European Radiology

, Volume 27, Issue 6, pp 2583–2590 | Cite as

Computed tomography features and predictive findings of ruptured gastrointestinal stromal tumours

  • Jin Sil Kim
  • Hyun Jin Kim
  • Seong Ho Park
  • Jong Seok Lee
  • Ah Young Kim
  • Hyun Kwon Ha
Gastrointestinal
  • 343 Downloads

Abstract

Objectives

To evaluate the CT features of ruptured GISTs and factors that might be predictive of rupture through comparison with CTs taken prior to rupture and CTs of non-ruptured GIST.

Methods

Forty-nine patients with ruptured GIST and forty-nine patients with non-ruptured GIST matched by age, gender and location were included. Clinical data including pharmacotherapy were reviewed. The imaging features were analyzed. Prior CT obtained before rupture were evaluated.

Results

The most common location of ruptured GIST was small bowel with mean size of 12.1 cm. Ruptured GIST commonly showed wall defects, >40 % eccentric necrosis, lobulated shaped, air density in mass, pneumoperitoneum, peritonitis, hemoperitoneum and ascites (p < 0.001–0.030). Twenty-seven of 30 patients with follow up imaging received targeted therapy. During follow-up, thickness of the tumour wall decreased. Increase in size and progression of necrosis were common during targeted therapy (p = 0.017).

Newly developed ascites, peritonitis and hemoperitoneum was more common (p < 0.001–0.036).

Conclusion

Ruptured GISTs commonly demonstrate large size, >40 % eccentric necrosis, wall defects and lobulated shape. The progression of necrosis with increase in size and decreased wall thickness during targeted therapy may increase the risk of rupture. Rupture should be considered when newly developed peritonitis, hemoperitoneum, or ascites are noted during the follow-up.

Key points

Ruptured GISTs demonstrate large size, eccentric necrosis, wall defects, and lobulated shape.

Rupture should be considered when peritonitis or hemoperitoneum/adjacent hematoma newly appears.

Progression of necrosis with increase in size increases the risk of rupture.

Keywords

Gastrointestinal stromal tumours Rupture Computed tomography Diagnostic imaging Intestinal neoplasm 

Notes

Acknowledgments

The scientific guarantor of this publication is Hyun Jin Kim. The authors of this manuscript declare norelationships with any companies, whose products or services may be related to the subject matter ofthe article. The authors state that this work has not received any funding. No complex statisticalmethods were necessary for this paper. Institutional Review Board approval was obtained. Writteninformed consent was waived by the Institutional Review Board. Methodology: retrospective,diagnostic or prognostic study, performed at one institution.

