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FDG-PET imaging used to detect bronchogenic carcinoma presenting as a solitary pulmonary nodule or mass
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214
EVALUATION OF MEDIA!WINAL AND HILAR ADENOPATHY WITH CT AND MRI.
FDG-PET IMAGING PRESENTING AS A Lowe V, Hoffman Duke University
D.Rochester, W.A. Fry, J.S. Panella, E.M. White, J.B. Bernstein, R.B. Port, R.H. Knop. Evanston Hospital Northwestern University, Evanston, Illinois. Sixteen consecutive patients with documented primary bronchogenic carcinoma were evaluated preoperatively with both dynamic intitsed CT and MRI studies of the chest and mediastinum. These patients subsequently underwent surgery with media&al lymph node dissection for staging. The CT and MRI examinations were compared with the postsurgical findings to determine the relative sensitivity and specificity of CT compared with MRI. The anatomy of the mediastinum, correlated with the new TNM system of lymph node classification, will be described.
USED TO DETECT BRONCHOGENIC CARCINOMA SOLITARY PULMONARY NODULE OR MASS: Patz EF, J, Paine S, Coleman RE, Goodman PC. Medical Center, Durham, North Carolina
Solitary pulmonary nodules or masses on chest radiographs often necessitate further evaluation as lung cancer is of ultimate concern. Many lesions remain indeterminate following standard evaluation, and a sensitive and specific study capable of making the distinction between a benign and a malignant abnormality would be extremely valuable. This study addresses the role of positron emission tomography (PET) with 18F-2-fluoro-2deoxy-d-glucose (FDG) for this purpose. Any patient who presented with an indeterminate solitary pulmonary nodule or mass following conventional radiographic evaluation was considered elegible. Chest radiographs and thoracic CT were used to localize the abnormality, and semi-quantitative analysis war,performed by calculating a standardized uptake ratio (SUR) on FDG-PET images. Fifty-nine patients with solitary pulmonary nodules (n=54) and pulmonary masses (n=5) were studied with FDG-PET imaging. Thirty-six had malignant lesions with a Mann (+/-S.D.) SUR of 6.8 +/-3.6. Twenty-three benign lesions had a mean SUR of 2.3 +/-1.7. The sensitivity of FDG-PET for a malignant lesion with an SUR greater than 2.5 was 94.4% (95% CI is 8.3X, 99.3%), while the specificity for malignancy with an SUR greater than 2.5 was 70% (95% CI is 47.1%, 86.1%). This was statistically significant (p-.0001). These results suggest that FDG-PET imaging is very accurate in detecting lung cancer presenting as a pulmonary nodule or mass.
215 CLINICAL TNM STAGING SYSTEM IN MALIGNANT PLEURAL MESOTHELIOMA , Leena Kivisaar?, Ulla-Stina Salminen3, Paula Maasifta4, Karin Lauri Tammilehtot Mattson4, 1Department of Epidemiology and Biostatistics, Institute of Occupational Health, Helsinki; Departments of 2Diagnostic Radiology, 3Thoracic and Cardiovascular Surgery, and 4Pulmonary Medicine, Helsinki University Central Hospital, Helsinki, Finland. There is no universally-recognised method for staging malignant mesothelioma, akhough computed tomography (CT) scanning has improved non-invasive staging. IUAC has recently proposed using the TNM staging system for mesothelioma, but in clinical practice it is dkficuk to evaluate the tumour (T) and nodal (N) involvement due to the unique plate-like growth pattern of this tumour. In order to establish TNM staging we analysed preoperative CT scans from 63 patients with histologicallyconfirmed malignant pleural mesothelioma. Most of the patients would participate in a clinical study programme which included debulking surgery, chemotherapy and hemithorax irradiation. Median age of patients were 56 years (range 36-79). There were 51 men and 12 women, and 30 had iumours with epithelial histology. Median survival for all the patients, measured from the date of histological confirmation of mesothelioma, was 10 months (range 0.2-l IO. The same radiologist (LK) analysed CT scans according to the TNM staging system. Acturial survival curves were constructed by the Kaplan-Meier method. Survival curves for the dinerent TNM categories were compared using Wilcoxon and log-rank tests. Node evaluation could not be completed in 3 cases because the tumour had encompassed the hilum and mediastinum. Signilicant or near- significant dlferences in prognosis correlated to the diierent M categories (p < 0.01) and the different T categories (p = 0.06), but not to the N categories or to the stages. Larger studies are needed to assess the importance of TNM staging for selecting treatment and as a prognostic factor.
