F. A. Calabrese

Impact of Primary Coronary Angioplasty Delay on Myocardial Salvage, Infarct Size, and Microvascular Damage in Patients With ST-Segment Elevation Myocardial Infarction : Insight From Cardiovascular Magnetic Resonance

OBJECTIVES We investigated the extent and nature of myocardial damage by using cardiovascular magnetic resonance (CMR) in relation to different time-to-reperfusion intervals. BACKGROUND Previous studies evaluating the influence of time to reperfusion on infarct size (IS) and myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) have yielded conflicting results. METHODS Seventy patients with STEMI successfully treated with primary percutaneous coronary intervention within 12 h from symptom onset underwent CMR 3 +/- 2 days after hospital admission. Patients were subcategorized into 4 time-to-reperfusion (symptom onset to balloon) quartiles: < or =90 min (group I, n = 19), >90 to 150 min (group II, n = 17), >150 to 360 min (group III, n = 17), and >360 min (group IV, n = 17). T2-weighted short tau inversion recovery and late gadolinium enhancement CMR were used to characterize reversible and irreversible myocardial injury (area at risk and IS, respectively); salvaged myocardium was defined as the normalized difference between extent of T2-weighted short tau inversion recovery and late gadolinium enhancement. RESULTS Shorter time-to-reperfusion (group I) was associated with smaller IS and microvascular obstruction and larger salvaged myocardium. Mean IS progressively increased overtime: 8% (group I), 11.7% (group II), 12.7% (group III), and 17.9% (group IV), p = 0.017; similarly, MVO was larger in patients reperfused later (0.5%, 1.5%, 3.7%, and 6.6%, respectively, p = 0.047). Accordingly, salvaged myocardium markedly decreased when reperfusion occurred >90 min of coronary occlusion (8.5%, 3.2%, 2.4%, and 2.1%, respectively, p = 0.004). CONCLUSIONS In patients with STEMI treated with primary percutaneous coronary intervention, time to reperfusion determines the extent of reversible and irreversible myocardial injury assessed by CMR. In particular, salvaged myocardium is markedly reduced when reperfusion occurs >90 min of coronary occlusion.

Computer-aided detection (CAD) in lung cancer screening at chest MDCT: ROC analysis of CAD versus radiologist performance.

To evaluate the performance of a computer-aided detection (CAD) algorithm in the detection of pulmonary nodules on high-resolution multidetector row computed tomography images in a large, homogeneous screening population, and to evaluate the effect of the system output on the performance of radiologists, using receiver operating characteristic analysis. Three radiologists with variable experience (1 to 7 y), independently read the 200 computed tomography scans and assigned each nodule candidate a confidence score (1-2-3: unlikely, probably, and definitely a nodule). CAD was applied to all scans; successively readers reevaluated all findings of the CAD, assigning, in consensus, a confidence score (1 to 3). The reference standard was established by the consensus of 2 experienced radiologists with 30 and 15 years of experience. Results were used to generate an free-response receiver operating characteristic analysis. The reference standard showed 125 nodules. Sensitivity for readers I-II-III was 57%, 68%, and 46%. A double reading resulted in an increase in sensitivity up to 75%. With CAD, sensitivity was increased to 94%, 96%, and 94% for readers I, II, and III. The area under the free-response receiver operating characteristic curve (Az) was 0.72, 0.82, 0.55, and 0.84 for readers I, II, III, and the CAD, when considering all nodules. Differences between readers I-II and CAD were not significant (P=0.9). There was a significant difference between reader III and the CAD. For nodules <6-mm Az was 0.40, 0.47, 0.14, and 0.72 for readers I, II, III, and the CAD. Differences between all readers and the CAD were significant (P<0.05). CAD can aid in daily radiologic routine detecting a substantial number of nodules unseen by radiologists. This is true for both board-certified radiologists and for less experienced readers especially in the detection of small nodules.

