肺癌脊柱骨转移ECT检查76例分析

目的:探讨肺癌脊柱骨转移患者全身静态骨显像(ECT)的特点及规律。方法:收集用ECT检查发现的35~85岁肺癌脊柱骨转移76例患者临床资料,将其分为49岁以下组及50岁以上组(包括50岁),分析其临床特点及ECT表现,并结合X线检查结果分析其早期诊断优势。结果:50岁以上组61例,占80.3%;49岁以下组15例,占19.7%;76例脊柱转移患者中50例为多发病灶(占65.8%),26例为单发病灶(占34.2%)。转移灶尤以胸腰椎最多见。全组病例的78.9%表现为溶骨性破坏,14.5%表现为蜂窝状溶骨性骨破坏,5.3%表现为小片状、斑片状成骨性改变,1.3%表现为斑片状溶骨及成骨混合性改变。结论:肺癌脊柱骨转移的发生有一定的规律及特点,较之X线检查,核素全身骨显像对于肺癌脊柱骨转移的早期临床诊断及治疗决策有重要的意义。     

Cancer in patients aged 90 years or older: radiation therapy.

PURPOSE: To investigate the clinical efficacy of radiation therapy for cancer in patients aged 90 years or older. MATERIALS AND METHODS: Cancer cases in 32 patients (11 men, 21 women) aged 90 years or older who underwent radiation therapy in 1970-1997 were retrospectively analyzed. The mean patient age was 92.2 years, with a range of 90-98 years. Head and neck cancer (n = 14 [44%]) and skin cancer (n = 6 [19%]) were the most common. RESULTS: Eleven (79%) of the 14 patients with head and neck cancer were treated with curative intent. Radiation response without any severe complication was observed in nine (90%) of the 10 patients with head and neck cancer treated with curative intent who finished treatment. The median survival time was 8 months (range, 3-55 months) in the 10 patients with head and neck cancer who completed treatment with curative intent. Complete response was achieved in all of the patients with skin cancer without any major sequelae. Complete response was also observed in all three of the patients with non-Hodgkin lymphoma, but two patients treated with adjuvant chemotherapy died of drug-induced pneumonitis. Palliation was achieved in all nine of the patients treated with palliative intent. CONCLUSION: Age of 90 years or older is not a limiting factor for radiation therapy.     

Residential radon and lung cancer characteristics in never smokers

Abstract

Purpose: The aim of this study is to assess if there is a relationship between residential radon and lung cancer histological types and patients’ age at diagnosis.

Materials and methods: We conducted a multicenter hospital-based case-control study with eight participating hospitals. We included 216 never-smoking cases with primary lung cancer and 329 never-smoking controls. Controls were frequency matched with cases on age and sex distribution. Of them, 198 cases (91.7%) and 275 controls (83.5%) had residential radon measurements.

Results: Lung cancer risk reached statistical significance only for adenocarcinoma (Odds ratio [OR] 2.19; 95% Confidence interval [CI] 1.44–3.33), for other histologies the results were marginally significant. Residential radon level was higher for patients diagnosed before 50 and 60 years old than for older lung cancer cases.

Conclusions: Residential radon in never smokers seems to be a risk factor for all lung cancer histologies. Individuals diagnosed at a younger age have a higher residential radon concentration, suggesting an accumulative effect on lung cancer appearance.     

急性心肌梗死80岁以上高龄患者急诊介入的临床效果

探讨80岁以上的高龄的急性心肌梗死（AMI）患者急诊介入治疗（PCI）的疗效及安全性。方法：对24例平均年龄（84．0±3．7）岁的急性心梗患者进行PCI,观察手术即刻效果及近远期疗效。结果：22例取得即刻成功（成功率91．7％）,共对32支靶病变血管行PCI,共植入支架41（平均1．7±0．8）枚。15支IRA为完全闭塞病变,即刻开通14支,院内死亡4例。平均随访（18．5±14．8）月,14例未再出现心绞痛,1例术后8月死：亍二肺癌。结论：急诊PCI对80岁以上的高龄AMI患者来说,仍是一种安全、有效的治疗手段。     

