Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Feb 2014
ReviewPET-CT: Current Applications and New Developments in the Thorax.
Positron emission tomography computed tomography(PET-CT) imaging has emerged as an essential clinical diagnostic tool in the evaluation of thoracic abnormalities. Currently, its primary role is for tumor imaging; it helps to differentiate benign from malignant nodules, stage tumors, determine response, and follow patients after therapy is complete. It has also been used for nononcologic diseases, but the indications are less well defined. PET is a fundamental component of the molecular imaging initiative, and as new more specific imaging probes and better instrumentation are developed, PET-CT is certain to improve diagnostic accuracy and become even more integrated into the imaging armamentarium.
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Semin Respir Crit Care Med · Feb 2014
ReviewHigh-Resolution CT of Interstitial Lung Disease: A Continuous Evolution.
Before the advent of high-resolution computed tomography (HRCT), the role of imaging, chest radiography in particular, in the management of patients with interstitial lung disease was limited. In the past 25 years, this has radically changed. HRCT has transformed the diagnostic landscape by providing detailed cross-sectional imaging of the lungs, which permit ready identification of a variety of different interstitial lung diseases. ⋯ Recently, HRCT data have been integrated with pulmonary function in staging models to predict prognosis particularly in idiopathic fibrosing lung disease. This article reviews these stages of evolution. The emergence of the multidisciplinary approach to diagnosis will also be considered.
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Computed tomography (CT) is the core imaging modality for the evaluation of thoracic disorders. With the recently developed dual-energy CT (DECT) technique, the clinical utility of CT in the management of pulmonary diseases can be expanded. The most actively investigated principle of dual energy is material decomposition based on attenuation differences at different energy levels. ⋯ The second major possibility offered by DECT is virtual monochromatic imaging that represents a new option for standard chest CT in daily routine. In this review, imaging principles and clinical applications of dual-energy thoracic CT are described. Knowledge of the applications of DECT may lead to wider use of this technique in the field of respiratory disorders.
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Lung cancer is the leading cause of cancer death worldwide and accounts for more deaths than breast, prostate, colon, and pancreatic cancers combined. A distinct minority (15%) of lung cancers are diagnosed at an early stage; 5-year survival (all lung cancers) approximates 15%. Randomized, controlled trials in the 1960s and 1970s found that chest radiographic screening did not confer a survival benefit for high-risk patients. ⋯ Who should be screened and how often? What is the appropriate workup when lesions are noted in asymptomatic individuals? What is the risk of cumulative radiation exposure from repetitive low-dose CT scans? What is the responsibility of health care personnel to evaluate nonpulmonary issues detected by CT (e.g., coronary calcifications). In this review, we address these and other questions that arise. Further, implementation of screening programs may be logistically difficult, require additional personnel and computer software, and will incur significant health care costs.