Volumetric evaluation of therapy response in patients with lung metastases. Preliminary results with a computer system (CAD) and comparison with unidimensional measurements

Purpose.The aim of this study was to assess the efficacy of a Computer–Aided Detection (CAD) system in the identification of lung metastases and to compare the volumetric CAD measurements with unidimensional observer measurements in the evaluation of treatment response in oncology patients.Materials and methods.Two observers (A and B) evaluated nine patients undergoing lung computed tomography (CT) just before and immediately after treatment with chemotherapy. Multislice CT scans were performed before and after the injection of contrast material with a high–resolution protocol (collimation 4x1 mm, 100 mAs, 120 kV). Response Evaluation Criteria in Solid Tumours (RECIST) criteria were used to consider the disease as stable, increased or decreased. Subsequently, target lesions (most significant lesions identified before and after chemotherapy) were evaluated with a computerised system (CAD) to establish volumetric measurements. Observers’ unidimensional measurements and CAD volumetric measurements were analysed for comparison.Results.Twenty–four nodules (diameter: 5–18 mm in the first study and 4–20 mm in the follow–up study) were included. Observers agreed in the assessment of therapy response in 21 nodules: eight were considered to have increased in size, and 13 were judged stable. Observer and CAD measurements disagreed in three nodules: two were considered stable by radiologists and increased by CAD; one was considered increased by radiologists and stable by CAD.As regards patient response, radiologists disagreed in two cases. CAD and observers did not agree in one case.Conclusions.Our preliminary data suggest that volumetric measurements can modify the diagnostic and therapeutic evaluation of oncology patients under chemotherapy.CAD volumetric measurements allow an easy and objective evaluation, reducing interobserver variability in the evaluation of chemotherapy response.

MDCT assessment of lung volume in patients undergoing bronchial stenting for treatment of pulmonary emphysema: correlation with respiratory tests and personal experience

Purpose.The aid of this study was to evaluate lung volume reduction with multidetector-row computed tomography (MDCT) in patients with emphysema who have undergone endobronchial valve placement.Materials and methods.Nine patients with emphysema were studied by low-dose chest MDCT (64-slice Somatom Sensation Cardiac, Siemens) with a collimation of 64x0.6 mm and a slice thickness of 1 mm. After treatment, MDCT scans were repeated at 7 and 30 days. A single observer calculated the volume of the treated lobe and of both lungs on a dedicated console. Volume calculations were then compared with the results of lung function tests.Results.Four patients in whom MDCT showed severe emphysema of the right upper lobe (RUL) were selected for endobronchial valve insertion. Volume assessment at 30 days showed a 29% reduction in RUL volume in patient A, a 15% reduction in patient B, a <1% reduction in patient C and a 30% reduction in patient D. Correlation with lung function tests confirmed a major reduction of forced expiratory volume in 1 s (FEV1) and vital capacity (VC) and improved walking test results after 7 and 30 days.Conclusions.In patients undergoing endobronchial valve placement, MDCT with dedicated software allows for a better evaluation of volume reduction of a single lobe and of the whole lung.

Imaging of myocardial infarction using a 64-slice MDCT scanner: Correlation between infarcted region and status of territory-dependent coronary artery

