Korean J Radiol.  2004 Sep;5(3):157-163. 10.3348/kjr.2004.5.3.157.

Cystic Changes in Intraabdominal Extrahepatic Metastases from Gastrointestinal Stromal Tumors Treated with Imatinib

• Kim HC
• Lee JM
• Choi SH
• Han H
• Kim SS
• Lee SH
• Han JK
• Choi BI

• KMID: 1118820
• DOI: http://doi.org/10.3348/kjr.2004.5.3.157

Abstract

OBJECTIVE
This study was undertaken for the purpose of describing the CT features of intra-abdominal extra-hepatic metastases from gastrointestinal stromal tumors in patients who were treated with imatinib. MATERIALS AND METHODS: Eleven patients with intra-abdominal extra-hepatic metastases from gastrointestinal stromal tumors, who were treated with imatinib between May 2001 and December 2003, were included in this study. The clinical findings and CT scans were retrospectively reviewed. The metastatic lesions were assessed according to the location, size (greatest diameter), attenuation, and the enhancing pattern before and after imatinib treatment. RESULTS: Prior to the treatment, the sizes and attenuation values of the metastatic lesions ranged from 5 to 20 cm and from 63 to 131 H, respectively. The metastatic lesions showed a heterogeneous enhancement pattern on the contrast-enhanced CT scans. After the treatment, the metastatic lesions became smaller in all 11 patients, and the corresponding attenuation value ranged from 15 to 51 H. The metastatic lesions became homogeneous and cystic in appearance on the follow-up CT scans, mimicking ascites. CONCLUSION: Intra-abdominal extra-hepatic metastases of patients with gastrointestinal stromal tumors treated with imatinib may appear as well-circumscribed cystic lesions on contrast-enhanced CT. These metastases are likely to become smaller and resemble ascites, but may persist indefinitely on the follow-up CT.

Keyword

Gastrointestinal stromal tumor; Neoplasms, metastases; Abdomen, CT

MeSH Terms

Adult
Aged
Antineoplastic Agents/*therapeutic use
Contrast Media
Gastrointestinal Stromal Tumors/*pathology/surgery
Humans
Iohexol/*analogs & derivatives/diagnostic use
Liver Neoplasms/drug therapy/*radiography/secondary
Male
Middle Aged
Peritoneal Neoplasms/drug therapy/*radiography/secondary
Piperazines/*therapeutic use
Protein-Tyrosine Kinase/antagonists & inhibitors
Pyrimidines/*therapeutic use
Research Support, Non-U.S. Gov't
Retrospective Studies
Tomography, X-Ray Computed/methods

Figure

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  Fig. 1 A 34-year-old man with peritoneal seeding and liver metastases after resection of gastrointestinal stromal tumor of the duodenum. A. CT scan before treatment shows multiple heterogeneous masses (82 H) (M) compressing inferior vena cava (arrowhead) and superior mesenteric vein (arrow). Metastatic lesion in liver (curved arrow). B. CT scan obtained after 8 weeks of treatment with imatinib shows peritoneal and hepatic metastases that have decreased in size and density (35 H). Note the decompressed inferior vena cava and superior mesenteric vein and shrunk metastatic lesions in the liver. C. CT scan obtained 2 months after stopping imatinib therapy shows increased size and density of peritoneal and hepatic metastases. After resumption of imatinib therapy, the metastatic lesions showed cystic changes again (now shown).

• 

  Fig. 2 A 68-year-old man with peritoneal seeding after resection of gastrointestinal stromal tumor of the stomach. A. CT scan before treatment shows 15×13 cm heterogeneous metastatic lesion (81 H) (G) in left subphrenic space. Note small metastatic nodule (arrow) in right subphrenic space and ascites (15 H). B. CT scan obtained after 8 weeks of treatment with imatinib shows metastatic lesion (G) that has decreased in size to 8×6 cm and is cyst-like in appearance lesion (28 H) around spleen (S). Note the disappearance of the ascites. C. CT scan obtained after 13 months of treatment with imatinib shows 5×3.5 cm cystic lesion (20 H).

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  Fig. 3 A 52-year-old man with peritoneal seeding after resection of gastrointestinal stromal tumor of the mesentery. A. CT scan before treatment shows multiple peritoneal implants (arrows) in both paracolic gutters. B. CT scan obtained after 4 weeks of treatment with imatinib shows that the metastatic lesions in the right paracolic gutter have some solid components, while that in the left paracolic gutter resembles ascites.

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