Abstract
The objective of this study was to report the CT and MRI appearances of primary and metastatic gastrointestinal stromal tumor (GIST). The clinical and imaging findings of 31 patients with histological and immunohistochemical diagnosis of GIST were reviewed. The CT and MRI findings were assessed independently for size, location, enhancement characteristics, and pattern of metastatic disease. The tumors were of enteric (n=13), gastric (n=12), duodenal (n=2), and rectal (n=3) origin. In one case the primary site was the mesentery, without involvement of bowel. Primary tumors were typically exophytic (79%), larger than 5 cm (84%), and inhomogeneously enhancing (84%). Central necrosis of all tumors (37%) and aneurysmal dilation of enteric tumors (33%) were less common. Metastases were most commonly to mesentery (26%) or liver (32%). Less common findings were ascites (7%) and omental caking (3%). Liver metastases were hypervascular in 92% of patients and rapidly became cystic following therapy with imatinib mesylate (Gleevec; Novartis, East Hanover, NJ, USA). Lung metastases, bowel obstruction, vascular invasion, and significant lymphadenopathy were not seen in any patient. GISTs have some specific CT findings which could help differentiate them from other gastrointestinal tumors. Liver metastases became cystic following therapy, mimicking simple cysts. MRI was better than single-phase CT for assessing liver metastases, while CT was more sensitive for mesenteric metastases.
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Croom KF, Perry CM (2003) Imatinib mesylate: in the treatment of gastrointestinal stromal tumours. Drugs 63(5):513–522
Miettinen M, Majidi M, Lasota J (2002) Pathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs): a review. Eur J Cancer 38[Suppl 5]:S39–S51
Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF (2000) Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol 7(9):705–712
Miettinen M, Furlong M, Sarlomo-Rikala M, Burke A, Sobin LH, Lasota J (2001) Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the rectum and anus: a clinicopathologic, immunohistochemical, and molecular genetic study of 144 cases. Am J Surg Pathol 25(9):1121–1133
Dematteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231(1):51–58
Plaat BE, Hollema H, Molenaar WM, Torn Broers GH, Pijpe J, Mastik MF, Hoekstra HJ, van den Berg E, Scheper RJ, van der Graaf WT (2000) Soft tissue leiomyosarcomas and malignant gastrointestinal stromal tumors: differences in clinical outcome and expression of multidrug resistance proteins. J Clin Oncol 18(18):3211–3220
Demetri GD, von Mehren M, Blanke CD, Van den Abbeele AD, Eisenberg B, Roberts PJ, Heinrich MC, Tuveson DA, Singer S, Janicek M, Fletcher JA, Silverman SG, Silberman SL, Capdeville R, Kiese B, Peng B, Dimitrijevic S, Druker BJ, Corless C, Fletcher CD, Joensuu H (2002) Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 347(7):472–480
Dagher R, Cohen M, Williams G, Rothmann M, Gobburu J, Robbie G, Rahman A, Chen G, Staten A, Griebel D, Pazdur R (2002) Approval summary: imatinib mesylate in the treatment of metastatic and/or unresectable malignant gastrointestinal stromal tumors. Clin Cancer Res 8(10):3034–3038
Clary BM, Dematteo RP, Lewis JJ, Leung D, Brennan MF (2001) Gastrointestinal stromal tumors and leiomyosarcoma of the abdomen and retroperitoneum: a clinical comparison. Ann Surg Oncol 8(4):290–299
Burkill GJ, Badran M, Al Muderis O, Meirion TJ, Judson IR, Fisher C, Moskovic EC (2003) Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread. Radiology 226(2):527–532
Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M (2003) From the archives of the AFIP: gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics 23(2):283–304
Chen MY, Bechtold RE, Savage PD (2002) Cystic changes in hepatic metastases from gastrointestinal stromal tumors (GISTs) treated with Gleevec (imatinib mesylate). Am J Roentgenol 179(4):1059–1062
Lau S, Tam KF, Kam CK, Lui CY, Siu CW, Lam HS, Mak KL (2004) Imaging of gastrointestinal stromal tumour (GIST). Clin Radiol 59(6):487–498
Lee CM, Chen HC, Leung TK, Chen YY (2004) Gastrointestinal stromal tumor: computed tomographic features. World J Gastroenterol 10(16):2417–2418
Takao H, Yamahira K, Doi I, Watanabe T (2004) Gastrointestinal stromal tumor of the retroperitoneum: CT and MR findings. Eur Radiol 14(10):1926–1929
Tateishi U, Hasegawa T, Satake M, Moriyama N (2003) Gastrointestinal stromal tumor: correlation of computed tomography findings with tumor grade and mortality. J Comput Assist Tomogr 27(5):792–798
Ghanem N, Altehoefer C, Furtwangler A, Winterer J, Schafer O, Springer O, Kotter E, Langer M (2003) Computed tomography in gastrointestinal stromal tumors. Eur Radiol 13(7):1669–1678
Bechtold RE, Chen MY, Stanton CA, Savage PD, Levine EA (2003) Cystic changes in hepatic and peritoneal metastases from gastrointestinal stromal tumors treated with Gleevec. Abdom Imaging 28(6):808–814
Miettinen M, Sarlomo-Rikala M, Lasota J (1998) Gastrointestinal stromal tumours. Ann Chir Gynaecol 87(4):278–281
Miettinen M, Sarlomo-Rikala M, Sobin LH, Lasota J (2000) Esophageal stromal tumors: a clinicopathologic, immunohistochemical, and molecular genetic study of 17 cases and comparison with esophageal leiomyomas and leiomyosarcomas. Am J Surg Pathol 24(2):211–222
Roberts PJ, Eisenberg B (2002) Clinical presentation of gastrointestinal stromal tumors and treatment of operable disease. Eur J Cancer 38[Suppl 5]:S37–S38
Fortman BJ (1999) Torricelli–Bernoulli sign in an ulcerating gastric leiomyosarcoma. Am J Roentgenol 173(1):199–200
Rioux M, Mailloux C (1997) Crescent-shaped necrosis: a new imaging sign suggestive of stromal tumor of the small bowel. Abdom Imaging 22(4):376–380
Dematteo RP, Heinrich MC, El Rifai WM, Demetri G (2002) Clinical management of gastrointestinal stromal tumors: before and after STI-571. Hum Pathol 33(5):466–477
Connolly EM, Gaffney E, Reynolds JV (2003) Gastrointestinal stromal tumours. Br J Surg 90(10):1178–1186
Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3(11):655–664
Cotrans RS, Kumar V, Collins T, Robbins SL (1999) Cellular pathology, I: cell injury and death. In: Cotrans RS, Kumar V, Collins T (eds) Robbins pathologic basis of disease. Saunders, Philadelphia, pp 1–29
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Sandrasegaran, K., Rajesh, A., Rushing, D.A. et al. Gastrointestinal stromal tumors: CT and MRI findings. Eur Radiol 15, 1407–1414 (2005). https://doi.org/10.1007/s00330-005-2647-7
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DOI: https://doi.org/10.1007/s00330-005-2647-7