Purpose. This study was performed to evaluate the ability of 64slice multidetector computed tomography (MDCT) to detect previous myocardial infarctions (MIs) in patients referred for the assessment of the coronary arteries. In patients with regional changes of left ventricular wall myocardial density, the territorydependent coronary vessel status was examined. Materials and methods. We retrospectively assessed 202 consecutive patients referred for 64-slice MDCT of the coronary arteries. In all cases, detailed, clinical, serological and electrocardiograph (ECG) data were collected to identify patients with a previous diagnosis of MI. An initial qualitative evaluation of MDCT images was performed in all patients to identify areas of suspected myocardial necrosis, which were defined as regions of lower density within normally enhanced left ventricular myocardium. Thereafter, in all patients with suspected MIs, attenuation values and left ventricular wall thickness were also measured at the level of the normal myocardium and within the hypodense regions. Each MI was also assigned to the distribution territory of a coronary vessel, and morphological data were combined with MDCT angiographic findings. Results. After clinical assessment, MI was found in 27 patients (six acute).; 64-slice MDCT was able to detect the presence of MI in 24/27 cases, showing sensitivity and specificity of 89% and 95%, respectively, and an overall diagnostic accuracy of 95%. Quantitative analysis showed a significant difference (p<0.01) between attenuation values of normal vs. infarcted myocardium (124.5±19 HU vs. 56.1±23 HU, respectively); wall thinning was exclusively observed in chronic MIs (p<0.01). In 23/24 detected cases, analysis of territory-dependent arteries showed findings compatible with presence of MI. Conclusions. The presence of MI is well depicted with retrospective 64-slice MDCT. The main advantage of 64-slice MDCT is that it allows to evaluate and relate the status of a vessel and its dependent myocardial region in a single exam.PurposeThis study was performed to evaluate the ability of 64-slice multidetector computed tomography (MDCT) to detect previous myocardial infarctions (MIs) in patients referred for the assessment of the coronary arteries. In patients with regional changes of left ventricular wall myocardial density, the territory-dependent coronary vessel status was examined.Materials and methodsWe retrospectively assessed 202 consecutive patients referred for 64-slice MDCT of the coronary arteries. In all cases, detailed, clinical, serological and electrocardiograph (ECG) data were collected to identify patients with a previous diagnosis of MI. An initial qualitative evaluation of MDCT images was performed in all patients to identify areas of suspected myocardial necrosis, which were defined as regions of lower density within normally enhanced left ventricular myocardium. Thereafter, in all patients with suspected MIs, attenuation values and left ventricular wall thickness were also measured at the level of the normal myocardium and within the hypodense regions. Each MI was also assigned to the distribution territory of a coronary vessel, and morphological data were combined with MDCT angiographic findings.ResultsAfter clinical assessment, MI was found in 27 patients (six acute).; 64-slice MDCT was able to detect the presence of MI in 24/27 cases, showing sensitivity and specificity of 89% and 95%, respectively, and an overall diagnostic accuracy of 95%. Quantitative analysis showed a significant difference (p<0.01) between attenuation values of normal vs. infarcted myocardium (124.5±19 HU vs. 56.1±23 HU, respectively); wall thinning was exclusively observed in chronic MIs (p<0.01). In 23/24 detected cases, analysis of territory-dependent arteries showed findings compatible with presence of MI.ConclusionsThe presence of MI is well depicted with retrospective 64-slice MDCT. The main advantage of 64-slice MDCT is that it allows to evaluate and relate the status of a vessel and its dependent myocardial region in a single exam.RiassuntoObiettivoVerificare retrospettivamente in una popolazione di pazienti sottoposti a cardio-TC la presenza di focali aree di ipodensità parietale, riferibili a pregressi infarti miocardici (IMA), e in tal caso valutare l’eventuale patologia del vaso tributario.Materiali e metodiSono stati revisionati storia clinica, dati laboratoristici e strumentali di 202 pazienti (pz) consecutivamente sottoposti ad esame di cardio-TC con tomografo TC spirale a 64-strati (TCMS-64). In tutti i pazienti le immagini sono state analizzate valutando visivamente la presenza di regioni di minor densità nel contesto del miocardio ventricolare sinistro riferibili ad aree di sospetta necrosi miocardica. Successivamente, nei sospetti IMA è stata effettuata anche una valutazione quantitativa misurando densità e spessore miocardico nell’area necrotica e nei segmenti miocardici contigui che presentavano normale densità. In base alla sede, ciascun IMA è stato inoltre assegnato al territorio di distribuzione di uno dei tre vasi coronarici, combinando dati morfologici e reperti angio-TCMS.RisultatiDopo revisione dei dati clinico-strumentali sono stati individuati 27 pregressi IMA, di cui 6 di recente insorgenza. La TCMS-64 ha identificato 24/27 IMA con una sensibilità e specificità rispettivamente del 89% e 95% ed un’accuratezza del 95%; in 2 IMA erano presenti formazioni trombotiche ed in 3 aneurismi calcifici. L’analisi quantitativa ha dimostrato una differenza significativa (p<0,01) tra i valori di densità del miocardio normale rispetto a quello infartuato (rispettivamente 124,5±19 HU e 56,1±23 HU). Assottigliamento parietale è stato osservato solamente nei pazienti con IMA cronico (p<0,01). In 23/24 IMA identificati con la metodica, la valutazione dei vasi coronarici di pertinenza ha evidenziato reperti compatibili con la presenza di necrosi nel territorio di distribuzione.ConclusioniLa presenza di pregressi IMA viene ben documentata con TCMS-64; con un singolo esame la metodica offre un approccio esaustivo, consentendo una valutazione combinata di arterie coronarie e territorio infartuato.

