Highlights • Radiomics is defined as the use of automated or semi-automated post-processing and analysis of large amounts of quantitative imaging features that can be derived from medical images. • ...The automated generation of these analytical features helps to quantify a number of variables in the imaging assessment of lung malignancy. • We aimed to summarize the current state of the art on this amazingly interesting topic.
The Masaoka-Koga staging system has been known as the strongest prognostic factor for both survival and recurrence of thymic epithelial tumor (TET). The purpose of our study was to find prognostic ...determinants among computed tomography (CT), histopathologic, and clinical features of TET.
Two radiologists reviewed retrospectively CT findings of 437 patients (male 242, female 195; mean age, 51 years) with TET. With medical record review, surgico-histopathologic results were subcategorized into Masaoka-Koga stages I through IV and World Health Organization histopathologic classifications A-B1, B2-B3, and carcinoma. Overall survival and progression-free survival were analyzed. Clinical, histopathologic, and CT features were correlated from each other.
In all, 437 tumors were in Masaoka-Koga stage I (n = 147, 33.6%), stage II (n = 121, 27.7%), stage III (n = 76, 17.4%), or stage IV (n = 93, 21.3%); A and B1 (n = 114, 26.1%) and B2 and B3 TET (n = 223, 51.0%); and thymic carcinoma (n = 100, 22.9%). In multivariable analyses, age, Masaoka-Koga stage IV, thymic carcinoma, and CT stages III and IV were significantly correlated with overall survival (p < 0.05), whereas adjuvant treatment, Masaoka-Koga stages III and IV, World Health Organization B2 and B3, thymic carcinoma, R2 resection, CT size, and CT stage IV were significantly associated with progression-free survival (p < 0.05). Computed tomography stages showed moderate association with Masaoka-Koga stages (K = 0.621).
For TET, CT staging is effective in distinguishing both overall survival and progression-free survival, and patients with Masaoka-Koga stage IV or thymic carcinoma or CT stage IV have the worst prognosis.
Objective: There is increasing recognition that left atrial (LA) strain can be a prognostic marker of various cardiac diseases. However, its prognostic value in acute myocarditis remains unclear. ...Therefore, this study aimed to evaluate whether cardiovascular magnetic resonance (CMR)-derived parameters of LA strain can predict outcomes in patients with acute myocarditis. Materials and Methods: We retrospectively analyzed the data of 47 consecutive patients (44.2 ± 18.3 years; 29 males) with acute myocarditis who underwent CMR in 13.5 ± 9.7 days (range, 0-31 days) of symptom onset. Various parameters, including feature-tracked CMR-derived LA strain, were measured using CMR. The composite endpoints included cardiac death, heart transplantation, implantable cardioverter-defibrillator or pacemaker implantation, rehospitalization following a cardiac event, atrial fibrillation, or embolic stroke. The Cox regression analysis was performed to identify associations between the variables derived from CMR and the composite endpoints. Results: After a median follow-up of 37 months, 20 of the 47 (42.6%) patients experienced the composite events. In the multivariable Cox regression analysis, LA reservoir and conduit strains were independent predictors of the composite endpoints, with an adjusted hazard ratio per 1% increase of 0.90 (95% confidence interval CI, 0.84-0.96; P = 0.002) and 0.91 (95% CI, 0.84-0.98; P = 0.013), respectively. Conclusion: LA reservoir and conduit strains derived from CMR are independent predictors of adverse clinical outcomes in patients with acute myocarditis.
Existing literature is inconclusive regarding how the nodular bronchiectatic form of Mycobacterium avium complex (MAC) disease will progress without treatment and when treatment initiation should be ...considered.
To assess the natural course of MAC pulmonary disease by serial thin-section computed tomography (CT).
Of 339 patients with nodular bronchiectatic form of MAC disease, we selected 265 untreated patients who had serial CTs (mean observation period, 32 ± 21 mo). Two independent chest radiologists reviewed retrospectively all CT scans for the presence and extent of lung abnormalities (maximal total score, 30).
