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Hiromitsu Sumikawa,
Takeshi Johkoh,
Kiminori Fujimoto,
Kazuya Ichikado,
Thomas V Colby,
Junya Fukuoka,
Hiroyuki Taniguchi,
Yasuhiro Kondoh,
Kensuke Kataoka,
Masahiro Yanagawa,
Mitsuhiro Koyama, Osamu Honda,
Noriyuki Tomiyama
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ABSTRACT: The aim of this study was to correlate high-resolution CT (HRCT) findings at the site of biopsy with the whole lung CT and pathologic diagnoses in usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP).
The study included 35 patients (25 UIP and 10 NSIP) diagnosed both pathologically and clinically. 81 surgical biopsy specimens (54 UIP, and 27 NSIP) and extracted areas corresponding to biopsy sites on HRCT were analyzed. CT interpretations were compared with pathological diagnoses in both extracted images and the whole lung. Concordant and discordant cases in multiple extracted images were divided and analyzed. Then the whole cases were categorized by including or not at least one UIP diagnosis of extracted images and evaluated.
The diagnoses in extracted sites significantly correlated with pathological diagnoses (p=0.047). There were significant differences in the concordances of extracted images compared with the diagnosis of whole lung and pathology (p=0.008, 0.003, respectively). All 7 cases that were not concordant were diagnosed as radiological UIP with whole lung CT. The cases with at least one UIP diagnosis of extracted CT images were diagnosed as UIP in pathology more frequently (18 in 25) (p=0.007).
Radiological UIP in whole CT had more frequently discordant diagnoses from multiple extracted images than NSIP. And there were more cases in pathological UIP that included at least one UIP diagnosis of extracted images compared with pathological NSIP.
European journal of radiology 12/2011; 81(10):2919-24. · 2.65 Impact Factor
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ABSTRACT: To evaluate the effects of ASIR on CAD system of pulmonary nodules using clinical routine-dose CT and lower-dose CT.
Thirty-five patients (body mass index, 22.17 ± 4.37 kg/m(2)) were scanned by multidetector-row CT with tube currents (clinical routine-dose CT, automatically adjusted mA; lower-dose CT, 10 mA) and X-ray voltage (120 kVp). Each 0.625-mm-thick image was reconstructed at 0%-, 50%-, and 100%-ASIR: 0%-ASIR is reconstructed using only the filtered back-projection algorithm (FBP), while 100%-ASIR is reconstructed using the maximum ASIR and 50%-ASIR implies a blending of 50% FBP and ASIR. CAD output was compared retrospectively with the results of the reference standard which was established using a consensus panel of three radiologists. Data were analyzed using Bonferroni/Dunn's method. Radiation dose was calculated by multiplying dose-length product by conversion coefficient of 0.021.
The consensus panel found 265 non-calcified nodules ≤ 30 mm (ground-glass opacity [GGO], 103; part-solid, 34; and solid, 128). CAD sensitivity was significantly higher at 100%-ASIR [clinical routine-dose CT, 71% (overall), 49% (GGO); lower-dose CT, 52% (overall), 67% (solid)] than at 0%-ASIR [clinical routine-dose CT, 54% (overall), 25% (GGO); lower-dose CT, 36% (overall), 50% (solid)] (p<0.001). Mean number of false-positive findings per examination was significantly higher at 100%-ASIR (clinical routine-dose CT, 8.5; lower-dose CT, 6.2) than at 0%-ASIR (clinical routine-dose CT, 4.6; lower-dose CT, 3.5; p<0.001). Effective doses were 10.77 ± 3.41 mSv in clinical routine-dose CT and 2.67 ± 0.17 mSv in lower-dose CT.
CAD sensitivity at 100%-ASIR on lower-dose CT is almost equal to that at 0%-ASIR on clinical routine-dose CT. ASIR can increase CAD sensitivity despite increased false-positive findings.
European journal of radiology 10/2011; 81(10):2877-86. · 2.65 Impact Factor
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ABSTRACT: A computed tomographic-guided percutaneous needle biopsy (CTGNB) is useful as an option for pathologic diagnosis of lung cancer, especially in patients with peripheral small-sized nodules. We aimed to assess the risk of pleural seeding of cancer cells, leading to postoperative relapse with dissemination caused by the procedure.
We investigated the clinical outcomes of 447 stage I lung cancer patients. Survival analysis was performed using the Kaplan-Meier method and a log-rank test. Pleural recurrence rates were also determined. Furthermore, propensity score matching analysis was used to reduce background bias from patient characteristics.
