Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 72
Filtrar
1.
Artigo em Inglês | MEDLINE | ID: mdl-33180550

RESUMO

BACKGROUND: The relative roles of mucus plugs and emphysema in mechanisms of airflow limitation and hypoxemia in smokers with chronic obstructive pulmonary disease (COPD) are uncertain. METHODS: We analyzed computed tomography (CT) lung images and lung function in participants in the Subpopulations and Intermediate Outcome Measures in COPD Study. Radiologists scored mucus plugs on CT lung images and imaging software automatically quantified percent emphysema. Unadjusted and adjusted relationships between mucus plug score, percent emphysema, and lung function were determined using regression. RESULTS: Among 400 smokers, 229 (57%) had mucus plugs and 207 (52%) had emphysema and subgroups could be identified with mucus dominant and emphysema dominant disease. Only 33% of smokers with high mucus plug scores had mucus symptoms. Mucus plug score and percent emphysema were independently associated with lower values for forced expiratory volume in one second and peripheral oxygen saturation (p values < 0.001). The relationships between mucus plug score and lung function outcomes were strongest in smokers with limited emphysema (p values <0.001). Compared to smokers with low mucus plug scores, those with high scores had worse COPD Assessment Test scores (17.4 ± 7.7 vs. 14.4 ± 13.3), more frequent annual exacerbations (0.75 ± 1.1 vs. 0.43 ± 0.85), and shorter 6-minute walk distance (329 ± 115 vs. 392 ± 117 meters)(p values < 0.001). CONCLUSION: Symptomatically silent mucus plugs are highly prevalent in smokers and independently associate with lung function outcomes. These data provide rationale for targeting mucus-high/emphysema-low COPD patients in clinical trials of muco-active treatments.

2.
Radiology ; 297(3): 675-684, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32930652

RESUMO

Background Classification of lung cancer screening CT scans depends on measurement of lung nodule size. Information about interobserver agreement is limited. Purpose To assess interobserver agreement in the measurements and American College of Radiology Lung CT Screening Reporting and Data System (Lung-RADS) classifications of solid lung nodules detected at lung cancer screening using manual measurements of average diameter and computer-aided semiautomated measurements of average diameter and volume (CT volumetry). Materials and Methods Two radiologists and one radiology resident retrospectively measured lung nodules from screening CT scans obtained between September 2016 and June 2018 with a Lung-RADS (version 1.0) classification of 2, 3, 4A, or 4B in the clinical setting. Average manual diameter and semiautomated computer-aided diameter and volume measurements were converted to the corresponding Lung-RADS categories. Interobserver agreement in raw measurements was assessed using intraclass correlation and Bland-Altman indexes, and interobserver agreement in Lung-RADS classification was assessed using bi-rater κ. Results One hundred twenty patients (mean age, 63 years ± 6 [standard deviation]; 67 women) were evaluated. All manual, semiautomated diameter, and semiautomated volume measurements were obtained by all three readers in 120 of 147 nodules (82%). Intraclass correlation coefficients were greater than or equal to 0.95 for all reader pairs using all measurement methods and were highest using volumetry. Bias and 95% limits of agreement for average diameter were smaller with semiautomated measurements than with manual measurements. κ values across all Lung-RADS classifications were greater than or equal to 0.81, with the lowest being for manual measurements and the highest being for volumetric measurements. Forty-three of 120 (36%) of the nodules were classified into a lower Lung-RADS category on the basis of volumetry compared with using manual diameter measurements by at least one reader, whereas the reverse occurred for four of 120 (3%) of the nodules. Conclusion Interobserver agreement was high with manual diameter measurements and increased with semiautomated CT volumetric measurements. Semiautomated CT volumetry enabled classification of more nodules into lower Lung CT Screening Reporting and Data System categories than manual or semiautomated diameter measurements. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Nishino in this issue.

