CT-guided pretreatment biopsy diagnosis in patients with thymic epithelial tumours: diagnostic accuracy and risk of seeding.

AIM: To investigate the diagnostic performance of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) for thymic epithelial tumours (TETs) and the complication rate after PTNB including seeding after PTNB. MATERIALS AND METHODS: This retrospective study identified PTNBs for anterior mediastinal lesions between May 2007 and September 2021. The diagnostic performance for TETs and complications were investigated. The concordance of the histological grades of TETs between PTNB and surgery was evaluated. The factors associated with pleural seeding after PTNB were determined using Cox regression analysis. RESULTS: Of 387 PTNBs, 235 PTNBs from 225 patients diagnosed as TETs (124 thymomas and 101 thymic carcinomas) and 150 PTNBs from 133 patients diagnosed as other than TETs were included. The sensitivity, specificity, and accuracy for TETs were 89.4% (210/235), 100% (210/210), and 93.5% (360/385), respectively, with an immediate complication rate of 4.4% (17/385). The concordance rate of the histological grades between PTNB and surgery was 73.3% (77/105) after excluding uncategorised types of thymomas. During follow-up after PTNB (median duration, 38.8 months; range, 0.3-164.6 months), no tract seeding was observed. Pleural seeding was observed in 26 patients. Thymic carcinoma (hazard ratio [HR], 5.94; 95% confidence interval [CI], 2.07-17.08; p=0.001) and incomplete resection (HR, 3.29; 95% CI, 1.20-9.02; p=0.02) were associated with pleural seeding, while the biopsy approach type (transpleural versus parasternal) was not associated (p=0.12). CONCLUSIONS: Pretreatment biopsy for TETs was accurate and safe and may be considered for diagnosing TETs, particularly when the diagnosis is challenging and histological diagnosis is mandatory.

Effect of an Arm Traction Device on Image Quality and Radiation Exposure during Neck CT: A Prospective Study.

BACKGROUND AND PURPOSE: The image quality of neck CT is frequently disturbed by streak artifact from the shoulder girdles. Our aim was to determine the effects of an arm traction device on image quality and radiation exposure in neck CT. MATERIALS AND METHODS: Patients with lymphoma with complete remission who were scheduled to undergo 2 consecutive follow-up neck CT scans for surveillance within a 1-year interval were enrolled in this prospective study. They underwent 2 consecutive neck CT scans (intervention protocol: patients with an arm traction device; standard protocol: no positioning optimization) on the same CT system. The primary outcome measures were image noise in the lower neck and dose-length product. Secondary outcomes were streak artifacts in the supraclavicular fossa, volume CT dose index, and the extent of the biacromial line shift. RESULTS: Seventy-three patients were enrolled and underwent 2 consecutive CT scans with a mean interval of 155 days. In the intervention protocol, a mean noise reduction in the lower neck of 25.2%-28.5% (P < .001) was achieved, and a significant decrease in dose-length product (413 versus 397, P < .001) was observed. The intervention protocol significantly decreased streak artifacts (P < .001) and volume CT dose index (13.9 versus 13.4, P < .001) and could lower the biacromial line an average of 2.1 cm. CONCLUSIONS: An arm traction device can improve image quality and reduce radiation exposure during neck CT. The device can be simply applied in cooperative patients with suspected lower neck lesions, and the approach offers distinct advantages over the conventional imaging protocol.

Current status of medical radiation exposure in Korea - recent efforts to develop a radiation exposure control system focussed on justification and optimisation.

Radiation exposure from diagnostic medical imaging has increased in Korea. Radiological societies play a key role in radiation safety issues in Korea, including guidelines, accreditation, advocacy, scientific activity, and education. Any medical radiation exposure must be justified, and examinations using ionising radiation must be optimised. Education of referring physicians and radiologists is also important for justification. Medical physicists and radiographers have an important role to play in quality management and optimisation. Regulations are essential to control medical radiation exposure. Therefore, national organisations have made a significant effort to regulate and monitor medical radiation exposure using guidelines, accreditation, and even the law. Medical radiation exposure must be controlled, and this could be achieved by continuous interest from health professionals and organisations.

Presence of macronodules in thoracic sarcoidosis: prevalence and computed tomographic findings.

