Thin-section CT Scans Research Articles

Central and Peripheral Airway Sites of Nitric Oxide Gas Exchange in COPD

This study investigated sites of nitric oxide (NO) gas exchange and response to inhaled corticosteroids (ICS) in patients with COPD and varying extents of emphysema. This was a prospective, randomized, single-blind, crossover study in treated, stable, ex-smoking patients with COPD who were ICS and leukotriene receptor antagonists naive. Lung function, high-resolution thin-section CT scan of the lung, and exhaled NO were measured at 50, 100, 150, and 200 mL/s. Airway NO was adjusted for NO axial backdiffusion. In 39 (18 women), clinically stable ex-smokers with COPD aged 73 +/- 9 years (mean +/- SD) on salmeterol 50 microg (S50) bid, after 180 microg aerosolized albuterol, FEV(1) (L) was 52% +/- 12% predicted and FEV(1)/FVC was 55% +/- 6%. Compared with 20 (12 men) age-matched controls, 39 patients with COPD had normal large airway NO flux and small airway/alveolar NO. Subsequently, 19 patients with COPD (Group A) were randomized and continued on S50, and 20 (Group B) were randomized to fluticasone propionate 250 microg (F250)/S50 bid for 86 +/- 16 days. Group A (S50) patients were then switched to F250/S50, and 12 of 19 completed 77 +/- 15 days; there was significant (P < .001) reduction only in the exhaled fraction of NO (FENO) at 50 mL/s and large airway NO flux. In 20 patients with COPD initially randomized to F250/S50 (Group B), after 57 +/- 22 days of S50 in 16 of 20 patients there was a significant (P = .04) increase only in (FENO) at 50 mL/s and large airway NO flux, which was not reduced after 60 +/- 23 days of fluticasone propionate 100 microg (F100)/S50(P = .07). There was no correlation between NO gas exchange and CT-scored emphysema. In COPD, there was normal NO gas exchange in both large and small airways/alveoli and only large airway NO flux was suppressed with F250/S50 but not F100/S50, despite varying extents of emphysema. Peripheral NO must be corrected for axial NO backdiffusion to avoid spurious conclusions. NCT #00568347.

In search of markers of treatment failure and poor prognosis in IPAH - the value of mosaic lung attenuation pattern on thin-section CT scans

Despite the development of specific therapies for pulmonary arterial hypertension (PAH) some patients fail to respond to such treatment. One of the potential reasons for the unresponsiveness to targeted therapies may be the presence of fibrous occlusion of small pulmonary veins that accompanies pre-capillary arteriopathy. This type of pathologic change is called pulmonary veno-occlusive disease (PVOD). Underdiagnosed PVOD occurs probably in 5-10% of idiopathic pulmonary hypertension (IPAH) and in a substantial proportion of PAH related to connective tissue diseases (mainly in scleroderma). A definite diagnosis of PVOD requires histological examination of lung sample, but surgical lung biopsy in pulmonary hypertension is combined with high risk of bleeding. Thus major interest is focused on a non-invasive diagnostic approach enabling early recognition of PVOD and referral for lung transplantation. The present review is focused on the radiological features suggestive of PVOD-like vasculopathy in PAH.

A Comparison between Liquid-Crystal Display Monitors and Cathode-Ray Tube Monitors: A Combined Assessment Study of Observer Performances by Using Storage Phosphor and Flat-Panel-Detector Radiography in Detecting Experimentally Induced Pulmonary Edema in

