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ABSTRACT: 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, p<0.01). The presence of calcification and nodule consistency were significantly different between 5 and 1mm CT images (McNemar test for the presence of calcification, p<0.01; Wilcoxon signed test for nodule consistency, p<0.01). On 1mm CT images 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.
Clinical radiology 02/2009; 64(2):127-32. · 1.65 Impact Factor
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Chang Hyun Lee,
Jin Mo Goo,
Hyun Ju Lee,
Kwang Gi Kim,
Jung-Gi Im,
Kyongtae T Bae,
C H Lee, J M Goo,
H J Lee,
K G Kim,
J-G Im,
K T Bae
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ABSTRACT: The purpose of our study was to determine the optimal timing window for pulmonary artery MDCT angiography.
We prospectively studied 150 patients. Routine chest CT scans were acquired using 1.3 mL/kg of contrast medium (370 mg I/mL) that was injected at a fixed injection duration of 30 seconds, followed by a 10-second saline chase. To measure early contrast enhancement, sequential monitoring scans were obtained every 2 seconds over a fixed level of the main pulmonary artery 5 seconds after the start of the injection. Then helical diagnostic scans were obtained at three different predetermined scanning delays (group A, 25 seconds; group B, 35 seconds; and group C, 45 seconds after the start of the injection). Time-enhancement curves; time to reach 100 H, 200 H, and peak enhancement; and enhancement duration greater than 200 H of the pulmonary artery were measured from the monitoring scan. Contrast enhancements of the pulmonary artery and descending aorta and vascular artifacts were assessed from the diagnostic scan.
Times to reach 100 H and 200 H at the pulmonary artery were mean 11 +/- 2.5 (SD) seconds and 16 +/- 3.0 seconds, respectively. Pulmonary artery enhancement duration of greater than 200 H was 25 +/- 2.7 seconds (only obtained in group C). Mean time to peak enhancement (335 +/- 62 H) at the pulmonary artery was 37 seconds. Mean enhancement measured on the diagnostic scan was 294 +/- 43 H, group A; 208 +/- 48 H, group B; and 157 +/- 15 H, group C for the pulmonary artery, and 240 +/- 42 H, group A; 277 +/- 49 H, group B; and 172 +/- 29 H, group C for the aorta (p < 0.01). Artifacts were noted in the superior vena cava (group A, 96.7%; group B, 18.3%; and group C, 0%) and in the subclavian vein (group A, 93.5%; group B, 38.7%; and group C, 0%), (p < 0.05).
With our study protocol of a 30-second injection and 10-second saline flush, the optimal temporal window to achieve pulmonary artery enhancement greater than 200 H was from 16 seconds to 41 seconds after the start of the injection.
American Journal of Roentgenology 03/2007; 188(2):313-7. · 2.78 Impact Factor
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ABSTRACT: To reduce the possibility of cardiac tamponade, a rare but lethal complication of central venous catheters, the tip of the central venous catheter should be located above the cephalic limit of the pericardial reflection, not only above the superior vena cava-right atrium junction. This study was performed to measure the superior vena cava lengths above and below the pericardial reflection in cardiac surgical patients. Cardiac surgical patients (n = 61; 27 male), whose age [mean +/- SD (range)] was 47 +/- 15 (15-75) years, were studied. The intrapericardial and extrapericardial lengths, and the length of the medial duplicated part were measured separately. The whole vertical lengths of the superior vena cava on either side were calculated respectively by adding the intra-and extrapericardial and medial duplication lengths. The lateral extrapericardial was 29.1 +/- 6.5 (Mean +/- SD) (9-49) mm (range), and lateral extrapericardial length was 32.6 +/- 6.9 (20-53) mm. The medial extrapericardial length was 23.3 +/- 5.0 (11-39) mm, medical duplicated length was 7.2 +/- 3.3 (4-20) mm, and medial intrapericardial was 28.3 +/- 7.0 (20-52) mm. The averaged superior vena cava length of both sides was 60.3 +/- 9.0 (44.5-90) mm. Almost half of the superior vena cava was found to be within the pericardium and half out. This information may be helpful in deciding how far a central venous catheter should be withdrawn beyond the superior vena cava-right atrial junction during right atrial electrocardiographic guided insertion, and in the prediction of optimal central venous catheter insertion depth.
Anaesthesia and intensive care 07/2005; 33(3):384-7. · 1.28 Impact Factor
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ABSTRACT: To evaluate whether preoperative computed tomography (CT) findings correlate with postoperative improvements in forced vital capacity (FVC) and forced expiratory volume during 1s (FEV1) in persons who have undergone unilateral decortication because of unilateral chronic tuberculous empyema.
