Tumour volume changes assessed with high-quality KVCT in lung cancer patients undergoing concurrent chemoradiotherapy

OBJECTIVE

We evaluated tumour volume changes in patients with lung cancer undergoing concurrent chemoradiotherapy using image-guided radiotherapy (RT).

METHODS

The kilovoltage image was obtained using CT on rail at every five fractions. The gross tumour volumes (GTVs), including the primary tumour and lymph nodes (LNs), were contoured to analyse the time and degree of tumour regression.

RESULTS

46 patients [32, non-small-cell lung cancer (NSCLC), and 14, small-cell lung cancer (SCLC)] were included in this study. In total, 281 CT scans and 82 sites of GTVs were evaluated. Significant volume changes occurred in both the NSCLC and SCLC groups (p < 0.001 and 0.002), and the average GTV change compared with baseline was 49.85 ± 3.65 [standard error (SE)]% and 65.95 ± 4.60 (SE)% for the NSCLC and SCLC groups, respectively. A significant difference in the degree of volume reduction between the primary tumour and LNs was observed in only the NSCLC group (p < 0.0001) but not in the SCLC group (p = 0.735). The greatest volume regression compared with the volume before the five fractions occurred between the 15 and 20 fractions in the NSCLC group and between the 5 and 10 fractions in the SCLC group.

CONCLUSION

Both primary tumour and LNs were well defined using CT on rail. Significant volume changes occurred during RT, and there was a difference in volume reduction between the NSCLC and SCLC groups, regarding the degree and timing of the tumour reduction in the primary tumour and LNs.

ADVANCES IN KNOWLEDGE

NSCLC and SCLC groups showed differences in the degree and timing of volume reduction. The primary tumour and LNs in NSCLC regressed differently.

Asymptomatic adults with isolated, unilateral right pulmonary vein atresia: multidetector CT findings

We report two cases of a very rare congenital anomaly, i.e. isolated unilateral pulmonary vein atresia. The patients were asymptomatic and the diagnosis was made using multidetector CT (MDCT), which also showed cyst formation in the right lung. Asymptomatic adult cases or association with cystic lung lesions have never been reported in this condition before.

Varying degrees of FDG uptake in multiple benign neurofibromas on PET/CT

We report fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings of three neurofibromas in the mediastinum and neck in a 26-year-old woman with neurofibromatosis type 1. PET/CT scans demonstrated varying degrees of FDG uptake with maximum standard uptake values (SUV(max)) of 5.3, 1.8 and 3.2 for left lower neck, left paratracheal and right paravertebral masses, respectively. Surgical resections were carried out and histopathology confirmed three benign neurofibromas with various tissue components and cellularities.

CT differentiation of pneumonic-type bronchioloalveolar cell carcinoma and infectious pneumonia

The objective was to analyse the potential of CT to distinguish pneumonic-type bronchioloalveolar cell carcinoma (BAC) from infectious pneumonia. The study consisted of 21 patients with pathologically proven BAC and 30 patients with infectious pneumonia. Both groups of patients had patchy or diffuse consolidation of more than half the area of a lobe or lobes on CT. CT findings in these two groups were compared with regard to morphological appearance, including CT angiogram, air bronchogram, mucous bronchogram, contrast enhancement pattern, pseudocavitation, cavity with air-fluid level, location, satellite lesion, ground-glass opacity and bulging of the interlobar fissure. Air-filled bronchi were morphologically analysed as dilatation, stretching, sweeping, widening of the branching angle, squeezing and crowding. Lymphadenopathy and pleural effusion were also analysed. CT findings favouring the diagnosis of BAC included an air-filled bronchus within the consolidation with stretching, squeezing, sweeping, widening of the branching angle and bulging of the interlobar fissure (p<0.05). It is concluded that CT may be helpful in differentiating pneumonic-type BAC from infectious pneumonia if the air-filled bronchus within the consolidation shows stretching, squeezing, widening of the branching angle or bulging of the interlobar fissure.

