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Purpose: The purpose of this article was to report the utility of computed tomography (CT) for detecting unsuspected cases of Coronavirus disease 2019 (COVID-19) and the utility of the Radiological Society of North America (RSNA)/Society of Thoracic Radiology (STR)/American College of Radiology (ACR) consensus guidelines for COVID-19 reporting., Materials and Methods: A total of 22 patients of the 156 reverse transcriptase polymerase chain reaction confirmed COVID-19 patients who were hospitalized between March 27, 2020 and March 31, 2020 at our quaternary care academic medical center and who underwent CT imaging within 1 week of admission were included in this retrospective study. Demographics and clinical data were extracted from the electronic medical record system. Two thoracic radiologists independently categorized each CT study on the basis of RSNA/STR/ACR consensus guidelines. Disagreement in categorization was resolved by consensus discussion with a third thoracic radiologist., Results: At the time of imaging, 16 patients (73%) were suspected of COVID-19, and 6 patients (27%) were not. Common symptoms at presentation were fever (73%), cough (77%), and gastrointestinal symptoms (59%). An overall 63% of suspected COVID-19 patients exhibited shortness of breath, whereas 0 unsuspected COVID-19 patients did (P=0.02). On the basis of the RSNA consensus guidelines, 68%, 18%, 9%, and 5% of studies were categorized as "typical appearance," "indeterminate appearance," "atypical appearance," and "negative for pneumonia," respectively. There was no difference of category distribution between suspected and unsuspected COVID-19 patients (P=0.20), with "typical appearance" being the most prevalent in both (69% vs. 67%, respectively)., Conclusions: It is important to recognize imaging features of COVID-19 pneumonia even in unsuspected patients. Implementation of the RSNA/STR/ACR consensus guidelines may increase consistency of reporting and convey the level of suspicion for COVID-19 to other health care providers, with "typical appearance" especially warranting further attention., Competing Interests: Dr B.P.L. is a textbook author and editor for Elsevier and receives royalties for his prior work. Dr E.J.F. reports grant funding from the American College of Radiology Innovation Fund and the National Cancer Institute Research Diversity Supplement for work not related to this manuscript. The remaining authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: We aimed to evaluate the feasibility, accuracy, and complications of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) of cavitary lesions., Methods: Consecutive PTNB procedures in an academic institution over a 4-year period were reviewed, 53 of which were performed on patients with cavitary lesions. The demographic data of patients, lesion characteristics, biopsy technique and complications, initial pathologic results, and final diagnosis were reviewed. A final diagnosis was established through surgical correlation, microbiology or clinico-radiologic follow-up for at least 18 months after biopsy., Results: The overall accuracy of PTNB was 81%. In 33 patients (62%) the cavitary lesion was found to be malignant (23 lung cancers and 10 metastases). The sensitivity and specificity for malignancy was 91% and 100%, respectively. In 20 patients (38%) a benign etiology was established (16 infections and 4 noninfectious etiologies), with PTNB demonstrating a sensitivity of 81% and specificity of 100% for infection. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Minor complications occurred in 28% of cases: 13 pneumothoraces (5 requiring chest tube), 1 small hemothorax, and 1 mild hemoptysis. A nonsignificant higher chest tube insertion rate was seen in cavities with a thinner wall., Conclusion: PTNB of cavitary lesions provides high accuracy, sensitivity, and specificity for both malignancy and infection and has an acceptable complication rate. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Samples for microbiology should be obtained in all patients, especially in the absence of on-site cytology, due to the high prevalence of infection in cavitary lesions.

