ABSTRACT
PURPOSE: To quantitate the effectiveness of low-dose computed tomography (CT) in the identification of pulmonary nodules while controlling for anatomic nodule characteristics and to establish what factors lead to reduced diagnostic sensitivity at low-dose CT. MATERIALS AND METHODS: Each of six participating radiologist independently rated 200 image panels by using a four-point confidence scale. Conventional images were obtained at 200 mAs; low-dose images were obtained at 20 mAs. To fully control their characteristics, nodules were simulated with a given diameter, shape, and section thickness while preserving the resolution, noise level, and reconstruction artifacts of the original images. Panels were matched so that nodules on low-dose and conventional images had equivalent sizes, locations, and relationships to blood vessels. RESULTS: Among 864 positive panels, 259 (60%) of 432 low-dose panels and 272 (63%) of 432 conventional panels were correctly interpreted (P = .259). Lowering the x-ray dose significantly reduced the detectability of peripheral nodules (P = .019) and nodules separated from blood vessels (P = .044). Surprisingly, 3-mm nodules were detected with approximately equal sensitivity (P = .181) at conventional and low-dose CT. The specificity of low-dose images was 88% (148 of 168 panels) versus 91% (153 of 168 panels) for conventional images (P = .372). CONCLUSION: Low-dose CT is acceptable for pulmonary nodule identification, making it suitable for primary screening. These results confirm the strong effect of size, location, and angiocentricity on the sensitivity of nodule detection with conventional CT.
Subject(s)
Solitary Pulmonary Nodule/diagnostic imaging , Tomography, X-Ray Computed/methods , Computer Simulation , Humans , Lung/diagnostic imaging , Observer Variation , Probability , ROC Curve , Radiation Dosage , Sensitivity and Specificity , Tomography Scanners, X-Ray Computed , Tomography, X-Ray Computed/instrumentation , Tomography, X-Ray Computed/statistics & numerical dataABSTRACT
PURPOSE: To evaluate assessment of diffuse lung disease with helical computed tomography (CT) and maximum intensity projection (MIP) and minimum intensity projection images. MATERIALS AND METHODS: Six patients with suspected lung disease (the control group) and 20 patients with documented disease underwent axial helical CT through the upper and lower lung fields. Findings on the MIP and minimum intensity projection images of each helical data set were compared with findings on the thin-section scan obtained at the midplane of the series. RESULTS: Owing to markedly improved visualization of peripheral pulmonary vessels (n = 26) and improved spatial orientation, MIP images were superior to helical scans to help identify pulmonary nodules and characterize them as peribronchovascular (n = 2) or centrilobular (n = 7). Minimum intensity projection images were more accurate than thin-section scans to help identify lumina of central airways (n = 23) and define abnormal low (n = 15) and high (ground-glass) (n = 8) lung attenuation. Conventional thin-section scans depicted fine linear structures more clearly than either MIP or minimum intensity projection images, including the walls of peripheral, dilated airways (n = 3) and interlobular septa (n = 3). MIP and minimum intensity projection images added additional diagnostic findings to those on thin-section scans in 13 (65%) of 20 cases. CONCLUSION: MIP and minimum intensity projection images of helical data sets may help diagnosis of a wide spectrum of diffuse lung diseases.
Subject(s)
Image Processing, Computer-Assisted/methods , Lung Diseases, Interstitial/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Case-Control Studies , Evaluation Studies as Topic , Female , Humans , Male , Pneumonia, Pneumocystis/diagnostic imaging , Pulmonary Emphysema/diagnostic imaging , Tuberculosis, Pulmonary/diagnostic imagingABSTRACT
After graft repair of an ascending aortic aneurysm, a patient was seen by us with a chest x-ray film indicating a retained foreign body. Mediastinal exploration had been unrevealing. Transesophageal echocardiography demonstrated the nature and exact location of the foreign body and therefore was instrumental in directing its retrieval.