To compare the observer performance 0f liquid crystal display (LCO) and cathode ray tube (CRT) monitors in detecting experimentally induced pulmonary edema in pigs by using soft-copy images of amorphous selenium-based flat-panel-detector radiography (OR) and storage phosphor computed radiography (CR). Oleic acid was injected intra-atrially into three pigs (weight, 20-25kg) at doses of 0.04, 0.05, and 0.06 ml/kg to induce pulmonary edema. Each set of CR, DR, and thin-section CT scans were obtained every 20-30 minutes from three pigs over 4-6hours. Thus, 37 sets (10 sets from pig-1, 11 sets from pig-2, and 16 sets from pig-3) of radiographs were obtained. Images were masked for identity. randomly sorted, and displayed on both live mega pixel (2048 x 2560 x 8 bits) LCD and CRT monitors. Eight radiologists rated each image for Ihe presence of ill-defined diffuse opacities and reticular-Iinear opacities in both lungs by using continuous rating scale of 0-100. A total of 4736 (37 sets 2 detector system 2 fields 2 lesion types 8 observers 2 monitor systems) observations were analyzed in terms of receiver operating characteristics. Average observer performance in detecting ill defined diffuse opacities, LCO and CRT monitors were not different significantly in both OR and CR images. Average performance in detecting reticular-linear opacities was significantly better with LCD than CRT. These differences were significant in evaluating DR images (AUC=.852±.038 on LCD; AUC=.785±.070 on CRT) but not significant in evaluating CR images (AUC=.795±.060 on LCD; AUC=.745±.070 on CRT) System on both LCO and CRT monitors (p=.042 on LCD; p=.044 on CRT). Moreover. with OR system. observer performance was better with LCD monitor than with CRT monitor (p=.013), whereas with CR system, observer performance was not different significantly on both monitors (p=.11 8). Overall the five-megapixel LCD monitor was equal or superior to CRT monitor of the same pixel size in detecting experimentally induced pulmonary edema. Moreover, the LCD monitor appears, to be more optimized for detecting pulmonary reticular-linear opacity, when interfaced with DR system rather than with CR system.

An asymptomatic young woman with abnormal manubrium sterni: diagnosis and discussion

First developing from a pair of longitudinal mesenchymal condensations in utero, the right and left sternal bars meet along the midline and fuse to form a single cartilaginous rod. Fusion commences at the manubrium and proceeds caudad [1]. Incomplete fusion of lower sternebrae results in well-known bony defects variously named sternal foramen, cleft or fissure [2]. Although clefts and foramina are commonly found in the corpus sterni, description of manubrial fissure or foramen had been sparse [3–5] before the study by Yekeler et al., who reported a manubrial cleft in the sterna of six of 1,000 adults [2]. In all of the six patients the cleft was confined to the superior portion of the bone, associated with a sclerotic band just inferior to it in five of them. To our knowledge, a complete manubrial cleft is extremely rare, with only two cases having been reported in the non-English literature [3, 4]. In one of the two cases, reported in 1979, Botsch et al. used conventional tomography to diagnose complete fissure of the manubrium [4], which showed slightly jagged and sclerotic medial margins of the right and left hemimanubria and an inverted-Y shape, almost identical to that in our patient, formed by the interhemimanubrial and hemimanubriosternal joints (Fig. 1b and c in the case presentation). It is difficult to postulate the developmental origin of a manubrial fissure. However, we suppose that there might be two possible mechanisms: first, on rare occasions, the cephalo-most part of the sternal bar might have been left unfused in utero. Second, there might have been some muscular dynamics facilitating horizontal segmentation of the manubrium at a later stage, similar to diversified movements of the forelimbs facilitating longitudinal segmentation of the sternum [6]. Now that thin-section CT scanning of the bony thorax is becoming routine in clinical practice, we believe that more cases of this condition will be found in the future.

L’ostéogenèse imparfaite, cause rare de surdité chez l’enfant

We report a case of bilateral hearing loss in a child, caused by osteogenesis imperfecta and we evaluate CT scan findings. A 12-year-old child consulted for bilateral hearing loss. A computed tomography scan of the petrous temporal bone showed bilateral extensive unmineralized bone involving the cochleae, vestibules, and semicircular canals extending to the internal auditory canals. Osteogenesis imperfecta of the temporal bone is a genetic connective tissue disorder with increased bone fragility, low bone mass, and other extraskeletal manifestations. Hearing loss is rare in the first 2 decades of life, but it is one of the frequent features of this disorder in adult patients. Thin-section CT scans of the temporal bone show a remarkable proliferation of unmineralized bone involving the otic capsule. This demineralization is similar to that observed in the cochlear form of otospongiosis.

