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ABSTRACT: ABSTRACT BACKGROUND: Little is known about the histopathology and prognosis of persistent pure ground-glass opacity (GGO) nodules of ≥ 10 mm in diameter. We aimed to compare the morphologic features of persistent pure GGO nodules (GGNs) of ≥ 10 mm in diameter at thin-section CT (TSCT) with histopathology and patient prognosis. METHODS: A total of 46 resected GGNs that were evaluated with TSCT and followed up for ≥ three years were included in this study. Correlations between histopathology (adenocarcinoma in situ [AIS], minimally invasive adenocarcinoma [MIA], and invasive adenocarcinoma) and CT characteristics were examined. CT and clinico-demographic data were investigated by univariate and multivariate analyses to identify features that helped distinguish invasive adenocarcinoma from AIS or MIA. Disease recurrence was also evaluated. RESULTS: The nodules included 19 AISs (41%), 9 MIAs (20%), and 18 invasive adenocarcinomas (39%). On univariate analysis, the presence of air bronchogram (P = .012), size of nodule (P = .032, cut off = 16.4 mm in diameter) and mass of nodule (P = .040, cut off = 0.472 g) were significant factors that differentiated invasive adenocarcinoma from AIS or MIA. On multivariate analysis, size (P = .010) and mass of nodule (P = .016) were significant determinants for invasive adenocarcinoma. There were no cases of recurrence during a follow-up period of ≥ 3 years after surgical resection. CONCLUSIONS: In persistent pure GGNs of ≥ 10 mm in diameter, size and mass of the nodule are determinants of invasive adenocarcinoma, for which surgical resection leads to excellent prognosis.
Chest 05/2013; · 5.25 Impact Factor
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ABSTRACT: Background
Digital tomosynthesis considerably reduces problems created by overlapping anatomy compared with chest X-ray (CXR). However, digital tomosynthesis requires a longer scan time compared with CXR, and thus may be vulnerable to motion artifacts.PurposeTo compare the diagnostic performance of digital tomosynthesis in subjects with and without respiratory motion artifacts.Material and Methods
The institutional review board approved this retrospective study, and the requirement for written informed consent was waived. A total of 46 subjects with imaging containing respiratory motion artifacts were enrolled in this study, 18 of whom were positive and 28 of whom were negative for lung nodules on computed tomography (CT). The control group was comprised of 92 age-matched subjects with imaging devoid of motion artifacts. Of these, 36 were positive and 56 were negative for lung nodules on subsequent CT scan. The size criteria of nodules were 4-10 mm. Three chest radiologists independently evaluated the radiographs and digital tomosynthesis images for the presence of pulmonary nodules. Multireader multicase receiver-operating characteristic (ROC) analyses was used for statistical comparisons.ResultsWithin the control group, the areas under curve (AUC) for observer performances in detecting lung nodules on digital tomosynthesis was higher than that on CXR (P = 0.017). Within the study group, there were no significant differences in AUCs for observer performances (P = 0.576).Conclusion
When no motion artifacts are present, the detection performance of nodules (4-10 mm) on digital tomosynthesis is significantly better than that on CXR, whereas there is not a significant difference in cases with motion artifacts.
