Can visceral fat parameters based on computed tomography be used to predict occult peritoneal metastasis in gastric cancer?

Figure 1 Determination of visceral fat parameters. A-D: Detection of visceral fat (VF) parameters in a 54-year-old male patient with gastric cancer with peritoneal metastasis (PM); A and B: Axial unenhanced and venous computed tomography (CT) images showing wall thickening in the cardia and the lesser and greater curvatures of the stomach; C: Regions of interest (ROI) were drawn using a semiautomated technique. The red area represents VF, while the blue area represents subcutaneous fat (SF); D: Sagittal image showing a three-dimensional (3D) ROI, delineated starting from the maximal axial section of the tumor and extending 25 mm; E-H: Determination of VF parameters in a 66-year-old female patient with gastric cancer without PM; E and F: Axial unenhanced and venous CT images showing irregular wall thickening and a mass in the cardia of the stomach; G and H: A 3D ROI drawn with a 25-mm height using a semiautomated technique. The red area represents VF, while the blue area represents SF.

Figure 2 Predictive performance of computed tomography attenuations for visceral fat in two regions of interest and two models for predicting peritoneal metastasis in gastric cancer. A: Receiving operator characteristic (ROC) curves of the visceral fat (VF) computed tomography (CT) attenuations on ROIs 1 and 2. The VF CT attenuations on ROI 2 [area under the curve (AUC): 0.657, sensitivity 93.0%, specificity 30.6%] showed a better predictive performance than those on ROI 1 (AUC: 0.599, sensitivity 60.0%, specificity 60.0%); B: ROC curves of the clinical and combined models. The two models showed comparable predictive performance for peritoneal metastasis in gastric cancer (AUC: 0.730 vs 0.749, P = 0.399)

Figure 3 Performance of computed tomography attenuations for visceral fat in predicting peritoneal metastasis in gastric cancer. A: High-volume group; B: Low-volume group.