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To investigate the proportion of clinical scenarios covered by EURO-2000 Guidelines and ESR iGuide, and assess compliance with both guidelines. The clinical indication on archived request forms for head, chest, abdomen-pelvis, and spine CT examinations performed in three hospitals in January 2018 was retrospectively matched with EURO-2000 Guidelines and ESR iGuide. For clinical scenarios addressed in the guidelines, the compliance with the guidelines was assessed. Analysis was performed on pooled data from the three centres and further stratified by centre, body region, and prescriber’s specialisation. The differences in categorical data distributions between centres, body regions, and prescribers’ specialisations were assessed with paired McNemar’s χ2 tests. A total of 6,812 requests for 7,217 CT examinations were analysed. Sixty-five percent of clinical situations that lead to prescribing CT examinations were addressed in EURO-2000 Guidelines compared with 81% for ESR iGuide. Proportions of clinical scenarios covered by the guidelines were statistically different between centres and body regions (p < 0.001) and varied according to prescribers’ specialisations (p ranging from < 0.001 to 0.531). Both EURO-2000 Guidelines and ESR iGuide encompassed more clinical scenarios in certain body regions, favouring, e.g. spine and head over abdomen and chest. The proportion of “unjustified examinations” was greater according to EURO-2000 Guidelines (46%) than ESR iGuide (23%) (p < 0.001). Both EURO-2000 Guidelines and ESR iGuide do not address numerous common clinical scenarios. The proportions of scenarios addressed differ according to the centre, body region, and prescribers’ specialisation. Any estimation of compliance with referral guidelines is therefore of relative significance. • ESR iGuide performs better than earlier EURO-2000 Guidelines for the coverage of all possible clinical scenarios leading to CT referrals. • Differences in coverage of clinical scenarios by both referral guidelines are observed for different body regions and/or prescribers’ subspecialties. • As referral guidelines are incomplete, any estimation of justified or unjustified CT requests is of relative significance.

Objectives: To estimate the variability of CT diagnostic reference levels (DRLs) according to the methods used for computing collected data. Methods: Dose-length products (DLP) were collected by our national nuclear control agency from the 250 devices installed in 140 medical centers in the country. In 2015, the number of head, thorax, abdomen, and lumbar spine examinations collected in these centers ranged from approximately 20,000 to 42,000. The impact on DRLs of the number of devices considered, as well as the differences in descriptive statistics (mean vs. median DLP) or methods of pooling DLP data (all devices vs. all patients), was investigated. Variability in DRLs was investigated using a bootstrapping method as a function of the numbers of devices and examinations per device. Results: As expected, DRLs derived from means were higher than those from medians, with substantial differences between device- and patient-related DRLs. Depending on the numbers of devices and DLP data per device, the variability ranged from 10 to 40% but was stabilized at a level of 10–20% if the number of devices was higher than 50 to 60, regardless of the number of DLP data per device. Conclusion: Number of devices and of DLP data per device, descriptive statistics, and pooling data influence DRLs. As differences in methods of computing survey data can artificially influence DRLs, harmonization among national authorities should be recommended. Key Points: • Due to CT dose variability, that of DRLs is at least of 10%. • DRLs derived from medians are lower than from means and differ from those obtained by pooling all patient data. • Fifty to 60 devices should be sufficient for estimating national DRLs, regardless of the number of data collected per device., SCOPUS: ar.j, info:eu-repo/semantics/published

To determine the variabilities of dose-area-products (DAP) of frequent X-ray examinations collected for comparison with diagnostic reference levels (DRLs). DAP values of chest, abdomen, and lumbar spine examinations obtained on devices from two manufacturers were collected in three centers over 1 to 2 years. The variability of the average DAP results defined as the 95% confidence interval in percentage of their median value was calculated for increasing sample sizes, each examination and center. We computed the sample sizes yielding variabilities lower or equal to 25% and 10%. The effect of narrowing patient selection based on body weight was also investigated (ranges of 67–73 Kg, or 60–80 Kg). DAP variabilities ranged from 75 to 170% of the median value when collecting small samples (10 to 20 DAP). To reduce this variability, larger samples are needed, collected over up to 2 years, regardless of the examination and center. A variability ≤ 10% could only be reached for chest X-rays, requiring up to 800 data. For the abdomen and lumbar spine, the lowest achievable variability was 25%, regardless of the body weight selection, requiring up to 400 data. Variabilities in DAP collected through small samples of ten data as recommended by authorities are very high, but can be reduced down to 25% (abdomen and lumbar spine) or even 10% (chest) through a substantial increase in sample sizes. Our findings could assist radiologists and regulatory authorities in estimating the reliability of the data obtained when performing X-ray dose surveys. • Low but reasonable variabilities cannot be reached with samples sized as recommended by regulatory authorities. Higher numbers of DAP values are required to reduce the variability. • Variabilities of 10% for the chest and 25% for abdomen and lumbar spine examinations are achievable, provided large samples of data are collected over 1 year. • Our results could help radiologists and authorities interpret X-rays dose surveys.

The surgical lung biopsy (SLB) is the recommended sampling technique when the pathological analysis of the lung is required in the work-up of an interstitial lung disease (ILD) but trans-bronchial lung cryobiopsy (TBLC) is increasingly recognized as an alternative approach. As TBLCs have lower mortality and morbidity risks than SLB, this study aimed to investigate the safety of TBLCs in patients at higher risk of complications and for whom SLB was not considered as an alternative., info:eu-repo/semantics/published

Objectives: The aim of this study was to assess the diagnostic role of eosinophils count in COVID-19 patients. Methods: Retrospective analysis of patients admitted to our hospital with suspicion of COVID-19. Demographic, clinical and laboratory data were collected on admission. Eosinopenia was defined as eosinophils < 100 cells/mm3. The outcomes of this study were the association between eosinophils count on admission and positive real-time reverse transcription polymerase chain reaction (rRT-PCR) test and with suggestive chest computerized tomography (CT) of COVID-19 pneumonia. Results: A total of 174 patients was studied. Of those, 54% had positive rRT-PCR for SARS-CoV-2. A chest CT-scan was performed in 145 patients; 71% showed suggestive findings of COVID-19. Eosinophils on admission had a high predictive accuracy for positive rRT-PCR and suggestive chest CT-scan (area under the receiver operating characteristic—ROC curve, 0.84 (95% CIs 0.78–0.90) and 0.84 (95% CIs 0.77–0.91), respectively). Eosinopenia and high LDH were independent predictors of positive rRT-PCR, whereas eosinopenia, high body mass index and hypertension were predictors for suggestive CT-scan findings. Conclusions: Eosinopenia on admission could predict positive rRT-PCR test or suggestive chest CT-scan for COVID-19. This laboratory finding could help to identify patients at high-risk of COVID-19 in the setting where gold standard diagnostic methods are not available.