Transbronchial biopsy is clinically useful in classifying patients with interstitial pneumonia associated with polymyositis and dermatomyositis

The histological type of intraluminal fibrosis is an important prognostic factor for interstitial pneumonia. We therefore examined whether transbronchial lung biopsy (TBLB) specimens are useful for predicting the clinical course and prognosis of patients with interstitial pneumonia associated with polymyositis and dermatomyositis (PM/DM), with particular attention to the different types of intraluminal fibrosis. Twenty-five cases of interstitial pneumonia associated with PM/DM were classified according to the pattern of intraluminal fibrosis as assessed by TBLB, and the clinical course and response to treatment were compared. Interstitial fibrosis was evaluated by sequential thin-section CT scans. In 19 of 25 (76%) cases, there was sufficient intraluminal fibrosis to perform an evaluation. Intraluminal fibrosis was classified as bud (polyp) type or mural incorporation type (either alone or mixed with bud type). The bud type was seen in five cases and these improved following treatment with corticosteroids only. The mural incorporation type was seen in 14 cases. In 11 of these 14 cases, progressive long-term fibrosis developed and four cases were fatal, in spite of corticosteroid and immunosuppressive therapy. The response to drugs (P < 0.01) and survival (P < 0.05) were significantly greater in patients with bud-type than mural incorporation-type intraluminal fibrosis. Classification of the pattern of intraluminal fibrosis as assessed by TBLB is useful for predicting the response to treatment, clinical course and prognosis of interstitial pneumonia associated with PM/DM.

Prognostic Significance of Thin-Section CT Scan Findings in Small-Sized Lung Adenocarcinoma

The purpose of this study is to evaluate the prognostic importance of thin-section (TS) CT scan findings in small-sized lung adenocarcinomas. We reviewed TS-CT scan findings and pathologic specimens from 359 consecutive patients who underwent surgical resection for peripheral lung adenocarcinomas <or= 20 mm in diameter during the period from July 1997 to May 2006. By using TS-CT scan images, tumors were defined as air-containing types if the maximum diameter of tumor opacity on mediastinal window images was less than or equal to half of that seen on lung window images, and as a solid-density type if the maximum diameter on the mediastinal window images was more than half of that on lung window images. We compared TS-CT scan findings to pathologic findings (ie, lymph node metastasis, pleural invasion, vessel invasion, and lymphatic invasion) and prognosis. The following prognostic factors were analyzed by chi2 test and Cox proportional hazard model: age; gender; tumor size; pathologic stage; TS-CT scan findings; histologic subtypes defined by Noguchi et al (ie, Noguchi type); pleural involvement; lymphatic invasion; and vascular invasion. No pathologic invasive findings or recurrence were found in patients with air-containing-type tumors. Pathologic invasive findings and recurrence were found in 10 to 30% of patients with solid-density-type tumors. The air-containing type tumors seen on TS-CT scans and Noguchi type A or B tumors were demonstrated as prognostic factors for good outcome by chi2 test (p < 0.001). Multivariate analyses revealed lymphatic permeation as a significant prognostic factor. The TS-CT scan findings were important predictive factors for postsurgical outcome in patients with lung adenocarcinoma.

Idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF; also known as cryptogenic fibrosing alveolitis) is a distinctive type of chronic fibrosing interstitial pneumonia of unknown cause associated with the histological pattern usual interstitial pneumonia (UIP). UIP is a distinct histological pattern observed in IPF but may also be found in other etiologies. The diagnosis of UIP can be established by surgical lung biopsy or by high-resolution thin-section CT scans (provided the radiographic features are classical). Historically, patients labeled as ‘IPF’ encompassed a group of disorders, including UIP, as well as other idiopathic interstitial pneumonias, which differ from UIP in prognosis and responsiveness to therapy. The term IPF should be restricted to patients with idiopathic UIP. The inciting cause(s) and pathogenesis of IPF have not been elucidated but alveolar epithelial cell injury and dysregulation or altered phenotypic expression of fibroblasts are key elements. Inflammatory cells may play minor roles in initiating or propagating the fibrotic process. The prognosis of idiopathic UIP is poor. Mean survival following diagnosis approximates at 3 years. Current medical therapies are of unproven value. Lung transplantation is a viable option for patients failing medical therapy.