Predictors of Progression-Free Survival and Local Tumor Control after Percutaneous Thermal Ablation of Oligometastatic Breast Cancer: Retrospective Study

PurposeTo describe ablation of bone, liver, lung, and soft tissue tumors from oligometastatic breast cancer and to define predictors of local progression and progression-free survival (PFS).Materials and MethodsA total of 33 women (mean age 52 ± 12 years old; range, 28–69 years), underwent 46 thermal ablations of liver (n = 35), lung (n = 7), and bone/soft tissue (n = 4) metastases. Mean tumor diameter was 18 ± 15 mm (range, 6–50 mm). Ablations were performed to eradicate all evident sites of disease (n = 24) or to control growing sites in the setting of other stable or responding sites of disease (n = 22). Patient characteristics, ablation margins, imaging responses, and cases of PFS were assessed. Follow-up imaging was performed using contrast-enhanced computed tomography (CT), magnetic resonance (MR) imaging, or positron-emission tomography/ CT.ResultsMedian PFS was 10 months (95% confidence interval [CI], 6.2 –14.5 months), and time to local progression was 11 months (95% CI, 5–16 months). Eight patients (24%) maintained no evidence of disease during a median follow-up period of 39 months. Ablation margin ≥5 mm was associated with no local tumor progression. Longer PFS was noted in estrogen receptor-positive patients (12 vs 4 months; P = .037) and younger patients (12 vs 4 months; P = .039) treated to eradicate all sites of disease (13 vs 5 months; P = .05). Eighteen patients (55%) developed new metastases during study follow-up.ConclusionsThermal ablation of oligometastatic pulmonary, hepatic, bone, and soft tissue tumors can eliminate local tumor progression if margins are ≥5 mm. Longer PFS was observed in patients who were estrogen receptor-positive and patients who were younger and in whom all sites of disease were eradicated.     

Symptomatic lumbar facet joint synovial cysts: clinical assessment of facet joint steroid injection after 1 and 6 months and long-term follow-up in 30 patients

PURPOSE: To study the results of facet joint intraarticular steroid injections in patients with symptomatic lumbar facet joint synovial cysts. MATERIALS AND METHODS: Data from 30 patients (age range, 44-82 years; mean age, 67 years) with nerve root pain due to a lumbar facet joint synovial cyst and treated with facet joint steroid injection were retrospectively studied. On the basis of MacNab criteria, the clinical course of nerve root pain was evaluated after 1 (n = 30) and 6 (n = 28) months. Data from long-term follow-up (mean, 26 months) were also available in 14 nonsurgically treated patients. RESULTS: After 1 month, the nerve root pain outcome was excellent or good in 20 patients (67%) and fair or poor in 10 (33%). After 6 months, 10 (50%) of these 20 patients still had excellent or good results, and 18 (60%) of the 30 patients had a fair or poor clinical status, 14 of whom underwent surgery; two patients (7%) were lost to follow-up. Excellent and good results were maintained at further follow-up (range, 9-50 months). CONCLUSION: One-third of patients with symptomatic lumbar facet joint synovial cysts had long-lasting acceptable benefit from facet joint steroid injections in this study. Steroid injection should be indicated before surgery.     

Transarterial Radioembolization Treatment of Pancreatic Cancer Patients with Liver-Dominant Metastatic Disease Using Yttrium-90 Glass Microspheres: A Single-Institution Retrospective Study

