Abstract
Objective: Survival in patients after surgical resection of pulmonary metastases correlates
with the complete resection of all metastatic deposits. The purpose of this study
was to evaluate the additional value of helical CT to see whether the slice thickness
and the reading environment was a factor determining the accuracy of helical scans.
Methods: Between 2004 and 2007, 93 patients (62 men, 31 women) underwent complete resection
of pulmonary metastases by open thoracotomy. A total of 125 thoracotomies were performed
with manual palpation of the involved lung. We retrospectively examined the helical
CT findings obtained using a 5-mm slice thickness in a routine preoperative analysis,
and within this study a second reading was performed independently, using 3-mm slice
thickness image sets. The CT images were evaluated in a consensus between two radiologists.
Results: Computed tomography scanning was performed a median of 12 days before thoracotomy
(range 1–121 days). Analysis of helical CT in 5-mm slice thickness detected metastases
with a sensitivity of 83.7 % whereas a 3-mm slice thickness had a sensitivity of 88.8 %.
There were statistically significantly more lesions using helical CT and a 3-mm slice
thickness technique than with the 5-mm slice thickness technique, compared to the
surgical results (p = 0.002). This was also found with regard to nodules which were finally histologically
confirmed as lung metastases (p = 0.014).
Conclusions: We conclude that a reduced slice thickness may have an important positive impact
on the treatment and outcome of patients with pulmonary metastases. The use of 3-mm
slice thickness helical CT may raise the sensitivity for pulmonary metastases detection
compared to 5-mm images, but the rate of false positive results may also increase.
Key words
thoracic surgery - pulmonary metastases - helical CT
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Dr. MD Joachim Pfannschmidt
Thoraxklinik am Universitätsklinikum
Department of Surgery
Amalienstr. 5
69126 Heidelberg
Germany
Fax: + 49 (0) 62 21 39 65 43
eMail: joachim.pfannschmidt@thoraxklinik-heidelberg.de
