title: Evaluation of the relationship between extremity soft tissue sarcomas and adjacent major vessels using contrast-enhanced multidetector CT and three-dimensional volume-rendered CT angiography: a preliminary study.
abstract: BACKGROUND
  Accurate description of the relationship between extremity soft tissue sarcoma and the adjacent major vessels is crucial for successful surgery. In addition to magnetic resonance imaging (MRI) or in patients who cannot undergo MRI, two-dimensional (2D) postcontrast computed tomography (CT) images and three-dimensional (3D) volume-rendered CT angiography may be valuable alternative imaging techniques for preoperative evaluation of extremity sarcomas.
  
  
  OBJECTIVE
  To preoperatively assess extremity sarcomas using multidetector CT (MDCT), with emphasis on postcontrast MDCT images and 3D volume-rendered MDCT angiography in evaluating the relationship between tumors and adjacent major vessels.
  
  
  METHODS
  MDCT examinations were performed on 13 patients with non-metastatic extremity sarcomas. Conventional CT images and 3D volume-rendered CT angiography were evaluated, with focus on the relationship between tumors and adjacent major vessels. Kappa consistency statistics were performed with surgery serving as the reference standard.
  
  
  RESULTS
  The relationship between sarcomas and adjacent vessels was described as one of three patterns: proximity, adhesion, and encasement. Proximity was seen in five cases on postcontrast CT images or in eight cases on volume-rendered images. Adhesion was seen in three cases on both postcontrast CT images and volume-rendered images. Encasement was seen in five cases on postcontrast CT images or in two cases on volume-rendered images. Compared to surgical results, postcontrast CT images had 100% sensitivity, 83.3% specificity, 87.5% positive predictive value, 100% negative predictive value, and 92.3% accuracy in the detection of vascular invasion (κ = 0.843, P = 0.002). 3D volume-rendered CT angiography had 71.4% sensitivity, 100% specificity, 100% positive predictive value, 75% negative predictive value, and 84.6% accuracy in the detection of vascular invasion (κ = 0.698, P = 0.008). On volume-rendered images, all cases with adhesion or encasement had arterial stenosis and all tumors' feeding arteries were clearly depicted.
  
  
  CONCLUSIONS
  2D postcontrast CT images are superior to 3D volume-rendered CT angiography in evaluating the relationship between extremity sarcomas and adjacent major vessels. 3D volume-rendered CT angiography is good at assessing the tumor's blood supply, the longitudinal extent of vascular involvement, and the vascular narrowing due to the tumor.
authors.affiliation: Department of Radiology, Cancer Hospital, Shantou University Medical College.
authors.forename: YangKang
authors.initials: Y
authors.lastname: Li
authors.forename: Yu
authors.initials: Y
authors.lastname: Zheng
authors.forename: JianBang
authors.initials: J
authors.lastname: Lin
authors.forename: AiQun
authors.initials: A
authors.lastname: Cai
authors.forename: XiuGuo
authors.initials: X
authors.lastname: Zhou
authors.forename: XiaoLong
authors.initials: X
authors.lastname: Wei
authors.forename: Ying
authors.initials: Y
authors.lastname: Cheng
authors.forename: GuoRui
authors.initials: G
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005121:Extremities / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012509:Sarcoma / Q000000981:diagnostic imaging* / Q000601:surgery; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide
keywords: CT angiography; Soft tissue sarcoma; extremity; multidetector row CT; volume rendering