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Objectives: The Asian Intensive Reader of Pneumoconiosis (AIR Pneumo) is a training program designed to improve diagnostic skills for chest radiographies (CXRs) in accordance with the ILO/ICRP 2000. The purpose was to determine the prevalence of occupational environmental pulmonary disease findings in construction workers on thin-slice computed tomography (thin-slice CT), and to compare the diagnostic performance with CXR evaluated by AIR Pneumo-trained physicians., Methods: Ninety-seven male construction workers underwent low-dose thin-slice CT and CXR on the same day. NIOSH B reader and a board-certified radiologist each interpreted the thin-slice CTs independently. The concordant findings on thin-slice CT were established as the reference standard and were statistically compared with CXRs. Four physicians interpreted CXRs independently according to the ILO/ICRP 2000., Results: Of the 97 cases, nine showed irregular or linear opacities, and 44 had pleural plaques on thin-slice CT. Five, four, three, and two of nine cases with irregular opacity were detected by the four readers on CXRs, respectively. Sixteen, 14, 9, and 5 of the 44 cases with pleural plaques were detected by the four readers, respectively. Specificities for irregular opacities ranged from 94% to 100%, and those for pleural plaques were from 86% to 96%., Conclusions: Thin-slice CT-detected irregular opacity was found in 9.3%, whereas pleural plaque was found in 45.4% among the construction workers. Chest radiography showed acceptable performance in classifying pneumoconiotic opacities according to ILO/ICRP 2000 by the AIR Pneumo and/or NIOSH-certified physicians., (© 2020 The Authors. Journal of Occupational Health published by John Wiley & Sons Australia, Ltd on behalf of The Japan Society for Occupational Health.)

Radiation therapy is a useful treatment for tumors and vascular malformations of the central nervous system. Radiation therapy is associated with complications, including leukoencephalopathy, radiation necrosis, vasculopathy, and optic neuropathy. Secondary tumors are also often seen long after radiation therapy. Secondary tumors are often benign tumors, such as hemangiomas and meningiomas, but sometimes malignant gliomas and soft tissue sarcomas emerge. We review the imaging findings of complications that may occur after brain radiation therapy.

Purpose: To compare therapeutic effect assessment capability of multidetector-row computed tomography (MDCT), magnetic resonance angiography (MRA), and dynamic perfusion MRI for chronic thromboembolic pulmonary hypertension (CTEPH) patients., Materials and Methods: Twenty-four consecutive CTEPH patients treated with conventional therapy underwent pre- and posttherapeutic MDCT, MRA, dynamic perfusion MRI, 6-minute walk distance (6-MWD), cardiac ultrasound (US), and right heart catheterization. According to therapeutic results, all patients were divided into response (n = 13) and nonresponse (n = 11) groups. CTEPH indexes for MDCT (CTEPH(CT) ) and MRA (CTEPH(MRA) ) were calculated on the basis of embolic burden. Pulmonary perfusion parameter maps were generated from all perfusion MR data, followed by determination of improvements in mean perfusion parameter at regions of interest (ROIs) for each patient. Receiver operating characteristic (ROC)-based positive tests were performed to determine the feasible threshold values for distinguishing two groups. Finally, diagnostic capabilities were compared by means of McNemar's test., Results: When feasible threshold values adapted, specificity (90.9 〈10/11〉%, P < 0.05) and accuracy (95.8 〈23/24〉%, P < 0.05) for improvement in pulmonary blood flow were significantly higher than those for CTEPH(CTA) (specificity: 36.4 〈4/11〉%, accuracy: 70.8 〈17/24〉%)., Conclusion: Dynamic perfusion MRI has better capability for assessment of therapeutic effect on CTEPH patients than does MDCT., (Copyright © 2012 Wiley Periodicals, Inc.)

