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Background: Hemorrhage in brain metastases (BMs) from lung cancer is common and associated with a poor prognosis. Research on associated factors of spontaneous hemorrhage in patients with BMs is limited. This study aimed to investigate the predictive risk factors for BM hemorrhage and assess whether hemorrhage affects patient survival. Methods: We retrospectively evaluated 159 BMs from 80 patients with lung adenocarcinoma from January 2017 to May 2022. Patients were classified into hemorrhagic and non-hemorrhagic groups. Patient demographics, lung cancer molecular subtype, treatment type, and tumor–node–metastasis stage were compared between the groups. Multivariate generalized estimating equation (GEE) analysis and gradient boosting were performed. To determine whether BM hemorrhage can stratify overall survival after BM (OSBM), univariate survival analysis was performed. Results: In the univariate analysis, hemorrhagic BMs were significantly larger and had a history of receiving combination therapy with tyrosine kinase inhibitor (TKI) and intracranial radiation (p < 0.05). Multivariate GEE showed that tumor size and combination therapy were independent risk factors for BM hemorrhage (p < 0.05). Gradient boosting demonstrated that the strongest predictor of BM hemorrhage was tumor size (variable importance: 49.83), followed by age (16.65) and TKI combined with intracranial radiation (13.81). There was no significant difference in OSBM between the two groups (p = 0.33). Conclusions: Hemorrhage in BMs from lung adenocarcinomas may be associated with BM tumor size and a combination of TKI and intracranial radiotherapy. BM hemorrhage did not affect OSBM.

The brain is an unusual site for distant metastases of thyroid cancer. The radiological features of brain metastases (BMs) have rarely been reported. Hemorrhage is frequently noted in BMs from thyroid cancer. This study aimed to investigate the clinico-radiological features of BMs from thyroid cancer and to determine the risk factors to predict BM hemorrhage.We retrospectively evaluated the MR images of 35 patients with BMs from thyroid cancer at our hospital from 2013 to 2020. The number, size, site, presence of extra-cranial metastasis, presence of perilesional edema, intra-tumoral hemorrhage, enhancement pattern, and presence of diffusion restriction on MRI were described. We further classified the thyroid cancers into hemorrhagic and nonhemorrhagic groups to investigate the factors associated with hemorrhage.54.29% of patients with thyroid BMs (19/35) had neurologic symptoms. 94.29% of patients (33/35) had extra-cranial metastases. The most common histology of primary thyroid cancer was papillary thyroid cancer (71.43%, 25/35), followed by anaplastic thyroid cancer (22.86%, 8/35). Thyroid cancer BMs were located mostly in the supra-tentorium (51.43%, 18/35) or both the supra and infra-tentorium (45.71%, 16/35). 60% of patients (21/35) showed hemorrhage within the BMs. The strongest predictor for BM hemorrhage was tumor size (variable importance: 50).Thyroid cancer BMs exhibit a bleeding tendency. Furthermore, larger BMs are more likely to have an intra-tumoral hemorrhage.

Phlegmonous esophagitis, a rare and life-threatening disorder, is characterized by bacterial infection of the submucosal and muscularis layers of the esophagus. Herein we report a case of acute phlegmonous esophagitis with mediastinitis complicated by an esophageal perforation in a patient with diabetes mellitus and alcoholic liver cirrhosis.

Background and Objectives Carbon monoxide (CO) poisoning can cause tissue hypoxia and left ventricular systolic dysfunction (LVSD) requiring intensive medical management. Our objectives were to find incidence and clinical course of LVSD CO intoxicated patients and make a clinical scoring to predict LVSD. Subjects and Methods We included all consecutive patients with CO exposure in the emergency room. LVSD was defined by LVEF 100/min), pulmonary edema on chest X-ray, serum NT pro-BNP (>100 pg/mL), troponin-I (>0.1 ng/mL) and lactic acid (>4.0 mg/dL) after a univariate analysis. Combining these into a clinical score, according to their beta score after a multivariate analysis (rage=0-16), allowed prediction of LVSD with a sensitivity of 84% and specificity of 91% (reference ≥8, area under the curve=0.952, p

