Diagnostic and Interventional Radiology
Chest Imaging - Original Article

Multiparametric MRI in differentiating pulmonary artery sarcoma and pulmonary thromboembolism: a preliminary experience

1.

Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China

2.

Department of Radiology, the second affiliated Hospital of Xi'an Medical College, Xi’an City,China

3.

Department of Clinical Pathology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China

4.

Respiratory Diseases Research Center, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China

5.

Siemens MR Northeastern Collaboration Application Department, Siemens MRI Center, Beijing,China

Diagn Interv Radiol 2017; 23: 15-21
DOI: 10.5152/dir.2016.15584
Read: 842 Downloads: 316 Published: 03 September 2019

Abstract

PURPOSE: We aimed to define multiparametric magnetic resonance imaging (MRI) findings to differentiate between pulmonary artery sarcoma (PAS) and pulmonary thromboembolism (PTE).

 

METHODS: Eleven patients with suspected PTE were prospectively included to undergo pulmonary MRI before surgery or biopsy. MRI protocol included an unenhanced sequence, diffusion-weighted imaging (DWI, b=800 s/mm2) and a dynamic contrast-enhanced sequence. Morphologic characteristics including distribution, filling defect, and intensity were observed on T1-, T2-, and fat-suppressed T2-weighted imaging, DWI, and contrast-enhanced MRI. Apparent diffusion coefficient (ADC) values were calculated.

 

RESULTS: Six patients were pathologically diagnosed as PAS and the other five as chronic PTE. There were no significant differences in age, gender, presenting symptoms, D-dimer, and N-terminal pro-brain natriuretic peptide between the two groups (P > 0.05). Among MRI findings that were tested for their ability to diagnose PAS, area under the curve (AUC) was significantly higher than 0.5 for main pulmonary artery involvement (AUC, 0.83±0.13; P = 0.011), hyperintensity on fat-suppressed T2-weighted imaging (AUC, 0.82±0.14; P = 0.025), hyperintensity on DWI (AUC, 0.88±0.12; P = 0.002), contrast enhancement (AUC, 0.92±0.10; P < 0.001) and pleural effusion (AUC, 0.82±0.14; P = 0.025). Moreover, grape-like appearance in distal pulmonary artery and cardiac invasion had 100% specificity for diagnosis of PAS. However, ADC value of PAS was not significantly different than that of chronic PTE (U, 12.00; P = 0.584).

 

CONCLUSION: Hyperintense filling defect in main pulmonary artery on fat-suppressed T2-weighted imaging and DWI and contrast enhancement may help to discriminate PAS from PTE.

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