Dose-Optimized Computed Tomography for Screening and Follow-Up of Solid Pulmonary Nodules in Obesity: A Phantom Study

2017 ◽  
Vol 46 (3) ◽  
pp. 204-209 ◽  
Author(s):  
Katharina Martini ◽  
Borna K. Barth ◽  
Kai Higashigaito ◽  
Stephan Baumueller ◽  
Hatem Alkadhi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Nodules ◽  
Phantom Study

scholarly journals Towards a close computed tomography monitoring approach for screen detected subsolid pulmonary nodules?

2014 ◽  
Vol 45 (3) ◽  
pp. 765-773 ◽  
Author(s):  
Ernst T. Scholten ◽  
Pim A. de Jong ◽  
Bartjan de Hoop ◽  
Rob van Klaveren ◽  
Saskia van Amelsvoort-van de Vorst ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Nodules ◽  
Lung Cancer Screening ◽  
Maximum Diameter ◽  
Cancer Screening Trial ◽  
Study Population ◽  
Safe Approach ◽  
Screening Trial ◽  
Measured Mass

Pulmonary subsolid nodules (SSNs) have a high likelihood of malignancy, but are often indolent. A conservative treatment approach may therefore be suitable. The aim of the current study was to evaluate whether close follow-up of SSNs with computed tomography may be a safe approach.The study population consisted of participants of the Dutch-Belgian lung cancer screening trial (Nederlands Leuvens Longkanker Screenings Onderzoek; NELSON). All SSNs detected during the trial were included in this analysis. Retrospectively, all persistent SSNs and SSNs that were resected after first detection were segmented using dedicated software, and maximum diameter, volume and mass were measured. Mass doubling time (MDT) was calculated.In total 7135 volunteers were included in the current analysis. 264 (3.3%) SSNs in 234 participants were detected during the trial. 147 (63%) of these SSNs in 126 participants disappeared at follow-up, leaving 117 persistent or directly resected SSNs in 108 (1.5%) participants available for analysis. The median follow-up time was 95 months (range 20–110 months). 33 (28%) SSNs were resected and 28 of those were (pre-) invasive. None of the non-resected SSNs progressed into a clinically relevant malignancy.Persistent SSNs rarely developed into clinically manifest malignancies unexpectedly. Close follow-up with computed tomography may be a safe option to monitor changes.

Frequency of Nonthromboembolic Imaging Abnormalities in Pregnant Women Referred for Computed Tomography Pulmonary Arteriography

2015 ◽  
Vol 66 (1) ◽  
pp. 24-29
Author(s):  
John M. Moriarty ◽  
Ferdia Bolster ◽  
Clare O'Connor ◽  
Patricia Fitzpatrick ◽  
Leo P. Lawler ◽  
...  
Keyword(s):  
Heart Failure ◽  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Pregnant Women ◽  
Pulmonary Nodules ◽  
Pleural Effusions ◽  
Pulmonary Arteriography ◽  
Potential Alternative ◽  
Age Range

Purpose The study sought to determine the frequency of nonthromboembolic imaging abnormalities in pregnant women referred for computed tomography pulmonary arteriography (CTPA). Materials and Methods CTPA studies on 100 consecutive pregnant women performed over a 5-year period were reviewed independently by 2 radiologists, with conflicts resolved by consensus. Age range was 18-43 years (mean 28 years). The presence or absence of pulmonary embolism and of nonthromboembolic imaging abnormalities was recorded. These were graded as A if the abnormalities were thought to provide potential alternative explanations for acute symptoms, B if findings were incidental that required clinical or radiologic follow-up, and C if the findings did not require further action. Results Pulmonary embolism was seen in 5 women. In 2 of these additional findings of consolidation and infarction were seen. Ninety-five women did not have pulmonary embolism. Eleven women (12%) had grade A abnormalities; 6 cases of consolidation, 2 cases of lobar collapse, and 3 cases of heart failure with pleural effusions. One woman had a grade B abnormality due to the presence of pulmonary nodules. Ten women had incidental grade C abnormalities. Conclusion Pulmonary embolism occurs in 5% of pregnant women referred for CTPA. In pregnant women without embolism on CTPA, potential alternative causes for patient symptoms are seen on CT in 12% of cases.

