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Evaluation of risk classifications for gastrointestinal stromal tumor using multi-parameter Magnetic Resonance analysis

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Abstract

Background

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal malignancy of the gastrointestinal tract. At present, it is generally believed that the prognosis of GIST is closely related to its risk classification. It may add value to correctly diagnose and evaluate the risk of invasion using a noninvasive imaging examination prior to surgery. MRI has the advantages of multiple parameters and high soft tissue resolution, which may be the potential method to preoperatively evaluate the risk of GIST.

Purpose

To retrospectively evaluate the diagnostic accuracy of multi-parameter MR analysis for preoperative risk classification of GIST.

Materials and methods

In this 6-year retrospective study, full MRI examination was performed on all 60 GIST cases confirmed classified by pathology, including 35 cases of very low-to-low-risk GIST and 25 cases of intermediate-to-high-risk GIST. Dynamic contrast-enhanced T1- and T2-weighted images, and apparent diffusion coefficient (ADC) maps were reviewed independently by two radiologists blinded to pathologic results. Volume, ADC ratio, three wash-in indexes (WII) were calculated and compared using t-test or Kruskal–Wallis nonparametric test. Sensitivity and specificity analyses were performed to calculate diagnostic accuracy using ROC analyses. Differences were considered significant at p < 0.05.

Results

All GISTs were resected. Patient age, sex, tumor location and tumor shape did not differ significantly across the two groups (p = 0.798, 0.767, 0.822 and 0.096, respectively). GIST in the intermediate-to-high-risk group presented significantly greater volume (p = 0.0045), lower ADC ratio (p = 0.0125) and faster enhancement (for WII2, p < 0.0001; for WII3, p = 0.0358) than that of GIST in the very low-to-low-risk group. This combination of the volume, ADC ratio and WII2 provided sensitivity of 88%, specificity of 94.29%, and accuracy of 91.7% for the risk classification of GIST.

Conclusion

Multi-parameter MR analysis provides a preoperative imaging standard for accurately distinguishing very low-to-low-risk GIST from intermediate-to-high-risk GIST.

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Acknowledgements

This research was supported by National Natural Science Foundation of China (81871029) and Scientific Research Fund Project of Health Commission of Hebei Province (20200138).

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Authors and Affiliations

  1. Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, People’s Republic of China

    Tao Zheng, Juan Du, Linsha Yang, Zhanqiu Wang, Defeng Liu, Shuo Wu, Xiaohan Wang & Lanxiang Liu

  2. Department of Intervention, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, People’s Republic of China

    Yanchao Dong

  3. Scientific Clinical Specialist, Siemens Ltd., Beijing, People’s Republic of China

    Qinglei Shi

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  1. Tao Zheng
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  2. Juan Du
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Contributions

TZ and LL designed and coordinated the study, TZ, JD, SW, ZW, DL, XW and QS carried out experiment and data process, and drafted the manuscript. All authors gave final approval for publication.

Corresponding author

Correspondence to Lanxiang Liu.

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Conflict of interest

Author Qinglei Shi was employed by the company Siemens Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Research involving human participants

This retrospective study involved human participants. This retrospective study that incorporates anonymous data was approved by the Ethics Committee of our hospital and the need for informed consent was waived.

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Zheng, T., Du, J., Yang, L. et al. Evaluation of risk classifications for gastrointestinal stromal tumor using multi-parameter Magnetic Resonance analysis. Abdom Radiol 46, 1506–1518 (2021). https://doi.org/10.1007/s00261-020-02813-y

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  • DOI: https://doi.org/10.1007/s00261-020-02813-y

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