DOI: 10.1148/radiol.2422060246
(Radiology 2007;242:634-635.)
© RSNA, 2007
Multidetector CT Angiography for Vascular Invasion of Musculoskeletal Tumors
Musturay Karcaaltincaba, MD
Department of Radiology, Hacettepe University School of Medicine, Sihhiye, Ankara 06100, Turkey
e-mail: musturayk{at}yahoo.com
Editor:
I read with great interest the article by Dr Feydy and colleagues (1) in the February 2006 issue of Radiology. Magnetic resonance (MR) angiography seems to be promising for use in the evaluation of vascular invasion of musculoskeletal tumors. I am surprised that the authors performed conventional angiography so frequently in their patients in the era of multidetector computed tomographic (CT) angiography. Multidetector CT angiography is replacing conventional angiography for most of the diagnostic indications in clinical practice because it is easier to use and is noninvasive in comparison with conventional angiography (2,3). I agree that most patients with musculoskeletal neoplasms undergo MR imaging for the definition of the extent of the tumor and local staging of musculoskeletal tumors. However, abdominal and chest CT are also commonly performed in these patients for the work-up of distant metastases. In 2004, my colleagues and I (4) proposed a CT protocol that combined abdominal CT and extremity multidetector CT angiography in patients with musculoskeletal tumors. By using this protocol, we were able to perform these two examinations sequentially by using a single injection of contrast material.
In the study by Dr Feydy and colleagues (1), it appears that the most important findings to exclude arterial invasion are the lack of arterial stenosis and the presence of a gap between the tumor and vascular structures; these findings can also be shown on two- and three-dimensional images at multidetector CT angiography. CT angiograms are superior to conventional angiograms because the extent of musculoskeletal masses and the relationship between the mass and the arteries can be defined in a better way at multidetector CT angiography. Multidetector CT angiograms may demonstrate osseous tumors better than MR angiograms. Therefore, I think that MR angiography is not the only noninvasive vascular imaging modality that can be used in these patients, and I suggest that multidetector CT angiography can be used in patients with musculoskeletal tumors to rule out vascular invasion.
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References
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- Feydy A, Anract P, Tomeno B, Chevrot A, Drape JL. Assessment of vascular invasion by musculoskeletal tumors of the limbs: use of contrast-enhanced MR angiography. Radiology 2006;238:611–621.[Abstract/Free Full Text]
- Fleischmann D, Hallett RL, Rubin GD. CT angiography of peripheral arterial disease. J Vasc Interv Radiol 2006;17:3–26.[CrossRef][Medline]
- Karcaaltincaba M, Akata D, Aydingoz U, et al. Three-dimensional MDCT angiography of the extremities: clinical applications with emphasis on musculoskeletal uses. AJR Am J Roentgenol 2004;183:113–117.[Free Full Text]
- Karcaaltincaba M, Aydingoz U, Akata D, et al. Combination of extremity computed tomography angiography and abdominal imaging in patients with musculoskeletal tumors. J Comput Assist Tomogr 2004;28:273–277.[CrossRef][Medline]
Response
Antoine Feydy, MD, PhD
Service de Radiologie B, CHU Cochin, 27 rue du Fbg St Jacques, 75679 Paris Cedex 14, France
e-mail: antoine.feydy{at}cch.aphp.fr
References 3 and 4 of Dr Karcaaltincaba's letter show the feasibility of multidetector CT angiography in the setting of musculoskeletal tumors. However, references 3 and 4 do not provide an assessment of the diagnostic value of multidetector CT angiography in the staging of musculoskeletal tumors. Further studies with surgical correlations could be conducted to assess the performances of this technique.
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