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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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MDCT images in axial (A) and coronal (B) orientation of a 81-year-old patient with an angiosarcoma of the abdominal aorta who had previously undergone open aortic surgery. The extensive extramural tumor formation is clearly visualized and may be confounded with chronic inflammatory disease and contained rupture.
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Figure 6: MDCT images in axial (A) and coronal (B) orientation of a 81-year-old patient with an angiosarcoma of the abdominal aorta who had previously undergone open aortic surgery. The extensive extramural tumor formation is clearly visualized and may be confounded with chronic inflammatory disease and contained rupture.

Mentions: Although few in number, our cases with sarcomas located in the aorta suggest that the typical imaging features are comparable to those seen in tumors occurring in the pulmonary vasculature. Potentially suspicious imaging findings of intraaortal filling defects include an atypical location for a thrombus, a pedunculated appearance and a subtle enhancement during first-pass perfusion (Figure 4) and hypermetabolism in F-18 FDG PET/CT (Figure 5), consistent with the intraluminal type of aortic sarcoma. Mural-type sarcomas show different imaging characteristics with predominant extraluminal perivascular growth and can be mistaken for inflammatory disease (Figure 6). The findings are summarized in Table 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)

MDCT images in axial (A) and coronal (B) orientation of a 81-year-old patient with an angiosarcoma of the abdominal aorta who had previously undergone open aortic surgery. The extensive extramural tumor formation is clearly visualized and may be confounded with chronic inflammatory disease and contained rupture.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: MDCT images in axial (A) and coronal (B) orientation of a 81-year-old patient with an angiosarcoma of the abdominal aorta who had previously undergone open aortic surgery. The extensive extramural tumor formation is clearly visualized and may be confounded with chronic inflammatory disease and contained rupture.
Mentions: Although few in number, our cases with sarcomas located in the aorta suggest that the typical imaging features are comparable to those seen in tumors occurring in the pulmonary vasculature. Potentially suspicious imaging findings of intraaortal filling defects include an atypical location for a thrombus, a pedunculated appearance and a subtle enhancement during first-pass perfusion (Figure 4) and hypermetabolism in F-18 FDG PET/CT (Figure 5), consistent with the intraluminal type of aortic sarcoma. Mural-type sarcomas show different imaging characteristics with predominant extraluminal perivascular growth and can be mistaken for inflammatory disease (Figure 6). The findings are summarized in Table 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