A retrospective study was carried out of 67 individuals who had undergone decortication because of chronic tuberculous empyema between January 1996 and December 2000. Of these, 13 subjects who had had preoperative chest CT and preoperative and postoperative pulmonary function tests (PFTs) were included in the investigation. On preoperative CT, the degree of volume reduction of the affected side was compared with that of the contralateral normal lung. The relative volume of empyema was calculated by dividing the volume occupied by the empyema by the sum of the total volume of the ipsilateral lung and the empyema volume. The thicknesses of pleura and extrapleural fat in the involved hemithorax were measured by CT at their thickest points, and the degree of atelectasis adjacent to the empyema in the diseased lung was assessed and classified. These five CT parameters and the ages of the patients were compared with preoperative and postoperative FVC and FEV1 changes.
A significant negative correlation was found between FVC changes and the relative volume of the affected lung (FVC: p = 0.039, RS = -0.58). FVC and FEV1 were found to be significantly and positively correlated with the relative volume of the empyema (FVC: p = 0.005, RS = 0.72; FEV1: p = 0.014, RS = 0.66) and the degree of atelectasis (FVC: p = 0.007, RS = 0.71; FEV1: p = 0.029, RS = 0.60) by Spearman's nonparametric correlation test. Other CT parameters and the ages of the patients were not found to be correlated with PFT changes.
The relative volume of the affected side, the relative volume of empyema and the degree of atelectasis can predict improvements in FVC and FEV1 after decortication in patients with chronic tuberculous empyema.
Clinical Radiology 05/2005; 60(4):503-7. · 1.95 Impact Factor
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ABSTRACT: The cross-section of the mainstem bronchi is not completely round. For preoperative selection of a double-lumen endobronchial tube size, it may be necessary to measure the mediolateral and the anteroposterior bronchial diameters, which can be measured respectively on chest radiograph and computed tomography. With Internal Review Board approval and patients' informed consent, 105 elective thoracic surgical patients who needed left-sided double-lumen tubes were enrolled. Double-lumen tube size was selected depending on the arithmetic mean of the mediolateral and anteroposterior bronchial diameters. Moreover, the outer diameters of the bronchial tube should be smaller than both mediolateral and anteroposterior diameters. The recommended bronchial diameter for each double-lumen tube size was chosen so that the mean of the two bronchial diameters was 0 to 2.0 mm larger than the upper limit of 95% confidence interval of the averaged outer diameter of the bronchial tube of the selected double-lumen tube. In no case was the predicted double-lumen tube size inappropriate. Generally, anteroposterior bronchial diameters appeared to be different from mediolateral diameters (P=0.001). The double-lumen tube size to be selected based on only one bronchial diameter was different from the one selected based on two perpendicularly measured bronchial diameters in 54.3% of patients (57/105). Preoperative selection of the double-lumen tube size based on the anteroposterior, mediolateral and mean bronchial diameters seems to be useful in that this may obviate the need to change an inappropriately sized double-lumen tube and may be helpful in reducing the related complications.
Anaesthesia and intensive care 03/2005; 33(1):59-63. · 1.28 Impact Factor
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ABSTRACT: To compare contrast-enhanced CT angiography (CTA) and gadolinium-enhanced MR angiography (MRA) for the detection of subsegmental-sized pulmonary emboli in a pig model.
In 5 anesthetized pigs, 3-mm diameter embolic materials made of Konjac, a semisolid food, were introduced through the internal jugular vein into pulmonary arteries. After embolization, CTA and MRA images were obtained. Respiration was suspended during CTA and MRA image acquisition. Two readers reviewed the CTA and MRA images to detect emboli. The pigs were sacrificed, and sliced specimens of inflated lung served as the gold standard.
Thirty-six emboli were detected within peripheral arteries. The sensitivity (and 95% confidence intervals) of CTA for the two readers were 57% (39-74%) and 66% (48-81%), and 88% (69-98%) and 92% (74-94%) for MRA. The specificity of CTA was 95% (91-97%) and 98% (96-99%), and that of MRA was 85% (74-93%) and 90% (80-96%). Interobserver agreement was higher for MRA (kappa 0.898) than CTA (kappa 0.574).
For the detection of subsegmental pulmonary emboli, MRA was superior to CTA, with a higher sensitivity and interobserver agreement by demonstrating perfusion deficits.
