This is the ideal resource for all those requiring an authoritative and up-to-date review of imaging appearances of diseases of the lung, pleura and mediastinum. Imaging Of Occupational And Envir Disorders Of The Chest Diseases of the Heart, Chest & Breast Diagnostic Imaging and Interventional. Radiology. June Book. Review. Imaging of Diseases of the Chest. 2nd ed. Peter. Armstrong,. Paul Dee, David. M. Hansell,. Theodore. E. Keats,. A. Michael.
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Book file PDF easily for everyone and every device. You can download and read online Imaging of Diseases of the Chest (5th Edition) file PDF Book only if you. Abstract. Chest radiography (CXR) and computed tomography (CT) are among the more commonly needed imaging investigations in patients with lung disease. Professor of Thoracic Imaging, Imperial College, London. Consultant .. are in keeping with chronic obstructive pulmonary disease (COPD). Given the strong.
The endpoints used in clinical studies today, such as lung function parameters, only show slow changes, thus necessitating long-term studies to show drug effects. Showing the changes through imaging techniques might achieve the same purpose more quickly and more quantifiably. Shortening the duration of clinical studies would help to win time for patients.
Effective drugs would be available sooner, and considerable costs would be saved—so long as surrogate parameters can be found. In the diagnosis of lung disease, the future, more even than today, belongs to imaging—both clinically and in research. To make the best use of this, closer collaboration between clinical physicians and radiologists will be important. Footnotes Conflict of interest statement The author declares that no conflict of interest exists. Radiological diagnosis in lung disease—factoring treatment options into the choice of diagnostic modality.
Dtsch Arztebl Int. Dalhoff K, Ewig S. Dtsch Arztebl Int Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Differential diagnosis is based on location and supplemented by morphological appearance and enhancement characteristics. Smaller lesions are much more easily appreciated on CT than on a chest X-ray. CT is superior to chest X-ray for assessment of pleural diseases.
Figure 2 shows a chest X-ray and corresponding CT scan showing a loculated and benign pleural effusion. Figure 2. Loculated pleural effusion A.
Chest X-ray: loculated pleural effusions indicated by star; note the left pulmonary artery can be seen separate to the mass lesion B. CT scan: pleural effusions indicated by star aAo, ascending aorta; dAo, descending aorta; Pulm A, pulmonary artery; SVC, superior vena cava Indications for high-resolution CT High-resolution CT is generally used for assessment of interstitial diseases.
It is not generally used for assessment of solitary pulmonary masses, although it can be used to assess whether a small nodule contains calcification and, therefore, is most commonly benign.
It is performed without intravenous contrast, using the same data acquisition technique but with a thinner reconstruction slice thickness, giving greater detail of the interstitium. Usually, the slices are separated by 5—10 mm such that masses arising between the slices may not be appreciated, so the technique is not suitable for assessment of malignant disease when used alone.
Bronchiectasis is an example of a disease process that is best assessed with high-resolution CT, although it is appreciable on standard CT. It is a disease that affects both small and large airways.
The regional segmental and sub-segmental bronchi become dilated and thick-walled, and this is best appreciated by comparison with the unaffected lung. Smaller peripheral bronchioles appear either as tiny nodules scattered randomly in the sub-pleural lung or branching structures due to occlusion of the airway lumen, which is below the resolution of CT. The intensity of uptake correlates with tissue metabolic activity.
Most, but not all, lung cancers show increased uptake of varying intensity. However, uptake is not synonymous with malignancy; infection and sarcoidosis are other common causes of increased 18FDG uptake. Prior to surgery or commencement of neo-adjuvant therapies, a tissue diagnosis is usually required.
CT can guide selection of the most appropriate biopsy method. For example, central lesions involving the airways are best approached using bronchoscopy or endobronchial ultrasound EBUS -guided biopsy, whereas peripheral lesions are often most successfully biopsied using CT guidance.
Relative contraindications for CT-guided biopsy are bleeding diastheses or anti-platelet therapies, which may need to be withheld after discussion with the treating doctor s. CT pulmonary angiography CTPA is beyond the scope of this overview but is one of the techniques available for investigation of suspected pulmonary embolism along with VQ scanning.
Appropriate use of imaging The options for imaging are becoming increasingly complex but there are several excellent online resources that GPs can freely consult in addition to their local radiologists. These include Australian resources such as the Diagnostic Imaging Pathways websites and North American websites, and offer comprehensive evidence-based information to guide selection of appropriate tests.
They are usually based on evaluating a specific presenting complaint and can be complex to read.
In the near future, it is planned that these resources will be integrated into electronic medical records to allow much easier use. Key points Radiological investigation is not warranted in uncomplicated upper respiratory tract infection, asthma, minor trauma or acute-on-chronic chest pain.