3.
Chest ; 2020 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-32822676

RESUMO

BACKGROUND: There is limited information about survival of stage I lung cancer diagnosed by screening. RESEARCH QUESTION: What was the survival rate of screen-detected stage I lung cancer in the National Lung Screening Trial (NLST), and was it affected by screening method, patient or tumor characteristics, or treatment method? STUDY DESIGN AND METHODS: The study cohort consisted of all NLST participants with screen-detected stage I lung cancer. Lung cancer-specific survival for stage I overall and for IA and IB substages were compared in the low-dose CT and chest radiography (CXR) screening randomization arms and with an analogous cohort from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute; the cumulative incidence competing risk method was used for analysis. Cox proportional hazards models were used to evaluate the association between lung cancer-specific survival and screening arm, patient factors, primary tumor size, and treatment. RESULTS: There were 324 screen-detected stage I lung cancers in the low-dose CT arm and 125 in the CXR arm. The 10-year survival in the low-dose CT arm was greater than in the CXR arm (73.4% vs 64.6%; P = .05), and both were greater than in the Surveillance, Epidemiology, and End Results cohort (55.6%; P < .001 vs low-dose CT arm, P = .04 vs CXR arm). Proportional hazards models revealed a greater likelihood of survival in the low-dose CT arm (hazard ratio [HR], 0.69; 95% CI, 0.5-0.98) and with primary tumor size below the median of 17 mm (HR, 0.61; 95% CI, 0.42-0.88). There was no survival difference between treatment with limited resection vs full resection (HR, 1.12; 95% CI, 0.65-1.9), whereas nonsurgical treatment was associated with a reduced likelihood of survival compared with full resection (HR, 3.0; 95% CI, 1.5-5.9). INTERPRETATION: Long-term lung cancer-specific survival of stage I lung cancer was greater with low-dose CT imaging than with CXR screening or in the general population, for smaller primary tumor size, and with surgical treatment.

4.
Artigo em Inglês | MEDLINE | ID: mdl-32673071

RESUMO

RATIONALE: Idiopathic pulmonary fibrosis (IPF) is a progressive, inflammatory lung disease without effective molecular markers of disease activity or treatment responses. Monocyte and interstitial macrophages that express the C-C motif chemokine receptor 2 (CCR2) are active in IPF and central to fibrosis. OBJECTIVES: To phenotype patients with IPF for potential targeted therapy, we developed 64Cu-DOTA-ECL1i, a radiotracer to non-invasively track CCR2+ monocytes and macrophages, using positron emission tomography (PET). METHODS: CCR2+ cells were investigated in mice with bleomycin or radiation-induced fibrosis, and human subjects with IPF. The CCR2+ cell populations were localized relative to fibrotic regions in lung tissue and characterized using immunoocalization, single cell mass cytometry, and Ccr2 RNA in situ hybridization, then correlated with parallel quantitation of lung uptake by 64Cu-DOTA-ECL1i PET. MEASUREMENTS AND MAIN RESULT: Mouse models established that increased 64Cu-DOTA-ECL1i PET uptake in the lung correlates with CCR2+ cell infiltration associated with fibrosis (n=72). As therapeutic models, inhibition of fibrosis by interleukin-1ß blockade (n=19) or antifibrotic pirfenidone (n=18) reduced CCR2+ macrophage accumulation and uptake of the radiotracer in mouse lungs. In lung tissues from patients with IPF, CCR2+ cells concentrated in perifibrotic regions and correlated with radiotracer localization (n=21). Human imaging revealed little lung uptake in healthy volunteers (n=7), while subjects with IPF (n=4) exhibited intensive signal in fibrotic zones. CONCLUSIONS: These findings support a role for imaging CCR2+ cells within the fibrogenic niche in IPF to provide a molecular target for personalized therapy and monitoring.

5.
Radiol Imaging Cancer ; 2(2): e190058, 2020 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-32300760

RESUMO

Lung cancer remains the overwhelmingly greatest cause of cancer death in the United States, accounting for more annual deaths than breast, prostate, and colon cancer combined. Accumulated evidence since the mid to late 1990s, however, indicates that low-dose CT screening of high-risk patients enables detection of lung cancer at an early stage and can reduce the risk of dying from lung cancer. CT screening is now a recommended clinical service in the United States, subject to guidelines and reimbursement requirements intended to standardize practice and optimize the balance of benefits and risks. In this review, the evidence on the effectiveness of CT screening will be summarized and the current guidelines and standards will be described in the context of knowledge gained from lung cancer screening studies. In addition, an overview of the potential advances that may improve CT screening will be presented, and the need to better understand the performance in clinical practice outside of the research trial setting will be discussed. © RSNA, 2020.

