Published in:
01-11-2015 | Oncology
Contrast enhanced chest-MDCT in oncologic patients. Prospective evaluation of the prevalence of incidental pulmonary embolism and added value of thin reconstructions
Published in: European Radiology | Issue 11/2015
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Objectives
To prospectively assess prevalence/characteristics of clinically unsuspected pulmonary embolism (PE) in cancer patients undergoing follow-up chest MDCT and investigate MDCT protocol.
Methods
We evaluated 1013 oncologic patients. MDCT images at 5 and 1.25 mm thickness were independently evaluated. Pulmonary artery opacification degree was assessed. Presence, level, and site of PE were reported. Type of malignancy and metastases were reported for PE-positive patients.
Results
After excluding 1.4 % (14/1013) of examinations due to inadequate vessel opacification, 999 patients (572 male; mean age:68 ± 12 years; range:26–93 years) entered the study. Prevalence of PE was 5 %. There was significant improvement in the sensitivity for both readers in the evaluation of 1.25 mm compared to 5 mm images (46–50 % to 82–92 %). 30 % (15/51) PE were not described by the radiologist in the prospectively issued report; 53 % (27/51) of PE were segmental, 72.5 % (37/51) unilateral. The right lower lobe was the most involved (59 %). 27 % patients had colon cancer, 18 % lung cancer. Among PE-positive patients (25 male; mean age 70 ± 10 years; range:44–87 years), 25 % (13/51) had lung cancer, 15 % (8/51) colon cancer.
Conclusions
Thin reconstructions are essential for PE diagnosis, regardless of reader experience. Regarding oncologic patients, incidental PE diagnosis influences anticoagulation therapy.
Key Points
• CT pulmonary angiography is the gold standard for PE diagnosis.
• Cancer and oncological treatments are risk factors for PE.
• The prevalence of unsuspected PE was 5 %.
• Thin reconstructions are essential for PE diagnosis regardless of reader experience.
• In oncologic patients, PE diagnosis influences anticoagulation therapy.