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Accuracy of CT for the Detection of Pleural Adhesions^*

Correlation With Video-Assisted Thoracoscopic Surgery

^* From the Department of Radiology (Dr. Mason), St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Radiology (Drs. Miller and White), and the Division of Thoracic and Cardiovascular Surgery (Dr. Krasna), University of Maryland School of Medicine, Baltimore, MD.

Study objective: The presence of pleural adhesions may render video-assisted thoracoscopic surgery (VATS) difficult or impossible. The aim of this study was to assess the value of chest CT in the detection of pleural adhesions prior to VATS.

Design: Prospective study of the accuracy of chest CT in detecting pleural adhesions prior to VATS.

Setting: Tertiary-referral teaching hospital and Veterans Administration hospital.

Patients: Between July 1994 and March 1995, 63 consecutive patients undergoing 64 VATS procedures were evaluated with chest CT prior to surgery.

Measurements and results: Preoperative scans were interpreted by consensus of two pulmonary radiologists prior to surgery. Suspected pleural adhesions and other findings related to the pleura were recorded on a form given to the surgeon prior to VATS. The surgeon confirmed or excluded each suspected adhesion during VATS, and documented any other lesions not identified preoperatively. Patient-by-patient and lesion-by-lesion analyses were performed. Pleural adhesions were correctly identified by CT in 28 of 39 cases (sensitivity, 71%) and excluded in 18 of 25 cases (specificity, 72%). On a lesion-by-lesion basis, 73 adhesions were identified during VATS, of which only 28 were identified prospectively at CT. There were 45 missed adhesions and 20 adhesions that were suggested falsely (sensitivity, 38%; specificity, 46%). Eighteen pleural spaces were correctly identified as being free of pleural adhesions.

Conclusions: CT is moderately sensitive and specific for preoperative identification of pleural adhesions in patients undergoing VATS but its accuracy is poorer for individual lesions.

Key Words: CT • pleural adhesions • video-assisted thoracoscopic surgery

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