Sonographic features of gastrointestinal leiomyosarcoma

US of gastrointestinal tract disease

The potential use of ultrasonography (US) in evaluating gut disease has been underappreciated in most diagnostic imaging departments in North America. The impression that US has a questionable role in bowel assessment is related to the operator-dependent nature of the modality, the technical challenges of performing bowel US examinations, and the lack of familiarity of radiologists and technologists with the US appearances of normal and abnormal bowel. However, with development of technical experience by the sonographer and integration of a clinical focus at patient evaluation, US can become a powerful tool for bowel assessment. Unlike computed tomography and magnetic resonance imaging, it provides a widely available, noninvasive, inexpensive method for evaluating the gut without the use of ionizing radiation. These factors are of particular importance in young patients and those who require recurrent follow-up imaging. Because US is performed with real-time imaging, the modality also allows the sonographer to view and assess the motility properties of the bowel, a feature that has not been previously used to its full potential. Color Doppler US can yield useful information about mural vascularity in bowel disease when used in conjunction with gray-scale findings and clinical symptoms. Radiologists should be familiar with the static and dynamic US appearances of the normal and abnormal bowel, recognize features of various pathologic conditions, and understand potential errors at imaging interpretation. Online supplemental material is available for this article.

Characterization of gastrointestinal tumors

Transabdominal ultrasonography is used increasingly for the evaluation of gastrointestinal disorders in small animals, including neoplasms such as lymphosarcoma, carcinoma, and smooth muscle tumors (leiomyoma, leiomyosarcoma). An updated summary of the clinical studies currently investigating the use of ultrasonography to detect and to characterize gastrointestinal neoplasia is presented in this article.

Assessment of abdominal sonography in the diagnosis of tumors of the gastroduodenal tract

This prospective study was conducted to assess the sensitivity, specificity, and predictive values of abdominal sonography for detecting tumors of the gastroduodenal tract. All examinations were carried out by the same sonographer who was unaware of endoscopic features and the results of X-ray examinations. The stomach was identified in 99% of the 423 patients examined. In fasting conditions, values were 64.6% and 72.4% using the 3.5-MHz and 7.5-MHz transducer, respectively, and increased up to 94.3% and 93.2% for fluid-filled stomachs. Of a total of 72 tumors identified by endoscopic examination, 56 were detected ultrasonographically. There were 16 false-negative and 3 false-positive results, for a sensitivity of 77.8% (95% CI, 66.4% to 86.7%), specificity of 99.1%, positive predictive value of 94.9%, and negative predictive value of 95.5%. Conventional ultrasound is a simple, rapid, and useful method to detect tumors of the gastroduodenal tract, particularly in the fluid-filled stomach. A high resolution is obtained with 7.5-MHz transducers, especially for tumors of the antropyloric region.

Leiomyosarcoma of the duodenum

Leiomyosarcoma of the duodenum is a rare disease and its characteristics have been described previously in the literature. We present a case of duodenal leiomyosarcoma, which was diagnosed by several imaging techniques prior to operation. Findings of computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, and angiography in this case are discussed.

Intramural hemorrhage simulating gastric neoplasm

We report a case of benign gastric ulcer with secondary extensive intramural hemorrhage causing a radiographic appearance consistent with a large ulcerated gastric neoplasm. This is the second such case reported and the first studied with sonography and computed tomographic scan. A brief review of the literature on intramural gastric hematoma is presented.