CT evaluation of gastric lymphoma

The purpose of our study was to determine the value of computed tomography (CT) with a drug-induced hypotonia and water filling in the diagnosis and preoperative staging of 27 patients with gastric lymphoma (GLy) confirmed by endoscopic biopsy. CT scans were performed in a supine and prone position with drug-induced hypotonia and water-filling of stomach with 500-700 ml., and intravenous administration of a non-ionic contrast agent. the prone position and drug-induced hypotonia allowed visualization of the whole gastric wall and prevented gas artifacts, commonly present during supine imaging. CT scans were analysed with respect to the thickness of the stomach wall, rugal thickening, presence of wall infiltration, mucosal nodularity, ulcerations and tumour masses, regional tumour spread, lymph node deposits and presence of distant metastases. The most common findings in GLy were ulcers of variable size, depth and number in 43% of cases, a mass with or without an ulcer in 36% of cases, and rugal thickening in 21% of cases. According to CT results, GLy was staged in four groups: I, II1, II2, III and IV. Precise preoperative staging was achieved in 73%, overstaging in 18% and understaging in 9% of patients. The sensitivity and specificity of the technique was 93% and 85% respectively. There was low grade MALT lymphoma in 69% and high grade MALT lymphoma in 31% of cases. We believe that CT performed ussing this method is a useful non-invasive method for preoperative evaluation and staging of gastric lymphoma and should be used before surgery is planned.