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OBJECTIVE To evaluate tumor responses in patients treated with anti-angiogenic agents for non-small cell lung cancer (NSCLC) by assessing intratumoral changes using a dual-energy CT (DECT) (based on Choi's criteria) and to compare it to traditional Response Evaluation Criteria in Solid Tumors (RECIST) criteria. MATERIALS AND METHODS Ten NSCLC patients treated with bevacizumab underwent DECT. Tumor responses to anti-angiogenic therapy were assessed and compared with the baseline CT results using both RECIST (size changes only) and Choi's criteria (reflecting net tumor enhancement). Kappa statistics was used to evaluate agreements between tumor responses assessed by RECIST and Choi's criteria. RESULTS The weighted κ value for the comparison of tumor responses between the RECIST and Choi's criteria was 0.72. Of 31 target lesions (21 solid nodules, 8 lymph nodes, and two ground-glass opacity nodules [GGNs]), five lesions (16%) showed discordant responses between RECIST and Choi's criteria. Iodine-enhanced images allowed for a distinction between tumor enhancement and hemorrhagic response (detected in 14% [4 of 29, excluding GGNs] of target lesions on virtual nonenhanced images). CONCLUSION DECT may serve as a useful tool for response evaluation after anti-angiogenic treatment in NSCLC patients by providing information on the net enhancement of target lesions without obtaining non-enhanced images.

We report the dynamic contrast-enhanced CT and histopathologic findings of a rare case of recurrent pulmonary capillary hemangiomas. The findings consisted of peripheral nodular enhancement at the early arterial phase and a subsequent "central filling-in" enhancement pattern on the delayed scans, which was identical to the well-known enhancement pattern of hemangiomas of the liver. Although there was no evidence of histological malignancy, pulmonary capillary hemangiomas manifested as multiple nodular lesions and showed postoperative recurrence.

1Radiology and Center for Imaging, 2 Pathology, and 3 Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea Diffuse pulmonary lymphangiomatosis (DPL) is a rare lymphatic disorder characterized by lymphatic channel proliferation. It is mostly reported in children and young adults. Here, we report a case involving a 52-year-old asymptomatic woman who presented with increased interstitial markings, as seen on a chest radiograph. Diffuse interstitial septal thickening was found on a serial follow-up chest computed tomography scan, and lymphangitic metastasis was the primary radiologic differential diagnosis. However, histologic sections of wedge resected lung revealed diffuse pleural and interlobular septal lymphatic proliferation characteristic of DPL. Index terms: Lymphangiomatosis; Interstitial; Lung; Computed tomography

A fibroepithelial polyp of the bronchus is a rare, benign, and endobronchial tumor, histologically consisting of fibrovascular stroma covered by normal respiratory epithelium. We report a case of a fibroepithelial polyp arising from the left main bronchus. On CT, a characteristic lobulating contour of the endobronchial nodule was well visualized, which histopathologically represented a typical papillary growth pattern of the nodule. Such a lobulating contour of the nodule might help make a correct diagnosis of this rare disease among other various endobronchial neoplasms.

Objective: We aimed to review the patterns of lung abnormalities of pulmonary cryptococcosis on CT images, position emission tomography (PET) findings of the disease, and the response of lung abnormalities to the therapies in non-AIDS patients. Materials and Methods: We evaluated the initial CT (n = 23) and 18F-fluorodeoxyglucose (FDG) PET (n = 10), and follow-up (n = 23) imaging findings of pulmonary cryptococcosis in 23 non-AIDS patients. Lung lesions were classified into five patterns at CT: single nodular, multiple clustered nodular, multiple scattered nodular, mass-like, and bronchopneumonic patterns. The CT pattern analyses, PET findings, and therapeutic responses were recorded. Results: A clustered nodular pattern was the most prevalent and was observed in 10 (43%) patients. This pattern was followed by solitary pulmonary nodular (n = 4, 17%), scattered nodular (n = 3, 13%), bronchopneumonic (n = 2, 9%), and single mass (n = 1, 4%) patterns. On PET scans, six (60%) of 10 patients showed higher FDG uptake and four (40%) demonstrated lower FDG uptake than the mediastinal blood pool. With specific treatment of the disease, a complete clearance of lung abnormalities was noted in 15 patients, whereas a partial response was noted in seven patients. In one patient where treatment was not performed, the disease showed progression. Conclusion: Pulmonary cryptococcosis most commonly appears as clustered nodules and is a slowly progressive and slowly resolving pulmonary infection. In two-thirds of patients, lung lesions show high FDG uptake, thus simulating a possible malignant condition.

