Advanced Gastric Cancer: Differentiation of Borrmann Type IV versus Borrmann Type III by Two-Phased Dynamic Multi-Detector Row CT with Use of the Water Filling Method

Abstract

Purpose: To characterize Borrmann type IV from Borrmann type III advanced gastric cancer (AGC) by two-phased multi-detector row computed tomography (MDCT) using the water filling method. Materials and Methods: A total of 143 patients (pathologically confirmed Borrmann type III and IV - 100 and 43 patients), who underwent preoperative MDCT, were enrolled. Two radiologists, retrospectively and independently, determined tumor enhancement pattern using a 5-grade scale without clinical information. A weighted kappa test was applied for interobserver variability. The score of tumor enhancement pattern correlated with Borrmann type as determined by Spearman’s correlation coefficient. The accuracy of differentiation of Borrmann type using MDCT was determined by receiver operating characteristic curves. Results: Interobserver agreement (weighted kappa = 0.683) was substantial. The tumor enhancement pattern score showed a significant correlation with Borrmann type (reviewer 1, r = 0.591, p < 0.001; reviewer 2, r = 0.616, p < 0.001). The accuracy for differentiation of Borrmann type on MDCT was 0.86 (p < 0.001) in both reviewers. The sensitivity and specificity of the diagnosis of Borrmann type IV were 79% and 82% in reviewer 1, and 88% and 78% in reviewer 2, respectively. Conclusion: Dual-phased MDCT using the water filling method can differentiate between Borrmann type IV and III AGC with high accuracy.