Hematoma in Epicardial Fat From Sinus of Valsalva Aneurysm.

Hematoma in epicardial fat is a rare finding on noncontrast computed tomography imaging. We describe a case with hematoma in epicardial fat that helped to diagnose an oozing, ruptured mycotic sinus of Valsalva aneurysm. (Level of Difficulty: Advanced.).

Cooperative function of Fmp30, Mdm31, and Mdm32 in Ups1-independent cardiolipin accumulation in the yeast Saccharomyces cerevisiae.

Cardiolipin (CL) is synthesized from phosphatidic acid (PA) through a series of enzymatic reactions occurring at the mitochondrial inner membrane (MIM). Ups1-Mdm35 mediates PA transfer from the mitochondrial outer membrane (MOM) to the MIM in the yeast Saccharomyces cerevisiae. Deletion of UPS1 leads to a ~80% decrease in the cellular CL level. However, the CL accumulation in ups1∆ cells is enhanced by the depletion of Ups2, which forms a protein complex with Mdm35 and mediates phosphatidylserine (PS) transfer from the MOM to the MIM for phosphatidylethanolamine (PE) synthesis by a PS decarboxylase, Psd1. In this study, we found that the accumulation of CL in ups1∆ cells was enhanced by deletion of not only UPS2, but also PSD1 and CHO1 encoding a PS synthase, suggesting that low PE levels in mitochondria were relevant to the enhancement of CL accumulation in ups1∆ cells. Furthermore, the Ups1-independent and low-level PE-enhanced CL accumulation was shown to depend on the functions of FMP30, MDM31, and MDM32. In addition, the physical interactions of Fmp30 with Mdm31 and Mdm32 were revealed. Thus, when the mitochondrial PE level is reduced, Fmp30, Mdm31, and Mdm32 seem to function cooperatively for the accumulation of CL in a UPS1-independent manner.

Lobar analysis of collapsibility indices to assess functional lung volumes in COPD patients.

BACKGROUND: We investigated correlations between lung volume collapsibility indices and pulmonary function test (PFT) results and assessed lobar differences in chronic obstructive pulmonary disease (COPD) patients, using paired inspiratory and expiratory three dimensional (3D) computed tomography (CT) images. METHODS: We retrospectively assessed 28 COPD patients who underwent paired inspiratory and expiratory CT and PFT exams on the same day. A computer-aided diagnostic system calculated total lobar volume and emphysematous lobar volume (ELV). Normal lobar volume (NLV) was determined by subtracting ELV from total lobar volume, both for inspiratory phase (NLVI) and for expiratory phase (NLVE). We also determined lobar collapsibility indices: NLV collapsibility ratio (NLVCR) (%)=(1-NLVE/NLVI)×100%. Associations between lobar volumes and PFT results, and collapsibility indices and PFT results were determined by Pearson correlation analysis. RESULTS: NLVCR values were significantly correlated with PFT results. Forced expiratory volume in 1 second, measured as percent of predicted results (FEV1%P) was significantly correlated with NLVCR values for the lower lobes (P<0.01), whereas this correlation was not significant for the upper lobes (P=0.05). FEV1%P results were also moderately correlated with inspiratory, expiratory ELV (ELVI,E) for the lower lobes (P<0.05). In contrast, the ratio of the diffusion capacity for carbon monoxide to alveolar gas volume, measured as percent of predicted (DLCO/VA%P) results were strongly correlated with ELVI for the upper lobes (P<0.001), whereas this correlation with NLVCR values was weaker for upper lobes (P<0.01) and was not significant for the lower lobes (P=0.26). CONCLUSION: FEV1%P results were correlated with NLV collapsibility indices for lower lobes, whereas DLCO/VA%P results were correlated with NLV collapsibility indices and ELV for upper lobes. Thus, evaluating lobar NLV collapsibility might be useful for estimating pulmonary function in COPD patients.

Doubling time calculations for lung cancer by three-dimensional computer-aided volumetry: effects of inter-observer differences and nodule characteristics.

