| Objective: Accurate judgment of the relationship between soft tissue sarcoma and adjacent major vessels and bone is an important guarantee for standardized surgical resection. This study aims to explore the value of conventional CT and MR images,CT angiography (CTA) and MR angiography (MRA) in the evaluation of vascular and osseous invasion by soft-tissue sarcoma(STS) in extremities.Methods: Due to a retrospective medical history and imaging study, the Hospital Ethics Committee exempts patients from informed consent of this study. The clinical,CT and MRI, surgical and pathological data were analyzed retrospectively in STS patients who met the criteria of inclusion in Tumor Hospital of Yunnan Province fromJanuary 2013 to June 2016. CT and MRI were performed using the Siemens Somatom Definition AS 128 slice helical CT scanner, Somatom Sensation 16 slice helical CT scanner and the Siemens Avanto 1.5T, Philips Ingenia 3.0T superconducting magnetic resonance instrument, and also obtained the maximum density projection and 3D volume reconstruction reconstructed images. The relationship between tumor and adjacent major vessels and bone was scored by two high-grade musculoskeletal imaging physicians on CT and MR imaging, CTA and MRA imaging. The receiver operating characteristic curve was drawn and the area under the curve was calculated.The sensitivity and specificitywere calculatedand compared with surgical records and pathologic results serving as the reference standard.Results: 109 patients with soft tissue sarcoma were enrolled. Among them, 53 males and 56 females were aged from 9 to 81 years and the median age was 49 years.There were 41 cases of left lower limb, right lower extremity in 39 cases, right upper limb in 17 cases, and left upper limb in 12 cases. All patients underwent surgical treatment, including 24 cases of amputation, radical resection in 16 cases, 69 cases of enlarged resection. Surgery and pathology confirmed 27 cases of vascular involvement,not affected in 82 cases and bone invasion in 20 cases,not invaded in 89 cases. Pathological types included undifferentiated sarcoma in 29 cases,21 cases of liposarcoma, 17 cases of synovial sarcoma,fibrosarcoma 15 cases, 4 cases of leiomyosarcoma, 3 cases of rhabdomyosarcoma, 4 cases of Ewing sarcoma and primitive neuroectodermal tumors, 3 cases of malignant peripheral nerve sheath tumors, 5 casesof uncertain differentiated tumors (3 cases with alveolar soft tissue sarcoma in 2 cases of clear cell sarcoma), one case of angiosarcoma, one case of malignant lymphoma, 6 cases of spindle cell malignant tumor (pathologically failed to determine tumor differentiation type). Compared to the surgical and pathological findings, the sensitivity and specificity of MR images and MR angiography were 85.19%, 84.15% and 96.30%, 74.39% respectively in the evaluation of vascular invasion by soft-tissue sarcoma in extremities. For CT images and CT angiography,the sensitivity and specificity were 81.48%, 98.78% and 96.30%, 74.39% respectively.The sensitivity and specificity of CT and MR images in diagnosis of bone invasion were 75.00%, 85.00% and 96,63%, 91.01% respectively.Conclusion: CT, MR images and CT angiography, MR angiography have high sensitivity and specificity in evaluating vascular and bone invasion of soft-tissue sarcoma in extremities, which is of great value in the preoperative staging, surgical margin assessment and choice of operation. CT images and CTA have higher efficiency in the diagnosis of STS involving major vessels than MRI, CT and MRI have no significant difference in diagnosis of adjacent bone invasion by soft-tissue sarcoma. |
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