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Diffusion weighted magnetic resonance imaging demonstrates tumor response following palliative embolization of a recurrent shoulder plasmacytoma.

Bérczi V, Rudas G, Kozák LR, Györke T, Mikala G, Masszi T, Kalina I, Kaposi PN - World J Surg Oncol (2014)

Bottom Line: The patient's symptoms rapidly improved post-embolization and the serum free light chain ratio stabilized at a lower level.The follow-up magnetic resonance image showed increased diffusivity in previously restricted tumor foci.This has negatively correlated with the decreased fludeoxyglucose uptake on PET, suggesting post-embolization necrosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Oncotherapy, Semmelweis University, Üllői út 78/a, H-1082 Budapest, Hungary. berczi@hotmail.com.

ABSTRACT
We report the palliative embolization and functional imaging follow-up of a recurrent shoulder plasmacytoma. The multiple myeloma patient complained of severe pain and discomfort, while he could not tolerate further chemotherapy. The left shoulder lesion had earlier received a high dose of irradiation. Thus, the well-vascularized lesion was embolized via feeding arteries branching off from the left subclavian artery in two sessions. The patient's symptoms rapidly improved post-embolization and the serum free light chain ratio stabilized at a lower level. The follow-up magnetic resonance image showed increased diffusivity in previously restricted tumor foci. This has negatively correlated with the decreased fludeoxyglucose uptake on PET, suggesting post-embolization necrosis.

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Post-embolization tumor response in the shoulder plasmacytoma could be best demonstrated with functional imaging studies. (A) Angiogram of the left shoulder revealed a well-vascularized lesion, which was supplied by branches from the left subclavian artery. (B) Selective catheterization of the feeding arteries and embolization of the tumor vasculature with 350 to 500 μm PVA particles were performed in two sessions from a right femoral puncture and a left brachial puncture, respectively. Some arterial branches were also closed off with coils. DWIBS MRI proved to be a sensitive modality for locating densely packed foci of tumor cells inside a heterogeneous lesion. (C) We co-registered ADC maps with T2 weighted images that allowed more precise comparison between baseline and follow-up scans. (D) The increase of ADC values by 4 weeks post-embolization was clearly visible on the fusion map. (E) Some DWIBS restricted foci also showed high 18FDG uptake on PET-CT. (F) Following embolization, decreased metabolic activity was detected, which was inversely correlated with increased diffusivity, a sign of tumor necrosis.
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Fig1: Post-embolization tumor response in the shoulder plasmacytoma could be best demonstrated with functional imaging studies. (A) Angiogram of the left shoulder revealed a well-vascularized lesion, which was supplied by branches from the left subclavian artery. (B) Selective catheterization of the feeding arteries and embolization of the tumor vasculature with 350 to 500 μm PVA particles were performed in two sessions from a right femoral puncture and a left brachial puncture, respectively. Some arterial branches were also closed off with coils. DWIBS MRI proved to be a sensitive modality for locating densely packed foci of tumor cells inside a heterogeneous lesion. (C) We co-registered ADC maps with T2 weighted images that allowed more precise comparison between baseline and follow-up scans. (D) The increase of ADC values by 4 weeks post-embolization was clearly visible on the fusion map. (E) Some DWIBS restricted foci also showed high 18FDG uptake on PET-CT. (F) Following embolization, decreased metabolic activity was detected, which was inversely correlated with increased diffusivity, a sign of tumor necrosis.

Mentions: A 58-year-old man was first diagnosed with solitary plasmacytoma of the left scapula 19 years ago. At the time he was treated with radiation therapy. The tumor had recurred multiple times, for which a total dose of 38 Gy of local irradiation was administered. A second lesion occurred in the right acetabulum. Afterwards, the patient was treated with multiple cycles of combination chemotherapy, and twice with autologous stem cell transplantation (Additional file1: Table S1). In spite of all therapeutic efforts, the disease did not go into full remission. During the last episode of recurrence, after two cycles of effective salvage with a VDT-PACE combination (bortezomib-dexamethason-thalidomide-cisplatine-doxorubicine-cyclophosphamide-etopozide), the regimen had to be stopped due to the sustained thrombocytopenia.The patient continued to complain of significant pain, and restricted movements of the upper limb. Computed tomography (CT) and MRI scans showed a multifocal tumor in the left scapula, which extended into the axilla thus, surgical resection was impossible. At this point, we decided to use TAE to achieve fast control of the patient’s symptoms. Angiography showed the lesion was well vascularized (Figure 1A). Embolization of the lesion was performed in two sessions; feeding arteries branching off from the left subclavian artery were selectively catheterized from a right femoral puncture and a left brachial puncture, and the tumor vessels were embolized to stasis (Figure 1B) with 350 to 550 μm Contour® PVA particles (Boston Scientific, Natick, MA, USA). Intravenous pethidine was administered for analgesia. The platelet count was 161 K at the time of the procedure. We neither observed bleeding nor any neurological deficit in association with the embolization. The post-procedural period was uneventful; and the patient was released to home on the next day.Figure 1


Diffusion weighted magnetic resonance imaging demonstrates tumor response following palliative embolization of a recurrent shoulder plasmacytoma.

