2012 RSNA at a Glance (Filtered Schedule) Exhibits & Posters â¢ CT ...

2012 RSNA at a Glance (Filtered Schedule) 

Exhibits & Posters 

• CT Appearances of Lung Adenocarcinomas and Their Histopathologic Correlates(LL-CHE1111) 

• Spectrum of Primary Pulmonary Lymphoproliferative Disorders: Imaging and Pathology Correlation(LL-CHE1112) 

• Combination of Iodine Quantification in Spectral CT Imaging and Thoracic VCAR: Assessment of Distally Lower De...(LL-CHE1113) 

• Standardization of CT-guided Coaxial Cutting Needle Lung Biopsy to Maximize Patient Safety and Diagnostic Yiel...(LL-CHE1114) 

• Ulcers, Plaques, and Flaps: Clearing Up the Confusion about Aortic Pathology(LL-CHE1115) 

• Essential Imaging Findings on Chest CT for Staging Esophageal Carcinoma with Special Emphasis on the Recently ...(LL-CHE1117) 

• How Nonvascular Thoracic MRI Makes a Difference in Clinical Management(LL-CHE1118) 

• Non-gated Chest CT Evidence of Myocardial Ischemia and Infarction(LL-CHE1119) 

• When IPF Turns Ugly: What to Expect in Acute Exacerbation UIP/IPF(LL-CHE1120) 

• Spectrum of Pulmonary Fibrosis CT Findings in Sickle Cell Disease Using an Enhanced Visual Scoring System(LL-CHE1121) 

• Evaluation of Cardiac Masses on Routine Chest CT: An Algorithmic Approach(LL-CHE1122) 

• The Various Conditions of Breast on Chest CT: Correlation with Mammography, Ultrasonography, or MR Imaging(LL-CHE1123) 

• Post-Treatment Imaging of Percutaneous Cryoablation in the Lung(LL-CHE1124) 

• Axilla on Chest(LL-CHE1126) 

• Pulmonary or Extra-pulmonary? A Frequent Dilemma in Chest Imaging(LL-CHE1127) 

• The "Leaking" Esophagus and Thoracic Complications, a Multimodality Pictorial Review(LL-CHE1128) 

• Pulmonary Atelectasis Revisited with Multislice CT(LL-CHE1129) 

• The Spectrum of Bronchopulmonary Sequestration: Imaging Update(LL-CHE1130) 

• Echogenic Solutions to Dyspnoea(LL-CHE1131) 

• Lung Adenocarcinoma Based on IASLC/ATS/ERS International Multidisciplinary Classification: Detection by Low-Do...(LL-CHE1133) 

• Stem to Stern: Imaging Manifestations of Diffuse Tracheobronchial Diseases(LL-CHE1134) 

• Signogram: Patterns and Signs of Diffuse Lung Disease(LL-CHE1135) 

• Phantom of the Lung; Pulmonary Artery Aneurysms in the Behcet's Disease(LL-CHE1136) 

• Lymph-o-rama: Unusual Manifestations of Lymphoma in the Chest(LL-CHE1137) 

• To be or Not to be... a “Pulmonary Nodule”(LL-CHE1138) 

• Radiological Appearance of Newer Cardiac Devices and Lead Sites(LL-CHE1139) 

• Pattern Based Approach to Lung Parenchymal Calcification with Radiological and Pathological Correlation (LL-CHE2272) 

• Undisclosed Diseases of the Chest: What Are They? Why Do Patients Deny Them? How Can the Radiologist Help?(LL-CHE2273) 

• What Is This White Stuff in the Lungs: Diffuse High Attenuating Lung Densities: A Pictorial Review and Differe...(LL-CHE2274) 

• The How and Consequences of Esophagectomy as Seen on CXR and CT(LL-CHE2275) 

• Mediastinal Malignant Lymphoma: Radiological Features Based on Pathological Classifications(LL-CHE2277) 

• Classic Signs in Thoracic Imaging(LL-CHE2278) 

• Digital Tomosynthesis of the Thorax: The Pros and Cons of Low Dose Alteration(LL-CHE2279) 

• Review of Thoracic Duct Imaging by Conventional and New Modalities(LL-CHE2280) 

• Multimodality Review of AIDS Defining Malignancies (ADMs) Involving the Chest with Emphasis on Patterns of Pre...(LL-CHE2281) 

• Imaging of Thoracic Injuries in Professional Rugby Players: Role of Magnetic Resonance Imaging and Computed To...(LL-CHE2282) 

• Think Outside the Lungs: Case Collection of Bone Findings on Chest Imaging(LL-CHE2283) 

• Revisiting the Posterior Mediastinum(LL-CHE2284) 

• Acute and Chronic Pulmonary Thromboembolism: A Challenge Learning Game for Radiology Residents(LL-CHE2285) 

• Spectrum of Imaging Findings in Reactivation Adult Pulmonary Tuberculosis and the Role of Radiological Interve...(LL-CHE2286) 

• Management and Diagnostic Imaging for Minute Pulmonary Nodules with or without Ground-Glass Opacity(LL-CHE2287) 

• The Many Faces of Pulmonary Aspergillosis: Radiologic Spectrum with Clinical Correlation(LL-CHE2288) 

• CPFE (Combined Pulmonary Fibrosis and Emphysema), the New Member of the Alphabet Soup of Interstitial Lung Dis...(LL-CHE2289) 

• Pulmonary Artery Aneurysms: A Dangerous Mimic of Solid Intrathoracic Neoplasms and Their Associated Diagnostic...(LL-CHE2290) 

• LIRADS (The Lung Imaging Reporting and Data System): A New Approach Using the Fleischner Society Guidelines an...(LL-CHE2291) 

• Mediastinal Tuberculosis: A Multimodality Approach to an Infection with Myriad Presentations(LL-CHE2292) 

• What You Should Know About the Superior Vena Cava(LL-CHE2293) 

• YouTube Bloopers: Complications of Tracheal and Esophageal Stents(LL-CHE2294) 

• Pulmonary Complications of Hematopoietic Stem Cell Transplantation (HSCT): A Radiologist’s Toolkit(LL-CHE2295) 

• Imaging Finding of the Pulmonary Manifestations of Systemic Diseases: What the Radiologist Needs to Know(LL-CHE2296) 

• What Did You Say That Is? Chest Radiographic Variants and Misunderstood Anatomy That Mimics Pathology(LL-CHE2297) 

• Guidance for Reporting Screening CT: Introducing the Lung Reporting and Data System (LuRADS)(LL-CHE2298) 

• "Stupid Catheter Tricks: A Case Based Review of Device Misplacement"(LL-CHE2299) 

• Pregnancy and the Thorax: Imaging of Cardiovascular and Pulmonary Complications(LL-CHE2300) 

• 10 Tricks for Conquering the Mediastinum on Chest X-ray(LL-CHE2301) 

• Fistulas, Ingrowth, and Leaks... Oh My! Esophageal Carcinoma Complications and the Utility of 3D CT in Complic...(LL-CHE2302) 

• Hyperdense Lung Findings: An Overlooked and Underappreciated Feature of Airspace and Interstitial Disease Proc...(LL-CHE2303) 

• Treasure Chest: Navigating the "Review Areas" on Chest Radiographs(LL-CHE2304) 

• Cystic Interstitial Lung Diseases: Recognizing the Common and Uncommon Entities(LL-CHE2305) 

• Clinically Useful Signs in Chest Imaging: What Are They Good for?(LL-CHE2306) 

• Multidetector CT in Pulmonary Thromboembolism: When the Parenchyma Can Help(LL-CHE2307) 

• Arch Madness: Spectrum of Aortic Arch Anomalies That May Present in Adulthood(LL-CHE2308) 

• Medistinal Fluid Containing Structures: Simple Cyst or Cystic Mass?(LL-CHE2309) 

• Pseudomasses and Pseudoabnormalities - You Don't Need a CT to Make the Diagnosis(LL-CHE2310) 

• Conventional Pulmonary Radiology: How Long Has It Been Since You Really Practiced It?(LL-CHE2311) 

• Pulmonary Angiography for Chronic Thromboembolic Pulmonary Hypertension: Catching the “Invisible” ...(LL-CHE2312) 

• Save Your Lungs: The Spectrum of Smoking-Related Lung Conditions(LL-CHE2313) 

• Automatic Naming System for Tracheobronchial Structures by Computational Anatomy(LL-CHE2314) 

• The New TNM Staging of Esophageal Cancer: What Chest Radiologists Need to Know(LL-CHE2315) 

• Combined pulmonary fibrosis with emphysema (CPFE): Three Morphological Types and Their Changes Over Time(LL-CHE2317) 

• HRCT Findings of Asbestosis Revisited; Radiologic and Pathologic Correlations(LL-CHE2318) 

• Visual Illusions in the Radiographic Image Revisited in the Digital Era.(LL-CHE2319) 

• Demystifying Ascending Aorta Repair: What the Radiologist Should Know(LL-CHE2320) 

• Pulmonary Calcifications: Beyond the Granuloma…(LL-CHE2321) 

• Mind the Spine: Look for the Unexpected at Chest Imaging(LL-CHE2322) 

• Excipient Lung(LL-CHE2323) 

• Digital Chest Tomosynthesis – Can It Compete with CT?(LL-CHE2324) 

• Foreign Bodies in the Respiratory Tract: Imaging Findings(LL-CHE2325) 

• Normal Variations and Abnormalities of the Diaphragm on Chest Radiograph (CXR): Contrast with Multi-planner Re...(LL-CHE2326) 

• Segmentectomy Planning Using 3D-CTA with a Virtual Safety Margin for Early Stage Lung Cancer(LL-CHE2327) 

• Strategies to Reduce Radiation Exposure of the Female Breast in Chest CT(LL-CHE2328) 

• Spectrum of Thoracic Neuroendocrine Proliferations and Neoplasms: Carcinoid, Carcinoid Tumorlets, DIPNECH, and...(LL-CHE2329) 

• Peripheral Endobronchial Polyp Resection by Computed Tomography Guided Bronchoscopy(LL-CHE2330) 

• Optimization of Pulmonary CT Angiography: Tips and Tricks(LL-CHE2331) 

• Thoracic Central Venous Catheters and Ports Complications Evaluated by Imaging Studies(LL-CHE2332) 

• Chest Radiology Eponyms: Who Were Those Guys??(LL-CHE2333) 

• Bronchiolocentric Lung Diseases: High-Resolution CT and Pathologic Findings(LL-CHE2334) 

• Pulmonary Dual-Energy CT… Like a Boss!(LL-CHE2335) 

• Focal Aortic Protrusions at CT: Differential Diagnosis and Distinguishing Features(LL-CHE2336) 

• Tumours of the Pleura: Imaging Findings According to the Different Histotypes (LL-CHE2337) 

• Clot or Not: The Imaging of Intra-Thoracic Thrombus, Associated Pathophysiology, and Potential Pitfalls(LL-CHE2338) 

• Chronic Obstructive Pulmonary Disease (COPD) – How the Radiologist Can Help(LL-CHE2339) 

• Anatomy of Pericardial Recesses on CT: Implications for Oncologic Imaging(LL-CHE2340) 

• Radiologic Review of Intrathoracic Metastases from Nonseminomatous Germ Cell Tumors of Testicular Origin: Thre...(LL-CHE2341) 

• Spectrum of Iatrogenic Esophageal Injuries Following Esophageal and Non Esophageal Procedures: Role of Imaging...(LL-CHE2342) 

• CT Guided Color Marking for Video Assisted Thoracoscopic Surgery in the Patients with Small Lung Nodules: A Pi...(LL-CHE2343) 

• Tobacco-smoking Induced Acute Eosinophilic Pneumonia; Take Care After Smoking tobacco for the First Time(LL-CHE2344) 

• Imaging of Fibrous Lesions of the Thorax: Radiologic-Pathologic Correlation (LL-CHE2345) 

• Block, Twist and Turn....Role of 3D Imaging- Vascular and Bronchial Complications Post Lung Surgeries(LL-CHE2346) 

• Acute or Subacute Chemical-induced Lung Injuries: Thin-Section CT Findings(LL-CHE2347) 

• Imitation is the Sincerest Form of Flattery: Recognizing Imaging Manifestations of Intrathoracic Lymphoma(LL-CHE2348) 

• Itchy and Erythematous Lungs: Clinical Presentation, Diagnosis and Differentials(LL-CHE2349) 

• The Journey of a Patient Through Acute Aortic Syndrome: A Comprehensive Review Through a Radiologist's Perspec...(LL-CHE2350) 

• Use of Digital Radiography with Dual-Energy Subtraction in Detection of Cardiovascular Pathologies(LL-CHE2351) 

• Imaging Features of Non-neoplastic Chest Wall Disorders(LL-CHE2352) 

• How to Manage Small Pulmonary Nodules Detected on CT?: Guidelines From the Japanese Society of CT Screening(LL-CHE2353) 

• Pulmonary Nontuberculous Mycobacterial Infection: A Great Mimicker(LL-CHE2354) 

• Congenital Thoracic Malformations: Plain Film Approach and MDCT Correlation(LL-CHE2355) 

• Role of Multidetector CT in the Evaluation of Airway Stents(LL-CHE2356) 

• X Marks the Spot: Review of Lung Pathology with Bronchovascular Distribution(LL-CHE2357) 

• Looking Beyond the Pulmonary Arteries for Causes of Chest Pain or Dyspnea on CT Pulmonary Angiogram(LL-CHE2358) 

Page 1 of 97

• Intrathoracic Mediastinal Thyroid Goiters: Imaging Manifestations and Differential Diagnosis(LL-CHE2359) 

• Role of Chest Imaging in the Evaluation of Complications Post-Bone Marrow Transplantation(LL-CHE2360) 

• Thoracic Aortic Diameter in MR: Slicing It Beyond the Anatomical Planes(LL-CHE2361) 

• Pulmonary Hemangioendothelioma – Pictorial Review of Clinical, Radiological and Histopathological Featur...(LL-CHE2362) 

• Misdiagnosis and Missed Diagnosis in the Interpretation of Chest Radiographs: A Practical Review(LL-CHE2363) 

• Dual Energy CT (DECT) Imaging for Pulmonary Hypertension (PH): Challenges and Opportunities(LL-CHE2364) 

• Diverse Fungal Pneumonia: A Pictorial Review(LL-CHE2365) 

• Dual Energy Subtraction Chest Radiography – When and Why?(LL-CHE2366) 

• Benign and Rare Malignant Esophageal Tumor: Multimodality Approach Using Chest CT, MRI, FDG/PET CT, and Endosc...(LL-CHE2367) 

• Drug-Induced Pulmonary Toxicity: Manifestations of CT and F18 FDG PET/CT(LL-CHE2368) 

• Fusion of Lung Perfusion Blood Volume (Lung PBV) and 99mTc-MAA SPECT Images in Patients with Pulmonary Embolis...(LL-CHE2369) 

• Lipomatous Lesions of the Chest: A Carefree Image Reading(LL-CHE2370) 

• The Lumpy Bumpy Pleura: Radiology-Pathology Correlation of Pleural Biopsies(LL-CHE2371) 

• Ground Glass and Part Solid Nodules: What Radiologists Need to Know(LL-CHE2372) 

• New Aspects and Issues Arising from Lung Cancer Screening with MDCT(LL-CHE2373) 

• CT and MRI of Pulmonary Arterial Abnormalities: A Pictorial Review(LL-CHE2374) 

• Pulmonary Coccidioidomycosis: Pictorial Review of Chest Radiographic and CT Findings(LL-CHE2375) 

• Chest-Devices: A Constantly Updated Online Guide to Recognizing Devices on Chest X Ray(LL-CHE2376) 

• Thoracic Fat-containing Lesions: Differential Diagnosis Using a Multimodality Imaging Evaluation(LL-CHE2377) 

• Pulmonary Fissures and Their Importance for Novel Respiratory Treatments - An Interactive MDCT Teaching Atlas(LL-CHE2378) 

• Chest in the Elderly: Physiological or Pathological Findings?(LL-CHE2379) 

• Interpretation of Fusion Imaging between Diffusion-Weighted Imaging and 3D Fat Suppressed Contrast-enhanced T1...(LL-CHE2380) 

• Sonographic Appearances of Thoracic Pathology: A Pictorial Review(LL-CHE2381) 

• Surgical Approach to Primary and Secondary Pleural Malignancies: Anatomy, Surgical Planning and Techniques, an...(LL-CHE2382) 

• Update in the Evaluation of the Solitary Pulmonary Nodule: Solid and Subsolid Lesions(LL-CHE2383) 

• Pulmonary Artery Sarcoma (PAS): A Challenging Diagnosis(LL-CHE2384) 

• The ABC of the Retrocrural Space(LL-CHE2385) 

• Time Is On Your Side: Common Post Pneumonectomy Complications and Their Chronicity(LL-CHE2386) 

• Secondary Causes of Pneumothorax: The Role of High Resolution CT (HRCT) in Diagnosis(LL-CHE2387) 

• Intra-thoracic Complications of Solid Abdominal Organ and Multivisceral Transplantation: Our institutional Exp...(LL-CHE2388) 

• Thoracic Calcifications/Ossifications on Frontal Chest Radiograph: A Comprehensive Imaging-based Approach to D...(LL-CHE2389) 

• Functional MR to Monitoring Cystic Fibrosis (CF) Lung Disease(LL-CHE2390) 

• PET/CT in Evaluation of Thoracic Lymphoma: Imaging Update(LL-CHE2391) 

• Importance of Accurate Pulmonary Artery/Vein Separation Prior to Lung Cancer Resection: Preliminary Trial Base...(LL-CHE2392) 

• Morphologic and Functional Image Biomarkers of Treatment Response in Advanced Non-Small Cell Lung Cancer(LL-CHE2393) 

• Lung Adenocarcinoma: Radiologic-Pathologic Correlation(LL-CHE2394) 

• Vasculitis of the Thorax: Pictorial Review of MDCT and 18FDG PET-CT Features of Typical Manifestations and Imp...(LL-CHE2395) 

• Correlation of Pulmonary Function Testing (PFT) in Lung Diseases(LL-CHE2396) 

• The Ins and Outs of Chest Wall Abnormalities: A Radiologist’s Guide to Evaluating Pectus Excavatum and P...(LL-CHE2397) 

• Dose Reduction Strategies in Pulmonary Embolism (PE) without Sacrificing Image Quality(LL-CHE2398) 

• The Many Faces of Pulmonary Hemorrhage: A Teaching Exhibit(LL-CHE2399) 

• Non-neoplastic Disorders of Esophagus on MDCT (LL-CHE2400) 

• Azygos System on MDCT: Pictorial Essay(LL-CHE2401) 

• Bronchoscopic Treatment of Emphysema: The Role of Thoracic CT(LL-CHE2402) 

• Calcium in the Airway(LL-CHE2403) 

• Dynamic Respiratory Motion Imaging of the Pulmonary Lobes Using 320-row ADCT(LL-CHE2404) 

• Clinical Applications of Low Dose Multidetector Chest CT (LDCT)(LL-CHE2405) 

• Pulmonary Manifestations/Complications of Renal Disorders: A Pictorial Review(LL-CHE2406) 

• Congenital Chest Malformations Simulating Pathology in the Adult(LL-CHE2407) 

• Clinical Impact of Novel CT Technologies for Diagnosing Various Chest Diseases: What the Radiologist and Radio...(LL-CHE2408) 

• Pneumothorax: Everything a Resident Needs to Know(LL-CHE2409) 

• The Use of MRI in the Characterization of the Central Lung Cancer from Associated Lung Collapse/Consolidation(LL-CHE2410) 

• 4-Dimensional (4-D) Assessment of Tracheal Diverticulum with 320-Slice Multidetector CT(LL-CHE2411) 

• Pulmonary Tuberculosis Confirmed by Percutaneous Transthoracic Needle Biopsy: CT Findings and Correlation with...(LL-CHE2412) 

• HRCT Features of Interstitial Lung Disease in Antisynthetase Syndrome(LL-CHE2413) 

• ECG-gated High Resolution CT of Chest (HRCT): A Technique to Reduce Cardiac Motion Artifacts and Radiation Dose(LL-CHE2414) 

• Bone Lesions in the Setting of a Known Malignancy: A Systematic Approach for the Thoracic Radiologist(LL-CHE2415) 

• Quantitative Diagnostic Imaging of Lungs and Airways in Patient with Asthma: Modern Imaging Techniques and The...(LL-CHE2416) 

• Chest Case of the Day(LL-EDE1003) 

Sunday, November 25, 2012 

10:45-12:15 PM • SSA04 • Room: S404CD • Chest (Functional Lung Imaging) 

10:45-12:15 PM • SSA05 • Room: N227 • ISP: Emergency Radiology (Imaging Chest Emergencies) 

12:30-01:30 PM • LL-CHE-SU • None assigned • Chest Lunch Hour CME Exhibits 

12:30-01:30 PM • LL-CHS-SU • Room: Lakeside Learning Center • Chest Lunch Hour CME Posters 

02:00-03:30 PM • RC101 • Room: E451B • Hot Topics in Thoracic Imaging 

Monday, November 26, 2012 

08:30-10:00 AM • MSRO21 • Room: S103AB • BOOST: Lung—Anatomy and Contouring (An Interactive Session) 

08:30-10:00 AM • RC201 • Room: E450A • Lung Cancer Screening: Update 2012 

10:30-12:00 PM • MSRO22 • Room: S103AB • BOOST: Lung—Integrated Science and Practice (ISP) Session 

10:30-12:00 PM • SSC03 • Room: S404AB • Chest (Emphysema and Airways Disease) 

10:30-12:00 PM • SSC04 • Room: S404CD • Chest (Thoracic Malignancy) 

12:15-01:15 PM • LL-CHE-MO • None assigned • Chest Lunch Hour CME Exhibits 

12:15-01:15 PM • LL-CHS-MO • Room: Lakeside Learning Center • Chest Lunch Hour CME Posters 

01:30-06:00 PM • VSIO21 • Room: S405AB • Interventional Oncology Series: Lung 

03:00-04:30 PM • MSRO23 • Room: S103AB • BOOST: Lung—Case-based Review (An Interactive Session) 

03:00-04:00 PM • SSE05 • Room: S404CD • ISP: Chest (Vascular) 

03:00-04:00 PM • SSE19 • Room: S505AB • Nuclear Medicine (PET/CT Chest Oncology) 

04:30-06:00 PM • SPDL21 • Room: E451A • Diagnosis Live powered by RSNA-DxLive: The Audience Participation Game (Chest and Abdomen) 

05:00-06:00 PM • LL-CHS-MOPM • Room: Lakeside Learning Center • Chest Afternoon CME Posters 

Tuesday, November 27, 2012 

08:30-12:00 PM • VSCH31 • Room: N230 • Chest Series: Lung Nodules/Lung Cancer 

08:30-12:00 PM • VSPD31 • Room: S102AB • Pediatric Radiology Series: Chest/Cardiovascular Imaging I 

10:30-12:00 PM • SSG05 • Room: S405AB • Chest (Diffuse Lung Disease) 

12:15-01:15 PM • LL-CHE-TU • None assigned • Chest Lunch Hour CME Exhibits 

12:15-01:15 PM • LL-CHS-TU • Room: Lakeside Learning Center • Chest Lunch Hour CME Posters 

03:00-04:00 PM • SSJ05 • Room: S404CD • Chest (Infection) 

03:00-04:00 PM • SSJ24 • Room: S104A • Radiation Oncology and Radiobiology (Lung) 

03:00-06:00 PM • VSPD32 • Room: S102AB • Pediatric Radiology Series: Chest/Cardiovascular Imaging II 

03:30-05:00 PM • MSCC34 • Room: S406A • Case-based Review of Nuclear Medicine: PET/CT Workshop—Cancers of the Thorax (In Conjunction with S... 

04:30-06:00 PM • RC401 • Room: S406B • Common Problems in Thoracic Imaging 

05:00-06:00 PM • LL-CHS-TUPM • Room: Lakeside Learning Center • Chest Afternoon CME Posters 

Wednesday, November 28, 2012 

08:30-10:00 AM • RC501 • Room: E353C • New Frontiers in Imaging COPD and the Airways (An Interactive Session) 

08:30-10:00 AM • RC551 • Room: E261 • PET/CT in the Thorax: Interpretation, Pitfalls, and Future Developments (How-to Workshop) 

10:30-12:00 PM • MSES42 • Room: S100AB • Essentials of Chest Imaging 

10:30-12:00 PM • SSK03 • Room: S404CD • Chest (Lung Nodule I) 

12:15-01:15 PM • LL-CHE-WE • None assigned • Chest Lunch Hour CME Exhibits 

12:15-01:15 PM • LL-CHS-WE • Room: Lakeside Learning Center • Chest Lunch Hour CME Posters 

03:00-04:00 PM • SSM04 • Room: S504AB • ISP: Cardiac (Dual Energy) 

03:00-04:00 PM • SSM05 • Room: S404CD • Chest (Interventional) 

04:30-06:00 PM • SPSC43 • Room: E353C • Controversy Session: V/Q Scans versus CT for Pulmonary Emboli 

05:00-06:00 PM • LL-CHS-WEPM • Room: Lakeside Learning Center • Chest Afternoon CME Posters 

Thursday, November 29, 2012 

08:30-10:00 AM • RC651 • Room: E261 • CT and MR Imaging of Thoracic Vasculitides (How-to Workshop) 

08:30-12:00 PM • VSCH51 • Room: E351 • Chest Series: Pulmonary Embolism and Pulmonary Arterial Hypertension&#8212Concepts and Controversies 

10:30-12:00 PM • MSCP52 • Room: S406A • Case-based Review of Pediatric Radiology: Thoracic Imaging (An Interactive Session) 

10:30-12:00 PM • SSQ03 • Room: S405AB • Chest (Radiation Dose) 

12:15-01:15 PM • LL-CHE-TH • None assigned • Chest Lunch Hour CME Exhibits 

12:15-01:15 PM • LL-CHS-TH • Room: Lakeside Learning Center • Chest Lunch Hour CME Posters 

03:00-04:00 PM • SPSH53 • Room: S406B • Hot Topic Session: Functional and Quantitative Imaging of the Lung 

04:30-06:00 PM • RC701 • Room: E353A • Interactive Game powered by RSNA-DxLive: The Audience Participation Game (Diffuse Lung Diseas... 

04:30-06:00 PM • RC712 • Room: S103CD • Aorta: Treatment Planning and Follow-up (An Interactive Session) 

04:30-06:00 PM • RC714 • Room: E353C • Acute and Chronic Pulmonary Emboli: Diagnosis and Treatment (An Interactive Session) 

04:30-06:00 PM • RC717 • Room: S504CD • Quantitative Imaging in Lung Disorders 

Friday, November 30, 2012 

08:30-10:00 AM • RC801 • Room: S406A • High-Resolution CT: A Pattern-based Approach (An Interactive Session) 

08:30-10:00 AM • RC825 • Room: E350 • Quantitative Imaging: Diffuse Lung Disease Assessment Using CT 

10:30-12:00 PM • SST03 • Room: E451B • ISP: Chest (Lung Nodule II) 

Back to @ a Glance 

LL-CHE1111 

CT Appearances of Lung Adenocarcinomas and Their Histopathologic Correlates 

Page 2 of 97

Vinit Amin, MD , Adam Jacobi, MD , Mary Beth Beasley 

PURPOSE/AIM 

Review new multidisciplinary adenocarcinoma classification recently recommended by International Association for Study of Lung Cancer/American Thoracic Society/European Respiratory 

Society International (2011).Discuss spectrum of imaging findings of adenocarcinoma on CT (in situ, atypical adenomatous hyperplasia, minimally invasive , invasive) and discuss prognostic 

implications of each sub-group.Correlate CT findings of adenocarcinoma types with histopathologic specimens obtained through biopsy/resection.To briefly discuss incidence of ground glass 

and semi-solid nodules and review proposed recommendations for follow up. 

CONTENT ORGANIZATION 

Brief Introduction to New Multidisciplinary Classification of Lung Adenocarcinoma.Review of CT Findings of Adenocarcinoma and Similar-Appearing ConditionsPathophysiology, Natural 

Course, and Prognosis of Different Adenocarcinoma Sub-TypesCorrelation between CT Findings and Histopathologic SpecimensFuture directions and summary 

SUMMARY 

Review new multidisciplnary classification of adenocarcinoma.Review spectrum of lung adenocarcinomas and their CT appearances.Appreciate correlation between CT appearances of 

adenocarcinoma and associated histopathologic findings.Become familiar with natural course and prognosis of adenocarcimomas with basic recommendations for imaging follow-up and 

treatment. 


LL-CHE1112 

Spectrum of Primary Pulmonary Lymphoproliferative Disorders: Imaging and Pathology Correlation 

Joao Inacio, MD , Carolina Souza, MD , Ashish Gupta, MD , Samanjit Hare, MBBS, MA , Marcio Gomes, MD , Harmanjatinder Sekhon, MD , Jean Seely, MD , Ana-Maria 

Bilawich, MD , John Mayo, MD , Nestor Muller, MD, PhD , Carole Dennie, MD 

PURPOSE/AIM 

To gain awareness of the continuum of pathologic entities that characterize the primary pulmonary lymphoproliferative disorders. Review their underlying histological and imaging 

appearances, with emphasis on correlation of findings between High Resolution Computed Tomography (HRCT) and Pathology. 


Primary Pulmonary Lymphoproliferative Disorders: Clinical, Radiological and Pathological spectrumPulmonary Lymphoid Hyperplasia:Focal /Nodular Lymphoid HyperplasiaDiffuse Pulmonary 

Lymphoid Hyperplasia/ Follicular BronchiolitisLymphoid Interstitial PneumoniaPrimary pulmonary Lymphoma:Low grade Bronchial Associated Lymphoid Tissue LymphomaDiffuse large B – cell 

lymphomaLymphomatoid GranulomatosisIntravascular large B cell lymphomaPosttransplantation lymphoproliferative disorder 

SUMMARY 

1. Pulmonary lymphoproliferative disorders comprise a complex group of diseases, resulting in a spectrum of focal and diffuse abnormal proliferation of lymphoid tissue in the lung, 

associated with a continuum of benign to malignant course.2. The spectrum of appearances of these entities on HRCT correlates closely with pathology findings. In the proper clinical 

setting, imaging findings can often suggest the presence of a lymphoproliferative disorder, guiding clinical decisions and management. 


LL-CHE1113 

Combination of Iodine Quantification in Spectral CT Imaging and Thoracic VCAR: Assessment of Distally Lower Density of Central Lung Cancer 

Ying Ge, MD , Ailian Liu, MD , Zhiyong Li , Yijun Liu , Huizhi Cao , Ruyi Bao, MD , Renwang Pu, MBBCh,FRCPC 

PURPOSE/AIM 

Assess the pathomechanism of the distally lower density of central lung cancer using iodine quantification through material decomposition technique with spectral CT imaging and analysis of 

pulmonary emphysema through Thoracic VCAR. 


8 patients with central lung cancer confirmed by operation underwent dual energy CTCT values of 70 keV and iodine-water concentrations were measured on the low density area and the 

corresponding area in contra-lateral normal lung in arterial phaseAnalyzed pulmonary emphysema distribution through Thoracic VCAR, and reconstructed the pseud-color MIP images with 

blue. 

SUMMARY 

Positive correlation was found between the CT value on 70 keV images and iodine-water concentrations (P>0.05),but it was lower in the low density area.There were no signs of emphysema in the 

distally lower density of central lung cancer with Thoracic VCAR.Combination of iodine quantification in spectral CT imaging and Thoracic VCAR could assess the pathomechanism of the distally 

lower density of central lung cancer induced by low blood perfusion or emphysema.Spectral CT imaging with multiple parameters is a new technique to make sure weather it is low blood perfusion or 

emphysema for radiologists in central lung cancer. 


LL-CHE1114 

Standardization of CT-guided Coaxial Cutting Needle Lung Biopsy to Maximize Patient Safety and Diagnostic Yield: Lessons Learned from 3000 Biopsies and Literature 

Review 

Kee-Min Yeow, MD , Richard Chen, MD , Yun Ju Yeow, BA,BA , Kuang-Tse Pan, MD , Kar-Wai Lui, MD , Yun-Chung Cheung, MD , Yi Kang Ku, MD , En-Haw Wu, MD , 

Yung-Liang Wan, MD 

PURPOSE/AIM 

Standardization of CT-coaxial cutting needle lung biopsy procedure to minimize pneumothorax, bleeding, systemic air embolization, and to maximize diagnostic yield 


1. Standard biopsy protocol to maximize patient safety and diagnostic yield is reviewed: a. indications. b. contraindications: c. pprinciples of needle path selection. d. standard cutting 

needle lung biopsy techniques -needle path selection, needle guide insertion, ensure good cutting samples, precautions of air embolization and pneumothorax, know your cutting biopsy 

device.2. Three tables summarizing factors affecting pneumothorax, bleeding, diagnostic yield, systemic complication.3. Special procedures: increased needle path for subpleural/pleural 

based nodule, tangential cut for cavitary lesion, coaxial FNAC for obviously malignant features if there is bleeding risk, holding needle guide in thin chest wall, dorsal/ventral angulated 

needle path for lesions under the rib, 1cm nodule using spacer, proactive needle guide aspiration of pneumothorax.4. Share our mistakes. 

SUMMARY 

This exhibit will review:a. the standardized CT-guided coaxial cutting needle biopsy procedureb. the factors affecting pneumothorax, bleeding, systemic air embolization and diagnostic 

yieldd. special techniques on "how to" for difficult cases and lessons learned from our mistakes 


LL-CHE1115 

Ulcers, Plaques, and Flaps: Clearing Up the Confusion about Aortic Pathology 

Conor Lowry, MD , Nikhil Goyal, MD , Suzanne Baron, MD , Brian Ghoshhajra, MD , James Malpeso , Ari Steiner, MD 

PURPOSE/AIM 

Aortic pathology can be complex and difficult to master for residents. Not uncommonly, descriptive terms are misused in describing aortic disease which can lead to incorrect diagnosis. We 

demonstrate examples of diagnoses such as atheromatous plaque, ulcerated plaque, penetrating ulcer, dissection, intramural hematoma, and transection.Using diagrams and cases we 

demonstrate the differences between these entities and mention appropriate management recommendations when required. 


Following entities will be discussed/shown:Atheromatous plaqueUlcerated plaquePenetrating aortic ulcerDissection flapIntramural hematomaTransection 

SUMMARY 

Major teaching points:Atheroma forms on intimaUlcerated plaque erodes plaque surface but stops at or before intimaPenetrating ulcer forms when erosion extends beyond the intimal 

surface and is a dissection equivalentIntramural hematoma occurs with vasa vasorum rupture and is a dissection equivalentDissection occurs with blood extension into the media and 

creates a flapTransection involves all layers 


LL-CHE1117 

Essential Imaging Findings on Chest CT for Staging Esophageal Carcinoma with Special Emphasis on the Recently Revised TNM Staging System 

Esther Ro, MD , Maria Martin, MD , Palmi Shah, MD 

PURPOSE/AIM 

Educate the radiologist on the revisions in the 7th edition TNM staging for esophageal carcinoma and the major differences from the 6th edition.Review findings on chest CT that have a 

direct impact on staging in accordance to the revised TNM system. Role of PET-CT where relevant will also be discussed. 


Review of anatomy relevant to staging: divisions of the esophagus and nodal stations.CT findings of local invasion that determine T classification. Discuss revisions to T staging.CT findings 

relevant to the revised N and M staging (e.g. lymph node count‚ regional versus metastatic lymph nodes).New separate stage groupings for SCC and adenocarcinoma in the 7th 

edition.Potential pitfalls of chest CT imaging for staging esophageal cancer. Utility of PET-CT as complementary imaging modality. 

SUMMARY 

The radiologist plays a vital role in staging esophageal carcinoma; thus‚ a firm grasp on the recent revisions to the TNM staging system is pertinent. Some of the major changes include new 

emphasis on the lymph node count and revised criteria for defining regional nodal and metastatic disease. The CT appearance of esophageal cancer has a direct impact on the TNM staging. 

Therefore‚ an understanding of the key CT findings‚ as well as the potential pitfalls‚ is essential for accurate staging. 

Page 3 of 97


LL-CHE1118 

How Nonvascular Thoracic MRI Makes a Difference in Clinical Management 

Jeanne Ackman, MD , Christopher Walker, MD , Carol Wu, MD , Mari Mino Kenudson, MD , Jo-Anne Shepard, MD 

PURPOSE/AIM 

Show multiple thoracic imaging cases in which MRI helped alter and/or solidify clinical managementHighlight advantages of MRI over CT in lesion characterizationEmphasize value of 

primarily non-contrast MRI as a means of follow-up of unknown, probably benign lesions on account of its lack of ionizing radiation and absence of known deleterious biological effects 


The value of MRI of the thorax will be demonstrated with:MR imaging of various lesions, with short patient history and CT and/or CXR correlation when relevant/availableMediastinal 

lesionsDistinction between cystic and solid lesionsDetection of septations, enhancement, and nodularityTriage of thymic lesions: hyperplasia versus tumor, thymoma versus lymphomaPleural 

lesionsBenignMalignantDiaphragmatic lesionsDiaphragmatic herniationEndometriosisMedical illustrations when applicableTable containing our non-vascular thoracic MR protocolA brief 

discussion about the narrowing gap in cost between CT & MRFuture directions 

SUMMARY 

From this exhibit, the attendees will be able to:Understand the value of thoracic MRI in clinical practiceLearn common indications for thoracic MRIBe familiar with MR findings that facilitate 

clinical management 


LL-CHE1119 

Non-gated Chest CT Evidence of Myocardial Ischemia and Infarction 

Brian Rau, MD , Carlos Andres Rojas, MD 

PURPOSE/AIM 

The goal of our exhibit is to demonstrate the wide range of imaging findings related to myocardial ischemia/infarction commonly seen on non-gated Chest CT. 


Imaging findings of myocardial injury from coronary artery disease are commonly seen in the adult population on non-gated Chest CT. It is important for the radiologist to recognize the 

imaging characteristics of myocardial injury from coronary artery disease on non-gated Chest CT to understand their clinical implications and differential considerations. Imaging findings of 

myocardial ischemia/infarction on Chest CT include left ventricular chamber enlargement, decreased myocardial enhancement, myocardial thinning, fatty metaplasia, papillary muscle/wall 

calcification, aneurysm/pseudoaneurysm formation, thrombus formation, and delayed enhancement. Important associated imaging findings on non-gated Chest CT such as pulmonary 

edema with dilation of the heart chambers and venous structures can be seen in the setting of acute and/or chronic left ventricular failure. In this educational exhibit we will depict 

examples of these imaging findings, pitfalls, and differential considerations. 

SUMMARY 

Myocardial ischemia/infarction results in a wide range of imaging findings on non-gated Chest CT. Recognition of these imaging findings is essential to aid in diagnosis and potentially guide 



LL-CHE1120 

When IPF Turns Ugly: What to Expect in Acute Exacerbation UIP/IPF 

Claudio Silva, MD , Juan-Carlos Diaz, MD , Julia Alegria, MD , Hernan Cabello, MD , Georgina Miranda, MD 

PURPOSE/AIM 

The purpose of the exhibit is:1) Review the clinical and radiological definitions for acute exacerbation of UIP/IPF (AE UIP/IPF)2) Discuss prognostic factors and patterns that have been 

described in the literature associated with poor prognosis3) Review possible outcome and patterns to be expected in follow-up CT studies 


a) Pathophysiology asociated with acute exacerbation of UIP/IPFb) Review of imaging findings to be expected on CT and its correlation with histology findingsc) Discussion on patterns 

associated with poor prognosisd) Differential diagnosise) Follow-up findings to be expected in those that survive the acute event 

SUMMARY 

The major teaching points for this exhibit are:1. AE UIP/IPF is a pathological state that can be defined by clinical and CT findings.2. There are certain patterns that have been associated with 

poor prognosis, readily detected by CT.3. Radiologists and pulmonologists must be aware of the imaging elements that determine poor prognosis, and what to expect in those who survive 

the acute setting 


LL-CHE1121 

Spectrum of Pulmonary Fibrosis CT Findings in Sickle Cell Disease Using an Enhanced Visual Scoring System 

Les Folio, DO, MPH , Jenifer Siegelman, MD, MPH , Alem Mehari, MD , Daniel Mollura, MD , Jesus Caban, PhD , Joe Fontana, MD , Alam Shoaib, MD , Genevieve Jacobs , 

Gregory Kato, MD 

PURPOSE/AIM 

We present Computed Tomography (CT) lung imaging findings in Sickle Cell Disease (SCD) and describe a visual scoring system we developed to objectively characterize the chronic 

parenchymal abnormalities of this disease. 


A scoring system with pictorial reference standards was created based on visual assessment of lobar percentages of interstitial markings, ground-glass opacities (GGO), and pleural 

thickening. Modifications were made to previously reported methods of fibrosis scoring to include pleural involvement to better capture SCD specific fibrotic features. Two radiologists 

independently reviewed 99 chest CTs from adults with HgbSS and HgbSC SCD as part of several studies correlating CT findings of lung fibrosis with clinical parameters and automated QCT 

(Quantitative CT). 

SUMMARY 

Following independent review, example CT images were selected and described to compile the pictorial spectrum of findings. The multidisciplinary team reviewed the results, images and 

description following analysis, which further validated the correlation between radiographic and pathogenic disease presentation. Our SCD Lung CT atlas may have merit for clinical grading, 

automation baselines, and provides a framework for future studies. 


LL-CHE1122 

Evaluation of Cardiac Masses on Routine Chest CT: An Algorithmic Approach 

Nikhil Goyal, MD , Iakovos Koutras, MD , Adam Bernheim, MD 

PURPOSE/AIM 

To provide an organized approach to evaluate incidentally noted cardiac masses on routine chest CT. 


List of key questions to ask when a cardiac mass is encounteredReview of cardiac masses by location (ie. - the differential depends on which chamber the mass resides in) (with sample 

cases)Review of sample cases imaging characteristics on CT, MR, and echoRecommendations for appropriate further testing when necessary (ex.- CT abdomen for right atrial mass to 

evaluate for HCC or RCC )Summary 

SUMMARY 

1. The differential of a cardiac mass can often be narrowed by deciding if the mass is predominantly myocardially based, pericardial, intraluminal, or associated with a valve.2. If 

intraluminal, the differential can be further narrowed by what chamber is predominantly involved. In the left atirum this includes myxoma vs. thrombus, but in the left atrial appendage, the 

differential includes thrombus vs mixing artifact. In the RA, spread from intra-abdominal malignancy should be considered.3. Followup may not be needed in some cases if the right features 

of cardiac masses are known which can lead to diagnosis. Otherwise, echo or MRI can be helpful for further characterization. In some instances, followup may require imaging other parts of 

the body. 


LL-CHE1123 

The Various Conditions of Breast on Chest CT: Correlation with Mammography, Ultrasonography, or MR Imaging 

Kyung A Kang , Mi-Jin Kang , Woo Ho Cho , Jihae Lee , Han Bee Lee, MD , Ji Young Kim , Joung Sook Kim , Gyeong Min Park, MD , Tae Kyung Kang 

PURPOSE/AIM 

1. To present normal anatomy of breast on chest CT2. To review benign and malignant disease of breast on CT3. To suggest a clue of breast cancer on CT 


1. Normal anatomy of the breast on chest CT: correlation with other US or mammography2. Various conditions of breast on chest CT : correlation with mammography, ultrasonography, or 

MR imaging1) Normal variant or physiologic condition: accessory breast, intramammary lymph node, lactating breast2) benign condition- gynecomastia, mastitis, injection granuloma, 

galactocele- postop. normal and abnormal finding- mammoplasty: normal CT finding, capsular rupture of mammoplasty bag- post- RT change- benign neoplasm 3) Malignant neoplasmcases- 

Summary of imaging characteristics of breast cancer on CT 

SUMMARY 

The breast is an important anatomic compartment in terms of increasing incidence of breast cancer, almost always included routine chest CT scan range. However, it is not easy to 

radiologist to detect abnormality or to differentiate benign or malignant condition. In this exhibit we present normal anatomy of breast and various diseases on chest CT. Thus we try to 

present clue to suggest malignant breast cancer that required further evaluation. Knowledge and familiarity with various conditions of breast may help appropriate care for patients 

Page 4 of 97


LL-CHE1124 

Post-Treatment Imaging of Percutaneous Cryoablation in the Lung 

Anshuman Bansal, MD , Fereidoun Abtin, MD , Antonio Gutierrez, MD , Robert Suh, MD 

PURPOSE/AIM 

Percutaneous cryoablation (PCT) is promising treatment option for primary lung tumors and metastases to the lung that is becoming more commonly used. Patients are commonly followed 

with post-ablative CT imaging at one month, and three month intervals thereafter. The purpose of this educational exhibit is to demonstrate and discuss the intra-procedural CT imaging 

findings of PCT suggestive of complete ablation, normal post cryoablative imaging findings, and post-cryoablative imaging findings suspicious for residual tumor or tumor recurrence. 


• Background and indications• Intra-procedural imaging characteristics of a successful ablation• Immediate post-procedural complications• Imaging characteristics of the post ablation 

zone o CT morphology o CT contrast enhancement o PET activity• Imaging findings concerning for residual tumor or recurrence of malignancy 

SUMMARY 

Given the increasing use of PCT in lung cancer patients, it is important for both interventional and diagnostic radiologists to understand normal and abnormal peri-operative and 

post-ablative imaging findings of cryoablation. 


LL-CHE1126 

Axilla on Chest 

Gyeong Min Park, MD , Mi-Jin Kang , Woo Ho Cho , Jihae Lee , Han Bee Lee, MD , Myeong Ja Jeong , Joung Sook Kim , Jae Hyung Kim , Tae Kyung Kang 

PURPOSE/AIM 

1. To review normal anatomy of axilla on CT2. To present various abnormalities on axilla3. To establish difference between benign and malignant lesions of axilla 


1. Normal anatomy of axilla on CT- Boundary and its contents2. Abnormal finding on axilla on chest CT- Trauma : laceration, hematoma, emphysema- Associated with axillary lymph nodes1 Normal 

feature2 Benign disease3 Malignanti. Metastasisii. Hematologic malignancy : Hodgkin’s lymphoma,non-Hodgkin’s lymphoma, leukemia,- Other masses other than lymph nodes1 Benign mass2 

Malignancy 

SUMMARY 

The axilla is an important anatomic compartment that in involved in a wide variety of pathologic condition, almost always included usual chest CT scan range. However, it is not easy for 

beginner radiologists to concentrate on axilla and detect abnormality when encounter with chest CT. After understand normal anatomy of axilla and learn about various disease of axilla on 

chest CT, find out the abnormality of axilla on chest CT will not be as difficult as before. In this exhibit we present various diseases in axilla can be detected on chest CT and establish 

difference between malignant and benign lesions in axilla. Knowledge of normal anatomy, and disease entity of axilla may lead radiologists to properly diagnose these diseases. 


LL-CHE1127 

Pulmonary or Extra-pulmonary? A Frequent Dilemma in Chest Imaging 

Ana Manzano Diaz, MD , Luis Uriza, MD , Carolina Gomez, MD , Susana Calle, MD , Mario Uribe, MD , Fernando Rodriguez, MD 

PURPOSE/AIM 

The purpose of this exhibit is to:1. Review imaging signs that permit differentiation of pulmonary from non-pulmonary opacities in the chest radiograph2. Review imaging signs that 

permit differentiation of pulmonary from non-pulmonary lesions in multidectctor CT images3. Discuss diferential diagnosis of pulmonary , pleural, chest wall, mediastinum and 

diaphragmatic lesiones that can be confused among themselves. 


1. Review of radiographic signs of pulmonary and extrapulmonary opacities 2. review of multislice CT signs of pulmonary and extrapulmonary opacities3. Description of pulmonary, 

pleural,chest wall,diaphragm, mediastinal and superior abdomen pathologies and their imaging presentations. 

SUMMARY 

The major teaching points of this exhibit are:1. Air bronchogram and parenchymal enhancement are the most reliable sign of pulmonarry etiology of a thoracic opacity.2. Absence of air 

bronchogram does not exclude a pulmonary etiology of a chest opacity 


LL-CHE1128 

The "Leaking" Esophagus and Thoracic Complications, a Multimodality Pictorial Review 

Francisco Garcia-Morales, MD , Gregg Rice, MD , Pramod Gupta, MD 

PURPOSE/AIM 

The purpose of this exhibit is:To review the pathophysiology of the "leaking" esophagus (perforation and acquired tracheo-esophageal fistula) including iatrogenic and non-iatrogenic.To 

discuss the different clinical scenarios and morbidity of the acute esophageal perforation and complications as well as the relative indolent presentation of contained perforation.To illustrate 

with sample cases the radiographic manifestations of the leaking esophagus and associated complications. 


Etiologies of the leaking esophagus:Perforation: Iatrogenic : after endoscopic procedures and nasogastric tube placement .Non Iatrogenic: Accidental caustic ingestion, infectious 

(Mycobacterium kansasii), neoplastic and secondary to radiation therapy.Post surgical.Acquired tracheo-esophageal fistulas secondary to esophageal cancerIatrogenic fistula after 

endotracheal intubation.Radiographic manifestations of contained perforation and complications including mediastinatis, aspiration, pulmonary edema, empyema, etc. 

SUMMARY 

Recognize the radiographic signs of esophageal perforation, particularly wih plain films, esophagrams and Computed tomography.Recognize the radiographic manifestationsof the 

complicated esophageal leak including mediastinatis, fistula formation, aspiration, edema, empyema, etc 


LL-CHE1129 

Pulmonary Atelectasis Revisited with Multislice CT 

Ana Manzano Diaz, MD , Carolina Gomez, MD , Diana Quesada, MD , Catalina de Valencia, MD , Sandra Ramirez, MD , Diana Rodriguez, MD 

PURPOSE/AIM 

The purpose a this exhibit is1. to review pulmonary atelectasis pathophysiology2. to discuss radiographic and CT signs of pulmonary atelectasis, with special emphasis on multiplanar CT 

reconstruction´s contribution3. to correlate conventional radiograph findings of pulmonary atelectasis with multislice CT images 


1. Definition2. Pathophysiology and Causes of lobar atelectasis3. Radiographic and MSCT signs of atelectasis with a profound review of imaging signs and findings4. Differential Diagnosis4. 

Pitfalls 

SUMMARY 

Tha major teaching points of this exhibit are:1. Direct signs of lobar atelectasis are: fissure displacement and bronchovascular crowding, both superbly represented on multiplanar MSCT 

reformation.2. Segmental or subsegmental atelectasis are almost imposible to differentiate con conventional radiogrpahs, from airspace consolidation, but usually nicely demostrated con 

MSCT3. Indirect signs of atelectasis include parenchymal opacity, bronchovascular displacement, compensatory hyperinsuflation, mediastinal displacement,yuxtraphrenic peak and are 

confirmed on MSCT multiplanar reformations and furthermore evaluated.4. Air bronchogram does not differentiate atelectasis from air-space consolidation. 


LL-CHE1130 

The Spectrum of Bronchopulmonary Sequestration: Imaging Update 

Christopher Walker, MD , Carol Wu, MD , Matthew Gilman, MD , J. David Godwin, MD , Jo-Anne Shepard, MD , Gerald Abbott, MD 

PURPOSE/AIM 

Graphic illustrations and case examples will demonstrate the variety of imaging appearances of bronchopulmonary sequestration in the adult patient. 


1. Introduction2. Definition and pathogenesis3. Clinical presentation and complications4. Imaging findings a. Intralobar sequestration 1. Radiography 2. CTA 3. 

MRI b. Extralobar sequestration 1. Radiography 2. CTA 3. MRI5. Pathology and intraoperative images6. Differential diagnosis a. Mimics b. Systemic arterial 

supply to lung7. Current treatment8. Conclusion 

SUMMARY 

There is a spectrum of imaging appearances of bronchopulmonary sequestration in the adult patient including consolidation, a mass lesion, and air or fluid-filled cystic /multicystic 

lesions. Sequestration is most easily diagnosed using CT or MRI and should be suspected when an anomalous vessel arises from aorta and supplies the pulmonary parenchymal abnormality 


LL-CHE1131 

Echogenic Solutions to Dyspnoea 

Maximiliano Francabandiera, MD, PhD , Christian Globaz , Jose Garcia Alvarado, MD , Veronica Veintimilla, MD , Sonia Lesyk, MD, PhD , Julieta Crosta, MD, MS , Fernando 

Page 5 of 97

Abramzon, MD 

PURPOSE/AIM 

To show the different images of pleural and lung pathology using thoracic ultrasound. 


We can classify our findings in:Pleural pathology:- Pleural effusion- Pleural thickening- Pleural masses- Pneumothorax: (Pleural or lung movement / Ring-down artifact / subsequent linear 

reverberation)Lung Pathology:- Consolidations: isoecoic lung to the liver, irregular margins and air bonchograms.- Atelectasis: parenchymal consolidation with irregular margins and air 

entrapment.- Tumors in contact with the pleura: echogenic/hipoecoic mass with sharp edges, which may have posterior acoustic enhancement and wall invasion evaluation.Chest wall 

lesions:Ultrasound has proven useful in the diagnosis of costal fractures, chest wall affection by tumoral infiltration from inside de thorax or by intrinsic lesion of the chest wall. It may be 

useful in the diagnosis of inflammatory lesions of the chest wall. Interventions:Ultrasound is useful in the cytologic or histologic puncture of pleural lesions, lung, mediastinal and chest wall. 

SUMMARY 

Thoracic ultrasound is a technique to consider for the diagnosis and management of multiple thoracic pathologies because is fast, safe and inexpensive, requiring no patient mobilization. It 

is superior to other techniques in certain conditions, and can also provide complementary data. 


LL-CHE1133 

Lung Adenocarcinoma Based on IASLC/ATS/ERS International Multidisciplinary Classification: Detection by Low-Dose CT Lung Cancer Screening and Follow-up 

Ryutaro Kakinuma, MD, PhD , Hiroaki Onaya, MD , Masahiko Kusumoto, MD , Koji Tsuta, MD , Akiko Maeshima , Yukio Muramatsu, MD , Hisao Asamura , Noriyuki 

Moriyama, MD, PhD 

PURPOSE/AIM 

The purpose of this exhibit is:1. To understand CT findings of lung adenocarcinoma based on IASLC/ATS/ERS international multidisciplinary classification2. To understand progression of 

adenocarcinoma on follow-up thin-section CT images 


Interactive training- Detection of adenocarcinoma on low-dose screening CTThin-section CT images- A time series images- Pure GGN to part-solid noduleImages of thin-section CT and 

pathological specimen- Adenocarcinoma in situ (AIS)- Minimally invasive adenocarcinoma (MIA)- Invasive adenocarcinomaIndex of cases 

SUMMARY 

The major teaching points of this exhibit are: 1. CT findings of lung adenocarcinoma based on IASLC/ATS/ERS international multidisciplinary classification 2. Sequential thin-section CT 

images of adenocarcinoma 


LL-CHE1134 

Stem to Stern: Imaging Manifestations of Diffuse Tracheobronchial Diseases 

Cylen Javidan-Nejad, MD , Smita Patel, MBBS , Arfa Khan, MD , Sanjeev Bhalla, MD , Ella Kazerooni, MD , Santiago Rossi, MD 

PURPOSE/AIM 

1.Review CT patterns (MSCT) of diffuse tracheobronchial diseases2.Review most common entities3.Describe underlying pathologic abnormalities4.Review clinical and imaging clues to narrow 

the radiologic differential diagnosis 


Define terminologyReview pathophysiology and imaging features of the lesions causing long segment tracheobronchial narrowing, such as tracheobronchomalacia, amyloidosis, relapsing 

polychondritis, tracheobronchopathia osteochondroplastica, C-ANCA positive vasculitis, polyposis, tuberculosis, sarcoidosis, fibrosing mediastinitis, and Crohn disease.Describe imaging 

features specific to each conditionA table will be provided which displays the key imaging features and useful supportive information provided by history, physical exam, or other clinical 

work-up. The differential diagnosis for each pattern will be provided.Highlight the value of multiplanar & minimum intensity reformations with MDCT imaging. Correlative virtual and 

conventional bronchoscopic images will be displayed where appropriate 

SUMMARY 

Lesions of the central airways are frequently missed because they are uncommon, the imaging findings are subtle, and they present with nonspecific symptoms. Knowledge of relevant CT 

imaging features in conjunction with clinical history can lead to earlier diagnosis and prevent diagnostic errors. 


LL-CHE1135 

Signogram: Patterns and Signs of Diffuse Lung Disease 

Clinton Jokerst, MD , Santiago Rossi, MD , Cylen Javidan-Nejad, MD , Joaquina Lopez Moras, MD , Sanjeev Bhalla, MD 

PURPOSE/AIM 

1. Review the most common patterns and signs of diffuse lung disease2. Highlight the classic diagnosis associated with each pattern or sign of diffuse lung disease3. Describe commmon and 

alternative diagnoses 4. Review clinical and imaging clues to narrow the radiological differential diagnosis 


1. Reviewof the most common entities presenting as patterns or signs, which include: tree in bud, crazy paving, halo, reverse halo, finger in glove, mosaic attenuation, head cheese, septal 

line thickening, miliary nodules, centrilobular nodules, and perilymphatic nodules2. For each the following will be provided:DefinitionList of clinical & imaging clues for narrowing the 

differential diagnosesA table for each pattern or sign listing the common causes for acute versus chronic presentations, the unusual causes & the hints that help lead to a specific 

diagnosis. Case examples of classic cause and differential diagnoses3. Where appropiate pathologic basis will be emphasized 

SUMMARY 

It is important to recognize the CT patterns and signs of diffuse lung disease and to understand the pathologic basis for them. A radiologist should identify them correctly, utilize a logical 

approach, and by using supporting imaging clues and clinical history, appropriately narrow the differential diagnosis and prevent diagnostic errors 


LL-CHE1136 

Phantom of the Lung; Pulmonary Artery Aneurysms in the Behcet's Disease 

Nijat Alishev , Ensar Yekeler, MD , Ahmet Gul , Atadan Tunaci, MD 

PURPOSE/AIM 

To define CT changes of pulmonary artery aneurysms in patients with Behcet’s disease during treatment. 


Behcet’s disease is a chronic multisystemic vasculitis of unknown etiology. The disease can be manifested by aneurysms and arterial and venous occlusions. The pulmonary arteries and aorta 

are the most common sites of aneurysm formation. Pulmonary artery aneurysms are life-threatening because of the high risk of rupture. The clinical effectiveness of corticosteroids and 

immunosuppressive agents in the treatment of vascular involvement in Behçet’s disease has been documented but the pathologic and radiologic bases of the beneficial effects are not 

well-known. In this study, we evaluated the imaging features of 35 Behçet’s disease patients with pulmonary artery aneurysms who have been treated with corticosteroids and 

immunosuppressive agents.In addition to CT findings, the pattern of disappearance of pulmonary artery aneurysms and possible pathophysiological mechanisms are discussed. 

SUMMARY 

Pulmonary artery aneurysms may regress and even disappear totally during or after medical treatment, which is the mainstay of our designation as “Phantom of the Lung”. 


LL-CHE1137 

Lymph-o-rama: Unusual Manifestations of Lymphoma in the Chest 

Joseph Azok, MD , Jonathan McConathy, MD, PhD , Cylen Javidan-Nejad, MD , Sanjeev Bhalla, MD 

PURPOSE/AIM 

Review and describe the spectrum of imaging findings of extra-nodal lymphoma in the chest. 


1. Introduction2. Imaging features of lymphoma in the lungs, mediastinum, and heart3. Lymphoma-like entities which occur in the chest 

SUMMARY 

The hallmark of lymphoma is the involvement of lymph nodes or secondary lymphoid tissues. Less commonly, extra-nodal lymphoma occurs and has a wide range of imaging appearances, 

making the diagnosis challenging. In particular, pulmonary involvement by lymphoma can mimic other entities such as pneumonia, lung cancer, and interstitial disease. These unusual 

manifestations of lymphoma within the lungs, mediastinum, and cardiovascular system will be highlighted through case examples. In addition, lymphoma-like entities such as lymphomatoid 

granulomatosis, post-transplant lymphoproliferative disorder (PTLD), and Castleman’s will be presented. 


LL-CHE1138 

To be or Not to be... a “Pulmonary Nodule” 

Naveen Kulkarni, MD , Iva Petkovska, MD , Stefan Nemec, MD , Diana Litmanovich, MD , Phillip Boiselle, MD , Alexander Bankier, MD 

Page 6 of 97

PURPOSE/AIM 

The current nomenclature for thoracic CT provides a stringent definition of the term “pulmonary nodule”. In clinical reporting, however, radiologists can find this definition difficult to apply, 

which potentially results in inadvertent categorization of lesions as “pulmonary nodules”. If a lesion misclassified as pulmonary nodule, patient will receive subsequent diagnostic follow-up 

that may not have been required. Therefore, our purpose was to design a hands-on guide for the accurate use of the term “pulmonary nodule”. 


This exhibit will provide, 1) an analysis of the morphological descriptors for the term “pulmonary nodule” in the current nomenclature for thoracic CT, 2) gallery examples illustrating the 

accurate use of these morphological descriptors, 3) spectrum of lesions that might be mistaken for pulmonary nodules, with explanations why the term “pulmonary nodule” does not apply to 

these lesions, 4) a proposed list of alternative terms, and 5) list of undesirable jargon terms used to describe nodule-like pulmonary lesions 

SUMMARY 

Our presentation will provide radiologists with a framework for appropriate use of the term “pulmonary nodules”, with special emphasis on potentially ambiguous lesions, such as subsolid 

nodules, and with regard to upcoming new recommendations for the management of solid and subsolid pulmonary nodules 


LL-CHE1139 

Radiological Appearance of Newer Cardiac Devices and Lead Sites 

Neal Khurana, MD , Christian Malalis, MD , Palmi Shah, MD 

PURPOSE/AIM 

New and sometimes unusual advancements in interventional and electrophysiological cardiology have led to new devices and new sites of cardiac lead placement. As their location is 

confirmed on chest radiographs, the radiologist is required to be familiar with their appearance. A pictorial review of some of these is presented, covering new sites of lead placement, such 

as midseptal right ventricle leads, and various new cardiac devices like percutaneous aortic valves and pulmonary outflow tract stents. 


1. Clinical discussion and description of:Percutaneous valve placementExtracorporeal membrane oxygenation cathetersLeft ventricular assist devicesPulmonary outflow tract stentsMidseptal 

and right ventricular outflow tract lead placementBrief discussion of some clinical indications for placement of those listed above2. Pictorial Review/Radiographic FindingsRadiographs with 

accompanying diagram/schematicReview of key radiographic findings that suggest normal versus abnormal/complicated impression.3. Example Radiographs/Cases 

SUMMARY 

The major teaching point of this exhibit is to make the radiologist aware of the appearance of some of the newer devices and some modifications in placement of the intracardiac leads. 


LL-CHE2272 

Pattern Based Approach to Lung Parenchymal Calcification with Radiological and Pathological Correlation 

Nicole Hughes, MD , Zhaolin Xu, MD,FRCPC , Joy Borgaonkar, MD, FRCPC , Daria Manos, MD, FRCPC 

PURPOSE/AIM 

Illustrate causes of lung parenchymal calcification. Explain how a pattern based approach aids in correctly identifying the cause of calcification.Correlate radiological imaging features with 

histopathological findings. 


Discuss CT viewing techniques that allow accurate diagnosis of lung parenchymal calcification.Review causes of lung parenchymal calcification with illustrative radiologic and pathologic 

examples. Demonstrate how specific CT patterns of calcification (including vertical distribution, distribution within the secondary pulmonary lobule and focal versus diffuse) enable accurate 

evaluation.Describe potential mimics of calcification. 

SUMMARY 

Lung parenchymal calcifications are a common radiologic finding occurring in a number of pulmonary and systemic diseases.Although pulmonary calcification is rarely symptomatic, the 

cause of calcification may be clinically important.Recognizing common radiologic patterns of pulmonary parenchymal calcification can aid in diagnosis and in some entities can correlate with 

disease severity and chronicity. When biopsy is required, it is beneficial to correlate radiologic and pathologic findings. 


LL-CHE2273 

Undisclosed Diseases of the Chest: What Are They? Why Do Patients Deny Them? How Can the Radiologist Help? 

Santiago Martinez-Jimenez, MD , Melissa Rosado De Christenson, MD , Jeffrey Kunin, MD , Ryo Benson, MD , Tyler Ternes, MD , Carlos Restrepo, MD 

PURPOSE/AIM 

1. To present a group of heterogeneous thoracic diseases that are difficult to diagnose due to the fact that patients tend to deny critical clinical information resulting in delayed diagnosis, 

difficult management and/or increased rate of complications2. To list key radiologic findings that suggest the diagnosis of these entities 


1. Diseases resulting from aspirated substances: Lipoid pneumonia, aspiration bronchiolitis in patients treated for obesity or eating disorders 2. Diseases resulting from injected substances: 

Talc/cellulose granulomatosis 3. Diseases resulting from atypical pathogens: Pneumocystis pneumonia, Lady Wyndermere syndrome 

SUMMARY 

Optimal imaging evaluation and diagnosis of patients with thoracic diseases is greatly enhanced by a thorough knowledge of the patient’s clinical history. In many cases, clinicians fail to 

provide important clinical information that may be available in the medical record. However, in the above mentioned entities, the diagnosis is extremely challenging until the patients fully 

disclose their behavioral habits and critical clinical data is provided. In such cases, raising awareness of typical imaging features and maintaining a high index of suspicion may allow an 

expeditious diagnosis and differentiation from more common thoracic diseases presenting with similar imaging findings. 


LL-CHE2274 

What Is This White Stuff in the Lungs: Diffuse High Attenuating Lung Densities: A Pictorial Review and Differential 

Brett Roberts, MD , Sushilkumar Sonavane, MD , Jubal Watts, MD , Nina Terry, MD,JD , Rahul Renapurkar, MD , Satinder Singh, MD 

PURPOSE/AIM 

To review imaging features in various diffuse high attenuation abnormalities of the lung parenchyma such as from calcification, ossification, foreign material. 


Classify the diffuse lung densities as below:Associated with nodules: granulomatous (e.g. histoplasmosis), inhalational (e.g. silicosis), metabolic (e.g. amyloidosis), metastasis (e.g 

osteosarcoma).Diffuse and denser calcifications: e.g. metastatic in renal failure, alveolar microlithiasis, dendriform pulmonary ossification. High attenuation emboli: e.g. 

methylmethacrylate, talc granulomatosis, post chemoembolization.Densities with or without calcification: e.g. amiodarone toxicity, post transplant.Discuss the imaging findings with 

representative cases. 

SUMMARY 

Major teaching points of this exhibit are as below:Explore common and uncommon conditions causing diffuse high density lesions in the lung.The imaging characteristics and pattern of 

diffuse high attenuation abnormalities coupled with the appropriate clinical background can suggest the underlying disease process. 


LL-CHE2275 

The How and Consequences of Esophagectomy as Seen on CXR and CT 

Tyson Chadaz, MD , Susan Hobbs, MD, PhD , John Wandtke, MD 

PURPOSE/AIM 

Discussion of current esophagectomy techniquesInitial post-operative plain film findings with emphasis on clues to post-operative complicationsSpecific complications related to different 

techniques and imaging identification 


- Review esophagectomy techniques with medical illustrationsTransthoracic esophagectomyTranshiatal esophagectomyMinimally invasive esophagectomyRobotic esophagectomyEsophageal 

reconstruction with stomach pull through or colonic interposition.- Review of immediate post-operative imaging findings- Discussion of complications related to different techniques, route, 

and choice of conduit such as pleural effusions, anastomotic leaks, strictures, infections, and conduit ischemia illustrated with imaging exams including plain films, fluoroscopic evaluations, 

and CT. 

SUMMARY 

The history of an esophagectomy covers a wide variety of surgical techniques. It is important to review the different approaches to the esophagectomy including choice of route and conduit 

such that a directed search for potential complications can be performed. Through medical illustrations of the different techniques and sample imaging of expected findings and unexpected 

complications, value can be added to the radiologist’s contribution to post esophagectomy imaging and care. 


LL-CHE2277 

Mediastinal Malignant Lymphoma: Radiological Features Based on Pathological Classifications 

Norihisa Nitta, MD , Akinaga Sonoda, MD, PhD , Hideji Otani, MD , Yukihiro Nagatani, MD , Kiyoshi Murata, MD , Tamotsu Nagata, MD,PhD , Masashi Takahashi, MD , 

Ken-ichi Mukaisho , Tomonori Tanaka, MD , Junya Fukuoka , Shuhei Inoue, MD 

Page 7 of 97 

PURPOSE/AIM 

1. To understand radiological images, clinical findings and pathological findings of mediastinal malignant lymphoma (MML)2. To think about the role of FDG-PET in diagnosis of MML3. To 

understand the importance of MML in radiological images of mediastinal tumors


1. Origins of MML in mediastinum (Two types: thymic origin and lymphnode origin)2. Pathological classifications of WHO (Three types: Hogikin’s lymphoma, B-cell lymphoma, T-cell 

lymphoma)3. Radiological (including FDG-PET), clinical, and pathological fidings of nodularsclerosing-type Hogikin lymphoma, large cell B-cell lymphoma, and T-cell lymphoblastic lymphoma 

(leukemia)4. Other MML (MALT lymphoma of thymus origin, cardiac lymphoma, etc.)5. Relation between virus and MML 

SUMMARY 

SummaryThe major teaching points of this exhibit are:1. Radiological (including FDG-PET), clinical and pathological findings of nodular sclerosing types; Hogikin’s lymphoma, large-cell, 

B-cell lymphoma, T-cell lymphblastic lymphoma (leukemia) are studied.2. Other mediastinal lymphomas might be also studied.3. Differentiation between mediastinal organ original 

lymphoma and mediastinal lymphonode origin lymphoma is indicated. 


LL-CHE2278 

Classic Signs in Thoracic Imaging 

Adonis Manzella, MD , Paulo Borba Filho, MD , Edson Marchiori, MD, PhD , Glaucia Zanetti, MD , Dante Escuissato, MD,PhD , Filipe Felix, MD , Eolo Albuquerque, MD 

PURPOSE/AIM 

The purpose of this presentation is:1) to describe 35 classic signs in thoracic radiology.2) to provide illustrations of these signs.3) to discuss the pertinent features related to each sign with 

emphasis on the cause of the appearance of these signs, and the differential diagnoses to be considered. 


Some of the signs that will be discussed in this exhibit are: coin lesion, popcorn calcification, miliary shadowing, sandstorm appearance, ground glass pattern, crazy-paving sign, halo sign, 

reversed halo sign, honeycomb lung, tree-in-bud, air bronchogram sign, tram-track sign, signet ring sign, finger-in-glove sign, bulging fissure sign, silhouette sign, bat wing appearance, CT 

angiogram sign, Monod sign, S sign of Golden, wave sign, double density sign, 1-2-3 sign, tapered margins sign etc. 

SUMMARY 

Classic signs in radiology, when invoked, immediately bring an image to mind and add confidence to the diagnosis of certain conditions. Familiarity with these signs helps in arriving at a 

diagnosis in day-to-day practice. 


LL-CHE2279 

Digital Tomosynthesis of the Thorax: The Pros and Cons of Low Dose Alteration 

Hong Sik Byun, MD , Myung Jin Chung, MD , Won-Jung Koh , Kyeongman Jeon, MD , John Sabol, PhD , Kyung Lee, MD, PhD , Soyi Kwon, MD 

PURPOSE/AIM 

Digital tomosynthesis (DT) was introduced and increasingly used in thoracic readiology as problem solving tool when plain radiography (XR) is inconclusive. However in different healthcare 

environments, this problem solving role of DT may not effective.We altered exam protocols of DT and thus applied low dose (LD) DT for an alternate of XR as an initial screening method. LD 

DT has comparable dose with XR and gives more diagnostic information than XR. LD DT, however, has many limitations and disadvantages compared to computed tomography and even to 

standard dose DT.In the exhibit, we will review and discuss about the pros and cons of DT and LD DT in thoracic application. 


• Overview of technology• Review of DT in thoracic applications• Discussion about the benefits and limitations of LD DT in thoracic applications• Illustration where LD DT may be useful, and 

comparison with other modalities• Illustration where LD DT may not be useful, or encounters problems• Discuss the potential role of LD DT for future use 

SUMMARY 

1. Introduce physical background and techniques of LD DT2. Illustrate the images of LD DT and review the findings of frequently encountered thoracic diseases3. Describe the utilization of 

LD DT4. Discuss the problems and limitations of LD DT5. Suggest how we can use LD DT wisely 


LL-CHE2280 

Review of Thoracic Duct Imaging by Conventional and New Modalities 

Kentaro Takanami, MD, PhD , Tomohiro Kaneta , Hiroshi Fukuda , Shoki Takahashi, MD 

PURPOSE/AIM 

1. To review the thoracic duct imaging by conventional modalities including radiography, scintigraphy, CT, and Ultrasonography (US).2. To demonstrate the three-dimensional (3D) thoracic 

duct imaging by MRI, 3D-US, and SPECT/CT.3. To discuss the clinical applications of the thoracic duct imaging. 


1. Introduction2. Review of thoracic duct imaging by the conventional and new imaging modalities.3. Clinical applications of the 3D thoracic duct imaging by the new modalities. 

SUMMARY 

The major teaching points of this exhibit are:1. Because chylothorax due to thoracic duct injury is a severe complication of trauma and intrathoracic surgery, thoracic duct imaging is 

clinically important. However, use of the conventional thoracic duct imaging has been limited because of their difficult procedure or invasiveness.2. Recently, 3D thoracic duct imaging by 

MRI, 3D-US, and SPECT/CT has been reported. They are simple and low invasive methods to image thoracic duct. Assessing the 3D course of thoracic duct before the intrathoracic surgery 

may prevent the thoracic duct injury by a surgical procedure.3. In this exhibition, we review the thoracic duct imaging by the conventional and new modalities, and demonstrate the 

techniques and clinical applications of the 3D thoracic duct imaging by the new modalities. 


LL-CHE2281 

Multimodality Review of AIDS Defining Malignancies (ADMs) Involving the Chest with Emphasis on Patterns of Presentation as well as Radiologic Mimics 

Jorge Rodriguez-Figueroa, MD , Hima Prabhakar, MD 

PURPOSE/AIM 

Progressive immunologic deterioration in patients with HIV increases their risk for specific AIDS defining malignancies. The purpose of this exhibit is to describe the current concepts of ADM 

diagnosis and treatment pertaining to the chest, illustrate the patterns of presentation and the review the applications of CT, MRI and PET/CT for diagnosis and differentiation from potential 

mimickers. 


We review typical and atypical radiologic appearances of ADMs involving the chest, as they behave at initial presentation and on follow-up. We discuss potential pitfalls including 

non-neoplastic mimics which may have similar presentations to ADMs. 

SUMMARY 

ADMs demonstrate variable patterns of presentation at diagnosis depending on the patient’s degree of immunopression, which may lead to poorer patient outcomes. An array of potential 

non-neoplastic mimics may confound the appropriate diagnosis. Interpretation of the studies with an understanding of the underlying pathogenesis and correlated with the patient’s degree 

of immunosuppression is essential in order to achieve an earlier diagnosis and treatment. 


LL-CHE2282 

Imaging of Thoracic Injuries in Professional Rugby Players: Role of Magnetic Resonance Imaging and Computed Tomography 

Daichi Hayashi, MBBS, PhD , Frank Roemer, MD , Ryan Kohler, MBBCh , Ali Guermazi, MD, PhD , Chris Gebers , Richard De Villiers, MMed 

PURPOSE/AIM 

To present a pictorial essay of the MR imaging and CT imaging features of thoracic injuries sustained by professional rugby players 


1. Present data on incidence of thoracic injuries in professional rugby players2. Describe the anatomy of the joints comprising the thoracic cage and major abdominal muscles attached to 

the rib cage3. Discuss an optimized MR imaging protocol in suspected thoracic injury4. Illustrate various types of thoracic injuries seen in rugby players: a. sternal contusion, retrosternal 

hematoma, manubriosternal disruption b. sternoclavicular dislocation c. rib fractures, hematoma, dislocation d. muscle injury of the pectoralis major, rectus abdominis and internal 

oblique5. Conclusion 

SUMMARY 

Professional rugby players are prone to traumatic thoracic injuries due to the minimal protective wear, unlike in American Football. In the Rugby World Cup 2007 thoracic injuries occurred at 

a rate of 8.3 cases per 1000 player-hours. Subtle injuries may be missed on plain radiography. CT and MR imaging play an important role in the diagnostic process. For optimum MR 

assessment of rib injuries, the patient should be in a prone position, and axial and oblique coronal STIR images should be obtained. Cross-sectional imaging helps in the decision-making 

process concerning return to training and competition. 


LL-CHE2283 

Think Outside the Lungs: Case Collection of Bone Findings on Chest Imaging 

Anusuya Mokashi, MD , Gail Yarmish, MD 

Page 8 of 97 

PURPOSE/AIM 

Pathologic entities affecting the bony thorax are often overlooked on routine chest imaging. The purpose of this exhibit is to improve the radiologist's familiarity with imaging features of

several common pathologic entities to manifest in the bony thorax in order to improve diagnostic accuracy. 


We will provide a comprehensive overview of the range of pathologic entities affecting bone which may be detected on routine chest imaging. Illustratvie cases will be provided with with 

correlative CT, MRI and/or nuclear bone scan. The major categories include:Trauma: Posterior Rib Fracture in Child Abuse, Shoulder DislocationRheum: Ankylosing SpondylitisMetabolic: 

Rickets, Hyper-PTHInfectious: Clavicular OsteomyelitisCongenital: Sprengel's Deformity, Sickle CellNeoplastic: Ewing sarcoma, Osteosarcoma, Chondrosarcoma, Fibrous Dysplasia, 

Metastatic Neuroblastoma, Osteochondroma, aneurysmal bone cyst 

SUMMARY 

The chest radiograph, an important part of the initial workup for a wide range of clinical indications, also provides a crucial opportunity to recognize significant musculoskeletal pathology. 

