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Sample records for bilateral pulmonary nodules

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

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    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.

  2. 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)

  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. 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...

  5. Bilateral meandering pulmonary veins

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    Thupili, Chakradhar R.; Udayasankar, Unni [Pediatric Imaging, Imaging Institute Cleveland Clinic, Cleveland, OH (United States); Renapurkar, Rahul [Imaging Institute Cleveland Clinic, Thoracic Imaging, L10, Cleveland, OH (United States)

    2015-06-15

    Meandering pulmonary veins is a rare clinical entity that can be mistaken for more complex congenital syndromes such as hypogenetic lung syndrome. We report imaging findings in a rare incidentally detected case of bilateral meandering pulmonary veins. We briefly discuss the role of imaging in diagnosing this condition, with particular emphasis on contrast-enhanced CT. (orig.)

  6. 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.

  7. 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

  8. 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....

  9. 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.)

  10. 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.).

  11. 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 ...

  12. 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

  13. 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.

  14. 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.

  15. 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...

  16. 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.

  17. CT SCAN EVALUATION OF PULMONARY NODULE

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    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

  18. 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

  19. 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.

  20. 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...

  1. 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.

  2. VATS intraoperative tattooing to facilitate solitary pulmonary nodule resection

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    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

  3. 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

  4. 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.

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

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    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.

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

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    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.

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. [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.

  12. 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.

  13. 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)

  14. 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...

  15. 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.

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

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    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.)

  17. Bilateral pulmonary sequestration: a case report

    International Nuclear Information System (INIS)

    Koo, Ja Hong; Jeon, Eui Yong; Seo, Heung Suk; Choi, Yo Won; Jeon, Seok Chol; Hahm, Chang Kok

    1995-01-01

    A 21-year-old woman presented with productive cough and hemoptysis. Chest radiograph shows a large thin-walled cystic lesion with an air-fluid level in medial portion of the left lower lung zone and opacity in paravertebral area of the right lower lung zone. Chest CT scan shows a thin-walled cavitary lesion in the posterior basal segment of left lower lobe with an air-fluid level. Area of consolidation containing air-filled cysts was also observed in medial aspect of right lower lobe. Selective angiogram obtained from aberrant artery arising from descending abdominal aorta showed two main branches of the artery supplying bilateral pulmonary lesions

  18. 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

  19. 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.

  20. 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)

  1. 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.

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. 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.)

  7. 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

  8. 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.

  9. 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

  10. Safety of Simultaneous Bilateral Pulmonary Resection for Metastatic Lung Tumors.

    Science.gov (United States)

    Matsubara, Taichi; Toyokawa, Gouji; Kinoshita, Fumihiko; Haratake, Naoki; Kozuma, Yuka; Akamine, Takaki; Takamori, Shinkichi; Hirai, Fumihiko; Tagawa, Tetsuzo; Okamoto, Tatsuro; Maehara, Yoshihiko

    2018-03-01

    We investigated the safety of simultaneous bilateral lung resection for lung metastases. We retrospectively analyzed 185 patients with pulmonary metastases who underwent unilateral or bilateral pulmonary resection from August 2009 to December 2016 at a single institution. Single-stage bilateral lung resection was undertaken in 19 patients, and the other 166 patients underwent unilateral pulmonary resection, including 20 patients who underwent repeated resections for synchronous or metachronous metastases. Operative time and drainage days in the bilateral group were significantly longer than those in the unilateral group (220±20 vs. 152±6.9 min: ppulmonary metastasectomy appears to be safe as long as only wedge resection is performed on at least one side. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  11. 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.

  12. 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.

  13. 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.)

  14. 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.

  15. 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...

  16. 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.

  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. 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)

  1. 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.)

  2. 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.

  3. 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.)

  4. 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.)

  5. 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

  6. 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.)

  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. 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.

  10. 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.

  11. 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.)

  12. Prenatal Diagnosis of Bilateral Pulmonary Agenesis: a Case Report

    International Nuclear Information System (INIS)

    Lee, Kyung A; Cho, Jeong Yeon; Lee, Seung Mi; Jun, Jong Kwan; Kang, Ji Eun; Seo, Jeong Wook

    2010-01-01

    We report a case of bilateral pulmonary agenesis (BPA), which was suspected during a prenatal US examination and diagnosed by fetal magnetic resonance imaging (MRI). BPA is an extremely rare congenital anomaly and, although many fetal structural defects can be detected with a high degree of confidence after introducing high-resolution US, the prenatal diagnosis of BPA remains problematic. Other thoracic abnormalities, such as a congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, and pulmonary sequestration, should be excluded from the list of possible diagnoses before coming to the conclusion of BPA, because BPA is absolutely incompatible with extrauterine life, and an accurate internal diagnosis can prevent a futile intervention from being performed

  13. Prenatal Diagnosis of Bilateral Pulmonary Agenesis: a Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung A; Cho, Jeong Yeon; Lee, Seung Mi; Jun, Jong Kwan; Kang, Ji Eun; Seo, Jeong Wook [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    We report a case of bilateral pulmonary agenesis (BPA), which was suspected during a prenatal US examination and diagnosed by fetal magnetic resonance imaging (MRI). BPA is an extremely rare congenital anomaly and, although many fetal structural defects can be detected with a high degree of confidence after introducing high-resolution US, the prenatal diagnosis of BPA remains problematic. Other thoracic abnormalities, such as a congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, and pulmonary sequestration, should be excluded from the list of possible diagnoses before coming to the conclusion of BPA, because BPA is absolutely incompatible with extrauterine life, and an accurate internal diagnosis can prevent a futile intervention from being performed.

  14. 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.)

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.)

  20. 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

  1. 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.

  2. 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...

  3. 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.

  4. 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.

  5. 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

  6. 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

  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. 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.

  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. Prenatal Diagnosis of Bilateral Pulmonary Agenesis: a Case Report

    Science.gov (United States)

    Lee, Kyung A; Lee, Seung Mi; Jun, Jong Kwan; Kang, Jieun; Seo, Jeong-Wook

    2010-01-01

    We report a case of bilateral pulmonary agenesis (BPA), which was suspected during a prenatal US examination and diagnosed by fetal magnetic resonance imaging (MRI). BPA is an extremely rare congenital anomaly and, although many fetal structural defects can be detected with a high degree of confidence after introducing high-resolution US, the prenatal diagnosis of BPA remains problematic. Other thoracic abnormalities, such as a congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, and pulmonary sequestration, should be excluded from the list of possible diagnoses before coming to the conclusion of BPA, because BPA is absolutely incompatible with extrauterine life, and an accurate internal diagnosis can prevent a futile intervention from being performed. PMID:20046503

  12. 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.

  13. 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.

  14. 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

  15. 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...

  16. 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

  17. 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...

  18. 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.)

  19. 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.

  20. 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.

  1. 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.

  2. Atresia of the bilateral pulmonary veins: a rare and dismal anomaly identified on cardiac CT

    International Nuclear Information System (INIS)

    Goo, Hyun Woo; Park, Sang-Hyub; Koo, Hyun Jung; Cho, Young Hoon; Lee, Eunsol

    2014-01-01

    Imaging findings of bilateral pulmonary vein atresia have not been described. To describe cardiac CT findings and clinical outcomes of bilateral pulmonary vein atresia. Three newborns with bilateral pulmonary vein atresia were encountered at our institution during a period of 8 years. We evaluated prenatal echocardiographic findings, clinical presentations, postnatal echocardiographic findings, chest radiographic findings, cardiac CT findings and clinical outcomes. All newborns presented immediately after birth with severe cyanosis, respiratory distress and acidosis that were unresponsive to medical management. Prenatal and postnatal echocardiographic studies and chest radiography were misleading, inconclusive or nonspecific in making the diagnosis in these children; however cardiac CT clearly demonstrated atresia of the bilateral pulmonary veins with multiple small mediastinal collateral veins and pulmonary edema. Surgical treatments were not feasible for this anomaly. Their clinical outcomes were universally dismal and all infants died within 3 days. Cardiac CT provides an accurate diagnosis of bilateral pulmonary vein atresia and leads to prompt treatment decision in these children. (orig.)

  3. Atresia of the bilateral pulmonary veins: a rare and dismal anomaly identified on cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo; Park, Sang-Hyub; Koo, Hyun Jung; Cho, Young Hoon; Lee, Eunsol [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of)

    2014-08-15

    Imaging findings of bilateral pulmonary vein atresia have not been described. To describe cardiac CT findings and clinical outcomes of bilateral pulmonary vein atresia. Three newborns with bilateral pulmonary vein atresia were encountered at our institution during a period of 8 years. We evaluated prenatal echocardiographic findings, clinical presentations, postnatal echocardiographic findings, chest radiographic findings, cardiac CT findings and clinical outcomes. All newborns presented immediately after birth with severe cyanosis, respiratory distress and acidosis that were unresponsive to medical management. Prenatal and postnatal echocardiographic studies and chest radiography were misleading, inconclusive or nonspecific in making the diagnosis in these children; however cardiac CT clearly demonstrated atresia of the bilateral pulmonary veins with multiple small mediastinal collateral veins and pulmonary edema. Surgical treatments were not feasible for this anomaly. Their clinical outcomes were universally dismal and all infants died within 3 days. Cardiac CT provides an accurate diagnosis of bilateral pulmonary vein atresia and leads to prompt treatment decision in these children. (orig.)

  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. Bilateral cervical ectopic thymic nodules with accessory thyroid tissue and an ectopic parathyroid in the neck region

    Directory of Open Access Journals (Sweden)

    Wea-Lung Lin

    2011-03-01

    Full Text Available Some remnants of thymic tissue may be deposited along the pathway of the descent of the neck during embryologic development of the thymus. Ectopic thymic tissue is usually deposited along the pathway from the mandibular angle to the manubrium of the sternum. Most reported cases of an ectopic thymus occurred in children, and cases are less common in adults. We report a 26-year-old woman, who was incidentally found to have 2 neck nodules on the posterior side of the bilateral upper pole of the thyroid gland while undergoing a subtotal thyroidectomy. The left-side neck nodule showed accessory thyroid follicles intermixed with ectopic thymic tissue, and the right-side neck nodule was ectopic parathyroid tissue together with ectopic thymic tissue.

  6. 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

  7. 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.

  8. 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.)

  9. 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.)

  10. [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.

  11. 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.

  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. 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. 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.)

  15. 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

  16. 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.

  17. NONIMMUNE HYDROPS-FETALIS AND BILATERAL PULMONARY HYPOPLASIA IN A NEWBORN-INFANT WITH EXTRALOBAR PULMONARY SEQUESTRATION

    NARCIS (Netherlands)

    BRUS, F; NIKKELS, PGJ; VANLOON, AJ; OKKEN, A

    Extralobar pulmonary sequestration was found in a newborn premature infant that presented with non-immune hydrops fetalis, massive bilateral hydrothorax and polyhydramnios in utero. The baby died of severe respiratory insufficiency 15 h after birth. Postmortem examination revealed distended

  18. 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.)

  19. 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 ...

  20. 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)

  1. 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.

  2. 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.

  3. 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.)

  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. 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.

  7. 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

  8. 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.

  9. 53. Bilateral ductal stenting for nonconfluent pulmonary arteries in a newborn

    Directory of Open Access Journals (Sweden)

    K. Al Dhahri

    2016-07-01

    Full Text Available Bilateral PDA dependent pulmonary circulation with right and left pulmonary artery discontinuity is very rare. Limited data available for bilateral PDA stenting. Bilateral PDA stenting in nonconfluent pulmonary arteries is challenging procedure but can be considered as an option in the management of complex conditions like this. 12 days old Preterm (36 weeks gestation male baby with birth weight of 2.6 kg developed respiratory distress with severe cyanosis and desaturation upto 50%. Baby was intubated and started on Prostaglandin 0.05 mic/kg/mt. His saturation improved to 80%. Echocardiogram showed complex cyanotic heart disease, Situs ambiguous, dextrocardia, complete unbalanced AV septal defect, pulmonary atresia , nonconfluent small branch pulmonary arteries supplied by the bilateral patent ductus arteriosus (PDA from right aortic arch and all four pulmonary veins form a confluence and drain into superior vena cava(SVC through vertical vein with no obstruction. Baby was taken up for PDA stenting. descending aortogram showed right aortic arch with vertical tortuous duct to right pulmonary artery (RPA and another short duct with acute angle from left subclavian artery to left pulmonary artery (LPA . Both ducti stented with coronary stents. Vertical vein angiogram showed both lungs drain to a confluence and then to SVC via ascending vertical vein with no obstruction. After stenting lung perfusion improved and the baby was stable and maintained 80% saturation on room air. Bilateral PDA dependent pulmonary circulation with right and left pulmonary artery discontinuity is very rare. Our case is unique with Heterotaxy, TAPVC, Dextrocardia and double ducti. Eventhough bilateral ductal stenting is technically challenging it is successful through femoral artery approach.

  10. 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

  11. 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

  12. 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%.

  13. 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.)

  14. 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.

  15. 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.

  16. 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.  

  17. 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

  18. [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.

  19. 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)

  20. Bilateral Re-Expansion Pulmonary Oedema– When the Cure Is ...

    African Journals Online (AJOL)

    Background: Re-expansion pulmonary oedema is a potentially fatal consequence of rapid reexpansion of a lung, which has been collapsed due to a pleural effusion or a pneumothorax. Case Report: We report a very unusual case in which the patient initially developed ipsilateral followed by contralateral pulmonary ...

  1. 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.

  2. 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.

  3. 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.

  4. 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.)

  5. Cloacal dysgenesis sequence with bilateral renal agenesis and normal pulmonary development in twin pregnancy.

    Science.gov (United States)

    Jegadeesh, Sundram; Mahajan, Jai Kumar

    2016-01-20

    Cloacal dysgenesis sequence (CDS) is a rare congenital anomaly. It is characterised by a smooth perineum with absence of anal and genitourinary orifices, with reported incidence of 1:50,000-250,000 births. Association with bilateral renal agenesis is still rarer and resultant severe oligohydramnios is associated with pulmonary hypoplasia. Only a few cases of CDS with bilateral renal agenesis have been reported in the English language literature, with associated pulmonary hypoplasia as a default phenomenon. We report a case of CDS and bilateral renal agenesis without associated pulmonary hypoplasia in a twin pregnancy, which, to the best of our knowledge, is the second reported case of this amalgamation. 2016 BMJ Publishing Group Ltd.

  6. 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

  7. 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.

  8. 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

  9. 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

  10. 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

  11. 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.

  12. 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.

  13. 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

  14. 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.

  15. 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)

  16. 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.)

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. 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.)

  2. Paget-Schroetter syndrome with bilateral pulmonary emboli

    Directory of Open Access Journals (Sweden)

    Garrison Glavich, MS

    2018-02-01

    Full Text Available Paget-Schroetter syndrome, also known as effort thrombosis, is a relatively rare disease process characterized by primary thrombosis to the subclavian and axillary veins. It usually presents in younger individuals, commonly affecting the dominant side upper extremity, and the diagnosis relies on a combination of imaging, laboratory tests, and clinical presentation. Upper extremity deep vein thrombosis can also lead to pulmonary emboli, as in this case of a 20-year-old female discovered to have right sided Paget-Schroetter syndrome.

  3. 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.

  4. 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.

  5. 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

  6. 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)

  7. 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

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. [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.

  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. Bilateral Pulmonary Thromboembolism: An Unusual Presentation of Infection with Influenza A (H1N1 Virus

    Directory of Open Access Journals (Sweden)

    Parviz Saleh

    2010-06-01

    Full Text Available AbstractSwine flue is a highly contagious acute respiratory diseasecaused by a subtype of influenza A virus. Herein we presentthree patients with H1N1 infection complicated with pulmonarythromboembolism. The patients had chest pain and unexplaineddyspnea. Imaging studies showed bilateral hilar predominance.Computed tomographic angiography confirmed bilateral thromboembolism(an unusual presentation of H1N1 infection. We didnot find any predisposing factor including endothelial damage,stasis, or hypercoagulable state in these patients. They did notreceive any medication. After anticoagulation and treatment withoseltamivir, all the patients were discharged in good condition.To the best of our knowledge bilateral pulmonary thromboembolismhas not been reported in English language literature inpatients with swine flu infection. Appropriate diagnosis andtreatment will be life saving in this condition.Iran J Med Sci 2010; 35(2: 149-153.

  20. [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.

  1. 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.

  2. 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)

  3. Mini-invasive resection and collapse therapy in patients with bilateral pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Korpusenko I.V.

    2015-06-01

    Full Text Available Objective. Improve the effectiveness of surgical treatment in patients with bilateral destructive pulmonary tuberculosis by mini-invasive resection and collapse therapy. Materials and Methods: Retrospective analysis of 222 patients’ cards with bilateral destructive pulmonary tuberculosis who were treated in the period from 1995 to 2014 in the thoracic department of Dnepropetrovsk regional clinical therapeutic and prophylactic association "Phthisiology". Patients were divided into 2 groups: basic (111 patients who underwent mini-invasive surgery and control (111 patients, who underwent standard surgical approach. The distribution of patients in investigated groups was representative by the majority of parameters. Results and discussion. The average duration of simultaneous bilateral VATS lung resections was 1,90 ± 0,12 hour, standard thoracotomies - 2,13 ± 0,19 per hour, estimated blood loss was 234±5,20ml and 433±3,70ml respectively. The average postoperative time in-patient was 52,40±2,63 days in basic and 80,10±3,58 days in the control group. Number of postoperative complications after lung resection with VATS was significantly lower (1.6 times, as compared with standard surgical approach. Volume of blood loss less than 400 ml was 93,40±3,20% in basic and 72,60±4,80% in the control group, the amount of intraoperative complications reduced by 2.2 times. Complete clinical response (decontamination and closing of cavities have been achieved in patients of the basic group by 1.6 times more often. Conclusions: For patients with bilateral pulmonary tuberculosis to perform mini-invasive surgical approach is the best option. Mini-invasive interventions with VATS due to its good abilities to visualize tissues and anatomical structures may significantly decrease the amount of intraoperative blood and plasma loss in the first postoperative day. It leads to the stabilization of tuberculosis process in the contralateral lung, responsible for

  4. 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

  5. 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.

  6. 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.

  7. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  9. 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

  10. 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

  11. 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.

  12. Pulmonary endothelial dysfunction induced by unilateral as compared to bilateral thoracic irradiation in rats

    International Nuclear Information System (INIS)

    Ward, W.F.; Molteni, A.; Ts'Ao, C.H.; Solliday, N.H.

    1987-01-01

    Rats were sacrificed 2 months after a single dose of 10-30 Gy of 60 Co gamma rays delivered to either a right unilateral or a bilateral thoracic port. Four indices of lung endothelial function were measured: the activities of angiotensin-converting enzyme (ACE) and plasminogen activator (PLA) and the production of prostacyclin (PGI2) and thromboxane (TXA2). The number of macrophages recovered by bronchoalveolar lavage (BAL) and the degree of right ventricular hypertrophy (an index of pulmonary hypertension) also were determined. Right lung ACE and PLA activity decreased linearly, and PGI2 and TXA2 production increased linearly with increasing radiation dose. The response curves for right unilateral and bilateral thoracic irradiation were not significantly different. In contrast, bilateral irradiation was more toxic than unilateral, since rats exposed to the former exhibited decreased body weight, an increased incidence of pleural effusions, an increase in the number of macrophages recovered by BAL, and right ventricular hypertrophy. These data demonstrate that pulmonary endothelial dysfunction induced by hemithorax irradiation represents a direct response of the endothelium to radiation injury and is not secondary to other phenomena such as shunting of function to the shielded lung

  13. 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

  14. 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

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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.)

  20. 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

  1. 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.

  2. 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.

  3. [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.

  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. 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.

  6. 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.

  7. 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)

  8. 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.

  9. 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

  10. 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)

  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. Bilateral Pulmonary Endarterectomy and Bentall Procedure Completed in One Surgical Session

    Science.gov (United States)

    Ricci, Davide; Cavozza, Corrado; Scoti, Peppino; Mercogliano, Domenico; Minzioni, Gaetano; Medici, Dante

    2012-01-01

    We describe the performance, in one surgical session, of bilateral pulmonary endarterectomy and a button-technique Bentall operation in a 68-year-old man. The patient had chronic thromboembolic pulmonary hypertension and an ascending aortic aneurysm with moderate aortic regurgitation. The procedures were concurrently completed during short periods of systemic circulatory arrest, with antegrade cerebral perfusion maintained through the brachiocephalic artery at a flow rate of 10 mL/min/kg. The patient's cerebral perfusion was monitored with use of near-infrared spectroscopy, to prevent symmetric bilateral values from falling below 20% of the base value. The patient experienced no multiorgan failure or neurologic sequelae and, by the 6th postoperative day, improved from New York Heart Association functional class IV to class I. The reliable maintenance of continuous antegrade cerebral perfusion made the lengthy combined operation feasible, with low risk. The use of near-infrared spectroscopy enabled real-time monitoring of the patient's cerebral blood flow. Our experience shows the possibility of safely performing lengthy or multiple procedures in one surgical session. PMID:23109784

  14. 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.

  15. 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.

