Solitary pulmonary nodule: preliminary study of evaluation with incremental dynamic CT.

Yamashita, Keiji; Matsunobe, S; Tsuda, T; Nemoto, Tadashi; Matsumoto, Kunio; Miki, Hiromu; Konishi, Jun

doi:10.1148/radiology.194.2.7824717

Cited by 166 publications

(88 citation statements)

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“…Allowing for slight differences in technique, similar results have been reported by others. [41][42][43][44][45] However, later studies highlighted the lack of specifi city. Even with the use of novel parameters to measure enhancement, contrast-enhanced CT scan does not reliably discriminate between malignant and active infl ammatory or infectious nodules (Appendix S3).…”

Section: Dynamic Ct Scan: Ct Scan With Dynamic Contrast Enhancement Imentioning

confidence: 99%

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

Gould

Donington

Lynch

et al. 2013

Chest

1,163

1,089

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we suggest that no additional diagnostic evaluation need be performed (Grade 2C) .Remark : This recommendation applies only to solid nodules. For guidance about follow-up of subsolid nodules, see Recommendations 6.5.1 to 6.5.4 . 2.3.3.In the individual with an indeterminate nodule that is identifi ed by chest radiography, we recommend that CT of the chest should be performed (preferably with thin sections Objectives: The objective of this article is to update previous evidence-based recommendations for evaluation and management of individuals with solid pulmonary nodules and to generate new recommendations for those with nonsolid nodules. Methods: We updated prior literature reviews, synthesized evidence, and formulated recommendations by using the methods described in the "Methodology for Development of Guidelines for Lung Cancer" in the American College of Chest Physicians Lung Cancer Guidelines, 3rd ed. Results: We formulated recommendations for evaluating solid pulmonary nodules that measure . 8 mm in diameter, solid nodules that measure Յ 8 mm in diameter, and subsolid nodules. The recommendations stress the value of assessing the probability of malignancy, the utility of imaging tests, the need to weigh the benefi ts and harms of different management strategies (nonsurgical biopsy, surgical resection, and surveillance with chest CT imaging), and the importance of eliciting patient preferences. Conclusions: Individuals with pulmonary nodules should be evaluated and managed by estimating the probability of malignancy, performing imaging tests to better characterize the lesions, evaluating the risks associated with various management alternatives, and eliciting their preferences for management. CHEST 2013; 143(5)(Suppl):e93S-e120SAbbreviations: AAH 5 atypical adenomatous hyperplasia; ACCP 5 American College of Chest Physicians; AIS 5 adenocarcinoma in situ; EBUS 5 endobronchial ultrasound; ENB 5 electromagnetic navigation bronchoscopy; FDG 5 fl uorodeoxyglucose; HU 5 Hounsfi eld unit; LR 5 likelihood ratio; SPECT 5 single-photon emission CT; TBB 5 transbronchial biopsy; TTNB 5 transthoracic needle biopsy; VATS 5 video-assisted thoracic surgery; VBN 5 virtual bronchoscopy navigation; VDT 5 volume doubling time

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Section: Dynamic Ct Scan: Ct Scan With Dynamic Contrast Enhancement Imentioning

confidence: 99%

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

Gould

Donington

Lynch

et al. 2013

Chest

1,163

1,089

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“…These studies allow for continuous assessment of the degree of contrast enhancement and the contrast washout rate [38]. Information similar to that available from dynamic studies may be obtained for a single scan by means of dual-energy imaging with contrast enhancement [40].…”

Section: Contrast Enhancementmentioning

confidence: 99%

Solitary Pulmonary Nodule—The Role of Imaging in the Diagnostic Process

Paśnik¹,

Bestry²,

Roszkowski‐Śliż³

2017

Advances in Respiratory Medicine

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A solitary pulmonary nodule is a round opacity less than 30 mm in diameter surrounded by normally aerated lung tissue. Determination of the character of the lesion following its detection (particularly when the identification was incidental) may require a complex diagnostic process. In most cases, nodules are benign in character; however, the probability of malignancy increases significantly for part-solid lesions. The main features that describe the solitary pulmonary nodule in computed tomography scans include their size, shape, density, presence of calcification and rate of growth. PET-CT examination provides additional information on the metabolic activity of the lesions, and MRI is helpful in assessment of local invasion of surrounding structures. Due to limited availability and highly specialized character, these examinations are not routinely used. Therefore, despite development of other imaging modalities, computed tomography remains the most important and crucial diagnostic tool. Clinical risk factors such as age or smoking status are very important for evaluation of the likelihood of malignancy of a nodular lesion. Due to the multidisciplinary nature of data required for complex assessment of a solitary nodular lesion, management routines are needed in the diagnostic process such as those proposed by the Fleischner Society.

