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Girvin F. Editorial Comment: Radiologists as Core Contributors to the Multidisciplinary Management of Pulmonary Fibrosis. AJR Am J Roentgenol 2024; 222:e2329461. [PMID: 37098969 DOI: 10.2214/ajr.23.29461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Francis Girvin
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY,
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2
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Girvin F, Phan A, Steinberger S, Shostak E, Bessich J, Zhou F, Borczuk A, Brusca-Augello G, Goldberg M, Escalon J. Malignant and Benign Tracheobronchial Neoplasms: Comprehensive Review with Radiologic, Bronchoscopic, and Pathologic Correlation. Radiographics 2023; 43:e230045. [PMID: 37561643 DOI: 10.1148/rg.230045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Tracheobronchial neoplasms are much less common than lung parenchymal neoplasms but can be associated with significant morbidity and mortality. They include a broad differential of both malignant and benign entities, extending far beyond more commonly known pathologic conditions such as squamous cell carcinoma and carcinoid tumor. Airway lesions may be incidental findings at imaging or manifest with symptoms related to airway narrowing or mucosal irritation, invasion of adjacent structures, or distant metastatic disease. While there is considerable overlap in clinical manifestation, imaging features, and bronchoscopic appearances, an awareness of potential distinguishing factors may help narrow the differential diagnosis. The authors review the epidemiology, imaging characteristics, typical anatomic distributions, bronchoscopic appearances, and histopathologic findings of a wide range of neoplastic entities involving the tracheobronchial tree. Malignant neoplasms discussed include squamous cell carcinoma, malignant salivary gland tumors (adenoid cystic carcinoma and mucoepidermoid carcinoma), carcinoid tumor, sarcomas, primary tracheobronchial lymphoma, and inflammatory myofibroblastic tumor. Benign neoplasms discussed include hamartoma, chondroma, lipoma, papilloma, amyloidoma, leiomyoma, neurogenic lesions, and benign salivary gland tumors (pleomorphic adenoma and mucous gland adenoma). Familiarity with the range of potential entities and any distinguishing features should prove valuable to thoracic radiologists, pulmonologists, and cardiothoracic surgeons when encountering the myriad of tracheobronchial neoplasms in clinical practice. Attention is paid to any features that may help render a more specific diagnosis before pathologic confirmation. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Francis Girvin
- From the Departments of Radiology (F.G., A.P., S.S., G.B.A., J.E.) and Pulmonary Critical Care Medicine (E.S., M.G.), NewYork Presbyterian and Weill Cornell Medical Center, 1300 York Ave, New York, NY 10065; Departments of Pulmonary Medicine (J.B.) and Pathology (F.Z.), New York University Langone Health, New York, NY; and Department of Pathology, Northwell Health, New York, NY (A.B.)
| | - Alexander Phan
- From the Departments of Radiology (F.G., A.P., S.S., G.B.A., J.E.) and Pulmonary Critical Care Medicine (E.S., M.G.), NewYork Presbyterian and Weill Cornell Medical Center, 1300 York Ave, New York, NY 10065; Departments of Pulmonary Medicine (J.B.) and Pathology (F.Z.), New York University Langone Health, New York, NY; and Department of Pathology, Northwell Health, New York, NY (A.B.)
| | - Sharon Steinberger
- From the Departments of Radiology (F.G., A.P., S.S., G.B.A., J.E.) and Pulmonary Critical Care Medicine (E.S., M.G.), NewYork Presbyterian and Weill Cornell Medical Center, 1300 York Ave, New York, NY 10065; Departments of Pulmonary Medicine (J.B.) and Pathology (F.Z.), New York University Langone Health, New York, NY; and Department of Pathology, Northwell Health, New York, NY (A.B.)
| | - Eugene Shostak
- From the Departments of Radiology (F.G., A.P., S.S., G.B.A., J.E.) and Pulmonary Critical Care Medicine (E.S., M.G.), NewYork Presbyterian and Weill Cornell Medical Center, 1300 York Ave, New York, NY 10065; Departments of Pulmonary Medicine (J.B.) and Pathology (F.Z.), New York University Langone Health, New York, NY; and Department of Pathology, Northwell Health, New York, NY (A.B.)
