Ruedi F. Thoeni, M.D.

Henry I. Goldberg, M.D.

Steven Ominsky, M.D.
John P. Cello, M.D.
Detection of Gastritis by Single- and
Double-Contrast Radiography1

Sixty-eight patients with various types of

gastritis, 23 patients with normal stom-
achs, and four patients with other gastric
diseases were examined in a prospective
study to assess the sensitivity and speci-
ficity of single-contrast (SC) and double- G ASTRITIS frequently is diagnosed as a cause of symptoms related
contrast (DC) upper gastrointestinal ex- to disorders of the upper gastrointestinal tract, and it is estimated
aminations in the evaluation of gastritis. that 80% of all persons over 50 years of age suffer from one of the
All patients underwent endoscopy with various types of gastritis (1). The main etiologic factors for gastritis
biopsy followed first by DC and then by are the ingestion of alcohol or anti-inflammatory drugs and an excess
SC radiography. The respective sensitivi- of bile (1-4), but many other factors can contribute to the development
ties of SC and DC radiography were 58% of gastritis.
and 72% for all examinations and 59% and It is generally accepted that gastritis is detected best by endoscopy;
77% for adequate examinations only. The however, in some instances the endoscopist sees inflammatory
respective specificities were 59% and 55% changes in the stomach of a patient who has no symptoms. Often
based on all examinations. Both methods findings of gross examination of a biopsy specimen are normal (5, 6);
were slightly more sensitive in the detec- it is therefore often necessary to use histologic examination to reach
tion of moderate-to-severe disease, with an accurate definitive diagnosis of gastritis.
sensitivities of 60% for SC and 74% for Erosive and other types of gastritis have been reported in several
DC examinations as compared with sensi- recent publications (7-13) to be diagnosed accurately using double-
tivities of 53% for SC and 70% for DC in contrast (DC) examinations of the upper gastrointestinal tract.
the detection of mild gastritis. Useful ra- However, one of these p4pers (1 1) reported a sensitivity of only 43%
diographic features included polypoid for the DC examination and of 24% for the single-contrast (SC) ex-
defects and erosions detected by both amination in the diagnosis of erosive gastritis. Our prospective blind
methods, abnormal folds and flattened study compares the sensitivity and specificity of SC and DC exami-
margins detected by the SC technique, nations in the diagnosis of different types of gastritis and assesses the
and narrowed lumen and crenulated mar- role of radiology in the examination of patients who have suspected
gins detected by the DC technique. In gastritis. In addition, the different radiographic features of both
93% of all cases, the correct diagnosis was methods for the diagnosis of gastritis are analyzed.
based on two or more of these radio-
graphic features. According to this study,
MATERIAL AND METHODS
the radiographic sensitivity in the detec-
tion of gastritis is reliable only in cases of This prospective study included 68 consecutive patients who
moderate-to-severe disease and only clinically were suspected of having gastritis, who had been examined
when based on findings of the DC exami- by endoscopy before undergoing radiography and who were found
nation. Neither SC nor DC radiography to have gastritis, or who were diagnosed radiographically as having
should be used as the primary screening gastritis. Twenty-three patients with normal stomachs and four pa-
method for patients with suspected gas- tients with gastric disease other than gastritis also were included. All
tritis, and the radiographic diagnosis patients underwent a biphasic radiographic examination of the upper
should be restricted to the terms “ero- gastrointestinal tract and endoscopy, and multiple biopsy specimens
sive” or “nonerosive gastritis.” were obtained. The mean time interval between the endoscopic and
radiographic examinations was three days (range: same day to five
Index terms: Gastritis Gastrointestinal
#{149} tract, days). The mean age of these 95 patients was 59 years, and the ages
endoscopy Gastrointestinal
#{149} tract, radiography. ranged from 19 to 84. Men were more frequently afflicted in our
(Stomach, gastritis, 7[2].291) group (M:F 1.2:1). Thirty-six of the 68 patients with gastritis pre-
sented with epigastric pain, 25 presented with hematemesis or mel-
Radiology 148: 621-626, September 1983
ena, and nine presented with vomiting. Ten patients had no symp-
toms related to the stomach, but they were examined for evaluation
of the esophagus or duodenum.
1 From the Departments of Radiology (R.F.T., H.LG., The final diagnosis of gastritis was accepted only if proved by
SO.) and Gastroenterology (J.P.C.), University of Cali-
fornia, San Francisco School of Medicine, and the De-
findings of endosopy and biopsy. Based on the classification of
partment of Radiology, Letterman Army Medical Cen- Weinstein (6) we distinguished between patients with specific gas-
ter, San Francisco, California. Received Dec. 7, 1982; tritis and those with nonspecific gastritis, and each case of gastritis
accepted and revision requested Jan. 25, 1983; revision also was designated as erosive or nonerosive. Only eight patients with
received March 29. Presented at the Sixty-eighth Sci-
entific Assembly and Annual Meeting of the Radio-
hypertrophic gastritis were classified as having a specific form of
logical Society of North America, Chicago, Illinois, gastritis. Erosive gastritis was found in 30 of the 59 patients with
Nov. 28-Dec. 3, 1982. cp nonspecific gastritis, hemorrhagic gastritis was found in 20 patients,

