Abstract
Today, PET/CT is an essential diagnostic tool in the clinical assessment of GIST, mainly during follow-up. PET/CT is sensitive in the early detection of the pharmacological response to Imatinib Mesylate and it is specific in the follow-up of metastatic disease.
In 2004, Choi demonstrated that the information deriving from Multidetector CT (MDCT) and PET are complementary in the evaluation of GIST’s response to medical treatment. He showed a correlation between the enhancement intensity of the lesions after iodinated contrast medium (c.m.) injection, estimated in Hounsfield Units (HU), and the 2-[fluorine-18]fluoro-2deoxy-D-glucose(18F-FDG) uptake, measured with the SUV (Standardized Uptake Value).
These concepts, joined with Van den Abbeele’s concerns, determined a new version of the criteria used to demonstrate a ‘good response’ of GIST to the therapy. In 2007, Choi’s criteria for the evaluation of GIST were recognized as being more predictive (in terms of TTP, time-to-progression) than the RECIST criteria. Recently an increased number of publications in the literature revealed the improved clinical use of injected PET/CT. The evaluation of tomodensitometric parameters in residual disease (detection of density or vascularisation modifications, dimensional variations), combined with metabolic parameters (increased/decreased metabolic activity), allows an affordable diagnostic assessment of GIST.
In this chapter our goal is to describe the technique and clinical indications for the use of injected PET/CT in restaging after surgery and/or therapy. The PET/CT technique does not cause a significant increase in examination costs if related to the clinical advantages.
The combined examination may reduce imaging costs if implemented with other diagnostic resources for GIST assessment (MDCT and MRI) and it requires a synergy between radiology and nuclear medicine in diagnostic performance.
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Biscaldi, E., Piccardo, A., Rollandi, G.A. (2011). Contrast-enhanced PET/CT in the Follow-up of GISTs. In: de Lutio di Castelguidone, E., Messina, A. (eds) GISTs — Gastrointestinal Stromal Tumors. Springer, Milano. https://doi.org/10.1007/978-88-470-1869-3_8
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