Abstract
Gastrointestinal stromal tumor (GIST) frequently metastasizes to the liver, and conventional staging computed tomography (CT) protocols use multiphasic contrast enhancement for detection of hepatic lesions. We evaluated the sensitivity of arterial phase CT imaging for hepatic GIST metastases compared with that of standard (portal venous [PV]) phase imaging. We conducted a retrospective review of patients who presented with hepatic GIST metastases identified on staging CT examinations between 2005 and 2015. Arterial and PV phase CT images were randomized and reviewed by 2 radiologists blinded to clinical history, correlative imaging, and number of controls. In total, 32 patients had hepatic metastases identified on multiphasic (arterial and PV) staging CT examinations. There was no significant difference in identification of metastases between arterial and PV phase imaging (31 vs 32, P = .32). Lesion size measurements did not significantly differ (P = .58). Arterial phase CT imaging did not significantly increase the sensitivity for hepatic GIST metastases compared with PV phase imaging alone.
Highlights
Gastrointestinal stromal tumors (GISTs) account for 90% of mesenchymal tumors in the gastrointestinal tract with incidence of 14 –20 cases per million and prevalence of 130 cases per million [1,2,3]
This study aims to determine whether arterial phase imaging augments the sensitivity of standard portal venous (PV) phase imaging when evaluating for hepatic GIST metastases
Conventional literature and guidelines support the inclusion of arterial phase imaging for identification of hepatic metastases when staging GIST [9,10,11,12,13,14,15]
Summary
Gastrointestinal stromal tumors (GISTs) account for 90% of mesenchymal tumors in the gastrointestinal tract with incidence of 14 –20 cases per million and prevalence of 130 cases per million [1,2,3]. GISTs are generally considered to be hypervascular tumors [6, 7]. The literature suggests that arterial phase computed tomography (CT) imaging may be helpful for detection of hypervascular liver metastases [1, 8]. Conventional literature states that GIST metastases can become isoattenuating to liver parenchyma and occult on portal venous (PV) phase imaging, necessitating multiphasic enhanced CT imaging for detection [9,10,11,12,13,14]. Current consensus guidelines support the use of multiphasic enhanced CT to stage newly diagnosed GISTs but state that monophasic studies are adequate for follow-up evaluations [9,10,11,12,13,14,15]
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