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British Journal of Radiology (2006) 79, e40-e44
© 2006 British Institute of Radiology
doi: 10.1259/bjr/62872118
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Response evaluation in gastrointestinal stromal tumours treated with imatinib: misdiagnosis of disease progression on CT due to cystic change in liver metastases

K M Linton, MBChB, MRCP1, M B Taylor, MBChB, MRCP, FRCR2 and J A Radford, MBChB, MD, FRCP1

1 Cancer Research UK Department of Medical Oncology, 2 Department of Diagnostic Radiology, Christie Hospital NHS Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK


Figure 1
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  		Figure 1. Patient 1: contrast enhanced CT prior to treatment with imatinib. (a) The primary gastrointestinal stromal tumour (GIST) (outlined) involves the duodenum and pancreatic head and measures 9.3 cm. (b) No liver metastases are visible at this level, although three subtle lesions were seen elsewhere in the liver. Patient 1: contrast enhanced CT after 8 weeks of treatment with imatinib. (c) The duodenal mass (outlined) has reduced in size to 7.4 cm. (d) Multiple small low-density lesions are now seen within the liver (same level as Figure 1bGo). These were initially reported as being new metastases, but subsequently were considered as being due to cystic change in pre-existing metastases.

 

Figure 2
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  		Figure 2. (a,b) Contrast enhanced. Patient 2: contrast enhanced CT prior to treatment with imatinib. (a) There is an 8 cm solid pelvic mass (outlined). (b) No liver metastases are visible on this section. Note surgical clips from previous hepatic resection (arrow) and L2 vertebral metastasis (*). Patient 2: contrast enhanced CT after 12 weeks of treatment with imatinib. (c) The pelvic mass has reduced in size to 5.1 cm. (d) (At the same level as Figure 2bGo) A low lesion (arrow) is one of eight newly visible lesions in the liver.

 




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