| | - Jamie Bessich
- From the Departments of Radiology (F.G., A.P., S.S., G.B.A., J.E.) and Pulmonary Critical Care Medicine (E.S., M.G.), NewYork Presbyterian and Weill Cornell Medical Center, 1300 York Ave, New York, NY 10065; Departments of Pulmonary Medicine (J.B.) and Pathology (F.Z.), New York University Langone Health, New York, NY; and Department of Pathology, Northwell Health, New York, NY (A.B.)
| | - Fang Zhou
- From the Departments of Radiology (F.G., A.P., S.S., G.B.A., J.E.) and Pulmonary Critical Care Medicine (E.S., M.G.), NewYork Presbyterian and Weill Cornell Medical Center, 1300 York Ave, New York, NY 10065; Departments of Pulmonary Medicine (J.B.) and Pathology (F.Z.), New York University Langone Health, New York, NY; and Department of Pathology, Northwell Health, New York, NY (A.B.)
| | - Alain Borczuk
- From the Departments of Radiology (F.G., A.P., S.S., G.B.A., J.E.) and Pulmonary Critical Care Medicine (E.S., M.G.), NewYork Presbyterian and Weill Cornell Medical Center, 1300 York Ave, New York, NY 10065; Departments of Pulmonary Medicine (J.B.) and Pathology (F.Z.), New York University Langone Health, New York, NY; and Department of Pathology, Northwell Health, New York, NY (A.B.)
| | - Geraldine Brusca-Augello
- From the Departments of Radiology (F.G., A.P., S.S., G.B.A., J.E.) and Pulmonary Critical Care Medicine (E.S., M.G.), NewYork Presbyterian and Weill Cornell Medical Center, 1300 York Ave, New York, NY 10065; Departments of Pulmonary Medicine (J.B.) and Pathology (F.Z.), New York University Langone Health, New York, NY; and Department of Pathology, Northwell Health, New York, NY (A.B.)
| | - Margaret Goldberg
- From the Departments of Radiology (F.G., A.P., S.S., G.B.A., J.E.) and Pulmonary Critical Care Medicine (E.S., M.G.), NewYork Presbyterian and Weill Cornell Medical Center, 1300 York Ave, New York, NY 10065; Departments of Pulmonary Medicine (J.B.) and Pathology (F.Z.), New York University Langone Health, New York, NY; and Department of Pathology, Northwell Health, New York, NY (A.B.)
| | - Joanna Escalon
- From the Departments of Radiology (F.G., A.P., S.S., G.B.A., J.E.) and Pulmonary Critical Care Medicine (E.S., M.G.), NewYork Presbyterian and Weill Cornell Medical Center, 1300 York Ave, New York, NY 10065; Departments of Pulmonary Medicine (J.B.) and Pathology (F.Z.), New York University Langone Health, New York, NY; and Department of Pathology, Northwell Health, New York, NY (A.B.)
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Girvin F, Zhou F, Escalon J, Steinberger S, Gupta D, Groner L. Granulomatous lymphadenitis in the inferior pulmonary ligament. BJR Case Rep 2022; 8:20220087. [PMID: 36632544 PMCID: PMC9809917 DOI: 10.1259/bjrcr.20220087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 01/14/2023] Open
Abstract
The inferior pulmonary ligament and related connective tissue septa are a recognizable site of granulomatous lymphadenitis on CT of the chest and may mimic a lung parenchymal lesion. The anatomy of the inferior pulmonary ligament, CT appearances and potential etiologies of this entity are reviewed and illustrated.
