Enhancing the interferon-γ release assay through omission of nil and mitogen values.

PURPOSE: To address the limited utility of the interferon (IFN)-γ release assay (IGRA) caused by its variability and inconsistency. METHODS: This retrospective cohort study was based on data obtained between 2011 and 2019. QuantiFERON-TB Gold-In-Tube was used to measure IFN-γ levels in nil, tuberculosis (TB) antigen, and mitogen tubes. RESULTS: Of 9,378 cases, 431 had active TB. The non-TB group comprised 1,513 IGRA-positive, 7,202 IGRA-negative, and 232 IGRA-indeterminate cases. Nil-tube IFN-γ levels were significantly higher in the active TB group (median = 0.18 IU/mL; interquartile range: 0.09-0.45 IU/mL) than in the IGRA-positive non-TB (0.11 IU/mL; 0.06-0.23 IU/mL) and IGRA-negative non-TB (0.09 IU/mL; 0.05-0.15 IU/mL) groups (P < 0.0001). From receiver operating characteristic analysis, TB antigen tube IFN-γ levels had higher diagnostic utility for active TB than TB antigen minus nil values. In a logistic regression analysis, active TB was the main driver of higher nil values. In the active TB group, after reclassifying the results based on a TB antigen tube IFN-γ level of 0.48 IU/mL, 14/36 cases with negative results and 15/19 cases with indeterminate results became positive, while 1/376 cases with positive results became negative. Overall, the sensitivity for detecting active TB improved from 87.2 to 93.7%. CONCLUSION: The results of our comprehensive assessment can aid in IGRA interpretation. Since nil values are governed by TB infection rather than reflecting background noise, TB antigen tube IFN-γ levels should be used without subtracting nil values. Despite indeterminate results, TB antigen tube IFN-γ levels can be informative.

Diagnostic accuracy and safety of CT-guided percutaneous lung biopsy with a coaxial cutting needle for the diagnosis of lung cancer in patients with UIP pattern.

This study aimed to assess the diagnostic accuracy and safety of CT-guided percutaneous core needle biopsy (PCNB) with a coaxial needle for the diagnosis of lung cancer in patients with an usual interstitial pneumonia (UIP) pattern of interstitial lung disease. This study included 70 patients with UIP and suspected to have lung cancer. CT-guided PCNB was performed using a 20-gauge coaxial cutting needle. The diagnostic accuracy, sensitivity, specificity, and percentage of nondiagnostic results for PCNB were determined in comparison with the final diagnosis. PCNB-related complications were evaluated. Additionally, the risk factors for nondiagnostic results and pneumothorax were analyzed. The overall diagnostic accuracy, sensitivity, and specificity were 85.7%, 85.5%, and 87.5%, respectively. The percentage of nondiagnostic results was 18.6% (13/70). Two or less biopsy sampling was a risk factor for nondiagnostic results (p = 0.003). The overall complication rate was 35.7% (25/70), and pneumothorax developed in 22 patients (31.4%). A long transpulmonary needle path was a risk factor for the development of pneumothorax (p = 0.007). CT-guided PCNB using a coaxial needle is an effective method with reasonable accuracy and an acceptable complication rate for the diagnosis of lung cancer, even in patients with UIP.

Ciliated muconodular papillary tumor of the lung with cavitary change: A case report with 11-year preoperative follow-up.

Ciliated muconodular papillary tumor (CMPT) is a rare benign lung tumor characterized by ciliated columnar cells, mucous cells, and basal cells. Herein, we report a case of CMPT with 11 years of preoperative follow-up, depicting the natural course of the tumor and changes in computed tomography (CT) findings. A 39-year-old man had a 5-mm solid pulmonary nodule in the right lower lobe that had slowly grown and transformed into a thin-walled cavitary lesion. Right lower lobe lobectomy was performed and the tumor was confirmed to be a CMPT. Although it is difficult to diagnose CMPT with CT findings alone, CMPT should be considered as a possible diagnosis when a slowly growing nodule undergoes cavitary changes.