Malattie del pericardio

Le malattie del pericardio, pur rappresentando complessivamente entita patologiche di non raro riscontro clinico ed in alcuni casi di significativo impatto sulla funzione ventricolare (in particolare diastolica), hanno da sempre ricevuto scarsa attenzione in ambito cardiologico, soprattutto se confrontate con altre cardiopatie, anche molto piu rare.

Imaging of myocardial infarction using a 64-slice MDCT scanner: correlation between infarcted region and status of territory-dependent coronary artery Imaging dell'infarto miocardico con TC spirale a 64 strati: correlazione tra territorio miocardico infartuato e stato del vaso coronarico di pertinenza

Purpose. This study was performed to evaluate the ability of 64slice multidetector computed tomography (MDCT) to detect previous myocardial infarctions (MIs) in patients referred for the assessment of the coronary arteries. In patients with regional changes of left ventricular wall myocardial density, the territorydependent coronary vessel status was examined. Materials and methods. We retrospectively assessed 202 consecutive patients referred for 64-slice MDCT of the coronary arteries. In all cases, detailed, clinical, serological and electrocardiograph (ECG) data were collected to identify patients with a previous diagnosis of MI. An initial qualitative evaluation of MDCT images was performed in all patients to identify areas of suspected myocardial necrosis, which were defined as regions of lower density within normally enhanced left ventricular myocardium. Thereafter, in all patients with suspected MIs, attenuation values and left ventricular wall thickness were also measured at the level of the normal myocardium and within the hypodense regions. Each MI was also assigned to the distribution territory of a coronary vessel, and morphological data were combined with MDCT angiographic findings. Results. After clinical assessment, MI was found in 27 patients (six acute).; 64-slice MDCT was able to detect the presence of MI in 24/27 cases, showing sensitivity and specificity of 89% and 95%, respectively, and an overall diagnostic accuracy of 95%. Quantitative analysis showed a significant difference (p<0.01) between attenuation values of normal vs. infarcted myocardium (124.5±19 HU vs. 56.1±23 HU, respectively); wall thinning was exclusively observed in chronic MIs (p<0.01). In 23/24 detected cases, analysis of territory-dependent arteries showed findings compatible with presence of MI. Conclusions. The presence of MI is well depicted with retrospective 64-slice MDCT. The main advantage of 64-slice MDCT is that it allows to evaluate and relate the status of a vessel and its dependent myocardial region in a single exam.PurposeThis study was performed to evaluate the ability of 64-slice multidetector computed tomography (MDCT) to detect previous myocardial infarctions (MIs) in patients referred for the assessment of the coronary arteries. In patients with regional changes of left ventricular wall myocardial density, the territory-dependent coronary vessel status was examined.Materials and methodsWe retrospectively assessed 202 consecutive patients referred for 64-slice MDCT of the coronary arteries. In all cases, detailed, clinical, serological and electrocardiograph (ECG) data were collected to identify patients with a previous diagnosis of MI. An initial qualitative evaluation of MDCT images was performed in all