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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.

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.

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This figure illustrates the imaging findings in a 74-year-old male patient with an extensive undifferentiated intimal sarcoma of the left pulmonary artery (A-C, F, G). Both, the MDCT and the F-18 FDG PET/CT readily demonstrate the local embolic spread in the pulmonary vasculature of the right lung (A, D, E; arrowheads) as well as a distant metastasis to the brain (H, I).
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Figure 3: This figure illustrates the imaging findings in a 74-year-old male patient with an extensive undifferentiated intimal sarcoma of the left pulmonary artery (A-C, F, G). Both, the MDCT and the F-18 FDG PET/CT readily demonstrate the local embolic spread in the pulmonary vasculature of the right lung (A, D, E; arrowheads) as well as a distant metastasis to the brain (H, I).

Mentions: The evidence of hypermetabolism of the filling defect as shown by F-18 FDG PET/CT, however, could be readily and unequivocally appreciated in all our patients with metabolic imaging (Figures 2, 3) and strengthened the suspicion of malignant disease. Due to the decisive implications of a radical surgical approach, a combination of different imaging studies was requested in many patients of our cohort. The complementary information of morphological, functional and metabolic imaging increases the diagnostic confidence and may facilitate the therapeutic decisions as shown in Figure 3. In equivocal cases, a whole-body staging such as PET/CT may further increase the probability of a malignant disease by revealing distant metastases (Figure 3).


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 the imaging findings in a 74-year-old male patient with an extensive undifferentiated intimal sarcoma of the left pulmonary artery (A-C, F, G). Both, the MDCT and the F-18 FDG PET/CT readily demonstrate the local embolic spread in the pulmonary vasculature of the right lung (A, D, E; arrowheads) as well as a distant metastasis to the brain (H, I).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: This figure illustrates the imaging findings in a 74-year-old male patient with an extensive undifferentiated intimal sarcoma of the left pulmonary artery (A-C, F, G). Both, the MDCT and the F-18 FDG PET/CT readily demonstrate the local embolic spread in the pulmonary vasculature of the right lung (A, D, E; arrowheads) as well as a distant metastasis to the brain (H, I).
Mentions: The evidence of hypermetabolism of the filling defect as shown by F-18 FDG PET/CT, however, could be readily and unequivocally appreciated in all our patients with metabolic imaging (Figures 2, 3) and strengthened the suspicion of malignant disease. Due to the decisive implications of a radical surgical approach, a combination of different imaging studies was requested in many patients of our cohort. The complementary information of morphological, functional and metabolic imaging increases the diagnostic confidence and may facilitate the therapeutic decisions as shown in Figure 3. In equivocal cases, a whole-body staging such as PET/CT may further increase the probability of a malignant disease by revealing distant metastases (Figure 3).

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