Shiota T.*, Kanaoka M.*, Nakamura T."", Gno S.**, Matsumura T.**, Yamada H.*** and Satn A.*"* *Dept. of Respiratory Division and**Internal Medicine, Ako City Hospital, ***Radiology, Rakuwakai Otowa Hospital Kinetic Turbo FLASH(Fast Low Angle Shot) imaging was performed to evaluate chest wall invasion by lung cancer. Ten patients with lung cancer, suspected of chest wall invasion on the basis of Cp, took part in this study. All the patients underwent MF? imaging with a 1.0-T superconducting unit(Magnetcm SP;Siemens). Thoracot~ was performed on all cases, and we subsequently confirmed the pre-operat-ive assessment. Turbo FLASH sequence with a 180 preparati-on pulse was used in kinetic MRI with the following para-msters:TR/TE of 6.513; inversion time, 500 msec; 128X256 matrix, single acquisition.; no delay time between images (temporal resolution, 1.0 seconds per image); section thickness, 10 mm; and a flip angle of 8". We employed the parasagittal or coronal plane in which includes the tumor and its contact pint with the adjacent chest wall. mty sequential Turlx FLJLSHimages were obtained during one breath cycle in about 20 seconds. If movement was found between the tumor and the adjacent chest wall as a function of the respiratory phase, we concluded that there was no chest wall invasion. We made a positive diagnosis of invasion in four cases, and a negative diagnosis of invasion in the other six cases with this technique. In all cases, the operative finding was the same as the pre-operative assessment. Cases with a minimal degree of thickening of the pleura and contact of the tumor with the chest wall should be carefully evaluated. In such cases, kinetic MRI usisng Turbo FLASH is valuable.
214
EVALUATION OF MEDIA!WINAL AND HILAR ADENOPATHY WITH CT AND MRI.
FDG-PET IMAGING PRESENTING AS A Lowe V, Hoffman Duke University
D.Rochester, W.A. Fry, J.S. Panella, E.M. White, J.B. Bernstein, R.B. Port, R.H. Knop. Evanston Hospital Northwestern University, Evanston, Illinois. Sixteen consecutive patients with documented primary bronchogenic carcinoma were evaluated preoperatively with both dynamic intitsed CT and MRI studies of the chest and mediastinum. These patients subsequently underwent surgery with media&al lymph node dissection for staging. The CT and MRI examinations were compared with the postsurgical findings to determine the relative sensitivity and specificity of CT compared with MRI. The anatomy of the mediastinum, correlated with the new TNM system of lymph node classification, will be described.
USED TO DETECT BRONCHOGENIC CARCINOMA SOLITARY PULMONARY NODULE OR MASS: Patz EF, J, Paine S, Coleman RE, Goodman PC. Medical Center, Durham, North Carolina
Solitary pulmonary nodules or masses on chest radiographs often necessitate further evaluation as lung cancer is of ultimate concern. Many lesions remain indeterminate following standard evaluation, and a sensitive and specific study capable of making the distinction between a benign and a malignant abnormality would be extremely valuable. This study addresses the role of positron emission tomography (PET) with 18F-2-fluoro-2deoxy-d-glucose (FDG) for this purpose. Any patient who presented with an indeterminate solitary pulmonary nodule or mass following conventional radiographic evaluation was considered elegible. Chest radiographs and thoracic CT were used to localize the abnormality, and semi-quantitative analysis war,performed by calculating a standardized uptake ratio (SUR) on FDG-PET images. Fifty-nine patients with solitary pulmonary nodules (n=54) and pulmonary masses (n=5) were studied with FDG-PET imaging. Thirty-six had malignant lesions with a Mann (+/-S.D.) SUR of 6.8 +/-3.6. Twenty-three benign lesions had a mean SUR of 2.3 +/-1.7. The sensitivity of FDG-PET for a malignant lesion with an SUR greater than 2.5 was 94.4% (95% CI is 8.3X, 99.3%), while the specificity for malignancy with an SUR greater than 2.5 was 70% (95% CI is 47.1%, 86.1%). This was statistically significant (p-.0001). These results suggest that FDG-PET imaging is very accurate in detecting lung cancer presenting as a pulmonary nodule or mass.
