Computed tomography features and predictive findings of ruptured gastrointestinal stromal tumours

Eur Radiol. 2017 Jun;27(6):2583-2590. doi: 10.1007/s00330-016-4515-z. Epub 2016 Oct 19.

Abstract

Objectives: To evaluate the CT features of ruptured GISTs and factors that might be predictive of rupture through comparison with CTs taken prior to rupture and CTs of non-ruptured GIST.

Methods: Forty-nine patients with ruptured GIST and forty-nine patients with non-ruptured GIST matched by age, gender and location were included. Clinical data including pharmacotherapy were reviewed. The imaging features were analyzed. Prior CT obtained before rupture were evaluated.

Results: The most common location of ruptured GIST was small bowel with mean size of 12.1 cm. Ruptured GIST commonly showed wall defects, >40 % eccentric necrosis, lobulated shaped, air density in mass, pneumoperitoneum, peritonitis, hemoperitoneum and ascites (p < 0.001-0.030). Twenty-seven of 30 patients with follow up imaging received targeted therapy. During follow-up, thickness of the tumour wall decreased. Increase in size and progression of necrosis were common during targeted therapy (p = 0.017). Newly developed ascites, peritonitis and hemoperitoneum was more common (p < 0.001-0.036).

Conclusion: Ruptured GISTs commonly demonstrate large size, >40 % eccentric necrosis, wall defects and lobulated shape. The progression of necrosis with increase in size and decreased wall thickness during targeted therapy may increase the risk of rupture. Rupture should be considered when newly developed peritonitis, hemoperitoneum, or ascites are noted during the follow-up.

Key points: • Ruptured GISTs demonstrate large size, eccentric necrosis, wall defects, and lobulated shape. • Rupture should be considered when peritonitis or hemoperitoneum/adjacent hematoma newly appears. • Progression of necrosis with increase in size increases the risk of rupture.

Keywords: Computed tomography; Diagnostic imaging; Gastrointestinal stromal tumours; Intestinal neoplasm; Rupture.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use
  • Ascites / diagnostic imaging
  • Ascites / etiology
  • Disease Progression
  • Female
  • Gastrointestinal Neoplasms / diagnostic imaging*
  • Gastrointestinal Neoplasms / drug therapy
  • Gastrointestinal Stromal Tumors / diagnostic imaging*
  • Gastrointestinal Stromal Tumors / drug therapy
  • Hematoma / diagnostic imaging
  • Hematoma / etiology
  • Hemoperitoneum / diagnostic imaging
  • Hemoperitoneum / etiology
  • Humans
  • Imatinib Mesylate / therapeutic use
  • Indoles / therapeutic use
  • Intestine, Small / pathology
  • Male
  • Middle Aged
  • Necrosis / etiology
  • Peritonitis / diagnostic imaging
  • Peritonitis / drug therapy
  • Pyrroles / therapeutic use
  • Rupture, Spontaneous
  • Sensitivity and Specificity
  • Sunitinib
  • Tomography, X-Ray Computed / methods
  • Tomography, X-Ray Computed / standards*
  • Young Adult

Substances

  • Antineoplastic Agents
  • Indoles
  • Pyrroles
  • Imatinib Mesylate
  • Sunitinib