Preliminary Diagnosis: Stomach cancer

I. What imaging technique is first-line for this diagnosis

  • CT scan of the abdomen and pelvis with PO and IV contrast.

II. Describe the advantages and disadvantages of this technique for diagnosis of stomach cancer.

Advantages

  • Relatively quick and highly sensitive and specific imaging modality in diagnosing a primary pathological process and detecting any secondary complications.

  • CT imaging with oral contrast may allow one to help evaluate the gastric mucosa for any evidence of ulcerations or exophytic or submucosal masses.

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  • Offers exquisite detail of the surrounding anatomical structures including vascular, osseous, lymphatic, and soft tissue.

  • May help detail the extent of invasion and infiltration of the neoplastic process.

  • May help guide biopsy and treatment.

Disadvantages

  • Exposes patients to ionizing radiation.

III. What are the contraindications for the first-line imaging technique?

  • CT imaging may be contraindicated in pregnant patients.

  • Intravenous contrast relatively contraindicated in patients with renal failure or contrast allergy.

IV. What alternative imaging techniques are available?

  • Contrasted fluoroscopically guided upper gastrointestinal examination

  • MR imaging

  • PET/CT

  • Ultrasound

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of stomach cancer.

Contrasted Fluoroscopically Guided Upper Gastrointestinal Examination
Advantages

  • Highly portable and relatively inexpensive imaging modality.

  • Contrast enhanced fluoroscopic imaging better details the mucosa of the gastric neoplasm.

Disadvantages

  • Less sensitive and specific in detailing any primary gastric pathology and any secondary complications.

  • May expose patients to a large amount of ionizing radiation.

  • Does not guide treatment.

  • Highly operator-dependent.

MR imaging
Advantages

  • Better details the soft tissue extension and infiltration of a primary gastric neoplasm.

  • Better details any marrow involvement.

  • Does not expose patients to ionizing radiation.

Disadvantages

  • Expensive

  • Time-consuming

  • May be subject to motion and susceptibility-weighted artifact, degrading image quality.

  • Less adept in detailing the mucosa and any mucosal irregularity compared with companion CT and contrasted fluoroscopic imaging.

PET/CT
Advantages

  • Highly sensitive and specific in detecting and detailing any primary gastric abnormality.

  • Highly sensitive to the smallest neoplastic process.

Disadvantages

  • Highly expensive imaging modality

  • Exposes patients to ionizing radiation.

Ultrasound
Advantages

  • Highly portable, fast, and relatively inexpensive imaging modality.

  • Does not expose patients to ionizing radiation.

Disadvantages

  • Highly operator-dependent.

  • Far less sensitive and specific in detailing and detecting a primary gastric abnormality or detecting any secondary complications.

VI. What are the contraindications for the alternative imaging techniques?

Contrasted Fluoroscopic Guided Upper Gastrointestinal Examination

  • May be contraindicated in pregnant patients.

MR imaging

  • Contraindicated in patients with non-MR compatible hardware.

PET/CT

  • May be contraindicated in pregnant patients.

Ultrasound

  • No specific contraindications exist.

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