The 5-year, disease-free survival rate was 89.1% in patients diagnosed with CTGNB, and 85.5% in those diagnosed using a transbronchial biopsy or open lung biopsy procedure. Local recurrence with pleural dissemination was found in 8 of 13 recurrence cases (61.5%) in the CTGNB group, which was higher as compared with the transbronchial biopsy or open lung biopsy group (p < 0.01). Subset analyses of p stage IB cases and those with subpleural lesions showed that local recurrence with dissemination was significantly more frequent in the CTGNB group (p = 0.02 and p < 0.01, respectively). In patients with subpleural lesions diagnosed with CTGNB, the rate of local recurrence with dissemination was 15.4%. Propensity score matching analysis confirmed the significantly increased frequency of pleural dissemination after CTGNB.
The CTGNB procedure might increase the risk of pleural implantation in stage I lung cancer patients, especially p stage IB cases with subpleural lesions, whereas the overall disease-free survival rate was not affected by this small population of patients with recurrence.
The Annals of thoracic surgery 04/2011; 91(4):1066-71. · 3.74 Impact Factor
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ABSTRACT: To evaluate thin-section computed tomography (CT) images of the lung reconstructed using adaptive statistical iterative reconstruction (ASIR) on standard- and reduced-dose CT.
Eleven cadaveric lungs were scanned by multidetector-row CT with two different tube currents (standard dose, 400 mA; reduced dose, 10 mA). The degree of ASIR was classified into six different levels: 0% (non-ASIR), 20%, 40%, 60%, 80%, and 100% (maximum-ASIR). The ASIR (20%, 60%, and 100%) images were compared with the ASIR (0%) images and assessed visually by three independent observers for image quality using a 7-point scale. The evaluation items included abnormal CT findings, normal lung structures, and subjective visual noise. The median scores assigned by the three observers were analyzed statistically. Quantitative noise was calculated by measuring the standard deviation in a circular region of interest on each selected image of ASIR (0%-100%).
On standard-dose CT, the overall image quality significantly improved with increasing degree of ASIR (P ≤ .009, Wilcoxon signed-ranks test with Bonferroni correction). As ASIR increased, however, intralobular reticular opacities and peripheral vessels tended to be obscure. On reduced-dose CT, the overall image quality of ASIR (100%) was significantly better than that of ASIR (20%) (P ≤ .009). As ASIR increased, however, intralobular reticular opacities tended to be obscure. Using ASIR significantly reduced subjective and quantitative image noise on both standard- and reduced-dose CT (P < .001, Bonferroni/Dunn's method).
ASIR improves the image quality by decreasing image noise. Maximum-ASIR may be needed for improving image quality on highly reduced-dose CT. However, excessive ASIR may obscure subtle shadows.
Academic radiology 10/2010; 17(10):1259-66. · 2.09 Impact Factor
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ABSTRACT: The aims of this study were to compare diagnostic accuracy between computed tomography (CT)-guided percutaneous cutting needle biopsy (PCNB) and surgery or open biopsy for thymic epithelial tumors in accordance with the World Health Organization (WHO) classification and to evaluate computed tomographic diagnosis additionally.
Subjects were 20 patients (11 men, 9 women) in whom CT, CT-guided PCNB, and surgery had been performed for anterior mediastinal tumors. All diagnoses of both CT-guided PCNB and surgery or open biopsy were made in accordance with the WHO classification. Computed tomographic diagnoses were performed by two radiologists on the basis of radiologic characteristics previously reported according to the simplified WHO classification (types A and AB, type B1, types B2 and B3, and thymic carcinoma). The concordance of the WHO classification or the simplified WHO classification between the diagnosis on either CT or CT-guided PCNB and that on surgery was evaluated using the weighted kappa statistic.
The histologic classifications on the basis of surgical resection specimens were as follows: type A, n = 3; type AB, n = 5; type B1, n = 3; type B2, n = 4; type B3, n = 4; and thymic carcinoma, n = 1. The overall concordance with the diagnosis according to the WHO classification established using CT-guided PCNB specimens (weighted kappa = 0.757) was higher than that using computed tomographic diagnosis (weighted kappa = 0.437).
CT-guided PCNB is a technique with good concordance of the WHO classification of thymic epithelial tumors between the diagnoses of surgery or open biopsy.
Academic radiology 06/2010; 17(6):772-8. · 2.09 Impact Factor
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ABSTRACT: To evaluate the image quality of both standard- and reduced-dose computed tomography (CT) by comparing multidetector CT with garnet-based detectors with multidetector CT with conventional detectors.
