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Sample records for benign pulmonary nodules

  1. Differentiation of malignant and benign pulmonary nodules with first-pass dual-input perfusion CT.

    Science.gov (United States)

    Yuan, Xiaodong; Zhang, Jing; Quan, Changbin; Cao, Jianxia; Ao, Guokun; Tian, Yuan; Li, Hong

    2013-09-01

    To assess diagnostic performance of dual-input CT perfusion for distinguishing malignant from benign solitary pulmonary nodules (SPNs). Fifty-six consecutive subjects with SPNs underwent contrast-enhanced 320-row multidetector dynamic volume CT. The dual-input maximum slope CT perfusion analysis was employed to calculate the pulmonary flow (PF), bronchial flow (BF), and perfusion index [Formula: see text]. Differences in perfusion parameters between malignant and benign tumours were assessed with histopathological diagnosis as the gold standard. Diagnostic value of the perfusion parameters was calculated using the receiver-operating characteristic (ROC) curve analysis. Amongst 56 SPNs, statistically significant differences in all three perfusion parameters were revealed between malignant and benign tumours. The PI demonstrated the biggest difference between malignancy and benignancy: 0.30 ± 0.07 vs. 0.51 ± 0.13 , P perfusion parameters, producing a sensitivity of 0.95, specificity of 0.83, positive likelihood ratio (+LR) of 5.59, and negative likelihood ratio (-LR) of 0.06 in identifying malignancy. The PI derived from the dual-input maximum slope CT perfusion analysis is a valuable biomarker for identifying malignancy in SPNs. PI may be potentially useful for lung cancer treatment planning and forecasting the therapeutic effect of radiotherapy treatment. • Modern CT equipment offers assessment of vascular parameters of solitary pulmonary nodules (SPNs) • Dual vascular supply was investigated to differentiate malignant from benign SPNs. • Different dual vascular supply patterns were found in malignant and benign SPNs. • The perfusion index is a useful biomarker for differentiate malignancy from benignancy.

  2. Incidental multiple pulmonary nodules: benign metastasizing leiomyoma and {sup 18}F-FDG PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seok Mo [Kosin University Medical School, Busan (Korea, Republic of)

    2007-06-15

    Benign metastasizing leiomyoma(BML) is a rare condition affecting women with a history of having undergone hysterectomy or myomectomy for a benign uterine fibroid, that is found to have metastasized to extrauterine sites, usually many years after hysterectomy. 1,2) Patient with BML almost always asymptomatic, although if the lesions are large enough, they can cause compressive symptoms. Among several hypothesis of pathogenesis, most plausible theory is that these tumors represent a true metastatic lesion but are very low-grade sarcoma. 3) Because the tumor is responsive to estrogen, menopause and pregnancy have slowed the growth of these lesion 4) and it seems reasonable to perform hysterectomy in patients with a uterine mass and, at the same time, perform oophorectomy for hormonal control. BML is an unusual cause of diffuse pulmonary nodules which should be considered in females with unexplained nodules and a history of surgery for uterine leiomyoma.

  3. Solitary pulmonary nodule

    Science.gov (United States)

    Lung cancer - solitary nodule; Infectious granuloma - pulmonary nodule; SPN ... More than half of all solitary pulmonary nodules are noncancerous ... infections. Infectious granulomas (which are formed by cells as ...

  4. Differentiation of benign and malignant solitary pulmonary nodules : value of contrast-enhanced dynamic MR imaging

    International Nuclear Information System (INIS)

    Kim, Jeong Ho; Kim, Hyung Jin; Han, Heon; Lee, Hong Lyeol; Kim, Kwang Ho; Suh, Chang Hae

    1999-01-01

    To evaluate the usefulness of contrast-enhanced dynamic MR imaging for differentiation of benign and malignant solitary pulmonary nodules (SPNs). Twenty-three patients with histologically or radiologically provened SPNs smaller than 40mm (14 benign, 9 malignant) underwent MR examination using the breath-hold fast multiplanar spoiled gradient echo (FMPSPGR) technique. Pre-enhancement MR examination was followed by serial scans obtained at one-minute intervals, beginning one-minute after the onset of bolus injection of paramagnetic contrast agent for a total of five scans. Signal intensities of SPNs were measured from pre- and post-contrast enhanced MR images and peak percentage increase in signal intensity (p%SI) was calculated. Mean percentage increase in signal intensity (m%SI) was also calculated and the time-m%SI curve was plotted. The enhancement patterns of SPNs were classified as homogeneous, peripheral rim-like, inhomogeneous, or no (or minimal) enhancement. We compared differences in p%SI, the pattern of the time-m%SI curve, and the pattern of enhancement between benign and malignant SPNs. On dynamic MR images, alignant SPNs (n=9) showed a significantly higher p%SI than benign SPNs (n=14) (malignant : mean 120.6, range 81.8-171.6; benign : mean 29.5, range 3.7-78.9)(p<0.0001). With 80 p%SI as the threshold for malignancy-positive, both sensitivity and specificity were 100%. The m%SI of malignant SPNs rapidly increased at one minute after enhancement and decreased gradually thereafter, whereas that of benign SPNs increased more slowly to form a plateau. Eighty-nine percent (8/9) of malignant SPNs showed homogeneous enhancement. In contrast, among benign SPNs, peripheral rim-like enhancement and no (or minimal) enhancement occurred in the same proportion of cases : 50%(7/14). The superb demonstration of different enhancement characteristics obtained using dynamic contrast-enhanced MR imaging is useful to discriminate malignant from benign SPNs

  5. Management of Pulmonary Nodules

    OpenAIRE

    Arvin Aryan

    2010-01-01

    Pulmonary nodule characterization is currently being redefined as new clinical, radiological and pathological data are reported, necessitating a reevaluation of the clinical management."nIn approach to an incidentally detected pulmonary nodule, we should consider that there are different risk situations, different lesion morphologies, and different sizes with various management options."nIn this session we will review the different risk situations for patients with pulmonary nodules...

  6. Indeterminate Pulmonary Nodules at Colorectal Cancer Staging

    DEFF Research Database (Denmark)

    Nordholm-Carstensen, Andreas; Wille-Jørgensen, Peer A; Jorgensen, Lars N

    2013-01-01

    This study aimed to estimate the prevalence of indeterminate pulmonary nodules and specific radiological and clinical characteristics that predict malignancy of these at initial staging chest computed tomography (CT) in patients with colorectal cancer. A considerable number of indeterminate...... pulmonary nodules, which cannot readily be classified as either benign or malignant, are detected at initial staging chest CT in colorectal cancer patients....

  7. Visual and semiquantitative analysis of 18F-fluorodeoxyglucose positron emission tomography using a partial-ring tomograph without attenuation correction to differentiate benign and malignant pulmonary nodules

    International Nuclear Information System (INIS)

    Skehan, S.J.; Coates, G.; Otero, C.; O'Donovan, N.; Pelling, M.; Nahmias, C.

    2001-01-01

    Many studies have reported the use of attenuation-corrected positron emission tomography with 18 F-fluorodeoxyglucose (FDG PET) with full-ring tomographs to differentiate between benign and malignant pulmonary nodules. We sought to evaluate FDG PET using a partial-ring tomograph without attenuation correction. A retrospective review of PET images from 77 patients (range 38-84 years of age) with proven benign or malignant pulmonary nodules was undertaken. All images were obtained using a Siemens/CTI ECAT ART tomograph, without attenuation correction, after 185 MBq 18 F-FDG was injected. Images were visually graded on a 5-point scale from 'definitely malignant' to 'definitely benign,' and lesion-to-background (LB) ratios were calculated using region of interest analysis. Visual and semiquantitative analyses were compared using receiver operating characteristic analysis. Twenty lesions were benign and 57 were malignant. The mean LB ratio for benign lesions was 1.5 (range 1.0-5.7) and for malignant lesions 5.7 (range 1.2-14.1) (p < 0.001). The area under the ROC curve for LB ratio analysis was 0.95, and for visual analysis 0.91 (p = 0.39). The optimal cut-off ratio with LB ratio analysis was 1.8, giving a sensitivity of 95% and a specificity of 85%. For lesions thought to be 'definitely malignant' on visual analysis, the sensitivity was 93% and the specificity 85%. Three proven infective lesions were rated as malignant by both techniques (LB ratio 2.6-5.7). FDG PET without attenuation correction is accurate for differentiating between benign and malignant lung nodules. Results using simple LB ratios without attenuation correction compare favourably with the published sensitivity and specificity for standard uptake ratios. Visual analysis is equally accurate. (author)

  8. Benign solitary solid cold thyroid nodules

    DEFF Research Database (Denmark)

    Døssing, Helle; Bennedbaek, Finn Noe; Karstrup, Steen

    2002-01-01

    PURPOSE: To evaluate the effects of ultrasonography (US)-guided interstitial laser photocoagulation (ILP) on the volume of benign solitary solid cold thyroid nodules and any nodule-related symptoms. MATERIALS AND METHODS: ILP was performed in 16 patients with normal thyroid function and a solid...... benign thyroid nodule. None of the patients had uptake on a radionuclide scan. Patients underwent one ILP session. A needle was positioned in the thyroid nodule with US guidance, and the laser fiber was placed in the lumen of the needle. Patients were treated for 287-1,200 seconds with an output power...... of 1-3 W. ILP was performed with continuous US guidance and terminated when the echogenic changes were stationary. Thyroid nodule volume and thyroid function were evaluated before and 1, 3, and 6 months after treatment. During the same period, 15 untreated patients (control group) were followed up...

  9. Clinical value of 99Tcm-MIBI imaging combined with serum tumor markers in diagnosis of benign and malignant pulmonary nodules

    International Nuclear Information System (INIS)

    Zhao Yigang; Song Bo

    2016-01-01

    Objective: To evaluate the significance of 99 Tc m -MIBI imaging combined with serum tumor markers (NSE, CYFRA21-1) in diagnosis of pulmonary nodules. Methods: 54 patients who were detected pulmonary nodules by Computed Tomography(CT) were involved in this study. All of them underwent 99 Tc m -MIBI imaging and serum tumor markers testing. The sensitivity, specificity and accuracy of two methods were calculated respectively and the sensitivity, specificity, accuracy, positive predictive value, negative predictive value of combined application of two methods were also calculated. Results: The accuracy rate and positive predictive value of 99 Tc m -MIBI imaging combined with serum tumor markers were higher than that of alone detection(P < 0.05). The specificity of the combination detection was higher than that of tumor marker detection(P < 0.05). There was no significantly difference on the specificity between combination detection and 99 Tc m -MIBI imaging(P > 0.05). The sensitivity, negative predictive value among combination, 99 Tc m -MIBI imaging and tumor marker detection had no significance difference(P > 0.05). Conclusion: 99 Tc m -MIBI imaging combined with serum tumor markers has great clinical significance in identifying pulmonary nodules. (authors)

  10. On the computed tomographic diagnosis of pulmonary nodules

    International Nuclear Information System (INIS)

    Higashi, Yuuichirou

    1988-01-01

    Computed tomography (CT) was used to examine 53 pulmonary nodules which were considered not definitely calcified on plain radiographs or conventional tomograms. An average CT number was calculate for each lesion. For the primary lung cancers, the average CT number was 36 HU with a standard deviation of 6.6 HU, while the benign lesions had the mean CT number of 69 HU, with a standard deviation of 42.8 HU. The mean CT number separating lung malignancies from benign lesions was 78.8 HU. To evaluate the attenuation values within each nodule, iso-CT value map was obtained by using Siemens therapy planning system, MEVAPLAN. Nodules were classified into five categories, Type I to V. All of three nodules classified as Type IV were benign. Iso-CT value map was effective in establishing the benignancy of nodules. The quantitative computed tomographic analysis of pulmonary nodules was evaluated by dual-energy CT. Dual-energy CT has the potential to eliminate the effect of spectral hardening by use of monoenergic images derived from dual-kV data and to separate high CT numbers due to calcium from those due to high density organic material. (author)

  11. Pulmonary nodules: detection, assessment, and CAD.

    Science.gov (United States)

    Girvin, Francis; Ko, Jane P

    2008-10-01

    The imaging of pulmonary nodules is an evolving and dynamic field. In this review, we discuss the detection and multitechnique characterization of pulmonary nodules, emphasizing the impact of technological advances on both noninvasive and invasive evaluation and surveillance. The potential contribution of MRI, evolving imaging-guided techniques, and computer applications are also discussed. Advances in MDCT and PET and the potential contribution of fast-imaging MRI sequences and computer applications should continue to improve our evaluation of the solitary pulmonary nodule.

  12. Malignancy risk estimation of pulmonary nodules in screening CTs

    DEFF Research Database (Denmark)

    van Riel, Sarah J; Ciompi, Francesco; Winkler Wille, Mathilde M

    2017-01-01

    PURPOSE: To compare human observers to a mathematically derived computer model for differentiation between malignant and benign pulmonary nodules detected on baseline screening computed tomography (CT) scans. METHODS: A case-cohort study design was chosen. The study group consisted of 300 chest CT...... scans from the Danish Lung Cancer Screening Trial (DLCST). It included all scans with proven malignancies (n = 62) and two subsets of randomly selected baseline scans with benign nodules of all sizes (n = 120) and matched in size to the cancers, respectively (n = 118). Eleven observers and the computer....... Differences in morphological features between malignant and size-matched benign nodules were analyzed using chi-square analysis with Bonferroni correction. A significant difference was defined at p

  13. Management of solid pulmonary nodules

    International Nuclear Information System (INIS)

    Poschenrieder, F.; Beyer, L.; Stroszczynski, C.; Hamer, O.W.; Rehbock, B.; Diederich, S.; Wormanns, D.

    2014-01-01

    The increasing availability of computed tomography has meant that the number of incidentally detected solitary pulmonary nodules (SPN) has greatly increased in recent years. A reasonable management of these SPN is necessary in order to firstly be able to detect malignant lesions early on and secondly to avoid upsetting the patient unnecessarily or carrying out further stressful diagnostic procedures. This review article shows how the dignity of SPNs can be estimated and based on this how the management can be accomplished taking established guidelines into consideration. (orig.) [de

  14. Pulmonary nodule characterization, including computer analysis and quantitative features.

    Science.gov (United States)

    Bartholmai, Brian J; Koo, Chi Wan; Johnson, Geoffrey B; White, Darin B; Raghunath, Sushravya M; Rajagopalan, Srinivasan; Moynagh, Michael R; Lindell, Rebecca M; Hartman, Thomas E

    2015-03-01

    Pulmonary nodules are commonly detected in computed tomography (CT) chest screening of a high-risk population. The specific visual or quantitative features on CT or other modalities can be used to characterize the likelihood that a nodule is benign or malignant. Visual features on CT such as size, attenuation, location, morphology, edge characteristics, and other distinctive "signs" can be highly suggestive of a specific diagnosis and, in general, be used to determine the probability that a specific nodule is benign or malignant. Change in size, attenuation, and morphology on serial follow-up CT, or features on other modalities such as nuclear medicine studies or MRI, can also contribute to the characterization of lung nodules. Imaging analytics can objectively and reproducibly quantify nodule features on CT, nuclear medicine, and magnetic resonance imaging. Some quantitative techniques show great promise in helping to differentiate benign from malignant lesions or to stratify the risk of aggressive versus indolent neoplasm. In this article, we (1) summarize the visual characteristics, descriptors, and signs that may be helpful in management of nodules identified on screening CT, (2) discuss current quantitative and multimodality techniques that aid in the differentiation of nodules, and (3) highlight the power, pitfalls, and limitations of these various techniques.

  15. Classification of pulmonary nodules in lung CT images using shape and texture features

    Science.gov (United States)

    Dhara, Ashis Kumar; Mukhopadhyay, Sudipta; Dutta, Anirvan; Garg, Mandeep; Khandelwal, Niranjan; Kumar, Prafulla

    2016-03-01

    Differentiation of malignant and benign pulmonary nodules is important for prognosis of lung cancer. In this paper, benign and malignant nodules are classified using support vector machine. Several shape-based and texture-based features are used to represent the pulmonary nodules in the feature space. A semi-automated technique is used for nodule segmentation. Relevant features are selected for efficient representation of nodules in the feature space. The proposed scheme and the competing technique are evaluated on a data set of 542 nodules of Lung Image Database Consortium and Image Database Resource Initiative. The nodules with composite rank of malignancy "1","2" are considered as benign and "4","5" are considered as malignant. Area under the receiver operating characteristics curve is 0:9465 for the proposed method. The proposed method outperforms the competing technique.

  16. Pulmonary nodules: a quantitative method of diagnosis by evaluating nodule perimeter difference to approximate oval using three-dimensional CT images.

    Science.gov (United States)

    Kamiya, Hisashi; Murayama, Sadayuki; Kakinohana, Yasumasa; Miyara, Tetsuhiro

    2011-01-01

    The purpose of this study was to investigate whether maximum nodule perimeter to the approximate oval could discriminate benign nodules from malignancy. Measurement of maximum nodule perimeter difference to the approximate oval was performed using volume-rendering images of three directions of each pulmonary nodule. The margin was then traced manually and our custom software delineated the approximate oval automatically. The maximum nodule perimeter difference was 26.5±23.3 mm for malignant and 16.6±16.9 mm for benign nodules, showing an almost statistically significant difference (P=.07). This study suggests that the maximum nodule perimeter difference to the approximate oval of the malignant nodules has a tendency to be longer than benign nodules. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Pulmonary nodules secondary to total parenteral alimentation

    International Nuclear Information System (INIS)

    Landry, B.A.; Melhem, R.E.

    1989-01-01

    A seven-year-old male, who had a retroperitoneal alveolar rhabdomyosarcoma and was on total parenteral alimentation (TPN) developed muliple pulmonary nodules, indistinguishable from metastases. These proved to be multiple lipid emboli on open biopsy. (orig.)

  18. Pulmonary nodules secondary to total parenteral alimentation

    Energy Technology Data Exchange (ETDEWEB)

    Landry, B.A.; Melhem, R.E.

    1989-07-01

    A seven-year-old male, who had a retroperitoneal alveolar rhabdomyosarcoma and was on total parenteral alimentation (TPN) developed muliple pulmonary nodules, indistinguishable from metastases. These proved to be multiple lipid emboli on open biopsy. (orig.).

  19. Histoplasmosis presenting with solitary pulmonary nodule: Two ...

    African Journals Online (AJOL)

    Pulmonary histoplasmosis is a granulomatous disease, whose diagnosis is not always easy, as it may simulate metastatic lesions due to similar radiographic findings. We herein report two cases of histoplasmosis with solitary pulmonary nodule in asymptomatic patients with histories of cancer surgeries, whose diagnoses ...

  20. "Nodule in Nodule" on Thyroid Ultrasonography: Possibility of Follicular Carcinoma Transformed from Benign Thyroid Tumor.

    Science.gov (United States)

    Kobayashi, Kaoru; Ota, Hisashi; Hirokawa, Mitsuyoshi; Yabuta, Tomonori; Fukushima, Mitsuhiro; Masuoka, Hiroo; Higashiyama, Takuya; Kihara, Minoru; Ito, Yasuhiro; Miya, Akihiro; Miyauchi, Akira

    2017-04-01

    It is generally considered impossible to differentiate follicular carcinomas from follicular adenomas by means of ultrasonography or cytology before surgery. Therefore, follicular carcinoma is histopathologically diagnosed by verifying capsular and/or vascular invasion after surgery. However, ultrasonography may play an important role in diagnosing follicular carcinoma preoperatively in a small number of cases. Four cases of follicular carcinoma or follicular neoplasm that transformed from a benign thyroid tumor and demonstrated a "nodule in nodule" appearance on ultrasonography are presented in this report. Characteristic ultrasound features of such patients are: (1) a "nodule in nodule" appearance, (2) a well-defined boundary line between the nodules, and (3) separate distribution of blood signals within each nodule. A small number of patients with follicular carcinomas or follicular neoplasms may present with a "nodule in nodule" appearance on ultrasonography. It was suggested a long time ago that follicular carcinomas may develop from benign thyroid tumors. The fact that follicular carcinomas appear within benign tumors may be evidence of thyroid tumorigenesis.

  1. Solitary pulmonary nodule by pulmonary hematoma under warfarin therapy

    International Nuclear Information System (INIS)

    Scheppach, W.; Kulke, H.; Liebau, G.; Braun, H.; Wuerzburg Univ.

    1983-01-01

    Pulmonary hematoma is a rare cause of a pulmonary nodule. Mostly it results from penetrating or blunt chest injuries. The case of a patient is reported, whose chest X-ray showed a pulmonary nodule suspected of malignancy. This patient was maintained permanently on anticoagulants (warfarin derivates) after cardiac valve replacement with a prosthesis. A definite diagnosis could not be established by non-invasive methods. A needle biopsy of the lung was impracticable because of the location of the pulmonary lesion; an exploratory thoracotomy could not be carried out due to a general indication of nonoperability. Control examinations showed that the pulmonary nodule had vanished completely within four months. In consideration of the patient's clinical situation it can be concluded that the pulmonary lesion was caused by a hematoma of the lung. (orig.) [de

  2. Clinical significance of pulmonary nodules detected on abdominal CT in pediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Breen, Micheal; Lee, Edward Y. [Boston Children' s Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Zurakowski, David [Boston Children' s Hospital and Harvard Medical School, Departments of Anesthesiology and Surgery, Boston, MA (United States)

    2015-11-15

    The clinical significance of a pulmonary nodule that is detected incidentally on CT studies in children is unknown. In addition, there is limited information regarding the management of incidentally detected pulmonary nodules discovered on abdominal CT studies in children. The purpose of this study was to investigate the clinical significance of incidental pulmonary nodules detected on abdominal CT studies in children. This was a retrospective study performed following institutional review board approval. Abdominal CT reports in patients younger than 18 years of age from July 2004 to June 2011 were reviewed for the terms ''nodule,'' ''nodular'' or ''mass'' in reference to the lung bases. The study population included those pediatric patients in whom pulmonary nodules were initially detected on abdominal CT studies. The largest pulmonary nodules detected on CT studies were evaluated for their features (size, shape, margin, attenuation, location, and presence of calcification and cavitation). Follow-up CT studies and clinical records were reviewed for demographic information, history of underlying malignancies and the clinical outcome of the incidental pulmonary nodules. Comparison of malignant versus benign pulmonary nodules was performed with respect to the size of the nodule, imaging features on CT, and patient history of malignancy using the Student's t-test and Fisher exact test. Youden J-index in receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off size for suggesting a high risk of malignancy of incidentally detected pulmonary nodules. Pulmonary nodules meeting inclusion criteria were detected in 62 (1.2%) of 5,234 patients. The mean age of patients with nodules was 11.2 years (range: 5 months-18 years). Thirty-one patients (50%) had follow-up CT studies and two of these patients (6%) were subsequently found to have malignant pulmonary nodules. Both of these

  3. Histoplasmosis presenting with solitary pulmonary nodule: Two ...

    African Journals Online (AJOL)

    2014-08-04

    Aug 4, 2014 ... hospital because of a right pulmonary nodule, discovered on a follow‑up chest radiogram. He had a history of abdominoperineal resection for rectal ... Given the patient's history of tumor resection, the ... Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

  4. Solitary pulmonary nodule and {sup 18}F-FDG PET/CT. Part 1: epidemiology, morphological evaluation and cancer probability

    Energy Technology Data Exchange (ETDEWEB)

    Mosmann, Marcos Pretto; Borba, Marcelle Alves; Macedo, Francisco Pires Negromonte; Liguori, Adriano de Araujo Lima; Villarim Neto, Arthur, E-mail: mosmann@gmail.com [Liga Norte Riograndense Contra o Cancer, Natal, RN (Brazil); Lima, Kenio Costa de [Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN (Brazil). Programa de Pos-Graduacao em Saude Coletiva

    2016-01-15

    Solitary pulmonary nodule corresponds to a common radiographic finding, which is frequently detected incidentally. The investigation of this entity remains complex, since characteristics of benign and malignant processes overlap in the differential diagnosis. Currently, many strategies are available to evaluate solitary pulmonary nodules with the main objective of characterizing benign lesions as best as possible, while avoiding to expose patients to the risks inherent to invasive methods, besides correctly detecting cases of lung cancer so as the potential curative treatment is not delayed. This first part of the study focuses on the epidemiology, the morphological evaluation and the methods to determine the likelihood of cancer in cases of indeterminate solitary pulmonary nodule. (author)

  5. Three Dimensional Volumetric Analysis of Solid Pulmonary Nodules on Chest CT: 
Cancer Risk Assessment

    Directory of Open Access Journals (Sweden)

    Mengqi LI

    2016-05-01

    Full Text Available Background and objective The management of pulmonary nodules relies on cancer risk assessment, in which the only widely accepted criterion is diameter. The development of volumetric computed tomography (CT and three-dimensional (3D software enhances the clarity in displaying the nodules’ characteristics. This study evaluated the values of the nodules’ volume and 3D morphological characteristics (edge, shape and location in cancer risk assessment. Methods The CT data of 200 pulmonary nodules were retrospectively evaluated using 3D volumetric software. The malignancy or benignity of all the nodules was confirmed by pathology, histology or follow up (>2 years. Logistic regression analysis was performed to calculate the odds ratios (ORs of the 3D margin (smooth, lobulated or spiculated/irregular, shape (spherical or non-spherical, location (purely intraparenchymal, juxtavascular or pleural-attached, and nodule volume in cancer risk assessment for total and sub-centimeter nodules. The receiver operating characteristic (ROC curve was employed to determine the optimal threshold for the nodule volume. Results Out of 200 pulmonary nodules, 78 were malignant, whereas 122 were benign. The Logistic regression analysis showed that the volume (OR=3.3; P0.05. ROC analysis showed that the optimal threshold for malignancy was 666 mm³. For sub-centimeter nodules, the 3D margin was the only valuable predictive factor of malignancy (OR=60.5, 75.0; P=0.003, 0.007. Conclusion The volume and 3D margin are important factors considered to assess the cancer risk of pulmonary nodules. Volumes larger than 666 mm³ can be determined as high risk for pulmonary nodules; by contrast, nodules with lobulated, spiculated, or irregular margin present a high malignancy probability.

  6. New classification of small pulmonary nodules by margin characteristics on high-resolution CT

    Energy Technology Data Exchange (ETDEWEB)

    Furuya, K.; Koga, M. [National Kyushu Cancer Center, Fukuoka (Japan). Dept. of Radiology; Murayama, S.; Murakami, J.; Yabuuchi, H.; Masuda, K. [Kyushu Univ., Fukuoka (Japan). Dept. of Radiology; Soeda, H. [Kyushu Univ., Fukuoka (Japan). Dept. of Radiology; Kyushu Univ., Fukuoka (Japan). Dept. of Pathology 1; Ichinose, Y. [National Kyushu Cancer Center, Fukuoka (Japan). Dept. of Chest Surgery; Katsuda, Y. [National Kyushu Cancer Center, Fukuoka (Japan). Dept. of Pathology

    1999-09-01

    Purpose: To analyze margin characteristics of pulmonary nodules on high-resolution CT (HRCT) in order to improve imaging diagnoses. Material and Methods: HRCT images of 193 pulmonary nodules of less than 30 mm maximum diameter (113 primary cancers, 15 metastatic cancers, 55 inflammatory nodules, and 10 benign tumors) were reviewed and classified as to 6 types of margins: round, lobulated, densely spiculated, ragged, tentacle or polygonal andhalo. The relationships of these imaging types to the diagnoses, the underlying pathological features, mainly those of tumor growth patterns in 93 neoplasms, and the pathological characteristics of 14 inflammatory nodules were investigated. Results: Eighty-two percent of the lobulated, 97% of the densely spiculated, 93% of the ragged and 100% of the halo nodules were malignant. Eighty percent of the tentacle or polygonal nodules were inflammatory and 66% of the round ones were benign. The 6 types differed statistically as to the nature of the benignity/malignancy (p{lt}0.001). Pathologically, in case of neoplasms, most of the 6 types had a relationship to a particular tumor growth pattern. Conclusion: This HRCT classification method is useful for determining the nature of small pulmonary nodules and reflects the underlying pathological characteristics. (orig.)

  7. Pulmonary nodule classification with deep residual networks.

    Science.gov (United States)

    Nibali, Aiden; He, Zhen; Wollersheim, Dennis

    2017-10-01

    PURPOSE  : Lung cancer has the highest death rate among all cancers in the USA. In this work we focus on improving the ability of computer-aided diagnosis (CAD) systems to predict the malignancy of nodules from cropped CT images of lung nodules. We evaluate the effectiveness of very deep convolutional neural networks at the task of expert-level lung nodule malignancy classification. Using the state-of-the-art ResNet architecture as our basis, we explore the effect of curriculum learning, transfer learning, and varying network depth on the accuracy of malignancy classification. Due to a lack of public datasets with standardized problem definitions and train/test splits, studies in this area tend to not compare directly against other existing work. This makes it hard to know the relative improvement in the new solution. In contrast, we directly compare our system against two state-of-the-art deep learning systems for nodule classification on the LIDC/IDRI dataset using the same experimental setup and data set. The results show that our system achieves the highest performance in terms of all metrics measured including sensitivity, specificity, precision, AUROC, and accuracy. The proposed method of combining deep residual learning, curriculum learning, and transfer learning translates to high nodule classification accuracy. This reveals a promising new direction for effective pulmonary nodule CAD systems that mirrors the success of recent deep learning advances in other image-based application domains.

  8. Analysis of Growth Curve Type in Pulmonary Nodules with
Different Characteristics

    Directory of Open Access Journals (Sweden)

    Xinyue WANG

    2017-05-01

    Full Text Available Background and objective Background and objective Follow up by computed tomography (CT and growth evaluation are routine methods for the differential diagnosis of indeterminate pulmonary nodules in clinical practice. Pulmonary nodules with diverse biological behaviors may show different growth patterns and velocities. The aim of this study is to identify the volume growth curve of both benign and malignant pulmonary nodules. This work also intends to determine these nodules’ growth patterns and provide evidence for the establishment of a follow-up strategy. Methods The CT data of 111 pulmonary nodules (54 solid, 57 subsolid were retrospectively evaluated using 3D volumetric software. All of these nodules have been followed up at least twice. Of these nodules, 35 were confirmed as lung cancers, whereas 5 were confirmed as benign by pathology or histology. Moreover, 71 nodules showed no growth in more than 2 years. Stable nodules were defined as low-risk nodules, as confirmed by reevaluation from experts. On the basis of their densities and diameters, the nodules were classified into four types: benign/low-risk solid nodules, malignant solid nodules (diameter ≤1 cm and >1 cm, benign/low-risk subsolid nodules, and malignant subsolid nodules (diameter ≤1 cm and >1 cm. The follow-up interval time (d were plotted on the x-axis, and the nodules’ volume (mm3 and logarithmic volume were plotted on the y-axis. Two radiologists subjectively determined the type of growth curve. Chi-square test was performed to compare the growth curves of benign/low-risk and malignant nodules. Results Of 18 solid cancers, 12 cases (66% were found with steep ascendant growth curves. Those of 3 cases (16.7% were flat ascendant, 2 cases (11.1% slowly ascendant, and 1 (5.56% case flat. Of 17 subsolid cancers, 8 cases (47.1% manifested steep ascendant growth curves. Those of 4 cases (23.5% were slowly ascendant, 3 (17.6% flat, and 2 (11.8% descendant–ascendant. Of 36

  9. Interstitial laser photocoagulation (ILP) of benign cystic thyroid nodules--a prospective randomized trial

    DEFF Research Database (Denmark)

    Døssing, Helle; Bennedbæk, Finn Noe; Hegedüs, Laszlo

    2013-01-01

    Recurrence rate, after aspiration, in cystic thyroid nodules is very high. Interstitial laser photocoagulation (ILP) is a minimally invasive procedure that reduces the need for surgery in patients with a benign solid thyroid nodule.......Recurrence rate, after aspiration, in cystic thyroid nodules is very high. Interstitial laser photocoagulation (ILP) is a minimally invasive procedure that reduces the need for surgery in patients with a benign solid thyroid nodule....

  10. Interstitial laser photocoagulation for benign thyroid nodules: time to treat large nodules.

    Science.gov (United States)

    Amabile, Gerardo; Rotondi, Mario; Pirali, Barbara; Dionisio, Rosa; Agozzino, Lucio; Lanza, Michele; Buonanno, Luciano; Di Filippo, Bruno; Fonte, Rodolfo; Chiovato, Luca

    2011-09-01

    Interstitial laser photocoagulation (ILP) is a new therapeutic option for the ablation of non-functioning and hyper-functioning benign thyroid nodules. Amelioration of the ablation procedure currently allows treating large nodules. Aim of this study was to evaluate the therapeutic efficacy of ILP, performed according to a modified protocol of ablation, in patients with large functioning and non-functioning thyroid nodules and to identify the best parameters for predicting successful outcome in hyperthyroid patients. Fifty-one patients with non-functioning thyroid nodules (group 1) and 26 patients with hyperfunctioning thyroid nodules (group 2) were enrolled. All patients had a nodular volume ≥40 ml. Patients were addressed to 1-3 cycles of ILP. A cycle consisted of three ILP sessions, each lasting 5-10 minutes repeated at an interval of 1 month. After each cycle of ILP patients underwent thyroid evaluation. A nodule volume reduction, expressed as percentage of the basal volume, significantly occurred in both groups (F = 190.4; P < 0.0001 for group 1 and F = 100.2; P < 0.0001 for group 2). Receiver-operator-characteristic (ROC) curves were constructed for: (i) percentage of volume reduction; (ii) difference in nodule volume; (iii) total amount of energy delivered expressed in Joule. ROC curves identified the percentage of volume reduction as the best parameter predicting a normalized serum TSH (area under the curve 0.962; P < 0.0001). Intraoperative complications consisted in: (i) mild pain occurring in five (6.5%) patients, (ii) vasovagal reaction in two (2.6%) patients, (iii) fever within 24 hours from ILP in five (6.5%) patients. No major complications including persistent pain, laringeal nerve dysfunction, hypoparathyroidism, pseudocystic transformation, and/or neck fascitis were observed. ILP represents a valid alternative to surgery also for large benign thyroid nodules, both in terms of nodule size reduction and cure of

  11. Surgical resection of highly suspicious pulmonary nodules without a tissue diagnosis

    International Nuclear Information System (INIS)

    Heo, Eun-Young; Lee, Kyung-Won; Jheon, Sanghoon; Lee, Jae-Ho; Lee, Choon-Taek; Yoon, Ho-II

    2011-01-01

    The safety and efficacy of surgical resection of lung nodule without tissue diagnosis is controversial. We evaluated direct surgical resection of highly suspicious pulmonary nodules and the clinical and radiological predictors of malignancy. Retrospective analyses were performed on 113 patients who underwent surgical resection without prior tissue diagnosis for highly suspicious pulmonary nodules. Clinical and radiological characteristics were compared between histologically proven benign and malignant nodules after resection. Total costs, length of hospitalization and waiting time to surgery were compared with those of patients who had tissue diagnosis prior to surgery. Among 280 patients with pulmonary nodules suspicious for lung cancer, 113 (40.4%) underwent operation without prior tissue diagnosis. Lung nodules were diagnosed as malignant in 96 (85%) of the 113 patients. Except for forced expiratory volume in 1 s, clinical characteristics were not significantly different according to the pathologic results. Forty-five (90%) of 50 patients with ground-glass opacity nodules had a malignancy. Mixed ground-glass opacity, bubble lucency, irregular margin and larger size correlated with malignancy in ground-glass opacity nodules (P<0.05). Fifty-one (81%) of 67 patients with solid nodules had a malignancy. Spiculation, pre-contrast attenuation and contrast enhancement significantly correlated with malignancy in solid nodules (P<0.05). Surgical resection without tissue diagnosis significantly decreased total costs, hospital stay and waiting time (P<0.05). Direct surgical resection of highly suspicious pulmonary nodules can be a valid procedure. However, careful patient selection and further investigations are required to justify direct surgical resection. (author)

  12. Pulmonary benign metastasizing leiomyoma: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Fu Yili

    2012-12-01

    Full Text Available Abstract Pulmonary benign metastasizing leiomyoma characterized by the growth of uterine leiomyoma in the lung is a very rare disease. We herein report the case of a 46-year-old asymptomatic woman who underwent a total abdominal hysterectomy for her multiple uterine leiomyomas 5 years ago, with the presence of multiple shadows in her chest roentgenogram during the regular check-up. Chest computerized tomography (CT showed multiple solitary nodules in both lungs. Video-assisted thoracoscopic surgery with a wedge resection of the lesion was performed. Histopathologically, the pulmonary nodule was composed of benign smooth muscle cells and demonstrated low mitotic activity and absence of necrosis. Immunohistochemical staining for smooth muscle actin (SMA and Desmin were extremely positive. CD10, CD117 and S-100 were negative in the tumor cells. Positive immunoreactivity for estrogen receptor (ER and progesterone receptor (PR were detected. The pathological diagnosis was pulmonary benign metastasizing leiomyoma.

  13. Indeterminate Pulmonary Nodules in Colorectal-Cancer

    DEFF Research Database (Denmark)

    Nordholm-Carstensen, Andreas; Jorgensen, Lars N; Wille-Jørgensen, Peer A

    2015-01-01

    BACKGROUND: The clinical significance of indeterminate pulmonary nodules (IPN) at staging computed tomography (CT) for colorectal cancer (CRC), and the optimal diagnostic approach, are debated. This study aimed to analyse variability in radiologists' detection of IPN at staging CT for CRC. METHODS......: All patients with CRC referred to our center between 2006 and 2011 were included. Primary staging CT scans were re-evaluated by an experienced thoracic radiologist whose findings were entered into a dedicated database and merged with data from the Danish Colorectal Cancer Group database, the National...... investigated radiological characteristics or clinicopathological factors were significantly associated with malignancy of IPN. CONCLUSION: The characterization of pulmonary findings on staging CT for CRC varied greatly between the radiologists, and double-reading of scans with IPN is recommended prior...

  14. 3D pulmonary nodules detection using fast marching segmentation ...

    African Journals Online (AJOL)

    This paper proposes an automated computer aided diagnosis system for detection of pulmonary nodules based on three dimensional (3D) structures. Lung ... The proposed detection methodology can give the accuracy of 92%. Keywords: lung cancer; pulmonary nodule; fast marching; 3D features; random forest classifier.

  15. Radiofrequency Ablation of Benign Thyroid Nodules and Recurrent Thyroid Cancers: Consensus Statement and Recommendations

    Energy Technology Data Exchange (ETDEWEB)

    Na, Dong Gyu [Human Medical Imaging and Intervention Center, Seoul (Korea, Republic of); Lee, Jeong Hyun [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Jung, So Lyung [Seoul St. Marys Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2012-06-15

    Radiofrequency ablation is a new non-surgical treatment modality for patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology has developed recommendations for the treatment of benign thyroid nodules and recurrent thyroid cancers using radiofrequency ablation. These recommendations are based on evidence from the current literature and expert consensus

  16. CT Fluoroscopy-Guided Core Biopsy for Diagnosis of Small (≤ 20 mm) Pulmonary Nodules

    International Nuclear Information System (INIS)

    Lee, Hye Larn; Kim, Yoon Kyung; Woo, Ok Hee; Yong, Hwan Seok; Kang, Eun Young; Kim, Hyun Koo; Shin, Bong Kyung

    2011-01-01

    To evaluate the efficacy of CT fluoroscopy-guided core biopsy of small pulmonary nodules. This study included 62 patients (35 men, 27 women; age range, 36-85 years) that had a small (≤ 20 mm) pulmonary nodule and underwent CT fluoroscopy-guided core biopsy. The overall diagnostic accuracy and complication rate were calculated. The diagnostic accuracy was compared between two groups according to the nodule size (≤ 10 mm vs. > 10 mm), and nodule density (solid vs. subsolid). Malignant or premalignant lesions were finally diagnosed in 39 patients; 36 true-positive and three false-negative findings (sensitivity, 92%). A benign lesion was finally diagnosed in 23 patients, with no false-positive results (specificity, 100%). The overall diagnostic accuracy was 95%. The sensitivity and diagnostic accuracy were 85% and 91% for nodules ≤ 10 mm, and 96% and 97% for nodules > 10 mm (p > 0.05). The sensitivity and diagnostic accuracy were 93% and 96% in the solid group and 90% and 92% in the subsolid group (p > 0.05). Seventeen (27%) patients had a pneumothorax and two (3%) required a closed thoracostomy. CT fluoroscopy-guided core biopsy of small pulmonary nodules yields high diagnostic accuracy with acceptable complication rates.

  17. CT Fluoroscopy-Guided Core Biopsy for Diagnosis of Small ({<=} 20 mm) Pulmonary Nodules

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hye Larn; Kim, Yoon Kyung; Woo, Ok Hee; Yong, Hwan Seok; Kang, Eun Young [Dept. of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kim, Hyun Koo [Dept. of Thoracic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Shin, Bong Kyung [Dept. of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2011-10-15

    To evaluate the efficacy of CT fluoroscopy-guided core biopsy of small pulmonary nodules. This study included 62 patients (35 men, 27 women; age range, 36-85 years) that had a small ({<=} 20 mm) pulmonary nodule and underwent CT fluoroscopy-guided core biopsy. The overall diagnostic accuracy and complication rate were calculated. The diagnostic accuracy was compared between two groups according to the nodule size ({<=} 10 mm vs. > 10 mm), and nodule density (solid vs. subsolid). Malignant or premalignant lesions were finally diagnosed in 39 patients; 36 true-positive and three false-negative findings (sensitivity, 92%). A benign lesion was finally diagnosed in 23 patients, with no false-positive results (specificity, 100%). The overall diagnostic accuracy was 95%. The sensitivity and diagnostic accuracy were 85% and 91% for nodules {<=} 10 mm, and 96% and 97% for nodules > 10 mm (p > 0.05). The sensitivity and diagnostic accuracy were 93% and 96% in the solid group and 90% and 92% in the subsolid group (p > 0.05). Seventeen (27%) patients had a pneumothorax and two (3%) required a closed thoracostomy. CT fluoroscopy-guided core biopsy of small pulmonary nodules yields high diagnostic accuracy with acceptable complication rates.

  18. CT SCAN EVALUATION OF PULMONARY NODULE

    Directory of Open Access Journals (Sweden)

    A. Ravi Kumar

    2016-06-01

    Full Text Available BACKGROUND Lung carcinomas are quite commonly diagnosed. Thanks to the ever increasing smokers’ population. Majority of the city dwellers are at a higher risk of having this disease when compared to the village counterparts. The stigma through which the person and the family have to undergo before confirming the diagnosis is enormous. So the radiographic methods of diagnosing the malignancies have to improve. Before confirming the diagnosis, the radiologists, the treating physicians should be somewhat confident about the diagnosis so as to prepare the patients and their relatives for the most probable diagnosis before the confirmatory report. The confirmatory procedures include the PET scan and the Histopathology. Both are time consuming procedures and in an economy like ours, finding a PET scanning centre is rather difficult. So the most probable diagnosis has to be thought of using minimal resource. This study puts in a sincere effort to understand and evaluate the pulmonary nodule when identified by a CT scan. This paper is intended to help the practicing radiologists and also make life easy for a practicing physician to identify correctly the lesions and also help the patients to prevent further progression of the disease. METHODS The study was a cross-sectional study. The sample size of the study consisted of thirty patients. CT scan was done in thirty patients who were identified to have lung nodules either by other mode of radiological studies or first time identified in a CT scan itself. The study was conducted in Fathima Institute of Medical Sciences, Kadapa. The study was conducted from 2014 to 2015. RESULT Non-solid nodules were more in number when compared to the solid nodules. All the non-solid nodules were confirmed to be adenomas. Eighty percent of the nodules which were more than 8 mm in size were confirmed to be malignant. One hundred percent of the spiculated border on CT was confirmed to be malignant. In the present study

  19. Pulmonary nodules and metastases in colorectal cancer.

    Science.gov (United States)

    Nordholm-Carstensen, Andreas

    2016-01-01

    Patients with newly diagnosed colorectal cancer (CRC) are subjected to a preoperative thoraco-abdominal CT scan to determine the cancer stage. This staging is of relevance with regard to treatment and prognosis. About 20% of the patients have distant metastatic spread at the time of diagnosis, i.e. synchronous metastases. Most common are hepatic metastases followed by pulmonary involvement. The optimal staging modality for detecting synchronous pulmonary metastases is debated. It has been argued, that synchronous pulmonary metastases (SPCM) are rare in CRC and that the consequence of detecting SPCM is minimal. Furthermore, the current staging practice is complicated by a high number of incidental findings on the thoracic CT, so-called indeterminate pulmonary nodules (IPN). IPN can potentially represent SPCM. The purpose of this thesis was to estimate the prevalence, characteristics and clinical significance of IPN and SPCM detected at the primary staging in CRC. Study I was a systematic review of published studies on IPN in CRC focusing on the prevalence and radiological characteristics of IPN proving to be malignant. This knowledge would be of value in management strategies for IPN. On average 9% of all patients staged with a thoracic CT had IPN, however, the prevalence varied significantly between patients series. This was mainly attributed to varying/lacking definitions on IPN and variable radiological expertise in the assessment of the scans. Data were too inconsistently reported in the case series for a robust statement to be made on potential radiological characteristics suggestive of malignancy in IPN. Lymph node metastasis was the most common clinicopathological finding associated with malignancy of IPN. In conclusion, one patient of every 100 scanned patients had an IPN proving to a SPCM at follow-up, but we found no evidence that IPN should result in intensified diagnostic work-up besides routine follow-up for CRC. Study II was an analysis of the

  20. Excavated pulmonary nodules: an unusual clinical presentation of lung metastasis in two cases

    Directory of Open Access Journals (Sweden)

    Lalya Issam

    2010-06-01

    Full Text Available Abstract Background Excavated pulmonary metastasis are rare. We present two cases of excavated pulmonary nodules proved to be metastases from osteosarcoma and gallblader lymphoma. Case presentation The first one is 39-year-old man in whom cholecystectomy made the diagnosis of primary non-Hodgkin's lymphoma of the gallbladder. He presented in chest CT scan excavated nodules that had been biopsied and confirmed the diagnosis of non hodgkin lymphoma. He underwent 8 courses of chemotherapy CHOP 21 with complete remission. The second one is an 21 years old man who presented a right leg osteoblastic osteosarcoma with only excavated pulmonary nodules in extension assessment. He had 3 courses of polychemotherapy API (doxorubicin, platinum, and ifosfamide with partial response. Unfortunately, he died following a septic shock. Review of the literature shows that excavated pulmonary nodules as metastasis are rare but we should consider this diagnosis every time we are in front of a cancer. Chest computed tomography is the best diagnosis imaging that could make this diagnosis. Differential diagnosis between benign and malignant bullous lesions is important because surgical excision affects survival in some malignancies. Conclusions Although pulmonary nodules are the most common cancer metastasis, a differential diagnosis of a concurrent primary malignancy should always be considered every time we have excavated lesions, even in patients with known malignant disease. Thorough chest evaluation is important, as multiple primary malignancies may occur concomitantly.

  1. Magnetic resonance imaging of pulmonary nodules: accuracy in a granulomatous disease-endemic region

    International Nuclear Information System (INIS)

    Henz Concatto, Natalia; Watte, Guilherme; Marchiori, Edson; Irion, Klaus; Felicetti, Jose Carlos; Camargo, Jose Jesus; Hochhegger, Bruno

    2016-01-01

    To estimate the diagnostic accuracy of signal intensity of the lesion-to-spinal cord ratio (LSR) and apparent diffusion coefficient (ADC) in diffusion-weighted (DW) magnetic resonance imaging of pulmonary nodules suspicious for lung cancer in granulomatous lung disease-endemic regions. Forty-nine patients with indeterminate solitary pulmonary nodules detected by chest computed tomography and histopathologically confirmed diagnoses were included in the study. DW images were analysed semiquantitatively by focusing regions of interest on the lesion and spinal cord at the same level (for LSR calculation). ADCs were estimated from ratios of the two image signal intensities. Ratios of T1 and T2 signal intensity between nodules and muscle were calculated for comparison. Mean ADCs ± standard deviations for lung cancer and benign lesions were 0.9 ± 0.2 and 1.3 ± 0.2 x 10 -3 mm 2 /s, respectively. Mean LSRs were 1.4 ± 0.3 for lung cancer and 1 ± 0.1 for benign lesions. ADCs and LSRs differed significantly between malignant and benign lesions (P < 0.001). Mean T2 signal intensity ratios also differed significantly between benign and malignant lesions (0.8 ± 0.2 vs. 1.6 ± 0.2; P < 0.05). DWI can help to differentiate malignant from benign lesions according to ADC and the LSR with good accuracy. (orig.)

  2. Guideline on management of solitary pulmonary nodule.

    Science.gov (United States)

    Álvarez Martínez, Carlos J; Bastarrika Alemañ, Gorka; Disdier Vicente, Carlos; Fernández Villar, Alberto; Hernández Hernández, Jesús R; Maldonado Suárez, Antonio; Moreno Mata, Nicolás; Rosell Gratacós, Antoni

    2014-07-01

    The aim of the proposed recommendations is be a tool to facilitate decision-making in patients with a solitary pulmonary nodule (SPN). For an optimal decision, accessibility to the different diagnostics techniques and patient preferences need to be incorporated. The first assessment, which includes a chest computed tomography scan, separates a group of patients with extrapulmonary neoplasm or a high surgical risk who require individualized management. Another two groups of patients are patients with SPN up to 8mm and those who have a subsolid SPN, for which specific recommendations are established. SPN larger than 8mm are classified according to their probability of malignancy into low (less than 5%), where observation is recommended, high (higher than 65%), which are managed with a presumptive diagnosis of localized stage carcinoma, and intermediate, where positron emission tomography-computed tomography has high yield for reclassifying them into high or low probability. In cases of intermediate or high probability of malignancy, transbronchial needle aspiration or biopsy of the nodule may be an option. Radiologic observation with low radiation computed tomography without contrast is recommended in SPN with low probability of malignancy, and resection with videothoracoscopy in undiagnosed cases with intermediate or high probability of malignancy. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  3. Pulmonary nodules and metastases in colorectal cancer

    DEFF Research Database (Denmark)

    Nordholm-Carstensen, Andreas

    2016-01-01

    Patients with newly diagnosed colorectal cancer (CRC) are subjected to a preoperative thoraco-abdominal CT scan to determine the cancer stage. This staging is of relevance with regard to treatment and prognosis. About 20% of the patients have distant metastatic spread at the time of diagnosis, i...... is minimal. Furthermore, the current staging practice is complicated by a high number of incidental findings on the thoracic CT, so-called indeterminate pulmonary nodules (IPN). IPN can potentially represent SPCM. The purpose of this thesis was to estimate the prevalence, characteristics and clinical...... detected in 7.5% of the patients and in 37% of these cases the metastatic spread was confined to the lungs. The prevalence of SPCM increased with the implementation of thoracic CT in CRC staging. SPCM impaired survival significantly and was associated with increasing age and rectal cancer. Resection...

  4. Subsolid pulmonary nodules: imaging evaluation and strategic management.

    Science.gov (United States)

    Godoy, Myrna C B; Sabloff, Bradley; Naidich, David P

    2012-07-01

    Given the higher rate of malignancy of subsolid pulmonary nodules and the considerably lower growth rate of ground-glass nodules (GGNs), dedicated standardized guidelines for management of these nodules have been proposed, including long-term low-dose computed tomography (CT) follow-up (≥3 years). Physicians must be familiar with the strategic management of subsolid pulmonary nodules, and should be able to identify imaging features that suggest invasive adenocarcinoma requiring a more aggressive management. Low-dose CT screening studies for early detection of lung cancer have increased our knowledge of pulmonary nodules, and in particular our understanding of the strong although imperfect correlation of the subsolid pulmonary nodules, including pure GGNs and part-solid nodules, with the spectrum of preinvasive to invasive lung adenocarcinoma. Serial CT imaging has shown stepwise progression in a subset of these nodules, characterized by increase in size and density of pure GGNs and development of a solid component, the latter usually indicating invasive adenocarcinoma. There is close correlation between the CT features of subsolid nodules (SSNs) and the spectrum of lung adenocarcinoma. Standardized guidelines are suggested for management of SSNs.

  5. VATS intraoperative tattooing to facilitate solitary pulmonary nodule resection

    Directory of Open Access Journals (Sweden)

    Boutros Cherif

    2008-03-01

    Full Text Available Abstract Introduction Video-assisted thoracic surgery (VATS has become routine and widely accepted for the removal of solitary pulmonary nodules of unknown etiology. Thoracosopic techniques continue to evolve with better instruments, robotic applications, and increased patient acceptance and awareness. Several techniques have been described to localize peripheral pulmonary nodules, including pre-operative CT-guided tattooing with methylene blue, CT scan guided spiral/hook wire placement, and transthoracic ultrasound. As pulmonary surgeons well know, the lung and visceral pleura may appear featureless on top of a pulmonary nodule. Case description This paper presents a rapid, direct and inexpensive approach to peripheral lung lesion resection by marking the lung parenchyma on top of the nodule using direct methylene blue injection. Methods In two patients with peripherally located lung nodules (n = 3 scheduled for VATS, we used direct methylene blue injection for intraoperative localization of the pulmonary nodule. Our technique was the following: After finger palpation of the lung, a spinal 25 gauge needle was inserted through an existing port and 0.1 ml of methylene blue was used to tattoo the pleura perpendicular to the localized nodule. The methylene blue tattoo immediately marks the lung surface over the nodule. The surgeon avoids repeated finger palpation, while lining up stapler, graspers and camera, because of the visible tattoo. Our technique eliminates regrasping and repalpating the lung once again to identify a non marked lesion. Results Three lung nodules were resected in two patients. Once each lesion was palpated it was marked, and the area was resected with security of accurate localization. All lung nodules were resected in totality with normal lung parenchymal margins. Our technique added about one minute to the operative time. The two patients were discharged home on the second postoperative day, with no morbidity. Conclusion

  6. Solitary pulmonary nodule: radiologic features and diagnostic approach

    International Nuclear Information System (INIS)

    Rodriguez Cambronero, Luis Enrique

    2012-01-01

    A literature review is conducted on the solitary pulmonary nodule, to determine the diagnostic methods and specific characteristics. The diagnostic methods used have been: chest radiography, computed tomography, positron emission tomography and magnetic resonance imaging. The radiological features are defined: location, size, definition of contours or edges (margins), densitometric and attenuation characteristics, cavitation, air bronchogram, growth, doubling time, satellite nodules, nutrient vessels [es

  7. Management of subsolid pulmonary nodules in CT lung cancer screening

    NARCIS (Netherlands)

    Heuvelmans, Marjolein A.; Oudkerk, Matthijs

    The distinct appearance and behavior of subsolid pulmonary nodules (SSNs) has resulted in separate recommendations for the management of solitary SSNs, both for incidentally detected as well as for screen detected nodules. However, these guidelines have been based primarily on expert opinion.

  8. Nodular-Deep: Classification of Pulmonary Nodules using Deep Neural Network

    Directory of Open Access Journals (Sweden)

    Qaisar Abbas

    2017-08-01

    Full Text Available Pulmonary nodules represent higher malignancy rate and an accurate detection is very crucial when clinically diagnosis by radiologists from high-resolution computed tomography (HRCT images. At an early stage, if lung cancer is not diagnosis then it leads toward death. In the past studies, it noticed that many computer-aided diagnostic (CADe system for classification of lung nodules are developed but tested on the limited dataset and focused on domain expert knowledge. Therefore, those CADx systems were not suitable for large-scale environments. To address these issues, an efficient and effective CADe system is developed to classify the pulmonary lung nodules into benign and malignant classes. In this paper, a new CADe system is implemented through the integration of variants of advanced deep learning algorithms known as Nodular-Deep. Convolutional neural network (CNN and recurrent neural network (RNN algorithms are combined with softmax linear classifier without using hand-crafted features and any pre- or post-processing steps. The Nodular-Deep system is tested on the 1200 scans obtained from LIDC-IDRI database covers a set of 2600 pulmonary nodules. This dataset contains an equal number of benign (non-cancerous and malignant (cancerous nodules. The performance of nodular-deep system is evaluated through 10-fold cross validation test through the statistical metrics such as sensitivity (SE, Specificity (SP and area under the receiver operating curve (AUC. On this 2600 pulmonary nodules, the Nodular-Deep system is achieved on average result such as 94% of SE, 96% of SP and 0.95 of AUC. This obtained results demonstrate that this nodular-Deep system outperforms compared to manual segmentation by a radiologist.

  9. Pulmonary Nodules with Cutaneous Manifestations: A Case Report and Discussion

    Directory of Open Access Journals (Sweden)

    Ardiles T

    2012-04-01

    Full Text Available The differential diagnosis of multiple pulmonary nodules is large and includes congenital and inherited disorders, malignancy, infectious etiologies, noninfectious granulomatous and inflammatory conditions,among many others. Diagnostic evaluation is aided by attention to extrapulmonary symptoms and features. We herein describe an unusual case of multiple pulmonary nodules attributed to cysticercosis and present a discussion of pathophysiologic changes related to medications and highlight the diagnostic value of extrapulmonary cutaneous features.

  10. Pulmonary necrobiotic nodules: a rare extraintestinal manifestation of Crohn's disease

    Directory of Open Access Journals (Sweden)

    G. Warwick

    2009-03-01

    Full Text Available The present article reports the case of a 22-yr-old female with new onset Crohn's colitis, anterior uveitis and multiple pulmonary nodules which, on histological examination, were necrobiotic nodules. This is a rare but recognised pulmonary extraintestinal manifestation of Crohn's disease and only the fourth reported case. The present case report is followed by a brief review of the relevant literature.

  11. Limited Utility of Pulmonary Nodule Risk Calculators for Managing Large Nodules.

    Science.gov (United States)

    Hammer, Mark M; Nachiappan, Arun C; Barbosa, Eduardo J Mortani

    The optimal management of large pulmonary nodules, at higher risk for lung cancer, has not been determined, and it remains unclear as to which patients should undergo follow-up imaging vs invasive tissue diagnosis via biopsy or surgical resection. Through search of radiology reports, 86 nodules from our institution were identified using the inclusion criterion of solid nodules measuring greater than 8mm. We evaluated these nodules with a number of risk prediction calculators, including the Brock University model, and compared these against the proven diagnosis. Of 86 nodules, 59 (69%) nodules were malignant. The most accurate predictive model, the Brock University calculator, underestimated the risk for this group at 33%. At its optimal threshold, this model had a positive predictive value of 81% and negative predictive value of 53%. Notwithstanding the low negative predictive value, the positive predictive value was no better than patients clinically selected for biopsy (86% of biopsies were malignant). Existing nodule risk prediction calculators are of limited usage in guiding the management of large pulmonary nodules. At present, the accuracy of these models in this setting is inferior to expert clinical judgment, and future work is needed to develop management algorithms for higher-risk nodules. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. FDG uptake heterogeneity evaluated by fractal analysis improves the differential diagnosis of pulmonary nodules

    International Nuclear Information System (INIS)

    Miwa, Kenta; Inubushi, Masayuki; Wagatsuma, Kei; Nagao, Michinobu; Murata, Taisuke; Koyama, Masamichi; Koizumi, Mitsuru; Sasaki, Masayuki

    2014-01-01

    Purpose: The present study aimed to determine whether fractal analysis of morphological complexity and intratumoral heterogeneity of FDG uptake can help to differentiate malignant from benign pulmonary nodules. Materials and methods: We retrospectively analyzed data from 54 patients with suspected non-small cell lung cancer (NSCLC) who were examined by FDG PET/CT. Pathological assessments of biopsy specimens confirmed 35 and 19 nodules as NSCLC and inflammatory lesions, respectively. The morphological fractal dimension (m-FD), maximum standardized uptake value (SUV max ) and density fractal dimension (d-FD) of target nodules were calculated from CT and PET images. Fractal dimension is a quantitative index of morphological complexity and tracer uptake heterogeneity; higher values indicate increased complexity and heterogeneity. Results: The m-FD, SUV max and d-FD significantly differed between malignant and benign pulmonary nodules (p < 0.05). Although the diagnostic ability was better for d-FD than m-FD and SUV max , the difference did not reach statistical significance. Tumor size correlated significantly with SUV max (r = 0.51, p < 0.05), but not with either m-FD or d-FD. Furthermore, m-FD combined with either SUV max or d-FD improved diagnostic accuracy to 92.6% and 94.4%, respectively. Conclusion: The d-FD of intratumoral heterogeneity of FDG uptake can help to differentially diagnose malignant and benign pulmonary nodules. The SUV max and d-FD obtained from FDG-PET images provide different types of information that are equally useful for differential diagnoses. Furthermore, the morphological complexity determined by CT combined with heterogeneous FDG uptake determined by PET improved diagnostic accuracy

  13. Application of Sonoelastography in Differential Diagnosis of Benign and Malignant Thyroid Nodules.

    Science.gov (United States)

    Esfahanian, Fatemeh; Aryan, Arvin; Ghajarzadeh, Mahsa; Yazdi, Meisam Hosein; Nobakht, Nasir; Burchi, Mehdi

    2016-01-01

    Sonoelastography is a new ultrasound method which could be helpful to determine which thyroid nodule is malignant. We designed this study to evaluate the accuracy of sonoelastography in differentiating of benign and malignant thyroid nodules in Iranian patients. Forty thyroid nodules in forty consecutive patients who had been referred for sonography-guided fine-needle aspiration biopsy were evaluated. Gray scale ultrasound and elastosonography by real-time, freehand technique applied for all patients. Elastography findings were classified into four groups. Nodules which were classified as patterns 1 or 2 in elastogram evaluation were classified as benign and probably malignant if elastogram scans were patterns 3 and 4 of elastogram scan. Mean age ± standard deviation (SD) was 42.2 ± 12.6 years, and mean ± SD thyroid-stimulating hormone level was 1.4 ± 1.9 IU/ml. Thirty-five cases (87.5%) were female and 5 (12.5%) were male. Histological examination indicated 27 (67.5%) benign and 13 (32.5%) malignant nodules. The most elastogram score was 2 (50%) followed by score 3. The cut-off point of 2 considered as the best value to differentiate benign and malignant thyroid nodules with sensitivity and specificity of 61% and 78% (area under the curve = 0.76, 95% confidence interval: 0.6-0.92, P = 0.007). Sonoelastography could help to differentiate benign and malignant thyroid nodules. As our sample size was limited, larger studies are recommended.

  14. Classification decision tree in CT imaging: application to the differential diagnosis of solitary pulmonary nodules

    International Nuclear Information System (INIS)

    Ma Hongxia; Guo Yulin; Wang Qiuping; Qiang Yongqian; Liu Min; Guo Xiaojuan; Guo Youmin; Chen Qihang

    2008-01-01

    Objective: To establish classification and regression tree (CART) for differentiating benign from malignant solitary pulmonary nudules (SPN). Methods: One hundred and sixteen consecutive cases with 116 solitary pulmonary nodules, which finally were pathologically proven 54 malignant nodules and 62 benign nodules, were prospectively registered in this research. Twelve clinical presentations and 22 CT findings were collected as predictors. A classification tree was established to distinguish benign SPNs from malignant ones. In the observer test, two groups (one made of junior radiologists and one of senior radiologists) were independently presented with clinical information and CT images without knowing the pathologic and machine-learning results. Performance of observers and CART were compared by receiver operating characteristic analysis. Results: Receiver operating characteristic analysis showed areas under the curve of CART, senior radiologists and junior radiologists respectively were 0.910±0.029, 0.827±0.038, 0.612±0.052. Difference between areas(DBF) between CART and junior radiologists was 0.297(P<0.01). DBF between CART and senior radiologists was 0.083 (P<0.05). DBF between senior and junior radiologists was 0.214 (P<0.01). CART showed a best diagnostic efficiency, followed by junior radiologists, and then senior radiologists. Conclusion: Our data mining techniques using CART prove a high accuracy in differentiating benign from malignant pulmonary nodules based on clinical variables and CT findings. It will be a potentially useful tool in further application of artificial intelligence in the imaging diagnosis. (authors)

  15. Comparison of muscle-to-nodule and parenchyma-to-nodule strain ratios in the differentiation of benign and malignant thyroid nodules: Which one should we use?

    Energy Technology Data Exchange (ETDEWEB)

    Aydin, Ramazan, E-mail: raydin1984@hotmail.com [Department of Radiology, Samsun Education and Research Hospital, Samsun (Turkey); Elmali, Muzaffer, E-mail: muzafel@yahoo.com.tr [Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun (Turkey); Polat, Ahmet Veysel, E-mail: veyselp@hotmail.com [Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun (Turkey); Danaci, Murat, E-mail: danacim55@yahoo.com [Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun (Turkey); Akpolat, Ilkser, E-mail: ilkserakpolat@yahoo.com [Department of Pathology, Ondokuz Mayis University, Faculty of Medicine, Samsun (Turkey)

    2014-03-15

    Objective: The aim of this study is to investigate the diagnostic accuracy of muscle-to-nodule strain ratio (MNSR) in the differentiation of benign and malignant thyroid nodules and to see if there was a difference between MNSR and parenchyma-to-nodule strain ratios (PNSR) in diagnosis. Methods: A total of 106 consecutive patients (88 women and 18 men; age range 19–79 years) with thyroid nodules were prospectively examined using ultrasound and sonoelastography before the fine-needle aspiration biopsy. The mean MNSR and PNSR were calculated for each nodule and the elasticity score was determined according to four-point scoring system. Results: According to the four-point scoring system, 44 of the 83 benign nodules had a score of one or two while 22 of the 23 malignant nodules had a score of three or four (p < 0.001). Using ROC analysis, the best cutoff point for MNSR 1.85 and for PNSR 3.14 was calculated. The sensitivity and specificity for the MNSR were 95.6%, 92.8%, respectively; for the PNSR were 95.6%, 93.4%, respectively, when the best cutoff points were used (p < 0.001). The κ value for the PNSR and MNSR methods was 0.87, which indicated an almost perfect agreement (p < 0.001). Conclusions: Sonoelastography has a high diagnostic accuracy in the differentiation of benign and malignant thyroid nodules. There was no significant difference between MNSR and PNSR in the differentiation of benign and malignant thyroid nodules. Therefore, we think that MNSR could safely be used in situations where PNSR could not be used.

  16. Formation of multiple pulmonary nodules during treatment with leflunomide

    Directory of Open Access Journals (Sweden)

    Gilberto Toshikawa Yoshikawa

    2015-06-01

    Full Text Available Pulmonary involvement is one of the extra-articular manifestations of rheumatoid arthritis and can be due to the disease itself or secondary to the medications used in order to treat it. We report the case of a 60-year-old woman who had been diagnosed with rheumatoid arthritis and developed multiple pulmonary nodules during treatment with leflunomide.

  17. Virtual touch tissue quantifications in the differential diagnosis of benign and malignant thyroid nodules

    International Nuclear Information System (INIS)

    Ha, Seung Mi; Cho, Seong Whi

    2016-01-01

    The aim of this study was to evaluate the diagnostic utility of the virtual touch tissue quantification (VTQ) technology for differentiating between benign and malignant thyroid nodules. 198 nodules (168 benign and 30 malignant nodules) identified in 164 patients with available VTQ velocity data and fine-needle aspiration cytology or post-surgical pathological results were included. The VTQ velocities of nodules and adjacent thyroid tissue were examined. Malignant nodules had a significantly higher VTQ velocity (3.06 ± 1.04 m/s, range: 1.90-6.46 m/s) than that of benign nodules (2.40 ± 0.85 m/s, range: 0.69-8.09 m/s) (p = 0.002). The VTQ velocity ratio between malignant nodules and adjacent thyroid tissue (1.39 ± 0.43, range: 0.89-2.65) was also statistically higher than that of benign nodules (1.15 ± 0.44, range: 0.26-3.47) (p = 0.008). The area under the receiver operating characteristic curve for the VTQ velocity was 0.72 with a cutoff point of 2.37 m/s and that of the VTQ velocity ratio was 0.68 with a cutoff point of 1.26. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the VTQ velocity were 86.7%, 50.6%, 23.9%, 95.5%, and 56.1%, respectively and 60.0%, 72.0%, 27.7%, 91.0%, and 70.2%, respectively for the VTQ velocity ratio. VTQ may be helpful in differentiating malignant and benign thyroid nodules with high negative predictive value

  18. Virtual touch tissue quantifications in the differential diagnosis of benign and malignant thyroid nodules

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Seung Mi; Cho, Seong Whi [Dept. of Radiology, Kangwon National University Hospital, Chuncheon (Korea, Republic of)

    2016-06-15

    The aim of this study was to evaluate the diagnostic utility of the virtual touch tissue quantification (VTQ) technology for differentiating between benign and malignant thyroid nodules. 198 nodules (168 benign and 30 malignant nodules) identified in 164 patients with available VTQ velocity data and fine-needle aspiration cytology or post-surgical pathological results were included. The VTQ velocities of nodules and adjacent thyroid tissue were examined. Malignant nodules had a significantly higher VTQ velocity (3.06 ± 1.04 m/s, range: 1.90-6.46 m/s) than that of benign nodules (2.40 ± 0.85 m/s, range: 0.69-8.09 m/s) (p = 0.002). The VTQ velocity ratio between malignant nodules and adjacent thyroid tissue (1.39 ± 0.43, range: 0.89-2.65) was also statistically higher than that of benign nodules (1.15 ± 0.44, range: 0.26-3.47) (p = 0.008). The area under the receiver operating characteristic curve for the VTQ velocity was 0.72 with a cutoff point of 2.37 m/s and that of the VTQ velocity ratio was 0.68 with a cutoff point of 1.26. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the VTQ velocity were 86.7%, 50.6%, 23.9%, 95.5%, and 56.1%, respectively and 60.0%, 72.0%, 27.7%, 91.0%, and 70.2%, respectively for the VTQ velocity ratio. VTQ may be helpful in differentiating malignant and benign thyroid nodules with high negative predictive value.

  19. Agile convolutional neural network for pulmonary nodule classification using CT images.

    Science.gov (United States)

    Zhao, Xinzhuo; Liu, Liyao; Qi, Shouliang; Teng, Yueyang; Li, Jianhua; Qian, Wei

    2018-02-23

    To distinguish benign from malignant pulmonary nodules using CT images is critical for their precise diagnosis and treatment. A new Agile convolutional neural network (CNN) framework is proposed to conquer the challenges of a small-scale medical image database and the small size of the nodules, and it improves the performance of pulmonary nodule classification using CT images. A hybrid CNN of LeNet and AlexNet is constructed through combining the layer settings of LeNet and the parameter settings of AlexNet. A dataset with 743 CT image nodule samples is built up based on the 1018 CT scans of LIDC to train and evaluate the Agile CNN model. Through adjusting the parameters of the kernel size, learning rate, and other factors, the effect of these parameters on the performance of the CNN model is investigated, and an optimized setting of the CNN is obtained finally. After finely optimizing the settings of the CNN, the estimation accuracy and the area under the curve can reach 0.822 and 0.877, respectively. The accuracy of the CNN is significantly dependent on the kernel size, learning rate, training batch size, dropout, and weight initializations. The best performance is achieved when the kernel size is set to [Formula: see text], the learning rate is 0.005, the batch size is 32, and dropout and Gaussian initialization are used. This competitive performance demonstrates that our proposed CNN framework and the optimization strategy of the CNN parameters are suitable for pulmonary nodule classification characterized by small medical datasets and small targets. The classification model might help diagnose and treat pulmonary nodules effectively.

  20. Ultrasound-guided microwave ablation in the treatment of benign thyroid nodules in 435 patients.

    Science.gov (United States)

    Liu, Yu-Jiang; Qian, Lin-Xue; Liu, Dong; Zhao, Jun-Feng

    2017-09-01

    The objective of the present study was to investigate the effectiveness and safety of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules. A total of 474 benign thyroid nodules in 435 patients who underwent ultrasound-guided microwave ablation from September 2012 to August 2015 were included. Nodule volume and thyroid function were measured before treatment and at 1, 3, 6, and 12 months and subsequently after every 6 months. The nodule volume reduction rate and changes of thyroid function were evaluated. The volume of all thyroid nodules significantly decreased after ultrasound-guided microwave ablation. The average volume was 13.07 ± 0.95 ml before treatment, and 1.14 ± 0.26 ml at 12-months follow-up. The mean volume reduction rate was 90% and the final volume reduction rate was 94%. The volume reduction rate of mainly cystic nodules was significantly higher than that of simple solid and mainly solid nodules (all P microwave ablation is an effective and safe technique for treatment of benign thyroid nodules, and has the potential for clinical applications. Impact statement Ultrasound-guided MWA is an effective and safe technique for the treatment of benign thyroid nodules. It can significantly reduce the nodule volume, improve the patients' clinical symptoms, has less complication, guarantees quick recovery, meets patients' aesthetic needs, and shows less interference on the physiological and psychological aspects of the body. MWA should be a good complement to traditional open surgery and has potentials in clinical applications.

  1. Mucoid impaction presenting as multiple pulmonary nodules in cystic fibrosis

    International Nuclear Information System (INIS)

    Carpenter, L.D.; Lambie, N.K.; Wilsher, M.L.

    1996-01-01

    Mucoid impaction has been described as a complication of asthma and more commonly in patients with allergic bronchopulmonary aspergillosis. In such cases, the impacted pools of mucus may present as discrete nodules on chest X-ray and hence simulate the appearance of metastatic malignancy. A case of mucoid impaction presenting as multiple pulmonary nodules in a patient with cystic fibrosis is described. The chest X-ray showed hyperinfiltration and scattered changes consistent with bronchiectasis. Computed tomography scan confirmed these and additional intra-pulmonary nodular densities. This report illustrates that mucus impaction as a cause of pulmonary nodules should be considered in any patient with chronic lung disease characterised by excess mucus production. 6 refs., 3 figs

  2. Diffusion-weighted MR imaging and ADC mapping in differentiating benign from malignant thyroid nodules

    International Nuclear Information System (INIS)

    Khizer, A.T.; Slehria, A.U.R.

    2015-01-01

    To determine the diagnostic accuracy of Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) mapping in differentiating benign from malignant thyroid nodules by taking histopathology as the gold standard. Study Design:Across-sectional analytical study. Place and Duration of Study: Department of Radiology at Combined Military Hospital (CMH), Lahore, from August 2012 to July 2013. Methodology: Thirty-five patients, who were referred to radiology department of CMH, Lahore, for ultrasound or Fine Needle Aspiration Cytology (FNAC) of thyroid gland, fulfilling the inclusion and exclusion criteria, were included in the study. They were evaluated on 1.5 Tesla MRI machine with T1- and T2-weighted imaging as well as fat-suppressed technique. DWI was done using b-values of 0 and 1000 s/mm2 and ADC values were calculated for the thyroid nodules. All of these patients were subjected to ultrasound guided core biopsy and histopathology results were correlated with ADC values. Results: The benign nodules showed facilitated diffusion while malignant nodules showed restricted diffusion. T-test was used to assess the difference in mean ADC values between benign and malignant nodules. The mean ADC value of the malignant thyroid nodules (0.94 ± 0.16 x 10/sup -3/mm2/s) was significantly lower than that of the benign thyroid nodules (1.93 ±0.13 x 10/sup -3/mm2/s) (p-value < 0.05). ADC value of 1.6 x 10/sup -3/mm2/s was used as a cut-off, for differentiating benign from malignant thyroid nodules. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of DWI and ADC values in differentiating benign from malignant thyroid nodules were 93%, 95%, 93%, 95% and 92.3%, respectively. Conclusion: DWI is a non-invasive diagnostic tool for characterization and differentiation between benign and malignant thyroid nodules. It not only decreases the burden of unnecessary surgeries when pre-operative FNAC and biopsy are inconclusive, but is also helpful in reaching a

  3. Correlation between the Quantifiable Parameters of Whole Solitary Pulmonary Nodules Perfusion Imaging Derived with Dynamic CT and Nodules Size

    Directory of Open Access Journals (Sweden)

    Shiyuan LIU

    2009-05-01

    Full Text Available Background and objective The solitary pulmonary nodules (SPNs is one of the most common findings on chest radiographs. The blood flow patterns of the biggest single SPNs level has been studied. This assessment may be only a limited sample of the entire region of interest (ROI and is unrepresentative of the SPNs as a volume. Ideally, SPNs volume perfusion should be measured. The aim of this study is to evaluate the correlation between the quantifiableparameters of SPNs volume perfusion imaging derived with 16-slice spiral CT and 64-slice spiral CT and nodules size. Methods Sixty-five patients with SPNs (diameter≤3 cm; 42 malignant; 12 active inflammatory; 11 benign underwent multi-location dynamic contrast material-enhanced serial CT scanning mode with stable table were performed; The mean values of valid sections were calculated, as the quantifiable parameters of volume SPNs perfusion imaging derived with16-slice spiral CT and 64-slice spiral CT. The correlation between the quantifiable parameters of SPNs volume perfusion imaging derived with 16-slice spiral CT and 64-slice spiral CT and nodules size were assessed by means of linear regression analysis. Results No significant correlations were found between the nodules size and each of the peak height (PHSPN (32.15 Hu±14.55 Hu,ratio of peak height of the SPN to that of the aorta (SPN-to-A ratio(13.20±6.18%, perfusion(PSPN (29.79±19.12 mLmin-1100 g-1 and mean transit time (12.95±6.53 s (r =0.081, P =0.419; r =0.089, P =0.487; r =0.167, P =0.077; r =0.023, P =0.880. Conclusion No significant correlations were found between the quantifiable parameters of SPNs volume perfusion imaging derived with 16-slice spiral CT and 64-slice spiral CT and nodules size.