Acta Radiologica 03/2013; · 1.37 Impact Factor
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Byung Woo Jhun,
Kyung-Jong Lee,
Kyeongman Jeon,
Gee Young Suh,
Man Pyo Chung,
Hojoong Kim,
O Jung Kwon,
Jong-Mu Sun,
Jin Seok Ahn,
Myung-Ju Ahn,
Keunchil Park,
Joon Young Choi, Kyung Soo Lee,
Joungho Han,
Sang-Won Um
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ABSTRACT: The two-stage system of limited and extensive disease has been widely employed for small cell lung cancer (SCLC). However, the International Association for the Study of Lung Cancer has proposed that the TNM classification should be incorporated into clinical practice. The purpose of this study was to evaluate the applicability of the Union for International Cancer Control (UICC) 7th TNM staging system to SCLC. We retrospectively reviewed the medical records of consecutive patients with newly diagnosed histologically proven SCLC between March 2005 and January 2010. Patients who had other concurrent malignancies or had combined-type SCLC were excluded. We assessed overall survival (OS) according to the T descriptor, N descriptor, M descriptor, and TNM stage grouping. In total, 320 SCLC patients were included. Median age was 65 years and 286 patients (89.4%) were male. Median OS was 12.7 months. There were no significant differences in OS according to the T descriptor (P=0.880). However, there were significant differences in OS according to the N (P<0.001) and M (P<0.001) descriptors and TNM stage grouping (P<0.001). Hazard ratios for OS, adjusted for known prognostic factors, differed significantly according to the N and M descriptor, and TNM stage grouping, but not according to the T descriptors. The UICC 7th TNM staging system may contribute to a more precise prognosis in SCLC patients. Further studies are required to evaluate the applicability of the TNM staging system to SCLC.
Lung cancer (Amsterdam, Netherlands) 03/2013; · 3.14 Impact Factor
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ABSTRACT: BACKGROUND: The objective of this study was to assess whether coregistered whole brain (WB) magnetic resonance imaging-positron emission tomography (MRI-PET) would increase the number of correctly upstaged patients compared with WB PET-computed tomography (PET-CT) plus dedicated brain MRI in patients with nonsmall cell lung cancer (NSCLC). METHODS: From January 2010 through November 2011, patients with NSCLC who had resectable disease based on conventional staging were assigned randomly either to coregistered MRI-PET or WB PET-CT plus brain MRI (ClinicalTrials.gov trial NCT01065415). The primary endpoint was correct upstaging (the identification of lesions with higher tumor, lymph node, or metastasis classification, verified with biopsy or other diagnostic test) to have the advantage of avoiding unnecessary thoracotomy, to determine appropriate treatment, and to accurately predict patient prognosis. The secondary endpoints were over staging and under staging compared with pathologic staging. RESULTS: Lung cancer was correctly upstaged in 37 of 143 patients (25.9%) in the MRI-PET group and in 26 of 120 patients (21.7%) in the PET-CT plus brain MRI group (4.2% difference; 95% confidence interval, -6.1% to 14.5%; P = .426). Lung cancer was over staged in 26 of 143 patients (18.2%) in the MRI-PET group and in 7 of 120 patients (5.8%) in the PET-CT plus brain MRI group (12.4% difference; 95% confidence interval, 4.8%-20%; P = .003), whereas lung cancer was under staged in 18 of 143 patients (12.6%) and in 28 of 120 patients (23.3%), respectively (-10.7% difference; 95% confidence interval, -20.1% to -1.4%; P = .022). CONCLUSIONS: Although both staging tools allowed greater than 20% correct upstaging compared with conventional staging methods, coregistered MRI-PET did not appear to help identify significantly more correctly upstaged patients than PET-CT plus brain MRI in patients with NSCLC. Cancer 2013;. © 2013 American Cancer Society.
Cancer 02/2013; · 4.77 Impact Factor
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ABSTRACT: A pulmonary mucinous cystadenocarcinoma is an extremely rare tumor that is considered to be a cystic variant of mucin-producing lung adenocarcinoma. We present a case of pulmonary mucinous cystadenocarcinoma in a 54-year-old woman. Chest CT scans showed a 4.3-cm-sized, lobulated, well-defined, and homogeneous mass in the right middle lobe with peripheral stippled calcifications that demonstrated low-attenuation with no enhancement after contrast administration; 18F-fluorodeoxyglucose (FDG) PET/CT demonstrated mild heterogeneous FDG uptake. The mass was diagnosed as adenocarcinoma with mucin production by transbronchial lung biopsy. Right middle lobectomy was performed, and the pathologic examination disclosed a pulmonary mucinous cystadenocarcinoma.