Purpose: To evaluate potential benefits of using multiplanar reconstruction (MPR) in computer-aided detection (CAD) of lung nodules on multidetector computed tomography (MDCT)., Materials and Methods: MDCT datasets of 60 patients with suspected lung nodules were retrospectively collected. Using "second-read" CAD, two radiologists (Readers 1 and 2) independently interpreted these datasets for the detection of non-calcified nodules (≥ 4 mm) with concomitant confidence rating. They did this task twice, first without MPR (using only axial images), and then 4 weeks later with MPR (using also coronal and sagittal MPR images), where the total reading time per dataset, including the time taken to assess the detection results of CAD software (CAD assessment time), was recorded. The total reading time and CAD assessment time without MPR and those with MPR were statistically compared for each reader. The radiologists' performance for detecting nodules without MPR and the performance with MPR were compared using jackknife free-response receiver operating characteristic (JAFROC) analysis., Results: Compared to the CAD assessment time without MPR (mean, 69s and 57s for Readers 1 and 2), the CAD assessment time with MPR (mean, 46s and 45s for Readers 1 and 2) was significantly reduced (P<0.001). For Reader 1, the total reading time was also significantly shorter in the case with MPR. There was no significant difference between the detection performances without MPR and with MPR., Conclusion: The use of MPR has the potential to improve the workflow in CAD of lung nodules on MDCT., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Purpose: Although somatostatin receptor positron emission tomography (PET)/CT is gaining increasing popularity and has shown its diagnostic superiority in several studies, (111)In-diethylenetriaminepentaacetic acid (DTPA)-octreotide is still the current standard for diagnosis of neuroendocrine tumours (NET). The aim of this study was to compare the costs for the two diagnostic tests and the respective consequential costs., Methods: From January 2009 to July 2009, 51 consecutive patients with enteropancreatic NET who underwent contrast-enhanced (68)Ga-DOTATOC PET/CT (n = 29) or (111)In-DTPA-octreotide (mean 3 whole-body scans plus 1.6 low-dose single photon emission computed tomography/CT; n = 22) were included. For cost analysis, direct costs (equipment) and variable costs (material, labour) per examination were calculated. Additionally required CT and/or MRI examinations within the staging process were assessed as consequential costs. An additional deterministic sensitivity analysis was performed., Results: A (68)Ga-DOTATOC PET/CT examination yielded total costs (equipment, personnel and material costs) of 548 euro. On the other hand, an (111)In-DTPA-octreotide examination resulted in 827 euro total costs. Costs for equipment and material had a share of 460 euro/720 euro for (68)Ga-DOTATOC/(111)In-DTPA-octreotide and labour costs of 89 euro/106 euro. With (68)Ga-DOTATOC additional MRI had to be performed in 7% of the patients resulting in a mean of 20 euro for supplementary imaging per patient; 82% of patients with (111)In-DTPA-octreotide needed additional MRI and/or CT resulting in mean additional costs of 161 euro per patient., Conclusion: (68)Ga-DOTATOC PET/CT was considerably cheaper than (111)In-DTPA-octreotide with respect to both material and personnel costs. Furthermore, by using (68)Ga-DOTATOC PET/CT considerably fewer additional examinations were needed reducing the consequential costs significantly.

Purpose: The purpose of this study was to compare the capability of integrated FDG-PET/CT for assessment of postoperative intra- and extrathoracic recurrence in non-small cell lung cancer (NSCLC) patients with that of standard radiological examinations., Materials and Methods: A total of 121 consecutive pathologically diagnosed NSCLC patients (80 males, 41 females; mean age, 71 years) underwent pathologically and surgically confirmed complete resection, followed by prospective integrated FDG-PET/CT and standard radiological examinations. Final diagnosis of recurrence was based on the results of more than 12 months of follow-up and/or pathological examinations. The probability of recurrence was assessed with either method for each patient by using 5-point visual scoring system, and final diagnosis was made by consensus between two readers. ROC analysis was used to compare the capability of the two methods for assessment of postoperative recurrence on a per-patient basis. The ROC-based positive test was used to determine optimal cut-off value for FDG uptake measurement at a site suspected on the basis of qualitatively assessed PET/CT. Finally, sensitivities, specificities and accuracies of all methods were compared by means of McNemar's test., Results: Areas under the curve of qualitatively assessed PET/CT and standard radiological examinations showed no significant differences (p>0.05). At an optimal cut-off value of 2.5, specificity and accuracy of quantitatively and qualitatively assessed PET/CT were significantly higher than those of qualitatively assessed PET/CT and standard radiological examinations (p<0.05)., Conclusion: Accuracy of assessment of postoperative intra- and extrathoracic recurrence in NSCLC patients by qualitative and/or quantitative FDG-PET/CT is equivalent to or higher than that by standard radiological examinations., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Abnormal pulmonary 18F-FDG foci may occur with benign lesions like pneumonia but seldomly without any pathological CT findings. We report the case of a focal pulmonary 18F-FDG uptake without CT correlate in an initial staging examination of a patient with squamous cell carcinoma of the base of the tongue. A follow-up study did not show any suspicious lesion in this area, but pneumonia with 18F-FDG uptake in another region of the lung. 18F-FDG foci without pathological CT are a rare finding and have been associated with emboli. In the literature two main mechanisms underlying focal 18F-FDG uptake in pulmonary embolism are mentioned: an inflammatory reaction of a pre-existing vascular thrombus and an iatrogenic microembolism caused during injection. In our case the 18F-FDG accumulation was assessed as an iatrogenic pulmonary microembolism.

