Chest Radiology

308 Pages·2016·1.44 MB·English

Chest Radiology
CH001-EB-X
How Do You Make Sure the Pulmonary Lesion is Calcified? Digital Tomosynthesis Can Help Your Diagnosis of
Calcified Pulmonary Lesions for No Further Work-up
All Day Room: CH Community, Learning Center
FDA Discussions may include off-label uses.
Participants
Ji Yung Choo, MD, PhD, Ansan, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Ki Yeol Lee, MD, PhD, Ansan , Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Eun Sil Kim, Ansan-Si, Korea, Republic Of (Presenter) Nothing to Disclose
Eun-Young Kang, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Yu-Whan Oh, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. To understand the technical concept of low dose digital tomosynthesis of the chest and its implementation
2. To understand which type of calcified lesion can be evaluated under digital tomosynthesis
3. To recognize the limitations and benefits of digital tomosynthesis of the chest in radiation exposure and image acquisition
TABLE OF CONTENTS/OUTLINE
Our exhibit will be divided into 6 sections and presented with illustration and relevant cases regarding usefulness of tomosynthesis
in evaluation of calcified and non-calcified pulmonary lesions: 1. Background and physics of digital tomosynthesis of the chest 2.
Comparison of calcified and non-calcified thoracic lesion 1) Calcified vs non-calcifie nodules 2) Calcified pleural lesion 3)
Vascular calcification 4) Airway calcification 5) Other high contrast pulmonary lesions3. Detectable calcification on CXR and
DTS - Density (Hounsfield unit), size, location4. Needs of follow-up or further work-up5. Other high contrast pulmonary lesions6.
Benefits and limitation of tomosynthesis of the chest 1) Radiation exposure 2) Image acquisition 3) Image quality
CH002-EB-X
Comprehensive Review of Congenital Proximal Interruption of the Pulmonary Arteries
All Day Room: CH Community, Learning Center
Participants
Chad Cox, MD , Riverview, FL (Presenter) Nothing to Disclose
Jonathan H. Chung, MD, Chicago, IL (Abstract Co-Author) Royalties, Reed Elsevier; Consultant, F. Hoffmann-La Roche Ltd;
Consultant, Boehringer Ingelheim GmbH; Consultant, Veracyte, Inc
John Donatelli, MD, Tampa, FL (Abstract Co-Author) Nothing to Disclose
Summer J. Decker, PhD, Tampa, FL (Abstract Co-Author) Nothing to Disclose
Jonathan M. Ford, PhD, Tampa, FL (Abstract Co-Author) Nothing to Disclose
Carlos Andres Rojas, MD, Tampa, FL (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1. Learn the embryological development of the pulmonary arterial system.2. Understand the clinical presentation, implications, and
associations of proximal pulmonary arterial interruption.3. Be able to recognize the key radiologic findings that occur in the setting
of proximal pulmonary arterial interruption. 4. Be able to list the differential diagnosis and distinguishing imaging features between
proximal interruption of pulmonary arteries and other mimics that impair pulmonary arterial blood supply.
TABLE OF CONTENTS/OUTLINE
1. Embryological development of pulmonary arteries.2. A complete review of congenital pulmonary arterial interruption including
etiology, demographics, inheritance patterns, clinical history and presentation, treatment, differential considerations, and
prognosis.3. Comprehensive review of imaging findings through ten different cases of proximal interruption of the pulmonary
arteries. This will be thoroughly demonstrated using multiple different imaging modalities including chest radiograph,
ventilation/perfusion imaging, CT, CTA, MRA, and conventional angiography. 4. Discussion of acquired etiologies of proximal arterial
interruption with a review of key radiologic findings in multiple cases including pulmonary artery sarcoma and fibrosing mediastinitis.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Jonathan H. Chung, MD - 2013 Honored Educator
CH003-EB-X
Parametric Response Mapping-Clinical Applications of a Novel Imaging Biomarker in Pulmonary Disease
All Day Room: CH Community, Learning Center
Participants
Dharshan R. Vummidi, MRCP, FRCR, Ann Arbor, MI (Presenter) Nothing to Disclose
Craig J. Galban, PhD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Meilan K. Han, Ann Arbor, MI (Abstract Co-Author) Consultant, Boehringer Ingelheim GmbH; Consultant, GlaxoSmithKline plc;
Consultant, Novartis AG; Consultant, AstraZeneca PLC; Royalties, UpToDate, Inc
Brian D. Ross, PhD, Ann Arbor, MI (Abstract Co-Author) Co-founder, ImBio, LLC Shareholder, ImBio, LLC Advisor, ImBio, LLC
Greg Yanik, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Vibha Lama, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Ella A. Kazerooni, MD, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
Parametric response mapping is a novel imaging biomarker that allows for the accurate characterization and quantification of the
COPD spectrum and more recently bronchiolitis obliterans syndrome in stem cell and lung transplantation.
