Detection Of Pulmonary Lesions Research Articles

Clinical characteristics and prognosis of laryngeal tuberculosis combined with respiratory tuberculosis

PurposeTo investigate the clinical characteristics, diagnosis and prognosis of patients with laryngeal tuberculosis (LTB) combined with respiratory tuberculosis. Materials and methodsA retrospective analysis was conducted on 134 patients who underwent endoscopy and were eventually diagnosed with LTB. The patients' demographic characteristics, clinical manifestations, endoscopic features, auxiliary examination, imaging examination and prognostic characteristics were analyzed. ResultsLTB patients had a median age of 45.5 years (range from 12 to 87 years) and a median course of 3.0 months (range from 0.1 to 72 months). The patients' symptoms mainly presented as hoarseness (97.0 %), abnormal sensation of pharyngeal (49.3 %), cough and sputum (41.0 %), pharyngalgia (39.6 %), dysphagia (10.4 %) and dyspnea (8.2 %). The positive rate of tuberculous symptoms was 25.4 %. Endoscopic features showed that the lesions mainly involved the glottis (87.3 %), presenting as unilateral lesions (66.7 %), near-full-length involvement (88.0 %), with mucosal waves significantly reduced (86.3 %), followed by supraglottis (43.3 %), subglottis (24.6 %) and the pharynx (15.7 %). The lesions may present as granulomatous proliferation (66.4 %), ulceration (65.7 %) or swelling and exudation (51.5 %). A total of 75 patients (56.0 %) were finally diagnosed with combined pulmonary tuberculosis (PTB), with a positive chest X-ray rate of 25.6 % and a positive chest CT rate of 71.2 %. A total of 42 patients who received anti-tuberculosis treatment were followed up, and 73.8 % of patients had significant improvement in symptoms. The morphology of the pharyngeal and laryngeal mucosa returned to basically normal (59.4 %) or scar-like (34.4 %). ConclusionsLTB is usually found in middle-aged men, and patients' symptoms are mainly hoarseness, abnormal sensation of pharyngeal, pharyngalgia, cough and sputum, and can be combined with tuberculous symptoms. These lesions mainly involve multiple subregions, mainly in the glottis, and can be combined with pharyngeal involvement. There were various types of lesions. Half of the patients were complicated with PTB, and chest CT was superior to X-ray in the detection of pulmonary lesions. After regular anti-tuberculosis treatment, the symptoms and morphology of the pharyngeal and laryngeal mucosa of most patients were significantly improved.

Leveraging Deep Learning Decision-Support System in Specialized Oncology Center: A Multi-Reader Retrospective Study on Detection of Pulmonary Lesions in Chest X-ray Images.

Chest X-ray (CXR) is considered to be the most widely used modality for detecting and monitoring various thoracic findings, including lung carcinoma and other pulmonary lesions. However, X-ray imaging shows particular limitations when detecting primary and secondary tumors and is prone to reading errors due to limited resolution and disagreement between radiologists. To address these issues, we developed a deep-learning-based automatic detection algorithm (DLAD) to automatically detect and localize suspicious lesions on CXRs. Five radiologists were invited to retrospectively evaluate 300 CXR images from a specialized oncology center, and the performance of individual radiologists was subsequently compared with that of DLAD. The proposed DLAD achieved significantly higher sensitivity (0.910 (0.854-0.966)) than that of all assessed radiologists (RAD 10.290 (0.201-0.379), p < 0.001, RAD 20.450 (0.352-0.548), p < 0.001, RAD 30.670 (0.578-0.762), p < 0.001, RAD 40.810 (0.733-0.887), p = 0.025, RAD 50.700 (0.610-0.790), p < 0.001). The DLAD specificity (0.775 (0.717-0.833)) was significantly lower than for all assessed radiologists (RAD 11.000 (0.984-1.000), p < 0.001, RAD 20.970 (0.946-1.000), p < 0.001, RAD 30.980 (0.961-1.000), p < 0.001, RAD 40.975 (0.953-0.997), p < 0.001, RAD 50.995 (0.985-1.000), p < 0.001). The study results demonstrate that the proposed DLAD could be utilized as a decision-support system to reduce radiologists' false negative rate.

