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Xi XY, Gao W, Gong JN, Guo XJ, Wu JY, Yang YH, Yang MF. Value of 18F-FDG PET/CT in differentiating malignancy of pulmonary artery from pulmonary thromboembolism: a cohort study and literature review. Int J Cardiovasc Imaging 2019; 35:1395-1403. [PMID: 30747369 DOI: 10.1007/s10554-019-01553-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 02/02/2019] [Indexed: 02/08/2023]
Abstract
To determine the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in differentiating malignancy of pulmonary artery (PA) from pulmonary thromboembolism (PTE) based on a larger number of cases by pooling our cases and those from the literature. Consecutive patients with a PA lesion who had undergone 18F-FDG PET/CT in our hospital were retrospectively reviewed. Moreover, PubMed, Embase, and Medline were searched for literature reporting individual maximum standardised uptake value (SUVmax) of the malignant PA lesion and/or PTE. 18F-FDG activity was compared between PA malignancy and PTE by pooling the data from literature and our patients. Receiver operating characteristic curve analysis was performed to determine the ability of SUVmax to differentiate PA malignancy from PTE. From our database, we identified 11 patients with pulmonary artery sarcoma (PAS), and nine cases of PTE. Fifty patients with a malignant PA lesion (40 cases of PAS and 10 cases of tumor embolism) and 22 subjects with PTE were extracted from the literature. In our cases, the SUVmax of PAS (11.1 ± 4.9, range: 5.5-19.9) was significantly higher than that of PTE (1.9 ± 0.6, range: 1.1-3.2; P < 0.001). There was no significant difference in the SUVmax between the literature data and our cases in malignant lesions or in PTE. Based on the pooled analysis of the literature data and our cases (61 cases of malignant lesions and 31 cases of PTE), the area under the curve for SUVmax to differentiate PA malignancy from PTE was 0.996 (95% CI: 0.989-1.000). At a cutoff value of 3.3, the sensitivity, specificity, and accuracy were 98.4%, 96.8%, and 97.8%, respectively. The 18F-FDG uptake value is an accurate index for determining PA malignancy.
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Affiliation(s)
- Xiao-Ying Xi
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Wei Gao
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Juan-Ni Gong
- Department of Respiratory and Critical Care, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Juan Guo
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiao-Yan Wu
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Yuan-Hua Yang
- Department of Respiratory and Critical Care, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Min-Fu Yang
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China.
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Pomoni A, Sotiriadis C, Gay F, Jouannic AM, Qanadli SD. Percutaneous endovascular biopsy of intravascular masses: efficacy and safety in establishing pre-therapy diagnosis. Eur Radiol 2017; 28:301-307. [DOI: 10.1007/s00330-017-4983-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/28/2017] [Accepted: 07/10/2017] [Indexed: 12/20/2022]
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3
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Plata MC, Lucía Rey D, Villaquirán C, Rosselli D. Intimal sarcoma of the pulmonary artery presenting as pulmonary embolism. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n3a10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hajsadeghi S, Kooranifar S, Ansarinejad N, Sadeghipour A, Iranpour A, Aziz Ahari A. Metastatic pulmonary artery sarcoma presented with tamponade: a case report. Clin Case Rep 2017; 5:1007-1010. [PMID: 28588856 PMCID: PMC5457986 DOI: 10.1002/ccr3.989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 11/13/2022] Open
Abstract
Pulmonary artery sarcoma is a rare tumor with varying presentations including pericardial effusion and pulmonary metastasis. Single‐nucleotide polymorphism array is a novel method that can be used to define tumor genome and be used as a guidance to choose the proper treatment regimen.
