Modified fusion imaging combining CT gastrography and CT angiography: An initial experience of preoperative mapping prior to laparoscopic exogastric wedge resection of small (<3 cm) gastric submucosal lesions

Purpose: To evaluate the feasibility of modified fusion imaging (MFI) combining CT gastrography (CTG) and CT angiography (CTA) in the preoperative mapping and intraoperative localization of small (<3 cm) submucosal lesions (SMLs) during laparoscopic exogastric wedge resection. Methods: Thirty consecutive patients scheduled for laparoscopic wedge resection of small SMLs (<3 cm) were enrolled. MFI was reconstructed using a volume rendering of the arterial phase CT data acquired after gastric distension. With MFI, the possibility of preoperative mapping and feasibility for successful intraoperative localization was evaluated using intraoperative findings as the reference standard. Results: In 21 of 30 patients (70%), preoperative mapping was possible. Preoperative mapping was feasible for successful intraoperative localization in 13 of 14 patients (93%) who underwent exogastric resection. Conclusions: MFI combining CTG and CTA is a feasible method for developing preoperative and intraoperative "road maps" for performing laparoscopic exogastric wedge resection of small SMLs.