Hyun Kyung Yang MD, Presenter: Nothing to Disclose

Young Hoon Kim MD, PhD, Abstract Co-Author: Nothing to Disclose

Yoon Jin Lee MD, Abstract Co-Author: Nothing to Disclose

Ji Hoon Park MD, Abstract Co-Author: Nothing to Disclose

Ji Young Kim MD, Abstract Co-Author: Nothing to Disclose

Kyoung Ho Lee MD, Abstract Co-Author: Nothing to Disclose

Hye Seung Lee MD, Abstract Co-Author: Nothing to Disclose

To describe the computed tomographic (CT) findings of leiomyoma and gastrointestinal stromal tumor (GIST) originated from the gastric cardia and to identify the features that differentiate each other.

The institutional review board of our institution approved this retrospective study and waived the requirement for patient informed consent. CT images of pathologically proved leiomyomas (n = 26) and GISTs (n = 19) in the gastric cardia were retrospectively reviewed. Analysis of the CT findings included evaluation of whether the tumor involved the esophagogastric junction (EGJ), contour, surface, border, growth pattern, enhancement pattern, and enhancement grade of the tumor, as well as the presence of low intralesional attenuation area, presence of calcification or hemorrhage and presence of surface dimple or ulcer. The attenuation of each lesion, the long diameter (LD), the short diameter (SD), and the LD/SD ratio were measured. Among these findings, statistically significant variables were determined by using the χ2 test (to compare the categorical variables), the Student t test (for quantitative analysis), and the receiver operating characteristic (ROC) curve (to determine the optimal cutoff of the LD/SD ratio and attenuation value).

EGJ involvement, homogeneous enhancement pattern, intermediate or low enhancement degree, absence of intralesional low attenuation and absence of surface dimple or ulcer were found significant for differentiating leiomyoma from GIST of the gastric cardia (P < .05 for each finding). LD/SD ratio >1.2 and attenuation value ≤71.2 HU yielded sensitivities of 84.6% and 61.5%, and specificities of 52.6% and 84.2%, respectively at ROC curve analysis. When at least three of these seven criteria were used in combination, the sensitivity and specificity for diagnosing leiomyoma were 100% (26 of 26) and 32% (6 of 19). When all seven criteria were used, the sensitivity and specificity were 8% (2 of 26) and 100% (19 of 19).

By using specific CT criteria, leiomyoma and GIST in the gastric cardia can be differentiated with a high degree of accuracy.

Knowledge of differentiating CT characters between the two submucosal tumors help avoiding unnecessary surgery or determining the appropriate surgical procedure.

Yang, H, Kim, Y, Lee, Y, Park, J, Kim, J, Lee, K, Lee, H, Leiomyoma of the Gastric Cardia: Differentiation from Gastrointestinal Stromal Tumor on CT.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007246.html