Chest CT Scan Images Research Articles

Combination of free-breathing radial 3D fat-suppressed T1-weighted gradient-echo sequence with diffusion weighted images: Potential for differentiating malignant from benign peripheral solid pulmonary masses

ObjectivesHigh resolution CT is the most commonly used radiological method for differentiating benign from malignant peripheral solid pulmonary masses, however, some of them are not easily diagnosed by morphology alone. Furthermore, due to the radiation dose, it is unsuitable for patients with disorders requiring repeated examinations over prolonged periods. The aims of this study were to evaluate whether a combination of diffusion-weighted images (DWI) and free-breathing radial 3D fat-suppressed T1-weighted gradient echo (radial volumetric interpolated breath-hold examination, radial VIBE) sequence can enable discrimination between benign from malignant peripheral solid pulmonary masses. Materials and methodsBoth chest CT scan and MR imaging with radial VIBE and DWI were obtained from 47 patients; 30 males and 17 females (mean age 64 years old; age range 48–83 years old). Benign and malignant peripheral solid pulmonary masses were conclusively identified by pathology results. Two radiologists independently reviewed all the images and record radiological features including morphological signs on radial VIBE, CT images, and ADC value. Receiver operating characteristic (ROC) was used to analyze the capability of radial VIBE as well as DWI to distinguish malignant from benign peripheral solid pulmonary masses. ResultsIn 77% of patients, malignant peripheral solid pulmonary masses were found. Morphological signs of mediastinal lymph node enlargement and lobulation were more easily found in malignant masses in both radial VIBE (mediastinal lymph node enlargement: p = 0.033, lobulation: p = 0.039) and CT (mediastinal lymph node enlargement: p = 0.004, lobulation: p = 0.012). The ADC value were also significant difference between benign and malignant groups (p = 0.001). Combined ADC value with radial VIBE was a most specific test than routine-dose CT (86.1% vs 75%, p < 0.001), but less sensitive than routine-dose CT (81.8% vs 90.9%; p < 0.001) for malignant peripheral solid pulmonary masses detection. Diagnostic accuracy was 89% for combining ADC value with radial VIBE, and 85% for routine-dose CT. ConclusionsCombination of morphological signs and ADC value seems to improve differentiating malignant from benign peripheral solid pulmonary masses. Especially in patients unable to endure radiation exposure, suspend respiration, radial VIBE provides similar morphological signs displaying to those on routine-dose CT.

Does Adenovirus and Coxsackie B Virus Infection Play a Role in Tracheobronchopathia Osteochondroplastica (TO).

Background: Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease. We report a case of TO. Methods: Chest CT scan and bronchoscope with biopsy was performed for diagnosis and blood tests explored for the latent etiology. Results: Chest CT scan and bronchoscopic images showed multiple nodular protrusions in the trachea and main bronchi. Histopathology demonstrated sub-mucosal ossification and inflammatory cell infiltration. Laboratory inspection showed adenovirus and coxsackie B virus IgM antibodies were positive. Conclusions: The patient recently had a virus infection and inflammation was observed in histopathology, which indicated adenovirus and coxsackie B virus may play a role in the occurrence or exacerbation of TO.

Clinical Characteristics of Myeloperoxidase Antineutrophil Cytoplasmic Antibody-Positive Interstitial Pneumonia

