E-ISSN 1305-3612
Musculoskeletal Imaging - Original Article
Imaging features of bone metastases in patients with gastrointestinal stromal tumors
1 Department of Radiology and Oncology, Harvard Medical School, Dana Farber Cancer Institute, Boston, Massachusetts, USA  
2 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA  
3 Department of Radiology and Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA  
4 Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA.  
Diagn Interv Radiol 2012; 18: 391-396
DOI: 10.4261/1305-3825.DIR.5179-11.1
Key Words: gastrointestinal stromal tumors • metastases • bone • positron-emission tomography and computed tomography
Abstract

PURPOSE
To determine the prevalence and imaging features of bone metastases in patients with gastrointestinal stromal tumors (GISTs).

 

MATERIALS AND METHODS
The medical records of 190 patients with pathologically proven GISTs were reviewed, and patients with bone metastases were identified. Computed tomography (CT) scans of the chest, abdomen, and pelvis were examined for features of bone metastases, and findings were correlated with the results of positron-emission tomography (PET) and histopathology.

 

RESULTS
Of 190 GIST patients, six (3.2%) had bone metastases: four patients had multiple bone metastases, and two patients had a solitary metastasis. The maximum diameter of the metastases ranged from 2 to 40 mm, and they most commonly involved the vertebrae, ribs, pelvic bones, and femurs. All lesions were well-marginated and lytic. A soft tissue component was identified in three patients. The bone metastases showed intense fluorine-18 fluorodeoxyglucose (FDG) uptake. After treatment with imatinib mesylate in three patients, the bone metastases developed peripheral sclerosis on CT and became less FDG-avid on PET. All six primary tumors were morphologically high-grade with high mitotic rates and necrosis.

 

CONCLUSION
Bone metastases from GISTs are uncommon; when detected with CT, they are characterized by single or multiple lytic lesions with or without soft tissue involvement. A sclerotic rim may appear around the metastatic lesions in response to treatment. Similar to the disease in other sites, bone metastases show intense FDG uptake, which decreases following treatment.

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