Early and delayed phases of contrast-enhanced CT for evaluating patients with malignant pleural effusion. Results of pairwise comparison by multiple observers

Abstract

Delayed phase of contrast-enhanced CT is preferable to early phase for evaluating pleural findings. Advances in knowledge: Pleural attenuation is greater for the delayed phase compared with the early phase of contrast-enhanced chest CT. In the pairwise comparison, all the observers prefer the delayed phase over the early phase for pleural evaluation.

When pneumonia is not COVID-19

“…From a clinical and radiological point of view, numerous non-infectious diseases can manifest as acute respiratory processes 46 and overlap both with COVID-19 and with other infectious diseases.…”

Diagnostics in Pleural Disease

“…The "split pleura" sign ( Figure 8) and the presence of > 30 mm distance between To optimise CT imaging of the pleura, iodinated intravenous contrast is recommended and ideally, a venous phase or "Pleural phase" scan 60-90 s post infusion should be taken. Failure to achieve a "Pleural phase" scan has been shown to result in poorer diagnostic yields [97,98]. PF drainage prior to imaging is not a prerequisite and in a series across 32 patients with pre and post drainage CTs, the second scan did not provide any new information to influence clinical management [99].…”

“…The CT features of malignant pleural disease have been derived through a number of small retrospective studies; though not the largest, the series by Leung et al was the earliest and remains the most recognised and cited. These studies largely agree that the following features on CT are more suggestive of malignant disease than benign ( Figure 9): nodular pleural thickening (sens 38-53%, spec 87-100%), pleural thickening along mediastinal surfaces (sens 14-74%, spec 83-97%), thickening of the parietal pleura >1 cm (sens 36-57%, spec 64-94%), and circumferential pleural thickening encasing the lung (sens 8-54%, spec 63-100%) [92,96,98,[102][103][104][105]. However, CT is not the be-all and end-all when it comes to securing a diagnosis of pleural malignancy.…”

Conspicuity of Malignant Pleural Mesothelioma in Contrast Enhanced MDCT – Arterial Phase or Late Phase?

“…However, most of these studies compared data from interindividual scans only [8-10]. One study only compared pleural enhancement on chest CT intraindividually on arterial phase and delayed phase scans in patients with malignant pleural effusion [13]. The authors, however, grouped several pleural malignancies together and focussed rather on subjective image analysis than on objective evaluation.…”

“…There is only one study that compares tumor visibility on MDCT intraindividually using different scan delays, but that study grouped several pleural malignancies together with MPM representing a minority of cases. Moreover, the authors focussed on subjective image evaluation and density measurements were evaluated for tumor lesions only and not for the surrounding soft tissue [13].…”