Gastrointestinal stromal tumors (GIST): a proposal of a “CT-based predictive model of Miettinen index” in predicting the risk of malignancy

  • M. A. Mazzei
  • N. Cioffi Squitieri
  • C. Vindigni
  • S. GuerriniEmail author
  • F. Gentili
  • G. Sadotti
  • P. Mercuri
  • L. Righi
  • G. Lucii
  • F. G. Mazzei
  • D. Marrelli
  • L. Volterrani
Hollow Organ GI



To identify the predictors of malignancy on CT for the evaluation of gastrointestinal stromal tumors (GIST) by correlating CT findings with the mitotic index in order to propose a “CT-based predictive model of Miettinen index.”


One radiologist and one resident in radiology with 14- and 4-year experience in oncological field reviewed the CT findings of 42 patients by consensus, with respect to lesion site, size, contour, tumor growth pattern, enhancing pattern, degree of enhancement of tumor, percentage of tumor necrosis, mesenteric fat infiltration, ulceration, calcification, regional lymphadenopathy, direct invasion to adjacent organs, and distant metastasis. All parameters were correlated with the mitotic index evaluated at histopathological analysis following surgery. Normality of variables was evaluated using Shapiro–Wilk test. Pearson’s correlation test was used to assess the interaction between variables. The diagnostic accuracy percentage of tumor necrosis was measured by receiver operating characteristic (ROC) analysis for detecting whether the number of mitosis per 50 high-power fields was > 5.


A significant statistical correlation was found between percentage of tumor necrosis and the mitotic index (p < 0.005), dimension, and location of the tumor.


CT could be an accurate technique in the prediction of malignancy of GIST in a CT risk assessment system, based on the location of the tumor, its size, and the percentage of tumor necrosis.


Computed tomography Gastrointestinal stromal tumor Gastric GIST Mitotic index 



A preliminary research with the title “Gastrointestinal stromal tumors of the stomach: CT percentage of tumor necrosis and prediction of malignancy” was presented as conference abstract at ECR 2015, Book of Abstracts—B—Scientific Sessions and Late-Breaking Clinical Trials.


No funding was obtained for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local institutional review board.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • M. A. Mazzei
    • 1
  • N. Cioffi Squitieri
    • 2
  • C. Vindigni
    • 3
  • S. Guerrini
    • 2
    Email author
  • F. Gentili
    • 4
  • G. Sadotti
    • 1
  • P. Mercuri
    • 1
  • L. Righi
    • 5
  • G. Lucii
    • 1
  • F. G. Mazzei
    • 4
  • D. Marrelli
    • 6
  • L. Volterrani
    • 1
  1. 1.Department of Medical, Surgical and Neuro Sciences, Diagnostic ImagingUniversity of Siena, Azienda Ospedaliera Universitaria SeneseSienaItaly
  2. 2.Department of Diagnostic Imaging and Laboratory Medicine, Diagnostic Imaging Unit, Azienda USL Toscana SUD-ESTMisericordia HospitalGrossetoItaly
  3. 3.Division of PathologyAzienda Ospedaliera Universitaria SeneseSienaItaly
  4. 4.Diagnostic ImagingAzienda Ospedaliera Universitaria SeneseSienaItaly
  5. 5.Department of Molecular and Developmental MedicineUniversity of Siena, Azienda Ospedaliera Universitaria SeneseSienaItaly
  6. 6.Unit of General Surgery and Surgical OncologyAzienda Ospedaliera Universitaria Senese, University of SienaSienaItaly

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