Showing papers by "Nestor L. Müller published in 1997"

Pulmonary embolism: prospective comparison of spiral CT with ventilation-perfusion scintigraphy.

Abstract: PURPOSE: To compare prospectively the accuracy of spiral computed tomography (CT) with that of ventilation-perfusion scintigraphy for diagnosing pulmonary embolism. MATERIALS AND METHODS: Within 48 hours of presentation, 142 patients suspected of having pulmonary embolism underwent spiral CT, scintigraphy, and (when indicated) pulmonary angiography. Pulmonary angiography was attempted if interpretations of spiral CT scans and of scintigrams were discordant or indeterminate and intermediate-probability, respectively. RESULTS: In the 139 patients who completed the study, interpretations of spiral CT scans and of scintigrams were concordant in 103 patients (29 with embolism, 74 without). In 20 patients, intermediate-probability scintigrams were interpreted (six with embolism at angiography, 14 without); diagnosis with spiral CT was correct in 16. Interpretations of spiral CT scans and those of scintigrams were discordant in 12 cases; diagnosis with spiral CT was correct in 11 cases and that with scintigraphy...

Pulmonary complications after bone marrow transplantation: high-resolution CT and pathologic findings.

Abstract: A wide variety of pulmonary complications occur in bone marrow transplant (BMT) recipients and are a major cause of morbidity and death. High-resolution computed tomography (CT) is excellent in the detection of pulmonary abnormalities, but these findings are generally nonspecific. However, the different complications, which reflect the immunologic status of the patients, occur in three phases. This pattern can be used to interpret CT scans. The neutropenic phase (up to 3 weeks after BMT) is characterized by fungal infections, notably angioinvasive aspergillosis, alveolar hemorrhage, pulmonary edema, and drug reactions. At CT, angioinvasive aspergillosis appears as a nodule surrounded by a halo of ground-glass attenuation; alveolar hemorrhage and drug reactions, as bilateral areas of ground-glass attenuation or consolidation; and pulmonary edema, as prominent pulmonary vessels, interlobar septal thickening, ground-glass attenuation, and pleural effusions. The second phase (3 weeks to 100 days after BMT) is...

Airway obstruction in asthmatic and healthy individuals: inspiratory and expiratory thin-section CT findings.

Abstract: PURPOSE: To determine differences in computed tomographic (CT) findings in asthmatic and healthy individuals and to correlate the findings with severity of airway obstruction. MATERIALS AND METHODS: Thirty-nine asthmatic patients and 14 healthy subjects were prospectively evaluated with thin-section CT. Inspiratory CT scans were subjectively evaluated for presence of bronchial wall thickening, bronchial dilatation, and mosaic lung attenuation; expiratory scans were subjectively evaluated for presence of air trapping. Objective measurement of bronchoarterial-diameter ratio was performed on inspiratory scans. CT findings were compared with pulmonary function test results. RESULTS: Bronchial wall thickening, severe air trapping, and reduced bronchoarterial-diameter ratio were observed more commonly in asthmatic patients than in healthy subjects. Bronchial wall thickening was more prevalent among patients with severe airflow obstruction (10 of 12 readings [83%]) than in patients with normal airflow (15 of 40 ...

Mosaic attenuation pattern on thin-section CT scans of the lung: differentiation among infiltrative lung, airway, and vascular diseases as a cause.

Abstract: PURPOSE: To determine whether infiltrative lung, airway, or vascular disease can be differentiated as the cause of mosaic attenuation on thin-section computed tomographic (CT) scans of the lung. MATERIALS AND METHODS: Thin-section CT scans were reviewed in 70 patients examined at three institutions. A mosaic attenuation pattern and pathologic or clinical proof of a specific type of disease were demonstrated. Causes of the mosaic pattern included infiltrative lung disease (n = 37), airway disease (n = 22), and vascular disease (n = 11). Thin-section CT findings were assessed independently by two observers blinded to clinical findings. RESULTS: The type of disease was identified correctly at CT in 58 (83%) of 70 patients by observer 1 and 57 (81%) of 70 patients by observer 2. Infiltrative lung disease was diagnosed correctly by both observers in 34 (92%) of 37 cases. Observer 1 identified 21 (95%) of 22 cases of airway disease and three (27%) of 11 cases of vascular disease. Observer 2 identified 19 (86%) ...

Bronchiolitis obliterans after lung transplantation: high-resolution CT findings in 15 patients.

Abstract: The purpose of this study was to compare the high-resolution CT findings in patients with pathologically proven bronchiolitis obliterans after lung transplantation with high-resolution CT findings in control subjects.High-resolution CT examinations of 15 patients with pathologically proven bronchiolitis obliterans after lung transplantation and 18 control subjects were retrospectively evaluated by two independent observers who were unaware of the diagnosis in each case. All 33 subjects underwent inspiratory high-resolution CT. Five patients with bronchiolitis obliterans and 16 control subjects underwent expiratory CT.Findings in patients with bronchiolitis obliterans included bronchial dilatation in 80%, mosaic perfusion in 40%, bronchial wall thickening in 27%, and air trapping in 80%, compared with the control subjects with bronchial dilatation in 22%, mosaic perfusion in 22%, and air trapping in 6%. The combination of bronchial dilatation on the inspiratory CT scan and air trapping on the expiratory CT...

Cigarette smoking: CT and pathologic findings of associated pulmonary diseases.

