Double Contrast-enhanced Ultrasound for the Preoperative Gross Classification of Gastric Cancer: a Comparison With Multidetector Computed Tomography

Purpose To compare the diagnostic performance of double contrast-enhanced ultrasound (DCEUS) and multi-detector row computed tomography (MDCT) in the gross classification of gastric cancer (GC) preoperatively. Methods 54 patients with GC proved by histology were included in this study. The sensitivity and specificity of DCEUS and MDCT for gross classification were calculated and compared. The area under the curve (AUC) from a receiver operating characteristic curve analysis was used to evaluate the difference of the diagnostic performance between these two methods.Results There were no significant differences between DCEUS and MDCT in terms of AUC values for early gastric cancer (EGC) and Borrmann Ⅰ-Ⅲ (P = 0.248, 0.317, 0.717 and 0.464, respectively). However, the sensitivities of DCEUS for EGC, Borrmann Ⅰ and Borrmann Ⅲ were higher than those of MDCT (75% versus 62%; 100% versus 50%; 90% versus 73%). The specificity of DCEUS for Borrmann Ⅲ was lower than that of MDCT (50% versus 75%). The AUC value of MDCT for Borrmann Ⅳ was significantly higher than that of DCEUS (0.927 versus 0.625; P=0.001). The accuracy and specificity of DCEUS and MDCT for Borrmann Ⅳ were similar, but the sensitivity of MDCT was significantly higher than that of DCEUS (88% versus 25%).Conclusion DCEUS may be considered as a useful complementary imaging modality to MDCT for the evaluation of the gross classification of GC preoperatively.

Pharmacotherapy Plays Main Role in Managing Acute Epiploic Appendagitis: A Case Report

Epiploic appendagitis is natural fats at the anti-mesenchymal surface of the colon. EP is self- limited. Misdiagnosis can lead to unnecessary hospitalization, antibiotic therapy, and surgical intervention. The incidence reported 8.8 cases / million / year. Here, we report on 36-year-old female patient who presented with acute abdominal pain that was getting worse with the change of position. Based on these symptoms and double contrast computed tomography, she was diagnosed with epiploic appendagitis in adjacent to the sigmoid. The patient was treated successfully with conservative management and antibiotics. Since the signs and symptoms of epiploic appendagitis are nonspecific, but considering of this disease as one of the differential diagnoses of acute abdominal pain can prevent the disease from misdiagnosing.

Double contrast-enhanced ultrasonography of a small intestinal neuroendocrine tumor: a case report of a recommendable imaging modality

A 57-year-old male presenting with spontaneously relieved abdominal cramp and distension was admitted to the West China Hospital. The diagnosis remained unclear after colonoscopy and computed tomography. Double contrast-enhanced ultrasonography was then performed and a neoplasm in the small intestine was suspected, supported by a thin-section computed tomography and positron emission tomography/computed tomography. This was confirmed pathologically after surgery to be a small intestinal G1 neuroendocrine tumor. Surgery was performed to remove approximately 25 cm of small bowel and a 3-cm solid mass located in the mesentery. The patient had a complete recovery and was tumor-free at the final follow-up. Small intestinal tumors including neuroendocrine tumors have always posed a diagnostic challenge. This case indicated that double contrast-enhanced ultrasonography is feasible in detection of small intestinal neuroendocrine tumors, and it may be an advisable approach assisting diagnosis of small intestinal tumors.