Of 265 patients, 126 patients (48%) had disease that had progressed and that needed treatment owing to radiologic deterioration or worsening symptoms, and the remaining 139 patients (52%) did not. On multivariate analysis, the presence of cavity (adjusted hazard ratio, 2.06; P = 0.004) and consolidation (adjusted hazard ratio, 1.55; P = 0.019) at initial CT remained as independent factors associated with disease progression and treatment requirement. The presence of cavitary lesions demonstrated the highest positive predictive value (61%) and significant correlation (P = 0.005) with smear positivity. Differences in the extent of each pattern and total CT score in the serial studies were significantly larger (P < 0.05) in patients requiring treatment. The total CT score increased by 2.41 in the treatment-requiring group compared with 0.25 in the group that did not receive treatment.
Without treatment, about half of patients demonstrate progressive disease on serial CT over a mean follow-up period of 32 months and, thus, required treatment. Patients showing cavities or consolidation on initial CT are more likely to have progressive disease and thus to require treatment eventually.
Background
Concurrent bronchoscopy using radial probe and convex endobronchial ultrasound (RP‐ and CP‐EBUS) is used to simultaneously evaluate both peripheral lung lesions for the histological ...diagnosis of the primary tumor and mediastinal lymph nodes for mediastinal staging. So far, little is known about the combined procedure with RP‐ and CP‐EBUS.
Methods
Between January 2020 and March 2021, the bronchoscopy database was reviewed to identify the clinical outcomes of the combined procedure with RP‐ and CP‐EBUS. Patients who underwent transbronchial biopsy using RP‐EBUS alone were classified as the RP‐EBUS group, while those who underwent a combined procedure with RP‐ and CP‐EBUS were classified as the combination group.
Results
The overall diagnostic yield of the bronchoscopic procedure in the combination group was significantly higher than the RP‐EBUS group (90.7% vs. 70.0%, p < 0.001). CP‐EBUS increased the diagnostic yield of the bronchoscopic procedure in the combination group by 9.3%. Although the mean procedure time was significantly longer, and the mean doses of midazolam and fentanyl were significantly higher in the combination group (p < 0.001), there were no differences in the overall complication rates between the two study groups (1.4% and 1.0% for the RP‐EBUS and combination groups, respectively, p = 0.766).
Conclusions
Combined bronchoscopy using RP‐ and CP‐EBUS is feasible and safe. In addition to mediastinal staging, CP‐EBUS increased the overall diagnostic yield of the bronchoscopic procedure by 9.3%.
The combined procedure with radial probe TBLB and convex probe endobronchial ultrasound is feasible and safe. The combined procedure increased the overall diagnostic yield of bronchoscopy, besides concurrent diagnosis and mediastinal staging.
Objectives
To investigate the value of the whole-lesion histogram apparent diffusion coefficient (ADC) metrics for differentiating low-risk from non-low-risk ductal carcinoma in situ (DCIS).
Methods
...The authors identified 93 women with pure DCIS who had undergone preoperative MR imaging and diffusion-weighted imaging from 2013 to 2016. Histogram analysis of pixel-based ADC data of the whole tumour volume was performed by two radiologists using a software tool. The results were compared between low-risk and non-low-risk DCIS. Associations between quantitative ADC metrics and low-risk DCIS were evaluated by receiver operating characteristics (ROC) curve and logistic regression analyses.
Results
In whole-lesion histogram analysis, mean ADC and 5th, 50th and 95th percentiles of ADC were significantly different between low-risk and non-low-risk DCIS (1.522, 1.207, 1.536 and 1.854 × 10
−3
mm
2
/s versus 1.270, 0.917, 1.261 and 1.657 × 10
−3
mm
2
/s, respectively;
p
= .004,
p
= .003,
p
= .004 and
p
= .024, respectively). ROC curve analysis for differentiating low-risk DCIS revealed that 5th percentile ADC yielded the largest area under the curve (0.786) among the metrics of whole-lesion histogram, and the optimal cut-off point was 1.078 × 10
−3
mm
2
/s (sensitivity 80%, specificity 75.9%,
p
= .001). Multivariate regression analysis revealed that a high 5th percentile of ADC (> 1.078× 10
−3
mm
2
/s; odds ratio OR = 10.494,
p
= .016), small tumour size (≤ 2 cm; OR = 12.692,
p
= .008) and low Ki-67 status (< 14%; OR = 10.879,
p
= .046) were significantly associated with low-risk DCIS.
Conclusions
Assessment with whole-lesion histogram analysis of the ADC could be helpful for identifying patients with low-risk DCIS.
Key Points
• Whole-lesion histogram ADC metrics could be helpful for differentiating low-risk from non-low-risk DCIS.