Objectives: To estimate the variability of X-ray diagnostic reference levels (DRLs) depending on the number of X-ray devices and data per device. Methods: Dose-area products (DAP) were collected by the national nuclear control agency from the 590 devices installed in 345 medical centers in the country. From 2015 to 2017, the number of chest (postero-anterior (PA) view alone, and both postero-anterior and lateral views (PA/LAT)), abdomen, pelvis, and lumbar spine examinations collected in these centers ranged from 23,000 to 77,000. The impact of the number of devices and DAP data per device on DRLs’ variabilities (95th confidence intervals divided by medians) is estimated using a bootstrapping method as a function of the number of devices and DAP per device. Results: The DRLs’ variabilities ranged from 30 to 200% depending on the number of devices and DAP data per device but stabilized at 30% when the number of devices was higher than 200 for chest PA and abdomen examinations, 300 for lumbar spine and pelvis examinations, and 400 for chest PA/LAT examinations, regardless of the number of DAP data per device. Extrapolations of our results suggest that thousands of devices are necessary to reduce DRLs’ variabilities to 10%. Conclusion: DAP-related DRL variabilities are high but only moderately influenced by the number of DAP data per device and of devices provided this number is higher than 200 to 400 devices according to the type of examination. Harmonization of methods of data collection between the authorities of the EU states should be recommended. Key Points: • DAP-related DRLs are not fixed values but ranges of values with at least 30% variability. • DAP-related DRLs strongly depend on the number of devices included when lower than 100. • If the number of devices included exceeds 200 to 400, the DRLs’ variabilities do not depend on the number of DAP per device and should not exceed 30%., SCOPUS: ar.j, info:eu-repo/semantics/published

Our aims were to explore the feasibility, safety, and efficacy of peroperative transbronchial lung cryobiopsy (TBLC) guided by electromagnetic navigation bronchoscopy (ENB) and ENB-guided methylene blue marking of presumably non-palpable pulmonary nodules, and to assess its impact on video-assisted thoracoscopic surgery (VATS) and postoperative lung function.This approach was applied to 16 consecutive patients (Group A, mean age 64 years) who were compared retrospectively to a historical group of 49 patients (Group B, mean age 62 years) with similar nodules resected without guidance. The usefulness of dye marking was graded. The success rates of both ENB-guided TBLC and nodule localization through dye marking were computed. The type of resection, volume of resected parenchyma, duration of procedures, and postoperative lung function were compared between groups. Unpaired t-test, chi-square test, unpaired Wilcoxon test, and exact Fisher test were used when appropriate.Malignancy was pathologically proven in all patients. TBLC revealed malignancy in 9 patients in Group A. The success rate of ENB-guided dye marking was 94%. Lobectomy was less frequently performed in Group A than in Group B (p = 0.022). Forced expiratory volume in 1 s and total lung capacity were significantly less reduced in Group A than in Group B (p = 0.006 and p = 0.019, respectively). Combined procedure was longer than surgery alone (p0.001), but its surgical part was shorter than VATS without guidance (p 0.001).Peroperative ENB-guided TBLC with methylene blue marking of non-palpable lung nodules is feasible. A sparing lung parenchyma procedure could be achieved thanks to the ENB-guided dye marking before VATS.

Rationale and Objectives Computed tomography (CT) airways measurements can be used as surrogates to spirometric measurements for assessing bronchodilation in a particular patient with chronic obstructive pulmonary disease. Although spirometric measurements show variations within the opening hours of a hospital department, we aimed to compare the variability of CT airways measurements between morning and afternoon in patients with chronic obstructive pulmonary disease to that of spirometric measurements. Materials and Methods Twenty patients had pulmonary function tests and CT around 8 am and 4 pm . Luminal area (LA) and wall thickness (WT) of third and fourth generation airways were measured twice by three readers. The percentage of airway area occupied by the wall (WA%) and the square root of wall area at an internal perimeter of 10 mm (√WAPi10) were calculated. The effects of examination time, reader, and measurement session on CT airways measurements were assessed, and the variability of these measurements was compared to that of spirometric measurements. Results Variability of LA3rd and LA4th was greater than that of spirometric measurements (P values ranging from .999). There was no effect of measurement session on any CT airway measurement (P values ranging from .535 to >.999). Conclusion As the variability of LA3rd and LA4th is greater than that of spirometric measurements, clinical studies should include cohorts with larger numbers of patients when considering LA than when considering spirometric measurements as end points.

The purpose of this study is to investigate the magnitude of differences between attenuation values measured on virtual unenhanced images and true unenhanced images obtained using third-generation dual-source dual-energy CT (DECT).A total of 83 patients requiring thoracoabdominal CT for cancer workup were included in this prospective study. CT examinations included true unenhanced acquisitions (tube potential, 120 kVp) and arterial and portal phase dual-energy CT (DECT) acquisitions (tube potential, 100 kVp and Sn 150 kVp [where Sn denotes the interposition of a tin filter in the high-energy beam]; tube current-exposure time product, 190 and 95 mAs). Virtual unenhanced images were created using two commercially available DECT postprocessing algorithms, one of which was designed to create liver images (hereafter referred to as VNC1 images) and the other of which was designed to create images of organs containing minor amounts of fat (hereafter referred to as VNC2 images). Attenuation values on the liver, spleen, paraspinal muscles, retroperitoneal fat, renal cortex and medulla, and gallbladder and bladder lumens were measured.The attenuation values of all tissues were significantly different between virtual unenhanced and true unenhanced images (p =0.001-0.042), except for the liver and spleen in the portal phase and muscles in both phases. When statistically significant, correlations between these differences and body mass index (weight in kilograms divided by the square of height in meters) depended on the tissue imaged and algorithm used. The percentage of cases in which these differences were 10 HU or greater was 1% for the liver and approximately 5% for the spleen and muscles, regardless of the algorithm and phase, but on VNC1 images it reached approximately 30% for the kidney, 70% for the gallbladder and bladder, and depending on the phase, 40-70% for fat. On VNC2 images, the percentage of cases in which these differences were 20 HU or greater was approximately 90% for fat.Abdominal virtual unenhanced images obtained with third-generation dual-source DECT still should not replace true unenhanced images because of substantial differences in attenuation measurements for fluid, fat, and renal tissues.

To test the hypothesis that referral guidelines are not sufficiently known by prescribers and that medico-legal concerns could influence the prescription of radiographs in minor chest trauma. We submitted a questionnaire including a typical clinical history and questions on reasons for prescribing radiographs of the ribs in minor chest trauma to 112 prescriptors (33 residents, 18 surgeons, 7 internists, 24 general practitioners and 30 ER physicians). All accepted to participate. Comparisons were performed by Fisher's exact test followed by a post-hoc analysis and by a McNemar test. Fifty-eight percent of prescriptors proposed rib radiographs, most (89%) being unaware of the guidelines. Only 11% of them changed their intention to order radiographs after information on referral guidelines and radiation dose (P=0.057). The mean dose delivered by rib radiographs was 38 times higher than that of a chest X-ray. Legal and medico-legal concerns (requirements from insurance policies and avoidance of lawsuits) were the main reasons for requesting radiographs. Unsharpness of guidelines in addition to social and medico-legal issues, rather than medical reasons or the lack of knowledge of the guidelines, strongly influence the prescription of radiographs of the ribs in minor chest trauma. • Most prescriptors order radiographs of the ribs in minor chest trauma. • Only few prescriptors are aware of referral guidelines. • Information on guidelines does not change their need for radiographs. • Motivations for ordering radiographs are rather legal than medical, but poor compliance to guidelines could also be explained by their unsharpness. • Radiation dose of rib radiographs was 38 times that of a PA chest radiograph.

