Imaging

Gastric lymphoma

Preliminary Diagnosis: Gastric Lymphoma

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 gastric lymphoma.

Advantages

  • Relatively quick

  • Highly sensitive and specific imaging modality in diagnosing a primary pathologic process and detecting any secondary complications.

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

  • Offers exquisite detail of the surrounding anatomic 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?

  • May be contraindicated in pregnant patients

  • Relative contraindication in patients with a previous history of intravenous contrast allergy.

IV. What alternative imaging techniques are available?

  • Contrasted fluoroscopic guided upper gastrointestinal examination

  • MR imaging

  • PET/CT

  • Ultrasound

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of gastric lymphoma.

Contrasted fluoroscopic guided upper gastrointestinal examination

Advantages

  • Highly portable

  • Relatively inexpensive imaging modality

  • Contrast enhanced fluoroscopic imaging provides better detail of the mucosa of the gastric neoplasm than CT

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

Disadvantages

  • 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 than other imaging modalities

  • Better details any marrow involvement than other imaging modalities

  • Does not expose patients to ionizing radiation

Disadvantages

  • Expensive

  • Time-consuming

  • Requires significant patient cooperation to minimize motion artifact

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

PET/CT

Advantages

  • Highly sensitive and specific in detecting and detailing any primary gastric abnormality (of those gastric neoplasms that are highly PE.

  • Highly sensitive to the smallest neoplastic process.

Disadvantages

  • Highly expensive imaging modality

  • Exposes patients to ionizing radiation.

Ultrasound

Advantages

  • Highly portable

  • Fast

  • Relatively inexpensive imaging modality

  • Does not expose patients to ionizing radiation

Disadvantages

  • Highly operator dependent

  • Far less sensitive and specific than other imaging modalities 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 to ultrasound exist

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