China is one of the countries with the highest incidence of gastric cancer. There are differences in epidemiological characteristics, clinicopathological features, tumor biological characteristics, treatment patterns, and drug selection between gastric cancer patients from the Eastern and Western countries. Non-Chinese guidelines cannot specifically reflect the diagnosis and treatment characteristics for the Chinese gastric cancer patients. The Chinese Society of Clinical Oncology (CSCO) arranged for a panel of senior experts specializing in all sub-specialties of gastric cancer to compile, discuss, and revise the guidelines on the diagnosis and treatment of gastric cancer based on the findings of evidence-based medicine in China and abroad. By referring to the opinions of industry experts, taking into account of regional differences, giving full consideration to the accessibility of diagnosis and treatment resources, these experts have conducted experts’ consensus judgement on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes. This guideline uses tables and is complemented by explanatory and descriptive notes covering the diagnosis, comprehensive treatment, and follow-up visits for gastric cancer.

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The Chinese Society of Clinical Oncology (CSCO): clinical guidelines for the diagnosis and treatment of gastric cancer.

Tumour angiogenesis and its relation to contrast enhancement on computed tomography: a review.

The spread of pelvic tumors to lymph nodes is an important means of tumor dissemination. Nodal metastases have important management and prognostic impact. Pelvic tumors usually metastasize first to regional lymph nodes, which are specific groups of nodes for each tumor, and are classified according to the TNM system as N-stage disease. If a pelvic tumor spreads to a lymph node outside of the defined regional nodes, this is considered M-stage disease, which usually results in upstaging of the disease to overall stage IV cancer and may potentially affect the patient's treatment options. Knowledge of the regional nodal spread of each tumor is essential in formulating effective search strategies for cross-sectional imaging studies performed for staging. Also important is correct description of the nomenclature of nodal metastases to facilitate proper staging. In this review, the patterns of regional nodal spread and N-stage classification are presented for carcinomas of the anus, bladder, cervix, endometrium, ovary, penis, prostate, rectum, testis, vagina, and vulva. Pelvic lymph node anatomy and nomenclature are reviewed with schematic illustrations and clinical examples from patients with pelvic tumors.

Lymphatic metastases from pelvic tumors: anatomic classification, characterization, and staging.

PURPOSE: To prospectively evaluate the accuracy of multi–detector row computed tomography (CT) gastrography for preoperative staging of gastric cancer, with pathologic and surgical results as the reference standard. MATERIALS AND METHODS: This study was approved by the institutional review board, and patients gave written informed consent. One hundred six patients (72 male, 34 female; mean age, 56 years) with endoscopically proved gastric cancer underwent unenhanced and contrast material–enhanced multi–detector row CT gastrography, with effervescent granules used as oral contrast material. Two experienced radiologists independently evaluated the depth of tumor invasion into the gastric wall (tumor staging), the involvement of regional lymph nodes (nodal staging), and the presence or absence of metastasis (metastatic staging) on transverse and volumetric CT images, which included images produced with multiplanar reformation and a virtual endoscopic technique. TNM staging of each tumor was compared with the...

Gastric cancer staging at multi-detector row CT gastrography: comparison of transverse and volumetric CT scanning.

Application of CT in the investigation of angiogenesis in oncology.

PURPOSE: To determine the efficacy of helical computed tomography (CT) in the detection of lymphadenopathy in patients with gastric cancer. MATERIALS AND METHODS: Helical CT (5-mm section thickness, 5-mm/sec table incrementation) was performed in 58 patients (39 men, 19 women; mean age, 63.8 years) with gastric cancer; 1,082 lymph nodes (138 positive, 944 negative for metastasis) were resected at surgery. Findings at CT and resection were compared. Sensitivity for detecting lymph nodes was evaluated according to nodal size and presence of metastasis. RESULTS: Seven (1.1%) of 649 lymph nodes 1-4 mm, 160 (45.1%) of 355 nodes 5-9 mm, and 56 (72%) of 78 nodes larger than 9 mm were detected at CT. For nodes of at least 5 mm, sensitivity for detecting metastasis-positive nodes (79 [75.2%] of 105 nodes) was higher than that for detecting metastasis-negative nodes (137 [41.8%] of 328; P < .01). Differences between positive and negative nodes in CT attenuation (110 HU +/- 25 vs 66 HU +/- 32) and short-to-long axis...

