Myofibroblastic inflammatory tumor of the lung: CT findings with pathologic correlation

The objective of this study was to describe the computed tomographic (CT) features of myofibroblastic inflammatory tumor of the lung with histopathologic correlation. The medical records and imaging studies of eight patients with pathologically proven myofibroblastic inflammatory tumor of the lung were reviewed. On radiographs and CT images, a poorly circumscribed mass or nodule was evident in five patients (six lesions), and a well-circumscribed lesion was evident in three patients (three lesions). Seven lesions were peripheral and two were centrally located. At CT, five lesions were of heterogeneous attenuation and four homogeneous. Increased perilesional parenchymal abnormalities, which were caused by peribronchial inflammatory infiltrates, were observed in three cases. The predominant histopathologic feature was organizing pneumonia type in three cases, lymphoplasmacytic type in three cases, and both organizing pneumonia and lymphoplasmacytic type in two cases. Variable degree of fibrous histiocytoma type was observed in all cases. The imaging characteristics of myofibroblastic inflammatory tumor of the lung are variable and nonspecific. The authors conclude that most cases appear as solitary, peripheral lesions with a predilection for the lower lobes. Associated findings may include perilesional inflammatory changes. Because myofibroblastic inflammatory tumor cannot be reliably differentiated from other pulmonary lesions based solely on the imaging appearance diagnostic biopsy is mandatory. Interpretation of the imaging findings combined with the histopathologic features of disease may help make correct diagnosis.     

The spectrum of pulmonary sarcoidosis: Variations of high-resolution CT findings and clues for specific diagnosis

Sarcoidosis is a systemic disease of unknown cause, characterized by widespread non-caseating granulomas. There is a wide spectrum of radiologic manifestations in pulmonary sarcoidosis, providing challenges to radiologists. However, recognition of the key features of sarcoidosis with knowledge of its pathologic background can often allow for specific diagnosis. In this review, we describe the variety of high-resolution CT findings in pulmonary sarcoidosis along with its pathologic features as the basis for radiographic manifestations, and discuss the key features on high-resolution CT for the specific diagnosis of pulmonary sarcoidosis.     

Non-hodgkin lymphoma of the ureter: CT demonstration with pathologic correlation

A case of a 42-year-old man with non-Hodgkin lymphoma of the ureter is reported. Diffuse lymphomatous infiltration of the ureter occurs rarely and is an uncommon cause of ureteral obstruction. Imaging-pathologic correlation is presented with CT images and autopsy specimens.     

64层螺旋CT在白血病肺浸润诊断中的价值探讨

目的探讨白血病肺浸润的64层螺旋CT表现,评价64层螺旋CT在白血病肺浸润中的诊断价值。方法分析我院经临床确诊的21例白血病肺浸润患者胸部CT表现特点,探讨其对于临床诊断价值。结果白血病肺部浸润的CT表现主要为肺间质性的改变,病变呈多样性,表现为小叶间隔增厚及外周支气管血管间质增厚、小结节影、毛玻璃样改变及斑片影。结论 64层螺旋CT能清晰显示白血病肺部浸润的影像特点及范围大小,对白血病肺部浸润具有较高的诊断价值。     

Multiplanar display of spiral CT data of the pulmonary hila in patients with lung cancer : Preliminary observations

Spiral or helical computed tomography (CT)-generated multiplanar reconstructions were used in the radio-logical assessment of the pulmonary hila in patients with central lung cancer. Twelve patients with non-small-cell lung cancer and hilar abnormalities were examined with contrast-enhanced spiral CT. Studies were performed on a Siemens Somatom S or Plus-S scanner using either a 24- or 32-second spiral. The study volume was from the arch of the aorta to the inferior pulmonary veins done in a single breath-hold, using 4-mm collimation, and reconstructed at 2-mm intervals. We assessed the quality of vascular enhancement and of multiplanar reconstructions. Bronchoscopic, surgical, and pathological findings were correlated. Excellent vascular opacification and good-quality reconstructions were obtained in all patients. No interscan motion was detected. No problems were encountered with the breathholding technique or in the reconstruction of images, even in patients with poor respiratory function. Multiplanar reconstructions were useful for the evaluation of mediastinal including vascular and airways invasion, for optimal definition of lymph node groups, for the planning of bronchoscopically guided biopsy, as well as for endobronchoscopic laser coagulation therapy and surgical treatment. Spiral CT-generated multiplanar reconstructions of the hila are helpful for staging, solving problems, guiding bronchoscopy, and planning surgery. Even patients with limited respiratory reserve can successfully complete the examination.     

Serial CT findings of Paragonimus infested dogs and the Micro-CT findings of the worm cysts.

