Adrien Jankowski

Differentiating pre- and minimally invasive from invasive adenocarcinoma using CT-features in persistent pulmonary part-solid nodules in Caucasian patients

OBJECTIVE To retrospectively investigate the diagnostic value of pre-operative CT-features between pre/minimally invasive and invasive lesions in part-solid persistent pulmonary ground glass nodules in a Caucasian population. MATERIALS AND METHODS Retrospective review of two pre-operative CTs for 31 nodules in 30 patients. There were 10 adenocarcinomas in situ, 1 minimally invasive adenocarcinoma, 20 invasive adenocarcinomas. We analyzed the correlation between histopathology and the following CT-features: maximal axial diameter, maximal orthogonal axial diameter, height, density, size of solid component, air bronchogram, pleural retraction, nodule mass, disappearance rate and their evolution during follow-up. RESULTS In univariate analysis, invasive adenocarcinomas had a higher maximal height, density, solid component size, mass, a lower disappearance rate and presented more often with pleural retraction (p<0.05). After logistic regression performed with the uncorrelated parameters using a method of selection of variables, only the size of solid component remained significant, with 100% sensitivity for invasive adenocarcinoma when larger than 5mm. CONCLUSION Preoperative CT-features can help differentiating in situ and minimally invasive adenocarcinomas from invasive adenocarcinomas in Caucasian patients. A solid component larger than 5mm in diameter had 100% sensitivity for the diagnosis of invasive adenocarcinoma.

Prediction of lobar collateral ventilation in 25 patients with severe emphysema by fissure analysis with CT.

OBJECTIVE Reducing pulmonary volume through implantation of endobronchial valves is a major interest to improve exercise tolerance and survival in patients with severe emphysema. The primary aim of this study was to evaluate how well CT-determined fissure integrity predicts interlobar collateral ventilation. The secondary objective was to show whether there is a relationship between the size of fissural defects and the presence of collateral ventilation. MATERIALS AND METHODS Thirty patients with heterogeneous emphysema (postbronchodilator forced expiratory volume in 1 second [FEV1] = 20-50% predicted and > 50% of emphysema in a lobe) underwent collateral ventilation measurements with a catheter through an occlusive balloon within this target lobe during flexible endoscopy. Two senior thoracic radiologists studied the fissures on thoracic high-resolution CT. RESULTS Collateral ventilation was successfully measured in 37 target lobes in 25 patients. The fissures surrounding the 37 target lobes were evaluated on CT. For the detection of collateral ventilation, the presence of a fissural defect on CT has a sensitivity, specificity, positive predictive value, and negative predictive value of 95%, 44%, 69%, and 88%, respectively. There was a statistically significant difference in the area of the defect between patients with collateral ventilation and those without collateral ventilation (p = 0.04). CONCLUSION Analysis of pulmonary fissures using CT is useful before endoscopic volume reduction because results are well correlated to endoscopic measurements of collateral ventilation. Further study with clinical outcomes is mandatory to determine if and when one test or the other or both should be used in patient selection.

Syndrome de lemierre : apport de l'imagerie

Resume Le syndrome de Lemierre est defini par une thrombophlebite septique de la veine jugulaire interne ou d’une de ses branches associee a des emboles septique a distance dont le point de depart est une angine a germes anaerobies. Il survient chez des patients jeunes sans antecedents et, en absence de traitement precoce, peut mettre en jeu le pronostic vital. Le role de l’imagerie, et notamment du scanner cervico-thoracique avec injection de produit de contraste iode est primordial pour le diagnostic et le bilan d’extension, comme nous le montrerons dans l’etude de trois cas recents.

Pulmonary artery and right ventricle assessment in pulmonary hypertension: correlation between functional parameters of ECG-gated CT and right-side heart catheterization.

Background Right ventricular function predicts outcome in patients with pulmonary hypertension (PH). Therefore accurate assessment of right ventricular function is essential to graduate severity, assess follow-up, and response to therapy. Purpose To evaluate whether PH severity could be assessed using electrocardiography-gated CT (ECG-gated CT) functional parameters. A further objective was to evaluate cardiac output (CO) using two ECG-gated CT methods: the reference Simpson technique and the fully automatic technique generated by commercially available cardiac software. Material and Methods Our institutional review board approved this study; patient consent was not required. Twenty-seven patients who had undergone ECG-gated CT and right heart catheterization (RHC) were included. Two independent observers measured pulmonary artery (PA) diameter, PA distensibility, aorta diameter, right ventricular cardiac output (CT-RVCO) and right ventricular ejection fraction (CT-RVEF) with automatic and Simpson techniques on ECG-gated CT. RHC-CO and mean pulmonary arterial pressure (mPAP) were measured on RHC. Relationship between ECG-gated CT and RHC measurements was tested with linear regression analysis. Results Inter-observer agreement was good for all measurements (r > 0.7) except for CT-RVCO calculated with Simpsons technique (r = 0.63). Pulmonary artery (PA) distensibility was significantly correlated to mPAP (r = −0.426, P = 0.027). CT-RVEF was correlated with mPAP only when issued from Simpson technique (r = −0.417, P = 0.034). CT-RVEF was not significantly correlated to RHC-CO (P > 0.2). CT-RVCO measured with Simpson technique (r = 0.487, P = 0.010) and automatic segmentation (r = 0.549, P = 0.005) correlated equally with RHC-CO. Conclusion CT-RVEF and CT-RVCO measured on ECG-gated CT are significantly correlated, respectively, to mPAP and RHC-CO in this population with severe reduction of the right ventricular ejection fraction and could be useful for evaluating and following patients with PH.

CT-guided biopsy of nonresolving focal air space consolidation.

