RESUMO
AIM: To determine if bronchovascular bundle (BVB) thickening on pretreatment computed tomography (CT) images helps predict survival in patients with peripheral small cell lung cancer (pSCLC) ≤3 cm. MATERIALS AND METHODS: The pretreatment CT examinations of 79 histopathologically proven pSCLC ≤3 cm (TNM stage I, 21; II, 13; III, 22; IV, 23) were reviewed retrospectively. The CT characteristics of the nodule and associated findings, including BVB thickening, were evaluated. Progression-free survival (PFS), overall survival (OS), and brain metastasis-free survival were compared with the presence of BVB thickening using Kaplan-Meier and Cox regression analysis. RESULTS: Among the 79 patients, 34 (43%) had BVB thickening. BVB thickening was prevalent in patients with mediastinal lymph node metastasis (50.9% versus 22.7%; p=0.024) and distant metastasis (60.9% versus 35.7%; p=0.049). Out of the 21 patients with TNM stage IA disease, the 16 patients (76.2%) without BVB thickening showed better PFS, OS, and brain metastasis-free survival (mean, 1,762 versus 483 days; p=0.019: 2,243 versus 1,328 days; p=0.038: 2,274 versus 1,287 days; p=0.038, respectively). Multivariate Cox regression analysis showed that the absence of BVB thickening (hazard ratio [HR], 7.806; 95% CI, 1.241-49.091; p=0.029) and surgery (HR, 0.075; 95% CI, 0.008-0.746; p=0.027) were independent and useful prognostic factors for PFS. CONCLUSIONS: BVB thickening was found more frequently in patients with advanced-stage pSCLC ≤3 cm, and the PFS was more favourable in patients without BVB thickening, with a similar tendency to that of OS and brain metastasis-free survival, in stage IA pSCLC.
Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/secundário , Brônquios/irrigação sanguínea , Neoplasias Pulmonares/patologia , Carcinoma de Pequenas Células do Pulmão/patologia , Tomografia Computadorizada por Raios X , Idoso , Neoplasias Encefálicas/mortalidade , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Carcinoma de Pequenas Células do Pulmão/mortalidade , Taxa de SobrevidaRESUMO
OBJECTIVE: To investigate the incidence of thoracic recurrence and the diagnostic value of chest CT for postoperative surveillance in curatively-resected colorectal cancer (CRC) patients. METHODS: This retrospective study consisted of 648 CRC patients (M:F, 393:255; mean age, 66.2 years) treated with curative surgery between January 2010 and December 2012. The presence of CRC recurrence over follow-ups was analysed and recurrence-free survival and risk factors of recurrence were assessed using Kaplan-Meier analysis with log-rank test and Cox-regression analysis, respectively. RESULTS: Over a median follow-up of 57 months, thoracic recurrence occurred in 8.0% (52/648) of patients with a median recurrence-free survival rate of 19.5 months. Among the 52 patients with thoracic recurrence, 18 (2.7%) had isolated thoracic recurrence, and only five (0.8%) were diagnosed through chest CT. Risk factors of overall thoracic recurrence included age, positive resection margin, presence of venous invasion, positive pathologic N-class, and presence of abdominal recurrence (odds ratio [OR] = 1.78, 19.691, 2.993, 2.502, and 31.137; p = 0.045, 0.004, 0.001, 0.005, and p < 0.001, respectively). As for isolated thoracic recurrence, serum carcinoembryonic antigen level ≥ 5 ng/mL during postoperative follow-up (OR = 9.112; p < 0.001) was demonstrated to be the only predictive factor. There were no thoracic recurrences in patients with CRC stages 0 and I. CONCLUSION: In patients with curatively-resected CRCs, routine surveillance using chest CT may be of limited value, particularly in those with CRC stages 0 or I, as recurrence only detectable through chest CT was shown to be rare. KEY POINTS: ⢠Postoperative thoracic recurrence only detectable through chest CT was shown to be rare. ⢠There were no thoracic recurrences in colorectal cancers stage 0 and I. ⢠Postoperative surveillance chest CT is of limited value in patients with curatively resected colorectal cancers.