Lung lesion doubling times: values and variability based on method of volume determination

To determine doubling times (DTs) of lung lesions based on volumetric measurements from thin-section CT imaging. Previously untreated patients with > or = two thin-section CT scans showing a focal lung lesion were identified. Lesion volumes were derived using direct volume measurements and volume calculations based on lesion area and diameter. Growth rates (GRs) were compared by tissue diagnosis and measurement technique. 54 lesions were evaluated including 8 benign lesions, 10 metastases, 3 lymphomas, 15 adenocarcinomas, 11 squamous carcinomas, and 7 miscellaneous lung cancers. Using direct volume measurements, median DTs were 453, 111, 15, 181, 139 and 137 days, respectively. Lung cancer DTs ranged from 23-2239 days. There were no significant differences in GRs among the different lesion types. There was considerable variability among GRs using different volume determination methods. Lung cancer doubling times showed a substantial range, and different volume determination methods gave considerably different DTs.

Automated classification of lung bronchovascular anatomy in CT using AdaBoost.

Lung CAD systems require the ability to classify a variety of pulmonary structures as part of the diagnostic process. The purpose of this work was to develop a methodology for fully automated voxel-by-voxel classification of airways, fissures, nodules, and vessels from chest CT images using a single feature set and classification method. Twenty-nine thin section CT scans were obtained from the Lung Image Database Consortium (LIDC). Multiple radiologists labeled voxels corresponding to the following structures: airways (trachea to 6th generation), major and minor lobar fissures, nodules, and vessels (hilum to peripheral), and normal lung parenchyma. The labeled data was used in conjunction with a supervised machine learning approach (AdaBoost) to train a set of ensemble classifiers. Each ensemble classifier was trained to detect voxels part of a specific structure (either airway, fissure, nodule, vessel, or parenchyma). The feature set consisted of voxel attenuation and a small number of features based on the eigenvalues of the Hessian matrix (used to differentiate structures by shape). When each ensemble classifier was composed of 20 weak classifiers, the AUC values for the airway, fissure, nodule, vessel, and parenchyma classifiers were 0.984+/-0.011, 0.949+/-0.009, 0.945+/-0.018, 0.953+/-0.016, and 0.931+/-0.015, respectively. The strong results suggest that this could be an effective input to higher-level anatomical based segmentation models with the potential to improve CAD performance.

Thin-Section CT Findings in Hematopoietic Stem Cell Transplantation Recipients with Respiratory Virus Pneumonia

The purpose of this study was to use serial thin-section CT scans to assess the incidence of respiratory viral infection and lung abnormalities in a large patient population at high risk of pulmonary complications. The study population consisted of 26 recipients of hematopoietic stem cell transplants who had proven respiratory viral pneumonia. In all cases, thin-section CT scans were obtained before fiberoptic bronchoscopy and bronchoalveolar lavage. The study included only patients in whom bronchoalveolar lavage fluid showed no evidence of organisms other than respiratory viruses. The CT scans were assessed for the presence, extent, and anatomic distribution of ground-glass attenuation, air-space consolidation, nodules, centrilobular branching structures (tree-in-bud), thickening of the bronchovascular bundles, and pleural effusion. Areas of ground-glass attenuation were identified in 24 (92%) of 26 patients and were the only finding in eight patients. Multiple nodules, seen in 17 (65%) of 26 patients, measured 3-10 mm in diameter or were larger than 10 mm. The nodules had a centrilobular or random distribution. A tree-in-bud appearance was seen in six of the patients with centrilobular nodules. This pattern had a bilateral distribution and involved mainly the lower lung zones. CT revealed thickening of the bronchovascular bundles in 16 (61%) of the patients. Thickening was bilateral in 14 and unilateral in two patients. Bronchial wall thickening involved the lower lobes in six patients and had a patchy random distribution in the remaining nine patients. Air-space consolidation was present in nine (35%) of the cases. It had a lobular or subsegmental distribution in eight of the patients and a segmental distribution in one patient. Areas of consolidation were randomly distributed throughout the lungs in all cases. Less common findings included bilateral pleural effusion and bronchial dilatation. Respiratory viral infection is common among adult recipients of hematopoietic stem cell transplants, occurring over a wide time span after transplantation. The presence of respiratory viral infection must be considered in any patient with new respiratory symptoms, fever, or findings at CT such as extensive or patchy areas of ground-glass opacities or a mixture of patterns, most commonly ground-glass attenuation, thickening of the bronchial walls, and multiple small nodules.

