Background: To investigate the imaging features of primary sarcomas of the great vessels in CT, MRI and 18 F-FDG\r\nPET/CT.\r\nMethods: Thirteen patients with a primary sarcoma of the great vessels were retrospectively evaluated. All available\r\nimages studies including F-18 FDG PET(/CT) (n = 4), MDCT (n = 12) and MRI (n = 6) were evaluated and indicative\r\nimage features of this rare tumor entity were identified.\r\nResults: The median interval between the first imaging study and the final diagnosis was 11 weeks (0ââ?¬â??12 weeks).\r\nThe most frequently observed imaging findings suggestive of malignant disease in patients with sarcomas of the\r\npulmonary arteries were a large filling defect with vascular distension, unilaterality and a lack of improvement\r\ndespite effective anticoagulation. In patients with aortic sarcomas we most frequently observed a pedunculated\r\nappearance and an atypical location of the filling defect. The F-18 FDG PET(/CT) examinations demonstrated an\r\nunequivocal hypermetabolism of the lesion in all cases (4/4). MRI proved lesion vascularization in 5/6 cases.\r\nConclusion: Intravascular unilateral or atypically located filling defects of the great vessels with vascular distension,\r\na pedunculated shape and lack of improvement despite effective anticoagulation are suspicious for primary\r\nsarcoma on MDCT or MRI. MR perfusion techniques can add information on the nature of the lesion but the\r\nfindings may be subtle and equivocal. F-18 FDG PET/CT may have a potential role in these patients and may be\r\nconsidered as part of the imaging workup.
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