  4. Beneficial effect of combined aspiration and interstitial laser therapy in patients with benign cystic thyroid nodules

    DEFF Research Database (Denmark)

    Døssing, H; Bennedbaek, F N; Hegedüs, L

    2006-01-01

    of the amount of aspirated cyst fluid, thereby calculating the volume of the solid part. Follow-up included ultrasound and determination of thyroid function. Pressure and cosmetic complaints were evaluated on a visual analogue scale. The median initial volume of the cystic nodule decreased from 9.6 ml [6......The aim of this study was to evaluate the effect of combined cyst aspiration and ultrasound-guided interstitial laser photocoagulation (ILP) on recurrence rate and the volume of benign cystic thyroid nodules. 10 euthyroid outpatients with a solitary and cytologically benign partially cystic thyroid...... part. Both pressure symptoms and cosmetic complaints were significantly reduced. The only side effect was mild pain or tenderness for a few days. Our study suggests that complete cyst aspiration and subsequent ultrasound-guided ILP of benign cystic thyroid nodules is a feasible and safe technique...

  5. Radiofrequency Ablation of Benign Thyroid Nodules and Recurrent Thyroid Cancers: Consensus Statement and Recommendations

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Hyun [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Na, Dong Gyu [Human Medical Imaging and Intervention Center, Seoul (Korea, Republic of); Jung, So Lyung [Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2012-03-15

    Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology has developed recommendations for the optimal use of radiofrequency ablation for thyroid nodules. These recommendations are based on a comprehensive analysis of the current literature, the results of multicenter studies, and expert consensus.

  6. Overview and strategic management of subsolid pulmonary nodules.

    Science.gov (United States)

    Godoy, Myrna C B; Naidich, David P

    2012-07-01

    A new classification of lung adenocarcinoma has been proposed recently-the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Abundant information from recent lung cancer computed tomography (CT) screening programs has increased our understanding of the strong, although imperfect, correlation between histologic findings of lung adenocarcinoma and subsolid pulmonary nodules on CT, including both "pure" ground-glass nodules (GGNs) and "part-solid" GGNs. Moreover, serial CT imaging has demonstrated stepwise progression of these nodules in a subset of patients, characterized by increase in size and density of GGNs and development of a solid component. Given the higher incidence of malignancy and the considerably lower growth rate of subsolid nodules, dedicated standardized guidelines for management of these nodules have been proposed, including long-term (≥3 y) CT follow-up using a low-dose technique. Radiologists should be familiar with the new terminology of lung adenocarcinomas and strategic management of subsolid pulmonary nodules.

  7. Semi-automated pulmonary nodule interval segmentation using the NLST data.

    Science.gov (United States)

    Balagurunathan, Yoganand; Beers, Andrew; Kalpathy-Cramer, Jayashree; McNitt-Gray, Michael; Hadjiiski, Lubomir; Zhao, Bensheng; Zhu, Jiangguo; Yang, Hao; Yip, Stephen S F; Aerts, Hugo J W L; Napel, Sandy; Cherezov, Dmitrii; Cha, Kenny; Chan, Heang-Ping; Flores, Carlos; Garcia, Alberto; Gillies, Robert; Goldgof, Dmitry

    2018-03-01

    To study the variability in volume change estimates of pulmonary nodules due to segmentation approaches used across several algorithms and to evaluate these effects on the ability to predict nodule malignancy. We obtained 100 patient image datasets from the National Lung Screening Trial (NLST) that had a nodule detected on each of two consecutive low dose computed tomography (LDCT) scans, with an equal proportion of malignant and benign cases (50 malignant, 50 benign). Information about the nodule location for the cases was provided by a screen capture with a bounding box and its axial location was indicated. Five participating quantitative imaging network (QIN) institutions performed nodule segmentation using their preferred semi-automated algorithms with no manual correction; teams were allowed to provide additional manually corrected segmentations (analyzed separately). The teams were asked to provide segmentation masks for each nodule at both time points. From these masks, the volume was estimated for the nodule at each time point; the change in volume (absolute and percent change) across time points was estimated as well. We used the concordance correlation coefficient (CCC) to compare the similarity of computed nodule volumes (absolute and percent change) across algorithms. We used Logistic regression model on the change in volume (absolute change and percent change) of the nodules to predict the malignancy status, the area under the receiver operating characteristic curve (AUROC) and confidence intervals were reported. Because the size of nodules was expected to have a substantial effect on segmentation variability, analysis of change in volumes was stratified by lesion size, where lesions were grouped into those with a longest diameter of segmentation of the nodules shows substantial variability across algorithms, with the CCC ranging from 0.56 to 0.95 for change in volume (percent change in volume range was [0.15 to 0.86]) across the nodules. When

  8. Preliminary study of visualizing membrane structures of spiculated pulmonary nodules in three-dimensional thoracic CT images

    Science.gov (United States)

    Kawata, Y.; Niki, N.; Ohmatsu, H.; Aokage, K.; Kusumoto, M.; Tsuchida, T.; Eguchi, K.; Kaneko, M.

    2016-03-01

    Research results from the National Lung Screening Trial revealed that screening for lung cancer with low-dose CT (LDCT) reduces lung cancer mortality in heavy smokers by 20% compared to radiography. While this study does show the efficacy of CT-based screening, radiologists often face the problem of estimating the malignant likelihoods of pulmonary nodules detected on LDCT screening for maximizing patient survival and for preserving lung function. Spiculation is considered as one of the indicators of nodule malignancy and an important feature to assess requirements on a patient-tailored follow-up procedure. However, the spiculation is also observed in some benign nodules, particularly in tuberculoma. The elucidation of the spliculation morphology in 3D thoracic CT images is an important preliminary step towards developing the malignant discrimination strategies from benign nodules. In this study, we present a visualization method to reveal a spatial configuration of spiculation of pulmonary nodules in three-dimensional thoracic CT images. Applying the method to an example of malignant nodule with the spiculated margins, the visualizing preliminary result of the spatial configuration reveals the presence of membrane structures of spiculation.

  9. Positron emission tomography of incidentally detected small pulmonary nodules

    DEFF Research Database (Denmark)

    Fischer, B M; Mortensen, J; Dirksen, A

    2004-01-01

    The aim of this study was to assess the value of fluorodeoxyglucose positron emission tomography (FDG PET) imaging of small pulmonary nodules incidentally detected by spiral computed tomography (CT) in a high-risk population. Ten patients (five females, five males, aged 54-72 years) were recruited...

  10. Innovative techniques for image-guided ablation of benign thyroid nodules: Combined ethanol and radiofrequency ablation

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hye Sun; Baek, Jung Hwan; Choi, Young Jun; Lee, Jeong Hyun [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2017-06-15

    In the treatment of benign thyroid nodules, ethanol ablation (EA), and radiofrequency ablation (RFA) have been suggested for cystic and solid thyroid nodules, respectively. Although combining these ablation techniques may be effective, no guidelines for or reviews of the combination have been published. Currently, there are three ways of combining EA and RFA: additional RFA is effective for treatment of incompletely resolved symptoms and solid residual portions of a thyroid nodule after EA. Additional EA can be performed for the residual unablated solid portion of a nodule after RFA if it is adjacent to critical structures (e.g., trachea, esophagus, and recurrent laryngeal nerve). In the concomitant procedure, ethanol is injected to control venous oozing after aspiration of cystic fluid prior to RFA of the remaining solid nodule.

  11. Computed tomographic fluoroscopy-guided transthoracic needle biopsy for diagnosis of pulmonary nodules

    International Nuclear Information System (INIS)

    Hirose, Takashi; Mori, Kiyoshi; Machida, Suguru; Tominaga, Keigo; Yokoi, Kohei; Adachi, Mitsuru

    2000-01-01

    The purpose of this study was to evaluate the usefulness of computed tomographic (CT) fluoroscopy-guided transthoracic needle biopsy (TTNB) with an 18-gauge automatic biopsy gun for the diagnosis of pulmonary nodules. Between March 1996 and January 1998, 50 patients in whom pulmonary lesions could not be diagnosed cytopathologically with fiberoptic bronchoscopy or were not clearly visualized with fluoroscopy underwent CT fluoroscopy-guided TTNB. Final pathological diagnoses were 23 lung carcinomas, five pulmonary metastases and 22 benign lesions. Sufficient tissue for analysis was obtained from 48 of the 50 lesions (96%). The overall diagnostic yield of CT fluoroscopy-guided TTNB was 90%. The sensitivity, specificity and accuracy for malignancy were 89%, 100% and 94%, respectively. In 20 of the 22 cases (91%) of benign lesions, histological analysis yielded correct and specific diagnoses. Complications occurred in 22 of the 50 cases (44%). The most common complication was pneumothorax, which occurred in 21 of the 50 cases (42%). Chest tube insertion was required in 6 (12%). Although CT fluoroscopy could not decrease the complication rate, CT fluoroscopy-guided TTNB with an automatic biopsy gun appears to be a promising technique for diagnosing pulmonary lesions, particularly benign lesions. (author)

  12. Predictive factors for malignancy in incidental pulmonary nodules detected in breast cancer patients at baseline CT

    Energy Technology Data Exchange (ETDEWEB)

    Hammer, Mark M.; Mortani Barbosa, Eduardo J. [University of Pennsylvania, Division of Cardiothoracic Imaging, Department of Radiology, Perelman School of Medicine, Philadelphia, PA (United States)

    2017-07-15

    Pulmonary nodules are commonly encountered at staging CTs in patients with extrathoracic malignancies, but their significance on a per-patient basis remains uncertain. We undertook a retrospective analysis of pulmonary nodules identified in patients with a diagnosis of breast cancer from 2010 - 2015, evaluating nodules present at a baseline CT (i.e. prevalent nodules). We reviewed 211 patients with 248 individual nodules. The rate of malignancy in prevalent nodules is low, approximately 13 %. Variables associated with metastasis include pleural studding, hilar lymphadenopathy and the presence of extrapulmonary metastasis, as well as number of nodules, nodule size and nodule shape. Using a combination of these factors, we have developed an evidence-based multivariate decision tree to predict which nodules are malignant in these patients, which is 91 % accurate and 100 % sensitive for metastasis. We propose a simplified clinical prediction algorithm to guide radiologists and oncologists in managing patients with breast cancer and incidental pulmonary nodules. (orig.)

  13. Therapy: a new nonsurgical therapy option for benign thyroid nodules?

    DEFF Research Database (Denmark)

    Hegedüs, Laszlo

    2009-01-01

    Despite the increasing implementation of iodization programs, benign nodular thyroid disease will remain a prevalent therapeutic concern for decades. recent research suggests that nonsurgical therapy, including radioactive iodine, radiofrequency thermal ablation and percutaneous laser ablation...

  14. Treatment of Benign Thyroid Nodules: Comparison of Surgery with Radiofrequency Ablation.

    Science.gov (United States)

    Che, Y; Jin, S; Shi, C; Wang, L; Zhang, X; Li, Y; Baek, J H

    2015-07-01

    Nodular goiter is one of the most common benign lesions in thyroid nodule. The main treatment of the disease is still the traditional surgical resection, however there are many problems such as general anesthesia, surgical scar, postoperative thyroid or parathyroid function abnormalities, and high nodules recurrence rate in residual gland. The purpose of this study was to compare the efficacy, safety, and cost-effectiveness of 2 treatment methods, surgery and radiofrequency ablation, for the treatment of benign thyroid nodules. From May 2012 to September 2013, 200 patients with nodular goiters who underwent surgery (group A) and 200 patients treated by radiofrequency ablation (group B) were enrolled in this study. Inclusion criteria were the following: 1) cosmetic problem, 2) nodule-related symptoms, 3) hyperfunctioning nodules related to thyrotoxicosis, and 4) refusal of surgery (for group B). An internally cooled radiofrequency ablation system and an 18-ga internally cooled electrode were used. We compared the 2 groups in terms of efficacy, safety, and cost-effectiveness during a 1-year follow-up. After radiofrequency ablation, the nodule volume decreased significantly from 5.4 to 0.4 mL (P = .002) at the 12-month follow-up. The incidence of complications was significantly higher from surgery than from radiofrequency ablation (6.0% versus 1.0%, P = .002). Hypothyroidism was detected in 71.5% of patients after surgery but in none following radiofrequency ablation. The rate of residual nodules (11.9% versus 2.9%, P = .004) and hospitalization days was significantly greater after surgery (6.6 versus 2.1 days, P radiofrequency ablation are both effective treatments of nodular goiter. Compared with surgery, the advantages of radiofrequency ablation include fewer complications, preservation of thyroid function, and fewer hospitalization days. Therefore, radiofrequency ablation should be considered a first-line treatment for benign thyroid nodules. © 2015 by American

  15. Pulmonary hyalinizing granuloma: Bilateral pulmonary nodules associated with chronic idiopathic thrombocytopenic purpura

    International Nuclear Information System (INIS)

    Satti, Mohamed B.; Batouk, Abdelnasir; Ahmad, Mohamed F.; Abdelaal, Mohamed A.; Abdelaziz, Muntasir M.

    2005-01-01

    We report a case of a 30-year-old female who had been treated periodically with steroids for idiopathic thrombocytopenic purpura ICTP over the last 10 years. Recently, during the course of investigation, she was found to have incidental asymptomatic multiple pulmonary nodules on chest CT. Following a needle biopsy to exclude malignancy, 2 nodules were excised and were histologically confirmed as pulmonary hyalinizing granuloma PHG. The remaining 2 nodules regressed on increasing her dose of steroids. The case is discussed with emphasis on the histological and radiological differential diagnosis, in addition to including ITP among the spectrum of immunologic conditions associated with PHG. (author)

  16. Investigation on the value of spectral CT imaging in diagnosis of benign and malignant thyroid nodules

    International Nuclear Information System (INIS)

    Li Hongwen; Liu Bin; Wu Xingwang; Wang Wanqin; Liu Wendong

    2014-01-01

    Objective: To explore the value of gemstone spectral imaging (GSI) in the detection and differential diagnosis of benign and malignant thyroid nodules. Methods: The spectral CT images in 88 patients with thyroid nodules were analyzed retrospectively. All the patients underwent spectral CT scanning, including 33 patients undergoing biphase enhanced CT imaging. Nodules were divided into benign and malignant ones according to histopathologic results. The iodine concentration, slope of spectral curve, effective atomic number in non-enhanced and enhanced scanning were compared between benign and malignant group by the Wilcoxon rank sum test, respectively. The optimal iodine concentration threshold to predict malignancy was obtained by receiver operating characteristic curve (ROC), sensitivity and specificity were achieved. Results: A total of 106 nodules were detected, including 76 benign and 30 malignant nodules. In non-contrast CT imaging, the average iodine concentration, slope of spectral curve, effective atomic number of were 2.35 × 100 μg/ml, 0.29 and 7.71 for benign group: -0.51 × 100 μg/ml, -0.06 and 7.52 for malignant group (Z value were -3.072, -3.107 and -3.055, respectively; P<0.05). In the arterial phase, the average iodine concentration, slope of spectral curve, effective atomic number of the two group were 27.22 × 100 μg/ml, 3.23 and 9.10 for benign group; 18.81 × 100 μg/ml, 2.24 and 8.69 for malignant group (Z value were -2.582, -2.582 and -2.564, respectively; P<0.05). In venous phase,no significant difference was found for each parameter between the two groups (P>0.05). The optimal iodine concentration to predict malignancy was -0.35 × 100 μg/ml in non-enhanced phase with 56.7% sensitivity and 73.7% specificity. The optimal iodine concentration was 22.91 × 100 μg/ml in arterial phase, with 76.2% sensitivity and 75.0% specificity. Using iodine concentration to predict malignancy in both non-contrast phase and arterial phase, the sensitivity

  17. Dual energy computed tomography of lung nodules: Differentiation of iodine and calcium in artificial pulmonary nodules in vitro

    International Nuclear Information System (INIS)

    Knöß, Naomi; Hoffmann, Beata; Krauss, Bernhard; Heller, Martin; Biederer, Jürgen

    2011-01-01

    Background: Iodine enhancement is a marker for malignancy in pulmonary nodules. The purpose of this in vitro study was to assess whether dual energy computed tomography (DECT) can be used to detect iodine and to distinguish iodine from disperse calcifications in artificial pulmonary nodules. Materials and methods: Small, medium, and large artificial nodules (n = 54), with increasing concentrations of iodine or calcium corresponding to an increase in Hounsfield Units (HU) of 15, 30, 45, and 90 at 120 kV, were scanned in a chest phantom with DECT at 80 and 140 kV. Attenuation values of each nodule were measured using semi-automated volumetric analysis. The mean DE ratio with 95% confidence intervals (CI) was calculated for each nodule. Results: The mean maximum diameter of the 18 small nodules was 12 mm (standard deviation: 0.4), 16 mm (0.4) for the 18 medium nodules, and 30 mm (1.1) for the 18 large nodules. There was no overlap of 95% CI of DE ratios of iodine and calcium in nodules ≥16 mm. In nodules <16 mm, there was an overlap of DE ratios in low contrast lesions. Conclusion: DECT can distinguish iodine from calcium in artificial nodules ≥16 mm in vitro. In smaller lesions, a clear differentiation is not possible.

  18. SU-F-R-22: Malignancy Classification for Small Pulmonary Nodules with Radiomics and Logistic Regression

    International Nuclear Information System (INIS)

    Huang, W; Tu, S

    2016-01-01

    Purpose: We conducted a retrospective study of Radiomics research for classifying malignancy of small pulmonary nodules. A machine learning algorithm of logistic regression and open research platform of Radiomics, IBEX (Imaging Biomarker Explorer), were used to evaluate the classification accuracy. Methods: The training set included 100 CT image series from cancer patients with small pulmonary nodules where the average diameter is 1.10 cm. These patients registered at Chang Gung Memorial Hospital and received a CT-guided operation of lung cancer lobectomy. The specimens were classified by experienced pathologists with a B (benign) or M (malignant). CT images with slice thickness of 0.625 mm were acquired from a GE BrightSpeed 16 scanner. The study was formally approved by our institutional internal review board. Nodules were delineated and 374 feature parameters were extracted from IBEX. We first used the t-test and p-value criteria to study which feature can differentiate between group B and M. Then we implemented a logistic regression algorithm to perform nodule malignancy classification. 10-fold cross-validation and the receiver operating characteristic curve (ROC) were used to evaluate the classification accuracy. Finally hierarchical clustering analysis, Spearman rank correlation coefficient, and clustering heat map were used to further study correlation characteristics among different features. Results: 238 features were found differentiable between group B and M based on whether their statistical p-values were less than 0.05. A forward search algorithm was used to select an optimal combination of features for the best classification and 9 features were identified. Our study found the best accuracy of classifying malignancy was 0.79±0.01 with the 10-fold cross-validation. The area under the ROC curve was 0.81±0.02. Conclusion: Benign nodules may be treated as a malignant tumor in low-dose CT and patients may undergo unnecessary surgeries or treatments. Our

  19. SU-F-R-22: Malignancy Classification for Small Pulmonary Nodules with Radiomics and Logistic Regression

    Energy Technology Data Exchange (ETDEWEB)

    Huang, W; Tu, S [Chang Gung University, Kwei-shan, Tao-Yuan, Taiwan (China)

    2016-06-15

    Purpose: We conducted a retrospective study of Radiomics research for classifying malignancy of small pulmonary nodules. A machine learning algorithm of logistic regression and open research platform of Radiomics, IBEX (Imaging Biomarker Explorer), were used to evaluate the classification accuracy. Methods: The training set included 100 CT image series from cancer patients with small pulmonary nodules where the average diameter is 1.10 cm. These patients registered at Chang Gung Memorial Hospital and received a CT-guided operation of lung cancer lobectomy. The specimens were classified by experienced pathologists with a B (benign) or M (malignant). CT images with slice thickness of 0.625 mm were acquired from a GE BrightSpeed 16 scanner. The study was formally approved by our institutional internal review board. Nodules were delineated and 374 feature parameters were extracted from IBEX. We first used the t-test and p-value criteria to study which feature can differentiate between group B and M. Then we implemented a logistic regression algorithm to perform nodule malignancy classification. 10-fold cross-validation and the receiver operating characteristic curve (ROC) were used to evaluate the classification accuracy. Finally hierarchical clustering analysis, Spearman rank correlation coefficient, and clustering heat map were used to further study correlation characteristics among different features. Results: 238 features were found differentiable between group B and M based on whether their statistical p-values were less than 0.05. A forward search algorithm was used to select an optimal combination of features for the best classification and 9 features were identified. Our study found the best accuracy of classifying malignancy was 0.79±0.01 with the 10-fold cross-validation. The area under the ROC curve was 0.81±0.02. Conclusion: Benign nodules may be treated as a malignant tumor in low-dose CT and patients may undergo unnecessary surgeries or treatments. Our

  20. Detection of benign prostatic hyperplasia nodules in T2W MR images using fuzzy decision forest

    Science.gov (United States)

    Lay, Nathan; Freeman, Sabrina; Turkbey, Baris; Summers, Ronald M.

    2016-03-01

    Prostate cancer is the second leading cause of cancer-related death in men MRI has proven useful for detecting prostate cancer, and CAD may further improve detection. One source of false positives in prostate computer-aided diagnosis (CAD) is the presence of benign prostatic hyperplasia (BPH) nodules. These nodules have a distinct appearance with a pseudo-capsule on T2 weighted MR images but can also resemble cancerous lesions in other sequences such as the ADC or high B-value images. Describing their appearance with hand-crafted heuristics (features) that also exclude the appearance of cancerous lesions is challenging. This work develops a method based on fuzzy decision forests to automatically learn discriminative features for the purpose of BPH nodule detection in T2 weighted images for the purpose of improving prostate CAD systems.

  1. Diagnostic value of coincidence detection emission tomography using fluorine 18 2-fluoro-2-deoxy-D-glucose in patients with solitary pulmonary nodules

    International Nuclear Information System (INIS)

    Najjar, F.

    2008-12-01

    Solitary Pulmonary Nodules (size 18 FDG). The aim of this project was to establish the diagnostic role of this imaging modality with and without attenuation correction (AC) in correlation with computed tomography (CT) findings in patients with solitary pulmonary nodules and its efficacy for the distinction between benign and malignant nodules. Sixty-eight patients were included in this study. All patients presented with suspected pulmonary nodules on thoracic CT. In addition, they had CDET scan using a dual-head coincidence gamma-camera with and without measured attenuation using caesium-137 source. Corrected images were independently interpreted from non-attenuation corrected images in a blinded manner of any clinical data. For data analysis, 18 FDG-CDET findings were evaluated by histology when or the final clinical outcome. Our results showed that the diagnostic accuracy of CDET has not been ameliorated when a lower thresholds of 18 FDG uptake was considered for the evaluation of nodule's malignancy in image interpretation. A total of 66 suspected nodules were observed by CT. In addition, 5 pulmonary nodules have been detected by CDET only. Malignant pulmonary disease was found in 38 of these nodules whereas 33 pulmonary nodules were proved to be benign. The sensitivity of 18 FDG-CDET imaging with and without AC was 91%, whereas its specificity has been decreased to 81% with AC and only 69% without AC. These results could be explained by additional false positive findings obtained with non AC mode in 8% of patients. All malignant nodules >20 mm in diameter have been identified by 18 FDG-CDET. However, both modalities techniques failed to detect malignancy in 3 patients. In . general, the diagnostic accuracy of 18 FDG-CDET without AC was relatively comparable to that found with AC (83% to 87%, respectively). Our results indicate that 18 FDG-CDET imaging with and without AC is a reliable method for the diagnosis of solitary pulmonary nodules and the distinction

  2. Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules

    DEFF Research Database (Denmark)

    Døssing, Helle; Bennedbæk, Finn Noe; Hegedüs, Laszlo

    2011-01-01

    Aim To evaluate the long-term efficacy of interstitial laser photocoagulation (ILP) in solitary benign thyroid nodules. Design and methods A total of 78 euthyroid outpatients (45 participating in randomized trials) with a benign solitary solid and scintigraphically cold thyroid nodule causing local...... discomfort were assigned to ILP. ILP (using one laser fiber) was performed under continuous ultrasound (US) guidance and with an output power of 1.5-3.5 W. Thyroid nodule volume was assessed by US and thyroid function determined by routine assays, before and during follow-up. Pressure symptoms and cosmetic...... complaints were evaluated on a visual analogue scale (0-10 cm). Of the total patients, six had thyroid surgery 6 months after ILP and three were lost to follow-up. The median follow-up for the remaining 69 patients was 67 months (range 12-114). Results The overall median nodule volume decreased from 8.2 ml...

  3. Inference method using bayesian network for diagnosis of pulmonary nodules

    International Nuclear Information System (INIS)

    Kawagishi, Masami; Iizuka, Yoshio; Yamamoto, Hiroyuki; Yakami, Masahiro; Kubo, Takeshi; Fujimoto, Koji; Togashi, Kaori

    2010-01-01

    This report describes the improvements of a naive Bayes model that infers the diagnosis of pulmonary nodules in chest CT images based on the findings obtained when a radiologist interprets the CT images. We have previously introduced an inference model using a naive Bayes classifier and have reported its clinical value based on evaluation using clinical data. In the present report, we introduce the following improvements to the original inference model: the selection of findings based on correlations and the generation of a model using only these findings, and the introduction of classifiers that integrate several simple classifiers each of which is specialized for specific diagnosis. These improvements were found to increase the inference accuracy by 10.4% (p<.01) as compared to the original model in 100 cases (222 nodules) based on leave-one-out evaluation. (author)

  4. A pulmonary nodule view system for the Lung Image Database Consortium (LIDC).

    Science.gov (United States)

    Lin, Hongli; Chen, Zhencheng; Wang, Weisheng

    2011-09-01

    The aim of this study was to develop a pulmonary nodule viewing system to visualize and retrieve data from the Lung Image Database Consortium. The pulmonary nodule viewing system, developed using Microsoft C++ and the .NET 2.0 Framework, is composed of a clinical information integrator, a nodule viewer, a search engine, and a data model. A pulmonary nodule viewing system using Lung Image Database Consortium data for computer-aided diagnosis research and training purpose was developed. The pulmonary nodule viewing system can be used to build a pulmonary nodule database for computer-aided diagnosis research and medical education. It can also be used to view and retrieve large data sets efficiently. Copyright © 2011 AUR. Published by Elsevier Inc. All rights reserved.

  5. Thyroid nodules with highly suspicious ultrasonographic features, but with benign cytology on two occasions: is malignancy still possible?

    Energy Technology Data Exchange (ETDEWEB)

    Rosario, Pedro Weslley; Calsolari, Maria Regina, E-mail: pedrowsrosario@gmail.com [Santa Casa de Belo Horizonte, MG (Brazil)

    2016-11-01

    There is no information about the frequency of malignancy specifically in the case of thyroid nodules with highly suspicious sonographic features, but with two fine needle aspiration (FNA) showing benign cytology. This was the objective of the study. Subjects and methods: We report the results of 105 patients with thyroid nodules considered 'highly suspicious' according to the ultrasonographic classification of American Thyroid Association, in whom FNA revealed benign cytology on two occasions (interval of 6 months). Results: Thyroidectomy was performed in 11 cases due to desire of the patient or significant growth of the nodule. In these patients, cytology continued to be benign in 9, was non-diagnostic in 1, and suspicious in 1. Histology revealed papillary carcinoma in only one nodule. In patients in whom a third FNA was obtained for this study (n = 94), cytology continued to be benign in 86, became non-diagnostic in 5, indeterminate in 2, and suspicious in 1. The last 8 patients (with non-benign cytology) were submitted to thyroidectomy and histology revealed malignancy in only one nodule. Conclusion: The rate of malignancy found here for nodules with highly suspicious sonographic features, even after two FNA showing benign cytology, was 2%. We believe that in these cases, the continuation of follow-up consisting of ultrasound at intervals of 2 years may still be adequate. (author)

  6. Computer-aided Detection Fidelity of Pulmonary Nodules in Chest Radiograph

    Directory of Open Access Journals (Sweden)

    Nikolaos Dellios

    2017-01-01

    Full Text Available Aim: The most ubiquitous chest diagnostic method is the chest radiograph. A common radiographic finding, quite often incidental, is the nodular pulmonary lesion. The detection of small lesions out of complex parenchymal structure is a daily clinical challenge. In this study, we investigate the efficacy of the computer-aided detection (CAD software package SoftView™ 2.4A for bone suppression and OnGuard™ 5.2 (Riverain Technologies, Miamisburg, OH, USA for automated detection of pulmonary nodules in chest radiographs. Subjects and Methods: We retrospectively evaluated a dataset of 100 posteroanterior chest radiographs with pulmonary nodular lesions ranging from 5 to 85 mm. All nodules were confirmed with a consecutive computed tomography scan and histologically classified as 75% malignant. The number of detected lesions by observation in unprocessed images was compared to the number and dignity of CAD-detected lesions in bone-suppressed images (BSIs. Results: SoftView™ BSI does not affect the objective lesion-to-background contrast. OnGuard™ has a stand-alone sensitivity of 62% and specificity of 58% for nodular lesion detection in chest radiographs. The false positive rate is 0.88/image and the false negative (FN rate is 0.35/image. From the true positive lesions, 20% were proven benign and 80% were malignant. FN lesions were 47% benign and 53% malignant. Conclusion: We conclude that CAD does not qualify for a stand-alone standard of diagnosis. The use of CAD accompanied with a critical radiological assessment of the software suggested pattern appears more realistic. Accordingly, it is essential to focus on studies assessing the quality-time-cost profile of real-time (as opposed to retrospective CAD implementation in clinical diagnostics.

  7. Rheumatoid arthritis and pulmonary nodules: An unexpected final diagnosis.

    Science.gov (United States)

    Zurita Prada, Pablo Antonio; Urrego Laurín, Claudia Lía; Assyaaton Bobo, Sow; Faré García, Regina; Estrada Trigueros, Graciliano; Gallardo Romero, José Manuel; Borrego Pintado, Maria Henar

    We report the case of a 50-year-old female smoker with an 11-year history of seropositive rheumatoid arthritis (rheumatoid factor and anti-cyclic citrullinated peptide antibodies) receiving triple therapy. She developed pulmonary nodules diagnosed as Langerhans cell histiocytosis by lung biopsy. We found no reported cases of the coexistence of these two diseases. Smoking abstinence led to radiologic resolution without modifying the immunosuppressive therapy. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  8. Usefulness of virtual images of the visceral pleura in identifying the localization of peripheral small pulmonary nodules intraoperatively

    International Nuclear Information System (INIS)

    Kambayashi, Takatoyo

    2011-01-01

    The objective of this study was to assess the usefulness of virtual images of the visceral pleura in identifying the localization of peripheral small pulmonary nodules intraoperatively. We examined 12 cases with 12 peripheral small pulmonary nodules between 2008 and 2010. All lesions were predicted to be difficult to identify during surgery, and virtual images of the visceral pleura were made and evaluated before surgery. We predicted the usefulness of virtual images of the visceral pleura in identifying the localization of peripheral small pulmonary nodules. The mean maximum dimensions were 10.5±4.36 mm. The mean depth from the visceral pleura was 4.0±4.67 mm. The lesions were the solid type in 6 cases and the ground-glass opacity type in 6 cases. In 7 cases primary lung cancer was present, while the other 5 cases had only benign lesions. In all cases, changes in the visceral pleura could be identified with virtual images of the visceral pleura before surgery. We identified 7 lesions out of 12 intraoperatively. The reasons for the failure to identify the lesions were an inability to adequately observe the visceral pleura because of pleural adhesion, or failure to perform single lung ventilation in 3 cases. Another reason was that the changes in the visceral pleura were too minor to identify intraoperatively (2 cases). Virtual images of the visceral pleura may be useful for identifying the localization of peripheral small pulmonary nodules, and the prediction of whether or not the identification of lesions is possible intraoperatively, without preoperative marking in order to identify peripheral pulmonary nodules. (author)

  9. Significance of pulmonary nodules in multi-detector computed tomography scan of noncancerous patients

    Directory of Open Access Journals (Sweden)

    Ali Toghiani

    2015-01-01

    Full Text Available Background: Computed tomography (CT scan is one the most useful devices in chest imaging. CT scan can be used in mediastinal abnormality, lungs, and pleural evaluations. According to the high prevalence and different causes of pulmonary nodules, we designed this study to evaluate the prevalence and the types of pulmonary nodules in noncancerous patients who underwent chest multi-detector CT (MDCT scan. Materials and Methods: This was a cross-sectional study which was in our hospital to evaluate the prevalence of pulmonary nodules in noncancerous patients who underwent MDCT. A checklist was used for data collection containing number, location, size, and shape of pulmonary nodules if present in CT scan, and we also included patient′s age and history of smoking. We analyzed the data with Statistical Program for Social Sciences software (version 18. Results: In this study, 115 patients (40% had a pulmonary nodule. The mean number of a total nodule in each patient was 0.8 ± 0.07. Mean number of intra-parenchymal, sub pleural, and perivascular nodules were 0.34 ± 0.04, 0.31 ± 0.04, and 0.14 ± 0.02, respectively. The mean number of calcified nodules was 0.13 ± 0.02. There was no significant correlation between age and nodule characteristics (P > 0.05. Conclusion: The prevalence of pulmonary nodules was quite frequent in MDCT scan of noncancerous cases. So, it should not be overvalued in noncancerous cases.

  10. Significance of pulmonary nodules in multi-detector computed tomography scan of noncancerous patients

    Science.gov (United States)

    Toghiani, Ali; Adibi, Atoosa; Taghavi, Arash

    2015-01-01

    Background: Computed tomography (CT) scan is one the most useful devices in chest imaging. CT scan can be used in mediastinal abnormality, lungs, and pleural evaluations. According to the high prevalence and different causes of pulmonary nodules, we designed this study to evaluate the prevalence and the types of pulmonary nodules in noncancerous patients who underwent chest multi-detector CT (MDCT) scan. Materials and Methods: This was a cross-sectional study which was in our hospital to evaluate the prevalence of pulmonary nodules in noncancerous patients who underwent MDCT. A checklist was used for data collection containing number, location, size, and shape of pulmonary nodules if present in CT scan, and we also included patient's age and history of smoking. We analyzed the data with Statistical Program for Social Sciences software (version 18). Results: In this study, 115 patients (40%) had a pulmonary nodule. The mean number of a total nodule in each patient was 0.8 ± 0.07. Mean number of intra-parenchymal, sub pleural, and perivascular nodules were 0.34 ± 0.04, 0.31 ± 0.04, and 0.14 ± 0.02, respectively. The mean number of calcified nodules was 0.13 ± 0.02. There was no significant correlation between age and nodule characteristics (P > 0.05). Conclusion: The prevalence of pulmonary nodules was quite frequent in MDCT scan of noncancerous cases. So, it should not be overvalued in noncancerous cases. PMID:26487874

  11. Ultrasound guided percutaneous microwave ablation of benign thyroid nodules: Safety and imaging follow-up in 222 patients

    International Nuclear Information System (INIS)

    Yue, Wenwen; Wang, Shurong; Wang, Bin; Xu, Qingling; Yu, Shoujun; Yonglin, Zhang; Wang, Xiju

    2013-01-01

    Objective: Microwave ablation is a minimally invasive technique that has been used to treat benign and malignant tumors of liver, lung and kidney. Towards thyroid nodules, only a few cases are reported so far. The aim of the study was to investigate the effectiveness and safety of ultrasound-guided percutaneous microwave ablation in the treatment of benign thyroid nodules with a large sample. Materials and methods: A total of 477 benign thyroid nodules in 222 patients underwent microwave ablation in our department from July 2009 to March 2012. Microwave ablation was carried out using microwave antenna (16G) under local anesthesia. Nodule volume, thyroid function and clinical symptoms were evaluated before treatment and at 1, 3, more than 6 months. The study was ethics committee approved and written informed consents were obtained from all patients. Results: All thyroid nodules significantly decreased in size after microwave ablation. A 6-month follow-up was achieved in 254 of 477 nodules, and the mean decrease in the volume of thyroid nodules was from 2.13 ± 4.42 ml to 0.45 ± 0.90 ml, with a mean percent decrease of 0.65 ± 0.65. A volume-reduction ratio greater than 50% was observed in 82.3% (209/254) of index nodules, and 30.7% (78/254) of index nodules disappeared 6-month after the ablation. The treatment was well tolerated and no major complications were observed except pain and transient voice changes. Conclusions: Microwave ablation seems to be a safe and effective technique for the treatment of benign thyroid nodules. Further prospective randomized studies are needed to define the role of the procedure in the treatment of thyroid nodules

  12. Advances in intelligent diagnosis methods for pulmonary ground-glass opacity nodules.

    Science.gov (United States)

    Yang, Jing; Wang, Hailin; Geng, Chen; Dai, Yakang; Ji, Jiansong

    2018-02-07

    Pulmonary nodule is one of the important lesions of lung cancer, mainly divided into two categories of solid nodules and ground glass nodules. The improvement of diagnosis of lung cancer has significant clinical significance, which could be realized by machine learning techniques. At present, there have been a lot of researches focusing on solid nodules. But the research on ground glass nodules started late, and lacked research results. This paper summarizes the research progress of the method of intelligent diagnosis for pulmonary nodules since 2014. It is described in details from four aspects: nodular signs, data analysis methods, prediction models and system evaluation. This paper aims to provide the research material for researchers of the clinical diagnosis and intelligent analysis of lung cancer, and further improve the precision of pulmonary ground glass nodule diagnosis.

  13. Computer-aided detection of lung cancer: combining pulmonary nodule detection systems with a tumor risk prediction model

    Science.gov (United States)

    Setio, Arnaud A. A.; Jacobs, Colin; Ciompi, Francesco; van Riel, Sarah J.; Winkler Wille, Mathilde M.; Dirksen, Asger; van Rikxoort, Eva M.; van Ginneken, Bram

    2015-03-01

    Computer-Aided Detection (CAD) has been shown to be a promising tool for automatic detection of pulmonary nodules from computed tomography (CT) images. However, the vast majority of detected nodules are benign and do not require any treatment. For effective implementation of lung cancer screening programs, accurate identification of malignant nodules is the key. We investigate strategies to improve the performance of a CAD system in detecting nodules with a high probability of being cancers. Two strategies were proposed: (1) combining CAD detections with a recently published lung cancer risk prediction model and (2) the combination of multiple CAD systems. First, CAD systems were used to detect the nodules. Each CAD system produces markers with a certain degree of suspicion. Next, the malignancy probability was automatically computed for each marker, given nodule characteristics measured by the CAD system. Last, CAD degree of suspicion and malignancy probability were combined using the product rule. We evaluated the method using 62 nodules which were proven to be malignant cancers, from 180 scans of the Danish Lung Cancer Screening Trial. The malignant nodules were considered as positive samples, while all other findings were considered negative. Using a product rule, the best proposed system achieved an improvement in sensitivity, compared to the best individual CAD system, from 41.9% to 72.6% at 2 false positives (FPs)/scan and from 56.5% to 88.7% at 8 FPs/scan. Our experiment shows that combining a nodule malignancy probability with multiple CAD systems can increase the performance of computerized detection of lung cancer.

  14. The value of HIC1 and SIRT1 expression levels in thyroid nodule for assessing benign or malignant nodules

    Directory of Open Access Journals (Sweden)

    Chuan-Hua Fang

    2016-09-01

    Full Text Available Objective: To study the value of HIC1 and SIRT1 expression levels in thyroid nodule for assessing benign or malignant nodules. Method: 70 cases of surgically removed thyroid cancer tissue samples were collected as pathology group, 70 cases of corresponding para-carcinoma tissue specimens were collected as control group, immunohistochemistry was used to detect HIC1 and SIRT1 protein expression levels, and fluorescence quantitative PCR was used to detect the mRNA expression levels of HIC1 and SIRT1 as well as OXTR, CDH1, RASSF1A, TIMP3, MMP13, S100A4, CCNG2 and MK. Results: HIC1 expression levels in thyroid carcinoma tissue of pathology group were significantly lower than those of control group while SIRT1 expression levels were significantly higher than those of control group; compared with thyroid cancer tissue with TNM I-II stage, negative ductal infiltration and negative lymph node metastasis, HIC1 expression levels significantly decreased while SIRT1 expression levels significantly increased in thyroid cancer tissue with TNM III-IV stage, positive ductal infiltration and positive lymph node metastasis; in thyroid cancer tissue with positive HIC1 expression, OXTR, CDH1, RASSF1A and TIMP3 expression levels were significantly higher than those in thyroid cancer tissue with negative HIC1 expression; in thyroid cancer tissue with positive SIRT1 expression, MMP13, S100A4, CCNG2 and MK expression levels were significantly higher than those in thyroid cancer tissue with negative SIRT1 expression. Conclusion: HIC1 expression deletion and SIRT1 expression increase in thyroid nodule tissue are associated with the occurrence and development of thyroid carcinoma, and methylation and deacetylation may be epigenetic mechanism of HIC1 and SIRT1 to regulate cell proliferation, invasion and angiogenesis.

  15. Surgical Treatment of Small Pulmonary Nodules Under Video-assisted Thoracoscopy 
(A Report of 129 Cases

    Directory of Open Access Journals (Sweden)

    Tong WANG

    2017-01-01

    Full Text Available Background and objective The development of image technology has led to increasing detection of pulmonary small nodules year by year, but the determination of their nature before operation is difficult. This clinical study aimed to investigate the necessity and feasibility of surgical resection of pulmonary small nodules through a minimally invasive approach and the operational manner of non-small cell lung cancer (NSCLC. Methods The clinical data of 129 cases with pulmonary small nodule of 10 mm or less in diameter were retrospectively analyzed in our hospital from December 2013 to November 2016. Thin-section computed tomography (CT was performed on all cases with 129 pulmonary small nodules. CT-guided hook-wire precise localization was performed on 21 cases. Lobectomy, wedge resection, and segmentectomy with lymph node dissection might be performed in patients according to physical condition. Results Results of the pathological examination of 37 solid pulmonary nodules (SPNs revealed 3 primary squamous cell lung cancers, 3 invasive adenocarcinomas (IAs, 2 metastatic cancers, 2 small cell lung cancers (SCLCs, 16 hamartomas, and 12 nonspecific chronic inflammations. The results of pathological examination of 49 mixed ground glass opacities revealed 19 IAs, 6 micro invasive adenocarcinomas (MIAs, 4 adenocarcinomas in situ (AIS, 1 atypical adenomatous hyperplasia (AAH, 1 SCLC, and 18 nonspecific chronic inflammations. The results of pathological examination of 43 pure ground glass opacities revealed 19 AIS, 6 MIAs, 6 IA, 6 AAHs, and 6 nonspecific chronic inflammations. Wedge resection under video-assisted thoracoscopic surgery (VATS was performed in patients with 52 benign pulmonary small nodules. Lobectomy and systematic lymph node dissection under VATS were performed in 33 patients with NSCLC. Segmentectomy with selective lymph node dissection, wedge resection, and selective lymph node dissection under VATS were performed in six patients with

  16. Management of solid pulmonary nodules; Management solider pulmonaler Rundherde

    Energy Technology Data Exchange (ETDEWEB)

    Poschenrieder, F.; Beyer, L.; Stroszczynski, C.; Hamer, O.W. [Universitaetsklinikum Regensburg, Institut fuer Roentgendiagnostik, Regensburg (Germany); Rehbock, B. [Praxis fuer Diagnostische Radiologie am St.-Hedwig-Krankenhaus Berlin-Mitte, Diagnostische Radiologie, Berlin (Germany); Diederich, S. [Marienhospital Duesseldorf, Institut fuer Diagnostische und Interventionelle Radiologie, Duesseldorf (Germany); Wormanns, D. [Evangelische Lungenklinik Berlin, Radiologisches Institut, Berlin (Germany)

    2014-05-15

    The increasing availability of computed tomography has meant that the number of incidentally detected solitary pulmonary nodules (SPN) has greatly increased in recent years. A reasonable management of these SPN is necessary in order to firstly be able to detect malignant lesions early on and secondly to avoid upsetting the patient unnecessarily or carrying out further stressful diagnostic procedures. This review article shows how the dignity of SPNs can be estimated and based on this how the management can be accomplished taking established guidelines into consideration. (orig.) [German] Die steigende Verfuegbarkeit leistungsstarker Computertomographen hat dazu gefuehrt, dass die Anzahl inzidentell detektierter solitaerer Lungenrundherde (''solitary pulmonary nodule'', SPN) in den letzten Jahren deutlich gestiegen ist. Diese SPN muessen einem sinnvollen Management zugefuehrt werden, um einerseits fruehzeitig auf maligne Laesionen reagieren zu koennen und andererseits bei benignen Laesionen eine unnoetige Beunruhigung des Patienten oder eine belastende weiterfuehrende Diagnostik zu vermeiden. Der Uebersichtsartikel stellt dar, wie die Dignitaet eines SPN eingeschaetzt werden kann und wie darauf basierend unter Beruecksichtigung etablierter Leitlinien das Management zielfuehrend gestaltet wird. (orig.)

  17. Clinical Value of Coincidence Detection Emission Tomography Using Fluoine-18-2-Fluoro-2-Deoxy-D-Glucose in the Diagnosis of Solitary Pulmonary Nodules: Correlation with Computed Tomography Findings

    International Nuclear Information System (INIS)

    Najjar, F.; Moretti, J.

    2007-01-01

    Solitary Pulmonary Nodules (size 40 mm) is the most frequent indication of coincidence detection emission tomography (CDET) with fluorine-18 fluoro-2-deoxy-D-glucose (18FDG). The aim of the present study was to establish the efficacy of this system with and without attenuation correction (AC) in correlation with computed tomography (CT) findings for the distinction between benign and malignant pulmonary nodules. Material and methods: Sixty-eight patients were included in this study. All patients presented with suspected pulmonary nodules on thoracic CT. In addition, they had CDET scan using a dual-head coincidence gamma-camera with and without measured attenuation using caesium- 137 source. Corrected images were independently interpreted from non-attenuation corrected images in a blinded manner of any clinical data. 18FDG-CDET findings were evaluated by histology when it was available. Otherwise, the final clinical outcome has been considered in data analysis. Results: A total of 71 suspected nodules were observed by CT. Malignant pulmonary disease was found in 38 of these nodules whereas 33 pulmonary nodules were proved to be benign. In addition, one malignant nodule was confirmed with negative CT findings. 18FDG-CDET imaging without AC demonstrated 48 suspected pulmonary lesions included 4 nodules with negative CT findings (sensitivity, 92%; specificity, 68.4%) Versus 43 lesions identified with AC (sensitivity, 92%; specificity, 81.5%). All of the malignant nodules >20 mm in diameter by 18FDG-CDET. In 5 patients (8% of cases), uncorrected images were spotting benign nodules which were considered as negative on corrected images. So lower specificity rate was obtained by non AC mode in comparison with AC mode (68.4% versus 81.5% respectively). Both modalities techniques failed to detect malignancy in 3 patients. In general, the diagnostic accuracy of 18FDG-CDET without AC was relatively comparable to that found with AC (82.6% to 87%, respectively).

  18. [CT-guided marking of pulmonary nodules with a special lung marking wire before video-assisted thoracoscopic surgery - review of 184 cases].

    Science.gov (United States)

    Schulze, M-K; Eichfeld, U; Kahn, T; Stumpp, P

    2012-06-01

    Minimally invasive techniques like video-assisted thoracoscopic surgery (VATS) are currently the method of choice for the resection of small pulmonary nodules, when they are located in the periphery of the lungs. To guarantee quick and safe intraoperative identification of the nodule, preoperative marking is necessary and sensible. We report about our experiences in 184 markings with a special lung marking wire, which is placed in or around the pulmonary nodule using CT guidance. In 184 patients (97 m, 87f, mean age: 58.1 ± 13.7 years) with pulmonary nodules, scheduled for resection with VATS, a special lung marking wire was placed preoperatively under CT guidance. We evaluated the technical success, safety, necessity of conversion to thoracotomy and histology in all patients. The marking wire could be positioned successfully in 181 cases (98.4 %). There was one major complication (uncontrollable pneumothorax). Minor adverse events like small pneumothorax (53.3 %) or a perifocal bleeding (30.4 %) did not necessitate treatment. Complete resection of the marked nodule was successful in 98.4 % of the patients. Conversion to thoracotomy was necessary in 29 patients (15.9 %) due to bleeding, adhesions, malignancy or wire dislocation. Histology revealed a benign nodule in 96 cases (54.4 %) and a malignant lesion in 78 cases (45.6 %), of which only 21 nodules (11.5 %) turned out to present a primary pulmonary carcinoma. CT-guided marking of pulmonary nodules using a special marking wire followed by thoracoscopic resection is an efficient and safe method for diagnosing suspicious nodules in the periphery of the lung. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Proposal of a technical guide for the evaluation and management of the solitary pulmonary nodule in function of the radiological characteristics obtained by computed tomography

    International Nuclear Information System (INIS)

    Clinton Hidalgo, Carolina

    2015-01-01

    A guide is proposed to guide clinical personnel in early diagnosis, assessment and management of the solitary pulmonary nodule, with high potential of to develop lung cancer, in function of the radiological characteristics obtained by computed tomography. The management of patients with diagnosis of solitary pulmonary nodule is standardized with the purpose of to unify diagnostic criteria in a multidisciplinary and institutional environment. Tomographic radiological characteristics are described to allow the suspicion of the solitary pulmonary nodule benignity or malignity. A flow diagram is developed to guide the physician to an adequate monitoring, control and eventual therapeutic treatment. A clear and structured perspective of the diagnostic and therapeutic process is provided to the treating physician and patient [es

  20. The effects of computed tomography with iterative reconstruction on solid pulmonary nodule volume quantification.

    Directory of Open Access Journals (Sweden)

    Martin J Willemink

    Full Text Available BACKGROUND: The objectives of this study were to evaluate the influence of iterative reconstruction (IR on pulmonary nodule volumetry with chest computed tomography (CT. METHODS: Twenty patients (12 women and 8 men, mean age 61.9, range 32-87 underwent evaluation of pulmonary nodules with a 64-slice CT-scanner. Data were reconstructed using filtered back projection (FBP and IR (Philips Healthcare, iDose(4-levels 2, 4 and 6 at similar radiation dose. Volumetric nodule measurements were performed with semi-automatic software on thin slice reconstructions. Only solid pulmonary nodules were measured, no additional selection criteria were used for the nature of nodules. For intra-observer and inter-observer variability, measurements were performed once by one observer and twice by another observer. Algorithms were compared using the concordance correlation-coefficient (pc and Friedman-test, and post-hoc analysis with the Wilcoxon-signed ranks-test with Bonferroni-correction (significance-level p<0.017. RESULTS: Seventy-eight nodules were present including 56 small nodules (volume<200 mm(3, diameter<8 mm and 22 large nodules (volume≥200 mm(3, diameter≥8 mm. No significant differences in measured pulmonary nodule volumes between FBP, iDose(4-levels 2, 4 and 6 were found in both small nodules and large nodules. FBP and iDose(4-levels 2, 4 and 6 were correlated with pc-values of 0.98 or higher for both small and large nodules. Pc-values of intra-observer and inter-observer variability were 0.98 or higher. CONCLUSIONS: Measurements of solid pulmonary nodule volume measured with standard-FBP were comparable with IR, regardless of the IR-level and no significant differences between measured volumes of both small and large solid nodules were found.

  1. Usefulness of the CAD System for Detecting Pulmonary Nodule in Real Clinical Practice

    International Nuclear Information System (INIS)

    Song, Kyoung Doo; Chung, Myung Jin; Kim, Hee Cheol; Lee, Kyung Soo; Jeong, Sun Young

    2011-01-01

    We wanted to evaluate the usefulness of the computer-aided detection (CAD) system for detecting pulmonary nodules in real clinical practice by using the CT images. Our Institutional Review Board approved our retrospective study with a waiver of informed consent. This study included 166 CT examinations that were performed for the evaluation of pulmonary metastasis in 166 patients with colorectal cancer. All the CT examinations were interpreted by radiologists and they were also evaluated by the CAD system. All the nodules detected by the CAD system were evaluated with regard to whether or not they were true nodules, and they were classified into micro nodules (MN, diameter < 4 mm) and significant nodules (SN, 4 ≤ diameter ≤ 10 mm). The radiologic reports and CAD results were compared. The CAD system helped detect 426 nodules: 115 (27%) of the 426 nodules were classified as true nodules and 35 (30%) of the 115 nodules were SNs, and 83 (72%) of the 115 were not mentioned in the radiologists' reports and three (4%) of the 83 nodules were non-calcified SNs. One of three non-calcified SNs was confirmed as a metastatic nodule. According to the radiologists' reports, 60 true nodules were detected, and 28 of the 60 were not detected by the CAD system. Although the CAD system missed many SNs that are detected by radiologists, it helps detect additional nodules that are missed by the radiologists in real clinical practice. Therefore, the CAD system can be useful to support a radiologist's detection performance

  2. Return of the pulmonary nodule: the radiologist's key role in implementing the 2015 BTS guidelines on the investigation and management of pulmonary nodules.

    Science.gov (United States)

    Graham, Richard N J; Baldwin, David R; Callister, Matthew E J; Gleeson, Fergus V

    2016-01-01

    The British Thoracic Society has published new comprehensive guidelines for the management of pulmonary nodules. These guidelines are significantly different from those previously published, as they use two malignancy prediction calculators to better characterize the risk of malignancy. There are recommendations for a higher nodule size threshold for follow-up (≥5 mm or ≥80 mm(3)) and a reduction of the follow-up period to 1 year for solid pulmonary nodules; both of these will reduce the number of follow-up CT scans. PET-CT plays a crucial role in characterization also, with an ordinal scale being recommended for reporting. Radiologists will be the key in implementing these guidelines, and routine use of volumetric image-analysis software will be required to manage patients with pulmonary nodules correctly.

  3. CT and MRI findings of cirrhosis-related benign nodules with ischaemia or infarction after variceal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Y.K., E-mail: jmyr@dreamwiz.co [Department of Diagnostic Radiology, Research Institute of Clinical Medicine, Chonbuk National University Hospital and Medical School, Jeon Ju (Korea, Republic of); Park, G.; Kim, C.S.; Han, Y.M. [Department of Diagnostic Radiology, Research Institute of Clinical Medicine, Chonbuk National University Hospital and Medical School, Jeon Ju (Korea, Republic of)

    2010-10-15

    Aim: To present computed tomography (CT) and magnetic resonance imaging (MRI) findings of cirrhosis-related benign nodules with ischaemia or infarction. Materials and methods: Sixteen consecutive patients (14 men and two women) who had been diagnosed with cirrhosis-related benign nodules with ischaemia or infarction after variceal bleeding based on the results of dynamic CT (n = 15) and MRI (n = 8) were included in this study. Five patients had histopathological confirmation via liver transplantation (n = 2) and percutaneous biopsy (n = 3). Images were analyzed for the enhancement pattern, signal intensities, location, and configuration of the lesions. Results: Most of the lesions were depicted as multifocal discrete or clustered nodules with some irregular patchy areas (size range 3-28 mm). They were predominantly found in subcapsular area or caudate lobe. Most nodular lesions were seen as hypoattenuating (hypointense) nodules with rim enhancement during dynamic CT or MRI. On T2-weighted images, nodular lesions were predominantly seen as target appearing hyperintense nodules. On follow-up images (range 2-24 months), most of the lesions disappeared or decreased in size. Conclusion: CT and MRI can be used to demonstrate characteristic findings of cirrhosis-related benign nodules with ischaemia or infarction. Rapid resolution of the nodules at follow-up imaging can also be helpful for diagnosing these lesions.

  4. Dual-energy CT in the evaluation of solitary pulmonary nodules by virtual non-enhanced images: initial experience

    International Nuclear Information System (INIS)

    Guo Xing; Ding Wei; Qin Huijuan

    2011-01-01

    Objective: To determine the accuracy and radiation dose of dual-energy computed tomography (CT) in evaluating solitary pulmonary nodules (SPNs) by virtual non-enhanced images. Methods: Sixty-one patients with SPNs including 39 malignant and 18 benign nodules proved by pathology underwent DECT scans. The CT values of SPNs on enhanced weighted average and virtual non-enhanced images were compared by using Liver VNC processing unit in terms of their diagnostic accuracy for distinguishing malignant and benign nodules with a 20 HU threshold. Diagnostic accuracy was compared. In 28 patients of all patients, image noise and quality score of the non-enhanced and virtual non-enhanced images were compared, and radiation doses of each patient were recorded. The paired t test was used to analyze the noise difference between the plain scan and virtual non-enhanced scan. The Mann-Whitney U test. was used to analyze statistically significant differences of the image quality score and radiation dose between the non-enhanced scan and virtual non-enhanced scan. Results: The sensitivity, specificity and accuracy for distinguishing benign and malignant nodules by using the virtual non-enhanced image of were 89.7% (35/39), 72.2% (13/18), 84.2% (48/57) respectively. The noise of common CT and virtual non- enhanced images were (8.49±1.94) HU and (10.14±2.18) HU, and there were statistically difference (t=9.45, P 0.05). The radiation doses of common CT and DECT were (3.72±0.48) mSv and (3.78±0.45) mSv, and there were no statistical difference (U= 350.50, P>0.05). Conclusion: DECT by using virtual non-enhanced images is useful tool to distinguish the benign and malignant SPN without additional radiation dose. (authors)

  5. Multicentre external validation of the BIMC model for solid solitary pulmonary nodule malignancy prediction

    Energy Technology Data Exchange (ETDEWEB)

    Soardi, Gian Alberto; Perandini, Simone; Motton, Massimiliano; Montemezzi, Stefania [AOUI Verona, UOC Radiologia, Ospedale Maggiore di Borgo Trento, Verona (Italy); Larici, Anna Rita; Del Ciello, Annemilia [Universita Cattolica del Sacro Cuore, Dipartimento di Scienze Radiologiche, Roma (Italy); Rizzardi, Giovanna [UO Chirurgia Toracica, Ospedale Humanitas Gavazzeni, Bergamo (Italy); Solazzo, Antonio [UO Radiologia, Ospedale Humanitas Gavazzeni, Bergamo (Italy); Mancino, Laura [UO Pneumologia, Ospedale dell' Angelo di Mestre, Mestre (Italy); Bernhart, Marco [UO Radiologia, Ospedale dell' Angelo di Mestre, Mestre (Italy)

    2017-05-15

    To provide multicentre external validation of the Bayesian Inference Malignancy Calculator (BIMC) model by assessing diagnostic accuracy in a cohort of solitary pulmonary nodules (SPNs) collected in a clinic-based setting. To assess model impact on SPN decision analysis and to compare findings with those obtained via the Mayo Clinic model. Clinical and imaging data were retrospectively collected from 200 patients from three centres. Accuracy was assessed by means of receiver-operating characteristic (ROC) areas under the curve (AUCs). Decision analysis was performed by adopting both the American College of Chest Physicians (ACCP) and the British Thoracic Society (BTS) risk thresholds. ROC analysis showed an AUC of 0.880 (95 % CI, 0.832-0.928) for the BIMC model and of 0.604 (95 % CI, 0.524-0.683) for the Mayo Clinic model. Difference was 0.276 (95 % CI, 0.190-0.363, P < 0.0001). Decision analysis showed a slightly reduced number of false-negative and false-positive results when using ACCP risk thresholds. The BIMC model proved to be an accurate tool when characterising SPNs. In a clinical setting it can distinguish malignancies from benign nodules with minimal errors by adopting current ACCP or BTS risk thresholds and guiding lesion-tailored diagnostic and interventional procedures during the work-up. (orig.)

  6. A panel of four genes accurately differentiates benign from malignant thyroid nodules

    Directory of Open Access Journals (Sweden)

    Qing-Xuan Wang

    2016-10-01

    Full Text Available Abstract Background Clinicians are confronted with an increasing number of patients with thyroid nodules. Reliable preoperative diagnosis of thyroid nodules remains a challenge because of inconclusive cytological examination of fine-needle aspiration biopsies. Although molecular analysis of thyroid tissue has shown promise as a diagnostic tool in recent years, it has not been successfully applied in routine clinical use, particularly in Chinese patients. Methods Whole-transcriptome sequencing of 19 primary papillary thyroid cancer (PTC samples and matched adjacent normal thyroid tissue (NT samples were performed. Bioinformatics analysis was carried out to identify candidate diagnostic genes. Then, RT-qPCR was performed to evaluate these candidate genes, and four genes were finally selected. Based on these four genes, diagnostic algorithm was developed (training set: 100 thyroid cancer (TC and 65 benign thyroid lesions (BTL and validated (independent set: 123 TC and 81 BTL using the support vector machine (SVM approach. Results We discovered four genes, namely fibronectin 1 (FN1, gamma-aminobutyric acid type A receptor beta 2 subunit (GABRB2, neuronal guanine nucleotide exchange factor (NGEF and high-mobility group AT-hook 2 (HMGA2. A SVM model with these four genes performed with 97.0 % sensitivity, 93.8 % specificity, 96.0 % positive predictive value (PPV, and 95.3 % negative predictive value (NPV in training set. For additional independent validation, it also showed good performance (92.7 % sensitivity, 90.1 % specificity, 93.4 % PPV, and 89.0 % NPV. Conclusions Our diagnostic panel can accurately distinguish benign from malignant thyroid nodules using a simple and affordable method, which may have daily clinical application in the near future.

  7. Diagnosis of lung cancer in individuals with solitary pulmonary nodules by plasma microRNA biomarkers

    Directory of Open Access Journals (Sweden)

    Cai Ling

    2011-08-01

    Full Text Available Abstract Background Making a definitive preoperative diagnosis of solitary pulmonary nodules (SPNs found by CT has been a clinical challenge. We previously demonstrated that microRNAs (miRNAs could be used as biomarkers for lung cancer diagnosis. Here we investigate whether plasma microRNAs are useful in identifying lung cancer among individuals with CT-detected SPNs. Methods By using quantitative reverse transcriptase PCR analysis, we first determine plasma expressions of five miRNAs in a training set of 32 patients with malignant SPNs, 33 subjects with benign SPNs, and 29 healthy smokers to define a panel of miRNAs that has high diagnostic efficiency for lung cancer. We then validate the miRNA panel in a testing set of 76 patients with malignant SPNs and 80 patients with benign SPNs. Results In the training set, miR-21 and miR-210 display higher plasma expression levels, whereas miR-486-5p has lower expression level in patients with malignant SPNs, as compared to subjects with benign SPNs and healthy controls (all P ≤ 0.001. A logistic regression model with the best prediction was built on the basis of miR-21, miR-210, and miR-486-5p. The three miRNAs used in combination produced the area under receiver operating characteristic curve at 0.86 in distinguishing lung tumors from benign SPNs with 75.00% sensitivity and 84.95% specificity. Validation of the miRNA panel in the testing set confirms their diagnostic value that yields significant improvement over any single one. Conclusions The plasma miRNAs provide potential circulating biomarkers for noninvasively diagnosing lung cancer among individuals with SPNs, and could be further evaluated in clinical trials.

  8. The Role of Insulin-Like Growth Factor 1 in the Development of Benign and Malignant Thyroid Nodules

    Directory of Open Access Journals (Sweden)

    Ayşe Karadayı

    2012-06-01

    Full Text Available Objective: This study aims to investigate the role of IGF-1 in the development of nodular thyroid disease. Material and Methods: A total number of 100 consecutive patients operated for nodular thyroid disease in our institution were included in this prospective study. In addition to classical pathological examinations, nodules and extranodular healthy tissues were sampled and immunochemically stained for IGF-1. The materials were independently evaluated using an Allred Scoring System ranging from 0 to 8. If the score was ≥1, the tissue was accepted as IGF-1 positive.Results: IGF-1 positivity was observed in 88% and 58% of the samples obtained from nodules and extranodular healthy tissues, respectively. Allred 8-unit scores were higher in benign nodules (n=89; 4.1±2.3 and papillary carcinomas (n=7; 6.7±1.3, than in extranodular healthy tissues in the same patients (2.3±2.3 and 3.3±1.9, respectively; and higher in papillary carcinomas than in benign nodules, when the scores were compared to each other (p<0.01 for all comparisons. Conclusions: Allred 8-unit scores for IGF-1 increase in the presence of benign thyroid nodules, papillary cancer. The results of our study support the findings of previous studies demonstrating the role of IGF-1 in the development of thyroidal nodules.

  9. Differential diagnosis of a solitary pulmonary nodule of the lung on the grounds of selected laboratory tests and radiological examination

    International Nuclear Information System (INIS)

    Szlachcinska, A.; Kozak, J.

    2011-01-01

    Objective: To present in detail the diagnosis of solitary pulmonary nodule and especially evaluation of: clinical data, analysis of radiological images, selected laboratory tests. Material and methods: There were 50 patients - 31 men and 19 women at the mean age 58.7 ± 11.4 years old who underwent surgical treatment because of a solitary pulmonary nodule. Interview, physical examination, computed tomography, bronchoscopy, spirometry, and laboratory tests needed for the operation were performed in all these patients. Additionally LDH, fibrinogen, ESR, and the tumour markers CEA, Ca 15-3, Ca 19-9, NSE, SCC, and Cyfra 21-1 were measured from the blood sample collected during admission. Results: Malignant tumour was diagnosed in 24 patients, benign in 26. There is a significant difference between patients with malignant and nonmalignant tumours in age (54.46 years vs. 63.33 years), size of the tumour in the lung scan of chest CT (1.53 cm vs. 1.91 cm) and location (lower right lobe vs. upper right lobe). There is no significant difference between type of tumour and sex, clinical symptoms and laboratory tests. Conclusions: 1. The risk factors of malignancy in patient with solitary pulmonary nodule are: age ≥ 56.5 years, size of the tumour in the lung scan of chest CT ≥ 1.45 cm, location in upper right lobe. 2. LDH, fibrinogen, ESR, and the tumour markers CEA, Ca 15-3, Ca 19-9, NSE, SCC, and Cyfra 21-1 are not useful in differential diagnosis of solitary pulmonary nodule. (authors)

  10. Prevalence and configuration of pulmonary nodules on multi-row CT in children without malignant diseases

    Energy Technology Data Exchange (ETDEWEB)

    Renne, Julius; Wacker, Frank; Berthold, Lars-Daniel; Weidemann, Juergen [Hannover Medical School, Institute for Diagnostic and Interventional Radiology, Hannover (Germany); Linderkamp, Christin [Hannover Medical School, Pediatric Oncology, Hannover (Germany)

    2015-09-15

    To assess the prevalence and morphologic characterization of pulmonary nodules in children on a chest computed tomography (CT). Two hundred and fifty-nine trauma chest CTs in children aged 0-18 years were retrospectively reviewed by two radiologists, each with more than 10 years of experience. Images were acquired on a 64-row CT. Pulmonary lobes with trauma affections such as contusion or haemorrhage were excluded. All pulmonary nodules were evaluated for distance from the pleural surface, location, calcification and size on axial slices. A total of 1,190/1,295 (92 %) pulmonary lobes without traumatic injury were included in this study. In 86 of 259 (33 %) patients, 131 pulmonary nodules were detected. Number of nodules per patient ranged from 1 to 4. Calcifications were seen in 19 % (25) of all nodules. Diameters ranged from 1 to 5 mm. 59 % (77) were located in the lower lobes, 9 % (12) in the middle lobe and 32 % (42) in the upper lobes. 84 % of the non-calcified nodules >2 mm showed a slightly angular or triangular (mostly pleural nodes) shape. Pulmonary nodules smaller than 5 mm can be detected frequently in children without malignant disease and are predominantly located in the lower lobes. (orig.)

  11. A novel minimally invasive near-infrared thoracoscopic localization technique of small pulmonary nodules: A phase I feasibility trial.

    Science.gov (United States)

    Ujiie, Hideki; Kato, Tatsuya; Hu, Hsin-Pei; Patel, Priya; Wada, Hironobu; Fujino, Kosuke; Weersink, Robert; Nguyen, Elsie; Cypel, Marcelo; Pierre, Andrew; de Perrot, Marc; Darling, Gail; Waddell, Thomas K; Keshavjee, Shaf; Yasufuku, Kazuhiro

    2017-08-01

    Localization and resection of nonvisible, nonpalpable pulmonary nodules during video-assisted thoracoscopic surgery are challenging. Our study was to determine the feasibility and safety of indocyanine green fluorescence localization and resection of small nodules using a near-infrared fluorescence thoracoscope. Twenty patients with undiagnosed peripheral nodules smaller than 3 cm scheduled for computed tomography-guided microcoil placement followed by video-assisted thoracoscopic surgery wedge resection were enrolled. After microcoil deployment, 100 to 150 μL of diluted indocyanine green was injected percutaneously near the nodule. The nodule initially was localized solely by using a near-infrared thoracoscope to visualize indocyanine green fluorescence. Thoracoscopic instruments were used to determine the staple line. Wedge resection was performed after confirmation of the location of the microcoil using fluoroscopy. Twenty patients underwent near-infrared, image-guided, video-assisted thoracoscopic surgery resection. The median computed tomography tumor size was 1.2 cm. The median depth from the pleural surface was 1.4 cm (range, 0.2-4.8 cm). The median computed tomography-guided intervention time was 35 minutes, and video-assisted thoracoscopic surgery procedural time was 54 minutes. Indocyanine green fluorescence was clearly identified in 18 of 20 patients (90%). The surgical margins were all negative on final pathology without the need for additional resection. The final diagnoses included 18 primary lung cancers, 1 metastatic lung cancer, and 1 benign lung tumor. Computed tomography-guided percutaneous indocyanine green injection and intraoperative near-infrared localization of small nodules are safe and feasible. These offer surgeons the ease of localization through direct indocyanine green fluorescence imaging without the use of fluoroscopy and may be a complementary technique to preoperative microcoil placement for nonvisible

  12. JOURNAL CLUB: Computer-Aided Detection of Lung Nodules on CT With a Computerized Pulmonary Vessel Suppressed Function.

    Science.gov (United States)

    Lo, ShihChung B; Freedman, Matthew T; Gillis, Laura B; White, Charles S; Mun, Seong K

    2018-03-01

    The purpose of this study is to evaluate radiologists' performance in detecting actionable nodules on chest CT when aided by a pulmonary vessel image-suppressed function and a computer-aided detection (CADe) system. A novel computerized pulmonary vessel image-suppressed function with a built-in CADe (VIS/CADe) system was developed to assist radiologists in interpreting thoracic CT images. Twelve radiologists participated in a comparative study without and with the VIS/CADe using 324 cases (involving 95 cancers and 83 benign nodules). The ratio of nodule-free cases to cases with nodules was 2:1 in the study. Localization ROC (LROC) methods were used for analysis. In a stand-alone test, the VIS/CADe system detected 89.5% and 82.0% of malignant nodules and all nodules no smaller than 5 mm, respectively. The false-positive rate per CT study was 0.58. For the reader study, the mean area under the LROC curve (LROCAUC) for the detection of lung cancer significantly increased from 0.633 when unaided by VIS/CADe to 0.773 when aided by VIS/CADe (p < 0.01). For the detection of all clinically actionable nodules, the mean LROC-AUC significantly increased from 0.584 when unaided by VIS/CADe to 0.692 when detection was aided by VIS/CADe (p < 0.01). Radiologists detected 80.0% of cancers with VIS/CADe versus 64.45% of cancers unaided (p < 0.01); specificity decreased from 89.9% to 84.4% (p < 0.01). Radiologist interpretation time significantly decreased by 26%. The VIS/CADe system significantly increased radiologists' detection of cancers and actionable nodules with somewhat lower specificity. With use of the VIS/CADe system, radiologists increased their interpretation speed by a factor of approximately one-fourth. Our study suggests that the technique has the potential to assist radiologists in the detection of additional actionable nodules on thoracic CT.

  13. Benign thyroid nodules treatment using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA).

    Science.gov (United States)

    Mauri, Giovanni; Cova, Luca; Monaco, Cristian Giuseppe; Sconfienza, Luca Maria; Corbetta, Sabrina; Benedini, Stefano; Ambrogi, Federico; Milani, Valentina; Baroli, Alberto; Ierace, Tiziana; Solbiati, Luigi

    2016-11-15

    To evaluate the reduction over time of benign thyroid nodules treated using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA) by the same equipe. Ninety patients (age 55.6 ± 14.1 years) underwent ablation for benign thyroid nodule causing compression/aesthetic dissatisfaction from 2011. Fifty-nine (age 55.8 ± 14.1 years) underwent RFA and 31 (age 55.2 ± 14.2 years) PLA, ultrasound guided. Technical success, complications, duration of ablation and treatment, energy deployed, volumetric percentage reduction at 1, 6 and 12 months were derived. A regression model for longitudinal measurements was used with random intercept and random slope. Values are expressed as mean ± standard deviation or N (%). Technical success was always obtained. No major complications occurred. Mean ablation time was 30.1 ± 13.8 vs. 13.9 ± 5.9 min (p < .0001) and mean energy deployment was 5422.3 ± 2484.5 J vs. 34 662.7 ± 15 812.3 J in PLA vs. RFA group. Mean volume reduced from 20.3 ± 16.4 ml to 13.17 ± 10.74 ml (42% ± 17% reduction) at 1st month, 8.7 ± 7.4 ml (60% ± 15% reduction) at 6th month and 7.1 ± 7.7 ml (70%% ± 16% reduction) at 12th month, in PLA group, and from 32.7 ± 19.5 ml to 17.2 ± 12.9 ml (51%±15% reduction) at 1st month, 12.8 ± 9.6 ml (64 ± 14% reduction) at 6th month and 9.9 ± 9.2 ml (74% ± 14% reduction) at 12th month in RFA group. No difference in time course of the relative volume reduction between the two techniques was found. RFA and PLA are similarly feasible, safe and effective in treating benign thyroid nodules when performed by the same equipe. RFA is faster than PLA but require significantly higher energy.

  14. Resection of pulmonary nodule in a patient with subglottic stenosis under modified spontaneous ventilation anesthesia

    DEFF Research Database (Denmark)

    Shen, Jianfei; Chen, Xuewei; Liang, Lixia

    2017-01-01

    . Here we present a case of pulmonary nodule resection in a patient with subglottic stenosis using uniportal thoracoscopy under spontaneous ventilation anesthesia (SVA). Compared with traditional double lumen endotracheal intubation, we believe this modified technique can significantly reduce airway...

