Aggressive fibromatosis: evaluation by computed tomography and angiography

Area of Science:

• Radiology
• Oncology
• Surgical Pathology

Background:

• Aggressive fibromatosis (desmoid tumor) is a locally invasive neoplasm characterized by fibroblastic proliferation.
• Accurate staging and margin assessment are crucial for effective surgical management of aggressive fibromatosis.
• Conventional imaging modalities may have limitations in fully delineating tumor extent and its relationship with adjacent structures.

Purpose of the Study:

• To evaluate the diagnostic accuracy of computed tomography (CT) in assessing the extent of aggressive fibromatosis.
• To compare the utility of CT, arteriography, and bone scintigraphy in delineating aggressive fibromatosis.
• To determine the optimal surgical margin based on imaging findings and the infiltrative nature of the tumor.

Main Methods:

• Retrospective review of 15 CT scans from 13 patients with aggressive fibromatosis.
• Analysis of tumor conspicuity, margin definition, and enhancement patterns on contrast-enhanced CT.
• Correlation of CT findings with arteriography (7 patients) and bone scintigraphy (6 patients) where available.

Main Results:

• CT generally showed disease extent but had poor margin definition in 9/15 lesions.
• Tumors were isodense/hypodense without contrast, enhancing to hyperdense with contrast.
• Arteriography improved delineation of lesions and vessels in some cases, while CT was clearer in others; bone scintigraphy provided additional information on bone involvement in 3/6 patients.

Conclusions:

• CT is valuable for assessing aggressive fibromatosis but has limitations in defining margins and visualizing small vessels.
• Arteriography and bone scintigraphy can offer complementary information.
• Surgical resection should encompass wide margins beyond imaging-defined limits due to potential microscopic infiltration.