The radiologist's familiarity with these entities and their presentations on chest imaging will improve identification and diagnosis of many of these important conditions. 


LL-CHE2284 

Revisiting the Posterior Mediastinum 

Joseph Reis, MD , Mike Nguyen, MD , John McGrath, MD , Susan Hobbs, MD, PhD , John Wandtke, MD 

PURPOSE/AIM 

This exhibit is to present common and uncommon diseases that can found in the posterior mediastinum. 


The posterior mediastinum is a common site for disease presentation. The etiologies include vascular, congenital, traumatic, infectious, and neoplastic. A partial list of diseases includes 

aortic aneurysms, azygous continuation of the IVC, duplication cysts, extramedullary hematopoiesis, Bochdalek’s hernias, adenopathy due to lymphoma, infection, or Castleman’s disease, 

and neurogenic tumors such as neurofibroma, schwannoma, and paraganglioma. Key differential diagnosis for posterior mediastinal diseases will be illustrated with radiographic, CT, MR, and 

PET studies. Normal anatomy of the posterior mediastinum will also be reviewed. 

SUMMARY 

The posterior mediastinum is an important anatomical space because many disease processes can arise there. After reviewing this exhibit, the attendee will be able to:1. Understand and 

describe normal posterior mediastinal anatomy.2. Appreciate the role of different imaging modalities in the diagnosis of posterior mediastinal diseases.3. Recognize both common and 

uncommon diseases of the posterior mediastinum. 


LL-CHE2285 

Acute and Chronic Pulmonary Thromboembolism: A Challenge Learning Game for Radiology Residents 

Andres Vasquez, MD , Alfonso Esguerra, MD , Bibiana Pinzon, MD , Jorge Abreu, MD , Yenny Moreno Vanegas, BSC 

PURPOSE/AIM 

Acute and Chronic Pulmonary thromboembolism are common conditions and present a series of special diagnostic challenges in particular to those junior members in training. The purpose 

of this exhbit is to show a tutorial of diagnostic imaging of Acute and Chronic Pulmonary thromboembolism in order to help the junior members in training to learn about this condition and 

make accurate diagnoses. 


The tutorial will be presented in a quiz format.- Basic topics about acute and chronic embolism- Chest plain film findings - Computed Tomography (CT) Angiography findings- Acute Vs 

Chronic Findings- Unknown cases- Property feedback in every question - Suggested readings 

SUMMARY 

The learning games are an effective way to engage the new generation of radiology "learners". We present a tutorial of Acute and Chronic thromboembolism where the participant can learn 

the principal topics in diagnostic imaging of this condition, in particular junior members in training. 


LL-CHE2286 

Spectrum of Imaging Findings in Reactivation Adult Pulmonary Tuberculosis and the Role of Radiological Interventions 

Gopal Vijayaraghavan, MD, MPH , Kamal Pathak, MD , Sarwat Hussain, MD , Jerry Balikian, MD 

PURPOSE/AIM 

Though the incidence of pulmonary tuberculosis in the advanced western world is considered low, with increasing international travel, increasing migrant population, there is a reemergence 

of adult pulmonary tuberculosis worldwide. It is therefore important for the practicing radiologist to be aware of the spectrum of imaging findings to ensure early diagnosis and appropriate 



Clinical presentation, imaging findings, smears and cultures to isolate the organism along with PCR testing and molecular imaging help establish the diagnosis. While routine chest x-ray 

interpretation is important, these findings are often supplemented by CT and occasional MR imaging. The spectrum of imaging findings in post primary tuberculosis, complications, sequel 

and post treatment residue are presented. Also the role of intervention; imaging guided percutaneous needle biopsies, pleural aspirations and the role of angiography and embolization of 

bronchial arteries to control hemoptysis are highlighted. Important differential diagnosis are briefly discussed. 

SUMMARY 

Imaging plays a crucial role in the diagnosis of pulmonary tuberculosis. The spectrum of imaging findings, their significance and the role of interventional radiology in the diagnosis, 

treatment and follow up of pulmonary tuberculosis is highlighted. 


LL-CHE2287 

Management and Diagnostic Imaging for Minute Pulmonary Nodules with or without Ground-Glass Opacity 

Masahiro Yanagawa, MD, PhD , Osamu Honda, MD, PhD , Misa Kawai , Tomoko Gyobu , Hiromitsu Sumikawa, MD , Noriyuki Tomiyama, MD, PhD , Yutaka Kawata , 

Mitsuhiro Koyama, MD 

PURPOSE/AIM 

With recent improvement and spread in CT technology, a lot of minute nodules have been detected incidentally. The purposes of this exhibit are:1. To learn the management of minute 

nodules with less than 8 mm in diameter, based on previous reports including the Fleischner Society guidelines.2. To learn the diagnostic imaging for minute lung cancer: morphologic 

diagnosis by high-resolution CT (HRCT), computer-aided detection (CADe) and diagnosis (CADx). 


1. Management of minute nodules2. Diagnostic imaging for minute lung cancer: with reviewing clinical cases- Diagnosis due to size criteria- Morphologic diagnosis by HRCT- CADe: clinical 

utility and effect by radiation dose- CADx: diagnosis by measuring doubling time 

SUMMARY 

The major teaching point of this exhibit are:1. It is important to decide the timing of follow-up CT on the basis of nodule size, nodule types [ground-glass opacity (GGO), part-solid nodule, 

and solid nodule], and patient background.2. Morphologic features by HRCT are often useful for diagnosis of lung cancer even in minute nodules: in particular, evaluation of GGO component 

is important.3. Iterative reconstruction technique can improve CADe despite of radiation dose.4. Measuring doubling time by CADx often can make an accurate diagnosis of minute solid 

nodules with non-specific features. 


LL-CHE2288 

The Many Faces of Pulmonary Aspergillosis: Radiologic Spectrum with Clinical Correlation 

Nita Nayak, MD , Cecilia Jude, MD , Maitraya Patel, MD , Poonam Batra, MD 

PURPOSE/AIM 

Pulmonary aspergillosis is a fungal infection with varied clinical and radiologic presentations. Pre-exisiting lung conditions and immunologic status of the host contribute to the radiologic 

patterns observed. This exhibit will present a series of clinical vignettes in order to illustrate the pathophysiology and imaging manifestations of pulmonary aspergillosis. 


The cases will be shown in a quiz format. Key clinical, pathological, and radiological aspects will be presented. Imaging signs such as air-crescent, finger-in-glove, tree-in-bud, and the CT 

halo sign will be illustrated. The cases discussed will include: 1) Cavitary lung disease and aspergilloma; 2) Asthma and allergic bronchopulmonary aspergillosis; 3) Asthma and 

bronchocentric granulomatosis; 4) Mild immunocompromised state and semi-invasive aspergillosis; 5) Severe immunocompromised state and angioinvasive aspergillosis; 6) Severe 

immunocompromised state and airway invasive aspergillosis. Additional images will be displayed to supplement discussion of these cases. 

SUMMARY 

The radiologic appearance of pulmonary aspergillus infection is influenced by pulmonary status and host immune function. This quiz format exhibit is designed to correlate the imaging 

findings with the clinical scenario in order to suggest a more specific diagnosis of pulmonary aspergillus infection. 


LL-CHE2289 

CPFE (Combined Pulmonary Fibrosis and Emphysema), the New Member of the Alphabet Soup of Interstitial Lung Disease 

Stephanie Burns, MD , Carlos Restrepo, MD , Jaishree Jagirdar, MD , Santiago Martinez-Jimenez, MD , Jorge Carrillo, MD 

Page 9 of 97 

PURPOSE/AIM 

1. Review current knowledge base of combined pulmonary fibrosis and emphysema (CPFE)2. Correlate computed tomographic findings of CPFE with gross and microscopic pathology


1. Definition, incidence, and pathophysiology of combined pulmonary fibrosis and emphysema2. Correlate computed tomography findings with gross and microscopic pathologic specimens3. 

Key features to distinguish combined pulmonary fibrosis and emphysema from other interstitial lung diseases4. Clinical implications of the diagnosis of combined pulmonary fibrosis and 

emphysema 

SUMMARY 

Combined pulmonary fibrosis and emphysema (CPFE) is the coexistence of pathologic changes of fibrosis and emphysema which is most frequent in smokers. This condition may be 

clinically underrecognized given normal spirometry and lung volumes. The diagnosis of CPFE can be made with high resolution CT imaging. Using correlation of high resolution CT with 

pathologic specimens, we developed a practical approach for general and thoracic radiologists to identify the features of CPFE and distinguish this from pure emphysema and from other 

interstitial lung diseases. 


LL-CHE2290 

Pulmonary Artery Aneurysms: A Dangerous Mimic of Solid Intrathoracic Neoplasms and Their Associated Diagnostic Challenge 

Christian Welch, MD , Helga Stark, MD, PhD , Paul Stark, MD 

PURPOSE/AIM 

1. Review the etiology and classification of pulmonary artery aneurysms2. Describe imaging findings utilizing conventional radiography, CT, MR and angiography.3. Evaluate potential for 

complications, pitfalls in diagnosis, and implications for therapy. 


1. Anatomic classification of pulmonary artery aneurysms: central vs. peripheral, fusiform vs. saccular, solitary vs. multiple, true vs. false.2. Etiologic classification of pulmonary artery 

aneursyms.3. Differential Diagnosis: AV malformations, pulmonary vein varices, solid tumors. 

SUMMARY 

Pulmonary artery aneurysms are distinctly unusual with a ratio of pulmonary artery to aortic aneurysm of 1:250. They have the potential for life-threatening complications, including 

pulmonary hemorrhage, massive hemothorax or massive hemoptysis. On conventional radiography, central pulmonary artery aneurysms can be mistaken for solid hilar or mediastinal 

masses, whereas peripheral pulmonary artery aneurysms can be confused with non-vascular pulmonary nodules.Timely detection and correct diagnosis facilitate expeditious therapy with 

percutaneous embolization or surgical resection, when appropriate. 


LL-CHE2291 

LIRADS (The Lung Imaging Reporting and Data System): A New Approach Using the Fleischner Society Guidelines and BIRADS Classification in the Management of a 

Pulmonary Nodule Discovered on CT 

Martina Martins Favre, MD , Dan Adler , Pierre Schnyder, MD , Catherine Beigelman-Aubry 

PURPOSE 

To help clinicians in the management of pulmonary nodule using the guidelines of the Fleischner Society more userfriendly, as it is in BIRADS classification, used in breast pathology.To 

compare the radiologic terminology using the classification of Fleischner Society for incidental pulmonary nodules discovered on CT scan and the BIRADS classification, used in breast 

pathology.To discuss a structured, analytic approach to report lung CT findings. 

METHOD AND MATERIALS 

We transmit the Fleischner Society guidelines in a simpler approach similar to the BIRADS classification, used in breast, to facilitate the management and relieve anxiety of patients 

presenting with incidental pulmonary nodules. The pulmonary nodules are described based on many signs as the shape and size. Using this criteria the nodules are then classified into three 

groups: benign, highly suspicious, indeterminate. Nodules less than 10 mm are most frequent and most commonly indeterminate. In 2005 the Fleischner Society published a consensus 

guidelines for incidental pulmonary nodules found on CT scan. The guidelines suggest follow-up with CT scan based on the size of the nodule and the patient risk factors. In our new 

approach we include also the non solid and semi solid nodules. 

RESULTS 

This classification consists on 6 types:LIRADS 1 - benign nodules LIRADS 2 - less than 4mm nodules LIRADS 3 - probably benign LIRADS 4 - suspicious nodules LIRADS 5 - highly suggestive 

of malignancyLIRADS 6 – confirmed malignant noduleUsing this method, the radiologists can estimate the clinical significance of the nodule based on a structured analysis of lesion features 

as seen in CT. By classifying nodules based on clinical significance, radiologists can facilitate evidenced-based approaches to nodules management and then further assist the determination 

of appropriate follow up. 

CONCLUSION 

The Lung Imaging Reporting and Data System (LiRADS) is our proposed classification to simplify and standardize CT report for management of pulmonary nodules. This classification is 

based on the excellent experience and background of the BI-RADS classification for breast abnormalities and based on guidelines provided by the Fleischner Society. 

CLINICAL RELEVANCE/APPLICATION 

To unify the radiologic terminology in reports using the classification of Fleischner Society for incidental pulmonary nodules discovered on CT scan. 


LL-CHE2292 

Mediastinal Tuberculosis: A Multimodality Approach to an Infection with Myriad Presentations 

Ashlesha Udare, MBBS,MD , Prabath Mondel, MBBS, MD , Bhagya Sannananja, MBBS, MD , Hardik Shah, MBBS,MD , Monika Bapat, MBBS , Karuna Agawane , Abhijit Raut, MD 

PURPOSE/AIM 

• To review the etiopathogenesis of mediastinal tuberculosis• To illustrate with examples the wide spectrum of imaging appearances and clinical manifestations• Role of imaging in diagnosis 

and follow-up 


Imaging anatomy, routes of spread & etiopathogenesis of mediastinal tuberculosis(TB) Clinicoradiological correlationPrimary Vs Secondary Classification of mediastinal TBPrimary 

involvement:LymphadenopathyAbscess formaionMediastinal fibosisSecondary Involvement:Tracheo-bronchial tree- stenosis, fistulae, abscess , ulcerationEsophagus- stricture, sinus tracts, 

fistulae, extrinisic compression, abscess, dysmotilityGreat Vessels- Aortitis, venacaval obstruction & stenosisHeart & pericardium- Pericarditis, endo-myocarditisSpine- Pott's spine, 

mediastinal abscess, neuropathyInterventionsCT & USG guided - biopsies, abscess drainage, esophageal stent, venous angioplasty & stenting 

SUMMARY 

A thorough knowledge of mediastinal anatomy & routes of spread is essential to diagnose mediastinal TBInvolvement of various organs results in myriad clinico radiological 

presentationsMultimodality imaging approach is essential for diagnosis & extent of diseaseInterventional techniques in mediastinal TB 


LL-CHE2293 

What You Should Know About the Superior Vena Cava 

Diego Varona Porres, MD , Alona Thomas Martinez, MD , Oscar Persiva Morenza, MPH , Esther Pallisa, MD , Alberto Roque, MD , Jordi Andreu 

PURPOSE/AIM 

1. Describe the radiological anatomy and basic embryology of the superior vena cava and the imaging techniques to study this vessel, particularly multislice CT.2. Show the various 

diseases affecting the superior vena cava and the differential diagnosis of these conditions.3. Discuss the clinical significance and radiological diagnoses of superior vena cava disease. 


1. Radiological anatomy and basic embryology of the superior vena cava.2. Imaging techniques to assess the superior vena cava, with emphasis on multislice CT.3. Diseases: Congenital 

(bilateral agenesis or persistent left superior vena cava), stenosis/obstruction related to superior vena cava syndrome (malignant or nonmalignant causes like catheters, fibrosing 

mediastinitis or intrathoracic goiter), thrombosis (catheters or neoplastic), increased caliber (congestive heart failure) and post-procedure (post-surgical changes or complications related to 

central venous catheters like perforation or rupture and migration). 

SUMMARY 

The superior vena cava should be carefully evaluated particularly in selected cases because the detection of disease can affect the patient management. 


LL-CHE2294 

YouTube Bloopers: Complications of Tracheal and Esophageal Stents 

James Kennen, DO , William Baughman, MD 

PURPOSE/AIM 

Review of the indiactions, types and complications of tracheal and esophageal stents and their normal and abnormal imaging appearance. 


Tracheal Stents Indications - permament treatment of benign and palliative treatment of malignant strictures, extrinsic compression, maintain airway patency after surgery or trauma, 

covering leaks and tracheoesophageal fistulas Stents - types and advantages and disadvantages - silicone, metal, hybrid Complications - malposition and migration, perforation and 

respiratory-esophageal or respiratory-vascular fistulas, luminal narrowing or obstruction by tumor or granulation tissue ingrowth or overgrowth and impacted mucuc/secretions, stent 

fracture, hemorrhage and death MDCT Appearnace and ExamplesEsophageal Stents Indications - same as for tarcheal stents Stents - types and advantages and dsiadvantages - expandale 

covered and uncovered metal and plastic Complications - similar to traceal stents, but obstruction from food impaction rather than mucus/secretions and also gastroesophageal reflux 

MDCT Appearance and Examples 

SUMMARY 

Tracheal and esophageal stents are increasingly being utilized for the palliative and permanent traetment of benign and malignant disease. MDCT is an accurate, non-invasive survellance 

modality of these stents and their complications. 

Page 10 of 97


LL-CHE2295 

Pulmonary Complications of Hematopoietic Stem Cell Transplantation (HSCT): A Radiologist’s Toolkit 

Nicholas Hilliard, MBBChir , Anu Balan, MBBS, MRCP , Emma Senior, MBBCh , Daria Manos, MD, FRCPC , Judith Babar, MBChB 

PURPOSE/AIM 

Describe common clinical scenarios in which thoracic imaging is necessary following HSCTWhen, how and with what: a framework to guide radiological investigationIllustrate recognised 

complicationsIndicate how findings give significant prognostic information 


Brief overview of HSCT with description of pulmonary complications encountered, and the time course in which these occurDiscussion of imaging techniques: the right investigation at the 

right timePictorial review of pulmonary complications on volumetric high-resolution CT (HRCT), divided into infectious and non infectious complications within each temporal phase post 

transplant (pre-engraftment, mid and late recovery phase) 

SUMMARY 

The assessment of pulmonary complications of HSCT is increasingly common, and can fall to both general and specialist radiologists, both in and out of hoursEarly recognition and treatment 

instigation is important for a good outcomeOur aim is to provide a toolkit for investigation and interpretation with illustration of differential diagnosesHRCT findings seen in pulmonary 

complications post HSCT can be non specific but if put into the context of the predictable timeline post BMT, there are sufficient characteristic HRCT features to help narrow a differential 

diagnosis and facilitate appropriate early treatment. 


LL-CHE2296 

Imaging Finding of the Pulmonary Manifestations of Systemic Diseases: What the Radiologist Needs to Know 

Reiko Nakajima , Mizue Hasegawa, MD , Yasuo Ookubo , Shuji Sakai, MD 

PURPOSE/AIM 

The lung is a common site of disease in several disorders which primarily affect other organs, and familiarity with these diseases is important. The purpose is:1. To review the pulmonary 

manifestations of systemic disease. 2. To understand clinical features and imaging findings of these diseases.3. To recommend for physicians what to do next. 


1. Review of various systemic disorders affecting in lung diseases.2. Review of clinical features and imaging findings including other organs of these diseasesA Tuberous sclerosis complexB 

Osler-Weber-Rendu dis¬easeC Kartagener syndromeD Systemic fibrosisE Ehlers-Danlos syndromeF Lipid storage diseaseG Erdheim-Chester diseaseH Birt-Hogg-Dubé SyndromeI 

SarcoidosisJ AmyloidosisK Multicentric CastlemanL Chronic active EBVM IgG 4 related diseaseN Collagen vascular diseasesO Relapsing polychondritis3. Discussion for what to recommend 

physicians as next step based on the imaging findings that they find. 

SUMMARY 

The major teaching points of this exhibit are:1. To review the pulmonary manifestations of systemic disease.2. To identify these diseases that can support the accurate diagnosis and 

contribute to the diagnosis when clinical findings are subtle. 


LL-CHE2297 

What Did You Say That Is? Chest Radiographic Variants and Misunderstood Anatomy That Mimics Pathology 

Christopher Walker, MD , Sudhakar Pipavath, MD , Subba Digumarthy, MD , Julie Takasugi, MD , Jonathan Chung, MD , J. David Godwin, MD 

PURPOSE/AIM 

Identify and clarify potentially confusing manifestations of normal thoracic structures through illustrations and radiographic examples 


1. Introduction 2. Normal variants a. Intrathoracic fat i. Extrapleural fat (NOT pleural thickening or plaque) ii. Indistinct heart (NOT 

pneumonia) iii. Apical cap (NOT apical pleural thickening) iv. Mediastinal lipomatosis (NOT mass) b. Vessels i. Apical opacity of Proto (NOT 

lung cancer) ii. Azygos vein enlargement (NOT lymphadenopathy) iii. Aortic nipple (NOT lymphadenopathy) iv. Brachiocephalic artery tortuosity (NOT 

mediastinal mass) c. Ligaments, fissures, and other lines i. Juxtaphrenic peak (NOT the pulmonary ligament) ii. Sublobar septum (NOT the inferior 

pulmonary ligament) iii. Mediastinal rotation (NOT lung herniation) iv. Pseudopneumothorax caused by rib lines or pneumomediastinum d. 

Osseous i. Rib fracture, spur, and osteophyte (NOT lung nodule) ii. Laminar pseudonodule iii. Pectus excavatum (NOT pneumonia, NOT 

cardiomegaly)3. Conclusion 

SUMMARY 

It is important for the imager to recognize normal anatomical structures, variants, and benign conditions that can be mistaken for pathology on chest radiographs. 


LL-CHE2298 

Guidance for Reporting Screening CT: Introducing the Lung Reporting and Data System (LuRADS) 

Daria Manos, MD, FRCPC , Joy Borgaonkar, MD, FRCPC , Jean Seely, MD , Heidi Roberts, MD , John Mayo, MD 

PURPOSE/AIM 

1. Introduce an evidence-based classification proposal for CT-screening detected lung nodules.2. Demonstrate how the system can guide management of CT detected nodules. 


Outline the need for defined work-up protocols for screen detected nodules. Discuss rates of adverse events, including intervention for noncancerous disease and factors that contribute to 

unnecessary work up.Outline the proposed 6 level Lung Reporting and Data System (LuRADS) modeled on the successful Breast Imaging Reporting and Data System (BI-RADS).For each of 

the 6 levels summarize the evidence regarding rates of malignancy and recommendations for management including indications, limitations and risks of PETCT and percutaneous 

biopsy.Provide illustrative imaging, management and outcome examples for each of the 6 LuRADS categories. 

SUMMARY 

The proposed 6 level LuRADS classification system for screen-detected lung nodules in high risk patients is more informative than the current narrative-based “positive” or “negative” 

radiology reporting scheme and assists in the rational management of lung nodules. The evidence-based guidelines should help limit costs, reduce radiation exposure and decrease adverse 

events associated with inappropriate intervention. LuRADS also provides a data collection framework for lung cancer screening quality assurance. 


LL-CHE2299 

"Stupid Catheter Tricks: A Case Based Review of Device Misplacement" 

Nathan Myatt, DO , Jason Wagner, MD , David Huard, MD 

PURPOSE/AIM 

Device misplacement is not a rare entity and should be well recognized by practicing radiologists. The intent of this exhibit is to provide challenging cases which should be enjoyable and 

educational for the viewers. 


The cases will be presented in quiz format. A case will be presented, questions will be raised in each case, and the answers will be provided after the viewer selects to see the answers. 

Additional educational information/tips will also be provided with each case. Cases will include, but are not limited to: main stem bronchus intubation, enteric tube in lung, arterial vascular 

line placement, vascular line placement in left superior intercostal vein, vascular line placement in persistent left SVC, PICC line tracking up neck base, broken port devices, port catheter 

only in chest wall, broken pacemaker leads, vascular line placement in pleural space, disconnected pacemaker leads, cases exploring enteric tube placement with hiatal hernia (intrathoracic 

stomach vs in the lung). 

SUMMARY 

Device mishaps are not uncommon occurrences which need to be recognized by practicing radiologists. This exhibit provides educational information/tips for recognizing device misplacement 

while being entertaining to the viewer. 


LL-CHE2300 

Pregnancy and the Thorax: Imaging of Cardiovascular and Pulmonary Complications 

Cylen Javidan-Nejad, MD , Daniel Vargas, MD , Kristopher Cummings, MD , Alison Cahill, MD , Sanjeev Bhalla, MD , Christine Menias, MD 

PURPOSE/AIM 

The purpose of this exhibit is to review the various cardiothoracic manifestations of pregnancy with emphasis on clinical manifestations, imaging findings using various modalities, and the 

pertinent information the radiologist can provide to impact clinical management 


Review of pathophysiology and imaging findings of various cardiothoracic diseases that present in conjunction with pregnancy, with emphasis on clinical relevance.The entities will be 

approached as follows: -Conditions involved with becoming pregnanthyperstimulation syndromemetastatic choriocarcinoma- Cardiopulmonary conditions seen in a pregnant 

patientphysiologic changes (hypervolemia)pulmonary edema in pre-eclampsia/eclampsiapulmonary embolismaortic dissection- Pre-existing vascular and cardiac disease that become 

complicated during pregnancyhereditary hemorrhagic telangiectasiaMarfanLoieys-Deitzvalvular heart disease- Cardiopulmonary complications during and after deliveryamniotic fluid 

embolismpost-partum cardiomyopathypulmonary embolism 

Page 11 of 97

SUMMARY 

It is important for the thoracic and general radiologist to anticipate and be familiar with cardiothoracic complications in pregnant individuals and pregnancy related conditions. 


LL-CHE2301 

10 Tricks for Conquering the Mediastinum on Chest X-ray 

Jo Yazer, MD , Daria Manos, MD, FRCPC , Joy Borgaonkar, MD, FRCPC , Judith Babar, MBChB 

PURPOSE/AIM 

1. Illustrate and explain the anatomic basis of 10 key mediastinal lines, stripes and interfaces visible on chest radiographs.2. Demonstrate how these 10 hot spots aid in the identification 

and localization of mediastinal pathology. 


1. Using chest radiographs paired with multiplanar and 3D cross-sectional imaging, we will demonstrate their anatomic explanation and will illustrate normal variations and pathological 

alterations. Case examples include congenital, neoplastic, infectious, vascular and inflammatory disease.2. A practical approach to the differential diagnosis of mediastinal pathologies using 

these 10 chest radiograph hot spots will be presented. 

SUMMARY 

The chest radiograph remains a valuable first line diagnostic test for the evaluation of the mediastinum. Understanding the anatomic basis for key chest x-ray lines, stripes and interfaces 

aids in the identification and localization of mediastinal abnormalities and helps to narrow the differential diagnosis. A systematic review of the chest x-ray with these ten hot spots will help 

limit misses and interpretation errors. 


LL-CHE2302 

Fistulas, Ingrowth, and Leaks... Oh My! Esophageal Carcinoma Complications and the Utility of 3D CT in Complication Detection 

Leeann Denham, MD , Sushilkumar Sonavane, MD , Jubal Watts, MD , Nina Terry, MD,JD , Satinder Singh, MD 

PURPOSE/AIM 

Chest CT scans are often performed to evaluate patients with esophageal carcinoma for complications. Thus, it is important for radiologists to be familiar with the CT findings of 

pre-treatment and post-operative complications associated with esophageal malignancies. This exhibit will provide case examples of an assortment of esophageal malignancy complications 

as well as emphasize the role of 3D CT imaging in the assessment of those findings. 


1. Esophageal Carcinoma Epidemiology 2. Treatments: Surgical and Non-Surgical 3. Treatment Complications 4. Role of 3D CT Imaging in Diagnosis of Complications5. Case Illustrations 

with multi-planar reformats of representative cases including: pre-treament complications (leak and fistula), post-surgical anastomotic complications (anastomotic: leak, fistula, stricture, 

and recurrence), and non-surgical complications (tumor ingrowth of stent) 

SUMMARY 

The major teaching points of this exhibit are:1. The various surgical and non-surgical complications of esophageal carcinoma treatment.2. The valuable role 3D CT imaging plays in definitive 

diagnosis of esophageal malignancy complications.3. The CT appearance of a variety of esophageal malignancy complications. 


LL-CHE2303 

Hyperdense Lung Findings: An Overlooked and Underappreciated Feature of Airspace and Interstitial Disease Processes 

Amit Chakraborty, MD , Pavani Adapa, MD , Laurant Grignon, MD , Matthew DeVries, MD 

PURPOSE/AIM 

Hyperdense imaging features applied to the evaulation of pulmonary nodules may similarly provide radiologists a differential diagnostic discriminator for airspace and interstital processes. 

We hope to increase awareness of hyperdense pulmonary airspace and interstitial opacities by review and discussion in a pictorial essay format. 


Approach to a differential diagnosis for hyperdense pulmonary airspace and interstitial processes.Review and discussion of hyperdense airspace and interstitial processes with conventional 

radiographs and computed tomography examples, providing appropriate pathologic correlation. -Primary pulmonary ossification-Coal worker's pneumoconiosis-Amiodarone toxicity-Fungal 

infection/ABPA-Pulmonary calcinosis-Alveolar microlithiasis-Talcosis-Silicosis-Sarcoidosis-Amorphous calcification of lung cancer-Calciphylaxis/Metastatic calcification-Cement emboli 

SUMMARY 

Major teaching points include:1. Hyperdense imaging findings of pulmonary airspace and interstitial processes may be helpful in providing a focused differential diagnosis.2. Review and 

discussion of pulmonary airspace and interstitial processes that result in hyperdense findings on imaging, several of which may be less frequently encountered by radiologists in daily 

practice. 


LL-CHE2304 

Treasure Chest: Navigating the "Review Areas" on Chest Radiographs 

Nicholas Bassett, MBBS , Simon Allen, MD , Thayahlan Iyngkaran, MBChB , Sheena McLaggan, MBBS 

PURPOSE/AIM 

This tutorial pays particular attention to the “Review Areas” on Chest Radiographs (CXR’s) and gives examples of easily overlooked abnormalities with Computed Tomography (CT) 

correlation. 


Chest radiographs are among the commonest radiological investigations and are performed on patients in many clinical settings from primary care to intensive care.Important pathology can 

easily be missed.The main “Review Areas” will be described, including the lung apices, costo-phrenic angles, retro-cardiac area, sub-diaphragmatic regions, the bones and soft tissues.CXR 

examples of normal appearances and pathology will be given for each of these areas, along with CT correlation where relevant.This will be followed by a number of “quiz” cases for self 

assessment. 

SUMMARY 

An interactive tutorial on the importance of the “Review Areas” on CXR. 


LL-CHE2305 

Cystic Interstitial Lung Diseases: Recognizing the Common and Uncommon Entities 

Hamza Jawad, MBBS , Christopher Walker, MD , Carol Wu, MD , Jonathan Chung, MD 

PURPOSE/AIM 

We will review interstitial lung diseases (ILDs) that present with cysts as the primary finding on chest CT. Radiologists will learn how to distinguish different types of cystic ILDs on CT. 

Differential diagnosis of cystic lung disease will be discussed as will the specific imaging and clinical findings which aid in narrowing the differential diagnosis. 


1. Introduction2. Differentiation of cystic lung disease on CT from honeycombing, emphysema, cystic bronchiectasis, cystic metastases, and post-infectious pneumatoceles.3. Five cystic lung 

diseases will be discussed along with their representative imaging findings: a) Lymphangioleiomyomatosis/Tuberous sclerosis; b) Langerhans cell histiocytosis; c) Birt-Hogg-Dubé syndrome; 

d) Lymphocytic interstitial pneumonia; and e) Light chain deposition disease. Viewers will also learn to differentiate between aforementioned diseases based on cyst size, cyst distribution, 

other abnormalities on CT, and clinical data.4. Conclusion 

SUMMARY 

Cystic lung diseases present a considerable diagnostic challenge because: 1) they are less frequently encountered in clinical practice and 2) CT findings can be similar in many of these 

diseases. This exhibit illustrates the CT findings of cystic lung diseases and provides a systematic approach to their diagnosis. 


LL-CHE2306 

Clinically Useful Signs in Chest Imaging: What Are They Good for? 

Hamza Jawad, MBBS , Christopher Walker, MD , Carol Wu, MD , Jonathan Chung, MD 

PURPOSE/AIM 

There are innumerable signs in chest imaging. We will describe the most clinically useful signs, with special attention to more recently discovered signs as well as those in which new 

insights have been discovered. 


We will show examples of radiological signs on chest imaging, discuss the mechanisms leading to these signs, and review their clinical significance.1. Pulmonary Signs:a) Lobar collapse: S 

sign of Golden, flat waist, luftsichel; b) Silhouette; c) Tree-in-bud; d) Halo; e) Reversed halo; f) Comet tail; g) Galaxy2. Mediastinal Signs:a) Continuous diaphragm sign; b) Cervicothoracic 

and thoracoabdominal; c) “Cervicothoracoabdominal”; d) Hilum overlay and hilar convergence; e) Doughnut3. Pleural and chest wall signs:a) Deep sulcus; b) Dependent viscera; c) Split 

pleura; d) Extrapleural fat4. Cardiac and vascular signs:a) Oreo cookie sign; b) Double density; c) Reverse 3. 

SUMMARY 

There are many clinically useful signs in chest imaging which can narrow the differential diagnosis or suggest a specific diagnosis. After reviewing this exhibit, the learners will be aware of 

these signs and their causal diseases. 

Page 12 of 97


LL-CHE2307 

Multidetector CT in Pulmonary Thromboembolism: When the Parenchyma Can Help 

Isabela Borges, MD , Thainah Alves, MD , Rosana Rodrigues, MD, PhD , Miriam Barreto, MD,PhD , Paulo Bernardes, MD , Arthur Souza, MD,PhD , Edson Marchiori, MD, PhD , 

Ricardo Batista, MD 

PURPOSE/AIM 

The diagnosis of PTE in many cases relies on direct visualization of the thrombus inside the vascular lumen on angiographic CT. Parenchymal findings in pulmonary thromboembolism can 

be varied and more or less specific. The knowledge of the radiological signs can be key for the correct diagnosis in patients with unsuspected clinical thromboembolism. We will review and 

illustrate the spectrum of multidetector CT parenchymal findings in patients with pulmonary embolism. 


1.Review of the epidemiology and pathophysiology of pulmonary parenchymal changes in PTE2.Definitions of pulmonary infarction3.Case-based spectrum of multidetector CT findings on 

pulmonary parenchyma:-Pleural-based wedge-shaped consolidation or ground-glass opacity-Reversed halo sign.-Ground-glass opacity and reticulation-Nodules-Cavitated lesions-Focal 

decreased attenuation (non-emphysematous)-Focal decrease of parenchymal enhancement-Atelectasis 

SUMMARY 

The characteristic pleural-based wedge opacity is the most specific parenchymal finding in pulmonary thromboembolism, but other CT radiological signs can be the actual imaging 

presentation in many cases. The awareness of the specific characteristics of pulmonary opacities, and of other related findings, may lead to the suspicion of PTE and aid in the diagnosis of 

clinically unsuspected cases. 


LL-CHE2308 

Arch Madness: Spectrum of Aortic Arch Anomalies That May Present in Adulthood 

Adam Prater, MD , Neil Amin, MD , Mark Green, MD , Travis Henry, MD , Sanjeev Bhalla, MD 

PURPOSE/AIM 

1. Review different aortic arch anomalies that radiologists may encounter in adult patients, possible presenting symptoms, and management.2. Provide a multitude of examples on the 

spectrum of aortic arch anomalies on different imaging modalities such as CXR, Fluoroscopy, CT, MRI, and Catheter Angiography. 


1. Discuss the normal embryologic origin of the aortic arch and the development of "normal" aortic arch anatomy.2. Discuss different aortic arch variants such as common origin of the left 

common carotid artery, four vessel arch, bovine arch, aberrant retroesophageal right subclavian artery, double aortic arch, right sided arch with aberrant left subclavian artery, right-sided 

arch with mirror image branching, cervical aortic arch, diverticulum of Kommerell, interrupted aortic arch, persistent 5th aortic arch, aortic coarctation, and aortic pseudocoarctation. 

SUMMARY 

Aortic arch variants are common. This comprehensive review will help the radiologist appropriately recognize these anomalies, identify potentital complications, and help direct treatment if 

necessary. 


LL-CHE2309 

Medistinal Fluid Containing Structures: Simple Cyst or Cystic Mass? 

Francisca Oyedeji, MD , Sirisha Jasti, MD , Nadia Yusaf, MD , Susan Hobbs, MD, PhD 

PURPOSE/AIM 

Approximately 15% of mediastinal masses are cystic in nature. The location of the lesion drives the differential diagnosis. The purpose of this exhibit is to review the imaging findings in 

different types of fluid containing lesions in the mediastinum. 


Review of the anatomy of the mediastinumReview different types of cystic lesions based on mediastinal location: a. Anterior (ex: thymic cyst, thymoma, pericardial cyst, cystic teratoma, 

lymphoma), b. Middle ( ex: duplication cyst, necrotic lymph nodes, pericardial recess), c. Posterior (ex: neurenteric cyst, meningocoele)Multimodality illustrations of different mediastinal 

cystic lesionsBrief discussion of clinical scenarios and treatment options with review of post-treatment imaging 

SUMMARY 

Imaging features of some of the cystic lesions may overlap with each other. However, by understanding the mediastinal anatomy and correlating imaging features with clinical history, the 

radiologist will be able to suggest a limited differential diagnosis and guide further management. 


LL-CHE2310 

Pseudomasses and Pseudoabnormalities - You Don't Need a CT to Make the Diagnosis 

Douglas Drumsta, MD , John Wandtke, MD 

PURPOSE/AIM 

Despite the utility of computed tomography (CT), the chest radiograph remains the initial step in the workup of most patients. Many diagnoses can be made with a chest radiograph 

however, the detection of a possible lesion/mass frequently leads to additional imaging. Awareness of common anatomic variants, artifacts, and other disease processes that may simulate a 

mass or a pneumothorax can prevent unnecessary additional imaging. The possible malposition of lines and tubes may also lead to unnecessary further imaging. The purpose of this exhibit 

is to make the radiologist aware of such pseudolesions so that a CT scan or other intervention may be avoided. 


This exhibit will be presented in a case based format with chest radiographs accompanied by the CT scan correlate and a description of the pseudolesion. 

SUMMARY 

The radiologist's knowledge of pseudolesions can aid in a more rapid diagnosis and prevent unnecessary CT scans or other interventions. A review of classic anatomic variants, disease 

processes that may simulate a mass or pneumothorax, and pseudo-malposition of lines and tubes will be shown. 


LL-CHE2311 

Conventional Pulmonary Radiology: How Long Has It Been Since You Really Practiced It? 

Alfonso Esguerra, MD , Andres Vasquez, MD , Bibiana Pinzon, MD 

PURPOSE/AIM 

Faced with an abnormal radiographic chest study, the deductive diagnostic process is often prematurely bypassed in favor of CT/MR studies. This attitude increases patient radiation 

exposure, contributes to further elevate medical costs, and deprives both radiologists and radiology residents from experiencing the intellectual thrill of integrating subtle chest radiographic 

signs into full fledged diagnoses.This exhibit will: 1. Aid experienced radiologists in reviving, and radiology residents in acquiring, their deductive diagnostic skills, when faced with 

radiographic chest cases. 2. Serve as a teaching model to Diagnostic Radiology Departments. 


Radiographic chest studies will be presented as unknowns.I. Topics include: Basic concepts, atelectasis, mediastinum, pleura, pulmonary hypertension, air trapping, congenital pathology.II. 

Answers are ellicited in the following interactive modes: 1.Click on answer. 2.Drag & Drop. 3.Odd-man out.4.Fill in the blanks. 5.Clinical dialogues. III. Correct answers, comments, and 

bibliography are furnished. 

SUMMARY 

This interactive exhibit aids viewers in evaluating their deductive skills and revive or acquire the thrill derived from studying radiographic chest unknown cases. Interactive gaming is used as 

the learning tool. Correct answers, comments and biobliography are furnished. 


LL-CHE2312 

Pulmonary Angiography for Chronic Thromboembolic Pulmonary Hypertension: Catching the “Invisible” Thrombus 

Ayako Shigeta , Hajime Yokota, MD , Toshihiko Sugiura , Nobuhiro Tanabe , Takashi Uno , Koichiro Tatsumi 

PURPOSE/AIM 

Pulmonary angiography (PAG) remains a gold standard imaging test for the diagnosis, exclusion and deciding the operability of chronic thromboembolic pulmonary hypertension (CTEPH). 

Vessel walls cannot be demonstrated by PAG, so the thrombus of CTEPH frequently appears to be only an irregularity and interruption of enhanced lumens, that is, it is “invisible”. The 

purpose of this review is to describe how to detect a thrombus due to CTEPH and to change the thrombus from “invisible” to “visible” in the reader’s mind. 


1. Anatomy of the pulmonary artery2. Techniques/indications for PAG3. How to interpret the results of PAG4. Typical angiographic patterns in CTEPH5. Comparison of pre- and postoperative 

angiographic findings in CTEPH6. Conditions that mimic CTEPH on PAG 

SUMMARY 

1. A summary of the basic knowledge of PAG.2. The characteristic angiographic features of CTEPH, including pouching defects, webs or bands, intimal irregularities, abrupt vascular 

narrowing and complete vascular obstruction.3. Comparing the pre- and postoperative angiographic findings in CTEPH and considering where the thrombus was before the operation, which 

makes it easier to detect abnormal findings in CTEPH patients.We expect this review to help the reader to recognize a thrombus and to identify CTEPH patients with an operable thrombus. 


Page 13 of 97

LL-CHE2313 

Save Your Lungs: The Spectrum of Smoking-Related Lung Conditions 

Karoly Viragh, MD , Kathleen Brown, MD 

PURPOSE/AIM 

Despite major public health efforts to stop smoking, 20% of the adult population smokes and 20% of deaths are related to smoking in the USA. The goal of the exhibit is to provide a 

case-based, interactive, integrated review of the entire spectrum of smoking-related lung conditions for the general radiologist with recent updates on strategies for quitting and advising 

patients. 


a. Review of the epidemiology of smoking with recent trends.b. Comprehensive, case-based, interactive, multimodality pictorial review of the entire spectrum of smoking-related lung 

conditions with mechanisms of disease, differential diagnosis, histopathological and clinical correlation, including: 1. COPD (centrilobular emphysema, chronic bronchitis); 2. Smoking-related 

interstitial lung disease (RB-ILD, DIP, Pulmonary LCH, smoking-induced AEP, IPF); 3. Lung carcinoma (SCLC, NSCLC).c. Case-based, interactive review of the most successful strategies for 

quitting smoking.d. Case-based, interactive review of the most successful strategies for advising patients.e. Self-assessment questions to reinforce key learning points. 

SUMMARY 

Familiarity with the complete spectrum of smoking-related lung conditions and strategies for advising and quitting smoking will aid the radiologist in providing better care, both as an 

imaging specialist and a general physician. 


LL-CHE2314 

Automatic Naming System for Tracheobronchial Structures by Computational Anatomy 

Hirotoshi Homma, MD , Masaki Mori, MD , Hirotsugu Takabatake, MD, PhD , Hiroshi Natori, MD, PhD , Kensaku Mori, PhD , Yukitaka Nimura 

PURPOSE/AIM 

We propose the virtual bronchoscopy system by 3-D CT data that automatically assigned anatomical names to the bronchial branches.This system can process the data of variant cases of 

branching types of tracheobronchial trees.Proposed computer assisted navigation system for virtual bronchoscopy will be one of the clinical development of computational anatomy. 


Nomenclature System of the Bronchial TreeAutomated System for Bronchial NomenclatureSatisfactory Labeling Rate in Segmental and Sub-Segmental BronchiExample of Properly 

Generated Names by the System to Variant Case on the rt. Upper Bronchus 

SUMMARY 

On the virtual bronchoscopy mode, the system gave proper anatomical bronchial names to them at the orifices, even for the variant types of branching in clinical cases.Strict name 

matching to doctors’ interpretation revealed 100% matched for the trachea and main bronchi. For the distal bronchi, the system properly given their name 84-100% of segmental bronchi 

and over 64% of sub-segmental bronchi.Insufficient detection of sub-segmental bronchi and its naming were noted on rt.B6a, rt.B10c, lt.B6c, and lt.B10c branches.The system extracted 

segmental and sub-segmental bronchi in 90 cases.Computer assisted navigation by intelligent virtual bronchoscopy is one of the clinical development of computational anatomy. 


LL-CHE2315 

The New TNM Staging of Esophageal Cancer: What Chest Radiologists Need to Know 

Su Jin Hong, MD , Tae Jung Kim , Kyung Won Lee, MD, PhD 

PURPOSE/AIM 

1. To discuss the revisions in the new 7th edition of the TNM staging system for esophageal cancer and identify the important differences from the 6th edition2. To identify the correct TNM 

stage of an esophageal cancer based on imaging findings: CT, endoscopic ultrasound (EUS) and PET/CT3. To understand the importance of multimodality assessment in esophageal cancer 

staging 


1. Overview and the methodology used to derive the new system2. To understand the major changes in anatomic classification- T classification: Tis and T4, N classification: N0-N3, M 

classification: M0 & M13. To understand the addition of non-anatomic cancer characteristics- histologic cell type, histologic grade and cancer location4. To understand the new concepts of 

stage groupings5. To demonstrate multimodality imaging assessment of esophageal cancer: CT, EUS and PET/CT6. To describe the most common pitfalls in esophageal cancer staging 

SUMMARY 

The new 7th edition of the TNM staging system for esophageal cancer has been extensively changed by data-driven approach and shown better correlation with patient survival. By being 

familiar with this new staging system and recognizing the relevant imaging findings of esophageal cancer, chest radiologists can make a significant contribution to treatment and outcome in 

esophageal cancer patients. 


LL-CHE2317 

Combined pulmonary fibrosis with emphysema (CPFE): Three Morphological Types and Their Changes Over Time 

Ryoko Egashira, MD , Ken Yamaguchi, MD , Noriyuki Kamochi , Yoshiaki Egashira , Hiroyuki Irie, MD 

PURPOSE/AIM 

To review the concept of CPFETo demonstrate the HRCT findings of CPFE with their changes over timeTo recognize the important complications in the course of CPFE 


1. Review the concept of CPFE History, synonymous terms/concepts2. Classify the CT patterns of CPFE into 3 morphological typesA) Upper-area emphysema and lower-zone fibrosis 

showing typical UIP patternB) Upper-area emphysema and lower-zone fibrosis showing NSIP-pattern like subpleural sparing and ground-glass attenuationC) UIP-pattern interstitial 

pneumonia with a mixture of emphysema within the fibrotic area Illustrate characteristic CT findings and their changes over time.3. Important complication in the courseCarcinogenesis, 

pulmonary artery hypertension, acute exacerbation and infection 

SUMMARY 

CPFE has components of both emphysema and fibrosis; therefore, emphysema and fibrosis may cancel each other and show normal pattern in screening pulmonary function test, although 

true pulmonary function is very poor.Radiologists should be aware of its HRCT findings as well as severe complications including carcinogenesis, pulmonary artery hypertension and acute 

exacerbation. 


LL-CHE2318 

HRCT Findings of Asbestosis Revisited; Radiologic and Pathologic Correlations 

Katsuya Kato, MD , Hiroaki Arakawa, MD , Kenzo Okamoto , Kazuto Ashizawa, MD , Takumi Kishimoto , Susumu Kanazawa, MD , Mayu Uka , Koichi Honma , Kouki Inai 

PURPOSE/AIM 

To review various HRCT imaging manifestations of asbestosisTo show impressive and useful radiologic and pathologic correlations to understand the HRCT findings of asbestosis 


1. Introduction2. Background3. HRCT findings of asbestosis with impressive pathologic correlations- Subpleural centrilobular dot-like opacities- Subpleural curvilinear lines- Pleural-based 

opacities- Parenchymal bands- Honeycombing4. Correlation between pathological grading (from 1 to 4) of asbestosis by the CAP-NIOSH and HRCT findings5. Key findings of differential 

diagnosis- Vs. idiopathic interstitial pneumonias (IIPs)- Vs. collagen vascular disease-related interstitial pneumonia6. Management 

SUMMARY 

Asbestos-related disease is a social problem that must be diagnosed precisely to be eligible for social compensation. Imaging findings play a major role in the diagnosis of asbestosis. 

Differentiation between asbestos-induced interstitial pneumonia and that induced by other causes is important. We think that it is important to correlate HRCT findings characteristic of 

asbestosis with pathological findings to accurately diagnose asbestosis. In this exhibition, we show that characteristic HRCT findings of asbestosis correlate well with its pathologic findings. 


LL-CHE2319 

Visual Illusions in the Radiographic Image Revisited in the Digital Era. 

Katia Nishiyama, MD , Fernando Kay, MD , Maysa Ferreira, BARCH , Thais Henriques, MD , Ricardo Guerrini, MD , Marcelo Funari, MD , Hamilton Shoji, MD , Gustavo 

Teles, MD , Rodrigo Passos, MD , Roberto Sasdelli Neto, MD , Eloisa Gebrim, MD 

PURPOSE/AIM 

To review the visual illusion artifacts in the digital radiography that may lead to a misdiagnosis. 


The digital technology should improve our diagnosis. Despite this technological advance, radiologists are still challenged by optical illusions found on radiographs. We will illustrate and 

discuss the most common observed visual illusions in this scenario, such as the Mach effect, the subjective contour formation and the parallax effect, which are responsible for the formation 

of false images. 

SUMMARY 

Some optical illusions may still be mistaken for significant pathology, even in the Digital Era. Radiologists should be aware of these pitfalls to avoid misdiagnosis. 


LL-CHE2320 

Demystifying Ascending Aorta Repair: What the Radiologist Should Know 

Nadia Yusaf, MD , Durga Singh, MD , Susan Hobbs, MD, PhD , Hongju Son, MD 

Page 14 of 97

PURPOSE/AIM 

1. Describe the common types of aortic root repair, including the Bentall procedure and Cabrol modification.2. Discuss optimization of image acquisition and reconstructions in evaluating the 

aorta post-treatment.3. Discuss features on images that are particularly pertinent for referring clinicians, as well as how to direct follow up examination.4. Discuss complications as a result 

of the surgical procedures that are best seen on CT or MR evaluation of the vascular structures. 


1) Illustrated description of the surgical procedure2) MR and CT examinations demonstrating successful repair with key imaging features.3) MR and CT examinations demonstrating 

procedural complications. 

SUMMARY 

Ascending thoracic aortic repair is critical for patient survival. Understanding potential complications and variations of aortic root repair is crucial for timely recognition of life-threatening 

conditions. This educational exhibit will provide infomation to assist the radiologist in evaluating follow up examinations in patients status post ascending aortic repair. 


LL-CHE2321 

Pulmonary Calcifications: Beyond the Granuloma… 

Katia Nishiyama, MD , Fernando Kay, MD , Thais Henriques, MD , Maysa Ferreira, BARCH , Felipe Shoiti Urakawa, MD , Marcelo Funari, MD , Ricardo Guerrini, MD , Gustavo 

Teles, MD , Hamilton Shoji, MD , Roberto Sasdelli Neto, MD , Rodrigo Passos, MD , Eloisa Gebrim, MD 

PURPOSE/AIM 

To review the differential diagnosis of calcified pulmonary lesions, once they may not always represent a residual condition. 


Discussion and illustration of many conditions that may manifest as a calcified pulmonary lesions such as Alveolar Microlithiasis, Metastatic Calcification, Calcium Disorders, Pulmonary 

Ossification, and Calcified Metastasis. 

SUMMARY 

Calcified nodules are a common finding in thoracic imaging, especially with the increasing number of chest tomography for lung cancer screening. Most of them are considered as 

granulomatous sequelae; however, there are some differential diagnoses that radiologists should be aware of to avoid misdiagnosis. 


LL-CHE2322 

Mind the Spine: Look for the Unexpected at Chest Imaging 

Katia Nishiyama, MD , Fernando Kay, MD , Thais Henriques, MD , Maysa Ferreira, BARCH , Ricardo Guerrini, MD , Marcelo Funari, MD , Hamilton Shoji, MD , Gustavo 

Teles, MD , Rodrigo Passos, MD , Roberto Sasdelli Neto, MD , Eloisa Gebrim, MD 

PURPOSE/AIM 

To review some of the most common incidental findings in the thoracic spine at chest imaging. 


Discussion and illustration of common and uncommon incidental thoracic spine findings such as Congenital Disorders, Hematological Diseases, Metabolic Diseases (Renal Osteodystrophy, 

Paget Disease, Mulitple Myeloma), Primary Tumors (Hemangiomas), Secondary Tumors (Metastasis). 

SUMMARY 

Different conditions may affect the thoracic spine, thus being frequently observed on chest CT or radiography. Therefore, the thoracic radiologist should be aware of these conditions, since 

these challenging findings may even help the diagnosis of concomitant pulmonary abnormalities. 


LL-CHE2323 

Excipient Lung 

Vicky Nguyen, MD , Shinnhuey Chou, MD , Sudhakar Pipavath, MD , Corinne Fligner, MD , J. David Godwin, MD 

PURPOSE/AIM 

Provide an overview of the evolution of drug excipients and the history of talcosisDepict chest radiographic and CT findings of intravenous abuse of modern-day oral medicationsElucidate 

the pathophysiology of “excipient lung” with pathologic and clinical correlations 


1. IntroductionTalcOther drug excipients – Generalization of the term “talcosis”2. Pulmonary imaging findingsFine centrilobular micronodulesDiffuse groundglass opacitiesBasal predominant 

panlobular emphysema3. PathologyCentrilobular pulmonary embolismGranulomatosisEmphysema4. Clinical manifestationsHistory of intravenous drug abuse or indwelling accessPulmonary 

arterial hypertensionTalc retinopathy5. Conclusion 

SUMMARY 

Prompt recognition of intravenous abuse of oral medications requires a high index of suspicion and familiarity with its imaging findings on the part of radiologists.The most common imaging 

presentation of intravenous talcosis is diffuse centrilobular micronodules.Granulomatous reaction is the predominant mechanism of pathogenesis in talcosis.Clinical manifestations range 

widely from asymptomatic to fulminant respiratory failure. 


LL-CHE2324 

Digital Chest Tomosynthesis – Can It Compete with CT? 

Shinnhuey Chou, MD , Sudhakar Pipavath, MD , Jeffrey Otjen, MD , Sherwin Chan, MD, PhD , Gregory Kicska, MD, PhD , Gautham Reddy, MD 

PURPOSE/AIM 

Provide an overview of the technology and principles of digital tomosynthesisIllustrate potential clinical indications and applications of chest tomosynthesis through imaging 

examplesCompare the utility of chest tomosynthesis with CT 


1. IntroductionConventional tomographyDigital tomosynthesis2. Potential indications and applications in thoracic imagingLung nodule/cancer detectionPulmonary 

tuberculosisAirwaysOsseous structures3. Tomosynthesis vs. CTDemonstrated improved sensitivity and specificity of tomosynthesis over radiographyComparable detection of artificial lung 

nodules based on phantom studyRadiation doseCostPotential for lung cancer screening4. Future work and Conclusion 

SUMMARY 

Digital chest tomosynthesis has demonstrated superior pulmonary nodule detection over chest radiography.Digital chest tomosynthesis is associated with significantly reduced radiation dose 

and cost compared with CT.Detection of artificial lung nodules is comparable between tomosynthesis and CT in phantom study – Potential application in lung cancer screening 


LL-CHE2325 

Foreign Bodies in the Respiratory Tract: Imaging Findings 

Kiyomi Furuya, MD , Kotaro Yasumori, MD , Sadanori Takeo , Takashi Kawanami , Ikuo Sakino, MD , Toru Muranaka, MD , Seiya Momosaki, MD, PhD , Shuji Matsuura , 

Masahiro Sakai, MD , Akihiko Kutsuna 

PURPOSE/AIM 

1. To review the clinical features of foreign bodes in the respiratory tract.2. To demonstrate various imaging findings caused by them with emphasizing characteristic patterns.3. To present 

pathological findings in actual cases.4. To ascess the usefulness of multidetector row CT (MDCT) for their correct diagnoses. 


1. Clinical overview of foreign bodies in the respiratory tract.2. Cases with imaging findings and diagnostic clues. Present cases consist of various endobronchial foreign bodies by aspiration 

in children and adult, abscess and granuloma by aspiration of aliment in the periphery of the lung, gossypiboma and inflammatory pseudotumor after surgery.3. Discussion. 

SUMMARY 

Foreign bodies in the respiratory tract demonstrate a wide variety of imaging findings: overinflation, pneumothorax, obstructive pneumonia, abscess and granuloma in the periphery of the 

lung, gossypiboma, and inflammaotry pseudotumor. Patients' age, clnical background, and past history can affect them. MDCT can demonstrate these imaging findings precisely, though 

some cases remain difficult to differentiate from cancers or other inflammation. Awareness of characteristic imaging features and pitfalls caused by foreign bodies in the respiratory tact, and 

careful attention to the clinical information will help in achieving correct diagnoses. 


LL-CHE2326 

Normal Variations and Abnormalities of the Diaphragm on Chest Radiograph (CXR): Contrast with Multi-planner Reformatted (MPR) Images of Computed Tomography (CT) 

Hideji Otani, MD , Norihisa Nitta, MD , Yukihiro Nagatani, MD , Akinaga Sonoda, MD, PhD , Masashi Takahashi, MD , Kiyoshi Murata, MD 

PURPOSE/AIM 

The purpose of this exhibit is;1. To review normal variations of the diaphragm with regard to manifestation of CXR and clinical importance.2. To understand how diaphragm abnormalities 

were reflected on CXR as image findings by comparing them to MPR images of CT. 

Page 15 of 97 

CONTENT ORGANIZATION

1. Normal anatomy of the diaphragm including the normal diaphragmatic hiatuses2. Normal images of the diaphragm on CXR3. Review of normal variations of the diaphragm on CXR, such 

as: scalloping, blurring, tenting, partial eventration, Chilaiditi syndrome, and thoracic kidney.4. Review of abnormalities and radiographic signs of the diaphragm on CXR, such as: 

subpulmonary effusion, basal pneumothorax, deep sulcus signs, continuous diaphragm signs, phrenic nerve paralysis, diaphragmatic hernia, diaphragmatic injury, and intraperitoneal free 

air.4. Contrast of chest radiographic findings with MPR images of CT. 

SUMMARY 

The major teaching points of this exhibit are:1. MPR images obtained with multi-detector row CT make it easy for us to reconfirm manifestation on CXR of diaphragm abnormalities.2. 

Familiarity with many normal variants mainly due to aging and diaphragmatic elevation caused by insufficient inspiration and phrenic nerve paralysis is crucial in differentiating them from 

organic lesions and avoiding unnecessary further examinations. 


LL-CHE2327 

Segmentectomy Planning Using 3D-CTA with a Virtual Safety Margin for Early Stage Lung Cancer 

Shingo Iwano, MD , Noriyasu Usami , Kohei Yokoi , Shinji Naganawa, MD 

PURPOSE/AIM 

We exhibit how to plan for segmentectomy of lung cancer by 3D-CTA with a virtual safety margin. When a pulmonary segmentectomy is planned for early stage lung cancers, it is important 

to identify the intersegmental pulmonary veins that divide the pulmonary segments. Three dimensional computed tomography angiography (3D-CTA) has shown efficacy for the 

pre-operative assessments of not only pulmonary arteries, but also pulmonary veins. However, using 3D-CTA alone, it is difficult to identify safety margins. A scheme that merged a virtual 

3D safety margin from a lung cancer into 3D-CTA can provide an overview of the three-dimensional relationship between the safety margin and pulmonary vessels. 


A. Indication of pulmonary segmentectomy.B. How to scan pulmonary 3D-CTA.C. How to make a virtual 3D safety margin.D. Anatomy of pulmonary arteries.E. Anatomy of pulmonary 

vessels.F. Segmentectomy simulation using a virtual 3D safety margin. 

SUMMARY 

3D-CTA with a virtual 3D safety margin can provide an overview of the three-dimensional relationship between the safety margin and pulmonary vessels. This method is noninvasive and 

useful for deciding the amount of lung to be removed in preoperative segmentectomy planning. 


LL-CHE2328 

Strategies to Reduce Radiation Exposure of the Female Breast in Chest CT 

Yon Mi Sung, MD , Yoon Kyung Kim, MD 

PURPOSE/AIM 

1. To review the radiation dose parameters used in computed tomography (CT)2. To describe various dose management methods for the female breast during chest CT 


IntroductionCT dose descriptors - CT dose index - volume CT dose index - dose length product - effective doseRadiation dose saving with X-ray exposure control - automatic tube 

current modulation - automated dose-saving algorithm for the breast - automatic tube voltage adjustmentRadiation dose saving with software features to optimize image quality - 

image domain based iterative reconstruction - raw data based iterative reconstructionRadiation dose saving to the breast using bismuth shielding 

SUMMARY 

The major teaching points of this exhibit are to understand the different methods to reduce radiation exposure of the female breast during chest CT and to minimize the harmful effect of 

radiation to the radiosensitive breast tissue. 


LL-CHE2329 

Spectrum of Thoracic Neuroendocrine Proliferations and Neoplasms: Carcinoid, Carcinoid Tumorlets, DIPNECH, and Carcinoid Syndrome 

Ryo Benson, MD , Melissa Rosado De Christenson, MD , Santiago Martinez-Jimenez, MD , Jeffrey Kunin, MD , Kenneth Watson, DO , Paul Pettavel, MD 

PURPOSE/AIM 

1. To present an update of the etiology, clinical manifestations, pathologic features, and management of thoracic neuroendocrine proliferations and neoplasms2. To illustrate characteristic 

imaging features and differential diagnostic considerations3. To provide a systematic approach to the evaluation and management of affected patients 


1. Definition2. Etiology3. Pathologic features of carcinoid tumorlets, diffuse idiopathic neuroendocrine cell hyperplasia (DIPNECH), typical and atypical carcinoids, and carcinoid syndrome4. 

Clinical manifestations5. Imaging: Radiography, computed tomography, scintigraphy6. Management: Surgical and medical treatment options 

SUMMARY 

Carcinoid tumorlets and DIPNECH are increasingly diagnosed on chest imaging studies and biopsy specimens. Typical and atypical carcinoid tumors are rare low grade malignant neoplasms. 

Carcinoid syndrome rarely affects patients with thoracic carcinoid tumor, but its recognition is critical for appropriate patient management. Although these lesions seem related, their 

pathologic features, imaging characteristics, prognosis and treatment vary widely. Understanding the protean imaging features of these lesions allows the radiologist to formulate an 

appropriate differential diagnosis, suggest the correct diagnosis, and positively impact patient management. 


LL-CHE2330 

Peripheral Endobronchial Polyp Resection by Computed Tomography Guided Bronchoscopy 

Leonardo Gutierrez , Sergio Nemoto , Endrigo Giordano , Marcelo Rossi, MD , Renato Mendonca, MD , Ula Passos, MD , Jorge Pedroso , Moacir Junior, MD 

PURPOSE/AIM 

Based in a multidisciplinary approach in the management of an isolated endobronchial polyp, the purpose of this review is to discuss the different available bronchoscospic techniques for 

endobronchial lesions resection depicting their advantages and disadvantages, as well as their potential complications, and to depict the clinical applications of computed tomography (CT) 

guided bronchoscopy in the assessment of peripheral endobronchial polyps. 


Case presentation and clinical challenges. Pulmonary endobronchial polyps – differential diagnosis, pathophysiology, and clinical presentation. Imaging workup – CT and virtual broncoscopy. 

Bronchoscopy – diagnostic and therapeutic techniques. CT-guided bronchoscopy – techniques, clinical indications and complications Future directions. Summary. 

SUMMARY 

Subsegmental endonbronchial polyps are difficult to reach by conventional bronchoscopy. CT-guided bronchoscopy may improve assessment of such lesions increasing diagnostic sensitivity 

and allowing therapeutic intervention with curative intent, precluding more expensive and aggressive strategies as surgical approach. 


LL-CHE2331 

Optimization of Pulmonary CT Angiography: Tips and Tricks 

Laura Jimenez-Juan, MD , Hatem Mehrez, PhD , Ali Ursani, BEng , Devang Odedra, BS , Hany Kashani, MD , Narinder Paul, MD 

PURPOSE/AIM 

1) To review optimal technical parameters for CT pulmonary angiography (CTPA).2) To discuss different strategies used to minimize radiation dose and achieve robust diagnostic quality 

studies. 


1) Description of the technical scan parameters involved in CTPA.2) Practical “how-to” guide to manipulate the parameters that influence radiation dose and image quality: image noise, 

signal, signal to noise ratio, contrast to noise ratio and factors that determine spatial resolution.3) Discussion of optimizing the iodine concentration, rate of injection and total volume of 

iodinated contrast for individual patients.4) Introduction to iterative reconstruction parameters in CTPA.5) Review of tricks to avoid poor quality studies related to respiratory motion, body 

habitus and streak artifacts. Illustrative examples of chronic and acute pulmonary embolism will be provided. 

SUMMARY 

CT pulmonary angiography is the standard of care to rule out pulmonary embolism. It is essential that the radiologist has a comprehensive knowledge of the scan parameters and other 

factors that can degrade image quality in order to provide maximum diagnostic accuracy at the lowest radiation dose. 


LL-CHE2332 

Thoracic Central Venous Catheters and Ports Complications Evaluated by Imaging Studies 

Olavo Kyosen Nakamura, MD , Yves Costa, MD , Gilberto Szarf, MD , Rodrigo Chate, MD , Fernando Kay, MD , Marcelo Funari, MD , Rodrigo Passos, MD , Roberto Sasdelli 

Neto, MD , Gustavo Teles, MD , Cesar Nomura, MD 

PURPOSE/AIM 

To review thoracic imaging studies (chest X-ray, computed tomography and magnetic resonance imaging of patients with different central venous catheter complications;To classify catheter 

related complications as early and late complications. 


Early catheter related complications, generally related to central venous catheter insertion (pneumothorax, primary malposition, arterial perforation);Late catheter related complications, 

occurring following the catheter insertion perioperative period (fracture, infection, thrombosis). 

Page 16 of 97

SUMMARY 

Central venous catheters have been widely used in medical practice, especially in oncologic patients. Many catheter-related complications occur during their insertion and imaging-guided 

placement can reduce catheter-related complications. Radiologists should be familiar with thoracic catheter and port appropriate position and with the main aspects of the early and late 

complications related to their insertion. 


LL-CHE2333 

Chest Radiology Eponyms: Who Were Those Guys?? 

Conor Lowry, MD , Jason DiPoce, MD , Joseph Lowry, MD , Anna Rozenshtein, MD 

PURPOSE/AIM 

1. To identify eponyms commonly used in chest radiology.2. To provide a short biographical sketch of the physician behind the eponym.3. To provide a short illustrated description of the 

chest radiology eponym's relevance and important teaching points. 


Dozens of chest radiology eponyms will be categorized according to anatomy, diseases, signs, and syndromes. A biographical sketch, representative radiologic images, and important 

radiologic teaching points will accompany the eponym. 

SUMMARY 

1. Eponyms are frequently used in chest radiology related to its rich history. It is helpful and important to appreciate this history in radiology that is reflected through the use of 

eponyms.2. Eponyms are often useful to describe complicated processes succinctly.3. Familiarity with eponyms is important so that clinicians understand each other and mistakes related to 

misusage are not made. 


LL-CHE2334 

Bronchiolocentric Lung Diseases: High-Resolution CT and Pathologic Findings 

Tomas Franquet, MD , Saul Suster, MD , Melissa Rosado De Christenson, MD , Aletta Ann Frazier, MD , Santiago Martinez-Jimenez, MD , Ana Gimenez, MD 

PURPOSE/AIM 

To review the spectrum of bronchiolocentric (airway-centered) lung diseases and illustrate these lesions with selected cases and graphic illustrations.To correlate the imaging findings with 

the histopathologic featuresTo provide a structured framework for developing a differential diagnosis 


Define the term “bronchiolocentric” (airway-centered)Define the lesions by their different etiologies:Primary bronchiolar diseases: follicular bronchiolitis, eosinophilic bronchiolitis, dust 

macules centering on bronchioles, bronchocentric granulomatosis and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH)Diffuse lung diseases with a prominent 

bronchiolar involvement: EAA, organizing pneumonia, sarcoidosis, and LCGNew bronchiolocentric interstitial pneumonias: Centrilobular fibrosis, peribronchiolar metaplasia and fibrosis, 

idiopathic bronchiolocentric interstitial pneumonia and airway centered interstitial fibrosisDevelop a differential diagnosis based on pathologic-radiologic correlation 

SUMMARY 

Major teaching points:The accuracy of a CT diagnosis of bronchiolocentric lung diseases is increased by the knowledge of their pathologic manifestationsThe final diagnosis of this group of 

diseases requires a balanced combination of clinical, pathological and imaging features 


LL-CHE2335 

Pulmonary Dual-Energy CT… Like a Boss! 

Mickael Ohana, MD, MSc , Mi-Young Jeung, MD , Aissam Labani, MD , Vanina Faucher, MD , Dominique Charneau , Catherine Roy, MD 

PURPOSE/AIM 

Become familiar with acquisitions protocols and post-processing used in dual-energy chest CT.Exploit the demonstrated advantages of spectral imaging in vascular and oncologic 

diseases.Use dual-energy to reduce iodine dose in CT angiography.Be aware of current developments in the imaging of ventilation. 


1. How to use it 1.1 Basic principles 1.2 Acquisitions protocols 1.3 Post-treatment2. When to use it 2.1 Pulmonary embolism 2.2 Vascular diseases 2.3 Oncology 2.4 Ground glass opacities 

and alveolar condensations 2.5 Reduce iodine load3. Where we are going to use it 3.1 Ventilation 3.2 Myocardic function 

SUMMARY 

Thanks to a simultaneous acquisition at high and low kilovoltage, the dual-energy CT allows separation of materials (iodine, water, calcium...) and image reconstruction at different energy 

levels (40-140 keV), at the cost of a slightly increased radiation dose.Post-processing exploits these possibilities and maximizes iodine detection, with a proven benefit in acute and chronic 

pulmonary embolism (visualization of perfusion defects), characterization of alveolar condensations and ground-glass opacities, detection of contrast uptakes in oncology, and reduction of 

iodine load in CT angiography. 


LL-CHE2336 

Focal Aortic Protrusions at CT: Differential Diagnosis and Distinguishing Features 

Erica Stein, MD , Leslie Quint, MD 

PURPOSE/AIM 

Focal aortic protrusions are commonly seen on CT scans of the chest and abdomen. The purpose of this educational exhibit is to describe and illustrate several of the most common 

etiologies, with emphasis on distinguishing features. 


The following entities will be discussed and illustrated:• Intimal tear in intramural hematoma showing a smooth ulcerlike projection.• Penetrating atherosclerotic ulcer with exuberant, 

irregular plaque and occasional intramural hematoma.• Traumatic pseudoaneurysms, typically protruding anteriorly at the ductus arteriosus, with irregular margins and other, coexistent 

posttraumatic findings.• Branch artery pseudoaneurysms on the nonpleural aortic margins with focal pooling of blood in an intramural hematoma, showing communication with branch 

vessels.• Saccular atherosclerotic and mycotic aneurysms showing spherical shaped bulges with acute margins.• Post-surgical pseudoaneurysms representing contained leaks due to 

dehiscence at a graft anastomosis or cannulation site.• Surgical side branch grafts mimicking contained leaks. 

SUMMARY 

Distinguishing features of various types of aortic protrusions will be presented. Familiarization with these disease entities is important given their varying clinical implications. 


LL-CHE2337 

Tumours of the Pleura: Imaging Findings According to the Different Histotypes 

Emilio Quaia, MD , Elisa Baratella, MD , Tiziano Stocca, MD , Luca De Paoli, MD , Biagio Cabibbo , Maria Cova, MD 

PURPOSE/AIM 

The purposes of this exhibit are:1. To describe the different histologic subtypes of the tumours of the pleura according to the WHO classification including the mesothelial tumours, the 

lymphoproliferative disorders, and mesenchymal tumors;2. To describe the different possible imaging findings (prevalently on CT) of the different tumoral histotypes. 


1. Description of pleural anatomy and physiology;2. WHO histological classification of the tumours of the pleura;3. Review the common and peculiar imaging findings of the different 

histotypes of the pleural tumours also with radiologic-pathologic correlation; 4. Description of the imaging findings of the most common pleural tumours including the pleural calcified 

plaques, the diffuse malignant mesothelioma, the different sarcoma histologic subtypes, and the solitary fibrous tumour. 

SUMMARY 

The teaching points of this exhibit are:1. The description of the WHO classification of the different histotypes of the pleural tumours;2. The descirption of the common and typical imaging 

findings of the different histologic histotypes of pleural tumour; 


LL-CHE2338 

Clot or Not: The Imaging of Intra-Thoracic Thrombus, Associated Pathophysiology, and Potential Pitfalls 

Clinton Jokerst, MD , Constantine Raptis, MD , Rishi Mhapsekar, MD , Andrew Bierhals, MD , Pamela Woodard, MD , Cylen Javidan-Nejad, MD 

PURPOSE/AIM 

This is a case-based review demonstrating imaging findings associated with the spectrum of thrombosis that can occur in the chest. We also review imaging findings associated with the 

pathophysiology that leads to thrombus formation. Potential imaging pitfalls are also addressed. 


1) Introduction2) Multimodality cases illustrating imaging findings associated with thrombus and the pathophysiology that leads to thrombus formation including:Intra-Cardiac: Left 

ventricular (LV) thrombus with apical aneurysm; LV thrombus with Eosinophilic Endocarditis; Left atrial thrombus with mitral stenosis; Right atrial thrombus with tumor invasion (from 

IVC)Extra-Cardiac: Catheter-associated thrombus; Acute vs chronic pulmonary embolism; Pulmonary vein thrombus following ablation; Intraluminal aortic thrombus; Pulmonary vein 

thrombus following ablation; Effort thrombosis3) Cases illustrating potential imaging pitfalls including: Myxoma mimicking thrombus; MRI flow artifact mimicking thrombus; Pulmonary 

Page 17 of 97

artery sarcoma mimicking thrombus4) Conclusion 

SUMMARY 

1) Thrombus often has characteristic imaging findings2) The pathophysiology that leads to thrombus formation is often identifiable with imaging3) Artifacts/tumors can mimic intra-thoracic 

thrombus; various imaging findings can help the radiologist distinguish between these entities 


LL-CHE2339 

Chronic Obstructive Pulmonary Disease (COPD) – How the Radiologist Can Help 

Sumit Karia, MBBS, MRCP , Anu Balan, MBBS, MRCP , Daria Manos, MD, FRCPC , Judith Babar, MBChB 

PURPOSE/AIM 

• To describe the use of volumetric HRCT in the diagnosis and characterisation of COPD (airway and emphysema predominant phenotypes)• Review spectrum of thoracic complications 

encountered• Emphasise the emerging uses of imaging to guide future medical and surgery therapy 


• Pictorial review of the spectrum of phenotypes in COPD, identifying the proportion of emphysema, bronchial wall thickening, air-trapping, and coexisting bronchiectasis• Evaluation of 

acute exacerbation of COPD; assessing CT features which help to differentiate infectious from non infectious exacerbations • Illustrate the use of CT in identifying complications; loculated 

pneumothoraces, tracheobronchomalacia, inflammatory and neoplastic nodules, assessing atherosclerotic burden as a marker of cardiovascular co-morbidity • Demonstrate the use of CT to 

objectively quantify the severity and zonal distribution of emphysema, to guide those patients who may benefit from lung reduction volume surgery or placement of endobronchial valves. • 

CT examples of endobronchial valves and common postoperative findings 

SUMMARY 

• COPD is a common systemic disease with increasing incidence• Accurate initial characterisation has implications for future management• Prompt recognition of the malignant and 

non-malignant complications are essential to reduce mortality and morbidity 


LL-CHE2340 

Anatomy of Pericardial Recesses on CT: Implications for Oncologic Imaging 

Piyaporn Boonsirikamchai, MD , Chitra Viswanathan, MD , Myrna Godoy, MD,PhD , Reginald Munden, MD, DMD , Edith Marom, MD , Mylene Truong, MD 

PURPOSE/AIM 

1. To review anatomy of the pericardium2. To illustrate CT imaging of pericardial sinuses and recesses including their variations that can potentially be misinterpreted as adenopathy3. To 

discuss the important imaging characteristics to help differentiate pericardial recesses from adenopathy 


Normal anatomy of pericardiumPericardial sinuses and recesses1. Transverse sinus – Superior and inferior aortic recesses – Right and left pulmonic recesses – Postcaval recess2. 

Oblique sinus3. Right and left pulmonary venous recessesPotential pitfalls 

SUMMARY 

The capability of multidetector CT to obtain volumetric data with high resolution and decreased respiratory and cardiac motion artifacts results in the routine visualization of the pericardial 

recesses, even in the absence of abnormal pericardial fluid accumulation. In oncologic imaging, misinterpretation of pericardial recesses as adenopathy can lead to inaccurate clinical 

staging, and, consequently, inappropriate management. A comprehensive understanding of pericardial anatomy together with the utilization of multiplanar reformation enables improved 

diagnostic accuracy. 


LL-CHE2341 

Radiologic Review of Intrathoracic Metastases from Nonseminomatous Germ Cell Tumors of Testicular Origin: Three Decades of Experience from a Large Referral Center 

with Emphasis on Surgical Management 

Darel Heitkamp, MD , Kenneth Kesler, MD , Shawn Teague, MD , Stacy Rissing, MD , Mark Frank, MD , Karen Rieger, MD , Dewey Conces, MD , Lawrence Einhorn 

PURPOSE/AIM 

The purpose of this exhibit is to:1. Familiarize the radiologist with the appearance and dissemination pattern of metastatic intrathoracic nonseminomatous germ cell tumors (NSGCT)2. Help 

the radiologist understand how surgical management decisions are based on tumor response to chemotherapy, and how radiology plays a vital role3. Share our institution's data as a 

leading referral center for germ cell neoplasms 


1. Introduction: basic information2. The current treatment model; role of radiology3. Imaging reviewPre-therapyPost-therapy with benign residual diseasePost-therapy salvage 

cases"Pulmonary" and "mediastinal" patterns of disease dissemination with surgical approach to mediastinal compartmentsReview of post-operative chest, common surgical devices, and 

common complications4. Review of extensive single institution surgical data 

SUMMARY 

The major teaching points of this exhibit are:1. Intrathoracic metastases from NSGCT of testicular origin have a predictable pattern of distribution on chest CT.2. Radiology plays a vital role 

in management of these patients.3. The current model of chemotherapy combined with surgery to remove any residual disease is viewed as the most successful cancer treatment model, 

against which therapies for other solid cancers are compared. 


