CT and MRI of Gastrointestinal Stromal Tumours: New Trends and Perspectives

Abstract

Gastrointestinal stromal tumors (GISTs) are defined as mesenchymal tumors of the gastrointestinal tract that express positivity for CD117, which is a c- KIT proto-oncogene antigen. Expression of the c- KIT protein, a tyrosine kinase growth factor receptor, allows the distinction between GISTs and other mesenchymal tumors such as leiomyoma, leiomyosarcoma, schwannoma and neurofibroma. GISTs can develop anywhere in the gastrointestinal tract, as well as in the mesentery and omentum. Over the years, the management of GISTs has improved due to a better knowledge of their behaviors and risk or recurrence, the identification of specific mutations and the use of targeted therapies. This has resulted in a better prognosis for patients with GISTs. In parallel, imaging of GISTs has been revolutionized by tremendous progress in the field of detection, characterization, survival prediction and monitoring during therapy. Recently, a particular attention has been given to radiomics for the characterization of GISTs using analysis of quantitative imaging features. In addition, radiomics has currently many applications that are developed in conjunction with artificial intelligence with the aim of better characterizing GISTs and providing a more precise assessment of tumor burden. This article sums up recent advances in computed tomography and magnetic resonance imaging of GISTs in the field of image/data acquisition, tumor detection, tumor characterization, treatment response evaluation, and preoperative planning.

Cinematic Rendering of Gastrointestinal Stromal Tumours: A Review of Current Possibilities and Future Developments

“…GISTs can be differentiated from other tumours using CT. 7,10,18,21,22 Several CT features such as submucosal origin of the tumour, extraluminal and exophytic growth, marked enhancement on arterial phase images, and early venous drainage are suggestive of the diagnosis of GIST. [3][4][5]30 GISTs most frequently originate from the muscularis propria. 2 Owing to the use of original high-resolution CT data, CR helps demonstrate the submucosal location of GIST (Figures 1 and 2).…”

“…2 In addition, GISTs can be submucosal, subserosal, or intraluminal, and this explains high variability in imaging features. [3][4][5] Finally, GISTs can be found in a variety of scenarios including chronic anemia secondary to chronic bleeding, acute gastrointestinal bleeding due to mucosal ulceration, spontaneous tumour rupture in case of larger GIST, or gastrointestinal obstruction secondary to intussusception. [5][6][7] Computed tomography (CT) is the most commonly used imaging technique for the assessment of GISTs.…”

“…[5][6][7] Computed tomography (CT) is the most commonly used imaging technique for the assessment of GISTs. 4,5,[7][8][9] CT provides crucial information that can suggest the diagnosis of GIST. 5,10 Due to the location of GISTs in the abdomen along with imaging features that overlap with those of other gastrointestinal conditions, the diagnosis of GIST with axial images only is not always straightforward.…”

Imaging of Gastrointestinal Stromal Tumours: The Next Wave of Radiology

“…At first glance, the article by Barat et al might appear to be a classic review on the use of CT and MRI imaging for the evaluation of gastrointestinal stromal tumours (GISTs). 1 We might expect the article to review the CT and MRI appearances of these unique tumours focusing on tumour size, location, and imaging characteristics. These findings would typically include enhancement patterns, the presence of calcification, as well as luminal location, and would be discussed as a way of distinguishing these tumours from other tumours including lymphoma, adenocarcinoma, and metastases.…”

“…Barat et al also focus on data acquisition and how dual-energy CT may play a role in monitoring response to therapy and determining when response to therapy is not successful before traditional modes of monitoring. 1 Dual-energy CT has improved the capability of material decomposition compared to conventional CT, which can potentially enhance our ability to detect subtle histologic changes during treatment. The authors also highlight the potential of cinematic rendering with texture mapping as a post-processing tool for analysis of GIST tumours.…”