AIM: To assess the prevalence and radiological findings of macronodules in patients with thoracic sarcoidosis. MATERIALS AND METHODS: Data was collected regarding 226 patients with pathologically proven thoracic sarcoidosis. Among them, macronodules defined as well-defined nodules greater than 5 mm were found in 58 patients. The macronodules were evaluated by their number, size, margin, shape, lobar location, distance from the pleura, and temporal change. Patients were classified into two groups, patients with macronodules (n = 58) and without macronodules (n = 168). The level of serum angiotensin-converting enzyme (ACE), systemic involvement, and the maximum standardized uptake value (maxSUV) on (18)F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) in both groups were then compared. RESULTS: A total of 216 macronodules were identified in 58 patients. The mean number of macronodules per patient was 3.3, and the mean size was 6.3 mm. Most of the macronodules were located in lower lobes (63.4%) and showed round-to-ovoid (95.8%) shape. The mean distance from the pleura was 5 mm. In 76% of the 63 nodules that were followed using CT scanning, any interval changes in size was also accompanied by the same change in mediastinal lymphadenopathy. On comparison of the two groups, the presence of lymphadenopathy, parenchymal involvement, and the maxSUV of thoracic lymphadenopathy were shown to be statistically different. CONCLUSION: Well-defined macronodules greater than 5 mm were not uncommonly seen in patients with thoracic sarcoidosis. The macronodules are usually located in the lower lobes near the pleura, and the interval changes in mediastinal lymphadenopathy may be associated with similar changes in the size of nodules.

Enteropathogenic Escherichia coli-induced macrophage inhibitory cytokine 1 mediates cancer cell survival: an in vitro implication of infection-linked tumor dissemination.

Mucosally adherent Escherichia coli is frequently observed in intestinal surface of patients with colorectal cancer, but rarely in healthy control. Particularly, enteropathogenic Escherichia coli (EPEC) is known to be closely associated with colorectal carcinogenesis in human. In this study, one consequence of EPEC infection in human intestinal cancer cells was induction of macrophage inhibitory cytokine 1 (MIC-1), which is a multifunctional cytokine with biological activities involved in cancer cell growth, differentiation and migration. The present investigation assessed the involvement of MIC-1 protein in EPEC infection-mediated cancer cell survival. The challenge with EPEC induced cancer cell detachment via cytoskeleton rearrangement, which was positively associated with induced MIC-1 expression. Moreover, MIC-1 also mediated RhoA GTPase-linked survival of the detached cancer cells. Blocking of MIC-1 or RhoA activity increased cellular apoptosis of the detached cancer cells. In terms of signaling pathway, MIC-1 triggered transforming growth factorß-activated kinase 1 (TAK1), which enhanced expression of RhoA GTPase. We conclude that EPEC enhances MIC-1 gene expression in the human intestinal cancer cells, which can be associated with enhanced tumor cell resistance to anchorage-dependent tumor cell death via enhanced TAK1 and RhoA GTPase.

CT findings of pulmonary non-tuberculous mycobacterial infection in non-AIDS immunocompromised patients: a case-controlled comparison with immunocompetent patients.

OBJECTIVE: To describe CT findings of non-tuberculous mycobacteria (NTM) pulmonary infection in non-AIDS immunocompromised patients (ICPs) and to compare these findings with those in immunocompetent patients. METHODS: From July 2000 to August 2007, 369 patients (mean age 58.3 years; 169 males and 200 females) with pulmonary NTM infection were retrospectively reviewed. Of these 369 patients, 24 ICPs (mean age 64.8 years; 15 males and 9 females) were identified. 16 patients had diabetes mellitus, and 6 patients had received long-term steroid therapy. One had received solid organ transplantation and one had received high-dose chemotherapy for haematological disease. 24 age- and sex-matched immunocompetent patients (mean age 64.6 years; 15 males and 9 females) were selected as the control group from the same registry. CT images were reviewed in consensus by three chest radiologists, who were blinded to immune status. Each lung lobe was evaluated in terms of extent of the lesion, bronchiectasis, parenchymal opacity and the presence of ancillary findings. results: A total of 287 lobes were evaluated in ICPs and the control group. The ICPs showed a higher prevalence of ill-defined nodules, with cavities and large opacity >2 cm with/without cavity (p=0.03, 0.04 and 0.02, respectively). Regardless of the immune status, the most common CT findings were bronchiectasis and ill-defined nodules without cavity. CONCLUSION: The most common CT findings of pulmonary NTM infection in ICPs were bronchiectasis and ill-defined nodules, similar to those in the control group. Ill-defined nodules with cavity and large opacity >2 cm with/without cavity were more frequently found in ICPs. ADVANCES IN KNOWLEDGE: In patients affected by NTM infection, large opacities and cavitation in pulmonary nodules are more frequent in ICPs than in immunocompetent patients.

