Gastric adenocarcinoma has an incidence rate of 7.3 per 100,000 with 27,600 new cases estimated in 2020 and a 5- year relative survival rate of 32% [18]. Although endoscopy with biopsy is the reference standard for diagnosing gastric cancer, patients often present with nonspecific symptoms and undergo an imaging test for workup of those symptoms; gastric cancer may be first detected on such imaging. CT Abdomen and Pelvis Although endoscopy is the reference standard for diagnosing gastric cancer, patients may present with nonspecific symptoms and may undergo an imaging test for workup of those symptoms; gastric cancer may be first detected on such imaging. Additionally, malignancy is now the most common cause of gastric outlet obstruction in adults because the incidence of PUD has decreased because of the widespread use of H2 blockers [12]. If a gastric outlet obstruction is suspected, a CT may be ordered for anatomic evaluation. In some cases, a gastric mass may not be well seen on CT because of gastric underdistension. However, multiple other imaging findings may nonetheless be identified on CT that are concerning for this diagnosis, such as nodular or irregular wall thickening or enhancement, soft tissue attenuation of wall thickening (rather than low attenuation thickening due to edema), perforation with an ulcerated mass, lymphadenopathy, and distant metastases [7,8,12]. When gastric disease is suspected, the CT examination should be performed with IV contrast (to assess for nodular wall thickening, soft tissue attenuation of the wall thickening) and neutral oral contrast such as water or dilute barium suspension to help delineate the intraluminal space [12]. There is limited value of performing a CT abdomen and pelvis without and with IV contrast for this indication. A CT abdomen and pelvis without IV contrast will be less sensitive in establishing this diagnosis [12,19].
Epigastric Pain. Gastric adenocarcinoma has an incidence rate of 7.3 per 100,000 with 27,600 new cases estimated in 2020 and a 5- year relative survival rate of 32% [18]. Although endoscopy with biopsy is the reference standard for diagnosing gastric cancer, patients often present with nonspecific symptoms and undergo an imaging test for workup of those symptoms; gastric cancer may be first detected on such imaging. CT Abdomen and Pelvis Although endoscopy is the reference standard for diagnosing gastric cancer, patients may present with nonspecific symptoms and may undergo an imaging test for workup of those symptoms; gastric cancer may be first detected on such imaging. Additionally, malignancy is now the most common cause of gastric outlet obstruction in adults because the incidence of PUD has decreased because of the widespread use of H2 blockers [12]. If a gastric outlet obstruction is suspected, a CT may be ordered for anatomic evaluation. In some cases, a gastric mass may not be well seen on CT because of gastric underdistension. However, multiple other imaging findings may nonetheless be identified on CT that are concerning for this diagnosis, such as nodular or irregular wall thickening or enhancement, soft tissue attenuation of wall thickening (rather than low attenuation thickening due to edema), perforation with an ulcerated mass, lymphadenopathy, and distant metastases [7,8,12]. When gastric disease is suspected, the CT examination should be performed with IV contrast (to assess for nodular wall thickening, soft tissue attenuation of the wall thickening) and neutral oral contrast such as water or dilute barium suspension to help delineate the intraluminal space [12]. There is limited value of performing a CT abdomen and pelvis without and with IV contrast for this indication. A CT abdomen and pelvis without IV contrast will be less sensitive in establishing this diagnosis [12,19].