LL-CHE2342 

Spectrum of Iatrogenic Esophageal Injuries Following Esophageal and Non Esophageal Procedures: Role of Imaging in Prompt Diagnosis and Management 

Rachna Madan, MD , Beatrice Trotman-Dickenson, FRCR, MRCP , Andetta Hunsaker, MD 

PURPOSE/AIM 

1. Review esophageal anatomy and potential for injury. 2. Describe clinical presentation and imaging appearance of esophageal injuries and ensuing complications related to esophageal 

instrumentation and non-esophageal procedures like diskectomy, cardiac surgery, endotracheal intubation, aortic surgery and surgery for lung cancer. 3. Discuss role of interdisciplinary 

collaboration in management of complications following iatrogenic esophageal injuries. 


1. Review the pathogenesis and clinical manifestations of iatrogenic esophageal injuries.2. Illustrate the radiologic manifestations of iatrogenic esophageal injuries using 

case-based-scenarios.3. Emphasize, through case-based-imaging, the appropriate diagnostic algorithm for imaging and management of esophageal injuries.4. Discuss the role of imaging in 

the early diagnosis, interdisciplinary management, and surveillance in an effort to reduce overall morbidity and mortality in patients with iatrogenic esophageal injuries. 

SUMMARY 

Our aim is to heighten awareness regarding iatrogenic esophageal injuries and present their varied clinical and imaging manifestations. Diagnostic algorithm is based upon suspicion of 

injury. Imaging protocols are individualized to optimize early detection of esophageal injury. 


LL-CHE2343 

CT Guided Color Marking for Video Assisted Thoracoscopic Surgery in the Patients with Small Lung Nodules: A Pictorial Review 

Megumi Nakamura , Takeshi Yoshizako, MD , Koji Uchida , Mitsunari Maruyama , Masakatsu Tsurusaki, MD, PhD , Hajime Kitagaki, MD 

PURPOSE/AIM 

The purpose of this exhibit is:1. To present several techniques of CT guided color marking before video assisted thoracoscopic surgery (VATS) for lung nodules.2: To discuss the utility and 

limitation of the technique. 


A. Introduction of indication and procedureB. Several techniques of the color marking for VATS (lung nodule; in sub-pleural lung, near diaphragm, near pericardium, near deep fistula, on 

multiple markings at same time, with pneumothorax, to biopsy on operation, with charcoal powder composed lung, and on long time distance after marking).C. Discussion of the utility and 

limitation of the color marking for VATS. 

SUMMARY 

CT guided color marking for VATS is useful under the conditions as follows,1. Marking of sub-pleural lesion2. Marking of a lesion near organ with the movement3. With a little pneumothorax 

and a low incidence4. Multiple markings at same time5. Unnecessary erasing the markerTherefore, the limitations of the technique are unclear-visualized on charcoal powder composed lung 

and decrease color dense according to the duration after marking. 


LL-CHE2344 

Tobacco-smoking Induced Acute Eosinophilic Pneumonia; Take Care After Smoking tobacco for the First Time 

Osamu Honjo , Masaki Mori, MD , Hirotoshi Homma, MD 

PURPOSE/AIM 

To review the clinical findings and radiographic features of acute eosinophilic pneumonia started by first-time smoking tobacco. 


In Japan not only the chronic disease(e.g. COPD), relation between acute eosinophilic pneumonia(ACP) and tobacco smoking is pointed out. The first smoking history is accepted before one 

Page 18 of 97

to two weeks of development of symptoms in many cases.The contents of this exhibit are follows;A. Etiology of ACPB. Clinical findings of ACPC. Labs tests of ACPD. Radiographic 

manifestations of ACPE. Differential diagnosis of ACPF. Treatment of ACPG. OutcomesH. Case reports 

SUMMARY 

The chest picture view of the cases experienced with our institution is shown, and it aims at increasing an understanding of the acute eosinophilic pneumonia resulting from smoking 

tobacco. 


LL-CHE2345 

Imaging of Fibrous Lesions of the Thorax: Radiologic-Pathologic Correlation 

Carol Gomez Barbosa, MD , Isabel García Gómez-Muriel , Luis Gorospe Sarasua , Arnaldo Javier Fernandez Orue, MD , Hector Pian 

PURPOSE/AIM 

1. To describe the imaging features of the main fibrous lesions of the thorax 2. To review the correlated radiologic and pathologic findings of the main fibrous thoracic lesions 


Histologically, fibrous lesions of the thorax share the presence of fibroblasts and/or fibrosis. Most of these lesions are benign, and are relatively rare.In this paper we review the imaging 

features of fibrous thoracic lesions and correlate them with their pathologic findings. The entities described include: solitary fibrous tumor of the pleura, chest wall desmoid tumor, 

desmoplastic malignant mesothelioma, desmoplastic small round cell tumor, fibrosing mediastinitis , tumoral and pseudotumoral bone lesions (fibrous dysplasia, dorsal elastofibroma, 

malignant fibrous histiocytoma ..), inflammatory myofibroblastic tumor, sclerosing hemangioma, progressive massive fibrosis..A definitive preoperative diagnosis of some of these entities 

may not be exclusively based on cytologic or histologic findings, but it may require taking into consideration the radiological and clinical context of the case. 

SUMMARY 

The importance of correctly identifying and characterizing these tumoral and pseudotumoral (usually benign) thoracic lesions is that they can sometimes mimic malignancy. A correct 

preoperative diagnosis is, quite frequently, difficult to achieve. 


LL-CHE2346 

Block, Twist and Turn....Role of 3D Imaging- Vascular and Bronchial Complications Post Lung Surgeries 

Manish Patel, MD , Sushilkumar Sonavane, MD , Jubal Watts, MD , Ruchi Yadav, MD , Rahul Renapurkar, MD , Satinder Singh, MD 

PURPOSE/AIM 

Lung transplant, pneumonectomy, lobectomy are frequently performed major thoracic surgeries at tertiary care hospitals. Computed tomography (CT) plays a crucial role in evaluating the 

bronchial and arterial complications. The purpose of the exhibit is to emphasize the role of 3-D CT imaging in evaluating vascular and bronchial complications after lung surgeries. 


The exhibit will be organized as below:Spectrum of complications and role of computed tomography after lung transplant, pneumonectomy, lobectomy.Role of 3D CT post processing in 

diagnosis of vascular and bronchial complications such as bronchial stenosis/occlusion, arterial stenosis, torsion of the lung, bronchopleural fistula, postpneumonectomy 

syndrome.Reviewing only the axial images can give false positive appearances.Present sample cases 

SUMMARY 

Major teaching points of this exhibit are as below:CT is important for detection of post surgical complications after lung surgeries.More importantly, 3D post processing helps in definitive 

diagnosis of arterial and bronchial complications. 


LL-CHE2347 

Acute or Subacute Chemical-induced Lung Injuries: Thin-Section CT Findings 

Masanori Akira, MD , Tomohisa Okuma, MD,PhD , Sayoko Tokura , Yoshikazu Inoue, MD, PhD , Narufumi Suganuma, MD 

PURPOSE/AIM 

To show thin-section computed tomography findings of acute or subacute lung parenchymal injuries caused by chemicals. 


irritant gases. a. hydrogen chloride (high water-solubility) b. chlorine gas exposure (moderate water-solubility) c. nitrogen dioxide (low water-solubility)chemical pneumonitis due to 

inhalation of paint thinnerlipoid pneumoniasmoking realted eosinophilic pneumoniaparaquatacute respiratory distress syndrome due to inhalationhypersensitivity pneumonitis due to 

inhalation of an insecticideeosinophilic pneumonia due to inhalation of an insecticide 

SUMMARY 

Many respiratory diseases are caused by chemicals. A great variety of substances can cause inhalation injury. Chemical-induced lung injury may also be caused by routes other than 

inhalation. Agrichemicals such as paraquat may cause lung injury following ingestion or dermal absorption. Lung injury caused by chemicals includes bronchitis, bronchiolitis, chemical 

pneumonitis, pulmonary edema, acute respiratory distress syndrome, bronchiolitis obliterans organizing pneumonia, hypersensitivity pneumonitis, acute eosinophilic pneumonia, and 

sarcoid-like granulomatous lung disease. We should know about CT features of lung parenchymal abnormalities caused by chemicals. 


LL-CHE2348 

Imitation is the Sincerest Form of Flattery: Recognizing Imaging Manifestations of Intrathoracic Lymphoma 

Brett Carter, MD , Leila Khorashadi, MD , Carol Wu, MD , Gerald Abbott, MD , John Lichtenberger, MD 

PURPOSE/AIM 

The purpose of this educational exhibit is to demonstrate the wide variety of imaging findings that may be present in intrathoracic lymphoma and how the disease process may mimic other 

diagnoses. 


The individual will be presented with 2 unknown cases (case A and case B) for each specific imaging manifestation of intrathoracic lymphoma. One unknown case will represent lymphoma 

and the other unknown case will represent another disease process that can manifest similarly. A differential diagnosis for each specific imaging manifestation of lymphoma will then 

provided. Examples on chest radiography, CT, PET/CT, and MRI will be included. Information regarding pathophysiology, diagnosis, treatment, and treatment monitoring (including RECIST) 

will be provided. 

SUMMARY 

Intrathoracic lymphoma has been classified into the following 4 types: primary lymphoma, recurrent or secondary lymphoma, post-transplantation lymphoproliferative disorder, and 

AIDS-related lymphoma. Given the variety of ways in which the chest may be affected by lymphoma, it is important for the radiologist to be aware of the full spectrum of radiologic findings 

that may be encountered, understand the similarity of those patterns to other disease processes, and be able to generate a specific differential diagnosis 


LL-CHE2349 

Itchy and Erythematous Lungs: Clinical Presentation, Diagnosis and Differentials 

Jitesh Ahuja, MD, MBBS , Carolina Souza, MD , Elena Pena, MD , Carole Dennie, MD , Jean Seely, MD , Ashish Gupta, MD 

PURPOSE/AIM 

To review the imaging features that may alert the radiologist to the possibility of eosinophilc lung disease in appropriate clinical settingTo review the imaging features and clinical 

manifestations of various subtypes of eosinophilic lung disease and discuss differential diagnosis 


Eosinophilic lung diseases are generally classified as those of unknown cause, including simple pulmonary eosinophilia, acute eosinophilic pneumonia, chronic eosinophilic pneumonia and 

idiopathic hypereosinophilic syndrome, and those of known cause including allergic bronchopulmonary aspergillosis, bronchocentric granulomatosis, parasitic infection and drug reaction as 

well as eosinophilic vasculitis such as Churg-Strauss Syndrome. Clinical features, laboratory findings and high- resolution computed tomography (HRCT) findings of each of these entities 

will be discussed. Commonest differential diagnoses will also be reviewed 

SUMMARY 

Eosinophilic lung diseases comprise a heterogeneous group of diseases with different clinical and imaging manifestations. Although there is a considerable overlap in the HRCT findings of 

these entities and other diffuse lung diseases, integration of clinical , laboratory and imaging findings are helpful and often allow a presumptive diagnosis of eosinophilic lung disease 


LL-CHE2350 

The Journey of a Patient Through Acute Aortic Syndrome: A Comprehensive Review Through a Radiologist's Perspective 

Shefali Kothary, MD , Shannon Scrudato, MD , Alan Legasto, MD 

PURPOSE/AIM 

1. Review Acute Aortic Syndrome (AAS) through the clinical course of a single patient who has encountered the complete spectrum of AAS.2. Review the pathophysiology and radiographic 

features of AAS, including penetrating atherosclerotic ulcer (PAU), intramural hematoma (IH) and aortic dissection (AD).3. Discuss the pertinent findings the clinician needs to know in order 

to appropriately treat the patient. 


1. Describe the spectrum of AAS including clinical features, epidemiology, and pathophysiology utilizing medical illustrations.2. Review the imaging findings of AAS associated with PAU, IH, 

Page 19 of 97

and AD on conventional radiographs, CT and MR, particularly using imaging examples from a single patient who experienced the entire spectrum of AAS.3. Review the management and 

surgical options of AAS. 

SUMMARY 

Acute Aortic Syndrome is a devastating disease with fatal consequences. AAS includes three emergent entities of the aorta, which share similar clinical manifestations but differ in 

pathophysiology. At the end of the exhibit the reviewer will see the progression of AAS in a single patient. Through a pictorial review, the radiologist will have a comprehensive 

understanding of this disease entity which will enable accurate diagnosis on multiple imaging modalities. 


LL-CHE2351 

Use of Digital Radiography with Dual-Energy Subtraction in Detection of Cardiovascular Pathologies 

Kianoush Gilani, MD , Indravadan Patel, MD , Sara Smith , Trevor Jenkins , Robert Gilkeson, MD 

PURPOSE/AIM 

To show the value of Digital Radiography with Dual-Energy Subtraction in detecting cardiovascular disease not detected on conventional chest radiograph. 


Dual-energy subtraction (DES) techniques can produce a conventional high-peak-kilovoltage image and a low-peak-kilovoltage image. Postprocessing of these two images results in the 

presentation of the standard high-peak-kilovoltage image, a subtracted soft-tissue image that removes overlying bones from the underlying lung and mediastinum, and a low-energy bone 

image that optimally displays bone and calcified thoracic structures. Our experience shows that detection of calcified cardiovascular pathologies is markedly improved on the low-energy 

bone image.This exhibit provides multiple examples of cardiovascular pathologies detected using digital radiography with DES technique in our institution. These include coronary artery 

disease, cardiac valvular pathologies, and pericardial disease among others. Many of these pathologies were either undiagnosed or underestimated using conventional chest radiograph. The 

images are correlated with CT and ultrasound findings to enhance the educational yield. 

SUMMARY 

Dual-energy subtraction digital radiography provides important new information in the assessment of cardiovascular disease not detected on conventional chest radiograph. 


LL-CHE2352 

Imaging Features of Non-neoplastic Chest Wall Disorders 

Yo Won Choi, MD , Kibo Yoon, MD , Seunghun Lee, MD 

PURPOSE/AIM 

Various disorders may affect the chest wall. Among them, contrary to neoplastic disorders, the imaging features of non-neoplastic ones, have been hardly discussed. The purpose of the 

exhibit is to display radiographic and CT findings of various non-neoplastic disorders of the chest wall, including arthritis and infectious and connective tissue diseases. 


Congenital developmental anomalies; Poland’s syndrome, funnel chest, pigeon breast, cervical rib.Infection; tuberculosis, osteomyelitis, actinomycosis, aspergillosisArthritis due to 

non-connective tissue disorders; costal chondritis, sternoclavicular hyperostosis, osteitis condensans of the clavicle, scapulothoracic bursitis, osteoarthritisConnective tissue disorders; 

autoimmune (rheumatoid arthritis, dermatomyositis, ankylosing spondylitis), hereditary (Marfan syndrome, Ehlers-Danlos syndrome)Trauma; hemorrhage, stress fracture, chest wall muscle 

atrophy due to surgeryOthers ; rickets, renal osteodystrophy, myositis ossificans 

SUMMARY 

Familiarity with radiologic features of non-neopalstic disorders of the chest wall facilitates accurate diagnosis and optimal patient management. 


LL-CHE2353 

How to Manage Small Pulmonary Nodules Detected on CT?: Guidelines From the Japanese Society of CT Screening 

Kazuto Ashizawa, MD , Ryutaro Kakinuma, MD, PhD , Takeshi Kobayashi , Tohru Nakagawa, MD , Tetsuro Kondo , Yuichiro Maruyama, MD , Yoko Kusunoki , Masayuki 

Hatakeyama , Masahiro Kaneko, MD 

PURPOSE/AIM 

The purpose of this exhibit is: 1.To review the radiologic and pathologic data of small lung cancers previously reported.2.To describe the guidelines from the Japanese Society of CT 

Screening for follow-up and management of small pulmonary nodules detected on CT. 


Content organization1. Introduction2. Summary of radiologic and pathologic data of small lung cancers previously reported3. Guidelines for follow-up and management of small pulmonary 

nodules detected on screening CT Step1. Pick up nodules which require follow up CT study or biopsy/surgery Step2. Classification of nodules into 3 groups, namely, pure GGN (non-solid), 

Part-solid, and solid Step3. Management of nodules based on their size and morphology in 3 groups 4. Representative cases5. Conclusion 

SUMMARY 

The major teaching points of this exhibit are:1.Understanding radiologic and pathologic data of small lung cancers previously reported.2.Introduction of guidelines proposed by the Japanese 

Society of CT Screening for follow-up and management of small pulmonary nodules detected on CT. 


LL-CHE2354 

Pulmonary Nontuberculous Mycobacterial Infection: A Great Mimicker 

Su Jin Hong, MD , Tae Jung Kim , Kyung Won Lee, MD, PhD 

PURPOSE/AIM 

1. To review usual manifestations of pulmonary nontuberculous mycobacterial(NTM) infection2. To demonstrate unusual manifestations of pulmonary NTM infections mimicking other 

diseases; nodular form and consolidative form3. To discuss clinical, microbiological, pathological and radiological characteristics of unusual pulmonary NTM infection 


1. Overview of pulmonary NTM infection: classification, ATS/IDSA criteria and treatment2. To demonstrate the usual imaging manifestations of pulmonary NTM infection1) cavitary(classic) 

form2) nodular bronchiectatic(nonclassic) form3) disseminated form in immunocompromised hosts3. To demonstrate the unusual imaging manifestations of pulmonary NTM infection1) 

nodular form(1) solitary: mimicking primary lung cancer(2) multiple: mimicking pulmonary metastases2) consolidative form(1) mass-like: mimicking primary lung cancer(2) diffuse: 

mimicking pneumonia4. To discuss radiologic and pathologic correlation with clinical implications of unusual pulmonary NTM infection 

SUMMARY 

The clinical and radiologic features of pulmonary NTM infection may mimic those of many diseases. By being familiar with various imaging findings of pulmonary NTM infection, radiologists 

may make the correct diagnosis initially and institute appropriate treatment. 


LL-CHE2355 

Congenital Thoracic Malformations: Plain Film Approach and MDCT Correlation 

Antonio Fernandez-Alarza , Matias De Albert , Elena Carreño, MD , Xesca Martinez Torrens, MD , Miguel Lemus Rosales, MD , Albert Pons Escoda 

PURPOSE/AIM 

To review the spectrum of plain film findings of the most common congenital thoracic malformations and its CT correlation. To describe a chest x-ray approach, emphasizing imaging “key 

features” that may help carrying out diagnosis. 


The most common malformations have been divided in the following groups.I. Mediastinal lines alterations:a) Left mediastinal alterations:1. Aortic arch dependant: Left superior intercostal 

vein, Aberrant subclavian artery,Ductus diverticulum.2. Non dependant of the aortic arch:Left superior vena cava.b) Right mediastinal alterations:Right aortic arch,Inferior vena cava 

agenesis,Anomaly pulmonary venous return.c) Anomalous mediastinal locations:Pericardial agenesis.II. Hilar/perihilar alterations:a) Bronchial segmentation anomaly:Cardiac 

bronchus,Tracheal bronchus.b) Decrease of the hilar’s size:Pulmonary artery agenesis,Aberrant pulmonary artery,Swyer-James.c) Increase of the hilar’s size:Bronchial atresia and 

bronchocele, Pulmonary varicose vein.III. Lung parenquimal alterations:Cystic adenomatoid malformation,Pulmonary sequestration. 

SUMMARY 

The reader will: Be familiar with the imaging features (plain film and CT) of the most common congenital thoracic malformations. Acknowledge that plain film is a helpful tool in the first 

evaluation of these entities.Be able to carry out a systematic approach of these entities. 


LL-CHE2356 

Role of Multidetector CT in the Evaluation of Airway Stents 

Myrna Godoy, MD,PhD , David Saldana, MD , Marcelo Benveniste, MD , Ioannis Vlahos, MRCP, FRCR , Edith Marom, MD , Jeremy Erasmus, MD , David Naidich, MD , Praveen 

Rao , David Ost, MD,MPH 

PURPOSE/AIM 

To review the different types of airway stents and indications for their use as well as the role of multidetector CT in pre-procedure planning and evaluation of stent-related complications. 


IntroductionStent typesMDCT evaluation for stent placement planningIndications for stent placementComplications of airway stent placement: - Mucoid impaction - Granulation tissue - 

Tumor ingrowth - Stent-related infection - Stent migration - Stent fracture - Tracheal lacerationConclusion 

Page 20 of 97

SUMMARY 

Airway stents are being increasingly used in clinical practice and MDCT imaging assists in both placement and diagnosis of stent-related complications. Knowledge of the stents most 

frequently used together with an understanding of the criteria important in pre-procedure planning and typical manifestations of stent-related complications are useful in ensuring 

appropriate treatment. 


LL-CHE2357 

X Marks the Spot: Review of Lung Pathology with Bronchovascular Distribution 

Theodora Potretzke, MD , Jeffrey Kanne, MD , Donald Yandow, MD 

PURPOSE/AIM 

Recognition of the anatomic pattern of disease distribution is critical to the formation of an appropriate differential diagnosis. The purpose of this exhibit is to review differential diagnostic 

considerations for a bronchovascular distribution of pulmonary disease. This pattern of disease may form a distinctive "X" on frontal chest radiographs and coronal CT. By the end of the 

exhibit, participants will be able to recognize this disease pattern, discuss its differential, and understand the key aspects of these disease entities. 


Review anatomy of the bronchovascular bundle with CT correlationX-ray and CT examples of bronchovascular disease distribution showing distinctive "X" patternDifferential considerations 

for this pattern with discussion of key aspects and case illustrations a. Neoplastic - Lymphoma, Kaposi Sarcoma, Lung carcinoma b. Infectious - Bronchopneumonia - bacterial and 

fungal c. Non infectious inflammatory - Sarcoidosis, Granulomatosis with polyangiitis, Allergic bronchopulmonary aspergillosis d. Vascular - Pulmonary hypertension 

SUMMARY 

A bronchovascular distribution of pulmonary disease has characteristic imaging findings and a broad differential. Recognizing this pattern can help the radiologist form a proper differential 

diagnosis. This exhibit provides an image-rich review of this topic. 


LL-CHE2358 

Looking Beyond the Pulmonary Arteries for Causes of Chest Pain or Dyspnea on CT Pulmonary Angiogram 

Ayman Sawas, MD , Refky Nicola, DO, MS , Susan Hobbs, MD, PhD 

PURPOSE/AIM 

1. Present etiologies of chest pain or dyspnea beside pulmonary embolism that are frequently identified on CT pulmonary angiogram.2. Emphasize the importance of persistent search on 

the exam for extravascular cause of chest pain. 


1. Introduction of objectives.2. Nonpulmonary arterial etiologies of chest pain and/or dyspnea identified at our institution will be presented to illustrate the myriad abnormalities that can be 

seen on CT pulmonary angiogram. These case examples will include pleural, pulmonary, osseous, neoplastic, cardiovascular, and below the diaphragm potential etiologies of chest pain or 

dyspnea.3. Summary. 

SUMMARY 

Chest pain and dyspnea are common presenting symptoms in the emergency sitting. The clinical presentation of pulmonary embolism is not clear. It is often difficult to exclude without an 

imaging exam. While it is important for a radiologist to first evaluate the exam for pulmonary embolism, when no embolism is found; it is now clinically important to critically review the 

exam for other etiologies for the symptoms provided. Proper identification of these alternate diagnoses can alter patient management improving patient outcomes and highlighting the 

importance of Radiology specialists. 


LL-CHE2359 

Intrathoracic Mediastinal Thyroid Goiters: Imaging Manifestations and Differential Diagnosis 

Cosette Stahl, DO , Paul Stark, MD , Helga Stark, MD, PhD 

PURPOSE/AIM 

The purpose of this exhibit is to:1. Review the classification, prevalence, pathology and imaging characteristics of intrathoracic mediastinal goiters.2. Illustrate the multiple imaging findings 

on conventional radiographs, CT scans, nuclear medicine studies and MR scans. 


Content organization:1. Classification of goiters.2. Epidemiology3. Pathology4. Clinical manifestations5. Imaging findings6. Differential diagnosis. 

SUMMARY 

Conclusions:Intrathoracic mediastinal thyroid goiters are an important cause of pathology and source of symptoms. Imaging plays an important role in diagnosis, differential diagnosis, 

follow-up and management. The major teaching points of this exhibit are:1. Most thyroid goiters are limited to the neck but 10% extend into the mediastinum.2. Intrathoracic goiters are 

either retrosternal or posterior descending.3. Goiters can be asymptomatic or compress the trachea and the superior vena cava.4. Intrathoracic goiters can mimic other mediastinal 

masses.5. Imaging plays an important role in the diagnosis of intrathoracic thyroid goiters. 


LL-CHE2360 

Role of Chest Imaging in the Evaluation of Complications Post-Bone Marrow Transplantation 

Babak Abdollahshamshirsaz, MD , Hassan Shoushtari, MD , Jeffrey Lipton, MD , Jerahmie Zelovitzky, MD , Heidi Roberts, MD , Narinder Paul, MD 

PURPOSE/AIM 

To illustrate the utility of conventional chest imaging (chest radiography and thoracic computed tomography) and investigative chest imaging (low dose and ultralow dose thoracic computed 

tomography using iterative reconstruction algorithms) in patients with thoracic complications following Bone Marrow Transplantation (BMT). 


1- Clinical-radiological-pathological correlation of common thoracic complications in febrile immunocompromised patients following BMT, 2 – Description of radiological patterns of disease 

using conventional imaging (CXR, standard dose and high resolution thoracic CT) and investigation techniques (low dose and ultralow dose CT with iterative reconstruction algorithms), 3 - 

Classification of imaging findings based on EORTC/MSG and International consensus for invasive fungal infection. 

SUMMARY 

Immunocompromised febrile patients following Bone Marrow Transplantation are some of the most vulnerable patients in Hospitals. This educational exhibit will emphasise disease patterns 

of the most serious conditions and highlight advances in thoracic imaging that provide accurate diagnosis with minimal patient irradiation. 


LL-CHE2361 

Thoracic Aortic Diameter in MR: Slicing It Beyond the Anatomical Planes 

Kristian Mortensen, MBBS, PhD , Deepa Gopalan, MRCP, FRCR 

PURPOSE/AIM 

- Discuss the increasing role of MR in assessment of aortic diameter in risk stratification for aortic dissection and rupture.- Improve knowledge of different MR sequences and measurement 

methodologies, while providing a protocol that takes aortic imaging from the anatomical planes to truly perpendicular diameter assessments. 


1. Overview of the role given to MR in measurement of aortic diameter in international guidelines.2. Presentation of MR sequences and post-processing methodologies for aortic diameter 

assessment, including 2D and 3D data acquisitions and their role in truly perpendicular measurements. Links will be made to CT, Echocardiography and angiography.3. Provision of a 

protocol for imaging of the dilated aorta with reference to 2D and 3D data acquisition and measurement positions, as well as strengths and weaknesses of different sequences. 

SUMMARY 

MR is emerging as a gold standard for mapping aortic diameter but the validity of this important marker suffers from a lack of standardization of imaging techniques and measurement 

protocols. This exhibit will raise awareness of appropriate MR sequences, and especially highlight the limitations of conventional anatomical imaging planes, when compared 2D double 

oblique imaging and 3D multiplanar reformatting. 


LL-CHE2362 

Pulmonary Hemangioendothelioma – Pictorial Review of Clinical, Radiological and Histopathological Features 

Katharine Tweed, FRCR , Anna Sharman, MBChB, FRCR , Rachel Benamore, MBBCHIR , Fergus Gleeson, MBBS 

PURPOSE/AIM 

1. To correlate clinical, radiological and histopathology of Pulmonary Hemangioendothelioma, a rare tumour with intermediate behaviour between hemangioma and angiosarcoma.2. To 

highlight the heterogeneity of pulmonary and pleural manifestations, particularly as a recent review of National Registry patients suggests pleural involvement as a potential prognostic 

indicator. 


1. Demonstrate a variety of clinical presentations of Pulmonary Hemangioendothelioma with pleural disease.2. Illustrate Pulmonary Hemangioendothelioma using multimodality techniques of 

MDCT, MRI and 18FDG – PET-CT.3. Correlate imaging findings of pleural and parenchymal Pulmonary Hemangioendothelioma with histopathology.4. Summarize features in Pulmonary 

Hemaangioendothelioma associated with a poor prognostic outcome. 

SUMMARY 

Comparison of the clinical, radiological and histopathological features of Pulmonary Hemangioendothelioma will aid early recognition and further understanding of prognosis in a rare and 

Page 21 of 97

heterogeneous tumour. 


LL-CHE2363 

Misdiagnosis and Missed Diagnosis in the Interpretation of Chest Radiographs: A Practical Review 

Eun-Young Kang, MD , Kyung Won Doo , Ok Hee Woo, MD , Hwan Seok Yong, MD , Ki Yeol Lee, MD, PhD , Yu-Whan Oh, MD 

PURPOSE/AIM 

1. To review misdiagnosis and missed diagnosis in the interpretation of chest radiographs in daily practice.2. To illustrate common misdiagnosis and missed diagnosis encountered in the 

interpretation of the chest radiographs. 


1. Misdiagnosis and missed diagnosis on chest radiographs into two categories: false positive interpretation, false negative interpretation.2. False positive interpretation: four categories 

including technical errors, artifact, extrathoracic lesion simulating lung lesion, normal and normal variant interpreted as pathology.3. False negative interpretation in various diseases4. The 

common sites to be missed in chest radiographs. 

SUMMARY 

1. Chest radiography continues to play an important role and remains the imaging modality of choice for initial examinations.2. Comprehensive knowledge and awareness with the diagnostic 

pitfalls of chest radiographs would be essential for the radiologists to increase the diagnostic accuracy in the interpretation of chest radiographs in clinical practice. 


LL-CHE2364 

Dual Energy CT (DECT) Imaging for Pulmonary Hypertension (PH): Challenges and Opportunities 

Seyed Ameli Renani, MBBS , Laurie Ramsay, BMBCh , Farzana Rahman, FRCR, MBBS , Arjun Nair, MBBCh, FRCR , Anand Devaraj, MBBS , Ioannis Vlahos, MRCP, FRCR , 

Veronica Smith, MBBCh, MRCP , Brendan Madden, MBBCh, MD 

PURPOSE/AIM 

To illustrate the potential value of DECT in the evaluation of patients with PH. 


PH tertiary referral center experience:• Brief DECT applicable techniques: low kVp, pulmonary blood volume (PBV) and iodine mapping• Technical details that can affect image quality and 

cause erroneous interpretationLow threshold (-960HU), impact of emphysemaHigh threshold (-600HU) impact of ground glass, emphysema, ILDFOV limitationsTechnical adaptations to avoid 

above• Explanation of PBV variability between different causes of PH• Significance and relationship of ground glass, mosaicism and PBV, DECT V/Q• CTEPH appearance, differences and 

progression from simple PE• Occlusive v non-occlusive PE at PBV, physiology impact• Right ventricle enhancement Iodine mapping• Central vs peripheral enhancement differences and PBV 

variability between PH and non PH populations• Relationship of PBV to PVR• Evolving PBV usage:Characterising diseaseCentral/PBV enhancement ratios and PBV variability for detecting PH 

in combination with morphological features or directing/monitoring therapy. 

SUMMARY 

This exhibit depicts the current and future potential of DECT to evaluate PH while avoiding several commonly unrecognized pitfalls that can affect interpretation of DECT images in these 



LL-CHE2365 

Diverse Fungal Pneumonia: A Pictorial Review 

Eun-Young Kang, MD , Kyung Won Doo , Ok Hee Woo, MD , Hwan Seok Yong, MD , Ki Yeol Lee, MD, PhD , Yu-Whan Oh, MD 

PURPOSE/AIM 

1. To provide a pictorial review of various fungal pneumonia2. To provide the practical radiologic approach of various fungal pneumonia 


1. Systemic mycosis: Primary pathogen vs. Opportunistic pathogen2. Fungal pneumonias caused by primary pathogen3. Fungal pneumonias caused by opportunistic pathogen: Aspergillosis, 

Candidiasis, Cryptococcosis, Mucormycosis, Pneumocystis jiroveci pneumonia4. Pictorial review of fungal pneumonia caused by opportunistic fungi5. Radiologic review of the spectrum of 

various pulmonary aspergillosis according to host immunity 

SUMMARY 

1. Fungal pneumonia is one of the major infectious diseases for significant morbidity and mortality particularly in immune compromised host.2. Imaging plays a crucial role in the detection 

and diagnosis of fungal pneumonia.3. When fungal pneumonia is suspected, knowledge of the various imaging features will narrow the differential diagnosis. 


LL-CHE2366 

Dual Energy Subtraction Chest Radiography – When and Why? 

Diana Lam, MD , Shinnhuey Chou, MD , Sudhakar Pipavath, MD , Gregory Kicska, MD, PhD , Tina Tailor, MD , J. David Godwin, MD 

PURPOSE/AIM 

Provide an overview of the reasons and principles behind dual energy (DE) subtraction chest radiographyIllustrate the clinical indications and applications of DE radiography through imaging 

examples and comparison with conventional chest radiographs 


1. IntroductionPitfalls in conventional chest radiography2. Principles of DE radiographySingle-exposure techniqueDouble-exposure technique3. ApplicationsCalcificationsPulmonary 

nodulesAirwaysOsseous structuresForeign bodies4. Limitations and PitfallsDecreased signal to noise ratioMisregistrationCostData archiveNodule / calcification misinterpretation5. Current 

indications and utilization in the U.S.6. Conclusion 

SUMMARY 

DE subtraction chest radiography produces soft tissue-selective image and bone-selective image to improve detection and differentiation of pulmonary vs. osseous lesions.DE radiography is 

limited by a lower signal to noise ratio, misregistration, misinterpretation, and cost. 


LL-CHE2367 

Benign and Rare Malignant Esophageal Tumor: Multimodality Approach Using Chest CT, MRI, FDG/PET CT, and Endoscopic US with Pathologic Correlation 

Hyun Joo Lee , Mi Young Kim , Hye Jeon Hwang, MD 

PURPOSE/AIM 

The purposes of this exhibit are:1. To provide an overview of the various benign and rare malignant esophageal tumor except esophageal cancer2. To demonstrate diagnostic tips on various 

esophageal tumor using chest CT, MRI, FDG/PETCT, and Endoscopic US3. To correlate imaging characteristics to pathologic findings 


1. Brief review of classification of various esophageal tumors2. Illustrate radiologic findings using multimodality with follows 1. Benign esophageal mucosal tumor: papilloma, adenoma, 

polyp 2. Benign esophageal submucosal tumor: leiomyoma, leiomyomatosis, fibrovascular polyp, granular cell tumor, lipoma, hemangioma, hamartoma, rare mesenchymal tumors, cysts 

3. Rare malignant tumors: solitary metastasis, lymphoma, spindle cell tumor, leioomyosarcoma, malignant melanoma, Kaposi’s sarcoma, small cell carcinoma3. To correlate radiologic 

feature to pathologic findings 

SUMMARY 

In benign and rare malignant esophageal tumor, multimodality approach and understanding of radiologist are very important for diagnosis and treatment (especially endoscopic intervention 

and robot surgery) in clinical practice. 


LL-CHE2368 

Drug-Induced Pulmonary Toxicity: Manifestations of CT and F18 FDG PET/CT 

John McGrath, MD , Mike Nguyen, MD , Hongju Son, MD , Gerald Holzwasser, MD , John Wandtke, MD , Susan Hobbs, MD, PhD 

PURPOSE/AIM 

We illustrate the spectrum of abnormalities seen on radiography and CT, as well as FDG PET/CT in patients with drug-induced lung disease which will aid in image interpretation and 

diagnosis, providing a critical guide to patient management. 


1. Discuss the proposed pathophysiology of lung injury secondary to drugs2. Review the most common drugs (cytotoxic and non-cytotoxic) associated with pulmonary toxicity3. Describe 

the patterns and sequential changes of interstitial/air space lung disease related to drug toxicity, presenting an image-rich series of cases4. Describe PET/CT findings of pulmonary drug 

toxicity5. Brief review of patient management 

SUMMARY 

The prevalence of drug induced pulmonary toxicity is increasing and this pulmonary injury can be progressive and fatal, therefore, early recognition is important. The diagnosis is based on 

a history of drug exposure, histologic evidence of lung damage, and exclusion of other causes of lung injury. Radiologic findings are also variable, demonstrating interstitial as well as 

alveolar patterns, with well-known patterns of DAD, NSIP and BOOP. Correlation of these findings with PET/CT may be confirmatory in some cases. Knowledge of these findings and of the 

drugs most frequently involved can facilitate diagnosis and institution of appropriate treatment. 

Page 22 of 97


LL-CHE2369 

Fusion of Lung Perfusion Blood Volume (Lung PBV) and 99mTc-MAA SPECT Images in Patients with Pulmonary Embolism Before and after Treatment 

Hirofumi Koike , Eijun Sueyoshi, MD , Hiroki Nagayama , Ichiro Sakamoto , Masataka Uetani, MD 

PURPOSE/AIM 

1. To present fusion of lung perfusion blood volume (lung PBV) and 99mTc-MAA SPECT images in patients with pulmonary embolism before and after treatment..2. To understand 

mechanism of lung PBV imaging.3. To present the lung PBV image findings correlated by 99mTc-MAA SPECT image in patients with pulmonary embolism before and after treatment .4. To 

understand the differences between lung PBV and 99mTc-MAA SPECT images in patients with PE before and after treatment.5. To know clinical feasibility of fusion of lung PBV and 

99mTc-MAA SPECT images in patients with PE before and after treatment. 


1. Mechanism of lung PBV CT imaging.2. Illustrative cases3. Review of fusion of lung PBV and 99mTc-MAA SPECT images in patients with PE before and after treatment.4. Discussion5. 

Summary 

SUMMARY 

The major teaching points of this exhibit are:1. Knowledge of fusion of lung PBV and 99mTc-MAA SPECT images in patients with PE before and after treatment.2. Understanding the 

mechanism and clinical meaning of lung PBV CT imaging.3. Knowledge of clinical feasibility of fusion of lung PBV and 99mTc-MAA SPECT images in patients with PE before and after 

treatment.4. Knowledge of the meaning of the differences between lung PBV and 99mTc-MAA SPECT images in patients with PE before and after treatment. 


LL-CHE2370 

Lipomatous Lesions of the Chest: A Carefree Image Reading 

Soichi Akata, MD , Jinho Park, MD, PhD , Jun Matsubayashi , Norihiko Ikeda , Toru Saguchi , Kazuhiro Saito , Mana Yoshimura , Koichi Tokuuye 

PURPOSE/AIM 

Although many chest lesions are nonspecific in the chest XP, CT and the MRI are superior in fat detection, we often experience that fat presence is important to a diagnosis. Various kinds of 

disease including the fat are present in a mediastinum, a chest wall, lung parenchyma, a bronchus, and there are the characteristic findings that are useful in a diagnosis, respectively. 


Generally, we can recognize it to be fat if it shows -50 ~ -150 HU by CT. We can recognize it to be fat by showing a signal similar to the subcutaneous fat with T1 and a T2-weighted image, and 

the signal decrease of the fat suppression image. Also, chemical shift imaging is useful for the lesion that a slight amount of fat is coexists. The various fat-containing lesions of the chest include 

lipoma, liposarcoma, thymolipoma, thymic hyperplasia, teratoma, mediastinal lipomatosis, hemangioma, extramedullary hematopoiesis, elastofibroma dorsi, diaphragmatic hernia and hamartoma. 

SUMMARY 

It is very useful in the evaluation of the lesion including the fat of the chest to use CT and MRI. Particularly, the chemical shift imaging of MRI can detect a very small amount of fat which 

cannot be pointed out by CT. The lesion including the fat is useful in a diagnosis and makes radiologist carefree. 


LL-CHE2371 

The Lumpy Bumpy Pleura: Radiology-Pathology Correlation of Pleural Biopsies 

Neera Malik, MD , Shilpa Lad, MD , Jean Seely, MD , Ashish Gupta, MD , Marcio Gomes, MD , Harmanjatinder Sekhon, MD , Kayvan Amjadi, MD 

PURPOSE/AIM 

To review imaging features of benign and malignant pleural diseaseTo review indications and technique for image-guided pleural biopsyTo highlight the importance of radiology-pathology 

correlation through illustrative case examplesTo develop an algorithm for problem-solving in cases of discordant radiology-pathology findings 


Imaging features of benign and malignant pleural disease are presented to facilitate prompt recognition of potential malignancy. Since high false negative rates of pleural biopsy can delay 

diagnosis, optimization of image-guided pleural biopsy technique is discussed, including the importance of core needle biopsy. Case-based examples underscoring the importance of 

radiology-pathology correlation is presented, with emphasis on cases of discordance. Discordant cases showcase problem-solving tools, including the emerging role of diffusion-weighted 

pleural imaging. From these examples, an algorithm for management of discordant pleural biopsy results is elucidated. 

SUMMARY 

Advanced malignant pleural disease carries a poor prognosis. Timely diagnosis and management relies on early recognition, accurate biopsy, and further work-up of lesions with 

radiology-pathology discordance. The key is establishing radiology-pathology concordance or discordance to reduce false negative diagnoses and expedite patient management. 


LL-CHE2372 

Ground Glass and Part Solid Nodules: What Radiologists Need to Know 

George Gavern, DO , Rashmi Balasubramanya, MD , Niloofar Hakakian, MD , Oleg Teytelboym, MD 

PURPOSE/AIM 

Lung cancer survival can be improved by CT screening. Ground glass and part solid (subsolid) nodules are a common CT finding, demonstrating distinct histology, growth rate, and 

malignant potential in comparison to solid nodules. This exhibit aims to illustrate imaging features of subsolid nodules with radiologic-pathologic correlation and to review current evaluation 

guidelines. 


Illustrate radiologic-pathologic correlation for subsolid nodulesReview implication of new lung adenocarcinoma classification by International Association for the Study of Lung Cancer, 

American Thoracic Society, and European Respiratory Society for understanding histology of subsolid nodulesReview and compare subsolid nodule follow up guidelines by National 

Comprehensive Cancer Network, Godoy et al, and International Early Lung Cancer Action ProgramIllustrate PET/CT for characterization of subsolid nodule malignant potential 

SUMMARY 

Teaching points:Subsolid nodules have distinct histology and malignant potential compared to solid nodules; development of solid component correlates with progression to invasive 

cancer.Intensely FDG avid ground glass nodules on PET-CT are benign; which is the opposite of the solid nodule pattern.Accurate evaluation of subsolid nodules is important for guiding the 

therapy, follow-up and future research. 


LL-CHE2373 

New Aspects and Issues Arising from Lung Cancer Screening with MDCT 

Masaki Matsusako, MD, PhD , Katsunori Oikado, MD , Mitsutomi Ishiyama, MD , Taiki Nozaki, MD , Yuka Morita, MD , Yukihisa Saida, MD , Yuka Okajima, MD , Eiko Karita , 

Chiharu Osakabe 

PURPOSE/AIM 

The purposes of this exhibit are :1. To illustrate atypical growth pattern of lung cancers2. To learn imaging findings of lung cancers which require careful interpretation3. To discuss emerging 

issues arising from lung cancer screening with MDCT 


1. Atypical growth pattern of lung cancersi. Lung cancers mimicking inflammatory lesionsii. Lung cancers growing along bronchovascular bundlesiii. Lung cancers producing air-spaces within 

the tumor2. Imaging findings of lung cancers which require careful interpretationi. Features modified by pathologic background lungii. Lung cancers likely to metastasize to the lymph 

nodes3. Unusual clinical courses of lung cancers4. Follow up extremely slow-growing lung cancers5. Issues of lung cancers in oldest-old persons 

SUMMARY 

1. Knowledge of atypical growth pattern of lung cancer is important for early detection and management.2. Lung cancer may grow slowly even if it is a solid nodule. Non-solid nodule or 

part-solid nodule may be locally invasive even when it is small in size.3. We need to consider how to manage and treat lung cancers detected in oldest-old patients in lung cancer screening. 


LL-CHE2374 

CT and MRI of Pulmonary Arterial Abnormalities: A Pictorial Review 

Prabhakar Rajiah, MD, FRCR , Jeffrey Kanne, MD 

PURPOSE/AIM 

To review and illsutrate the CT and MRI appearances of various pulmonary arterial abnormalities 


A. Embryogenesis of pulmonary arteryB. Role of CT and MRIC. Agenesis, aplasia, hypoplasiaD. Proximal interruptionE. Major aortopulmonary collateralsF. Pulmonary slingG. ALCAPAH. 

Aneurysm, pseudoaneurysmI. StenosisJ. AVM, AV fistulaK. ArteritisL. Endovascular metastasisM. Sarcoma 

SUMMARY 

The major teaching points of this exhibit are1. CT and MRI are vital in the evaluation of pulmonary arterial abnormalities2. Aplasia, hypoplasia and interruption can be distinguished based 

on presence of bronchus3. The course of MAPCAs can be traced using CT/MRI4. ALCAPA is associated with steal phenomenon5. In sling, the LPA originates from RPA6. Pulmonary AVMs are 

associated with feeding artery and draining vein.7. High T2 wall signal is seen in pulmonary arteritis8. Endovascular mets can produce tree-in bud opacities9. Sarcoma expands arterial 

lumen and has contrast enhancement 


Page 23 of 97

LL-CHE2375 

Pulmonary Coccidioidomycosis: Pictorial Review of Chest Radiographic and CT Findings 

Nita Nayak, MD , Cecilia Jude, MD , Maitraya Patel, MD , Poonam Batra, MD 

PURPOSE/AIM 

Pulmonary coccidioidomycosis infection is a respiratory illness seen in endemic regions. Although mostly self-limited, the lung is the primary site of disease when symptomatic. Based on 

clinical presentation and imaging abnormalities, pulmonary disease may be categorized as acute, chronic and disseminated. Comorbid conditions and immune status frequently dictate the 

severity of pulmonary findings. 


There is a spectrum of imaging findings in pulmonary coccidioidomycosis. This exhibit will review chest radiographic and CT characteristics of: 1. Acute disease: a) Parenchymal – 

consolidation, nodules; b) Thoracic adenopathy; c) Pleural effusion; 2. Chronic disease: a) Residual nodules; b) Cavities; c) Fibrocavitary disease; d) Fibrosis; 3. Disseminated disease: 

miliary nodules. Complications, such as bronchopleural fistula and aspergilloma, will be depicted. Epidemiology and pathogenesis will be discussed. Patients with immunocompromised state, 

diabetes mellitus and pregnant women frequently show severe, progressive, or disseminated disease. 

SUMMARY 

Coccidioidomycosis is an endemic mycosis which is being encountered beyond Southwestern USA. Lung involvement is frequently seen. The spectrum of pulmonary imaging manifestations 

includes acute, chronic and disseminated forms. Compromised immune status correlates with increased disease severity. 


LL-CHE2376 

Chest-Devices: A Constantly Updated Online Guide to Recognizing Devices on Chest X Ray 

Manuel Martinez-Perez, MD , Javier Fernandez Jara, MD , Jimena Cubero Carralero , Alvaro Villalba Gutierrez, MD , Jorge De Luis - Yanes , Maria Cristina Cardenas 

Valencia, BMedSc 

PURPOSE/AIM 

CHEST- DEVICES serves as a free guide for radiologists, chest specialists and other physicians to recognizing and evaluating devices and wires on chest x ray, especially in those situations 

where the clinical information is not available. 


We propose a web-based resource to get accurate information about the different models of medical devices and their clinical use. Our site is divided by anatomical areas and designed for 

easy access without the need of any knowledge about the device’s utility.We would like to encourage radiologists and other chest specialists all over the world to contribute to building up 

this site by submitting verified cases, free of copyright restrictions. 

SUMMARY 

Medical devices are in continuous evolution and change. Radiologists should be familiar with both new and old devices. A free, easily available web-based guide of medical devices on chest 

x ray would help to keep radiologists and other physicians updated. 


LL-CHE2377 

Thoracic Fat-containing Lesions: Differential Diagnosis Using a Multimodality Imaging Evaluation 

Daniela Nery, MD , Olavo Kyosen Nakamura, MD , Yves Costa, MD , Ismar Silva Neto , Rodrigo Chate, MD , Marcelo Funari, MD , Fernando Kay, MD , Gilberto Szarf, MD , 

Gustavo Teles, MD , Cesar Nomura, MD , Danilo Bianco, MD , Roberto Sasdelli Neto, MD , Pedro Santana-Netto, MD , Ana Carolina Sandoval Macedo , Rodrigo Passos, MD 

PURPOSE/AIM 

To review and discuss the wide spectrum of thoracic fat-containing lesions, including several benign and rarely malignant conditions;To illustrate different fat-containing lesions findings in 

thoracic imaging exams [e.g. radiography, computed tomography (CT), and magnetic resonance imaging (MRI)], correlating with available clinical data. 


Structured systematic review of fat-containing thoracic lesions and correlation with epidemiological data, clinical findings, and imaging presentation performed in our Institution;To 

demonstrate fat-containing lesions divided in different groups by thoracic topography: endobronchial (lipoma and hamartoma), parenchymal (lipoma, lipoid pneumonia and hamartoma), 

mediastinal (lipomatosis, thymolipoma, teratoma and appendagitis), cardiac (lipomatous hypertrophy of the interatrial septum and arrhythmogenic right ventricular dysplasia), pleural 

(lipoma) and diaphragmatic hernias (Morgagni and Bochdalek). 

SUMMARY 

The use of CT and MR imaging is valuable in the evaluation of fat-containing lesions in the thorax. A great number of lesions in the chest have a nonspecific soft-tissue density or signal at 

imaging. Some lesions will demonstrate characteristic imaging findings and topography, guiding to a specific diagnosis among the wide spectrum of lesions. 


LL-CHE2378 

Pulmonary Fissures and Their Importance for Novel Respiratory Treatments - An Interactive MDCT Teaching Atlas 

Naveen Kulkarni, MD , David O'Donnell, MBBCh , Phillip Boiselle, MD , Afra Yildirim, MD , Carole Ridge, MD , Diana Litmanovich, MD , Alexander Bankier, MD 

PURPOSE/AIM 

Knowledge of pulmonary fissures anatomy and variants is key for understanding extent of lung disease, and for the detection of volume loss. Its importance has also emerged in accurate 

allocation of patients to novel therapies such as minimally invasive surgery and bronchial valve placement to treat disorders such as COPD. Thin-section multidetector CT of chest facilitates 

detailed assessment of fissures. Our exhibit will illustrate the normal anatomy, variants, and abnormalities of the pulmonary fissures. It’s implication on increased diagnostic accuracy, as 

well as on pre-treatment decision and post-treatment follow-up will be emphasized 


Using an interactive electronic interface, we will illustrate the normal anatomy, anatomic variants, and abnormalities of pulmonary fissures. Clinical relevance of imaging findings for 

pre-treatment decision-making and post-treatment follow-up will be emphasized using didactic tools such as animated decision trees and flow charts. A set of clinical test cases for 

self-assessment will be included 

SUMMARY 

This exhibit will provide an electronic reference manual on the normal and abnormal appearance of pulmonary fissures. This information will provide radiologists with a thorough 

understanding of pulmonary fissures and the practical implications of this knowledge in routine clinical decision making 


LL-CHE2379 

Chest in the Elderly: Physiological or Pathological Findings? 

Elisa Baratella, MD , Emilio Quaia, MD , Vincenzo Cioffi, MD , William Toscano, MD , Ferruccio Degrassi, MD , Roberto Cuttin-Zernich , Maria Cova, MD 

PURPOSE/AIM 

1. To describe the variety of chest changing related to the aging;2. To describe the radiologic appearance of the most common thoracic pathology of the elderly; 


1. Illustration of the morphologic changes of chest wall, thoracic spine, diaphragm and muscles;2. Description of “dirty lung”;3. Description of changing of airways (wall thickness of 

bronchus, bronchial diverticula and tracheomalacia) and of cardiovascular system (vascular and cardiac calcifications);4. Illustration of the different thoracic pathology most frequently 

observed in the elderly, including emphysema, tuberculosis, pleural calcified lesions and neoplasms. 

SUMMARY 

Diagnostic imaging has an important role to demonstrate different findings in the elderly and to define the different thoracic pathologies of the elderly. 


LL-CHE2380 

Interpretation of Fusion Imaging between Diffusion-Weighted Imaging and 3D Fat Suppressed Contrast-enhanced T1-Weighted Imaging (FDWI) and PET-CT for T, N, and M 

Staging of Lung Cancer 

Hiroyuki Horikoshi, MD , Aya Okayama, MD , Tsukasa Akiyoshi, MD, PhD , Michiko Kobayashi 

PURPOSE/AIM 

The prognosis of patients with lung cancer is dependent on the stage of disease at the time of diagnosis. The purpose of this exhibit is 1) To describe the imaging method of chest fusion 

imaging between diffusion-weighted imaging and 3D fat suppressed contrast-enhanced T1-weighted imaging (FDWI) 2) To illustrate the T,N, and M staging of lung cancers using chest FDWI 

and PET-CT. 3) To correlate the FDWI and PET-CT of lung cancers with pathologic finding. 


The content organization of this exhibit is:1. Imaging technique in the chest fusion imaging between diffusion-weighted imaging and 3D fat suppressed contrast-enhanced T1-weighted 

imaging (FDWI).2. Imaging quality of the chest FDWI and PET-CT.3. The T,N, and M staging of lung cancers using the chest FDWI and 

PET-CT. 

4. Radiologic-pathologic correlation of lung cancers in the chest FDWI and PET-CT. 

SUMMARY 

This exhibit will provide a basic understanding of the T, N, and M staging of lung cancers using the FDWI and PET-CT. The major teaching points of this exhibit are: 1. the combination of 

chest FDWI and PET-CT is a useful method for the T, N, and M staging of lung cancer. 2. The chest FDWI is a novel technique for the staging of lung cancer. 


Page 24 of 97

LL-CHE2381 

Sonographic Appearances of Thoracic Pathology: A Pictorial Review 

Natasa Devic, MBBS, MRCS , Caroline Patterson, BMBS,MRCP , Olga Lazoura , Mohanaluxmi Sriharan, MBBS, BSC , Dariush Douraghi-Zadeh, BSC, BMBS , Julia Hillier, MBBCh 

, Simon Padley, MBBS , Catriona Davies, MBBS, FRCR 

PURPOSE/AIM 

Ultrasound has a recognised role in the diagnosis and management of thoracic disease. Improvements in ultrasound technology and contrast media have led to improved spatial and 

contrast resolution and improved delineation of intra-thoracic structures. This review illustrates the spectrum of pleural, pulmonary and diaphragmatic pathology detectable on thoracic 

ultrasound. 


Pleural conditions visible sonographically include pleural effusion, empyema, pneumothorax, benign and malignant pleural thickening and masses. Pulmonary conditions visible 

sonographically include consolidation, alveolar-interstitial disease and peripheral lung masses. Assessment of diaphragm structure and motility is also possible. Images of these pathologies 

will be depicted. 

SUMMARY 

Thoracic ultrasound is an important diagnostic tool for the radiologist as it is quick, portable, readily available, repeatable, provides real-time dynamic imaging, and does not expose patients 

to ionising radiation. It may also be used to enhance the accuracy and safety of pleural procedures; however, ultrasonography is a user-dependent technology, and as usage increases, it is 

necessary to ensure clinicians are competent. As such, recognition of sonographically-detectable thoracic pathology is an essential skill. 


LL-CHE2382 

Surgical Approach to Primary and Secondary Pleural Malignancies: Anatomy, Surgical Planning and Techniques, and Imaging Appearance of Normal and Abnormal 

Postoperative Findings 

Patricia de Groot, MD , David Rice, MD , Myrna Godoy, MD,PhD , Reginald Munden, MD, DMD 

PURPOSE/AIM 

1. Review anatomic and morphological imaging findings of resectable malignant pleural disease2. Describe and illustrate surgical approaches used in treatment of pleural disease3. Review 

radiologic appearance of normal postoperative findings4. Show postoperative complications and their imaging appearance using case examples 


1. Thoracic anatomy related to staging of pleural malignancies2. Surgical planning and techniques used for pleural diseasea. Extrapleural pneumonectomyb. Pleurectomy/decorticationc. 

Palliative limited pleurectomyd. Talc pleurodesis3. Normal postoperative imaging findings4. Postoperative complications5. Potential imaging pitfalls 

SUMMARY 

Multiplanar radiologic imaging plays a crucial role in determining resectability of primary and secondary pleural malignancy, and also informs cardiothoracic surgical planning. The surgeon 

will tailor the operation and the approach depending on the extent and location of disease. In order to aid appropriate management of these patients, radiologists must not only be 

conversant with the staging of pleural neoplasms and knowledgeable about cardiothoracic surgical techniques, but have the ability to recognize and differentiate expected postoperative 

findings from recurrent disease and from postsurgical complications that require attention. 


LL-CHE2383 

Update in the Evaluation of the Solitary Pulmonary Nodule: Solid and Subsolid Lesions 

Santiago Rossi, MD , Jane Ko, MD , Ignacio Rossi , Chitra Viswanathan, MD , Mylene Truong, MD , Jeremy Erasmus, MD 

PURPOSE/AIM 

- To review the differential diagnoses of solitary solid and subsolid pulmonary nodules- To review strategies in evaluating and managing solitary solid and subsolid pulmonary nodules.- To 

discuss the imaging findings useful in differentiating benign form malignant lesions. 


- Clinical Assessment- Imaging EvaluationMorphologyGrowthEnhancement CharacteristicsMetabolism: FDG-PET- Decision AnalysisIntegrating clinical and imaging featuresManagement 

algorithms (follow up, biopsy, surgery) 

SUMMARY 

Noninvasive image-based assessment and management of solitary pulmonary nodules are evolving given advances in multidetector CT imaging technology, knowledge adquired from lung 

cancer screening studies, and understanding of the behavior of lung adenocarcinoma. Strategies for evaluating and managing solid and subsolid pulmonary nodules take into consideration 

lesion size, morphology, and growth rate as well as patients risk factors for malignancy, including age, smoking history,and hsitory of neoplasia. Although subsolid nodules can exhibit 

indolent behavior, it is important to identify the subset of lesions associated with invasive adenocarcinoma and requiring a more aggressive imaging and managment approach. 


LL-CHE2384 

Pulmonary Artery Sarcoma (PAS): A Challenging Diagnosis 

Alicia Merina, MD , Diana Plata Ariza , Carlos Penalver , Danitza Mandich , Sergio Alonso Charterina, MD , Maria Antonia Sanchez Nistal , Roberto Carrera Terron, MD 

PURPOSE/AIM 

The purpose of this paper is:•To describe and illustrate CT findings in patients with PAS based on the current literature.•To highlight the distinguishing clinical and radiological features of 

PAS, in order to aid its future diagnosis, focusing on the differential diagnosis with pulmonary embolism. 


We will simultaneously discuss the relevant literature while reviewing the findings in our six cases, following the items: 1- Epidemiology2- Clinical presentation3- Medical history4- Chest 

radiography5- Initial diagnosis6- Time to reach the PAS diagnose7- CT findings: pulmonary artery filling defect characteristics and distribution. Associated findings as mosaic pattern, beaded 

arteries or distal oligohemia. Metastases.8- Prognosis 

SUMMARY 

Pulmonary artery sarcoma (PAS) is a rare but lethal tumor that often remains undiagnosed until surgery or autopsy. The initial presentation of PAS is unspecific and generally lacks 

characteristic clinical presentations, which poses a particular challenge to an early diagnosis. This retrospective analysis seeks to establish the most important clues which may serve as an 

additional aid to successfully diagnose PAS before mediastinal extension occurs. 


LL-CHE2385 

The ABC of the Retrocrural Space 

Juan Carlos Quintero , Felisa Hermida , Jose Antonio Pumar , Purificacion Pardo Rojas , Manuel Trillo , Amad Abu-Suboh 

PURPOSE/AIM 

Illustrate the normal anatomy of the retrocrural spaceHighlight the capacity it MDCT in the evaluation of this space and our pathology 


The retrocrural space is one small region of triangular morphology in posterior mediastinum. The multiplanar capacity multiplanar of the MDCT and MR allows the evaluation of this 

space.During the last 36 months (March 2009 – March 2012) we collect any illustrative examples of the anatomy. Also we selected variants of the normal as well as one series of 

pathological conditionsTo know, and understand the normal anatomy of them as variants of the normal approach are essential for accurately diagnosing al benign conditions and pathological 

affect that this compartment 

SUMMARY 

- Content of retrocrural space- Anatomic variants: diaphragmatic cruras, congenital anomalies of inferior vena cava, foregut malformations- Diaphragmatic cruras: tumors, inflammation, 

trauma- Lymphadenopathy: tumors, inflammation, infections, miscellaneous- Tumors: neurogenic, germ cell origin, lymphoma- Vascular: aneurysms, dissection, hematoma, rupture, 

inflammation, venous collaterals, compression- Inflammation: retroperitoneal fibrosis, lypomatosis, spondylosis- Infections: infectious spondylitis, abscesses, tuberculosis- Other: 

hematoma, pneumomediastinum, pleural effusion, extramedullary hematopoiesis 


LL-CHE2386 

Time Is On Your Side: Common Post Pneumonectomy Complications and Their Chronicity 

Dean Kolnick, MD , Eric Ledermann, DO, MBA , Cameron Hassani, MD , Jennifer Martino, MD , Anna Shmukler, MD 

PURPOSE/AIM 

Pneumonectomy is a common procedure associated with both expected anatomic andphysiologic changes as well as a spectrum of complications. These anatomic changes and complications 

are often associated with time from surgery and may result in the need for surgical revision, repeated imaging follow-up and prolonged hospital stay.The aim of this presentation is to 

familiarize the radiologist with common anatomicchanges secondary to pneumonectomy as well as provide a framework for recognizingand diagnosing common complications based the 

chronicity. 


Cases to be included, grouped by chronicity:Immediate post operative changes and complications:Changes in position of major organsPost Pneumonectomy Space formationPost 

Pneumonectomy Space Hemorrhage/ Vascular stump blowoutContra lateral pneumothoraxCardiac/Pericardial HerniationEarly complications:Air LeaksEmpyemaChylothoraxBronchopleural 

fistula earlyVascular Stump ThrombusLung torsionLate complications:Post Pneumonectomy SyndromeLate EmpyemaBronchopleural fistula lateEsophagopleural fistula 

SUMMARY 

Common surgical complications secondary to pneumonectomy can be grouped based onchronicity, providing a useful framework for the diagnostic radiologist. 

Page 25 of 97


LL-CHE2387 

Secondary Causes of Pneumothorax: The Role of High Resolution CT (HRCT) in Diagnosis 

Victoria Young, MBCHB, MRCS , Nicholas Hilliard, MBBChir , Stefan Marciniak , Judith Babar, MBChB , Anu Balan, MBBS, MRCP 

PURPOSE/AIM 

Categorise the common causes of secondary pneumothorax Discuss the value of HRCT in determining a cause Illustrate findings that can be seen 


Define secondary pneumothorax and subgroups of causes Discussion of discriminating HRCT features across different conditions Pictorial review of common causes; for example, cystic 

conditions: Langerhans cell histiocytosis, lymphangiomyomatosis, Birt-Hogg-Dubé 

SUMMARY 

In presentations of pneumothorax where there is a suspicion of underlying lung disease HRCT can be extremely useful in delineating a cause We will give examples of common, and 

uncommon, lung disease that can be seen on the HRCT of pneumothorax and provide an aid to interpretation Correct diagnosis gives information important for correct prognosis and 

management 


LL-CHE2388 

Intra-thoracic Complications of Solid Abdominal Organ and Multivisceral Transplantation: Our institutional Experience 

Fatima Dambha, MBBS , Louise Wing, MBBCh , Nicholas Hilliard, MBBChir , Sara Upponi, MBBS , Judith Babar, MBChB , Anu Balan, MBBS, MRCP 

PURPOSE/AIM 

Multivisceral and solid abdominal organ transplantation require ongoing immunosuppression to ensure graft survival, this leads to stereotypical pulmonary complications When, how and with 

what: a framework to guide radiological investigation Illustrate common complications Indicate how findings can alter management 


Brief overview of the multivisceral transplantation Discussion of imaging techniques: the right investigation at the right time Pictorial review of complication, split into early (e.g. infectious - 

cavitating fungal infection, viral pneumonitis) and late (e.g. graft versus host disease, post transplant lymphoproliferative disorder). 

SUMMARY 

Multivisceral transplantation is a highly complex procedure with significant morbidity; due to the high immunosuppression required death is frequently from sepsisThere are few centres that 

perform transplantation (particularly multivisceral), however later complications may be seen by general radiologists in smaller hospitals Our aim is to provide a toolkit for investigation and 

interpretation with indication of common, serious, complications 


LL-CHE2389 

Thoracic Calcifications/Ossifications on Frontal Chest Radiograph: A Comprehensive Imaging-based Approach to Diagnosis 

Franchesca Wotton, MBBCh,MRCP , Varut Vardhanabhuti, MBBS, MRCP , Harbir Sidhu, FRCR , Gauraang Bhatnagar, FRCR , Richard Riordan, MBBS, MRCP , Nanda 

Venkatanarasimha, MBBS,FRCR 

PURPOSE/AIM 

1. Review the radiographic findings of diseases that presents with calcifications/ossifications within the thorax using frontal chest radiograph with follow-up CT imaging.2. Demonstrate 

typical approach based on specific findings on chest radiography so that a radiologist can be more accurate at refining differential diagnosis. 


IntroductionClassificationsComprehensive list of cases will be discussed including (but not limited to) the following:Pulmonary Post-Infectious (Varizella) Granulomatous (Histoplasmosis, 

Sarcoid, TB) Organic Dust (Silicosis, Baritosis) Systemic (HyperPTH, Amyloidosis) Benign (Harmatoma, Plaques) Malignant tumors (Lung, Mesothelioma, Breast, Osteosarcoma 

Metastasis, Lymphoma) Vascular (Pulmonary HT, Hemosiderosis, Mitral Valve Stones) Idiopathic (Alveolar Microlithiasis) Drugs (Busulfan, Amiodarone)Intra-Thoracic/Extra-Pulmonary 

Cardiac (Mitral Valve, Pericardial & Ventricular) Mediastinal (LNs)Extra-Thoracic Chest wall (Diaphyseal Aclasia) Soft tissue (Calcific Tendinitis, Myositis Ossificans) Metastatic/Systemic 

(HyperPTH, Chronic Renal Failure, Osteopetrosis, Paget’s) 

SUMMARY 

Thoracic calcifications/ossifications may be the initial manifestation of disease. Interpretation of their presence and specific pattern may obviate the need for invasive biopsy. 


LL-CHE2390 

Functional MR to Monitoring Cystic Fibrosis (CF) Lung Disease 

Pierluigi Ciet, MD , Federica De Leo , Silvia Bertolo , Harm Tiddens, MD , Giovanni Morana, MD 

PURPOSE/AIM 

CF is the most common lethal hereditary disease in the Caucasian. The cycle of obstruction, infection and inflammation is the main cause of lung damage. Currently, no sensitive, 

radiation-free imaging methods are available to localize and quantify lung inflammation. Recently PET-TC has been proposed in CF, but its use is limited by radiation exposure and high 

costs. Developments in MRI have made possible its larger use in thoracic imaging to obtain not only morphological,but also functional information.Our purpose is giving an overview of 

these new techniques and their potential applications in CF. 


After a brief overview of standard morphological MR protocols, a more details review of functional protocols is provided. Firstly we’ll give a new insight to apply Diffusion Weighted Imaging 

(DWI) to detect lung inflammation in CF. Secondly we’ll present the new Fourier Decomposition (FD) sequence, which provides ventilation and perfusion maps in free-breathing acquisition 

without contrast media (lung_fmri Siemens).Finally pro and cons of each technique will be discussed for a practical approach in CF follow up. 

SUMMARY 

Functional MR has the potential to supply new relevant functional information in thoracic imaging. Its impact in CF follow-up has still to be defined, but it might open new therapeutic 

scenarios in CF and in other lung diseases 


LL-CHE2391 

PET/CT in Evaluation of Thoracic Lymphoma: Imaging Update 

Naveen Kulkarni, MD , Amita Sharma, MBBS , Subba Digumarthy, MD , Carol Wu, MD , Jo-Anne Shepard, MD , Victorine Muse, MD 

PURPOSE/AIM 

Radiological evaluation of thoracic lymphoma was previously limited to nodal assessment by CT. The integration of functional imaging using FDG-PET/ CT has given new insight into the 

biological variability of lymphoma. FDG avidity, however, does not uniformly correlate with clinical behavior or histology, so interpretation needs to be performed within the context of the 

lymphoma subtype. The aim of this exhibit is to illustrate the current integrated clinical and radiologic approach to the diagnosis, treatment and monitoring of response in patients with 

thoracic lymphoma 


This exhibit will review and illustrate the current classification, staging and imaging characteristic of the common thoracic lymphoma. Specific emphasis will be on the current role of 

FDG-PET/CT in its clinical management (baseline staging, prognostic indicator, risk adapted therapy, and assessing treatment response). Illustrated case studies will reinforce the need for 

correlative clinical history to correctly interpret PET/CT findings 

SUMMARY 

The thoracic lymphoma manifests different clinical and histological presentations. This educational exhibit illustrates the correct approach to interpretation of FDG-PET/CT by emphasizing an 

integrated approach for staging, prognosis, and treatment response assessment in the common thoracic lymphomas. 


LL-CHE2392 

Importance of Accurate Pulmonary Artery/Vein Separation Prior to Lung Cancer Resection: Preliminary Trial Based on Analysis Multi-phase Image Data Obtained in 

Perfusion Study in the Lung Field 

Noritoshi Ushio, RT , Masayuki Mayumi, RT , Yukihiro Nagatani, MD , Jyousei Ueda , Akinaga Sonoda, MD, PhD , Norihisa Nitta, MD , Kazumasa Kobashi , Masashi 

Takahashi, MD , Masatake Imai , Kiyoshi Murata, MD , Ayumi Uranishi 

PURPOSE/AIM 

The purpose of this exhibit is; 1. To review the importance of correct recognition of pulmonary vein and artery in separate prior to lung cancer resection. 2. To review how to perform 

perfusion study in the lung field by 320-row ADCT. 3. To introduce our preliminary trials for complete separation between pulmonary artery and vein based on CT attenuation value (CTAV). 


* Normal anatomy of pulmonary artery and vein including periphery * General knowledge as to how correct recognition about course of pulmonary vessels has influence on lung cancer 

surgery * Principle of perfusion study in lung field with injection of 40ml of contrast mdeia at 5ml/s * Our preliminary trial for complete separation between pulmonary artery and vein 

*Technological advance for reduction of exposure dose on patient which allows us to obtain many images, such as Adaptive Iterative Dose Reduction (AIDR). 

SUMMARY 

The major teaching points of this exhibit are: 1. Accurate separate recognition of both pulmonary artery and vein is crucial prior to lung cancer operation. 2. Reduction in radiation exposure 

dose in 320-row CT combined with AIDR technique allows us to perform perfusion study in lung field. 3. CTAV in the pulmonary artery and vein maximized 7-12 second and 15-22 second 

after the injection of contrast material, respectively, according to our preliminary trial. 

Page 26 of 97


LL-CHE2393 

Morphologic and Functional Image Biomarkers of Treatment Response in Advanced Non-Small Cell Lung Cancer 

Naveen Kulkarni, MD , Surabhi Bajpai, MBBS, DMRD , Jo-Anne Shepard, MD , Subba Digumarthy, MD , Rebacca Heist, MD , Dushyant Sahani, MD 

PURPOSE/AIM 

Targeted therapies are increasingly used in advanced non-small cell lung cancer (NSCLC). Conventional tumor burden assessment has several limitations in meeting the oncologic challenges 

with such therapies. Novel image biomarkers extend beyond measuring tumor burden to assessing tumor volume, density and function/angiogenesis. In this exhibit, we review these novel 

approaches and their criteria applied for response assessment and current challenges with these techniques. 


In this electronic exhibit, using didactic tools such as animated decision trees and flow charts, we will review Relationship of tumor features (angiogenesis, metabolism, etc) to 

imaging. Imaging biomarkers (CECT, PET-CT and Perfusion CT) and their role in lung cancer imagingResponse criteria’s [Morphologic response (RECIST), Tumor density (Choi), SUV 

(EORTC)] Tumor necrosis and cavitation and its prognostic implicationsEstablishing prognosis, planning therapy, and monitoring lung tumor response. 

SUMMARY 

With use of targeted therapies in advanced NSCLC there are new oncologic challenges which cannot be fulfilled by conventional imaging. Novel image biomarkers are quantitative, robust and 

reproducible and appropriate in assessing early tumor response. This exhibit will review their application, response assessment criteria’s and limitations. 


LL-CHE2394 

Lung Adenocarcinoma: Radiologic-Pathologic Correlation 

Myrna Godoy, MD,PhD , Piyaporn Boonsirikamchai, MD , Edith Marom, MD , Mylene Truong, MD , David Naidich, MD , Neda Kalhor , Cesar Moran, MD 

PURPOSE/AIM 

1. To review the new IASLC/ATS/ERS classification of lung adenocarcinoma.2. To illustrate the CT-pathologic correlation of the different types of lung adenocarcinoma.3. To review strategic 

approach to diagnosis and management of subsolid pulmonary nodules. 


A. IntroductionB. IASLC/ATS/ERS classification of lung adenocarcinomaC. CT-pathologic correlation 1. Preinvasive lesions - Atypical adenomatous hyperplasia - Adenocarcinoma 

in situ 2. Minimally invasive adenocarcinoma 3. Invasive adenocarcinoma - Lepidic predominant - Acinar predominant - Papillary predominant - Micropapillary 

predominant - Solid predominant 4. Variants of invasive adenocarcinomaD. Algorithm for strategic management of subsolid pulmonary nodules 

SUMMARY 

A new classification of lung adenocarcinoma has been recently proposed – the IASLC/ATS/ERS classification. We will illustrate the correlation of pure ground-glass, part-solid, and solid 

nodules, with the spectrum of pre-invasive to invasive lung adenocarcinoma. Radiologists should be aware of the new nomenclature, pathologic correlation, radiological work-up 

recommendations and clinical significance of subsolid pulmonary nodules. 


LL-CHE2395 

Vasculitis of the Thorax: Pictorial Review of MDCT and 18FDG PET-CT Features of Typical Manifestations and Important Mimics 

Katharine Tweed, FRCR , Anna Sharman, MBChB, FRCR , Rachel Benamore, MBBCHIR , Fergus Gleeson, MBBS 

PURPOSE/AIM 

1. To highlight the utility and limitations of multimodality MDCT and 18FDG PET-CT in securing the prompt diagnosis and in monitoring treatment of pulmonary manifestations of multisystem 

disease with non-specific clinical symptoms.2. To understand the primary small, medium and large vessel vasculitides with a predilection for thoracic manifestations. 


1. Illustrations of typical MDCT imaging appearances of primary small and medium vessel vasculitis including Wegener’s granulomatosis, other ANCA-positive vasculitides and Churg Strauss 

disease.2. MDCT features compared and contrasting pulmonary vasculitis secondary to collagen vascular disease and rheumatoid arthritis.3. Demonstrations of the appearances of large 

vessel vasculitis including Takayasu’s and Behçet’s disease.4. Delineation of atypical imaging features and mimics of vasculitis.5. Illustrate the range of responses to and complications of 

therapy.6. A display of the extra-thoracic manifestations of vasculitis. 

SUMMARY 

Novel therapies for primary and secondary vasculitides have increased the importance of MDCT in their diagnosis and treatment monitoring. Complementary multimodality techniques may 

be used to increase diagnostic accuracy and examine the response to treatment. 


LL-CHE2396 

Correlation of Pulmonary Function Testing (PFT) in Lung Diseases 

Jonathan Chung, MD , Dipti Nevrekar, MD , Christian Cox, MD , Jeffrey Kanne, MD 

PURPOSE/AIM 

1. Summarize how pulmonary function testing is performed2. Review the different classes of spirometric flow curves3. Demonstrate the correlation between CT appearances and pulmonary 

function results in various pulmonary conditions 


1. Introduction2. Summary of how PFTs are performed3. Features of a normal PFT flow-volume loop4. Differential diagnosis of various patterns of PFTsa. Obstructive, restrictive, mixed, 

decreased DLCO, normal5. Real-life correlative cases comparing CT to PFTs in lung diseases.6. Conclusion 

SUMMARY 

Pulmonary function testing is a valuable tool in diagnosing and monitoring patients with lung diseases. Knowledge of abnormal pulmonary function testing patterns and their concomitant 

differential diagnoses can help radiologists in image interpretation. 


LL-CHE2397 

The Ins and Outs of Chest Wall Abnormalities: A Radiologist’s Guide to Evaluating Pectus Excavatum and Pectus Carinatum 


PURPOSE/AIM 

Pectus deformities are the most common congenital abnormality of the anterior chest wall, with an incidence of 1/400 children. Radiographic assessment is essential in evaluating the 

degree of deformity and resultant functional complications. The purpose of this exhibit is to create a tool for radiologists to review the imaging features and reporting of pectus deformities in 

a method which is relevant to the referrer. 


1. Discuss the epidemiology; associated pathologic entities, i.e. Marfan syndrome; clinical findings; and resultant functional abnormalities of pectus deformities.2. Review the imaging 

findings of pectus excavatum and pectus carinatum on xray, CT and cardiac MR.3. Discuss how to calculate vertebral index, frontosagittal index, and haller index, which are used to 

measure the severity of pectus deformities, through illustrations and imaging examples.4. Review the treatment options and surgical management for pectus deformities. 

SUMMARY 

1. Pectus deformities are common congenital entities which result in both cosmetic and functional abnormalities.2. At the end of this discussion the reader should be familiar with the 

imaging features and reporting of pertinent findings of pectus deformities, including the degree of deformity and associated complications, in a manner which will help in making treatment 

decisions. 


