CT Chest Without and With IV Contrast There is no relevant literature regarding the specific use of CT chest without and with IV contrast in the evaluation of pulmonary metastasis from malignant or aggressive primary musculoskeletal tumors. However, IV contrast may lead to equivocal assessment of mineralization which can be a useful morphologic feature to distinguish benign versus malignant pulmonary nodules. Therefore, CT chest with IV contrast is not generally useful as the sole imaging technique, and there is felt to be little additional benefit in the CT assessment of pulmonary nodules without and with IV contrast compared to CT chest without IV contrast in this setting. CT Chest Without IV Contrast CT chest is the most sensitive imaging modality for the detection of pulmonary metastases. CT imaging for lung metastases has been criticized by some as being too sensitive. Several studies have attempted to find size and morphologic criteria to help discriminate between malignant and benign pulmonary nodules [9,12]. Rissing et al [55] showed that those only with pulmonary lesions <5 mm were associated with equivalent survival to those with normal scans. Often when a pulmonary metastasis is identified on a different imaging modality, CT is then required for biopsy or treatment planning. Guidance varies regarding whether to use CT chest versus chest radiography as surveillance for lung metastases in patients with sarcoma. Much of the debate also takes cost-analysis and radiation exposure into consideration. A retrospective study by Cho et al [56] of 176 patients with stage II or stage III high-grade extremity sarcomas calculated similar 5-year survival rates whether surveilled with chest radiography or CT chest. However, when stratifying survival rates by stage, they found a survival benefit for stage III patients when monitored with CT chest likely related to the increased rates of lung metastasis with high-grade sarcoma.
Malignant or Aggressive Primary Musculoskeletal Tumor Staging And Surveillance PCAs. CT Chest Without and With IV Contrast There is no relevant literature regarding the specific use of CT chest without and with IV contrast in the evaluation of pulmonary metastasis from malignant or aggressive primary musculoskeletal tumors. However, IV contrast may lead to equivocal assessment of mineralization which can be a useful morphologic feature to distinguish benign versus malignant pulmonary nodules. Therefore, CT chest with IV contrast is not generally useful as the sole imaging technique, and there is felt to be little additional benefit in the CT assessment of pulmonary nodules without and with IV contrast compared to CT chest without IV contrast in this setting. CT Chest Without IV Contrast CT chest is the most sensitive imaging modality for the detection of pulmonary metastases. CT imaging for lung metastases has been criticized by some as being too sensitive. Several studies have attempted to find size and morphologic criteria to help discriminate between malignant and benign pulmonary nodules [9,12]. Rissing et al [55] showed that those only with pulmonary lesions <5 mm were associated with equivalent survival to those with normal scans. Often when a pulmonary metastasis is identified on a different imaging modality, CT is then required for biopsy or treatment planning. Guidance varies regarding whether to use CT chest versus chest radiography as surveillance for lung metastases in patients with sarcoma. Much of the debate also takes cost-analysis and radiation exposure into consideration. A retrospective study by Cho et al [56] of 176 patients with stage II or stage III high-grade extremity sarcomas calculated similar 5-year survival rates whether surveilled with chest radiography or CT chest. However, when stratifying survival rates by stage, they found a survival benefit for stage III patients when monitored with CT chest likely related to the increased rates of lung metastasis with high-grade sarcoma.