6.
Radiographics ; 40(1): 28-43, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31782933

RESUMO

Quantitative analysis of thin-section CT of the chest has a growing role in the clinical evaluation and management of diffuse lung diseases. This heterogeneous group includes diseases with markedly different prognoses and treatment options. Quantitative tools can assist in both accurate diagnosis and longitudinal management by improving characterization and quantification of disease and increasing the reproducibility of disease severity assessment. Furthermore, a quantitative index of disease severity may serve as a useful tool or surrogate endpoint in evaluating treatment efficacy. The authors explore the role of quantitative imaging tools in the evaluation and management of diffuse lung diseases. Lung parenchymal features can be classified with threshold, histogram, morphologic, and texture-analysis-based methods. Quantitative CT analysis has been applied in obstructive, infiltrative, and restrictive pulmonary diseases including emphysema, cystic fibrosis, asthma, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, connective tissue-related interstitial lung disease, and combined pulmonary fibrosis and emphysema. Some challenges limiting the development and practical application of current quantitative analysis tools include the quality of training data, lack of standard criteria to validate the accuracy of the results, and lack of real-world assessments of the impact on outcomes. Artifacts such as patient motion or metallic beam hardening, variation in inspiratory effort, differences in image acquisition and reconstruction techniques, or inaccurate preprocessing steps such as segmentation of anatomic structures may lead to inaccurate classification. Despite these challenges, as new techniques emerge, quantitative analysis is developing into a viable tool to supplement the traditional visual assessment of diffuse lung diseases and to provide decision support regarding diagnosis, prognosis, and longitudinal evaluation of disease. ©RSNA, 2019.

7.
Lung Cancer ; 139: 179-184, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31812129

RESUMO

OBJECTIVE: Non-calcified nodules (NCNs) associated with false positive low-dose CT (LDCT) lung cancer screens have been attributed to various causes. Some, however, may represent lung cancer precursors. An association of NCNs with long-term lung cancer risk would provide indirect evidence of some NCNs being cancer precursors. METHODS: LDCT arm participants in the National Lung Screening Trial (NLST) received LDCT screens at baseline and years 1-2. The relationship between NCNs found on LDCT screens and subsequent lung cancer diagnosis over different time periods was examined at the person and lobe level. For the latter, a lobe had a cancer outcome only if the cancer was located in the lobe. Separate analyses were performed on baseline and post-baseline LDCT findings; for the latter, those with baseline NCNs were excluded and only new (non-pre-existing) NCNs examined. Raw and adjusted rate-ratios (RRs) were computed for presence of NCNs and subsequent lung cancer risk; adjusted RRs controlled for demographic and smoking factors. RESULTS: 26,309 participants received the baseline LDCT screen. Over median 11.3 years follow-up, 1675 lung cancers were diagnosed. Adjusted RRs for time periods 0-4, 4-8 and 8-12 years following the baseline screen were 5.1 (95 % CI:4.4-5.9), 1.5 (95 % CI:1.3-1.9) and 1.5 (95 % CI:1.2-1.8) at the person-level and 14.7 (95 % CI:12.6-17.2), 2.6 (95 % CI: 2.0-3.4) and 2.2 (95 % CI:1.6-2.9) at the lobe-level. 18,585 participants were included in the post-baseline analysis. Adjusted RRs for periods 0-4, 4-8 and 8-11 years were 5.6 (95 % CI: 4.5-7.0), 1.9 (95 % CI: 1.3-2.7) and 1.6 (95 % CI: 0.9-2.9) at the person-level and 19.6 (95 % CI:14.9-25.3), 2.5 (95 % CI:1.3-4.7) and 3.3 (95 % CI:1.4-7.6) at the lobe-level. Raw RRs were similar. CONCLUSION: NCNs are associated with excess long-term lung cancer risk, suggesting that some may be lung cancer precursors.