Usefulness of Staging Chest CT in Breast Cancer: Evaluating Diagnostic Yield of Chest CT According to the Molecular Subtype and Clinical Stage.

The aim of this study is to investigate the clinical utility of staging chest CT in breast cancer by evaluating diagnostic yield (DY) of chest CT in detection of metastasis, according to the molecular subtype and clinical stage. This retrospective study included 840 patients with 855 breast cancers from January 2017 to December 2018. The number of patients in clinical stage 0/I, II, III and IV were 457 (53.5%), 298 (34.9%), 92 (10.8%) and 8 (0.9%), respectively. Molecular subtype was identified in 841 cancers and there were 709 (84.3%) luminal type, 55 (6.5%) human epidermal growth factor receptor 2 (HER2)-enriched type and 77 (9.2%) triple-negative (TN) type. The DYs in clinical stage 0/I, cII, cIII and cIV were 0.2% (1/457), 1.7% (5/298), 4.3% (4/92) and 100.0% (8/8), respectively. The DYs in luminal type, HER2-enriched type and TN type were 1.7% (12/709), 3.6% (2/55) and 2.6% (2/77), respectively. Clinical stage was associated with the DY (p = 0.000). However, molecular subtype was not related to the DY (p = 0.343). Molecular subtype could not provide useful information to determine whether staging chest CT should be performed in early-stage breast cancer. However, chest CT should be considered in advanced breast cancer.

Visual assessment of calcification in solitary pulmonary nodules on chest radiography: correlation with volumetric quantification of calcification.

PURPOSE: To assess the ability of digital chest radiography (CXR) to reveal calcification in solitary pulmonary nodules (SPNs), and to examine the correlation between a visual assessment and volumetric quantification of the calcification. MATERIALS AND METHODS: This study was a retrospective review of 220 SPNs identified by both CXR and chest CT. Eleven observers did blind review of the CXR images and scored nodule calcification on a confidence scale of 1 to 5. The area under the receiver operating characteristics (ROC) curve (AUC) was obtained to analyze the diagnostic performance. The intraclass correlation coefficient (ICC) for interrater reliability was calculated. The AUC and ICC were calculated according to the following nodule diameter groups: group 1 (< 10 mm), group 2 (≥ 10 mm and < 20 mm), and group 3 (≥ 20 mm). RESULTS: Of the 220 SPNs, 145 SPNs (65.6%) were identified as non-calcified and 75 (34.4%) as calcified. The average percentage of calcification volume in SPN > 160 HU (Vol160HU) among the 75 calcified nodules was 47.5%. The mean Vol160HU of the 68 SPNs classified as having definite calcification was 51.1%. The overall AUC was 0.71. The AUCs for groups 1, 2, and 3 was 0.835, 0.639, and 0.620, respectively. The ICCs for groups 1, 2, 3 was 0.65, 0.48, and 0.33, respectively. CONCLUSION: The overall diagnostic performance of digital CXR to predict calcification in SPNs was moderately accurate and the diagnostic performance for predicting calcification in SPNs was significantly higher, and interobserver reproducibility was good when SPN < 10 mm compared with ≥ 10 mm in diameter. KEY POINTS: • The misdiagnosis of a non-calcified nodule as a calcified one by CXR could lead to poor management choices for the SPN. • The diagnostic performance of CXR in predicting calcification was best for nodules < 10 mm in diameter. SPNs with calcification of approximately 50% of their volume tend to be considered calcified. • The diagnostic performance of CXR in identifying calcification was low for nodules ≥ 10 mm in diameter; therefore, we should carefully evaluate calcification carefully for nodules ≥ 10 mm.

Usefulness of low dose chest CT for initial evaluation of blunt chest trauma.

