Gastric Ulcer



Gastric Ulcer


Michael P. Federle, MD, FACR





Key Facts


Imaging



  • Benign gastric ulcer



    • Sharply defined mucosal defect (ulcer); smooth, even, radiating folds to edge of ulcer crater


    • Projects beyond expected contour of stomach (UGI and CT)


    • Usually on lesser curve, posterior wall, or antrum


    • CT may show extravasation of gas and oral contrast (lesser sac or peritoneal cavity)


  • Malignant ulcer



    • Uneven shape; irregular or asymmetric edges; interruption and clubbing of radiating folds


    • Does not project beyond contour of stomach


    • CT may show mets to nodes, peritoneum, liver


  • Upper GI series to show ulcer


  • CT to show complications (± ulcer itself)


  • CT gastroscopy (in experienced hands) may compete with endoscopy


  • Sump ulcers: Distal 1/2 of greater curvature (NSAIDs)


  • Incisura defect: Smooth or narrow indentation on curvature opposite ulcer (muscle contraction)


Top Differential Diagnoses



  • Gastritis


  • Gastric GIST


  • Gastric metastases and lymphoma


Pathology



  • 2 major risk factors: H. pylori (60-80%) and NSAIDs (20%)


Clinical Issues



  • Benign (95%), malignant (5%)


  • Often multiple: 20-30% prevalence


  • Hemorrhage, perforation, gastric outlet obstruction and fistula






(Left) Graphic shows a gastric ulcer with smooth gastric folds radiating to the edge of the ulcer crater. Note the infolding of the gastric wall “pointing” toward the ulcer, known as the incisura sign. (Right) Film from an upper GI series show an ulcer niche image projecting off the lesser curve of the antrum. Note the smooth gastric folds that radiate to the edge of the ulcer crater.






(Left) CT of a perforated gastric ulcer shows thickening of the antral wall and submucosal edema image, along with free intraperitoneal gas image and ascites image. The patient was taken to surgery where a perforated antral ulcer was oversewn along with an omental patch. (Right) A subsequent upper GI series in the same patient shows a large prepyloric ulcer image, as a fixed outpouching of barium. The antrum and pylorus are distorted.



TERMINOLOGY


Abbreviations



  • Peptic ulcer disease


Definitions



  • Inflammatory erosion of gastric mucosa


IMAGING


General Features



  • Best diagnostic clue



    • Sharply marginated barium collection with folds radiating to edge of ulcer crater on upper GI series


  • Location



    • Benign gastric ulcer



      • Usually lesser curvature or posterior wall of antrum or body


      • 3-11% on greater curvature, 1-7% on anterior wall


    • Malignant gastric ulcer



      • Usually greater curvature


  • Morphology



    • Same criteria are used for findings on upper GI series, CT “virtual gastroscopy,” and endoscopy


    • Benign ulcer



      • Sharply defined mucosal defect (ulcer); smooth, even, radiating folds to edge of ulcer crater


      • Project beyond expected contour of stomach (UGI and CT)


      • Usually on lesser curve, posterior wall, or antrum


    • Malignant ulcer



      • Uneven shape; irregular or asymmetric edges; interruption and clubbing of radiating folds


      • Does not project beyond contour of stomach


Radiographic Findings

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Jun 8, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Gastric Ulcer

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