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Background Little is known about the histopathology and prognosis of persistent pure ground-glass opacity nodules (GGNs) of ≥ 10 mm in diameter. We aimed to compare the morphologic features of persistent pure GGNs of ≥ 10 mm in diameter at thin-section CT (TSCT) scan with histopathology and patient prognosis. Methods A total of 46 resected GGNs that were evaluated with TSCT scan and followed up for ≥ 3 years were included in this study. Correlations between histopathology (adenocarcinoma in situ [AIS], minimally invasive adenocarcinoma [MIA], and invasive adenocarcinoma) and CT scan characteristics were examined. CT scan and clinicodemographic data were investigated by univariate and multivariate analyses to identify features that helped distinguish invasive adenocarcinoma from AIS or MIA. Disease recurrence was also evaluated. Results The nodules included 19 AISs (41%), nine MIAs (20%), and 18 invasive adenocarcinomas (39%). On univariate analysis, the presence of air bronchogram ( P = .012), size of nodule ( P = .032, cutoff=16.4 mm in diameter), and mass of nodule ( P = .040, cutoff=0.472 g) were significant factors that differentiated invasive adenocarcinoma from AIS or MIA. On multivariate analysis, size ( P = .010) and mass of nodule ( P = .016) were significant determinants for invasive adenocarcinoma. There were no cases of recurrence during a follow-up period of ≥ 3 years after surgical resection. Conclusions In persistent pure GGNs of ≥ 10 mm in diameter, the size and mass of the nodule are determinants of invasive adenocarcinoma, for which surgical resection leads to excellent prognosis.

Background Protective ventilation strategy has been shown to reduce ventilator-induced lung injury in patients with ARDS. In this study, we questioned whether protective ventilatory settings would attenuate lung impairment during one-lung ventilation (OLV) compared with conventional ventilation in patients undergoing lung resection surgery. Methods One hundred patients with American Society of Anesthesiology physical status 1 to 2 who were scheduled for an elective lobectomy were enrolled in the study. During OLV, two different ventilation strategies were compared. The conventional strategy (CV group, n = 50) consisted of F io 2 1.0, tidal volume (V t ) 10 mL/kg, zero end-expiratory pressure, and volume-controlled ventilation, whereas the protective strategy (PV group, n = 50) consisted of F io 2 0.5, V t 6 mL/kg, positive end-expiratory pressure 5 cm H2O, and pressure-controlled ventilation. The composite primary end point included Pa o 2/F io 2 o 2), Pa co 2, and peak inspiratory pressure (PIP) were repeatedly measured. Results During OLV, although 58% of the PV group needed elevated F io 2 to maintain an Sp o 2 > 95%, PIP was significantly lower than in the CV group, whereas the mean Pa co 2 values remained at 35 to 40 mm Hg in both groups. Importantly, in the PV group, the incidence of the primary end point of pulmonary dysfunction was significantly lower than in the CV group (incidence of Pa o 2/F io 2 Conclusion Compared with the traditional large V t and volume-controlled ventilation, the application of small V t and PEEP through pressure-controlled ventilation was associated with a lower incidence of postoperative lung dysfunction and satisfactory gas exchange. Trial registry Australian New Zealand Clinical Trials Registry; No.: ACTRN12609000861257; URL: www.anzctr.org.au

The purpose of this study was to identify the CT scan features that predict patient outcome after reexpansion procedures in patients with the fibrotic stage of endobronchial TB.We retrospectively enrolled 30 patients (four men, 26 women) aged 32 +/- 11 years who had lobar or whole-lung atelectasis as sequela of endobronchial TB. Patients underwent helical CT scan examinations and subsequent reexpansion procedures for atelectasis, including balloon dilatation (n = 2), stent placement (n = 23), and surgical bronchoplasty (n = 5). Two thoracic radiologists evaluated the location and extent of airway narrowing, the extent of volume loss, parenchymal calcification, mucus plugging, and bronchiectasis within atelectasis on preprocedural CT scans. The success of reexpansion procedures was defined as the recovery of lung volume being80% of the estimated original volume as determined during follow-up imaging. Preprocedural CT scans and clinical features were compared for the results of the reexpansion procedures using the Wilcoxon two-sample test or Fisher exact test.Atelectasis was reexpanded in 30% (nine of 30) of patients after reexpansion procedures. The presence of parenchymal calcification and bronchiectasis within atelectasis showed a high tendency of failure in reexpansion procedures (P.001). Mucus plugging, the extent of airway narrowing, volume loss on CT images, and endobronchial TB activity at the time of intervention did not affect the results (P.05). Patients with successful results were significantly younger than those with unsatisfactory results.Parenchymal calcification and bronchiectasis within atelectasis are correlated with a high chance of failure in reexpansion procedures. Knowledge of CT scan features may help radiologists to predict the results of lung-conserving therapy to avoid unnecessary interventions.

