Dipartimento di Radiologia Diagnostica ed Interventistica, Azienda Ospedaliera San Paolo, Via di Rudinì 8, 20142, Milano, Italy.
Oncologia, Dipartimento di Medicina, Azienda Ospedaliera San Paolo, Via di Rudinì 8, 20142, Milano, Italy.
Eur Radiol. 2015 Nov;25(11):3200-6. doi: 10.1007/s00330-015-3739-7. Epub 2015 Apr 23.
To prospectively assess prevalence/characteristics of clinically unsuspected pulmonary embolism (PE) in cancer patients undergoing follow-up chest MDCT and investigate MDCT protocol.
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.
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.
Thin reconstructions are essential for PE diagnosis, regardless of reader experience. Regarding oncologic patients, incidental PE diagnosis influences anticoagulation therapy.
• 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.
前瞻性评估在接受随访胸部 MDCT 的癌症患者中临床未疑诊的肺栓塞（PE）的患病率/特征，并研究 MDCT 方案。
我们评估了 1013 例肿瘤患者。分别独立评估 5mm 和 1.25mm 层厚的 MDCT 图像。评估肺动脉的显影程度。报告 PE 的存在、水平和部位。报告 PE 阳性患者的恶性肿瘤类型和转移情况。
排除 14 例（1.4%）因血管显影不足的检查后，999 例患者（572 例男性；平均年龄：68±12 岁；范围：26-93 岁）进入研究。PE 的患病率为 5%。与 5mm 图像相比，两位读者在评估 1.25mm 图像时的敏感性均显著提高（46-50%至 82-92%）。30%（15/51）的 PE 在前瞻性报告中未被放射科医生描述；53%（27/51）的 PE 为节段性，72.5%（37/51）为单侧。最常受累的部位是右下叶（59%）。27%的患者患有结肠癌，18%的患者患有肺癌。在 PE 阳性患者（25 例男性；平均年龄 70±10 岁；范围：44-87 岁）中，25%（13/51）患有肺癌，15%（8/51）患有结肠癌。
无论读者经验如何，薄重建对于 PE 的诊断都是至关重要的。对于肿瘤患者，偶然发现的 PE 诊断会影响抗凝治疗。
CT 肺动脉造影是 PE 诊断的金标准。
癌症和肿瘤治疗是 PE 的危险因素。
未疑诊的 PE 的患病率为 5%。
无论读者经验如何，薄重建对于 PE 的诊断都是至关重要的。
在肿瘤患者中，PE 诊断会影响抗凝治疗。