  15. The influence of inspiratory effort and emphysema on pulmonary nodule volumetry reproducibility.

    Science.gov (United States)

    Moser, J B; Mak, S M; McNulty, W H; Padley, S; Nair, A; Shah, P L; Devaraj, A

    2017-11-01

    To evaluate the impact of inspiratory effort and emphysema on reproducibility of pulmonary nodule volumetry. Eighty-eight nodules in 24 patients with emphysema were studied retrospectively. All patients had undergone volumetric inspiratory and end-expiratory thoracic computed tomography (CT) for consideration of bronchoscopic lung volume reduction. Inspiratory and expiratory nodule volumes were measured using commercially available software. Local emphysema extent was established by analysing a segmentation area extended circumferentially around each nodule (quantified as percent of lung with density of -950 HU or less). Lung volumes were established using the same software. Differences in inspiratory and expiratory nodule volumes were illustrated using the Bland-Altman test. The influences of percentage reduction in lung volume at expiration, local emphysema extent, and nodule size on nodule volume variability were tested with multiple linear regression. The majority of nodules (59/88 [67%]) showed an increased volume at expiration. Mean difference in nodule volume between expiration and inspiration was +7.5% (95% confidence interval: -24.1, 39.1%). No relationships were demonstrated between nodule volume variability and emphysema extent, degree of expiration, or nodule size. Expiration causes a modest increase in volumetry-derived nodule volumes; however, the effect is unpredictable. Local emphysema extent had no significant effect on volume variability in the present cohort. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  16. Value of diffusion-weighted MR imaging using various parameters for assessment and characterization of solitary pulmonary nodules

    International Nuclear Information System (INIS)

    Koyama, Hisanobu; Ohno, Yoshiharu; Seki, Shinichiro; Nishio, Mizuho; Yoshikawa, Takeshi; Matsumoto, Sumiaki; Maniwa, Yoshimasa; Itoh, Tomoo; Nishimura, Yoshihiro; Sugimura, Kazuro

    2015-01-01

    Highlights: •Signal–intensity ratio evaluation between lesion and spinal cord is practical method. •Apparent diffusion coefficients may not contribute to the diagnosis of malignant. •True diffusion coefficients may have low potential for the differentiation. •Perfusion fractions may be less specific parameter of diagnosis of pulmonary nodule. •Choice of b values shows little impact for differentiation of pulmonary nodules. -- Abstract: Objectives: To determine the appropriate parameters and evaluation method for characterizing solitary pulmonary nodules (SPNs) using quantitative parameters of diffusion-weighted imaging (DWI). Methods: Thirty-two subjects with 36 SPNs underwent DWI with seven different b values (0, 50, 100, 150, 300, 500, and 1000 s/mm 2 ). Five quantitative parameters were obtained from the region of interest drawn over each SPN: apparent diffusion coefficients (ADCs), true diffusion coefficients (DCs), and perfusion fractions (PFs), and signal–intensity ratios between lesion and spinal cord from DWI (b values: 1000 [LSR 1000 ] and 500 [LSR 500 )]). All quantitative parameters and the diagnostic capabilities were statistically compared. Results: SPNs were diagnosed as follow: malignant (n = 27) and benign (n = 9). Parameter comparisons for malignant and benign showed both LSRs differed significantly (p < 0.05). Applying feasible threshold values showed LSR 500 specificity (88.9% [8/9]) and accuracy (77.8% [28/36]) were significantly higher than ADC, DC, and PF specificity and accuracy (p < 0.05). LSR 1000 accuracy (72.2% [26/36]) was significantly higher than DC accuracy, and its specificity (88.9% [8/9]) was significantly higher than ADC, DC, and PF specificities (p < 0.05). Conclusions: For quantitative differentiation of SPNs, LSR evaluation was more useful and practical than ADC, DC, and PF, and choice of b values showed little impact for the differentiation

  17. Persistent pulmonary subsolid nodules: model-based iterative reconstruction for nodule classification and measurement variability on low-dose CT.

    Science.gov (United States)

    Kim, Hyungjin; Park, Chang Min; Kim, Seong Ho; Lee, Sang Min; Park, Sang Joon; Lee, Kyung Hee; Goo, Jin Mo

    2014-11-01

    To compare the pulmonary subsolid nodule (SSN) classification agreement and measurement variability between filtered back projection (FBP) and model-based iterative reconstruction (MBIR). Low-dose CTs were reconstructed using FBP and MBIR for 47 patients with 47 SSNs. Two readers independently classified SSNs into pure or part-solid ground-glass nodules, and measured the size of the whole nodule and solid portion twice on both reconstruction algorithms. Nodule classification agreement was analyzed using Cohen's kappa and compared between reconstruction algorithms using McNemar's test. Measurement variability was investigated using Bland-Altman analysis and compared with the paired t-test. Cohen's kappa for inter-reader SSN classification agreement was 0.541-0.662 on FBP and 0.778-0.866 on MBIR. Between the two readers, nodule classification was consistent in 79.8 % (75/94) with FBP and 91.5 % (86/94) with MBIR (p = 0.027). Inter-reader measurement variability range was -5.0-2.1 mm on FBP and -3.3-1.8 mm on MBIR for whole nodule size, and was -6.5-0.9 mm on FBP and -5.5-1.5 mm on MBIR for solid portion size. Inter-reader measurement differences were significantly smaller on MBIR (p = 0.027, whole nodule; p = 0.011, solid portion). MBIR significantly improved SSN classification agreement and reduced measurement variability of both whole nodules and solid portions between readers. • Low-dose CT using MBIR algorithm improves reproducibility in the classification of SSNs. • MBIR would enable more confident clinical planning according to the SSN type. • Reduced measurement variability on MBIR allows earlier detection of potentially malignant nodules.

  18. Significance of pulmonary nodules in multi-detector computed tomography scan of noncancerous patients

    OpenAIRE

    Toghiani, Ali; Adibi, Atoosa; Taghavi, Arash

    2015-01-01

    Background: Computed tomography (CT) scan is one the most useful devices in chest imaging. CT scan can be used in mediastinal abnormality, lungs, and pleural evaluations. According to the high prevalence and different causes of pulmonary nodules, we designed this study to evaluate the prevalence and the types of pulmonary nodules in noncancerous patients who underwent chest multi-detector CT (MDCT) scan. Materials and Methods: This was a cross-sectional study which was in our hospital to eval...

  19. Cavitary pulmonary nodules in atypical collagen disease and lupoid drug reaction. Report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Muren, C.; Strandberg, O.

    The case histories of two patients with cavitary pulmonary nodules and the findings at chest radiography are reviewed. The first patient had a connective tissue disease with features common to systematic lupus erythematosus and Wegener's granulomatosis. In the second patient the lung changes developed as part of a drug reaction to carbamezapine and/or phenytoin. The common denominator of the cavitating nodules is probably the presence of granulomas, developing as a sequela of pulmonary vasculitis. (orig.).

  20. Volumetric measurements of pulmonary nodules at multi-row detector CT: in vivo reproducibility

    International Nuclear Information System (INIS)

    Wormanns, Dag; Marheine, Anke; Beyer, Florian; Heindel, Walter; Diederich, Stefan; Kohl, Gerhard; Klotz, Ernst

    2004-01-01

    The aim of this study was to assess the in vivo measurement precision of a software tool for volumetric analysis of pulmonary nodules from two consecutive low-dose multi-row detector CT scans. A total of 151 pulmonary nodules (diameter 2.2-20.5 mm, mean diameter 7.4±4.5 mm) in ten subjects with pulmonary metastases were examined with low-dose four-detector-row CT (120 kVp, 20 mAs (effective), collimation 4 x 1 mm, normalized pitch 1.75, slice thickness 1.25 mm, reconstruction increment 0.8 mm; Somatom VolumeZoom, Siemens). Two consecutive low-dose scans covering the whole lung were performed within 10 min. Nodule volume was determined for all pulmonary nodules visually detected in both scans using the volumetry tool included in the Siemens LungCare software. The 95% limits of agreement between nodule volume measurements on different scans were calculated using the Bland and Altman method for assessing measurement agreement. Intra- and interobserver agreement of volume measurement were determined using repetitive measurements of 50 randomly selected nodules at the same scan by the same and different observers. Taking into account all 151 nodules, 95% limits of agreement were -20.4 to 21.9% (standard error 1.5%); they were -19.3 to 20.4% (standard error 1.7%) for 105 nodules <10 mm. Limits of agreement were -3.9 to 5.7% for intraobserver and -5.5 to 6.6% for interobserver agreement. Precision of in vivo volumetric analysis of nodules with an automatic volumetry software tool was sufficiently high to allow for detection of clinically relevant growth in small pulmonary nodules. (orig.)

  1. Frequency and characteristics of pulmonary nodules in children at computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Samim, Atia; Littooij, Annemieke S.; Wessels, Frank J.; Nievelstein, Rutger A.J.; Jong, Pim A. de [University Medical Centre Utrecht/Wilhelmina Children' s Hospital, Department of Radiology, Utrecht (Netherlands); Heuvel-Eibrink, Marry M. van den [Princess Maxima Centre for Pediatric Oncology, Department of Pediatric Oncology, Utrecht (Netherlands)

    2017-12-15

    Normative data on pulmonary nodules in children without malignancy are limited. Knowledge of the frequency and characteristics of pulmonary nodules in healthy children can influence care decisions in children with malignant disease. To provide normative data concerning the frequency and characteristics of pulmonary nodules on computed tomography (CT) in young children. All children ages 1 year-12 years who underwent chest CT after high-energy trauma were retrospectively investigated. Exclusion criteria were a history of malignancy, thick image slices, motion artefacts and extensive post-traumatic pulmonary changes. Two radiologists were asked to independently identify all nodules and to characterize each nodule with respect to location, size, perifissural location and calcification. Discrepancies were adjudicated by a third reader, who set the reference standard in this study. Interobserver agreement in detection and characterization was assessed using the kappa coefficient (κ). Identified were 120 patients, of whom 72 (75% male; median age: 8.0 years [interquartile range: 4-11]) were included. A total of 59 pulmonary nodules were present in 27 patients (38%; 95% confidence interval: 26-49%; range: 1-5 nodules per patient, with a mean diameter of 3.2 mm [standard deviation: 0.9 mm]). For nodule detection, the per-patient interobserver agreement was substantial (κ=0.78) and per-lobe agreement was moderate (κ=0.40). For characterization, there was fair to substantial agreement (κ=0.36-0.74). Small pulmonary nodules on chest CT are a common finding in otherwise healthy children, but detection and characterization have only moderate interobserver agreement. (orig.)

  2. Frequency and characteristics of pulmonary nodules in children at computed tomography

    International Nuclear Information System (INIS)

    Samim, Atia; Littooij, Annemieke S.; Wessels, Frank J.; Nievelstein, Rutger A.J.; Jong, Pim A. de; Heuvel-Eibrink, Marry M. van den

    2017-01-01

    Normative data on pulmonary nodules in children without malignancy are limited. Knowledge of the frequency and characteristics of pulmonary nodules in healthy children can influence care decisions in children with malignant disease. To provide normative data concerning the frequency and characteristics of pulmonary nodules on computed tomography (CT) in young children. All children ages 1 year-12 years who underwent chest CT after high-energy trauma were retrospectively investigated. Exclusion criteria were a history of malignancy, thick image slices, motion artefacts and extensive post-traumatic pulmonary changes. Two radiologists were asked to independently identify all nodules and to characterize each nodule with respect to location, size, perifissural location and calcification. Discrepancies were adjudicated by a third reader, who set the reference standard in this study. Interobserver agreement in detection and characterization was assessed using the kappa coefficient (κ). Identified were 120 patients, of whom 72 (75% male; median age: 8.0 years [interquartile range: 4-11]) were included. A total of 59 pulmonary nodules were present in 27 patients (38%; 95% confidence interval: 26-49%; range: 1-5 nodules per patient, with a mean diameter of 3.2 mm [standard deviation: 0.9 mm]). For nodule detection, the per-patient interobserver agreement was substantial (κ=0.78) and per-lobe agreement was moderate (κ=0.40). For characterization, there was fair to substantial agreement (κ=0.36-0.74). Small pulmonary nodules on chest CT are a common finding in otherwise healthy children, but detection and characterization have only moderate interobserver agreement. (orig.)

  3. Comparative Efficacy of Radiofrequency and Laser Ablation for the Treatment of Benign Thyroid Nodules

    DEFF Research Database (Denmark)

    Ha, Eun Ju; Baek, Jung Hwan; Kim, Kyung Won

    2015-01-01

    PURPOSE: To compare the efficacy of radiofrequency ablation (RFA) and laser ablation (LA) for treatment of benign solid thyroid nodules, using a systematic review including traditional pooling and Bayesian network meta-analysis. MATERIALS AND METHODS: A comprehensive literature search in Pub...... of 33, identified 10 eligible papers covering a total of 184 patients for meta-analysis. The percentage mean change [absolute mean change] in nodule volume over a 6-month follow-up was compared between RFA and LA. RESULTS: Based on the traditional frequentist approach, the pooled percentage mean changes...... (95% confidence interval) of RFA and LA were 76.1% (70.1-82.1) and 49.9% (41.4-58.5), respectively, and the pooled absolute mean changes (95% confidence interval) of RFA and LA were 8.9 mL (6.6-11.2) and 5.2 mL (4.3-6.1), respectively. Based on the Bayesian network meta-analysis, RFA achieved a larger...

  4. Discrimination method of large log-likelihood study in differential diagnosis of pulmonary diffuse mild micro-nodule

    International Nuclear Information System (INIS)

    Chen Budong; Ma Daqing; He Wen; Tang Hongqu; Qian Linxue; Zhou Ronglin

    2001-01-01

    Objective: To analyze HRCT and thin-slice CT scan findings in 150 patients with pulmonary diffuse mild micro-nodule, and to find the features with the purpose of identifying random micro-nodule, peri-lymphatic micro-nodule, and centrilobular micro-nodule. Methods: The useful features i 150 patients with pulmonary diffuse mild micro-nodule were translated into scores by means of discrimination method of large log-likelihood to identify the micro-nodular category. Results: The accuracy of diagnosis was 94.0% for random micro-nodule, 76.0% for peri-lymphatic micro-nodule, and 90.0% for centrilobular micro-nodule. Conclusion: HRCT and thin-slice CT scans were helpful in differential diagnosis of pulmonary diffuse mild micro-nodule. The discrimination method of large log-likelihood was propitious to diagnosis and differential diagnosis

  5. Persistent pulmonary subsolid nodules: model-based iterative reconstruction for nodule classification and measurement variability on low-dose CT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyungjin; Kim, Seong Ho; Lee, Sang Min; Lee, Kyung Hee [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Park, Chang Min; Park, Sang Joon; Goo, Jin Mo [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Seoul National University, Cancer Research Institute, Seoul (Korea, Republic of)

    2014-11-15

    To compare the pulmonary subsolid nodule (SSN) classification agreement and measurement variability between filtered back projection (FBP) and model-based iterative reconstruction (MBIR). Low-dose CTs were reconstructed using FBP and MBIR for 47 patients with 47 SSNs. Two readers independently classified SSNs into pure or part-solid ground-glass nodules, and measured the size of the whole nodule and solid portion twice on both reconstruction algorithms. Nodule classification agreement was analyzed using Cohen's kappa and compared between reconstruction algorithms using McNemar's test. Measurement variability was investigated using Bland-Altman analysis and compared with the paired t-test. Cohen's kappa for inter-reader SSN classification agreement was 0.541-0.662 on FBP and 0.778-0.866 on MBIR. Between the two readers, nodule classification was consistent in 79.8 % (75/94) with FBP and 91.5 % (86/94) with MBIR (p = 0.027). Inter-reader measurement variability range was -5.0-2.1 mm on FBP and -3.3-1.8 mm on MBIR for whole nodule size, and was -6.5-0.9 mm on FBP and -5.5-1.5 mm on MBIR for solid portion size. Inter-reader measurement differences were significantly smaller on MBIR (p = 0.027, whole nodule; p = 0.011, solid portion). MBIR significantly improved SSN classification agreement and reduced measurement variability of both whole nodules and solid portions between readers. (orig.)

  6. CT Imaging Features in the Characterization of Non-Growing Solid Pulmonary Nodules in Non-Smokers

    International Nuclear Information System (INIS)

    Perandini, Simone; Soardi, Gian Alberto; Motton, Massimiliano; Augelli, Raffaele; Zantedeschi, Lisa; Montemezzi, Stefania

    2016-01-01

    A disappearing or persistent solid pulmonary nodule is a neglected clinical entity that still poses serious interpretative issues to date. Traditional knowledge deriving from previous reports suggests particular features, such as smooth edges or regular shape, to be significantly associated with benignity. A large number of benign nodules are reported among smokers in lung cancer screening programmes. The aim of this single-center retrospective study was to correlate specific imaging features to verify if traditional knowledge as well as more recent acquisitions regarding benign SPNs can be considered reliable in a current case series of nodules collected in a non-smoker cohort of patients. Fifty-three solid SPNs proven as non-growing during follow-up imaging were analyzed with regard to their imaging features at thin-section CT, their predicted malignancy risk according to three major risk assessment models, minimum density analysis and contrast enhanced-CT in the relative subgroups of nodules which underwent such tests. Eleven nodules disappeared during follow-up, 29 showed volume loss and 16 had a VDT of 1121 days or higher. There were 48 nodules located peripherally (85.71%). Evaluation of the enhancement after contrast media (n=29) showed mean enhancement ±SD of 25.72±35.03 HU, median of 18 HU, ranging from 0 to 190 HU. Minimum density assessment (n=30) showed mean minimum HU ±SD of −28.27±47.86 HU, median of −25 HU, ranging from −144 to 68 HU. Mean malignancy risk ±SD was 15.05±26.69% for the BIMC model, 17.22±19.00% for the Mayo Clinic model and 19.07±33.16% for the Gurney’s model. Our analysis suggests caution in using traditional knowledge when dealing with current small solid peripheral indeterminate SPNs and highlights how quantitative growth at follow-up should be the cornerstone of characterization

  7. Multilevel Contextual 3-D CNNs for False Positive Reduction in Pulmonary Nodule Detection.

    Science.gov (United States)

    Dou, Qi; Chen, Hao; Yu, Lequan; Qin, Jing; Heng, Pheng-Ann

    2017-07-01

    False positive reduction is one of the most crucial components in an automated pulmonary nodule detection system, which plays an important role in lung cancer diagnosis and early treatment. The objective of this paper is to effectively address the challenges in this task and therefore to accurately discriminate the true nodules from a large number of candidates. We propose a novel method employing three-dimensional (3-D) convolutional neural networks (CNNs) for false positive reduction in automated pulmonary nodule detection from volumetric computed tomography (CT) scans. Compared with its 2-D counterparts, the 3-D CNNs can encode richer spatial information and extract more representative features via their hierarchical architecture trained with 3-D samples. More importantly, we further propose a simple yet effective strategy to encode multilevel contextual information to meet the challenges coming with the large variations and hard mimics of pulmonary nodules. The proposed framework has been extensively validated in the LUNA16 challenge held in conjunction with ISBI 2016, where we achieved the highest competition performance metric (CPM) score in the false positive reduction track. Experimental results demonstrated the importance and effectiveness of integrating multilevel contextual information into 3-D CNN framework for automated pulmonary nodule detection in volumetric CT data. While our method is tailored for pulmonary nodule detection, the proposed framework is general and can be easily extended to many other 3-D object detection tasks from volumetric medical images, where the targeting objects have large variations and are accompanied by a number of hard mimics.

  8. Impact of a Health Information Technology Intervention on the Follow-up Management of Pulmonary Nodules.

    Science.gov (United States)

    Lacson, Ronilda; Desai, Sonali; Landman, Adam; Proctor, Randall; Sumption, Siobhan; Khorasani, Ramin

    2018-02-01

    Lung cancer is the leading cause of cancer deaths in the USA. The most common abnormalities suspicious for lung cancer on CT scan include pulmonary nodules. Recommendations to improve care for patients with pulmonary nodules require follow-up management. However, transitions in care, especially for patients undergoing transitions to ambulatory care sites from the emergency department (ED) and inpatient settings, can exacerbate failures in follow-up testing and compromise patient safety. We evaluate the impact of a discharge module that includes follow-up recommendations for further management of pulmonary nodules on the study outcome and follow-up management of patients with pulmonary nodules within 1 year after discharge. After IRB approval, we collected data on all patients undergoing chest or abdominal CT exams over a 12-month baseline and 12-month intervention period at an academic medical center. The inpatient discharge module was implemented in November 2011; the ED module was implemented in May 2012. Multivariable logistic regression was performed to account for care setting, imaging modality, recommendations, and patient demographics. Implementation of a discharge module resulted in improved follow-up of patients with pulmonary nodules within 1 year after discharge (OR = 1.64, p = 0.01); the ED implementation resulted in better follow-up compared to the inpatient module (OR = 2.24, p < 0.01). Twenty-seven percent of patients with pulmonary nodules received follow-up management, which, although significantly improved from the 18% baseline, remains low. An electronic discharge module is associated with improved follow-up management of patients with pulmonary nodules, and may be combined with interventions to further improve management of these patients.

  9. Characterization of solitary pulmonary nodules with 18F-FDG PET/CT relative activity distribution analysis

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Liang; Lin, Jie; Tang, Kun; Zheng, SiSi; Yin, WeiWei; Zheng, XiangWu [The First Affiliated Hospital of Wenzhou Medical University, Division of PET/CT, Department of Radiology, Wenzhou (China); Tong, Li [The First People' s Hospital of Hefei, CT Department, Hefei (China); Li, WenFeng [The First Affiliated Hospital of Wenzhou Medical University, Department of Radiotherapy and Chemotherapy, Wenzhou (China); Cheng, DeZhi [The First Affiliated Hospital of Wenzhou Medical University, Department of Cardiothoracic Surgery, Wenzhou (China)

    2015-07-15

    To compare the capability of relative activity distribution (RAD), a new index of fluorodeoxyglucose F18 ({sup 18}F-FDG) uptake, with those of the typical markers for differentiating benign and malignant solitary pulmonary nodules (SPNs) by integrated positron emission tomography (PET)/computed tomography (CT). RAD, maximal standardised uptake value (SUV{sub max}), partial volume corrected SUV{sub max} (corrSUV{sub max}), and retention index (RI) were calculated prospectively for 115 malignant and 60 benign SPNs. Area under receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy were compared (P < 0.05). Malignant lesions (0.98 ± 0.03) had significantly lower RAD than benign lesions (1.01 ± 0.02). AUC (0.935) was significantly larger and specificity (96.67 %) was significantly higher for RAD than for SUV{sub max} (P ≤ 0.0001), corrSUV{sub max} (P < 0.0001), RI (P < 0.0001), and visual assessment (P = 0.01 and 0.002, respectively). Further, RAD had significantly higher sensitivity (92.17 %) than SUV{sub max} (P = 0.0007) and higher accuracy (93.71 %) than SUV{sub max} (P < 0.0001), corrSUV{sub max} (P < 0.0001), and RI (P = 0.002). RAD seems to be more specific and accurate than the typical markers for differentiating malignant and benign SPNs by {sup 18}F-FDG PET/CT. (orig.)

  10. Paediatric CT: the effects of increasing image noise on pulmonary nodule detection

    International Nuclear Information System (INIS)

    Punwani, Shonit; Davies, Warren; Greenhalgh, Rebecca; Humphries, Paul; Zhang, Jie

    2008-01-01

    A radiation dose of any magnitude can produce a detrimental effect manifesting as an increased risk of cancer. Cancer development may be delayed for many years following radiation exposure. Minimizing radiation dose in children is particularly important. However, reducing the dose can reduce image quality and may, therefore, hinder lesion detection. We investigated the effects of reducing the image signal-to-noise ratio (SNR) on CT lung nodule detection for a range of nodule sizes. A simulated nodule was placed at the periphery of the lung on an axial CT slice using image editing software. Multiple copies of the manipulated image were saved with various levels of superimposed noise. The image creation process was repeated for a range of nodule sizes. For a given nodule size, output images were read independently by four Fellows of The Royal College of Radiologists. The overall sensitivities in detecting nodules for the SNR ranges 0.8-0.99, 1-1.49, and 1.5-2.35 were 40.5%, 77.3% and 90.3%, respectively, and the specificities were 47.9%, 73.3% and 75%, respectively. The sensitivity for detecting lung nodules increased with nodule size and increasing SNR. There was 100% sensitivity for the detection of nodules of 4-10 mm in diameter at SNRs greater than 1.5. Reducing medical radiation doses in children is of paramount importance. For chest CT examinations this may be counterbalanced by reduced sensitivity and specificity combined with an increased uncertainty of pulmonary nodule detection. This study demonstrates that pulmonary nodules of 4 mm and greater in diameter can be detected with 100% sensitivity provided that the perceived image SNR is greater than 1.5. (orig.)

  11. Volumetric measurements of pulmonary nodules: variability in automated analysis tools

    Science.gov (United States)

    Juluru, Krishna; Kim, Woojin; Boonn, William; King, Tara; Siddiqui, Khan; Siegel, Eliot

    2007-03-01

    Over the past decade, several computerized tools have been developed for detection of lung nodules and for providing volumetric analysis. Incidentally detected lung nodules have traditionally been followed over time by measurements of their axial dimensions on CT scans to ensure stability or document progression. A recently published article by the Fleischner Society offers guidelines on the management of incidentally detected nodules based on size criteria. For this reason, differences in measurements obtained by automated tools from various vendors may have significant implications on management, yet the degree of variability in these measurements is not well understood. The goal of this study is to quantify the differences in nodule maximum diameter and volume among different automated analysis software. Using a dataset of lung scans obtained with both "ultra-low" and conventional doses, we identified a subset of nodules in each of five size-based categories. Using automated analysis tools provided by three different vendors, we obtained size and volumetric measurements on these nodules, and compared these data using descriptive as well as ANOVA and t-test analysis. Results showed significant differences in nodule maximum diameter measurements among the various automated lung nodule analysis tools but no significant differences in nodule volume measurements. These data suggest that when using automated commercial software, volume measurements may be a more reliable marker of tumor progression than maximum diameter. The data also suggest that volumetric nodule measurements may be relatively reproducible among various commercial workstations, in contrast to the variability documented when performing human mark-ups, as is seen in the LIDC (lung imaging database consortium) study.

  12. Efficacy and Safety of Ultrasound-Guided Percutaneous Polidocanol Sclerotherapy in Benign Cystic Thyroid Nodules: Preliminary Results

    Directory of Open Access Journals (Sweden)

    Xiaohua Gong

    2017-01-01

    Full Text Available Objective. To evaluate the efficacy and safety of percutaneous polidocanol injection (PPI in treating cystic thyroid nodules. Materials and Methods. A total of 158 cystic or predominantly cystic thyroid nodules (>80% cystic component in 143 patients were evaluated. 114 patients with compressive symptoms or aesthetic complaints were offered PPI. 44 individuals without compressive symptoms and aesthetic complaints who were only followed up clinically were used as the control group. The efficacy and safety of PPI were evaluated for 1 month, 3 months, 6 months, 9 months, and 12 months of follow-up. Results. In the PPI group, the mean baseline volume of 15.6±18.9 cm3 reduced at the 1-month follow-up to 5.1±5.6 cm3 (p<0.001 and 0.6±0.9 (p<0.001, and nodules shrunk according to the time after PPI (p<0.001. A complete response (if ≥70% decrease to PPI at the 12-month follow-up occurred in 100% of the cystic or predominant cystic nodules. None of the nodules recurred at the 12-month follow-up after PPI. The side effects were mild. Twenty patients (17.5% developed mild localized pain, and fourteen cases (12.3% experienced mild or moderate fever after PPI. Conclusions. PPI is a safe and effective alternative to treat benign cystic or predominant cystic thyroid nodules.

  13. A COMPREHENSIVE FRAMEWORK FOR AUTOMATIC DETECTION OF PULMONARY NODULES IN LUNG CT IMAGES

    Directory of Open Access Journals (Sweden)

    Mehdi Alilou

    2014-03-01

    Full Text Available Solitary pulmonary nodules may indicate an early stage of lung cancer. Hence, the early detection of nodules is the most efficient way for saving the lives of patients. The aim of this paper is to present a comprehensive Computer Aided Diagnosis (CADx framework for detection of the lung nodules in computed tomography images. The four major components of the developed framework are lung segmentation, identification of candidate nodules, classification and visualization. The process starts with segmentation of lung regions from the thorax. Then, inside the segmented lung regions, candidate nodules are identified using an approach based on multiple thresholds followed by morphological opening and 3D region growing algorithm. Finally, a combination of a rule-based procedure and support vector machine classifier (SVM is utilized to classify the candidate nodules. The proposed CADx method was validated on CT images of 60 patients, containing the total of 211 nodules, selected from the publicly available Lung Image Database Consortium (LIDC image dataset. Comparing to the other state of the art methods, the proposed framework demonstrated acceptable detection performance (Sensitivity: 0.80; Fp/Scan: 3.9. Furthermore, we visualize a range of anatomical structures including the 3D lung structure and the segmented nodules along with the Maximum Intensity Projection (MIP volume rendering method that will enable the radiologists to accurately and easily estimate the distance between the lung structures and the nodules which are frequently difficult at best to recognize from CT images.

  14. Role of Computer Aided Diagnosis (CAD) in the detection of pulmonary nodules on 64 row multi detector computed tomography.

    Science.gov (United States)

    Prakashini, K; Babu, Satish; Rajgopal, K V; Kokila, K Raja

    2016-01-01

    To determine the overall performance of an existing CAD algorithm with thin-section computed tomography (CT) in the detection of pulmonary nodules and to evaluate detection sensitivity at a varying range of nodule density, size, and location. A cross-sectional prospective study was conducted on 20 patients with 322 suspected nodules who underwent diagnostic chest imaging using 64-row multi-detector CT. The examinations were evaluated on reconstructed images of 1.4 mm thickness and 0.7 mm interval. Detection of pulmonary nodules, initially by a radiologist of 2 years experience (RAD) and later by CAD lung nodule software was assessed. Then, CAD nodule candidates were accepted or rejected accordingly. Detected nodules were classified based on their size, density, and location. The performance of the RAD and CAD system was compared with the gold standard that is true nodules confirmed by consensus of senior RAD and CAD together. The overall sensitivity and false-positive (FP) rate of CAD software was calculated. Of the 322 suspected nodules, 221 were classified as true nodules on the consensus of senior RAD and CAD together. Of the true nodules, the RAD detected 206 (93.2%) and 202 (91.4%) by the CAD. CAD and RAD together picked up more number of nodules than either CAD or RAD alone. Overall sensitivity for nodule detection with the CAD program was 91.4%, and FP detection per patient was 5.5%. The CAD showed comparatively higher sensitivity for nodules of size 4-10 mm (93.4%) and nodules in hilar (100%) and central (96.5%) location when compared to RAD's performance. CAD performance was high in detecting pulmonary nodules including the small size and low-density nodules. CAD even with relatively high FP rate, assists and improves RAD's performance as a second reader, especially for nodules located in the central and hilar region and for small nodules by saving RADs time.

  15. C-arm cone-beam computed tomography needle path overlay for percutaneous biopsy of pulmonary nodules.

    Science.gov (United States)

    Floridi, Chiara; Muollo, Alessandra; Fontana, Federico; Rotolo, Nicola; Ierardi, Anna Maria; Duka, Ejona; Pellegrino, Carlo; Carrafiello, Gianpaolo

    2014-11-01

    The aim of this study was to evaluate the feasibility of percutaneous transthoracic needle biopsy of pulmonary nodules under cone-beam computed tomography (CBCT) with "XperGuide" navigation guidance. From February 2010 to January 2012, 100 patients (63 men and 37 women; mean age 67.27 years; range 21-88 years) with 100 lung nodules (44 ≤ 3 cm, 56 > 3 cm) underwent CBCT-XperGuide guided percutaneous transthoracic needle biopsies. Technical success, diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and complications were evaluated. Of 100 nodules (mean size 5.19 cm), 68 were diagnosed as malignant, 27 as benign, and five as indeterminate. Technical success was 95 %. Only 33 of 100 patients underwent surgery: the final pathological diagnosis was concordant with the biopsy diagnosis in 26 cases and discordant in 7 cases (false negatives). Accuracy, sensitivity, specificity, PPV and NPV were 92.6, 90.9, 100, 100 and 72 %, respectively. CBCT-XperGuide navigation is a new, accurate and safe imaging guidance for percutaneous lung biopsies.

  16. Shape based automated detection of pulmonary nodules with surface feature based false positive reduction

    International Nuclear Information System (INIS)

    Nomura, Y.; Itoh, H.; Masutani, Y.; Ohtomo, K.; Maeda, E.; Yoshikawa, T.; Hayashi, N.

    2007-01-01

    We proposed a shape based automated detection of pulmonary nodules with surface feature based false positive (FP) reduction. In the proposed system, the FP existing in internal of vessel bifurcation is removed using extracted surface of vessels and nodules. From the validation with 16 chest CT scans, we find that the proposed CAD system achieves 18.7 FPs/scan at 90% sensitivity, and 7.8 FPs/scan at 80% sensitivity. (orig.)

  17. Role of digital tomosynthesis and dual energy subtraction digital radiography in detecting pulmonary nodules

    International Nuclear Information System (INIS)

    Kumar, Sarvana G.; Garg, Mandeep Kumar; Khandelwal, Niranjan; Gupta, Pankaj; Gupta, Dheeraj; Aggarwal, Ashutosh Nath; Bansal, Subash Chand

    2015-01-01

    Highlights: • Accuracy of digital tomosynthesis for nodule detection is substantially higher. • Improvement in diagnostic accuracy is most pronounced for nodules <10 mm. • There is five times increase in radiation dose compared to DR. - Abstract: Objective: Digital tomosynthesis (DT) and dual-energy subtraction digital radiography (DES-DR) are known to perform better than conventional radiography in the detection of pulmonary nodules. Yet the comparative diagnostic performances of DT, DES-DR and digital radiography (DR) is not known. The present study compares the diagnostic performances of DT, DES-DR and DR in detecting pulmonary nodules. Subjects and methods: The institutional Review Board approved the study and informed written consent was obtained. Fifty-five patients (30 with pulmonary nodules, 25 with non-nodular focal chest pathology) were included in the study. DT and DES-DR were performed within14 days of MDCT. Composite images acquired at high kVp as part of DES-DR were used as DR images. Images were analyzed for presence of nodules and calcification in nodules. Interpretations were assigned confidence levels from 1 to 5 according to Five-Point rating scale. Areas under the receiver operating characteristic curves were compared using Z test. Results: A total of 110 (88 non-calcified, 22 calcified) nodules were identified on MDCT. For detection of nodules, DR showed cumulative sensitivity and specificity of 25.45% and 67.97%, respectively. DT showed a cumulative sensitivity and specificity of 60.9% and 85.07%, respectively. The performance was significantly better than DR (p < 0.003). DES-DR showed sensitivity and specificity of 27.75% and 82.64%, not statistically different from those of DR (p—0.92). In detection of calcification, there was no statistically significant difference between DT, DES-DR and DR. Conclusions: DT performs significantly better than DES-DR and DR at the cost of moderate increase in radiation dose

  18. False positive reduction for pulmonary nodule detection using two-dimensional principal component analysis

    Science.gov (United States)

    Choi, Wook-Jin; Choi, Tae-Sun

    2009-08-01

    Pulmonary nodule detection is a binary classification problem. The main objective is to classify nodule from the lung computed tomography (CT) images. The intra class variability is mainly due to the grey-level variance, texture differences and shape. The purpose of this study is to develop a novel nodule detection method which is based on Two-dimensional Principal Component Analysis (2DPCA). We extract the futures using 2DPCA from nodule candidate images. Nodule candidates are classified using threshold. The proposed method reduces False Positive (FP) rate. We tested the proposed algorithm by using Lung Imaging Database Consortium (LIDC) database of National Cancer Institute (NCI). The experimental results demonstrate the effectiveness and efficiency of the proposed method. The proposed method achieved 85.11% detection rate with 1.13 FPs per scan.

  19. Automatic detection of spiculation of pulmonary nodules in computed tomography images

    DEFF Research Database (Denmark)

    Ciompi, F; Jacobs, C; Scholten, E.T.

    2015-01-01

    We present a fully automatic method for the assessment of spiculation of pulmonary nodules in low-dose Computed Tomography (CT) images. Spiculation is considered as one of the indicators of nodule malignancy and an important feature to assess in order to decide on a patient-tailored follow......-up procedure. For this reason, lung cancer screening scenario would benefit from the presence of a fully automatic system for the assessment of spiculation. The presented framework relies on the fact that spiculated nodules mainly differ from non-spiculated ones in their morphology. In order to discriminate...... to classify spiculated nodules via supervised learning. We tested our approach on a set of nodules from the Danish Lung Cancer Screening Trial (DLCST) dataset. Our results show that the proposed method outperforms other 3-D descriptors of morphology in the automatic assessment of spiculation. © (2015...

  20. Discriminative Localization in CNNs for Weakly-Supervised Segmentation of Pulmonary Nodules.

    Science.gov (United States)

    Feng, Xinyang; Yang, Jie; Laine, Andrew F; Angelini, Elsa D

    2017-09-01

    Automated detection and segmentation of pulmonary nodules on lung computed tomography (CT) scans can facilitate early lung cancer diagnosis. Existing supervised approaches for automated nodule segmentation on CT scans require voxel-based annotations for training, which are labor- and time-consuming to obtain. In this work, we propose a weakly-supervised method that generates accurate voxel-level nodule segmentation trained with image-level labels only. By adapting a convolutional neural network (CNN) trained for image classification, our proposed method learns discriminative regions from the activation maps of convolution units at different scales, and identifies the true nodule location with a novel candidate-screening framework. Experimental results on the public LIDC-IDRI dataset demonstrate that, our weakly-supervised nodule segmentation framework achieves competitive performance compared to a fully-supervised CNN-based segmentation method.

  1. Dynamic Gd-DTPA enhanced breath-hold 1.5 t MRI of normal lungs and patients with interstitial lung disease and pulmonary nodules: preliminary results

    International Nuclear Information System (INIS)

    Semelka, R.C.; Maycher, B.; Shoenut, J.P.; Kroeker, R.; Griffin, P.; Lertzman, M.

    1992-01-01

    A FLASH technique was used, which encompassed the entire thorax in the transverse plane, before and after dynamic intravenous injection of godalinium DTPA (Gd-DTPA) to study 7 patients with normal lungs, 12 patients with interstitial lung disease (ILD), and 11 patients with pulmonary nodules. Comparative CT studies were obtained within 2 weeks of the MRI study in the patients with lung disease. Quantitative signal intensity (SI) measurements were performed. Qualitative evaluation of lung parenchyma was determined in a prospective blinded fashion, and in the normal group comparison was made with the CT images. In normal patients, SI of lung parenchyma increased by 7.7±1.3%. On precontrast images, second-order pulmonary branchings were visible while post-contrast, fifth- to sixth-order branches were apparent. In patients with ILD, interstitial changes enhanced to a variable extent, increases in SI ranging from minimal (49.9%) to substantial (308.4%). Detection of pulmonary nodules improved following contrast injection. The minimum lesion size detectable decreased from 8 mm precontrast to 5 mm post-contrast. Percentage contrast enhancement was greater for malignant nodules (124.2±79.7%) than benign nodules (5.8±4.7%) (p<0.01). (orig.)

  2. Research on a Pulmonary Nodule Segmentation Method Combining Fast Self-Adaptive FCM and Classification

    Directory of Open Access Journals (Sweden)

    Hui Liu

    2015-01-01

    Full Text Available The key problem of computer-aided diagnosis (CAD of lung cancer is to segment pathologically changed tissues fast and accurately. As pulmonary nodules are potential manifestation of lung cancer, we propose a fast and self-adaptive pulmonary nodules segmentation method based on a combination of FCM clustering and classification learning. The enhanced spatial function considers contributions to fuzzy membership from both the grayscale similarity between central pixels and single neighboring pixels and the spatial similarity between central pixels and neighborhood and improves effectively the convergence rate and self-adaptivity of the algorithm. Experimental results show that the proposed method can achieve more accurate segmentation of vascular adhesion, pleural adhesion, and ground glass opacity (GGO pulmonary nodules than other typical algorithms.

  3. Automatic detection of large pulmonary solid nodules in thoracic CT images

    International Nuclear Information System (INIS)

    Setio, Arnaud A. A.; Jacobs, Colin; Gelderblom, Jaap; Ginneken, Bram van

    2015-01-01

    Purpose: Current computer-aided detection (CAD) systems for pulmonary nodules in computed tomography (CT) scans have a good performance for relatively small nodules, but often fail to detect the much rarer larger nodules, which are more likely to be cancerous. We present a novel CAD system specifically designed to detect solid nodules larger than 10 mm. Methods: The proposed detection pipeline is initiated by a three-dimensional lung segmentation algorithm optimized to include large nodules attached to the pleural wall via morphological processing. An additional preprocessing is used to mask out structures outside the pleural space to ensure that pleural and parenchymal nodules have a similar appearance. Next, nodule candidates are obtained via a multistage process of thresholding and morphological operations, to detect both larger and smaller candidates. After segmenting each candidate, a set of 24 features based on intensity, shape, blobness, and spatial context are computed. A radial basis support vector machine (SVM) classifier was used to classify nodule candidates, and performance was evaluated using ten-fold cross-validation on the full publicly available lung image database consortium database. Results: The proposed CAD system reaches a sensitivity of 98.3% (234/238) and 94.1% (224/238) large nodules at an average of 4.0 and 1.0 false positives/scan, respectively. Conclusions: The authors conclude that the proposed dedicated CAD system for large pulmonary nodules can identify the vast majority of highly suspicious lesions in thoracic CT scans with a small number of false positives

  4. A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features.

    Science.gov (United States)

    Girardi, Fábio Muradás; Silva, Laura Mezzomo da; Flores, Cecilia Dias

    2017-11-04

    A discussion in literature about a standardized decision support tool for the management of thyroid nodules remains. The purpose of this study was to create a statistical prediction model for thyroid nodules management. Two hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case. In multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%. The prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  5. An Unusual Radiologic Manifestation of Pulmonary Tuberculosis with Bilateral Multiple Lung Nodules and Diffuse Alveolar Hemorrhage: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Seo In; Seon, Hyun Ju; Kim, Yun Hyeon [Dept. of Radiology, Chunnam National University Hospital, Gwangju (Korea, Republic of); Choi, Sung [Dept. of Radiology, Chunnam National University Hwasun Hospital, Hwasun(Korea, Republic of)

    2011-12-15

    Pulmonary tuberculosis presenting as bilateral multiple lung nodules or diffuse alveolar hemorrhage is very rare. Here, we report a case of pulmonary tuberculosis presenting as bilateral multiple lung nodules and diffuse alveolar hemorrhage mimicking granulomatous vasculitis, such as Wegener's granulomatosis.

  6. Diagnostic Value and Cost Considerations of Routine Fine-Needle Aspirations in the Follow-Up of Thyroid Nodules with Benign Readings

    NARCIS (Netherlands)

    van Roosmalen, Jeroen; van Hemel, Bettien; Suurmeijer, Albert; Groen, Henk; Ruitenbeek, Teus; Links, Thera P.; Plukker, John T. M.

    2010-01-01

    Background: Fine-needle aspiration (FNA) is the most accurate tool to identify malignancy in solitary thyroid nodules. Although some recommend routinely repeating FNA for nodules that are initially read as benign, there is no consensus. We evaluated clinical relevancy and considered costs of routine

  7. Pulmonary nodule registration in serial CT scans based on rib anatomy and nodule template matching

    International Nuclear Information System (INIS)

    Shi Jiazheng; Sahiner, Berkman; Chan, H.-P.; Hadjiiski, Lubomir; Zhou, C.; Cascade, Philip N.; Bogot, Naama; Kazerooni, Ella A.; Wu, Y.-T.; Wei, J.

    2007-01-01

    An automated method is being developed in order to identify corresponding nodules in serial thoracic CT scans for interval change analysis. The method uses the rib centerlines as the reference for initial nodule registration. A spatially adaptive rib segmentation method first locates the regions where the ribs join the spine, which define the starting locations for rib tracking. Each rib is tracked and locally segmented by expectation-maximization. The ribs are automatically labeled, and the centerlines are estimated using skeletonization. For a given nodule in the source scan, the closest three ribs are identified. A three-dimensional (3D) rigid affine transformation guided by simplex optimization aligns the centerlines of each of the three rib pairs in the source and target CT volumes. Automatically defined control points along the centerlines of the three ribs in the source scan and the registered ribs in the target scan are used to guide an initial registration using a second 3D rigid affine transformation. A search volume of interest (VOI) is then located in the target scan. Nodule candidate locations within the search VOI are identified as regions with high Hessian responses. The initial registration is refined by searching for the maximum cross-correlation between the nodule template from the source scan and the candidate locations. The method was evaluated on 48 CT scans from 20 patients. Experienced radiologists identified 101 pairs of corresponding nodules. Three metrics were used for performance evaluation. The first metric was the Euclidean distance between the nodule centers identified by the radiologist and the computer registration, the second metric was a volume overlap measure between the nodule VOIs identified by the radiologist and the computer registration, and the third metric was the hit rate, which measures the fraction of nodules whose centroid computed by the computer registration in the target scan falls within the VOI identified by the

  8. Computer-aided diagnosis of pulmonary nodules using a two-step approach for feature selection and classifier ensemble construction.

    Science.gov (United States)

    Lee, Michael C; Boroczky, Lilla; Sungur-Stasik, Kivilcim; Cann, Aaron D; Borczuk, Alain C; Kawut, Steven M; Powell, Charles A

    2010-09-01

    Accurate classification methods are critical in computer-aided diagnosis (CADx) and other clinical decision support systems. Previous research has reported on methods for combining genetic algorithm (GA) feature selection with ensemble classifier systems in an effort to increase classification accuracy. In this study, we describe a CADx system for pulmonary nodules using a two-step supervised learning system combining a GA with the random subspace method (RSM), with the aim of exploring algorithm design parameters and demonstrating improved classification performance over either the GA or RSM-based ensembles alone. We used a retrospective database of 125 pulmonary nodules (63 benign; 62 malignant) with CT volumes and clinical history. A total of 216 features were derived from the segmented image data and clinical history. Ensemble classifiers using RSM or GA-based feature selection were constructed and tested via leave-one-out validation with feature selection and classifier training executed within each iteration. We further tested a two-step approach using a GA ensemble to first assess the relevance of the features, and then using this information to control feature selection during a subsequent RSM step. The base classification was performed using linear discriminant analysis (LDA). The RSM classifier alone achieved a maximum leave-one-out Az of 0.866 (95% confidence interval: 0.794-0.919) at a subset size of s=36 features. The GA ensemble yielded an Az of 0.851 (0.775-0.907). The proposed two-step algorithm produced a maximum Az value of 0.889 (0.823-0.936) when the GA ensemble was used to completely remove less relevant features from the second RSM step, with similar results obtained when the GA-LDA results were used to reduce but not eliminate the occurrence of certain features. After accounting for correlations in the data, the leave-one-out Az in the two-step method was significantly higher than in the RSM and the GA-LDA. We have developed a CADx system for

  9. Pulmonary nodules and masses in lung transplant recipients: clinical and CT findings

    International Nuclear Information System (INIS)

    Morla, Olivier; Liberge, Renan; Arrigoni, Pierre Paul; Frampas, Eric

    2014-01-01

    The purpose of this study was to review the clinical and CT findings of pulmonary nodules and masses in lung transplant recipients and to determine distinguishing features among the various aetiologies. This retrospective study included 106 lung transplant recipients who had a chest CT performed over a 7-year period in a single institution. Twenty-four cases of pulmonary nodules and masses were observed on CT. Among the single lesions, three (50 %) were due to infections, one (17 %) to organizing pneumonia, and two (33 %) remained of undetermined origin. Among the multiple lesions, 14 (78 %) were due to infection, three to post-transplant lymphoproliferative disorder (17 %), and one to bronchogenic carcinoma (5 %). The two main microorganisms were P. aeruginosa and Aspergillus spp. Among 12 solid nodules > 1 cm, four (33 %) were due to malignancy: three post-transplant lymphoproliferative disorders (25 %), and one bronchogenic carcinoma (8 %). Among five cavitary nodules four (80 %) were due to aspergillosis. Infection is the most frequent aetiology of pulmonary nodules and masses in lung transplant recipients, but other causes such as post-transplant lymphoproliferative disorder, bronchogenic carcinoma, or organizing pneumonia should be considered. (orig.)

  10. Does the thinking aloud condition affect the search for pulmonary nodules?

    Science.gov (United States)

    Littlefair, Stephen; Brennan, Patrick; Reed, Warren; Williams, Mark; Pietrzyk, Mariusz W.

    2012-02-01

    Aim: To measure the effect of thinking aloud on perceptual accuracy and visual search behavior during chest radiograph interpretation for pulmonary nodules. Background: Thinking Aloud (TA) is an empirical research method used by researchers in cognitive psychology and behavioural analysis. In this pilot study we wanted to examine whether TA had an effect on the perceptual accuracy and search patterns of subjects looking for pulmonary nodules on adult posterioranterior chest radiographs (PA CxR). Method: Seven academics within Medical Radiation Sciences at The University of Sydney participated in two reading sessions with and without TA. Their task was to localize pulmonary nodules on 30 PA CxR using mouse clicks and rank their confidence levels of nodule presence. Eye-tracking recordings were collected during both viewing sessions. Time to first fixation, duration of first fixation, number of fixations, cumulative time of fixation and total viewing time were analysed. In addition, ROC analysis was conducted on collected outcome using DBM methodology. Results: Time to first nodule fixation was significantly longer (p=0.001) and duration of first fixation was significantly shorter (p=0.043). No significant difference was observed in ROC AUC scores between control and TA conditions. Conclusion: Our results confirm that TA has little effect on perceptual ability or performance, except for prolonging the task. However, there were significant differences in visual search behavior. Future researchers in radio-diagnosis could use the think aloud condition rather than silence so as to more closely replicate the clinical scenario.

  11. Designing A New CAD System for Pulmonary Nodule Detection in High Resolution Computed Tomography (HRCT Images

    Directory of Open Access Journals (Sweden)

    M Bakhshayesh Karam

    2012-07-01

    Full Text Available Background: Lung diseases and lung cancer are among the most dangerous diseases with high mortality in both men and women. Lung nodules are abnormal pulmonary masses and are among major lung symptoms. A Computer Aided Diagnosis (CAD system may play an important role in accurate and early detection of lung nodules. This article presents a new CAD system for lung nodule detection from chest computed tomography (CT images.Methods: Twenty-five adult patients with lung nodules in their CT scan images presented to the National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Tehran, Iran in 2011-2012 were enrolled in the study. The patients were randomly assigned into two experimental (9 female, 6 male, mean age 43±5.63 yrs and control (6 female, 4 male, mean age 39±4.91 yrs groups. A fully-automatic method was developed for detecting lung nodules by employing medical image processing and analysis and statistical pattern recognition algorithms.esults: Using segmentation methods, the lung parenchyma was extracted from 2-D CT images. Then, candidate regions were labeled in pseudo-color images. In the next step, some features of lung nodules were extracted. Finally, an artificial feed forward neural network was used for classification of nodules.Conclusion: Considering the complexity and different shapes of lung nodules and large number of CT images to evaluate, finding lung nodules are difficult and time consuming for physicians and include human error. Experimental results showed the accuracy of the proposed method to be appropriate (P<0.05 for lung nodule detection.

  12. Application of the iris filter for automatic detection of pulmonary nodules on computed tomography images.

    Science.gov (United States)

    Suárez-Cuenca, Jorge Juan; Tahoces, Pablo G; Souto, Miguel; Lado, María J; Remy-Jardin, Martine; Remy, Jacques; Vidal, Juan José

    2009-10-01

    We have developed a computer-aided diagnosis (CAD) system to detect pulmonary nodules on thin-slice helical computed tomography (CT) images. We have also investigated the capability of an iris filter to discriminate between nodules and false-positive findings. Suspicious regions were characterized with features based on the iris filter output, gray level and morphological features, extracted from the CT images. Functions calculated by linear discriminant analysis (LDA) were used to reduce the number of false-positives. The system was evaluated on CT scans containing 77 pulmonary nodules. The system was trained and evaluated using two completely independent data sets. Results for a test set, evaluated with free-response receiver operating characteristic (FROC) analysis, yielded a sensitivity of 80% at 7.7 false-positives per scan.

  13. Detectability of pulmonary nodules with electronic collimation and conventional antiscatter grid

    International Nuclear Information System (INIS)

    Plenkovich, D.; Plavsic, B.; Robinson, A.E.; Lichtenstein, R.L.

    1989-01-01

    Electronic collimation is a method for rejection of scattered radiation and veiling glare in digital radiography. Digital images of a frozen, unembalmed, human chest phantom with simulated pulmonary nodules were obtained with use of the electronic collimation technique and a conventional 10:1 antiscatter grid. Observers were asked to locate multiple nodules and to record one of three levels of confidence. For each criterion, the total number of correct responses was divided by the total number of nodules to obtain the ordinate of a point. The total number of false-positive answers generated was divided by the number of images to obtain the abscissa of the point. The analysis was repeated for each scatter rejection method and for either the lungs or the mediastinum. The electronic collimation technique has improved the detectability of nodules projected over the mediastinum

  14. Profuse coarse pulmonary nodules in a patient with lymphangioleiomyomatosis

    DEFF Research Database (Denmark)

    Rasmussen, Daniel B; Shaker, Saher B; Seersholm, Niels

    2014-01-01

    Lymphangioleiomyomatosis (LAM) is a rare disease characterized by progressive cystic destruction of the lungs. We present an unusual radiological presentation of lymphangioleiomyomatosis in a patient followed for 33 years with profuse coarse lung nodules in addition to the classical cystic lesions...

  15. Preliminary study of diagnostic workstation with different matrix size for detection of small pulmonary nodules

    International Nuclear Information System (INIS)

    Wu Jie; Wang Xuejian; Wang Bo; Tong Juan; Wei Yuqing; Shen Guiquan; Wang Limei; Cao Jun; Sui He

    2004-01-01

    Objective: To assess the influence in detecting small pulmonary nodules (SPNs) on soft-copy images displayed with different matrix sizes. Methods: Seventy-six chest compute radiographs were selected for the study. Of the 76 test images, 36 pulmonary nodules smaller than 20 mm in diameter were proven by CT, which were further divided into two groups: 1.0-2.0 cm and Z values and standard error of three kinds of view system for individual observers. Results: For 1.0-2.0 cm group, the mean A Z values were 0.7936 for DRCS with 2-fold magnification and window technique, 0.8225 for 1 K monitor with 2-fold magnification and window technique, and 0.8367 for 2 K monitor without magnification; for Z values increased slightly as the display matrix size improved, but there were no significant differences among the three sets in the detection of SPNs in the ROC analyses. Conclusion: It is acceptable to detect small pulmonary nodules of 1.0-2.0 cm in diameter on 1 K monitor and DRCS with magnification. High resolution diagnostic workstation is recommended for detecting small pulmonary nodules <1.0 cm in diameter. Reasonable equipment for the detection of subtle abnormality may result in better cost-efficacy and diagnostic accuracy

  16. Pulmonary Nodules as an Initial Manifestation of Behçet's Disease

    DEFF Research Database (Denmark)

    Malekmohammad, M; Emamifar, A

    2014-01-01

    are not common in the absence of pulmonary artery aneurysm (PAA). This report describes a 36-year-old man with recurrent fever, nonmassive hemoptysis, and persistent cough with lung nodules in CT scan who had undergone open lung biopsy. On the basis of morphological findings, BD was suggested and more precise...

  17. Detection and quantification of the solid component in pulmonary subsolid nodules by semiautomatic segmentation

    Energy Technology Data Exchange (ETDEWEB)

    Scholten, Ernst T. [University Medical Center, Department of Radiology, Utrecht (Netherlands); Kennemer Gasthuis, Department of Radiology, Haarlem (Netherlands); Jacobs, Colin; Riel, Sarah van [Radboud University Medical Center, Diagnostic Image Analysis Group, Nijmegen (Netherlands); Ginneken, Bram van [Radboud University Medical Center, Diagnostic Image Analysis Group, Nijmegen (Netherlands); Fraunhofer MEVIS, Bremen (Germany); Vliegenthart, Rozemarijn [University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen (Netherlands); University of Groningen, University Medical Centre Groningen, Center for Medical Imaging-North East Netherlands, Groningen (Netherlands); Oudkerk, Matthijs [University of Groningen, University Medical Centre Groningen, Center for Medical Imaging-North East Netherlands, Groningen (Netherlands); Koning, Harry J. de [Erasmus Medical Center, Department of Public Health, Rotterdam (Netherlands); Horeweg, Nanda [Erasmus Medical Center, Department of Public Health, Rotterdam (Netherlands); Erasmus Medical Center, Department of Pulmonology, Rotterdam (Netherlands); Prokop, Mathias [Radboud University Medical Center, Department of Radiology, Nijmegen (Netherlands); Gietema, Hester A.; Mali, Willem P.T.M.; Jong, Pim A. de [University Medical Center, Department of Radiology, Utrecht (Netherlands)

    2014-10-07

    To determine whether semiautomatic volumetric software can differentiate part-solid from nonsolid pulmonary nodules and aid quantification of the solid component. As per reference standard, 115 nodules were differentiated into nonsolid and part-solid by two radiologists; disagreements were adjudicated by a third radiologist. The diameters of solid components were measured manually. Semiautomatic volumetric measurements were used to identify and quantify a possible solid component, using different Hounsfield unit (HU) thresholds. The measurements were compared with the reference standard and manual measurements. The reference standard detected a solid component in 86 nodules. Diagnosis of a solid component by semiautomatic software depended on the threshold chosen. A threshold of -300 HU resulted in the detection of a solid component in 75 nodules with good sensitivity (90 %) and specificity (88 %). At a threshold of -130 HU, semiautomatic measurements of the diameter of the solid component (mean 2.4 mm, SD 2.7 mm) were comparable to manual measurements at the mediastinal window setting (mean 2.3 mm, SD 2.5 mm [p = 0.63]). Semiautomatic segmentation of subsolid nodules could diagnose part-solid nodules and quantify the solid component similar to human observers. Performance depends on the attenuation segmentation thresholds. This method may prove useful in managing subsolid nodules. (orig.)

  18. Automatic detection of spiculation of pulmonary nodules in computed tomography images

    Science.gov (United States)

    Ciompi, F.; Jacobs, C.; Scholten, E. T.; van Riel, S. J.; W. Wille, M. M.; Prokop, M.; van Ginneken, B.

    2015-03-01

    We present a fully automatic method for the assessment of spiculation of pulmonary nodules in low-dose Computed Tomography (CT) images. Spiculation is considered as one of the indicators of nodule malignancy and an important feature to assess in order to decide on a patient-tailored follow-up procedure. For this reason, lung cancer screening scenario would benefit from the presence of a fully automatic system for the assessment of spiculation. The presented framework relies on the fact that spiculated nodules mainly differ from non-spiculated ones in their morphology. In order to discriminate the two categories, information on morphology is captured by sampling intensity profiles along circular patterns on spherical surfaces centered on the nodule, in a multi-scale fashion. Each intensity profile is interpreted as a periodic signal, where the Fourier transform is applied, obtaining a spectrum. A library of spectra is created by clustering data via unsupervised learning. The centroids of the clusters are used to label back each spectrum in the sampling pattern. A compact descriptor encoding the nodule morphology is obtained as the histogram of labels along all the spherical surfaces and used to classify spiculated nodules via supervised learning. We tested our approach on a set of nodules from the Danish Lung Cancer Screening Trial (DLCST) dataset. Our results show that the proposed method outperforms other 3-D descriptors of morphology in the automatic assessment of spiculation.

  19. Solitary pulmonary nodules: impact of functional CT on the cost-effectiveness of FDG-PET

    International Nuclear Information System (INIS)

    Miles, K.A.; Keith, C.J.; Wong, D.C.; Griffiths, M.R.

    2002-01-01

    Full text: FDG-PET has been shown to be cost-effective for the evaluation of solitary pulmonary nodules (SPNs) in Australia. This study evaluates the impact on cost-effectiveness produced by incorporating a novel CT technique, functional CT, into diagnostic algorithms for characterisation of SPNs. Four diagnostic strategies were evaluated using decision tree sensitivity analysis. The first strategy comprised patients undergoing conventional CT alone (CT). The second comprised conventional CT followed by functional CT study (FCT), when the SPN was not benign on conventional CT. The third strategy comprised conventional CT, which if positive is followed by FDG-PET (PET) and a fourth strategy where patients with a positive conventional CT undergo functional CT, which if positive also undergo FDG-PET (FCT+PET). Values for disease prevalence and diagnostic accuracy of PET, CT and functional CT were obtained from a literature review, using Australia values where available. Procedure costs were derived from the Medicare Benefits Schedule and DRG Cost Weights for Australian public hospitals. The cost per patient, accuracy and Incremental Cost-Accuracy Ratio (ICAR) were determined for each strategy. Sensitivity analysis evaluated the effect of disease prevalence on cost-effectiveness. Results: At the prevalence of malignancy reported from Australian series (54%), the FCT strategy incurs the least cost ($5560/patient), followed by the FCT+PET ($5910/patient). The FCT+PET strategy is the most cost-effective strategy with an ICAR of $12059/patient, followed by the PET strategy with an ICAR of $12300/patient. At levels of disease prevalence below 54% the above relationship for cost-effectiveness remains the same. For high levels of disease prevalence, CT or FCT are found to be more cost-effective. At typical prevalence of malignancy the cost-effectiveness of PET is enhanced by the addition of functional CT, but at high prevalence functional CT alone is most cost

  20. Multi-detector spiral CT study of the relationships between pulmonary ground-glass nodules and blood vessels

    Energy Technology Data Exchange (ETDEWEB)

    Gao, Feng; Li, Ming; Ge, Xiaojun; Ren, Qingguo; Hua, Yanqing [Huadong Hospital Fudan University, Department of Radiology, Shanghai (China); Zheng, Xiangpeng [Huadong Hospital Fudan University, Department of Radiation Oncology, Shanghai (China); Chen, Yan [Huadong Hospital Fudan University, Department of Pathology, Shanghai (China); Lv, Fangzhen [Huadong Hospital Fudan University, Department of Thoracic Surgery, Shanghai (China)

    2013-12-15

    To investigate the relationships between pulmonary ground-glass nodules (GGN) and blood vessels and their diagnostic values in differentiating GGNs. Multi-detector spiral CT imaging of 108 GGNs was retrospectively reviewed. The spatial relationships between GGNs and supplying blood vessels were categorized into four types: I, vessels passing by GGNs; II, intact vessels passing through GGNs; III, distorted, dilated or tortuous vessels seen within GGNs; IV, more complicated vasculature other than described above. Relationship types were correlated to pathologic and/or clinical findings of GGNs. Of 108 GGNs, 10 were benign, 24 preinvasive nodules and 74 adenocarcinomas that were pathologically proven. Types I, II, III and IV vascular relationships were observed in 9, 58, 21 and 20 GGNs, respectively. Type II relationship was the dominating relationship for each GGN group, but significant differences were shown among them. Correlation analysis showed strong correlation between invasive adenocarcinoma and type III and IV relationships. Subgroup analysis indicated that type III was more commonly seen in IAC with comparison to type IV more likely seen in MIA. Different GGNs have different relationships with vessels. Understanding and recognising characteristic GGN-vessel relationships may help identify which GGNs are more likely to be malignant. (orig.)

  1. Clinical application of CT and CT-guided percutaneous transthoracic needle biopsy in patients with indeterminate pulmonary nodules

    Energy Technology Data Exchange (ETDEWEB)

    Cardoso, Luciana Vargas; Souza Júnior, Arthur Soares, E-mail: fabianonatividade@terra.com.br [Rio Preto-Ultra-X Radiological Diagnosis Institute, São José do Rio Preto, SP (Brazil)

    2014-07-15

    Objective: To investigate the clinical application of CT and CT-guided percutaneous transthoracic needle biopsy (CT-PTNB) in patients with indeterminate pulmonary nodules (IPNs). Methods: We retrospectively studied 113 patients with PNs undergoing CT and CT-PTNB. Variables such as gender, age at diagnosis, smoking status, CT findings, and CT-PTNB techniques were analyzed. Data analysis was performed with the Student's t-test for independent samples the chi-square test, and normal approximation test for comparison of two proportions. Results: Of the 113 patients studied, 68 (60.2%) were male and 78 (69%) were smokers. The diameter of malignant lesions ranged from 2.6 cm to 10.0 cm. Most of the IPNs (85%) were located in the peripheral region. The biopsied IPNs were found to be malignant in 88 patients (77.8%) and benign in 25 (22.2%). Adenocarcinoma was the most common malignant tumor, affecting older patients. The IPN diameter was significantly greater in patients with malignant PNs than in those with benign IPNs (p < 0.001). Having regular contour correlated significantly with an IPN being benign (p = 0.022), whereas spiculated IPNs and bosselated IPNs were more often malignant (in 50.7% and 28.7%, respectively). Homogeneous attenuation and necrosis were more common in patients with malignant lesions (51.9% and 26.9%, respectively). Conclusions: In our sample, CT and CT-PTNB were useful in distinguishing between malignant and benign IPNs. Advanced age and smoking were significantly associated with malignancy. Certain CT findings related to IPNs (larger diameter, spiculated borders, homogeneous attenuation, and necrosis) were associated with malignancy. (author)

  2. Uterine intravenous leiomyomatosis with intracardiac extension and pulmonary benign metastases on FDG PET/CT: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Hui Chun; Wang, Yu Bin; Chen, Xiao Hong; Cu, Lan Lan [PET/CT Center, Gansu Provincial Hospital, Lanzhou (China)

    2016-04-15

    A 48-year-old woman presented with a 50-day history of irregular vaginal bleeding and lower abdominal pain. Ultrasound indicated an extremely large occupying lesion in the pelvic cavity that was highly suggestive of malignancy. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed to further assess the nature of pelvic abnormality. PET/CT images demonstrated a diffusely lobulated mass ranging from cervix up to the inferior pole of kidneys with mild FDG uptake. Simultaneously, multiple nodules in bilateral lungs and a hypodense lesion in the right ventricle were shown without FDG-avidity. Based on the imaging results, the presumptive diagnosis was uterine intravenous leiomyomatosis with intracardiac extension and pulmonary benign metastases, which was subsequently confirmed by MRI and the lesion biopsy.

  3. Cryptogenic Organizing Pneumonia With Lung Nodules Secondary to Pulmonary Manifestation of Crohn Disease

    Directory of Open Access Journals (Sweden)

    Taufiq Zaman

    2017-05-01

    Full Text Available Crohn disease is an immune-mediated inflammatory condition with gastrointestinal and extraintestinal manifestations in patients. Pulmonary involvement of Crohn disease is one manifestation. There have been case reports which have shown Crohn disease and lung nodules which were noted to be histopathological as cryptogenic organizing pneumonia (COP. In our case, a 22-year-old woman with Crohn disease was seen with complaints of chest pain and cough. Computed tomographic scan of chest showed multiple bilateral lung nodules, for which biopsy was done, which showed COP. The case study is followed by a deeper discussion of COP and the extraintestinal manifestation seen in inflammatory bowel disease.

  4. Effect of ultrasound-guided interstitial laser photocoagulation on benign solitary solid cold thyroid nodules

    DEFF Research Database (Denmark)

    Døssing, Helle; Bennedbaek, Finn Noe; Hegedüs, Laszlo

    2006-01-01

    power of 2.5-3.5 W. Thyroid nodule volume was assessed by US. Pressure and cosmetic complaints were evaluated on a visual analogue scale. MAIN OUTCOME: In the ILP- 1 group, thyroid nodule volume decreased from 10.1 +/- 4.3 mL (mean +/- standard deviation [SD]) to 5.7 +/- 3.2 mL (p = 0......OBJECTIVE: Interstitial laser photocoagulation (ILP) is a safe and effective procedure when inducing thyroid nodule necrosis. In this prospective randomized study, we evaluated a possible dose-response relationship as well as patient satisfaction. DESIGN: Thirty euthyroid outpatients...

  5. Pulmonary Nodule Management in Lung Cancer Screening: A Pictorial Review of Lung-RADS Version 1.0.

    Science.gov (United States)

    Godoy, Myrna C B; Odisio, Erika G L C; Truong, Mylene T; de Groot, Patricia M; Shroff, Girish S; Erasmus, Jeremy J

    2018-05-01

    The number of screening-detected lung nodules is expected to increase as low-dose computed tomography screening is implemented nationally. Standardized guidelines for image acquisition, interpretation, and screen-detected nodule workup are essential to ensure a high standard of medical care and that lung cancer screening is implemented safely and cost effectively. In this article, we review the current guidelines for pulmonary nodule management in the lung cancer screening setting. Copyright © 2018 Elsevier Inc. All rights reserved.

  6. The importance of risk models for management of pulmonary nodules; Die Bedeutung von Risikomodellen fuer das Management pulmonaler Rundherde

    Energy Technology Data Exchange (ETDEWEB)

    Prosch, H.; Baltzer, P. [Medizinische Universitaet Wien, Allgemeines Krankenhaus, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Wien (Austria)

    2014-05-15

    Pulmonary nodules are a frequent finding in computed tomography (CT) investigations. Further diagnostic work-up of detected nodules mainly depends on the so-called pre-test probability, i.e. the probability that the nodule is malignant or benign. The pre-test probability can be calculated by combining all relevant information, such as the age and the sex of the patient, the smoking history, and history of previous malignancies, as well as the size and CT morphology of the nodule. If additional investigations are performed to further investigate the nodules, all results must be interpreted taking into account the pre-test probability and the test performance of the investigation in order to estimate the post-test probability. In cases with a low pre-test probability, a negative result from an exact test can exclude malignancies but a positive test cannot prove malignancy in such a setting. In cases with a high pre-test probability, a positive test result can be considered as proof of malignancy but a negative test result does not exclude malignancy. (orig.) [German] Pulmonale Rundherde sind ein haeufiger Befund bei CT-Untersuchungen des Thorax. Die weiterfuehrende Abklaerung der gefunden Rundherde haengt im Wesentlichen von der so genannten Vortestwahrscheinlichkeit ab, der Wahrscheinlichkeit ob der Rundherd maligne ist oder nicht. Diese Vortestwahrscheinlichkeit laesst sich durch die Kombination aller relevanten Vorinformationen wie Alter und Geschlecht des Patienten, Raucheranamnese, Tumoranamnese, Groesse und CT-Morphologie des Rundherdes genau berechnen oder intuitiv abschaetzen. Werden weiterfuehrende Untersuchungen zur Abklaerung des Rundherdes durchgefuehrt, ist das Ergebnis dieser Untersuchung, die Nachtestwahrscheinlichkeit fuer das Vorliegen von Malignitaet, in Abhaengigkeit von der Vortestwahrscheinlichkeit und der Testguete der Untersuchung zu interpretieren. Waehrend ein genauer Test im Falle niedriger Vortestwahrscheinlichkeiten Malignitaet mit

  7. The effects of iodine attenuation on pulmonary nodule volumetry using novel dual-layer computed tomography reconstructions

    International Nuclear Information System (INIS)

    Harder, A.M. den; Hamersvelt, R.W. van; Leiner, T.; Schilham, A.M.R.; Willemink, M.J.; Jong, P.A. de; Bangert, F.; Milles, Julien

    2017-01-01

    To assess the effect of iodine attenuation on pulmonary nodule volumetry using virtual non-contrast (VNC) and mono-energetic reconstructions. A consecutive series of patients who underwent a contrast-enhanced chest CT scan were included. Images were acquired on a novel dual-layer spectral CT system. Conventional reconstructions as well as VNC and mono-energetic images at different keV levels were used for nodule volumetry. Twenty-four patients with a total of 63 nodules were included. Conventional reconstructions showed a median (interquartile range) volume and diameter of 174 (87 - 253) mm 3 and 6.9 (5.4 - 9.9) mm, respectively. VNC reconstructions resulted in a significant volume reduction of 5.5% (2.6 - 11.2%; p<0.001). Mono-energetic reconstructions showed a correlation between nodule attenuation and nodule volume (Spearman correlation 0.77, (0.49 - 0.94)). Lowering the keV resulted in increased volumes while higher keV levels resulted in decreased pulmonary nodule volumes compared to conventional CT. Novel dual-layer spectral CT offers the possibility to reconstruct VNC and mono-energetic images. Those reconstructions show that higher pulmonary nodule attenuation results in larger nodule volumes. This may explain the reported underestimation in nodule volume on non-contrast enhanced compared to contrast-enhanced acquisitions. (orig.)

  8. The effects of iodine attenuation on pulmonary nodule volumetry using novel dual-layer computed tomography reconstructions

    Energy Technology Data Exchange (ETDEWEB)

    Harder, A.M. den; Hamersvelt, R.W. van; Leiner, T.; Schilham, A.M.R.; Willemink, M.J.; Jong, P.A. de [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Bangert, F. [Sint Antonius Ziekenhuis, Department of Radiology, Nieuwegein (Netherlands); Milles, Julien [Philips Healthcare, Best (Netherlands)

    2017-12-15

    To assess the effect of iodine attenuation on pulmonary nodule volumetry using virtual non-contrast (VNC) and mono-energetic reconstructions. A consecutive series of patients who underwent a contrast-enhanced chest CT scan were included. Images were acquired on a novel dual-layer spectral CT system. Conventional reconstructions as well as VNC and mono-energetic images at different keV levels were used for nodule volumetry. Twenty-four patients with a total of 63 nodules were included. Conventional reconstructions showed a median (interquartile range) volume and diameter of 174 (87 - 253) mm{sup 3} and 6.9 (5.4 - 9.9) mm, respectively. VNC reconstructions resulted in a significant volume reduction of 5.5% (2.6 - 11.2%; p<0.001). Mono-energetic reconstructions showed a correlation between nodule attenuation and nodule volume (Spearman correlation 0.77, (0.49 - 0.94)). Lowering the keV resulted in increased volumes while higher keV levels resulted in decreased pulmonary nodule volumes compared to conventional CT. Novel dual-layer spectral CT offers the possibility to reconstruct VNC and mono-energetic images. Those reconstructions show that higher pulmonary nodule attenuation results in larger nodule volumes. This may explain the reported underestimation in nodule volume on non-contrast enhanced compared to contrast-enhanced acquisitions. (orig.)

  9. [Fluctuant pulmonary nodules as presentation of a MALT lymphoma].

    Science.gov (United States)

    Dolz Aspas, R; Toyas Miazza, C; Ruiz Ruiz, F; Morales Rull, J L; Pérez Calvo, J I

    2003-11-01

    Mucosa associated lymphoid tissue (MALT) lymphomas are a group of non- Hodgkin"s lymphomas of low malignancy degree. The most frequent location is the gastrointestinal tract. Its primary pulmonary presentation is unusual and heterogeneous from point of view radiological. Woman 61 years old with antecedents of vitiligo, gastric ulcus, cirrhosis by VHC, that go into the hospital by sudden disnea, thoracic paint with pleural characterises and fever of 38.5 degrees C, Her thorax radiography and thoracic TAC showed nodes that affect to different pulmonary lobes. The cytology by PAAF confirms their malignant nature. In subsequent radiological controls it was notice the nodels took away completely and returns in different pulmonary place in each recurrence. The presentation like fluctuant pulmonary nodes is exceptional in a MALT lymphoma. It was described a higher incidence of VHC infection and tumour. The evidence of chronic hepatitis by virus C disease, and local chronic inflammatory process as well as autoimmune disorders may be considerate like a factor that contribute to MALT lymphoma.

  10. Observer Variability and the Performance between Faculties and Residents: US Criteria for Benign and Malignant Thyroid Nodules

    International Nuclear Information System (INIS)

    Kim, Sung Hun; Park, Chang Suk; Jung, So Lyung

    2010-01-01

    To evaluate the interobserver variability and performance in the interpretation of ultrasonographic (US) findings of thyroid nodules. 72 malignant nodules and 61 benign nodules were enrolled as part of this study. Five faculty radiologists and four residents independently performed a retrospective analysis of the US images. The observers received one training session after the first interpretation and then performed a secondary interpretation. Agreement was analyzed by Cohen's kappa statistic. Degree of performance was analyzed using receiver operating characteristic (ROC) curves. Agreement between the faculties was fair-to-good for all criteria; however, between residents, agreement was poor-to-fair. The area under the ROC curves was 0.72, 0.62, and 0.60 for the faculties, senior residents, and junior residents, respectively. There was a significant difference in performance between the faculties and the residents (p < 0.05). There was a significant increase in the agreement for some criteria in the faculties and the senior residents after the training session, but no significant increase in the junior residents. Independent reporting of thyroid US performed by residents is undesirable. A continuous and specialized resident training is essential to enhance the degree of agreement and performance

  11. Effect of ultrasound-guided interstitial laser photocoagulation on benign solitary solid cold thyroid nodules - a randomised study

    DEFF Research Database (Denmark)

    Døssing, Helle; Bennedbaek, Finn Noe; Hegedüs, Laszlo

    2005-01-01

    and thyroid function was determined by routine assays before and during follow-up. Pressure and cosmetic complaints before and at 6 months were evaluated on a visual analogue scale. ILP was performed under US guidance and with an output power of 2.5-3.5 W. RESULTS: In the ILP group, the nodule volume......AIM: To evaluate the efficacy of ultrasound (US)-guided interstitial laser photocoagulation (ILP) on thyroid function, nodule size and patient satisfaction in benign solitary solid cold thyroid nodules by comparing one ILP session with no treatment in a prospective randomised study. MATERIALS...... decreased from 8.2 ml (6.1; 11.9) (median; quartiles) to 4.8 ml (3.0; 6.6) after 6 months (P = 0.001). The overall median reduction was 44% (37; 52), which correlated with a significant decrease in pressure symptoms as well as cosmetic complaints. In the control group, a non-significant increase in median...