To prospectively compare the prevalence and frequency of subchondral bone marrow edema (BME) in the lumbar facet joints of low back pain patients and healthy subjects. Lumbar magnetic resonance imaging (MRI) examinations were performed on 55 asymptomatic participants (18 men; age range 21–63; mean 36 ± 12 years; body mass index (BMI) range 16–31; mean 22.6 ± 3.2 kg/m2) and 79 low back pain patients (36 men; age range 18–77; mean 47 ± 14 years; BMI range 18–40; mean 27.8 ± 4.4 kg/m2). In both groups, facet joint subchondral BME signal was evaluated using T2-weighted STIR imaging, and facet joint osteoarthritis was characterized as mild, moderate, and severe. The BME signal was found in seven asymptomatic participants (12.7%) and 28 low back pain patients (35.4%) (P = 0.003). A significant portion of the patients (15.2%) presented more than one BME signal (P = 0.011). By pooling the ten facet joints of all subjects in each group, a significant difference in osteoarthritis grade distribution was observed between the two groups (P

To evaluate how pulmonary artery (PA) distensibility performs in detecting pulmonary hypertension due to left heart disease (PH-LHD) in comparison with parameters from ungated computed tomography (CT) and echocardiography. One hundred patients (79 men, mean age = 63 ± 17 years) with either severe heart failure with reduced ejection fraction (HFrEF), aortic stenosis, or primary mitral regurgitation prospectively underwent right heart catheterization, ungated CT, ECG-gated CT, and echocardiography. During the ECG-gated CT, the right PA distensibility was calculated. In ungated CT, dPA, dPA/AA, the ratio of dPA to the diameter of the vertebra, segmental PA diameter, segmental PA-to-bronchus ratio, and the main PA volume were measured; the egg-and-banana sign was recorded. During echocardiography, the tricuspid regurgitation (TR) gradient was measured. The areas under the ROC curves (AUC) of these signs were computed and compared with DeLong test. Correlation between PA distensibility and PA pressure (PAP) was investigated through Pearson’s coefficient. PA distensibility was lower in patients with PH than in those without PH (11.4 vs. 21.2%, p

To determine variability of volume computed tomographic dose index (CTDIvol) and dose–length product (DLP) data, and propose a minimum sample size to achieve an expected precision. CTDIvol and DLP values of 19,875 consecutive CT acquisitions of abdomen (7268), thorax (3805), lumbar spine (3161), cervical spine (1515) and head (4106) were collected in two centers. Their variabilities were investigated according to sample size (10 to 1000 acquisitions) and patient body weight categories (no weight selection, 67–73 kg and 60–80 kg). The 95 % confidence interval in percentage of their median (CI95/med) value was calculated for increasing sample sizes. We deduced the sample size that set a 95 % CI lower than 10 % of the median (CI95/med ≤ 10 %). Sample size ensuring CI95/med ≤ 10 %, ranged from 15 to 900 depending on the body region and the dose descriptor considered. In sample sizes recommended by regulatory authorities (i.e., from 10–20 patients), mean CTDIvol and DLP of one sample ranged from 0.50 to 2.00 times its actual value extracted from 2000 samples. The sampling error in CTDIvol and DLP means is high in dose surveys based on small samples of patients. Sample size should be increased at least tenfold to decrease this variability. • Variability of dose descriptors is high regardless of the body region. • Variability of dose descriptors depends on weight selection and the region scanned. • Larger samples would reduce sampling errors of radiation dose data in surveys. • Totally or partially disabling AEC reduces dose variability and increases patient dose. • Median values of dose descriptors depend on the body weight selection.

Item does not contain fulltext Purpose To quantify the reproducibility and accuracy of experienced thoracic radiologists in differentiating between subsolid and solid pulmonary nodules at CT. Materials and Methods The institutional review board of Beth Israel Deaconess Medical Center approved this multicenter study. Six thoracic radiologists, with a mean of 21 years of experience in thoracic radiology (range, 17-22 years), selected images of 10 solid and 10 subsolid nodules to create a database of 120 nodules; this selection served as the reference standard. Each radiologist then interpreted 120 randomly ordered nodules in two different sessions that were separated by a minimum of 3 weeks. The radiologists classified whether or not each nodule was subsolid. Inter- and intraobserver agreement was assessed with a κ statistic. The number of correct classifications was calculated and correlated with nodule size by using Bland-Altman plots. The relationship between disagreement and nodule morphologic characteristics was analyzed by calculating the intraclass correlation coefficient. Results Interobserver agreement (κ) was 0.619 (range, 0.469-0.745; 95\% confidence interval (CI): 0.576, 0.663) and 0.670 (range, 0.440-0.839; 95\% CI: 0.608, 0.733) for interpretation sessions 1 and 2, respectively. Intraobserver agreement (κ) was 0.792 (95\% CI: 0.750, 0.833). Averaged for interpretation sessions, correct classification was achieved by all radiologists for 58\% (70 of 120) of nodules. Radiologists agreed with their initial determination (the reference standard) in 77\% of cases (range, 45\%-100\%). Nodule size weakly correlated with correct classification (long axis: Spearman rank correlation coefficient, rs = 0.161 and P = .049; short axis: rs = 0.128 and P = .163). Conclusion The reproducibility and accuracy of thoracic radiologists in classifying whether or not a nodule is subsolid varied in the retrospective study. This inconsistency may affect surveillance recommendations and prognostic determinations. (©) RSNA, 2015 Online supplemental material is available for this article.

Purpose To assess inter-observer variability in identifying traction bronchiectasis on computed tomography (CT) using additional criteria for chronic fibrosing interstitial pneumonia. Methods Seven experts categorized CT image set representing 39 patients into three groups on the basis of the presence of traction bronchiectasis, using a three-point scale: 3-definitely/probably yes; 2-possibly yes; and 1-definitely/probably no. This scale served as a reference standard. The image set included cases of chronic fibrosing interstitial pneumonia, non-interstitial lung disease, and difficult-to-determine cases. Forty-eight observers similarly assessed the same image set, first according to the Fleischner Society definition, and second with additional criteria, in which traction bronchiectasis was observed exclusively in chronic fibrosing interstitial pneumonia. The agreement level between the reference standard and each observer's evaluation in each session was calculated using weighted kappa values which were compared between the two sessions using a paired t test. Results The mean weighted kappa value for all observers was significantly higher in the second reading session (mean 0.75) than in the first reading session (mean 0.62) (p < 0.001). Conclusion Inter-observer agreement in identifying traction bronchiectasis improves when using the additional criteria which specify chronic fibrosing interstitial pneumonia as the underlying disease.

PURPOSE The aim of the study was to compare radiation dose and image quality between the "average" and the "very strong" automatic exposure control (AEC) strength curves. MATERIALS AND METHODS Images reconstructed with filtered back-projection techniques and radiation dose data of unenhanced helical chest computed tomography (CT) examinations obtained at 2 hospitals (hospital A, hospital B) using the same scanner devices and acquisition protocols but different AEC strength curves were evaluated over a 3-month period. The selected AEC strength curve applied to "slim" patients (diameter

To test the hypothesis that quality clinical audits improve compliance with the procedures in computed tomography (CT) scanning. This retrospective study was conducted in two hospitals, based on 6950 examinations and four procedures, focusing on the acquisition length in lumbar spine CT, the default tube current applied in abdominal un-enhanced CT, the tube potential selection for portal phase abdominal CT and the use of a specific “paediatric brain CT” procedure. The first clinical audit reported compliance with these procedures. After presenting the results to the stakeholders, a second audit was conducted to measure the impact of this information on compliance and was repeated the next year. Comparisons of proportions were performed using the Chi-square Pearson test. Depending on the procedure, the compliance rate ranged from 27 to 88 % during the first audit. After presentation of the audit results to the stakeholders, the compliance rate ranged from 68 to 93 % and was significantly improved for all procedures (P ranging from

