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Gastrointestinal Stromal Tumor: Role of CT in Diagnosis and in Response Evaluation and Surveillance after Treatment with Imatinib¹

¹ From the Departments of Diagnostic Radiology (X.H., H.C., E.M.L., C.C.) and Sarcoma Medical Oncology (R.S.B., J.C.T.), Unit 57, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030. Recipient of a Certificate of Merit award for an education exhibit at the 2004 RSNA Annual Meeting. Received April 14, 2005; revision requested May 11 and received July 11; accepted July 11. H.C. and R.S.B. are consultants to and J.C.T. has received a research grant from the speakers bureau of Novartis Pharma, Basel, Switzerland; all other authors have no financial relationships to disclose. Address correspondence to H.C. (e-mail: hchoi{at}mdanderson.org).

Gastrointestinal stromal tumors (GISTs), which arise from the interstitial cells of Cajal, are the most common nonepithelial tumors of the gastrointestinal tract. It is now well known that imatinib, a new molecularly targeted tyrosine kinase receptor blocker, results in a dramatic response and markedly improved long-term survival in patients with GISTs. The increasing recognition of GISTs and the prolonged survival have made imaging increasingly important not only for diagnosis but also for monitoring the effects of treatment and detecting tumor progression. Computed tomography (CT) is the imaging modality of choice for these purposes. The imaging findings at initial presentation, during treatment, and at tumor progression were studied in 113 patients with primary and advanced GISTs before and up to 37 months after imatinib treatment. GISTs occur anywhere along the gastrointestinal tract, most commonly in the stomach and small bowel. At contrast material–enhanced CT, localized primary GISTs are typically exophytic, large, hypervascular masses. When the tumors respond to treatment, the changes in tumor size may initially vary; however, GISTs typically become homogeneous and hypoattenuating, with disappearance of enhancing tumor nodules and tumor vessels in the early posttreatment period. Development of a nodule within the treated tumor is unique to GISTs and indicates recurrence regardless of changes in tumor size.

© RSNA, 2006

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