Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
Abdom Radiol (NY). 2017 May;42(5):1365-1373. doi: 10.1007/s00261-016-1033-z.
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.
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.
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.
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.
本研究旨在确定 CT 肠造影术对小肠胃肠道间质瘤（GIST）检测和生物学侵袭性的影响，并确定与生物学侵袭性相关的任何影像学表现。
回顾经组织学证实的小肠 GIST 患者的 CT 成像记录。生物学侵袭性基于初始组织学分级（极低、低、中、高级；或恶性），如果在临床随访过程中出现局部或远处转移，则升级为恶性类别。比较影像学表现、发现和 CT 检查类型与生物学侵袭性。
共发现 111 例小肠 GIST，疑似小肠出血是最常见的检查指征（45/111；40.5%）。虽然 CT 诊断的恶性 GIST 数量相对稳定（每年 2-3 例），但非恶性 GIST 的数量显著增加（1998-2005 年平均每年 1.5 例，2006-2013 年平均每年 8.4 例）。在疑似小肠出血的患者中，CT 肠造影术发现 33 例 GIST（33/33，21%为恶性），而腹盆腔 CT 发现 12 例 GIST（12/12，50%为恶性；p<0.03）。肿瘤大小（p<0.0001）、内部坏死（p=0.005）、内部空气或肠内对比剂（p≤0.021）和溃疡（p≤0.021）与高级别和恶性肿瘤显著相关，而不规则或侵袭性肿瘤边界（p<0.01）与恶性肿瘤相关。
由于疑似小肠出血患者中使用 CT 肠造影术，小肠 GIST 的检出率可能会增加。CT 肠造影术检出的绝大多数小肠 GIST 并不为恶性。
