Imaging
Gastric lymphoma
- Preliminary Diagnosis: Gastric Lymphoma
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of gastric lymphoma.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of gastric lymphoma.
- VI. What are the contraindications for the alternative imaging techniques?
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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