Contrast-enhanced CT findings of intravenous leiomyomatosis. Issue 5 (May 2018)

• Record Type: Journal Article
• Authors: Wang, H.; Nie, P.; Chen, B.; Hou, F.; Dong, C.; He, F.; Xu, W.
• Is Part Of: Clinical radiology. Volume 73:Issue 5(2018)
• Page Start: 503.e1
• Page End: 503.e6
• Publication Date: 2018-05
• Subjects: Medical radiology -- Periodicals; Radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiology -- Periodicals; Societies, Medical -- Periodicals; Medical radiology; Radiotherapy; Electronic journals; Periodicals; 616.0757
• DOI: 10.1016/j.crad.2017.12.016
• Languages: English
• ISSNs: 0009-9260

Abstract

Abstract : Aim: To characterise the contrast-enhanced computed tomography (CT) imaging findings of nine patients with intravenous leiomyomatosis (IVL). Materials and methods: The contrast-enhanced CT imaging findings of nine patients with histopathologically proven IVL were examined. The location, morphology, extension pathway, adhesion, and degree and pattern of enhancement of the tumour were assessed. Results: Four patients had tumours located within the inferior vena cava, and five had tumours that involved the right heart. Seven patients with residual uterus myoma showed enhanced heterogeneous contrast of the uterus. Eight tumours extended into the inferior vena cava through the iliac veins and one through the bilateral iliac veins. All the IVLs demonstrated heterogeneous enhancement on contrast-enhanced CT and appeared to have lower density than the contrast-enhanced venous blood. On the coronal and sagittal images, tumours were continuous and, when the right heart was involved, the lesions displayed a characteristic "walking stick head" or "snake head" appearance. The lesion looked similar to a "sieve" on axial contrast-enhanced CT images, and a "luffa sponge" on post-processing coronal or sagittal images. Conclusion: Contrast-enhanced CT imaging has unique advantages in the diagnosis of IVL, namely, luffa sponge and sieve appearance, which can be helpful for differential diagnosis. Contrast-enhanced CT can demonstrate tumour location and full-scale extension pathway, which are important for diagnosis, surgical planning, and follow-up of the tumour. Highlights: Intravenous leiomyomatosis have characteristic appearances on contrast-enhanced CT. On coronal and sagittal images, the lesions are contiguous within the IVC and when tumour extends into the right atrium, it creates the appearance of a 'snake's head' or 'walking stick'. The lesions resemble a 'sieve' on axial contrast-enhanced CT images, and a 'luffa sponge' on 3D volume rendered images. Contrast-enhanced CT has a role in the diagnosis, surgical planning and follow up of patients with intravenous leiomyomatosis.