PurposeTo retrospectively evaluate the safety and efficacy of transarterial radioembolization (TARE) with yttrium-90 (⁹⁰Y)-labeled glass microspheres in pancreatic adenocarcinoma patients with liver-dominant metastatic disease.Materials and MethodsThis retrospective, single-center study evaluated 26 patients (12 men and 14 women; mean age, 65.5 ± 11.2 years) with liver-dominant metastatic pancreatic cancer who were treated with TARE from April 2010 to September 2017. All patients received systemic chemotherapy before TARE, and 19 received systemic therapy after embolization. Nineteen patients had extrahepatic disease at the time of TARE. Response to treatment was determined by Response Evaluation Criteria in Solid Tumors at 3 months.ResultsMedian overall survival (OS) from pancreatic cancer diagnosis was 33.0 months (range, 8.5–87.5 months); median OS from diagnosis of liver metastasis was 21.8 months (range, 2.0–86.2 months); and median OS from TARE treatment was 7.0 months (range, 1.0–84.1 months). Grade 1–2 clinical toxicities were noted in 21 patients (80.8%), and 24 patients (92.3%) had grade 1–2 biochemical toxicities. Four patients (15.4%) had grade 3 clinical toxicities, and 6 patients (23.1%) had grade 3 biochemical toxicities. Imaging was available in 22 patients (84.6%) and demonstrated partial response in 1 patient, stable disease in 9 patients, and progressive disease in 12 patients. Improved hepatic progression-free survival was associated in patients younger than 65 years and in those whose carbohydrate antigen 19-9 level decreased or remained stable after treatment.ConclusionsTARE with ⁹⁰Y-labeled glass microspheres is safe and led to promising OS in liver-dominant metastatic pancreatic cancer.     

CT-Guided Percutaneous Cryoablation in Patients with Lung Nodules Mainly Composed of Ground-Glass Opacities

PurposeTo assess the safety and efficacy of cryoablation in patients with lung nodules mainly composed of ground-glass opacities (GGOs).Materials and MethodsIn this retrospective study, 50 patients (mean age, 65.0 years ± 12.3; 28 women) with a diagnosis of lung GGO nodules who underwent cryoablation were included (from June 2016 to June 2021). The local recurrence rate, incidence of regional metastases to lymph nodes, incidence of distant metastases, adverse events, and lung function condition were analyzed.ResultsFollow-up computed tomography (CT) was performed at a mean of 33 months (range, 3–60 months) after the cryoablation procedure. Outcomes were only evaluated in 30 patients. A total of 20 patients were excluded. Of these 20 patients, 10 patients had no cancer detected by histopathological analysis and a diagnosis was made using CT or positron emission tomography (PET)-CT, The other 10 patients had nodules with a diameter of <10 mm and a consolidation-to-tumor ratio of >0.25; thus, histopathological analysis was not performed because of the small nodule size, and patients were diagnosed using CT or PET-CT. The local recurrence rate was 0% (0 of 30). Evidence of regional metastases of lymph nodes was not found in any patients (0%; 0 of 30), and the incidence of distant metastases was 0% (0 of 30). No major adverse events were noted. Lung function recovered to normal within 1 month after cryoablation in all patients.ConclusionsCryoablation may serve as a safe and feasible option for the treatment of lung nodules mainly composed of GGOs.     

Radiofrequency ablation for single lung tumours not suitable for surgery: seven years’ experience

Purpose

This study was done to review recurrence patterns in patients with lung cancer (primary or secondary) treated with percutaneous image-guided radiofrequency (RF) ablation.

Materials and methods

From January 2003 to August 2010, 32 patients (24 with primary non-small-cell lung cancer and eight with metastases) with single lung cancer were treated with RF ablation. Post-treatment imaging results were available for each patient. Follow-up was performed using computed tomography (CT) scans at 1, 3, 6, 12, 18 and 24 months after the procedure and annually thereafter. Patterns of recurrence were classified as local, intrapulmonary, nodal, mixed and distant. We evaluated overall survival after RF ablation and the factors associated with recurrence.

Results

Seventeen (53.1%) patients showed no evidence of recurrence at follow-up imaging (range 12-72 months; mean, 32.5 months). Recurrence was seen in 15 (46.9 %) patients (range 6-36 months; mean 14.8 months). Local recurrence (40%) after RF ablation was the most frequent. Median disease-free survival was 20 months. Sex, tumour location, tumour size and tumour stage were not associated with a risk of recurrence. Patient age was related to the risk of recurrence (p<0.05).

Conslucions

Local recurrence is the most common pattern in our series. A more aggressive initial RF ablation might offer improvement in outcomes, but this hypothesis needs to be confirmed by larger studies involving a larger number of patients.     