To evaluate the feasibility of low-concentration contrast medium (CM) for vascular enhancement, image quality, and radiation dose on computed tomography aortography (CTA) using a combined low-tube-voltage and iterative reconstruction (IR) technique. Ninety subjects underwent dual-source CT (DSCT) operating in dual-source, high-pitch mode. DSCT scans were performed using both high-concentration CM (Group A, n = 50; Iomeprol 400) and low-concentration CM (Group B, n = 40; Iodixanol 270). Group A was scanned using a reference tube potential of 120 kVp and 120 reference mAs under automatic exposure control with IR. Group B was scanned using low-tube-voltage (80 or 100 kVp if body mass index ≥25 kg/m(2)) at a fixed current of 150 mAs, along with IR. Images of the two groups were compared regarding attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), iodine load, and radiation dose in various locations of the CTA. In comparison between Group A and Group B, the average mean attenuation (454.73 ± 86.66 vs. 515.96 ± 101.55 HU), SNR (25.28 ± 4.34 vs. 31.29 ± 4.58), and CNR (21.83 ± 4.20 vs. 27.55 ± 4.81) on CTA in Group B showed significantly greater values and significantly lower image noise values (18.76 ± 2.19 vs. 17.48 ± 3.34) than those in Group A (all Ps

Pulmonary embolism (PE) is usually associated with deep vein thrombosis (DVT) in the lower extremities. However, foreign bodies in the pulmonary arteries can rarely cause PE without evidence of DVT. In this report, we present a case of diffuse PE associated with a migrated thread-like structure of the right-side heart and pulmonary arteries in a 70 year-old woman. The patient underwent several episodes of percutaneous vertebroplasty (PV) to treat compression fractures. The thread-like foreign bodies were identified as the bone cement injected during the previous PV procedures. We present this case study to emphasise that clinicians should consider the possibility of PE as a late complication, especially those with a history of PV.

Cardiac lipoma is a rare benign primary cardiac tumor and is usually asymptomatic (1). It is usually discovered incidentally but can be related to hemodynamic obstruction depending on its location (2). There have been several reports regarding cardiac lipoma, including its clinical presentation and characteristic findings on computed tomography (CT) (2, 3). However, few cases documented the characteristic CT findings of solitary or multiple cardiac lipomas in the patient with tuberous sclerosis; and to our knowledge, no cases of biventricular lipoma or lipomatous hypertrophy with multifocal fat in a non-tuberous sclerosis patient have ever been reported (4). Therefore, we here report a case of right ventricular (RV) lipomatous mass and multifocal fat infiltration in both ventricles, which were incidentally detected in a young woman showing an abnormal electrocardiogram (ECG) finding. CASE REPORT

Takayasu's arteritis is a chronic inflammatory disorder that mainly involves medium to large sized arteries. Although it affects coronary and pulmonary arteries occasionally, physicians should consider the possibility of involvement of coronary or pulmonary arteries in patients with Takayasu's arteritis with chest pain or exertional dyspnoea. We report a case of Takayasu's arteritis who presented with exertional dyspnoea and generalised oedema due to severe bilateral pulmonary and left main coronary arterial stenoses. The patient was successfully treated by a one-stage percutaneous transluminal balloon angioplasty and stent implantation of the involved left main coronary and pulmonary arteries. The endovascular treatment may be one of the treatment options for the stenotic vascular lesions in patients with Takayasu's arteritis.

To determine the improvement of emphysema quantification with density correction and to determine the optimal site to use for air density correction on volumetric computed tomography (CT).Seventy-eight CT scans of COPD patients (GOLD II-IV, smoking history 39.2±25.3 pack-years) were obtained from several single-vendor 16-MDCT scanners. After density measurement of aorta, tracheal- and external air, volumetric CT density correction was conducted (two reference values: air, -1,000 HU/blood, +50 HU). Using in-house software, emphysema index (EI) and mean lung density (MLD) were calculated. Differences in air densities, MLD and EI prior to and after density correction were evaluated (paired t-test). Correlation between those parameters and FEV1 and FEV1/FVC were compared (age- and sex adjusted partial correlation analysis).Measured densities (HU) of tracheal- and external air differed significantly (-990 ± 14, -1016 ± 9, P0.001). MLD and EI on original CT data, after density correction using tracheal- and external air also differed significantly (MLD: -874.9 ± 27.6 vs. -882.3 ± 24.9 vs. -860.5 ± 26.6; EI: 16.8 ± 13.4 vs. 21.1 ± 14.5 vs. 9.7 ± 10.5, respectively, P0.001). The correlation coefficients between CT quantification indices and FEV1, and FEV1/FVC increased after density correction. The tracheal air correction showed better results than the external air correction.Density correction of volumetric CT data can improve correlations of emphysema quantification and PFT.

