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OBJECTIVE: The aim of the study is to quantify observer agreement in the magnetic resonance imaging (MRI) classification of inflammatory or fibrotic interstitial lung disease (ILD). METHODS: Our study is a preliminary analysis of a larger prospective cohort. The MRI images of 18 patients with ILD (13 females; mean age, 65 years) were acquired in a 1.5 T scanner and included axial fat-saturated T2-weighted (T2-WI, n = 18) and coronal fat-saturated T1-weighted images before and 1, 3, 5, and 10 minutes after gadolinium administration (n = 16). The MRI studies were evaluated with 2 different methods: a qualitative evaluation (visual assessment and measurement of few regions of interest; evaluations were performed independently by 5 radiologists and 3 times by 1 radiologist) and a segmentation-based analysis with software extraction of signal intensity values (evaluations were performed independently by 2 radiologists and twice by 1 radiologist). Interstitial lung disease was classified as inflammatory or fibrotic, based on previously described imaging criteria. RESULTS: Regarding the qualitative evaluation, intraobserver agreement was excellent (κ = 0.92, P < 0.05) for T2-WI and fair (κ = 0.29, P < 0.05) for T1 dynamic study, while interobserver agreement was moderate (κ = 0.56, P < 0.05) and poor (κ = 0.11, P = 0.18), respectively. In contrast, upon segmentation-based analysis, intraobserver and interobserver agreement were excellent for T2-WI (κ = 0.886, P < 0.001; κ = 1.00, P < 0.001; respectively); for T1-WI, intraobserver agreement was excellent (κ = 0.87, P < 0.05) and interobserver agreement was good (κ = 0.75, P < 0.05). CONCLUSIONS: Segmentation-based MRI analysis is more reproducible than a qualitative evaluation with visual assessment and measurement of few regions of interest.
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Enfermedades Pulmonares Intersticiales , Imagen por Resonancia Magnética , Femenino , Humanos , Anciano , Estudios Prospectivos , Estudios Retrospectivos , Imagen por Resonancia Magnética/métodos , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Variaciones Dependientes del ObservadorRESUMEN
PURPOSE: Correlate magnetic resonance imaging (MRI) parameters at baseline with disease progression in nonidiopathic pulmonary fibrosis interstitial lung disease (ILD). MATERIALS AND METHODS: Prospective observational cohort study, in which patients with non-idiopathic pulmonary fibrosis ILD underwent MRI at baseline (1.5 T). T2-weighted images (T2-WI) were acquired by axial free-breathing respiratory-gated fat-suppressed "periodically rotated overlapping parallel lines with enhanced reconstruction" and T1-weighted images (T1-WI) by coronal end-expiratory breath-hold fat-suppressed "volumetric interpolated breath-hold examination" sequences, before and at time points T1, T3, T5, and T10 minutes after gadolinium administration. After MRI segmentation, signal intensity values were extracted by dedicated software. Percentage of the ILD volume and a ratio between signal intensity of ILD (SIILD) and normal lung (SInormal lung) were calculated for T2-WI; percentage of signal intensity (%SI) at each time point, time to peak enhancement, and percent relative enhancement of ILD in comparison with normal lung (%SIILD/normal lung) were calculated for T1-WI. MRI parameters at baseline were correlated with diagnosis of disease progression and variation in percent predicted forced vital capacity (%FVC) and diffusing capacity of the lung for carbon monoxide after 12 months. RESULTS: Comprehensive MRI evaluation (T2-WI and T1-WI) was performed in 21 of the 25 patients enrolled (68% females; mean age: 62.6 y). Three of the 24 patients who completed follow-up fulfilled criteria for disease progression. Baseline T2-WI SIILD/SInormal lung was higher for the progression group (P = 0.052). T2-WI SIILD/SInormal lung and T1-WI %SIILD/normal lung at T1 were positively correlated with the 12-month variation in %FVC (r = 0.495, P = 0.014 and r = 0.489, P= 0.034, respectively). CONCLUSIONS: Baseline MRI parameters correlate with %FVC decline after 12 months.
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Parasitoses are infectious diseases of global distribution, with predominance in areas of poor sanitation. Parasites cause damage through direct tissue injury and the inflammatory response generated by their migration and establishment in various organs. Thoracic involvement by parasitic disease can generate both specific and nonspecific clinical, laboratorial, and radiologic manifestations, which often makes their diagnosis challenging. The correct diagnosis is crucial for definition of treatment, which sometimes requires rapid intervention. Based on a literature review of the last few decades, this article aimed to characterize the main radiologic findings related to thoracic manifestations of parasitic diseases, correlating them with radiographic and tomographic images of patients with confirmed diagnosis of such pathologies. The included parasitic diseases are malaria, Chagas disease, toxoplasmosis, amoebiasis, ascariasis, toxocariasis, strongyloidiasis, dirofilariasis, cysticercosis, echinococcosis, schistosomiasis, and paragonimiasis.
