ABSTRACT
Background and objectives The results of previous PET-CT studies are contradictory for discriminating malignant from benign pleural effusions. We purpose to develop a PET-CT score for differentiating between benign and malignant effusions. Patients and methods We conducted a prospective study of consecutive patients with pleural effusions undergoing PET-CT from October 2013 to October 2019 (referral cohort). PET-CT scan features evaluated using the SUV were: linear thickening; nodular thickening; nodules; masses; circumferential thickening; mediastinal and fissural pleural involvement; intrathoracic lymph nodes; pleural loculation; inflammatory consolidation; pleural calcification; cardiomegaly; pericardial effusion; bilateral effusion; lung mass; liver metastasis and other extra-pleural malignancy. The results were validated in an independent prospective cohort from November 2019 to June 2021. Results One hundred and ninety-nine patients were enrolled in the referral cohort (91 with malignant effusions and 108 benign). The most useful parameters for the development of a PET-CT score were: nodular pleural thickening, pleural nodules with SUV>7.5, lung mass or extra pleural malignancy (10 points each), mammary lymph node with SUV>4.5 (5 points) and cardiomegaly (−1 point). With a cut-off value of >9 points in the referral cohort, the score established the diagnosis of malignant pleural effusion with sensitivity 87.9%, specificity 90.7%, positive predictive value 88.9%, negative predictive value 89.9%, positive likelihood ratio 7.81 and negative likelihood ratio 0.106. These results were validated in an independent prospective cohort of 75 patients. Conclusions PET-CT score was shown to provide relevant information for the identification of malignant pleural effusion (AU)
Antecedentes y objetivos Los estudios PET-TAC previos en el análisis del derrame pleural son contradictorios. Nuestro objetivo es desarrollar una puntuación mediante PET-TAC para diferenciar entre derrames benignos y malignos. Pacientes y métodos Estudio prospectivo en pacientes con derrame pleural a los que se realizó una PET-TAC desde octubre de 2013 hasta octubre de 2019 (cohorte de referencia). Los datos analizados fueron: engrosamiento lineal; engrosamiento nodular; nódulos; masas; engrosamiento circunferencial; afectación pleural mediastínica y cisural; ganglios linfáticos torácicos; loculación pleural; consolidación; calcificación pleural; cardiomegalia; derrame pericárdico; derrame bilateral; masa pulmonar; metástasis hepáticas y otras neoplasias malignas extrapleurales. Se calculó el SUV de todos estos parámetros. Los resultados se validaron en una cohorte independiente. Resultados Se incluyó a 199 pacientes en la cohorte de referencia (91 derrames malignos y 108 benignos). Los parámetros que mostraron más utilidad para discriminar ambos derrames y desarrollar una puntuación fueron: engrosamiento pleural nodular, nódulos pleurales con SUV > 7,5, masa pulmonar o malignidad extrapleural (10 puntos cada uno), ganglio en cadena mamaria con SUV > 4,5 (5 puntos) y cardiomegalia (1 punto). Con un punto de corte > 9 en la cohorte de derivación, se estableció el diagnóstico de derrame pleural maligno con una sensibilidad del 87,9%, especificidad del 90,7%, valor predictivo positivo del 88,9%, valor predictivo negativo del 89,9% razón de verosimilitud positiva del 7,81 y razón de verosimilitud negativa del 0,106. Estos resultados fueron validados en una cohorte prospectiva independiente de 75 pacientes. Conclusiones Una puntuación basada en PET-TAC proporciona información relevante para el diagnóstico del derrame pleural maligno (AU)
Subject(s)
Humans , Pleural Effusion/diagnostic imaging , Pleural Effusion, Malignant/diagnostic imaging , Positron Emission Tomography Computed Tomography , Sensitivity and Specificity , Diagnosis, Differential , Fluorodeoxyglucose F18 , Prospective StudiesABSTRACT
BACKGROUND AND OBJECTIVES: The results of previous PET-CT studies are contradictory for discriminating malignant from benign pleural effusions. We purpose to develop a PET-CT score for differentiating between benign and malignant effusions. PATIENTS AND METHODS: We conducted a prospective study of consecutive patients with pleural effusions undergoing PET-CT from October 2013 to October 2019 (referral cohort). PET-CT scan features evaluated using the SUV were: linear thickening; nodular thickening; nodules; masses; circumferential thickening; mediastinal and fissural pleural involvement; intrathoracic lymph nodes; pleural loculation; inflammatory consolidation; pleural calcification; cardiomegaly; pericardial effusion; bilateral effusion; lung mass; liver metastasis and other extra-pleural malignancy. The results were validated in an independent prospective cohort from November 2019 to June 2021. RESULTS: One hundred and ninety-nine patients were enrolled in the referral cohort (91 with malignant effusions and 108 benign). The most useful parameters for the development of a PET-CT score were: nodular pleural thickening, pleural nodules with SUV>7.5, lung mass or extra pleural malignancy (10 points each), mammary lymph node with SUV>4.5 (5 points) and cardiomegaly (-1 point). With a cut-off value of >9 points in the referral cohort, the score established the diagnosis of malignant pleural effusion with sensitivity 87.9%, specificity 90.7%, positive predictive value 88.9%, negative predictive value 89.9%, positive likelihood ratio 7.81 and negative likelihood ratio 0.106. These results were validated in an independent prospective cohort of 75 patients. CONCLUSIONS: PET-CT score was shown to provide relevant information for the identification of malignant pleural effusion.
