scholarly journals Solid Indeterminate Pulmonary Nodules Less Than or Equal to 250 mm3: Application of the Updated Fleischner Society Guidelines in Clinical Practice

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Andrea Borghesi ◽  
Silvia Michelini ◽  
Giorgio Nocivelli ◽  
Mario Silva ◽  
Alessandra Scrimieri ◽  
...  
Keyword(s):  
Doubling Time ◽  
Pulmonary Nodules ◽  
Chest Ct ◽  
Ct Scans ◽  
Inclusion Criteria ◽  
Histologic Diagnosis ◽  
Indeterminate Nodules ◽  
Risk Patients ◽  
New Guidelines

Background. The latest version of the Fleischner Society guidelines for management of incidental pulmonary nodules was published in 2017. The main purpose of these guidelines is to reduce the number of unnecessary computed tomography (CT) examinations during the follow-up of small indeterminate nodules. Objective. The present study aimed to evaluate the performance of these guidelines for management of solid indeterminate pulmonary nodules (SIPNs) ≤ 250 mm3. Materials and Methods. During a 7-year period, we retrospectively reviewed the chest CT scans of 672 consecutive patients with SIPNs. The study sample was selected according to the following inclusion criteria: solitary SIPN; diameter ≥ 3 mm; volume ≤ 250 mm3; two or more CT scans performed with the same scanner and same acquisition/reconstruction protocol; thin-section 1-mm images in DICOM format; histologic diagnosis or follow-up ≥ 2 years; and no oncological history. Applying these criteria, a total of 27 patients with single SIPNs ≤ 250 mm3 were enrolled. For each SIPN, the volume and doubling time were calculated using semiautomatic software throughout the follow-up period. For each SIPN, we applied the Fleischner Society guidelines, and the recommended management was compared to what was actually done. Results. A significant volumetric increase was detected in 5/27 (18.5%) SIPNs; all growing nodules were observed in high-risk patients. In these SIPNs, a histologic diagnosis of malignancy was obtained. Applying the Fleischner Society recommendations, all five malignant nodules would have been identified. None of the SIPNs < 100 mm3 in low-risk patients showed significant growth during the follow-up period. The application of the new guidelines would have led to a significant reduction in follow-up CT examinations (Hodges-Lehmann median difference, -2 CT scans; p = 0.0001). Conclusion. The application of the updated Fleischner Society guidelines has been shown to be effective in the management of SIPNs ≤ 250 mm3 with a significant reduction in radiation dose.

scholarly journals Cross-sectional analysis of follow-up chest MRI and chest CT scans in patients previously affected by COVID-19

2021 ◽  
Author(s):  
Martina Pecoraro ◽  
Stefano Cipollari ◽  
Livia Marchitelli ◽  
Emanuele Messina ◽  
Maurizio Del Monte ◽  
...  
Keyword(s):  
Chest Ct ◽  
Ct Scans ◽  
Imaging Biomarker ◽  
Cross Sectional ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Sectional Analysis ◽  
Ct And Mri ◽  
Interlobular Septal Thickening

Abstract Purpose The aim of the study was to prospectively evaluate the agreement between chest magnetic resonance imaging (MRI) and computed tomography (CT) and to assess the diagnostic performance of chest MRI relative to that of CT during the follow-up of patients recovered from coronavirus disease 2019. Materials and methods Fifty-two patients underwent both follow-up chest CT and MRI scans, evaluated for ground-glass opacities (GGOs), consolidation, interlobular septal thickening, fibrosis, pleural indentation, vessel enlargement, bronchiolar ectasia, and changes compared to prior CT scans. DWI/ADC was evaluated for signal abnormalities suspicious for inflammation. Agreement between CT and MRI was assessed with Cohen’s k and weighted k. Measures of diagnostic accuracy of MRI were calculated. Results The agreement between CT and MRI was almost perfect for consolidation (k = 1.00) and change from prior CT (k = 0.857); substantial for predominant pattern (k = 0.764) and interlobular septal thickening (k = 0.734); and poor for GGOs (k = 0.339), fibrosis (k = 0.224), pleural indentation (k = 0.231), and vessel enlargement (k = 0.339). Meanwhile, the sensitivity of MRI was high for GGOs (1.00), interlobular septal thickening (1.00), and consolidation (1.00) but poor for fibrotic changes (0.18), pleural indentation (0.23), and vessel enlargement (0.50) and the specificity was overall high. DWI was positive in 46.0% of cases. Conclusions The agreement between MRI and CT was overall good. MRI was very sensitive for GGOs, consolidation and interlobular septal thickening and overall specific for most findings. DWI could be a reputable imaging biomarker of inflammatory activity.