结直肠癌患者的临床、内镜、病理学特点

目的探讨结直肠癌患者临床、内镜、病理特点。方法对1991—2005年肠镜及病理证实的结直肠癌患者,按年龄分为青年组(≤30岁),中年组(31~59岁),老年组(≥60岁),从临床表现、内镜表现和病理学三方面进行回顾性分析。结果(1)本组结直肠癌患病高峰为50~65岁,男性结直肠癌构成比高于女性。(2)青年组以腹痛就诊者占70.73%,中老年组以便血就诊者占65.50%,说明临床症状具有不典型性。(3)各组直肠癌均有较高的比例,青年组右半结肠癌的发病率(34.15%)明显高于中老年组(16.33%)。(4)青年组以低分化腺癌、黏液腺癌为多,肿瘤分化程度低,恶性程度高;中老年组以高分化腺癌多见,肿瘤分化程度高,恶性程度低。结论不同年龄组结直肠癌患者有不同的临床、内镜、病理特点,对有下消化道症状的患者,应尽早、全面地进行结肠镜检查。     

Radioiodine whole-body scans, thyroglobulin levels, 99mTc-MIBI scans and computed tomography: results in patients with lung metastases from differentiated thyroid cancer

OBJECTIVES: The correlation between a 131I whole-body scan (WBS), a 99mTc sestamibi (99mTc-MIBI) WBS, a computed tomography (CT) scan and the value of routine follow-up for 131I WBS and thyroglobulin (Tg) levels in patients with lung metastases from differentiated thyroid cancer was assessed. METHOD: Pulmonary metastases were detected in 32 patients out of 583 with differentiated thyroid cancer (DTC) who were admitted to our clinic between 1985 and 2004 (age range, 22-79 years; mean, 58 +/- 19 years; 15 women and 17 men). Pulmonary metastases were diagnosed by considering the 131I WBS, increased Tg levels and/or other positive radiological findings. Papillary carcinoma was diagnosed in 15/32 patients and follicular carcinoma in 13/32. A mixed type found in 4/32 patients was classified histopathologically. A total of 3.7-53.65 GBq (100-1450 mCi) 131I was given to each patient. The duration of follow-up ranged from 36 to 240 months. A 131I WBS, the determination of Tg levels and/or a CT scan were carried out in the assessment of a diagnosis and follow-up of patients with lung metastases. A 99mTc-MIBI WBS was performed on 19 patients who were chosen at random from the 583. RESULTS: Nineteen of 32 patients had lung metastases before they received the first 131I treatment. Six of the 32 had distant-organ metastases other than in the lungs. Four of these six patients had only lung and bone metastases. Pulmonary metastases were observed on the 131I WBS patients 31/32 (96.8%) whereas no pulmonary metastases, were detected on the CT scans in 3/32 patients. The last diagnostic whole-body scan (DWBS) was normal in 13/32 patients. At the first examination, the Tg levels in 27/32 (84.4%) patients were below 30 ng . ml(-1). At the final examination, 20/32 (62.5%) patients had Tg levels higher than 30 ng . ml(-1), while Tg levels were lower than 30 ng . ml(-1) in 12/32 patients. Tg levels decreased in 21/32 and increased in 3/32 patients. The 131I WBS continued to be abnormal in 2/3 patients with increased Tg levels but became normal in one patient whose CT scan still showed macro-nodular lesions. Tg levels did not change significantly in 8/32 patients. The 131I WBS became normal in 5/8 patients, while the CT scans for 4/5 showed micro-nodules. Metastases were detected in 12/19 patients who underwent 99mTc-MIBI whole-body scanning: 18/19 showed metastases on the 131I WBSs and 17/19 on the CT scans. Of the seven patients without a sign of metastasis on the 99mTc-MIBI WBS, one was negative in terms of metastasis on the 131I WBS and one on the CT scan. Fibrosis was observed on the CT scans of 2/32 patients. One patient developed dedifferentiation, as determined by the negative 131I WBS and positive CT scan. CONCLUSION: 131I whole-body scanning and the determination of Tg levels are the most important procedures for the evaluation of lung metastases in differentiated thyroid cancer. Computed tomography is a useful addition to 131I whole-body scanning. MIBI imaging alone may not be enough to detect lung metastases from differentiated thyroid cancer.     

