Thin-section CT in obstructive pulmonary disease: discriminatory value.

Purpose: To use thin-section computed tomography (CT) to distinguish between causes of obstructive pulmonary disease, to determine which distinctions give rise to diagnostic imprecision, and to identify the most useful CT features.

Materials And Methods: Thin-section CT scans of 105 patients with obstructive pulmonary disease (asthma, n = 35; centrilobular emphysema, n = 30; panlobular emphysema, n = 21; and obliterative bronchiolitis, n = 19) and 33 healthy subjects were assessed independently by two observers. The most likely diagnosis and a confidence rating were assigned.

Asymmetric ARDS following pulmonary resection: CT findings initial observations.

Purpose: To investigate whether asymmetric distribution of acute respiratory distress syndrome (ARDS) following lobectomy is due to compensatory hyperexpansion of the residual lung within the hemithorax operated on and to discern if this distribution reflects true asymmetry of the disease process.

Materials And Methods: Retrospective review of the intensive care unit database was performed over a period of 6 years to identify all cases of lung injury following lung surgery that satisfied the American-European consensus criteria for ARDS. Time to onset following surgery, time of subsequent computed tomographic (CT) examination, patient age and sex, and nature of surgery were recorded, as well as eventual patient status (ie, death or discharge).

Idiopathic interstitial pneumonias: imaging-pathology correlation.

The terminology related to idiopathic interstitial pneumonia (IIP) remains confusing and in some cases wholly inaccurate. In addition, a greater understanding of the correlation between high-resolution computed tomography (HRCT) appearances and the corresponding histopathological changes found in the interstitial pneumonias has resulted in a crucial role for HRCT in the investigation of IIPs. The role of the radiologist is becoming increasingly important with a strong emphasis on establishing a diagnosis without resorting to lung biopsy.

Successful treatment of endogenous lipoid pneumonia due to Niemann-Pick Type B disease with whole-lung lavage.

In Type B Niemann-Pick disease, progressive pulmonary infiltration is a major cause of morbidity and mortality, although the disease is usually diagnosed before adulthood in other organ systems. To date, no successful treatment of pulmonary involvement by Niemann-Pick disease has been documented. We describe the case of a patient with Niemann-Pick Type B disease who presented with extensive endogenous lipoid pneumonia and life-threatening hypoxia following bypass grafting for severe coronary artery disease.

Nonspecific interstitial pneumonia and usual interstitial pneumonia: comparative appearances at and diagnostic accuracy of thin-section CT.

Purpose: To compare the morphologic abnormalities on thin-section computed tomographic (CT) images in a group of patients with histopathologically confirmed nonspecific interstitial pneumonia (NSIP) or usual interstitial pneumonia (UIP) and a clinical presentation of idiopathic pulmonary fibrosis.

Materials And Methods: Thin-section CT imaging patterns and distribution of disease in 53 patients with histologic diagnoses of NSIP (n = 21) or UIP (n = 32) were quantified retrospectively and independently by four observers. The appearances of NSIP and UIP at CT were compared with univariate and multivariate techniques.

High-resolution CT of diffuse lung disease: value and limitations.

The relative speed with which HRCT has become the imaging technique of choice for evaluating patients with suspected lung disease can be regarded as a testament to its effectiveness. It is as well, however, to remember some of the caveats that apply to the interpretation of the numerous studies that have championed the clinical application of HRCT. It seems unlikely that CT will be supplanted in the near future by other cross-sectional or volumetric imaging techniques for the evaluation of diffuse lung disease.

Computed tomography screening for lung cancer: back to basics.

After some years in the doldrums, interest in screening for lung cancer is resurging. Conflicting evidence from previous lung cancer screening trials, based on plain chest radiography, has been the subject of much debate: the failure to demonstrate a reduction in mortality has led to the widely held conclusion that screening for lung cancer is ineffective. The validity of this assumption has been questioned sporadically and a large study currently under way in the U.

ERS transform for the automated detection of bronchial abnormalities on CT of the lungs.

The identification of bronchi on Computed Tomography (CT) images of the lungs provides valuable clinical information in patients with suspected airways diseases including bronchiectasis, emphysema, or constrictive obliterative bronchiolitis. The automated recognition of the airways is, therefore, an important part of a diagnosis aid system for resolving potential ambiguities associated with intensity-based feature extractors. On CT images, near-perpendicular cross sections of bronchi normally appear as elliptical rings and this paper presents a novel technique for their recognition.

Computed tomography of diffuse lung disease: functional correlates.

An appreciation of functional and morphological characteristics is fundamental to the understanding of diffuse lung disease. The detailed information available from high-resolution computed tomography (HRCT) and the facility to subjectively or objectively quantify disease has elucidated the sometimes complex pulmonary function profiles of several diffuse lung diseases. The many reasons why correlations between the extent of HRCT abnormalities and physiological measures of disease may be less strong than expected and are considered in this review.

Small airways diseases: detection and insights with computed tomography.

