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Joyce S, Carey BW, Moore N, Mullane D, Moore M, McEntee MF, Plant BJ, Maher MM, O'Connor OJ. Computed tomography in cystic fibrosis lung disease: a focus on radiation exposure. Pediatr Radiol 2021; 51:544-553. [PMID: 33743038 DOI: 10.1007/s00247-020-04706-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/03/2020] [Accepted: 05/05/2020] [Indexed: 11/27/2022]
Abstract
Thoracic computed tomography (CT) is the imaging reference method in the diagnosis, assessment and management of lung disease. In the setting of cystic fibrosis (CF), CT demonstrates increased sensitivity compared with pulmonary function tests and chest radiography, and findings correlate with clinical outcomes. Better understanding of the aetiology of CF lung disease indicates that even asymptomatic infants with CF can have irreversible pulmonary pathology. Surveillance and early diagnosis of lung disease in CF are important to preserve lung parenchyma and to optimise long-term outcomes. CF is associated with increased cumulative radiation exposure due to the requirement for repeated imaging from a young age. Radiation dose optimisation, important for the safe use of CT in children with CF, is best achieved in a team environment where paediatric radiologists work closely with paediatric respiratory physicians, physicists and radiography technicians to achieve the best patient outcomes. Despite the radiation doses incurred, CT remains a vital imaging tool in children with CF. Radiologists with special interests in CT dose optimisation and respiratory disease are key to the appropriate use of CT in paediatric imaging. Paediatric radiologists strive to minimise radiation dose to children whilst providing the best possible assessment of lung disease.
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Affiliation(s)
- Stella Joyce
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland
| | - Brian W Carey
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Niamh Moore
- Department of Radiography, University College Cork, Cork, Ireland
| | - David Mullane
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Michael Moore
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Mark F McEntee
- Department of Radiography, University College Cork, Cork, Ireland
| | - Barry J Plant
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Medicine, Cork University Hospital, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland. .,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland. .,APC Microbiome Institute, University College Cork, Cork, Ireland.
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Automatic Quantitative Computed Tomography Evaluation of the Lungs in Patients With Systemic Sclerosis Treated With Autologous Stem Cell Transplantation. J Clin Rheumatol 2019; 26:S158-S164. [PMID: 31868835 DOI: 10.1097/rhu.0000000000001242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVE Interstitial lung disease stands among the leading causes of death in systemic sclerosis (SSc) patients. Autologous hematopoietic stem cell transplantation (AHSCT) has been proven superior to conventional immunosuppressive therapy in severe and progressive SSc. Here, pulmonary quantitative measurements were obtained in high-resolution computed tomography (HRCT) scans of patients with SSc before and after AHSCT. METHODS The medical records of thirthy-three patients who underwent AHSCT between 2011 and 2017 were evaluated for clinical and tomographic features at baseline (pre-AHCST) and 18 months after the procedure. Quantitative analysis of HRCT images by a fully automated program calculated lung volumes, densities, attenuation percentiles, and vascular volume. Patients were divided into 2 groups, according to changes in forced vital capacity (FVC). The "best response" group included patients that had an increased FVC of 10% or greater, and the "stable response" group included those who had a decreased or an increased FVC of less than 10%. RESULTS In the best response group (15 patients), there was reduction (p < 0.05) of mean lung density and density percentile values after AHSCT. In the stable response group (18 patients), there were no significant changes in lung volumes and pulmonary densities after AHSCT. Pulmonary HRCT densities showed moderate/strong correlation with function. CONCLUSIONS Quantitative HRCT analysis identified significant reduction in pulmonary densities in patients with improved pulmonary function after AHSCT. Lung density, as evaluated by the quantitative HRCT analysis tool, has potential to become a biomarker in the evaluation of interstitial lung disease treatment in patients with SSc.