OBJECTIVE: To investigate the serial CT findings of Paragonimus westermani infected dogs and the microscopic structures of the worm cysts using Micro-CT. MATERIALS AND METHODS: This study was approved by the committee on animal research at our institution. Fifteen dogs infected with P. westermani underwent serial contrast-enhanced CT scans at pre-infection, after 10 days of infection, and monthly thereafter until six months for determining the radiologic-pathologic correlation. Three dogs (one dog each time) were sacrificed at 1, 3 and 6 months, respectively. After fixation of the lungs, both multi-detector CT and Micro-CT were performed for examining the worm cysts. RESULTS: The initial findings were pleural effusion and/or subpleural ground-glass opacities or linear opacities at day 10. At day 30, subpleural and peribronchial nodules appeared with hydropneumothorax and abdominal or chest wall air bubbles. Cavitary change and bronchial dilatation began to be seen on CT scan at day 30 and this was mostly seen together with mediastinal lymphadenopathy at day 60. Thereafter, subpleural ground-glass opacities and nodules with or without cavitary changes were persistently observed until day 180. After cavitary change of the nodules, the migratory features of the subpleural or peribronchial nodules were seen on all the serial CT scans. Micro-CT showed that the cyst wall contained dilated interconnected tubular structures, which had communications with the cavity and the adjacent distal bronchus. CONCLUSION: The CT findings of paragonimiasis depend on the migratory stage of the worms. The worm cyst can have numerous interconnected tubular channels within its own wall and these channels have connections with the cavity and the adjacent distal bronchus.     

CT and MR imaging findings of xanthogranulomatous cholecystitis: correlation with pathologic findings

The aim of this study was to evaluate CT and MRI findings in xanthogranulomatous cholecystitis (XGC) and to correlate the imaging findings with various pathologic parameters. The study included 13 patients with histopathologically confirmed XGC. The CT (n=13) and MRI (n=5) obtained in these patients were evaluated retrospectively. On CT, low-attenuation areas in the wall of XGC correlated with foam and inflammatory cells or necrosis and/or abscess in XGC. Areas of iso- to slightly high signal intensity on T2-weighted images, showing slight enhancement at early phase and strong enhancement at last phase on dynamic study, corresponded with areas of abundant xanthogranulomas. Areas with very high signal intensity on T2-weighted images without enhancement corresponded with necrosis and/or abscesses. Luminal surface enhancement (LSE) of gallbladder wall represented preservation of the epithelial layer. The early-enhanced areas of the liver bed on dynamic CT and MR images corresponded with accumulation of inflammatory cells and abundant fibrosis. Our results indicate that CT and MRI findings correlate well with the histopathologic findings of XGC.     

Solitary fibrous tumor of the trachea: CT findings with a pathological correlation.

We present the multidetector CT findings with a pathologic correlation for the case of a solitary fibrous tumor located in the trachea. The MDCT revealed a well-circumscribed intraluminal mass arising from the trachea, with strong nodular enhancement in the periphery of the mass. The enhancement pattern of the mass corresponded histopathologically to a focal hypocellular area in the center and prominent blood vessels along the periphery of the mass. We also present volume-rendered and virtual bronchoscopic images of this rare submucosal tracheal tumor.     

Chronic, reactive conditions of the oral cavity simulating mucosal carcinomas: CT and MR imaging findings with pathologic correlation in five patients

To investigate the radiologic and pathologic findings of chronic, inflammatory, reactive conditions of the oral cavity, which clinically and radiologically simulate mucosal malignancy, computed tomography (CT; n=4) and magnetic resonance (MR; n=2) images, as well as surgical specimens, obtained from five patients with surgically proved, chronic inflammatory mass of the oral cavity were retrospectively reviewed. All patients had a palpable mass or ulcerative lesion in the oral cavity. On CT and MR images, all three lesions in the oral tongue and one lesion in the retromolar trigone were seen as a superficial, ill-marginated, well-enhancing ellipsoid or focal soft tissue mass. Pathologic examinations revealed various depths and degrees of acute and chronic inflammation, granulation tissue, and fibrosis in the subepithelial stroma, accompanied by pseudoepitheliomatous hyperplasia in these four patients. In the remaining one patient with lesion in the hard palate, CT showed a relatively well-marginated, well-enhancing soft tissue mass, which histologically proved to be irritation fibroma. Neither clinical nor radiologic manifestations could afford clues to make the correct diagnosis, which therefore should rely on histology. Some forms of chronic, inflammatory, reactive conditions of the oral cavity are nearly indistinguishable from the malignant tumors both clinically and radiologically. Knowledge of this entity may obviate the unnecessary and somewhat disfiguring operation.     