Extramedullary plasmacytoma is a rare manifestation of multiple myeloma, and involvement of the mediastinum by extramedullary plasmacytoma is very rare. We report here on a rare case of a large mediastinal extramedullary plasmacytoma and several pleural nodules with pleural effusions in a 45-year-old male patient with multiple myeloma that involved the thoracic spine and the calvarium. The mediastinal extramedullary plasmacytoma manifested on CT as an 11 × 4.5 cm-sized, relatively homogeneous, mildly enhancing, anterior mediastinal mass with several pleural nodules, and this simulated malignant lymphoma or malignant thymic epithelial tumor.

Objective This study was designed to describe the radiological findings of extensively drug-resistant (XDR) pulmonary tuberculosis (TB) and to compare the observed findings with findings of drug-sensitive (DS) and non-XDR multidrug-resistant (MDR) TB in non-AIDS patients. Materials and Methods From September 1994 to December 2007, 53 MDR TB patients (M:F = 32:21; mean age, 38 years) and 15 XDR TB non-AIDS patients (M:F = 8:7; mean age, 36 years) were enrolled in the study. All of the MDR TB patients had received no treatment or less than one month of anti-TB treatment. In addition, all XDR TB patients received either no anti-TB treatment or only first-line anti-TB drugs. In addition, 141 consecutive DS TB patients (M:F = 79:62; mean age, 51 years) were also enrolled in the study for comparison. Chest radiograph, CT and demographic findings were reviewed and were compared among the three patient groups. Results For patients with XDR TB, the most frequent radiographic abnormalities were nodules (15 of 15 patients, 100%), reticulo-nodular densities (11 of 15, 73%), consolidation (9 of 15, 60%) and cavities (7 of 15, 47%) that were located mainly in the upper and middle lung zones. As seen on radiographs, significant differences were found for the frequency of nodules and ground-glass opacity lesions (all p < 0.001) (more frequent in DS TB patients than in MDR and XDR TB patients). For the use of CT, significant differences (more frequent in MDR and XDR TB patients) were found for the frequency of multiple cavities, nodules and bronchial dilatation (p = 0.001 or p < 0.001). Patients with MDR TB and XDR TB were younger as compared to patients with DS TB (p < 0.001). Imaging findings were not different between patients with MDR TB and XDR TB. Conclusion By observation of multiple cavities, nodules and bronchial dilatation as depicted on CT in young patients with acid-fast bacilli (AFB) positive sputum, the presence of MDR TB or XDR TB rather than DS TB can be suggested. There is no significant difference in imaging findings between patients with XDR TB and MDR TB.

Purpose: To compare the diagnostic accuracy and complication rates of fluoroscopyguided percutaneous transthoracic fine needle aspiration biopsy (FNAB) and core biopsy (CB). Materials and Methods: Ninety-one fluoroscopy-guided lung biopsies were performed in 86 patients using a 22-gauge fine needle (n=52) or a 21-gauge automated cutting needle (n=39). The size of pulmonary lesions were 1-9 cm. Histologic diagnosis rates and complications rates of the two groups were compared. Results: The overall sensitivity of FNAB was 98% (51/52) which was higher than that of CB 89.7% (35/39) (p=0.160, Fisher's exact test). For the diagnosis of malignancy, sensitivities of FNAB and CB were 97.2% (35/36) and 89.7% (26/29), respectively (p=0.316). For the diagnosis of benignancy, sensitivities of FNAB and CB were 100% (16/16) and 90% (9/10), respectively (p=0.384). The specific histologic diagnosis rate of CB was 80% (8/10) in benignancy, which was higher than that of FNAB 56% (9/16) (p=0.398). The pneumothorax rates were 7.7% (4/52) for FNAB and 15.4% (6/39) for CB (p=0.316). Conclusion: Although not statistically significant, a higher overall sensitivity was found in fluoroscopy-guided FNAB in the diagnosis of both malignancy and benignancy, and FNAB also achieved lower complication rates. More specific histologic diagnoses were obtained with CB.