  16. Minimally invasive surgical treatment of patients with bilateral pulmonary tuberculosis complicated with pleural empyema

    Directory of Open Access Journals (Sweden)

    Korpusenko I.V

    2015-03-01

    Full Text Available Objective of our study was to increase the effectiveness of surgical treatment of bilateral destructive pulmonary tuberculosis complicated by pleural empyema by using VTS-technologies. The study was done in Dnepropetrovsk regional clinical therapeutic and prophylactic association "Phthisiology" in the period from 2008 to 2013. A retrospective analysis of 43 cases of bilateral destructive pulmonary tuberculosis complicated by pleural empyema on one side and dissemination focus or limited destructive process on contralateral side has been performed. Selected cases were divided into 2 groups: main (eighteen cases where the following procedures were done: performed transsternal occlusion of the main bronchus, sanation of empyema cavity using videothoracosopy, in 30-45 days followed by pleuropneumectomy with usage of minithoracothomy and control (nineteen cases who had undergone drainage of the empyema cavity, sanation, in 45-60 days followed by pleuropmeumectomy with usage of anterolateral access. The distribution of main and control groups for analyzed parameters was representative. Sanation of pleural cavity with videothoracosopy usage compared with Bulau’s drainage provides better antibacterial effect, effective sanitation of the pleural cavity as evidenced by following changes: significant decrease in the number of microbial cells; normalization of total white blood cells count and rod-shaped granulocytes in the peripheral blood 10 days after treatment; normalization of leukocyte intoxication index. The use of minimally invasive surgical treatment allowed to reduce intraoperative complications by 2 times, amount of intraoperative blood loss and hemotrasfusions by 1.5 times, postoperative mortality by 2.5 times. Pleural cavity sanation with videothoracoscopy usage with following pneumoectomy leads to reduce in the incidence and severity of postoperative complications. The most promising is stage-by-stage surgical approach with consecutive use

  17. 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.

  18. 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.)

  19. 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.)

  20. 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

  1. 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

  2. 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

  3. 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

  4. 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.)

  5. 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.)

  6. 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.

  7. 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.

  8. 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.

  9. 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.)

  10. 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.

  11. 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.

  12. 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).

  13. 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...

  14. Pulmonary melanoma and "crazy paving" patterns in chest images: a case report and literature review.

    Science.gov (United States)

    Feng, Yikuan; Zhao, Jianping; Yang, Qun; Xiong, Weining; Zhen, Guohua; Xu, Yongjian; Zhang, Zhenxiang; Zhang, Huilan

    2016-08-03

    In the lung, melanoma is mostly arranged as patterns of multiple nodules, solitary nodules, or miliary invasions. Very rarely, it also displays a "crazy paving" pattern (also described as a "paving stone," "flagstone," or "slabstone" pattern), which is rarer still in discrete bilateral nodules. This pattern is considered to be caused by pulmonary alveolar proteinosis, but its association with various diseases is unclear. A 60-year-old man was diagnosed with pulmonary melanoma. Computed tomography revealed discrete bilateral nodules surrounded by a "paving" pattern. A literature review found more than 40 types of diseases that have presented with "paving" patterns in the lung-predominantly pulmonary alveolar proteinosis, viral pneumonia, exogenous lipoid pneumonia, bacterial pneumonia, pulmonary alveolar microlithiasis, interstitial pneumonia, ARDS, squalene aspiration pneumonia, radiation pneumonitis, drug-induced pneumonitis, pulmonary leptospirosis, pulmonary hemorrhage, and pulmonary nocardiosis. We describe the first case of pulmonary melanoma in the form of discrete bilateral nodules accompanied with a computed tomography paving pattern. Although pulmonary paving patterns are rare, more than 40 diseases reportedly display them; clinicians should consider melanoma of the lung in differential diagnoses for patients who show such a pattern.

  15. Bilateral branch pulmonary artery stenosis and Mitral valve prolapse in a patient with Noonan syndrome: A case report

    Directory of Open Access Journals (Sweden)

    Meenakshi Kadiyala

    2014-01-01

    Full Text Available Rasopathy syndromes are a class of phenotypically similar, but genetically distinct multiple anomaly syndromes caused by germ line mutations in genes that encode protein components of the Ras/mitogen activated protein kinase (MAPK pathway. Noonan syndrome, cardiofaciocutaneous syndrome and Costello syndrome are part of this group of developmental syndromes and have similar cardiac abnormalities. A 19-year-old male presented with complaints of exertional breathlessness class I for 6 months. Clinical examination revealed characteristic facial features, skeletal abnormalities, growth and neurocognitive problems reported in patients with Noonan syndrome. There was evidence of severe pulmonary hypertension. Trans-thoracic echocardiography revealed right atrial and right ventricular enlargement, severe pulmonary hypertension, no intra cardiac shunt, prolapse of anterior mitral leaflet with mild mitral regurgitation. CT pulmonary angiogram revealed bilateral branch pulmonary artery stenosis. A final diagnosis of Noonan syndrome was made.

  16. 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

  17. 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

  18. 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)

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

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    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.)

  20. Hereditary hemorrhagic telangiectasia with bilateral pulmonary vascular malformations: A case report

    Directory of Open Access Journals (Sweden)

    Lončarević Olivera

    2016-01-01

    Full Text Available Introduction. Hereditary hemorrhagic telangiectasia (HHT also known as Osler-Weber-Rendu syndrome is an autosomal dominant disease that occurs due to vascular dysplasia associated with the disorder in the signaling pathway of transforming growth factor β (TGF-β. The clinical consequence is a disorder of blood vessels in multiple organ systems with the existence of telangiectasia which causes dilation of capillaries and veins, are present from birth and are localized on the skin and mucosa of the mouth, respiratory, gastrointestinal and urinary tract. They can make a rupture with consequent serious bleeding that can end up with fatal outcome. Since there is a disruption of blood vessels of more than one organic system, the diagnosis is very complex and requires a multidisciplinary approach. Case report. We reported a 40-year-old female patient with a long-time evolution of problems, who was diagnosed and treated at the Clinic for Lung Diseases of the Military Medical Academy in Belgrade, Serbia, because of bilaterally pulmonary arteriovenous malformations associated with HHT. Embolization was performed in two acts, followed with normalization of clinical, radiological and functional findings with the cessation of hemoptysis, effort intolerance with a significant improvement of the quality of life. Conclusion. HHT is a rare dominant inherited multisystem disease that requires multidisciplinary approach to diagnosis and treatment. Embolization is the method of choice in the treatment of arteriovenous malformations with minor adverse effects and very satisfying therapeutic effect.

  1. 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

  2. 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)

  3. 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

  4. 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.

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

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    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.)

  6. 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.

  7. 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.

  8. 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

  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. 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.)

  11. Infants with Atypical Presentations of Alveolar Capillary Dysplasia with Misalignment of the Pulmonary Veins Who Underwent Bilateral Lung Transplantation.

    Science.gov (United States)

    Towe, Christopher T; White, Frances V; Grady, R Mark; Sweet, Stuart C; Eghtesady, Pirooz; Wegner, Daniel J; Sen, Partha; Szafranski, Przemyslaw; Stankiewicz, Pawel; Hamvas, Aaron; Cole, F Sessions; Wambach, Jennifer A

    2018-03-01

    To describe disease course, histopathology, and outcomes for infants with atypical presentations of alveolar capillary dysplasia with misalignment of the pulmonary veins (ACDMPV) who underwent bilateral lung transplantation. We reviewed clinical history, diagnostic studies, explant histology, genetic sequence results, and post-transplant course for 6 infants with atypical ACDMPV who underwent bilateral lung transplantation at St. Louis Children's Hospital. We compared their histology with infants with classic ACDMPV and compared their outcomes with infants transplanted for other indications. In contrast with neonates with classic ACDPMV who present with severe hypoxemia and refractory pulmonary hypertension within hours of birth, none of the infants with atypical ACDMPV presented with progressive neonatal respiratory failure. Three infants had mild neonatal respiratory distress and received nasal cannula oxygen. Three other infants had no respiratory symptoms at birth and presented with hypoxemia and pulmonary hypertension at 2-3 months of age. Bilateral lung transplantation was performed at 4-20 months of age. Unlike in classic ACDMPV, histopathologic findings were not distributed uniformly and were not diffuse. Three subjects had apparent nonmosaic genetic defects involving FOXF1. Two infants had extrapulmonary anomalies (posterior urethral valves, inguinal hernia). Three transplanted children are alive at 5-16 years of age, similar to outcomes for infants transplanted for other indications. Lung explants from infants with atypical ACDMPV demonstrated diagnostic but nonuniform histopathologic findings. The 1- and 5-year survival rates for infants with atypical ACDMPV are similar to infants transplanted for other indications. Given the clinical and histopathologic spectra, ACDMPV should be considered in infants with hypoxemia and pulmonary hypertension, even beyond the newborn period. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. 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

  13. 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

  14. 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)

  15. 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

  16. Bilateral pulmonary thromboembolism and Budd-Chiari syndrome in a patient with Crohn s disease on oral contraceptives.

    Science.gov (United States)

    Valdés Mas, M; Martínez Pascual, C; Egea Valenzuela, J; Martínez Bonil, M C; Vargas Acosta, A M; Ortiz Sánchez, M L; Miras López, M; Carballo Alvarez, F

    2009-09-01

    Budd-Chiari syndrome can be defined as an interruption or diminution of the normal blood flow out of the liver. Patients with Budd-Chiari syndrome present with varying degrees of symptomatology that can be divided into the following categories: fulminant, acute, subacute and chronic. The subacute form is the most common presentation. A majority of patients with Budd-Chiari syndrome have an underlying hypercoagulability state. We present the case of a young woman with Crohn s disease on oral contraceptives who developed bilateral pulmonary thromboembolism and Budd-Chiari syndrome.

  17. [Subtotal cor triatriatum sinister associated with bilateral partial anomalous pulmonary venous return].

    Science.gov (United States)

    Işık, Onur; Akyüz, Muhammet; Ayık, Mehmet Fatih; Atay, Yüksel

    2016-03-01

    Cor triatriatum sinister is a rare congenital cardiac pathology, representing only 0.1% of congenital cardiac anomalies, and often associated with other cardiac defects. In classic cor triatriatum sinister, the pulmonary venous chamber receives all pulmonary veins and drains into the left atrium through a variable-sized orifice. The case of a 4-month-old male patient who had subtotal cor triatriatum sinister associated with right and left upper anomalous pulmonary venous return is presented.

  18. 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.

  19. 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.)

  20. 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

  1. 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

  2. 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

  3. 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

  4. 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)

  5. 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.

  6. 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.)

  7. Post-operative Unexpected Bilateral Massive Pulmonary Embolism in a Thirty-Year-Old Woman: A Case Report

    Directory of Open Access Journals (Sweden)

    Öznur Şen

    2015-12-01

    Full Text Available Pulmonary embolism (PE is a rare, yet serious complication. That, generally follows invasive procedures in adults. The present report details the case of bilateral pulmonary embolism in a thirty-year-old women after ovarian cyst surgery. A thirty-year-old female patient, who had ovarian cystectomy ten days previously, consulted the emergency department with the complaints of sickness and syncope. Her blood pressure, pulse and respiratory rate were 90/40 mmHg, 150/min. and 35/min, respectively. During examination and phlebotomy, she had a cardiac arrest and responded to a 3-minute cardiopulmonary resuscitation (CPR with tracheal intubation. During imaging procedures, she had three further cardiac arrests and was admitted to the intensive care unit. The preliminary diagnoses were acute renal failure (ARF and PE. Fluid replacement, inotropic support, anticoagulant therapies, as well as sedation to prevent brain damage were started immediately. Thrombolytic therapy was not attempted because she had surgery ten days ago and hematoma was observed on abdominal ultrasound. Inhaled nitric oxide and inhaled iloprost with sildenafil were employed to reduce pulmonary hypertension. When discharged 136 days after hospitalization she was a tracheotomized and, spontaneously breathing home care patient with hypoxic brain injury. Early detection and treatment of PE are of great importance for a good prognosis and prevention of life-threatening complications.

  8. 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

  9. 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

  10. 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.

  11. Horseshoe lung associated with left-lung hypoplasia, left pulmonary artery sling and bilateral agenesis of upper lobe bronchi

    International Nuclear Information System (INIS)

    Oguz, Berna; Haliloglu, Mithat; Alan, Serdar; Ozcelik, Ugur

    2009-01-01

    Horseshoe lung, a rare congenital anomaly, is almost always associated with unilateral (usually right-sided) lung hypoplasia, and, in most cases, in conjunction with the scimitar syndrome. We present an 8-month-old boy with horseshoe lung associated with left-lung hypoplasia, left pulmonary artery sling and bilateral agenesis of the upper lobe bronchi, diagnosed by multidetector CT (MDCT) imaging. The study also revealed an anomalous origin of the left vertebral artery as the last branch of the aortic arch, distal to the left subclavian artery, and an anomalous origin of the left common carotid artery from the brachiocephalic trunk. A hemivertebral anomaly of the seventh cervical vertebra was incidentally detected. MDCT with high-quality multiplanar and three-dimensional reconstructions is a noninvasive and rapid technique for detecting the complex combination of vascular, tracheobronchial and parenchymal anomalies, and any potential bone anomalies, in one imaging study. (orig.)

  12. Horseshoe lung associated with left-lung hypoplasia, left pulmonary artery sling and bilateral agenesis of upper lobe bronchi

    Energy Technology Data Exchange (ETDEWEB)

    Oguz, Berna; Haliloglu, Mithat [Hacettepe University Faculty of Medicine, Department of Radiology, Ankara (Turkey); Alan, Serdar; Ozcelik, Ugur [Hacettepe University Faculty of Medicine, Department of Pediatrics, Ankara (Turkey)

    2009-09-15

    Horseshoe lung, a rare congenital anomaly, is almost always associated with unilateral (usually right-sided) lung hypoplasia, and, in most cases, in conjunction with the scimitar syndrome. We present an 8-month-old boy with horseshoe lung associated with left-lung hypoplasia, left pulmonary artery sling and bilateral agenesis of the upper lobe bronchi, diagnosed by multidetector CT (MDCT) imaging. The study also revealed an anomalous origin of the left vertebral artery as the last branch of the aortic arch, distal to the left subclavian artery, and an anomalous origin of the left common carotid artery from the brachiocephalic trunk. A hemivertebral anomaly of the seventh cervical vertebra was incidentally detected. MDCT with high-quality multiplanar and three-dimensional reconstructions is a noninvasive and rapid technique for detecting the complex combination of vascular, tracheobronchial and parenchymal anomalies, and any potential bone anomalies, in one imaging study. (orig.)

  13. 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.)

  14. 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.)

  15. [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

  16. 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.)

  17. 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.

  18. 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 ...

  19. 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.

  20. Deep Venous Thrombosis and Bilateral Pulmonary Embolism Revealing Silent Celiac Disease: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Igor Dumic

    2017-01-01

    Full Text Available Celiac disease (CD is a systemic, chronic autoimmune disease that occurs in genetically predisposed individuals following dietary gluten exposure. CD can present with a wide range of gastrointestinal and extraintestinal manifestations and requires lifelong adherence to a gluten-free diet [GFD]. Venous thromboembolism (VTE as a presentation of celiac disease is unusual and rarely reported. We present a case of a 46-year-old man who was admitted for shortness of breath and pleuritic chest pain and was found to have iron deficiency anemia, deep venous thrombosis, and bilateral pulmonary emboli (PE. After work-up for his anemia, the patient was diagnosed with CD. Comprehensive investigation for inherited or acquired prothrombotic disorders was negative. It is becoming increasingly recognized that CD is associated with an increased risk for VTE. PE, however, as a presentation of CD is exceedingly rare and to the best of our knowledge this is the third case report of such an occurrence and the only case report of a patient from North America. It is important to recognize that the first symptoms or signs of celiac disease might be extraintestinal. Furthermore, VTE as a presentation of CD is rare but life-threatening.

  1. 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.

  2. 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.

  3. 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.)

  4. 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

  5. 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).

  6. 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.)

  7. Clinical manifestations and pulmonary radiological features in patients with triphosgene poisoning

    International Nuclear Information System (INIS)

    Ye Caier, Chen Weijian; Wu Enfu; Yang Yunjun; Ye Min; Liu Zaiyi

    2007-01-01

    Objective: To examine the clinical manifestations and pulmonary radiological features in patients with triphosgene poisoning. Methods: Clinical manifestations, laboratory tests and CT scans were analyzed retrospectively in 17 patients with triphosgene poisoning. We focused on the severity, development and repair of pulmonary impairment. Results: Plain film and CT scans in five mild cases demonstrated bilateral scattered pulmonary patchy shadows. Of 12 cases with moderate to severe diseases, three showed bilateral multiple pulmonary patchy shadows and nodules with confluence of part of the lesions on plain film and CT scans; bilateral lungs were involved in nine cases with imaging findings of bilateral disseminated pulmonary round or ovary nodules with different size, ill-defined and partly-confluent patchy shadows and thickening of both interlobular septum and the wall of bronchus. Of clinical interests, imaging findings were closely correlated with clinical course and laboratory results. Conclusion: Radiological examinations with plain films and CT scans could reveal the severity, evolvement of pulmonary edema in patients with triphosgene poisoning, and these are of clinical benefit in the early management and prognostic evaluation of patients with triphosgene poisoning. (authors)

  8. 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 ...

  9. 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

  10. 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.

  11. 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

  12. 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.

  13. 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.)

  14. Pulmonary candidiasis after hematopoietic stem cell transplantation: thin-section CT findings.

    Science.gov (United States)

    Franquet, Tomás; Müller, Nestor L; Lee, Kyung S; Oikonomou, Anastasia; Flint, Julia D

    2005-07-01

    To retrospectively evaluate thin-section computed tomographic (CT) findings in hematopoietic stem cell transplant (ie, bone marrow transplant) patients with histopathologically proved pulmonary candidiasis. Ethical approval was obtained from the institutional review board of each of the three institutions; informed consent was not required. The study included 17 hematopoietic stem cell transplant recipients with proved pulmonary candidiasis. Histopathologic specimens were acquired at transbronchial biopsy (n = 8), open lung biopsy (n = 6), and autopsy (n = 3). The patients included seven men and 10 women (age range, 20-62 years; mean age, 37 years). The thin-section CT scans were retrospectively reviewed by two thoracic radiologists for the presence, appearance, and distribution of parenchymal abnormalities. Multiple nodules were present in 15 (88%) patients, including centrilobular nodules and tree-in-bud pattern in seven (41%) patients. Nodules were bilateral in 12 patients and unilateral in three. An associated halo of ground-glass opacity was identified in five (33%) patients. Nodules were the only CT finding in five patients (29%). Areas of air-space consolidation were identified in 11 (65%) patients. Areas of ground-glass opacity were seen in six (35%) of 17 patients and were always associated with other abnormalities. Other less common CT findings included pleural effusion (n = 3), thickening of the bronchial walls (n = 2), and cavitation (n = 1). The most common thin-section CT findings of pulmonary candidiasis in hematopoietic stem cell transplant patients are multiple bilateral nodular opacities often associated with areas of consolidation. Copyright RSNA, 2005

  15. Pulmonary metastatic calcification: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Bozi, Lilian Christine Franchiotti [Radiology, Hospital Universitario Antonio Pedro (HUAP), Niteroi, RJ (Brazil); Melo, Alessandro Severo Alves de; Marchiori, Edson, E-mail: edmarchiori@gmail.com [Department of Radiology, School of Medicine, Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil)

    2012-09-15

    The present report describes the case of a 48-year-old female patient suffering from chronic renal failure on dialysis for 13 years. She presented with hemoptysis, fever, productive cough and dyspnoea. Chest radiography showed predominance of ill-defined opacities in the middle and lower lung fields, bilaterally. Chest computed tomography showed ground glass opacities associated with poorly defined centrilobular nodules with ground-glass attenuation. The patient was submitted to bronchoalveolar lavage that was negative for mycobacteria and fungi. On the basis of such findings, open lung biopsy was performed, which revealed metastatic pulmonary calcification. (author)

  16. 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.)

  17. 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.

  18. CT Pulmonary Angiography and Suspected Acute Pulmonary Embolism

    Energy Technology Data Exchange (ETDEWEB)

    Enden, T.; Kloew, N.E. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. of Cardiovascular Radiology

    2003-05-01

    Purpose: To evaluate the use and quality of CT pulmonary angiography in our department, and to relate the findings to clinical parameters and diagnoses. Material and Methods: A retrospective study of 324 consecutive patients referred to CT pulmonary angiography with clinically suspected pulmonary embolism (PE). From the medical records we registered clinical parameters, blood gases, D-dimer, risk factors and the results of other relevant imaging studies. Results: 55 patients (17%) had PE detected on CT. 39 had bilateral PE, and 8 patients had isolated peripheral PE. 87% of the examinations showing PE had satisfactory filling of contrast material including the segmental pulmonary arteries, and 60% of the subsegmental arteries. D-dimer test was performed in 209 patients, 85% were positive. A negative D-dimer ruled out PE detected at CT. Dyspnea and concurrent symptoms or detection of deep vein thrombosis (DVT), contraceptive pills and former venous thromboembolism (VTE) were associated with PE. The presence of only one clinical parameter indicated a negative PE diagnosis (p < 0.017), whereas two or more suggested a positive PE diagnosis (p < 0.002). CT also detected various ancillary findings such as consolidation, pleural effusion, nodule or tumor in nearly half of the patients; however, there was no association with the PE diagnosis. Conclusion: The quality of CT pulmonary angiography was satisfactory as a first-line imaging of PE. CT also showed additional pathology of importance in the chest. Our study confirmed that a negative D-dimer ruled out clinically suspected VTE.

  19. CT volumetry of artificial pulmonary nodules using an ex vivo lung phantom: Influence of exposure parameters and iterative reconstruction on reproducibility

    Energy Technology Data Exchange (ETDEWEB)

    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.

  20. 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.

