Clinical features of acute fibrinous and organizing pneumonia: An early histologic pattern of various acute inflammatory lung diseases.

BACKGROUND: Acute fibrinous and organizing pneumonia (AFOP) is a rare histologic pattern of acute lung involvement with intra-alveolar fibrin deposition. However, the clinical significance of the pathological findings of AFOP remains unclear. This study aimed to explore the clinical significance of AFOP through a comprehensive clinical examination. METHODS: The medical records of patients with lung diseases accompanied by the pathological finding of intra-alveolar organization between January 2010 and December 2019 were retrospectively reviewed. The clinical and radiological findings were compared between the groups with and without the histologic pattern of AFOP. RESULTS: We identified 34 patients with AFOP (AFOP group) and 143 without AFOP (non-AFOP group). The underlying diseases of the AFOP group were as follows: 19 patients had cryptogenic organizing pneumonia (OP), 5 had connective tissue diseases, 3 had radiation pneumonitis, 3 had chronic eosinophilic pneumonia, 2 had myelodysplastic syndromes, and 2 had drug-induced pneumonia. Fever was more common, the time from symptom onset to biopsy was shorter, and the serum C-reactive protein level was higher in the AFOP group than in the non-AFOP group. On high-resolution computed tomography, 85% of patients had OP pattern, and halo sign was more common in the AFOP group. Corticosteroids were effective in 94% of the patients in the AFOP group; however, recurrences were more frequent, and a higher corticosteroid dose was needed during recurrence. CONCLUSIONS: AFOP might be an early phase of a histologic pattern associated with known etiologies. In addition, it could be a marker indicating intense inflammatory diseases with a tendency of recurrence.

Nontuberculous mycobacterial lung disease accompanied by organizing pneumonia.

We herein report our experience with patients who had nontuberculous mycobacterial lung disease (NTM disease) accompanied by organizing pneumonia (OP). Out of 98 NTM disease patients who had undergone a biopsy or surgical resection, 11 patients had OP that was revealed histologically. After excluding six patients who had OP-related diseases (idiopathic interstitial pneumonia, rheumatoid arthritis, etc.), the remaining five patients were studied. Two of them (a 73-year-old man and a 66-year-old woman) showed common clinical feature: acute-onset symptoms of cough and fever, infiltrating shadows and dramatic improvement following treatment with a corticosteroid and anti-mycobacterial therapy. Our cases demonstrate that NTM disease is sometimes accompanied by OP histologically, and some such cases show common clinical features.

Flow-preserved coil embolization using a side-holed indwelling catheter for common hepatic artery pseudoaneurysm: report of three cases.

We report three cases of hepatic artery pseudoaneurysm, which were all treated successfully using a combination of coil embolization and a side-holed 5F indwelling catheter for maintaining minimal hepatic artery blood flow with exclusion of the pseudoaneurysm. The tip of an infusion catheter was placed in the right hepatic artery and a side hole was positioned at the celiac axis. Coil embolization was then performed from the proper to the common hepatic artery using detachable coils. Hemostasis was achieved in all patients, with a final angiogram showing the hepatic arteries through the indwelling catheter. One major hepatic infarction and one focal liver abscess caused by reflux cholangitis manifested on postoperative days (PODs) 11 and 87, respectively. All patients survived and the indwelling catheter was removed on POD 136­382 without complication.

Familial interstitial pneumonia complicated by lung cancer in 2 sisters.

A 29-year-old woman was referred to our hospital because of progressive dyspnea on exertion, and her 36-year-old sister was also referred for the evaluation of an abnormal chest radiograph. Radiologic and pathologic findings of the 2 sisters resembled each other closely. In both cases, computed tomography revealed diffuse reticulation, micronodules, diffusely distributed interlobular septal thickening, and an ill-defined nodule in the left lower lobe. Radiologic-pathologic correlation revealed that the reticulation and micronodules corresponded to centrilobular and perilobular fibrosis without architectural lung distortion and that the nodules represented pulmonary adenocarcinoma. To our knowledge, this is the first report of familial interstitial pneumonia complicated by lung cancer in 2 family members, suggesting a possible etiologic association between familial interstitial pneumonia and lung cancer.