INTRODUCTION: The purpose of this study was to investigate doubling time (DT) differences among solid, part-solid (PS) and non-solid (NS) types of lung cancers. We also compared inter-observer differences in size measurements between diameter and three-dimensional (3D) volume measurements of lung cancers, including PS- and NS-type nodules, using 3D computer-aided volumetry (3D-CAV). METHODS: The long-axis diameters and 3D volumes of lung tumours were measured using CAV by two chest radiologists for 71 consecutive patients with peripheral lung cancer who underwent at least two CT examinations before surgical resection. We evaluated the inter-observer variability for the ratio of diameter change (RCdiameter) and volume change (RCvolume), which were based on two CT images obtained at different times prior to resection. Inter-observer agreement was evaluated by Bland-Altman plots. Based on the volumes obtained from 3D-CAV, we calculated the DTs and compared DT differences between solid, PS and NS types of lung tumours. RESULTS: The inter-observer Spearman's rank correlation coefficients were 0.87 for RCvolume and 0.64 for RCdiameter (p < 0.001). For all internal appearance types, the rs values for RCvolume were greater than those for RCdiameter. The median DT values for solid, PS and NS were 278, 347 and 584 days, respectively. NS- and PS-type tumours had significantly longer DTs (p = 0.024; by Spearman's rank correlation coefficient). CONCLUSIONS: DT determinations using 3D-CAV had good correlations with the internal appearances of lung cancers. Lung tumour volume measurements by 3D-CAV exhibited better inter-observer correlations than did diameter measurements.

Pulmonary lobar volumetry using novel volumetric computer-aided diagnosis and computed tomography.

OBJECTIVES: To compare the accuracy of pulmonary lobar volumetry using the conventional number of segments method and novel volumetric computer-aided diagnosis using 3D computed tomography images. METHODS: We acquired 50 consecutive preoperative 3D computed tomography examinations for lung tumours reconstructed at 1-mm slice thicknesses. We calculated the lobar volume and the emphysematous lobar volume < -950 HU of each lobe using (i) the slice-by-slice method (reference standard), (ii) number of segments method, and (iii) semi-automatic and (iv) automatic computer-aided diagnosis. We determined Pearson correlation coefficients between the reference standard and the three other methods for lobar volumes and emphysematous lobar volumes. We also compared the relative errors among the three measurement methods. RESULTS: Both semi-automatic and automatic computer-aided diagnosis results were more strongly correlated with the reference standard than the number of segments method. The correlation coefficients for automatic computer-aided diagnosis were slightly lower than those for semi-automatic computer-aided diagnosis because there was one outlier among 50 cases (2%) in the right upper lobe and two outliers among 50 cases (4%) in the other lobes. The number of segments method relative error was significantly greater than those for semi-automatic and automatic computer-aided diagnosis (P < 0.001). The computational time for automatic computer-aided diagnosis was 1/2 to 2/3 than that of semi-automatic computer-aided diagnosis. CONCLUSIONS: A novel lobar volumetry computer-aided diagnosis system could more precisely measure lobar volumes than the conventional number of segments method. Because semi-automatic computer-aided diagnosis and automatic computer-aided diagnosis were complementary, in clinical use, it would be more practical to first measure volumes by automatic computer-aided diagnosis, and then use semi-automatic measurements if automatic computer-aided diagnosis failed.

Correlation between dynamic CT findings and pathological prognostic factors of small lung adenocarcinoma.

PURPOSE: To compare pathological prognostic factors of small lung adenocarcinomas with findings of contrast-enhanced dynamic computed tomography (CT) scans. MATERIALS AND METHODS: We evaluated 108 patients with lung adenocarcinomas ≤ 30 mm in diameter who underwent dynamic CT scans (80-96 ml of contrast material, 2.5-3 ml/s injection) and tumor resections. Attenuation values of both the early phase (20-36 s after injection) and delayed phase (91-95 s) of enhanced CT minus baseline plain CT attenuation were defined as ΔEarly and ΔDelay. The early enhancement ratio was defined as ΔEarly/ΔDelay×100 (%). We statistically compared the early enhancement ratios between the presence and absence of each pathological finding (lymph node metastasis, lymphatic permeation, vascular invasion, and pleural involvement). Patients were divided into 2 groups based on early enhancement ratios: ratio ≥50% (n = 41) and ratio <50% (n = 67) and we statistically compared these 2 groups. RESULTS: The early enhancement ratios in the group with lymph node metastasis, lymphatic permeation, and vascular invasion were significantly lower than in the group without these findings (24.9% vs 48.6%; P < 0.001, 30.0% vs 47.5%; P = 0.002, and 26.5% vs 47.0%; P = 0.002, respectively). Lymph node metastasis, lymphatic permeation, and vascular invasion were significantly more frequent in tumors with a ratio <50% than in tumors with ratio ≥50% (P < 0.001, P = 0.008, and P = 0.005, respectively). CONCLUSIONS: There was a significant correlation between the early enhancement ratio of enhanced dynamic CT and the pathological prognostic factors in small lung adenocarcinomas.

3D-CT lung volumetry using multidetector row computed tomography: pulmonary function of each anatomic lobe.