scholarly journals The clinical significance of indeterminate pulmonary nodules in melanoma patients at baseline and during follow-up chest CT

2019 ◽  
Vol 6 ◽  
pp. 85-90 ◽  
Author(s):  
Magdy Soliman ◽  
Teresa Petrella ◽  
Pascal Tyrrell ◽  
Frances Wright ◽  
Nicole J. Look Hong ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Pulmonary Nodules ◽  
Chest Ct ◽  
Melanoma Patients

scholarly journals Cost-Effectiveness of Follow-Up for Subsolid Pulmonary Nodules in High-Risk Patients

2020 ◽  
Vol 15 (8) ◽  
pp. 1298-1305 ◽  
Author(s):  
Mark Morris Hammer ◽  
Lauren L. Palazzo ◽  
Adelle Paquette ◽  
Andrew L. Eckel ◽  
Francine L. Jacobson ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Pulmonary Nodules ◽  
High Risk Patients ◽  
Risk Patients

Aneurysms of the intracavernous carotid artery: a multidisciplinary approach to treatment

1991 ◽  
Vol 75 (4) ◽  
pp. 525-534 ◽  
Author(s):  
Mark E. Linskey ◽  
Laligam N. Sekhar ◽  
Joseph A. Horton ◽  
William L. Hirsch ◽  
Howard Yonas
Keyword(s):  
Carotid Artery ◽  
Low Risk ◽  
Ct Scans ◽  
Xenon Ct ◽  
Content Type ◽  
Giant Aneurysms ◽  
Aneurysm Embolization ◽  
Risk Patients ◽  
Fine Print

✓ Of 43 cavernous sinus aneurysms diagnosed over 6½ years, 23 fulfilled indications for treatment; of these 19 were treated, eight surgically and 11 with interventional radiological techniques. Six small and two giant aneurysms were treated surgically: four were clipped, two were repaired primarily, and two were trapped with placement of a saphenous-vein bypass graft. Seven large and four giant aneurysms were treated with interventional radiological techniques: in five cases the proximal internal carotid artery (ICA) was sacrificed; one aneurysm was trapped with detachable balloons; and five were embolized with preservation of the ICA lumen. The mean follow-up period was 25 months. At follow-up examination, three patients in the surgical group were asymptomatic, two had improved, and three had worsened. Three of these patients had asymptomatic infarctions apparent on computerized tomography (CT) scans. At follow-up examination, four radiologically treated patients were asymptomatic, five had improved, two were unchanged, and none had worsened. One patient had asymptomatic and one minimally symptomatic infarction apparent on CT scans; both lesions were embolic foci after aneurysm embolization with preservation of the ICA. It is concluded that treatment risk depends more on the adequacy of collateral circulation than on the size of the aneurysm. A multidisciplinary treatment protocol for these aneurysms is described, dividing patients into high-, moderate-, and low-risk groups based on pretreatment evaluation of the risk of temporary or permanent ICA occlusion using a clinical balloon test occlusion coupled with an ICA-occluded stable xenon/CT cerebral blood flow study. Radiological techniques are suggested for most low-risk patients, while direct surgical techniques are proposed for most moderate- and high-risk patients.