Analysis of initial and follow-up CT findings in patients with invasive pulmonary aspergillosis after solid organ transplantation.

AIM: To assess initial and follow-up CT findings of invasive pulmonary aspergillosis (IPA) in solid organ transplant (SOT) recipients using new diagnostic criteria, and to compare initial CT findings of survivors with those of patients who died. MATERIALS AND METHODS: Forty-six adult SOT patients who met the 2008 EORTC/MSG criteria for proven or probable invasive pulmonary aspergillosis were assessed. Initial CT findings of the 21 survivors and 15 patients who died of IPA-related causes were compared using the internationally recognized thoracic glossary of terms. The extents of the largest lesions in each of 18 surviving were measured and changes of those lesions were recorded. RESULTS: Consolidation or mass was the most common finding, observed in 33 of 46 patients (72%), followed by large nodules (59%), ground-glass opacity (50%), and infarcted consolidation (48%). Consolidation or mass was significantly less frequent in survivors than in patients who died (62% versus 93%). Cavitation was more common (43% versus 13%), and significantly smaller (7.5 cm(2) versus 19 cm(2), p = 0.014) in survivors. Follow-up CT in survivors showed that the halo sign resolved rapidly within 4 weeks. The extent of consolidation, infarcted consolidation, and internal low-density area decreased gradually with time to reduce to half the size in 3 weeks. Large nodules persisted for the first 7 days (84%), followed by slow regression. CONCLUSION: Consolidation or mass is the most common CT finding of IPA in SOT recipients. Absence of consolidation or mass and presence of small cavities may be associated with better prognosis. The time for resolution of each pattern after treatment varies.

Radiological findings and clinical features of thoracic immunoglobulin G4-positive plasma cell granuloma: two cases.

Plasma cell granulomas, inflammatory pseudotumours and myofibroblastomas are synonymous with characteristic plasma cell infiltration in various body organs including the pancreas, liver, retroperitoneum and mediastinal structures causing idiopathic fibrosclerosis. Recently, a new concept has arisen regarding the relationship between immunoglobulin (Ig)G4-positive cell infiltration and idiopathic systemic fibrosclerosis. We report two cases showing IgG4-positive cell infiltration in the lung presenting as lung nodules with or without extrapulmonary manifestations.

Clinical course and lung function change of idiopathic nonspecific interstitial pneumonia.

Most studies of idiopathic nonspecific interstitial pneumonia (NSIP) have primarily studied mortality. In order to clarify the detailed outcome and prognostic markers in idiopathic NSIP, the clinical course with initial radiological and clinical features was analysed. The clinical course of 83 patients who were classified with idiopathic NSIP (72 fibrotic, 11 cellular; 27 males and 56 females; mean+/-sd age 54.4+/-10.1 yrs) was retrospectively analysed. In fibrotic NSIP, 16 (22%) patients died of NSIP-related causes with a median (range) follow-up of 53 (0.3-181) months. Despite the favourable survival (5-yr 74%), patients with fibrotic NSIP were frequently hospitalised with recurrence rate of 36%. Reduced forced vital capacity at 12 months was a predictor of mortality. On follow-up, lung function was improved or stable in approximately 80% of the patients. The extent of consolidation and ground-glass opacity on initial high-resolution computed tomography correlated significantly with serial changes of lung function, and the presence of honeycombing was a predictor of poor prognosis. During follow-up, eight (10%) patients developed collagen vascular disease. In conclusion, the overall prognosis of fibrotic nonspecific interstitial pneumonia was good; however, there were significant recurrences despite initial improvement and a subset of the patients did not respond to therapy. Some patients developed collagen vascular diseases at a later date.

Radiological and clinical findings of pulmonary aspergillosis following solid organ transplant.

