Computed tomography of the brain, liver, and upper abdomen in the staging of small cell carcinoma of the lung

Computed tomography (CT) examinations of the brain, liver, and upper abdomen were obtained in 60 previously untreated patients with histologically proven small cell carcinoma of the lung (SCCL). These results, together with clinical findings and laboratory investigations including radionuclide scans, determined the final staging of the patients. Computed tomography changed the stage from limited to extensive disease in three patients and from extensive to limited disease in seven patients. Overall, 10 of 60 patients (16%) had their final stage altered by CT. This study indicates that CT examinations may yield valuable information in some cases of small cell lung cancer but that it is of limited value in the routine staging of these patients.     

Computed tomography of the thorax and standard radiographic evaluation of the chest: a comparative study.

Comparison of standard radiographic evaluation of the chest with computed tomography (CT) was carried out in 109 patients who were examined on a prototype EMI CT5000 scanner. Forty-eight patients had lung problems, and 61 were evaluated because of a mediastinal mass or widening, or for the detection of an occult thymoma in myasthenia gravis. Computed tomography was of value in the staging of bronchogenic carcinoma, particularly in the detection of direct mediastinal and pleural extension, and in evaluating patients with solitary or multiple nodules by detecting additional lesions and calcification. Thymomas not detected on conventional imaging modalities were visualized in 4 of 33 patients with myasthenia gravis or red cell aplasia. One of these was a false positive. In 28 patients with a mediastinal mass or widening on the chest roentgenogram, incremental information was noted on CT in 22. These included a definitive diagnosis of lesions composed of fat, evaluation of the isolated esophagus after colon by bypass surgery,and identification of the cause of paraspinal widening.     

Computed tomography in pulmonary sarcoidosis

A group of 34 proven cases of pulmonary sarcoidosis was investigated by computed tomography (CT) to determine whether CT provided any information beyond that obtained from conventional chest films. Computed tomography disclosed a surprisingly high prevalence of minor pleural changes in sarcoidosis, including two patients with small pleural effusions. Unsuspected bullae and isolated "granulomatous" nodules were additionally demonstrated. Increases in lung density and alterations in gravity dependent vascular perfusion were assessed; these may reflect alterations in the vascular bed, and the increased density is possibly due to diffuse invasion of the lung not recognizable by conventional chest X-ray films. Tracheal compression was noted in one case and vertebral densities in three. Prominence of "small air spaces" was recorded in four patients; the nature of the pathology responsible for this finding is at present speculative. While not replacing conventional chest radiography, CT does make a definite contribution to the assessment of pulmonary sarcoidosis.     

The use of computed tomography in evaluating chest wall pathology

Forty-nine patients with chest wall lesions were evaluated by computed tomography (CT) and conventional radiography. Computed tomography was found to be indispensable for detecting and precisely localizing these lesions. It revealed unsuspected bone destruction and lung, pleural, and mediastinal involvement, as well as invasion of the spinal canal. In more than two thirds of the patients, CT provided additional information of clinical importance in management and, in one third, treatment was altered or the surgical approach modified because of the CT findings. Computed tomography is an essential diagnostic modality in evaluating chest wall lesions.     

Computerized tomography in the staging and the follow-up of Hodgkin's lymphoma of the thorax

As yet, the role of Computed Tomography (CT) as a routine imaging technique in the staging and follow-up of thoracic Hodgkin's disease has not been assessed. The authors report the results obtained in 120 patients affected with thoracic Hodgkin's disease, staged and followed by means of chest X-rays and CT. CT better identified intrathoracic involvement of mediastinal nodes, of lung parenchyma, of pleura, and of pericardial and chest walls in 54/120 patients (45%), with staging modifications in 18 (15%) of them only. Treatment was changed only in 12 patients (10%) where radiation therapy had been planned. The clinical value of the additional information yielded by CT was especially evident in the follow-up: CT allowed the correct evaluation of persistent/recurrent disease in 51/117 patients (43.5%), a figure high enough to suggest the use of CT in the routine follow-up of patients affected with thoracic Hodgkin's disease.     

