1,721,048 research outputs found
Overview on Radiologic Patterns in Interstitial Lung Disease
No full textHigh resolution computed tomography (HRCT) plays a central role in the diagnostic process of interstitial lung disease (ILD). Although the HRCT findings usually correspond to recognizable chest radiography abnormalities, they are much more clearly identifiable on HRCT. In this chapter the role of chest radiography and HRCT in the diagnostic process of ILD are discussed. Main HRCT findings in ILD are described with a focus on specific situations where HRCT has a particular diagnostic importance and on the prognostic utility of specific CT patterns. The role of magnetic resonance imaging (MRI) and positron emission tomography (PET) in ILD patients is also discussed
Towards the adoption of quantitative computed tomography in the management of interstitial lung disease
Full text linkThe shortcomings of qualitative visual assessment have led to the development of computer-based tools to characterise and quantify disease on high-resolution computed tomography (HRCT) in patients with interstitial lung diseases (ILDs). Quantitative CT (QCT) software enables quantification of patterns on HRCT with results that are objective, reproducible, sensitive to change and predictive of disease progression. Applications developed to provide a diagnosis or pattern classification are mainly based on artificial intelligence. Deep learning, which identifies patterns in high-dimensional data and maps them to segmentations or outcomes, can be used to identify the imaging patterns that most accurately predict disease progression. Optimisation of QCT software will require the implementation of protocol standards to generate data of sufficient quality for use in computerised applications and the identification of diagnostic, imaging and physiological features that are robustly associated with mortality for use as anchors in the development of algorithms. Consortia such as the Open Source Imaging Consortium have a key role to play in the collation of imaging and clinical data that can be used to identify digital imaging biomarkers that inform diagnosis, prognosis and response to therapy
Comparison between whole-body MRI and Fluorine-18-Fluorodeoxyglucose PET or PET/CT in oncology: a systematic review
Full text linkBackground. The aim of the article is to systematically review published data about the comparison between positron emission tomography (PET) or PET/computed tomography (PET/CT) using Fluorine-18-Fluorodeoxyglucose (FDG) and whole-body magnetic resonance imaging (WB-MRI) in patients with different tumours. Methods. A comprehensive literature search of studies published in PubMed/MEDLINE, Scopus and Embase databases through April 2012 and regarding the comparison between FDG-PET or PET/CT and WB-MRI in patients with various tumours was carried out. Results. Forty-four articles comprising 2287 patients were retrieved in full-text version, included and discussed in this systematic review. Several articles evaluated mixed tumours with both diagnostic methods. Concerning the specific tumour types, more evidence exists for lymphomas, bone tumours, head and neck tumours and lung tumours, whereas there is less evidence for other tumour types. Conclusions. Overall, based on the literature findings, WB-MRI seems to be a valid alternative method compared to PET/CT in oncology. Further larger prospective studies and in particular cost-effectiveness analysis comparing these two whole-body imaging techniques are needed to better assess the role of WB-MRI compared to FDG-PET or PET/CT in specific tumour types
Radiological and nuclear medicine imaging of sarcoidosis
No full textSarcoidosis is a multisystem chronic inflammatory disease of unknown etiology characterized by widespread growth of non-caseating granulomas. The diagnosis of sarcoidosis is based on clinical and imaging presentation, histologic confirmation and the absence of alternative diseases. Radiology and Nuclear Medicine play an essential role in the diagnostic work-up of patients with sarcoidosis to assess disease extent and activity. In addition, imaging modalities have shown their potential in managing these patients in terms of treatment response and prognostic assessment. Sarcoidosis has a predilection for chest involvement, showing typical and atypical manifestations in the lungs, airways and hilar/ mediastinal lymph nodes. Chest radiography (X-ray) still plays an important role in suggesting diagnosis for cases with typical presentation of sarcoidosis, while computed tomography (CT) has higher accuracy in detecting early stage disease and in narrowing differential diagnosis, particularly in atypical manifestations. For extrathoracic involvement, both CT and MR (magnetic resonance) have comparable performance even though MR is the modality of choice for assessing neurosarcoidosis and cardiac sarcoidosis. In the last decades positron emission tomography/ CT (PET/CT) has demonstrated an increasing and relevant value in assessing disease extent and activity, treatment planning and therapy response, with a crucial role in the management of cardiac sarcoidosis. In this article, an overview of the possible imaging manifestations of thoracic and extrathoracic sarcoidosis and current concepts on staging, response assessment and prognosis is provided. Finally, the potential applications of non-FDG radiotracers is briefly discussed
Quantitative computed tomography predicts outcomes in idiopathic pulmonary fibrosis
Full text linkBackground and objective: Prediction of disease course in patients with progressive pulmonary fibrosis remains challenging. The purpose of this study was to assess the prognostic value of lung fibrosis extent quantified at computed tomography (CT) using data-driven texture analysis (DTA) in a large cohort of well-characterized patients with idiopathic pulmonary fibrosis (IPF) enrolled in a national registry. Methods: This retrospective analysis included participants in the Australian IPF Registry with available CT between 2007 and 2016. CT scans were analysed using the DTA method to quantify the extent of lung fibrosis. Demographics, longitudinal pulmonary function and quantitative CT metrics were compared using descriptive statistics. Linear mixed models, and Cox analyses adjusted for age, gender, BMI, smoking history and treatment with anti-fibrotics were performed to assess the relationships between baseline DTA, pulmonary function metrics and outcomes. Results: CT scans of 393 participants were analysed, 221 of which had available pulmonary function testing obtained within 90 days of CT. Linear mixed-effect modelling showed that baseline DTA score was significantly associated with annual rate of decline in forced vital capacity and diffusing capacity of carbon monoxide. In multivariable Cox proportional hazard models, greater extent of lung fibrosis was associated with poorer transplant-free survival (hazard ratio [HR] 1.20, p < 0.0001) and progression-free survival (HR 1.14, p < 0.0001). Conclusion: In a multi-centre observational registry of patients with IPF, the extent of fibrotic abnormality on baseline CT quantified using DTA is associated with outcomes independent of pulmonary function