Korean journal of radiology: official journal of the Korean Radiological Society 01/2013; 14(2):384-388. · 1.32 Impact Factor
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ABSTRACT: To determine the optimum low dose (LD) digital tomosynthesis (DT) setting, and to compared the image quality of the LD DT with that of the standard default (SD) DT.
Nine DT settings, by changing tube voltage, copper filter, and dose ratio, were performed for determining the LD setting. Among combinations of DT setting, a condition providing the lowest radiation dose was determined. Eighty artificial nodules less than 1 cm in diameter (subcentimeter nodules: 40, micronodules less than 4 mm: 40) were attached to a Styrofoam and a diaphragm of the phantom. Among these, 38 nodules were located at the periphery of the lung (thin area) and 42 nodules were located at the paravertebral or sub-diaphragmatic area (thick area). Four observers counted the number of nodules detected in the thick and thin areas. The detection sensitivity in SD and LD settings were calculated separately. Data were analyzed statistically.
The lowest LD setting was a combination of 100 kVp, 0.3 mm additional copper filter, and a 1 : 5 dose ratio. The effective dose for the LD and SD settings were 62 µSv and 140 µSv, separately. A 56.7% dose reduction was achieved in the LD setting compared with the SD setting. Detection sensitivities were not different between the SD and the LD settings except between observers 1 and 2 for the detection of micronodules in the thick area.
LD DT can be effective in nodule detection bigger than 4 mm without a significant decrease in image quality compared with SD DT.
Korean journal of radiology: official journal of the Korean Radiological Society 01/2013; 14(3):525-531. · 1.32 Impact Factor
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ABSTRACT: The objective of this study was to evaluate the clinicoradiological findings of thoracic Castleman disease.
The study included 34 patients (22 male and 12 female patients; mean age, 32 [SD, 18.1] years) with thoracic Castleman disease. Clinicoradiological findings of the 34 patients were analyzed. Regarding computed tomography findings, lesion number, location, degree of enhancement (moderate, >20 Hounsfield units than back muscle enhancement; high, >40 Hounsfield units), and associated findings were recorded.
Of 34 patients, hyaline-vascular type (HVT) was found in 27 patients (79%), plasma cell type (PCT) in 5 patients (15%), and mixed type (6%) in 2 patients. In HVTs (n = 27), lesions were found, in decreasing order, in the lower neck (n = 9, 33%), pulmonary hilum (n = 6, 22%), and the upper paratracheal area (n = 4, 15%). Ten (37%) of 27 HVT patients had symptoms, whereas all (100%) with PCT had generalized symptoms. In 26 (96%) of 27 HVT patients, disease was unicentric, whereas it was multicentric in all PCT patients. Moderate to high degree of lesion enhancement was seen in 22 (92%) of 24 HVT patients and 4 (80%) of 5 PCT patients. Feeding vessels or draining veins were identified in 12 (44%) of 27 HVT patients and 2 (40%) of 5 PCT patients. The diseases were cured with surgical removal in HVT, whereas they showed variable prognosis in PCT.
Irrespective of subtypes, Castleman disease is characterized radiologically by unicentric or multicentric enhancing lymph node enlargement; in HVT, they show good prognosis after surgical treatment, but in PCT, they show variable prognosis.