  1. Bloqueio pleural bilateral: analgesia e funções pulmonares em pós-operatório de laparotomias medianas Bloqueo pleural bilateral: analgesia y funciones pulmonares en pós-operatorio de laparotomias medianas Bilateral pleural block: analgesia and pulmonary functions in postoperative of median laparotomies

    Directory of Open Access Journals (Sweden)

    Karl Otto Geier

    2004-08-01

    TODO: Bloqueo pleural bilateral fue realizado en decúbito dorsal horizontal en 21 pacientes con 20 ml de bupivacaína a 0,375% con adrenalina a 1:400.000 administrados por catéter en cada hemitórax durante el pós-operatorio inmediato. Soluciones aleatorias de bupivacaína y de solución fisiológica fueron administradas por estudiantes en la práctica o enfermeras que desconocían el contenido de las jeringas, y sus resultados analgésicos evaluados de acuerdo con la escala de dolor Prince Henry al comparar los valores pre y pós-bloqueo pleural bilateral. En función del dolor pós-operatorio, ensayos espirométricos de las funciones pulmonares también fueron determinados mediante un espirómetro portátil. RESULTADOS: Analgesia pós-operatoria, con duración media de 247,75 ± 75 minutos fue constatada en todos los pacientes con la bupivacaína, aunque haya persistido dolor residual de menor intensidad en la región suprapúbica en cinco pacientes (8% y en dos pacientes en la apófisis xifóide (3,2%. Ningún efecto analgésico fue obtenido con solución fisiológica. De frente al dolor pós-operatorio, las funciones pulmonares, evaluadas antes y después de los bloqueos, registraron mejoría con la bupivacaína en CVF (p BACKGROUND AND OBJECTIVES: Notwithstanding pleural block having become almost an analgesic panacea, contradictory results have been published. This study aimed at observing analgesic and spirometric behavior of pulmonary function in the immediate postoperative period of 21 patients submitted to urgency median laparotomies under bilateral pleural block. METHODS: Bilateral pleural block was induced in the supine position with 20 mL of 0.375% bupivacaine with 1:400,000 epinephrine administered via catheter in each hemithorax during the immediate postoperative period. Randomized bupivacaine and saline were administered by residents or nurses blind to syringes content, and their analgesic outcomes were evaluated according to Prince Henry's pain score by

  2. Imaging findings of severe and critical severe pulmonary infections with A H1N1 influenza

    International Nuclear Information System (INIS)

    Chen Feng; Zhao Dawei; Wen Shuo; Li Hongjun; Wang Wei; He Ning; Zhang Ruichi; Song Wenyan

    2010-01-01

    Objective: To evaluate the pulmonary imaging features in patients with severe or critical severe A H1N1 influenza. Methods: Clinical and imaging findings of 18 cases with H1N1 pneumonia were retrospectively analyzed. These patients were divided into 2 groups including severe group (n=11) and critical group (n=7). Results: Among the severe group, bilateral ill-defined nodules and patch shadows were found in 8 cases, local ill-defined patchy was shown in 3 cases, and consolidation of right inferior lung was demonstrated by CT scan in 1 case. Among the critical group, diffuse ground-glass attenuation with partial consolidation were found in bilateral lungs of 4 cases, subcutaneous emphysema was observed in 1 case. CT showed diffuse ground-glass attenuation and nodular like consolidation in bilateral inferior lungs in 1 case, and other 3 cases showed diffuse consolidation of bilateral lungs. Conclusions: The radiologic findings of severe and critical severe pulmonary infections with H1N1 include ill-defined nodules and patch shadows of bilateral lung in sever patients, diffuse peribronchial ground-glass opacity and multifocal consolidation in critical severe patients. The radiologists should learn the features of H1N1 pneumonia on thoracic plain film and CTT to make diagnosis in time. (authors)

  3. 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.

  4. CT findings of pulmonary mucosa-associated lymphoid tissue lymphoma

    International Nuclear Information System (INIS)

    Zhang Weidong; Guan Yubao; Li Chuanxing; Wu Peihong

    2010-01-01

    Objective: To study the CT findings of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. Methods: The CT examinations of 12 patients with pathologically proven pulmonary MALT lymphoma were reviewed retrospectively. Evaluated imaging findings included number, distribution, shape, attenuation and other associated findings of each lesion were evaluated. Results: Thirty-two pulmonary lesions, including consolidations, masses, nodules and lesions with ground glass attenuation, were identified in 12 patients. Multiple lesions were founded in 10 of 12 patients and solitary lesion in 2 patients. Multiple lesions found in one lung in 2 patients, and multiple lesions found in both lungs in 8 patients. Ten cases demonstrated 21 consolidation lesions with air bronchogram, and one of the ten cases demonstrated two lesions with airway dilatation. Three cases demonstrated 5 masses or nodular lesions, 3 of these 5 lesions showed air bronchogram. Two cases demonstrated 6 ground glass attenuation lesions. One case showed mediastinal and hilar lymphadenopathy. Conclusion: Pulmonary MALT lymphoma usually appears as multiple bilateral consolidations, masses, nodules with air bronchogram or lesions with ground- glass attenuation at CT imaging. The imaging findings described above and with an indolent clinical course may suggest the diagnosis of pulmonary MALT lymphoma. (authors)

  5. Metastatic pulmonary calcification: high-resolution computed tomography findings in 23 cases

    Directory of Open Access Journals (Sweden)

    Luciana Camara Belém

    Full Text Available Abstract Objective: The aim of this study was to evaluate the high-resolution computed tomography (HRCT findings in patients diagnosed with metastatic pulmonary calcification (MPC. Materials and Methods: We retrospectively reviewed the HRCT findings from 23 cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26-89 years]. The patients were examined between 2000 and 2014 in nine tertiary hospitals in Brazil, Chile, and Canada. Diagnoses were established by histopathologic study in 18 patients and clinical-radiological correlation in 5 patients. Two chest radiologists analyzed the images and reached decisions by consensus. Results: The predominant HRCT findings were centrilobular ground-glass nodules (n = 14; 60.9%, consolidation with high attenuation (n = 10; 43.5%, small dense nodules (n = 9; 39.1%, peripheral reticular opacities associated with small calcified nodules (n = 5; 21.7%, and ground-glass opacities without centrilobular ground-glass nodular opacity (n = 5; 21.7%. Vascular calcification within the chest wall was found in four cases and pleural effusion was observed in five cases. The abnormalities were bilateral in 21 cases. Conclusion: MPC manifested with three main patterns on HRCT, most commonly centrilobular ground-glass nodules, often containing calcifications, followed by dense consolidation and small solid nodules, most of which were calcified. We also described another pattern of peripheral reticular opacities associated with small calcified nodules. These findings should suggest the diagnosis of MPC in the setting of hypercalcemia.

  6. Metastatic pulmonary calcification: high-resolution computed tomography findings in 23 cases

    Energy Technology Data Exchange (ETDEWEB)

    Belem, Luciana Camara; Souza, Carolina A.; Souza Junior, Arthur Soares; Escuissato, Dante Luiz; Hochhegger, Bruno; Nobre, Luiz Felipe; Rodrigues, Rosana Souza; Gomes, Antonio Carlos Portugal; Silva, Claudio S.; Guimaraes, Marcos Duarte; Zanetti, Glaucia; Marchiori, Edson, E-mail: edmarchiori@gmail.com [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil); Ottawa Hospital Research Institute, University of Ottawa, (Canada); Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), SP (Brazil); Ultra X, Sao Jose do Rio Preto, SP (Brazil); Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil); Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA), Porto Alegre, RS (Brazil); Universidade Federal de Santa Catarina (UFSC), Florianopolis, SC (Brazil). Hospital Universitario

    2017-07-15

    Objective: The aim of this study was to evaluate the high-resolution computed tomography (HRCT) findings in patients diagnosed with metastatic pulmonary calcification (MPC). Materials and Methods: We retrospectively reviewed the HRCT findings from 23 cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26-89) years]. The patients were examined between 2000 and 2014 in nine tertiary hospitals in Brazil, Chile, and Canada. Diagnoses were established by histopathologic study in 18 patients and clinical-radiological correlation in 5 patients. Two chest radiologists analyzed the images and reached decisions by consensus. Results: The predominant HRCT findings were centrilobular ground-glass nodules (n = 14; 60.9%), consolidation with high attenuation (n = 10; 43.5%), small dense nodules (n = 9; 39.1%), peripheral reticular opacities associated with small calcified nodules (n = 5; 21.7%), and ground-glass opacities without centrilobular ground-glass nodular opacity (n = 5; 21.7%). Vascular calcification within the chest wall was found in four cases and pleural effusion was observed in five cases. The abnormalities were bilateral in 21 cases. Conclusion: MPC manifested with three main patterns on HRCT, most commonly centrilobular ground-glass nodules, often containing calcifications, followed by dense consolidation and small solid nodules, most of which were calcified. We also described another pattern of peripheral reticular opacities associated with small calcified nodules. These findings should suggest the diagnosis of MPC in the setting of hypercalcemia. (author)

  7. Pulmonary manifestation of leptospirosis

    Energy Technology Data Exchange (ETDEWEB)

    Im, Jung Gi; Yeon, Kyung Mo; Han, Man Chung; Kim, Chu Wan; Lee, Jung Sang; Kim, Suhng Gwon; Han, Yong Chol; Chang, Woo Hyun; Chi, Je Geun [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1986-02-15

    Authors analysed and present chest X-ray findings of serologically proven leptospirosis from Seoul National University Hospital, either admitted or referred for serological verification, during recent 2 years. Radiological findings were correlated with the lung specimen findings of experimentally induced leptospirosis in guinea pig. The results are as follows: 1. 24 cases (56%) showed positive X-ray findings. 2. Predominant radiological patterns of involved lung were tiny dot, small nodule, rosette density in 11 cases, massive confluent consolidation in 4 cases, and diffuse ill-defined velly increased density in 9 cases. 3. Distribution of pulmonary lesions were bilateral (100%), non-lobar, non-segmental (95%), and there were conspicuous tendency of peripheral lung predominance. 4. Extrapulmonary manifestation, such as pleural effusion or cardiomegaly was rate. 5. Pulmonary lesions resolved completely usually 5 to 10 days after their appearance. 6. From the gross and microscopic findings of serially sacrificed guinea pig's lung and a case of autopsy, authors concluded that fine dot-like density in chest X-ray was due to paleolithic hemorrhage in intraalveolar space at initial stage, growing up to ressette density or confluent consolidation as the pathetic extends to surrounding lung forming purpura and coalescent hemorrhage.

  8. Medical image of the week: urothelial carcinoma with pulmonary metastases presenting with shoulder pain

    Directory of Open Access Journals (Sweden)

    Jarrett B

    2017-06-01

    Full Text Available No abstract available. Article truncated after 150 words. A 68 year old man with a past medical history significant only for mild hyperlipidemia and distant cigar smoking presented to this primary physician’s office with a chief complaint of left sided shoulder pain for more than 6 months duration. His only other complaint was a hacking morning cough that was attributed to GERD after resolution with omperazole therapy. He was without any other complaints such as weight loss, fevers, chills, night sweats, shortness of breath, or dyspnea on exertion. His physical exam was without any abnormality. An initial radiograph of the rileft shoudler was obtained which was without any obvious bony abnormality but demonstrated numerous potential pulmonary nodules (Figure 1. He was then referred to pulmonology for further assessment. A chest CT scan peformed with contrast again demonstrated numerous pulmonary nodules with thick walled central cavitations throughout the lung parenchyma bilaterally (Figures 2 & 3. Additional testing performed included …

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. 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.

  14. A case of pulmonary alveolar microlithiasis with Cor Pulmonale.

    Science.gov (United States)

    Chen, Wen; Gu, Tao

    2012-03-01

    Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by the formation and deposition of microliths within the alveoli and a paucity of symptoms in contrast to the imaging findings. It has familial tendency and is thought to be an autosomal recessive disorder with the mutation in the SLC34A2 gene. We describe a case of PAM with Cor Pulmonale. Ultrasonic cardiogram showed pulmonary hypertension (82 mmHg). Chest radiography revealed diffuse, bilateral sandstorm-like micronodules with greater density in the lower lung fields. HRCT scans demonstrated diffuse ground-grass opacities, thickening and calcification of interlobular septa and confluent calcified nodules. A diagnosis of PAM was suggested and confirmed by transbronchial lung biopsy (TBLB).

  15. 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)

  16. Vocal nodules in a colombian teachers group with dysphonia

    Directory of Open Access Journals (Sweden)

    Andrés Felipe Alvarado Díaz

    2013-12-01

    Full Text Available Objectives: This study determined the prevalence of vocal nodules associated with dysphonia in teachers aged from 35 to 65 years, taking into consideration both individual and occupational variables. Methodology: Descriptive study that included the information contained in 262 medical records of teachers diagnosed with dysphonia in occupational health consultations at the institutions that provide health services in Bogotá, Colombia from March 2009 to March 2012. The presence of laryngeal nodules was based on the findings of a nasofibrolaryngoscopy procedure. Results: Nodules were found in 67 teachers, which corresponded to a rate of 25.5%, being apparently (highest observed rates associated primarily with the following variables: females, ages from 45 to 54 years, bilateral nodules, and teaching position (preschool and physical education. Of the teachers with nodules, 76.1% had fewer than five doctor's appointments, and 75% had more than 90 days of sick leave. Conclusion: A high percentage of teachers have vocal nodules associated with dysphonia. This may be apparently related to different variables such as sex, type of nodule, area and teaching position. Was observed only a statistically significant association among presence of nodules and age (p=0.018. In addition this disorder generates a large number of incapacities and employee absenteeism.

  17. 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

  18. 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

  19. 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 ...

  20. 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.

  1. Saddle-nose and bilateral cauliflower ear deformities with pyoderma gangrenosum-like ulcers, cavitary pulmonary lesions, digital gangrene and pulselessness in a young female.

    Science.gov (United States)

    Subhadarshani, Sweta; Gupta, Vishal; Chahal, Anurag; Verma, Kaushal K

    2017-06-15

    We report a young female who presented with saddle-nose and bilateral cauliflower ear deformities along with pyoderma gangrenosum-like ulcers, digital gangrene and pulselessness. Subsequently, she was found to have bilateral conductive hearing loss, a corneal opacity, mild aortic regurgitation and radiological evidence of cavitary changes in lungs and aortoarteritis. Our patient had a constellation of symptoms which posed a diagnostic challenge. Finally, a diagnosis of relapsing polychondritis with several unusual features was made. Overlap with Takayasu's arteritis and granulomatosis with polyangitis, which has been reported rarely in the literature, cannot be excluded. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. 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...

  3. Large right atrial myxoma containing gastric heterotopia presenting with dyspnea and bilateral leg edema due to pulmonary emboli and cardiovascular obstruction: the first known report of gastric heterotopia in the cardiovascular system.

    Science.gov (United States)

    Cappell, Mitchell S; Lapin, Seth; Rose, Malcolm

    2008-02-01

    A 52-year-old male presented with progressive dyspnea, bilateral leg edema, and elevated central venous pressure due to a large right atrial myxoma that caused vascular obstruction and pulmonary emboli. The myxoma contained gastric heterotopia. Other unusual features of this atrial myxoma included its large size, right atrial location, and attachment to the right atrial wall. Although gastric heterotopia has been reported throughout the gastrointestinal tract, and occasionally in other organs, this is the first report of gastric heterotopia in the cardiovascular system. This report confirms and extends previous reports of glandular elements or enteric glands within atrial, or cardiac, myxomas. The clinical presentation of the currently reported patient is explained as follows: the elevated central venous pressure resulted from cardiovascular obstruction and the dyspnea from multiple pulmonary emboli due to the large atrial myxoma. In this case, the clinical presentation was not attributable to the gastric heterotopia. The association of gastric heterotopia with atrial myxoma may, however, be clinically important because of the propensity of gastric heterotopia in the gastrointestinal tract to produce complications. The reported association may provide clues to the histogenesis of these two entities.

  4. Bilateral dacryoadenitis

    Directory of Open Access Journals (Sweden)

    Charlotte Derr

    2012-01-01

    Full Text Available Acute dacryoadenitis is an uncommon condition that involves inflammation of the lacrimal gland. In rare instances, dacryoadenitis may be bilateral. A delay in proper treatment of an otherwise simple case of dacryoadenitis may lead to significant soft tissue morbidity such as cellulitis, lacrimal gland abscess, or orbital abscess. We report the case of a 24-year-old male who presented to the emergency department with acute bilateral dacryoadenitis. The patient′s symptoms did not respond to oral antibiotics and he subsequently required admission for intravenous antibiotics. During his hospitalization the patient had diagnostic testing to try to determine the etiology for his symptoms. The unique aspects of managing a case of bilateral dacryoadenitis as well as treatment recommendations are discussed in this case report.

  5. Bilateral pulmonary thromboembolism and Budd-Chiari syndrome in a patient with Crohn's disease on oral contraceptives Tromboembolismo de pulmón bilateral y síndrome de Budd-Chiari en paciente con enfermedad de Crohn y toma de anticonceptivos orales

    Directory of Open Access Journals (Sweden)

    M. Valdés Mas

    2009-09-01

    Full Text Available Budd-Chiari syndrome can be defined as an interruption or diminution of the normal blood flow out of the liver. Patients with Budd-Chiari syndrome present with varying degrees of symptomatology that can be divided into the following categories: fulminant, acute, subacute and chronic. The subacute form is the most common presentation. A majority of patients with Budd-Chiari syndrome have an underlying hypercoagulability state. We present the case of a young woman with Crohn's disease on oral contraceptives who developed bilateral pulmonary thromboembolism and Budd-Chiari syndrome.El síndrome de Budd-Chiari consiste en la interrupción o disminución de flujo de las venas suprahepáticas. Tiene una gran variabilidad clínica en cuanto a su forma de presentación siendo la más frecuente la forma subaguda. La gran mayoría de los pacientes responden a estados de hipercoagulabilidad. Presentamos el caso de una paciente joven con enfermedad de Crohn que estaba en tratamiento con anticonceptivos orales y desarrolló un cuadro clínico de tromboembolismo de pulmón bilateral y síndrome de Budd-Chiari.

  6. 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

  7. Radiologic findings of diffuse Pulmonary hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Mi Ra; Song, Koun Sik; Lee, Jin Seong; Lim, Tae Hwan [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

    1998-12-01

    To describe the chest radiographic and CT findings of diffuse pulmonary hemorrhage. Two radiologists retrospectively analysed the chest radiographic and CT findings of six patients with diffuse pulmonary hemorrhage. Using open lung biopsy(n=3D2) and transbronchial lung biopsy or bronchoalveolar lavage(n=3D4), diagnosis was based on the presence of hemosiderin-laden macrophage or intra-alveolar hemorrhage. Underlying diseases were Wegener's granulomatosis(n=3D2), antiphospholipid antibody syndrome(n=3D2), Henoch-Schonlein purpura(n=3D1), and idopathic pulmonary hemosiderosis(n=3D1). In all patients, sequential chest radiographs, obtained during a one to six-month period, were available. HRCT scans were obtained in five patinets, and conventional CT scans in one. Follow-up HRCT scans were obtained in two. We also analyzed the patterns of involvement, distribution and sequential changes in the pulmonary abnormalities seen on chest radiographs and CT scans. Chest radiographs showed multifocal patchy consolidation(n=3D6), ground-glass opacity(n=3D3), and multiple granular or nodular opacity(n=3D3). These lesions were intermingled in five patients, while in one there was consolidation only. Sequential chest radiographs demonstrated the improvement of initial pulmonary abnormalities and appearance of new lesions elsewhere within 5-6 days, though within 7-25 (average, 13) days, these had almost normalized. HRCT scans showed patchy consolidation(n=3D5), multiple patchy ground-glass opacity(n=3D5), or ill-defined air space nodules(n=3D4). These lesions were intermingled in five patients, and in one, ground-glass opacity only was noted. In two patients there were interlobular septal thickening and intalobular reticular opacity. The distribution of these abnormalities was almost always bilateral, diffuse with no zonal predominancy, and spared the apex of the lung and subpleural region were less affected. Although chest radiographic and CT findings of diffuse pulmonary

  8. Radiologic findings of diffuse Pulmonary hemorrhage

    International Nuclear Information System (INIS)

    Seo, Mi Ra; Song, Koun Sik; Lee, Jin Seong; Lim, Tae Hwan

    1998-01-01

    To describe the chest radiographic and CT findings of diffuse pulmonary hemorrhage. Two radiologists retrospectively analysed the chest radiographic and CT findings of six patients with diffuse pulmonary hemorrhage. Using open lung biopsy(n=3D2) and transbronchial lung biopsy or bronchoalveolar lavage(n=3D4), diagnosis was based on the presence of hemosiderin-laden macrophage or intra-alveolar hemorrhage. Underlying diseases were Wegener's granulomatosis(n=3D2), antiphospholipid antibody syndrome(n=3D2), Henoch-Schonlein purpura(n=3D1), and idopathic pulmonary hemosiderosis(n=3D1). In all patients, sequential chest radiographs, obtained during a one to six-month period, were available. HRCT scans were obtained in five patinets, and conventional CT scans in one. Follow-up HRCT scans were obtained in two. We also analyzed the patterns of involvement, distribution and sequential changes in the pulmonary abnormalities seen on chest radiographs and CT scans. Chest radiographs showed multifocal patchy consolidation(n=3D6), ground-glass opacity(n=3D3), and multiple granular or nodular opacity(n=3D3). These lesions were intermingled in five patients, while in one there was consolidation only. Sequential chest radiographs demonstrated the improvement of initial pulmonary abnormalities and appearance of new lesions elsewhere within 5-6 days, though within 7-25 (average, 13) days, these had almost normalized. HRCT scans showed patchy consolidation(n=3D5), multiple patchy ground-glass opacity(n=3D5), or ill-defined air space nodules(n=3D4). These lesions were intermingled in five patients, and in one, ground-glass opacity only was noted. In two patients there were interlobular septal thickening and intalobular reticular opacity. The distribution of these abnormalities was almost always bilateral, diffuse with no zonal predominancy, and spared the apex of the lung and subpleural region were less affected. Although chest radiographic and CT findings of diffuse pulmonary

  9. Pulmonary tuberculosis with airspace consolidation vs mycoplasma pneumonia in adults: high-resolution CT findings

    International Nuclear Information System (INIS)

    Cha, Chull Hee; Choi, Gyo Chang; Park, Jai Soung; Hwang, Jung Hwa; Kim, Kyung Rak; Im, Han Haek; Kim, Dae Ho; Choi, Deuk Lin

    1997-01-01

    To analyse and compare high-resolution CT findings of pulmonary tuberculosis with consolidation and mycoplasma pneumonia. Twenty patients with pulmonary tuberculosis [confirmed by sputum culture (n=9) and bronchoscopic biopsy (n=11)] and airspace consolidation on high-resolution CT and 17 patients with mycoplasma pneumonia, confirmed by serologic test, were included in this study. High-resolution CT findings were analyzed in terms of ground-glass opacities, distribution of consolidation, type of nodules, cavities, interlobular septal thickening, bronchial dilatations, bronchial wall thickening and pleural effusion. In patients with tuberculosis, average age was 33.5 years (range, 20-67); in those with mycoplasma pneumonia it was 32.5 years (range, 17-74). Segmental and subsegmental distributions were most common in both diseases; the preferred site of consolidation was different, however; for tuberculosis it was the upper lobes (13 cases, 65%; bilateral involvement, 7 cases); for mycoplasma pneumonia it was the lower lobes (11 cases, 64.7%). Non-segmental (diffuse and random) distribution of ground-glass opacities were seen in two patients(11.8%) with mycoplasma pneumonia. Centrilobular nodules, branching linear opacities and alveolar nodules were not different in both diseases, but there were nodules above 10mm in 14 cases of tuberculosis and in only one case of mycoplasma pneumonia. Tree-in-bud appearances were seen in five cases of tuberculosis. Cavities without air-fluid level were noted in ten cases of tuberculosis. Other interlobular septal thickening, bronchial wall thickening, bronchial dilatation and pleural effusion were not different in both diseases. There was considerable overlap between high resolution CT findings of tuberculosis with airspace consolidation and those of mycoplasma pneumonia. The location of consolidation, type of nodules, and the presence of tree-in-bud appearance and cavities help in the differentiation of the two diseases, however

  10. Follicular Variant of Papillary Thyroid Cancer with Bilateral Renal Metastases Discovered Incidentally During Work-Up of Primary Endometrial Cancer: A Rare Occurrence.

