CT Scoring System of Middleton et al for Desmoid Precursor Lesions in a Patient with Familial Adenomatous Polyposis

Description

Middleton et al developed a scoring system for staging desmoid and desmoid precursor lesions in the mesentery of patients with familial adenomatous polyposis (FAP). This can help to monitor the stepwise progression of the condition. The authors are from St. Mark's Hospital, Northwick Park Hospital and St. Bartholomew's Hospital in England.

Patient selection: familial adenomatous polyposis (FAP)

Analysis: periodic CT imaging of mesentery, usually after an initial surgery

Parameters:

(1) perivascular thickening

(2) mesenteric stranding

(3) whorled mesenteric thickening

(4) mesenteric mass (desmoid)

Perivascular Thickening	Mesenteric Stranding	Whorled Mesenteric Thickening	Mesenteric Mass	Score
absent	absent	absent	absent	1
present	absent	absent	absent	2
NA	present	absent	absent	3
NA	NA	present	absent	4
NA	NA	NA	present	5

Additional findings:

(1) bowel tethering

(2) ureteral involvement

Scores 3 and 4 indicates mesenteric fibromatosis.

Score 5 indicates desmoid tumor.

In the classic case there is progression of lesions from mesenteric fibrosis to desmoid tumor.

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Description

Specialty

ICD-10