Background. An increasing number of pulmonary nodules of unknown nature are detected as a result of screening by CT in high lung cancer risk patients. Objectives. The purposes of this study were to assess the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) combined with transbronchial lung cryobiopsy (TBLC) and to compare it with standard transbronchial biopsy (TBB) in pulmonary nodules of less than 2 cm in diameter. Methods. We prospectively included 32 patients (18 men and 14 women, mean age 68 ± 9 years) with nodules of less than 2 cm in diameter and no metastasis at 18FDG PET-CT. The nodule position was determined by ENB, radial endobronchial ultrasonography miniprobe, and fluoroscopy. Eight samples were obtained, six by TBB and two by TBLC. Results. Nodule diameter averaged 16 ± 3 mm. Twenty-five nodules were malignant and 18 were surgically resected. Surgery was avoided in four patients as the biopsies revealed a benign disease. The samples obtained by TBLC were five times larger than those by TBB. The diagnostic yields of TBLC and TBB were 69% and 38%, respectively (p=0.017). Adverse events consisted in 15 mild or moderate bleedings and one pneumothorax. Conclusions. In the setting of peripheral pulmonary lesions of less than 20 mm in diameter, ENB-combined TBLC is feasible and safe, provides larger samples, and has higher diagnostic yield than TBB., SCOPUS: ar.j, info:eu-repo/semantics/published

The objective of our study was to evaluate in vivo urinary calculus characterization with third-generation dual-source dual-energy CT (DECT) at reduced versus standard radiation dose.One hundred fifty-three patients requiring unenhanced CT for suspected or known urolithiasis were prospectively included in our study. They underwent two acquisitions at reduced-dose CT (90 kV and 50 mAsThe radiologist visualized 279 calculi on standard-dose CT and 262 on reduced-dose CT; 17 calculi were missed on reduced-dose CT, all of which were ≤ 3 mm. Among the 262 calculi visualized at both doses, the CT number ratio was obtained with the software for 227 calculi and was not different between the doses (p = 0.093). Among these 262 calculi, 197 were labeled at both doses; 194 of the 197 labeled calculi were labeled with the same color code. Among the 65 remaining calculi, 48 and 61 (all ≤ 5 mm) were not labeled at standard-dose and reduced-dose CT (p = 0.005), respectively. At reduced-dose CT, the mean CTDIWith third-generation dual-source DECT, a larger proportion of calculi ≤ 5 mm are not characterized as UA or non-UA at a reduced dose.

Computed tomography (CT) airways measurements can be used as surrogates to spirometric measurements for assessing bronchodilation in a particular patient with chronic obstructive pulmonary disease. Although spirometric measurements show variations within the opening hours of a hospital department, we aimed to compare the variability of CT airways measurements between morning and afternoon in patients with chronic obstructive pulmonary disease to that of spirometric measurements.Twenty patients had pulmonary function tests and CT around 8 am and 4 pm. Luminal area (LA) and wall thickness (WT) of third and fourth generation airways were measured twice by three readers. The percentage of airway area occupied by the wall (WA%) and the square root of wall area at an internal perimeter of 10 mm (√WAPi10) were calculated. The effects of examination time, reader, and measurement session on CT airways measurements were assessed, and the variability of these measurements was compared to that of spirometric measurements.Variability of LAAs the variability of LA

Objective:Testing the hypothesis that CT airway measurements could be influenced by total lung capacity (TLC), gender and height in normal individuals.Methods:In this ethics committee-approved prospective trial, 87 healthy never-smoking volunteers who provided written informed consent were included. From a helical CT scan of the chest, the wall thickness (WT) and the lumen area were twice measured in the third- and fourth-generation airways by three readers using a dedicated software. In addition, the TLC was also measured using CT (TLCCT). The percentage of airway area occupied by the wall (WA%) and the square root of wall area at an internal perimeter of 10 mm (√WAPi10) were calculated. CT airway measurements were compared between genders by using a mixed linear model. The correlations between height, TLCCT and CT airway measurements were tested by using a Pearson correlation analysis. These correlations were arbitrarily considered as significant if there was a significant correlation observed for each ...

Resume Le diagnostic d’asbestose, fibrose pulmonaire due a l’inhalation d’amiante, a ete propose en 2003 sur des bases anamnestiques, tomodensitometriques, fonctionnelles respiratoires et biometrologiques chez une patiente de 64 ans. Ce diagnostic a ete confirme par l’examen anatomopathologique de la piece de resection chirurgicale d’un cancer bronchique en 2010. Le diagnostic d’asbestose est desormais rare en raison de la reduction de l’empoussierage au cours des dernieres decennies et surtout par l’interdiction de l’utilisation de l’amiante dans les pays occidentaux. Les principales manifestations thoraciques specifiques de l’exposition a l’amiante sont desormais des pathologies pleurales benignes et le mesotheliome. Il est aussi devenu exceptionnel d’avoir la confirmation histologique du diagnostic d’asbestose, obtenu chez cette patiente a la faveur du traitement chirurgical d’une autre complication de l’exposition professionnelle.

When lung volume in animals is passively increased beyond total lung capacity (TLC; transrespiratory pressure = +30 cmH2O), stimulation of the phrenic nerves causes a rise, rather than a fall, in pleural pressure. It has been suggested that this was the result of inward displacement of the lower ribs, but the mechanism is uncertain. In the present study, radiopaque markers were attached to muscle bundles in the midcostal region of the diaphragm and to the tenth rib pair in five dogs, and computed tomography was used to measure the displacement, length, and configuration of the muscle and the displacement of the lower ribs during relaxation at seven different lung volumes up to +60 cmH2O transrespiratory pressure and during phrenic nerve stimulation at the same lung volumes. The data showed that 1) during phrenic nerve stimulation at 60 cmH2O, airway opening pressure increased by 1.5 ± 0.7 cmH2O; 2) the dome of the diaphragm and the lower ribs were essentially stationary during such stimulation, but the muscle fibers still shortened significantly; 3) with passive inflation beyond TLC, an area with a cranial concavity appeared at the periphery of the costal portion of the diaphragm, forming a groove along the ventral third of the rib cage; and 4) this area decreased markedly in size or disappeared during phrenic stimulation. It is concluded that the lung-deflating action of the isolated diaphragm beyond TLC is primarily related to the invaginations in the muscle caused by the acute margins of the lower lung lobes. These findings also suggest that the inspiratory inward displacement of the lower ribs commonly observed in patients with emphysema (Hoover's sign) requires not only a marked hyperinflation but also a large fall in pleural pressure.