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Affiliation(s)
- Francis Girvin
- Department of Radiology, Presbyterian / Weill Cornell Medical Center, NewYork, United States
| | - Fang Zhou
- Department of Pathology, University Langone Health, New York, United States
| | - Joanna Escalon
- Department of Radiology, Presbyterian / Weill Cornell Medical Center, NewYork, United States
| | - Sharon Steinberger
- Department of Radiology, Presbyterian / Weill Cornell Medical Center, NewYork, United States
| | - Deepti Gupta
- Department of Radiology, Presbyterian / Weill Cornell Medical Center, NewYork, United States
| | - Lauren Groner
- Department of Radiology, Presbyterian / Weill Cornell Medical Center, NewYork, United States
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Escalon JG, Sullivan D, Pua BB, Girvin F, Verzosa Weisman S, Steinberger S, Toy D, Groner L, Legasto AC, Gruden JF. Management of Incidental Pulmonary Nodules: Influencing Patient Care Through Subspecialized Imaging Review. Curr Probl Diagn Radiol 2021; 51:524-528. [PMID: 34974882 DOI: 10.1067/j.cpradiol.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/18/2021] [Accepted: 11/07/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate whether thoracic radiologist review of computed tomography-detected incidental pulmonary nodules initially reported by non-thoracic imagers would change management recommendations. MATERIALS AND METHODS The Radiology Consultation Service identified 468 computed tomography scans (one per patient) performed through the adult emergency department from August 2018 through December 2020 that mentioned the presence of a pulmonary nodule. Forty percent (186/468) were read by thoracic radiologists and 60% (282/468) were read by non-thoracic radiologists. The Radiology Consultation Service contacted all patients in order to assess risk factors for lung malignancy. Sixty-seven patients were excluded because they were unreachable, declined participation, or were actively followed by a pulmonologist or oncologist. A thoracic radiologist assessed the nodule and follow up recommendations in all remaining cases. RESULTS A total of 215 cases were re-reviewed by thoracic radiologists. The thoracic radiologist disagreed with the initial nodule recommendations in 38% (82/215) of cases and agreed in 62% (133/215) of cases. All discordant cases resulted in a change in management by the thoracic radiologist with approximately one-third (33%, 27/82) decreasing imaging utilization and two-thirds (67%, 55/82) increasing imaging utilization. Nodules were deemed benign and follow up eliminated in 11% (9/82) of discordant cases. DISCUSSION Our study illustrates that nodule review by thoracic radiologists results in a change in management in a large percentage of patients. Continued research is needed to determine whether subspecialty imaging review results in increased or more timely lung cancer detection.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY.
| | - Deirdre Sullivan
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Bradley B Pua
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Francis Girvin
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | | | - Sharon Steinberger
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Dennis Toy
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Lauren Groner
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Alan C Legasto
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - James F Gruden
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
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5
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Weisman SV, Cheng EP, Girvin F, Toy D, Hossain R, Steinberger S, Escalon J, Legasto AC. Acute Thoracic Complications of Minimally Invasive Cardiac Procedures. Curr Treat Options Cardio Med 2021. [DOI: 10.1007/s11936-021-00919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Girvin F, Toy D, Escalon J. A unique case of unilateral pulmonary edema from partial anomalous pulmonary venous return in conjunction with superior vena cava stenosis. Clin Imaging 2021; 79:110-112. [PMID: 33933823 DOI: 10.1016/j.clinimag.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/24/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
While PAPVR is most commonly an incidental finding on chest CT, a unique case is presented where PAPVR in conjunction with SVC stenosis resulted in chronic symptomatic asymmetric pulmonary edema. The case reflects an unusual anatomic cause of unilateral edema, as a combination of both congenital and subsequently acquired anatomic anomalies.
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Affiliation(s)
- Francis Girvin
- NewYork Presbyterian Weill Cornell Medical Center, Department of Radiology, Cardiothoracic Imaging Division, 1300 York Avenue, New York, NY 10065, United States of America.
| | - Dennis Toy
- NewYork Presbyterian Weill Cornell Medical Center, Department of Radiology, Cardiothoracic Imaging Division, 1300 York Avenue, New York, NY 10065, United States of America.
| | - Joanna Escalon
- NewYork Presbyterian Weill Cornell Medical Center, Department of Radiology, Cardiothoracic Imaging Division, 1300 York Avenue, New York, NY 10065, United States of America.
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7
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Girvin F, Hoda S, Kim S. Atypical appearance of elastofibroma dorsi at thoracotomy sites: a case series and review of the literature. BJR Case Rep 2020; 6:20190112. [PMID: 33029376 PMCID: PMC7527012 DOI: 10.1259/bjrcr.20190112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022] Open
Abstract
Thus far, only a single case describing an atypical appearance of elastofibroma dorsi at a prior thoracotomy site has been published in the literature. We describe a series of three cases recently imaged at our institution with the same atypical appearance, in order to highlight and increase recognition of this more unusual morphology in post-operative patients.
