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  • Korean J Radiol 5(3), September 2004 157

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

    Objective: This study was undertaken for the purpose of describing the CT features of intra-abdominal extra-hepatic metastases from gastrointestinal stro- mal 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 appear- ance on the follow-up CT scans, mimicking ascites.

    Conclusion: Intra-abdominal extra-hepatic metastases of patients with gas- trointestinal stromal tumors treated with imatinib may appear as well-circum- scribed 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.

    astrointestinal stromal tumors, formerly classified as leiomyomas or leiomyosarcomas, constitute the most common form of mesenchymal tumor in the gastrointestinal tract, with the stomach being the most

    common site of origin (1). The diagnosis of these tumors became feasible through the application of CD117 immunohistochemistry, which allows these neoplasms to be distinguished from leiomyomas or leiomyosarcomas (2). Moreover, the recently developed KIT-tyrosine kinase inhibitor (STI 571, imatinib [Gleevec], Novartis, Basel, Switzerland) has dramatically improved the treatment of gastrointestinal stromal tumors (3).

    The radiologic findings of gastrointestinal stromal tumors were recently described in the radiologic literature (1, 4 8), and are ostensibly similar to those of the previously described leiomyomas or leiomyosarcomas (9). The characteristic features of this disease are its recurrence at the primary site and the presence of metastases, primarily in the liver and the peritoneum (4). Recently, it was reported that the hepatic metastases in patients treated with imatinib resembled cystic lesions (10 12). In line with these observations, our findings indicate that when gastrointestinal stromal

    Hyo-Cheol Kim, MD1

    Jeong Min Lee, MD1

    Seung Hong Choi, MD1

    Heon Han, MD2

    Sam Soo Kim, MD2

    Sang Hyun Lee, MD3

    Joon Koo Han, MD1

    Byung Ihn Choi, MD1

    Index terms: Gastrointestinal stromal tumor Neoplasms, metastases Abdomen, CT

    Korean J Radiol 2004;5:157-163 Received October 19, 2003; accepted after revision February 9, 2004.

    1Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, SNUMRC, and Clinical Research Institute, Seoul National University Hospital; 2Department of Radiology, Kangwon National University College of Medicine; 3Radiation Medicine Branch, National Cancer Center

    This study was supported in part by the 2003 BK21 Project for Medicine, Dentistry and Pharmacy.

    Address reprint requests to: Jeong Min Lee, MD, Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea. Tel. (822) 760-2584 Fax. (822) 743-6385 e-mail: leejm@radcom.snu.ac.kr

    G

  • Kim et al.

    158 Korean J Radiol 5(3), September 2004

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  • tumors are treated with imatinib, the intra-abdominal extra-hepatic metastases come to have a homogeneous or al