Thoracic Imaging 2003 - Society of Thoracic Radiology

More documents

Recommendations

Info

Patz et al (12) identified that there is no significant relationship between tumor size and survival. In a similar study to investigate the relationship between tumor size and stage distribution, Heyneman et al (13) could not find a statistically significant relation between the size of small primary lung cancers and the distribution of disease stage at the time of presentation. Small T1 Lung Cancer: Evaluation with FDG-PET and Dynamic CT 18 F-luorodeoxyglucose (FDG) positron emission tomography (FDG-PET) is a noninvasive diagnostic technique using metabolic (biochemical) differences between benign and malignant tissues. Increased glucose metabolism in malignant tissue may be related to multiple factors such as proliferation rate and number of viable cancer cells. FDG PET, however, is neither uniformly specific nor sensitive, especially when the abnormality is small. The localized form of bronchioloalveolar carcinomas and carcinoid tumors demonstrate less FDG uptake than other non-small cell lung cancers (14,15). False negative FDG PET scans are seen in about 5% of T1 lung cancers and in only 3% of such lesions with their diameters greater than 5 mm. The long-term survival for patients with a negative PET scan with lung cancers suggests that these tumors of low FDG uptake behave indolently. Therefore, management decision to follow up such lesions with conventional imaging to determine interval growth may be justified (15). Angiogenesis is a complex process and may be determinants to the growth and metastasis of a malignant tumor. Vascular endothelial growth factor (VEGF) has been known as a vascular permeability factor and plays a crucial role in tumor angiogenesis. Microvessel density (MVD) measurements with immunohistochemical staining technique have been used to measure angiogenic activity. VEGF expression is significantly associated with MVD of non-small cell lung cancer, especially in adenocarcinomas of the lung. Dynamic CT of pulmonary nodules provides quantitative information on blood flow pattern and is a useful diagnostic method in distinguishing between benign and malignant nodules. The peak attenuation of tumor on dynamic CT mirrors intra-lesional micro-vessel densities (MVDs), especially in adenocarcinoma of the lung. The peak attenuation value of dynamic CT may be an index for VEGF-related tumor angiogenesis (16). In addition, the peak attenuation and relative flow on dynamic CT correlate with the standardized uptake value of FDG-PET scans in lung cancer. The peak attenuation and relative flow on dynamic CT as an index of blood pooling may be related to increased glucose metabolism in lung cancer (17). Extrathoracic Metastasis of Small T1 Lung Cancer It has been suggested that because the prevalence of extrathoracic metastases is low, routine metastatic work up using bone scans, liver scans, or brain imaging is not justified in patients with T1 lung cancer, especially in stage-1 T1 cancer (T1 cancer without nodal metastasis). In addition, positive bone or liver scans frequently represent areas of nonmalignant change (e.g., inflammation or old fracture) and may unnecessarily delay surgery while leading to an invasive and costly work up. Furthermore, the adrenals are prominent site of nonmalignant lesions even in patients with lung cancer. Salbeck et al (18) reported that none of 26 patients with stage-1 lung cancer had extrathoracic metastasis. Salvatierra et al (19) reported the frequency of metastases in stage 1 (without hilar or mediastinal nodal metastasis) and 2 (with hilar nodal metastasis) T1 lung cancer as being 8% (2/12 patients had metastases). In the study of Kormas et al (20), four (3%) of 158 patients with non-small