Comparing true tumor volume to unidimensional and bidimensional measurements in lung cancer—A better discriminator of response?

13020 Background: Accurate evaluation of response is crucial to determine if a treatment is effective for a particular patient or if an experimental agent is effective against a specific tumor type. Current measurement techniques such as WHO and RECIST are limited by only identifying changes in size in the axial plane, and with one or two dimensions. We devised and tested a semi-automated algorithm to calculate tumor volume and other parameters on thin-section CT scans to assess response in patients with non-small cell lung cancer (NSCLC) treated with gefitinib in a clinical trial. Methods: CT scans of 15 measurable pre- and post-gefitinib-treated non-small-cell lung cancers in 15 patients were analyzed. A semi-automated three-dimensional segmentation algorithm was developed for lung cancer and applied to each tumor at baseline and follow-up. The computer automatically identified the boundaries of the tumors in three dimensions and the “true” volume and calculated the greatest diameter and the product of the greatest diameter and its perpendicular. Exact McNemar tests were used to analyze differences between RECIST, WHO and volumetric changes from baseline to follow up. Results: The computer accurately segmented 14 of 15 tumors. One paramediastinal tumor required manual separation from the mediastinum. Seventy-three percent (11/15) of patients had an absolute change of at least 20% in tumor volume, compared with 7% (1/15) and 27% (4/15) with similar changes in uni-dimensional (p &lt; 0.01) and bi-dimensional (p = 0.04) tumor measurements, respectively. Forty-seven percent (7/15) of patients had an absolute change of at least 30% in tumor volume, but an absolute change of at least 30% was found in no patients by uni-dimensional measurement (p = 0.02) and in 13% of patients by bi-dimensional measurement (p = 0.06). Analysis of percentage change using an adjusted/scaled method will also be presented. Conclusions: By measuring tumor volume, greater numbers of patients were identified having absolute changes of at least 20% and 30% than by using RECIST or WHO. Therefore, volumetric changes may have the potential to be an earlier or better marker of regression or progression. No significant financial relationships to disclose.

Thin-section spiral CT evaluation of morphologic effects of aging lung in asymptomatic adult subjects

目的 应用薄层螺旋高分辨率CT(HRCT)评价无临床症状人群肺老化的各项影像学征象,分析其与被检查者年龄的相关性,探讨其临床诊断应用价值.方法应用薄层螺旋HRCT对106名无胸部疾病及临床症状者[分30～44岁(31例)、45～59岁(30例)和60岁以上(45例)3个年龄组]进行肺上中下野3个区域的高分辨CT扫描,观察肺间质性改变、肺气肿样改变、马赛克样灌注、肺叶密度梯度差异和胸膜肥厚5项征象,按照标准化评分系统进行评分,再应用SPSS软件对各个指标进行统计学分析.结果在3个年龄组中,肺间质性改变、肺气肿样改变和马赛克样灌注组间差异有统计学意义(χ2值分别为8.10、9.73和15.54,P值均<0.01);而肺叶密度梯度和胸膜肥厚差异无统计学意义(χ2值分别为3.66和3.24,P值均＞0.05).根据各征象的评价标准计算出的积分值与研究对象的年龄呈高度正相关(r=0.709,P<0.01).结论无胸部疾病临床症状者HRCT可见肺间质性改变、肺气肿、马赛克样灌注、肺叶密度梯度差异和胸膜肥厚等结构改变,这些改变随年龄增长而增加.HRCT是评价早期肺老化的重要手段之一。

Can Maximum Intensity Projection Images With Multidetector-Row Computed Tomography Help to Differentiate Between the Micronodular Distribution of Focal and Diffuse Infiltrative Lung Diseases?