621
and nonerosive gastritis was found in diagnosed if congestion and submu- oid pattern with the nodular segments
seven patients. Three of these seven cosal hemorrhage were seen during measuring more than 4 mm in diame-
patients had superficial gastritis, and endoscopy. Moderate gastritis was ter. A prominent areae gastricae pat-
four had atrophic gastritis. diagnosed if friability was marked tern that consisted of smooth and
Diagnosis of erosive/hemorrhagic and/or some erosions were present. nonenlarged segments was not con-
gastritis is primarily based on the en- Severe gastritis was diagnosed if dif- sidered abnormal.
doscopic appearance of the stomach. fuse mucosal bleeding was present The final radiographic diagnosis was
Biopsies are performed in these cases and/or multiple erosions were seen. Of compared with the endoscopic and
only to exclude a specific form of gas- 68 patients, 50 had mild gastritis, 16 histologic diagnoses; and the sensitiv-
tritis such as sarcoidosis. In our patients had moderate gastritis, and two had ity, specificity, and accuracy of the ra-
erosive gastritis was diagnosed if severe gastritis. diographic method were assessed. The
multiple erosions, which are superfi- Gastric changes were considered a radiographs were analyzed for ade-
cial shallow defects that do not pene- major clinical problem in 36% of these quacy of examination and for the fol-
trate the gastric muscularis mucosae, patients, an associated clinical but im- lowing radiographic features: width of
were seen during endoscopy (6, 14). portant problem in another 42%, and lumen; appearance of gastric folds and
These erosions frequently were asso- an incidental finding without any margins; and presence or absence of
ciated with inflammatory changes, and clinical significance in 22% of the pa- polypoid filling defects, erosions, and
histological examination of biopsy tients with gastritis. Treatment was abnormal areae gastricae. The useful-
specimens showed infiltrates of mu!- changed for 62% of these patients be- ness of the different radiographic signs
tiple polymorphonuclear leukocytes. cause of the radiographic diagnosis of for diagnosing gastritis also was de-
Hemorrhagic gastritis, which is the gastritis. termined. Because the slight differ-
hemorrhagic variant of erosive gastri- The radiographic examination of the ences in interpretation of the various
tis, was diagnosed endoscopically if stomach was performed as a biphasic examinations between the two inde-
either multiple punctate areas of study. A DC examination was per- pendent radiologists did not vary sig-
hemorrhage or diffusely bleeding formed followed by an SC examination nificantly, they are not reported
friable mucosa were present (5). with compression. Glucagon was not here.
Diagnosis of nonerosive nonspecific used routinely during this investiga-
gastritis is primarily based on histo- tion: only ten patients received 0.1 mg
RESULTS
logical evidence. Superficial gastritis glucagon before the examination. After
was diagnosed in our study if inflam- the examination was completed, the Among the 68 patients with gastritis,
matory cells that were predominantly radiographs obtained at both exami- we obtained a mean sensitivity of 58%
confined to the lamina propria near the nations (views of the stomach in su- with the SC examination and of 72%
gastric pit region were present. The pine, LPO and RPO positions, two with the DC examination when all ra-
gland zone was intact in these cases. views of antrum in the LPO position, diographs were analyzed, and these
Atrophic gastritis was diagnosed his- and two upright views of the fundus) percentages rose to 59% for SC radiog-
tologically if infiltrates of inflamma- were separated from one another, raphy and 77% for the DC radiography
