EURORAD ESR

Case 15066

Gastric GIST: MRI for classification and surveillance, with endoscopic ultrasound correlation

Author(s)
Tonolini Massimo, MD (1); Bareggi Emilia, MD (2).

Departments of Radiology (1) and Digestive Endoscopy (2), “Luigi Sacco" University Hospital
Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
male, 74 year(s)
 
 
  • Figure 1
    Upper digestive endoscopy

    Initial endoscopy revealed a sizeable (measuring approximately 3 cm) focal intraluminal bulge at the gastric body along the lesser curvature, lined by normal mucosa.

     
    Area of Interest: Stomach; Imaging Technique: Percutaneous; Procedure: Endoscopy; Special Focus: Neoplasia;
     
     
  • Figure 2
    Endoscopic ultrasound (EUS) - some weeks after Fig.1

    The intraluminal bulge at the gastric body corresponded to a demarcated, ovoid-shaped hypoechoic mass (caliper) arising from the muscularis propria, measuring 27x20mm, with mild inhomogeneity and color Doppler...

     
    Area of Interest: Stomach; Imaging Technique: Ultrasound; Procedure: Endoscopy; Special Focus: Neoplasia;
     
     
  • Figure 3
    MRI with gastric distension and pharmacological hypotonisation -6 months later
     

    T2-weighted images (a, b) showed well-distended stomach with intraluminal water. The known submucosal mass (arrowheads) at the lesser curvature showed exophytic growth, intermediate signal intensity higher than the...

     
    Area of Interest: Stomach; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    T2-weighted images (a, b) showed well-distended stomach with intraluminal water. The known submucosal mass (arrowheads) at the lesser curvature showed exophytic growth, intermediate signal intensity higher than the...

     
    Area of Interest: Stomach; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    On fat-suppressed T2-weighted imaging, the gastric submucosal mass (arrowheads) showed exophytic growth, homogeneous signal intensity higher than the lifted mucosa (thin arrows) without macroscopic fat, necrotic or...

     
    Area of Interest: Stomach; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    On high (800) b-value diffusion-weighted imaging the gastric submucosal mass (arrowheads) showed visually mild hyperintensity, with corresponding apparent diffusion coefficient (ADC, map in e) value 1.8x10-3 mm2/s...

     
    Area of Interest: Stomach; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    On high (800) b-value diffusion-weighted imaging the gastric submucosal mass (arrowheads) showed visually mild hyperintensity, with corresponding apparent diffusion coefficient (ADC, map in e) value 1.8x10-3 mm2/s...

     
    Area of Interest: Stomach; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    The gastric submucosal mass (arrowheads) showed low-to-intermediate signal intensity on precontrast T1-weighted images (f), progressive contrast enhancement from the arterial (g) through the venous (h) and equilibrium...

     
    Area of Interest: Stomach; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    The gastric submucosal mass (arrowheads) showed low-to-intermediate signal intensity on precontrast T1-weighted images (f), progressive contrast enhancement from the arterial (g) through the venous (h) and equilibrium...

     
    Area of Interest: Stomach; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    The gastric submucosal mass (arrowheads) showed low-to-intermediate signal intensity on precontrast T1-weighted images (f), progressive contrast enhancement from the arterial (g) through the venous (h) and equilibrium...

     
    Area of Interest: Stomach; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    The gastric submucosal mass (arrowheads) showed low-to-intermediate signal intensity on precontrast T1-weighted images (f), progressive contrast enhancement from the arterial (g) through the venous (h) and equilibrium...

     
    Area of Interest: Stomach; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
Initial endoscopy revealed a sizeable (measuring approximately 3 cm) focal intraluminal bulge at the gastric body along the lesser curvature, lined by normal mucosa.
 
The intraluminal bulge at the gastric body corresponded to a demarcated, ovoid-shaped hypoechoic mass (caliper) arising from the muscularis propria, measuring 27x20mm, with mild inhomogeneity and color Doppler intralesional vascular signals (not shown).
 
T2-weighted images (a, b) showed well-distended stomach with intraluminal water. The known submucosal mass (arrowheads) at the lesser curvature showed exophytic growth, intermediate signal intensity higher than the lifted mucosa (thin arrows).
 
T2-weighted images (a, b) showed well-distended stomach with intraluminal water. The known submucosal mass (arrowheads) at the lesser curvature showed exophytic growth, intermediate signal intensity higher than the lifted mucosa (thin arrows).
 
On fat-suppressed T2-weighted imaging, the gastric submucosal mass (arrowheads) showed exophytic growth, homogeneous signal intensity higher than the lifted mucosa (thin arrows) without macroscopic fat, necrotic or cystic changes.
 
On high (800) b-value diffusion-weighted imaging the gastric submucosal mass (arrowheads) showed visually mild hyperintensity, with corresponding apparent diffusion coefficient (ADC, map in e) value 1.8x10-3 mm2/s consistent with non-restricted diffusion.
 
On high (800) b-value diffusion-weighted imaging the gastric submucosal mass (arrowheads) showed visually mild hyperintensity, with corresponding apparent diffusion coefficient (ADC, map in e) value 1.8x10-3 mm2/s consistent with non-restricted diffusion.
 
The gastric submucosal mass (arrowheads) showed low-to-intermediate signal intensity on precontrast T1-weighted images (f), progressive contrast enhancement from the arterial (g) through the venous (h) and equilibrium (i) phases of the dynamic study.
 
The gastric submucosal mass (arrowheads) showed low-to-intermediate signal intensity on precontrast T1-weighted images (f), progressive contrast enhancement from the arterial (g) through the venous (h) and equilibrium (i) phases of the dynamic study.
 
The gastric submucosal mass (arrowheads) showed low-to-intermediate signal intensity on precontrast T1-weighted images (f), progressive contrast enhancement from the arterial (g) through the venous (h) and equilibrium (i) phases of the dynamic study.
 
The gastric submucosal mass (arrowheads) showed low-to-intermediate signal intensity on precontrast T1-weighted images (f), progressive contrast enhancement from the arterial (g) through the venous (h) and equilibrium (i) phases of the dynamic study.
 
 
 
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