Janeiro/Fevereiro 2015 Caros amigos, este é nosso segundo

Janeiro/Fevereiro 2015
Caros amigos, este é nosso segundo informativo e iniciamos as atividades do
nosso departamento de imagem da SBPT em 2015. Este informativo visa trazer
mensalmente os artigos mais interessantes da área e ira revisar os seguintes jornais:
Radiology, American Journal of Roentgenology, Chest, Thorax, Lung, AJRCCM,
Respiratory Medicine, European radiology, European Journal of Radiology, Academic
radiology,
e Journal of thoracic Imaging. Além disso divulgaremos todo trabalho
enviado por algum membro do departamento que tenha interesse!
Um forte abraço a todos.
Departamento de Imagem da SBPT
Sugestões: [email protected]
Artigo interessante que demonstra a possibilidade de metástases de disseminação
aerógena
December 2014, Volume 203, Number 6
Cardiopulmonary Imaging
Review
Aerogenous Metastases: A Potential Game Changer in the Diagnosis and
Management of Primary Lung Adenocarcinoma
ABSTRACT :
OBJECTIVE. The purposes of this article are to summarize the relevant literature on
aerogenous metastasis, explain the putative pathogenetic mechanism of aerogenous
spread, present the characteristic imaging and pathologic features, and review the
importance of aerogenous spread to staging and clinical management.
CONCLUSION. Cumulative evidence suggests that aerogenous spread may exist and
is underrecognized. Imaging features are helpful in differentiating possible aerogenous
spread of tumor from hematogenous and lymphatic metastases and from synchronous
primary tumors. The putative occurrence of intrapulmonary aerogenous metastasis of
lung cancer has staging, management, and prognostic implications.
Keywords: aerogenous metastases, lung adeno-carcinoma, metastases
Artigo interessante que demonstra a prevalência de nódulos no Brasil e o diâmetro
normal de linfonodos em crianças
January 2015, Volume 204, Number 1
Mediastinal Lymph Nodes and Pulmonary Nodules in Children: MDCT Findings in a
Cohort of Healthy Subjects
Giordano Rafael Tronco Alves1, Edson Marchiori1, Klaus Loureiro Irion2, Marcos
Duarte Guimarães3, Carol Fernandes Jerzewski Sotero da Cunha4, Vinícius Valério
Silveira de Souza5 and Bruno Hochhegger1
ABSTRACT :
OBJECTIVE. Existing data are very limited on incidentally detected pulmonary nodules
or mediastinal lymph nodes in healthy children who undergo chest MDCT. We aimed to
evaluate the prevalence, distribution, and average dimensions of these occasional
findings in a cohort of otherwise healthy patients.
MATERIALS AND METHODS. Two radiologists reviewed in consensus the scans of
patients referred for chest MDCT during the preoperative workup for pectus carinatum
or pectus excavatum treatments. Exclusion criteria included the presence of any
documented malignancy (by date of MDCT or during the 2 years after the
examination), history of recent infections, or trauma. Patients’ records were assessed
after 2 years for the development of any malignancy.
RESULTS. A total of 99 individuals (63 boys, 36 girls; mean age, 13.5 years; range, 4–
18 years) who fulfilled the study criteria were evaluated. The presence of at least one
pulmonary nodule was observed in 75% of the patients, with a mean diameter of 2.8
mm. Of a total number of 225 pulmonary nodules, only 24 (10.7%) were calcified.
Mediastinal lymph nodes were also identified in 81% of the cases, with a maximum
diameter of 7 mm (smallest axis).
CONCLUSION. The presence of pulmonary nodules or mediastinal lymph nodes on
the basis of preoperative chest MDCT scans in healthy children is frequent. Given that
95% of the nodules and 100% of the lymph nodes measured less than 6 mm and 7
mm, respectively, we conclude that incidental findings under these limits are very
unlikely to be pathologic.
Artigo que demonstra o uso da RM no diagnóstico de hiperplasia tímica
Differentiation of Rebound and Lymphoid Thymic Hyperplasia from Anterior
Mediastinal Tumors with Dual-Echo Chemical-Shift MR Imaging in Adulthood:
Reliability of the Chemical-Shift Ratio and Signal Intensity Index
Adriano M. Priola, MD, Sandro M. Priola, MD, Giovannino Ciccone, MD, PhD, Andrea
Evangelista, MSc, Aldo Cataldi, MD, Dario Gned, MD, Francesco Pazè, MD, Lorena
Ducco, MD, Federica Moretti, MD, Maria Brundu, MD, Andrea Veltri, MD
Purpose
To prospectively evaluate (a) effectiveness and limits of dual-echo chemical-shift
magnetic resonance (MR) imaging for distinguishing hyperplastic thymus from anterior
mediastinal tumors in adulthood by using chemical-shift ratio (CSR) and signal intensity
index (SII), with proposal of optimal threshold value for each, and (b) whether age
affects these indexes.