We aimed to compare the diagnostic performance and inter-observer consistency between low dose chest CT (LDCT) and standard dose chest CT (SDCT) in the patients with blunt chest trauma.A total of 69 patients who met criteria indicative of blunt chest trauma (77% of male; age range, 16-85) were enrolled. All patients underwent LDCT without intravenous (IV) contrast and SDCT with IV contrast using parameters as following: LDCT, 40 mAs with automatic tube current modulation (ATCM) and 100 kVp (BMI <25, n = 51) or 120 kVp (BMI>25, n = 18); SDCT, 180 mAs with ATCM and 120 kVp. Transverse, coronal, sagittal images were reconstructed with 3-mm slice thickness without gap and provided for evaluation of 3 observers. Reference standard images (transverse, coronal, sagittal) were reconstructed using SDCT data with 1-mm slice thickness without gap. Reference standard was established by 2 experienced thoracic radiologists by consensus. Three observers independently evaluated each data set of LDCT and SDCT.Multiple-reader receiver operating characteristic analysis for comparing areas under the ROC curves demonstrated that there was no significant difference of diagnostic performance between LDCT and SDCT for the diagnosis of pulmonary injury, skeletal trauma, mediastinal injury, and chest wall injury (P > 0.05). The intraclass correlation coefficient was measured for inter-observer consistency and revealed that there was good inter-observer consistency in each examination of LDCT and SDCT for evaluation of blunt chest injury (0.8601-1.000). Aortic and upper abdominal injury could not be appropriately compared as LDCT was performed without using contrast materials and this was limitation of this study.The effective radiation dose of LDCT (average DLP = 1.52 mSv⋅mGy cm) was significantly lower than those of SDCT (7.21 mSv mGy cm).There is a great potential benefit to use of LDCT for initial evaluation of blunt chest trauma because LDCT could maintain diagnostic image quality as SDCT and provide significant radiation dose reduction. A further study of LDCT with IV contrast for evaluation of aortic and upper abdominal injury is needed.

Usefulness of Ultralow-Dose (Submillisievert) Chest CT Using Iterative Reconstruction for Initial Evaluation of Sharp Fish Bone Esophageal Foreign Body.

OBJECTIVE: The purpose of this article was to evaluate the usefulness of ultralow-dose chest CT as an initial imaging study for evaluation of sharp fish bone esophageal foreign body (FB). MATERIALS AND METHODS: A total of 57 subjects who underwent ultralow-dose chest CT were included in this retrospective study. All subjects had a history of ingestion and symptoms of esophageal FB. All ultralow-dose chest CT data were reconstructed twice, once with filtered back projection (FBP) and once with iterative reconstruction, and three observers reviewed the images independently. ROC analysis was used to evaluate diagnostic performance of ultralow-dose chest CT. Intraclass correlation coefficient (ICC) was calculated for analysis of interobserver agreement. RESULTS: Among 57 patients, 42 were confirmed as having esophageal FB. Significant objective noise reduction of mediastinum was achieved using an iterative reconstruction technique. Subjective image noise of iterative reconstruction was significantly better than that of FBP. Overall diagnostic performance of ultralow-dose chest CT for esophageal FB of iterative reconstruction (AUC = 0.999) was significantly better than that of FBP (AUC = 0.95) (p = 0.02). Interobserver agreement was greater for iterative reconstruction (ICC = 0.944) than for FBP (ICC = 0.778). CONCLUSION: Ultralow-dose chest CT using iterative reconstruction provided satisfactory diagnostic image quality for identifying fish bone esophageal FB with reduced radiation dose and high observer accuracy. Therefore, ultralow-dose chest CT would be adequate as a first-line imaging modality for fish bone esophageal FB.

Simple pulmonary eosinophilia found on follow-up computed tomography of oncologic patients.