Video-assisted thoracoscopic surgery for primary pulmonary cryptococcosis

The surgical outcome for primary pulmonary cryptococcosis remains unclear. In this study, we investigated the clinical characteristics, treatment, and outcomes of video-assisted thoracoscopic surgery (VATS) for primary pulmonary cryptococcosis. We retrospectively reviewed the medical records of 49 patients with confirmed pulmonary cryptococcosis who underwent VATS for pulmonary nodules at the National Taiwan University Hospital between May 2013 and March 2019. Serum cryptococcal antigen (CryAg)-positive and CryAg-negative patients were compared. The diagnosis of pulmonary cryptococcosis was confirmed using histopathology or tissue swab culture. The mean age of the patients was 56.0±12.2 years, and 27 patients (55.1%) were male. Most patients were asymptomatic (67.3%) and admitted following the detection of pulmonary lesions on a computed tomography scan of the chest. A greater proportion of patients in the CryAg-positive group (62.5%) underwent lobectomy compared with those in the CryAg-negative group (7.3%, P<0.001). Three patients (6.1%) had neurological symptoms (headache or dizziness) and all were serum CryAg-positive. One patient with Cryptococcus gattii developed fluctuating serum CryAg titers after a 12-month antifungal treatment. No relapse occurred in the remaining 48 patients, irrespective of postoperative antifungal treatment. In patients with primary pulmonary cryptococcosis, serum CryAg detection rate is low, and VATS was an effective and safe diagnostic and therapeutic tool.

Detection of lung lesions in breath-hold VIBE and free-breathing Spiral VIBE MRI compared to CT

BackgroundDetection of pulmonary nodules in MRI requires fast imaging strategies without respiratory motion impairment, such as single-breath-hold Cartesian VIBE. As patients with pulmonary diseases have limited breath-hold capacities, this study investigates the clinical feasibility of non-Cartesian Spiral VIBE under free-breathing compared to CT as the gold standard.MethodsProspective analysis of 27 oncological patients examined in PET/CT and PET/MR. A novel motion-robust 3D ultrashort-echo-time (UTE) MR sequence was evaluated in comparison with CT and conventional breath-hold MR. CT scans were performed under breath-hold in end-expiratory and end-inspiratory position (CT ex, CT in). MR data was acquired with non-contrast-enhanced breath-hold Cartesian VIBE followed by a free-breathing 3D UTE Spiral VIBE. Impact of respiratory motion on pulmonary evaluation was investigated by two readers in Cartesian VIBE, followed by UTE Spiral VIBE and CT ex and the reference standard of CT in. Diagnostic accuracy was calculated, and visual image quality assessed.ResultsHigher detection rate and sensitivity of pulmonary nodules in free-breathing UTE Spiral VIBE in comparison with breath-hold Cartesian VIBE were found for lesions > 10 mm (UTE Spiral VIBE/VIBE/CT ex): 93%/54%/100%; Lesions 5–10 mm: 67%/25%/ 92%; Lesions < 5 mm: 11%/11%/78%. Lobe-based analysis revealed sensitivities and specificities of 64%/96%/41% and 96%/93%/100% for UTE Spiral VIBE/VIBE/CT ex.ConclusionFree-breathing UTE Spiral VIBE indicates higher sensitivity for detection of pulmonary nodules than breath-hold Cartesian VIBE and is a promising but time-consuming approach. However, sensitivity and specificity of inspiratory CT remain superior in comparison and should be preferred for detection of pulmonary lesions.

Congenital Lesions of the Lung

1. Clinicians can provide better care for patients with congenital lung abnormalities when they understand the developmental sequence and different types of abnormalities. 2. Knowing the appropriate antenatal and postnatal imaging strategies for congenital lung abnormalities will optimize diagnosis and guide treatment. After completing this article, readers should be able to: 1. Understand the developmental sequence of congenital lung abnormalities (CLA). 2. Distinguish the different types of CLA. 3. Identify the antenatal and postnatal imaging to optimize the diagnosis of CLA. 4. Know the treatment strategies for CLA. Congenital lung abnormalities (CLAs), also termed bronchopulmonary malformation (BPM), are increasingly identified in the perinatal setting. The use of ultrasonography with improved resolution for antenatal screening, along with supplementary fetal magnetic resonance imaging (MRI) has increased the detection of pulmonary lesions. The estimated incidence is 1 in 2,000 to 1 in 2,500 live births. A large percentage of these will remain asymptomatic in the neonatal period and later. An understanding of the pathophysiology and timing of the development of these lesions is essential in the diagnosis and treatment of these infants. CLAs are likely to represent a spectrum of developmental miscues, along with tracheobronchial obstruction, that result in the downstream formation of these lesions. (1) Lung development occurs through 5 distinct stages as follows: Embryonic (4–7 weeks): Lung buds develop off the primitive foregut. Lobar branching occurs along with vascular inflow and outflow development. Pseudoglandular (7–17 weeks): The tracheobronchial tree grows and branches, ultimately forming 20 generations of airways. Vascular ingrowth matches the tracheobronchial tree to the preacinar level and achieves a mature configuration. Arteries follow airway branching with the veins located in the adjacent connective tissue. Cannicular (16–23 weeks): Terminal branching of the bronchial tree occurs, forming respiratory bronchioles and initiating the formation of air-blood interface along with the differentiation of type 1 and 2 pneumocytes. Type …