AIM: To evaluate the radiological and clinical findings in patients with pulmonary aspergillosis after solid organ transplantation. MATERIALS AND METHODS: This study included 13 consecutive patients (five liver, four kidney, and four heart transplant; 10 male and three female; median age 54 years; range 13-63 years) with histologically confirmed pulmonary aspergillosis after solid organ transplantation at a tertiary referral hospital. Chest radiographs and computed tomography (CT) examinations performed for diagnosis were available in all patients. Radiological findings, such as lesion characteristics, location, and associated findings, were assessed retrospectively by two radiologists. The changes in radiological findings and clinical response after treatment were also assessed. Clinical findings, such as time of onset, initial symptoms, clinical course, and laboratory findings, were reviewed. RESULTS: The most common radiographic and CT findings were pulmonary nodules or masses (n=12). The number of nodules or masses was less than 10 in eight patients. Associated findings were surrounding ground-glass opacity (n=4), central low density (n=8), central air cavity (n=5), and air bronchogram (n=3). Follow-up radiographs and/or CT after treatment showed improvement in eight patients, persistence in two, and deterioration in three. The onset time of pulmonary aspergillosis was a median of 32 days (range 15-165 days). The most common symptom at diagnosis was fever (n=6). Ten of 13 patients did not have leucopaenia. There were two aspergillosis-associated deaths during the follow-up period. CONCLUSION: The most common radiological finding of pulmonary aspergillosis after solid organ transplantation is multiple nodules or masses, which commonly appear within 1 month following transplantation.

Can a warning leak in a patient with unruptured aneurysm mask an underlying gastrointestinal pathology? A case report.

Aggravating headache accompanied by nausea and epigastric discomfort suggesting a warning leak in a 39-year-old woman with a giant thrombosed intracranial aneurysm prompted us to undertake coiling of the aneurysm. After uneventful coil embolization of the aneurysm, collapse of the lung related to bronchospam developed, and was found to have a gastrointestinal pathology which had gone undetected before the procedure. Despite its rarity, gastrointestinal pathology mimicking warning leak should have been considered in a patient with a warning leak sign.

Myocardial enhancement pattern in patients with acute myocardial infarction on two-phase contrast-enhanced ECG-gated multidetector-row computed tomography.

AIM: To evaluate the myocardial enhancement pattern of the left ventricle on two-phase contrast-enhanced electrocardiogram (ECG)-gated multidetector computed tomography (MDCT) images in patients with acute myocardial infarction (AMI). METHODS: Two-phase contrast-enhanced ECG-gated MDCT examinations were performed in 16 patients with AMI. The presence, location and pattern of myocardial enhancement were evaluated. MDCT findings were compared with the catheter angiographic results. RESULTS: Subendocardial (n = 9) or transmural (n = 6) area of early perfusion defects of the myocardium was detected in 15 of 16 patients (94%) on early-phase CT images. Variable delayed myocardial enhancement patterns on late-phase CT images were observed in 12 patients (75%): (1) subendocardial residual perfusion defect and subepicardial late enhancement (n = 6); (2) transmural late enhancement (n = 1); (3) isolated subendocardial late enhancement (n=1); and (4) isolated subendocardial residual perfusion defect (n = 2). On catheter angiography, 14 of 15 corresponding coronary arteries showed significant stenosis. CONCLUSION: Variable abnormal myocardial enhancement pattern was seen on two-phase, contrast-enhanced ECG-gated MDCT in patients with AMI. Assessment of myocardial attenuation on CT angiography gives additional information of the location and extent of infarction.

Case report: pericardial rupture and cardiac herniation after blunt trauma: a case diagnosed using cardiac MRI.

Pericardial rupture following blunt chest trauma is rare, and is not usually diagnosed pre-operatively. If pericardial rupture is not recognized and treated promptly, it may be fatal owing to cardiac herniation. We report a case of traumatic herniation of the heart for which a CT scan and MRI made a major contribution to the diagnosis.

Volume of cervical lymph nodes using 3D ultrasonography. Differentiation of metastatic from reactive lymphadenopathy in primary head and neck malignancy.

