Figure 1
Post-embolization tumor response in the shoulder plasmacytoma could be best demonstrated with functional imaging studies. (A) Angiogram of the left shoulder revealed a well-vascularized lesion, which was supplied by branches from the left subclavian artery. (B) Selective catheterization of the feeding arteries and embolization of the tumor vasculature with 350 to 500 μm PVA particles were performed in two sessions from a right femoral puncture and a left brachial puncture, respectively. Some arterial branches were also closed off with coils. DWIBS MRI proved to be a sensitive modality for locating densely packed foci of tumor cells inside a heterogeneous lesion. (C) We co-registered ADC maps with T2 weighted images that allowed more precise comparison between baseline and follow-up scans. (D) The increase of ADC values by 4 weeks post-embolization was clearly visible on the fusion map. (E) Some DWIBS restricted foci also showed high 18FDG uptake on PET-CT. (F) Following embolization, decreased metabolic activity was detected, which was inversely correlated with increased diffusivity, a sign of tumor necrosis.