TABLE OF CONTENTS/OUTLINE
Parametric response mapping (PRM) is a quantitative imaging biomarker used for the assessment of obstructive lung disease. It is a
post processing technique consisting of linking inspiratory and expiratory CT lung scans to provide a classification of individual
voxels of lung parenchyma as normal, functional small airways disease (fSAD), and emphysema.Current clinical and imaging
biomarkers cannot accurately phenotype chronic obstructive pulmonary disease (COPD) into airway predominant, parenchymal
predominant or mixed. PRM allows for characterization and quantification of obstructive pulmonary disease from any volumetric
inspiratory/expiratory HRCT acquisition without any additional radiation exposure.On the provided color maps, green - normal lung,
yellow - functional small airways disease, red - emphysema.Emerging applications of PRM are in recognizing bronchiolitis obliterans
syndrome (BOS) in the context of hematopoietic stem cell transplant (HSCT) and lung transplantation earlier than afforded by the
current clinical criteria and thereby influencing management.
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Ella A. Kazerooni, MD - 2014 Honored Educator
CH004-EB-X
The Imaging Spectrum and Longitudinal Changes of Pulmonary Artery Sarcoma (PAS) Masquerading
Pulmonary Thromboembolism (PTE): The Multimodality Imaging Access
All Day Room: CH Community, Learning Center
Awards
Certificate of Merit
Participants
Cherry Kim, MD, Seoul, Korea, Republic Of (Presenter) Nothing to Disclose
Mi Young Kim, MD, PhD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
Joon-Won Kang, MD, Seoul, Korea, Republic Of (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
To update the specific signs and imaging spectrum of PAS in multimodal imaging including CT, MR and PET-CT, and to show the
correlated gross pathologic specimens. To demonstrate the early imaging findings of PAS causing delayed diagnosis, and its
longitudinal changes in the imaging including final outcome after treatment. To review and suggest the diagnostic tips of PAS in the
imaging.
TABLE OF CONTENTS/OUTLINE
1. The specific signs and imaging spectrum of PAS in CT, MR and PET-CT and the correlation with the gross pathology findings
1)Wall elipse sign
2)The pattern of tumor extension
3)Tumor heterogeneity with enhancement pattern
4)Nodularity and lobulation of the tumor (inner & outer wall undulation)
5)The adventitial enhancement of PA
6)The angle between PA wall and the tumor
7)Multiplicity or intravascular metastasis
8)Tumor vessel sign
9)Ancillary finding of lungs
10)Maximum standardized uptake value of fluorine 18-FDG
2. PAS masquerading PTE, causing delayed diagnosis: the early findings and its longitudinal changes
1)The early findings, mimicking PTE
2)Longitudinal change on follow up on imaging including final outcome after the latest treatment.
3. When the radiologists need to consider PAS preferentially than PTE?
- We suggest diagnostic criteria, taking into account of clinical and radiologic manifestations for early recognition.
