Skip to main content

Advertisement

SpringerLink
Log in

Impact of CT enterography on the diagnosis of small bowel gastrointestinal stromal tumors

  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objective

Our purpose is to determine the impact of CT enterography on small bowel gastrointestinal stromal tumor (GIST) detection and biologic aggressiveness, and to identify any imaging findings that correlate with biologic aggressiveness.

Methods

Records of patients with histologically confirmed small bowel GISTs who underwent CT imaging were reviewed. Biologic aggressiveness was based on initial histologic grading (very low, low, intermediate, high grade; or malignant), with upgrade to malignant category if local or distant metastases developed during clinical follow-up. Imaging indications, findings, and type of CT exam were compared with the biologic aggressiveness.

Results

111 small bowel GISTs were identified, with suspected small bowel bleeding being the most common indication (45/111; 40.5%). While the number of malignant GISTs diagnosed by CT remained relatively constant (2–3 per year), the number of non-malignant GISTs increased substantially (mean 1.5/year, 1998–2005; 8.4/year, 2006–2013). In patients with suspected small bowel bleeding, CT enterography identified 33 GISTs (7/33, 21% malignant) compared to 12 GISTs by abdominopelvic CT (6/12, 50% malignant; p < 0.03). Tumor size (p < 0.0001), internal necrosis (p = 0.005), internal air or enteric contrast (p ≤ 0.021), and ulceration (p ≤ 0.021) were significantly associated with high-grade and malignant tumors, and irregular or invasive tumor borders (p < 0.01) was associated with malignant tumors.

Conclusion

The detection of small bowel GISTs can increase due to the use of CT enterography in patients with suspected small bowel bleeding. The large majority of small bowel GISTs detected by CT enterography are not malignant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Joensuu H, Fletcher C, Dimitrijevic S, et al. (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3(11):655–664

    Article  CAS  Google Scholar 

  2. Miettinen M, Lasota J (2001) Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch 438(1):1–12

    Article  CAS  Google Scholar 

  3. Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M (2003) Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics 23(2):283–304, 456; quiz 532

    Article  Google Scholar 

  4. Emory TS, Sobin LH, Lukes L, Lee DH, O’Leary TJ (1999) Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol 23(1):82–87

    Article  CAS  Google Scholar 

  5. Miettinen M, El-Rifai W, Leslie H, Lasota J (2002) Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review. Hum Pathol 33(5):478–483

    Article  Google Scholar 

  6. Perez EA, Livingstone AS, Franceschi D, et al. (2006) Current incidence and outcomes of gastrointestinal mesenchymal tumors including gastrointestinal stromal tumors. J Am Coll Surg 202(4):623–629

    Article  Google Scholar 

  7. Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M (2003) Gastrointestinal stromal tumors: radiological features with pathological correlation. Radiographics 23(2):283–304

    Article  Google Scholar 

  8. Gong JS, Kang WY, Liu T, Zhu J, Xu JM (2012) CT findings of a gastrointestinal stromal tumor arising from small bowel. Quant Imaging Med Surg 2(1):57–58

    PubMed  PubMed Central  Google Scholar 

  9. Huprich JE, Fletcher JG, Fidler JL, et al. (2011) Prospective blinded comparison of wireless capsule endoscopy and multiphase CT enterography in obscure gastrointestinal bleeding. Radiology 260(3):744–751

    Article  Google Scholar 

  10. Hakim FA, Alexander JA, Huprich JE, Grover M, Enders FT (2011) CT-enterography may identify small bowel tumors not detected by capsule endoscopy: eight years experience at Mayo Clinic Rochester. Dig Dis Sci 56(10):2914–2919

    Article  Google Scholar 

  11. Agrawal JR, Travis AC, Mortele KJ, et al. (2012) Diagnostic yield of dual-phase computed tomography enterography in patients with obscure gastrointestinal bleeding and a non-diagnostic capsule endoscopy. J Gastroenterol Hepatol 27(4):751–759

    Article  Google Scholar 

  12. Gerson LB, Fidler JL, Cave DR, Leighton JA (2015) ACG clinical guideline: diagnosis and management of small bowel bleeding. Am J Gastroenterol 110(9):1265–1287; quiz 1288

    Article  CAS  Google Scholar 

  13. Fletcher CD, Berman JJ, Corless C, et al. (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33(5):459–465

    Article  Google Scholar 

  14. Agaimy A (2010) Gastrointestinal stromal tumors (GIST) from risk stratification systems to the new TNM proposal: more questions than answers? A review emphasizing the need for a standardized GIST reporting. Int J Clin Exp Pathol 3(5):461–471

    PubMed  PubMed Central  Google Scholar 

  15. Sahani DV, Sainani NI, Blake MA, et al. (2011) Prospective evaluation of reader performance on MDCT in characterization of cystic pancreatic lesions and prediction of cyst biologic aggressiveness. AJR Am J Roentgenol 197(1):W53–W61

