CT Abdomen Although a CT abdomen examination may provide the same clues to diagnose gastric cancer as a CT abdomen and pelvis examination, the latter is usually chosen when nonspecific/overlapping symptoms are encountered. Additionally, including the pelvis may be valuable for assessing distant metastases. 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 [12]. There is limited value in performing a CT abdomen without and with IV contrast for this indication. A CT abdomen without IV contrast will be less sensitive in establishing this diagnosis [12,19]. CT Abdomen Multiphase Multiphase contrast-enhanced examinations are not routinely performed in patients with gastric cancer, but a CT angiographic protocol including precontrast, arterial, and portal venous phases or a 2-phase dual-energy protocol with arterial and portal venous phases may be used for patients with suspected acute GI bleeding [12]. FDG-PET/CT Skull Base to Mid-Thigh Although patients with gastric cancer may exhibit increased radiotracer uptake at the site of malignancy on FDG- PET, there is no relevant literature to support the use of FDG-PET/CT as the test of choice for initial imaging for gastric cancer. Fluoroscopy Biphasic Esophagram A biphasic esophagram does not evaluate the stomach and hence would not be useful for initial imaging for gastric cancer. Epigastric Pain Fluoroscopy Single Contrast Esophagram A single-contrast esophagram does not evaluate the stomach, and hence would not be useful for initial imaging for gastric cancer. Fluoroscopy Upper GI Series The double-contrast upper GI series is a beneficial diagnostic test for evaluating structural and functional abnormalities of the esophagus, stomach, and duodenum [17].
Epigastric Pain. CT Abdomen Although a CT abdomen examination may provide the same clues to diagnose gastric cancer as a CT abdomen and pelvis examination, the latter is usually chosen when nonspecific/overlapping symptoms are encountered. Additionally, including the pelvis may be valuable for assessing distant metastases. 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 [12]. There is limited value in performing a CT abdomen without and with IV contrast for this indication. A CT abdomen without IV contrast will be less sensitive in establishing this diagnosis [12,19]. CT Abdomen Multiphase Multiphase contrast-enhanced examinations are not routinely performed in patients with gastric cancer, but a CT angiographic protocol including precontrast, arterial, and portal venous phases or a 2-phase dual-energy protocol with arterial and portal venous phases may be used for patients with suspected acute GI bleeding [12]. FDG-PET/CT Skull Base to Mid-Thigh Although patients with gastric cancer may exhibit increased radiotracer uptake at the site of malignancy on FDG- PET, there is no relevant literature to support the use of FDG-PET/CT as the test of choice for initial imaging for gastric cancer. Fluoroscopy Biphasic Esophagram A biphasic esophagram does not evaluate the stomach and hence would not be useful for initial imaging for gastric cancer. Epigastric Pain Fluoroscopy Single Contrast Esophagram A single-contrast esophagram does not evaluate the stomach, and hence would not be useful for initial imaging for gastric cancer. Fluoroscopy Upper GI Series The double-contrast upper GI series is a beneficial diagnostic test for evaluating structural and functional abnormalities of the esophagus, stomach, and duodenum [17].