CT localisation of small pulmonary nodules prior to thorascopic resection: Evaluation of a point marker system

PURPOSE: To evaluated the utility of a 5-mm long point marker system for CT localisation of small pulmonary nodules prior to thorascopic resection. MATERIALS AND METHODS: Percutaneous localisation of 57 pulmonary nodules was performed with computed tomographic (CT) guidance in 52 patients. The size of the nodules ranged from 3mm to 20mm (mean: 9mm, median: 8mm). The mean distance of the outer rim to the pleura ranged from 3mm to 55mm (mean: 19mm, median: 15mm). A stainless steel, 5-mm long point marker with a 30-cm long nylon suture and introducer system (21-gauge) was firmly attached to the funnel at the proximal end of the marker. RESULTS: The point marker system was successfully placed without being dislodged in 56 out of the 57 lesions (98%) and served as a clear guide during thoracoscopy. In 10 out of 52 patients (19%), non-symptomatic pneumothorax cases were observed. In 6 out of 52 patients (10%), haemorrhages into the lung parenchyma were observed. In no case did insertion of the point marker system cause strong pain and require an analgesic agent to be added. No patients produced hemopysis or air emboli. All nodules, including a dislodgment case, were successfully resected and the suture served as a clear guide during thoracoscopy. Pathologic findings of nodules included 37 malignancies and 20 non-malignancies. CONCLUSION: The marker system used for thoracoscopic resection was a safe and useful procedure.     

Cecal volvulus: CT findings and correlation with pathophysiology

The purpose of this study is to report the computed tomography (CT) features of cecal volvulus and to determine the accuracy of CT in distinguishing the three pathophysiological types of cecal volvulus. The CT studies of ten patients with surgically confirmed cecal volvulus were reviewed. For each patient, CT findings were looked for and recorded. The precise location of the cecum within the abdomen, the presence of an ileocecal twist, and the clockwise or counterclockwise direction of the whirl sign were specifically analyzed. All these results were confronted to the surgical diagnosis retrospectively correlated with the three types of cecal volvulus. According to our classification based on the analysis of the location of the cecum within the abdomen and the presence or the absence of a whirl sign on CT scans, the cecal volvulus was defined as the axial torsion type in four (40%) patients, loop type in four (40%) patients, and cecal bascule type in two (20%). For each patient, the result was in full accordance with the type of cecal volvulus diagnosed at surgery. CT is not only a valuable diagnostic technique in diagnosing cecal volvulus and its complications, but it is also useful in distinguishing the three pathophysiological types of cecal volvulus.     

On visual determination of full inspiration on CT images

The aim of this study was to evaluate the ability of experienced thoracic radiologists to assess full inspiration based on two CT slices, one above and one below the carina, in normal subjects. Ten healthy volunteers were studied. Total lung capacity (TLC) was measured with a body plethysmograph. High-resolution computed tomography (HRCT) was performed in two slices at TLC and at various expired volumes. Mean Hounsfield values (HU) were calculated. Unidentifiable images, stored on a web server, were analysed visually by experienced thoracic radiologists. The results show that the mean lung density at TLC varied by approximately 40 HU between individuals. Within an individual this may correspond to a decrease in lung volume of approximately 25% of TLC. On visual determination of images taken at 65–74% of TLC, more than one-third of the images were assessed as taken at full inspiration; of the images taken at 75–84% of TLC, approximately 50% were assessed as taken at full inspiration. We conclude that visual determination of full inspiration on CT images in normal subjects is highly inaccurate. If quantitative density measurements are to be used in the diagnosis or follow-up of lung disease, thorough control of full inspiration is recommended. Electronic Publication     

Bronchiolar inflammatory diseases: high-resolution CT findings with histologic correlation

Bronchiolar diseases pose a significant challenge to the clinician confronted with the evaluation and management of the affected patient. A variety of infectious and non-infectious diseases may affect the bronchioles causing either reversible or fixed bronchiolar obstruction. High-resolution CT (HRCT) is currently the best imaging modality for evaluation of small-airway disease. In fact, a wide spectrum of abnormalities are identified at HRCT in patients with bronchiolar diseases. These abnormalities are shown on HRCT in the presence of a normal or unclear chest radiograph. Additionally, HRCT performed at suspended full expiration may demonstrate the physiologic consequences of bronchiolar disease, e. g., air trapping. The differential diagnosis of pulmonary manifestations of bronchiolar diseases at HRCT is based on the different patterns of abnormality. Familiarity with the presentation of different bronchiolar inflammatory processes aid the radiologist in narrowing the differential diagnosis or even in suggesting a specific diagnosis. This article reviews the HRCT findings of various bronchiolar inflammatory diseases outlining their pathologic features. Knowledge of the underlying gross and microscopic pathologic features leads to a better understanding of their CT appearances. Received: 23 January 1998; Revision received: 14 August 1998; Accepted: 10 February 1999     

