With the evolution of immunochemical staining techniques and better imaging modalities with better image resolution and whole body coverage, gastrointestinal stromal tumor (GIST), the most common mesenchymal tumor of the gastrointestinal tract, is often encountered in clinical practice. Metastasis is common with malignant GIST and can be found in up to 50% of patients at presentation. Liver and peritoneum are the two most common sites of metastasis and accounted for 95% of cases. Lymphatics, bone and lung metastasis are rare. Malignant GIST with intracranial metastasis is even rarer, with only a few cases reported in the literature, and most of these had earlier metastasis elsewhere. Radiological features for GISTs are not specific but it does contribute to confirming early and accurate diagnosis of malignant GISTs by judging the tumor size, enhancement pattern and the invasion of adjacent structures. We report a case of a 26-year-old male with metastatic GIST to the liver and subsequently to the brain and skull vault. This is the first case reported in our locality and he is the youngest patient reported with this disease entity. The clinical progress, radiological features and the role of imaging will be discussed further in this paper. The radiological and clinical features of the primary tumor will specifically be addressed. The purpose of this paper is to enrich the current database of this rare disease entity and to alert both radiologists and clinicians about the imaging features of GIST with intracranial metastasis.
Adult ; Brain Neoplasms ; diagnostic imaging ; secondary ; Gastrointestinal Stromal Tumors ; complications ; diagnostic imaging ; Humans ; Male ; Radiography

To analyze the correlation of the CT imaging features and CT texture analysis (CTTA) parameters with risk stratifications of the gastric stromal tumors (GSTs).
 Methods: CT (plain scans with portal phase contrast enhanced scans) images from 98 GSTs patients before surgery were collected. CT features of the tumors were retrospectively analyzed and pathological risk stratifications were determined. Feature parameters of CTTA at plain and portal phase were obtained by using a MaZda software. The correlations of CT imaging features and CTTA parameters with the risk stratifications were analyzed.
 Results: CT imaging features including tumor size, growth pattern, shape, margin, the relationship between mass and adjacent organs, enhancement pattern, necrosis or cystic change, and the abnormal tumor vessels were associated with the risk stratifications (P<0.05). For CTTA, entropy was associated with the risk stratifications (P<0.05).
 Conclusion: Certain CT imaging features and CTTA parameters are associated with risk classifications in GSTs.
Gastrointestinal Stromal Tumors ; diagnostic imaging ; Humans ; Retrospective Studies ; Stomach Neoplasms ; diagnostic imaging ; Tomography, X-Ray Computed

Imaging study is the primary method to evaluate the efficacy of targeted therapy for gastrointestinal stromal tumor(GIST). The application of RECIST morphological criteria has limitations in the evaluation of targeted therapy, which may result in incorrect reflection of responses by conventional size-based criteria. Recent proposed Choi criteria, which combined the size and the CT value, has extended the application of radiology in the evaluation of GIST. The early change of apparent diffusion coefficient(ADC) values on diffusion-weighted imaging(DWI) can reflect the response of GIST to targeted therapy. The prominent change of ADC can be detected within one week after therapy. Through comprehensive analysis of the imaging characteristics associated with the biological behavior of GIST, new approaches may be developed in the evaluation of response of GIST to targeted therapy.
Diagnostic Imaging ; Diffusion Magnetic Resonance Imaging ; Gastrointestinal Stromal Tumors ; drug therapy ; Humans ; Prognosis ; Treatment Outcome