    Article  Google Scholar 

  16. Lau S, Tam KF, Kam CK, et al. (2004) Imaging of gastrointestinal stromal tumour (GIST). Clin Radiol 59(6):487–498

    Article  CAS  Google Scholar 

  17. Anzidei M, Napoli A, Zini C, et al. (2011) Malignant tumours of the small intestine: a review of histopathology, multidetector CT and MRI aspects. Br J Radiol 84(1004):677–690

    Article  CAS  Google Scholar 

  18. Graca BM, Freire PA, Brito JB, et al. (2010) Gastroenterologic and radiologic approach to obscure gastrointestinal bleeding: how, why, and when? Radiographics 30(1):235–252

    Article  Google Scholar 

  19. Huprich JE, Fletcher JG (2009) CT enterography: principles, technique and utility in Crohn’s disease. Eur J Radiol 69(3):393–397

    Article  Google Scholar 

  20. Caterino S, Lorenzon L, Petrucciani N, et al. (2011) Gastrointestinal stromal tumors: correlation between symptoms at presentation, tumor location and prognostic factors in 47 consecutive patients. World J Surg Oncol 9:13

    Article  Google Scholar 

  21. Fletcher JG, Huprich J, Loftus EV Jr, Bruining DH, Fidler JL (2008) Computerized tomography enterography and its role in small-bowel imaging. Clin Gastroenterol Hepatol 6(3):283–289

    Article  Google Scholar 

  22. Huprich JE, Fletcher JG, Alexander JA, et al. (2008) Obscure gastrointestinal bleeding: evaluation with 64-section multiphase CT enterography—initial experience. Radiology 246(2):562–571

    Article  Google Scholar 

  23. Rubin BP, Heinrich MC, Corless CL (2007) Gastrointestinal stromal tumour. The Lancet 369(9574):1731–1741

    Article  CAS  Google Scholar 

  24. Minardi AJ Jr, Zibari GB, Aultman DF, McMillan RW, McDonald JC (1998) Small-bowel tumors. J Am Coll Surg 186(6):664–668

    Article  Google Scholar 

  25. Masselli G, Di Tola M, Casciani E, et al. (2016) Diagnosis of small-bowel diseases: prospective comparison of multi-detector row CT enterography with MR enterography. Radiology 279(2):420–431

    Article  Google Scholar 

  26. Burkill GJ, Badran M, Al-Muderis O, et al. (2003) Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread. Radiology 226(2):527–532

    Article  Google Scholar 

  27. Kochhar R, Manoharan P, Leahy M, Taylor MB (2010) Imaging in gastrointestinal stromal tumours: current status and future directions. Clin Radiol 65(8):584–592

    Article  CAS  Google Scholar 

  28. Sandrasegaran K, Rajesh A, Rushing DA, et al. (2005) Gastrointestinal stromal tumors: CT and MRI findings. Eur Radiol 15(7):1407–1414

    Article  Google Scholar 

  29. O’Sullivan PJ, Harris AC, Ho SG, Munk PL (2006) The imaging features of gastrointestinal stromal tumours. Eur J Radiol 60(3):431–438

    Article  Google Scholar 

  30. Horton KM, Juluru K, Montogomery E, Fishman EK (2004) Computed tomography imaging of gastrointestinal stromal tumors with pathology correlation. J Comput Assist Tomogr 28(6):811–817

    Article  Google Scholar 

  31. Yang TH, Hwang JI, Yang MS, et al. (2007) Gastrointestinal stromal tumors: computed tomographic features and prediction of malignant risk from computed tomographic imaging. J Chin Med Assoc 70(9):367–373

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Rogerio N. Vasconcelos, John M. Barlow, Michael L. Wells, Shannon P. Sheedy, Jeff L. Fidler & Joel G. Fletcher

  2. Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland

    Steven G. Dolan

  3. Division of Gastroenterology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Stephanie Hansel

  4. Division of Biostatistics, Mayo Clinic, Rochester, MN, USA

    Scott Harmsen

Authors
  1. Rogerio N. Vasconcelos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven G. Dolan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John M. Barlow
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael L. Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shannon P. Sheedy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jeff L. Fidler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stephanie Hansel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Scott Harmsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Joel G. Fletcher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joel G. Fletcher.

Ethics declarations

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

All patients consented to the retrospective use of medical records for research purposes. This study was approved by our institutional research board.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vasconcelos, R.N., Dolan, S.G., Barlow, J.M. et al. Impact of CT enterography on the diagnosis of small bowel gastrointestinal stromal tumors. Abdom Radiol 42, 1365–1373 (2017). https://doi.org/10.1007/s00261-016-1033-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-016-1033-z

Keywords

Search

Navigation