Background Solitary pulmonary nodule (SPN) evaluation based on analyses of combined wash-in (WI) and washout (WO) values obtained by helical dynamic CT (HDCT) scanning is useful for malignant SPN characterization, because this method has higher specificity and accuracy than that based on analyses of WI values only. However, increased specificity results in reduced sensitivity and the missing of malignant SPNs. Thus, the purpose of this study was to seek the most effective method for SPN characterization during HDCT scanning. Methods After obtaining unenhanced CT scans, dynamic CT scanning was performed using a helical technique (images were obtained at 30, 60, 90, and 120 s, and at 5 and 15 min after the initiation of IV contrast administration) in 486 patients with a solid or partly solid SPN. Diagnostic efficacies were compared for three approaches involving considerations of WI values (in Housfield units [HU]) only, both WI and WO HU values, and WI HU values and morphologic characteristics. Results Considering WI values only (≥ 25 HU), sensitivity, specificity, and accuracy for malignancy were 98% (233 of 237 nodules), 46% (114 of 249 nodules), and 71% (347 of 486 nodules), respectively. Using both a WI value of ≥ 25 HU and a WO value of 5 to 36 HU, the corresponding values were 89% (212 of 237 nodules), 79% (197 of 249 nodules), and 84% (409 of 486 nodules), respectively; for a WI value of ≥ 25 HU and a malignant morphology, the corresponding values were 92% (219 of 237 nodules), 79% (197 of 249 nodules), and 86% (416 of 486 nodules), respectively (these values were significantly different between the WI-only group and the other two groups; p=0.001). Conclusions The efficacy of SPN evaluation based on analyses of WI values plus morphologic features during HDCT scanning appears to be equivalent to that based on analyses of WI plus WO values, thus obviating the need for WO scans, which saves time and reduces radiation exposure of the patient.

Little is known about the histopathology and prognosis of persistent pure ground-glass opacity nodules (GGNs) of ≥ 10 mm in diameter. We aimed to compare the morphologic features of persistent pure GGNs of ≥ 10 mm in diameter at thin-section CT (TSCT) scan with histopathology and patient prognosis.A total of 46 resected GGNs that were evaluated with TSCT scan and followed up for ≥ 3 years were included in this study. Correlations between histopathology (adenocarcinoma in situ [AIS], minimally invasive adenocarcinoma [MIA], and invasive adenocarcinoma) and CT scan characteristics were examined. CT scan and clinicodemographic data were investigated by univariate and multivariate analyses to identify features that helped distinguish invasive adenocarcinoma from AIS or MIA. Disease recurrence was also evaluated.The nodules included 19 AISs (41%), nine MIAs (20%), and 18 invasive adenocarcinomas (39%). On univariate analysis, the presence of air bronchogram (P = .012), size of nodule (P = .032, cutoff = 16.4 mm in diameter), and mass of nodule (P = .040, cutoff = 0.472 g) were significant factors that differentiated invasive adenocarcinoma from AIS or MIA. On multivariate analysis, size (P = .010) and mass of nodule (P = .016) were significant determinants for invasive adenocarcinoma. There were no cases of recurrence during a follow-up period of ≥ 3 years after surgical resection.In persistent pure GGNs of ≥ 10 mm in diameter, the size and mass of the nodule are determinants of invasive adenocarcinoma, for which surgical resection leads to excellent prognosis.