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Affiliation(s)
- Francis Girvin
- Department of Radiology, NYU LangoneMedical Center, New York, United States
| | - Syed Hoda
- Department of Pathology, NYU Langone Medical Center, New York, United States
| | - Stacy Kim
- Department of Radiology, NYU LangoneMedical Center, New York, United States
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Girvin F, Naidich D. CT features of electronic-cigarette or vaping-associated lung injury (EVALI); our experience during the recent outbreak. BJR Case Rep 2020; 6:20200027. [PMID: 32922848 PMCID: PMC7465747 DOI: 10.1259/bjrcr.20200027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 11/25/2022] Open
Abstract
As an emerging clinical syndrome, our knowledge of the clinical, pathologic and radiologic features of electronic-cigarette or vaping-associated lung injury is evolving. CT appearances are described in six cases imaged at our institution (NYU Langone Health, New York) in the cluster of 2019.
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Gruden JF, Naidich DP, Machnicki SC, Cohen SL, Girvin F, Raoof S. An Algorithmic Approach to the Interpretation of Diffuse Lung Disease on Chest CT Imaging: A Theory of Almost Everything. Chest 2019; 157:612-635. [PMID: 31704148 DOI: 10.1016/j.chest.2019.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/25/2019] [Accepted: 10/12/2019] [Indexed: 12/17/2022] Open
Abstract
We propose an algorithmic approach to the interpretation of diffuse lung disease on high-resolution CT. Following an initial review of pertinent lung anatomy, the following steps are included. Step 1: a preliminary review of available chest radiographs, including the "scanogram" obtained at the time of the CT examination. Step 2: a review of optimal methods of data acquisition and reconstruction, emphasizing the need for contiguous high-resolution images throughout the entire thorax. Step 3: initial uninterrupted scrolling of contiguous high-resolution images throughout the chest to establish the quality of examination as well as an overview of the presence and extent of disease. Step 4: determination of one of three predominant categories - primarily reticular disease, nodular disease, or diseases associated with diffuse alteration in lung density. Based on this determination, one of the three following Steps are followed: Step 5: evaluation of cases primarily involving diffuse lung reticulation; Step 6: evaluation of cases primarily resulting in diffuse lung nodules; and Step 7: evaluation of cases with diffuse alterations in lung density including those with diffusely diminished lung density vs those with heterogenous or diffusely increased lung density, respectively. It is anticipated that this algorithmic approach will substantially enhance initial interpretations of a wide range of pulmonary disease.
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Affiliation(s)
- James F Gruden
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - David P Naidich
- Department of Radiology, New York University-Langone Medical Center, New York, NY.
| | | | - Stuart L Cohen
- Department of Radiology, Northwell Health Radiology, Northwell Health, New York, NY
| | - Francis Girvin
- Department of Radiology, New York University-Langone Medical Center, New York, NY
| | - Suhail Raoof
- Lenox Hill Hospital, Northwell Health, New York, NY
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Raoof S, Naidich DP, Ryu JH, Machnicki S, Patel S, Gafoor K, Franquet T, Gupta N, Girvin F. Response. Chest 2019; 153:1515-1516. [PMID: 29884270 DOI: 10.1016/j.chest.2018.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Suhail Raoof
- Pulmonary Division, Lenox Hill Hospital, New York, NY.
| | - David P Naidich
- Department of Radiology, New York University - Langone Medical Center, New York, NY
| | - Jay H Ryu
- Department of Medicine/Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Stephen Machnicki
- Department of Radiology, New York University - Langone Medical Center, New York, NY
| | - Shalin Patel
- Department of Medicine, Lenox Hill Hospital, New York, NY
| | - Khalid Gafoor
- Department of Medicine, Lenox Hill Hospital, New York, NY
| | - Tomás Franquet
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Nishant Gupta
- Department of Pulmonary, Critical Care, and Medicine, University of Cincinnati, Cincinnati, OH
| | - Francis Girvin
- Department of Radiology, New York University - Langone Medical Center, New York, NY
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Cherian SV, Girvin F, Naidich DP, Machnicki S, Brown KK, Ryu JH, Gupta N, Mehta V, Estrada-Y-Martin RM, Narasimhan M, Oks M, Raoof S. Lung Hyperlucency: A Clinical-Radiologic Algorithmic Approach to Diagnosis. Chest 2019; 157:119-141. [PMID: 31356811 DOI: 10.1016/j.chest.2019.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/27/2019] [Accepted: 06/10/2019] [Indexed: 11/24/2022] Open
Abstract
Areas of diminished lung density are frequently identified both on routine chest radiographs and chest CT examinations. Colloquially referred to as hyperlucent foci of lung, a broad range of underlying pathophysiologic mechanisms and differential diagnoses account for these changes. Despite this, the spectrum of etiologies can be categorized into underlying parenchymal, airway, and vascular-related entities. The purpose of this review is to provide a practical diagnostic algorithmic approach to pulmonary hyperlucencies incorporating clinical history and characteristic imaging patterns to narrow the differential.
