Advertisement

Abdominal Radiology

, Volume 42, Issue 2, pp 442–450 | Cite as

Diagnostic performance of stomach CT compared with endoscopic ultrasonography in diagnosing gastric subepithelial tumors

  • Joon Chul Ra
  • Eun Sun LeeEmail author
  • Jong Beum Lee
  • Jae Gyu Kim
  • Beom Jin Kim
  • Hyun Jeong Park
  • Sung Bin Park
  • Byung Ihn Choi
Article

Abstract

Purpose

To evaluate the diagnostic ability of multi-detector computed tomography (MDCT) compared to endoscopic ultrasonography (EUS) as a standard reference, and investigate the factors influencing the detection of small gastric subepithelial tumors (SETs) (<5 cm) on MDCT with stomach protocol.

Methods

We retrospectively investigated 70 patients who were suspected with gastric SETs on esophagogastroduodenoscopy (EGD), and underwent both EUS and computed tomographic (CT) scanning. EUS was performed by two gastroenterologists, and location, size, echotexture, echogenicity, and layer of origin were described when gastric SETs were detected on EUS. MDCTs were reviewed based on consensus of two radiologists blinded to the EUS result. Size, location, enhancement pattern, and contour of the lesion detected on CT were described. We calculated the diagnostic ability of CT compared to EUS with respect to detection of gastric SETs, and investigated the factors influencing detection of SETs on CT. We also used receiver operating characteristic (ROC) curve to obtain optimal cut-off size for predicting CT visibility of small SETs.

Results

Of the 70 patients, who underwent both CT and EUS due to suspicious presence of SET on EGD, EUS detected 56 probable cases of SET and 14 cases of external compression. CT led to detection of 39 cases of SET out of the 56 cases. Sensitivity and specificity of CT was 69.6% and 100.0%, respectively. Positive predictive value (PPV) and negative predictive value (NPV) of CT were 100.0% and 45.2%, respectively. There was a significant difference in mean size of CT-detected lesions compared to CT-invisible lesions (14.36 mm vs. 8.52 mm, p < 0.001), but no significant differences in terms of layer of origin and location between these two groups (p > 0.5) were observed. The ROC analysis revealed that the optimal cut-off value, also referred to prediction of CT visibility, was 10 mm. Out of 70 cases, 26 cases (37.14%) were identified as external compression or insignificant lesions such as lipoma, hemangioma, lymphangioma, or gastritis cystica on CT, and do not require regular follow-up.

Conclusions

Stomach CT shows good feasibility with respect to depiction of small SETs, especially in cases where size is larger than 10 mm. Henceforth, it is proposed that stomach CT would be a complimentary or problem-solving tool for SET in evaluating the presence of external compression and characterization of tumors.

Keywords

Endoscopic ultrasonography Multi-detector computed tomography Esophagogastroduodenoscopy Stomach neoplasms Subepithelial tumors 

Notes

Compliance with ethical standards

Funding

This study was funded by the Chung-Ang University Research Grants in 2016.

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 (retrospective study) formal consent is not required.

