The search for pulmonary metastases in pediatric patients: CT vs. conventional radiology

The radiologic literature has suggested that computed tomography is the method of choice for diagnosing pulmonary metastases. In an effort to examine this commonly accepted hypothesis, a retrospective study was done on all patients seen at the Children's Hospital of Philadelphia with soft tissue (excluding Wilms and osseous tumors who had CT scan during their treatment. In quantitative terms, the CT scan showed more lesions than plain radiographs in 66% of the cases studied, but the results also show that in most instances, evaluation of the CT scan did not often yield conclusions not already drawn from the conventional radiographs. Most often, its greatest use was to confirm the conclusions already reached from the plain films. Similar findings have been noted by other authors. CT has proved useful for guidance during skinny-needle biopsy. As previously reported by others, our biopsy results show a high correlation in the pediatric patient, between CT demonstrated lesions and biopsy proved metastases, rather than other unsuspected benign causes. We shall present our data, illustrative examples, and our conclusions.