Imaging Pearls ❯ Stomach ❯ Gastric Folds
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- “In an adequately distended stomach, the normal nondependent gastric body is less than or equal to 5 mm in thickness. The antral wall, in contrast, may normally measure less than or equal to 12 mm in thickness.”
CT of Gastric Emergencies Guniganti PG et al. RadioGraphics 2015; 35:1909–1921
- Large Gastric Folds: Differential Dx
- Chronic gastritis/lymphoid hyperplasia
- Benign tumors
- Gastric malignancy
- Zollinger-Ellison syndrome
- Ménétrier's disease - Zollinger-Ellison Syndrome: Facts
- Duodenal ulceration, diarrhea and gastric gland hyperplasia caused by serum hypergastrinemia from pancreatic or duodenal neoplasm, or rarely by primary G cell hyperplasia of antral mucosa
- Associated with MEN1 syndrome and multicentric carcinoid tumors
- The differential diagnosis for refractory peptic ulcer disease includes Helicobacter pylori infection, retained gastric antrum, antral G cell hyperplasia, gastric malignancy, surreptitious use of non-steroidal anti-inflammatory drugs (NSAIDs) and gastrinoma. - Zollinger-Ellison Syndrome: Facts
- Gastrinoma is a rare, non- ß islet cell tumor that secretes gastrin. It is thought to be the cause of 0.1%-1% of peptic ulcer disease. Gastrinoma leads to the characteristic Zollinger-Ellison Syndrome (ZES) that was first described in 1955 as peptic ulcer disease, gastric acid hypersecretion and the presence of a pancreatic tumor. The typical symptoms at presentation for Zollinger-Ellison syndrome include abdominal pain, reflux and diarrhea. The abdominal pain in ZES is typically epigastric, and results from peptic ulcer disease. Of patients with ZES with ulcers, 75% of patients have solitary ulcers, but distal involvement of the duodenum and jejunum occurs in the other 25%. Interestingly, however, 20% have no evidence of peptic ulcer disease at presentation. - “The second type of carcinoid tumor includes those that arise in the setting of Zollinger-Ellison syndrome, especially patients with multiple endocrine neoplasia type 1.The gastric wall is typically thickened. Again, there are typically multiple masses present but of variable size. One primary difference compared with the first category is that these may ulcerate and can metastasize.”
Hypervascular Gastric Masses: CT Findings and Clinical Correlates
Johnson PT, Horton KM, Fishman EK
AJR 2010;195:W415-W420 - “Gastrinoma is the second most common syndromic ICT. Because of the excess production of gastrin, many patients will have Zollinger-Ellison syndrome, and gastrinoma is the most common ICT in patients with MEN 1. Most patients present with epigastric pain related to recurrent or intractable peptic ulcer disease, or with ulcers in unusual (eg, postbulbar) locations. Patients may also have diarrhea due to excessive delivery of acid to the small bowel. Diagnosis is made by documenting elevated serum gastrin levels. Gastrinomas are frequently malignant, with approximately 30% of patients presenting with liver metastases.”
Multidetector Row CT of Pancreatic Islet Cell Tumors
Horton KM, Hruban RH, Yeo C, Fishman EK
RadioGraphics March 2006: 26;453-464