OBJECTIVES: To investigate the prevalence of simple pulmonary eosinophilia (SPE) and validate CT findings of SPE found on follow-up CT of oncologic patients. METHODS: We retrospectively reviewed 6977 cases of oncologic patients who underwent chest CT. A total of 66 individuals who met criteria for having SPE were identified. CT scans were fully re-assessed by consensus of 2 radiologists in terms of characteristics of pulmonary lesions. RESULTS: The prevalence of SPE was 0.95%. A total of 193 lesions were identified and most of the lesions showed part-solid pattern (69.9%), round to ovoid contour (46.1%), ill-defined margin (90.2%), or partial halo appearance (74.8%). In addition, almost half of the lesions showed the vascular contact (49%). SPE appeared as either solitary (42.4%) or multiple lesions (57.6%). The majority of lesions were located in the periphery (76.2%), and lower lung zonal (67.4%) predominance was found. CONCLUSIONS: The frequency of SPE in oncologic patients with CT findings of GGO, part-solid lesion was high (17.5%). Therefore, when key features of CT findings suggesting SPE (part-solid nodule; ill-defined margin; peripheral distribution; and lower lung zone predominance) are newly discovered on follow-up chest CT in oncologic patients, it would be useful to correlate with blood test and do short-term follow-up in order to avoid unnecessary invasive procedure.

Value of MDCT in diagnosis and management of esophageal sharp or pointed foreign bodies according to level of esophagus.

OBJECTIVE: The purpose of this study was to validate the usefulness of MDCT for diagnosis of a sharp or pointed esophageal foreign body according to esophageal level. MATERIALS AND METHODS: Forty-two patients with a history of sharp or pointed foreign body ingestion were reviewed retrospectively. Two observers interpreted the CT and the conventional radiography datasets separately. If a foreign body was directly identified, it was regarded as a positive finding. Even if no high-density foreign body was found, detection of a secondary finding was considered to be a positive finding. Diagnostic performance of MDCT and conventional radiography were compared according to esophageal level. Final diagnosis was made by esophagoscopy or surgery in addition to the clinicoradiologic result. RESULTS: MDCT was statistically superior to conventional radiography for diagnosis of a thoracic esophageal foreign body for both observers (p < 0.001 for each). No significant difference in sensitivity between CT and conventional radiography for diagnosis of cervical esophageal foreign body was noted regardless of observer. Both observers could identify all complicated conditions with MDCT regardless of esophageal level. However, in two of three cases of complicated thoracic esophageal foreign bodies, neither observer could detect foreign bodies on conventional radiography; furthermore, the observers could not identify pneumomediastinum. CONCLUSION: In cases of sharp or pointed foreign body ingestion, if the result of an initial inspection of oro- and hypopharynx reveals negative findings, the first imaging modality should be MDCT for better diagnosis and management.

Papillary thyroid carcinoma involving cervical neck lymph nodes: correlations with lymphangiogenesis and ultrasound features.

Stratification of risk factors for cervical lymph node metastasis (LNM) in thyroid papillary carcinoma is important for providing standards for post-operative adjuvant radio-iodine therapy and for patient prognosis. We investigated pathological factors based on the lymphatic vessel system and radiological features associated with tumor with cervical neck LNM. Among patients who had undergone thyroidectomy confirmed to be papillary thyroid carcinoma, we selected 126 age-sex matched paired patients without cervical LNM (group 1) and with LNM (group 2) to evaluate risk factors. Pathological factors evaluated were size, multiplicity, and extra thyroid extension state, based on the pathological reports using stored data. The lymphatic vessel density (LVD) of each tumor was evaluated by staining for VEGFR-3 and D2-40 and correlated with cervical LNM state. Malignant ultrasound features were evaluated to compare the differences between these two groups. Larger tumor size, multiplicity, extrathyroid extension were more common in group 2 (p<0.05). The median percentage of VEGFR-3 for group 1 was 20 (range 0-30) and D2-40 was 13 (range 7-23) while for group 2, VEGFR-3 was 80 (70-90) and D2-40 was 78 (54-114). LVD measured by intratumoral D2-40 staining was 20.6% and 79.4% for group 1 and group 2, respectively. Intra-tumoral lymphatics measured by D2-40 stain had a strong correlation with cervical LNM (Odds 1.230, CI 1.01.-1.499 p value 0.040). Ultrasound (US) features had no significant differences between the two groups although calcifications tended to be higher in group 2 (84% vs. 76% p=0.264). Lymphatic vessel density and nodule echogenicity were not associated with LNM. Intratumoral lymphangiogenesis was most strongly associated with LNM and thus, could be a useful predictive marker for cervical LNM.