LL-CHE2398 

Dose Reduction Strategies in Pulmonary Embolism (PE) without Sacrificing Image Quality 

Nathan Plaa , Majid Homiedan, MBBS , Patrick Mc Laughlin, FFRRCSI , Savvas Nicolaou, MD 

PURPOSE/AIM 

1.Describe general approach to PE in the acute setting 2.Describe modalities used to image PE, and ways to eliminate or reduce radiation in each modality and introduce dual energy CT 

3.Describe risks of radiation and offer algorithm for imaging pregnant patient 


*Overview of clinical findings found in PE and DDx *Review risks of radiation *Review the utility of the pioped two study recommendations , the wells criteria and D Dimer in PE imaging 

*Describe new guidelines from the fleischner society to image acute PE *Advantages and disadvantages of available lower-dose modalities used in PE imaging (Chest X-ray(CXR),lower 

extremity ultrasound LEUS),MRI, Lung scintigraphy(LS),CT pulmonary angiography CTPA)) and discuss dual energy CT *Methods for dose reduction in each modality including,adaptive 

collimation,dose modulation,decrease kvp to 100 based on BMI and utilize iterative reconstruction to eliminate noise *Provide an imaging algorithm when considering dose reduction and 

assessing PE in the pregnant patient 

SUMMARY 

1.CXR and LEUS provide very low/no radiation risk and should be considered first line2.Non-diagnostic first line tests should proceed to second line tests (LS,CTPA).3.Dose-reduction 

strategies allow PE to be investigated safely in pregnancy4.More research is needed to evaluate safety of MRI in pregnant patients 

Page 27 of 97


LL-CHE2399 

The Many Faces of Pulmonary Hemorrhage: A Teaching Exhibit 


PURPOSE/AIM 

1. To review the spectrum of imaging findings in pulmonary hemorrhage, an entity in which early recognition is often essential to starting life-saving therapy.2. To describe the clinical and 

radiographic features of pathologic entities that can result in pulmonary hemorrhage using imaging correlation and medical illustrations. 


1. Review the pathophysiology of pulmonary hemorrhage.2. Review the spectrum of imaging findings in pulmonary hemorrhage using conventional radiographs and CT.3. Discuss the 

pathologic entities resulting in diffuse pulmonary hemorrhage, such as polyarteritis nodosa, Wegner’s granulomatosis, and idiopathic pulmonary hemorrhage, including clinical features, 

pathophysiology, radiographic features, and bronchoscopic correlation. 

SUMMARY 

1. Pulmonary hemorrhage is often a life-threatening condition, and it is essential for the radiologist to be familiar with the spectrum of imaging findings of this entity so that the diagnosis 

can be made promptly and accurately.2. By the end of this discussion the reviewer should have considerable understanding of the radiographic features of pulmonary hemorrhage and the 

pathologic entities that can result in diffuse pulmonary hemorrhage. 


LL-CHE2400 

Non-neoplastic Disorders of Esophagus on MDCT 

Hyoung Nam Lee, MD , Young Tong Kim , Sung Shick Jou , Jeongah Hwang, MD 

PURPOSE/AIM 

Various non-neoplastic disorders could develop in the esophagus and be shown on CT image. This article is to review the various findings in non-noeplastic disorder of the esophagus on 

MDCT image. 


1. Inflammatory condition. esophagitis - corrosive or reflux esophagitis abscess by foreign body diverticulitis2. Esophageal injury spontaneous - Boerhaave syndrome - 

Intramural hematoma traumatic3. Esophageal fistula Esophagorespiratory fistula - congenital - acquired Esophagonediastinal or esophagonodal fistula4. Esophageal mucocele by bypass 

surgery5. Esophgeal hernia esophageal or paraesophageal hernia omental fat herniation6. Developmental cysts of esophagus7. Esophageal motility disorder diffuse esophageal 

spasm achalasia 

SUMMARY 

Esophageal disorder had been evaluated by conventional esophagography and endoscopy. Current MDCT may be useful in evaluating the non-neoplastic disorder of the esophagus. 


LL-CHE2401 

Azygos System on MDCT: Pictorial Essay 

Jeongah Hwang, MD , Young Tong Kim , Sung Shick Jou , Hyoung Nam Lee, MD 

PURPOSE/AIM 

Since three dimensional and reformatted CT images show changes in location and size of azygos system, changes in surrounding vessels, and combined anomalies of vessels or organs, CT 

is useful for diagnosing congenital and acquired abnormalities of azygos system. In this article, we review CT findings of various disorders involving azygos system. 


1. Normal or normal variation Azygos arch valve Azygos fissure2. Congenital abnormalities Congenital absence of azygos vein Azygos continuation with IVC anomalies Idiopathic 

aneurysm of azygos vein3. Acquired abnormalites Azygos system as collaterals A. Superior vena cava obstruction B. Inferior vena cava obstruction C. portal hypertension D. cardiac 

arrest during CT scanning Thrombus or thrombophlebitis of azygos vein A. central catheterization B. postoperative infection 

SUMMARY 

MDCT image may be useful in evaluating anatomical relationship and various disorders involving azygos system. 


LL-CHE2402 

Bronchoscopic Treatment of Emphysema: The Role of Thoracic CT 

Pilar Calvillo Batlles, MD , Lucia Flors, MD , Laura M Trilles , Enrique Cases, MD , Juan Camacho Alcazar, MD , Juan Reig, MD , Pilar Palacios Moya 

PURPOSE/AIM 

1. To review the different devices and techniques employed in the bronchoscopic emphysema treatment (BET) and discuss their indications and potential complications.2. To describe the 

role of CT for patient selection and BET planning.3. To illustrate the expected post-treatment imaging appearance and potential complications. 


1. Introduction2. Bronchoscopic emphysema treatmenta. Techniques:• One-way valves• Biological and synthetic polymers• Thermoablation• Coils and othersb. Inclusion and exclusion 

criteria:• Clinical status• Functional respiratory tests• Thoracic CT• Perfusion scintigraphy3. CT imaginga. Technical parametersb. Pre-treatment assessment:• Emphysema: type and 

distribution• Presence of bulla• Fissures state• Signs of pulmonary artery hypertension and right cardiac overload• Lung volume quantificationc. Post-treatment assessment: • Location and 

permeability (valves)• Consolidation and atelectasis (polymers)• Lung volume reduction (qualitative and quantitative)• Complications 

SUMMARY 

BETs are new developing techniques that improve quality-of-life in severely emphysematous patients with a low rate of complications. The radiologist needs to know the imaging findings of 

appropriate candidates, post-treatment pulmonary changes and possible complications. 


LL-CHE2403 

Calcium in the Airway 

Jose Vilar, MD , Luis Requeni, MD , Carles Fonfria , Miryam Atares, MD , Jordi Blay Beltran, MD , Mª Luisa Domingo , Santiago Isarría 

PURPOSE/AIM 

Discuss the different causes of calcium deposition in the airways according to their localization and help the radiologist to recognize the patterns of airway calcification and their 

significance. 


CLASIFICATION ATTENDING TO THE LOCALIZATION:TRACHEATracheopatía osteochondroblastica: Submucosal nodules generally contacting the tracheal cartilageAmyloidosis: Concentric 

thickening with nodular lesionsBRONCHIBroncholith: Calcified lymph nodes that erode the bronchial wallCarcinoid: One third may present calcificationHamartoma: Pop corn calcification 

and/or ossification occurs in 30% of the casesLung Cancer: May be due to dystrophic changes or to engulfment of a previous calcificationForeign body: Intrabronchial foreign bodies may 

contain calcium or provoque a local reaction with calcificationDISTAL AIRWAYSBroncholithBronchiolectasis: Chronicity may produce dendriform calcificationsAlveolar microlithisasis: Small 

calculi are formed within the alveolar lumenAspirationPITFALLSNormal density at the airway walls; amiodarone toxicity; aspiration of barium; foreign bodies and surgical material; blood 

and mucus in bronchopulmonary aspergillosis. 

SUMMARY 

The location of the calcifications in the airway allows us to establish an appropriate differential diagnosis in each case. 


LL-CHE2404 

Dynamic Respiratory Motion Imaging of the Pulmonary Lobes Using 320-row ADCT 

Hiroshi Moriya, MD , Tatsuya Akimoto , Manabu Nakagawa, MD 

PURPOSE/AIM 

To illustrate the technique of dynamic respiratory scanning using 320-row ADCT.To demonstrate the dose reduction techniques, Adaptive Iterative Dose Reduction (AIDR3D) and a new 

image-reconstruction method using temporal images(PhyZiodynamics).To visualize the different movements in each lobes of the lung.To illustrate the evaluation methods of interlober 

adhesion. 


a. technological aspect of 320-row ADCT for respiratory movementb. dynamic volume scanningc. techniques of radiation dose reduction(AIDR3D and PhyZiodynamics)d. image 

reconstruction techniquese. movements of each lobes in the lungf. interlober-movements of the cases with lung cancer, COPD and other diseases 

SUMMARY 

a. 320-row ADCT allows dynamic motion images to be obtained in a single breath. These 4D-images are visualized the movements of each pulmonary lobes. Thus, these dynamic images 

are useful for the diagnosis of the interlobar adhesion/invasion of lung cancer.b. The exposure dose can be reduced by employing low-dose (5-20mAs) intermittent scanning usuing AIDR3D 

and PhyZiodynamics.c. Acceptable image quality can be obtained, without any substantial artifacts affecting diagnostic acceptability. 


Page 28 of 97

LL-CHE2405 

Clinical Applications of Low Dose Multidetector Chest CT (LDCT) 

Isabel Simon-Yarza, MD , Guillermo Viteri-Ramirez, MD , Jordi Broncano, MD , Javier Arias, MD , Gorka Bastarrika, MD , Alberto Villanueva 

PURPOSE/AIM 

The radiation dose from CT examinations has been a growing concern over the past several years. Reducing radiation dose has always been a challenge for radiologists. LDCT is the 

imaging diagnostic tool in some prevalent thoracic diseases like lung cancer, lung emphysema, pulmonary embolism or coronay artherisclerosis.However, LDCT is not actually a widespread 

technique. We have used LDCT (120 KV, 20mAs, DLP 50-60mGy-cm) for over three years in some scenarios different from those were pointed out before.We would like to persuade 

radiologists and clinics about how useful is LDCT in the daily practice.We propose the use of LDCT as a way to avoid unnecessary radiation. 


1. Follow-up in oncologic patients.2. Characterization and follow-up of lung infectious diseases (i.e. reversed halo sign in TB).3. Suspicion of chest congenital malformations in adults.4. 

Emergency patients (i.e. epipericardial fat necrosis, pneumothorax, diaphragmatic hernia).5. Planning of interventional procedures (i.e. acquisition in prone position when loculated pleural 

effusion is suspected).6. Follow-up of incidentally detected lung nodules.7. Miscellany (i.e. incidentally detected dense skin lesions) 

SUMMARY 

LDCT is useful in some specific thoracic diseases. It should be used in the daily radiological practice . 


LL-CHE2406 

Pulmonary Manifestations/Complications of Renal Disorders: A Pictorial Review 

Apurva Bonde, MBBS, MD , Ashu Seth Bhalla, MBBS,MD 

PURPOSE/AIM 

To discuss imaging findings of pulmonary manifestations/complications of various renal disorders. 


Computed Tomography (CT) scans particularly High Resolution CT (HRCT) scans play a major role in the diagnosis of pulmonary manifestations/complications of renal disorders.We have 

categorized the renal lesions associated with pulmonary lesions into:Acute kidney injuryVasculitis syndromes-Wegener Granulomatosis, Churg Strauss SyndromeCollagen vascular 

diseases-Systemic Lupus Erythematosus,SclerodermaInfectious conditionsChronic kidney disease and dialysis related complicationsThe pulmonary lesions include:Pulmonary 

oedemaPulmonary hemorhageVasculitisAir trapping and hyperinflationPulmonary embolism and infarctPulmonary infectionsPulmonary lesions associated with renal transplantation will not be 

included. 

SUMMARY 

We have described imaging features of pulmonary manifestations/complications of renal disorders. 


LL-CHE2407 

Congenital Chest Malformations Simulating Pathology in the Adult 

Manuel Escobar, MD, PhD , Nadine Romera , Roman Vidal, MD , Carles Vilà-Parera , Alberto Villanueva , Jose Caceres, MD, PhD 

PURPOSE/AIM 

Many congenital chest malformations (CCM) are asymptomatic and therefore are not discovered until adulthood. Some of them may present with bizarre images that may be confused with 

other processes. 


Cases of CCM are divided into three main categories: pulmonary, major vessels and diaphragm.Pulmonary malformations:Hypogenetic lung sindrome simulating RML disease.Atypical 

pulmonary agenesis simulates chronic pleural disease.Congenital adenomatoid malformation simulating other cystic lesions.Pulmonary sequestration presenting as recurring 

pneumonia.Congenital bronchial atresia simulating localized emphysema.Major vessels:Right and double aortic arch simulating mediastinal lymph nodesPulmonary sling simulating middle 

mediastinal massCongenital absence of superior/inferior vena cava simulating paratracheal nodes.Diaphragm:Congenital diaphragmatic duplication simulating lower lobe disease and 

abnormal fissures.Congenital hernias simulating lower lobe infiltrates or pleural fluid. 

SUMMARY 

It is important to recognize the imaging manifestations of congenital malformations of the chest to avoid confusing them with other entities. 


LL-CHE2408 

Clinical Impact of Novel CT Technologies for Diagnosing Various Chest Diseases: What the Radiologist and Radiology Technologist Should Know 

Isao Tanaka , Haruhiko Machida, MD , Rika Fukui , Xiao Zhu Lin, MD , Tubasa Iwasaki , Eiko Ueno, MD , Yun Shen, PhD 

PURPOSE/AIM 

To describe limitations of standard CT for diagnosing various chest diseasesTo illustrate novel CT technologies to overcome the limitations of standard CTTo demonstrate the clinical 

application and utility of the novel CT technologies in diagnosing the diseases by presenting various clinical images 


1. Limitations of standard CT2. Novel CT technologies3. Clinical impact of technologies・ toggling-table helical scanpulmonary arteriovenous malformation (AVM): limited 4D flow datagemstone 

spectral imaging (GSI)pulmonary embolism (PE): no data of lung perfusion・ ECG-gated and -nongated scanStanford type A aortic dissection: motion artifact・ high definition CT 

(HDCT)fine pulmonary lesions: limited spatial resolution・ iterative reconstruction (IR)streak artifact/radiation exposure 

SUMMARY 

Assessment by standard CT is limited for various chest diseases, artifacts, and radiation exposure. Toggling-table helical scan, GSI, and HDCT are novel technologies that can improve CT 

assessment and provide unique information for pulmonary AVM, PE, and other conditions; ECG-gated and -nongated scan and IR can reduce artifacts and radiation dose. The radiologist and 

radiology technologist should understand the clinical impact of these technologies for improving patient care. 


LL-CHE2409 

Pneumothorax: Everything a Resident Needs to Know 

Girish Kukade, FRCR,MD , Sameer Raniga, FRCR,MD , ANULI KUKADE, MD,MRCP , Majid Al Muquaimi, MD,FRCR 

PURPOSE/AIM 

1. Pneumothorax is frequently encountered in hospital practice at all age groups with well known typical appearance.2. Due to variations like small volume, patient’s position or due to 

associated abnormalities, there is a potential for missing or misdiagnosing it, with disastrous consequences. Some mimics and complications related to treatment are also presented.3. This is 

a case based review of the challenging diagnosis on chest radiograph for the benefit of residents, radiologists and radiographers, using cases primarily encountered at our hospital in the 

last 3 years. 


1. Brief review of typical, atypical and subtle signs on erect & supine views.2. Assess for an underlying cause and associated abnormalities, which may be overlooked.3. Review cases 

depicting variations in appearance due to loculations, the mimics & complications related to treatment, with potential disasters. 

SUMMARY 

The major teaching points are:Practical tips & tricks for diagnosis covering typical, atypical and subtle signs, followed by variant appearances, distracting findings, mimics and some 

complications related to treatment. 


LL-CHE2410 

The Use of MRI in the Characterization of the Central Lung Cancer from Associated Lung Collapse/Consolidation 

Kenneth Lau , Richard McIntyre, BSC , Chris Daley, MBBS , Stephen Stuckey, MBBS 

PURPOSE/AIM 

Although MRI has the advantages of good tissue contrast, multiplanar capability and no ionizing radiation, it is not commonly used in lung imaging due to the signal loss from respiratory 

motion, a paucity of protons in lungs, and magnetic field inhomogeneities. The advent of faster sequences, respiratory-gating and diffusion MRI may overcome some of these limitations. 

The aim of this exhibit is to demonstrate the utility of MRI in discriminating central lung cancers from distal lung collapse/consolidation. 


10 patients with central lung cancer and distal collapse/consolidation had MRI, PET and bronchoscopy. The lung cancers demonstrated diffusion restriction and early gadolinium enhancement 

because of increased tumor permeability. The tumor sizes and shapes could be delineated on MRI and were comparable to PET. MRI could further define the degree of bronchial 

compression, local tumor extension including vessels and pleura, and metastatic involvement of lymph nodes and adrenals. 4 patients had pneumonia with segmental/lobar collapse, with 

different MRI signal characteristics and these findings regressed on follow-up imaging. 

SUMMARY 

MRI is capable of defining central tumour from associated lung collapse/consolidation, and therefore assists tumor staging. In this respect MRI may be an alternative investigative tool to 

PET/CT. 


LL-CHE2411 

4-Dimensional (4-D) Assessment of Tracheal Diverticulum with 320-Slice Multidetector CT 

Theodore Lau , Kenneth Lau 

Page 29 of 97

PURPOSE/AIM 

The 320-slice multidetector CT (320-MDCT) has the ability to provide a dynamic volume assessment of the airway during respiratory cycles. This exhibit aims to demonstrate the utility of 

320-MDCT in dynamic assessment of tracheal diverticulum. 


Dynamic volume CTs of 350 patients with suspected vocal cord dysfunction was reviewed. 7 (2%) had tracheal diverticula, all located in right paratracheal region, ranging 5-22mm in size. 1 

diverticulum had thickened wall suggesting past inflammation. No diverticula had wide neck and likely had congenital etiology representing vestigial supernumerary lungs. Thread-like 

communications were demonstrated between diverticula and trachea, 4/7 very tortuous. The communications were better visualized on expiratory phase with collapse on inspiratory phase 

in 43%. The diverticula demonstrated 5-15% change of size during the respiratory cycle indicating underlying tracheal communication. 3 of these patients were symptomatic with recurrent 

aspiration pneumonitis and chronic cough likely due to mucous secretion in the diverticula. 

SUMMARY 

The 320-MDCT with its 4-D capability has value in dynamic assessment of tracheal diverticula and its communications, in distinguishing this condition from oesphageal diverticulum or 

para-apical lung cyst, as management differs. 


LL-CHE2412 

Pulmonary Tuberculosis Confirmed by Percutaneous Transthoracic Needle Biopsy: CT Findings and Correlation with Analysis Result of Underlying Lung Disease 

Ki Hwan Kim , Ki Yeol Lee, MD, PhD , Eun-Young Kang, MD , Yu-Whan Oh, MD , Baek Hyun Kim, MD , Bo-Kyung Je, MD, PhD , Ji Yung Choo 

PURPOSE/AIM 

To assess the computed tomography (CT) findings of pulmonary TB confirmed by percutaneous transthoracic needle biopsy (PTNB). 


1.Unusual radiographic manifestations of TB may be encountered in as many as one third of cases of adult-onset TB, which may seriously delay treatment. We are going to review the 

atypical CT findings of pulmonary TB and analyze the CT pattern.2. Illustration of the CT findings of pulmonary TB in the patients with coexisted usual interstitial pneumonia (UIP), 

pneumoconiosis and emphysema. Because when there is a pre-existing interstitial lung disease of UIP, the diagnosis of TB is often difficult and frequently delayed. Particularly, if the sputum 

is negative for AFB and the clinical signs in patients are atypical, the diagnosis of TB may be overlooked. 

SUMMARY 

1. Knowledge and awareness about the common findings on chest CT in patients with PTNB confirmed pulmonary TB with negative sputum AFB test 2. Comprehension of atypical CT 

findings of pulmonary TB associated with coexisted UIP, pneumoconiosis and emphysema. 


LL-CHE2413 

HRCT Features of Interstitial Lung Disease in Antisynthetase Syndrome 

Marie-Pierre Debray, MD , Jean-Marc Naccache , Raphael Borie , Antoine Khalil, MD , Elisabeth Schouman-Claeys, MD , Pierre-Yves Brillet, MD 

PURPOSE/AIM 

Describe the clinical and serologic presentation of the antisynthetase syndrome (ASS), an underestimated subset of the idiopathic inflammatory myopathies (IIM).Describe the imaging and 

pathologic features of interstitial lung disease associated to this syndrome. 


Classification of IIM, specificities of ASS.Description of imaging features and histologic data of interstitial lung disease (ILD) associated to ASS. Illustrations from a large group of patients 

with ASS. 

SUMMARY 

ASS is characterized by the association of an antisynthetase antibody (ASA), with various clinical manifestations, including myositis, arthritis, interstitial lung disease, Raynaud’s 

phenomenon and « mechanics hands ». It is recognized as a subset of the IIM with a high incidence of ILD, reported in more than 70% of patients with ASA and driving the prognosis. 

Myositis may be absent and ILD the sole manifestation of ASS, with clinically acute or gradual onset. Contrary to other subtypes of IIM, computed tomography descriptions of ILD in ASS are 

scarce and concern mainly patients positive for anti-Jo1 antibody. They report a high frequency of ground-glass opacities and, to a lesser degree, consolidations. Reported histopathologic 

data include nonspecific interstitial pneumonia, usual interstitial pneumonia, organizing pneumonia and diffuse alveolar damage. 


LL-CHE2414 

ECG-gated High Resolution CT of Chest (HRCT): A Technique to Reduce Cardiac Motion Artifacts and Radiation Dose 

Kenneth Lau , Jourena Li, MBBS , Nicholas Ardley , Kevin Buchan , Theodore Lau 

PURPOSE/AIM 

Cardiac and aortic pulsation artifacts degrade the image quality of HRCT. They cause double margins of pulmonary vessels, pleura or fissures which may obscure underlying lung diseases 

and resemble ground-glass attenuation. The aim of this exhibit is to demonstrate the capability of ECG-gating in motion artifact and radiation dose reduction. 


ECG-gated HRCT was acquired at end-diastole which had shorter x-ray exposure time compared to the routine non-ECG-gated HRCT. This enhanced the temporal resolution, and therefore, 

reduced cardiac, and to some extent, breathing artifacts. The distances of any double margins of the pleura, fissures and vessels due to motion in various segments were reduced to an 

average of 1.1mm; compared with 3 mm on non-ECG-gated HRCT. This was most apparent in the lower lungs around the heart. The excellent lung-soft tissue interface and the use of 

iterative reconstruction offset the reduced photons associated with shorter x-ray exposure and helped maintain image clarity of lungs. With shorter exposure, mean radiation dose for 

ECG-gated HRCT was 1.17mSv which demonstrated an overall 30% reduction compared to non-ECG-gated group. 

SUMMARY 

ECG-gated HRCT technique can significantly reduce cardiac and respiratory motion artifact, avoiding erroneous diagnosis of lung parenchymal disease. It also helps lowering the radiation 

dose. 


LL-CHE2415 

Bone Lesions in the Setting of a Known Malignancy: A Systematic Approach for the Thoracic Radiologist 

Navneet Singh, MD , Alan Moody, MD , Andrea Donovan, MD , Patricia Dunlop, MD , Klaus Gast, MD , Harry Shulman, MD , Lisa Ehrlich, MD , Anna Zavodni, MD 

PURPOSE/AIM 

Bone lesions are often identified by thoracic radiologists on computed tomography of the chest during the staging and surveillance examinations of patients with a known malignancy. The 

purpose of this exhibit is to discuss a systematic approach to the assessment and further evaluation of these lesions. 


1) Describe and illustrate the lexicon of bone descriptors2) Demonstrate common and classical lesions, demonstrating a spectrum of aggressive and non-aggressive disease.a. Malignant 

lesions pre- and post-therapyb. Benign tumors demonstrating a classic appearancec. Non-cancerous abnormalities including infection and insufficiency fractures3) Provide an appropriate 

algorithm for the assessment of bone lesions integrating history, physical exam and imaging findings. 

SUMMARY 

Staging and surveillance studies of the chest often result in non-musculoskeletal specialists evaluating bone lesions; this assessment can drastically impact patient care. We review the 

common and classic bone lesions of the chest and provide a practical approach to their assessment and further evaluation. 


LL-CHE2416 

Quantitative Diagnostic Imaging of Lungs and Airways in Patient with Asthma: Modern Imaging Techniques and Their Clinical Implications 

Chang Hyun Lee, MD, PhD , Eric Hoffman, PhD , John Newell, MD , Archana Laroia, MD 

PURPOSE/AIM 

Imaging techniques such as computed tomography, magnetic resonance imaging, and positron emission tomography have dramatically advanced in the recent years. We can now quantify 

regional changes of lungs in patients with asthma. The purpose of this presentation is to describe and illustrate examples of some of these modern imaging techniques. 


Modern imaging techniques:A. MDCT Radiographic findings in asthmatics - Hyperinflation, air trapping, complications in asthmatics Quantitative airway measurement such as wall thickening, wall area, and wall 

area fraction Parenchymal density based imaging % Low attenuation area and air trapping Perfusion imaging Dynamic contrast imaging Ventilation imaging Xenon-enhanced CT imaging using dual energy 

technique Its clinical implicationsB. Other imagings incluiding functional MRI, PET, SPECT, EBUS Hyperpolarized helium ventilation imaging Diffusion MR imaging 

SUMMARY 

Quantitative modern imaging techniques can provide useful data leading to an improved understanding of pathophysiology of asthma. Knowledge of the clinical implications of quantitative 

radiologic imaging techniques is helpful both to the radiologists and physicians in assessing the patient with asthma. 


LL-EDE1003 

Chest Case of the Day 

Eric Goodman, MD , Afshin Karimi, MD , Andrew Yen, MD , Anthony Herrera, MD , Sidhartha Tavri, MBBS , Raja Ramaswamy, MD , Cosette Stahl, DO , Christian Welch, MD 

Page 30 of 97

, Thomas Kinney, MD 

PURPOSE/AIM 

1. To analyze interesting chest cases. 2. To understand the appropriate differential diagnosis. 3. To understand the clinical significance of the diagnosis presented. 

Chest (Functional Lung Imaging) 

Sunday • 10:45 - 12:15 PM • S404CD 

CH MR 


PRESIDING: 

Hiroto Hatabu , MD, PhD * , Boston, MA 

Hans-Ulrich Kauczor , MD * , Heidelberg, GERMANY 

Computer Code: SSA04 • AMA PRA Category 1 Credits: 1.5 • ARRT Category A+ Credit: 1.5 

To receive credit, relinquish attendance voucher at end of session. 

SSA04-01 • 10:45 AM 

Gas-trapping Severity & Ventilation Heterogeneity Assessments via 19F MRI: Proof of Concept and Initial Experiences in Human Subjects at 3T 

Ahmed Halaweish BSc, PhD , Durham, NC • H. Page McAdams MD * • Niel R. MacIntyre MD • William M. Foster PhD • Richard D. Moon MD • Maureen D. Ainslie MS, RT • Cecil 

Charles PhD 

PURPOSE 

To evaluate ventilation heterogeneity and gas-trapping severity via 19F (fluorine) enhanced magnetic resonance imaging (MRI) in normals and subjects with lung disease 


This study was IRB approved, HIPAA compliant and informed consent was obtained for all subjects. All subjects underwent spirometry prior to imaging to establish normality and/or 

severity of disease conditions according to ATS standards. A total of 24 subjects (normal n=7, COPD n=9, Asthma n=3, CF n=3, Lung Tx n=2) were recruited and imaged on a 

Siemens Trio 3T MRI scanner (Siemens, Erlangen, Germany). Imaging consisted of three-plane 2D FLASH localizers (1H @ 123.25 MHz) to approximate the lung field of view (FOV) 

during maximal expansion and facilitate anatomical correlation with the functional datasets and functional 19F MR imaging utilizing a 3D GRE VIBE sequence (19F @115.96 MHz, FFS, 

TR – 15 ms, TE – 1.62 ms, NEX – 2, Matrix – 64x64, slice thickness – 15mm, pixel size – 6.25x6.25 mm, flip angle - 70°) at end-expiration. Conventional 1H imaging was performed 

utilizing the body coil, while the 19F imaging was performed utilizing a vest-like coil tuned to the frequency of 19F (Clinical MR Solutions, Milwaukee, WI). Subjects were connected to a 

large (~50L) Douglas bag via a mouthpiece and 35mm clean bore tubing, prefilled with a normoxic mixture of perfluoropropane (PFP) (21% O2/79% PFP) and instructed to freely 

breath. A total of 8 sequential breath holds were performed, interleaved with 4-5 breaths of the O2/PFP mixture (wash-in), or room air (wash-out). 

RESULTS 

All procedures were well tolerated with no significant adverse events. Qualitative 3D analysis of ventilation dynamics demonstrated a homogenous gas distribution within the normal 

subjects, with increasing heterogeneity in subjects with lung disease. Normal subjects demonstrated minimal to no gas-trapping. Diseased subjects showed persistent air-trapping 

following washout of the gas. 

CONCLUSION 

Ventilation imaging with 19F enhanced MR is technically feasible and well tolerated. Images of diseased subjects show spatial and temporal heterogeneity and gas trapping. 


19F enhanced MRI shows promise in establishing a robust methodology to assess pulmonary disease severity and onset, while eliminating the need for expensive equipment and 

radiation exposure. 

SSA04-02 • 10:55 AM 

Evaluation of Severity in COPD Using Dynamic Chest X-ray Examination 

Takehiko Abe MD , Kiyose, Tokyo, JAPAN • Norihisa Motohashi MD, PhD • Masamitsu Ito • Naoko Koyanagi • Tomomichi Izuka • Misako Aoki MD • Yuji Shiraishi • Hideo Ogata • 

Shoji Kudou 

PURPOSE 

To evaluate the severity in COPD using dynamic chest X-ray examination without effort breathing 


Dynamic chest X-ray from 29 normal volunteers, 30 mild COPD patients (GOLD Stage I or II) and 31 severe COPD patients (GOLD Stage III or IV) were obtained in the upright position 

in about 10 seconds of tidal breathing at rest. The dynamic image data captured at 7.5 frames per second was synchronized with the pulsed X-ray. The institutional review board 

approval and written informed consent were obtained in all persons.The maximal differential values in each ventilation phase at the corresponding small local area of lung in the series 

of dynamic chest X-ray were calculated. The regional relative flow rate ratio was obtained from the peak values of inspiratory phase divided by the peak values of expiratory phase. All 

groups were compared about the average of flow rate ratio. 

RESULTS 

The average of the ratio in normal volunteers, in mild COPD patients and in severe COPD patients were 0.21±0.03, 0.22±0.04 and 0.26±0.04 (mean±SD),respectively. Significant 

difference was confirmed between the normal volunteers and the severe COPD patients (p=0.00047), and between the the mild COPD patients and the severe COPD patients 

(p=0.0092),respectively. 

CONCLUSION 

The inspiratory / expiratory flow rate ratios in COPD patients were larger than those of healthy volunteers. The new method for ventilation function has possibility to evaluate severity of 

COPD. 


New method of dinamic chest x-ray evaluate the sevirarity of Chronic Obstructive Pulmonary Disease.The inspiratory / expiratory flow rate ratios in COPD patients were larger than 

healthy volunteers. 

SSA04-03 • 11:05 AM 

Comparison of Gas-Phase and Dissolved-Phase HP 129Xe MR Signal Distribution in Healthy Volunteers, Subjects with COPD and Age-matched Controls (AMC) 

Juliana Marcela Bueno MD , Durham, NC • Sivaram Kaushik MS • Zackary Cleveland PhD • Kingshuk Choudhury PhD • Bastiaan Driehuys PhD * • H. Page McAdams MD * 

PURPOSE 

Inhaled hyperpolarized (HP) 129Xe dissolves in pulmonary tissue and blood, simulating oxygen diffusion through the alveolar-capillary membrane. Dissolved 129Xe has a large 

chemical shift range, enabling its distribution in gas-exchange tissues to be imaged separately from gas-phase 129Xe. The purpose of this study was to analyze differences in gas and 

dissolved-phase HP 129Xe MR signal distribution in young healthy volunteers (HV), COPD subjects and age-matched controls (AMC). 


The study was IRB-approved, HIPAA-compliant, and conducted under a GE Healthcare IND for HP 129Xe. Coronal supine HP 129Xe gas and dissolved-phase MR images were acquired 

in 6 HV, 6 AMC and 6 COPD (GOLD Stage II) subjects. Images were analyzed by separating right and left lung into 3 zones (apical, middle, lower). Each zone was assessed for 

anterior/posterior intensity gradient (A>P, A=P, A

CONCLUSION 

It is feasible to study lung ventilation function using DECT after krypton inhalation in animals. The 50% or 60% krypton dose might be appropriate for ventilation imaging. 


Inert krypton is feasible for use in use ventilation CT images with dual energy technique, and it might be a useful alternative to xenon. 

SSA04-05 • 11:25 AM 

Heterogeneities in Alveolar Structure and Density Across the Healthy Human Lung by in Vivo 3He Lung Morphometry 

James Dennis Quirk PhD * , Saint Louis, MO • Dana Zhao • Jason C. Woods PhD • David S. Gierada MD * 

• Mark Conradi PhD • Dmitriy A. Yablonskiy PhD 

PURPOSE 

The purpose of this study was to non-invasively characterize heterogeneity in acinar structure at the alveolar level across the human lung and its response to gravitational compression. 


In vivo lung morphometry with hyperpolarized 3He diffusion MRI was used to obtain supine images on12 adult non-smokers during a breath-hold (Siemens 1.5T Sonata scanner; 7x7 

mm pixels; 3, 30-mm axial slices; θ=5.5°; TR/TE=13/8.3 ms; b=0-10 s/cm2; Δ=1.8 ms). The 3He lung morphometry technique treats the lung acini as networks of cylindrical airways 

covered by alveolar sleeves, allowing measurement of airway geometrical parameters including their radii, the alveolar sleeve depth, alveolar density, and surface-to-volume ratio. To 

examine in-plane heterogeneity each lung was divided at the midpoint into anterior and posterior halves. 

RESULTS 

Compared to the anterior lung, the posterior lung regions had 15% higher alveolar density and 17% decreased acinar duct lumen radius. Such gravitational differences in lung density 

were previously detected by histology and other imaging techniques and were often attributed to changes in alveolar size. 3He lung morphometry identified that the main gravitational 

effect was compression of the alveolar duct lumen in the dependent lung regions (28% reduction in lumen volume) and that the alveoli themselves are of similar size in both regions. 

No significant differences in acinar structure were detected between the right and left lungs. Superior-inferior differences were also detected; the apex has 6% smaller acinar duct 

radius and 8% smaller duct lumen compared to the lung base. These gradients are not explained by gravitational effects and therefore represent innate structural differences. 

CONCLUSION 

3He lung morphometry is uniquely capable of safely and non-invasively measuring differences in acinar geometry across the lung and independent of perfusion gradients that 

complicate density measurements by CT or 1H MRI. By detecting and characterizing the physical variations in pulmonary micro-structure, we can characterize the biomechanics of lung 

compression and improve our understanding of spatial heterogeneity in lung physiology and the onset of disease. 


3He lung morphometry MRI can non-invasively characterize acinar micro-structural heterogeneity across the lung and the gravitational compression of posterior lung regions in the 

supine position. 

SSA04-06 • 11:35 AM 

Comparison of Quantitative and Semi-quantitative Measures of Regional and Global Pulmonary Parenchymal Perfusion by Magnetic Resonance Imaging —The MESA COPD 

Study 

Katja Hueper , Hannover, Lower Saxony, GERMANY • Megha Parikh • Jie Zheng PhD • David A. Bluemke MD, PhD • R. Graham Barr • Jens Vogel-Claussen MD • Chia-Ying 

Liu • Thomas A. Goldstein PhD • Eric A. Hoffman PhD * • Joao A. C. Lima MD * • Martin R. Prince MD, PhD * 

• Jan Skrok MD • Christian Schoenfeld 

PURPOSE 

To compare quantitative and semiquantitative measures of regional pulmonary parenchymal perfusion using dynamic contrast-enhanced MRI and to correlate these regional lung 

perfusion measures with global lung perfusion (GLP) and lung diffusing capacity (DLCO). 


One hundred and forty participants in the MESA COPD study (n=81 COPD; n=59 controls) were included in the analysis. Pulmonary perfusion was measured on a 1.5 T MRI scanner 

(GE Healthcare) using time resolved imaging of contrast kinetics (TRICKS) with 0.1 mmol/kg Gd-DTPA injected at 5 ml/s. The arterial input function for absolute quantification of 

pulmonary blood flow (PBF) was derived from cardiac perfusion MRI in the right-ventricular cavity (0.05 mmol/kg Gd-DTPA). PBF was calculated on a pixel-by-pixel basis by using the 

Fermi function model and displayed in parameter maps. Semiquantitative parameters for regional lung perfusion were determined from signal-intensity time curves: peak signal 

increase (SI) = peak - 20% signal intensities; upslope = maximum rate of signal increase as determined by use of a linear fit. Mean perfusion values over 3 coronal slices and both 

lungs were calculated.GLP was calculated as the ratio of cardiac output and total lung volume. 

RESULTS 

Overall, mean total regional PBF (84±45 ml*min-1*100ml-1) was in excellent agreement with GLP (86±21 ml*min-1*100ml-1) and was positively correlated with GLP (r=0.45, 

p

SSA04-09 • 12:05 PM 

Reproducibility Study of Proton Based Lung Perfusion and Ventilation MRI by Means of Fourier Decomposition 

Mathieu Lederlin , Pessac, Bordeaux, FRANCE • Grzegorz Bauman DiplPhys • Monika Eichinger MD • Julien Dinkel MD • Mathilde Brault • Julien Asselineau • Paul Perez • 

Hans-Ulrich Kauczor MD * • Michael Ulrich Puderbach MD * 

PURPOSE 

As a free breathing, non-contrast enhanced, non-triggered MR technique, the Fourier Decomposition (FD) method is promising for evaluating pulmonary ventilation and perfusion in a 

clinical setting. The goal of this work was to verify the technical and medical reproducibility of the FD method. 


Sixteen healthy volunteers were investigated through 4-6 sets of coronal slices using SSFP sequence covering the chest volume on a 1.5T whole-body MR scanner. Each time-resolved 

set consisted of 198 images for every slice location with a total acquisition time of 59.4 s. The identical measurement protocol was repeated after 24 hours. Neither breath-holding nor 

ECG triggering were required. Images in every data stack were corrected for the respiratory motion using fully automatic non-rigid registration algorithm. Pixel-wise application of FD 

along the time axis of the data stack converted them into sets of images representing spectral frequencies. Integration of appropriate spectral ranges produced perfusion- and 

ventilation-weighted images. Analysis of signal intensities, amplitudes of perfusion and ventilation in manually segmented regions of interest were performed for all post-processed 

data. Two blinded chest radiologists rated image quality of ventilation and perfusion images using a 3-point scale. Technical and medical agreements were assessed using Bland-Altman 

analysis and kappa statistics, respectively. 

RESULTS 

Agreement over time of lung signal on native, perfusion and ventilation-weighted images were very good with intra-class correlation coefficients of 0.98, 0.94 and 0.86, respectively. 

The within-subject standard deviations were low. For native, perfusion and ventilation-weighted images, signal was greater in posterior than in anterior slices. Perfusion-weighted 

images were of better quality than ventilation-weighted images (ranges of diagnostic images of 87-95 % and 69-75 %, respectively). However, image quality was more reproducible in 

ventilation than in perfusion-weighted images (κ=0.71-0.81 and κ=0.55-0.73, respectively). 

CONCLUSION 

Technical reproducibility of FD lung MRI is very good. Medical reproducibility of perfusion and ventilation-weighted FD images is acceptable. 


Lung FD perfusion and ventilation-weighted MR images demonstrate a good reproducibility and are thus applicable in a clinical setting. 

ISP: Emergency Radiology (Imaging Chest Emergencies) 

Sunday • 10:45 - 12:15 PM • N227 

CH CT ER 


PRESIDING: 

Sanjeev Bhalla , MD , Saint Louis, MO 

Savvas Nicolaou , MD , Vancouver, BC, CANADA 

Gerd Schueller , MD, MBA , Vienna, AUSTRIA 

Computer Code: SSA05 • AMA PRA Category 1 Credits: 1.5 • ARRT Category A+ Credit: 1.5 


SSA05-01 • 10:45 AM 

Emergency Radiology Keynote Speaker: CT Pulmonary Angiography—New Concepts 

Sanjeev Bhalla MD , Saint Louis, MO 

SSA05-02 • 10:55 AM 

Traumatic Pneumothorax Detection with Thoracic US: Correlation with Multidetector CT—Initial Experience 

Stefania Ianniello , Roma, ITALY • Vincenza Di Giacomo • Barbara Sessa MD • Riccardo Palliola • Vittorio Miele MD 

PURPOSE 

The purpose of this study was to assess the diagnostic accuracy of thoracic ultrasound, as part of Extended to thorax- Focused Assessment with Sonography for Trauma (e-FAST), in 

the detection of traumatic pneumothorax.Chest CT was considered the reference standard examination. 


We evaluated 550 injured patients admitted to our Emergency Department between January 2011 and February 2012. All hemodynamically instable or borderline politrauma 

patients underwent e-FAST at the arrival in Emergency Room (during Primary Survey-from 5 to 15 minutes after patient's arrival) for the detection of pneumothorax, hemothorax and 

hemoperitoneum. All ultrasound examinations were performed at the bedside by using the same US imaging unit (Esaote MyLab). All patients positive for hemoperitoneum underwent 

urgent laparotomy; those patients negative for hemoperitoneum (N=164) underwent Multidetector CT (MDCT).Estimates of sensitivity, specificity, positive predictive value, negative 

predictive value, and overall accuracy were calculated for Thoracic US versus MDCT using MDCT as the reference standard for pneumothorax detection.Right and left lung were 

considered separately for each patient. 

RESULTS 

Extended-FAST , followed by Multidetector CT, was performed in 164 patients. The time interval between US and MDCT ranged from 25 to 60 minutes.Chest ultrasound 

detected 53 cases of pneumothorax , while Multidetector CT discovered 56 cases of pneumothorax. Ultrasound missed 3 cases of pneumothorax, but all of them were not 

"life-threatening": thickness less than 5 mm at the CT scan. There were 4 False Positive diagnoses of pneumothorax at ultrasound examination (PPV 92% - Specificity 98%). The 

Sensitivity of eFAST for pneumothorax was 94% (268 True Negatives, NPV 98%). In the first year of experience in the field of Chest ultrasound in our Emergency Department, the 

overall diagnostic accuracy of this diagnostic tool for the diagnosis of pneumothorax was 97%. 

CONCLUSION 

In this study, Bedside Thoracic-US is an accurate, rapid and practical method for the detection of traumatic pneumothorax and therefore can be an effective diagnostic tool to 

definitively rule out this serious potential consequence of blunt thoracic trauma. 


The lung lends itself perfectly to ultrasound examination.Thoracic US should be more widely used in the critically ill patient. 

SSA05-03 • 11:05 AM 

Augmented Arterial Enhancement and Optimization of Bolus Geometry for Non-Gated Thoracic CT Angiography Using a Novel Contrast Formula 

Charbel Saade MS , Camperdown, Sydney, AUSTRALIA • Roger Bourne PhD • Patrick C. Brennan PhD 

PURPOSE 

To examine arterial enhancement of the thoracic aorta during non-gated thoracic CT Angiography by optimizing bolus geometry using a novel contrast formula. 


Thoracic CTA was performed on 200 patients with acute aortic syndrome using a 64 channel computed tomography scanner (VCT, GE, Connecticut) and a dual barrel contrast injector 

(Stellant, Medrad, Pennsylvania). Patients were allotted in equal numbers to one of two acquisition/contrast groups. Patient demographics were equally distributed. Group A, the 

department’s usual protocol, comprised of a craniocaudal scan direction with 120 mL of contrast (Ultravist 370 mgI/mL; Schering, Germany), intravenously injected at a flow rate (FR) 

of 4.5 mL/s; Group B, involved a caudocranial scan direction and a novel contrast formula based on patient cardiovascular dynamics, using 50 mLs of saline at 4.5 mL/s. The mean 

vascular enhancement of 9 arterial and 2 venous segments within the thoracic aorta and superior vena cava were measured for each patient and arteriovenous contrast ratio (AVCR) 

calculated. Data generated were compared between groups using Mann-Whitney U non-parametric statistics. 

RESULTS 

Mean vessel enhancement in the segments of the ascending aorta, transverse and descending aorta all measured were up to 12% (p

CONCLUSION 

Iodinated contrast medium did not significantly alter changes in Hb or Hct titres or pain levels in patients presenting with symptomatic SCD compared with the same patients 

presenting with a similar clinical picture but managed without the use of IV contrastThe use of iodinated contrast medium in adult patients with symptomatic SCD appears safe 


Administration of iodinated contrast medium in adult patients with symptomatic SCD did not worsen pain or alter Hb or Hct levels and appears safe to use 

SSA05-05 • 11:25 AM 

Evaluation of a CT Pulmonary Angiogram Dose Reduction Protocol: Image Quality in CT Pulmonary Angiograms Using 64 MDCT 

Vijay Ramalingam MD , Boston, MA • Melissa Adriana Pavez MD • Baojun Li PhD • Avneesh Gupta MD • Jaroslaw Nicholas Tkacz MD • Anuradha Rebello • Christina Alexandra 

LeBedis MD • Jorge A. Soto MD * • Stephan W. Anderson MD 

PURPOSE 

To evaluate the effects of a low dose CT Pulmonary Angiogram protocol on image quality. 


This IRB approved study included 800 adult patients over a 14 month period (September 2009- November 2010). A low dose CT Pulmonary Angiogram protocol was implemented by 

increasing the noise index from 19 to 23 and reducing the maximum tube current from 800 mA to 650 mA. The study included 400 patients prior to implementation of the low dose 

protocol and 400 patients after implementation. Four radiologists, blinded to the timing of the protocol change, each evaluated CTPA studies from 100 patients before the protocol 

change and 100 patients after. Subjective image quality (scale from 1-5) was assessed. Readers were asked whether they believed each study was performed before or after 

implementation of the dose reduction protocol. Fisher’s exact test was employed to compare radiologists’ assessments of studies before and after the low dose protocol implementation. 

The radiation dose (total DLP) was recorded for all patients. 

RESULTS 

Average radiation dose (total DLP) was reduced by 39.6% after implementation of the low dose protocol. There were increased assessments of higher image quality (scores =4, 5) of 

CTPA studies completed before low dose protocol implementation when compared to those performed with lower dose, a statistically significant difference (335/400 versus 304/400, 

p=0.008). There were decreased assessments of non-diagnostic and poor image quality (scores=1, 2) before the low dose protocol implementation when compared to those performed 

with lower dose, a statistically significant difference (9/400 versus 27/400, p=.003). Finally, radiologists were more apt to conclude that the study took place before the low dose 

protocol was implemented in those studies performed prior to the dose reduction as compared to those performed after (281/400 versus 194/400, p

the iodine maps were measured by two readers using an ROI analysis. 

RESULTS 

CT angiography showed no pulmonary embolism in 9 patients. Fifteen patients showed a total of 56 clots with lobar (n=19), segmental (n=28) and sub-segmental(n=9).The iodine-based 

material decomposition images of all clots showed lober, segmental or sub-segmental iodine distribution defects. There was significant difference (P

CONCLUSION 

Along with the increase of noise index, the effective radiation dose and the error rate of volumetric measurement for GGO nodules by HDCT gradually decreases. In the same noise 

index, the error rate of volumetric measurement of nodules by HDCT is gradually decreases along with the increase of ASIR. 


We can accurately measure the volume of ground-glass opacity nodules by HDCT with the low radiation dose. 

LL-CHS-SU2B Specific Reduction of Breast Dose with High-Tube Voltage and Iterative Reconstruction at Non-enhanced Low-Dose Chest CT 

PURPOSE 

Clinically, the radiation dose must be as low as possible not only to reduce overall radiation exposure but also to reduce the exposure of critical organs within the scan range. The 

purpose of this study was to maintain the image quality while further reducing the breast dose at high-tube voltage scanning and to decrease the overall radiation dose by using an 

iterative reconstruction technique. 


We used a chest phantom and simulated nodules (3-, 5- and 8 mm in diameter, attenuation -800-, -630-, and -450 HU) in the phantom study and preliminarily enrolled 10 patients 

in the clinical study. Helical CT acquisitions were performed at 50 effective mAs (standard tube voltage, 120 kV) and 31 effective mAs (high-tube voltage, 140 kV). The effective mAs 

value at 140 kV was preliminarily computed to produce the same image noise as at 120 kV. All acquisitions were reconstructed with an iterative reconstruction (iDose4). The iDose 

level was set at level 4 (29% noise-reduction). The radiation dose to the breast and phantom center was measured with glass rod dosimeters. Two radiologists independently 

inspected the images to detect the nodules.In the clinical study, we compared images acquired at 120 kV and 140 kV and evaluated images of the lung field for sharpness of the 

peripheral vessels and/or interlobular fissures, artifacts, graininess, and overall image quality. 

RESULTS 

In the phantom study, when the image noise on images was the same, the relative radiation doses at 140 kV were 0.93 in the phantom center and 0.88 in the breast portions 

compared to images acquired at 120 kV. Nodule detection by the 2 radiologists was the same and there was no statistically significant difference between images acquired at 120 

kV and 140 kV (p>0.05).In the clinical study there was no statistically significant difference between 120 kV and 140 kV images with respect to sharpness of the contour of the left 

ventricle, the peripheral vessels and/or the interlobular fissures, or overall image quality (p

images as equal or better for appearance of lung parenchyma, artifacts, overall diagnostic acceptability, diagnostic confidence for evaluation of PE and general image preference. 

CONCLUSION 

SafeCT images were consistently preferred over “ASIR-50%” reconstructed images of CT examinations obtained at half dose in a number of image quality related criteria. 


Improvements in image quality of low dose CT exams may help drive the concept of ALARA (As Low As Reasonably Achievable) further in protecting patients from ionizing radiation. 

LL-CHS-SU5A Comparison of Adaptive Statistical Iterative and Filtered Back Projection Reconstruction Techniques in the Evaluation of Pulmonary Nodules 

PURPOSE 

To compare image quality and visualization of pulmonary nodules smaller than 10mm on chest computed tomography (CT) with adaptive statistical iterative reconstruction (ASiR) 

and filtered back projection (FBP) reconstruction techniques and determine optimum reconstruction mode for visualization of lung nodules. 


This retrospective study was approved by the institutional review board. Written informed consent was waived. CT data from 23 patients (13 men, 10 women; 57.65 years ±15) 

were acquired with tube voltage of 120 kVp and auto mA mode with noise index at 10 in 64-section multi-detector CT (GE, Discovery CT750HD). 57 nodules were found in the lung, 

data sets were reconstructed with FBP, 50% ASiR-FBP blending (ASiR50) and 100% ASiR (ASiR100) mode for lung window. Noise and contrast noise ratio (CNR) of pulmonary 

nodules were compared among the three groups. Image quality was assessed by two radiologists for pulmonary nodules and small anatomic structures (interlobular septa, 

centrilobular region, and small bronchi and bronchioles) in a blinded and randomized manner. Data were analyzed by using one way ANOVA analysis and wilcoxon rank test. 

RESULTS 

All nodules were displayed on each of the three set images. For objective assessment of pulmonary nodules, the CNR of pulmonary nodules were higher with ASiR100 group 

(68.8±59. 6) than with FBP (27.7±18.9) (p

To describe widely used conventional and newer dose reduction strategies (reduced kVp, iterative reconstruction). 4) To discuss appropriateness guidelines for chest CT. 

B. Dual-Energy CT: Emerging Thoracic Applications 

Martine J. Remy-Jardin MD, PhD, Lille, FRANCE * 

LEARNING OBJECTIVES 

1) To describe the principles of dual-energy imaging. 2) To review new clinical applications in the field of functional imaging. 3) To illustrate new options for standard CT using virtual 

monochromatic spectral imaging. 

ABSTRACT 

The introduction of dual-energy CT is modifying the noninvasive approach of chest disorders by adding functional assessement to high-spatial and high-resolution diagnostic imaging. 

To date, the most investigated application has been the iodine mapping at pulmonary CT angiography, often referred to as lung perfusion imaging. For radiologists, the new 

challenge is the integration of perfusion imaging in the diagnostic work-up of acute and chronic disorders of the pulmonary circulation. CT angiograms can also benefit from the 

possibility to generate a virtual nonenhanced and an iodine-enhanced image from a single acquisition, thus preventing from additional acquisitions and reducing patients' radiation 

exposure. In parallel, the high atomic numbers of xenon and krypton have raised interest toward a new option for regional assessment of lung function with CT. This technique 

enables simultaneous visualization of morphological changes and status of regional ventilation with qualitative and quantitative analysis of diseased lung without additional radiation 

dose. This lecture will also discuss dual energy in specific clinical situations such as the evaluation of pulmonary nodules, diffuse and focal hyperdense thoracic diseases. Because 

virtual monochromatic spectral imaging can also be easily generated with dual energy, radiologists have a new option to optimize standard chest CT angiograms. The reconstruction 

of low- and high-energy images from the same examination offers the possibility to administer low-concentrated contrast agents with adequate opacification of all thoracic 

circulations from the same acquisition. These new options for chest imaging will be described in clinical conditions of daily practice. 

C. Thoracic MR Imaging: Update and New Developments 

Jens Bremerich MD, Basel, SWITZERLAND 


1) Understand limitations and potential clinical benefits of pulmonary MRI. 2) Compare pulmonary MRI to CT. 3) Understand recent advances and future developments in pulmonary 

MRI. 


Introduction:Pulmonary MR is an attractive tool for imaging of morphology and function of the lungs with ionizing radiation. In the past, however, widespread clinical application has 

been hampered by unfavourable magnetic properties of the lung such as low water proton density and substantial magnetic field inhomogeneity. Recently, new imaging protocols 

and sequences became available that may overcome these limitations. This abstract reviews current applications and future developements of pulmonary MR.Methods:For pulmonary 

imaging fast techniques such as turbo spin echo or segmented gradient echo are recommended to enable breath held acquisition. As an alternative, free breathing respiratory gated 

sequences may be used. Standard imaging protocols comprise T1 and T2 weighted images for morphology assessment and edema detection. Diffusion weighted MR may be added to 

identify diffusion restriction which is a feature of many malignant tumors. Cine images during in- and exspiration can be used to assess pleural infiltration of peripheral masses. T1 

weighted images pre and post gadolinium may be used for further characterisation of masses and inflammatory disease.Results:There is increasing evidence, that MR may be used to 

identify and characterise pulmonary masses, monitor pulmonary perfusion and ventilation, assess chest wall motion, identify involvement of chest wall in peripheral lung tumors and 

to identify pulmonary embolism. In the future, MR may even be used for screening of a high risk population for lung cancer.Conclusion:Increasing scientific evidence supports the 

notion, that MR can be a relevant clinical tool for assessment of pulmonary masses, circulation, perfusion, and ventilation. 

D. Digital Radiography: Update 2012 

Heber Macmahon MD, Chicago, IL * 


1) Understand recent developments in digital technology. 2) Compare the clinical benefits of dual energy subtraction, temporal subtraction, and bone suppression imaging. 3) 

Understand recent advances in computer aided diagnosis for chest radiography. 

BOOST: Lung—Anatomy and Contouring (An Interactive Session) 

Monday • 08:30 - 10:00 AM • S103AB 

CH OI RO 


Course No. MSRO21 

AMA PRA Category 1 Credits: 1.5 • ARRT Category A+ Credit: 1.5 

John Breneman , MD , Co-Director , Cincinnati, OH , 

Bruce G. Haffty , MD , Co-Director , New Brunswick, NJ , 

Jeffrey A. Bogart , MD , Director , Syracuse, NY , 

Joseph Kamel Salama , MD , Durham, NC , 

Ernest Mark Scalzetti , MD , Syracuse, NY , 

Elisabeth Dexter , MD , Buffalo, NY 

LEARNING OBJECTIVES Review thoracic anatomy that impacts surgical decision making: 1) Proximity to pulmonary vessels. 2) Proximity to great vessels/heart. 3) Involvement of 

airway/esophagus/chest wall. 4) Involvement of diaphragm/pericardium/phrenic nerve. 


Monday 08:30 - 10:00 AM 

Course No. RC201 • Room E450A 

Lung Cancer Screening: Update 2012 

AMA PRA Category 1 Credits: 1.5• ARRT Category A+ Credit: 1.5 

CH CT OI 


Caroline Chiles, Winston Salem, NC , MD 

A. Current Data Summary and Recommendations 

Denise Ru Aberle MD, Los Angeles, CA 


1) To review the results of the National Lung Screening Trial. 2) To understand the risks and benefits of lung cancer screening. 3) To identify remaining questions to be answered 

through future research. 

B. Establishing a Program: Nuts and Bolts 

Reginald F. Munden MD, DMD, Houston, TX 


At the end of this session, the participant will be able to: 1) Understand important issues to be addressed in planning a lung cancer screening program. 2) Appreciate the need to 

have a multidisciplinary approach to lung cancer screening. 3) Determine the resources needed to undertake a lung cancer screening program. 


Launching a lung cancer screening program is not simply a matter of opening the doors and offering low-dose CT to anyone who wishes to be screened. There are many decisions 

that need to be resolved prior to launching a screening program, such as the criteria for screening - NLST, NCCN or one based on previous screening trials. A system of registration, 

recording and follow-up of patients will need to be established. Other considerations include whether the radiologists is responsible for follow-up of patients or whether a physician of 

record is required. Is self referral allowed? It is extremely important to develop a protocol to manage positive findings for patients that the physicians who will ultimately treat the 

patient agree upon. This session will discuss many of the fundamental issues related to establishing a lung cancer screening program. 

C. Establishing a Program: Lung Nodule Management 

Thomas Edward Hartman MD, Rochester, MN * 


1) To review existing nodule management guidelines. 2) To determine the role of existing nodule management guidelines in a lung cancer screening practice. 3) To identify future 

guidelines that may impact nodule management for lung cancer screening. 

D. Establishing a Program: Incidental Findings 

Caroline Chiles MD, Winston Salem, NC 


1) Review other causes of morbidity and mortality in the lung cancer screening population. 2) Illustrate important pathologies included in the screening chest CT field-of-view. 3) 

provide guidelines for evaluation and management of coronary artery calcification. 

BOOST: Lung—Integrated Science and Practice (ISP) Session 

Monday • 10:30 - 12:00 PM • S103AB 

CH OI RO 


Course No. MSRO22 


John Breneman , MD , Co-Director , Cincinnati, OH , 

Bruce G. Haffty , MD , Co-Director , New Brunswick, NJ , 

Simon Shek-Man Lo , MD , Moderator , Cleveland, OH , 

Joseph Kamel Salama , MD , Moderator , Durham, NC 

Page 38 of 97 

MSRO22-01 • Invited Speaker 

Jeffrey A. Bogart , MD , Syracuse, NY

Page 39 of 97 

Jeffrey A. Bogart , MD , Syracuse, NY 

MSRO22-03 • Clinical (and Not Dosimetric) Factors Might Be of Primary Importance When Predicting Radiation Pneumonitis (RP) in Patients Treated with Stereotactic 

Radiotherapy (SBRT) to the Lung 

Ryan Allen Baker , Tampa, FL 

William Stevens , MD, PhD * , Tampa, FL 

, Gang Han , Tampa, FL , Siriporn Sarangkasiri , MS , Tampa, FL , Mary Lou DeMarco , Tampa, FL , Carolyn Turke , Tampa, FL , Craig 

, Thomas Jonathan Dilling , MD , Tampa, FL 

PURPOSE 

Few analyses have been published regarding clinical and dosimetric factors predictive of RP in patients receiving lung SBRT. We report here on predictive factors from a series of 

240 patients. 


From 297 isocenters treated in 263 patients, 263 isocenters (240 patients) had evaluable information regarding RP. Age, gender, current smoking status and pack-years, lobe of 

lung, current O2 use, Charlson Comorbidity Index, prior lung radiotherapy (yes/no), dose/fractionation, V5, V13, V20, Vprescription, mean lung dose (MLD), GTV and PTV volume, 

total lung volume, PTV/lung volume ratio, and Conformality Index were recorded. 

RESULTS 

Median follow-up was15.6 months (range: 3.0 – 58.7 months). Twenty-nine patients (11.0%) developed symptomatic pneumonitis (26 grade 2, 3 grade 3). The mean V20 was 

6.5% (0.4 – 20.2%) and the average MLD was 5.03 Gy (0.55-12.2 Gy). In univaraible analysis, female gender (p=0.0257) and Age-Adjusted Charlson Comorbidity Index 

(p=0.0366) were significantly predictive of RP. Among dosimetric parameters, V5 (p=0.0186), V13 (p=0.0438) and Vprescription (where dose = 60 Gy) (p=0.0128) were 

significant. Vprescription was not significant in patients receiving 50 Gy. There was only a trend toward significance for V20 (p=0.0610). PTV/normal lung volume ratio was highly 

significant (p=0.0024). However, Conformality Index was not statistically predictive. In multivariable analysis, the clinical factors of female gender, pack years smoking, and larger 

GITV and PTV volumes were predictive (p=0.0094, 0.0312, 0.0364, and 0.052, respectively), but no dosimetric factors were significant. 

CONCLUSION 

In this large series of patients, it appears that clinical factors (not just dosimetric ones) are predictive of pneumonitis. The interrelationship between these variables is unclear. It 

may be, for instance, that female gender correlated with smaller lung volumes (and therefore a higher ratio of GTV or PTV to normal lung volume). These factors would secondarily 

lead to higher V5, V13, V20, and MLD. Therefore, clinical factors might be the predominant predictors when treating patients with SBRT to the lung. 


Female gender, pack years smoking, and larger GITV and PTV volumes were predictive of radiation pneumonitis in patients undergoing SBRT to the lung. 

MSRO22-04 • Stereotactic Ablative Radiotherapy for Oligometastatic Lung Tumors 

Nicholas Trakul , MD, PhD , Stanford, CA , Lisa Jacobs , Stanford, CA , Billy W. Loo Jr , MD, PhD * , Stanford, CA , Maximilian Diehn , MD, PhD , Stanford, CA 

PURPOSE 

Stereotactic ablative radiotherapy (SABR) is increasingly being utilized for patients with oligometastatic lung tumors. Data on outcomes for oligometastatic tumors treated with 

SABR remain relatively limited and we reviewed outcomes of such patients treated at our institution. 


We retrospectively reviewed patients with lung metastases treated with SABR at Stanford between July 2003 and July 2011. We identified 50 patients with a total of 74 lesions. 

The number of lesions treated ranged from 1 to 4. A variety of SABR regimens were used, with the majority receiving 25 Gy in 1 fraction or 50 Gy in 4 fractions. The median 

biologically effective dose was 87.5 Gy. We analyzed local control (LC), overall survival time (OS), and time to next treatment and stratified patients by clinical factors such as 

histology, number of lesions, and if patients had received previous treatment. Relevant toxicities were scored. 

RESULTS 

Median follow up time was 10.5 months (range 3 to 51 months). For the entire cohort, OS and LC at 12 month were 89.1% and 82.1%, respectively. Median OS was 29 months 

and median LC was not reached. The only factor which was strongly associated with LC was tumor histology. Specifically, colorectal cancer metastases had significantly worse local 

control than other tumor types. LC at 12 month was 29.5% for the 19 colorectal cancer metastases and 93.6% for all other histologies (p 60%. Medically inoperable. Moving of the lung lesion during breathing less than 5mm as detected by 4D-CT. Initial staging: whole body and deep inspiration 

breath hold F-18 FDG PET/CT in radiation treatment position, MRI of the brain. Radiation treatment planning: 4D-CT and angio-CT in radiation treatment position for target 

volume delineation. Using 4D-CT for target volume delineation, a Boolean operation was used to sum the multiple gross target volumes (GTV) delineated in diagnostic lung window 

to form an internal target volume (ITV). The planning target volume (PTV) was derived by a three-dimensional isotropic expansion of the ITV by 5mm to account for both 

microscopic extension and daily setup errors. Prescription dose varied from 5x7Gy to 5x12Gy, depending on the location of the lesion. 80% prescription isodose line = PTV. Median 

time for follow-up: 12 months, maximal time: 34 months. 

RESULTS 

For 38/47 lung lesions, the ITV derived by Boolean operation was identical or smaller than the ITV derived by non-gated PET, in 9/47 lesions bigger due to spiculae as seen in the 

diagnostic lung window. Actuarial local control after 2 years: for all patients: 91%. BED > 100Gy vs. BED < 100Gy: 100% vs. 71% (log rank test: p = 0.04). Coverage of 

microscopic extension: with 5x7Gy: 13%, with 5x12Gy 78%. No treatment related deaths, no grade 3/4 toxicities. Pneumonitis grade 1-2: 3%. 

CONCLUSION 

If treated with a BED > 100Gy, our preliminary data suggest a high long term local control at low rates of treatment-related toxicity. The microscopic extension beyond the GTV is 

covered sufficiently. Non-gated F-18 FDG PET/CT in radiation treatment position is helpful for the ITV delineation of lung lesions and may be used to evaluate the magnitude of the 

daily setup errors prior to radiation treatment. 


To achieve a long term control, a SBRT delivery of a BED < 100Gy should be avoided due to low doses within the GTV and insufficient coverage of the microscopic extension 

beyond the GTV. 

MSRO22-06 • Improving Treatment Outcome of Radiation Therapy in Non-small Cell Lung Cancer (NSCLC): Results of 288670 Patients from SEER-17 Database 

Feng-Ming Kong , Ann Arbor, MI 


Purpose/Objective(s): There have been remarkable advances in radiation technology in treatment of non-small cell lung cancer (NSCLC) recently. It is well known that radiation 

provides local tumor control and technology matters. This study aimed to examine whether 1) radiation can improve survival over other nonsurgical treatment and 2) the survival 

during the recent years with advancement of technology.Materials/Methods: The study population includes all 1st primary NSCLC from the SEER-17 database 1999-2008. The data 

were stratified by AJCC stage and treatment type (surgery only, surgery + radiation, radiation only, neither surgery nor radiation and unknown treatment). Chemotherapy data 

were not available in the SEER-17 data. Frequency distributions and percentages by strata were analyzed. Median Survival times with associated 95% confidence intervals 

(95%CIs) were estimated by the Kaplan-Meier method. Data are presented as median survival time (in month) (95%CI). The “na” refers to an interval that was too narrow to be 

computable.Results: A total of 288670 patients included in this analysis. The stage distribution was as following: 19% stage I, 4% stage II, 26% stage III, 46% stage IV and 11% 

unknown. The median survival was 49 (48-50), 27 (26-29), 9 (9-10), 4 (na) and 7 (6-8) months, for stage I, II, III, IV and unknown, respectively. Overall, 78% were treated 

with non-surgical modality; only 32% received radiation treatment. In patients who did not have surgery, treatment of radiation generated a significant better survival in each 

stage: stage I 18 (18-19) vs 12 (11-12) months (P

from fiducial marker placement is an important consideration in a patient population with limited respiratory reserve, and newer fiducial-less technologies need to be developed 

and further studied as a potential solution. The low rate of rib fracture in this experience (2%) compared to the published literature using linac-based stereotactic systems (8%; 

Andolino, et al. 2011) may be attributable to the CyberKnife’s ability to track the tumor throughout the respiratory cycle, thereby decreasing the delivered dose to the adjacent 

ribs. Whether different delivery systems of SBRT result in different disease control or morbidity outcomes needs to be prospectively studied. 

MSRO22-08 • Primary Pulmonary Carcinoid Tumor 

Ryan Herde , Layton, UT 


Purpose/Objective(s): Carcinoid tumors of the lung are rare tumors which comprise approximately 1 to 2% of all lung malignancies in adults and roughly 20 to 30% of all carcinoid 

tumors. In addition, little is known about the etiology of these tumors and unlike most lung cancers, no external environmental toxin has been clearly identified as a causative 

agent. In this retrospective study, we report the history of primary pulmonary carcinoid tumor and a single institution experience.Materials/Methods: We conducted a 

retrospective study in patients with a diagnosis of carcinoid tumor treated at the Huntsman Cancer Hospital, University of Utah. We identified 35 patients diagnosed with primary 

pulmonary carcinoid tumor from 1989 to 2009. We obtained patient data from the Huntsman Cancer Institute Tumor Registry and directly from chart abstraction. Kaplan-Meier 

curves were drawn and used to calculate disease free survival and overall survival in our study patients.Results: Of 35 patients, there were 22 males and 13 females with an 

average age of 51 years (range 24-77) at diagnosis. Five out of 35 patients (14.3%) had atypical carcinoids, and the remaining 30 patients (85.7%) had typical carcinoids. Only 4 

of 35 (11.4%) patients presented with typical carcinoid syndrome while 31 (88.6%) had non-carcinoid presentations or incidental findings (n=10). Twenty-five (71.4%) patients 

had a history of tobacco use. The median tumor size was 2.0 cm (range 0.9 - 6 cm). Of the 21 patients presenting with non-carcinoid symptoms, dyspnea and hemoptysis were 

each reported in 8 patients and persistent cough was seen in 6. Tumors were located at or proximal to the bronchus intermedius in 10 patients (28.6%) while 25 (71.4%) had 

tumors distal to this site. All patients received surgical treatment, consistent with lobectomy (n=23), wedge/segmental or a less than lobectomy (n=10), and pneumonectomy 

(n=1). In addition to surgery, 3 out of 35 patients received adjuvant chemotherapy and radiation therapy for atypical carcinoid tumors. Median follow-up time was 72.8 months 

(range 0.2-256.5 months), and only one patient had persistent disease while the remaining 34 patients had no recurrent or metastatic disease. The Kaplan-Meier 2-, 5-, and 

10-year overall survivals and disease-free survivals were 94%, 89% and 86%, and 94%, 87%, and 87%, respectively.Conclusions: Most primary pulmonary carcinoid tumors 

demonstratednon-classic clinical presentations. Surgical resection was primary and adequate therapy for most carcinoid tumors. Overall survival and disease-free survival rates 

were very high in our long term follow-ups. Adjuvant chemotherapy or radiotherapy was reserved for patients with atypical carcinoid tumors and adverse pathological findings. 

MSRO22-09 • Differences in Local Control for Primary Versus Metastatic Lesions of the Lung Following Stereotactic Ablative Radiotherapy (SABR) 

Michael Warren Guiou , MD , Columbus, OH , Terence Williams , MD,PhD , Columbus, OH 

OH 

, Simon Shek-Man Lo , MD , Cleveland, OH , Nina A. Mayr , MD , Columbus, 

PURPOSE 

SABR for early-stage non-small cell lung cancer (NSCLC) results in high local control (LC) rates of over 90%, when the biological equivalent dose (BED) exceeds 100 Gy10. These 

results have been extrapolated to justify SABR for oligometastatic disease to the lung from non-lung primary tumors, but dose response data for these lesions are elusive. We 

sought to compare LC for primary NSCLC vs. non-lung primary metastases treated with SABR. 


Patients were immobilized using stereotactic body frame or vacuum cushion with or without compression depending on habitus, lung function or comfort. 4D-CT simulation was 

performed and SABR was delivered with 7-10 noncoplanar beams. Patients were followed 3-monthly with clinical exam and chest CT. Serial 3D volume of treated lesions was 

calculated. Local failure was defined as persistent increase in volume greater than 20%. Comparisons between groups were calculated using Kaplan Meier analysis. 

RESULTS 

In 42 patients (33 primary NSCLC, 9 mets) 50 lesions (37 primary NSCLC, 13 mets) were treated. Most of the mets (11/13, 85%) originated from colorectal adenocarcinoma 

primaries. SABR regimens ranged from 5-18 Gy per fraction delivered in 3-5 fractions to the planning target volume . Mean BED was 81 ± 24 Gy10 with no significant difference 

between lung primaries and metastases (84 vs. 77 Gy10, p=0.4). Mean follow-up was 16±10 vs. 16±7 months for primary NSCLC and metastatic patients, respectively. LC at 2 

years was significantly greater for primary NSCLC vs. metastases (87 vs. 54%, p=0.03). Comparing LC exclusively for adenocarcinoma histologies, LC was higher for primary lung 

than for metastatic adenocarcinomas (82% vs. 45%, p=0.034). No patient experienced Grade ≥3 toxicity. 

CONCLUSION 

Our results suggest that metastatic pulmonary lesions are more resistant to treatment with SABR than primary lung tumors, even when directly comparing LC for 

adenocarcinomas. The radiobiological and molecular underpinnings of this difference are unclear. SABR regimens tailored towards the primary vs. metastatic origin of lung lesions 

may be needed, as metastatic lesions likely require higher doses for tumor control. 


SABR is an emerging technology for the treatment of oliogmetastatic disease. Determining the optimal dosing regimen for metastatic lesions is of utmost importance to maximize 

clinical benefit. 

Chest (Emphysema and Airways Disease) 

Monday • 10:30 - 12:00 PM • S404AB 

CH CT 


PRESIDING: 

Warren B. Gefter , MD , Philadelphia, PA 

Martine J. Remy-Jardin , MD, PhD * , Lille, FRANCE 

Computer Code: SSC03 • AMA PRA Category 1 Credits: 1.5 • ARRT Category A+ Credit: 1.5 


SSC03-01 • 10:30 AM 

Emphysema Quantification Using Size Distribution of 3D Low Attenuation Clusters on CT: Comparison with Pulmonary Function Test 

Mizuho Nishio MD , Kobe, Hyogo, JAPAN • Sumiaki Matsumoto MD, PhD * • Hisanobu Koyama MD • Yoshiharu Ohno MD, PhD * • Takeshi Yoshikawa MD * • Yasuko Fujisawa * • 

Naoki Sugihara MS * • Kazuro Sugimura MD, PhD * 

PURPOSE 

To verify that the size distribution of three-dimensional (3D) low attenuation clusters on computed tomography (CT), as with that of two-dimensional low attenuation clusters, follows a 

power law the exponent of which is useful for emphysema quantification. 


Thirty patients (25 men, 5 women; age, 53-85 years; smoking history, 2.5-240 pack-years) were included in this study. They underwent CT scans with a 320-detector-row scanner 

(Aquilion ONE, Toshiba Medical Systems). The raw data were reconstructed into contiguous 1-mm-thick images. At 20 different thresholds ranging from -995 to -900 HU, the 

percentage of lung region with low attenuation (LA%) was first computed. Then, by linear regression of the cumulative frequency distribution of the sizes of 3D low attenuation clusters 

on a log-log plot, the exponent (D) of a hypothetical power law for these sizes and the corresponding Pearson's correlation coefficient were obtained. Finally, at each threshold, LA% 

and D were correlated with pulmonary function test, where the significance of the corresponding Pearson's correlation coefficient was tested with Bonferroni correction at the level of 

2.5x10-3. 

RESULTS 

In the linear regression, Pearson's correlation coefficients ranged from -0.99 to -0.83, corroborating the existence of a power law for the size distribution of 3D low attenuation clusters. 

The Pearson's correlation coefficient between D and the diffusing capacity of the lung for carbon monoxide (DLCO) was statistically significant at the threshold of -925 HU (coefficient = 

-0.55; P value = 1.7x10-3). The coefficient between LA% and DLCO was statistically significant at multiple thresholds ranging from -995 to -955 HU (coefficients, -0.66 to -0.56; P 

values, 8.8x10-5 to 1.4x10-3). 

CONCLUSION 

The size distribution of 3D low attenuation clusters followed a power law. Not only the percentage of lung region with low attenuation but also the exponent of this power law showed 

significant correlation with pulmonary function test. 


The size distribution of 3D low attenuation clusters on CT can provide an additional parameter to quantify pulmonary emphysema. 

SSC03-02 • 10:40 AM 

The Effect of Smoking Status on Quantitative CT Measures of Emphysema in Cigarette Smokers 

Jordan Zach , Denver, CO • David Augustine Lynch MD * • Carla G. Wilson • Andre Williams PhD • Douglas C. Everett PhD • John Hokanson MPH, PhD • Douglas Stinson 

PURPOSE 

Prior studies have shown that active smoking is associated with lower extent of emphysema as quantified on chest CT. The purpose of this study is to evaluate whether quantitative CT 

(QCT) measures of emphysema differ based on current smoking status while controlling for demographic parameters and lung function in COPD study subjects. 


As part of the COPDGene study, 10,307 subjects aged 45-80 and with vast smoking histories underwent spirometry and volumetric CT at full inspiration. Of those, 7,662 current and 

former smokers (49% former smokers, 54% male, 70% non-Hispanic white, mean age 60.0 ± SD 9.1 years, mean BMI 28 ± SD 6) met criteria to be classified under the GOLD system 

and had QCT analysis completed. Open-source 3DSlicer software provided automated lung segmentations and densitometry measures. Emphysema was defined as lung tissue with 

attenuation values ≤-950 Hounsfield Units (HU) on inspiratory CT and is expressed as percent of total lung capacity (%LAA-950HU). Multiple linear regression was utilized to determine 

the primary effect of current smoking status on QCT derived %LAA-950HU. The model controlled for age, gender, race, height, weight, FEV1, smoking history in years, and average 

cigarettes smoked per day. 

