Abstract: Background: In asthma, multidetector row computed tomography (MDCT) detects abnormalities that are related to disease severity, including increased bronchial wall thickness. However, whether these abnormalities could be related to asthma control has not been investigated yet. Objective: Our goal was to determine which changes in airways could be linked to disease control. Methods: Twelve patients with poor asthma control were included and received a salmeterol/fluticasone propionate combination daily for 12 weeks. Patients underwent clinical, functional, and MDCT examinations before and after the treatment period. MDCT examinations were performed using a low-dose protocol at a controlled lung volume (65% TLC). Bronchial lumen (LA) and wall areas (WA) were evaluated at a segmental and subsegmental level using BronCare software. Lung density was measured at the base of the lung. Baseline and end-of-treatment data were compared using the Wilcoxon signed-rank test. Results: After the 12-week treatment period, asthma control was achieved. Airflow obstruction and air trapping decreased as assessed by the changes in FEV(1) (p < 0.01) and expiratory reserve volume (p < 0.01). Conversely, LA and WA did not vary significantly. However, a median decrease in LA of >10% was observed in half of the patients with a wide intra- and intersubject response heterogeneity. This was concomitant with a decrease in lung density (p < 0.02 in the anteroinferior areas). Conclusions: MDCT is insensitive for demonstrating any decrease in bronchial wall thickness. This is mainly due to changes in bronchial caliber which may be linked to modifications of the elastic properties of the bronchopulmonary system under treatment.
Abstract: MDCT using thin collimation and postprocessing techniques, such as multiplanar reformations along and perpendicular to the central axes of the central airways, and volume rendering techniques, such as virtual bronchoscopy and virtual bronchography, has become the imaging modality of choice for the diagnosis of nonneoplastic tracheal and bronchial stenoses. It may ensure accurate assessment of the location and extent of the stenosis and good characterization of the presence, distribution, type, and calcification of airway wall thickening. The consideration of these abnormalities in combination with associated CT findings observed in the mediastinum, hilum, or lung parenchyma and available clinical and laboratory data help the radiologist to shorten the list of different diagnoses. The role of MDCT is also to guide surgical and interventional endoscopic procedures and assess response to treatment.
Abstract: Erdheim-Chester disease (ECD) is a rare form of non-Langerhans' cell histiocytosis that may present with pulmonary involvement. We undertook the current study to evaluate the characteristic features of pulmonary involvement in ECD, in the largest single-center series of patients reported to date.
Abstract: To retrospectively assess the association of mediastinal, cardiovascular and pleuropulmonary findings on chest CT of 40 patients with immunohistochemically and histologically proven Erdheim-Chester disease (ECD).
Abstract: This study aimed to evaluate the variability of lumen (LA) and wall area (WA) measurements obtained on two successive MDCT acquisitions using energy-driven contour estimation (EDCE) and full width at half maximum (FWHM) approaches. Both methods were applied to a database of segmental and subsegmental bronchi with LA > 4 mm(2) containing 42 bronchial segments of 10 successive slices that best matched on each acquisition. For both methods, the 95% confidence interval between repeated MDCT was between -1.59 and 1.5 mm(2) for LA, and -3.31 and 2.96 mm(2) for WA. The values of the coefficient of measurement variation (CV(10), i.e., percentage ratio of the standard deviation obtained from the 10 successive slices to their mean value) were strongly correlated between repeated MDCT data acquisitions (r > 0.72; p < 0.0001). Compared with FWHM, LA values obtained using EDCE were higher for LA < 15 mm(2), whereas WA values were lower for bronchi with WA < 13 mm(2); no systematic EDCE underestimation or overestimation was observed for thicker-walled bronchi. In conclusion, variability between CT examinations and assessment techniques may impair measurements. Therefore, new parameters such as CV(10) need to be investigated to study bronchial remodeling. Finally, EDCE and FWHM are not interchangeable in longitudinal studies.
Abstract: Nonneoplastic stenosis of proximal airways may result from longstanding intubations or tracheostomy, granulomatous infection, or systemic diseases such as relapsing polychondritis, amyloidosis, Wegener's granulomatosis, sarcoidosis, and inflammatory bowel disease. It also may be caused by saber sheath trachea, tracheobronchopathia osteoplastica, or broncholithiasis. An early diagnosis of the tracheal and bronchial stenosis has become possible with the advent of routine CT imaging. Multiplanar and volume rendering reformations after thin collimation MDCT acquisition help assess the location and extent of the stenosis and characterize the presence, distribution, and type of airway wall thickening. They also help surgeons and endoscopists to select adequate procedures and assess the response to treatment.
