Imaging Pearls ❯ Stomach ❯ Lipoma
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- “Cinematic Rendering (CR) is a recently developed, three dimensional display technique. It uses the same standard acquisition CT volumetric data with a complex global lighting model to create photo-realistic images. The more realistic representation of complex lighting interactions givesmore surface detail and enhances evaluation of spatial relationshipsrelative to volume-rendered images. CR hasbeen used in the evaluation of liver masses and renal cell carcinoma, as well as the pre-operative planning of ovarian cancer. CR may have unique roles in the evaluation and treatment planning of gastric masses, and serve as an important adjunct to standard high-resolution CT. CR is of particular interest in the evaluation of gastric masses becauseits superior evaluation of surface detail is applicable to the evaluation of gastric mucosa, and its ability to represent large volume of tissue in a single image is ideal for vascular mapping and surgical and endoscopy planning.”
Implementation of cinematic rendering of gastric masses into clinical practice: a pictorial review
Claire Brookmeyer · Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdominal Radiology 2022 https://doi.org/10.1007/s00261-022-03604-3 - “The mucosal changes that occur in gastric adenocarcinoma are of particular interest, and can be evaluated through the application of CR. Gastric adenocarcinoma is the most common gastric malignancy. Adenocarcinoma originates in the mucosal layer and so the mucosal fold pattern is often focally altered at the site of disease. CR is capable of showing a large volume of mucosal tissue in a single image, thus offering direct juxtaposition between normal mucosal pattern and focally abnormal folds. At this time, imaging is not used to evaluate the depth of invasion within the gastric wall or the intramural submucosal spread of disease, but CR may provide a further avenue to investigate for these applications, as subtle textural changes can often be appreciated on CR. Even if such textural changes are difficult for the human eye to appreciate, machine learning and artificial intelligence algorithms may be able to leverage the input from CR images to improve detection.”
Implementation of cinematic rendering of gastric masses into clinical practice: a pictorial review
Claire Brookmeyer · Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdominal Radiology 2022 https://doi.org/10.1007/s00261-022-03604-3 - “Although we have found CR to be useful at our institution in the evaluation of gastric masses, there are several limitations in its application. First and foremost, CR images are limited by the quality of the CT volumetric data set from which they are created, sooptimal CT acquisition parameters and patient preparationwith gastric distention is critical. Additionally, CR rendering may require a separate workflow from other radiologic exams. Currently, cinematic rendering software is separate from most PACS due to the complex calculations needed for the global lighting model, so this may necessitate an independent workstation for creation of CR images. It also takes time and radiologist expertise to manipulate many CR parameters to create optimal images,”
Implementation of cinematic rendering of gastric masses into clinical practice: a pictorial review
Claire Brookmeyer · Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdominal Radiology 2022 https://doi.org/10.1007/s00261-022-03604-3 - “ CR has tremendous potential in the treatment planning for gastric masses, although its exact role and effect on surgical planning and endoscopy planning has yet to be delineated. Studies in which surgeons were randomized to having access to CR images or not would be capable of prospectively identifying any changes in outcomes related to the opportunity to review CR images for pre-operative planning. CR may also be employed as a problem-solving tool in clinically suspected gastric abnormalities that are not detected or incompletely characterized on routine multiplanar CT. This may include evaluation of non-mass gastric abnormalities, including suspected GI bleed or gastric ulceration “
Implementation of cinematic rendering of gastric masses into clinical practice: a pictorial review
Claire Brookmeyer · Steven P. Rowe · Linda C. Chu · Elliot K. Fishman
Abdominal Radiology 2022 https://doi.org/10.1007/s00261-022-03604-3
- Gastric Lipoma: Facts
- Usually asymptomatic but may present with GI bleeding due to ulcerations
- May lead to a intussusception
- Attenuation usually in the -70 to -120 HU range - Leiomyoma: Facts
- True leiomyoma's are rare
- Leiomyoma's are always benign
- Leiomyoma's are negative for c-KIT and strongly positive for desmin and smooth muscle stain
- Tumors range in size from 1-5 cm in diameter
- “Gastric lipoma is a rare lesion, accounting for only 5% of gastrointestinal tract lipomas and fewer than 1% of all gastric tumors . Most gastric lipomas are small asymptomatic lesions that are detected as incidental findings at autopsy. The tumor is composed of well-differentiated adipose tissue surrounded by a fibrous capsule. Most gastric lipomas are found in the submucosa, and most are located in the pyloric antrum. When the tumors are large (> 3–4 cm), the most common clinical presentation is upper gastrointestinal hemorrhage, either chronic or acute, caused by ulceration of the neoplasm.”
Imaging Characteristics of Gastric Lipomas in 16 Adult and Pediatric Patients
Thompson WT et al.
AJR . 2003;181: 981-985 - “When the tumors are large (> 3–4 cm), the most common clinical presentation is upper gastrointestinal hemorrhage, either chronic or acute, caused by ulceration of the neoplasm. Abdominal pain and obstructive symptoms are also common, especially if there is endoluminal growth that could cause intussusception . It is not rare for distal lesions in the prepyloric area to prolapse into the duodenal bulb.”
Imaging Characteristics of Gastric Lipomas in 16 Adult and Pediatric Patients
Thompson WT et al.
AJR . 2003;181: 981-985 - “CT has proven to be of considerable value in the diagnosis of gastrointestinal lipomas
.The lesions appear as well-circumscribed areas of uniform, fatty density with an attenuation ranging from –70 to –120 H. Thus, a gastric lipoma can be definitively diagnosed using CT, which obviates endoscopy or even surgery if the patient is asymptomatic.”
Imaging Characteristics of Gastric Lipomas in 16 Adult and Pediatric Patients
Thompson WT et al.
AJR . 2003;181: 981-985 - “CT is the imaging examination of choice for obtaining a specific diagnosis of lipoma. The smallest lesion revealed on CT was 4 cm and had an ulcer that was visible on both upper gastrointestinal examination and CT. A homogeneous gastric mass with a density of between –70 and –120 H has been previously reported as pathognomonic for the diagnosis of gastric lipoma.”
Imaging Characteristics of Gastric Lipomas in 16 Adult and Pediatric Patients
Thompson WT et al.
AJR . 2003;181: 981-985