Is there utility for fluorine-18-fluorodeoxyglucose positron-emission tomography scan before surgery in breast cancer? A 15-year overall survival analysis

BACKGROUND The prognostic value of preoperative fluorine-18-fluorodeoxyglucose positronemission tomography(18 F-FDG PET)scan for determining overall survival(OS)in breast cancer(BC)patients is controversial.AIM To evaluate the OS predictive value of preoperative PET positivity after 15 years.METHODS We performed a retrospective search of the Universitair Ziekenhuis Brussel patient database for nonmetastatic patients who underwent preoperative PET between 2002-2008.PET positivity was determined by anatomical region of interest(AROI)findings for breast and axillary,sternal,and distant sites.The prognostic role of PET was examined as a qualitative binary factor(positive vs negative status)and as a continuous variable[maximum standard uptake value(SUVmax)]in multivariate survival analyses using Cox proportional hazards models.Among the 104 identified patients who received PET,36 were further analyzed for the SUVmax in the AROI.RESULTS Poor OS within the 15-year study period was predicted by PET-positive status for axillary(P=0.033),sternal(P=0.033),and combined PET-axillary/sternal(P=0.008)nodes.Poor disease-free survival was associated with PET-positive axillary status(P=0.040)and combined axillary/sternal status(P=0.023).Cox models confirmed the long-term prognostic value of combined PETaxillary/sternal status[hazard ratio(HR):3.08,95%confidence interval:1.42-6.69].SUVmax of ipsilateral breast and axilla as continuous covariates were significant predictors of long-term OS with HRs of 1.25(P=0.048)and 1.54(P=0.029),corresponding to relative increase in the risk of death of 25%and 54%per SUVmax unit,respectively.In addition,the ratio of the ipsilateral axillary SUVmax over the contralateral axillary SUVmax was the most significant OS predictor(P=0.027),with 1.94 HR,indicating a two-fold relative increase of mortality risk.CONCLUSION Preoperative PET is valuable for prediction of long-term survival.Ipsilateral axillary SUVmax ratio over the uninvolved side represents a new prognostic finding that warrants further investigation.

Positron-emission tomography for hepatocellular carcinoma:Current status and future prospects

Hepatocellular carcinoma(HCC)is one of the leading causes of cancer mortality worldwide.Various imaging modalities provide important information about HCC for its clinical management.Since positron-emission tomography(PET)or PET-computed tomography was introduced to the oncologic setting,it has played crucial roles in detecting,distinguishing,accurately staging,and evaluating local,residual,and recurrent HCC.PET imaging visualizes tissue metabolic information that is closely associated with treatment.Dynamic PET imaging and dual-tracer have emerged as complementary techniques that aid in various aspects of HCC diagnosis.The advent of new radiotracers and the development of immuno-PET and PET-magnetic resonance imaging have improved the ability to detect lesions and have made great progress in treatment surveillance.The current PET diagnostic capabilities for HCC and the supplementary techniques are reviewed herein.

Findings of ¹⁸F-Fluorodeoxyglucose Positron-Emission Tomography in Methotrexate-Related Lymphoproliferative Disorder

Introduction: The use of methotrexate (MTX) for rheumatoid arthritis (RA) is increasing. However, the immune suppression state leads to the occurrence of lymphoproliferative disorder (MTX-LPD). The purpose of this study was to describe the findings of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in MTX-LPD patients, and compare it with non-MTX-related malignant lymphoma (ML). Materials and Methods: We retrospectively reviewed 11 MTX-LPD patients (9 female, mean age 68.3 years) and 21 ML patients (7 female, mean age 60.6 years) with a histopathological diagnosis. FDG-PET imaging was performed using a standard oncology procedure. We assessed the disease distribution based on FDG-PET images and measured the maximum standardized up take values (SUVmax) for each region. Results: Mean values of SUVmax in MTX-LPD and ML were 14.6 and 17.2, respectively (p = 0.49). In MTX-LPD, 55 lesions met the Cotswold classification, consisting of 37 nodal and 18 extranodal lesions. In ML, 82 lesions were found, consisting of 68 nodal and 14 extranodal lesions. MTX-LPD showed a higher incident of the involvement in extranodal lesions throughout the whole body (p < 0.001). Conclusion: Because this disease occurs widely throughout the whole body, we need to pay attention to the less frequent sites as well when performing PET imaging in patients with MTX-LPD.