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Affiliation(s)
- Shokoufeh Hajsadeghi
- Department of Cardiovascular Disease Hazrat-e Rasool General Hospital Iran University of Medical Sciences Tehran Iran
| | - Siavash Kooranifar
- Department of Pulmonary and Critical Care Hazrat-e Rasool General Hospital Iran University of Medical Sciences Tehran Iran
| | - Nafise Ansarinejad
- Department of Hematology and Oncology Hazrat-e Rasool General Hospital Iran University of Medical Sciences Tehran Iran
| | - Alireza Sadeghipour
- Department of Pathology Hazrat-e Rasool General Hospital Iran University of Medical Sciences Tehran Iran
| | - Aida Iranpour
- Department of Internal Medicine Hazrat-e Rasool General Hospital Iran University of Medical Sciences Tehran Iran
| | - Alireza Aziz Ahari
- Department of Radiology Hazrat-e Rasool General Hospital Iran University of Medical Sciences Tehran Iran
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Lee Y, Kim HJ, Yoon H, Choi CM, Oh YM, Lee SD, Lim CM, Kim WS, Koh Y, Lee JS. Clinical Characteristics and Treatment Outcomes of Primary Pulmonary Artery Sarcoma in Korea. J Korean Med Sci 2016; 31:1755-1760. [PMID: 27709853 PMCID: PMC5056207 DOI: 10.3346/jkms.2016.31.11.1755] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/20/2016] [Indexed: 01/18/2023] Open
Abstract
Pulmonary artery sarcomas (PAS) are rare malignant neoplasms. Right heart failure due to tumour location is the main cause of death in PAS patients. The hemodynamic influence of PAS may effect prognosis, but this has not been proven. We aimed to identify the clinical characteristics and prognostic factors of PAS in Korea, their association with pulmonary hypertension (PH). PAS patients treated at the Asan Medical Center between 2000 and 2014 were reviewed. We examined demographic characteristics, diagnostic and treatment modalities. Potential prognostic factors were evaluated by univariate and multivariate analysis. Twenty patients were diagnosed with PAS. Ten patients were male, the median age was 54 years (range, 33-75 years). The most common symptom observed was dyspnea (65%). The most common histologic type was spindle cell sarcoma (30%). Ten patients had a presumptive diagnosis of pulmonary embolism (PE) and received anticoagulation therapy. Seventeen patients underwent surgery, but only 5 patients had complete resection. Eleven patients received post-operative treatment (chemotherapy = 3, radiotherapy = 5, chemoradiotherapy = 3). PH was observed in 12 patients before treatment and in 6 patients after treatment. Overall median survival was 24 months. Post-treatment PH was associated with poor prognosis (HR 9.501, 95% CI 1.79-50.32; P = 0.008) while chemotherapy was negatively associated with mortality (HR 0.102, 95% CI 0.013-0.826; P = 0.032) in univariate analysis. Post-treatment PH was also associated with poor prognosis in multivariate analysis (HR 5.7, 95% CI 1.08-30.91; P = 0.041). PAS patients are frequently misdiagnosed with PE in Korea. Post-treatment PH is associated with a poor prognosis.
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Affiliation(s)
- Yunkyoung Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Jung Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Heeyoung Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Min Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yeon Mok Oh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Do Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chae Man Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Woo Sung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Younsuck Koh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Seung Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Guimaraes MD, Hochhegger B, Santos MK, Santana PRP, Sousa AS, Souza LS, Marchiori E. Magnetic resonance imaging of the chest in the evaluation of cancer patients: state of the art. Radiol Bras 2015. [PMID: 25798006 PMCID: PMC4366027 DOI: 10.1590/0100-3984.2013.1921] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Magnetic resonance imaging (MRI) has several advantages in the evaluation of cancer
patients with thoracic lesions, including involvement of the chest wall, pleura,
lungs, mediastinum, esophagus and heart. It is a quite useful tool in the diagnosis,
staging, surgical planning, treatment response evaluation and follow-up of these
patients. In the present review, the authors contextualize the relevance of MRI in
the evaluation of thoracic lesions in cancer patients. Considering that MRI is a
widely available method with high contrast and spatial resolution and without the
risks associated with the use of ionizing radiation, its use combined with new
techniques such as cine-MRI and functional methods such as perfusion- and
diffusion-weighted imaging may be useful as an alternative tool with performance
comparable or complementary to conventional radiological methods such as radiography,
computed tomography and PET/CT imaging in the evaluation of patients with thoracic
neoplasias.