Results
Interreader agreement was excellent (intraclass correlation coefficient: CSR, 0.893; SII,
0.898). Mean CSR and SII ± standard deviation were 0.545 ± 0.162 and 46.29% ±
18.41 for group A and 1.045 ± 0.094 and −0.06% ± 4.89 for group B, respectively, with
significant differences for both indexes between groups (P < .0001). No overlap was
found for SII between groups; CSR values overlapped in a few younger adults.
Distinguishing hyperplastic thymus from tumors was better with SII than CSR.
Respective sensitivity, specificity, and cutoff points were 100%, 100%, and 8.92% for
SII and 100%, 96.7%, and 0.849 for CSR. Significant correlation was found for CSR (r
= −0.761) and SII (r = 0.821) with age in group A (P < .001). For group B, significant
correlation with age was seen for CSR (r = 0.702, P < .001) but not SII (r = −0.196, P =
.127). All subjects but one in group A and none in group B had signal intensity
decrease at chemical-shift MR imaging.
Conclusion
With dual-echo chemical-shift MR imaging, SII and CSR have high accuracy to
distinguish thymic hyperplasia from tumors, although overlapped CSR values can
occur in early adulthood.
Artigo que compara a perfusão por CT, perfusão por Rm e PET/CT na avaliação
do nódulo pulmonar, demonstrando a melhor acurácia da perfusão por CT
Solitary Pulmonary Nodules: Comparison of Dynamic First-Pass Contrastenhanced Perfusion Area-Detector CT, Dynamic First-Pass Contrast-enhanced
MR Imaging, and FDG PET/CT
Yoshiharu Ohno, MD, PhD, Mizuho Nishio, MD, PhD, Hisanobu Koyama, MD, PhD,
Shinichiro Seki, MD, Maho Tsubakimoto, MD, Yasuko Fujisawa, BS, Takeshi
Yoshikawa, MD, PhD, Sumiaki Matsumoto, MD, PhD, Kazuro Sugimura, MD
To prospectively compare the capabilities of dynamic perfusion area-detector
computed tomography (CT), dynamic magnetic resonance (MR) imaging, and positron
emission tomography (PET) combined with CT (PET/CT) with use of fluorine 18
fluorodeoxyglucose (FDG) for the diagnosis of solitary pulmonary nodules.
Results
All indexes showed significant differences between malignant nodules and benign
nodules with low biologic activity (P < .0001). The area under the receiver operating
characteristic curve for total perfusion was significantly larger than that for other
indexes (.0006 ≤ P ≤ .04). The specificity and accuracy of total perfusion were
significantly higher than those of maximum relative enhancement ratio (specificity, P <
.0001; accuracy, P < .0001), slope of enhancement ratio (specificity, P < .0001;
accuracy, P < .0001), and SUVmax (specificity, P < .0001; accuracy, P < .0001).
Conclusion
Dynamic perfusion area-detector CT is more specific and accurate than dynamic MR
imaging and FDG PET/CT in the diagnosis of solitary pulmonary nodules in routine
clinical practice.
Artigo que demonstra os passos necessários para implantação de um centro de
Rastreamento de cancer de pulmão
Components Necessary for High-Quality Lung Cancer Screening:
American College of Chest Physicians and American Thoracic Society Policy
Statement
Peter Mazzone, MD, MPH, FCCP; Charles A. Powell, MD; Douglas Arenberg, MD,
FCCP; Peter Bach, MD; Frank Detterbeck, MD, FCCP; Michael K. Gould, MD, FCCP;
Michael T. Jaklitsch, MD; James Jett, MD, FCCP; David Naidich, MD, FCCP; Anil
Vachani, MD; Renda Soylemez Wiener, MD; Gerard Silvestri, MD, FCCP
Chest. 2015;147(2):295-303. doi:10.1378/chest.14-2500 Text Size: A A A
Lung cancer screening with a low-dose chest CT scan can result in more benefit than
harm when performed in settings committed to developing and maintaining high-quality
programs. This project aimed to identify the components of screening that should be a
part of all lung cancer screening programs. To do so, committees with expertise in lung
cancer screening were assembled by the Thoracic Oncology Network of the American
College of Chest Physicians (CHEST) and the Thoracic Oncology Assembly of the
American Thoracic Society (ATS). Lung cancer program components were derived
from evidence-based reviews of lung cancer screening and supplemented by expert
opinion. This statement was developed and modified based on iterative feedback of the
committees. Nine essential components of a lung cancer screening program were
identified. Within these components 21 Policy Statements were developed and
translated into criteria that could be used to assess the qualification of a program as a
screening facility. Two additional Policy Statements related to the need for multisociety
governance of lung cancer screening were developed. High-quality lung cancer
screening programs can be developed within the presented framework of nine
essential program components outlined by our committees. The statement was
developed, reviewed, and formally approved by the leadership of CHEST and the ATS.
It was subsequently endorsed by the American Association of Throacic Surgery,
American Cancer Society, and the American Society of Preventive Oncology.
