Double contrast-enhanced ultrasonography improves diagnostic accuracy of T staging compared with multi-detector computed tomography in gastric cancer patients

Figure 6 Images of T4a gastric cancer in a 60-year-old man. A: Gastroscopic image shows a diffuse ulcerative tumor; B: MDCT image shows the tumor (arrows) with diffuse thickening of the whole gastric wall, band-like perigastric fat infiltration, and cluster of enhancing nodes (star) around perigastric region; C: US image shows the hypoechoic diffuse tumor (arrows) with irregular margin of the serosa, banded infiltration of the adjacent fat plane, and cluster of nodes (star) in perigastric region; D and E: CEUS images show the tumor (arrows) with surrounding perigastric fat plane and cluster of nodes (star) synchronous hyper-enhancement in the arterial phase (D), and synchronous hypo-enhancement in the venous phase (E). The hyper-enhancement strip of the submucosal and serosal layers and hypo-enhancement strip of the muscularis propria are disruptive.