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Imaging therapy response of gastrointestinal stromal tumors (GIST) with FDG PET, CT and MRI: a systematic review. | LitMetric

Imaging therapy response of gastrointestinal stromal tumors (GIST) with FDG PET, CT and MRI: a systematic review.

Clin Transl Imaging

Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

Published: May 2017

AI Article Synopsis

  • The text discusses the need for effective diagnostic tools in monitoring therapy responses for gastrointestinal stromal tumors (GIST), highlighting the challenge of distinguishing between true disease progression and false progression due to other factors.
  • The review analyzes various imaging techniques (like CT and PET-CT) used in GIST treatment, noting that CT remains the standard despite its limitations, while modified criteria like the Choi criteria aim to improve therapy assessment.
  • It concludes that while FDG PET-CT is valuable for early response evaluation, further research is required to better understand its role and establish optimal monitoring intervals.

Article Abstract

Purpose: Improvement of the therapeutic approaches in gastrointestinal stromal tumors (GIST) by the introduction of targeted therapies requires appropriate diagnostic tools, which allow sufficient assessment of therapeutic response, including differentiation of true progression from pseudoprogression due to myxoid degeneration or intratumoral hemorrhage. In this literature review the impact and limitations of different imaging modalities used in GIST therapy monitoring are discussed.

Methods: PubMed and Cochrane library search were performed using appropriate keywords. Overall, 39 original papers fulfilled the defined criteria and were included in this systematic review.

Results: Morphological imaging modalities like computed tomography (CT) are primarily used for both diagnosis and therapy monitoring. However, therapy with tyrosine kinase inhibitors and other targeted therapies in GIST may lead only to a minor tumor volume reduction even in cases of response. Therefore, the use of Response Evaluation Criteria in Solid Tumors (RECIST) has limitations. To overcome those limitations, modified response criteria have been introduced for the CT-based therapy assessment, like the Choi criteria as well as criteria based on dual energy CT studies. Functional imaging techniques, mostly based on FDG PET-CT are in use, in particular for the assessment of early treatment response.

Conclusions: The impact and the limitations of PET-based therapy monitoring, as well as its comparison with CT, MRI and survival data are discussed in this review. CT is still the standard method for the evaluation of therapy response despite its several limitations. FDG PET-CT is helpful for the assessment of early therapy response; however, more prospective data are needed to define its role as well as the appropriate time intervals for therapy monitoring. A multiparametric evaluation based on changes in both morphological and functional data has to be assessed in further prospective studies.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5658474PMC
http://dx.doi.org/10.1007/s40336-017-0229-8DOI Listing

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