J Korean Soc Radiol.  2011 Feb;64(2):117-121. 10.3348/jksr.2011.64.2.117.

The CT and MR Imaging Findings of Adulthood Sinonasal Alveolar Rhabdomyosarcoma with Disseminated Metastases on 18F-FDG PET/CT: Report of Two Cases

• Bahn YE
• Lee SK

• KMID: 2097926
• DOI: http://doi.org/10.3348/jksr.2011.64.2.117

Abstract

We report herein two cases of adulthood sinonasal alveolar rhabdomyosarcoma that showed intense hypermetabolism and disseminated metastasis on 18F-FDG PET/CT. The contrast-enhanced CT (CECT) and gadolinium-enhanced T1-weighted images (Gd-T1WI) showed multiple rings of intense enhancement (the "botryoid sign") of the mass. Adulthood rhabdomyosarcoma should be considered when a sinonasal mass shows the "botryoid sign" on CECT or Gd-T1WI, and intense hypermetabolism with disseminated metastases on 18F-FDG PET/CT.

MeSH Terms

Fluorodeoxyglucose F18
Magnetic Resonance Imaging
Neoplasm Metastasis
Rhabdomyosarcoma
Rhabdomyosarcoma, Alveolar
Tomography, X-Ray Computed
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 Sinonasal rhabdomyosarcoma of the alveolar subtype with disseminated metastases to the bone marrow and lymph nodes in a 68-year-old woman. A. An axial 18F-FDG PET/CT image shows a lobular, intensely hypermetabolic mass (SUVmax = 14.6 g/mL) in the right sinonasal area (arrows). B. The coronal and sagittal maximum intensity projection images of 18F-FDG PET demonstrate intense hypermetabolism involving the axial and appendicular skeleton and the lymph nodes of the right retropharyngeal chain and the left level VA (small arrows), as well as the primary site (arrows). C. A coronal reformatted non-enhanced CT image shows a right-sided sinonasal mass with bony destruction. D. A coronal reformatted contrast-enhanced CT image reveals a mass with multiple rings of intense enhancement (the "botryoid sign").

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  Fig. 2 Sinonasal rhabdomyosarcoma of the alveolar subtype with disseminated bone marrow and breast metastases in a 48-year-old woman. A. An axial non-enhanced CT image shows a large hyperattenuating mass (arrows) in the left nasal cavity, the ethmoid sinus and the bilateral sphenoid sinuses with bony destruction (small arrows). B. An axial spoiled gradient-echo T1-weighted image (T1WI) (TR/TE=7.3/3.0, FA=20) reveals a sinonasal mass (arrows), which is hypointense compared to that of the adjacent muscles, and the mass contains a focus of hyperintense hemorrhage (small arrow). C. An axial gadolinium-enhanced spoiled gradient-echo T1WI (TR/TE=7.3/3.0, FA=20) demonstrates a mass with multiple rings of intense enhancement (the "botryoid sign") (arrows). D. An axial 18F-FDG PET/CT image shows a lobular intensely hypermetabolic mass (SUVmax = 11.9 g/mL) in the sinonasal area (arrows). E. A coronal maximum intensity projection image of 18F-FDG PET demonstrates multiple bone marrow metastases involving the axial and appendicular skeleton (small arrows), as well as the primary site (arrows).

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