Journal of computer assisted tomography 01/2013; 37(1):1-8. · 1.38 Impact Factor
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Takeyuki Watadani,
Fumikazu Sakai,
Takeshi Johkoh,
Satoshi Noma,
Masanori Akira,
Kiminori Fujimoto,
Alexander A Bankier, Kyung Soo Lee,
Nestor L Müller,
Jae-Woo Song,
Jai-Soung Park,
David A Lynch,
David M Hansell,
Martine Remy-Jardin,
Tomás Franquet,
Yukihiko Sugiyama
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ABSTRACT: Purpose:To quantify observer agreement and analyze causes of disagreement in identifying honeycombing at chest computed tomography (CT).Materials and Methods:The institutional review board approved this multiinstitutional HIPAA-compliant retrospective study, and informed patient consent was not required. Five core study members scored 80 CT images with a five-point scale (5 = definitely yes to 1 = definitely no) to establish a reference standard for the identification of honeycombing. Forty-three observers from various subspecialties and geographic regions scored the CT images by using the same scoring system. Weighted κ values of honeycombing scores compared with the reference standard were analyzed to investigate intergroup differences. Images were divided into four groups to allow analysis of imaging features of cases in which there was disagreement: agreement on the presence of honeycombing, agreement on the absence of honeycombing, disagreement on the presence of honeycombing, and other (none of the preceding three groups applied).Results:Agreement of scores of honeycombing presence by 43 observers with the reference standard was moderate (Cohen weighted κ values: 0.40-0.58). There were no significant differences in κ values among groups defined by either subspecialty or geographic region (Tukey-Kramer test, P = .38 to >.99). In 29% of cases, there was disagreement on identification of honeycombing. These cases included honeycombing mixed with traction bronchiectasis, large cysts, and superimposed pulmonary emphysema.Conclusion:Identification of honeycombing at CT is subjective, and disagreement is largely caused by conditions that mimic honeycombing.© RSNA, 2012.
Radiology 12/2012; · 5.73 Impact Factor
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ABSTRACT: The purpose of this study was to discern differences in the clinical and radiologic presentations of intrathoracic tuberculous lymphadenitis in adult patients with and those without HIV infection.
Between 2000 and 2010, 66 patients (28 men, 38 women; mean age, 45 ± 13.9 years) were found to have intrathoracic tuberculous lymphadenitis. Of these patients, 17 (26%) (15 men, two women; mean age, 47 ± 9.9 years) were HIV-seropositive. Thoracic CT scans were evaluated for involved lymph node stations, long-axis diameter of involved lymph nodes, presence of central necrosis in enlarged nodes, and other associated findings.
In HIV-positive patients, tuberculous lymphadenitis had more multifocal (mean number of involved nodal stations, 8.4 versus 3.6; p < 0.001) nodal involvement, had smaller nodes (mean long-axis diameter, 17 mm versus 21 mm; p = 0.004), and was more frequently associated with lung parenchymal lesions and extrathoracic lymph node and organ involvement (p < 0.05) than in HIV-negative patients. Tuberculous lymphadenitis was the sole manifestation of tuberculous infection in 22 of 49 (45%) HIV-negative patients and in 2 of 17 (12%) HIV-positive patients (p = 0.018).
Tuberculous lymphadenitis in patients with HIV infection is characterized by multiple-station lymphadenitis with extensive lung parenchymal, extrathoracic lymph node, and extrathoracic organ involvement.
American Journal of Roentgenology 12/2012; 199(6):1234-40. · 2.78 Impact Factor
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ABSTRACT: This retrospective study evaluates serial changes of lung abnormalities on high-resolution CT (HRCT) and clarifies prognostic determinants among CT findings in fibrotic idiopathic interstitial pneumonias (IIPs) with little honeycombing.
We enrolled 154 patients with a histologic diagnosis of a fibrotic IIP (< 5% honeycombing on CT) who were followed clinically for at least 2 years. One hundred one patients had usual interstitial pneumonia (UIP) and 53 had fibrotic nonspecific interstitial pneumonia (NSIP). On baseline CT, the extent and distribution of lung abnormalities were visually assessed, and serial CT scans were evaluated with a follow-up period of at least 6 months (n = 132).
