Gastrointestinal Stromal Tumors: Imaging Findings and a Multidisciplinary Approach to Treatment

Gastrointestinal stromal tumors (GISTs) have evolved from historically misclassified smooth muscle tumors to a distinct disease entity, defined by gain-of-function mutations in KIT or PDGFRA proto-oncogenes. The advent of targeted therapy for this entity in the form of a tyrosine kinase inhibitor (TKI), imatinib mesylate, has transformed the treatment for GISTs, reducing recurrence and improving survival in patients with advanced disease. Radiologists play a critical role in initial lesion identification, surgical planning, and posttherapy surveillance, with cross-sectional imaging (CT and MRI) being vital in characterizing tumor features such as endophytic or exophytic nature, pseudocapsule, ulceration, necrosis, and changes in enhancement. Incorporating the Choi criteria into routine practice further refines response assessment, guiding adjustments in therapeutic strategy. A multidisciplinary approach is essential for optimal GIST management, requiring close collaboration between surgeons, oncologists, pathologists, and radiologists to establish a diagnosis, determine resectability, consider neoadjuvant or adjuvant TKIs, and monitor for disease recurrence (with imaging intervals tailored to risk classification). Future directions involve greater incorporation of molecular profiling to personalize treatments and the integration of newer-generation TKIs for imatinib-resistant cases, highlighting the continued importance of interdisciplinary coordination.