ABSTRACT
The aim of this study was to assess the ability of dual-energy computed tomography (DECT) to classify phantom renal lesions as cysts or enhancing masses. Six cylinders ranging in diameter from 0.5 to 3.0 cm were filled with distilled water or titrated iodinated contrast solutions with CT attenuation values at 120 kVp of 0 Hounsfield units (HU) for a cyst proxy or 10, 20, or 40 HU to represent enhancing masses. These were placed in a 12-cm-diameter renal phantom containing puréed beef mixed with iodinated contrast medium to simulate enhancing renal parenchyma of 100 and 250 HU and submerged within a 28-cm water bath. These combinations produced 48 individual phantom renal lesions of differing sizes, internal and parenchymal enhancement (12 cysts and 36 enhancing masses). DECT using 80 and 140 kVp was performed on a dual-source CT scanner. Commercial software created a color-encoded overlay indicating the location of iodine within the phantom. The lesions were individually graded as a cyst or enhancing mass by blinded, consensus interpretation of two genitourinary radiologists. Thirty-five of 36 enhancing masses and 10/12 cysts were correctly identified, equating to a sensitivity and specificity of 97% (95% CI 84-100%) and 83% (95% CI 51-97%), respectively. All lesions of 20- and 40-HU enhancement and 92% of 10-HU lesions were identified correctly. In a phantom model, the DECT iodine overlay technique is highly sensitive in detecting enhancing renal masses. Refinement of the technique remains necessary to improve specificity. If validated in patients, this may obviate the need for unenhanced acquisitions for renal mass characterization.
Subject(s)
Iodine , Kidney/pathology , Radiography, Dual-Energy Scanned Projection/methods , Tomography, X-Ray Computed/methods , Computer Simulation , Contrast Media/pharmacology , Humans , Image Processing, Computer-Assisted , Observer Variation , Phantoms, Imaging , Radiographic Image Interpretation, Computer-Assisted/methods , Radiography, Dual-Energy Scanned Projection/instrumentation , Sensitivity and Specificity , Software , Tomography, X-Ray Computed/instrumentationABSTRACT
We report findings in 70 patients with both diffuse interstitial lung disease and either polymyositis (PM) or dermatomyositis (DM). Initial presentations were most commonly either musculoskeletal (arthralgias, myalgias, and weakness) or pulmonary (cough, dyspnea, and fever) symptoms alone; in only 15 patients (21.4%) did both occur simultaneously. Pulmonary disease usually took the form of acute to subacute antibiotic-resistant community-acquired pneumonia. Chest radiographs and computed tomography most commonly demonstrated bilateral irregular linear opacities involving the lung bases; occasionally consolidation was present. Jo-1 antibody was present in 19 (38%) of 50 patients tested. Synchronous associated malignancy was present in 4 of 70 patients (5.7%). Surgical lung biopsies disclosed nonspecific interstitial pneumonia (NSIP) in 18 of 22 patients (81.8%), organizing diffuse alveolar damage (DAD) in 2, bronchiolitis obliterans organizing pneumonia (BOOP) in 1, and usual interstitial pneumonia (UIP) in 1. Treatment usually included prednisone in 40-60 mg/d dosages for initial control, followed by lower dose prednisone plus an immunosuppressive agent such as azathioprine or methotrexate for disease suppression. Survival was significantly better than that observed for historical control subjects with idiopathic UIP, and was more consistent with survival previously reported in idiopathic NSIP. There was no difference in survival between Jo-1 positive and Jo-1 negative groups.
Subject(s)
Dermatomyositis/complications , Lung Diseases, Interstitial/complications , Polymyositis/complications , Dermatomyositis/drug therapy , Dermatomyositis/mortality , Female , Humans , Lung Diseases, Interstitial/drug therapy , Lung Diseases, Interstitial/mortality , Male , Middle Aged , Polymyositis/drug therapy , Polymyositis/mortality , Retrospective Studies , Survival RateABSTRACT
BACKGROUND: The purpose of this investigation was to identify and characterize abdominal lymphomas as they occur in a large solid-organ-transplant population. METHODS: A large transplant population was isolated, and all patients developing an abdominal lymphoma were identified. These patients were further characterized after review of their medical records and radiologic examinations. RESULTS: Twenty-eight (1%) of 2925 patients developed lymphoma following transplantation. Of these 28 patients, 14 developed abdominal manifestations of disease. Examples of the wide variety of abdominal manifestations of posttransplant lymphoma are presented. Most of these patients had positive titers for Epstein-Barr virus and were treated with cyclosporin as a part of their immunotherapy. The majority of patients died secondary to this aggressive disease process. CONCLUSION: The development of lymphoma following solid organ transplantation is more common than in the general population. One-half of the patients in our study population developed abdominal manifestations of this disease.
