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Review
. 2023 Jun;8(2):549-556.
doi: 10.1177/23969873231151488. Epub 2023 Jan 23.

Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications - the PLEURA study

Tolga D Dittrich  1   2 , Mara Aujesky  1   2 , Salome Rudin  1   2 , Annaelle Zietz  1   2 , Benjamin Wagner  1   2 , Alexandros Polymeris  1   2 , Valerian L Altersberger  1   2 , Tim Sinnecker  1   2 , Henrik Gensicke  1   2   3 , Stefan T Engelter  1   2   3 , Philippe Lyrer  1   2 , Viviane Hess  2   4 , Raoul Sutter  2   5 , Christian H Nickel  2   6 , Leo H Bonati  1   2   7 , Urs Fischer  1   2 , Marios Psychogios  2   8 , Mira Katan  1   2 , Gian Marco De Marchis  1   2
Affiliations
Review

Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications - the PLEURA study

Tolga D Dittrich et al. Eur Stroke J. 2023 Jun.

Abstract

Background: Computed tomography angiography (CTA) of the supraaortic arteries is commonly used for acute stroke workup and may reveal apical pulmonary lesions (APL).

Aim: To determine the prevalence, follow-up algorithms, and in-hospital outcomes of stroke patients with APL on CTA.

Methods: We retrospectively included consecutive adult patients with ischemic stroke, transient ischemic attack, or intracerebral hemorrhage and available CTA at a tertiary hospital between January 2014 and May 2021. We reviewed all CTA reports for the presence of APL. APL were classified as malignancy suspicious or benign appearing based on radiological-morphological criteria. We performed regression analyses to investigate the impact of malignancy suspicious APL on different in-hospital outcome parameters.

Results: Among 2715 patients, APL on CTA were found in 161 patients (5.9% [95%CI: 5.1-6.9]; 161/2715). Suspicion of malignancy was present in one third of patients with APL (36.0% [95%CI: 29.0-43.7]; 58/161), 42 of whom (72.4% [95%CI: 60.0-82.2]; 42/58) had no history of lung cancer or metastases. When performed, further investigations confirmed primary or secondary pulmonary malignancy in three-quarters (75.0% [95%CI: 50.5-89.8]; 12/16), with two patients (16.7% [95%CI: 4.7-44.8]; 2/12) receiving de novo oncologic therapy. In multivariable regression, the presence of radiologically malignancy suspicious APL was associated with higher NIHSS scores at 24 h (beta = 0.67, 95%CI: 0.28-1.06, p = 0.001) and all-cause in-hospital mortality (aOR = 3.83, 95%CI: 1.29-9.94, p = 0.01).

Conclusions: One in seventeen patients shows APL on CTA, of which one-third is malignancy suspicious. Further work-up confirmed pulmonary malignancy in a substantial number of patients triggering potentially life-saving oncologic therapy.

Keywords: CT angiography; Stroke; cancer; pulmonary lesions.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MP has received funds from Medtronic, Stryker, Penumbra, Phenox, Rapid Medical. He has received speakers honoraria from Stryker, Penumbra, Acandis, Phenox, Medtronic. GMDM received speaker honoraria from Medtronic; he declares no other conflicts of interest related to this work. The remaining authors report no conflicts of interest related to this work.

Figures

Figure 1.
Figure 1.
Flow chart of patient selection. CT: computed tomography. *For each patient with multiple hospitalizations during the study period, the first case with performed CT angiography was included.
See this image and copyright information in PMC

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