8.
J Clin Invest ; 128(3): 997-1009, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29400693

RESUMO

BACKGROUND: The link between mucus plugs and airflow obstruction has not been established in chronic severe asthma, and the role of eosinophils and their products in mucus plug formation is unknown. METHODS: In clinical studies, we developed and applied a bronchopulmonary segment-based scoring system to quantify mucus plugs on multidetector computed tomography (MDCT) lung scans from 146 subjects with asthma and 22 controls, and analyzed relationships among mucus plug scores, forced expiratory volume in 1 second (FEV1), and airway eosinophils. Additionally, we used airway mucus gel models to explore whether oxidants generated by eosinophil peroxidase (EPO) oxidize cysteine thiol groups to promote mucus plug formation. RESULTS: Mucus plugs occurred in at least 1 of 20 lung segments in 58% of subjects with asthma and in only 4.5% of controls, and the plugs in subjects with asthma persisted in the same segment for years. A high mucus score (plugs in ≥ 4 segments) occurred in 67% of subjects with asthma with FEV1 of less than 60% of predicted volume, 19% with FEV1 of 60%-80%, and 6% with FEV1 greater than 80% (P < 0.001) and was associated with marked increases in sputum eosinophils and EPO. EPO catalyzed oxidation of thiocyanate and bromide by H2O2 to generate oxidants that crosslink cysteine thiol groups and stiffen thiolated hydrogels. CONCLUSION: Mucus plugs are a plausible mechanism of chronic airflow obstruction in severe asthma, and EPO-generated oxidants may mediate mucus plug formation. We propose an approach for quantifying airway mucus plugging using MDCT lung scans and suggest that treating mucus plugs may improve airflow in chronic severe asthma. TRIAL REGISTRATION: Clinicaltrials.gov NCT01718197, NCT01606826, NCT01750411, NCT01761058, NCT01761630, NCT01759186, NCT01716494, and NCT01760915. FUNDING: NIH grants P01 HL107201, R01 HL080414, U10 HL109146, U10 HL109164, U10 HL109172, U10 HL109086, U10 HL109250, U10 HL109168, U10 HL109257, U10 HL109152, and P01 HL107202 and National Center for Advancing Translational Sciences grants UL1TR0000427, UL1TR000448, and KL2TR000428.


Assuntos
Asma/patologia , Eosinofilia/patologia , Muco/metabolismo , Doença Pulmonar Obstrutiva Crônica/patologia , Adulto , Asma/complicações , Estudos de Casos e Controles , Cisteína/química , Elasticidade , Peroxidase de Eosinófilo/metabolismo , Eosinofilia/complicações , Feminino , Volume Expiratório Forçado , Humanos , Hidrogéis , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Oxidantes/química , Compostos de Sulfidrila/química , Tomografia Computadorizada por Raios X
9.
J Allergy Clin Immunol ; 142(6): 1773-1780.e9, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29438772

RESUMO

BACKGROUND: Quantitative computed tomographic (QCT) biomarkers of airway morphology hold potential for understanding and monitoring regional airway remodeling in asthmatic patients. OBJECTIVE: We sought to determine whether the change in airway lumen area between total lung capacity (TLC) and functional residual capacity (FRC) lung volumes measured from CT imaging data was correlated with severe outcomes in asthmatic patients. METHODS: We studied 152 asthmatic patients (90 female and 62 male patients) and 33 healthy subjects (12 female and 21 male subjects) using QCT. Postprocessing of airways at generations 1 to 5 (1 = trachea) was performed for wall area percentage, wall thickness percentage (WT%), lumen area at baseline total lung capacity (LATLC), lumen area at baseline functional residual capacity (LAFRC), and low attenuation area at FRC. A new metric (reflecting remodeling, distal air trapping, or both), Delta Lumen, was determined as follows: Percentage difference in lumen area (LATLC - LAFRC)/LATLC × 100. RESULTS: Postprocessing of 4501 airway segments was performed (3681 segments in the 152 patients with asthma and 820 segments in the 33 healthy subjects; range, 17-28 segments per subject). Delta Lumen values were negatively correlated with WT% and low attenuation area (P < .01) in asthmatic patients. Delta Lumen values were significantly lower for airway generations 3 to 5 (segmental airways) in subjects undergoing hospitalization because of exacerbation and in patients with refractory asthma requiring treatment with systemic corticosteroids. WT% and low attenuation area were positively and Delta Lumen values were negatively associated with systemic corticosteroid treatment (P < .05), suggesting that a reduced Delta Lumen value is a potential outcome biomarker in patients with severe asthma. CONCLUSION: Reduced Delta Lumen value in the central airways measured by using QCT is a promising exploratory biomarker of unstable refractory asthma that warrants further study.


