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Background: Ever since Katzenstein and Fiorelli introduced the term nonspecific interstitial pneumonia (NSIP) to denote those cases of interstitial pneumonia that cannot be categorized as any of the other types of idiopathic interstitial pneumonias (IIP), there has been continuing debate on whether it is a real clinical entity or not. The American Thoracic Society/European Respiratory Symposium task group tried to identify idiopathic NSIP as a separate disease and exclude it from the category of IIP. However, it appears that the clinical presentation of NSIP and usual interstitial pneumonia (UIP) are the same. Objective : To show that the radiologic features of NSIP and UIP should be relied upon, instead of clinical presentation and pathologic findings, to differentiate between the two. Materials and Methods: Consecutive patients who had received a diagnosis of either NSIP or UIP on the basis of open lung biopsy between January 2001 and December 2007 were identified for inclusion in this retrospective review. The study included 61 subjects: 32 men and 29 women with a mean age of 59.39 ± 14.5 years. Chest computed tomography images of all the cases were collected for a review. High resolution computed tomography (HRCT) and all pathologic specimens were also evaluated. A weighted kappa coefficient was used to evaluate whether radiology can be used instead of biopsy for the diagnosis of NSIP and UIP. Comparison of the mean ages and the time intervals (i.e., interval between symptom onset and the time of diagnosis) in the UIP and NSIP groups was done using the Mann-Whitney U test. Association between gender and biopsy result was evaluated by the Fisher exact test. Data were evaluated using SPSS, v.13. Results : Sixty-one patients were included in this study, 32 were male and 29 were female. On the basis of biopsy findings, 50 (82%) patients had UIP and 11 (18%) had NSIP. Thirty (60%) of the 50 patients who had UIP were male and 20 (40%) were female; 2 (18.2%) of the 11 patients who suffered from NSIP were male and 9 (81.8%) were female. Based on HRCT findings, 36 (60%) patients were diagnosed to have UIP and 24 (40%) were diagnosed with NSIP. When diagnosis was based on biopsy findings, the time interval in the UIP group was 13.59 ± 8.29 months and in the NSIP group it was 7.90 ± 4.18 months. When diagnosed on the basis of HRCT findings, the time interval in the UIP group was 14.22 ± 8.94 months and in the NSIP group it was 10.54 ± 5.78 months. When diagnosis was on the basis of biopsy, the mean age in the UIP group was 61.30 ± 14.18 years and in the NSIP group it was 50.73 ± 13.14 years. Conclusion : HRCT can be used instead of invasive methods like lung biopsy to differentiate between UIP and NSIP.

Introduction: This study evaluates scan time reduction using time-of-flight (TOF) PET, when quantitative parameters including volumetric measures are considered. Methods: 32 patients were included in the study. The reconstruction parameters for TOF were 2 iterations, 18 and 24 subsets, and for non-TOF was 3 iterations and 18 subsets. A post smoothing filter with FWHM of 5.4 mm and 6.4 mm were used for TOF and 6.4 mm for non-TOF. TOF reconstruction was performed with 2, 2.5 and 3 min/bed position, and 3 min/bed position scan time was applied in non-TOF. Quantitative parameters such as coefficient of variation (COV), signal-to-noise ratio (SNR), lesion-to-background ratio (LBR), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were utilized. Standard uptake value (SUV) was also measured. Different segmentation thresholds were studied. Results: Improvement in SNR for TOF relative to non-TOF was observed when utilizing 18 subsets, 5.4 mm filter size with 3 min scan time/bed position (Pvalue< 0.0001), and for 18 subsets, 6.4 mm filter size when 2.5- and 3-min scan time/bed positions was applied (P-value≤0.02). Scan time reduction did not illustrate significant variation for the SUVs and lesion size. In all TOF protocols for both TLG and MTV, the measured values decreased with increasing segmentation thresholds, as expected, with significantly more impact for higher thresholds (70%, 75%). Meanwhile, higher values were observed for higher post smoothing filter in each specified threshold. With increasing of the threshold, ΔTLG was increased with more impact for higher post smoothing filter. ΔMTV were -10.10±11.09 (-1.35±8.59) and 0.68±17.51 (12.42±18.90) in 2 min/bed position with 5.4 (6.4 mm post smoothing filter) for threshold of 45% and 75% respectively. Conclusion: Scan time reduction from 3 to 2 min can be obtained with TOF in comparison with non-TOF, especially when higher segmentation threshold values with higher subset number (24) and 6.4 mm filters are utilized. [ABSTRACT FROM AUTHOR]