Assuntos
Colectomia , Neoplasias Colorretais/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Torácicas/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Idoso , Biomarcadores Tumorais/sangue , Antígeno Carcinoembrionário/sangue , Neoplasias Colorretais/secundário , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Incidência , Masculino , Período Pós-Operatório , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Torácicas/diagnósticoRESUMO
BACKGROUND: Patients with a previous history of hypersensitivity reaction (HSR) to iodinated contrast media (ICM) are at high risk of the development of HSR to ICM. Many studies have tried to evaluate the diagnostic potential of skin tests in this population but have not yet reached a common conclusion. We investigated the role of skin tests in patients with HSR to ICM in terms of positive rate, cross-reactivity rate, and tolerability to skin test-negative ICM according to the type of HSR. METHODS: We performed literature searches of the MEDLINE and EMBASE databases and included studies where skin tests were performed in patients with HSR to ICM, with extractable outcomes. Outcomes were pooled using a random-effects model. RESULTS: Twenty-one studies were included. Pooled per-patient positive rates of skin tests were 17% (95% CI, 10-26%) in patients with immediate HSR, and up to 52% (95% CI, 31-72%) when confined to severe immediate HSR. Among patients with nonimmediate HSR, the positive rate was 26% (95% CI, 15-41%). The pooled per-patient cross-reactivity rate was higher in nonimmediate HSR (68%; 95% CI, 48-83%) than that in immediate HSR (39%; 95% CI, 29-50%). Median per-test cross-reactivity rates between pairs of ICM were 7% (IQR, 6-9%) in immediate HSR and 38% (IQR, 22-51%) in nonimmediate HSR. Pooled per-patient recurrence rates of HSR to skin test-negative ICM were 7% (95% CI, 4-14%) in immediate HSR and 35% (95% CI, 19-55%) in nonimmediate HSR. CONCLUSION: Skin tests may be helpful in diagnosing and managing patients with HSR to ICM, especially in patients with severe immediate HSR.
Assuntos
Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade Tardia/diagnóstico , Hipersensibilidade Imediata/diagnóstico , Compostos de Iodo/efeitos adversos , Reações Cruzadas , Hipersensibilidade a Drogas/etiologia , Humanos , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Imediata/induzido quimicamente , Testes CutâneosRESUMO
AIM: To evaluate the differences in the characterization and recommendation for follow-up of subcentimetre solitary pulmonary nodules (SSPNs) between 5 and 1mm section CT, and to compare the assessments generated by four radiologists MATERIALS AND METHODS: Five hundred and twenty-nine patients who had SSPNs on chest CT reconstructed using both 5 and 1mm sections were enrolled. Two image subsets of 5 and 1mm CT images of each nodule were interpreted independently by four radiologists. Nodule size, consistency (solid, partly solid, non-solid), the presence of calcification, and recommendations for follow-up were evaluated. If a non-calcified solid nodule was confirmed using CT, recommendation for follow-up was based on Fleischner Society guidelines. Data assessed by each radiologist were compared, and interobserver agreements were determined using the intraclass correlation coefficients and kappa value. RESULTS: Using 1mm CT images, the nodule sizes were significantly larger than on 5mm CT images (paired t-test, p<0.01). The presence of calcification and nodule consistency were significantly different between 5 and 1mm CT images (McNemar test for the presence of calcification, p<0.01; Wilcoxon signed test for nodule consistency, p<0.01). On 1mm CT images there was significantly higher agreement regarding nodule consistency than on 5mm CT (kappa=0.78 and 0.67, respectively). CONCLUSIONS: Concurrent use of thin-section and thick-section CT can provide more accurate nodule assessment and higher interobserver agreement in SSPN.