Pyogenic granuloma is a benign vascular tumor of the skin or mucosae usually observed after irritative processes. We report the case of a non-compliant hemodialysis patient with severe hyperparathyroidism who rapidly developed growing pyogenic granuloma of the distal part of the left thumb. This tumor mimicked sarcoma and caused recurrent bleeding during hemodialysis sessions. Hand radiograph revealed an osteolytic lesion compatible with a brown tumor. Among other brown tumors, several of those found in the ribs were responsible of a severe respiratory restrictive deficit. This report highlights the difficulty to choose the adequate treatment of severe hyperparathyroidism, and discusses the benefit/risk balance of performing parathyroidectomy., Journal Article, info:eu-repo/semantics/published

Single-lung transplantation (SLT) in patients with emphysema leads to a cranial displacement of the diaphragm on the transplanted side and a shift of the mediastinum toward the transplanted lung. The objective of the present study was to assess the effect of unilateral lung inflation on the mechanics of the diaphragm. Two endotracheal tubes were inserted in the two main stem bronchi of six anesthetized dogs, and radiopaque markers were attached along muscle fibers in the midcostal region of the two halves of the diaphragm. The animals were then placed in a computed tomographic scanner, the left or the right lung was passively inflated, and the phrenic nerves were stimulated while the two endobronchial tubes were occluded. As lung volume increased, the fall in airway opening pressure (ΔPao) in the inflated lung during stimulation decreased markedly, whereas ΔPao in the noninflated lung decreased only moderately ( P < 0.001). Also, the two hemidiaphragms shortened both during relaxation and during phrenic stimulation, but the ipsilateral hemidiaphragm was consistently shorter than the contralateral hemidiaphragm. In addition, the radius of curvature of the ipsilateral hemidiaphragm during stimulation increased, whereas the radius of the contralateral hemidiaphragm remained unchanged. These observations indicate that 1) in the presence of unilateral lung inflation, the respiratory action of the diaphragm is asymmetric; and 2) this asymmetry is primarily determined by the differential effect of inflation on the length and curvature of the two halves of the muscle. These observations also imply that in patients with emphysema, SLT improves the action of the diaphragm on the transplanted side.

To prospectively investigate the effect of submaximal inspiration on computed tomographic (CT) indexes used to quantify emphysema and to discriminate between effects of lung tissue loss and increase in total lung capacity (TLC) on these indexes.In this ethical committee-approved study, 20 control subjects and 16 patients with chronic obstructive pulmonary disease (COPD) who provided written informed consent were included. Three 1-mm-thick sections were obtained from each participant at 100%, 90%, 80%, 70%, and 50% of vital capacity (VC). At each volume, eight percentiles of attenuation distribution, as well as relative area (RA) of lung occupied by attenuation coefficients lower than nine thresholds, were calculated. A linear regression line between TLC and each CT index was plotted for control subjects. Mean distance from data points measured in patients with COPD to the normal regression line was used to reflect the effect of lung tissue loss, regardless of TLC.The RA of lung occupied by attenuation coefficients lower than -950 HU (RA(950)) at any percentage of VC lower than 100% decreased significantly from that at 100% VC (P ≤ .002) in control subjects and patients with COPD; however, between 100% VC and 90% VC, the average difference in RA(950) was only 3% and 2% in control subjects and patients with COPD, respectively. The 1st percentile at any percentage of VC lower than 100% increased from that at 100% VC (P.001) in control subjects. This percentile did not significantly differ from 100% VC at 90% VC or 80% VC (P = .176 and P = 0.077, respectively), but it did significantly differ from 100% VC at 70% VC and 50% VC (P ≤ .002 for both) in patients with COPD. Slope and mean distance were different from zero for all RAs and percentiles except for mean distance for RAs between RA(900) and RA(920).Submaximal inspiration induces underestimation of pulmonary emphysema. Both lung tissue loss and TLC influence CT indexes, suggesting the need to establish normal CT values.

The objective of this study was to evaluate the role of the mediastinum in the mechanics of the canine diaphragm. Two sets of experiments were performed. In the first experiment on five animals, the mediastinum was severed from the sternum to the vena cava, and radiopaque markers were attached to muscle bundles in the midcostal region of the diaphragm. The three-dimensional location of the markers during relaxation at different lung volumes and during phrenic nerve stimulation at the same lung volumes was then measured using computed tomography. From these data, accurate measurements of muscle displacement and muscle length were obtained, and these measurements, together with the changes in airway opening pressure, were compared with those previously obtained in animals with an intact mediastinum. Severing the mediastinum per se appeared to have no influence on the pressure-generating capacity of the diaphragm or on the lung-volume dependence of this capacity. The great vessels and the esophagus in these animals, however, were left intact, so the possibility remained that these structures continued to impact on the diaphragm through their close attachments to the muscle. In the second experiment, therefore, loads were applied caudally to the central tendon to assess the force-displacement relationship of the entire mediastinum, and this relationship, combined with the known displacement of the diaphragm dome during phrenic nerve stimulation, was used to infer the force exerted by the mediastinum on the muscle during contraction. The results showed that this force is small compared with that developed by the diaphragm, except at very high lung volumes. It is concluded, therefore, that the mediastinum has only little influence on the mechanics of the canine diaphragm.

The lung-expanding action of the diaphragm is primarily related to the descent of the dome produced by the shortening of the muscle fibers. However, when the phrenic nerves in dogs are selectively stimulated at functional residual capacity, the muscle insertions into the lower ribs also move caudally. This rib motion should enhance the descent of the dome and increase the fall in pleural pressure (DeltaPpl). To quantify the role of this mechanism in determining DeltaPpl during isolated diaphragm contraction and to evaluate the volume dependence of this role, radiopaque markers were attached to muscle bundles in the midcostal region of the muscle in six animals, and the three-dimensional location of the markers during relaxation at different lung volumes and during phrenic nerve stimulation at the same lung volumes was measured using computed tomography. From these data, accurate measurements of muscle length, dome displacement, and lower rib displacement were obtained. The values of dome displacement were then corrected for lower rib displacement, and the values of DeltaPpl corresponding to the corrected dome displacements were obtained using the measured relationship between DeltaPpl and dome displacement. The measurements showed that phrenic stimulation at all lung volumes causes a caudal displacement of the lower ribs and that this displacement, taken alone, contributes approximately 25% of the DeltaPpl produced by the diaphragm. To the extent that this lower rib displacement is itself caused by DeltaPpl, the lung-expanding action of the diaphragm during isolated contraction may therefore be viewed as a self-facilitating phenomenon.

The objective of this study was to prospectively investigate the influence of oral, IV, and oral and IV contrast media on the information provided by MDCT at standard and simulated low radiation doses in adults suspected of having acute appendicitis.One hundred thirty-one consecutive patients (80 women, 51 men; age range, 18-87 years; mean age, 37 years) suspected of having appendicitis were randomly assigned to either ingest or not ingest iodinated contrast material. Thereafter, all patients underwent IV unenhanced and enhanced abdominopelvic MDCT with a 4 x 2.5 mm collimation at 120 kVp and 100 mAs(eff). Dose reduction corresponding to 30 mAs(eff) was simulated. Two radiologists independently read scans during separate sessions, assessed appendix visualization, and proposed a diagnosis (i.e., appendicitis or an alternative diagnosis). The final diagnosis was based on either surgical findings or clinical follow-up. Data were analyzed by factorial analysis of multiple correspondences followed by an ascending hierarchic classification method.Factorial analysis and ascending hierarchic classification revealed that, in terms of diagnostic correctness, reader influence predominated over the influence of IV and oral contrast media use and radiation dose but that correctness was also influenced by the patient's sex (p = 0.048) and was lower in cases of alternative diseases (p0.001). Visualization of the appendix depended predominantly on the reader rather than on the use of IV, oral, or oral and IV contrast agents or on radiation dose.Diagnostic correctness is much more influenced by the reader than by the use of contrast medium (oral, IV, or both) or of simulated low-radiation-dose technique.

