Korean J Radiol.  2009 Jun;10(3):252-259. 10.3348/kjr.2009.10.3.252.

Positioning During CT Gastrography in Patients with Gastric Cancer: the Effect on Gastric Distension and Lesion Conspicuity

• Kim HJ
• Kim AY
• Lee JH
• Yook JH
• Yu ES
• Ha HK

• KMID: 1779452
• DOI: http://doi.org/10.3348/kjr.2009.10.3.252

Abstract

OBJECTIVE
We wanted to prospectively evaluate the effect of various positions of the patient on gastric distension and lesion conspicuity during performance of CT gastrography (CTG). MATERIALS AND METHODS: One hundred thirteen consecutive patients with gastric cancer underwent CTG in the 30degrees left posterior oblique (LPO), supine, and prone positions. Two radiologists scored (a grade from 1-4) the degree of gastric distension and the lesion conspicuity according to the three scanning positions and the three gastric portions. Two- (2D) and three-dimensional (3D) images were used for analysis. Finally, these data were compared with the endoscopic findings and surgical results. RESULTS: The mean scores of gastric distension and lesion conspicuity for the LPO and supine positions were higher than those for the prone position (p < 0.001) in the gastric middle and lower portions. However, there was no significant difference between the LPO and supine positions (p > or = 0.21). As for the gastric upper portion, the mean scores of gastric distension in the prone position were higher than those in the two other positions (p < 0.001). The prone position showed better lesion conspicuity than the two other positions for only one of two cases of gastric cancer in the upper portion of the stomach. CONCLUSION: CTG performed in the LPO position or the supine position combined with CTG performed in the prone position is optimal for achieving good gastric distension and evaluating the lesion conspicuity of gastric cancer.

Keyword

Computed tomography (CT), gastrography; Gastric cancer; Distension; Lesion conspicuity

MeSH Terms

Female
Humans
Image Processing, Computer-Assisted/methods
Imaging, Three-Dimensional/methods
Male
Middle Aged
Observer Variation
*Posture
Prospective Studies
Stomach/radiography
Stomach Neoplasms/*radiography
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 51-year-old woman who underwent CT gastrography according to three scanning positions. On two-dimensional axial images, grade of distension of gastric lower portion was 4 (more than 75%) in 30° left posterior oblique position (A), 3 (between 50% and 75% of expected maximal distension) in supine position (B), and 3 in prone position (C). As for gastric upper portion, grade of distension was 3 in 30° left posterior oblique position (D), 3 in supine position (E), and 4 in prone position (F).

• 

  Fig. 2 65-year-old man with early gastric cancer in middle portion. This lesion shows irregular mucosal nodularity with depressed lesion in gastric angle (arrows in A-C). Grade of lesion conspicuity in both 30° left posterior oblique (A) and supine positions (B) was 4 (good). However, lesion conspicuity in prone position (C) was 2 (poor) due to partially collapsed stomach with exaggerated rugal folds. This fiberoptic gastroscopic finding well corresponds to virtual gastroscopic images (D). This lesion was histopathologically diagnosed as early gastric cancer after surgery.

• 

  Fig. 3 53-year-old man with advanced gastric cancer in upper portion. This lesion shows ulcerofungating mass in upper portion (arrows in B, C). Lesion conspicuity in 30° left posterior oblique position (A) was 1 (not detectable) due to retained fluid, whereas grade of lesion conspicuity in both supine (B) and prone positions (C) was 4 (good). Fiberoptic gastroscopic findings (D) and surgical specimen (E) well corresponds to surface shaded display images. This lesion was histopathologically diagnosed as advanced gastric cancer.

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