SESSION TITLE: Connective Tissue-Associated Interstitial Lung Disease SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: The aim of this study is to assess the clinical characteristics and outcomes of patients with MPO-ANCA positive interstitial pneumonia (IP). METHODS: We have conducted a retrospective study of 41 patients (20 males and 21 females ; mean age, 73.0 years) with MPO-ANCA positive IP admitted to our hospital between January 2004 and December 2014. 41 patients were classified into IP with systemic involvement of vasculitis (IP associated with microscopic polyangiitis : MPA-IP) and without other organ involvement (pulmonary limited vasculitis : PLV). The clinical features, chest CT scan images, laboratory findings, pulmonary function tests, and survival between these two groups were compared. RESULTS: Among 41 patients with MPO-ANCA positive IP, 28 were MPA-IP and 13 were PLV. Median follow-up period was 31 months. Among 28 patients with MPA-IP, 9 had no other organ involvement and diagnosed as PLV or idiopathic IP at the time of diagnosis, and renal involvement appeared and developing MPA 26.0 ± 22.8 months later. The HRCT pattern of IP were UIP in 22 patients, possible UIP in 13 and inconsistent with UIP in 6. 36 patients (28 MPA-IP and 8 PLV) were treated as MPA (corticosteroid with/or without immunosuppressant), whereas 5 patients (all PLV) were treated as idiopathic IP (N-acetylcysteine, pirfenidone, or corticosteroid). The mortality was 46.4 % in MPA-IP and 28.6 % in PLV. The cause of death in MPA-IP/PLV were infection in 7/1, diffuse alveolar hemorrhage in 4/0, acute exacerbation of IP in 1/2, heart failure in 1/0, and lung cancer in 0/1. As for pulmonary function tests, %FVC was significantly higher in PLV. There were no differences in laboratory findings, and survival (median survival time; 73.0 months vs. not reached) between patients with MPA-IP and PLV. CONCLUSIONS: The prognosis of PLV was as worse as MPA-IP. Further study is needed to clarify clinical characteristics of PLV. CLINICAL IMPLICATIONS: PLV or idiopathic IP can develop MPA-IP. The prognosis of PLV is worse as MPA-IP. DISCLOSURE: The following authors have nothing to disclose: Aika Suzuki, Susumu Sakamoto, Yusuke Usui, Keishi Sugino, Kazutoshi Isobe, Yujiro Takai, Sakae Homma No Product/Research Disclosure Information

Classification of Lung Regions using Morphometrics for Chest CT Scans

Medical diagnosis is extremely important but complicated task that should be performed accurately and efficiently. Disease diagnosis is one of the applications where data mining tools are proving successful results. Chronic obstructive pulmonary disease (also known as COPD) is a condition that makes breathing difficult. Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death worldwide and the only chronic disease with increasing mortality rates. COPD is the name for a group of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. The primary cause of COPD is smoking. Progression of the disease is irreversible but can be stabilized or prevented by quitting. If COPD is detected earlier, the formation of lung cancer is prevented. In CT scan may provide additional information and also it provides more detailed images of parts of the body that cannot easily be seen on a standard chest radiograph. First the input image is pre-processed then the lung region is segmented from that image, segmented the cavity region in that lung region, extracted some features for training the classifier and used the Extreme Learning Machine (ELM) classifier to identify the COPD affected lung. The preprocessing is done by using the median Filtering to avoid the noise in the input image and to increase the image quality. After the lung and cavity segmentation, some parameters are chosen to train the classifier to identify whether an x-ray image is a normal or affected. The ELM Classifier is then trained using the parameters chosen from the sample chest CT scan images to identify the normal lung and tuberculosis affected lung.

FRI0140 The clinical utility of CD64 expression on neutrophil in acute-onset interstitial lung damage complicated in patients with rheumatoid arthritis

BackgroundAcute-onset interstitial lung damage (AILD) is one of the most cumbersome involvements complicated during the therapy for rheumatoid arthritis (RA). Especially, discrimination of the cause developing AILD is very important...

Automatic Segmentation of Connected Thin Peripheral Vessels in Chest CT Scan Images

Vessel enhancement and segmentation is one of the crucial pre-processing steps in accurate vessel tree reconstruction in many chest CT scan imaging applications. Conservative vessel enhancement approaches used eigenvalues of Hessianbased filters, which are found to be sensitive to noise, fails to detect small ones, and sometimes give discontinued vessels due to junction suppression. Since Hessian-based filters cannot distinguish step edges from vessels effectively, in this paper, we propose a novel framework to overcome the problems for vessel enhancement for thorax CT images. The road map of proposed work has three steps. First, extract the lung region from thorax CT images based on Gray-level thresholding and morphological operations; then, according to the idea of the matched filter in different directions, and local entropy thresholding, to obtain more precise analysis in noisy environment and thus can correctly reveal entire vessels. Also, qualitative as well as quantitative evaluations performed on CT images show that the proposed filter generates better performance in comparison against two Hessian-based approaches (Frangi and Shikata)..

