Role of 18F-FDG PET/CT in restaging and follow-up of patients with GIST

  • Domenico AlbanoEmail author
  • Bonacina Mattia
  • Raffaele Giubbini
  • Francesco Bertagna
Hollow Organ GI



Gastrointestinal stromal tumor (GIST) is a rare tumor with high risk of recurrence and poor prognosis in case of advanced GIST. The aim of this study was to evaluate the possible role of 18F-FDG PET/CT in restaging GIST.


Fifty-four patients (30 male) with histological proven GIST underwent 100 18F-FDG PET/CT for restaging in suspected recurrence or during follow-up. Histopathology results and/or clinical/imaging follow-up for at least 12 months were considered as reference standard. Moreover, the diagnostic accuracy and clinical impact of 18F-FDG PET/CT were calculated.


Twenty-seven (27%) 18F-FDG PET/CT were positive, while the remaining 73 (73%) were negative. Sensitivity, specificity, PPV, NPV, and accuracy of PET/CT were 89% (95% CI 72–98%), 97% (95% CI 90–100%), 93% (95% CI 76–98%), 96% (95% CI 89–98%), and 95% (95% CI 89–98%). 18F-FDG PET/CT had a positive clinical impact in 18/100 studies changing the management, in 8 cases switching from local therapy to systemic therapy due to the detection of disseminate disease at PET/CT, in three cases recognizing relapse not detected by conventional imaging, and in 7 cases demonstrating to be true negative and avoiding unnecessary therapies.


18F-FDG PET/CT seems to be an accurate method for detection and localization of local and distant recurrence in GIST with good sensitivity and specificity and significant impact on clinical decision-making.




Compliance with ethical standards

Conflict of interests

The authors declare that they have no conflict of interest.


