Underwent Chest Computed Tomography Scans Research Articles

Tuberculous bronchonodal fistula in adult patients: CT findings.

To describe the computed tomography (CT) findings of bronchonodal fistulas occurring in seven adult patients with active pulmonary tuberculosis (TB). Seven patients with confirmed tuberculous bronchonodal fistula who underwent chest CT scans were enrolled. The patient demographics and CT and bronchoscopic findings were analyzed. The bronchonodal fistula site, distribution and characteristics of the involved lymph nodes, airway change, and parenchymal lesions found on CT were reviewed. The seven patients comprised four males and three females. All patients were over 70 years old (range 72-85 years; mean age 78 years). The site of occurrence of the bronchonodal fistula was on the right side between the lobar bronchi and paratracheal or hilar lymph nodes in five patients and on the left side between the left main bronchus and subcarinal lymph nodes in two patients. The involved lymph nodes were necrotic in four patients and necrotic with partial calcification in three. In all patients, active pulmonary TB lesions involving multiple lobes were found as consolidations (n = 3), poorly defined nodules (n = 4), cavities (n = 1), or centrilobular nodules exhibiting tree-in-bud appearance (n = 7). Bronchonodal fistula can occur as a complication of active pulmonary TB with TB lymphadenitis in adult patients, especially in the elderly. The fistulas usually involved the right side. The lobar bronchus was frequently involved on the right side and the main bronchus on the left side.

New Predictive Equation for Lung Volume Using Chest Computed Tomography for Size Matching in Lung Transplantation

PurposeLung size matching is important in lung transplantation (LT). With advances in computed tomography (CT) technology, multidetector row CT can accurately measure the thoracic cage and lung volumes. The objective of this study was to generate a new regression equation using demographic data based on the measured CT lung volume in a healthy population to predict the CT lung volume of the donor in LT size matching. Materials and MethodsThe medical records of healthy subjects who underwent chest CT scans to screen for lung cancer were retrospectively reviewed. CT lung volume was semi-automatically measured using a threshold-based auto-segmentation technique. New regression equations for CT lung volume were generated by multiple linear regression analysis using demographic data including height (H, cm), weight (W, kg), and age (A, years). The percentage error rate (%) of the equations were calculated as ([Estimated CT lung volume – Measured CT lung volume]/Measured CT lung volume × 100). A percentage error rate within ±20% was considered acceptable. ResultsA total of 141 men aged 27 to 55 years (mean, 46.7 ± 6.2 years) and 128 women aged 20 to 55 years (mean, 45.4 ± 7.2 years) were enrolled. The final regression equations for CT lung volume were (−5.890 + 0.067H – 0.030W + 0.020A) in men and (−6.698 + 0.072H – 0.024W) in women. The mean absolute error rate was 10.9 ± 9.0% and 11.0 ± 8.5% in men and women, respectively. Percentage error rates were within ±20% in 121 of 141 (85.8%) men and 113 of 128 (88.3%) women. ConclusionThese equations could predict the CT lung volume of healthy subjects using demographic data. Using these equations, the predicted CT lung volume of donors could be matched to the measured CT lung volume of recipients in lung transplantation.

The effect of azithromycin in adults with stable neutrophilic COPD: a double blind randomised, placebo controlled trial.

BackgroundChronic Obstructive Pulmonary Disease (COPD) is a progressive airway disease characterised by neutrophilic airway inflammation or bronchitis. Neutrophilic bronchitis is associated with both bacterial colonisation and lung function decline and is common in exacerbations of COPD. Despite current available therapies to control inflammation, neutrophilic bronchitis remains common. This study tested the hypothesis that azithromycin treatment, as an add-on to standard medication, would significantly reduce airway neutrophil and neutrophils chemokine (CXCL8) levels, as well as bacterial load. We conducted a randomised, double-blind, placebo-controlled study in COPD participants with stable neutrophilic bronchitis.MethodsEligible participants (n = 30) were randomised to azithromycin 250 mg daily or placebo for 12 weeks in addition to their standard respiratory medications. Sputum was induced at screening, randomisation and monthly for a 12 week treatment period and processed for differential cell counts, CXCL8 and neutrophil elastase assessment. Quantitative bacteriology was assessed in sputum samples at randomisation and the end of treatment visit. Severe exacerbations where symptoms increased requiring unscheduled treatment were recorded during the 12 week treatment period and for 14 weeks following treatment. A sub-group of participants underwent chest computed tomography scans (n = 15).ResultsNine participants with neutrophilic bronchitis had a potentially pathogenic bacteria isolated and the median total bacterial load of all participants was 5.22×107 cfu/mL. Azithromycin treatment resulted in a non-significant reduction in sputum neutrophil proportion, CXCL8 levels and bacterial load. The mean severe exacerbation rate was 0.33 per person per 26 weeks in the azithromycin group compared to 0.93 exacerbations per person in the placebo group (incidence rate ratio (95%CI): 0.37 (0.11,1.21), p = 0.062). For participants who underwent chest CT scans, no alterations were observed.ConclusionsIn stable COPD with neutrophilic bronchitis, add-on azithromycin therapy showed a trend to reduced severe exacerbations sputum neutrophils, CXCL8 levels and bacterial load. Future studies with a larger sample size are warranted.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12609000259246

