Idiopathic interstitial pneumonias: do HRCT criteria established by ATS/ERS/JRS/ALAT in 2011 predict disease progression and prognosis?

PURPOSE: The objective of the study was to determine whether HRCT criteria for Usual Interstitial Pneumonia (UIP), possible UIP or no-UIP pattern recommended by ATS/ERS/JRS/ALAT guidelines 2011 are able to predict progression and prognosis of the disease in a group of patients with fibrotic idiopathic interstitial pneumonia (IIP). MATERIALS AND METHODS: This was a retrospective study conducted with the approval of the ethics committee. Two radiologists at baseline HRCT distributed 70 patients with fibrotic IIP into three groups on the basis of the 2011 guidelines: UIP pattern (group 1), possible UIP pattern (group 2), inconsistent with UIP pattern (group 3). The different abnormalities (honeycombing, reticulation, ground-glass and traction bronchiectasis), fibrotic score (reticulation + honeycombing) and overall CT score were visually scored at baseline and during the follow-up (total HRCT 178). The mortality rate of the three groups was compared. The baseline abnormalities were then correlated with the mortality rate in the UIP group. RESULTS: The inter-observer agreement in the classification of the abnormalities in the three groups was almost perfect (k = 0.92). After consensus, 44 patients were classified into group 1, 13 into group 2 and 13 into group 3. During a mean follow-up of 1386 days, overall CT score, fibrotic score, honeycombing and traction bronchiectasis showed a significant progression in group 1. The mortality rate was significantly higher in group 1 (18 deaths) versus group 2 and 3 (1 death each). In group 1, baseline honeycombing rate higher than 25 %, fibrotic score higher than 30, overall CT score greater than 45 and traction bronchiectasis in more than 4 lobes defined the worst prognosis. CONCLUSION: HRCT classification based on 2011 guidelines showed high accuracy in stratifying fibrotic changes because in our study UIP, possible UIP and inconsistent with UIP pattern seem to be correlated with different disease progression and mortality rate.

80-kV pulmonary CT angiography with 40 mL of iodinated contrast material in lean patients: comparison of vascular enhancement with iodixanol (320 mg I/mL)and iomeprol (400 mg I/mL).

OBJECTIVE: The purpose of this article is to compare the vascular enhancement obtained with a low-kilovoltage pulmonary CT angiography (CTA) protocol in lean patients, using 40 mL of a moderate-concentration isoosmolar (iodixanol, 320 mg I/mL) and a high-concentration low-osmolar (iomeprol, 400 mg I/mL) iodinated contrast medium injected at the same iodine delivery rate. SUBJECTS AND METHODS: Forty-two lean patients (31 men and 11 women; body mass index, ≤ 23 kg/m(2)) with suspected pulmonary embolism and non-small cell lung carcinoma underwent pulmonary CTA with a 64-MDCT scanner using a tube voltage of 80 kV. Twenty-three patients (54.8%) received 40 mL of iodixanol (320 mg I/mL) injected at a rate of 5 mL/s, and the remaining 19 patients (45.2%) were administered an equal volume of iomeprol (400 mg I/mL) at a flow rate of 4 mL/s. Intraarterial density was measured in the common pulmonary artery trunk, the main right and left pulmonary arteries, lobar arteries, and at the segmental level, for a total of 15 regions of interest per patient. Intravascular enhancement homogeneity from central to subsegmental level was also assessed visually using a semiquantitative score (1 = poor, 2 = good, and 3 = excellent). RESULTS: The overall vascular density of pulmonary arteries down to the segmental level was significantly higher with iodixanol (320 mg I/mL) than with iomeprol (400 mg I/mL) (p = 0.036). Enhancement homogeneity was good with both contrast agents, with no statistically significant difference between them (p = 0.8966). CONCLUSION: In 80-kV pulmonary CTA of lean patients, higher intravascular enhancement can be achieved with 40 mL of iodixanol (320 mg I/mL) than with the same volume of iomeprol (400 mg I/mL), with good vessel conspicuity down to the subsegmental level.

Intraoperative radioguided sentinel lymph node biopsy in non-small cell lung cancer.

OBJECTIVES: The aim of this study was to determine the accuracy and the role of the sentinel lymph node (SLN) technique in patients with early non-small cell lung cancer (NSCLC). METHODS: This study was carried out on 29 consecutive patients (M/F = 24:5, mean age 65.9 +/- 7.1 years) with resectable NSCLC (Stage IA-IB). Intraoperative injection with a (99m)Tc-nanocolloid suspension was performed in the first ten patients; the following patients were injected under computed tomography scan guidance. A total dose of 37 MBq (1 ml) was administered in two to four divided aliquots (depending on the size), injected in the periphery of the tumour. Intraoperative radioactivity counting started a mean of 1 h (range 50-70 min) after the injection. The SLN was defined as the node with the highest count rate using a handheld gamma probe counter. Resection with mediastinal node dissection was performed and findings were correlated with histologic and immunohistochemistry (IHC) examination. RESULTS: Three of the 29 patients did not have NSCLC (two benign lesions, and one metastatic breast tumour) and were excluded. The SLN was identified in 25/26 (96.1%) patients (a total of 31 SLNs); 7/31 (22.5%) of the SLNs were positive for metastatic involvement after histologic and IHC examination. One inaccurately identified SLN was encountered (3.8%). CONCLUSIONS: These preliminary results demonstrate the feasibility of this procedure in identifying the first site of potential nodal metastases of NSCLC. The actual clinical impact of this procedure remains to be elucidated by further investigation in larger groups of patients.