Abdominal Radiology

, Volume 42, Issue 5, pp 1365–1373 | Cite as

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

  • Rogerio N. Vasconcelos
  • Steven G. Dolan
  • John M. Barlow
  • Michael L. Wells
  • Shannon P. Sheedy
  • Jeff L. Fidler
  • Stephanie Hansel
  • Scott Harmsen
  • Joel G. FletcherEmail author



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.


CT CT enterography Small bowel GIST 


Compliance with ethical standards


No funding was received for this study.

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 formal consent is not required.

Informed consent

All patients consented to the retrospective use of medical records for research purposes. This study was approved by our institutional research board.


  1. 1.
    Joensuu H, Fletcher C, Dimitrijevic S, et al. (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3(11):655–664CrossRefGoogle Scholar
  2. 2.
    Miettinen M, Lasota J (2001) Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch 438(1):1–12CrossRefGoogle Scholar
  3. 3.
    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; quiz 532CrossRefGoogle Scholar
  4. 4.
    Emory TS, Sobin LH, Lukes L, Lee DH, O’Leary TJ (1999) Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol 23(1):82–87CrossRefGoogle Scholar
  5. 5.
    Miettinen M, El-Rifai W, Leslie H, Lasota J (2002) Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review. Hum Pathol 33(5):478–483CrossRefGoogle Scholar
  6. 6.
    Perez EA, Livingstone AS, Franceschi D, et al. (2006) Current incidence and outcomes of gastrointestinal mesenchymal tumors including gastrointestinal stromal tumors. J Am Coll Surg 202(4):623–629CrossRefGoogle Scholar
  7. 7.
    Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M (2003) Gastrointestinal stromal tumors: radiological features with pathological correlation. Radiographics 23(2):283–304CrossRefGoogle Scholar
  8. 8.
    Gong JS, Kang WY, Liu T, Zhu J, Xu JM (2012) CT findings of a gastrointestinal stromal tumor arising from small bowel. Quant Imaging Med Surg 2(1):57–58PubMedPubMedCentralGoogle Scholar
  9. 9.
    Huprich JE, Fletcher JG, Fidler JL, et al. (2011) Prospective blinded comparison of wireless capsule endoscopy and multiphase CT enterography in obscure gastrointestinal bleeding. Radiology 260(3):744–751CrossRefGoogle Scholar
  10. 10.
    Hakim FA, Alexander JA, Huprich JE, Grover M, Enders FT (2011) CT-enterography may identify small bowel tumors not detected by capsule endoscopy: eight years experience at Mayo Clinic Rochester. Dig Dis Sci 56(10):2914–2919CrossRefGoogle Scholar
  11. 11.
    Agrawal JR, Travis AC, Mortele KJ, et al. (2012) Diagnostic yield of dual-phase computed tomography enterography in patients with obscure gastrointestinal bleeding and a non-diagnostic capsule endoscopy. J Gastroenterol Hepatol 27(4):751–759CrossRefGoogle Scholar
  12. 12.
    Gerson LB, Fidler JL, Cave DR, Leighton JA (2015) ACG clinical guideline: diagnosis and management of small bowel bleeding. Am J Gastroenterol 110(9):1265–1287; quiz 1288CrossRefGoogle Scholar
  13. 13.
    Fletcher CD, Berman JJ, Corless C, et al. (2002) Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 33(5):459–465CrossRefGoogle Scholar
  14. 14.
    Agaimy A (2010) Gastrointestinal stromal tumors (GIST) from risk stratification systems to the new TNM proposal: more questions than answers? A review emphasizing the need for a standardized GIST reporting. Int J Clin Exp Pathol 3(5):461–471PubMedPubMedCentralGoogle Scholar
  15. 15.
    Sahani DV, Sainani NI, Blake MA, et al. (2011) Prospective evaluation of reader performance on MDCT in characterization of cystic pancreatic lesions and prediction of cyst biologic aggressiveness. AJR Am J Roentgenol 197(1):W53–W61CrossRefGoogle Scholar
