Preliminary Diagnosis: Gastrointestinal Mesenchymal Tumor
I. What imaging technique is first-line for this diagnosis
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CT scan of the abdomen and pelvis with PO and IV contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of gastrointestinal mesenchymal tumor.
Advantages
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Relatively quick
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Highly sensitive and specific imaging modality in diagnosing a primary pathologic process and detecting any secondary complications
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May help one to evaluate the gastric mucosa for any evidence of ulcerations or exophytic or submucosal masses
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May help detail the extent of invasion and infiltration of the neoplastic process
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May help guide biopsy and treatment
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Offers exquisite detail of the surrounding anatomic structures including vascular, osseous, lymphatic, and soft tissue
Disadvantages
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Exposes patients to ionizing radiation
III. What are the contraindications for the first-line imaging technique?
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May be contraindicated in pregnant patients
IV. What alternative imaging techniques are available?
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Contrasted fluoroscopic guided upper gastrointestinal examination
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MR imaging
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PET/CT
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Ultrasound
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of gastrointestinal mesenchymal tumor.
Contrasted fluoroscopic guided upper gastrointestinal examination
Advantages
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Highly portable
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Relatively inexpensive imaging modality
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Better details the mucosa of the gastric neoplasm than other imaging modalities
Disadvantages
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Less sensitive and specific than other imaging modalities in detailing any primary gastric pathology and any secondary complications
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May expose patients to a large amount of ionizing radiation
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Does not guide treatment
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Highly operator dependent
MR imaging
Advantages
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Better details the soft tissue extension and infiltration of a primary gastric neoplasm than other imaging modalities
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Details any marrow involvement
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Does not expose patients to ionizing radiation
Disadvantages
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Expensive
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Time-consuming
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Requires significant patient cooperation to minimize motion artifact
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Less adept in detailing the mucosa and any mucosal irregularity compared to companion CT and contrasted fluoroscopic imaging
PET/CT
Advantages
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Highly sensitive and specific in detecting and detailing any primary gastric abnormality
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Highly sensitive to the smallest neoplastic process
Disadvantages
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Highly expensive imaging modality
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Exposes patients to ionizing radiation
Ultrasound
Advantages
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Highly portable
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Fast
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Relatively inexpensive imaging modality
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Does not expose patients to ionizing radiation
Disadvantages
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Highly operator dependent
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Far less sensitive and specific in detailing and detecting a primary gastric abnormality or detecting any secondary complications
VI. What are the contraindications for the alternative imaging techniques?
Contrasted fluoroscopic guided upper gastrointestinal examination
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May be contraindicated in pregnant patients
MR imaging
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Contraindicated in patients with non-MR compatible hardware
PET/CT
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May be contraindicated in pregnant patients
Ultrasound
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No specific contraindication to ultrasound exists
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