Algorithm for Examining Patients with Pathology of the Upper Gastrointestinal Tract using Multispiral Computed Tomography

DOI: 10.47026/2413-4864-2021-1-18-32

UDC: 616.33/.34-073.756.8
BBC: Р413-436

Dmitrieva A.N.

Algorithm for Examining Patients with Pathology of the Upper Gastrointestinal Tract using Multispiral Computed Tomography

Keywords: stomach, esophagus, esophageal-gastric junction, multispiral computed tomography

The aim of the study was to develop a technique for conducting multispiral computed tomography (MSCT) when examining the upper parts of the gastrointestinal tract. A prospective analysis of MSCT images was performed in 85 people who were examined at the AI "Republican Clinical Oncology Dispensary" under the Ministry of Public Health of the Chuvash Republic in 2015-2019. All patients underwent computed tomography using Light Speed VEX Plus and Light Speed RT 16 devices ("GE", USA) using our modified esophageal and gastric MSCT technique with an emphasis on the esophageal-gastric junction (EGJ). The characteristic quantitative MSCT-signs of the esophageal wall, the stomach, and the EGJ area in the norm, as well as the ones in an abnormal esophageal wall in esophagitis and gastritis are presented. The esophageal wall thickness in the normal condition and esophagitis was 3.12±0.69 mm and 8.16±1.65 mm (p = 0.000, R=0.909), and the maximum external diameter of the abdominal part of esophagus was 14.2±1.68 mm and 17.96±3.7 mm (p = 0.000, R = 0.579), respectively. The ROC analysis revealed a threshold value equal to 5.5 mm for distinguishing the wall thickness values characteristic for the unchanged esophagus and the esophagus with inflammatory pathology (sensitivity-96%, specificity-100%, p = 0.000). The threshold value for the external diameter of the abdominal esophageal segment was 17.5 mm (sensitivity – 64%, specificity – 100%, p = 0.000). The thickness of the stomach wall in the normal condition and in gastritis made 4.6±0.48 mm and 7.52±2.71 mm (p = 0.000, R = 0.673), respectively. At this, the threshold value of this characteristic was equal to 5.5 mm (sensitivity – 87.1%, specificity – 100%). The wall thickness in the area of the cardia in the normal condition was 5.4±1.01 mm, in presence of inflammation – 10.36±1.85 mm (p = 0.000, R = 0.858), the threshold value – 7.5 mm (sensitivity – 95.83%, specificity – 98.04%, p = 0.000). The thickness of individual layers in the unchanged stomach walls did not exceed 2 mm, the thickness of the mucosa was 1.01±0.11 mm. The use of the proposed method of esophageal and gastric MSCT with an emphasis on the EGJ area using the MSCT criteria characteristic of the unchanged wall helps to reliably differentiate the pathologies of the EGJ, the stomach and the esophagus. The method of gastric MSCT that we developed can be recommended to be included in the mandatory standard algorithm for examining the patients with pathology of the upper gastrointestinal tract.

