Imaging the pulmonary extracellular matrix

The pulmonary extracellular matrix (ECM) plays an important role in the structure and function of the lung. In many respiratory diseases the profile of the ECM reflects pathological changes. The capacity to visualize the ECM and its alterations is of considerable importance to facilitate a better understanding of pulmonary diseases and eventually augment therapeutic solutions. This short review summarizes the current and novel possibilities for imaging the pulmonary ECM by the use of computed tomography (CT), optical coherence tomography (OCT), confocal laser endomicroscopy (CLE) and molecular imaging. While not all these techniques are as yet implemented in standard clinical practice, we address their main features along with the key possibilities for the future

Борис Алексеевич Нелепо (к 80-летию со дня рождения)

15 августа 2012 г. исполнилось бы 80 лет со дня рождения известного ученого-океанолога, доктора физико-математических наук, профессора, лауреата Государственной премии УССР (1979 г.) и СССР (1989 г.) в области науки и техники, директора Морского гидрофизического института АН УССР в 1974 – 1985 гг., первого главного редактора «Морского гидрофизического журнала», академика НАН Украины Бориса Алексеевича Нелепо (1932 – 2007)

Primary lung cancer in patients with previous malignancies: A nationwide study

Overall survival of patients with cancer continues to increase and so they receive more frequent CT imaging, making oncological patients a growing population that effectively receives lung cancer screening in the course of daily practice. However, it is currently uncertain how early lung cancer detection in this subgroup of patients should be optimally managed. We describe the relationship between primary lung cancer and prior malignancies in a nationwide cohort, in an attempt to identify possible areas of improvement in nodule management. We found that a substantial number of subjects with lung cancer suffered from a prior malignancy; however, with the exception of otorhinolaryngeal malignancies, they did not show a high absolute risk for lung cancer. Future research should provide more data on how to handle this subgroup of patients in clinical and screening setting

Cyst-related primary lung malignancies : an important and relatively unknown imaging appearance of (early) lung cancer

It is well known that lung cancer can manifest itself in imaging as solid and subsolid nodules or masses. However, in this era of increased computed tomography use another morphological computed tomography appearance of lung cancer is increasingly being recognised, presenting as a malignancy in relation to cystic airspaces. Despite the fact that it seems to be a relatively common finding in daily practice, literature on this entity is scarce and presumably the overall awareness is limited. This can lead to misinterpretation and delay in diagnosis and, therefore, increased awareness is urgently needed. This review aims to illustrate the imaging appearances of cyst-related primary lung malignancies, demonstrate its mimickers and potential pitfalls, and discuss the clinical implications based on the available literature and our own experience in four different hospitals

Primary lung cancer in patients with previous malignancies : a nationwide study

Overall survival of patients with cancer continues to increase and so they receive more frequent CT imaging, making oncological patients a growing population that effectively receives lung cancer screening in the course of daily practice. However, it is currently uncertain how early lung cancer detection in this subgroup of patients should be optimally managed. We describe the relationship between primary lung cancer and prior malignancies in a nationwide cohort, in an attempt to identify possible areas of improvement in nodule management. We found that a substantial number of subjects with lung cancer suffered from a prior malignancy; however, with the exception of otorhinolaryngeal malignancies, they did not show a high absolute risk for lung cancer. Future research should provide more data on how to handle this subgroup of patients in clinical and screening setting

Microsimulation modeling of extended annual CT screening among lung cancer cases in the National Lung Screening Trial