  12. Quantitative CT analysis of pulmonary pure ground-glass nodule predicts histological invasiveness

    Energy Technology Data Exchange (ETDEWEB)

    Li, Qiong, E-mail: liqiongsmmu2008@qq.com [Department of Radiology, Changzheng Hospital, Second Military Medical University, NO. 415, Fengyang Road, Shanghai 200003 (China); Fan, Li, E-mail: fanli0930@163.com [Department of Radiology, Changzheng Hospital, Second Military Medical University, NO. 415, Fengyang Road, Shanghai 200003 (China); Cao, En-Tao, E-mail: cet123cs@126.com [Department of Radiology, Suzhou Municipal Hospital (East District), No.16 West Baita Road, Suzhu, Jiangsu Province 215001 (China); Li, Qing-Chu, E-mail: Wudi327@hotmail.com [Department of Radiology, Changzheng Hospital, Second Military Medical University, NO. 415, Fengyang Road, Shanghai 200003 (China); Gu, Ya-Feng, E-mail: 2528473557@qq.com [Department of Radiology, Changzheng Hospital, Second Military Medical University, NO. 415, Fengyang Road, Shanghai 200003 (China); Liu, Shi−Yuan, E-mail: liusy1186@163.com [Department of Radiology, Changzheng Hospital, Second Military Medical University, NO. 415, Fengyang Road, Shanghai 200003 (China)

    2017-04-15

    Objective: To assess whether quantitative computed tomography (CT) can help predict histological invasiveness of pulmonary adenocarcinoma appearing as pure ground glass nodules (pGGNs). Methods: A total of 110 pulmonary pGGNs were retrospectively evaluated, and pathologically classified as pre-invasive lesions, minimally invasive adenocarcinoma (MIA) and invasive pulmonary adenocarcinoma (IPA). Maximum nodule diameters, largest cross-sectional areas, volumes, mean CT values, weights, and CT attenuation values at the 0th,2th,5th, 25th, 50th,75th, 95th, 98th and100th percentiles on histogram, as well as 2th to 98th, 5th to 95th, 25th to 75th,and 0th to 100thslopes, respectively, were compared among the three groups. Results: Of the 110 pGGNs, 50, 28, and 32 were pre-invasive lesions, MIA, and IPA, respectively. Maximum nodule diameters, largest cross-sectional areas, andmass weights were significantly larger in the IPA group than in pre-invasive lesions. The 95th, 98th, 100th percentiles, and 2th to 98th, 25th to 75th, and 0th to 100thslopes were significantly different between pre-invasive lesions and MIA or IPA. Logistic regression analysis showed that the maximum nodule diameter (OR = 1.21, 95%CI: 1.071–1.366, p < 0.01) and 100th percentile on histogram (OR = 1.02, 95%CI: 1.009–1.032, p < 0.001) independently predicted histological invasiveness. Conclusions: Quantitative analysis of CT imaging can predict histological invasiveness of pGGNs, especiallythe maximum nodule diameter and 100th percentile on CT number histogram; this can instruct the long-term follow-up and selective surgical management.

  13. Pulmonary nodule classification in lung cancer screening with three-dimensional convolutional neural networks.

    Science.gov (United States)

    Liu, Shuang; Xie, Yiting; Jirapatnakul, Artit; Reeves, Anthony P

    2017-10-01

    A three-dimensional (3-D) convolutional neural network (CNN) trained from scratch is presented for the classification of pulmonary nodule malignancy from low-dose chest CT scans. Recent approval of lung cancer screening in the United States provides motivation for determining the likelihood of malignancy of pulmonary nodules from the initial CT scan finding to minimize the number of follow-up actions. Classifier ensembles of different combinations of the 3-D CNN and traditional machine learning models based on handcrafted 3-D image features are also explored. The dataset consisting of 326 nodules is constructed with balanced size and class distribution with the malignancy status pathologically confirmed. The results show that both the 3-D CNN single model and the ensemble models with 3-D CNN outperform the respective counterparts constructed using only traditional models. Moreover, complementary information can be learned by the 3-D CNN and the conventional models, which together are combined to construct an ensemble model with statistically superior performance compared with the single traditional model. The performance of the 3-D CNN model demonstrates the potential for improving the lung cancer screening follow-up protocol, which currently mainly depends on the nodule size.

  14. Intralesional saline injection for effective ultrasound-guided aspiration of benign viscous cystic thyroid nodules

    International Nuclear Information System (INIS)

    Ko, Eun Sook; Shin, Jung Hee; Sung, Jin Yong

    2014-01-01

    We aimed to evaluate the efficacy and safety of vigorous saline injection for viscous cystic thyroid nodules. Eighteen patients who underwent ultrasound-guided aspiration for viscous cystic thyroid nodules using a saline injection were included in our study. After failing to aspirate the cyst by the usual method, we vigorously injected saline into the cyst in multiple directions to break up and liquefy the viscous cystic contents to enable aspiration. The initial and the residual volume of the nodule were calculated, and the volume reduction rate and the time taken to perform the aspiration were recorded. The mean volume of the cystic nodules before aspiration was 11.0 mL (range, 1.2 to 26.0 mL), while the postaspiration volume was 4.2 mL (range, 0.2 to 14.5 mL). The mean aspirated volume was 63.7% of the initial volume. The mean procedure time was 12.4 minutes (range, 5 to 26 minutes). There were no significant complications related to the procedure. A vigorous saline injection followed by aspiration can be a useful method to aspirate viscous cystic thyroid nodules as a prestep for further intervention or simple management.

  15. Localized thin-section CT with radiomics feature extraction and machine learning to classify early-detected pulmonary nodules from lung cancer screening

    Science.gov (United States)

    Tu, Shu-Ju; Wang, Chih-Wei; Pan, Kuang-Tse; Wu, Yi-Cheng; Wu, Chen-Te

    2018-03-01

    Lung cancer screening aims to detect small pulmonary nodules and decrease the mortality rate of those affected. However, studies from large-scale clinical trials of lung cancer screening have shown that the false-positive rate is high and positive predictive value is low. To address these problems, a technical approach is greatly needed for accurate malignancy differentiation among these early-detected nodules. We studied the clinical feasibility of an additional protocol of localized thin-section CT for further assessment on recalled patients from lung cancer screening tests. Our approach of localized thin-section CT was integrated with radiomics features extraction and machine learning classification which was supervised by pathological diagnosis. Localized thin-section CT images of 122 nodules were retrospectively reviewed and 374 radiomics features were extracted. In this study, 48 nodules were benign and 74 malignant. There were nine patients with multiple nodules and four with synchronous multiple malignant nodules. Different machine learning classifiers with a stratified ten-fold cross-validation were used and repeated 100 times to evaluate classification accuracy. Of the image features extracted from the thin-section CT images, 238 (64%) were useful in differentiating between benign and malignant nodules. These useful features include CT density (p  =  0.002 518), sigma (p  =  0.002 781), uniformity (p  =  0.032 41), and entropy (p  =  0.006 685). The highest classification accuracy was 79% by the logistic classifier. The performance metrics of this logistic classification model was 0.80 for the positive predictive value, 0.36 for the false-positive rate, and 0.80 for the area under the receiver operating characteristic curve. Our approach of direct risk classification supervised by the pathological diagnosis with localized thin-section CT and radiomics feature extraction may support clinical physicians in determining

  16. Subsolid pulmonary nodule morphology and associated patient characteristics in a routine clinical population

    Energy Technology Data Exchange (ETDEWEB)

    Mets, Onno M.; Jong, Pim A. de [University Medical Center Utrecht, Radiology, Utrecht (Netherlands); Scholten, Ernst T.; Chung, Kaman; Ginneken, Bram van [Radboud University Nijmegen Medical Centre, Diagnostic Imaging Analysis Group, Nijmegen (Netherlands); Schaefer-Prokop, Cornelia M. [Radboud University Nijmegen Medical Centre, Diagnostic Imaging Analysis Group, Nijmegen (Netherlands); Meander Medical Center, Radiology, Amersfoort (Netherlands)

    2017-02-15

    To determine the presence and morphology of subsolid pulmonary nodules (SSNs) in a non-screening setting and relate them to clinical and patient characteristics. A total of 16,890 reports of clinically obtained chest CT (06/2011 to 11/2014, single-centre) were searched describing an SSN. Subjects with a visually confirmed SSN and at least two thin-slice CTs were included. Nodule volumes were measured. Progression was defined as volume increase exceeding the software interscan variation. Nodule morphology, location, and patient characteristics were evaluated. Fifteen transient and 74 persistent SSNs were included (median follow-up 19.6 [8.3-36.8] months). Subjects with an SSN were slightly older than those without (62 vs. 58 years; p = 0.01), but no gender predilection was found. SSNs were mostly located in the upper lobes. Women showed significantly more often persistent lesions than men (94 % vs. 69 %; p = 0.002). Part-solid lesions were larger (1638 vs. 383 mm{sup 3}; p < 0.001) and more often progressive (68 % vs. 38 %; p = 0.02), compared to pure ground-glass nodules. Progressive SSNs were rare under the age of 50 years. Logistic regression analysis did not identify additional nodule parameters of future progression, apart from part-solid nature. This study confirms previously reported characteristics of SSNs and associated factors in a European, routine clinical population. (orig.)

  17. Simple localization of peripheral pulmonary nodules - CT-guided percutaneous hook-wire localization

    International Nuclear Information System (INIS)

    Poretti, F.P.; Vorwerk, D.; Brunner, E.

    2002-01-01

    Background: Video-assisted thoracoscopic surgery (VATS) is an alternative approach to small intrapulmonary nodules, if transbronchial or percutaneous biopsy have failed. We investigated the feasibility and effectiveness of the percutaneous CT-guided placement of hook-wires to localize such nodules before video-assisted thoracoscopy. Subjects and Methods: 19 patients with new by diagnosed intrapulmonary nodules underwent CT-guided hook-wire localization by application of a X-Reidy-Set (Cook, Inc., Bjaeverskov, Denmark). The average age of the patient was 63 years (range: 19-80 years), the mean distance between the nodule and the pleura visceral was 7.58 mm (range: 0-25 mm) and the mean diameter was 11.58 mm (range: 5-25 mm). After localization, the patients underwent a VATS resection of the lesion within a mean time of 30 min (range 10-48 min). Results: In all cases, resection of the nodules was successful. In 4 older patients the marking was complicated by poor cooperability. At the end of manipulation the end of the hook was distanced from the nodule. But also in these cases, resection was successfully performed. 8 patients developed an asymptomatic pneumothorax: 5 of them in a minor (max. 1.5 cm rim), three of them in a moderate (max. 3 cm rim) dimension. In 4 patients, in whom the tumor was hit directly by the needle, local bleeding occurred. In one case, haemoptoe was present. In no patient did a dislocation of the hookwire-system occur. Conclusion: CT-guided placement of a hook-wire system is a simple and reasonable procedure which facilitates safe VATS resection of small pulmonary nodules. (orig.) [de

  18. Relationship between solitary pulmonary nodule lung cancer and CT image features based on gradual clustering

    Science.gov (United States)

    Zhang, Weipeng

    2017-06-01

    The relationship between the medical characteristics of lung cancers and computer tomography (CT) images are explored so as to improve the early diagnosis rate of lung cancers. This research collected CT images of patients with solitary pulmonary nodule lung cancer, and used gradual clustering methodology to classify them. Preliminary classifications were made, followed by continuous modification and iteration to determine the optimal condensation point, until iteration stability was achieved. Reasonable classification results were obtained. the clustering results fell into 3 categories. The first type of patients was mostly female, with ages between 50 and 65 years. CT images of solitary pulmonary nodule lung cancer for this group contain complete lobulation and burr, with pleural indentation; The second type of patients was mostly male with ages between 50 and 80 years. CT images of solitary pulmonary nodule lung cancer for this group contain complete lobulation and burr, but with no pleural indentation; The third type of patients was also mostly male with ages between 50 and 80 years. CT images for this group showed no abnormalities. the application of gradual clustering methodology can scientifically classify CT image features of patients with lung cancer in the initial lesion stage. These findings provide the basis for early detection and treatment of malignant lesions in patients with lung cancer.

  19. Computer-aided detection of small pulmonary nodules in multidetector spiral computed tomography (MSCT) in children

    International Nuclear Information System (INIS)

    Honnef, D.; Behrendt, F.F.; Hohl, C.; Mahnken, A.H.; Guenther, R.W.; Das, M.; Mertens, R.; Stanzel, S.

    2008-01-01

    Purpose: Retrospective evaluation of computer-aided detection software (CAD) for automated detection (LungCAD, Siemens Medical solutions, Forchheim, Germany) and volumetry (LungCARE) of pulmonary nodules in dose-reduced pediatric MDCT. Materials and Methods: 30 scans of 24 children (10.4±5.9 years, 13 girls, 11 boys, 39.7±29.3 kg body weight) were performed on a 16-MDCT for tumor staging (n=18), inflammation (n=9), other indications (n=3). Tube voltage 120 kVp and effective mAs were adapted to body weight. Slice thickness 2 mm, increment 1 mm. A pediatric radiologist (U1), a CAD expert (U2) and an inexperienced radiologist (U3) independently analyzed the lung window images without and with the CAD as a second reader. In a consensus decision U1 and U2 were the reference standard. Results: Five examinations had to be excluded from the study due to other underlying lung disease. A total of 24 pulmonary nodules were found in all data sets with a minimal diameter of 0.35 mm to 3.81 mm (mean 1.7±0.85 mm). The sensitivities were as follows: U1 95.8% and 100% with CAD; U2 91.7% U3 66.7%. U2 and U3 did not detect further nodules with CAD. The sensitivity of CAD alone was 41.7% with 0.32 false-positive findings per examination. Interobserver agreement between U1/U2 regarding nodule detection with CAD was good (k=0.6500) and without CAD very good (k=0.8727). For the rest (U1/U3; U2/U3 with and without CAD), it was weak (k=0.0667-0.1884). Depending on the measured value (axial measurement, volume), there is a significant correlation (p=0.0026-0.0432) between nodule size and CAD detection. Undetected pulmonary nodules (mean 1.35 mm; range 0.35-2.61 mm) were smaller than the detected ones (mean 2.19 mm; range 1.35-3.81 mm). No significant correlation was found between CAD findings and patient age (p=0.9263) and body weight (p=0.9271) as well as nodule location (subpleural, intraparenchymal; p=1.0) and noise/SNR. (orig.)

  20. Pulmonary aspergilloma

    Science.gov (United States)

    ... the aspergillus fungus is found. Alternative Names Fungus ball; Mycetoma; Aspergilloma; Aspergillosis - pulmonary aspergilloma Images Lungs Pulmonary nodule - front view chest x-ray Pulmonary nodule, solitary - CT ...

  1. [Multiple pulmonary nodules and posterior uveitis as unusual manifestation of pulmonary tuberculosis].

    Science.gov (United States)

    Ibarburen González-Arenas, C; Zapatero Gaviria, A; Gómez Santos, D; García-Castaño, B; Tomás Ros, M; Merino Morales, F

    1990-12-01

    Pulmonar tuberculosis still being one of the diseases more frequent in our area, this producing different clinical and radiological presentation. A case with posterior uveitis and bilateral lungs nodules which required a thoracotomy to perform a diagnosis, is presented.

  2. Pulmonary and Meningeal Cryptococcosis after Corticosteroid Therapy for Autoimmune Hepatitis: Coexistence of Cryptococci within Pulmonary Cancer Nodule

    Directory of Open Access Journals (Sweden)

    Takashi Yuri

    2013-01-01

    Full Text Available A case of autoimmune hepatitis complicated with pulmonary and meningeal cryptococcosis during long-term treatment with corticosteroid is reported. An 84-year-old woman who received long-term corticosteroid therapy (40 mg/day prednisolone for two years for autoimmune hepatitis developed a headache, slight fever, and anorexia and was diagnosed with cryptococcal meningitis two months prior to hospital admission. Due to deterioration of her condition, the patient was transferred to our university hospital. After admission, a pulmonary nodule 1 cm in diameter was noticed in the patient’s right lower lobe. Cryptococcal meningitis was diagnosed as positive for cryptococcal antigen from both serum and cerebrospinal fluid (CSF as well as the growth of Cryptococcus neoformans (C. neoformans in fungal culture. A combination therapy of amphotericin B and flucytosine was started, and the corticosteroid therapy was gradually reduced and finally discontinued. In addition to continuous cryptococcal infection, complications of Pseudomonas aeruginosa and methicillin-resistance Staphylococcus aureus infection caused death after a 2-month hospitalization. Autopsy disclosed encapsulated yeast in the lungs and subarachnoid space characteristic of Cryptococcus. The pulmonary nodule was found to be squamous cell carcinoma coexisting with C. neoformans within and around the cancer cell nests.

  3. Pulmonary and Meningeal Cryptococcosis after Corticosteroid Therapy for Autoimmune Hepatitis: Coexistence of Cryptococci within Pulmonary Cancer Nodule.

    Science.gov (United States)

    Yuri, Takashi; Kimura, Ayako; Yoshizawa, Katsuhiko; Emoto, Yuko; Kinoshita, Yuichi; Tsubura, Airo

    2013-01-01

    A case of autoimmune hepatitis complicated with pulmonary and meningeal cryptococcosis during long-term treatment with corticosteroid is reported. An 84-year-old woman who received long-term corticosteroid therapy (40 mg/day prednisolone for two years) for autoimmune hepatitis developed a headache, slight fever, and anorexia and was diagnosed with cryptococcal meningitis two months prior to hospital admission. Due to deterioration of her condition, the patient was transferred to our university hospital. After admission, a pulmonary nodule 1 cm in diameter was noticed in the patient's right lower lobe. Cryptococcal meningitis was diagnosed as positive for cryptococcal antigen from both serum and cerebrospinal fluid (CSF) as well as the growth of Cryptococcus neoformans (C. neoformans) in fungal culture. A combination therapy of amphotericin B and flucytosine was started, and the corticosteroid therapy was gradually reduced and finally discontinued. In addition to continuous cryptococcal infection, complications of Pseudomonas aeruginosa and methicillin-resistance Staphylococcus aureus infection caused death after a 2-month hospitalization. Autopsy disclosed encapsulated yeast in the lungs and subarachnoid space characteristic of Cryptococcus. The pulmonary nodule was found to be squamous cell carcinoma coexisting with C. neoformans within and around the cancer cell nests.

  4. A deep 3D residual CNN for false-positive reduction in pulmonary nodule detection.

    Science.gov (United States)

    Jin, Hongsheng; Li, Zongyao; Tong, Ruofeng; Lin, Lanfen

    2018-03-03

    The automatic detection of pulmonary nodules using CT scans improves the efficiency of lung cancer diagnosis, and false-positive reduction plays a significant role in the detection. In this paper, we focus on the false-positive reduction task and propose an effective method for this task. We construct a deep 3D residual CNN (convolution neural network) to reduce false-positive nodules from candidate nodules. The proposed network is much deeper than the traditional 3D CNNs used in medical image processing. Specifically, in the network, we design a spatial pooling and cropping (SPC) layer to extract multilevel contextual information of CT data. Moreover, we employ an online hard sample selection strategy in the training process to make the network better fit hard samples (e.g., nodules with irregular shapes). Our method is evaluated on 888 CT scans from the dataset of the LUNA16 Challenge. The free-response receiver operating characteristic (FROC) curve shows that the proposed method achieves a high detection performance. Our experiments confirm that our method is robust and that the SPC layer helps increase the prediction accuracy. Additionally, the proposed method can easily be extended to other 3D object detection tasks in medical image processing. © 2018 American Association of Physicists in Medicine.

  5. Analysis of the incidence and factors predictive of outcome in patients with head and neck cancer with pulmonary nodules.

    Science.gov (United States)

    Green, Richard; Macmillan, Mark T; Tikka, Theofano; Bruce, Lorna; Murchison, John T; Nixon, Iain J

    2017-11-01

    The management of pulmonary nodules is challenging; unfortunately, little is known about the incidence and significance of pulmonary nodules in patients with head and neck cancer. A review was conducted of 400 consecutive patients with head and neck cancer. Imaging was reviewed to identify the incidence of nodules and patient, tumor, and radiological factors associated with the risk of malignancy. Nodules were found in 58% of patients, with a malignant rate of 6%. Age was the only predictor of having a nodule and advanced-stage III + IV was a predictor of malignancy (P = .023; odds ratio [OR] 10.64; confidence interval 1.33-84.98). Patients presenting with head and neck cancer have a higher incidence of pulmonary nodules and a higher risk of malignancy. In contrast to the British Thoracic Society (BTS) guidelines, which use size to guide the need for serial scans, we would recommend follow-up imaging in all patients with head and neck cancer with nodules, irrespective of size. © 2017 Wiley Periodicals, Inc.

  6. New development of MR imaging lung nodule simulator for detecting peripheral pulmonary nodules: Experimental and clinical studies

    International Nuclear Information System (INIS)

    Kono, M.; Yamasaki, K.; Adachi, S.; Kameda, K.; Tanaka, K.

    1987-01-01

    There are no appropriate phantoms for MR imaging because the parameters (rho, T1, T2) are not equivalent to those in human tissues. To evaluate the detectability of peripheral lung nodules with MR imaging, the authors devised lung nodule phantoms made of polyvinyl alcohol for evaluating spatial and contrast resolution. To evaluate the environmental effect around the phantoms, a thoracic phantom was made of polyvinyl alcohol, solid oils and artificial bone. Based on experimental results, T1, T2 values of the lung nodule phantom varied as a function of position. To determine tissue characterization of peripheral lung nodules with MR imaging, lung nodule phantoms with T1 and T2 values similar to those of lung cancer were compared with actual T1 and T2 values of lung nodules. It was strongly suggested that these phantoms would be useful for differentiation of malignant nodules from inflammatory lesion

  7. Preoperative Pulmonary Nodule Localization: A Comparison of Methylene Blue and Hookwire Techniques.

    Science.gov (United States)

    Kleedehn, Mark; Kim, David H; Lee, Fred T; Lubner, Meghan G; Robbins, Jessica B; Ziemlewicz, Timothy J; Hinshaw, J Louis

    2016-12-01

    Small pulmonary nodules are often difficult to identify during thoracoscopic resection, and preoperative CT-guided localization performed using either hookwire placement or methylene blue injection can be helpful. The purpose of this study is to compare the localization success and complication rates of these two techniques. One hundred two consecutive patients who underwent a total of 109 localization procedures performed with CT fluoroscopic guidance were analyzed. The procedures included 52 hookwire insertions and 57 methylene blue injections. The localization success and complication rates associated with the two groups were compared. All nodules in both groups were identified intraoperatively, except for those in two patients in the hookwire group who did not proceed to undergo same-day surgery, including one with a massive systemic air embolus that resulted in death. Hookwires were dislodged in seven of 52 cases (13%), but the surgeons were still able to locate the nodules through visualization of the parenchymal puncture sites. The total number of complications was higher in the hookwire insertion group than in the methylene blue injection group, but this trend was not statistically significant, with all types of complications occurring in 28 cases (54%) versus 26 cases (46%) (p = 0.45), major complications noted in four cases (8%) versus one case (2%) (p = 0.19), pneumothorax observed in 20 cases (38%) versus 14 cases (25%) (p = 0.15), and perilesional hemorrhage occurring in six cases (12%) versus two cases (4%) (p = 0.15), respectively. The present study suggests that methylene blue injection and hookwire insertion are statistically equivalent for preoperative pulmonary nodule localization; however, seven of 52 hookwires dislodged, and trends toward more frequent and severe complications were noted in the hookwire insertion group.

  8. A novel computer-aided detection system for pulmonary nodule identification in CT images

    Science.gov (United States)

    Han, Hao; Li, Lihong; Wang, Huafeng; Zhang, Hao; Moore, William; Liang, Zhengrong

    2014-03-01

    Computer-aided detection (CADe) of pulmonary nodules from computer tomography (CT) scans is critical for assisting radiologists to identify lung lesions at an early stage. In this paper, we propose a novel approach for CADe of lung nodules using a two-stage vector quantization (VQ) scheme. The first-stage VQ aims to extract lung from the chest volume, while the second-stage VQ is designed to extract initial nodule candidates (INCs) within the lung volume. Then rule-based expert filtering is employed to prune obvious FPs from INCs, and the commonly-used support vector machine (SVM) classifier is adopted to further reduce the FPs. The proposed system was validated on 100 CT scans randomly selected from the 262 scans that have at least one juxta-pleural nodule annotation in the publicly available database - Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI). The two-stage VQ only missed 2 out of the 207 nodules at agreement level 1, and the INCs detection for each scan took about 30 seconds in average. Expert filtering reduced FPs more than 18 times, while maintaining a sensitivity of 93.24%. As it is trivial to distinguish INCs attached to pleural wall versus not on wall, we investigated the feasibility of training different SVM classifiers to further reduce FPs from these two kinds of INCs. Experiment results indicated that SVM classification over the entire set of INCs was in favor of, where the optimal operating of our CADe system achieved a sensitivity of 89.4% at a specificity of 86.8%.

  9. Computer-aided pulmonary nodule detection. Performance of two CAD systems at different CT dose levels

    International Nuclear Information System (INIS)

    Hein, Patrick Alexander; Rogalla, P.; Klessen, C.; Lembcke, A.; Romano, V.C.

    2009-01-01

    Purpose: To evaluate the impact of dose reduction on the performance of computer-aided lung nodule detection systems (CAD) of two manufacturers by comparing respective CAD results on ultra-low-dose computed tomography (ULD-CT) and standard dose CT (SD-CT). Materials and Methods: Multi-slice computed tomography (MSCT) data sets of 26 patients (13 male and 13 female, patients 31 - 74 years old) were retrospectively selected for CAD analysis. Indication for CT examination was staging of a known primary malignancy or suspected pulmonary malignancy. CT images were consecutively acquired at 5 mAs (ULD-CT) and 75 mAs (SD-CT) with 120kV tube voltage (1 mm slice thickness). The standard of reference was determined by three experienced readers in consensus. CAD reading algorithms (pre-commercial CAD system, Philips, Netherlands: CAD-1; LungCARE, Siemens, Germany: CAD-2) were applied to the CT data sets. Results: Consensus reading identified 253 nodules on SD-CT and ULD-CT. Nodules ranged in diameter between 2 and 41 mm (mean diameter 4.8 mm). Detection rates were recorded with 72% and 62% (CAD-1 vs. CAD-2) for SD-CT and with 73% and 56% for ULD-CT. Median also positive rates per patient were calculated with 6 and 5 (CAD-1 vs. CAD-2) for SD-CT and with 8 and 3 for ULD-CT. After separate statistical analysis of nodules with diameters of 5 mm and greater, the detection rates increased to 83% and 61% for SD-CT and to 89% and 67% for ULD-CT (CAD-1 vs. CAD-2). For both CAD systems there were no significant differences between the detection rates for standard and ultra-low-dose data sets (p>0.05). Conclusion: Dose reduction of the underlying CT scan did not significantly influence nodule detection performance of the tested CAD systems. (orig.)

  10. Patient and Clinician Characteristics Associated with Adherence. A Cohort Study of Veterans with Incidental Pulmonary Nodules.

    Science.gov (United States)

    Moseson, Erika M; Wiener, Renda Soylemez; Golden, Sara E; Au, David H; Gorman, John D; Laing, Amber D; Deffebach, Mark E; Slatore, Christopher G

    2016-05-01

    Many patients are diagnosed with small pulmonary nodules for which professional societies recommend subsequent imaging surveillance. Adherence to these guidelines involves many steps from both clinicians and patients but has not been well studied. In a health care setting with a nodule tracking system, we evaluated the association of communication processes and distress with patient and clinician adherence to recommended follow up and Fleischner Society guidelines, respectively. We conducted a prospective, longitudinally assessed, cohort study of patients with incidentally detected nodules who received care at one Veterans Affairs Medical Center. We measured patient-centered communication with the Consultation Care Measure and distress with the Impact of Event Scale. We abstracted data regarding participant adherence to clinician recommendations (defined as receiving the follow-up scan within 30 d of the recommended date) and clinician adherence to Fleischner guidelines (defined as planning the follow-up scan within 30 d of the recommended interval) from the electronic medical record. We measured associations of communication and distress with adherence using multivariable-adjusted generalized estimating equations. Among 138 veterans, 39% were nonadherent at least once during follow up. Clinicians were nonadherent to Fleischner guidelines for 27% of follow-up scans. High-quality communication (adjusted odds ratio, 3.65; P = 0.02) and distress (adjusted odds ratio, 0.38; P = 0.02) were associated with increased and decreased participant adherence, respectively. Neither was associated with clinician adherence. Patients and clinicians often do not adhere to nodule follow-up recommendations. Interventions designed to improve communication quality and decrease distress may also improve patient adherence to nodule follow-up recommendations.

  11. MRI for solitary pulmonary nodule and mass assessment: Current state of the art.

    Science.gov (United States)

    Ohno, Yoshiharu; Kauczor, Hans-Ulrich; Hatabu, Hiroto; Seo, Joon Beom; van Beek, Edwin J R

    2018-03-23

    Since the clinical introduction of magnetic resonance imaging (MRI), the chest has been one of its most challenging applications, and many physicists and radiologists have tried since the 1980s to use MR for assessment of different lung diseases as well as mediastinal and pleural diseases. Since then, however, technical advances in sequencing, scanners, and coils, adaptation of parallel imaging techniques, utilization of contrast media, and development of postprocessing tools have been reported by many basic and clinical researchers. As a result, state-of-the-art thoracic MRI is now substituted for traditional imaging techniques and/or plays a complementary role in the management of patients with various chest diseases, and especially in the detection of pulmonary nodules and in thoracic oncology. In addition, MRI has continued to be developed to help overcome the limitations of computed tomography (CT) and nuclear medicine examinations. It can currently provide not only morphological, but also functional, physiological, pathophysiological, and molecular information at 1.5T with a gradual shift from 1.5T to 3T MR systems. In this review, we focus on these recent advances in MRI for pulmonary nodule detection and pulmonary nodule and mass evaluation by using noncontrast-enhanced and contrast-enhanced techniques as well as new molecular imaging methods such as chemical exchange saturation transfer imaging for a comparison with other modalities such as single or multidetector row CT, 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET), and/or PET/CT. 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018. © 2018 International Society for Magnetic Resonance in Medicine.

  12. The Role of Nuclear Medicine in The Diagnosis and Management of Solitary Pulmonary Nodules

    Directory of Open Access Journals (Sweden)

    Farzaneh Shariati

    2013-10-01

    Full Text Available   Solitary pulmonary nodule (SPN is a frequent finding on the chest x-ray and computed tomography. Nuclear medicine techniques play an important role in the diagnosis and management of SPN. In the current review, we briefly will explain the different nuclear medicine modalities in this regard including positron emission tomography (PET using 18-F-FDG, and 11-C-Methionine, and single photon emission computerized tomography (SPECT using somatostatin receptor scintigraphy, 201-Thallium, and 99m-Tc-MIBI.  

  13. Lung cancer probability in patients with CT-detected pulmonary nodules : a prespecified analysis of data from the NELSON trial of low-dose CT screening

    NARCIS (Netherlands)

    Horeweg, Nanda; van Rosmalen, Joost; Heuvelmans, Marjolein A.; van der Aalst, Carlijn M.; Vliegenthart, Rozemarijn; Scholten, Ernst Th; ten Haaf, Kevin; Nackaerts, Kristiaan; Lammers, Jan-Willem J.; Weenink, Carla; Groen, Harry J.; van Ooijen, Peter; de Jong, Pim A.; de Bock, Geertruida H.; Mali, Willem; de Koning, Harry J.; Oudkerk, Matthijs

    2014-01-01

    Background The main challenge in CT screening for lung cancer is the high prevalence of pulmonary nodules and the relatively low incidence of lung cancer. Management protocols use thresholds for nodule size and growth rate to determine which nodules require additional diagnostic procedures, but

  14. [3D Super-resolution Reconstruction and Visualization of Pulmonary Nodules from CT Image].

    Science.gov (United States)

    Wang, Bing; Fan, Xing; Yang, Ying; Tian, Xuedong; Gu, Lixu

    2015-08-01

    The aim of this study was to propose an algorithm for three-dimensional projection onto convex sets (3D POCS) to achieve super resolution reconstruction of 3D lung computer tomography (CT) images, and to introduce multi-resolution mixed display mode to make 3D visualization of pulmonary nodules. Firstly, we built the low resolution 3D images which have spatial displacement in sub pixel level between each other and generate the reference image. Then, we mapped the low resolution images into the high resolution reference image using 3D motion estimation and revised the reference image based on the consistency constraint convex sets to reconstruct the 3D high resolution images iteratively. Finally, we displayed the different resolution images simultaneously. We then estimated the performance of provided method on 5 image sets and compared them with those of 3 interpolation reconstruction methods. The experiments showed that the performance of 3D POCS algorithm was better than that of 3 interpolation reconstruction methods in two aspects, i.e., subjective and objective aspects, and mixed display mode is suitable to the 3D visualization of high resolution of pulmonary nodules.

  15. Diagnostic value of 18F-FDG-PET/CT for the evaluation of solitary pulmonary nodules: a systematic review and meta-analysis.

    Science.gov (United States)

    Ruilong, Zong; Daohai, Xie; Li, Geng; Xiaohong, Wang; Chunjie, Wang; Lei, Tian

    2017-01-01

    To carry out a meta-analysis on the performance of fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography (PET/CT) for the evaluation of solitary pulmonary nodules. In the meta-analysis, we performed searches of several electronic databases for relevant studies, including Google Scholar, PubMed, Cochrane Library, and several Chinese databases. The quality of all included studies was assessed by Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Two observers independently extracted data of eligible articles. For the meta-analysis, the total sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratios were pooled. A summary receiver operating characteristic curve was constructed. The I-test was performed to assess the impact of study heterogeneity on the results of the meta-analysis. Meta-regression and subgroup analysis were carried out to investigate the potential covariates that might have considerable impacts on heterogeneity. Overall, 12 studies were included in this meta-analysis, including a total of 1297 patients and 1301 pulmonary nodules. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio with corresponding 95% confidence intervals (CIs) were 0.82 (95% CI, 0.76-0.87), 0.81 (95% CI, 0.66-0.90), 4.3 (95% CI, 2.3-7.9), and 0.22 (95% CI, 0.16-0.30), respectively. Significant heterogeneity was observed in sensitivity (I=81.1%) and specificity (I=89.6%). Subgroup analysis showed that the best results for sensitivity (0.90; 95% CI, 0.68-0.86) and accuracy (0.93; 95% CI, 0.90-0.95) were present in a prospective study. The results of our analysis suggest that PET/CT is a useful tool for detecting malignant pulmonary nodules qualitatively. Although current evidence showed moderate accuracy for PET/CT in differentiating malignant from benign solitary pulmonary nodules, further work needs to be carried out to improve its reliability.

  16. Characterization of fibrillar collagens and extracellular matrix of glandular benign prostatic hyperplasia nodules.

    Directory of Open Access Journals (Sweden)

    Tyler M Bauman

    Full Text Available Recent studies have associated lower urinary tract symptoms (LUTS in men with prostatic fibrosis, but a definitive link between collagen deposition and LUTS has yet to be demonstrated. The objective of this study was to evaluate ECM and collagen content within normal glandular prostate tissue and glandular BPH, and to evaluate the association of clinical parameters of LUTS with collagen content.Fibrillar collagen and ECM content was assessed in normal prostate (48 patients and glandular BPH nodules (24 patients using Masson's trichrome stain and Picrosirius red stain. Second harmonic generation (SHG imaging was used to evaluate collagen content. Additional BPH tissues (n = 47 were stained with Picrosirius red and the association between clinical parameters of BPH/LUTS and collagen content was assessed.ECM was similar in normal prostate and BPH (p = 0.44. Total collagen content between normal prostate and glandular BPH was similar (p = 0.27, but a significant increase in thicker collagen bundles was observed in BPH (p = 0.045. Using SHG imaging, collagen content in BPH (mean intensity = 62.52; SEM = 2.74 was significantly higher than in normal prostate (51.77±3.49; p = 0.02. Total collagen content was not associated with treatment with finasteride (p = 0.47 or α-blockers (p = 0.52, pre-TURP AUA symptom index (p = 0.90, prostate-specific antigen (p = 0.86, post-void residual (PVR; p = 0.32, prostate size (p = 0.21, or post-TURP PVR (p = 0.51. Collagen content was not associated with patient age in patients with BPH, however as men aged normal prostatic tissue had a decreased proportion of thick collagen bundles.The proportion of larger bundles of collagen, but not total collagen, is increased in BPH nodules, suggesting that these large fibers may play a role in BPH/LUTS. Total collagen content is independent of clinical parameters of BPH and LUTS. If fibrosis and overall ECM deposition are

  17. Radiomics analysis of pulmonary nodules in low-dose CT for early detection of lung cancer.

    Science.gov (United States)

    Choi, Wookjin; Oh, Jung Hun; Riyahi, Sadegh; Liu, Chia-Ju; Jiang, Feng; Chen, Wengen; White, Charles; Rimner, Andreas; Mechalakos, James G; Deasy, Joseph O; Lu, Wei

    2018-02-19

    To develop a radiomics prediction model to improve pulmonary nodule (PN) classification in low-dose CT. To compare the model with the American College of Radiology (ACR) Lung CT Screening Reporting and Data System (Lung-RADS) for early detection of lung cancer. We examined a set of 72 PNs (31 benign and 41 malignant) from the Lung Image Database Consortium image collection (LIDC-IDRI). 103 CT radiomic features were extracted from each PN. Before the model building process, distinctive features were identified using a hierarchical clustering method. We then constructed a prediction model by using a support vector machine (SVM) classifier coupled with a least absolute shrinkage and selection operator (LASSO). A 10-fold cross-validation (CV) was repeated ten times (10×10-fold CV) to evaluate the accuracy of the SVM-LASSO model. Finally, the best model from the 10×10-fold CV was further evaluated using 20×5- and 50×2-fold CVs. The best SVM-LASSO model consisted of only two features: the bounding box anterior-posterior dimension (BB_AP) and the standard deviation of inverse difference moment (SD_IDM). The BB_AP measured the extension of a PN in the anterior-posterior direction and was highly correlated (r=0.94) with the PN size. The SD_IDM was a texture feature that measured the directional variation of the local homogeneity feature IDM. Univariate analysis showed that both features were statistically significant and discriminative (P=0.00013 and 0.000038 respectively). PNs with larger BB_AP or smaller SD_IDM were more likely malignant. The 10×10-fold CV of the best SVM model using the two features achieved an accuracy of 84.6% and 0.89 AUC. By comparison, Lung-RADS achieved an accuracy of 72.2% and 0.77 AUC using four features (size, type, calcification, and spiculation). The prediction improvement of SVM-LASSO comparing to Lung-RADS was statistically significant (McNemar's test P=0.026). Lung-RADS misclassified 19 cases because it was mainly based on PN size

  18. Computer-aided detection of pulmonary nodules: a comparative study using the public LIDC/IDRI database

    International Nuclear Information System (INIS)

    Jacobs, Colin; Prokop, Mathias; Rikxoort, Eva M. van; Ginneken, Bram van; Murphy, Keelin; Schaefer-Prokop, Cornelia M.

    2016-01-01

    To benchmark the performance of state-of-the-art computer-aided detection (CAD) of pulmonary nodules using the largest publicly available annotated CT database (LIDC/IDRI), and to show that CAD finds lesions not identified by the LIDC's four-fold double reading process. The LIDC/IDRI database contains 888 thoracic CT scans with a section thickness of 2.5 mm or lower. We report performance of two commercial and one academic CAD system. The influence of presence of contrast, section thickness, and reconstruction kernel on CAD performance was assessed. Four radiologists independently analyzed the false positive CAD marks of the best CAD system. The updated commercial CAD system showed the best performance with a sensitivity of 82 % at an average of 3.1 false positive detections per scan. Forty-five false positive CAD marks were scored as nodules by all four radiologists in our study. On the largest publicly available reference database for lung nodule detection in chest CT, the updated commercial CAD system locates the vast majority of pulmonary nodules at a low false positive rate. Potential for CAD is substantiated by the fact that it identifies pulmonary nodules that were not marked during the extensive four-fold LIDC annotation process. (orig.)

  19. Computer-aided detection of pulmonary nodules: a comparative study using the public LIDC/IDRI database

    NARCIS (Netherlands)

    Jacobs, C.; Rikxoort, E.M. van; Murphy, K.; Prokop, M.; Schaefer-Prokop, C.M.; Ginneken, B. van

    2016-01-01

    To benchmark the performance of state-of-the-art computer-aided detection (CAD) of pulmonary nodules using the largest publicly available annotated CT database (LIDC/IDRI), and to show that CAD finds lesions not identified by the LIDC's four-fold double reading process.The LIDC/IDRI database

  20. Comparison of digital tomosynthesis and chest radiography for the detection of pulmonary nodules: systematic review and meta-analysis.

    Science.gov (United States)

    Kim, Jun H; Lee, Kyung H; Kim, Kyoung-Tae; Kim, Hyun J; Ahn, Hyeong S; Kim, Yeo J; Lee, Ha Y; Jeon, Yong S

    2016-12-01

    To compare the diagnostic accuracy of digital tomosynthesis (DTS) with that of chest radiography for the detection of pulmonary nodules by meta-analysis. A systematic literature search was performed to identify relevant original studies from 1 January 1 1976 to 31 August 31 2016. The quality of included studies was assessed by quality assessment of diagnostic accuracy studies-2. Per-patient data were used to calculate the sensitivity and specificity and per-lesion data were used to calculate the detection rate. Summary receiver-operating characteristic curves were drawn for pulmonary nodule detection. 16 studies met the inclusion criteria. 1017 patients on a per-patient basis and 2159 lesions on a per-lesion basis from 16 eligible studies were evaluated. The pooled patient-based sensitivity of DTS was 0.85 [95% confidence interval (CI) 0.83-0.88] and the specificity was 0.95 (0.93-0.96). The pooled sensitivity and specificity of chest radiography were 0.47 (0.44-0.51) and 0.37 (0.34-0.40), respectively. The per-lesion detection rate was 2.90 (95% CI 2.63-3.19). DTS has higher diagnostic accuracy than chest radiography for detection of pulmonary nodules. Chest radiography has low sensitivity but similar specificity, comparable with that of DTS. Advances in knowledge: DTS has higher diagnostic accuracy than chest radiography for the detection of pulmonary nodules.

  1. Detection and size measurements of pulmonary nodules in ultra-low-dose CT with iterative reconstruction compared to low dose

    NARCIS (Netherlands)

    Sui, Xin; Meinel, Felix G.; Song, Wei; Xu, Xiaoli; Wang, Zixing; Wang, Yuyan; Jin, Zhengyu; Chen, Jiuhong; Vliegenthart, Rozemarijn; Schoepf, U. Joseph

    Background: In this study, the accuracy of ultra-low-dose computed tomography (CT) with iterative reconstruction (IR) for detection and measurement of pulmonary nodules was evaluated. Methods: Eighty-four individuals referred for lung cancer screening (mean age: 54.5 +/- 10.8 years) underwent

  2. Fleischner recommendations for the management of subsolid pulmonary nodules : high awareness but limited conformance - a survey study

    NARCIS (Netherlands)

    Mets, Onno M; de Jong, Pim A; Chung, Kaman; Lammers, Jan-Willem J; van Ginneken, Bram; Schaefer-Prokop, Cornelia M

    2016-01-01

    OBJECTIVES: The aim of this study was to assess awareness and conformance to the Fleischner society recommendations for the management of subsolid pulmonary nodules (SSN) in clinical practice. METHODS: An online questionnaire with four imaging cases was sent to 1579 associates from the European

  3. Fleischner recommendations for the management of subsolid pulmonary nodules: high awareness but limited conformance - a survey study

    NARCIS (Netherlands)

    Mets, O.M.; Jong, P.A. de; Chung, K; Lammers, J.J.; Ginneken, B. van; Schaefer-Prokop, C.M.

    2016-01-01

    OBJECTIVES: The aim of this study was to assess awareness and conformance to the Fleischner society recommendations for the management of subsolid pulmonary nodules (SSN) in clinical practice. METHODS: An online questionnaire with four imaging cases was sent to 1579 associates from the European

  4. Automatic detection of pulmonary nodules in CT images by incorporating 3D tensor filtering with local image feature analysis.

    Science.gov (United States)

    Gong, Jing; Liu, Ji-Yu; Wang, Li-Jia; Sun, Xi-Wen; Zheng, Bin; Nie, Sheng-Dong

    2018-02-01

    Computer-aided detection (CAD) technology has been developed and demonstrated its potential to assist radiologists in detecting pulmonary nodules especially at an early stage. In this paper, we present a novel scheme for automatic detection of pulmonary nodules in CT images based on a 3D tensor filtering algorithm and local image feature analysis. We first apply a series of preprocessing steps to segment the lung volume and generate the isotropic volumetric CT data. Next, a unique 3D tensor filtering approach and local image feature analysis are used to detect nodule candidates. A 3D level set segmentation method is used to correct and refine the boundaries of nodule candidates subsequently. Then, we extract the features of the detected candidates and select the optimal features by using a CFS (Correlation Feature Selection) subset evaluator attribute selection method. Finally, a random forest classifier is trained to classify the detected candidates. The performance of this CAD scheme is validated using two datasets namely, the LUNA16 (Lung Nodule Analysis 2016) database and the ANODE09 (Automatic Nodule Detection 2009) database. By applying a 10-fold cross-validation method, the CAD scheme yielded a sensitivity of 79.3% at an average of 4 false positive detections per scan (FP/Scan) for the former dataset, and a sensitivity of 84.62% and 2.8 FP/Scan for the latter dataset, respectively. Our detection results show that the use of 3D tensor filtering algorithm combined with local image feature analysis constitutes an effective approach to detect pulmonary nodules. Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  5. Usefulness of concurrent reading using thin-section and thick-section CT images in subcentimetre solitary pulmonary nodules.

    Science.gov (United States)

    Lee, H Y; Goo, J M; Lee, H J; Lee, C H; Park, C M; Park, E-A; Im, J-G

    2009-02-01

    To evaluate the differences in the characterization and recommendation for follow-up of subcentimetre solitary pulmonary nodules (SSPNs) between 5 and 1mm section CT, and to compare the assessments generated by four radiologists Five hundred and twenty-nine patients who had SSPNs on chest CT reconstructed using both 5 and 1mm sections were enrolled. Two image subsets of 5 and 1mm CT images of each nodule were interpreted independently by four radiologists. Nodule size, consistency (solid, partly solid, non-solid), the presence of calcification, and recommendations for follow-up were evaluated. If a non-calcified solid nodule was confirmed using CT, recommendation for follow-up was based on Fleischner Society guidelines. Data assessed by each radiologist were compared, and interobserver agreements were determined using the intraclass correlation coefficients and kappa value. Using 1mm CT images, the nodule sizes were significantly larger than on 5mm CT images (paired t-test, pimages (McNemar test for the presence of calcification, pimages there was significantly higher agreement regarding nodule consistency than on 5mm CT (kappa=0.78 and 0.67, respectively). Concurrent use of thin-section and thick-section CT can provide more accurate nodule assessment and higher interobserver agreement in SSPN.

  6. Thoracoscopic detection of occult indeterminate pulmonary nodules using bronchoscopic pleural dye marking

    Directory of Open Access Journals (Sweden)

    William S. Krimsky

    2014-02-01

    Full Text Available Background: The annual incidence of a small indeterminate pulmonary nodule (IPN on computed tomography (CT scan remains high. While traditional paradigms exist, the integration of new technologies into these diagnostic and treatment algorithms can result in alternative, potentially more efficient methods of managing these findings. Methods: We report on an alternative diagnostic and therapeutic strategy for the management of an IPN. This approach combines electromagnetic navigational bronchoscopy (ENB with an updated approach to placement of a pleural dye marker. This technique lends itself to a minimally invasive wedge resection via either video-assisted thoracoscopic surgery (VATS or a robotic approach. Results: Subsequent to alterations in the procedure, a cohort of 22 patients with an IPN was reviewed. Navigation was possible in 21 out of 22 patients with one patient excluded based on airway anatomy. The remaining 21 patients underwent ENB with pleural dye marking followed by minimally invasive wedge resection. The median size of the nodules was 13.4 mm (range: 7–29. There were no complications from the ENB procedure. Indigo carmine dye was used in ten patients. Methylene blue was used in the remaining 11 patients. In 81% of cases, the visceral pleural marker was visible at the time of surgery. In one patient, there was diffuse staining of the parietal pleura. In three additional patients, no dye was identified within the hemithorax. In all cases where dye marker was present on the visceral pleural surface, it was in proximity to the IPN and part of the excised specimen. Conclusions: ENB with pleural dye marking can provide a safe and effective method to localize an IPN and can allow for subsequent minimally invasive resection. Depending on the characteristics and location of the nodule, this method may allow more rapid identification intraoperatively.

  7. Computer-aided diagnosis of pulmonary nodules on CT scans: Segmentation and classification using 3D active contours

    International Nuclear Information System (INIS)

    Way, Ted W.; Hadjiiski, Lubomir M.; Sahiner, Berkman; Chan, H.-P.; Cascade, Philip N.; Kazerooni, Ella A.; Bogot, Naama; Zhou Chuan

    2006-01-01

    We are developing a computer-aided diagnosis (CAD) system to classify malignant and benign lung nodules found on CT scans. A fully automated system was designed to segment the nodule from its surrounding structured background in a local volume of interest (VOI) and to extract image features for classification. Image segmentation was performed with a three-dimensional (3D) active contour (AC) method. A data set of 96 lung nodules (44 malignant, 52 benign) from 58 patients was used in this study. The 3D AC model is based on two-dimensional AC with the addition of three new energy components to take advantage of 3D information: (1) 3D gradient, which guides the active contour to seek the object surface (2) 3D curvature, which imposes a smoothness constraint in the z direction, and (3) mask energy, which penalizes contours that grow beyond the pleura or thoracic wall. The search for the best energy weights in the 3D AC model was guided by a simplex optimization method. Morphological and gray-level features were extracted from the segmented nodule. The rubber band straightening transform (RBST) was applied to the shell of voxels surrounding the nodule. Texture features based on run-length statistics were extracted from the RBST image. A linear discriminant analysis classifier with stepwise feature selection was designed using a second simplex optimization to select the most effective features. Leave-one-case-out resampling was used to train and test the CAD system. The system achieved a test area under the receiver operating characteristic curve (A z ) of 0.83±0.04. Our preliminary results indicate that use of the 3D AC model and the 3D texture features surrounding the nodule is a promising approach to the segmentation and classification of lung nodules with CAD. The segmentation performance of the 3D AC model trained with our data set was evaluated with 23 nodules available in the Lung Image Database Consortium (LIDC). The lung nodule volumes segmented by the 3D AC

  8. Is Diagnostic Performance of Quantitative 2D-Shear Wave Elastography Optimal for Clinical Classification of Benign and Malignant Thyroid Nodules?: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Nattabi, Haliimah A; Sharif, Norhafidzah M; Yahya, Noorazrul; Ahmad, Rozilawati; Mohamad, Mazlyfarina; Zaki, Faizah M; Yusoff, Ahmad N

    2017-10-17

    This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules. PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve. After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64-0.69), 0.78 (CI: 0.76-0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80-18.43), 0.31 (CI: 0.22-0.44), and 3.87 (CI: 2.83-5.29), respectively. Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  9. Learning aspects and potential pitfalls regarding detection of pulmonary nodules in chest tomosynthesis and proposed related quality criteria

    International Nuclear Information System (INIS)

    Asplund, Sara; Johnsson, Aase A.; Vikgren, Jenny

    2011-01-01

    Background In chest tomosynthesis, low-dose projections collected over a limited angular range are used for reconstruction of an arbitrary number of section images of the chest, resulting in a moderately increased radiation dose compared to chest radiography. Purpose To investigate the effects of learning with feedback on the detection of pulmonary nodules for observers with varying experience of chest tomosynthesis, to identify pitfalls regarding detection of pulmonary nodules, and present suggestions for how to avoid them, and to adapt the European quality criteria for chest radiography and computed tomography (CT) to chest tomosynthesis. Material and Methods Six observers analyzed tomosynthesis cases for presence of nodules in a jackknife alternative free-response receiver-operating characteristics (JAFROC) study. CT was used as reference. The same tomosynthesis cases were analyzed before and after learning with feedback, which included a collective learning session. The difference in performance between the two readings was calculated using the JAFROC figure of merit as principal measure of detectability. Results Significant improvement in performance after learning with feedback was found only for observers inexperienced in tomosynthesis. At the collective learning session, localization of pleural and sub pleural nodules or structures was identified as the main difficulty in analyzing tomosynthesis images. Conclusion The results indicate that inexperienced observers can reach a high level of performance regarding nodule detection in tomosynthesis after learning with feedback and that the main problem with chest tomosynthesis is related to the limited depth resolution

  10. A New Method of Measuring the Amount of Soft Tissue in Pulmonary Ground-Glass Opacity Nodules: a Phantom Study

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Won; Kim, Tae Jung; Dae, Chang Min [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Im, Jung Gi [Seoul National University Hospital, Seoul (Korea, Republic of)

    2008-06-15

    To devise a new method to measure the amount of soft tissue in pulmonary ground-glass opacity nodules, and to compare the use of this method with a previous volumetric measurement method by use of a phantom study. Phantom nodules were prepared with material from fixed normal swine lung. Forty nodules, each with a diameter of 10 mm, were made with a variable mean attenuation. The reference-standard amount of soft tissue in the nodules was obtained by dividing the weight by the specific gravity. The imaging data on the phantom nodules were acquired with the use of a 16- channel multidetector CT scanner. The CT-measured amount of soft tissue of the nodules was calculated as follows: soft tissue amount = volume x (1 + mean attenuation value / 1,000). The relative percentage error (RPE) between the CT-measured amount of the soft tissue and the reference-standard amount of the soft tissue was also measured. The RPEs determined with use of the new method were compared with the RPEs determined with the current volumetric measurement method by the use of the paired t test. The CT-measured amount of soft tissue showed a strong correlation with the reference-standard amount of soft tissue (R2 = 0.996, p < 0.01). The mean RPE of the CT-measured amount of soft tissue in the nodules was 7.79 {+-} 1.88%. The mean RPE of the CT-measured volume was 114.78 {+-} 51.02%, which was significantly greater than the RPE of the CT-measured amount of soft tissue (p < 0.01). The amount of soft tissue measured by the use of CT reflects the reference-standard amount of soft tissue in the ground-glass opacity nodules much more accurately than does the use of the CT-measured volume.

  11. Enhancement characteristics of benign and malignant focal peripheral nodules in the peripheral zone of the prostate gland studied using contrast-enhanced transrectal ultrasound

    International Nuclear Information System (INIS)

    Tang, J.; Yang, J.-C.; Luo, Y.; Li, J.; Li, Y.; Shi, H.

    2008-01-01

    Aim: To assess the value of contrast-enhanced grey-scale transrectal ultrasound (CETRUS) in predicting the nature of peripheral zone hypoechoic lesions of the prostate. Materials and Methods: Ninety-one patients with peripheral zone hypoechoic lesions on ultrasound were evaluated with CETRUS followed by lesion-specific and sextant transrectal ultrasound-guided biopsies. The enhancement patterns of the lesions were observed and graded subjectively using adjacent peripheral zone tissue as the reference. Time to enhancement (AT), time to peak intensity (TTP) and peak intensity (PI) were quantified within each nodule. Ultrasound findings were correlated with biopsy findings. Results: Transrectal ultrasound-guided biopsy of the hypoechoic lesions revealed prostate cancer in 44 patients and benign prostatic diseases in 47. The intensity of enhancement within the lesions were graded as no enhancement, increased, equal, or decreased compared with adjacent peripheral zone tissue in two, 30, five and seven in the prostate cancer group and 14, 15, four and 14 in the benign group, respectively. The difference was statistically significant (p < 0.05). The peak enhancement intensity was found to be the most optimal discriminatory parameter (area under curve AUC 0.70; 95% CI: 0.58, 0.82). Conclusion: Malignant hypoechoic nodules in the peripheral zone of the prostate are more likely to enhance early and more intensely on CETRUS. A non-enhanced hypoechoic peripheral zone lesion was more likely to be benign

  12. Dual time-point FDG PET/CT for differentiating benign from ...

    African Journals Online (AJOL)

    Objective. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) is an accurate non-invasive imaging test for differentiating benign from malignant solitary pulmonary nodules (SPNs). We aimed to assess its diagnostic accuracy for differentiating benign from malignant SPNs in a tuberculosis (TB)-endemic area.

  13. Automatic classification of pulmonary peri-fissural nodules in computed tomography using an ensemble of 2D views and a convolutional neural network out-of-the-box

    NARCIS (Netherlands)

    Ciompi, Francesco; de Hoop, Bartjan; van Riel, Sarah J; Chung, Kaman; Scholten, Ernst Th; Oudkerk, Matthijs; de Jong, Pim A; Prokop, Mathias; van Ginneken, Bram

    2015-01-01

    In this paper, we tackle the problem of automatic classification of pulmonary peri-fissural nodules (PFNs). The classification problem is formulated as a machine learning approach, where detected nodule candidates are classified as PFNs or non-PFNs. Supervised learning is used, where a classifier is

  14. [Risk factor analysis of the patients with solitary pulmonary nodules and establishment of a prediction model for the probability of malignancy].

    Science.gov (United States)

    Wang, X; Xu, Y H; Du, Z Y; Qian, Y J; Xu, Z H; Chen, R; Shi, M H

    2018-02-23

    Objective: This study aims to analyze the relationship among the clinical features, radiologic characteristics and pathological diagnosis in patients with solitary pulmonary nodules, and establish a prediction model for the probability of malignancy. Methods: Clinical data of 372 patients with solitary pulmonary nodules who underwent surgical resection with definite postoperative pathological diagnosis were retrospectively analyzed. In these cases, we collected clinical and radiologic features including gender, age, smoking history, history of tumor, family history of cancer, the location of lesion, ground-glass opacity, maximum diameter, calcification, vessel convergence sign, vacuole sign, pleural indentation, speculation and lobulation. The cases were divided to modeling group (268 cases) and validation group (104 cases). A new prediction model was established by logistic regression analying the data from modeling group. Then the data of validation group was planned to validate the efficiency of the new model, and was compared with three classical models(Mayo model, VA model and LiYun model). With the calculated probability values for each model from validation group, SPSS 22.0 was used to draw the receiver operating characteristic curve, to assess the predictive value of this new model. Results: 112 benign SPNs and 156 malignant SPNs were included in modeling group. Multivariable logistic regression analysis showed that gender, age, history of tumor, ground -glass opacity, maximum diameter, and speculation were independent predictors of malignancy in patients with SPN( P prediction model for the probability of malignancy as follow: p =e(x)/(1+ e(x)), x=-4.8029-0.743×gender+ 0.057×age+ 1.306×history of tumor+ 1.305×ground-glass opacity+ 0.051×maximum diameter+ 1.043×speculation. When the data of validation group was added to the four-mathematical prediction model, The area under the curve of our mathematical prediction model was 0.742, which is greater

  15. Ultralow dose CT for pulmonary nodule detection with chest X-ray equivalent dose - a prospective intra-individual comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Messerli, Michael [University Zurich, Department of Nuclear Medicine, University Hospital Zurich, Zurich (Switzerland); Cantonal Hospital St. Gallen, Division of Radiology and Nuclear Medicine, St. Gallen (Switzerland); Kluckert, Thomas; Knitel, Meinhard; Desbiolles, Lotus; Bauer, Ralf W.; Wildermuth, Simon [Cantonal Hospital St. Gallen, Division of Radiology and Nuclear Medicine, St. Gallen (Switzerland); Waelti, Stephan [Cantonal Hospital St. Gallen, Division of Radiology and Nuclear Medicine, St. Gallen (Switzerland); University of Montreal, Department of Radiology, CHU Sainte-Justine, Montreal, Quebec (Canada); Rengier, Fabian [University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Warschkow, Rene [Cantonal Hospital St. Gallen, Department of Surgery, St. Gallen (Switzerland); Alkadhi, Hatem [University Zurich, Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich (Switzerland); Leschka, Sebastian [Cantonal Hospital St. Gallen, Division of Radiology and Nuclear Medicine, St. Gallen (Switzerland); University Zurich, Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich (Switzerland)

    2017-08-15

    To prospectively evaluate the accuracy of ultralow radiation dose CT of the chest with tin filtration at 100 kV for pulmonary nodule detection. 202 consecutive patients undergoing clinically indicated chest CT (standard dose, 1.8 ± 0.7 mSv) were prospectively included and additionally scanned with an ultralow dose protocol (0.13 ± 0.01 mSv). Standard dose CT was read in consensus by two board-certified radiologists to determine the presence of lung nodules and served as standard of reference (SOR). Two radiologists assessed the presence of lung nodules and their locations on ultralow dose CT. Sensitivity and specificity of the ultralow dose protocol was compared against the SOR, including subgroup analyses of different nodule sizes and types. A mixed effects logistic regression was used to test for independent predictors for sensitivity of pulmonary nodule detection. 425 nodules (mean diameter 3.7 ± 2.9 mm) were found on SOR. Overall sensitivity for nodule detection by ultralow dose CT was 91%. In multivariate analysis, nodule type, size and patients BMI were independent predictors for sensitivity (p < 0.001). Ultralow dose chest CT at 100 kV with spectral shaping enables a high sensitivity for the detection of pulmonary nodules at exposure levels comparable to plain film chest X-ray. (orig.)

  16. Thallium-201 SPECT in differential diagnosis of malignancy from benign pathology in patients with a solitary pulmonary lesion

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Byeong Cheol; Lee, Jae Tae; Chon, Kyung Ah [College of Medicine, Kyungpook National Univ., Taegu (Korea, Republic of)] [and others

    1998-06-01

    Tl-201 SPECT has been used in differentiating benign and malignant pulmonary lesions. While its sensitivity may be high, the specificity and predictive values are reported to be variable depending on the type of benign lung lesion. The purpose of this study was to prospectively assess the efficacy of Tl-201 SPECT for differentiating benign and malignant single pulmonary lesion in a population with a high prevalence of benign pulmonary lesion, especially, tuberculosis. One-hundred thirty-three patients, having 89 malignant and 44 benign lesions (23 active tuberculosis, 5 inactive tuberculosis, 3 aspergilloma, 3 focal pneumonia, 2 thymoma, and 8 others), were imaged using a dual-headed system at 15 minute (early) and 3 hour (delayed) following administration of 111MBq Tl-201. The images were read visually and lesion-to-background ratios(L/B) were obtained from transverse tomographic slices. Retention index was expressed as [(delayed L/B-early L/B) / early L/B]. 82/89(92%) and 83/89(93%) of the malignant lesions were visually positive o the early and delayed images, and 27/44 (61%) and 26/44(59%) of the benign lesions were also visually positive on both images. Although a statistically significant difference was found between the mean L/B's of the malignant and benign lesions, L/B was not useful for differentiating the two due to a large overlap. There was no difference in retention indices. Despite of its high sensitivity, the specificity of Tl-201 SPECT was unacceptably low in patients with active benign lesions. The positive and negative predictive values for lung cancer in a population with a high prevalence of the benign single pulmonary lesion was only marginal.

  17. Application of positron emission tomography-computed tomography in the diagnosis of pulmonary ground-glass nodules.

    Science.gov (United States)

    Hu, Lili; Pan, Yuanwei; Zhou, Zhigang; Gao, Jianbo

    2017-11-01

    The aim of the present study was to investigate the value of positron emission tomography-computed tomography (PET-CT) using 18 F-fluorodeoxyglucose in the clinical diagnosis of pulmonary ground-glass nodule. In total, 54 patients with pulmonary GGN that were identified by PET-CT examination were selected and confirmed by pathology and clinical diagnosis in hospital between April 2014 and April 2015. The association between PET-CT findings and pathology, and the value of PET-CT were then evaluated. In the 54 patients, solitary pulmonary GGN with a nodule diameter of between 0.6 and 2.0 cm were detected. Amongst them, the PET-CT examination of 42 patients revealed hyper metabolic nodules, and were all mixed GGN type nodules with a diameter >1 cm. The PET-CT examination of the remaining 12 patients demonstrated no evidence of metabolic abnormalities and the nodules in these patients were pure or mixed GGN with a diameter <1 cm (except 2 cases with a diameter ≥1 cm). Furthermore, the diagnoses for all patients were pathologically confirmed by CT-guided needle biopsy or thoracoscopic surgical resection. Amongst them, there were 41 cases of lung adenocarcinoma, 4 cases of fungal infection, 7 cases of inflammation and 2 cases of adenomatoid hyperplasia. Additionally, PET-CT has a lower detection rate for smaller GGN exhibits no clear advantage for pure GGN, but has a higher detection rate for larger GGN. In conclusion, to a certain extent, PET-CT makes up for the shortcomings of traditional imaging and has some clinical value for the diagnosis of GGN.

  18. Effect of Scanning and Reconstruction Parameters on Three Dimensional Volume and CT Value Measurement of Pulmonary Nodules: A Phantom Study

    Directory of Open Access Journals (Sweden)

    Datong SU

    2017-08-01

    Full Text Available Background and objective The computed tomography (CT follow-up of indeterminate pulmonary nodules aiming to evaluate the change of the volume and CT value is the common strategy in clinic. The CT dose needs to considered on serious CT scans in addition to the measurement accuracy. The purpose of this study is to quantify the precision of pulmonary nodule volumetric measurement and CT value measurement with various tube currents and reconstruction algorithms in a phantom study with dual-energy CT. Methods A chest phantom containing 9 artificial spherical solid nodules with known diameter (D=2.5 mm, 5 mm, 10 mm and density (-100 HU, 60 HU and 100 HU was scanned using a 64-row detector CT canner at 120 Kilovolt & various currents (10 mA, 20 mA, 50 mA, 80 mA,100 mA, 150 mA and 350 mA. Raw data were reconstructed with filtered back projection and three levels of adaptive statistical iterative reconstruction algorithm (FBP, ASIR; 30%, 50% and 80%. Automatic volumetric measurements were performed using commercially available software. The relative volume error (RVE and the absolute attenuation error (AAE between the software measures and the reference-standard were calculated. Analyses of the variance were performed to evaluate the effect of reconstruction methods, different scan parameters, nodule size and attenuation on the RPE. Results The software substantially overestimated the very small (D=2.5 mm nodule's volume [mean RVE: (100.8%±28%] and underestimated it attenuation [mean AAE: (-756±80 HU]. The mean RVEs of nodule with diameter as 5 mm and 10 mm were small [(-0.9%±1.1% vs (0.9%±1.4%], however, the mean AAEs [(-243±26 HU vs (-129±7 HU] were large. The ANOVA analysis for repeated measurements showed that different tube current and reconstruction algorithm had no significant effect on the volumetric measurements for nodules with diameter of 5 mm and 10 mm (F=5.60, P=0.10 vs F=11.13, P=0.08, but significant effects on the measurement of CT

  19. Influence of radiation dose and iterative reconstruction algorithms for measurement accuracy and reproducibility of pulmonary nodule volumetry: A phantom study

    International Nuclear Information System (INIS)

    Kim, Hyungjin; Park, Chang Min; Song, Yong Sub; Lee, Sang Min; Goo, Jin Mo

    2014-01-01

    Purpose: To evaluate the influence of radiation dose settings and reconstruction algorithms on the measurement accuracy and reproducibility of semi-automated pulmonary nodule volumetry. Materials and methods: CT scans were performed on a chest phantom containing various nodules (10 and 12 mm; +100, −630 and −800 HU) at 120 kVp with tube current–time settings of 10, 20, 50, and 100 mAs. Each CT was reconstructed using filtered back projection (FBP), iDose 4 and iterative model reconstruction (IMR). Semi-automated volumetry was performed by two radiologists using commercial volumetry software for nodules at each CT dataset. Noise, contrast-to-noise ratio and signal-to-noise ratio of CT images were also obtained. The absolute percentage measurement errors and differences were then calculated for volume and mass. The influence of radiation dose and reconstruction algorithm on measurement accuracy, reproducibility and objective image quality metrics was analyzed using generalized estimating equations. Results: Measurement accuracy and reproducibility of nodule volume and mass were not significantly associated with CT radiation dose settings or reconstruction algorithms (p > 0.05). Objective image quality metrics of CT images were superior in IMR than in FBP or iDose 4 at all radiation dose settings (p < 0.05). Conclusion: Semi-automated nodule volumetry can be applied to low- or ultralow-dose chest CT with usage of a novel iterative reconstruction algorithm without losing measurement accuracy and reproducibility

  20. Electromagnetic Navigational Bronchoscopy versus CT-guided Percutaneous Sampling of Peripheral Indeterminate Pulmonary Nodules: A Cohort Study.

    Science.gov (United States)

    Bhatt, Kavita M; Tandon, Yasmeen K; Graham, Ruffin; Lau, Charles T; Lempel, Jason K; Azok, Joseph T; Mazzone, Peter J; Schneider, Erika; Obuchowski, Nancy A; Bolen, Michael A

    2018-03-01

    Purpose To compare the diagnostic yield and complication rates of electromagnetic navigational bronchoscopic (ENB)-guided and computed tomography (CT)-guided percutaneous tissue sampling of lung nodules. Materials and Methods Retrospectively identified were 149 patients sampled percutaneously with CT guidance and 146 patients who underwent ENB with transbronchial biopsy of a lung lesion between 2013 and 2015. Clinical data, incidence of complications, and nodule pathologic analyses were assessed through electronic medical record review. Lung nodule characteristics were reviewed through direct image analysis. Molecular marker studies and pathologic analyses from surgical excision were reviewed when available. Multiple-variable logistic regression models were built to compare the diagnostic yield and complication rates for each method and for different patient and disease characteristics. Results CT-guided sampling was more likely to be diagnostic than ENB-guided biopsy (86.0% [129 of 150] vs 66.0% [99 of 150], respectively), and this difference remained significant even after adjustments were made for patient and nodule characteristics (P guided sampling (P guided sampling, 88.9% [32 of 36]; CT-guided sampling, 82.0% [41 of 50]). The two groups had similar rates of major complications (symptomatic hemorrhage, P > .999; pneumothorax requiring chest tube and/or admission, P = .417). Conclusion CT-guided transthoracic biopsy provided higher diagnostic yield in the assessment of peripheral pulmonary nodules than navigational bronchoscopy with a similar rate of clinically relevant complications. © RSNA, 2017 Online supplemental material is available for this article.

  1. Designing a new CAD system for pulmonary nodule detection in High Resolution Computed Tomography (HRCT images

    Directory of Open Access Journals (Sweden)

    Parsa Hosseini M

    2012-07-01

    Conclusion: Considering the complexity and different shapes of lung nodules and large number of CT images to evaluate, finding lung nodules are difficult and time consuming for physicians and include human error. Experimental results showed the accuracy of the proposed method to be appropriate (P<0.05 for lung nodule detection.

  2. Towards automatic pulmonary nodule management in lung cancer screening with deep learning

    Science.gov (United States)

    Ciompi, Francesco; Chung, Kaman; van Riel, Sarah J.; Setio, Arnaud Arindra Adiyoso; Gerke, Paul K.; Jacobs, Colin; Th. Scholten, Ernst; Schaefer-Prokop, Cornelia; Wille, Mathilde M. W.; Marchianò, Alfonso; Pastorino, Ugo; Prokop, Mathias; van Ginneken, Bram

    2017-04-01

    The introduction of lung cancer screening programs will produce an unprecedented amount of chest CT scans in the near future, which radiologists will have to read in order to decide on a patient follow-up strategy. According to the current guidelines, the workup of screen-detected nodules strongly relies on nodule size and nodule type. In this paper, we present a deep learning system based on multi-stream multi-scale convolutional networks, which automatically classifies all nodule types relevant for nodule workup. The system processes raw CT data containing a nodule without the need for any additional information such as nodule segmentation or nodule size and learns a representation of 3D data by analyzing an arbitrary number of 2D views of a given nodule. The deep learning system was trained with data from the Italian MILD screening trial and validated on an independent set of data from the Danish DLCST screening trial. We analyze the advantage of processing nodules at multiple scales with a multi-stream convolutional network architecture, and we show that the proposed deep learning system achieves performance at classifying nodule type that surpasses the one of classical machine learning approaches and is within the inter-observer variability among four experienced human observers.

  3. Towards automatic pulmonary nodule management in lung cancer screening with deep learning.

    Science.gov (United States)

    Ciompi, Francesco; Chung, Kaman; van Riel, Sarah J; Setio, Arnaud Arindra Adiyoso; Gerke, Paul K; Jacobs, Colin; Scholten, Ernst Th; Schaefer-Prokop, Cornelia; Wille, Mathilde M W; Marchianò, Alfonso; Pastorino, Ugo; Prokop, Mathias; van Ginneken, Bram

    2017-04-19

    The introduction of lung cancer screening programs will produce an unprecedented amount of chest CT scans in the near future, which radiologists will have to read in order to decide on a patient follow-up strategy. According to the current guidelines, the workup of screen-detected nodules strongly relies on nodule size and nodule type. In this paper, we present a deep learning system based on multi-stream multi-scale convolutional networks, which automatically classifies all nodule types relevant for nodule workup. The system processes raw CT data containing a nodule without the need for any additional information such as nodule segmentation or nodule size and learns a representation of 3D data by analyzing an arbitrary number of 2D views of a given nodule. The deep learning system was trained with data from the Italian MILD screening trial and validated on an independent set of data from the Danish DLCST screening trial. We analyze the advantage of processing nodules at multiple scales with a multi-stream convolutional network architecture, and we show that the proposed deep learning system achieves performance at classifying nodule type that surpasses the one of classical machine learning approaches and is within the inter-observer variability among four experienced human observers.

  4. Initial development of a computer-aided diagnosis tool for solitary pulmonary nodules

    Science.gov (United States)

    Catarious, David M., Jr.; Baydush, Alan H.; Floyd, Carey E., Jr.

    2001-07-01

    This paper describes the development of a computer-aided diagnosis (CAD) tool for solitary pulmonary nodules. This CAD tool is built upon physically meaningful features that were selected because of their relevance to shape and texture. These features included a modified version of the Hotelling statistic (HS), a channelized HS, three measures of fractal properties, two measures of spicularity, and three manually measured shape features. These features were measured from a difficult database consisting of 237 regions of interest (ROIs) extracted from digitized chest radiographs. The center of each 256x256 pixel ROI contained a suspicious lesion which was sent to follow-up by a radiologist and whose nature was later clinically determined. Linear discriminant analysis (LDA) was used to search the feature space via sequential forward search using percentage correct as the performance metric. An optimized feature subset, selected for the highest accuracy, was then fed into a three layer artificial neural network (ANN). The ANN's performance was assessed by receiver operating characteristic (ROC) analysis. A leave-one-out testing/training methodology was employed for the ROC analysis. The performance of this system is competitive with that of three radiologists on the same database.

  5. Solitary pulmonary nodules: cost-savings indicated by Australian experience with FDG-PET

    International Nuclear Information System (INIS)

    Keith, C.J.; Miles, K.A.; Pitman, A.G.; Hicks, R.J.

