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DOI:10.2214/AJR.07.3516
AJR 2008; 191:885-889
© American Roentgen Ray Society

Original Research

Venous Thromboembolism and Occult Malignancy: Simultaneous Detection During Pulmonary CT Angiography with CT Venography

Guillaume Bierry1, Nathalie Holl1, Frauke Kellner2, Sophie Riehm1, Marie-Noelle Roedlich1, Michel Greget1 and Francis Veillon1

1 Department of Radiology 1, University Hospital of Strasbourg, 10 Ave. Molière, 67098 Strasbourg Cedex, France.
2 Department of Radiology, Inselspital Bern, Bern, Switzerland.

OBJECTIVE. We explored the potential for patients with proven venous thromboembolism or pulmonary embolism (PE) to have occult malignancies detected during the same CT examination. To verify this, we compared the presence of occult malignancies identified on pulmonary artery CT angiography (CTA) and CT venography (CTV) when venous thromboembolism (VTE) was present.

SUBJECTS AND METHODS. Pulmonary artery CTA combined with CTV was performed on a 16-MDCT scanner on 186 adult patients suspected of having pulmonary embolism without any known malignancies. CTV was performed from the diaphragm to the knee 180 seconds after CTA. Two radiologists evaluated the presence of VTE, that is PE or deep venous thrombosis (DVT), and tumor lesions on both examinations in consensus. The malignant nature of the possibly identified tumors was confirmed by pathologic examination.

RESULTS. VTE was found in 49 patients (26%). Malignant tumors were detected in 24 patients (13%). Eleven patients with malignant tumors had VTE (46% of patients with malignant tumors; 22% with VTE and 6% of all patients). There was correlation with presence of malignancies between both and DVT and DVT associated with PE but not between presence of malignancies and PE only. Patients with DVT and those with DVT associated with PE had a risk ratio of 3.2 and 3.3, respectively, for having a malignant tumor discovered simultaneously.

CONCLUSION. A high number of malignant tumors can be incidentally discovered on pulmonary artery CTA, even more so with additional CTV. Radiologists should scrutinize scans to pick up unknown malignancies, especially in patients with identified VTE.

Keywords: CT venography • occult malignancy • pulmonary CT angiography • venous thromboembolism


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