Table 2. .

Imaging modalities and their indications, advantages and limitations in the management of gastric cancer

	Clinical indications				Advantages	Limitations
	T-staging	N-staging	M-staging	Treatment response assessment
CT	Primary staging modality	Primary staging modality	Primary staging modality	All are currently insufficient to justify changes in treatment decision making	Widely available Short scanning times	Exposes patient to ionizing radiation Poor soft tissue contrast, reflected in limited gastric wall layer differentiation
EUS	Evaluation of possibility of endoscopic mucosal resection of early, node-negative, gastric cancer	Affirmation of N0 in patients with N0 as diagnosed by primary staging (CT) to guide neoadjuvant treatment decisions	None		Combination with FNA for histologic confirmation of suspected lymph nodes	Invasive Operator-dependent Limited field of view
18F-FDG PET	None	Metabolic information improves diagnostic accuracy of CT	No conclusive evidence regarding additional diagnostic information over CT, EUS and laparoscopy		Metabolic information provides high positive predictive value	Low sensitivity High costs Time consuming Not all gastric carcinomas are FDG-avid Low spatial resolution
MRI	Comparable diagnostic performance to CT, so indicated when CT is contraindicated or when CT results are ambiguous	Comparable performance to CT, so only indicated when CT is contraindicated or when CT results are ambiguous	Limited evidence, but can aid characterization of small liver metastases (≤10 mm).		High soft-tissue contrast and gastric wall layer differentiation Room for technical improvement with functional imaging (DW-MRI, DCE-MRI, integrated PET/MRI) and new contrast agents.	High costs Not widely available Long acquisition times

DCE, dynamic contrast-enhanced; DWI, diffusion-weighted imaging; EUS, endoscopic ultrasound; ¹⁸F-FDG PET, ¹⁸F-fluorodeoxyglucose positron emission tomography; FNA, fine needle aspiration; MRI, magnetic resonance imaging.