    Science.gov (United States)

    Lubana, Sandeep Singh; Singh, Navdeep; Tuli, Sandeep S; Bashir, Tayyaba; Sachmechi, Issac; Kemeny, Margaret M

    2015-07-16

    Follicular variant of papillary thyroid cancer (FV-PTC) is the second most common subtype of papillary thyroid cancer (PTC) after classic PTC. FV-PTC is characterized by nuclear features consistent with classic PTC but has a follicular architecture that lacks classic papillary morphology. Thyroid cancer rarely metastasizes to the kidney. Only 6 cases of FV-PTC metastasizing to the kidney have been reported in the English literature. We are reporting a case of FV-PTC with bilateral renal metastases discovered incidentally during work-up of primary endometrial cancer. A 70-year-old woman presented with post-menopausal bleeding secondary to endometrial cancer. Staging work-up showed multiple bilateral lung nodules, bilateral soft tissue kidney masses, and multinodular goiter. The pathological and immnohistochemical profile of the lung biopsy was consistent with primary well-differentiated lung adenocarcinoma. Follow-up computerized tomography scan showed stable lung nodules and enlarging renal masses, which was suggestive of bilateral renal cancer. While the histologic features of the renal biopsy were not typical, the immunohistochemical staining of renal biopsy was positive for Paired box 8, thyroid transcription factor-1, thyroglobulin, and cytokeratin 7, suggesting the thyroid as the primary cancer site. The final histopathology on surgical specimen of total thyroidectomy revealed follicular variant of papillary thyroid cancer. The presence of pulmonary nodules and kidney masses does not always suggest the lung or the kidney as primary tumor sites. The clinician should be aware of the possibility of metastasis and look for the primary source, which in the present case was FV-PTC. Immunohistochemistry plays an important role in determining the primary site of origin. In case of multiple-organ metastases, each metastatic lesion should be biopsied as soon as possible for definitive diagnosis and appropriate treatment.

  11. Pulmonary lymphangioleiomyomatosis

    International Nuclear Information System (INIS)

    Shawki, Hilal B.; Muhammad, Shakir M.; Reda, Amal N.; Abdulla, Thair S.; Ardalan, Delaram M.

    2007-01-01

    A 38-year-old Iraqi female, presented with one-year history of exertional dyspnea and exercise intolerance, without systemic or constitutional symptoms. Clinical examination revealed bilateral basal crackles with signs suggestive of left side pleural effusion, chest x-ray showed left sided pleural effusion, and diffuse bilateral basal pulmonary shadowing. Her biochemical analysis, hematological tests, electrocardiogram and echocardiography were normal, aspiration of the fluid revealed a chylothorax, the radiological shadowing was proved by computed tomography scan of the chest to be diffuse cystic lesions involving mostly lower lobes. Open lung biopsy showed dilated lymphatic vessels with surrounding inflammatory cells and smooth muscle fibers consistently with the diagnosis of pulmonary lymphangioleiomyomatosis. (author)

  12. Is pulmonary function affected by bilateral dual transversus abdominis plane block? A randomized, placebo-controlled, double-blind, crossover pilot study in healthy male volunteers

    DEFF Research Database (Denmark)

    Petersen, Maria; Elers, Jimmi; Børglum, Jens

    2011-01-01

    : Transversus abdominis plane (TAP) blocks have been shown to reduce postoperative pain after various abdominal surgical procedures in several studies. The motor nerves of the abdominal wall are located in the same plane as the sensory nerves affected by the TAP block. The aim of this study was t...... was to examine whether the application of an ultrasound-guided TAP block would affect the muscles of the anterior abdominal wall with respect to their function as accessory respiratory muscles and hence pulmonary function....

  13. 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.

  14. 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.

  15. Bilateral agreements

    International Nuclear Information System (INIS)

    Anon.

    2004-01-01

    The bilateral agreements concern Brazil with United States relative to the co operation in nuclear energy, Germany with Russian Federation relative to the elimination and disposal of nuclear weapons; The multilateral agreements concerns the signature of the Protocols to amend the Paris and Brussels Conventions, the multilateral nuclear environmental programme in the Russian Federation, the status of Conventions in the field of nuclear energy. (N.C.)

  16. 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.

  17. Wegener′s granulomatosis disease mimicking pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Naveen Pandhi

    2015-01-01

    Full Text Available Wegener′s granulomatosis (WG is an uncommon autoimmune disease with multi-system involvement that manifests as vasculitis, granulomatosis, and necrosis. While its standard form involves the upper and lower respiratory tracts and kidneys, it may essentially involve any organ. We present a case in a young female patient presenting with symptoms of cough with expectoration, fever, dyspnea and chest discomfort, having cavitating lesion in right upper lobe and nodule in left upper lobe with bilateral paranasal sinus involvement on computed tomography. Allergic rhino-sinusitis with pulmonary tuberculosis was suspected, and patient was investigated further. Upon further investigation, renal involvement was detected, and serology revealed cytoplasmic antineutrophil cytoplasmic antibody. WG was suspected and was proven by histopathology of nasal tissue which revealed necrotizing granulomas.

  18. Current status of pulmonary metastasectomy

    DEFF Research Database (Denmark)

    Hornbech, Kåre; Ravn, Jesper; Steinbrüchel, Daniel Andreas

    2011-01-01

    for unresected patients. In this article, we discuss the current status on pulmonary metastasectomy. Preoperative assessment and selection of surgical candidates is covered. The different surgical strategies including surgical approach, unilateral versus bilateral exploration, lymph node dissection, and repeat...

  19. 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.

  20. Unexplained childhood anaemia: idiopathic pulmonary hemosiderosis.

    Science.gov (United States)

    Siu, K K; Li, Rever; Lam, S Y

    2015-04-01

    This report demonstrates pulmonary haemorrhage as a differential cause of anaemia. Idiopathic pulmonary hemosiderosis is a rare disease in children; it is classically described as a triad of haemoptysis, pulmonary infiltrates on chest radiograph, and iron-deficiency anaemia. However, anaemia may be the only presenting feature of idiopathic pulmonary hemosiderosis in children due to occult pulmonary haemorrhage. In addition, the serum ferritin is falsely high in idiopathic pulmonary hemosiderosis which increases the diagnostic difficulty. We recommend that pulmonary haemorrhage be suspected in any child presenting with iron-deficiency anaemia and persistent bilateral pulmonary infiltrates.

  1. Bilateral agreements

    International Nuclear Information System (INIS)

    1998-01-01

    Ten bilateral agreements are presented. These are: 1) Co-operation agreement relating to the peaceful uses of nuclear energy between Argentina and EURATOM (1996); 2) Agreement on co-operation in the peaceful uses of nuclear energy between Argentina and Greece (1997); 3) Implementing arrangement for technical exchange and co-operation in the area of peaceful uses of nuclear energy between Argentina and the United States (1997); 4) Agreement concerning co-operation in nuclear science and technology between Australia and Indonesia (1997); 5) Implementation of the 1985 Agreement for co-operation concerning the peaceful uses of nuclear energy between the People's Republic of China and the United States (1998); 6) Protocol of co-operation between France and Lithuania (1997); 7) Agreement on co-operation in energy research, science and technology, and development between Germany and the United States (1998); 8) Agreement on early notification of a nuclear accident and exchange of information on nuclear facilities between Greece and Romania (1997); 9) Agreement on early notification of nuclear accidents and co-operation in the field of nuclear safety between Hungary and the Ukraine (1997); 10) Agreement in the field of radioactive waste management between Switzerland and the United States (1997). (K.A.)

  2. 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.

  3. 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...

  4. Subxiphoid uniportal video-assisted thoracoscopic surgery for synchronous bilateral lung resection.

    Science.gov (United States)

    Yang, Xueying; Wang, Linlin

    2018-01-01

    With advancements in medical imaging and current emphasis on regular physical examinations, multiple pulmonary lesions increasingly are being detected, including bilateral pulmonary lesions. Video-assisted thoracic surgery is an important method for treating such lesions. Most of video-assisted thoracic surgeries for bilateral pulmonary lesions were two separate operations. Herein, we report a novel technique of synchronous subxiphoid uniportal video-assisted thoracic surgery for bilateral pulmonary lesions. Synchronous bilateral lung resection procedures were performed through a single incision (~4 cm, subxiphoid). This technique was used successfully in 11 patients with bilateral pulmonary lesions. There were no intraoperative deaths or mortality recorded at 30 days. Our results show that the subxiphoid uniportal thoracoscopic procedure is a safe and feasible surgical procedure for synchronous bilateral lung resection with less surgical trauma, postoperative pain and better cosmetic results in qualifying patients. Further analysis is ongoing, involving a larger number of subjects.

  5. 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.)

  6. 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.)

  7. 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 ...

  8. 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

  9. Hemangiomatose capilar pulmonar, uma rara causa de hipertensão pulmonar: primeiro caso brasileiro Pulmonary capillary hemangiomatosis. A rare cause of pulmonary hypertension: the first Brazilian case

    Directory of Open Access Journals (Sweden)

    Helano Neiva de Castro

    2005-08-01

    Full Text Available A hemangiomatose capilar pulmonar é uma doença rara, caracterizada por proliferação de capilares que invadem o interstício pulmonar e o septo alveolar. Documentamos o primeiro caso brasileiro: um paciente do sexo masculino, de 21 anos, com hipertensão pulmonar grave, que evoluiu para óbito. Na tomografia computadorizada de alta resolução apresentava pequenas opacidades intersticiais nodulares maldefinidas, bilateralmente. Foi realizada biópsia pulmonar post-mortem e encontrada intensa proliferação multifocal de capilares nas paredes alveolares, septos interlobulares e tecido conjuntivo peribrônquico. O diagnóstico de hemangiomatose capilar pulmonar deve ser considerado nos pacientes com hipertensão pulmonar e alterações sugestivas na tomografia computadorizada de alta resolução.Pulmonary capillary hemangiomatosis is a rare disorder characterized by a proliferation of capillaries that invade the pulmonary interstitium and alveolar septae. Herein, we report the first Brazilian case of pulmonary capillary hemangiomatosis. A 21-year-old man presented with severe pulmonary hypertension that eventually resulted in his death. Upon admission, a computed tomography scan of the chest revealed diffuse ill-defined bilateral pulmonary nodules. A postmortem lung biopsy revealed pronounced multifocal proliferation of capillaries in the alveolar walls, interlobular septa and peribronchial connective tissue. A diagnosis of pulmonary capillary hemangiomatosis should be considered in patients presenting pulmonary hypertension and suspicious changes on high-resolution computed tomography scans.

  10. Simultaneous bilateral primary spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Arife Zeybek

    2014-04-01

    Full Text Available Simultaneous bilateral primary pneumothorax is a very rare (1.6 / 100,000 and life-threatening condition. Clinical presentation may vary from mild dyspnea to tension pneumothorax. It may be milder particularly in younger patients, but more severe in patients with advanced age, and tube thoracostomy is a life preserver in the latter group. Since mortality and recurrence rates following tube thoracostomy are high, endoscopic approaches to bilateral hemithorax have been reported in literature. Apical wedge resection and pleural procedures are recommended in video thoracoscopy or mini thoracotomy even if no bulla and/or bleb are detected. Bilateral surgical interventions and additional pleural procedures are associated with increased rate of post-operative complications and longer postoperative hospital-stays. As a first-line approach, the surgical method toward any side of lung with air leakage following a previous tube thoracostomy is considered less invasive, especially in younger patients. Here, we present a case of simultaneous bilateral primary spontaneous pneumothorax (SBPSP in a 21-year old male with no history of smoking and chronic pulmonary disease. A unilateral surgical intervention was performed, and no recurrence was observed during 5-year follow up.

  11. Pulmonary alveolar micro-lithiasis: the imageological findings and follow-up views

    International Nuclear Information System (INIS)

    Yang Guangzhao; Mi Peichao; Li Senhua

    2001-01-01

    Objective: To study the imageological findings and the evolution of pulmonary alveolar micro-lithiasis (PAM). Methods: The clinical and imageological information of 3 siblings suffering from PAM were collected, and their imageological findings and changes in follow-up plain radiographs were analyzed retrospectively. Results: On chest radiographs, the typical 'sandstorm' pattern was shown in all 3 cases. The severity and extent of microliths and interstitial fibrosis were increased with age and clinical course by comparing with the radiographs 24 years ago. On conventional CT, bilateral diffuse micro-nodules in parenchyma were demonstrated with pulmonary window in 3 cases, concentrating in the subpleural zones of middle and lower lung fields and the areas around bronchovesicular bundles. All were associated with various degrees of fibrosis. The nodules and calcifications were visible in both lungs with mediastinal window, forming so-called flame sign and white line sign in the concentrated areas. The extents and degrees of the microliths, small cysts and interstitial fibrosis were revealed more clearly and truly on HRCT. MRI showed diffusely increased signal intensity on T 1 WI and lower signal intensity on T 2 WI in both lung fields. Conclusion: The chest radiograph was still an initial modality in detecting the disease. CT could comprehensively reveal the pathological status of the PAM and played a decisive role in the diagnosis and differential diagnosis. MRI had only limited value in evaluating the condition

  12. 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.

  13. 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.

  14. Idiopathic Pulmonary Calcification and Ossification in an Elderly ...

    African Journals Online (AJOL)

    Histology of tissue from autopsy showed intraparenchymal pulmonary calcification and ossification with marrow elements. Idiopathic pulmonary calcification and ossification is rare. At autopsy, she was also found to have had bilateral subarachnoid haemorrhage (SAH), a diagnosis missed during clinical evaluation.

  15. Pulmonary disease in patients with human immunodeficiency virus infection

    DEFF Research Database (Denmark)

    Lundgren, J D; Orholm, Marianne; Lundgren, B

    1989-01-01

    cause pulmonary disease alone or in combination. Bilateral interstitial infiltrates are the most frequent chest x-ray abnormality and are most frequently caused by infection with Pneumocystis carinii. Cytomegalovirus, Mycobacterium tuberculosis, nonspecific interstitial pneumonitis and pulmonary Kaposi...

  16. 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...

  17. [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.

  18. 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.)

  19. 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

  20. Asymptomatic Pulmonary Allograft Kaposi Sarcoma: A Case Report.

    Science.gov (United States)

    Nannini, Nazarena; Rebusso, Alessandro; Lunardi, Francesca; Loy, Monica; Calabrese, Francesca; Battistella, Lucia; Schiavon, Marco; Rea, Federico; Calabrese, Fiorella

    2017-08-01

    Solid-organ transplant recipients are at high risk of developing malignancies. A greater risk of Kaposi sarcoma has been reported in lung recipients in our country, particularly in those from Southern Italy, probably due to the high prevalence of Human herpes virus 8 infection. Kaposi sarcoma affecting only the lung allograft is extremely rare. We describe a case of a lung recipient who developed Kaposi sarcoma only in the graft, 22 months after transplant. The patient, a 65-year-old man from Southern Italy, underwent bilateral lung transplant for idiopathic pulmonary fibrosis in January 2009. He developed mild/moderate acute cellular rejection (≥A2) in 4 of 6 scheduled transbronchial biopsies thus was treated with increased immunosuppressive therapy, shifting from cyclosporine to tacrolimus and mycophenolate mofetil. In July 2010, a high-resolution computed tomography scan showed small bilateral lung nodules, despite a generally good condition. After 2 months, his condition worsened with a severe weight loss. A positron emission tomography scan showed mild metabolic activity in the lesions with no other localizations. In October 2010, a lung biopsy was performed, with results showing typical histologic and immunohistochemical features of Kaposi sarcoma. Molecular tissue evaluations and serologic analyses were positive for Human herpes virus 8. The patient's immunosuppressive therapy was suspended, and he started liposomal doxorubicin treatment; however, after the first cycle, he developed severe respiratory dysfunction. The patient died 27 months after lung transplant for neoplasm. Our report highlights the importance of considering Kaposi sarcoma in the differential diagnosis for lung nodules in lung transplant recipients, even in the absence of any initial specific symptom or cutaneous lesion.

  1. 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

  2. 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

  3. 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.

  4. 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

  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. Bilateral Giant Juvenile Fibroadenoma of Breast.

    Science.gov (United States)

    Makkar, Nikhil; Singh, Sumitoj; Paul, Surinder; Sandhu, Mandeep Singh; Kumar, Ashok

    2017-06-01

    Fibroadenomas are benign lesions of breast commonly found in young age group. These focal tumours contain both mesenchymal and glandular tissue. Giant juvenile fibroma of breast is rare variant of fibroadenoma found usually in less than 20 years of age. They present with rapid enlargement of single or multiple, discrete, painless large nodule of breast. A 14-years-old premenarche girl presented with large bilateral breast lumps for two months. FNAC showed features of juvenile fibroadenoma. Breast conserving surgical excision of lumps was performed and histopathology confirmed the diagnosis of juvenile fibroadenoma. Giant juvenile fibroadenomas are characterised by rapid enlargement of encapsulated mass. The aetiology is unknown, although end-organ hypersensitivity to normal level of estrogen is postulated. We present a case of bilateral giant juvenile fibroadenoma for its rarity.

  9. Pulmonary hypertension secondary to partial pulmonary venous obstruction in a child with Cantu syndrome.

    Science.gov (United States)

    Kobayashi, Daisuke; Cook, Amanda L; Williams, Derek A

    2010-07-01

    We report on an African-American male with Cantu syndrome who required a pericardial window for a significant pericardial effusion in infancy and was subsequently found to have partial pulmonary venous obstruction (PVO) leading to pulmonary hypertension. Measurement of bilateral pulmonary capillary wedge pressures is important to uncover partial PVO.

  10. 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)

  11. 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

  12. Tomographic findings of acute pulmonary toxoplasmosis in immunocompetent patients.

    Science.gov (United States)

    de Souza Giassi, Karina; Costa, Andre Nathan; Apanavicius, Andre; Teixeira, Fernando Bin; Fernandes, Caio Julio Cesar; Helito, Alfredo Salim; Kairalla, Ronaldo Adib

    2014-11-25

    Toxoplasmosis is one of the most common human zoonosis, and is generally benign in most of the individuals. Pulmonary involvement is common in immunocompromised subjects, but very rare in immunocompetents and there are scarce reports of tomographic findings in the literature. The aim of the study is to describe three immunocompetent patients diagnosed with acute pulmonary toxoplasmosis and their respective thoracic tomographic findings. Acute toxoplasmosis was diagnosed according to the results of serological tests suggestive of recent primary infection and the absence of an alternative etiology. From 2009 to 2013, three patients were diagnosed with acute respiratory failure secondary to acute toxoplasmosis. The patients were two female and one male, and were 38, 56 and 36 years old. Similarly they presented a two-week febrile illness and progressive dyspnea before admission. Laboratory tests demonstrated lymphocytosis, slight changes in liver enzymes and high inflammatory markers. Tomographic findings were bilateral smooth septal and peribronchovascular thickening (100%), ground-glass opacities (100%), atelectasis (33%), random nodules (33%), lymph node enlargement (33%) and pleural effusion (66%). All the patients improved their symptoms after treatment, and complete resolution of tomographic findings were found in the followup. These cases provide a unique description of the presentation and evolution of pulmonary tomographic manifestations of toxoplasmosis in immunocompetent patients. Toxoplasma pneumonia manifests with fever, dyspnea and a non-productive cough that may result in respiratory failure. In animal models, changes were described as interstitial pneumonitis with focal infiltrates of neutrophils that can finally evolve into a pattern of diffuse alveolar damage with focal necrosis. The tomographic findings are characterized as ground glass opacities, smooth septal and marked peribronchovascular thickening; and may mimic pulmonary congestion

  13. Bilateral masseter and internal pterygoid muscle hypertrophy: a diagnostic challenge.

    Science.gov (United States)

    Andreadis, Dimitrios; Stylianou, Florentia; Link-Tsatsouli, Iris; Markopoulos, Anastasios

    2014-01-01

    To describe an unusual case of bilateral masseter and pterygoid muscle hypertrophy. A 53-year-old female patient presented with a bilateral, painless swelling at the parotid areas without improvement after using antibiotics/systemic corticosteroids/nonsteroidal anti-inflammatory agents. Her medical history included thyroid nodules, but no dental/occlusal disorders were observed. The initial differential diagnosis included salivary gland/jaw bone/masseter pathology, but the CT/MRI revealed only an increase in the size of the masseter and pterygoid muscles. The patient was informed of the benign nature of the swelling and was advised to discontinue the use of nonsteroidal anti-inflammatory agents. The bilateral hypertrophy of masseter muscles should be considered in differential diagnosis in cases of unilateral or bilateral swelling of the parotid or lateral mandible area. © 2013 S. Karger AG, Basel.

