Thoracic Imaging 2003 - Society of Thoracic Radiology

WEDNESDAY
212
lesions generally mimicked benign diseases and typically
occurred in patients with underlying lung disease such as emphysema
or fibrosis. Interestingly, despite being missed on one or
more prior studies, 28 (88%) of 32 missed lesions were still
Stage IA lung cancers at the time of diagnosis. In a separate
study, these authors determined that an automated lung nodule
detection method correctly identified 84% of missed cancers.
In order to reduce the risk of missing lung cancer on CT, one
should pay careful attention to both the peripheral and central
portions of the lungs. Cine methods of viewing, which enhance the
ability to distinguish small nodules from vascular structures,
should be used in settings where they are available. Additionally,
one should consider the use of sliding-thin-slab MIP images as a
complement to routine axial images. Gruden et al. have recently
shown that MIP slabs enhance the detection rate of nodules, especially
in the central portion of the lungs. In addition to carefully
inspecting the lung parenchyma, one should thoroughly evaluate
the airways in order to avoid missing a nonobstructing endobronchial
lesion. In the near future, it is likely that computer-aided
diagnosis will play an important role in reducing lung cancer detection
failures. This topic is addressed in the following lecture.
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