The objective of this study was to evaluate whether maximum intensity projection (MIP) images increased the ability of experienced and resident radiologists to differentiate between the micronodular distribution of focal and diffuse infiltrative lung diseases. The cases used in the study were those of 26 patients with focal or diffuse micronodular lung diseases, including 7 cases of sarcoidosis, 6 of miliary tuberculosis, 3 of pulmonary tuberculosis, 3 of chronic bronchitis, 2 of human T-lymphotropic virus type 1-associated bronchoalveolar disorder, 2 of diffuse aspiration bronchiolitis, 1 of atypical mycobacterial infection, and 1 of lymphangitic carcinomatosis. Scans of the entire lung during a single breath hold at 1.25-2.5 mm thickness and a pitch of 6 were performed using a multidetector-row computed tomography (MDCT) apparatus with a 4-row detector. Additional MIP image slabs were produced from the initial axial images on all study patients on a workstation according to a protocol that incorporated a slab thickness of 10 mm, a reconstructed interval of 10 mm, and a window width of -1500 Hounsfield units. The ability of 10 radiologists (5 board-certified radiologists and 5 radiology residents) to interpret contiguous thin-section CT scans and additional MIP images was then studied in an observer performance study. The results of both sets of observer performances were compared using receiver operating characteristic analysis. In the resident observers, the mean area under the receiver operating characteristic curve (Az) value increased significantly from 0.654 without the MIP images to 0.753 with the MIP images (P < 0.01). In the board-certified radiologists, however, the mean Az values remained unchanged at 0.867 without the MIP images and 0.846 with the MIP images. This study showed that MIP images may help radiologists in training to differentiate between the micronodular distribution of focal and diffuse infiltrative lung diseases.

P-246 Retrospective analysis of growth pattern of lung adenocarcinomaby serial thin-section CT (TS-CT) scans

P-246 Retrospective analysis of growth pattern of lung adenocarcinomaby serial thin-section CT (TS-CT) scans

Evaluation of quantitative CT indexes in idiopathic interstitial pneumonitis using a low-dose technique

Objective To evaluate and compare histogram features (mean lung attenuation, skewness, kurtosis) of low-dose and standard-dose CT in a group of patients affected by idiopathic interstitial pneumonitis. Methods We analyzed 16 patients affected by idiopathic interstitial pneumonitis. Spiral whole lung thin-section CT acquisition at standard dose (100 mAs) and three additional low-dose (50 mAs) CT images were obtained. After obtained frequency histograms, mean lung attenuation (MLA), skewness and kurtosis and three range of density (−700/−200 HU; −700/−400 HU; −500/−200 HU) of the standard-and low-dose thin-section CT scans were analyzed and compared. Results The parameters obtained with low-dose and standard-dose spiral CT were correlated in a highly significant manner and were equivalent ( p < 0.01). The greatest correlation was found between standard-and low-dose kurtosis and standard and low-dose −700/−400 HU subrange of density ( r = 0.92; p < 0.0001). Conclusions Our results prove that a quantitative CT objective evaluation in lung fibrosis can be successfully obtained with low-dose spiral CT, with reduced mA.

Hypothesis on the Evolution of Cavitary Lesions in Nontuberculous Mycobacterial Pulmonary Infection: Thin-Section CT and Histopathologic Correlation