PURPOSE: We sought to determine the volume of each anatomic lung lobe reconstructed using 3-dimensional computed tomography (3D-CT) imaging from multidetector CT images and to compare these with pulmonary function test results. MATERIALS AND METHODS: We reviewed preoperative 3D-CT images and spirometry results of 111 patients (86 men and 25 women) with pulmonary neoplasms who were considered candidates for lung resections. On a 3D-CT image, the entire lung was semiautomatically separated into 5 anatomic lobes: right upper lobe, right middle lobe, right lower lobe, left upper lobe, and left lower lobe. For each lobe, total lobar volume, emphysematous lobar volume with low attenuation values of less than -950 HU, and normal lobar volume (NLV=total lobar volume-emphysematous lobar volume) were calculated. Vital capacity, forced expiratory volume in 1 second, and diffusing capacity for carbon monoxide (DLCO) were measured by spirometry. Relationships between NLV values of each lobe and pulmonary function results were determined by the Pearson correlation coefficients and multiple regression analysis. RESULTS: The NLV values for both lower lobes (right lower lobe and left lower lobe) and the other lobes (right upper lobe, right middle lobe, and left upper lobe) were significantly correlated with vital capacity and forced expiratory volume in 1 second; lower lobes showed a stronger tendency toward these correlations. The NLV values of the lower lobes were significantly correlated with DLCO (P<0.001), although the NLV values of the other lobes were not correlated with DLCO (P=0.112). CONCLUSIONS: Pulmonary function results, particularly DLCO, were primarily affected by the NLVs of the lower lobes.

Correlation between dual-phase dynamic multi-detector CT findings and fibrosis within lung adenocarcinoma tumors.

OBJECTIVE: We focused on fibrosis within lung adenocarcinoma tumors in order to retrospectively analyze correlations with dual-phase contrast enhanced dynamic CT findings. MATERIALS AND METHODS: We evaluated 89 patients with stage I lung adenocarcinoma who underwent dynamic CT scans (80-96 mL of contrast material, 2.5-3 mL/s injection) and tumor resections. Attenuation values of both the early phase (21-37 s after injection) and the delay phase (91-95 s) of enhanced CT minus the baseline plain CT attenuation were calculated as ΔEarly and ΔDelay. An early enhancement ratio was defined as ΔEarly/ΔDelay×100. These enhancement patterns were compared with patient and tumor characteristics, including scar grades that were the degrees of fibrosis within tumors evaluated semi-quantitatively by pathologists. RESULTS: From multivariate analysis, only the tumor scar grade showed significant correlations with ΔEarly (p<0.001) and the early enhancement ratio (p<0.001). For ΔEarly and the early enhancement ratio, there were significant differences among 4 groups based on tumor scar grades (p=0.003 and p=0.006, respectively); a higher scar grade tumor tended to show lower enhancement at the early phase. CONCLUSIONS: There was a significant negative correlation between the amount of fibrosis and the enhancement grade at the early phase of contrast enhanced dynamic CT in stage I lung adenocarcinoma. Dynamic CT findings could be modified by the degree of fibrosis within a lung tumor.

Semi-automatic volumetric measurement of lung cancer using multi-detector CT effects of nodule characteristics.

RATIONALE AND OBJECTIVES: The aims of this study were to determine interobserver variability in volume measurements of lung tumors (including part-solid and nonsolid types) using novel computer-aided diagnosis (CAD) tools and a machine learning approach and to determine the potential reasons for variability. MATERIALS AND METHODS: In 60 consecutive patients with peripheral lung cancer, the three-dimensional volumes of nodules were measured using the perimeter method by an experienced chest radiologist. In addition, for the same patients, maximal diameters and three-dimensional volumes were measured with and without a novel CAD tool by six observers. The coefficient of variance (CV) as index of interobserver variability was calculated. For the measurement of volume, the results of the perimeter method were compared to those of the CAD method. Furthermore, the CV was calculated for the following subgroups: nodule diameter, internal opacity, margin, spiculation, and adherence to vessels and the chest wall. RESULTS: There was significant interobserver variability among the six observers for manual, but not CAD, measurements of maximal diameter (P < .001 and P = .207, respectively). Volume measured with the perimeter method by a chest radiologist was well correlated with volume measured with the aid of the CAD system by six radiologists (r = 0.98-0.99). There was no significant difference in the CV for size, internal opacity, spiculation of nodules, or adherence to pulmonary vessels and the chest wall. The CV was significantly higher for obscure marginal nodules than for clear marginal nodules (P < .01). CONCLUSIONS: The novel CAD tool could be used to measure the volume of not only solid but also part-solid and nonsolid lung tumors.