European Radiology
January 2015, Volume 25, Issue 1, pp 81-88
Computed tomographic characteristics of interval and post screen carcinomas in
lung cancer screening
Ernst Th. Scholten, Nanda Horeweg, Harry J. de Koning, Rozemarijn Vliegenthart,
Matthijs Oudkerk, Willem P. Th. M. Mali, Pim A. de Jong
Artigo que demonstra os tipos mais comuns de canceres perdidos no rastreamento:
bolhas de paredes espessas e lesões enobrônquicas
Objectives
To analyse computed tomography (CT) findings of interval and post-screen carcinomas
in lung cancer screening.
Methods
Consecutive interval and post-screen carcinomas from the Dutch–Belgium lung cancer
screening trial were included. The prior screening and the diagnostic chest CT were
reviewed by two experienced radiologists in consensus with knowledge of the tumour
location on the diagnostic CT.
Results
Sixty-one participants (53 men) were diagnosed with an interval or post-screen
carcinoma. Twenty-two (36 %) were in retrospect visible on the prior screening CT.
Detection error occurred in 20 cancers and interpretation error in two cancers. Errors
involved intrabronchial tumour (n  =  5), bulla with wall thickening (n  =  5),
lymphadenopathy (n  =  3), pleural effusion (n  =  1) and intraparenchymal solid nodules
(n  =  8). These were missed because of a broad pleural attachment (n  =  4), extensive
reticulation surrounding a nodule (n  =  1) and extensive scarring (n  =  1). No definite
explanation other than human error was found in two cases. None of the interval or
post-screen carcinomas involved a subsolid nodule.
Conclusions
Interval or post-screen carcinomas that were visible in retrospect were mostly due to
detection errors of solid nodules, bulla wall thickening or endobronchial lesions. Interval
or post-screen carcinomas without explanation other than human errors are rare.
Journal of Thoracic Imaging:
January 2015 - Volume 30 - Issue 1 - p 29–45
doi: 10.1097/RTI.0000000000000125
Review and SA-CME Article
Developmental Lung Malformations in Children: Recent Advances in Imaging
Techniques, Classification System, and Imaging Findings
Thacker, Paul G. MD*; Schooler, Gary R. MD†; Caplan, Michael J. MD‡; Lee, Edward
Y. MD, MPH§
Artigo revisa interessantemente os achados de malformações pulmonares
Abstract
Congenital lung anomalies represent a diverse group of developmental
malformations of the lung parenchyma, arterial supply, and venous
drainage, which may present anywhere from the prenatal period through
adulthood. It is imperative for radiologists to be aware of imaging
techniques and imaging appearance of these anomalies across the
pediatric age range. This review presents the spectrum of these lesions
that are often encountered in daily clinical practice. Each anomaly is
discussed in terms of underlying etiology, clinical presentation, and
imaging characterization with emphasis on the most up-to-date research
and treatment. Knowledge of these areas is essential for accurate, timely
diagnosis, which aids in optimizing patient outcomes.
Artigo interessante que demonstra a possibilidade de termos nódulos difusos em
linfangioliomiomatose em 20% dos pacientes
Computed tomographic features of lymphangioleiomyomatosis: Evaluation in 138
patients
Kazunori Tobinocorrespondenceemail, Takeshi Johkoh, Kiminori Fujimoto, Fumikazu
Sakai, Hiroaki Arakawa, Masatoshi Kurihara, Toshio Kumasaka, Kengo Koike,
Kazuhisa Takahashi, Kuniaki SeyamaPurpose
The aim was to characterize the computed tomographic (CT) findings from Japanese
patients with lymphangioleiomyomatosis (LAM).
Materials and methods
CT scans of the chest, abdomen, and pelvis from 124 patients with sporadic LAM (SLAM, mean age, 37.4 years) and 14 patients with tuberous sclerosis complex (TSC)LAM (mean age, 35.6 years) were analyzed.
Results
Pulmonary nodules (18.8%) and hepatic angiomyolipoma (AML, 24.3%) were more
common in our patients than those in previous reports. Compared with TSC-LAM, SLAM group had a higher frequency of pulmonary nodules (28.6% vs 32.3%, P < 0.01)
and lower frequencies of air-space consolidation (21.4% vs 2.4%, P < 0.01),
pneumothorax (28.6% vs 8.1%, P = 0.02), pulmonary hilar lymphadenopathy (14.3% vs
0.8%, P < 0.01), renal AML (85.7% vs 17.4%, P < 0.01), hepatic AML (71.4% vs
17.4%, P < 0.01), and retrocrural lymphadenopathy (14.3% vs 1.4%, P = 0.04). Axial
lymphatic abnormalities (i.e., thoracic duct dilatation, lymphadenopathy, and
lymphangioleiomyoma) were most common in the pelvis and tended to decrease in
incidence with increased distance from the pelvis.
Conclusion
The incidence of some CT findings in Japanese patients differed from those in previous
reports. Axial lymphatic abnormalities noted here suggest that the origin of LAM cells
may be the pelvis.