A Case of Toxic Multinodular Goiter with Anaplastic Carcinoma

This report concerns a 71-year-old female with long standing untreated toxic multinodular goiter (TMG) coexisting with anaplastic thyroid carcinoma who presented with progressive shortness of breath and easy fatigability. Thyroid function tests showed suppressed TSH and elevated FT4 and FT3. Anti-thyroid hormone drugs were started. Thyrotropin receptor antibody was negative. A thyroid scan revealed both hot and cold nodules and fine needle aspiration biopsy (FNAB) of the thyroid gland showed colloid nodule. Chest CT scan imaging revealed an enlarged thyroid gland with the right lobe compressing the trachea. Patient underwent total thyroidectomy, final histopathology showed Anaplastic thyroid carcinoma. Our case is interesting from a pathophysiologic perspective,since it suggests that TMG can potentially transform into an aggressive form of thyroid carcinoma. High index of suspicion in patients with TMG with other risk factors for malignancy requires careful evaluation to detect cancer.

Aspergillose pulmonaire et infection à VIH : à propos de deux cas

The occurrence of invasive pulmonary aspergillosis is unusual during the course of AIDS. Patients at risk have a CD4 T-lymphocyte count under 50 cells/mm(3) combined with other risk factors in 50% of the cases. Positive diagnosis is based on chest CT scan imaging and isolation of Aspergillus in broncho-alveolar fluid. Detection of galactomannan antigen in serum and broncho-alveolar lavage fluid (BALF) is a reliable complementary tool in assessing the diagnosis. The first line therapy is Voriconazole. The prognosis, often severe, depends on prompt initiation of the appropriate antifungal treatment. We report two cases of invasive pulmonary aspergillosis in AIDS patients.

The optimal oblique angle of fluoroscope for thoracic sympathetic ganglion block

The target in the thoracic sympathetic ganglion block (TSGB) is the anterior edge of the costovertebral articulation along the lateral surface of vertebral bodies T2-4. The present study attempts to determine an optimal safe angle for fluoroscopy in fluoroscope-assisted TSGB through the use of chest CT scan images. Additionally, we seek to determine if differences in these measurements exist in patients with chronic obstructive pulmonary disease (COPD). Chest CT scans from 320 patients were included. The range of angle and entry point distance to midline was measured in all subjects. The range of angle was from the minimum angle to thoracic sympathetic ganglion passing over the lateral aspect of body to the maximum angle to the thoracic sympathetic ganglion not puncturing the pleural space. Additionally, these measurements from 50 COPD patients were subsequently compared age-matched individuals without COPD. No significant difference in optimal angle was found for any of the levels between T2 and T4. The optimal angle was significantly different between right and left sides, although no such difference was identified between genders. The older patients had a significantly smaller optimal angle than the younger. Similarly, individuals with COPD had a significantly smaller optimal angle and entry distance. The measurements derived from this study can be used as a reference for TSGB and radiofrequency lesioning to prevent the complications. Specifically, our data indicate that the optimal oblique angle of fluoroscopy is 18°-19° for non-COPD patients and 16°-17° for COPD patients.

Lymph node dissection with cervical approach as a salvage surgery for locoregional failure after definitive chemoradiotherapy in a patient with recurrent esophageal carcinoma: report of a case

Salvage surgery is one important therapeutic option after locoregional failure of definitive chemoradiotherapy (dCRT) in patients with advanced or recurrent esophageal carcinoma. We have performed cervical lymph node dissection as a salvage surgery after chemoradiotherapy in a patient with recurrent esophageal carcinoma. A 54-year-old Japanese man was admitted to our hospital because of multiple lymph node metastases after endoscopic submucosal dissection (ESD) for early-stage esophageal carcinoma. The patient underwent a circumferential ESD of early-stage esophageal carcinoma in another hospital. The esophageal carcinoma, measuring 75 × 60 mm in size, was a superficial spreading type located in the middle portion of the thoracic esophagus. Histology of the resected specimen revealed a moderately to poorly differentiated squamous cell carcinoma, and the depth of invasion was limited within the mucosal layer associated with a small area being attached to the muscularis mucosae. Five months after ESD, lymph node metastases in the regions of right recurrent nerve and the left tracheobronchus were found, for which dCRT was performed. These metastatic lymph nodes disappeared in the chest CT scan images. Lymph node metastasis in the region of the right recurrent nerve then reappeared 8 months after the completion of CRT. Considering the solitary lymph node metastasis and surgical invasiveness, lymph node dissection using a cervical approach was selected as a salvage surgery. Cervical approach for the lymph node dissection in the region of right recurrent nerve may be one feasible option as a minimally invasive salvage surgery for patients with recurrent esophageal carcinoma after dCRT.