Yield of Preoperative Whole-body CT in Patients Presenting with Single Brain Malignancy:: Experience at a Tertiary-care Center
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Published on: December 19, 2017
Huan Dong1, Mougnyan Cox1, Santosh Selvarajan1
1Thomas Jefferson University Hospitals, 132 South 10th Street, 1087 Main Building, Philadelphia, PA 19107.
Rationale And Objectives:
Single brain malignancy (SBM) often poses a diagnostic dilemma, with differential diagnosis of primary brain malignancy (PBM) versus metastasis commonly rendered. This study assesses the yield of preoperative computed tomography (CT) of the chest, abdomen, and pelvis (CTCAP) in patients with SBM.
Materials And Methods:
Institutional review board (IRB)-approved retrospective review of the imaging database at a tertiary-care center was performed for patients with magnetic resonance findings compatible with a diagnosis of SBM. Demographic information, lesion characteristics (location and size), and pathology were recorded. Findings of CTCAP for metastatic workup prior to SBM excisional biopsy were also documented, if performed.
Results:
Eighty-six of 92 patients with new diagnosis of SBM on MR imaging had subsequent lesion resection and pathology consistent with malignancy. PBM accounted for 51 cases (59%) and metastasis accounted for 35 cases (41%). When stratified by age group, PBM was more common in patients <50 years old (15 of 18 (83%)), whereas similar rates of PBM and metastatic disease were identified in older patients. When stratified by lesion size, PBM was more common in tumors ≥40 mm (25 of 31 (81%)), whereas similar rates of PBM and metastatic disease were identified in smaller lesions. Lung cancer was the most common CTCAP and pathology-confirmed source of metastatic SBM (68% and 66%, respectively).
Conclusions:
The yield of preoperative CTCAP can be increased by targeting patients older than 50 years of age with SBMs smaller than 40 mm in size.
