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Published on: June 11, 2019
Multiparametric MRI in differentiating pulmonary artery sarcoma and pulmonary thromboembolism: a preliminary
Min Liu1, Chunhai Luo, Ying Wang
1Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China. drradiology@163.com.
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.
Insights
Multiparametric MRI can differentiate pulmonary artery sarcoma (PAS) from pulmonary thromboembolism (PTE). Key MRI findings include hyperintensity on fat-suppressed T2-weighted imaging and diffusion-weighted imaging (DWI), along with contrast enhancement.
Area of Science:
- Radiology
- Oncology
- Cardiovascular Imaging
Background:
- Pulmonary artery sarcoma (PAS) is a rare malignancy, often misdiagnosed as pulmonary thromboembolism (PTE).
- Accurate differentiation is crucial for timely and appropriate treatment of these distinct conditions.
Purpose of the Study:
- To define multiparametric magnetic resonance imaging (MRI) findings that distinguish between pulmonary artery sarcoma (PAS) and pulmonary thromboembolism (PTE).
Main Methods:
- Prospective enrollment of 11 patients with suspected PTE for pulmonary MRI.
- MRI protocol included unenhanced, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced sequences.
- Morphologic characteristics and apparent diffusion coefficient (ADC) values were analyzed.
Main Results:
- Six patients had PAS, and five had chronic PTE; no significant clinical or laboratory differences were noted.
- MRI findings with high diagnostic value for PAS included main pulmonary artery involvement, hyperintensity on fat-suppressed T2-weighted imaging and DWI, and contrast enhancement.
- Grape-like appearance and cardiac invasion showed 100% specificity for PAS, while ADC values did not differ between groups.
Conclusions:
- Multiparametric MRI, particularly hyperintense filling defects on fat-suppressed T2-weighted imaging and DWI with contrast enhancement, aids in discriminating PAS from PTE.
- These imaging features can guide diagnosis and treatment planning for patients with suspected pulmonary artery abnormalities.
