblique coronal 2D MPR image shows smooth, tapered, beaklike luminal narrowing of the distal esophagus (arrows).
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Figure 14. Paraesophageal hernia. Oblique coronal 2D MPR image shows that the gastric fundus has herniated through the esophageal hiatus (arrows).
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Copyright © 2006 by the Radiological Society of North America.