Purpose: The purpose of this study was to determine the utility of three-dimensional (3D) automatic exposure control (AEC) for low-dose CT examination in a chest phantom study., Materials and Methods: A chest CT phantom including simulated focal ground-glass opacities (GGOs) and nodules was scanned with a 64-detector row CT with and without AEC. Performance of 3D AEC included changing targeted standard deviations (SDs) of image noise from scout view. To determine the appropriate targeted SD number for identification, the capability of overall identification with the CT protocol adapted to each of the targeted SDs was compared with that obtained with CT without AEC by means of receiver operating characteristic analysis., Results: When targeted SD values equal to or higher than 250 were used, areas under the curve (Azs) of nodule identification with CT protocol using AEC were significantly smaller than that for CT protocol without AEC (p < 0.05). When targeted SD numbers at equal to or more than 180 were adapted, Azs of CT protocol with AEC had significantly smaller than that without AEC (p < 0.05)., Conclusion: This phantom study shows 3D AEC is useful for low-dose lung CT examination, and can reduce the radiation dose while maintaining good identification capability and good image quality., (Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.)

Purpose: Positron emission tomography (PET)/computed tomography (CT) with (18)F-fluorodeoxyglucose is widely used for post-therapeutic surveillance of malignant lymphoma. Debate still exists as to whether intravenous contrast media during the CT stage of a PET/CT scan should be used. The purpose of this study was to investigate the clinical value of contrast agent in PET/CT in patients with lymphoma following treatment., Patients and Methods: One hundred and twenty-two consecutive patients with malignant lymphoma underwent 146 PET/CT scans to monitor therapeutic response (n = 57) or surveillance during follow-up (n = 89). All patients had a conventional PET/CT scan with low-dose CT without contrast (ldCT), and then a full-dose CT scan with contrast (ceCT). Two datasets were interpreted separately and prevalence of discrepant results between the two methods was evaluated. In addition, differences of diagnostic performance were investigated for restaging., Results: Both PET + ldCT and PET + ceCT were positive in 22 cases and negative in 35 cases when monitoring response to therapy. There were no cases in which these techniques demonstrated inconsistent findings. For restaging, the patient-based sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of PET + ldCT were 70, 91, 76, 87, and 84%, respectively, and those of PET + ceCT were 74, 92, 81, 89, and 87%, respectively. Discrepant results between the two methods occurred in only 2 of 89 cases (2%)., Conclusion: PET/ceCT yielded more accurate findings than PET/ldCT in a limited number of cases. PET/ldCT may, therefore, be sufficient for routine PET/CT scanning for post-therapeutic assessment or restaging of lymphoma patients.