The features of radiation induced lung fibrosis related with dosimetric parameters.

BACKGROUND AND PURPOSE: Radiation induced lung fibrosis (RILF) is a major complication after lung irradiation and is very important for long term quality of life and could result in fatal respiratory insufficiency. However, there has been little information on dosimetric parameters for radiotherapy planning in the aspect of RILF. The features of RILF related with dosimetric parameters were evaluated. METHODS AND MATERIALS: Forty-eight patients with non-small cell lung carcinoma who underwent post-operative radiation therapy (PORT) without adjuvant chemotherapy were analyzed. The degree of lung fibrosis was estimated by fibrosis volume and the dosimetric parameters were calculated from the plan of 3-dimensional conformal radiotherapy. RESULTS: The fibrosis volume and V-dose as dosimetric parameters showed significant correlation and the correlation coefficient ranged from 0.602 to 0.683 (P<0.01). The degree of the correlation line was steeper as the dose increase and threshold dose was not found. Mean lung dose (MLD) showed strong correlation with fibrosis volume (correlation coefficient = 0.726, P<0.01). CONCLUSIONS: The fibrosis volume is continuously increased with V-dose as the reference dose increases. MLD is useful as a single parameter for comparing rival plans in the aspect of RILF.

Usefulness of combined assessment with computed tomographic signs of right ventricular dysfunction and cardiac troponin T for risk stratification of acute pulmonary embolism.

The aim of this study was to evaluate the incremental value of combined assessment with computed tomographic (CT) signs of right ventricular (RV) dysfunction and cardiac troponin T level for predicting early death or adverse outcomes due to acute pulmonary embolism (PE). One hundred seventy-three non-high-risk patients with acute PE, confirmed by CT pulmonary angiography, were retrospectively evaluated. The area under the curve and hazard ratio of CT signs and troponin T levels were compared for predicting early death or adverse outcomes. Patients were classified into intermediate- and low-risk groups on the basis of CT signs and troponin T levels, and mortality was compared. Seventeen patients (9.8%) died within 3 months. Early mortality of intermediate-risk patients (14% to 19%) was higher than that of low-risk patents (2% to 6%). A ratio of RV volume to left ventricular volume > 1.5 had the highest area under the curve (0.709) and hazard ratio (5.402) for predicting early death. The combination of CT signs and elevated troponin T level had an increased area under the curve and hazard ratio for predicting early death and adverse outcomes compared to those of CT signs or elevated troponin T level alone. In conclusion, the combined assessment of the ratio of RV volume to left ventricular volume and an elevated troponin T level provided incrementally more prognostic information in non-high-risk patients with acute PE compared to the single predictor of CT signs or troponin T level.

Emphysema as a risk factor for the outcome of surgical resection of lung cancer.

It is unclear whether emphysema, regardless of airflow limitation, is a predictive factor associated with survival after lung cancer resection. Therefore, we investigated whether emphysema was a risk factor associated with the outcome after resection for lung cancer. This study enrolled 237 patients with non small cell lung cancer with stage I or II who had surgical removal. Patient outcome was analyzed based on emphysema. Emphysema was found in 43.4% of all patients. Patients with emphysema were predominantly men and smokers, and had a lower body mass index than the patients without emphysema. The patients without emphysema (n=133) survived longer (mean 51.2+/-3.0 vs. 40.6+/-3.1 months, P=0.042) than those with emphysema (n=104). The univariate analysis showed a younger age, higher FEV(1)/FVC, higher body mass index, cancer stage I, and a lower emphysema score were significant predictors of better survival. The multivariate analysis revealed a younger age, higher body mass index, and cancer stage I were independent parameters associated with better survival, however, emphysema was not. This study suggests that unfavorable outcomes after surgical resection of lung cancer should not be attributed to emphysema itself.

