Herzberg Moriz, Beer Meinrad, Anupindi Sudha, Vollert Kurt, Kröncke Thomas
Department of Diagnostic and Interventional Radiology and Neuroradiology, Klinikum Augsburg, Stenglinstraße 2, 86156, Germany.
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Ulm, Albert-Einstein-Allee 23, 89081, Germany.
J Pediatr Surg. 2018 Sep;53(9):1862-1870. doi: 10.1016/j.jpedsurg.2018.03.022. Epub 2018 Mar 29.
Gastrointestinal stromal tumors (GIST) are extremely rare in children. Imaging plays a key role in staging and monitoring therapy (surgical and with tyrosine kinase inhibitors). The vast majority of articles addressing imaging of GIST base on adults and are based on CT. The subtype "pediatric GIST" - if at all - is only mentioned in a dependent clause. Although the imaging features in children and adults are similar, histology, clinical course and thus imaging approach are different.
A PubMed search using the search terms "Gastrointestinal stromal tumor, GIST, WT GIST, children, pediatric, carney's triad, imaging, staging, follow-up, MRI, CEUS, ultrasonography, Positron emission tomography" was conducted. Studies that reported on laparoscopy, endoscopy and surgical techniques only were excluded.
Based on our selective literature review, we present alternative radiological imaging strategies using MRI, contrast enhanced ultrasound (CEUS) and PET-CT to stage and follow-up pediatric GIST patients. As pediatric GIST often is a chronic disease, minimizing exposure to ionizing radiation is mandatory.
MRI, contrast enhanced ultrasound and PET-CT instead of CT are the imaging modalities to evaluate pediatric GIST.
Systematic review LEVEL OF EVIDENCE: III.
胃肠道间质瘤（GIST）在儿童中极为罕见。影像学在分期及监测治疗（手术及酪氨酸激酶抑制剂治疗）中起着关键作用。绝大多数关于GIST影像学的文章以成人为基础且基于CT。“儿童GIST”这一亚型即便有所提及，也只是在从属从句中。尽管儿童和成人的影像学特征相似，但组织学、临床病程以及因此而来的影像学检查方法有所不同。
使用搜索词“胃肠道间质瘤、GIST、野生型GIST、儿童、儿科、卡尼三联征、影像学、分期、随访、MRI、CEUS、超声检查、正电子发射断层扫描”在PubMed上进行检索。仅报道腹腔镜检查、内镜检查及手术技术的研究被排除。
基于我们的选择性文献综述，我们提出使用MRI、对比增强超声（CEUS）和PET-CT对儿童GIST患者进行分期及随访的替代放射影像学策略。由于儿童GIST通常是一种慢性疾病，尽量减少电离辐射暴露至关重要。
评估儿童GIST的影像学检查方法是MRI、对比增强超声和PET-CT而非CT。
系统评价 证据等级：III级
