Multi-slice spiral computed tomography in differential diagnosis of gastric stromal tumors and benign gastric polyps, and gastric stromal tumor risk stratification assessment

Abstract

BACKGROUND The biological characteristics of gastric stromal tumors are complex, and their incidence has increased in recent years. Gastric stromal tumors (GST) have potential malignant tendencies, and the probability of transformation into malignant tumors is as high as 20%-30%. AIM To investigate the value of multi-slice spiral computed tomography (MSCT) in the differential diagnosis of GST and benign gastric polyps, and GST risk stratification assessment. METHODS We included 64 patients with GST (GST group) and 60 with benign gastric polyps (control group), confirmed by pathological examination after surgery in PLA General Hospital, from January 2016 to June 2021. The differences in the MSCT imaging characteristic parameters and enhanced CT values between the two groups before surgery were compared. According to the National Institutes of Health’s standard, GST is divided into low- and high-risk groups for MSCT imaging characteristic parameters and enhanced CT values. RESULTS The incidences of extraluminal growth, blurred boundaries, and ulceration in the GST group were significantly higher than those in the control group ( P < 0.05). The CT values and enhanced peak CT values in the arterial phase in the CST group were higher than those in the control group ( P < 0.05). The MSCT differential diagnosis of GST and gastric polyp sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, and areas under the curve (AUCs) were 73.44 %, 83.33%, 26.56%, 16.67%, 0.784, respectively. The receiver operating characteristic curves were plotted with the arterial CT value and enhanced peak CT value, with a statistical difference. The results showed that the sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, and AUC value of arterial CT in the differential diagnosis of GST and gastric polyps were 80.18%, 62.20%, 19.82%, 37.80%, and 0.710, respectively. The sensitivity, specificity, misdiagnosis rate, missed diagnosis rate, and AUC value of the enhanced peak CT value in the differential diagnosis of GST and gastric polyps were 67.63%, 60.40%, 32.37%, 39.60%, and 0.710, respectively. The incidence of blurred lesion boundaries and ulceration in the high-risk group was significantly higher than that in the low-risk group ( P < 0.05). The arterial phase and enhanced peak CT values in the high-risk group were significantly higher than those in the low-risk group ( P < 0.05). CONCLUSION Presurgical MSCT examination has important value in the differential diagnosis of GST and gastric benign polyps and can effectively evaluate the risk grade of GST patients.

CT and MRI of Gastrointestinal Stromal Tumours: New Trends and Perspectives

“…In addition, mean attenuation values on arterial phase images and peak attenuation values were greater in high-risk GISTs (78.72 ± 12.66 [SD] HU and 80.79 ± 12.37 [SD] HU, respectively) compared to the low-intermediate-risk GISTs (55.71 ± 13.77 [SD] HU, P < .001 and 72.66 ± 12.46 [SD] HU, P = .015, respectively). 46 Grazzini et al confirmed the high value of enlarged feeding or draining vessels but also that of tumor necrosis in a series of 54 patients with 56 GISTs. 57 They found that these 2 features on contrast-enhanced CT images had 89.3% accuracy (50/56 GISTs) for the diagnosis of high-risk GISTs.…”

“…2,[43][44][45] One study involving 124 patients (64 with GISTs and 60 with benign gastric polyp) who underwent CT examination, found that extraluminal growth (50%; 32/64), irregular margins (83%; 53/64) and tumour ulceration (28%; 18/64) were more frequently observed in gastric GISTs than in benign gastric polyps (10 [6/60]; 33% [20/ 60]; and 7% [4/60], respectively) (P < .001, <.001 and .002, respectively). 46 Similarly, GISTs showed greater degrees of enhancement during the arterial phase compared to benign gastric polyps. 46 In this study, the best capabilities for tumour discrimination were obtained using semantic features (area under the curve [AUC], .784) rather than using attenuation values on arterial phase images (AUC, .710) or peak attenuation values (AUC, .710).…”

“…46 Similarly, GISTs showed greater degrees of enhancement during the arterial phase compared to benign gastric polyps. 46 In this study, the best capabilities for tumour discrimination were obtained using semantic features (area under the curve [AUC], .784) rather than using attenuation values on arterial phase images (AUC, .710) or peak attenuation values (AUC, .710). 46 Liu et al found that dual-energy CT helped discriminate between GISTs and gastric schwanommas due to significant difference in iodine concentration between gastric schwanommas and gastric GISTs on both arterial and portal venous phases.…”

“…46 In this study, the best capabilities for tumour discrimination were obtained using semantic features (area under the curve [AUC], .784) rather than using attenuation values on arterial phase images (AUC, .710) or peak attenuation values (AUC, .710). 46 Liu et al found that dual-energy CT helped discriminate between GISTs and gastric schwanommas due to significant difference in iodine concentration between gastric schwanommas and gastric GISTs on both arterial and portal venous phases. 47 Another study involving 50 gastric leiomyomas and 110 gastric GISTs revealed that CT features such as cardia location, endophytic growth and homogeneous gradual enhancement helped differentiate between gastric leiomyomas and gastric GISTs, with these 3 variables being independently and significantly associated with the diagnosis of gastric leiomyoma at logistic regression analysis.…”