Consolidation with a twisted appearance along the airways: a report of five cases of interstitial pneumonia.

High-resolution CT showed areas of airspace consolidation with a twisted appearance of the airways, along with areas of peribronchial ground-glass attenuation and traction bronchiectasis, in five patients with interstitial pneumonia. These areas of airspace consolidation were termed "twisted consolidation" (TwC). The five patients included two patients receiving treatment for rheumatoid arthritis (RA), one patient with newly diagnosed RA, and one patient who subsequently showed RA. Three patients showed improvement after steroid administration. An association of TwC with RA is suspected, but further studies are necessary.

Cerebral air embolism as a complication of computed tomography-guided marking of the lung: depiction of air inflow route from a pulmonary vein to the left atrium.

Air embolism in the arterial system is a very rare but potentially fatal complication of percutaneous transthoracic needle biopsy or marking. We report a case of a patient with interstitial pneumonia associated with Sjögren syndrome, who presented with systemic arterial air embolism as a complication of computed tomography-guided marking of the lung. The air inflow route was depicted clearly on computed tomography from the peripheral pulmonary vein that crossed the needle pathway to the left atrium.

Whole-body MR imaging vs. FDG-PET: comparison of accuracy of M-stage diagnosis for lung cancer patients.

PURPOSE: To conduct a prospective comparison of the accuracy of whole-body MR imaging and positron emission tomography (PET) with fluorine-18 deoxyglucose (FDG) (FDG-PET) to assess the M-stage in lung cancer patients. MATERIALS AND METHODS: A total of 90 consecutive lung cancer patients (mean age = 68 years) underwent whole-body MR imaging and FDG-PET as well as other standard radiological imaging procedures before and after treatment. Probabilities of metastases on whole-body MR imaging and FDG-PET were assessed by using 5-point scoring systems on a per-site basis and on a per-patient basis. Receiver operating characteristic (ROC) curve analysis was used to compare diagnostic capabilities. Sensitivity, specificity, and accuracy were also compared by using the McNemar's test on a per-site and per-patient basis. RESULTS: For assessment of head and neck metastases and bone metastases, accuracies of whole-body MR imaging (95.0% and 94.8%, respectively) were significantly higher than those of FDG-PET (89.1% and 88.2%, respectively; P < 0.05). For assessment of the M-stage on a per-patient basis, accuracy of whole-body MR imaging (80.0%) was also significantly higher than that of FDG-PET (73.3%; P < 0.05). CONCLUSION: Whole-body MR imaging is an accurate diagnostic technique and may be considered at least as effective as FDG-PET for assessment of the M-stage of lung cancer patients.

Assessment of bolus injection protocol with appropriate concentration for quantitative assessment of pulmonary perfusion by dynamic contrast-enhanced MR imaging.

PURPOSE: To determine the appropriate concentration for quantitative assessment of dynamic contrast-enhanced pulmonary MR imaging. MATERIALS AND METHODS: A total of 40 consecutive patients with small bronchioalveolar carcinoma underwent perfusion single-photon emission tomography (SPECT) and three-dimensional (3D) dynamic MR imaging with a 3D radiofrequency spoiled gradient-echo sequence. In each patient, 5 mL of contrast media with 0.1, 0.3, and 0.5 mmol/mL were administered at a rate of 5 mL/second. All patients were divided into two groups (<70 kg and > or =70 kg) for assessment of appropriate concentration to quantitatively assess regional perfusion parameter in routine clinical practice. Pulmonary blood flow (PBF) in each protocol was calculated from a signal intensity (SI)-time course curve. Differences and limits of agreement of PBF between dynamic MR imaging (PBF(MR)) using three different concentrations and perfusion SPECT (PBF(SPECT)) were statistically compared in both patient groups. RESULTS: PBF(MR) using 0.3 mmol/mL in the <70-kg group and 0.5 mmol/mL in the > or =70-kg group showed no significant difference compared with PBF(SPECT) (P > 0.05). Limits of agreements in 0.3 mmol/mL in the <70-kg group and 0.5 mmol/mL in the > or =70-kg group were smaller than those of the other concentrations and small enough for clinical purposes. CONCLUSION: Appropriate concentrations provide accurate and reproducible assessments of regional pulmonary perfusion parameters on 3D dynamic MR perfusion imaging. We suggest using 5 mL of contrast media with 0.3 mmol/mL for patients weighing less than 70 kg and 0.5 mmol/mL for patients weighing 70 kg or more.

