<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2021-0014_s_006_w2aab3b7c62b1b6b1aab1c16b1Aa"><h3>Background</h3><p>Critically ill cancer patients have an increased risk of developing acute neurological signs. The study objective was to evaluate the use and the usefulness of emergency head computed tomography (EHCT) in this category of patients.</p></sec><sec id="j_raon-2021-0014_s_007_w2aab3b7c62b1b6b1aab1c16b2Aa"><h3>Patients and methods</h3><p>This retrospective, single-centre, cohort study included patients with EHCT performed during Intensive Care Unit (ICU) admission for a period of three years. Indications, imagistic findings, type of malignancy, and outcome were evaluated to identify diagnostic yield and correlations between abnormal findings on positive scans, malignancy type, and mortality rate.</p></sec><sec id="j_raon-2021-0014_s_008_w2aab3b7c62b1b6b1aab1c16b3Aa"><h3>Results</h3><p>Sixty-four EHCTs were performed in 54 critically ill cancer patients, with 32 scans (50%) showing previously unknown lesions and considered to be positive. The most frequent abnormal findings were ischemic (15 EHCTs, 47%) and haemorrhagic (13 EHCTs, 40%) lesions. Thirty-eight EHCTs (59%) were indicated for altered mental status, with a positivity rate of 50%. Eighteen EHCTs (48%) were performed in hematological malignancy patients: 9 (50%) of which were positive with 8/9 (89%) displaying hemorrhagic lesions. Twenty EHCTs were performed in solid tumour patients, 10 (50%) of which were positive, with 9/10 (90%) displaying ischemic lesions. Out of 54 patients, 30 (55%) died during ICU stay. The mortality rate was higher in patients with hematological malignancies and positive EHCT (78% <italic>vs</italic>. 58%).</p></sec><sec id="j_raon-2021-0014_s_009_w2aab3b7c62b1b6b1aab1c16b4Aa"><h3>Conclusions</h3><p>Diagnostic yield of EHCT in critically ill cancer patients is much higher than in other categories of ICU patients. We support the systematic use of EHCT in critically ill, mainly hemato-oncological patients with nonspecific neurological dysfunction, as it may lead to early identification of intracranial complications.</p></sec></abstract>

BackgroundCritically ill cancer patients have an increased risk of developing acute neurological signs. The study objective was to evaluate the use and the usefulness of emergency head computed tomography (EHCT) in this category of patients.Patients and methodsThis retrospective, single-centre, cohort study included patients with EHCT performed during Intensive Care Unit (ICU) admission for a period of three years. Indications, imagistic findings, type of malignancy, and outcome were evaluated to identify diagnostic yield and correlations between abnormal findings on positive scans, malignancy type, and mortality rate.ResultsSixty-four EHCTs were performed in 54 critically ill cancer patients, with 32 scans (50%) showing previously unknown lesions and considered to be positive. The most frequent abnormal findings were ischemic (15 EHCTs, 47%) and haemorrhagic (13 EHCTs, 40%) lesions. Thirty-eight EHCTs (59%) were indicated for altered mental status, with a positivity rate of 50%. Eighteen EHCTs (48%) were performed in hematological malignancy patients: 9 (50%) of which were positive with 8/9 (89%) displaying hemorrhagic lesions. Twenty EHCTs were performed in solid tumour patients, 10 (50%) of which were positive, with 9/10 (90%) displaying ischemic lesions. Out of 54 patients, 30 (55%) died during ICU stay. The mortality rate was higher in patients with hematological malignancies and positive EHCT (78% vs. 58%).ConclusionsDiagnostic yield of EHCT in critically ill cancer patients is much higher than in other categories of ICU patients. We support the systematic use of EHCT in critically ill, mainly hemato-oncological patients with nonspecific neurological dysfunction, as it may lead to early identification of intracranial complications.

Analysis of emergency head computed tomography in critically ill oncological patients

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

BackgroundCritically ill cancer patients have an increased risk of developing acute neurological signs. The study objective was to evaluate the use and the...

Patients	Total	Solid tumours	Haematological tumours
EHCT+, all	24	15	9
EHCT+, dead (%)	14 (58)	7 (46)	7 (78)
EHCT-, all	30	18	12
EHCT-, dead (%)	16 (53)	9 (50)	7 (58)

Indications for EHCT	(+) EHCT (n = 32)	Ischemic stroke (n = 15)	Haemorrhagic lesions (n = 13)	p value
Altered mental status	19 (59.4)	11 (28.9)	10 (26.3)	0.80
Focal deficits neurological	13 (40.6)	5 (23.8)	6 (28.6)	0.73
Seizures	5 (15.6)	1 (14.3)	1 (14.3)	-
Other	3 (9.4)	1 (6.2)	0 (0.0)	-

Variables	EHCT (n = 64)	(+) EHCT (n = 32)	(-) EHCT (n = 32)	p value
Indications
Altered mental status	38 (59.4)	19 (59.4)	19 (59.4)	1.00
Focal deficits neurological	21 (32.8)	13 (40.6)	8 (25.0)	0.27
Seizures	7 (10.9)	5 (15.6)	2 (6.2)	0.26
Other	16 (25.0)	3 (9.4)	13 (40.6)	< 0.01
Results
Ischemic stroke	15 (23.4)	15 (46.9)
Haemorrhagic lesions	13 (20.3)	13 (40.6)
Cerebral oedema	10 (15.6)	10 (31.2)
Brain metastases	5 (7.8)	5 (15.6)
CNS infiltrates	1 (1.6)	1 (3.1)
Arterio-malformation venous	2 (3.1)	2 (6.2)
Hydrocephalus	1 (1.6)	1 (3.1)
Primary brain tumour	2 (3.1)	2 (6.2)

Patients with AMS	Total	Solid tumours	Haematological
AMS & EHCT+, all	13	6	7
AMS & EHCT+, dead (%)	10 (76)	4 (67)	6 (85)
AMS & EHCT-, all	17	8	9
AMS & EHCT-, dead (%)	12(70)	6 (75)	6 (67)

Variables	Overall (n = 54)	(+) EHCT (n = 24)	(-) EHCT (n = 30)	p value
Age	61 (12.7)	62 (13.2)	60 (12.4)	0.74
Gender
Male	28 (51.9)	16 (67.7)	12 (40.0)	0.05
Female	26 (48.1)	8 (33.3)	18 (60.0)
Malignancy type
Solid tumour	33 (61.1)	15 (62.5)	18 (60.0)	0.85
malignancy Haematological	21 (38.9)	9 (37.5)	12 (40.0)
Outcome
ICU LOS	10.5 (6–14)	8.5 (4–11)	12.5 (7–15)	0.03
Hospital LOS	18 (12–30)	15.5 (10–26)	20.0 (14–34)	0.10
ICU mortality	30 (55.6)	14 (58.3)	16 (53.3)	0.71

Analysis of emergency head computed tomography in critically ill oncological patients

Article Category: Research Article

Published Online: Mar 19, 2021

Page range: 172 - 178

Received: Dec 14, 2020

Accepted: Feb 21, 2021

DOI: https://doi.org/10.2478/raon-2021-0014

© 2021 Cristian Pristavu, Adrian Martin, Anca Irina Ristescu, Emilia Patrascanu, Laura Gavril, Olguta Lungu, Madalin Manole, Daniel Rusu, Ioana Grigoras, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Mortality in patients with positive and negative EHCTs

Distribution of ischemic and haemorrhagic lesions according to EHCTs indications

Characteristics of ECHTs

Mortality in patients with positive and negative EHCTs indicated for AMS

Characteristics of EHCT patients