The study was approved by the internal ethics review board. Informed consent was obtained. Eleven cadaveric lungs inflated and fixed by using the Heitzman method were scanned by using both CT with garnet-based detectors and CT with conventional detectors. Tube current was 400 mA for standard-dose and 10 mA for reduced-dose CT, and voltage was 120 kVp. Either normal scan mode with 984 views (conventional and garnet-based detectors) or high-resolution mode with 2496 views was used. Image quality at conventional-detector CT and garnet-based-detector CT in all modes was graded by two independent observers with a five-point scale. The evaluation items included normal lung structures, subjective visual noise, and abnormal CT findings. Quantitative image noise measurements were calculated by measuring the standard deviations in a circular region of interest on each selected image.
At standard-dose CT, image quality at CT with garnet-based detectors (high-resolution mode) was significantly improved (P < .001, Tukey-Kramer). However, there was no significant difference between quantitative image noise measurements (P > or = .24). At reduced-dose CT, only noise differed significantly, with both subjective visual noise and quantitative image noise measurements significantly greater at CT with garnet-based detectors (high-resolution mode) (P < or = .01). There was no significant difference in image quality except for noise between conventional-detector CT and garnet-based-detector CT (P > or = .06).
The image quality of standard-dose garnet-based-detector CT (high-resolution) was significantly improved. Although highly reduced-dose garnet-based-detector CT (high-resolution mode) provided more image noise, overall image quality was not different between conventional-detector CT and garnet-based-detector CT.
Radiology 06/2010; 255(3):944-54. · 5.73 Impact Factor
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Masahiro Yanagawa,
Yuko Tanaka,
Masahiko Kusumoto,
Shunichi Watanabe,
Ryosuke Tsuchiya, Osamu Honda,
Hiromitsu Sumikawa,
Atsuo Inoue,
Masayoshi Inoue,
Meinoshin Okumura,
Noriyuki Tomiyama,
Takeshi Johkoh
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ABSTRACT: To evaluate a custom-developed software for analyzing malignant degrees of small peripheral adenocarcinomas on volumetric CT data compared to pathological prognostic factors.
Forty-six adenocarcinomas with a diameter of 2cm or less from 46 patients were included. The custom-developed software can calculate the volumetric rates of solid parts to whole nodules even though solid parts show a punctate distribution, and automatically classify nodules into the following six types according to the volumetric rates of solid parts: type 1, pure ground-glass opacity (GGO); type 2, semiconsolidation; type 3, small solid part with a GGO halo; type 4, mixed type with an area that consisted of GGO and solid parts which have air-bronchogram or show a punctate distribution; type 5, large solid part with a GGO halo; and type 6, pure solid type. The boundary between solid portion and GGO on CT was decided using two threshold selection methods for segmenting gray-scale images. A radiologist also examined two-dimensional rates of solid parts to total opacity (2D%solid) which was already confirmed with previous reports.
There were good agreements between the classification determined by the software and radiologists (weighted kappa=0.778-0.804). Multivariate logistic regression analyses showed that both 2D%solid and computer-automated classification were significantly useful in estimating lymphatic invasion (p=0.0007, 0.0027), vascular invasion (p=0.003, 0.012), and pleural invasion (p=0.021, 0.025).
Using our custom-developed software, it is feasible to predict the pathological prognostic factors of small peripheral adenocarcinomas.
Lung cancer (Amsterdam, Netherlands) 04/2010; 70(3):286-94. · 3.14 Impact Factor
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ABSTRACT: BUF/Mna rats develop thymomas spontaneously, which histologically mimic human thymomas. Although neoplasms in this rat strain contain a large number of immature lymphocytes, the phenotype has not been sufficiently assessed. We characterized T cell phenotypes in tumors from BUF/Mna rats in the present study. We also analyzed BUF/Mna-Rnu/+ rats, a heterozygous strain with suppressive thymomagenesis, and compared the histology and T cell maturation with those from the BUF/Mna rats. A total of 11 BUF/Mna and 10 BUF/Mna-Rnu/+ rats were used. Three-color flow cytometry was performed with anti-CD3, CD4, and CD8 antibodies to identify infiltrated lymphocytes, while tumor histology was evaluated with hematoxylin-eosin staining. The weight ratios of the entire thymic tissue including thymoma as compared to the BUF/Mna and BUF/Mna-Rnu/+ rat bodies were 0.8+/-0.8% and 1.2+/-1.8%, respectively. Histological findings for both rat congenic strains showed abundant lymphocytes surrounding large polygonal neoplastic thymic epithelia, which was compatible with the type B1 classification of the World Health Organization for human thymoma. CD4+CD8+ T cells accounted for 73.7+/-8.0% of the cells in tumors from BUF/Mna and 67.2+/-9.4% in those from BUF/Mna-Rnu/+ rats. Further, CD3-CD4-CD8+ T cells, intermediate between CD4-CD8-and CD4+CD8+ cells, accounted for 47.7+/-17.5% and 38.0+/-14.0% of the cells in tumors from the BUF/Mna and BUF/Mna-Rnu/+ strains, respectively. Thus, the proportion of developing thymic lymphocytes in and histology of thymomas from BUF/Mna and BUF/Mna-Rnu/+ rats were similar. These results suggest that both BUF/Mna and BUF/ Mna-Rnu/+ strains are suitable animal models for human thymoma to understand the development of immature thymic lymphocytes.