40岁以下肺癌患者病理类型及CT影像学表现

目的 分析40岁以下肺癌患者的病理类型及分化程度,评价CT影像学表现特征及其诊断价值.资料与方法 回顾性分析2009-01～12共80例经病理诊断为肺癌的40岁以下患者的临床及影像学资料.结果 患者从出现症状到明确诊断平均(4.4±0.4)个月,确诊时出现转移63例,占78.75％;腺癌50例,小细胞癌23例,鳞癌5例,细支气管肺泡癌1例,大细胞癌1例.其中36例可辨别分化程度,中高分化3例,中分化15例,中低分化7例,低分化11例;中央型肺癌38例,CT表现为支气管截断或狭窄33例,分叶16例,肺不张及阻塞性炎症23例;周围型肺癌42例,CT表现为分叶34例,毛刺22例,血管集束16例,胸膜凹陷17例.结论 40岁以下人群肺癌以腺癌和小细胞癌为主,其中中央型肺癌以小细胞肺癌及腺癌为主,周围型肺癌以腺癌为主,分化程度较差;患者确诊时多发生转移.     

螺旋CT对SARS和其他社区获得性肺炎的鉴别诊断及其预后评价

目的　用多层螺旋CT做胸部影像检查 ,探讨SARS和其他社区获得性肺炎 (communityacquiredpneumonia ,CAP)的鉴别诊断价值 ,并对两组患者的预后进行评价。方法　SARS患者 6 4例 ,男 2 8例 ,女 36例 ,年龄 18～ 93岁 (平均 4 2 3岁 ) ,CAP患者 4 6例 ,男 2 9例 ,女 17例 ,年龄 2 8～ 88岁 (平均 70 1岁 ) ,其中 2 3例检出呼吸道致病微生物。 110例患者均经过多排螺旋CT扫描。结果年龄、白细胞总数和CT显示肺内病变呈磨玻璃样密度影 3项指标 ,对SARS诊断的总敏感度、总特异度和总准确度分别为 93 8%、6 0 9%和 80 0 %。CAP组CT显示的肺内实变影、纤维索条影及支气管壁增厚 3项作为SARS的反指征 ,总敏感度、总特异度和总准确度分别为 91 3%、82 8%和 86 4 %。SARS和CAP组的死亡例数分别为 7(10 9% )和 4例 (8 7% )。后期随访表明 :SARS中 4 8 8% (2 1/ 4 3例 )的病例肺部遗留程度不同的异常改变 ,5 0岁以上患者随年龄增加肺部后遗表现趋于严重。结论　结合患者临床情况、肺内病变密度、形态特征以及肺内其他的伴随征象 ,螺旋CT对于SARS的早期诊断和与CAP的鉴别诊断有较高的准确性。 >5 0岁的SARS感染者预后欠佳。     

Relationship between clot location and outcome after basilar artery thrombolysis.

PURPOSETo identify factors that predict survival and good neurologic outcome in patients undergoing basilar artery thrombolysis.METHODSOver a 42-month period, 20 of 22 consecutive patients with angiographic proof of basilar artery thrombosis were treated with local intraarterial urokinase. Brain CT scans, neurologic examinations, symptom duration, clot location, and degree of recanalization were analyzed retrospectively.RESULTSOverall survival was 35% at 3 months. Survival in patients with only distal basilar clot was 71%, while survival in patients with proximal or midbasilar clot was only 15%. At 3 months, 29% of patients with distal basilar clot and 15% of patients with proximal or midbasilar clot had good neurologic outcomes (modified Rankin score of 0 to 2 and Barthel index of 95 to 100). Complete recanalization was achieved in 50% of patients; 60% of those survived and 30% had good neurologic outcomes. Of patients with less than complete recanalization, only 10% survived. Neither duration of symptoms before treatment (range, 1 to 79 hours), age (range, 12 to 83 years), nor neurologic status at the initiation of treatment (Glasgow Coma Scale score range, 3 to 15) predicted outcome. Pretreatment CT findings (positive or negative for related ischemic changes) did not predict outcome or hemorrhagic transformation.CONCLUSIONThe single best predictor of survival after basilar thrombosis and intraarterial thrombolysis was distal clot location. Complete recanalization favored survival. Radiologically evident related infarctions, advanced age, delayed diagnosis, and poor pretreatment neurologic status did not predict poor outcome and therefore should not be considered absolute contraindications for intraarterial thrombolysis in patients with basilar artery thrombosis.     

