Pitfalls in CT evaluation of chest wall invasion by lung cancer

Computed tomography in a patient with a peripheral lung cancer in the right upper lobe revealed obliteration of the extrapleural fat and direct connection of the tumor with an intercostal soft tissue mass of similar density. The findings were suggestive of chest wall invasion by the cancer which was, however, proven to be false after en bloc resection of the tumor and the contiguous chest wall. Such a diagnostic pitfall could be avoided if special attention were paid to the asymmetry of the CT image at the level of upper thoracic outlet due to improper positioning of the patient.     

Tumor invasion of the chest wall and mediastinum in lung cancer: evaluation with pneumothorax CT

For preoperative evaluation of chest wall and mediastinal invasion by lung cancer, computed tomography (CT), combined with artificial pneumothorax (pneumothorax CT), was performed in 43 patients with lung cancer in whom conventional CT scans showed that the mass was contiguous to the chest wall (n = 30) and/or mediastinum (n = 25) but without evidence of definite tumor invasion. Invasion was diagnosed on the basis of whether an air space existed between the mass and the adjacent structures. In three patients pneumothorax was not produced. After the procedure, four patients developed symptomatic pneumothorax, and one, subcutaneous emphysema. Comparison of diagnoses based on findings at pneumothorax CT, surgery, and pathologic examination showed that pneumothorax CT is 100% accurate for chest wall invasion and 76% accurate for mediastinal invasion. The authors conclude that this procedure is helpful in accurate evaluation of the T criterion in lung cancer, especially for patients in whom findings at conventional CT suggest tumor invasion of the chest wall and mediastinum.     

Chest wall infiltration by lung cancer: value of thin-sectional CT with different reconstruction algorithms

The aim of this investigation was to evaluate whether thin-sectional CT with different reconstruction algorithms can improve the diagnostic accuracy with regard to chest wall invasion in patients with peripheral bronchogenic carcinoma. Forty-one patients with intrapulmonary lesions and tumor contact to the thoracic wall as seen on CT staging underwent additional 1-mm CT slices with reconstruction in a high-resolution (HR) and an edge blurring, soft detail (SD) algorithm. Five criteria were applied and validated by histological findings. Using the criteria of the intact fat layer, HRCT had a sensitivity of 81 % and a specificity of 79 %, SD CT had a sensitivity of 96 % and a specificity of 78 %, and standard CT technique had a sensitivity of 50 % and a specificity of 71 %, respectively. Regarding changes of intercostal soft tissue, HRCT achieved a sensitivity of 71 % and a specificity of 96 %, SD CT had a sensitivity of 94 % and a specificity of 96 % (standard CT technique: sensitivity 50 % and specificity 96 %) . For the other criteria, such as pleural contact area, angle, and osseous destruction, no significant differences were found. Diagnostic accuracy of chest wall infiltration can be improved by using thin sectional CT. Especially the application of an edge-blurring (SD) algorithm increases sensitivity and specificity without additional costs. Received: 4 September 1997; Revision received: 13 August 1998; Accepted: 15 January 1999     

Pleural and chest wall invasion in bronchogenic carcinoma: CT evaluation

CT scans of 47 patients who had peripheral bronchogenic carcinoma contiguous to the pleural surface and who had undergone thoracotomy were retrospectively reviewed. The CT features of the primary neoplasm that were analyzed included the angle and amount of contact with the adjacent pleural surface, associated pleural thickening, fat plane between the tumor and chest wall, rib destruction, and chest wall mass. CT was of limited predictive value in separating those patients who had parietal pleural/chest wall involvement from those who did not. The combination of two or three CT findings (obtuse angle, greater than 3 cm contact with pleural surface, associated pleural thickening) resulted in a sensitivity of 87% and a specificity of 59%. The clinical symptom of focal chest pain, while not as sensitive (67%) as CT, was much more specific (94%) for parietal pleura/chest wall invasion.     

胸部CT隐性肺癌7例

肺癌是常见恶性肿瘤。影像检查是发现肺癌的主要手段,尤其胸部CT是目前发现肺癌最有效的成像方式之一。但是,笔者发现有些肺癌患者由于病灶自身的特征,胸部CT无法发现异常。自1997年5月～2005年5月,笔者收集了此类患者共7例（均通过手术证实）,现对其临床资料做相关回顾性分析。     

Diagnosis of chest wall invasion by lung cancer: useful criteria for exclusion of the possibility of chest wall invasion with MR imaging

PURPOSE: To compare the accuracy of thin-section CT, conventional static MR imaging (conventional MRI), and breathing dynamic echo planar magnetic resonance imaging (BDEPI) in evaluating lung cancer invasion to the chest wall. MATERIALS AND METHODS: Thin-section CT, conventional MRI, and BDEPI were performed preoperatively in 20 patients suspected of having primary lung cancers adjacent to the chest wall on conventional CT. The results of imaging findings were compared with those of surgical and histopathological findings. RESULTS: All patients were confirmed to have no chest wall invasion after surgery. By thin-section CT, 10 of 20 patients were correctly diagnosed as having no chest wall invasion (50% specificity). Two of the 20 patients were incorrectly diagnosed as having chest wall invasion by conventional MRI and BDEPI (90% specificity). CONCLUSION: When chest wall invasion is suspected on CT scans, static and breathing dynamic MRI are recommended to avoid false positive interpretations.     