CT acquisition protocols by pathology, SIRM position paper part 1: head and neck, brain and spine, chest, cardiovascular
No full textThe current medical scenario in diagnostic imaging is characterized by an extremely frequent use of computed tomography, which becomes the main source of medical exposure. The radiation dose depends on patient’s characteristics, anatomical districts, and diseases under investigation; the first two parameters cannot be modified; the correct application of specific protocols for the disease under investigation, helps improve both standardization and dose reduction. This perfectly fits with the ALARA principles (As Low As Reasonably Achievable) according to which patients must be exposed to the right dose of radiation, which, in turn, must be as low as possibly achievable. To support the radiologists in the daily clinical practice and to standardize the exposure of patients, the Italian Society of Medical and Interventional Radiology (SIRM), through his specific subcommittee, has created this position paper
Adenoid cystic carcinoma of the parotid gland: a first case report on 11C-methionine PET/CT detection of histologically confirmed pulmonary metastases
No full textAdenoid cystic carcinoma of the parotid gland: a first case report on 11C-methionine PET/CT detection of histologically confirmed pulmonary metastase
Pleural Disease
No full textThe most frequent benign pleural disease is pleural effusion; other benign conditions involving the pleura include empyema, pneumothorax, pleural plaques, and fibrothorax. Malignant pleural disease is a common clinical problem, as about 25 % of all pleural effusions in elderly patients have a neoplastic origin. The pleura may be involved by one of several primary or secondary malignant tumors. Primary tumors account for about 10 % of pleural malignancies and are malignant pleural mesothelioma, localized fibrous tumor, and pleural sarcoma. Secondary tumors account for about 90 % of pleural neoplasms; the principal causes are adenocarcinoma or, less frequently, lymphoma and thymoma. Depending on the location, size, and underlying histologic features, pleural tumors may produce a spectrum of findings; CT is the best method for characterizing location and composition of pleural masses and is particularly useful in distinguishing pleural from peripheral pulmonary lesions. In this chapter, imaging features of the above-mentioned pathological entities are described
Structured Reporting of Lung Cancer Staging: A Consensus Proposal
No full textBackground: Structured reporting (SR) in radiology is becoming necessary and has recently been recognized by major scientific societies. This study aimed to build CT-based structured reports for lung cancer during the staging phase, in order to improve communication between radiologists, members of the multidisciplinary team and patients. Materials and Methods: A panel of expert radiologists, members of the Italian Society of Medical and Interventional Radiology, was established. A modified Delphi exercise was used to build the structural report and to assess the level of agreement for all the report sections. The Cronbach’s alpha (Cα) correlation coefficient was used to assess internal consistency for each section and to perform a quality analysis according to the average inter-item correlation. Results: The final SR version was built by including 16 items in the “Patient Clinical Data” section, 4 items in the “Clinical Evaluation” section, 8 items in the “Exam Technique” section, 22 items in the “Report” section, and 5 items in the “Conclusion” section. Overall, 55 items were included in the final version of the SR. The overall mean of the scores of the experts and the sum of scores for the structured report were 4.5 (range 1–5) and 631 (mean value 67.54, STD 7.53), respectively, in the first round. The items of the structured report with higher accordance in the first round were primary lesion features, lymph nodes, metastasis and conclusions. The overall mean of the scores of the experts and the sum of scores for staging in the structured report were 4.7 (range 4–5) and 807 (mean value 70.11, STD 4.81), respectively, in the second round. The Cronbach’s alpha (Cα) correlation coefficient was 0.89 in the first round and 0.92 in the second round for staging in the structured report. Conclusions: The wide implementation of SR is critical for providing referring physicians and patients with the best quality of service, and for providing researchers with the best quality of data in the context of the big data exploitation of the available clinical data. Implementation is complex, requiring mature technology to successfully address pending user-friendliness, organizational and interoperability challenges
Non-fibrotic lung diseases on high resolution computed tomography: imaging and differential diagnosis
No full textThe possibility of distinguishing fibrosing from non-fibrosing lung diseases on high resolution computed tomography (HRCT) is very important in order to be able to establish the appropriate therapy early in the course of the disease and, in some pathologies, to avoid the evolution towards a fibrosing irreversible pattern. For this reason, this article will deal with non-fibrosing pulmonary parenchymal diseases, with an acute or subacute course, which occur on HRCT with a prevalent pattern of diffuse density increase (ground glass opacities and consolidations).
Since these alterations, especially ground glass opacities, are often the early sign of the onset of diseases that evolve towards fibrosis, it is important to be able to recognize them and to propose a correct differential diagnosis
- …