Abstract: The new generation of multidetector CT (MDCT) has revolutionized noninvasive imaging of proximal and distal airways. Exquisite anatomic details of the airway lumen and airway wall on axial CT images benefit in routine practice from postprocessing tools in adequate orientation. This method ensures an excellent assessment of the morphology and location of any pathology. It may be combined with use of very low dose CT. Airway lumen and airway wall areas may be quantitatively assessed on MDCT images by using specific techniques that are reproducible and accurate.
Abstract: Erdheim-Chester disease (ECD) is a rare form of non-Langerhans' cell histiocytosis. The aim of this study was to assess the value of whole-body scanning with (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in a large cohort of ECD patients from a single center.
Abstract: Multidetector row computed tomography (MDCT) is the imaging modality of reference for the diagnosis of bronchiectasis. MDCT may also detect a focal stenosis, a tumor or multiple morphologic abnormalities of the bronchial tree. It may orient the endoscopist towards the abnormal bronchi, and in all cases assess the extent of the bronchial lesions. The CT findings of bronchial abnormalities include anomalies of bronchial division and origin, bronchial stenosis, bronchial wall thickening, lumen dilatation, and mucoid impaction. The main CT features of bronchiectasis are increased bronchoarterial ratio, lack of bronchial tapering, and visibility of peripheral airways. Other bronchial abnormalities include excessive bronchial collapse at expiration, outpouchings and diverticula, dehiscence, fistulas, and calcifications.
Abstract: Multidetector computed tomography (MDCT) acquisition during a single breath hold using thin collimation provides high resolution volumetric data set permitting multiplanar and three dimensional reconstruction of the proximal airways. In chronic obstructive pulmonary disease (COPD) patients, this technique provides an accurate assessment of bronchial wall thickening, tracheobronchial deformation, outpouchings reflecting dilatation of the submucous glands, tracheobronchomalacia, and expiratory air trapping. New software developed to segment adequately the lumen and walls of the airways on MDCT scans allows quantitative assessment of the airway dimensions which has shown to be reliable in clinical practice. This technique can become important in longitudinal studies of the pathogenesis of COPD, and in the assessment of therapeutic interventions.
Abstract: This study aimed to assess the feasibility of quantification of bronchial dimensions at MDCT using dedicated software (BronCare). We evaluated the reliability of the software to segment the airways and defined criteria ensuring accurate measurements. BronCare was applied on two successive examinations in 10 mild asthmatic patients. Acquisitions were performed at pneumotachographically controlled lung volume (65% TLC), with reconstructions focused on the right lung base. Five validation criteria were imposed: (1) bronchus type: segmental and subsegmental; (2) lumen area (LA)>4 mm2; (3) bronchus length (Lg) > 7 mm; (4) confidence index - giving the percentage of the bronchus not abutted by a vessel - (CI) >55% for validation of wall area (WA) and (5) a minimum of 10 contiguous cross-sectional images fulfilling the criteria. A complete segmentation procedure on both acquisitions made possible an evaluation of LA and WA in 174/223 (78%) and 171/174 (98%) of bronchi, respectively. The validation criteria were met for 56/69 (81%) and for 16/69 (23%) of segmental bronchi and for 73/102 (72%) and 58/102 (57%) of subsegmental bronchi, for LA and WA, respectively. In conclusion, BronCare is reliable to segment the airways in clinical practice. The proposed criteria seem appropriate to select bronchi candidates for measurement.
Abstract: Erdheim-Chester disease (ECD) is a rare non-Langerhans form of histiocytosis characterized by xanthomatous tissue infiltration with CD68(+) CD1a(-) foamy histiocytes. Endocrine problems, such as diabetes insipidus and hypogonadotropic hypogonadism, frequently occur in ECD, but bilateral adrenal infiltration has rarely been reported in this disease.
