Evaluation of Alterations in Tumor Tissue of Gastrointestinal Stromal Tumor (GIST) in Computed Tomography Following Treatment with Imatinib.

BACKGROUND: The aim of this study was to evaluate the alterations in the neoplastic tissue of GIST following Imatinib treatment. MATERIAL/METHODS: CT studies of 14 patients with inoperable primary tumors and 56 patients with metastatic and recurrent disease after chemotherapy were analyzed retrospectively. The following alterations in features of primary and secondary tumors were analyzed: dimension, degree and type of contrast enhancement, outlines of lesions, presence of intratumoral bleeding, presence of calcifications. RESULTS: In the analyzed group of primary, metastatic and recurrent tumors after treatment with Imatinib in most cases a decrease in size and contrast enhancement were observed; the outlines of lesions became well circumscribed. Following the treatment, the number of tumors enhancing inhomogeneously decreased. In primary tumors the percentage of calcifications increased, whereas in metastatic tumors calcifications were observed only after treatment. There was no bleeding found within primary tumors after treatment. In metastatic disease, increased percentage of tumors with transient intratumoral bleeding was observed. There were also some unconventional CT images following treatment, such as: cystic transformation of lesions, enlargement of lesions, appearing of new lesions suggesting progression of the disease, stationary dimensions of lesions during local progression of the disease, simultaneous decrease and increase in size of metastatic lesions or appearance of new ones. CONCLUSIONS: Right from the start of Imatinib therapy in inoperable and disseminated GIST patients, specific CT images, not seen during conventional cytotoxic chemotherapy, were observed.

Characteristics of computed tomography imaging of gastrointestinal stromal tumor (GIST) and related diagnostic problems.

In this article, authors presented several characteristic features of Gastrointestinal Stromal Tumors (GISTs), which may lead to diagnostic errors and unexpected difficulties during interpretation of CT images. In case of GIST, one may encounter problems at every level of diagnostics and treatment response monitoring, especially after introduction of modern molecular targeting therapies. RECIST scale criteria, used until now for evaluation of response to treatment in solid tumors are based merely on the size of the tumor and turned out to be inadequate after introduction of treatment with new molecular target drugs such as Imatinib.

[Usefulness of proton MR spectroscopy for determining diagnosis and treatment outcome in unipolar depressive disorder]. / Ocena przydatnosci protonowej spektroskopii MR w diagnostyce i monitorowaniu leczenia choroby afektywnej jednobiegunowej.

PURPOSE: The aim of the study was to evaluate the usefulness of proton MR spectroscopy for determining the biochemical abnormalities in acute episode of depression and after regression of the disease in course of unipolar depressive disorder. MATERIAL AND METHODS: Forty one patients (age 18-55 years) with known unipolar depressive disorder (a Hamilton Depression Rating Scale of 16 or greater) were evaluated by the means of HMRS during acute episode of depression and after positive therapeutic response (at least 50% reduced Hamilton score for at least 4 consecutive weeks). All patients underwent single-volume 1H MRS (TR=1500 ms, TE=35 ms) using a 1.5T scanner. Four brain areas were analyzed: both frontal lobes and both hippocampi. RESULTS: In the acute fase of the disease patients had statistically significant increases in Cho/Cr levels in right hippocampus area and increases in ml/Cr levels in left frontal lobes relative to controls. After positive therapeutic response no significant abnormalities were found. CONCLUSION: These results suggest that abnormal increased brain metabolites should reverse after treatment. In the time of new imaging technics we hope that in the future 1H MRS may be helpful for determining the accuracy of the diagnosis and can improved prediction of therapeutic response in unipolar depression.

[Optimalisation of lymph node assessment in patients undergoing therapy for lymphoma using a multi-row CT]. / Optymalizacja oceny wezlów chlonnych u pacjentów w trakcie leczenia chloniaków z zastosowaniem wielorzedowej tomografii komputerowej.

PURPOSE: Aim of the study was evaluation the accuracy of routinely performed helical computed tomography (CT) compared to modern multidetector row CT (MDCT) in staging and assessing response to treatment of patients with lymphoma, especially in cranio-caudal dimention. MATERIAL AND METHODS: 60 patients with known Hodgkin's disease localised in chest were evaluated by the means of two methods: axial reconstruction of 5-6 mm thick slices--typical set for helical CT and 2-mm thin slices with coronal and sagital reconstruction--typical set for MSCT. Each of 120 obtained examinations (240 images reconstructions) were evaluated by 2 blinded readers. RESULTS: Accuracy of measurements was greater at MSCT in all dimentions of evaluated lymph nodes (p<<0.0001). MSCT revealed in 15% of patients presence of lymph nodes enlarged only in craniocaudal length. Such nodes in conventional CT could be interpreted as "normal". Application of third dimention in lymph nodes assessment caused the change in clinical classification in 15% of patients in the study. Only in 40% of cases grade of response to treatment was the same in both CT ant MSCT techniques. CONCLUSIONS: MSCT improves the detection rate of enlarge lymph nodes, especially in cranio-caudal dimention and shoud replece conventional spiral CT in assessment patients with lymphoma. In the time of new imaging technics we propose to modify the clinical staging of limphoma.