Gastrointestinal Cancer Imaging: Deeper Than the Eye Can See

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Presentation transcript:

Gastrointestinal Cancer Imaging: Deeper Than the Eye Can See Richard S. Kwon, Dushyant V. Sahani, William R. Brugge Gastroenterology Volume 128, Issue 6, Pages 1538-1553 (May 2005) DOI: 10.1053/j.gastro.2005.03.034 Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 1 The depths of resolution of confocal microscopy (CM), optical coherence tomography (OCT), and endoscopic ultrasonography (EUS) are progressively greater, but with a loss of resolution. Gastroenterology 2005 128, 1538-1553DOI: (10.1053/j.gastro.2005.03.034) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 2 Methylene blue-stained Barrett’s epithelium with a focal, superficial malignancy unstained by methylene blue (arrow). Gastroenterology 2005 128, 1538-1553DOI: (10.1053/j.gastro.2005.03.034) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 3 Optical coherence tomography radial image of Barrett’s epithelium with early esophageal cancer (arrow; image provided courtesy of Pieralberto Testoni, MD, Milan, Italy). Gastroenterology 2005 128, 1538-1553DOI: (10.1053/j.gastro.2005.03.034) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 4 Optical coherence tomography linear image of Barrett’s epithelium with high-grade dysplasia. Note the absence of goblet cells (image provided courtesy of Norman Nishioka, MD, Massachusetts General Hospital). Gastroenterology 2005 128, 1538-1553DOI: (10.1053/j.gastro.2005.03.034) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 5 Imaging of a superficial gastric carcinoma. (A) Before indigo carmine staining, minor mucosal changes were found. (B) After indigo carmine staining, converging folds to a depressed lesion >20 mm were found. On pathology, there was a deep invasion of the submucosa. Because the depressed lesion was >10 mm, surgery was indicated (image provided courtesy of Moises Guelrud, MD, New England Medical Center). Gastroenterology 2005 128, 1538-1553DOI: (10.1053/j.gastro.2005.03.034) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 6 Multidetector CT of gastric cancer involving the antral wall (arrows). Gastroenterology 2005 128, 1538-1553DOI: (10.1053/j.gastro.2005.03.034) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 7 EUS of pancreatic cancer with color Doppler imaging enhancement of the adjacent portal vein. Gastroenterology 2005 128, 1538-1553DOI: (10.1053/j.gastro.2005.03.034) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 8 A CT image reformatted along the pancreatic duct to show a main-duct IPMN in the head of the pancreas is shown. There is segmental dilatation of the main pancreatic duct in the head (arrows), with normal-appearing pancreatic parenchyma and a normal-caliber distal duct. Gastroenterology 2005 128, 1538-1553DOI: (10.1053/j.gastro.2005.03.034) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 9 Screening CT colonography images in a 57-year-old man are shown. On the endoluminal view, a pedunculated polyp in the right colon is seen, and a well-defined soft tissue abnormality is seen as a projection into the lumen (arrow). Gastroenterology 2005 128, 1538-1553DOI: (10.1053/j.gastro.2005.03.034) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 10 Confocal microscopic image of early colon cancer: (A) normal rectum; (B) rectal cancer (image provided courtesy of Ralph Kiesslich, MD, Mainz, Germany). Gastroenterology 2005 128, 1538-1553DOI: (10.1053/j.gastro.2005.03.034) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 11 PET/CT image of recurrent rectal cancer in a 52-year-old man operated on 7 months previously. Selected images in 3 rows are shown. The top row shows axial CT, fused PET/CT, and PET images, with the corresponding coronal image shown in the bottom row. A soft tissue abnormality on CT in the presacral space shows increased 18F-fluoro-deoxy-d-glucose uptake (arrows). This was confirmed as tumor recurrence on biopsy. Gastroenterology 2005 128, 1538-1553DOI: (10.1053/j.gastro.2005.03.034) Copyright © 2005 American Gastroenterological Association Terms and Conditions