Assuntos
Nódulo Pulmonar Solitário/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Calcinose/diagnóstico por imagem , Calcinose/patologia , Feminino , Humanos , Assistência de Longa Duração , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Nódulo Pulmonar Solitário/patologia , Tomografia Computadorizada por Raios X/métodosRESUMO
Assuntos
Tuberculose Pulmonar/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Diagnóstico Precoce , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/etiologia , Adulto JovemRESUMO
OBJECTIVE: The purpose of our study was to determine the optimal timing window for pulmonary artery MDCT angiography. SUBJECTS AND METHODS: We prospectively studied 150 patients. Routine chest CT scans were acquired using 1.3 mL/kg of contrast medium (370 mg I/mL) that was injected at a fixed injection duration of 30 seconds, followed by a 10-second saline chase. To measure early contrast enhancement, sequential monitoring scans were obtained every 2 seconds over a fixed level of the main pulmonary artery 5 seconds after the start of the injection. Then helical diagnostic scans were obtained at three different predetermined scanning delays (group A, 25 seconds; group B, 35 seconds; and group C, 45 seconds after the start of the injection). Time-enhancement curves; time to reach 100 H, 200 H, and peak enhancement; and enhancement duration greater than 200 H of the pulmonary artery were measured from the monitoring scan. Contrast enhancements of the pulmonary artery and descending aorta and vascular artifacts were assessed from the diagnostic scan. RESULTS: Times to reach 100 H and 200 H at the pulmonary artery were mean 11 +/- 2.5 (SD) seconds and 16 +/- 3.0 seconds, respectively. Pulmonary artery enhancement duration of greater than 200 H was 25 +/- 2.7 seconds (only obtained in group C). Mean time to peak enhancement (335 +/- 62 H) at the pulmonary artery was 37 seconds. Mean enhancement measured on the diagnostic scan was 294 +/- 43 H, group A; 208 +/- 48 H, group B; and 157 +/- 15 H, group C for the pulmonary artery, and 240 +/- 42 H, group A; 277 +/- 49 H, group B; and 172 +/- 29 H, group C for the aorta (p < 0.01). Artifacts were noted in the superior vena cava (group A, 96.7%; group B, 18.3%; and group C, 0%) and in the subclavian vein (group A, 93.5%; group B, 38.7%; and group C, 0%), (p < 0.05). CONCLUSION: With our study protocol of a 30-second injection and 10-second saline flush, the optimal temporal window to achieve pulmonary artery enhancement greater than 200 H was from 16 seconds to 41 seconds after the start of the injection.
Assuntos
Angiografia/métodos , Iohexol/análogos & derivados , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Feminino , Humanos , Iohexol/administração & dosagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Fatores de TempoRESUMO
RATIONALE AND OBJECTIVES: The purpose of this study is to investigate the temporal relation between the change in the resistive index (RI) from renal Doppler sonography and that of serum creatinine values in the course of experimentally induced reversible acute renal failure (ARF) in rabbits. METHODS: Reversible ARF was induced in 10 New Zealand white rabbits by injecting a glycerol solution (6.0 mL/kg) into the thigh muscle. Doppler sonography was performed before injection, and 6, 12, and 24 hours, and 3, 5, 7, and 14 days after injection of glycerol. Blood samples for measuring serum creatinine levels were obtained in the same time sequence. Three rabbits, which died during the course of the experiment, were excluded from the study group. RESULTS: The RI elevated rapidly after glycerol injection, peaked at 12 hours, and then decreased to normal values by 7 days. Conversely, serum creatinine values were elevated and peaked at 1 day and then decreased to normal by 14 days. The change in the RI preceded the change in serum creatinine levels in the course of reversible ARF. There was a weak linear correlation between RI and serum creatinine levels, with a correlation coefficient of 0.33. CONCLUSION: Doppler sonography with measurement of resistive index may be useful in predicting the course of ARF.