Background: An initial evaluation of non-small cell lung cancer (NSCLC) patients with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan can modify treatment planning. We investigated the clinical significance of FDG PET/CT quantitative parameters (QPs) in NSCLC patients. Materials and Methods: We included 125 NSCLC patients for initial staging FDG PET/CT scan. The primary tumor (T), regional lymph node metastases (N), and distant metastases (M) were evaluated on FDG PET/CT images. QPs, including standard uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated separately for each T, N, and M lesion and also for the whole body. Statistical analysis through SPSS version 22 was used to evaluate the clinical significance of PET/CT QPs concerning primary tumor pathology characteristics, initial tumor stage, and patient's prognosis. Results: We followed the patients for 19.28 (±11.42) months. Considering primary tumor pathology, there was a significant difference in FDG PET/CT QPs, including primary tumor SUVmax (p=0.00), metastases SUVmax (p=0.014), whole-body MTV (p=0.045), and whole-body TLG (p=0.002). There was also a significant difference in QPs, including primary tumor SUVmax (p=0.00) and regional lymph node metastases SUVmax (p=0.048) when accounting for tumor initial stage. There was a significant prognostic value for the whole-body TLG (p=0.01) and a cut-off point of 568 was reached to differentiate better versus worse survival outcome. Conclusion: We demonstrated a statistically significant difference in FDG PET/CT QPs when accounting for primary NSCLC pathology characteristics and initial stage, as well as patient's prognosis, and recommend incorporating QP values into clinical PET/CT reports. [ABSTRACT FROM AUTHOR]

Background: The most important advantage of positron emission tomography/computed tomography (PET/CT) imaging is its capability of quantitative analysis. The aim of the current study was to choose the proper standardized uptake value (SUV) threshold, when the time-of-flight (TOF) and point spread function (PSF) were used for respiratory artifact reduction in the liver dome in a new-generation PET/CT scanner. Materials and Methods: The current study was conducted using a National Electrical Manufacturers Association International Electrotechnical Commission body phantom, with activity ratios of 2:1 and 4:1. A total of 27 patients, with respiratory artifacts in the thorax region, were analyzed. PET images were retrospectively reconstructed using either a high definition (HD) + PSF (i.e., a routine protocol) algorithm or HD+PSF+TOF (PSF+TOF; i.e., to reduce the respiratory artifact) algorithms, with various reconstruction parameters. The SUVmax and SUVmean, at different thresholds (i.e., at 45%, 50%, and 75%), were also assessed. Results: Although in comparison to the routine protocol a higher SUV was observed when using the PSF+TOF method, this approach was used to reduce the respiratory artifact. The appropriate threshold for SUV was strongly related to the lesion size, reconstruction parameters, and activity ratio. The mean of the relative difference between PSF+TOF algorithm and routine protocol for SUVmax varied from 10.58±14.99% up to 35.49±32.60% (which was dependent on reconstruction parameters). Conclusion: In comparison with other types of SUVs, the SUVmax value illustrated its significant overestimation, especially at the 4:1 activity ratio. The poor agreement between SUVmax and SUV50% was also observed. When the TOF and PSF are utilized to reduce respiratory artifacts, the SUV50% can be an accurate semi-quantitative parameter for PET/CT images, for all lesion sizes. For smaller lesions, however, a smaller filter size was required to observe an accurate SUV. [ABSTRACT FROM AUTHOR]

Chiari Type I malformation (CM-I) is a rare disorder with displaced cerebellar tonsils through foramen magnum. Here we present a 30-year-old man with severe central and obstructive sleep apneas as presenting manifestations of CM-I. The patient underwent neurosurgery and the follow-up polysomnography revealed the resolution of central apnea while obstructive apnea remained unchanged. Central sleep apnea (CSA) could be associated with an underlying pathology; thus, further investigation is recommended in affected subjects. [ABSTRACT FROM AUTHOR]

Background: collagen vascular diseases (CVDs) are well known causes of pulmonary involvement, leading to significant morbidity. The purpose of this study was to identify several thoracic computed tomographic findings of CVDs. Materials and Methods: The study included 56 patients (15 males and 41 females) with histopathologically and clinically proven CVDs who were identified retrospectively. The presence, extent and distribution of various CT findings were evaluated by a radiologist. Results: Lung parenchyma (96.4%) was the most common area of involvement. The lower lobes (89.2%) were the most frequent sites of involvement. The predominant CT patterns were reticulation (55.3%), peripheral subpleural interlobular septal thickening (51.7%) and ground glass opacity (50%). The most common histopathological findings according to CT features were obliterative bronchiolitis (OB, 44.6%) and non-specific interstitial pneumonia (NSIP, 33.9%). Usual interstitial pneumonia was seen in 12.5% and organizing pneumonia in 26.7% of patients. Conclusion: A combination of reticular pattern, peripheral subpleural interlobular septal thickening and ground glass opacity is seen in the majority of patients with CVDs. The results indicate that OB is more prevalent than what has been reported in previous studies. The CT patterns of pulmonary fibrosis are similar to those in most other studies. [ABSTRACT FROM AUTHOR]

