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Differentiation of Malignant and Benign Musculoskeletal Tumors: Combined Color and Power Doppler US and Spectral Wave Analysis¹

¹ From the Departments of Radiology (G.B., M.F.H.S., S.P., W.R.J.), Orthopedics (F.R., A.F., T.S.), and Neurology (K.S.), University Hospital of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. Received February 5, 2001; revision requested March 26; revision received August 6; accepted September 28. Address correspondence to G.B. (e-mail: gerd.bodner@uibk.ac.at).

View larger version (202K): [in a new window]   Figure 1. Neurofibrosarcoma (4-6 cm) in right gluteal area in a 55-year-old patient. Three-dimensional power Doppler US image shows anarchic vessel architecture with multiple loops (solid arrows) and caliber changes (open arrows).

View larger version (203K): [in a new window]   Figure 2. Myositis proliferans in right thigh of a 16-year-old patient. Three-dimensional power Doppler US image demonstrates prominent tumor vessels (arrows) diminishing in size to smaller vessels (arrowheads) at the tumor periphery.

View larger version (164K): [in a new window]   Figure 3a. Liposarcoma in right inguinal region of a 61-year-old patient. (a) Longitudinal color Doppler US image shows tumor vessel at tumor margin, with a connection to itself corresponding to a self loop (arrows). Images obtained in a second plane (not shown) confirmed self connection. (b) SWA of self loop shows peak systolic flow of 40.4 cm/sec (curved arrow) and high diastolic flow of 20.2 cm/sec (straight arrow), with a resulting RI of 0.5.

View larger version (123K): [in a new window]   Figure 3b. Liposarcoma in right inguinal region of a 61-year-old patient. (a) Longitudinal color Doppler US image shows tumor vessel at tumor margin, with a connection to itself corresponding to a self loop (arrows). Images obtained in a second plane (not shown) confirmed self connection. (b) SWA of self loop shows peak systolic flow of 40.4 cm/sec (curved arrow) and high diastolic flow of 20.2 cm/sec (straight arrow), with a resulting RI of 0.5.

View larger version (148K): [in a new window]   Figure 4a. Color Doppler US images obtained in a 71-year-old patient. (a) Longitudinal scan shows chondrosarcoma in left femur, with SWA in tumor vessel (curved arrow), with maximal systolic flow velocity increase of 110 cm/sec (straight arrow), representing a stenosed tumor vessel. Flow velocity prior to stenosed vessel segment was 45 cm/sec (image not shown). (b) Transverse scan shows chondrosarcoma. SWA of occluded tumor vessel shows reduced systolic flow of 9 cm/sec (solid arrow) and no diastolic flow (open arrow), suggesting that this vessel is distally occluded. (c) Longitudinal scan shows chondrosarcoma in left femur, with SWA of arteriovenous shunt showing a delayed systolic peak (left arrow) and high diastolic flow (right arrow), with resulting RI of 0.35, suggesting direct connection from arterial to venous tumor vessel.

View larger version (170K): [in a new window]   Figure 4b. Color Doppler US images obtained in a 71-year-old patient. (a) Longitudinal scan shows chondrosarcoma in left femur, with SWA in tumor vessel (curved arrow), with maximal systolic flow velocity increase of 110 cm/sec (straight arrow), representing a stenosed tumor vessel. Flow velocity prior to stenosed vessel segment was 45 cm/sec (image not shown). (b) Transverse scan shows chondrosarcoma. SWA of occluded tumor vessel shows reduced systolic flow of 9 cm/sec (solid arrow) and no diastolic flow (open arrow), suggesting that this vessel is distally occluded. (c) Longitudinal scan shows chondrosarcoma in left femur, with SWA of arteriovenous shunt showing a delayed systolic peak (left arrow) and high diastolic flow (right arrow), with resulting RI of 0.35, suggesting direct connection from arterial to venous tumor vessel.

View larger version (52K): [in a new window]   Figure 4c. Color Doppler US images obtained in a 71-year-old patient. (a) Longitudinal scan shows chondrosarcoma in left femur, with SWA in tumor vessel (curved arrow), with maximal systolic flow velocity increase of 110 cm/sec (straight arrow), representing a stenosed tumor vessel. Flow velocity prior to stenosed vessel segment was 45 cm/sec (image not shown). (b) Transverse scan shows chondrosarcoma. SWA of occluded tumor vessel shows reduced systolic flow of 9 cm/sec (solid arrow) and no diastolic flow (open arrow), suggesting that this vessel is distally occluded. (c) Longitudinal scan shows chondrosarcoma in left femur, with SWA of arteriovenous shunt showing a delayed systolic peak (left arrow) and high diastolic flow (right arrow), with resulting RI of 0.35, suggesting direct connection from arterial to venous tumor vessel.