International journal of clinical and experimental pathology 01/2010; 3(6):587-92. · 1.89 Impact Factor
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ABSTRACT: The aim of this study was to determine the computed tomography (CT) values of various pulmonary abnormalities in cubic region of interest (ROI) and square ROI and evaluate the CT findings by histogram analysis in the ROI.
The study included 89 patients with the following 8 pulmonary CT patterns: normal lung, ground-glass attenuation, fine reticular opacity, coarse reticular opacity, honeycombing, airspace consolidation, nodular opacity, and emphysema. Cubic and square ROIs were selected in each CT pattern, and 5 values (contrast, variance, entropy, skewness, and kurtosis) were calculated.
In the histogram of ground-glass attenuation, fine reticular opacity, and coarse reticular opacity, peaks had moved to the right compared with the normal lung. Only emphysema had higher contrast and lower entropy than the normal lung (P < 0.001). The other abnormalities had lower contrast and higher entropy than the normal lung.
In conclusion, the shapes of histograms were characteristic of various abnormalities of the lung, and the values reflected the histogram quantitatively.
Journal of computer assisted tomography 08/2009; 33(5):731-8. · 1.38 Impact Factor
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Tadahisa Daimon,
Kiminori Fujimoto,
Keisuke Tanaka,
Junya Yamamoto,
Kanako Nishimura,
Yuko Tanaka,
Masahiro Yanagawa,
Hiromitsu Sumikawa,
Atsuo Inoue, Osamu Honda,
Noriyuki Tomiyama,
Hironobu Nakamura,
Yukihiko Sugiyama,
Takeshi Johkoh
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ABSTRACT: The aim of this study was to measure the volume of each pulmonary segment by volumetric computed tomography (CT) data using a newly developed three-dimensional software application and to identify the differences between those with chronic obstructive pulmonary disease (COPD) and controls.
CT scans of 11 COPD patients and 16 controls were included. The volume of each pulmonary segment was measured by each of two operators to evaluate the reproducibility of the software. This measured volume was then divided by the total lung volume to revise individual variations.
Volumes of the right (rt) S2, rt S5, left (lt) S1 + S2, lt S3, and lt S5 were significantly larger in COPD patients than in controls (P < 0.05). Regarding the ratio of the volume of each pulmonary segment per total lung volume, the areas of rt S2 and lt S1 + S2 were significantly larger in COPD patients than in controls (P < 0.05), whereas lt S10 was significantly smaller in COPD patients than in controls (P < 0.05).
We measured the volume of each pulmonary segment based on volumetric CT data using this software. In addition, we demonstrated that the upper lung volume of COPD subjects was larger than that of controls, whereas the lower lung volumes were almost the same.
Japanese journal of radiology 05/2009; 27(3):115-22. · 0.65 Impact Factor
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Masahiro Yanagawa, Osamu Honda,
Shigeyuki Yoshida,
Yusuke Ono,
Atsuo Inoue,
Tadahisa Daimon,
Hiromitsu Sumikawa,
Naoki Mihara,
Takeshi Johkoh,
Noriyuki Tomiyama,
Hironobu Nakamura
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ABSTRACT: Most studies of computer-aided detection (CAD) for pulmonary nodules have focused on solid nodule detection. The aim of this study was to evaluate the performance of a commercially available CAD system in the detection of pulmonary nodules with or without ground-glass opacity (GGO) using 64-detector-row computed tomography compared to visual interpretation.
Computed tomographic examinations were performed on 48 patients with existing or suspicious pulmonary nodules on chest radiography. Three radiologists independently reported the location and pattern (GGO, solid, or part solid) of each nodule candidate on computed tomographic scans, assigned each a confidence score, and then analyzed all scans using the CAD system. A reference standard was established by a consensus panel of different radiologists, who found 229 noncalcified nodules with diameters > or = 4 mm. True-positive and false-positive results and confidence levels were used to generate jackknife alternative free-response receiver-operating characteristic plots.