Significant differences were noted in the extent of reticulation and ground-glass opacification (GGO) between the UIP and fibrotic NSIP groups (p < 0.001). On serial scans, honeycombing (5% in UIP and 3% in fibrotic NSIP; p = 0.08) and reticulation (3% in UIP and 8% in fibrotic NSIP; p = 0.03) progressed in extent and GGO (-2% in UIP and -10% in fibrotic NSIP; p = 0.009) decreased in extent. Overall extent of lesions increased in UIP (6%) and decreased in NSIP (-4%) (p = 0.04). On univariate and multivariate Cox proportional hazards analysis, the overall extent of parenchymal abnormalities was a prognostic factor predictive of poor survival duration.
Even in cases of fibrotic IIP with little honeycombing, serial CT reveals an increase in the extent of honeycombing and reticulation and a decrease in extent of GGO. Overall extent of lung fibrosis on the baseline CT examination appears predictive of survival in fibrotic IIP with little honeycombing.
American Journal of Roentgenology 11/2012; 199(5):982-9. · 2.78 Impact Factor
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ABSTRACT: To evaluate tumor responses in patients treated with anti-angiogenic agents for non-small cell lung cancer (NSCLC) by assessing intratumoral changes using a dual-energy CT (DECT) (based on Choi's criteria) and to compare it to traditional Response Evaluation Criteria in Solid Tumors (RECIST) criteria.
Ten NSCLC patients treated with bevacizumab underwent DECT. Tumor responses to anti-angiogenic therapy were assessed and compared with the baseline CT results using both RECIST (size changes only) and Choi's criteria (reflecting net tumor enhancement). Kappa statistics was used to evaluate agreements between tumor responses assessed by RECIST and Choi's criteria.
The weighted κ value for the comparison of tumor responses between the RECIST and Choi's criteria was 0.72. Of 31 target lesions (21 solid nodules, 8 lymph nodes, and two ground-glass opacity nodules [GGNs]), five lesions (16%) showed discordant responses between RECIST and Choi's criteria. Iodine-enhanced images allowed for a distinction between tumor enhancement and hemorrhagic response (detected in 14% [4 of 29, excluding GGNs] of target lesions on virtual nonenhanced images).
DECT may serve as a useful tool for response evaluation after anti-angiogenic treatment in NSCLC patients by providing information on the net enhancement of target lesions without obtaining non-enhanced images.
Korean journal of radiology: official journal of the Korean Radiological Society 11/2012; 13(6):702-10. · 1.32 Impact Factor
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ABSTRACT: BACKGROUND: The role of (18) F-fluorodeoxyglucose positron emission tomography/computed tomography ((18) F-FDG PET/CT) in evaluating pulmonary artery lesions has not yet been established. The purpose of this study is to evaluate the usefulness of (18) F-FDG PET/CT imaging in differentiating malignant from benign pulmonary artery (PA) lesions. METHODS: In this retrospective study, 18 subjects with 26 low-attenuated filling defects suspicious for PA malignancy on contrast-enhanced chest CT were enrolled; all of whom subsequently underwent (18) F-FDG PET/CT. The maximum standardized uptake value (SUVmax) for all PA lesions, defined as the (18) F-FDG uptake, was measured. The final diagnosis was then determined by pathological findings, follow-up chest CT or clinical follow-up, and compared with the PET imaging. RESULTS: In total, 6 PA sarcomas, 5 tumour embolism, and 15 pulmonary thromboembolism (PTE) occurred in this cohort. Not only was the SUVmax of the malignant PA lesions (10.2 ± 10.8) was significantly higher than that associated with PTE (1.7 ± 0.3; P < 0.001), no overlap occurred between groups. Conversely, no statistically significant difference in SUVmax occurred between PA sarcomas (12.8 ± 14.7) and tumour embolism (7.0 ± 1.32; P = 1.000). CONCLUSIONS: (18) F-FDG PET/CT is a useful imaging modality for differentiating malignant from benign PA lesions in patients with inconclusive low-attenuation filling defects on contrast-enhanced chest CT.