Sports after hip resurfacing arthroplasty

BACKGROUND: No information is available concerning patients' sports activity after hip resurfacing arthroplasty. HYPOTHESIS: Patients treated by hip resurfacing arthroplasty will be able to achieve a high level of sports activity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We surveyed 112 patients by postal questionnaire to determine their sporting activities at a mean of 23.5 (range, 9-40) months after hip resurfacing surgery. Data were also analyzed separately for older and younger patients and women and men, respectively. RESULTS: Of 112 patients, 110 participated in an average of 4.6 sport disciplines after surgery, compared with 105 patients pre-operatively engaged in an average of 4.8 disciplines. About 26% performed sports 4 times per week or more--almost 60% for longer than 60 min at each session. A high proportion of our patients were still engaged in downhill skiing (51%) and in high-impact disciplines such as tennis (12%) or contact sports (22%). More than 50% of the patients commenced sports within the first 3 months after surgery. During activities, 70% were completely pain-free. The group of older patients (mean age, 60.2 years) participated in more different disciplines with a higher weekly frequency and longer session length than younger patients (mean age, 46.4 years). CONCLUSION: The present study reports for the first time on the detailed sports activity and activity extent after hip resurfacing arthroplasty. Our patients could return to a high level of sports participation after surgery. Age-related differences were found that have not yet been published. Nevertheless, further follow-up is necessary to assess the influence of high-level activity on loosening and revision rates after hip resurfacing arthroplasty.     

Thoracic calcification in the elderly--frequency and clinical value

Chest X-ray films of 200 patients, aged between 90 and 102 years, were analysed for frequency of distribution and varying degrees of thoracic calcification. Calcification was found within the aortic wall in 89%, costal cartilage 79%, lung parenchyma 65%, lung hilum and/or mediastinum 64%, and tracheobronchial cartilages 55%. The degree of calcification was dependent on the tissue and sex involved (significant p less than 0.001). Calcification is of clinical value more often in younger patients than in the elderly. The classification, pathogenesis and differential diagnosis of thoracic calcifications are discussed.     

Symptoms of locally advanced non-small-cell lung carcinoma

A group of 50 patients with locally disseminated non-small-cell lung cancer was analyzed. The diagnosis was confirmed upon the analysis of the samples obtained by bronchoscopy or percutaneous needle biopsy of the lungs. CT scan of the thorax, as well as transesophageal echosonography of the mediastinum and ultrasound of the abdomen were performed for the evaluation of the disease dissemination. The aim of the study was to establish the main characteristics of lung cancer in locally disseminated disease with particular reference to the analysis of the symptoms. The majority of patients were aged between 56 and 60 years (n = 13; 26%). The majority was with planocellular cancer of central localization (n = 38; 76%). In 20 (40%) patients surgery was performed, and in 30 (60%) patients the surgery was finished with exploration. The most frequent symptoms were cough in 29 (58%), hemoptysis in 27 (54%) and chest pain in 24 (48%) patients. Frequency of the symptoms was multiplied in the patients with the advanced disease. Frequency of hemoptysis was equal in the group of patients who were operated and those with exploratory thoracotomy.     

Unresectable pulmonary malignancies: CT-guided percutaneous radiofrequency ablation--preliminary results