Purpose: The purpose of this study was to prospectively compare the efficacy of oxygen-enhanced MR imaging (O(2)-enhanced MRI) and CT for pulmonary functional loss assessment and clinical stage classification of asthmatics., Materials and Methods: O(2)-enhanced MRI, CT and %FEV(1) measurement were used 34 consecutive asthmatics classified into four stages ('Mild Intermittent [n=7]', 'Mild Persistent [n=8], 'Moderate Persistent [n=14]' and 'Severe Persistent [n=5]'). Relative enhancement ratio maps for every subject were generated, and determine mean relative enhancement ratios (MRERs). Mean lung density (MLD) and the airway wall area (WA) corrected by body surface area (WA/BSA) were also measured on CT. To compare the efficacy of the two methods for pulmonary functional loss assessment, all indexes were correlated with %FEV(1). To determine the efficacy of the two methods for clinical stage classification, all parameters for the four clinical stages were statistically compared., Results: %FEV(1) showed fair or moderate correlation with all parameters (0.15≤r(2)≤0.30, p<0.05). WA, WA/BSA and MRER of the 'Severe Persistent' group were significantly larger than those of 'Mild Intermittent' and 'Mild Persistent' groups (p<0.05), and MRER of the 'Moderate Persistent' group significantly lower than that of the 'Mild Intermittent' group (p<0.05)., Conclusion: O(2)-enhanced MRI is as effective as CT for pulmonary functional loss assessment and clinical stage classification of asthmatics., (Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.)

Purpose: The aim of the study was to compare two analytical methods-maximum slope (MS) and the dualinput single-compartment model (CM)-in computed tomography (CT) measurements of hepatic perfusion and to assess the effects of extrahepatic systemic factors., Materials and Methods: A total of 109 patients underwent hepatic CT perfusion. The scans were conducted at the hepatic hilum 7-77 s after administration of contrast material. Hepatic arterial perfusion (HAP) and portal perfusion (HPP) (ml/min/100 ml) and the arterial perfusion fraction (APF, %) were calculated with the two methods, followed by correlation assessment. Partial correlation analysis was used to assess the effects on hepatic perfusion values by various factors, including age, sex, risk of cardiovascular disease, compensation for respiratory misregistration, arrival time of contrast material at the abdominal aorta, transit time from abdominal aorta to hepatic parenchyma, and liver dysfunction., Results: The mean HAPs, HPPs, and APFs were, respectively, 31.4, 104.2, and 23.9 for MS and 27.1, 141.3, and 22.1 for CM. HAP and APF showed significant (P<0.0001) and moderate correlation (γ=0.417 and 0.548) and HPP showed poor correlation (γ=0.172) between the two methods. While MS showed weak correlations (γ=-0.39 to 0.34; P<0.001 to <0.02) between multiple extrahepatic factors and perfusion values, CM showed weak correlation only between the patients' sex and HAP (γ=0.31, P=0.001)., Conclusion: Hepatic perfusion values estimated by the two methods are not interchangeable. CM is less susceptible to extrahepatic systemic factors.

Purpose: To directly compare the capabilities of perfusion scan, SPECT, co-registered SPECT/CT, and quantitatively and qualitatively assessed MDCT (i.e. quantitative CT and qualitative CT) for predicting postoperative clinical outcome for lung volume reduction surgery (LVRS) candidates., Materials and Methods: Twenty-five consecutive candidates (19 men and six women, age range: 42-72 years) for LVRS underwent preoperative CT and perfusion scan with SPECT. Clinical outcome of LVRS for all subjects was also assessed by determining the difference between pre- and postoperative forced expiratory volume in 1s (FEV(1)) and 6-min walking distance (6MWD). All SPECT examinations were performed on a SPECT scanner, and co-registered to thin-section CT by using commercially available software. On planar imaging, SPECT and SPECT/CT, upper versus lower zone or lobe ratios (U/Ls) were calculated from regional uptakes between upper and lower lung fields in the operated lung. On quantitatively assessed CT, U/L for all subjects was assessed from regional functional lung volumes. On qualitatively assessed CT, planar imaging, SPECT and co-registered SPECT/CT, U/Ls were assessed with a 4-point visual scoring system. To compare capabilities of predicting clinical outcome, each U/L was statistically correlated with the corresponding clinical outcome., Results: Significantly fair or moderate correlations were observed between quantitatively and qualitatively assessed U/Ls obtained with all four methods and clinical outcomes (-0.60