Both malignant tumors derived from gastrointestinal tract and metastasis from peritoneal spread, hematogenous dissemination and lymph node can lead to acute abdomen. Such acute abdomen patients have poor prognosis, high mortality, and complex clinical manifestations. It is difficult to make a correct diagnosis in clinical practice. Recent studies show that gastrointestinal tumors are associated with clinical emergency. Malignant gastrointestinal tumors mostly result in obstruction, so upper gastrointestinal contrast for gastric cancer and post-enhanced CT for colon cancer are recommended; gastrointestinal stromal tumors usually cause bleeding, so computed tomography angiography (CTA) is the first choice for examination; primary gastrointestinal lymphoma tends to cause perforation and usually occurs in small intestine, so CT is the first examination for patients with ischemic acute abdomen, and post-enhanced CT is essential to exclude small intestine carcinoid because of its rising incidence in recent years. The possibility of gastrointestinal metastasis should be kept in mind for patients with cancer presenting acute abdomen. This article focuses on the imaging features of common gastrointestinal tumors and their acute obstruction, perforation, and hemorrhage, and aims to improve the understanding of such symptoms in clinical practice so that correct diagnosis and treatment can be made in time.
Abdomen, Acute ; diagnostic imaging ; Carcinoid Tumor ; diagnostic imaging ; Gastrointestinal Stromal Tumors ; diagnostic imaging ; Humans ; Intestinal Neoplasms ; diagnostic imaging ; Intestines ; diagnostic imaging

Objective: Contrast-enhanced CT is an important method of preoperative diagnosis and evaluation for the malignant potential of gastric submucosal tumor (SMT). It has a high diagnostic accuracy rate in differentiating gastric gastrointestinal stromal tumor (GIST) with a diameter greater than 5 cm from gastric benign SMT. This study aimed to use deep learning algorithms to establish a diagnosis model (GISTNet) based on contrast-enhanced CT and evaluate its diagnostic value in distinguishing gastric GIST with a diameter ≤ 5 cm and other gastric SMT before surgery. Methods: A diagnostic test study was carried out. Clinicopathological data of 181 patients undergoing resection with postoperative pathological diagnosis of gastric SMT with a diameter ≤ 5 cm at Department of Gastrointestinal Surgery of Renji Hospital from September 2016 to April 2021 were retrospectively collected. After excluding 13 patients without preoperative CT or with poor CT imaging quality, a total of 168 patients were enrolled in this study, of whom, 107 were GIST while 61 were benign SMT (non-GIST), including 27 leiomyomas, 24 schwannomas, 6 heterotopic pancreas and 4 lipomas. Inclusion criteria were as follows: (1) gastric SMT was diagnosed by contrast-enhanced CT before surgery; (2) preoperative gastroscopic examination and biopsy showed no abnormal cells; (3) complete clinical and pathological data. Exclusion criteria were as follows: (1) patients received anti-tumor therapy before surgery; (2) without preoperative CT or with poor CT imaging quality due to any reason; (3) except GIST, other gastric malignant tumors were pathologically diagnosed after surgery. Based on the hold-out method, 148 patients were randomly selected as the training set and 20 patients as the test set of the GISTNet diagnosis model. After the GISTNet model was established, 5 indicators were used for evaluation in the test set, including sensitivity, specificity, positive predictive value, negative predictive value and the area under the receiver operating curve (AUC). Then GISTNet diagnosis model was compared with the GIST-risk scoring model based on traditional CT features. Besides, in order to compare the accuracy of the GISTNet diagnosis model and the imaging doctors in the diagnosis of gastric SMT imaging, 3 radiologists with 3, 9 and 19 years of work experience, respectively, blinded to clinical and pathological information, tested and judged the samples. The accuracy rate between the three doctors and the GISTNet model was compared. Results: The GISTNet model yielded an AUC of 0.900 (95% CI: 0.827-0.973) in the test set. When the threshold value was 0.345, the sensitivity specificity, positive and negative predictive values of the GISTNet diagnosis model was 100%, 67%, 75% and 100%, respectively. The accuracy rate of the GISTNet diagnosis model was better than that of the GIST-risk model and the manual readings from two radiologists with 3 years and 9 years of work experience (83% vs. 75%, 60%, 65%), and was close to the manual reading of the radiologist with 19 years of work experience (83% vs. 80%). Conclusion: The deep learning algorithm based on contrast-enhanced CT has favorable and reliable diagnostic accuracy in distinguishing gastric GIST with a diameter ≤ 5 cm and other gastric SMT before operation.
Deep Learning ; Diagnosis, Differential ; Gastrointestinal Stromal Tumors/diagnostic imaging* ; Humans ; Retrospective Studies ; Stomach Neoplasms/diagnostic imaging* ; Tomography, X-Ray Computed