The objectives of our study were to evaluate the thin-section CT findings of the cavitary form of nontuberculous mycobacterial pulmonary infection and correlate these imaging findings with the histopathologic findings concerning the development of bronchiectasis and of centrilobular nodules and cavitary lesions. We retrospectively reviewed thin-section CT scans (2.5-mm collimation, both axial and coronal reformation images) of 24 cases (male-female ratio, 13:11; mean age, 61 years; age range, 43-82 years) of the cavitary form of culture-proven Mycobacterium avium-intracellulare complex pulmonary infection including two cases with lobectomy specimens. Any changes in CT findings detected on the follow-up CT scans that were available for seven patients (follow-up interval, 6-24 months; mean, 12 months) were also assessed. Thin-section CT findings were bronchiectasis (24/24 patients, 100%), a patent bronchus running into a cavitary lesion (the "feeding bronchus" appearance) (18/24, 75%), nodules less than 10 mm (17/24, 71%), centrilobular nodules (17/24, 71%), nodules of 10-30 mm (13/24, 54%), peribronchial nodules (8/24, 33%), lobular consolidation (6/24, 25%), bronchial wall thickening (4/24, 17%), and consolidation (2/24, 8%). Two lobectomy specimens showed large cavitary consolidations with the feeding bronchus appearance on pathologic specimens. In two patients, small peribronchial nodules had changed into cavitary nodules with the feeding bronchus appearance on follow-up CT, which represented inflamed focal cystic bronchiectasis. In the cavitary form of M. avium-intracellulare complex pulmonary infection, the feeding bronchus appearance is another very frequent thin-section CT finding. This appearance may suggest that peribronchial nodules of M. avium-intracellulare complex infection evolve into inflamed focal cystic bronchiectasis manifesting as cavitary lesions.

Surgically Curable Peripheral Lung Carcinoma: Correlation of Thin-Section CT Findings With Histologic Prognostic Factors and Survival

Study objectives To define characteristics of surgically curable, early cancers of the lung, we retrospectively studied relationships between thin-section CT (TS-CT) scans, pathologic features, and outcome data in 287 patients with resected small-diameter (< 20 mm) peripheral lung carcinoma. Cases included 260 adenocarcinomas, 16 squamous cell carcinomas, 6 small cell carcinomas, 3 large cell carcinomas, and 2 others Measurements and results All tumors were classified by tumor shadow disappearance rate (TDR) on TS-CT as having either an “air-containing” or “solid-density” pattern. Adenocarcinomas are typically classified into these patterns. Air-containing patterns (n = 136) showed 1% pleural involvement and 2% vascular invasion, with no lymphatic permeation by pathology. Solid-density patterns (n = 124) showed 34% pleural involvement, 42% vascular invasion, and 29% lymphatic permeation. No cases of relapse or death were observed in cases with the air-containing pattern, in contrast to the high relapse and death rate in solid-density cases (p < 0.0001). All non-adenocarcinoma cases (n = 25) had a solid-density pattern, with 4% pleural involvement, 52% vascular invasion, and 44% lymphatic permeation. The overall 5-year survival rate for non-adenocarcinoma was 60%, similar to that for solid-density adenocarcinoma Conclusions When peripheral lung cancers < 20 mm in diameter show air-containing patterns on TS-CT images, surgical outcomes may be favorable with curable disease To define characteristics of surgically curable, early cancers of the lung, we retrospectively studied relationships between thin-section CT (TS-CT) scans, pathologic features, and outcome data in 287 patients with resected small-diameter (< 20 mm) peripheral lung carcinoma. Cases included 260 adenocarcinomas, 16 squamous cell carcinomas, 6 small cell carcinomas, 3 large cell carcinomas, and 2 others All tumors were classified by tumor shadow disappearance rate (TDR) on TS-CT as having either an “air-containing” or “solid-density” pattern. Adenocarcinomas are typically classified into these patterns. Air-containing patterns (n = 136) showed 1% pleural involvement and 2% vascular invasion, with no lymphatic permeation by pathology. Solid-density patterns (n = 124) showed 34% pleural involvement, 42% vascular invasion, and 29% lymphatic permeation. No cases of relapse or death were observed in cases with the air-containing pattern, in contrast to the high relapse and death rate in solid-density cases (p < 0.0001). All non-adenocarcinoma cases (n = 25) had a solid-density pattern, with 4% pleural involvement, 52% vascular invasion, and 44% lymphatic permeation. The overall 5-year survival rate for non-adenocarcinoma was 60%, similar to that for solid-density adenocarcinoma When peripheral lung cancers < 20 mm in diameter show air-containing patterns on TS-CT images, surgical outcomes may be favorable with curable disease

Screening for Pancreatic Neoplasia in Asymptomatic High Risk Individuals: A Prospective, Controlled Study