    2002-01-01

    Full text: To date, decision tree analyses demonstrating the cost-effectiveness of PET in Australia have been constrained by the need to use overseas values for diagnostic performance and disease prevalence. This study uses Australian PET experience to estimate the cost-savings produced by incorporation of FDG-PET into diagnostic algorithms for characterisation of solitary pulmonary nodules (SPNs). Values for disease prevalence and diagnostic accuracy of PET from a combined series of 89 SPNs from the Wesley Hospital and Peter MacCallum Cancer Institute were applied to two previously published decision tree models. Procedure costs were derived from the Medicare Benefits Schedule and DRG Cost Weights for Australian public hospitals. A cost of $1200 was assigned to PET. Sensitivity analyses evaluated the effect of disease prevalence and PET cost on the cost savings produced by each strategy. The values for disease prevalence (0.54), PET sensitivity (92%) and specificity (95%) from the combined series indicated cost savings per patient of $774 and $554 for the two decision trees. PET would remain cost-saving for values of prevalence up to 0.90 and 0.76, and PET costs of $1974 and $1967, for each model respectively. FDG-PET evaluation of SPNs would produce cost-savings within Australia even with substantial variations in disease prevalence and PET costs. Copyright (2002) Blackwell Science Pty Ltd

  6. Lung Cancer: Screening and Evaluation of Patients With Solitary Pulmonary Nodules.

    Science.gov (United States)

    Mott, Timothy F

    2018-01-01

    Low-dose computed tomography (CT) scan is the only modality currently considered acceptable for lung cancer screening in high-risk populations. Screening recommendations vary. The US Preventive Services Task Force recommends annual low-dose CT scan to screen high-risk patients (ie, asymptomatic patients ages 55 to 80 years with a 30 pack-year smoking history and who currently smoke or have quit within the previous 15 years). The American Academy of Family Physicians recommends a shared decision-making discussion between the clinician and patient regarding the benefits and potential harms of screening. Medicare covers lung cancer screening to age 77 years as part of a shared decision-making visit and when offered in conjunction with smoking cessation. Approximately 320 high-risk patients who smoke need to be screened annually over 3 years to prevent 1 death from lung cancer. The false-positive rate is 96%. Solitary pulmonary nodules or masses identified on screening or incidentally on other imaging should be managed based on appearance and size and the clinical risk factors of the patient, in accordance with guidelines. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  7. Computed Tomography-Guided Methylene Blue Labeling Prior to Thoracoscopic Resection of Small Deeply Placed Pulmonary Nodules. Do We Really Need Palpation?

    Science.gov (United States)

    Findik, Gokturk; Demiröz, S Mustafa; Apaydın, Selma Mine Kara; Ertürk, Hakan; Biri, Suzan; Incekara, Funda; Aydogdu, Koray; Kaya, Sadi

    2017-08-01

    Background  Video-assisted thoracic surgery (VATS) is widely used for thoracic surgery operations, and day by day it becomes routine for the excision of undetermined pulmonary nodules. However, it is sometimes hard to reach millimetric nodules through a VATS incision. Therefore, some additional techniques were developed to reach such nodules little in size and which are settled on a challenging localization. In the literature, coils, hook wires, methylene blue, lipidol, and barium staining, and also ultrasound guidance were described for this aim. Herein we discuss our experience with CT-guided methylene blue labeling of small, deeply located pulmonary nodules just before VATS excision. Method  From April 2013 to October 2016, 11 patients with millimetric pulmonary nodules (average 8, 7 mm) were evaluated in our clinic. For all these patients who had strong predisposing factors for malignancy, an 18F-FDG PET-CT scan was also performed. The patients whose nodules were decided to be excised were consulted the radiology clinic. The favorable patients were taken to CT room 2 hours prior to the operation, and CT-guided methylene blue staining were performed under sterile conditions. Results  Mean nodule size of 11 patients was 8.7 mm (6, 2-12). Mean distance from the visceral pleural surface was 12.7 mm (4-29.3). Four of the nodules were located on the left (2 upper lobes, 2 lower lobes), and seven of them were on the right (four lower lobes, two upper lobes, one middle lobe). The maximum standardized uptake values (SUV max) on 18F-FDG PET/CT scan ranged between 0 and 2, 79. Conclusion  CT-guided methylene blue staining of millimetric deeply located pulmonary nodules is a safe and feasible technique that helps surgeon find these undetermined nodules by VATS technique without any need of digital palpation. Georg Thieme Verlag KG Stuttgart · New York.

  8. [Comparison of LCD and CRT monitors for detection of pulmonary nodules and interstitial lung diseases on digital chest radiographs by using receiver operating characteristic analysis].

    Science.gov (United States)

    Ikeda, Ryuji; Katsuragawa, Shigehiko; Shimonobou, Toshiaki; Hiai, Yasuhiro; Hashida, Masahiro; Awai, Kazuo; Yamashita, Yasuyuki; Doi, Kunio

    2006-05-20

    Soft copy reading of digital images has been practiced commonly in the PACS environment. In this study, we compared liquid-crystal display (LCD) and cathode-ray tube (CRT) monitors for detection of pulmonary nodules and interstitial lung diseases on digital chest radiographs by using receiver operating characteristic (ROC) analysis. Digital chest images with a 1000x1000 matrix size and a 8 bit grayscale were displayed on LCD/CRT monitor with 2M pixels in each observer test. Eight and ten radiologists participated in the observer tests for detection of nodules and interstitial diseases, respectively. In each observer test, radiologists marked their confidence levels for diagnosis of pulmonary nodules or interstitial diseases. The detection performance of radiologists was evaluated by ROC analyses. The average Az values (area under the ROC curve) in detecting pulmonary nodules with LCD and CRT monitors were 0.792 and 0.814, respectively. In addition, the average Az values in detecting interstitial diseases with LCD and CRT monitors were 0.951 and 0.953, respectively. There was no statistically significant difference between LCD and CRT for both detection of pulmonary nodules (P=0.522) and interstitial lung diseases (P=0.869). Therefore, we believe that the LCD monitor instead of the CRT monitor can be used for the diagnosis of pulmonary nodules and interstitial lung diseases in digital chest images.

  9. [Three-dimensional Mass Measurement of Subsolid Pulmonary Nodules on Chest CT: Intra and Inter-observer Variability].

    Science.gov (United States)

    Liu, Huiting; Wang, Ying; Feng, Lei; Yu, Tielian

    2015-05-01

    Subsolid pulmonary nodules tend to exhibit considerably slower growth rates than solid lesions, nevertheless, higher malignancy probability. The diagnosis of indeterminate nodules largely depends on the growth evaluation during follow-up. The growth can manifested as an increase in size or the appearance and/or subsequent increase of solid components. The mass reflect the product of volume and density and can be more sensitive in growth evaluation. However, the repeatability needs a further validation. The purpose of this study is to assess the intra and inter-observer variability of mass measurement for subsolid nodules. 80 subsolid nodules in 44 patients were retrospectively enrolled. Both the volume and mass were measured by two radiologists using blind method independently. Intra-observer and inter-observer variability were analyzed and compared by Bland-Altman method intra-class correlation test and Wilcoxon test. Software achieved satisfied segmentation for 92.5% nodules. Of them, 35% underwent manual modification. The 95% limits of agreement for intra-observer variability were -11.5%-10.4% for mass and -8.4%-8.8% for volume. The 95% limits of agreement for inter-observer variability were -17.4%-19.3% for mass and -17.9%-19.4% for volume.The intra-class correlation foefficients between volume and mass measument was 0.95 and 0.93 (both Psegmentation caused the worse mass measurement repeatability in spite of the reader satisfaction. The repeatability of mass measurement has no significant difference with that of volume measurement and may act as a reliable method in the follow-up of subsolid nodules.

  10. Three-dimensional Mass Measurement of Subsolid Pulmonary Nodules on Chest CT: Intra and Inter-observer Variability

    Directory of Open Access Journals (Sweden)

    Huiting LIU

    2015-05-01

    Full Text Available Background and objective Subsolid pulmonary nodules tend to exhibit considerably slower growth rates than solid lesions, nevertheless, higher malignancy probability. The diagnosis of indeterminate nodules largely depends on the growth evaluation during follow-up. The growth can manifested as an increase in size or the appearance and/or subsequent increase of solid components. The mass reflect the product of volume and density and can be more sensitive in growth evaluation. However, the repeatability needs a further validation. The purpose of this study is to assess the intra and inter-observer variability of mass measurement for subsolid nodules. Methods 80 subsolid nodules in 44 patients were retrospectively enrolled. Both the volume and mass were measured by two radiologists using blind method independently. Intra-observer and inter-observer variability were analyzed and compared by Bland-Altman method intra-class correlation test and Wilcoxon test. Results Software achieved satisfied segmentation for 92.5% nodules. Of them, 35% underwent manual modification. The 95% limits of agreement for intra-observer variability were -11.5%-10.4% for mass and -8.4%-8.8% for volume. The 95% limits of agreement for inter-observer variability were -17.4%-19.3% for mass and -17.9%-19.4% for volume.The intra-class correlation foefficients between volume and mass measument was 0.95 and 0.93 (both P<0.001 and no significant differences (P=0.78, 0.09 was found for intra- and inter-observer variability. Manual modification of the segmentation caused the worse mass measurement repeatability in spite of the reader satisfaction. Conclusion The repeatability of mass measurement has no significant difference with that of volume measurement and may act as a reliable method in the follow-up of subsolid nodules.

  11. Computer-aided diagnosis for classifying benign versus malignant thyroid nodules based on ultrasound images: A comparison with radiologist-based assessments

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    Chang, Yongjun [School of Electrical Engineering, Korea Advanced Institute of Science and Technology, 291, Daehak-ro, Yuseong-gu, Daejeon 34141 (Korea, Republic of); Paul, Anjan Kumar [Funzin, Inc., 148 Ankuk-dong, Jongro-gu, Seoul 03060 (Korea, Republic of); Kim, Namkug, E-mail: namkugkim@gmail.com; Baek, Jung Hwan; Choi, Young Jun [Department of Radiology, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul 05505 (Korea, Republic of); Ha, Eun Ju [Department of Radiology, Ajou University School of Medicine, Wonchon-Dong, Yeongtong-Gu, Suwon 16499 (Korea, Republic of); Lee, Kang Dae; Lee, Hyoung Shin [Department of Otolaryngology Head and Neck Surgery, Kosin University College of Medicine, 34 Amnamdong, Seu-Gu, Busan 49267 (Korea, Republic of); Shin, DaeSeock; Kim, Nakyoung [MIDAS Information Technology, Pangyo-ro 228, Bundang-gu, Seongnam-si, Gyeonggi 13487 (Korea, Republic of)

    2016-01-15

    Purpose: To develop a semiautomated computer-aided diagnosis (CAD) system for thyroid cancer using two-dimensional ultrasound images that can be used to yield a second opinion in the clinic to differentiate malignant and benign lesions. Methods: A total of 118 ultrasound images that included axial and longitudinal images from patients with biopsy-confirmed malignant (n = 30) and benign (n = 29) nodules were collected. Thyroid CAD software was developed to extract quantitative features from these images based on thyroid nodule segmentation in which adaptive diffusion flow for active contours was used. Various features, including histogram, intensity differences, elliptical fit, gray-level co-occurrence matrixes, and gray-level run-length matrixes, were evaluated for each region imaged. Based on these imaging features, a support vector machine (SVM) classifier was used to differentiate benign and malignant nodules. Leave-one-out cross-validation with sequential forward feature selection was performed to evaluate the overall accuracy of this method. Additionally, analyses with contingency tables and receiver operating characteristic (ROC) curves were performed to compare the performance of CAD with visual inspection by expert radiologists based on established gold standards. Results: Most univariate features for this proposed CAD system attained accuracies that ranged from 78.0% to 83.1%. When optimal SVM parameters that were established using a grid search method with features that radiologists use for visual inspection were employed, the authors could attain rates of accuracy that ranged from 72.9% to 84.7%. Using leave-one-out cross-validation results in a multivariate analysis of various features, the highest accuracy achieved using the proposed CAD system was 98.3%, whereas visual inspection by radiologists reached 94.9% accuracy. To obtain the highest accuracies, “axial ratio” and “max probability” in axial images were most frequently included in the

  12. Influence of the in-plane artefact in chest tomosynthesis on pulmonary nodule size measurements

    International Nuclear Information System (INIS)

    Soederman, Christina; Allansdotter Johnsson, Aase; Vikgren, Jenny; Rossi Norrlund, Rauni; Molnar, David; Svalkvist, Angelica; Maansson, Lars Gunnar; Baath, Magnus

    2016-01-01

    The aim of the present study was to investigate how the in-plane artefact present in the scan direction around structures in tomosynthesis images should be managed when measuring the size of nodules in chest tomosynthesis images in order to achieve acceptable measurement accuracy. Data from measurements, performed by radiologists, of the longest diameter of artificial nodules inserted in chest tomosynthesis images were used. The association between the measurement error and the direction of the longest nodule diameter, relative to the scan direction, was evaluated using the Kendall rank correlation coefficient. All of the radiologists had chosen to not include the artefact in the measurements. Significant association between measurement error and the direction of the longest diameter was found for nodules larger than 12 mm, which indicates that, for these nodules, there is a risk of underestimating the nodule size if the in-plane artefact is omitted from manual diameter measurements. (authors)

  13. CT fluoroscopy guided transpleural cutting needle biopsy of small ({<=}2.5 cm) subpleural pulmonary nodules

    Energy Technology Data Exchange (ETDEWEB)

    Prosch, Helmut; Oschatz, Elisabeth; Eisenhuber, Edith; Wohlschlager, Helmut [Otto Wagner Hospital, Department of Radiology, Sanatoriumsstrasse 2, 1140 Vienna (Austria); Mostbeck, Gerhard H., E-mail: gerhard.mostbeck@wienkav.at [Otto Wagner Hospital, Department of Radiology, Sanatoriumsstrasse 2, 1140 Vienna (Austria)

    2011-01-15

    Purpose: Small subpleural pulmonary lesions are difficult to biopsy. While the direct, short needle path has been reported to have a lower rate of pneumothorax, the indirect path provides a higher diagnostic yield. Therefore, we tried to optimize the needle pathway and minimize the iatrogenic pneumothorax risk by evaluating a CT fluoroscopy guided direct approach to biopsy subpleural lesions. Material and methods: Between 01/2005 and 01/2007, CT fluoroscopy guided core biopsies were performed in 24 patients. Using our technique, the tip of the guide needle remains outside the visceral pleura (17 G coaxial guide needle, 18 G Biopsy-gun, 15 or 22 mm needle path). The position of the lesion relative to the needle tip can be optimized using CT fluoroscopy by adjusting the breathing position of the patient. The Biopty gun is fired with the needle tip still outside the pleural space. Cytological smears are analyzed by a cytopathologist on-site, and biopsies are repeated as indicated with the coaxial needle still outside the pleura. Results: Median nodule size was 1.6 cm (0.7-2.3 cm). A definitive diagnosis was obtained in 22 patients by histology and/or cytology. In one patient, only necrotic material could be obtained. In another patient, the intervention had to be aborted as the dyspnoic patient could not follow breathing instructions. An asymptomatic pneumothorax was present in seven patients; chest tube placement was not required. Conclusion: The presented biopsy approach has a high diagnostic yield and is especially advantageous for biopsies of small subpleural lesions in the lower lobes.

  14. Spontaneous regression of multiple pulmonary metastatic nodules of hepatocarcinoma: a case report

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    Bahk, Yong Whee; Park, Seog Hee; Kim, Sun Moo [St. Mary' s Hospital, Catholic Medical College, Seoul (Korea, Republic of)

    1981-09-15

    Although are spontaneous regression of either primary or metastatic malignant tumor in the absence of or inadequate therapy has been well documented. Since the earliest day of this century various malignant tumors have been reported to spontaneously disappear or to be arrested of their growth, but the cases of hepatocarcinoma has been very rare. From the literature, we were able to find out 5 previously reported cases of hepatocarcinoma which showed spontaneous regression at the primary site. Recently we have seen a case of multiple pulmonary metastatic nodules of hepatocarcinoma which completely regressed spontaneously and this forms the basis of the present case report. The patient was 55-year-old male admitted to St. Mary's Hospital, Catholic Medical College because of a hard palpable mass in the epigastrium on April 26, 1978. The admission PA chest roentgenogram revealed multiple small nodular densities scattered throughout both lung field especially in lower zones and toward the peripheral portion. A hepatoscintigram revealed a large cold area involving the left lobe and inermediate zone of the liver. Alfa-fetoprotein and hepatitis B serum antigen test were positive whereas many other standard liver function tests turned out to be negative. A needle biopsy of the tumor revealed well differentiated hepatocellular carcinoma. The patient was put under chemotherapy which consisted of 5 FU 500 mg intravenously for 6 days from April 28 to May 3, 1978. The patient was discharged after this single course of 5 FU treatment and was on a herb medicine, the nature and quantity of which obscure. No other specific treatment was given. The second admission took place on Dec. 3, 1980 because of irregularity in bowel habits and dyspepsia. A follow up PA chest roentgenogram obtained on the second admission revealed complete disappearance of previously noted multiple pulmonary nodular lesions (Fig. 3). Follow up liver scan revealed persistence of the cold area in the left

  15. Observer training for computer-aided detection of pulmonary nodules in chest radiography

    NARCIS (Netherlands)

    De Boo, D.W.; van Hoorn, F.; van Schuppen, J.; Schijf, L.; Scheerder, M.J.; Freling, N.J.; Mets, O.; Weber, M.; Schaefer-Prokop, C.M.

    2012-01-01

    To assess whether short-term feedback helps readers to increase their performance using computer-aided detection (CAD) for nodule detection in chest radiography.The 140 CXRs (56 with a solitary CT-proven nodules and 84 negative controls) were divided into four subsets of 35; each were read in a

  16. Observer training for computer-aided detection of pulmonary nodules in chest radiography

    NARCIS (Netherlands)

    de Boo, Diederick W.; van Hoorn, François; van Schuppen, Joost; Schijf, Laura; Scheerder, Maeke J.; Freling, Nicole J.; Mets, Onno; Weber, Michael; Schaefer-Prokop, Cornelia M.

    2012-01-01

    To assess whether short-term feedback helps readers to increase their performance using computer-aided detection (CAD) for nodule detection in chest radiography. The 140 CXRs (56 with a solitary CT-proven nodules and 84 negative controls) were divided into four subsets of 35; each were read in a

  17. Pulmonary Nodule Classification with Deep Convolutional Neural Networks on Computed Tomography Images.

    Science.gov (United States)

    Li, Wei; Cao, Peng; Zhao, Dazhe; Wang, Junbo

    2016-01-01

    Computer aided detection (CAD) systems can assist radiologists by offering a second opinion on early diagnosis of lung cancer. Classification and feature representation play critical roles in false-positive reduction (FPR) in lung nodule CAD. We design a deep convolutional neural networks method for nodule classification, which has an advantage of autolearning representation and strong generalization ability. A specified network structure for nodule images is proposed to solve the recognition of three types of nodules, that is, solid, semisolid, and ground glass opacity (GGO). Deep convolutional neural networks are trained by 62,492 regions-of-interest (ROIs) samples including 40,772 nodules and 21,720 nonnodules from the Lung Image Database Consortium (LIDC) database. Experimental results demonstrate the effectiveness of the proposed method in terms of sensitivity and overall accuracy and that it consistently outperforms the competing methods.

  18. Additional value of FDG PET/CT to contrast-enhanced CT in the differentiation between benign and malignant intraductal papillary mucinous neoplasms of the pancreas with mural nodules

    International Nuclear Information System (INIS)

    Takanami, Kentaro; Hiraide, Tomomichi; Tsuda, Masashi; Nakamura, Yausuhiro; Kaneta, Tomohiro; Takase, Kei; Takahashi, Shoki; Fukuda, Hiroshi

    2011-01-01

    This study aimed at determining the additional value of F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT to contrast-enhanced CT in the differentiation between benign and malignant intraductal papillary mucinous neoplasms (IPMNs) of the pancreas with mural nodules. This retrospective review of medical records was approved by our institutional review board. The preoperative PET/CT images of 16 non-diabetic patients with surgically proven IPMN, where mural nodules of 3 mm or larger were shown by preoperative contrast-enhanced CT, were retrospectively evaluated. The 16 patients were divided into two groups: 7 patients with benign IPMN [adenoma (n=1) and borderline tumor (n=6)] and 9 patients with malignant IPMN [carcinoma in situ (CIS) (n=8) and invasive carcinoma (n=1)]. Nuclear medicine physician blinded to the pathologic assessment of malignancy of IPMN set a spherical volume of interest (VOI) over the mural nodules on PET/CT images and recorded the peak standardized uptake value (SUV max ) in the VOI, referring the contrast-enhanced CT images. Statistical differences in the size of mural nodule, the diameter of main pancreatic duct (MPD), and SUV max of the tumors between benign IPMNs and malignant IPMNs were compared using the Mann-Whitney U test. Statistical significance was set at p max of the malignant IPMNs with mural nodules of 3 mm or larger was higher than that of benign IPMNs (2.7±0.6 vs. 1.9±0.3, p<0.01). Meanwhile, there was no significant difference in mural nodule diameter and MPD diameter between the two groups. FDG PET/CT showed an excellent diagnostic accuracy for the differentiation between malignant and benign IPMNs with mural nodules: the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in malignant IPMN with mural nodule of FDG PET/CT were 77.8, 100, 100, 77.8, and 87.5 for the cutoff value of 2.3; and 100, 57.1, 75.0, 100, and 81.3 for the cutoff value of 2

  19. Prospective evaluation of multiparametric ultrasound and quantitative elastosonography in the differential diagnosis of benign and malignant thyroid nodules: Preliminary experience

    Energy Technology Data Exchange (ETDEWEB)

    Cantisani, Vito, E-mail: vito.cantisani@uniroma1.it [Department of Radiology, Oncology, and Anatomy Pathology, University “La Sapienza”, Policlinico Umberto I, Rome, Itlay (Italy); D’Andrea, Vito [Department of Surgical Sciences, University “La Sapienza”, Rome (Italy); Biancari, Fausto [Department of Surgery, Oulu University Hospital, Oulu (Finland); Medvedyeva, Olena; Di Segni, Mattia; Olive, Matteo [Department of Radiology, Oncology, and Anatomy Pathology, University “La Sapienza”, Policlinico Umberto I, Rome, Itlay (Italy); Patrizi, Gregorio; Redler, Adriano; De Antoni E, Enrico [Department of Surgical Sciences, University “La Sapienza”, Rome (Italy); Masciangelo, Raffaele [Department of Hygiene and Infectious Disease, University “La Sapienza”, Rome (Italy); Frezzotti, Francesca [Department of Surgical Sciences, University “La Sapienza”, Rome (Italy); Ricci, Paolo [Department of Radiology, Oncology, and Anatomy Pathology, University “La Sapienza”, Policlinico Umberto I, Rome, Itlay (Italy)

    2012-10-15

    Purpose: To assess the clinical value of quantitative elastosonography compared with multiparametric ultrasound in differentiating the nature of thyroid nodules. Methods and materials: Ninety-seven consecutive patients (32 males, 65 females, mean age, 54 years, range 20–81 years) with thyroid nodules previously detected at color-Doppler ultrasound (CDUS), were prospectively examined with elastosonography with dedicated quantitative software (Elasto-Q, Toshiba) before surgery. Ultrasound examination and elastosonography were evaluated by two investigators in consensus. US features, color-Doppler pattern, and strain ratio value were evaluated. Sensitivity and specificity of CDUS and sono-elastography were compared using X{sup 2} test and ROC curves. Results: Sensitivity and specificity of hypoechogenicity, irregular margins or suspicious halo features, CDUS blood flow pattern, and strain ratio in the diagnosis of malignant nodules were 56.8%, 62.2%, 54.1% and 97.3% and 71.7%, 93.3%, 28.3%, and 91.7%, respectively. Elastosonography was more sensitive and specific than all ultrasonographic features in predicting malignancy of the thyroid nodules (p < 0.0001). According to elastosonographic features the lesions characterized by strain ratio ≥2 were highly likely to be of malignant nature (p < 0.0001, O.R. 396, 95%, CI: 44–3530). Conclusions: The results of the present study suggest that elastosonography with Q system is a valuable tool in the characterization of thyroid nodules and it seems to be far more accurate than CDUS. These findings as well as those of previous studies support its use in selecting patients who are candidates for surgery.

  20. Probability of Cancer in Pulmonary Nodules Detected on First Screening CT

    Science.gov (United States)

    McWilliams, Annette; Tammemagi, Martin C.; Mayo, John R.; Roberts, Heidi; Liu, Geoffrey; Soghrati, Kam; Yasufuku, Kazuhiro; Martel, Simon; Laberge, Francis; Gingras, Michel; Atkar-Khattra, Sukhinder; Berg, Christine D.; Evans, Ken; Finley, Richard; Yee, John; English, John; Nasute, Paola; Goffin, John; Puksa, Serge; Stewart, Lori; Tsai, Scott; Johnston, Michael R.; Manos, Daria; Nicholas, Garth; Goss, Glenwood D.; Seely, Jean M.; Amjadi, Kayvan; Tremblay, Alain; Burrowes, Paul; MacEachern, Paul; Bhatia, Rick; Tsao, Ming-Sound; Lam, Stephen

    2013-01-01

    BACKGROUND Major issues in the implementation of screening for lung cancer by means of low-dose computed tomography (CT) are the definition of a positive result and the management of lung nodules detected on the scans. We conducted a population-based prospective study to determine factors predicting the probability that lung nodules detected on the first screening low-dose CT scans are malignant or will be found to be malignant on follow-up. METHODS We analyzed data from two cohorts of participants undergoing low-dose CT screening. The development data set included participants in the Pan-Canadian Early Detection of Lung Cancer Study (PanCan). The validation data set included participants involved in chemoprevention trials at the British Columbia Cancer Agency (BCCA), sponsored by the U.S. National Cancer Institute. The final outcomes of all nodules of any size that were detected on baseline low-dose CT scans were tracked. Parsimonious and fuller multivariable logistic-regression models were prepared to estimate the probability of lung cancer. RESULTS In the PanCan data set, 1871 persons had 7008 nodules, of which 102 were malignant, and in the BCCA data set, 1090 persons had 5021 nodules, of which 42 were malignant. Among persons with nodules, the rates of cancer in the two data sets were 5.5% and 3.7%, respectively. Predictors of cancer in the model included older age, female sex, family history of lung cancer, emphysema, larger nodule size, location of the nodule in the upper lobe, part-solid nodule type, lower nodule count, and spiculation. Our final parsimonious and full models showed excellent discrimination and calibration, with areas under the receiver-operating-characteristic curve of more than 0.90, even for nodules that were 10 mm or smaller in the validation set. CONCLUSIONS Predictive tools based on patient and nodule characteristics can be used to accurately estimate the probability that lung nodules detected on baseline screening low-dose CT scans

  1. Automatic detection of solitary pulmonary nodules using swarm intelligence optimized neural networks on CT images

    Directory of Open Access Journals (Sweden)

    Ezhil E. Nithila

    2017-06-01

    Full Text Available Lung Cancer is one of the most dangerous diseases that cause a large number of deaths. Early detection and analysis will be the only remedy. Computer-Aided Diagnosis (CAD plays a key role in the early detection and diagnosis of lung cancer. This paper develops a CAD system that focus on new heuristic search algorithm to optimize the Back Propagation Neural Network (BPNN in characterizing nodule from non-nodules. The proposed CAD system consists of four main stages: (i image acquisition (ii lesion detection, (iii texture feature extraction and (iv tumor characterization using a classifier. The optimization mechanism employs Particle Swarm Optimization (PSO with new inertia weight for NN in order to investigate the classification rate of these algorithms in reducing the problems of trapping in local minima and the slow convergence rate of current evolutionary learning algorithms. The experiments were conducted on CT images to classify into nodule and non-nodule from the tumor region of interest. The performance of the CAD system was evaluated for the texture characterized images taken from LIDC-IDRI and SPIE-AAPM databases. Due to improved inertia weight used in Particle Swarm (PS the CAD achieves highest classification accuracy of 98% for solid nodules, 99.5% for part solid nodules and 97.2% for non solid nodules respectively. The experimental results suggest that the developed CAD system has great potential and promise in the automatic diagnosis of tumors of lung.

  2. Effect of slab thickness on the CT detection of pulmonary nodules: use of sliding thin-slab maximum intensity projection and volume rendering.

    Science.gov (United States)

    Kawel, Nadine; Seifert, Burkhardt; Luetolf, Marcus; Boehm, Thomas

    2009-05-01

    The objective of this study was to evaluate the detection rates of pulmonary nodules on CT as a function of slab thickness using sliding thin-slab maximum intensity projection (MIP) and volume rendering (VR). Eighty-eight oncology patients (33 women, 55 men; mean age, 59 years; age range, 18-81 years) who routinely underwent chest CT examinations were prospectively included. Two radiologists independently evaluated each CT examination for the presence of pulmonary nodules using MIP and VR, with each image reconstructed using three different slab thicknesses (5, 8, 11 mm). The standard of reference was the maximum number of detected nodules, which were classified by localization and size, judged to be true-positives by a consensus panel. Interreader agreement was assessed by kappa value on a nodule-by-nodule basis. Sensitivities for both reconstruction techniques and for the three slab thicknesses were calculated using the proportion procedure for survey data with the patient as the primary sample unit and were compared using the Wilcoxon's signed rank test with Bonferroni correction for both readers separately. One thousand fifty-eight true-positive nodules were detected. Interreader agreement was fair to moderate. Sensitivity for pulmonary nodules was superior for 8-mm MIP (reader 1, 84%; reader 2, 81%) and was significantly better than the sensitivities of all other tested techniques for both readers (p 8 mm). A higher sensitivity was achieved using MIP than VR. MIP with a slab thickness of 8 mm is superior in the detection of pulmonary nodules to all other tested techniques.

  3. Cloud-Based NoSQL Open Database of Pulmonary Nodules for Computer-Aided Lung Cancer Diagnosis and Reproducible Research.

    Science.gov (United States)

    Ferreira Junior, José Raniery; Oliveira, Marcelo Costa; de Azevedo-Marques, Paulo Mazzoncini

    2016-12-01

    Lung cancer is the leading cause of cancer-related deaths in the world, and its main manifestation is pulmonary nodules. Detection and classification of pulmonary nodules are challenging tasks that must be done by qualified specialists, but image interpretation errors make those tasks difficult. In order to aid radiologists on those hard tasks, it is important to integrate the computer-based tools with the lesion detection, pathology diagnosis, and image interpretation processes. However, computer-aided diagnosis research faces the problem of not having enough shared medical reference data for the development, testing, and evaluation of computational methods for diagnosis. In order to minimize this problem, this paper presents a public nonrelational document-oriented cloud-based database of pulmonary nodules characterized by 3D texture attributes, identified by experienced radiologists and classified in nine different subjective characteristics by the same specialists. Our goal with the development of this database is to improve computer-aided lung cancer diagnosis and pulmonary nodule detection and classification research through the deployment of this database in a cloud Database as a Service framework. Pulmonary nodule data was provided by the Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI), image descriptors were acquired by a volumetric texture analysis, and database schema was developed using a document-oriented Not only Structured Query Language (NoSQL) approach. The proposed database is now with 379 exams, 838 nodules, and 8237 images, 4029 of them are CT scans and 4208 manually segmented nodules, and it is allocated in a MongoDB instance on a cloud infrastructure.

  4. Comparison of sensitivity and reading time for the use of computer-aided detection (CAD) of pulmonary nodules at MDCT as concurrent or second reader

    International Nuclear Information System (INIS)

    Beyer, F.; Zierott, L.; Juergens, K.U.; Heindel, W.; Fallenberg, E.M.; Stoeckel, J.; Wormanns, D.

    2007-01-01

    The purpose of this study was to compare sensitivity for detection of pulmonary nodules in MDCT scans and reading time of radiologists when using CAD as the second reader (SR) respectively concurrent reader (CR). Four radiologists analyzed 50 chest MDCT scans chosen from clinical routine two times and marked all detected pulmonary nodules: first with CAD as CR (display of CAD results immediately in the reading session) and later (median 14 weeks) with CAD as SR (display of CAD markers after completion of first reading without CAD). A Siemens LungCAD prototype was used. Sensitivities for detection of nodules and reading times were recorded. Sensitivity of reading with CAD as SR was significantly higher than reading without CAD (p < 0.001) and CAD as CR (p < 0.001). For nodule size of 1.75 mm or above no significant sensitivity difference between CAD as CR and reading without CAD was observed; e.g., for nodules above 4 mm sensitivity was 68% without CAD, 68% with CAD as CR (p 0.45) and 75% with CAD as SR (p < 0.001). Reading time was significantly shorter for CR (274 s) compared to reading without CAD (294 s; p = 0.04) and SR (337 s; p < 0.001). In our study CAD could either speed up reading of chest CT cases for pulmonary nodules without relevant loss of sensitivity when used as CR, or it increased sensitivity at the cost of longer reading times when used as SR. (orig.)

  5. Pulmonary nodule detection in oncological patients - Value of respiratory-triggered, periodically rotated overlapping parallel T2-weighted imaging evaluated with PET/CT-MR.

    Science.gov (United States)

    de Galiza Barbosa, Felipe; Geismar, Jan Henning; Delso, Gaspar; Messerli, Michael; Huellner, Martin; Stolzmann, Paul; Veit-Haibach, Patrick

    2018-01-01

    To prospectively evaluate the detection and conspicuity of pulmonary nodules in an oncological population, using a tri-modality PET/CT-MR protocol including a respiration-gated T2-PROPELLER sequence for possible integration into a simultaneous PET/MR protocol. 149 patients referred for staging of malignancy were prospectively enrolled in this single-center study. Imaging was performed on a tri-modality PET/CT-MR setup and was comprised of PET/CT and 3T-MR imaging with 3D dual-echo GRE pulse sequence (Dixon) and an axial respiration-gated T2-weighted PROPELLER (T2-P) sequence. Images were assessed for presence, conspicuity, size and interpretation of the pulmonary parenchymal nodules. McNemar's test was used to evaluate paired differences in nodule detection rates between MR and CT from PET/CT. The correlation of pulmonary nodule size in CT and MR imaging was assessed using Pearson correlation coefficient. 299 pulmonary nodules were detected on PET/CT. The detectability was significantly higher on T2-P (60%, p10mm were detected equally well with T2-P (92.2%) and CT (p >0.05). In a per-patient analysis, there was no significant change in the clinical interpretation of the nodules detected with T2-P and CT. Despite the overall lower detection rate compared with CT, the free-breathing respiratory gating T2-w sequence showed higher detectability in all evaluated categories compared to breath-hold T1-weighted MR sequences. Specifically, the T2-P was found to be not statistically different from CT in FDG-positive nodules, in detection of nodules >10mm and concerning conspicuity of pulmonary nodules. Overall, the additional time investment into T2-P seems to be justified since clinical relevant assessment of pulmonary lung nodules can mostly be done by T2-P in a whole body PET/MR staging of oncologic patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Correlation of emphysema score with perceived malignancy of pulmonary nodules: a multi-observer study using the LIDC-IDRI CT lung database

    Science.gov (United States)

    Wiemker, Rafael; Bülow, Thomas; Blaffert, Thomas; Dharaiya, Ekta

    2009-02-01

    Presence of emphysema is recognized to be one of the single most significant risk factors in risk models for the prediction of lung cancer. Therefore, an automatically computed emphysema score would be a prime candidate as an additional numerical feature for computer aided diagnosis (CADx) for indeterminate pulmonary nodules. We have applied several histogram-based emphysema scores to 460 thoracic CT scans from the IDRI CT lung image database, and analyzed the emphysema scores in conjunction with 3000 nodule malignancy ratings of 1232 pulmonary nodules made by expert observers. Despite the emphysema being a known risk factor, we have not found any impact on the readers' malignancy rating of nodules found in a patient with higher emphysema score. We have also not found any correlation between the number of expert-detected nodules in a patient and his emphysema score, or the relative craniocaudal location of the nodules and their malignancy rating. The inter-observer agreement of the expert ratings was excellent on nodule diameter (as derived from manual delineations), good for calcification, and only modest for malignancy and shape descriptions such as spiculation, lobulation, margin, etc.

  7. [A case of pulmonary dirofilariasis with a single nodule on an apical lesion of the right upper lobe].

    Science.gov (United States)

    Hijikata, Naoya; Asanuma, Kouzo; Sato, Shintaro; Harasawa, Keiji; Miyaoka, Keisuke; Ishizu, Hideki

    2011-01-01

    A 75-year-old man with chronic gastritis and gastro-esophageal regurgitation syndrome was admitted to our hospital complaining of continuous productive cough, and an abnormal shadow was noted on a chest X-ray film. Chest computed tomography revealed a nodule 2.8 cm in diameter with a regular margin on the right apex. Fiberoptic bronchoscopy was performed, but did not yield a definitive diagnosis. We suspected primary lung cancer, and therefore, lung partial resection was performed under thoracoscopic surgery. The intraoperative pathological findings revealed inflammatory granuloma with necrosis, and pulmonary dirofilariasis was finally diagnosed. Pulmonary dirofilariasis is an important differential diagnosis in elderly patients with a chest abnormal nodular shadow. Lesions have been reportedly observed in the peripheral portion of the right lower lobe in many previous reports. However, in this case, a nodular lesion was noted in the right apex.

  8. Comparison of Bayesian penalized likelihood reconstruction versus OS-EM for characterization of small pulmonary nodules in oncologic PET/CT.

    Science.gov (United States)

    Howard, Brandon A; Morgan, Rustain; Thorpe, Matthew P; Turkington, Timothy G; Oldan, Jorge; James, Olga G; Borges-Neto, Salvador

    2017-10-01

    To determine whether the recently introduced Bayesian penalized likelihood PET reconstruction (Q.Clear) increases the visual conspicuity and SUV max of small pulmonary nodules near the PET resolution limit, relative to ordered subset expectation maximization (OS-EM). In this institutional review board-approved and HIPAA-compliant study, 29 FDG PET/CT scans performed on a five-ring GE Discovery IQ were retrospectively selected for pulmonary nodules described in the radiologist's report as "too small to characterize", or small lung nodules in patients at high risk for lung cancer. Thirty-two pulmonary nodules were assessed, with mean CT diameter of 8 mm (range 2-18). PET images were reconstructed with OS-EM and Q.Clear with noise penalty strength β values of 150, 250, and 350. Lesion visual conspicuity was scored by three readers on a 3-point scale, and lesion SUV max and background liver and blood pool SUV mean and SUV stdev were recorded. Comparison was made by linear mixed model with modified Bonferroni post hoc testing; significance cutoff was p OS-EM at β = 150 (p OS-EM at β = 150 and 250 (p OS-EM reconstruction, but only with low noise penalization. Q.Clear with β = 150 may be advantageous when evaluation of small pulmonary nodules is of primary concern.

  9. Evaluation of an experimental breath-holding image acquisition with regard to pulmonary nodule detection on chest FDG PET image

    International Nuclear Information System (INIS)

    Tsuda, Keisuke; Sasaki, Tatsuya; Nemoto, Kouichi; Fujii, Hirofumi; Iwabuchi, Yuto; Fukushi, Masahiro; Moriyama, Noriyuki

    2010-01-01

    Breath-hold imaging has been performing more frequently to reduce the respiratory motion artifact in chest imaging by means of positron emission tomography (PET) using 2-deoxy-2-[ 18 F]-fluoro-D-glucose (FDG). It is difficult to hold breath for 30 seconds or more. We evaluated an experimental breath-holding image acquisition using phantoms with regard to pulmonary nodule detection on chest FDG PET image to examine whether the total acquisition time could be reduced. Images obtained during 180 seconds of continuous movement were compared with static images recorded during 60-180 seconds (15 seconds x 4, 6, 8, 10, 12 times). Although shorter acquisition times resulted in greater variability in background activity, images recorded under static conditions for 90 seconds (15 seconds x 6 times) or less showed nodules that were smaller than those observable in images recorded during continuous movement for 180 seconds. Breath-holding therefore permits the detection of smaller nodules on chest FDG PET images at shorter acquisition times. (author)

  10. Effect of an Automated Tracking Registry on the Rate of Tracking Failure in Incidental Pulmonary Nodules.

    Science.gov (United States)

    Shelver, Jonathan; Wendt, Chris H; McClure, Melissa; Bell, Brian; Fabbrini, Angela E; Rector, Thomas; Rice, Kathryn

    2017-06-01

    Following incidental lung nodules with interval CT scanning is an accepted method to detect early lung cancer, but delayed tracking or failure to track is reported in up to 40% of patients. Our institution developed and implemented an automated lung nodule registry tracking system. This system uses a code at the time that a suspicious nodule is discovered to populate the registry. Suspicious nodules were defined as any nodule, solid or ground glass, tracking system. The primary outcome was the rate of tracking failure, defined as suspicious nodules that had no follow-up imaging or whose follow-up was delayed when compared with published guidelines. Secondary outcomes were predictors of tracking failure and reasons for tracking failure. After implementation of the registry tracking system in the two VAMCs, we found a significant decrease in tracking failure, from a preimplementation rate of 74% to a postimplementation rate of 10% (P tracking system can be exported to other health care facilities and significantly reduces the rate of tracking failure. Published by Elsevier Inc.

  11. Sequential radiographic changes of nodules in patients with miliary pulmonary tuberculosis

    International Nuclear Information System (INIS)

    Yeon, Jae Woo; Park, Chan Sup; Bae, In Young; Kwak, Seung Min; Cho, Chul Ho; Kwon, Min Joong; Joo, Ji Soen; Chung, Won Kyun

    1998-01-01

    The purpose of this study is to evaluate sequential changes in miliary nodules, as seen on chest radiographs in patients with miliary tuberculosis. We retrospectively analyzed sequential changes in miliary nodules, as seen on the chest radiographs of 13 patients with miliary tuberculosis who recovered completely after antituberculous medication. Two were children and 11 were adults, and their ages ranged from 2 months to 73 years (mean, 38 years). In cases in which miliary tuberculosis had been diagnosed from initial chest radiographs, follow-up chest radiographs were obtained 5 to 15 (mean, 10) months later. After complete resolution of miliary nodules, as seen on chest radiographs, high-resolution CT scanning was performed in three patients. As seen on follow-up chest radiographs obtained at one week, the number and size of miliary nodules had decreased in eight to nine patients (89%), and on those obtained at one month, these decreases were seen in all 13 patients. The mean duration of complete resolution of miliary nodules was 6.3 months; in children, this was 3.5 (range, 2-5) months, and in adults, 6.8 (range, 3-10) months. In all three patients involved, high-resolution CT scans obtained after complete radiographic resolution of miliary nodules showed no recurrence. In patients with miliary tuberculosis, the size and number of nodules had decreased within one month of adequate chemotherapy and on chest radiographs, complete resolution was seen at 6.3 months, on average. (author). 17 refs., 1 tab., 3 figs

  12. The incidental pulmonary nodule in a child. Part 1: recommendations from the SPR Thoracic Imaging Committee regarding characterization, significance and follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Westra, Sjirk J. [Massachusetts General Hospital, Division of Pediatric Radiology, Boston, MA (United States); Brody, Alan S. [Cincinnati Children' s Hospital Medical Center, Department of Radiology (CH-1), Cincinnati, OH (United States); Mahani, Maryam Ghadimi [University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children' s Hospital Department of Radiology, Ann Arbor, MI (United States); Guillerman, R.P. [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States); Hegde, Shilpa V. [Arkansas Children' s Hospital, Department of Radiology, Little Rock, AR (United States); Iyer, Ramesh S. [Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States); Lee, Edward Y. [Boston Children' s Hospital, Department of Pediatric Radiology, Boston, MA (United States); Newman, Beverley [Lucile Packard Children' s Hospital at Stanford University, Department of Radiology, Stanford, CA (United States); Podberesky, Daniel J. [Nemours Children' s Hospital, Department of Radiology, Orlando, FL (United States); Thacker, Paul G. [Medical University of South Carolina, Department of Radiology, Charleston, SC (United States)

    2015-05-01

    No guidelines are in place for the follow-up and management of pulmonary nodules that are incidentally detected on CT in the pediatric population. The Fleischner guidelines, which were developed for the older adult population, do not apply to children. This review summarizes the evidence collected by the Society for Pediatric Radiology (SPR) Thoracic Imaging Committee in its attempt to develop pediatric-specific guidelines. Small pulmonary opacities can be characterized as linear or as ground-glass or solid nodules. Linear opacities and ground-glass nodules are extremely unlikely to represent an early primary or metastatic malignancy in a child. In our review, we found a virtual absence of reported cases of a primary pulmonary malignancy presenting as an incidentally detected small lung nodule on CT in a healthy immune-competent child. Because of the lack of definitive information on the clinical significance of small lung nodules that are incidentally detected on CT in children, the management of those that do not have the typical characteristics of an intrapulmonary lymph node should be dictated by the clinical history as to possible exposure to infectious agents, the presence of an occult immunodeficiency, the much higher likelihood that the nodule represents a metastasis than a primary lung tumor, and ultimately the individual preference of the child's caregiver. Nodules appearing in children with a history of immune deficiency, malignancy or congenital pulmonary airway malformation should not be considered incidental, and their workup should be dictated by the natural history of these underlying conditions. (orig.)

  13. Performance of radiologists in detection of small pulmonary nodules on chest radiographs: effect of rib suppression with a massive-training artificial neural network.

    Science.gov (United States)

    Oda, Seitaro; Awai, Kazuo; Suzuki, Kenji; Yanaga, Yumi; Funama, Yoshinori; MacMahon, Heber; Yamashita, Yasuyuki

    2009-11-01

    A massive-training artificial neural network is a nonlinear pattern recognition tool used to suppress rib opacity on chest radiographs while soft-tissue contrast is maintained. We investigated the effect of rib suppression with a massive-training artificial neural network on the performance of radiologists in the detection of pulmonary nodules on chest radiographs. We used 60 chest radiographs; 30 depicted solitary pulmonary nodules, and 30 showed no nodules. A stratified random-sampling scheme was used to select the images from the standard digital image database developed by the Japanese Society of Radiologic Technology. The mean diameter of the 30 pulmonary nodules was 14.7 +/- 4.1 (SD) mm. Receiver operating characteristic analysis was used to evaluate observer performance in the detection of pulmonary nodules first on the chest radiographs without and then on the radiographs with rib suppression. Seven board-certified radiologists and five radiology residents participated in this observer study. For all 12 observers, the mean values of the area under the best-fit receiver operating characteristic curve for images without and with rib suppression were 0.816 +/- 0.077 and 0.843 +/- 0.074; the difference was statistically significant (p = 0.019). The mean areas under the curve for images without and with rib suppression were 0.848 +/- 0.059 and 0.883 +/- 0.050 for the seven board-certified radiologists (p = 0.011) and 0.770 +/- 0.081 and 0.788 +/- 0.074 for the five radiology residents (p = 0.310). In the detection of pulmonary nodules, evaluation of a combination of rib-suppressed and original chest radiographs significantly improved the diagnostic performance of radiologists over the use of chest radiographs alone.

  14. Emphysema and soluble CD14 are associated with pulmonary nodules in HIV-infected patients: implications for lung cancer screening.

    Science.gov (United States)

    Triplette, Matthew; Sigel, Keith M; Morris, Alison; Shahrir, Shahida; Wisnivesky, Juan P; Kong, Chung Y; Diaz, Phillip T; Petraglia, Alycia; Crothers, Kristina

    2017-07-31

    Lung cancer screening may benefit HIV-infected (HIV) smokers because of an elevated risk of lung cancer, but may have unique harms because of HIV-specific risk factors for false-positive screens. This study seeks to understand whether inflammatory biomarkers and markers of chronic lung disease are associated with noncalcified nodules at least 4 mm (NCN) in HIV compared with uninfected patients. This is a cohort study of Examinations of HIV-Associated Lung Emphysema (EXHALE), including 158 HIV and 133 HIV-uninfected participants. Participants underwent a laboratory assessment [including measurement of D-dimer, interleukin 6, and soluble CD14 (sCD14)], chest computed tomography (CT), and pulmonary function testing. We created multivariable logistic regression models to determine predictors of NCN in the participants stratified by HIV status, with attention to semiqualitative scoring of radiographic emphysema, markers of pulmonary function, and inflammatory biomarkers. Of the 291 participants, 69 had NCN on chest CT. As previously reported, there was no difference in prevalence of these nodules by HIV status. Emphysema and elevated sCD14 demonstrated an association with NCN in HIV participants independent of smoking status, CD4 cell count, HIV viral load, and pulmonary function. Emphysema and sCD14, a marker of immune activation, was associated with a higher prevalence of NCN on chest CT in HIV participants. Patients with chronic immune activation and emphysema may be at higher risk for both false-positive findings and incident lung cancer, thus screening in this group requires further study to understand the balance of benefits and harms.

  15. The clinical significance of perioperative serum IL-10 level changes in patients with benign and malignant pulmonary diseases

    International Nuclear Information System (INIS)

    Qi Falian; Xu Jun; Du Xiumin; Lu Zhaotong; Fu Qiang

    2003-01-01

    Objective: To study the clinical significance of perioperative changes of serum IL-10 level in patients with benign and malignant pulmonary diseases. Methods: Serum IL-10 levels in patients with benign (n=17) and malignant (n=25) pulmonary diseases were measured before and 1, 3, 7, 14 days after operation with RIA. Values in 82 controls were also taken. Results: The preoperative levels of serum IL-10 in patients with lung cancer were significantly higher than those in other groups (p 0.05); The levels of serum IL-10 in 36.4% of all the patients with lung cancer on day 14 were higher than the upper limit of the normal value. In patients with benign lung diseases, perioperative changes were slight and non-significant. Conclusion: Serum IL-10 level is a reliable parameter for distinguishing benign lung disease from malignant ones. Defining preoperative and postoperative changes of serum IL-10 levels might be of prognostic value in patients with lung cancer

  16. Improved detection of pulmonary nodules on energy-subtracted chest radiographs with a commercial computer-aided diagnosis software: comparison with human observers

    International Nuclear Information System (INIS)

    Szucs-Farkas, Zsolt; Patak, Michael A.; Yuksel-Hatz, Seyran; Ruder, Thomas; Vock, Peter

    2010-01-01

    To retrospectively analyze the performance of a commercial computer-aided diagnosis (CAD) software in the detection of pulmonary nodules in original and energy-subtracted (ES) chest radiographs. Original and ES chest radiographs of 58 patients with 105 pulmonary nodules measuring 5-30 mm and images of 25 control subjects with no nodules were randomized. Five blinded readers evaluated firstly the original postero-anterior images alone and then together with the subtracted radiographs. In a second phase, original and ES images were analyzed by a commercial CAD program. CT was used as reference standard. CAD results were compared to the readers' findings. True-positive (TP) and false-positive (FP) findings with CAD on subtracted and non-subtracted images were compared. Depending on the reader's experience, CAD detected between 11 and 21 nodules missed by readers. Human observers found three to 16 lesions missed by the CAD software. CAD used with ES images produced significantly fewer FPs than with non-subtracted images: 1.75 and 2.14 FPs per image, respectively (p=0.029). The difference for the TP nodules was not significant (40 nodules on ES images and 34 lesions in non-subtracted radiographs, p = 0.142). CAD can improve lesion detection both on energy subtracted and non-subtracted chest images, especially for less experienced readers. The CAD program marked less FPs on energy-subtracted images than on original chest radiographs. (orig.)

  17. Detection of pulmonary nodules at multirow-detector CT: effectiveness of double reading to improve sensitivity at standard-dose and low-dose chest CT

    International Nuclear Information System (INIS)

    Wormanns, Dag; Beyer, Florian; Heindel, Walter; Ludwig, Karl; Diederich, Stefan

    2005-01-01

    The purpose of this study was to assess the effectiveness of double reading to increase the sensitivity of lung nodule detection at standard-dose (SDCT) and low-dose multirow-detector CT (LDCT). SDCT (100 mAs effective tube current) and LDCT (20 mAs) of nine patients with pulmonary metastases were obtained within 5 min using four-row detector CT. Softcopy images reconstructed with 5-mm slice thickness were read by three radiologists independently. Images with 1.25-mm slice thickness served as the gold standard. Sensitivity was assessed for single readers and combinations. The effectiveness of double reading was expressed as the increase of sensitivity. Average sensitivity for detection of 390 nodules (size 3.9±3.2 mm) for single readers was 0.63 (SDCT) and 0.64 (LDCT). Double reading significantly increased sensitivity to 0.74 and 0.79, respectively. No significant difference between sensitivity at SDCT and LDCT was observed. The percentage of nodules detected by all three readers concordantly was 52% for SDCT and 47% for LDCT. Although double reading increased the detection rate of pulmonary nodules from 63% to 74-79%, a considerable proportion of nodules remained undetected. No difference between sensitivities at LDCT and SDCT for detection of small nodules was observed. (orig.)

  18. Association of Decision-making with Patients' Perceptions of Care and Knowledge during Longitudinal Pulmonary Nodule Surveillance.

    Science.gov (United States)

    Sullivan, Donald R; Golden, Sara E; Ganzini, Linda; Wiener, Renda Soylemez; Eden, Karen B; Slatore, Christopher G

    2017-11-01

    Patient participation in medical decision-making is widely advocated, but outcomes are inconsistent. We examined the associations between medical decision-making roles, and patients' perceptions of their care and knowledge while undergoing pulmonary nodule surveillance. The study setting was an academically affiliated Veterans Affairs hospital network in which 121 participants had 319 decision-making encounters. The Control Preferences Scale was used to assess patients' decision-making roles. Associations between decision-making, including role concordance (i.e., agreement between patients' preferred and actual roles), shared decision-making (SDM), and perceptions of care and knowledge, were assessed using logistic regression and generalized estimating equations. Participants had a preferred role in 98% of encounters, and most desired an active role (shared or patient controlled). For some encounters (36%), patients did not report their actual decision-making role, because they did not know what their role was. Role concordance and SDM occurred in 56% and 26% of encounters, respectively. Role concordance was associated with greater satisfaction with medical care (adjusted odds ratio [Adj-OR], 5.39; 95% confidence interval [CI], 1.68-17.26), higher quality of patient-reported care (Adj-OR, 2.86; 95% CI, 1.31-6.27), and more disagreement that care could be better (Adj-OR, 2.16; 95% CI, 1.12-4.16). Role concordance was not associated with improved pulmonary nodule knowledge with respect to lung cancer risk (Adj-OR, 1.12; 95% CI, 0.63-2.00) or nodule information received (Adj-OR, 1.13; 95% CI, 0.31-4.13). SDM was not associated with perceptions of care or knowledge. Among patients undergoing longitudinal nodule surveillance, a majority had a preference for having active roles in decision-making. Interestingly, during some encounters, patients did not know what their role was or that a decision was being made. Role concordance was associated with greater patient

  19. Towards automatic pulmonary nodule management in lung cancer screening with deep learning

    NARCIS (Netherlands)

    Ciompi, F.; Chung, K; Riel, S.J. van; Setio, A.A.A.; Gerke, P.K.; Jacobs, C.; Scholten, E.T.; Schaefer-Prokop, C.M.; Wille, M.M.W.; Marchiano, A.; Pastorino, U.; Prokop, M.; Ginneken, B. van

    2017-01-01

    The introduction of lung cancer screening programs will produce an unprecedented amount of chest CT scans in the near future, which radiologists will have to read in order to decide on a patient follow-up strategy. According to the current guidelines, the workup of screen-detected nodules strongly

  20. Clinical implications of nonspecific pulmonary nodules identified during the initial evaluation of patients with head and neck squamous cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Minsu [Eulji University School of Medicine, Department of Otorhinolaryngology, Eulji Medical Center, Seoul (Korea, Republic of); Lee, Sang Hoon; Lee, Yoon Se; Roh, Jong-Lyel; Choi, Seung-Ho; Nam, Soon Yuhl; Kim, Sang Yoon [Asan Medical Center, University of Ulsan College of Medicine, Department of Otolaryngology, Songpa-gu, Seoul (Korea, Republic of); Lee, Choong Wook [Asan Medical Center, University of Ulsan College of Medicine, Department of Radiology, Seoul (Korea, Republic of)

    2017-09-15

    We aimed to identify the clinical implications of nonspecific pulmonary nodules (NPNs) detected in the initial staging workup for patients with head and neck squamous cell carcinoma (HNSCC). Medical records of patients who had been diagnosed and treated in our hospital were retrospectively analysed. After definite treatment, changes of NPNs detected on initial evaluation were monitored via serial chest computed tomography. The associations between NPNs and the clinicopathological characteristics of primary HNSCC were evaluated. Survival analyses were performed according to the presence of NPNs. The study consisted of 158 (49.4%) patients without NPNs and 162 (50.6%) patients with NPNs. The cumulative incidence of probabilities of pulmonary malignancy (PM) development at 2 years after treatment were 9.0% and 6.2% in NPN-negative and NPN-positive patients, respectively. Overall and PM-free survival rates were not significantly different according to NPN status. Cervical lymph node (LN) involvement and a platelet-lymphocyte ratio (PLR) ≥126 increased the risk of PMs (both P <0.05). NPNs detected in the initial evaluation of patients with HNSCC did not predict the risk of pulmonary malignancies. Cervical LN involvement and PLR ≥126 may be independent prognostic factors affecting PM-free survival regardless of NPN status. (orig.)

  1. The use of computerised tomography guided percutaneous fine needle aspiration in the evaluation of solitary pulmonary nodules.

    LENUS (Irish Health Repository)

    Khan, K A

    2012-02-01

    The evaluation of a solitary pulmonary nodule (SPN) has changed over the years with increased access to percutaneous computerised tomography (CT) guided fine needle aspiration (FNA), where bronchoscopy is unhelpful. The aim of our study was to evaluate the sample adequacy, diagnostic and complication rate of CT-FNA of a SPN at our academic teaching hospital over an 18 month period. CT-FNA was performed by a radiologist, with a cytopathologist in attendance to confirm the adequacy of the sample obtained. The size of the nodule, sample material and adequacy, diagnosis and complications were recorded. A total of 101 patients were included, 54 male and the mean age was 68 +\\/- 11 years. The mean size of the SPN was 2.3 cm (range 1-11 cm). 56 (56%) patients had a right SPN, 45 (45%) had a left SPN. CT-FNA was diagnostic in 80 (80%) patients and non-diagnostic in 21 (20%) patients. The sample was insufficient for immunocytochemistry, although the morphological appearance was diagnostic in 20 (25%) of the 80 patients. Pneumothorax occurred in 26\\/101 (26%) patients post CT-FNA, of these 7 (27%) required chest drain insertion, while 19 (73%) were managed conservatively. CT FNA is a useful tool for the diagnosis of a SPN, with our diagnostic accuracy comparable to that reported in the literature. However, CT-FNA may not provide adequate sample volume to perform ancillary testing and has a moderate complication rate.

  2. Unusual uptake of prostate specific tracer {sup 68}Ga-PSMA-HBED-CC in a benign thyroid nodule

    Energy Technology Data Exchange (ETDEWEB)

    Tripathi, Madhavi; Chakraborty, Partha Sarathi; Sahoo, Manas Kumar; Bal, Chandrasekhar; Aggarwal, Shipra; Arora, Geetanjali; Kumar, Praveen; Kumar, Rajeev; Gupta, Ravikant [A.I.I.M.S, New Delhi (India)

    2016-12-15

    {sup 68}Ga-Prostate specific membrane antigen- N,N′-bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine-N,N′-diacetic acid- positron emission tomography/computed tomography or 68 Ga- HBED-CC-PSMA PET/CT, popularly known as PSMA PET/CT, is able to detect a small volume of recurrent prostate carcinoma (PC) when there is a prostate specific antigen (PSA) rise on follow-up after prostatectomy or other definitive treatment for PC. The use of PSMA PET/CT in the initial staging in PC is uncertain at this time. Clinical studies are underway to define its exact role in the management of the disease. At the same time it is important to be aware of unexpected sites of uptake of this ligand. We present here the case of a 62-year-old male patient who underwent prostatectomy for adenocarcinoma prostate. He also had a long-standing left solitary thyroid nodule (STN). Four months after surgery, he had a rising trend in serum PSA levels on three occasions, but the absolute value was less than 4 at all times. He underwent a {sup 68}Ga-PSMA-HBED-CC PET/CT, but it did not reveal any recurrent/metastatic site of disease. However, there was increased tracer uptake in the left STN. Fine needle aspiration cytology revealed features of atypia of undetermined significance, Bethesda category III. The patient underwent a left hemithyroidectomy and the histopathology showed features of a follicular adenoma.

  3. The additional value of the lateral chest radiograph for the detection of small pulmonary nodules-a ROC analysis.

    Science.gov (United States)

    Kluthke, Robin Alexander; Kickuth, Ralph; Bansmann, Paul Martin; Tüshaus, Carolin; Adams, Stephan; Liermann, Dieter; Kirchner, Johannes

    2016-11-01

    For the past 30 years, many authors have described different advantages of the use of the additional lateral chest radiograph. However, some radiologic departments gave up performing the lateral view recently. A potential reason for this might be a lack of evidence for any diagnostic benefit of the additional lateral view of the thorax in recent studies. The objective of this study was to evaluate the diagnostic benefit of the additional lateral view for the detection of small pulmonary nodules compared with CT examinations as a gold standard. The patient population consisted of 45 patients with SPN and 45 patients without SPN. Four radiologists with varying experience in the assessment of thoracic imaging first examined the sole posteroanterior (PA) projection. After a few days, they were instructed to examine the PA and the additional lateral view. A receiver-operating characteristic analysis was accomplished to compare the documented results. The mean Az value of the sole PA view was 0.75 and 0.77 by the combination of PA and additional lateral view. So, there was no significant difference between the detectable Az values (Δ = 0.02; p = 0.384). With a cut-off value of >3, the additional view even reduced the sensitivity by averaging to 5.6%. The decrease of sensitivity by using the additional view was most detectable within the group of more experienced radiologists. The additional lateral view of the chest provides no diagnostic benefit in the detection of small pulmonary nodules in comparison with the sole PA projection. Nevertheless, the results of the present study must not be understood as a general evaluation of the benefits of the lateral radiograph per se, because we did not examine other relevant issues (i.e. cardiac failure, lung parenchyma diseases or abnormalities in hilar anatomy). Advances in knowledge: Our study demonstrates a lack of evidence for any diagnostic benefit of the additional lateral view of the thorax in detecting SPN.

  4. iPads and LCDs show similar performance in the detection of pulmonary nodules

    Science.gov (United States)

    McEntee, Mark F.; Lowe, Joanna; Butler, Marie Louise; Pietrzyk, Mariusz; Evanoff, Michael G.; Ryan, John; Brennan, Patrick C.; Rainford, Louise A.

    2012-02-01

    In February 2011 the University of Chicago Medical School distributed iPads to its trainee doctors for use when reviewing clinical information and images on the ward or clinics. The use of tablet computing devices is becoming widespread in medicine with Apple™ heralding them as "revolutionary" in medicine. The question arises, just because it is technical achievable to use iPads for clinical evaluation of images, should we do so? The current work assesses the diagnostic efficacy of iPads when compared with LCD secondary display monitors for identifying lung nodules on chest x-rays. Eight examining radiologists of the American Board of Radiology were involved in the assessment, reading chest images on both the iPad and the an off-the-shelf LCD monitor. Thirty chest images were shown to each observer, of which 15 had one or more lung nodules. Radiologists were asked to locate the nodules and score how confident they were with their decision on a scale of 1-5. An ROC and JAFROC analysis was performed and modalities were compared using DBM MRMC. The results demonstrate no significant differences in performance between the iPad and the LCD for the ROC AUC (piPad does not significantly change performance compared to an off-the-shelf LCD.

  5. Computer-aided diagnosis of lung cancer: the effect of training data sets on classification accuracy of lung nodules

    Science.gov (United States)

    Gong, Jing; Liu, Ji-Yu; Sun, Xi-Wen; Zheng, Bin; Nie, Sheng-Dong

    2018-02-01

    This study aims to develop a computer-aided diagnosis (CADx) scheme for classification between malignant and benign lung nodules, and also assess whether CADx performance changes in detecting nodules associated with early and advanced stage lung cancer. The study involves 243 biopsy-confirmed pulmonary nodules. Among them, 76 are benign, 81 are stage I and 86 are stage III malignant nodules. The cases are separated into three data sets involving: (1) all nodules, (2) benign and stage I malignant nodules, and (3) benign and stage III malignant nodules. A CADx scheme is applied to segment lung nodules depicted on computed tomography images and we initially computed 66 3D image features. Then, three machine learning models namely, a support vector machine, naïve Bayes classifier and linear discriminant analysis, are separately trained and tested by using three data sets and a leave-one-case-out cross-validation method embedded with a Relief-F feature selection algorithm. When separately using three data sets to train and test three classifiers, the average areas under receiver operating characteristic curves (AUC) are 0.94, 0.90 and 0.99, respectively. When using the classifiers trained using data sets with all nodules, average AUC values are 0.88 and 0.99 for detecting early and advanced stage nodules, respectively. AUC values computed from three classifiers trained using the same data set are consistent without statistically significant difference (p  >  0.05). This study demonstrates (1) the feasibility of applying a CADx scheme to accurately distinguish between benign and malignant lung nodules, and (2) a positive trend between CADx performance and cancer progression stage. Thus, in order to increase CADx performance in detecting subtle and early cancer, training data sets should include more diverse early stage cancer cases.

  6. High-resolution CT of airspace nodules in idiopathic pulmonary hemosiderosis

    Energy Technology Data Exchange (ETDEWEB)

    Engeler, C.E. [Minnesota Univ., Minneapolis, MN (United States). Dept. of Radiology

    1995-12-01

    We describe the radiographic findings of idiopathic pulmonary hemosiderosis in a 20-year-old patient and compare high-resolution CT findings with conventional CT and radiography. (orig.). With 2 figs.

  7. Automatic Categorization and Scoring of Solid, Part-Solid and Non-Solid Pulmonary Nodules in CT Images with Convolutional Neural Network.

    Science.gov (United States)

    Tu, Xiaoguang; Xie, Mei; Gao, Jingjing; Ma, Zheng; Chen, Daiqiang; Wang, Qingfeng; Finlayson, Samuel G; Ou, Yangming; Cheng, Jie-Zhi

    2017-09-01

    We present a computer-aided diagnosis system (CADx) for the automatic categorization of solid, part-solid and non-solid nodules in pulmonary computerized tomography images using a Convolutional Neural Network (CNN). Provided with only a two-dimensional region of interest (ROI) surrounding each nodule, our CNN automatically reasons from image context to discover informative computational features. As a result, no image segmentation processing is needed for further analysis of nodule attenuation, allowing our system to avoid potential errors caused by inaccurate image processing. We implemented two computerized texture analysis schemes, classification and regression, to automatically categorize solid, part-solid and non-solid nodules in CT scans, with hierarchical features in each case learned directly by the CNN model. To show the effectiveness of our CNN-based CADx, an established method based on histogram analysis (HIST) was implemented for comparison. The experimental results show significant performance improvement by the CNN model over HIST in both classification and regression tasks, yielding nodule classification and rating performance concordant with those of practicing radiologists. Adoption of CNN-based CADx systems may reduce the inter-observer variation among screening radiologists and provide a quantitative reference for further nodule analysis.

  8. Pulmonary and Meningeal Cryptococcosis after Corticosteroid Therapy for Autoimmune Hepatitis: Coexistence of Cryptococci within Pulmonary Cancer Nodule

    OpenAIRE

    Yuri, Takashi; Kimura, Ayako; Yoshizawa, Katsuhiko; Emoto, Yuko; Kinoshita, Yuichi; Tsubura, Airo

    2013-01-01

    A case of autoimmune hepatitis complicated with pulmonary and meningeal cryptococcosis during long-term treatment with corticosteroid is reported. An 84-year-old woman who received long-term corticosteroid therapy (40 mg/day prednisolone for two years) for autoimmune hepatitis developed a headache, slight fever, and anorexia and was diagnosed with cryptococcal meningitis two months prior to hospital admission. Due to deterioration of her condition, the patient was transferred to our universit...

  9. Blood flow patterns of solitary pulmonary nodules with enhancement: clinical value of multi-slice spiral CT

    International Nuclear Information System (INIS)

    Li Shenjiang; Xiao Xiangsheng; Liu Shiyuan; Liu Huimin; Li Yuli; Li Huimin; Li Chengzhou; Zhang Chenshi; Tao Zhiwei; Yang Chunshan; Jiang Qingjun; Ouyang Lin; Yu Hong

    2004-01-01

    Objective: To evaluate the efficacy of dynamic multi-slice spiral computed tomography (MSCT) for providing quantitative information about blood flow patterns of solitary pulmonary nodules (SPNs) and the correlation of vascular endothelial growth factor (VEGF)-positive tumor angiogenesis and the quantifiable parameters of blood flow pattern in solitary bronchogenic adenocarcinoma. Methods Seventy-eight patients with SPNs (with strong enhancement) (diameter ≤4 cm; 68 malignant; 10 active inflammatory) underwent multi-location dynamic contrast enhanced (nonionic contrast material was administrated via the antecubital vein at a rate of 4 ml/s by using an autoinjector) serial CT. Precontrast and postcontrast attenuation on every scan was recorded. Perfusion, peak height, and ratio of peak height of the SPN to that of the aorta were calculated. Perfusion was calculated from the maximum gradient of the time-attenuation curve and the peak height of the aorta. The quantifiable parameters (perfusion, peak height, ratio of peak height of the bronchogenic adenocarcinoma to that of the aorta and mean transit time) of blood flow pattern in 30 VEGF-positive solitary bronchogenic adenocarcinoma were compared with microvessel densities (MVD) and VEGF expression by immunohistochemistry. Results: No statistically significant difference in the peak height was found between malignant (35.79 ± 10.76) HU and active inflammatory (39.76 ± 4.59) HU nodules (t=1.148, P=0.255). SPN-to-aorta ratio (14.27 ± 4.37)% and perfusion value (3.02 ± 0.96)ml -1 ·min -1 ·kg -1 in malignant SPNs were significantly lower than those of active inflammatory nodules(18.51 ± 2.71)%, (6.34 ± 4.39)ml -1 ·min -1 ·kg -1 (t=2.978, P=0.004, t=5.590, P -1 ·min -1 ·kg -1 , mean transit time (14.86 ± 5.84) s, and MVD (70.15 ± 20.03). Each of peak height, ratio of peak height of the bronchogenic adenocarcinoma to that of the aorta, and perfusion correlated positively with MVD (r=0.781, P<0.0001; r=0

  10. Automated detection of pulmonary nodules in PET/CT images: Ensemble false-positive reduction using a convolutional neural network technique

    International Nuclear Information System (INIS)

    Teramoto, Atsushi; Fujita, Hiroshi; Yamamuro, Osamu; Tamaki, Tsuneo

    2016-01-01

    Purpose: Automated detection of solitary pulmonary nodules using positron emission tomography (PET) and computed tomography (CT) images shows good sensitivity; however, it is difficult to detect nodules in contact with normal organs, and additional efforts are needed so that the number of false positives (FPs) can be further reduced. In this paper, the authors propose an improved FP-reduction method for the detection of pulmonary nodules in PET/CT images by means of convolutional neural networks (CNNs). Methods: The overall scheme detects pulmonary nodules using both CT and PET images. In the CT images, a massive region is first detected using an active contour filter, which is a type of contrast enhancement filter that has a deformable kernel shape. Subsequently, high-uptake regions detected by the PET images are merged with the regions detected by the CT images. FP candidates are eliminated using an ensemble method; it consists of two feature extractions, one by shape/metabolic feature analysis and the other by a CNN, followed by a two-step classifier, one step being rule based and the other being based on support vector machines. Results: The authors evaluated the detection performance using 104 PET/CT images collected by a cancer-screening program. The sensitivity in detecting candidates at an initial stage was 97.2%, with 72.8 FPs/case. After performing the proposed FP-reduction method, the sensitivity of detection was 90.1%, with 4.9 FPs/case; the proposed method eliminated approximately half the FPs existing in the previous study. Conclusions: An improved FP-reduction scheme using CNN technique has been developed for the detection of pulmonary nodules in PET/CT images. The authors’ ensemble FP-reduction method eliminated 93% of the FPs; their proposed method using CNN technique eliminates approximately half the FPs existing in the previous study. These results indicate that their method may be useful in the computer-aided detection of pulmonary nodules

  11. A approach for differential diagnosis of primary lung cancer and breast cancer relapse presenting as a solitary pulmonary nodule in patients after breast surgery

    International Nuclear Information System (INIS)

    Fujita, Takashi; Iwata, Hiroharu; Yatabe, Yasushi

    2009-01-01

    The differential diagnosis of primary lung cancer from metastatic breast cancer is crucial in patients presenting with a solitary pulmonary nodule after breast surgery. However definitive diagnosis of these nodules is often difficult due to similar radiological and pathological features in primary lung and metastatic breast cancer nodules. We assessed the feasibility of our diagnostic approach for these nodules by morphopathological and immunohistochemical examination (thyroid transcription factor-1 (TTF-1), surfactant pro-protein B (SPPB), estrogen receptor (ER), mammaglobin-1 (MGB1)), and estimated the frequency of primary lung cancer occurrence in 23 breast cancer patients. Biopsy specimens were obtained using CT-guided needle biopsy (NB) and transbronchial lung biopsy (TBLB) in 21 patients (91.3%). Surgical resection was performed for diagnosis and treatment in two patients. Differential diagnosis was obtained by morphopathological methods alone in 17 patients (73.9%, primary lung cancer: 6 cases, metastatic breast cancer: 11 cases) and by immunohistochemical examination in the remaining 6 (26.1%, primary lung cancer: 1 case, metastatic breast cancer: 5 cases). Our results show the clinical feasibility of our approach to the differential diagnosis of breast cancer relapse and primary lung cancer presenting as a solitary nodule in breast cancer patients. (author)

  12. The probability of malignancy in small pulmonary nodules coexisting with potentially operable lung cancer detected by CT

    Energy Technology Data Exchange (ETDEWEB)

    Yuan, Yue; Matsumoto, Tsuneo; Hiyama, Atsuto; Miura, Goji; Tanaka, Nobuyuki; Emoto, Takuya; Kawamura, Takeo; Matsunaga, Naofumi [Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, 755-8505, Yamaguchi (Japan)

    2003-11-01

    The aim of this study was to assess the probability of malignancy in one or two small nodules 1 cm or less coexisting with potentially operable lung cancer (coexisting small nodules). The preoperative helical CT scans of 223 patients with lung cancer were retrospectively reviewed. The probability of malignancy of coexisting small nodules was evaluated based on nodule size, location, and clinical stage of the primary lung cancers. Seventy-one coexisting small nodules were found on conventional CT in 58 (26%) of 223 patients, and 14 (6%) patients had malignant nodules. Eighteen (25%) of such nodules were malignant. The probability of malignancy was not significantly different between two groups of nodules larger and smaller than 0.5 cm (p=0.1). The probability of malignancy of such nodules within primary tumor lobe was significantly higher than that in the other lobes (p<0.01). Metastatic nodules were significantly fewer in clinical stage-IA patients than in the patients with the other stage (p<0.01); however, four (57%) of seven synchronous lung cancers were located in the non-primary tumor lobes in the clinical stage-I patients. Malignant coexisting small nodules are not infrequent, and such nodules in the non-primary tumor lobes should be carefully diagnosed. (orig.)

  13. Multi-Institutional Evaluation of Digital Tomosynthesis, Dual-Energy Radiography, and Conventional Chest Radiography for the Detection and Management of Pulmonary Nodules.

    Science.gov (United States)

    Dobbins, James T; McAdams, H Page; Sabol, John M; Chakraborty, Dev P; Kazerooni, Ella A; Reddy, Gautham P; Vikgren, Jenny; Båth, Magnus

    2017-01-01

    Purpose To conduct a multi-institutional, multireader study to compare the performance of digital tomosynthesis, dual-energy (DE) imaging, and conventional chest radiography for pulmonary nodule detection and management. Materials and Methods In this binational, institutional review board-approved, HIPAA-compliant prospective study, 158 subjects (43 subjects with normal findings) were enrolled at four institutions. Informed consent was obtained prior to enrollment. Subjects underwent chest computed tomography (CT) and imaging with conventional chest radiography (posteroanterior and lateral), DE imaging, and tomosynthesis with a flat-panel imaging device. Three experienced thoracic radiologists identified true locations of nodules (n = 516, 3-20-mm diameters) with CT and recommended case management by using Fleischner Society guidelines. Five other radiologists marked nodules and indicated case management by using images from conventional chest radiography, conventional chest radiography plus DE imaging, tomosynthesis, and tomosynthesis plus DE imaging. Sensitivity, specificity, and overall accuracy were measured by using the free-response receiver operating characteristic method and the receiver operating characteristic method for nodule detection and case management, respectively. Results were further analyzed according to nodule diameter categories (3-4 mm, >4 mm to 6 mm, >6 mm to 8 mm, and >8 mm to 20 mm). Results Maximum lesion localization fraction was higher for tomosynthesis than for conventional chest radiography in all nodule size categories (3.55-fold for all nodules, P < .001; 95% confidence interval [CI]: 2.96, 4.15). Case-level sensitivity was higher with tomosynthesis than with conventional chest radiography for all nodules (1.49-fold, P < .001; 95% CI: 1.25, 1.73). Case management decisions showed better overall accuracy with tomosynthesis than with conventional chest radiography, as given by the area under the receiver operating characteristic curve

  14. Development and validation of a prediction model for measurement variability of lung nodule volumetry in patients with pulmonary metastases.

