Lang P, Grampp S, Vahlensieck M, Johnston J O, Honda G, Rosenau W, Matthay K K, Peterfy C, Higgins C B, Genant H K
Department of Radiology, University of California, San Francisco 94143, USA.
AJR Am J Roentgenol. 1995 Jul;165(1):135-42. doi: 10.2214/ajr.165.1.7785572.
The purposes of our study were to investigate the use of MR angiography with two- (2D) and three-dimensional (3D) displays in evaluating vascular morphology of musculoskeletal neoplasms for preoperative planning of limb-salvage surgery and to assess the use of MR angiography for monitoring changes in neovascularity and evaluating response to chemotherapy.
We used MR angiography (2D time-of-flight) to study 13 patients with primary bone tumors (nine osteogenic sarcomas, two Ewing's sarcomas, and two primary lymphomas of bone) at the time of initial presentation. Eight patients (all of whom had osteogenic sarcoma) also underwent MR angiography following chemotherapy before limb-salvage surgery. Two-dimensional maximum intensity projections were obtained. Three-dimensional reconstructions of vascular structures were created from the angiographic source images and were displayed simultaneously with 3D reconstructions of tumor and normal bone generated from conventional MR images.
Two-dimensional maximum intensity projections were useful for evaluating small vessel neovascularity; 3D displays demonstrated spatial relationships of tumor, feeder vessels, and normal vascular structures. Tumor encroachment onto or encasement of normal vascular structures was shown in four patients on 2D maximum intensity projections and on 3D displays. The eight patients with osteogenic sarcoma who had follow-up imaging showed marked neovascularity prior to chemotherapy. Five patients responded to chemotherapy (> or = 90% tumor necrosis at histology); MR angiography showed marked reduction in tumor neovascularity in these patients. Three patients did not respond to chemotherapy; MR angiography showed unchanged neovascularity in one and increased neovascularity in two of these patients.
MR angiography provides good visualization of peripheral vascular branches and tumor neovascularity in patients with primary bone tumors. MR angiography demonstrates encroachment onto and encasement of major vessels by the tumor mass and appears to be useful for assessing response to chemotherapy in osteogenic sarcoma and possibly other primary bone tumors by detecting treatment-induced changes in tumor neovascularity.
本研究的目的是探讨二维（2D）和三维（3D）显示的磁共振血管造影在评估肌肉骨骼肿瘤的血管形态以用于保肢手术的术前规划中的应用，并评估磁共振血管造影在监测新生血管变化及评估化疗反应方面的应用。
我们使用磁共振血管造影（2D时间飞跃法）对13例初诊时的原发性骨肿瘤患者（9例骨肉瘤、2例尤因肉瘤和2例原发性骨淋巴瘤）进行研究。8例患者（均为骨肉瘤）在保肢手术前行化疗后也接受了磁共振血管造影检查。获得二维最大强度投影。从血管造影源图像创建血管结构的三维重建，并与从传统磁共振图像生成的肿瘤和正常骨骼的三维重建同时显示。
二维最大强度投影有助于评估小血管新生血管；三维显示展示了肿瘤、供血血管和正常血管结构的空间关系。在二维最大强度投影和三维显示上，4例患者显示肿瘤侵犯或包绕正常血管结构。8例接受随访成像的骨肉瘤患者在化疗前显示出明显的新生血管。5例患者对化疗有反应（组织学上肿瘤坏死≥90%）；磁共振血管造影显示这些患者的肿瘤新生血管明显减少。3例患者对化疗无反应；磁共振血管造影显示其中1例患者新生血管无变化，2例患者新生血管增加。
磁共振血管造影能很好地显示原发性骨肿瘤患者的外周血管分支和肿瘤新生血管。磁共振血管造影可显示肿瘤肿块对主要血管的侵犯和包绕，并且通过检测治疗引起的肿瘤新生血管变化，似乎有助于评估骨肉瘤以及可能其他原发性骨肿瘤对化疗的反应。