  14. [Hydatidosis simulating a cardiac tumour with pulmonary metastases].

    Science.gov (United States)

    Martín-Izquierdo, Marta; Martín-Trenor, Alejandro

    2016-01-01

    The presence of multiple symptomatic pulmonary nodules and one cardiac tumour in a child requires urgent diagnosis and treatment. Until a few decades ago, the diagnosis of a cardiac tumour was difficult and was based on a high index of suspicion from indirect signs, and required angiocardiography for confirmation. Echocardiography and other imaging techniques have also helped in the detection of cardiac neoplasms. However, it is not always easy to make the correct diagnosis. The case is presented of a 12 year-old boy with pulmonary symptoms, and diagnosed with a cardiac tumour with lung metastases. The presence of numerous pulmonary nodules was confirmed in our hospital. The echocardiogram detected a solid cardiac nodule in the right ventricle. Magnetic resonance imaging confirmed the findings and the diagnosis. Puncture-aspiration of a lung nodule gave the diagnosis of hydatidosis. He underwent open-heart surgery with cardiac cyst resection and treated with anthelmintics. The lung cysts were then excised, and he recovered uneventfully. This child had multiple pulmonary nodules and a solid cardiac nodule, and was suspected of having a cardiac tumour with pulmonary metastases. However, given the clinical history, background and morphology of pulmonary nodules, another possible aetiology for consideration is echinococcosis. The clinical picture of cardiac hydatidosis and its complications is highly variable. The clinical history is essential in these cases, as well as having a high index of suspicion. Hydatidosis should be included in the differential diagnosis of a solid, echogenic, cardiac nodule. The treatment for cardiopulmonary hydatid cysts is surgical, followed by anthelmintics. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  15. Thoracoscopic versus open pulmonary metastasectomy

    DEFF Research Database (Denmark)

    Eckardt, Jens; Licht, Peter B

    2012-01-01

    guideline recommendations metastasectomy with therapeutic intent is now performed by VATS in 40% of thoracic surgeons surveyed. The evidence base for optimal surgical approach is limited to case-series and registries and no comparative surgical studies were observer-blinded.METHODS:Patients considered...... eligible for pulmonary metastasectomy by VATS prospectively underwent high-definition VATS by one surgical team followed by immediate thoracotomy with bimanual palpation and resection of all palpable nodules by a second surgical team during the same anaesthesia. Both surgical teams were blinded during...... intent but several non-imaged and therefore unexpected nodules are frequent during subsequent observer blinded thoracotomy. A substantial proportion of these nodules are malignant and despite modern imaging and surgical technology they would have been missed if VATS was used exclusively...

  16. Diffuse pulmonary meningotheliomatosis: A literature review of a rare diffuse parenchymal lung disease with unclear clinical significance

    Directory of Open Access Journals (Sweden)

    James B Gleason

    2017-01-01

    Full Text Available Introduction: Diffuse pulmonary meningotheliomatosis is a rare disease, with unclear clinical significance and very few reported cases in the literature. In this study, we review the demographics, presentation, imaging, diagnostic workup, and histologic findings of the 25 patients previously published in the literature with an outline of the disease history. Materials and Methods: We conducted a review of the literature through July 2016 for studies reporting cases of diffuse pulmonary meningotheliomatosis by searching multiple scholarly databases. Results: Of the 25 cases identified 2 were male (8%, and 23 were female (92%. Ages ranged from 37 to 73 with a median age of 59.5 years at diagnosis. 15 (60% were asymptomatic and imaging abnormalities were discovered incidentally. 8 (32% had unexplained respiratory complaints. 11 (44% had history of or active malignancy. 3 (12% were diagnosed by transbronchial biopsy while the remainder had surgical lung biopsies. Conclusion: Diffuse pulmonary meningotheliomatosis should be considered in all patients with diffuse bilateral pulmonary nodules on HRCT. The condition is more prevalent in females and its clinical significance is unclear, although nearly half of those diagnosed had a history of malignancy. CT imaging and surgical lung biopsy are the modalities of choice for diagnosis but transbronchial biopsies have recently been used obtain the diagnosis. Additional research needs to be done to further characterize the nature of this condition and the clinical scenarios in which is presents.

  17. Red nodule on the breast

    Directory of Open Access Journals (Sweden)

    Roberta Colucci

    2012-01-01

    Full Text Available A 63-year-old woman living in the countryside referred to our department with a 2-month history of a red nodule localized on the right breast. Histological examination, immunohistochemical analyses and serologic evaluation conducted with ELISA and Western blot were performed. Clinical diagnosis of borrelial lymphocytoma was not possible solely on the clinical presentation of a classical nodular form without lymphoadenopathy. An absence of a referred prior tick bite and a previous or concomitant erythema migrans at clinical presentation rendered a more challenging diagnosis. The fact that the patient lived in the countryside, the appearance of the breast nodule in September, and serologic, histologic, and immunohistochemical analysis facilitated the diagnosis of borrelial lymphocytoma. We report this case to highlight the importance of an investigation of Lyme borreliosis when a patient living in the countryside presents with a red nodule of the nipple and areola.

  18. Medical image of the week: pulmonary amyloidosis

    Directory of Open Access Journals (Sweden)

    Rohant N

    2015-06-01

    Full Text Available A 61-year-old man with chronic obstructive pulmonary disease (COPD on oxygen and chronic steroids presented with a mechanical fall. Initial vital signs and laboratory studies were unremarkable. A chest radiograph performed in the emergency department to evaluate for fractures demonstrated innumerable, high-density pulmonary nodules most pronounced and confluent in the periphery and lung bases (Figure 1. Computed tomography of the chest demonstrated multiple pulmonary nodules and masses with course, eccentric calcifications (Figure 2. Further workup, including biopsies of the masses and full body imaging, revealed primary pulmonary amyloidosis limited to the lung parenchyma. Primary amyloidosis, a disorder of extracellular proteinaceous fibril deposition, is rarely seen affecting the lung parenchyma as the only site of disease as demonstrated here (1. The gentleman underwent autologous bone marrow transplant and did well for approximately 5 years before he developed a progressive cough, hemoptysis, and increased oxygen requirements. He is now being evaluated for lung transplant.

  19. Pulmonary artery-to-pulmonary artery anastomoses: angiographic demonstration in patients with chronic thromboembolic pulmonary hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Hodson, J. [Department of Imaging, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London (United Kingdom); Graham, A. [Department of Imaging, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London (United Kingdom); Hughes, J.M.B. [Department of Respiratory Medicine, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London (United Kingdom); Gibbs, J.S.R. [Department of Cardiology, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London (United Kingdom); Jackson, J.E. [Department of Imaging, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London (United Kingdom)]. E-mail: jejackson@hhnt.org

    2006-03-15

    AIM: To describe direct pulmonary artery-to-pulmonary artery anastomoses seen at pulmonary angiography in patients with chronic thromboembolic pulmonary hypertension and discuss their possible significance. MATERIALS AND METHODS: Between 1 August 2000 and 31 July 2004 43 patients (male-to-female ratio 25:18) with a diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) underwent selective pulmonary angiography to assess the extent of disease and suitability for surgical pulmonary endarterectomy. The mean pulmonary artery pressure ranged from 27-84 mmHg (average of 51 mmHg). Selective bilateral digital subtraction pulmonary angiograms performed in all individuals were reviewed for the presence of intrapulmonary collaterals. RESULTS: In 15 of the 43 patients (male-to-female ratio =7:8) definite (n=12) or probable (n=3) pulmonary artery-to-pulmonary artery anastomoses were demonstrated. Of the remaining 28 patients in whom intrapulmonary collaterals were not seen it was felt that in 16 the angiograms were of insufficient diagnostic quality (grades 4-5) to exclude their presence. Twelve patients, eight of whom had angiograms of sufficient diagnostic quality (grades 1-3), demonstrated one or more areas of luxury perfusion but intrapulmonary collaterals were not seen. CONCLUSION: Direct pulmonary artery-to-pulmonary artery anastomoses were demonstrated in patients with chronic thromboembolic pulmonary hypertension, which to our knowledge have not been previously described. The importance of these collateral vessels is unclear but they may play a role in the maintenance of pulmonary parenchymal viability in patients with chronic pulmonary embolic disease. The rate of development of these collaterals and their prognostic significance in patients with chronic thromboembolic pulmonary hypertension are areas worthy of further study.

  20. Pulmonary artery-to-pulmonary artery anastomoses: angiographic demonstration in patients with chronic thromboembolic pulmonary hypertension

    International Nuclear Information System (INIS)

    Hodson, J.; Graham, A.; Hughes, J.M.B.; Gibbs, J.S.R.; Jackson, J.E.

    2006-01-01

    AIM: To describe direct pulmonary artery-to-pulmonary artery anastomoses seen at pulmonary angiography in patients with chronic thromboembolic pulmonary hypertension and discuss their possible significance. MATERIALS AND METHODS: Between 1 August 2000 and 31 July 2004 43 patients (male-to-female ratio 25:18) with a diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) underwent selective pulmonary angiography to assess the extent of disease and suitability for surgical pulmonary endarterectomy. The mean pulmonary artery pressure ranged from 27-84 mmHg (average of 51 mmHg). Selective bilateral digital subtraction pulmonary angiograms performed in all individuals were reviewed for the presence of intrapulmonary collaterals. RESULTS: In 15 of the 43 patients (male-to-female ratio =7:8) definite (n=12) or probable (n=3) pulmonary artery-to-pulmonary artery anastomoses were demonstrated. Of the remaining 28 patients in whom intrapulmonary collaterals were not seen it was felt that in 16 the angiograms were of insufficient diagnostic quality (grades 4-5) to exclude their presence. Twelve patients, eight of whom had angiograms of sufficient diagnostic quality (grades 1-3), demonstrated one or more areas of luxury perfusion but intrapulmonary collaterals were not seen. CONCLUSION: Direct pulmonary artery-to-pulmonary artery anastomoses were demonstrated in patients with chronic thromboembolic pulmonary hypertension, which to our knowledge have not been previously described. The importance of these collateral vessels is unclear but they may play a role in the maintenance of pulmonary parenchymal viability in patients with chronic pulmonary embolic disease. The rate of development of these collaterals and their prognostic significance in patients with chronic thromboembolic pulmonary hypertension are areas worthy of further study

  1. Bilateral clear cell sarcoma of the kidney

    International Nuclear Information System (INIS)

    Zekri, W.; Yehia, D.; Alfaar, A.S.; Elshafie, M.M.; Younes, A.A.; Zaghloul, M.S.; El-Kinaai, N.; Taha, H.; Refaat, A.; Zekri, W.; Elshafie, M.M.; Zaghloul, M.S.; Taha, H.; Refaat, A.; Younes, A.A.; Alfaar, A.S.; Yehia, D.

    2015-01-01

    Clear cell sarcoma of the kidney (CCSK) accounts for 2-5% of all pediatric renal malignancies, and is known for its propensity to metastasize to bone and other sites. We are reporting two cases with bilateral CCSK that were diagnosed at our institution. One patient initially presented with bilateral renal masses, as well as pulmonary, hepatic and bone metastasis; while other present only with bilateral masses with no evident distant metastasis. Both patients received aggressive neo-adjuvant chemotherapy to decrease tumor size. One patient completed his designated treatment and initially showed complete remission (CR); eventually suffering from relapse. The other patient’s tumor progressed during the course of chemotherapy. Both cases manifested brain dissemination at the time of relapse or progression. This emphasizes the importance of staging stratification in CCSK. This also illustrates CCSK’s ability to metastasize to bone and other sites including the brain (a primary relapse site in our cases)

  2. Host range, symbiotic effectiveness and nodulation competitiveness ...

    African Journals Online (AJOL)

    ERIC-PCR DNA fingerprinting patterns were used to identify the isolates occupying nodules. All the isolates nodulated cowpea, groundnut (Arachis hypogeae) and mungbean (Vigna radiata), but only AII-2-1, AII-3-4 and BIII-2-2 nodulated soybean (Glycine max). Apart from cowpea where all the isolates were effective, there ...

  3. Bilateral ekstrauterin graviditet

    DEFF Research Database (Denmark)

    Kirkegaard, Ida; Kruse, Christina

    2009-01-01

    Bilateral tubal pregnancies are extremely rare and they are usually found after assisted reproductive techniques have been applied. A rare case of bilateral tubal pregnancy after natural conception, occurring in a woman without any predisposing factors for ectopic pregnancy, is presented....... The condition was diagnosed during laparoscopic surgery, and she was optimally treated with conservative tubal surgery. A short review of the literature is provided and discussed along with the clinical features, diagnostic difficulties and treatment options of bilateral tubal pregnancy. Udgivelsesdato: 2009...

  4. 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.

  5. CT of diffuse pulmonary diseases

    International Nuclear Information System (INIS)

    Itoh, Harumi; Murata, Kiyoshi; Todo, Giro

    1987-01-01

    While the theory of chest radiographic interpretation in diagnosing diffuse pulmonary diseases has not yet been established, X-ray computed tomography (CT), having intrinsic high contrast resolution and improved spatial resolution, has proved to offer important imformation concerning the location and invasion of diffuse pulmonary lesions. This study related to CT-pathologic correlation, focusing on perivascular interstitial space and secondary pulmonary lobule at macroscopic levels. The perivascular interstitial space was thickened as a result of the infiltration of cancer, granulomas, and inflammatory cells. This finding appeared as irregular contour of the blood vessel on CT. Centrilobular nodules were distributed at the tip of the bronchus or pulmonary artery on CT. The distance from the terminal and respiratory bronchioles to the lobular border was 2 to 3 mm. Lobular lesions were delineated as clear margin on CT. Contribution of these CT features to chest radiographic interpretation must await further studies. (Namekawa, K.)

  6. 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.

  7. Pulmonary microcystic fibromyxoma : Report of 3 cases

    NARCIS (Netherlands)

    Shilo, Konstantin; Miettinen, Markku; Travis, William D.; Timens, Wim; Nogueira, Rosete; Franks, Teri J.

    2006-01-01

    Three cases of pulmonary myxoid tumors showing a variable degree of microcystic change are described. They are presented as incidental solitary peripheral lung nodules on routine radiologic studies. The patients included 2 women, 45 and 65 years old, and 1 man, 33 years old. Clinical work-up showed

  8. Pregnancy following bilateral salpingectomy

    DEFF Research Database (Denmark)

    Oturai, Annette Bang

    2008-01-01

    This report presents a rare case of spontaneous pregnancy following bilateral salpingectomy. A woman with a history of bilateral salpingectomy was admitted to hospital because of abdominal pain and positive urine HCG. Surprisingly, ultrasound confirmed a live intrauterine fetus. The pregnancy...

  9. Radiological features of AIDS complicated by pulmonary cryptococcosis: Literature review and a report of 10 cases

    Directory of Open Access Journals (Sweden)

    Xiao Yu

    2016-03-01

    Conclusion: The radiological signs featured AIDS complicated by pulmonary cryptococcosis such as singular or multiple nodules with cavity and “halo sign” can facilitate its diagnosis. But the diagnosis should be made in combination to the clinical history.

  10. 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.

  11. 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

  12. 10Be in manganese nodules

    International Nuclear Information System (INIS)

    Thomas, J.; Parker, P.; Mangini, A.; Cochran, K.; Turekian, K.; Krishnaswami, S.; Sharma, P.

    1981-01-01

    10 Be (t/sub 1/2) = 1.5 MY) is(formed in the upper atmosphere by cosmic ray spallation on nitrogen and oxygen. It is transported to the earth's surface via precipitation. In the oceans it is eventually associated with solid phases depositing on the ocean floor such as manganese nodules and deep-sea sediments. One of the assumptions that is normally made in analysis of such processes is that 10 Be has been produced at a relatively uniform rate over the pat several million years. If we assume, in addition, that the initial specific concentration of 10 Be as it precipitates with a solid phase is invariant with time, then we would expect that the decrease of the 10 Be concentration as a function of depth in a deep-sea core or in a manganese nodule would provide a record of sediment accumulation rate in the former and of growth rate in the latter. The possibility of using cosmic-ray produced 10 Be for the dating of marine deposits had been proposed 25 years ago by Arnold and Goel et al. The method of analysis used by these investigators, and those subsequently pursuing the problem, was low-level β counting. Though the potential of using 10 Be for dating manganese nodules was explored more than a decade ago, only a few measurements of 10 Be in nodules exist in date. This is largely because of the 10 Be measurements in environmental samples have gained considerable momentum during the past 3 to 4 years, after the development of accelerator mass spectrometry for its determination

  13. Location of pulmonary modules prior to video thoracoscopic surgery by CT-guided hook wire placement: Preliminary study

    International Nuclear Information System (INIS)

    Ferreiras, J.; Salmeron, I.; Bustos Garcia de Castro, A.; Hernando, F.; Gomez, A.; Torres, A.

    1996-01-01

    Despite the efficacy of computerized tomography (CT) or radiologically-guided percutaneous biopsy and that offluoroscopically-guided trans bronchial biopsy in characterizing pulmonary nodules, it is not always possible to determine the etiology using these techniques, making it necessary to resort to thoracotomy. Recent developments in endoscopicsurgery equipment and the availability of advance video imaging technology have extended the indications for both diagnostic and therapeutic thoracoscopy. Thus, a number of procedures that previously could only be performed bymeans of thoracotomy, such as resection of peripheral pulmonary nodules, can nowbe carried out by means of video thoracoscopic (VT) surgery. Palpation orvisual location of pulmonary nodules by thoracoscopy is essential but is not always possible when the nodules measure less than 20 mm or when their location is not subpleural. In such cases, a procedure for their prior location is useful. In eight patients with pulmonary nodules who were to undergo subsequent VT surgery, the attempt was made to locate the nodules by CT-guided placementof a hook wire, similar to that employed in breast, and methylene blue injection. The hook wire was correctly introduced without significant complications in all eight cases. The eight nodules were successfully resected during the thoracoscopic procedure, in which the hook wire and methylene blue staining were of great assistance. In certain cases, the location of pulmonary nodules by means of CT-guidehook wire placement and methylene blue injection allows the video thoracoscopic resection of lesions of difficult access. (Author)

  14. Pulmonary Rehabilitation

    Science.gov (United States)

    Pulmonary rehabilitation (rehab) is a medically supervised program to help people who have chronic breathing problems, including COPD (chronic obstructive pulmonary disease) Sarcoidosis Idiopathic pulmonary fibrosis Cystic fibrosis During ...

  15. Pregnancy following bilateral salpingectomy

    DEFF Research Database (Denmark)

    Oturai, Annette Bang

    2008-01-01

    This report presents a rare case of spontaneous pregnancy following bilateral salpingectomy. A woman with a history of bilateral salpingectomy was admitted to hospital because of abdominal pain and positive urine HCG. Surprisingly, ultrasound confirmed a live intrauterine fetus. The pregnancy...... was unwanted, and the woman decided to terminate the pregnancy. She was offered diagnostic examination to localise a potential fistula, but she declined. In a MEDLINE search of English literature this is only the second case of spontaneous pregnancy following bilateral salpingectomy Udgivelsesdato: 2008/4/21...

