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. 2021 Aug 12;32(2):938–949. doi: 10.1007/s00330-021-08205-0

Table 3.

Final version of the items and results for the staging section of the CT report

Item Information to be included in the radiological report Agreement (median) Consensus (IQR) Stability (p)
Clinical referral

- Site (upper/middle/ lower 1/3, lesser/greater curvature, anterior /posterior wall);

-Features (stenosing, ulcerated, perforated) and staging of the neoplasm obtained by endoscopy;

- Possible previous partial gastrectomy and/or other types of gastric surgery and/or endoscopic resections;

The radiologist should point out in this section if clinical information provided were not adequate.

 9 1.5 /
Technique

- Specify if correct gastric distension has been performed, the modality of distension (air or water, and the reasons for any failure of distension;

- Specify if gastric hypotonization has been carried out;

- Report any adverse reaction to intravenous contrast media (in that case, report the contrast agent administered);

- Report the presence of any motion artifacts or problems that occurred during CT examination;

- Report if dual-energy technique (DECT) was used.

 9 0 0.705
Findings
T parameter

- Site (lesser/greater curve, upper/middle/lower 1/3, anterior/posterior wall);

- Features (stenosing, ulcerated, perforated);

- Gastric wall infiltration ( ≤ T2 or ≥ T3);

- Distance from the esophago-gastric junction or possible esophageal infiltration (the involvement of the esophagus should be expressed in mm from the hiatus);

- Possible infiltration of perigastric organs/structures (pancreas, liver, mesocolon, etc.);

- Possible duodenal infiltration;

- Maximum dimension (D-max) of the lesion [23];

- Anatomical anomalies (hiatal hernia, gastric migration);

- Possible infiltration of vascular structures.

 9 0 0.480
N parameter

- Presence/absence of LN involvement (N0 vs N +);

- Site of metastatic LN (stations number according to JGCA or anatomical description according to AJCC) [25, 43];

- Short diameter of the largest metastatic LN for each station;

- Possible adhesion/infiltration of anatomical structures by LNs (e.g., pancreatic capsule, spleen, hepatic artery, etc.);

- In case of confluent lymphadenopathy, report it and indicate the maximum diameter of the package.

 9 1 0.376
Peritoneal carcinomatosis

- Presence/absence of ascites;

- Presence/absence of peritoneal carcinomatosis;

- Specify if supra- or sub-mesocolic involvement;

- Specify if nodules in the omental bursa;

- Report the diameter of the largest nodule (up to 2);

- Specify whether bowel loop involvement and/or infiltration of the mesentery root;

- Presence/absence of Krukenberg tumor;

- Presence/absence of “omental cake”.

 9 0 0.480
Liver metastases

- Presence/absence of liver metastases;

- Number: indicate if unique, or number up to max 3, or if> 3 indicate “multiple”;

- Site (liver segments involved);

- Maximum diameter (single measure in mm) of largest metastases (up to 2 in accordance with RECIST1.1) [44];

- Specify the infiltration of a major intrahepatic vessel (portal vein, IVC, suprahepatic veins);

- Describe any hepatopathy (liver cirrhosis, signs of portal hypertension).

 9 0 0.429
Other metastases

- Site (lung, bone, distant lymph nodes ...);

- Number: indicate if unique, or number up to max 3, or if > 3 indicate “multiple”;

- Size: indicate the Dmax of the largest lesion for each involved organ;

- Report non-measurable lesions (lymphangitis, pleural effusion ...).

 9 0 0.075
Useful information for the surgeon

- Vascular anomalies;

- Presence of incisional hernias.

 9 1 0.185
Conclusions/advice

- The radiologist should provide a clinical-radiological staging (cTNM (CT): T expressed as </ = T2 or > / = T3 or T4b, N expressed as N0 or N +, M expressed as M0 or M +);

- The radiologist should recommend the discussion of the clinical case at the multidisciplinary group.

 8 2.5 0.812