Thin-section multiplanar reformats from multidetector-row CT data: utility for assessment of regional tumor extent in non-small cell lung cancer.

PURPOSE: To determine the clinical utility of thin-section multiplanar reformats (MPRs) from multidetector-row CT (MDCT) data sets for assessing the extent of regional tumors in non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS: Sixty consecutive NSCLC patients, who were considered candidates for surgical treatment, underwent contrast-enhanced MDCT examinations, surgical resection and pathological examinations. All MDCT examinations were performed with a 4-detector row computed tomography (CT). From each raw CT data set, 5mm section thickness CT images (routine CT), 1.25 mm section thickness CT images (thin-section CT) and 1.25 mm section thickness sagittal (thin-section sagittal MPR) and coronal images (thin-section coronal MPR) were reconstructed. A 4-point visual score was used to assess mediastinal, interlobar and chest wall invasions on each image set. For assessment of utility in routine clinical practice, mean reading times for each image set were compared by means of Fisher's protected least significant difference (PLSD) test. A receiver operator characteristic (ROC) analysis was performed to determine the diagnostic capability of each of the image data sets. Finally, sensitivity, specificity and accuracy of the reconstructed images were compared by McNemar test. RESULTS: Mean reading times for thin-section sagittal and coronal MPRs were significantly shorter than those for routine CT and thin-section CT (p<0.05). Areas under the curve (Azs) showing interlobar invasion on thin-section sagittal and coronal MPRs were significantly larger than that on routine CT (p=0.03), and the Az on thin-section sagittal MPR was also significantly larger than that on routine CT (p=0.02). Accuracy of chest wall invasion by thin-section sagittal MPR was significantly higher than that by routine CT (p=0.04). CONCLUSION: Thin-section multiplanar reformats from multidetector-row CT data sets are useful for assessing the extent of regional tumors in non-small cell lung cancer patients.

Oxygen-enhanced MR imaging: correlation with postsurgical lung function in patients with lung cancer.

PURPOSE: To prospectively determine if lung function as assessed with oxygen-enhanced magnetic resonance (MR) imaging correlates with postsurgical lung function in patients with lung cancer, as compared with quantitative and qualitative findings of computed tomography (CT) and scintigraphy. MATERIALS AND METHODS: Study received institutional review board approval, and informed patient consent was obtained. Thirty consecutive patients (16 men and 14 women, aged 44-81 years; mean age, 65 years) considered candidates for lung resection underwent oxygen-enhanced MR imaging, CT, perfusion scintigraphy, and measurement of forced expiratory volume in 1 second (FEV1). A respiratory-synchronized inversion-recovery half-Fourier single-shot turbo spin-echo MR sequence was used for data acquisition. Correlation of postsurgical lung function (postsurgical FEV1) as determined with oxygen-enhanced MR imaging (FEV1MR), quantitative assessment with CT (FEV1Quant), qualitative assessment with CT (FEV1Qual), and perfusion scintigraphy (FEV1PS) was conducted with actual postsurgical FEV1, and the limits of agreement of each were determined with Bland-Altman analysis. RESULTS: Correlation between postsurgical FEV1MR and actual postsurgical FEV1 values was excellent (r2= 0.81, P < .001); it was better than that of FEV1Qual (r2= 0.76) and FEV1PS (r2= 0.77) and similar to that of FEV1Quant (r2= 0.81) values. The limits of agreement of FEV1MR were between -9.9% and 10.9%. CONCLUSION: Oxygen-enhanced MR imaging can be used to predict posturgical lung function in patients with lung cancer, similar to quantitative CT.

