Multimodal Imaging of Solitary Fibrous Tumor in the CNS, Head and Neck, and Spine, with Pathologic Correlation

Abstract

Solitary fibrous tumor is a rare mesenchymal neoplasm arising from the serosal membranes, dura, and deep soft tissues. A solitary fibrous tumor of the CNS, head, neck, and spine can be challenging to diagnose on imaging. Preoperative consideration of a solitary fibrous tumor is critical, especially in the setting of a high-grade solitary fibrous tumor, which has a high recurrence rate and metastatic potential. This review highlights multimodal imaging features of solitary fibrous tumors, including CT, MR imaging (SWI, MRA, MRS, DWI, and perfusion), FDG PET, and catheter-directed angiography. Radiologic pathologic correlations are also provided. The management of solitary fibrous tumor is a team effort orchestrated with surgery, radiation oncology, and neurointerventional and diagnostic radiology. For high-grade solitary fibrous tumors, preoperative tumor embolization followed by surgical resection and adjuvant radiation therapy improves patient outcomes. Additional whole-body staging and follow-up MR imaging are important to evaluate recurrence or distal metastasis.Learning Objective: To recognize the multimodal imaging appearance of solitary fibrous tumor in the CNS, head and neck, and spine