Effect of gene expression profile (GEP) testing on clinical management in 19% of consecutively treated patients with stage IB/IIA melanoma at a single institution.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21080-e21080
Author(s):  
Lynn Thacher Dengel ◽  
Alexandra W. Hickman ◽  
Craig L. Slingluff
Keyword(s):  
High Risk ◽  
Distant Metastases ◽  
Risk Scores ◽  
Inclusion Criteria ◽  
Single Institution ◽  
Stage Ib ◽  
Risk Result ◽  
Risk Patients ◽  
Biopsy Methods

e21080 Background: A 31-GEP test is predictive of metastasis in cutaneous melanoma. We hypothesized that GEP testing would “upgrade” surveillance to routine imaging in at least 16% of stage IB/IIA patients, similar to the upgrade rate from sentinel node biopsy. Methods: A GEP score was obtained for consecutive patients with Stage IB/IIA melanoma treated between 6/2014-6/2016. A retrospective review of a prospectively collected database was performed. Results: 67 patients with Stage IB/IIA melanoma met inclusion criteria. In four cases, a GEP result was not available. Of the 63 tested cases, 68% were Stage IB (N = 43), and 32% were Stage IIA (N = 20). A high-risk result was seen in 12% of stage IB (5/43) and 42% of stage IIA (8/19) patients. Insurance denied coverage of scans in 1/13 patients with a high-risk GEP result. The remaining 12 Stage IB/IIA patients with high-risk scores were “upgraded” to high-intensity surveillance. With a median follow-up of 14 months, 1/13 patients with a high-risk GEP result developed distant metastases 21 months after diagnosis of a Stage IIA melanoma. Conclusions: Results from this retrospective single institution study show that GEP testing altered patient management in 19% of Stage IB/IIA patients. Early detection in 1/13 patients with high-risk scores in this series supports further investigation into stratifying traditionally low-risk patients by GEP testing.

scholarly journals The Pulmonary Sequalae in Discharged Patients With COVID-19:A Short-term Observational Study

2020 ◽  
Author(s):  
Dehan Liu ◽  
Wanshu Zhang ◽  
Feng Pan ◽  
Lin Li ◽  
Lian Yang ◽  
...  
Keyword(s):  
Chest Ct ◽  
Ct Scans ◽  
Optimal Time ◽  
Imaging Features ◽  
Short Term ◽  
Lung Lesions ◽  
Cumulative Percentage ◽  
Time Points ◽  
Time Point

Abstract Background: A cluster of patients with coronavirus disease 2019 (COVID-19) pneumonia were discharged from hospitals in Wuhan, China. We aimed to determine the cumulative percentage of complete radiological resolution at each time point, to explore the relevant affecting factors, and to describe the chest CT findings at different time points after hospital discharge.Methods: Patients with COVID-19 pneumonia confirmed by RT-PCR who were discharged consecutively from the hospital between 5 February 2020 and 10 March 2020 and who underwent serial chest CT scans on schedule were enrolled. The radiological characteristics of all patients were collected and analysed. The total CT score was the sum of non-GGO involvement determined at discharge. Afterwards, all patients underwent chest CT scans during the 1st, 2nd, and 3rd weeks after discharge. Imaging features and distributions were analysed across different time points.Results: A total of 149 patients who completed all CT scans were evaluated; there were 67 (45.0%) men and 82 (55.0%) women, with a median age of 43 years old (IQR 36-56). The cumulative percentage of complete radiological resolution was 8.1% (12 patients), 41.6% (62), 50.3% (75), and 53% (79) at discharge and during the 1st, 2nd, and 3rd weeks after discharge, respectively. Patients ≤44 years old showed a significantly higher cumulative percentage of complete radiological resolution than patients >44 years old at the 3-week follow-up. The predominant patterns of abnormalities observed at discharge were ground-glass opacity (GGO) (65 [43.6%]), fibrous stripe (45 [30.2%]), and thickening of the adjacent pleura (16 [10.7%]). Lung lesions showed obvious resolution from 2 to 3 weeks after discharge, especially in terms of GGO and fibrous stripe. “Tinted” sign and bronchovascular bundle distortion as two special features were discovered during the evolution.Conclusion: Lung lesions in COVID-19 pneumonia patients can be absorbed completely during short-term follow-up with no sequelae. Three weeks after discharge might be the optimal time point for early radiological estimation.