Prognostic value of dynamic MR imaging for non-small-cell lung cancer patients after chemoradiotherapy.

PURPOSE: To determine the prognostic value of dynamic MRI for non-small-cell lung cancer (NSCLC) patients after chemoradiotherapy. MATERIALS AND METHODS: A total of 114 consecutive patients with NSCLC underwent dynamic MRI after chemoradiotherapy. The patients were divided into two groups (local control (n=22) and local failure (n=92)) according to the presence of local recurrence. From the signal intensity-time course curve in each subject, the maximum relative enhancement ratio and slope of enhancement were calculated, and compared between two groups by Student's t-test. To determine the feasible threshold values of both MR indexes for group differentiation, ROC-based positive tests were performed. Finally, the Kaplan-Meier survival curves of each group divided by the adapted threshold value were compared by log-rank test. RESULTS: The maximum relative enhancement ratio and the slope of enhancement in the local control group were significantly lower than those in the local failure group (P<0.05). Using 0.08/sec as the threshold value of the slope of enhancement, the sensitivity and specificity for differentiation between the two groups were 90.9% and 91.3%, respectively. When the slope of enhancement was adopted for estimation of prognosis after therapy, the mean survival period of the slope of enhancement0.08/sec (P<0.0001). CONCLUSION: Dynamic MRI has potential prognostic value for NSCLC patients after chemoradiotherapy.

Dynamic MR imaging: value of differentiating subtypes of peripheral small adenocarcinoma of the lung.

PURPOSE: To determine the utility of dynamic magnetic resonance imaging (MRI) in the differential subtyping of small adenocarcinomas of the lung. MATERIALS AND METHODS: Twenty-nine pathologically diagnosed peripheral adenocarcinomas (less than 20 mm in diameter) underwent dynamic contrast-enhanced MRI. Maximum relative enhancement ratio, slope of enhancement, and corrected start time of enhancement were calculated from signal intensity-time curve of pulmonary lesion for each subject, and were statistically compared among bronchioloalveolar carcinoma (BAC) group (7 cases), mixed BAC group (10 cases), and adenocarcinoma group (12 cases). RESULTS: Maximum relative enhancement ratio (P<0.001) and slope of enhancement (P<0.001) of BAC group were significantly higher than those of mixed BAC and adenocarcinoma groups. Start times of BAC group were significantly earlier than those of mixed BAC (P=0.0001) and adenocarcinoma groups (P<0.0001). Adapting the thresholds values of MR indexes from the positive tests, sensitivity, specificity, positive predictive value, negative predictive value and accuracy for differentiating BAC from other subtypes were 85.7, 100.0, 100.0, 95.7, and 96.6%, respectively. CONCLUSIONS: Dynamic MRI is useful for differentiating subtypes of small peripheral adenocarcinoma.

Centrically reordered inversion recovery half-Fourier single-shot turbo spin-echo sequence: improvement of the image quality of oxygen-enhanced MRI.

PURPOSE: The purpose of the study presented here was to determine the improvement in image quality of oxygen-enhanced magnetic resonance (MR) subtraction imaging obtained with a centrically reordered inversion recovery half-Fourier single-shot turbo spin-echo (c-IR-HASTE) sequence compared with that obtained with a conventional sequentially reordered inversion recovery single-shot HASTE (s-IR-HASTE) sequence for pulmonary imaging. MATERIALS AND METHODS: Oxygen-enhanced MR imaging using a 1.5 T whole body scanner was performed on 12 healthy, non-smoking volunteers. Oxygen-enhanced MR images were obtained with the coronal two-dimensional (2D) c-IR-HASTE sequence and 2D s-IR-HASTE sequence combined with respiratory triggering. For a 256x256 matrix, 132 phase-encoding steps were acquired including four steps for phase correction. Inter-echo spacing for each sequence was 4.0 ms. The effective echo time (TE) for c-IR-HASTE was 4.0 ms, and 16 ms for s-IR-HASTE. The inversion time (TI) was 900 ms. To determine the improvement in oxygen-enhanced MR subtraction imaging by c-IR-HASTE, CNRs of subtraction image, overall image quality, and image degradation of the c-IR-HASTE and s-IR-HASTE techniques were statistically compared. RESULTS: CNR, overall image quality, and image degradation of c-IR-HASTE images showed significant improvement compared to those s-IR-HASTE images (P<0.05). CONCLUSION: Centrically reordered inversion recovery half-Fourier single-shot turbo spin-echo (c-IR-HASTE) sequence enhanced the signal from the lung and improved the image quality of oxygen-enhanced MR subtraction imaging.