  16. 16.
    Lau S, Tam KF, Kam CK, et al. (2004) Imaging of gastrointestinal stromal tumour (GIST). Clin Radiol 59(6):487–498CrossRefGoogle Scholar
  17. 17.
    Anzidei M, Napoli A, Zini C, et al. (2011) Malignant tumours of the small intestine: a review of histopathology, multidetector CT and MRI aspects. Br J Radiol 84(1004):677–690CrossRefGoogle Scholar
  18. 18.
    Graca BM, Freire PA, Brito JB, et al. (2010) Gastroenterologic and radiologic approach to obscure gastrointestinal bleeding: how, why, and when? Radiographics 30(1):235–252CrossRefGoogle Scholar
  19. 19.
    Huprich JE, Fletcher JG (2009) CT enterography: principles, technique and utility in Crohn’s disease. Eur J Radiol 69(3):393–397CrossRefGoogle Scholar
  20. 20.
    Caterino S, Lorenzon L, Petrucciani N, et al. (2011) Gastrointestinal stromal tumors: correlation between symptoms at presentation, tumor location and prognostic factors in 47 consecutive patients. World J Surg Oncol 9:13CrossRefGoogle Scholar
  21. 21.
    Fletcher JG, Huprich J, Loftus EV Jr, Bruining DH, Fidler JL (2008) Computerized tomography enterography and its role in small-bowel imaging. Clin Gastroenterol Hepatol 6(3):283–289CrossRefGoogle Scholar
  22. 22.
    Huprich JE, Fletcher JG, Alexander JA, et al. (2008) Obscure gastrointestinal bleeding: evaluation with 64-section multiphase CT enterography—initial experience. Radiology 246(2):562–571CrossRefGoogle Scholar
  23. 23.
    Rubin BP, Heinrich MC, Corless CL (2007) Gastrointestinal stromal tumour. The Lancet 369(9574):1731–1741CrossRefGoogle Scholar
  24. 24.
    Minardi AJ Jr, Zibari GB, Aultman DF, McMillan RW, McDonald JC (1998) Small-bowel tumors. J Am Coll Surg 186(6):664–668CrossRefGoogle Scholar
  25. 25.
    Masselli G, Di Tola M, Casciani E, et al. (2016) Diagnosis of small-bowel diseases: prospective comparison of multi-detector row CT enterography with MR enterography. Radiology 279(2):420–431CrossRefGoogle Scholar
  26. 26.
    Burkill GJ, Badran M, Al-Muderis O, et al. (2003) Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread. Radiology 226(2):527–532CrossRefGoogle Scholar
  27. 27.
    Kochhar R, Manoharan P, Leahy M, Taylor MB (2010) Imaging in gastrointestinal stromal tumours: current status and future directions. Clin Radiol 65(8):584–592CrossRefGoogle Scholar
  28. 28.
    Sandrasegaran K, Rajesh A, Rushing DA, et al. (2005) Gastrointestinal stromal tumors: CT and MRI findings. Eur Radiol 15(7):1407–1414CrossRefGoogle Scholar
  29. 29.
    O’Sullivan PJ, Harris AC, Ho SG, Munk PL (2006) The imaging features of gastrointestinal stromal tumours. Eur J Radiol 60(3):431–438CrossRefGoogle Scholar
  30. 30.
    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):811–817CrossRefGoogle Scholar
  31. 31.
    Yang TH, Hwang JI, Yang MS, et al. (2007) Gastrointestinal stromal tumors: computed tomographic features and prediction of malignant risk from computed tomographic imaging. J Chin Med Assoc 70(9):367–373CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Rogerio N. Vasconcelos
    • 1
  • Steven G. Dolan
    • 2
  • John M. Barlow
    • 1
  • Michael L. Wells
    • 1
  • Shannon P. Sheedy
    • 1
  • Jeff L. Fidler
    • 1
  • Stephanie Hansel
    • 3
  • Scott Harmsen
    • 4
  • Joel G. Fletcher
    • 1
    Email author
  1. 1.Department of RadiologyMayo ClinicRochesterUSA
  2. 2.Department of RadiologyCork University HospitalCorkIreland
  3. 3.Division of Gastroenterology, Department of Internal MedicineMayo ClinicRochesterUSA
  4. 4.Division of BiostatisticsMayo ClinicRochesterUSA

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