Digital tomosynthesis for aortic arch calcification evaluation: performance comparison with chest radiography with CT as the reference standard

Recently developed digital tomosynthesis has shown improved detection of pulmonary lesions with a radiation dose comparable to conventional CR but with a much lower radiation dose than CT. To compare the diagnostic performance of digital tomosynthesis (DT) with that of chest radiography (CR) for the detection of aortic arch calcification (AAC). The study included 100 patients who underwent multidetector computed tomography (MDCT), DT, and CR (DT and CR were obtained within one week of CT examination). We evaluated and compared the diagnostic performances of DT and CR for the detection of AAC with MDCT as the reference standard. The extent (four grades 0-3) of AAC on DT and CR was also compared with CT calcium score. Inter-observer agreement was analyzed by using kappa statistics. On DT, overall accuracy for AAC was superior to that of CR (94% and 71%, respectively, P < 0.01). Inter-observer agreement was good with DT and CR (kappa values = 0.74 and 0.62, respectively) for the presence of AAC, and good with DT and moderate with CR (kappa value = 0.64 and 0.53, respectively) for AAC grading. The overall correlation coefficient on AAC grading between DT and CT (calcium score) was superior to that between CR and CT (0.90 and 0.60, respectively). DT is superior to CR for detection and extent evaluation of AAC.

18F-FDG PET/CT and respiratory synchronization: effect in the detection and classification of pulmonary lesions

Respiratory movement reduces sensitivity in the detection of pulmonary lesions. This disadvantage can be reduced with synchronized acquisition of PET with respiratory movement (4D). Our objective was to assess the effect of 4D PET/CT in the metabolic activity of 18F FDG and the final classification of pulmonary lesions. Material and Methods 12 patients with 18 pulmonary lesions whose sizes were within 0.8-4 cm were assessed. Maximum SUV was obtained in the image acquired under standard conditions (3D) and that obtained in the respiratory period with higher metabolic activity in 4D images. The percentage of difference between both values was calculated. Furthermore, changes in classification of pulmonary nodes (benign or malignant) obtained from the assessment of 4D and 3D PET images were evaluated. Results 17/18 pulmonary lesions showed an increase in the SUV max value in the 4D in regards to 3D image. Five lesions showed SUV max values > 2.5 in 4D image and <2.5 in 3D image. Of these, 3 were correctly classified as malignant with 4D, although the number of false positives increased to 2. Conclusion 18F-FDG 4D PET/CT shows values of metabolic activity that are more in accordance with the correct classification of malignant lesions, thus reducing the false negatives although the false positives increase.

18F-FDG PET-TAC y sincronización respiratoria: efecto en la detección y catalogación de lesiones pulmonares

The respiratory movement reduces the sensitivity in the detection of pulmonary lesions. The synchroniced acquisition of PET with respiratory movement (4D) can reduce this inconvenient. Our objective was assess the effect of 4D PET-CT in the metabolic activity of 18F FDG and final classification of pulmonary lesions. Material and methods 12 patients with 18 pulmonary lesions with sizes within 0.8–4 cm were assessed. The maximum SUV was obtained in the imaging acquired in standard conditions (3D) and the obtained in the respiratory period with higher metabolic activity in 4D images. The difference of percentage between both values was calculated. Moreover were evaluated the changes of the classification of pulmonary nodes (benign or malignant) obtained from the assessment of 4D and 3D PET images. Results 17/18 pulmonary lesions showed an increase in the SUV max value in the 4D with respect to 3D image. 5 lesions showed SUV max values >2.5 in 4D image and <2.5 in 3D image. From these 3 were correctly catalogued as malignant with 4D although the number of false positive increased to 2. Conclusion 18F-FDG 4D PET-CT shows values of metabolic activity more realistic allowing the correct classification reducing the false negative although increasing the false positive.