CH006-EB-X
Dual Energy CT (DECT) of the Chest: Salient Contributions beyond the Lungs
All Day Room: CH Community, Learning Center
Participants
Alexi Otrakji, MD, Boston, MA (Presenter) Nothing to Disclose
Subba R. Digumarthy, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Shaunagh McDermott, FFR(RCSI), Boston, MA (Abstract Co-Author) Nothing to Disclose
Efren J. Flores, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Mannudeep K. Kalra, MD, Boston, MA (Abstract Co-Author) Technical support, Siemens AG; Technical support, Medical Vision
Jo-Anne O. Shepard, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Rodrigo Canellas, MD, Cambridge, MA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
DECT is being increasingly applied for evaluation of thoracic abnormalities beyond pulmonary vasculature. Ancillary nonpulmonary
findings can often be seen on different image types generated from DECT datasets including virtual monoenergetic and material
decomposition (virtual non-contrast (VNC) and iodine (water subtracted)) images. VNC images can help differentiate between
vascular and calcified lesions in the mediastinun and chest wall. Iodine distribution and iodine concentration (mg/cc) help assess
the vascularity of the lesions on iodine images. The purpose of this exhibit is to highlight appearance of non-pulmonary ancillary
lesions in 15000+ DECT examinations of the chest performed in the past three years at our institution.
TABLE OF CONTENTS/OUTLINE
The exhibit employs a case based format to display appearance of various non-pulmonary ancillary findings seen on DECT of the
chest including: Cardiac abnormalities on chest DECT: thrombus, pericardial abnormalities, cardiac calcification. Mediastinal
abnormalities: Mediastinal lesions including thymic lesions and lymph nodes Thyroid abnormalities: Calcifications, nodules Pleural
abnormalities: Pleural nodules versus talc pleurodesis, empyema Chest wall abnormalities: including tumors, abscess, psudoaneurysm
Cutaneous lesions: Melanoma metastases and cysts Breast implants and lesions
Honored Educators
Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying
educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality
educational content in their field of study. Learn how you can become an honored educator by visiting the website at:
https://www.rsna.org/Honored-Educator-Award/
Subba R. Digumarthy, MD - 2013 Honored Educator
CH007-EB-X
Endobronchial Lesions: Detection, Causes and Management
All Day Room: CH Community, Learning Center
Awards
Identified for RadioGraphics
Participants
Marie-Michele Theriault, MD, Sherbrooke, QC (Presenter) Nothing to Disclose
Joy N. Borgaonkar, MD, FRCPC, Halifax, NS (Abstract Co-Author) Nothing to Disclose
Judith L. Babar, MBChB, Cambridge, United Kingdom (Abstract Co-Author) Nothing to Disclose
Robert M. Miller, MD, Halifax, NS (Abstract Co-Author) Nothing to Disclose
Daria Manos, MD, FRCPC, Halifax, NS (Abstract Co-Author) Speakers Bureau, F. Hoffmann-La Roche Ltd
TEACHING POINTS
The bronchial tree can be challenging to evaluate with CT; small endobronchial lesions can be easily missed and diffuse wall
thickening may be easily overlooked. An isolated mucus plug or a persisting small band of atelectasis may be the first manifestation
of an endobronchial malignancy. Several other ancillary CT findings, including the double artery sign, the finger-in-glove sign and
post-obstructive bronchiectasis, may improve detection of endobronchial lesions. The differential diagnosis of central bronchial tree
lesions include focal abnormalities such as debris and tumors, as well as diffuse abnormalities, which usually result from
inflammatory, infectious or infiltrative processes.
TABLE OF CONTENTS/OUTLINE
Anatomy and function of the bronchial tree. Pitfalls in the diagnosis of early endobronchial lesions. Review of ancillary CT signs that
may improve detection and characterization of endobronchial lesions. Pattern-based approach to the differential diagnosis of
endobronchial lesion with case examples. Appropriate management of endobronchial abnormalities.