215 CLINICAL TNM STAGING SYSTEM IN MALIGNANT PLEURAL MESOTHELIOMA , Leena Kivisaar?, Ulla-Stina Salminen3, Paula Maasifta4, Karin Lauri Tammilehtot Mattson4, 1Department of Epidemiology and Biostatistics, Institute of Occupational Health, Helsinki; Departments of 2Diagnostic Radiology, 3Thoracic and Cardiovascular Surgery, and 4Pulmonary Medicine, Helsinki University Central Hospital, Helsinki, Finland. There is no universally-recognised method for staging malignant mesothelioma, akhough computed tomography (CT) scanning has improved non-invasive staging. IUAC has recently proposed using the TNM staging system for mesothelioma, but in clinical practice it is dkficuk to evaluate the tumour (T) and nodal (N) involvement due to the unique plate-like growth pattern of this tumour. In order to establish TNM staging we analysed preoperative CT scans from 63 patients with histologicallyconfirmed malignant pleural mesothelioma. Most of the patients would participate in a clinical study programme which included debulking surgery, chemotherapy and hemithorax irradiation. Median age of patients were 56 years (range 36-79). There were 51 men and 12 women, and 30 had iumours with epithelial histology. Median survival for all the patients, measured from the date of histological confirmation of mesothelioma, was 10 months (range 0.2-l IO. The same radiologist (LK) analysed CT scans according to the TNM staging system. Acturial survival curves were constructed by the Kaplan-Meier method. Survival curves for the dinerent TNM categories were compared using Wilcoxon and log-rank tests. Node evaluation could not be completed in 3 cases because the tumour had encompassed the hilum and mediastinum. Signilicant or near- significant dlferences in prognosis correlated to the diierent M categories (p < 0.01) and the different T categories (p = 0.06), but not to the N categories or to the stages. Larger studies are needed to assess the importance of TNM staging for selecting treatment and as a prognostic factor.
Shiota T.*, Kanaoka M.*, Nakamura T."", Gno S.**, Matsumura T.**, Yamada H.*** and Satn A.*"* *Dept. of Respiratory Division and**Internal Medicine, Ako City Hospital, ***Radiology, Rakuwakai Otowa Hospital Kinetic Turbo FLASH(Fast Low Angle Shot) imaging was performed to evaluate chest wall invasion by lung cancer. Ten patients with lung cancer, suspected of chest wall invasion on the basis of Cp, took part in this study. All the patients underwent MF? imaging with a 1.0-T superconducting unit(Magnetcm SP;Siemens). Thoracot~ was performed on all cases, and we subsequently confirmed the pre-operat-ive assessment. Turbo FLASH sequence with a 180 preparati-on pulse was used in kinetic MRI with the following para-msters:TR/TE of 6.513; inversion time, 500 msec; 128X256 matrix, single acquisition.; no delay time between images (temporal resolution, 1.0 seconds per image); section thickness, 10 mm; and a flip angle of 8". We employed the parasagittal or coronal plane in which includes the tumor and its contact pint with the adjacent chest wall. mty sequential Turlx FLJLSHimages were obtained during one breath cycle in about 20 seconds. If movement was found between the tumor and the adjacent chest wall as a function of the respiratory phase, we concluded that there was no chest wall invasion. We made a positive diagnosis of invasion in four cases, and a negative diagnosis of invasion in the other six cases with this technique. In all cases, the operative finding was the same as the pre-operative assessment. Cases with a minimal degree of thickening of the pleura and contact of the tumor with the chest wall should be carefully evaluated. In such cases, kinetic MRI usisng Turbo FLASH is valuable.