Xenon-Enhanced Dual-Energy CT Imaging in Combined Pulmonary Fibrosis and Emphysema

<div><p>Background</p><p>Little has been reported on the feasibility of xenon-enhanced dual-energy computed tomography (Xe-DECT) in the visual and quantitative analysis of combined pulmonary fibrosis and emphysema (CPFE).</p><p>Objectives</p><p>We compared CPFE with idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD), as well as correlation with parameters of pulmonary function tests (PFTs).</p><p>Methods</p><p>Studied in 3 groups were 25 patients with CPFE, 25 with IPF without emphysema (IPF alone), 30 with COPD. Xe-DECT of the patients’ entire thorax was taken from apex to base after a patient’s single deep inspiration of 35% stable nonradioactive xenon. The differences in several parameters of PFTs and percentage of areas enhanced by xenon between 3 groups were compared and analyzed retrospectively.</p><p>Results</p><p>The percentage of areas enhanced by xenon in both lungs were calculated as CPFE/IPF alone/COPD = 72.2 ± 15.1% / 82.2 ± 14.7% /45.2 ± 23.2%, respectively. In the entire patients, the percentage of areas enhanced by xenon showed significantly a positive correlation with FEV₁/FVC (R = 0.558, P < 0.0001) and %FEV₁, (R = 0.528, P < 0.0001) and a negative correlation with %RV (R = -0.594, P < 0.0001) and RV/TLC (R = -0.579, P < 0.0001). The percentage of areas enhanced by xenon in patients with CPFE showed significantly a negative correlation with RV/TLC (R = -0.529, P = 0.007). Xenon enhancement of CPFE indicated 3 different patterns such as upper predominant, diffuse, and multifocal defect. The percentage of areas enhanced by xenon in upper predominant defect pattern was significantly higher than that in diffuse defect and multifocal defect pattern among these 3 different patterns in CPFE.</p><p>Conclusion</p><p>The percentage of areas enhanced by xenon demonstrated strong correlations with obstructive ventilation impairment. Therefore, we conclude that Xe-DECT may be useful for distinguishing emphysema lesion from fibrotic lesion in CPFE.</p></div

Comparison with the percentage of areas enhanced by xenon among 3 different patterns in CPFE.

<p>The percentage of areas enhanced by xenon in upper predominant defect pattern was significantly higher than that in diffuse defect (<i>P</i> = 0.0208) and multifocal defect pattern (<i>P</i> = 0.0003) among 3 different patterns in CPFE (one-way ANOVA with Tukeys correction for 3 comparison groups).</p

Image analysis of ventilation defect in COPD and IPF alone.

<p>(A) COPD shows largely focal xenon ventilation defects.(B) IPF alone shows slightly decreased xenon ventilation with several defects and volume loss with diffuse hypoventilation in the fibrotic lesion.</p

Correlation coefficients for relationships between the percentage of areas enhanced by Xenon and pulmonary function parameters in CPFE patients (n = 25), IPF alone (n = 25), and COPD (n = 30).

<p>Correlation coefficients for relationships between the percentage of areas enhanced by Xenon and pulmonary function parameters in CPFE patients (n = 25), IPF alone (n = 25), and COPD (n = 30).</p

Study flow chart.

<p>Study flow chart.</p

Correlation coefficients for relationships between the percentage of areas enhanced by Xenon and pulmonary function parameters in the whole patients (n = 80).

<p>Correlation coefficients for relationships between the percentage of areas enhanced by Xenon and pulmonary function parameters in the whole patients (n = 80).</p

Sonographic visualization of nipple blood flow can help differentiate Paget disease from benign eczematous nipple lesions

<div><p>Purpose</p><p>Paget disease of the breast is a rare cancer that originates from the nipple–areolar complex. It is often overlooked and misdiagnosed as benign chronic eczema of the nipple. We aimed to retrospectively verify whether blood flow analysis using Doppler sonography was useful for detecting the presence of Paget disease.</p><p>Methods</p><p>In this retrospective study, 12 patients with pathologically proven unilateral nipple eczematous lesions (seven with Paget disease and five with simple dermatitis) were included. Nipple blood flow signal was observed using Doppler sonography, and the detected blood flow signals were quantified using digitally recorded images. Quantified blood flow ratio and pathologically examined capillary density were evaluated between affected and unaffected nipples. Findings of mammography, grayscale sonography, and contrast-enhanced magnetic resonance imaging (CE-MRI) were reviewed.</p><p>Results</p><p>In patients with Paget disease, Doppler effects in the affected nipple were more clearly visible than those in the unaffected nipple. These effects were sufficiently visible to identify Paget disease. No obvious effects were observed in the affected and unaffected nipples of simple dermatitis. The quantified blood flow ratio and pathologically examined capillary density were significantly higher for the Paget lesion than those for the non-Paget lesion. The sensitivity of CE-MRI and Doppler sonography was markedly correlated, revealing blood flow changes in the nipple lesions of Paget disease.</p><p>Conclusion</p><p>Doppler sonography visualized the proliferation of blood vessels in Paget lesions. The visualization of increased nipple blood flow using Doppler sonography is a simple and low-cost method that provides useful data for identifying Paget disease during routine medical care.</p></div

Sonographic visualization of nipple blood flow can help differentiate Paget disease from benign eczematous nipple lesions - Fig 3

<p>(a) Visualized hypervascularity of the affected nipple with Paget disease (Case 1). (b) Unchanging blood flow signals of the affected nipple with simple dermatitis (Case 8).</p

Comparison of nipple blood flow ratios between the affected and unaffected nipples with each condition.

<p>Comparison of nipple blood flow ratios between the affected and unaffected nipples with each condition.</p

Histopathological examinations of capillary proliferation of the nipple–areolar region by hematoxylin and eosin staining.

<p>(a) Normal skin control with Paget disease (×40). (b) Normal skin control with Paget disease (×100). (c) Paget lesion at ×40). (d) Paget lesion at ×100). (e) Dermatitis at ×40). (f) Dermatitis at ×100). Bar, 50 μm (b, d, and f).</p