Figures
- FIGURE 1
Images of a 73-year-old female patient admitted to hospital for secondary hypertension workup and management. a) A routine chest radiograph showed a right basal pulmonary nodule, which was misdiagnosed as the right nipple, but b) computed tomography (CT) and c) CT-guided biopsy confirmed the presence of a carcinoid tumour. In addition, a) chest radiography and CT (not shown) confirmed an aberrant right subclavian artery, known clinically as arteria lusoria, which is the most common embryological abnormality of the aortic arch. Images courtesy of the Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
- FIGURE 2
Computed tomography (CT) scans of a growing part-solid nodule. a) In 2014. b) Axial and c) coronal views from 3 years later, in 2017. The 70-year-old female smoker patient was investigated due to cough. Positron emission tomography/CT did not show fluorodeoxyglucose uptake in the lesion. Biopsy confirmed adenocarcinoma. Images courtesy of the Medical Imaging Centre, Semmelweis University, Budapest, Hungary.
- FIGURE 3
Low-field magnetic resonance imaging (0.55 T) images (T2 FBLADE sequence). a) Axial and b) coronal views of a metastatic lung nodule in the right upper lobe (S3 segment), and c) axial view of another metastatic pulmonary lesion in the right upper lobe and a growing mediastinal lymph node, in a young female pregnant patient with metastatic breast cancer. Images courtesy of the National Institute of Oncology, Budapest, Hungary.
- FIGURE 4
a) A fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) image in three sectional planes of an 82-year-old smoker. In the left upper lobe, a pulmonary mass with a hypermetabolic border (maximum standardised uptake value 13.6) and a necrotic centre comes into view. Staging remained without evidence of mediastinal or extrathoracic metastasis. b) The maximum intensity projection (MIP) shows an overview of the entire PET scan. Information about the distribution of FDG uptake assisted CT-guided puncture, which was taken from the marginal area of the pulmonary mass and confirmed a pulmonary squamous cell carcinoma.
- FIGURE 5
Positron emission tomography (PET)/computed tomography (CT) of a 56-year-old smoker who presented with a chronic dry cough. In the left lower lobe of the lung, a) CT showed a solid compaction (23 mm) close to the hilus, which in b) fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT showed only a slightly increased uptake (maximum standardised uptake value (SUVmax) 3.2) and was not considered to be malignant. c) Somatostatin receptor expression was significantly increased in the gallium-68 dodecane tetraacetic acid-conjugated octreotide (68Ga-DOTATOC) PET/CT at this site (SUVmax 43). Left lower lobe resection revealed a typical carcinoid.
- FIGURE 6
Low-dose computed tomography screening of a 77-year-old female smoker, which confirmed a tumour-suspicious speculated solid lesion in the right upper lobe. Image courtesy of the National Institute of Oncology, Budapest, Hungary.
- FIGURE 7
a) Algorithm for management of solid pulmonary nodules (PNs) based on British Thoracic Society guidelines. Reproduced and modified from [102] with permission. b) Algorithm for management of sub-solid PNs based on Fleischner Society guidelines. Information from [27]. PET: positron emission tomography; CT: computed tomography; GGO: ground-glass opacity; PSN: part-solid nodules.
- FIGURE 8
Computed tomography (CT)-guided transthoracic lung biopsy performed in the 82-year-old lung cancer patient shown in figure 4. Biopsy location was additionally guided by positron emission tomography/CT. In the case of this central tumour far from the chest wall, bronchoscopic tissue sampling would also have been feasible.
Tables
- TABLE 1
Comparison of conventional and digital chest radiography
Conventional Digital Examination time Longer; film development required Shorter; can be viewed immediately; no film development required Post-processing manipulation (e.g. magnification, windowing, greyscale inversion) Not possible Possible; in the case of under- or over-exposed film, they do not need to be repeated, so the patient's radiation exposure is also reduced Graphic quality Lower Higher Storage Storage space is required; chemicals and films are highly polluting Completed films can be stored digitally, which can be viewed simultaneously and remotely Interpretation time Prolonged Shorter Price More expensive Cheaper Accessibility More complicated Easier - TABLE 2
Differences in imaging duration and radiation dose between chest computed tomography scanner types
16-slice 64-slice 128-slice Imaging duration (s) ∼8.3 ∼8.5 ∼3.5 Effective dose (mSv) 9.52 7.5 9.46 CTDIvol (mGy per 100 mAs body) 11.65 17.11 10.4±2.1 Note that these are example values, since different studies have reached different results regarding the dose efficiency of multislice computed tomography scans. CTDIvol: volume computed tomography dose index.