Positron-emission tomography/computed tomography imaging in head and neck oncology:An update

Cancers of the head and neck account for more than half a million cases worldwide annually, with a significant majority diagnosed as squamous cell carcinoma(HNSCC). Imaging studies such as contrast-enhanced computed tomography(CT), magnetic resonance imaging(MRI) and ^(18)F-2-fluoro-2-deoxy-D-glucose positron-emission tomography/computed tomography(^(18)F-FDG PET/CT) are widely used to determine the presence and extent of tumors and metastatic disease, both before and after treatment. Advances in PET/CT imaging have allowed it to emerge as a superior imaging modality compared to both CT and MRI, especially in detection of carcinoma of unknown primary, cervical lymph node metastasis, distant metastasis, residual/recurrent cancer and second primary tumors, often leading to alteration in management. PET/CT biomarker may further provide an overall assessment of tumor aggressiveness with prognostic implications. As new developments emerged leading to better understanding and use of PET/CT in head and neck oncology, the aim of this article is to review the roles of PET/CT in both pre- and post-treatment management of HNSCC and PET-derived parameters as prognostic indicators.

Experimental Observing Damage Evolution in Cement Pastes Exposed to External Sulfate Attack by in situ X-ray Computed Tomography

The paper presents experimental investigation results of crack pattern change in cement pastes caused by external sulfate attack(ESA).To visualize the formation and development of cracks in cement pastes under ESA,an X-ray computed tomography(X-ray CT)was used,i e,the tomography system of Zeiss Xradia 510 versa.The results indicate that X-CT can monitor the development process and distribution characteristics of the internal cracks of cement pastes under ESA with attack time.In addition,the C3A content in the cement significantly affects the damage mode of cement paste specimens during sulfate erosion.The damage of ordinary Portland cement(OPC)pastes subjected to sulfate attack with high C3A content are severe,while the damage of sulfate resistant Portland cement(SRPC)pastes is much smaller than that of OPC pastes.Furthermore,a quadratic function describes the correlation between the crack volume fraction and development depth for two cement pastes immermed in sulfate solution.

3D tomographic analysis of equatorial plasma bubble using GNSS-TEC data from Indonesian GNSS Network

Equatorial Plasma Bubbles(EPBs)are ionospheric irregularities that take place near the magnetic equator.EPBs most commonly occur after sunset during the equinox months,although they can also be observed during other seasons.The phenomenon significantly disrupts radio wave signals essential to communication and navigation systems.The national network of Global Navigation Satellite System(GNSS)receivers in Indonesia(>30°longitudinal range)provides an opportunity for detailed EPB studies.To explore this,we conducted preliminary 3D tomography of total electron content(TEC)data captured by GNSS receivers following a geomagnetic storm on December 3,2023,when at least four EPB clusters occurred in the Southeast Asian sector.TEC and extracted TEC depletion with a 120-minute running average were then used as inputs for a 3D tomography program.Their 2D spatial distribution consistently captured the four EPB clusters over time.These tomography results were validated through a classical checkerboard test and comparisons with other ionospheric data sources,such as the Global Ionospheric Map(GIM)and International Reference Ionosphere(IRI)profile.Validation of the results demonstrates the capability of the Indonesian GNSS network to measure peak ionospheric density.These findings highlight the potential for future three-dimensional research of plasma bubbles in low-latitude regions using existing GNSS networks,with extensive longitudinal coverage.

Computed tomography enterography-based radiomics for assessing mucosal healing in patients with small bowel Crohn's disease

BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significant challenge due to its limited accessibility through conventional endoscopic methods.AIM To establish a noninvasive radiomic model based on computed tomography enterography(CTE)for MH assessment in SBCD patients.METHODS Seventy-three patients diagnosed with SBCD were included and divided into a training cohort(n=55)and a test cohort(n=18).Radiomic features were obtained from CTE images to establish a radiomic model.Patient demographics were analysed to establish a clinical model.A radiomic-clinical nomogram was constructed by combining significant clinical and radiomic features.The diagnostic efficacy and clinical benefit were evaluated via receiver operating characteristic(ROC)curve analysis and decision curve analysis(DCA),respectively.RESULTS Of the 73 patients enrolled,25 patients achieved MH.The radiomic-clinical nomogram had an area under the ROC curve of 0.961(95%confidence interval:0.886-1.000)in the training cohort and 0.958(0.877-1.000)in the test cohort and provided superior clinical benefit to either the clinical or radiomic models alone,as demonstrated by DCA.CONCLUSION These results indicate that the CTE-based radiomic-clinical nomogram is a promising imaging biomarker for MH and serves as a potential noninvasive alternative to enteroscopy for MH assessment in SBCD patients.