    Science.gov (United States)

    Hwang, Eui Jin; Goo, Jin Mo; Kim, Jihye; Park, Sang Joon; Ahn, Soyeon; Park, Chang Min; Shin, Yeong-Gil

    2017-08-01

    To develop a prediction model for the variability range of lung nodule volumetry and validate the model in detecting nodule growth. For model development, 50 patients with metastatic nodules were prospectively included. Two consecutive CT scans were performed to assess volumetry for 1,586 nodules. Nodule volume, surface voxel proportion (SVP), attachment proportion (AP) and absolute percentage error (APE) were calculated for each nodule and quantile regression analyses were performed to model the 95% percentile of APE. For validation, 41 patients who underwent metastasectomy were included. After volumetry of resected nodules, sensitivity and specificity for diagnosis of metastatic nodules were compared between two different thresholds of nodule growth determination: uniform 25% volume change threshold and individualized threshold calculated from the model (estimated 95% percentile APE). SVP and AP were included in the final model: Estimated 95% percentile APE = 37.82 · SVP + 48.60 · AP-10.87. In the validation session, the individualized threshold showed significantly higher sensitivity for diagnosis of metastatic nodules than the uniform 25% threshold (75.0% vs. 66.0%, P = 0.004) CONCLUSION: Estimated 95% percentile APE as an individualized threshold of nodule growth showed greater sensitivity in diagnosing metastatic nodules than a global 25% threshold. • The 95 % percentile APE of a particular nodule can be predicted. • Estimated 95 % percentile APE can be utilized as an individualized threshold. • More sensitive diagnosis of metastasis can be made with an individualized threshold. • Tailored nodule management can be provided during nodule growth follow-up.

  15. Logistic regression analysis of conventional ultrasonography, strain elastosonography, and contrast-enhanced ultrasound characteristics for the differentiation of benign and malignant thyroid nodules.

    Science.gov (United States)

    Pang, Tiantian; Huang, Leidan; Deng, Yingyuan; Wang, Tianfu; Chen, Siping; Gong, Xuehao; Liu, Weixiang

    2017-01-01

    The aim of the study is to screen the significant sonographic features by logistic regression analysis and fit a model to diagnose thyroid nodules. A total of 525 pathological thyroid nodules were retrospectively analyzed. All the nodules underwent conventional ultrasonography (US), strain elastosonography (SE), and contrast -enhanced ultrasound (CEUS). Those nodules' 12 suspicious sonographic features were used to assess thyroid nodules. The significant features of diagnosing thyroid nodules were picked out by logistic regression analysis. All variables that were statistically related to diagnosis of thyroid nodules, at a level of p logistic regression analysis model. The significant features in the logistic regression model of diagnosing thyroid nodules were calcification, suspected cervical lymph node metastasis, hypoenhancement pattern, margin, shape, vascularity, posterior acoustic, echogenicity, and elastography score. According to the results of logistic regression analysis, the formula that could predict whether or not thyroid nodules are malignant was established. The area under the receiver operating curve (ROC) was 0.930 and the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 83.77%, 89.56%, 87.05%, 86.04%, and 87.79% respectively.

  16. Interscan variation of semi-automated volumetry of subsolid pulmonary nodules

    Energy Technology Data Exchange (ETDEWEB)

    Scholten, Ernst T. [University Medical Center, Department of Radiology, Utrecht (Netherlands); Kennemer Gasthuis, Department of Radiology, Haarlem (Netherlands); Jong, Pim A. de; Willemink, Martin J.; Mali, Willem P.T.M.; Gietema, Hester A. [University Medical Center, Department of Radiology, Utrecht (Netherlands); Jacobs, Colin; Riel, Sarah van [Radboud University Medical Center, Diagnostic Image Analysis Group, Nijmegen (Netherlands); Ginneken, Bram van [Radboud University Medical Center, Diagnostic Image Analysis Group, Nijmegen (Netherlands); Fraunhofer MEVIS, Bremen (Germany); Vliegenthart, Rozemarijn [University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen (Netherlands); University of Groningen, University Medical Centre Groningen, Center for Medical Imaging-North East Netherlands, Groningen (Netherlands); Oudkerk, Matthijs [University of Groningen, University Medical Centre Groningen, Center for Medical Imaging-North East Netherlands, Groningen (Netherlands); Koning, Harry J. de [Erasmus Medical Center, Department of Public Health, Rotterdam (Netherlands); Horeweg, Nanda [Erasmus Medical Center, Department of Public Health, Rotterdam (Netherlands); Erasmus Medical Center, Department of Pulmonology, Rotterdam (Netherlands); Prokop, Mathias [Radboud University Medical Center, Department of Radiology, Nijmegen (Netherlands)

    2015-04-01

    We aimed to test the interscan variation of semi-automatic volumetry of subsolid nodules (SSNs), as growth evaluation is important for SSN management. From a lung cancer screening trial all SSNs that were stable over at least 3 months were included (N = 44). SSNs were quantified on the baseline CT by two observers using semi-automatic volumetry software for effective diameter, volume, and mass. One observer also measured the SSNs on the second CT 3 months later. Interscan variation was evaluated using Bland-Altman plots. Observer agreement was calculated as intraclass correlation coefficient (ICC). Data are presented as mean (± standard deviation) or median and interquartile range (IQR). A Mann-Whitney U test was used for the analysis of the influence of adjustments on the measurements. Semi-automatic measurements were feasible in all 44 SSNs. The interscan limits of agreement ranged from -12.0 % to 9.7 % for diameter, -35.4 % to 28.6 % for volume and -27.6 % to 30.8 % for mass. Agreement between observers was good with intraclass correlation coefficients of 0.978, 0.957, and 0.968 for diameter, volume, and mass, respectively. Our data suggest that when using our software an increase in mass of 30 % can be regarded as significant growth. (orig.)

  17. Implementation of combined SVM-algorithm and computer-aided perception feedback for pulmonary nodule detection

    Science.gov (United States)

    Pietrzyk, Mariusz W.; Rannou, Didier; Brennan, Patrick C.

    2012-02-01

    This pilot study examines the effect of a novel decision support system in medical image interpretation. This system is based on combining image spatial frequency properties and eye-tracking data in order to recognize over and under calling errors. Thus, before it can be implemented as a detection aided schema, training is required during which SVMbased algorithm learns to recognize FP from all reported outcomes, and, FN from all unreported prolonged dwelled regions. Eight radiologists inspected 50 PA chest radiographs with the specific task of identifying lung nodules. Twentyfive cases contained CT proven subtle malignant lesions (5-20mm), but prevalence was not known by the subjects, who took part in two sequential reading sessions, the second, without and with support system feedback. MCMR ROC DBM and JAFROC analyses were conducted and demonstrated significantly higher scores following feedback with p values of 0.04, and 0.03 respectively, highlighting significant improvements in radiology performance once feedback was used. This positive effect on radiologists' performance might have important implications for future CAD-system development.

  18. Francisella philomiragia Adenitis and Pulmonary Nodules in a Child with Chronic Granulomatous Disease

    Directory of Open Access Journals (Sweden)

    Timothy Mailman

    2005-01-01

    Full Text Available Francisella philomiragia is a rare and opportunistic pathogen capable of producing invasive infection in patients with compromised neutrophil function and in patients that have survived a near-drowning. A case of F philomiragia adenitis and lung nodules, refractory to cephalosporin therapy, is reported in a 10-year-old boy with chronic granulomatous disease following a facial abrasion from a saltwater crab. To the authors' knowledge, this is the first Canadian clinical isolate to be reported. Genus and species identification was confirmed via 16S ribosomal RNA sequence analysis. A literature review revealed three groups at risk of F philomiragia infection: young patients with chronic granulomatous disease; adults with hematogenous malignancy; and near-drowning patients. Pneumonia, fever without an apparent source and sepsis are the main clinical presentations. Invasive procedures may be required to isolate this organism and ensure appropriate antimicrobial therapy. Limited awareness of F philomiragia has led to delayed identification, patient death and misidentification as Francisella tularensis - a biosafety level three pathogen and potential bioterrorism agent.

  19. Solitary pulmonary nodules: Impact of quantitative contrast-enhanced CT on the cost-effectiveness of FDG-PET

    International Nuclear Information System (INIS)

    Comber, L.A.; Keith, C.J.; Griffiths, M.; Miles, K.A.

    2003-01-01

    AIM: To determine the impact of quantitative contrast-enhanced computed tomography (QECT) on the cost-effectiveness of diagnostic strategies for the assessment of solitary pulmonary nodules (SPNs). MATERIALS AND METHODS: Four diagnostic strategies were evaluated using decision tree analysis: conventional CT alone; conventional CT followed by QECT; conventional CT followed positron emission tomography (PET); and conventional CT followed by QECT and PET (QECT+PET). The average cost per patient, accuracy of management and incremental cost:accuracy ratio (ICAR) were determined for each strategy. Although baseline assumptions reflected the Australian setting, sensitivity analysis was used to extrapolate the results to the UK. RESULTS: At the baseline prevalence of malignancy (54%) and cost of PET relative to surgery (16%), the QECT strategy incurs the least cost ($5560/patient) but the QECT+PET strategy is the most cost-effective (ICAR $12059/patient). At reported levels of disease prevalence (68.5%) and cost of PET relative to surgery (29.9%) in the UK, the QECT strategy is the most cost-effective. CONCLUSION: QECT offers a cost-effective approach to evaluation of SPNs. Whether QECT is used alone or in combination with PET will depend upon local availability and regional values for prior probability of malignancy within SPNs and the cost of PET relative to surgery

  20. Usefulness of combined use of contrast-enhanced ultrasound and TI-RADS classification for the differentiation of benign from malignant lesions of thyroid nodules.

    Science.gov (United States)

    Zhang, Yan; Zhou, Ping; Tian, Shuang-Ming; Zhao, Yong-Feng; Li, Jia-Le; Li, Lan

    2017-04-01

    To study the thyroid image reporting and data system (TI-RADS) classification and the contrast-enhanced ultrasound (CEUS) enhancement pattern of thyroid nodules, and to determine whether combined use of both methods is helpful in the diagnosis of thyroid nodules. A total of 319 thyroid nodules in 246 patients were assessed with TI-RADS, CEUS and a combination of both methods. The diagnostic performance of TI-RADS, CEUS and a combination of both methods was compared. The accuracy in the diagnosis of thyroid nodules was 90.3 % for TI-RADS, 90.0 % for CEUS and 96.0 % for a combination of both methods respectively. A statistically significant difference was not observed in the diagnostic accuracy of CEUS and TI-RADS (P > 0.05). However, a significant difference was observed between a combination of both methods and either alone (P TI-RADS classifications of 4a and 4b thyroid nodules compared with TI-RADS alone (P  0.05). The improved TI-RADS, when combined with CEUS, could significantly improve the diagnostic accuracy for thyroid nodules, especially for TI-RADS class-4 thyroid nodules. • TI-RADS can be used as the primary diagnostic standard for thyroid nodules • CEUS can be used as an important complement to TI-RADS • The improved TI-RADS can significantly improve the qualitative diagnostic accuracy.

  1. Detection of small pulmonary nodules in high-field MR at 3 T: evaluation of different pulse sequences using porcine lung explants

    Energy Technology Data Exchange (ETDEWEB)

    Regier, M.; Kaul, M.G.; Ittrich, H.; Bansmann, P.M.; Kemper, J.; Nolte-Ernsting, C.; Adam, G. [University Hospital of Hamburg, Center for Diagnostic Imaging and Image Guided Therapy, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Kandel, S.; Hoffmann, B.; Heller, M.; Biederer, J. [University Hospital of Kiel, Department of Diagnostic Radiology, Kiel (Germany)

    2007-05-15

    To evaluate two MR imaging sequences for the detection of artificial pulmonary nodules inside porcine lung explants. 67 agarose nodules ranging 3-20 mm were injected into ten porcine lungs within a dedicated chest phantom. The signal on T1-weighted images and radiopacity were adjusted by adding 0.125 mmol/l Gd-DTPA and 1.5 g/l of iodine. A T1-weighted three-dimensional gradient-echo (T1-3D-GRE; TR/TE:3.3/1.1 ms, slice:8 mm, flip-angle:10 ) and a T2-weighted half-Fourier fast-spin echo sequence (T2-HF-FSE; TR/TE:2000/66 ms, slice:7 mm, flip-angle:90 ) were applied in axial orientation using a 3-T system (Intera, Philips Medical Systems, Best, The Netherlands), followed by CT (16 x 0.5 mm) as reference. Nodule sizes and locations were assessed by three blinded observers. In nodules of >10 mm, sensitivity was 100% using 3D-GRE-MRI and 94% using the HF-FSE sequence. For nodules 6-10 mm, the sensitivity of MRI was lower than with CT (3D-GRE:92%; T2-HF-FSE:83%). In lesions smaller than 5 mm, the sensitivity declined to 80% (3D-GRE) and 53% (HF-FSE). Small lesion diameters were overestimated with both sequences, particularly with HF-FSE. This study confirms the feasibility of 3 T-MRI for lung nodule detection. In lesions greater than 5 mm, the sensitivity of the 3D-GRE sequence approximated CT (>90%), while sensitivity and PPV with the HF-FSE sequence were slightly inferior. (orig.)

  2. Change descriptors for determining nodule malignancy in national lung screening trial CT screening images

    Science.gov (United States)

    Geiger, Benjamin; Hawkins, Samuel; Hall, Lawrence O.; Goldgof, Dmitry B.; Balagurunathan, Yoganand; Gatenby, Robert A.; Gillies, Robert J.

    2016-03-01

    Pulmonary nodules are effectively diagnosed in CT scans, but determining their malignancy has been a challenge. The rate of change of the volume of a pulmonary nodule is known to be a prognostic factor for cancer development. In this study, we propose that other changes in imaging characteristics are similarly informative. We examined the combination of image features across multiple CT scans, taken from the National Lung Screening Trial, with individual scans of the same patient separated by approximately one year. By subtracting the values of existing features in multiple scans for the same patient, we were able to improve the ability of existing classification algorithms to determine whether a nodule will become malignant. We trained each classifier on 83 nodules determined to be malignant by biopsy and 172 nodules determined to be benign by their clinical stability through two years of no change; classifiers were tested on 77 malignant and 144 benign nodules, using a set of features that in a test-retest experiment were shown to be stable. An accuracy of 83.71% and AUC of 0.814 were achieved with the Random Forests classifier on a subset of features determined to be stable via test-retest reproducibility analysis, further reduced with the Correlation-based Feature Selection algorithm.

  3. Clinical impact of abnormal FDG uptake in pulmonary nodules detected by CT in patients with only history of non-lung cancers

    International Nuclear Information System (INIS)

    Wong, C.O.; Nunez, R.; Welsh, R.J.; Chmielewski, G.W.; Hill, E.A.; Hill, J.C.; Ravikrishnan, K.P.; Darlene Fink-Bennett; Dworkin, H.J.

    2001-01-01

    Objective: The aim is to assess the clinical impact of positive FDG uptake in single (SPN) or multiple (MPN) pulmonary nodules detected by CT in patients with known past history of non-lung cancers (but no known lung cancers). Materials and Methods: Twenty-eight sequential patients with non-lung cancers (15 breast, 8 colon, 5 prostate) referred for evaluation of SPN or MPN by PET over a period of two years were included. F-18 FDG PET images, covering chest and upper abdomen, were interpreted blindly and then correlated with CT findings for the precise location of abnormal FDG uptake in the chest. Results: There was a significant number of abnormal FDG uptake in both SPN or MPN. Positive abnormal uptake suggestive of malignancy was found in 25% of patients in the form of SPN and 39% of patients in the form of MPN (p<0.03). Positive cases in the pattern of multiple foci of pulmonary uptake were attributed to metastatic disease. Otherwise positive cases were followed by tissue diagnosis and/or surgical attention. The negative cases were followed clinically. Of the 11 positive cases of MPN, 2 patients (18%) showed only abnormal FDG uptake in just one of the nodules, which was later confirmed at surgery to be a primary cancer of lung in both patients. Conclusion: These results suggest that PET scan would be just as useful in patients with SPN and known non-lung cancers as other patients with no history of any cancers. Not all patients with non-lung cancer and MPN have pulmonary metastasis by PET criteria. PET may single out a primary lung malignancy in patients with non-lung cancer and MPN. PET has thus great clinical impact in these patients with pulmonary nodules and known non-lung cancers as the management would otherwise be completely different in situations revealed by the study

  4. Computed tomography in the detection of pulmonary metastases. Improvement by application of spiral technology

    International Nuclear Information System (INIS)

    Kauczor, H.U.; Hansen, M.; Schweden, F.; Strunk, H.; Mildenberger, P.; Thelen, M.

    1994-01-01

    Computed tomography is the imaging modality of choice for detection or exclusion of pulmonary metastases. In most cases these are spheric, multiple, bilateral, and located in the peripheral areas of the middle and lower fields of the lungs. Differential diagnosis of solitary pulmonary nodules is difficult. Evaluating whether they are malignant or benign is insufficient despite the application of multiple CT criteria. Spiral computed tomography acquiring an imaging volume in a breathhold has led to significant improvement in the sensitivity of detecting pulmonary nodules. Imaging protocols are presented, and the influence of the different parameters is discussed. Although not all pulmonary metastases may be detected with spiral computed tomography, it is the most important examination when considering pulmonary metastasectomy. Computed tomography is the imaging modality of choice when monitoring pulmonary metastases during systemic therapeutic regimens by measuring all nodules or 'indicator lesions'. (orig.) [de

  5. Evaluation of pulmonary nodules: comparison of a prototype dual crystal (LSO/NAI) dual head coincidence camera and full ring positron emission tomography (PET)

    International Nuclear Information System (INIS)

    Joshi, U.; Raijmakers, P.G.H.M.; Lingen, A. van; Comans, E.F.I.; Pijpers, R.; Teule, G.J.J.; Hoekstra, O.S.

    2005-01-01

    Purpose: To determine the concordance of a prototype dual head coincidence camera (LSO-PS) and full ring PET (BGO-PET) using 18 F-fluorodeoxyglucose (FDG) in the evaluation of pulmonary nodules (PNs). Materials and methods: Patients referred for evaluation of ≤3 PNs (≤3 cm diameter) were prospectively studied on the same day with both BGO-PET and LSO-PS. Imaging was performed at 60 and 120 min after injection of 370 MBq FDG, respectively. Images were independently interpreted by four observers with each observer blinded to the other modality for the same patient. Lesions were scored in terms of relative intensity versus background. Non-attenuation corrected (nonAC) BGO-PET was used as the reference test. Results: Forty-seven patients with 54 PNs (mean diameter 1.7 cm, S.D. 0.7) were included. Twelve nodules were in the ≤1.0 cm - 27 in the 1.1-2.0 cm - and 15 in the 2.1-3.0 cm range. Interobserver agreement was similar for both FDG imaging modalities. Using a sensitive assessment strategy with LSO-PS (≥ faint intensity deemed positive), there was a 97% (38/39, 95%CI 87-100%) concordance with BGO-PET and one false positive case with LSO-PS. Conservative reading (moderate or intense intensity deemed positive) resulted in a 92% (36/39, 95%CI 80-97%) concordance with BGO-PET, without false positives. The only lesion missed by LSO-PS using both assessment strategies involved a nodule 1.5 cm diameter that demonstrated moderate increased FDG uptake on BGO-PET. Conclusion: Depending on the test positivity criteria, LSO-PS demonstrates a high concordance (92-97%) with nonAC BGO-PET for the characterization of pulmonary nodules

  6. Comparative analysis of 99mTc-depreotide and 99mTc-EDDA/HYNIC-TOC thorax scintigrams acquired for the purpose of differential diagnosis of solitary pulmonary nodules.

    Science.gov (United States)

    Płachcińska, Anna; Mikołajczak, Renata; Kozak, Józef; Rzeszutek, Katarzyna; Kuśmierek, Jacek

    2006-01-01

    Aiming at comparison of diagnostic efficacy of 2 radiopharmaceuticals: 99mTc-depreotide (Neospect, Amersham) and 99mTc-EDDA/HYNIC-Tyr3-octreotide (Tektrotyd, Polatom), in differentiation between malignant and benign etiology of solitary pulmonary nodules (SPNs), radionuclide studies with 2 radiotracers were performed in 18 patients. For both radiopharmaceuticals the same acquisition and processing protocols were applied. Studies were acquired with SPECT technique, after administration of 740 MBq of activity. Scintigrams were assessed visually, as: positive (+), equivocal (+/-) and negative (-). Additionally, uptake intensity of both radiotracers in nodules was assessed semiquantitatively, using a tumour-to-background ratio. Verification of scintigraphic results was based in 14 cases upon a pathological examination of tumour samples (histopathology) and in the remaining 4 - on clinical observation and bacteriological studies. Normal scintigrams obtained with both radiopharmaceuticals differed significantly. 99mTc-depreotide was markedly accumulated in spine, sternum, ribs and lungs (mean lung/heart ratio = 2.2). This accumulation was not observed on 99mTc- -EDDA/HYNIC-TOC scintigrams (mean lung/heart ratio = 0.7). In 6 patients a malignant etiology--lung cancer--was revealed (5--adenocarcinoma, 1--squamous cell) and the other 12 cases turned out to be benign (4 hamartomas, 3 tuberculomas, a tuberculous infiltrate, an alien body with inflammatory reaction, a hyperplasia of lymphatic tissue and 2 cases of unknown etiology, from which one had a stable size and the other resolved during a 6 month observation period). In all 6 cases of lung cancer positive results were obtained with both tracers. Moreover, in 2 patients metastases in mediastinum could be observed on scintigrams obtained with both radiopharmaceuticals. From among 12 cases of benign etiology 6 99mTc-depreotide scintigrams were true negative, 1--equivocal and 5--false positive, whereas 6 99m

  7. The incidental pulmonary nodule in a child. Part 2: Commentary and suggestions for clinical management, risk communication and prevention

    Energy Technology Data Exchange (ETDEWEB)

    Westra, Sjirk J. [Massachusetts General Hospital, Division of Pediatric Radiology, Boston, MA (United States); Thacker, Paul G. [Medical University of South Carolina, Department of Radiology, Charleston, SC (United States); Podberesky, Daniel J. [Nemours Children' s Hospital, Department of Radiology, Orlando, FL (United States); Lee, Edward Y. [Boston Children' s Hospital, Department of Pediatric Radiology, Boston, MA (United States); Iyer, Ramesh S. [Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States); Hegde, Shilpa V. [Arkansas Children' s Hospital, Department of Radiology, Little Rock, AR (United States); Guillerman, R.P. [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States); Mahani, Maryam Ghadimi [University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children' s Hospital, Department of Radiology, Ann Arbor, MI (United States)

    2015-05-01

    The incidental detection of small lung nodules in children is a vexing consequence of an increased reliance on CT. We present an algorithm for the management of lung nodules detected on CT in children, based on the presence or absence of symptoms, the presence or absence of elements in the clinical history that might explain these nodules, and the imaging characteristics of the nodules (such as attenuation measurements within the nodule). We provide suggestions on how to perform a thoughtfully directed and focused search for clinically occult extrathoracic disease processes (including malignant disease) that may present as an incidentally detected lung nodule on CT. This algorithm emphasizes that because of the lack of definitive information on the natural history of small solid nodules that are truly detected incidentally, their clinical management is highly dependent on the caregivers' individual risk tolerance. In addition, we present strategies to reduce the prevalence of these incidental findings, by preventing unnecessary chest CT scans or inadvertent inclusion of portions of the lungs in scans of adjacent body parts. Application of these guidelines provides pediatric radiologists with an important opportunity to practice patient-centered and evidence-based medicine. (orig.)

  8. The calcified lung nodule: What does it mean?

    Directory of Open Access Journals (Sweden)

    Khan Ali

    2010-01-01

    Full Text Available The aim of this review is to present a pictorial essay emphasizing the various patterns of calcification in pulmonary nodules (PN to aid diagnosis and to discuss the differential diagnosis and the pathogenesis where it is known. The imaging evaluation of PN is based on clinical history, size, distribution and the gross appearance of the nodule as well as feasibility of obtaining a tissue diagnosis. Imaging is instrumental in the management of PN and one should strive not only to identify small malignant tumors with high survival rates but to spare patients with benign PN from undergoing unnecessary surgery. The review emphasizes how to achieve these goals. One of the most reliable imaging features of a benign lesion is a benign pattern of calcification and periodic follow-up with computed tomography showing no growth for 2 years. Calcification in PN is generally considered as a pointer toward a possible benign disease. However, as we show here, calcification in PN as a criterion to determine benign nature is fallacious and can be misleading. The differential considerations of a calcified lesion include calcified granuloma, hamartoma, carcinoid, osteosarcoma, chondrosarcoma and lung metastases or a primary bronchogenic carcinoma among others. We describe and illustrate different patterns of calcification as seen in PN on imaging.

  9. Effect of CT scanning parameters on volumetric measurements of pulmonary nodules by 3D active contour segmentation: a phantom study

    International Nuclear Information System (INIS)

    Way, Ted W; Chan, H-P; Goodsitt, Mitchell M; Sahiner, Berkman; Hadjiiski, Lubomir M; Zhou Chuan; Chughtai, Aamer

    2008-01-01

    The purpose of this study is to investigate the effects of CT scanning and reconstruction parameters on automated segmentation and volumetric measurements of nodules in CT images. Phantom nodules of known sizes were used so that segmentation accuracy could be quantified in comparison to ground-truth volumes. Spherical nodules having 4.8, 9.5 and 16 mm diameters and 50 and 100 mg cc -1 calcium contents were embedded in lung-tissue-simulating foam which was inserted in the thoracic cavity of a chest section phantom. CT scans of the phantom were acquired with a 16-slice scanner at various tube currents, pitches, fields-of-view and slice thicknesses. Scans were also taken using identical techniques either within the same day or five months apart for study of reproducibility. The phantom nodules were segmented with a three-dimensional active contour (3DAC) model that we previously developed for use on patient nodules. The percentage volume errors relative to the ground-truth volumes were estimated under the various imaging conditions. There was no statistically significant difference in volume error for repeated CT scans or scans taken with techniques where only pitch, field of view, or tube current (mA) were changed. However, the slice thickness significantly (p < 0.05) affected the volume error. Therefore, to evaluate nodule growth, consistent imaging conditions and high resolution should be used for acquisition of the serial CT scans, especially for smaller nodules. Understanding the effects of scanning and reconstruction parameters on volume measurements by 3DAC allows better interpretation of data and assessment of growth. Tracking nodule growth with computerized segmentation methods would reduce inter- and intraobserver variabilities

  10. Detection of simulated pulmonary nodules by single-exposure dual-energy computed radiography of the chest: effect of a computer-aided diagnosis system (Part 2)

    International Nuclear Information System (INIS)

    Kido, Shoji; Kuriyama, Keiko; Kuroda, Chikazumi; Nakamura, Hironobu; Ito, Wataru; Shimura, Kazuo; Kato, Hisatoyo

    2002-01-01

    Objective: To evaluate the performance of the computer-aided diagnosis (CAD) scheme on the detection of pulmonary nodules (PNs) in single-exposure dual-energy subtraction computed radiography (CR) images of the chest, and to evaluate the effect of this CAD scheme on radiologists' detectabilities. Methods and material: We compared the detectability by the CAD scheme with the detectability by 12 observers by using conventional CR (C-CR) and bone-subtracted CR (BS-CR) images of 25 chest phantoms with a low-contrast nylon nodule. Results: Both in the CAD scheme and for the observers, the detectability of BS-CR images was superior to that of C-CR images (P<0.005). The detection performance of the CAD scheme was equal to that of the observers. The nodules detected by the CAD did not necessarily coincide with those by the observers. Thus, if observers can use the results of the CAD system as a 'second opinion', their detectabilities increase. Conclusion: The CAD system for detection of PNs in the single-exposure dual-energy subtraction method is promising for improving radiologists' detectabilities of PNs

  11. Radiomic features analysis in computed tomography images of lung nodule classification.

    Directory of Open Access Journals (Sweden)

    Chia-Hung Chen

    Full Text Available Radiomics, which extract large amount of quantification image features from diagnostic medical images had been widely used for prognostication, treatment response prediction and cancer detection. The treatment options for lung nodules depend on their diagnosis, benign or malignant. Conventionally, lung nodule diagnosis is based on invasive biopsy. Recently, radiomics features, a non-invasive method based on clinical images, have shown high potential in lesion classification, treatment outcome prediction.Lung nodule classification using radiomics based on Computed Tomography (CT image data was investigated and a 4-feature signature was introduced for lung nodule classification. Retrospectively, 72 patients with 75 pulmonary nodules were collected. Radiomics feature extraction was performed on non-enhanced CT images with contours which were delineated by an experienced radiation oncologist.Among the 750 image features in each case, 76 features were found to have significant differences between benign and malignant lesions. A radiomics signature was composed of the best 4 features which included Laws_LSL_min, Laws_SLL_energy, Laws_SSL_skewness and Laws_EEL_uniformity. The accuracy using the signature in benign or malignant classification was 84% with the sensitivity of 92.85% and the specificity of 72.73%.The classification signature based on radiomics features demonstrated very good accuracy and high potential in clinical application.

  12. Differentiating pre- and minimally invasive from invasive adenocarcinoma using CT-features in persistent pulmonary part-solid nodules in Caucasian patients

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, Julien G., E-mail: JCohen@chu-grenoble.fr [Clinique Universitaire de Radiologie et Imagerie Médicale (CURIM), Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9 (France); Reymond, Emilie [Clinique Universitaire de Radiologie et Imagerie Médicale (CURIM), Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9 (France); Lederlin, Mathieu [Service de Radiologie, Université Segalen Bordeaux, Centre Hospitalier Universitaire de Bordeaux, 12 rue Dubernat, 33404 Bordeaux Cedex (France); Medici, Maud [Centre d’Investigation Clinique – Innovation Technologique (CIC-IT), Pavillon Taillefer, 38706 La Tronche Cedex (France); Lantuejoul, Sylvie [Departement d’Anatomie et Cytologie Pathologique (DACP), Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9 (France); Laurent, François [Service de Radiologie, Université Segalen Bordeaux, Centre Hospitalier Universitaire de Bordeaux, 12 rue Dubernat, 33404 Bordeaux Cedex (France); Arbib, François [Departement de Pneumologie, Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9 (France); Jankowski, Adrien [Clinique Universitaire de Radiologie et Imagerie Médicale (CURIM), Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9 (France); and others

    2015-04-15

    Highlights: •We analyzed CT-features of part-solid ground glass nodules in Caucasians. •These CT-features were compared to pathology on full resection specimen. •Several CT-features can help differentiating invasive adenocarcinoma. •A solid component larger than 5 mm had 100% sensitivity for invasive adenocarcinoma. -- Abstract: Objective: To retrospectively investigate the diagnostic value of pre-operative CT-features between pre/minimally invasive and invasive lesions in part-solid persistent pulmonary ground glass nodules in a Caucasian population. Materials and methods: Retrospective review of two pre-operative CTs for 31 nodules in 30 patients. There were 10 adenocarcinomas in situ, 1 minimally invasive adenocarcinoma, 20 invasive adenocarcinomas. We analyzed the correlation between histopathology and the following CT-features: maximal axial diameter, maximal orthogonal axial diameter, height, density, size of solid component, air bronchogram, pleural retraction, nodule mass, disappearance rate and their evolution during follow-up. Results: In univariate analysis, invasive adenocarcinomas had a higher maximal height, density, solid component size, mass, a lower disappearance rate and presented more often with pleural retraction (p < 0.05). After logistic regression performed with the uncorrelated parameters using a method of selection of variables, only the size of solid component remained significant, with 100% sensitivity for invasive adenocarcinoma when larger than 5 mm. Conclusion: Preoperative CT-features can help differentiating in situ and minimally invasive adenocarcinomas from invasive adenocarcinomas in Caucasian patients. A solid component larger than 5 mm in diameter had 100% sensitivity for the diagnosis of invasive adenocarcinoma.

  13. Pulmonary adenocarcinomas appearing as part-solid ground-glass nodules: Is measuring solid component size a better prognostic indicator?

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Eui Jin; Ryu, Youngjin; Lee, Sang Min [Seoul National University Medical Research Center, Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, 101, Daehangno, Jongno-gu, Seoul (Korea, Republic of); Park, Chang Min; Goo, Jin Mo [Seoul National University Medical Research Center, Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, 101, Daehangno, Jongno-gu, Seoul (Korea, Republic of); Seoul National University, Cancer Research Institute, Seoul (Korea, Republic of); Kim, Young Tae [Seoul National University, Cancer Research Institute, Seoul (Korea, Republic of); Seoul National University College of Medicine, Department of Thoracic and Cardiovascular Surgery, Seoul (Korea, Republic of); Kim, Young Whan [Seoul National University College of Medicine, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul (Korea, Republic of)

    2014-10-02

    To assess whether measuring the solid portion of adenocarcinomas appearing as part-solid ground-glass nodules (GGNs) can predict a patient's prognosis accurately and how the prognosis corresponds to that of solid nodules. 501 patients (solid nodule group, 304; part-solid GGN group, 197) underwent curative surgery for stage I adenocarcinomas. Maximal diameters of the whole lesion including ground-glass opacities (D{sub whole}) and solid components only (D{sub solid}) were measured on CT. Disease-free survival (DFS) and overall survival (OS) were calculated from the date of surgery. D{sub solid} was a significant prognostic factor in the part-solid GGN group, while D{sub whole} was not. Part-solid GGNs with D{sub solid} ≤2 cm showed significantly better DFS (P = 0.016) and OS (P = 0.004) than solid nodules; however, those with D{sub solid} >2 cm did not show a significant difference. Hazard ratio (HR) for increase in D{sub solid} was significantly greater in part-solid GGNs than in solid nodules (P = 0.009). For OS, HR for increase in D{sub solid} was greater in part-solid GGNs than in solid nodule, which was marginally not significant (P = 0.060). D{sub solid} was better than D{sub whole} for prognosis prediction of adenocarcinomas appearing as part-solid GGNs. In addition, the influence of D{sub solid} on prognosis in the part-solid GGN group was greater than in the solid nodule group. (orig.)

  14. Comparative analysis of 99mTc-depreotide and 99mTc-EDDA/HYNIC-TOC thorax scintigrams acquired for the purpose of differential diagnosis of solitary pulmonary nodules

    International Nuclear Information System (INIS)

    Plachcinska, A.; Kusmierek, J.; Mikolajczak, R.; Kozak, J.; Rzeszutek, K.

    2006-01-01

    Aiming at comparison of diagnostic efficacy of 2 radiopharmaceuticals: 99m Tc-depreotide (Neospect, Amersham) and 99m Tc-EDDA/HYNIC-Tyr3-octreotide (Tektrotyd, Polatom), in differentiation between malignant and benign etiology of solitary pulmonary nodules (SPNs), radionuclide studies with 2 radiotracers were performed in 18 patients. For both radiopharmaceuticals the same acquisition and processing protocols were applied. Studies were acquired with SPECT technique, after administration of 740 MBq of activity. Scintigrams were assessed visually, as: positive (+), equivocal (±) and negative (-). Additionally, uptake intensity of both radiotracers in nodules was assessed semiquantitatively, using a tumour-to-background ratio. Verification of scintigraphic results was based in 14 cases upon a pathological examination of tumour samples (histopathology) and in the remaining 4 - on clinical observation and bacteriological studies. Normal scintigrams obtained with both diopharmaceuticals differed significantly. 99m Tc-depreotide was markedly accumulated in spine, sternum, ribs and lungs (mean lung/heart ratio = 2.2). This accumulation was not observed on 99m Tc- -EDDA/HYNIC-TOC scintigrams (mean lung/heart ratio = 0.7). In 6 patients a malignant etiology - lung cancer - was revealed (5 - adenocarcinoma, 1 - squamous cell) and the other 12 cases turned out to be benign (4 hamartomas, 3 tuberculomas, a tuberculous infiltrate, an alien body with inflammatory reaction, a hyperplasia of lymphatic tissue and 2 cases of unknown etiology, from which one had a stable size and the other resolved during a 6 month observation period). In all 6 cases of lung cancer positive results were obtained with both tracers. Moreover, in 2 patients metastases in mediastinum could be observed on scintigrams obtained with both radiopharmaceuticals. From among 12 cases of benign etiology 6 99m Tc-depreotide scintigrams were true negative, 1 - equivocal and 5 - false positive, whereas 6 99m Tc

  15. Computer-aided detection (CAD) of solid pulmonary nodules in chest x-ray equivalent ultralow dose chest CT - first in-vivo results at dose levels of 0.13 mSv

    Energy Technology Data Exchange (ETDEWEB)

    Messerli, Michael, E-mail: Michael.Messerli@usz.ch [Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen (Switzerland); Kluckert, Thomas; Knitel, Meinhard [Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen (Switzerland); Rengier, Fabian [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg (Germany); Warschkow, René [Department of Surgery, Cantonal Hospital St. Gallen (Switzerland); Alkadhi, Hatem [Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich (Switzerland); Leschka, Sebastian [Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen (Switzerland); Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich (Switzerland); Wildermuth, Simon; Bauer, Ralf W. [Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen (Switzerland)

    2016-12-15

    Highlights: • Computer-aided detection (CAD) of solid pulmonary nodules was compared in 202 patients in standard dose and ultralow dose CT. • The per–nodule sensitivity of CAD was 70% in standard dose CT and 68% in ultralow dose CT. • The per–nodule sensitivity of CAD in standard dose CT was similar to ultralow dose CT in all size subgroups (all p > 0.05). • Adding CAD markings in ultralow dose CT significantly improved the sensitivity of two radiologists from 77% to 88% and from 66% to 79%, respectively. • CAD can serve as an excellent second reader for nodule detection in CT even at dose levels similar to chest X-ray. - Abstract: Objectives: To determine the value of computer-aided detection (CAD) for solid pulmonary nodules in ultralow radiation dose single-energy computed tomography (CT) of the chest using third-generation dual-source CT at 100 kV and fixed tube current at 70 mAs with tin filtration. Methods: 202 consecutive patients undergoing clinically indicated standard dose chest CT (1.8 ± 0.7 mSv) were prospectively included and scanned with an additional ultralow dose CT (0.13 ± 0.01 mSv) in the same session. Standard of reference (SOR) was established by consensus reading of standard dose CT by two radiologists. CAD was performed in standard dose and ultralow dose CT with two different reconstruction kernels. CAD detection rate of nodules was evaluated including subgroups of different nodule sizes (<5, 5–7, >7 mm). Sensitivity was further analysed in multivariable mixed effects logistic regression. Results: The SOR included 279 solid nodules (mean diameter 4.3 ± 3.4 mm, range 1–24 mm). There was no significant difference in per–nodule sensitivity of CAD in standard dose with 70% compared to 68% in ultralow dose CT both overall and in different size subgroups (all p > 0.05). CAD led to a significant increase of sensitivity for both radiologists reading the ultralow dose CT scans (all p < 0.001). In multivariable analysis, the use

  16. Computer-aided detection (CAD) of solid pulmonary nodules in chest x-ray equivalent ultralow dose chest CT - first in-vivo results at dose levels of 0.13 mSv

    International Nuclear Information System (INIS)

    Messerli, Michael; Kluckert, Thomas; Knitel, Meinhard; Rengier, Fabian; Warschkow, René; Alkadhi, Hatem; Leschka, Sebastian; Wildermuth, Simon; Bauer, Ralf W.

    2016-01-01

    Highlights: • Computer-aided detection (CAD) of solid pulmonary nodules was compared in 202 patients in standard dose and ultralow dose CT. • The per–nodule sensitivity of CAD was 70% in standard dose CT and 68% in ultralow dose CT. • The per–nodule sensitivity of CAD in standard dose CT was similar to ultralow dose CT in all size subgroups (all p > 0.05). • Adding CAD markings in ultralow dose CT significantly improved the sensitivity of two radiologists from 77% to 88% and from 66% to 79%, respectively. • CAD can serve as an excellent second reader for nodule detection in CT even at dose levels similar to chest X-ray. - Abstract: Objectives: To determine the value of computer-aided detection (CAD) for solid pulmonary nodules in ultralow radiation dose single-energy computed tomography (CT) of the chest using third-generation dual-source CT at 100 kV and fixed tube current at 70 mAs with tin filtration. Methods: 202 consecutive patients undergoing clinically indicated standard dose chest CT (1.8 ± 0.7 mSv) were prospectively included and scanned with an additional ultralow dose CT (0.13 ± 0.01 mSv) in the same session. Standard of reference (SOR) was established by consensus reading of standard dose CT by two radiologists. CAD was performed in standard dose and ultralow dose CT with two different reconstruction kernels. CAD detection rate of nodules was evaluated including subgroups of different nodule sizes (<5, 5–7, >7 mm). Sensitivity was further analysed in multivariable mixed effects logistic regression. Results: The SOR included 279 solid nodules (mean diameter 4.3 ± 3.4 mm, range 1–24 mm). There was no significant difference in per–nodule sensitivity of CAD in standard dose with 70% compared to 68% in ultralow dose CT both overall and in different size subgroups (all p > 0.05). CAD led to a significant increase of sensitivity for both radiologists reading the ultralow dose CT scans (all p < 0.001). In multivariable analysis, the use

  17. Software-based risk stratification of pulmonary adenocarcinomas manifesting as pure ground glass nodules on computed tomography.

    Science.gov (United States)

    Nemec, Ursula; Heidinger, Benedikt H; Anderson, Kevin R; Westmore, Michael S; VanderLaan, Paul A; Bankier, Alexander A

    2018-01-01

    To assess the performance of the "Computer-Aided Nodule Assessment and Risk Yield" (CANARY) software in the differentiation and risk assessment of histological subtypes of lung adenocarcinomas manifesting as pure ground glass nodules on computed tomography (CT). 64 surgically resected and histologically proven adenocarcinomas manifesting as pure ground-glass nodules on CT were assessed using CANARY software, which classifies voxel-densities into three risk components (low, intermediate, and high risk). Differences in risk components between histological adenocarcinoma subtypes were analysed. To determine the optimal threshold reflecting the presence of an invasive focus, sensitivity, specificity, negative predictive value, and positive predictive value were calculated. 28/64 (44%) were adenocarcinomas in situ (AIS); 26/64 (41%) were minimally invasive adenocarcinomas (MIA); and 10/64 (16%) were invasive ACs (IAC). The software showed significant differences in risk components between histological subtypes (Prisk components was associated with histological invasiveness (specificity 100%, positive predictive value 100%). CANARY-based risk assessment of ACs manifesting as pure ground glass nodules on CT allows the differentiation of their histological subtypes. A threshold of 45% of low-risk components reflects invasiveness in these groups. • CANARY-based risk assessment allows the differentiation of their histological subtypes. • 45% or less of low-risk component reflects histological invasiveness. • CANARY has potential role in suspected adenocarcinomas manifesting as pure ground-glass nodules.

  18. Automated lung nodule classification following automated nodule detection on CT: A serial approach

    International Nuclear Information System (INIS)

    Armato, Samuel G. III; Altman, Michael B.; Wilkie, Joel; Sone, Shusuke; Li, Feng; Doi, Kunio; Roy, Arunabha S.

    2003-01-01

    We have evaluated the performance of an automated classifier applied to the task of differentiating malignant and benign lung nodules in low-dose helical computed tomography (CT) scans acquired as part of a lung cancer screening program. The nodules classified in this manner were initially identified by our automated lung nodule detection method, so that the output of automated lung nodule detection was used as input to automated lung nodule classification. This study begins to narrow the distinction between the 'detection task' and the 'classification task'. Automated lung nodule detection is based on two- and three-dimensional analyses of the CT image data. Gray-level-thresholding techniques are used to identify initial lung nodule candidates, for which morphological and gray-level features are computed. A rule-based approach is applied to reduce the number of nodule candidates that correspond to non-nodules, and the features of remaining candidates are merged through linear discriminant analysis to obtain final detection results. Automated lung nodule classification merges the features of the lung nodule candidates identified by the detection algorithm that correspond to actual nodules through another linear discriminant classifier to distinguish between malignant and benign nodules. The automated classification method was applied to the computerized detection results obtained from a database of 393 low-dose thoracic CT scans containing 470 confirmed lung nodules (69 malignant and 401 benign nodules). Receiver operating characteristic (ROC) analysis was used to evaluate the ability of the classifier to differentiate between nodule candidates that correspond to malignant nodules and nodule candidates that correspond to benign lesions. The area under the ROC curve for this classification task attained a value of 0.79 during a leave-one-out evaluation

  19. Computer-Aided Diagnosis with Deep Learning Architecture: Applications to Breast Lesions in US Images and Pulmonary Nodules in CT Scans

    Science.gov (United States)

    Cheng, Jie-Zhi; Ni, Dong; Chou, Yi-Hong; Qin, Jing; Tiu, Chui-Mei; Chang, Yeun-Chung; Huang, Chiun-Sheng; Shen, Dinggang; Chen, Chung-Ming

    2016-04-01

    This paper performs a comprehensive study on the deep-learning-based computer-aided diagnosis (CADx) for the differential diagnosis of benign and malignant nodules/lesions by avoiding the potential errors caused by inaccurate image processing results (e.g., boundary segmentation), as well as the classification bias resulting from a less robust feature set, as involved in most conventional CADx algorithms. Specifically, the stacked denoising auto-encoder (SDAE) is exploited on the two CADx applications for the differentiation of breast ultrasound lesions and lung CT nodules. The SDAE architecture is well equipped with the automatic feature exploration mechanism and noise tolerance advantage, and hence may be suitable to deal with the intrinsically noisy property of medical image data from various imaging modalities. To show the outperformance of SDAE-based CADx over the conventional scheme, two latest conventional CADx algorithms are implemented for comparison. 10 times of 10-fold cross-validations are conducted to illustrate the efficacy of the SDAE-based CADx algorithm. The experimental results show the significant performance boost by the SDAE-based CADx algorithm over the two conventional methods, suggesting that deep learning techniques can potentially change the design paradigm of the CADx systems without the need of explicit design and selection of problem-oriented features.

  20. Software-based risk stratification of pulmonary adenocarcinomas manifesting as pure ground glass nodules on computed tomography

    International Nuclear Information System (INIS)

    Nemec, Ursula; Heidinger, Benedikt H.; Bankier, Alexander A.; Anderson, Kevin R.; VanderLaan, Paul A.; Westmore, Michael S.

    2018-01-01

    To assess the performance of the ''Computer-Aided Nodule Assessment and Risk Yield'' (CANARY) software in the differentiation and risk assessment of histological subtypes of lung adenocarcinomas manifesting as pure ground glass nodules on computed tomography (CT). 64 surgically resected and histologically proven adenocarcinomas manifesting as pure ground-glass nodules on CT were assessed using CANARY software, which classifies voxel-densities into three risk components (low, intermediate, and high risk). Differences in risk components between histological adenocarcinoma subtypes were analysed. To determine the optimal threshold reflecting the presence of an invasive focus, sensitivity, specificity, negative predictive value, and positive predictive value were calculated. 28/64 (44%) were adenocarcinomas in situ (AIS); 26/64 (41%) were minimally invasive adenocarcinomas (MIA); and 10/64 (16%) were invasive ACs (IAC). The software showed significant differences in risk components between histological subtypes (P<0.001-0.003). A relative volume of 45% or less of low-risk components was associated with histological invasiveness (specificity 100%, positive predictive value 100%). CANARY-based risk assessment of ACs manifesting as pure ground glass nodules on CT allows the differentiation of their histological subtypes. A threshold of 45% of low-risk components reflects invasiveness in these groups. (orig.)

  1. Software-based risk stratification of pulmonary adenocarcinomas manifesting as pure ground glass nodules on computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Nemec, Ursula [Vienna General Hospital, Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Heidinger, Benedikt H.; Bankier, Alexander A. [Harvard Medical School, Radiology, Beth Israel Deaconess Medical Center, Boston, MA (United States); Anderson, Kevin R.; VanderLaan, Paul A. [Harvard Medical School, Pathology, Beth Israel Deaconess Medical Center, Boston, MA (United States); Westmore, Michael S. [Imbio, Delafield, WI (United States)

    2018-01-15

    To assess the performance of the ''Computer-Aided Nodule Assessment and Risk Yield'' (CANARY) software in the differentiation and risk assessment of histological subtypes of lung adenocarcinomas manifesting as pure ground glass nodules on computed tomography (CT). 64 surgically resected and histologically proven adenocarcinomas manifesting as pure ground-glass nodules on CT were assessed using CANARY software, which classifies voxel-densities into three risk components (low, intermediate, and high risk). Differences in risk components between histological adenocarcinoma subtypes were analysed. To determine the optimal threshold reflecting the presence of an invasive focus, sensitivity, specificity, negative predictive value, and positive predictive value were calculated. 28/64 (44%) were adenocarcinomas in situ (AIS); 26/64 (41%) were minimally invasive adenocarcinomas (MIA); and 10/64 (16%) were invasive ACs (IAC). The software showed significant differences in risk components between histological subtypes (P<0.001-0.003). A relative volume of 45% or less of low-risk components was associated with histological invasiveness (specificity 100%, positive predictive value 100%). CANARY-based risk assessment of ACs manifesting as pure ground glass nodules on CT allows the differentiation of their histological subtypes. A threshold of 45% of low-risk components reflects invasiveness in these groups. (orig.)

  2. Computer-assisted detection of pulmonary nodules: evaluation of diagnostic performance using an expert knowledge-based detection system with variable reconstruction slice thickness settings

    International Nuclear Information System (INIS)

    Marten, Katharina; Grillhoesl, Andreas; Seyfarth, Tobias; Rummeny, Ernst J.; Engelke, Christoph; Obenauer, Silvia

    2005-01-01

    The purpose of this study was to evaluate the performance of a computer-assisted diagnostic (CAD) tool using various reconstruction slice thicknesses (RST). Image data of 20 patients undergoing multislice CT for pulmonary metastasis were reconstructed at 4.0, 2.0 and 0.75 mm RST and assessed by two blinded radiologists (R1 and R2) and CAD. Data were compared against an independent reference standard. Nodule subgroups (diameter >10, 4-10, <4 mm) were assessed separately. Statistical methods were the ROC analysis and Mann-Whitney Utest. CAD was outperformed by readers at 4.0 mm (Az = 0.18, 0.62 and 0.69 for CAD, R1 and R2, respectively; P<0.05), comparable at 2.0 mm (Az = 0.57, 0.70 and 0.69 for CAD, R1 and R2, respectively), and superior using 0.75 mm RST (Az = 0.80, 0.70 and 0.70 and sensitivity = 0.74, 0.53 and 0.53 for CAD, R1 and R2, respectively; P<0.05). Reader performances were significantly enhanced by CAD (Az = 0.93 and 0.95 for R1 + CAD and R2 + CAD, respectively, P<0.05). The CAD advantage was best for nodules <10 mm (detection rates = 93.3, 89.9, 47.9 and 47.9% for R1 + CAD, R2 + CAD, R1 and R2, respectively). CAD using 0.75 mm RST outperformed radiologists in nodules below 10 mm in diameter and should be used to replace a second radiologist. CAD is not recommended for 4.0 mm RST. (orig.)

  3. Segmentation of pulmonary nodules in computed tomography using a regression neural network approach and its application to the Lung Image Database Consortium and Image Database Resource Initiative dataset.

    Science.gov (United States)

    Messay, Temesguen; Hardie, Russell C; Tuinstra, Timothy R

    2015-05-01

    We present new pulmonary nodule segmentation algorithms for computed tomography (CT). These include a fully-automated (FA) system, a semi-automated (SA) system, and a hybrid system. Like most traditional systems, the new FA system requires only a single user-supplied cue point. On the other hand, the SA system represents a new algorithm class requiring 8 user-supplied control points. This does increase the burden on the user, but we show that the resulting system is highly robust and can handle a variety of challenging cases. The proposed hybrid system starts with the FA system. If improved segmentation results are needed, the SA system is then deployed. The FA segmentation engine has 2 free parameters, and the SA system has 3. These parameters are adaptively determined for each nodule in a search process guided by a regression neural network (RNN). The RNN uses a number of features computed for each candidate segmentation. We train and test our systems using the new Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI) data. To the best of our knowledge, this is one of the first nodule-specific performance benchmarks using the new LIDC-IDRI dataset. We also compare the performance of the proposed methods with several previously reported results on the same data used by those other methods. Our results suggest that the proposed FA system improves upon the state-of-the-art, and the SA system offers a considerable boost over the FA system. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

  4. Analysis of pulmonary coin lesions

    International Nuclear Information System (INIS)

    Kim, O; Kim, K. H.; Oh, K. K.; Park, C. Y.

    1979-01-01

    For A long time the solitary pulmonary nodule has remained a difficult problem to solve and has attracted a great deal of attension in recent years. Circumscribed coin lesions of the lung were generally peripheral in location with respect to the pulmonary hilus. Because of this, important clinical problem in management and diagnosis arise. Such a lesion is discovered through roentgenologic examination. So the roentgenologists is the first be in a position to offer advise. This presentation is an attempt to correlate a useful diagnosis with roentgenologic findings of pulmonary coin lesion which enables us to get differential diagnosis of benign and malignant lesion. Histologically proven 120 cases of the pulmonary coin lesion during the period of 8 years were reviewed through plain film, tomogram, bronchoscopy, variable laboratory findings, and clinical history. The results are as follows: 1. Male to female sex ratio was 3 : 1. In age distribution, most of the malignant pulmonary coin lesion appeared in 6th decade (39%) and 5th decade (27%). In benign lesion, the most cases were in 3 rd decade. 2. Pathological cell type are as follows: Primary bronchogenic cancer 43.3%, tuberculoma 25.8%, inflammatory lesion 17.5%, benign tumor 10%, and bronchial adenoma, harmartoma, A.V. malformation, mesothelioma, are 1 case respectively. As a result benign and malignant lesion showed equal distribution (49.1% : 50.3%). 3. In symptom analysis ; cough is the most common (43.5%) symptom in malignant lesion, next follows hemoptysis (20.9%) and chest pain (14.5%). In benign lesion, most of the patient (32.7%) did not complain any symptom. 4. In malignant lesion, the most common nodular size was 4 cm (32.3%), and in benign lesion 2 cm sized coin was most common (39.3%). 5. In general, margin of nodule was very sharp and well demarcated in benign lesion (83.3%), and in malignant lesion that was less demarcated and poorly defined. 6. Most case of calcification (82.7%) was seen in benign

  5. Thyroid Nodules

    Science.gov (United States)

    Thyroid nodules Overview Thyroid nodules are solid or fluid-filled lumps that form within your thyroid, a small gland located at the base of ... just above your breastbone. The great majority of thyroid nodules aren't serious and don't cause ...

  6. Improving the Diagnostic Specificity of CT for Early Detection of Lung Cancer: 4D CT-Based Pulmonary Nodule Elastometry

    Science.gov (United States)

    2015-10-01

    A549 and SK-MES-1 cells from American Tissue Culture Collection (ATCC), carbon nanotubes (catalogue number 900–1501, lot GS1801), SES research...protocol and optimize software 3a. Inoculate 10 rats with orthotopic human lung cancer cells ( A549 , left lung) and carbon nanotubes (right lung...benign lesions and follow with serial MicroCT imaging, analyze data 4a. Inoculate remaining 40 rats ( A549 cells, left lung in Rowett nude rats) and

  7. Data-driven decision support for radiologists: re-using the National Lung Screening Trial dataset for pulmonary nodule management.

    Science.gov (United States)

    Morrison, James J; Hostetter, Jason; Wang, Kenneth; Siegel, Eliot L

    2015-02-01

    Real-time mining of large research trial datasets enables development of case-based clinical decision support tools. Several applicable research datasets exist including the National Lung Screening Trial (NLST), a dataset unparalleled in size and scope for studying population-based lung cancer screening. Using these data, a clinical decision support tool was developed which matches patient demographics and lung nodule characteristics to a cohort of similar patients. The NLST dataset was converted into Structured Query Language (SQL) tables hosted on a web server, and a web-based JavaScript application was developed which performs real-time queries. JavaScript is used for both the server-side and client-side language, allowing for rapid development of a robust client interface and server-side data layer. Real-time data mining of user-specified patient cohorts achieved a rapid return of cohort cancer statistics and lung nodule distribution information. This system demonstrates the potential of individualized real-time data mining using large high-quality clinical trial datasets to drive evidence-based clinical decision-making.

  8. Benign Metastasizing Leiomyoma: A Rare Type of Lung Metastases—Two Case Reports and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Rokana Taftaf

    2014-01-01

    Full Text Available Benign metastasizing leiomyoma (BML is a rare disease that usually occurs in women of reproductive age. They typically have history of uterine leiomyoma treated with hysterectomy. BML can metastasize to distant organs, with the lung being the most common organ. We report two patients who presented with benign metastasizing leiomyoma to the lung. Our first case was a fifty-two-year-old female who presented with multiple lung masses, with a past medical history of uterine leiomyoma who underwent hysterectomy 17 years ago. A CT-guided biopsy showed benign appearing spindle cells and pathology confirmed her diagnosis with additional positive estrogen/progesterone receptor stains. Our second case was a fifty-six-year-old female who presented with multiple cavitary pulmonary nodules. She subsequently underwent a video-assisted thoracoscopic surgery (VATS with wedge resection of one of the nodules. Pathology confirmed the diagnosis based on morphology and immunohistochemical staining strongly positive for estrogen/progesterone receptors. Benign metastasizing leiomyoma is a rare condition which may affect women of reproductive age. This should be considered in the differential in patients who present with multiple pulmonary nodules, especially with a history of uterine leiomyoma. Additional stains, such as estrogen/progesterone receptors, may need to be done to confirm the diagnosis.

  9. Comparing Pulmonary Nodule Location During Electromagnetic Bronchoscopy With Predicted Location on the Basis of Two Virtual Airway Maps at Different Phases of Respiration.

    Science.gov (United States)

    Furukawa, Brian S; Pastis, Nicholas J; Tanner, Nichole T; Chen, Alexander; Silvestri, Gerard A

    2018-01-01

    Electromagnetic navigational bronchoscopy (ENB) is guided bronchoscopy to pulmonary nodules (PN) that relies on a preprocedural chest CT to create a three-dimensional (3D) virtual airway map. The CT is traditionally done at a full inspiratory breath hold (INSP), but the procedure is performed while the patient tidal breaths, when lung volumes are closer to functional residual capacity. Movement of a PN from INSP to expiration (EXP) has been shown to average 17.6 mm. Therefore, the hypothesis of this study is that preprocedural virtual maps built off a CT closer to physiological lung volumes during bronchoscopy may better represent the actual 3D location of a PN. Consecutive patients with a PN needing a histological diagnosis were enrolled. A preprocedure INSP and EXP CT scan were obtained to create two virtual maps. During the airway inspection, the system tracked the sensor probe to collect 3D points that were reconstructed into the lumen registration map. This map is thought to best represent the patient's airways during bronchoscopy. Predicted PN location on an EXP and INSP map was compared with lumen registration. Twenty consecutive PN underwent ENB. The predicted PN location, compared with lumen registration, was significantly closer on EXP vs INSP (4.5 mm ± 3.3 mm vs 14.8 mm ± 9.7 mm; p location using an EXP scan for ENB is significantly closer to actual nodule location when compared with an INSP scan, but whether this leads to increased yields needs to be determined. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  10. Thoracic Malignancies and Pulmonary Nodules in Patients under Evaluation for Transcatheter Aortic Valve Implantation (TAVI: Incidence, Follow Up and Possible Impact on Treatment Decision.

    Directory of Open Access Journals (Sweden)

    Lars Henning Schmidt

    Full Text Available Transcatheter aortic valve implantation (TAVI has become the treatment of choice in patients with severe aortic valve stenosis who are not eligible for operative replacement and an alternative for those with high surgical risk. Due to high age and smoking history in a high proportion of TAVI patients, suspicious findings are frequently observed in pre-procedural chest computer tomography (CCT.CCT scans of 484 consecutive patients undergoing TAVI were evaluated for incidentally discovered solitary pulmonary nodules (SPN.In the entire study population, SPN ≥ 5 mm were found in 87 patients (18%. These patients were compared to 150 patients who were incidentally collected from the 397 patients without SPN or with SPN 8 mm (p = 0.328 were significant predictors of overall survival.Despite the high prevalence of SPNs in this single center TAVI cohort lung cancer incidence at midterm follow-up seems to be low. Thus, aggressive diagnostic approaches for incidentally discovered SPN during TAVI evaluation should not delay the treatment of aortic stenosis. Unless advanced thoracic malignancy is obvious, the well documented reduction of morbidity and mortality by TAVI outweighs potentially harmful delays regarding further diagnostics. Standard guideline-approved procedure for SPN can be safely performed after TAVI.

  11. Multicenter external validation of two malignancy risk prediction models in patients undergoing 18F-FDG-PET for solitary pulmonary nodule evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Perandini, Simone; Soardi, G.A.; Signorini, M.; Motton, M.; Montemezzi, S. [Azienda Ospedaliera Universitaria Integrata di Verona, UOC Radiologia, Ospedale Maggiore di Borgo Trento, Verona (Italy); Larici, A.R.; Del Ciello, A. [Universita Cattolica del Sacro Cuore, Dipartimento di Scienze Radiologiche, Roma (Italy); Rizzardi, G. [Ospedale Humanitas Gavazzeni, UO Chirurgia Toracica, Bergamo (Italy); Solazzo, A. [Ospedale Humanitas Gavazzeni, UO Radiologia, Bergamo (Italy); Mancino, L.; Zeraj, F. [Ospedale dell' Angelo di Mestre, UO Pneumologia, Venezia (Italy); Bernhart, M. [Ospedale dell' Angelo di Mestre, UO Radiologia, Venezia (Italy)

    2017-05-15

    To achieve multicentre external validation of the Herder and Bayesian Inference Malignancy Calculator (BIMC) models. Two hundred and fifty-nine solitary pulmonary nodules (SPNs) collected from four major hospitals which underwent 18-FDG-PET characterization were included in this multicentre retrospective study. The Herder model was tested on all available lesions (group A). A subgroup of 180 SPNs (group B) was used to provide unbiased comparison between the Herder and BIMC models. Receiver operating characteristic (ROC) area under the curve (AUC) analysis was performed to assess diagnostic accuracy. Decision analysis was performed by adopting the risk threshold stated in British Thoracic Society (BTS) guidelines. Unbiased comparison performed In Group B showed a ROC AUC for the Herder model of 0.807 (95 % CI 0.742-0.862) and for the BIMC model of 0.822 (95 % CI 0.758-0.875). Both the Herder and the BIMC models were proven to accurately predict the risk of malignancy when tested on a large multicentre external case series. The BIMC model seems advantageous on the basis of a more favourable decision analysis. (orig.)

  12. Solitary Pulmonary Nodule on Helical Dynamic CT Scans: Analysis of the Enhancement Patterns Using a Computer-Aided Diagnosis (CAD) System

    International Nuclear Information System (INIS)

    Choi, Eun Jung; Jin, Gong Yong; Han, Young Min; Lee, Young Sun; Kweon, Keun Sang

    2008-01-01

    We wanted to investigate the usefulness of a computer-aided diagnosis (CAD) system in assisting radiologists to diagnosis malignant solitary pulmonary nodules (SPNs), as compared with diagnosing SPNs with using direct personal drawing. Forty patients with SPNs were analyzed. After the pre-contrast scan was performed, an additional ten series of post-contrast images were obtained at 20-second intervals. Two investigators measured the attenuation values of the SPNs: a radiologist who drew the regions of interest (ROIs), and a technician who used a CAD system. The Bland and Altman plots were used to compare the net enhancement between a CAD system and direct personal drawing. The diagnostic characteristics of the malignant SPNs were calculated by considering the CAD and direct personal drawing and with using Fisher's exact test. On the Bland and Altman plot, the net enhancement difference between the CAD system and direct personal drawing was not significant (within ± 2 standard deriation). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of diagnosing malignant SPNs using CAD was 92%, 85%, 75%, 96% and 88%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of diagnosing malignant SPNs using direct drawing was 92%, 89%, 79%, 92% and 88%, respectively. The CAD system was a useful tool for diagnosing malignant SPNs

  13. Manganese nodules

    Science.gov (United States)

    Hein, James R.; Harff, Jan; Petersen, Sven; Thiede, Jorn

    2016-01-01

    The existence of manganese (Mn) nodules (Figure 1) has been known since the late 1800s when they were collected during the Challenger expedition of 1873–1876. However, it was not until after WWII that nodules were further studied in detail for their ability to adsorb metals from seawater. Many of the early studies did not distinguish Mn nodules from Mn crusts. Economic interest in Mn nodules began in the late 1950s and early 1960s when John Mero finished his Ph.D. thesis on this subject, which was published in the journal Economic Geology (Mero, 1962) and later as a book (Mero, 1965). By the mid-1970s, large consortia had formed to search for and mine Mn nodules that occur between the Clarion and Clipperton fracture zones (CCZ) in the NE Pacific (Figure 2). This is still the area considered of greatest economic potential in the global ocean because of high nickel (Ni), copper (Cu), and Mn contents and the dense distribution of nodules in the area. While the mining of nodules was fully expected to begin in the late 1970s or early 1980s, this never occurred due to a downturn in the price of metals on the global market. Since then, many research cruises have been undertaken to study the CCZ nodules, and now 15 contracts for exploration sites have been given or are pending by the International Seabed Authority (ISA). Many books and science journal articles have been published summarizing the early work (e.g., Baturin, 1988; Halbach et al., 1988), and research has continued to the present day (e.g., ISA, 1999; ISA, 2010). Although the initial attraction for nodules was their high Ni, Cu, and Mn contents, subsequent work has shown that nodules host large quantities of other critical metals needed for high-tech, green-tech, and energy applications (Hein et al., 2013; Hein and Koschinsky, 2014).

  14. Projected outcomes using different nodule sizes to define a positive CT lung cancer screening examination.

    Science.gov (United States)

    Gierada, David S; Pinsky, Paul; Nath, Hrudaya; Chiles, Caroline; Duan, Fenghai; Aberle, Denise R

    2014-11-01

    Computed tomography (CT) screening for lung cancer has been associated with a high frequency of false positive results because of the high prevalence of indeterminate but usually benign small pulmonary nodules. The acceptability of reducing false-positive rates and diagnostic evaluations by increasing the nodule size threshold for a positive screen depends on the projected balance between benefits and risks. We examined data from the National Lung Screening Trial (NLST) to estimate screening CT performance and outcomes for scans with nodules above the 4mm NLST threshold used to classify a CT screen as positive. Outcomes assessed included screening results, subsequent diagnostic tests performed, lung cancer histology and stage distribution, and lung cancer mortality. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the different nodule size thresholds. All statistical tests were two-sided. In 64% of positive screens (11598/18141), the largest nodule was 7 mm or less in greatest transverse diameter. By increasing the threshold, the percentages of lung cancer diagnoses that would have been missed or delayed and false positives that would have been avoided progressively increased, for example from 1.0% and 15.8% at a 5 mm threshold to 10.5% and 65.8% at an 8 mm threshold, respectively. The projected reductions in postscreening follow-up CT scans and invasive procedures also increased as the threshold was raised. Differences across nodules sizes for lung cancer histology and stage distribution were small but statistically significant. There were no differences across nodule sizes in survival or mortality. Raising the nodule size threshold for a positive screen would substantially reduce false-positive CT screenings and medical resource utilization with a variable impact on screening outcomes. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  15. Reduction of the irradiation dose and reproducibility of the volumetry of pulmonary nodules; Reduction de la dose d'irradiation et reproductibilite de la volumetrie de nodules pulmonaires

    Energy Technology Data Exchange (ETDEWEB)

    Gosset, N.; Maertelaer, V. de; Tack, D.; Gevenois, P

    2006-10-15

    The objective of this work is to estimate the influence of the reduction of the irradiation dose of the T.D.M. on the reproducibility of the semi-automatic volumetric measure of lung nodules. After study it seems that the reproducibility of the volumetric measures of lung nodules is good in standard doses and in low doses but not in passing from the one to the other one. (N.C.)

  16. Pulmonary manifestations of malaria

    Energy Technology Data Exchange (ETDEWEB)

    Rauber, K.; Enkerlin, H.L.; Riemann, H.; Schoeppe, W.

    1987-05-01

    We report on the two different types of pulmonary manifestations in acute plasmodium falciparum malaria. The more severe variant shows long standing interstitial pulmonary infiltrates, whereas in the more benign courses only short-term pulmonary edemas are visible.

  17. Thyroid nodule

    Science.gov (United States)

    ... symptoms, including: Fatigue Palpitations Chest pain Memory loss Thyroid nodules are sometimes found in people who have Hashimoto's disease. This may cause symptoms of an underactive thyroid gland, such as: Dry ...

  18. US Diagnosis for Thyroid Nodules with an Indeterminate Cytology

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Jong Geun; Kim, Dong Wook [Busan Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of); Kang, Tae Woo [Saegyaero Hospital, Busan (Korea, Republic of)

    2011-09-15

    We wanted to assess the diagnostic efficacy of thyroid ultrasound (US) for evaluating thyroid nodules with indeterminate cytology. Among 1865 nodules in 1278 patients who received a prospective US diagnosis of their thyroid nodule(s) and who subsequently underwent US-guided fine-needle aspiration, 130 nodules with indeterminate cytology were enrolled in the study. Each thyroid nodule was prospectively classified by a single radiologist into 1 of 5 diagnostic categories: 'benign', 'probably benign', 'indeterminate', 'suspicious for malignancy' and 'malignant.' The solid nodules were classified using all 5 categories and the partially cystic nodules classified using 4 categories ('indeterminate' was omitted). We calculated the diagnostic efficacy of thyroid US by comparing the US diagnoses with the pathology results. Of 130 nodules with indeterminate cytology (130/1865, 7.0%), 62 nodules were surgically removed. Nineteen nodules were assigned to the indeterminate category on US. The malignantly rate of the US-indeterminate category was 56.5% (35/62). The sensitivity, specificity and positive and negative predictive values were 81.0%, 81.8%, 81.0%, 81.8% and 81.4%, respectively, when US-indeterminate nodules were excluded. There was no significant difference of diagnostic efficacy when these nodules were reclassified as malignant, but there was a significant difference of diagnostic efficacy when these nodules were reclassified as benign. Our US classification may be a feasible method for managing thyroid nodules with indeterminate cytology

  19. Cost-effectiveness of FDG-PET for the management of solitary pulmonary nodules: a decision analysis based on cost reimbursement in Germany

    International Nuclear Information System (INIS)

    Dietlein, M.; Weber, K.; Moka, D.; Theissen, P.; Schicha, H.; Gandjour, A.; Lauterbach, K.W.

    2000-01-01

    Management of solitary pulmonary nodules (SPNs) of up to 3 cm was modelled on decision analysis comparing ''wait and watch'', transthoracic needle biopsy (TNB), exploratory surgery and full-ring dedicated positron emission tomography (PET) using fluorine-18 2-fluorodeoxyglucose (FDG). The incremental cost-effectiveness ratios (ICERs) were calculated for the main risk group, a cohort of 62-year-old men, using first ''wait and watch'' and second exploratory surgery as the baseline strategy. Based on published data, the sensitivity and specificity of FDG-PET were estimated at 0.95 and 0.80 for detecting malignancy in SPNs and at 0.74 and 0.96 for detecting metastasis in normal-sized mediastinal lymph nodes. The costs quoted correspond to reimbursement in 1999 by the public health provider in Germany. Decision analysis modelling indicates the potential cost-effectiveness of the FDG-PET strategy for management of SPNs. Taking watchful waiting as the low-cost baseline strategy, the ICER of PET [3218 euros (EUR) per life year saved] was more favourable than that of exploratory surgery (4210 EUR/year) or that of TNB (6120 EUR/year). Changing the baseline strategy to exploratory surgery, the use of PET led to cost savings and additional life expectancy. This constellation was described by a negative ICER of -6912 EUR/year. The PET algorithm was cost-effective for risk and non-risk patients. However, the ICER of PET as the preferred strategy was sensitive to a hypothetical deterioration of any PET parameters by more than 0.07. To transfer the diagnostic efficacy from controlled studies to the routine user and to maintain the cost-effectiveness of this technology, obligatory protocols for data acquisitions would need to be defined. If the prevalence of SPNs is estimated at the USA level (52 per 100,000 individuals) and assuming that multiple strategies without PET are the norm, the overall costs of a newly implemented PET algorithm would be limited to far less than one EUR

  20. The role of dual time point FDG PET imaging in the evaluation of solitary pulmonary nodules with an initial standard uptake value less than 2.5

    International Nuclear Information System (INIS)

    MacDonald, K.; Searle, J.; Lyburn, I.

    2011-01-01

    Aim: To evaluate the accuracy of dual time point 2-[ 18 F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography (PET) imaging in the evaluation of the mildly metabolic solitary pulmonary nodule (SPN) and to assess whether accuracy could be improved by delaying second image acquisition to 180 minutes. Materials and methods: Fifty-four patients were included in the study. Thirty-six had an SUV max max of SPNs on delayed imaging, in which an SUV max of 2.5 or more was regarded as a criterion for malignancy. The second method was retention index (RI) analysis, in which an increase of 10% or more in SUV max between the initial and delayed images, was regarded as an indication of malignancy. Results: For the group as a whole (n = 54), the sensitivity, specificity and accuracy of using an SUV max of 2.5 or more as an indication of malignancy at the time of initial image acquisition (60 min) was 58, 89, and 74%, respectively. For SPNs that had an initial SUV max max of 2.5 or more as a criterion for malignancy on the delayed image acquisition (180 min), was 36, 96, and 78% respectively. However, if an RI of >10% was used as a criterion for malignancy between the initial and delayed images, the sensitivity, specificity, and accuracy was 73, 80, and 78%, respectively. These results are similar to a recent paper, where image acquisition occurred at 60 and 120 min post-tracer injection. Conclusion: Dual time point FDG PET imaging with RI analysis, is a useful technique in evaluating SPN with an initial SUV max <2.5. Prolonging second image acquisition from 120 to 180 min does not appear to improve the accuracy of this technique. However, given that maximal FDG uptake by lung carcinomas is thought to be in the region of 5 h, it may be that improving the accuracy of dual time point FDG PET imaging requires a more significant delay in second image acquisition in this specific subgroup.

  1. Clinical relevance of imaging proliferative activity in lung nodules

    Energy Technology Data Exchange (ETDEWEB)

    Buck, Andreas K.; Schirrmeister, Holger; Kratochwil, Clemens; Wahl, Andreas; Glatting, Gerhard; Mottaghy, Felix M.; Neumaier, Bernd; Reske, Sven N. [University of Ulm, Department of Nuclear Medicine, Ulm (Germany); Hetzel, Martin [University of Ulm, Department of Internal Medicine II - Pulmonary Medicine, Ulm (Germany); Halter, Gisela [University of Ulm, Department of Thoracic Surgery, Ulm (Germany); Moeller, Peter; Mattfeldt, Torsten [University of Ulm, Department of Pathology, Ulm (Germany)

    2005-04-01

    Recently, the thymidine analogue 3'-deoxy-3'[{sup 18}F]fluorothymidine (FLT) has been introduced for imaging proliferation with positron emission tomography (PET). In this prospective study, we examined the accuracy of FLT for differentiation of benign from malignant lung lesions and for tumour staging. A total of 47 patients with newly diagnosed pulmonary nodules on chest CT suspicious for malignancy were examined with FLT-PET in addition to routine staging procedures. A total of 43 patients also underwent 2-[{sup 18}F]fluoro-2-deoxy-D-glucose (FDG) PET imaging. Within 2 weeks, patients underwent resective surgery or core biopsy of the pulmonary lesion. Histopathology revealed malignant lung tumours in 32 patients (20 non-small cell lung cancer, 1 small cell lung cancer, 1 pulmonary carcinoid, 1 non-Hodgkin's lymphoma, nine metastases from extrapulmonary tumours) and benign lesions in 15 patients. Increased FLT uptake was exclusively related to malignant tumours. FLT-PET was false negative in two patients with non-small cell lung cancer, in the patient with a pulmonary carcinoid and in three patients with lung metastases. The sensitivity of FLT-PET for detection of lung cancer was 90%, the specificity 100% and the accuracy 94%. Fifteen out of 21 patients with lung cancer had mediastinal lymph node metastases. FLT-PET was true positive in 7/15 patients, resulting in a sensitivity of 53% for N-staging (specificity 100%, accuracy 67%). Clinical TNM stage was correctly identified in 67% (20/30) patients, compared to 85% (23/27) with FDG-PET. FLT-PET has a high specificity for the detection of malignant lung tumours. Compared with FDG, FLT-PET is less accurate for N-staging in patients with lung cancer and for detection of lung metastases. FLT-PET therefore cannot be recommended for staging of lung cancer. (orig.)