Assuntos
Asma/diagnóstico por imagem , Sistema Respiratório/diagnóstico por imagem , Corticosteroides/uso terapêutico , Adulto , Remodelação das Vias Aéreas , Asma/tratamento farmacológico , Asma/patologia , Asma/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Respiração , Testes de Função Respiratória , Sistema Respiratório/patologia , Sistema Respiratório/fisiopatologia , Adulto Jovem
10.
Br J Radiol ; 91(1088): 20170600, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29485899

RESUMO

The diaphragm is an unique skeletal muscle separating the thoracic and abdominal cavities with a primary function of enabling respiration. When abnormal, whether by congenital or acquired means, the consequences for patients can be severe. Abnormalities that affect the diaphragm are often first detected on chest radiographs as an alteration in position or shape. Cross-sectional imaging studies, primarily CT and occasionally MRI, can depict structural defects, intrinsic and adjacent pathology in greater detail. Fluoroscopy is the primary radiologic means of evaluating diaphragmatic motion, though MRI and ultrasound also are capable of this function. This review provides an update on diaphragm embryogenesis and discusses current imaging of various abnormalities, including the emerging role of three-dimensional printing in planning surgical repair of diaphragmatic derangements.


Assuntos
Diafragma/diagnóstico por imagem , Diafragma/embriologia , Diafragma/anormalidades , Humanos
11.
Br J Radiol ; 91(1090): 20170401, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28830225

RESUMO

After years of assessment through controlled clinical trials, low-dose CT screening for lung cancer is becoming part of clinical practice. As with any cancer screening test, those undergoing lung cancer screening are not being evaluated for concerning signs or symptoms, but are generally in good health and proactively trying to prevent premature death. Given the resultant obligation to achieve the screening aim of early diagnosis while also minimizing the potential for morbidity from workup of indeterminate but ultimately benign screening abnormalities, careful implementation of screening with conformance to currently recognized best practices and a focus on quality assurance is essential. In this review, we address the importance of each component of the screening process to optimize the effectiveness of CT screening, discussing options for quality assurance at each step. We also discuss the potential added advantages, quality assurance requirements and current status of quantitative imaging biomarkers related to lung cancer screening. Finally, we highlight suggestions for improvements and needs for further evidence in evaluating the performance of CT screening as it transitions from the research trial setting into daily clinical practice.


Assuntos
Detecção Precoce de Câncer/normas , Neoplasias Pulmonares/diagnóstico por imagem , Programas de Rastreamento/normas , Garantia da Qualidade dos Cuidados de Saúde , Tomografia Computadorizada por Raios X/normas , Comunicação , Tomada de Decisões , Detecção Precoce de Câncer/métodos , Humanos , Programas de Rastreamento/métodos , Relações Enfermeiro-Paciente , Relações Médico-Paciente , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador , Tomografia Computadorizada por Raios X/métodos
12.
AJR Am J Roentgenol ; 209(5): 1009-1014, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28898131

RESUMO

OBJECTIVE: As low-dose CT (LDCT) lung cancer screening moves into routine clinical practice, evaluation of nodules identified as new becomes critical. We examine the frequency and clinical outcomes of new lung nodules reported at the two postbaseline annual screening examinations (hereafter referred to as postbaseline time 1 [T1] and time 2 [T2]), compared with those detected at baseline in the National Lung Screening Trial. MATERIALS AND METHODS: Radiologists classified nodules detected at T1 and T2 as new or preexisting on the basis of comparison with findings from prior LDCT screening examinations. Subjects were tracked for lung cancer incidence and mortality. We examined the incidence of new nodules and their associated lung cancer risk by nodule size (i.e., mean diameter). RESULTS: A total of 25,002 subjects underwent the baseline LDCT screening examination and either a T1 or T2 LDCT screen. At both T1 and T2, 2.6% of subjects had new solid nodules. Of the new solid nodules, 53.0% were < 6 mm, 29.5% were 6 to < 10 mm, and 17.1% were ≥ 10 mm. Lung cancer risk (defined as diagnosis within 2 years of baseline) increased from 1.1% for nodules < 4 mm to 24.0% for those ≥ 20 mm. Compared with solid nodules detected at baseline, the cancer risk was higher for new solid nodules that were 4 to < 6 mm (p < 0.001) and 6 to < 8 mm (p < 0.001) but lower for new nodules ≥ 20 mm (p = 0.03). Cancers associated with new nodules had significantly poorer survival than did those associated with baseline nodules and were significantly less likely to be adenocarcinoma. CONCLUSION: The incidence of new nodules was 2-3% annually, with the cancer risk increasing by nodule size. New nodules may convey differential lung cancer risks by size, compared with baseline nodules.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/etiologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/etiologia , Nódulo Pulmonar Solitário/diagnóstico por imagem , Adenocarcinoma/mortalidade , Idoso , Detecção Precoce de Câncer , Feminino , Humanos , Incidência , Neoplasias Pulmonares/mortalidade , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Fatores de Risco , Nódulo Pulmonar Solitário/complicações , Nódulo Pulmonar Solitário/patologia , Taxa de Sobrevida , Fatores de Tempo
13.
Eur Radiol ; 27(12): 5113-5118, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28616728