  1. 1.
    Soreide K, Sandvik OM, Soreide JA, Giljaca V, Jureckova A, Bulusu VR. Global epidemiology of gastrointestinal stromal tumours (GIST): A systematic review of population-based cohort studies. Cancer Epidemiol 2016;40:39–46.CrossRefGoogle Scholar
  2. 2.
    Agaram NP, Besmer P, Wong GC, Guo T, Socci ND, Maki RG, et al. Pathologic and Molecular Heterogeneity in Imatinib-Stable or Imatinib-Responsive Gastrointestinal Stromal Tumors. Clin Cancer Res 2007; 13: 170–181.CrossRefGoogle Scholar
  3. 3.
    Joensuu H. Gastrointestinal stromal tumor (GIST). Annals of Oncology 2006; 17: 280–286.CrossRefGoogle Scholar
  4. 4.
    Miettinen M, Lasota J. Gastrointestinal stromal tumors — definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Archiv 2001; 438: 1–12.CrossRefGoogle Scholar
  5. 5.
    Yan BM, Kaplan GG, Urbanski S, Nash CL, Beck PL: Epidemiology of gastrointestinal stromal tumors in a defined Canadian Health Region: a population-based study. Int J Surg Pathol 2008; 16: 241–250.CrossRefGoogle Scholar
  6. 6.
    Jamali F, Darwiche S, El-Kinge N, Tawil A, Sowed A. Disease progression following Imatinib failure in gastrointestinal stromal tumors: Role of surgical therapy. The Oncologist 2007; 12: 438–442.CrossRefGoogle Scholar
  7. 7.
    DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: Recurrence patterns and prognostic factors for survival. Ann Surg 2000; 231: 51–58.CrossRefGoogle Scholar
  8. 8.
    Parfitt J, Streutker C, Riddell R, Driman D. Gastrointestinal stromal tumors: A contemporary review. Pathology — Research and Practice 2006; 202: 837–847.Google Scholar
  9. 9.
    Goh BK, Chow PK, Chuah KL, Yap WM, Wong WK. Pathologic, radiologic and PET scan response of gastrointestinal stromal tumors after neoadjuvant treatment with imatinib mesylate. Eur J Surg Oncol 2006; 32: 961–963.CrossRefGoogle Scholar
  10. 10.
    Barnes G, Bulusu VR, Hardwick RH, Carroll N, Hatcher H, Earl HM, et al. A review of the surgical management of metastatic gastrointestinal stromal tumours (GISTs) on imatinib mesylate (Glivec). Int J Surg 2005; 3: 206–212.CrossRefGoogle Scholar
  11. 11.
    Verweij J, Casali PG, Zalcberg J, LeCesne A, Reichardt P, Blay JY, et al. Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial. Lancet 2004; 364: 1127–1134.CrossRefGoogle Scholar
  12. 12.
    Ponsaing L, Hansen MB. Therapeutic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol 2007; 13: 3316–3322.CrossRefGoogle Scholar
  13. 13.
    Scola D, Bahoura L, Copelan A, Shirkhoda A, Sokhandon F. Getting the GIST: a pictorial review of the various patterns of presentation of gastrointestinal stromal tumors on imaging. Abdom Radiol (NY) 2017;42:1350-64.CrossRefGoogle Scholar
  14. 14.
    Vernuccio F, Taibbi A, Picone D, et al. Imaging of Gastrointestinal Stromal Tumors: From Diagnosis to Evaluation of Therapeutic Response. Anticancer Res 2016;36:2639–48.PubMedGoogle Scholar
  15. 15.
    Albano D, Zizioli V, Treglia G, et al. Role of 18F-FDG PET/CT in restaging and follow-up of patients with uterine sarcomas. Rev Esp Med Nucl Imagen Mol. 2019;38:10–16PubMedGoogle Scholar
  16. 16.
    Albano D, Zizioli V, Odicino F, et al. Clinical and prognostic value of 18F-FDG PET/CT in recurrent endometrial carcinoma. Rev Esp Med Nucl Imagen Mol. 2019;38:87–93.CrossRefGoogle Scholar
  17. 17.
    Antoch G, Kanja J, Bauer S, Kuehl H, Renzing-Koehler K, Schuette J, et al. Comparison of PET, CT, and Dual-Modality PET/CT Imaging for Monitoring of Imatinib (STI571) Therapy in Patients with Gastrointestinal Stromal Tumors. J Nucl Med 2004;45:357–365.PubMedGoogle Scholar
  18. 18.
    Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Can Netw 2010;8 Suppl 2:S1–41.CrossRefGoogle Scholar
  19. 19.
    Bertagna F, Bosio G, Orlando E, Biasotto G, Giubbini R. Role of F-18-FDG-PET/CT in restaging of patients affected by gastrointestinal stromal tumours (GIST). Nucl Med Rev Cent East Eur. 2010;13:76–80.PubMedGoogle Scholar
  20. 20.
    Gayed I, Vu T, Iyer R, Johnson M, Macapinlac H, Swanston N, Podoloff D. The role of 18F-FDG PET in staging and early prediction of response to therapy of recurrent gastrointestinal stromal tumors. J Nucl Med. 2004;45:17–21.PubMedGoogle Scholar
  21. 21.
    American Joint Committee on Cancer. Gastrointestinal Stromal Tumor. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017:523.Google Scholar
  22. 22.
    Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 2002;33:459–65.CrossRefGoogle Scholar
  23. 23.
    Ponsaing L, Hansen MB. Therapeutic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol 2007; 13:3316–3322.CrossRefGoogle Scholar
  24. 24.
    Miyake KK, Nakamoto Y, Mikami Y, Tanaka S, Higashi T, Tadamura E, et al. The predictive value of preoperative 18F-fluorodeoxyglucose PET for postoperative recurrence in patients with localized primary gastrointestinal stromal tumour. Eur Radiol 2016;26:4664–4674.CrossRefGoogle Scholar
  25. 25.
    Stroobants S, Goeminne J, Seegers M, Dimitrijevic S, Dupont P, Nuyts J, et al. 18FDG-positron emission tomography for the early prediction of response in advanced soft tissue sarcoma treated with imatinib mesylate (Glivec). Eur J Cancer 2003; 39:2012–20.CrossRefGoogle Scholar
  26. 26.
    Jager PL, Gietema JA, van der Graaf WT. Imatinib mesylate for the treatment of gastrointestinal stromal tumours: best monitored with FDG PET. Nucl Med Commun 2004;25:433–438.CrossRefGoogle Scholar
  27. 27.
    Yoshikawa K, Shimada M, Kurita N, Sato H, Iwata T, Morimoto S et al. The efficacy of PET-CT for predicting the malignant potential of gastrointestinal stromal tumors. Surg Today 2013; 43: 1162–1167.CrossRefGoogle Scholar
  28. 28.
    Park JW, Cho CH, Jeong DS, Chae HD. Role of F-fluoro-2-deoxyglucose positron emission tomography in gastric GIST: predicting malignant potential pre-operatively. J Gastric Cancer. 2011;11:173–179.CrossRefGoogle Scholar
  29. 29.
    Kamiyama Y, Aihara R, Nakabayashi T, Mochiki E, Asao T, Kuwano H, et al. 18Ffluorodeoxyglucose positron emission tomography: useful technique for predicting malignant potential of gastrointestinal stromal tumors. World J Surg 2005;29:1429–1435.CrossRefGoogle Scholar
  30. 30.
    Yamada M, Niwa Y, Matsuura T, Miyahara R, Ohashi A, Maeda O, et al. Gastric GIST malignancy evaluated by 18FDG-PET as compared with EUS-FNA and endoscopic biopsy. Scand J Gastroenterol 2007;42:633–641.CrossRefGoogle Scholar
  31. 31.
    Cho MH, Park CK, Park M, Kim WK, Cho A, Kim H. Clinicopathologic Features and Molecular Characteristics of Glucose Metabolism Contributing to 18F-fluorodeoxyglucose Uptake in Gastrointestinal Stromal Tumors. Plos One 2015;10:e0141413.CrossRefGoogle Scholar
  32. 32.
    Goerres GW, Stupp R, Barghouth G, Hany TF, Pestalozzi B, Dizendorf E, et al. The value of PET, CT and in-line PET/CT in patients with gastrointestinal stromal tumours: long-term outcome of treatment with imatinib mesylate. Eur J Nucl Med Mol Imaging 2005;32:153–162.CrossRefGoogle Scholar
  33. 33.
    Prior JO, Montemurro M, Orcurto MV, Michielin O, Luthi F, Benhattar J, et al. Early prediction of response to sunitinib after imatinib failure by 18F-fluorodeoxyglucose positron emission tomography in patients with gastrointestinal stromal tumor. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2009; 27:439–45.CrossRefGoogle Scholar
  34. 34.
    Kaneta T, Takahashi S, Fukuda H, Arisaka, Oriuchi N, Hayashi T, et al. Clinical significance of performing 18F-FDG PET on patients with gastrointestinal stromal tumors: a summary of a Japanese multicenter study. Ann Nucl Med 2009;23:459–464.Google Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Nuclear Medicine, Spedali Civili BresciaBresciaItaly
  2. 2.Nuclear MedicineUniversity of Brescia and Spedali Civili BresciaBresciaItaly

Personalised recommendations