# Choi — Choi CT response criteria for GIST treated with targeted therapy

> Per-timepoint response assessment for GIST on comparable contrast-enhanced CT, combining the sum of target-lesion diameters, target attenuation and progression morphology such as a new nodule within a treated mass.

**Situação:** vigente · **Órgão:** Oncologia · **Órgão emissor:** Choi et al. · **Versão:** 2007 original; protocol variants must be identified · **Ano:** 2007

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: CT
- Fonte primária: Choi H, Charnsangavej C, Faria SC, Macapinlac HA, Burgess MA, Patel SR, Chen LL, Podoloff DA, Benjamin RS. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated with imatinib mesylate: proposal of new computed tomography response criteria (2007) — https://pubmed.ncbi.nlm.nih.gov/17470865/
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Apply the original OR logic, preserve phase and ROI comparability, and search for progression within a responding mass. Identify any modified Choi protocol instead of silently changing the 2007 criteria.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| CR | Complete response | Complete response: disappearance of all known lesions with no new lesion. Confirm that previously measurable and nonmeasurable GIST manifestations have resolved on a technically comparable study; a residual treated mass prevents an anatomic Choi CR even if it is entirely hypoattenuating. | Communicate complete imaging response and the comparison date, then defer treatment duration, surgery and surveillance to the multidisciplinary GIST team. CR is not an instruction to stop a tyrosine-kinase inhibitor and does not establish pathologic complete response or cure. | CR is the most favorable imaging category but carries no individual survival, recurrence or resistance probability. The original criteria were derived from a limited single-institution metastatic-GIST cohort and correlated with metabolic response rather than proving eradication of viable tumor. | Choi et al. 2007, J Clin Oncol 25:1753-1759, DOI 10.1200/JCO.2006.07.3049, proposed CT response criteria: CR requires disappearance of all lesions and no new lesions; study Purpose and Methods define the metastatic GIST and imatinib context. | ✓ |
| PR | Partial response by size or attenuation | Partial response: at least a 10% decrease in the sum of target-lesion longest diameters OR at least a 15% decrease in target-lesion CT attenuation, with no new lesion and no obvious progression of nonmeasurable disease. The original Boolean is OR, not AND; measure attenuation on a comparable portal-venous phase with the same ROI method. | Report the size and attenuation branches separately so the treating team can see why PR was assigned. A density-only response can represent genuine TKI effect despite little shrinkage, but the category alone neither fixes treatment duration nor selects resection, dose or next-line therapy. | The original study found the combined CT criteria more sensitive to early metabolic response than size-only RECIST and associated response with time to progression, but PR is not a calibrated patient-specific prognosis. Acquisition or ROI differences can create a false attenuation response. | Choi et al. 2007, DOI 10.1200/JCO.2006.07.3049, proposed CT response criteria and CT-FDG-PET correlation: PR is a size decrease of at least 10% OR attenuation decrease of at least 15%, subject to progression exclusions. Kalkmann et al. 2012, PMC3362866, CT measurement technique and attenuation quality safeguards. | ✓ |
| SD | Stable disease | Stable disease: the examination meets none of the CR, PR or PD rules and there is no symptomatic deterioration attributed to tumor progression. Retain actual SLD and attenuation changes, because a near-threshold density change or technically incomparable CT should not be hidden behind the word stable. | Describe whether stability is size-based, attenuation-based or technically limited and continue clinical correlation with adherence, toxicity and treatment interval. SD can represent meaningful disease control during TKI therapy and does not by itself justify stopping or changing treatment. | SD does not mean biological inactivity and supplies no fixed probability of later progression. Small viable intratumoral nodules can be missed if only global diameter and mean attenuation are reviewed, so morphology must remain part of the assessment. | Choi et al. 2007, DOI 10.1200/JCO.2006.07.3049, proposed criteria: SD does not meet CR, PR or PD and has no symptomatic deterioration from tumor progression. Kalkmann et al. 2012, PMC3362866, response-assessment pitfalls and nodule-within-a-mass review. | ✓ |
| PD | Progressive disease including nodule within a mass | Progressive disease is present with at least a 10% size increase that does not meet the 15% attenuation-response criterion, any credible new lesion, or a new or enlarging enhancing intratumoral nodule within a treated mass. New-lesion and nodule-within-a-mass findings override otherwise favorable global size or density change. | Promptly flag technically confirmed PD for multidisciplinary oncology review and document the exact trigger, comparison and possible resistant clone. Confirm an equivocal focus and review adherence and mutation context; the imaging code must not autonomously select a different TKI, dose, operation or palliative plan. | PD denotes imaging evidence of progression or focal resistance but does not quantify survival, mutation or treatment-response probability. Size increase alone can be misleading after TKI-related myxoid degeneration, hemorrhage or necrosis, which is why the density exception and morphology overrides are required. | Choi et al. 2007, DOI 10.1200/JCO.2006.07.3049, proposed criteria: PD includes a size increase of at least 10% without a qualifying density response, new lesions, or new or enlarging intratumoral nodules. Kalkmann et al. 2012, PMC3362866, Therapy response assessment and pitfalls illustrate nodule within a mass and standardized portal-venous measurement. | ✓ |