The sensitivity of GGO for 3 radiologists (60%-80%) was significantly higher than that for the CAD system (21%) (McNemar's test, P < .0001). For overall and solid nodules, the figure-of-merit values without and with the CAD system were significantly different (P = .005-.04) on jackknife alternative free-response receiver-operating characteristic analysis. For GGO and part-solid nodules, the figure-of-merit values with the CAD system were greater than those without the CAD system, indicating no significant differences.
Radiologists are significantly superior to this CAD system in the detection of GGO, but the CAD system can still play a complementary role in detecting nodules with or without GGO.
Academic radiology 04/2009; 16(8):924-33. · 2.09 Impact Factor
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Tadahisa Daimon,
Takeshi Johkoh, Osamu Honda,
Hiromitsu Sumikawa,
Kazuya Ichikado,
Yasuhiro Kondoh,
Hiroyuki Taniguchi,
Kiminori Fujimoto,
Masahiro Yanagawa,
Atsuo Inoue,
Noriyuki Tomiyama,
Hironobu Nakamura,
Yukihiko Sugiyama
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ABSTRACT: The purpose of this study was to analyze the CT findings of interstitial lung diseases that are associated with collagen vascular disease (CVD), with particular attention to nonspecific interstitial pneumonia (NSIP), and to examine whether it is possible to predict the clinical diagnosis of CVDs based on the CT findings alone.
CT scans of 49 patients with NSIP associated with CVD (15 males, 34 females; mean age, 55+/-10 years; age range, 25-76 years) were included in this retrospective study. All patients underwent a surgical biopsy. The clinical diagnosis comprised rheumatoid arthritis (RA) (n=15), systemic sclerosis (SSc) (n=8), polymyositis and dermatomyositis (PM/DM) (n=18), Sjögren's syndrome (SjS) (n=4), and mixed connective tissue disease (MCTD) (n=4). Each CT was reviewed by two independent observers who made a clinical diagnosis based on the CT findings alone.
The observers made a correct diagnosis for 22 (45%) of the 49 patients. A correct diagnosis was made for: RA in 7 (47%) of 15 patients; SSc in 3 (38%) of 8 patients; PM/DM in 11 (61%) of 18 patients; SjS in 1 (25%) of 4 patients. None of the 4 MCTD cases was diagnosed.
It is difficult to make a correct clinical diagnosis of the various types of CVDs based solely on CT findings. However, it is probable to make a reasonably accurate clinical diagnosis in cases that show the typical CT findings, especially for PM/DM patients.
Internal Medicine 02/2009; 48(10):753-61. · 0.94 Impact Factor
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Osamu Honda,
Takeshi Johkoh,
Junko Sekiguchi,
Noriyuki Tomiyama,
Naoki Mihara,
Hiromitsu Sumikawa,
Atsuo Inoue,
Masahiro Yanagawa,
Tadahisa Daimon,
Meinoshin Okumura,
Hironobu Nakamura
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ABSTRACT: The aim of the present study was to investigate the difference in doubling time between squamous cell carcinoma (SCC) and adenocarcinoma of solid pulmonary cancer using three-dimensional volumetric software. We included 40 patients with adenocarcinoma and 11 patients with SCC, who underwent CT examinations more than once before surgical treatment. Tumor volumes and doubling times were obtained using three-dimensional volumetric computer software. Statistical analysis was performed using Mann-Whitney's U-test except for negative doubling times (doubling times less than 0 day). Negative doubling time was found in 5 of the 40 adenocarcinomas (13%), but not in any of the patients with SCC. Doubling time was beyond 400 days in 11 of the 40 adenocarcinomas (28%), but was always less than 400 days in SCC. The mean doubling time of SCC was 126+/-58 days (range, 39-221 days; median, 131 days), while that of adenocarcinomas, except for the negative doubling times, was 976+/-3134 days (range, 69-18,678 days; median, 258 days). Doubling time differed significantly between adenocarcinomas and SCC (p<0.01). In conclusion, the median doubling time of SCC lung cancers is less than that of adenocarcinomas, as measured with automated volumetric measurement software.
Lung cancer (Amsterdam, Netherlands) 02/2009; 66(2):211-7. · 3.14 Impact Factor
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Tadahisa Daimon,
Takeshi Johkoh,
Hiromitsu Sumikawa, Osamu Honda,
Kiminori Fujimoto,
Takeharu Koga,
Hiroaki Arakawa,
Masahiro Yanagawa,
Atsuo Inoue,
Naoki Mihara,
Noriyuki Tomiyama,
Hironobu Nakamura,
Yukihiko Sugiyama
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ABSTRACT: To determine thin-section computed tomography (CT) characteristics of acute eosinophilic pneumonia (AEP).