Purpose: The purpose of this study was to prospectively and directly compare diagnostic capabilities of whole-body integrated FDG-PET/CT and standard radiologic examination for assessment of recurrence in postoperative non-small cell lung cancer (NSCLC) patients., Materials and Methods: A total of 92 consecutive pathologically diagnosed NSCLC patients (65 males, 27 females; mean age, 71 years) underwent pathologically and surgically proven complete resection, followed by prospective whole-body FDG-PET/CT and standard radiological examinations. Final diagnosis of recurrence was based on the results of more than 1 year of follow-up and/or pathological examinations. On both methods, the probability of recurrence was assessed in each patient by using a five-point visual scoring system, and the each final diagnosis was made by consensus between two readers. Kappa analyses were performed to determine inter-observer agreement for both methods, and ROC analyses were used to compare capability of the two methods for assessment of postoperative recurrence on a per-patient basis. Sensitivity, specificity and accuracy were also compared between PET/CT and standard radiological examination by means of McNemar's test., Results: All inter-observer agreements were almost perfect (integrated PET/CT: kappa=0.89; standard radiological examination: kappa=0.81). There were no statistically significant differences in area under the curve, sensitivity, specificity and accuracy between integrated FDG-PET/CT and standard radiologic examinations (p>0.05)., Conclusion: Integrated FDG-PET/CT can be used for assessment of postoperative recurrence in NSCLC patients with accuracy as good as that of standard radiological examinations., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To compare directly the capabilities of multidetector-row computed tomography (MDCT) and MRI for disease severity assessment and outcome prediction for acute pulmonary thromboembolism (APTE) patients., Materials and Methods: Fifty consecutive APTE patients underwent MDCT, MR angiography, dynamic perfusion MRI, treatment and follow-up examination. Pulmonary blood flow (PBF), pulmonary blood volume, and mean transit time maps were generated from perfusion MRI, and all segmental parameters were determined by using region of interest measurements. Receiver operator curve analyses were used to determine the most accurate parameter for diagnosis of the APTE segment. Then, APTE index from perfusion MRI (PE(perfusion MRI) index), right ventricle/left ventricle (RV/LV) diameter ratio and APTE indexes from embolic burdens observed on MDCT (PE(CT) index) and MR angiography (PE(MRA) index) were calculated. Finally, ability to differentiate mortality (n = 8) from survival (n = 42) groups and to predict patient outcome were statistically assessed., Results: PBF was a significantly more accurate parameter than others (P < 0.05). When feasible threshold value was applied, specificity and accuracy of RV/LV diameter ratio and PE(Perfusion MRI) index were significantly higher than those of PE(CT) and PE(MRA) indexes (P < 0.05). Logistic regression analysis demonstrated that each index was a significant predictor (P < 0.05)., Conclusion: Dynamic perfusion MRI can be effective for disease extent assessment and outcome prediction for APTE patients., (Copyright 2010 Wiley-Liss, Inc.)

Rationale and Objectives: Academic and clinical interest in reducing radiation from computed tomography (CT) examinations has increased, and the purpose of this study was to determine the capabilities of reduced-dose multidetector-row CT (MDCT) in assessing lung destruction and pulmonary functional loss in pulmonary emphysema patients., Materials and Methods: Twenty-five consecutive smokers (15 men and 10 women; mean age 67.9 years; age range 49-86 years) underwent MDCT examinations using two different effective tube currents (standard-dose protocol [150 mAs] and reduced-dose protocol [50 mAs]). For quantitative and qualitative assessments of lung destruction in each subject, percentage of low attenuation emphysematous destruction areas (%LAAs) were computationally calculated, and visual emphysema scores (ESs) were determined for both protocols. To determine the capabilities for quantitative and qualitative assessments of lung destruction by using reduced-dose protocol, %LAAs and ESs of both protocols were compared statistically. To compare the capabilities for quantitative and qualitative assessments of pulmonary functional loss, %LAAs and ESs of both protocols were correlated with forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC)., Results: %LAAs and ESs had significant correlations between both protocols (%LAAs: r = 0.95, P < .001; ESs: r = 0.97, P < .001). The limits of agreement of %LAAs were -1.8 + or - 9.2%. The agreement of ESs between both protocols was substantial (kappa = 0.70). %LAAs and ESs of both protocols had significant correlations with FEV1/FVC (%LAAs of 150 mAs: r = -0.49, P < .05; %LAAs of 50 mAs: r = -0.44, P < .05; ESs of 150 mAs: r = -0.67, P < .001; ESs of 50 mAs: r = -0.66, P < .001)., Conclusion: Reduced-dose MDCT had a potential of substitution for standard-dose MDCT on the both assessments in pulmonary emphysema patients., (Copyright 2010 AUR. Published by Elsevier Inc. All rights reserved.)