To test the hypothesis that the frequency-size distribution of low-attenuation areas could be a parameter to quantify pulmonary emphysema.Ethics committee approval and written informed consent were obtained. Multidetector computed tomographic (CT) scans were performed with simultaneous acquisition of four 1-mm sections of the whole chest in 80 patients (57 men, 23 women; age range, 38-79 years) who were referred for surgical resection of lung cancer. From the raw data, 1.25-mm-thick sections were reconstructed at 10-mm intervals. The relative area of lung with attenuation coefficients lower than -960 HU (RA(960)) and the 1st percentile of the distribution of attenuation coefficients were calculated. The cumulative frequency-size distributions of the RA(960) and the 1st percentile, when represented on a log-log plot, followed linear relationships. The slopes of these lines (D(960) and D(p1)) were compared with areas found macroscopically to have emphysema and with two different microscopic measurements assessed on resected specimens. Spearman correlation coefficients of each CT index with macroscopic and microscopic measurements were calculated.The RA(960) and the 1st percentile showed statistically significant correlations with macroscopic and microscopic indexes (P.001), whereas D(960) and D(p1) did not (Por = .165).The RA(960) and the 1st percentile reflect the extent of emphysema as compared to macroscopic and microscopic measurements, while D(960) and D(p1) do not.

Ascites causes an increase in the elastance of the abdomen and impairs the lung-expanding action of the diaphragm, but its overall effects on the pressure-generating ability of the muscle remain unclear. In the present study, radiopaque markers were attached to muscle bundles in the midcostal region of the diaphragm in five dogs, and the three-dimensional locations of the markers during relaxation and during phrenic nerve stimulation in the presence of increasing amounts of ascites were determined using a computed tomographic scanner. From these data, accurate measurements of muscle length and quantitative estimates of diaphragm curvature were obtained, and the changes in transdiaphragmatic pressure (Pdi) were analyzed as functions of muscle length and curvature. With increasing ascites, the resting length of the diaphragm increased progressively. In addition, the amount of muscle shortening during phrenic nerve stimulation decreased gradually. When ascites was 100 ml/kg body wt, therefore, the muscle during contraction was longer, leading to a 20–25% increase in Pdi. As ascites increased further to 200 ml/kg, however, muscle length during contraction continued to increase, but Pdi did not. This absence of additional increase in Pdi was well explained by the increase in the diameter of the ring of insertion of the diaphragm to the rib cage and the concomitant increase in the radius of diaphragm curvature. These observations indicate that the pressure-generating ability of the diaphragm is determined not only by muscle length as conventionally thought but also by muscle shape.

After single-lung transplantation (SLT) for emphysema, heterogeneity of ventilation distribution in the graft can be assessed by measuring the slope of the alveolar plateau, computed from a single-breath test, performed in lateral decubitus with this lung in the nondependent position. We tested the validity of this technique in patients with SLT for interstitial lung diseases (ILD). Twelve patients with SLT for ILD, 12 nontransplanted patients with ILD, and 10 healthy control subjects performed single-breath washouts in right and left lateral decubitus; nitrogen slope ( SN2) and the difference between SF6 and He slopes ( SSF6- SHe) were measured between 75 and 100% of expired volume. In 10 transplant recipients, the volume of each lung was measured in both postures by computerized tomography. Slopes were unaffected by posture in normal control subjects and patients with ILD. On the other hand, SN2 and SSF6- SHe in transplant recipients were smaller with the graft in the nondependent than in the dependent position (0.366 ± 0.445 vs. 1.035 ± 0.498 for SN2; 0.094 ± 0.201 vs. 0.218 ± 0.277 for SSF6- SHe). Values of SN2 and SSF6- SHe obtained in the former position were similar to those obtained in normal controls, while values obtained in the latter position were similar to those obtained in nontransplanted patients with ILD. Computerized tomography studies with the graft in the nondependent position indicated that this lung contributed 82% of the volume expired below functional residual capacity. We conclude that, in patients with SLT for ILD, the slope of the alveolar plateau obtained with the graft in the nondependent position reflects heterogeneity of ventilation distribution in this lung.

Abnormalities of the airways are found in a wide spectrum of diseases and conditions, with CT features that can overlap. CT features include bronchiectasis/bronchiolectasis, mucous plugging, bronchial wall thickening, and tree-in-bud pattern/centrolobular micronodules. They can be accurately assessed through image processing available on a console or workstation, such as MPR or VRT (SSD, minIP, and MIP). Recent advances in software have provided airway tree segmentation and virtual bronchoscopy navigation, as well as objective quantification of airway changes. Future developments in this objective quantification and in the reduction of the radiation dose are mandatory if CT is to play a more important role in the routine diagnosis, prognosis, and monitoring of airway diseases.

To compare standard-dose and simulated low-dose multidetector computed tomography (CT) in patients suspected of having lumbar disk herniation.The institutional review board approved the research protocol with a waiver of patient informed consent. Sixty consecutive patients underwent multidetector CT with four detector rows at 1 mm collimation at 140 kVp, with tube current-time product adapted to body mass index (BMI): 200 (BMI22 kg/m(2)), 300 (BMIor =22 to30 kg/m(2)), and 400 effective mAs (BMIor =30 kg/m(2)). Simulated doses at 65%, 50%, 35%, and 20% of the dose were used for acquisition. During two separate sessions, three independent radiologists coded each of three caudal disks as normal, bulging, or herniated and graded canal and foramen compromise. Median numbers of discrepancies between the standard and reduced doses were compared with Friedman and Wilcoxon tests. Agreements within and between readers were evaluated through kappa statistics.Dose reduction had no effect on a reader's ability to identify bulging disks (P = .128) and left and right foramen compromises (P = .413 and .665, respectively). However, for normal disks (P = .002), herniated disks (P = .004), and canal compromise (P = .002), dose reduction did have a significant effect. For normal disks and canal compromise, a reduction dose effect was not detected at 65% (P = .121 and .250, respectively) but appeared at 50% (P = .004 and .008, respectively). For herniation, a dose reduction effect was detected at 35% (P = .031). Agreements within and between readers ranged from poor to excellent and tended to decrease with dose reduction.For patients suspected of having lumbar disk herniation, tube charge settings could be reduced to 65% of the standard dose adapted to the BMI.

To prospectively investigate the effects of radiation dose and section thickness on quantitative multidetector computed tomographic (CT) indexes of pulmonary emphysema.The institutional review board approved this protocol. Written informed consent was obtained from all patients. Seventy patients (49 men, 21 women; age range, 38-79 years) referred for surgical resection of a lung tumor underwent multidetector CT with 4 x 1-mm collimation, 120 kVp, and 20 and 120 effective mAs. At each radiation dose, 1.25-, 5.0-, and 10.0-mm-thick sections were reconstructed at 10-mm intervals. From scans of the lobe or whole lung to be resected, relative areas (RAs) of lung with attenuation coefficients lower than nine thresholds and eight percentiles of the distribution of attenuation coefficients were compared with the histopathologic extent of emphysema, which was measured microscopically--by using the corrected mean interwall distance (MIWD) and the corrected mean perimeter (MP)--and macroscopically. Correlations between the data obtained by using attenuation thresholds and percentiles and the parameters macroscopic extent of emphysema, MIWD, and MP were investigated by using Spearman coefficients.The 1st percentile (r range, -0.394 to -0.675; P.001) and attenuation coefficients of -980, -970, and -960 HU (r range, 0.478-0.664; P.001) yielded the strongest correlations with macroscopic extent, MIWD, and MP, regardless of radiation dose or section thickness. The effects of radiation dose and section thickness on RAs of lung with attenuation coefficients lower than -960 HU (P = .007 and P.001, respectively) and lower than -970 HU (P = .001 and P.001, respectively) were significant. The effect of section thickness on the 1st percentile was significant (P.001), whereas the effect of dose was not (P = .910).At CT quantification of pulmonary emphysema, the tube current-time product can be reduced to 20 mAs, but both tube current-time product and section thickness should be kept constant in follow-up examinations.