隐性肺癌的CT诊断价值（附10例分析）

目的　探讨隐蔽部位肺癌漏误诊的原因。方法　本组经手术病理证实隐蔽部位肺癌10例，常规摄胸部正位像，有6例加摄侧位像；所有病例均经CT扫描检查，平扫6例，平扫加增扫4例，在病灶或肺门区加5mm薄扫。结果　本组病例常规X线检查发现原发病灶1例，胸腔积液3例；CT扫描显示病灶并明确诊断9例，未显示病灶1例。结论（1）CT对隐蔽部位肺癌定位准确、并有助于其定性、定量分析。（2）高千伏摄影有助于减少隐蔽部位肺癌的漏诊。（3）常规摄胸部正侧位像并结合CT扫描是提高隐蔽部位肺癌诊断水平的关键，必要时应结合纤支镜检和MRI。     

Incidence of pulmonary nodules detected by computed tomography in patients with bronchial carcinoma

Computed tomography (CT) is more sensitive in detecting pulmonary nodules than conventional chest radiography. The incidence of pulmonary nodules on thoracic CT scans, not visible on chest radiographs, in patients with small-cell carcinoma of the bronchus (SCCB) was 27%, and in patients with non-small-cell carcinoma (non-SCCB) the incidence was 28%. Some of these nodules may be malignant. This has implications for the surgical staging of patients with lung cancer in the United Kingdom, where there is a lower incidence of benign granulomatous nodules than in the USA.     

CT findings in primary thymic carcinoma

Computed tomography of five cases of thymic carcinoma was reviewed. The subtypes of thymic carcinoma were squamous (two cases), lymphoepithelioma-like (one case), undifferentiated (one case), and basaloid (one case). The patients ranged from 52 to 72 years of age. Computed tomography showed anterior mediastinal tumors infiltrating along the pleura or mediastinum with frequent internal necrosis or calcifications. The three nonsquamous cell cases developed extrathymic metastases to the mediastinal lymph nodes, lung, or chest wall. Although the CT features of thymic carcinomas were similar to those of invasive thymoma, the former showed more aggressive behavior. Among the four variants of thymic carcinoma, squamous carcinomas were less aggressive and had less tendency to develop necrosis than the others.     

Computed vs. conventional tomography in evaluation of primary and secondary pulmonary neoplasms.

One hundred patients, ultimately proved to have chest malignancies, were evaluated prospectively with conventional chest tomography and computed tomography. In 58 patients with primary malignancies, conventional tomograms were more useful in evaluation of the hilus than CT scans. The mediastinum was better assessed by CT. Thus, evaluation of the presence of neoplasia is better accomplished by conventional examination, while extent of disease is best assessed by CT. Thoracotomy for curative resection was not attempted (in the latter cases of this series) based on CT findings of mediastinal involvement. In 42 patients with metastases to the chest, CT scans of the lung parenchyma were more sensitive than whole lung tomography but had little additional impact on patient treatment. Nevertheless, in 18 patients the results of CT or whole lung tomography directly affected patient therapy.     

Large-image intensifier photofluorography and conventional radiography in pulmonary emphysema. Correlation with computed tomography

Large-screen image intensifier (II) photofluorography was compared with full-size screen-film chest radiography in the diagnosis of pulmonary emphysema in 84 patients. Photospot films and conventional radiographs were interpreted independently by three radiologists. Computed tomography (CT) was used as an independent reference technique, and diagnostic performance of chest radiography in various CT patterns of emphysema was evaluated. The difference in diagnostic sensitivity for emphysema in favor of conventional chest radiography over photofluorography (0.65 versus 0.56) was statistically significant (p less than 0.05). Specificity of the imaging modalities was equal: 0.78 in full-size films and 0.77 in photospot films. All CT patterns of emphysema had great false negative response rates in chest radiography, which is an inaccurate technique for the diagnosis of emphysema. CT is required for reliable radiologic evaluation of emphysema.     

