Citation
Rijswijk, C. van. (2005, June 30). Soft tissue tumors: perfusion and diffusion-weighted MR
imaging. Retrieved from https://hdl.handle.net/1887/4284
Version:
Corrected Publisher’s Version
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Licence agreement concerning inclusion of doctoral thesis in the
Institutional Repository of the University of Leiden
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https://hdl.handle.net/1887/4284
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Introduction
Soft tissue tumors are defined as mesenchymal, extraskeletal tumors excluding tumors arising of reticuloendothelial, glial and parenchymal organ tissue.
Neuroectodermal tumors of peripheral and autonomic nervous systems are also included. Histologically, soft tissue tumors are classified according to the adult tissue they resemble, comprising more than 20 histologic subtypes (1). The World Health Organization (WHO) classification of Soft Tissue Tumors divides soft tissue tumors, based on their biological potential into the following four categories: benign,
intermediate (locally aggressive), intermediate (rarely metastasizing) and malignant (2). Magnetic resonance (MR) imaging has been a well-established tool for local staging of soft tissue tumors (3-6). High resolution morphologic MR imaging has limited value in characterizing soft tissue tumors.
The increasing interest in functional imaging developments in MR imaging has enabled non-invasive assessment of tumor neovascularity (7-10). Vascular assessment based on the pathophysiology of tumor angiogenesis is of great interest for a variety of reasons related to diagnosis and treatment of diseases. Dynamic contrast-enhanced MR imaging is an emerging technique that uses rapid acquisition of images as an injected MR gadolinium-chelate passes through the area of interest, and may provide information related to tumor angiogenesis (11-13).
In addition to information related to tumor vascularity, MR imaging can provide an estimate of localized diffusion in the musculoskeletal tissues (14). Diffusion-weighted MR imaging measures the movement of protons in biological tissue due to Brownian motion, which is related to true physiologic perfusion as well as molecular diffusion (15). Molecular diffusion is determined by the physical properties of the biological tissue. By designing pulse sequences that are sensitized to motion of protons we can perform these diffusion measurements.
PURPOSE AND OUTLINE OF THE THESIS
The purpose of this thesis is to explore and evaluate new and optimized MR imaging techniques, including fast dynamic contrast-enhanced MR imaging and diffusion-weighted MR imaging, in the diagnosis of soft tissue tumors and in monitoring response to treatment.
Chapter 2 provides a summary of available literature on the role of different
imaging modalities in initial lesion detection and identification of local recurrence.
Chapter 3 describes the dynamic contrast-enhanced MR imaging features of synovial
sarcoma, a tumor that is often mistaken for a benign lesion on conventional imaging
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studies. Chapter 4 provides a classification of peripheral vascular malformations using dynamic contrast-enhanced MR imaging. Chapter 5 describes the additional value of static- and dynamic Gd-DTPA-enhanced MR imaging relative to non-enhanced MR imaging in the differentiation between benign and malignant soft tissue lesions.
Chapter 6 reports on diffusion-weighted MR imaging in the differentiation between
benign and malignant soft tissue tumors. Chapter 7 describes the potential of dynamic contrast-enhanced MR imaging in monitoring tumor response to isolated limb
REFERENCES
1. Enzinger FM WS. Soft tissue tumors. St. Louis: Mosby, 1995.
2. Fletcher CDM, Unni KK, Mertens F (eds.): World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. IARC Press: Lyon 2002.
3. Kransdorf MJ, Jelinek JS, Moser RP, Jr., Utz JA, Brower AC, Hudson TM et al. Soft-tissue masses: diagnosis using MR imaging. AJR Am J Roentgenol 1989; 153(3):541-7.
4. Berquist TH, Ehman RL, King BF, Hodgman CG, Ilstrup DM. Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions. AJR Am J Roentgenol 1990; 155(6):1251-5.
5. Moulton JS, Blebea JS, Dunco DM, Braley SE, Bisset GS, III, Emery KH. MR imaging of soft-tissue masses: diagnostic efficacy and value of distinguishing between benign and malignant lesions. AJR Am J Roentgenol 1995; 164(5):1191-1199.
6. Bloem JL, van der Woude HJ, Geirnaerdt M, Hogendoorn PC, Taminiau AH, Hermans J. Does magnetic resonance imaging make a difference for patients with musculoskeletal sarcoma? Br J Radiol. 1997;70:327-337.
7. van der Woude HJ, Bloem JL, Schipper J, et al. Changes in tumor perfusion induced by
chemotherapy in bone sarcomas: color Doppler flow imaging compared with contrast-enhanced MR imaging and three-phase bone scintigraphy. Radiology 1994;191(2):421-431.
8. Griebel J, Mayr NA, de Vries A, Knopp MV, Gneiting T, Kremser C et al. Assessment of tumor microcirculation: a new role of dynamic contrast MR imaging. J Magn Reson Imaging 1997; 7(1):111-119.
9. Delorme S, Knopp MV. Non-invasive vascular imaging: assessing tumour vascularity. Eur Radiol 1998; 8(4):517-27.
10. Taylor JS, Tofts PS, Port R, Evelhoch JL, Knopp M, Reddick WE et al. MR imaging of tumor microcirculation: promise for the new millennium. J Magn Reson Imaging 1999; 10(6):903-907. 11. Verstraete KL, De Deene Y, Roels H, Dierick A, Uyttendaele D, Kunnen M. Benign and malignant
musculoskeletal lesions: dynamic contrast-enhanced MR imaging--parametric ”first-pass” images depict tissue vascularization and perfusion. Radiology 1994; 192(3):835-43.
12. Verstraete KL, Van der Woude HJ, Hogendoorn PCW De-Deene Y, Kunnen M, Bloem JL. Dynamic contrast-enhanced MR imaging of musculoskeletal tumors: basic principles and clinical applications. J Magn Reson Imaging 1996;6(2):311-321
13. van der Woude HJ, Verstraete KL, Hogendoorn PC, Taminiau AH, Hermans J, Bloem JL. Musculoskeletal tumors: does fast dynamic contrast-enhanced subtraction MR imaging contribute to the characterization? Radiology 1998; 208(3):821-8.
14. Baur A, Reiser MF. Diffusion-weighted imaging of the musculoskeletal system in humans. Skeletal Radiol 2000; 29(10):555-562.
15. Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 1988; 168(2):497-505.
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