Weeda Ylva A, Kalisvaart Gijsbert M, van Velden Floris H P, Gelderblom Hans, van der Molen Aart J, Bovee Judith V M G, van der Hage Jos A, Grootjans Willem, de Geus-Oei Lioe-Fee
Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Diagnostics (Basel). 2022 Nov 7;12(11):2722. doi: 10.3390/diagnostics12112722.
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms. Tyrosine kinase inhibitor (TKI) therapy is currently part of routine clinical practice for unresectable and metastatic disease. It is important to assess the efficacy of TKI treatment at an early stage to optimize therapy strategies and eliminate futile ineffective treatment, side effects and unnecessary costs. This systematic review provides an overview of the imaging features obtained from contrast-enhanced (CE)-CT and 2-deoxy-2-[F]fluoro-D-glucose ([F]FDG) PET/CT to predict and monitor TKI treatment response in GIST patients. PubMed, Web of Science, the Cochrane Library and Embase were systematically screened. Articles were considered eligible if quantitative outcome measures (area under the curve (AUC), correlations, sensitivity, specificity, accuracy) were used to evaluate the efficacy of imaging features for predicting and monitoring treatment response to various TKI treatments. The methodological quality of all articles was assessed using the Quality Assessment of Diagnostic Accuracy Studies, v2 (QUADAS-2) tool and modified versions of the Radiomics Quality Score (RQS). A total of 90 articles were included, of which 66 articles used baseline [F]FDG-PET and CE-CT imaging features for response prediction. Generally, the presence of heterogeneous enhancement on baseline CE-CT imaging was considered predictive for high-risk GISTs, related to underlying neovascularization and necrosis of the tumor. The remaining articles discussed therapy monitoring. Clinically established imaging features, including changes in tumor size and density, were considered unfavorable monitoring criteria, leading to under- and overestimation of response. Furthermore, changes in glucose metabolism, as reflected by [F]FDG-PET imaging features, preceded changes in tumor size and were more strongly correlated with tumor response. Although CE-CT and [F]FDG-PET can aid in the prediction and monitoring in GIST patients, further research on cost-effectiveness is recommended.
胃肠道间质瘤（GISTs）是罕见的间叶组织肿瘤。酪氨酸激酶抑制剂（TKI）治疗目前是不可切除和转移性疾病常规临床实践的一部分。早期评估TKI治疗的疗效对于优化治疗策略、避免无效治疗、副作用和不必要的费用非常重要。本系统评价概述了从对比增强（CE）-CT和2-脱氧-2-[F]氟代-D-葡萄糖（[F]FDG）PET/CT获得的影像特征，以预测和监测GIST患者的TKI治疗反应。我们系统检索了PubMed、科学网、考克兰图书馆和Embase。如果使用定量结果指标（曲线下面积（AUC）、相关性、敏感性、特异性、准确性）来评估影像特征对预测和监测各种TKI治疗反应的疗效，则这些文章被认为符合纳入标准。使用诊断准确性研究质量评估第2版（QUADAS-2）工具和放射组学质量评分（RQS）的修改版对所有文章的方法学质量进行评估。共纳入90篇文章，其中66篇文章使用基线[F]FDG-PET和CE-CT影像特征进行反应预测。一般来说，基线CE-CT影像上的不均匀强化被认为是高危GIST的预测指标，这与肿瘤潜在的新生血管形成和坏死有关。其余文章讨论了治疗监测。临床确定的影像特征，包括肿瘤大小和密度的变化，被认为是不利的监测标准，会导致对反应的低估和高估。此外，[F]FDG-PET影像特征所反映的葡萄糖代谢变化先于肿瘤大小的变化，并且与肿瘤反应的相关性更强。虽然CE-CT和[F]FDG-PET有助于GIST患者的预测和监测，但建议进一步开展成本效益研究。
