Whole-body magnetic resonance imaging for detection of the lymphatic and hematogenous metastasis of soft tissue tumors of the trunk and extremities in children

The aim of the study was to improve the diagnosis of lymphatic and hematogenous metastasis of soft tissue tumors in children with disseminated lesions.
Material and methods. WBMRI was performed on 15 patients with soft tissue tumors: 13 had malignant lesions, 2 had benign lesions. 7 men, 8 women; age from 1.5 to 16 years. MR imaging was performed using a SIeMenS MAgneToМ AVAnTo 1,5T and SKYRA 3T (germany). WBMRI was performed with T1-se and T2 – STIR sequences in coronary projection. We analyzed the sensitivity, specificity, PPV, NPV of WBMRI in detecting metastasis.
Results. 13 patients were determined disseminated forms of soft tissue tumors with presence of the primary tumor, 2 patients had metastases of the primary lesion that was not detected. Skeletal metastases were found in 5 children, of whom 4 in the bone marrow. 7 patients had enlarged lymph nodes, 1 patient in this case had a false positive result on WBMRI. changes in the lung tissue were detected in 3 patients and were confirmed with CT of the chest. In 1 patient with small foci of up to 3 mm, identified in the CT of the chest is given a false negative conclusion on WBMRI. other organs (spleen, peritoneum, pleura, brain), as the metastatic character of malignant forms of soft tissue tumors, and in particular lesion at the neurofibromatosis type 1 is identified at the WBMRI in 3 patients.
Conclusion. WBMRI showed high information content to identify the primary pathological process and metastatic. Sensitivity of WBMRI and SSC for the detection of bone metastases – 98% and 47.1%, specificity – 100% and 100%, respectively.
WBMRI is more informative for the detection metastases of the target organs than abdominal ultrasound: sensitivity – 100% and 66.7%, specificity – 100% and 100%, respectively. WBMRI gives way ultrasound study lymph nodes: sensitivity – 100% and 100%, specificity – 87.5% and 100%, respectively. WBMRI gives way CT of the chest to identify MTS in lung: sensitivity – 75% and 100%, specificity – 100% and 100%, respectively.

1. Palmerini E., Staals E.L., Alberghini M., Zanella L., Ferrari C., Benassi M.S., Picci P., Mercuri M., Bacci G., Ferrari S. Synovial sarcoma: retrospective analysis of 250 patients treated at a single institution. Cancer. 2009, v. 115, p. 2988-2998.

2. Philip A. Pizzo, David G. Poplack. Principles and Practice of Pediatric Oncology. 2001, p. 619-644.

3. Pisters P.W., Leung D.H., Woodruff J., Shi W., Brennan M.F. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J. Clin. Oncol. 1996, v. 14, p. 1679-1689.

4. M. van Vliet, Kliffen M., Krestin G.P., C.F. van Dijke. Soft tissue sarcomas at a glance: clinical, histological, and MR imaging features of malignant extremity soft tissue tumor. Eur. Radiol. 2009, v. 19, p. 1499-1511.

5. Sherman C.E., O’Connor M.I. Musculoskeletal tumor imaging: an orthopedic oncologist perspective. Semin. Musculoskelet Radiol. 2013, v. 17 (2), p. 221-226.

6. Walker E.A., Song A.J., Murphey M.D. Magnetic resonance imaging of soft-tissue masses. Semin. Roentgenol. 2010, v. 45 (4), p. 277-297.

7. Wu J.S., Hochman M.G. Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology. 2009, v. 253 (2), p. 297-316.

8. Епифанова С.В. Роль магнитно-резонансной и компьютерной томографии в предоперационной оценке распространенности опухолей опорно-двигательного аппарата. Автореф. диссертаци канд. мед. наук. М., 2013, с. 5-7.

9. ChristianF., KellenbergerM.D. et al. Fast STIR Whole-body MR imaging in children. RadioGraphics. 2004, v. 24, p. 1317-1330.

10. Daidrup-Link H. et al. Whole-Body MR Imaging for detection of bone metastases in children and young adults: comparison with skeletal scintigraphy and FDG PET. AJL. 2001, v. 177, p. 229-236.

11. Sinchun Hwang, David M. Panicek. Magnetic resonance imaging of bone marrow in oncology, part 2. Skeletal Radiology. 2007, v. 36, p. 1017-1027.

12. Taoka T., Mayr N.A., Lee H.J. et al. Factors influencing visualization of vertebral metastases on MR imaging versus bone scintigraphy. Am. J. Roentgenol. 2001, v. 176, p. 1525-1530.

13. Yamaguchi T. Intertrabecular vertebral metastases: metastases only detectable on MR imaging. Semin Musculoskelet Radiol. 2001, v. 5, p. 171-175.

14. Михайлова Е.В., Барбашова А.С. Опыт применения МРТ всего тела в детской онкологии. Диагностическая и интервенционная радиология. 2011, т. 5, № 2, с. 275-277.