Multidetector CT is the main tool for staging gastric cancer and response assessment, and protocols and interpretation vary between departments in ways that change management. The Korean Society of Abdominal Radiology ran a modified Delphi and produced ten statements, each agreed by at least 80% of the panel.
Two technical points anchor the document. Adequate gastric distension is treated as a prerequisite rather than a nicety - an incompletely distended stomach produces apparent wall thickening and overstages routinely. And a dedicated arterial phase is required, not for the tumour but for the surgeon: it identifies vascular variants such as an aberrant left hepatic artery, which changes the operation.
The rest refines interpretation. T, N and M criteria are set out with multiplanar reformations and three-dimensional visualisation to improve accuracy; dedicated criteria are introduced for re-staging after chemotherapy, where the practical difficulty is distinguishing viable tumour from treatment-induced fibrosis; and a risk-stratified surveillance approach is proposed, with de-escalation for very-low-risk disease such as pT1aN0.
This is a national society consensus, so the evidence behind individual statements varies and Delphi agreement measures expert opinion rather than data. Its value is in standardising things that are currently decided by whoever set up the protocol. Gastric cancer is common in Indian practice and CT protocols here are similarly unstandardised, so the distension and arterial-phase statements are the two worth taking to a departmental meeting - they cost nothing and change staging accuracy and surgical planning immediately.
- Audit gastric distension on recent staging CTs - underdistension overstages T category
- Include a dedicated arterial phase and report hepatic arterial variants explicitly for the surgeon
- Use multiplanar reformations routinely rather than axial images alone for T and N staging
- State in re-staging reports whether residual thickening is viable tumour or fibrosis, or that you cannot tell
- Consider de-escalated surveillance for pT1aN0 disease, per the risk-stratified proposal
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