Role of MDCT as an effective imaging tool in detection of complications amongst oncological patients in a tertiary care oncology institute.
Emerg Radiol. 2019 Jan 21. doi: 10.1007/s10140-019-01671-6. [Epub ahead of print]
Rao A1, Parampalli R2.
OBJECTIVES: The objectives of the study are to evaluate the role of multidetector computed tomography (MDCT), its sensitivity and specificity in recognizing the complications related to oncology, and its treatment in patients with known malignancies and to determine how clinician's diagnosis, diagnostic dilemma, and management decisions are affected by the results of computed tomography (CT) in a tertiary care oncology setup.
MATERIALS AND METHODS: A thorough retrospective search of the database of 1 year in the Department of Radiology was done at our tertiary oncology center, of patients who were diagnosed or suspected with complications associated with cancer. In addition, patients, in whom acute emergencies were detected by the MDCT, were also included as these were mostly part of the complications related to the malignancies. A total of 207 patients were included after excluding patients in whom the final diagnosis was uncertain or in patients who died before a definitive diagnosis was made. Clinical details were noted and compared with the CT diagnosis of the complication.
RESULTS: Out of the 207 patients, majority of complications were related to cardiovascular system [22.2%]. Gastrointestinal malignancies constituted the next most common [20.7%], followed by genitourinary [17.8%], central nervous system [9.6%], and respiratory system complications [8.2%]. The musculoskeletal and head and neck complications were seen in 4.8% of the total patients. The iatrogenic complications and those complications arising due to chemotherapy or radiotherapy were separated constituting about 5.3% of the total number of patients in the study. CT showed a sensitivity of 96.4%, specificity of 66.6%, positive predictive value of 98.4%, and negative predictive value of 46.1% in detecting these complications. Overall, CT detected 96.6% of complications which were not suspected clinically and detected 83% of complications supporting the clinical suspicion.
CONCLUSION: MDCT plays an important role in detecting the complications associated with malignancies. It helps in definitive diagnosis of those complications which are clinically suspected and also in recognizing those complications which may not be apparent clinically and thus can change the management strategies. This is probably the first comprehensive study in the English literature evaluating and highlighting the role of MDCT in recognizing various complications in patients with known malignancies.