RESULTS 

A higher proportion of current smokers were classified as smoking controls without COPD, 57% compared with 41% of former smokers. Mean (± SD) %LAA-950HU was 3.7 ± 6.5 in 

current smokers, compared with 10.1 ± 11.8 in former smokers (p

Mapping Pulmonary Emphysema Using X-ray Dark-Field Scatter Imaging 

Felix G. Meinel MD , Munich, Germany • Julia Herzen PhD • Simone Schleede • Ali Onder Yildirim • Alexander Bohla • Sven Florian Thieme MD • Felix Schwab PhD • Fabian 

Bamberg MD, MPH * • Sigrid Auweter • Arne Tapfer • Silvia Adam-Neumair • Rod Loewen • Ronald D. Ruth • Maximilian F. Reiser MD • Oliver Eickelberg • Franz Pfeiffer • 

Konstantin Nikolaou MD * 

PURPOSE 

To assess whether x-ray dark-field imaging can be used to localize emphysematous changes in a murine model of pulmonary emphysema. 


Three female C57BL/6N mice were treated with a single orotracheal application of porcine pancreatic elastase (100 U/kg body weight) dissolved in phosphate-buffered saline (PBS). 

Three control mice received 80 mL PBS. After 28 days, pulmonary function tests were performed. Subsequently, lungs were excised, inflated with air and fixed in 4% (m/v) 

paraformaldehyde. X-ray dark-field scatter projections were acquired at a laser-driven compact synchrotron x-ray source using a photon energy of 36 keV and an exposure time of 5 s. 

Lungs were then stained using a standard hematoxylin eosin staining protocol and analyzed histopathologically. For each lung, x-ray coherent scatter and transmission were calculated 

for each pixel (pixel size 127 μM) and plotted against each other. In healthy lungs, a linear curve was fitted to this scatter plot as a standard of reference. For the diseased lugns, we 

then calculated the distance of each pixel from this reference line, color-coded these values and superimposed the color-coded maps on the conventional transmission images. 

RESULTS 

Pulmonary function tests and histopathology confirmed that mice in the elastase group but not in the PBS group had developed marked emphysema at 28 days. Specifically, tissue 

elastance was lower in the emphysema group than in the control group (10.4 vs. 23.0 cmH2O/mL). The slope of a linear curve fitted to the scatter plotted against the transmission for 

each pixel was higher for emphysematous lungs (-3.0 ± 0.4) than for healthy lungs (-6.1 ± 2.1). Calculation of the distance of each individual pixel from the fitted linear curve of 

healthy lungs produced color-coded maps of emphysema distribution within each diseased lung that correlated well with histopathology. 

CONCLUSION 

X-ray dark-field projection images can be used to localize pulmonary emphysema without the use of CT by integrating x-ray absorption and scatter information. 


Assessing the regional distribution of pulmonary emphysema is crucial for clinical decision-making regarding lung volume reduction surgery and insertion of endobronchial valves. 

SSC03-04 • 11:00 AM 

Parametric Response Map Relates Emphysema and Small Airways Disease to Clinical Phenotypes 

MeiLan K. Han • Craig J. Galban PhD * • Jennifer Lynn Boes PhD • Timothy D. Johnson PhD • Brian Dale Ross PhD * • Ella A. Kazerooni MD , Ann Arbor, MI • Alnawaz Rehemtulla 

PhD * • Fernando J. Martinez MD 

PURPOSE 

Gas trapping as defined by % voxels < -856 HU on expiratory HRCT images has been proposed as a marker of small airways disease. However, high correlation exists between this 

metric and emphysema as defined by % voxels


Forty-eight severe asthma, 17 mild / moderate asthma and 30 healthy subjects underwent detailed clinical and physiological characterisation as well as quantitative analysis of paired 

inspiratory and expiratory thoracic CT including fractal analysis of the segmented airway tree and lung parenchymal low attenuation clusters. Two retrospective limited CT scans of the 

right upper lobe apical segmental (RB1) bronchus over a mean duration of 2.6 years, were available for many severe asthma subjects enabling temporal analysis of proximal airway 

remodelling. Factor and cluster analysis techniques were utilised to determine three novel asthma phenotypes based on quantitative proximal and distal airway remodelling indices. 

RESULTS 

Severe and mild / moderate asthma subjects demonstrated smaller mean (SEM) RB1 lumen volume (LV) in comparison to healthy controls (272.3 (16.4); 259.0 (12.9); 366.4 (35.6), p 

= 0.007) but no significant difference in RB1 wall volume (WV). Air trapping measured by mean lung density expiratory to inspiratory ratio (MLD E/I) was significantly greater in severe 

and mild / moderate asthma subjects compared to healthy controls (0.861 (0.01); 0.866 (0.02); 0.830 (0.01), p = 0.04). Fractal dimension of the segmented airway tree was 

significantly lower in asthma subjects compared to control subjects (p = 0.007). All three novel quantitative CT determined asthma clusters demonstrate air trapping. Cluster 1 

demonstrates increased RB1 WV and RB1 LV, but decreased RB1 %WV. On the contrary cluster 3 asthma subjects have smallest RB1 WV and LV but highest RB1 %WV in comparison 

to other clusters. Temporal assessment revealed significant increase in RB1 WA/ body surface area (BSA) over time but no change in RB1 LA/BSA. 

CONCLUSION 

Three distinct asthma phenotypes were identified based on quantitative CT indices. 


Quantitative CT analysis provides a new perspective in asthma phenotyping, which may prove useful in patient selection for novel therapies. 

SSC03-08 • 11:40 AM 

Expiratory Tracheal Collapse in Patients with Coexisting Metabolic Syndrome and COPD: A Manifestation of the Airway Phenotype 

Diana Litmanovich MD , Boston, MA • Carl O'Donnell PhD • Gaetane Michaud MD • Mary E. Millett RN • Stephen Loring MD • Phillip M. Boiselle MD 

PURPOSE 

Chronic bronchitis has recently been reported in association with metabolic syndrome (MetS) among patients with COPD. Our purpose is to determine if another manifestation of the 

airway phenotype, dynamic expiratory tracheal collapse, is associated with MetS in patients with COPD. 


100 COPD patients prospectively underwent pulmonary function testing (PFT), 6-minute walk test (6MWT), Saint George’s respiratory quality of life questionnaire (SGRQ), and 

spirometrically-monitored MDCT at total lung capacity (TLC) and during dynamic exhalation (64-MDCT, 40 mAs, 120 kVp, and 0.625 mm detector collimation). Cross-sectional area 

(CSA) of the trachea was measured 1 cm above the aortic arch at TLC and dynamic expiration, and percentage expiratory reduction in the tracheal lumen was calculated. We compared 

mean values of percentage expiratory tracheal collapse, 6MWT distance, and SGRQ scores between subgroups of COPD patients with and without coexisting MetS. 

RESULTS 

The presence or absence of MetS was definitively established in 94 participants. The two subgroups with (n=16) and without (n=78) MetS were similar in age and gender distribution 

(mean age, 65 ± 6 yrs versus 65 ± 7 yrs, respectively; 56% women versus 45% women respectively). Although percent predicted FEV1 did not differ significantly between the 2 

subgroups (69 ± 17 versus 64 ± 23, p = 0.263), participants with MetS demonstrated significantly greater expiratory tracheal collapse (mean 69 ± 13% versus 57 ± 19%, p = 0.004), 

higher (worse) SGRQ scores (mean 48 ± 16 versus 35 ± 20, p = 0.012) and shorter 6MWT distance (mean 333 ± 145m versus 431 ± 114m, p = 0.019) compared to those without 

MetS. Similar differences were observed when the subgroup without MetS was limited to 16 age- and gender-matched controls: tracheal collapse = 69 ± 13% in MetS versus 54 ± 

21% in controls (p=0.026); SGRQ = 48 ± 16 versus 37 ± 22 (p=0.121); and, 6MWT = 333 ± 145 versus 420 ± 106 (p=0.07). 

CONCLUSION 

COPD patients with coexisting MetS exhibit significantly greater expiratory tracheal collapse, worse respiratory quality of life, and decreased exercise capacity than those without MetS. 

This may reveal an association of MetS with an inflammatory airway phenotype that includes expiratory tracheal collapse. 


Radiologists and pulmonologists should have higher suspicion for excessive expiratory tracheal collapse in COPD patients with coexisting MetS. 

SSC03-09 • 11:50 AM 

Repeatability of MR Based Biventricular Cardiac Function and Flow Measurements in Patients with COPD 

Oliver Sedlaczek MD , Heidelberg, Baden-Wuerttemberg, Germany • Ursula Wolf • Angela Anjorin • Julia Ley-Zaporozhan MD • Hans-Ulrich Kauczor MD * • Sebastian Ley MD 

PURPOSE 

Patients with COPD have an increased risk of left and right ventricular (LV, RV) dysfunction. However, echocardiography is typically challenging due to a limited acoustic window in 

these patients. MR is known to be the non-invasive reference standard for assessment of cardiac function. If these parameters should be used for therapy monitoring a good 

repeatability is important. However, so far, repeatability has only been demonstrated in healthy volunteers or patients with cardiovascular issues and not in patients with obstructive 

pulmonary disease. Therefore, the aim of this study was to assess the 24h repeatability of MR derived cardiac function in stable COPD patients in a multicenter setting. 


22 COPD patients (2x GOLD I, 10x GOLD II, 6x GOLD III, 4x GOLD IV) with a mean age of 65±8 years were included. Measurements were done in 2 centers using a 1.5T Magnetom 

Avanto (Siemens, Medical Solutions, Germany). RV and LV function were assessed in short-axis-orientation using an ECG-triggered segmented CINE SSFP (2.2x1.9x8mm3; TR/TE: 

47.5/1.08 ms). Phase-contrast flow measurements were done in the main-pulmonary-artery (MPA) and ascending-aorta (1.3x1.3x5 mm3; TR/TE: 12.8/2.74 ms). 

RESULTS 

The RV ejection-fraction (EF) was significantly different between day 1 and day 2 (49% vs 45%, p=0.08), while the RV stroke volume showed no difference (61ml vs 61ml, p=0.8). The 

LV-EF and LV-SV did not differ between both examinations (67% vs 63%, p=0.1 and 56ml vs 59ml, p=0.3). The average-velocity and net-forward-flow in the MPA showed no 

difference (19cm/s vs 18 cm/s, p=0.5 and 83ml vs. 83ml, p=0.9). The same is seen for the aortic parameters (13cm/s vs. 13cm/s, p=0.9 and 78ml vs. 80ml, p=0.6). 

CONCLUSION 

This is the first study exploring the repeatability of MR derived cardiac parameters in patients with COPD. It was found, that cardiac functional parameters can be assessed with a good 

repeatability in patients with COPD. 


Cardiac Magentic Resonance shows a good repeatability in patients with COPD for assessment of left and right ventricular functional parameters. 

Chest (Thoracic Malignancy) 

Monday • 10:30 - 12:00 PM • S404CD 

CH CT OI 


PRESIDING: 

Kyung Soo Lee , MD, PhD , Seoul, Korea, Republic of 

Reginald F. Munden , MD, DMD , Houston, TX 

Computer Code: SSC04 • AMA PRA Category 1 Credits: 1.5 • ARRT Category A+ Credit: 1.5 


SSC04-01 • 10:30 AM 

Preoperative Staging of Non-Small Cell Lung Cancer with Coregistered Whole Body MRI-PET: A Prospective Randomized Controlled Trial 

Chin A Yi MD, PhD • Kyung Soo Lee MD, PhD , Seoul, Korea, Republic of • Ho Yun Lee MD • Seonwoo Kim • O. Jung Kwon • Joon Young Choi • Byung-Tae Kim MD • Hye Sun 

Hwang • Hojoong Kim MD • Joungho Han • Young Mog Shim MD 

PURPOSE 

Currently PET-CT plus brain MRI is considered the general method of lung cancer staging. However, upcoming simultaneously acquired whole body MRI-PET is expected to be the future 

way of accurate staging in patients with non-small cell lung cancer (NSCLC). The purpose of this randomized controlled study was to assess whether coregistered whole body MRI-PET 

correctly helps upstage lung cancer status in more patients with NSCLC than dose PET-CT plus brain MRI. 


We randomly assigned NSCLC patients who have resectable disease on the basis of conventional staging (clinical study including physical examination and dedicated thoracic CT) either 

to coregistered MRI-PET (whole body MRI data coregistered with whole body PET data) or whole body PET-CT plus dedicated brain MRI group. The primary end point was correct 

upstaging, thereby avoiding futile thoracotomy. Correct upstaging was defined as any one of the following: pathologically confirmed positive mediastinal lymph nodes for cancer cells 

(stage IIIA [N2]), stage IIIB or stage IV disease, or recurrence or metastasis within 6 months after randomization. 

RESULTS 

165 patients were assigned to coregistered MRI-PET and 151 patients to PET-CT plus brain MRI. 53 patients (22 in coregistered MRI-PET group and 31 in PET-CT plus brain MRI group) 

declined to participate or did not satisfy the inclusion criteria. Lung cancer was correctly upstaged in 37 (26%) of 143 patients in coregistered MRI-PET group and 26 (22%) of 120 

patients in PET-CT plus brain MRI group; difference, 4 per cents [95% CI, -6.1, 14.5]). Lung cancer was incorrectly upstaged in 18% (26 of 143) of patients in coregistered MRI-PET 

group and 6% (7 of 120) patients in PET-CT plus brain MRI group recipients, while it was incorrectly understaged in 12% (17 of 143) and 23% (28 of 120), respectively. 

CONCLUSION 

Preoperative staging with coregistered MRI-PET does not appear to allow one to identify more patients with mediastinal and extrathoracic metastasis than PET-CT plus brain MRI in 

patients with NSCLC, thereby no significant increase in number of patients who can have advantage of avoiding futile thoracotomy.This is ongoing study until the final stage is 

determined at 6 month-follow up. 


Besides the advantage of reduced exposure to radiation, coregistered MRI-PET may not spare more patients from futile thoracotomy than PET-CT plus brain MRI in preoperative staging 

of NSCLC. 

SSC04-02 • 10:40 AM 

EGFR Mutations and EGFR Gene Copy Number Status in Lung Adenocarcinomas: Relationship with GGO Volume Percentage on Thin-Section Chest CT, Histologic Finding, and 

Prognosis 

Hyun-Ju Lee MD, PhD , Seoul, KOREA, REPUBLIC OF • Young Tae Kim MD, PhD • Chang Hyun Kang • Binsheng Zhao DSc • Yongqiang Tan PhD • Lawrence H. Schwartz MD * • 

Thorsten Persigehl MD • Doo Hyun Chung MD, PhD 

PURPOSE 

To retrospectively correlate EGFR mutations and EGFR gene copy number status with quantitative GGO volume percentage (GGO%), histology, lung cancer stage, and survival in 

surgically resected lung adenocarcinomas (ADs). 

Page 42 of 97


290 consecutive patients (M:F=133:157; mean age, 63) who underwent curative surgical resection of lung AD between Oct. 2007 and Sep. 2009 comprised our study population. EGFR 

mutations and EGFR gene copy number status of the surgically resected lung ADs were evaluated through direct DNA sequencing and fluorescence in situ hybridization, respectively. On 

preoperative thin-section chest CT, the GGO% of each tumor was measured using a semiautomated algorithm. Distribution of EGFR mutations and EGFR gene copy number according to 

GGO%, histologic features, pathologic stage, and 2-year survival rate was evaluated. 

RESULTS 

Mean GGO% was higher in EGFR mutations (51%) than in EGFR wild type (29%) (p=0.001): GGO% in exon 21 missense mutation (62%) was higher than that in other types of 

mutation (39%) (p=0.005). The presence of a lepidic component was more frequent in EGFR mutations (74.3%) than in EGFR wild type (31.6%) (p

negative predictive value of 95% and positive predictive value of 87%. 

CONCLUSION 

Apparent diffusion coefficient value is a non-invasive promising imaging modality that can be used for differentiation of invasive from non invasive thymoma. 


Diffusion weighted MR imaging can be added to routine MR imaging of thymic epithelial tumors 

SSC04-07 • 11:30 AM 

Sex Difference in Normal Thymic Appearance in Adults, 20-30 Years of Age 

Jeanne B. Ackman MD , Boston, MA • Bojan Kovacina MD • Brett Wilson Carter MD * • Carol C. Wu MD • Amita Sharma MBBS • Elkan F. Halpern PhD * • Jo-Anne O. Shepard MD 

PURPOSE 

To determine if there is a sex difference in thymic appearance in adults, ages 20-30 years. 


This retrospective study was approved by the IRB and was HIPAA compliant. 238 consecutive subjects (175 men, 63 women) who underwent chest CT with IV contrast in 2008 were 

enrolled, after exclusion of all subjects with known thymic disease, illnesses associated with thymic disease, other chronic disease, cancer, and history of corticosteroid use or radiation 

therapy. The difference in average thymic ROI measurement and subjective assessment of thymic density by 0-3 scale between male and female thymi were assessed by Wilcoxon Rank 

Sum test. The AP measurement of the thymus was compared by Student’s t-test. Comparison of average maximal thymic lobe thickness was made by Student’s t-test. The average 

maximal thymic lobe thickness with confidence interval (2SD) was calculated for all thymi and then separately for triangular and trapezoidal thymi. Comparison of thymic morphology 

(trapezoidal versus triangular) was accomplished with a Continuity Adjusted Chi-Square test. 

RESULTS 

There was a significant sex difference with respect to thymic density as measured objectively by average thymic ROI measurement (p 

CONCLUSION 

Normal thymus in young women exhibits significantly higher attenuation and a more commonly trapezoid configuration than that of men. 


Awareness of this sex difference in normal thymic appearance should decrease the number of over-called thymic masses and unnecessary referrals for work-up and diagnostic 

intervention in young women. 

SSC04-08 • 11:40 AM 

Dual-Energy CT in Differentiating between Solid and Cystic Mediastinal Tumors 

Yoo Jin Hong MD , Seoul, KOREA, REPUBLIC OF • Jin Hur MD • Yeojin Lee MD • Hye-Jeong Lee MD • Young Jin Kim MD • Byoung Wook Choi MD 

PURPOSE 

Because cysts containing nonserous fluid can have high attenuation at computed tomography (CT), they may be mistaken for solid lesions. The purpose of this study was to evaluate 

the diagnostic value of dual-energy computed tomography (DECT) in differentiating solid mediastinal tumors from cystic mediastinal tumors. 


We prospectively enrolled 16 patients (12 males; mean age: 52.7 years) who had suspected mediastinal masses on chest radiography or noncontrast chest CT. All patients underwent 

two-phase dual-energy CT using gemstone spectral imaging (GSI) mode (GE HD750). For quantitative analysis, two investigators measured the following parameters in the early and 

the delayed phases for masses; CT attenuation density (HU values) and iodine concentration (mg/ml). Pathological results were used as a final diagnosis. 

RESULTS 

There were a total of 13 solid tumors and 3 cystic tumors. On CT, the mean HU values were not significantly different between solid and cystic tumors on the early phase (48.7 ± 18.9 

vs 43.6 ± 9.3 HU; p = 0.659), while the mean HU values were significantly different between two groups on the delayed phases (53.9 ± 9.29 vs 40.1 ± 6.46 HU; p = 0.027). The 

mean iodine concentration (mg/cc) were significantly different between solid and cystic tumors on the early and delayed phases (1.73 ± 0.66 vs 0.47 ± 0.32; p = 0.006 and 1.91 ± 

0.95 vs 0.47 ± 0.35; p = 0.021). The mean effective radiation dose was 6.1 ± 2.5mSv. 

CONCLUSION 

Dual-energy CT with iodine concentration value can be useful in the differentiation between solid and cystic mediastinal tumors. 


Dual-energy CT with quantitative measurements could be a helpful complementary tool to differentiate solid and cystic tumors in cases in which single phase contrast CT is 

inconclusive. 

SSC04-09 • 11:50 AM 

Development and Validation of an Accurate Method to Quantify Pleural Effusion on CT 

Matthew Paul Moy MD , Wantagh, NY • Jeffrey Michael Levsky MD, PhD • Linda B. Haramati MD * • Netanel Berko MD • Alla Godelman • Benjamin Zalta MD • David William Appel 

DMD • Munish Chitkara MD • Jocelyn Scheinert MD 

PURPOSE 

There is no standardized system to quantify pleural effusion size on CT. A validated quantification system would improve communication and may lead to a more appropriate use of 

imaging guidance for thoracentesis. 


Thirty-four CTs chosen to demonstrate a wide range of pleural effusion sizes were evaluated with a volume segmentation tool. The effusion volume was normalized by dividing by the 

hemi-thorax volume to yield an effusion percentage (%). The same CTs were then reviewed by two cardiothoracic radiologists in consensus for qualitative and simple quantitative 

features related to effusion size. Bivariate and multivariate regressions were used to ascertain the relationship between these features and effusion %. A classification rule was 

developed using the features that best predicted size and distinguished between small (40%) effusions. Inter-reader agreement for effusion 

size was assessed on the CTs for three groups of physicians (PGY-3 radiology residents, experienced pulmonologists, and cardiothoracic radiologists), both before and after 

implementation of the classification rule. 

RESULTS 

The CT features that best divided effusions into small, moderate and large sizes were anteroposterior (AP) quartile (p=.048) and maximum AP depth, in cm, at the mid-clavicular line 

(p=.042). According to the decision rule, 1st AP quartile effusions are small, 2nd AP quartile effusions are moderate and 3rd/4th AP quartile effusions are large. In borderline cases, AP 

depth is measured with 3cm and 10cm thresholds for the upper limit of small and moderate, respectively. Small effusions measured 328 mL or less, representing a relative 

contraindication to thoracentesis per published guidelines. Use of the rule improved inter-observer agreement from κ=0.56 to 0.79 for all physicians (p

PURPOSE/AIM 

Illustrate HIV-related thoracic diseases in the modern era of HAART with radiographic and CT imagesElucidate disease pathophysiology with pathologic and clinical correlations 


1. Introduction – Recent progress and statistics of HIV and HAART2. HIV-related thoracic diseases – Imaging findings and pathologic correlationsa. Immune reconstitution 

inflammatory syndrome (IRIS)IRIS in the setting of TB, Non-TB mycobacteria, pneumocystis, etc.IRIS in the absence of known residual antigenic loadb. COPD / Emphysema in 

HIVc. Pulmonary hypertensiond. Primary lung cancere. Drug-induced pulmonary diseases and toxicityDiffuse interstitial lung disease, focal consolidationsHypersensitivity reaction, 

bacterial pneumoniaf. Non-infectious pulmonary complicationsNSIPLIPLymphoma3. TBDrug sensitive TBDrug resistant TBMulti-drug resistant TB (MDR-TB)Extremely drug resistant 

TB (XDR-TB)4. Conclusion 

SUMMARY 

In the modern era, IRIS, COPD, and lung cancer are increasingly recognized in patients with HIV.Understanding imaging features of drug resistant TB in HIV including MDR and 

XDR-TB is important for the new age radiologist. 

LL-CHE-MO7B Radiation Dose Reduction in Thoracic Imaging: Pretty Picture or Diagnostic Ability! 

PURPOSE/AIM 

Present an overview of the ALARA principle in radiation safetyDescribe essential terminologies and parameters related to radiation safetyIllustrate the various dose reduction 

techniques and applications by accessible and digestible means of graphics and CT images 


1. Introduction – ALARA2. Terminologies and parametersmAkVpDoseExposureNoise3. Existing technique and limitationsFiltered back projection (FBP)Automatic exposure 

controlModified protocols4. Dose reduction methodsIterative reconstruction in image space (IRIS)Adaptive statistical iterative reconstruction (ASIR)Model-based iterative 

reconstruction (MBIR)Prospective cardiac gatingDual energy CT – possible dose reduction in selective scenarios5. ApplicationsCardiovascular CTPediatricsMetal / hardware6. 

Conclusion 

SUMMARY 

Tremendous ongoing efforts are being devoted to balance CT radiation dose reduction with diagnostic image quality.Standard FBP image reconstruction is limited by noise and streak 

artifacts, especially at low dose.Iterative reconstruction is an alternative to FBP for reducing radiation dose.Dual energy CT may reduce radiation dose by eliminating the need for 

pre-contrast CT. 

Monday• 12:15 - 01:15 PM • Lakeside Learning Center 

CH 


LL-CHS-MO 

Chest Lunch Hour CME Posters 

Cristopher Meyer, MD 

LL-CHS-MO1A EGFR Mutation in Lung Adenocarcinomas: Relationship with CT Characteristics and Histologic Subtypes According to IASLC/ATS/ERS Classification 

PURPOSE 

To retrospectively identify quantitative CT features that correlate with EGFR mutation status in surgically resected lung adenocarcinomas (ADs) stratified by IASLC/ATS/ERS 

classification 


In 153 surgically resected lung ADs, EGFR mutation status was determined by direct DNA sequencing and categorized into exon 19 deletion, exon 21 missense, and exon 18 or 20 

mutations. Histologic subtypes were classified according to IASLC/ATS/ERS classification of lung ADs. On preoperative chest CT, the GGO volume percentage (%) and total tumor 

volume of each tumor were measured using a semiautomated algorithm (watershed transformation with active contours and Markov random field based on density distribution). 

Distribution of EGFR mutation according to histologic subtype, GGO volume % and total tumor volume was evaluated. Statistical comparisons were performed using the Chi-square, 

one-way ANOVA, and two-sided Chi-square trend tests. 

RESULTS 

The exon 21 missense mutation was significantly more frequent in lepidic predominant ADs (AD in situ, minimally invasive AD, and lepidic predominant invasive AD) than in the 

other subtypes of dominant histology (acinar-, papillary-, micropapillary-, and solid-predominant as well as invasive mucinous AD) (P=0.0002). GGO volume % with the exon 21 

missense mutation (62±32%) was significantly higher than that in EGFR wild type tumors (30±38%) (P=0.0001) and exon 19 mutated tumors (29±38%) (P=0.0006). A significant 

trend was found that the prevalence of exon 21 missense mutation increased along with increasing GGO volume % (P=0.0008); no trend was found in exon 19 deletion (P=0.168). 

There were no differences in total tumor volume among tumors with exon 21 missence (10±13 cm3), exon 19 deletion (8.7±8.4 cm3), and EGFR wild type (14±30 cm3) (P>.05). 

No trend was found that the prevalence of any type of EGFR mutation increased as total tumor volume increased or decreased (P>0.05). 

CONCLUSION 

The prevalence of EGFR exon 21 missense increased along with increasing GGO volume %. This can be supported by the fact that exon 21 missense was significantly more frequent 

in LPAs according to IASLE/ATS/ERS classification. 


Identification of the relationship between CT features and EGFR mutation can help to define categories of lung adenocarcinoma that have distinct radiologic, molecular, and 

pathologic characteristics. 

LL-CHS-MO1B Relationship between Whole Tumor Size and Solid Component Size on High-Resolution Computed Tomography Concerning the Prediction of the Degree 

of Pathologic Malignancy in Primary Lung Adenocarcinoma 

PURPOSE 

It is known that in adenocarcinoma of the lung, GGO tumors have a better prognosis than solid type tumors. The aim of this study is to determine whether it is more useful to 

evaluate the whole tumor size or that of only the solid component size, i.e. excepting areas of ground glass opacity (GGO), on preoperative high-resolution computed tomography 

(HRCT) to predict the pathologic malignancy degree of tumors in lung adenocarcinoma 7 cm or less. 


Using preoperative HRCT data of 277 patients with adenocarcinoma 7 cm or less who underwent curative surgical resection from January 2005 to December 2007, we retrospectively 

measured the whole tumor sizes and solid component size. The whole tumor and solid component sizes with lung window setting (WTLW and SCLW) and whole tumor sizes with a 

mediastinal window setting (WTMW) on HRCT were compared with the pathological findings. 

RESULTS 

The mean WTLW, SCLW and WTMW were 2.58, 1.94 and 1.80 cm, respectively. There was significant correlation between the WTLW and that measured on pathological specimens 

(r=0.516, P

nodule enlargement more than 2 mm in diameter and/or appearance of solid component in the nodule. Medical records were also assessed for the evaluation of the outcome of 

these patients. 

RESULTS 

Size of maximal pGGN in each patient at the preoperative HRCT was 4-30 (median 7, mean 8) mm in diameter. The interval between preoperative and last HRCT examination was 

20-127 (median 73.5) months; more than 60 months (long-term group) in 10 patients and less than 60 months (shot-term group) in the other 6. The reason of short-term 

follow-up period less than 60 months was patient death in 4 and hospital transfer in 2. Progression of pGGN was observed in 6 of 10 patients in long-term group and only one of 6 

patients in short-term group. One patient underwent stereotactic radio-surgery for an invasive adenocarcinoma which developed from non-resected pGGN at 68 months after 

surgery. The others underwent no treatment for these progressing lesions, none of which caused metastasis or patient death. 

CONCLUSION 

Non-resected pGGNs often progress during long-term follow-up period more than 5 years after surgery in the cases of resected multiple lung adenocarcinomas. 


Long-term follow-up period is necessary to detect progression of non-resected pGGNs in the cases of resected multiple lung adenocarcinomas. Repeat HRCT with short interval is 

not necessary. 

LL-CHS-MO3A Diagnostic Value of Apparent Diffusion Coefficients in the Differentiation of Benign and Malignant Pulmonary Lesions 

PURPOSE 

The role of diffusion-weighted imaging (DWI) in differential diagnosis of pulmonary malignant tumours and solid benign lesions by using mean apparent diffusion coefficient (ADC) 

values was evaluated prospectively in this study. 


Forty four patients with pulmonary lesions were included. Diffusion weighted images in the axial plane were obtained by using a 1.5 Tesla MRI device, parallel imaging, single shot 

echo-planar spin echo T2 weighted sequences on 3 axes, and diffusion sensitive gradients with 3 different b values (0, 500, 1000 s/mm2). ADC maps which were obtained with high 

b values, despite without the knowledge of histopathological diagnoses. Then the patients were divided into benign and malignant groups according to their histopathological 

diagnoses. Sensitivity, specificity and other table statistics were used to evaluate the data. Optimal cut off value of ADC in differentiation of the lesions as benign or malignant, were 

estimated by using ROC analysis. 

RESULTS 

The lesions were malignant in thirty four (77.3%), and were benign in ten (22.7%) of the patients. There were statistically significant differences (p

RESULTS 

All seven cases (five men and two women; age range, 48–65 years) were diagnosed pathologically as hamartomas. No case had characteristic calcifications, and all lesions showed 

internal fat on histopathological analysis. In CT assessment (Fig. 1), no case showed calcium attenuation and the average density was -21.4 Hounsfield units (SD = 9.6 HU).All cases 

showed intermediate signal (lower than fat and higher than spinal muscle) in T1-weighted MRI sequences and showed high-intensity signals in T2-weighted sequences. In the 

chemical-shift MRI setting (Fig. 2), the average nodule signal intensity index was 45.8% (SD = 21.9). The correlation between average nodule signal intensity and CT HUs was 

-0.94. No nodule showed restriction in diffusion-weighted sequences. 

CONCLUSION 

Chemical-shift MRI could be an important tool to detect fat in pulmonary hamartomas with inconclusive CT findings. Our data also confirmed that pulmonary hamartomas had high 

signal intensity in T2-weighted sequences and showed no restriction in diffusion-weighted sequences. 


Chemical-shift MRI could be an important tool to detect fat in pulmonary hamartomas with inconclusive CT findings 

LL-CHS-MO5B Breath-hold after Deep Expiratory, before Removal of the Biopsy Needle, Decreased the Pneumothorax Rate in Percutaneous CT-guided Transthoracic 

Biopsy of Lung Nodules 

PURPOSE 

Purpose: To assess the effect of a breath-hold after deep expiratory approach on the rate of pneumothorax after computed tomography (CT)–guided transthoracic needle biopsy of 

pulmonary nodules. 


Materials and methods:The institutional review board approved the study, and all patients gave written informed consent. Between January 2008 and December 2011, percutaneous 

CT-guided lung biopsy was performed in 440 patients. Two hundred and twenty-one biopsies were performed without (group 1) and two hundred and nineteen were performed with 

(group 2) a breath-hold after deep expiratory approach. Multivariate analysis was performed between groups for risk factors for pneumothorax, including patient demographic 

characteristics, lesion characteristics, and biopsy technique. 

RESULTS 

Results: An increased number of pneumothoraces (35 [15.8%] vs 18 [8.2%]; P = 0.014) but no significant difference in rate of drainage catheter insertions (4 [1.8%] vs 2 [0.9%]; 

P = 0.418) were noted in group 1 compared with group 2. At logistic regression analysis for pneumothorax, lesion size (including the transverse diameter and longitudinal diameter), 

distance from pleura, with or without breath-hold after deep expiratory approach were independent risk factors. 

CONCLUSION 

Conlusion:Breath-hold after deep expiratory approach during percutane-ous CT-guided transthoracic lung biopsy reduces the rate of overall pneumothorax. Use of this technique 

attenuates the influence of traditional risk factors for pneumothorax. 


Breath-hold after deep expiratory before removal of the biopsy needle decreased the pneumothorax rate in Percutaneous CT-guided Transthoracic Biopsy of Lung Nodules 

Interventional Oncology Series: Lung 

Monday • 01:30 - 06:00 PM • S405AB 

CH IR OI RO 


Course No. VSIO21 

ARRT Category A+ Credit: 5.0 • AMA PRA Category 1 Credits: 4.25 

Alison R. Gillams , MBChB * , Moderator , London, UNITED KINGDOM 


VSIO21-01 • Setting the Stage 

Seth Jay Kligerman , MD * , Baltimore, MD 


1) Learn about the TNM staging system for lung cancer. 2) Recognize the important changes within the revised 7th edition and understand the rationale behind the changes. 3) 

Learn about the natural history of colorectal metastases to the lung. 4) Understand the results and limitations of chemotherapy for the treatment of pulmonary metastatses from 

colorectal cancer. 


Lung cancer remains the leading cause of cancer related deaths in the United States. In 2009, the IASLC accepted a new staging system for lung cancer which incorporates NSCLC, 

small cell lung cancer and carcinoid tumors. Many of the important changes within the new TNM classification occurred within the Tumor (T) classification. Based on size alone 

tumors

conventional therapy for lung cancer. This study was designed to evaluate the survival of patients with stage 1 lung cancer after treatment with cryotherapy. 


The institutional review board approved the prospective tumor registry. Cryoablation was performed on 47 T1 N0 M0 lung cancers in 45 patients between 2006 and 2011. All 

ablative procedures were performed with a Percryo 17 or 24 device. The number of probes was determined by the geometry of the tumor. Kaplan-Meyer curves were generated to 

total survival, tumor specific survival and disease specific survival. 

RESULTS 

We found a 5 year survival of 69.7 +/- 12.7% for all patients. The cancer specific survival was 87.4 +/- 10.5% with a disease specific survival of 46.9 +/- 22%. The most 

common complications were hemoptysis in 40% of patients and pneumothorax in 36.1% of patients, (12% requiring chest tubes). There were no deaths in the first 30 days post 


CONCLUSION 

Cryotherapy for lung cancer is safe and effective in the treatment of early stage lung cancer. Survival rates are statistically higher than rates that have been reported in 

radiofrequency ablation and radiation therapy studies. However, the survival rates reported here are slightly lower than those reported after sublobar resection. 


Cryotherapy is an additional therapeutic option in patient with early stage lung cancer. 

VSIO21-07 • Follow-up Imaging—All Modalities 

Elizabeth H. Moore , MD , Sacramento, CA 


1) Review the imaging findings after lung ablation. 2) Discuss the appropriate timing and modality for follow-upof lung ablation. 3) Review the pertinent imaging data. 

VSIO21-08 • Whole-Body 3T MRI with and without Newly Developed Quick 3D and Double Fat Suppression Techniques vs FDG-PET/CT vs. Conventional Radiological 

Method: Capability for Postoperative Recurrence Assessments in Non-Small Cell Lung Cancer 

Yoshiharu Ohno , MD, PhD * , Kobe, Hyogo, JAPAN , Mizuho Nishio , MD , Kobe, Hyogo, JAPAN , Hisanobu Koyama , MD , Kobe, Hyogo, JAPAN , Takeshi Yoshikawa , MD 

* , Kobe, Hyogo, JAPAN , Sumiaki Matsumoto , MD, PhD * , Kobe, Hyogo, JAPAN , Saori Satou , RT * , Otawara, Tochigi, Japan , Daisuke Takenaka , MD , Akashi, Hyogo, 

JAPAN , Shinichiro Seki , Kobe, Hyogo, JAPAN , Toshiaki Minami , Kobe-city, Hyogo, JAPAN , Kazuro Sugimura , MD, PhD * , Kobe, JAPAN 

PURPOSE 

To compare the capability for assessment of postoperative recurrence in non-small cell lung cancer (NSCLC) patients among whole-body MRI at 3T system with and without newly 

developed quick segmented 3D T1-weighted gradient echo sequence (Quick 3D) and a double fat suppression (DFS) technique for enhancing fat free capability (WB-MRI with and 

without Quick 3D and DFS), FDG-PET/CT and conventional radiological method. 


A total of 75 consecutive NSCLC patients treated as pathologically and surgically confirmed complete resections underwent WB-MRI with and without Quick 3D and DFS, 

FDG-PET/CT and conventional radiological method. Final diagnosis of recurrence was based on the results of more than 12 months of follow-up and/or pathological examinations. 

On each method, probabilities of postoperative recurrence in each patient were assessed by using a 5-point visual scoring system, and final diagnosis was made by consensus 

between two readers. Interobserver agreement for postoperative recurrence on each method was assessed by weighted kappa statistics. ROC analyses were performed to compare 

capabilities for postoperative recurrence assessment among all methods on a per-patient basis. Finally, sensitivities, specificities and accuracies of all methods were compared by 

means of McNemar’s test. 

RESULTS 

Interobserver agreements for postoperative recurrence on all methods were substantial or almost perfect (0.75

Signal (LMS ratio).The correlations between post ablation follow-up CT volume of tumors and CE-MRI LMS ratio at the follow-up periods were assessed. 

RESULTS 

The preablation tumor volumes range: 0.30-6.1cm (mean: 1.5cm³, SD:1.3). LMS ratio < 1was associated with post ablation reduction of tumor volume (denoting scaring),while 

LMS ratio>1were noted in: preablation due to high contrast enhancement of the tumor,in24h post ablation due to the inflammatory response associated with the thermal ablation 

and due to tumor residue or progress. Weak correlation was detected between the LMS-ratios and CT-volumetric changes in 24h post ablation. Strong correlation between the LMS 

ratios was estimated between the follow up periods of 3months(SpearmanR:0.62,p=0.0021),6months (SpearmanR:0.66,p=0.001),9months(SpearmanR:0.61,p

Ralf W. Bauer MD * , Frankfurt, Hessen, Germany • Boris Schulz • Martin Beeres MD • Boris Bodelle MD • Firas Al-Butmeh • Thomas Lehnert MD • Thomas Josef Vogl MD, PhD • 

Josef Matthias Kerl MD * 

PURPOSE 

High-pitch dual-source CT pulmonary angiography (CTPA) has recently shown to go along with significantly lower dose values than conventional single-source CT. In this study, we 

investigated the potential of second generation iterative image reconstruction (IR) for further patient dose reduction and image quality improvement in high-pitch dual-source CTPA. 


60 consecutive patients underwent CT pulmonary angiography (CTPA) in dual-source high-pitch mode (pitch 3.0, 100 kV, 50 ml contrast material) without breathing command. Images 

in group 1 (30 patients) were acquired at full dose (180 mAs) and reconstructed with filtered back projection (FBP). In group 2 (30 patients) tube current was reduced by half (90 mAs) 

and images were reconstructed with iterative reconstruction (SAFIRE, intermediate strength, step 3 of 5). Automated exposure control was used in every patient. CTDIvol, DLP, 

pulmonary arterial (PA) attenuation, image noise, signal-to-noise-ratio, incidence of total or partial interruption of the contrast column in the PA tree, motion artifacts of the diaphragm 

and pulmonary structures were recorded. Parameters were compared by the Wilcoxon-Mann-Whitney-U test. 

RESULTS 

Mean CTDIvol (3.8±0.3 vs. 2.7±0.8 mGy) and DLP (138±18 vs. 97±31 mGycm) were 29% and therewith significantly (p 0.05) with IR. With a mean examination time was 0.65±0.10 

s there were no breathing artifacts. Further, we did not observe a partial or total interruption of the contrast column in the PA tree in the freely breathing patients. 

CONCLUSION 

The use of second generation iterative reconstruction allows for an additional significant reduction of patient dose during high-pitch CTPA whereas image quality is at least maintained or 

even slightly improved. Besides that, high-pitch dual-source CTPA obviates the need for scanning in breath-hold since the ultra fast examination time freezes patient motion. As a 

benefit of that breath-hold-induced contrast artifacts that may mimic or mask PE can be overcome. 


High-pitch dual-source combined with iterative reconstruction enables CTPA in clinical routine with an unprecedented low average DLP of 

SSE05-04 • 03:30 PM 

Measurement and Image Quality: High-Pitch vs Prospective ECG-gated CT for Assessment of the Thoracic Aorta 

Opeyemi Ibidapo MD , New York, NY • Jane P. Ko MD 

Ruiz • James S. Babb PhD • Bernard Assadourian 

• Jay Patel MD • Geraldine Teresa Brusca-Augello DO • John Patrick Fantauzzi MD • Francis Gerard Girvin MBChB • Ryan 

PURPOSE 

To compare high-pitch (HP) to prospective ECG-gated (PECG) chest CT for qualitative and quantitative assessment of the ascending aorta. 


We compared 65 consecutive CT studies for ascending aortic aneurysm with HP and PECG techniques using 120 and 100kVp on the same MDCT scanner. Three thoracic radiologists 

evaluated randomized and anonymized CTs. Image quality was graded on a (1 - excellent, no motion or blurring to 5 -nondiagnostic ) scale. Largest aortic dimensions and Hounsfield 

standard deviation (SDROI) were obtained for the sinus of valsalva, ascending aorta, arch, and descending thoracic aorta. Radiation dose estimates were compared. Mixed model 

analysis of covariance measures comparing HP and PECG study endpoints and coefficient of variation (CV) were calculated. 

RESULTS 

Chest CTs comprised 37 HP (22 with and 14 without contrast) and 28 PECG (23 with and 5 without contrast); Image quality was diagnostic and similar in all cases, however PECG 

image quality was greater than HP overall (mean, SD) (1.80+/-0.65) vs (2.03+/-0.65) p=0.0001; sinus of valsalva (2.12+/- 0.78)vs (2.42+/- 0.83) p=0.005, ascending (1.71+/- 

0.59) vs (1.97+/- 0.58) p=0.002, arch (1.59+/- 0.56) vs (1.83+/- 0.54) p=0.002, descending aorta (1.76+/- 0.51) vs (1.88+/- 0.40) p=0.486. No significant difference for 100 (1.79 

+/- 0.59)vs 120kVp (1.94+/-0.61) p=0.133.For aortic dimensions, no difference (p>0.05) in interobserver variation between HP vs PECG for sinus of valsalva (CVs 3.6% vs 3.4%), 

ascending aorta (CVs 4.0% vs 3.8%), and arch (CVs 9.9% vs 12.4%). Overall SDROI was lower (P

PURPOSE 

To compare the prediction capability for postoperative recurrence in patients with lung adenocarcinoma between FDG-PET/CT and indexes suggested by guideline. 


76 consecutive patients with lung adenocarcinoma underwent FDG-PET/CT, and evaluated indexes that were suggested as useful by guideline. Then, all patients were treated as 

pathologically and surgically confirmed complete resection, and underwent follow-up examinations more than 12 months. According to the results of follow-up and/or pathological 

examinations, all patients were divided into recurrent (n=10) and non-recurrent (n=66) groups. On FDG-PET/CT in each subject, the maximum value of standard uptake value 

(SUVmax) at each primary lesion was assessed by ROI measurements. Then, SUVmax normalized by tumor size (nSUVmax) in each subject was also evaluated. In addition, 

preoperative tumor markers (i.e. CEA and CYFRA) and performance status, clinical and pathological stages as well as T, N and M factors, and surgical procedure in each patient were 

also assessed. To evaluate the difference between two groups, all indexes were compared by using Student’s t-test or chi-square test. Then, the parameters as having significant 

difference between two groups were correlated with postoperative recurrence by step-wise regression test. To determine the feasible threshold values for distinguishing recurrent from 

non-recurrent groups, ROC-based positive test were performed. Finally, sensitivities, specificities and accuracies were compared each other by means of McNemar’s test. 

RESULTS 

SUVmax, nSUVmax, CEA and pathological stage had significant difference between two groups (p

accuracy, PPV and NPV were 82.1%, 80.1%, 80.8%,65.5%and 90.7%, respectively. The area under the ROC curve was 0.846±0.0215 for SUVmax (P=0.0001). The optimal cutoff 

value was 2.3 for SUVmax. When taking this cutoff value, the sensitivity, specificity, accuracy, PPV and NPV for the depiction of malignant nodes were 71.2%,85.2%,82.4%,54.1% and 

92.3%,respectively, lower than the visual interpretation. But statistical significancy was got only in specificity and accuracy (P=0.000,P=0.000, respectively).The sensitivity, specificity, 

accuracy, PPV and NPV for mediastinal nodal staging were 79.1%,71.2%,73.7%,55.8% and 88.1%,also lower than the visual interpretation. But statistical significancy was also got 

only in specificity and accuracy (P=0.000,P=0.000, respectively). 

CONCLUSION 

Both Visual interpretation and SUVmax of 18F-FDG PET/CT appear to provide acceptable accuracy for NSCLC MLN staging, but Visual interpretation had better specificity and accuracy 

than SUVmax. 


Visual interpretation can replace SUVmax on 18F-FDG PET/CT for preoperative MLN staging in patients with NSCLC. 

SSE19-06 • 03:50 PM 

Combined Clinico-Radiologic Risk Stratification for Prediction of Malignancy in Pulmonary Nodules with Low or Absent Uptake on 18F-FDG PET/CT 

Sriram Vaidyanathan MBBS, MRCS , Leeds, W Yorks, UNITED KINGDOM • Shishir Karthik MBBS, FRCR • Puneet Malhotra MBBS • Paul Plant • Matthew Eric Callister • Andrew 

Frederick Scarsbrook MBBS 

PURPOSE 

While solitary pulmonary nodules (SPNs) are increasingly being detected, there is a paucity of data to guide optimal management in patients with low or absent FDG uptake at PET/CT. 

The study aim was to evaluate a novel risk stratification model combining clinico-radiologic and metabolic characteristics. 


Consecutive patients from a large tertiary referral centre with SPNs demonstrating low or absent uptake on PET/CT (SUVmax of ≤ 2.5) were analysed over a 3 year period (January 

2007 to December 2009). Data included demographics, nodule characteristics (size, margin, morphology and location), degree of metabolic activity within the nodule (SUVmax), interval 

change on subsequent imaging and/or histological diagnosis. Pre-test clinical scoring was performed using a Bayesian model and combined with metabolic characteristics post hoc. 

Patients were followed-up for a minimum of 2 years. 

RESULTS 

98 nodules in 87 patients with a median (range) age of 68 (46 -87) years were included. Malignancy was confirmed in 27 (28%) patients. Mean (SD) nodule size was 1.4 (0.62) cm. 

84 (86%) were solid, 10 (10%) semi-solid, and 4 (4%) ground glass. 51 (52%) were smooth, 32 (33%) spiculated, and 15 (15%) lobulated in outline. 32 (33%) SPNs demonstrated 

FDG uptake, mean (SD) SUVmax was 0.61 (0.92). 55 (56%) nodules were stable at 2 years, 11 (11%) decreased or resolved, 27 (28%) increased and 4 (4%) proceeded directly to 

surgical resection. 53 of the 55 stable nodules were benign, all 11 nodules that decreased were benign and 22/27 nodules that increased were malignant. Patients with either a high 

pre-test clinical probability score (> 70%) or SUVmax > 1.5 were deemed intermediate risk and those with both high risk. Combining the pre-test risk score significantly increased test 

accuracy and likelihood with an estimated sensitivity of 85% and specificity of 77%. Specificity increased to 98% in the high risk group. 

CONCLUSION 

This study has demonstrated the potential utility of composite risk stratifiction using clinico-radiologic and metabolic factors in predicting malignancy in SPNs with low or minimal FDG 

uptake on PET/CT. 


Outcomes in of patients with low FDG uptake pulmonary nodules are unclear. We present a combined clinico-radiologic risk stratification for predicting malignancy in these patients. 

Diagnosis Live powered by RSNA-DxLive: The Audience Participation Game (Chest and Abdomen) 

Monday • 04:30 - 06:00 PM • E451A 

CH GI 

Computer Code: SPDL21 • AMA PRA Category 1 Credits: 1.5 • ARRT Category A+ Credit: 0 


Paul J. Chang , MD * , Chicago, IL 

Neety Panu , MD, FRCPC , Thunder Bay, ON, CANADA 

Gregory Lewis Katzman , MD * , Chicago, IL 



1) The participant will be introduced to a series of radiology case studies via an interactive team game approach designed to encourage “active” consumption of educational content. 2) 

The participant will be able to use their mobile wireless device (tablet, phone, laptop) to electronically respond to various imaging case challenges; participants will be able to monitor their 

individual and team performance in real time. 3) The attendee will receive a personalized self-assessment report via email that will review the case material presented during the session, 

along with individual and team performance. 

Abstract 

The extremely popular audience participation educational experience is back! Diagnosis Live! is an expert-moderated session featuring a series of interactive case studies that will 

challenge radiologists’ diagnostic skills and knowledge. Building on last year’s successful Diagnosis Live! premiere, this session features a lively, fast-paced game format: participants will 

be automatically assigned to teams who will then use their personal mobile devices to test their knowledge in a fast-paced session that will be both educational and entertaining. After the 

session, attendees will receive a personalized self-assessment report via email that will review the case material presented during the session, along with individual and team 

performance. 

Monday• 05:00 - 06:00 PM • Lakeside Learning Center 

CH 

LL-CHS-MOPM 

Chest Afternoon CME Posters 

James Ravenel, MD 

LL-CHS-MO1C Impact and Usefulness of Xenon Ventilation CT Using Dual Energy Technique in Patients with Pulmonary Emphysema: A Feasible Study 

PURPOSE 

To evaluate the usefulness of xenon ventilation CT using dual-source and dual-energy technique in patients with pulmonary emphysema. 



Institutional review board approval and written informed consent were obtained. Ten patients (mean age: 75 years, range: 56-87 years) with pulmonary emphysema and seven 

healthy volunteers (mean age: 30 years, range: 25-38 years) underwent xenon ventilation CT with single inhalation of 35% xenon gas, using dual-source and dual-energy technique. 

Scanned data of 2mm thickness were analyzed with three-material-decomposition method on off-lined computer of CT console and xenon-enhanced images were obtained. After 

three-dimensional (3D) reconstruction of xenon-enhanced images, mean xenon enhancement values of whole lung were measured and correlated with pulmonary function test 

results. 

RESULTS 

We could successfully obtain xenon enhanced images calculated by using three-material-decomposition method for all subjects. No undesirable effects potentially related to xenon inhalation 

were observed. In all healthy volunteers, xenon was distributed homogeneously. In contrast, in all of the seven emphysema cases, total decrease and inhomogeneous distribution of xenon 

enhancement of lung fields were well demonstrated with 3D images. Mean xenon enhancement values in patients with pulmonary emphysema were significantly lower than those in healthy 

volunteers (20.8±7.2 vs 32.3±3.5 HU; p

To assess the performance of a PE-CAD program in the detection of PE missed in clinical practice 


2,358 consecutive CT angiographic studies from January 2009-March 2012 were retrospectively reviewed for the presence of pulmonary emboli (PE) by a thoracic radiologist. If a PE 

was present on the study but not described in the report by an attending radiologist, it was considered a missed PE. For PE positive CTs, all prior contrast enhanced thoracic CTs 

were reviewed to assess for a missed PE. The presence, location of the most proximal PE (main, lobar, segmental [S], subsegmental [SS]), number (single vs. multiple), and 

chronicity (acute vs. chronic) of PE were agreed upon by two fellowship trained thoracic radiologists. Studies with missed PE were assessed with a prototype PE-CAD program (Philips 

Healthcare), which required a slice thickness of ≤2mm. The consensus locations of missed PE were marked with software (Easyscil; Philips Healthcare) prior to running the CAD 

program and set as the gold standard (GS). CAD marks localized to and not localized to a GS mark were deemed true positives and false positives (FP), respectively. 

RESULTS 

Between 3/04 and 3/12, 100 studies with at least one missed PE were identified. 80 studies (59 CT PE, 12 CTs of the chest, 8 CTAs of the aorta, and 1 PET-CT) had reconstructions 

with ≤2mm and were assessed by PE-CAD. The PE-CAD program identified at least one PE in 45/58 (75.6%) CTs with acute PE. In CTs with multiple acute PE, PE-CAD correctly 

marked at least one PE in 25/26 cases (96.2%) while it correctly marked 20/32 (62.5%) cases with a single missed acute embolus. PE-CAD correctly marked a PE in 26/36 cases 

(72.2%) where the most proximal PE was in a SS branch including 14/24 (58.3%) single and 12/12 (100%) multiple SS emboli. PE-CAD correctly marked a PE in 17/20 cases 

(85%) where the most proximal PE was in a S branch, including 6/8 (75%) single and 11/12 (91.7%) multiple S emboli. Cases with multiple acute lobar (n=1) and main (n=1) 

emboli were detected by PE-CAD. PE-CAD identified 5/22 (22.7%) cases of chronic PE. PE-CAD averaged 3.1 FP marks per case (n=247, range 0-23). 

CONCLUSION 

PE-CAD correctly identified 75.6% of cases of acute PE which had been previously missed in clinical practice. 


PE-CAD detected a high percentage of previously missed PEs and could be used in practice to reduce the number of false negative studies and improve patient care. 

LL-CHS-MO2D A New Quantitative Index of Lobar Air Trapping in Chronic Obstructive Pulmonary Disease (COPD): Comparison with Conventional Methods 

PURPOSE 

To determine the feasibility of newly-proposed index (attenuation-volume index, AVI) for quantitative assessment of lobar air trapping defined as the increase in CT attenuation value 

(CTAV) divided by the volume decrease ratio using inspiratory and expiratory CT for minimizing the influence of respiratory level. 


Study group consisted of 21 COPD patients including 12 in group A (GOLD 2 and 3) and 9 in group B (GOLD 1), and 26 in group C (normal controls), who underwent both 

expiratory/inspiratory scans by 320-row CT and pulmonary functional test. Volume image data with 0.5-mm thickness was automatically segmented into 6 lung lobes with minimal 

manual intervention using dedicated workstation. Increase in CTAV (ICT), pixel index (PI) defined as proportion of pixels under -900 HU at expiration and air trapping ratio (ATR) 

defined as ratio of mean CTAV at expiration/inspiration were calculated in addition to AVI. Four indices in total lung (TL) were correlated with FEV1/FEV % and compared among 3 

groups using t-test. Also in each group, 4 indices were compared among 3 groups and 6 lung lobes using t-test and average of variance, respectively. 

RESULTS 

In TL, AVI as well as other 3 indices had excellent correlation with FEV1/FEV%. (r= 0.76, p

and progression. 

LL-CHS-MO4D Lung Perfused Blood Volume with Spectral CT Imaging as a New Quantitative Tool? Assess the Contrast Material Distribution of the Pulmonary 

Parenchyma in Patients with Lung Cancer 

PURPOSE 

To quantitatively investigate the pulmonary blood flow and its change induced by lung cancer by measuring the iodine concentration distribution in pulmonary parenchyma on lung 

perfused blood volume (LPBV) images with spectral CT imaging. 


Thirty patients with lung cancer (ten cases central lung cancer, twenty cases peripheral lung cancer, average age 61.9 years), confirmed by pathology and underwent spectral CT 

imaging with a standard injection protocol, were enrolled in this study. LPBV images were generated by analysis of the iodine content of the lung parenchyma. The average diameter 

of peripheral lung cancer was 3.46 cm. We evaluated the quantification of lung PBV using a workstation including lung tumor, pulmonary parenchyma in the distal end of lung 

cancers and the corresponding area in the contra-lateral normal lung on the LPBV images. 

RESULTS 

Mean lung PBVs (0.74±0.56 mg/cc) for the pulmonary parenchyma in the distal end of lung cancers was significantly lower than that in the corresponding area in the contra-lateral 

normal lung (1.20±0.53 mg/cc) (t=1.52, P=0.000). In peripheral lung cancer, we also found significantly lower (P=0.002). This lower PBVs were not related to the sizes of tumor 

(P>0.05). However, there was a positive correlation between tumor PBVs and lung PBVs for the pulmonary parenchyma in the distal end of lung cancers (P=0.021). 

CONCLUSION 

LPBV with spectral CT imaging could be used to quantitatively evaluate the pulmonary blood flow and its change induced by lung cancers. There was a correlation between tumor 

perfusion and pulmonary blood flow of the affected lung areas. 


LPBV with spectral CT imaging could quantitatively evaluate the pulmonary blood flow and its change induced by lung cancer. It is valuable for pre-radiotherapy evaluation in lung 

cancer patients. 

LL-CHS-MO5C 4D Flow MRI Indicates Changes in Pulmonary 3D Hemodynamics in Arterial Hypertension 

PURPOSE 

To evaluate helicity, vorticity and wall shear stress (WSS) in PAH patients and normal volunteers using 4D flow MRI. 


With IRB approval, three patients (age: 59±9.5, 2 females, MPAP: 51.5±20mm Hg) and seven volunteers (age: 36 ±10, six females) were scanned on a 1.5T MR system. The 

ejection fraction was comparable between two groups (P value> 0.05). Time-resolved 3D pulmonary flow was measured using ECG and respiration synchronized 4D flow MRI with 

full coverage of the right ventricular out flow tract, main pulmonary artery and right and left pulmonary branches (RPA and LPA). 3D blood flow visualization and visual grading of flow 

patterns was used to identify helicity and vortex flow in all vessel segments. In addition, WSS and vessel cross-sectional area was quantified in analysis planes positioned at the level 

of the MPA, RPA, and LPA in PAH patients and volunteers. 

RESULTS 

Helical flow was observed in the RPA (3 volunteers, 2 patients). Vortical flow was more frequent in PAH in the MPA (1 volunteer, 2 patients) and LPA (1 patient). WSS in controls 

(MPA: 0.6 N/m2±0.12, LPA: 0.5 N/m2±0.1, RPA: 0.8 N/m2±0.13) was generally higher when compared to patients (MPA: 0.5 N/m2±0.28, LPA: 0.5 N/m2±0.23, RPA: 0.4 

N/m2±0.09). Most pronounced differences were seen in the RPA which also showed more asymmetric WSS distribution along the vessel circumference. In addition, PAH arteries had 

a larger cross-sectional area (MPA: 1013 mm2±203, LPA: 309 mm2±114, RPA: 286 mm2±72) compared to the normal population (MPA: 558 mm2±224, LPA: 248 mm2±78, RPA: 

227 mm2±42). 

CONCLUSION 

4D flow MRI is feasible for comprehensive assessment of pulmonary flow characteristics and illustrates subtle, but distinct hemodynamic changes in PAH patients compared to a 

normal population. As shown in previous studies, WSS in the RPA was found to markedly decrease in PAH patients compared to normal controls. This pattern was not as apparent in 

the MPA and LPA. 


High pulmonary artery pressure leads to right heart failure, but its effect on hemodynamic factors (i.e. helicity, vorticity and wall shear stress) and their role in disease progression is 

not clear. 

Chest Series: Lung Nodules/Lung Cancer 

Tuesday • 08:30 - 12:00 PM • N230 

CH OI 


Course No. VSCH31 


Theresa C. McLoud , MD , Moderator , Boston, MA , 

Jin Mo Goo , MD, PhD * , Moderator , Seoul, Seoul, KOREA, REPUBLIC OF 

VSCH31-01 • Introduction by Moderators 

Page 54 of 97 

VSCH31-02 • Radiologic-Pathologic Correlation of Ground-Glass and Part-Solid Nodules 

Jeffrey R. Galvin , MD , Baltimore, DC 


1) Provide an understanding of the histologic change that leads to invasive adenocarcinoma. 2) Explain the basis for apparent slow growth of some adenocarcinomas. 3) Describe 

the typical imaging findings in atypical adenomatous hyperplasia, bronchioloalveolar carcinoma, and invasive adenocarcinoma. 

VSCH31-03 • Lung Nodule Characterization: CT 

Jane P. Ko , MD , New York, NY 


1) To utilize morphological and attenuation features on CT for nodule characterization. 2) To understand quantitative analysis and enhancement techniques for further evaluating 

lung nodules. 

VSCH31-04 • Computerized Analysis of Attenuation Values for Differentiation of Preinvasive Lesions from Invasive Pulmonary Adenocarcinomas Manifesting as 

Part-solid Nodules 

Hee Dong Chae , MD , Seoul, Seoul, KOREA, REPUBLIC OF , Chang Min Park , MD, PhD , Seoul, Seoul, KOREA, REPUBLIC OF , Sang Joon Park , Seoul, KOREA, REPUBLIC OF , 

Yong Sub Song , MD , Seoul, Gyeonggi, KOREA, REPUBLIC OF , Sang Min Lee , MD , Seoul, Seoul, KOREA, REPUBLIC OF , Hyun-Ju Lee , MD, PhD , Seoul, KOREA, REPUBLIC 

OF , Jin Mo Goo , MD, PhD * , Seoul, Seoul, KOREA, REPUBLIC OF 

PURPOSE 

To determine whether a computerized analysis of computed tomographic (CT) attenuation values help differentiate preinvasive lesions from invasive pulmonary adenocarcinomas 

(IPAs) manifesting as part-solid nodules (PSNs). 


Our institutional review board approved this retrospective study, with waiver of informed consent. From January 2005 to October 2011, 40 patients with 40 

pathologically-confirmed PSNs (mean size, 14mm ± 4.2) underwent low dose thin-section CT and comprised our study population. Each PSN was manually segmented from its 

surrounding structured background and its various voxel attenuation values were extracted using an in-house feature extraction software. To investigate the differentiating factors 

of preinvasive lesions from IPAs, multivariate logistic regression analysis and receiver-operating characteristics curve analysis were performed. 

RESULTS 

There were 25 IPAs and 15 preinvasive lesions. Preinvasive lesions consisted of 2 atypical adenomatous hyperplasias and 13 adenocarcinomas-in-situ. Between IPAs and 

preinvasive lesions, there were significant differences in the average attenuation number, variance, volume, skewness, kurtosis and entropy (P

within the tumor at CT. 


After institutional review board approval, written informed consent was taken from 46 patients with a lung adenocarcinoma with or without EGFR mutation. Each patient underwent 

whole body MRI including diffusion-weighted images (DWIs), CT and 18F-FDG PET/CT. ADC value at MRI, SUVmax at PET/CT, and the proportion of ground-glass opacity (GGO) 

within the tumor at CT were analyzed. 

RESULTS 

This study included 24 adenocarcinomas with EGFR mutation and 22 adenocarcinomas without EGFR mutation. The average ADC value of adenocarcinomas with EGFR mutation 

(1.39 x 10-3 mm2/sec) was significantly higher than that of adenocarcinomas without EGFR mutation (1.24 x 10-3 mm2/sec) (P < .05). The average SUVmax of adenocarcinomas 

with EGFR mutation was significantly lower than that of adenocarcinomas without EGFR mutation (P < .05). The average proportion of GGO within the adenocarcinomas with EGFR 

mutation (15%) was higher than that of adenocarcinomas without EGFR mutation (10%). However, the proportion of GGO within the tumor did not show statistical difference 

between EGFR mutation positive and negative groups (P = .91). 

CONCLUSION 

ADC value at DW MRI is higher, SUVmax at PET/CT is lower, and GGO component at CT within the whole tumor was larger in adenocarcinomas with EGFR mutation, than in those 

without EGFR mutation; further confirming the fact that the presence of EGFR mutation is related histopathologically with well-differentiated and low-grade category of lung 

adenocarcinoma. 


The assessment of genomic characteristics of lung adenocarcinomas helps identify underlying histopathologic differentiation and grade of the tumor which are related with DW MRI, 

PET/CT, and CT results 

VSCH31-07 • Lung Nodule Characterization: Biopsy 

David F. Yankelevitz , MD * , New York, NY 


1) To understand basic mechanisms for targeted treatments. 2) To understand what type of markers can be obtained from small specimens that can influence lung cancer 

treatment. 3) To learn how to develop protocols for obtaining and processing small specimens so as to maximize their usefulness. 

VSCH31-08 • Panel Discussion 

Page 55 of 97 

VSCH31-09 • Management Recommendations: Solid and Part-Solid Nodules 

David Paul Naidich , MD * , New York, NY 


1) Gain familiarity with the relationship between the new classification of peripheral adenoarcinomas of the lung and the CT appearance of sub-solid nodules. 2) Have reviewed 

optimal technique for imaging sub-solid lung nodules. 3) Be familiar with current Fleischner Society guidelines for the management of patients with sub-solid lung noduleslearning 

objectives. 

VSCH31-10 • Optimization of Volume-Doubling Time Cutoff for Fast-growing Lung Nodules in CT Lung Cancer Screening Improves Accuracy of Lung Cancer Diagnosis 

Marjolein Anne Heuvelmans , BSC , Groningen, Groningen, NETHERLANDS , Matthys Oudkerk , MD, PhD , Groningen, Netherlands , Geertruida H. De Bock , Groningen, 

Netherlands , Harry de Koning , Rotterdam, Netherlands , Xue-Qian Xie , MD , Groningen, Groningen, NETHERLANDS , Peter M.A. van Ooijen , Groningen, NETHERLANDS , 

Marcel Greuter , PhD , Groningen, Groningen, NETHERLANDS , Pim A. De Jong , MD, PhD , Utrecht, Netherlands , Harry Groen , Groningen, NETHERLANDS , Rozemarijn 

Vliegenthart , MD, PhD , Groningen, NETHERLANDS 

PURPOSE 

To reduce false-positive findings in low-dose computed tomography (CT) lung cancer screening by determining optimal volume-doubling time (VDT) cutoff values for differentiating 

benign from malignant fast-growing pulmonary nodules. 


All subjects were participants of the Dutch-Belgian lung cancer screening trial (NELSON). All subjects underwent at least two low-dose CT examinations during the first and second 

screening round of the NELSON study (April 2004 - March 2008), and were referred to a pulmonologist because of a fast-growing nodule with VDT < 400 days. Histology was used 

as a reference standard for diagnosis, or, to confirm benignity, stability of size on repeated CTs. Nodule volume and VDT were semi-automatically generated with a software 

programme. Receiver operating characteristic curve analysis was performed to determine the optimal VDT cutoff for differentiating benign and malignant nodules. 

RESULTS 

In total, 102 fast-growing nodules were included (84 individuals), of which 38 (37%) were confirmed to be malignant (38 individuals). Mean follow-up of non-resected benign 

nodules (n = 52) was 4.1 years (range 2.1-5.7 years). The optimal VDT cutoff for the 3-month follow-up in round 1 was 210 days. This cut-off reduced false-positive referrals by 

37% compared to the current VDT cutoff of 400 days (22 versus 35 false-positive referrals). Positive predictive value increased by 53%, from 17 to 26%. Sensitivity for lung cancer 

diagnosis was 91% (10/11 malignant nodules with VDT < 400 days). The remaining malignant nodule would have necessitated referral to the pulmonologist based on large size. 

For the regular CT in year 2, the VDTs varied more among malignant nodules, precluding lowering of the VDT cutoff of 400 days. 

CONCLUSION 

Lowering the VDT cutoff from 400 to 210 days on the 3-month follow-up CT in a baseline lung cancer screening round considerably reduced false-positive referrals while 

maintaining sensitivity for lung cancer diagnosis. 


False positive results in fast-growing nodules in a lung cancer screening trial can be considerably reduced by an optimized VDT cutoff, with maintained sensitivity. 

VSCH31-11 • Lung Cancer Screening: Update 2012 

Caroline Chiles , MD , Winston Salem, NC 


1) Review current guidelines for lung cancer screening. 2) Discuss recent contributions from international lung cancer screening trials. 

VSCH31-12 • PET/MR in Non-small Cell Lung Cancer: Initial Experience 

Ivan Platzek , MD , Dresden, Saxony, GERMANY , Axel Rolle , MD , Coswig, Saxony, Germany , Bettina Beuthien-Baumann , MD , Dresden, Saxony, GERMANY , Jens 

Langner , PhD , Dresden, Saxony, GERMANY , Hesham Al-Qady , MD , Coswig, Saxony, Germany , Silke Braun , MD , Dresden, Germany , Gert Hoffken , MD , Dresden, 

Saxony, GERMANY , Michael Laniado , MD , Dresden, Saxony, GERMANY , Jorg Kotzerke , MD , Dresden, Saxony, GERMANY , Jorg van den Hoff , PhD , Dresden, Saxony, 

GERMANY 

PURPOSE 

Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG), mostly performed in combination with computed tomography (CT) as PET/CT, plays a fundamental role 

in the staging of non-small lung cancer (NSCLC). The aim of this pilot study was to evaluate the feasibility of PET combined with magnetic resonance imaging (PET/MR) for initial 

staging of NSCLC. 


Ten patients with NSCLC underwent contrast enhanced CT and PET/MR for staging. Average time between the CT and PET/MR was 19 d (1-35 d). PET/MR was performed on a 

Philips Ingenuity TF PET/MR system. 4.5 MBq 18F-FDG /kg body weight were administered intravenously (275-317 MBq 18F-FDG /patient, mean 296 MBq). Average time between 

tracer injection and start of the PET scan was 77 min (54-122 min). The PET scan extended from the base of the scull to the upper leg, diagnostic MR was restricted to the thorax. 

Total examination time was 55 min. PET/MR was evaluated by a radiologist and a nuclear medicine physician in consensus, and CT by two radiologists in consensus. The readers 

were blinded for the CT or PET/MR results, respectively. Nine patients received surgical treatment, while one patient received primary radiotherapy after video assisted 

mediastinoscopic with lymph node biopsy. revealed squamous cell carcinomain six patients and adenocarcinoma in four patients. Four patients had lymph node metastases (10 out 

of 158 resected lymph nodes). 

RESULTS 

T stage was correctly determined with both PET/MR and CT in all patients. N staging was correct in 7 of 10 patients with both methods (n=5 N0, n=2 N1). Two patients with N1 

disease were rated as N0 by both PET/MR and CT (five false negative lymph nodes). One patient with no metastatic disease was classified as N1 by CT (two false positive lymph 

nodes) and as N0 by PET/MR. There were no false positive lymph nodes with PET/MR. 

CONCLUSION 

PET/MR seems to be at least equal to CT for N-staging of NSCLC. Additional data are necessary to determine the sensitivity and specificity of PET/MR for lymph node metastases 

and distant metastases of NSCLC, especially in comparison to PET/CT. 


A staging examination for non-small cell lung cancer (NSCLC) can be performed with a hybrid PET/MR system within a resonable timeframe and with promising results regarding T- 

and N-staging. 

VSCH31-13 • Lung Cancer Staging System: Concepts and Controversies 

Jeremy J. Erasmus , MD , Houston, TX 


After participation the learner will 1) Be able to apply the current seventh edition of the International Association for the Study of Lung Cancer (IASLC) TNM staging system. 2) Be 

conversant with how the changes in the seventh edition of IASLC staging system affect patient management. 3) Understand the limitations of the IASLC staging system in the 

imaging evaluation and management of patients with non-small cell lung cancer. 


Accurate staging of NSCLC is essential in determining appropriate management. The TNM-7 staging system replaced TNM-6 in 2009. The T descriptor changes are: 1) subclassify 

T1 as T1a (2 cm to 3 cm to 5 cm to 7 cm as T3; 4) reclassify T4 tumors 

by additional nodule(s) in the lung (primary lobe) as T3; 5) reclassify M1 by additional nodule(s) in the ipsilateral lung (different lobe) as T4; and 6) reclassify pleural 

dissemination (malignant pleural effusions, pleural nodules) as M1. The presence and location of nodal metastases are important in determining resectability and prognosis. The N 

descriptors are unchanged as there are no significant survival differences in analysis by station. However, nodal stations will be grouped in 6 zones within the current N1 and N2 

subsets for further evaluation. M descriptor are to subdivide M1 into M1a (malignant pleural or pericardial effusion, malignant pleural nodule, nodule in contralateral lung) and M1b 

(distant metastasis). The current TNM-7 has TNM and stage groupings that more accurately reflect the survival and prognosis of patients with NSCLC than TNM-6. However, 

limitations persist including the difficultly in accurately measuring irregular lesions to determine the appropriate T descriptor and maintenance from TNM-6 of non-size-based T 

descriptors, such as atelectasis, that may not have independent prognostic significance. Also, TNM-7 fails to differentiate a metastasis from a synchronous primary malignancy and 

single from multiple satellite contralateral nodules (M1a) i.e. patients with a single M1a satellite nodule and no nodal metastasis have similar survival to those with a satellite

nodule in the primary (T3) or non-primary (T4) lobes after resection. An important modification would be to also incorporate the biological behavior of the tumor into staging 

(although the ability to determine this is currently rudimentary. 

VSCH31-14 • Angiogenesis in Non-small Cell Lung Cancer: Early Assessment of Therapeutic Response to Antiangiogenic Chemotherapy with Perfusion 

Multidetector-Row CT (MDCT) 

Nunzia Tacelli , MD , Lille, FRANCE , Teresa Santangelo , Lille, North, France , Arnaud Scherpereel , MD, PhD , Lille, FRANCE , Francois Pontana , MD , Lille, France , 

Jacques Remy , MD * , Mouvaux, Nord, France , Martine J. Remy-Jardin , MD, PhD * , Lille, FRANCE 

PURPOSE 

To evaluate changes in lung tumour perfusion before and after antiangiogenic chemotherapy and to determine whether perfusion changes could help predict therapeutic response. 


40 consecutive patients with non-small cell lung carcinoma, treated by chemotherapy (platinum-based and third generation drugs) alone (Group 1; n=23) or combined with 

bevacizumab (Group 2; n=17) underwent quantitative CT perfusion examinations with 64-slice MDCT before (T0: n=40) and after 1 (T1; n=40), 3 (T2; n=34) and 6 (T3; n=26) 

cycles of chemotherapy with a planned interval of 3 weeks between each cycle. The CT parameters evaluated included: (a) tumour blood volume (BV) and capillary permeability 

(CP) indexed to tumour volume; (b) RECIST measurements. Tumour response was also assessed on the basis of clinician’s overall evaluation. 

RESULTS 

At T0, no statistically significant difference was observed in the median values of BV (p=0.7844) and CP (p=0.8696) between Group 1 and Group 2. In Group 1, no significant 

changes were observed in the median values of BV and CP over time. In Group 2, a significant reduction in the median values of the BV and CP was observed between (a) T0 and 

T1 (BV: p=0.0395; CP: p=0.0150); (b) T1 and T2 (BV: p=0.0554; CP: p=0.0043); (c) while they did not change between T2 and T3 (BV: p=0.9097; CP: p=0.9097). In Group 2, 

the median values of BV at T1 were significantly reduced in patients classified as having partial response at T2 compared with patients classified as having stable or progressive 

disease at T2 on the basis of RECIST (p=0.0120) and clinical criteria (p=0.0079). 

CONCLUSION 

Perfusion CT demonstrates early changes in tumour vascularity in patients treated by conventional chemotherapy combined to antiangiogenic treatment that can help predict 

therapeutic response. 


Perfusion CT performed a short interval after antiangiogenic chemotherapy initiation allows earlier detection of chemotherapeutic effects than RECIST criteria and can predict 

therapeutic response. 

VSCH31-15 • Molecular Imaging of Lung Cancer 

King C. Li , MD , Winston Salem, NC 


After participation in this session the participant should be able to: 1) Identify the most promising molecular imaging advances for diagnosis and treatment of lung cancer. 2) 

Identify the limitations and potential solultions for translating these novel approaches to the clinic. 

VSCH31-16 • Panel Discussion 

Pediatric Radiology Series: Chest/Cardiovascular Imaging I 

Tuesday • 08:30 - 12:00 PM • S102AB 

CA CH VI PD 


Course No. VSPD31 


R. Paul Guillerman , MD , Moderator , Houston, TX , 

Cynthia Karfias Rigsby , MD , Moderator , Chicago, IL 

Page 56 of 97 

VSPD31-01 • State of the Art MRI and MRI of Congenital Heart Disease 

Frandics Pak Chan , MD, PhD , Stanford, CA 


1) To review the MRI environment and anethesia requirements for pediatric patients with congenital heart disease. 2) To understand what MRI can do that echocardiography or 

catheter angiography cannot, and how this is used to advantage in congenital heart disease. 3) To explore advanced techniques, such as four-dimensional phase contrast imaging, 

real-time imaging, and non-contrast coronary angiography, that can expedite and increase the capability of cardiac MRI studies. 


Cardiac MRI is an established imaging tool for the assessment of congenital heart disease in children and adults. The lack of oncogenic radiation makes MRI the preferred tool over 

CT. However, in young patients who require general anesthesia, the imager should be familiar with the risks involved. While usually safe, general anesthesia has heightened risk 

in patients with aortic obstruction, pulmonary hypertension, arrhythmia, and ventricular failure. In current clinical practice, the three-dimensional capability of cardiac MRI is used 

to accurately assess ventricular volume and function. Flow measurement by two-dimensional phase contrast is used to assess shunt ratio, cardiac output, and valvular 

regurgitation. Comprehensive cardiac MRI examination for a patient with complex congenital heart disease can be time-consuming, and it requires an MRI operator with 

considerable skill and knowledge of cardiac anatomy. Four-dimensional phase contrast imaging capture a volume of the cardiac anatomy and flow physiology, which can be 

analyzed by post-processing, thereby simplifying the scan protocol and shortening the study time. Other advanced MRI techniques include real-time and pseudo-gated imaging for 

fetal studies, delayed-enhancement of myocardium for endocardial fibroelastosis, and MR coronary angiography for coronary anomalies. 