Although imaging of patient with COPD in not recommended in clinical practice, many researches and drug trial include imaging studies in evaluation of COPD. In particular, thin-section volumetric CT covering the whole lung with following quantitative assessment has been accepted one of the essential components of studies. This chapter encompasses the whole aspect of CT in COPD, including basic CT physics, radiation dose consideration, diagnosis and visual assessment of COPD, fundamentals of quantitative assessment of emphysema, airway wall thickening, and air trapping and its clinical values. Assessment of other components of COPD includes chest wall changes, vascular changes, osteoporosis, and so on. In addition, new emerging imaging methods such as MRI, dual-energy CT, PET, and optical imaging to evaluate not only morphologic but also functional aspects of lung in COPD will be introduced. Functional imaging includes direct visualization of ventilation, perfusion, chest wall motion, and inflammation. The promising results of early studies will be introduced, highlighting the potential of imaging approach for the future studies.

Purpose To correlate currently available quantitative CT measurements for airway disease with physiological indices and the body-mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index in patients with chronic obstructive pulmonary disease (COPD). Materials and methods This study was approved by our institutional review board (IRB number 2778). Written informed consent was obtained from all subjects. The subjects included 188 current and former cigarette smokers from the COPDGene cohort who underwent inspiratory and expiratory CT and also had physiological measurements for the evaluation of airflow limitation, including FEF25-75%, airway resistance (Raw), and specific airway conductance (sGaw). The BODE index was used as the index of clinical symptoms. Quantitative CT measures included % low attenuation areas [% voxels ≤ 950 Hounsfield unit (HU) on inspiratory CT, %LAA−950ins], percent gas trapping (% voxels ≤ −856 HU on expiratory CT, %LAA −856exp), relative inspiratory to expiratory volume change of voxels with attenuation values from −856 to −950 HU [Relative Volume Change (RVC)−856 to −950], expiratory to inspiratory ratio of mean lung density (E/I-ratio MLD), Pi10, and airway wall thickness (WT), luminal diameter (LD) and airway wall area percent (WA%) in the segmental, subsegmental and subsubsegmental bronchi on inspiratory CT. Correlation coefficients were calculated between the QCT measurements and physiological measurements in all subjects and in the subjects with mild emphysema (%LAA−950ins Results Quantitative CT measurements had significant correlations with physiological indices. Among them, E/I-ratio MLD had the strongest correlations with FEF25-75% (r = −0.648, Conclusion Quantitative CT measurements of gas trapping such as E/I-ratio MLD, correlate better with physiological indices for airway disease than those of airway such as WA% or LD. In mild emphysema, however, quantitative CT measurements of airway correlate better with the physiological indices. RVC−856 to −950 is a predictor of the BODE index.

Lung diseases (LD) are common extra-articular manifestations in rheumatoid arthritis (RA). However, little is known about factors associated with susceptibility to rheumatoid arthritis-related lung diseases (RA-LD). The aim of the present study was to investigate whether the single nucleotide polymorphisms (SNPs) of PADI4 and HLA-DRB1 alleles were associated with RA-LD. Blood samples and clinical data were collected from 116 consecutive RA patients who satisfied the 1987 American College of Rheumatology classification criteria. RA-LD was diagnosed using high-resolution computed tomography of the chest. All patients were genotyped for SNPs of PADI4 and HLA-DRB1 alleles and analyzed for full amino acid sequence of the HLA protein corresponding to a 4-digit HLA typing. Data were analyzed by independent t test (or Mann–Whitney test) for continuous variables, Chi-square test (or Fisher’s exact test) and trend test for categorical variables, and logistic regression analysis. Ninety-four (81.0 %) RA patients had LD, of which eight (6.9 %) had interstitial lung disease (ILD) and 92 (79.3 %) had airway abnormalities in which 64 (55.2 %) showed bronchiectasis and 47 (40.5 %) revealed bronchial wall thickening. The recessive genotype of padi4_92 was susceptible to airway abnormalities (OR = 2.22, 95 % CI = 1.05–4.49, p = 0.034). Tryptophan at position 9 of HLA-DRB1 sequence was associated with the susceptibility to RA-ILD (OR = 22.89, 95 % CI = 1.20–432.56, p = 0.037). PADI4 polymorphisms and HLA-DRB1 alleles could attribute differently to the development of airway abnormalities and ILD, respectively, in RA.