Subject(s)
Aorta, Thoracic , Aortic Aneurysm/surgery , Aortic Dissection/surgery , Foreign Bodies/etiology , Surgical Sponges/adverse effects , Aorta, Thoracic/diagnostic imaging , Echocardiography, Transesophageal , Foreign Bodies/diagnostic imaging , Humans , Male , Middle Aged , Postoperative ComplicationsABSTRACT
PURPOSE: To identify characteristic computed tomographic (CT) findings in unusual pulmonary lymphoproliferative disorders seen in adults with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: The authors retrospectively reviewed the CT scans and pathologic specimens from nine patients with pulmonary lymphoproliferative disorders. CT scans were evaluated for nodules, reticulation, areas of ground-glass attenuation, consolidation, and bronchial disease. Changes seen in pathologic specimens were classified as consistent with classic lymphocytic interstitial pneumonitis (LIP), mucosa-associated lymphoid tissue lymphoma (MALTOMA), or atypical lymphoproliferative disorder (ALD). Immunopathologic results were reviewed when available. RESULTS: Eight patients had AIDS. Five patients had classic LIP. One patient had MALTOMA, and three patients had ALD. Altogether, 2-4-mm-diameter nodules were the predominant CT finding in eight patients; these were peribronchovascular in four patients. The presence of interstitial nodules correlated with the pathologic finding of nodular disease in seven patients. CONCLUSION: Familiarity with these AIDS-related disorders and their CT appearance should assist in the differential diagnosis.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , HIV Infections/complications , Lymphoproliferative Disorders/complications , Lymphoproliferative Disorders/diagnostic imaging , Acquired Immunodeficiency Syndrome/diagnostic imaging , Acquired Immunodeficiency Syndrome/pathology , Adult , Female , HIV Infections/diagnostic imaging , HIV Infections/pathology , Humans , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/diagnostic imaging , Lung Diseases, Interstitial/pathology , Lymphoma, B-Cell, Marginal Zone/complications , Lymphoma, B-Cell, Marginal Zone/diagnostic imaging , Lymphoma, B-Cell, Marginal Zone/pathology , Lymphoproliferative Disorders/pathology , Male , Middle Aged , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To identify characteristic features of cytomegalovirus (CMV) pneumonitis at computed tomography (CT), particularly markers that may help differentiate CMV from Pneumocystis carinii pneumonia. MATERIALS AND METHODS: Bronchoalveolar lavage (BAL) and biopsy results in 21 patients with acquired immunodeficiency syndrome, cytopathologic evidence of CMV infection without other infections, and available CT scans were retrospectively evaluated. CT findings were correlated with radiographic and pathologic findings when available. RESULTS: BAL findings were positive for CMV in only six cases, 13 patients had extrathoracic CMV infection, and 10 had Kaposi sarcoma. CT findings included ground-glass attenuation, dense consolidation, bronchial wall thickening or bronchiectasis, and interstitial reticulation without air-space disease (12 patients had discrete pulmonary nodules or masses). Biopsy revealed air-space disease as the dominant process in eight cases. Histopathologic findings correlated well with CT appearances. CONCLUSION: CMV pneumonitis should be suspected in patients with either extrathoracic CMV or documented Kaposi sarcoma, especially when radiographic or CT evidence of pulmonary nodules or masses exists.
Subject(s)
AIDS-Related Opportunistic Infections/diagnostic imaging , Cytomegalovirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed , AIDS-Related Opportunistic Infections/pathology , Adult , Biopsy , Cytomegalovirus Infections/pathology , Diagnosis, Differential , Female , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pneumonia, Pneumocystis/diagnostic imaging , Pneumonia, Viral/pathology , Retrospective StudiesABSTRACT
The occurrence of bronchiectasis has only rarely been noted among the protean manifestations of HIV infection in the lungs. We retrospectively identified bronchiectasis on CT scans in 12 HIV + and/or AIDS patients in the absence of either documented mycobacterial infection or a history of prior recurrent pyogenic infection. Pneumonitis was documented in 10 of 12 cases. In eight cases, bronchiectasis was associated with episodes of pyogenic infection; four of these patients also had documented opportunistic infections, including three cases of Pneumocystis carinii pneumonia (PCP). Two patients had infection due solely to PCP. In two cases, bronchiectasis was found in association with one case each of lymphocytic interstitial pneumonitis and nonspecific interstitial pneumonitis, respectively. Although the true incidence of bronchiectasis in this population remains to be established, in our experience bronchiectasis should be considered among the varied pulmonary manifestations of HIV infection. Furthermore, the seemingly rapid development and extent of bronchiectasis in this population suggest an accelerated form of the disease.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Bronchiectasis/complications , Bronchiectasis/diagnostic imaging , HIV Seropositivity , Tomography, X-Ray Computed , AIDS-Related Opportunistic Infections , Adult , Cytomegalovirus Infections/etiology , Female , Humans , Male , Middle Aged , Pneumonia, Pneumocystis/etiology , Pneumonia, Viral/etiology , Pulmonary Fibrosis/etiology , Retrospective StudiesABSTRACT
CT is the imaging method of choice after standard chest radiography for examining patients with suspected bronchiectasis. In most institutions throughout the world, CT has largely eliminated the need for bronchography in the diagnosis of bronchiectasis. Nonetheless, controversy persists concerning the overall accuracy of CT. In an effort to improve overall diagnostic accuracy, we review the wide range of CT appearances of this protean disorder, and emphasize potential problems and technical pitfalls that may arise in routine clinical imaging.
