1. Dr/ ABD ALLAH NAZEER. MD.
Radiological imaging
of gastric pathology.

2. Normal gross anatomy.
Normal volume is 1.5 liters, capacity is 3 liters, potentially more.
● Fine mosaic-like pattern of mucosa because of punctuations by gastric pits or
foveolae.
● Longitudinal infoldings of mucosa and submucosa known as rugae are coarser
proximally and when stomach is empty.
Cardia: Narrow conical portion distal to gstroesophageal junction
● Many authors claim that cardiac mucosa is reflux-associated epithelia and not
normally present
● Of note in the AJCC Cancer Staging Manual, 7th Edition (2010), carcinomas of the
esophagus and esophagogastric junction (the proximal 5 cm of the stomach) are
staged identically
Fundus: ● Dome shaped proximal stomach
Body/corpus: ● Remainder of stomach to incisura angularis
Incisura angularis: Where stomach narrows before it joins duodenum
Antrum: Incisura angularis to pyloric sphincter (3-4 cm)
Pylorus: Muscular ring that controls flow of food content into proximal duodenum
Lesser curvature: Medial curvature of stomach on the right
Greater curvature: Lateral curvature of stomach.

4. Non-neoplastic anomalies: achalasia of cardia arteriovenous
malformation diaphragmatic hernia gastric dilation gastric gland
heterotopia heterotopic pancreas/pancreatic metaplasia mucolipidosis pyloric stenosis
Gastritis: features to report acute allergic autoimmune carditis Crohn’s
disease chronic chronic atrophic collagenous erosive granulomatous graft versus
host disease ischemic lymphocytic malakoplakia pseudomembranous reactive
(chemical) gastropathy suppurative ulcerative colitis
Infections: anthrax Candida CMV Cryptosporidium EBV giardia Helicobacter
heilmannii Helicobacter pylori herpes simplex histoplasmosis measles mycobacterium
avium-intracellulare syphilis toxoplasmosis tuberculosis
Ulcers: peptic ulcer disease acute gastric ulcer chronic peptic ulcer
Other non-neoplastic lesions: amyloid aneurysms antral vascular
ectasia bezoars calcinosis chloral hydrate colchicine
toxicity cyanide cysts diverticula duplication iron kayexelate proton pump
inhibitors xanthoma
Polyps: adenoma Cowden’s Cronkhite-Canada familial colonic polyposis foveolar
hyperplasia fundic gland gastritis cystica polyposa hyperplastic inflammatory
fibroid juvenile mixed Peutz-Jeghers
Hypertrophic gastropathy: enlarged mucosal folds hypertrophic hypersecretory
gastropathy Menetrier’s disease Zollinger-Ellison syndrome
Diseases of the stomach.

5. Dysplastia: dysplasia
Neuroendocrine tumors: classification NET G1/carcinoid large cell
neuroendocrine small cell
Carcinoma: general WHO
classification intestinal diffuse intramucosal GE
junction adenosquamous amphicrine hepatoid lymphoepithelioma-
like oncocytic Paneth cell rhabdoid sarcomatoid squamous cell
Lymphoma: general lymphoid hyperplasia anaplastic large cell diffuse
large B cell Hodgkin’s MALT mantle cell T cell
Stromal / other tumors: adenosarcoma alveolar soft parts
sarcoma choriocarcinoma elastofibroma follicular dendritic cell
sarcoma GANT GIST glomus granular cell Langerhans’ cell
histiocytosis leiomyoma lipoma malignant fibrous
histiocytoma metastases to stomach schwannoma synovial
sarcoma teratoma
Miscellaneous: staging-general staging-GIST staging-
neuroendocrine grossing specimens features to report histologic
treatment effect

6. Non-neoplastic anomalies: achalasia
of cardia arteriovenous
malformation diaphragmatic
hernia gastric dilation gastric gland
heterotopia heterotopic
pancreas/pancreatic
metaplasia mucolipidosis pyloric
stenosis
Congenital anomalies of the stomach

