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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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This figure illustrates an in-depth preoperative work-up in a 46-year-old female patient with an undifferentiated intimal sarcoma of the central pulmonary artery. Both, the MDCT (A, B) and the MRI (C, D) clearly demonstrate a subtotal occlusion of the pulmonary trunk due to an intraluminal process. Imaging findings are suggestive of a focal expansion beyond the vessel wall (A-D, arrowheads). The MR first-pass perfusion sequence (F) demonstrates a subtle perfusion of the lesion as compared to the non-enhanced control scan (E, circle). The F-18 FDG PET/CT proves a high metabolic activity (SUVmax = 7.8) within the lesion (G, H) and strengthens the suspicion of malignant disease.
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Figure 2: This figure illustrates an in-depth preoperative work-up in a 46-year-old female patient with an undifferentiated intimal sarcoma of the central pulmonary artery. Both, the MDCT (A, B) and the MRI (C, D) clearly demonstrate a subtotal occlusion of the pulmonary trunk due to an intraluminal process. Imaging findings are suggestive of a focal expansion beyond the vessel wall (A-D, arrowheads). The MR first-pass perfusion sequence (F) demonstrates a subtle perfusion of the lesion as compared to the non-enhanced control scan (E, circle). The F-18 FDG PET/CT proves a high metabolic activity (SUVmax = 7.8) within the lesion (G, H) and strengthens the suspicion of malignant disease.

Mentions: The demonstration of lesion vascularization using first pass perfusion or dynamic contrast-enhanced MRI tech-niques can be challenging. We observed only subtle and inhomogeneous contrast enhancements in our patient cohort. Color-coding of the perfusion images may facilitate the perception of the subtle signal changes (Figure 2).


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)

This figure illustrates an in-depth preoperative work-up in a 46-year-old female patient with an undifferentiated intimal sarcoma of the central pulmonary artery. Both, the MDCT (A, B) and the MRI (C, D) clearly demonstrate a subtotal occlusion of the pulmonary trunk due to an intraluminal process. Imaging findings are suggestive of a focal expansion beyond the vessel wall (A-D, arrowheads). The MR first-pass perfusion sequence (F) demonstrates a subtle perfusion of the lesion as compared to the non-enhanced control scan (E, circle). The F-18 FDG PET/CT proves a high metabolic activity (SUVmax = 7.8) within the lesion (G, H) and strengthens the suspicion of malignant disease.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: This figure illustrates an in-depth preoperative work-up in a 46-year-old female patient with an undifferentiated intimal sarcoma of the central pulmonary artery. Both, the MDCT (A, B) and the MRI (C, D) clearly demonstrate a subtotal occlusion of the pulmonary trunk due to an intraluminal process. Imaging findings are suggestive of a focal expansion beyond the vessel wall (A-D, arrowheads). The MR first-pass perfusion sequence (F) demonstrates a subtle perfusion of the lesion as compared to the non-enhanced control scan (E, circle). The F-18 FDG PET/CT proves a high metabolic activity (SUVmax = 7.8) within the lesion (G, H) and strengthens the suspicion of malignant disease.
Mentions: The demonstration of lesion vascularization using first pass perfusion or dynamic contrast-enhanced MRI tech-niques can be challenging. We observed only subtle and inhomogeneous contrast enhancements in our patient cohort. Color-coding of the perfusion images may facilitate the perception of the subtle signal changes (Figure 2).

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