Abstract: The incidental finding of a pulmonary nodule on computed tomography (CT) is becoming an increasingly frequent event. The discovery of such a nodule should evoke the possibility of a small bronchogenic carcinoma, for which excision is indicated without delay. However, invasive diagnostic procedures should be avoided in the case of a benign lesion. The objectives of this review article are: (1) to analyze the CT criteria defining benign nodules, nodules of high suspicion of malignancy and indeterminate nodules, (2) to analyze the diagnostic performances and limitations of complementary investigations requested to characterize indeterminate lung nodules, (3) to review the criteria permitting to assess the probability of malignancy of indeterminate nodules and (4) to report on the new guidelines provided by the Fleischner Society for the management of small indeterminate pulmonary nodules, according to their prior probability of malignancy.
Abstract: Lung cancer has the highest mortality-rate per cancer, with an overall 5-year survival <15%. Several non-randomized studies pointed out the high sensitivity of low dose computed tomography (LDCT) to detect early stage lung cancer. In France, Depiscan, a pilot RCT of LDCT versus chest X-ray (CXR), started on October 2002 to determine the feasibility of enrollment by general practitioners (GPs), investigations and diagnostic procedures by university hospital radiologists and multidisciplinary teams, data management by centralized clinical research assistants, and anticipate the future management of a large national trial.
Abstract: The purpose of this article is to assess detection, tracking, and reading time of solid lung nodules > or = 4 mm on pairs of MDCT chest screening examinations using a computer-aided detection (CAD) system.
Abstract: To retrospectively review the bone findings at radiography, scintigraphy, computed tomography (CT), and magnetic resonance (MR) imaging in 11 patients with immunohistochemical and histologic proof of Erdheim-Chester disease.
Abstract: Erdheim-Chester disease (ECD) is a rare, non-Langerhans form of histiocytosis of unknown origin, characterized by infiltration of tissues by spumous histiocytes. ECD features heterogeneous systemic manifestations, and the general prognosis remains poor despite various treatment options.
Abstract: This article updates the description of an anatomical variation of the liver, in which the gallbladder is adjacent to the ligamentum teres, that was described until now as "right-sided ligamentum teres and right umbilical portion of the portal vein". A study of eight patients showing this anatomical variation has led to a new archetypal anatomical description of the hepatic and portal veins, using multidetector-row computed tomography (MDCT) with three-dimensional (3D) volume-rendering (VR) reconstructions. While 2D axial imaging gave the same information, MDCT imaging with VR reconstructions provided a clear 3D visualization of this anatomical variation. Typical features can be described as follows: (1) juxtaposition of the ligamentum teres and the gallbladder; (2) typical portal vein branching with a right posterior branch, a left posterior branch and a main medial branch that terminates in the ligamentum teres; (3) two main hepatic veins and a hypotrophied medial hepatic vein. We think, based on the direct comparison of anatomical findings and knowledge of chronological embryological development, that this abnormality results from the defective development of the central part of the liver and not from the persistence of the right rather than the left umbilical vein. Because of the presence of only one medial plane, containing both the gallbladder and the ligamentum teres, we propose renaming it "fusion of hepatic planes".
Abstract: CT scanners provide an accurate high resolution assessment of airway- and lung diseases. New post processing techniques contribute to quantitative assessment of lung volumes, airway dimensions and extent of lung disease. The ability to seperate airway predominant from parenchymal--predominant pathology in COPD may in the future prove usefull in applying specific therapies and monitoring them.
Abstract: Idiopathic interstitial pneumonias comprise usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), desquamative interstitial pneumonia (DIP), respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), cryptogenic organizing pneumonia (COP), acute interstitial pneumonia (AIP), and lymphoid interstitial pneumonia (LIP). Each of these entities has a typical imaging and histologic pattern, although in practice the imaging patterns may be variable. Each entity may be idiopathic or may be secondary to a recognizable cause such as collagen vascular disease or inhalational exposure. The diagnosis of idiopathic interstitial pneumonia is made by means of correlation of clinical, imaging, and pathologic features. The characteristic computed tomographic (CT) features of UIP are predominantly basal and peripheral reticular pattern with honeycombing and traction bronchiectasis. NSIP is characterized by predominantly basal ground-glass opacity and/or reticular pattern, often with traction bronchiectasis. DIP and RB-ILD are smoking-related lung diseases characterized by ground-glass opacity and centrilobular nodules. COP is characterized by patchy peripheral or peribronchovascular consolidation. AIP manifests as diffuse lung consolidation and ground-glass opacity. LIP is associated with a CT pattern of ground-glass opacity sometimes associated with perivascular cysts.