Assuntos
Injúria Renal Aguda/diagnóstico por imagem , Creatinina/sangue , Resistência Vascular , Injúria Renal Aguda/sangue , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/fisiopatologia , Animais , Modelos Animais de Doenças , Feminino , Glicerol/administração & dosagem , Injeções Intramusculares , Rim/diagnóstico por imagem , Rim/efeitos dos fármacos , Masculino , Coelhos , Fatores de Tempo , Ultrassonografia Doppler , Resistência Vascular/efeitos dos fármacosRESUMO
PURPOSE: To compare the MR signal intensity patterns and enhancement pattern of intracranial tuberculomas with their histopathologic features. METHODS: MR images of six patients with surgically proved intracranial tuberculoma were reviewed retrospectively and were compared with histologic findings of the resected specimen. Detailed histologic examination was performed to look for the extent and characteristics of caseation necrosis, fibrosis, and inflammatory cellular infiltrates at each area of different signal intensities and at the enhancing areas on MR. Signal intensities for T1- and T2-weighted images were compared with normal gray matter. RESULTS: On T1-weighted images, the granulomas showed a slightly hyperintense rim surrounded by a complete or partial rim of slight hypointensity and central isointensity or mixed isointensity and hyperintensity in five patients and homogeneous isointensity in one patient. Histologically, the zone of central isointensity or mixed intensity corresponded to caseation necrosis plus adjacent cellular infiltrates. The hyperintense and hypointense rims corresponded to the layers of collagenous fiber and the layers of the inflammatory cellular infiltrates, respectively. On T2-weighted images, the entire portion of the granuloma showed slightly heterogeneous isointensity or hypointensity with small markedly hypointense foci in five patients, and a hyperintense center surrounded by a hypointense rim in one patient. Histologic layers were not discriminated on T2-weighted images. On postcontrast T1-weighted images, there were single or multiple conglomerate ring enhancements within a tuberculoma in all six patients, corresponding to the layers of both collagenous and inflammatory cells. CONCLUSION: Combination of the described signal intensity patterns and conglomerate ringlike enhancing appearance of the lesion is characteristic of tuberculoma, and may play an important role in differentiating intracranial tuberculomas from other ring-enhancing brain lesions.
Assuntos
Encéfalo/patologia , Imageamento por Ressonância Magnética , Tuberculoma Intracraniano/diagnóstico , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculoma Intracraniano/patologiaRESUMO
Pulmonary vasculitis includes various disease entities with a wide range of clinical presentations and overlapping imaging features. Radiological findings of vasculitis in the angiitis-granulomatosis group are nodular and patchy opacities, whereas the principal feature of those diseases causing widespread capillaritis is diffuse air space consolidation. Aneurysms or stenoses of pulmonary arteries are seen in patients with Takayasu arteritis or Behçet's disease.
Assuntos
Arterite/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Síndrome de Behçet/diagnóstico por imagem , Granulomatose com Poliangiite/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Humanos , Pneumopatias/diagnóstico por imagem , Arterite de Takayasu/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
The coexistence of pneumothorax and pneumopericardium in patients with primary lung cancer is a very rare phenomenon. We report one such case, in which squamous cell carcinoma of the lung was complicated by pneumopericardium and pneumothorax. Several explanations of the mechanisms involved will be discussed.
Assuntos
Carcinoma de Células Escamosas/complicações , Neoplasias Pulmonares/complicações , Pneumopericárdio/complicações , Pneumotórax/complicações , Carcinoma de Células Escamosas/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pneumopericárdio/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
The radiologic and clinical findings of foreign bodies in the chest of children are well recognized. Foreign bodies in adults are infrequent, however, and the radiologic findings of these unusual circumstances have rarely been described. We classified various thoracic foreign bodies into three types according to their cause: Type I, Aspiration, Type II, Trauma or Accident; Type III, Iatrogenic. This pictorial essay will illustrate the radiologic findings and consequences of thoracic foreign bodies in adults, which have rarely been described in the radiologic literature. The clinical significance of thoracic foreign bodies will be also be discussed.
