Whole-body computed tomography as first-line imaging procedure to exclude cancer in patients with neurological suspicion of paraneoplastic syndromes: shall clinical practice adhere to recommendations?

• Published in: Radiography (London, England. 1995) England. 1995), 2023-01, Vol.29 (1), p.8-13
• Main Authors: Parillo, M., Quattrocchi, C.C., Pilato, F., Di Lazzaro, V., Beomonte Zobel, B.
• Format: Article
• Language: English
• Subjects: Appropriateness; Cancer screening; Female; Full-body computed tomography; Humans; Lung Neoplasms; Male; Paraneoplastic neurological syndrome; Paraneoplastic Syndromes - diagnostic imaging; Paraneoplastic Syndromes, Nervous System - diagnostic imaging; PNS; Retrospective Studies; Tomography, X-Ray Computed; WB-CT
• ISSN: 1078-8174; 1532-2831
• DOI: 10.1016/j.radi.2022.09.001

To assess the efficacy of whole-body computed tomography (WB-CT) as imaging procedure to exclude cancer in patients with neurological symptoms and signs at clinical onset. A retrospective observational study was designed to identify consecutive WB-CT requested by the Neurology Unit with a suspicion of an underlying tumor potentially linked to a paraneoplastic neurological syndrome (PNS) between January 2019 and February 2022. The following data were collected: diagnosis at admission and at discharge, the presence of onconeural antibodies, the scans dose length product (DLP), the estimated effective dose (ED), the total estimated time requested; the PNS-Care-Score was retrospectively calculated only in subjects with available antibodies. The total number of patients included was 158. In 13/158 (positive group) a malignant or locally aggressive neoplasm was found while in 145/158 no malignant lesions were found on the WB-CT. Among the positive group, in 7/13 onconeural antibodies were diagnosed, resulting negative in all cases and the most frequent tumor was lung cancer (30.8%). PNS-Care-Score was of 6–7 in 2/7 (probable PNS) and in no case the PNS-Care-Score was ≥8 (definite PNS). The mean DLP for all the scans was 2798 ± 952 mGy cm (average estimated ED of 42 ± 14 mSv). The total estimated time requested for all scans was 11,060 min. If a PNS is suspected, we encourage the prescription of unenhanced chest CT and/or abdomen/testis/female pelvis ultrasound and/or mammography based on clinical picture. The WB-CT using a single portal phase would be appropriate as a second-line technique while magnetic resonance imaging might be indicated for the exclusion of nervous system diseases. Our suggestion results in saving in terms of radiation exposure, financial resources and time.