VSPD31-02 • Antenatal Cardiovascular MRI Using a New Method to Trigger the Fetal Heart: Imaging of the Fetal Heart and Flow Measurements of the Fetal Aorta 

Bjoern Schoennagel , MD , Hamburg, GERMANY , Chressen Catharina Much , Hamburg, Hamburg, GERMANY , Hendrick Kooijmann , PhD * , Hamburg, Germany , Gerhard 

B. Adam , MD , Hamburg, GERMANY , Jin Yamamura , MD , Hamburg, Germany , Ulrike Wedegaertner , MD , Hamburg, Hamburg, GERMANY 

PURPOSE 

To perform fetal cardiac magnetic resonance imaging (MRI) and blood flow measurements of the fetal aorta using a newly developed MR compatible Doppler-Ultrasound (DUS) 

device for triggering of the fetal heart in utero in a sheep model. 


Four pregnant sheep carrying singleton fetuses (123 days gestational age) were anesthetized to undergo fetal MRI examination on a 1.5 T imager. The Doppler-Ultrasound sensor 

was placed on the abdomen of the ewe, above the fetal heart and fixed with a belt. The recorded signal of the fetal heart was transferred to the ECG trigger unit of the MR 

scanner and used for cardiac triggering. For fetal cardiac MRI triggered cine series (25 phases) from short axis-, 2- and 4- chamber views were acquired to determine LV function. 

Additionally, blood flow velocity measurements of the fetal aorta were performed. Mean values and peak velocities were calculated. 

RESULTS 

Triggering of the fetal heart rate was possible in all examinations. Using the trigger signal excellent MR images of the fetal heart and high quality flow measurements of the fetal 

aorta were obtained. The mean left ventricular ejection fraction (LVEF) was 41.1% (± 3.6). Blood flow velocity measurements in the fetal aorta descendens revealed very good 

results with a mean peak flow velocity of 60cm/s (± 3.4). 

CONCLUSION 

Fetal cardiac MRI and blood flow measurements were successfully performed using a newly developed DUS device for fetal cardiac triggering in a sheep model. Excellent image 

quality allowed the evaluation of cardiac anatomy, LV volumetry and even determination of blood flow velocity of the fetal aorta. 


The newly developed Doppler-Ultrasound device for triggering fetal cardiac MRI and blood flow measurements might enable intrauterine evaluation of complex congenital heart 

failure and cardiac function 

VSPD31-03 • Antenatal Cardiovascular MRI Using a New Method to Trigger the Fetal Heart: Blood Flow Measurements of the Fetal Aorta and Comparison to Ultrasound 

Bjoern Schoennagel , MD , Hamburg, GERMANY , Chressen Catharina Much , Hamburg, Hamburg, GERMANY , Hendrick Kooijmann , PhD * , Hamburg, Germany , Gerhard 

B. Adam , MD , Hamburg, GERMANY , Ulrike Wedegaertner , MD , Hamburg, Hamburg, GERMANY , Jin Yamamura , MD , Hamburg, Germany 

PURPOSE 

To assess blood flow measurements of the fetal aorta perfoming cardiac MRI using a newly developed MR compatible Doppler-Ultrasound device for triggering of the fetal heart in 

utero and to compare them with ultrasound studies in a sheep model. 


Four pregnant sheep carrying singleton fetuses (123 days gestational age) underwent ultrasound examination for determination of blood flow velocity in the fetal aorta descendens. 

The ewes were then anesthetized to undergo fetal MRI examination on a 1.5 T imager. A newly developed MR-compatible Doppler-Ultrasound sensor was placed on the abdomen 

of the ewe, above the fetal heart and fixed with a belt. The recorded signal of the fetal heart was transferred to the ECG trigger unit of the MR scanner and used for cardiac 

triggering. Blood flow velocity measurements of the fetal aorta descendens were performed and compared to ultrasound measurements. Mean values and peak velocities were 

calculated. 

RESULTS 

Triggering of the fetal heart rate was possible in all examinations. Using the trigger signal excellent MR images of the fetal heart and high quality flow measurements of the fetal 

aorta were obtained. Comparison of both methods revealed no significant differences with mean peak flow velocities of 60cm/s (±3.4) and 62 cm/s (±9.2). 

CONCLUSION 

Blood flow measurements of the fetal aorta were successfully performed using the newly developed MR-compatible Doppler-Ultrasound device for fetal cardiac triggering in a sheep 

model, revealing no significant differences compared to fetal ultrasound examinations. 


The newly developed Doppler-Ultrasound device for triggering fetal cardiovascular MRI enables precise intrauterine fetal blood flow measurements and might be an alternative to 

fetal ultrasound. 

VSPD31-04 • 4D MRI for Postoperative Evaluation of Hemodynamics in Patients with Transposition of the Great Arteries (D-TGA) 

Julia Geiger , MD , Freiburg, Baden-Wuerttemberg, GERMANY , Daniel Hirtler , Freiburg, Baden-Wuerttemberg, GERMANY , Raoul Arnold , MD , Heidelberg, Germany , Bernd 

Jung , Freiburg, Baden-Wuerttemberg, GERMANY , Brigitte Stiller , Freiburg, Baden-Wuerttemberg, GERMANY , Mathias F. J. Langer , MD, PhD , Freiburg, 

Baden-Wrttemberg, GERMANY , Michael Markl , PhD , Freiburg, BW, Germany

Page 57 of 97 

PURPOSE 

To investigate aortic and pulmonary 3D hemodynamics in children after arterial switch procedure for transposition of the great arteries (D-TGA) related to differences in 

post-interventional anatomy. 


4D MRI with 3-directional velocity encoding (TE=2.4ms, TR=38ms, venc 200cm/s, spatial resolution~2.5mm³) was performed in 17 patients after repair of TGA and in 12 

volunteers (age=12±5.4 vs. 23±1.6 years). Patients were divided into two groups according to the position of the pulmonary trunk (TP) in relation to the ascending aorta (AAo): 

anterior (n=10) and right anterior (n=7). Aortic and pulmonary blood flow was visualized by time-resolved 3D particle traces emitted from planes at the level of the valves. 

Analysis included visual grading (ranking 0-2) of flow disturbances (vortices, helices) and increased pulmonary flow velocity (v>1.5m/s). Blood flow distribution to the right and 

left pulmonary artery (flow ratio RPA:LPA) and flow velocity was quantified at the valves and in the RPA and LPA. 

RESULTS 

Increased vortex flow was detected in the TP in patients with anterior TP position (7/10, grade 1.6) compared with the patients with right anterior TP position and volunteers (no 

vortex flow). Increased helix flow was seen in the LPA of both patient groups (9/17, grade 1.3) while helix flow was less frequent in the RPA and TP (4/17, 3/17). All patients had 

an enlarged aortic sinus normalized to BSA (diameter = 29mm±5mm), 11 presented local increased helices in the AAo not encompassing the complete lumen (grade 1.5). All 

volunteers had physiological right-handed helices in the AAo. Systolic peak velocity in the TP was significantly higher in patients (1.74m/s±0.63m/s) than in volunteers 

(0.95m/s±0.12m/s), in the RPA 2.04m/s±0.43m/s vs. 0.98m/s±0.14m/s, in the LPA 1.78m/s±0.54m/s vs. 0.89m/s±0.13m/s. The flow ratio RPA:LPA was more heterogenous in 

patients with a predominant flow to the RPA (flow ratio RPA:LPA = 1.56±0.78). 

CONCLUSION 

4D MRI facilitates a comprehensive evaluation of flow alterations in TGA-patients after switch repair. Increased vortex flow for the anterior TP position, frequent helices in the LPA, 

increased flow velocity and asymmetric pulmonary flow were the main findings. 


Flow-sensitive 4D MRI enables visualization and quantification of postsurgical hemodynamic alterations in the pulmonary arteries and aorta of TGA-patients and may help to 

optimize surgical strategies. 

VSPD31-05 • Development of a New Technique for First-Pass Pulmonary Perfusion (FPP) in Children, and Its Application for Assessment of Differential Pulmonary 

Blood Flow (d-PBF) and Regional Perfusion in Repaired Tetralogy of Fallot (TOF) 

Rajesh Krishnamurthy , MD * , Houston, TX , Serife Kavuk , MD , Houston, TX , David Chu , PhD , Houston, TX , Shiraz Maskatia , MD , Houston, TX , Prakash Mohan 

Masand , MD , Houston, TX , George S. Bisset III , MD , Houston, TX , Shaine Morris , Houston, TX 

PURPOSE 

Assessment of branch pulmonary artery (BPA) morphology using contrast enhanced MRA (CEMRA) and d-PBF using phase contrast imaging (PCI) is an important part of the 

routine MR protocol for repaired TOF. The accuracy of PCI for d-PBF is diminished in the setting of flow turbulence related to stenosis and regurgitation, or due to stents and coils. A 

FPP technique that can directly assess blood flow and regional perfusion at the parenchymal level will avoid the pitfalls, and is therefore desirable. 


A FPP tchnique was developed with the following parameters: CEMRA sequence with 2 x 2 parallel imaging factor, 20% keyhole window, 3D coverage of lungs at 1.5-2 mm 

resolution, half-dose Gd, age-based power injection protocol, and temporal resolution of 0.8-1.5s to obtain 20-30 time points over 20 seconds. 14 patients with repaired TOF were 

studied, 9 with BPA stenosis, and 5 without BPA stenosis. PCI of the BPA was performed in all patients to assess d-PBF. FPP was followed by a high resolution diagnostic CEMRA 

using 1.5-dose Gd for morphologic assessment. FPP analysis comprised of qualitative and quantitative assessment of global and regional perfusion of the lungs, including whole 

lung and regional perfusion, differential PBF, Time to peak enhancement (TTP) and Mean transit time (MTT) (see figure). 

RESULTS 

12/14 FPP studies were diagnostic. 2/14 FPP studies were not quantifiable due to artifacts. 5/14 patients had artifacts related to stents, and 9/14 had moderate to severe 

regurgitation, with variable detrimental effect on PCI and CEMRA evaluation, but not on FPP analysis. 7/9 patients with BPA stenosis had concordant findings on FPP and CEMRA. 

In 2 patients, peripheral BPA stenosis was diagnosed by FPP, but not by CEMRA. Variable prolongation of TTP and MTT was noted in the setting of BPA stenosis, and may provide 

a means of estimating stenosis severity. Quantitative comparisons of FPP versus PCI and CEMRA data are pending. 

CONCLUSION 

Preliminary results of a new technique for pediatric FPP are described, offering improved sensitivity for peripheral BPA stenosis compared to CEMRA, and an alternative means of 

assessment of d-PBF and regional perfusion when PCI and CEMRA data are unavailable or erroneous. 


A new technique for assessment of differential pulmonary blood flow and regional lung perfusion in children which overcomes current limitations of CEMRA and phase contrast 

imaging 

VSPD31-06 • Familial Arrhythmogenic Right Ventricular Dysplasia (ARVD): MRI Retrospective Study in Children 

Patricia Diez Martinez , MD , Montreal, QC, Canada , Chantale Lapierre , MD , Montreal, QC, CANADA , Anne Fournier , MD , Montreal, QC, Canada , Julie Déry , MD 

, Montreal, QC, CANADA 

PURPOSE 

To evaluate cardiac MRI findings of familial arrhythmogenic right ventricular dysplasie (ARVD) in a pediatric population. To correlate MR data with other 2010 ARVD task force 

criteria. 


Retrospective study (January 2001 to March 2012), 68 MR in 37 children from 22 families with proven first degree relative with ARVD. Age range from 1 mo. to 19 yo. MRI criteria: 

quantitative function and volume of right and left ventricles, regional right ventricle (RV) akinesia or dyskinesia, dyssynchronous RV contraction and RV fatty infiltration. Ventricular 

involvement classified as: inlet, outlet or apex localization. 

RESULTS 

MRI examinations were: normal in 54, abnormal in 14. The 14 abnormal cardiac contractility included: dyskinesia n=8, akinesia n=6, with only one patient with RV dilatation. 

Abnormal contractility was noted in the RV free wall: apex (n=10), inlet (n=2), outlet (n=2). There was no RV fatty infiltration, no LV anomaly. Mean age of the positive cases was 

15.6 yo. Only 3 patients were symptomatic (cardiac arrest, syncope, ventricular tachycardia). The other 2010 ARVD task force criteria were lacking. Following the study, 5 patients 

had an implantable defibrillator. 

CONCLUSION 

According to the 2010 ARVD task force, isolated RV wall contractility abnormalities in addition to familial context lead to a diagnosis of ARVD. In our small series, contractility 

abnormalities precede global dilatation and alteration of function. There is no obvious recommendation regarding MR follow-up in these patients. Because most positive patients 

were adolescents, focused cardiac MR seems optimal at that age. Larger cohorts are needed to confirm our results. 


Regional RV free wall dyskinesia/akinesia adjacent to the apex is the first manifestation of familial ARVD and becomes conspicuous in adolescence. 

VSPD31-07 • Imaging of Adolescents and Young Adults with Congenital Heart Disease 

Lorna Browne , MD, FRCR , Houston, TX 


1) Describe the relevant complex cardiac anatomy encountered in CHD adolescents and young adults, many of whom have undergone prior surgical repairs. 2) Describe the most 

likely lesions encountered in CHD adolescents and young adults. 3) Discuss some common surgical repairs and encountered complications. 4) Determine appropriate MR protocols 

for evaluating congenital heart disease according to the anatomic, pathologic, and hemodynamic characteristics of the defect and type of previous surgical repair. 5) Discuss the 

main clinical questions that are specifically posed in individual cases of pre and post operative CHD in adolescents and young adults. 

Active Handout 

http://media.rsna.org/media/abstract/2012/12021285/kxqp871_12021285_VSPD31-07_Browne_cp.pdf 

VSPD31-08 • Coronary Artery Imaging in Children 

Cynthia Karfias Rigsby , MD , Chicago, IL 


1) To provide an overview of the imaging modalities used to image coronary arteries in children. 2) To show examples of anomalies of coronary artery origin, course, and 

termination. 3) To illustrate coronary artery anomalies associated with congenital heart disease. 4) To demonstrate coronary artery findings in Kawasaki disease. 


Coronary artery anomalies can be classified as anomalies of origin and course, anomalies of coronary termination, coronary anatomy with congenital heart disease and acquired 

coronary abnormalities. Normal coronary artery anatomy and an imaging focused discussion of each of the different type of coronary abnormalities will be presented. 

VSPD31-09 • Comparison of Three Coronary Imaging Techniques in Children 

Cynthia Karfias Rigsby , MD , Chicago, IL , Andrada Roxana Popescu , MD , Chicago, IL , Emma Boylan , BA , Chicago, IL , Xiaoming Bi , PhD * , Chicago, IL , R. Andrew 

DeFreitas , Chicago, IL 

PURPOSE 

To compare coronary artery visualization using three different coronary imaging techniques in an age-matched pediatric population. 


This retrospective study is IRB approved and HIPAA compliant. A database search was undertaken of all patients who underwent coronary imaging with MR T2 prepared 

steady-state free precession imaging following extracellular contrast injection (SSFP) or using MR inversion recovery with fast low-angle shot following injection of a blood-pool 

contrast agent (IR FLASH) or with ECG gated coronary CTA with injection of iodinated contrast (CTA). Age-matched patients in four groups (0-1 year, 1-5 years, 5-10 years, and 

>10 years) with each group having 3 SSFP, 3 IR FLASH, and 3 CTA studies were chosen for independent image review by two pediatric radiologists and one pediatric and adult 

cardiologist. Coronary assessment was graded on a scale of 1 (cannot visualize coronary origins), 2 (right (RCA) and left (LMCA) origins well visualized), 3 (RCA and LMCA origins, 

proximal RCA and LAD well seen), 4 (RCA well seen distally, marginals not seen or motion degraded; LMCA, LAD, LCx well visualized, diagonals not seen or motion-degraded), and 

5 (RCA and LMCA and branches well visualized including marginals and diagonals). 

RESULTS 

36 coronary imaging studies were reviewed, 9 studies in each age category. Average coronary assessment scores over all age groups were 2.86 (SSFP), 3.08 (IR FLASH) and 4.53 

(CTA). The lowest average scores were in the 0-1 year age group, 1.56 (SSFP), 2.78 (IR FLASH), and 3.78 (CTA) with coronary origins visualized in all patients with IR FLASH and 

CTA but not all with SSFP. The highest average scores were in the >10 year age group, 3.33 (SSFP), 3.78 (IR FLASH), and 5 (CTA). CTA image quality scores were significantly

Page 58 of 97 

better than SSFP (p=0.001) and IR FLASH (p=0.001). 

CONCLUSION 

Relative to SSFP, IR FLASH improves visualization of coronary origins in infants. CTA image quality exceeded both coronary MR imaging techniques. 


Coronary origins and proximal coronary arteries are often the main indication for coronary imaging in children, use of IR FLASH offers the best coronary imaging quality without 

penalty in radiation. 

VSPD31-10 • Two-years Follow-up by Cardiac Magnetic Resonance (CMR) After Percutaneous Pulmonary Valve Implantation (PPVI) 

Francesco Secchi , MD , Milano, MI, ITALY , Elda Chiara Resta , Milano, MI, ITALY , Marcello Petrini , Milano, MI, ITALY , Veronica Gaia Nardella , BMEDSC , Milano, MI, 

ITALY , Mario Carminati , MD , San Donato Milanese, Italy , Francesco Sardanelli , MD * , San Donato Milanese, Milan, ITALY 

PURPOSE 

To evaluate the diagnostic value of CMR before and after percutaneous pulmonary valve (Melody, Medtronic) implantation. 


After IRB approval and informed consent, patients with congenital heart diseases and pulmonary conduit dysfunction were prospectively scheduled for 1.5-T CMR before and after 

1, 3, 6, 12 and 24 months from PPVI. We used a cine true-FISP sequence (TR/TE=45/1.5 ms, thickness 8 mm) to study the right (RV) and left ventricle (LV) function and a 

turbo-FLASH phase-velocity mapping sequence (41/3.2 ms, 5 mm, respectively; velocity encoding from 150 to 300 ms) to evaluate pulmonary flow. Pressure gradient (PG) was 

estimated from peak flow velocity using Bernoulli's equation. Wilcoxon test was used. 

RESULTS 

From January 2008 to March 2012, we enrolled 33 patients (21±8 years old), all of them studied within one week before valve implantation and 21 of them studied after two 

years from PPVI. End-diastolic volume index (EDVI), end-systolic volume index (ESVI), and ejection fraction (EF) of the RV before PPVI were 82±38 mL/m², 44±12 mL/m², and 

49±13%, the same data after two years were 64±21 mL/m² (P=.011), 29±14 mL/m² (P=.001) and 55±12% (P=.044), respectively. EDVI, ESVI, and EF of LV before valve 

implantation were 67±17 mL/m², 31±13 mL/m² and 56±9 %, the same data after PPVI were 75±25 mL/m² (P=.092), 31±13 mL/m² (P=.304) and 57±9% (P=.204), respectively. 

Before PPVI pulmonary regurgitation fraction (RF) and PG were 16±17 % and 32±16 mmHg, respectively. RF and PG after PPVI were 0.3±1 % (P=.007) and 14±11 mmHg 

(P3 yrs old respectively.Image noise, signal-to-noise ratio(SNR), contrast-to-noise ratio(CNR), CT value in superior vena cava, the right atrium, 

right ventricle, the main pulmonary artery, left atrium, left ventricle, ascending and the descending aorta in the two groups were compared with the Student t test and Mann-Whitney U. 

RESULTS 

The difference of Image noise, signal- to-noise ratio (SNR), contrast-to-noise ratio (CNR) in superior vena cava, the right atrium, right ventricle in the two groups was statistical 

significance(all of the P values were

1) Become familiar with new classifications systems for pediatric diffuse lung disease. 2) Recognize specific forms of pediatric lung disease based on characteristic imaging 

features. 3) Learn the appropriate roles and efficacy of CT in the diagnosis and management of pediatric diffuse lung disease. 


Pediatric diffuse lung disease encompasses a heterogeneous group of rare disorders characterized by impaired gas exchange and widespread pathology of the pulmonary 

interstitium, airspaces or airways. Several forms of pediatric diffuse lung disease exhibit distinct clinical, pathologic, and radiologic patterns not observed in adults due to 

the differences in injury and repair processes in the immature lung and the influence of the stage of lung growth and development on disease manifestations. In response to these 

unique considerations in children, a novel classification of pediatric diffuse lung disease has been developed by the Children’s Interstitial Lung Disease (ChILD) Research 

Cooperative. The correlative radiologic findings for specific forms of pediatric diffuse lung disease have been defined by recent studies, but the role of imaging in guiding disease 

management after diagnosis is less established. The imaging findings can be diagnostic for some disorders, while in other disorders the imaging findings are nonspecific and lung 

biopsy or genetic testing is needed for diagnosis. 

Chest (Diffuse Lung Disease) 

Tuesday • 10:30 - 12:00 PM • S405AB 


PRESIDING: 

Katherine Rachel Birchard , MD , Chapel Hill, NC 

David Augustine Lynch , MD * , Denver, CO 

Computer Code: SSG05 • AMA PRA Category 1 Credits: 1.5 • ARRT Category A+ Credit: 1.5 



SSG05-01 • 10:30 AM 

Oxygen-enhanced MRI in Patients with Connective Tissue Diseases: Capability for Pulmonary Functional and Disease Severity Assessments as Compared with Thin-Section 

CT 

Yoshiharu Ohno MD, PhD * , Kobe, Hyogo, JAPAN • Mizuho Nishio MD • Hisanobu Koyama MD • Takeshi Yoshikawa MD * • Sumiaki Matsumoto MD, PhD * • Shinichiro Seki • 

Masaru Yoshii RT • Kazuro Sugimura MD, PhD * 

PURPOSE 

To prospectively and directly o compare capability of O2-enhanced MRI for assessment of pulmonary function and disease severity in patients with connective tissue diseases (CTDs). 


Nine consecutive normal volunteers (five men and three women) and 36 consecutive CTD patients (23 men and 13 women) underwent thin-section MDCT, O2-enhanced MRI, 

pulmonary function test and serum KL-6. All O2-enhanced MRIs were performed on three 1.5 T MR scanners, and all thin-section CTs were obtained on three 64-detector row and a 

320-detector row scanners. From signal intensity-time course curve of O2-enhanced MR data, relative-enhancement ratio (RER) map was generated. Then, mean RER in each subject 

was determined from ROI measurements. From each thin-section MDCT data, CT-based disease severity was evaluated with a visual scoring system. Then, mean RER and CT-based 

disease severity were statistically compared between normal and CTD subjects by using Student’s t-test. To assess capability for pulmonary functional loss and disease severity 

assessments in CTD patients, mean RERs and CT-based disease severity were statistically correlated with pulmonary functional parameters and serum KL-6. In addition, mean RER was 

statistically correlated with CT-based disease severity in CTD patients. 

RESULTS 

Mean RER and CT-based disease severity had significant difference between normal and CTD subjects (p

RESULTS 

Sixteen patients (48.5%) were peripartum women and 8 patients (24.2%) had children of the same illness due to common exposure. The onset was around the end of the winter, 

February to March, in most cases (n=24, 72.7%). Three patients (9.1%) underwent lung transplantation and 6 patients (18.2%) died of end-stage lung fibrosis. The predominant 

imaging feature was diffuse centrilobular nodules involving both lungs (n=33; mean extent, 75.3%), which were correlated with necrotizing bronchiolitis with peribronchiolar fibrosis on 

patients’ pathology. In Group I patients, diffuse ground glass opacity (n=5; 41.2%) and pneumomediastinum (n=6; 50%) often appeared on follow up, compared to Group II patients 

(n=2; 7.1% and n=1; 5.1%) (p=0.0001 for both). 

CONCLUSION 

Here we report a case series of 33 patients with progressive lung fibrosis leading to severe illness or death associated with inhalation of humidifier disinfectants. Interpretation of the 

airway-centered pathophysiology from the charateristic imaging features gave a crucial role in diagnosis and management of these critically-ill patients of unknown inhalation injury. 


Radiological assement of pathophysiology in correlation with clinical findings plays a pivotal role in management and prediction of clinical outcome in patients of unknown inhalation 

lung injury. 

SSG05-05 • 11:10 AM 

Multicenter Study of Computer-aided Quantitative Analysis of Pulmonary Fibrosis Using 3D-CT Obtained by Different CT Scanners 

Tae Iwasawa MD, PhD , Yokohama, Kanagawa, JAPAN • Tetsu Kanauchi MD • Toshiko Hoshi MD • Takashi Ogura MD • Toshiyuki Gotoh PhD • Mari Saito PhD 

PURPOSE 

Direct comparison of manual scoring of pulmonary fibrosis by radiologists and by computer-aided three-dimensional quantitative analysis of CT images obtained by different scanners. 


The subjects of this multi-center prospective study were 74 patients with idiopathic pulmonary fibrosis (IPF/UIP) (mean age 70.6 years, mean vital capacity: 76.6 (%pred)). The CT 

images were obtained with four different scanners at different exposure setting (each used routinely at each hospital); GE 16-row multiple-row detector CT (MDCT) (120 kVp and 

variable mAs less than 220mAs using automatic exposure control (AEC), 20 patients), Philips 256-row MDCT (120kVp, low-dose scan with iterative reconstruction, 14 patients), Toshiba 

16-row MDCT (120 kVp and fixed 250 mAs, 20 patients) and Toshiba 64-row MDCT (120 kVp and variable mAs less than 250 mAs using AEC, 20 patients). The computer-aided system 

classified the lung on the CT images into normal, ground-glass opacities, consolidation, emphysema and fibrosis (F) patterns, pixel by pixel. We calculated ratio of each lesion to the 

total lung on CT image. The radiologists separately measured the ratios of these patterns on both lungs using 4 slices per patient, and the average of 8 areas represented the extent of 

each pattern per patient. We compared the computer-generated ratios with those estimated by the radiologists. The study protocol was approved by the internal review board of each 

institution, and written informed consent was waived. 

RESULTS 

The ratio of each pattern measured by the software correlated significantly with those estimated by the radiologists on 592 areas and on 74 patients (p

PURPOSE 

The aim of this study was to evaluate the appearances on high-resolution CT (HRCT) and the correlation with pathological diagnosis and the mortality in the cases with nonspecific 

interstitial pneumonia (NSIP) comparing to those with usual interstitial pneumonia (UIP). 


The study included 114 patients with idiopathic NSIP (n=39) and UIP (n=75) diagnosed by both clinical and pathological diagnosis. Two independent observer groups respectively 

evaluated the extent and the distribution of various CT findings and determined the following five diagnoses; a. UIP pattern, b. possible UIP c. UIP or NSIP pattern, D. NSIP pattern and 

E. Suggestive of alternative diagnosis. CT findings were compared with the pathological diagnosis and the prognosis in clinical. 

RESULTS 

Radiologists classified as 17 cases of UIP pattern, 24 cases of possible UIP, 13 cases of UIP or NSIP pattern, 56 cases of NSIP pattern and 4 cases of suggestive of alternative 

diagnosis. In comparison with pathological diagnosis, UIP pattern, possible UIP pattern and UIP or NSIP pattern had pathological UIP except for each one case. The mean survival of UIP 

pattern, possible UIP, UIP or NSIP pattern, NSIP pattern was 33.5, 73.0, 101.0 and 140.2 months, respectively. The prognosis of definite UIP was not significantly different from that of 

the other 3 categories (log rank test: p=0.013, 0.018,

displacement values. All patients of the IPF group had a reduced displacement in the subpleural space correlating with fibrotic areas and honey combing in CT.3 false positive results 

in the control group are explained due to congestion, pleural thickening and a peripheral infiltration . 

CONCLUSION 

Although measurement of shear wave velocities in subpleural space shows a great variation the semiquatitative analysis of the subpleural lung parenchyma from displacement maps 

could be a useful tool for early diagnosing and noninvasively control early canges in lung fibrosis. 


Diagnosing lung fibrosis by US 

LL-CHS-TU1B Lung Perfused Blood Volume with Spectral CT Imaging as a New Quantitative Tool? Assess the Pulmonary Parenchyma Microcirculation in Patients 

with Liver Cirrhosis 

PURPOSE 

To quantitatively investigate the pulmonary blood flow and its change induced by liver cirrhosis by measuring the iodine concentration distribution in pulmonary parenchyma on lung 

perfused blood volume (LPBV) images with spectral CT imaging. 


Twenty-five patients with liver cirrhosis and fifteen normal volunteers, who had no detectable intrinsic lung and heart disease, underwent dual-energy CT lung angiography using 

spectral imaging mode with a standard injection protocol. Patients were divided into each two groups including 13 cases compensated cirrhosis and 12 cases decompensated 

cirrhosis. LPBV images were generated by analysis of the iodine-water concertrations of the lung parenchyma. Regions of interest (ROIs) were selected for posterior basal segment 

of right lower lobe. We evaluated the quantification of lung PBV using a workstation between normal volunteers and different type cirrhosis. 

RESULTS 

Mean lung PBVs in decompensated cirrhosis group, compensated group, normal control group were 1.02 ± 0.52 mg/cc, 1.46 ± 0.50 mg/cc, and 1.53 ± 0.88mg/cc respectively. Mean lung PBVs 

in decompensated cirrhosis group was significantly lower than that in compensated group (t=-2.15, p=0.04) and that in normal control group (t=-3.85,p=0.006), indicating less blood flow by 

decompensated cirrhosis. However, there were no statistical differences between compensated cirrhosis group and control group (t=-1.17, p=0.25). 

CONCLUSION 

The findings of this preliminary study suggest that quantification of lung PBV may reflect the pulmonary parenchyma perfusion, which is useful to quantitatively evaluate pulmonary 

blood flow change in patients with hepatopulmonary syndrome. 


A better quantitatively evaluating of the pathophysiological change underlying HPS helps to guide its treatment. LPBV with spectral CT imaging may become a new quantitative tool. 

LL-CHS-TU2A Phase-Contrast MRI Reveals No Significant Changes in Pulmonary Hemodynamics by Oxygen Inhalation in Patients with Pulmonary Fibrosis 

PURPOSE 

For patients with pulmonary fibrosis, supplemental oxygen use can improve their symptoms and exercise performance. The underlying mechanical hypothesis is that a decrease in 

pulmonary vascular resistance in these patients can be achieved by improving their hypoxemia. The purpose of this study was to provide evidence for changes in pulmonary vascular 

resistance in pulmonary fibrosis patients by O2 inhalation using phase-contrast MRI (PC-MRI). 


Eleven pulmonary fibrosis patients underwent PC-MRI both in room air (RA) and with 100% O2 inhalation (nasal tube; 3 L/min). Evaluation criteria were heart rate (HR), SpO2, 

cardiac output (CO), average velocity (AveVel), acceleration time (AT) and Ratio by calculated from a time-intensity curve in a pulmonary trunk delineated by PC-MRI. Ratio was 

defined as the maximal change in flow rate during ejection divided by acceleration volume. Statistical comparisons were by paired t-tests. Informed consent was obtained from all 


RESULTS 

SpO2 was significantly improved by O2 inhalation (RA: 96.6 ± 1.1 vs. O2: 99.5 ± 90.7%; P< 0.001). HR was reduced by O2 inhalation, but was not statistically significant (RA: 78.8 

± 8.2 vs. O2: 75.7 ± 9.3 beats/min; P = 0.07). After O2 inhalation, CO (RA: 5.0±1.6 vs. O2: 5.0±1.6 L/min; P= 0.7), AveVel (RA: 15.0±4.7 vs. O2: 14.7±5.3 cm/sec; P= 0.5), AT 

(RA: 108±19 vs. O2: 111±31 msec; P= 0.6), and Ratio (RA: 254±89 vs. O2: 248±88 /sec2 ; P= 0.8) were not changed. 

CONCLUSION 

After O2 inhalation, significant changes in pulmonary hemodynamics were not observed on PC-MRI for patients with pulmonary fibrosis. Thus, even if O2 inhalation improves SpO2 

of patients with pulmonary fibrosis, it is not due to decreases in pulmonary vascular resistance. 


Based on PC-MRI evaluations, even if O2 inhalation improves SpO2 of patients with pulmonary fibrosis, it is not due to decreases in pulmonary vascular resistance. 

LL-CHS-TU2B Thin-Section Chest CT Findings in Polymyalgia Rheumatica: A Comparison between, with, and without Rheumatoid Arthritis 

PURPOSE 

Polymyalgia rheumatica (PMR) with rheumatoid arthritis (RA) patients have been documented as having poor prognosis and need early intervention with disease-modifying 

antirheumatic drugs. Although thin-section chest CT is of proven value in assessing many diffuse pulmonary diseases, the thin-section CT findings in PMR have not been fully 

assessed. The purpose of our study was to assess thin-section chest CT findings in PMR with RA and to compare them with the findings in PMR without RA. 


We retrospectively reviewed the medical records and thin-section CT findings of 25 consecutive patients with an established diagnosis of PMR with RA between 2004 and 2011, and 

compared these findings of 29 consecutive PMR patients without RA. Patients who had other autoimmune disease were excluded. No statistical differences were seen between the 

two groups in age, gender, smoking habits, history of steroid pulse and biological therapy, or duration of disease. Fifteen thin-section CT findings based on the recommendations of 

the Nomenclature Committee of the Fleischner society were retrospectively evaluated by 2 radiologists in consensus. 

RESULTS 

Thirty-seven PMR patients (68.5%) showed abnormalities on thin-section CT. The frequency of thin-section CT abnormalities was higher in PMR with RA group (76%) than in PMR 

without RA group (62%). Ground-glass opacity (56% vs 24%), traction bronchiectasis (44% vs 3%), architectural distortion (32% vs 0%), centrilobular nodules (32% vs 7%), 

honeycombing (20% vs 0%) were significantly more common in the PMR with RA group than in the PMR without RA group (Fisher’s exact test, p < 0.01). 

CONCLUSION 

PMR patients showed high frequency abnormalities on thin-section CT regardless of the association with RA. PMR patients with RA have more increased prevalence of thin-section 

chest CT abnormalities than those without RA. 


Prognosis and treatment between PMR with and without RA is different, and therefore radiologists should be familiar with chest CT findings of PMR with RA. 

LL-CHS-TU3A Micro CT Reveals Pathological Features of Ground-Glass Opacities (GGO) in HRCT 

PURPOSE 

HRCT has been a useful tool for first-step diagnosis of diffuse lung disease. However, It also has a limitation of both spatial and contrast resolution. We evaluate GGO depicted with 

HRCT, using micro CT such as a synchrotron radiation CT (SRCT) which has a resolution of 12-micro-m. 


Lung specimens were obtained at autopsy, and were inflated and fixed by Heitzman's method. They include alveolitis, diffuse alveolar damage (DAD), pulmonary alveolar 

hemorrhage (PAH), and bronchioloalveolar carcinoma (BAC), which depicted as GGO with HRCT. Each specimen was cut down to a cylindrical sample with 6-mm diameter and 

20-mm height. The SRCT system was located in SPring-8 (Hyogo, Japan), which is one of the largest synchrotron radiation facilities in the world. SRCT images were obtained using 

the lung samples. After that, the sample specimens were sliced to 200-Î¼m thickness, and were observed with stereomicroscopy and contact radiograph. Finally, approximately 

10-Î¼m thick microscopic images were obtained and compared with SRCT images, point by point. 

RESULTS 

SRCT demonstrated well the distinction between alveolar air-space and alveolar wall (parenchymal interstitium) in the peripheral lung. SRCT could also demonstrate the pathologic 

process in detail in alveolitis, DAD, PAH, and BAC. In the case of alveolitis, SRCT showed systematic alveolar wall thickening without destruction of the peripheral lung (Figure). In 

the case of DAD, SRCT demonstrated multiple foci of dense consolidation, dilation of peripheral airspace, and destruction of alveoli. The foci of consolidation were confirmed as 

dense fibrotic lesions in comparison with the microscopic image. PAH was observed alveolar wall thickening with serrated sequence, which corresponding to degenerated red blood 

cell laid on alveolar wall. BAC was imaged as alveolar wall thickening and no destruction of peripheral lung. 

CONCLUSION 

We could confirm each SRCT image in various disease processes demonstrated well the pathologic features, because the images correlated with the microscopic findings, point by 

point. Therefore, SRCT image could reveal pathologic features of GGO in HRCT. 


Micro CT image is useful to understand the pathologic consists. Furthermore, it seems that the analysis with thicker image of the micro-CT is useful to understand the 

HRCT-pathologic correlation. 

LL-CHS-TU3B The Utility of Expiratory Thin-Section CT for Fibrotic Interstitial Pneumonia 

PURPOSE 

To examine the utility of expiratory thin-section CT (TSCT) for differentiating between idiopathic pulmonary fibrosis (IPF) and collagen vascular interstitial pneumonia (CVD-IP). 


Expiratory and inspiratory TSCT were performed in our institution between January 2007 and December 2011 for 75 cases (36 women and 39 men; mean age 65 years, ranging from 

36 to 86 years) with IPF (n=34) and CVD-IP (n=41). The associated diagnoses in patients with CVD-IP were rheumatoid arthritis (n=22), Sjogren syndrome (n=3), scleroderma 

(n=2), polymyositis/dermatomyositis (n=1), and unspecified connective tissue disease and others (n=15). Two chest radiologists evaluated the presence of air trapping on expiratory 

TSCT images and parenchymal abnormalities (ground-glass opacity, consolidation, intralobular interstitial thickening, septal thickening, honeycombing, traction bronchiectasis, 

centrilobular nodule, cysts, emphysema, etc.) on inspiratory TSCT images, and Fisher’s exact test was used to make statistical comparisons of TSCT findings between IPF and 

CVD-IP. 

RESULTS 

The overall frequency of air trapping observed on expiratory TSCT images was 33 of 75 (44%). Air trapping was found in 4 of 34 (12%) and 29 of 41 (70%) cases of IPF and 

CVD-IP, respectively. 17 of 29 cases for which air trapping was exhibited with CVD-IP were diagnosed as rheumatoid arthritis. There was a significant difference in the frequency of 

air trapping between CVD-IP and IPF (p< 0.0001). Statistical analysis suggested that the frequency of centrilobular nodules in CVD-IP was significantly higher that of IPF (p=0.024). 

In contrast, statistical analysis showed that the frequency of interlobular interstitial thickening and traction bronchiectasis in IPF was significantly higher than that of CVD-IP 

(p=0.012, 0.0170, respectively). 

CONCLUSION 

Page 62 of 97

The presence of air trapping on expiratory TSCT images and centrilobular nodules on inspiratory TSCT images suggests CVD-IP rather than IPF. 


Expiratory TSCT is useful for distingishing IPF from CVD-IP. 

LL-CHS-TU4A Microscopic Polyangiitis: Imaging of Pulmonary Involvement 

PURPOSE 

To determine the prevalence of pulmonary involvement in a large sample of patients affected by microscopic polyangiitis (MPA) and analyze the various pattern of parenchymal 

findings on high-resolution CT (HRCT) and their evolution over time. 


Between January 2006 and February 2012, 52 patients (34 F (65.4%), 18 M (34.6%)), mean age 60 years (range 18-86) affected by MPA, were subjected to HRCT. The HRCT 

examination was performed by CT scan 128 layers and CT scan 16 layers. The average follow-up was 32.7 months (range 1-118). 

RESULTS 

Pulmonary involvement was found in 59.6% (31/52). The main parenchymal findings observed were ground-glass opacities in 22.6% (7/31), parenchymal consolidations in 16.1% 

(5/31) and pulmonary fibrosis in 29% (9/31). 75% (9/12) of ground-glass opacities and consolidations showed a diffuse distribution and the remaining 25% (3/12) a focal 

distribution. These findings correspond to alveolar hemorrhage associated with necrotizing alveolar capillaritis. All these findings disappeared at follow-up. In all patients, pulmonary 

fibrosis was prior to the diagnosis of MPA (average of about 1 year). Pulmonary fibrosis is an expression of a reparative response to a chronic tissue damage caused by the release of 

products of activated neutrophils by auto antibodies ANCA type p-MPO. All pulmonary fibrosis showed aggravation at follow-up. 

CONCLUSION 

In literature are still few the studies that analyze the pulmonary involvement in MPA. It is crucial to recognize an alveolar hemorrhage, considering its clinical impact. It may look 

like clusters of variable density from ground-glass to parenchymal consolidations. Considering the high prevalence of pulmonary fibrosis in the MPA, this disease must always be 

considered as a possible underlying pathology. 


It is fundamental to recognize an alveolar hemorrhage because it is a life-threatening condition. In pulmonary fibrosis the MPA should be considered as a possible underlying 

pathology. Similarly, in the MPA, it is important to evaluate the presence of pulmonary fibrosis. 

LL-CHS-TU4B Progression of Usual Interstitial Pneumonitis (UIP) in a Low-Dose CT Screening Cohort 

PURPOSE 

To identify the earliest findings of UIP and how it progresses over time. 


480 patients were identified from the early lung cancer action project (ELCAP) screening database based on key word descriptors of fibrosis. The most recent CT chest scans were 

screened for the presence of a UIP pattern as outlined in the 2011 official American Thoracic Society Statement on Idiopathic Pulmonary Fibrosis. For each case, the earliest and 

latest CT scans were reviewed. The most involved section of each of the 5 lobes was scored as to the pre-honeycomb (PH) findings (A: dilated bronchi only; B: ground glass 

opacification; C: linear and ground glass opacities) and honeycomb (H) findings (< 10%; 2: 10-25%; 3: 25-50%; 4: > 50%). Progression within the lobe was defined as a change 

from in the pre-honeycomb findings from A to B to C or an increase in the honeycomb percentage and the total number of lobes in such changes occurred were counted. 

RESULTS 

A total of 11 cases were identified as meeting the criteria for UIP. Of the 11 cases, the first CT scan showed that 4 had only H and 7 had both PH and H findings. Median time of 

follow-up was 6 yrs (IQR 4-8 yrs). One case remained unchanged while progression was seen in 10 (91%), including the one with the shortest follow-up; progression was seen in 1 

lobe in 4, 2 lobes in 2, 3 lobes in 2 and 4 lobes in 2. PH findings progressed to higher categories of PH or to H findings and H findings progressed to the next higher percentage 

category of H findings. 

CONCLUSION 

The earliest finding of UIP is ground glass opacification, followed by ground glass opacification with thickening of the interlobular septae which sometimes progressed to 

honeycombing. Honeycombing progressed by increasing involvement of the lobe (not necessarily peripherally). 


Given the potential to improve patient outcomes with interventions prior to extensive lung remodeling in UIP, it is important to gain more information on what findings to look for in 

its early stages. 

LL-CHS-TU5A Dynamic Hyperinflation in COPD Patients: Is It Related to Emphysema and Airway Morphology in Inspiration and Expiration Thoracic CT? 

PURPOSE 

Dynamic hyperinflation (DH), progressive airtrapping during exercise, is related to dyspnea in COPD patients. A subgroup of COPD patients divided over all GOLD stages suffer from 

dynamic hyperinflation. This study relates automatically extracted measures of airway morphology, airtrapping and emphysema to dynamic hyperinflation. 


As part of a research study, eighteen COPD patients underwent low dose CT (64x0.75mm, Siemens Sensation 64) at full inspiration and expiration. Using a portable ergo-spirometry 

system (Oxycon Mobile) to measure operational lung volume during activities of daily life, the study population was divided into ten patients suffering from DH and eight non-DH. 

Research software (Diagnostic Image Analysis Group, Nijmegen, The Netherlands; Fraunhofer MEVIS, Bremen, Germany) automatically segmented the lungs and airways in both the 

inspiration and expiration scans. As measures for emphysema, the percentages of lung volume below -950 HU (IN-950) and the 15th percentile of the cumulative histogram (PD15) 

were computed in inspiration scans. As a quantification of air-trapping, the percentages of lung volume below -856 HU were computed in expiration scans (EX-856). Airway 

morphology was extracted from the inspiration scans as the wall area percentage at airways with a circumference of 10mm (Pi10), computed using regression on all cross-sectional 

airway measurements. Means and standard deviations for each measurement are reported for the two groups. 

RESULTS 

The means and standard deviations of the measurements for the DH and non-DH groups were 19.7 ± 8.6% and 14.6 ± 10.5% for IN-950, -956 ± 15 HU and -945 ± 23 HU for 

PD15, 47.2 ± 13.7% and 35.1 ± 10.9% for EX-856, and 48.0 ± 6.9% and 40.7 ± 9.3% for Pi10, respectively. The differences between the DH and non-DH group are thus more 

pronounced for EX-856 and Pi10 than for IN-950 and PD15. 

CONCLUSION 

Quantitative measurements from inspiration and expiration CT scans related to airway morphology appear to be more informative for distinguishing COPD patients suffering from 

dynamic hyperinflation from non-hyperinflators than emphysema related measurements. 


Understanding the underlying pathways of hyperinflation is important for the management of COPD since reduction of dynamic hyperinflation is strongly correlated with less dyspnea 

complaints. 

LL-CHS-TU5B Non-invasive Assessment of Pulmonary Arterial Hypertension with 3D Time-resolved MR Angiography in Patients with Pulmonary Idiopathic Fibrosis 

PURPOSE 

The aim of this study was to evaluate the effectiveness of high-temporal-resolution MR angiography (HTR-MRA) as a complementary diagnostic tool in the management of patients 

affected by pulmonary arterial hypertension secondary to idiopathic pulmonary fibrosis. 


Thirty-five patients with IPF (21 male and 14 female, average age 64 ± 8.2 years, range 55 - 76 years) were included in the study. The inclusion criteria were: presence of an 

extensive pulmonary parenchymal disease with significant fibrosis evidenced by pulmonary CT scan. Exclusion criteria were diagnosis of collagen pathologies, cardiac pathologies, 

included myocardium infarct, or hematological pathologies. All patients underwent right heart catheterization and HTR-MRA. RHC was performed within 10 days from HTR-MRA. 

Thirteen healthy normotensive volunteers were used as controlgroup. 

RESULTS 

mMTT and mTTP were significantly prolonged in IPF patients compared with those of the control subjects: [mMTT, 42.97 ± 7.55 (95% CI = 40.38 - 5.56) vs 11.31 ± 5.15 (CI 95% 

= 9.54 to 13.08); mTTP, 46.23 ± 8.36 , (95% CI = 43.36 - 49.10 ) vs 16.57 ± 5.35 (95% CI = 14.73 - 18.41)] (p

PURPOSE 

Chest radiography is an important diagnostic test for the detection of tuberculosis (TB) but there are not enough experts to read chest radiographs (CXRs) in high burden countries. We 

compared the reading performance of inexperienced observers with and without the support of a computer-aided diagnosis (CAD) system with that of an experienced reader. 


A set of 100 digital CXRs (Oldelca DR, Delft Imaging Systems, Veenendaal, The Netherlands) of TB suspects was collected from two sites in Sub-Saharan Africa. Sputum culture was 

used as the reference standard. All cases were scored on a scale of 0 to 100 for the presence of active TB by seven non-experts (undergraduate medical students) and one expert 

CRRS certified reader for reading CXRs for TB. Prior to reading, the non-experts received one hour of general instruction from a thoracic radiologist and one hour of case reading 

training with another CRRS certified reader. Cases were also processed by a CAD system (CAD4TB, version 1.08, Diagnostic Image Analysis Group, Nijmegen, The Netherlands). Scores 

of human readers and CAD were independently combined by averaging. Performance was evaluated as area under the ROC curve (Az), multi-reader-multi-case (MRMC) analysis was 

used to compare performance with and without CAD and pairwise comparisons were made with bootstrap estimation. p

was considered statistically significant. 

RESULTS 

Mean CT severity score decreased in the treated group (-0.29 ± 2.06) and increased in the control group (0.96 ± 1.98) (p=0.05). Percentage change for specific CT findings in the 

treated group were observed for bronchial wall thickening (11%), centrilobular nodules (17%), macronodules (-25%), consolidation (-10%), and cavitary nodules (-100%) between 

pre and post-treatment CT scans. Percentage change for specific CT findings in the control group were observed for bronchial wall thickening (84%), centrilobular nodules (14%), 

macronodules (10%), consolidation (-33%), and cavitary nodules (-85%) on surveillance CT (Figure 1). 

CONCLUSION 

CT detects differences between treated and untreated patients with MAC at a statistically significant level but similar trends were observed in both treated and control groups. Changes 

in CT findings should not be used in isolation in therapeutic decision making for chronic MAC infection. 


Asymptomatic untreated patients with chronic MAC infection can exhibit thoracic CTchanges that mimic treatment effect. CT features alone should not prompt treatment in 

asymptomatic patients. 

SSJ05-06 • 03:50 PM 

Pulmonary Visceral Larva Migrans Caused by Toxocara Canis: CT Findings and Their Correlation with Laboratory Features 

Jina Park MD , Seoul, Seoul, KOREA, REPUBLIC OF • Yo Won Choi MD • Dong Ho Shin • Jae-Sook Ryu 

PURPOSE 

To evaluate CT findings of pulmonary visceral larva migrans caused by Toxocara canis and to correlate the CT findings with laboratory features. 


Chest CT scans of 25 patients (21 men and 4 women; mean age, 51.5 years) with pulmonary abnormalities on CT and ELISA results positive for Toxocara canis were retrospectively 

assessed by two chest radiologists in terms of ground-glass opacity (GGO), consolidation, nodules, thickening of bronchovascular bundles, interlobular septal thickening, crazy-paving 

pattern, subsegmental atelectasis, bronchiectasis, honeycombing, enlarged hilar/mediastinal lymph nodes, pleural effusion, and pericardial effusion. The distribution (central vs 

peripheral predominant; upper vs lower lung predominant) and extent of pulmonary parenchymal abnormalities were also evaluated. Among the 25, 18 (72%) had peripheral 

eosinophilia and 23 (92%) had a recent history of eating raw bovine or canine liver.We analyzed the correlation between the total number of pulmonary abnormalities and laboratory 

findings including the absolute count and percentage of peripheral blood eosinophil, IgE level, and ELISA value, taken less than 15 days before/after the CT, using Spearman 

correlation. 

RESULTS 

Chest CT most commonly showed nodules (n=20, 80%) with (n=17, 68%) or without a halo (n=3, 12%), followed by GGO (n=16, 64%), subsegmental atelectasis (n=8, 32%), and 

consolidation (n=4, 16%). Nodules were usually of less than 5 mm (n=15, 60%) or of 5 to 10 mm in diameter (n=11, 44%) but those > 10 mm were seen in only two patients (8%). 

These parenchymal abnormalities showed peripheral (n=25, 100%) and lower lung (n=21, 84%) predominance, and mostly occupied less than 5% of the total lung area (n=24, 

96%).The percentage of peripheral eosinophils significantly correlated with the total number of parenchymal abnormalities on chest CT scan (p=0.043). 

CONCLUSION 

Patients with pulmonary toxocariasis usually show pulmonary nodules of less than 1 cm in diameter, GGO, consolidation, or subsegmental atelectasis on CT. Those patients may not 

show peripheral eosinophilia, a common clue to the diagnosis, if pulmonary abnormalities are small in number. 


Pulmonary toxocariasis usually shows nodules and GGO of peripheral lower lung predominance. Patients with such pulmonary abnormalities small in number may not show peripheral 

eosinophilia. 

Radiation Oncology and Radiobiology (Lung) 

Tuesday • 03:00 - 04:00 PM • S104A 

CH RO 

PRESIDING: 

Simon Shek-Man Lo , MD , Cleveland, OH 

Joseph Kamel Salama , MD , Durham, NC 

Computer Code: SSJ24 • AMA PRA Category 1 Credit: 1.0 • ARRT Category A+ Credit: 1.0 



SSJ24-01 • 03:00 PM 

Helical Tomotherapy vs Linear Accelerator-based Radiotherapy for Stereotactic Body Radiotherapy for Medically Inoperable Non-small Cell Lung Cancer: A Dosimetric 

Comparison 

Gregory Thompson MD , Cincinnati, OH • Luis Carlos Bohorquez • Michael A. S. Lamba PhD • Thomas Skidmore MD 

PURPOSE 

To investigate differences in the coverage of the planning target volume (PTV) and avoidance of organs at risk (OAR) between linear accelerator based radiotherapy (LA-SBRT) and 

helical TomoTherapy intensity modulated radiotherapy (HT-SBRT) for stereotactic body radiotherapy (SBRT) for medically inoperable non-small cell lung cancer (MI-NSCLC) with limited 

respiratory target motion. 


Ten cases of early-stage, biopsy-proven MI-NSCLC previously treated using 3D conformal or intensity modulated radiotherapy to deliver LA-SBRT were selected. Intrafractional 

respiratory gating was not used during treatment delivery. The prescribed dose was 54 Gy in 3 fractions to the PTV such that 99% of the PTV received 90% of the prescribed dose. The 

lung, esophagus, spinal cord, and heart were deemed as an OAR. Similar treatment plans were then produced and subsequently optimized for delivery using HT. PTV coverage and OAR 

avoidance were compared using compared dose–volume parameters, conformity index, conformity number, and homogeneity index. 

RESULTS 

Both LA-SBRT and HT-SBRT provided adequate coverage of the PTV with a mean D99 of 94.1% and 97.1% respectively. Conformity index, conformity number, and homogeneity index 

were similar between the techniques (1.00, 0.58, and 1.35 for LA-SBRT and 1.00, 0.51, and 1.35 for HT-SBRT respectively). For OAR avoidance, HT-SBRT allowed for better avoidance 

of the spinal cord and/or esophagus for tumors in close proximity. Mean maximum spinal cord and esophageal dose for these tumors for LA-SBRT were 15.6 Gy and 20.4 Gy and for 

HT-SBRT 12.4 Gy and 18.9 Gy respectively. Ipsilateral and contralateral lung V5 and ipsilateral lung V20 were greater for HT-SBRT (35%, 18%, and 12% respectively) compared to 

LA-SBRT (27%, 11%, and 9% respectively). 

CONCLUSION 

When deciding on a modality in which to deliver SBRT, both LA-SBRT and HT-SBRT adequately cover the PTV. In situations where the PTV is in close proximity to an OAR, avoidance of 

the OAR is superior with HT-SBRT. The lung volume irradiated is greater with HT-SBRT. Additionally factors such as compensation for respiratory target motion and overall treatment 

time must be considered and are generally less favorable for HT-SBRT. 


Helical TomoTherapy and Linear Accelerator-based delivery of SBRT for NSCLC are similar in target coverage with benefits and trade-offs with respect to avoidance of various organs at 

risk. 

SSJ24-02 • 03:10 PM 

Dose-Painted IMRT with Dose Escalation in Locally Advanced Rectal Cancer 

Maged Ghaly , Manhasset, NY 


PURPOSE:After preoperative chemoradiation, clinical response and tumorpathologic downstaging showed a close correlation with improved outcomes. Wereport our initial experience in 

dose escalation using dose-painted intensity-modulated radiationtherapy(DP-IMRT) inpatients with locally advanced rectal cancer. Methods and Materials:Ten patients with locally 

advanced rectal cancer (T3-4 and N0) wereprospectively identified. Tumors werestaged preoperatively using the cTNM classification by PET/CT, EUS and MRI. Allwere treated with 

preoperative 5-fluorouraciland (DP-IMRT). Doses were prescribed as follows:56 Gy/2.0 Gy fractions(fxn) to the rectal tumor planning target volume (PTV) and 47.6Gy/1.7Gyfxn 

toelective nodal PTV. Surgery wasperformed 6-8 weeks after chemoradiation. The surgical procedure was tailoredaccording to tumor downstaging, and thus the choice of 

sphincter-preservingsurgery was based on the distance between the lower pole of the tumor and theanorectal ring “after” chemoradiation.Following surgery, patients were reevaluated 

for tumor response by both imagingstudies (ycTNM) and pathological staging (ypTN). Acute and late toxicities weremonitored by the treating physician.RESULTS:All patients completed 

therapy. Tumors were in the lower one-third in 5patients,middle one-third in 3, and upper one-third in 2. With preoperative endorectalultrasound, PET/CT and magnetic resonance 

imaging, the clinical staging of thetumors was: 7 (T3N0M0), 1 (T3N0M1) and 2(T4N0M0). Acute toxicity was limited toa moderate proctitis (RTOG acute toxicity scoring system, Grade 

2) in allpatients, with two patients with tumors extending into the anal canal havingGrade 3 dermatitis. Nine patients underwent surgery. One patient refused surgerybased on a 

normal post-treatment PET/CT. A complete clinical response wasobtained in 7 of 10 patients with four pathologically pT0N0, and three had onlyresidual microfoci of carcinoma (pT1N0). 

Residual disease was limited to themuscularis propria (pT2N0) in three patients. No difference in perioperativecomplications was seen.CONCLUSION:Preoperative dose-escalation using 

dose-paintedintensity-modulated radiationtherapy (DP-IMRT) seems to be safe.Acute toxicity was mainly local, with moderate proctitis (Grade 2) andoccasional dermatitis (Grade 3) for 

very low-lying tumors. This modalityprovides a high rate of tumor downstaging and downsizing especially forpatients with lesions in the lower one-third of the rectum with a possible 

potentialfor an increased ability to perform sphincter-preservingsurgery. 

SSJ24-03 • 03:20 PM 

Stereotactic Body Radiation Therapy for Primary Lung Cancers which were Clinically Diagnosed Without Pathological Confirmation: A Single-Institution Experience 

Tadamasa Yoshitake MD , Fukuoka City, Fukuoka Ken, Japan • Yoshiyuki Shioyama • Katsumasa Nakamura MD, PhD • Tomonari Sasaki MD,PhD • Saiji Ohga MD • Takeshi 

Nonoshita • Kaori Asai • Hideki Hirata • Hiroshi Honda MD 

Page 65 of 97 

PURPOSE 

Pathological diagnosis of small lung lesions is sometimes difficult in inoperable patients. The purpose of the present study was to evaluate the outcome of stereotactic body 

radiotherapy (SBRT) for small lung lesions that are clinically diagnosed as primary lung cancer without pathologic confirmation. 


Between April 2003 and July 2011, 82 patients with small pulmonary lesions clinically diagnosed as primary lung cancer were treated with SBRT in Kyushu University Hospital. The 

median age of the 66 patients was 75 years (range 51- 92 years). Forty four patients were male, and 38 were female. The median tumor size was 19 mm (range 8-40 mm). 

Thin-section CT findings for these pulmonary lesions showed solid nodules and ground-glass opacity (GGO) nodules in 53 and 29 patients, respectively. The radiation dose was 48 Gy in 

4 fractions in all patients. 

RESULTS 

Median follow-up was 20 months (range 6-83 months). Recurrence was observed in 13 (15.9%) patients (local failure, 6; regional failure, 5; distant metastases, 6) with solid nodules. 

There was no recurrence in 29 patients with GGO nodules. Two patients died of recurrence and 10 patients died from other diseases. Local control rate, cause-specific survival and 

overall survival at 3 years were 88%, 98% and 79%, respectively. Two (2.4%) patients and 5 (6.1%) patients had grade 2 radiation pneumonitis and grade 2 rib fracturing,

overall survival at 3 years were 88%, 98% and 79%, respectively. Two (2.4%) patients and 5 (6.1%) patients had grade 2 radiation pneumonitis and grade 2 rib fracturing, 

respectively. There were no adverse effects of grade 3 or greater during follow-up. 

CONCLUSION 

SBRT is to be considered a safe and effective treatment option for small lung lesions clinically diagnosed as primary lung cancer without pathologic confirmation, especially in patients 

with GGO nodules. 


(dealing with small lung lesions clinically diagnosed as primary lung cancer ) Stereotactic body radiation therapy is to be considered a safe and effective treatment option. 

SSJ24-04 • 03:30 PM 

Local Control Rates with Five Fractions of Stereotactic Body Radiotherapy (SBRT) for Chemotherapy Refractory Oligometastatic Cancers to Lung 

Deepinder Singh MD , Rochester, NY • Michael T. Milano MD, PhD • Mary Z. Hare • Kenneth Usuki • Hong Zhang MD, PhD • Yuhchyau Chen MD, PhD 

PURPOSE 

Purpose: To report our institutional experience with 5 fractions of SBRT for the treatment of chemotherapy refractory oligometastatic cancer to lung . 


Methods: Thirty four consecutive patients with oligo-metastatic cancer to lung who were noted to be refractory to chemotherapy, were treated with image guided SBRT between 2008 

and 2011. The median prescription dose was 50 Gy in 5 fractions (range 45-60 Gy) to the isocenter, with the 80% isodose line covering the PTV (defined as GTV + 7-10 mm 

volumetric expansion). The follow-up ranged from 2.4-39.8 months with a median of 15 months. 

RESULTS 

Results: The age ranged from 38 to 81 years among the 34 patients comprising of 17 males and 17 females each. There were 13 patients with metastases from colon cancer, followed 

by head and neck metastases 6 patients, breast, melanoma and sarcoma with 4 patients each, and renal cell cancer with 3 patients. The 1- and 2-year local control (LC) rates for all 

patients were 93% and 87% respectively. The majority of the patients (n=4) who failed locally occurred within 12 months. N0 patient failed locally after 13 months except for one 

patient with colon cancer who was noted to have progression of local disease at 26 months. Majority of the local failures were noted among the patients with adenocarcinoma histology 

followed by melanoma, sarcoma and squamous cell carcinoma. However with multivariate analysis, age, gender, previous chemotherapy or previous surgery or radiation had no 

significant effect on local control rates. No patient was reported to have any symptomatic pneumonitis at any point of time. 

CONCLUSION 

Conclusions: SBRT is very safe and plays important role offering excellent one and two year LC in patients with oligo-metastatic disease to lungs who are deemed refractory to 

chemotherapy. Majority of the local failures were noted within first 12 months but there after the LC were maintained well at 24 months to as far as over 36 months. 


Role of SBRT in improving local control rates for oligo-metastatic cancer to lungs in chemotherapy refractory patients. 

SSJ24-05 • 03:40 PM 

Stereotactic Body Radiation Therapy (SBRT) for Early Stage Medically Inoperable Non-Small Cell Lung Cancer 

Chance Matthiesen , Edmond, OK 


Purpose/Objective(s): SBRT delivers a highly conformal, high dose per fraction to a target volume while minimizing dose to surrounding normal tissue. The use of SBRT has become 

increasingly popular for medically inoperable patients diagnosed with early stage non-small cell lung cancer (NSCLC). We reviewed our clinical outcomes and toxicity profiles regarding 

our use of SBRT for such patients.Materials/Methods: A retrospective review was done of 49 consecutive patients diagnosed with early stage NSCLC and treated with SBRT from 

2006-2011. Patients had a median age 66 years (range 53-92). Cancers were medically inoperable due to tumor location (9) or patient comorbidities (40). Thirty-six lesions (73.5%) 

were T1N0M0 (median maximum diameter 2.0 cm) and 13 (26.5%) were T2N0M0 (median maximum diameter 4.3 cm). Histologies included squamous cell carcinoma (53.1%), 

adenocarinoma (28.6%), NSCLC not otherwise specified (4.0%), and undetermined / not biopsied (14.3%). The median SBRT prescription was 60 Gy in 3-5 fractions (range 48-72 Gy 

in 3-6 fractions). PET/CT imaging within one month prior to treatment was performed in 38 patients (77.6%). The median SUV was 10.7 (range 2.0-51), and 90.9% of T2 lesions with 

pretreatment PET/CT had SUV’s greater than 10.0.Results:Median follow-up was 16 months, (range 1-59 months). Infield local control for all patients was 87.8%. Thirteen patients 

(26.5%) failed within the chest. Six (12.2%) were infield and 7 (14.3%) were nodal. Twenty-eight of the 49 patients (57.1%) are alive (median follow-up 16 months), of which 26 

(92.9%) have no local recurrence or systemic progression. Twenty patients (40.8%) have died, of whom nine deaths (18.3%) were attributed to local/regional recurrence and / or 

systemic progression of lung cancer. Other causes of death included medical comorbidities in eight patients (16.3%) and second primaries in three patients (6.1%). Median survival in 

patients with non-cancer deaths was 14 months, (range 8-32 months). Factors associated with local / nodal failure included squamous cell histology (9 of 13 patients, 69.2%), and 

tumor SUV > 12.0 (8 of 13 patients, 61.5 %,). Median SUV of recurring patients was 12.8, (range 1.6-25.7), and included nine T1 and four T2 lesions. Nine patients (18.4%) had 

complications following SBRT including chest wall pain (6) and rib fracture (3). High dose per fraction (20 Gy x 3 courses, 44% of complications) and PTV involving the rib (56% of 

complications) were associated with these outcomes.Conclusions: SBRT for medically inoperable NSCLC is a reasonable treatment approach for many patients. Squamous cell histology 

and SUV > 12.0 are associated with increased risk of local / regional recurrence. High dose per fraction courses and PTV involving the rib increases the risk for post-treatment chest 

wall complications. 

SSJ24-06 • 03:50 PM 

Defining the Best Quantitative Method to Determine the Gross Tumor Volume (GTV) for Radiotherapy Planning in Lung Cancer Patients, Based on FDG-PET/CT Imaging 

Jose Leite Cavalcanti Filho MD,MSc , Rio de Janeiro, Rio de Janeiro, BRAZIL • Ronaldo Cavalieri • Marcio Reisner • Luiz Machado Neto MD • Tadeu Takao Almodovar Kubo MSc • 

Romeu Cortes Domingues MD 

PURPOSE 

The aim of this study is to determine the best quantitative method using FDG-PET/CT imaging, to define the contour and GTV for radiotherapy planning in locally advanced lung cancer 



10 patients with locally advanced lung cancer who were candidate for radiotherapy, underwent a FDG-PET/CT study before any treatment.The GTV was defined by three methods: 1) 

Visual analysis by a Radiation Oncologist using FDG-PET/CT imaging in a 3-D radiotherapy planning system (gold standard). 2) Using 2.5 maximum standard uptake value (SUVmax) 

as threshold, to rendering the metabolic volume of the primary lesion (SUV 2.5). 3) Using as threshold, 40% of the primary lesion SUVmax, to rendering the metabolic volume (SUV 

40%). The results of these three methods were evaluated and compared statistically, using the t-test and Pearson correlation. 

RESULTS 

The mean GTV defined by Radiation Oncologist visual analysis in a 3-D radiotherapy planning system, using 2.5 SUVmax as threshold and using 40% of the primary lesion SUVmax as 

threshold were respectively: 109 cm3, 129 cm3 and 63 cm3.Considering as gold standard the GTV defined by the Radiation Oncologist visual analysis and normalizing the other 

quantitative methods results by it, the minor percentage difference was achieved using the 2.5 SUVmax threshold.The Pearson correlation showed that statistically relevance was 

achieved (P < 0.05) when all variables were combined and the quantitative method SUV 2.5 had high correlation with the Radiation Oncologist visual analysis (r = 0.970). 

CONCLUSION 

The SUV 2.5 method used to define the contour and GTV for lung cancer patients, with FDG-PET/CT imaging, is the closest to the Radiation Oncologist visual analysis. 


The SUV 2.5 has good reproducibility, low operator interference, specially in atelectasis tumors, and gives important orientation to the Radiation Oncologist in defining the radiotherapy 

planning. 

Pediatric Radiology Series: Chest/Cardiovascular Imaging II 

Tuesday • 03:00 - 06:00 PM • S102AB 

CA CH VI PD 

Course No. VSPD32 


George A. Taylor , MD , Moderator , Boston, MA , 

Robert Harris Cleveland , MD * , Moderator , Boston, MA 

Page 66 of 97 

VSPD32-01 • Pitfalls and Errors in Pediatric Thoracic Imaging 

George A. Taylor , MD , Boston, MA 



1) Understand the common sources of error in pediatric thoracic imaging. 2) Demonstrate understanding of the influence of biases on the diagnostic process. 3) Analyze image 

viewing teachniques and apply them to strategies for improving image interpretation. 


The goal of this presentation is to describe common patterns and potential etiologies of diagnostic error in pediatric thoracic imaging identified over a 13-year experience at a large 

academic children’s hospital. Errors are defined as a diagnosis that was delayed, wrong or missed; they are classified as perceptual, cognitive, system-related or 

unavoidable.Perceptual errors were the most common type of error, defined as a diagnostic finding that is noticeable but missed. Cognitive contributors to perceptual errors will be 

discussed, including the role of search satisfaction, visual distractors, and visual isolation. Cognitive errors were defined as faulty information processing, related to 

overinterpretationof an imaging finding, misinterpretation of a finding or failure to consider a different diagnosis for a given finding [premature closure]); faulty data gathering 

(poorly performed imaging examination, inadequate review of patient history or lack of consideration of a patient’s underlying condition), or insufficient knowledge base. The 

presentation will also discuss a number of cognitive biases that subconsciously affect our ability to effectively reach the right diagnosis. These will include examples of availability 

heuristics (memory of a similar case), framing effect (how data are presented), the anchoring heuristic (premature closure), the reluctance to confront authority (blind obedience), 

and reader overconfidence. Finally, we will review organizational errors in which systems issues such as faulty medical history and inefficient processes contribute to diagnostic 

errors in the chest. The presentation will suggest strategies for systematic and individual improvement. 

VSPD32-02 • Task-Specific Dose Reduction for Neonatal Chest Imaging Using a CsI Direct Radiographic (DR) Detector 

Jacquelyn Whaley , MS * , Rochester, NY , Steven Don , MD * , Saint Louis, MO , Lynn La Pietra , PhD * , Rochester, NY , Charles Floyd Hildebolt , DDS, PhD , Saint 

Louis, MO , Kirk Smith , BS , Saint Louis, MO , Samuel Richard , PhD, BSC * , Rochester, NY , David H. Foos * , Rochester, NY 

PURPOSE 

Determine task-specific dose reduction potential in neonatal ICU imaging using a CsI DR detector. 


Eleven neonatal cadavers (350-3715g) were imaged using a CsI detector at 50 and 70 kVp at 3 effective doses (2, 10, 25 µSv). Four pediatric radiologists independently marked 

the location of three features in each image: carina, endotracheal tube tip (ETT), and largest pneumatocele. For the carina and ETT, the centroid of a marked feature in each 

image was used as reference. Distances (mm) from a feature marking to the reference were calculated and the mean and 95% confidence limits (CL) were computed.For

Page 67 of 97 

pneumatoceles, the location in lower dose images corresponding to the marking in the 25 µSv image was used as reference. The frequency that a marking was within 5 mm of 

the reference was calculated. Repeated-measures ANOVA was used to test the null hypothesis that the frequencies were not different across kVp and dose. Appropriate 

adjustments were employed. Post-hoc testing was performed on all data using the Tukey honestly significant difference (HSD) test. 

RESULTS 

Ability to mark the carina was not significantly different (1.3 mm, HSD p>0.40) across kVp and dose. Differences were significant for marking the ETT tip (0.5 mm, HSD p0.05). Differences across dose were significant. The mean frequency for 

50 kVp images was 79% (60%, 98%) at 10 µSv and 52% (33%, 71%) at 2 µSv (HSD p=0.02). For 70 kVp images the mean frequency was 73% (58%, 88%) at 10 µSv and 

49% (33%, 64%) at 2 µSv (HSD p=0.04). 

CONCLUSION 

The magnitude of differences for the ETT marking task were found to be clinically unimportant when considering the length of the 4 mm bezel end and the 1.3 mm variability in 

marking the carina. The ability to mark the pneumatocele was significantly degraded in images captured with 2 µSv when compared to images captured at 10 µSv. 


Neonates currently imaged for chest receive an effective dose of 15-20 µSv. Task-specific techniques could be employed such as a low-dose ETT study and a higher-dose lung 

parenchymal study. 

VSPD32-03 • Dynamics of the Upper Airway in Sleep Apnea by Cine MRI 

Mark E. Wagshul , PhD , Bronx, NY , Sanghun Sin , PhD , Bronx, NY , Michael L. Lipton , MD, PhD , Bronx, NY , Keivan Shifteh , MD , Bronx, NY , Raanan Arens , MD 

, Bronx, NY 

PURPOSE 

We recently reported a new technique for retrospective, respiratory gating to produce isotropic resolution cine MRI of the upper airway. We demonstrate the technique in 

obstructive sleep apnea syndrome (OSAS) patients, and show that it can be used to document unique dynamics of the airway in the vicinity of an airway constriction. 


Respiratory gated MRI were triggered on a nasal cannula flow waveform, and retrospective gating was used to constrain the acquisition based on a pre-set range of respiratory 

rate and breathing tidal volume. Images used a 3D gradient echo technique (TE/TR = 3.5/7.5 ms, 10 cine frames, 36 sagittal slices, 1.1 mm isotropic), covering the entire length 

of the upper airway. Histogram analysis of a small region in the vicinity of the airway was used on a slice-by-slice basis to segment the airway from the surrounding soft tissue and 

generate airway area change waveforms over the respiratory cycle. Respiratory dynamics in the vicinity of a constriction was investigated in seven non-OSAS and two OSAS 

patients by measuring the timing of the peak airway size as a function of airway position. 

RESULTS 

In control patients, the timing of peak airway size demonstrated a smooth transition from nasopharynx to oropharynx, although the progression of the changes varied from 

subject to subject; in some subjects being synchronous, in some with peak timing increasing with position, while in others decreasing with position. In the two OSAS patients, in 

contrast, there was an abrupt shift in timing at the site of a constriction, with the peak timing shifting nearly half a cycle from below to above the constriction. 

CONCLUSION 

Compared to prior real-time MRI techniques, our method captures the entire airway under identical respiratory condition; quantitative comparisons of size changes are possible 

along the entire airway. Our data show a unique dynamics in the vicinity of a constriction, whereby the airway above and below the constriction are moving out of phase. This 

dynamic feature many be a unique element of respiratory dynamics of OSAS and may help form a better understanding of tissue-airway interactions, needed to improve therapy in 

OSAS. 


Obstructive sleep apnea syndrome is a growing public health problem affecting children and adolescents; dynamic imaging can provide better information needed to guide therapy 

in these patients. 

VSPD32-05 • Chest-MRI in the Follow-up of Pulmonary Alterations in Pediatric Patients with Middle Lobe Syndrome (MLS): Comparison with XR 

Francesco Fraioli , MD , Rome, Rome, Italy , Goffredo Serra , Rome, RM, Italy , Andrea Fiorelli , Rome, Italy , Matteo Paoletti , Rome, Italy , Simone Liberali , Rome, 

Rome, ITALY , Carlo Catalano , MD , Rome, ITALY 

PURPOSE 

To evalutate the role of chest-MRI, in comparison with XR, in the follow-up of pulmonary alterations detected by CT at time of diagnosis in pediatric patients with Middle Lobe 

Syndrome (MLS). 


17 patients with MLS (mean age: 6.2 ys) underwent chest-CT at diagnosis (100 kV, CARE dose with quality reference: 70 mAs; collimation: 24 x 1,2 mm, rotation-time: 0,33 sec; 

scan-time: 5 sec); at follow-up after a mean time of 15.3 months, all patients were evaluated with Chest-MRI (respiratory-triggered T2-weighted BLADE sequence: TR: 2000; TE: 

27 ms; FOV: 400 mm; flip-angle: 150°; slice-thickness: 5 mm; DWI sequences: TR: 5632, 12; TE: 83; flip angle: 90; slice thickness 5 mm; b600 s/mm2) and chest-XR. The 

presence of several pulmonary alterations was reported for each image-modality: consolidations; bronchiectasis; bronchial-wall- thickening; mucous plugging. Hilomediastinal 

lymphadenopathies were assessed on CT and MRI. 

RESULTS 

CT reported at diagnosis consolidations in 100% of patients; bronchiectasis: 35%; bronchial-wall-thickening: 53%; mucous plugging: 35%. MRI/XR reported, respectively, 

consolidations: 65% - 35%; bronchiectasis: 35% - 29%; bronchial-wall-thickening: 59% - 6%; mucous-plugging: 25% - 0%. DWI correlated ( p

Page 68 of 97 

additional radiation dose. 

VSPD32-08 • Back to Basics: Radiography of the Pediatric Chest 

Robert Harris Cleveland , MD * , Boston, MA 


1) Review strategies to improve diagnostic accuracy in interpreting chest radiographs. 2) Enhance confidence for NOT obtaining follow-up CT. 3) Increase appreciation of when 

follow-up CT is needed. 


In this session, we will review the role of the chest x-ray (CXR) in the era of high tech imaging. Specifically the need to re-establish a sense of confidence in interpreting CXR will 

be addressed. Situations where a confident interpretaion of the CXR obviates the need for CT will be stressed as well as those where the CXR clearly requires CT follow-up.The 

need to “image gently”, following ALARA, guidelines is now widely accepted in pediatric radiology and is growing in acceptance in adult imaging. In our department (Children’s 

Hospital Boston) this has lead to a 24% decrease in CT volume between 2006 and 2010. This in turn, means that a need for an increased nuanced approach to interpreting CXR is 

required.Specific recommendations to increase the accuracy in interpreting CXR will be discussed. As the indications for a high percentage of CXR in pediatrics are nonspecific, the 

need to constantly be vigilent regarding unexpected and uncommon conditions will be stressed.Particular attention will be paid to the broad range of conditions related to wheezing 

(or noisy breathing) and dyspnea including airway obstruction and interstitial lung disease.The increasing incidence of complications in pediatric community acquired pnuemonia 

and the appropriate role of CXR in that situation will also be discussed. 

VSPD32-09 • Analysis of 590 Children with Foreign Bodies in Airway with Special Reference to Role of 3D CT 

Hua Rong , MD , Xuzhou, Jiangsu, CHINA 

PURPOSE 

Analyse the clinical features and 3D CT imaging findings of children with foreign bodies aspiration. The aim of this study is to improve the understanding about FBA in children and 

decrease the rate of misdiagnosis, missed diagnosis and morbidity. 


1501 children(range, 50 days-10years) who underwent the three-dimensional reconstruction CT between January 2009 and July 2010 for the evaluation of children with suspected 

foreign body aspiration were included in this study. 584 children were diagnosed by fiberoptic bronchoscopy, 6 children coughed FBs out themselves, and these 590 children were 

the main research objects in our study, there were 389 boys and 201 girls with a mean age of 18 months(range, 50 days-10years). We gathered their clinical history,evaluated 

the locations and patterns of airway obstruction and complications on 3D CT images. Analyse the pathogenesis regularity, clinical features and imaging findings of FBA in children. 