cell lung cancer had brain metastases at the time of diagnosis and additional five patients (total of nine patients, 6%) had brain metastases within one year. Ferrigno et al (21) reported that 3/20 patients (15%) with stage 1 lung cancer had brain metastases. It is generally accepted that adrenal metastases occur in about 3% of patients with lung cancer (22). Jung et al (2) performed a study to determine the frequency of extrathoracic metastases in T1 non-small cell lung cancer at the time of diagnosis and at one-year follow-up study and to compare the frequency of metastases in terms of cell type of lung cancer, the size and CT findings of the tumor at the time of diagnosis. Ninety patients with T1 lung cancer at CT were included. Evaluation of extrathoracic metastases was made at the time of initial diagnosis and at one-year follow-up study. The frequency of metastases was compared in terms of cell type (squamous vs. nonsquamous), size (< 2 cm vs. > 2 cm) and the initial CT findings of the tumor. Twelve (13%) of 90 patients had extrathoracic metastases demonstrated at the time of diagnosis and ten at one-year follow-up study [total, 22/90 (24%)]. The most frequent sites of extrathoracic metastases at one year follow-up study were brain (12/90, 13%), bone (6/90, 7%) and liver (5/90, 4%) in order of frequency similar to those of the previous reports (11,39). Tumors with GGO at CT showed significantly lower prevalence of metastases (p = .042). Area of GGO (n = 23) was seen in 11/13 (85%) patients with bronchioloalveolar carcinoma and 12/53 (23%) patients with adenocarcinoma other than bronchioloalveolar carcinoma (p < .001). There was no significant difference in the prevalence of metastases between squamous and nonsquamous cell carcinoma, between tumors of < 2 cm (n = 17) and of > 2 cm in diameter (n = 73) and between tumors with or without mediastinal nodal metastases (p > .05). They concluded that extrathoracic metastases are evident at presentation in 13% of patients and at oneyear follow-up in an additional 11% of patients. The prevalence is significantly lower in tumors with GGO. Conclusion Small T1 lung cancer with large area of GGO (> 50% of tumor volume) within it on thin-section CT shows good prognosis and less likelihood of mediastinal nodal or extrathoracic metastasis, whereas the cancer with coarse spiculation and thickening of bronchovascular bundles around the lesion shows more frequent lymph node metastasis or local vessel invasion than cancer without such findings. About 5% of T1 lung cancers, mostly focal nodular bronchioloalveolar carcinoma and carcinoids, show negative uptake on FDG PET scans and appear to be indolent in their growth therefore lead to long-term survival of patients with such tumors. About 21% of T1 lung cancers show mediastinal nodal metastasis at the time of diagnosis and about 24% of T1 lung cancers show extrathoracic metastasis, mostly brain metastasis at the time of diagnosis or at one year follow-up studies. 217 WEDNESDAY
WEDNESDAY 218 REFERENCES Seely JM, Mayo JR, Miller RR, Müller NL. T1 lung cancer: prevalence of mediastinal nodal metastases and diagnostic accuracy of CT. Radiology 1993;186:129–132. Jung K-J, Lee KS, Kim H, et al. T1 Lung Cancer at CT: Frequency of Extrathoracic Metastases. J Comput Assist Tomogr 2000;24:711-718. Nomori H, Hirohashi S, Noguchi M, Matsuno Y, Shimosato Y. Tumor cell heterogeneity and subpopulations with metastatic ability in differentiated adenocarcinoma of the lung. Histologic and cytofluorometric DNA analysis. Chest 1991;99:934-940. Noguchi M, Morikawa A, Kawasaki M, et al. Small adenocarcinoma of the lung. Histologic characteristics and prognosis. Cancer 1995;75:2844-2852. Jang HJ, Lee KS, Kwon OJ, Rhee CH, Shim YM, Han J. Bronchioloalveolar