Computed tomography structural lung changes in discordant airflow limitation.

BackgroundThere is increasing evidence that structural lung changes may be present before the occurrence of airflow limitation as assessed by spirometry. This study investigated the prevalence of computed tomography (CT) quantified emphysema, airway wall thickening and gas trapping according to classification of airflow limitation (FEV1/FVC <70% and/or < the lower limit of normal (LLN)) in (heavy) smokers.MethodsA total number of 1,140 male former and current smokers participating in a lung cancer screenings trial (NELSON) were included and underwent chest CT scanning and spirometry. Emphysema was quantified by the 15th percentile, air way wall thickening by the square root of wall area for a theoretical airway with 10mm lumen perimeter (Pi10) and gas trapping by the mean lung density expiratory/inspiratory (E/I)-ratio. Participants were classified by entry FEV1/FVC: group 1>70%; group 2<70% but >LLN; and group 3<LLN. 32 restricted subjects, i.e. FEV1/FVC >70% but FEV1 <80% predicted, were excluded. Multivariate regression analysis correcting for covariates was used to asses the extent of emphysema, airway wall thickening and gas trapping according to three groups of airflow limitation.ResultsMean (standard deviation) age was 62.5 (5.2) years and packyears smoked was 41.0 (18.0). Group 2 subjects when compared to group 1 had a significantly lower 15th percentile, −920.6 HU versus −912.2 HU; a higher Pi10, 2.87 mm versus 2.57 mm; and a higher E/I-ratio, 88.6% versus 85.6% (all p<0.001).ConclusionSubjects with an FEV1/FVC<70%, but above the LLN, have a significant greater degree of structural lung changes on CT compared to subjects without airflow limitation.

Significance of plasma transforming growth factor-$beta; levels in radiotherapy for non?small-cell lung cancer*1

Purpose In dose-escalation studies of radiotherapy (RT) for non–small-cell lung cancer (NSCLC), radiation pneumonitis (RP) is the most important dose-limiting complication. Transforming growth factor-β1 (TGF-β1) has been reported to be associated with the incidence of RP. It has been proposed that serial measurements of plasma TGF-β1 can be valuable to estimate the risk of RP and to decide whether additional dose-escalation can be safely applied. The aim of this study was to evaluate prospectively the time course of TGF-β1 levels in patients irradiated for NSCLC in relation to the development of RP and dose–volume parameters. Methods and materials Plasma samples were obtained in 68 patients irradiated for medically inoperable or locally advanced NSCLC (dose range, 60.8–94.5 Gy) before and 4, 6, and 18 weeks after the start of RT. Plasma TGF-β1 levels were determined using a bioassay on the basis of TGF-β1-induced plasminogen activator inhibitor-1 expression in mink lung cells. All patients underwent chest computed tomography scans before RT that were repeated at 18 weeks after RT. The computed tomography data were used to calculate the mean lung dose (MLD) and to score the radiation-induced radiologic changes. RP was defined on the basis of the presence of either radiographic changes or clinical symptoms. Symptomatic RP was scored according to the Common Toxicity Criteria (Grade 1 or worse) and the Southwestern Oncology Group criteria (Grade 2 or worse). Multivariate analyses were performed to investigate which factors (pre- or posttreatment TGF-β1 level, MLD) were associated with the incidence of RP. To improve our understanding of the time course of TGF-β1 levels, we performed a multivariate analysis to investigate which factors (pre-RT TGF-β1 level, MLD, RP) were independently associated with the posttreatment TGF-β1 levels. Results The pre-RT TGF-β1 levels were increased in patients with NSCLC (median 21 ng/mL, range, 5–103 ng/mL) compared with healthy individuals (range, 4–12 ng/mL). On average, the TGF-β1 levels normalized toward the end of treatment and remained stable until 18 weeks after RT. In 29 patients, however, TGF-β1 was increased at the end of RT with respect to the pre-RT value. The multivariate analyses revealed that the MLD was the only variable that correlated significantly with the risk of both radiographic RP (p = 0.05) and symptomatic RP, independent of the scoring system used (p = 0.05 and 0.03 for Southwestern Oncology Group and Common Toxicity Criteria systems, respectively). The TGF-β1 level at the end of RT was significantly associated with the MLD (p <0.001) and pre-RT TGF-β1 level (p = 0.001). Conclusion The MLD correlated significantly with the incidence of both radiographic and symptomatic RP. The results of our study did not confirm the reports that increased levels of TGF-β1 at the end of RT are an independent additional risk factor for developing symptomatic RP. However, the TGF-β1 level at the end of a RT was significantly associated with the MLD and the pre-RT level.

