CT Analysis of Lung Cancer and Coexistent Emphysema

PURPOSE: To evaluate the relation of the location and cell type of lung cancer to the location and degree in coexistent emphysema on high-resolution computed tomography (HRCT) scans. MATERIALS AND METHODS: Ninety-eight of 209 lung cancer patients having HRCT scans were retrospectively analyzed to assess the total lung emphysema and peritumoral regional emphysema. Single and primary lung cancers were included. The clinical data, including sex, age, smoking history and the pathologic cancer subtype, were recorded to correlate with the HRCT findings. The lobar distribution, central-peripheral predominance, surrounding parenchymal abnormality for cancer, cephalocaudal predominance, and subtype for emphysema were analyzed on HRCT. Using a CT scoring method, we scored the whole lung emphysema and peritumoral emphysema, and correlated the grading of emphysema with pulmonary functional values. RESULTS: Sixty-nine of 98 patients with lung cancer (71%) had emphysema. Lung cancer with emphysema was significantly higher in men than in women, and was significantly related to smoking. The mean age of cancer patients without emphysema was significantly lower than that of cancer patients with emphysema (68 yrs vs. 61 yrs, p=0.0006). Emphysema of grade I (0-25%) was found in 52 cases, grade II (25-50%) in 15, and grade III (50-75%) in 2. Total emphysema score was paralleled to peritumoral emphysema score in 64.3%, while the remaining patients had a higher peritumoral emphysema score (grade II or III) than total emphysema score (grade 0 or I). There was no statistical correlation in the developmental location between the emphysema and the lung cancer (significant correlation was only noted in grade II group of total emphysema score). The incidence of non-small cell carcinoma tended to be higher than that of small cell carcinoma in the two groups. CONCLUSION: The possibility of lung cancer in patients with pulmonary nodule, coexisting emphysema, and especially in elderly patients having a history of smoking must be clarified on HRCT. The location or type of lung cancer was not significantly correlated to the location or the degree of coexistent emphysema.

Remote Metastasis to the Gastric Cardia in Esophageal Carcinoma: CT Findings

PURPOSE: To assess the CT findings of remote metastasis to the gastric cardia in patients with esophageal carcinoma. MATERIALS AND METHODS: Among patients with esophageal carcinomas treated between June 1994 and May 1999, five males aged 65-75 (mean, 67.4) years with histologically proven remote metastasis to the gastric cardia from esophageal squamous cell carcinoma, detected at surgery (n=2) or endoscopic biopsy (n=3), underwent CT scanning. We retrospectively evaluated the findings in terms of the location, size and appearance of each lesion and the presence or absence of associated lymphadenopathy. RESULTS: The primary esophageal carcinomas were located in the middle third (n=4) and lower third (n=1) of the esophagus. All five gastric metastases were solitary and occurred in the gastric cardia, and were separated from the primary tumors. CT showed that the metastases ranged in size from 4.2 to 8.0 (mean, 6.7) cm, and all were larger than the primary tumors. All were ulcerated, and in four cases there was associated abdominal lymphadenopathy. They were all well defined, poorly enhanced, submucosal masses that were endogastric in three cases and exogastric in two. The latter were difficult to differentiate from extrinsic masses compressing the gastric cardia. CONCLUSION: Our results suggest that when a submucosal gastric cardial mass with associated lymphadenopathy is detected by CT during the initial staging or follow-up evaluation of esophageal carcinoma, remote gastric metastasis should be considered.

Diffusion-weighted Imaging of Cerebral Ischemic Infarcts: Comparison with T2-weighted Imaging in Signal Intensity

PURPOSE: To investigate whether ischemic infarct can be staged by evaluating signal intensities on diffusionweighted (DWI) and turbo spin echo T2-weighted images(T2WI). MATERIALS AND METHODS: DWI and T2WI of 27 patientswith ischemic infarct were retrospectively evaluated. Infarcts were divided into five stages depending on time ofonset : hyperacute within 12 hours, acute between 12 hours and 3 days, subacute between 3 and 10 days, earlychronic between 10 and 30 days, and late chronic after 30 days. Signal intensities of these lesions compared withnormal brain on DWI and T2WI were visually evaluated and divided into six patterns. Pattern 1 included high signalon DWI and iso-signal on T2WI, pattern 2 showed high signal on both DWI and T2WI with higher contrast on DWI,pattern 3 showed the same high signal on both images; pattern 4 revealed high signal on both images with highercontrast on T2WI, pattern 5 showed iso-signal on DWI and high signal on T2WI, and pattern 6 revealed low signal onDWI and high signal on T2WI. These five clinical stages and six MRI patterns were correlated in each patient. RESULTS: Six cases were hyperacute, six were acute, eight were subacute, three were early chronic, and four werelate chronic. At the hyperacute stage, five cases showed pattern 1 (83%) and one case, pattern 2. At the acutestage, all six cases showed pattern 2. At the subacute subcute stage, seven cases showed pattern 2(87.5%) and onecase pattern 4. At the early chronic stage, two cases showed pattern 2(66.7%) and one case, pattern 5. At the latechronic stage, all cases showed pattern 6. CONCLUSION: DWI is useful for the detection of early ischemic infarct,and stages of ischemic infarcts can be estimated by evaluating signal intensities on DWI and T2WI.

The usefulness of CT for the preoperative evaluation of lymph node in patients with gastric cancer

An accurate preoperative evaluation of lymph nodes(LNs) in gastric cancer is a prerequisite for successful surgery and favorable prognosis. We retrospectively analyzed the Ct accuracy in perigastric LN localization and LN staging of gastric cancer as well as the size criteria for the metastasized LN in 64 patients who hed undergone a surgery for gastric cancer. The results of perigastric LNs evaluation by CT are as follows; sensitivity 67%(64/95), specificity 90%(839/929), accuracy 88%(903/1024). Of 95 pathologically metastasized LN groups, 66 could be retrospectively identified on Ct scans(69%). In LN staging, CT was correct in 60%(38/64), overstaged in 32%(21/64), and understaged in 8%(5/64). The perigastric LN groups which were easily localized on CT were #3, 7, 8, and 13. The mean size of metastasized LNs on CT according to the I.N group was #3 (13mm), #4(9mm), #6 (10mm), #7(10.5mm), #8 (10mm), #9 (11mm), #13 (9mm).