Sudden cardiac death (SCD) is defined as the unexpected natural death from a cardiac cause within an hour of the onset of symptoms in the absence of any other cause. Although such a rapid course of death is mainly attributed to a cardiac arrhythmia, identification of structural heart disease by cardiovascular computed tomography (CCT) and cardiovascular magnetic resonance (CMR) imaging is important to predict the long-term risk of SCD. In adults, SCD most commonly results from coronary artery diseases, coronary artery anomalies, inherited cardiomyopathies, valvular heart diseases, myocarditis, and aortic dissection with coronary artery involvement or acute aortic regurgitation. This review describes the CCT and CMR findings of structural heart diseases related to SCD, which are essential for radiologists to diagnose or predict.

The anomalous origin of the right coronary artery (RCA) is a rare condition. Most RCA anomalies are usually found incidentally, but these findings have clinical significance because many patients, particularly young ones, present with sudden death, myocardial ischemia and syncope without other symptoms. We describe a case of a 39-year-old male patient that presented with effort chest pain and was diagnosed with anomalous RCA that originated from the ascending aorta with prior history of repairing ruptured sinus valsalva and ventricular septal defect. The anomalous origin of RCA was identified by multidetector computed tomography (MDCT). Successful percutaneous coronary intervention was performed guided by MDCT coronary images and intravascular ultrasound.

We report a case of streaky fat deposition and late hyperenhancement in the middle layer of the left ventricular myocardium detected on computed tomography coronary angiography and cardiac magnetic resonance imaging in a patient with dilated cardiomyopathy. CT revealed multiple curvilinear streaks of hypoattenuating foci involving the middle layer of the LV myocardium, with a mean attenuation value of -70 HU, comparable to that of fat. Late mid-wall hyperenhancement foci were noted in the fatty deposition sites of the left ventricle wall on delayed contrast-enhanced cardiac MRI. However, an area of late mid-wall hyperenhancement was smaller than that of fat deposition.

Inadvertent left internal mammary artery (LIMA)-great cardiac vein (GCV) anastomosis is a rare complication of coronary artery bypass graft surgery. Patients with iatrogenic aortocoronary fistula (ACF) were usually treated surgical repair, percutaneous embolic occlusion with coil or balloon. We report a case of iatrogenic LIMA to GCV anastomosis successfully treated with coil embolization and protected left main coronary intervention through the percutaneous transfemoral approach.

Objective To evaluate the diagnostic performance of obliteration of normal heterogeneous enhancement of the spleen (ONHES) on arterial phase (AP) computed tomography (CT) images in diffuse infiltrative splenic lymphoma (DISL). Materials and methods One hundred and thirty-six patients with lymphoma who had undergone two-phase (arterial and portal venous) abdominal CT were included in this study. We retrospectively evaluated the diagnostic performance of ONHES on AP CT in diagnosing DISL. Two observers evaluated ONHES on AP CT using the 5-point confidence level and assessed the presence or absence of subjective splenomegaly on axial CT images. Another two observers measured the splenic index as proposed by objective CT criteria. Statistical analysis included interobserver agreement and diagnostic performance of CT findings. Results Eleven of the 136 patients with lymphoma had DISL. The area under the receiver operating characteristic curve of ONHES (0.948 for observer 1 and 0.922 for observer 2) was superior to that of the splenic index (0.872 for observer 3 and 0.877 for observer 4), but the difference was not statistically significant (p > 0.05). The diagnostic performance of ONHES in conjunction with subjective splenomegaly showed higher diagnostic performance, as compared with subjective splenomegaly alone (accuracy: 100% and 85.3% for observer 1, 98.5% and 87.5% for observer 2; positive predictive value: 100% and 35.5% for observer 1, 90.9% and 39.3% for observer 2, respectively). Conclusion Obliteration of normal heterogeneous enhancement of the spleen in conjunction with subjective splenomegaly can improve the diagnostic performance for DISL. Our results suggest that ONHES on AP CT images could be useful as an adjunctive diagnostic indicator of DISL in patients with lymphoma.

