title: Impact of CT enterography on the diagnosis of small bowel gastrointestinal stromal tumors.
abstract: 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.
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Rogerio N
authors.initials: RN
authors.lastname: Vasconcelos
authors.affiliation: Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Dolan
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Barlow
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Wells
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Shannon P
authors.initials: SP
authors.lastname: Sheedy
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Jeff L
authors.initials: JL
authors.lastname: Fidler
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hansel
authors.affiliation: Division of Biostatistics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Harmsen
authors.affiliation: Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. fletcher.joel@mayo.edu.
authors.forename: Joel G
authors.initials: JG
authors.lastname: Fletcher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: CT; CT enterography; GIST; Small bowel