Epithelial apoptosis as a clinical marker in idiopathic interstitial pneumonia.

BACKGROUNDS: Epithelial cell apoptosis plays an important role in the pathogenesis of idiopathic interstitial pneumonia (IIP). METHODS: Serum levels of caspase-cleaved cytokeratin-18 (M30) were measured in 55 patients with IIP and 34 healthy controls using enzyme-linked immunosorbent assays. The IIP cases included usual interstitial pneumonia (UIP; n = 30), nonspecific interstitial pneumonia (NSIP; n = 15), and cryptogenic organizing pneumonia (COP; n = 10). The radiological scoring was performed based on high-resolution computed tomography (HRCT) findings. RESULTS: Patients with IIP had higher serum M30 levels than did the control group (178.6 ± 91.5 vs. 113.7 ± 46.8 U/L, p < 0.05). Among IIP patients, COP patients had higher serum M30 levels than did UIP or NSIP patients (264.9 ± 132.7, 139.2 ± 49.7, and 201.2 ± 81.1 U/L, respectively; COP vs. UIP, p < 0.01). Serum M30 levels were negatively correlated with forced vital capacity (FVC; r(s) = -0.31), percent-predicted FVC (FVC%; r(s) = -0.38), and percent-predicted forced expiratory volume in 1 s (FEV(1)%; r(s) = -0.36). Serum M30 levels were correlated with radiological ground-glass opacity scores (r(s) = 0.61). CONCLUSION: The epithelial apoptosis marker serum level was correlated with IIP clinical status and is a potential marker to assess IIP.

CT findings in patients with pericardial effusion: differentiation of malignant and benign disease.

OBJECTIVE: This study was designed to validate the usefulness of a CT finding of abnormal pericardial thickening and to investigate the value of associated thoracic changes in predicting the presence of malignant pericardial effusion. MATERIALS AND METHODS: Seventy-four consecutively registered patients with pericardial effusion detected with transthoracic echocardiography were included in the study. The patients fulfilled the following criteria: undergoing pericardial fluid cytologic examination or pericardial tissue biopsy and undergoing chest CT examination less than 30 days after pericardial fluid or tissue examination. CT images were reviewed for the presence of pericardial thickening, the pattern of pericardial thickening, and the presence of pleural effusion and mediastinal lymph node enlargement. RESULTS: Twenty-eight cases of malignant and 46 cases of benign pericardial effusion were identified. Mean pericardial thickening was greater in association with malignant disease (7.25 +/- 2.91 mm) than with benign disease (4.11 +/- 1.39 mm) (p < 0.05). Abnormal pericardial thickening (p < 0.05) and mediastinal lymph node enlargement (p < 0.001) were statistically significant findings of malignant pericardial effusion. The sensitivity of abnormal pericardial thickening was 42.9% and that of mediastinal lymph node enlargement was 60.7%. CONCLUSION: CT findings of irregular pericardial thickening and mediastinal lymphadenopathy have the potential to be reliably specific findings suggesting the presence of malignant pericardial effusion. It would be useful, however, to obtain pericardial fluid or tissue for cause-based management of pericardial effusion, especially in patients with malignant disease.

Serum angiopoietin-1 as a prognostic marker in resected early stage lung cancer.