Introduction: Several studies have suggested that non-small-cell lung cancer (NSCLC) patients who harbor anaplastic lymphoma kinase (ALK) rearrangement might have different imaging features compared with those without the rearrangement. The goal of this work was to systematically investigate the computed tomography (CT) imaging features of ALK-rearranged NSCLC., Materials and Methods: We searched published studies that investigated CT imaging features of ALK-rearranged NSCLC compared with ALK-negative, including epidermal growth factor receptor (EGFR)-mutant and ALK/EGFR-negative, NSCLC. We extracted clinicopathologic characteristics and CT imaging features of patients in the included studies. Features were compared and tested in the form of odds ratios (ORs) or weighted mean differences at a 95% confidence interval., Results: Twelve studies with 2210 patients with NSCLC were included. Compared with ALK-negative NSCLC, ALK-rearranged NSCLC was more likely to be solid (OR, 2.37; P < .001) and less likely to have cavitation (OR, 0.45; P = .002). In advanced stages, patients with ALK-rearranged NSCLC, compared with EGFR-mutant NSCLC, were more likely to have lymphadenopathy (OR, 3.47; P < .001), pericardial metastasis (OR, 2.18; P = .04), pleural metastasis (OR, 2.07; P = .004), and lymphangitic carcinomatosis (OR, 3.41; P = .02), but less likely to have lung metastasis (OR, 0.52; P = .003). Compared with ALK/EGFR-negative NSCLC, ALK-rearranged NSCLC was more likely to have lymphangitic carcinomatosis (OR, 3.88; P = .03), pleural metastasis (OR, 1.89; P = .02), and pleural effusion (OR, 2.94; P = .003)., Conclusion: ALK-rearranged NSCLC has imaging features that are different compared with EGFR-mutant and ALK/EGFR-negative NSCLC. These imaging features might provide clues as to the presence of ALK rearrangement and help in the selection of patients who might benefit from expedited molecular testing or repeat testing after a negative assay., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: Mutations in the BRAF gene have emerged as a validated molecular target in the treatment of non-small cell lung cancer (NSCLC). These mutations can be classified into three functional classes based on their mechanisms of oncogenesis. The relationship between these functional classes and their imaging features has not been systematically investigated. The goal of this work is to determine if imaging features of the primary tumor and the pattern of metastasis correlate with the functional class of BRAF mutation., Methods: We reviewed pre-treatment computed tomography (CT) images of patients with BRAF-mutated NSCLC with known functional class. We assessed and recorded the features of the primary tumor and the patterns of lymphadenopathy and distant metastasis. Wilcoxon rank-sum test and Kruskal-Wallis test were performed to compare continuous characteristics, and Fisher's exact test was used to compare categorical features between groups., Results and Conclusions: 105 patients with BRAF-mutant NSCLC had pre-treatment imaging available for review (n = 43 class I, n = 40 class II, and n = 22 class III). Approximately half of the primary tumors were considered masses (n = 54/105, 51%) and most were solid (n = 81/105, 77%). There were no statistically significant differences in imaging features of the primary tumor among the three functional classes. Intrathoracic metastases occurred more frequently in class I tumors compared to tumors with class II and III mutations (p = 0.03). The odds of class I mutation were higher among tumors involving the pleural space (OR: 4.39, 95% CI: 1.11-17.4) and lower among tumors disseminating to the abdomen (OR: 0.25, 95% CI: 0.07-0.92). Our findings suggest that class I (V600) mutated NSCLC may be more likely to have intrathoracic metastases, while classes II and III (non-V600) mutated NSCLC may be more likely to have intra-abdominal metastases at the time of presentation., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The purpose of our study was to determine accuracy of CT texture analysis (CTTA) for differentiating benign from malignant pulmonary nodules, and well-differentiated from poorly differentiated lung cancers, with histology as the standard of reference.In this IRB-approved study, 175 adult patients (average age 66 ± 12 years; age range 27-89 years, male 82: female 93) who underwent a noncontrast chest CT examination prior to CT-guided biopsy of pulmonary nodules were included. There were 57 benign (24 tumors or tumor-like lesions; 33 inflammatory conditions) and 120 malignant (29 well-differentiated adenocarcinomas, 48 poorly differentiated adenocarcinomas, and 43 squamous cell carcinomas) diagnoses on pathology. CTTA was performed on the prebiopsy noncontrast CT images using a commercially available software (TexRAD limited, UK). The CTCA features analyzed included mean HU values, percent positive pixels (PPP), mean value of positive pixels (MPP), standard deviation (SD), normalized SD, skewness, kurtosis, and entropy.The ROC analyses showed that normalized SD [AUC: 0.63, (CI: 0.55-72), P = .003] had moderate accuracy for differentiating between benign and malignant lesions. For differentiating among well-differentiated and poorly differentiated tumors, the ROC analysis showed that except skewness all other parameters were statistically significant The AUC values of other CTTA parameters were: mean (AUC: 0.73-0.76, P = .001- < .0001).CT texture analyses can reliably predict well- and poorly differentiated lung malignancies. However, inflammatory lung lesions with tissue heterogeneity negatively affect the performance of CTTA when it comes to differentiation between benign and malignant pulmonary nodules.