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“…The differentiation of solitary pulmonary nodules (SPNs) as benign or malignant remains a diagnostic challenge for thoracic radiology. During the past decade, promising results for more specific differentiation of malignant and benign nodules using dynamic contrast material-enhanced CT have been reported [1][2][3][4][5][6]. Techniques in these studies rely on single-level acquisition with long time intervals, which were considered to be problematic for quantitative assessment of whole tumour perfusion because the blood flow within tumours is spatially and temporally heterogeneous [7,8].…”

mentioning

confidence: 99%

First-pass perfusion imaging of solitary pulmonary nodules with 64-detector row CT: comparison of perfusion parameters of malignant and benign lesions

Zg²,

Tw³

et al. 2010

BJR

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ABSTRACT. The purpose of this study was to determine the usefulness of first-pass whole nodule perfusion imaging in the differentiation of benign and malignant solitary pulmonary nodules (SPNs). 77 patients with non-calcified SPNs (46 malignant, 22 benign and 9 active inflammatory) underwent first-pass perfusion imaging with a 64-detector row CT scanner. Perfusion, peak enhancement intensity (PEI), time to peak (TTP) and blood volume (BV) were measured and statistically compared among different groups. Mean perfusion, PEI and BV for benign SPNs were significantly lower than those for malignant nodules (p,0.05) and active infections (p,0.05), but the differences were not statistically significant between malignant tumours and active infections (p.0.05). Receiver operating characteristic (ROC) curve analysis showed that SPNs with perfusion greater than 30.6 ml min -1 ml -1 , PEI higher than 23.3 HU or BV larger than 12.2 ml per 100 g were more likely to be malignant. In conclusion, first-pass perfusion imaging with 64-detector row CT is a feasible way of assessing whole nodule perfusion and helpful in differentiating benign from malignant SPNs. The differentiation of solitary pulmonary nodules (SPNs) as benign or malignant remains a diagnostic challenge for thoracic radiology. During the past decade, promising results for more specific differentiation of malignant and benign nodules using dynamic contrast material-enhanced CT have been reported [1][2][3][4][5][6]. Techniques in these studies rely on single-level acquisition with long time intervals, which were considered to be problematic for quantitative assessment of whole tumour perfusion because the blood flow within tumours is spatially and temporally heterogeneous [7,8]. Nevertheless, current technological advances in multidetector row CT (MDCT), specifically sequential volume acquisition and data processing, allow for more accurate evaluation of tissue haemodynamics than that attainable with previous CT techniques. A recent study on MDCT perfusion techniques assessed whole tumour perfusion with the volume coverage of 40 mm in patients with non-small-cell lung carcinoma and achieved good measurement reproducibility [8].To the best of our knowledge, no data exist on the application of first-pass perfusion CT for the differentiation of benign and malignant SPNs [1][2][3][4][5][6]8]. The purpose of our study, therefore, was to determine the utility of first-pass whole nodule perfusion imaging in the differentiation of benign and malignant SPNs. Methods and materialsBetween August 2006 and May 2007, a total of 93 patients with a newly detected SPN at cross-sectional imaging or conventional radiography (61 men and 32 women; age range 22-79 years; mean age 54.9 years) were recruited prospectively according to the following criteria: presence of SPN 30 mm or less in diameter, without evidence of calcification or fat attenuation, absence of contraindication to the administration of contrast medium and probable ability to co-operate with the procedure. Of these, 77 p...

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Solitary pulmonary nodule: preliminary study of evaluation with incremental dynamic CT.

Abstract: Maximum attenuation of 20-60 HU appears to be a good predictor of malignancy.

Cited by 166 publications

References 0 publications

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

Solitary Pulmonary Nodule—The Role of Imaging in the Diagnostic Process

First-pass perfusion imaging of solitary pulmonary nodules with 64-detector row CT: comparison of perfusion parameters of malignant and benign lesions

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