Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030.
Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.
AJR Am J Roentgenol. 2020 Dec;215(6):1329-1334. doi: 10.2214/AJR.19.22741. Epub 2020 Oct 6.
The purpose of this study is to evaluate the CT and clinical characteristics of in situ pulmonary artery thrombosis (PAT) associated with radiation therapy (RT). A database search was performed to identify patients who had PAT develop after receiving RT. The CT characteristics of PAT, including the number, location, and appearance of filling defects as well as the presence of associated lung fibrosis, were recorded. The terminology (in situ thrombosis vs acute or chronic pulmonary embolism) used by the interpreting radiologists to describe PAT, the time between the completion of RT and development of PAT, the change in the size of the PAT, and observation of any new thrombi and emboli on follow-up imaging, were also recorded. Of the 27 patients in the study cohort, 22 (81%) had lung cancer and five (19%) had mesothelioma. Most PATs were solitary (93%) and nonocclusive (96%) and formed an obtuse angle to the vessel wall (89%). All PATs were eccentric within the involved PA and were located within the RT volume. The time from completion of RT to initial diagnosis of PAT on CT ranged from 53 to 2522 days (mean, 675 days). Radiation-induced lung fibrosis was present in the ipsilateral lung in all patients. No evidence of additional PA filling defects that suggested embolization were seen on follow-up images of any of the patients, even those who did not receive anticoagulant therapy. In situ PAT associated with RT, which to our knowledge has not previously been described in the English literature, has imaging features different from those of acute pulmonary emboli and does not appear to embolize. Radiologist awareness of PAT can facilitate accurate diagnosis and impact management.
本研究旨在评估与放射治疗（RT）相关的原位肺动脉血栓形成（PAT）的 CT 和临床特征。进行了数据库检索，以确定在接受 RT 后发生 PAT 的患者。记录了 PAT 的 CT 特征，包括充盈缺损的数量、位置和外观以及相关肺纤维化的存在。记录了放射科医生用于描述 PAT 的术语（原位血栓形成与急性或慢性肺栓塞）、RT 完成与 PAT 发生之间的时间、PAT 大小的变化以及在随访影像学上观察到的任何新血栓和栓子。在研究队列的 27 名患者中，22 名（81%）患有肺癌，5 名（19%）患有间皮瘤。大多数 PAT 是单发的（93%）和非闭塞性的（96%），与血管壁形成钝角（89%）。所有 PAT 均偏心位于受累的 PA 内，位于 RT 体积内。从 RT 完成到 CT 上首次诊断 PAT 的时间范围为 53 至 2522 天（平均 675 天）。所有患者的同侧肺均存在放射性肺纤维化。在任何患者的随访图像上，甚至在未接受抗凝治疗的患者中，均未发现提示栓塞的其他 PA 充盈缺损的证据。与我们所知的先前在英语文献中未描述过的 RT 相关的原位 PAT 具有与急性肺栓塞不同的影像学特征，并且似乎不会栓塞。放射科医生对 PAT 的认识可以促进准确诊断并影响治疗管理。