  16. Pulmonary complications in renal transplantation

    International Nuclear Information System (INIS)

    Choi, Jung Bin; Choi, Yo Won; Jeon, Seok Chol; Park, Choong Ki; Lee, Seung Rho; Hahm, Chang Kok; Joo, Kyung Bin

    2003-01-01

    To evaluate the radiographic and CT findings of pulmonary complications other than pulmonary edema arising from renal transplantation. Among 393 patients who had undergone renal transplantation at our hospital during a previous ten-year period, 23 with pulmonary complications other than pulmonary edema were included in this study. The complications involved were infection caused by CMV (n=6), bacteria (n=4), fungus (n=4), tuberculosis (n=2), varicella (n=1) or chlamydia (n=1), and malignancy involving lung cancer (n=4) or Kaposi's sarcoma (n=1). Two chest radiologists reviewed all images. The complications manifesting mainly as pulmonary nodules were lung cancer (4/4), tuberculosis (1/2), and Kaposi's sarcoma (1/1). Pulmonary consolidation was a main feature in bacterial infection (4/4), fungal infection (3/4), tuberculosis (1/2), chlamydial infection (1/1), and varicellar pneumonia (1/1). Ground-glass attenuation was a main CT feature in CMV pneumonia (4/6), and increased interstitial making was a predominant radiographic feature in CMV pneumonia (2/6). The main radiologic features described above can be helpful for differential diagnosis of the pulmonary complications of renal transplantation

  17. Pulmonary complications in renal transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jung Bin; Choi, Yo Won; Jeon, Seok Chol; Park, Choong Ki; Lee, Seung Rho; Hahm, Chang Kok; Joo, Kyung Bin [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2003-04-01

    To evaluate the radiographic and CT findings of pulmonary complications other than pulmonary edema arising from renal transplantation. Among 393 patients who had undergone renal transplantation at our hospital during a previous ten-year period, 23 with pulmonary complications other than pulmonary edema were included in this study. The complications involved were infection caused by CMV (n=6), bacteria (n=4), fungus (n=4), tuberculosis (n=2), varicella (n=1) or chlamydia (n=1), and malignancy involving lung cancer (n=4) or Kaposi's sarcoma (n=1). Two chest radiologists reviewed all images. The complications manifesting mainly as pulmonary nodules were lung cancer (4/4), tuberculosis (1/2), and Kaposi's sarcoma (1/1). Pulmonary consolidation was a main feature in bacterial infection (4/4), fungal infection (3/4), tuberculosis (1/2), chlamydial infection (1/1), and varicellar pneumonia (1/1). Ground-glass attenuation was a main CT feature in CMV pneumonia (4/6), and increased interstitial making was a predominant radiographic feature in CMV pneumonia (2/6). The main radiologic features described above can be helpful for differential diagnosis of the pulmonary complications of renal transplantation.

  18. Pulmonary Langerhans Cell Histiocytosis in an Adult Male Presenting with Central Diabetes Insipidus and Diabetes Mellitus: A Case Report

    Science.gov (United States)

    Choi, Yeun Seoung; Lim, Jung Soo; Kwon, Woocheol; Jung, Soon-Hee; Park, Il Hwan; Lee, Myoung Kyu; Lee, Won Yeon; Yong, Suk Joong; Lee, Seok Jeong; Jung, Ye-Ryung; Choi, Jiwon; Choi, Ji Sun; Jeong, Joon Taek; Yoo, Jin Sae

    2015-01-01

    Pulmonary Langerhans cell histiocytosis is an uncommon diffuse cystic lung disease in adults. In rare cases, it can involve extrapulmonary organs and lead to endocrine abnormalities such as central diabetes insipidus. A 42-year-old man presented with polyphagia and polydipsia, as well as a dry cough and dyspnea on exertion. Magnetic resonance imaging of the hypothalamic-pituitary system failed to show the posterior pituitary, which is a typical finding in patients with central diabetes insipidus. This condition was confirmed by a water deprivation test, and the patient was also found to have type 2 diabetes mellitus. Computed tomographic scanning of the lungs revealed multiple, irregularly shaped cystic lesions and small nodules bilaterally, with sparing of the costophrenic angles. Lung biopsy through video-assisted thoracoscopic surgery revealed pulmonary Langerhans cell histiocytosis. On a follow-up visit, only 1 year after the patient had quit smoking, clinical and radiological improvement was significant. Here, we report an uncommon case of pulmonary Langerhans cell histiocytosis that simultaneously presented with diabetes insipidus and diabetes mellitus. PMID:26508947

  19. Pulmonary Langerhans Cell Histiocytosis in an Adult Male Presenting with Central Diabetes Insipidus and Diabetes Mellitus: A Case Report.

    Science.gov (United States)

    Choi, Yeun Seoung; Lim, Jung Soo; Kwon, Woocheol; Jung, Soon-Hee; Park, Il Hwan; Lee, Myoung Kyu; Lee, Won Yeon; Yong, Suk Joong; Lee, Seok Jeong; Jung, Ye-Ryung; Choi, Jiwon; Choi, Ji Sun; Jeong, Joon Taek; Yoo, Jin Sae; Kim, Sang-Ha

    2015-10-01

    Pulmonary Langerhans cell histiocytosis is an uncommon diffuse cystic lung disease in adults. In rare cases, it can involve extrapulmonary organs and lead to endocrine abnormalities such as central diabetes insipidus. A 42-year-old man presented with polyphagia and polydipsia, as well as a dry cough and dyspnea on exertion. Magnetic resonance imaging of the hypothalamic-pituitary system failed to show the posterior pituitary, which is a typical finding in patients with central diabetes insipidus. This condition was confirmed by a water deprivation test, and the patient was also found to have type 2 diabetes mellitus. Computed tomographic scanning of the lungs revealed multiple, irregularly shaped cystic lesions and small nodules bilaterally, with sparing of the costophrenic angles. Lung biopsy through video-assisted thoracoscopic surgery revealed pulmonary Langerhans cell histiocytosis. On a follow-up visit, only 1 year after the patient had quit smoking, clinical and radiological improvement was significant. Here, we report an uncommon case of pulmonary Langerhans cell histiocytosis that simultaneously presented with diabetes insipidus and diabetes mellitus.

  20. Pulmonary vein stenosis and the pathophysiology of "upstream" pulmonary veins.

    Science.gov (United States)

    Kato, Hideyuki; Fu, Yaqin Yana; Zhu, Jiaquan; Wang, Lixing; Aafaqi, Shabana; Rahkonen, Otto; Slorach, Cameron; Traister, Alexandra; Leung, Chung Ho; Chiasson, David; Mertens, Luc; Benson, Lee; Weisel, Richard D; Hinz, Boris; Maynes, Jason T; Coles, John G; Caldarone, Christopher A

    2014-07-01

    Surgical and catheter-based interventions on pulmonary veins are associated with pulmonary vein stenosis (PVS), which can progress diffusely through the "upstream" pulmonary veins. The mechanism has been rarely studied. We used a porcine model of PVS to assess disease progression with emphasis on the potential role of endothelial-mesenchymal transition (EndMT). Neonatal piglets underwent bilateral pulmonary vein banding (banded, n = 6) or sham operations (sham, n = 6). Additional piglets underwent identical banding and stent implantation in a single-banded pulmonary vein 3 weeks postbanding (stented, n = 6). At 7 weeks postbanding, hemodynamics and upstream PV pathology were assessed. Banded piglets developed pulmonary hypertension. The upstream pulmonary veins exhibited intimal thickening associated with features of EndMT, including increased transforming growth factor (TGF)-β1 and Smad expression, loss of endothelial and gain of mesenchymal marker expression, and coexpression of endothelial and mesenchymal markers in banded pulmonary vein intimal cells. These immunopathologic changes and a prominent myofibroblast phenotype in the remodeled pulmonary veins were consistently identified in specimens from patients with PVS, in vitro TGF-β1-stimulated cells isolated from piglet and human pulmonary veins, and human umbilical vein endothelial cells. After stent implantation, decompression of a pulmonary vein was associated with reappearance of endothelial marker expression, suggesting the potential for plasticity in the observed pathologic changes, followed by rapid in-stent restenosis. Neonatal pulmonary vein banding in piglets recapitulates critical aspects of clinical PVS and highlights a pathologic profile consistent with EndMT, supporting the rationale for evaluating therapeutic strategies designed to exploit reversibility of upstream pulmonary vein pathology. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All

  1. Cystic change in pulmonary tuberculosis in an immunocompetent adult: a case report

    International Nuclear Information System (INIS)

    Ko, Sung Min; Seo, Soo Ji; Choi, Won Il; Jeon, Young June

    2008-01-01

    Cystic change associated with pulmonary tuberculosis is rarely encountered, and few reports are available on the radiologic findings of pulmonary tuberculosis presenting as multiple cystic lesions associated with consolidation or bronchohematogenous nodules. The cystic lesions in our pulmonary tuberculosis patient occurred during steroid treatment without antituberculous chemotherapy and progressively increased in size, but subsequently became smaller after the initiation of antituberculous chemotherapy. Herein, we report the chest radiographic and computed tomographic findings of cystic change in pulmonary tuberculosis in an immunocompetent adult

  2. Cytological diagnosis of microfilariae in subcutaneous nodule

    Directory of Open Access Journals (Sweden)

    Narayanan K Panicker

    2012-01-01

    Full Text Available Microfilariaemia presenting with subcutaneous nodule is rare. We report a case of a 22-year-old female patient who presented with a subcutaneous nodule on right forearm. Fine-needle aspiration cytology from the nodule showed many sheathed motile microfilaria on wet mount preparation during day time. Wuchereria loa loa is known to be associated with soft tissue swellings as reported earlier. Nocturnal motility and cytomorphological features differentiate Wuchereria bancrofti from Wuchereria loa loa.

  3. Bilateral Ultrasound Guided Supraclavicular Block in a Patient on Antiplatelet Drugs

    Directory of Open Access Journals (Sweden)

    Lokesh Kumar KS

    2015-04-01

    Full Text Available A 63 year old male hypertensive and diabetic patient, with coronary artery and chronic obstructive pulmonary disease, presented with bilateral both bone forearm fracture. Open reduction and internal fixation was done successfully with bilateral ultrasound guided supraclavicular block. The problems associated with peripheral nerve block in an Ischemic Heart Disease (IHD patient on antiplatelet therapy are discussed.

  4. Cushing's Syndrome From Pituitary Microadenoma and Pulmonary Nodules.

    Science.gov (United States)

    Tating, Dan Louie Renz P; Montevirgen, Natasha Denise S; Cajucom, Loyda

    2016-03-01

    Cushing's syndrome is a state of cortisol excess, possibly from a tumor in the pituitary gland, the adrenal gland, or an ectopic nonpituitary ACTH-secreting source. The first form, pituitary in origin, was originally described by Harvey Cushing, MD, and was labeled as Cushing's disease. Long-term therapy with glucocorticoids also can lead to iatrogenic Cushing's syndrome.

  5. Successful in utero intervention for bilateral renal agenesis.

    Science.gov (United States)

    Bienstock, Jessica L; Birsner, Meredith L; Coleman, Fred; Hueppchen, Nancy A

    2014-08-01

    We report a case of bilateral renal agenesis treated with serial amnioinfusion in which the newborn survived the newborn period and was able to undergo peritoneal dialysis as a bridge to planned renal transplantation. A 34-year-old woman, gravida 1 para 0, presented at 23 1/7 weeks of gestation with a diagnosis of anhydramnios and bilateral renal agenesis. The patient underwent weekly serial amnioinfusion with the goal of improving fetal pulmonary development. At 28 weeks of gestation, the patient delivered a live newborn who required minimal respiratory support. The neonate is currently 9 months old and is undergoing daily peritoneal dialysis. Serial amnioinfusion appears to have mitigated the severe pulmonary compromise that has, in the past, led to the death of newborns with bilateral renal agenesis.

  6. Auxin transport, metabolism, and signalling during nodule initiation: indeterminate and determinate nodules

    NARCIS (Netherlands)

    Kohlen, W.; Ng, Jason Liang Pin; Deinum, E.E.; Mathesius, Ulrike

    2018-01-01

    Most legumes can form a unique type of lateral organ on their roots: root nodules. These structures host symbiotic nitrogen-fixing bacteria called rhizobia. Several different types of nodules can be found in nature, but the two best-studied types are called indeterminate and determinate nodules.

  7. 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.

  8. Atypical Radiological Manifestation of Pulmonary Metastatic Calcification

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Eun Hae; Kim, Eun Sun; Kim, Chul Hwan; Ham, Soo Youn; Oh, Yu Whan [Korea University College of Medicine, Seoul (Korea, Republic of)

    2008-04-15

    Metastatic pulmonary calcification is a condition of calcium deposition in the normal pulmonary parenchyma, and this is secondary to abnormal calcium metabolism without any prior soft tissue damage. The predisposing factors for this condition include chronic renal failure, hypercalcemia and increased tissue alkalinity. The most common radiologic manifestation consists of poorly defined nodular opacities in the upper lung zone. These opacities reflect the deposition of calcium salts in the pulmonary interstitium. We present here a case of metastatic pulmonary calcification in a patient who recovered from pneumonia with sepsis and whose high-resolution CT (HRCT) images demonstrated localized parenchymal airspace calcification that was limited to the bilateral lower lobes. These lower lobes had been involved with pneumonic consolidation without calcification, as seen on the previous CT scan. In summary, we report here on an atypical presentation of metastatic pulmonary calcification that showed dense airspace consolidation localized to the bilateral lower lobes in a patient with primary hyperparathyroidism and pneumonia.

  9. Strategy for polymetallic nodule mining

    Digital Repository Service at National Institute of Oceanography (India)

    Sharma, R.

    'Jrlii, SinL:C tbe economic viahility of deep sCnodules and sulfides are being looked upon as an alternative tu the existing but fast dwindling land rcsourccs. Land reseNcs of... and dcscrib\\:s the approach for delineation of a mine !>itc and collection of baseline dala. 42 tn\\ertUlllQIUII ChaUenaa- VoL 10 N.... 3 • 1990 Criteria for delineation of mine site The term 'minesilc' is defined as an ocean bottom area where underspccifie...

  10. Anesthetic dilemma in planning bilateral cataract surgery for an infant associated with congenital cardiac anomaly

    Directory of Open Access Journals (Sweden)

    Devalina Goswami

    2015-01-01

    Full Text Available In a patient with tetralogy of Fallot (TOF and pulmonary atresia, treating the cardiac problem or the associated congenital illness is always a challenge. We describe the challenges and successful initial management of bilateral cataract to prevent visual loss in an infant with TOF with pulmonary atresia.

  11. Lung radiology and pulmonary function of children chronically exposed to air pollution.

    Science.gov (United States)

    Calderón-Garcidueñas, Lilian; Mora-Tiscareño, Antonieta; Fordham, Lynn A; Chung, Charles J; Valencia-Salazar, Gildardo; Flores-Gómez, Silvia; Solt, Anna C; Gomez-del Campo, Alberto; Jardón-Torres, Ricardo; Henríquez-Roldán, Carlos; Hazucha, Milan J; Reed, William

    2006-09-01

    We analyzed the chest radiographs (CXRs) of 249 clinically healthy children, 230 from southwest Mexico City and 19 from Tlaxcala. In contrast to children from Tlaxcala, children from southwest Mexico City were chronically exposed to ozone levels exceeding the U.S. National Ambient Air Quality Standards for an average of 4.7 hr/day and to concentrations of particulate matter (PM) with aerodynamic diameters bilateral hyperinflation (151 of 230) and increased linear markings (121 of 230) . Hyperinflation and interstitial markings were significantly more common in Mexico City children (p < 0.0002 and 0.00006 respectively) . Mexico City boys had a higher probability of developing interstitial markings with age (p = 0.004) . Computed tomography (CT) scans were obtained in 25 selected Mexico City children with abnormal CXRs. Mild bronchial wall thickening was seen in 10 of 25, prominent central airways in 4 of 25, air trapping in 8 of 21, and pulmonary nodules in 2 of 21. Only 7.8% of Mexico City children had abnormal lung function tests based on predicted values. These findings are consistent with bronchiolar, peribronchiolar, and/or alveolar duct inflammation, possibly caused by ozone, PM, and lipopolysaccharide exposure. The epidemiologic implications of these findings are important for children residing in polluted environments, because bronchiolar disease could lead to chronic pulmonary disease later in life.

  12. Medical image of the week: septic pulmonary emboli misdiagnosed as metastatic disease

    Directory of Open Access Journals (Sweden)

    Dandachi D

    2014-07-01

    Full Text Available No abstract available. Article truncated at 150 words. A 54-year-old previously healthy man presented with acute onset of left-sided, sharp pleuritic chest pain and dry cough. He denied having fever, hemoptysis, shortness of breath, or unintentional weight loss. Review of system was positive for bright blood per rectum for the last year. He had a root canal procedure done 3 weeks prior to presentation. His is a 30 pack-year smoker, drinks alcohol occasionally, but denied any IV drug use. On admission, he was afebrile and hemodynamically stable. Clinical examination was positive for fecal occult blood test. CBC revealed WBC of 12,800/mm3 and his hemoglobin was11.9 g/dL. Thoracic CT scan with contrast was negative for pulmonary embolism, but showed multiple bilateral pulmonary nodules suspicious for malignancy (Figure 1. The left upper lobe showed a subpleural 2.4 x 1.5 cm rounded opacity and emphysematous changes. CT of the abdomen and pelvis showed folds in the stomach but was otherwise unremarkable...

  13. Evaluation of effectiveness of a computer system (CAD) in the identification of lung nodules with low-dose MSCT: scanning technique and preliminary results

    International Nuclear Information System (INIS)

    Fraioli, Francesco; Catalano, Carlo; Almberger, Maria; Bertoletti, Linda; Cantisani, Vito; Danti, Massimiliano; Pediconi, Federica; Passariello, Roberto

    2005-01-01

    Purpose: Evaluation of the effectiveness of a computer-aided diagnosis (CAD) in the identification of pulmonary nodules. Materials and methods: Two observers (A1, A2) with different levels of experience independently evaluated 20 chest MSCT studies with and without the aid of a CAD system (LungCheck, R2 Technology, Inc.). The study parameters were as follows: 140 kVs, 40 mAs, collimation 4x1 mm, slice thickness 1.25 mm, reconstruction interval 1.0 mm. The observers analysed the images with and without CAD and evaluated: 1) nodule size (longer axis); 2) number and location of nodules; 3) reading time for each observer. The gold standard was represented by the evaluation of both readers in consensus with the aid of the CAD system. Results: Without CAD support the two readers identified 77 (A1) and 79 (A2) nodules and with CAD 81 (A1) and 82 (A2) nodules. Working in consensus the two observers identified 81 nodules without the aid of CAD and 84 nodules with the aid of CAD. Total number of nodules identified by CAD was 104, 25 of which were false positive and 5 false negative. The average reading time with the aid of CAD decreased by as much as 40% for both the observers. Conclusions: The preliminary results of our study suggest that the CAD technique is an accurate automatic support tool in the identification of pulmonary nodules. It reduces reading time and automatically supplies the size, volume, density and number of nodules, thus being useful both in screening programmes and in the follow-up of cancer patients, in whom comparison of the images is particularly difficult [it

  14. Reinnervation of bilateral posterior cricoarytenoid muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis.

    Directory of Open Access Journals (Sweden)

    Meng Li

    Full Text Available OBJECTIVE: To evaluate the feasibility, effectiveness, and safety of reinnervation of the bilateral posterior cricoarytenoid (PCA muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis. METHODS: Forty-four patients with bilateral vocal fold paralysis who underwent reinnervation of the bilateral PCA muscles using the left phrenic nerve were enrolled in this study. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time, pulmonary function testing, and laryngeal electromyography were performed preoperatively and postoperatively. Patients were followed-up for at least 1 year after surgery. RESULTS: Videostroboscopy showed that within 1 year after reinnervation, abductive movement could be observed in the left vocal folds of 87% of patients and the right vocal folds of 72% of patients. Abductive excursion on the left side was significantly larger than that on the right side (P 0.05. No patients developed immediate dyspnea after surgery, and the pulmonary function parameters recovered to normal reference value levels within 1 year. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. Eighty-seven percent of patients in this series were decannulated and did not show obvious dyspnea after physical activity. Those who were decannulated after subsequent arytenoidectomy were not included in calculating the success rate of decannulation. CONCLUSIONS: Reinnervation of the bilateral PCA muscles using the left phrenic nerve can restore inspiratory vocal fold abduction to a physiologically satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity.

  15. Bilateral simultaneous infective keratitis.

    Science.gov (United States)

    On Annie, Lai Hiu; Ray, Manotosh

    2017-08-01

    To analyze the demographics, risk factors, clinical and microbiological characteristics of cases of bilateral simultaneous infective keratitis. In this retrospective case series, patients with clinical evidence of bilateral simultaneous infective keratitis were identified from January 1, 2011 to August 31, 2016. Demographics, risk factors, clinical and microbiological characteristics, and treatment outcomes were analyzed. Five patients (ten eyes) with bilateral simultaneous infective keratitis were identified. The mean age was 32.8 years (SD,±8.8; range, 24-44). All the patients were disposable soft contact lens wearers before presentation. The average size of the infiltrate was 4.76mm 2 (SD±9.0; range, 0.2-31.34). A total of 4 types of bacteria were isolated, with Pseudomonas aeruginosa being the most frequently isolated bacteria involving 5 eyes of four patients. Infection resolved with medical treatment in 9 eyes, 1 patient required therapeutic corneal transplantation for impending corneal perforation. The average time taken for infection to resolve was 6.7days (SD±4.5; range, 2-16). In this case series, the most common risk factor of bilateral simultaneous microbial keratitis was use of soft disposable contact lens and the most commonly isolated bacteria was Pseudomonas aeruginosa. Bilateral simultaneous infective keratitis is uncommon and is a serious complication of contact lens use in immunocompetent adult patients. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  16. Position of solitary thyroid nodules by gammagraphy

    International Nuclear Information System (INIS)

    Basteris M, J.; Gomez D, R.

    2007-01-01

    In this work it is presented which it is the position more frequent of the solitary thyroid nodules. It was used the method of retrospective longitudinal observational investigation in 125 patients that went to the laboratory for realization of detection of thyroid nodules in the years 2004 and 2005 through gammagraphy. (Author)

  17. 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...

  18. Staged bilateral carotid endarterectomy

    DEFF Research Database (Denmark)

    Schroeder, T; Sillesen, H; Engell, Hans Christian

    1986-01-01

    In a series of 56 staged bilateral carotid endarterectomies, new neurologic symptoms developed in 5% and 20% following the first and second procedure, respectively. All complications were transient or minor. The incidence of postendarterectomy hypertension was significantly higher following...... the second procedure, when operations were staged less than 3 weeks apart. A correlation between these hypertensive episodes and the occurrence of new neurologic symptoms could not be shown. However, as this correlation has been proved in several other reports, bilateral carotid endarterectomy is advised...... to be staged at least 3 weeks apart. In addition, a conservative attitude towards contralateral asymptomatic lesions is proposed....

