Multidetector-row computed tomographic angiography findings of musculoskeletal tumors: retrospective analysis and correlation with surgical findings.

BACKGROUND: Although magnetic resonance imaging (MRI) is a valuable method in staging musculoskeletal tumors, it may not give enough information on the association between the tumor and the main vascular structures adjacent to the tumor. In this respect, computed tomographic angiography (CTA) may be a useful alternative imaging technique. PURPOSE: To evaluate the effectiveness of CTA in determining vascular invasion in patients with musculoskeletal tumors and suspected vascular invasion by MRI, and to correlate the CTA findings with the surgical findings. MATERIAL AND METHODS: Twenty patients who had musculoskeletal tumors and lacked a fat plane between the tumor and adjacent vessels by MRI were included in this study. All patients were evaluated with CTA, and the CTA findings were reviewed by two radiologists to determine the presence of vascular invasion. Statistical analysis was carried out by using surgical findings as the gold standard. RESULTS: There were nine women and 11 men (mean age 31 years) with either bone (n=9) or soft-tissue (n=11) tumors. Twelve patients without invasion according to the CTA examination were also surgically negative (true-negative cases). Of the eight patients with invasion shown by CTA, only three had adhesions and were considered surgically negative (false-positive cases). Five had invasions proven by surgery and were considered surgically positive (true-positive cases). Compared to the surgical findings, CTA had 100% sensitivity, 80% specificity, 62.5% positive predictive value, 100% negative predictive value, and 80% accuracy. CONCLUSION: CTA is a more accurate imaging technique than MRI in evaluating vascular invasion of musculoskeletal tumors, and provides valuable preoperative data.

Spondyloepiphyseal dysplasia tarda with progressive arthropathy.

Spondyloepiphyseal dysplasia tarda with progressive arthropathy, described by Wynne-Davies et al., is a rare autosomal recessive disorder. It is characterised by generalised platyspondyly and epiphyseal involvement, with enlargement of both ends of the short tubular bones of the hands. Clinical features include onset in childhood, a disproportionately short stature and premature osteoarthritis. We describe the clinical and radiographic findings of a young woman suffering from spondyloepiphyseal dysplasia tarda with progressive arthropathy.

Primary soft tissue hydatid disease: report of two cases with MRI characteristics.

Hydatid disease of the soft tissues forms a rare mass lesion of the extremities. Two cases of primary hydatid disease in soft tissues are presented with MR imaging findings. A cystic mass with multiloculated or multicystic appearance was identified on MR images in both cases. The lesions were surrounded by a rim with two layers representing a collageneous and a vascularized pericyst. The contrast-enhanced images demonstrated the vascularized component of the wall clearly in the first case. In diagnosis of hydatid disease and in its differentiation from other cystic lesions of the extremities, we think that the described MR appearances can be used confidently.

Magnetic resonance imaging of intramuscular haemangiomas with emphasis on contrast enhancement patterns.

Fifteen patients with intramuscular haemangiomas were evaluated with magnetic resonance imaging (MRI). Phleboliths were demonstrated by plain films or CT in six cases, which are characteristic for haemangioma. MRI showed intermediate or slightly high signal intensity on T1-weighted spin-echo images, and overall extremely bright signal on T2-weighted images. Twelve patients had a heterogeneous signal intensity and serpentine pattern on all sequences. A draining vessel was identified in a patient with histologically confirmed diagnosis of arteriovenous type of hemangioma. In three cases with localized small lesions, the MR appearance on T1 and T2-weighted conventional spin-echo sequences was homogenous. Two of the three showed a serpentine pattern on contrast enhanced images. In a patient with a soft tissue mass suspected of representing a haemangioma, MRI may provide more specific information, regarding the characteristics and extent of the lesion than other imaging techniques. In small localized lesions, contrast enhanced MRI may also offer significant advantage, making the identification of serpentine pattern possible which is a characteristic morphological feature of haemangioma.

Image-directed color Doppler ultrasonography in the evaluation of superficial solid tumors.

Image-directed color Doppler ultrasonography (ICDUS) studies of 86 patients with superficial solid masses yielded significantly lower resistive index (RI) values in acute inflammatory lesions, but no significant difference between the maximum systolic flow velocities (S) of the patient groups with malignant, benign, and acute inflammatory lesions. When analyzed separately, the malignant soft-tissue tumor subgroup was shown to have significantly higher mean RI compared to that of the malignant node subgroup. We conclude that RI may be useful in the differentiation of acute inflammatory masses from other pathological entities. Malignant soft-tissue tumors, especially sarcomas, may have different Doppler features from those of carcinomatous tumors.

Liposarcoma of soft tissue: MRI findings with pathologic correlation.

OBJECTIVE: To evaluate the MRI findings of liposarcomas of different histologic types and correlate these with the histopathologic features. DESIGN: The MR images of seven liposarcomas were reviewed retrospectively to assess the tumor size, location, margination, signal characteristics and enhancement patterns in different histologic types. PATIENTS: Seven liposarcomas comprising three well-differentiated, two myxoid and two pleomorphic types were evaluated. RESULTS AND CONCLUSION: All tumors showed well-defined and mostly lobulated margins. The well-differentiated liposarcomas were composed mainly of fat with septations or nodules, were hyperintense on T2-weighted images, and demonstrated faint enhancement or no enhancement following intravenous contrast. Myxoid liposarcomas were homogeneous or mildly heterogeneous and a pseudocapsule was present in one case. Pleomorphic types showed a markedly heterogeneous internal structure. Both myxoid and pleomorphic lesions-showed moderate or marked heterogeneous enhancement after contrast administration. Well-differentiated liposarcomas may be differentiated from other types of the tumor by their largely lipomatous appearance. The malignancy grade increases in parallel with tumor heterogeneity and contrast enhancement.