Role of photon-counting computed tomography in pediatric cardiovascular imaging

Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible light,whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric signals.This direct conversion allows photon-counting detectors to sort photons into discrete energy levels,thereby enhancing image quality through superior noise reduction,improved spatial and contrast resolution,and reduced artifacts.In pediatric applications,PCCT offers substantial benefits,including lower radiation doses,which may help reduce the risk of malignancy in pediatric patients,with perhaps greater potential to benefit those with repeated exposure from a young age.Enhanced spatial resolution facilitates better visualization of small structures,vital for diagnosing congenital heart defects.Additionally,PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images,which enhance soft-tissue contrast and potentially reduce contrast media doses.Initial clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conven-tional CT,particularly in challenging pediatric cardiovascular cases.As PCCT technology matures,further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices,ensuring optimized diagnostic outcomes and patient safety.

Recent progress in the applications of presynaptic dopaminergic positron emission tomography imaging in parkinsonism

Nowadays,presynaptic dopaminergic positron emission tomography,which assesses deficiencies in dopamine synthesis,storage,and transport,is widely utilized for early diagnosis and differential diagnosis of parkinsonism.This review provides a comprehensive summary of the latest developments in the application of presynaptic dopaminergic positron emission tomography imaging in disorders that manifest parkinsonism.We conducted a thorough literature search using reputable databases such as PubMed and Web of Science.Selection criteria involved identifying peer-reviewed articles published within the last 5 years,with emphasis on their relevance to clinical applications.The findings from these studies highlight that presynaptic dopaminergic positron emission tomography has demonstrated potential not only in diagnosing and differentiating various Parkinsonian conditions but also in assessing disease severity and predicting prognosis.Moreover,when employed in conjunction with other imaging modalities and advanced analytical methods,presynaptic dopaminergic positron emission tomography has been validated as a reliable in vivo biomarker.This validation extends to screening and exploring potential neuropathological mechanisms associated with dopaminergic depletion.In summary,the insights gained from interpreting these studies are crucial for enhancing the effectiveness of preclinical investigations and clinical trials,ultimately advancing toward the goals of neuroregeneration in parkinsonian disorders.

Macular microvascular and structural changes on optical coherence tomography angiography in atypical optic neuritis

BACKGROUND Atypical optic neuritis,consisting of neuromyelitis optica spectrum disorders(NMOSD)or myelin oligodendrocyte glycoprotein antibody disease(MOGAD),has a very similar presentation but different prognostic implications and longterm management strategies.Vascular and metabolic factors are being thought to play a role in such autoimmune neuro-inflammatory disorders,apart from the obvious immune mediated damage.With the advent of optical coherence tomography angiography(OCTA),it is easy to pick up on these subclinical macular microvascular and structural changes.AIM To study the macular microvascular and structural changes on OCTA in atypical optic neuritis.METHODS This observational cross-sectional study involved 8 NMOSD and 17 MOGAD patients,diagnosed serologically,as well as 10 healthy controls.Macular vascular density(MVD)and ganglion cell+inner plexiform layer thickness(GCIPL)were studied using OCTA.RESULTS There was a significant reduction in MVD in NMOSD and MOGAD affected as well as unaffected eyes when compared with healthy controls.NMOSD and MOGAD affected eyes had significant GCIPL thinning compared with healthy controls.NMOSD unaffected eyes did not show significant GCIPL thinning compared to healthy controls in contrast to MOGAD unaffected eyes.On comparing NMOSD with MOGAD,there was no significant difference in terms of MVD or GCIPL in the affected or unaffected eyes.CONCLUSION Although significant microvascular and structural changes are present on OCTA between atypical optic neuritis and normal patients,they could not help in differentiating between NMOSD and MOGAD cases.

