Thoracic computed tomography in patients with suspected malignant pleural effusions

AIM: To assess the role of contrast-enhanced computed tomography (CT) prosp ectively in patients with suspected malignant pleural effusions. MATERIALS AND METHODS: Forty consecutive patients referred for the investig ation of a suspected malignant pleural effusion had contrast-enhanced thora cic CT, thoracoscopy, thoracotentesis and pleural biopsy, either percutaneo usly or at thoracoscopy, Final diagnoses were based on histopathological or cytological analysis (n = 30), autopsy findings (n = 3) or clinical follow -up (n = 7). The pleural surfaces were classified at contrast-enhanced CT a s normal or abnormal and, if abnormal, as benign or malignant in appearance using previously established CT criteria for malignant pleural thickening by two observers unaware of the pathological diagnosis, RESULTS: Pleural effusions were malignant in 32 patients and benign in eigh t patients. Pleural surfaces assessed at CT showed features of malignancy i n 27 of the 32 patients with a malignant effusion (sensitivity 84%, specifi city 100%), Overall, CT appearances indicated the presence of malignancy in 28 of 32 (87%) patients. All eight patients with benign pleural disease we re correctly diagnosed by CT. CONCLUSION: Contrast-enhanced CT is of value in patients with suspected mal ignant pleural effusions, The previously established criteria for malignant pleural thickening of nodularity, irregularity and pleural thickness >1cm are reliable in the presence of a pleural effusion. (C) 2001 The Royal Coll ege of Radiologists.