Gastrointestinal stromal tumor CT: Difference between revisions

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{{Gastrointestinal stromal tumor}}
{{CMG}}{{AE}}{{Akshun}}


{{CMG}}{{AE}}{{PSD}}
{{Gastrointestinal stromal tumor}}
==Overview==
==Overview==
Abdominal CT scan may be helpful in the diagnosis of gastrointestinal stromal tumor.
A [[Computed tomography|CT scan]] of the [[abdomen]] and [[pelvis]] is the imaging test of choice and an important tool in the [[diagnosis]] of gastrointestinal stromal tumor (GIST). [[CT scan]] can be used to determine the size, location and [[Cancer staging|staging]] of GIST. A [[CT scan]] can accurately de-mark surrounding structures, multiple [[tumors]] and [[metastases]]. On a [[CT scan]], a small GIST (< 5 cms) appears as [[homogeneous]] mass with clear boundaries, while a large GIST (>10cms) appears as a [[heterogeneous]] mass with irregular borders and have local or distant spread.


==CT scan==
==CT scan==
Appearance of GIST on a CT scan vary with size and location. Typically the mass is of soft tissue density with central areas of lower density when necrosis is present (usually in larger tumours). Enhancement is typically peripheral (due to central necrosis). Calcification is uncommon (3%). Metastases (distant, peritoneal, omental) or direct invasion into adjacent organs may be seen in more aggressive lesions. Lymph node enlargement is not a feature.<ref>{{Cite web | title = Gastrointestinal stromal tumour
A [[CT scan]] of the [[abdomen]] and [[pelvis]] is the imaging test of choice and an important tool in the [[diagnosis]] of gastrointestinal stromal tumor (GIST). However, a [[biopsy]] ([[Endoscopy|endoscopic]] or [[CT-scans|CT]] guided) is the [[Gold standard (test)|gold standard]] in diagnosing GIST. <ref>{{Cite web | title = Gastrointestinal stromal tumour
| url = http://radiopaedia.org/articles/gastrointestinal-stromal-tumour-1}}</ref>
| url = http://radiopaedia.org/articles/gastrointestinal-stromal-tumour-1}}</ref><ref name="pmid15654796">{{cite journal |vauthors=Tran T, Davila JA, El-Serag HB |title=The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000 |journal=Am. J. Gastroenterol. |volume=100 |issue=1 |pages=162–8 |year=2005 |pmid=15654796 |doi=10.1111/j.1572-0241.2005.40709.x |url=}}</ref><ref name="pmid16625094">{{cite journal |vauthors=Miettinen M, Makhlouf H, Sobin LH, Lasota J |title=Gastrointestinal stromal tumors of the jejunum and ileum: a clinicopathologic, immunohistochemical, and molecular genetic study of 906 cases before imatinib with long-term follow-up |journal=Am. J. Surg. Pathol. |volume=30 |issue=4 |pages=477–89 |year=2006 |pmid=16625094 |doi= |url=}}</ref><ref name="pmid12563150">{{cite journal |vauthors=Burkill GJ, Badran M, Al-Muderis O, Meirion Thomas J, Judson IR, Fisher C, Moskovic EC |title=Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread |journal=Radiology |volume=226 |issue=2 |pages=527–32 |year=2003 |pmid=12563150 |doi=10.1148/radiol.2262011880 |url=}}</ref><ref name="pmid15855894">{{cite journal |vauthors=Hersh MR, Choi J, Garrett C, Clark R |title=Imaging gastrointestinal stromal tumors |journal=Cancer Control |volume=12 |issue=2 |pages=111–5 |year=2005 |pmid=15855894 |doi= |url=}}</ref><ref name="pmid11034250">{{cite journal |vauthors=Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF |title=Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management |journal=Ann. Surg. Oncol. |volume=7 |issue=9 |pages=705–12 |year=2000 |pmid=11034250 |doi= |url=}}</ref>
 
*[[CT scan]] can be used to determine the size, location and [[Cancer staging|staging]] of GIST.  
 