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Santos MK, Ferreira Júnior JR, Wada DT, Tenório APM, Barbosa MHN, Marques PMDA. Artificial intelligence, machine learning, computer-aided diagnosis, and radiomics: advances in imaging towards to precision medicine. Radiol Bras 2019; 52:387-396. [PMID: 32047333 PMCID: PMC7007049 DOI: 10.1590/0100-3984.2019.0049] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The discipline of radiology and diagnostic imaging has evolved greatly in recent years. We have observed an exponential increase in the number of exams performed, subspecialization of medical fields, and increases in accuracy of the various imaging methods, making it a challenge for the radiologist to "know everything about all exams and regions". In addition, imaging exams are no longer only qualitative and diagnostic, providing now quantitative information on disease severity, as well as identifying biomarkers of prognosis and treatment response. In view of this, computer-aided diagnosis systems have been developed with the objective of complementing diagnostic imaging and helping the therapeutic decision-making process. With the advent of artificial intelligence, "big data", and machine learning, we are moving toward the rapid expansion of the use of these tools in daily life of physicians, making each patient unique, as well as leading radiology toward the concept of multidisciplinary approach and precision medicine. In this article, we will present the main aspects of the computational tools currently available for analysis of images and the principles of such analysis, together with the main terms and concepts involved, as well as examining the impact that the development of artificial intelligence has had on radiology and diagnostic imaging.
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Affiliation(s)
- Marcel Koenigkam Santos
- Centro de Ciências das Imagens e Física Médica (CCIFM) da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - José Raniery Ferreira Júnior
- Escola de Engenharia de São Carlos da Universidade de São Paulo (EESC-USP), São Carlos, SP, Brazil.,Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Danilo Tadao Wada
- Centro de Ciências das Imagens e Física Médica (CCIFM) da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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Santos MK, Cruvinel DL, de Menezes MB, Teixeira SR, Vianna EDO, Elias Júnior J, Martinez JAB. Quantitative computed tomography analysis of the airways in patients with cystic fibrosis using automated software: correlation with spirometry in the evaluation of severity. Radiol Bras 2016; 49:351-357. [PMID: 28100929 PMCID: PMC5238409 DOI: 10.1590/0100-3984.2015.0145] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To perform a quantitative analysis of the airways using automated software,
in computed tomography images of patients with cystic fibrosis, correlating
the results with spirometric findings. Materials and Methods Thirty-four patients with cystic fibrosis were studied-20 males and 14
females; mean age 18 ± 9 years-divided into two groups according to
the spirometry findings: group I (n = 21), without severe
airflow obstruction (forced expiratory volume in first second [FEV1] >
50% predicted), and group II (n = 13), with severe
obstruction (FEV1 ≤ 50% predicted). The following tracheobronchial
tree parameters were obtained automatically: bronchial diameter, area,
thickness, and wall attenuation. Results On average, 52 bronchi per patient were studied. The number of bronchi
analyzed was higher in group II. The correlation with spirometry findings,
especially between the relative wall thickness of third to eighth bronchial
generation and predicted FEV1, was better in group I. Conclusion Quantitative analysis of the airways by computed tomography can be useful for
assessing disease severity in cystic fibrosis patients. In patients with
severe airflow obstruction, the number of bronchi studied by the method is
higher, indicating more bronchiectasis. In patients without severe
obstruction, the relative bronchial wall thickness showed a good correlation
with the predicted FEV1.
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Affiliation(s)
- Marcel Koenigkam Santos
- PhD, MD, Radiologist, Collaborating Professor at the Center for Imaging Sciences and Medical Physics of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Danilo Lemos Cruvinel
- MD, Radiology Specialist at the Center for Imaging Sciences and Medical Physics of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Marcelo Bezerra de Menezes
- PhD, MD, Attending Pulmonologist in the Pulmonology Sector of the Department of Clinical Medicine of the Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Sara Reis Teixeira
- PhD, MD, Attending Radiologist at the Center for Imaging Sciences and Medical Physics of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Elcio de Oliveira Vianna
- PhD, MD, Pulmonologist, Professor in the Pulmonology Sector of the Department of Clinical Medicine of the Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Jorge Elias Júnior
- PhD, MD, Radiologist, Professor at the Center for Imaging Sciences and Medical Physics of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - José Antonio Baddini Martinez
- PhD, MD, Pulmonologist, Professor in the Pulmonology Sector of the Department of Clinical Medicine of the Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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Affiliation(s)
- Marcel Koenigkam Santos
- Attending Physician at Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HCFMRP-USP), MD, Radiologist at MED - Medicina Diagnóstica, Ribeirão Preto, SP, Brazil. E-mail:
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Lachi T, Nakayama M. Radiological findings of pulmonary tuberculosis in indigenous patients in Dourados, MS, Brazil. Radiol Bras 2015; 48:275-81. [PMID: 26543277 PMCID: PMC4633070 DOI: 10.1590/0100-3984.2014.0070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/09/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the radiological findings of pulmonary tuberculosis in indigenous patients from the city of Dourados, MS, Brazil, according to age and sex. MATERIALS AND METHODS Chest radiographic images of 81 patients with pulmonary tuberculosis, acquired in the period from 2007 to 2010, were retrospectively analyzed by two radiologists in consensus for the presence or absence of changes. The findings in abnormal radiographs were classified according to the changes observed and they were correlated to age and sex. The data were submitted to statistical analysis. RESULTS The individuals' ages ranged from 1 to 97 years (mean: 36 years). Heterogeneous consolidations, nodules, pleural involvement and cavities were the most frequent imaging findings. Most patients (55/81 or 67.9%) were male, and upper lung and right lung were the most affected regions. Fibrosis, heterogeneous consolidations and involvement of the left lung apex were significantly more frequent in males (p < 0.05). Presence of a single type of finding at radiography was most frequent in children (p < 0.05). CONCLUSION Based on the hypothesis that indigenous patients represent a population without genetically determined resistance to tuberculosis, the present study may enhance the knowledge about how the pulmonary form of this disease manifests in susceptible individuals.