tory cells into the gland zone and loss coded, and interpreted separately and if only adequate examinations were
of glands of variable degrees were seen blindly by two independent radiolo- included in the analysis. There was a
(6). Endoscopically atrophic gastritis gists. Included in this group of radio- statistically significant difference be-
was characterized by a pale mucosa graphs were those of normal stomachs tween the sensitivity of the two meth-
with a shiny surface and the prominant and of the stomachs with abnormalities ods (P = .015), but not between ade-
submucosal pattern of vessels (15, other than gastritis. quate or all examinations within each
16). Radiographically the diagnosis of method (P > 0.05)(Student’s T-test, Chi
Hypertrophic gastritis was charac- gastritis was made if erosions were square). The respective sensitivities of
terized endoscopically by nodular seen in the stomach and/or if at least SC and DC examinations for mild gas-
thickened mucosal folds associated two of the following radiographic tritis were 53% and 70%, and they rose
with congestion and swelling, and it features were present: narrowed to 60% and 74% respectively, for mod-
was frequently accompanied by ero- lumen; abnormal gastric folds; serrated, erate to severe disease.
sions and hemorrhage. At histological flattened, or crenulated margins; Among the 23 patients with normal
examination, inflammatory cells and polypoid filling defects; and abnormal stomachs, we found a mean specificity
an increased mucosal thickness of the (coarse) areae gastricae. The radio- of 59% for SC radiography and 55% for
surface cells were observed (17, 18). graphic diagnosis therefore was based DC radiography if all examinations
The terms “acute” and “chronic” are on a subjective impression using these were included and of 61% for SC ex-
not used to describe gastritis in our radiographic signs as indicators. In a aminations and 54% for DC examina-
group of patients because these terms well distended stomach, rugal folds tions if only adequate examinations
indicate only the histologic presence of that were scalloped or nodular were were included. There was no statisti-
acute signs of inflammation (poly- diagnosed as abnormal in any part of cally significant difference in the
morphonuclear leukocytes) or signs of the stomach. Persistence of rugal folds specificity between the two methods (P
chronic inflammation (plasma cells and in the antrum despite adequate dis- > 0.05). The overall accuracy for the SC
lymphocytes), not the duration of the tention of the stomach was considered examinations amounted to 57% for all
disease, and they often cause confu- abnormal regardless of their appear- and 59% for adequate examinations
sion. ance. Serrated margins were charac- only. Almost all false-positive results
Radiographically only three terized by very small irregularities of were diagnosed based on only one or
subgroups of gastritis were distin- the gastric walls (Fig. 1), and crenulated two radiographic features of gastritis.
guished: nonerosive, erosive, and hy- margins were characterized by larger The overall accuracy for DC radiogra-
pertrophic gastritis. undulating margins. The areae gastri- phy was 67% for all and 70% for ade-
Arbitarily three grades of histologi- cae were determined to be abnormal if quate examinations only. There was a
cally confirmed gastritis were defined they were “coarse.” A coarse areae statistically significant difference be-
endoscopically: mild, moderate, and gastricae pattern was defined as an ir- tween the overall accuracy of the two
severe gastritis. Mild gastritis was regular, mesh-like, nodular or polyp- methods (P = 0.044), but not between

