Gastric tumors: radiologic-pathologic correlation and accuracy of T staging with dynamic CT

Incremental dynamic computed tomography (CT) was prospectively performed in 89 patients with gastric tumors (78 gastric cancers, five malignant lymphomas, and six submucosal tumors) after the intake of 400 mL of water, and findings were compared with those obtained at pathologic examination. Dynamic CT of healthy control subjects (15 patients without gastric lesions) showed the gastric wall as a two- or three-layered structure (multilayered pattern): a markedly enhanced inner layer; an intermediate layer of low attenuation; and (sometimes) an outer layer of slightly high attenuation, which corresponded histologically to the mucosal layer, submucosal layer, and muscular-serosal layer, respectively. In 68 lesions that were removed at surgery, the detectability of early and advanced gastric cancers and the accuracy of classification of gross appearance and serosal invasion as determined with CT were 53%, 92%, 80%, and 80%, respectively. All detected advanced gastric cancers were seen as enhanced areas with the destruction of the multilayered pattern. Differentiation between infiltrating gastric cancer (n = 5) and malignant lymphoma (n = 5) was successful. Five of six submucosal tumors were demonstrated as having an overlying intact mucosal layer.