Acta Radiologica 08/2003; 44(4):403-10. · 1.37 Impact Factor
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ABSTRACT: Purpose: To compare contrast-enhanced CT angiography (CTA) and gadolinium-enhanced MR angiography (MRA) for the detection of subsegmental-sized pulmonary emboli in a pig model.Material and Methods: In 5 anesthetized pigs, 3-mm diameter embolic materials made of Konjac, a semisolid food, were introduced through the internal jugular vein into pulmonary arteries. After embolization, CTA and MRA images were obtained. Respiration was suspended during CTA and MRA image acquisition. Two readers reviewed the CTA and MRA images to detect emboli. The pigs were sacrificed, and sliced specimens of inflated lung served as the gold standard.Results: Thirty-six emboli were detected within peripheral arteries. The sensitivity (and 95% confidence intervals) of CTA for the two readers were 57% (39–74%) and 66% (48–81%), and 88% (69–98%) and 92% (74–94%) for MRA. The specificity of CTA was 95% (91–97%) and 98% (96–99%), and that of MRA was 85% (74–93%) and 90% (80–96%). Interobserver agreement was higher for MRA (kappa 0.898) than CTA (kappa 0.574).Conclusion: For the detection of subsegmental pulmonary emboli, MRA was superior to CTA, with a higher sensitivity and interobserver agreement by demonstrating perfusion deficits.
Acta Radiologica 07/2003; 44(4):403 - 410. · 1.37 Impact Factor
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ABSTRACT: Pulmonary vasculitis includes various disease entities with a wide range of clinical presentations and overlapping imaging features. Radiological findings of vasculitis in the angiitis-granulomatosis group are nodular and patchy opacities, whereas the principal feature of those diseases causing widespread capillaritis is diffuse air space consolidation. Aneurysms or stenoses of pulmonary arteries are seen in patients with Takayasu arteritis or Behçet's disease.
British Journal of Radiology 12/2000; 73(875):1224-31. · 1.31 Impact Factor
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ABSTRACT: We compared the soft-copy images produced by a digital chest radiography system that uses a flat-panel X-ray detector based on amorphous selenium with images produced by a storage phosphor radiography system for the visualization of anatomic regions of the chest.
Two chest radiologists and two residents analyzed 46 pairs of posteroanterior chest radiographs on high-resolution video monitors (2560 x 2048 x 8 bits). In each pair, one radiograph was obtained with a storage phosphor radiography system, and the other radiograph was obtained with a selenium-based flat-panel detector radiography system. Each pair of radiographs was obtained at the same exposure settings. The interpreter rated the visibility and radiographic quality of 11 different anatomic regions. Each pair of images was ranked on a five-point scale (1 = prefer image A, 3 = no preference, 5 = prefer image B) for preference of technique. Statistical significance of preference was determined using the Wilcoxon's signed rank test.
The interpreters had a statistically significant preference for the selenium-based radiography system in six (unobscured lung, hilum, rib, minor fissure, heart border, and overall appearance) of 11 anatomic regions (p<0.001) and for the storage phosphor system in two regions (proximal airway and thoracic spine) (p<0.05). Chest radiologists strongly preferred selenium-based images in eight regions, and they did not prefer storage phosphor images in any region.
The soft-copy images produced by the selenium-based radiography system were perceived as equal or superior to those produced by the storage phosphor system in most but not all anatomic regions.
American Journal of Roentgenology 10/2000; 175(4):1013-8. · 2.78 Impact Factor
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ABSTRACT: The authors report the clinical and computed tomographic (CT) findings in six patients with chyliform pleural effusion. All six patients had a medical history of pleurisy before presentation; five of them had tuberculous pleural effusion. The CT scans of all six patients showed variable amounts of pleural fluid collection with a layering of fat at the nondependent site.
Radiology 09/2000; 216(2):478-80. · 5.73 Impact Factor
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ABSTRACT: To describe findings of pulmonary tuberculoma at 2-[fluorine 18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET).
Ten consecutive patients who underwent PET and subsequently were proved to have pulmonary tuberculoma were analyzed. Tuberculosis was proved histopathologically in eight by means of wedge resection or lobectomy (n = 7) or needle biopsy (n = 1) and in two by means of clinical follow-up for more than 2 years. PET scans were evaluated by using peak standardized uptake values. Computed tomographic (CT) and histopathologic findings also were reviewed.
