Innovation in Chest Radiology

Abstract

The guest editors of this issue have been very impressed by the great variety and excellent quality of lung imaging research manuscripts submitted for this issue. We were forced to maintain a very high standard within our review process and are sorry to have disappointed many of you, but in spite of this, we still present you with an overloaded special issue with 17 papers devoted to “Innovation in Chest Radiology.” The breadth of the work becomes obvious if one tries to classify the various papers, as we tried (and failed) to do. It demonstrates how the field of chest imaging is increasingly relying on computer applications, quantification, and early identification of disease, while the focus is changing from purely morphologic description to the incorporation of functional assessment using both magnetic resonance imaging (MRI) and computed tomography (CT). Chest radiography has received renewed interest in the ability to detect nodules, particularly with the use of novel computer assisted diagnosis systems. The study by Bley et al is one in a series of studies that demonstrate the potential impact of computer-aided design systems, 1–3 and further studies are eagerly awaited. The excellent spatial resolution and the natural contrast in the lung allowed CT to remain the mainstay in diagnosing chest disease. Detection of lung nodules is an important issue, albeit that even CT, considered by most the reference standard, has its issues, such as interobserver variability when considering size characteristics as well as measurement methods, 4–6 not to mention the costs and additional investigations associated with CT screening for lung cancer. 7 Nevertheless, it seems that growth over time using computeraided volumetry can provide reproducible and accurate measurement of nodule growth. 8,9 In addition, dynamic contrast-enhanced imaging and CT perfusion imaging using a first pass model was demonstrated as potentially useful for the differentiation between benign and malignant nodules. 10 In addition, these dynamic techniques may help outline malignant and recurrent disease, particularly in a post-treatment situation. 11 CT is regarded as a reference imaging modality in the diagnosis of pulmonary vascular diseases in particular acute pulmonary embolism. Optimization of CT scanning parameters and contrast injection protocols are important for this purpose. 12,13 In the assessment and distinction of pulmonary embolism from other causes of altered pulmonary vascularity, the minimum intensity projection technique 14 and 3D selective-scale texture analysis of CT pulmonary angiography 15 were demonstrated to be useful. Recent studies also show that computer-assisted detection of filling defects within the pulmonary arterial tree may also be a method that could aid the radiologist in the detection of pulmonary embolism. 16,17 CT is steadily gaining ground in the objective quantification of pulmonary emphysema. Currently, lung densitometry for the assessment of pulmonary emphysema has been validated against pathology, pulmonary function, and health status and is a highly reproducible measurement. 18,19 A large multicenter study demonstrated that quantitated