Thoracic Computed Tomography in Patients with Suspected Malignant Pleural Effusions

Traill, Zoë; Davies, Robert J. O.; Gleeson, Fergus

doi:10.1053/crad.2000.0573

Cited by 125 publications

(89 citation statements)

References 16 publications

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“…It is vital to have adequate enhancement of the pathological pleura so that it can be seen in patients with empyema and malignant effusions [3,[8][9][10]. Waite et al [9] demonstrated that 96% of patients with empyema and up to 10% of patients with malignant effusions showed parietal pleural enhancement; 95% of the latter are metastatic in origin, with common primaries being lung and breast, while mesothelioma accounts for 5% [11].…”

Section: Discussionmentioning

confidence: 99%

Multidetector CT imaging of pleura: comparison of two contrast infusion protocols

Raj¹,

Kirke²,

Bankart³

et al. 2011

BJR

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Objectives: Imaging of the pleura by multidetector CT (MDCT) can be challenging. There is no clear evidence or guidelines on contrast infusion parameters for imaging pleura. We compared two contrast protocols for assessing pleural pathology on MDCT.Methods: This was a prospective study in which consecutive patients with MDCT for suspected pleural disease on chest radiograph were randomised into two groups. The first group received 150 ml of intravenous contrast at a rate of 2.5 ml s -1 and the second group received 100 ml at 2 ml s -1. Images were acquired after a 60 s delay. Hounsfield units of the pleura, thoracic aorta, main pulmonary artery, portal vein and superior mesenteric artery were measured and analysed by two independent readers. Results: 40 patients (20 in each group) who had pleural enhancement on MDCT were included for final analysis. The mean pleural enhancement value was 83 HU (Group A) vs 59 HU (Group B) (p50.0004). The mean aortic enhancement was 241 HU (A) vs 141 HU (B) (p,0.0001); main pulmonary artery enhancement was 208 HU (A) vs 139 HU (B) (p,0.0002); portal venous enhancement was 169 HU (A) vs 115 HU (B) (p,0.0001); and the superior mesenteric artery enhancement was 215 HU (A) vs 128 HU (B) (p,0.0001). Conclusion: Enhancement of the pleura and major vessels was significantly higher in the group receiving more contrast at a greater infusion rate. This technique of a single scan through the entire pleural surface with a delayed acquisition is promising. When pleural disease is suspected, contrast infusion protocols should be modified to achieve the best results and clinicians should be encouraged to specifically request a ''pleural CT''.

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Section: Discussionmentioning

confidence: 99%

Multidetector CT imaging of pleura: comparison of two contrast infusion protocols

Raj¹,

Kirke²,

Bankart³

et al. 2011

BJR

View full text Add to dashboard Cite

show abstract

“…When investigating a pleural effusion a contrast enhanced thoracic CT scan should be performed before full drainage of the fluid as pleural abnormalities will be better visualised. 62 CT scanning has been shown to be superior to plain radiographs in the differentiation of pleural from parenchymal disease. It is particularly helpful in the assessment and management of loculated pleural effusions.…”

Section: Ultrasound Findingsmentioning

confidence: 99%

BTS guidelines for the investigation of a unilateral pleural effusion in adults

Maskell

Butland

2003

Thorax

192

121

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“…Pleural fluid cytology is of low sensitivity and discrimination between mesothelial cellular atypia due to inflammation and MPM can be challenging [4]. Computed tomography (CT) scan appearances, while of reasonable specificity for identifying malignant thickening of the pleura, distinguish poorly between MPM and adenocarcinoma [5].…”

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confidence: 99%

A prospective trial evaluating the role of mesothelin in undiagnosed pleural effusions

Hooper

Morley

Virgo

et al. 2012

European Respiratory Journal

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Mesothelin has been proposed as a useful tool in the diagnosis of malignant pleural mesothelioma (MPM). We aimed to examine its diagnostic utility and the impact of renal impairment on results.We prospectively recruited 230 patients with new undiagnosed pleural effusions, testing serum (n5216) and pleural fluid (n5206) mesothelin (by ELISA) during the initial consultation.28 (12%) out of 230 patients had MPM. Serum mesothelin gave sensitivity 59.3%, specificity 64.7%, negative predictive value (NPV) 91.2%, positive predictive value (PPV) 20.5%, and pleural fluid sensitivity 72.0%, specificity 87.5%, NPV 95.5%, PPV 46.2% for distinguishing effusions due to MPM. In a matched comparison, diagnostic characteristics of pleural fluid mesothelin were superior to serum (p50.0001). Serum mesothelin levels in patients without MPM were higher in patients with renal impairment (p50.007) while pleural fluid levels were unaffected. 19 (54%) out of 35 patients with a benign pleural effusion and an estimated glomerular filtration rate f59 mL?min -1 had a false-positive serum mesothelin result.The diagnostic accuracy of pleural fluid mesothelin is superior to that of serum and is unaffected by renal function. In patients with a low pre-test probability of mesothelioma, a negative mesothelin test could be reassuring, because of its high NPV. Routine use of mesothelin testing in undiagnosed pleural effusions at presentation appears to be unhelpful.

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Thoracic Computed Tomography in Patients with Suspected Malignant Pleural Effusions

Cited by 125 publications

References 16 publications

Multidetector CT imaging of pleura: comparison of two contrast infusion protocols

Multidetector CT imaging of pleura: comparison of two contrast infusion protocols

BTS guidelines for the investigation of a unilateral pleural effusion in adults

A prospective trial evaluating the role of mesothelin in undiagnosed pleural effusions

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