Early detection of local tumour recurrence and pulmonary metastasis in cardiac angiosarcoma with PET-CT and MRI
1 Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Straße 33, 48149 Muenster, Germany
2 Department of Thoracic and Cardiovascular Surgery, University of Muenster, Albert-Schweitzer-Straße 33, 48149 Muenster, Germany
3 Department of Nuclear Medicine, University of Muenster, Albert-Schweitzer-Straße 33, 48149 Muenster, Germany
* Corresponding author. Tel: +49 251 8347302; fax: +49 251 8347312. E-mail address: kujuerg{at}uni-muenster.de
A 62-year-old woman underwent radical tumour resection and surgical reconstruction of both atria and left ventricle, as well as mitral valve replacement due to initially diagnosed cardiac angiosarcoma in November 2004; surgical intervention was followed by adjuvant chemotherapy. Preoperative tumour staging included whole-body positron emission tomography-CT (PET-CT) with 18-fluorine-2-fluoro-2-desoxy-D-glucose demonstrating a 4.1 x 7.2 cm hypervascular mass (Panel A), which arose from the inferolateral wall of the left atrium, that infiltrated the left ventricle, the mitral valve annulus, and the great coronary vein. Concomitant pericardial effusion was noticed. The mass showed an increased glucose uptake [Panel B; standardized uptake value (SUV), 5.4 vs. liver 1.3]. Lymphogenic and haematogenous tumour spread were excluded by PET-CT; postoperative course was uneventful.
Within the following 20 months, follow-up studies using PET-CT showed a regular postoperative situs (Panel C). Recent PET-CT study revealed a 2.3 x 3.9 cm mass bulging out the inferolateral left ventricular wall (Panel D) with intensive glucose uptake (SUV 9.5 vs. liver 2.5; Panel E). Cardiac magnetic resonance imaging (MRI) confirmed local tumour recurrence with an infiltration of the left ventricular wall and epicardial layer (Panels F and G). A pulmonary nodule in the left superior lower lobe presenting with an increased glucose uptake (SUV 1.5) was histologically confirmed as pulmonary metastasis from cardiac angiosarcoma following a wedge resection. Further metastasis and lymphogenic tumour spread were excluded by PET-CT.
PET-CT and MRI permit early detection of local recurrence and metastatic tumour spread of cardiac angiosarcoma, and therefore, enable efficient surgical therapy.
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