References

Agababyan T.A., Silant’eva N.K., Skoropad V.Yu. Diagnostika vneorgannogo rasprostraneniya raka zheludka metodom mul‘tispiral‘noi komp‘yuternoi tomografii [Evaluation of Local Spread of Gastric Cancer with Multidetector Computed Tomography]. Meditsinskaya vizualizatsiya, 2011, no. 6, pp. 21–30.
Akberov R.F., Zyyatdinov K.Sh., Mikhailov M.K., Yakhin M.M., Nurgaliev R.G., SakhapovaR., Safiullina L.R., Diomidova V.N., Utkel’baev R.I. Kompleksnaya kliniko-luchevaya diagnostika zabolevanii, funktsional’nykh narushenii, porokov razvitiya i opukholevykh porazhenii pishchevoda, zheludka i piloroduodenal’noi zony [Comprehensive clinical-beam diagnosis of diseases, functional disorders, malformations and tumor lesions of the esophagus, stomach and pylorododenal zone]. Naberezhnye Chelny, 2010, 413 p.
Afanas’eva N.I., Kulagin A.L., Sologubova G.F., Yudin A.L., Yumatova E.A. Mul‘tiplanarnaya i trekhmernaya obrabotka dannykh mul‘tidetektornoi komp‘yuternoi tomografii v otsenke protyazhennosti kardioezofageal‘nogo raka [Multidetector Computed Tomography Multiplanar and Three-Dimensional Data Processing in the Evaluation of the Extension of Cardioesophageal Cancer]. Vestnik Rossiiskogo nauchnogo tsentra rentgenoradiologii Minzdrava Rossii, 2013, vol. 1, no. 13, p. 10.
Diomidova V.N. Vizual’naya kharakteristika neizmenennogo i operirovannogo zheludka pri ul’trazvukovom issledovanii [Visual Characteristic of Unaltered and Operated Stomach with the Help of Ultrasound Research]. Meditsinskaya vizualizatsiya, 2015, no. 4, pp. 46–55.
Diomidova V.N. Ekhografiya v differentsial’noi diagnostike patologii zheludka [Echoography in differential diagnosis of stomach pathology]. Cheboksary, 2007, 140 p.
Diomidova V.N., Dmitrieva A.N. Chastota i kharakter porazheniya zheludka v strukture gastrointestinal’nykh stromal’nykh opukholei [Incidence and Character of Gastric Lesions in the Structure of Gastrointestinal Stromal Tumors]. Prakticheskaya meditsina, 2020, vol. 18, no. 4, pp. 69–74. DOI: 10.32000/2072-1757-2020-4-69-74.
Diomidova V.N., Saifieva S.Kh. Diagnosticheskoe izobrazhenie (diagnostic imaging) zheludka i dvenadtsatiperstnoi kishki pri mul’tiparametricheskom ul’trazvukovom issledovanii [Diagnostic Imaging of Stomach and Duodenum in Multiparameter Ultrasound Examinatin]. Acta Medica Eurasica, 2016, no. 2. Available at: http://acta-medica-eurasica.ru/single/2016/2/2.
Dmitrieva A.N., Mal’chugina E.L. Luchevaya diagnostika kardioezofageal’nogo raka v Chuvashskoi Respublike metodom mul’tispiral’noi komp’yuternoi tomografii [X-ray Diagnostics of Cardioesophageal Cancer in Chuvash Republic Using Multidetector Somputed Tomography Metod]. Povolzhskii onkologicheskii vestnik, 2017, vol. 3(30), pp. 51–59.
Dmitrieva A.N. Informativnost’ metodov luchevoi diagnostiki pri rake pishchevodno-zheludochnogo perekhoda [Informative Value of Radiation Diagnosis Methods in Esophageal-Gastric Junction Cancer]. Acta medica Eurasica, 2019, no. 1, pp. 7–17. Available at: http://acta-medica-eurasica.ru/single/2019/1/2.
Zdravookhranenie v Rossii. 2019: stat. sb. [Healthcare in Russia. 2019: statistical collection]. Moscow, Rosstat Publ., 2019, 170 p.
Kaprin A.D., Starinskii V.V., Petrova G.V. Zlokachestvennye novoobrazovaniya v Rossii v 2018 godu (zabolevaemost’ i smertnost’) [Malignant neoplasms in Russia in 2018 (morbidity and mortality)]. Moscow, 2019, 250 p.
Makimbetov E.K., Salikhar R.I., Tumanbaev A.M., Toktanalieva A.N., Kerimov A.D. Epidemiologiya raka v mire [Epidemiology of cancer in the world]. Sovremennye problemy nauki i obrazovaniya, 2020, no. 2. Available at: http://science-education.ru/ru/article/view?id=29718.
Portnoi L.M. Sovremennaya luchevaya diagnostika v gastroenterologii i gastroenteroonkologii [Modern radiation diagnostics in gastroenterology and gastroentero-oncology]. Moscow, Vidar Publ., 2001.