RESULTS 

3D CT , bronchoscopic examination, and clinical verified the foreign bodies in 590 children. The most common age group was 1-3 years. The ratio of foreign bodies in the right and 

left bronchial trees was 1.05:1. CT revealed the common complications of FBA such as emphysema (n =379), pneumonia (n = 174), and atelectasis (n = 26), the remaining 120 

patients showed no complications on 3D CT. There were serious complications including pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumatorrhachis could 

also be observed. The types of foreign bodies were diverse, the most common were peanuts and sunflower seeds. The diagnostic accuracy of the three-dimensional reconstruction 

CT was high, in our study, its sensitivity and specificity was 99.83% and 99.89 % , respectively. 

CONCLUSION 

Pediatric airway foreign body aspiration is associated with a high rate of mortality. 3D CT is a non-invasive and useful examination of evaluating children with suspected foreign 

body aspiration. we must pay special attention to clinical history and 3D CT , improve the understanding of the complex and varied clinical manifestations and imaging findings, 

decrease the rate of misdiagnosis, misdiagnosis and delay treatment of FBA in airway. 


3D CT Should be applied in children with foreign bodies in airway 

VSPD32-10 • Neonatal and Pediatric, Portable, Digital-Radiographic AP Chest Imaging: Weight-specific kVp Selection to Optimize Effective Dose and Image Quality 

Samuel Richard , PhD, BSC * , Rochester, NY , Jacquelyn Whaley , MS * , Rochester, NY , Lynn La Pietra , PhD * , Rochester, NY , Steven Don , MD * , Saint Louis, MO , 

David H. Foos * , Rochester, NY 

PURPOSE 

Investigation of weight-specific kVp techniques for neonatal and pediatric, portable, digital-radiographic chest imaging to reduce effective dose (ED) and optimize image quality. 


A Monte Carlo-based software (PCXMC V.2) was employed to estimate the ED (ICRP 103) for AP chest exams across neonatal and pediatric body weights (6 patients, 0.3–19 kg) at 

three kVp (50, 60, and 70) with 0.1 mm Cu filtration added and fixed exposure to the detector behind the patient (1 mR). The image quality was assessed for the corresponding 

techniques by calculating the human-observer performance detectability index for the detection of small lung nodules imaged with a wireless CsI detector (DRX-1C, Carestream 

Health, Inc.). The ratio of image quality and ED was compared as a function of kVp and weight to evaluate overall imaging performance to identify the best kVp as a function of 

weight. 

RESULTS 

Under fixed detector exposure behind the patient, the ED was lower by 5% when using 50 kVp compared with 60 and 70 kVp for ≤3 kg neonates, and it was lower by 25% 

compared with the dose at 50 kVp when using 70 kVp for >3 kg pediatric patients. Under these same techniques, image quality in terms of the detectability index indicated 20% 

improvement with 50 kVp for patients with a weight of ≤3 kg compared with 60 and 70 kVp, and 5% improvement compared with 50 kVp when using 70 kVp for 10-19 kg 

patients. Overall imaging performance calculated from the detectability index-to-ED ratio indicated optimal performance when using: 50 kVp for patients ≤3 kg (improvement by 

30% compared with 60-70 kVp); 60 kVp for patients between 3 and 10 kg (improvements by about 5% compared with 50 and 70 kVp); and 70 kVp for patients between 10-19 kg 

(improvements by 15-30% compared with 50 and 60 kVp). 

CONCLUSION 

Pediatric patients are particularly sensitive to X-ray dose. This work provides a careful evaluation of the tradeoffs between image quality and ED to optimize imaging performance 

for the wide range of weight found across pediatric patients. Furthermore, this work demonstrates weight-specific kVp optimization for neonatal and pediatric portable digital 

radiography chest imaging. 


Typically less than 3 kg neonates are imaged at or above 60 kVp and this work highlights that they should be imaged a lower kVp to optimize imaging quality and effective dose. 

VSPD32-11 • Post-Infectious Bronchiolitis Obliterans in Young Children: CT and Clinical Features Predicting the Responsiveness to Pulse Methylprednisolone Therapy 

Hee Mang Yoon , MD , Seoul, Songpa-Ku, KOREA, REPUBLIC OF , Jin Seong Lee , MD , Seoul, KOREA, REPUBLIC OF , Jae-Yeon Hwang , MD , Seoul, KOREA, REPUBLIC OF , 

Young Ah Cho , Seoul, KOREA, REPUBLIC OF , Hye-Kyung Yoon , MD , Seoul, KOREA, REPUBLIC OF , Jinho Yu , Seoul, NA, Korea, Republic of , Soo-Jong Hong , Seoul, NA, 

Korea, Republic of , Chong Hyun Yoon , Seoul, Korea, Republic of 

PURPOSE 

To evaluate whether computed tomography (CT) and clinical features could predict the responsiveness to intravenous pulse methylprednisolone therapy (PMT) for the young 

children with post-infectious bronchiolitis obliterans (BO). 


From January 2000 to December 2011, a total of 65 children younger than 10 years old were diagnosed as post-infectious BO. Seventeen patients received PMT were included in 

this study. The patients were classified into two groups of responder and non-responder, according to the estimated percentage of area of air trapping on the pre- and post-PMT 

CT. We assessed the extent of air-trapping and the presence of thickened bronchial wall, bronchiolitis, and bronchiectasis on pre-PMT CT. We also reviewed the medical records 

and compared the age of the patients and the interval between the history of pneumonia and PMT. 

RESULTS 

Nine patients were classified as responder group, and eight as non-responder group. All patients in responder group showed thickened bronchial wall on pre-PMT CT, but only four 

of eight patients of non-responder group had thickened bronchial wall (p=.029). Bronchiolitis, bronchiectasis, and the extent of air-trapping were not significantly different 

between two groups. The interval between the history of pneumonia and PMT was significantly shorter in responder group than in non-responder group (median: 4 and 50 

months, respectively, p=.004). Patients in responder group were younger than those in non-responder group (mean: 3.9±4.3 and 6.9±2.9 years, respectively, p=.048). 

CONCLUSION 

We could predict favorable response to PMT in children with post-infectious BO on the basis of pre-PMT CT finding of thickened bronchial wall, PMT at a younger age, and the 

shorter interval between history of pneumonia and PMT. 


If young children with post-infectious bronchiolitis obliterans show the thickened bronchial wall on CT, we could anticipate the improvement of air-trapping by the prompt 

application of PMT. 

VSPD32-12 • Evaluation of Noise Reduction and Image Quality Improvement in Children Low-dose Chest CT Using Adaptive Statistical Iterative Reconstruction and 

Model-based Iterative Reconstruction 

Ji hang Sun , Beijing, China , Qi feng Zhang , Beijing, China , Yue Liu , MD , Beijing, Beijing, China , Xiao Min Duan , Beijing, CHINA , Yun Peng , MD , Beijing, China 

PURPOSE 

To evaluate the noise reduction and image quality improvement in children low-dose chest CT using adaptive statistical iterative reconstruction (ASIR) and a full model-based 

iterative reconstruction algorithm (VEO). 


18 children (age 3m~12y, mean age 5.8years) who underwent low-dose chest CT scans were included. Age-dependent noise index (NI) was used for the acquisition: NI=11 for 

0~1 year old, NI=13 for 1~3 years old, and NI=15 for 3~18 years old. Images were retrospectively reconstructed into 3 series with 0.625mm slice thickness: series A with VEO 

technique, series B with 40%ASIR and series C with conventional filtered back-projection (FBP). Two radiologists independently evaluated images including abnormal CT findings, 

normal lung structures, and subjective visual noise on a 5-point scale with 3 being clinically acceptable. Quantitative image noises on the left ventricle (LV) and muscle (MS) were 

measured and statistically compared between the three groups. 

RESULTS 

Average CTDIvol for the group was 1.19±0.78mGy. At 0.625mm slice thickness the image quality scores were 4.0, 4.1 and 2.3 for series A, B and C reconstructions, respectively; 

indicating both VEO and 40%ASIR provided acceptable image quality. On the other hand, quantitative image noises on LV and MS were (10.3 and 16.6), (22.8 and 23.2) and (27.2 

and 28.1), respectively, for series A, B and C. VEO reconstruction decreased image noise by 62% and 40% for left ventricle and muscle, respectively, compared to the conventional 

FBP reconstruction, and 55% and 28% compared to the 40%ASIR. 

CONCLUSION 

Compared to the conventional FBP reconstruction, overall image quality was improved by VEO and ASIR. The huge noise reduction (60%) of VEO compared to both FBP and ASIR

may be realized into dose reduction (70%-80%) in the future. 


The use of a full model-based iterative reconstruction algorithm (VEO) significantly reduces image noise and may provide significant radiation dose reduction to pediatric CT 


VSPD32-13 • Non-contact Respiratory Gated CNT Micro-CT Imaging of Mice and Usage in Delicate Mouse Models 

Daku Siewe , BS , Carrboro, NC , Laurel Burk , Chapel Hill, NC , Sean McLean , Chapel Hill, NC , Otto Zhou , PhD , Chapel Hill, NC , Yueh Z. Lee , MD, PhD , Chapel Hill, NC 

PURPOSE 

The goal of this study is to demonstrate the efficacy of using a novel non-contact sensor-gated carbon nanotube (CNT) x-ray micro-CT system to image mice with congenital 

diaphragmatic hernias. 


5 mice (4 wild type, one CDH) were imaged during peak inspiration and end-exhalation using a non-contact CNT micro-CT system. Micro-CT imaging was gated via non-contact 

respiratory sensor on an unconstrained animal. Animals were allowed to breathe freely during the imaging under isofluorane anesthesia. Images were reconstructed using 

isotropic voxels of 77-μm resolution (50 kVp, 400 projections, 30-ms x-ray pulse). Lung volumes were measured from CT images with region-growing techniques and thresholds 

derived from the surrounding air and soft tissues. Functional parameters such as tidal volume, FRC and minute volume, were calculated for each mouse. 

RESULTS 

Typical micro-CT imaging techniques usea physical sensor for gating and physical constraints to hold down the animal. This would be ineffective in a congenital diaphragmatic 

hernia model (CDH) and mouse pups since they are typically too frail or small (

C. The Postoperative Chest: Pitfalls and Pearls 

Jo-Anne O. Shepard MD, Boston, MA 


1) To recognize the expected and unexpected post operative findings follpwing various thoracic surgeries. 2) To know the complications and their imaging characteristics on CXR and 

CT. 


Post-operative complications are unique to the type of surgery performed. While all pulmonary resections are prone to pneumothorax from bronchopleural fistula, hemorrhage, 

pneumonia, and empyema, more unusual complications such as venous infarction, lobar torsion, and pulmonary artery pseudoaneurysm can develop. Pneumonectomy has a higher 

morbidity and mortality rate including complictions of non-cardiogenic pulmonary edema, cardiac volvulus, and post-pneumonectomy syndrome. Tracheobronchial surgeries may 

lead to dehiscence and delayed airway stenosis. Following eophagectomy chylothorax can develop from trauma to the thoracic duct and anastomatic dehiscence can develop leading 

to pneumomediastinum, mediastinitis or abscess. Aortic pseudoaneurysm may develop as a delayed complication of cannulation of the aorta during cardiopulmonary bypass. 

Median sternotomy may result in dehiscence and osteomyelitis manifesting as the "wandering wire sign". Retained foreign bodies including sponges and needles may act as a nidus 

of infection or erode adjacent blood vessels causing hemorrhage. Knowledge of these complicatons and recognition of their imaging appearances are essential for the optimal care 

of post-operative patients. 

Tuesday • 05:00 - 06:00 PM • Lakeside Learning Center 

CH 


LL-CHS-TUPM 


Edith Marom, MD 

LL-CHS-TU1C Sepsis Related Diaphragmatic Atrophy Quantification with CT Volumetry: A New Tool for Intensivists 

PURPOSE 

Intensive care unit (ICU) acquired myopathy is frequent and sepsis is a well-known risk factor. The diaphragm is particularly susceptible to sepsis in animal models but diaphragm 

atrophy is difficult to explore in-vivo. The aim of our study was to evaluate the diaphragm volume with CT scan in critically ill patients and compare it to physiological data assessed 

by diaphragmatic force measurement. 


23 Critically ill patients underwent repetitive diaphragmatic force measurement after non-invasive magnetic stimulation of the phrenic nerves and two thoraco abdominal CT’s, one at 

admission and one during the ICU stay (21days±7). Diaphragm, psoas volumes and diaphragmatic force were collected. 15 patients with normal thoraco abdominal CT scan were also 

included as control group comparable for age, weight and height. Diaphragm and psoas volumes were performed in the control group . Non-parametric analysis with a p

information. 

LL-CHS-TU3C Differential Chest CT Findings of Pulmonary Parasitic Infestation between the Paragonimiasis and the Non-paragonimiatic Infestation 

PURPOSE 

To understand the chest CT findings of pulmonary parasitic infestation and to analyze the differential findings between paragonimiasis and non-paragonimiatic infestation. 


Between January 2008 and November 2011, 75 patients (46 men; 52.9 ±14.1 years) with serologically proven parasitic infestation and available chest CT images were evaluated. 

CT images of 40 paragonimiasis and 35 non-paragonimiatic infestations (13 Sparganosis, 12 Toxocariasis, 8 Cysticercosis, and 2 Clonorchiasis) were assessed for the presence or 

absence and characteristics of pleural change, consolidation, cavitary lesion, aggregated cyst, worm migration tract, and pure ground glass opacity (GGO). The characteristics of 

consolidation include the size, perilesional GGO, perilesional centrilobular nodule, and internal low attenuation as well as the multiplicity and bilaterality 

RESULTS 

Most common pleural change (n= 30/75, 40%) was pleural effusion (32%) followed by pleural thickening and pneumothorax. Most common parenchymal lesion (n= 70/75, 93.3%) 

was consolidation (80%) followed by cavitary lesion, aggregated cyst, worm migration tract, and only pure GGO. The mean size of the maximal consolidation was 2.27 ± 1.64 cm. 

The consolidation usually accompanies perilesional GGO or perilesional centrilobular nodule or internal low attenuation. The multiplicity and bilaterality of pleuropulmonary lesion were 

57.3% and 42.7%, respectively. Accompanying internal low attenuation, perilesional centrilobular nodule, cavitary lesion, and worm migration tract was more frequent in the 

paragonimiasis than non-paragonimiatic infestation with statistical significance (p < or = 0.005) 

CONCLUSION 

Most common finding of pulmonary parasitic infestation is subpleural or peripheral consolidation, which frequently accompany the internal low attenuation and perilesional GGO. The 

presence of internal low attenuation, perilesional centrilobular nodule, cavitary lesion, and worm migration tract is more frequent in paragonimiasis than non-paragonimiatic 

infestation 


It may be assistive to know CT findings of non-paragonimiatic infestation as well as paragonimiatic infestation for the exact diagnosis of parasitic infestation. 

LL-CHS-TU3D National Trends in Resection of Benign Pulmonary Nodules: Association with CT and PET Imaging 

PURPOSE 

We examined national temporal trends in lung resections in order to test our hypothesis that there is a relationship between increased CT utilization and an increase in the resection 

of benign pulmonary nodules. 


We retrospectively identified all patients with a lung resection in the Nationwide Inpatient Sample (1993-2008) and included in our population those who had diagnoses that could 

present as a pulmonary nodule and be PET avid. Annual proportions of benign nodule resection (benign/total) were calculated. Bivariate and multivariate analyses were performed to 

examine annual trends in proportions of benign nodule resection while adjusting for age, sex, population lung cancer incidence, PET and CT utilization. Analyses were stratified into 

early (1993-2000) and recent (2001-2008) eras based on the initial recording of national PET utilization data in 2001. 

RESULTS 

1,202,357 patients had a principle procedure of lung resection from 1993-2008. 797,983 met inclusion criteria, 181,052 (23%) had benign pulmonary nodules and 616,931 (77%) 

had lung cancer. Prior to 2001, we found a direct association (p=.02) between proportion of annual benign nodule resections (1993-18.3%, 2000-23.3%) and CT utilization while 

adjusting for age, sex, and lung cancer incidence. From 2001-2008, there was a modest increase in proportion of benign nodule resections (2001-24.1%, 2008-25.4%) along with 

marked increases in both CT and PET utilization. However, in the adjusted model there was no apparent association of CT or PET utilization with proportion of benign nodule 

resections. 

CONCLUSION 

Benign pulmonary nodule resections in the US showed an annual proportional increase from 1993 to 2008. The greatest increase occurred prior to 2001 and was highly associated 

with CT utilization. Beginning in 2001, with the introduction of widespread PET utilization, there was no apparent association between benign resections and CT utilization. 


With widespread CT screening, avoiding benign resections will remain a diagnostic challenge, especially for PET-positive granulomas. 

LL-CHS-TU4C CT Findings of Pulmonary Tuberculosis Involving Basal Segments: Comparison with Tuberculosis in Apical or Apicoposterior Segments 

PURPOSE 

To compare computed tomography (CT) findings of pulmonary TB in basal segments and apical or apicoposterior segments 


We retrospectively reviewed chest CT scans of 986 consecutive adults who were diagnosed with active pulmonary TB. Active pulmonary TB confined to the basal segments was found 

in 21 patients. Sixty patients had disease localized to the apical or apicoposterior segments only. These groups were compared for differences in patient age, underlying disease, CT 

abnormalities of the lung parenchyma, airways, mediastinal and hilar lymph nodes, and pleura. 

RESULTS 

A significant difference was observed between the two groups with underlying disease prevalence associated with an immunocompromised state (basal, 6/21, 28.6%; apical or 

apicoposterior, 3/60, 5%; p = 0.008). Chest CT findings, including consolidation (p = 0.0016), lymphadenopathy (p = 0.0297), and pleural effusion (p = 0.008) were more common 

in basal segment TB than in apical or apicoposterior segment TB. Small nodules were less common in basal segment TB than in apical or apicoposterior segment TB (p = 0.0299). 

The tree-in-bud sign was the most common CT finding in both the basal segment TB (17/21, 81%) and apical or apicoposterior segment TB groups (53/60, 88.3%) (p = 0.4633). 

CONCLUSION 

Basal segment TB was commonly associated with an immunocompromised state and had typical CT findings of both primary and postprimary TB. However, basal segment TB was 

more common with other CT findings, which were previously thought to be typical radiologic findings of primary pulmonary TB. 


Understanding of CT findings of pulmonary TB involving only basal segments would be helpful for early diagnosis and treatment of TB. 

LL-CHS-TU4D Correlation of Radio- and Histomorphological Pattern of Pulmonary Adenocarcinoma 

PURPOSE 

Recently, a novel subtyping system with respect to tumor architecture has been proposed for pulmonary adenocarcinomas (ADC) and has been confirmed to have high impact on 

survival. We sought to investigate the correlations of radio- and histomorphological parameters. 


A total of 174 resected pulmonary ADC have been retrospectively analyzed. Histomorphologic ADC growth patterns (lepidic, acinar, papillary, micropapillary, solid) have been 

assessed and quantified according to the new histological classification of ADC. Morphological data from preoperative computed tomography (CT) imaging (including location, 

spheroid morphology, solid part-solid or non-solid appearance, percentage of ground glass opacity, margin configuration and bronchogram) of the resected pulmonary ADC were 

analyzed. Association between histomorphology, CT appearance and survival has been assessed. 

RESULTS 

Margin configuration as well as solidity/ground-glass opacity of ADC were associated with distinct histomorphological ADC growth patterns. Solid predominant ADC usually had 

smooth margins and were also solid in CT scans, while lepidic predominant ADC had mixed margins, were located in the periphery, showed brochogram, and were associated with a 

high percentage of GGO. In addition, non-spherical tumor growth was a negative predictor of overall and disease specific patient survival. 

CONCLUSION 

Some CT morphologic parameters are associated with histomorphologic growth patterns of pulmonary ADC. This may allow for the development of prognostic algorithms in 

non-resectable cases on the basis of biopsy data and radiological imaging. 


Combined CT and histomorphological analysis might have significant impact on ADC subtyping and respective algorithms might ultimately contribute to an improved outcome 

of patients. 

LL-CHS-TU5C Analysis of Nodule Detection CAD Performance in a Large Unselected Series of Chest Radiographs 

PURPOSE 

Until now, the performance of CAD systems on chest radiographs (CXRs) has been reported almost exclusively based on results obtained with small numbers of highly selected 

cases, which typically include either a limited number of nodules, or normal lungs. In order to simulate the effect of using CAD in routine clinical practice, we analyzed the results 

obtained in unselected cases which also had CT scans for verification. 


A commercial CAD system (ClearRead +Detect 5.2, formerly OnGuard 5.2, manufactured by Riverain Technologies) which incorporates bone suppression was used. We showed 

previously that the sensitivity of this system was 76% for selected malignant nodules, with an average of 0.5 false-positive (FP) marks per PA CXR. In the present study, we applied 

the same CAD to two sets of unselected CXRs. The first set included 106 consecutive patients with 46 erect PA and 60 portable AP CXRs who had chest CT scans on the same day. Of 

these, 81 patients had various abnormalities (10 patients with 23 nodules, 36 with diffuse lung disease, 21 patients with pleural effusion, and 14 with atelectasis or consolidation) 

and 25 patients had no significant abnormalities. Seventy one of 106 CXRs had medical devices or post-surgical changes. The second set included 102 normal subjects with 98 PA 

and 4 AP CXRs, by searching for key word “screening” in radiology reports. CAD performance and the radiological findings corresponding to FP marks were analyzed. 

RESULTS 

In the first set, CAD marked 18 of 23 nodules (sensitivity: 78%) on 10 CXRs. CAD had a mean of 1.5 FP marks per image on all 106 CXRs (0.7 on 25 CXRs with no significant 

abnormalities and 1.7 per image on 81 CXRs with various abnormalities). Among 154 FP marks, 51% were caused by abnormal opacities such as consolidation, scars or devices, 

and the rest were due to miscellaneous normal structures (49%). In the second set, 48 FP marks on 102 CXRs (0.5 FP marks per image) were caused by normal structures (90%), 

and abnormal opacities (10%) such as old rib fracture. 

CONCLUSION 

The CAD false-positive rate is very low in normal cases (0.5) and higher in abnormal cases (1.7), but most of the “false” marks are related to abnormal findings. 


Currently available nodule CAD for CXRs has a very low false-positive rate in normal cases, and many false-positive marks in abnormals are due to abnormal findings. 

LL-CHS-TU5D Lung Tattooing (LT) Combined with Immediate Video Assisted Thoracoscopic Resection (IVATR) as a Single Procedure in a Hybrid Room: Our 

Institutional Experience in a Pediatric Population 

PURPOSE 

To review our experience of Lung Tattooing (LT) and Immediate Video Assisted Thoracoscopic Resection (IVATR) performed as a single procedure in a hybrid room under the same 

anesthesia, for technical difficulties, complications and diagnostic yield of the procedure. 

Page 71 of 97


Retrospective analysis of 31 patients (16M; 15F) who underwent lung tattooing of 34 lesions (n=34), from January 2001 to July 2011. Data was collected from the Interventional 

Radiology database, Electronic Patient Chart (EPC), and Picture Archiving and Communication System (PACS). Mean age was 11.06±4.8 years; mean weight was 41.73±25.7 

kilograms. 

RESULTS 

A total of 34 (n=34) lesions were treated in 31 patients. Tattooing was performed on lesions ranging from 2 mm-20mm in size (Median=3mm), 0-13mm in depth (Median=2mm) 

from pleura, under CT (n=29) or ultrasound (n=5) guidance. Lesions were reached through a posterior (n=15), anterior (n=12) or lateral/oblique (n=7) approach. Autologous blood 

mixed with Methylene blue was used in a mixture of 10:1 (n=34). Technical success was 91.1% and diagnostic yield was 100%. Smearing of dye occurred in two, and 

non-visualization occurred in one patient. There was no morbidity, mortality or conversion to open thoracotomy. LT with IVATR was performed as a single procedure under general 

anesthesia in hybrid procedure room without requiring patient transfer. In 8 patients it was combined with other interventional radiological procedures and in 4 patients it was 

combined with other non-radiological surgical procedures with a median procedure time was 295 minutes. The median procedure time for remaining 24 patients was 197 minutes. 

CONCLUSION 

LT with IVATR as a single procedure in a hybrid room is safe and effective in pediatric patients, with several inherent advantages. 


Usage of hybrid suites is an excellent option for pediatric patients to perform the combined procedures with Interventional Radiology. 

Wednesday 08:30 - 10:00 AM 

Course No. RC501 • Room E353C 

New Frontiers in Imaging COPD and the Airways (An Interactive Session) 



CH 

A. Imaging Emphysema 

Alexander A. Bankier MD, Boston, MA * 


1) To understand the epidemiological and clinical importance of pulmonary emphysema. 2) To know the morphological subtypes of emphysema and their key CT characteristics. 3) 

To understand the role that emphysema plays in the context of chronic obstructive pulmonary disease (COPD). 

B. Phenotyping of COPD 

Philippe A. Grenier MD, Paris, Ile de France, FRANCE 


1) To know the different phenotypes of COPD patients which can be identified on CT scans. 2) To know the CT findings of inflammatory changes and wall remodelling of small and 

large airways occurring in COPD. 3) To understand the methods used for CT quantitative assessment of emphysema and airway wall remodelling. 

C. Smoking-related Interstitial Lung Diseases 

Jeffrey P. Kanne MD, Madison, WI * 


1) Describe the CT findings of smoking related interstitial lung diseases, including pulmonary Langerhans cell histiocytosis, respiratory bronchiolitis-associated interstitial lung 

disease, and desquamative interstitial pneumonia. 2) List the differential diagnosis for CT findings of smoking-related interstitial lung diseases. 

D. Small Airways Disease 

Eric J. Stern MD, Seattle, WA 


1) Understand the different HRCT manifestations of small airways diseases. 2) Appreciate the value of MIP imaging in evaluating small airways. 3) Understand the importance of 

supplemental imaging for evaluating patients with small airways diseases. 

Wednesday 08:30 - 10:00 AM 

Course No. RC551 • Room E261 

PET/CT in the Thorax: Interpretation, Pitfalls, and Future Developments (How-to Workshop) 



CH CT NM 

Osama R. Mawlawi, Houston, TX , PhD 

Edith Michelle Marom, Bellaire, TX , MD 

Mylene Thi Mytien Truong, Houston, TX , MD 

Eric Michael Rohren, Houston, TX , MD, PhD * 


1) The physics of SUV quantification. 2) Artifacts from the use of CT for attenuation correction: high CT attenuation material, respiratory artifact, truncation artifact. 3) Clinical pitfalls in 

interpretation: physiologic uptake and iatrogenic procedures. 4) To show current and future development of novel tracers for PET/CT. 


The routine use of integrated PET/CT in the staging and follow up of oncology patients has improved diagnostic accuracy but many interpretation pitfalls are encountered. These may be 

related to the physics of SUV quantification. Other potential pitfalls are introduced by the use of CT for attenuation correction, including those related to contrast media, the presence of 

metallic prostheses, or due to respiratory motion and truncation. However, other pitfalls in interpretation may be encountered due to biological factors, such as normal variants of FDG uptake, 

as well as uptake due to iatrogenic causes. Knowledge of these artifacts is important in preventing misinterpretation. Current and future developments in novel tracers will be discussed. 

Active Handout 

http://media.rsna.org/media/abstract/2012/9000264/lzqm844_9000264_RC551_Truong.pdf 

Essentials of Chest Imaging 

Wednesday • 10:30 - 12:00 PM • S100AB 

CH 


Course No. MSES42 


MSES42A • Congenital Lung in the Adult Patient 

Matthew David Gilman , MD , Boston, MA 


1) Understand the anatomic basis of the major congenital lung diseases (noncardiac) which may be seen in adult patients. 2) Understand and recognize their characteristic 

imaging features on chest radiography and cross sectional imaging. 3) Understand their pertinent clinical features and complications. 


Developmental anomalies of the lung, airways and pulmonary vessels are infrequently encountered in adult clinical practice. Although congenital lung anomalies may be subclinical 

for long periods, patients may become symptomatic and suffer significant morbidity when complications arise. To allow appropriate clinical management, it is important for imagers 

to be able to recognize and accurately diagnose these rare diseases when they do present. Although they are uncommon, the imaging features of congenital lung anomalies are 

often so characteristic as to allow their specific diagnosis. This session reviews the anatomic basis, characteristic imaging features, pertinent clinical features, and complications of 

the major developmental lung and airway anomalies. These include: disorders of bronchial development, bronchial atresia, congenital lobar overinflation, congenital pulmonary 

airway malformation (CPAM), congenital cysts, disorders of pulmonary vascular development (AVM, Scimitar, proximal interruption of the pulmonary artery, pulmonary sling) and 

disorders of lung and vascular development (sequestration). 

MSES42B• Understanding Lung Infections through Rad-path Correlation 

Tomas C. Franquet , MD * , Barcelona, N/A, SPAIN 


1) Summarize the radiologic and CT findings of some of the most common pulmonary infections. 2) Correlate imaging findings with the macroscopic and microscopic features. 3) 

Suggest a specific infection on the basis of the clinical setting, the natural history of infection, and the immunologic status of the host. 


Pulmonary infections are frequently encountered in our clinical practice and may present with different radiologic patterns at radiography and HRCT. Pathologically, different 

features may be found with pulmonary infections including: large nodules (with or without cavitation, granulomatous, abscess-like, infarct, histiocytic proliferations), small (often 

miliary) nodules (with or without granulomas, necrosis, inflammation, calcification), peribroncho-vascular and diffuse interstitial infiltrates, acute (broncho) pneumonia, diffuse 

alveolar damage, diffuse alveolar hemorrhage, organizing pneumonia, granulomatous interstitial pneumonia, eosinophilic reactions, bronchitis/bronchiolitis, and combinations of 

these. This session reviews the pathologic basis and characteristic imaging features in some of the most common infectious processes seen in both immunocompetent and 

immunocompromised patients. The parallel presentation of radiological image with the macroscopic and microscopic pathology will enhance the understanding of the diverse range 

of infectious pulmonary diseases. 

MSES42C • Cystic Lung Disease 

Page 72 of 97

MSES42C • Cystic Lung Disease 

Tan Lucien Hassan Mohammed , MD , Seattle, WA 


1) Become familiar with common cystic lung diseases, and their imaging patterns. 2) Understand imaging mimickers of cystic lung diseases and formulate appropriate differential 

diagnoses. 

Chest (Lung Nodule I) 

Wednesday • 10:30 - 12:00 PM • S404CD 

CH 

PRESIDING: 

H. Page McAdams , MD * , Durham, NC 

James G. Ravenel , MD , Charleston, SC 

Computer Code: SSK03 • AMA PRA Category 1 Credits: 1.5 • ARRT Category A+ Credit: 1.5 



SSK03-01 • 10:30 AM 

Computer Aided Detection Helps Radiologists to Detect Pulmonary Nodules in Chest Radiographs, When Having Bone Suppressed Images Available 

Steven Schalekamp MD * , Nijmegen, Gelderland, Netherlands • Bram van Ginneken PhD • Lorentz Quekel • Miranda Snoeren • Cornelia Maria Schaefer-Prokop MD • Nico 

Karssemeijer PhD * • Emmeline Koedam • Rianne Wittenberg MD 

PURPOSE 

Studies evaluating the effects of computer aided detection (CAD) to support radiologists in the detection of pulmonary nodules in chest radiographs (CXR) described the radiologists’ 

difficulties to discriminate true from false positive candidates. We investigated the effect of an improved CAD system on nodule detection performance in CXR with the additional 

availability of bone suppression images (BSI). 


Five radiologists and 3 residents served as observers and were asked to separately score location and confidence score for the detection of nodules in CXR without (mode A) and with 

the availability of CAD candidates (mode B). The study group consisted of 108 PA and lateral CXRs with a CT proven solitary pulmonary nodule and 192 age-matched CT proven 

negative controls. For both reading modes readers had BSI available. CAD marks and BSI were created by a commercially available software package (ClearRead +Detect 5.2, formerly 

Onguard 5.2; ClearRead Bone Suppression 2.4, formerly Softview 2.4, Riverain Medical, Miamisburg, Ohio). Multi reader multi case (MRMC) Receiver operating characteristics (ROC) 

were used for statistical analysis: partial area under the curve, at a specificity interval of 80-100% served as figure of merit. 

RESULTS 

Average nodule size was 17.5mm (7-36mm), with a malignancy rate of 83%. Standalone CAD performance was 74% with 1.0 FP/image. Observer performance significantly increased 

with the use of CAD and outperformed CXR with use of BSI (p=0.047). Mean sensitivity of the observers was 74% with 0.25 FP/image without CAD and 80% with 0.33 FP/image with 

CAD. Operating at a specificity of 90%, lung nodule detection sensitivity increased from 70.3% with CXR and BSI to 73.0% with additional availability of CAD. On average 10.5% of all 

true positive CAD marks were rejected by the radiologists, indicating potential for further improvement with the use of CAD. 

CONCLUSION 

Even with bone suppressed images available, computer aided detection shows additional value in lung nodule detection for radiologists. 


CAD and bone suppression images are both promising tools to decrease effects of misinterpretation and “unintentional blindness” as the most common causes of missing lung cancer 

on chest radiographs. 

SSK03-02 • 10:40 AM 

Diffusion-weighted MRI for the Detection of Pulmonary Nodules at 1.5 Tesla: Comparison with Standard T1w 3D-GRE and T2w STIR Imaging 

Marc Regier , Hamburg, GERMANY • Azien Laqmani • Frank Oliver Gerhard Henes MD • Michael Groth • Hendrik Kooijman * • Dorothee Schwarz • Gerhard B. Adam MD 

PURPOSE 

To intraindividually compare the diagnostic potential of diffusion weighted MRI (DWI) and standard T1w and T2w MR imaging sequences for the detection of pulmonary nodules at 1.5T. 


36 patients suffering from underlying cancer disease in which 64-slice MDCT had assured the presence of at least one pulmonary nodule, were examined at 1.5 Tesla using a sixteen 

channel torso coil. The imaging protocol consisted of a respiratory gated DWI (TR/TE, 2700/65ms; TI, 180ms; slice thickness, 4mm; b-factors, 0, 400, 500, 600 and 1000s/mm²), a 

T1w 3D-GRE (TR/TE, 4.9/2.4ms; slice thickness, 2mm) and a T2w STIR sequence (TR/TE, 3000/102ms; slice thickness, 4mm). All data were transferred to a dedicated workstation. 

Two blinded radiologists independently analyzed the MR data in a random order and assessed size and location of every nodule. The MDCT images served as the reference. For 

statistical analysis the sensitivity, specificity, positive-predicitive- (PPV) and negative-predictive-value (NPV) were determined for all sequences. The diameter and SNR of lesions, lung 

parenchyma and air were assessed. 

RESULTS 

Reading the CT data a total of 94 noduIes was found, ranging from 3 to 58mm. In nodules larger than 10mm, diagnostic accuracy was close to 100% for all sequences and readers. For 

nodules of 6-10mm the sensitivity of DWI (89%) was equivalent to T1w 3D-GRE (90%), but slightly lower than T2w STIR (95%). In lesions 

CONCLUSION 

This study confirms the feasibility of DWI to detect small lung lesions at 1.5T. In nodules >5mm DWI enables the depiction of lung lesions with detection rates comparable to T1w 

3D-GRE, but furthermore allows for a higher lesion-to-lung contrast. 


DWI might supplement morphology based cancer monitoring and treatment planning as it allows for lung nodule detection with high a contrast ratio and moreover also provides 

biological information. 

SSK03-03 • 10:50 AM 

Lung Cancer Early Diagnosis with Digital Chest Tomosynthesis: First Year Results from the SOS Study 

Maurizo Grosso MD , Cuneo, Italy • Liliana Comello • Roberto Priotto MD • Luca Bertolaccini • Emanuele Roberto • Alberto Terzi • Stephane Chauvie PhD * 

PURPOSE 

To prove the feasibility of Digital Tomosynthesis (DTS) of the Chest in the SOS (Studio OSservazionale) Study as an early diagnostic tool in high risk population for lung cancer and as 

an alternative to CT to have comparable accuracy at lower effective dose. 


The 1-year accrual started in December 2010. Smokers or former smokers (n. cygarettes/die * smoke’s years 400), aged 45–75 years without previous malignancy in the last 5 years were considered eligible. 

The subjects performed a chest X-ray and a DTS scan. Subjects with DTS lesions larger than 5 mm and non-calcified performed CT. DTS images were analyzed in consensus session by 1 experienced and 1 

resident radiologists. Effective doses were calculated with Monte Carlo and measured with TLD on an Alderson phantom for X-ray, DTS and CT. 

RESULTS 

1351 subjects were enrolled. In 979/1351 (72.5%) subjects no nodules were detected in DTS. 217/1351 (16.1%) subjects presented nodules below 5 mm and 155/1351 (11.5%) 

above, 99 (7.3%) of them non-calcifed. These subjects underwent CT scan. Lung cancer lesions were detected in 10/1351 (0.7%) subjects, 8 of them underwent surgical resection. 

221 nodules larger than 3 mm were detected by CT. 49/221 (22.2%) were detected by X-ray and 163/221 (73.8%) by DTS. In particular 39/128 (30.5%) and 126/128 (98.4%) 

nodules larger than 5 mm were detected by X-ray and DTS respectively. Effective dose for X-ray, DT and CT were respectively 0.05, 0.15 and 4 mSv. The mean effective dose given to 

a subject enrolled in the study was 0.71 mSv. 

CONCLUSION 

the sensitivity for nodules detection is significantly higher in DTS respect to X-ray. Detectability of DTS is almost comparable to CT for nodules larger than 5 mm, with four-fold less 

effective dose. DTS could represent an helpful alternative to low-dose TC in lung cancer screening. 


Early diagnosis of lung cancer in high risk patient 

SSK03-04 • 11:00 AM 

Analysis of the Detection of Lung Nodules in Volumetric CT Data by Radiology Residents Using Gaze Tracking 

Kingshuk Roychoudhury , Durham, NC • Martin Tall • Sandy Napel PhD * • Sukantadev Bag • Brian Harrawood MS • Geoffrey D. Rubin MD * 

• Justus E. Roos MD 

PURPOSE 

Detecting lung nodules in volumetric CT data is daunting because a large volume of complex anatomy must be exhaustively searched for the presence of small objects. We have 

developed a volumetric gaze tracking technique that records the gaze path as subjects page through CT lung volumes (LV). We analyze the gaze data to understand the process of 

detection and to identify influences on accuracy of detection in trainees. 


Three 1st year radiology residents (R) and two fellows (F) each studied a set of 40 LVs. For each study, one of 3 patient CT scans (2 M, 1 F; 120 kVp, 350-460 mA, 1-1.3 mm slice 

thickness) was chosen and 3 to 6 simulated nodules 4-6 mm in diameter were digitally embedded at various locations in the LV. In addition to the gaze path, recorded unobtrusively, 

subjects gave a location and confidence level from 1 to 5 for all detected nodules. The nearest distance (ND) from the gaze path to each nodule location was calculated for each study. 

For each study, we computed V = the percentage of total LV occupied by a cylinder of radius 50 pixels (13.4mm) with the gaze path as its axis. 

RESULTS 

Overall sensitivity was 57 %(mean) ± 2.8%(SD) for fellows and 49%± 2.8% for residents (p =0.01, logistic regression (LR). V had no significant effect on sensitivity (p =0.42, LR)). 

No detections were reported when ND was beyond 50 ± 9 pixels across readers, with no significant difference between R and F (p=0.61, two sample t-test). Residents were within the 

ND threshold for 83% ± 4% of nodules, significantly more than F, who were within the ND threshold for 75% ± 16% of nodules (p=0.007, LR). Inside the threshold, the sensitivity was 

79% ± 8% for F, significantly higher than 60% ± 10% for R (p

Preliminary results from this study suggest that successful identification of lung nodules requires training in two aspects: i) adequate spatial search of CT lung volumes ii) ability to 

discriminate l 

SSK03-05 • 11:10 AM 

The Clinical Evaluation of the Motion-Artifact-reducing Software for the Dual-Energy Subtraction Chest Radiography 

Osamu Honda MD, PhD , Amagasaki, Hyogo, Japan • Takeshi Iwaki • Kiyosumi Kawamoto • Mitsuhiro Koyama MD • Tsukasa Doi • Noriyuki Tomiyama MD, PhD • Hiromitsu 

Sumikawa MD • Masahiro Yanagawa MD, PhD • Misa Kawai • Tomoko Gyobu • Yutaka Kawata 

PURPOSE 

To evaluate the clinical utility of the motion-artifact-reducing software for the dual-shot energy subtraction radiography on a direct conversion flat-panel detector system. 


42 nodules of 28 patients, which were confirmed by chest CT examination, were included in this study. Dual energy subtraction radiography was performed in all patients. The lung 

field was divided into 4 lung fields (right, left × upper, lower), and 10 readers evaluated the chest radiograph, soft tissue image and bone image without the motion-artifact-reducing 

software. Those with the motion-artifact-reducing software were also evaluated one month later. The scores of the nodule detection were assigned from 0 (definitely normal) to 100 

(definitely abnormal) by readers’ confidence. The sensitivity of nodule detection was calculated with the score of not less than 90 in both lung and in 4 lung fields, and the statistical 

analysis was performed with paired t-test. 

RESULTS 

The sensitivity with the motion-artifact-reducing software (right lung: 45.9, left lung: 24.6) was significantly better than that without the motion-artifact-reducing software (right lung: 

36.9, left lung: 17.7) in both lung (p

can reliably predict nodule position on follow up CT. 


After IRB approval, 44 patients with sub-cm pulmonary nodules were identified from a lung cancer screening database. Two readers independently measured the distance of the 

nodules from the lung apex and the carina on the baseline and follow-up scans by cross-referencing the axial images with the CT scanogram on a PACS workstation. Maximal difference 

between the distances was calculated. Craniocaudal coverage was determined for the follow-up CTs by multiplying the number of images by the interval between images. 

RESULTS 

The mean difference in distances measured by the two readers (mean +/- SD) was 1.8 +/- 1.8 mm relative to the apex and 1.8 +/- 1.4 mm relative to the carina (Pearson’s correlation 

coefficients > 0.99). The mean maximal difference (MMD) between baseline and follow-up was 8.2 +/- 5.3 mm and 7.9 +/- 5.6 mm from the apex and carina (p = 0.68, paired 2-tailed 

t test). MMD was also not significantly different for subgroups of nodules above or below the carina (p = 0.89, and 0.48 respectively). The absolute maximal difference between 

baseline and follow-up was 24 mm from the apex and 29 mm from the carina. The average craniocaudal coverage on the follow-up scans was 32.1 +/- 3.5 cm. 

CONCLUSION 

Interobserver agreement was excellent for all measurements. The difference in nodule position between baseline and follow-up averaged < 1cm and in all cases was < 3 cm. There was 

no advantage in using the carina as a landmark, even for lower lung zone nodules. Since 99% of nodules should fall within a 4.8 cm scanning volume (MMD +/- 3SD), craniocaudal 

coverage of 6 cm centered around the expected nodule location measured from to the lung apex should reliably image target nodules, while reducing the average craniocaudal coverage 

and radiation dose by about 80%. 


Targeted nodule follow-up based on a measurement from the lung apex on baseline CT should result in an average 80% radiation dose reduction without disrupting radiologist or 

technologist workflow. 

Wednesday • 12:15 - 01:15 PM 

CH 

LL-CHE-WE 

Chest Lunch Hour CME Exhibits 

LL-CHE-WE6A A Picture is Worth a Thousand Words: Multimodality Characterization, Classification, and Staging of Malignant Pleural Mesothelioma 


PURPOSE/AIM 

The purpose of this educational exhibit is to present the various imaging appearances of malignant pleural mesothelioma and illustrate the updated staging system across multiple 

imaging modalities. 


The variety of intrathoracic manifestations of malignant pleural mesothelioma will be presented on chest radiography, CT, PET/CT, and MRI. Pathophysiology, diagnosis, staging, and 

treatment will be addressed. Specific similarities to other disease processes will also be discussed. 

SUMMARY 

Malignant pleural mesothelioma (MPM) is the most common primary malignancy of the pleura and is strongly associated with asbestos exposure. Mean survival time of patients 

diagnosed with MPM is approximately 12 months. However, improved survival has been demonstrated when the diagnosis is made at early stages of the disease. Therefore, it is 

important for the radiologist to be familiar with the imaging manifestations of MPM, the translation of these findings into the updated staging system, and the manner in which 

appropriate staging impacts treatment and survival. 

LL-CHE-WE6B Thoracic MRI: Lung Lesion Evaluation and Lung Cancer Evaluation and Staging 

PURPOSE/AIM 

Lung cancer is the leading cause of cancer related mortality in the US, accounting for nearly a third of cancer related deaths. Evolution of MRI technology has significantly improved 

MRI capability in lung nodule characterization and lung cancer staging. Recent developments in diffusion imagining have further contributed to enhancing utility in thoracic MRI 

imaging. Whole body imaging techniques provide fast and accurate staging tool. This exhibit aims to review the available MRI techniques, provide practical tips for protocol 

optimization and pictorial illustration of thoracic MRI abnormality spectrum. 


- Review current literature for thoracic MRI accuracy in evaluation of lung nodule and lung cancer staging.- Compare MRI performance with CT and FDG PET/CT.- Review thoracic 

MRI techniques with specific emphasis on diffusion imaging.- Provided practical tips for optimizing MRI technique.- Provide pictorial illustration of thoracic MRI abnormalities.- 

Illustrate application of MRI for comprehensive lung cancer staging. 

SUMMARY 

Advances in MRI technology and development of diffusion sequences have significantly enhanced MRI capability for lung lesions characterization and lung cancer staging. This exhibit 

reviews the available techniques and provides image-based illustration of the abnormality spectrum. 

LL-CHE-WE7A Before, During and After the Lung Transplantation: A Pictorial Review for the General Radiologist 

PURPOSE/AIM 

Perform an efficient pre-transplantation evaluation.Detect, recognize and differentiate the various life-threatening complications occurring at short and mid-term after lung 

transplantation.Propose adequate follow-up for the detection of chronic rejection and adverse effects of immunosuppression. 


1. Pre-transplantation recipient evaluation2. Surgical issues3. Immunological complications4. Infections5. General complications 

SUMMARY 

Lung transplantation is a valuable therapeutic option for patients with advanced non-neoplastic lung diseases, hindered by a relatively low long-term survival rate.Potential recipients 

go through a complete selection process, where non-invasive investigations are favored.Heavy post-operative complications are common; radiologists must have a good knowledge 

of the physiopathology and the natural history of lung transplantation to adapt their imaging protocols and their interpretation.Plain x-rays keep a major role in detecting early 

complications such as hemothorax, misplaced tubes, reperfusion edema, acute rejection and infections.Chest CT is the best examination for mid and long-term adverse outcomes, 

such as bronchial stenosis, chronic rejection, fungal infection, initial disease recurrence and lung cancer.Follow-up carefully adapted to clinical evolution is mandatory. 

LL-CHE-WE7B Iterative Reconstruction Techniques for Thoracic Computed Tomography: Not Just a Low Dose Technique! 

PURPOSE/AIM 

Iterative reconstruction (IR) methods have emerged in computed tomography (CT) as a method to reduce image noise and facilitate reduced patient radiation exposure. However, 

IR can significantly improve CT image quality in many other aspects. The purpose of this presentation is to review the fundamentals of iterative reconstruction techniques, the 

opportunities and challenges presented by the various generations of IR software and specific applications in thoracic CT. 


1. A historical overview of IR 2. A review of IR fundamentals across the generations of software iteration with clinical examples 3. Introduction to currently available IR software 4. 

Clinical examples of opportunities and challenges with current IR techniques. 

SUMMARY 

The potential for reduction in patient radiation dose is generally considered the biggest advantage of IR methods. However, specific IR techniques can significantly improve spatial 

resolution; reduce metallic beam hardening, blooming artifact and image noise. The practicality of using IR reconstructions for “real time” imaging will be addressed and the spectrum 

of in vivo application for IR techniques will be explored and illustrated with clinical examples. 

LL-CHE1125-WEA Hybrid PET/MR Imaging: The Technology and Its Applications in Thoracic Malignancies 

PURPOSE/AIM 

Outline the technology behind hybrid PET/MR scanners and review PET/MR imaging technology and its advantages and disadvantages versus PET/CT in staging of malignancies 

involving the thorax. 


1. Outline the technology behind hybrid PET/MR scanners.2. Describe imaging protocols for imaging the thorax with PET/MR3. Discuss rationale for potential application of hybrid 

PET/MR in imaging thoracic malignancies4. Clinical case based review of advantages of PET/MR imaging over PET/CT5. Illustrate disadvantage of PET/MR imaging in imaging of chest 

in patients with malignancies 

SUMMARY 

Recently introduced hybrid PET/MR equipments offer unique applications in staging of malignancies involving the thorax. Specific adjustments to MR imaging protocols are required to 

obtain attenuation correction sequences for PET component. The technique brings distinct advantages of MR to PET imaging as compared to CT in staging of the thoracic 

malignancies in particular for pleural, chest wall, diaphragmatic, and mediastinal involvement. This educational exhibit outlines the physical basis of PET/MR and illustrates the 

advantages and disadvantages of the technology versus the more established PET/CT with help of a gallery of clinical cases. 

Wednesday • 12:15 - 01:15 PM • Lakeside Learning Center 

CH 


LL-CHS-WE 

Chest Lunch Hour CME Posters 

Mylene Truong, MD 

LL-CHS-WE1A Low Volume Contrast Media CTPA With Dual-Energy CT Monoenergetic Imaging vs Routine CTPA: A Retrospective Study of Feasibility and Reliability 

PURPOSE 

To retrospectively evaluate the feasibility and reliability of low volume contrast media CTPA with dual-energy CT monoenergetic imaging. 

Page 75 of 97 

METHOD AND MATERIALS


This retrospective study was approved by the institutional review board. Sixty-six patients(29 Male/37 Female, age range 29-88 years) performed CTPA from June to December in 

2011 in our hospital were randomly sampled in this study. 35 patients were performed with 20ml contrast media in dual-energy CT, which was dichotomized as two kinds of 

monoenergetic imaging: 70KeV (group A) and optimal KeV (group B), while 31 in group C were examined in routine CT with 40-50ml contrast media. The signal intensity(SI) and 

noise index(NI) of pulmonary arteries were measured, and the signal-to-noise ratio(SNR) and contrast-to-noise ratio(CNR) were calculated. All images were blindly assessed by two 

experienced radiologists, the image quality score(IQS), central vascular enhancement(CVE) and peripheral vascular enhancement(PVE) were rated using a 5-point scale, and the PE 

numbers were marked. The radiation doses were recorded. 

RESULTS 

Compared with group C, the mean SI has no statistical significance with group A, but lower than group B(p


Clinicians may need to be educated on the limitations of a "limited" CTPA as single or multiple segmental or subsegmental PE can be missed on these exams, leading to potential 

mortality and morbidity. 

LL-CHS-WE3B Frequency and Origin of Lung Perfusion Defects on Dual-Energy Computed Tomography (DECT) in an Unselected Patient Group 

PURPOSE 

Lung perfusion defects seen on DECT are not necessarily caused by pulmonary embolism (PE) and therefore may cause interpretation difficulties. Purpose of the study was to assess 

frequency and underlying cause of perfusion defects on DECT in an unselected patient group. 


The study group consisted of 213 consecutive patients who underwent DECT for suspected acute pulmonary embolisms (APE) between May 2009 and April 2011. State-of the art 

protocols were used with a second generation DECT scanner. Two radiologists retrospectively analysed all scans with respect to the presence, morphology and location of perfusion 

defects. Perfusion defects were correlated with the lung parenchymal findings and CTPA (computed tomography pulmonary angiography) findings. 

RESULTS 

In n=200 (94%) of the included 213 patients, perfusion maps were available for evaluation. 22 patients were found positive for APE, a total of 138 separate APE were found. In 

38,4% of the APE a wedge shaped perfusion defect was detected, 36,3% gave no perfusion defects, 12,3% caused a non-wedge shaped defect and in the remaining APE (13%) the 

lung perfusion could not be evaluated due to underlying causes (eg consolidation). Wedge shaped perfusion defects were exclusively caused by APE.In 97% (n=194) of the patients 

at least one non-wedge shaped perfusion defect was found for which an underlying lung disease could be identified. These conditions included pleural fluid with compression 

atelectasis (45%, n=84), emphysema (30%, n=60) and pneumonic consolidations (29%, n=58). Most of the perfusion maps showed perfusion defects that were caused by artefacts 

such as beam-hardening (97%,n=194) typically at the level of the venous inflow or by pulsation artefacts (96%,n=192), mostly in the lingula. They could be identified by their 

location and correlating parenchymal findings. None of them was found to interfere with diagnosis. 

CONCLUSION 

In an unselected study group, the majority of patients show perfusion defects on DECT that are not caused by APE. Correct interpretation therfore requires close correlation with lung 

parenchymal findings and CTPA findings. 


Being familiar with the morphology of perfusion defects provides a clue for the underlying cause. 

LL-CHS-WE4A Non-contrast-enhanced 3T MR Angiography vs Time-resolved Contrast-enhanced 3T MR Angiography vs Contrast-enhanced 64-Detector Row CT 

Angiography: Preoperative Assessment of Pulmonary Vasculature in Non-small Cell Lung Cancer Patients 

PURPOSE 

To compare the capability for preoperative assessment of pulmonary vasculature in non-small cell lung cancer (NSCLC) patients among non-contrast-enhanced 3T MR angiography 

(non-CE-3T MRA), time-resolved contrast-enhanced 3T MR angiography (CE-3T MRA) and contrast-enhanced 64-detector row CT angiography (CE-CTA). 


A total of 49 consecutive stage IA NSCLC patients underwent non-CE-3T MRA, CE-3T MRA, CE-CTA and lobectomy with and without video-asisted thoracic surgery (VATS). 

Non-CE-3T MRA was performed by using cardiac- and respiratory gated flesh blood imaging (FBI) as well as time-space labeling inversion pulse (Time SLIP) imaging based on an 

arterial spin labeling technique. On each method, identifications of lobar and/or segmental pulmonary artery and vein, which were important for surgical procedures, in each patient 

were assessed by using a 5-point visual scoring system, and the final diagnosis was made by consensus between two readers. The interobserver agreement for pulmonary 

vasculature assessment on each method was assessed by weighted kappa statistics. Identifications of pulmonary vasculature were statistically compared among all radiological 

examinations as well as operative findings by Wilcoxon’s signed-rank test. 

RESULTS 

Interobserver agreements for pulmonary vasculature identification on all methods were almost perfect (0.87≤κ≤0.90). Identifications of pulmonary vasculature had no significant 

difference among all radiological methods (p>0.05). On the other hand, identification of pulmonary vasculature on each radiological method was significantly lower than those of 

operative findings (p

measurements. 

ISP: Cardiac (Dual Energy) 

Wednesday • 03:00 - 04:00 PM • S504AB 

CA CT 


PRESIDING: 

U. Joseph Schoepf , MD * , Charleston, SC 

Suhny Abbara , MD * , Boston, MA 

Konstantin Nikolaou , MD * , Munich, Bavaria, GERMANY 

Computer Code: SSM04 • AMA PRA Category 1 Credit: 1.0 • ARRT Category A+ Credit: 1.0 


SSM04-01 • 03:00 PM 

Cardiac Keynote Speaker: Monochromatic CT 

Xiangyang Tang PhD , Atlanta, GA 

SSM04-03 • 03:10 PM 

Monoenergetic Extrapolation of Cardiac Dual Energy CT for Artifact Reduction 

Francesco Secchi MD , Milano, MI, ITALY • Ullrich Ebersberger MD • Philipp Blanke MD • Garrett W. Rowe BS • Francesco Sardanelli MD * • U. Joseph Schoepf MD * 

PURPOSE 

The purpose of our investigation was to evaluate monoenergetic extrapolation of cardiac dual-energy CT (DECT) data for the potential of reducing artifacts from metal and high iodine 

contrast concentration. 


With IRB approval and in HIPAA compliance, 35 patients (22 men, 61±12 years) underwent dual-source CT based cardiac DECT (100 kVp and 140 kVp). Contrast material injection 

protocols were adapted to the patient’s weight, using nonionic low-osmolar 370 mgI/ml iopromide. Data sets were transferred to a stand-alone workstation and a dedicated 

monoenergetic analysis software was used for postprocessing. Reconstructions with the following six photon energies were generated: 40 kiloelectron-voltage (keV), 60keV, 80keV, 

100keV, and 120keV. Artifact severity was graded on a 5-point Likert scale (0=massive artifact, 5=absence of artifact). The size of artifact extent and image noise (expressed as 

HU-STD) in anatomic structures adjacent to the artifact were measured. Quantitative and subjective image quality was compared using Friedman and Wilcoxon tests. 

RESULTS 

We observed artifacts arising from densely concentrated contrast material in the superior vena cava (SVC) in 18 patients, from sternal wires in 14, from bypass clips in 8, and from 

coronary artery stents in 7. The size of artifact extension in monoenergetic reconstructions from 40 to 120keV decreased from 21.3 to 19mm for the SVC (p

were obtained at high keV images (100keV, 120keV and 140keV) than high keV images (40keV, 60keV and 80keV). 

CONCLUSION 

The FWHM of of ISLA the artery stent assessment can be improved using monochromic images (keV) in spectral CT imaging with fast kVp switching dual energy technology. 


The monochromic images (keV) in spectral CT imaging with fast kVp switching dual energy technology can improve stent diagnosis performance. 

Chest (Interventional) 

Wednesday • 03:00 - 04:00 PM • S404CD 

CH CT IR 


PRESIDING: 

Jo-Anne O. Shepard , MD , Boston, MA 

Baskaran Sundaram , MBBS , Ann Arbor, MI 

Computer Code: SSM05 • AMA PRA Category 1 Credit: 1.0 • ARRT Category A+ Credit: 1.0 


SSM05-01 • 03:00 PM 

C-arm Cone-beam CT Virtual Navigation-guided Percutaneous Transthoracic Localization of Pulmonary Nodules Prior to Video-assisted Thoracoscopic Surgery Using Barium 

Suspension 

Jae Yeon Wi MD , Seoul, KOREA, REPUBLIC OF • Chang Min Park MD, PhD • Jin Mo Goo MD, PhD * • Hyun-Ju Lee MD, PhD • Nyoung Keun Lee BA • Sang Min Lee MD 

PURPOSE 

To describe our initial experience of percutaneous barium marking for localization of small pulmonary nodules under C-arm cone-beam CT (CBCT) virtual navigation guidance prior to 

video-assisted thoracoscopic surgery (VATS). 


From August 2011 to March 2012, 24 consecutive patients (7 men and 17 women; mean age, 54 years; range, 41-70 years) with lung nodules eligible for limited resection with VATS 

underwent CBCT virtual navigation -guided percutaneous barium marking for the localization. A 140% barium sulfate suspension (mean amount, 0.15mL; range, 0.1-0.2mL) was 

injected around the nodules via a 21-gauge needle. The technical details including radiation exposure during the procedures, and procedure-related complication rates of CBCT virtual 

navigation guiding system were evaluated. 

RESULTS 

Barium marking was performed for 24 nodules (mean size, 8.2mm; range, 4-17mm): 13 pure ground-glass nodules, 5 part-solid nodules, and 6 solid nodules. All nodules were 

successfully marked within 10mm (mean distance, 3.2mm; range, 0-10mm) from the barium ball (mean diameter, 6.3mm; range, 2.5-10mm ) formed by the injected barium 

suspension. The mean procedure time was 10.3 min (range, 6-22 min). The mean radiation exposure during the procedures was 6.3mSv (range, 1.9-18.5 mSv). Complications included 

pneumothorax in one patient (4.2%) and aspiration of injected barium to adjacent airway in one (4.2%), which did not need any additional management. All barium balls were easily 

identified as radiopaque nodules on intraoperative fluoroscopy and target nodules as well as barium balls were successfully resected through VATS wedge resection. Pathology revealed 

10 adenocarcinoma- in-situ, 8 atypical adenomatous hyperplasias, 3 metastasis and 1 benign lesion. Two patients diagnosed as adenocarcinomas with frozen specimen underwent 

further lobectomy. 

CONCLUSION 

CBCT virtual navigation -guided percutaneous barium marking is an effective, convenient and safe pre-operative localization procedure prior to VATS, which enables accurate resection 

and diagnosis of small or faint pulmonary nodules. 


Small or faint pulmonary nodules which are eligible for limited resection by VATS can be localized accurately and safely with CBCT virtual navigation -guided percutaneous barium 

marking. 

SSM05-02 • 03:10 PM 

Impact of Antiplatelet Agents on Percutaneous Transthoracic Lung Biopsy-Related Hemoptysis 

Yong Sub Song MD , Seoul, Gyeonggi, KOREA, REPUBLIC OF • Chang Min Park MD, PhD • Hyun-Ju Lee MD, PhD • Mi-Suk Shim MD • Jin Mo Goo MD, PhD * • Kyung Woo Park • 

Kwanggi Kim PhD 

PURPOSE 

Antiplatelet therapy may aggravate the occurrence and severity of percutaneous transthoracic lung biopsy (PTLB)-related hemoptysis. Thus, the impact of antiplatelet therapy on 

PTLB-related hemoptysis needs to be studied for proper management. 


1346 PTLBs in 1251 patients constituted our study population. Among them, 163 PTLBs were performed in patients treated with antiplatelet therapy: 143 patients with single aspirin, 

12 patients with single clopidogrel and 8 patients with dual antiplatelet therapy, aspirin plus clopidogrel. Their influence on the occurrence and severity of PTLB-related hemoptysis was 

retrospectively evaluated. 

RESULTS 

Among 1346 PTLBs, there were 128 (9.5%) cases of hemoptysis including 21 severe hemoptysis (1.5%). Multivariate analysis revealed DAT (odds ratio (OR), 10.09), female sex (OR, 

1.88), smaller lesions (OR, 0.88), deeply-located lesions (OR, 1.17) and use of cutting needles (OR, 3.22) were independent risk factors for overall hemoptysis. For severe hemoptysis, 

DAT (OR, 13.02), ground-glass nodules (OR, 8.86) and deeply-located lesions (OR, 1.24) were proven to be independent risk factors. Single aspirin or clopidogrel was not a significant 

risk factor for either overall or severe hemoptysis. 

CONCLUSION 

Our results revealed that single antiplatelet therapy is not an independent risk factor for the occurrence of PTLB-related hemoptysis, whereas DAT increases risk. 


Patients who receive DAT with aspirin plus clopidogrel and are planning to undergo PCNB should be considered to discontinue antiplatelet therapy prior to PCNB if it can be done safely. 

SSM05-03 • 03:20 PM 

Percutaneous CT-guided Core and Aspiration Biopsy for Pulmonary Nodules Smaller Than 1 cm: 305 Procedures in Tertiary Referral Center 

Ji-Eun Kim MD , Seoul, Seoul, KOREA, REPUBLIC OF • Eun Jin Chae MD, PhD • Sanghyun Choi • Eun Young Kim • Sang Young Oh MD • Hye Jeon Hwang MD • Hyun Joo Lee • 

Sang Min Lee MD • Kyung-Hyun Do MD • Joon Beom Seo MD, PhD • Mi Young Kim • Jae-Woo Song MD, PhD 

PURPOSE 

We conducted a retrospectively analysis to evaluate the diagnostic outcomes of 305 computed tomography (CT)-guided fine needle aspiration and core biopsy for small pulmonary 

nodules measuring less than 1 cm. 


We determined the diagnostic yield of CT-guided aspiration and core biopsies performed with 20-gauge coaxial needles for 305 lesions in 290 patients. Independent risk factors for 

diagnostic failure (ie. nondiagnostic, false-positive, and false-negative results) were determined with multivariate logistic regression analysis. 

RESULTS 

The final diagnoses were established in 268 lesions of 305 lesions. Non-diagnostic biopsy results were obtained for 27 of the 268 lesions (10.1 %). The overall sensitivity, specificity, 

positive predictive value, and negative predictive value for the diagnosis of malignancy were 89.7% (148 of 165 lesions), 99.0% (102 of 103 lesions), 99.3% (148 of 149 lesions), and 

85.7% (102 of 119 lesions), respectively; diagnostic accuracy was 93.3% (250 of 268 lesions). Combined use of aspiration and core biopsy showed the higher diagnostic performance 

compared to aspiration alone or core biopsy alone (p=0.003) on univariate analysis. On multivariate analysis, the acquisition of two or fewer specimens (odds ratio [OR], 2.43; 

p=0.02), benign lesions (OR 2.50; p=0.03) and ground glass opacity nodules (OR, 1.89; p=0.01) were the significant risk factors for diagnostic failure. 

CONCLUSION 

CT-guided aspiration and core biopsies resulted in a high diagnostic yield in pulmonary nodules smaller than 1 cm. Factors such as the acquisition of two or fewer specimens, benign 

lesions, and ground glass opacity nodules significantly increased the rate of diagnostic failure. 


CT-guided aspiration and core biopsies are diagnostic methods in evaluation of pulmonary nodules smaller than 1 cm. 

SSM05-04 • 03:30 PM 

Comparison of CT-guided Fine Needle Aspiration vs Core Needle Biopsy of Pulmonary Nodules: Is Bigger Better? 

Page 79 of 97 

Bippan Sangha MD 

, Vancouver, BC, CANADA • Jennifer Jessup • John R. Mayo MD * • Robert O'Connor • Cameron John Hague MD 

PURPOSE 

To determine if there is a significant difference in outcome for 251 consecutive lung biopsies obtained with either core (CN) or fine needle (FN) biopsy. 


Using a retrospective cohort design, 126 consecutive CN (2006-2008) and 125 consecutive FN (2001-2003) were studied. Reviewing the medical and procedural imaging records we 

determined the rates of: pathologic diagnostic yield and confidence, biopsy related complications (pneumothorax, chest tube placement, pulmonary hemorrhage, hemoptysis), hospital 

admission, and biopsy complication-related hospital length of stay. The final diagnosis was confirmed by linkage with the provincial lung cancer data base or telephone contact with the 

referring clinician. Lung cancer registry and clinical follow-up was available to February 1, 2012 (mean follow up CN vs FN: 1041 vs 1738 days). 

RESULTS 

Significantly more (p0.05) difference was found in the sensitivity of CN compared to FN (89% (85/95) vs 95% (84/88)). No significance difference (p>0.05) was found in the 

specificity between CN and FN (100% (21/21) vs 81% (9/11)) or with false positive frequency (CN vs FNA: 0 vs 2). In outcome proven benign diagnosis, no significant difference 

(p>0.05) was found for sensitivity of specific benign diagnosis for CN compared to FN (24% (6/25) vs 17% (4/23)).No significant difference (p>0.05) was seen in complications of CN 

vs FN; CT detected pneumothorax (46% (59/126) vs 50% (62/125)); chest tube placement (4% (5/126) vs. 2% (2/125)), hemoptysis (6% (8/126) vs. 4% (5/125)), CT detected 

pulmonary hemorrhage (46% (58/126) vs. 38% (47/125)). No significant difference (p>0.05) was noted for both the number of hospital admissions (5/126 vs. 2/125) or the length of 

stay (4.6 vs. 2.5 days) for complications related to CN and FN. 

CONCLUSION 

Compared to FN lung biopsy, CN provided more diagnostic samples with no significant (p>0.05) difference in complication rate.


Core needle biopsy provides greater diagnostic yield with no significant difference in complication rate when compared to fine needle aspiration. 

SSM05-05 • 03:40 PM 

A Prospective Multi-Center Study to Evaluate the Safety and Accuracy of an Optical Needle Guidance System for CT-Guided Lung Biopsies 

Narinder S. Paul MD * , Toronto, ON, Canada • David Valenti * • Klaus Gast MD * • Louis-Martin Normand Joseph Boucher MD, PhD • Taebong Chung MD • Ganesan Annamalai MD 

• Alexandre Semionov MD, PhD • Patrik Rogalla MD • Robyn A. Pugash MD * 

PURPOSE 

To evaluate the utility of a new stereotactic optical needle guidance system in CT guided needle aspirations and biopsies (CT-NAB) of lung nodules, by prospectively measuring its safety 

and effectiveness across multiple institutions and radiologists. 


A multi-center, prospective, single-arm, un-blinded study conducted in 3 Canadian tertiary referral centers, with four hospitals, by 7 experienced interventional radiologists. Fifty 

patients clinically referred for CT-NAB of a suspicious lung nodule were enrolled between 8/2010 and 2/2011. The CT-Guide navigation system (ActiViews, Haifa, Israel) was used for 

needle guidance. The system consists of a self adhesive skin patch printed with colored and radio-opaque reference markers, a miniature needle hub mounted disposable video camera 

and a computer / screen combination to display the guidance information. The primary end point was the frequency of achieving a satisfactory position for CT-NAB. Other collected 

data included procedure time, number of CT scans, radiation dose, procedure complexity and all adverse events. 

RESULTS 

Forty eight subjects, 28 males, mean age 66.7y (range 36 to 89y) complied with all inclusion/exclusion criteria and completed the study. The mean lesion size was 3.25cm (range 

1.0-9.2 cm) with 10 lesions under 1.5 cm and 19 lesions larger than 3.0 cm. 71% of cases were characterized as complex due to small lesion size, location or patient pre-conditions. 

All subjects (100%), regardless of lesion size or complexity met the primary end point. Procedure time and number of CT scans had significant correlation (P=0.002) with procedure 

complexity level but not with lesion size. Only one subject (2.1%), with a 1.7 cm lesion in the left lower lobe, required a chest tube for a moderate pneumothorax that became 

symptomatic a day after the patient was discharged. All other adverse events were considered mild or moderate and none of them required any treatment. No adverse event was 

related to the navigation device. 

CONCLUSION 

The CT-Guide navigation system is safe and effective in assisting CT-NAB procedures of lung nodules. Utilizing the navigation system eliminated the established dependence of 

procedure time on lesion-size. 


The use of a navigation system to assist in CT-NAB of lung nodules is safe and beneficial especially in patients with small lesions. 

SSM05-06 • 03:50 PM 

Clinical Value and Affecting Factors of Open MR-guided Percutaneous Needle Lung Biopsy for Solitary Pulmonary Nodules 

Chengli Li , Jinan, Shandong, CHINA 

PURPOSE 

To explore the Clinical value and affected factors of Open MR-guided percutaneous needle lung biopsy for solitary pulmonary Nodules. 


A total of 284 patients with pulmonary nodule or tumor(253 cases of solitary, 31 cases of multiple foci) underwent MR-guided transthoracic biopsy in low-field open MRI equipped with IPath 

200 optical tracking system. In 164 patients, the lung nodule measured ≥ 3.0cm, in 103 patients, the lung nodule was 1.5 ~ 3.0cm,and in 17 patients, the lung nodule was≤ 1.5cm. Aspirating 

needles(MRI eye® Chiba) had been used to make specimens from the best-target level and site. MR-Compatible Biopsy needles (14 or 16 Guaue, Daum GmbH Schwerin,Germany)were used . 

RESULTS 

A total of 313 biopsies were done and got pathological specimens. The first puncture success rate of nodules≥ 3.0cm, nodules=1.5 ~ 3cm and nodules≤ 1.5cm were 100%, 98.6%, 

77.8%,respectively. 203 cases were malignant, and 70 cases were benign according to the puncture pathological diagnosis. The total diagnostic accuracy was 92.2% (263/284) for 

histologic specimens. The positive and negative prediction value were 100%(256/256) and 80%(28/35),respectively. 

CONCLUSION 

MR-guided percutaneous transthoracic needle biopsy of solitary pulmonary lesions is a successful efficient and safty diagnostic method with few complications. As a supplement to US 

or CT-guided biopsies,it is worth further clinical promotion and application. 


Interventional MRI, BIOPSY, solitary pulmonary lesion 

Controversy Session: V/Q Scans versus CT for Pulmonary Emboli 

Wednesday • 04:30 - 06:00 PM • E353C 



Computer Code: SPSC43 • AMA PRA Category 1 Credits: 1.5 • ARRT Category A+ Credit: 1.5 


Moderator 

Helen T. Winer-Muram , MD * , Indianapolis, IN 

Henry Duval Royal , MD , Saint Louis, MO 

Ann N. C. Leung , MD , Stanford, CA 

Helen T. Winer-Muram , MD * , Indianapolis, IN 


At the completion of the course the participants will be able to: 1) Understand the role of V/Q studies in the work up of patients with a suspected PE. 2) Understand the advantages and 

disadvantages of CT studies in the work up of patients with a suspected PE. 3) Use the information to select the more appropriate imaging modality in a given situation. 4) Understand 

the recommended diagnostic algorithm for the evaluation of pregnant women suspected of having a PE. 

Wednesday • 05:00 - 06:00 PM • Lakeside Learning Center 

CH 

LL-CHS-WEPM 



Jane Ko, MD 

LL-CHS-WE1C Bone Suppression Imaging Improves Observer Performance for the Detection of Lung Nodules in Chest Radiographs 

PURPOSE 

Overprojection by osseous structures has been reported in 22 to 95% of missed lung cancer cases as underlying reason for misdiagnosis. Purpose of the study was to assess the 

effect of bone suppressed imaging on observer performance in detecting lung nodules in chest radiographs. 

Page 80 of 97 


Posteroanterior and lateral digital chest radiographs of 108 patients with a CT proven solitary nodule, and 192 controls were read by 5 radiologists and 3 residents. Conspicuity of 

nodules on the radiographs was classified in four categories: obvious (n=32), moderate (n=32), subtle (n=28) and very subtle (n=16). Commercially available software (ClearRead 

Bone Suppression 2.4, formerly Softview, Riverain Medical, Miamisburg, Ohio) was used to generate bone suppressed images (BSI) of the PA radiographs. Observers read the PA 

and lateral chest radiographs without and with the availability of BSI. Anatomic locations of suspicion and confidence scores were digitally recorded. Multi reader multi case (MRMC) 

receiver operating characteristics (ROC) were used for statistical analysis: partial area under the curve using a clinically acceptable specificity between 80 and 100% served as the 

figure of merit. 

RESULTS 

Average age was 64.8 years for nodule patients and 63.5 years for controls. Average nodule size was 17.5mm (median 17mm). ROC analysis showed improved detection with use of 

bone suppression imaging compared to chest radiographs alone (p= 0.008). Operating at a specificity of 90%, lung nodule detection sensitivity increased from 67% without BSI to 

72% with BSI. Increase of detection performance was highest for moderate en subtle nodules with 11% (66% vs. 73%). Two of 8 nodules that were not reported by any of the 

observers with CXR alone, were seen by at least 4 observers with BSI. 

CONCLUSION 

Bone suppression imaging improves radiologists’ detection performance for pulmonary nodules, in particularly for nodules with intermediate conspicuity. 


Bone suppressed imaging of chest radiographs can prevent missing lung cancer caused by overprojection of bony structures. 

LL-CHS-WE1D Digital Tomosynthesis as a Problem-solving Imaging Technique to Confirm or Exclude Suspected Thoracic Lesions on Chest X-ray Radiography 

PURPOSE 

To assess the capabilities of digital tomosynthesis (DT) as a problem-solving imaging technique to confirm or exclude suspected thoracic lesions on chest x-ray radiography (CXR). 


Four-hundred-and-sixty-five patients (263 male, 202 female; age, 72.47±11.33 years) with suspected thoracic lesion(s) after the initial on-site analysis of CXR underwent DT. Two 

independent readers (experience, 3 and 20 years) prospectively analyzed in consensus CXR and DT images on a PACS–integrated workstation and proposed a diagnosis according to 

a confidence score for each lesion: 1 or 2=definite or probable benign lesion or pseudolesion deserving no further diagnostic work-up; 3=indeterminate; 4 or 5=probable or definite 

pulmonary lesion deserving further diagnostic work-up by computed tomography (CT). In patients who did not undergo chest CT the DT findings had to be confirmed by 6-12 months 

imaging follow-up. 

RESULTS 

DT identified a total number of 232 thoracic lesions, 195 pulmonary and 37 pleural, in 232/465 patients while in the remaining 233/465 patients DT did not confirm any lesion which 

were considered as pseudolesions. Pseudolesions included vascular kinkings (n=55 patients), anatomical lung variants as accessory fissures (n=20 patients), prominent cardiac 

auricula (n=32 patients), or composite areas of increased opacity resulting from overlap of vascular and bone structures of the chest (n=126 patients). Only 338/465 patients 

underwent CT since DT confirmed the presence of true pulmonary non-calcified lesion(s). Mean effective dose was 0.06 mSv (range 0.03–0.1 mSv) for CXR, 0.107 mSv (range 

0.094–0.12 mSv) for DTS, and 3 mSv (range 2-4 mSv) for CT. 

CONCLUSION

DT allowed to exclude all pseudolesions initially considered as potential thoracic lesions on the preliminary on-site assessment of CXR and allowed to exclude the presence of 

pulmonary lesions deserving CT assessment in about three-fourth of the patients. 


DT allowed to exclude immediately the presence of a true pulmonary lesion(s) avoding further patient diagnostic work-up with a much lower dose than CT. 

LL-CHS-WE2C Spectral CT Angiography Imaging of Bronchial Artery in Central Lung Cancer 

PURPOSE 

To evaluate the image quality of spectral CT angiography of bronchial artery and provide theoretical evidence of blood supply and intervention therapy for central lung cancer. 


45 central lung cancer patients underwent spectral CT examination using a single-tube, fast dual-tube voltage switching technique. 101 sets of monochromatic images were 

generated from 40keV to 140keV on HDCT (Discovery CT 750HD, GE Healthcare). Image noise and contrast-to-noise ratio (CNR) for bronchial artery from the monochromatic images 

were measured. An optimal monochromatic image set was selected for obtaining the best CNR for bronchial artery. The image noise and CNR of bronchial artery at the selected 

monochromatic level were compared with those from the conventional polychromatic images. Image quality was evaluated by 2 radiologists independently using a 4 point scale 

(4-very good and smooth, 3- good but not smooth, 2-diagnostic, 1-non-diagnostic). 

