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

Abstract

BackgroundTo investigate the imaging features of primary sarcomas of the great vessels in CT, MRI and 18 F-FDG PET/CT.MethodsThirteen 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.ResultsThe 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.ConclusionIntravascular 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.

Aortic Intimal Sarcoma Contributes to Atherosclerotic Renovascular Hypertension: An Autopsy Case Report and Review of the Literature

“…Thus, it is important to make an effort to detect intravascular masses through imaging studies. Recently, the advantages of MRI for diagnosing AIS have been reported by von Falck et al who demonstrated that a pedunculated or lobulated appearance and subtle enhancement during first-pass perfusion were consistent with AIS (18). Regrettably, Gd-enhanced MRI, which was performed in our patient, did not focus upon the origins of the renal arteries, which could have detected the primary lesion at the right renal artery bifurcation area.…”

“…In addition, FDG-PET/enhanced CT or MRI-DWIBS failed to yield findings indicative of AIS. The FDG uptake has been reported to be poor in intimal sarcomas (18,19).…”

“…Upper endoscopy and colonoscopy failed to show a primary lesion. 18 Ffluorodeoxyglucose (FDG) whole-body positron emission tomography (PET)/enhanced whole-body computed tomography (CT) showed abnormal multiple sites of isotope accumulation in the sternum, vertebrae, ilia and femurs.…”

Large Vessel Vasculitis with an Isolated Lesion of a Single-lobe Pulmonary Artery

“…Intimal sarcoma of the pulmonary artery was reported to have a prevalence of 0.001% based on autopsy findings (6). Generally, a lesion of the pulmonary intimal sarcoma is localized to a single pulmonary artery, as in this case (7). FDG-PET scanning shows an increased uptake of FDG to the intimal sarcoma lesions in most cases (2).…”

PH Grand Rounds: Persistent Pulmonary Artery Filling Defects: Looking Beyond Anticoagulation Failure

“…The degree of FDG uptake tends to be significantly higher in the latter group. 6,7 The mainstay of therapy for these tumors is surgical resection, which may prolong tumor-free survival. 7,8 The role of chemotherapy is unclear, and there are no consensus recommendations for specific therapeutic regimens.…”