patients to identify areas of suspected myocardial necrosis, which were defined as regions of lower density within normally enhanced left ventricular myocardium. Thereafter, in all patients with suspected MIs, attenuation values and left ventricular wall thickness were also measured at the level of the normal myocardium and within the hypodense regions. Each MI was also assigned to the distribution territory of a coronary vessel, and morphological data were combined with MDCT angiographic findings.ResultsAfter clinical assessment, MI was found in 27 patients (six acute).; 64-slice MDCT was able to detect the presence of MI in 24/27 cases, showing sensitivity and specificity of 89% and 95%, respectively, and an overall diagnostic accuracy of 95%. Quantitative analysis showed a significant difference (p<0.01) between attenuation values of normal vs. infarcted myocardium (124.5±19 HU vs. 56.1±23 HU, respectively); wall thinning was exclusively observed in chronic MIs (p<0.01). In 23/24 detected cases, analysis of territory-dependent arteries showed findings compatible with presence of MI.ConclusionsThe presence of MI is well depicted with retrospective 64-slice MDCT. The main advantage of 64-slice MDCT is that it allows to evaluate and relate the status of a vessel and its dependent myocardial region in a single exam.RiassuntoObiettivoVerificare retrospettivamente in una popolazione di pazienti sottoposti a cardio-TC la presenza di focali aree di ipodensità parietale, riferibili a pregressi infarti miocardici (IMA), e in tal caso valutare l’eventuale patologia del vaso tributario.Materiali e metodiSono stati revisionati storia clinica, dati laboratoristici e strumentali di 202 pazienti (pz) consecutivamente sottoposti ad esame di cardio-TC con tomografo TC spirale a 64-strati (TCMS-64). In tutti i pazienti le immagini sono state analizzate valutando visivamente la presenza di regioni di minor densità nel contesto del miocardio ventricolare sinistro riferibili ad aree di sospetta necrosi miocardica. Successivamente, nei sospetti IMA è stata effettuata anche una valutazione quantitativa misurando densità e spessore miocardico nell’area necrotica e nei segmenti miocardici contigui che presentavano normale densità. In base alla sede, ciascun IMA è stato inoltre assegnato al territorio di distribuzione di uno dei tre vasi coronarici, combinando dati morfologici e reperti angio-TCMS.RisultatiDopo revisione dei dati clinico-strumentali sono stati individuati 27 pregressi IMA, di cui 6 di recente insorgenza. La TCMS-64 ha identificato 24/27 IMA con una sensibilità e specificità rispettivamente del 89% e 95% ed un’accuratezza del 95%; in 2 IMA erano presenti formazioni trombotiche ed in 3 aneurismi calcifici. L’analisi quantitativa ha dimostrato una differenza significativa (p<0,01) tra i valori di densità del miocardio normale rispetto a quello infartuato (rispettivamente 124,5±19 HU e 56,1±23 HU). Assottigliamento parietale è stato osservato solamente nei pazienti con IMA cronico (p<0,01). In 23/24 IMA identificati con la metodica, la valutazione dei vasi coronarici di pertinenza ha evidenziato reperti compatibili con la presenza di necrosi nel territorio di distribuzione.ConclusioniLa presenza di pregressi IMA viene ben documentata con TCMS-64; con un singolo esame la metodica offre un approccio esaustivo, consentendo una valutazione combinata di arterie coronarie e territorio infartuato.