  19. Positron emission tomography/computed tomography imaging features of renal cell carcinoma and pulmonary metastases in a dog.

    Science.gov (United States)

    Song, Sun-Hye; Park, Noh-Won; Eom, Ki-Dong

    2014-05-01

    A 9-year-old spayed female cocker spaniel dog was referred for hematuria. A large abdominal mass and multiple pulmonary nodules were identified radiographically. A whole-body 2-deoxy-2-[(18)F]fluoro-d-glucose positron emission tomography/computed tomography (PET/CT) scan revealed intensely increased uptake in a renal mass and the pulmonary nodules. Renal cell carcinoma was diagnosed on histological examination.

  20. Positron emission tomography/computed tomography imaging features of renal cell carcinoma and pulmonary metastases in a dog

    OpenAIRE

    Song, Sun-Hye; Park, Noh-Won; Eom, Ki-Dong

    2014-01-01

    A 9-year-old spayed female cocker spaniel dog was referred for hematuria. A large abdominal mass and multiple pulmonary nodules were identified radiographically. A whole-body 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography (PET/CT) scan revealed intensely increased uptake in a renal mass and the pulmonary nodules. Renal cell carcinoma was diagnosed on histological examination.

  1. Osler-Weber-Rendu syndrome complicated with pulmonary arteriovenous malformation: A case report and review of literatures

    Directory of Open Access Journals (Sweden)

    Kuan-Yu Wang

    2015-01-01

    Full Text Available Osler-Weber-Rendu syndrome is a hereditary disease which is diagnosed by criterions of clinical symptoms and examinations. Here, we report a definite case of Osler-Weber-Rendu syndrome who had epistaxis, skin telangiectasia, and pulmonary arteriovenous malformation (PAVM. His initial clinical presentations were growing pulmonary nodule with cough and occasional chest pain. PAVM with rupture of aneurysm was diagnosed histologically after wedge resection of the nodule in his right lower lung.

  2. 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.

  3. A cardiac hydatid cyst underlying pulmonary embolism: a case report

    African Journals Online (AJOL)

    induced dyspnea and blood expectorations. Multiple and bilateral opacities were visualized on standard chest x-ray. Signs of right-sided hypertrophy were seen on ECG. Imaging findings led to the diagnosis of pulmonary embolism complicating ...

  4. Bilateral lunate intraosseous ganglia

    International Nuclear Information System (INIS)

    Pablos, J.M.; Valdes, J.C.; Gavilan, F.

    1998-01-01

    An intraosseous ganglion is a relatively uncommon, benign, cyst-like lesion that occurs in young and middle-aged adults. Most commonly seen adjacent to the hip, ankle, knee, or wrist, they are histologically identical to their soft tissue counterparts. A review of the literature revealed only two previously reported examples of bilateral symmetrical ganglia of the lunate bones. (orig.)

  5. Homogeneous bilateral block shifts

    Indian Academy of Sciences (India)

    Homogeneous bilateral block shifts. ADAM KORÁNYI. Department of Mathematics, The Graduate Center, City University of New York,. New York, NY 10016, USA. E-mail: Adam.Koranyi@lehman.cuny.edu. MS received 18 January 2013. Abstract. A new 3-parameter family of homogeneous 2-by-2 block shifts is described.

  6. Homogeneous bilateral block shifts

    Indian Academy of Sciences (India)

    A new 3-parameter family of homogeneous 2-by-2 block shifts is described. These are the first examples of irreducible homogeneous bilateral block shifts of block size larger than 1. Author Affiliations. Adam Korányi1. Department of Mathematics, The Graduate Center, City University of New York, New York, NY 10016, USA ...

  7. Bilateral breast carcinoma

    International Nuclear Information System (INIS)

    Kim, Eung Jo; Oh, Ki Keun

    1990-01-01

    We evaluate 311 breast cancer patients admitted to Yong Dong Severance Hospital Between October 1st 1985 and July 31th 1989, and were able to obtain the following conclusions. 1) There were 14(4.5%) bilateral breast cancers among the 311 confirmed breast cancers. 2) Among the bilateral breast cancers, 5(31%) were synchronous and 9(69%) metachronous. 3) Average interval between the first and the second breast cancer in metachronous cancers was 3.8 year(1-15 years). 4) Bilateral breast cancer was most prevalent in the fifth decade (6/14) with the mean age of 47 years. 5) Film mammogram and sonomammogram showed findings of typical breast malignancies. There was no additional specific findings for each cancer in bilateral breast cancers which was different from unilateral cancers. Therefor, in the patients with unilateral breast cancer, possibility of the second lesion in the contralateral side must be considered and a close follow up observation should be done for at least 3 years

  8. Bilateral akillesseneruptur hos nyretransplanterede

    DEFF Research Database (Denmark)

    Skovgaard, D; Feldt-Rasmussen, B F; Nimb, L

    1996-01-01

    Increased incidence of tendinitis and tendon ruptures is reported in recipients of a kidney transplant. Two cases of bilateral achilles tendon rupture after minimal trauma are described. Tendon ruptures are more frequent in individuals with kidney disease in dialysis or after transplantation comp...

  9. Homogeneous bilateral block shifts

    Indian Academy of Sciences (India)

    Douglas class were classified in [3]; they are unilateral block shifts of arbitrary block size (i.e. dim H(n) can be anything). However, no examples of irreducible homogeneous bilateral block shifts of block size larger than 1 were known until now.

  10. Pulmonary light-chain deposition disease: CT and pathology findings in nine patients

    International Nuclear Information System (INIS)

    Sheard, S.; Nicholson, A.G.; Edmunds, L.; Wotherspoon, A.C.; Hansell, D.M.

    2015-01-01

    Aim: To review the clinical features of nine patients with pulmonary light-chain deposition disease (LCDD) and record their high-resolution CT (HRCT) and histopathological findings. Materials and methods: Patients with a diagnosis of LCDD on lung biopsy specimen were retrospectively identified. The HRCT characteristics of nodules, cysts, and ancillary findings; change at follow-up; and histopathological findings were documented. Results: Features common to all nine cases were thin-walled cysts. In seven cases, vessels traversing the cysts were identified. The majority of patients (8/9) had at least one pulmonary nodule. There was no zonal predominance of either cysts or nodules. The disease appeared stable in the majority of cases with no serial change in HRCT appearances (5/6 cases with follow-up data, mean duration 29 months). Conclusion: To the authors' knowledge, this is the largest series of pulmonary LCDD patients in the literature, and the first systematic assessment of HRCT findings. Pulmonary cysts are a unifying feature, usually with pulmonary nodules, and serial change on HRCT is unusual. - Highlights: • Nine cases of pulmonary light chain deposition disease with high-resolution CT. • CT scans assessed for abnormal features. • Clinical data and histopathological findings obtained. • All patients had thin-walled cysts on CT, often with traversing vessels. • CT features of disease in this group are cysts, nodules and an indolent course

  11. Presentation of Apocrine Breast Carcinoma in a Woman with Bilateral Silicone Prosthesis; Presentacion de un carcinoma apocrino de mama en una mujer con protesis bilateral de silicona

    Energy Technology Data Exchange (ETDEWEB)

    Alonso, J. A.; Salvador, R.; Salvador, M.; Barranco, C.

    2003-07-01

    We present a case of apocrine breast carcinoma in a 45 year-old woman with bilateral silicone breast prosthesis whose clinical manifestations and mammography were that of a palpable nodule-high glandular density, rounded and with imprecise borders devoid of any visible microcalcifications. A bibliographical revision confirmed the infrequent association of this type of tumor with the presence of silicone breast implants, precisely in which we consider its radiological interest to lie. (Author) 11 refs.

  12. Nitrogen assimilation in soybean nodules, 1

    International Nuclear Information System (INIS)

    Ohyama, Takuji; Kumazawa, Kikuo

    1980-01-01

    In order to elucidate the pathways to assimilate the ammonia produced by N 2 -fixation in soybean nodules, 15 N-labeled compounds were administered to intact nodules or nodule slices pretreated with various inhibitors of nitrogen assimilation. After exposure to 15 N 2 , 15 N-incorporation into various nitrogenous compounds was investigated in attached nodules injected with methionine sulfoximine (MSX) or azaserine (AS). MSX treatment increased the 15 N content of ammonia more than 6 times, however, depressed 15 N content of most of amides and amino acids. AS treatment enhanced 15 N content of amido-N of glutamine as well as ammonia, but decreased amino-N of glutamine and most of amino acids. Experiments with nodule slices pretreated with MSX or AS solution and then fed with 15 N-labeled ammonia or amido- 15 N of glutamine showed the same trends. Aminooxyacetate inhibited nitrogen flow from glutamic acid to other amino acids. These results strongly indicate that the ammonia produced by N 2 -fixation is assimilated by GS/GOGAT system to glutamic acid and then transaminated to various amino acids in situ. 15 N-incorporation patterns in nodule slices fed with 15 N-labeled ammonia, hydroxylamine, nitrite were similar, but nitrate seemed to be reduced in a definite compartment and assimilated similarly as in intact nodules fed with 15 N 2 (author)

  13. Synchronous bilateral testicular seminoma. Presentation of a clinical case and review of the literature

    International Nuclear Information System (INIS)

    Roldán, G.; Musé, I.

    2004-01-01

    Introduction: The patients with testicular germ cell tumors (TGT) present in the contralateral tumor development in approximately 3% of the cases. A small subset presenting with synchronous bilateral tumors (TBS). Case report: Patient is a 41-year study of infertility in who have performed bilateral testicular biopsies. Using ultrasound bilateral testicular nodules were diagnosed predominantly right. It performs a bilateral orchiectomy evidencing bilateral pure classic seminoma (T1 and T4). Staging the regional nodal involvement and distance rule and visceral with normal tumor markers. Receive adjuvant radiotherapy (3060 cGy) including inguinal lymph node chains, and pelvic and lumbo-aortic remaining free of disease at 33 months after surgery. Discussion: 85% of all bilateral TGT metachronous are presented as 15% synchronously. TBS represent less than 1% of the most representative series. In most cases they are seminomas and have been associated with infertility and history Family suggestive of genetic predisposition. Bilateral orchiectomy is local treatment of choice and subsequent planned strategy is according the loco-regional extension stressing the importance of hormone replacement and psychological support. Conclusions: In patients with a family history suggestive or infertile should be evaluated for TBS, especially if it carries a seminoma. the bilateral orchiectomy is local treatment of choice. We found no evidence seminomatous TBS have a worse prognosis compared with patients with unilateral or bilateral metachronous tumors of similar size lesional

  14. 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.)

  15. CT manifestations of pulmonary Langerhans cell histiocytosis

    International Nuclear Information System (INIS)

    Qiang Jun; Yu Wei; Gao Wanqin; Song Haiqiao; Ma Yingjian

    2010-01-01

    Objective: To analyzes the CT manifestations of pulmonary Langerhans cell histiocytosis (PLCH). Methods: CT features of 11 patients with PLCH proved pathologically were analyzed retrospectively. Results: The main findings in 11 PLCHs were cysts and nodules. Two cases only had cysts, and 1 only had nodules, which most had cavitations. The other 8 cases showed cysts and nodules with 4 cases mainly manifested with cysts and nine mainly manifested with nodules. Two cases had pulmonary interstitial changes. One case only had cysts in the left upper lung field and 10 cases had lesions not only in the upper and middle but in the lower lung field, which 2 cases had more lesions in the lower and costo-phrenic angle field and 8 cases had less lesions in the costo-phrenic angle field. Three of these 8 cases had more lesions in the superior lobe and apical segment of lower lobe. Conclusion: CT manifestations of PLCH are helpful for the early diagnosis. (authors)

  16. Pulmonary Hypertension and Pulmonary Vasodilators.

    Science.gov (United States)

    Keller, Roberta L

    2016-03-01

    Pulmonary hypertension in the perinatal period can present acutely (persistent pulmonary hypertension of the newborn) or chronically. Clinical and echocardiographic diagnosis of acute pulmonary hypertension is well accepted but there are no broadly validated criteria for echocardiographic diagnosis of pulmonary hypertension later in the clinical course, although there are significant populations of infants with lung disease at risk for this diagnosis. Contributing cardiovascular comorbidities are common in infants with pulmonary hypertension and lung disease. It is not clear who should be treated without confirmation of pulmonary vascular disease by cardiac catheterization, with concurrent evaluation of any contributing cardiovascular comorbidities. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Pulmonary Edema

    Science.gov (United States)

    ... by viral infections such as the hantavirus and dengue virus. Lung injury. Pulmonary edema can occur after ... it may be fatal even if you receive treatment. Prevention Pulmonary edema is not always preventable, but ...

  18. Pulmonary Embolism

    Science.gov (United States)

    A pulmonary embolism is a sudden blockage in a lung artery. The cause is usually a blood clot in ... loose and travels through the bloodstream to the lung. Pulmonary embolism is a serious condition that can ...

  19. Pulmonary Fibrosis

    Science.gov (United States)

    Pulmonary fibrosis is a condition in which the tissue deep in your lungs becomes scarred over time. This tissue gets thick ... blood may not get enough oxygen. Causes of pulmonary fibrosis include environmental pollutants, some medicines, some connective ...

  20. Bilateral "turkey ear" as a cutaneous manifestation of lupus vulgaris.

    Science.gov (United States)

    Lu, Yingjie; Wang, Hongmiao; Zheng, Hua; Li, Xiao

    2018-03-14

    Lupus vulgaris is a common form of cutaneous tuberculosis in China, mostly involving the head and neck region. Turkey ear is a clinically descriptive term, used for a massively enlarged earlobe with bluish-red or violaceous indurated plaques and nodules, which can be a sign of lupus vulgaris. A 47-year-old female presented with edema and reddish ulcerated lesions on both ears which was diagnosed as lupus vulgaris by conventional laboratory investigations and the patient showed good response to antituberculous therapy. Occurrence of turkey ears in lupus pernio (sarcoidosis) should also be mentioned here as this presentation was originally described in this condition. Two case reports of turkey ear have been reported with cutaneous tuberculosis (not bilateral). However, occurrence of bilateral turkey ears in cutaneous tuberculosis has not been described so far in the literature.

  1. Management of a solitary thyroid nodule

    International Nuclear Information System (INIS)

    Rao, R.S.

    1999-01-01

    Solitary nodule in the thyroid is a common clinical entity. A careful clinical assessment is the crucial first step in deciding the modality of treatment. The only worthwhile investigation is FNAC. Other investigations are done merely for the sake of a complete academic work up and can usually be dispensed with in most of the cases. Not every solitary nodule requires surgery. The optimum surgery for a solitary nodule is a total lobectomy. The specimen should be subjected to histological examination before recommending further treatment

  2. [Nodules on localized scleroderma or morphea].

    Science.gov (United States)

    Bayle, P; Bazex, J; Marguery, M-C; Lamant, L

    2005-02-01

    Localized scleroderma or morphea usually appears as flat or depressed lesions. We report 3 cases of morphea with atypical appearance, alternating pigmented and depigmented patches with nodules or sclerous bands, occurring in adult men. The occurrence of nodular elements on generalized or localized scleroderma, although rare, was first reported in the literature by Addisson in 1884. These nodules usually appear during evolution. These scleroderma are then described as being keloidal or nodular. We report 3 cases of nodules on localized scleroderma which appeared at the beginning of the dermatosis and where the scleroderma had a similar unusual irregularly pigmented appearance.

  3. A rare cause of anuria: Bilateral synchronous isolated mid-ureteric tubercular lesions

    Directory of Open Access Journals (Sweden)

    Anuj D Dangi

    2015-01-01

    Full Text Available A young female presenting with right flank pain, fever, raised creatinine and bilateral hydronephrosis was treated with antibiotics elsewhere, with presumptive diagnosis of bilateral pyelonephritis. She had partial relief in symptoms and her creatinine level showed an improvement. Three months later during evaluation at our center she had anuria, hypertensive crisis and pulmonary edema which were managed with emergency bilateral percutaneous nephrostomies. Cross-sectional imaging and ureteroscopy suggested bilateral synchronous intramural mid-ureteric lesions as underlying pathology. Histopathology of the ureteric segments during laparotomy revealed caseating granulomas suggestive of tuberculosis. This clinical presentation has not been previously described in urinary tuberculosis.

  4. Pulmonary vascular abnormalities in chronic obstructive pulmonary disease undergoing lung transplant.

    Science.gov (United States)

    Peinado, Victor I; Gómez, Federico P; Barberà, Joan Albert; Roman, Antonio; Angels Montero, M; Ramírez, Josep; Roca, Josep; Rodriguez-Roisin, Roberto

    2013-12-01

    Little is known about the structure and function relationships of pulmonary vessels in the most severe chronic obstructive pulmonary disease (COPD) spectrum. We investigated morphometric, cellular, and physiologic characteristics of pulmonary arteries from COPD patients undergoing bilateral lung transplant. Seventeen patients with very severe COPD (forced expiratory volume in 1 second, 24% ± 7%) were assessed using inert gas exchange and pulmonary hemodynamics while breathing ambient air and 100% oxygen. Morphometry, in vitro reactivity to hypoxia, and inflammatory cell counts of pulmonary arteries were measured in explanted lungs. Patients had moderate ventilation-perfusion imbalance along with mild release of hypoxic pulmonary vasoconstriction. Mild pulmonary hypertension was observed in 7 patients. Explanted lungs had predominant emphysema with mild small airway involvement. In vitro reactivity was modestly altered, with relatively preserved endothelium-dependent relaxation, and vascular remodelling was discrete, with intense CD8+ T lymphocytes infiltrate. In vitro reactivity correlated with pulmonary vascular resistance (on ambient air) and oxygen-induced pulmonary artery pressure changes. Patients with pulmonary hypertension had more severe morphologic and physiologic emphysema. In end-stage COPD patients undergoing lung transplant, pulmonary vascular involvement is unexpectedly modest, with low-grade endothelial dysfunction. In this sub-set of COPD patients, pulmonary emphysema may constitute the major determinant of the presence of pulmonary hypertension. © 2013 International Society for Heart and Lung Transplantation Published by International Society for the Heart and Lung Transplantation All rights reserved.

  5. A young child with bilateral diaphragmatic palsy after bilateral bidirectional Glenn shunt.

    Science.gov (United States)

    Shamsuddin, A K; Biswas, S K; Rahman, M Z; Biswas, S; Hasan, N A; Sharifuzzaman, M

    2014-07-01

    A 13-months old boy was admitted in National Heart Foundation Hospital and Research Institute on 3 August 2011 with the diagnosis of Dextrocardia, A-V discordance, DORV, large perimembranous VSD, severe infundibular and valvular PS, bilateral SVC. He was operated on 10 August 2011. Bilateral bidirectional Glenn shunt was done off pump along with interruption of PDA. Antegrade pulmonary blood flow was minimized by tight PA banding. Baby was extubated 3 hours after surgery but had to reintubate immediately due to intense respiratory distress. Subsequent three trials of extubation failed. Chest x-ray revealed elevation of both the hemidiaphragm. Ultrasonogram of abdomen and Bronchogram along with fluoroscopy done and bilateral diaphragmatic palsy was diagnosed. Tracheostomy was done on 25th August 2011. Plication of left hemidiaphragm was done on 27th August and right hemidiaphragm plication was done on 10th September 2011. Though it took long period of time we managed to take him out of ventilator on 57th postoperative day. He was oxygen dependent for a period of time and finally he managed to take his own breath without tracheostomy tube from 67th postoperative day. After a long eventful postoperative hospital stay he was discharged home on 78th postoperative day. Discharge Chest x-ray revealed well expanded lung with flattened diaphragm. Echo revealed well functioning bilateral Glenn shunt. Tracheostomy wound healed nicely and there was no evidence of tracheal stenosis.

  6. Bilateral matrix-exponential distributions

    DEFF Research Database (Denmark)

    Bladt, Mogens; Esparza, Luz Judith R; Nielsen, Bo Friis

    2012-01-01

    In this article we define the classes of bilateral and multivariate bilateral matrix-exponential distributions. These distributions have support on the entire real space and have rational moment-generating functions. These distributions extend the class of bilateral phasetype distributions of [1]....... As an application we demonstrate that certain multivariate disions, which are governed by the underlying Markov jump process generating a phasetype distribution, have a bilateral matrix-exponential distribution at the time of absorption, see also [4]....

  7. Bilateral renal calculi

    Science.gov (United States)

    Sreenevasan, G

    1974-01-01

    Bilateral renal calculi were present in 114 (10.7%) of 1,070 cases of proved urinary calculus admitted to the Urological Department of the General Hospital, Kuala Lumpur, during the period November 1968—May 1973. The management of bilateral renal calculi is discussed with reference to the first 100 cases in this series. The introduction of renography has greatly facilitated the decision as to which kidney should be operated on first. The management of patients with and without uraemia is discussed and the use of the modified V and V—Y incisions for the removal of staghorn calculi is described. Complications and results are briefly reviewed. ImagesFig. 1Fig. 4Fig. 6Fig. 7 PMID:4845653

  8. Bilateral tuberculate supernumerary teeth.

    Science.gov (United States)

    Eigbobo, Joycelyn Odegua; Osagbemiro, Babatope Bamidele

    2011-05-16

    Supernumerary teeth are teeth in excess of the normal series occurring in any region of the dental arch. They are located mostly in the anterior maxillary region and are classified according to their location and morphology. The tuberculate type of supernumerary tooth possesses more than one cusp or tubercle (barrel shaped). It is rare to find bilateral tuberculate supernumerary teeth in the premaxillary region and when found they rarely erupt. This report describes a 13-year-old boy with erupted palatally placed bilateral tuberculate supernumerary teeth. The presence of these supernumerary teeth led to the labial displacement and rotations of the anterior maxillary teeth. The treatment involved extraction of the supernumerary teeth and a referral for orthodontic management of the crowding, displacement and rotations. The occurrence of erupted palatally placed tuberculate anterior teeth in this case is a rare experience. However, the associated orthodontic problems are within familiar spectrum.