Background: The purpose of this study was to determine whether computed tomography-guided fiducial placement is a feasible and safe localization procedure to aid resection of small pulmonary nodules., Methods: A retrospective review was performed of 20 nodules (mean size 11 mm; range, 6 to 19 mm) referred for preoperative computed tomography-guided fiducial placement in 19 patients (average age 64 ± 11 years; 13 women and 6 men)., Results: The technical success rate for the placement of fiducials was 95%, with deployment of fiducials into the pleural space in 1 case. Biopsy specimen was obtained at time of the fiducial placement in 4 cases, with sensitivity of 75% and specificity of 100% for malignancy. Two procedures (10%) were complicated by a pneumothorax requiring chest tube placement. The median time between fiducial placement and surgery was 7 days (range, 1 to 123). One to four fiducials were placed a median distance of 0 mm (range, 0 to 7 mm) from the edge of the nodule. Fiducials were identified by on-table fluoroscopy in all cases, and all nodules were completely excised with negative surgical margins. Mean fluoroscopy time was 46 seconds, and mean radiation dose was 12.97 mGy. The final diagnosis was primary lung cancer in 85% of cases, with organizing pneumonia and sarcoidosis accounting for the three benign nodules., Conclusions: Computed tomography-guided fiducial placement is a feasible and safe technique that allows biopsy at the time of the procedure and aids localization of small pulmonary nodules during video-assisted thoracic surgery., (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the complications of CT-guided percutaneous transthoracic needle aspiration and/or core biopsy (PTNAB) of lung nodules in patients with pulmonary arterial hypertension (PHTN)., Method and Materials: We analyzed PTNAB of 74 lung lesions (mean size: 3.6 ± 2.1 cm) in 74 patients (M: F 38:36; age 68 ± 15 years) with documented PHTN on cardiac ultrasound. 39 patients with lung lesions (M: F 24:15; age 65 ± 14) who underwent PTNAB in the same period with right ventricle systolic pressure (RVSP) <35 mm Hg were selected as controls. Pulmonary arterial pressures were estimated on cardiac ultrasounds by using the tricuspid regurgitation jet method. Two thoracic radiologists reviewed the medical records and PTNAB images on a PACS station and documented nodule size, location, distance traversed in lung, technical success and complications., Results: Fine needle aspirates were obtained in all and core biopsy in 23% (17/74) of the nodules. 61% (45/74) of the nodules were in the middle and 39% (29/74) were in the outer third of lung. PHTN was mild, moderate and severe in 84% (62/74), 13% (10/74) and 3% (2/74) of the patients. Biopsy was complicated by hemorrhage in 26% (19/74), moderate hemoptysis in 1.3% (1/74), pneumothorax in 17% (12/74), chest tube in 1.3% (1/74) and hemothorax in 1.3% (1/74) of the patients. The complications rate in control group was similar, hemorrhage in 33% (19/39) (p=0.6), moderate hemoptysis in 5% (2/39) (p=0.3), pneumothorax in 28% (11/39) (p=0.2), chest tube in (0/39) (p=0.3), and hemothorax in 3% (1/39) of the patients (p=0.7)., Conclusion: Percutaneous needle biopsy of lung lesions in patients with mild to moderate PHTN can be performed without significant increase in complications., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Unlabelled: Lung cancer is the leading cause of cancer-related deaths in the United States. Several surgical techniques are currently used as part of the standard of care for early-stage lung cancer. Differentiating normal postoperative changes from complications is essential in the management of these patients. This article will review the various surgical approaches used, ranging from wedge resection to pneumonectomy, and will outline their expected postsurgical changes. Early and late postsurgical complications will be described, some of which are unique to the type of