Quantitative assessment of regional pulmonary perfusion in the entire lung using three-dimensional ultrafast dynamic contrast-enhanced magnetic resonance imaging: Preliminary experience in 40 subjects.

PURPOSE: To assess regional differences in quantitative pulmonary perfusion parameters, i.e., pulmonary blood flow (PBF), mean transit time (MTT), and pulmonary blood volume (PBV) in the entire lung on a pixel-by-pixel basis in normal volunteers and pulmonary hypertension patients. MATERIALS AND METHODS: Three-dimensional ultrafast dynamic contrast-enhanced MR imaging was performed in 15 normal volunteers and 25 patients with pulmonary hypertension. From the signal intensity-time course curves, PBF, MTT and PBV maps were generated using deconvolution analysis, indicator dilution theories, and the central volume principle, on a pixel-by-pixel basis. From pulmonary perfusion parameter maps of normal volunteers and pulmonary hypertension patients, regional PBF, MTT, and PBV were statistically evaluated. RESULTS: Regional PBF, MTT, and PBV showed significant differences in the gravitational and isogravitational directions (P < 0.05). The quantitative pulmonary perfusion parameter maps demonstrated significant differences between normal volunteers and pulmonary hypertension patients (P < 0.05). CONCLUSION: Three-dimensional ultrafast dynamic contrast-enhanced MR imaging is feasible for the assessment of regional quantitative pulmonary perfusion parameters in the entire lung on a pixel-by-pixel basis in normal volunteers and pulmonary hypertension patients.

Metastases in mediastinal and hilar lymph nodes in patients with non-small cell lung cancer: quantitative and qualitative assessment with STIR turbo spin-echo MR imaging.

PURPOSE: To evaluate short inversion time inversion-recovery (STIR) turbo spin-echo (TSE) magnetic resonance (MR) imaging for detection of metastases in lymph nodes by using quantitative and qualitative analyses. MATERIALS AND METHODS: One hundred ten patients (68 men and 42 women) with non-small cell lung cancer who ranged in age from 36 to 82 years (mean age, 64 years) were examined with respiratory-triggered STIR TSE MR imaging. Ratios of signal intensity in a lymph node to that in a 0.9% saline phantom (lymph node-saline ratios [LSRs]) for all lymph nodes were classified into three groups according to nodal short-axis diameter. LSRs of each group were compared by using pathologic diagnosis as the standard of reference. For quantitative analysis, the LSR threshold value for a positive test was determined on a per-node basis and tested for ability to enable a correct diagnosis on a per-patient basis. For qualitative analysis, signal intensities of lymph nodes were assessed by using a five-point visual scoring system. Results of quantitative and qualitative analyses were compared on a per-patient basis with McNemar testing. RESULTS: In 110 patients, 92 of 802 lymph nodes were pathologically diagnosed as containing metastases, while 710 lymph nodes did not contain metastases. Mean LSR in the lymph node group with metastasis was higher than that in the group without metastasis (P <.05). When an LSR of 0.6 was used as the positive-test threshold at quantitative analysis, sensitivity was 93% (37 of 40 patients) and specificity was 87% (61 of 70 patients) on a per-patient basis. With a score of 4 as the positive-test threshold at qualitative analysis, sensitivity was 88% (35 of 40 patients) and specificity was 86% (60 of 70 patients) on a per-patient basis. There was no significant difference (P >.05) between results of quantitative and those of qualitative analysis. CONCLUSION: Quantitative and qualitative analyses of STIR TSE MR images enable differentiation of lymph nodes with metastasis from those without. Qualitative analysis can substitute for quantitative analysis of STIR TSE MR imaging data.