9. Radiographic features
Children with hypertrophic pyloric stenosis may show gastric distension prominent,
peristaltic waves (caterpillar sign), and mottled retained gastric content.
A upper gastrointestinal series (barium meal) excludes other, more serious causes of
pathology, but the findings of a UGI series infer rather than directly visualize the
hypertrophied muscle.
Plain film (abdominal radiograph): Non specific and may show a distended
stomach with minimal distal intestinal bowel gas.
Ultrasound: Ultrasound is usually the primary imaging modality 3, and its
advantages over a barium meal are that it directly visualizes the pyloric muscle and
does not use ionizing radiation. Unfortunately it is incapable of excluding other
diagnoses such as midgut volvulus.
The hypertrophied muscle is hypoechoic, and the central mucosa is hyperechoic. There
are measurement criteria that vary slightly from source to source. In a normal
situation, the pyloric muscle thickness (diameter of a single muscular wall on a
transverse image) should normally be less than 3 mm (most accurate 3) and the length
(longitudinal measurement) should not exceed 15 mm.
With the patient right side down the pylorus should be watched and should not be
seen to open.
Described sonographic signs include: antral nipple sign, cervix sign, target sign

10. Barium meals demonstrate delayed gastric emptying.
When some contrast does pass into the duodenum, the
pylorus appears elongated with a narrow lumen (string
sign) which may appear duplicated due to puckering of
the mucosa (double-track sign). The pylorus indents the
contrast-filled antrum (shoulder sign) or base of the
duodenal bulb (mushroom sign). Additionally the entrance
to the pylorus may be beak-shaped (beak sign).
Described barium signs include:
shoulder sign
string sign
double-track sign
mushroom sign
beak sign

11. Hypertrophic pyloric stenosis.

12. Hypertrophic pyloric stenosis.

14. Two cases Bochdalek hernia.

15. Morgagni hernia.

16. Two cases diaphragmatic hernia.

17. Achalasia of the cardia.

20. Hypertrophic gastritis with thick gastric folds. Erosive gastritis.

21. Atrophic gastritis in patient with known gastric atrophy
related to pernicious anemia

22. Gastritis in 25-year-old woman.

23. Hypertrophic gastritis.

25. Gastric ulcer with bull's eye sign.

26. Barium meal demonstrates a giant gastric ulcer in profile.

27. Perforated gastric ulcer.

28. Gastric tuberculosis.

29. Gastric anisakiasis.

30. Epithelial
Polyps, Papillomata, Adenomata, Polyposis.
Mesenchymal.
Leiomyomata, Neurofibromata, Fibromata,
Lipomata, Osteomata, Osteochondromata,
Myomata .
Endothelial
Hemangiomata, Lymphadenomata,
Endotheliomata .
Cysts
Simple, Dermoid, Echinococcus .
Benign tumour of the stomach.

32. Double-contrast barium meal. Large polyp
(arrows) arising from the gastric fundus.

33. Hyperplastic gastric polyps.

34. Ulcerating leiomyoma of stomach.

36. Gastric lipoma at the pyloric canal.

37. Hydatid cyst perforation into the gastric antrum

38. Malignant tumour of the stomach.

44. Early gastric cancers. Carcinoma stomach from lesser curvature.

45. Raised image with irregular stenosis and rigidity of the greater curvature of
stomach, gastric antrum to prepyloric level : intestinal type gastric adenocarcinoma.

46. Gastric carcinoma located on the antro-pyloric tract.

47. Gastric carcinoma.

48. Gastric adenocarcinoma: axial contrast-enhanced CT (CECT)
showing tumour arising from the lesser curvature of the stomach
(asterisk) associated with enlarged regional gastrohepatic nodes

49. Advanced gastric carcinoma.

50. Exophytic adenocarcinoma.

51. Signet ring cell carcinoma.

52. Mucinous adenocarcinoma.

53. Gastro-intestinal stromal tumour(GIST).

54. GIST arising from the posterior wall of the gastric fundus.

55. High-grade GISTLow -grade GIST

56. Enhanced CT scan of GIST.

57. High grade gastrointestinal stromal tumor.

62. Diffuse large B-cell lymphoma.

63. Gastric lymphoma.

64. Two cases of gastric lymphoma.

65. Carcinoid tumours of the stomach.

66. Carcinoid tumor.

67. Angiosarcoma of the stomach.

68. Carcinosarcoma of the stomach.

69. Direct gastric metastasis of primary pancreatic cancer.

70. Hematogenous metastasis of neuroendocrine carcinoma to stomach.

71. Thank You.