• A high 5th percentile ADC was a significant factor associated with low-risk DCIS.
• Risk stratification of DCIS is important for their management.
Generally, structural destruction of lung parenchyma, such as pulmonary emphysema, is considered to be related to the low diagnostic yields and high complication rates of lung biopsies of peripheral ...lung lesions. Currently, little is known about the clinical outcomes of using endobronchial ultrasound with a guide sheath (EBUS-GS) to diagnose peripheral lesions in patients with emphysema.
This retrospective study was performed to identify the clinical outcomes of EBUS-GS in patients with pulmonary emphysema. This study included 393 consecutive patients who received EBUS-GS between February 2017 and April 2018. The patients were classified according to the severity of their emphysema, and factors possibly contributing to a successful EBUS-GS procedure were evaluated.
The overall diagnostic yield of EBUS-GS in patients with no or mild emphysema was significantly higher than in those with moderate or severe pulmonary emphysema (78% vs. 61%, P = 0.007). There were no procedure-related complications. The presence of a bronchus sign on CT (P < 0.001) and a "within the lesion" status on EBUS (P = 0.009) were independently associated with a successful EBUS-GS procedure. Although the diagnostic yield of EBUS-GS in patients with moderate-to-severe emphysema was relatively low, a bronchus sign and "within the lesion" status on EBUS were contributing factors for a successful EBUS-GS.
EBUS-GS is a safe procedure with an acceptable diagnostic yield, even when performed in patients with pulmonary emphysema. The presence of a bronchus sign and "within the lesion" status on EBUS were predictors of a successful procedure.
Virtual bronchoscopy navigation (VBN) is widely used for assistance in the histological examination of lung nodules. However, little is known about the optimal CT radiation dose for VBN. Therefore, ...we performed an animal study to evaluate the feasibility of low dose CT (LDCT) for VBN.
Ten pigs underwent standard dose CT (as a reference) and four different LDCT protocols: LDCT 1, 120 kVp, 15 mAs; LDCT 2, 120 kVp, 8 mAs; LDCT 3, 100 kVp, 7 mAs; and LDCT 4, 100 kVp, 4 mAs. As targets for the VBN, 10 mm virtual lesions were created in the central and peripheral bronchi. To assess the performance of the VBN, the navigation direction (direction of reconstructed pathways to the target) and the number of branching's (the number of peripheral bronchi to the target) were evaluated.
The mean effective doses significantly differed across the four LDCTs (P < 0.001). For both central and peripheral virtual targets, there were significant differences in the accuracy of the navigation direction and the number of branching's of the VBNs across the four LDCTs (P < 0.001 for all). Regarding the accuracy of the navigation direction and the number of branching's, the areas under the curves of the ROCs were 0.9352 and 0.9324, respectively, for central virtual targets, and 0.8696 and 0.8783, respectively, for peripheral virtual targets. Youden's index indicated that the optimal effective CT scan dose for both central and peripheral virtual targets was 0.238 mSv.
LDCT is feasible for VBN.
Blunt airway trauma is rare but life threatening. Injuries to other vital organs accompany this type of injury in most cases; therefore, conservative treatment may be considered first. In cases of ...delayed fibrotic airway stenosis after conservative treatment, surgical treatment or bronchoscopic intervention are therapeutic options. We herein report a case of delayed airway stenosis after a blunt traumatic airway injury that was successfully managed by silicone stenting.
Radial probe endobronchial ultrasound using a guide sheath (EBUS-GS) is used to diagnose peripheral lung cancer. The aim was to identify the accuracy of molecular analysis that were performed with ...EBUS-GS specimens in patients with non-small cell lung cancer (NSCLC).
From December 2015 to September 2017, we retrospectively studied 91 patients with peripheral NSCLC who underwent surgery after EBUS-GS. Epidermal growth factor receptor (EGFR) mutational and anaplastic lymphoma kinase (ALK) translocation status obtained from surgical specimens served as the references.
Compared to the reference data, EGFR mutational testing of EBUS-GS specimens was in 97% agreement, and the κ coefficient was 0.931 (P< 0.001). In addition, on ALK translocation testing, the results of all 91 patients were in agreement with the reference data (concordance rate of 100%, κ coefficient 1.000; P< 0.001).
We found that EBUS-GS could be used for molecular diagnosis, such as EGFR mutational and ALK translocation status, in patients with peripheral NSCLC.
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