Purpose: The authors have developed a system that searches for radiologic reports, and we have evaluated the utility of this system for clinical application, research and medical education. Materials and Methods: The system retrieves radiologic reports from the OCS (ordering communication system) server and stores them in a separate computer. A CGI (common gateway interface) program was written to search the database with variable keywords given by the user. The system satisfied the requirements of functionality, accessibility and security. Results: Users could search for radiologic reports with variable keywords using the web browser, and the user could refine the results using combinations of these keywords. The system has been running successfully for 2 years, and radiologists have used this system for searching or collecting cases, keeping reports and gathering statistics. Conclusion: The simple text searching system has been developed in a short time period with only small costs and a bit of hard effort, and this system is practical for clinical use, research and medical education.

Thymic epithelial tumor is a distinctive pathologic entity exhibiting variable histologic features and heterogeneous oncologic behavior. Among the various classification systems, that of the World Health Organization has been adopted because of good correlation between histologic appearance and oncologic behavior. Radiologically, a smooth contour and round shape are most suggestive of a type-A tumor, whereas an irregular contour most strongly suggests type C. Pleural seeding is rare in type-A and AB tumors; calcification is suggestive of type B. Type-C tumors are significantly larger and more commonly associated with lymphadenopathy than type B3. At T2-weighted MR imaging, lobular internal architecture is more prominent in types B1, B2, and B3 tumors than in others. However, imaging findings among the various types overlap to some extent, and the ability of imaging studies to differentiate types AB, B1, B2, and B3 is limited.

The accurate evaluation of mediastinal and pulmonary hilar lymphadenopathy, especially in patients with lung cancer, is important for determining treatment options and evaluating the response to therapy. To indicate nodal location in detail, mediastinal and hilar lymph nodes have been assigned to one of 14 nodal stations. Mediastinal nodes of greater than 10 mm short-axis diameter are regarded as abnormal, irrespective of their nodal station, while hilar nodes are considered abnormal if their diameter is greater than 10 mm in any axis or they are convex compared to surrounding lung. By providing multiplanar images, multi-detector row CT allows detailed evaluation of thoracic anatomic structures more easily than in the past, when axial images only were available. At cross-referenced imaging, a lymph node depicted at axial imaging in one anatomical location can be visualized simultaneously and automatically at coronal imaging at the exactly corresponding anatomical location. Cross-referenced coincidental axial and coronal images help assess both the size and morphology of mediastinal and hilar lymph nodes.

Benign esophageal lesions occur in various diseases. Barium studies are useful for the evaluation of mucosal surface lesions but provide little information about the extramucosal extent of disease. Computed tomography and magnetic resonance imaging, on the other hand, permit the assessment of wall thickness, mediastinal involvement, adjacent lymphadenopathy, and distant spread. In diseases such as fibrovascular polyps, duplication cysts, scleroderma, trauma, caustic esophagitis, hiatal hernia, esophageal diverticulum, achalasia, and paraesophageal varices, the findings of imaging studies are specific, obviating the need for further invasive diagnostic work-up. The advent of helical computed tomography and its volume data set allows the acquisition of multiplanar images, and magnetic resonance imaging is useful both for this and for tissue characterization. Thus, multiplanar cross-sectional imaging further extends the role of imaging modalities to the evaluation of benign esophageal lesions. Through an awareness of the multiplanar cross-sectional appearances of various benign esophageal lesions, the radiologist can play an important role in the detection, diagnosis, further diagnostic planning, and treatment of the diseases in which they occur.