Testing the hypothesis that CT densitometry indexes could be influenced by total lung capacity (TLC), gender and height in normal individuals.In this ethics committee-approved prospective study, 100 healthy non-smoking volunteers who provided written informed consent were included. From a helical scan of the chest, the relative area (RA) of the lung with attenuation coefficients lower than -960 HU and the 1st and 15th percentiles of the distribution of attenuation coefficients were calculated. Regression lines were drawn between each CT index and volunteers' height and total TLC at CT.In males, there was no statistically significant correlation between any CT index and height. In females, there was a statistically significant correlation between the RA of the lung with attenuation coefficients lower than -960 HU and the 1st percentile and height but not with the 15th percentile. For both genders, there were significant correlations between all CT indexes and TLC. The relationships between CT indexes and TLC were different in males and females.CT indexes are correlated with TLC and height but more closely with TLC than with height, and differently in males and females.CT indexes are influenced by TLC, gender and height in normal individuals and are more closely correlated with TLC than with height. The relationships between CT indexes and TLC or height are different in males and females. CT indexes used to quantify emphysema should thus be adjusted according to TLC and gender.

To determine the effect of bronchodilation on airway indexes reflecting airway disease in patients with chronic obstructive pulmonary disease (COPD) and to determine the minimum number of segmental and subsegmental airways required.This study was approved by the local ethical committee, and written informed consent was obtained from all subjects. Twenty patients with COPD who had undergone pre- and postbronchodilator pulmonary function tests and computed tomographic (CT) examinations were prospectively included. Eight healthy volunteers underwent two CT examinations. Luminal area and wall thickness (WT) of third- and fourth-generation airways were measured twice by three readers. The percentage of total airway area occupied by the wall and the square root of wall area at an internal perimeter of 10 mm (√WAPi10) were calculated. The effects of pathologic status, session, reader, bronchodilation, and CT examination were assessed by using mixed linear model analyses. The number of airways to measure for a definite percentage error of √WAPi10 was computed by using a bootstrap method.There were no significant session, reader, or bronchodilation effects on WT in third-generation airways and √WAPi10 in patients with COPD (P values ranging from .187 to.999). WT in third-generation airways and √WAPi10 were significantly different in patients with COPD and control subjects (P = .018 and.001, respectively). Measuring 12 third- or fourth-generation airways ensured a maximal 10% error of √WAPi10.WT in third-generation airways and √WAPi10 are not significantly different before and after bronchodilation and are different in patients with COPD and control subjects. Twelve is the minimum number of third- or fourth-generation airways required to ensure a maximal 10% error of √WAPi10. (©) RSNA, 2015 Clinical trial registration no. NCT01142531 Online supplemental material is available for this article.

The purpose of this statement is to describe and define the phenotypic abnormalities that can be identified on visual and quantitative evaluation of computed tomographic (CT) images in subjects with chronic obstructive pulmonary disease (COPD), with the goal of contributing to a personalized approach to the treatment of patients with COPD. Quantitative CT is useful for identifying and sequentially evaluating the extent of emphysematous lung destruction, changes in airway walls, and expiratory air trapping. However, visual assessment of CT scans remains important to describe patterns of altered lung structure in COPD. The classification system proposed and illustrated in this article provides a structured approach to visual and quantitative assessment of COPD. Emphysema is classified as centrilobular (subclassified as trace, mild, moderate, confluent, and advanced destructive emphysema), panlobular, and paraseptal (subclassified as mild or substantial). Additional important visual features include airway wall thickening, inflammatory small airways disease, tracheal abnormalities, interstitial lung abnormalities, pulmonary arterial enlargement, and bronchiectasis.

The purpose of this study was to investigate the nature of FDG-avid and non-FDG-avid lesions detected at colonoscopy in patients presenting with incidental focal colonic FDG uptake at PET/CT.Among 9073 patients who underwent PET/CT over a 4-year period, 82 patients without a history of colonic disease had focal colonic FDG uptake and underwent colonoscopy. In consensus, a radiologist and a nuclear physician read images from these PET/CT examinations. They recorded the location of focal FDG uptake in the colon and associated CT abnormalities and measured maximum standardized uptake value (SUVmax) and metabolic volume (MV). Readings were performed twice--first without and second with knowledge of lesion location at colonoscopy. The final diagnosis was based on colonoscopic findings and histopathologic results categorized into benign, premalignant, or malignant.One hundred seven foci of colonic FDG uptake at PET/CT and 150 lesions at colonoscopy were detected. Among 107 foci of FDG uptake, 65 (61%) corresponded to a lesion at colonoscopy (true-positive findings), and 42 (39%) did not (false-positive findings). Among 150 lesions found at colonoscopy, 85 (57%) were not FDG avid (false-negative findings). The MV of true-positive findings was lower than that of false-positive findings (4.0 ± 0.4 cm(3) vs 6.2 ± 0.7 cm(3); p = 0.006), but SUVmax did not differ (7.4 ± 0.5 vs 7.7 ± 0.5; p = 0.649). Considering the histopathologic categories of the lesions and the false-positive findings, there was no difference in SUVmax (p = 0.103), but MV was lower in premalignant lesions than in false-positive findings (p = 0.005).Focal colonic FDG uptake may indicate the presence of a benign, pre-malignant, or malignant lesion. Subsequent colonoscopy should not be restricted to the colonic site of FDG uptake.

To prospectively compare computed tomographic (CT) quantification of pulmonary emphysema in elastase-treated rats with morphometry and to evaluate the information yielded by CT quantification and pulmonary function tests.This study was approved by the local committee on care and use of animals in research. Thirty-six animals were used. Emphysema was produced by means of one or two tracheal injections of 300 IU of elastase, 8 weeks apart, in seven and 12 rats, respectively. As a control group, 10 rats received an injection of normal saline. The dynamic resistance, dynamic compliance, and static compliance were measured. CT was performed with 1-mm section thickness and 3-mm intervals. Relative areas of lung with attenuation coefficients lower than nine chosen thresholds (from -900 to -980 HU) and eight percentiles (from 1st to 18th percentiles) of the distribution of attenuation coefficients were compared with measurements of alveoli size--that is, mean interwall distance (MIWD) and mean perimeter per field (MP). Correlations between data obtained with thresholds and percentiles and MIWD and MP were investigated by means of Spearman coefficients (r(s)). Values of pulmonary function tests, most appropriate relative area threshold, and percentile were investigated by means of stepwise multiple regressions.For thresholds, relative surface area with attenuation coefficients less than -940 HU (RA(940)) showed the strongest correlations with findings at microscopy (r(s) = 0.676, P.001 for MIWD; r(s) = -0.720, P.001 for MP). For percentiles, the 3rd percentile showed the strongest correlations (r(s) = -0.647, P.001 for MIWD; r(s) = 0.701, P.001 for MP). Dynamic compliance and RA(940) or 3rd percentile were complementary for predicting microscopic measurements.In rats, RA(940) and the 3rd percentile reflect the extent of elastase-induced pulmonary emphysema and are complementary to dynamic compliance to predict microscopic extent.

