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Use of computed tomography for distinguishing heterotopic pancreas from gastrointestinal stromal tumor and leiomyoma

Abdominal Radiology volume 46, pages 168–178 (2021)Cite this article

Abstract

Purpose

To determine whether morphologic features and semiquantitative parameters of computed tomography (CT) could be used to distinguish heterotopic pancreas from gastrointestinal stromal tumor (GIST) and leiomyoma.

Methods

This retrospective study evaluated CT images of heterotopic pancreases (n = 28), GISTs (n = 57), and leiomyomas (n = 26) located in the upper gastrointestinal tract. Morphologic imaging features of lesions were analyzed, including location, contour, margin, attenuation, growth pattern, enhancement type, enhancement degree, enlarged vessels feeding or draining the mass, hyperenhancement of the overlying mucosa, low intralesional attenuation, calcification, and a duct-like structure. Semiquantitative parameters included long diameter (LD), short diameter (SD), LD/SD ratio, and lesion and aorta CT values during plain CT (Lp and Ap), arterial phase (La and Aa), and venous phase (Lv and Av). Diagnostic performance of these findings and parameters were evaluated by receiver operating characteristic (ROC) analysis.

Results

Morphologic CT findings (including lesion contour, margin, attenuation, growth pattern, enhancement type, and enhancement degree) and semiquantitative parameters except for LD/SD were demonstrated to be significant for differentiating heterotopic pancreas from GIST and leiomyoma (all P < 0.01). Of these, location, low intralesional attenuation, duct-like structure and LD, SD, Lv, and Sv values showed good diagnostic performance with the areas under curve (AUC) higher than 0.70. The presence of a duct-like structure demonstrated the best diagnostic ability with AUC of 0.929 [95% confidence interval (CI) 0.864–0.969], sensitivity of 5.7% (95% CI 67.3–96.0), and specificity of 100% (95% CI 95.7–100), respectively. When the three morphologic features (location, low intralesional attenuation, duct-like structure) were used in combination, the AUC was improved to 0.980 (95% CI 0.952–1).

Conclusion

CT features, especially the morphologic features, could be used to differentiate heterotopic pancreas from GIST and leiomyoma in the upper gastrointestinal tract and, thus, provide a more accurate method for non-invasive preoperative diagnosis. Additionally, the presence of a duct-like structure demonstrated to be a reliable indicator for heterotopic pancreas among the morphologic and semiquantitative CT features.

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Abbreviations

CT:

Computed tomography

GIST:

Gastrointestinal stromal tumor

EVFDM:

Enlarged vessels feeding or draining the mass

LD:

Long diameter

SD:

Short diameter

ROI:

Regions of interests

AUC:

Area under the curve

ROC:

Receiver operating characteristic

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Funding

The funding was supported by Research Grant of National Nature Science Foundation of China, No. 81971571.

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    Affiliations

    1. Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China

      Cai-Wei Yang, Xi-Jiao Liu, Yi Wei, Shang Wan, Zheng Ye, Shan Yao, Ni Zeng, Yue Cheng & Bin Song

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    1. Cai-Wei Yang
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    Correspondence to Bin Song.

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    Cai-Wei Yang and Xi-Jiao Liu have contributed equally to this work.

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    Yang, CW., Liu, XJ., Wei, Y. et al. Use of computed tomography for distinguishing heterotopic pancreas from gastrointestinal stromal tumor and leiomyoma. Abdom Radiol 46, 168–178 (2021). https://doi.org/10.1007/s00261-020-02631-2

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    • DOI: https://doi.org/10.1007/s00261-020-02631-2

    Keywords

    • Heterotopic pancreas
    • Computed tomography
    • Gastrointestinal stromal tumors
    • Leiomyoma