Diseases affecting the small airways are difficult to detect by traditional diagnostic tests. Widespread involvement is needed before symptoms and abnormalities on pulmonary function testing or chest radiography become apparent. Obstruction of the bronchioles may be detected indirectly by computed tomography (CT) because regional under-ventilation results in reduced perfusion which in turn is shown as a mosaic attenuation pattern of the lung parenchyma.

Functional consequences of pleural disease evaluated with chest radiography and CT.

Purpose: To identify a system for the quantification of pleural thickening with an acceptable level of interobserver variation and good functional correlation in individuals with pleural disease.

Materials And Methods: The extent of pleural thickening and plaques was assessed in 50 patients by using the following: (a) a radiographic score based on the International Labour Office system, (b) a subjective simple computed tomographic (CT) score, (c) a subjective comprehensive CT score, (d) an objective nonautomated method, and (e) an objective computer-aided semiautomated method.

Results: Similar correlations between the extent of diffuse pleural thickening and forced vital capacity were seen for each system (objective CT, r = -0.

Pulmonary perfusion in supine and prone positions: an electron-beam computed tomography study.

Acute respiratory distress syndrome is characterized by alterations in the ventilation-perfusion ratio. Present techniques for studying regional pulmonary perfusion are difficult to apply in the critically ill. Electron-beam computed tomography was used to study the effects of prone positioning on regional pulmonary perfusion in six healthy subjects.

Acute respiratory distress syndrome caused by pulmonary and extrapulmonary injury: a comparative CT study.

Purpose: To determine computed tomographic (CT) differences between acute respiratory distress syndrome (ARDS) due to pulmonary injury (ARDS(p)) and extrapulmonary injury (ARDS(ex)).

Materials And Methods: CT appearances in 41 patients (27 male, 14 female; mean age, 47.1 years +/- 17.

Nitrofurantoin-induced lung disease: two cases demonstrating resolution of apparently irreversible CT abnormalities.

A reticular pattern on high resolution CT (HRCT) invariably represents significant lung pathology and is the dominant feature of irreversible fibrosis. We present two cases of nitrofurantoin-induced pulmonary toxicity in which the initial HRCT showed a widespread reticular pattern and associated distortion of the lung parenchyma, thought to represent established fibrosis. Follow-up HRCT scans after withdrawal of the drug showed resolution of this supposedly irreversible pattern.

The prognostic significance of the histologic pattern of interstitial pneumonia in patients presenting with the clinical entity of cryptogenic fibrosing alveolitis.

Lone cryptogenic fibrosing alveolitis (CFA) is a progressive interstitial lung disease, with a median survival of 3 to 6 yr from the onset of dyspnea. CFA can be subdivided into prognostically significant histopathologic patterns, including nonspecific interstitial pneumonia (NSIP). We reviewed 78 patients with a clinicopathologic diagnosis of CFA, biopsied between 1978 and 1989, to evaluate the prevalence and prognostic significance of these histopathologic patterns, in particular NSIP.

Nonspecific interstitial pneumonia: variable appearance at high-resolution chest CT.

Purpose: To describe the computed tomographic (CT) findings in patients with nonspecific interstitial pneumonia (NSIP) and to compare these with the CT findings of other chronic infiltrative lung diseases.

Materials And Methods: Findings in 50 patients with biopsy-proved NSIP and a CT scan were reviewed by two thoracic radiologists in consensus. After the findings were described, the observers judged whether the findings were compatible with previously published descriptions of NSIP or whether the findings would support the diagnosis of a different chronic infiltrative lung disease.

Computed tomography of diffuse interstitial lung disease in children.

Unlike diseases of the airways, interstitial lung diseases in childhood are exceedingly rare and are usually associated with significant morbidity and mortality. Interstitial lung disease in the paediatric age group is a particular diagnostic challenge because the clinical presentation and radiographic features are so non-specific. High resolution computed tomography (HRCT) has proved its worth in adults with interstitial lung disease and has a role, albeit more limited, in the non-invasive evaluation of paediatric interstitial lung disease.

Effect of lung-volume-reduction surgery in patients with severe emphysema.

Background: Although many patients with severe emphysema have undergone lung-volume-reduction surgery, the benefits are uncertain. We conducted a randomized, controlled trial of the surgery in patients with emphysema. Patients with isolated bullae were excluded because such patients are known to improve after bullectomy.

Asbestos-related benign pleural disease.

Benign pleural disease is the commonest manifestation of asbestos exposure encountered by radiologists. Benign pleural thickening can appear as circumscribed parietal pleural plaques or as more diffuse thickening of the visceral pleura. Benign-asbestos induced pleural effusions are a significant and under-recognized manifestation of asbestos exposure with important sequelae, such as diffuse pleural thickening which may be associated with functional impairment and for which compensation may be sought.

Gradient correction and classification of CT lung images for the automated quantification of mosaic attenuation pattern.

Purpose: The detection of density differences, or "mosaic attenuation pattern," on CT images may be difficult when the regional inhomogeneity of the density of the lung parenchyma is subtle. The purpose of this work was to develop a fully automated method for the reproducible quantification of the underattenuated areas of the lung parenchyma. This technique may be useful in increasing the precision of investigation of structure/function relationships.