Thin-section CT scans of 29 patients (14 males, 15 females; mean age, 26+/-15 years; age range, 15-72 years) with AEP were included this retrospective study. The clinical diagnosis of AEP was established by Allen's criteria. Each thin-section CT was reviewed by two observers.
Bilateral areas with ground-glass attenuation were observed on thin-section CT in all patients. Areas of air-space consolidation were present in 16 (55%) of 29 patients. Poorly defined centrilobular nodules were present in 9 patients (31%). Interlobular septal thickening was present in 26 patients (90%). Thickening of bronchovascular bundles was present in 19 patients (66%). Pleural effusions were present in 23 patients (79%) (bilateral=22, right side=1, left side=0). The predominant overall anatomic distribution was central in only 2 (7%) of 29 patients, peripheral in 9 patients (31%), and random in 18 patients (62%). The overall zonal predominance was upper in 4 patients (14%), lower in 8 patients (28%), and random in 17 patients (58%).
CT findings in AEP patients consisted mainly of bilateral areas of ground-glass attenuation, interlobular septal thickening, thickening of bronchovascular bundles, and the presence of a pleural effusion without cardiomegaly. The most common overall anatomic distribution and zonal predominance of the abnormal CT findings were random.
European Journal of Radiology 04/2008; 65(3):462-7. · 2.61 Impact Factor
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Hiromitsu Sumikawa,
Takeshi Johkoh,
Kazuya Ichikado,
Hiroyuki Taniguchi,
Yasuhiro Kondoh,
Kiminori Fujimoto,
Masahiro Yanagawa,
Atsuo Inoue,
Naoki Mihara, Osamu Honda,
Noriyuki Tomiyama,
Hironobu Nakamura,
Thomas V Colby
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ABSTRACT: To determine the pathological correlation with various high-resolution CT (HRCT) findings in cases with nonspecific interstitial pneumonia (NSIP), paying special attention to pathological subgroups.
The study involved 29 patients diagnosed with NSIP by surgical lung biopsy. A total of 54 specimens were obtained and grouped according to Katzenstein's classification (groups 1-3) for NSIP. Two observers then evaluated the HRCT findings for every biopsy site and classified the findings according to the main pattern evident into the following four radiologic pattern groups: A, ground-glass attenuation and fine reticulation; B, ground-glass and coarse reticulation; C, consolidation and D, ground-glass attenuation and consolidation.
The pathological pattern was NSIP group 1 in 6 patients, group 2 in 22 and group 3 in 25, while 1 specimen was normal. The main HRCT pattern was pattern A in 15 specimens, B in 8, C in 9 and D in 21. Although there were no significant correlation between HRCT patterns and histological subgroups (Chi-square test, p=0.07), pattern C was more frequently seen in group 2 (7 of 9) and pattern A was more common in group 3 (11 of 15). HRCT pattern A corresponded pathologically to areas of thickened alveolar septa with temporal uniformity. Pattern B correlated with areas with airspace enlargement/emphysema or dilation of small airways superimposed on thickened alveolar septa. Pattern C was pathologically associated with areas of severe thickened alveolar septa, mucin stasis in the small airways and intraluminal organization.
The pathological backgrounds of the same CT findings in patients with NSIP varied among all pathological subgroups. Areas of ground-glass attenuation and air-space consolidation did not always correspond to reversible pathological findings.
European journal of radiology 02/2008; 70(1):35-40. · 2.65 Impact Factor
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Hiromitsu Sumikawa,
Takeshi Johkoh,
Thomas V Colby,
Kazuya Ichikado,
Moritaka Suga,
Hiroyuki Taniguchi,
Yasuhiro Kondoh,
Takashi Ogura,
Hiroaki Arakawa,
Kiminori Fujimoto,
Atsuo Inoue,
Naoki Mihara, Osamu Honda,
Noriyuki Tomiyama,
Hironobu Nakamura,
Nestor L Müller
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ABSTRACT: Patients with a clinicopathological diagnosis of idiopathic pulmonary fibrosis (IPF) may have typical findings of usual interstitial pneumonia (UIP) on computed tomography (CT) or nonspecific or atypical findings, including those often seen in nonspecific interstitial pneumonia.
The aims of this study were to revisit the high-resolution CT findings of IPF and to clarify the correlation between the CT findings and mortality.
The study included 98 patients with a histologic diagnosis of UIP and a clinical diagnosis of IPF. Two observers evaluated the CT findings independently and classified each case into one of the following three categories: (1) definite UIP, (2) consistent with UIP, or (3) suggestive of alternative diagnosis. The correlation between the CT categories and mortality was evaluated using the Kaplan-Meier method and the log-rank test, as well as Cox proportional hazards regression models.