Subject(s)
Pleural Effusion, Malignant , Pleural Effusion , Humans , Positron Emission Tomography Computed Tomography , Pleural Effusion, Malignant/diagnostic imaging , Pleural Effusion, Malignant/etiology , Prospective Studies , Fluorodeoxyglucose F18 , Diagnosis, Differential , Pleural Effusion/diagnostic imaging , Pleural Effusion/etiology , Cardiomegaly , Sensitivity and SpecificitySubject(s)
Humans , Male , Middle Aged , Mediastinum/diagnostic imaging , Asthma/diagnosis , Tomography, X-Ray ComputedSubject(s)
Mediastinum , Thorax , Humans , Mediastinum/diagnostic imaging , Tomography, X-Ray ComputedSubject(s)
Biopsy/methods , Bronchoscopy/methods , COVID-19/diagnosis , Cryosurgery/methods , Lung/pathology , Pandemics , SARS-CoV-2 , Adult , Aged , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Spain/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Pulmonary Eosinophilia/etiology , Coronavirus Infections/complications , Pulmonary Eosinophilia/pathology , Biopsy , Severe acute respiratory syndrome-related coronavirus/isolation & purification , Polymerase Chain Reaction , Pneumonia, Viral/complications , Acute DiseaseABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Aged , Pleural Effusion, Malignant/diagnostic imaging , Pleural Effusion, Malignant/pathology , Tomography, Emission-Computed , Positron Emission Tomography Computed Tomography/methods , Thorax/diagnostic imaging , Thoracoscopy/methods , Prospective Studies , Radiographic Image Interpretation, Computer-Assisted , Logistic Models , Sensitivity and SpecificityABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Pulmonary Embolism/diagnostic imaging , Pulmonary Veins/diagnostic imaging , Chondrosarcoma/diagnostic imaging , Neoplasm Metastasis , Pulmonary Embolism/pathology , Pulmonary Veins/pathology , Prostaglandins/administration & dosageABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Hernia/diagnostic imaging , Lung Diseases/psychology , Intercostal Muscles/pathology , Thoracic Wall , Ultrasonography/instrumentation , Hernia/physiopathology , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methodsSubject(s)
Chondrosarcoma/secondary , Embolism/complications , Neoplastic Cells, Circulating , Pulmonary Veins , Humans , Male , Middle AgedSubject(s)
Hernia/diagnostic imaging , Lung Diseases/diagnostic imaging , Postoperative Complications/diagnostic imaging , Ultrasonography , Adenocarcinoma/surgery , Aged , Diagnosis, Differential , Female , Humans , Lung Neoplasms/surgery , Neoplasm Recurrence, Local/diagnostic imaging , Pneumonectomy , Surgical Wound Dehiscence/diagnostic imaging , Thoracic Surgery, Video-Assisted/adverse effects , Tomography, X-Ray Computed , Valsalva ManeuverABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Chylothorax/epidemiology , Pleural Effusion/etiology , Drainage , Chylomicrons/analysis , Triglycerides/analysisABSTRACT
OBJECTIVES: The aim of this report is to identify the radiological findings of unilateral tuberculous lung destruction (UTLD). MATERIALS AND METHODS: Thirteen patients with (UTLD) were reviewed from 1999 to 2014. Only patients with radiological evidence of absence of pulmonary parenchyma preserved were included. Clinical and demographic data were obtained and radiological studies (chest radiograph and CT) were retrospectively reviewed. RESULTS: The left lung was more commonly involved (85%). The following radiological findings were found in all cases: a decrease in the diameter of the pulmonary vessels of the affected lung, herniation of the contralateral lung and hypertrophy of the ribs and/or thickening of extrapleural fat. Two radiological patterns were identified: UTLD with cystic bronchiectasis (85%) and UTLD without residual cystic bronchiectasis (15%). Forty-six per cent of cases had respiratory infection symptoms with presence of air-fluid levels in the affected lung as the most common finding in these patients. CONCLUSIONS: Total unilateral post-tuberculous lung destruction is an irreversible complication with the following main radiological features: predominantly left-sided location, decreases in the diameter of the ipsilateral pulmonary vessels, herniation of the contralateral lung and hypertrophy of the ribs and/or thickening of extrapleural fat. TEACHING POINTS: ⢠Unilateral tuberculous lung destruction is an irreversible complication of tuberculosis. ⢠Left-side predominance and herniation of the contralateral lung are characteristic. ⢠Decreased diameter of the ipsilateral pulmonary vessels occurred in all patients. ⢠The pattern with residual cystic bronchiectasis is the most frequent. ⢠Superimposed non-tuberculous infections may affect the destroyed lung.
Subject(s)
Chylothorax , Adult , Aged , Aged, 80 and over , Chylothorax/diagnosis , Chylothorax/etiology , Chylothorax/therapy , Female , Humans , Male , Middle Aged , Retrospective Studies , Triglycerides/analysisABSTRACT
No disponible
