Comparison of Radiologic Procedures for Evaluating Pleurodesis Success in Malignant Pleural Effusion

Abstract

Background: Pleurodesis is a widely used treatment for malignant pleural effusion (MPE) to prevent recurrent fluid accumulation and improve patient comfort. Various radiologic modalities are employed to assess the success of pleurodesis, but their comparative effectiveness remains under discussion. Objective: To compare the efficacy of various radiologic procedures in evaluating pleurodesis outcomes, identify the most reliable imaging approach, and provide clinical recommendations to enhance post-procedure monitoring in patients with malignant pleural effusion (MPE). Methodology: A prospective study was conducted on 250 patients with MPE undergoing chemical pleurodesis. Radiologic assessments were performed 48 hours, 7 days, and 30 days post-procedure using CXR, TUS, CT, and PET-CT. Radiologic markers, including pleural thickening, lung expansion, and residual effusion volume, determined pleurodesis's success. The sensitivity and specificity of each imaging modality were analyzed. Results: Pleurodesis success at 30 days was 60% on CXR, 72% on TUS, 76% on CT, and 90% on PET-CT. Sensitivity and specificity were highest for PET-CT (92.1% and 88.3%), followed by CT (85.3%, 80.4%), TUS (80.6%, 75.2%), and CXR (71.4%, 65.7%). Multivariate analysis identified older age (>60 years), lung cancer diagnosis, high pleural drainage (>1200 mL), smoking history, and loculated effusions on CT as independent predictors of pleurodesis failure (p < 0.05). Conclusion: CT and PET-CT provide superior early detection of pleurodesis success compared to conventional CXR and TUS. PET-CT, despite its limited availability, shows the highest predictive accuracy. Incorporating advanced imaging in post-pleurodesis evaluation may enhance patient management and treatment planning.