Relatively small size linitis plastica of the stomach: Multislice CT detection of tissue fibrosis

Background: Linitis plastica (scirrhous gastric carcinoma) has a poor prognosis due to delay in diagnosis. Pathological feature of this tumor is diffuse fibrosis of the gastric wall. Detection of small fibrotic lesion in the gastric wall would contribute to early diagnosis of linitis plastica, since the primary lesion usually lacks remarkable protrusion or ulceration. Methods: We performed a multislice CT evaluation of 20 patients with gastric carcinoma with 8 data acquisition system (Aquilion, Toshiba Medical Systems Corporation, Japan). Results: Out of 20 primary lesions, 3 were diagnosed as relatively small size (less than 10 cm in maximum diameter) linitis plastica. We have successfully demonstrated an en face virtual endoscopic image of the primary ulcers of linitis plastica by arterial-phase, and reactive fibrosis (a desmoplastic response) of the gastric wall by delayed-phase multiplanar reformation (MPR) images perpendicular to the en face image. This preoperative information was useful to evaluate extent of tumor invasion. Conclusions: The multislice CT evaluation of linitis plastica using delayed-phase images was potentially useful in the detection of relatively small fibrotic lesion and in determining the optimal mode of resection of the stomach.