Helical CT of pulmonary nodules in patients with extrathoracic malignancy: CT-surgical correlation.

Diederich, Stefan; Semik, M; Lentschig, Markus; Winter, Florian; Hh, Scheld; Roos, N.; Bongartz, G.

doi:10.2214/ajr.172.2.9930781

Cited by 93 publications

(64 citation statements)

References 23 publications

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“…Several studies reported sensitivities below 70% for detection of nodules with diameters less or equal to 5 mm at SDCT [9,10]. Our data support these earlier findings: the mean sensitivity of a single reader was 63% at SDCT and 64% at LDCT.…”

Section: Discussionsupporting

confidence: 89%

“…Several studies have reported a sensitivity for detection of small pulmonary nodules below 70% at standard radiation dose CT, using either simulated nodules that were superimposed to normal CT scans [9], comparing the detection results with surgically resected nodules [10] or with findings at autopsy [11]. In particular, radiologists tend to overlook centrally located nodules [12].…”

Section: Introductionmentioning

confidence: 99%

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Detection of pulmonary nodules at multirow-detector CT: effectiveness of double reading to improve sensitivity at standard-dose and low-dose chest CT

et al. 2004

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The purpose of this study was to assess the effectiveness of double reading to increase the sensitivity of lung nodule detection at standard-dose (SDCT) and low-dose multirow-detector CT (LDCT). SDCT (100 mAs effective tube current) and LDCT (20 mAs) of nine patients with pulmonary metastases were obtained within 5 min using four-row detector CT. Softcopy images reconstructed with 5-mm slice thickness were read by three radiologists independently. Images with 1.25-mm slice thickness served as the gold standard. Sensitivity was assessed for single readers and combinations. The effectiveness of double reading was expressed as the increase of sensitivity. Average sensitivity for detection of 390 nodules (size 3.9+/-3.2 mm) for single readers was 0.63 (SDCT) and 0.64 (LDCT). Double reading significantly increased sensitivity to 0.74 and 0.79, respectively. No significant difference between sensitivity at SDCT and LDCT was observed. The percentage of nodules detected by all three readers concordantly was 52% for SDCT and 47% for LDCT. Although double reading increased the detection rate of pulmonary nodules from 63% to 74-79%, a considerable proportion of nodules remained undetected. No difference between sensitivities at LDCT and SDCT for detection of small nodules was observed.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Detection of pulmonary nodules at multirow-detector CT: effectiveness of double reading to improve sensitivity at standard-dose and low-dose chest CT

et al. 2004

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“…However, these lesions were very small in size (<4 mm), only just visible by WB-MRI, showed partial calcification in CT as well as absent FDG uptake on PET and therefore were difficult to interpret. Limited assessment and impaired diagnostic accuracy of lung nodules below 6 mm in both CT (69%) or MRI (43%) and a reduced sensitivity of PET for small-sized lung lesions has been previously described in the literature [30][31][32]. As a result of breathing-induced movement of lung parenchyma and depending on the resolution of the PET component, FDG activity can often be underestimated in small lung metastases or show no uptake at all.…”

Section: Discussionmentioning

confidence: 99%

Whole-body MRI at 1.5 T and 3 T compared with FDG-PET-CT for the detection of tumour recurrence in patients with colorectal cancer

