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Purpose: The aim of the study was to investigate differences in non-small cell lung cancer (NSCLC) intra-thoracic staging by using contrast-enhanced computed tomography (ce-CT) at the arterial phase (AP), at the arterial plus delayed phases (AP + DEP), and at the delayed phase (DEP), and to evaluate their potential impact on disease staging., Materials and Methods: Two chest radiologists with different level of expertise and a general radiologist independently reviewed the chest CT exams of 150 patients with NSCLC; CT scans were performed 40 s (AP) and 60 s (DEP) after contrast material injection. Image assessment included three reading sessions: session A (AP), session B (AP + DEP) and session C (DEP). CT descriptors for the primary tumour (T), regional nodal involvement (N), and intra-thoracic metastases (M) were evaluated in each reading session. Readers had to assign a confidence level (CL) for the assessment of each descriptor and define the TNM stage. Friedman and Cochran Q test was used to compare the assessments of the 3 reading sessions; inter-reader agreement was determined (Intraclass Correlation Coefficient - ICC)., Results: The CL was significantly higher in sessions B and C than in session A for all descriptors, with the exception of pulmonary arterial invasion. Primary tumour inner necrosis and regional nodal involvement were detected in a significantly higher number of cases in sessions B and C as compared to session A (p ≤ 0.001). DEP significantly changed N stage determination (p < 0.001), particularly N3, and excluded chest wall invasion (p = 0.05) and venous invasion (p = 0.001). The agreement was good among the 3 readers (ICC = 0.761) and excellent between the 2 chest radiologists (ICC ≥ 0.940), regardless of the contrast phase., Conclusions: The 60-second DEP ce-CT for staging NSCLC significantly increased the readers' CL, changed the N stage determination, and helped excluding chest wall invasion and venous invasion., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose: The aim of this study was to investigate the relationship between whole-tumor CT perfusion and FDG PET/CT parameters in non-small cell lung cancer (NSCLC)., Methods: Twenty-five patients with NSCLC were prospectively included. CT perfusion parameters calculated were blood flow (BF), blood volume (BV), mean transit time, and peak enhancement intensity. SUVmax, SUVpeak, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were evaluated for PET/CT. Tumor diameter and volume were measured, and lesions were divided according to maximum axial diameter in more than 3 cm and 3 cm or less. The correlations between CT perfusion and PET/CT parameters were assessed in all tumors, as well as according to tumor diameter and volume., Results: Lesion diameter and volume showed a negative correlation with BF and BV (r = -0.78, -0.78, -0.57, -0.48, respectively) and a positive correlation with mean transit time (r = 0.55, 0.65, respectively). The negative correlation between BF and lesion diameter and volume was confirmed in the subgroup of lesions of more than 3 cm (r = -0.68, -0.68, respectively). A positive correlation between SUVmax, SUVpeak, SUVmean, and lesion volume was observed (r = 0.50, 0.50, 0.46, respectively) and confirmed in lesions 3 cm or less (r = 0.81, 0.79, 0.78, respectively). Metabolic tumor volume and TLG showed a positive correlation with lesion diameter and volume in the overall population (r = 0.93, 0.87, 0.88, 0.90, respectively) and in lesions of more than 3 cm (r = 0.89, 0.84, 0.84, 0.79, respectively). Blood flow and BV showed a negative correlation with MTV and TLG (r = -0.77, -0.74, and -0.58, -0.48, respectively) in the overall population and with MTV in lesions of more than 3 cm (r = -0.69, -0.62, respectively)., Conclusions: Perfusion and metabolic parameters seem to depend on tumor size. The bigger the tumor, the lower the BF and the BV and, conversely, the higher the SUVpeak, MTV, and TLG. This information would be useful in the clinical setting when diagnosing or treating NSCLC, especially with novel therapies and/or for radiation treatment modulation.

We report an unusual case of malignant pseudothyroiditis (MPT) occurred in a 35-year-old female patient presenting with symptoms and signs of thyroiditis. Fine-needle aspiration biopsy of the thyroid demonstrated the presence of a MPT induced by a metastatic extrathyroidal carcinoma. F-FDG-PET/CT showed increased radiopharmaceutical uptake in the thyroid, in multiple cervical and mediastinal lymph nodes, and in a right pulmonary nodule. Histological examination demonstrated the presence of a metastatic non-small cell lung cancer (NSCLC). In this unusual case of MPT F-FDG-PET/CT has been useful in staging the disease and in detecting the primary tumor site.

Purpose: This study was done to prospectively assess the repeatability and intra- and interobserver variability of first-pass perfusion with 64-detector-row computed tomography (CT) in non-small-cell lung cancer (NSCLC) with a maximum diameter of up to 8 cm., Materials and Methods: Twelve patients with NSCLC underwent 64-detector-row first-pass CT perfusion (CTP) of the whole tumour. Two different techniques were used according to lesion size (cine mode; sequential mode). After 24 h, each study was repeated to assess repeatability. Lesion blood volume (BV), blood flow (BF), mean transit time (MTT) and peak enhancement intensity (PEI) were automatically calculated by two chest radiologists in two different reading sessions. Intra- and interobserver variability was also assessed., Results: The first-pass CTP technique was repeatable and precise with within-subject coefficient of variation (WCV) of 9.3, 16.4, 11.2 and 14.9 %, respectively, for BV, BF, MTT and PEI. High intra- and interobserver agreement was demonstrated for each perfusion parameter, with Cronbach's α coefficients and intraclass correlation coefficients ranging from 0.99 to 1. Precision of measurements was slightly better for intraobserver analysis with WCV ranging between 1.05 and 3.03 %., Conclusions: Non-small-cell lung cancer first-pass perfusion performed with 64-detector-row CT showed good repeatability and high intra- and interobserver agreement for all perfusion parameters and may be considered a reliable and robust tool for assessing tumour vascularisation.

Three-dimensional (3D) conformal radiation therapy (CRT) and stereotactic body radiation therapy (SBRT) are designed to deliver the maximum therapeutic radiation dose to the tumor, allowing improved local disease control, while minimizing irradiation of surrounding normal structures. The complex configuration of the multiple beams that deliver the radiation dose to the tumor in 3D CRT and SBRT produces patterns of lung injury that differ in location and extent from those seen after conventional radiation therapy. Radiation-induced changes in lung tissue after 3D CRT and SBRT occur within the radiation portals. The imaging appearance of irradiated tissues varies according to the time elapsed after the completion of therapy, with acute-phase changes of radiation pneumonitis represented by ground-glass opacities and consolidation and with late-phase changes of radiation fibrosis manifesting as volume loss, consolidation, and traction bronchiectasis. Knowledge of treatment timelines and radiation field locations, as well as familiarity with the full spectrum of possible radiation-induced lung injuries after 3D CRT and SBRT, is important to correctly interpret the abnormalities that may be seen at computed tomography (CT). Differential diagnoses in this context might include infections, lymphangitic carcinomatosis, local recurrence of malignancy, and radiation-induced tumors. The integration of morphologic information obtained at CT with metabolic information obtained at positron emission tomography is helpful in distinguishing radiation-induced parenchymal abnormalities from residual, recurrent, and new cancers. Thus, multimodality follow-up imaging may lead to substantial changes in disease management., (Copyright © RSNA, 2011.)