Anesthesia and Intensive Care Department, Regional Institute of Oncology, Iasi, Romania.
Anesthesia and Intensive Care Department, School of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.
Radiol Oncol. 2021 Mar 19;55(2):172-178. doi: 10.2478/raon-2021-0014.
Critically ill cancer patients have an increased risk of developing acute neurological signs. The study objective was to evaluate the use and the usefulness of emergency head computed tomography (EHCT) in this category of patients.
This retrospective, single-centre, cohort study included patients with EHCT performed during Intensive Care Unit (ICU) admission for a period of three years. Indications, imagistic findings, type of malignancy, and outcome were evaluated to identify diagnostic yield and correlations between abnormal findings on positive scans, malignancy type, and mortality rate.
Sixty-four EHCTs were performed in 54 critically ill cancer patients, with 32 scans (50%) showing previously unknown lesions and considered to be positive. The most frequent abnormal findings were ischemic (15 EHCTs, 47%) and haemorrhagic (13 EHCTs, 40%) lesions. Thirty-eight EHCTs (59%) were indicated for altered mental status, with a positivity rate of 50%. Eighteen EHCTs (48%) were performed in hematological malignancy patients: 9 (50%) of which were positive with 8/9 (89%) displaying hemorrhagic lesions. Twenty EHCTs were performed in solid tumour patients, 10 (50%) of which were positive, with 9/10 (90%) displaying ischemic lesions. Out of 54 patients, 30 (55%) died during ICU stay. The mortality rate was higher in patients with hematological malignancies and positive EHCT (78% . 58%).
Diagnostic yield of EHCT in critically ill cancer patients is much higher than in other categories of ICU patients. We support the systematic use of EHCT in critically ill, mainly hemato-oncological patients with nonspecific neurological dysfunction, as it may lead to early identification of intracranial complications.
危重症癌症患者发生急性神经系统体征的风险增加。本研究旨在评估此类患者行急诊头部计算机断层扫描（EHCT）的应用及有效性。
这是一项回顾性、单中心、队列研究，纳入了在重症监护病房（ICU）入住期间行 EHCT 的患者，研究时间为 3 年。评估了适应证、影像学表现、恶性肿瘤类型和预后，以确定诊断率以及阳性扫描异常表现、恶性肿瘤类型和死亡率之间的相关性。
54 例危重症癌症患者共行 64 次 EHCT，其中 32 次（50%）显示了先前未知的病变，被认为是阳性。最常见的异常表现为缺血性（15 次 EHCT，47%）和出血性（13 次 EHCT，40%）病变。38 次 EHCT（59%）因精神状态改变而进行，阳性率为 50%。18 次 EHCT（48%）用于血液恶性肿瘤患者，其中 9 次（50%）为阳性，9/9（89%）显示出血性病变。20 次 EHCT 用于实体瘤患者，10 次（50%）为阳性，9/10（90%）显示缺血性病变。54 例患者中，30 例（55%）在 ICU 期间死亡。血液恶性肿瘤和 EHCT 阳性患者的死亡率更高（78%，58%）。
EHCT 在危重症癌症患者中的诊断率明显高于其他 ICU 患者类别。我们支持对主要为血液恶性肿瘤且伴有非特异性神经功能障碍的危重症患者常规行 EHCT，因为这可能有助于早期识别颅内并发症。
