Computed Tomography Fluoroscopy To Assist Transbronchial Needle Aspiration Clinical Experience

We have performed over 35 procedures using CT-fluoroscopic-assisted TBNA, of which the first 27 have been analyzed 34 . The 27 patients were selected to undergo this procedure either because of previous unsuccessful biopsy (n 7) or on the basis of a clinical decision that the lesion might be too small or inaccessible to reach if TBNA was done in a blind fashion. Only one patient had undergone prior percutaneous needle biopsy. Among the 27 procedures, 15 were performed for mediastinal nodes and...

Radiological Evaluation

Although an increasing number of solitary pulmonary opacities are diagnosed by computed tomography (CT), either incidentally or as part of lung cancer screening studies, many are still initially detected on chest radiographs. If the nodule is diffusely calcified (Fig. 3), or comparison with older radiographs shows stability in size for more than 2 years, the nodule is presumed to be benign and no further evaluation is recommended. Many nodules, however, require further radiological evaluation...

Anatomic Imaging A Computed Tomography

Computed tomography is the most widely utilized cross-sectional imaging modality for staging patients with bronchogenic carcinoma. With regard to the assessment of lymph nodes, CT relies on anatomic features, most notably lymph node size, in order to distinguish between benign and malignant lymph nodes. Although very early investigations with CT suggested sensitivities and specificities comparable to mediastinoscopy, subsequent studies performed with more thorough nodal sampling have shown that...

Aortic Dissection

Aortic dissection is the most common and lethal of the acute aortic disorders, with a reported incidence of 0.2-0.8 4 . Risk factors for the development of aortic dissection include hypertension, cystic medial necrosis due to connective tissue disease (i.e., Marfan's and Ehlers-Danlos syndrome), congenital lesions such as bicuspid aortic valve and aortic coarctation, pregnancy, trauma, and arteritis. Patients who develop intramural hematomas, a variant of aortic dissection described below, may...

Improved Spatial Resolution

MHCT can be used to improve spatial resolution. This is especially apparent in the z axis (orthogonal plane to slice acquisition plane), where slice thickness determines the z axis resolution, but improved spatial resolution is also visible in the axial plane. By allowing a greater number of images to be acquired in the same amount of time, one can obtain thinner image slices. The spatial resolution advantage in the axial plane is due to reduced amount of partial volume averaging artifacts. The...

Lung Cancer Screening A Historical Perspective

Screening studies for lung cancer date to the 1950s and 1960s when several studies were undertaken using a variety of screening protocols that combined chest radiography and sputum analysis. The protocols employed different screening time intervals and the study design was either uncontrolled or controlled but nonrandomized. The most widely publicized study was the Philadelphia Pulmonary Neoplasm Research Project, in which only 6 of 94 patients with lung cancer detected at screening survived...

Intramural Hematoma

Intramural hematoma (IMH) of the aorta is an acute clinical entity that represents a hemorrhage confined to the aortic media in which there is no intimal tear (Fig. 4D). It is thought to arise from rupture of the vasa vasorum within the aortic media and as in aortic dissection tends to affect hypertensive patients, although it can result from trauma or develop as a complication of a penetrating atherosclerotic ulcer. Since only first recognized as a distinct radiographic entity in 1985 14 , it...

Hyperpolarized Gas Enhanced Magnetic Resonance Imaging of the Lung

Duke University Medical Center Durham, North Carolina University of Cincinnati and Children's Hospital Medical Center Cincinnati, Ohio Duke University Medical Center Durham, North Carolina The role of conventional hydrogen magnetic resonance imaging (MRI) for evaluation of the lung parenchyma remains limited, despite advances in instrumentation and pulse-sequence design 1-4 . This is because (1) the concentration of hydrogen protons in lung tissue is low, (2) only a small fraction of these...

Nodule Growth

Evaluation of growth is performed by reviewing preexisting chest radiographs or CTs. The majority of malignant nodules double in volume between 30 and 400 days 34 . Nodular opacities that double in volume more rapidly than 30 days are usually infectious or inflammatory in origin (Fig. 18), whereas those that double in volume more slowly than 400 days are usually benign pul- Figure 15 Squamous-cell lung cancer. Computed tomography shows thick-walled cavitary nodule in left upper lobe. Thick...

Digital Chest Radiography

The results of the LDCT studies described in the previous section have clearly shown the limited ability of conventional chest radiography to detect early lung cancer. Emerging technological advancements in digital chest radiography, including computer-aided diagnosis, temporal subtraction, and dual energy subtraction methods, may significantly improve the ability of chest radiography to detect small lung nodules 44-46 . These techniques are described in further detail in Chapter 13. Once this...

CT Quantification of Emphysema

Panacinar Emphysema

University of Michigan Health System, Ann Arbor, Michigan Before the reintroduction of lung volume reduction surgery (LVRS) in the mid-1990s as a surgical treatment for advanced emphysema 1 , the routine clinical use of medical imaging for emphysema was largely limited to the chest radiograph. Emphysema was commonly depicted on computerized tomography (CT) scans of the thorax performed for other reasons, such as lung cancer diagnosis or staging however, there has been little reason to apply...

Conventional Autofluorescence and Virtual Bronchoscopy

Conventional bronchoscopy is a valuable technique for localizing preinvasive lung cancer within the airways. In general, conventional bronchoscopy can detect nodular or polypoid lesions > 2 mm in size and flat or superficially spreading lesions > 2 cm in diameter 21,57 . With regard to carcinoma in situ, 75 of lesions are superficial or flat and 25 are nodular or polypoid 21,56 . Autofluorescence bronchoscopy (AF) is a recently developed optical imaging method that is designed to improve...