A

CU0138-2

Volume: 239,75 (mm*3) Extents (x. y, z): 11, 12, 7 (mm)

Length, Width, Height (ECU): 11.0148, 3,25055, 5.0335 (mm) Aspect Ratios (L/H. UW, W/H): 2.13613, 1.33504, 1.6375

Volume: 239,75 (mm*3) Extents (x. y, z): 11, 12, 7 (mm)

Length, Width, Height (ECU): 11.0148, 3,25055, 5.0335 (mm) Aspect Ratios (L/H. UW, W/H): 2.13613, 1.33504, 1.6375

Figure 4 Three-dimensional volumetric analysis of lung nodule showing early detection of malignant growth rate in proven non-small-cell lung cancer. (A) Three-dimensional volumetric reconstruction images of a small left apical lung nodule with a volume measurement of 193.531 mm3. (B) Follow-up 3D volumetric reconstruction images of the same nodule performed 4 months later reveals interval increase in volume to 239.75 mm3. Interval growth of the nodule was not readily apparent on axial highresolution CT images. (Courtesy of David Yankelevitz, New York Presbyterian Hospital/Weil Cornell Medical Center, New York, New York; from Ref. 65.)

The ELCAP investigators recently reported an analysis of missed lung nodules on screening LDCT that were subsequently identified on followup diagnostic CT scans [34]. Among the 163 patients who underwent diagnostic CT imaging, 36 (22%) had additional nodules which were not detected on LDCT. The majority (85%) of missed nodules measured 5 mm in diameter or less and none were greater than 10 mm in diameter. Thus, small size appears to be the most important factor related to missed nodules on LDCT. Interestingly, a majority of missed nodules were located peripherally.

Recent advances in technology will likely improve the ability of LDCT to detect and accurately characterize lung nodules [27-29,35-38]. These advances include the use of multidetector CT scanners, cine-based viewing, computerized detection methods, and three-dimensional reconstruction methods. Moreover, the addition of more specific noninvasive methods of imaging evaluation such as CT nodule enhancement [39] and 18F-labeled 2-deoxy-D-glu-cose positron emission tomography imaging (FDG PET) [40-43] may help to reduce the number of cases requiring close follow-up or biopsy [21]. These techniques are discussed further in Chapter 2.

With regard to the use of LDCT for mass screening of lung cancer, future studies are necessary to determine: (1) the reproducibility of the promising preliminary results of LDCT screening when it is applied at other institutions, (2) the effect of LDCT screening upon lung cancer mortality, (3) the cost-effectiveness of LDCT screening, (4) the subgroups of present and former smokers who are most likely to benefit from this screening tool, and (5) the optimal complementary screening method(s) to combine with LDCT in order to detect the full spectrum of lung cancer cell types [21].

The Society of Thoracic Radiology has recently constructed a consensus statement on the topic of screening for lung cancer with LDCT (www. thoracicrad.org). Excerpts from this statement are provided in Table 3.

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