- TABLE 3
Indications for magnetic resonance imaging (MRI) in the context of lung cancer diagnosis and follow-up
Role in diagnosis and staging Role in follow-up Determination of tumour invasion in the chest wall and the mediastinal structures Monitoring of response to treatment Differentiation between solid and vascular hilar masses N- and M-stage evaluation, e.g. screening for brain, vertebral/spine metastases Assessment of tumour cellularity Assessment of diaphragmatic abnormalities during treatment Characterisation of different subtypes Assessment of distant metastatic disease (whole-body MRI) N- and M-stage evaluation, e.g. screening for brain, vertebral/spine metastasis Assessment of distant metastatic disease (whole-body MRI) Assessment of diaphragmatic abnormalities Differentiation of lung cancer from progressive massive fibrosis, tuberculomas, obstructive pneumonia and surrounding post-obstructive atelectasis - TABLE 4
Differential diagnoses of cellular fluorine-18 (18F) fluorodeoxyglucose (FDG) uptake during tumour staging
Anatomical region Physiological, norm variant False-positive18F-FDG uptake False-negative 18F-FDG uptake General BAT
Brain
Myocardium
Kidneys
Urinary tractInflammation
Area of surgery
Iodinated contrast medium
Incorrect alignment (fusion) of PET and CT
Incorrect attenuation correctionHyperglycaemia
Small tumours
Low 18F-FDG avidity
Regions of low physiological 18F-FDG uptake
Incorrect alignment (fusion) of PET and CT
Incorrect attenuation correctionHead and neck Brain: white and grey matter
Neck: neck muscles and BAT, e.g. supraclavicularHead:
Sinusitis
Neck:
Thyroiditis
Graves disease
Warthin tumour
Reactive lymphadenopathyIntracranial metastasis
Glioma, low-gradeThorax Thymus
Oesophagus
BAT: mediastinal, pericardial, paravertebral, intercostal
Myocardium
Autochthone muscles
Lactating breastsSclerosis of the aorta
Oesophagitis
Pleural empyema
Pleurodesis
Pneumonia, abscess
Radiation pneumonitis
Granulomatosis: mycobacteria, sarcoidosis, aspergillosis, arteritis
Reactive mediastinal lymphadenopathy (including sarcoid-like lesion)
Thymus rebound following chemotherapy
Mastitis, gynaecomastia
Metal implantsLung:
Lepidic adenocarcinoma
Carcinoids
Solitary pulmonary nodules <8 mmAbdomen Stomach, intestine
Liver, spleen
Kidneys, ureter, urinary bladder
BAT: perirenalAdrenocortical hyperplasia
Vascular bypass
Polyp and adenoma
PancreatitisMALT lymphoma
Hepatocellular carcinoma
Renal cell carcinomaBones, joints Skeletal musculature Reactive bone marrow stimulation due to G-CSF
Bone marrow stimulation (anaemia, post-chemotherapy)
Inflammation, infection: arthritis, phlebitis, spondylodiscitis, osteomyelitis
Fibrous dysplasia
Paget disease of the bone
Bone cystRadiation of the bones
Chondrosarcoma
Solitary plasmacytoma of bone
Sclerotic metastasesBAT: brown adipose tissue; PET: positron emission tomography; CT: computed tomography; MALT: mucosa-associated lymphoid tissue; G-CSF: granulocyte colony-stimulating factor. Information from [69, 70].
- TABLE 5
Comparison of prediction models for malignant character of pulmonary nodules identified by chest computed tomography (CT)
Brock model Herder model Mayo Clinic model Patient characteristics Age + + + Sex + Smoking history + + Family history of lung cancer + Emphysema + Previous history of extrathoracic cancer + + Nodule characteristics Size + + + Upper lobe location + + + Type (solid/part-solid/GGO) + Spiculated margins + + + Nodule count + FDG-PET/CT + + GGO: ground-glass opacity; FDG: fluorodeoxyglucose; PET: positron emission tomography.
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- Article
- Abstract
- Shareable abstract
- Epidemiology of lung cancer
- Introduction to the imaging methods in lung cancer diagnostics
- The role of chest radiography in diagnosis and follow-up
- The role of CT in diagnosis and follow-up
- The role of MRI in diagnosis and follow-up
- The role of nuclear medicine in diagnosis and follow-up
- Lung cancer screening
- Pulmonary nodules and their management
- Evaluating complications of treatment in lung cancer
- Radiomics and lung cancer
- Interventional radiology in lung cancer treatment
- Conclusions
- Acknowledgements
- Footnotes
- References
- Figures & Data
- Info & Metrics