Objective To ascertain the incidence of acute and chronic complications of aortic intramural hematoma (IMH) and to analyze the predictors of the development of each complication. Materials and methods This retrospective study includes 107 consecutive patients diagnosed with aortic IMH by means of computed tomography (CT) during the period from January 1998 to December 2003 and followed up with serial CT examinations (median follow-up period, 320 days). There were 36 patients with type A and 71 with type B IMH. Initial and follow-up CT scans were reviewed, with special attention given to the development of complications, such as increase in the thickness of IMH, clinical and hemodynamic evolution requiring urgent surgery, and development of aortic dissection and/or aneurysm. If each complication developed within 30 days after the initial episode, we classified it as an acute complication; the others were classified as chronic complications. The time interval between the initial and the subsequent CT examination showing each complication was recorded. To identify the predictors of each complication, we analyzed the demographic and CT findings with regard to the following factors: age, sex, maximum thickness of the hematoma, maximum aortic diameter on initial CT examination, ulcerlike projection (ULP) on initial and follow-up CT examinations, and the degree of atherosclerosis. The Cox proportional hazards regression model with stepwise multivariate analyses was used to determine the significant predictors of each complication. Results Sixteen patients had acute complications consisting of aortic dissection (n = 7), aortic aneurysm (n = 6), and acute clinical and hemodynamic evolution requiring operation (n = 3). Three additional patients with aortic dissection (n = 1) and aneurysm (n = 2) underwent emergency surgery. Twenty-three patients with chronic complications had aortic dissection (n = 3), and aortic aneurysm (n = 20). Cox proportional hazards regression model revealed that the maximal diameter of involved aorta is the only significant predictor of the development of acute complications (P = 0.006), whereas the age (P = 0.040), type A IMH (P = 0.015), presence of ULP (P = 0.015), and newly developed ULP as revealed on follow-up CT examination (P = 0.032) were significant predictors of the development of chronic complications. With regard to the aortic dissection in 10 patients (9.3%; type A/B ratio, 5:5; median time interval, 34 days), Cox proportional hazards regression model revealed that the maximal thickness of the hematoma is the only significant predictor (P = 0.018). Twenty-one saccular and 5 fusiform aneurysms (24.3%) developed, as revealed on follow-up CT examinations (median time interval, 180 days). The presence of ULP (P = 0.030), type A (P = 0.038) and the maximal thickness of the hematoma (P = 0.017) were significant predictors for the development of an aneurysm. Conclusions The maximum thickness of a hematoma on the initial CT is the significant factor predicting the development of aortic dissection and aortic aneurysm. Patients with type A IMH and ULP, as revealed by initial and short-term follow-up CT examinations, should be carefully followed up with subsequent CT examination to monitor the development of an aortic aneurysm, which is a relatively common chronic complication of IMH.

ImportanceAirflow obstruction on spirometry is universally used to define chronic obstructive pulmonary disease (COPD), and current or former smokers without airflow obstruction may assume that they are disease free.ObjectiveTo identify clinical and radiologic evidence of smoking-related disease in a cohort of current and former smokers who did not meet spirometric criteria for COPD, for whom we adopted the discarded label of Global Initiative for Obstructive Lung Disease (GOLD) 0.Design, setting, and participantsIndividuals from the Genetic Epidemiology of COPD (COPDGene) cross-sectional observational study completed spirometry, chest computed tomography (CT) scans, a 6-minute walk, and questionnaires. Participants were recruited from local communities at 21 sites across the United States. The GOLD 0 group (n = 4388) (ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity >0.7 and FEV1 ≥80% predicted) from the COPDGene study was compared with a GOLD 1 group (n = 794), COPD groups (n = 3690), and a group of never smokers (n = 108). Recruitment began in January 2008 and ended in July 2011.Main outcomes and measuresPhysical function impairments, respiratory symptoms, CT abnormalities, use of respiratory medications, and reduced respiratory-specific quality of life.ResultsOne or more respiratory-related impairments were found in 54.1% (2375 of 4388) of the GOLD 0 group. The GOLD 0 group had worse quality of life (mean [SD] St George's Respiratory Questionnaire total score, 17.0 [18.0] vs 3.8 [6.8] for the never smokers; P

