![]() ![]() Contrast may be useful when a nodule is located adjacent to the hilum and mediastinum. CT scanning is performed using a multislice technique, and no intravenous contrast is required for the detection of pulmonary metastases. It has been shown to have higher sensitivity than chest radiography (CXR) in the detection of pulmonary metastases. CT scanning is more sensitive, but it has high rates of false positivity.ĬT scanning is the modality of choice for detection and follow-up of pulmonary metastasis, because of its higher spatial, temporal, and contrast resolution and lack of superimposition of adjacent structures. Chest tomosynthesis is another low-dose technique with higher sensitivity that is used in the detection of lung nodules. Computer-aided detection (CAD) has also been used for automatic detection of pulmonary nodules. Dual-energy subtracted radiographs are more sensitive than conventional radiographs because of subtraction of overlying bony tissue. Small changes in tumor volume can be detected using volumetric techniques.Ĭhest radiography may not identify small metastatic lesions and may underestimate the tumor burden. CT is also used in assessing response to treatment. Several thermal ablation options are available for treatment of pulmonary metastases, which is performed under CT guidance. CT guidance is often required for obtaining samples from a suspected metastatic disease. In patients with primary renal or testicular cancer, chest CT scanning should be performed based on the presence of metastatic disease elsewhere. For patients with bone or soft-tissue sarcoma, malignant melanoma, or head and neck carcinoma, CT scanning of the chest should be performed as an initial evaluation. Chest CT scanning without contrast is more sensitive than CXR. Differential diagnoses for multiple pulmonary nodules include infections (eg, histoplasmosis, coccidioidomycosis in endemic areas, cryptococcal and nocardial infections as opportunistic infections in immunocompromised patients, septic emboli, abscess, paragonimiasis, hydatid), granulomatous diseases (eg, tuberculosis, sarcoidosis), and vascular/collagen-vascular diseases (eg, Wegener granulomatosis, rheumatoid arthritis).Ĭhest radiography (CXR) is the initial imaging modality used in the detection of suspected pulmonary metastasis in patients with known malignancies. Patients with lymphangitic carcinomatosis present with respiratory dysfunction, including severe dyspnea. The most common pattern of pulmonary metastasis is the presence of multiple, well-defined nodules. While a large number of patients with pulmonary metastases are asymptomatic at the time of diagnosis, some patients develop symptoms such as hemoptysis, cough, shortness of breath, chest pain, weakness, and weight loss. In patients with poor cardiorespiratory function and comorbidities, imaging-guided thermal ablation procedures are an effective alternative to surgical resection to improve survival. Imaging guidance is also used in histologic confirmation of metastatic disease. Imaging plays an important role in the screening and detection of pulmonary metastases. This typically implies an adverse prognosis and alters the management plan. The development of pulmonary metastases in patients with known malignancies indicates disseminated disease and places the patient in stage IV in TNM (tumor, node, metastasis) staging systems. Twenty percent of metastatic disease is isolated to the lungs. with the ungs being the second most frequent site of metastases from extrathoracic malignancies. Pulmonary metastasis is seen in 20-54% of extrathoracic malignancies, ![]()
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