References

  1. 1.
    Hirota S, Isozaki K, Moriyama Y et al (1998) Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 279:577–580CrossRefPubMedGoogle Scholar
  2. 2.
    Yang J, Yu J, Ma Z, Kang W, Tian S, Ye X (2015) Clinical pathological features and prognosis analysis of gastrointestinal stromal tumor: a series of 558 cases. Zhonghua Wai Ke Za Zhi 53:274–279PubMedGoogle Scholar
  3. 3.
    Demetri GD, von Mehren M, Blanke CD et al (2002) Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 347:472–480CrossRefPubMedGoogle Scholar
  4. 4.
    Hohenberger P, Ronellenfitsch U, Oladeji O et al (2010) Pattern of recurrence in patients with ruptured primary gastrointestinal stromal tumour. Br J Surg 97:1854–1859CrossRefPubMedGoogle Scholar
  5. 5.
    Baheti AD, Shinagare AB, O'Neill AC et al (2015) MDCT and clinicopathological features of small bowel gastrointestinal stromal tumours in 102 patients: a single institute experience. Br J Radiol 88:20150085CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Chok AY, Goh BK, Koh YX et al (2015) Validation of the MSKCC Gastrointestinal Stromal Tumor Nomogram and Comparison with Other Prognostication Systems: Single-Institution Experience with 289 Patients. Ann Surg Oncol 22:3597–3605CrossRefPubMedGoogle Scholar
  7. 7.
    Cegarra-Navarro MF, de la Calle MA, Girela-Baena E, Garcia-Santos JM, Lloret-Estan F, de Andres EP (2005) Ruptured gastrointestinal stromal tumors: radiologic findings in six cases. Abdom Imaging 30:535–542CrossRefPubMedGoogle Scholar
  8. 8.
    Pinaikul S, Woodtichartpreecha P, Kanngurn S, Leelakiatpaiboon S (2014) 1189 Gastrointestinal stromal tumor (GIST): computed tomographic features and correlation of CT findings with histologic grade. J Med Assoc Thai 97:1189–1198PubMedGoogle Scholar
  9. 9.
    Arolfo S, Teggia PM, Nano M (2011) Gastrointestinal stromal tumors: thirty years experience of an institution. World J Gastroenterol 17:1836–1839CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Hasegawa T, Matsuno Y, Shimoda T, Hirohashi S (2002) Gastrointestinal stromal tumor: consistent CD117 immunostaining for diagnosis, and prognostic classification based on tumor size and MIB-1 grade. Hum Pathol 33:669–676CrossRefPubMedGoogle Scholar
  11. 11.
    Zhou C, Duan X, Zhang X, Hu H, Wang D, Shen J (2015) Predictive features of CT for risk stratifications in patients with primary gastrointestinal stromal tumour. Eur Radiol 1–8Google Scholar
  12. 12.
    Tirumani SH, Shinagare AB, O’Neill AC, Nishino M, Rosenthal MH, Ramaiya NH (2016) Accuracy and feasibility of estimated tumour volumetry in primary gastric gastrointestinal stromal tumours: validation using semiautomated technique in 127 patients. Eur Radiol 26:286–295CrossRefPubMedGoogle Scholar
  13. 13.
    Rezai P, Pisaneschi MJ, Feng C, Yaghmai V (2013) A radiologist's guide to treatment response criteria in oncologic imaging: Functional, molecular, and disease-specific imaging biomarkers. Am J Roentgenol 201:246–256CrossRefGoogle Scholar
  14. 14.
    Yang TH, Hwang JI, Yang MS et al (2007) Gastrointestinal stromal tumors: computed tomographic features and prediction of malignant risk from computed tomographic imaging. J Chin Med Assoc 70:367–373CrossRefPubMedGoogle Scholar
  15. 15.
    Sandrasegaran K, Rajesh A, Rushing DA, Rydberg J, Akisik FM, Henley JD (2005) Gastrointestinal stromal tumors: CT and MRI findings. Eur Radiol 15:1407–1414CrossRefPubMedGoogle Scholar
  16. 16.
    Lee NK, Kim S, Kim GH et al (2010) Hypervascular subepithelial gastrointestinal masses: CT-pathologic correlation. Radiographics 30:1915–1934CrossRefPubMedGoogle Scholar
  17. 17.
    Dematteo RP, Heinrich MC, El-Rifai WM, Demetri G (2002) Clinical management of gastrointestinal stromal tumors: before and after STI-571. Hum Pathol 33:466–477CrossRefPubMedGoogle Scholar
  18. 18.
    Komatsu Y, Ohki E, Ueno N et al (2015) Safety, efficacy and prognostic analyses of sunitinib in the post-marketing surveillance study of Japanese patients with gastrointestinal stromal tumor. Jpn J Clin Oncol. doi: 10.1093/jjco/hyv126 PubMedCentralGoogle Scholar
  19. 19.
    Kim R, Emi M, Arihiro K, Tanabe K, Uchida Y, Toge T (2005) Chemosensitization by STI571 targeting the platelet‐derived growth factor/platelet‐derived growth factor receptor‐signaling pathway in the tumor progression and angiogenesis of gastric carcinoma. Cancer 103:1800–1809CrossRefPubMedGoogle Scholar
  20. 20.
    El-Kenawi AE, El-Remessy AB (2013) Angiogenesis inhibitors in cancer therapy: mechanistic perspective on classification and treatment rationales. Br J Pharmacol 170:712–729CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kamba T, McDonald D (2007) Mechanisms of adverse effects of anti-VEGF therapy for cancer. Br J Cancer 96:1788–1795CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Kim KW, Shinagare AB, Krajewski KM et al (2015) Fluid retention associated with imatinib treatment in patients with gastrointestinal stromal tumor: quantitative radiologic assessment and implications for management. Korean J Radiol 16:304–313CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Misawa S, Takeda M, Sakamoto H, Kirii Y, Ota H, Takagi H (2014) Spontaneous rupture of a giant gastrointestinal stromal tumor of the jejunum: a case report and literature review. World J Surg Oncol 12:153CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Hamrick-Turner JE, Chiechi MV, Abbitt PL, Ros PR (1992) Neoplastic and inflammatory processes of the peritoneum, omentum, and mesentery: diagnosis with CT. Radiographics 12:1051–1068CrossRefPubMedGoogle Scholar
  25. 25.
    (2014) Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 25 Suppl 3:iii21–26Google Scholar

Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Jin Sil Kim
    • 1
  • Hyun Jin Kim
    • 1
  • Seong Ho Park
    • 1
  • Jong Seok Lee
    • 1
  • Ah Young Kim
    • 1
  • Hyun Kwon Ha
    • 1
  1. 1.Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of MedicineSongpa-GuKorea

Personalised recommendations