EURORAD ESR

Case 13086

The more you look the more you find: imaging observations of lumbosacral Malignant Peripheral Nerve Sheath Tumor

Author(s)
J.P. Jablonska, V. Favia, C. Campagna, G. Angelelli

Radiology Department, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy;
 
Patient
male, 23 year(s)
 
 
  • Figure 1
    A 23 yo male patient complaining of the lumbosacral mass

    A 23 year old male patient admitted to our hospital complaining of a disconcerting mass in the lumbosacral region.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Image manipulation / Reconstruction; Procedure: Observer performance; Special Focus: Tissue characterisation;
     
     
  • Figure 2
    Lumbosacral spine X-ray

    No bone lesions but abnormal shadow at level of lumbosacral region.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Plain radiographic studies; Procedure: Observer performance; Special Focus: Tissue characterisation;
     
     
  • Figure 3
    CT findings
     

    Precontrast CT scan revealing an oval, dishomogenous and hyperdense mass in the lumbosacral region.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: CT; Procedure: Imaging sequences; Special Focus: Tissue characterisation;

    Contrast-enhanced CT scans showed no enhancement during the arterial phase.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Tissue characterisation;

    No enhancement modifications in the venous phase.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Tissue characterisation;

    No enhancement modifications in the delayed phase.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Tissue characterisation;
     
     
  • Figure 4
    Ultrasound findings
     

    Well-defined, low echo signal, heterogeneous mass.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Ultrasound; Procedure: Comparative studies; Special Focus: Tissue characterisation;

    Important peripherical hypervascularisation of the mass.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Comparative studies; Special Focus: Tissue characterisation;
     
     
  • Figure 5
    Pre-contrast MR findings
     

    Conventional T1-weighted scan showed inhomogeneous iso-/hyper- intense mass.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;

    Sagittal conventional STIR image allowed homogeneous and global fat suppression.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;
     
     
  • Figure 6
    Post-contrast MR findings
     

    Precontrast T1-weighted scan.

     
    Area of Interest: Musculoskeletal system; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;

    The arterious phase THRIVE scans definetly improved evaluation of the lesion, showing its important contrast enhancement.

     
    Area of Interest: Musculoskeletal system; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;

    The early venous phase THRIVE scans showing progressive contrast enhancement of the lesion.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;

    SPIR in the delayed phase, in order to the fatty tissue component suppression, allowed to characterise the central foci as hemoglobin catabolites.

     
    Area of Interest: Musculoskeletal soft tissue; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;
     
     
A 23 year old male patient admitted to our hospital complaining of a disconcerting mass in the lumbosacral region.
 
No bone lesions but abnormal shadow at level of lumbosacral region.
 
Precontrast CT scan revealing an oval, dishomogenous and hyperdense mass in the lumbosacral region.
 
Contrast-enhanced CT scans showed no enhancement during the arterial phase.
 
No enhancement modifications in the venous phase.
 
No enhancement modifications in the delayed phase.
 
Well-defined, low echo signal, heterogeneous mass.
 
Important peripherical hypervascularisation of the mass.
 
Conventional T1-weighted scan showed inhomogeneous iso-/hyper- intense mass.
 
Sagittal conventional STIR image allowed homogeneous and global fat suppression.
 
Precontrast T1-weighted scan.
 
The arterious phase THRIVE scans definetly improved evaluation of the lesion, showing its important contrast enhancement.
 
The early venous phase THRIVE scans showing progressive contrast enhancement of the lesion.
 
SPIR in the delayed phase, in order to the fatty tissue component suppression, allowed to characterise the central foci as hemoglobin catabolites.
 
 
 
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