Chest wall tuberculosis: a review of CT appearances

Tuberculous abscesses of the chest wall, though uncommon are not infrequently encountered in countries endemic to the disease. This pictorial review of 14 patients highlights the varied appearance of tuberculosis (TB) of the chest wall on CT. The patients ranged in age from 9 to 55 years (a mean of 25 years) with a preponderance of chest wall lesions in young adults and in females (male to female ratio of 2:5). Cases in which there was no involvement of the chest wall other than of the spine have been excluded. In all cases CT demonstrated peripherally enhancing chest wall collections some of which were accompanied by changes in adjacent bone. Enlargement of intrathoracic lymph nodes with comparatively lesser involvement of lung parenchyma and pleura was also seen.     

Chest wall Castleman's disease: CT and MRI findings

Castleman's disease is an usually benign lymphoid tumor of uncertain etiology that generally appears as a solitary mediastinal mass. We present a case of Castleman's disease in the right chest wall of a 60-year-old woman. Magnetic resonance imaging showed a well-defined, oval mass that was early enhanced on T1-weighted images. The mass was diagnosed by percutaneous core needle biopsy with computed tomography guidance. The patient has remained well for 5 years without an increase in tumor size. We also summarize the international literature.     

Radiation-induced myositis mimicking chest wall tumor invasion in two patients with lung cancer: a PET/CT study

Two patients with lung cancer who had undergone stereotactic body radiation therapy (SBRT) exhibited increased F-18 FDG uptake in the chest wall after 6 months and 18 months, respectively, after SBRT. The prescribed dose of 50 Gy to the planning target volume was delivered on 4 consecutive days in each patient. It is important for nuclear medicine physicians to be familiar with F-18 FDG PET/CT findings ascribed to radiation-induced myositis in lung cancer patients treated with SBRT so that an appropriate differential diagnosis can be established.     

CT对肺癌手术可行性的估价

目的：评价CT预测肺癌手术可行性的意义。材料与方法：对47例肺癌患者术前的CT预测与手术结果进行比较。作为不可根治的CT阳性表现如下：（1）肿瘤周围的大血管受侵，（2）肺门和纵隔淋巴结转移，（3）肿瘤侵及胸壁、胸膜、心包、横膈等组织。结果：正确预测不可根治13例，错误预测不可根治5例，正确预测可根治28例，错误预测可根治1例。结论：当CT仅提示一种阳性征象，并不能作为手术的禁忌征，反之，同时出现一种以上阳性表现，则应充分认识其不可根治性。     

Chest wall recurrence of breast cancer detected by scintimammography

A case of chest wall recurrence of breast cancer detected by scintimammography is presented. A 63-year-old woman who had a right mastectomy for breast carcinoma 24 years earlier was evaluated for left axillary adenopathy. Although it was suspected that a second primary malignancy had developed in the left breast, results of mammography and magnetic resonance imaging of that breast were negative. Scintimammography performed with Tc-99m sestamibi confirmed a normal left breast but revealed a lesion in the right chest wall at the site of the previous mastectomy. This was surgically confirmed as recurrent breast carcinoma, which subsequently altered patient management.     

CT evaluation of chest wall recurrences of breast cancer

CT findings regarding chest wall recurrences in 19 breast cancers previously treated with radical mastectomy are reported. CT provides detailed information on the endothoracic extension of the tumoral spread.     

Mediastinal and heart wall invasion by actinomycosis: CT and MRI appearances

Widespread use of antibiotics facilitates the development of some uncommon chronic infections such as actinomycosis. The clinical and radiographic findings overlap those of other inflammatory and neoplastic conditions. With a review of the literature, we report the CT and MRI findings in a case of thoracic actinomycosis, presenting with right ventricular failure caused by heart involvement. CT was helpful in identifying the mediastinal extent of the disease and in demonstrating the absence of pulmonary involvement. MRI, however, offered complementary information, especially in assessing heart involvement without the need for intravenous contrast media. On T2-weighted images the mediastinal process was noted to be of relatively low signal intensity, possibly indicating its benign nature. The association with heart involvement was suggestive of thoracic actinomycosis. Correspondence to: C. Fisch     

MSCT 诊断多原发肺癌的临床应用价值

多原发肺癌(multiple primary lung cancer,MPLC)是指在同一患者肺内同时或先后发生2个或2个以上原发性肺癌。根据癌灶发现时间可将 MPLC 分为发生时间间隔<6个月的同时性 MPLC(synchronous MPLC,sMPLC)和间隔在6个月或以上的异时性 MPLC(metachronous MPLC,mMPLC)[1]。随着检查技术快速发展,近年来 MPLC 的检出也越来越多。笔者通过总结 MPLC 的 MSCT 征象、临床诊断及治疗,评价 MSCT诊断 MPLC 的临床应用价值。