PURPOSE: To assess the usefulness of volume measurement using 3D US for depicting metastatic cervical lymph nodes. MATERIAL AND METHODS: Thirty-five cervical lymph nodes in 13 patients with primary head and neck malignancy were included in this study. US with volume acquisition was prospectively performed with a 5-10 MHz linear mechanical volume probe. Volume measurement of the node was calculated using a 3D automatic volume calculation program. The excised nodes matched on US were examined histopathologically. RESULTS: The volume of malignant nodes ranged from 0.444 to 4.442 cm3, the volume of the benign nodes from 0.143 to 1.176 cm3. Combinations of high positive (>80%) and negative (>90%) predictive values were obtained at a cut-off value of 0.7 cm3. CONCLUSION: Volume measurement of cervical nodes using 3D US can be a useful tool for differentiating metastatic from benign nodes in patients with primary head and neck malignancy.

Systemic arterial supply to the lungs in adults: spiral CT findings.

Systemic arterial supply to the lungs can be congenital or due to acquired disease. Congenital diseases encompass bronchopulmonary sequestration and congenital pulmonary venolobar syndrome, in which the involved lung parenchyma is supplied by the aberrant systemic arteries. An anomalous systemic artery can also supply an area of otherwise normal lung parenchyma. In acquired diseases, hypertrophied normal systemic arteries supply the lungs. Hypertrophied systemic arteries include the bronchial arteries, intercostal arteries, internal mammary arteries, inferior phrenic arteries, branches of the thyrocervical trunk, branches of the hepatic arteries, and branches of the abdominal aorta. Hypertrophy of normal systemic arteries is encountered in patients with bronchiectasis, pulmonary tuberculosis, other pulmonary infections, pulmonary thromboembolism, or chronic obstructive pulmonary disease. These systemic arteries are considered to supply the lungs by means of anastomoses between bronchial and pulmonary arteries within the lung parenchyma or transpleural systemic-pulmonary artery anastomoses. In most cases, the correct diagnosis and treatment plan can be determined by identification of the systemic arteries on computed tomographic scans.

Pulmonary tuberculoma evaluated by means of FDG PET: findings in 10 cases.

PURPOSE: To describe findings of pulmonary tuberculoma at 2-[fluorine 18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET). MATERIALS AND METHODS: Ten consecutive patients who underwent PET and subsequently were proved to have pulmonary tuberculoma were analyzed. Tuberculosis was proved histopathologically in eight by means of wedge resection or lobectomy (n = 7) or needle biopsy (n = 1) and in two by means of clinical follow-up for more than 2 years. PET scans were evaluated by using peak standardized uptake values. Computed tomographic (CT) and histopathologic findings also were reviewed. RESULTS: Nine of 10 tuberculomas showed FDG uptake at PET, and the mean peak standardized uptake value was 4.2 +/- 2.2 (SD). FDG uptake (range, 1. 9-3.7) in lesions adjacent to main abnormalities was demonstrated in four patients. On CT scans, the mean of the longest nodule diameters was 21 mm +/- 8, and there were some areas of branching linear opacities or satellite nodules that suggested pulmonary tuberculosis in seven patients. Histopathologic findings were chronic granulomatous inflammation with caseation necrosis (n = 7) and healed tuberculosis with aspergilloma (n = 1). CONCLUSION: Pulmonary tuberculoma commonly causes an increase in FDG uptake. These results suggest that in geographic regions with a high prevalence of granulomatous lesions, positive FDG PET results should be interpreted with caution in differentiating benign from malignant pulmonary abnormalities.

Recurrent uterine cervical carcinoma: spectrum of imaging findings.

Uterine cervical carcinoma is one of the most common malignant tumors occurring in females. After primary treatment, patients are usually followed up with CT or MRI and the findings of these modalities may be the first sign of recurrent disease. Because earlier additional treatment by chemotherapy or radiation therapy may improve the prognosis, the early detection of recurrent cervical carcinoma is clinically important. In this article, we review the CT and MR imaging findings of recurrent uterine cervical carcinoma, and assign them to one of four groups: a) recurrence at the primary site, involving the intrapelvic organs, b) extension to the pelvic side-wall, c) metastases to pelvic and extrapelvic lymph nodes, or d) metastases to distant organs. A further contribution of CT and MR imaging is the detection of hydronephrosis due to ureteral obstruction. The cases in each group are illustrated and discussed, and since an awareness of the spectrum of imaging findings of recurrent cervical carcinoma is likely to lead to its early detection, radiologists should be familiar with the information presented.