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Affiliation(s)
- Sujith V Cherian
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Health - McGovern Medical School, Houston, TX
| | - Francis Girvin
- Department of Radiology, Division of Thoracic Radiology, NYU Langone Health, New York, NY
| | - David P Naidich
- Department of Radiology, Division of Thoracic Radiology, NYU Langone Health, New York, NY
| | | | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO
| | - Jay H Ryu
- Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH
| | - Vishisht Mehta
- Division of Pulmonary Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rosa M Estrada-Y-Martin
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Texas Health - McGovern Medical School, Houston, TX
| | - Mangala Narasimhan
- Division of Pulmonary, Critical Care and Sleep Medicine, Long Island Jewish Medical Center, New Hyde Park, NY
| | - Margarita Oks
- Medicine and Radiology, Barbara and Donald Zuckerberg School of Medicine at Hofstra/Northwell, New York, NY
| | - Suhail Raoof
- Pulmonary, Critical Care & Sleep Medicine, Lenox Hill Hospital, New York, NY; Medicine and Radiology, Barbara and Donald Zuckerberg School of Medicine at Hofstra/Northwell, New York, NY.
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Abstract
Diseases that are predominantly peribronchovascular in distribution on computed tomography by definition involve the bronchi, adjacent vasculature, and associated lymphatics involving the central or axial lung interstitium. An understanding of diseases that can present with focal peribronchovascular findings is useful for establishing diagnoses and guiding patient management. This review will cover clinical and imaging features that may assist in differentiating amongst the various causes of primarily peribronchovascular disease.
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Affiliation(s)
- Jane P Ko
- Department of Radiology, NYU Langone Health, New York, NY.
| | - Francis Girvin
- Department of Radiology, NYU Langone Health, New York, NY
| | - William Moore
- Department of Radiology, NYU Langone Health, New York, NY
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13
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Affiliation(s)
- Francis Girvin
- NYU Langone Health, Radiology Department, Centre of Biomedical Imaging (CBI), 660 First Avenue, NY, USA
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14
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Feng L, Delacoste J, Smith D, Weissbrot J, Flagg E, Moore WH, Girvin F, Raad R, Bhattacharji P, Stoffel D, Piccini D, Stuber M, Sodickson DK, Otazo R, Chandarana H. Simultaneous Evaluation of Lung Anatomy and Ventilation Using 4D Respiratory-Motion-Resolved Ultrashort Echo Time Sparse MRI. J Magn Reson Imaging 2018; 49:411-422. [PMID: 30252989 DOI: 10.1002/jmri.26245] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Computed tomography (CT) and spirometry are the current standard methods for assessing lung anatomy and pulmonary ventilation, respectively. However, CT provides limited ventilation information and spirometry only provides global measures of lung ventilation. Thus, a method that can enable simultaneous examination of lung anatomy and ventilation is of clinical interest. PURPOSE To develop and test a 4D respiratory-resolved sparse lung MRI (XD-UTE: eXtra-Dimensional Ultrashort TE imaging) approach for simultaneous evaluation of lung anatomy and pulmonary ventilation. STUDY TYPE Prospective. POPULATION In all, 23 subjects (11 volunteers and 12 patients, mean age = 63.6 ± 8.4). FIELD STRENGTH/SEQUENCE 3T MR; a prototype 3D golden-angle radial UTE sequence, a Cartesian breath-hold volumetric-interpolated examination (BH-VIBE) sequence. ASSESSMENT All subjects were scanned using the 3D golden-angle radial UTE sequence during normal breathing. Ten subjects underwent an additional scan during alternating normal and deep breathing. Respiratory-motion-resolved sparse reconstruction was performed for all the acquired data to generate dynamic normal-breathing or deep-breathing image series. For comparison, BH-VIBE was performed in 12 subjects. Lung images were visually scored by three experienced chest radiologists and were analyzed by two observers who segmented the left and right lung to derive ventilation parameters in comparison with spirometry. STATISTICAL TESTS Nonparametric paired two-tailed Wilcoxon signed-rank test; intraclass correlation coefficient, Pearson correlation coefficient. RESULTS XD-UTE achieved significantly improved image quality compared both with Cartesian BH-VIBE and radial reconstruction without motion compensation (P < 0.05). The global ventilation parameters (a sum of the left and right lung measures) were in good correlation with spirometry in the same subjects (correlation coefficient = 0.724). There were excellent correlations between the results obtained by two observers (intraclass correlation coefficient ranged from 0.8855-0.9995). DATA CONCLUSION Simultaneous evaluation of lung anatomy and ventilation using XD-UTE is demonstrated, which have shown good potential for improved diagnosis and management of patients with heterogeneous lung diseases. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:411-422.
