title: Contrast enhanced chest-MDCT in oncologic patients. Prospective evaluation of the prevalence of incidental pulmonary embolism and added value of thin reconstructions.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Dipartimento di Radiologia Diagnostica ed Interventistica, Azienda Ospedaliera San Paolo, Via di Rudinì 8, 20142, Milano, Italy. silvia.3soldi@gmail.com.
authors.forename: Silvia
authors.initials: S
authors.lastname: Tresoldi
authors.affiliation: Dipartimento di Radiologia Diagnostica ed Interventistica, Azienda Ospedaliera San Paolo, Via di Rudinì 8, 20142, Milano, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Flor
authors.affiliation: Oncologia, Dipartimento di Medicina, Azienda Ospedaliera San Paolo, Via di Rudinì 8, 20142, Milano, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Luciani
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Lombardi
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Colombo
authors.affiliation: Dipartimento di Radiologia Diagnostica ed Interventistica, Azienda Ospedaliera San Paolo, Via di Rudinì 8, 20142, Milano, Italy.|Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via di Rudinì 8, 20142, Milano, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Cornalba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging; D003287:Contrast Media; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D033162:Incidental Findings; D007472:Iohexol / Q000031:analogs & derivatives; D007479:Iopamidol / Q000031:analogs & derivatives; D008175:Lung Neoplasms / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009369:Neoplasms / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007472:Iohexol; C038192:iopromide; D007479:Iopamidol
keywords: Cancer; Diagnostic imaging; Multidetector computed tomography; Pulmonary arteries; Pulmonary embolism