Nine of 10 tuberculomas showed FDG uptake at PET, and the mean peak standardized uptake value was 4.2 +/- 2.2 (SD). FDG uptake (range, 1. 9-3.7) in lesions adjacent to main abnormalities was demonstrated in four patients. On CT scans, the mean of the longest nodule diameters was 21 mm +/- 8, and there were some areas of branching linear opacities or satellite nodules that suggested pulmonary tuberculosis in seven patients. Histopathologic findings were chronic granulomatous inflammation with caseation necrosis (n = 7) and healed tuberculosis with aspergilloma (n = 1).
Pulmonary tuberculoma commonly causes an increase in FDG uptake. These results suggest that in geographic regions with a high prevalence of granulomatous lesions, positive FDG PET results should be interpreted with caution in differentiating benign from malignant pulmonary abnormalities.
Radiology 08/2000; 216(1):117-21. · 5.73 Impact Factor
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ABSTRACT: OBJECTIVE: The aim of this study was to describe CT findings of patients with bronchial anthracofibrosis. CONCLUSION: Atelectasis caused by smooth bronchial narrowing, surrounded by calcified or noncalcified lymph nodes, in elderly and nonsmoking women is a typical finding of anthracofibrosis. Calcified lymph nodes adjacent to the involved bronchi and multifocal involvement of bronchial narrowing may be helpful in differentiating this condition from lung cancer.
American Journal of Roentgenology 03/2000; 174(2):523-7. · 2.78 Impact Factor
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ABSTRACT: OBJECTIVE: The purpose of our study was to describe radiologic manifestations of pulmonary tuberculosis in patients with systemic lupus erythematosus. CONCLUSION: The prevalence of pulmonary tuberculosis was high in patients with systemic lupus erythematosus. Imaging of these patients showed miliary dissemination and patchy consolidation. However, cavitation was rare. These findings may reflect impaired immune response against tuberculous bacilli.
American Journal of Roentgenology 01/2000; 173(6):1639-42. · 2.78 Impact Factor
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ABSTRACT: The purpose of our study was to determine the CT appearance and clinical significance of a right paratracheal air cyst at the level of the thoracic inlet.
Sixty-five consecutive patients with paratracheal air cysts were included in this study. The location, level, size, and shape of the paratracheal air cysts on CT were analyzed. The spirometric data, tracheal indexes, and CT-determined emphysema scores of these patients were compared with those of 60 consecutive patients in a control group.
The air cysts were located at the right posterolateral aspect of the trachea in 64 (98%) of 65 patients and at T1-T2 vertebral levels in 57 (88%) of 65 patients. The mean diameter of the right paratracheal cysts was 10 mm in the axial plane and 14 mm in the vertical plane. CT showed a communicating channel with the trachea in five patients. The ratio of forced expiratory volume obtained in 1 sec to forced vital capacity, and forced expiratory flow between 25% and 75% of vital capacity in patients with paratracheal air cysts, were significantly lower than those of the control group (p < .05). Differences in the tracheal indexes and CT-determined emphysema scores between the study group and the control group were found to be statistically significant (p = .001).
The most probable nature of a right paratracheal cyst in the thoracic inlet is tracheal diverticulum with a narrow stalk. The presence of a right paratracheal air cyst on CT could be a sign of obstructive lung disease clinically and of the presence of emphysema radiologically.
American Journal of Roentgenology 07/1999; 173(1):65-70. · 2.78 Impact Factor
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ABSTRACT: The objective of this study was to compare chest radiography with computed tomography (CT) in the prediction of a specific diagnosis in adult patients with anterior mediastinal masses. Chest radiographs and CT scans of 128 patients with anterior mediastinal masses were randomized and analyzed retrospectively by two independent observers. The observers listed the three most likely diagnoses in order of probability and recorded the degree of confidence in their first-choice diagnosis. Findings from chest radiographs and CT scans were recorded by each observer and used for a stepwise discriminant analysis between diagnoses. Results showed that the correct first-choice diagnosis, regardless of the degree of confidence, was made in 36% of chest radiographs and 48% of CT scans (p < 0.05). The correct diagnosis was included among top three diagnoses in 59% and 72% of the studies, respectively (p < 0.001). A high confidence diagnosis (level 1) was reached in 9% and 34% of each study, respectively, (p < 0.001), and was correct in 58% and 80% of the studies, respectively. Interobserver agreement (k statistics) on the correct first-choice diagnosis was 0.45 and 0.53, respectively. Interpretations of the CT scans were most often accurate in the confident diagnosis of benign germ cell tumors (n = 10, 100%), thymolipomas (n = 3, 100%), and omental hernia (n = 2, 100%). Seven of 15 radiographic findings and 11 of 22 CT findings were discriminant. We conclude that although CT is better then chest radiography in determining the pathologic diagnosis of an anterior mediastinal mass, CT is still poor at making that prediction with confidence. However, several anterior mediastinal masses could be diagnosed accurately by CT.
