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.