Retinal capillary density among healthy Egyptian and South Asian students:an optical coherence tomography angiography study

AIM:To compare the macular and optic nerve perfusion and vascular architecture using optical coherence tomography angiography(OCTA)in normal eyes of Egyptian(Caucasians)and South Asian(Asians)volunteers.METHODS:Cross-sectional analytical OCTA study performed on 90 eyes of South Asian(n=45)and Egyptians(n=45)were analyzed.All participants underwent bestcorrected visual acuity test,slit lamp,and fundus examination.OCTA images;macular 6×6 mm^(2) grid and optic nerve 4.5×4.5 mm^(2) grid were used to examine the parafoveal and peripapillary regions,respectively.RESULTS:The mean capillary vessel density(CVD)in macular sectors among South Asians and Egyptians participants were(50.31%±2.53%,51.2%±5.93%)and(49.71%±3.6%,51.94%±4.79%)in superficial(SCP)and deep capillary plexuses(DCP),respectively(P>0.05).Mean CVD in both groups was higher in DCP compared to SCP in all sectors but was not significant(P>0.05).Mean foveal CVD increases with an increase in central retinal thickness in both SCP and DCP(P<0.001),among both groups.Mean area of the foveal avascular zone(FAZ)was 0.28±0.09 and 0.27±0.08 mm2 in South Asian and Egyptians,respectively.FAZ area decreases with an increase in the thickness and foveal CVD(P<0.001).Mean CVD in the peripapillary area was 48.23%±5.78% in South Asian and 49.52%±2.38% in Egyptian volunteers.The mean retinal nerve fiber layer thickness was found to be higher in the nasal quadrant among South Asian females than the Egyptian females(P<0.05).CONCLUSION:No significant racial disparity is found in this study.The findings are helpful for assessing and improving the normative data on the differences in South Asian and Egyptian populations.

Comparison of the effect of ranibizumab in retinal vein occlusion and macular edema with different optical coherence tomographic patterns

AIM:To explore the morphological and functional parameters to evaluate the effectiveness of intravitreal injections of ranibizumab(IVR)in treating macular edema(ME)secondary to retinal vein occlusion(RVO).METHODS:This retrospective study involved 65 RVO patients(65 eyes)who received IVR and were followedup for more than 3mo.ME was categorized into cystoid macular edema(CME),diffuse retinal thickening(DRT),and serous retinal detachment(SRD)according to optical coherence tomography(OCT)images.The comparison of best corrected visual acuity(BCVA;logMAR)and central macular thickness(CMT)among different follow-up points and those among 3 groups were performed by Kruskal-Wallis test.The correlation between BCVA and baseline parameters during treatment was analyzed using Spearman correlation analysis.RESULTS:BCVA tended to improve in all groups,with marked improvement in CME and DRT groups.CMT showed the greatest reduction after 1wk,and remained stable over the following 3mo.DRT patients had the worst BCVA and the highest CMT at baseline,but the differences became smaller after IVR treatment.CMT in SRD group was significantly better than in CME and DRT groups 3mo after IVR.Most patients of CME and SRD groups transitioned to a normal pattern at 3mo follow-up.DRT patients were most likely to transform into the other morphological groups,while SRD patients showed minimal transitions.BCVA at baseline was identified as the most important prognostic indicator in all 3 groups.Additionally,DRT patients with a longer clinical course,higher CMT and central retinal vein occlusion(CRVO)tend to exhibit worse BCVA after treatment.In addition,CRVO patients are more likely to have worse BCVA at 2 and 3mo follow-up compared with branch retinal vein occlusion(BRVO)patients in CME group.SRD patients with higher baseline CMT were prone to experiencing worse BCVA after treatment.CONCLUSION:The effectiveness of IVR is strongly correlated with baseline BCVA in all 3 groups.Baseline parameters including clinical course,CMT,and RVO position are also useful in predicting the BCVA at different time points after treatment.

Tomographic reconstruction of the Earth’s magnetosheath from multiple spacecraft:a theoretical study

Following our earlier work on tomographic reconstruction of the magnetosheath soft X-ray emissions with superposed epoch analysis of many images recorded from a single spacecraft we now explore the instantaneous reconstruction of the magnetosheath and magnetopause using a few images recorded simultaneously from a few spacecraft.This work is motivated by the prospect of possibly having two or three soft X-ray imagers in space in the coming years,and that many phenomena which occur at the magnetopause boundary,such as reconnection events and pressure pulse responses,do not lend themselves as well to superposed epoch analysis.If the reconstruction is successful-which we demonstrate in this paper that it can be-this collection of imagers can be used to reconstruct the magnetosheath and magnetopause from a single image from each spacecraft,allowing for high time resolution reconstructions.In this paper we explore the reconstruction using,two,three,and four spacecraft.We show that the location of the subsolar point of the magnetopause can be determined with just two satellites,and that volume emissions of soft X-rays,and the shape of the boundary,can be reconstructed using three or more satellites.