Imaging dell'infarto miocardico con TC spirale a 64 strati: Correlazione tra territorio miocardico infartuato e stato del vaso coronarico di pertinenza

Purpose. This study was performed to evaluate the ability of 64slice multidetector computed tomography (MDCT) to detect previous myocardial infarctions (MIs) in patients referred for the assessment of the coronary arteries. In patients with regional changes of left ventricular wall myocardial density, the territorydependent coronary vessel status was examined. Materials and methods. We retrospectively assessed 202 consecutive patients referred for 64-slice MDCT of the coronary arteries. In all cases, detailed, clinical, serological and electrocardiograph (ECG) data were collected to identify patients with a previous diagnosis of MI. An initial qualitative evaluation of MDCT images was performed in all patients to identify areas of suspected myocardial necrosis, which were defined as regions of lower density within normally enhanced left ventricular myocardium. Thereafter, in all patients with suspected MIs, attenuation values and left ventricular wall thickness were also measured at the level of the normal myocardium and within the hypodense regions. Each MI was also assigned to the distribution territory of a coronary vessel, and morphological data were combined with MDCT angiographic findings. Results. After clinical assessment, MI was found in 27 patients (six acute).; 64-slice MDCT was able to detect the presence of MI in 24/27 cases, showing sensitivity and specificity of 89% and 95%, respectively, and an overall diagnostic accuracy of 95%. Quantitative analysis showed a significant difference (p<0.01) between attenuation values of normal vs. infarcted myocardium (124.5±19 HU vs. 56.1±23 HU, respectively); wall thinning was exclusively observed in chronic MIs (p<0.01). In 23/24 detected cases, analysis of territory-dependent arteries showed findings compatible with presence of MI. Conclusions. The presence of MI is well depicted with retrospective 64-slice MDCT. The main advantage of 64-slice MDCT is that it allows to evaluate and relate the status of a vessel and its dependent myocardial region in a single exam.PurposeThis study was performed to evaluate the ability of 64-slice multidetector computed tomography (MDCT) to detect previous myocardial infarctions (MIs) in patients referred for the assessment of the coronary arteries. In patients with regional changes of left ventricular wall myocardial density, the territory-dependent coronary vessel status was examined.Materials and methodsWe retrospectively assessed 202 consecutive patients referred for 64-slice MDCT of the coronary arteries. In all cases, detailed, clinical, serological and electrocardiograph (ECG) data were collected to identify patients with a previous diagnosis of MI. An initial qualitative evaluation of MDCT images was performed in all patients to identify areas of suspected myocardial necrosis, which were defined as regions of lower density within normally enhanced left ventricular myocardium. Thereafter, in all patients with suspected MIs, attenuation values and left ventricular wall thickness were also measured at the level of the normal myocardium and within the hypodense regions. Each MI was also assigned to the distribution territory of a coronary vessel, and morphological data were combined with MDCT angiographic findings.ResultsAfter clinical assessment, MI was found in 27 patients (six acute).; 64-slice MDCT was able to detect the presence of MI in 24/27 cases, showing sensitivity and specificity of 89% and 95%, respectively, and an overall diagnostic accuracy of 95%. Quantitative analysis showed a significant difference (p<0.01) between attenuation values of normal vs. infarcted myocardium (124.5±19 HU vs. 56.1±23 HU, respectively); wall thinning was exclusively observed in chronic MIs (p<0.01). In 23/24 detected cases, analysis of territory-dependent arteries showed findings compatible with presence of MI.ConclusionsThe presence of MI is well depicted with retrospective 64-slice MDCT. The main advantage of 64-slice MDCT is that it allows to evaluate and relate the status of a vessel and its dependent myocardial region in a single exam.RiassuntoObiettivoVerificare retrospettivamente in una popolazione di pazienti sottoposti a cardio-TC la presenza di focali aree di ipodensità parietale, riferibili a pregressi infarti miocardici (IMA), e in tal caso valutare l’eventuale patologia del vaso tributario.Materiali e metodiSono stati revisionati storia clinica, dati laboratoristici e strumentali di 202 pazienti (pz) consecutivamente sottoposti ad esame di cardio-TC con tomografo TC spirale a 64-strati (TCMS-64). In tutti i pazienti le immagini sono state analizzate valutando visivamente la presenza di regioni di minor densità nel contesto del miocardio ventricolare sinistro riferibili ad aree di sospetta necrosi miocardica. Successivamente, nei sospetti IMA è stata effettuata anche una valutazione quantitativa misurando densità e spessore miocardico nell’area necrotica e nei segmenti miocardici contigui che presentavano normale densità. In base alla sede, ciascun IMA è stato inoltre assegnato al territorio di distribuzione di uno dei tre vasi coronarici, combinando dati morfologici e reperti angio-TCMS.RisultatiDopo revisione dei dati clinico-strumentali sono stati individuati 27 pregressi IMA, di cui 6 di recente insorgenza. La TCMS-64 ha identificato 24/27 IMA con una sensibilità e specificità rispettivamente del 89% e 95% ed un’accuratezza del 95%; in 2 IMA erano presenti formazioni trombotiche ed in 3 aneurismi calcifici. L’analisi quantitativa ha dimostrato una differenza significativa (p<0,01) tra i valori di densità del miocardio normale rispetto a quello infartuato (rispettivamente 124,5±19 HU e 56,1±23 HU). Assottigliamento parietale è stato osservato solamente nei pazienti con IMA cronico (p<0,01). In 23/24 IMA identificati con la metodica, la valutazione dei vasi coronarici di pertinenza ha evidenziato reperti compatibili con la presenza di necrosi nel territorio di distribuzione.ConclusioniLa presenza di pregressi IMA viene ben documentata con TCMS-64; con un singolo esame la metodica offre un approccio esaustivo, consentendo una valutazione combinata di arterie coronarie e territorio infartuato.

