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