scholarly journals Current Practice in the Management of Pulmonary Nodules Detected on Computed Tomography Chest Scans

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Clarus Leung ◽  
Tawimas Shaipanich
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Surgical Resection ◽  
Pulmonary Nodule ◽  
Current Practice ◽  
Pulmonary Nodules ◽  
Lung Cancer Screening ◽  
Time Interval ◽  
Positive Finding

Lung cancer is associated with high mortality. It can present as one or more pulmonary nodules identified on computed tomography (CT) chest scans. The National Lung Screening Trial has shown that the use of low-dose CT chest screening can reduce deaths due to lung cancer. High adherence to appropriate follow-up of positive results, including imaging or interventional approaches, is an important aspect of pulmonary nodule management. Our study is one of the first to evaluate the current practice in managing pulmonary nodules and to explore potential causes for nonadherence to follow-up. This is a retrospective analysis at St. Paul’s Hospital, a tertiary healthcare center in Vancouver, British Columbia, Canada. We first identified CT chest scans between January 1 to June 30, 2014, that demonstrated one or more pulmonary nodules equal to or greater than 6 mm in diameter. We then looked for evidence of interventional (surgical resection or biopsy, or bronchoscopy for transbronchial biopsy and cytology) and radiological follow-up of the pulmonary nodule by searching on the province-wide CareConnect eHealth Viewer patient database. A total of 1614 CT reports were analyzed and 139 (8.6%) had a positive finding. Out of the 97 patients who received follow-up, 54.6% (N = 53) was referred for a repeat CT chest scan and 36.1% (N = 35) and 9.3% (N = 9) were referred for interventional biopsy and surgical resection, respectively. In our study, 30.2% (N = 42) of the patients with pulmonary nodules were nonadherent to follow-up. Despite the radiologist’s recommendation for follow-up within a certain time interval, only 36% had repeat imaging in a timely manner. Our findings reflect the current practice in the management of pulmonary nodules and suggest that there is a need for improvement at our academic center. Adherence to follow-up is important for the potentially near-future implementation of lung cancer screening.

scholarly journals Diagnosis of solitary pulmonary nodules and patients follow-up strategy

2016 ◽  
Vol 97 (5) ◽  
pp. 736-743
Author(s):  
V A Porhanov ◽  
L V Shulzhenko ◽  
I S Polyakov ◽  
E V Bolotova ◽  
A A Smolin
Keyword(s):  
Computed Tomography ◽  
Malignant Tumors ◽  
Delayed Diagnosis ◽  
Pulmonary Nodules ◽  
Clinical Problem ◽  
Screening Tests ◽  
Solitary Pulmonary Nodules ◽  
Need For Treatment ◽  
Follow Up Care

Solitary pulmonary nodule is the common clinical problem. Following the detection of solitary nodules practitioner first face the question of the probability of malignancy and the future strategy and tactics of the patient management. The report highlights the issues of differential diagnosis of solitary nodules and modern standards of management of these patients, including issues of their follow-up care. The importance of a multidisciplinary approach to this problem is emphasized. Strategy for the management of patients with solitary nodules include: (1) the computed tomography performance, its comparing with previous data; (2) an assessment of the margin, size, calcification type, solitary nodule type (solid, subsolid); (3) the risk of malignancy assessment. Further actions can be performed according to algorithms: nodule ≤8 mm; nodule >8 mm. According to screening tests for the early detection of lung cancer in smokers at high risk for development of malignant tumors, solitary nodules are found in 50% of cases. When choosing a strategy it is necessary to inform the patient about all the positives and negatives of follow-up care by means of computed tomography. Its main goal is to secure patient with benign nodules against unwanted invasive procedures, especially if there is no need for treatment. This advantage is put on one side of the scale, and on the second - the risk of delayed diagnosis of cancer, and excessive exposure to radiation. In light of the above all the patients with solitary nodules of undefined etiology should be referred to a specialized pulmonary center for multidisciplinary experts evaluating - pulmonologists, thoracic surgeons, pathologists and radiology specialists, which allows to develop the most optimal strategy for these patients.