Radiological diagnosis of small pulmonary nodules detected on low‐dose screening computed tomography

Early detection and treatment of small malignant pulmonary lesions can improve survival; however, screening by CT detects many false positives. This study retrospectively evaluated a protocol for the diagnostic work-up of nodules detected by low-dose CT (LDCT) that are < or = 10 mm in diameter. A health screening programme included LDCT. Lesions detected were allocated to one of four categories: negative, semi-negative, positive and semi-positive. Positive and semi-positive categories included non-calcified nodules without a polygonal shape, and these patients had an initial diagnostic HRCT and were then followed up using high-resolution CT (HRCT) at intervals determined by the characteristics of the lesion on screening LDCT and the initial diagnostic HRCT. There were 275 nodules detected on screening LDCT; 84 patients had lesions classified as positive and 99 as semi-positive. Thirteen nodules detected on screening LDCT were only determined to be polygonal and benign following the diagnostic HRCT. The sensitivity and specificity of the screening CT, when compared with diagnostic HRCT, for determining if nodules should be classified as positive were 100% and 97%. The sensitivity and specificity of the initial diagnostic HRCT for being able to predict lung cancer were 87.5% and 91.7% respectively. Following the detection of a pulmonary lesion on screening LDCT, a diagnostic HRCT is necessary to determine the timing of follow-up HRCT. Diagnostic HRCT is needed to rationalize the screening for lung cancer to reduce the frequency of unnecessary follow-up scans.

Mediastinal abnormalities: detection with storage phosphor digital radiography.

Conventional film radiography (FR) and six postprocessing algorithms of isodose storage phosphor digital radiography (SR) (0.2-mm X 10-bit pixel matrix) were compared in the evaluation of 40 mediastinal and 30 pulmonary lesions in 60 patients who underwent computed tomography of the chest. The six SR algorithms varied among each other in only one image parameter. One algorithm approximated conventional image characteristics. The other five algorithms were designed to optimize imaging of the mediastinum and tested the effects of gray-scale reversal, adjustment of optical density, a linear instead of a sigmoid gradation curve, and moderate edge enhancement of high and medium spatial frequencies. Performance was evaluated by calculating the average area under the receiver operating characteristic curve (Az) of 5,040 observations by six readers. Post-processing with high-frequency edge enhancement and density optimization for the mediastinum significantly improved performance of SR over FR in the detection of mediastinal lesions (Az = .80 +/- .02 vs .73 +/- .01, respectively). Gray-scale reversal significantly decreased performance (Az = .64 +/- .03). All SR algorithms that were postprocessed to optimize imaging of the mediastinum were significantly inferior to FR in the detection of pulmonary lesions.

Detection of pulmonary lesions in patients with congenital and acquired heart disease by wedge pulmonary arteriography

Summary The WPA provides a clinical method for detecting pathologic lesions of the small pulmonary arteries in patients with congenital or acquired heart disease. Abrupt narrowing in the caliber of 300 to 900 micra arteries is the characteristic finding in patients with severe occlusive disease of the small pulmonary arteries, as is seen in late-stage large ventricular septal defect and functionally related cardiac defects. Decreased arborization and background filling are seen in proportion to the increase in pulmonary vascular resistance in mitral stenosis. In atrial septal defect abundant arborization and background filling are found in proportion to the magnitude of the pulmonary flow.

Simple bronchial erosion as cause of pulmonary hemorrhage.

Prior to the use of bronchoscopy and roentgenoscopy in detection of pulmonary lesions, coughing of blood was almost always attributed to pulmonary tuberculosis. With increased employment of indirect visualization of pulmonary structures by roentgenoscopy and direct inspection of the tracheobronchial tree by bronchoscopy, many other causes have been found to be responsible for bleeding from the respiratory tract. The majority of lesions that cause bleeding from the tracheobronchial tree are well known and are usually easily identified when the circulatory and respiratory tracts are carefully examined. I shall neither attempt to enumerate the more frequent causes of pulmonary hemorrhage nor suggest methods in differential diagnosis but shall confine this report to discussion of a type of bleeding, the etiology and treatment of which are apparently not well understood. Many references are found in medical literature to conditions such as dry bronchiectasis, hemorrhagic bronchiectasis, idiopathic. pulmonary hemorrhage, Osler's disease, hemangioma of