Objective To investigate the performance of the combined model based on both clinicopathological features and CT texture features in predicting liver metastasis of high-risk gastrointestinal stromal tumors(GISTs). Methods The high-risk GISTs confirmed by pathology from January 2015 to December 2020 were analyzed retrospectively,including 153 cases from the Cancer Hospital of the University of Chinese Academy of Sciences and 51 cases from the Shaoxing Central Hospital.The cases were randomly assigned into a training set(n=142)and a test set(n=62)at a ratio of 7∶3.According to the results of operation or puncture,they were classified into a liver metastasis group(76 cases)and a non-metastasis group(128 cases).ITK-SNAP was employed to delineate the volume of interest of the stromal tumors.Least absolute shrinkage and selection operator(LASSO)was employed to screen out the effective features.Multivariate logistic regression was adopted to construct the models based on clinicopathological features,texture features extracted from CT scans,and the both(combined model),respectively.Receiver operating characteristic(ROC)curve and calibration curve were established to evaluate the predictive performance of the models.The area under the curve(AUC)was compared by Delong test. Results Body mass index(BMI),tumor size,Ki-67,tumor occurrence site,abdominal mass,gastrointestinal bleeding,and CA125 level showed statistical differences between groups(all P<0.05).A total of 107 texture features were extracted from CT images,from which 13 and 7 texture features were selected by LASSO from CT plain scans and CT enhanced scans,respectively.The AUC of the prediction with the training set and the test set respectively was 0.870 and 0.855 for the model based on clinicopathological features,0.918 and 0.836 for the model based on texture features extracted from CT plain scans,0.920 and 0.846 for the model based on texture features extracted from CT enhanced scans,and 0.930 and 0.889 for the combined model based on both clinicopathological features and texture features extracted from CT plain scans.Delong test demonstrated no significant difference in AUC between the models based on the texture features extracted from CT plain scans and CT enhanced scans(P=0.762),whereas the AUC of the combined model was significantly different from that of the clinicopathological feature-based model and texture feature-based model(P=0.001 and P=0.023,respectively). Conclusion Texture features extracted from CT plain scans can predict the liver metastasis of high-risk GISTs,and the model established with clinicopathological features combined with CT texture features has best prediction performance.
Gastrointestinal Stromal Tumors/diagnostic imaging* ; Humans ; Liver Neoplasms/diagnostic imaging* ; ROC Curve ; Retrospective Studies ; Tomography, X-Ray Computed/methods*

OBJECTIVETo investigate the features of tumor appearance on transabdominal color doppler ultrasonography (CDUS) and its diagnostic value in the differential diagnosis between intestinal stromal tumor and intestinal carcinoma.

METHODSThe preoperative features of the tumor mass on CDUS were reviewed retrospectively in 25 patients with intestinal stromal tumor and in 30 with intestinal carcinoma. All the cases were confirmed by surgery and pathological examination.

RESULTSOf the 25 cases with intestinal stromal tumor, 23 (92%) were found to be located in the small intestine and the majority presented as a hypoechoic solid mass with clear demarcation and rich color flow signals on CDUS, not growing around the intestinal cavity. A heterogeneous echogenic mass with anechoic space was shown in some stromal tumors. The CDUS showed that carcinoma were all in the colon or the rectum, and showed heterogeneous echoic solid masses with ill-defined margin, few color flow signals and pseudokidney sign was often observed in intestinal carcinoma because the mass grew around the intestinal cavity. Internal echo pattern, the relation between mass and intestinal cavity, and color doppler flow signal of intestinal stromal tumors were significantly different from those of intestinal carcinomas (all P<0.05). There were no statistical differences in lymphatic metastasis (P>0.05).

CONCLUSIONCDUS is an effective method to differentiate intestinal stromal tumor from carcinoma.

