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Contrast enhanced chest-MDCT in oncologic patients. Prospective evaluation of the prevalence of incidental pulmonary embolism and added value of thin reconstructions

  • Oncology
  • Published:
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Abstract

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.

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References

  1. Wood JE (2002) Major pulmonary embolism; review of a pathophysiologic approach to the golden hour of haemodynamically significant pulmonary embolism. Chest 121:877–905

    Article  PubMed  Google Scholar 

  2. Storto ML, Di Credico A, Guido F, Larici AR, Bonomo L (2005) Incidental detection of pulmonary emboli on routine MDCT of the chest. AJR Am J Roentgenol 184(1):264–267

    Article  PubMed  Google Scholar 

  3. Torbicki A, Perrier A, Konstantinides S et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29(18):2276–2315

    Article  CAS  PubMed  Google Scholar 

  4. Fred HL (2013) Unsuspected pulmonary thromboemboli: a continuing clinical challenge. Tex Heart Inst J 40(1):9–12

    PubMed Central  PubMed  Google Scholar 

  5. Shujaat A, Shapiro JM, Eden E (2013) Utilization of CT pulmonary angiography in suspected pulmonary embolism in a major urban emergency department. Pulm Med. doi:10.1155/2013/915213

    PubMed Central  PubMed  Google Scholar 

  6. Becattini C, Agnelli G, Vedovati MC et al (2011) Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test. Eur Heart J 32(13):1657–1663

    Article  PubMed  Google Scholar 

  7. Shinagare AB, Guo M, Hatabu H et al (2011) Incidence of pulmonary embolism in oncologic outpatients at a tertiary cancer center. Cancer 117(16):3860–3866

    Article  PubMed Central  PubMed  Google Scholar 

  8. Kurcz J, Garcarek J, Guziński M, Czarnecka A, Sąsiadek MJ (2013) Multislice computed tomography angiography as an imaging modality of choice in patients with suspicion of pulmonary embolism - own experiences and modern imaging techniques. Adv Clin Exp Med 22(5):705–713

    PubMed  Google Scholar 

  9. Paddon AJ (2005) Incidental pulmonary embolism detected by routine CT in patients with cancer. Cancer Imaging 5:25–26

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Bach AG, Schmoll HJ, Beckel C et al (2014) Pulmonary embolism in oncologic patients: frequency and embolus burden of symptomatic and unsuspected events. Acta Radiol 55(1):45–53

    Article  PubMed  Google Scholar 

  11. Refaat R, El Shinnawy MA (2013) Does the anatomic distribution of acute pulmonary emboli at MDCT pulmonary angiography in oncology-population differ from that in non-oncology counterpart? Egypt J Radiol Nucl Med 44:463–474

    Article  Google Scholar 

  12. Browne AM, Cronin CG, English C, Ni Mhuircheartaigh J, Murphy JM, Bruzzi JF (2010) Unsuspected pulmonary emboli in oncology patients undergoing routine computed tomography imaging. J Thorac Oncol 5(6):798–803

    Article  PubMed  Google Scholar 

  13. Dentali F, Ageno W, Becattini C et al (2010) Prevalence and clinical history of incidental, asymptomatic pulmonary embolism: a meta-analysis. Thromb Res 125:518–522

    Article  CAS  PubMed  Google Scholar 

  14. Farrell C, Jones M, Girvin F, Ritchie G, Murchison JT (2009) Unsuspected pulmonary embolism identified using multidetector computed tomography in hospital outpatients. Clin Radiol 65(1):1–5

    Article  PubMed  Google Scholar 

  15. Trujillo-Santos J, Monreal M (2013) Management of unsuspected pulmonary embolism in cancer patients. Expert Rev Hematol 6(1):83–88

    Article  CAS  PubMed  Google Scholar 

  16. Schoepf UJ, Holzknecht N, Helmberger TK, Crispin A, Hong C, Becker CR et al (2002) Subsegmental pulmonary emboli: improved detection with thin-collimation multi-detector row spiral CT. Radiology 222(2):483–490

    Article  PubMed  Google Scholar 

  17. Gladish GW, Choe DH, Marom EM, Sabloff BS, Broemeling LD, Munden RF (2006) Incidental pulmonary emboli in oncology patients: prevalence, CT evaluation, and natural history. Radiology 240(1):246–255

    Article  PubMed  Google Scholar 

  18. Gosselin MV, Rubin GD, Leung AN, Huang J, Rizk NW (1998) Unsuspected pulmonary embolism: prospective detection on routine helical CT scans. Radiology 208(1):209–15

    Article  CAS  PubMed  Google Scholar 

  19. Nielsen HK, Husted SE, Krusell LR, Fasting H, Charles P, Hansen HH (1994) Silent pulmonary embolism in patients with deep venous thrombosis. Incidence and fate in a randomized, controlled trial of anticoagulation versus no anticoagulation. J Intern Med 235(5):457–461

