Two- and Three-Dimensional Examination of the Stomach (Virtual Gastroscopy): Technical Note

Endoscopy of the stomach is performed so routinely and with acceptable results that there are few requests for detailed radiologic examination, predominantly after bariatric or hiatus hernia surgery. Nevertheless, computed tomographic (CT) examination with 3-dimensional (3D) virtual gastroscopy may provide additional and complementary information useful in therapeutic decision making, and it also offers an alternative gastric examination for patients in whom conventional endoscopy is not straightforward. Abdominal CT is usually performed without gastric distention. However, double-contrast barium meals and enemas, enteroclysis, CTof the colon, and CT enterography of the small intestine have all shown that distention of the alimentary tract is critical for demonstration of mucosal pathology. Horton and Fishman [1] suggested the use of water for gastric distention. Springer et al [2] obtained the best results with air contrast but found 3D spatial resolution to be limited by computer performance and software constraints at that time. More recently, with the advent of rapid 3D applications, some investigators have evaluated CT 3D gastric imaging, with and without 2-dimensional (2D) imaging, and described promising results for characterizing advanced gastric cancer [3], gastrointestinal stromal tumours (GIST) [4], and moderate results for early gastric cancer [4e6]. In this technical note, we present one approach to 3D CT examination of the stomach.