carcinoma: focal area of ground-glass attenuation at thin-section CT as an early sign. Radiology 1996;199:485-488. Lee KS, Kim Y, Han J, Ko EJ, Park C-K, Primack SL. Bronchioloalveolar carcinoma: clinical, histopathologic, and radiologic findings. RadioGraphics 1997;17:1345-1357. Kuriyama K, Seto M, Kasugai T, et al. Ground-glass opacity on thin-section CT: value in differentiating subtypes of adenocarcinoma of the lung. AJR 1999;173:465-469. Aoki T, Nakata H, Watanabe H, et al. Evolution of peripheral lung adenocarcinomas: CT findings correlated with histology and tumor doubling time. AJR 2000;174:763-768. Kim EA, Johkoh T, Lee KS, et al. Quantification of ground-glass opacity on high-resolution CT of small peripheral adenocarcinoma of the lung: pathologic and prognostic implication. AJR 2001;177:1417-1422. Aoki T, Tomoda Y, Watanabe H, et al. Peripheral lung adenocarcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival. Radiology 2001;220:803-809 Nakata M, Saeki H, Takata I, et al. Focal ground-glass opacity detected by low-dose helical CT. Chest 2002;121:1464-1467 Patz EF, Rossi S, Harpole DH, Herndon JE, Goodman PC. Correlation of tumor size and survival in patients with stage IA non-small cell lung cancer. Chest 2000;117:1568-1571. Heyneman LE, Herdon JE, Goodman PC, Patz EF. Stage distribution in patients with a small (< 3 cm) primary nonsmall cell lung carcinoma. Implication for lung carcinoma screening. Cancer 2001;92:3051-3055. Kim B-T, Kim Y, Lee KS, et al. Localized form of bronchioloalveolar carcinoma: FDG PET findings. AJR 1998;170:935-939. Marom EM, Sarvis S, Herdon JE, Patz EF. T1 lung cancers: sensitivity of diagnosis with fluorodeoxyglucose PET. Radiology 2002;223:453-459. Tateishi U, Nishihara H, Watanabe S, Morikawa T, Abe K, Miyasaka K. Tumor angiogenesis and dynamic CT in lung adenocarcinoma: radiologic-pathologic correlation. J Comput Assist Tomogr 2001;25:23-27. Tateishi U, Nishihara H, Tsukamoto E, Morikawa T, Tamaki N, Miyasaka K. Lung tumors evaluated with FDG-PET and dynamic CT: the relationship between vascular density and glucose metabolism. J Comput Assist Tomogr 2002;26:185- 190. Salbeck R, Grau HC, Artmann H. Cerebral tumor staging in patients with bronchial carcinoma by computed tomography. Cancer 1990;66:2007-2011. Salvatierra A, Baamonde C, Llamas JM, Cruz F, Lopez-Pujol J. Extrathoracic staging of bronchogenic carcinoma. Chest 1990;97:1052-1058. Kormas P, Bradshaw JR, Jeyasingham K. Preoperative computed tomography of the brain in non-small cell bronchogenic carcinoma. Thorax 1992;47:106-108. Ferrigno D, Buccheri G. Cranial computed tomography as a part of the initial staging procedures for patients with non-small-cell lung cancer. Chest 1994;106:1025-1029. Oliver TW, Bernardino ME, Miller JI, Mansour K, Greene D, Davis WA. Isolated adrenal masses in nonsmall-cell bronchogenic carcinoma. Radiology 1984;153:217-218.
Page 1 and 2:
The Society of Thoracic Radiology T
Page 3 and 4:
Dear Friends, Welcome to Miami Beac
Page 5 and 6:
Continuing Medical Education Credit
Page 7 and 8:
Warren B. Gefter, MD University of
Page 9 and 10:
Ernest M. Scalzetti, MD SUNY Upstat
Page 11 and 12:
Registration Hours Saturday, March
Page 13 and 14:
Program Committee Ella A. Kazerooni
Page 15 and 16:
Small Airway Disease Americana 3 Mo
Page 17 and 18:
Benjamin Felson Memorial Lecture Am
Page 19 and 20:
Session 2-B Concurrent Session Clin
Page 21 and 22:
Workshops (choose 1) 1:00 - 1:45 D1
Page 23 and 24:
Sunday
Page 25 and 26:
March 2, 2003 General Session Sunda
Page 27 and 28:
SUNDAY 46 One type of direct-readou
Page 29 and 30:
CT-PET Imaging Suzanne Aquino, M.D.
Page 31 and 32:
SUNDAY 58 an accompanying decreased
Page 33 and 34:
SUNDAY 60 Radiofrequency Ablation i
Page 35 and 36:
SUNDAY 62 17. Sewell PE, Vance RB.