  2. A thyroid nodule classification method based on TI-RADS

    Science.gov (United States)

    Wang, Hao; Yang, Yang; Peng, Bo; Chen, Qin

    2017-07-01

    Thyroid Imaging Reporting and Data System(TI-RADS) is a valuable tool for differentiating the benign and the malignant thyroid nodules. In clinic, doctors can determine the extent of being benign or malignant in terms of different classes by using TI-RADS. Classification represents the degree of malignancy of thyroid nodules. TI-RADS as a classification standard can be used to guide the ultrasonic doctor to examine thyroid nodules more accurately and reliably. In this paper, we aim to classify the thyroid nodules with the help of TI-RADS. To this end, four ultrasound signs, i.e., cystic and solid, echo pattern, boundary feature and calcification of thyroid nodules are extracted and converted into feature vectors. Then semi-supervised fuzzy C-means ensemble (SS-FCME) model is applied to obtain the classification results. The experimental results demonstrate that the proposed method can help doctors diagnose the thyroid nodules effectively.

  3. Recurrent respiratory papillomatosis with pulmonary involvement

    International Nuclear Information System (INIS)

    Ikawa, Marcos Hiroyuki

    2008-01-01

    A five-year-old girl developed hoarseness with gradual worsening at the age of eight months. Three months later, she underwent bronchoscopy in which papillomas in the vocal cords, larynx and trachea were observed. Because of serious bronchospasm crises and respiratory failure, she needed several hospitalizations, definitive tracheostomy and multiple endoscopic procedures for papilloma excision. The most recent chest radiography (Figure A) and computed tomography (CT) scans (Figures B and C) showed a nodule inside the trachea and multiple pulmonary nodules, cysts and consolidations. The anatomopathological findings from curettage of the lesions revealed benign squamous-cell papillomas. Recurrent respiratory papillomatosis (RRP) is directly related to the human papillomavirus (HPV). Its spread to the lower airways is uncommon, with involvement of trachea and/or proximal bronchi in 5% of the patients, and extension to the lungs in only 1% of the cases. (author)

  4. Pulmonary cavitary mass containing a mural nodule: differential diagnosis between intracavitary aspergilloma and cavitating lung cancer on contrast-enhanced computed tomography

    International Nuclear Information System (INIS)

    Park, Y.; Kim, T.S.; Yi, C.A.; Cho, E.Y.; Kim, H.; Choi, Y.S.

    2007-01-01

    Aim: The objective of this study was to identify whether there were any significant differences in the computed tomography (CT) findings of an intracavitary aspergilloma and a cavitating lung cancer containing a mural nodule. Materials and methods: The CT and histopathological findings of 12 patients (male:female ratio 3:9; aged 51-76 years) with cavitating lung cancer containing a mural nodule and 26 patients (male:female ratio 14:12; aged 29-72 years) with intracavitary aspergilloma were retrospectively reviewed. Results: The mural nodules within cavitating lung cancer were more enhanced (p < 0.001) and showed a nondependent location more frequently (p = 0.012) than those of intracavitary aspergillomas. The cavitary walls were thicker in cavitating lung cancer (mean 5.8 mm thick) than those in intracavitary aspergillomas (mean 2.6 mm thick; p = 0.035). Adjacent bronchiectasis and volume decrease of the involved lobe were observed more frequently in intracavitary aspergillomas than in cavitating lung cancers (p < 0.001 and p = 0.008, respectively). Conclusion: Whether a mural nodule within a cavitary lesion is contrast-enhanced or not is one of the most important features in making a differential diagnosis between an intracavitary aspergilloma and a cavitating lung cancer. Assessment of dependent location of a mural nodule within the cavity and wall thickness of the cavity itself can also be helpful for differentiation

  5. Pulmonary cavitary mass containing a mural nodule: differential diagnosis between intracavitary aspergilloma and cavitating lung cancer on contrast-enhanced computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Park, Y. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Kim, T.S. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of)]. E-mail: tskim.kim@samsung.com; Yi, C.A. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Cho, E.Y. [Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Kim, H. [Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Choi, Y.S. [Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of)

    2007-03-15

    Aim: The objective of this study was to identify whether there were any significant differences in the computed tomography (CT) findings of an intracavitary aspergilloma and a cavitating lung cancer containing a mural nodule. Materials and methods: The CT and histopathological findings of 12 patients (male:female ratio 3:9; aged 51-76 years) with cavitating lung cancer containing a mural nodule and 26 patients (male:female ratio 14:12; aged 29-72 years) with intracavitary aspergilloma were retrospectively reviewed. Results: The mural nodules within cavitating lung cancer were more enhanced (p < 0.001) and showed a nondependent location more frequently (p = 0.012) than those of intracavitary aspergillomas. The cavitary walls were thicker in cavitating lung cancer (mean 5.8 mm thick) than those in intracavitary aspergillomas (mean 2.6 mm thick; p = 0.035). Adjacent bronchiectasis and volume decrease of the involved lobe were observed more frequently in intracavitary aspergillomas than in cavitating lung cancers (p < 0.001 and p = 0.008, respectively). Conclusion: Whether a mural nodule within a cavitary lesion is contrast-enhanced or not is one of the most important features in making a differential diagnosis between an intracavitary aspergilloma and a cavitating lung cancer. Assessment of dependent location of a mural nodule within the cavity and wall thickness of the cavity itself can also be helpful for differentiation.

  6. A lung cancer case with numerous calcified metastatic nodules of the brain

    International Nuclear Information System (INIS)

    Fukuda, Y.; Homma, T.; Kohga, H.; Uki, J.; Shisa, H.

    1988-01-01

    A case of pulmonary adenocarcinoma with numerous calcified metastatic nodules of the brain is reported. Autopsy revealed about 400 metastatic nodules in the central nervous system, most of which were calcified. (orig.)

  7. Comparison of the effects of model-based iterative reconstruction and filtered back projection algorithms on software measurements in pulmonary subsolid nodules

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, Julien G. [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Centre Hospitalier Universitaire de Grenoble, Clinique Universitaire de Radiologie et Imagerie Medicale (CURIM), Universite Grenoble Alpes, Grenoble Cedex 9 (France); Kim, Hyungjin; Park, Su Bin [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Ginneken, Bram van [Radboud University Nijmegen Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen (Netherlands); Ferretti, Gilbert R. [Centre Hospitalier Universitaire de Grenoble, Clinique Universitaire de Radiologie et Imagerie Medicale (CURIM), Universite Grenoble Alpes, Grenoble Cedex 9 (France); Institut A Bonniot, INSERM U 823, La Tronche (France); Lee, Chang Hyun [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Goo, Jin Mo; Park, Chang Min [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Seoul National University College of Medicine, Cancer Research Institute, Seoul (Korea, Republic of)

    2017-08-15

    To evaluate the differences between filtered back projection (FBP) and model-based iterative reconstruction (MBIR) algorithms on semi-automatic measurements in subsolid nodules (SSNs). Unenhanced CT scans of 73 SSNs obtained using the same protocol and reconstructed with both FBP and MBIR algorithms were evaluated by two radiologists. Diameter, mean attenuation, mass and volume of whole nodules and their solid components were measured. Intra- and interobserver variability and differences between FBP and MBIR were then evaluated using Bland-Altman method and Wilcoxon tests. Longest diameter, volume and mass of nodules and those of their solid components were significantly higher using MBIR (p < 0.05) with mean differences of 1.1% (limits of agreement, -6.4 to 8.5%), 3.2% (-20.9 to 27.3%) and 2.9% (-16.9 to 22.7%) and 3.2% (-20.5 to 27%), 6.3% (-51.9 to 64.6%), 6.6% (-50.1 to 63.3%), respectively. The limits of agreement between FBP and MBIR were within the range of intra- and interobserver variability for both algorithms with respect to the diameter, volume and mass of nodules and their solid components. There were no significant differences in intra- or interobserver variability between FBP and MBIR (p > 0.05). Semi-automatic measurements of SSNs significantly differed between FBP and MBIR; however, the differences were within the range of measurement variability. (orig.)

  8. Comparison of the effects of model-based iterative reconstruction and filtered back projection algorithms on software measurements in pulmonary subsolid nodules.

    Science.gov (United States)

    Cohen, Julien G; Kim, Hyungjin; Park, Su Bin; van Ginneken, Bram; Ferretti, Gilbert R; Lee, Chang Hyun; Goo, Jin Mo; Park, Chang Min

    2017-08-01

    To evaluate the differences between filtered back projection (FBP) and model-based iterative reconstruction (MBIR) algorithms on semi-automatic measurements in subsolid nodules (SSNs). Unenhanced CT scans of 73 SSNs obtained using the same protocol and reconstructed with both FBP and MBIR algorithms were evaluated by two radiologists. Diameter, mean attenuation, mass and volume of whole nodules and their solid components were measured. Intra- and interobserver variability and differences between FBP and MBIR were then evaluated using Bland-Altman method and Wilcoxon tests. Longest diameter, volume and mass of nodules and those of their solid components were significantly higher using MBIR (p algorithms with respect to the diameter, volume and mass of nodules and their solid components. There were no significant differences in intra- or interobserver variability between FBP and MBIR (p > 0.05). Semi-automatic measurements of SSNs significantly differed between FBP and MBIR; however, the differences were within the range of measurement variability. • Intra- and interobserver reproducibility of measurements did not differ between FBP and MBIR. • Differences in SSNs' semi-automatic measurement induced by reconstruction algorithms were not clinically significant. • Semi-automatic measurement may be conducted regardless of reconstruction algorithm. • SSNs' semi-automated classification agreement (pure vs. part-solid) did not significantly differ between algorithms.

  9. Vasculature surrounding a nodule: A novel lung cancer biomarker.

    Science.gov (United States)

    Wang, Xiaohua; Leader, Joseph K; Wang, Renwei; Wilson, David; Herman, James; Yuan, Jian-Min; Pu, Jiantao

    2017-12-01

    To investigate whether the vessels surrounding a nodule depicted on non-contrast, low-dose computed tomography (LDCT) can discriminate benign and malignant screen detected nodules. We collected a dataset consisting of LDCT scans acquired on 100 subjects from the Pittsburgh Lung Screening study (PLuSS). Fifty subjects were diagnosed with lung cancer and 50 subjects had suspicious nodules later proven benign. For the lung cancer cases, the location of the malignant nodule in the LDCT scans was known; while for the benign cases, the largest nodule in the LDCT scan was used in the analysis. A computer algorithm was developed to identify surrounding vessels and quantify the number and volume of vessels that were connected or near the nodule. A nonparametric receiver operating characteristic (ROC) analysis was performed based on a single nodule per subject to assess the discriminability of the surrounding vessels to provide a lung cancer diagnosis. Odds ratio (OR) were computed to determine the probability of a nodule being lung cancer based on the vessel features. The areas under the ROC curves (AUCs) for vessel count and vessel volume were 0.722 (95% CI=0.616-0.811, plung cancer group 9.7 (±9.6) compared to the non-lung cancer group 4.0 (±4.3) CONCLUSION: Our preliminary results showed that malignant nodules are often surrounded by more vessels compared to benign nodules, suggesting that the surrounding vessel characteristics could serve as lung cancer biomarker for indeterminate nodules detected during LDCT lung cancer screening using only the information collected during the initial visit. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Acoustic radiation force impulse imaging for differentiation of thyroid nodules.

    Directory of Open Access Journals (Sweden)

    Joerg Bojunga

    Full Text Available BACKGROUND: Acoustic Radiation Force Impulse (ARFI-Imaging is an ultrasound-based elastography method enabling quantitative measurement of tissue stiffness. The aim of the present study was to evaluate sensitivity and specificity of ARFI-imaging for differentiation of thyroid nodules and to compare it to the well evaluated qualitative real-time elastography (RTE. METHODS: ARFI-imaging involves the mechanical excitation of tissue using acoustic pulses to generate localized displacements resulting in shear-wave propagation which is tracked using correlation-based methods and recorded in m/s. Inclusion criteria were: nodules ≥5 mm, and cytological/histological assessment. All patients received conventional ultrasound, real-time elastography (RTE and ARFI-imaging. RESULTS: One-hundred-fifty-eight nodules in 138 patients were available for analysis. One-hundred-thirty-seven nodules were benign on cytology/histology, and twenty-one nodules were malignant. The median velocity of ARFI-imaging in the healthy thyroid tissue, as well as in benign and malignant thyroid nodules was 1.76 m/s, 1.90 m/s, and 2.69 m/s, respectively. While no significant difference in median velocity was found between healthy thyroid tissue and benign thyroid nodules, a significant difference was found between malignant thyroid nodules on the one hand and healthy thyroid tissue (p = 0.0019 or benign thyroid nodules (p = 0.0039 on the other hand. No significant difference of diagnostic accuracy for the diagnosis of malignant thyroid nodules was found between RTE and ARFI-imaging (0.74 vs. 0.69, p = 0.54. The combination of RTE with ARFI did not improve diagnostic accuracy. CONCLUSIONS: ARFI can be used as an additional tool in the diagnostic work up of thyroid nodules with high negative predictive value and comparable results to RTE.

  11. CT volumetry of artificial pulmonary nodules using an ex vivo lung phantom: Influence of exposure parameters and iterative reconstruction on reproducibility

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    Wielpütz, Mark O., E-mail: Mark.wielpuetz@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); Translational Lung Research Center (TLRC-H), German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Lederlin, Mathieu, E-mail: mathieu.lederlin@chu-bordeaux.fr [Department of Thoracic and Cardiovascular Imaging, University Hospital of Bordeaux, Av de Magellan, 33600 Pessac (France); Department of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Wroblewski, Jacek, E-mail: JacekWr@gmx.net [Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); Translational Lung Research Center (TLRC-H), German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Dinkel, Julien, E-mail: jdinkel@partners.org [Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 (United States); Department of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Translational Lung Research Center (TLRC-H), German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Eichinger, Monika, E-mail: Monika.eichinger@thoraxklinik-heidelberg.de [Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Amalienstr. 5, 69126 Heidelberg (Germany); Translational Lung Research Center (TLRC-H), German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Department of Radiology, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); and others

    2013-09-15

    Objectives: To evaluate the influence of exposure parameters and raw-data based iterative reconstruction (IR) on the measurement variability of computer-aided nodule volumetry on chest multidetector computed tomography (MDCT). Materials and methods: N = 7 porcine lung explants were inflated in a dedicated ex vivo phantom and prepared with n = 162 artificial nodules. MDCT was performed eight consecutive times (combinations of 120 and 80 kV with 120, 60, 30 and 12 mA s), and reconstructed with filtered back projection (FBP) and IR. Nodule volume and diameter were measured semi-automatically with dedicated software. The absolute percentage measurement error (APE) was computed in relation to the 120 kV 120 mA s acquisition. Noise was recorded for each nodule in every dataset. Results: Mean nodule volume and diameter were 0.32 ± 0.15 ml and 12.0 ± 2.6 mm, respectively. Although IR reduced noise by 24.9% on average compared to FBP (p < 0.007), APE with IR was equal to or slightly higher than with FBP. Mean APE for volume increased significantly below a volume computed tomography dose index (CTDI) of 1.0 mGy: for 120 kV 12 mA s APE was 3.8 ± 6.2% (FBP) vs. 4.0 ± 5.2% (IR) (p < 0.007); for 80 kV 12 mA s APE was 8.0 ± 13.0% vs. 9.3 ± 15.8% (n.s.), respectively. Correlating APE with image noise revealed that at identical noise APE was higher with IR than with FBP (p < 0.05). Conclusions: Computer-aided volumetry is robust in a wide range of exposure settings, and reproducibility is reduced at a CTDI below 1.0 mGy only, but the error rate remains clinically irrelevant. Noise reduction by IR is not detrimental for measurement error in the setting of semi-automatic nodule volumetry on chest MDCT.

  12. Evaluation of diffuse thyroid diseases and thyroid nodules by CT

    International Nuclear Information System (INIS)

    Okamoto, Kyoko; Imanishi, Yoshimasa; Nakaji, Shunsuke; Shinagawa, Toshihito

    2007-01-01

    Imanishi et al. have previously reported that the changes in CT values reveal not only the change in iodine concentration in thyroid follicles, but also represent secondary changes in follicular content and follicular cells and/or interstitial structures. Thus, we performed thyroid CT without contrast material in 138 controls, 417 cases with diffuse thyroid diseases, and 279 cases with thyroid nodules, and evaluated the CT images based on the relation between the change in CT values and pathological changes. In 89% of the controls and 43% of patients with diffuse thyroid diseases, the thyroid CT revealed diffuse high density. In contrast, the 94% of thyroids that demonstrated diffuse low density were from patients with diffuse thyroid diseases. Eighty-four percent of malignant nodules and 64% of benign nodules had inhomogeneous densities, and only 26% of benign thyroid nodules had homogeneous density. However, 71% of nodules that showed high and low densities with regular and clear borders, and 82% of nodules that showed papillary proliferation in a cyst pattern were benign. Although only 58% of nodules with calcification were malignant, 66% of nodules with calcification in the central portion, and 86% of nodules with calcification of a disseminated and convergent pattern in distribution were malignant. Sixty-two percent of thyroids that surrounded nodules had chronic thyroiditis, hypoplasia and/or adenomatous goiter. Thus, unclear borders between a nodule and the surrounding thyroid tissue did not increase the possibility of malignancy. However, the unclear and/or lobulated border between a nodule and extra thyroid tissue increased the possibility of malignancy. We concluded that thyroid CT without contrast material is useful for the diagnosis of thyroid diseases. (author)

  13. Sonographic scoring of solid thyroid nodules: effects of nodule size and suspicious cervical lymph node

    Directory of Open Access Journals (Sweden)

    Ozlem Unsal

    Full Text Available Abstract Introduction Ultrasound is the most frequently used imaging method to evaluate thyroid nodules. Sonographic characteristics of thyroid nodules which are concerning for malignancy are important to define the need for fine needle aspiration biopsy or open surgery. Objective To evaluate malignancy risk of solid thyroid nodules through sonographic scoring. The effects of nodule size ≥2 cm and associated pathologic cervical lymph node in scoring were examined in addition to generally excepted suspicious features. Methods Medical data of 123 patients underwent thyroid surgery were reviewed, and 89 patients (58 females, 31 males were included in the study. The presence and absence of each suspicious sonographic feature of thyroid nodules were scored as 1 and 0, respectively. Total ultrasound score was obtained by adding the positive ultrasound findings. Differently from the literature, nodule size ≥2 cm and associated pathologic cervical node were added in scoring criteria. The diagnostic performance of nodule characteristics for malignancy and the effect of total US score to discriminate malignant and benign disease were calculated. Results A significant relationship was found between malignancy and hypoechogenity, border irregularity, intranodular vascularity, and microcalcification (p < 0.05. Pathologic cervical node was observed predominantly in association with malignant nodules. Positive predictive value of suspicious cervical node for malignancy was 67%, similar to microcalcification. Nodule size ≥2 cm was not distinctive for diagnosis of malignancy. The number of suspicious sonographic features obtained with receiver operating characteristic analysis to discriminate between malignant and benign disease was three. Conclusion Sonographic scoring of thyroid nodules is an effective method for predicting malignancy. The authors suggest including associated pathologic node in the scoring criteria. Further studies with larger cohorts

  14. Diagnostic and therapeutic manipulations under ultrasound and computed tomography guidance of pathologic pulmonary and pleural lesions

    International Nuclear Information System (INIS)

    Nedeva-Petkova, M.; Velkova, K.

    2006-01-01

    More than 50 000 patient with new indeterminate pulmonary nodules are identified by roentgenographic assessment each year. Forty percent to 50 % of patients will ultimately be found to have malignant lesions, of which 75% will be primary lung cancers. The most appropriate strategy for the diagnosis of such indeterminate pulmonary nodules is still debated. Conventional chest X-ray followed by computed tomography have been found to accurately predict the presence of malignancy in up to 60% of lesions on the basis of their morphologic and tissue density characteristics. However, a tissue diagnosis is required unless the lesion has remained unchanged during a 2-year period of observation or if benign calcification can be identified within the lesion. Sputum cytologic studies and bronchoscope biopsy have similar limitations in diagnosing small peripheral lesions without endobronchial involvement. The aim of this paper is to show that the percutaneous transthoracic biopsy (PTB) under CT or ultrasound guidance is an accurate means of identifying malignant pulmonary nodules. The primary limitation of percutaneous biopsy is in definitively determining the benignity of a lesion. (authors)

  15. Pulmonary Paraganglioma Manifesting as an Endobronchial Mass

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ki Nam; Lee, Ki Nam; Roh, Mee Sook; Choi, Pil Jo; Yang, Doo Kyung [College of Medicine, Dong-A University, Pusan (Korea, Republic of)

    2008-02-15

    The thoracic manifestations of paragangliomas include well-enhancing mediastinal masses, metastatic parenchymal nodules, lymphadenopathy from malignant paragangliomas, and pulmonary edema as a complication of epinephrine-producing paragangliomas. The much less common manifestations include a primary mass in the lung, heart, esophagus and/or trachea. Primary pulmonary paraganglioma was first reported by Heppleston in 1958, and only 19 cases have been reported since then in the English literature. Three of these cases were malignancies with lymph nodes metastases. In the remaining cases, the lesions behaved in a benign manner. The patients are usually female and in their middle age. Most patients are free of symptoms and hypertension, and the tumors are often discovered incidentally on routine chest radiographs.

  16. Asymptomatic Papulo-nodules Localized to One Finger

    Science.gov (United States)

    Rambhia, Kinjal D; Khopkar, Uday S

    2015-01-01

    Subcutaneous or deep granuloma annulare is a benign asymptomatic condition characterized by firm asymptomatic nodules in deep subcutaneous tissues that may be associated with intradermal lesions. A 53-year-old female presented with asymptomatic skin-colored, firm nodules over the right ring finger. Histopathology revealed a palisading granuloma with central degenerated collagen and mucin deposition in the dermis suggestive of granuloma annulare. Isolated and unilateral involvement of a single digit with clusters of nodules of subcutaneous granuloma annulare (GA) in an adult is rare and differentiation from its simulator rheumatoid nodule is essential. PMID:26538728

  17. Hyper-functioning Thyroid Nodule with Scintigraphic Owl's Eye Appearance

    International Nuclear Information System (INIS)

    Al-Kordi, R.S.; Elgazzar, A.H.

    2006-01-01

    Hyper-functioning thyroid nodules may produce various scintigraphic appearances on thyroid scans. Autonomously hyper functioning thyroid nodules invariably demonstrate degenerative changes. These changes may give rise to central or less commonly peripheral photopenic areas on a thyroid scan within otherwise a hot nodule. In this report we present a case of hyper functioning autonomous nodule with peripheral degeneration and residual central functioning tissue giving the appearance of an owl's eye. Although rare, this pattern can be seen in a variety of benign and malignant thyroid conditions. (author)

  18. Malignancy risk estimation of screen-detected nodules at baseline CT: comparison of the PanCan model, Lung-RADS and NCCN guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Riel, Sarah J. van; Ciompi, Francesco; Jacobs, Colin; Scholten, Ernst T.; Prokop, Mathias; Ginneken, Bram van [Radboud University Nijmegen Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen (Netherlands); Winkler Wille, Mathilde M.; Naqibullah, Matiullah [University of Copenhagen, Department of Pulmonology Gentofte Hospital, Hellerup (Denmark); Lam, Stephen [British Columbia Cancer Agency, Department of Integrative Oncology, Vancouver, British Columbia (Canada); Schaefer-Prokop, Cornelia [Radboud University Nijmegen Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen (Netherlands); Meander Medical Center, Department of Radiology, Amersfoort (Netherlands)

    2017-10-15

    To compare the PanCan model, Lung-RADS and the 1.2016 National Comprehensive Cancer Network (NCCN) guidelines for discriminating malignant from benign pulmonary nodules on baseline screening CT scans and the impact diameter measurement methods have on performances. From the Danish Lung Cancer Screening Trial database, 64 CTs with malignant nodules and 549 baseline CTs with benign nodules were included. Performance of the systems was evaluated applying the system's original diameter definitions: D{sup longest-C} (PanCan), D{sup meanAxial} (NCCN), both obtained from axial sections, and D{sup mean3D} (Lung-RADS). Subsequently all diameter definitions were applied uniformly to all systems. Areas under the ROC curves (AUC) were used to evaluate risk discrimination. PanCan performed superiorly to Lung-RADS and NCCN (AUC 0.874 vs. 0.813, p = 0.003; 0.874 vs. 0.836, p = 0.010), using the original diameter specifications. When uniformly applying D{sup longest-C}, D{sup mean3D} and D{sup meanAxial}, PanCan remained superior to Lung-RADS (p < 0.001 - p = 0.001) and NCCN (p < 0.001 - p = 0.016). Diameter definition significantly influenced NCCN's performance with D{sup longest-C} being the worst (D{sup longest-C} vs. D{sup mean3D}, p = 0.005; D{sup longest-C} vs. D{sup meanAxial}, p = 0.016). Without follow-up information, the PanCan model performs significantly superiorly to Lung-RADS and the 1.2016 NCCN guidelines for discriminating benign from malignant nodules. The NCCN guidelines are most sensitive to nodule size definition. (orig.)

  19. Fluoxetin-induced pulmonary granulomatosis.

    Science.gov (United States)

    de Kerviler, E; Trédaniel, J; Revlon, G; Groussard, O; Zalcman, G; Ortoli, J M; Espié, M; Hirsch, A; Frija, J

    1996-03-01

    A patient treated with fluoxetin for a manic depressive disorder developed pulmonary inflammatory nodules with noncaseating giant cell granulomas, interstitial pneumonia and non-necrotizing vasculitis, whilst remaining asymptomatic. A progressive resolution of pulmonary nodules occurred after withdrawal of the offending agent, and the chest radiograph returned to normal in 9 months. The diagnosis was assessed by an open lung biopsy.

  20. Thyroid nodules with nondiagnostic results on repeat fine-needle aspiration biopsy: which nodules should be considered for repeat biopsy or surgery rather than follow-up?

    Energy Technology Data Exchange (ETDEWEB)

    Eun, Na Lae; Chang, Hang Seok; Gweon, Hye Mi; Kim, Jeong Ah; Youk, Ji Hyun; Son, Eun Jun [Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Yoo, Mi Ri [Dept. of Radiology, Dongjak Kyunghee Hospital, Seoul (Korea, Republic of); Park, Ah Young [Dept. of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan (Korea, Republic of); Moon, Hee Jung [Dept. of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-07-15

    The goal of this study was to assess the clinicopathologic and ultrasonographic features of thyroid nodules with nondiagnostic results on repeat ultrasonography (US)-guided fineneedle aspiration biopsy (FNAB) according to size and the number of suspicious findings and to determine the proper management of nodules with consecutive nondiagnostic results. This retrospective study included 297 nodules with nondiagnostic results on repeat FNAB that were evaluated by US over the course of at least 12 months of follow-up, a follow-up biopsy, or an operation. We compared clinical and US variables between benign and malignant nodules in thyroid nodules with repeat nondiagnostic results. The comparison of benign and malignant nodules with repeat nondiagnostic results revealed that age, marked hypoechogenicity, irregular or microlobulated margins, microcalcifications, and nonparallel shape were significantly associated with malignancy. Multivariate logistic regression analysis in malignant nodules revealed that microcalcifications and irregular or microlobulated margins were independently associated with malignancy. Among them, only irregular or microlobulated margins were independently significant as a predictor of malignancy in repeatedly nondiagnostic nodules measuring >10 mm. Using receiver operating characteristic analysis, the best cutoff value for the “number of suspicious findings” between benign and malignant nodules was three in nodules of all sizes, three in nodules measuring ≤10 mm, and two in nodules measuring >10 mm. Irregular or microlobulated margins may be the most frequent US features in repeatedly nondiagnostic nodules >10 mm. The presence of “two or more suspicious findings” can be used as the cutoff for distinguishing benign and malignant nodules.

  1. THE STUDY OF CLINICAL PRESENTATION OF SOLITARY NODULE THYROID

    Directory of Open Access Journals (Sweden)

    Lakshmikanthan Premalatha

    2017-07-01

    Full Text Available BACKGROUND Thyroid disorders are the most common endocrine disorder seen in clinical practice and solitary thyroid nodule is one of the common presentations of thyroid disease. A discrete swelling in an otherwise impalpable gland is termed isolated or solitary nodule of thyroid.1 The prevalence of thyroid nodule increases from near zero at 15 years to 50% by about 60 to 65 years on sonography. At most 10% of these nodules are palpable even by experienced clinicians. This study is about the clinical presentation, histopathology and management of solitary nodule thyroid in MGM GH Tiruchirappalli. AIMS AND OBJECTIVES- To determine the age and sex incidence among the cases of solitary nodule thyroid. To study the percentage of euthyroid, hypothyroid or hyperthyroid state in patients presenting with solitary nodule thyroid. To study the proportion of malignant and benign cases among the solitary nodule thyroid at M.G.M. Govt. Hospital, Tiruchirappalli. MATERIALS AND METHODS This study includes 58 cases of solitary nodule of thyroid noted during the period Jan 2016-Dec 2016. Factors were tabulated and analysed statistically. RESULTS From the present study, the mean age at presentation found to be 42.5 years with preponderance to females. Because of periods of fluctuations in the demands of the hormonal requirement in female in their life cycle (puberty, menstrual cycles, pregnancy, menopause, the chances of thyroid nodule formation are very high as compared with male counterparts. From the study, distribution of malignancy is about 10.34. The incidence of malignancy found to be 12%, sensitivity is 87.5%, specificity is 100% for FNAC and HPE. CONCLUSION Majority of the patients are between 30-49 years of age. Incidence of solitary thyroid nodule is more common in female. Female: male ratio is almost about 15:1 Commonest symptom is swelling over anterior or lateral aspect of neck Among the benign lesion dominant nodule is most common and papillary and

  2. Radiological and pathological analysis of LDCT screen detected and surgically resected sub-centimetre lung nodules in 44 asymptomatic patients

    Directory of Open Access Journals (Sweden)

    Xing Hu

    2016-01-01

    Conclusion: ACa, AIS and AAH nodules detected on LDCT included more women (77% than men in our cohort. Smoking as inclusive criteria for LDCT screening of lung cancer needs to be further evaluated in the Chinese population. The reconstructed nodule shape, density and margin may help radiologists to identify small cancer and pre-cancer nodules from benign conditions.

  3. [Cytogenic chorionic nodule of the uterus].

    Science.gov (United States)

    Frappart, L; Lin, H C; Gauthier, A M; Griot, A; Palayer, C; Vernevaut, Y; Bremond, A; Rochet, Y; Lesbros, F

    1985-01-01

    The authors report five observations of endometrial stromal nodules. These nodules are composed of cells identical to those of the endometrial stroma. They constitute the benign form of endometrial stromal tumors. From the macroscopic point of view, they present as nodular formations, most often single, well defined, non-fasciculated, whitish or yellowish sometimes cystisized. From the microscopic point of view, these nodules contain areas of plexiform or glandular arrangement with, occasionally, pseudo-rosettes. Small collagenous zones can often be observed. E.S.N. should be distinguished on the one hand from endolymphatic stromal myosis, and on the other hand from sarcoma of the endometrial stroma. Histogenesis of the lesion is also discussed.

  4. Small Nodules Localization on CT Images of Lungs

    Science.gov (United States)

    Snezhko, E. V.; Kharuzhyk, S. A.; Tuzikov, A. V.; Kovalev, V. A.

    2017-05-01

    According to the World Health Organization (WHO) lung cancer remains the leading cause of death of men among all malignant tumors [1, 2]. One of the reasons of such a statistics is the fact that the lung cancer is hardly diagnosed on the yearly stages when it is almost asymptomatic. The purpose of this paper is to present a Computer-Aided Diagnosis (CAD) software developed for assistance of early detection of nodules in CT lung images including solitary pulmonary nodules (SPN) as well as multiple nodules. The efficiency of nodule localization was intended to be as high as the level of the best practice. The software developed supports several functions including lungs segmentation, selection of nodule candidates and nodule candidates filtering.

  5. Benign positional vertigo

    Science.gov (United States)

    Vertigo - positional; Benign paroxysmal positional vertigo; BPPV: dizziness- positional ... Benign positional vertigo is also called benign paroxysmal ... ear has fluid-filled tubes called semicircular canals. When you ...

  6. Segmentation of nodules on chest computed tomography for growth assessment

    International Nuclear Information System (INIS)

    Mullally, William; Betke, Margrit; Wang Jingbin; Ko, Jane P.

    2004-01-01

    Several segmentation methods to evaluate growth of small isolated pulmonary nodules on chest computed tomography (CT) are presented. The segmentation methods are based on adaptively thresholding attenuation levels and use measures of nodule shape. The segmentation methods were first tested on a realistic chest phantom to evaluate their performance with respect to specific nodule characteristics. The segmentation methods were also tested on sequential CT scans of patients. The methods' estimation of nodule growth were compared to the volume change calculated by a chest radiologist. The best method segmented nodules on average 43% smaller or larger than the actual nodule when errors were computed across all nodule variations on the phantom. Some methods achieved smaller errors when examined with respect to certain nodule properties. In particular, on the phantom individual methods segmented solid nodules to within 23% of their actual size and nodules with 60.7 mm3 volumes to within 14%. On the clinical data, none of the methods examined showed a statistically significant difference in growth estimation from the radiologist

  7. [Fine-needle Aspiration of Thyroid Nodules: Is it Worth Repeating?

    Science.gov (United States)

    Fernandes, Vera; Pereira, Tânia; Eloy, Catarina

    2017-06-30

    The fine-needle aspiration has a significant role in assessing the malignancy risk of thyroid nodules. There is uncertainty regarding the value of repeat fine-needle aspiration in benign nodules. This study aims to evaluate the concordance of results in consecutive fine-needle aspiration and to study the relevance of repetition in benign results. Retrospective study of the 4800 thyroid nodules fine-needle aspiration held in Instituto de Patologia e Imunologia Molecular da Universidade do Porto between January 1, 2014 and May 2, 2016. Of the initial sample, we selected the repeated fine-needle aspiration on the same nodule. The first fine-needle aspiration result of the 309 nodules underwent revaluation was non-diagnostic in 103 (33.3%), benign in 120 (38.8%) and atypia/follicular lesion of undetermined significance in 86 (27.8%). The agreement between the first and second fine-needle aspiration was significantly higher in cases with an initial benign result (benign: 85.8%, non-diagnostic: 27.2% and atypia/follicular lesion of undetermined significance: 17.4%, p < 0.005). The fine-needle aspiration repeating motifs in initially benign nodules (n = 78) were repetition suggestion in 58, nodule growth in 17 and suspicious ultrasonographic features in 3. The fine-needle aspiration repetition in nodules with initial non-diagnostic and atypia/follicular lesion of undetermined significance result changed the initial diagnosis in a significant proportion of patients, modifying their therapeutic approach. The high concordance of results in initially benign nodules makes fine-needle aspiration repetition not cost-effective in most cases. The fine-needle aspiration should be repeated when the initial cytology result is non-diagnostic or atypia/follicular lesion of undetermined significance.

  8. Evaluation of an improved method of simulating lung nodules in chest tomosynthesis

    International Nuclear Information System (INIS)

    Svalkvist, Angelica; Allansdotter Johnsson, Aase; Vikgren, Jenny

    2012-01-01

    Background Simulated pathology is a valuable complement to clinical images in studies aiming at evaluating an imaging technique. In order for a study using simulated pathology to be valid, it is important that the simulated pathology in a realistic way reflect the characteristics of real pathology. Purpose To perform a thorough evaluation of a nodule simulation method for chest tomosynthesis, comparing the detection rate and appearance of the artificial nodules with those of real nodules in an observer performance experiment. Material and Methods A cohort consisting of 64 patients, 38 patients with a total of 129 identified pulmonary nodules and 26 patients without identified pulmonary nodules, was used in the study. Simulated nodules, matching the real clinically found pulmonary nodules by size, attenuation, and location, were created and randomly inserted into the tomosynthesis section images of the patients. Three thoracic radiologists and one radiology resident reviewed the images in an observer performance study divided into two parts. The first part included nodule detection and the second part included rating of the visual appearance of the nodules. The results were evaluated using a modified receiver-operating characteristic (ROC) analysis. Results The sensitivities for real and simulated nodules were comparable, as the area under the modified ROC curve (AUC) was close to 0.5 for all observers (range, 0.43-0.55). Even though the ratings of visual appearance for real and simulated nodules overlapped considerably, the statistical analysis revealed that the observers to were able to separate simulated nodules from real nodules (AUC values range 0.70-0.74). Conclusion The simulation method can be used to create artificial lung nodules that have similar detectability as real nodules in chest tomosynthesis, although experienced thoracic radiologists may be able to distinguish them from real nodules

  9. Fine Needle Aspiration Cytology of Thyroid Nodules: Correlation with Surgical Histopathology Histopathology

    Directory of Open Access Journals (Sweden)

    Nargess Ghazaleh

    2008-01-01

    Full Text Available Objective: Approximately 7% of people have thyroid nodules. The most important consideration in evaluating patients with thyroid nodules is whether the nodule is malignant. Fine needle aspiration (FNA biopsy is the best, safest, and most cost-effective measure for distinguishing malignancy, thus preventing unnecessary surgeries. In this survey, adequacy of smears, cytologic findings, histologic findings, and their concordance, have been studied. Materials and Methods: FNA biopsy was performed in 200 patients with palpable thyroid nodules in 2004-2005. Cytologic findings and adequacy of specimens were recorded. Of the 200 patients, 39 had surgery; postoperative histological results were compared with FNA biopsy results.Results: Of FNA smears, 88% were adequate; of these adequate smears, 57.2% were benign, 34.2% were suspicious for malignancy, and 8.6% were reported as malignant. When results of surgical pathology were compared with FNA cytology results, all benign surgical specimens also had benign cytology results, and all malignant surgical specimens had malignant results on cytology evaluation. In nodules with suspicious cytology, histopathology showed that 50% were malignant and 50% were benign.Conclusions: FNA is a simple and cost-effective procedure for identifying benign and malignant nodules. The incidence of malignant pathology in nodules with suspicious cytology was higher than other studies.Turk Jem 2008; 12: 73-4

  10. Satellite pulmonary nodule in the same lobe (T4N0) should not be staged as IIIB non-small cell lung cancer.

    Science.gov (United States)

    Bryant, Ayesha S; Pereira, Sara J; Miller, Daniel L; Cerfolio, Robert James

    2006-11-01

    Treatment of non-small cell lung cancer depends on stage. Patients with T4 lesions represent a heterogeneous group. A case-control study of patients with pathologically proven, node-negative T4 lesions (T4 N0 M0) was conducted. Patients with T4 disease were stratified as T4 from a satellite nodule (T4-satellite) or T4 from local invasion (T4-invasion). T4-satellite patients were matched 1:4 for sex and histology with resected control patients with stage IA, IB, and IIA non-small cell lung cancer and matched 1:3 with stage II non-small cell lung cancer. Survival and the maximal standardized uptake value on F-18 fluorodeoxyglucose-positron emission tomography scans were compared. There were 337 patients, 26 patients with T4-satellite lesions, 25 with T4-invasion lesions, and 286 controls (104 patients with T1 N0 M0, 104 with T2 N0 M0, and 78 with T1 N1 M0 or T2 N1 M0 lesions). The two T4 groups were similar for age, race, sex, and neoadjuvant therapy rates. The 5-year survival was 80% for the T1 N0 M0 patients, 68% for T2 N0 M0, 57% for T4-satellite N0 M0, 45% for T1 N1 M0 or T2 N1 M0, and 30% for the T4-invasion N0 M0 patients (p = 0.016). Multivariate analysis showed that only the type of T4 impacted survival (p = 0.011). The median maximal standardized uptake values of the cancers were 4.2 for T1 N0 M0, 4.8 for T4-satellite, 5.4 for T2 N0 M0, 7.8 for T1 N1 M0 or T2 N1 M0, and 8.8 for the T4-invasion patients. Larger studies are needed; however, patients with T4-satellite non-small cell lung cancer who undergo complete resection have survival and maximal standardized uptake values similar to patients with stage IB and stage IIA lesions. Their survival is significantly better than those with T4-invasion. Patients with T4-satellite N0 M0 lesions should not be classified as stage IIIB and should not be grouped with patients with T4-invasion, and resection should be considered.

  11. Prognosis of thyroid nodules in individuals living in the Zhitomir region of Ukraine.

    Directory of Open Access Journals (Sweden)

    Naomi Hayashida

    Full Text Available After the accident at the Chernobyl Nuclear Power Plant (CNPP, the incidence of thyroid cancer increased among children. Recently, a strong relationship between solid thyroid nodules and the incidence of thyroid cancer was shown in atomic bomb survivors. To assess the prognosis of benign thyroid nodules in individuals living in the Zhitomir region of Ukraine, around the CNPP, we conducted a follow-up investigation of screening data from 1991 to 2000 in the Ukraine.Participants of this study were 160 inhabitants with thyroid nodules (nodule group and 160 inhabitants without thyroid nodules (normal control group intially identified by ultrasonography from 1991 to 2000. All participants were aged 0 to 10 years old and lived in the same area at the time of the accident. We performed follow-up screening of participants and assessed thyroid nodules by fine needle aspiration biopsy.Among the nodule group participants, the number and size of nodules were significantly increased at the follow-up screening compared with the initial screening. No thyroid nodules were observed among the normal control group participants. The prevalence of thyroid abnormality, especially nodules that could be cancerous (malignant or suspicious by fine needle aspiration biopsy, was 7.5% in the nodule group and 0% in the normal control group (P<0.001.Our study indicated that a thyroid nodule in childhood is a prognostic factor associated with an increase in the number and size of nodules in individuals living in the Zhitomir region of Ukraine.

  12. Giant hepatic regenerative nodules in Alagille syndrome

    International Nuclear Information System (INIS)

    Rapp, Jordan B.; Bellah, Richard D.; Anupindi, Sudha A.; Maya, Carolina; Pawel, Bruce R.

    2017-01-01

    Children with Alagille syndrome undergo surveillance radiologic examinations as they are at risk for developing cirrhosis and hepatocellular carcinoma. There is limited literature on the imaging of liver masses in Alagille syndrome. We report the ultrasound (US) and magnetic resonance imaging (MRI) appearances of incidental benign giant hepatic regenerative nodules in this population. To describe the imaging findings of giant regenerative nodules in patients with Alagille syndrome. A retrospective search of the hospital database was performed to find all cases of hepatic masses in patients with Alagille syndrome during a 10-year period. Imaging, clinical charts, laboratory data and available pathology were reviewed and analyzed and summarized for each patient. Twenty of 45 patients with confirmed Alagille syndrome had imaging studies. Of those, we identified six with giant focal liver masses. All six patients had large central hepatic masses that were remarkably similar on US and MRI, in addition to having features of cirrhosis. In each case, the mass was located in hepatic segment VIII and imaging showed the mass splaying the main portal venous branches at the hepatic hilum, as well as smaller portal and hepatic venous branches coursing through them. On MRI, signal intensity of the mass was isointense to liver on T1-weighted sequences in four of six patients, but hyperintense on T1 in two of six patients. In all six cases, the mass was hypointense on T2- weighted sequences. The mass post-contrast was isointense to adjacent liver in all phases in five the cases. Five out of six patients had pathological correlation demonstrating preserved ductal architecture confirming the final diagnosis of a regenerative nodule. Giant hepatic regenerative nodules with characteristic US and MR features can occur in patients with Alagille syndrome with underlying cirrhosis. Recognizing these lesions as benign giant hepatic regenerative nodules should, thereby, mitigate any need for

  13. Giant hepatic regenerative nodules in Alagille syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Rapp, Jordan B. [Lewis Katz School of Medicine at Temple University, Department of Radiology, Temple University Hospital, Philadelphia, PA (United States); Bellah, Richard D.; Anupindi, Sudha A. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA (United States); Maya, Carolina [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Pawel, Bruce R. [University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA (United States); The Children' s Hospital of Philadelphia, Department of Pathology and Laboratory Medicine, Philadelphia, PA (United States)

    2017-02-15

    Children with Alagille syndrome undergo surveillance radiologic examinations as they are at risk for developing cirrhosis and hepatocellular carcinoma. There is limited literature on the imaging of liver masses in Alagille syndrome. We report the ultrasound (US) and magnetic resonance imaging (MRI) appearances of incidental benign giant hepatic regenerative nodules in this population. To describe the imaging findings of giant regenerative nodules in patients with Alagille syndrome. A retrospective search of the hospital database was performed to find all cases of hepatic masses in patients with Alagille syndrome during a 10-year period. Imaging, clinical charts, laboratory data and available pathology were reviewed and analyzed and summarized for each patient. Twenty of 45 patients with confirmed Alagille syndrome had imaging studies. Of those, we identified six with giant focal liver masses. All six patients had large central hepatic masses that were remarkably similar on US and MRI, in addition to having features of cirrhosis. In each case, the mass was located in hepatic segment VIII and imaging showed the mass splaying the main portal venous branches at the hepatic hilum, as well as smaller portal and hepatic venous branches coursing through them. On MRI, signal intensity of the mass was isointense to liver on T1-weighted sequences in four of six patients, but hyperintense on T1 in two of six patients. In all six cases, the mass was hypointense on T2- weighted sequences. The mass post-contrast was isointense to adjacent liver in all phases in five the cases. Five out of six patients had pathological correlation demonstrating preserved ductal architecture confirming the final diagnosis of a regenerative nodule. Giant hepatic regenerative nodules with characteristic US and MR features can occur in patients with Alagille syndrome with underlying cirrhosis. Recognizing these lesions as benign giant hepatic regenerative nodules should, thereby, mitigate any need for

  14. Morphologic classification of ductal breast tumors on ultrasound : differential diagnosis of benign and malignant tumors

    International Nuclear Information System (INIS)

    Won, Mi Sook; Chung, Soo Young; Yang, Ik; Lee, Yul; Park, Hai Jung; Lee, Myoung Hwan; Yoon, In Sook; Koh, Mi Gyoung

    1997-01-01

    To evaluate the morphologic differential diagnosis of benign and malignant ductal breast tumors, as seen on US US findings in 29 pathologically proven cases of ductal breast tumor were retrospectively reviewed. All patients were female and their mean age was 42 years. Nineteen tumors were benign and ten were malignant, and all ductal or cystic lesions showed solid masses. According to the location of the mural nodule, we classified the sonographic appearance of these tumors into three types:intraductal, intracystic and amorphic. The intraductal type was divided into three subtypes:incompletely obstructive, completely obstructive and multiple mural nodules. For the intracystic type, too, three subtypes were designated:the intracystic mural nodule (mural cyst), intracystic mural nodule with the duct (mural cyst+duct) and intracystic multiple mural nodules. The amorphic type is defined as an atypical ductal tumor with the mural nodule extending into adjacent parenchyma. The margin of the duct or cyst was smooth in 68.4% of benign, and irregular in 90% of malignant ductal tumors. Internal echogeneity of the duct or cyst usually showed homogeneity in both benign and malignant tumors. 73.7% of tumors connecting the duct were benign and 50% were malignant. In benign tumors, 52.6% of mural nodule had an irregular margin, while in malignant tumors, the corresponding proportion was 100%;both types usually showed heterogeneous hypoechogeneity. Among benign tumors, the most common morphologic type was the intraductal incompletely obstructive subtype (36.8%);among those that were malignant, the amorphic type was most common, accounting for 40% of tumors. No amorphic type was benign and no incompletely obstructive subtype was malignant. When ductal breast tumors are morphologically classified on the basis of sonographic findings, the intraductal incompletely obstructive subtype suggests benignancy, and the amorphic type, malignancy. The morphologic classification of ductal

  15. Sarcoma-like mural nodule in a borderline mucinous tumor of the ovary: A rare entity

    Directory of Open Access Journals (Sweden)

    Prithwijit Ghosh

    2014-01-01

    Full Text Available Sarcoma-like mural nodule (SLMN is a very uncommon and misleading benign entity which may be associated with benign, borderline or malignant mucinous neoplasm of the ovary. It should be distinguished from other malignant mural nodules with sarcoma, carcinosarcoma or anaplastic carcinoma for proper management. We report a rare case of SLMN in a borderline mucinous tumor of the ovary in a 30-year-old lady. In spite of having confusing histopathological features the final diagnosis was made depending on the younger age of the patient, well circumscription of the nodule, absence of vascular invasion and immunohistochemical profile.

  16. Micromonospora is a normal occupant of actinorhizal nodules

    Indian Academy of Sciences (India)

    Supplementary table 1. Number of isolates per nodule. Nodule Colonies Average Nodule Colonies Average. AV1 Nodule 1 2 13 EEM Nodule 1 17 9.4. Nodule 2 O Nodule 2 13. Nodule 3 2 Nodule 3 9. AV2 Nodule 1 19 16.1 Nodule 4 7. Nodule 2 25 Nodule 5 18. Nodule 3 38 Nodule 6 4. AV4 Nodule 1 8 14.0 Nodule 7 12.

  17. Recurrent respiratory papillomatosis with pulmonary involvement; Papilomatose respiratoria recorrente com envolvimento pulmonar

    Energy Technology Data Exchange (ETDEWEB)

    Ikawa, Marcos Hiroyuki [Universidade Federal de Sao Paulo, SP (Brazil). Escola Paulista de Medicina. Dept. de Diagnostico por Imagem; Meirelles, Gustavo Souza Portes [Centro de Medicina Diagnostica Fleury, Sao Paulo, SP (Brazil)]. E-mail: gmeirelles@gmail.com

    2008-01-15

    A five-year-old girl developed hoarseness with gradual worsening at the age of eight months. Three months later, she underwent bronchoscopy in which papillomas in the vocal cords, larynx and trachea were observed. Because of serious bronchospasm crises and respiratory failure, she needed several hospitalizations, definitive tracheostomy and multiple endoscopic procedures for papilloma excision. The most recent chest radiography (Figure A) and computed tomography (CT) scans (Figures B and C) showed a nodule inside the trachea and multiple pulmonary nodules, cysts and consolidations. The anatomopathological findings from curettage of the lesions revealed benign squamous-cell papillomas. Recurrent respiratory papillomatosis (RRP) is directly related to the human papillomavirus (HPV). Its spread to the lower airways is uncommon, with involvement of trachea and/or proximal bronchi in 5% of the patients, and extension to the lungs in only 1% of the cases. (author)

  18. Nonsurgical, image-guided, minimally invasive therapy for thyroid nodules

    DEFF Research Database (Denmark)

    Gharib, Hossein; Hegedüs, Laszlo; Pacella, Claudio Maurizio

    2013-01-01

    Context: Nodular thyroid disease is very common. Most nodules are asymptomatic, are benign by fine-needle aspiration, remain stable, and can be followed by observation alone in the majority of the patients. Occasionally, nodules grow or cause symptoms requiring treatment. So far, surgery has been...... our main option for treatment. Objective: In this review, we discuss nonsurgical, minimally invasive approaches for small thyroid masses, including indications, efficacy, side effects, and costs. Evidence Acquisition: We selected recent publications related to minimally invasive thyroid techniques...... therapy is recommended for recurrent benign thyroid cysts. Either ultrasound-guided laser or radiofrequency ablation can be used for symptomatic solid nodules with normal or abnormal thyroid function. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical...

  19. Evaluation of 19 cases of benign lesions with high accumulation of tracer on 18F-FDG PET imaging

    International Nuclear Information System (INIS)

    Wang Quanshi; Wu Hubing; Wang Mingfang; Huang Zuhan

    2003-01-01

    Objective: To review PET images of benign lesions with high accumulation of 18 F-FDG and to analyse the possibility of FDG PET imaging for differentiating the benign from the malignant. Methods: 18 F-FDG PET imaging was performed on 19 patients with benign diseases including 13 cases of active tuberculosis and 6 cases of other benign diseases. Positive pathologic or bacteriological results were obtained for all the patients. PET images were evaluated with standardized uptake value (SUV), lesion shapes , and radioactivity distribution. CT or MRI and histopathologic findings also were reviewed. Results: 1) Thirteen patients with active tuberculosis showed high uptake of 18 F-FDG. The SUV was 3.1±1.8. But radioactivity distribution in some lesions was not uniform and there were defect areas in the lesions. Histopathologic findings proved that the defect areas were induced by caseous necrosis. Seven cases of pulmonary tuberculosis showed two or multiple stripe and funicular high accumulation and other lesions displayed high uptake in sheet or irregular shape; 1 case of scrofula and 1 case of splenetic tuberculosis showed defect areas in the lesions; the other scrofula case showed focal intense uptake. Two of lumbar tuberculosis showed intense uptake in the lumbar vertebra, and one of the two cases complicated with the cold abscess showed bilateral high accumulation in the shape of sheet along musculus psoas major. In the peritoneal tuberculosis case, PET images showed diffuse incrassation and intense uptake in peritoneum and mesentery. CT findings revealed that the peritoneum and mesentery thickened. 2) Pulmonary abscess, pulmonary cryptococcus granuloma, cerebral cryptococcus granuloma, pulmonary inflammatory pseudotumor, leiomyoma, and breast adenoma all showed high accumulation in the shapes of nodule or mass. Mean SUV was 4.5±3.1. CT or MRI findings were the same as on PET images shape. Histopathologic work-up did not find necrosis in the lesions. Conclusions

  20. Development of a clinical decision model for thyroid nodules

    Directory of Open Access Journals (Sweden)

    Eberhardt John

    2009-08-01

    Full Text Available Abstract Background Thyroid nodules represent a common problem brought to medical attention. Four to seven percent of the United States adult population (10–18 million people has a palpable thyroid nodule, however the majority (>95% of thyroid nodules are benign. While, fine needle aspiration remains the most cost effective and accurate diagnostic tool for thyroid nodules in current practice, over 20% of patients undergoing FNA of a thyroid nodule have indeterminate cytology (follicular neoplasm with associated malignancy risk prevalence of 20–30%. These patients require thyroid lobectomy/isthmusectomy purely for the purpose of attaining a definitive diagnosis. Given that the majority (70–80% of these patients have benign surgical pathology, thyroidectomy in these patients is conducted principally with diagnostic intent. Clinical models predictive of malignancy risk are needed to support treatment decisions in patients with thyroid nodules in order to reduce morbidity associated with unnecessary diagnostic surgery. Methods Data were analyzed from a completed prospective cohort trial conducted over a 4-year period involving 216 patients with thyroid nodules undergoing ultrasound (US, electrical impedance scanning (EIS and fine needle aspiration cytology (FNA prior to thyroidectomy. A Bayesian model was designed to predict malignancy in thyroid nodules based on multivariate dependence relationships between independent covariates. Ten-fold cross-validation was performed to estimate classifier error wherein the data set was randomized into ten separate and unique train and test sets consisting of a training set (90% of records and a test set (10% of records. A receiver-operating-characteristics (ROC curve of these predictions and area under the curve (AUC were calculated to determine model robustness for predicting malignancy in thyroid nodules. Results Thyroid nodule size, FNA cytology, US and EIS characteristics were highly predictive of

  1. Whole lung computed tomography for detection of pulmonary metastasis of osteosarcoma confirmed at thoracotomy

    International Nuclear Information System (INIS)

    Ishida, Itsuro; Fukuma, Seigo; Sawada, Kinya; Seki, Yasuo; Tanaka, Fumitaka

    1980-01-01

    Whole lung computed tomography (CT) was performed in patients with osteosarcoma of bone to evaluate its diagnostic efficacy in comparison to that in conventional chest radiography and in whole lung tomography to detect metastatic nodules in the lung. In 11 of the 12 patients with osteosarcoma, CT detected pulmonary nodules and in 6 of the 11 patients pulmonary nodules were detected by CT, conventional chest radiography and whole lung tomography, respectively, and 22 pulmonary nodules were resected at thoracotomy and proved to be metastatic lesions. Nineteen nodules of the 22 nodules resected were detected by CT and nine of the 22 nodules were discovered only by CT, while only 10 of 22 nodules were recognized by the conventional chest radiography and the whole lung tomography. Two pulmonary nodules, measuring 1 mm and 2 mm in diameter, respectively, were not detected by any of these three methods. In three nodules that showed to be false positive in CT in the two patients, two nodules were histologically suture granulomas induced by the previous operation, and a deformed protuberance of the chest wall was erroneously interpreted to be a subpleural and intrapulmonary nodule in the remaining. We conclude that CT is the most efficient method to detect pulmonary nodules in the patients with osteosarcoma, but that the minimal size of the detectable nodule by CT is 3 mm in diameter. But a smaller nodule having a tendency to ossify can be detected by CT. (author)

  2. A report of 10 individuals with weathering nodules and review of the literature

    Directory of Open Access Journals (Sweden)

    Jeremy Udkoff

    2016-01-01

    Full Text Available Weathering nodules are a benign skin condition that usually present as papules on the helices of patients with significant prior sun exposure. They are easily recognized clinically and blanch upon application of pressure to the adjacent helical rim: a positive blanch sign. We describe the clinical presentation of weathering nodules in 10 patients, nine men and one woman, aging from 38 to 70 (median 59, and their associated risk factors. Eight patients had a history of actinic keratosis, three had a history of nonmelanoma skin cancer, and all patients had increased Sun exposure through outdoor activities. Weathering nodules are rarely mentioned in the literature and may be confused with other cutaneous disorders. Therefore, it is paramount for clinicians to become familiar with weathering nodules and include them in the differential diagnosis of ear nodules. Appropriate diagnosis will help avoid unnecessary biopsies while reassuring the patient that the lesions are benign.

  3. Thyroid Nodule Size at Ultrasound as a Predictor of Malignancy and Final Pathologic Size.

    Science.gov (United States)

    Cavallo, Allison; Johnson, Daniel N; White, Michael G; Siddiqui, Saaduddin; Antic, Tatjana; Mathew, Melvy; Grogan, Raymon H; Angelos, Peter; Kaplan, Edwin L; Cipriani, Nicole A

    2017-05-01

    Thyroid-related mortality has remained constant despite the increasing incidence of thyroid carcinoma. Most thyroid nodules are benign; therefore, ultrasound and fine needle aspiration (FNA) are integral in cancer screening. We hypothesize that increased nodule size at ultrasound does not predict malignancy and correlation between nodule size at ultrasound and pathologic exam is good. Resected thyroids with preoperative ultrasounds were identified. Nodule size at ultrasound, FNA diagnosis by Bethesda category, size at pathologic examination, and final histologic diagnosis were recorded. Nodule characteristics at ultrasound and FNA diagnoses were correlated with gross characteristics and histologic diagnoses. Nodules for which correlation could not be established were excluded. Of 1003 nodules from 659 patients, 26% were malignant. Nodules 6 cm). At ultrasound size cutoffs of 2, 3, 4, and 5 cm, smaller nodules had higher malignancy rates than larger nodules. Of the 455 not subject to FNA, 11% were malignant. Ultrasound size alone is a poor predictor of malignancy, but a relatively good predictor of final pathologic size (R 2  = 0.748), with less correlation at larger sizes. In nodules subject to FNA, false negative diagnoses were highest (6-8%) in nodules 3-6 cm, mostly due to encapsulated follicular variant of papillary carcinoma. Thyroid nodule size is inversely related to malignancy risk, as larger nodules have lower malignancy rates. However, the relationship of size to malignancy varies by FNA status. All nodules (regardless of FNA status) demonstrate a risk trough at ≥2 cm. Nodules subject to FNA show step-wise decline in malignancy rates by size, demonstrating that size alone should not be considered as an independent risk factor. Size at ultrasound shows relatively good correlation with final pathologic size. False negative rates are low in this series. Lesions with the appropriate constellation of clinical and radiographic findings should

  4. Nodulation and Rhizobium Population in Root Nodules of Selected ...

    African Journals Online (AJOL)

    Nodulation and rhizobium population in root nodules of 5- year old Leucaena leucocephala; Gliricidia sepium and Acacia mangium were assessed. Nodules of these tree legumes were quantified in terms of their numbers, lateral and vertical distribution while the rhizobium population in cultured nodules was counted as ...

  5. Lung Nodule Detection via Deep Reinforcement Learning

    Directory of Open Access Journals (Sweden)

    Issa Ali

    2018-04-01

    Full Text Available Lung cancer is the most common cause of cancer-related death globally. As a preventive measure, the United States Preventive Services Task Force (USPSTF recommends annual screening of high risk individuals with low-dose computed tomography (CT. The resulting volume of CT scans from millions of people will pose a significant challenge for radiologists to interpret. To fill this gap, computer-aided detection (CAD algorithms may prove to be the most promising solution. A crucial first step in the analysis of lung cancer screening results using CAD is the detection of pulmonary nodules, which may represent early-stage lung cancer. The objective of this work is to develop and validate a reinforcement learning model based on deep artificial neural networks for early detection of lung nodules in thoracic CT images. Inspired by the AlphaGo system, our deep learning algorithm takes a raw CT image as input and views it as a collection of states, and output a classification of whether a nodule is present or not. The dataset used to train our model is the LIDC/IDRI database hosted by the lung nodule analysis (LUNA challenge. In total, there are 888 CT scans with annotations based on agreement from at least three out of four radiologists. As a result, there are 590 individuals having one or more nodules, and 298 having none. Our training results yielded an overall accuracy of 99.1% [sensitivity 99.2%, specificity 99.1%, positive predictive value (PPV 99.1%, negative predictive value (NPV 99.2%]. In our test, the results yielded an overall accuracy of 64.4% (sensitivity 58.9%, specificity 55.3%, PPV 54.2%, and NPV 60.0%. These early results show promise in solving the major issue of false positives in CT screening of lung nodules, and may help to save unnecessary follow-up tests and expenditures.

  6. Acetylsalicylic Acid Compared to Placebo in Treating High-Risk Patients With Subsolid Lung Nodules | Division of Cancer Prevention

    Science.gov (United States)

    This randomized phase II trial studies acetylsalicylic acid compared to placebo in treating high-risk patients with subsolid lung nodules. A nodule is a growth or lump that may be malignant (cancer) or benign (not cancer). Chemoprevention is the use of drugs to keep cancer from forming or coming back. The use of acetylsalicylic acid may keep cancer from forming in patients with subsolid lung nodules. |

  7. Pulmonary nodules and metastases in colorectal cancer

    DEFF Research Database (Denmark)

    Nordholm-Carstensen, Andreas

    2016-01-01

    Patients with newly diagnosed colorectal cancer (CRC) are subjected to a preoperative thoraco-abdominal CT scan to determine the cancer stage. This staging is of relevance with regard to treatment and prognosis. About 20% of the patients have distant metastatic spread at the time of diagnosis, i...... detected in 7.5% of the patients and in 37% of these cases the metastatic spread was confined to the lungs. The prevalence of SPCM increased with the implementation of thoracic CT in CRC staging. SPCM impaired survival significantly and was associated with increasing age and rectal cancer. Resection...

  8. Differential diagnosis of thyroid nodules with virtual touch tissue imaging of ARFI elastography

    Science.gov (United States)

    Li, Tao; Zhou, Pei; Ding, Mingyue; Mi, Yongwei; Li, Yiyong; Zhang, Ji

    2016-04-01

    The aim of this study was to evaluate the diagnostic performance of virtual touch tissue imaging (VTI) based on ARFI elastography technique for differentiating malignant from benign thyroid nodules. One hundred pathologically proven thyroid nodules (80 benign, 20 malignant) in 76 participants were recruited in this study. The likelihood of malignancy in the light of VTI features was scored into 6 levels by one experienced sonogist who was blinded to pathological results. In addition, the mean gray value within the thyroid nodule (mGVTN) derived from VTI image was calculated for quantitative analysis. Receiver-operating characteristic curve (ROC) analyses were performed to assess the diagnostic performance of VTI score and mGVTN. The frequency of malignant nodules (11/20) classified between VTI levels 4 to 6 was more than that of benign nodules (6/80) (p thyroid nodules. The diagnosis performance of mGVTN was almost consistent with that of VTI score, which indicated that the mGVTN as a quantitative parameter might facilitate doctors diagnosing malignant thyroid nodules by VTI.

  9. Hyperparathyroidism caused by distant pulmonary lesions and parathyromatosis after ethanol injection/parathyroidectomy for secondary hyperparathyroidism.

    Science.gov (United States)

    Nakamura, Michio; Tanaka, Kiho; Fujii, Takeshi

    2017-07-01

    Secondary hyperparathyroidism (SHPT) treatment includes parathyroidectomy and percutaneous ethanol injection therapy (PEIT), which are invasive procedures. The condition in which benign hyperfunctioning parathyroid tissue is distributed throughout the neck and mediastinum is termed parathyromatosis. Here, we present the case of a 51-year-old woman who began hemodialysis in 1986 due to chronic kidney disease of unknown etiology and developed SHPT in 1999. She underwent 6 rounds of PEIT followed by total a parathyroidectomy with partial forearm autotransplantation. Between 2011 and 2013, surgeons removed several nodules from her pulmonary and cervical regions and the transplanted masses from her forearm; all showed hyperplasia but exhibited no histological evidence of malignancy. Damage to the parathyroid capsule after repeated PEITs may cause local cervical recurrence and pulmonary lesions, although distant lesions are extremely rare in SHPT. This case is of interest due to the possible association between PEIT and parathyromatosis and distal lesions. © 2017 International Society for Hemodialysis.

  10. Cooled microwave ablation of thyroid nodules: Initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Korkusuz, Yücel [Department of Nuclear Medicine, University Hospital Frankfurt (Germany); Mader, Oscar Maximilian, E-mail: info@dzta.de [Department of Nuclear Medicine, University Hospital Frankfurt (Germany); Kromen, Wolfgang [Department of Neuro Radiology University Hospital (Germany); Happel, Christian [Department of Nuclear Medicine, University Hospital Frankfurt (Germany); German Centre for Thermoablation of Thyroid Nodules, University Hospital, Frankfurt (Germany); Ahmad, Shadi [Department of General and Visceral Surgery, Agaplesion Elisabethenstift, Darmstadt (Germany); Gröner, Daniel; Koca, Mithat; Mader, Alexander [Department of Nuclear Medicine, University Hospital Frankfurt (Germany); Grünwald, Frank; Korkusuz, Hüdayi [Department of Nuclear Medicine, University Hospital Frankfurt (Germany); German Centre for Thermoablation of Thyroid Nodules, University Hospital, Frankfurt (Germany)

    2016-11-15

    Highlights: • cMWA is a safe and effective treatment for thyroid nodules. • Ultrasound imaging allows guidance during microwave ablation. • Pain level during cMWA treatment is reduced in comparison to RFA. - Abstract: Objective: To evaluate if internally cooled microwave ablation (cMWA) is a safe and effective method for treatment of benign and malign thyroid nodules. Methods: 9 patients with 11 symptomatic cold benign thyroid nodules and 1 recurrent thyroid carcinoma ranging in volume from 9.1 to 197 ml (mean size 52 ±  57 ml) were treated with cMWA. The mean age of the patients was 59 years. Pain during the treatment was measured on a 10-point scale. Side effects revealed by ultrasound or patients’ complaints were documented. Periablative efficacy was measured 24 h after cMWA as change (Δ) in serum thyreoglobulin (Tg). Nodule elasticity was measured on a 4-point scale, blood circulation and echogenicity on a 3-point scale. Results: All patients tolerated cMWA well. Median pain intensity averaged 2.1 ± 0.8 (range: 1–3). Postablative hematoma was observed in all cases. In no cases ablation led to hoarseness, superficial burns, nodule ruptures, vagal reactions or dysphagia. cMWA lead to a significant decrease of blood circulation, nodule echogenicity and a significant increase of elasticity (Δ  =  1.1  ±  0.33; 0.8  ±  0.4 and 1.1  ±  0.6 points)(p < 0.05). An average increase of 4495 ng/ml Tg was measured (p < 0.05). Conclusions: cMWA is an effective and secure method for treatment of thyroid nodules.

  11. Computer-aided diagnosis in chest radiography: beyond nodules.

    NARCIS (Netherlands)

    Ginneken, B. van; Hogeweg, L.E.; Prokop, M.

    2009-01-01

    Chest radiographs are the most common exam in radiology. They are essential for the management of various diseases associated with high mortality and morbidity and display a wide range of findings, many of them subtle. In this survey we identify a number of areas beyond pulmonary nodules that could

  12. Virtual touch tissue quantification (VTQ) in the diagnosis of thyroid nodules with coexistent chronic autoimmune Hashimoto's thyroiditis: A preliminary study

    International Nuclear Information System (INIS)

    Han, Ruijun; Li, Fenghua; Wang, Yan; Ying, Zhiqiang; Zhang, Yun

    2015-01-01

    Highlights: • Virtual Touch Tissue Quantification could provide quantitative measurements to estimate tissue stiffness noninvasively. • Severity of Hashimoto's thyroiditis could affect stiffness of extra-nodular thyroid tissue significantly. • Shear wave velocity of malignant nodules significantly higher than that of benign nodules. • Acoustic Radiation Force Impulse imaging is useful in differential diagnosis between malignant/benign thyroid nodules with HT. - Abstract: Objectives: This study aimed at detecting whether Virtual Touch Tissue Quantification (VTQ) could be applied to differentiate between benign and malignant thyroid nodules with chronic autoimmune Hashimoto's thyroiditis (HT). Methods: Convenient ultrasound and Virtual Touch Tissue Quantification were performed in 118 patients with 140 thyroid nodules with histology results. The HT group consisted of 46 patients with 58 nodules. The non-HT group consisted of 72 patients with 82 nodules. Results: The stiffness of extra-nodular thyroid tissue could be significantly affected by the severity of chronic autoimmune thyroiditis. The shear wave velocity of thyroid benign nodules and malignant nodules did not significantly differ in the HT group as compared with the non-HT group (benign nodules: 2.13 ± 0.32 m/s vs 1.98 ± 0.48 m/s, P = 0.122; malignant nodules: 3.32 ± 0.77 m/s vs 3.30 ± 0.74 m/s, P = 0.894). In two groups, the shear wave velocity of malignant nodules is significantly higher than that of benign nodules (HT group: 3.32 ± 0.77 m/s vs 2.13 ± 0.32 m/s; non-HT group: 3.30 ± 0.74 m/s vs 1.98 ± 0.48 m/s, P < 0.001). The best cutoff point for shear wave velocity between malignant and benign thyroid nodules was 2.75 m/s. Conclusions: Virtual Touch Tissue Quantification technology could be performed in the differential diagnosis between malignant thyroid nodules and benign thyroid nodules independently from the coexistence of chronic autoimmune thyroiditis

  13. Idiopathic pulmonary haemosiderosis with mineralizing pulmonary elastosis: A case report

    Directory of Open Access Journals (Sweden)

    Bal Amanjit

    2008-02-01

    Full Text Available Abstract Introduction Idiopathic pulmonary haemosiderosis characterized by repeated episodes of intra-alveolar haemorrhage is rare in adults and has a relatively benign course compared to cases seen in children. Case Presentation The case presented here is of an adult man with idiopathic pulmonary haemosiderosis with mineralizing pulmonary elastosis. Conclusion Pathologists are generally not familiar with this histologic reaction pattern associated with iron encrustation of pulmonary elastic tissue.

  14. Usefulness of semiquantitative elastography in predicting malignancy in thyroid nodules.

    Science.gov (United States)

    Franco Uliaque, C; Pardo Berdún, F J; Laborda Herrero, R; Pérez Lórenz, C

    2016-01-01

    To retrospectively review the diagnostic capacity of semiquantitative elastography in differentiating between benign and malignant thyroid nodules. We analyzed 314 thyroid nodules in 295 consecutive patients referred to the endocrinology department for cytological study, studying all by conventional ultrasonography, elastography, and fine-needle aspiration cytology (FNAC). Using a semiquantitative elastography system that portrays tissue stiffness through a color map, we designed our own classification system for thyroid nodules based on their characteristics on elastography. We classified nodules into three groups: predominantly soft, predominantly stiff, and mosaic patterned. We used logistic regression analysis to investigate the relation between elastography and thyroid cancer. We obtained a definite diagnosis of malignancy after surgery in 19 nodules, of which on elastography 8 had the mosaic pattern, 6 were predominantly stiff, and 5 were predominantly soft. We found no significant association between the pattern on elastography and the probability of malignancy in any of the models. According to our study, la probability of malignancy in a thyroid nodule is not related to the findings at elastography. Therefore, semiquantitative elastography as used in this study cannot obviate FNAC. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Improved efficiency of CT interpretation using an automated lung nodule matching program.

    Science.gov (United States)

    Koo, Chi Wan; Anand, Vikram; Girvin, Francis; Wickstrom, Maj L; Fantauzzi, John P; Bogoni, Luca; Babb, James S; Ko, Jane P

    2012-07-01

    The purpose of this study was to assess the impact of an automated program on improvement in lung nodule matching efficiency. Four thoracic radiologists independently reviewed two serial chest CT examinations from each of 57 patients. Each radiologist performed timed manual lung nodule matching. After 6 weeks, all radiologists independently repeated the timed matching portion using an automated nodule matching program. The time required for manual and automated matching was compared. The impact of nodule size and number on matching efficiency was determined. An average of 325 (range, 244-413) noncalcified solid pulmonary nodules was identified. Nodule matching was significantly faster with the automated program irrespective of the interpreting radiologist (p 0.5). The automated program achieved 90%, 90%, 79%, and 92% accuracy for the four readers. The improvement in efficiency for a given patient using the automated technique was proportional to the number of matched nodules (p < 0.0001) and inversely proportional to nodule size (p < 0.05). Use of the automated lung nodule matching program significantly improves diagnostic efficiency. The time saved is proportionate to the number of nodules identified and inversely proportional to nodule size. Adoption of such a program should expedite CT examination interpretation and improve report turnaround time.

  16. Case report: Pulmonary syphilis mimicking pulmonary hematogenous metastases on chest CT and integrated PET/CT

    Directory of Open Access Journals (Sweden)

    Hyung Jun Kim

    2011-01-01

    Full Text Available We report a case of syphilis with pulmonary involvement. Chest CT scan and 18 F-fluorodeoxyglucose (FDG PET/CT showed multiple pulmonary nodules mimicking pulmonary hematogenous metastases. This was confirmed on follow-up images that showed therapeutic response to penicillin.

  17. Cytogenetic study of a pulmonary sclerosing hemangioma.

    Science.gov (United States)

    Pareja, María J; Vargas, María T; Sánchez, Ana; Ibáñez, José; González-Cámpora, Ricardo

    2009-11-01

    Pulmonary sclerosing hemangioma (PSH) is an uncommon benign tumor that presents as a solitary asymptomatic and slow-growing nodule. It occurs in both young and old persons; peak incidence is in the fifth decade. Both sexes are affected by this tumor, but women more frequently than men. On histological examination, PSH shows prominent sclerotization and vascularization of the tissue. Recent studies conclude that PSH derives from type II pneumocytes, but the potential for progression and histogenesis remains controversial. We report a case of pulmonary sclerosing hemangioma in a 61-year-old woman with a neoplastic node 1 cm in diameter. The karyotype was 46,XX,t(8;18),der(14;15),+14 in all the cells analyzed. PTEN (10q23) and IgH (14q32) probes were analyzed in interphase nuclei and paraffin-embedded tissues of tumor cells. These chromosome abnormalities could provide information about the relationship of genetic changes to the biological properties of sclerosing hemangioma tumors.

  18. 12-month efficacy of a single radiofrequency ablation on autonomously functioning thyroid nodules.