BACKGROUND The efficacy of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy can be measured based on the rate of treatment response, based on the Response Evaluation Criteria in Solid Tumors (RECIST) criteria or progression-free survival (PFS). However, there are some patients harboring sensitive EGFR mutations who responded poorly to EGFR-TKI therapy. In addition, there is variability in the PFS after EGFR-TKI treatment. METHODS We performed a retrospective analysis of the medical records of 85 patients with non-small cell lung cancer, who had achieved a stable disease or better response at the first evaluation of treatment response, after receiving a 2-month course of gefitinib. We calculated the tumor shrinkage rate (TSR) by measuring the longest and perpendicular diameter of the main mass on computed tomography before, and 2 months after, gefitinib therapy. RESULTS There was a significant positive correlation between the TSR and PFS (R=0.373, p=0.010). In addition, a simple linear regression analysis showed that the TSR might be an indicator for the PFS (B±standard error, 244.54±66.79; p=0.001). On univariate analysis, the sex, histologic type, smoking history and the number of prior chemotherapy regimens, were significant prognostic factors. On multivariate regression analysis, both the TSR (β=0.257, p=0.029) and adenocarcinoma (β=0.323, p=0.005) were independent prognostic factors for PFS. CONCLUSION Our results showed that the TSR might be an early prognostic indicator for PFS in patients receiving EGFR-TKI therapy.

Intravascular lymphoma (IVL) is a rare type of extranodal non-Hodgkin's lymphoma. It is characterized by the proliferation of malignant lymphocytes within the lumen of small vessels and sparing of surrounding tissue (1,2,3,5). Pulmonary presentation of IVL is rare in Asian population and shows poor prognosis (4,5). It can be also a cause of unexplained interstitial lung disease. Because the prognosis is poor, the need of more intensive treatment should be considered. Two women, 56 years old (patient 1) and 59 years old (patient 2), commonly had a one month history of fever, weight loss, and upper respiratory symptoms. They did not show skin lesions and hepatosplenomegaly. Chest computed tomography (CT) scans also commonly showed ground-glass opacities and consolidations in both lungs (Fig. 1). In the bone marrow study, secondary hemophagocytosis (patient 1) and lymphoma involvement (patient 2) were observed, respectively. A positron emission tomography (PET) scan with 2 patients revealed diffuse increased glucose uptake in both of the lungs. These findings of CT scan and PET scan considered atypical bacterial or viral pneumonia, and acute hypersensitivity pneumonitis as possible diagnosis. An open lung biopsy for a confirmative diagnosis showed that CD20, CD79a, bcl-2, and MUM-1 were positive in the intravascular atypical cells (Fig. 1). Patient 1 was given best supportive care because of poor general condition due to delayed diagnosis. It was much delayed (2 months [patient 1], 1 month [patient 2], respectively) to diagnose finally from the initial hospital visit. On several reports, the prognosis of IVL is very poor, early introduction of systemic chemotherapy may be important to improve prognosis (4,6). The previous reports recommended an anthracycline-based chemotherapy regimen including CHOP. Rituximab is added in cases of B-cell lineage (2,3,6). Therefore we decided to use intensive chemotherapy for patient 2, who was given 3 cycles of R-hyper CVAD regimen. After 2 cycles of R-hyper CVAD, partial remission was observed. However, disease rapidly progressed and the patients eventually expired at three (patient 1) and four months (patient 2) after initial presentation, respectively. For early diagnosis of IVL with lung involvement, the early suspect based on symptoms, chest CT scan and PET scan are important because of no specific findings for IVL of lung involvement, and early aggressive diagnostic procedures (such as trans-bronchial biopsy, open lung biopsy) are required. Because the prognosis of IVL is poor, the more intensive treatment including front-line autologous transplantation should be explored. Here, we reported two cases of intravascular large B-cell lymphoma involving the lungs with their images and histopathology findings. Fig. 1 Findings of 56-year-old (A, B) and 59-year-old (C, D) women with pulmonary intravascular lymphoma. (A) Chest CT scan shows patchy GGOs and consolidations in both lungs, mainly located in the central portion. (B) Open lung biopsy specimen shows that many ...

