With the stomach distended by water, CT shows the wall thickening or mass, how far it goes through the wall, the nodal stations, peritoneal disease and liver metastases — the peritoneum is the one most often missed.
Orient first
- Linitis plastica: diffuse thickening and a rigid, non-distensible stomach.
- T-stage on CT relies on the outer wall contour and perigastric fat; T4 invades the serosa or adjacent organs (verify the TNM edition).
- Peritoneal carcinomatosis often escapes CT; diagnostic laparoscopy is commonly performed before resection.
Acquire the study
- CT chest-abdomen-pelvis, portal venous phase, with 500–1000 ml water as negative oral contrast just before scanning and a spasmolytic if allowed; thin reformats.
The manoeuvre
- Distended stomach: focal or diffuse wall thickening in mm, enhancement pattern; location (cardia, body, antrum).
- Outer wall contour: smooth (early T-stage) vs nodular fat stranding (T3) vs infiltration of adjacent organs.
- Nodes: perigastric, along the left gastric, common hepatic and splenic arteries — short-axis diameter in mm.
- Peritoneum: omental nodularity, ascites, ovarian masses (Krukenberg).
- Liver metastases on the portal venous phase.
What confirms it
- Gastric wall thickening or mass with a biopsy-proven carcinoma; stage stated by edition.
What licenses you to exclude it
- CT of an undistended stomach cannot exclude a tumour — the study must be repeated with water distension or endoscopy performed.
The classic misread
- Calling a collapsed antrum a tumour.