Subject(s)
Bronchiectasis/diagnostic imaging , Tomography, X-Ray Computed , Bronchography , Diagnosis, Differential , Humans , Lung/diagnostic imagingABSTRACT
The authors describe the radiographic appearance of the left atrial catheter, a widely used postsurgical intracardiac device. Recognition of the characteristic appearance of this catheter should be of value in detection of potential complications, including line fracture with resultant retention and/or embolization, infection, prosthetic valve dysfunction, and even cardiac tamponade.
Subject(s)
Cardiac Catheterization/instrumentation , Catheters, Indwelling , Foreign Bodies/diagnostic imaging , Heart , Tomography, X-Ray Computed , Aged , Catheters, Indwelling/adverse effects , Equipment Failure , Foreign Bodies/etiology , Heart/diagnostic imaging , Heart Atria , Humans , MaleABSTRACT
The progression of lung disease in patients with cystic fibrosis (CF) was evaluated with chest radiography. The severity and extent of the various radiographic changes were scored with the Chrispin or the Birmingham method, which involves the use of imprecise and subjective terms, such as line shadows, large pulmonary shadows, and nodular cystic lesions. Although computed tomography (CT) has been shown to be helpful in the evaluation of lung disease in CF, no scoring system or other objective criteria have been developed for the evaluation of the wide range of pulmonary changes in these patients. A CT scoring system was devised that incorporates all of the changes seen in the lungs of patients with CF. Such a scoring system may facilitate objective evaluation of existing and newly developed therapeutic regimens and may be a valuable tool in the preoperative evaluation of patients being considered for lobectomy or bullectomy and in the selection of patients for lung transplantation.
Subject(s)
Cystic Fibrosis/diagnostic imaging , Tomography, X-Ray Computed/methods , Adolescent , Adult , Bronchiectasis/diagnostic imaging , Bronchiectasis/etiology , Child , Cystic Fibrosis/complications , Humans , Retrospective Studies , Severity of Illness IndexABSTRACT
Despite advances in "high tech," it is anticipated that plain chest film radiography will continue to play a significant role in the management of patients in the ICU. Digital radiography will most likely displace conventional approaches. As demonstrated throughout this article, CT has played an increasingly important role in the evaluation of the critically ill patient. The results are especially impressive, because most were obtained on earlier-generation CT machines, which are now totally outdated. Newer scanners have many technical improvements, including rapid scanning, which permits breathholding, and thin-section scanning, which has been discussed in great detail throughout this volume. Whether MR imaging will play an important role in ICU care remains to be determined.
Subject(s)
Intensive Care Units , Lung Diseases/diagnostic imaging , Lung/diagnostic imaging , Radiography, Thoracic , Tomography, X-Ray Computed , Catheterization , Chest Tubes , Enteral Nutrition , Humans , Intubation , Magnetic Resonance Imaging , Pacemaker, Artificial , Radiographic Image EnhancementABSTRACT
Lung hernia is an abnormal protrusion of the lung beyond the confines of the thoracic cage. Hernias are classified as cervical, intercostal, or diaphragmatic. Each of these types can be either congenital or acquired. Acquired hernias can be spontaneous, posttraumatic, or pathologic as a result of a neoplastic or inflammatory process. This report describes five cases of lung hernias. Two were congenital cervical hernias, detected as incidental findings on chest radiographs of infants. One was a posttraumatic intercostal hernia detected on a chest radiograph and confirmed with CT. The remaining two were acquired intercostal hernias at the site of prior chest-tube drainage of tuberculous empyemas. Although both of these were clearly shown on CT scans, only one was visible on chest radiographs.