Adult ; Aged ; Carcinoma ; diagnostic imaging ; Diagnosis, Differential ; Gastrointestinal Stromal Tumors ; diagnostic imaging ; Humans ; Intestinal Neoplasms ; diagnostic imaging ; Middle Aged ; Retrospective Studies ; Ultrasonography, Doppler, Color

The aim of the present study was to investigate the diagnostic value of the contrast-enhanced ultrasonography for gastrointestinal stromal tumors (GISTs). The conventional transabdominal ultrasonography and contrast-enhanced ultrasonography using an intraluminal contrast agent were performed in 66 cases. The different diagnostic value between conventional transabdominal ultrasonography and contrast-enhanced hydrocolon ultrasonography was compared, including the depiction ratio and location accuracy. The morpholpgical features of GISTs were observed. The sensitivity of the contrast-enhanced hydrocolon ultrasonography in the depiction of the GISTs (57/66, 86.4%) was higher than that of the conventional transabdominal ultrasonography(33/66, 50%, P<0. 05). Furthermore, the accuracy of the contrast-enhanced ultrasonography in the location of the GISTs (52/57, 91. 2%) was higher than that of the conventional transabdominal ultrasonography (13/33, 39. 4%, P<0. 05). The GISTs with higher or lower risk have different ultrasonic features. The contrast-enhanced ultrasonography was a more valuable diagnostic method for GIST than the conventional transabdominal ultrasonography.
Adult ; Aged ; Contrast Media ; administration & dosage ; Endosonography ; methods ; Female ; Gastrointestinal Neoplasms ; diagnostic imaging ; Gastrointestinal Stromal Tumors ; diagnostic imaging ; Humans ; Male ; Middle Aged

OBJECTIVETo analyze the association between CT features and survival rate of GIST, and to elucidate the significance of CT features for prognosis.

METHODSClinical data of 38 patients with pathologically and immunohistochemically proven GISTs, including 11 patients at high biological risk, 13 at moderate risk, 10 at low risk and 4 at very low risk. Patients who underwent CT examination for primary tumors were included. Association between CT features and survival rate was examined.

RESULTSThe mean follow-up period of 38 cases was 42.6 months and the 3-year survival rate was 86.8%. Univariate analysis revealed that tumor growth pattern, diameter, lobulated shape, irregular margin, necrosis, ulceration, adjacent invasion, and liver metastasis were associated factors of 3-year survival rate. Circumference invasion and hepatic metastases predicted poor 3-year survival rate (P<0.05). Calcification and intensity were not associated with prognosis (P>0.05).

CONCLUSIONSCT can demonstrate the tumor growth pattern, size, shape, boundary, density, necrosis, hemorrhage, calcification, ulcer, enhance features and metastasis. CT can play an important role in estimating the survival rate of GIST.

Adult ; Aged ; Female ; Follow-Up Studies ; Gastrointestinal Neoplasms ; diagnostic imaging ; Gastrointestinal Stromal Tumors ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Prognosis ; Survival Rate ; Tomography, X-Ray Computed ; methods

Gastrointestinal stromal tumor (GIST) represents the most common intramural mesenchymal tumor of the gastrointestinal tract, but the synchronous occurrence of GIST in the stomach and gynecological cancer is rare. We present a unique case of a 56-year-old female patient who was diagnosed with the synchronous development of GIST and an isolated parenchymal splenic metastasis of ovarian cancer. She underwent a wide local excision of gastric lesions with splenectomy. A morphological (histological and immunohistochemical) study established a spindle-cell type of gastrointestinal tumor that expressed CD117, and a parenchymal recurrence of ovarian papillary serous adenocarcinoma. The patient has remained alive and disease-free for 30 months since the last operation. A small GIST concomitant with an isolated parenchymal splenic metastasis of ovarian cancer is rarely encountered. The coexistence of GIST with other malignancies constitutes an intriguing oncologic model. Surgeons are advised to be alert against possible primary GIST accompanying other neoplasms.
Female ; Gastrointestinal Stromal Tumors ; diagnostic imaging ; secondary ; Humans ; Middle Aged ; Ovarian Neoplasms ; complications ; Radiography ; Splenic Neoplasms ; secondary