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European Radiology

, Volume 26, Issue 7, pp 2400–2408 | Cite as

Accuracy and role of contrast-enhanced CT in diagnosis and surgical planning in 88 soft tissue tumours of extremities

  • Lucia VergaEmail author
  • Elena Maria Brach del Prever
  • Alessandra Linari
  • Sara Robiati
  • Armanda De Marchi
  • Domenico Martorano
  • Michele Boffano
  • Raimondo Piana
  • Carlo Faletti
Musculoskeletal

Abstract

Objectives

Soft tissue tumours (STT) require accurate diagnosis in order to identify potential malignancies. Preoperative planning is fundamental to avoid inadequate treatments. The role of contrast-enhanced computed tomography (CT) for local staging remains incompletely assessed. Aims of the study were to evaluate CT accuracy in discriminating active from aggressive tumours compared to histology and evaluate the role of CT angiography (CTA) in surgical planning.

Materials and methods

This retrospective cohort series of 88 cases from 1200 patients (7 %) was locally studied by contrast-enhanced CT and CTA in a referral centre: 74 malignant tumours, 14 benign lesions. Contrast-enhancement patterns and relationship of the mass with major vessels and bone were compared with histology on surgically excised samples. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were evaluated in discriminating active from aggressive tumours.

Results

Sensitivity in differentiating aggressive tumours from active lesions was 89 %, specificity 84 %, PPV 90 %, NPV 82 %. The relationship between mass and major vessels/bone was fundamental for surgical strategy respectively in 40 % and in 58 % of malignant tumours.

Conclusion

Contrast-enhanced CT and CTA are effective in differentiating aggressive masses from active lesions in soft tissue and in depicting the relationship between tumour and adjacent bones and major vessels.

Key Points

Accurate delineation of vascular and bony involvement preoperatively is fundamental for a correct resection.

CT plays a critical role in differential diagnosis of soft tissue masses.

Contrast-enhanced CT and CT angiography are helpful in depicting tumoral vascular involvement.

CT is optimal for characterization of bone involvement in soft tissue malignancies.

Keywords

Contrast-enhanced CT CT angiography Soft tissue sarcoma Surgical planning Tumour vascularization 

Notes

Acknowledgments

The scientific guarantor of this publication is Faletti Carlo. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