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Affiliation(s)
- Marcos Duarte Guimaraes
- PhD, Radiologist, Specialist in Internal Medicine, Responsible for Chest Imaging Units at Hospital Heliópolis and A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Bruno Hochhegger
- PhD, Associate Professor at Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Marcel Koenigkam Santos
- PhD, Radiologist at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Pablo Rydz Pinheiro Santana
- MD, Member of Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), Thoracic Radiologist at Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Arthur Soares Sousa
- PhD, Professor and Post-graduation Advisor, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Luciana Soares Souza
- MD, Radiologist, Faculdade de Medicina São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Edson Marchiori
- PhD, Adjunct Coordinator of Post-Graduation, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Right pulmonary artery atresia with left circumflex coronary collaterals supplying the affected lung diagnosed by V/Q scintigraphy and CTA: a case report and review of the literature. Ann Nucl Med 2014; 28:1027-31. [DOI: 10.1007/s12149-014-0891-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
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8
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Kamaleshwaran KK, Pattabiraman V, Mehta S, Mohanan V, Shinto AS. Spindle cell sarcoma of pulmonary artery mimicking thromboembolism with lung metastasis detected in fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med 2014; 29:249-51. [PMID: 25400365 PMCID: PMC4228589 DOI: 10.4103/0972-3919.142631] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary artery sarcoma (PAS), although rare, must be considered in the differential diagnosis of pulmonary thromboembolism (PTE). This tumor is highly malignant and the prognosis is very poor. As much as the standardized uptake values (SUVs) at fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) have helped in differentiating between benign and malignant tumors, visualization of a low-attenuation filling defect within a pulmonary artery on contrast-enhanced chest computed tomography (CT) can be suggestive of a malignancy, such as PAS, if the lesion shows high FDG uptake at PET. We present a case of PAS that showed high FDG uptake on integrated FDG PET/CT and with lung metastasis. Patient underwent endoscopic bronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA), which confirmed spindle cell sarcoma.
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Affiliation(s)
- Koramadai Karuppusamy Kamaleshwaran
- Department of Nuclear Medicine and Positron Emission Tomography/Computed Tomography, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Vr Pattabiraman
- Department of Pulmonology, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Sangita Mehta
- Department of Pathology, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Vyshakh Mohanan
- Department of Nuclear Medicine and Positron Emission Tomography/Computed Tomography, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
| | - Ajit Sugunan Shinto
- Department of Nuclear Medicine and Positron Emission Tomography/Computed Tomography, Kovai Medical Centre and Hospital Limited, Coimbatore, Tamil Nadu, India
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9
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Coskun U, Sinan UY, Calpar I, Yildizeli B, Yanartas M, Filinte D, Kucukoglu MS. Pulmonary artery sarcoma masquerading as chronic pulmonary thromboembolism. Tex Heart Inst J 2014; 41:518-22. [PMID: 25425987 DOI: 10.14503/thij-13-3598] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We describe the case of a 60-year-old woman who presented with pulmonary artery sarcoma, a very rare tumor of the cardiovascular system. Her tumor was initially misdiagnosed as chronic pulmonary thromboembolism, and she underwent pulmonary endarterectomy. Early diagnosis of primary pulmonary artery sarcoma is crucial. That alternative should always be considered before settling on a diagnosis of pulmonary embolism. Suspicion should be aroused by the failure of anticoagulant treatment to alleviate pulmonary perfusion abnormalities and systemic symptoms. Surgical resection of the tumor-preferably by pulmonary endarterectomy, followed by reconstruction as needed-is currently the most promising treatment for pulmonary artery sarcoma.
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