RESUMO

PURPOSE: The National Lung Screening Trial (NLST) demonstrated a reduction in lung cancer and all-cause mortality with low-dose CT (LDCT) screening. The aim of our study was to examine the time to diagnosis (TTD) of lung cancer in the LDCT arm of the NLST and assess its relationship with cancer characteristics and survival. METHODS: The subjects (N = 462) with a positive baseline screen and subsequent lung cancer diagnosis within 3 years were evaluated by data and image review to confirm the baseline abnormality. The cases were analysed for the relationship between TTD and imaging features, cancer type, stage and survival for 7 years from baseline screen. RESULTS: Cancer was judged to be present at baseline in 397/462 cases. The factors that showed significant association (p value trend less than 0.05) with longer TTD included smaller nodule size, pure ground glass nodules (GGNs), smooth/lobulated margins, stages I/II, adenocarcinoma, and decreasing lung cancer mortality. The logistic regression model for lung cancer death showed significant inverse relationships with size less than 20 mm (OR = 0.32), pure GGNs (OR = 0.24), adenocarcinoma (OR = 0.57) and direct relationship with age (OR = 1.4). CONCLUSION: TTD after a positive LDCT screen in the NLST showed a strong association with imaging features, stage and mortality. KEY POINTS: • NLST observed variable time to lung cancer diagnosis from positive baseline screen. • Time to diagnosis was associated with imaging features, cancer type and stage. • In univariate but not multivariate analysis, longer TTD correlated with decreased mortality.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Programas de Rastreamento/métodos , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Idoso , Feminino , Humanos , Modelos Logísticos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade
14.
J Allergy Clin Immunol ; 139(1): 1-10, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-28065276

RESUMO

There have been significant advancements in the various imaging techniques being used for the evaluation of asthmatic patients, both from a clinical and research perspective. Imaging characteristics can be used to identify specific asthmatic phenotypes and provide a more detailed understanding of endotypes contributing to the pathophysiology of the disease. Computed tomography, magnetic resonance imaging, and positron emission tomography can be used to assess pulmonary structure and function. It has been shown that specific airway and lung density measurements using computed tomography correlate with clinical parameters, including severity of disease and pathology, but also provide unique phenotypes. Hyperpolarized 129Xe and 3He are gases used as contrast media for magnetic resonance imaging that provide measurement of distal lung ventilation reflecting small-airway disease. Positron emission tomography can be useful to identify and target lung inflammation in asthmatic patients. Furthermore, imaging techniques can serve as a potential biomarker and be used to assess response to therapies, including newer biological treatments and bronchial thermoplasty.