Thirty-three of the 98 CT scans were classified as definite UIP, 36 as consistent with UIP, 29 as suggestive of an alternative diagnosis. The mean survival was 45.7, 57.9, and 76.9 months, respectively. There was no significant difference in survival among the three categories (all P > 0.05). Traction bronchiectasis and fibrosis scores were significant predictors of outcome (hazard ratios: 1.30 and 1.10, respectively; 95% confidence intervals: 1.18-14.2 and 1.03-1.19, respectively).
In patients with IPF and UIP pattern on the biopsy, the pattern of abnormality on thin-section CT, whether characteristic of UIP or suggestive of alternative diagnosis, does not influence prognosis. Prognosis is influenced by traction bronchiectasis and fibrosis scores.
American Journal of Respiratory and Critical Care Medicine 02/2008; 177(4):433-9. · 11.08 Impact Factor
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Hiromitsu Sumikawa,
Takeshi Johkoh,
Tomofumi Nagareda,
Junko Sekiguchi,
Kumiko Matsuo,
Yuka Fujita,
Javzandulam Natsag,
Atsuo Inoue,
Naoki Mihara, Osamu Honda,
Noriyuki Tomiyama,
Masato Minami,
Meinoshin Okumura,
Hironobu Nakamura
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ABSTRACT: The purpose of this study was to evaluate software designed to calculate whole tumor volumes and the ratio of the solid component to whole volume (%solid) in pulmonary nodules with ground-glass opacity in three dimensions.
The study included 49 patients with histologically diagnosed adenocarcinomas smaller than 2 cm in diameter. The %solid was calculated both automatically using new software, and by manual measurement of the following four parameters by two observers: the ratio of the largest diameter (a) and the area (b) at the mediastinal window to those at the lung window, and the ratio of the largest diameter (c) and the area (d) of the solid component to those of the ground-glass component at the lung window. Agreement of intra- and inter-observer data by both Spearman's rank correlation test and Bland-Altman's method, and a comparison by Spearman's rank correlation test of the %solid in both Noguchi sub-classifications and vessel invasion in histologic specimens, between the software and manual methods, were assessed.
Of the 49 nodules, 48 were successfully measured and assessed. The agreement of the observers with the software was better (Bland-Altman's method; mean difference, -0.3%; 95% limits of agreement, -3.1 to 2.5%) than with the manual measurements (a: 5.3%, -17.6 to 28.3%; b: 8.3%, -10.6 to 26.9%; c: 10.7%, -17.6 to 39%; d: 6.4%, -22 to 34.8%). The correlation between %solid and the histological group was worse with the software (Spearman's rank correlation test; r=0.487, p<0.001) than with the manual method (a, r=0.534; b, r=0.557; c, r=0.552; d, r=0.545).
Although the software requires improvement in the calculation of %solid with volumetric analysis, this is a reproducible and promising quantitative method for determining the grades of malignancy of small lung cancers.
European Journal of Radiology 01/2008; 65(1):104-11. · 2.61 Impact Factor
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Motoko Nishiura,
Takeshi Johkoh,
Shuji Yamamoto, Osamu Honda,
Takenori Kozuka,
Mitsuhiro Koyama,
Noriyuki Tomiyama,
Seiki Hamada,
Takamichi Murakami,
Takashi Matsumoto,
Yoshifumi Narumi,
Hironobu Nakamura
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ABSTRACT: The aim of this study was to evaluate the decreasing of cardiac motion artifact and whether the extent of ground-glass attenuation of idiopathic pulmonary fibrosis (IPF) was accurately assessed by electrocardiography (ECG)-triggered high-resolution computed tomography (HRCT) by 0.5-s/rotation multidetector-row CT (MDCT).
ECG-triggered HRCT were scanned at the end-diastolic phase by a MDCT scanner with the following scan parameters; axial four-slice mode, 0.5 mm collimation, 0.5-s/rotation, 120 kVp, 200 mA/rotation, high-frequency algorithm, and half reconstruction. In 42 patients with IPF, both conventional HRCT (ECG gating(-), full reconstruction) and ECG-triggered HRCT were performed at the same levels (10-mm intervals) with the above scan parameters. The correlation between percent diffusion of carbon monoxide of the lung (%DLCO) and the mean extent of ground-glass attenuation on both conventional HRCT and ECG-triggered HRCT was evaluated with the Spearman rank correlation coefficient test.
The correlation between %DLCO and the mean extent of ground-glass attenuation on ECG-triggered HRCT (observer A: r = -0.790, P < 0.0001; observer B: r = -0.710, P < 0.0001) was superior to that on conventional HRCT (observer A: r = -0.395, P < 0.05; observer B: r = -0.577, P = 0.002) for both observers.