  9. Bilateral Wilms' tumor

    International Nuclear Information System (INIS)

    Malcolm, A.W.; Jaffe, N.; Folkman, M.J.; Cassady, J.R.

    1980-01-01

    Twenty children with bilateral Wilms' tumor were presented to the Children's Hospital Medical Center and Children's Cancer Research Foundation, Sidney Farber Cancer Institute, and Joint Center for Radiation Therapy (CHMC-CCRF, SFCI, JCRT) from January 1, 1956 to December 31, 1976. Of these 20, 16 had simultaneous and 4 had metachronous disease on presentation. All patients were treated with surgery, radiation and chemotherapy. Of the 16 patients with simultaneous disease, 10 (63%) are alive and free of disease 12+ to 175+ months post diagnosis and treatment, with median follow-up of 121 months. There were no long-term survivors in the metachronous group; all were dead of disease within 21 months from initial presentation of original tumor. With these data we relate prognosis to extent of disease and discuss a general approach to the management of bilateral Wilms' tumor

  10. Bilateral Mandibular Paramolars

    Science.gov (United States)

    Dhull, Rachita Singh; Panda, Swagatika; Acharya, Sonu; Yadav, Shweta; Mohanty, Gatha

    2014-01-01

    ABSTRACT Supernumerary tooth is a developmental anomaly and has been argued to arise from multiple etiologies. These teeth may remain embedded in the alveolar bone or can erupt into the oral cavity. They can cause a variety of complications in the develo­ping dentition. Supernumerary teeth can present in various forms and in any region of the mandible or maxilla, but have a predisposition for the anterior maxilla. Here is the presentation of a case of unusual location of supernumerary teeth located in between mandibular first and second molar region bilaterally. How to cite this article: Dhull KS, Dhull RS, Panda S, Acharya S, Yadav S, Mohanty G. Bilateral Mandibular Paramolars. Int J Clin Pediatr Dent 2014;7(1):40-42. PMID:25206236

  11. Bilateral chronic subdural hematoma

    DEFF Research Database (Denmark)

    Andersen-Ranberg, Nina Christine; Rom Poulsen, Frantz; Bergholt, Bo

    2017-01-01

    OBJECTIVE Bilateral chronic subdural hematoma (bCSDH) is a common neurosurgical condition frequently associated with the need for retreatment. The reason for the high rate of retreatment has not been thoroughly investigated. Thus, the authors focused on determining which independent predictors...... are associated with the retreatment of bCSDH with a focus on surgical laterality. METHODS In a national database of CSDHs (Danish Chronic Subdural Hematoma Study) the authors retrospectively identified all bCSDHs treated in the 4 Danish neurosurgical departments over the 3-year period from 2010 to 2012...... that a separated hematoma density and the absence of postoperative drainage were independent predictors of retreatment. CONCLUSIONS In bCSDHs bilateral surgical intervention significantly lowers the risk of retreatment compared with unilateral intervention and should be considered when choosing a surgical...

  12. Synchronous, bilateral tonsillar carcinomas

    DEFF Research Database (Denmark)

    Saber, Camelia Nami; Grønhøj, Christian; Jensen, David Hebbelstrup

    2017-01-01

    -based, consecutive cohort of OPSCCs. METHODS: We identified all patients diagnosed with tonsillar squamous cell carcinoma (TSCC) in eastern Denmark during a 15-year period to detect the incidence of synchronous BiTSCCs. The tumours were assessed for p16Ink4a expression, the presence of HPV DNA and HPV genotypes....... Furthermore, we systematically reviewed the literature examining BiTSCCs. RESULTS: Of the total of 1119 TSCCs diagnosed in eastern Denmark from 2000 to 2014, we identified 12 BiTSCCs, nine of which initially presented as a cancer of unknown primary (CUP) in the neck. Nine cases were bilaterally HPV16 positive...... (HPV16+), while two cases were HPV16+ in one tonsil and respectively, HPV33 and HPV35 positive in the contralateral tonsil. One case was bilaterally HPV-negative. We also identified an increase in the incidence of BiTSCCs after 2012 when histological examination of the entire tonsil tissue became...

  13. Nodule bottom backscattering study using multibeam echosounder

    Digital Repository Service at National Institute of Oceanography (India)

    Chakraborty, B.; Raju, Y.S.N.; Nair, R.R.

    A study is carried out to observe the angular dependence of backscattering strength at nodule area where grab sample and photographic data is available. Theoretical study along with the experimentally observed data shows that the backscattering...

  14. Actinorhizal nitrogen fixing nodules: infection process, molecular ...

    African Journals Online (AJOL)

    Actinorhizal nitrogen fixing nodules: infection process, molecular biology and genomics. Mariana Obertello, Mame Oureye SY, Laurent Laplaze, Carole Santi, Sergio Svistoonoff, Florence Auguy, Didier Bogusz, Claudine Franche ...

  15. Atypical Localized Rheumatoid Nodule: Case Report

    Directory of Open Access Journals (Sweden)

    KORHAN BARIS BAYRAM

    2015-01-01

    Full Text Available Rheumatoid nodules can be seen in about 30% of patiens with rheumatoid arthritis. They are occasionally localized subcutaneous, but they can rarely seen in visceral organs. Their appearance can be confused with many clinical conditions when they have atypical localizations. To exclude the presence of a malignancy, these lesions should always be investigated. We aimed to discuss a patient with rheumatoid nodule localized in close neighborhood of hyoid bone, presumed as malignancy.

  16. Differentiated thyroid carcinoma in a scintigraphically hot nodule: diagnosis and interdisciplinary therapeutical approach

    International Nuclear Information System (INIS)

    Stahl, A.; Hess, U.; Langhammer, H.; Harms, J.; Zwicknagl, M.

    2002-01-01

    A hyperfunctioning differentiated thyroid carcinoma is a rare occurrence. Nevertheless, this diagnosis must be considered in a scintigraphically hot nodule if there is a clinical or sonographic suggestion of malignancy. The case of a 57-year old patient with hyperthyreosis and a scintigraphically hot thyroid nodule is presented. Further evaluation led to the diagnosis of a differentiated thyroid carcinoma with extensive lymph node and pulmonary metastases (pT2b, pN1b, pM1). The scintigraphically hot nodule corresponded to the primary tumor, whereas scintigraphic detection of the lymph node metastases was only possible postoperatively. Extensive resection of the lymph node metastases was achieved by the intraoperative application of a gamma probe (2nd operation). This allowed sufficient uptake of radioiodine in the pulmonary metastases for their detection and subsequent devitalization by radioiodine therapy. Complete elimination of all tumor tissue was documented at a control follow-up after six months. Gamma probe-guided surgery may allow for additional removement of non-palpable lymph node metastases. In selected cases this may optimize the surgical results and thereby facilitate the subsequent radioiodine elimination of advanced differentiated thyroid carcinomas. (author)

  17. Automated detection of lung nodules in low-dose computed tomography

    International Nuclear Information System (INIS)

    Cascio, D.; Cheran, S.C.; Chincarini, A.; De Nunzio, G.; Delogu, P.; Fantacci, M.E.; Gargano, G.; Gori, I.; Retico, A.; Masala, G.L.; Preite Martinez, A.; Santoro, M.; Spinelli, C.; Tarantino, T.

    2007-01-01

    A computer-aided detection (CAD) system for the identification of pulmonary nodules in low-dose multi-detector computed-tomography (CT) images has been developed in the framework of the MAGIC-5 Italian project. One of the main goals of this project is to build a distributed database of lung CT scans in order to enable automated image analysis through a data and cpu GRID infrastructure. The basic modules of our lung-CAD system, consisting in a 3D dot-enhancement filter for nodule detection and a neural classifier for false-positive finding reduction, are described. The system was designed and tested for both internal and sub-pleural nodules. The database used in this study consists of 17 low-dose CT scans reconstructed with thin slice thickness (∝300 slices/scan). The preliminary results are shown in terms of the FROC analysis reporting a good sensitivity (85% range) for both internal and sub-pleural nodules at an acceptable level of false positive findings (1-9 FP/scan); the sensitivity value remains very high (75% range) even at 1-6 FP/scan. (orig.)

  18. Diagnostic value of dual section helical CT in suspected acute pulmonary embolism

    International Nuclear Information System (INIS)

    Marangoni, Alberto A.; Torrecillas, Maria D.; Marchegiani, Silvio H.; Surur, Alberto

    2003-01-01

    Purpose: To asses the role of Dual Section Helical Computed Tomography (DSHCT) in patients with clinically suspected acute pulmonary embolism (APE). Material and Methods: A retrospective evaluation of 102 patients (57 male, 45 female; age range: 30-83 years; mean: 56 years) with high suspicion of APE studied by DSHCT, was carried out. From the medical records we analyzed clinical parameters, blood gases, D-dimer, risk factors and other imaging examinations. US Doppler of the inferior limbs was performed in 58/102 patients (57%). Results. 52 patients (51%) had APE on DSHCT. Scans of the other 50 patients (49%) were negative for APE. In 39/50 cases (78%) without evidence of APE, DSHCT detected ancillary thoracic findings such as atelectasia (n=11), pulmonary consolidation/edema (n=10), interstitial lung disease (n=8), pleural effusion (n=6), emphysema (n=2), nodules (n=2). 11 cases (22%) DSHCT showed no abnormal features. In this group, with persistent clinical symptoms, angio MRI showed 2 additional cases of APE (false negatives on DSHCT). On DSHCT 51/52 patients (98%) with APE showed satisfactory filling of iodinate contrast in segmental pulmonary arteries, and 45/52 patients (87%) in sub segmental arteries. On DSHCT 36 patients showed bilateral APE, and 7 had isolated peripheral APE. In 7/12 patients DSHCT demonstrated deep venous thrombosis (DVT) of the inferior limbs. In other 27/58 cases (47%) US Doppler was positive for DVT. Conclusion: DSHCT can be effectively used to rule out suspected APE and also provides additional information in patients without APE. In addition DSHCT also contributes to demonstrate deep venous thrombosis. (author)

  19. Features of idiopathic pulmonary alveolar proteinosis in high resolution computed tomography

    International Nuclear Information System (INIS)

    Mehrian, Payam; Homayounfar, Nasrin; Karimi, Mohammad Ali; Jafarzadeh, Hamid

    2014-01-01

    Although the crazy-paving pattern on computed tomography is characteristic for pulmonary alveolar proteinosis (PAP), it is not specific and has not been compared between idiopathic and secondary PAPs in the large studies. The aim of this study was to determine the high resolution computed tomography (HRCT) features of idiopathic PAP. HRCT images of 35 patients (mean age: 38±14years; 54.3% male) with idiopathic PAP (proved by bronchoalveolar lavage or biopsy) were reviewed by two experienced pulmonary radiologist and detailed findings were reported. The predominant HRCT presentation of PAP was interlobular septal thickening (ILST;100%) and ground glass opacities (GGOs; 91.7%), resulting in crazy-paving pattern (83%). All patients had diffuse bilateral lung involvement that was symmetric in 97%. ILST and GGO without crazy-paving were seen in 17% and 14.7%, respectively. The overall extent of parenchymal involvement was 50 to 75% in 80% of patients. Thirty three cases (94%) had areas of geographic sparing within the affected lung. Peripheral sparing was seen in 85.7% of patients, including three patterns with some overlap: costophrenic angle (80%), apices (60%), and subpleural (57%) sparing. Other HRCT findings were: consolidation (63%), pulmonary nodules (31.4%), mediastinal and/or hilar lymphadenopathy (23%), mass-like consolidation (17%), pleural effusion (8.6%), and honey combing (5.7%). All female patients (n=16) had crazy-paving, while 13 out of 19 (68%) male patients had crazy-paving on their lung HRCT (p=0.02). This study demonstrated that the predominant HRCT presentation of idiopathic PAP was interlobular septal thickening and ground glass opacities, resulting in crazy-paving pattern

  20. Losartan ameliorates "upstream" pulmonary vein vasculopathy in a piglet model of pulmonary vein stenosis.

    Science.gov (United States)

    Zhu, Jiaquan; Ide, Haruki; Fu, Yaqin Yana; Teichert, Anouk-Martine; Kato, Hideyuki; Weisel, Richard D; Maynes, Jason T; Coles, John G; Caldarone, Christopher A

    2014-12-01

    Pulmonary vein stenosis (PVS) is a relentless disease with a poor prognosis. Although surgical repair can effectively treat "downstream" (near left atrial junction) PVS, residual "upstream" (deep in lung parenchyma) PVS commonly dictates long-term survival. Our initial studies revealed an association between PVS and transforming growth factor-β signaling, which led us to investigate the effect of losartan on upstream pulmonary vein vasculopathy in a piglet model of PVS. Neonatal Yorkshire piglets underwent sham surgical banding (sham, n = 6), staged bilateral pulmonary vein banding of all pulmonary veins except the right middle pulmonary vein (banded, n = 6), and staged pulmonary vein banding with losartan treatment (losartan, 1 mg/kg/d, n = 7). After 7 weeks, the hemodynamic data were obtained and the piglets killed. Pulmonary vein banding (compared with sham) was associated with continuous turbulent flow in banded pulmonary veins, pulmonary hypertension (pulmonary artery/systemic blood pressure ratio 0.51 ± 0.06 vs 0.23 ± 0.02, P < .001), and diffuse pulmonary vein intimal hyperplasia in the upstream pulmonary veins (P < .001). Losartan administration decreased the pulmonary artery/systemic blood pressure ratios compared with those in the banded piglets (0.36 ± 0.08 vs 0.51 ± 0.06, P = .007) but it remained greater than those in the sham group (P = .001). Losartan was also associated with diminished pulmonary vein intimal hyperplasia compared with that in the banded piglets (P < .001) but still remained more than that in the sham group (P = .035). Pulmonary vein banding reduced vascular endothelial-cadherin expression, indicative of diminished endothelial integrity, which was restored with losartan. Losartan treatment improved PVS-associated pulmonary hypertension and intimal hyperplasia and might be a beneficial prophylactic therapy for patients at high risk of developing PVS after pulmonary vein surgery. Copyright © 2014 The American Association for

  1. Radiological findings of pulmonary aspergillosis

    International Nuclear Information System (INIS)

    Song, Kounn Sik; Im, Chung Kie

    1985-01-01

    The pulmonary aspergillosis is a group of three separate disease, comprising invasive aspergillosis, aspergilloma, and allergic bronchopulmonary aspergillosis, or a disease process in which one of three entities overlap with another process such as mucoid impaction, pulmonary infiltration with eosinophilia, bronchocentric granulomatosis, microgranulomatous hypersensitivity, or asthma. The radiological findings of 24 cases of pulmonary aspergillosis diagnosed and treated at Seoul National University Hospital during the past 7 years were analyzed retrospectively. The results were as follows: 1. Final diagnosis of 24 cases of pulmonary aspergillosis was aspergilloma in 16 cases, invasive aspergillosis in 2 cases, variant form of allergic bronchopulmonary aspergillosis in 3 cases, and endobronchial aspergillosis in 3 cases. 2. The underlying causes of the aspergilloma were healed tuberculous cavity in 6 cases, bronchiectasis in 8 cases, and no underlying cause were found in 2 cases. All the 16 cases of aspergilloma were correctly diagnosed without difficultly by demonstrating the intracavitary mass or air meniscus. 3. Radiological findings of the invasive aspergillosis in kidney transplant patients were multiple round nodules with early cavitation and formation of aspergilloma which shows slowly progressive cavitation over 13 months in one case, and diffusely scattered miliary nodules with occasional cavitation in the other case. 4. Classic allergic bronchopulmonary aspergillosis were not found in our series but variant form of ABPA was found in 3 young female patients. All the three patients shows some degree of central bronchiectasis and combined aspergilloma was found in 2 cases. 5. Three patients diagnosed as endobronchial aspergillosis-saprophytic infection of aspergillus in the bronchial tree-by bronchoscopic biopsy shows nonspecific radiological findings

  2. Bosutinib induced pleural effusions: Case report and review of tyrosine kinase inhibitors induced pulmonary toxicity

    Directory of Open Access Journals (Sweden)

    Natalia I. Moguillansky, MD

    2017-01-01

    Full Text Available Tyrosine kinase inhibitors are known to cause pulmonary complications. We report a case of bosutinib related bilateral pleural effusions in a patient with chronic myeloid leukemia. Characteristics of the pleural fluid are presented. We also discuss other tyrosine kinase inhibitors induced pulmonary toxicities, including pulmonary hypertension and interstitial lung disease.

  3. Qualitative CT Criterion for Subsolid Nodule Subclassification: Improving Interobserver Agreement and Pathologic Correlation in the Adenocarcinoma Spectrum.

    Science.gov (United States)

    Chen, Po An; Huang, Eric P; Shih, Lu Yang; Tang, En Kuei; Chien, Chu Chun; Wu, Ming Ting; Wu, Fu Zong

    2018-03-09

    The main aim of this study was to evaluate the clinical validity and correlation with pathologic invasiveness in the pulmonary adenocarcinoma spectrum based on the novel qualitative computed tomography criterion for subsolid nodule (SSN) classification, which classified SSN into pure ground-glass nodule, heterogeneous ground-glass nodule, and part-solid nodule. In addition, we compared the performance of the conventional and novel classifications. The computed tomography images of 41 SSN nodules were interpreted by six observers independently, and the SSN characteristics were classified according to both the conventional and the novel classification systems. Each observer assessed 41 nodules in two different classifications separated by a minimum of 8 weeks. The kappa (κ) coefficient test was used to determine the reliability. The correlation between pulmonary adenocarcinoma spectrum and the SSN classification was analyzed with Spearman correlation coefficients. Interobserver agreement (κ) was 0.702 (range 0.42-0.89) and 0.707 (range 0.58-0.88) for the conventional and the novel classifications for SSN, respectively, and intraobserver agreement (κ) was 0.92 and 0.88 for the conventional and the novel classifications for SSN, respectively. The novel SSN classification (correlation coefficient range 0.622-0.732) is more strongly correlated with the pathologic invasiveness degree of lesions in adenocarcinoma spectrum than the conventional SSN classification (correlation coefficient range 0.458-0.644). The agreement between observers on the novel SSN classification system was good and had better correlation with pathologic invasiveness than the conventional SSN classification. Further studies are needed to confirm these results on interobserver agreement. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  4. Analysis of nodule meristem persistence and ENOD40 functioning in Medicago truncatula nodule formation

    NARCIS (Netherlands)

    Wan Xi,

    2007-01-01

    Medicago root nodules are formed as a result of the interaction of the plant with the soil-borne bacterium Sinorhizobium meliloti. Several plant genes are induced during nodule formation and MtENOD40 is one of the earliest genes activated. The precise function as well as the molecule

  5. Analysis of nodule meristem persistence and ENOD40 functioning in Medicago truncatula nodule formation

    NARCIS (Netherlands)

    Wan Xi,

    2007-01-01

    Medicago root nodules are formed as a result of the interaction of the plant with the soil-borne bacterium Sinorhizobium meliloti. Several plant genes are induced during nodule formation and MtENOD40 is one of the earliest genes activated. The precise function as well as the molecule harboring the

  6. "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.

  7. High-Resolution CT Findings of Re-Expansion Pulmonary Edema

    Energy Technology Data Exchange (ETDEWEB)

    Baik, Jun Hyun; Park, Young Ha [St. Vincent' s Hospital, The Catholic University of Korea, Suwon (Korea, Republic of); Ahn, Myeong Im; Park, Seog Hee [Seoul St. Mary' s Hospital, The Catholic University of Korea, Seoul (Korea, Republic of)

    2010-04-15

    To describe the high-resolution CT (HRCT) findings of re-expansion pulmonary edema (REPE) following a thoracentesis for a spontaneous pneumothorax. HRCT scans from 43 patients who developed REPE immediately after a thoracentesis for treatment of pneumothorax were retrospectively analyzed. The study group consisted of 41 men and two women with a mean age of 34 years. The average time interval between insertion of the drainage tube and HRCT was 8.5 hours (range, 1-24 hours). The patterns and distribution of the lung lesions were analyzed and were assigned one of the following classifications: consolidation, ground-glass opacity (GGO), intralobular interstitial thickening, interlobular septal thickening, thickening of bronchovascular bundles, and nodules. The presence of pleural effusion and contralateral lung involvement was also assessed. Patchy areas of GGO were observed in all 43 patients examined. Consolidation was noted in 22 patients (51%). The geographic distribution of GGO and consolidation was noted in 25 patients (58%). Interlobular septal thickening and intralobular interstitial thickening was noted in 28 patients (65%), respectively. Bronchovascular bundle thickening was seen in 13 patients (30%), whereas ill-defined centrilobular GGO nodules were observed in five patients (12%). The lesions were predominantly peripheral in 38 patients (88%). Of these lesions, gravity-dependent distribution was noted in 23 cases (53%). Bilateral lung involvement was noted in four patients (9%), and a small amount of pleural effusion was seen in seven patients (16%). The HRCT findings of REPE were peripheral patchy areas of GGO that were frequently combined with consolidation as well as interlobular septal and intralobular interstitial thickening.

  8. 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 betwee