Abstract: Many acute and chronic lung diseases are characterized by diffuse infiltration of the lung parenchyma. High-resolution computed tomography (CT) has been widely accepted as the imaging standard of reference for the assessment of these diseases. However, only approximately 10% of the lung parenchyma is scanned with high-resolution CT, and characteristic foci of disease may be missed. With use of the established characteristic high-resolution CT patterns, multi-detector row chest CT has revolutionized the evaluation of diffuse lung disease. Multi-detector row CT generates isotropic volumetric high-resolution data, allowing contiguous three-dimensional (3D) visualization of the lung parenchyma, with the capacity to create high-quality two-dimensional (2D) and 3D reformatted images. Minimum intensity projection is the postprocessing technique of choice for the detection and characterization of most patterns of diffuse lung disease. Maximum intensity projection (MIP) allows the detection and characterization of micronodules; the recognition of enlarged pulmonary veins, which is extremely useful in the diagnosis of pulmonary edema and the assessment of mosaic perfusion; and differentiation between perilymphatic, miliary, and centrilobular distribution. MIP can also help differentiate between constrictive bronchiolitis and mixed emphysema. Two-dimensional reformatted images are now of equal importance with the 2D axial images in diagnosing specific diffuse lung diseases. In the future, 3D reformatted images may be used to help quantify these disorders.
Abstract: The purpose of our study was to evaluate the ability of superparamagnetic iron oxide (SPIO)-enhanced MR imaging to detect liver fibrosis in patients with chronic liver disease and to compare the findings with histopathological data. Sixty-seven patients with chronic hepatitis ( n=58) or focal nodular hyperplasia (FNH; n=9) were studied using a 1.5-T MR system. The protocol included proton density-weighted, T2-weighted spin-echo (SE) and fast SE (FSE) sequences before and after SPIO administration and T2*-weighted gradient-recalled-echo (GRE) sequences after SPIO. Pre- and post-contrast T2-weighted and T2*-weighted sequences were retrospectively evaluated by three independent observers for evidence of non-tumor hypersignal intensities. Three liver patterns were considered: thick reticulations; thin reticulations; and/or multiple areas of hypersignal intensities. Unenhanced or enhanced patterns were compared with histopathological specimens, which had been obtained by percutaneous biopsy of the right lobe within a maximum of 12 months of MR examination. Liver fibrosis was histologically graded using a five-level scale (F0-F4), according to the METAVIR classification. Histopathology demonstrated significant fibrosis (F2-F4) in 57 patients, non-significant fibrosis in 1 patient (F1), and normal liver surrounding FNH in 9 patients (F0). After SPIO administration, at least one pattern of non-tumor hypersignal intensities was seen in 43 (76%) of the 57 patients with F>/=2 with good agreement (kappa=0.68) compared with 2 (20%) of the 10 F0/1 patients ( p<0.01). Attenuated non-homogeneous liver-signal intensities with persistent thick reticulations, thin reticulations, or multiple areas of hypersignals were observed in, respectively, 30, 52, and 56% of patients with F>/=2 with moderate agreement (kappa=0.51). Before SPIO, MR images were positive in 21 of 57 (37%) F>/=2 and zero F0/1 patients. Post-contrast proton-density-weighted and T2*-weighted GRE were the most sensitive sequences for detecting non-tumor hypersignal intensities. In patients with chronic liver diseases, SPIO-enhanced MR imaging exhibits non-tumor hypersignal intensities indicative of liver fibrosis by decreasing the signal from the non-fibrotic areas where Kupffer cells are present.
Abstract: To evaluate, with thin-section computed tomography (CT), changes in bronchial cross-sectional area and lung attenuation induced by bronchial stimulation in patients with mild intermittent asthma, at a given lung volume monitored with pneumotachography.