The value of thoracic computed tomography in the detection of recurrent Hodgkin's disease

Fifty chest radiographs and concurrent thoracic computed tomography (CT) scans obtained in a total of 44 patients with 50 separate episodes of suspected recurrent Hodgkin's disease were reviewed. Recurrent disease was present in 18 episodes, involving the mediastinum in 12, the lung parenchyma in five and both mediastinum and lung parenchyma in one. In four episodes, mediastinal recurrence was demonstrated on both the chest radiograph and CT scan. In a further two cases, the chest radiograph appeared normal but CT detected recurrence in the mediastinum. In 20 cases, the mediastinal appearances on chest radiography were suspicious but not diagnostic of recurrence, usually because of previous radiotherapy resulting in residual mediastinal widening. Computed tomography diagnosed recurrent disease which was subsequently proven in seven of these cases. Recurrent disease was suggested by CT in a further case, subsequently shown to be radiation fibrosis. Of the 12 remaining chest radiographs in which the mediastinal assessment was indeterminate, CT was true negative for recurrent disease in 10 cases and was also indeterminate in two. Recurrent disease in the lung parenchyma was demonstrated on the chest radiograph and CT scan on five occasions. There was one incident in which the chest radiograph was normal but CT detected recurrent parenchymal disease. The appearances of the lung parenchyma were indeterminate for recurrent disease on three chest radiographs but CT was helpful in only one case in which radiation change alone was diagnosed. In eight cases the diagnosis of recurrent disease by CT resulted in a decision to initiate treatment. Computed tomography is of value in detecting relapse in patients with suspected recurrent Hodgkin's disease when the chest radiograph is inconclusive, and may enable differentiation of radiation change from recurrent disease in the mediastinum.     

Lung cancer staging: the role of computed tomography and magnetic resonance imaging

Because complete resection remains the only reliable method of cure of lung cancer, one important aim of preoperative staging is to select patients with localised disease who may benefit from surgery, while avoiding unnecessary thoracotomies in patients with unresectable neoplasm. Computed tomography (CT) of the chest is a valuable method for staging local and regional spread of lung neoplasms, although limitations in its accuracy are well-known. While gross invasion of the mediastinum and major structures as well as the presence of metastatic disease can be easily demonstrated with CT, differentiation between tumour contiguity and subtle invasion of mediastinum or chest wall often remains a problem. Although magnetic resonance imagaing (MRI) may have the same limitations as CT, in specific situations it may b superior in diagnosing minimal chest wall or mediastinal invasion. Moreover, MRI is useful in the assessment of patients with superior sulcus tumours as well as in patients with contraindication to intravenous administration of ionic contrast material. Since nodal size is the only useful criterion for evaluating lymph node metastases, CT and MRI show similar, poor accuracies in lymph node staging reesulting from both low sensitivity (normal-sized nodes may contain microscopic metastases) and low specificity (enlarged lymph nodes may be reactive). For this reason, if enlarged lymph nodes are detected, further evaluation is recommended before excluding the patient from a potentially curative resection. Advantages and limitations of CT and MRI in the preoperative staging of non-small-cell carcinoma are reviewed in this article. The imaging of small-cell carcinoma is not included because most patients with this cell type do not benefit from surgical resection. Similarly we do not discuss imaging of distant metastases.     

Variable CT appearance of plasma cell granuloma of the lung

Plasma cell granuloma of the lung is an uncommon benign inflammatory pseudotumor. Although it typically presents as a solitary mass on chest radiography, several chest film appearances have been described. Three cases are presented that illustrate the variable range and nonspecificity of CT appearances of plasma cell granuloma of the lung. Computed tomography is useful in the evaluation of these lesions primarily to establish important anatomic relationships associated with each of the various manifestations.     