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Affiliation(s)
- Tatiana Lachi
- Master, MD, Radiologist, Hospital Regional de Mato Grosso
do Sul, Auxiliary Professor at Universidade Federal de Mato Grosso do Sul (UFMS), Campo
Grande, MS, Brazil
| | - Mauro Nakayama
- PhD, Associate Professor at Universidade Federal da Grande
Dourados (UFGD), Dourados, MS, Brazil
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Francisco FAF, Rodrigues RS, Barreto MM, Escuissato DL, Araujo Neto CA, Silva JLPE, Silva CS, Hochhegger B, Souza Jr. AS, Zanetti G, Marchiori E. Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis? Radiol Bras 2015; 48:205-10. [PMID: 26379317 PMCID: PMC4567357 DOI: 10.1590/0100-3984.2014.0123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/13/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The present study was aimed at retrospectively reviewing high-resolution computed tomography (HRCT) findings in patients with pulmonary alveolar microlithiasis in order to evaluate the frequency of tomographic findings and their distribution in the lung parenchyma. MATERIALS AND METHODS Thirteen patients (9 females and 4 males; age, 9 to 59 years; mean age, 34.5 years) were included in the present study. The HRCT images were independently evaluated by two observers whose decisions were made by consensus. The inclusion criterion was the presence of abnormalities typical of pulmonary alveolar microlithiasis at HRCT, which precludes lung biopsy. However, in 6 cases lung biopsy was performed. RESULTS Ground-glass opacities and small parenchymal nodules were the predominant tomographic findings, present in 100% of cases, followed by small subpleural nodules (92.3%), subpleural cysts (84.6%), subpleural linear calcifications (69.2%), crazy-paving pattern (69.2%), fissure nodularity (53.8%), calcification along interlobular septa (46.2%) and dense consolidation (46.2%). CONCLUSION As regards distribution of the lesions, there was preferential involvement of the lower third of the lungs. No predominance of distribution in axial and anteroposterior directions was observed.
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Affiliation(s)
| | - Rosana Souza Rodrigues
- PhD, Professor, Program of Post-graduation in Radiology,
Universidade Federal do Rio de Janeiro (UFRJ), Physician at the Service of Radiology,
Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro
(UFRJ) and Instituto D’Or de Pesquisa e Educação, Rio de Janeiro, RJ, Brazil
| | - Miriam Menna Barreto
- PhD, Professor, Program of Post-graduation in Radiology,
Universidade Federal do Rio de Janeiro (UFRJ), Physician at the Service of Radiology,
Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro
(UFRJ), Rio de Janeiro, RJ, Brazil
| | - Dante Luiz Escuissato
- PhD, Associate Professor of Radiology, Department of
Medical Practice, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Cesar Augusto Araujo Neto
- PhDs, Associate Professors, Department of Medicine and
Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Jorge Luiz Pereira e Silva
- PhDs, Associate Professors, Department of Medicine and
Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Claudio S. Silva
- MD, Radiology Department, Facultad de Medicina Clinica
Alemana, Universidad del Desarrollo Santiago, Chile
| | - Bruno Hochhegger
- PhD, Associate Professor of Imaging Diagnosis, Universidade
Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Arthur Soares Souza Jr.
