Skip to main content
Erschienen in: European Radiology 7/2005

01.07.2005 | Gastrointestinal

Gastrointestinal stromal tumors: CT and MRI findings

verfasst von: Kumaresan Sandrasegaran, Arumugam Rajesh, Daniel A. Rushing, Jonas Rydberg, Fatih M. Akisik, John D. Henley

Erschienen in: European Radiology | Ausgabe 7/2005

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat Croom KF, Perry CM (2003) Imatinib mesylate: in the treatment of gastrointestinal stromal tumours. Drugs 63(5):513–522PubMed Croom KF, Perry CM (2003) Imatinib mesylate: in the treatment of gastrointestinal stromal tumours. Drugs 63(5):513–522PubMed
2.
Zurück zum Zitat 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–S51CrossRef 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–S51CrossRef
3.
Zurück zum Zitat Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF (2000) Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol 7(9):705–712PubMed Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF (2000) Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol 7(9):705–712PubMed
4.
Zurück zum Zitat 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):1121–1133CrossRefPubMed 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):1121–1133CrossRefPubMed
5.
Zurück zum Zitat 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):51–58CrossRefPubMed 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):51–58CrossRefPubMed
6.
Zurück zum Zitat 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):3211–3220PubMed 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):3211–3220PubMed
7.
Zurück zum Zitat 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):472–480CrossRefPubMed 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):472–480CrossRefPubMed
8.
Zurück zum Zitat 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 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
9.
Zurück zum Zitat 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 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
10.
Zurück zum Zitat 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):527–532PubMed 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):527–532PubMed
11.
Zurück zum Zitat 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):283–304PubMed 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):283–304PubMed
12.
Zurück zum Zitat 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 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
13.
Zurück zum Zitat 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 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
14.
Zurück zum Zitat Lee CM, Chen HC, Leung TK, Chen YY (2004) Gastrointestinal stromal tumor: computed tomographic features. World J Gastroenterol 10(16):2417–2418 Lee CM, Chen HC, Leung TK, Chen YY (2004) Gastrointestinal stromal tumor: computed tomographic features. World J Gastroenterol 10(16):2417–2418
15.
Zurück zum Zitat 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 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
16.
Zurück zum Zitat 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):792–798CrossRefPubMed 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):792–798CrossRefPubMed
17.
Zurück zum Zitat 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):1669–1678CrossRefPubMed 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):1669–1678CrossRefPubMed
18.
Zurück zum Zitat 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 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
19.
Zurück zum Zitat Miettinen M, Sarlomo-Rikala M, Lasota J (1998) Gastrointestinal stromal tumours. Ann Chir Gynaecol 87(4):278–281PubMed Miettinen M, Sarlomo-Rikala M, Lasota J (1998) Gastrointestinal stromal tumours. Ann Chir Gynaecol 87(4):278–281PubMed
20.
Zurück zum Zitat 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 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
21.
Zurück zum Zitat Roberts PJ, Eisenberg B (2002) Clinical presentation of gastrointestinal stromal tumors and treatment of operable disease. Eur J Cancer 38[Suppl 5]:S37–S38CrossRef Roberts PJ, Eisenberg B (2002) Clinical presentation of gastrointestinal stromal tumors and treatment of operable disease. Eur J Cancer 38[Suppl 5]:S37–S38CrossRef
22.
Zurück zum Zitat Fortman BJ (1999) Torricelli–Bernoulli sign in an ulcerating gastric leiomyosarcoma. Am J Roentgenol 173(1):199–200 Fortman BJ (1999) Torricelli–Bernoulli sign in an ulcerating gastric leiomyosarcoma. Am J Roentgenol 173(1):199–200
23.
Zurück zum Zitat 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 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
24.
Zurück zum Zitat 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):466–477CrossRefPubMed 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):466–477CrossRefPubMed
25.
Zurück zum Zitat Connolly EM, Gaffney E, Reynolds JV (2003) Gastrointestinal stromal tumours. Br J Surg 90(10):1178–1186 Connolly EM, Gaffney E, Reynolds JV (2003) Gastrointestinal stromal tumours. Br J Surg 90(10):1178–1186
26.
Zurück zum Zitat Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3(11):655–664CrossRefPubMed Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G (2002) Management of malignant gastrointestinal stromal tumours. Lancet Oncol 3(11):655–664CrossRefPubMed
27.
Zurück zum Zitat 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 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
Metadaten
Titel
Gastrointestinal stromal tumors: CT and MRI findings
verfasst von
Kumaresan Sandrasegaran
Arumugam Rajesh
Daniel A. Rushing
Jonas Rydberg
Fatih M. Akisik
John D. Henley
Publikationsdatum
01.07.2005
Erschienen in
European Radiology / Ausgabe 7/2005
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-005-2647-7

Weitere Artikel der Ausgabe 7/2005

European Radiology 7/2005 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.