622 Radiology
#{149} September 1983
 2.
1. Serrated and flattened gastric margins (straight arrows) with persistent narrowing of the antrum are seen on this SC image of a patient with
moderate hemorrhagic gastritis. Thickened folds (curved arrows) are also present in the proximal antrum.
2. Nodular filling defects (arrows) and irregular narrowing of the antrum are noted on this SC image of a patient with moderate-to-severe
erosive gastritis. Erosions were not identified on the radiographs.

4.
3. A compression radiograph of the antrum obtained during the SC examination demonstrates thickened nodular folds (straight
arrows) and nodular filling defects, some of which show erosions (curved arrows), in a patient with moderate-to-severe erosive
gastritis. The collection of barium (open arrow) is artifact.
4. Nodular folds (curved arrows) and persistence of crenulated margins (straight arrows) in the area of the lesser curvature
on this DC image indicate the presence of inflammatory changes in the antrum of a patient with hemorrhagic gastritis.

Volume 148 Number 3 Radiology . 623

 5. Multiple nodular filling defects (straight arrows), some of which show central erosions (curved arrows), are identified on
a DC image of a patient with moderate erosive gastritis.
6. A linear ulcer (straight arrow), multiple nodular filling defects (curved arrows), thickened folds (open arrows), and a few
scattered erosions (arrowheads) are identified on this DC image of a patient with hemorrhagic gastritis.

accuracy for adequate and all exami- and coarse areae gastricae pattern were 5 and 6), and erosions (Fig. 7) were
nations. the least useful radiographic features. useful features, and they led only
For all three types of gastritis (ero- Demonstration by both the SC and DC rarely to false-positive results (TABLE
sive / hemorrhagic nonspeci fic, non- techniques of thin folds was specific for 1).
erosive nonspecific, and specific hy- atrophic gastritis, and demonstration
DISCUSSION
pertrophic gastritis) the sensitivity of of persistent scalloped or nodular folds
the DC technique for detecting gastritis in the fundus and body was specific for Most of our 68 patients with gastritis
was higher than that of the SC method. hypertrophic gastritis. Lack of dem- had a mild form of the disease. Only a
The difference in the respective sensi- onstration by the DC technique of few patients with severe gastritis were
tivities of the two methods was largest polypoid filling defects in the antrum included in our study because patients
for detecting atrophic gastritis (43% for was specific for nonerosive nonspecific with severe gastritis often present with
SC examinations and 83% for DC ex- gastritis. The remaining radiographic acute bleeding (14), and they undergo
aminations), and smallest for detecting features demonstrated by both tech- endoscopy initially after stabilization.
hypertrophic gastritis (88% for SC ex- niques were not specific for any par- Most of these patients therefore are not
aminations and 94% for DC examina- ticular type of gastritis. candidates for a radiographic exami-
tions). The sensitivity for detecting When the radiographic features of nation when their gastritis is in the
erosive/hemorrhagic gastritis was 55% abnormal folds, serrated or crenulated acute state. Because treatment is insti-
for SC examinations and 68% for DC or flattened gastric margins, narrowing tuted immediately, these patients often
examinations. Among the cases of hy- of the lumen, abnormal areae gastricae, undergo SC or DC examinations only
pertrophic gastritis, abnormal folds in polypoid defects, and erosions were after several days of treatment for gas-
the body and fundus and to a lesser analyzed in the correctly diagnosed tritis, and the acute inflammatory
degree also in the antrum were seen cases of gastritis, it was found that only changes are then less severe. Our
equally well by both methods. Among 7% of the diagnoses were based on one group therefore is representative of the
the four patients with atrophic gastri- single feature, 36% were based on two incidence of the different grades of
tis, lack of distensibility of the stomach features, 36% were based on three fea- gastritis routinely evaluated by radi-
(“tubular stomach”) was observed in tures, 18% were based on four features, ography.
only one patient by each method, but and 3% were based on five or more Our results show a statistically sig-
abnormally thin folds were seen in two features. For the SC method, abnormal nificant difference between the sensi-
patients by the SC method and in three folds, flattened margins (Fig. 1), poly- tivities of SC and DC examinations for
patients by the DC method. poid defects (Fig. 2) and erosions (Fig. detecting gastritis. The overall sensi-
For the SC technique, narrowing of 3) were useful radiographic features, tivities for SC (58%) and DC (72%) ra-
the lumen and abnormal margins were and they led only rarely to false-posi- diography and the sensitivities for
the least useful radiographic signs. For tive results. For the DC technique, detecting erosive gastritis alone (55%
the DC technique, abnormal folds in narrowing of the lumen, crenulated for SC and 68% for DC examinations)
the body and/or fundus of the stomach margins (Fig. 4), polypoid defects (Figs. are much higher than those reported

624 Radiology
#{149} September 1983
7. Multiple complete or varioliform erosions (arrows) are seen on the DC image of a patient with erosive gastritis.
8. A coarse and irregular pattern of the areae gastricae is identified on a DC image of a patient with nonerosive superficial gastritis. Erosive
duodenitis (arrows) also can be identified.

