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Gastrointestinal Stromal Tumors Treated with Imatinib: Monitoring Response with Contrast-Enhanced Sonography

Nathalie Lassau1, Michele Lamuraglia1,2, Linda Chami1, Jerome Leclère1, Sylvie Bonvalot3, Philippe Terrier4, Alain Roche1 and Axel Le Cesne5

1 Department of Medical Imaging, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
2 Section of Internal Medicine, Department of Internal Medicine and Public Medicine, University of Bari, Bari, Italy.
3 Department of Surgery, Institut Gustave Roussy, Villejuif, France.
4 Department of Pathology, Institut Gustave Roussy, Villejuif, France.
5 Department of Medicine, Institut Gustave Roussy, Villejuif, France.


Figure 1
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  		Fig. 1A —Hepatic metastasis from gastrointestinal stromal tumor in 69-year-old man. Sonogram on day before treatment (day-1) shows tumor measuring 53 x 51 x 49 mm in liver segments VI-VII.

 

Figure 2
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  		Fig. 1B —Hepatic metastasis from gastrointestinal stromal tumor in 69-year-old man. Contrast-enhanced Doppler sonogram at day-1 shows tumor vascularization. On selected single 2D image, percentage of tumor surface taking up contrast agent was visually evaluated at approximately 80% when contrast uptake was maximal.

 

Figure 3
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  		Fig. 1C —Hepatic metastasis from gastrointestinal stromal tumor in 69-year-old man. On same selected image as B, lesion has been outlined and percentage of pixels exhibiting signal enhancement by contrast agent (yellow) was quantified using Photoshop software (Adobe) as 87%.

 

Figure 4
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  		Fig. 1D —Hepatic metastasis from gastrointestinal stromal tumor in 69-year-old man. At day 1, percentage of tumor contrast uptake was 35%, indicating early good response.

 

Figure 5
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  		Fig. 1E —Hepatic metastasis from gastrointestinal stromal tumor in 69-year-old man. At 2 months, percentage of contrast uptake was 2%, confirming good response.

 

Figure 6
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  		Fig. 2A —Two hepatic metastases from gastrointestinal stromal tumor in 72-year-old woman. Doppler sonogram after injection of Sonovue (BR1, Bracco) on day before treatment shows that contrast uptake is approximately 80% throughout the two metastases (arrows).

 

Figure 7
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  		Fig. 2B —Two hepatic metastases from gastrointestinal stromal tumor in 72-year-old woman. At day 7, decrease is seen in contrast uptake by tumor, particularly in anterior lesion (arrows).

 

Figure 8
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  		Fig. 2C —Two hepatic metastases from gastrointestinal stromal tumor in 72-year-old woman. Contrast-enhanced Doppler sonograms using Vascular Recognition Imaging (Toshiba) show intraparenchymal static microbubbles (green) and intravascular mobile microbubbles (red and blue). Decrease in contrast uptake by tumor was confirmed at day 7 (C) and day 14 (D). At 6 months (E), total tumor necrosis is seen, with no contrast uptake.

 

Figure 9
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  		Fig. 2D —Two hepatic metastases from gastrointestinal stromal tumor in 72-year-old woman. Contrast-enhanced Doppler sonograms using Vascular Recognition Imaging (Toshiba) show intraparenchymal static microbubbles (green) and intravascular mobile microbubbles (red and blue). Decrease in contrast uptake by tumor was confirmed at day 7 (C) and day 14 (D). At 6 months (E), total tumor necrosis is seen, with no contrast uptake.

 

Figure 10
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  		Fig. 2E —Two hepatic metastases from gastrointestinal stromal tumor in 72-year-old woman. Contrast-enhanced Doppler sonograms using Vascular Recognition Imaging (Toshiba) show intraparenchymal static microbubbles (green) and intravascular mobile microbubbles (red and blue). Decrease in contrast uptake by tumor was confirmed at day 7 (C) and day 14 (D). At 6 months (E), total tumor necrosis is seen, with no contrast uptake.

 

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