Screening for Pancreatic Neoplasia in Asymptomatic High Risk Individuals: A Prospective, Controlled Study Marcia Canto, Michael Goggins, Sanjay Jagannath, Sergey Kantsevoy, Constance Griffin, Jennifer Axilbund, Kieran Brune, Gloria Petersen, Elliot Fishman, Charles Yeo, Ralph Hruban, Francis Giardiello, Anthony Kalloo Individuals from familial pancreatic cancer (PC) kindreds and persons with Peutz Jeghers syndrome (PJS) are at increased risk for PC. EUS and ERCP abnormalities associated with chronic pancreatitis (CP have been described in relatives from familial PC kindreds.AIM: To screen for early pancreatic neoplasia and to evaluate the radiologic pancreatic abnormalities in high-risk individuals compared to controls. METHODS:We prospectively evaluated high risk individuals with either: 1) > 1 first-degree relative with PC from kindreds with familial PC with > 2 affected members, or 2) Peutz-Jeghers syndrome. Each patient had screening with a dual phase, thin section CT scan and EUS, each interpreted in a blinded fashion. If EUS was abnormal, EUS-guided fine needle aspiration (FNA) and ERCP were performed. ERCP was performed by an endoscopist unaware of the clinical and radiologic findings. EUS and ERCP findings of high risk subjects were compared with those of normal controls. RESULTS:We studied 63 high risk patients (mean age 57 yrs, 47%male); 58 were from familial PC kindreds and 5 had Peutz-Jeghers syndrome. We also evaluated 130 normal controls (mean age 56 yrs, 44% male). No patients had symptoms referable to the pancreas, a suspicion of pancreatic cancer, or a history of pancreatitis. In the high risk group, a 1.5 cm pancreatic mass was detected in a PJS patient by both EUS and CT, which was surgically resected and found to be an intraductal papillary mucinous neoplasm with carcinoma-in-situ. Screening also detected 2 asymptomatic non-pancreatic cancers in the high risk group: a renal cell carcinoma (EUS and CT) and an ovarian cancer (CT only); both cancers were treated operatively. EUS showed CP (3 or more of 9 features) in 72% of high risk patients, which was significantly more common than in controls (14%, p<.01). ERCP was successful in 36/38 high-risk individuals; 67% had evidence of CP(mild=20%, moderate=44%, severe=2%) and 29% had one or more saccules. ERCP evidence of CP was more common in high risk subjects compared to controls (67% vs. 11%, p=.003). CP-like changes were present in 67% of high risk patients by both EUS and ERCP and only 1/3 of these patients regularly consumed alcohol. CONCLUSIONS: We identified significant asymptomatic pancreatic and extrapancreatic neoplasms by screening individuals at high risk of developing PC.Asymptomatic EUSandERCP features ofCP are common in such individuals and are not associated with alcohol intake.

Intrapulmonary lymph nodes: thin-section CT findings, pathological findings, and CT differential diagnosis from pulmonary metastatic nodules.

We compared the thin-section CT findings of 11 intrapulmonary lymph nodes with pathological findings and evaluated the possibility of CT scan differential diagnosis from pulmonary metastatic nodules. First, we retrospectively reviewed CT scan and pathological findings of intrapulmonary lymph nodes. The median size of these nodules was 6.2 mm. The nodules appeared round (n=3) or angular (n=8) in shape with a sharp border, and they were found below the level of the carina. The median distance from the nearest pleural surface was 4.6 mm, and 3 of the 11 nodules were attached to the pleura. On thin-section CT scan, linear densities extending from the intrapulmonary lymph nodes were frequently visualized, and were pathologically proven to be ectatic lymphoid channels. We then compared the thin-section CT findings of 8 metastatic nodules less than 1 cm in diameter with those of the 11 intrapulmonary lymph nodes. The median size of these nodules was 6.8 mm, and the median distance from the nearest pleural surface was 16 mm. All nodules appeared round in shape. None of the nodules had linear densities extending from the nodules. The linear densities on thin-section CT scan may be the most useful characteristic of intrapulmonary lymph nodes, when differential diagnosis from metastatic nodules is necessary.