Choong-Ki Park

Does contrast enhancement on CT suggest tumor response for chemotherapy in small cell carcinoma of the lung

Purpose The purpose of this article is to assess the correlation between contrast enhancement on CT and the tumor reduction ratio in small cell carcinoma of the lung after first-line chemotherapy. Materials and Methods Twenty-eight patients with small cell carcinoma of lung underwent preenhancement and postenhancement CT scans before and after first-line chemotherapy, followed by second-line chemotherapy in 7 patients who had relapsed. The authors retrospectively analyzed the correlation between the tumor reduction ratio and the CT numbers of contrast enhancement in each case by multiple regression analysis using SPSS. Results The mean tumor-reduction ratio was 58.2 ± 43.2% after first-line chemotherapy, and the mean CT enhancement was 33.2 ± 11.0 Hounsfield units (HU). The correlation coefficient between the tumor reduction ratio and the CT numbers of contrast enhancement was 0.57 (r2 = 0.32), and p value was < 0.002. After chemotherapy, more than 90% tumor reduction was seen in 11 patients. They revealed an average 41.9 ± 7.6 HU tumor enhancement. Less than 50% tumor reduction was seen in 10 patients. They revealed an average 26.2 ± 7.9 HU tumor enhancement. If these criteria of 30 HU contrast enhancement and 80% tumor reduction ratio were applied as a guide for chemotherapy response, the sensitivity, specificity, positive predictive value, and negative predictive value would be calculated as 85.7%, 84.6%, 85.7%, and 84.6%, respectively. Conclusion In small cell carcinoma of the lung, it is statistically proven that the more enhanced tumor on CT, the better response to chemotherapy. Tumor enhancement of 30 HU is a suggestive guide for chemotherapy response in patients with small cell carcinoma.

Heterotopic paragonimiasis in the omentum.

Paragonimus westermani is a lung fluke but may be found in organs other than the lungs. A case of omental paragonimiasis was found incidentally by plain radiography and computed tomography and showed multiple, irregularly shaped, conglomerated calcifications in the intraperitoneum. Many P. westermani ova were detected in the resected omentum. This uncommon calcification on the plain abdominal radiography and computed tomography scan was considered to represent radiologic findings of ectopic paragonimiasis.

Development of Standard Digital Images for Pneumoconiosis

We developed the standard digital images (SDIs) to be used in the classification and recognition of pneumoconiosis. From July 3, 2006 through August 31, 2007, 531 retired male workers exposed to inorganic dust were examined by digital (DR) and analog radiography (AR) on the same day, after being approved by our institutional review board and obtaining informed consent from all participants. All images were twice classified according to the International Labour Office (ILO) 2000 guidelines with reference to ILO standard analog radiographs (SARs) by four chest radiologists. After consensus reading on 349 digital images matched with the first selected analog images, 120 digital images were selected as the SDIs that considered the distribution of pneumoconiosis findings. Images with profusion category 0/1, 1, 2, and 3 were 12, 50, 40, and 15, respectively, and a large opacity were in 43 images (A = 20, B = 22, C = 1). Among pleural abnormality, costophrenic angle obliteration, pleural plaque and thickening were in 11 (9.2%), 31 (25.8%), and 9 (7.5%) images, respectively. Twenty-one of 29 symbols were present except cp, ef, ho, id, me, pa, ra, and rp. A set of 120 SDIs had more various pneumoconiosis findings than ILO SARs that were developed from adequate methods. It can be used as digital reference images for the recognition and classification of pneumoconiosis.

Characteristics of Coronary Artery to Pulmonary Artery Fistula on Coronary Computed Tomography Angiography

Objective The aim of the study was to evaluate the characteristics of coronary artery-to-pulmonary artery fistula (CPAF) found by coronary computed tomography (CT) angiography. Methods Among 10,121 cases of coronary CT angiography performed for 7 years, we found 32 cases of CPAF. We retrospectively evaluated the demographics, clinical symptoms, and anatomical characteristics such as the origin, number of origins, course, opening site of the fistula, and the presence of aneurysmal changes (defined as dilatation 1.5 times the diameter of the origin). We also categorized the fistula openings according to size compared with that of the proximal left anterior descending coronary artery. Results The patients were 14 men and 18 women with a mean (range) age of 56.5 (34–86) years. Nineteen patients had no related symptoms, and the other 13 patients had symptoms such as angina, chest discomfort, palpitations, or shoulder pain. Among these patients, 2 patients were diagnosed with coronary artery disease. The origins of CPAF were single (n = 15, 46.9%) or multiple (n = 17, 53.1%). The CPAFs arose most commonly from the conus branch of the right coronary artery (n = 20, 62.5%) and proximal left anterior descending (n = 17, 53.1%). All CPAFs coursed anteriorly to the main pulmonary artery and drained into the anterolateral aspect. Twenty-five patients (78.1%) exhibited aneurysmal changes. The openings were small in 13 (40.6%), medium in 13 (40.6%), and large in 6 (18.8%) patients. Conclusions More than half of patients with CPAF had no related symptoms. Coronary artery-to-pulmonary artery fistula may have a single origin or multiple origins. All of the CPAFs coursed anteriorly to the main pulmonary artery and drained into the anterolateral aspect; the CPAFs identified here frequently exhibited aneurysmal changes.

Telangiectatic pulmonary arteriovenous malformation.

Telangiectatic pulmonary arteriovenous malformation is defined as a pulmonary arteriovenous malformation involving every segmental artery of at least one lobe of the lung. The authors report a case of telangiectatic pulmonary arteriovenous malformation in the left lower lobe of the lung.

Pure intrasellar meningioma located under the pituitary gland: case report.

Most intrasellar meningiomas are located in the subdiaphragmatic and supraglandular region because they originate from the diaphragma sellae. Subglandular meningiomas located under the pituitary gland are extremely rare. Intrasellar meningiomas in the subdiaphragmatic and subglandular region probably originate from the dura in the sellar floor. We report a case of a subglandular meningioma along with a review of the literature.