References

  1. 1.
    Hwang JH, Kimmey MB (2004) The incidental upper gastrointestinal subepithelial mass. Gastroenterology 126(1):301–307CrossRefPubMedGoogle Scholar
  2. 2.
    Humphris JL, Jones DB (2008) Subepithelial mass lesions in the upper gastrointestinal tract. J Gastroenterol Hepatol 23(4):556–566. doi: 10.1111/j.1440-1746.2007.05232.x CrossRefPubMedGoogle Scholar
  3. 3.
    Polkowski M, Butruk E (2005) Submucosal lesions. Gastrointest Endosc Clin N Am 15(1):33–54, viii. doi: 10.1016/j.giec.2004.07.005
  4. 4.
    Polkowski M (2005) Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of malignant submucosal tumors. Endoscopy 37(7):635–645. doi: 10.1055/s-2005-861422 CrossRefPubMedGoogle Scholar
  5. 5.
    Hedenbro JL, Ekelund M, Wetterberg P (1991) Endoscopic diagnosis of submucosal gastric lesions. The results after routine endoscopy. Surg Endosc 5(1):20–23CrossRefPubMedGoogle Scholar
  6. 6.
    Tio TL, Tytgat GN, den Hartog Jager FC (1990) Endoscopic ultrasonography for the evaluation of smooth muscle tumors in the upper gastrointestinal tract: an experience with 42 cases. Gastrointest Endosc 36(4):342–350CrossRefPubMedGoogle Scholar
  7. 7.
    Rosch T, Kapfer B, EUSCEu German, et al. (2002) Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study. Scand J Gastroenterol 37(7):856–862CrossRefPubMedGoogle Scholar
  8. 8.
    Ponsaing LG, Kiss K, Loft A, Jensen LI, Hansen MB (2007) Diagnostic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol 13(24):3301–3310CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Chak A (2002) EUS in submucosal tumors. Gastrointest Endosc 56(4 Suppl):S43–S48CrossRefPubMedGoogle Scholar
  10. 10.
    Zhu H, Wu ZY, Lin XZ, et al. (2008) Gastrointestinal tract lymphangiomas: findings at CT and endoscopic imaging with histopathologic correlation. Abdom Imaging 33(6):662–668. doi: 10.1007/s00261-007-9354-6 CrossRefPubMedGoogle Scholar
  11. 11.
    Park SH, Han JK, Kim TK, et al. (1999) Unusual gastric tumors: radiologic-pathologic correlation. Radiographics 19(6):1435–1446. doi: 10.1148/radiographics.19.6.g99no051435 CrossRefPubMedGoogle Scholar
  12. 12.
    Park SH, Han JK, Choi BI, et al. (2000) Heterotopic pancreas of the stomach: CT findings correlated with pathologic findings in six patients. Abdom Imaging 25(2):119–123CrossRefPubMedGoogle Scholar
  13. 13.
    Levy AD, Sobin LH (2007) From the archives of the AFIP: gastrointestinal carcinoids: imaging features with clinicopathologic comparison. Radiographics 27(1):237–257. doi: 10.1148/rg.271065169 CrossRefPubMedGoogle Scholar
  14. 14.
    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. doi: 10.1148/rg.232025146. (quiz 532)
  15. 15.
    Levy AD, Quiles AM, Miettinen M, Sobin LH (2005) Gastrointestinal schwannomas: CT features with clinicopathologic correlation. AJR Am J Roentgenol 184(3):797–802. doi: 10.2214/ajr.184.3.01840797 CrossRefPubMedGoogle Scholar
  16. 16.
    Lee MJ, Lim JS, Kwon JE, et al. (2007) Gastric true leiomyoma: computed tomographic findings and pathological correlation. J Comput Assist Tomogr 31(2):204–208. doi: 10.1097/01.rct.0000237812.95875.bd CrossRefPubMedGoogle Scholar
  17. 17.
    Kim JY, Lee JM, Kim KW, et al. (2009) Ectopic pancreas: CT findings with emphasis on differentiation from small gastrointestinal stromal tumor and leiomyoma. Radiology 252(1):92–100. doi: 10.1148/radiol.2521081441 CrossRefPubMedGoogle Scholar
  18. 18.
    Kim JK, Won JH, Cho YK, et al. (2001) Glomus tumor of the stomach: CT findings. Abdom Imaging 26(3):303–305CrossRefPubMedGoogle Scholar
  19. 19.
    Kim HC, Lee JM, Kim KW, et al. (2004) Gastrointestinal stromal tumors of the stomach: CT findings and prediction of malignancy. AJR Am J Roentgenol 183(4):893–898. doi: 10.2214/ajr.183.4.1830893 CrossRefPubMedGoogle Scholar
  20. 20.
    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):811–817CrossRefPubMedGoogle Scholar
  21. 21.
    Hong HS, Ha HK, Won HJ, et al. (2008) Gastric schwannomas: radiological features with endoscopic and pathological correlation. Clin Radiol 63(5):536–542. doi: 10.1016/j.crad.2007.05.026 CrossRefPubMedGoogle Scholar
  22. 22.
    Goto O, Kambe H, Niimi K, et al. (2012) Discrepancy in diagnosis of gastric submucosal tumor among esophagogastroduodenoscopy, CT, and endoscopic ultrasonography: a retrospective analysis of 93 consecutive cases. Abdom Imaging 37(6):1074–1078. doi: 10.1007/s00261-012-9928-9 CrossRefPubMedGoogle Scholar
  23. 23.
    Okten RS, Kacar S, Kucukay F, Sasmaz N, Cumhur T (2012) Gastric subepithelial masses: evaluation of multidetector CT (multiplanar reconstruction and virtual gastroscopy) vs. endoscopic ultrasonography. Abdom Imaging 37(4):519–530. doi: 10.1007/s00261-011-9791-0 CrossRefPubMedGoogle Scholar
  24. 24.
    Miettinen M, Lasota J (2006) Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 23(2):70–83CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Joon Chul Ra
    • 1
  • Eun Sun Lee
    • 1
    Email author
  • Jong Beum Lee
    • 1
  • Jae Gyu Kim
    • 2
  • Beom Jin Kim
    • 2
  • Hyun Jeong Park
    • 1
  • Sung Bin Park
    • 1
  • Byung Ihn Choi
    • 1
  1. 1.Department of Radiology, Chung-Ang University HospitalChung-Ang University College of MedicineSeoulKorea
  2. 2.Department of Gastroenterology, Chung-Ang University HospitalChung-Ang University College of MedicineSeoulKorea

Personalised recommendations