Lymph-node metastases: efficacy for detection with helical CT in patients with gastric cancer.

Background: Because of its poor prognosis, the diagnosis of hepatocellular carcinoma with sarcomatous change (HCCSC) is clinically important. The purpose of this study is to elucidate the characteristic CT findings of HCCSC. 
Methods: Two-phased dynamic incremental CT images of six histologically proven HCCSC were retrospectively reviewed. 
Results: All tumors (100%) exhibited peripheral enhancement on delayed CT images. Lymphadenopathy was observed in 100% (six of six patients); intrahepatic metastases, in 83% (five of six). Both metastatic lesions showed findings similar to those of the primary hepatic tumors, such as peripheral enhancement. Histopathologically, delayed and/or prolonged peripherally enhanced areas consisted of viable cancer cells with sarcomatous changes. 
Conclusions: The appearance of HCCSC on CT is that of an irregularly demarcated intrahepatic mass with delayed or prolonged peripheral enhancement, frequently with intrahepatic metastases and lymphadenopathy.

Hepatocellular carcinoma with sarcomatous change: characteristic findings of two-phased incremental CT.

Sixteen postoperative patients with anorectal malformation were evaluated by MRI, and the results compared with the clinical assessment. Patients were classified into three groups — good (group 1,n=10), fair (group 2,n=3) and poor (group 3,n=3) — on the basis of Kelly's clinical score of incontinence. The degree of development of the puborectalis and external sphincter muscles and the levator hammock was evaluated on MRI in comparison with patients without anorectal disease. The proportions of fair or poor development of the muscles were 37% in group 1,22% in group 2 and 67% in group 3. Although fair or poor development of the muscles was seen more frequently in group 3, there was no statistically significant difference between groups. However, poorly developed muscles were seen only in patients with fair or poor clinical scores. The difference in the anorectal angle measured on sagittal MRI images between patients in group 1 and groups 2 or 3 was significant. Our study indicates that MRI evaluation based solely on muscle development can be misleading, and measurement of the anorectal angle should be included in the MRI evaluation.

Postoperative MRI evaluation of anorectal malformations with clinical correlation.

In order to clarify the factors contributing to the signal intensities (SIs) of HCC on T1-weighted images, the amount of water, lipid, copper (Cu), iron (Fe), and manganese (Mn) was determined in HCC and surrounding hepatic parenchyma of 13 patients. The relationships among these findings, the histopathologic findings, and the SIs of T1-weighted images were evaluated.Among the 13 HCC, 3 had a high SI, 5 were isointense, and 5 had a low SI on T1-weighted images compared to the surrounding hepatic parenchyma. The paramagnetic ions which contributed to the SI patterns were assumed to be Cu in HCC (38.0±62.4 μg/g ww), and Fe in the liver (61.1±42.4 μg/g ww) and HCC (40.0±34.3 μg/g ww). In 8 HCC with high- or isointensity, 2 were grades I, 5 were grade II, and one was grade III according to the Edmondson-Steiner's histopathologic classification. It is concluded that the SI patterns alone can not be a sign of low grade malignancy because of the existence of Fe in livers and HCC.

MR IMAGING OF HEPATOCELLULAR CARCINOMA Correlation of metal content and signal intensity

Background: Although intratumoral patent portal vein (ITPV) is one of the characteristic features of benign hepatic lesions, ITPVs can be demonstrated in malignant tumors. We present the spectrum of MR and CT findings of ITPV identified in intrahepatic cholangiomas with pathological correlations. Methods: The ultrasound, CT and/or MRI findings of pathologically-confirmed intrahepatic cholangiomas were reviewed and correlated with surgical specimen or autopsy findings. Results: Intratumoral patent vessels were radiographically-demonstrated in 5 patients with intrahepatic cholangiomas. All intratumoral vessels were secondary or tertiary order portal vein branches. Some wall thickening was identified on pathological examinations. Conclusion: The radiological demonstration of intratumoral portal vein is not a specific sign of benignity. In the case of a hepatic tumor with a patent portal tract, cholangioma should be considered, as well as benign tumors or lymphoma.

Radiologically identifiable intratumoral portal vein in intrahepatic cholangiomas: a diagnostic pitfall

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