Assuntos
Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/etiologia , Tórax , Acidentes , Adolescente , Adulto , Idoso , Esôfago/diagnóstico por imagem , Feminino , Coração/diagnóstico por imagem , Humanos , Doença Iatrogênica , Inalação , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Ferimentos e Lesões/complicações , Ferimentos por Arma de Fogo/complicaçõesRESUMO
OBJECTIVE: Bronchogenic carcinoma can mimic or be masked by pulmonary tuberculosis (TB), and the aim of this study was to describe the radiologic findings and clinical significance of bronchogenic carcinoma and pulmonary TB which coexist in the same lobe. MATERIALS AND METHODS: The findings of 51 patients (48 males and three females, aged 48-79 years) in whom pulmonary TB and bronchogenic carcinoma coexisted in the same lobe were analyzed. The morphologic characteristics of a tumor, such as its diameter and margin, the presence of calcification or cavitation, and mediastinal lymphadenopathy, as seen at CT, were retrospectively assessed, and the clinical stage of the lung cancer was also determined. Using the serial chest radiographs available for 21 patients, the possible causes of delay in the diagnosis of lung cancer were analyzed. RESULTS: Lung cancers with coexisting pulmonary TB were located predominantly in the upper lobes (82.4%). The mean diameter of the mass was 5.3 cm, and most tumors (n=42, 82.4%) had a lobulated border. Calcification within the tumor was seen in 20 patients (39.2%), and cavitation in five (9.8%). Forty-two (82.4%) had mediastinal lymphadenopathy, and more than half the tumors (60.8%) were at an advanced stage [IIIB (n=11) or IV (n=20)]. The average delay in diagnosing lung cancer was 11.7 (range, 1-24) months, and the causes of this were failure to observe new nodules masked by coexisting stable TB lesions (n=8), misinterpretation of new lesions as aggravation of TB (n=5), misinterpretation of lung cancer as tuberculoma at initial radiography (n=4), masking of the nodule by an active TB lesion (n=3), and subtleness of the lesion (n=1). CONCLUSION: Most cancers concurrent with TB are large, lobulated masses with mediastinal lymphadenopathy, indicating that the morphologic characteristics of lung cancer with coexisting pulmonary TB are similar to those of lung cancer without TB. The diagnosis of lung cancer is delayed mainly because of masking by a tuberculous lesion, and this suggests that in patients in whom a predominant or growing nodule is present and who show little improvement of symptoms despite antituberculous or other medical therapy, coexisting cancer should be suspected.
Assuntos
Carcinoma Broncogênico/complicações , Neoplasias Pulmonares/complicações , Tuberculose Pulmonar/complicações , Idoso , Carcinoma Broncogênico/diagnóstico por imagem , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnóstico por imagemRESUMO
OBJECTIVE: To determine the effects of respiration on the size of lung cysts by comparing inspiratory and expiratory high-resolution CT (HRCT) scans. MATERIALS AND METHODS: The authors evaluated the size of cystic lesions, as seen on paired inspiratory and expiratory HRCT scans, in 54 patients with Langerhans cell histiocytosis (n = 3), pulmonary lymphangiomyomatosis (n = 4), confluent centrilobular emphysema (n = 9), paraseptal emphysema and bullae (n = 16), cystic bronchiectasis (n = 13), and honeycombing (n = 9). Using paired inspiratory and expiratory HRCT scans obtained at the corresponding anatomic level, a total of 270 cystic lesions were selected simultaneously on the basis of five lesions per lung disease. Changes in lung cyst size observed during respiration were assessed by two radiologists. In a limited number of cases (n = 11), pathologic specimens were obtained by open lung biopsy or lobectomy. RESULTS: All cystic lesions in patients with Langerhans cell histiocytosis, lymphangiomyomatosis, cystic bronchiectasis, honeycombing, and confluent centrilobular emphysema became smaller on expiration, but in two cases of paraseptal emphysema and bullae there was no change. CONCLUSION: In cases in which expiratory CT scans indicate that cysts have become smaller, cystic lesions may communicate with the airways. To determine whether, for cysts and cystic lesions, this connection does in fact exist, paired inspiratory and expiratory HRCT scans are necessary.