Abstract: The purpose of this study was to describe thin-section CT findings of lung involvement in patients with primary Sjögren's syndrome (PSS), and to correlate them with pulmonary function tests (PFT). The chest thin-section CT examinations of 35 patients with proven diagnosis of PSS and respiratory symptoms were retrospectively assessed by two observers, in a first step independently with interobserver evaluation, and in a second step in consensus. The extent of the most frequent CT findings was scored. Correlation was made with PFT in 31 of these patients. Three main CT patterns were identified with good interobserver agreement (kappa coefficient 0.71): 19 of 35 (54%) large and/or small airways disease; 7 of 35 (20%) interstitial lung fibrosis (ILF); and 5 of 35 (14%) suggestive of lymphocytic interstitial pneumonia (LIP). The CT scans were normal in 2 patients (6%) and showed only dilatation of pulmonary vessels due to pulmonary arterial hypertension in two others (6%). Airway disease patients had predominantly obstructive profiles (mean FEV(1)/FVC ratio 69.7+/-12.7%, mean MEF(25) 50.1+/-22.9%), whereas patients with ILF and LIP had predominantly restrictive profiles and/or a decreased diffusing lung capacity (mean TLC 87.0+/-26.0 and 64.6+/-18.6%, mean DL(CO) 57.4+/-21.2 and 52.0+/-8.0%). Significant correlation ( p<0.01) was found between the scores of ground-glass attenuation and TLC ( r=-0.84) and DL(CO) ( r=-0.70) and between the score of air trapping and FEV1 ( r=-1.0). In patients with PSS and respiratory symptoms, thin-section CT may provide characterization of lung involvement which correlates with pulmonary function.
Abstract: Combining helical volumetric CT acquisition and thin-slice thickness during breath hold provides an accurate assessment of both focal and diffuse airway diseases. With multiple detector rows, compared with single-slice helical CT, multislice CT can cover a greater volume, during a simple breath hold, and with better longitudinal and in-plane spatial resolution and improved temporal resolution. The result in data set allows the generation of superior multiplanar and 3D images of the airways, including those obtained from techniques developed specifically for airway imaging, such as virtual bronchography and virtual bronchoscopy. Complementary CT evaluation at suspended or continuous full expiration is mandatory to detect air trapping that is a key finding for depicting an obstruction on the small airways. Indications for CT evaluation of the airways include: (a) detection of endobronchial lesions in patients with an unexplained hemoptysis; (b) evaluation of extent of tracheobronchial stenosis for planning treatment and follow-up; (c) detection of congenital airway anomalies revealed by hemoptysis or recurrent infection; (d) detection of postinfectious or postoperative airway fistula or dehiscence; and (e) diagnosis and assessment of extent of bronchiectasis and small airway disease. Improvement in image analysis technique and the use of spirometrically control of lung volume acquisition have made possible accurate and reproducible quantitative assessment of airway wall and lumen areas and lung density. This contributes to better insights in physiopathology of obstructive lung disease, particularly in chronic obstructive pulmonary disease and asthma.
Abstract: This pictorial review illustrates the anatomical features of normal intra-articular components of the hip and their common disorders on MR arthrography. On T1-weighted MR arthrograms, the normal contrast-filled joint cavity shows a homogeneous high signal intensity. Normal acetabular labrum appears as a well-delineated triangle showing a low signal intensity, surrounded by contrast material in the perilabral recess. Intra-articular paramagnetic contrast outlines labral tears, loose bodies, communicating labral cysts and cartilage lesions (traumatic tears, focal defects, degenerative fissures and thinning), and improves their detection. Overall, MR arthrography enables accurate detection and staging of hip intra-articular structure abnormalities.
Abstract: Magnetic resonance (MR) imaging of the thorax with three-dimensional (3D) reconstruction and functional quantification was evaluated as a tool for structure-function evaluation of chest-wall mechanics. Good agreement was found between the corresponding spirometric and MR imaging values of lung volumes. Fast MR imaging of the thorax with 3D reconstruction should improve the ability to evaluate the inspiratory pump in clinical and research investigations.
Abstract: To compare the effectiveness and safety of transjugular renal biopsy with those of percutaneous renal biopsy for diagnosis of renal parenchymal disease.
Abstract: To compare thin-section computed tomographic (CT) scans obtained during suspended end expiration with helical CT scans obtained during continuous expiration for the assessment of air trapping.
Abstract: To evaluate a lung biopsy technique in which a detachable, 18-gauge, coaxial guide around a central notched stylet is used as a cutting needle.
Abstract: To compare prospectively the accuracy of spiral computed tomography (CT) with that of ventilation-perfusion scintigraphy for diagnosing pulmonary embolism.
