The differential diagnosis of mesenteric invasive fibromatosis and gastrointestinal stromal tumor based on CT enhancement

doi:10.3877/cma.j.issn.2095-3224.2020.06.011

Abstract

Abstract:

Objective

To investigate the CT differential features of mesenteric invasive fibromatosis (MAF) and gastrointestinal stromal tumor (GIST).

Methods

CT images of 53 pathologically proven cases of MAF (n=14) and GIST (n=39) were retrospectively reviewed. Location, contour, border, enhancement pattern, presence of necrosis, vessels, and air within the lesion were analyzed. Long diameter (LD), short diameter (SD), LD/SD ratio, degree of enhancement were measured and calculated. Significant CT criteria were identified using t-test, and receiver operating characteristic (ROC) curve. Sensitivity and specificity values were calculated when single or multiple CT criteria were used.

Results

Most of the MAF were extra-gastrointestinal location (χ²=10.437, P=0.001), oval or irregular (χ²=9.192, P=0.004), homogeneous enhancement (χ²=12.458, P=0.000), absence of intra-lesional necrosis (χ²=6.632, P=0.014), lower degree of enhancement (the CT value of venous phase was 23.9±8.2 HU). When homogeneous enhancement and LD/SD ratio were combined, the sensitivity and specificity for diagnosing MAF were 92.9% and 97.4%, respectively.

Conclusion

The following seven CT features are helpful to distinguish MAF from GIST: extra-gastrointestinal location, oval or irregular shape, homogeneous enhancement, absence of intra-lesional necrosis, LD/SD≥1.19, increased CT value≤22 HU in arterial phase and CT value ≤31 HU in arterial phase.

Key words: Colorectal neoplasms, Mesentery, Fibromatosis, Gastrointestinal stromal tumor, Tomography, X-ray computed

Dafu Zhang, Youguo Dai, Guangjun Yang, Zhiping Zhang, Zhenhui Li. The differential diagnosis of mesenteric invasive fibromatosis and gastrointestinal stromal tumor based on CT enhancement[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(06): 597-604.

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Figures/Tables 11

References 24

[1]	Yantiss RK, Spiro IJ, Compton CC, et al. Gastrointestinal stromal tumor versus intra-abdominal fibromatosis of the bowel wall: a clinically important differential diagnosis [J]. Am Surg Pathol, 2000, 24(7): 947-957.
[2]	Yannopoulos K, Stout AP. Primary solid tumors of the mesentery [J]. Cancer, 1963, 16(7): 914-927.
[3]	Burke AP, Sobin LH, Shekitka KM, et al. Intra-abdominal fibromatosis: a pathologic analysis of 130 tumors with comparison of clinical subgroups [J]. Am J Surg Pathol, 1990, 14(4): 335-341.
[4]	Papazoglou A, Komporozos V. Diagnosis and treatment of sporadic and familial adenomatous polyposis (fap) - associated desmoid tumors: literature review [J]. Hellenic Journal of Surgery, 2018, 90(6): 299-307.
[5]	Gronchi A, Jones RL. Treatment of desmoid tumors in 2019 [J]. JAMA Oncology, 2019, 5(4): 567-568.
[6]	Braschi-amirfarzan M, Keraliya AR, Krajewski KM, et al.Role of imaging in management of desmoid-type fibromatosis: a primer for radiologists [J]. Radiographics a Review Publication of the Radiological Society of North America Inc, 2016, 36(3): 767-782.
[7]	Kasper B, Baumgarten C, Garcia J, et al. An update on the management of sporadic desmoid-type fibromatosis: a european consensus initiative between sarcoma patients euronet (spaen) and european organisation for research and treatment of cancer (eortc)/soft tissue and bone sarcoma group (stbsg) [J]. Annals of Oncology Official Journal of the European Society for Medical Oncology, 2017, 28(10): 2399-2408.
[8]	Abbonante F, Ribuffo D, Vitagliano T, et al. Abdominal desmoid tumors. A new reconstructive approach [J]. Annali Italiani Di Chirurgia, 2015, 86: 78-84.
[9]	Sheth PJ, Del moral S, Wilky BA, et al. Desmoid fibromatosis: MRI features of response to systemic therapy [J]. Skeletal Radiology, 2016, 45(10): 1365-1373.
[10]	Arpaci T, Tokat F, Arpaci R, et al. Primary pericardial extragastrointestinal stromal tumor: a case report and literature review [J]. Oncology Letters, 2015, 9(6): 2726-2728.
[11]	Anon. Desmoid-type fibromatosis in the head and neck: CT and MR imaging characteristics [J]. Neuroradiology, 2013, 55(3): 351-359.
[12]	Xu H, Koo HJ, Lim S, et al. Desmoid-type fibromatosis of the thorax [J]. Medicine, 2015, 94(38): e1547.
[13]	Walker EA, Petscavage JM, Brian PL, et al.Imaging features of superficial and deep fibromatoses in the adult population [J]. Sarcoma, 2012, 2012: 215810..
[14]	Hoda, Syed A. Enzinger and weiss's soft tissue tumors, 6th edition [J]. Advances in Anatomic Pathology, 2014, 21(3): 216.
[15]	Levy AD, Rimola J, Mehrotra AK, et al. Benign fibrous tumors and tumorlike lesions of the mesentery: radiologic-pathologic correlation1 [J]. Radiographics, 2006, 26(1): 245-264.
[16]	Okuno S. The enigma of desmoid tumors [J]. Current Treatment Options in Oncology, 2006, 7(6): 438-443.
[17]	Lynch HT, Fitzgibbons R. Surgery, desmoid tumors, and familial adenomatous polyposis: case report and literature review [J]. Am J Gastroenterol, 1997, 91(12): 2598-2601.
[18]	Anon. Desmoid-type fibromatosis: a front-line conservative approach to select patients for surgical treatment [J]. Ann Surg Oncol, 2009, 16(9): 2587-2593.
[19]	Penel N, Cesne AL, Bonvalot S, et al. Surgical versus non-surgical approach in primary desmoid-type fibromatosis patients: a nationwide prospective cohort from the french sarcoma group [J]. European Journal of Cancer, 2017, 83: 125-131.
[20]	Zhu H, Chen H, Zhang S, et al. Intra-abdominal fibromatosis: differentiation from gastrointestinal stromal tumour based on biphasic contrast-enhanced CT findings [J]. Clinical Radiology, 2013, 68(11): 1133-1139.
[21]	Kreuzberg B, Koudelova J, Ferda J, et al. Diagnostic problems of abdominal desmoid tumors in various locations [J]. Euro J Radiol, 2007, 62(2): 180-185.
[22]	郑晨，齐雪梅，梁长虎, 等. CT增强扫描在腹内型侵袭性纤维瘤病和胃肠道间质瘤鉴别诊断中的价值 [J]. 医学影像学杂志, 2017, 27(6): 1104-1108.
[23]	袁芬，刘震，李泽然, 等. CT增强鉴别诊断腹内型韧带样纤维瘤病与胃肠道间质瘤的价值 [J]. 医学影像学杂志, 2020, 30(3): 444-448.
[24]	程庆红，王嗣伟，盛茂. 腹内型侵袭性纤维瘤病与间质瘤的CT鉴别诊断 [J]. CT理论与应用研究, 2019, 28(2): 105-112.