Assuntos
Cistos/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Enfisema Pulmonar/diagnóstico por imagem , RespiraçãoRESUMO
Angiolipoma is a rare benign soft tissue tumor, an unusual variant of lipoma, consisting of fatty and vascular components and located in the subcutis, usually in the trunk and extremities. We report a case of posterior mediastinal angiolipoma extending into the spinal canal and showing both fat and angiomatous features on CT scan.
Assuntos
Angiolipoma/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico por imagem , Canal Medular/patologia , Idoso , Angiolipoma/patologia , Feminino , Humanos , Neoplasias do Mediastino/patologia , Tomografia Computadorizada por Raios XRESUMO
Alveolar soft-part sarcoma is a rare soft tissue sarcoma of young adults with unknown histogenesis, and the organ most frequently involved in metastasis is the lung. We report the CT findings of three patients of pulmonary metastases of alveolar soft-part sarcoma, which manifested as clearly enhanced pulmonary nodules or masses. On enhanced scans, some of the masses were seen to contain dilated and tortuous intratumoral vessels.
Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Sarcoma Alveolar de Partes Moles/diagnóstico por imagem , Sarcoma Alveolar de Partes Moles/secundário , Tomografia Computadorizada por Raios X , Adulto , Feminino , Humanos , Neoplasias Pulmonares/irrigação sanguínea , Masculino , Sarcoma Alveolar de Partes Moles/irrigação sanguíneaRESUMO
OBJECTIVE: To describe the thin-section CT findings of arc-welders' pneumoconiosis. MATERIALS AND METHODS: Eighty-five arc-welders with a three to 30 (mean, 15)- year history of exposure underwent thin-section CT scanning. The extent of abnormalities detected was correlated with the severity of dyspnea and pulmonary function tests. For comparison, images of 43 smoking males (mean 25 pack-year) who underwent thin-section CT for other reasons (smokers' group) were also analyzed. RESULTS: Fifty-four welders (63.5%) and six smokers (14.0%) showed positive findings. Predominant thin-section CT findings were poorly-defined centrilobular micronodules (30/54, 55.6%), branching linear structure (18/54, 33.3%), and ground-glass attenuation (6/54, 11.1%). In the smokers' group, poorly-defined micronodules were found in four patients, branching linear structures in one, and ground-glass attenuation in one. In welders, the extent of abnormalities seen on thin-section CT showed no significant correlation with the severity of dyspnea or the results of pulmonary function test. CONCLUSION: Poorly-defined centrilobular micronodules and branching linear structures were the thin-section CT findings most frequently seen in patients with arc-welders' pneumoconiosis. Less commonly, extensive ground-glass attenuation was also seen.
Assuntos
Compostos Férricos , Pneumoconiose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Soldagem , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pneumoconiose/etiologia , Fumar/efeitos adversosRESUMO
OBJECTIVE: To compare the clinical utility of the different imaging techniques used for the evaluation of tracheobronchial diseases. MATERIALS AND METHODS: Forty-one patients with tracheobronchial diseases [tuberculosis (n = 18), bronchogenic carcinoma (n = 10), congenital abnormality (n = 3), post-operative stenosis (n = 2), and others (n = 8)] underwent chest radiography and spiral CT. Two sets of scan data were obtained: one from routine thick-section axial images and the other from thin-section axial images. Multiplanar reconstruction (MPR) and shaded surface display (SSD) images were obtained from thin-section data. Applying a 5-point scale, two observers compared chest radiography, routine CT, thin-section spiral CT, MPR and SSD imaging with regard to the detection, localization, extent, and characterization of a lesion, information on its relationship with adjacent structures, and overall information. RESULTS: SSD images were the most informative with regard to the detection (3.95+/-0.31), localization (3.95+/-0.22) and extent of a lesion (3.85+/-0.42), and overall information (3.83+/-0.44), while thin-section spiral CT scans provided most information regarding its relationship with adjacent structures (3.56+/-0.50) and characterization of the lesion (3.51+/-0.61). CONCLUSION: SSD images and thin-section spiral CT scans can provide valuable information for the evaluation of tracheobronchial disease.