scholarly journals Complications of Percutaneous Renal Biopsy

2019 ◽  
Vol 36 (02) ◽  
pp. 097-103
Author(s):  
Kenaz Bakdash ◽  
Kristofer M. Schramm ◽  
Aparna Annam ◽  
Matthew Brown ◽  
Kimi Kondo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Biopsy ◽  
Bleeding Complications ◽  
Modifiable Risk Factors ◽  
Delayed Presentation ◽  
Histologic Diagnosis ◽  
Poor Renal Function ◽  
Percutaneous Renal Biopsy ◽  
Risk Patients

AbstractPercutaneous renal biopsy is widely used for diagnosis, prognosis, and management of nephropathies. Complications may arise after renal biopsy, most commonly in the form of bleeding. Efforts should be taken to optimize modifiable risk factors such as hypertension, thrombocytopenia, and coagulopathy prior to the procedure. Unmodifiable risk factors such as poor renal function, gender, and underlying histologic diagnosis may be used to identify high-risk patients. Delayed presentation of bleeding complications is common, and close clinical follow-up is crucial.

Value of Chest CT Scans in Routine Ovarian Carcinoma Follow-Up

2001 ◽  
Vol 177 (4) ◽  
pp. 857-859 ◽  
Author(s):  
T. Sella ◽  
E. Rosenbaum ◽  
D. Z. Edelmann ◽  
R. Agid ◽  
A. I. Bloom ◽  
...  
Keyword(s):  
Ovarian Carcinoma ◽  
Chest Ct ◽  
Ct Scans

scholarly journals Laryngotracheobronchial papillomatosis: chest CT findings

2017 ◽  
Vol 43 (4) ◽  
pp. 259-263 ◽  
Author(s):  
Helena Ribeiro Fortes ◽  
Felipe Mussi von Ranke ◽  
Dante Luiz Escuissato ◽  
Cesar Augusto Araujo Neto ◽  
Gláucia Zanetti ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Lung Parenchyma ◽  
Pulmonary Involvement ◽  
Chest Ct ◽  
Ct Scans ◽  
Lung Nodules ◽  
Inclusion Criteria ◽  
Air Trapping ◽  
Recurrent Respiratory Infections ◽  
Ct Findings

ABSTRACT To evaluate the findings on chest CTs in 16 patients (8 men and 8 women) with laryngotracheobronchial papillomatosis. Methods: This was a retrospective study involving patients ranging from 2 to 72 years of age. The evaluation of the CT scans was independently performed by two observers, and discordant results were resolved by consensus. The inclusion criteria were presence of abnormalities on the CT scans, and the diagnosis was confirmed by anatomopathological examination of the papillomatous lesions. Results: The most common symptoms were hoarseness, cough, dyspnea, and recurrent respiratory infections. The major CT findings were nodular formations in the trachea, solid or cavitated nodules in the lung parenchyma, air trapping, masses, and consolidation. Nodular formations in the trachea were observed in 14 patients (87.5%). Only 2 patients had lesions in lung parenchyma without tracheal involvement. Only 1 patient had no pulmonary dissemination of the disease, showing airway involvement only. Solid and cavitated lung nodules were observed in 14 patients (87.5%) and 13 (81.2%), respectively. Masses were observed in 6 patients (37.5%); air trapping, in 3 (18.7%); consolidation in 3 (18.7%); and pleural effusion, in 1 (6.3%). Pulmonary involvement was bilateral in all cases. Conclusions: The most common tomography findings were nodular formations in the trachea, as well as solid or cavitated nodules and masses in the lung parenchyma. Malignant transformation of the lesions was observed in 5 cases.

Sign in / Sign up

Export Citation Format

Share Document