ECG-triggered HRCT by 0.5 s/rotation MDCT can reduce the cardiac motion artifact and is useful for evaluating the extent of ground-glass attenuation of IPF.
Radiation Medicine 12/2007; 25(10):523-8.
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ABSTRACT: Motion artifacts, which can mimic thickened bronchial wall and the cystic appearance of bronchiectasis, constitute a potential pitfall in the diagnosis of interstitial or bronchial disease. Therefore, purpose of our study was to evaluate whether 64-detector row CT (64-MDCT) enables a reduction in respiratory or cardiac motion artifacts in the lung area on thin-section CT without ECG gating, and to examine the correlation between cardiac motion artifact and heart rate.
Thirty-two patients with suspected diffuse lung disease, who underwent both 8- and 64-MDCT (gantry rotation time, 0.5 and 0.4s, respectively), were included. The heart rates of an additional 155 patients were measured (range, 48-126 beats per minute; mean, 76 beats per minute) immediately prior to 64-MDCT, and compared to the degree of cardiac motion artifact. Two independent observers evaluated the following artifacts on a monitor without the knowledge of relevant clinical information: (1) artifacts on 8- and 64-MDCT images with 1.25-mm thickness and those on 64-MDCT images with 0.625-mm thickness in 32 patients; and (2) artifacts on 64-MDCT images with 0.625-mm thickness in 155 patients.
Interobserver agreement was good in evaluating artifacts on 8-MDCT images with 1.25-mm thickness (weighted Kappa test, kappa=0.61-0.71), and fair or poor in the other evaluations (kappa<0.31). Two observers stated that cardiac motion artifacts were more significant on 8-MDCT than on 64-MDCT in all 32 patients. Statistically significant differences were found at various checkpoints only in comparing artifacts between 8- and 64-MDCT for 1.25-mm thickness (Wilcoxon's signed-rank test, p<0.0017). Cardiac motion artifacts on 64-MDCT had no significant correlation with heart rate (Spearman's correlation coefficient by rank test).
The high temporal resolution of 64-MDCT appears to reduce cardiac motion artifact that can affect thin-section scans of the lung parenchyma.
European journal of radiology 12/2007; 69(1):102-7. · 2.65 Impact Factor
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Osamu Honda,
Takeshi Johkoh,
Hiromitsu Sumikawa,
Atsuo Inoue,
Noriyuki Tomiyama,
Naoki Mihara,
Yuka Fujita,
Mitsuko Tsubamoto,
Masahiro Yanagawa,
Tadahisa Daimon,
Javzandulam Natsag,
Hironobu Nakamura
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ABSTRACT: To retrospectively evaluate the effect of contrast medium on the three-dimensional volumetric measurement of pulmonary nodules.
The study was approved by the local institutional review committee, with waiver of informed consent. Sixty pulmonary nodules in 60 patients (17 women, 43 men; age range, 29-82 years) were imaged before and after administration of contrast medium with a 64-channel multidetector computed tomographic (CT) scanner; reconstructed images with a section thickness of 0.625 mm were obtained by using a bone algorithm and a standard algorithm. Volumetric measurements of pulmonary nodules were performed by using commercially available software, and the postcontrast volume ratio was calculated by dividing the postcontrast volume by the precontrast volume. Precontrast and postcontrast volumes were then analyzed by using a Wilcoxon signed rank test.
The median measured volumes of pulmonary nodules were 817 mm(3) (precontrast imaging, bone algorithm), 887 mm(3) (postcontrast imaging, bone algorithm), 812 mm(3) (precontrast imaging, standard algorithm), and 855 mm(3) (postcontrast imaging, standard algorithm). The measured volumes obtained with the bone algorithm were significantly larger than those obtained with the standard algorithm, both before and after administration of contrast medium (P < .01); with both the standard algorithm and the bone algorithm, the measured postcontrast volumes were significantly larger than the precontrast volumes (P < .01). The postcontrast volume ratio was more than 1.0 in 45 cases (75%) when the bone algorithm was used and in 53 cases (88%) when the standard algorithm was used. The mean postcontrast volume ratio was 1.054 with the bone algorithm and 1.065 with the standard algorithm.
The measured volume of pulmonary nodules obtained by using three-dimensional volumetric software increased after administration of contrast medium. Moreover, the measured volume of pulmonary nodules that was obtained with the bone algorithm was larger than that obtained with the standard algorithm, regardless of whether contrast medium was used.
Radiology 12/2007; 245(3):881-7. · 5.73 Impact Factor