*A [[CT scan]] accurately de-mark surrounding structures, multiple [[tumors]] and [[metastases]].  
*A CT scan of the abdomen and pelvis is the imaging test of choice and an important tool in the diagnosis of GIST.  
*The size of GIST determined by a [[CT scan]] can also be used to classify the severity of GIST.
*CT scan can be used to determine the size, location and staging of the GIST.  
**Small GIST (< 5 cms) are [[homogeneous]] with clear boundaries and have an [[intraluminal]] pattern of growth.
*A CT can accurately de-mark surrounding structures, multiple tumors and metastases.  
**Intermediate GIST (size of 5-10 cms) are [[heterogeneous]] with irregular borders and [[Intraluminal|intra]] or extra-luminal pattern of [[growth]].
*The size of GIST determined by a CT scan can also be ised to classify the severity of GIST.  
**Large GISTs (>10 cms) are [[heterogeneous]] with irregular borders and have local or distant spread.
**Small GIST (< 5 cm) are homogeneous with clear boundaries and intraluminal pattern of growth.
**[[Malignant]] GIST with [[metastasis]] (distant, [[peritoneal]], [[omental]]) may have the following findings:
**Intermediate GIST (size of 5-10 cm) are heterogeneous with irregular borders and intra or extra-luminal pattern of growth.
***Size greater than 10 cm
**Large GISTs (>10 cm) are heterogeneous with irregular borders and local or distant spread.
***[[Calcification|Calcifications]]
 
***Irregular margins
Computed tomography (CT) is the imaging test of choice for diagnosing GIST.
***[[Heterogeneous]] and lobulated
On a CT scan, a malignant GIST with metastasis may have the following findings
***[[Lymphadenopathy]]
*size greater than 10 cm
***[[Ulceration]]
*calcifications
***Extraluminal and [[mesenteric]] fat [[Infiltration (medical)|infiltration]]
*irregular margins
*[[CT-scans|CT]] with [[contrast]] (oral) is superior to a normal [[CT scan]]. A CT with [[contrast]] can better visualize:
*heterogeneous, lobulated
**Thickness of the [[small bowel]]
*lymphadenopathy
**Deep ileal loops without [[superimposition]]
*ulceration
**Evaluation of surrounding [[mesentery]]
*extraluminal and mesenteric fat infiltration  
{|
CT with contrast (oral) is superior to normal CT. CT with contrast can better visualize the
|-
*thickness of the small bowel
|
*deep ileal loops without superimposition  
[[image:GIST CT-Noncontrast image.jpg|thumb|left|CT without contrast showing an incidental finding of a small GIST in the posterior stomach wall (arrow). ([Courtesy: By Inversitus - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=33932071])]]
*evaluation of surrounding mesentery
|
MRI is more accurate than CT for delineating rectal GISTs and in detecting liver metastasis, hemorrhage and necrosis.
[[image:CT image of a GIST tumor in the gastric cardia.jpg|thumb|center|CT scan showing a GIST located in the gastric cardia. ([Courtesy: By Jto410 (from my radiology practice) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons])]]
|
|-
|}


==References==
==References==

Latest revision as of 03:49, 4 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

A CT scan of the abdomen and pelvis is the imaging test of choice and an important tool in the diagnosis of gastrointestinal stromal tumor (GIST). CT scan can be used to determine the size, location and staging of GIST. A CT scan can accurately de-mark surrounding structures, multiple tumors and metastases. On a CT scan, a small GIST (< 5 cms) appears as homogeneous mass with clear boundaries, while a large GIST (>10cms) appears as a heterogeneous mass with irregular borders and have local or distant spread.

CT scan

A CT scan of the abdomen and pelvis is the imaging test of choice and an important tool in the diagnosis of gastrointestinal stromal tumor (GIST). However, a biopsy (endoscopic or CT guided) is the gold standard in diagnosing GIST. [1][2][3][4][5][6]

CT without contrast showing an incidental finding of a small GIST in the posterior stomach wall (arrow). ([Courtesy: By Inversitus - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=33932071])
CT scan showing a GIST located in the gastric cardia. ([Courtesy: By Jto410 (from my radiology practice) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons])

References

  1. ↑ "Gastrointestinal stromal tumour".
  2. ↑ Tran T, Davila JA, El-Serag HB (2005). "The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000". Am. J. Gastroenterol. 100 (1): 162–8. doi:10.1111/j.1572-0241.2005.40709.x. PMID 15654796.
  3. ↑ Miettinen M, Makhlouf H, Sobin LH, Lasota J (2006). "Gastrointestinal stromal tumors of the jejunum and ileum: a clinicopathologic, immunohistochemical, and molecular genetic study of 906 cases before imatinib with long-term follow-up". Am. J. Surg. Pathol. 30 (4): 477–89. PMID 16625094.
  4. ↑ Burkill GJ, Badran M, Al-Muderis O, Meirion Thomas J, Judson IR, Fisher C, Moskovic EC (2003). "Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread". Radiology. 226 (2): 527–32. doi:10.1148/radiol.2262011880. PMID 12563150.
  5. ↑ Hersh MR, Choi J, Garrett C, Clark R (2005). "Imaging gastrointestinal stromal tumors". Cancer Control. 12 (2): 111–5. PMID 15855894.
  6. ↑ Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF (2000). "Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management". Ann. Surg. Oncol. 7 (9): 705–12. PMID 11034250.


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