Dynamic perfusion MRI versus perfusion scintigraphy: prediction of postoperative lung function in patients with lung cancer.

OBJECTIVE: The purpose of this study was to determine the capability of dynamic perfusion MRI as an alternative to pulmonary perfusion scintigraphy for prediction of postoperative lung function in patients with lung cancer. SUBJECTS AND METHODS. Sixty patients with lung cancer (35 men, 25 women) underwent dynamic perfusion MRI, perfusion scintigraphy, and preoperative and postoperative pulmonary function tests (forced expiratory volume in 1 sec [FEV(1)]). Perfusion MRIs were obtained with a 3D turbo field-echo sequence (TR/TE, 2.7/0.6; flip angle, 40 degrees; matrix, 128 x 96) using a 1.5-T scanner. Regional blood flow was calculated from the signal intensity-time curves after bolus injection of contrast medium on MRI (Q(MRI)) and uptake ratios of radioisotope on perfusion scintigraphy (Q(PS)). Postoperative lung functions predicted by MRI (FEV(1,MRI)) and perfusion scintigraphy (FEV(1,PS)) were calculated from preoperative FEV(1) and regional Qs. To determine the capability of MRI as an alternative to scintigraphy, we evaluated correlations and the limits of agreement between predicted FEV(1,MRI) and postoperative FEV(1) and between predicted FEV(1,PS) and postoperative FEV(1). RESULTS: The correlation coefficient of postoperative FEV(1) with FEV(1,MRI) (r = 0.93, p < 0.0001) was better than that with FEV(1,PS) (r = 0.89, p < 0.0001). The limits of agreement between postoperative FEV(1) and predicted FEV(1,MRI) (0.9% +/- 10.4%) were smaller than those between postoperative FEV(1) and predicted FEV(1,PS) (2.1% +/- 13.2%). CONCLUSION: Dynamic perfusion MRI is a feasible alternative to pulmonary perfusion scintigraphy for predicting postoperative lung function in patients with lung cancer.

CT-guided transthoracic needle aspiration biopsy of small (< or = 20 mm) solitary pulmonary nodules.

OBJECTIVE: The purpose of our study was to determine the diagnostic accuracy and to analyze the factors influencing the diagnostic accuracy and incidences of pneumothorax and chest tube insertion rates for percutaneous CT-guided needle biopsy of small (< or = 20 mm) solitary pulmonary nodules. SUBJECTS AND METHODS: One hundred sixty-two patients with 162 small solitary pulmonary nodules underwent CT-guided transthoracic needle aspiration biopsy. The overall diagnostic accuracy, pneumothorax rate, and chest tube insertion rate were calculated. Factors influencing the diagnostic accuracy and pneumothorax rate were statistically evaluated. Influencing factors, diagnostic accuracies, pneumothorax rates, and chest tube insertion rates were statistically compared. RESULTS: Overall diagnostic accuracy, pneumothorax rate, and chest tube insertion rate were 77.2%, 28.4%, and 2.5%, respectively. Diagnostic accuracy was significantly affected by length of needle path and lesion size (p < 0.05). The pneumothorax rate was significantly affected by the percentage of predicted forced expiratory volume in 1 sec, the number of punctures, and the needle path length (p < 0.05). The chest tube insertion rate was significantly affected by the number of punctures (p < 0.05). For diagnostic accuracy, needle path lengths of 40 mm or less and lesion sizes greater than 10 mm were significantly more accurate than other factors (p < 0.05). For pneumothorax rates, a percentage of predicted forced expiratory volume in 1 sec of greater than 70%, a single puncture, and a needle path length of 40 mm or less were significantly lower than other factors (p < 0.05). CONCLUSION: CT-guided transthoracic needle aspiration biopsy is a useful diagnostic tool for small solitary pulmonary nodules smaller than 20 mm in diameter. The diagnostic accuracy is significantly improved for large (> 10 mm) lesion size and short (< or = 40 mm) needle path length.