PURPOSE: To assess whether percutaneous radiofrequency (RF) ablation of unresectable pulmonary malignancies is safe and technically feasible and to evaluate the usefulness of computed tomographic (CT) nodule densitometry as a tool for following up tumors after ablation. MATERIALS AND METHODS: Twelve patients (seven men and five women; mean age, 60.6 years) with unresectable disease (because of poor lung reserve or multifocality) underwent nodule CT densitometry and CT-guided percutaneous RF ablation of 19 lung tumors (six [32%] tumors were adenocarcinoma, one (5%) was large cell carcinoma, two (10%) were bronchoalveolar carcinoma, four (21%) were colorectal carcinoma, and six (32%) were sarcoma less than 50 cm2 in area (range, 0.25-35.00 cm2). No patients had symptoms of their disease before RF ablation. Follow-up CT densitometry was scheduled for 1, 3, 6, and 12 months after RF ablation. Lesions were evaluated for change in area and contrast enhancement at follow-up CT. RESULTS: RF ablation was well tolerated by all patients. Intraprocedural complications included 12 cases of pneumothoraces (two patients required chest tube placement, while 10 were asymptomatic and required no further treatment), two cases of pleural effusion, and two cases of moderate pain (one case during and one case both during and after the procedure). Mean follow-up was 4(1/2) months (range, 1-12 months). In the eight patients with 3-month follow-up, lesion size increased in two and remained stable in six. Mean contrast enhancement, however, decreased from 46.8 HU (range, 19-107 HU) at baseline to 9.6 HU (range, 0-32 HU) at 1-2-month follow-up. In the one patient with 12-month CT densitometry follow-up, lesion enhancement was less than 50% of that at baseline, and lesion diameter remained stable. CONCLUSION: These preliminary results show that percutaneous RF ablation is a safe and technically feasible management option for unresectable pulmonary malignancies. CT densitometry may have potential for future use as a noninvasive method of following up tumors after RF ablation.     

Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer

PURPOSE: To estimate the radiation-related lung cancer risks associated with annual low-dose computed tomographic (CT) lung screening in adult smokers and former smokers, and to establish a baseline risk that the potential benefits of such screening should exceed. MATERIALS AND METHODS: The estimated lung radiation dose from low-dose CT lung examinations corresponds to a dose range for which there is direct evidence of increased cancer risk in atomic bomb survivors. Estimated dose-, sex-, and smoking status-dependent excess relative risks of lung cancer were derived from cancer incidence data for atomic bomb survivors and used to calculate the excess lung cancer risks associated with a single CT lung examination at a given age in a U.S. population. From these, the overall radiation risks associated with annual CT lung screening were estimated. RESULTS: A 50-year-old female smoker who undergoes annual CT lung screening until age 75 would incur an estimated radiation-related lung cancer risk of 0.85%, in addition to her otherwise expected lung cancer risk of approximately 17%. The radiation-associated cancer risk to other organs would be far lower. If 50% of all current and former smokers in the U.S. population aged 50-75 years received annual CT screening, the estimated number of lung cancers associated with radiation from screening would be approximately 36,000, a 1.8% (95% credibility interval: 0.5%, 5.5%) increase over the otherwise expected number. CONCLUSION: Given the estimated upper limit of a 5.5% increase in lung cancer risk attributable to annual CT-related radiation exposure, a mortality benefit of considerably more than 5% may be necessary to outweigh the potential radiation risks.     

Pulmonary nodules in osteosarcoma patients: differential diagnosis of central venous catheter–related infections in the lungs

PURPOSE: The purpose of this study was to evaluate the differential diagnosis of pulmonary nodules by conventional radiography and computed tomography (CT) in osteosarcoma patients with central venous catheter. MATERIALS AND METHODS: Between March 1997 and December 2001 at our Department of Musculoskeletal Oncology, 231 patients with peripheral osteosarcoma received a central venous catheter to allow infusion therapy and blood sampling. The mean age of these patients was 16 years (range 4-63), and 90 were aged 15 years or younger. All patients underwent radiological investigation for tumour staging and comparison with the following study in accordance with the protocol in place at our Department of Oncology and Division of Diagnostic Imaging. RESULTS: Of a total of 231 patients, 13 (5.6%) developed an infection of the central venous line, with fever that was very high in some cases. In ten cases (4.3%), radiology showed damage to the alveolar interstitium typical of inflammatory forms, whereas in the remaining three (1.3%) it depicted nodular opacities, which required differentiation between lung metastases and septic emboli. After appropriate antibiotic and replacement of the central venous line, CT demonstrated disappearance of the lung nodules in all three patients, enabling a diagnosis of nodular septic embolism. CONCLUSIONS: Placement of a central venous catheter for infusion therapy, chemotherapy and blood sampling has improved the quality of life of cancer patients. The most common complications of the use of central venous catheters include infection and venous thrombosis whereas pulmonary septic emboli are rare.