Assuntos
Asma/diagnóstico por imagem , Asma/patologia , Biomarcadores , Humanos , Pulmão/patologia , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
15.
Pediatr Transplant ; 21(3)2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28120553

RESUMO

Obtaining information on transplanted lung microstructure is an important part of the current care for monitoring transplant recipients. However, until now this information was only available from invasive lung biopsy. The objective of this study was to evaluate the use of an innovative non-invasive technique, in vivo lung morphometry with hyperpolarized ³He MRI-to characterize lung microstructure in the pediatric lung transplant population. This technique yields quantitative measurements of acinar airways' (alveolar ducts and sacs) parameters, such as acinar airway radii and alveolar depth. Six pediatric lung transplant recipients with cystic fibrosis underwent in vivo lung morphometry MRI, pulmonary function testing, and quantitative CT. We found a strong correlation between lung lifespan and alveolar depth-patients with more shallow alveoli were likely to have a negative outcome sooner than those with larger alveolar depth. Combining morphometric results with CT, we also determined mean alveolar wall thickness and found substantial increases in this parameter in some patients that negatively correlated with DLCO. In vivo lung morphometry uniquely provides previously unavailable information on lung microstructure that may be predictive of a negative outcome and has a potential to aid in lung selection for transplantation.


Assuntos
Imagem de Difusão por Ressonância Magnética , Transplante de Pulmão , Pulmão/diagnóstico por imagem , Pulmão/fisiologia , Adolescente , Criança , Fibrose Cística/diagnóstico por imagem , Fibrose Cística/cirurgia , Feminino , Hélio/química , Humanos , Masculino , Permeabilidade , Estudos Prospectivos , Alvéolos Pulmonares/patologia , Testes de Função Respiratória , Razão Sinal-Ruído , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Eur Radiol ; 27(8): 3249-3256, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28050695

RESUMO

OBJECTIVES: This study retrospectively analyses the screening CT examinations and outcomes of the National Lung Screening Trial (NLST) participants who had interval lung cancer diagnosed within 1 year after a negative CT screen and before the next annual screen. METHODS: The screening CTs of all 44 participants diagnosed with interval lung cancer (cases) were matched with negative CT screens of participants who did not develop lung cancer (controls). A majority consensus process was used to classify each CT screen as positive or negative according to the NLST criteria and to estimate the likelihood that any abnormalities detected retrospectively were due to lung cancer. RESULTS: By retrospective review, 40/44 cases (91%) and 17/44 controls (39%) met the NLST criteria for a positive screen (P < 0.001). Cases had higher estimated likelihood of lung cancer (P < 0.001). Abnormalities included pulmonary nodules ≥4 mm (n = 16), mediastinal (n = 8) and hilar (n = 6) masses, and bronchial lesions (n = 6). Cancers were stage III or IV at diagnosis in 32/44 cases (73%); 37/44 patients (84%) died of lung cancer, compared to 225/649 (35%) for all screen-detected cancers (P < 0.0001). CONCLUSION: Most cases met the NLST criteria for a positive screen. Awareness of missed abnormalities and interpretation errors may aid lung cancer identification in CT screening. KEY POINTS: • Lung cancer within a year of a negative CT screen was rare. • Abnormalities likely due to lung cancer were identified retrospectively in most patients. • Awareness of error types may help identify lung cancer sooner.


Assuntos
Detecção Precoce de Câncer/normas , Neoplasias Pulmonares/diagnóstico por imagem , Programas de Rastreamento/normas , Tomografia Computadorizada por Raios X , Idoso , Erros de Diagnóstico/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Estudos Retrospectivos
17.
J Comput Assist Tomogr ; 40(4): 589-95, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27096403

RESUMO

OBJECTIVE: The aim of this study was to compare the performance of 2- (2D) and 3-dimensional (3D) quantitative computed tomography (CT) methods for classifying lung nodules as lung cancer, metastases, or benign. METHODS: Using semiautomated software and computerized analysis, we analyzed more than 50 quantitative CT features of 96 solid nodules in 94 patients, in 2D from a single slice and in 3D from the entire nodule volume. Multivariable logistic regression was used to classify nodule types. Model performance was assessed by the area under the receiver operating characteristic curve (AUC) using leave-one-out cross-validation. RESULTS: The AUC for distinguishing 53 primary lung cancers from 18 benign nodules and 25 metastases ranged from 0.79 to 0.83 and was not significantly different for 2D and 3D analyses (P = 0.29-0.78). Models distinguishing metastases from benign nodules were statistically significant only by 3D analysis (AUC = 0.84). CONCLUSIONS: Three-dimensional CT methods did not improve discrimination of lung cancer, but may help distinguish benign nodules from metastases.


