Comparison of Spiral-Computed Tomography with Water-Filling of the Stomach and Endosonography for Gastric Lymphoma of Mucosa-Associated Lymphoid Tissue-Type

Background: Endosonography has been reported as the method of choice for local staging of patients with gastric lymphoma of mucosa-associated lymphoid tissue (MALT)-type. As endosonography is still restricted to specialized centers, we have investigated the use of spiral computed tomography of the abdomen with water-filling of the stomach (hydro-spiral CT) for enhanced contrast in patients with gastric lymphoma. Patients and Methods: Patients with a histological verified diagnosis of gastric lymphoma of MALT-type were included in this prospective series. All patients underwent routine staging procedures including endosonography of the upper GI-tract carried out by a single individual. In addition, patients were subjected to hydro-spiral CT either before or after endosonography within a maximal time span of 4 weeks. Results of hydro-spiral CT were compared to those of the endosonographic evaluation and histological work-up of biopsy specimens. Results: A total of 14 patients with primary gastric lymphoma of MALT-type (3 with a high-grade component) were studied prospectively. All patients underwent hydro-spiral CT before initiation of treatment, and 2 patients were also studied following chemotherapy. In the pretherapeutic setting, hydro-spiral CT identified gastric lymphoma in 8 patients, while a false negative result was seen in 6 patients. In addition, the localization of the lymphoma within the stomach was divergent between CT and endosonography in 1 patient. In the 2 patients who were also studied after therapy, CT showed unchanged thickening of the stomach wall in spite of normalization in the endosonographic assessment as well as the histologic evaluation. Conclusion: Our results demonstrate the superiority of endosonography over hydro-spiral CT for the staging and follow-up of patients with gastric lymphoma, who should therefore be managed at centers where endosonography is available.