- PhD, Professor, Faculdade de Medicina de São José do Rio
Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Gláucia Zanetti
- PhD, Professor, Program of Post-graduation in Radiology at
Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Professor of Medical
Practice, Faculdade de Medicina de Petrópolis, Petrópolis, RJ, Brazil
| | - Edson Marchiori
- PhD, Full Professor Emeritus, Universidade Federal
Fluminense (UFF), Niterói, RJ, Associate Professor, Universidade Federal do Rio de
Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Affiliation(s)
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Silva GM, Zanetti GMR, Barillo JL, Marchiori E. Peripheral primitive neuroectodermal tumor of chest wall in young adult. Radiol Bras 2015; 48:60-1. [PMID: 25798010 PMCID: PMC4366031 DOI: 10.1590/0100-3984.2014.0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
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Affiliation(s)
- Bruno Hochhegger
- Medical Imaging Research Laboratory of Universidade Federal de Ciências da Saúde de Porto Alegre and Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | - Adalberto Sperb Rubin
- Medical Imaging Research Laboratory of Universidade Federal de Ciências da Saúde de Porto Alegre and Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Fiorelli A, Petrillo M, Vicidomini G, Di Crescenzo VG, Frongillo E, De Felice A, Rotondo A, Santini M. Quantitative assessment of emphysematous parenchyma using multidetector-row computed tomography in patients scheduled for endobronchial treatment with one-way valves†. Interact Cardiovasc Thorac Surg 2014; 19:246-55. [PMID: 24821017 DOI: 10.1093/icvts/ivu107] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To investigate the role of volume quantitative assessment using multidetector-row computed tomography to select patients scheduled for endobronchial one-way valves treatment. METHODS Twenty-five consecutive patients (15 with heterogeneous emphysema and 10 with giant emphysematous bulla) undergoing endobronchial valves treatment were enrolled. All patients were studied pre- and postoperatively with standard pulmonary functional tests and quantitative volume assessment of target lobe and entire lung. Emphysematous parenchyma was obtained applying density thresholds of -1.024/-950 Hounsfield units. Among different subtype of patients, we evaluated: (i) the differences between preoperative versus postoperative data; (ii) the correlation between functional and volumetric quantification changes and (iii) the critical threshold value of volumetric quantification of the target lobe in close association with clinical effects. RESULTS Among heterogeneous emphysematous and giant emphysematous bulla patients, a significant improvement of flow-expiratory volume in 1 s (from 36.9 ± 15.3 to 43.9 ± 10.4; P = 0.01; and from 35.8 ± 6.0 to 47.5 ± 7.9; P < 0.0001, respectively); and of forced vital capacity (from 41.9 ± 5.9 to 47.3 ± 9.3; P = 0.0009 and from 40.7 ± 5.9 to 48.8 ± 4.9; P = 0.0002, respectively); and a significant reduction of residual volume (from 185 ± 14 to 157 ± 14.7; P = 0.005; and from 196 ± 13.5 to 137 ± 21; P < 0.0001, respectively) and of total lung volume (from 166.7 ± 13 to 137 ± 18 ; P = 0.0003, and from 169 ± 15 to 134 ± 18; P < 0.0001, respectively) were seen after treatment. The volumetric measurements showed a reduction of volume of the treated lobe among heterogeneous emphysematous patients (from 1448 ± 204 to 1076 ± 364; P = 0.0008); and in those with giant emphysematous bulla (from 1668 ± 140 to 864 ± 199; P < 0.0001). The entire lung and target lobe volume changes were inversely correlated with change in forced expiratory volume in 1 s in patients with heterogeneous emphysematous (r = -0.7; P = 0.0006; and r = -0.7; P = 0.0009, respectively) and giant emphysematous bulla (r = -0.8; P = 0.001; and r = -0.7; P = 0.009, respectively). Among patients with heterogenous emphysematous and giant emphysematous bulla, the value of sensitivity and specificity were 66.6 and 83%, respectively (for a volumetric qunatification >1.5239), and of 60 and 100%, respectively (for a volumetric qunatification >1.762). CONCLUSIONS Our study showed that the volumetric quantification adds further informations to the routine evaluation for optimizing the selection of patients scheduled for endobronchial valve treatment.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
| | - Mario Petrillo
- Radiology Unit, Second University of Naples, Naples, Italy
| | | | | | | | - Alberto De Felice
- Pulmonary Rehabilitation Unit, Salvatore Maugeri Foundation, Scientific Institute of Telese, Telese Terme (BN), Italy
| | | | - Mario Santini
- Thoracic Surgery Unit, Second University of Naples, Naples, Italy
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Irion KL, Hochhegger B. Emphysema: diagnosis, classification, quantification and treatment planning. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000100003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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