CT征像		MAF（n=14）	GIST（n=39）	χ²值	P值
位置				10.473	0.001
	胃肠道	4	30
	胃肠道外	10	9
形态				9.192	0.004
	圆形/分叶状	4	29
	卵圆形/不规则形	10	10
边缘（周围脂肪间隙）				1.318	0.251^a
	清楚	7	28
	模糊	7	11
强化形式				12.458	0.000^a
	均匀强化	8	3
	不均匀强化	6	36
病灶内坏死、囊变				6.632	0.014
	有	3	24
	无	11	15
病灶内血管				3.38	0.115
	有	5	25
	无	9	14
病灶内积气				0.097	0.755^a
	有	2	9
	无	12	30
病灶内钙化				2.427	0.119^a
	有	0	9
	无	14	30

CT征像		MAF（n=14）	GIST（n=39）	χ²值	P值
位置				10.473	0.001
	胃肠道	4	30
	胃肠道外	10	9
形态				9.192	0.004
	圆形/分叶状	4	29
	卵圆形/不规则形	10	10
边缘（周围脂肪间隙）				1.318	0.251^a
	清楚	7	28
	模糊	7	11
强化形式				12.458	0.000^a
	均匀强化	8	3
	不均匀强化	6	36
病灶内坏死、囊变				6.632	0.014
	有	3	24
	无	11	15
病灶内血管				3.38	0.115
	有	5	25
	无	9	14
病灶内积气				0.097	0.755^a
	有	2	9
	无	12	30
病灶内钙化				2.427	0.119^a
	有	0	9
	无	14	30

CT测量值	MAF（n=14）	GIST（n=39）	t/Z值	P值
LD	10.2±3.9	7.7±4.8	-1.867	0.062^a
SD	6.7±2.3	6.5±3.7	0.16	0.873
LD/SD	1.52±0.31	1.16±0.14	5.919	0.000
DE（AP）	11.7±4.9	44.8±26.0	-3.774	0.000^a
DE（PP）	23.9±8.2	46.9±16.8	-2.876	0.004^a

CT测量值	MAF（n=14）	GIST（n=39）	t/Z值	P值
LD	10.2±3.9	7.7±4.8	-1.867	0.062^a
SD	6.7±2.3	6.5±3.7	0.16	0.873
LD/SD	1.52±0.31	1.16±0.14	5.919	0.000
DE（AP）	11.7±4.9	44.8±26.0	-3.774	0.000^a
DE（PP）	23.9±8.2	46.9±16.8	-2.876	0.004^a

CT征像	敏感度（%）	特异度（%）
胃肠外定位	10/14（71.4）	30/39（76.9）
外形（卵圆形＋不规则）	10/14（71.4）	29/39（74.4）
均匀强化	8/14（57.1）	36/39（92.3）
无坏死、囊变	11/14（78.6）	24/39（61.5）
LD/SD>1.19	13/14（92.9）	27/39（69.2）
动脉期强化程度（AP）≤22 HU	12/14（85.7）	31/39（79.5）
静脉期强化程度（PP）≤31 HU	10/14（71.4）	31/39（79.5）

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