References

  1. 1.
    Campanacci M (1999) Bone and soft tissue tumours. Springer-Verlag, New YorkCrossRefGoogle Scholar
  2. 2.
    Enneking WF (1990) Clinical musculoskeletal pathology. 3 Rev Sub. University of Florida PressGoogle Scholar
  3. 3.
    NICE Improving Outcomes Guidelines for soft tissue sarcoma. Cancer service guidance CSG Sarcoma. Issued: March 2006Google Scholar
  4. 4.
    Casali PG, Jost L, Sleijfer S, Verweij J, Blay JY (2008) Soft tissue sarcomas: ESMO clinical recommendations for diagnosis, treatment and follow up. Ann Oncol 19:ii89–ii93PubMedGoogle Scholar
  5. 5.
    Grimer R, Judson I, Peake D, Seddon B (2010) Guidelines for the management of soft tissue sarcomas. Sarcoma 2010:506182PubMedPubMedCentralGoogle Scholar
  6. 6.
    Cutts S, Ferrero A, Piana R, Haywood R (2012) The management of soft tissue sarcomas. Review. Surgeon 10:25–32CrossRefPubMedGoogle Scholar
  7. 7.
    Singer S (1999) New diagnostic modalities in soft tissue sarcoma. Semin Surg Oncol 17:11–22CrossRefPubMedGoogle Scholar
  8. 8.
    Balach T, Stacy GS, Haydon RC (2011) The clinical evaluation of soft tissue tumors. Radiol Clin N Am 49:1185–1196, vi CrossRefPubMedGoogle Scholar
  9. 9.
    Colleran G, Madewell J, Foran P, Shelly M, O’Sullivan PJ (2011) Imaging of soft tissue and osseous sarcomas of the extremities. Semin Ultrasound CT MR 32:442–455CrossRefPubMedGoogle Scholar
  10. 10.
    Knapp EL, Kransdorf MJ, Letson GD (2005) Diagnostic imaging update: soft tissue sarcomas. Cancer Control 12:22–26PubMedGoogle Scholar
  11. 11.
    Tzeng C-WD, Smith JK, Heslin MJ (2007) Soft tissue sarcoma: preoperative and postoperative imaging for staging. Surg Oncol Clin N Am 16:389–402CrossRefPubMedGoogle Scholar
  12. 12.
    Tuncbilek N, Karakas HM, Okten OO (2005) Dynamic contrast enhanced MRI in the differential diagnosis of soft tissue tumors. Eur J Radiol 53:500–505CrossRefPubMedGoogle Scholar
  13. 13.
    Vilanova JC, Woertler K, Narvaez JA et al (2007) Soft tissue tumors update: MR imaging features according to the WHO classification. Eur Radiol 17:125–138CrossRefPubMedGoogle Scholar
  14. 14.
    Daniel A Jr, Ullah E, Wahab S, Kumar V Jr (2009) Relevance of MRI in prediction of malignancy of musculoskeletal system—a prospective evaluation. BMC Musculoskelet Disord 10:125CrossRefPubMedGoogle Scholar
  15. 15.
    Yamamoto T, Kurosaka M, Soejima T, Fujii M (2001) Contrast-enhanced three-dimensional helical CT for soft tissue tumors in the extremities. Skelet Radiol 30:384–387CrossRefGoogle Scholar
  16. 16.
    Cheong D, Letson GD (2011) Computer-assisted navigation and musculoskeletal sarcoma surgery. Cancer Control 18:171–176PubMedGoogle Scholar
  17. 17.
    Thévenin FS, Drapé JL, Biau D et al (2010) Assessment of vascular invasion by bone and soft tissue tumours of the limbs: usefulness of MDCT angiography. Eur Radiol 20:1524–1531CrossRefPubMedGoogle Scholar
  18. 18.
    Comandone A, Brach del Prever EM, Aglietta M et al (2004, revised 2008) Guide Lines soft tissue sarcoma. Piedmont Oncological Network Press, Turin. www.reteoncologica.it
  19. 19.
    Gay F, Pierucci F, Zimmerman V et al (2012) Contrast-enhanced ultrasonography of peripheral soft-tissue tumors: feasibility study and preliminary results. Diagn Interv Imaging 93:37–46CrossRefPubMedGoogle Scholar
  20. 20.
    De Marchi A, Brach del Prever EM, Linari A et al (2010) Accuracy of core-needle biopsy after contrast-enhanced ultrasound in soft-tissue tumours. Eur Radiol 20:2740–2748CrossRefPubMedGoogle Scholar
  21. 21.
    Masciocchi C, Lanni G, Conti L et al (2012) Soft-tissue inflammatory myofibroblastic tumors (IMTs) of the limbs: potential and limits of diagnostic imaging. Skelet Radiol 41:643–649CrossRefGoogle Scholar
  22. 22.
    Ilaslan H, Sundaram M (2006) Advances in musculoskeletal tumor imaging. Orthop Clin N Am 37:375–391, vii CrossRefGoogle Scholar
  23. 23.
    Errani C, Kreshak J, Ruggieri P et al (2013) Imaging of bone tumors for the musculoskeletal oncologic surgeon. Eur J Radiol 82:2083–2091CrossRefPubMedGoogle Scholar
  24. 24.
    Morris CD, Parsons TW 3rd, Schwab JH, Panicek DM (2012) Imaging interpretation of oncologic musculoskeletal conditions. Instr Course Lect 61:541–551PubMedGoogle Scholar
  25. 25.
    Huwart L, Michoux N, Van Beers BE (2007) Magnetic resonance imaging of angiogenesis in tumors. J Radiol 88:331–338CrossRefPubMedGoogle Scholar
  26. 26.
    Fenstermacher MJ (2003) Imaging evaluation of patients with soft tissue sarcoma. Surg Oncol Clin N Am 12:305–332CrossRefPubMedGoogle Scholar
  27. 27.
    Pang KK, Hughes T (2003) MR imaging of the musculoskeletal soft tissue mass: is heterogeneity a sign of malignancy? J Chin Med Assoc 66:655–661PubMedGoogle Scholar
  28. 28.
    Loizides A, Peer S, Plaikner M, Djurdjevic T, Gruber H (2012) Perfusion pattern of musculoskeletal masses using contrast-enhanced ultrasound: a helpful tool for characterization? Eur Radiol 22:1803–1811CrossRefPubMedGoogle Scholar
  29. 29.
    Li Y, Zheng Y, Lin J, Cai A, Zhou X, Wei X et al (2013) Evaluation of the relationship between extremity soft tissue sarcomas and adjacent major vessels using contrast-enhanced multidetector CT and three-dimensional volume-rendered CT angiography: a preliminary study. Acta Radiol 54:966–972CrossRefPubMedGoogle Scholar
  30. 30.
    Feydy A, Anract P, Tomeno B, Chevrot A, Drapé JL (2006) Assessment of vascular invasion by musculoskeletal tumors of the limbs: use of contrast enhanced MR angiography. Radiology 238:611–621CrossRefPubMedGoogle Scholar
  31. 31.
    Argin M, Isayev H, Kececi B, Arkun R, Sabah D (2009) Multidetector-row computed tomographic angiography findings of musculoskeletal tumors: retrospective analysis and correlation with surgical findings. Acta Radiol 50:1150–1159CrossRefPubMedGoogle Scholar
  32. 32.
    King DM, Hackbarth DA, Kilian CM, Carrera GF (2009) Soft-tissue sarcoma metastases identified on abdomen and pelvis CT imaging. Clin Orthop Relat Res 467:2838–2844CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Lee SY, Jee WH, Jung JY, Park MY, Kim SK, Jung CK et al (2015) Differentiation of malignant from benign soft tissue tumours: use of additive qualitative and quantitative diffusion weighted MR imaging to standard MR imaging at 3.0 T. Eur Radiol. doi: 10.1007/s00330-015-3878-x Google Scholar
  34. 34.
    Fendler WP, Chalkidis RP, Ilhan H, Knösel T, Herrmann K, Issels RD et al (2015) Evaluation of several FDG PET parameters for prediction of soft tissue tumour grade at primary diagnosis and recurrence. Eur Radiol 25:2214–2221CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Lucia Verga
    • 1
    Email author
  • Elena Maria Brach del Prever
    • 2
    • 1
  • Alessandra Linari
    • 3
  • Sara Robiati
    • 1
  • Armanda De Marchi
    • 1
  • Domenico Martorano
    • 1
  • Michele Boffano
    • 4
  • Raimondo Piana
    • 4
  • Carlo Faletti
    • 1
  1. 1.Department of Imaging, Azienda Ospedaliera Città della Salute e della ScienzaCTO HospitalTorinoItaly
  2. 2.Department of Public Health and PaediatricsUniversity of TurinTorinoItaly
  3. 3.Department of Pathology, Azienda Ospedaliera Città della Salute e della ScienzaRegina Margherita HospitalTorinoItaly
  4. 4.Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliera Città della Salute e della ScienzaCTO HospitalTorinoItaly

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