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Use of computed tomography for distinguishing heterotopic pancreas from gastrointestinal stromal tumor and leiomyoma.
Abdom Radiol (NY). 2020 Jul 01 [Online ahead of print]AR

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.

Authors+Show Affiliations

Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China. songlab_radiology@163.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32613400

Citation

Yang, Cai-Wei, et al. "Use of Computed Tomography for Distinguishing Heterotopic Pancreas From Gastrointestinal Stromal Tumor and Leiomyoma." Abdominal Radiology (New York), 2020.
Yang CW, Liu XJ, Wei Y, et al. Use of computed tomography for distinguishing heterotopic pancreas from gastrointestinal stromal tumor and leiomyoma. Abdom Radiol (NY). 2020.
Yang, C. W., Liu, X. J., Wei, Y., Wan, S., Ye, Z., Yao, S., Zeng, N., Cheng, Y., & Song, B. (2020). Use of computed tomography for distinguishing heterotopic pancreas from gastrointestinal stromal tumor and leiomyoma. Abdominal Radiology (New York). https://doi.org/10.1007/s00261-020-02631-2
Yang CW, et al. Use of Computed Tomography for Distinguishing Heterotopic Pancreas From Gastrointestinal Stromal Tumor and Leiomyoma. Abdom Radiol (NY). 2020 Jul 1; PubMed PMID: 32613400.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of computed tomography for distinguishing heterotopic pancreas from gastrointestinal stromal tumor and leiomyoma. AU - Yang,Cai-Wei, AU - Liu,Xi-Jiao, AU - Wei,Yi, AU - Wan,Shang, AU - Ye,Zheng, AU - Yao,Shan, AU - Zeng,Ni, AU - Cheng,Yue, AU - Song,Bin, Y1 - 2020/07/01/ PY - 2020/04/13/received PY - 2020/06/23/accepted PY - 2020/06/15/revised PY - 2020/7/3/entrez KW - Computed tomography KW - Gastrointestinal stromal tumors KW - Heterotopic pancreas KW - Leiomyoma JF - Abdominal radiology (New York) JO - Abdom Radiol (NY) N2 - 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. SN - 2366-0058 UR - https://www.unboundmedicine.com/medline/citation/32613400/Use_of_computed_tomography_for_distinguishing_heterotopic_pancreas_from_gastrointestinal_stromal_tumor_and_leiomyoma L2 - https://dx.doi.org/10.1007/s00261-020-02631-2 DB - PRIME DP - Unbound Medicine ER -
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