Multidetector-row computed tomographic angiography findings of musculoskeletal tumors: retrospective analysis and correlation with surgical findings

Abstract

Background: Although magnetic resonance imaging (MRI) is a valuable method in staging musculoskeletal tumors, it may not give enough information on the association between the tumor and the main vascular structures adjacent to the tumor. In this respect, computed tomographic angiography (CTA) may be a useful alternative imaging technique. Purpose: To evaluate the effectiveness of CTA in determining vascular invasion in patients with musculoskeletal tumors and suspected vascular invasion by MRI, and to correlate the CTA findings with the surgical findings. Material and Methods: Twenty patients who had musculoskeletal tumors and lacked a fat plane between the tumor and adjacent vessels by MRI were included in this study. All patients were evaluated with CTA, and the CTA findings were reviewed by two radiologists to determine the presence of vascular invasion. Statistical analysis was carried out by using surgical findings as the gold standard. Results: There were nine women and 11 men (mean age 31 years) with either bone ( n=9) or soft-tissue ( n=11) tumors. Twelve patients without invasion according to the CTA examination were also surgically negative (true-negative cases). Of the eight patients with invasion shown by CTA, only three had adhesions and were considered surgically negative (false-positive cases). Five had invasions proven by surgery and were considered surgically positive (true-positive cases). Compared to the surgical findings, CTA had 100% sensitivity, 80% specificity, 62.5% positive predictive value, 100% negative predictive value, and 80% accuracy. Conclusion: CTA is a more accurate imaging technique than MRI in evaluating vascular invasion of musculoskeletal tumors, and provides valuable preoperative data.