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CT Evaluation of the Response of Gastrointestinal Stromal Tumors After Imatinib Mesylate Treatment: A Quantitative Analysis Correlated with FDG PET Findings

¹ Department of Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030.
² Department of Sarcoma, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030.
³ Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030.

View larger version (21K): [in a new window]   Fig. 1. —Scatterplot shows sizes of 173 lesions in 36 patients during treatment. Change in absolute tumor size was small but statistically significant up to 8 months after treatment (p = 0.0070, linear regression analysis).

View larger version (11K): [in a new window]   Fig. 2. —Graph shows change in mean tumor size on CT images in 29 patients. Decrease in mean tumor size measured 2 months after treatment was significant (p = 0.0025, Student's t test; p = 0.0013, Wilcoxon's signed rank test).

View larger version (13K): [in a new window]   Fig. 3. —Graph shows change in mean glucose metabolism, or maximum standardized uptake value (SUVmax,) on FDG PET images in 29 patients. Decrease in mean SUVmax 2 months after treatment was significant (p < 0.0001, Student's t test; p < 0.0001, Wilcoxon's signed rank test).

View larger version (14K): [in a new window]   Fig. 4. —Graph shows change in mean tumor density in Hounsfield units in 29 patients. Decrease in mean Hounsfield units 2 months after treatment was significant (p < 0.0025, Student's t test; p < 0.0011, Wilcoxon's signed rank test).

View larger version (132K): [in a new window]   Fig. 5A. —51-year-old man with primary gastrointestinal stromal tumor in colon and recurrent disease with peritoneal metastases. Pretreatment CT scan (A) shows peritoneal mass (arrows, A) with relatively low density (42 H) corresponding to lesion with markedly increased glucose uptake (arrows, B) on FDG PET scan (B).

View larger version (91K): [in a new window]   Fig. 5B. —51-year-old man with primary gastrointestinal stromal tumor in colon and recurrent disease with peritoneal metastases. Pretreatment CT scan (A) shows peritoneal mass (arrows, A) with relatively low density (42 H) corresponding to lesion with markedly increased glucose uptake (arrows, B) on FDG PET scan (B).

View larger version (136K): [in a new window]   Fig. 5C. —51-year-old man with primary gastrointestinal stromal tumor in colon and recurrent disease with peritoneal metastases. and D, CT scan (C) obtained 2 months after treatment shows that mass has become larger (arrows, C). CT density (30 H), however, had decreased with no appreciable glucose uptake (arrows, D) seen on FDG PET scan (D), corresponding to clinical improvement.

View larger version (100K): [in a new window]   Fig. 5D. —51-year-old man with primary gastrointestinal stromal tumor in colon and recurrent disease with peritoneal metastases. CT scan (C) obtained 2 months after treatment shows that mass has become larger (arrows, C). CT density (30 H), however, had decreased with no appreciable glucose uptake (arrows, D) seen on FDG PET scan (D), corresponding to clinical improvement.

View larger version (158K): [in a new window]   Fig. 6A. —45-year-old man with recurrent gastrointestinal stromal tumor of small-bowel mesentery and hepatic metastasis. Pretreatment CT scan (A) shows hyperdense (87 H) mesenteric mass (arrows, A) in region of previous surgery corresponding to lesion with markedly increased glucose uptake (arrows, B) on FDG PET scan (B).

View larger version (90K): [in a new window]   Fig. 6B. —45-year-old man with recurrent gastrointestinal stromal tumor of small-bowel mesentery and hepatic metastasis. Pretreatment CT scan (A) shows hyperdense (87 H) mesenteric mass (arrows, A) in region of previous surgery corresponding to lesion with markedly increased glucose uptake (arrows, B) on FDG PET scan (B).

View larger version (154K): [in a new window]   Fig. 6C. —45-year-old man with recurrent gastrointestinal stromal tumor of small-bowel mesentery and hepatic metastasis. CT scan obtained 2 months after treatment shows that mass (arrows) has significantly decreased in both density (29 H) and size.

View larger version (76K): [in a new window]   Fig. 6D. —45-year-old man with recurrent gastrointestinal stromal tumor of small-bowel mesentery and hepatic metastasis. FDG PET scan obtained 2 months after treatment shows no appreciable glucose uptake (arrows). On images obtained 4 months after treatment (not shown), mass had further decreased in size and density and has since remained stable.

View larger version (155K): [in a new window]   Fig. 6E. —45-year-old man with recurrent gastrointestinal stromal tumor of small-bowel mesentery and hepatic metastasis. Photomicrograph of mesenteric mass resected at 7 months after treatment shows gross replacement of tumor by myxoid degeneration (light pink) with only microscopic viable tumor (arrows). (H and E, x40)

View larger version (123K): [in a new window]   Fig. 7A. —68-year-old man with primary gastrointestinal stromal tumor of stomach and recurrent disease with hepatic and peritoneal metastases. Pretreatment CT scan shows large mesenteric and hepatic masses on late arterial phase image, with hyperdense tumor nodules (arrows) along periphery. Notice multiple prominent tumor vessels (arrowheads).

View larger version (121K): [in a new window]   Fig. 7B. —68-year-old man with primary gastrointestinal stromal tumor of stomach and recurrent disease with hepatic and peritoneal metastases. CT scan obtained 2 months after treatment shows that lesions (arrows) have become significantly hypodense, and peripheral tumor nodules and tumor vessels are no longer detectable.

View larger version (146K): [in a new window]   Fig. 8A. —56-year-old man with newly diagnosed gastrointestinal stromal tumor of jejunum with hepatic and peritoneal metastases. Pretreatment CT scan shows multiple diffuse (arrowhead) or rim-enhancing (arrows) lesions.

View larger version (82K): [in a new window]   Fig. 8B. —56-year-old man with newly diagnosed gastrointestinal stromal tumor of jejunum with hepatic and peritoneal metastases. FDG PET scan obtained 3 days after A shows no appreciable glucose uptake.

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