The purpose of our study was to verify that increased widening of the anterior portion of the subacromial-subdeltoid bursa is associated with anteromedial shoulder pain.Bursography, sonography, and CT were performed in six cadaver shoulders and compared with anatomic sections in neutral position and while the humerus was extended and internally rotated. For the clinical study, the width of the anterior portion of the bursa was measured in both positions in both shoulders of 27 patients referred because of shoulder pain and in eight asymptomatic volunteers. Pain was coded as absent, experienced in the anteromedial portion of the shoulder, or experienced elsewhere but not anteromedially, and we compared the pain scores between shoulder positions.In all cadaver shoulders, when compared with CT scans and anatomic sections, sonography showed the morphology of the bursa, its relationships with surrounding structures, and morphologic changes associated with position. In volunteers, the mean width of the bursa was 0.74 +/- 0.05 and 0.93 +/- 0.09 mm (p = 0.013), respectively, in neutral and stress position. In patients, the same values were 0.70 +/- 0.07 and 0.81 +/- 0.14 mm (p = 0.286) in the asymptomatic side and 1.20 +/- 0.11 and 1.75 +/- 0.23 mm (p0.001) in the symptomatic side, respectively. The bursa was wider in patients experiencing pain anteromedially than in those who experienced pain elsewhere and volunteers (p = 0.002 and0.001, respectively), and the bursa was wider in symptomatic shoulders than in asymptomatic shoulders (p0.001).Widening of the anterior portion of the subacromial-subdeltoid bursa is associated with anteromedial shoulder pain and the clinical syndrome of coracoid impingement.

To retrospectively evaluate pulmonary artery (PA) clot load scores and computed tomographic (CT) cardiovascular parameters as predictors of mortality in patients with severe pulmonary embolism (PE).Institutional review board approval was obtained with waiver of informed consent. A total of 82 consecutive patients (42 women, 40 men; mean age+/-standard deviation, 61 years+/-15) were admitted to the intensive care unit for PE-related conditions and were evaluated by using CT pulmonary angiography. Two independent readers who were blinded to clinical outcome quantified PA clot load by using four scoring systems. Cardiovascular measurements included right ventricular (RV) and left ventricular (LV) short-axis measurements; RV short axis to LV short axis (RV/LV) ratios; main PA, ascending aorta, azygos vein, and superior vena cava diameters; and main PA diameter to aorta diameter ratios. Reflux of contrast medium into the inferior vena cava, leftward bowing of the interventricular septum, pleural or pericardial effusion, pulmonary consolidation, infarct, platelike atelectasis, and mosaic ground-glass opacity were also recorded. Results were correlated with patient outcome during hospital stay by using the Wilcoxon rank sum and chi2 tests.Twelve patients died within 1-14 days. RV and LV short axis; RV/LV ratio; azygos vein, superior vena cava, and aorta diameters; and contrast medium reflux into the inferior vena cava were significantly different between survivors and nonsurvivors (P.05). No significant relationship was found between PA clot load and mortality rate. RV/LV ratio and azygos vein diameter allowed correct prediction of survival in 89% of patients (P.001).RV/LV ratio and azygos vein diameter are predictors of mortality in patients with severe PE.

To prospectively compare the diagnostic performance of ultrasonography (US) and unenhanced multi-detector row computed tomography (CT) in patients suspected of having acute appendicitis by using surgery or clinical follow-up as the reference standard.The institutional review board approved the research protocol. Written informed consent was obtained from all patients or, for those who were adolescents, from their parents. Ninety-four patients (59 female and 35 male patients) aged 16-81 years (mean, 38 years) who were suspected of having acute appendicitis underwent both US and unenhanced multi-detector row CT of the entire abdomen. The examinations were performed within 1-2 hours of each other. US and CT images were obtained and prospectively interpreted by a different radiologist from a group of abdominal radiologists or a group of residents and general radiologists. Radiologists proposed an overall diagnosis and an alternative diagnosis. Data from US and CT were compared, and the definite diagnosis was established with surgical findings (n = 40) or results of clinical follow-up (n = 54) as the reference standard. Comparisons were made for each group of radiologists and the patient's age, body mass index (BMI), and sex. Proportion comparisons were made by using the Pearson chi2 test or the Fisher exact test. Continuous variables were compared between groups with the Mann-Whitney U test.Thirty patients had definite appendicitis. The sensitivity, specificity, positive and negative predictive values, and accuracy were not significantly different between US and CT or between groups of radiologists (P values ranged from .389 to.99), regardless of the patient's BMI (P values ranged from .073 to.99). Misclassifications were compared with the definite alternative diagnosis and were not significantly different between US and CT or between groups of radiologists (P = .061-.592), regardless of patient age (P = .875) or sex (P = .151 and.99 for male and female patients, respectively). The frequency of inconclusive examinations, however, was significantly higher with US than with CT, regardless of radiologist experience (P = .020 and.001, respectively).Although the diagnostic performances of US and multi-detector row CT are comparable, more inconclusive images were obtained with US.

Summary A cavitated mass of unknown origin was surgically resected in a 64-year-old lady with a 16 years long history of allergic bronchopulmonary aspergillosis without asthma. This lesion had been growing since several months with clinical manifestations of recurrent bronchopulmonary superinfections. The lesion corresponded to a large bronchiectasis with bronchial epithelium still present in some places, but largely destroyed and replaced by a granulation tissue rich in eosinophils with some giant cells. The excavation was filled with a necrotic and haemorragic material containing a few Aspergillus hyphae. The pathological diagnosis was bronchocentric granulomatosis (BCG). BCG is a rare disorder, mostly seen, in asthmatic patients, with bronchopulmonary aspergillosis. The clinical features and non-invasive investigations in this disease are not pathognomonic and do not allow to make a confident diagnosis, which can only be confirmed on a pathological basis. In this case, patient had never suffered from asthma. Moreover, the presentation of BCG as an excavated mass is very uncommon. The surgical procedure was considered as therapeutic. Otherwise, the response of BCG to steroids is excellent and its prognosis better than that of angiocentric granulomatosis.

To prospectively compare low- and standard-dose unenhanced multi-detector row computed tomography (CT) in patients suspected of having acute appendicitis.Ninety-five consecutive patients underwent two unenhanced multi-detector row CT examinations with 4 x 2.5-mm collimation, 120 kVp, and 30 and 100 effective mAs. Two radiologists independently read the images obtained at each dose during two sessions. Readers recorded visualization of the appendix and presence of gas in its lumen, appendicolith, periappendiceal fat stranding, cecal wall thickening, and abscess or phlegmon to measure the diameter of the appendix and to propose diagnosis (appendicitis or alternative). Data were compared according to dose and reader, with definite diagnosis established on basis of surgical findings (n = 37) or clinical follow-up. chi(2) tests and logistic regression were used. Measurement agreements were assessed with Cohen kappa statistics.Twenty-nine patients had a definite diagnosis of appendicitis. No difference was observed between the frequency of visualization of the appendix (P =.874) neither in its mean diameter (P =.101-.696, according to readers and sessions) nor in the readers' overall diagnosis (P =.788) at each dose. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of each sign were not different between doses. Fat stranding, appendicolith, and diameter were the most predictive signs, regardless of dose, yielding approximately 90% of correct diagnoses. The ability to propose a correct alternative diagnosis was not influenced by the dose.Low-dose unenhanced multi-detector row CT has similar diagnostic performance as standard-dose unenhanced multi-detector row CT for the diagnosis of acute appendicitis.