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

Rogerio N. Vasconcelos, Steven G. Dolan, John M. Barlow, Michael Wells, Shannon P. Sheedy, Jeff L. Fidler, Stephanie Hansel, Scott Harmsen, Joel Garland Fletcher

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalAbdominal Radiology
DOIs
StateAccepted/In press - Jan 5 2017

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Gastrointestinal Stromal Tumors
Hemorrhage
Neoplasms
Necrosis
Air
Neoplasm Metastasis

Keywords

  • CT
  • CT enterography
  • GIST
  • Small bowel

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology
  • Radiological and Ultrasound Technology

Cite this

Impact of CT enterography on the diagnosis of small bowel gastrointestinal stromal tumors. / Vasconcelos, Rogerio N.; Dolan, Steven G.; Barlow, John M.; Wells, Michael; Sheedy, Shannon P.; Fidler, Jeff L.; Hansel, Stephanie; Harmsen, Scott; Fletcher, Joel Garland.

In: Abdominal Radiology, 05.01.2017, p. 1-9.

Research output: Contribution to journalArticle

Vasconcelos, Rogerio N. ; Dolan, Steven G. ; Barlow, John M. ; Wells, Michael ; Sheedy, Shannon P. ; Fidler, Jeff L. ; Hansel, Stephanie ; Harmsen, Scott ; Fletcher, Joel Garland. / Impact of CT enterography on the diagnosis of small bowel gastrointestinal stromal tumors. In: Abdominal Radiology. 2017 ; pp. 1-9.
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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.",
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AU - Vasconcelos, Rogerio N.

AU - Dolan, Steven G.

AU - Barlow, John M.

AU - Wells, Michael

AU - Sheedy, Shannon P.

AU - Fidler, Jeff L.

AU - Hansel, Stephanie

AU - Harmsen, Scott

AU - Fletcher, Joel Garland

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N2 - 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.

AB - 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.

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