Purpose: To prospectively and directly compare the capability of whole-body diffusion-weighted (DW) imaging, whole-body magnetic resonance (MR) imaging with and that without DW imaging, and integrated fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for M-stage assessment in non-small cell lung cancer (NSCLC) patients., Materials and Methods: The institutional review board approved this study; informed consent was obtained from patients. A total of 203 NSCLC patients (109 men, 94 women; mean age, 72 years) prospectively underwent whole-body DW imaging, whole-body MR imaging, and FDG PET/CT. Final diagnosis of the M-stage in each patient was determined on the basis of results of all radiologic and follow-up examinations. Two chest radiologists and two nuclear medicine physicians independently assessed all examination results and used a five-point visual scoring system to evaluate the probability of metastases. Final diagnosis based on each of the methods was made by consensus of two readers. Receiver operating characteristic (ROC) analysis was used to compare the capability for M-stage assessment among whole-body DW imaging, whole-body MR imaging with and that without DW imaging, and PET/CT on a per-patient basis. Sensitivity, specificity, and accuracy were compared with the McNemar test., Results: Area under ROC curve (A(z)) values of whole-body MR imaging with DW imaging (A(z) = 0.87, P = .04) and integrated FDG PET/CT (A(z) = 0.89, P = .02) were significantly larger than that of whole-body DW imaging (A(z) = 0.79). Specificity and accuracy of whole-body MR imaging with (specificity, P = .02; accuracy, P < .01) and that without DW imaging (specificity, P = .02; accuracy, P = .01) and integrated FDG PET/CT (specificity, P < .01; accuracy, P < .01) were significantly higher than those of whole-body DW imaging., Conclusion: Whole-body MR imaging with DW imaging can be used for M-stage assessment in NSCLC patients with accuracy as good as that of PET/CT.

Purpose: To compare the nodule management capabilities of dynamic MRI, dynamic multidetector-row computed tomography (MDCT) and coregistered positron emission tomography (PET)/CT., Materials and Methods: Dynamic MRI, dynamic MDCT, PET, microbacterial, and pathological examinations were administered to 175 consecutive patients with 202 nodules (<30 mm in diameter). The final diagnoses resulted in the classification of 202 nodules into two groups: requiring further intervention and treatment (N = 163) and no further evaluation (N = 39) groups. Maximum relative enhancement and slope of enhancement ratio were calculated as dynamic MR indices. Maximum enhancement, net enhancement, slope of enhancement, and absolute loss of enhancement were calculated as dynamic CT indices. maximum value of standard uptake value (SUV(max)) was measured on coregistered PET/CT. Receiver operating characteristics (ROC) analyses were performed to determine feasible threshold values for nodule management, and results were tested using McNemar's test., Results: When feasibility threshold values were adopted for nodule management, the specificity (82.1%) and accuracy (93.6%) of the slope of the enhancement ratio were significantly higher than those of dynamic CT indices (P < 0.05) and SUV(max) (P < 0.05)., Conclusion: Dynamic MRI can play a more specific and/or accurate role for nodule management as compared with dynamic MDCT and coregistered PET/CT., (2008 Wiley-Liss, Inc)

