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Imaging features of primary sarcomas of the great vessels in CT, MRI and PET/CT: a single-center experience.

von Falck C, Meyer B, Fegbeutel C, Länger F, Bengel F, Wacker F, Rodt T - BMC Med Imaging (2013)

Bottom Line: The F-18 FDG PET(/CT) examinations demonstrated an unequivocal hypermetabolism of the lesion in all cases (4/4).MRI proved lesion vascularization in 5/6 cases.MR perfusion techniques can add information on the nature of the lesion but the findings may be subtle and equivocal.

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ABSTRACT

Background: To investigate the imaging features of primary sarcomas of the great vessels in CT, MRI and (18)F-FDG PET/CT.

Methods: Thirteen patients with a primary sarcoma of the great vessels were retrospectively evaluated. All available images studies including F-18 FDG PET(/CT) (n = 4), MDCT (n = 12) and MRI (n = 6) were evaluated and indicative image features of this rare tumor entity were identified.

Results: The median interval between the first imaging study and the final diagnosis was 11 weeks (0-12 weeks). The most frequently observed imaging findings suggestive of malignant disease in patients with sarcomas of the pulmonary arteries were a large filling defect with vascular distension, unilaterality and a lack of improvement despite effective anticoagulation. In patients with aortic sarcomas we most frequently observed a pedunculated appearance and an atypical location of the filling defect. The F-18 FDG PET(/CT) examinations demonstrated an unequivocal hypermetabolism of the lesion in all cases (4/4). MRI proved lesion vascularization in 5/6 cases.

Conclusion: Intravascular unilateral or atypically located filling defects of the great vessels with vascular distension, a pedunculated shape and lack of improvement despite effective anticoagulation are suspicious for primary sarcoma on MDCT or MRI. MR perfusion techniques can add information on the nature of the lesion but the findings may be subtle and equivocal. F-18 FDG PET/CT may have a potential role in these patients and may be considered as part of the imaging workup.

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CT pulmonary angiography (CTPA) of a 49-year-old female patient with a myxofibrosarcoma of the right pulmonary artery. Suspicious imaging features were already present in the primary imaging (A, C). However, the patient was treated conservatively for suspected pulmonary embolism. A follow-up exam was acquired three month later and demonstrated massive disease progression with tumor expansion beyond the vessel wall and local lymph node metastases (B, D)
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Figure 1: CT pulmonary angiography (CTPA) of a 49-year-old female patient with a myxofibrosarcoma of the right pulmonary artery. Suspicious imaging features were already present in the primary imaging (A, C). However, the patient was treated conservatively for suspected pulmonary embolism. A follow-up exam was acquired three month later and demonstrated massive disease progression with tumor expansion beyond the vessel wall and local lymph node metastases (B, D)

Mentions: As deducible from the relative frequency of the above-mentioned findings, we found a combination of indicative imaging features in most patients. In the CTA examinations of the pulmonary arteries in three patients, we observed large, unilateral right-sided filling defects in the pulmonary arteries that obturate the whole cross-sectional area of the vessel and lead to a vascular expansion (Figure 1). However, pulmonary embolism was the primary tentative diagnosis in all three cases and the patients received accordant conservative treatment. The follow-up examinations showed a progression of the findings (Figure 1) or at least a lack of improvement, respectively, despite a sufficient anticoagulation therapy and hence strongly suggest a neoplastic nature of the filling defects.


Imaging features of primary sarcomas of the great vessels in CT, MRI and PET/CT: a single-center experience.

von Falck C, Meyer B, Fegbeutel C, Länger F, Bengel F, Wacker F, Rodt T - BMC Med Imaging (2013)

CT pulmonary angiography (CTPA) of a 49-year-old female patient with a myxofibrosarcoma of the right pulmonary artery. Suspicious imaging features were already present in the primary imaging (A, C). However, the patient was treated conservatively for suspected pulmonary embolism. A follow-up exam was acquired three month later and demonstrated massive disease progression with tumor expansion beyond the vessel wall and local lymph node metastases (B, D)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750466&req=5

Figure 1: CT pulmonary angiography (CTPA) of a 49-year-old female patient with a myxofibrosarcoma of the right pulmonary artery. Suspicious imaging features were already present in the primary imaging (A, C). However, the patient was treated conservatively for suspected pulmonary embolism. A follow-up exam was acquired three month later and demonstrated massive disease progression with tumor expansion beyond the vessel wall and local lymph node metastases (B, D)
Mentions: As deducible from the relative frequency of the above-mentioned findings, we found a combination of indicative imaging features in most patients. In the CTA examinations of the pulmonary arteries in three patients, we observed large, unilateral right-sided filling defects in the pulmonary arteries that obturate the whole cross-sectional area of the vessel and lead to a vascular expansion (Figure 1). However, pulmonary embolism was the primary tentative diagnosis in all three cases and the patients received accordant conservative treatment. The follow-up examinations showed a progression of the findings (Figure 1) or at least a lack of improvement, respectively, despite a sufficient anticoagulation therapy and hence strongly suggest a neoplastic nature of the filling defects.

Bottom Line: The F-18 FDG PET(/CT) examinations demonstrated an unequivocal hypermetabolism of the lesion in all cases (4/4).MRI proved lesion vascularization in 5/6 cases.MR perfusion techniques can add information on the nature of the lesion but the findings may be subtle and equivocal.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: To investigate the imaging features of primary sarcomas of the great vessels in CT, MRI and (18)F-FDG PET/CT.

Methods: Thirteen patients with a primary sarcoma of the great vessels were retrospectively evaluated. All available images studies including F-18 FDG PET(/CT) (n = 4), MDCT (n = 12) and MRI (n = 6) were evaluated and indicative image features of this rare tumor entity were identified.

Results: The median interval between the first imaging study and the final diagnosis was 11 weeks (0-12 weeks). The most frequently observed imaging findings suggestive of malignant disease in patients with sarcomas of the pulmonary arteries were a large filling defect with vascular distension, unilaterality and a lack of improvement despite effective anticoagulation. In patients with aortic sarcomas we most frequently observed a pedunculated appearance and an atypical location of the filling defect. The F-18 FDG PET(/CT) examinations demonstrated an unequivocal hypermetabolism of the lesion in all cases (4/4). MRI proved lesion vascularization in 5/6 cases.

Conclusion: Intravascular unilateral or atypically located filling defects of the great vessels with vascular distension, a pedunculated shape and lack of improvement despite effective anticoagulation are suspicious for primary sarcoma on MDCT or MRI. MR perfusion techniques can add information on the nature of the lesion but the findings may be subtle and equivocal. F-18 FDG PET/CT may have a potential role in these patients and may be considered as part of the imaging workup.

Show MeSH
Related in: MedlinePlus