The Utility of Conventional CT, CT Perfusion and Quantitative Diffusion-Weighted Imaging in Predicting the Risk Level of Gastrointestinal Stromal Tumors of the Stomach: A Prospective Comparison of Classical CT Features, CT Perfusion Values, Apparent Diffusion Coefficient and Intravoxel Incoherent Motion-Derived Parameters
Milica Mitrovic-Jovanovic,
Aleksandra Djuric-Stefanovic,
Keramatollah Ebrahimi,
Marko Dakovic,
Jelena Kovac,
Dimitrije Šarac,
Dusan Saponjski,
Aleksandra Jankovic,
Ognjan Skrobic,
Predrag Sabljak,
Marjan Micev
Affiliations
Milica Mitrovic-Jovanovic
Department of Digestive Radiology, Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
Aleksandra Djuric-Stefanovic
Department of Digestive Radiology, Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
Keramatollah Ebrahimi
Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000 Belgrade, Serbia
Marko Dakovic
Faculty of Physical Chemistry, University of Belgrade, 11000 Belgrade, Serbia
Jelena Kovac
Department of Digestive Radiology, Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
Dimitrije Šarac
Department of Digestive Radiology, Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
Dusan Saponjski
Department of Digestive Radiology, Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
Aleksandra Jankovic
Department of Digestive Radiology, Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
Ognjan Skrobic
Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000 Belgrade, Serbia
Predrag Sabljak
Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000 Belgrade, Serbia
Marjan Micev
Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000 Belgrade, Serbia
Background: The role of advanced functional imaging techniques in prediction of pathological risk categories of gastrointestinal stromal tumors (GIST) is still unknown. The purpose of this study was to evaluate classical CT features, CT-perfusion and magnetic-resonance-diffusion-weighted-imaging (MR-DWI)-related parameters in predicting the metastatic risk of gastric GIST. Patients and methods: Sixty-two patients with histologically proven GIST who underwent CT perfusion and MR-DWI using multiple b-values were prospectively included. Morphological CT characteristics and CT-perfusion parameters of tumor were comparatively analyzed in the high-risk (HR) and low-risk (LR) GIST groups. Apparent diffusion coefficient (ADC) and intravoxel-incoherent-motion (IVIM)-related parameters were also analyzed in 45 and 34 patients, respectively. Results: Binary logistic regression analysis revealed that greater tumor diameter (p p p = 0.007), irregular shape (p p p p = 0.001) and shorter time-to-peak (p = 0.006), were significant predictors of HR GIST. Multivariate analysis extracted irregular shape (p = 0.006) and enlarged feeding or draining vessels (EFDV) (p = 0.017) as independent predictors of HR GIST (area under curve (AUC) of predicting model 0.869). Conclusion: Although certain classical CT imaging features remain most valuable, some functional imaging parameters may add the diagnostic value in preoperative prediction of HR gastric GIST.