PURPOSE: We evaluated the clinical significance of angiopoietins and vascular endothelial growth factor (VEGF) in patients with resected early stage lung cancer. PATIENTS AND METHODS: The study enrolled 101 patients with completely resected non-small cell lung cancer (NSCLC) of stage I or II, along with 70 healthy volunteers. Serum concentrations of angiopoietin-1, angiopoietin-2, and VEGF were measured with an ELISA. Immunohistochemical expression of angiopoietin-1 was compared with the microvessel density on the lung cancer tissues. RESULTS: The patients had lower serum angiopoietin-1 (32.1+/-9.9 ng/mL vs. 39.0+/-10.8 ng/mL, p<0.001), higher angiopoietin-2 (1949.2+/-1099.4 pg/mL vs. 1498.6+/-650.0 pg/mL, p<0.01), and higher VEGF (565.1+/-406.3 pg/mL vs. 404.6+/-254.8 pg/mL, p<0.01) levels than the controls. The angiopoietin-2 level was higher in stage II than in stage I patients (p<0.05). The levels of angiopoietin-1 (r=0.28) and angiopoietin-2 (r=0.36) each correlated with the VEGF level. Patients with a higher level of angiopoietin-1 (> or =31.2 ng/mL) had better disease-specific and relapse-free survival than those with a lower angiopoietin-1 level (<31.2 ng/mL). Angiopoietin-1 expression negatively correlated with the microvessel density. CONCLUSION: Serum angiopoietin-1 is a potential marker for predicting postoperative survival and recurrence in patients with early stage NSCLC.

Clinical usefulness of the fluorodeoxyglucose (FDG)-PET maximal standardized uptake value (SUV) in combination with CT features for the differentiation of adenocarcinoma with a bronchioloalveolar carcinoma from other subtypes of non-small cell lung cancers.

PURPOSE: To evaluate the clinical usefulness of fluorodeoxyglucose (FDG)-PET maximal SUV in combination with CT features for differentiation of adenocarcinoma with bronchioloalveolar carcinoma (BAC) from other subtypes of non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: This retrospective study included 125 patients (104 men and 21 women; mean age, 64 years) who underwent CT and subsequent FDG-PET examinations for preoperative evaluation and underwent curative intent operation with the final diagnoses of NSCLC made by surgical histopathology. We categorized NSCLC into adenocarcinoma with BAC feature and other subtypes. Finally, there were 16 cases of adenocarcinoma with BAC and 109 cases of other NSCLC subtypes included in the study. Several CT features of lung cancer were analyzed, including tumor size, presence of spiculation, margin (irregular or smooth), pattern of the mass (pure solid, pure ground glass opacity and mixed), associated pleural effusion and location (center, mid and periphery). Maximal SUV and visual scores of FDG uptakes of primary NSCLC were evaluated. The diagnostic performances of CT alone, PET alone, and combination of two modalities to predict adenocarcinoma with BAC from other subtypes of NSCLC were calculated. RESULTS: A nodule with a mixed pattern with partly solid and ground glass opacity was significantly more frequent CT feature of an adenocarcinoma with BAC (8/16, 50%) as compared with the other subtypes (2/109, 1.8%) (p<0.0001). Maximal SUV of adenocarcinoma with BAC (mean=7.2) was significantly lower than that of other subtypes of NSCLC (mean=13.33) (p<0.0001). Sensitivity, specificity, PPV, and NPV of CT for differentiating adenocarcinoma with BAC from other subtypes was 50% (8/16), 98.2% (107/109), 80% (8/10), and 93% (107/115), respectively. Sensitivity, specificity, PPV, and NPV of FDG-PET was 68.8% (11/16), 86.2% (94/109), 42.3% (11/26), and 94.9% (94/99), respectively. Sensitivity, specificity, PPV, and NPV of combination of two modalities was 81.3% (13/16), 85.3% (93/109), 44.8% (13/29), 96.9% (93/96), respectively. CONCLUSION: Careful combined assessment of the FDG-PET maximal SUV and CT findings have the potential to differentiate an adenocarcinoma with BAC from other NSCLC subtypes, such as a pure BAC. These findings might be useful for imaging interpretations and will help initial planning of NSCLC management.

Diagnostic performance of (18)F-FDG PET/CT for lymph node staging in patients with operable non-small-cell lung cancer and inflammatory lung disease.