    Article  CAS  PubMed  Google Scholar 

  20. Winston CB, Wechsler RJ, Salazar AM, Kurtz AB, Spirn PW (1996) Incidental pulmonary emboli detected at helical CT: effect on patient care. Radiology 201(1):23–27

    Article  CAS  PubMed  Google Scholar 

  21. Ryu JH, Olson EJ, Pellikka PA (1998) Clinical recognition of pulmonary embolism: problem of unrecognized and asymptomatic cases. Mayo Clin Proc 73(9):873–879

    Article  CAS  PubMed  Google Scholar 

  22. Pineda LA, Hathwar VS, Grant BJ (2001) Clinical suspicion of fatal pulmonary embolism. Chest 120(3):791–795

    Article  CAS  PubMed  Google Scholar 

  23. Abdel-Razeq HN, Mansour AH, Ismael YM (2011) Incidental pulmonary embolism in cancer patients: clinical characteristics and outcome – a comprehensive cancer center experience. Vasc Health Risk Manag 7:153–158

    PubMed Central  PubMed  Google Scholar 

  24. O'Connell C, Razavi P, Ghalichi M et al (2011) Unsuspected pulmonary emboli adversely impact survival in patients with cancer undergoing routine staging multi-row detector computed tomography scanning. J Thromb Haemost 9(2):305–311

    Article  PubMed  Google Scholar 

  25. Zompatori M, Attinà D, Niro F, Palareti G (2013) Subsegmental pulmonary embolism: is the emperor still naked? Radiol Med 118(6):901–908

    Article  PubMed  Google Scholar 

  26. den Exter PL, Jiménez D, Kroft LJM, Huisman MV (2012) Outcome of incidentally diagnosed pulmonary embolism in patients with malignancy. Curr Opin Pulm Med 18(5):399–405

    Article  Google Scholar 

  27. Cronin CG, Lohan DG, Keane M, Roche C, Murphy JM (2007) Prevalence and significance of asymptomatic venous thromboembolic disease found on oncologic staging CT. AJR Am J Roentgenol 189(1):162–170

    Article  PubMed  Google Scholar 

  28. Sebastian AJ, Paddon AJ (2006) Clinically unsuspected pulmonary embolism: an important secondary finding in oncology CT. Clin Radiol 61(1):81–85

    Article  CAS  PubMed  Google Scholar 

  29. Kearon C, Akl EA, Comerota AJ et al (2012) Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2):419–494

    Google Scholar 

  30. Piatek C, O'Connell C (2012) Unsuspected pulmonary embolism: impact on mortality among cancer patients. Curr Opin Pulm Med 18(5):406–409

    Article  PubMed  Google Scholar 

  31. Lauw MN, van Doormaal FF, Middeldorp S, Buller HR (2013) Cancer and venous thrombosis: current comprehensions and future perspectives. Semin Thromb Hemost 39(5):507–514

    Article  CAS  PubMed  Google Scholar 

  32. Ritchie G, McGurk S, McCreath C, Graham C, Murchison JT (2007) Prospective evaluation of unsuspected pulmonary embolism on contrast enhanced multidetector CT (MDCT) scanning. Thorax 62(6):536–540

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is Prof. Gianpaolo Cornalba, MD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: prospective observational study, performed at one institution.

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Authors and Affiliations

  1. Dipartimento di Radiologia Diagnostica ed Interventistica, Azienda Ospedaliera San Paolo, Via di Rudinì 8, 20142, Milano, Italy

    Silvia Tresoldi, Nicola Flor & Gianpaolo Cornalba

  2. Oncologia, Dipartimento di Medicina, Azienda Ospedaliera San Paolo, Via di Rudinì 8, 20142, Milano, Italy

    Andrea Luciani

  3. Scuola di Specializzazione in Radiodiagnostica, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy

    Maria Antonietta Lombardi & Bernardo Colombo

  4. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via di Rudinì 8, 20142, Milano, Italy

    Gianpaolo Cornalba

Authors
  1. Silvia Tresoldi
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  2. Nicola Flor
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  3. Andrea Luciani
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  4. Maria Antonietta Lombardi
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  6. Gianpaolo Cornalba
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Correspondence to Silvia Tresoldi.

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Tresoldi, S., Flor, N., Luciani, A. et al. Contrast enhanced chest-MDCT in oncologic patients. Prospective evaluation of the prevalence of incidental pulmonary embolism and added value of thin reconstructions. Eur Radiol 25, 3200–3206 (2015). https://doi.org/10.1007/s00330-015-3739-7

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  • DOI: https://doi.org/10.1007/s00330-015-3739-7

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