Assuntos
Broncopatias/diagnóstico por imagem , Imageamento Tridimensional , Tomografia Computadorizada por Raios X , Doenças da Traqueia/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodosRESUMO
The objective of this study was to compare chest radiography with computed tomography (CT) in the prediction of a specific diagnosis in adult patients with anterior mediastinal masses. Chest radiographs and CT scans of 128 patients with anterior mediastinal masses were randomized and analyzed retrospectively by two independent observers. The observers listed the three most likely diagnoses in order of probability and recorded the degree of confidence in their first-choice diagnosis. Findings from chest radiographs and CT scans were recorded by each observer and used for a stepwise discriminant analysis between diagnoses. Results showed that the correct first-choice diagnosis, regardless of the degree of confidence, was made in 36% of chest radiographs and 48% of CT scans (p < 0.05). The correct diagnosis was included among top three diagnoses in 59% and 72% of the studies, respectively (p < 0.001). A high confidence diagnosis (level 1) was reached in 9% and 34% of each study, respectively, (p < 0.001), and was correct in 58% and 80% of the studies, respectively. Interobserver agreement (k statistics) on the correct first-choice diagnosis was 0.45 and 0.53, respectively. Interpretations of the CT scans were most often accurate in the confident diagnosis of benign germ cell tumors (n = 10, 100%), thymolipomas (n = 3, 100%), and omental hernia (n = 2, 100%). Seven of 15 radiographic findings and 11 of 22 CT findings were discriminant. We conclude that although CT is better then chest radiography in determining the pathologic diagnosis of an anterior mediastinal mass, CT is still poor at making that prediction with confidence. However, several anterior mediastinal masses could be diagnosed accurately by CT.
Assuntos
Neoplasias do Mediastino/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Feminino , Germinoma/diagnóstico por imagem , Hérnia Ventral/diagnóstico por imagem , Humanos , Linfoma/diagnóstico por imagem , Masculino , Cisto Mediastínico/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem , Tuberculose dos Linfonodos/diagnóstico por imagemRESUMO
The cross-section of the mainstem bronchi is not completely round. For preoperative selection of a double-lumen endobronchial tube size, it may be necessary to measure the mediolateral and the anteroposterior bronchial diameters, which can be measured respectively on chest radiograph and computed tomography. With Internal Review Board approval and patients' informed consent, 105 elective thoracic surgical patients who needed left-sided double-lumen tubes were enrolled. Double-lumen tube size was selected depending on the arithmetic mean of the mediolateral and anteroposterior bronchial diameters. Moreover, the outer diameters of the bronchial tube should be smaller than both mediolateral and anteroposterior diameters. The recommended bronchial diameter for each double-lumen tube size was chosen so that the mean of the two bronchial diameters was 0 to 2.0 mm larger than the upper limit of 95% confidence interval of the averaged outer diameter of the bronchial tube of the selected double-lumen tube. In no case was the predicted double-lumen tube size inappropriate. Generally, anteroposterior bronchial diameters appeared to be different from mediolateral diameters (P=0.001). The double-lumen tube size to be selected based on only one bronchial diameter was different from the one selected based on two perpendicularly measured bronchial diameters in 54.3% of patients (57/105). Preoperative selection of the double-lumen tube size based on the anteroposterior, mediolateral and mean bronchial diameters seems to be useful in that this may obviate the need to change an inappropriately sized double-lumen tube and may be helpful in reducing the related complications.