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Background CT scan measures of emphysema and airway disease have been correlated with lung function in cohorts of subjects with a range of COPD severity. The contribution of CT scan-assessed airway disease to objective measures of lung function and respiratory symptoms such as dyspnea in severe emphysema is less clear. Methods Using data from 338 subjects in the National Emphysema Treatment Trial (NETT) Genetics Ancillary Study, densitometric measures of emphysema using a threshold of −950 Hounsfield units (%LAA-950) and airway wall phenotypes of the wall thickness (WT) and the square root of wall area (SRWA) of a 10-mm luminal perimeter airway were calculated for each subject. Linear regression analysis was performed for outcome variables FEV 1 and percent predicted value of FEV 1 with CT scan measures of emphysema and airway disease. Results In univariate analysis, there were significant negative correlations between %LAA-950 and both the WT ( r = −0.28, p = 0.0001) and SRWA ( r = −0.19, p = 0.0008). Airway wall thickness was weakly but significantly correlated with postbronchodilator FEV 1 % predicted (R = −0.12, p = 0.02). Multivariate analysis showed significant associations between either WT or SRWA (β = −5.2, p = 0.009; β = −2.6, p = 0.008, respectively) and %LAA-950 (β = −10.6, p = 0.03) with the postbronchodilator FEV 1 % predicted. Male subjects exhibited significantly thicker airway wall phenotypes (p = 0.007 for WT and p = 0.0006 for SRWA). Conclusions Airway disease and emphysema detected by CT scanning are inversely related in patients with severe COPD. Airway wall phenotypes were influenced by gender and associated with lung function in subjects with severe emphysema.

Recent trends in the treatment of intrathoracic granulocytic sarcoma (IGS) call for an overview of its radiographic manifestations. Nine patients from our institution and a review of 41 from the literature provide the basis of our conclusions on the typical and atypical appearance of IGS. Of the nine patients with IGS, all had chest radiographs, five had computed tomographic (CT) scans, and one had magnetic resonance (MR) scans. Radiographic studies and medical records were examined to establish the site and appearance of IGS. Three cases were histologically proved; in the others, the diagnosis was based on clinical presentation and response to chemotherapy. The mediastinum was the most common site of involvement (six of nine cases). A focal mass or mediastinal widening was visible on chest radiographs, and a focal mass or diffuse infiltration or replacement of fat was visible on chest CT. Less common sites of involvement were the lungs (two cases), the pleura (two), the pericardium (two), and the hilar (two). Mediastinal or hilar mass or mediastinal widening is the characteristic finding in IGS. Less common manifestations such as pleural and pericardial effusions and lung opacities should be confirmed histologically, since fluid or tissue is readily accessible.

A digital radiography system based on reusable, photostimulable phosphor technology was evaluated in approximately 3,500 portable chest radiographs of patients in an intensive care unit. The system functioned well in this application. No major problems were encountered in the visualization of tubes or catheters or in the detection of pneumothoraces. Assessment of fluid volume status or the presence of small pleural effusions, especially when these were bilateral, was initially somewhat difficult but became easier as investigators became familiar with the system. Radiologists were quicker than nonradiologists to accept the minimized two-on-one display format. Critical evaluation of the overall performance of digital systems such as this one is needed for a better definition of the system's strengths and weaknesses. Specifically, statistical analyses of the ability to detect disease states such as pneumothoraces, interstitial lung disease, lung nodules, and pleural abnormalities need to be performed.

Hodgkin Disease (HD) is an uncommon disease, accounting for less than 1% of all neoplasms that occur yearly in the United States, and only 30% of all lymphomas. Despite this, it has been estimated that nearly 8,000 new cases of HD will be diagnosed in 2003, and that approximately 1,300 patients will die, These statistics, coupled with a appreciation for the remarkable advances that have been achieved in the understanding, diagnosis, staging, treatment, and prognosis of Hodgkin’s, have caused HD to become a subject of fascination for oncologists and radiologists alike (Fig. 2.1).