surgery performed. In addition, local tumor recurrence is a form of postoperative complication and must be distinguished from typical postoperative or postradiation change. Knowledge of both common and uncommon postoperative complications is crucial in the follow-up of lung cancer patients., Summary Statement: Familiarity with the appearance of postoperative complications in lung cancer patients is vital to distinguish it from the normal postoperative or postradiation appearance in follow-up imaging., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Diffuse pulmonary hemorrhage (DPH) refers to an uncommon but significant condition of bleeding into the alveolar space. Anemia and hemoptysis are important clinical features, but they may be absent. Although the radiographic and computed tomography findings are often varied and nonspecific, the imaging manifestations of pulmonary hemorrhage and the associated findings in the thorax often provide important diagnostic information that may lead to a specific diagnosis. DPH significantly influences patient management and has important prognostic implications. This review article explores the imaging findings in DPH and its differential diagnosis, highlighting important clues to this diagnosis and to its underlying etiology. DPH is an uncommon condition characterized by bleeding into the alveolar space that, when recognized on imaging, provides important diagnostic and prognostic information., (Published by Mosby, Inc.)

Bronchopulmonary sequestration is a rare lesion characterized by abnormal lung tissue that lacks a normal bronchial communication and is supplied by an anomalous systemic artery. It has a variety of imaging appearances, including that of consolidation, a mass, or an air or fluid-filled cystic or multicystic lesion. This article reviews the imaging spectrum of bronchopulmonary sequestration, its important parenchymal mimics, and conditions that share the feature of anomalous systemic arterial supply to the lung., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Advances in nanotechnology and microfluidics are enabling the analysis of small amounts of human cells. We tested whether recently developed micro-nuclear magnetic resonance (μNMR) technology could be leveraged for diagnosing pulmonary malignancy using fine needle aspirate (FNA) of primary lesions and/or peripheral blood samples. We enrolled a cohort of 35 patients referred for CT biopsy of primary pulmonary nodules, liver or adrenal masses and concurrently obtained FNA and peripheral blood samples. FNA sampling yielded sufficient material for μNMR analysis in 91% of cases and had a sensitivity and specificity of 91.6% and 100% respectively. Interestingly, among blood samples with positive circulating tumor cells (CTC), μNMR analysis of each patient's peripheral blood led to similar diagnosis (malignant vs benign) and differential diagnosis (lung malignancy subtype) in 100% and 90% (18/20) of samples, respectively. μNMR appears to be a valuable, non-invasive adjunct in the diagnosis of lung cancer., From the Clinical Editor: The authors of this study established that recently developed micro-nuclear magnetic resonance (μNMR) technology can be leveraged for diagnosing pulmonary malignancy using fine needle aspirate (FNA) of primary lesions and/or peripheral blood samples derived from 35 patients, suggesting practical clinical applicability of this technique., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: The purposes of this article are to describe common and uncommon imaging signs and patterns of pulmonary infections and to discuss their underlying anatomic and pathophysiologic basis., Conclusion: Imaging plays an integral role in the diagnosis and management of suspected pulmonary infections and may reveal useful signs on chest radiographs and CT scans. Detected early, these signs can often be used to predict the causative agent and pathophysiologic mechanism and possibly to optimize patient care.