title: Leiomyomas in the gastric cardia: CT findings and differentiation from gastrointestinal stromal tumors.
abstract: OBJECTIVE
  To describe CT findings of leiomyomas and gastrointestinal stromal tumors (GISTs) in the gastric cardia and to identify their differentiating features.
  
  
  METHODS
  CT images of pathologically proven leiomyomas (n=26) and GISTs (n=19) in the gastric cardia were retrospectively reviewed for esophagogastric junction (EGJ) involvement, contour, surface, growth pattern, enhancement pattern and degree of the tumor, and the presences of intralesional low attenuation, calcification and surface dimples or ulcers. The long (LD) and short diameters (SD), LD/SD ratio, and attenuation value of each lesion were measured.
  
  
  RESULTS
  EGJ involvement, homogeneous enhancement, intermediate or low enhancement, absences of intralesional low attenuation and surface dimples or ulcers, LD/SD ratio >1.2, and attenuation value ≤71.2HU were significant findings for differentiating leiomyomas from GISTs (P<0.05 for each finding). An LD/SD ratio of >1.2 and attenuation value of ≤71.2HU yielded sensitivities of 84.6% and 61.5%, and specificities of 52.6% and 84.2%, respectively, on the receiver operating characteristic curve analysis. When at least five of these seven criteria were used in combination, the sensitivity and specificity for diagnosing leiomyomas were 100% (26 of 26) and 89.5% (17 of 19), respectively. When any six of these criteria were used, a specificity of 100% was achieved.
  
  
  CONCLUSIONS
  CT features including EGJ involvement, enhancement pattern and degree, presences of intralesional low attenuation and surface dimples or ulcers, LD/SD ratio, and attenuation value could help differentiating leiomyomas from GISTs in the gastric cardia, particularly in the manner of combination.
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
authors.forename: Hyun Kyung
authors.initials: HK
authors.lastname: Yang
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea. Electronic address: yhkrad@gmail.com.
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
authors.forename: Yoon Jin
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
authors.forename: Kyoung Ho
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
authors.forename: Hye Seung
authors.initials: HS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D002299:Cardia / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D046152:Gastrointestinal Stromal Tumors; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Computed tomography; Gastrointestinal stromal tumors; Leiomyoma; Stomach neoplasms; Subepithelial tumors