Assuntos
Imageamento Tridimensional/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Carga Tumoral
18.
J Appl Physiol (1985) ; 120(2): 159-65, 2016 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-26542518

RESUMO

The progressive decline of lung function with aging is associated with changes in lung structure at all levels, from conducting airways to acinar airways (alveolar ducts and sacs). While information on conducting airways is becoming available from computed tomography, in vivo information on the acinar airways is not conventionally available, even though acini occupy 95% of lung volume and serve as major gas exchange units of the lung. The objectives of this study are to measure morphometric parameters of lung acinar airways in living adult humans over a broad range of ages by using an innovative MRI-based technique, in vivo lung morphometry with hyperpolarized (3)He gas, and to determine the influence of age-related differences in acinar airway morphometry on lung function. Pulmonary function tests and MRI with hyperpolarized (3)He gas were performed on 24 healthy nonsmokers aged 19-71 years. The most significant age-related difference across this population was a 27% loss of alveolar depth, h, leading to a 46% increased acinar airway lumen radius, hence, decreased resistance to acinar air transport. Importantly, the data show a negative correlation between h and the pulmonary function measures forced expiratory volume in 1 s and forced vital capacity. In vivo lung morphometry provides unique information on age-related changes in lung microstructure and their influence on lung function. We hypothesize that the observed reduction of alveolar depth in subjects with advanced aging represents a remodeling process that might be a compensatory mechanism, without which the pulmonary functional decline due to other biological factors with advancing age would be significantly larger.


Assuntos
Células Acinares/fisiologia , Adaptação Fisiológica/fisiologia , Pulmão/fisiologia , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Hélio , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
J Comput Assist Tomogr ; 39(4): 584-90, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25938213

RESUMO

OBJECTIVE: We reduced the computed tomography (CT)-reconstructed field of view (FOV), increasing pixel density across airway structures and reducing partial volume effects, to determine whether this would improve accuracy of airway wall thickness quantification. METHODS: We performed CT imaging on a lung phantom and 29 participants. Images were reconstructed at 30-, 15-, and 10-cm FOV using a medium-smooth kernel. Cross-sectional airway dimensions were compared at each FOV with repeated-measures analysis of variance. RESULTS: Phantom measurements were more accurate when FOV decreased from 30 to 15 cm (P < 0.05). Decreasing FOV further to 10 cm did not significantly improve accuracy. Human airway measurements similarly decreased by decreasing FOV (P < 0.001). Percent changes in all measurements when reducing FOV from 30 to 15 cm were less than 3%. CONCLUSIONS: Airway measurements at 30-cm FOV are near the limits of CT resolution using a medium-smooth kernel. Reducing reconstructed FOV would minimally increase sensitivity to detect differences in airway dimensions.


Assuntos
Asma/diagnóstico por imagem , Asma/fisiopatologia , Processamento de Imagem Assistida por Computador/métodos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Tomografia Computadorizada Multidetectores , Adulto , Análise de Variância , Pesos e Medidas Corporais/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagens de Fantasmas , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
20.
J Am Coll Radiol ; 12(4): 390-5, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25842017

RESUMO

The Quantitative Imaging Biomarker Alliance (QIBA) is a multidisciplinary consortium sponsored by the RSNA to define processes that enable the implementation and advancement of quantitative imaging methods described in a QIBA profile document that outlines the process to reliably and accurately measure imaging features. A QIBA profile includes factors such as technical (product-specific) standards, user activities, and relationship to a clinically meaningful metric, such as with nodule measurement in the course of CT screening for lung cancer. In this report, the authors describe how the QIBA approach is being applied to the measurement of small pulmonary nodules such as those found during low-dose CT-based lung cancer screening. All sources of variance with imaging measurement were defined for this process. Through a process of experimentation, literature review, and assembly of expert opinion, the strongest evidence was used to define how to best implement each step in the imaging acquisition and evaluation process. This systematic approach to implementing a quantitative imaging biomarker with standardized specifications for image acquisition and postprocessing for a specific quantitative measurement of a pulmonary nodule results in consistent performance characteristics of the measurement (eg, bias and variance). Implementation of the QIBA small nodule profile may allow more efficient and effective clinical management of the diagnostic workup of individuals found to have suspicious pulmonary nodules in the course of lung cancer screening evaluation.


Assuntos
Algoritmos , Detecção Precoce de Câncer/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Biomarcadores , Humanos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...