Journal of Thoracic Imaging 02/1996; 11(4):265-71. · 0.98 Impact Factor
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ABSTRACT: To compare the MR signal intensity patterns and enhancement pattern of intracranial tuberculomas with their histopathologic features.
MR images of six patients with surgically proved intracranial tuberculoma were reviewed retrospectively and were compared with histologic findings of the resected specimen. Detailed histologic examination was performed to look for the extent and characteristics of caseation necrosis, fibrosis, and inflammatory cellular infiltrates at each area of different signal intensities and at the enhancing areas on MR. Signal intensities for T1- and T2-weighted images were compared with normal gray matter.
On T1-weighted images, the granulomas showed a slightly hyperintense rim surrounded by a complete or partial rim of slight hypointensity and central isointensity or mixed isointensity and hyperintensity in five patients and homogeneous isointensity in one patient. Histologically, the zone of central isointensity or mixed intensity corresponded to caseation necrosis plus adjacent cellular infiltrates. The hyperintense and hypointense rims corresponded to the layers of collagenous fiber and the layers of the inflammatory cellular infiltrates, respectively. On T2-weighted images, the entire portion of the granuloma showed slightly heterogeneous isointensity or hypointensity with small markedly hypointense foci in five patients, and a hyperintense center surrounded by a hypointense rim in one patient. Histologic layers were not discriminated on T2-weighted images. On postcontrast T1-weighted images, there were single or multiple conglomerate ring enhancements within a tuberculoma in all six patients, corresponding to the layers of both collagenous and inflammatory cells.
Combination of the described signal intensity patterns and conglomerate ringlike enhancing appearance of the lesion is characteristic of tuberculoma, and may play an important role in differentiating intracranial tuberculomas from other ring-enhancing brain lesions.
American Journal of Neuroradiology 11/1995; 16(9):1903-8. · 2.93 Impact Factor
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ABSTRACT: The purpose of this study is to investigate the temporal relation between the change in the resistive index (RI) from renal Doppler sonography and that of serum creatinine values in the course of experimentally induced reversible acute renal failure (ARF) in rabbits.
Reversible ARF was induced in 10 New Zealand white rabbits by injecting a glycerol solution (6.0 mL/kg) into the thigh muscle. Doppler sonography was performed before injection, and 6, 12, and 24 hours, and 3, 5, 7, and 14 days after injection of glycerol. Blood samples for measuring serum creatinine levels were obtained in the same time sequence. Three rabbits, which died during the course of the experiment, were excluded from the study group.
The RI elevated rapidly after glycerol injection, peaked at 12 hours, and then decreased to normal values by 7 days. Conversely, serum creatinine values were elevated and peaked at 1 day and then decreased to normal by 14 days. The change in the RI preceded the change in serum creatinine levels in the course of reversible ARF. There was a weak linear correlation between RI and serum creatinine levels, with a correlation coefficient of 0.33.
Doppler sonography with measurement of resistive index may be useful in predicting the course of ARF.
Investigative Radiology 04/1995; 30(3):168-72. · 4.59 Impact Factor
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ABSTRACT: The coexistence of pneumothorax and pneumopericardium in patients with primary lung cancer is a very rare phenomenon. We report one such case, in which squamous cell carcinoma of the lung was complicated by pneumopericardium and pneumothorax. Several explanations of the mechanisms involved will be discussed.
Korean Journal of Radiology 1(2):118-20. · 1.54 Impact Factor
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ABSTRACT: Alveolar soft-part sarcoma is a rare soft tissue sarcoma of young adults with unknown histogenesis, and the organ most frequently involved in metastasis is the lung. We report the CT findings of three patients of pulmonary metastases of alveolar soft-part sarcoma, which manifested as clearly enhanced pulmonary nodules or masses. On enhanced scans, some of the masses were seen to contain dilated and tortuous intratumoral vessels.
Korean Journal of Radiology 1(1):56-9. · 1.54 Impact Factor
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ABSTRACT: Angiolipoma is a rare benign soft tissue tumor, an unusual variant of lipoma, consisting of fatty and vascular components and located in the subcutis, usually in the trunk and extremities. We report a case of posterior mediastinal angiolipoma extending into the spinal canal and showing both fat and angiomatous features on CT scan.
Korean Journal of Radiology 1(4):212-4. · 1.54 Impact Factor
