図１〜図７で大量の遊離ガスがあり（△），肝周囲に少量（厚さ1cm以内）の，図３〜図７でMorison窩に大量（厚さ2cm以上）の腹水がある（※）ので消化管穿孔の所見である．図７と図８の胃前庭部の胃壁は他部位の胃壁と比べ極めて強く造影され（▲），肥厚し腫瘍性病変を示唆する．図７で遊離ガス（△）と連続する穿孔部位が描出されており（↑），消化管穿孔の原因は胃の腫瘍性病変である可能性が高い．丸数字12：十二指腸．手術で胃前庭部前壁に，穿孔した硬い腫瘤を触れ胃癌の穿孔と思われた．大網充填術を施行したが，多臓器不全を合併し死亡した．

参考症例１（胃癌穿孔）：63歳男性．3時間前に心窩部痛が出現し，次第に増強してきたので来院．体温：37.4℃，腹部全体に腹膜刺激症状を認めた．
図１で遊離ガス（△）を認め，図１と図２の▲は転移性病変を示唆する．図３〜図６の↑は他部位の胃壁と比較してやや強く，不整に造影される壁肥厚性病変で，胃癌であろう．丸数字12：十二指腸．同所見が手術で確認され，後日の内視鏡検査でも胃癌が確認された（図A：↑）．

参考症例２（5mmスライス，非穿孔性胃癌）：47歳女性．検診で胃の異常所見を指摘された．↑が潰瘍（△）を伴う胃体部前壁の癌病変，胃透視（腹臥位）では▲が潰瘍（△）を伴う癌病変．

文献考察：multidetector CTによる胃癌診断はかなり精度が高い．
Gastrointest Endosc. 2004 May;59(6):619-26.
Usefulness of three-dimensional, multidetector row CT (virtual gastroscopy and multiplanar reconstruction) in the evaluation of gastric cancer: a comparison with conventional endoscopy, EUS, and histopathology.
Bhandari S, Shim CS, Kim JH, Jung IS, Cho JY, Lee JS, Lee MS, Kim BS.

BACKGROUND: The aim of this study was to assess the role of three-dimensional multidetector row CT for detection, precise localization, and staging of gastric cancer by comparison with conventional endoscopy, EUS, and histopathology. METHODS: Sixty-three patients with gastric cancer (31 early stage, 32 advanced) were evaluated by EGD with biopsies, EUS, and three-dimensional multidetector row CT between January 2003 to August 2003. Three-dimensional multidetector row CT findings were analyzed by a single radiologist blinded to the endoscopic findings. Among 63 patients, the findings were confirmed in 48 at surgery or by EMR. In the remaining cases, the findings were confirmed by EGD and biopsy specimen. The accuracy of three-dimensional multidetector row CT for detection, localization, and staging of gastric cancer was determined, compared with endoscopy, EUS, and histopathology. RESULTS: Among the 63 patients, there were 67 gastric cancers. The overall accuracy of three-dimensional multidetector row CT for detection of gastric lesions was 94% (63/67), with accuracies of 96.7% (30/31) and 100% (32/32) for detection of, respectively, early and advanced stage gastric cancer. The overall accuracy, sensitivity, and specificity for EUS and three-dimensional multidetector row CT in the pre-operative determination of depth of invasion (T stage) were, respectively, 87.5%, 82.4%, and 96%; and 83.3%, 69.1%, and 94.4%. The accuracy, sensitivity, and specificity of EUS and three-dimensional multidetector row CT for lymph node staging was, respectively, 79.1%, 57%, and 89.5%; and 75%, 57.4%, and 89.3%. CONCLUSIONS: Three-dimensional multidetector row CT, along with virtual gastroscopy is a promising method for pre-operative evaluation of gastric cancer.PMID: 15114303