ANZ Journal of Surgery 09/2012; · 1.25 Impact Factor
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ABSTRACT: We retrospectively analyzed the CT features of late-onset noninfectious pulmonary complications in patients with pathologically proven graft-versus-host disease (GVHD) after allogeneic stem cell transplant (SCT).
We analyzed the CT features of late-onset noninfectious pulmonary complications in 14 patients with pathologic diagnoses of GVHD who survived disease free for more than 3 months after SCT. Late-onset noninfectious pulmonary complications were diagnosed by excluding pulmonary infection in these patients with respiratory symptoms and signs. The presence, extent, and distribution of CT features were evaluated in terms of geographic hypoattenuation, expiratory airtrapping, ground-glass attenuation (GGA), reticulation, crazy paving pattern, bronchiectasis, nodules, and honeycombing. Further disease classification was made on the basis of clinical, radiologic, and pulmonary function test results and histologic findings. The longitudinal changes of late-onset noninfectious pulmonary complications were followed with CT.
The 14 patients with late-onset noninfectious pulmonary complications were classified into subgroups with bronchiolitis obliterans (BO) (n = 7), nonclassifiable interstitial pneumonia (n = 5), and combined BO and nonclassifiable interstitial pneumonia (n = 2). The CT features of nonclassifiable interstitial pneumonia were GGA (5/7, 71%), reticulation (4/7, 57%), and crazy paving pattern (4/7, 57%) with a peribronchovascular distribution (6/7, 86%). All patients with nonclassifiable interstitial pneumonia had progression of disease with an increased extent of traction bronchiectasis, reticulation, and honeycombing on follow-up CT scans (median follow-up period, 22 months).
Although not commonly encountered, nonclassifiable interstitial pneumonia as a pattern of chronic GVHD should be included in the differential diagnosis of unexplained peribronchial GGA or progressive traction bronchiectasis after SCT.
American Journal of Roentgenology 09/2012; 199(3):581-7. · 2.78 Impact Factor
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Hyun Jung Yoon,
Ho Yun Lee, Kyung Soo Lee,
Yoon-La Choi,
Myung-Ju Ahn,
Keunchil Park,
Jin Seok Ahn,
Jong-Mu Sun,
Jhingook Kim,
Tae Sung Kim,
Myung Jin Chung,
Chin A Yi
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ABSTRACT: Purpose:To evaluate the feasibility and safety of repeat biopsy for mutational analysis in patients with non-small cell lung cancer (NSCLC) who have a resistance history to previous chemotherapy.Materials and Methods:This prospective study was institutional review board approved, and written informed consent was obtained from all patients. Of 126 patients referred for repeat biopsy (hereafter, rebiopsy) with NSCLC that was resistant to conventional chemotherapy or epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors, 94 patients (31 men, 63 women; mean age ± standard deviation, 57 years ± 10.3) were selected for rebiopsy. Thirty-two patients were excluded for several reasons after strict review of the chest computed tomography (CT) images. Percutaneous transthoracic lung biopsy was performed with C-arm cone-beam CT guidance. The technical success rates for the rebiopsy and the adequacy rates of specimens for mutational analysis were evaluated. Any biopsy-related complications were recorded.Results:The technical success rate for biopsy was 100%. In 75 (80%) of 94 patients, specimens were adequate for mutational analysis. Of 75 specimens, 35 were tested for EGFR mutation, 34 for anaplastic lymphoma kinase gene (ALK) rearrangement, and six for both. The results were positive for EGFR-sensitizing mutation (exon 19 or 21) in 20, for EGFR T790M mutation in five, and for ALK rearrangement in 11. Postprocedural complications occurred in 13 (14%) of 94 patients.Conclusion:When performed by employing rigorous CT criteria, rebiopsies for the mutational analysis of NSCLCs treated previously with chemotherapy are feasible in all patients and are adequate in approximately four-fifths of patients referred for gene analysis, with acceptable rates of complications.© RSNA, 2012.