    Science.gov (United States)

    Bernardi, Stella; Stacul, Fulvio; Michelli, Andrea; Giudici, Fabiola; Zuolo, Giulia; de Manzini, Nicolò; Dobrinja, Chiara; Zanconati, Fabrizio; Fabris, Bruno

    2017-09-01

    Radiofrequency ablation has been advocated as an alternative to radioiodine and/or surgery for the treatment of autonomously functioning benign thyroid nodules. However, only a few studies have measured radiofrequency ablation efficacy on autonomously functioning benign thyroid nodules. The aim of this work was to evaluate the 12-month efficacy of a single session of radiofrequency ablation (performed with the moving shot technique) on solitary autonomously functioning benign thyroid nodules. Thirty patients with a single, benign autonomously functioning benign thyroid nodules, who were either unwilling or ineligible to undergo surgery and radioiodine, were treated with radiofrequency ablation between April 2012 and May 2015. All the patients underwent a single radiofrequency ablation, performed with the 18-gauge needle and the moving shot technique. Clinical, laboratory, and ultrasound evaluations were scheduled at baseline, and after 1, 3, 6, and 12 months from the procedure. A single radiofrequency ablation reduced thyroid nodule volume by 51, 63, 69, and 75 % after 1, 3, 6, and 12 months, respectively. This was associated with a significant improvement of local cervical discomfort and cosmetic score. As for thyroid function, 33 % of the patients went into remission after 3 months, 43 % after 6 months, and 50 % after 12 months from the procedure. This study demonstrates that a single radiofrequency ablation allowed us to withdraw anti-thyroid medication in 50 % of the patients, who remained euthyroid afterwards. This study shows that a single radiofrequency ablation was effective in 50 % of patients with autonomously functioning benign thyroid nodules. Patients responded gradually to the treatment. It is possible that longer follow-up studies might show greater response rates.

  19. Cytological Results of Ultrasound-Guided Fine-Needle Aspiration Cytology for Thyroid Nodules: Emphasis on Correlation with Sonographic Findings

    Science.gov (United States)

    Lee, Mi-Jung; Hong, Soon Won; Chung, Woung Youn; Kwak, Jin Young; Kim, Min Jung

    2011-01-01

    Purpose To compare the cytological results of ultrasound-guided fine-needle aspiration (US-FNA) cytology of thyroid nodules to sonographic findings and determine whether US findings are helpful in the interpretation of cytological results. Materials and Methods Among the thyroid nodules that underwent US-FNA cytology, we included the 819 nodules which had a conclusive diagnosis. Final diagnosis was based on pathology from surgery, repeated FNA cytology or follow-up of more than one year. Cytological results were divided into five groups: benign, indeterminate (follicular or Hurthle cell neoplasm), suspicious for malignancy, malignant, and inadequate. US findings were categorized as benign or suspicious. Cytological results and US categories were analyzed. Results Final diagnosis was concluded upon in 819 nodules based on pathology (n=311), repeated FNA cytology (n=204) and follow-up (n=304), of which 634 were benign and 185 were malignant. There were 560 benign nodules, 141 malignant nodules, 49 nodules with inadequate results, 21 with indeterminate results, and 48 that were suspicious for malignancy. The positive and negative predictive values of the US categories were 59.1% and 97.0%, and those of the cytological results were 93.7% and 98.9%. The US categories were significantly correlated with final diagnosis in the benign (p=0.014) and suspicious for malignancy (pcytological result groups, but not in the inadequate and indeterminate cytological results groups. The false positive and negative rates of cytological results were 1.9% and 3.2%. Conclusion Sonographic findings can be useful when used alongside cytological results, especially in nodules with cytological results that are benign or suspicious for malignancy. PMID:21786450

  20. Preoperative TSH level and risk of thyroid cancer in patients with nodular thyroid disease: nodule size contribution.

    Science.gov (United States)

    Zafón, Carles; Obiols, Gabriel; Mesa, Jordi

    2015-01-01

    Many reports have supported the relationship between high preoperative TSH levels and risk of thyroid cancer in nodular thyroid disease (NTD). We investigated whether TSH levels are related to the risk of differentiated thyroid carcinoma (DTC) in patients who have undergone total thyroidectomy for NTD. The relationship between TSH and size of malignant nodule was investigated. Finally, we assessed whether TSH levels are related to DTC and presence of additional benign nodules. A retrospective study of 980 patients was conducted. Variables included age at diagnosis, TSH level, nodule size, gender, final histology (benign versus DTC), and type of malignancy. Malignancy was present in 261 (26.6%) patients. These patients had higher median TSH levels as compared to those with no malignancy (1.61 mU/L (0.9-2.5) versus 0.9 mU/L (0.3-1.6); p-value<0.001). TSH was higher in patients with DTC in whom the largest nodule was malignant than in patients in whom the largest nodule was benign (1.80 mU/L (1.1-2.6) versus 1.38 mU/L (0.7-2.1) respectively; p-value=0.025). A significant correlation was seen between malignant nodule size and TSH level, but not between TSH levels and size of the largest benign nodule. Our study supported an association between preoperative TSH levels and risk of DTC in patients with NTD. There was also a direct relationship between malignant nodule size and TSH levels. By contrast, no relationship was found between the size of benign nodules and TSH levels. Copyright © 2014 SEEN. Published by Elsevier Espana. All rights reserved.

  1. Ultrasonographic elastography of thyroid nodules: Is adding strain ratio to colour mapping better?

    International Nuclear Information System (INIS)

    Chong, Y.; Shin, J.H.; Ko, E.S.; Han, B.-K.

    2013-01-01

    Aim: To determine the diagnostic performance of colour mapping and strain ratio for characterizing malignant thyroid nodules on ultrasonographic (US) elastography. Materials and methods: The study was approved by the institutional review board and written informed consent was obtained. One hundred and thirty-one patients with 142 thyroid nodules >0.5 cm were prospectively enrolled between July 2010 and January 2011. Seven radiologists performed US elastography (iU22 Vision 2010; Philips, Seattle, WA, USA) using colour mapping and strain ratio for thyroid nodules blinded to the cytopathological results. Diagnostic performances of colour mapping alone, strain ratio alone, colour mapping and strain ratio, and colour mapping or strain ratio were compared using receiver operating characteristic (ROC) curve analysis. Results: Of the 142 nodules, 69 (48.6%) were benign and 73 (51.4%) were malignant. Colour mapping of elastography showed a more frequent blue colour in malignant nodules than in benign nodules (65.8% versus 24.6%, p < 0.0001). A higher ratio than 1.21 as the best cut-off value was found in 65.8% of malignant nodules and 46.4% of benign nodules (p = 0.030). Area under the ROC curve (AUC) of colour mapping alone was significantly greater than that of colour mapping or strain ratio (AUC = 0.706 versus AUC = 0.63, p = 0.0195) and similar to that of colour mapping and strain ratio (AUC = 0.673, p = 0.1364). Conclusion: US elastography is helpful to predict malignant thyroid nodules. However, adding strain ratio to colour mapping does not improve performance compared to colour mapping alone

  2. NODUL TIROID SOLITER

    Directory of Open Access Journals (Sweden)

    I Gusti Ayu Prema Yani Sidemen

    2014-10-01

    Full Text Available Latar Belakang: Nodul tiroid adalah pembengkakan atau massa pada kelenjar tiroid.Pembedahan merupakan pilihan terapi utama, namun pembedahan yang tidak dilakukandengan baik berisiko tinggi mencederai 2 struktur penting, yakni kelenjar paratiroid dannervus rekuren laringeal. Risiko nodul tiroid akan meningkat seiring pertambahan usiadan kurangnya asupan sodium.Insiden terjadinya nodul tiroid lebih sering ditemukanpada laki-laki dan usia di atas 50 tahun, namun pada kasus ini nodul tiroid soliterditemukan pada seorang perempuan dewasa muda sehingga melatar belakangi penulisuntuk mendiskusikan kasus ini dalam laporan kasus.Kasus: Seorang pasien perempuan 32 tahun dengan keluhan tumbuh benjolan padaleher kiri sejak ± 1 tahun yang lalu. Benjolan tersebut dirasakan semakin membesar.Pasien tidak mengeluhkan rasa nyeri di daerah benjolan. Gangguan pada saat makanataupun minum, riwayat sesak, dada berdebar-debar, sering berkeringat, ataupunpenurunan berat badan disangkal. Pada pemeriksaan fisik didapatkan keadaan umumdalam batas normal.  Pada pemeriksaan status lokalis pada region colli anterior lateralsinistra ditemukan massa lunak yang mobile dengan batas tegas dan ukuran ± 3,2 cm x3,4 cm.Hasil: Hasil pemeriksaan patologi anatomi menunjukkan terdapat degenerasi kistikpada massa tiroid tersebut. Pasien kemudian menjalani tindakan pembedahan, yaknitiroidektomi dengan isthmolobectomy. Tiroidektomi dengan teknik diseksi kapsularpada pasien ini berhasil dibuktikan dengan tidak terdapatnya kerusakan pita suara ataukejang pasca operasi.Kesimpulan: Kondisi pasca tiroidektomi dengan teknik diseksi kapsular pada pasien inibaik, tidak terdapat komplikasi kerusakan pita suara dan nervus rekuren laringeal,pasien hidup, dan luka operasi terawat baik.

  3. Pulmonary involvement of secondary syphilis.

    Science.gov (United States)

    Ogawa, Yoshihiko; Imai, Yuichiro; Yoshihara, Shingo; Fujikura, Hiroyuki; Hirai, Nobuyasu; Sato, Masatoshi; Ogawa, Taku; Uno, Kenji; Kasahara, Kei; Yano, Hisakazu; Mikasa, Keiichi

    2018-01-01

    Pulmonary involvement in secondary syphilis is considered a rare occurrence; however, the number of cases has increased in the 2000s. This is likely due to the increased use of computed tomography scans and molecular diagnostic testing. We report a case of an HIV-positive man with pleural chest pain and bilateral subpleural nodules on chest computed tomography. His rapid plasma reagin and Treponema pallidum hemagglutination tests were positive, and the specimen of one of the pulmonary nodules obtained by transthoracic biopsy was positive for the polA gene of Treponema pallidum. Since clinical manifestations of syphilis are highly variable, clinicians should bear in mind that pleural chest pain with bilateral subpleural nodules can be caused by pulmonary syphilis.

  4. Thyroid nodule recognition in computed tomography using first order statistics.

    Science.gov (United States)

    Peng, Wenxian; Liu, Chenbin; Xia, Shunren; Shao, Dangdang; Chen, Yihong; Liu, Rui; Zhang, Zhiping

    2017-06-02

    Computed tomography (CT) is one of the popular tools for early detection of thyroid nodule. The pixel intensity of thyroid in CT image is very important information to distinguish nodule from normal thyroid tissue. The pixel intensity in normal thyroid tissues is homogeneous and smooth. In the benign or malignant nodules, the pixel intensity is heterogeneous. Several studies have shown that the first order features in ultrasound image can be used as imaging biomarkers in nodule recognition. In this paper, we investigate the feasibility of utilizing the first order texture features to identify nodule from normal thyroid tissue in CT image. A total of 284 thyroid CT images from 113 patients were collected in this study. We used 150 healthy controlled thyroid CT images from 55 patients and 134 nodule images (50 malignant and 84 benign nodules) from 58 patients who have undergone thyroid surgery. The final diagnosis was confirmed by histopathological examinations. In the presented method, first, regions of interest (ROIs) from axial non-enhancement CT images were delineated manually by a radiologist. Second, average, median, and wiener filter were applied to reduce photon noise before feature extraction. The first-order texture features, including entropy, uniformity, average intensity, standard deviation, kurtosis and skewness were calculated from each ROI. Third, support vector machine analysis was applied for classification. Several statistical values were calculated to evaluate the performance of the presented method, which includes accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area of under receiver operating characteristic curve (AUC). The entropy, uniformity, mean intensity, standard deviation, skewness (P < 0.05), except kurtosis (P = 0.104) of thyroid tissue with nodules have a significant difference from those of normal thyroid tissue. The optimal classification was obtained from the presented

  5. Hyper-Echoic Rim in Thyroid Nodules: A New Ultrasonographic Feature for Malignancy Prediction.

    Science.gov (United States)

    Dong, YiJie; Zhan, WeiWei; Zhou, JianQiao; Song, LinLin; Ni, XiaoFeng; Zhang, BenYan

    2016-09-01

    The goal of this study was to verify the ultrasound features of hyper-echoic rims in thyroid nodules and to evaluate their diagnostic value in predicting thyroid malignancies. We retrospectively analyzed 228 pathologically proven thyroid nodules (137 malignant and 91 benign nodules). Forty-eight thyroid nodules had a hyper echogenic rim. All malignant nodules (137) were papillary carcinomas, which were studied to identify the correlation between the hyper-echoic rim (detected by ultrasound) and other histologic features. Presence of a hyper-echoic rim had high specificity (94.51%), but low sensitivity (31.39%) in predicting malignancy (p hyper-echogenic rim could be one additional ultrasound parameter in the diagnosis of thyroid lesions. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  6. Thyroid Nodules Individual Pathologic Assessment in Imam Reza Hospital Tabriz

    Directory of Open Access Journals (Sweden)

    Saeed Judi

    2017-02-01

    Full Text Available Background and Objectives: Single thyroid nodule is a common clinical finding in patients with thyroid gland enlargment or with palpable mass in anterior neck. Because of various pathologic kinds and wide spectrum of nodules from inflammatory disease to benign and malignan tumors, pathologically diagnosis of disease is very important because treatment, prognosiss and approach will differ with respect to diagnosis. Because of importance and high incidence of disease, we decided to investigate records of patients in pathology department of Imam Reza hospital of Tabriz between 2011-14. Our goals were determination of pathologic incidence of single thyroid nodules and investigation of them by sex and age. After extracting results from records, we presented them in the form of tables and figure. Material and Methods: In total, 17349 patients referred to pathology department of Imam Reza hospital between 2011-14. In 191 cases the first clinical diagnosiss was single thyroid nodule. Thyroids specimes were sent to pathology department. Results: The most common pathologic report was multinodular goiter in 90 patients (47%. Other kinds were follicular adenoma 28%, papillary carcinoma 15%, follicular carcinoma and diffuse goiter 3%, lymphocytic thyroiditis, medulary carcinoma 1%, granuloma, lymphoma and abscess each one 0.5%, respectively. Conclusion: Most cases of thyroid nodules are nodular goiter and it is prevalent among females.

  7. Hyperfunction thyroid nodules: Their risk for becoming or being associated with thyroid cancers

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Sun; Kim, Ji Hoon; Na, Dong Gyu; Paeng, Jin Chul; Min, Hye Sook; Choi, Seung Hong; Sohn, Chul Ho; Chang, Ki Hyun [Seoul National University Hospital, Seoul (Korea, Republic of)

    2013-08-15

    To retrospectively evaluate the risk of thyroid cancer in patients with hyperfunctioning thyroid nodules through ultrasonographic-pathologic analysis. Institutional review board approval was obtained and informed consent was waived. From 2003 to 2007, 107 patients consecutively presented with hot spots on thyroid scans and low serum thyroid-stimulating hormone levels. Among them, 32 patients who had undergone thyroid ultrasonography were analyzed in this study. Thyroid nodules depicted on ultrasonography were classified based on size and categorized as benign, indeterminate, or suspicious malignant nodules according to ultrasonographic findings. The thyroid nodules were determined as either hyperfunctioning or coexisting nodules and were then correlated with pathologic results. In 32 patients, 42 hyperfunctioning nodules (mean number per patient, 1.31; range, 1-6) were observed on thyroid scans and 68 coexisting nodules (mean, 2.13; range, 0-7) were observed on ultrasonography. Twenty-five patients (78.1%) had at least one hyperfunctioning (n = 17, 53.1%) or coexisting (n = 16, 50.0%) nodule that showed a suspicious malignant feature larger than 5 mm (n = 8, 25.0%), or an indeterminate feature 1 cm or greater (n = 20, 62.5%) in diameter, which could have been indicated by using fine needle aspiration (FNA). Seven patients were proven to have 11 thyroid cancers in 3 hyperfunctioning and 8 coexisting nodules. All of these had at least one thyroid cancer, which could have been indicated by using FNA. The estimated minimal risk of thyroid cancer was 6.5% (7/107). Patients with hyperfunctioning nodules may not be safe from thyroid cancer because hyperfunctioning nodules can coexist with thyroid cancer nodules. To screen out these cancers, ultrasonography should be performed.

  8. Thyroid carcinoma and hot nodule

    Energy Technology Data Exchange (ETDEWEB)

    Fukata, Shuji; Tamai, Hajime; Matsubayashi, Sunao; Nagai, Keisuke; Hirota, Yoshihiko; Matsuzuka, Fumio; Katayama, Shoichi; Kuma, Kanji; Nagataki, Shigenobu

    1987-09-01

    A 70-year-old woman presented with a nodule in the thyroid gland. /sup 131/I scintigraphy of the gland showed a hot nodule. Histology of the resected thyroid revealed a papillary adenocarcinoma. Although a thyroid carcinoma with a hot nodule seen on the radioiodine isotope scan is a very rare occurrence, it is clinically very important because it may indicate a thyroid malignancy.

  9. [Logistic regression analysis of clinical and ultrasonic features of breast nodules].

    Science.gov (United States)

    Zhang, Xiu-mei; Shao, Yu-hong; Xiong, Xia; Wan, Yuan-lian

    2011-03-22

    To create a breast nodule estimation model based on grayscale and color Doppler ultrasonography using Logistic regression that can screen out the specific features for distinguishing breast malignancy from benignancy. From July, 2009 to May, 2010, 217 patients were enrolled in the study in peking university first hospital. Clinical data and ultrasonic features were evaluated in 219 breast nodules of 217 patients confirmed by surgical pathology. Logistic regression model was established to screen out significant ultrasonic indexes for differentiating breast malignancy from benignancy. A receiver operating characteristics curve was made to assess diagnostic value of the Logistic regression model. Correlation was analyzed between the Logistic regression model and surgical pathology. Logistic regression model: Logit(p) = -16.884 + 0.037 × age + 3.228 × longitudinal-transverse axis ratio + 1.412 × border + 2.663 × halo + 1.813 × microcalcium + 1.157 × resistance index + 2.204 × enlarged axillary lymph node (χ(2) = 167.107, P = 000). The areas of ROC curve for probability and identification of breast malignant and benign nodule were 0.948 and 0.882 respectively. Diagnostic sensitivity, specificity and accuracy were 91.6%, 84.9% and 88.9%. Logistic regression model positively correlated with surgical pathology (r = 0.768, P = 0.000). Our Logistic regression model can effectively differentiate malignant breast nodules from benign and can identify the ultrasonic features associated with breast cancer.

  10. Primary Pulmonary Meningioma Mimicking Lung Metastasis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Su Wan; Choe, Du Hwan; Lee, Byung Hee; Ko, Jae Soo [Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    2009-02-15

    Primary pulmonary meningioma is a very rare tumor and it usually presents as a solitary pulmonary nodule. We report here on a case of primary pulmonary meningioma that was first suspected of being a metastatic lesion from lung cancer, but the correct diagnosis was established after resection. The imaging findings together with a brief literature review are described.

  11. Thoracoscopic or open surgery for pulmonary metastasectomy

    DEFF Research Database (Denmark)

    Eckardt, Jens; Licht, Peter B

    2014-01-01

    are now performed routinely worldwide. This prompted us to conduct a prospective observer-blinded study on pulmonary metastasectomy. METHODS: Eligible patients with oligometastatic pulmonary disease on computed tomography (CT) underwent high-definition VATS, with digital palpation by 1 surgical team...... number of additional nodules were detected during thoracotomy despite advancements in CT imaging and VATS technology. Many of these nodules were malignant and would have been missed if VATS was used exclusively. Consequently, we considered VATS inadequate if the intention is to resect all pulmonary...

  12. Radiofrequency thermal ablation of a metastatic lung nodule

    Energy Technology Data Exchange (ETDEWEB)

    Highland, Adrian M. [Department of Clinical Radiology, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ (United Kingdom); Mack, Paul [Diana Princess of Wales Hospital, Scartho Road, Grimsby, DN33 2BA (United Kingdom); Breen, David J. [Department of Radiology, Southampton University Hospitals, Tremona Road, Southampton, SO16 6YD (United Kingdom)

    2002-07-01

    Pulmonary metastases are a common finding in patients with colonic adenocarcinoma. We report the treatment of a metastatic lung nodule with radiofrequency (RF) ablation under CT guidance. This case illustrates the use of RF ablation in a patient in whom surgical resection was no longer possible and where chemotherapy was unlikely to produce benefit. This technique may offer a viable method of cytoreduction when other treatments have not succeeded. (orig.)

  13. Radiofrequency thermal ablation of a metastatic lung nodule

    International Nuclear Information System (INIS)

    Highland, Adrian M.; Mack, Paul; Breen, David J.

    2002-01-01

    Pulmonary metastases are a common finding in patients with colonic adenocarcinoma. We report the treatment of a metastatic lung nodule with radiofrequency (RF) ablation under CT guidance. This case illustrates the use of RF ablation in a patient in whom surgical resection was no longer possible and where chemotherapy was unlikely to produce benefit. This technique may offer a viable method of cytoreduction when other treatments have not succeeded. (orig.)

  14. Update on the role of ultrasound guided radiofrequency ablation for thyroid nodule treatment

    DEFF Research Database (Denmark)

    Radzina, Maija; Cantisani, Vito; Rauda, Madara

    2017-01-01

    in significant reduction of thyroid nodule mean volume and improvement of the patient symptoms. However, future multicenter studies are warranted to better clarify the multi-parametric patient selection criteria and evaluate RFA technique efficacy, advantages and limitations in the variety of thyroid nodular......Thyroid nodules can be frequently detected in general population, most of them are benign, however malignant cases are rising in the past decades. Ultrasound (US) is the most common imaging modality to assess thyroid nodular lesions, plan patient work-up and guide minimally invasive treatment...... with other ablation techniques has been provided as well. US guided Radiofrequency ablation has been proved to be effective and safe in cases of benign thyroid nodules and a promising treatment method alternative to surgery for patients with recurrent papillary thyroid cancer. It's major role lies...

  15. The Effect of Indigenous Root-Nodulating Bacteria on Nodulation ...

    African Journals Online (AJOL)

    This study was initiated to isolate and characterize indigenous rhizobia nodulating faba bean, and evaluate symbiotic characteristics between the crop and the rhizobia in major faba bean producing areas in Tigray highlands. Field crops were also surveyed for nodulation in selected sites of seven (7) faba bean growing ...

  16. Malignant-looking thyroid nodules with size reduction: Core needle biopsy results

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ha Young; Baek, Jung Hwan; Ha, Eun Jun; Park, Jee Won; Lee, Jeong Hyun; Song, Dong Eun; Shong, Young Kee [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2016-08-15

    The aim of this study was to evaluate whether malignant-looking thyroid nodules with size reduction were malignant or not. From November 2010 to July 2011, we retrospectively enrolled 16 patients with 16 nodules (11 females and five males; mean age, 55 years) who underwent core needle biopsy (CNB), and whose thyroid nodules had malignant ultrasonographic (US) features, although they showed size reduction (>20% decrease in maximum diameter) during the follow-up period (mean, 37±27 months). The histologic findings of the CNB specimen were reviewed and correlated with the US findings. US studies were analyzed for their internal content, shape, margin, echogenicity, the presence of microcalcification and macrocalcification, inner isoechoic rim, and low-echoic halo. All nodules were confirmed as benign by CNB. Pathologic analysis was available for 12 CNB specimens. US imaging showed central hypoechogenicity or marked hypoechogenicity in all cases and a peripheral isoechoic rim in 15 nodules. US-pathologic correlation showed that the central hypoechoic area was primarily composed of fibrosis (12/12) and hemorrhage (8/12) and that the isoechoic rim was composed of follicular cells. In our study, the CNB results of all of the malignant-looking thyroid nodules with size reduction were benign and were primarily composed of internal fibrosis and hemorrhage. Understanding these US and pathologic features could prevent repeated fine-needle aspiration or unnecessary diagnostic surgery.

  17. Quantitative imaging features to predict cancer status in lung nodules

    Science.gov (United States)

    Liu, Ying; Balagurunathan, Yoganand; Atwater, Thomas; Antic, Sanja; Li, Qian; Walker, Ronald; Smith, Gary T.; Massion, Pierre P.; Schabath, Matthew B.; Gillies, Robert J.

    2016-03-01

    Background: We propose a systematic methodology to quantify incidentally identified lung nodules based on observed radiological traits on a point scale. These quantitative traits classification model was used to predict cancer status. Materials and Methods: We used 102 patients' low dose computed tomography (LDCT) images for this study, 24 semantic traits were systematically scored from each image. We built a machine learning classifier in cross validation setting to find best predictive imaging features to differentiate malignant from benign lung nodules. Results: The best feature triplet to discriminate malignancy was based on long axis, concavity and lymphadenopathy with average AUC of 0.897 (Accuracy of 76.8%, Sensitivity of 64.3%, Specificity of 90%). A similar semantic triplet optimized on Sensitivity/Specificity (Youden's J index) included long axis, vascular convergence and lymphadenopathy which had an average AUC of 0.875 (Accuracy of 81.7%, Sensitivity of 76.2%, Specificity of 95%). Conclusions: Quantitative radiological image traits can differentiate malignant from benign lung nodules. These semantic features along with size measurement enhance the prediction accuracy.

  18. Lung nodule detection on chest CT: evaluation of a computer-aided detection (CAD) system

    International Nuclear Information System (INIS)

    Lee, In Jae; Gamsu, Gordon; Czum, Julianna; Johnson, Rebecca; Chakrapani, Sanjay; Wu, Ning

    2005-01-01

    To evaluate the capacity of a computer-aided detection (CAD) system to detect lung nodules in clinical chest CT. A total of 210 consecutive clinical chest CT scans and their reports were reviewed by two chest radiologists and 70 were selected (33 without nodules and 37 with 1-6 nodules, 4-15.4 mm in diameter). The CAD system (ImageChecker CT LN-1000) developed by R2 Technology, Inc. (Sunnyvale, CA) was used. Its algorithm was designed to detect nodules with a diameter of 4-20 mm. The two chest radiologists working with the CAD system detected a total of 78 nodules. These 78 nodules form the database for this study. Four independent observers interpreted the studies with and without the CAD system. The detection rates of the four independent observers without CAD were 81% (63/78), 85% (66/78), 83% (65/78), and 83% (65/78), respectively. With CAD their rates were 87% (68/78), 85% (66/78), 86% (67/78), and 85% (66/78), respectively. The differences between these two sets of detection rates did not reach statistical significance. In addition, CAD detected eight nodules that were not mentioned in the original clinical radiology reports. The CAD system produced 1.56 false-positive nodules per CT study. The four test observers had 0, 0.1, 0.17, and 0.26 false-positive results per study without CAD and 0.07, 0.2, 0.23, and 0.39 with CAD, respectively. The CAD system can assist radiologists in detecting pulmonary nodules in chest CT, but with a potential increase in their false positive rates. Technological improvements to the system could increase the sensitivity and specificity for the detection of pulmonary nodules and reduce these false-positive results

  19. The value of virtual touch tissue image (VTI) and virtual touch tissue quantification (VTQ) in the differential diagnosis of thyroid nodules

    International Nuclear Information System (INIS)

    Zhang, Feng-Juan; Han, Ruo-Ling; Zhao, Xin-Ming

    2014-01-01

    Highlights: • All nodules in the research were confirmed by histopathology. • The classification method of VTI was easy to learn. • VTQ could provide quantitative elasticity measurements for thyroid nodules. • VTI classification could provide semi-quantitative elasticity analysis. • The area ratio could show invasive extent of malignant tumor. - Abstract: Objectives: To explore the value of virtual touch tissue image (VTI) and virtual touch tissue quantification (VTQ) in the differential diagnosis of thyroid nodules. Methods: One-hundred and seven patients with 113 thyroid nodules were performed conventional ultrasound and acoustic radiation force impulse (ARFI) elastography. The stiffness of the nodules on virtual touch tissue image (VTI) was graded, and the area ratios (AR) of nodules on VTI images versus on B-mode images were calculated. Shear wave velocity (SWV) within the thyroid nodules were measured using virtual touch tissue quantification (VTQ) technique. The pathological diagnosis as the gold standard draws the receiver-operating characteristic curve (ROC) to find the cut-off point of VTI grades, AR and SWV to predict thyroid cancer. Results: The difference in VTI grades of malignant and benign nodules was statistically significant (P < 0.05), as well as in AR and SWV. There was no significant difference in the AR of nodules or the SWV of nodules in benign group or in malignant group. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of VTI grades, AR, and SWV in the differential diagnosis of thyroid nodules were calculated. There was no significant difference in diagnostic accuracy among the three methods. Conclusion: VTI grades, AR of nodules on VTI images versus on B-mode images and SWV within the nodules can help the differential diagnosis of thyroid nodules

  20. Benign prostate hyperplasia (BPH) - resources

    Science.gov (United States)

    Resources - benign prostatic hyperplasia (BPH); Prostate enlargement resources; BPH resources ... The following organizations provide information on benign prostatic hyperplasia ( prostate enlargement ... Urology Care Foundation -- www. ...

  1. Balance the nodule shape and surroundings: a new multichannel image based convolutional neural network scheme on lung nodule diagnosis

    Science.gov (United States)

    Sun, Wenqing; Zheng, Bin; Huang, Xia; Qian, Wei

    2017-03-01

    Deep learning is a trending promising method in medical image analysis area, but how to efficiently prepare the input image for the deep learning algorithms remains a challenge. In this paper, we introduced a novel artificial multichannel region of interest (ROI) generation procedure for convolutional neural networks (CNN). From LIDC database, we collected 54880 benign nodule samples and 59848 malignant nodule samples based on the radiologists' annotations. The proposed CNN consists of three pairs of convolutional layers and two fully connected layers. For each original ROI, two new ROIs were generated: one contains the segmented nodule which highlighted the nodule shape, and the other one contains the gradient of the original ROI which highlighted the textures. By combining the three channel images into a pseudo color ROI, the CNN was trained and tested on the new multichannel ROIs (multichannel ROI II). For the comparison, we generated another type of multichannel image by replacing the gradient image channel with a ROI contains whitened background region (multichannel ROI I). With the 5-fold cross validation evaluation method, the CNN using multichannel ROI II achieved the ROI based area under the curve (AUC) of 0.8823+/-0.0177, compared to the AUC of 0.8484+/-0.0204 generated by the original ROI. By calculating the average of ROI scores from one nodule, the lesion based AUC using multichannel ROI was 0.8793+/-0.0210. By comparing the convolved features maps from CNN using different types of ROIs, it can be noted that multichannel ROI II contains more accurate nodule shapes and surrounding textures.

  2. The radiographic findings in diagnosis of pulmonary lymphoma

    International Nuclear Information System (INIS)

    Song Wei; Wang Li; Yan Hongzhen

    2001-01-01

    Objective: To study the radiographic findings in the diagnosis of pulmonary lymphoma and pseudo lymphoma. Methods: Eight patients with pulmonary lymphoma and 2 with pseudo lymphoma were examined by X-ray film, tomography, and CT. Results: Single or multiple nodules or masses were observed in 8 patients with pulmonary lymphoma, shaggy borders or halo of ground-glass attenuation in 7 patients, 2 patients had multiple patchy infiltrates bilaterally, 2 had diffuse interstitial infiltrates and 1 had miliary nodules. Multiple consolidations with air bronchogram and without hilar and mediastinal lymphadenopathy were observed in 2 patients with pulmonary pseudo lymphoma. Conclusion: Radiographic findings of pulmonary lymphoma were varied, the most common findings were the nodules or masses with shaggy borders or halo of ground-glass attenuation. The specific findings of pulmonary pseudo lymphoma were multiple consolidations with air bronchogram and without hilar and mediastinal lymphadenopathy. The final diagnosis relied on pathology

  3. Usefulness of ultrasonography is the evaluation of thyroid nodules.

    Science.gov (United States)

    Franco Uliaque, Carolina; Pardo Berdún, Francisco Javier; Laborda Herrero, Ricardo; Lórenz, Carmen Pérez

    2016-01-01

    To evaluate the diagnostic capacity of ultrasonography (US) for differentiating between malignant and benign thyroid nodules and its usefulness in obviating unnecessary invasive procedures. From January 2012 through December 2014, a total of 321 fine-needle aspiration biopsy (FNAB) procedures were done in 302 patients selected according to the criteria recommended by the American Association of Clinical Endocrinology guidelines and the American Thyroid Association guidelines. We analyzed the following characteristics on US: location, size, morphology, contour, consistency, echostructure, echogenicity, calcifications, and vascularization. We used univariate and multivariate analyses to investigate the relationship between the US findings and thyroid cancer. The prevalence of malignancy in our study population was 5.92%. The US findings that were significantly associated with a greater probability of malignancy were microcalcifications, central vascularization, and hypoechogenicity. The US findings that were associated with a lower risk of malignancy were areas of colloid degeneration and nodule heterogeneity. Our results suggest that decisions about whether to perform FNAB should be based on the presence of suspicious US findings found with our statistic model rather than on the size of the nodule. Thus, unnecessary FNAB procedures on nodules without suspicious US characteristics can be avoided. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults

    DEFF Research Database (Denmark)

    Russ, Gilles; Bonnema, Steen J; Erdogan, Murat Faik

    2017-01-01

    , called EU-TIRADS. This comprises a thyroid US lexicon; a standardized report; definitions of benign and low-, intermediate-, and high-risk nodules, with the estimated risks of malignancy in each category; and indications for FNA. Illustrated by numerous US images, the EU-TIRADS aims to serve physicians...... of the risk of malignancy is crucial in patients with nodules, in order to select those who should have a fine needle aspiration (FNA) biopsy performed. Due to the pivotal role of thyroid US in the management of patients with nodules, the European Thyroid Association convened a panel of international experts...... to set up European guidelines on US risk stratification of thyroid nodules. Based on a review of the literature and on the American Association of Clinical Endocrinologists, American Thyroid Association, and Korean guidelines, the panel created the novel European Thyroid Imaging and Reporting Data System...

  5. Benign Liver Tumors

    Science.gov (United States)

    ... Legacy Society Make Gifts of Stock Donate Your Car Personal Fundraising Partnership & Support Share Your Story Spread the Word Give While You Shop Contact Us Donate Now Benign Liver Tumors Back ...

  6. Benign osseous metaplasia of the breast: Case report

    Directory of Open Access Journals (Sweden)

    Hassan Alyami

    Full Text Available Introduction: Benign Osseous metaplasia of the breast is rare, with only a few cases reported in the literature. Here we present a case of benign osseous metaplasia of the breast presenting as a breast lump. Case presentation: 38-year-old previously well woman presented with a one-year history of bilateral breast pain and a left-sided breast lump. Ultrasound and mammography suggested calcified fibroadenoma. An ultrasound-guided true cut biopsy revealed fibrous tissue containing foci of adenosis in the presence of a myoepithelial cell layer. Excision biopsy was performed, and histopathological examination showed bone matrix deposition occupying most of the nodule with peripheral hyalinized tissue but no evidence of malignancy. A diagnosis of benign osseous metaplasia of the breast was made, and the patient recovered well without recurrence after lump excision. Discussion: Only a few cases of osseous metaplasia are reported in the literature. Most reported cases are malignant, such as in fibrosarcoma, malignant mesenchymoma, osteoid sarcoma, osteogenic sarcoma, and osteochondrosarcoma.Very few cases of osseous sarcoma are reported in benign lesions such as fibroadenoma, pleomorphic adenoma, benign mesenchymoma, phyllodes tumor, and amyloid tumor of the breast. Joshi et al. first reported a case of benign osseous metaplasia of the breast presenting as breast lump in an HIV-positive patient [18]. We, therefore, consider this case to be the second case report of benign osseous metaplasia of the breast presenting as a breast lump, but the patient had no chronic illness. Conclusion: A breast lump can be the first presentation of benign osseous metaplasia. Keywords: Benign osseous metaplasia, Breast lump, Case report

  7. A threshold value in Shear Wave elastography to rule out malignant thyroid nodules: A reality?

    Energy Technology Data Exchange (ETDEWEB)

    Veyrieres, J.-B., E-mail: jbveyrieres@hotmail.fr [Département d’imagerie médicale, Hôpital d’Instruction des Armées St Anne, Bd Saint Anne, BP 20545 Toulon cedex (France); Albarel, F., E-mail: frederique.albarel@ap-hm.fr [Département médical d’endocrinologie et des pathologies métaboliques, Hôpital Universitaire la Timone, Assistance publique des Hôpitaux de Marseille, 264 rue Saint Pierre, 13385 Marseille cedex 5 (France); Lombard, J. Vaillant, E-mail: Josiane.vaillant@ap-hm.fr [Département d’imagerie médicale, Hôpital Universitaire la Timone, Assistance publique des Hôpitaux de Marseille, 264 rue Saint Pierre, 13385 Marseille cedex 5 (France); Berbis, J., E-mail: Julie.berbis@ap-hm.fr [Département de santé publique, Université de Médecine, 27, Bd Jean Moulin, 13385 Marseille cedex 5 (France); Sebag, F., E-mail: frederic.sebag@ap-hm.fr [Département de chirurgie des pathologies endocriniennes et métaboliques, Hôpital Universitaire la Timone, Assistance publique des Hôpitaux de Marseille, 264 rue Saint Pierre, 13385 Marseille cedex 5 (France); and others

    2012-12-15

    Objectives: To evaluate hability of a threshold value in ShearWave™ elastography to rule out malignant thyroid nodules while studying its pertinence in association with morphological signs. Equipment and methods: 148 patients (110 women and 38 men; 52.5 y.o. 15.8) referred for surgery of thyroid nodules underwent standard ultrasound as well as elastography. Characteristics of the morphological signs and maximum elastographic index were calculated in relation to histology. Association of morphological signs alone and then of elastography was also evaluated. One hundred and fifty one nodules were studied on a double-blind basis. Results: 297 nodules were studied. Thirty-five cancers were detected (11.6%). Elastographic index was higher in malignant nodules (115 kPa 60.4) than in benign nodules (41 kPa 25.8) (p < 0.001, Student's t-test). Cut off value of 66 kPa was the best to discriminate malignant nodules with a sensitivity of 80% (CI 95%, 62.5; 90.9) and a specificity of 90.5% (CI 95%, 86.1; 93.6) (p = 0.0001). Association of elastography and morphological ultrasound signs presented a sensitivity of 97% (CI 95%, 83.3; 99.8) and a negative predictive value of 99.5% (CI 95%, 95.6; 99.9). Interobserver reproducibility proved to be excellent with an interclass correlation of 0.97 (CI 95%, 0.96; 0.98) (p < 0.001). Conclusion: The 66 kPa threshold in Shear Wave elastography is the best ultrasound sign to rule out malignant thyroid nodules. The method is simple, quantitative, reproducible and usable in the study of nodules larger than 3 cm. Progress must still be made in the study of calcified nodules and follicular tumors.

  8. Effect of local background anatomical patterns on the detection of subtle lung nodules in chest radiographs

    Science.gov (United States)

    Samei, Ehsan; Flynn, Michael J.; Eyler, William R.; Peterson, Edward

    1998-04-01

    Anatomical noise in chest radiography, created by the projection of anatomical features in the thorax such as ribs and pulmonary vessels, greatly influences the detection of subtle lung nodules in chest radiographs. Detection may be hindered by 1) the 'global' statistical characteristics of the background in relation to the signal associated withthe nodule, and/or 2) the interference of the 'local' background pattern with the nodule signal. This investigation aimed at assessing the influence of the latter process in the detection of subtle lung nodules. Six 8 X 8 cm images were extracted from the lung regions o six digital chest radiographs of normal patients from our clinic. Simulated nodules emulating the radiographic characteristics of subtle tissue-equivalent lesions ranging in size from 3.2 to 6.4 mm were numerically superimposed on the images. For each of the six lung images, a set of thirty-one processed images were produced, six containing no nodule, and the remaining 25 containing single nodules of five different sizes placed at five different locations within 6 mm of the center. The variation in location allowed different local background patterns to overlay the nodules. An observer detection study was then performed using 14 experienced radiologists. The observer data were analyzed to determine the variation in detectability with nodule location for all five sizes of the nodules. The preliminary results indicate that the variation in detectability of a nodule due to the influence of its local background surroundings is equivalent to that caused by changing its CD product by a factor of 4.45.

  9. Surgery for Pulmonary Multiple Ground Glass Opacities

    Directory of Open Access Journals (Sweden)

    Qun WANG

    2016-06-01

    Full Text Available The incidence of pulmonary ground glass opacity (GGO has been increasing in recent years, with a great number of patients having multiple GGOs. Unfortunately, the management of multiple GGOs is still controversial. Pulmonary GGO is a radiological term, consisting of different pathological types. Some of the GGOs are early-staged lung cancer. GGO is an indolent nodule, only a small proportion of GGOs change during observation, which does not influence the efficacy of surgery. . The timing of surgery for multiple GGOs mainly depends on the predominant nodule and surgery is recommended if the solid component of the predominant nodule >5 mm. Either lobectomy or sub-lobectomy is feasible. GGOs other than the predominant nodule can be left unresected. Multiple GGOs with high risk factors need mediastinal lymph node dissection or sampling.

  10. Approach and management of thyroid nodule. A literature review = Nódulo tiroideo, enfoque y manejo. Revisión de la literatura

    Directory of Open Access Journals (Sweden)

    Román-González, Alejandro

    2013-04-01

    Full Text Available Introduction: Thyroid nodules are commonly found, and their incidence is increasing. The main objective during the evaluation of these nodules is to determine if they are benign or malignant. Materials and methods: We made a narrative review of the literature by searching Ovid, Medline and Lilacs from 1950 to 2010. Results: Most thyroid nodules are benign, but in 4% to 8% of cases they may be malignant, hence the importance of appropriate study and management. Nodules larger than 1 cm should undergo fine needle aspirate; however, the clinical features of the patient and the characteristics of the nodule on ultrasound assessment should always be taken into account. The following are risk factors associated with the presence of thyroid nodules: age over 45 years, female gender and smoking. The measurement of tumor markers in the initial study of patients with thyroid nodule is not recommended.Conclusion: Ultrasound and thyroid fine needle aspirate are the most important diagnostic methods in the evaluation of thyroid nodules, because they enable to make changes in therapeutic decisions thus decreasing the number of unnecessary thyroidectomies. Treatment and prognosis of thyroid nodules will depend on the patient´s risk factors and the cytological and pathological findings.

  11. Nodules size: An important factor in nodule mining?

    Digital Repository Service at National Institute of Oceanography (India)

    Valsangkar, A.B.

    . In order to minimize ecological and environmental problems, it is emphasized that the nodules should be screened on sea bottom during mining, which may be possible by future technological modification of mining devises...

  12. [Nodulation competitiveness of nodule bacteria: Genetic control and adaptive significance].

    Science.gov (United States)

    Onishchuk, O P; Vorobyov, N I; Provorov, N A

    2017-01-01

    The most recent data on the system of cmp (competitiveness) genes that determine the nodulation competitiveness of rhizobial strains, i.e., the ability to compete for nodule formation in leguminous plants, is analyzed. Three genetic approaches for the construction of economically valuable strains of rhizobia are proposed: the amplification of positive regulators of competitiveness, the inactivation of the negative regulators of this trait, and the introduction of efficient competitiveness factors into strains capable of active nitrogen fixation.

  13. Quantitative CT analysis of pulmonary ground-glass opacity nodules for distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma: the added value of using iodine mapping

    International Nuclear Information System (INIS)

    Son, Ji Ye; Lee, Ho Yun; Kim, Jae-Hun; Lee, Kyung Soo; Han, Joungho; Jeong, Ji Yun; Kwon, O.J.; Shim, Young Mog

    2016-01-01

    To determine whether quantitative analysis of iodine-enhanced images generated from dual-energy CT (DECT) have added value in distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma (MIA) showing ground-glass nodule (GGN). Thirty-four patients with 39 GGNs were enrolled in this prospective study and underwent DECT followed by complete tumour resection. Various quantitative imaging parameters were assessed, including virtual non-contrast (VNC) imaging and iodine-enhanced imaging. Of all 39 GGNs, four were adenocarcinoma in situ (AIS) (10 %), nine were MIA (23 %), and 26 were invasive adenocarcinoma (67 %). When assessing only VNC imaging, multivariate analysis revealed that mass, uniformity, and size-zone variability were independent predictors of invasive adenocarcinoma (odds ratio [OR] = 19.92, P = 0.02; OR = 0.70, P = 0.01; OR = 16.16, P = 0.04, respectively). After assessing iodine-enhanced imaging with VNC imaging, both mass on the VNC imaging and uniformity on the iodine-enhanced imaging were independent predictors of invasive adenocarcinoma (OR = 5.51, P = 0.04 and OR = 0.67, P < 0.01). The power of diagnosing invasive adenocarcinoma was improved after adding the iodine-enhanced imaging parameters versus VNC imaging alone, from 0.888 to 0.959, respectively (P = 0.029). Quantitative analysis using iodine-enhanced imaging metrics versus VNC imaging metrics alone generated from DECT have added value in distinguishing invasive adenocarcinoma from AIS or MIA. (orig.)

  14. Sucrose synthase and enolase expression in actinorhizal nodules of Alnus glutinosa: comparison with legume nodules.

    NARCIS (Netherlands)

    Ghelue, van M.; Ribeiro, A.; Solheim, B.; Akkermans, A.D.L.; Bisseling, T.; Pawlowski, K.

    1996-01-01

    Abstract Two different types of nitrogen-fixing root nodules are known - actinorhizal nodules induced by Frankia and legume nodules induced by rhizobia. While legume nodules show a stem-like structure with peripheral vascular bundles, actinorhizal nodule lobes resemble modified lateral roots with a

  15. Prognostic parameters in benign astrocytomas

    DEFF Research Database (Denmark)

    Westergaard, L; Gjerris, F; Klinken, L

    1993-01-01

    To elucidate the prognosis of different types of benign astrocytomas and to ascertain whether patients with partially resected benign astrocytomas, or any subtype of these, would benefit from postoperative radiotherapy, we studied retrospectively material comprising 300 patients with benign astro...... time of patients with non-pilocytic supratentorial benign astrocytomas. The study emphasizes the necessity of a prospective combined multicenter analysis of the effect of radiation on benign astrocytomas....

  16. Prognostic parameters in benign astrocytomas

    DEFF Research Database (Denmark)

    Westergaard, L; Gjerris, F; Klinken, L

    1993-01-01

    To elucidate the prognosis of different types of benign astrocytomas and to ascertain whether patients with partially resected benign astrocytomas, or any subtype of these, would benefit from postoperative radiotherapy, we studied retrospectively material comprising 300 patients with benign...... time of patients with non-pilocytic supratentorial benign astrocytomas. The study emphasizes the necessity of a prospective combined multicenter analysis of the effect of radiation on benign astrocytomas....

  17. Intelligent Recognition of Lung Nodule Combining Rule-based and C-SVM Classifiers

    Directory of Open Access Journals (Sweden)

    Bin Li

    2012-02-01

    Full Text Available Computer-aided detection(CAD system for lung nodules plays the important role in the diagnosis of lung cancer. In this paper, an improved intelligent recognition method of lung nodule in HRCT combing rule-based and cost-sensitive support vector machine(C-SVM classifiers is proposed for detecting both solid nodules and ground-glass opacity(GGO nodules(part solid and nonsolid. This method consists of several steps. Firstly, segmentation of regions of interest(ROIs, including pulmonary parenchyma and lung nodule candidates, is a difficult task. On one side, the presence of noise lowers the visibility of low-contrast objects. On the other side, different types of nodules, including small nodules, nodules connecting to vasculature or other structures, part-solid or nonsolid nodules, are complex, noisy, weak edge or difficult to define the boundary. In order to overcome the difficulties of obvious boundary-leak and slow evolvement speed problem in segmentatioin of weak edge, an overall segmentation method is proposed, they are: the lung parenchyma is extracted based on threshold and morphologic segmentation method; the image denoising and enhancing is realized by nonlinear anisotropic diffusion filtering(NADF method; candidate pulmonary nodules are segmented by the improved C-V level set method, in which the segmentation result of EM-based fuzzy threshold method is used as the initial contour of active contour model and a constrained energy term is added into the PDE of level set function. Then, lung nodules are classified by using the intelligent classifiers combining rules and C-SVM. Rule-based classification is first used to remove easily dismissible nonnodule objects, then C-SVM classification are used to further classify nodule candidates and reduce the number of false positive(FP objects. In order to increase the efficiency of SVM, an improved training method is used to train SVM, which uses the grid search method to search the optimal

  18. Intelligent Recognition of Lung Nodule Combining Rule-based and C-SVM Classifiers

    Directory of Open Access Journals (Sweden)

    Bin Li

    2011-10-01

    Full Text Available Computer-aided detection(CAD system for lung nodules plays the important role in the diagnosis of lung cancer. In this paper, an improved intelligent recognition method of lung nodule in HRCT combing rule-based and costsensitive support vector machine(C-SVM classifiers is proposed for detecting both solid nodules and ground-glass opacity(GGO nodules(part solid and nonsolid. This method consists of several steps. Firstly, segmentation of regions of interest(ROIs, including pulmonary parenchyma and lung nodule candidates, is a difficult task. On one side, the presence of noise lowers the visibility of low-contrast objects. On the other side, different types of nodules, including small nodules, nodules connecting to vasculature or other structures, part-solid or nonsolid nodules, are complex, noisy, weak edge or difficult to define the boundary. In order to overcome the difficulties of obvious boundary-leak and slow evolvement speed problem in segmentatioin of weak edge, an overall segmentation method is proposed, they are: the lung parenchyma is extracted based on threshold and morphologic segmentation method; the image denoising and enhancing is realized by nonlinear anisotropic diffusion filtering(NADF method;candidate pulmonary nodules are segmented by the improved C-V level set method, in which the segmentation result of EM-based fuzzy threshold method is used as the initial contour of active contour model and a constrained energy term is added into the PDE of level set function. Then, lung nodules are classified by using the intelligent classifiers combining rules and C-SVM. Rule-based classification is first used to remove easily dismissible nonnodule objects, then C-SVM classification are used to further classify nodule candidates and reduce the number of false positive(FP objects. In order to increase the efficiency of SVM, an improved training method is used to train SVM, which uses the grid search method to search the optimal parameters

  19. Thyroid nodule and the value of tumormarkers

    International Nuclear Information System (INIS)

    Goerges, R.; Bockisch, A.

    2008-01-01

    According to common scientific opinion thyroglobulin (hTg) is not recommended as a tumor marker for clarifying the dignity of thyroid nodules, due to a strong overlap between values of differentiated thyroid carcinoma (DTC) and benign thyroid nodules. Moreover, other benign thyroid diseases with cellular lesion, i.e. nodules and overt inflammation, lead to significantly increased thyroglobulin values (values in a four-digit range and even more in very rare cases). The determination of hTg before thyroid ablation can be a useful ''screening marker'' for patients with CUP-syndrome and suspicious thyroid lesions to identify subjects suffering under DTC. Furthermore, in the case of DTC preoperatively measured hTg will help to validate and evaluate hTg values in the follow-up of these patients. hTg determination can be disturbed by methodological artefacts, in particular by interfering anti-hTg auto-antibodies. For the authentication of hTg values anti-hTg auto-antibody measurement and/or recovery testing is therefore essential although both methods have advantages and disadvantages in that respect. Calcitonin (hCt) is a relatively reliable and specific marker for medullary thyroid carcinoma (MTC) or neoplastic C-cell hyperplasia provided that optimal techniques and appropriate interpretation of test results are applied. The use of two-site assays with a high specificity for the monomer molecule is advised, but false-positive values can still occur, i.e. in renal insufficiency, during therapy with proton pump inhibitors, in goiters with ''physiological'' C-cell hyperplasia and in autoimmune thyroiditis. The Thyroid Section of the German Society of Endocrinology recommends hCt-screening for patients with nodular goiter although some questions regarding epidemiology, health economy and methodology are not resolved yet. Basal hCT values exceeding 100 pg/ml are highly predictive for MTC after exclusion of the reasons mentioned above which can cause artificially increased

  20. 5-Hydroxymethylcytosine Expression in Proliferative Nodules Arising within Congenital Nevi Allows Differentiation from Malignant Melanoma.

    Science.gov (United States)

    Pavlova, Olesya; Fraitag, Sylvie; Hohl, Daniel

    2016-12-01

    Differentiation of proliferative nodules in giant congenital nevi from melanoma arising within such nevi is an important diagnostic challenge. DNA methylation is a well-established epigenetic modification already observed in the earliest stages of carcinogenesis, which increases during melanoma progression. The ten-eleven translocation enzymes catalyze the oxidation of 5-methylcytosine to 5-hydroxymethylcytosine (5-hmC), which has recently been reported as an epigenetic hallmark associated with tumor aggressiveness and poor prognosis in a wide variety of cancers. In this study, we analyzed 12 proliferative nodules and 13 melanomas both arising in giant congenital nevi and matched results with a control group including 67 benign and malignant melanocytic lesions. Proliferative nodules displayed high 5-hmC expression levels (90.65%) compared with melanomas with almost complete loss of this marker (7.87%). We showed that low 5-hmC levels in melanomas correlate with downregulation of isocitrate dehydrogenase and ten-eleven translocation families of enzymes implicated in the cytosine methylation cycle. Simultaneously, these enzymes were overexpressed in proliferative nodules leading to strong 5-hmC expression. We emphasize the significance of 5-hmC loss for discrimination of melanomas from benign proliferative nodules arising within giant congenital nevi, and for establishing the correct diagnosis in ambiguous cases when histological and immunohistochemical characteristics are not sufficiently specific. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  1. Determination of thyroglobulin in the cytology needle lavage for diagnosis of the thyroid nodule

    International Nuclear Information System (INIS)

    Marrero Rodríguez, María Teresa; Turcios Tristá, Silvia Elena

    2016-01-01

    The determination of thyroglobulin in the lavage of the biopsy needle has been incorporated as a new tool for the diagnosis of thyroid lymphadenopathy. Objective: To determine the value of thyroglobulin quantification in the biopsy needle lavage in the diagnosis of the thyroid nodule. Material and Method: The biological material obtained from the rinsing of the needles used in the biopsy of the patients with diagnosis of thyroid nodule was taken as the study sample. An Immunoradiometric method was used to determine thyroglobulin. The Mann-Whitney non-parametric test was used to compare the median values of the thyroglobulin variable between malignant and benign lesions according to histopathological diagnosis. Significant differences (p <0.01) were found between mean thyroglobulin levels between benign nodules (502.6 ng / mL) and malignant nodules (11.9 ng / mL). Conclusion: The determination of thyroglobulin in the lavage of the needle used in the biopsy proved to be a useful procedure for the differential diagnosis of the thyroid nodule, so it would be very useful as a support for cytology.

  2. Nódulo sincrônico pulmonar e hepático em paciente com antecedente de carcinoma broncogênico: a importância da confirmação histopatológica Synchronous pulmonary and hepatic nodules in a patient with previous bronchogenic carcinoma: the relevance of histopathological confirmation

    Directory of Open Access Journals (Sweden)

    José de Jesus Peixoto Camargo

    2009-06-01

    Full Text Available A apresentação de lesão sincrônica pulmonar e hepática em um paciente com antecedente de carcinoma broncogênico operado gera a suspeita de recidiva tumoral e indica a necessidade de re-estadiamento. Apresentamos o caso de um paciente de 71 anos submetido à lobectomia pulmonar com ressecção de pericárdio e linfadenectomia mediastinal (T3N0M0. Cinco anos após a cirurgia, detectou-se a presença de uma nova lesão pulmonar. No re-estadiamento, foi diagnosticada uma lesão sincrônica no fígado. Apesar da forte suspeita de recidiva tumoral, prosseguiu-se a investigação e uma punção hepática revelou carcinoma hepatocelular. Para esclarecer a etiologia da lesão pulmonar (hipóteses de recidiva de carcinoma brônquico ou de metástase de carcinoma hepatocelular, foi realizada uma biópsia a céu aberto, compatível com reação inflamatória crônica com focos de antracose e de calcificação distrófica. O paciente foi então submetido à ressecção hepática não-regrada com intuito curativo. Teve boa evolução, com alta no 10º dia de pós-operatório. O presente relato destaca a importância do diagnóstico histopatológico em pacientes com antecedente de carcinoma broncogênico e suspeita de recidiva. Hipóteses diagnósticas e condutas terapêuticas são discutidas.The synchronous presentation of pulmonary and hepatic nodules in a patient with previously resected bronchogenic carcinoma raises suspicion of recurrence and mandates restaging. We present the case of a 71-year-old male with a history of lobectomy with pericardial resection and mediastinal lymphadenectomy (T3N0M0. At five years after the operation, he presented with a new pulmonary lesion. Restaging detected a synchronous nodule in the liver. Despite the strong suspicion of tumor recurrence, further investigation with a percutaneous liver biopsy revealed hepatocellular carcinoma. In order to investigate the etiology of the pulmonary lesion (hypotheses of recurrent

  3. CEUS: An essential component in a multimodality approach to small nodules in patients at high-risk for hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Jang, Hyun-Jung; Kim, Tae Kyoung; Burns, Peter N; Wilson, Stephanie R

    2015-01-01

    Highlights: • CEUS resolves hypervascular pseudolesions, frequent on CT and MR, from vascular shunts. • US has the advantage of showing a baseline nodule for characterization. • CEUS shows excellent sensitivity to contrast agents, providing superior arterial phase sensitivity. • Real-time CEUS performance shows optimally perfusion patterns of benign tumor nodules. • CEUS performed at surveillance detection of nodules is efficient and effective. - Abstract: Contrast-enhanced ultrasound (CEUS) plays an essential role in the evaluation of small nodules in livers at high-risk for hepatocellular carcinoma (HCC) and offers unique advantages over CT/MRI. These include the sensitive depiction of arterial hypervascularity of HCC, better demonstration of rapid washout for non-HCC malignancy as well as of very late washout of HCC. Visualization of early vascular filling patterns for benign hypervascular lesions is of indisputable value. A frequently uncounted benefit of CEUS includes the value of its performance following nodule detection at ultrasound surveillance, including one-stop exclusion of typical benignancy, preclusion of arterial pseudolesions shown on CT/MR, and the avoidance of miscorrelation of a nodule on surveillance and subsequent diagnostic imaging. Therefore, CEUS can effectively be used in the diagnostic algorithm for new liver nodules detected during HCC surveillance. Despite the fact that CEUS is actively used as a major diagnostic test for HCC in Asia, Europe, and Canada with increasing demands in clinical practice, CEUS is not included in the diagnostic tests for HCC in some major practice guidelines. In this manuscript, we focus on small nodules in patients at high-risk for HCC, and review some of the unique advantages of CEUS that contribute to lesion characterization and subsequent patient management, showing why CEUS should be an essential component of the diagnostic algorithm for HCC

  4. The role of technetium-99m methoxyisobutylisonitrile scintigraphy in the differential diagnosis of cold thyroid nodules

    Energy Technology Data Exchange (ETDEWEB)

    Mezosi, E.; Bajnok, L.; Sztojka, I.; Szabo, J.; Leovey, A.; Kakuk, G.; Nagy, E. [Department of Medicine, University Medical School, Debrecen (Hungary); Gyory, F. [Department of Surgery, University Medical School, Debrecen (Hungary); Varga, J.; Galuska, L. [Nuclear Medicine Centre, University Medical School, Debrecen (Hungary)

    1999-08-01

    Various diagnostic techniques have been successfully used in the clinical management of cold nodules; however, the decision on whether to employ surgery or a conservative treatment is not always easy. This study was designed to appraise the diagnostic value of technetium-99m methoxyisobutylisonitrile (MIBI) scintigraphy in the assessment of cold nodules detected using {sup 99m}Tc-pertechnetate. Fifty-two patients were included in the study. All had already been selected for surgery, based on their clinical and laboratory findings, including fine-needle aspiration biopsy. The total number of cold nodules on {sup 99m}Tc-pertechnetate scans was 59. The thyroid scan was performed 20-40 min after i.v. injection of 400 MBq of {sup 99m}Tc-MIBI. Uptake of MIBI in thyroid nodules was compared with that in the surrounding normal thyroid tissue, and a score of between 0 and 3 was assigned to each nodule as follows: 0, cold; 1, decreased; 2, equal; 3, hot. Definitive histology revealed nodular goitre in 24 cases, adenoma in 19, thyroiditis in 1, differentiated cancer in 12, medullary cancer in 2, and anaplastic cancer in 1. None of the degenerative nodules were hot on MIBI scan, while the adenomas showed a variety of MIBI imaging patterns, most frequently the score 3 pattern. In the diagnosis of differentiated thyroid cancer the sensitivities of score 3 and score 2+3 MIBI uptake patterns were 83% (10/12) and 100%, respectively. The score 3 MIBI uptake pattern had a specificity of 100% and a positive predictive value of 100% with respect to thyroid (benign and malignant) neoplastic diseases, whereas a specificity of 72% and a positive predictive value of 43% were observed in the detection of differentiated cancer. After a cold nodule had been detected using {sup 99m}Tc-pertechnetate, a second scan with high MIBI uptake increased by 7.8 times the probability that this nodule would be a differentiated cancer. In conclusion, {sup 99m}Tc-MIBI scintigraphy is a useful method in the

  5. Pulmonary amyloidosis: computed tomography findings

    International Nuclear Information System (INIS)

    Marchiori, Edson; Ferreira, Angela; Crespo, Sheila Jandira Vianna

    2003-01-01

    We report the computed tomography findings of five patients with pathology proven pulmonary amyloidosis. Tracheobronchial amyloidosis with calcified nodules and plaques in the tracheal wall were seen in two patients. Two other patients had diffuse parenchymal disease with calcified lesions, one had reticular and nodular sub pleural opacities whereas the other had nodular interlobular septal thickening and a parenchymal consolidation. The latter presented the nodular type of the disease with multiple sharp nodules scattered throughout the lungs and interspersed calcifications. The computed tomography findings observed were not specific but strongly suggestive of amyloidosis. (author)

  6. Pulmonary tuberculosis in patients with idiopathic pulmonary fibrosis

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Myung Jin; Goo, Jin Mo E-mail: jmgoo@plaza.snu.ac.kr; Im, Jung-Gi

    2004-11-01

    Objectives: Patients with idiopathic pulmonary fibrosis (IPF) have an increased risk of pulmonary tuberculosis. However, detecting pulmonary tuberculosis may be difficult due to the underlying fibrosis. The aim of this report is to describe the radiological and clinical findings of pulmonary tuberculosis in patients with idiopathic pulmonary fibrosis. Materials and methods: We reviewed 143 consecutive patients in whom IPF was diagnosed by either the histological or radio-clinical criteria. Among them, nine patients were histologically (n=2) or bacteriologically (n=7) confirmed to have active pulmonary tuberculosis. The location and patterns of pulmonary tuberculosis were examined on a thin section CT scan. Results: The most common thin section CT findings were subpleural nodules (n=6; mean diameter, 3.2 cm) and a lobar or segmental consolidation (n=3). The lesions were located most commonly in the right lower lobe (n=4). The incidence of tuberculosis in patients with idiopathic pulmonary fibrosis was more than five times higher than that of the general population. Conclusion: The atypical manifestation of pulmonary tuberculosis is common in patients with idiopathic pulmonary fibrosis, which may mimic lung cancer or bacterial pneumonia.

  7. Pulmonary tuberculosis in patients with idiopathic pulmonary fibrosis

    International Nuclear Information System (INIS)

    Chung, Myung Jin; Goo, Jin Mo; Im, Jung-Gi

    2004-01-01

    Objectives: Patients with idiopathic pulmonary fibrosis (IPF) have an increased risk of pulmonary tuberculosis. However, detecting pulmonary tuberculosis may be difficult due to the underlying fibrosis. The aim of this report is to describe the radiological and clinical findings of pulmonary tuberculosis in patients with idiopathic pulmonary fibrosis. Materials and methods: We reviewed 143 consecutive patients in whom IPF was diagnosed by either the histological or radio-clinical criteria. Among them, nine patients were histologically (n=2) or bacteriologically (n=7) confirmed to have active pulmonary tuberculosis. The location and patterns of pulmonary tuberculosis were examined on a thin section CT scan. Results: The most common thin section CT findings were subpleural nodules (n=6; mean diameter, 3.2 cm) and a lobar or segmental consolidation (n=3). The lesions were located most commonly in the right lower lobe (n=4). The incidence of tuberculosis in patients with idiopathic pulmonary fibrosis was more than five times higher than that of the general population. Conclusion: The atypical manifestation of pulmonary tuberculosis is common in patients with idiopathic pulmonary fibrosis, which may mimic lung cancer or bacterial pneumonia

  8. Nodular hidradenoma: A rare diagnosis to keep in mind in differential diagnosis of dermal nodules

    Directory of Open Access Journals (Sweden)

    Seval Doğruk Kaçar

    2014-12-01

    Full Text Available Nodular hidradenoma is a rare benign tumor of skin appendages. It mainly occurs in adults with a slight female predominance. Typical lesions are localized in the scalp, face and the upper extremities. Clinically it presents as a slowly progressive, solitary, hard, mobile dermal and subcutaneous nodule. Total surgical excision is suggested due to the risk of malignant transformation. We, herein, present a 60-year-old male patient whose slow growing subcutaneous nodule on his back was diagnosed as nodular hidradenoma after histopathologic examination.

  9. [Benign chronic pain].

    Science.gov (United States)

    Serrie, A; Thurel, C

    1994-09-15

    Recent data indicate that 25 to 30% of the population in industrialized countries suffers from benign chronic pain. Among these patients, 50 to 75% are professionally incapable for varied lengths of time, from a few days to some weeks or months, or even definitively. The aetiology and clinical presentation of chronic benign pain are enormously varied because this definition includes such different pathologies as headache, pain of rheumatologic, postsurgical, organic, and post-zoster origin, lombalgia, radiculalgia, post-amputation pain, neuropathologic pain, causalgia, algoneurodystrophic pain, psychosomatic and idiopathic pain. Since these syndromes and causes of pain could not be discussed individually, they have been grouped according to their neurophysiology and pathophysiology.

  10. Benign Jaw Lesions.

    Science.gov (United States)

    Gohel, Anita; Villa, Alessandro; Sakai, Osamu

    2016-01-01

    There are both odontogenic and nonodontogenic benign lesions in the maxilla and mandible. These lesions may have similar imaging features, and the key radiographic features are presented to help the clinician narrow the differential diagnosis and plan patient treatment. Both intraoral and panoramic radiographs and advanced imaging features are useful in assessing the benign lesions of the jaws. The location, margins, internal contents, and effects of the lesions on adjacent structures are important features in diagnosing the lesions. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. CT findings of pulmonary cryptococcosis in immunocompetent children

    International Nuclear Information System (INIS)

    Wang Bei; Peng Yun; Zhou Chunjun; Zhao Shunying

    2012-01-01

    Objective: The aim of our study was to study the CT findings of cryptococcosis in immunocompetent children. Methods: CT scan and clinical data of 21 immunocompetent children with proven pulmonary cryptococcosis were retrospectively collected and analyzed. Results: The CT scans demonstrated 1 mm subpleural nodule in the lingula of left lung in 1 patient and multiple nodules in 20 patients.Of 20 patients with multiple nodules, peripheral or subpleural distribution was found in 12 patients,and diffuse distribution in 8 patients. Of 20 patients with multiple nodules,Nodules of < 10 mm was found in 18 patients,< 3 mm in 14 patients, and > 10 mm in 2 patients. Round nodular with smooth margin was detected in 15 of 20 patients with multiple nodules. Lymphadenopathy was found in 17 patients including 3 patients with mild contrast enhancement and 2 patients with circular enhancement. Extrapulmonary lesions distributing in liver, spleen, kidney, and the nervous system were found in 14 patients. In follow-up, 1 patient died and 20 patients fully recovered. Conclusions: Pulmonary multiple nodules with lymphadenopathy is the characteristic CT findings in immunocompetent children with pulmonary cryptococcosis which is prone to involve multiple extra-pulmonary organs. (authors)

  12. CT of pulmonary tuberculosis in children

    International Nuclear Information System (INIS)

    Moon, Woo Kyung; Kim, Woo Sun; Lee, Hoan Jong; Kim, In One; Yeon, Kyung Mo; Han, Man Chung

    1996-01-01

    This paper illustrates the spectrum of CT findings of pulmonary tuberculosis in children and shows the advantages and complementary nature of CT compared with conventional radiography. Common CT manifestations of pulmonary tuberculosis in children are mediastinal or hilar lymphadenopathy, air-space con-solidation, atelectasis, and disseminated nodules. CT is useful in the detection of the disease in equivocal chest radiographs, in the characterization of lesions, by demonstrating caseation necrotic areas, calcification and bronchogenic spread nodules, and in defining the extent of the disease and its complications. This information will be helpful in the diagnosis and evaluation of tuberculosis in children

  13. Acquired pulmonary stenosis

    Science.gov (United States)

    Littler, W. A.; Meade, J. B.; Hamilton, D. I.

    1970-01-01

    Four cases of pulmonary artery stenosis resulting from extrinsic pressure are presented. All of these cases presented with the triad of chest pain, dyspnoea, and a pulmonary systolic murmur. Respiratory variation of this murmur was noted in three of the patients, the murmur increasing during expiration and diminishing or disappearing during inspiration. It is suggested that this may be a useful sign in diagnosing this syndrome. The tumour in these four cases was an intrapericardial sarcoma, a benign teratoma, Hodgkin's disease, and a malignant thymoma respectively. Images PMID:5485008

  14. Benign bone tumors

    International Nuclear Information System (INIS)

    Gilday, D.L.; Ash, J.M.

    1976-01-01

    There is little information in the literature concerning the role of bone scanning in benign bone neoplasms except for sporadic reports. Since the advent of /sup 99m/Tc-polyphosphate, bone imaging has proven feasible and useful in locating the cause of bone pain, such as in osteoid osteomas, which are not always radiologically apparent, and in evaluating whether or not a radiologic lesion is indeed benign and solitary. Blood-pool images are particularly important in neoplastic disease, since the absence of hyperemia in the immediate postinjection period favors the diagnosis of a benign neoplasm, as does low-grade uptake on the delayed study. The scan, including pinhole magnification images, is especially valuable in diagnosing lesions in the spine and pelvis, which are poorly seen radiologically. We have studied various types of benign bone tumors, including simple and aneurysmal bone cysts, fibrous cortical defects, and nonossifying fibromas, all of which had minimal or no increased uptake of the radiopharmaceutical, unless traumatized. Although osteochondromas and enchondromas showed varied accumulation of activity, the scan was useful in differentiating these from sarcomatous lesions. All osteoid osteomas demonstrated marked activity, and could be accurately located preoperatively, as could the extent of fibrous dysplasia. The bone scan in the reticuloses also showed abnormal accumulation of activity, and aided in arriving at the prognosis and treatment of histiocytic bone lesions

  15. Uraemia from Benign Hypertension

    African Journals Online (AJOL)

    tance,' and the criteria for the recognition of malignant hypertension have become so well established that there is no dispute about the diagnosis when this condition ends in uraemia. By contrast, benign hypertension mani- fests itself mainly as cardiac or cerebrovascular disease,"" and although the occurrence of renal ...

  16. Benign gastric filling defect

    Energy Technology Data Exchange (ETDEWEB)

    Oh, K. K.; Lee, Y. H.; Cho, O. K.; Park, C. Y. [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1979-06-15

    The gastric lesion is a common source of complaints to Orientals, however, evaluation of gastric symptoms and laboratory examination offer little specific aid in the diagnosis of gastric diseases. Thus roentgenography of gastrointestinal tract is one of the most reliable method for detail diagnosis. On double contract study of stomach, gastric filling defect is mostly caused by malignant gastric cancer, however, other benign lesions can cause similar pictures which can be successfully treated by surgery. 66 cases of benign causes of gastric filling defect were analyzed at this point of view, which was verified pathologically by endoscope or surgery during recent 7 years in Yensei University College of Medicine, Severance Hospital. The characteristic radiological picture of each disease was discussed for precise radiologic diagnosis. 1. Of total 66 cases, there were 52 cases of benign gastric tumor 10 cases of gastric varices, 5 cases of gastric bezoar, 5 cases of corrosive gastritis, 3 cases of granulomatous disease and one case of gastric hematoma. 2. The most frequent causes of benign tumors were adenomatous polyp (35/42) and the next was leiomyoma (4/42). Others were one of case of carcinoid, neurofibroma and cyst. 3. Characteristic of benign adenomatous polyp were relatively small in size, smooth surface and were observed that large size, benign polyp was frequently type IV lesion with a stalk. 4. Submucosal tumors such as leiomyoma needed differential diagnosis with polypoid malignant cancer. However, the characteristic points of differentiation was well circumscribed smooth margined filling defect without definite mucosal destruction on surface. 5. Gastric varices showed multiple lobulated filling defected especially on gastric fundus that changed its size and shape by respiration and posture of patients. Same varices lesions on esophagus and history of liver disease were helpful for easier diagnosis. 6. Gastric bezoar showed well defined movable mass

  17. Benign gastric filling defect

    International Nuclear Information System (INIS)

    Oh, K. K.; Lee, Y. H.; Cho, O. K.; Park, C. Y.

    1979-01-01

    The gastric lesion is a common source of complaints to Orientals, however, evaluation of gastric symptoms and laboratory examination offer little specific aid in the diagnosis of gastric diseases. Thus roentgenography of gastrointestinal tract is one of the most reliable method for detail diagnosis. On double contract study of stomach, gastric filling defect is mostly caused by malignant gastric cancer, however, other benign lesions can cause similar pictures which can be successfully treated by surgery. 66 cases of benign causes of gastric filling defect were analyzed at this point of view, which was verified pathologically by endoscope or surgery during recent 7 years in Yensei University College of Medicine, Severance Hospital. The characteristic radiological picture of each disease was discussed for precise radiologic diagnosis. 1. Of total 66 cases, there were 52 cases of benign gastric tumor 10 cases of gastric varices, 5 cases of gastric bezoar, 5 cases of corrosive gastritis, 3 cases of granulomatous disease and one case of gastric hematoma. 2. The most frequent causes of benign tumors were adenomatous polyp (35/42) and the next was leiomyoma (4/42). Others were one of case of carcinoid, neurofibroma and cyst. 3. Characteristic of benign adenomatous polyp were relatively small in size, smooth surface and were observed that large size, benign polyp was frequently type IV lesion with a stalk. 4. Submucosal tumors such as leiomyoma needed differential diagnosis with polypoid malignant cancer. However, the characteristic points of differentiation was well circumscribed smooth margined filling defect without definite mucosal destruction on surface. 5. Gastric varices showed multiple lobulated filling defected especially on gastric fundus that changed its size and shape by respiration and posture of patients. Same varices lesions on esophagus and history of liver disease were helpful for easier diagnosis. 6. Gastric bezoar showed well defined movable mass

  18. Risk of thyroid cancer in euthyroid asymptomatic patients with thyroid nodules with an emphasis on family history of thyroid cancer

    International Nuclear Information System (INIS)

    JHwang, Shin Hye; Kim, Eun Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Kwak, Jin Young

    2016-01-01

    To determine the factors associated with thyroid cancer, focusing on first-degree family history and ultrasonography (US) features, in euthyroid asymptomatic patients with thyroid nodules. This retrospective study included 1310 thyroid nodules of 1254 euthyroid asymptomatic patients who underwent US-guided fine-needle aspiration biopsy between November 2012 and August 2013. Nodule size and clinical risk factors- such as patient age, gender, first-degree family history of thyroid cancer, multiplicity on US and serum thyroid stimulating hormone (TSH) levels - were considered together with US features to compare benign and malignant nodules. Multiple logistic regression analysis was performed to assess the risk of thyroid malignancy according to clinical and US characteristics. Although all of the clinical factors and US findings were significantly different between patients with benign and malignant nodules, a solitary lesion on US (p = 0.041–0.043), US features and male gender (p < 0.001) were significant independent risk factors for thyroid malignancy in a multivariate analysis. Patient age, a first-degree family history of thyroid cancer and high normal serum TSH levels did not independently significantly increase the risk of thyroid cancer. However, multicollinearity existed between US assessment and patient age, first-degree family history of thyroid cancer and serum TSH values. Ultrasonography findings should be the primary criterion used to decide the management of euthyroid asymptomatic patients with thyroid nodules. The concept of first-degree family history as a risk factor for thyroid malignancy should be further studied in asymptomatic patients

  19. Risk of thyroid cancer in euthyroid asymptomatic patients with thyroid nodules with an emphasis on family history of thyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    JHwang, Shin Hye; Kim, Eun