Silant’eva N.K., Agababyan T.A., Skoropad V.Yu., Grishina O.G. Zadachi komp’yuternoi tomografii pri obsledovanii bol’nykh rakom zheludka v onkoradiologicheskoi klinike [The role of Computed Tomography in Patients with Gastric Cancer in Radio-Oncological Hospital]. Sibirskii onkologicheskii zhurnal, 2015, vol. 1(5), pp. 5–13.
Arnold M., Ferlay J., van Berge Henegouwen M.I., Soerjomataram I. Global burden of oesophageal and gastric cancer by histology and subsite in 2018. Gut., 2020, vol. 69(9), pp. 1564–1571. DOI: 10.1136/gutjnl-2020-321600. Epub 2020 Jun 30. PMID: 32606208.
Atici A.E., Cakir T., Reyhan E., Duman М., Ozer I., Ulas М., Bostanci E.B. Preoperative Use of PET/CT in Patients With Colorectal and Gastric Cancer and Its Impact on Treatment Decision Making. Surg., 2016, vol. 101, pp. 318–327.
Bray F. et al. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 2018, vol. 68, iss. 6. https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21492.
Inoue M., Tsugane S. Epidemiology of gastric cancer in Japan. Postgrad Med J., 2005, vol. 81(957), pp. 419–424. DOI: 10.1136/pgmj.2004.029330. PMID: 15998815; PMCID: PMC1743301.
Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma. 2^nd English Edition. Gastric Cancer., 1998, vol. 1(1), pp. 10–24. DOI: 10.1007/s101209800016. PMID: 1957040.
Kadowaki K., Murakami T., Yoshioka H. et al. Helical CT imaging of gastric cancer: normal wall appearance and the potential for staging. Med., 2000, vol. 18, no. 1, pp. 47–54.
Marks W.M., Callen P.W., Moss A.A. Gastroesophageal region: source of confusion on CT. J. Roentgenol., 1981, vol. 136, no. 2, pp. 359–362.
Reinig J.W., Stanley J.H., Schabel S.I. CT evaluation of thickened esophageal walls. AJR Am J Roentgenol., 1983, vol. 140(5), pp. 931–934. DOI: 10.2214/ajr.140.5.931. PMID: 6601436.
Rosa F., Costamagna G., Doglietto G.B., Alfieri S. Classification of nodal stations in gastric cancer. Gastroenterol. Hepatol., 2017, Jan 17.2.2. DOI: 10.21037/tgh.2016.12.03.
Rossi M., Broglia L., Maccioni F., Bezzi M., Laghi A., Graziano P., Mingazzini P.L., Rossi P. Hydro-CT in patients with gastric cancer: preoperative radiologic staging. Eur Radiol., 1997, vol. 7(5), pp. 659–664. DOI: 10.1007/BF02742921. PMID: 9166562.
Tellez-Avila F.I., García-Osogobio S., Chavez-Tapia N.C., Ramirez-Luna M.A., Franco-Guzman A., Sosa-Lozano A., Giovannini M. Utility of endoscopy in patients with incidental gastrointestinal luminal wall thickening detected with CT. Surg Endosc., 2009, vol. 23(10), pp. 2191–2196. DOI: 10.1007/s00464-008-0274-5. Epub 2009 Jan 1. PMID: 19118429.
Yan C, Zhu ZG, Yan M, Zhang H, Pan ZL, Chen J, Xiang M, Chen MM, Liu BY, Yin HR, Lin YZ. Value of multidetector-row computed tomography in the preoperative T and N staging of gastric carcinoma: a large-scale Chinese study. J Surg Oncol., 2009, vol. 100(3), pp. 205–214. DOI: 10.1002/jso.21316. PMID: 19530124.
Zhao-Yong X., Rui-Mei Ch., Guo-Cheng D., Yi L., Ke R.T. and N Staging of Gastric Cancer Using Dual-Source Computed Tomography. Gastroenterology Research and Practice. 2018. Dec. 4.2018.5015202. DOI: 10.1155/2018/5015202.

About authors

Dmitrieva Anastasia N.: Post-Graduate Student, Department of Propaedeutics of Internal Diseases with a Course of Radiation Diagnostics, Chuvash State University; Radiologist, Republican Clinical Oncology Dispensary, Russia, Cheboksary (dmitrieva.rabota@mail.ru; )

Article link

Dmitrieva A.N. Algorithm for Examining Patients with Pathology of the Upper Gastrointestinal Tract using Multispiral Computed Tomography [Electronic resource] // Acta medica Eurasica. – 2021. – №1. P. 18-32. – URL: https://acta-medica-eurasica.ru/en/single/2021/1/3/. DOI: 10.47026/2413-4864-2021-1-18-32.

Single article

Dmitrieva A.N.