by Ott et al. (1 1) who found a sensitivity TABLE I: Incidence of Radiographic Features of Gastritis Seen by SC and DC
of 24% for SC and 43% for DC radiog- Examinations
raphy in detecting erosive gastritis. A
Incidence (‘U
direct comparison of the report by Ott Gastritis Normal Stomach
et al. (11) and our study is difficult be- Features SC DC SC DC
cause not all the signs that we used
Abnormal folds 24 37 11 28
were analyzed in their investigation. In
Margins serrated 22 14 22 13
our investigation, we had a high Margins flattened 8 3 0 0
number of false-positive findings for Crenulated margins 22 15 24 4
Narrowing of lumen 39 29 30 Il
both techniques, and there was no
Areae gastricae abnormal 1 12 0 13
statistical difference between those Polypoid defects 7 10 2 2
values for each technique. In our search Erosions 4 30 0 4
of the literature we did not find any
investigation that has analyzed the rate
of false-positive findings in radio-
graphic examinations of gastritis. One tract if 0.1 mg of glucagon was injected to a diagnosis of gastritis based on one
paper (19), while not specifying the intravenously (20). or two features, and this false-positive
radiographic technique used, did con- The sensitivity of each method result usually was related to increased
sider the radiographic examination sometimes was impaired by technical secretion and poor coating with barium.
useless for diagnosing gastritis, except problems, including the presence of a Occasionally, barium in the small
when findings of the radiographic ex- large amount of secretion, blood clots, bowel obscured the antrum, which
amination were negative, which was muscle spasm, or an inadequate film- most frequently is the site of gastritis
deemed to be clinically important. Our exposure technique. During a review (1, 5), and mimicked erosions.
results contradict this belief in that a of the false-negative results, we found We found no radiographic sign that
false-negative finding of gastritis was that many subtle changes such as was specifically diagnostic of any par-
rare with the DC technique, particu- coarse areae gastricae or small erosions, ticular type of gastritis, with the ex-
larly if a moderate or severe form of particularly the incomplete type, could ception of thickened, nodular and
gastritis was present. However, if the be identified retrospectively. We also scalloped folds for diagnosing hyper-
diagnosis was based on one or two ra- found that the use of magnification trophic gastritis, and thin folds for
diographic features, the false-positive lenses to examine the radiographs im- diagnosing atrophic gastritis. How-
findings were too high in either tech- proved sensitivity markedly. However, ever, the number of patients in the
nique to make the technique reliable. many of the changes (such as submu- subgroups for specific and nonerosive
Our results might have been im- cosal hemorrhage) were too superficial nonspecific gastritis in our investiga-
proved for both methods if glucagon to be detected radiographically, even tion is not large enough to make a final
had been used routinely. In an un- with faultless technique. This fact conclusion. For the SC method we
published study we found marked contributed to the higher rates of found that abnormal folds and flat-
improvement of the sensitivity of DC false-negative findings associated with tened gastric margins (Fig. 1) in the
radiography for detecting superficial the mild forms of gastritis. area of the lesser curvature were gen-
lesions in the upper gastrointestinal False-positive results invariably led erally good diagnostic criteria for gas-