Background: This study aimed at evaluating HRCT pulmonary manifestations in children with Common Variable Immunodeficiency (CVID) hospitalized in the Pediatric Ward of Masih Daneshvari Hospital during a 10-year period. Materials and Methods: This retrospective study evaluated 25 children hospitalized with the diagnosis of CVID in the Pediatric Ward of Masih Daneshvari Hospital from 2001 to 2011 and their pulmonary HRCT scans were evaluated. Results: The most common pulmonary HRCT findings were lymphadenopathy (66.7%), bronchiectasis (50%), air trapping (33.3%) and peribronchial wall thickening (33.3%). The highest percentage of CT-scan findings was detected in patients aged 13-17 yrs. Conclusion: Most of the pulmonary changes due to CVID are preventable or treatable. Also, it is possible to prevent irreversible complications of disease if it is diagnosed early. Therefore, HRCT is strongly recommended as an accurate and effective method for monitoring and fast recognition of pulmonary manifestations of the disease especially bronchiectasis which is a very common finding indicative of poor prognosis. [ABSTRACT FROM AUTHOR]

Background: Recently, genetic mutations in surfactant protein C (SFTPC) have been linked to diffuse parenchymal lung diseases (DPLD). The present study investigated SFTPC mutations among Iranian patients with DPLD for the first time., Materials and Methods: In this study, we examined 28 patients diagnosed with DPLD. Patients were divided into two groups: 23 cases (82.1%) had interstitial lung disease (ILD), 7 (30.4%) of which were categorized as familial ILD, and 5 cases (17.9%) had pulmonary alveolar proteinosis (PAP). Genetic variations in the SFTPC gene were detected by direct DNA sequencing., Results: The mean (±SD) age of patients was 21.8 (± 17.1) years and 60.7% of the patients were male. Overall, 11 different mutations were detected in the SFTPC gene. Two novel mutations, c.202-43 G>A and c.416 G>C, were detected among patients. The c.201+49 C>T mutation showed a significant difference with the minor allele frequency (MAF) data. There was no significant difference between the most frequent mutations in Iranian patients and those of the general population in the world. The proximity analysis showed similarity between Iranian patients and patients of the African race. We did not find any correlation between SFTPC mutations and DPLD in the patients., Conclusion: It seems that the rs2070684 (c.201+49 C>T) mutation could be used as a specific genetic marker for distinguishing the Iranian population from other human races in the world. There was a correlation between some intronic variations and the development of disease. A new missense mutation, c.416 G>C that encodes Arg139Thr, could probably damage the protein structure and/or function and cause the signs and symptoms of DPLD., (Copyright© 2024 National Research Institute of Tuberculosis and Lung Disease.)

Background: An initial evaluation of non-small cell lung cancer (NSCLC) patients with 18F- fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan can modify treatment planning. We investigated the clinical significance of FDG PET/CT quantitative parameters (QPs) in NSCLC patients., Materials and Methods: We included 125 NSCLC patients for initial staging FDG PET/CT scan. The primary tumor (T), regional lymph node metastases (N), and distant metastases (M) were evaluated on FDG PET/CT images. QPs, including standard uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated separately for each T, N, and M lesion and also for the whole body. Statistical analysis through SPSS version 22 was used to evaluate the clinical significance of PET/CT QPs concerning primary tumor pathology characteristics, initial tumor stage, and patient's prognosis., Results: We followed the patients for 19.28 (±11.42) months. Considering primary tumor pathology, there was a significant difference in FDG PET/CT QPs, including primary tumor SUVmax (p=0.00), metastases SUVmax (p=0.014), whole-body MTV (p=0.045), and whole-body TLG (p=0.002). There was also a significant difference in QPs, including primary tumor SUVmax (p=0.00) and regional lymph node metastases SUVmax (p=0.048) when accounting for tumor initial stage. There was a significant prognostic value for the whole-body TLG (p=0.01) and a cut-off point of 568 was reached to differentiate better versus worse survival outcome., Conclusion: We demonstrated a statistically significant difference in FDG PET/CT QPs when accounting for primary NSCLC pathology characteristics and initial stage, as well as patient's prognosis, and recommend incorporating QP values into clinical PET/CT reports., Competing Interests: Conflict of Interest Authors of this manuscript declare that there is no funding or conflict of interest for this work., (Copyright© 2020 National Research Institute of Tuberculosis and Lung Disease.)

