title: Cardiovascular involvement by osteosarcoma: an analysis of 20 patients.
abstract: BACKGROUND
  Although hematogenous spread of osteosarcoma is well known, the imaging findings of cardiovascular involvement by osteosarcoma are seldom reported and can be difficult to recognize. The enhanced resolution of modern CT and MRI scanners may lead to better detection of cardiovascular involvement.
  
  
  OBJECTIVE
  To describe the key imaging findings and clinical behavior of cardiovascular involvement by osteosarcoma.
  
  
  METHODS
  We retrospectively reviewed the imaging findings and clinical characteristics of 20 patients with cardiovascular involvement by osteosarcoma identified by two pediatric radiologists from a review of imaging studies at our institution from 2007 to 2013.
  
  
  RESULTS
  At initial diagnosis, the median age of the patients was 15.1 years (range 4.8-24.6 years), and 7 (35%) patients had detectable metastases. Median time to detection of cardiovascular metastases was 1.8 years (range 0-7.3 years). Sixteen patients died of disease; 4 have survived a median of 7.4 years since initial diagnosis. The sites of cardiovascular involvement were the systemic veins draining the primary and metastatic osteosarcoma, pulmonary arteries, pulmonary veins draining the pulmonary metastases, and heart. A dilated and mineralized terminal pulmonary arteriole is an early sign of metastatic osteosarcoma in the lung. Unfamiliarity with the imaging features resulted in under-recognition and misinterpretation of intravascular tumor thrombus as bland thrombus.
  
  
  CONCLUSIONS
  Knowledge of imaging findings in the era of modern imaging modalities has enhanced our ability to detect cardiovascular involvement and lung metastases early and avoid misinterpreting tumor thrombus in draining systemic veins or pulmonary arteries as bland thrombus.
authors.affiliation: Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, MDT Boone Pickens Academic Tower, 1400 Pressler St., Unit 1473, Houston, TX, 77030, USA. syedururi@mdanderson.org.
authors.forename: Sireesha
authors.identifier: http://orcid.org/0000-0001-6391-3446
authors.initials: S
authors.lastname: Yedururi
authors.affiliation: Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, MDT Boone Pickens Academic Tower, 1400 Pressler St., Unit 1473, Houston, TX, 77030, USA.
authors.forename: Ajaykumar C
authors.initials: AC
authors.lastname: Morani
authors.affiliation: Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, MDT Boone Pickens Academic Tower, 1400 Pressler St., Unit 1473, Houston, TX, 77030, USA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Gladish
authors.affiliation: Department of Internal Medicine, Medstar Harbor Hospital, Baltimore, MD, USA.
authors.forename: Srilakshmi
authors.initials: S
authors.lastname: Vallabhaneni
authors.affiliation: Department of Pediatrics Hematology/Oncology/BMT, Carolinas Healthcare System, Levine Children's Hospital/Levine Cancer Institute, Charlotte, NC, USA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Anderson
authors.affiliation: Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Hughes
authors.affiliation: Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Wei-Lien
authors.initials: WL
authors.lastname: Wang
authors.affiliation: Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Najat C
authors.initials: NC
authors.lastname: Daw
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D006801:Humans; D008297:Male; D015588:Observer Variation; D012516:Osteosarcoma / Q000175:diagnosis* / Q000556:secondary*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D019043:Vascular Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D055815:Young Adult
keywords: Children; Computed tomography; Heart; Inferior vena cava; Magnetic resonance imaging; Osteosarcoma; Positron emission tomography-computed tomography; Superior vena cava; Tumor thrombus; Vascular metastasis