Objective: The purpose of the present study is to prospectively compare the capability of dynamic oxygen-enhanced MRI and quantitative CT for pulmonary functional loss assessment and clinical stage classification of smoking-related chronic obstructive pulmonary disease (COPD)., Subjects and Methods: Ten nonsmoking and 61 consecutive smoking-related COPD subjects underwent dynamic oxygen-enhanced MRI, CT, and pulmonary function tests. COPD subjects were classified into four clinical stages on the basis of the ATS-ERS guidelines. Wash-in time and relative enhancement ratio maps were generated by pixel-by-pixel analyses. Mean wash-in time and relative enhancement ratio were determined as averages of region of interest (ROI) measurements. CT-based functional lung volumes were measured on quantitative CT using the density-masked CT technique. For comparison of assessment capability for smoking-related functional loss, the three parameters were correlated with the percentage predicted forced expiratory volume in 1 second (%FEV1) and the percentage predicted diffusing capacity of the lung for carbon monoxide corrected for alveolar volume (%DL(CO)/VA). To determine the clinical stage classification capability, these parameters were statistically compared for nonsmoking subjects and all clinical stages of smoking-related COPD subjects., Results: Correlation between mean wash-in time and %FEV1 (r = -0.74, p < 0.0001) and between mean relative enhancement ratio and %DL(CO)/VA (r = 0.66, p < 0.0001) was better than that between CT-based functional lung volume and either %FEV1 (r = 0.61, p < 0.0001) or %DL(CO)/VA (r = 0.56, p < 0.0001). Mean wash-in time showed a significant difference between nonsmoking and smoking-related COPD subjects at all clinical stages (p < 0.05)., Conclusion: Dynamic oxygen-enhanced MRI has potential for pulmonary functional loss assessment and clinical stage classification of smoking-related COPD as does quantitative CT.

Purpose: To conduct a prospective comparison of the accuracy of short inversion time (TI) inversion-recovery (STIR) turbo spin-echo (SE) imaging and coregistered 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) with computed tomography (CT) (coregistered FDG-PET/CT) to assess the N-stage in non-small-cell lung cancer (NSCLC) patients., Materials and Methods: A total of 115 consecutive NSCLC patients prospectively underwent CT, STIR turbo SE imaging, and FDG-PET, as well as surgical and pathological examinations. All STIR turbo SE images were obtained with a 0.9% saline phantom, which was placed alongside the chest wall of each patient, and coregistered FDG-PET/CTs were reconstructed using commercially available software. For quantitative assessments, the ratio of signal intensity (SI) of each lymph node to that of 0.9% saline phantom (lymph node-saline ratio [LSR]) and maximal standardized uptake value (SUV(max)) of each lymph node were calculated. Feasible threshold values were determined by using the receiver operating characteristic (ROC) curve-based positive test, and diagnostic capabilities of N-stage were compared by McNemar's test on a per patient basis., Results: When feasible, threshold values were adopted, quantitative sensitivity (90.1%) and accuracy (92.2%) of STIR turbo SE imaging were significantly higher than those of quantitative and qualitative sensitivities (76.7% and 74.4%) and accuracies (83.5% and 82.6%) of coregistered FDG-PET/CT on a per patient basis (P < 0.05)., Conclusion: STIR turbo SE imaging is at least as valid as coregistered FDG-PET/CT for quantitative and qualitative assessment of the N-stage for NSCLC patients., ((c) 2007 Wiley-Liss, Inc.)

Rationale and Objective: Co-registered SPECT and CT imaging (SPECT-CT) has potential for more precise evaluation of regional pulmonary function and may be useful for prediction of postoperative lung function in non-small cell lung cancer (NSCLC) patients. The purpose of the present study was to prospectively assess the capability of co-registered SPECT-CT using krypton-81m (Kr-81m) and technetium-99m-labeled macroaggregated albumin (Tc-99m MAA) for prediction of postoperative lung function of NSCLC patients compared with SPECT and planar imaging., Materials and Methods: Sixty consecutive patients considered candidates for lung resection underwent 16-slice CT, ventilation and perfusion scintigraphy with SPECT examinations, and preoperative and postoperative measurement of FEV(1)%. In each subject, SPECT and CT data were automatically fused by using commercially available software. Each postoperative FEV(1)% value was predicted from uptakes of Kr-81m and Tc-99m MAA within total and resected lungs. Then, reproducibility coefficients and the limits of agreement between actual and each predicted postoperative lung function were statistically assessed., Results: Reproducibility coefficients of SPECT-CT (Kr-81m: 5.1%, Tc-99m MAA: 5.2%) were smaller than those of SPECT and planar image using Kr-81m (SPECT: 7.4%, planar image: 12.1%) and using Tc-99m MAA (SPECT: 7.2%, planar image: 11.8%). The limits of agreement for SPECT-CT (Kr-81m: 3.3 +/- 10.5%, Tc-99m MAA: 5.4 +/- 11.0%) were also smaller than that of SPECT and planar image and small enough for clinical purposes., Conclusions: Co-registered SPECT-CT using Kr-81m and Tc-99m MAA was able to more reproducibly and accurately predict postoperative lung function compared with SPECT and planar imaging.