Long-term survival after development of pulmonary lymphangitic carcinomatosis is considered unusual. However, modern chemotherapy can result in surprising stability or only gradual progression of lymphangitic carcinomatosis. We evaluated the course of radiographic findings in 10 patients with chronic lymphangitic carcinomatosis.Ten patients met our criterion of having lymphangitic carcinomatosis for at least 6 months. The primary tumor was a carcinoma of the breast in six cases, the ovary in two, the pancreas in one, and the skin in one. Serial radiographs (all cases) and CT scans (eight cases) were analyzed retrospectively.Survival with lymphangitic carcinomatosis ranged from 11 to 30 months (median, 13 months). With chemotherapy, the radiographic abnormalities and pulmonary symptoms initially regressed in six patients, progressed in two, and remained unchanged in two; the radiographic findings of lymphangitic carcinomatosis were progressing at the time of death in four patients. All patients had periods of at least 4 months of relative stability or slow progression of pulmonary radiographic abnormalities. Serial transbronchial biopsies in one case confirmed persistent lymphangitic carcinomatosis despite therapy, and autopsy disclosed persistent lymphangitic tumor in two others.Stability or slow progression of radiographic findings can occur in some patients with lymphangitic carcinomatosis. Therefore, chronicity of radiographic findings should not be taken as evidence against lymphangitic carcinomatosis as the cause of an interstitial abnormality in a patient with cancer.

The advent of picture archiving and communication systems (PACS) promises to confer a number of significant advantages upon the practice of medicine, in general, and upon radiology, in particular. This promise, notwithstanding, numerous important obstacles to a complete, clinically effective, implementation of this technology exist. Not the least of these obstacles pertains to the area of quality assurance (QA). The remainder of this manuscript will review the approach that many conventional departments of radiology have taken to QA problems. This information will be used as a foundation for conjecture about QA issues that are likely to be important in a totally digital environment.© (1991) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

• Four imaging examinations—gallium citrate Ga 67 scintigraphy, liver-spleen scans, lymphangiography, and computed tomography—were used in the initial staging of mycosis fungoides and Sezary syndrome in 62 patients (85% with stage I or II disease). None of the imaging modalities added significantly to the information already available from physical examinations and routinely performed lymph node biopsies. The results of this investigation did not support routine performance of imaging studies in patients with early stages of cutaneous T-cell lymphoma. ( Arch Dermatol . 1990;126:914-918)

Diagnostic B-scan ultrasonography has the capacity to evaluate many potential sites of abdominal and pelvic involvement by Hodgkin's disease and non-Hodgkin's lymphoma. The varying ultrasonographic features of lymphomatous involvement in the peritoneal cavity and retroperitoneal space are described and potential diagnostic pitfalls are discussed.

Changes in X-ray attenuation of rabbit V2 carcinoma, as determined by computed tomography (CT) scanning, were assessed following the intraarterial and intravenous administration of a water soluble contrast agent. After intraarterial contrast medium administration, a significant increase in CT attenuation values occurred in both blood and V2 carcinoma, and the attenuation values remained above control values for at least 120 min. A similar, although less pronounced, increase in VA attenuation values occurred following intravenous contrast medium administration. Comparison of V2 CT enhancement values after intraarterial and intravenous administration suggested that tumor enhancement was greater after intraarterial administration.

Sixty patients underwent flexible fiberoptic bronchoscopy and percutaneous needle aspiration of peripheral lung lesions with fluoroscopic monitoring. A single general anesthetic was used. We found that percutaneous needle aspiration was the more accurate of the two procedures in establishing a diagnosis but that flexible fiberoptic bronchoscopy proved complementary in some instances. The incidence of pneumothorax was 27% but aspiration was needed in only 8%. There were no other complications. In 84% of patients with primary carcinoma of the lung presenting as a peripheral lesion, the diagnosis was established by these procedures. The accuracy was less in metastatic lesions and considerably less in benign lesions.