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Enfermedades Parasitarias/diagnóstico por imagen , Enfermedades Torácicas/diagnóstico por imagen , Enfermedades Torácicas/parasitología , Animales , HumanosRESUMEN
PURPOSE: The aim of the study was to determine the accuracy of multidetector computed tomography in the evaluation of histologically confirmed pulmonary hamartomas (PHs), with a special focus on fat detection. MATERIALS AND METHODS: Data from 55 patients who had received a histologically confirmed diagnosis of PH and had undergone 64-slice thoracic MDCT were retrospectively evaluated. RESULTS: PHs manifested predominantly as peripheral pulmonary nodules with lobulated margins. The average lesion diameter was 1.51 cm (SD 0.6 cm). Histologic analyses identified fat content in 43/55 (78.2%) surgical specimens. The accuracy, sensitivity, and specificity of fat detection at a density threshold of -40 HU were 83.7%, 100%, and 87.2%, respectively. A threshold of -33 HU yielded better results (95.3%, 100%, and 96.3%, respectively). Popcorn-like calcifications were found in only 12/55 (21.8%) PHs and were the only imaging feature suggestive of PH in 7.2% of cases. Most (66%) lesions with popcorn-like calcifications also contained fat. CONCLUSIONS: The adoption of a new threshold for fat content (<-33 HU) can lead to further improvements in the overall ability to detect PHs by CT.
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Tejido Adiposo/diagnóstico por imagen , Hamartoma/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Tomografía Computarizada Multidetector , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Nódulo Pulmonar Solitario/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVE: To investigate whether patients with a diagnosis of chronic rhinosinusitis (CRS) show characteristic pulmonary changes on chest CT compared with a control group without sinusopathy. METHODS: This retrospective, observational study included patients with and without a diagnosis of CRS who underwent CT examination of the lungs between 2012 and 2014. Two radiologists, who were blinded for the presence of CRS, reviewed the scans for the presence of any abnormalities consensually. The χ(2) test was used for correlative analysis, with a significance level of 0.05. RESULTS: A total of 123 CT series (51.2% from male patients, mean age 41 ± 16 years) were reviewed, including those from 59 (48%) patients with a diagnosis of CRS. Patients with CRS were more likely than the control group to exhibit atelectasis, bronchiolectasis, centrilobular nodules and ground-glass opacities (all p < 0.05), with a significant predilection for middle lobe and lingular involvement observed (p < 0.001). Other abnormalities, such as bronchial wall thickening and air trapping, did not differ between groups. CONCLUSION: Atelectatic changes, ground-glass opacities, bronchiolectasis and centrilobular nodules are the most frequent abnormalities associated with CRS, with peculiar middle lobe and lingular involvement observed on chest CT examinations. ADVANCES IN KNOWLEDGE: CRS is a frequent disorder that displays typical pulmonary changes at CT. The recognition of such findings can prevent patients with this condition from undergoing unnecessary investigations that might be based on the presence of the aforementioned radiological features.
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Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/etiología , Sinusitis/complicaciones , Sinusitis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Enfermedad Crónica , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
OBJECTIVE: To assess interobserver agreement between thoracic radiologists, radiology residents, and emergency physicians in diagnosing pulmonary embolism (PE). MATERIALS AND METHODS: Emergency physicians, radiology residents, and thoracic radiologists evaluated 123 computed tomography pulmonary angiography images. Interobserver agreement was analysed using kappa statistics. RESULTS: Very good agreements were observed between thoracic radiologists and radiology residents (0.81 and 0.82). Fair and moderate agreements (0.39 and 0.42) were demonstrated between emergency physicians and thoracic radiologists. CONCLUSIONS: Important differences in interobserver agreement were found, with emergency physicians tending to overdiagnose PE.
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Embolia Pulmonar , Radiología , Humanos , Angiografía , Medicina de Emergencia/normas , Internado y Residencia , Pulmón/diagnóstico por imagen , Variaciones Dependientes del Observador , Embolia Pulmonar/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador , Radiografía Torácica/normas , Radiología/educación , Radiología/normas , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Patients with preexisting lung cavities are at risk of developing intracavitary fungal colonization. Because Aspergillus spp. are the most commonly implicated fungi, these fungal masses are called aspergillomas. Their characteristic "ball-in-hole" appearance, however, may be found in a variety of other conditions that can produce radiologic findings mimicking aspergilloma. In this paper, we review the main diseases that may mimic the radiographic findings of aspergilloma, with brief descriptions of clinical, radiologic, and histopathologic findings.
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Enfermedades Pulmonares/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Aspergilosis Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Biopsia , Diagnóstico Diferencial , Humanos , Pulmón/microbiología , Pulmón/patología , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/patología , Valor Predictivo de las Pruebas , Pronóstico , Aspergilosis Pulmonar/microbiología , Aspergilosis Pulmonar/patología , Factores de RiesgoRESUMEN
A variety of fungal pulmonary infections can produce radiologic findings that mimic lung cancers. Distinguishing these infectious lesions from lung cancer remains challenging for radiologists and clinicians. In such cases, radiographic findings and clinical manifestations can be highly suggestive of lung cancer, and misdiagnosis can significantly delay the initiation of appropriate treatment. Likewise, the findings of imaging studies cannot replace the detection of a species as the aetiological agent. A biopsy is usually required to diagnose the infectious nature of the lesions. In this article, we review the clinical, histologic and radiologic features of the most common fungal infections that can mimic primary lung cancers, including paracoccidioidomycosis, histoplasmosis, cryptococcosis, coccidioidomycosis, aspergillosis, mucormycosis and blastomycosis.