Objective To assess clinical feasibility of low-attenuation cluster analysis in evaluation of chronic obstructive pulmonary disease (COPD). Materials and Methods Subjects were 199 current and former cigarette smokers that underwent CT for quantification of COPD and had physiological measurements. Quantitative CT (QCT) measurements included low-attenuation area percent (LAA%) (voxels ≤ −950 Hounsfield unit [HU]), and two-dimensional (2D) and three-dimensional D values of cluster analysis at three different thresholds of CT value (−856, −910, and −950 HU). Correlation coefficients between QCT measurements and physiological indices were calculated. Multivariable analyses for percentage of predicted forced expiratory volume at one second (%FEV1) was performed including sex, age, body mass index, LAA%, and D value had the highest correlation coefficient with %FEV1 as independent variables. These analyses were conducted in subjects including those with mild COPD (global initiative of chronic obstructive lung disease stage = 0–II). Results LAA% had a higher correlation coefficient (-0.549, p < 0.001) with %FEV1 than D values in subjects while 2D D−910HU (−0.350, p < 0.001) revealed slightly higher correlation coefficient than LAA% (−0.343, p < 0.001) in subjects with mild COPD. Multivariable analyses revealed that LAA% and 2D D value−910HU were significant independent predictors of %FEV1 in subjects and that only 2D D value−910HU revealed a marginal p value (0.05) among independent variables in subjects with mild COPD. Conclusion Low-attenuation cluster analysis provides incremental information regarding physiologic severity of COPD, independent of LAA%, especially with mild COPD.

Purpose To evaluate the relationships between DLCO, and Quantitative CT (QCT) measurements and visual assessment of pulmonary emphysema and to test the relative roles of visual and quantitative assessment of emphysema. Materials and methods The subjects included 199 current and former cigarette smokers from the COPDGene cohort who underwent inspiratory and expiratory CT and also had diffusing capacity for carbon monoxide corrected for alveolar volume (DLCO/VA). Quantitative CT measurements included % low attenuation areas (%LAA−950ins = voxels ≤−950 Hounsfield unit (HU), % LAA−910ins, and % LAA−856ins), mean CT attenuation and 15th percentile HU value on inspiratory CT, and %LAA−856exp (voxels ≤−856 HU on expiratory CT). The extent of emphysema was visually assessed using a 5-point grading system. Univariate and multiple variable linear regression analyses were employed to evaluate the correlations between DLCO/VA and QCT parameters and visual extent of emphysema. Results The DLCO/VA correlated most strongly with 15th percentile HU (R2 = 0.440, p

This study aimed to evaluate the utility of dual-source computed tomography (DSCT) for quantification of the mitral valve area (MVA) in patients with atrial fibrillation (AF) and mitral stenosis (MS) and to compare the results of DSCT with those of cardiovascular magnetic resonance (CMR) and transthoracic echocardiography (TTE). One hundred-two patients with AF and MS who had undergone electrocardiography-gated DSCT, TTE and CMR prior to operation were retrospectively enrolled. The MVA was planimetrically determined by DSCT, CMR, and TTE, as well as by Doppler TTE using the pressure half-time method (TTE–PHT). Agreement, relationship between measurements, and the highest accuracy were evaluated using Bland–Altman, Pearson correlation, and receiver operating characteristic analyses. The MVA on DSCT (mean, 1.27 ± 0.27 cm2) was significantly larger than that on CMR (1.15 ± 0.28 cm2, P < 0.05), TTE-planimetry and TTE–PHT (1.16 ± 0.28 and 1.07 ± 0.30 cm2, respectively; P < 0.05). TTE-planimetry had better correlation with planimetry on DSCT and CMR (r = 0.65 and 0.67, respectively; P < 0.05) than TTE–PHT (r = 0.51 and 0.55, respectively; P < 0.05). Using an MVA of 1.0 cm2 on TTE-planimetry and TTE–PHT as the reference, the optimal thresholds for detecting severe MS on DSCT was 1.19 cm2. The planimetry of the MVA measured by DSCT may be a reliable, alternative method for the quantification of MS in patients with AF.