Volume 148 Number 3 Radiology #{149} 625

tritis. When complete distention of the For each method a combination of 7. Laufer I, Hamilton J, Mullens JE. Demon-
stration of superficial gastric erosions by
stomach could not be achieved, how- several of the analyzed radiographic
double contrast radiography. Gastroenter-
ever, false-positive results occurred features resulted in the most accurate ology 1975; 68:387-391.
based on these two features. If polyp- diagnoses. Most frequently, two, three, 8. Op den Orth JO, Dekker W. Gastric ero-
oid defects (Fig. 2) and erosions were or four features were used to diagnose sions: radiological and endoscopic aspects.
identified, the diagnosis of gastritis gastritis correctly (93%). Even though Radiologia Clin 1976; 45:88-99.
9. Popova ZP, Kameneva VI, Alipeenko LA.
could be made correctly in almost all we did not analyze in a blind fashion
Das roentgenendoskopische Bild in “kom-
instances (TABLE I). Erosions (Fig. 3) the diagnostic results obtained with a pletten” und “inkompletten” Erosionen des
only became visible on compression combination of the SC and DC phases, Magens. Radiol Diagnos, Inter Zeitsch fuer
spot-radiographs of the SC technique. we believe, based on the original in- das Gebiet der Roentgendiag 1980; 21:
641-644.
However, these two features were seen terpretations of the attending radiolo-
10. Poplack W, Paul RE, Goldsmith M, Matsue
only in moderate and severe types of gists, that final diagnoses from biphasic H, Moore JP, Norton R. Demonstration of
gastritis. Like many other authors (9, studies did not yield significantly more erosive gastritis by the double-contrast
1 1), we found that the erosions detect- sensitive results than those achieved technique. Radiology 1975; 117:519-521.
11. Ott DJ, Gelfand DW, Wu WC, Kerr RM.
ed usually were of the complete or with the DC examination alone for
Sensitivity of single- vs. double-contrast
varioliform type. diagnosing gastritis. radiology in erosive gastritis. AJR 1982;
With the DC technique we found 138:263-266.
that crenulated margins (Fig. 4) and 12. Catalano D, Pagliari U. Gastroduodenal
CONCLUSION erosions: radiological findings. Gastrointest
narrowing of the lumen were useful
Radiol 1982; 7:235-240.
features and that false-positive results Our data suggests that DC radiogra- 13. Lotz WV, Liebenow S. Areae gastricae and
were obtained using these features phy is superior to SC radiography in varioliforme Erosionen-Qualit#{228}etskriter-
only if complete distention could not detecting gastritis, but both methods ien der roentgenologischen Magenunter-
be achieved, or if the small bowel ob- show slightly improved results when suchung. (English abstract) ROEFO 1980;
132:491-495.
scured the area of interest (TABLE I). a moderate-to-severe form of gastritis
14. Lee ER, Dagradi AE. Hemorrhagic erosive
The most useful radiographic signs of is present. Both methods, however, gastritis: a clinical study. Am J Gastroenterol
the DC examination were erosions and have too high a number of false-posi- 1975; 63:201-208.
polypoid defects (Figs. 5-7), which tive findings to use the radiographic 15. Meshkinpour H, Orlando RA, Arguello JF,
DeMicco MP. Significance of endoscopi-
represent mucosal elevations with or examination as the initial screening
cally visible blood vessels as an index of
without central depressions and/or test. The endoscopic examination atrophic gastritis. Am J Gastroenterol 1979;
erosions (21). These usually occurred in therefore should remain the primary 71:376-379.
clusters in the antrum, but occasionally method of examining patients with 16. Kirkpatrick JR, Davies GT, Evans KT. The
diagnosis ofatrophic gastritis. Ann Clin Res
they were seen in the body or fundus suspected gastritis. DC radiography
1973; 5:39-45.
of the stomach. In none of our cases did may be of use in patients who are not 17. Albo RJ, Peters HE, Williams RR. Giant
the histologic examination show the candidates for endoscopy or who have hypertrophic gastritis. Am J Surg 1973;
rare entity of lymphoid hyperplasia of undergone an unsuccessful or incom- 126:229-234.
plete endoscopic examination. In pa- 18. Fieber 55, Rickert RR. Hyperplastic gas-
the stomach that may be confused with
tropathy: analysis of 50 selected cases from
the polypoid filling defects related to tients with proved gastritis, the DC 1955-1980. Am J Gastroenterol 1981; 76:
gastritis (22). False-positive results examination may be used at follow-up 321-329.
based on these two features occurred to establish the success of treatment. 19. Desmond AM, Reynolds KW. Erosive gas-
only if coating was impaired or if dis- Because most of the radiographic signs tritis: its diagnosis, management, and sur-
gical treatment. Br J Surg 1972; 59:5-13.
tention was incomplete. The appear- other than erosions do not assist in 20. Thoeni RF. Unpublished data.
ance of the gastric folds often was not diagnosing a particular type of gastritis, 21. Green PHR, Fevre DI, Barrett PJ, Hunt JH,
a reliable feature in our study, and we recommend that only the terms Gillepsie PE, Nagy GS. Chronic erosive
many false-positive results related to “erosive” or “nonerosive gastritis” be (verrucous) gastritis: a study of 108 patients.
Endoscopy 1977; 9:74-78.
this appearance occurred solely be- used for the radiographic diagnosis of
22. Tim LO, Bank 5, Marks IN, Novis BH, Botha
cause of technically unsatisfactory nonspecific gastritis. JC, Odes HS, Helman CA, Barbezat GO.
distention of the stomach. False-posi- Benign lymphoid hyperplasia of the gastric
tive findings based on narrowing of Acknowledgment: We thank Sheldon R. antrum-another cause of etat mamme-
lonne. Br J Radiol 1977; 50:29-31.
the lumen and abnormal gastric mar- Kiser, Ph.D. for the statistical analysis of our
23. Keto P, Suoranta H, Tarpila S. Areae gas-
gins also were frequently related to data.
tricae and gastritis in double contrast barium
incomplete distention of the stomach. meal. ROEFO 1979; 130:576-578.
It is generally accepted that a coarse 24. Rienm#{252}ller R. Die Bedeutung der Areae
gastricae bei der hypotonen Doppelkon-
pattern of the areae gastricae (Fig. 8) is
strastuntersuchung des Magens. Roent-
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626 Radiology
#{149} September 1983