title: Multidetector-row CT of tumour-bowel fistula: Experience at a tertiary cancer centre.
abstract: OBJECTIVE
  To study the clinical and multidetector computed tomography (MDCT) features of tumour-bowel fistula (TBF).
  
  
  METHODS
  Fifty-one patients (27 women; mean age 57.4 years, range 30-77years) with TBF presenting to our institution between January 2005 and February 2012 were identified retrospectively from the radiology database. MDCT images before, at, and subsequent to diagnosis of TBF were reviewed by three radiologists in consensus; clinical presentation, management, and outcome were documented from electronic medical records.
  
  
  RESULTS
  Of 51 patients, small bowel (n = 22) was the most common site with gastrointestinal stromal tumour (GIST) being the most common sarcoma subtype (n = 10). TBF was treatment-associated (TTBF) in 40 patients [78%; 22 of whom had received molecular targeted therapy (MTT)], and spontaneous (STBF) in 11 patients (22%). Thirty-one patients (61%) were symptomatic at the time of TBF detection. TTBF was more often asymptomatic (19/40 versus 1/11; Fisher's exact test p = 0.03). In the TTBF group, 16 had a partial response, seven had stable disease, and 17 had progressive disease. Treatment was discontinued or changed to an alternative regimen in 27/40 patients, and 13/40 patients continued with the same regimen. TBF persisted in 27/33 patients (82%) who underwent CT follow-up. Thirty-one of the 51 patients were deceased at the time of analysis. Time from diagnosis of TBF to death was shorter with STBF (1.8 months) than with TTBF (6.4 months).
  
  
  CONCLUSIONS
  TBF is often associated with MTT and can be seen with treatment response or progression. TTBF is more frequently asymptomatic. TBF is usually managed conservatively by discontinuing treatment, but often persists on CT follow-up.
authors.affiliation: Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: stirumani@partners.org.
authors.forename: S H
authors.initials: SH
authors.lastname: Tirumani
authors.affiliation: Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Shinagare
authors.affiliation: Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Jagannathan
authors.affiliation: Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Krajewski
authors.affiliation: Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: N H
authors.initials: NH
authors.lastname: Ramaiya
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D046152:Gastrointestinal Stromal Tumors / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007412:Intestinal Fistula / Q000150:complications / Q000000981:diagnostic imaging*; D007421:Intestine, Small / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D015588:Observer Variation; D016522:Oncology Service, Hospital; D011856:Radiographic Image Enhancement / Q000379:methods; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media