Radiology 08/2012; · 5.73 Impact Factor
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Journal of Pediatric Surgery 08/2012; 47(8):1629. · 1.45 Impact Factor
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ABSTRACT: To evaluate the usefulness of histopathologic scoring for survival prediction in patients with solitary pulmonary nodular (SPN) lung adenocarcinomas and to correlate the histopathologic scoring with the results of computed tomography (CT) and fluorine 18 fluorodeoxyglucose positron emission tomography (PET)/CT.
This retrospective study was institutional review board approved and the requirement for informed consent was waived. A total of 148 patients with SPN lung adenocarcinoma underwent PET/CT and CT. Correlations between histopathologic scores estimated by using two predominant histologic subtypes from each surgically resected specimen and the mass of the nodule at CT or maximum standardized uptake value (SUV(max)) at PET/CT were assessed. Disease-free survival (DFS) was estimated by using the Kaplan-Meier method, and the log-rank test was used to evaluate differences in each histopathologic subtype.
In 135 (91%) patients, tumors had a mixed subtype. The most frequently observed histologic subtypes, in decreasing order, were acinar (51%), lepidic (18%), solid (10%), and papillary (9%). DFS rates at 5 years were higher than 90% for the group of patients with nodules that showed the lepidic growth pattern, and 50% for patients with nodules that showed the micropapillary pattern. The pathologic score proved to be a significant predictor of DFS (P < .001). Both SUV(max) and the mass of the nodule were closely correlated with pathologic score.
Pathologic scoring appears to help predict DFS in patients with SPN lung adenocarcinoma and shows close correlation with imaging biomarkers including the mass of the nodule at CT and SUV(max) at PET/CT.
Radiology 07/2012; 264(3):884-93. · 5.73 Impact Factor
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Boksoon Chang,
Jung Hye Hwang,
Yoon-Ho Choi,
Man Pyo Chung,
Hojoong Kim,
O Jung Kwon,
Ho Yun Lee, Kyung Soo Lee,
Young Mog Shim,
Joungho Han,
Sang-Won Um
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ABSTRACT: ABSTRACT BACKGROUND: Although focal ground-glass opacity lung nodules are generally reported to grow slowly, their natural course is unclear. The purpose of this study was to elucidate the natural course of screening-detected pure ground-glass opacity lung nodules in patients with no history of malignancy. METHODS: We retrospectively reviewed the database of subjects who had undergone screenings involving low-dose computed tomography scans. We included patients with pure ground-glass opacity lung nodules who were followed for more than two years after the initial screening. RESULTS: Between June 1997 and September 2006, 122 pure ground-glass opacity nodules were found in 89 patients. The median nodule size was 5.5 (3-20) mm in the largest diameter on initial low-dose computed tomography scan. The median follow-up period per patient was 59 months. On a per-person basis, the frequency of growth was 13.5% (12/89). On a per-nodule basis, the frequency of growth was 9.8% (12/122). Nodule growth was significantly associated with initial size and new development of an internal solid portion. The median volume doubling time was 769 for growing pure ground-glass opacity nodules. A total of 11 growing nodules were surgically validated and all lesions were confirmed as primary lung cancer. CONCLUSIONS: About 90% of the screening-detected pure ground-glass opacity lung nodules did not grow during long-term follow-up in subjects with no history of malignancy and most of growing nodules had an indolent clinical course. A strategy of long-term follow-up and selective surgery for growing nodules should be considered for pure ground-glass opacity lung nodules.