et al. 2009

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The purpose of this study was to assess the diagnostic accuracy of whole-body MRI (WB-MRI) at 1.5 T or 3 T compared with FDG-PET-CT in the follow-up of patients suffering from colorectal cancer. In a retrospective study, 24 patients with a history of colorectal cancer and suspected tumour recurrence underwent FDG-PET-CT and WB-MRI with the use of parallel imaging (PAT) for follow-up. High resolution coronal T1w-TSE and STIR sequences at four body levels, HASTE imaging of the lungs, contrast-enhanced T1w- and T2w-TSE sequences of the liver, brain, abdomen and pelvis were performed, using WB-MRI at either 1.5 T (n = 14) or 3 T (n = 10). Presence of local recurrent tumour, lymph node involvement and distant metastatic disease was confirmed using radiological follow-up within at least 5 months as a standard of reference. Seventy seven malignant foci in 17 of 24 patients (71%) were detected with both WB-MRI and PET-CT. Both investigations concordantly revealed two local recurrent tumours. PET-CT detected significantly more lymph node metastases (sensitivity 93%, n = 27/29) than WB-MRI (sensitivity 63%, n = 18/29). PET-CT and WB-MRI achieved a similar sensitivity for the detection of organ metastases with 80% and 78%, respectively (37/46 and 36/46). WB-MRI detected brain metastases in one patient. One false-positive local tumour recurrence was indicated by PET-CT. Overall diagnostic accuracy for PET-CT was 91% (sensitivity 86%, specificity 96%) and 83% for WB-MRI (sensitivity 72%, specificity 93%), respectively. Examination time for WB-MRI at 1.5 T and 3 T was 52 min and 43 min, respectively; examination time for PET-CT was 103 min. Initial results suggest that differences in accuracy for local and distant metastases detection using FDG-PET-CT and WB-MRI for integrated screening of tumour recurrence in colorectal cancer depend on the location of the malignant focus. Our results show that nodal disease is better detected using PET-CT, whereas organ disease is depicted equally well by both investigations.

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“…Both conventional CT and HRCT have a sensitivity of 100% regarding nodules of 10 mm or higher (5). When the nodule size is smaller than 6 mm, the sensitivity of conventional CT drops to 63% and HRCT between 48-69% (5,6). Another way to increase detection is decreasing the slice thickness.…”

Section: Radiographic Diagnosis and Preoperative Imagingmentioning

confidence: 99%

Lung Metastatic Disease: Surgical Resection and Locoregional Chemotherapy

Hengst¹,

Hendriks²,

Schil³

2012

Toraks Cer Bult

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Currently, surgical resection remains the gold standard for resectable lung metastases. Prognostic factors are histology, complete resection, number of metastases and disease-free interval. However, there is a high rate of recurrent disease in the thorax, even if systemic chemotherapy is applied. Because the latter is limited in dose due to systemic toxicity, new treatment options are being developed to selectively deliver high-dose chemotherapy into the lung, reducing systemic toxicity. Isolated lung perfusion (ILuP), similar to isolated limb perfusion, is an experimental surgical technique to deliver highdose chemotherapy into the lung without systemic exposure. Biological response modifiers like tumour necrosis factor can also be administered. ILuP results in significantly higher concentration of chemotherapy in the target organ compared to systemic chemotherapy, together with a survival benefit in experimental models of pulmonary metastases. Several phase I studies have shown that ILuP is technically feasible with low morbidity and low impact on the patient's pulmonary function. However, the utility of this technique is limited because it is an invasive technique. Other techniques to selectively deliver high-dose locoregional chemotherapy are embolic trapping (chemo-embolization), selective pulmonary artery perfusion (SPAP) without control of the venous effluent and the minimally invasive lung suffusion technique. This review will discuss surgical resection of lung metastases and address several techniques developed to deliver high doses of chemotherapy into the lung, as well as the current progress in experimental and clinical studies.

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Helical CT of pulmonary nodules in patients with extrathoracic malignancy: CT-surgical correlation.

Cited by 93 publications

References 23 publications

Detection of pulmonary nodules at multirow-detector CT: effectiveness of double reading to improve sensitivity at standard-dose and low-dose chest CT

Detection of pulmonary nodules at multirow-detector CT: effectiveness of double reading to improve sensitivity at standard-dose and low-dose chest CT

Whole-body MRI at 1.5 T and 3 T compared with FDG-PET-CT for the detection of tumour recurrence in patients with colorectal cancer

Lung Metastatic Disease: Surgical Resection and Locoregional Chemotherapy

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