Bérczi V, Rudas G, Kozák LR, Györke T, Mikala G, Masszi T, Kalina I, Kaposi PN - World J Surg Oncol (2014)

Post-embolization tumor response in the shoulder plasmacytoma could be best demonstrated with functional imaging studies. (A) Angiogram of the left shoulder revealed a well-vascularized lesion, which was supplied by branches from the left subclavian artery. (B) Selective catheterization of the feeding arteries and embolization of the tumor vasculature with 350 to 500 μm PVA particles were performed in two sessions from a right femoral puncture and a left brachial puncture, respectively. Some arterial branches were also closed off with coils. DWIBS MRI proved to be a sensitive modality for locating densely packed foci of tumor cells inside a heterogeneous lesion. (C) We co-registered ADC maps with T2 weighted images that allowed more precise comparison between baseline and follow-up scans. (D) The increase of ADC values by 4 weeks post-embolization was clearly visible on the fusion map. (E) Some DWIBS restricted foci also showed high 18FDG uptake on PET-CT. (F) Following embolization, decreased metabolic activity was detected, which was inversely correlated with increased diffusivity, a sign of tumor necrosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4150974&req=5

Fig1: Post-embolization tumor response in the shoulder plasmacytoma could be best demonstrated with functional imaging studies. (A) Angiogram of the left shoulder revealed a well-vascularized lesion, which was supplied by branches from the left subclavian artery. (B) Selective catheterization of the feeding arteries and embolization of the tumor vasculature with 350 to 500 μm PVA particles were performed in two sessions from a right femoral puncture and a left brachial puncture, respectively. Some arterial branches were also closed off with coils. DWIBS MRI proved to be a sensitive modality for locating densely packed foci of tumor cells inside a heterogeneous lesion. (C) We co-registered ADC maps with T2 weighted images that allowed more precise comparison between baseline and follow-up scans. (D) The increase of ADC values by 4 weeks post-embolization was clearly visible on the fusion map. (E) Some DWIBS restricted foci also showed high 18FDG uptake on PET-CT. (F) Following embolization, decreased metabolic activity was detected, which was inversely correlated with increased diffusivity, a sign of tumor necrosis.
Mentions: A 58-year-old man was first diagnosed with solitary plasmacytoma of the left scapula 19 years ago. At the time he was treated with radiation therapy. The tumor had recurred multiple times, for which a total dose of 38 Gy of local irradiation was administered. A second lesion occurred in the right acetabulum. Afterwards, the patient was treated with multiple cycles of combination chemotherapy, and twice with autologous stem cell transplantation (Additional file1: Table S1). In spite of all therapeutic efforts, the disease did not go into full remission. During the last episode of recurrence, after two cycles of effective salvage with a VDT-PACE combination (bortezomib-dexamethason-thalidomide-cisplatine-doxorubicine-cyclophosphamide-etopozide), the regimen had to be stopped due to the sustained thrombocytopenia.The patient continued to complain of significant pain, and restricted movements of the upper limb. Computed tomography (CT) and MRI scans showed a multifocal tumor in the left scapula, which extended into the axilla thus, surgical resection was impossible. At this point, we decided to use TAE to achieve fast control of the patient’s symptoms. Angiography showed the lesion was well vascularized (Figure 1A). Embolization of the lesion was performed in two sessions; feeding arteries branching off from the left subclavian artery were selectively catheterized from a right femoral puncture and a left brachial puncture, and the tumor vessels were embolized to stasis (Figure 1B) with 350 to 550 μm Contour® PVA particles (Boston Scientific, Natick, MA, USA). Intravenous pethidine was administered for analgesia. The platelet count was 161 K at the time of the procedure. We neither observed bleeding nor any neurological deficit in association with the embolization. The post-procedural period was uneventful; and the patient was released to home on the next day.Figure 1

Bottom Line: The patient's symptoms rapidly improved post-embolization and the serum free light chain ratio stabilized at a lower level.The follow-up magnetic resonance image showed increased diffusivity in previously restricted tumor foci.This has negatively correlated with the decreased fludeoxyglucose uptake on PET, suggesting post-embolization necrosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Oncotherapy, Semmelweis University, Üllői út 78/a, H-1082 Budapest, Hungary. berczi@hotmail.com.

ABSTRACT
We report the palliative embolization and functional imaging follow-up of a recurrent shoulder plasmacytoma. The multiple myeloma patient complained of severe pain and discomfort, while he could not tolerate further chemotherapy. The left shoulder lesion had earlier received a high dose of irradiation. Thus, the well-vascularized lesion was embolized via feeding arteries branching off from the left subclavian artery in two sessions. The patient's symptoms rapidly improved post-embolization and the serum free light chain ratio stabilized at a lower level. The follow-up magnetic resonance image showed increased diffusivity in previously restricted tumor foci. This has negatively correlated with the decreased fludeoxyglucose uptake on PET, suggesting post-embolization necrosis.

Show MeSH
Related in: MedlinePlus