As (18)F-fluorodeoxyglucose (FDG) is taken up by inflammatory lymph nodes, it could be falsely interpreted as metastasis. Therefore, we evaluated the diagnostic ability of positron emission tomography/computed tomography (PET/CT) for lymph node staging of lung cancer when inflammatory lung disease coexisted. Patients with operable non-small-cell lung cancer and FDG-avid lymph nodes were retrospectively classified into two groups; those with inflammatory lung disease (ILD) and those without it (NILD). Receiver operating characteristic (ROC) curve analysis was performed for maximum standardized uptake value (SUVmax), pattern of FDG uptake, maximum Hounsfield unit, and size, and then the areas under the ROC curves (AUCs) were compared between subgroups. There were 124 patients (ILD/NILD = 38/86) and 396 FDG-avid lymph nodes (ILD/NILD = 140/256). The average number of FDG-avid lymph nodes was greater in ILD (3.7 vs. 2.9, p = 0.039), whereas the proportion of metastasis was higher in NILD (25.4% vs. 11.4%, p = 0.002). With all N1-N3 lymph nodes and the NILD group, the AUC values of all four parameters were significantly greater than 0.5 (p < 0.05), and SUVmax was the most valuable parameter for lymph node metastasis. However, in the ILD group, only the AUC value of SUVmax was significantly greater than 0.5. These results were reproduced when analyses were performed with N1-N2 lymph nodes. In conclusion, SUVmax was the most valuable PET/CT parameter for assessment of lymph node metastasis in patients with operable non-small-cell lung cancer. In addition, it was the only valuable parameter when inflammatory lung disease coexisted.

Receiver operating characteristic analysis of the diagnostic performance of a computed tomographic examination and the Alvarado score for diagnosing acute appendicitis: emphasis on age and sex of the patients.

OBJECTIVE: To compare the diagnostic performance of computed tomography (CT) and the Alvarado score and to determine whether patient age and sex influence the use of CT and the Alvarado score for diagnosing acute appendicitis. MATERIALS AND METHODS: We retrospectively reviewed the CT scans and medical records of 372 patients who presented with right lower quadrant pain and underwent CT to rule out acute appendicitis.The population was classified by age and sex to determine its influence on the use of the Alvarado score and CT. Receiver operating characteristic analysis was used to calculate and compare the diagnostic performance of both modalities. RESULTS: The overall area under the receiver operating characteristic curves for CT and the Alvarado score was 0.965 (highly accurate) and 0.732 (moderately accurate), respectively. There was little effect of patient age and sex on diagnostic performance of CT. However, the diagnostic performance of the Alvarado score was variable according to the patient age and sex (lowest in older women). Furthermore, the overall sensitivity of the Alvarado score was too low (72.8%) for determining immediate surgical intervention. CONCLUSION: Clinical assessment using the Alvarado score should be supplemented with CT examination for accurate diagnosis of acute appendicitis in all patients who are suspected of acute appendicitis.

Primary pulmonary malignant fibrous histiocytoma mimics pulmonary artery aneurysm with partial thrombosis: various radiologic evaluations.

Primary pulmonary malignant fibrous histiocytoma (MFH) is very rare, so only a few imaging features have been reported. We report one case of rapidly growing primary pulmonary MFH mimicking a partially thrombosed pulmonary artery aneurysm and its radiologic findings, including multidetector row computed tomography (MDCT), conventional angiography, and fluorodeoxyglucose-positron emission tomography CT ([18F] FDG-PET/CT). On multi-phasic MDCT, this mass mimicked a pulmonary artery aneurysm with partial thrombosis. However, pulmonary artery aneurysm was excluded and suggested as a hypervascular parenchymal mass by subsequent conventional angiography. On [18F] FDG-PET/CT, it was a highly metabolic mass, showing a maximal standard uptake value (SUV) 12.1. Although primary pulmonary MFH is very rare and has no specific imaging findings, our experience might be helpful to differentiate a hypervascular pulmonary mass.