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Affiliation(s)
- Li Feng
- Center for Advanced Imaging Innovation and Research (CAIR), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jean Delacoste
- Department of Radiology, University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - David Smith
- Center for Advanced Imaging Innovation and Research (CAIR), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Joseph Weissbrot
- Center for Advanced Imaging Innovation and Research (CAIR), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Eric Flagg
- Center for Advanced Imaging Innovation and Research (CAIR), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - William H Moore
- Center for Advanced Imaging Innovation and Research (CAIR), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Francis Girvin
- Center for Advanced Imaging Innovation and Research (CAIR), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Roy Raad
- Center for Advanced Imaging Innovation and Research (CAIR), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Priya Bhattacharji
- Center for Advanced Imaging Innovation and Research (CAIR), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - David Stoffel
- Center for Advanced Imaging Innovation and Research (CAIR), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Davide Piccini
- Department of Radiology, University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Matthias Stuber
- Department of Radiology, University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Daniel K Sodickson
- Center for Advanced Imaging Innovation and Research (CAIR), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Ricardo Otazo
- Center for Advanced Imaging Innovation and Research (CAIR), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hersh Chandarana
- Center for Advanced Imaging Innovation and Research (CAIR), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
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15
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Dane B, Patel H, O'Donnell T, Girvin F, Brusca-Augello G, Alpert JB, Niu B, Attia M, Babb J, Ko JP. Image Quality on Dual-energy CTPA Virtual Monoenergetic Images: Quantitative and Qualitative Assessment. Acad Radiol 2018; 25:1075-1086. [PMID: 29398436 DOI: 10.1016/j.acra.2017.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/08/2017] [Accepted: 12/17/2017] [Indexed: 01/14/2023]
Abstract
RATIONALE AND OBJECTIVES This study aims to determine the optimal photon energy for image quality of the pulmonary arteries (PAs) on dual-energy computed tomography (CT) pulmonary angiography (CTPA) utilizing low volumes of iodinated contrast. MATERIALS AND METHODS The study received institutional review board exemption and was Health Insurance Portability and Accountability Act compliant. Adults (n = 56) who underwent dual-energy CTPA with 50-60 cc of iodinated contrast on a third-generation dual-source multidetector CT were retrospectively and consecutively identified. Twelve virtual monoenergetic kiloelectron volt (keV) image data sets (40-150 keV, 10-keV increments) were generated with a second-generation noise-reducing algorithm. Standard regions of interest were placed on main, right, left, and right interlobar pulmonary arteries; pectoralis muscle; and extrathoracic air. Attenuation [mean CT number (Hounsfield unit, HU)], noise [standard deviation (HU)], signal to noise (SNR), and contrast to noise ratio were evaluated. Three blinded chest radiologists rated (from 1 to 5, with 5 being the best) randomized monoenergetic and weighted-average images for attenuation and noise. P <.05 was considered significant. RESULTS Region of interest mean CT number increased as keV decreased, with 40 keV having the highest value (P < .001). Mean SNR was highest for 40-60 keV (P <.05) (14.5-14.7) and was higher (P <.05) than all remaining energies (90-150 keV) for all vessel regions combined. Contrast to noise ratio was highest for 40 keV (P <.001) and decreased as keV increased. SNR was highest at 60 and 70 keV, only slightly higher than 40-50 keV (P <.05). Reader scores for 40-50 keV were greater than other energies and weighted-average images (P <.05). CONCLUSIONS Kiloelectron volt images of 40-50 keV from the second-generation algorithm optimize attenuation on dual-energy CTPA and can potentially aid in interpretation and avoiding nondiagnostic examinations.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016.