Multilocular thymic cysts can be easily misdiagnosed as malignant tumor on computer tomography:A case report

BACKGROUND Multilocular thymic cyst(MTC)is a rare mediastinal lesion which is considered to occur in the process of acquired inflammation.It is usually characterized by well-defined cystic density and is filled with transparent liquid.CASE SUMMARY We report on a 39-year-old male with a cystic-solid mass in the anterior mediastinum.Computer tomography(CT)imaging showed that the mass was irregular with unclear boundaries.After injection of contrast agent,there was a slight enhancement of stripes and nodules.According to CT findings,it was diagnosed as thymic cancer.CONCLUSION After surgery,MTC accompanied by bleeding and infection was confirmed by pathological examination.The main lesson of this case was that malignant thymic tumor and MTC of the anterior mediastinum sometimes exhibit similar CT findings.Caution is necessary in clinical work to avoid misdiagnosis.

Deep learning-based inpainting of saturation artifacts in optical coherence tomography images

Limited by the dynamic range of the detector,saturation artifacts usually occur in optical coherence tomography(OCT)imaging for high scattering media.The available methods are difficult to remove saturation artifacts and restore texture completely in OCT images.We proposed a deep learning-based inpainting method of saturation artifacts in this paper.The generation mechanism of saturation artifacts was analyzed,and experimental and simulated datasets were built based on the mechanism.Enhanced super-resolution generative adversarial networks were trained by the clear–saturated phantom image pairs.The perfect reconstructed results of experimental zebrafish and thyroid OCT images proved its feasibility,strong generalization,and robustness.

IN VIVO VALIDATION OF DUAL-MODALITY SYSTEM FOR SIMULTANEOUS POSITRON EMISSION TOMOGRAPHY AND OPTICAL TOMOGRAPHIC IMAGING

We report on tests of combined positron emission tomography(PET)andfluorescence molecular tomography(FMT)imaging system for in vivo investigation on small animals.A nude mouse was inoculated with MD-MB-231 breast cancer cells which expressed redfluorescent protein(RFP).For FMT system,reflective illumination mode was adopted with full-angle data acquisition.[18F]-Fluorodeoxyglucose([18F]-FDG)was used as radioactive tracer for PET.Both data were acquired simultaneously and then reconstructed separately before fusion.Fluorescent tomography results showed exactly where the tumor was located while PET results offered more metabolic information.Results confirmed feasibility for tumor detection and showed superiority to single modality imaging.

Glaucoma surgery experiments using digital microscope-integrated optical coherence tomography and OCT-compatible instruments

There is a certain failure rate in traditional glaucoma surgery because of the lack of depth information in microscope images.In this work,we present a digital microscope-integrated optical coherence tomography(MIOCT)system and several custom-made OCT-compatible instruments for glaucoma surgery.Sixteen ophthalmologists were asked to perform trabeculectomy and canaloplasty on live porcine eyes using the system and instruments.After surgery,a subjective feedback survey about the user experience was taken.The experiment results showed that our system can help surgeons easily locate important tissue structures during surgery.The custom-made instruments also solved the shadowing problem in OCT imaging.Surgeons preferred to use the system in their future practice.

Preoperative prediction of lymphovascular and perineural invasion in gastric cancer using spectral computed tomography imaging and machine learning