Purpose : The purpose of our study is to describe the chest radiographic and CT findings of simple pulmonary eosinophilia. Materials and Methods : Twenty-six patients with simple pulmonary eosinophilia under went chest radiography and CT scanning; the results were analyzed retrospectively by two chest radiologists, focusing on the patterns and distribution of the parenchymal abnormalities. Results : The chest radiographs were normal in eight patients (31%), while among the remaining 18 patients, they showed subtle opacity (n=9), nodules (n=8), consolidation (n=2), and mass (n=1). Follow-up chest radiographs (n=18) demonstrated com-plete (n=16) or partial (n=1) resolution of parenchymal lesions or migratory lesions (n=1). On CT, nodule(s) (n=19) were most commonly seen, followed by ground-glass opacity (n=16), consolidation (n=3), and mass (n=1). A peripheral halo surrounding a nodule or an area of consolidation was seen in 18 patients. The nodules(s) (n=19) were subpleural (n=13) or random (n=6). Areas of ground-glass opacity (n=16) were subpleural (n=13), random (n=2), or central (n=1). All lesions were patchy ratherthan diffuse. Follow-up CT in nine patients showed complete (n=7) or partial (n=2) resolution of parenchymal lesions. Conclusion : Chest radiographs of patients with simple pulmonary eosinophilia often reveal no abnormality. The most common finding is subtle opacity or nodule(s), while CT reveals transient nodule(s) with a surrounding halo or transient areas of ground-glass opacity.

Objective To describe the radiologic findings of migrating lobar atelectasis of the right lung. Materials and methods Chest radiographs (n = 6) and CT scans (n = 5) of six patients with migrating lobar atelectasis of the right lung were analyzed retrospectively. The underlying diseases associated with lobar atelectasis were bronchogenic carcinoma (n = 4), bronchial tuberculosis (n = 1), and tracheobronchial amyloidosis (n = 1). Results Atelectasis involved the right upper lobe (RUL) (n = 3) and both the RUL and right middle lobe (RML) (n = 3). On supine anteroposterior radiographs (n = 5) and on an erect posteroanterior radiograph (n = 1), the atelectatic lobe(s) occupied the right upper lung zone, with a wedge shape abutting onto the right mediastinal border. On erect posteroanterior radiographs (n = 6), the heavy atelectatic lobe(s) migrated downward, forming a peri- or infrahilar area of increased opacity and obscuring the right cardiac margin. Erect lateral radiographs (n = 4) showed inferior shift of the anterosuperiorly located atelectatic lobe(s) to the anteroinferior portion of the hemithorax. Conclusion Atelectatic lobe(s) can move within the hemithorax according to changes in a patient's position. This process involves the RUL or both the RUL and RML.

We report a case of biopsy-proven secondary hemosiderosis of the lung in a 58-year-old patient with mitral valvular heart disease. Both chest radiography and high-resolution CT demonstrated patchy areas of ground-glass opacity ; the former indicated that it was in both lungs, while the latter showed inter-and intralobular septal thickening. These findings were reversible when pulmonary venous hypertension was corrected.

Purpose : The aim of this study was to assess the diagnostic accuracy of chest comput-ed radiography for thedetection of bronchiectasis diagnosed by high-resolution CT. Materials and Methods : Our study included 100consecutive patients with bronchiec-tasis and 20 normal subjects, all seen on high-resolution CT. Two independentobservers analyzed chest computed radiographs and recorded the presence and type of bronchiectasis, and the invo lved lobe. Results : On high-resolution CT, bronchiectasis was seen in one lobe in 29 patients, two lobes in 29,three lobes in 16, four lobes in 14, five lobes in 10, and six lobes in t wo. The bronchiectasis was tubular in 55patients, mixed tubular and cystic in 29, and cystic in 16. For observer 1, the sensitivity, specificity, andaccuracy of chest com-puted radiography was 95%, 85%, and 93%, respective l y, while for observer 2, thecorresponding figures were 93%, 85%, and 92%. Sensitivity and specificity for observ-er 1 were 33% and 96% for theright upper lobe (46% and 95% for observer 2), 68% and 86% for the right middle lobe (76% and 86%), 70% and 78%for the right lower lobe (48% and 83%), 50% and 100% for the left upper lobe (50% and 97%), 63% and 90% for thelingular segment (49% and 93%), and 87% and 75% for the left lower lobe (75% and 90%), respective l y. Tubularbronchiectasis involving a single lobe was the most common source of false negative readings based on the findingsof chest com-puted radiography. Conclusion : Because chest computed radiography is not inferior to high-resolutionCT for the detection of bronchiectasis, the routine use of chest computed radiography in screening forbronchiectasis is feasible. Howeve r, due to its low sensitivity in detect-ing bronchiectasis in a specific lobe,preoperative high-resolution CT examination may be needed.