Subject(s)
Hernia/diagnostic imaging , Lung Diseases/diagnostic imaging , Aged , Hernia/congenital , Humans , Infant , Intercostal Muscles , Lung Diseases/congenital , Male , Middle Aged , Neck , RadiographySubject(s)
Cocaine , Mediastinal Emphysema/etiology , Pneumopericardium/etiology , Substance-Related Disorders/complications , Adult , Humans , Male , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/diagnostic imaging , Pneumopericardium/diagnosis , Pneumopericardium/diagnostic imaging , Radiography , UltrasonographyABSTRACT
We report two cases of rotated pectoral flaps performed following sternal debridement. The key to the diagnosis is recognition that the characteristic central area of low density represents fat and not fluid. This, along with the finding of sharply defined fascial planes and an absence of one or both pectoralis major muscles, should allow confident differentiation between this entity and a postoperative chest wall abscess.
Subject(s)
Muscles/diagnostic imaging , Radiography, Thoracic , Surgical Flaps , Aged , Humans , Male , Middle AgedSubject(s)
Acquired Immunodeficiency Syndrome/diagnostic imaging , Lung Diseases/diagnostic imaging , Acquired Immunodeficiency Syndrome/complications , Humans , Lung/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Lymphoproliferative Disorders/diagnostic imaging , Opportunistic Infections/diagnostic imaging , Radiography , Sarcoma, Kaposi/diagnostic imagingABSTRACT
We present the radiologic features of four patients proven to have Hermansky-Pudlak syndrome. All four patients had evidence of pulmonary involvement characterized by a progressive, diffuse, bilateral interstitial fibrosis. Extensive bullous changes were seen in one patient. Two patients with evidence of diffuse colitis exhibited an asymmetrical pattern of focal, superficial, and deep ulcerations similar to that of Crohn's disease. The association of these radiographic abnormalities with albinism, ocular abnormalities, bleeding diathesis, and Puerto Rican ancestry establishes the diagnosis.
Subject(s)
Albinism/diagnostic imaging , Colitis/diagnostic imaging , Crohn Disease/diagnostic imaging , Pulmonary Fibrosis/diagnostic imaging , Adult , Barium Sulfate , Blood Platelet Disorders/diagnostic imaging , Female , Humans , Male , Middle Aged , Radiography , SyndromeABSTRACT
Fibrobullous disease of the upper lobes of the lungs is a rare extraskeletal manifestation of ankylosing spondylitis, occurring in 1.3% of patients with ankylosing spondylitis. We present a patient with this disease, and discuss this pulmonary manifestation. Because the radiographic appearance of the chest in this disease resembles that in tuberculosis, many patients are misdiagnosed and treated for tuberculosis despite negative bacteriology. Computed tomography is useful in delineating the extent of pleural thickening, bullous changes, volume loss, parenchymal fibrosis, and bronchiectasis, as well as identifying or excluding an intracavitary pulmonary mycetoma.
Subject(s)
Pulmonary Fibrosis/etiology , Spondylitis, Ankylosing/complications , Tomography, X-Ray Computed , Adult , Diagnosis, Differential , Humans , Male , Pulmonary Fibrosis/diagnostic imaging , Tuberculosis, Pulmonary/diagnostic imagingSubject(s)
Lung Diseases, Obstructive/complications , Lung Neoplasms/complications , Pulmonary Atelectasis/diagnostic imaging , Tomography, X-Ray Computed , Adenocarcinoma/complications , Adenocarcinoma, Bronchiolo-Alveolar/complications , Carcinoma, Small Cell/complications , Cicatrix/complications , Humans , Lung Neoplasms/pathology , Lymphoma/complications , Neoplasm Staging , Pulmonary Atelectasis/etiologyABSTRACT
Forty-nine patients with chest wall lesions were evaluated by computed tomography (CT) and conventional radiography. Computed tomography was found to be indispensable for detecting and precisely localizing these lesions. It revealed unsuspected bone destruction and lung, pleural, and mediastinal involvement, as well as invasion of the spinal canal. In more than two thirds of the patients, CT provided additional information of clinical importance in management and, in one third, treatment was altered or the surgical approach modified because of the CT findings. Computed tomography is an essential diagnostic modality in evaluating chest wall lesions.