Poland's syndrome with lung cancer. A case report

Poland's syndrome, a rare congenital anomaly characterized by pectoralis muscle defect, has been reported in association with lymphoreticular malignancies and some solid tumors. Lung cancer associated with Poland's syndrome has not been previously described. We present the first report of a case of Poland's syndrome associated with lung cancer and demonstrate the CT findings.

Middle mediastinal lesions: imaging findings and pathologic correlation

Lesions primarily involving the middle mediastinum are uncommon and include lymph node diseases, cystic lesions, neurogenic tumors, mesenchymal tumors, tumors of mediastinal organ, amd other benign processes. In this article, we illustrate imaging findings of a variety of middle mediastinal lesions with pathologic correlation.

Primary amyloidoma of the cervical spine

Primary solitary amyloidoma of the spine is a disease characterized by localized deposits of amyloid. We describe and illustrate the radiologic appearance of primary solitary amyloidoma of the spine on plain radiographs, CT scans, and MR images. The imaging findings revealed features of a nonspecific soft-tissue mass with calcifications. Epidural extension of the amyloidoma caused spinal cord compression.

Pseudomembranous necrotizing bronchial aspergillosis

We report a case of pseudomembranous necrotizing bronchial aspergillosis in a patient with acute myelocytic leukaemia who died of massive haemoptysis. Lobar collapse was demonstrated on chest radiography. CT showed a marked necrotic thickening of the lobar bronchus with extension of the disease in to the peribronchial region.

Sequential changes of sonographic and computed tomography findings in the normal rabbit liver after percutaneous ethanol injection. Correlation with pathologic findings

RATIONALE AND OBJECTIVES

The authors assessed the sequential sonographic and computed tomographic (CT) findings and their correlations with pathologic findings of the normal rabbit liver after percutaneous ethanol injection (PEI).

METHODS

In 30 anesthetized rabbits, 1 mL of ethanol was injected percutaneously under sonographic guidance. The animals were divided into five groups of six rabbits each according to the times of sonography and CT examinations after PEI: day 1 (immediately after), day 3, week 1, week 2, and week 4. The radiologic findings were analyzed regarding echogenicity (sonography) and density patterns before and after contrast administration (CT). The relations between radiologic findings and pathologic findings were examined using statistical analysis. The lesion size was measured using sonography and CT and compared with the actual size of the pathologic specimen.

RESULTS

Sonography and CT showed various radiologic findings according to the time elapsed after PEI. The livers were hyperechoic in 100% (6/6) of the rabbits on day 1; this changed to isoechoic (67%, 12/18) or slightly hypoechoic (22%, 4/18) after week 1 through week 4 after PEI on sonography. CT scanning showed well-defined, hypodense lesions with no contrast enhancement in 100% (6/6) of the rabbits on day 1, and the lesions were slightly hypodense and relatively poorly defined in 88% (21/24) after day 3. Peripheral enhancement was noted in 83% (15/18) after week 1. Histopathologic examination revealed thrombosis and atrophic hepatic cell cords correlating well with hyperechogenicity on sonography and very low density on CT immediately after PEI. Coagulation necrosis was a main pathologic finding in the central portion of the lesions after day 3 and correlated with the CT findings of central low density without contrast enhancement. After week 1, peripheral granulation tissue and fibrosis were correlated with peripheral contrast enhancement on CT. Lesion size was largest in the week 1 group, and the size difference was statistically significant between the week 1 group and the day 1 group.

CONCLUSIONS

Sonographic and CT findings of the PEI-treated normal rabbit liver varied with time in a predictable manner and correlated with pathologic findings. After a week, the PEI-treated normal liver shows perilesional enhancement that is nodular and irregular (particularly until 2 weeks); this must be taken into account when evaluating the therapeutic effect after PEI using conventional CT studies. Although long-term data are missing, control CT scans for residual tumor should not be performed before the second week after PEI because of the difficulty discerning enhancing tumor from enhancing fibrosis.

Use of film duplicator to lighten dark radiographs

The authors introduce a simple technique for lightening overexposed or overdeveloped dark radiographs. With the technique, an increase of exposure time in film duplicator allows production of duplicate radiographs with an appropriate tone. With this manipulation, image details are greatly improved, and the original radiograph is not damaged.