From the Department of Radiological Sciences (J.J.Y., M.P.) and Division of Digestive Diseases (L.H.), University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, Calif; and Department of Radiological Sciences, Olive View-UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (A.P., C.M.J., M.N., M.D., S.F.M.).
Radiographics. 2019 May-Jun;39(3):668-689. doi: 10.1148/rg.2019180113. Epub 2019 Apr 5.
Gastric cancer is a leading cause of cancer-related deaths worldwide and is associated with an overall 5-year survival rate of less than 20%. The most common histologic subtype of gastric cancer is adenocarcinoma. Imaging techniques for evaluating gastric adenocarcinoma include endoscopic US, fluoroscopic upper gastrointestinal imaging, CT, PET/CT, and MRI. Hydrodynamic multiphasic contrast material-enhanced CT is the imaging modality of choice for preoperative clinical staging of regional, nodal, and metastatic involvement. Radiologic manifestations of gastric adenocarcinoma at double-contrast upper gastrointestinal imaging and CT include polyps, ulceration, indistensibility, wall thickening, and abnormal enhancement. There are multiple pathways of disease spread. These pathways include lymphatic dissemination; subperitoneal dissemination along the perigastric ligaments, mesentery, or omentum; direct invasion into adjacent organs; transperitoneal seeding; and hematogenous dissemination. The spread of disease is affected by the location of the tumor in the stomach, and the ligamentous and lymphatic anatomy. Key imaging features that affect clinical staging with use of the TNM classification system for gastric adenocarcinoma, as described in the eighth edition of the are briefly discussed. Accurate radiologic assessment of gastric adenocarcinoma requires identification of perigastric ligament infiltration, regional and metastatic nodal disease, and direct and metastatic organ involvement, all of which directly affect tumor staging, treatment, and prognosis. RSNA, 2019.
胃癌是全球癌症相关死亡的主要原因之一，总体 5 年生存率低于 20%。胃癌最常见的组织学亚型是腺癌。评估胃腺癌的影像学技术包括内镜超声、荧光透视上消化道成像、CT、PET/CT 和 MRI。水动力多期对比增强 CT 是术前评估区域、淋巴结和转移受累的首选影像学方法。双对比上消化道成像和 CT 显示胃腺癌的放射学表现包括息肉、溃疡、充盈缺损、壁增厚和异常强化。疾病有多种传播途径。这些途径包括淋巴扩散；沿胃周韧带、肠系膜或大网膜的腹膜下扩散；直接侵犯邻近器官；腹膜内播种；和血行播散。疾病的传播受肿瘤在胃中的位置以及韧带和淋巴解剖结构的影响。简要讨论了第八版中用于胃腺癌的 TNM 分类系统的影响临床分期的关键影像学特征。准确的胃腺癌放射学评估需要识别胃周韧带浸润、区域和转移性淋巴结疾病以及直接和转移性器官受累，所有这些都直接影响肿瘤分期、治疗和预后。RSNA，2019 年。