Page 37 and 38:
SUNDAY 64 cal ventilation will be r
Page 39 and 40:
SUNDAY 66 radiologic, and histopath
Page 41 and 42:
SUNDAY 68 application. The untreate
Page 43 and 44:
SUNDAY 70 The Expanded Spectrum of
Page 45 and 46:
SUNDAY 72 Hypersensitivity Pneumoni
Page 47 and 48:
SUNDAY 74 Small Airway Diseases Mic
Page 49 and 50:
SUNDAY 76 The “Head-cheese Sign
Page 51 and 52:
SUNDAY 78 “Holes” in the Lung:
Page 53 and 54:
SUNDAY 80 Pleural Effusions Gerald
Page 55 and 56:
SUNDAY 82 Asbestos Related Pleural
Page 57 and 58:
SUNDAY 84 Other Pleural Neoplasms S
Page 59 and 60:
SUNDAY 86 Image-Guided Therapy of M
Page 61 and 62:
Notes 88
Page 63 and 64:
March 3, 2003 General Session 7:00
Page 65 and 66:
Cardiac MRI: Established Indication
Page 67 and 68:
Cardiac MRI: New Developments Gauth
Page 69 and 70:
5. The volume of contrast medium re
Page 71 and 72:
Acute Aortic Syndrome Ernest M. Sca
Page 73 and 74:
as well as separation of the cusps
Page 75 and 76:
Pulmonary Veins: Imaging for Radiof
Page 77 and 78:
Imaging of Cardiopulmonary Support
Page 79 and 80:
plied to the hollow fibers by an ex
Page 81 and 82:
swelling of the entire leg, calf sw
Page 83 and 84:
Multi-channel Pulmonary CTA: New Te
Page 85 and 86:
terminate scintigrams, CT correctly
Page 87 and 88:
CT Strucural and Functional Imaging
Page 89 and 90:
curves (TDCs) are generated by manu
Page 91 and 92:
7. Crawford T, Yoon C, Wolfson K, e
Page 93 and 94:
80. Fleischmann D, Rubin GD, Bankie
Page 95 and 96:
127 MONDAY
Page 97 and 98:
129 MONDAY
Page 99 and 100:
REFERENCES Bergin CJ, Rios G, King
Page 101 and 102:
Notes 134
Page 103 and 104:
March 4, 2003 General Session 7:00
Page 105 and 106:
Adult Manifestations of Congenital
Page 107 and 108:
will usually display the limbs of t
Page 109 and 110: Imaging of the Pericardium Paul L.
Page 111 and 112: Cardiomyopathy Martin J. Lipton, M.
Page 113 and 114: TUESDAY 150 Nuclear Cardiology Upda
Page 115 and 116: TUESDAY 152 ties. The predominant 1
Page 117 and 118: TUESDAY 154 Imaging protocols: Util
Page 119 and 120: Manpower Shortage in Radiology: Sol
Page 121 and 122: 159 TUESDAY
Page 127 and 128: NIBIB Update for Thoracic Radiology
Page 129 and 130: vertically along the right atrium t
Page 131 and 132: Multidetector Pediatric Chest CT: P
Page 133 and 134: The Spectrum of Pulmonary Infection
Page 135 and 136: Immune deficiency occurs frequently
Page 137 and 138: TUESDAY 180 The Internet and the Pr
Page 139 and 140: TUESDAY 182 Workshop A1: Lymphoma:
Page 141 and 142: TUESDAY 184 Digital Images: Camera
Page 143 and 144: TUESDAY 186 Analysis of Mediastinal
Page 145 and 146: Unusual Manifestations of Lung Canc
Page 147 and 148: Wednesday
Page 149 and 150: March 5, 2003 General Session Wedne
Page 151 and 152: WEDNESDAY 208 principle is that “
Page 153 and 154: WEDNESDAY 210 years and a current o
Page 155 and 156: WEDNESDAY 212 lesions generally mim
Page 157 and 158: WEDNESDAY 214 capable of studying t
Page 159: WEDNESDAY 216 Small T1 Lung Cancer:
Page 163 and 164: WEDNESDAY 220 Therefore, radiologis
Page 165 and 166: WEDNESDAY 222 sectional area varies
Page 167 and 168: WEDNESDAY 224 Lung Cancer Staging A
Page 169 and 170: Metastatic Disease to Lung Gordon L
Page 171 and 172: Thoracic Metastates from Osteosarco
Page 173 and 174: STR tutorial: Use of MD CT reconstr
Page 175 and 176: ogenic edema, fat embolism, heroin
Page 177 and 178: WEDNESDAY 236 Pulmonary Arterial Hy
Page 179 and 180: WEDNESDAY 238 pathological process,
Page 181 and 182: Thursday
Page 183 and 184: THURSDAY 250 Pulmonary Tuberculosis
Page 185 and 186: THURSDAY 252 1. Clinical criteria:
Page 187 and 188: THURSDAY 254 AIDS patients are also
Page 189 and 190: THURSDAY 256 Viral Infection on HRC
Page 191 and 192: THURSDAY 258 Imaging of Coccidioido
Page 193 and 194: THURSDAY 260 from the laryngeal sur
Page 195 and 196: THURSDAY 262 Inflammatory Diseases
Page 197 and 198: Virtual Endoscopy in the Thorax: Pr
Page 199 and 200: Notes 269 THURSDAY
Page 201: SECOND LEVEL THIRD LEVEL
show all

Thoracic Imaging 2003 - Society of Thoracic Radiology

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?