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Occult Malignancy Common Occurrence With New Venous Thromboembolism (VTE)

August 3, 2009
Written by: , Filed in: Nuclear Medicine
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A recent study was conducted to ascertain the occurrence of occult malignancy in patients undergoing combined pulmonary CT angiography (CTA) and CT venography (CTV).

In inpatients, the presence of new Venous Thromboembolism (VTE), particularly DVT, should alert the radiologist that a careful search for an underlying occult malignancy should also be made due to the increased risk.

Participants
The study included 186 inpatients who underwent pulmonary CTA and CTV for clinical indication.

Methodology
Patients with a history of malignancy or venous thromboembolism (VTE) were excluded. Patients aged <40 years were excluded, as they did not undergo CTV due to concerns regarding radiation exposure. All CTs were performed on a 16-MDCT scanner. Overall, 140 mL of intravenous contrast was injected at 3 mL/s. The pulmonary CTA used 1.0-mm reconstruction and 0.7-mm reconstruction increment. The abdomen and lower limbs were scanned (CTV) from the diaphragm down to the subpopliteal recess using 5-mm reconstruction and 5-mm reconstruction increment 180 seconds after the start of contrast medium injection. The pulmonary CTA used 100 to 140 mAs and 120 kVp. The CTV used 100 mAs and 120 kVp. In all patients, pulmonary embolism (PE), deep vein thrombosis (DVT), and lesions suspicious for tumor were recorded. [text_ad] Results
49 of 186 (26.3%) patients had VTE. Twenty-five (13.4%) had PE and DVT, 11 (5.9%) had PE and not DVT, and 13 (7.0%) had DVT and not PE. An occult cancer was seen in 24 (12.9%) patients. Eleven of 24 patients (45.8% of patients with an occult cancer, 6% of all patients) presented with VTE. Eight of these patients had PE and DVT, 2 had DVT only, and 1 had PE only.

Thirteen patients (7% of all patients) had an occult malignancy detected but no VTE. There was a significant correlation between detecting occult malignancy and DVT (P =0.01).

Patients with a DVT had a risk ratio of 3.2 to have cancer also discovered.

There was a significant correlation between detecting occult malignancy and the presence of both PE and DVT (P =0.02). Patients with both a PE and DVT had a risk ratio of 3.3 to have cancer also discovered. The correlation between detecting occult malignancy and the presence of PE alone was not statistically significant (P =0.06).

Conclusions
In inpatients, the presence of new VTE, particularly DVT, should alert the radiologist that a careful search for an underlying occult malignancy should also be made due to the increased risk.

Reviewer’s Comments
The authors note that their series may have had a higher frequency of occult malignancy detected than prior studies due to their exclusion of outpatients and patients presenting to the emergency department as well as their exclusion of patients aged <40 years. Author: Vineet R. Jain, MD

Reference:
Bierry G, Holl N, et al. Venous Thromboembolism and Occult Malignancy: Simultaneous Detection During Pulmonary CT Angiography With CT Venography. AJR; 2008; 191 (September): 885-889

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