Purpose: To microsimulate the effects of three additional annual CT screening rounds on lung cancer (LC) survival in the National Lung Screening Trial (NLST). Methods: We used multiple imputation to model the effect of additional screening in the full NLST cohort on the time to LC diagnosis and on LC death in those participants who were diagnosed with LC by the end of NLST. Nodule growth models were derived from a Dutch in-vivo study. Microsimulations were repeated 500 times. The method was validated by simulating three rounds of CT screening in the original chest radiography (CXR) cohort. The times up to which the simulations remained within the 95 % confidence bands of the CT cohort's original results were used to estimate the validity of the results in the CT cohort with three additional simulated screening rounds. Results: Validation of the simulation approach on the CXR cohort resulted in a LC mortality reduction which remained well within the 95 % confidence intervals of the original CT cohort up to 6.5 years after the start of simulations. Simulating additional CT screening in the CT cohort led to LCs being diagnosed earlier than originally, resulting in a relative risk reduction in LC mortality of 11 % (95 % confidence bands, 7 %–14 %) at 6.5 years. This is equivalent to preventing 71 % (48 %–94 %) more LC deaths than the original CT cohort achieved in comparison to the original CXR cohort. Conclusion: Three additional annual CT screening rounds in the NLST may have led to substantial further LC mortality reduction

Normal Range of Emphysema and Air Trapping on CT in Young Men

OBJECTIVE. The purpose of our study was to assess the normal range of CT measures of emphysema and air trapping in young men with normal lung function. MATERIALS AND METHODS. A cohort of 70 young men with high-normal spirometry and body plethysmography underwent paired inspiratory and expiratory CT. Visual and quantitative scores of emphysema and air trapping were obtained. On CT, emphysema was defined as the 15th percentile of the attenuation curve (Perc(15)), and as the percentage of inspiratory voxels below -950 (IN-950) and below -960 (IN-960) HU. On CT, air trapping was defined as the expiratory-to-inspiratory ratio of mean lung density (EI-ratio(MLD)), and the percentage of voxels below -856 HU in expiration (EXP-856). Means, medians, and upper limits of normal (ULN) are presented for the total population and for smokers and nonsmokers separately. RESULTS. The mean age (+/- SD) of the subjects was 36.1 +/- 9.3 years. Smoking history was limited (range, 0-11 pack-years). Spirometry was high normal, ranging from 113% to 160% of predicted for vital capacity (VC), and from 104% to 140% of predicted for forced expiratory volume in 1 second (FEV1). The ULN was 2.73% for IN-950, 0.87% for IN-960, -936 HU for Perc(15), 89.0% for EI-ratio(MLD), and 17.2% for EXP-856. Visual CT scores showed minimal emphysema in eight (11%), > 5 lobules of air trapping in five (7%), and segmental air trapping in three (4%) subjects. CT measures were similar for never-and ever-smokers. CONCLUSION. We report the normal range of CT values for young male subjects with normal lung function, which is important to define pulmonary diseas

Subsolid pulmonary nodule morphology and associated patient characteristics in a routine clinical population

Objectives: To determine the presence and morphology of subsolid pulmonary nodules (SSNs) in a non-screening setting and relate them to clinical and patient characteristics. Methods: A total of 16,890 reports of clinically obtained chest CT (06/2011 to 11/2014, single-centre) were searched describing an SSN. Subjects with a visually confirmed SSN and at least two thin-slice CTs were included. Nodule volumes were measured. Progression was defined as volume increase exceeding the software interscan variation. Nodule morphology, location, and patient characteristics were evaluated. Results: Fifteen transient and 74 persistent SSNs were included (median follow-up 19.6 [8.3–36.8] months). Subjects with an SSN were slightly older than those without (62 vs. 58 years; p = 0.01), but no gender predilection was found. SSNs were mostly located in the upper lobes. Women showed significantly more often persistent lesions than men (94 % vs. 69 %; p = 0.002). Part-solid lesions were larger (1638 vs. 383 mm3; p <0.001) and more often progressive (68 % vs. 38 %; p = 0.02), compared to pure ground-glass nodules. Progressive SSNs were rare under the age of 50 years. Logistic regression analysis did not identify additional nodule parameters of future progression, apart from part-solid nature. Conclusions: This study confirms previously reported characteristics of SSNs and associated factors in a European, routine clinical population. Key Points: • SSNs in women are significantly more often persistent compared to men. • SSN persistence is not associated with age or prior malignancy. • The majority of (persistent) SSNs are located in the upper lung lobes. • A part-solid nature is associated with future nodule growth. • Progressive solitary SSNs are rare under the age of 50 years