RESULTS 

The monochromatic images at 49keV were found to provide the best CNR for bronchial artery. At this level, the monochromatic images had 100% higher CNR than the polychromatic images 

with a moderate 33% noise increase. The image quality assessment was also statistically higher with monochromatic images at 49keV than conventional polychromatic images, 3.83 and 3.26 

respectively (p

CONCLUSION 

Preoperative PET imaging is frequently positive in carcinoid tumors and the biological behavior correlates well with SUV; whereas, size is not as strong of a predictor of malignancy. 

Size ≥ 3.5 cm and SUV ≥ 6 have a predictive value of > 95% for malignant histology. 


In patients with carcinoid tumors of the lung, pre-operative FDG-PET imaging can suggest a more aggressive biology. 

LL-CHS-WE4D The Effect of Iterative Reconstruction Technique on Image Quality of Contrast-enhanced Chest CT with Low Tube Voltage Settings 

PURPOSE 

To evaluate the image quality of an iterative reconstruction technique (iDose4) in contrast-enhanced chest CT with low tube voltage settings in comparison with standard-dose 

filtered back projection(FBP) CT in patients with normal body mass index(BMI). 


80 patients with normal body mass index (BMI) were referred for a contrast-enhanced chest CT. The patients were randomly assigned into groups 120-KVp and 80-KVp. Standard 

convolution FBP was used to reconstruct 120-kVp (group A) and 80-KVp (group C) image sets, and iterative reconstruction technique (iDose4) was used to reconstruct 80-kVp (group 

B) image sets. The mean image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and effective dose (ED) were assessed with each protocol. Image quality were 

graded (scale:1-3) and compared among 3 groups. 

RESULTS 

Radiation dose was 70.29% less for the low KVp protocol. Noise was significantly lower in low dose images reconstructed with iDose4 (Group B) compared to images reconstructed with 

FBP(Group C) for the 80 KVp setting, with a dearease of 26.74%. Group B had the highest SNR and CNR. There was no difference in subjective image quality scores between Group B and A 

(P>0.05). 

CONCLUSION 

In contrast-enhanced chest CT examinations, images reconstructed with iterative reconstruction technique had better image quality at a lower radiation dose than images 

reconstructed with a conventional FBP algorithm. 


using iDose4 as an additional radiation dose reduction tool may be a viable technique. 

LL-CHS-WE5C Ground-glass Nodules in Patients with Extrapulmonary Malignancies: Differentiation of Transient from Persistent Ground-glass Nodules 

PURPOSE 

To retrospectively investigate the clinical and thin-section CT features of transient ground-glass nodules (GGNs) detected in patients with extrapulmonary malignancies, and to 

determine the differentiating factors of transient versus persistent GGNs. 


Our institutional review board approved this retrospective study. From January 2005 to February 2012, 61 individuals with 76 GGNs and accompanying extrapulmonary malignancies 

were identified among 16,777 individuals who underwent chest CT. Their clinical features as well as the thin-section CT characteristics of each GGN were reviewed and compared 

between transient and persistent GGNs. To investigate the differentiating factors of transient from persistent GGNs and to measure their performance, logistic regression analysis and 

receiver-operating characteristics (ROC) curve analysis were performed. 

RESULTS 

Thirty-six (47.4%) of the 76 GGNs were transient. Between transient and persistent GGNs, there were significant differences in patient age, patient sex, mode of detection, presence 

of eosinophilia, multiplicity, lesion margin, lesion border, presence of pleural retraction, and presence of bubble appearance (P

VSCH51-03 • CTA for Pulmonary Embolism: Ten Ways to Do It Better 

Lawrence R. Goodman , MD , Milwaukee, WI 


There are many ways to optimize scanning for PE. This lecture will focus on 4 general areas: 1) Better patient selection. 2) Improving scan quality. 3) Optimizing dose reduction. 

4) Improving scan interpretation. 

VSCH51-04 • Impact of Iterative Reconstructions on the Diagnosis of Acute Pulmonary Embolism (PE) on Low-Dose CT Angiograms: Clinical Experience in 53 Patients 

Francois Pontana , MD , Lille, France , Simon Henry , Lille, North, France , Jean-Baptiste Faivre , MD , Lille, North, FRANCE , Nunzia Tacelli , MD , Lille, FRANCE , Sofiane 

Bendaoud , MD , Lille, North, France , Martine J. Remy-Jardin , MD, PhD * , Lille, FRANCE 

PURPOSE 

To evaluate the impact of iterative reconstructions on the diagnosis of acute PE on low-dose CT angiograms. 


53 consecutive patients suspected of acute PE were prospectively enrolled in a study designed to compare low-dose and full-dose images simultaneously available from the same 

dataset. The examinations were acquired in the conditions of routine clinical practice with (a) both tubes set at similar energy (120 kVp), and (b) the total reference mAs (i.e., 110 

mAs) split up in a way that 40% was applied to tube A (i.e., 44 eff mAs) while 60% was applied to tube B (i.e., 66 eff mAs) with a 4D dose modulation (mean DLP value of the 

53 examinations: 264.6±80.0 mGy.cm). Three series of images were generated: (a) full-dose images (generated from both tubes), reconstructed with FBP (Group 1), used as the 

standard of reference; (b) low-dose images (generated from tube A; 60% dose reduction) reconstructed with FBP (Group 2) and using an iterative reconstruction algorithm 

(Sinogram Affirmed Iterative Reconstruction; SAFIRE) (Group 3). 

RESULTS 

In Group 1: (a) acute PE was diagnosed in 8 patients (15%) with a total number of 82 endoluminal clots located at the level of central (n=5), segmental (n=39) and 

subsegmental (n=38) pulmonary arteries; (b) the mean level of objective noise (measured at the level of pulmonary arteries and chest wall muscles) was 41.41 ±3.75. In Group 

2, a significant increase in the mean level of objective noise compared to Group 1 (48.37 ±4.72; p30) patients undergoing CTPA 

using standard department protocol. Using Portal Software (Philips), circular regions of interest (ROI) were placed on the main, lobar, segmental, and subsegmental branches on 

the FBP image and copied to the identical location on the IMR image. CT attenuation (HU) and noise measurements (standard deviation) were made at each level. ROIs were 

placed in the paraspinal musculature to calculate contrast to noise ratio (CNR).The 50 reconstructions (25 FBP, 25 IMR) were anonymized and randomized. 3 blinded thoracic 

radiologists independently subjectively graded image noise, vascular enhancement, plastic appearance, image quality, and diagnostic confidence on a scale of 1 (very poor) to 5 

(ideal) for each category. Statistics for the measurements and reader scores were calculated using the 2 tailed t-test and Wilcoxon signed rank test, respectively. 

RESULTS 

25 patients (8M/17F) with an average age of 46.5 years (range 23-67) underwent CTPA. The average BMI was 40.1±9.6 (range 30.1-60.1). Average vessel attenuation was 

similar in the IMR (297.4 HU) and FBP (296.1 HU) groups. Vessel attenuation was similar at each PA level. Averaged noise was significantly lower in the IMR (7.7±2.2) compared 

to FBP (54±49.6) group (p

failure on CT. 

VSCH51-11 • Quantitative Lung Perfused Blood Volume Imaging on Dual-Energy CT: Capability for Quantitative Assessment of Disease Severity in Patients with Acute 

Pulmonary Thromboembolism 

Sachiko Miura , MD , Kashihara, Nara, JAPAN , Yoshiharu Ohno , MD, PhD * , Kobe, Hyogo, JAPAN , Yuko Nishimoto , MD , Kashihara city, shijocho840, JAPAN , Kimihiko 

Kichikawa , MD , Kashihara, Nara, Japan 

PURPOSE 

To investigate the capability for quantitative disease severity assessment of lung perfused blood volume (PBV) on dual-energy CT (DECT) in patients with acute pulmonary 

thromboembolism (APTE) 


18 consecutive APTE patients underwent contrast-enhanced DECT, echocardiography and/ or pulmonary angiography at the onset. Normalized lung PBV image was generated by 

pixel analysis in each patient. Then, normalized PBV (nPBV) in each lung field was determined by ROI measurement, and nPBV in total lung was calculated as averaged value from 

all ROI measurements. In addition, heterogenity of nPBV in total lung was also evaluated as standard deviation from all ROI measurements in each patient. According to the 

results of echocardiography, all patients were divided into right heart dysfunction (n=9) and non-dysfunction (n=9) groups. To determine the differences of nPBV images between 

two groups, mean nPBV and heterogenity were compared by means of Mann-Whitney U test. To evaluate the capability for disease severity assessment, both indexes were 

correlated with tricuspid regurgitation pressure gradient. To determine the feasible threshold value for distinguishing right heart dysfunction group from non-dysfunction group, 

ROC-based positive tests were performed. Finally, sensitivity, specificity and accuracy were compared each other by using McNemar's test. 

RESULTS 

Mean nPBV in total lung of right heart dysfunction group (50.6±22.3 %) was significantly lower than that of non-dysfunction group (106.6±30.2 %, p

acquired thoracic diseases in infants and children are reviewed. Important clinical aspects, characteristic imaging features, and key points that allow differentiation among various 

thoracic diseases that occur in a diverse spectrum of conditions including congenital anomalies, neoplasm, and infection are highlighted. 

Chest (Radiation Dose) 

Thursday• 10:30 - 12:00 PM • S405AB 


PRESIDING: 

Mannudeep K. S. Kalra , MD * , Boston, MA 

Narinder S. Paul , MD * , Toronto, ON, Canada 

Computer Code: SSQ03 • AMA PRA Category 1 Credits: 1.5 • ARRT Category A+ Credit: 1.0 


SSQ03-01 • 10:30 AM 

Effect of Localizer Radiograph on Radiation Dose Associated with Automatic Exposure Control: Human Cadaver and Patient Study 


Sarabjeet Singh MD , Boston, MA • Dean Pekarovic RT • Ethen Jamnik • Shima Aran MD • Akshay Saini • Sarvenaz Pourjabbar MD • Garry Choy MD 

MD * 

PURPOSE 

To evaluate the effect of localizer radiograph on CT radiation dose associated with automatic exposure control with a human cadaver and patient study. 

• Mannudeep K. S. Kalra 


With IRB approval and informed consent, a human cadaver (64 year old male) was scanned within 2 hours of death for chest CT on 64-slice MDCT(Siemens Definition Flash). The 

subject was placed supine with arms above the head and iso-centered in the gantry with the help of two orthogonal laser markers by two experienced CT technologists. Chest CT 

scans were repeated at 8 combinations of localizer radiographs (AP, AP-lateral, AP-PA, lateral-AP, lateral PA, PA, PA-AP, PA-lateral). Two chest image series with fixed tube current and 

combined longitudinal-angular automatic exposure control (AEC) were acquired with every localizer combination. In 20 patients (abdominal:n=10, chest:n=10), additional lateral 

localizer was acquired. Applied effective mAs, CTDI volume (CTDIvol), DLP and image noise were recorded for both cadaver and patient dataset. Data were analyzed using ANOVA and 

linear correlation tests. 

RESULTS 

CTDIvol (7 mGy) and image noise for images acquired with fixed mAs was identical regardless of number or combination of localizer radiograph. With AEC, the CTDIvol fluctuates with 

the number and projection of radiographs (p

CONCLUSION 

Reduced anatomic coverage CTPA for PE is feasible in 18-40 years age-group. The radiation dose is reduced by approximately 66%. Hence we highly recommend this technique in 

young patients. 


Reduced Z axis CTPA is feasible and reduces radiation by 66%, hence is highly recommended in pregnancy, young patients who get repeated scans or who have normal apices and 

bases on chest radiographs. 

SSQ03-05 • 11:10 AM 

Image Quality of the Lung on Ultralow Dose CT: Adaptive Statistical Iterative Reconstruction (ASiR) vs Model Based Iterative Reconstruction (MBIR) 

Masahiro Yanagawa MD, PhD , Suita, Osaka, JAPAN • Osamu Honda MD, PhD • Tomoko Gyobu • Yutaka Kawata • Hiromitsu Sumikawa MD • Noriyuki Tomiyama MD, PhD • Misa 

Kawai • Mitsuhiro Koyama MD 

PURPOSE 

To evaluate thin-section CT images of the lung reconstructed using ASiR and MBIR on ultralow dose CT by comparing to filtered back-projection (FBP). 


We obtained approval from our internal Ethics Review Board. Ten cadaveric lungs inflated and fixed by the method of Heitzman were scanned by CT (CT750HD; GE). CT images were 

obtained with a 0.625 mm-detector collimation, detector pitch (0.984:1), 0.4 sec-gantry rotation, 512x512 matrix, 120 kV, 20mA, and non-high resolution mode. All CT images were 

reconstructed at 0.625-mm slice thickness and 20-cm field of view with FBP, ASiR (ASiR30%,ASiR60%, and ASiR90%), and MBIR. Compared to FBP, the following CT findings were 

graded on a 5-point scale (1:worst


qCT measures of the lung airways are increasingly used to assess disease progression in COPD, cystic fibrosis, and asthma, but radiation dose concerns limit longitudinal studies and 

minimum achievable. 

SSQ03-09 • 11:50 AM 

Adaptive Iterative Dose Reduction Using Three Dimensional Processing (AIDR 3D) vs Filter Back Projection: Utility for Quantitative Bronchial Assessment on Low-Dose 

Thin-Section MDCT in Patients with Pulmonary Emphysema 

Hisanobu Koyama MD , Kobe, Hyogo, JAPAN • Yoshiharu Ohno MD, PhD * • Mizuho Nishio MD • Sumiaki Matsumoto MD, PhD * • Naoki Sugihara MS * • Kazuro Sugimura MD, PhD 

* • Daisuke Takenaka MD • Takeshi Yoshikawa MD * • Shinichiro Seki • Masaru Yoshii RT 

PURPOSE 

To evaluate the utility of adaptive iterative dose reduction using three dimensional processing (AIDR 3D) for quantitative bronchial assessment on low-dose CT (LD-CT) as substitution 

with standard-dose CT (SD-CT) in patients with pulmonary emphysema. 


Eighteen patients underwent SD-CT (150 mAs) and LD-CT (25 mAs) scans with a 16-detector-row CT scanner and pulmonary function test. Except tube current, other scan parameters 

had no difference between both protocols. In each patient, LD-CT was reconstructed by using AIDR 3D and filter back projection (FBP). In addition, SD-CT was reconstructed by using 

FBP. For quantitative bronchial assessment, wall area percentage of sub-segmental bronchi (WA%) and airway luminal volume percentage from main bronchus to the peripheral bronchi 

(LV%) were acquired in each data set. To evaluate the impact of reconstructed method for quantitative bronchial assessment on low-dose CT, correlation and the limits of agreement of 

WA% and LV% between SD-CT and both LD-CTs were statistically evaluated by using Pearson’s correlation and Bland-Altman analysis. To assess the correlation between quantitative 

bronchial assessment on each LD-CT and airflow limitation, WA% and LV% on each LD-CT were correlated %FEV1 by using Pearson’s correlation. 

RESULTS 

The correlation and limits of agreement for WA% between SD-CT and LD-CT reconstructed by AIDR 3D (correlation coefficient: r=0.87, p

To determine whether density mappings of HU values in inspiration and expiration computed tomography (CT) datasets are more precise for detection of air trapping (AT) than a 

threshold-based method in expiration alone. 


In a prospective study, forty-nine spirometrically controlled non-enhanced lung CT during inspiration and expiration were performed in lung transplant patients. Assessment of AT 

was performed using both, a standard threshold-based method in expiration (HU values from -910 HU to -850 HU) and density mappings of HU values in inspiration and expiration. 

To achieve a point-to-point correspondence of HU values in the density mappings, automatic segmentation of the lungs followed by non-rigid registration of the inspiration and 

expiration datasets were performed. Differences in HU-values ≤120 HU and ≤140 HU were measured using three threshold ranges (-910 HU to -800 HU, -910 HU to -750 HU, and 

-910 HU to -700 HU). Both methods were correlated with pulmonary function tests (PFT) using residual volume (RV) and the ratio of RV and total lung capacity (TLC) as correlating 

parameters. 

RESULTS 

Density mappings correlated significantly better with PFT than the threshold-based method. Cochran Q and McNemar testing revealed statistically significant differences of PFT, 

threshold-based method and different density mappings (p 

CONCLUSION 

Density mappings of HU-values showed significantly better agreement to PFT than the threshold-based method for detection of air trapping. Differences in HU-values ≤140 HU and a 

threshold range of -910 HU to -700 HU showed the best agreement when compared to PFT. 


The proposed method allows better assessment of AT for early treatment of bronchiolitis obliterans syndrome in lung transplant patients. 

LL-CHS-TH2A Computer-aided Diagnosis for Pulmonary Emphysema Classification Based on Texton Learning via Sparse Representation 

PURPOSE 

Computer-aided diagnosis for pulmonary emphysema is very important. The purpose of this study is to propose a reliable and high performance computational method for the 

classification of different kinds of pulmonary emphysema and normal pulmonary tissues. 


A novel pulmonary emphysema classification method is proposed in a statistics way of image morphological features using a texton learning via sparse representation. The proposed 

method mainly includes four stages: 1. With ROI (Region of Interest) image pre-processing, ROI images are normalized to have zero mean and unit standard deviation; 2. An 

overcomplete dictionary of textons is constructed via sparse representation; 3. texton feature histograms are learned from the training set; 4. Finally, a ROI image can be classified 

into the corresponding class by a classifier using the feature histogram. 

RESULTS 

The proposed scheme was applied to 18 patient cases of non-contrast CT images. Each CT image covers the whole torso region with an isotopic spatial resolution of 0.63 [mm] and 

a 12 [bits] density resolution. The test images were obtained from 18 different subjects, including 9 healthy subjects and 9 subjects with three subtypes of pulmonary emphysema, 

including Panlobular emphysema (PLE), Paraseptal emphysema (PSE), centrilobular emphysema (CLE) in different stage. Totally 1984 64×64 region of interests (ROIs) are extracted 

from the 9 healthy subjects and 1856 64×64 ROIs are extracted from 9 subjects with emphysema. In the experiments, training set was constructed only by 80 ROIs, which account 

for 4.2% of totally ROIs, for the healthy subjects and subjects with emphysema separately. The classification results are well in accordance with the diagnostic findings performed by 

doctors in HRCT. the proposed method achieve good ROI classification accuracies around 99% with parameter optimization. 

CONCLUSION 

Pulmonary emphysema classification based on texton learning via sparse representation is a promising method for computer-aided diagnosis of the emphysema disease. With this 

methods, the classification accuracy is steadily improved. 


This study shows that texture classification method based on texton learning via sparse representation is very useful for the computer-aided diagnosis in pulmonary emphysema 

classification in CT image 

LL-CHS-TH2B 4D Dynamic Low Dose CT Virtual Bronchoscopy for Diagnosis of Tracheobronchomalacia 

PURPOSE 

To correlate 4D dynamic low dose CT virtual bronchoscopy (DLD-VB) with pulmonary function tests (PFT) in detection of Tracheobronchomalacia (TBM). 


A prospective study recruiting 50 patents presenting with non-specific respiratory symptoms and no known history of airways or lung disease and stable symptoms. DLD-VB was 

performed using a volume CT with 320 x 0.5mm detector rows covering the central airway from the thoracic inlet to the first bronchial divisions. Patients maintained a 2s inspiratory 

breath-hold then exhaled quickly while 5 volume CT acquisitions using 120kv, 22.5-37.5mAs were performed. 0.5/0.5mm transaxial CT images were reconstructed using mediastinal 

and lung algorithms, 4D DLD-VB cine loops were created. All images were interrogated blinded to PFT results to record evidence of tracheomalacia i.e. reduction in AP airway 

diameter of ≥50%; as none (normal) or present; graded as tracheomalacia (TM), bronchomalacia (BM) or tracheobronchomalacia (TBM). Patients were grouped by PFT severity of 

COPD into; control group (none) – no COPD, GpA – mild, GpB-moderate and GpC-severe. Statistical analysis performed with Chi-square and Fisher’s exact test. Console DLP 

(mGy*cm) was read to determine radiation dose. 

RESULTS 

50 patients were enrolled (23M), 68y (50-85y), BMI = 29.2 (19.0-48.3).PFT grouping of COPD severity; none =12 (24%), mild=9 (18%), moderate=20 (40%) and severe=9 

(18%).DLD-VB grouping of airways disease; none =27 (54%), TM=13 (26%), BM=6 (12%), TBM=4 (8%).Patients with normal DLD-VB had PFT grading of COPD as; none=7 

(58%), GpA=5 (56%), GpB=12 (60%), GpC=3 (33%).Patients with TM, TBM or BM had PFT grading of COPD as; none=5 (42%), GpA=4 (44%), GpB=8 (40%), GpC=6 (67%) 

chi-square test p=0.636.After combining PFT groups (control + GpA + GpB) = GpD and comparing to GpC; with normal DLD-VB; GpD=24 (59%), GpC=3 (33%) and with TM, TBM 

or BM; GpD=17 (41%), GpC=6 (67%). Fisher’s exact test p=0.27. DLP = 286.4 (190.3-359.3), effective dose 4.0mSv (2.7-5.0mSv). 

CONCLUSION 

4D DLD-VB demonstrates significant airways collapse across a spectrum of PFT fndings from normal to severe COPD. Increased COPD severity trends to more severe airways 

collapse. 


4D Dynamic Low Dose CT Virtual Bronchoscopy is a promising tool for detection of Tracheobronchomalacia, is easy to perform and has an acceptable radiation dose profile. 

LL-CHS-TH3A Bronchial Diverticula Detected by MDCT: Comparison between COPD Patients and Healthy Volunteers 

PURPOSE 

With the routine use of thin-section MDCT scans, bronchial diverticula (BD) are increasingly recognized, but their prevalence and significance have not been fully determined. Our 

purpose is to compare the prevalence of BD between COPD patients and healthy volunteers (HVs) and to assess the relationship between BD and clinical and functional parameters in 

COPD patients 


We prospectively studied 100 patients meeting GOLD criteria for COPD (mean age 65 ± 7 yrs) and 81 HVs with normal pulmonary function tests (PFTs) and no history of smoking 

(mean age 47 ± 17 yrs). Participants underwent 64-MDCT (40 mAs, 120 kVp, 0.625 mm collimation, reconstruction of 0.625 mm axial and coronal oblique images, and 2.5 mm 

MinIP coronal oblique reformations). Number, size (maximum diameter), and location of BD in the central airways (subcarinal or main bronchi) were recorded. COPD patients also 

underwent PFTs, a 6-minute walk test (6MWT), and a validated cough-specific quality of life questionnaire. Bronchial wall thickness (Pi10) and extent of emphysema (%LAA-950) 

were analyzed in a subset of 50 COPD participants using an automated software program (Pulmonary Workstation version 2.0, VIDA Diagnostics, Coralville, Iowa). Differences in 

proportions were compared by Χ2 and in means by the T-test. 

RESULTS 

The prevalence of BD was 30% in HV and 28% in COPD patients (P=.81), and their mean size was 1.5 mm in HV and 1.4 mm in COPD patients (P=.82). No significant correlation 

between the number of BD and GOLD stage, pack yrs of smoking, FEV1, DLCO, cough severity, 6MWT distance, bronchial wall thickness, and extent of emphysema was found in 

COPD patients (all P values > 0.35). 

CONCLUSION 

BD have a similar prevalence in COPD patients and healthy volunteers, without correlation to smoking or COPD severity. 


As an incidental finding on CT scans, radiologists should not attribute BD to smoking or COPD. 

LL-CHS-TH3B Relationship between Change in Lung Volume and Change in Mean Lung Attenuation Across the Range of COPD Severity 

PURPOSE 

Quantitative CT (QCT) measurements of inspiratory and end-expiratory lung attenuation measurements are used to quantify and characterize obstructive lung disease. We chose to 

examine a cohort of healthy non-smokers, smokers, and former smokers to determine if severity of disease impacted the relationship of attenuation measures and lung volumes. We 

hypothesized that in healthier individuals, mean lung attenuation would change more for a given change in lung volume than in those with COPD. 


QCT measurements from volumetric inspiratory and end-expiratory thoracic CT scans for 3164 subjects enrolled in the COPDGene study (98 normal nonsmokers, 1392 smokers 

without COPD, and 229, 690, 478, and 277 smokers with GOLD stages 1, 2, 3, and 4 COPD, respectively) were made by trained analysts using Pulmonary Workstation 2 software 

from VIDA Diagnostics, Inc. TLC (total lung capacity), FRC (forced residual capacity) and mean lung attenuation (MLA) values were measured. The ratio of FRC to TLC (FRC/TLC) was 

compared to the ratios of inspiratory and end-expiratory measurements of MLA (MLA E/I). Results were grouped by GOLD stage, and linear regression analysis was performed. 

RESULTS 

Analyses were performed across all 3164 subjects and separately by GOLD stage. The mean and standard deviation of FRC/TLC was 0.578 ± 0.128. Across all 3164 subjects, the R2 

value, slope and y intercept of the regression equation between FRC/TLC and MLA E/I were 0.791, 2.57 and -1.83 respectively. In nonsmokers without COPD, the R2, slope and y 

intercept of regression equation were 0.782, 1.92, and -1.11. Corresponding values for smokers without COPD were 0.665, 1.59 and -0.81. Values for smokers with GOLD stages 

1-4 were: Stage 1 (0.658, 1.67 and -0.91), Stage 2 (0.663, 1.91 and -1.11), Stage 3 (0.556, 2.08 and -1.26), and Stage 4 (0.707, 3.44 and -2.55). 

CONCLUSION 

MLA E/I correlates strongly with FRC/TLC across the range of COPD severity. However, with increasing severity of COPD, the relationship between change in lung attenuation and 

change in lung volume alters substantially. 


Evaluation of the relationship between change in lung volume and change in mean attenuation may facilitate assessment of severity of air trapping in subjects with COPD. 

LL-CHS-TH4A Quantitative CT Assessment of Centrilobular and Paraseptal Emphysema and “Smoker’s Lung” Using Texture Features: Automated Classification of 

Smoking-related Lung Injury 

PURPOSE 

Quantification and subtyping of smoking-related lung injury may be helpful in phenotyping disease and measuring treatment response. This study shows an automated texture-based 

Page 88 of 97

method to identify the extent and pattern of emphysema and/or “smoker’s lung” (centrilobular nodularity, respiratory bronchiolitis) on CT images. 


Chest CT scans were obtained from 6 non-smokers with no emphysema (NNE), 6 smokers with no emphysema (SNE), 6 smokers with centrilobular emphysema (CLE, GOLD stages 

1-3), and 6 smokers with paraseptal emphysema (PSE, GOLD stages 1-3) in the COPDGene Study. Regions-of-interest (ROIs) of 35-pixel diameter representing normal tissue in 

the NNE scans, centrilobular nodularity in the SNE scans, CLE in the CLE scans, and PSE in the PSE scans were manually selected. In total, 678 NNE ROIs, 438 SNE ROIs, 292 CLE 

ROIs, and 166 PSE ROIs were selected.30 texture features were computed for each ROI and employed in a two-stage decision tree classifier that first classified ROIs as 

emphysematous or non-emphysematous and subsequently discriminated between CLE and PSE among the ROIs deemed emphysematous and between normal and “smoker’s lung” 

textures among the remaining ROIs. A 6-fold, randomized cross-validation procedure was used to train and evaluate the classifier. 

RESULTS 

84.2% of ROIs from NNE scans were classified as normal, while 13.6% were classified as “smoker’s lung” and 2.2% as CLE (p < .001). Of SNE ROIs, 79.6% were classified as 

“smoker’s lung”, while 19.2% were classified as normal and 1.1% as CLE (p < .001). While 81.8% of CLE ROIs were classified correctly, 5.2% were classified as “smoker’s lung” and 

10.3% as PSE (p < .001). Of PSE ROIs, 91.0% were correctly classified, while 6.6% were classified as CLE and 2.4% as non-emphysematous (p < .001). 

CONCLUSION 

Near-complete discrimination between emphysema and non-emphysematous tissue is achieved by our automated scheme. Although there was overlap between normal and 

“smoker’s lung” textures, as well as between CLE and PSE textures, the four classes of texture are clearly distinct. Thus, disease type and extent can be quantified in patients with 

smoking-related lung injury. 


Objective identification and quantification of smoking-related lung injury may be helpful in directing treatment and monitoring patient response to therapy. 

LL-CHS-TH4B A Method for Generating Solitary Pulmonary Nodule Contour Models Based on a Stipulated Empirical Definition for Detecting Contour Features 

CONCLUSION 

We stipulated an empirical definition of contour differentiation for solitary pulmonary nodules using a numerical scoring system and generated representative contour models. Pre-set 

score based on the stipulated definition showed a high agreement ratio with two expert radiologists. The stipulated definition of solitary pulmonary nodules will be expected to play 

important roles in intra-group sharing of information on nodules, in numerical understanding of the contour, and in the education of radiologists in training. 

Background 

The contour of solitary pulmonary nodules obtained with computed tomography (CT) shows important information for differential diagnosis. Nevertheless, it is well known that there 

is frequent discrepancy in diagnosing nodules for the ambiguous definition of contour among radiologists. Therefore, we attempted to stipulate an empirical definition of contour 

differentiation based on numerical scores and generated models for sharing of nodule information. Furthermore, we investigated the relationships between the pre-set scores of the 

contour model and radiologists' scoring. 

Evaluation 

Solitary pulmonary nodules with a well-defined contour seen on CT were selected. The categorization and the scoring of nodules were stipulated by two highly experienced 

radiologists specializing in thoracic images. The features of the contour were grouped into 7 categories (smooth, ragged, corona radiata, coarse spiculation, notch, concave and 

convex). Each feature was scored on a 5-point scale. The 7 features were synthesized by the pixel operations of the polygon with custom-designed software using Matlab(R) 

(Mathworks, Natick, MA, USA). The 25 synthesized nodules embedded in a thoracic CT image were differentiated with the 5-point scoring system by two radiologists (A and B). 

Discussion 

The agreement ratios between the pre-set scores and the radiologists' ratings was 65% (A: 67.8, B: 62.2). If a difference of ±1 is included in the agreement, the ratios was 86.7% 

(A: 87.8, B: 85.6). The agreement ratios within ±1.96 SD was 96.2% (A: 96.7, B: 95.6). 

LL-CHS-TH5A Measuring Treatment Response in Lung Cancer: Does Volumetric CT Allow for a Better Prediction? 

PURPOSE 

With the introduction of multidetector CT, volumetric measurements of tumor size have become feasible. We set out to investigate if the greater accuracy of volumetric tumor 

measurements allows for a more accurate prediction of treatment response, as measured by patient survival, in patients with advanced non small cell lung cancer (NSCLC). 


Patients with non resectable NSCLC (stages III or IV, n=100) who were repeatedly evaluated for treatment response by CT were included. Tumor response was measured by 

comparing tumor dimensions using response evaluation criteria for solid tumors (RECIST), and comparing tumor volumes over time (Vitrea, Vital Images). Patient survival was 

compared with the size criteria for treatment response using Kaplan Meier survival statistics and Cox regression analysis. 

RESULTS 

Median overall patient survival was 760 days (std. error: 186 days), for stage IIIA: 853 days, IIIB: 826 days, IV: 587 days. There was substantial overlap of survival between the 

stages, and the survival difference was not statistically significant (p=0.4). Using RECIST, 5 patients demonstrated complete response, 41 partial response, 47 stable disease, and 7 

progressive disease. Patient survival was not significantly associated with RECIST class (p=0.47), nor the change of the sum of tumor diameters (p=0.47), or the change of the sum 

of volumetric tumor dimensions (p=0.45). 

CONCLUSION 

In a group of 100 patients with advanced NSCLC, CT measurements of tumor size did not significantly predict patient survival, and the use of the geometrically more accurate 

volumetric measurements did not improve the predictive powers. These observations are in accordance with some earlier data from the literature, and suggest that the size response 

to treatment may not be a useful parameter to drive treatment decisions in individual patients. 


Volumetric CT measurements are not significantly associated with patient survival in patients with adavnced non small cell lung cancer. 

LL-CHS-TH5B Relating Automatic Quantification of Airway Wall Thickness, Emphysema and Air Trapping in Inspiration and Expiration Chest CT Scans to COPD GOLD 

Stages 

PURPOSE 

Previous studies investigated the relation of emphysema and air trapping measurements to COPD GOLD stages. This study investigates the additional value of airway wall thickness 

measurements in inspiration chest CT scans. 


A database of low-dose chest CT scans of control subjects (GOLD 0, n=44) and COPD subjects (GOLD I-IV, n=45/44/41/34) was used. In house developed software (Fraunhofer 

MEVIS, Bremen, Germany; Diagnostic Image Analysis Group, Nijmegen, the Netherlands) automatically segmented the lungs and airways in both the inspiration and expiration 

scans. Airway wall thickness was assessed in orthogonal cross-sections every 1mm throughout the entire airway tree (inspiration only) using an intensity-integration technique which 

accounts for partial volume effects. Wall thickness was averaged across all cross-sections with a lumen diameter of 2.75-3.25mm (WT3). Emphysema was determined as the 

percentage of lung volume below -950 HU in inspiration scans (IN-950), air trapping was determined as the percentage of lung volume below -850 HU in expiration scans 

(EX-850).Multiple linear regression models for different combinations of CT measurements (IN-950, EX-850, WT3, IN-950 & EX-850, IN-950 & WT3, IN-950 & EX-850 & WT3) as input 

variables and numeric GOLD stage (integer number 0-4) as output variable were established and compared to each other in terms of adjusted squared correlation coefficient R2 

between output of the regression model and true GOLD stages. 

RESULTS 

The overall highest correlation was observed for the combination of all three measurements as input variables with adjusted R2=0.72, closely followed by R2=0.69 for the 

combination of inspiration only measurements IN-950 and WT3. Lower values were observed for all remaining models (IN-950 & EX-850: 0.64 / EX-850: 0.64 / IN-950: 0.53 / WT3: 

0.23). 

CONCLUSION 

The combination of airway wall thickness and emphysema measurements from only inspiration CT scans provides more information for the prediction of lung function as determined 

by GOLD stages than combination of emphysema and air trapping measurements in inspiration and expiration CT scans. 


Airway wall thickness measurements contribute valuable information for the prediction of lung function from chest CT scans and may provide additional insight into development of 

COPD. 

LL-CHS-TH6A Can Iterative Reconstruction Restore Image Quality at 60% Dose Reduction: Clinical Experience in 50 Patients with Simultaneous Availability of 

Low-Dose and Standard-Dose Images from Dual-Source Datasets 

PURPOSE 

The main objective was to compare image quality of low-dose images reconstructed with a raw-data-based iterative reconstruction algorithm (Sinogram Affirmed Iterative 

Reconstruction; SAFIRE) with standard-dose filtered back projection (FBP) CT. The secondary objective was to evaluate the impact of SAFIRE on the detection of CT features of lung 

infiltration. 


50 consecutive dual-source chest CT datasets, acquired in the conditions of routine clinical practice (120 kVp; 110 mAs) with (a) both tubes set at similar energy, and (b) the total 

reference mAs split up in a way that 40% of the reference mAs was applied to tube A (i.e., 44 eff mAs) while 60% of the reference mAs was applied to tube B (i.e., 66 eff mAs) 

with a 4D dose modulation. Two series of images were generated: (a) full-dose images (generated from both tubes) reconstructed with FBP (Group 1); and (b) low-dose images 

(generated from tube A; 60% dose reduction) reconstructed with SAFIRE (Group 2). The CT parameters analyzed on both groups of images included: (a) subjective and objective 

image noise on lung and mediastinal images; (b) the presence and conspicuity of elementary lesions of lung infiltration. 

RESULTS 

In Group 2 images, there was: (a) a significant reduction in the objective image noise measured at the level of the trachea on mediastinal (16.04 ±5.66 vs 17.66 ±5.84) (p=0.0284) 

and lung images (29.77±6.79 vs 37.96 ±9.03) (p

137 patients with suspected PE underwent monochromatic pulmonary CTA using gemstone spectral imaging mode with pitch of 1.375 and fast switching of 80 and 140 kVp on a GE Discovery 

CT750 HD scanner, Monochromatic image data sets and iodine-based material decomposition images with 0.625-mm slice thickness were reconstructed and processed on the dedicated 

workstation(Advantage Workstation 4.4, GE).Monochromatic CT angiographic images were reviewed for the identification and localization of pulmonary embolism. The number and location of 

perfusion defects were also recorded on the iodine maps .The iodine density of perfusion defects and normal lung parenchyma of the same or equivalent level on the iodine maps were 

measured and compared..Two independent samples T-test were used to compare iodine density between different groups. 

RESULTS 

For 96 patients, iodine distribution was homogeneous and CT angiography showed no pulmonary embolism. A total of 401 clots were detected in 41 patients (21 man,20women; mean age 

63.90±14.76), with main (n=36), lobar (n=90),segmental (n=194) and sub-segmental (n=81) distribution. And there were 154 iodine distribution defects along with these clots. There was a 

significant difference in iodine density between normal lung parenchyma [(23.86±8.99)100μg/L] and iodine distribution defects [(4.86±4.62) 100μg/L] (t=-18.823,P

deployment mechanisms, and trial data. 3) Discuss the use of investigational devices for the endovascular repair of thoracoabdominal aortic aneurysms. 4) Analyze the normal 

appearance and post-procedural complications of aortic endografts on follow up imaging including CTA and MRA. 

D. Postendograft Imaging Essentials 

Geoffrey D. Rubin MD, Durham, NC * 


1) To understand the spectrum of complications and techniques for demonstrating and identifying those complications following endovascular repair of aortic aneurysms. 

Thursday 04:30 - 06:00 PM 

Course No. RC714 • Room E353C 

Acute and Chronic Pulmonary Emboli: Diagnosis and Treatment (An Interactive Session) 



CH VI IR ER 

William Tom Kuo, Stanford, CA , MD * 

Anne C. Roberts, San Diego, CA , MD * 


1) To understand the current guidelines and approach to endovascular therapy for acute massive and acute submassive PE. 2) To evaluate the best imaging and diagnostics for acute 

pulmonary emboli, and to use current PE algorithms to determine appropriate therapy for acute emboli. 3) Findings indicating chronic pulmonary emboli on a variety of imaging technologies. 

4) Participants will also be exposed to the surgical therapy available for chronic pulmonary emboli, and the results of that surgery. 


Acute pulmonary embolism (PE) is the third most common cause of death among hospitalized patients. Treatment escalation beyond anticoagulation therapy is necessary in patients with 

massive PE (defined by hemodynamic shock) as well as in many patients with submassive PE (defined by right ventricular strain). The best current evidence suggests that modern 

catheter-directed therapy to achieve rapid central clot debulking should be considered as an early or first-line treatment option for patients with acute massive PE; and emerging evidence 

suggests a catheter-directed thrombolytic infusion should be considered as adjunctive therapy for many patients with acute submassive PE. This course reviews the current approach to 

endovascular therapy for acute PE in the context of appropriate diagnosis, risk stratification, and management of acute massive and acute submassive PE. 

Thursday 04:30 - 06:00 PM 

Course No. RC717 • Room S504CD 

Quantitative Imaging in Lung Disorders 



CH BQ 

David Augustine Lynch, Denver, CO , MD * 

James D. Crapo, Denver, CO , MD 

Harvey Owen Coxson, Vancouver, BC, CANADA , PhD * 

David Augustine Lynch, Denver, CO , MD * 


1) Describe the methodology and limitations of non-invasive imaging in quantifying lung structure. 2) Describe the opportunities for non-invasive imaging in understanding the structure of the 

lung, and how that relates to phenotyping subjects for clinical trials and longitudinal studies. 3) Understand the clinical relevance of quantitative imaging of COPD. 4) Learn how to interpret 

quantitative CT results in the lung. 


Chronic lung diseases are characterized by heterogeneous small airway and parenchymal abnormalities. There is increasing evidence to suggest that these morphologic phenotypes, while 

related, may have different clinical presentations, prognosis and therapeutic responses to medications. With the advent of imaging modalities such as computed tomography, magnetic 

resonance imaging and optical coherence tomography, it is now possible to evaluate and quantify these morphologic phenotypes in large clinical studies using non or minimally invasive 

methods. Therefore, these new quantitative imaging techniques are very likely to play a front-line role in the study of chronic lung diseases and will produce valuable data that will be critical in 

our understanding of pathogenesis and the effect of therapeutic interventions. 

Friday 08:30 - 10:00 AM 

Course No. RC801 • Room S406A 

High-Resolution CT: A Pattern-based Approach (An Interactive Session) 




A. High-Resolution CT: Principles and Anatomic Considerations 

Gerald F. Abbott MD, Boston, MA * 


1) To define and illustrate the anatomic structures that form the basis of high resolution CT (HRCT) imaging of the lung. 2) To define and illustrate the anatomic basis of the most 

common imaging patterns detected on HRCT. 

B. High-Resolution CT: Patterns and Differential Diagnoses 

Brett M. Elicker MD, San Francisco, CA 


1) Identify common findings and patterns on high resolution CT of the lung and be able to give focused differential diagnoses that incorporate basic clinical information. 

C. High-Resolution CT: Unknown Cases 

Sujal R. Desai MBBS, London, London, UNITED KINGDOM 


1) To understand the key relationship between high-resolution CT (HRCT) patterns and macroscopic histopathologic changes in diffuse interstitial lung diseases (DILD). 2) To learn 

the characteristic HRCT appearances of DILDs in which a confident (and accurate) radiologic diagnosis can be made. 3) To appreciate the importance of atypical and overlapping 

HRCT features in many DILDs. 

Friday 08:30 - 10:00 AM 

Course No. RC825 • Room E350 

Quantitative Imaging: Diffuse Lung Disease Assessment Using CT 



CH BQ CT PH 

Page 91 of 97 

Michael F. McNitt-Gray, Los Angeles, CA , PhD * 

A. The Role of Quantitative CT in the Assessment of Diffuse Lung Disease 

Jonathan G. Goldin MBChB, PhD, Los Angeles, CA 


The learner will be able to: 1) Identify the application of quantitative imaging principles in the assessment of patients with Diffuse Lung Disease. 2) Identify conditions required for 

successful application of quantitative imaging principles.3) Analyze quantitative imaging techniques and apply this knowledge to protocol development and patient management in 

the setting of both clinical workup and clinical trials involving patients with Diffuse Lung Disease. 

B. Quantitation in the Assessment of COPD 

David Augustine Lynch MD, Denver, CO * 


1) Describe the methodology and limitations of non-invasive imaging in quantifying lung structure. 2) Describe the opportunities for non-invasive imaging in understanding the 

structure of the lung, and how that relates to phenotyping subjects for clinical trials and longitudinal studies. 3) Understand the clinical relevance of quantitative imaging of COPD. 4) 

Learn how to interpret quantitative CT results in the lung. 


COPD is characterized on CT by emphysema, bronchial wall thickening, and small airway abnormalities. These morphologic findings may be quantified and grouped into phenotypes, 

with different clinical presentations and prognosis. Clinicians are increasingly using these quantitative imaging techniques to study COPD. This course will provide information on the 

results of large-scale clinical trials ongoing in COPD. The limitations and sources of variation of current quantitative imaging methods will be discussed. Relationships between 

quantitative CT measures, genetic markers, and clinical abnormalities will be stressed. 

C. Standardization of Imaging and Measurement Protocols 

Matthew Sherman Brown PhD, Los Angeles, CA *


1) Understand sources of quantitative lung CT measurement variation including technical, physiologic, and algorithmic. 2) Review strategies for standardization across multiple sites 

and imaging platforms. 3) Assess the impact on sample size in multicenter clinical trials. 

ISP: Chest (Lung Nodule II) 

Friday • 10:30 - 12:00 PM • E451B 



PRESIDING: 

David F. Yankelevitz , MD * , New York, NY 

Heber Macmahon , MD * , Chicago, IL 

Computer Code: SST03 • AMA PRA Category 1 Credits: 1.5 • ARRT Category A+ Credit: 1.5 


SST03-01 • 10:30 AM 

Chest Keynote Speaker 

David F. Yankelevitz MD * , New York, NY 

SST03-02 • 10:40 AM 

Features of Resolving and Non-resolving Indeterminate Pulmonary Nodules on Short-term Follow-up CT: The NELSON Study 

Yingru Zhao MD , Groningen, Groningen, NETHERLANDS • Monique D. Dorrius • Peter M.A. van Ooijen • Marcel Greuter PhD • Geertruida H. De Bock • Ying Wang MD • Pim A. De 

Jong MD, PhD • Matthijs Oudkerk • Rozemarijn Vliegenthart MD, PhD 

PURPOSE 

To analyze computed tomography (CT) features associated with disappearance of indeterminate pulmonary nodules in low-dose CT lung cancer screening. 


The Dutch-Belgian lung cancer screening trial (NELSON) was institutional review board approved. For this retrospective evaluation of indeterminate pulmonary nodules found at 

baseline, patient consent was waived. Indeterminate nodules were re-examined by CT at 3 months. Regular repeat screening CT rounds were at year 2, 4 and 6. This study included 

solid, intraparenchymal nodules. A nodule was defined as resolving if it had disappeared on follow-up CT. Nodule disappearance was regarded as spontaneous, not the effect of 

treatment. CT features of resolving nodules and non-resolving, stable and malignant nodules were compared. 

RESULTS 

At baseline, 1059 solid, intraparenchymal nodules (805 participants) were identified as indeterminate. During subsequent screening rounds, 9.3% (99/1059) of the nodules 

disappeared, 75.8% of these before the 3-month CT and 93.0% before the year 2 screening. Non-peripheral nodules, and nodules with non-smooth margin were more likely to 

disappear than peripheral and smooth nodules, respectively (19.7 vs 7.6%, p< 0.001, and 13.6 vs 7.5%, p< 0.01, respectively). 

CONCLUSION 

Nodule distance to costal pleural and margin are related to probability of pulmonary nodule disappearance at follow-up. Thus resolving pulmonary nodules share CT features with 

malignant nodules. A 3-month repeat CT for indeterminate pulmonary nodules can identify most resolving nodules. 


As CT features of resolving pulmonary nodules overlap with malignant nodules, CT features can not be used to predict nodule disappearance. 

SST03-03 • 10:50 AM 

Invasive Pulmonary Adenocarcinomas vs Their Pre-invasive Lesions Appearing as Ground-Glass Nodules: Differentiation Using Thin-Section CT Features 

Sang Min Lee MD , Seoul, Seoul, KOREA, REPUBLIC OF • Chang Min Park MD, PhD • Jin Mo Goo MD, PhD * • Hyun-Ju Lee MD, PhD 

PURPOSE 

To retrospectively investigate the differentiating thin-section CT features between invasive pulmonary adenocarcinomas (IPAs) and their preinvasive lesions appearing as ground-glass 

nodules (GGNs). 


From January 2005 to October 2011, 253 patients with 272 pathologically-proven GGNs (179 IPAs and 93 preinvasive lesions) were included in this study. Preinvasive lesions consisted 

of 21 atypical adenomatous hyperplasias and 72 adenocarcinomas-in-situ. To identify the differentiating CT features between IPAs and preinvasive lesions and to evaluate their 

differentiating accuracy, logistic regression analysis and receiver-operating characteristic curve analysis were performed respectively. 

RESULTS 

There were 64 pure GGNs and 208 mixed GGNs. In pure GGNs, preinvasive lesions were significantly smaller and non-lobulated (P

Significant differences in volumetric measurement exist between lung nodule software packages. Variation in volumetric results can result in different classification of lung nodules. 


Standardization of software systems for nodule volumetry in low-dose CT lung cancer screening is essential to yield accurate lung nodule categorization. 

SST03-06 • 11:20 AM 

Measurement Variability of Commercially Available Volumetry Software in Pulmonary Ground-glass Nodules: Variations in Volume, Attenuation and Mass 

Hyungjin Kim MD , Seoul, Seoul, KOREA, REPUBLIC OF • Chang Min Park MD, PhD • Sang Min Lee MD • Hyun-Ju Lee MD, PhD • Jin Mo Goo MD, PhD * 

PURPOSE 

To prospectively assess the variability of semi-automated volume, attenuation and mass measurements in pulmonary ground-glass nodules (GGNs), and to analyze the morphologic 

features influencing measurement variability. 


From November 2011 to March 2012, 38 patients with 48 GGNs 0.05) Margin of GGNs (ill-defined vs. well-defined) was the only influencing factor on 

intra-observer volume variability, (P=0.034) and inter-scan volume variability was significantly affected by intra-observer volume variability. Nodule type (pure GGN vs. part-solid 

nodule) was the most important influencing factor on intra-observer attenuation variability. 

CONCLUSION 

Variations in volume, attenuation and mass measurements of GGNs using commercial software were reasonably small. GGN margin and part-solid nodule type were important 

morphologic factors contributing to measurement variability. 


Mass measurement of GGNs with volumentry software can be a useful method in the follow-up of GGNs with acceptable measurement variability, reflecting both their volume and 

attenuation. 

SST03-07 • 11:30 AM 

Computer-assisted Quantitative Analysis of CT Images of Lung Adenocarcinomas: Correlation with IASLC Pathologic Classification and Interobserver Agreement 

Opeyemi Ibidapo MD , New York, NY • Jane P. Ko MD 

Wan Koo MD • Artem Mikheev • Henry Rusinek PhD 

• Jinyu Li • Joanna G. Becker • James Suh MD • Harvey I. Pass MD • David Paul Naidich MD * • Emily Bao Tsai MD • Chi 

PURPOSE 

To validate 3D computer-assisted analysis of lung adenocarcinomas (AdCa) on chest CT by (1) establishing the correlation of the proportion of solid component (%S) with IASLC 

pathologic classification and (2) assessing interobserver agreement on measured parameters 


Chest CTs (high-frequency kernel, 1 mm sections) of 30 resected AdCas in 30 patients were evaluated by two blinded readers who segmented the solid component of each lesion with 

two methods: manually with an electronic paintbrush (EP) on a DICOM viewer and with an automatic, threshold-based segmentation technique (ATS). A thoracic radiologist initially 

characterized nodules as partsolid (n=22), nonsolid (n=1), and solid (n=7) on CT. A pulmonary pathologist classified each resected cancer according to the IASLC system as AdCa in 

situ (AIS), minimally invasive AdCa (MIA), lepidic predominant AdCa (LPA), and other invasive AdCa (INV). Pathology classifications were correlated with %S on the most recent CT 

prior to surgery. Inter-observer agreement on nodule volume, mass, and %S was assessed interclass correlation coefficients (ICC) and Bland-Altman diagrams. 

RESULTS 

Nodules were 2.46 +/- 2.91 cm3 (mean+/- SD) in volume, 1.66 +/- 2.08 g in mass, and 10.9 +/- 9 mm in longest dimension. Of the 30 AdCas, there were 13 INV, 11 LPA, 3 MIA and 

3 AIS. %S by volume determined by ATS was 37% +/- 25% for INV, 20% +/- 9% for LPA and 7% +/- 6% for MIA and AIS. %S by mass was 46% +/- 27% for INV, 31% +/- 12% for 

LPA and 12% +/- 10% for MIA and AIS. The proportion of solid component in INV was larger than in LPA both by volume (P=0.02) and mass (p=0.04). %S in LPA was significantly 

larger than in MIA/AIS (P=0.002) both by volume and mass. Excellent interobserver agreement on %S was identified for the automatic method, with ICC = 0.984 (95% confidence 

interval, CI, of 0.971-0.992), while EP segmentation was not reliable, with ICC=0.324 (95% CI 0.049-0.557). Observers also agreed on total nodule volume (ICC=0.998, 95% 

CI=0.968-0.997) and nodule mass (ICC=0.994, 95% CI 0.981-0.997). 

CONCLUSION 

A reliable automated technique for characterizing the degree of solid and subsolid components enables differentiation of histopathologic subtypes of AdCas. 


Subsolid nodules are frequently lung AdCa. Reliable quantitative computer-assisted techniques address limitations in assessing the degree of solid portions that correlate with 

aggressive pathology. 

SST03-08 • 11:40 AM 

Dynamic First-Pass Perfusion Area-Detector CT Analyzed by Newly Developed and Previously Applied Methods vs Dynamic First-Pass MRI vs FDG-PET/CT: Differential 

Capability of Malignant SPN from Benign SPN 

Yoshiharu Ohno MD, PhD * , Kobe, Hyogo, JAPAN • Mizuho Nishio MD • Hisanobu Koyama MD • Takeshi Yoshikawa MD * • Sumiaki Matsumoto MD, PhD * • Yasuko Fujisawa * • 

Naoki Sugihara MS * • Shinichiro Seki • Masaru Yoshii RT • Kazuro Sugimura MD, PhD * 

PURPOSE 

To compare differentiation capability of malignant nodules from benign nodules among dynamic first-pass perfusion area-detector CT (perfusion ADCT) analyzed by newly developed and 

previously reported models, dynamic first-pass MRI and FDG-PET/CT. 


45 consecutive patients (26 male, 19 female; mean age 73 years) with 85 nodules underwent dynamic perfusion ADCT, dynamic MRI, PET/CT, and microbacterial and/or pathological 

examinations. 85 nodules were classified into two groups based on the final diagnoses: malignant (n=62) and benign nodules (n=23). All perfusion CT examinations were performed on 

a 320-detector row CT system. All dynamic MRI were performed by using 3D T1-FFE sequence with ultra-short echo time on a 1.5 T scanner. All PET/CT examinations were performed 

by using standard technique on a PET/CT scanner. For quantitative assessment of perfusion CT, nodule perfusions by single-input maximum-slope model (NPSMS) and dual-input 

maximum slope model (NPDMS) were calculated. For semi-quantitative assessment of dynamic MRI, maximum enhancement ratio (MER) and maximum slope of enhancement ratio 

(MSER) were calculated according to the past literatures. On PET/CT in each nodule, maximum value of SUV (SUVmax) was determined. Then, all indexes were compared between 

malignant and benign nodules by Student’s t-test. On each index, ROC analysis was performed, and feasible threshold value was determined. Finally, sensitivity, specificity and 

accuracy were compared each other by using McNemar’s test. 

RESULTS 

All indexes had significant difference between malignant and benign nodules (p

Disclosure Index 

A 

Abbara, S. - Research Grant, Bracco Group Pending research funded, Becton, Dickinson and Company Consultant, Perceptive Informatics, Inc 

Abbott, G. F. - Author, Thieme Medical Publishers, Inc Author, Amirsys, Inc 

Abramson, S. D. - Support, Siemens AG Royalties, The McGraw-Hill Companies 

Agarwal, P. P. - Research support, General Electric Company 

Ahrar, K. - Research Grant, BioTex, Inc 

Alva Lopez, L. - Medical Advisory Board, Covidien AG 

Antoch, G. - Speaker, Siemens AG Speaker, Bayer AG 

Arakawa, H. - Research Consultant, Canon Inc Consultant, Johnson & Johnson Consultant, F. Hoffmann-La Roche Ltd 

Armato, S. G. III - License agreement, Hologic, Inc License agreement, General Electric Company License agreement, Toshiba Corporation License agreement, Deus Technologies, LLC License agreement, Riverain Medical License 

agreement, Median Technologies License agreement, Mitsubishi Corporation 

Aviram, G. - Consultant, ActiViews Ltd 

B 

Bae, K. T. - Patent agreement, Covidien AG Patent agreement, Bayer AG Expert Advisory Committee, Bracco Group 

Bamberg, F. - Speakers Bureau, Bayer AG Speakers Bureau, Siemens AG Research Grant, Bayer AG Research Grant, Siemens AG 

Bankier, A. A. - Author with royalties, Reed Elsevier Consultant, Olympus Corporation 

Bastarrika, G. - Speaker, Bayer AG Speaker, General Electric Company Speaker, Siemens AG 

Bauer, R. W. - Research Consultant, Siemens AG Speakers Bureau, Siemens AG 

Bi, X. - Employee, Siemens AG 

Bierhals, A. J. - Stockholder, Express Scripts Holding Company 

Blake, M. A. - Editor with royalties, Springer Science+Business Media Deutschland GmbH 

Brillet, P. - Consultant, Novartis AG Consultant, Takeda Pharmaceutical Company Limited 

Brown, M. S. - Director, MedQIA Imaging Core Laboratory 

Brown, R. - Investor, RadExchange, LLC 

Buchan, K. - Employee, Koninklijke Philips Electronics NV 

C 

Carlson, S. K. - Stockholder, Medspira, LLC 

Carr, J. C. - Speaker, Lantheus Medical Imaging, Inc 

Carroll, T. J. - Research Grant, Bracco Group 

Carter, B. W. - Author, Amirsys, Inc 

Chan, S. S. - Research Grant, General Electric Company 

Chang, P. J. - Co-founder, Stentor/Koninklijke Philips Electronics NV Technical Advisory Board, Amirsys, Inc Medical Advisory Board, Koninklijke Philips Electronics NV Medical Advisory Board, MModal Inc Medical Advisory Board, 

lifeIMAGE Medical Advisory Board, Merge Healthcare Incorporated 

Chauvie, S. - Stockholder, Dixit srl 

Chung, J. H. - Research Grant, Siemens AG 

Chung, M. - Consultant, Samsung Electronics Co Ltd Patent agreement, General Electric Company 

Ciancibello, L. - Former employee, Koninklijke Philips Electronics NV Grant, Siemens AG 

Cleveland, R. H. - Research Consultant, Alexion Pharmaceuticals, Inc 

Cohen, A. M. - Research Consultant, Medical Components, Inc 

Coldwell, D. M. - Consultant, Sirtex Medical Ltd 

Collins, B. T. - Speakers Bureau, Accuray Incorporated 

Coxson, H. O. - Research Grant, GlaxoSmithKline plc Contract, GlaxoSmithKline plc Contract, Olympus Medical Systems Corp Steering Committee, GlaxoSmithKline plc 

Cury, R. C. - Research Grant, Astellas Group Consultant, Astellas Group Research Grant, General Electric Company 

Czernin, J. - Stockholder, Sofie Biosciences Stockholder, Momentum Biosciences LLC Stockholder, Montevideo Pharma 

D 

Dhanantwari, A. - Employee, Koninklijke Philips Electronics NV 

Don, S. - Research Grant, Carestream Health, Inc Speaker, Siemens AG 

Dowe, D. A. - Consultant, General Electric Company Speakers Bureau, General Electric Company 

Driehuys, B. - Research funded, General Electric Company Stockholder, Polarean, Inc 

E 

Earls, J. P. - Consultant, General Electric Company Speakers Bureau, General Electric Company 

Engelmann, R. - License agreement, Hologic, Inc License agreement, General Electric Company License agreement, Toshiba Corporation License agreement, Deus Technologies, LLC License agreement, Riverain Medical License 

agreement, Median Technologies License agreement, Mitsubishi Corporation 

Entezari, P. - Grant, Siemens AG 

F 

Fain, S. B. - Research Grant, General Electric Company Research Consultant, Marvel Medtech, LLC 

Fernando, H. - Consultant, CSA Medical, Inc Research Consultant, Galil Medical Ltd Research Grant, Deep Breeze Ltd 

Fligner, C. L. - Reviewer, Health on Line Spouse, Consultant, PAREXEL International Corporation Spouse, Consultant, UpToDate, Inc Spouse, Contract, Bio-Rad Laboratories, Inc 

Flohr, T. G. - Employee, Siemens AG 

Foos, D. H. - Employee, Carestream Health, Inc 

Franquet, T. C. - Author, Amirsys, Inc 

Fujimoto, K. - Advisory Board, Bayer AG Research Consultant, Bayer AG 

Fujisawa, Y. - Employee, Toshiba Corporation 

G 

Galban, C. J. - Inventor, ImBio, LLC 

Gast, K. - Research Grant, Activiews Ltd 

Ghoshhajra, B. B. - Research Consultant, Marval Biosciences Inc Research Consultant, Siemens AG 

Gierada, D. S. - Contract, VuCOMP, Inc 

Gilkeson, R. C. - Research Grant, General Electric Company Research support, Siemens AG 

Gillams, A. R. - Grant, Covidien AG Speaker, Covidien AG Grant, Microsulis Medical Ltd 

Godwin, J. II - Research Consultant, Gilead Sciences, Inc Board of Directors, Spiration, Inc Research Consultant, Celgene Corporation 

Gomes, M. M. - Grant, Eli Lilly and Company Grant, AstraZeneca PLC 

Goo, J. - Research Consultant, INFINITT Healthcare Co, Ltd 

Green, G. E. - Co-author with royalties, Amirsys, Inc 

Guermazi, A. - President, Boston Imaging Core Lab, LLC Research Consultant, Merck KGaA Research Consultant, Novartis AG Research Consultant, sanofi-aventis Group Research Consultant, Stryker Corporation Research 

Consultant, AstraZeneca PLC 

Page 94 of 97

H 

Halpern, E. F. - Research Consultant, Hologic, Inc 

Hameed, T. A. - Research Grant, Koninklijke Philips Electronics NV 

Han, R. C. - Consultant, Eli Lilly and Co 

Haramati, L. B. - Investor, Ortho Space Ltd Investor, Kryon Systems Ltd Spouse, Board Member, Bio Protect Ltd Spouse, Board Member, Ortho Space Ltd Spouse, Board Member, Kryon Systems Ltd 

Hartman, T. E. - Author, Cambridge University Press 

Harvey, J. A. - Researcher, Hologic, Inc Researcher, Pfizer Inc Shareholder, Matakina International Limited Shareholder, Hologic, Inc 

Hatabu, H. - Research Grant, Toshiba Corporation Research Grant, AZE, Ltd 

Henry, T. S. - Spouse, Medical Science Liaison, F. Hoffmann-La Roche Ltd 

Heussel, C. P. - Review Board, Gilead Sciences, Inc Review Board, Merck & Co, Inc Review Board, Astellas Group Review Board, Novartis AG Review Board, Boehringer Ingelheim GmbH Review Board, Basilea Pharmaceutica Ltd 

Review Board, Eli Lilly and Company Speakers Bureau, Gilead Sciences, Inc Speakers Bureau, AstraZeneca PLC Speakers Bureau, Merck & Co, Inc Speakers Bureau, Pfizer Inc Speakers Bureau, NUVISAN GmbH Speakers Bureau, Eli 

Lilly and Company Speakers Bureau, F. Hoffmann-La Roche Ltd Speakers Bureau, Bracco Group Speakers Bureau, Meda AB Speakers Bureau, Intermune, Inc Speakers Bureau, Chiesi Farmaceutici SpA Stockholder, GlaxoSmithKline 

plc Stockholder, STADA Arzneimittel AG Research Grant, Novartis AG 

Ho, V. B. - Institutional research support, General Electric Company 

Hoffman, E. A. - Founder, VIDA Diagnostics, Inc Shareholder, VIDA Diagnostics, Inc 

Holzwasser, G. R. - Consultant, Carestream Health, Inc 

Horie, M. - Former Employee, Toshiba Corporation 

Horrow, M. M. - Spouse, Employee, AstraZeneca PLC 

I 

Iagaru, A. - Advisory Board, Siemens AG Advisory Board, Spectrum Pharmaceuticals, Inc 

J 

Jackman, D. M. - Consultant, F. Hoffmann-La Roche Ltd Consultant, Foundation Medicine, Inc 

Jacobson, F. L. - Research Grant, Toshiba Corporation 

Johkoh, T. - Research Consultant, Bayer AG Research Consultant, F. Hoffman-La Roche Ltd 

K 

Kalra, M. K. - Faculty, General Electric Company 

Kanematsu, M. - Consultant, DAIICHI SANKYO Group 

Kanne, J. P. - Research Consultant, PTC Therapeutics, Inc Research Consultant, Perceptive Informatics, Inc 

Karssemeijer, N. - Shareholder, Matakina International Limited Scientific Board, Matakina International Limited Shareholder, QView Medical, Inc Research Grant, Riverain Medical 

Katzman, G. L. - Author, Amirsys, Inc Stockholder, Amirsys, Inc 

Kauczor, H. - Board Member, Siemens AG Research Grant, Boehringer Ingelheim GmbH Speakers Bureau, Boehringer Ingelheim GmbH Consultant, Boehringer Ingelheim GmbH Speakers Bureau, Bracco Group Speakers Bureau, 

Bayer AG Speakers Bureau, Siemens AG 

Kerl, J. - Research Consultant, Siemens AG Speakers Bureau, Siemens AG 

Kinney, T. B. - Data Monitoring Safety Board, Crux Biomedical, Inc 

Kligerman, S. J. - Author, Amirsys, Inc Research Grant, Riverain Medical 

Kooijman, H. - Employee, Koninklijke Philips Electronics NV 

Kooijmann, H. - Employee, Koninklijke Philips Electronics NV 

Krishnamurthy, R. - Research Consultant, Eisai Co, Ltd Research support, Koninklijke Philips Electronics NV Scientific Advisory Board, Vital Images, Inc 

Krzymyk, K. - Employee, Siemens AG 

Kunimatsu, A. - Research Grant, Bayer AG 

Kuo, M. D. - Shareholder, Confluence Life Sciences, Inc Board Member, Confluence Life Sciences, Inc Consultant, Confluence Life Sciences, Inc Shareholder, Imagenedx, Inc Board Member, Imagenedx, Inc Consultant, Imagenedx, 

Inc 

Kuo, W. T. - Consultant, Veniti, Inc Consultant, Abbott Laboratories Consultant, C. R. Bard, Inc 

Kuribayashi, S. - Research Grant, General Electric Company 

L 

La Pietra, L. - Employee, Carestream Health, Inc 

Langford, C. A. - In-kind support, F. Hoffmann-La Roche Ltd In-kind support, Bristol-Myers Squibb Company 

Lee, T. - Research Grant, General Electric Company Consultant, General Electric Company License agreement, General Electric Company 

Leipsic, J. A. - Speakers Bureau, General Electric Company Speakers Bureau, Edwards Lifesciences Corporation Medical Advisory Board, General Electric Company Medical Advisory Board, Edwards Lifesciences Corporation 

Levin, D. C. - Consultant, HealthHelp Board of Directors, Outpatient Imaging Affiliates, LLC 

Li, F. - License agreement, Hologic, Inc License agreement, General Electric Company License agreement, Toshiba Corporation License agreement, Deus Technologies, LLC License agreement, Riverain Medical License agreement, 

Median Technologies License agreement, Mitsubishi Corporation 

Li, J. - Employee, General Electric Company 

Lima, J. A. - Grant, Toshiba Corporation Grant, Bracco Group Grant, Astellas Group Grant, Deltanoid Pharmaceuticals, Inc 

Liu, Y. - Employee, Koninklijke Philips Electronics NV 

Loo, B. W. Jr - Speaker, Varian Medical Systems, Inc Speaker, General Electric Company 

Lowe, V. J. - Research Grant, General Electric Company Research Grant, Siemens AG Research Grant, Eli Lilly and Company Advisory Board, Bayer AG 

Lynch, D. A. - Research support, Siemens AG Scientific Advisor, Perceptive Informatics, Inc Consultant, Actelion Ltd Consultant, InterMune, Inc 

M 

Macapinlac, H. A. - Speakers Bureau , Cardinal Health, Inc 

Macmahon, H. - License agreement, Hologic, Inc License agreement, General Electric Company License agreement, Toshiba Corporation License agreement, Deus Technologies, LLC License agreement, Riverain Medical License 

agreement, MEDIAN Technologies License agreement, Mitsubishi Corporation 

Maidment, A. D. - Research support, Hologic, Inc Consultant, Real Time Tomography, LLC 

Martinez-Jimenez, S. - Research Grant, General Electric Company Research Grant, Amyrsis, Inc 

Matsumoto, S. - Research Grant, Toshiba Corporation 

Mayo, J. R. - Speaker, Siemens AG 

McAdams, H. - Research Grant, General Electric Company Consultant, ACR ImageMetrix Author, Reed Elsevier Author, UpToDate, Inc 

McConathy, J. E. - Research Consultant, Eli Lilly and Company Speakers Bureau, Eli Lilly and Company 

McNitt-Gray, M. F. - Institutional research agreement, Siemens AG Research Grant, Siemens AG Instructor, Medical Technology Management Institute 

Mehrez, H. - Employee, Toshiba Corporation 

Min, J. K. - Speakers Bureau, General Electric Company Advisory Board, General Electric Company Stockholder, General Electric Company 

Moeslein, F. M. - Consultant, Delcath Systems, Inc Lecturer, Delcath Systems, Inc Consultant, Sirtex Medical Ltd Proctor, Sirtex Medical Ltd 

Moore, W. H. - Research Grant, EDDA Technology, Inc Medical Board, EDDA Technology, Inc 

N 

Naidich, D. P. - Consultant, Siemens AG Advisory Board, VIDA Diagnostics, Inc 

Napel, S. - Medical Advisory Board, Fovia, Inc Consultant, Carestream Health, Inc 

Newell, J. D. Jr - Research Consultant, Siemens AG Research Grant, Siemens AG Consultant, WebMD Health Corp Author, Springer Science+Business Media Deutschland GmbH Consultant, VIDA Diagnostics, Inc 

Nietert, P. J. - Research Consultant, BioSystems International 

Nikolaou, K. - Speakers Bureau, Siemens AG Speakers Bureau, Bracco Group Speakers Bureau, Bayer AG 

O 

Obara, M. - Employee, Koninklijke Philips Electronics NV 

Page 95 of 97

Obara, M. - Employee, Koninklijke Philips Electronics NV 

Ohno, Y. - Research Grant, Toshiba Corporation Research Grant, Koninklijke Philips Electronics NV Research Grant, Bayer AG Research Grant, DAIICHI SANKYO Group Research Grant, Eisai Co, Ltd Research Grant, Covidien AG 

Research Grant, Guerbet SA 

P 

Paltiel, H. J. - Equipment support, Koninklijke Philips Electronics NV 

Patel, R. S. - Consultant, Sirtex Medical Ltd Research Consultant, Arstasis, Inc 

Paul, N. S. - Research funding, Toshiba Corporation 

Pena, E. - Speaker, General Electric Company 

Pickens, D. R. III - Stockholder, Johnson & Johnson 

Pipavath, S. N. - Research Grant, General Electric Company Royalties, Amirsys, Inc 

Prince, M. R. - Patent agreement, General Electric Company Patent agreement, Hitachi, Ltd Patent agreement, Siemens AG Patent agreement, Toshiba Corporation Patent agreement, Koninklijke Philips Electronics NV Patent 

agreement, Nemoto Kyorindo Co, Ltd Patent agreement, Bayer AG Patent agreement, Lantheus Medical Imaging, Inc Patent agreement, Bracco Group Patent agreement, Covidien AG Patent agreement, Topspins, Inc Stockholder, 

Topspins, Inc 

Prokop, M. - Speakers Bureau, Bayer AG Speakers Bureau, Bracco Group Speakers Bureau, Toshiba Corporation Speakers Bureau, Koninklijke Philips Electronics NV Research Grant, Toshiba Corporation 

Puderbach, M. U. - Research Grant, Siemens AG 

Pugash, R. A. - Research Grant, Activiews Ltd 

Q 

Quirk, J. D. - Stockholder, Pfizer Inc 

R 

Rabin, M. S. - Advisory Board, F. Hoffmann-La Roche Ltd Advisory Board, AcuityBio Corporation 

Raptis, C. A. - Speakers Bureau, Lantheus Medical Imaging, Inc 

Read, K. M. - Employee, Koninklijke Philips Electronics NV 

Rehemtulla, A. - Stockholder, ImBio, LLC 

Remy, J. - Research Consultant, Siemens AG 

Remy-Jardin, M. J. - Research Grant, Siemens AG 

Richard, S. - Employee, Carestream Health, Inc 

Robb, R. A. - Royalties, AnalyzeDirect, Inc Royalties, LAS Systems, Inc Royalties, St. Jude Medical, Inc Royalties, Kardia, Inc Research support, Kardia, Inc 

Roberts, A. C. - Researcher, Elbit Medical Imaging Ltd Research Consultant, Guerbet SA Speakers Bureau, Cook Group Incorporated 

Roberts, C. C. - Royalties, Amirsys, Inc 

Roemer, F. W. - Vice-President, Boston Imaging Core Lab LLC Shareholder, Boston Imaging Core Lab LLC Research Consultant, Merck KGaA 

Rohren, E. M. - Consultant, Eli Lilly and Company 

Rosado De Christenson, M. L. - Author, Thieme Medical Publishers, Inc Author, Amirsys, Inc Author, American Registry of Pathology 

Rosen, B. R. - Research Consultant, Siemens AG 

Ross, B. D. - Co-founder, ImBio, LLC Shareholder, ImBio, LLC Advisor, ImBio, LLC 

Rubin, G. D. - Medical Advisory Board, Fovia, Inc Advisory Board, General Electric Company Consultant, Heartflow, Inc Consultant, TeraRecon, Inc Consultant, Informatics in Context, Inc 

S 

Sabol, J. M. - Employee, General Electric Company 

Sahani, D. V. - Research collaboration, General Electric Company Consultant, Bracco Group 

Sardanelli, F. - Consultant, Bracco Group Research Grant, Bracco Group Consultant, Bayer AG Research Grant, Bayer AG Research Grant, IMS International Medical Scientific 

Satou, S. - Employee, Toshiba Corporation 

Schalekamp, S. - Research Grant, Riverain Medical 

Schmidt, B. - Employee, Siemens AG 

Schoepf, U. - Research Consultant, Bayer AG Research Grant, Bayer AG Research Consultant, Bracco Group Research Grant, Bracco Group Research Consultant, General Electric Company Research Grant, General Electric 

Company Research Consultant, Siemens AG Research Grant, Siemens AG 

Schroeder, J. D. - Research Grant, Siemens AG 

Schwartz, L. H. - Consultant, GlaxoSmithKline plc Consultant, F. Hoffmann-La Roche Ltd 

Schwartzstein, R. - Consultant, Respironics, Inc 

Shen, Y. - Employee, General Electric Company Researcher, General Electric Company 

Shoushtari, H. - Research Grant, Carestream Health, Inc Research support, Toshiba Corporation 

Shuman, W. P. - Research Grant, General Electric Company 

Sieren, J. - Research Consultant, VIDA Diagnostics, Inc 

Silverman, E. K. - Grant, GlaxoSmithKline plc Consultant, GlaxoSmithKline plc Speaker, AstraZeneca PLC Consultant, AstraZeneca PLC Consultant, Merck & Co, Inc 

Singh, S. P. - Advisory Board, General Electric Company 

Solomon, S. B. - Research Grant, General Electric Company Research Grant, AngioDynamics, Inc Consultant, Johnson & Johnson Consultant, Covidien AG 

Sosna, J. - Consultant, ActiViews Ltd Research Grant, Koninklijke Philips Electronics NV 

Soto, J. A. - Researcher, General Electric Company 

Steiner, R. M. - Consultant, Educational Symposia Consultant, Johnson & Johnson 

Stevens, C. W. - Speakers Bureau, MedImmune, Inc 

Sugihara, N. - Employee, Toshiba Corporation 

Sugimura, K. - Research Grant, Toshiba Corporation Research Grant, Koninklijke Philips Electronics NV Research Grant, Bayer AG Research Grant, Eisai Co, Ltd Research Grant, DAIICHI SANKYO Group 

Suster, S. - Author, Amirsys, Inc 

T 

Taguchi, K. - Research Grant, Siemens AG 

Takahashi, M. - Research Consultant, F. Hoffman-La Roche Ltd Research Consultant, Novartis AG 

Takahashi, M. - Research Consultant, Guerbet SA Research Grant, Koninklijke Philips Electronics NV 

Takasugi, J. E. - Research Consultant, Uptake Medical Corp 

Taniguchi, H. - Research Consultant, Bayer AG Research Consultant, F. Hoffman-La Roche Ltd Research Consultant, Pfizer Inc 

Tapson, V. F. - Research, sanofi-aventis Group Research, Actelion Ltd Research, Gilead Sciences, Inc Research, United Therapeutics Corporation Research, Bayer AG Research, Novartis AG Research, Pfizer Inc Consultant, 

sanofi-aventis Group Consultant, Actelion Ltd Consultant, Gilead Sciences, Inc Consultant, United Therapeutics Corporation Consultant, Bayer AG Consultant, Novartis AG Consultant, Bristol-Myers Squibb Company Speaker, 

sanofi-aventis Group Speaker, Actelion Ltd Speaker, Gilead Sciences, Inc Speaker, United Therapeutics Corporation 

Terry, N. L. - Stockholder, General Electric Company Stockholder, CVS Caremark Corporation Stockholder, Johnson & Johnson Stockholder, Pfizer Inc 

Teytelboym, O. - Research Consultant, Eli Lilly and Company 

Trimmer, C. K. - Consultant, Cook Group Incorporated 

V 

Valenti, D. - Research Grant, Activiews Ltd 

Van Cauteren, M. - Employee, Koninklijke Philips Electronics NV 

van Helvoort, H. - Research Grant, Novartis AG 

Vilar, J. S. - Investigator, General Electric Company 

Vlahos, I. - Consultant, Siemens AG Consultant, General Electric Company 

W 

Wacker, F. K. - Research Grant, Siemens AG 

Page 96 of 97

Wandtke, J. C. - Research Grant, Carestream Health, Inc 

Whaley, J. - Employee, Carestream Health, Inc 

White, C. S. - Research Grant, Riverain Medical 

Winer-Muram, H. T. - Spouse, Employee, Eli Lilly and Company Spouse, Stockholder, Eli Lilly and Company 

Woodard, P. K. - Research support, Siemens AG Research support, Astellas Group Research support, Lantheus Medical Imaging, Inc Research consultant, Medtronics 

Y 

Yamashita, Y. - Consultant, DAIICHI SANKYO Group 

Yankelevitz, D. F. - Research Grant, Carestream Health, Inc Research Grant, AstraZeneca PLC Royalties, General Electric Company 

Yanof, J. H. - Employee, Koninklijke Philips Electronics NV 

Yoshikawa, T. - Research Grant, Toshiba Corporation Research Grant, Koninklijke Philips Electronics NV 

Page 97 of 97

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