Objective: The purpose of this study was to compare the diagnostic performance of positron emission tomography (PET) alone, computed tomography (CT) alone, side-by-side reading, and fused images for restaging or follow-up of patients with malignant lymphoma., Methods: Fifty patients with histologically confirmed non-Hodgkin lymphoma underwent an (18)fluoro-2-deoxyglucose (FDG)-PET scan, followed by a CT scan. CT alone, PET alone, side-by-side reading, and fused images were interpreted separately and visually using a five-point grading scale for the following eight regions: cervical, supraclavicular, axillary, mediastinal, para-aortic to iliac, mesenteric, inguinal, and extra-nodal. Diagnostic accuracy was compared on the basis of the final diagnoses determined by histological confirmation and/or clinical course., Results: For all regions combined, the interpretation of PET alone (sensitivity = 86.1%, specificity = 99.4%, accuracy = 91.0%), side-by-side reading (96.0%, 99.4%, 98.9%), and fused images (98.0%, 99.4%, 99.2%) yielded significantly higher diagnostic performance than that of CT alone (59.4%, 96.1%, 91.0%; P < 0.001). The cervical, supraclavicular, and extra-nodal regions were more accurately diagnosed with PET (P < 0.05), whereas the para-aortic to iliac regions were diagnosed more accurately with side-by-side reading and fused images than with CT alone or PET alone (P < 0.05)., Conclusions: Although fused images are clinically valuable, side-by-side reading showed equivalent performance, whereas the interpretation of PET alone yielded reasonably high diagnostic performance for restaging or follow-up of patients with malignant lymphoma.

Purpose: To determine the clinical utility of thin-section multiplanar reformats (MPRs) from multidetector-row CT (MDCT) data sets for assessing the extent of regional tumors in non-small cell lung cancer (NSCLC) patients., Materials and Methods: Sixty consecutive NSCLC patients, who were considered candidates for surgical treatment, underwent contrast-enhanced MDCT examinations, surgical resection and pathological examinations. All MDCT examinations were performed with a 4-detector row computed tomography (CT). From each raw CT data set, 5mm section thickness CT images (routine CT), 1.25 mm section thickness CT images (thin-section CT) and 1.25 mm section thickness sagittal (thin-section sagittal MPR) and coronal images (thin-section coronal MPR) were reconstructed. A 4-point visual score was used to assess mediastinal, interlobar and chest wall invasions on each image set. For assessment of utility in routine clinical practice, mean reading times for each image set were compared by means of Fisher's protected least significant difference (PLSD) test. A receiver operator characteristic (ROC) analysis was performed to determine the diagnostic capability of each of the image data sets. Finally, sensitivity, specificity and accuracy of the reconstructed images were compared by McNemar test., Results: Mean reading times for thin-section sagittal and coronal MPRs were significantly shorter than those for routine CT and thin-section CT (p<0.05). Areas under the curve (Azs) showing interlobar invasion on thin-section sagittal and coronal MPRs were significantly larger than that on routine CT (p=0.03), and the Az on thin-section sagittal MPR was also significantly larger than that on routine CT (p=0.02). Accuracy of chest wall invasion by thin-section sagittal MPR was significantly higher than that by routine CT (p=0.04)., Conclusion: Thin-section multiplanar reformats from multidetector-row CT data sets are useful for assessing the extent of regional tumors in non-small cell lung cancer patients.