Chest 07/2012; · 5.25 Impact Factor
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ABSTRACT: Tumor response may be assessed readily by the use of Response Evaluation Criteria in Solid Tumor version 1.1. However, the criteria mainly depend on tumor size changes. These criteria do not reflect other morphologic (tumor necrosis, hemorrhage, and cavitation), functional, or metabolic changes that may occur with targeted chemotherapy or even with conventional chemotherapy. The state-of-the-art multidetector CT is still playing an important role, by showing high-quality, high-resolution images that are appropriate enough to measure tumor size and its changes. Additional imaging biomarker devices such as dual energy CT, positron emission tomography, MRI including diffusion-weighted MRI shall be more frequently used for tumor response evaluation, because they provide detailed anatomic, and functional or metabolic change information during tumor treatment, particularly during targeted chemotherapy. This review elucidates morphologic and functional or metabolic approaches, and new concepts in the evaluation of tumor response in the era of personalized medicine (targeted chemotherapy).
Korean journal of radiology: official journal of the Korean Radiological Society 07/2012; 13(4):371-90. · 1.32 Impact Factor
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ABSTRACT: Abstract BACKGROUND:Mycobacterium avium and Mycobacterium intracellulare are grouped together as the M. avium complex; however, little is known regarding the clinical impact of this species differentiation. This study compared the clinical features and prognoses of patients with M. avium and M. intracellulare lung disease. METHODS:From 2000 to 2009, a total of 590 patients were newly diagnosed with M. avium complex lung disease: 323 (55%) patients had M. avium lung disease, and 267 (45%) patients had M. intracellulare lung disease. RESULTS:Compared with the patients with M. avium lung disease, the patients with M. intracellulare lung disease were more likely to exhibit the following characteristics: older age (64 vs. 59 years, P = 0.002); a lower body mass index (19.5 vs. 20.6 kg/m(2), P < 0.001); respiratory symptoms such as cough (84 vs. 74%, P = 0.005); a history of previous treatment for tuberculosis (51 vs. 31%, P < 0.001); the fibrocavitary form of the disease (26 vs. 13%, P < 0.001); smear-positive sputum (56 vs. 38%, P < 0.001); antibiotic therapy during the 24 months of follow-up (58% vs. 42%, P < 0.001); and an unfavorable microbiologic response after combination antibiotic treatment (56 vs. 74%, P = 0.001). CONCLUSIONS:Patients with M. intracellulare lung disease exhibited a more severe presentation and had a worse prognosis than patients with M. avium lung disease in terms of disease progression and treatment response. Therefore, species differentiation between M. avium and M. intracellulare may have prognostic and therapeutic implications.
Chest 05/2012; · 5.25 Impact Factor
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ABSTRACT: The aim of this study was to evaluate retrospectively the chest computed tomography findings of influenza A (H1N1) pneumonia and their relationship with clinical outcome.
Chest computed tomography findings and clinical outcomes of 76 patients with influenza A (H1N1) pneumonia were assessed. Computed tomography findings were evaluated for the presence and distribution of parenchymal abnormalities, which were then classified into 3 patterns: bronchopneumonia, cryptogenic organizing pneumonia (COP), and acute interstitial pneumonia (AIP) patterns. Clinical courses were divided into 2 groups on the basis of necessitating admission to intensive care unit or mechanical ventilation therapy (group 1) or not (group 2).
Lung abnormalities consisted of ground-glass opacity (93%, 71 patients), consolidation (66%, 50 patients), small nodules (61%, 46 patients), and tree-in-bud sign (22%, 17 patients). Lesions were classified into bronchopneumonia (49%, 37 patients), COP (30%, 23 patients), AIP (18%, 14 patients), and unclassifiable (3%, 2 patients) patterns. Patients with AIP pattern had a tendency to belonging to group 1, accounting for 40% (8 of 20 patients) of group 1 course and only 11% (6 of 56 patients) of group 2 course (P = 0.004).
Computed tomography findings of influenza A (H1N1) pneumonia in adults can be classified into COP, AIP, and bronchopneumonia patterns. Patients presenting with AIP pattern have a tendency to show poor prognosis.
Journal of computer assisted tomography 05/2012; 36(3):285-90. · 1.38 Impact Factor