Abstract: The health risks associated with cigarette smoking are well known. Cigarette smoking is the most important causative factor in the development of bronchogenic carcinoma. Pulmonary diseases such as chronic bronchitis, centrilobular and panacinar emphysema, respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), and pulmonary Langerhans cell histiocytosis are also related to cigarette smoking. In adenocarcinoma and squamous cell carcinoma, the most common manifestation at computed tomography (CT) is a solitary pulmonary nodule; in small cell carcinoma, hilar and mediastinal adenopathy secondary to metastases; and in large cell carcinoma, a mass with central necrosis or cavitation in the lung periphery. For chronic bronchitis, the most common CT finding is bronchial wall thickening, but this finding is nonspecific. Emphysema, both centrilobular and panacinar associated with alpha-1-antitrypsin deficiency, usually manifests as areas of decreased attenuation and may involve bullous changes. Ho...

Cylindrical bronchiectasis: diagnostic findings on thin-section CT.

Abstract: The aim of this study was to determine the frequency of diagnostic findings of bronchiectasis on thin-section CT and the usefulness of those findings in distinguishing patients with cylindrical bronchiectasis from healthy subjects.The study was retrospective and included 26 healthy adults, 10 consecutive patients with surgically proven cylindrical bronchiectasis, and 49 patients who had been prospectively diagnosed at three institutions as having cylindrical bronchiectasis. All patients had 1.0- to 1.5-mm-collimation CT scans obtained at 10-mm intervals through the chest. The CT scans were independently reviewed in random order by two chest radiologists.Findings in patients with bronchiectasis that were not seen by either observer in any of the healthy subjects included visualization of a bronchus within 1 cm of the costal pleura and visualization of a bronchus abutting the mediastinal pleura. The two observers saw these findings on 96 (81%) and 63 (53%) of 118 CT scans in the 59 patients with bronchiecta...

Bronchoarterial ratio on thin section CT: comparison between high altitude and sea level.

Abstract: PURPOSE Our goal was to measure normal bronchial to accompanying pulmonary arterial diameter ratios and normal bronchial wall thickness on thin section CT at high altitude and at sea level. METHOD Seventeen normal, healthy, nonsmoking subjects living at 1,600 m altitude and 16 living at sea level underwent thin section CT (1.5 to 2.0 mm collimation). All images were photographed at window levels of -450 and -700 HU and window width of 1,500-1,600 HU. Internal diameters of the segmental and subsegmental bronchi were measured and compared with the diameter of the adjacent pulmonary artery. Bronchial wall thickness of each bronchus was measured. Only bronchi and arteries seen in cross section and within 1 mm from each other were included in the analysis. RESULTS Four hundred sixty-seven bronchi (215 at high altitude, 252 at sea level) were assessed. At window level of -450 HU, the bronchoarterial ratio was 0.76 +/- 0.14 (mean +/- SD) at altitude and 0.62 +/- 0.13 at sea level (p < 0.001). Bronchial wall thickness measured 0.92 +/- 0.09 mm (mean +/- SD) at altitude and 1.12 +/- 0.19 mm at sea level (p < 0.001). At window level of -700 HU, there was an artifactual decrease in the bronchoarterial diameter ratios and an increase in bronchial wall thickness. CONCLUSION Bronchoarterial ratio increases and bronchial wall thickness decreases with altitude. These findings are presumably related to hypoxic bronchodilatation and vasoconstriction.

Bronchiolitis obliterans due to neuroendocrine hyperplasia: high-resolution CT--pathologic correlation.

Abstract: Maura J. Brown1, John English2, Nestor L MUller1 F oci of neuroendocrine cell hyperplasia have been described in the lungs of patients who have a vanety of underlying diseases, including bronchiectasis, interstitial fibrosis, and pulmonary artery hypertension [I]. In these patients the neuroendocrine hyperplasia is presumably associated with the preexisting lung disease [2J. Recently. Aguayo et al. [31 reported the clinical and pathologic findings in six patients with neuroendocrine cell hyperplasia associated with symptomatic airflow obstruction due to bronchiolitis obliterans. These patients had no other underlying diseases and were nonsmokers. The authors postulated that the neuroendocrine cell hyperplasia preceded and presumably caused the airway fibrosis. We report the high-resolution CT and his-

High-resolution CT of pediatric lung disease: imaging findings.

Abstract: The HRCT findings of diseases of the pulmonary parenchyma and airways in children are often similar to those seen in adults. However, some conditions, particularly IPF, pulmonary fibrosis associated with scleroderma, and Langerhans histiocytosis, may have different presentations and a more rapid progression in children than in adults. HRCT may be helpful for assessing patients with suspected diseases of the pulmonary parenchyma or airways, particularly when radiographic findings are normal or nonspecific.

Pulmonary nodules: differential diagnosis using 18F-fluorodeoxyglucose single-photon emission computed tomography.

Abstract: The objective of this study was to prospectively evaluate the feasibility and efficacy of single-photon emission computed tomography (SPECT) with 18F-fluorodeoxyglucose (FDG) for differentiating malignant from benign pulmonary nodules.Twenty-six patients with 28 radiologically indeterminate focal pulmonary lesions were examined. Fasting patients were injected with 5 MBq/kg of FDG (maximum dose, 370 MBq). Imaging was performed with dual-head SPECT cameras equipped with 511-keV collimators.Seventeen of 21 pathologically malignant nodules showed FDG uptake on SPECT imaging (sensitivity, 81%). None of the seven benign modules showed uptake (specificity, 100%). SPECT imaging with FDG was positive in all 16 malignant nodules that were larger than or equal to 2 cm in diameter. However, only one (20%) of five nodules smaller than 2 cm in diameter showed positive on SPECT imaging.Using current technology, we found FDG SPECT imaging useful for distinguishing benign from malignant pulmonary nodules that were larger ...