Since the introduction and enthusiastic acceptance of computed tomography (CT), a growing reluctance has emerged towards recommendations for the continued routine utilization of lymphography for the staging of Hodgkin’s disease and non-Hodgkin’s lymphomas. A number of arguments have been proffered, arguments ranging from adverse time considerations, to technical expertise, to patient preference, and extending ultimately to the all important differences in the sites imaged and the accuracies obtained. In attempting to explain our own approach towards this heterogeneous group of patients, we are constrained to acknowledge that what we propose represents personal opinion rather than irrefutable doctrine, i.e., it is an approach which seems to make sense to us, and which appears to work well in our hands. Because of acknowledged complexities surrounding the selection of an imaging modality, our approach may not be totally applicable to all departments of radiology and to all medical centers.

When a patient presents with thoracic metastases from a tumor whose site of origin is not apparent from the initial history, physical examination, and routine laboratory studies, there is a considerable likelihood that the individual will be subjected to an extensive and frequently unrewarding series of radiologic examinations. An analysis of the "behavior" of so-called tumors of unknown origin suggests that these tumors metastasize to distant sites with a frequency that is different from the more common tumors, that is to say, those whose primary site is readily apparent. While compulsive testing should unquestionably be eschewed, certain radiologic tests are still appropriate. These studies should be supplemented, when necessary, by newer pathologic studies, primarily those that involve the rapidly developing field of immunocytochemistry.

Use of mechanical prostheses for direct surgical replacement of cardiac valves was originally proposed in 1953 by Hufnagel [1]. Sixteen years later, Bjork introduced the nowfamous valvular prosthesis that bears his name. Throughout the world, to date, more than 80,000 Bjork-Shiley valves have been implanted [2, 31. As beneficial as these valves have been, their use is not without a potential for the development of severe, life-threatening complications. Mechanical failure has been described either when one of the valve struts fractures (with resultant embolization of the disk) or when fibrotic material encroaches upon the valve seat, precluding complete opening or closure of the disk [2, 4]. As the prevalence of valve prostheses has increased, so have the number of reported prosthetic failures. The radiographic literature has largely ignored the signs of prosthetic valvular malfunction. To draw attention to this problem, and in the hope that doing so will increase survival rates, we report a case of acute dysfunction of a prosthetic mitral valve due to fracture of the valve’s strut with embolization of the disk.

The hemoptysis which occurs following lymphography typically consists of one or more episodes of blood-tinged sputum, and generally requires no treatment. In contradistinction to this "mild" form of hemoptysis, the current report describes a case of hemoptysis following lymphography--hemoptysis so severe as to require multiple transfusions. Time course and possible etiologic factors are discussed.

We have endeavored through the use of an actual clinical scenario to emphasize that reliance on skull radiographs for assessing the acutely traumatized patient is both unwarranted and unwise. Not only are these films fundamentally useless, but they have the potential to lull us into a false sense of security. A negative skull examination cannot and does not imply that the brain substance is normal. If there is a legitimate indication for any examination, that examination should be computed tomography. To reinforce this notion, we offer for your consideration the following algorithm for the management of head trauma (Table 1: see text).

In this report, we challenge the commonly held assumption that the adult respiratory distress syndrome (ARDS) is a homogeneous process associated with generalized and relatively uniform damage to the alveolar capillary membrane. We studied 13 patients with ARDS, comparing the pulmonary parenchymal changes seen by standard bedside chest roentgenograms with those seen by computed tomography of the chest. Three patients demonstrated generalized lung involvement by both radiologic techniques. In another eight patients, despite the appearance of generalized involvement on the standard chest x-ray film, the computed tomographic scans showed patchy infiltrates interspersed with areas of normal-appearing lung. Two patients showed patchy involvement by both techniques. The fact that ARDS spares some regions of lung parenchyma is useful knowledge in understanding the gas-exchange abnormalities of ARDS, the variable responsiveness to positive end-expiratory pressure, and the occurrence of oxygen toxicity. The problem of regional inhomogeneity should also be kept in mind when interpreting lung biopsy specimens or bronchoalveolar lavage fluid in patients with ARDS. (JAMA1986;255:2463-2465)