Comprehensive Computed Tomography Evaluation of Gastric Cancer: 2026 Consensus Recommendation From the Korean Society of Abdominal Radiology

Gastric cancer continues to be a significant global health challenge, particularly in East Asia, necessitating precise imaging for optimal management. Although multidetector computed tomography (MDCT) has become the primary tool for staging and response evaluation, clinical practice is hampered by a lack of standardized protocols and interpretation criteria. To address these needs, the Korean Society of Abdominal Radiology established a consensus-based guideline for gastric cancer CT. Using a modified Delphi process with a panel of experts, 10 key statements were developed and validated with a high level of agreement (≥80%). These recommendations emphasize the necessity of adequate gastric distention and a dedicated arterial phase to identify critical vascular variations, such as aberrant left hepatic arteries, for surgical planning. The guideline provides refined criteria for T, N, and M staging, including the use of multiplanar reformations and three-dimensional visualization to improve diagnostic accuracy. Furthermore, it introduces dedicated criteria for re-staging after chemotherapy, highlighting the differentiation of viable tumor from treatment-induced fibrosis. Finally, a risk-stratified approach for postoperative surveillance is proposed, suggesting that surveillance may be de-escalated in very-low-risk groups, such as pT1aN0 disease. These recommendations are intended to standardize CT practice and improve clinical decision-making in the management of gastric cancer.