Solitary fibrous tumor of the orbit: CT and pathologic correlation

We report the CT findings of a solitary fibrous tumor of the orbit. The radiologic features included relatively homogeneous contrast enhancement and smooth remodelling of the bones of the orbit, findings consistent with the benign nature of this relatively rare tumor. Received: 30 December 1997 Accepted: 10 June 1998     

Subsecond multisection CT of regional pulmonary ventilation

RATIONALE AND OBJECTIVES: To evaluate the adequacy of multibreath and single-breath stable xenon gas techniques to measure regional ventilation during cardiac-gated, high-speed, multisection imaging, the authors carried out a series of studies using electron-beam computed tomography (CT) and a recently introduced subsecond multisection spiral CT scanner. MATERIALS AND METHODS: In four anesthetized pigs, the authors implemented single-breath and/or dynamic multibreath wash-in and washout protocols with respiratory-- and cardiac-gated image acquisition. The effects of varying tidal volume and inspiratory flow rate were evaluated independently. Scanning was done at end expiration to avoid artifacts from partial volumed conducting airways, which are filled with inspired gas concentration during inspiration. RESULTS: A single breath of 100% xenon provides adequate enhancement in the lung parenchyma (mean, 32 HU +/- 1.85 [standard error]) and should not cause unwanted side effects (mean xenon concentration in lung periphery, 21%). The single-breath method is suitable for studies requiring only short periods of apnea. Using the multibreath method, in dependent portions of the lung, there was close agreement between measured changes and predictions based on the xenon calibration data. More than 10 breaths were needed to clear tracer from poorly ventilated areas, and some nondependent regions demonstrated apparently "linear" rather than exponential clearance curves, possibly reflecting longer washout times. Analysis of wash-in and washout curves revealed vertical ventilation gradients and, at higher inspiratory flow rates, redistribution of ventilation to areas of the lung with greater pathway conductance. CONCLUSION: With careful attention to lung volume and use of cardiac gating, it is now possible to correlate lung structure with function to a degree heretofore not possible.     

Age-related incidence of pulmonary embolism and additional pathologic findings detected by computed tomography pulmonary angiography

Objective

To compare the incidence of pulmonary embolism (PE) and additional pathologic findings (APF) detected by computed tomography pulmonary angiography (CTPA) according to different age-groups.

Materials and methods

1353 consecutive CTPA cases for suspected PE were retrospectively reviewed. Patients were divided into seven age groups: ≤29, 30–39, 40–49, 50–59, 60–69, 70–79 and ≥80 years. Differences between the groups were tested using Fisher's exact or chi-square test. A p-value < 0.0024 indicated statistical significance when Bonferroni correction was used.

Results

Incidence rates of PE ranged from 11.4% to 25.4% in different age groups. The three main APF were pleural effusion, pneumonia and pulmonary nodules. No significant difference was found between the incidences of PE in different age groups. Furthermore, APF in different age groups revealed no significant differences (all p-values > 0.0024).

Conclusion

The incidences of PE and APF detected by CTPA reveal no significant differences between various age groups.     

CT findings of the commonly overlooked groove pancreatitis

Purpose

The aim of this study was to highlight the different computed tomography (CT) features of groove pancreatitis (GP) in order to make this entity more familiar to radiologist.

Parosteal lipoma of the rib. CT findings and pathologic correlation

Parosteal lipoma is a rare benign tumor composed of adipose tissue contiguous to the periosteum of the underlying bone. These tumors are slow-growing, nontender masses that affect, almost exclusively, the diaphysis of the long bones of the upper and lower limbs. We hereby describe the CT characteristics with the correlative pathological findings in a rare case of parosteal lipoma of the rib.     

Insertion of virtual pulmonary nodules in CT data of the chest: development of a software tool

The purpose of this study was to develop a software tool for the insertion of virtual lung nodules into CT data. Forty software-generated nodules were inserted at random locations and sizes on 20 multi-detector row CT studies of the chest (4×1-2.5-mm slice collimation). On each scan, two virtual nodules were inserted. The size, shape, margin and attenuation could arbitrarily vary and were individually adjusted to match real lesions of each patient (real nodules: 6.5±3.1 mm; virtual nodules: 6.1±3.2 mm). Additionally, noise and a random pattern simulating local density variations were added to virtual nodules. Three blinded readers evaluated 40 real and 40 simulated nodules according to a 5-point confidence scale ranging from 1 (definitely simulated) to 5 (definitely real). A multivariate analysis of covariance was performed for statistical assessment (SPSS 11.5, Chicago, IL). Real and simulated lesions were indistinguishable for all three readers (Pillai’s trace statistic: P=0.881). However, nodule size was a statistically significant covariable regarding the differentiation of virtual compared to real nodules. Larger simulated nodules were easier to detect than smaller ones (Pillai’s trace statistic: P<0.05). The developed algorithm allowed for the synthetic generation of lung nodules that were indistinguishable from real nodules.