### Citações por categoria
- **CR**: Choi H, Charnsangavej C, Faria SC, Macapinlac HA, Burgess MA, Patel SR, Chen LL, Podoloff DA, Benjamin RS. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated with imatinib mesylate: proposal of new computed tomography response criteria (2007) — https://pubmed.ncbi.nlm.nih.gov/17470865/ · Choi et al. 2007, J Clin Oncol 25:1753-1759, DOI 10.1200/JCO.2006.07.3049, proposed CT response criteria: CR requires disappearance of all lesions and no new lesions; study Purpose and Methods define the metastatic GIST and imatinib context.
- **PR**: Choi H, Charnsangavej C, Faria SC, Macapinlac HA, Burgess MA, Patel SR, Chen LL, Podoloff DA, Benjamin RS. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated with imatinib mesylate: proposal of new computed tomography response criteria (2007) — https://pubmed.ncbi.nlm.nih.gov/17470865/ · Choi et al. 2007, DOI 10.1200/JCO.2006.07.3049, proposed CT response criteria and CT-FDG-PET correlation: PR is a size decrease of at least 10% OR attenuation decrease of at least 15%, subject to progression exclusions. Kalkmann et al. 2012, PMC3362866, CT measurement technique and attenuation quality safeguards.
- **SD**: Choi H, Charnsangavej C, Faria SC, Macapinlac HA, Burgess MA, Patel SR, Chen LL, Podoloff DA, Benjamin RS. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated with imatinib mesylate: proposal of new computed tomography response criteria (2007) — https://pubmed.ncbi.nlm.nih.gov/17470865/ · Choi et al. 2007, DOI 10.1200/JCO.2006.07.3049, proposed criteria: SD does not meet CR, PR or PD and has no symptomatic deterioration from tumor progression. Kalkmann et al. 2012, PMC3362866, response-assessment pitfalls and nodule-within-a-mass review.
- **PD**: Choi H, Charnsangavej C, Faria SC, Macapinlac HA, Burgess MA, Patel SR, Chen LL, Podoloff DA, Benjamin RS. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated with imatinib mesylate: proposal of new computed tomography response criteria (2007) — https://pubmed.ncbi.nlm.nih.gov/17470865/ · Choi et al. 2007, DOI 10.1200/JCO.2006.07.3049, proposed criteria: PD includes a size increase of at least 10% without a qualifying density response, new lesions, or new or enlarging intratumoral nodules. Kalkmann et al. 2012, PMC3362866, Therapy response assessment and pitfalls illustrate nodule within a mass and standardized portal-venous measurement.

## Referências cruzadas
- _fronteira compartilhada_ → [RECIST 1.1 — Response Evaluation Criteria in Solid Tumours v1.1](https://radcommons.laudos.ai/systems/recist-1-1.md) — Choi adapts RECIST for GIST by adding CT attenuation change, since size-only RECIST underestimates response to imatinib.
- _fronteira compartilhada_ → [mRECIST — Modified RECIST for hepatocellular carcinoma](https://radcommons.laudos.ai/systems/mrecist.md) — Both are density/enhancement-aware response criteria adapting RECIST for a specific tumor type (Choi for GIST, mRECIST for HCC).

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-07-24 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | dismissed |
| 2007-05-01 | published | Choi and colleagues proposed CT response criteria combining target-lesion size, attenuation and progression morphology for metastatic GIST treated with imatinib. | confirmed |
| 2007-01-01 | published | Choi response criteria for GIST published. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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