scholarly journals Clinical Characteristics and Outcomes of Surgically Resected Solitary Pulmonary Nodules Due to Nontuberculous Mycobacterial Infections

2019 ◽  
Vol 8 (11) ◽  
pp. 1898 ◽  
Author(s):  
Yeonseok Choi ◽  
Byung Woo Jhun ◽  
Jhingook Kim ◽  
Hee Jae Huh ◽  
Nam Yong Lee
Keyword(s):  
Computed Tomography ◽  
Antibiotic Therapy ◽  
Pulmonary Nodules ◽  
Limited Data ◽  
Solitary Pulmonary Nodules ◽  
Chest Computed Tomography ◽  
Bronchial Wash ◽  
History Of ◽  
Never Smokers

Background: Limited data are available regarding the detailed characteristics and outcomes of surgically resected nontuberculous mycobacterial (NTM) granulomas. Methods: We evaluated the characteristics of 49 NTM granulomas presenting as solitary pulmonary nodules (SPNs) between January 2007 and December 2016. Results: Twenty-five patients (51%) were male and 27 (55%) were never-smokers. Seven (14%) patients had a history of tuberculosis. More than half (51%) of patients were asymptomatic. On chest computed tomography, the median SPN diameter was 18 mm, and approximately half of all SPNs (49%) were located in the upper lobes on chest computed tomography. NTM strain were preoperatively isolated from sputum (46%, 12/26), bronchial wash fluid (54%, 14/26), and needle biopsy specimens (12%, 3/26). Mycobacterium avium (71%, 22/31) was the organism most commonly isolated, followed by Mycobacterium intracellulare (16%, 5/31). Postoperative pneumothorax and atelectasis developed in four (8%) patients and one (2%) patient, respectively. Five patients received postoperative antibiotic therapy. Over a median follow-up period of 18.0 months, one patient with residual lesions after surgery started macrolide-based therapy due to aggravated symptoms. Conclusions: Most NTM granulomas can be treated completely by surgical resection without antibiotic therapy, and microbiological examination of surgical specimens is important for optimal management.

scholarly journals Evaluation and Follow Up Solitary Pulmonary Nodule

2020 ◽  
Vol 5 (3) ◽  
pp. 85
Author(s):  
Wiwi Pertiwi Hasimin ◽  
Muhammad Yamin Sunaryo
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Growth Rate ◽  
Solitary Pulmonary Nodule ◽  
Pulmonary Nodules ◽  
Solitary Pulmonary Nodules ◽  
Chest Computed Tomography ◽  
Size Growth ◽  
Risk Of Malignancy

With the increased utilisation of chest computed tomography, solitary pulmonary nodules are increasingly being identified. It is not clear whether this is of an increased incidence, increased awareness (ie, recognition of an abnormality as opposed to considering it an inconsequential finding), or increased identification because of an increasing prevalence of CT imaging. Whatever the reason, how to approach these patients is an issue that increasingly confronts clinicians. Through the evaluation of patient risk factors combined with computed tomography characteristics of solitary pulmonary nodules, including size, growth rate, margin characteristics, calcification, density and location; a clinician can assess the risk of malignancy. This literature will describe the evaluation and follow-up of pulmonary nodules based on several guidelines and how they apply to populations in Asia because of the different patient populations compare with Western countries ranging from risk factors, high infectious factors that can be confounding diagnosis and different genetic predispositions.

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