3Present address: Department of Radiology, Chungnam National University Hospital, Daejeon, Korea. eriaortic fibrosis, more commonly known as retroperitoneal fibrosis, is an uncommon disease that was first described in 1905 by Albaran [1] and further documented by Ormond in 1948 [2]. It is characterized by the progressive proliferation of connective tissue in the retroperitoneal space, specifically along the aorta [3, 4]. To our knowledge, ours is the first report in the English-language literature describing the CT and 18F-FDG PET findings of periaortic fibrosis with isolated involvement of the thoracic aorta. In this article, we describe the CT and FDG PET findings of an unusual case of periaortic fibrosis around the descending thoracic aorta. Intense FDG uptake on PET scans caused a false diagnosis of malignant tumor.

Objective To measure and compare the quantitative parameters of the lungs and airways in Korean never-smokers and current or former smokers (“ever-smokers”). Materials and Methods Never-smokers (n = 119) and ever-smokers (n = 45) who had normal spirometry and visually normal chest computed tomography (CT) results were retrospectively enrolled in this study. For quantitative CT analyses, the low attenuation area (LAA) of LAAI-950, LAAE-856, CT attenuation value at the 15th percentile, mean lung attenuation (MLA), bronchial wall thickness of inner perimeter of a 10 mm diameter airway (Pi10), total lung capacity (TLCCT), and functional residual capacity (FRCCT) were calculated based on inspiratory and expiratory CT images. To compare the results between groups according to age, sex, and smoking history, independent t test, one way ANOVA, correlation test, and simple and multiple regression analyses were performed. Results The values of attenuation parameters and volume on inspiratory and expiratory quantitative computed tomography (QCT) were significantly different between males and females (p < 0.001). The MLA and the 15th percentile value on inspiratory QCT were significantly lower in the ever-smoker group than in the never-smoker group (p < 0.05). On expiratory QCT, all lung attenuation parameters were significantly different according to the age range (p < 0.05). Pi10 in ever-smokers was significantly correlated with forced expiratory volume in 1 second/forced vital capacity (r = −0.455, p = 0.003). In simple and multivariate regression analyses, TLCCT, FRCCT, and age showed significant associations with lung attenuation (p < 0.05), and only TLCCT was significantly associated with inspiratory Pi10. Conclusion In Korean subjects with normal spirometry and visually normal chest CT, there may be significant differences in QCT parameters according to sex, age, and smoking history.

To provide a new detailed visual assessment scheme of computed tomography (CT) for chronic obstructive pulmonary disease (COPD) by using standard reference images and to compare this visual assessment method with quantitative CT and several physiologic parameters.This research was approved by the institutional review board of each institution. CT images of 200 participants in the COPDGene study were evaluated. Four thoracic radiologists performed independent, lobar analysis of volumetric CT images for type (centrilobular, panlobular, and mixed) and extent (on a six-point scale) of emphysema, the presence of bronchiectasis, airway wall thickening, and tracheal abnormalities. Standard images for each finding, generated by two radiologists, were used for reference. The extent of emphysema, airway wall thickening, and luminal area were quantified at the lobar level by using commercial software. Spearman rank test and simple and multiple regression analyses were performed to compare the results of visual assessment with physiologic and quantitative parameters.The type of emphysema, determined by four readers, showed good agreement (κ = 0.63). The extent of the emphysema in each lobe showed good agreement (mean weighted κ = 0.70) and correlated with findings at quantitative CT (r = 0.75), forced expiratory volume in 1 second (FEV(1)) (r = -0.68), FEV(1)/forced vital capacity (FVC) ratio (r = -0.74) (P.001). Agreement for airway wall thickening was fair (mean κ = 0.41), and the number of lobes with thickened bronchial walls correlated with FEV(1) (r = -0.60) and FEV(1)/FVC ratio (r = -0.60) (P.001).Visual assessment of emphysema and airways disease in individuals with COPD can provide reproducible, physiologically substantial information that may complement that provided by quantitative CT assessment.