Lung cancer screening

Lung cancer screening with CT remains controversial. Lung cancer is the leading cause of cancer death. To date, no screening test has been demonstrated to reduce mortality. Given the large population of adult cigarette smokers and former smokers worldwide, there is a large population at risk for lung cancer. While a lot has been learned from prospective single-arm cohort studies about the feasibility of performing annual CT to screen for lung cancer, many questions have also been raised. While we know that screening for lung cancer with CT detects many small nodules, with up to half the subjects having a positive baseline screen, and up to 75% of subjects having a positive screen at least once if screened annually for 5 years, the great majority of these nodules exhibit benign biologic behavior. The innumerable small nodules detected with screening CT, and diagnostic chest CT in general, present a daily clinical challenge, and result in extensive medical resource utilization and additional radiation exposure. Algorithms for how and when to follow small nodules detected on CT are in evolution. Ongoing studies are designed to determine if lung cancer screening with CT reduces lung cancer mortality.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47978/1/10406_2005_Article_134.pd

Reference absolute and indexed values for left and right ventricular volume, function and mass from cardiac computed tomography

Introduction Left ventricular ( LV ) and right ventricular ( RV ) volumetric and functional parameters are important biomarkers for morbidity and mortality in patients with heart failure. Purpose To retrospectively determine reference mean values of LV and RV volume, function and mass normalised by age, gender and body surface area ( BSA ) from retrospectively electrocardiographically gated 64‐slice cardiac computed tomography ( CCT ) by using automated analysis software in healthy adults. Materials and Methods The study was approved by the institutional review board with a waiver of informed consent. Seventy‐four healthy subjects (49% female, mean age 49.6 ± 11) free of hypertension and hypercholesterolaemia with a normal CCT formed the study population. Analyses of LV and RV volume (end‐diastolic, end‐systolic and stroke volumes), function (ejection fraction), LV mass and inter‐rater reproducibility were performed with commercially available analysis software capable of automated contour detection. General linear model analysis was performed to assess statistical significance by age group after adjustment for gender and BSA . Bland–Altman analysis assessed the inter‐rater agreement. Results The reference range for LV and RV volume, function, and LV mass was normalised to age, gender and BSA . Statistically significant differences were noted between genders in both LV mass and RV volume ( P ‐value < 0.0001). Age, in concert with gender, was associated with significant differences in RV end‐diastolic volume and LV ejection fraction ( P ‐values 0.027 and 0.03). Bland–Altman analysis showed acceptable limits of agreement (±1.5% for ejection fraction) without systematic error. Conclusion LV and RV volume, function and mass normalised to age, gender and BSA can be reported from CCT datasets, providing additional information important for patient management.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109344/1/jmiro12186.pd

Automated iterative neutrosophic lung segmentation for image analysis in thoracic computed tomography

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134994/1/mp2679.pd

Computerâ aided detection of lung nodules: False positive reduction using a 3D gradient field method and 3D ellipsoid fitting

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134878/1/mp4667.pd

Relationship between diffusion capacity and small airway abnormality in COPDGene.

Impaired single breath carbon monoxide diffusing capacity (DLCO) is associated with emphysema. Small airways disease (SAD) may be a precursor lesion to emphysema, but the relationship between SAD and DLCO is undescribed. We hypothesized that in mild COPD, functional SAD (fSAD) defined by computed tomography (CT) and Parametric Response Mapping methodology would correlate with impaired DLCO. Using data from ever-smokers in the COPDGene cohort, we established that fSAD correlated significantly with lower DLCO among both non-obstructed and GOLD 1-2 subjects. The relationship between DLCO with CT-defined emphysema was present in all GOLD stages, but most prominent in severe disease. TRIAL REGISTRATION: NCT00608764. Registry: COPDGene. Registered 06 February 2008, retrospectively registered

Automatic multiscale enhancement and segmentation of pulmonary vessels in CT pulmonary angiography images for CAD applications

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135074/1/mp4558.pd

Type I Interferons Are Associated with Subclinical Markers of Cardiovascular Disease in a Cohort of Systemic Lupus Erythematosus Patients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94405/1/Somers_2012_Type_I_Interferons_subclinical_markers.pdf165

Pulmonary nodule registration in serial CT scans based on rib anatomy and nodule template matching

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135002/1/mp2575.pd

Prognostic implications of physiologic and radiographic changes in idiopathic interstitial pneumonia

Idiopathic interstitial pneumonias are a diverse group of lung diseases with varied prognoses. We hypothesized that changes in physiologic and radiographic parameters would predict survival. We retrospectively examined 80 patients with usual interstitial pneumonia and 29 patients with nonspecific interstitial pneumonia. Baseline characteristics were examined together with 6-month change in forced vital capacity, diffusing capacity for carbon monoxide, and ground glass infiltrate and fibrosis on high resolution computed tomography. Patients with usual interstitial pneumonia were more likely to have a statistically significant or marginally significant decline in lung volume, diffusing capacity for carbon monoxide, and an increase in ground glass infiltrates (p <= 0.08) compared with patients with nonspecific interstitial pneumonia. For patients with usual interstitial pneumonia, change in forced vital capacity was the best physiologic predictor of mortality (p = 0.05). In a multivariate Cox proportional hazards model controlling for histopathologic diagnosis, gender, smoking history, baseline forced vital capacity, and 6-month change in forced vital capacity, a decrease in forced vital capacity remained an independent risk factor for mortality (decrease > 10%; hazard ratio 2.47; 95% confidence interval 1.29, 4.73; p = 0.006). We conclude that a 6-month change in forced vital capacity gives additional prognostic information to baseline features for patients with idiopathic interstitial pneumonia.Supported by National Institutes of Health NHLBI grants P50HL46487, NIH/NCRR 3 MO1 RR00042-33S3, NIH/NIA P60 AG08808-06, NHLBI, 1 K24 HL04212, and 1 K23 HL68713.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91973/1/2003 AJRCCM - Prognostic Implications of Physiologic and Radiographic Changes in Idiopathic Interstitial Pneumonia.pd

Diagnosis and monitoring of systemic sclerosis-associated interstitial lung disease using high-resolution computed tomography

Patients with systemic sclerosis are at high risk of developing systemic sclerosis-associated interstitial lung disease. Symptoms and outcomes of systemic sclerosis-associated interstitial lung disease range from subclinical lung involvement to respiratory failure and death. Early and accurate diagnosis of systemic sclerosis-associated interstitial lung disease is therefore important to enable appropriate intervention. The most sensitive and specific way to diagnose systemic sclerosis-associated interstitial lung disease is by high-resolution computed tomography, and experts recommend that high-resolution computed tomography should be performed in all patients with systemic sclerosis at the time of initial diagnosis. In addition to being an important screening and diagnostic tool, high-resolution computed tomography can be used to evaluate disease extent in systemic sclerosis-associated interstitial lung disease and may be helpful in assessing prognosis in some patients. Currently, there is no consensus with regards to frequency and scanning intervals in patients at risk of interstitial lung disease development and/or progression. However, expert guidance does suggest that frequency of screening using high-resolution computed tomography should be guided by risk of developing interstitial lung disease. Most experienced clinicians would not repeat high-resolution computed tomography more than once a year or every other year for the first few years unless symptoms arose. Several computed tomography techniques have been developed in recent years that are suitable for regular monitoring, including low-radiation protocols, which, together with other technologies, such as lung ultrasound and magnetic resonance imaging, may further assist in the evaluation and monitoring of patients with systemic sclerosis-associated interstitial lung disease. A video abstract to accompany this article is available at: https://www.globalmedcomms.com/respiratory/Khanna/HRCTinSScILD