Radiology of Pulmonary Metastases: Comparison of Imaging Techniques with Operative Findings

Abstract

The operative findings at 27 thoracotomies in 24 patients were compared with the results of chest X-rays, computerized tomographies and conventional tomographies. Radiological and operative findings corresponded in 15 of 27 cases. The computerized tomography proved to be the most sensitive method for the estimation of the number of metastases. The foci often located close to the pleura repeatedly cause an exudative reaction of the visceral pleura and thus mark the interlobular septa. These changes were most distinctly recognized by conventional tomography and gave indications for the topographic classification of the metastases. Despite the careful evaluation of the imaging techniques small metastases were often not detected.

Multi slice computed tomography in the study of pulmonary metastases

“…The problems involved in diagnosing pulmonary metastases include both detection and characterisation. Although chest X-rays were once used, it has long been demonstrated that CT, including conventional CT, is far superior [4,19], yielding a sensitivity of 68%-78% as opposed to 44%-56% for chest X-rays [3,5,6]. This superiority is attributable to the greater contrast resolution between the nodule and the lung parenchyma and easier detection of lesions, thanks to elimination of the superimposition of structures such as the chest wall, mediastinum, diaphragm and vessels [20].…”

“…In passato a tal fine veniva utilizzata la radiografia del torace, ma già da anni è stata dimostrata la superiorità della TC [4,19], anche se di tipo convenzionale, con risultati di sensibilità segnalati in letteratura del 44%-56% per la radiografia del torace e del 68%-78% per la TC [3,5,6]. La superiorità della TC è in rapporto ad una maggiore risoluzione di contrasto tra nodulo e parenchima polmonare ed ad un più agevole riconoscimento delle lesioni in assenza di sovrapposizione di strutture quali parete toracica, mediastino, diaframma e vasi [20].…”

“…Various studies have shown that conventional radiology has a sensitivity of 44%-56% in detecting lung metastases, but despite this poor performance, it is still used in the follow-up protocols of some malignant tumours [3][4][5][6]. CT has been widely demonstrated to be far more accurate than chest X-rays in demonstrating pulmonary metastases [7].…”

“…Diversi studi hanno dimostrato che la radiologia tradizionale nella individuazione delle metastasi polmonari presenta una sensibilità del 44%-56%, tuttavia è prevista nei protocolli di follow-up di alcuni tumori maligni [3][4][5][6]. Come ampiamente dimostrato in letteratura già da molti anni la TC è molto più accurata della radiografia del torace nel riconoscimento delle metastasi polmonari [7].…”

Resección de metástasis pulmonares

“…La mayoría de los cirujanos de tórax prefiere la toracotomía, dado que por la vía toracoscópica no se estaría cumpliendo el segundo criterio básico y único factor pronóstico validado universalmente, la resección de todas las lesiones 15 . Esto se basa en que las imágenes preoperatorias son fundamentales para programar la resección y se ha visto que la TAC subestima lesiones hasta en un 27-40% de las veces [15][16][17] . Por esto habría que palpar directamente la superficie pulmonar buscando lesiones no diagnosticadas, e incluso en forma bilateral, a pesar que las imágenes nos revelen compromiso unilateral.…”