Significance of plasma transforming growth factor-β levels in radiotherapy for non–small-cell lung cancer

Purpose In dose-escalation studies of radiotherapy (RT) for non–small-cell lung cancer (NSCLC), radiation pneumonitis (RP) is the most important dose-limiting complication. Transforming growth factor-β1 (TGF-β1) has been reported to be associated with the incidence of RP. It has been proposed that serial measurements of plasma TGF-β1 can be valuable to estimate the risk of RP and to decide whether additional dose-escalation can be safely applied. The aim of this study was to evaluate prospectively the time course of TGF-β1 levels in patients irradiated for NSCLC in relation to the development of RP and dose–volume parameters. Methods and materials Plasma samples were obtained in 68 patients irradiated for medically inoperable or locally advanced NSCLC (dose range, 60.8–94.5 Gy) before and 4, 6, and 18 weeks after the start of RT. Plasma TGF-β1 levels were determined using a bioassay on the basis of TGF-β1-induced plasminogen activator inhibitor-1 expression in mink lung cells. All patients underwent chest computed tomography scans before RT that were repeated at 18 weeks after RT. The computed tomography data were used to calculate the mean lung dose (MLD) and to score the radiation-induced radiologic changes. RP was defined on the basis of the presence of either radiographic changes or clinical symptoms. Symptomatic RP was scored according to the Common Toxicity Criteria (Grade 1 or worse) and the Southwestern Oncology Group criteria (Grade 2 or worse). Multivariate analyses were performed to investigate which factors (pre- or posttreatment TGF-β1 level, MLD) were associated with the incidence of RP. To improve our understanding of the time course of TGF-β1 levels, we performed a multivariate analysis to investigate which factors (pre-RT TGF-β1 level, MLD, RP) were independently associated with the posttreatment TGF-β1 levels. Results The pre-RT TGF-β1 levels were increased in patients with NSCLC (median 21 ng/mL, range, 5–103 ng/mL) compared with healthy individuals (range, 4–12 ng/mL). On average, the TGF-β1 levels normalized toward the end of treatment and remained stable until 18 weeks after RT. In 29 patients, however, TGF-β1 was increased at the end of RT with respect to the pre-RT value. The multivariate analyses revealed that the MLD was the only variable that correlated significantly with the risk of both radiographic RP ( p = 0.05) and symptomatic RP, independent of the scoring system used ( p = 0.05 and 0.03 for Southwestern Oncology Group and Common Toxicity Criteria systems, respectively). The TGF-β1 level at the end of RT was significantly associated with the MLD ( p <0.001) and pre-RT TGF-β1 level ( p = 0.001). Conclusion The MLD correlated significantly with the incidence of both radiographic and symptomatic RP. The results of our study did not confirm the reports that increased levels of TGF-β1 at the end of RT are an independent additional risk factor for developing symptomatic RP. However, the TGF-β1 level at the end of a RT was significantly associated with the MLD and the pre-RT level.