| | - Hersh Patel
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | | | - Francis Girvin
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | | | - Jeffrey B Alpert
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | - Bowen Niu
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | | | - James Babb
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | - Jane P Ko
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
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16
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Gafoor K, Patel S, Girvin F, Gupta N, Naidich D, Machnicki S, Brown KK, Mehta A, Husta B, Ryu JH, Sarosi GA, Franquet T, Verschakelen J, Johkoh T, Travis W, Raoof S. Cavitary Lung Diseases. Chest 2018. [DOI: 10.1016/j.chest.2018.02.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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17
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Taslakian B, Latson LA, Truong MT, Aaltonen E, Shiau MC, Girvin F, Alpert JB, Wickstrom M, Ko JP. CT pulmonary angiography of adult pulmonary vascular diseases: Technical considerations and interpretive pitfalls. Eur J Radiol 2016; 85:2049-2063. [PMID: 27776659 DOI: 10.1016/j.ejrad.2016.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/30/2016] [Accepted: 09/15/2016] [Indexed: 12/28/2022]
Abstract
Computed tomography pulmonary angiography (CTPA) has become the primary imaging modality for evaluating the pulmonary arteries. Although pulmonary embolism is the primary indication for CTPA, various pulmonary vascular abnormalities can be detected in adults. Knowledge of these disease entities and understanding technical pitfalls that can occur when performing CTPA are essential to enable accurate diagnosis and allow timely management. This review will cover a spectrum of acquired abnormalities including pulmonary embolism due to thrombus and foreign bodies, primary and metastatic tumor involving the pulmonary arteries, pulmonary hypertension, as well as pulmonary artery aneurysms and stenoses. Additionally, methods to overcome technical pitfalls and interventional treatment options will be addressed.
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Affiliation(s)
| | - Larry A Latson
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | - Mylene T Truong
- Department of Radiology, University of Texas, MD Anderson Cancer Center, TX, USA.
| | - Eric Aaltonen
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | - Maria C Shiau
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | - Francis Girvin
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | | | - Maj Wickstrom
- Department of Radiology, NYU Langone Medical Center, NY, USA.
| | - Jane P Ko
- Department of Radiology, NYU Langone Medical Center, NY, USA.
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18
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Farrell C, Jones M, Girvin F, Ritchie G, Murchison JT. Unsuspected pulmonary embolism identified using multidetector computed tomography in hospital outpatients. Clin Radiol 2009; 65:1-5. [PMID: 20103414 DOI: 10.1016/j.crad.2009.09.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Revised: 09/01/2009] [Accepted: 09/07/2009] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the incidence of unsuspected pulmonary embolism (PE) in an unselected population of outpatients undergoing contrast-enhanced multidetector computed tomography (MDCT) for indications other than the investigation of PE. MATERIALS AND METHODS Outpatients undergoing CT of the chest over a 6-month period were retrospectively identified and images reviewed. Inpatients and patients undergoing unenhanced CT of the chest were excluded. Data, including referring specialty, patient age and sex, reasons for examination, level of embolism, image quality, and section thickness were recorded. Radiology reports were reviewed with respect to whether or not the embolism was noted at the time of initial reporting. RESULTS Following exclusions 440 patients were reviewed (195 women and 245 men). PE was identified in 10 of the 440 patients, an incidence of 2.23%. One pulmonary embolus was in the main pulmonary artery, three were in lobar arteries, three in segmental arteries, and three in subsegmental arteries. Patients over the age of 60 years were more likely to have an embolism (9/300, 2.9%) compared with those under 60 years (1/140, 0.7%). Seven of the 10 positive examinations were carried out in patients who were known or later shown to have malignancy. Seven of the 10 emboli were reported at the time of initial reporting. CONCLUSION The outpatient population has a significant incidence of unsuspected PE. PE should be actively sought when reporting examinations performed for alternative indications, particularly where cancer is a known or suspected diagnosis.
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Affiliation(s)
- C Farrell
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
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19
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Girvin F, Vlahos I. A 30-Year-Old Man With a History of Polysubstance Abuse and Hepatitis C Presents With Exertional Dyspnea and Patchy Ground-Glass Opacities. Chest 2006; 130:1608-11. [PMID: 17099044 DOI: 10.1378/chest.130.5.1608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Francis Girvin
- New York School of Medicine/New York University and Bellevue Medical Center, New York, NY 10016, USA.
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