Volumetric evaluation of therapy response in patients with lung metastases. Preliminary results with a computer system (CAD) and comparison with unidimensional measurements@@@Valutazione volumetrica della risposta alla terapia in pazienti con metastasi polmonari. Prime esperienze con un sistema di misurazione computerizzato (CAD) e confronto con misurazioni unidimensionali

Purpose.The aim of this study was to assess the efficacy of a Computer–Aided Detection (CAD) system in the identification of lung metastases and to compare the volumetric CAD measurements with unidimensional observer measurements in the evaluation of treatment response in oncology patients.Materials and methods.Two observers (A and B) evaluated nine patients undergoing lung computed tomography (CT) just before and immediately after treatment with chemotherapy. Multislice CT scans were performed before and after the injection of contrast material with a high–resolution protocol (collimation 4x1 mm, 100 mAs, 120 kV). Response Evaluation Criteria in Solid Tumours (RECIST) criteria were used to consider the disease as stable, increased or decreased. Subsequently, target lesions (most significant lesions identified before and after chemotherapy) were evaluated with a computerised system (CAD) to establish volumetric measurements. Observers’ unidimensional measurements and CAD volumetric measurements were analysed for comparison.Results.Twenty–four nodules (diameter: 5–18 mm in the first study and 4–20 mm in the follow–up study) were included. Observers agreed in the assessment of therapy response in 21 nodules: eight were considered to have increased in size, and 13 were judged stable. Observer and CAD measurements disagreed in three nodules: two were considered stable by radiologists and increased by CAD; one was considered increased by radiologists and stable by CAD.As regards patient response, radiologists disagreed in two cases. CAD and observers did not agree in one case.Conclusions.Our preliminary data suggest that volumetric measurements can modify the diagnostic and therapeutic evaluation of oncology patients under chemotherapy.CAD volumetric measurements allow an easy and objective evaluation, reducing interobserver variability in the evaluation of chemotherapy response.

Valutazione volumetrica della risposta alla terapia in pazienti con metastasi polmonari. Prime esperienze con un sistema di misurazione computerizzato (CAD) e confronto con misurazioni unidimensionali

Purpose.The aim of this study was to assess the efficacy of a Computer–Aided Detection (CAD) system in the identification of lung metastases and to compare the volumetric CAD measurements with unidimensional observer measurements in the evaluation of treatment response in oncology patients.Materials and methods.Two observers (A and B) evaluated nine patients undergoing lung computed tomography (CT) just before and immediately after treatment with chemotherapy. Multislice CT scans were performed before and after the injection of contrast material with a high–resolution protocol (collimation 4x1 mm, 100 mAs, 120 kV). Response Evaluation Criteria in Solid Tumours (RECIST) criteria were used to consider the disease as stable, increased or decreased. Subsequently, target lesions (most significant lesions identified before and after chemotherapy) were evaluated with a computerised system (CAD) to establish volumetric measurements. Observers’ unidimensional measurements and CAD volumetric measurements were analysed for comparison.Results.Twenty–four nodules (diameter: 5–18 mm in the first study and 4–20 mm in the follow–up study) were included. Observers agreed in the assessment of therapy response in 21 nodules: eight were considered to have increased in size, and 13 were judged stable. Observer and CAD measurements disagreed in three nodules: two were considered stable by radiologists and increased by CAD; one was considered increased by radiologists and stable by CAD.As regards patient response, radiologists disagreed in two cases. CAD and observers did not agree in one case.Conclusions.Our preliminary data suggest that volumetric measurements can modify the diagnostic and therapeutic evaluation of oncology patients under chemotherapy.CAD volumetric measurements allow an easy and objective evaluation, reducing interobserver variability in the evaluation of chemotherapy response.