Metastatic mediastinal neoplasm masquerading as aortic dissection: a skip sign on computed tomography for their distinction

Four years after undergoing a left lower lobe lobectomy for squamous cell carcinoma, a 77-year-old man presented with a mass lesion in the left upper mediastinum associated with chest pain. Computed tomography revealed a homogeneous density immediately adjacent to the aortic arch and thoracic aorta consistent with aortic dissection. Upon thoracotomy, however, the lesion was found to be an oat cell carcinoma. Retrospective review of the computed tomography scans detected a normal segment of descending aorta, indicating the interruption of the paraaortic lesion. Such a skip sign can be used to rule out aortic dissection.     

Limited value of CT brain scans in the staging of small cell lung cancer

Computed tomography of the brain was performed as part of the initial staging evaluation of 84 patients with small cell lung cancer. Brain scans indicative of metastatic disease were obtained in 12 (14%) patients, two of whom had no neurologic signs or symptoms. One of these had no other extrathoracic disease. Brain scans without evidence of metastatic disease were obtained in 72 patients, 58 (80.5%) of whom had no signs or symptoms suggestive of metastatic intracranial disease. In the 14 patients with neurologic symptoms but negative computed tomographic scans, other explanations than brain metastases were found. It was concluded that head scanning is a sensitive and accurate method of detecting central nervous system metastases in patients with small cell lung cancer. However, head computed tomography should not be included as part of the initial staging evaluation of the neurologically asymptomatic patients. In only one of 60 such patients did the brain scan change the initial clinical staging, which included chest films, liver and bone scans, and bone marrow biopsy.     

CT demonstration of postpneumonectomy tumor recurrence

Seven patients with suspected recurrent tumor who had undergone pneumonectomy for carcinoma of the lung were studied by computed tomography (CT) to evaluate the location, extent, and nature of the tumor. In six patients with proven recurrence in the chest, CT demonstrated the tumor in five, four as a mass near the bronchial stump and one as a parasternal mass. (In one patient, surgical clip artifacts prevented interpretation). This information was useful in planning radiation therapy treatments in four patients.     

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.     

Computed tomography in advanced carcinoma of the uterine cervix

Computed tomography (CT) and clinical examination including complete evaluation of the true pelvis were performed in 32 patients of whom 2 had possible advanced primary and 30 possible recurrent carcinoma of the uterine cervix. Confirmation of the staging by surgery or autopsy was obtained in 22 patients and by repeat clinical examinations and CT in 10 patients. The CT diagnosis was correct in 29 and the clinical pelvic examination in 25 patients. The results confirm previous reports that CT is a complementary method to pelvic examination in advanced cervical carcinoma.     

Comparison of the value of general and oblique images and whole lung tomography in a high kilovoltage technic in the detection of pulmonary coin lesions

The ranking of high kvp pa. and lateral chest x-ray, left and right oblique films and whole lung tomography in the detection of pulmonary coin-shaped lesions is compared. Out of a total number of 327 coin lesions in 115 patients detected by high kvp whole lung tomography, only 52% were found on pa and lateral chest films. Additional oblique films improved the score to 64%. Oblique films proved to be especially helpful in detecting pleural lesions. Although CT has a higher sensitivity in detecting nodules (with decreasing specificity) whole lung tomography will continue to play an important role in the management of tumour patients.     

Solitary pulmonary metastases in high-risk melanoma patients: a prospective comparison of conventional and computed tomography

A prospective comparison of chest radiography, conventional tomography, and computed tomography (CT) in the detection or confirmation of solitary pulmonary nodules was made in 42 patients with high propensity for pulmonary metastases due to advanced local (Clark level IV or V) or regional malignant melanoma. Unequivocal nodules were revealed by chest radiography in 11 patients, conventional tomography in 16, and computed tomography in 20 patients. Both plain films and tomography in three of these 20 were normal, but follow-up verified pulmonary metastases. Computed tomography detected more pulmonary nodules than conventional tomography in 11 patients in addition to identifying lesions in extrapulmonary sites. Therefore, chest CT is recommended before institution of immunotherapy or surgical removal of a solitary pulmonary melanoma metastasis. Once chemotherapy had been instituted for bulky regional or cutaneous involvement, however, the findings of either conventional or computed tomography were comparable in this study.