Assessment of vascular invasion by bone and soft tissue tumours of the limbs: usefulness of MDCT angiography.
OBJECTIVE
To evaluate the accuracy of computed tomography angiography (CTA) in predicting arterial encasement by limb tumours, by comparing CTA with surgical findings (gold standard).


METHODS
Preoperative CTA images of 55 arteries in 48 patients were assessed for arterial status: cross-sectional CTA images were scored as showing a fat plane between artery and tumour (score 0), slight contact between artery and tumour (score 1), partial arterial encasement (score 2) or total arterial encasement (score 3). Reformatted CTA images were assessed for arterial displacement, rigid wall, stenosis or occlusion. At surgery, arteries were classified as free or surgically encased; 45 arteries were free and 10 were surgically encased.


RESULTS
Multivariate logistic regression identified the axial CTA score as a relevant predictor for arterial encasement and subsequent vascular intervention during surgery. All sites where CTA showed a fat plane between the tumour and the artery were classified as free at surgery (n = 28/28). The sensitivity of total arterial encasement on CTA (score 3) was 90%, specificity 93%, accuracy 93% and positive likelihood ratio 13.5.


CONCLUSIONS
CTA evidence of total arterial encasement is a highly specific indication of arterial encasement. The presence of fat between the tumour and the artery on CTA rules out arterial involvement at surgery.
Thévenin
Fabrice S
FS
Department of Radiology B, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75679 Paris Cedex 14, France. fabricethevenin@yahoo.fr
Drapé
Jean-Luc
JL
Biau
David
D
Campagna
Raphaël
R
Richarme
Delphine
D
Guerini
Henri
H
Chevrot
Alain
A
Larousserie
Frédérique
F
Babinet
Antoine
A
Anract
Philippe
P
Feydy
Antoine
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D001859:Bone Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012983:Soft Tissue Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*