Objectives To evaluate the diagnostic accuracy of percutaneous computed tomography (CT)-guided coaxial core needle biopsy in patients with nonresolving pulmonary focal air space consolidations and negative fiberoptic bronchoscopy results. Methods From 1997 to 2005, 23 patients (11 woman, 12 men; age range, 45 to 81 y; mean age, 66 y) presenting with nonresolving pneumonia persisting more than 8 weeks (mean, 22 wk; range, 8 to 40 wk) with negative fiberscopic results, underwent coaxial percutaneous biopsy using an automated core needle (18-gauge) under CT guidance. Histologic and bacteriologic evaluations were obtained. The final diagnosis was confirmed by surgical pathology, culture results, or clinical follow-up. Results Specimens adequate for histopathologic evaluations were obtained in 20 (87%) cases. Final diagnoses were lung cancer (n=15) and benign diseases (infectious pneumonia, 3; lipoid pneumonia, 1; Erdheim Chester disease: 1; and nonspecific chronic pneumonia, 3). Diagnostic yield of core needle biopsy was 78% (18 of 23). The sensitivity and specificity for malignancy were 87% and 100%, respectively. Immediate pneumothorax was present in 11 patients of cases, but only 2 patients required pleural drainage. Discussion CT-guided lung biopsy using a core needle biopsy provides a high degree of diagnostic accuracy and allows specific characterization of nonresolving pulmonary focal air space consolidation.

Imagerie du ganglioneurome surrénalien : à propos d’un cas

The authors report a case of adrenal ganglioneuroma diagnosed in a young woman with melanoma. This benign hormone silent tumor arises from neural crest tissue. The imaging features at US, CT and MRI are described. Diagnosis was confirmed at CT guided biopsy.

Imagerie des complications survenant après chirurgie de résection pulmonaire

Postoperative complications after pneumonectomy, lobectomy, or wedge resection are relatively frequent and potentially significant. Chest radiographs and CT have a crucial role in the early detection and prompt management of these complications. The purpose of this paper is to illustrate the most frequent or severe complications, based on the timing of occurrence. Early complications include bronchopleural fistula, empyema, atelectasis, pneumonia, hemothorax, chylothorax, pulmonary edema, lobar torsion, cardiac hernia, gossypiboma and esophagopleural fistula. Late complications include bronchopleural fistula, esophagopleural fistula, postpneumonectomy syndrome, chest wall arteriovenous fistula and local tumor recurrence.

Endoscopic volume reduction before or after lung transplantation

Endobronchial valve therapy in patients with severe emphysema achieves similar clinical benefits to lung volume reduction surgery without the potential morbidity. We report successful endobronchial valve treatments in two patients with severe emphysema. Valves were placed in the first patient 5 months before lung transplantation and in the second patient 10 years after lung transplantation, using a flexible bronchoscope under local anaesthesia. The objective was to reduce pulmonary hyperinflation and improve lung function. The potential benefit of this procedure was anticipated by lobar collateral ventilation measurements. Two months later, forced expiratory volume in 1 s, forced vital capacity and dyspneoa improved in both cases.

Prothèses trachéobronchiques métalliques : rôle du scanner multibarrette

Resume Introduction Le recours a l’insertion d’une prothese endoluminale tracheale ou bronchique est de plus en plus frequent pour palier une obstruction des voies aeriennes non operable. Le choix du type de prothese puis de ses dimensions reste difficile mais conditionne le succes therapeutique et les eventuelles complications qui devront etre detectees precocement et de maniere peu invasive. Etat des connaissances Le but de cette revue est de presenter notre experience d’equipe multidisciplinaire concernant l’apport du scanner multibarrette pour mettre en evidence les obstructions des voies aeriennes, preciser les conditions anatomiques locales importantes a connaitre avant de selectionner une prothese metallique et assurer un suivi peu invasif. Conclusions Le protocole d’acquisition du scanner doit utiliser des coupes fines, les reconstructions multiplanaires et 3D jouant un role important tant dans l’evaluation preoperatoire que postoperatoire.

De novo malignancies screening after liver transplantation for alcoholic liver disease: a comparative opportunistic study

Patients having received a liver transplantation (LT) for alcoholic liver disease (ALD) have a high risk of de novo malignancies, especially in the upper aerodigestive tract and lungs due to their smoking and alcohol history. The aim of this retrospective study was to compare a group of patients transplanted for ALD who continue to smoke and who were included in an intensive screening program for tobacco‐related cancers implemented at the Grenoble University Hospital and a group of similar patients followed according to usual practice (chest computed tomography [CT] scan every 5 years) at the Edouard Herriot Hospital in Lyon. The intensive screening program consisted of an annual checkup, including a clinical examination by an otorhinolaryngologist, a chest CT scan, and an upper digestive endoscopy. A total of 147 patients were included: 71 patients in Grenoble and 76 patients in Lyon. The cumulative incidence of a first tobacco‐related cancer was 12.3% at 3 years, 20.6% at 5 years, 42.6% at 10 years, and 64.0% at 15 years. A curative treatment was possible in 80.0% of the patients in Grenoble versus 57.9% in Lyon (P = 0.068). The rates of curative treatment were 63.6% versus 26.3% (P = 0.062) for lung cancers, 100.0% versus 87.5% (P = 0.498) for lip‐mouth‐pharynx and larynx cancers, and 66.7% versus 100.0% (P = 1) for esophageal cancers, respectively. In addition, for lung cancers, regardless of study group, 68.7% received a curative treatment when the diagnosis was made by CT scan screening versus 14.3% when it was made because of symptoms (P = 0.008). In conclusion, our study strongly confirms the high rate of tobacco‐related de novo malignancies in LT patients for ALD and suggests that the screening of lung cancer by annual chest CT scan could significantly increase the rate of curative treatment.