Background: The 6-minute walking test, cardiopulmonary exercise testing, and spirometry are useful tools for evaluation of respiratory impairment and functional capacity in patients with lung disease. Sarcoidosis is a multisystem granulomatous disease of unknown etiology., Objectives: Since the pulmonary involvement can affect the quality of life in sarcoidosis patients, this study is aimed to evaluate the tests mentioned above in order to examine the functional capacity of sarcoidosis patients in different stages as well as the cause of exercise intolerance., Methods: This cross-sectional study was carried out on 50 Iranian patients with sarcoidosis. Patients were classified into three groups based on the findings of the chest radiography as well as the pulmonary CT scan, reported by an expert radiologist. Pulmonary, cardiac, and activity function have been evaluated in the patients, using cardiopulmonary exercise testing, the 6-minutes walking test, and spirometry., Results: In cardiopulmonary exercise testing, percent-predicted peak VO 2 (57.75±15.49, p=0.015) and percent-predicted O 2 pulse (70.54±17.37, p=0.013) were significantly lower in the third group, in comparison with the others. Also, VE/CO 2 (AT) (34.99±5.67, p=0.000) was significantly higher in the third group, in comparison with the other ones. Percent-predicted VO 2 showed a strong positive correlation with age (r=0.377, p=0.009), TSH (r= 0.404, p=0.007), and percent-predicted FVC (r=0.443, p=0.002). In addition, O 2 pulse had a positive correlation with BMI (r=0.324, p=0.026), percent-predicted FVC (r=0.557, p= 0.000), and percent-predicted FEV 1 (r=0.316, p=0.032)., Conclusions: According to this study, ventilatory limitation, pulmonary involvement, and deconditioning are the main causes of activity limitations in sarcoidosis patients., (Copyright: © 2020.)

Introduction: PET/CT scan has an emerging role in head and neck oncology with a few well-established indications, including: detection of unknown primary tumor site, tumor staging, radiotherapy planning, treatment response assessment and detection of recurrent disease. The purpose of this study is reporting PET/CT findings in head and neck cancer patients to emphasize its role in head and neck oncology., Materials and Methods: In a retrospective study, we reviewed our PET/CT database and found 94 patients with primary head and neck cancer. This is a descriptive report of PET/CT scan findings in head and neck cancer patients referred to Masih Daneshvari hospital, Tehran, Iran between 2013 and 2016., Results: The most common primary tumor sites were oral cavity (27%) and nasopharynx (22%). The most common indication for referral was tumor restaging (76%) including treatment response evaluation and differentiation between recurrence and post-treatment fibrosis. In 60% of patients with negative primary tumor site, PET/CT was able to detect evidence of regional or distant metastasis. PET/CT was able to localize the primary tumor site in 66% of patients with unknown primary tumor site. We also had 19 patients with primary head and neck cancer referred for initial staging, demonstrating evidence of metastasis in 66% of all cases., Conclusion: Most patients are referred for restaging and demonstrate evidence of regional or distant metastasis with significant value for further treatment planning. Providing insurance coverage and familiarizing referring physicians about correct indications of this relatively new diagnostic modality will be to the best interest of head and neck cancer patients in the long run.

Background: The purpose of this study was to determine the normal diameters of larger airways in the Persian population, since these demographic variables are essential for interpretation of chest CTs and/or plain X-rays., Material/methods: During a 6-month period, sagittal and coronal diameters of tracheas of all cases admitted for a chest CT to the radiology department of the National Research Institute of Tuberculosis and Lung Disease (NRITLD) were measured. The patients had to accept to take part in the study and had to fulfill the inclusion and exclusion criteria of the study. Ninety-nine percent confidence intervals (99% CI) were used to define the upper and lower limits of normal., Results: Two hundred subjects, including 132 men and 68 women aged 20-85 years, were studied. CORONAL AND SAGITTAL DIAMETERS OF TRACHEAS IN THE UPPER PART WERE AS FOLLOWS: 1.8±0.24 and 2.06±0.27cm for men, and 1.48±0.20 and 1.49±0.24 for women, respectively. For the lower part that was: 1.8±0.23, 1.86±0.27, 1.51±0.18, and 1.46±0.23, respectively. For the right and left main-stem bronchi the values were as follows: 1.16±0.17 and 1.02±0.22 for men and 0.93±0.13 and 0.81±0.13 for women, respectively., Conclusions: The values determined by us had a narrower range of normality than the ones found in the previous reports, so they will stay more friendly for interpretation of individual cases.