Protective ventilation strategy has been shown to reduce ventilator-induced lung injury in patients with ARDS. In this study, we questioned whether protective ventilatory settings would attenuate lung impairment during one-lung ventilation (OLV) compared with conventional ventilation in patients undergoing lung resection surgery.One hundred patients with American Society of Anesthesiology physical status 1 to 2 who were scheduled for an elective lobectomy were enrolled in the study. During OLV, two different ventilation strategies were compared. The conventional strategy (CV group, n=50) consisted of FIO2 1.0, tidal volume (Vt) 10 mL/kg, zero end-expiratory pressure, and volume-controlled ventilation, whereas the protective strategy (PV group, n=50) consisted of FIO2 0.5, Vt 6 mL/kg, positive end-expiratory pressure 5 cm H2O, and pressure-controlled ventilation. The composite primary end point included PaO2/FIO2300 mm Hg and/or the presence of newly developed lung lesions (lung infiltration and atelectasis) within 72 h of the operation. To monitor safety during OLV, oxygen saturation by pulse oximeter (SpO2), PaCO2, and peak inspiratory pressure (PIP) were repeatedly measured.During OLV, although 58% of the PV group needed elevated FIO2 to maintain an SpO295%, PIP was significantly lower than in the CV group, whereas the mean PaCO2 values remained at 35 to 40 mm Hg in both groups. Importantly, in the PV group, the incidence of the primary end point of pulmonary dysfunction was significantly lower than in the CV group (incidence of PaO2/FIO2300 mm Hg, lung infiltration, or atelectasis: 4% vs 22%, P.05).Compared with the traditional large Vt and volume-controlled ventilation, the application of small Vt and PEEP through pressure-controlled ventilation was associated with a lower incidence of postoperative lung dysfunction and satisfactory gas exchange.Australian New Zealand Clinical Trials Registry; No.: ACTRN12609000861257; URL: www.anzctr.org.au.

Solitary pulmonary nodule (SPN) evaluation based on analyses of combined wash-in (WI) and washout (WO) values obtained by helical dynamic CT (HDCT) scanning is useful for malignant SPN characterization, because this method has higher specificity and accuracy than that based on analyses of WI values only. However, increased specificity results in reduced sensitivity and the missing of malignant SPNs. Thus, the purpose of this study was to seek the most effective method for SPN characterization during HDCT scanning.After obtaining unenhanced CT scans, dynamic CT scanning was performed using a helical technique (images were obtained at 30, 60, 90, and 120 s, and at 5 and 15 min after the initiation of IV contrast administration) in 486 patients with a solid or partly solid SPN. Diagnostic efficacies were compared for three approaches involving considerations of WI values (in Housfield units [HU]) only, both WI and WO HU values, and WI HU values and morphologic characteristics.Considering WI values only (or = 25 HU), sensitivity, specificity, and accuracy for malignancy were 98% (233 of 237 nodules), 46% (114 of 249 nodules), and 71% (347 of 486 nodules), respectively. Using both a WI value ofor = 25 HU and a WO value of 5 to 36 HU, the corresponding values were 89% (212 of 237 nodules), 79% (197 of 249 nodules), and 84% (409 of 486 nodules), respectively; for a WI value ofor = 25 HU and a malignant morphology, the corresponding values were 92% (219 of 237 nodules), 79% (197 of 249 nodules), and 86% (416 of 486 nodules), respectively (these values were significantly different between the WI-only group and the other two groups; p = 0.001).The efficacy of SPN evaluation based on analyses of WI values plus morphologic features during HDCT scanning appears to be equivalent to that based on analyses of WI plus WO values, thus obviating the need for WO scans, which saves time and reduces radiation exposure of the patient.

Poster: "ESTI 2012 / E-0005 / CT Findings of Influenza A (H1N1) Pneumonia in Adults: Pattern Analysis and Prognostic Comparisons " by: " H. Kang 1, K. S. Lee2, Y. J. Jeong1, H. Y. Lee2, K. I. Kim3, K. J. NAM1; 1Busan/KR, 2Seoul/KR, 3Yangsan/KR"