BACKGROUND Lymphovascular invasion(LVI)and perineural invasion(PNI)are important prognostic factors for gastric cancer(GC)that indicate an increased risk of metastasis and poor outcomes.Accurate preoperative prediction of LVI/PNI status could help clinicians identify high-risk patients and guide treatment deci-sions.However,prior models using conventional computed tomography(CT)images to predict LVI or PNI separately have had limited accuracy.Spectral CT provides quantitative enhancement parameters that may better capture tumor invasion.We hypothesized that a predictive model combining clinical and spectral CT parameters would accurately preoperatively predict LVI/PNI status in GC patients.AIM To develop and test a machine learning model that fuses spectral CT parameters and clinical indicators to predict LVI/PNI status accurately.METHODS This study used a retrospective dataset involving 257 GC patients(training cohort,n=172;validation cohort,n=85).First,several clinical indicators,including serum tumor markers,CT-TN stages and CT-detected extramural vein invasion(CT-EMVI),were extracted,as were quantitative spectral CT parameters from the delineated tumor regions.Next,a two-step feature selection approach using correlation-based methods and information gain ranking inside a 10-fold cross-validation loop was utilized to select informative clinical and spectral CT parameters.A logistic regression(LR)-based nomogram model was subsequently constructed to predict LVI/PNI status,and its performance was evaluated using the area under the receiver operating characteristic curve(AUC).RESULTS In both the training and validation cohorts,CT T3-4 stage,CT-N positive status,and CT-EMVI positive status are more prevalent in the LVI/PNI-positive group and these differences are statistically significant(P<0.05).LR analysis of the training group showed preoperative CT-T stage,CT-EMVI,single-energy CT values of 70 keV of venous phase(VP-70 keV),and the ratio of standardized iodine concentration of equilibrium phase(EP-NIC)were independent influencing factors.The AUCs of VP-70 keV and EP-NIC were 0.888 and 0.824,respectively,which were slightly greater than those of CT-T and CT-EMVI(AUC=0.793,0.762).The nomogram combining CT-T stage,CT-EMVI,VP-70 keV and EP-NIC yielded AUCs of 0.918(0.866-0.954)and 0.874(0.784-0.936)in the training and validation cohorts,which are significantly higher than using each of single independent factors(P<0.05).CONCLUSION The study found that using portal venous and EP spectral CT parameters allows effective preoperative detection of LVI/PNI in GC,with accuracy boosted by integrating clinical markers.

Computed tomography for prediction of esophageal variceal bleeding

This letter to the editor relates to the study entitled“The role of computed tomography for the prediction of esophageal variceal bleeding:Current status and future perspectives”.Esophageal variceal bleeding(EVB)is one of the most common and severe complications related to portal hypertension(PH).Despite marked advances in its management during the last three decades,EVB is still associated with significant morbidity and mortality.The risk of first EVB is related to the severity of both PH and liver disease,and to the size and endoscopic appearance of esophageal varices.Indeed,hepatic venous pressure gradient(HVPG)and esophagogastroduodenoscopy(EGD)are currently recognized as the“gold standard”and the diagnostic reference standard for the prediction of EVB,respectively.However,HVPG is an invasive,expensive,and technically complex procedure,not widely available in clinical practice,whereas EGD is mainly limited by its invasive nature.In this scenario,computed tomography(CT)has been recently proposed as a promising modality for the non-invasive prediction of EVB.While CT serves solely as a diagnostic tool and cannot replace EGD or HVPG for delivering therapeutic and physiological information,it has the potential to enhance the prediction of EVB more effectively when combined with liver disease scores,HVPG,and EGD.However,to date,evidence concerning the role of CT in this setting is still lacking,therefore we aim to summarize and discuss the current evidence concerning the role of CT in predicting the risk of EVB.

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

BACKGROUND Gastric cancer(GC)is the most common malignant tumor and ranks third for cancer-related deaths among the worldwide.The disease poses a serious public health problem in China,ranking fifth for incidence and third for mortality.Knowledge of the invasive depth of the tumor is vital to treatment decisions.AIM To evaluate the diagnostic performance of double contrast-enhanced ultrasonography(DCEUS)for preoperative T staging in patients with GC by comparing with multi-detector computed tomography(MDCT).METHODS This single prospective study enrolled patients with GC confirmed by preoperative gastroscopy from July 2021 to March 2023.Patients underwent DCEUS,including ultrasonography(US)and intravenous contrast-enhanced ultrasonography(CEUS),and MDCT examinations for the assessment of preoperative T staging.Features of GC were identified on DCEUS and criteria developed to evaluate T staging according to the 8th edition of AJCC cancer staging manual.The diagnostic performance of DCEUS was evaluated by comparing it with that of MDCT and surgical-pathological findings were considered as the gold standard.RESULTS A total of 229 patients with GC(80 T1,33 T2,59 T3 and 57 T4)were included.Overall accuracies were 86.9%for DCEUS and 61.1%for MDCT(P<0.001).DCEUS was superior to MDCT for T1(92.5%vs 70.0%,P<0.001),T2(72.7%vs 51.5%,P=0.041),T3(86.4%vs 45.8%,P<0.001)and T4(87.7%vs 70.2%,P=0.022)staging of GC.CONCLUSION DCEUS improved the diagnostic accuracy of preoperative T staging in patients with GC compared with MDCT,and constitutes a promising imaging modality for preoperative evaluation of GC to aid individualized treatment decision-making.