Imaging Strategies and Research Advances in Gastrointestinal Stromal Tumors.

opinion statementThe therapeutic landscape of GIST has evolved considerably with the widespread use of tyrosine kinase inhibitors and improved molecular characterization. For localized disease, complete surgical resection remains the primary treatment strategy, while TKI therapy is indicated for unresectable, metastatic, or high-risk tumors and as adjuvant treatment in selected patients. In this setting, imaging is fundamental to treatment selection and longitudinal management. In our practice, contrast-enhanced CT is the first-line modality for initial staging and assessment of resectability. Imaging findings guide decisions regarding upfront surgery versus neoadjuvant TKI therapy, particularly in large or anatomically challenging tumors where downsizing may facilitate organ-preserving resection. During systemic therapy, we rely on CT for routine monitoring but recognize that size criteria alone may underestimate early response. We therefore integrate MRI or FDG PET/CT selectively when treatment response is unclear or early resistance is suspected. Postoperatively, surveillance strategies are tailored according to recurrence risk and adjuvant therapy status. High-risk patients undergo closer imaging follow-up, whereas surveillance intensity may be reduced in low-risk cases to limit cumulative radiation exposure. Ultimately, careful integration of imaging with clinical and molecular factors enables more individualized and stage-appropriate management of GIST.