Tumor development requires adequate system of blood vessels supplying adequate nutrition and removal of waste products
At earliest stages of neoangiogenesis, tumors recruit vessels from host, most of which come from venous capillary network in form of vascular sinusoids
At same time, tumors produce variety of endothelial growth factors, which initiate new tumor development within tumor and surrounding areas
At early stages, tumors have hypervascular periphery with hyperemic rim of tissue
As tumors progress, central areas may become ischemic due to inability to develop adequate vascular networks
Later, ischemic central areas may undergo necrosis
Tumor Vessel Morphology
Tumor vascular networks usually demonstrate abnormal branching patterns without typical hierarchical order of blood vessel branching seen in normal tissues
Tumor neovascularity can also be differentiated from normal tissues by irregular sizes of vessels and presence of arteriovenous shunts
On more microscopic level, tumor blood vessels are characterized by paucity of smooth muscle within vessel walls, making them more pliable and less pressure resistant
Morphologic appearance of tumor vessels may not allow direct assessment of function of tumor microcirculation or differentiation of benign from malignant tumors due to 20-80% of vascular network being perfused within any given tumor at particular time, while large portions of tumor vascular bed remain dormant
This leads to significant variations in tumor blood flow velocities and tumor vascularity between different areas within same tumor
Factors Affecting Tumor Perfusion
Disorganized vascular networks
Substantial deviations in tumor vessel size
Increased interstitial pressure
Increased interstitial pressure within tumors considered one of most important factors affecting blood flow within tumors
Several factors result in increased interstitial pressure within tumors
Increased permeability of tumor vessels
Deficiencies on lymphatic drainages, often blocked by proliferating tumors and metastatic deposits
Rapid proliferation of tumor cells in relatively confined spaces
IMAGING
Liver Masses
Renal Masses
Breast Masses
Thyroid Masses
Ovarian Masses
Selected References
Dietrich CF et al: How to perform contrast-enhanced ultrasound (CEUS). Ultrasound Int Open. 4(1):E2-E15, 2018
Barr RG et al: Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology. 271(1):133-42, 2014
Claudon M et al: Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med. 34(1):11-29, 2013
Fleischer AC et al: Advances in sonographic detection of ovarian cancer: depiction of tumor neovascularity with microbubbles. AJR Am J Roentgenol. 194(2):343-8, 2010
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
TERMINOLOGY
Tumor Angiogenesis
Tumor development requires adequate system of blood vessels supplying adequate nutrition and removal of waste products
At earliest stages of neoangiogenesis, tumors recruit vessels from host, most of which come from venous capillary network in form of vascular sinusoids
At same time, tumors produce variety of endothelial growth factors, which initiate new tumor development within tumor and surrounding areas
At early stages, tumors have hypervascular periphery with hyperemic rim of tissue
As tumors progress, central areas may become ischemic due to inability to develop adequate vascular networks
Later, ischemic central areas may undergo necrosis
Tumor Vessel Morphology
Tumor vascular networks usually demonstrate abnormal branching patterns without typical hierarchical order of blood vessel branching seen in normal tissues
Tumor neovascularity can also be differentiated from normal tissues by irregular sizes of vessels and presence of arteriovenous shunts
On more microscopic level, tumor blood vessels are characterized by paucity of smooth muscle within vessel walls, making them more pliable and less pressure resistant
Morphologic appearance of tumor vessels may not allow direct assessment of function of tumor microcirculation or differentiation of benign from malignant tumors due to 20-80% of vascular network being perfused within any given tumor at particular time, while large portions of tumor vascular bed remain dormant
This leads to significant variations in tumor blood flow velocities and tumor vascularity between different areas within same tumor
Factors Affecting Tumor Perfusion
Disorganized vascular networks
Substantial deviations in tumor vessel size
Increased interstitial pressure
Increased interstitial pressure within tumors considered one of most important factors affecting blood flow within tumors
Several factors result in increased interstitial pressure within tumors
Increased permeability of tumor vessels
Deficiencies on lymphatic drainages, often blocked by proliferating tumors and metastatic deposits
Rapid proliferation of tumor cells in relatively confined spaces
IMAGING
Liver Masses
Renal Masses
Breast Masses
Thyroid Masses
Ovarian Masses
Selected References
Dietrich CF et al: How to perform contrast-enhanced ultrasound (CEUS). Ultrasound Int Open. 4(1):E2-E15, 2018
Barr RG et al: Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology. 271(1):133-42, 2014
Claudon M et al: Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med. 34(1):11-29, 2013
Fleischer AC et al: Advances in sonographic detection of ovarian cancer: depiction of tumor neovascularity with microbubbles. AJR Am J Roentgenol. 194(2):343-8, 2010
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