CH008-EB-X
When Chest CT Falls Short, Thoracic MR Stands Tall
All Day Room: CH Community, Learning Center
Participants
Dania Daye, MD, PhD, Boston, MA (Presenter) Nothing to Disclose
Melissa Price, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Shaunagh McDermott, FFR(RCSI), Boston, MA (Abstract Co-Author) Nothing to Disclose
Jo-Anne O. Shepard, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
Jeanne B. Ackman, MD, Boston, MA (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
When lesions on chest CT are indeterminate, MR can serve a complementary role. Its higher soft tissue contrast can more
definitively characterize tissue, often yielding a more specific diagnosis. Despite the advantages thoracic MR offers, it remains
underutilized. The aims of this exhibit are to: Define the limitations of chest CT and review the advantages of thoracic MRI in the
characterization of mediastinal, pleural, and pulmonary lesions Illustrate, using a case-based approach, different scenarios in which
thoracic MRI can be instrumental in making a specific diagnosis.
TABLE OF CONTENTS/OUTLINE
Illustrative cases will be presented in quiz format to demonstrate how MR can supplement incomplete information provided by CT
regarding thoracic lesions, narrowing the differential diagnosis and changing clinical management. For each case, CT and MR
images will be provided, followed by a differential diagnosis and a final pathologic diagnosis, when applicable. The list of cases
will include: Thymic Cyst Thymic Hyperplasia Foregut Duplication Cyst Mediastinal Hemangioma Esophageal Leiomyoma Chronic
Mediastinal Fibrosis Mesothelioma Solitary Fibrous Tumor of the Pleura Pulmonary Hamartoma Pulmonary Hematoma or Abscess
CH009-EB-X
What's Up There? Differential Diagnosis of Apical Tumors in the Thoracic Cavity, Beyond Pancoast Tumor
All Day Room: CH Community, Learning Center
Participants
Philip C. Louden, MD, Charlottesville, VA (Presenter) Nothing to Disclose
Lucia Flors, MD, Charlottesville, VA (Abstract Co-Author) Nothing to Disclose
Juliana M. Bueno, MD, Chicago, IL (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
The anatomy of the thoracic inlet is complex. Multiple structures localized in the thoracic inlet may give rise to various lesions that
manifest as apical tumors. Lesions in this location may originate from the pulmonary superior sulcus or adjacent vascular, neural,
osseous and muscular structures. Moreover, lesions from midline structures in the thoracic inlet, such as the thyroid, can extend
laterally and manifest as apical tumors. The primary lung cancer that presents in this location is known as Pancoast tumor. Other
entities may present in this region although characteristic imaging findings allow differentiation. After reviewing this exhibit the
learner will be able to: Identify the anatomic compartments of the thoracic inlet. List the spectrum of lesions localized in the
thoracic inlet and their various origins, which include: peripheral nerve sheath tumors, desmoid tumor, thoracic duct cyst,
aneurysms of the supraaortic branches, extrapleural lipoma, plasmocytoma and thyroid lesions. Recognize the role of cross
sectional imaging (CT and MRI) in the characterization of lesions in this location. Identify unique imaging characteristics that allow
differentiation.
TABLE OF CONTENTS/OUTLINE
Anatomy of the thoracic inlet (superior sulcus) Case-based review of common lesions in this location and their imaging
characteristics Conclusions
CH010-EB-X
Imaging of the Cardiothoracic Manifestations of Vasculitis: Pearls and Pitfalls
All Day Room: CH Community, Learning Center
Participants
Zeeshaan S. Bhatti, MD, Ann Arbor, MI (Presenter) Nothing to Disclose
Dharshan R. Vummidi, MRCP, FRCR, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
Ora Singer, MD, MS, Ann Arbor, MI (Abstract Co-Author) Nothing to Disclose
TEACHING POINTS
1.) To review the revised Chapel Hill Consensus classification of vasculitis. 2.) To discuss the clinical and imaging manifestation of
the most common vasculitides, with emphasis on cardiothoracic involvement.3.) To highlight pearls and pitfalls in the radiologic
diagnosis of vasculitides with illustrative examples.4.) To propose a diagnostic algorithm, integrating imaging features with clinical
history, laboratory data, and histopathology.

TABLE OF CONTENTS/OUTLINE
1.) Chapel Hill Classification of Vasculitis: Large vessel Medium vessel Small vessel2.) Large Vessel Vasculitis: Takayasu’s disease
Giant cell arteritis3.) Medium Vessel Vasculitis: Polyarteritis nodosa Behcet’s disease4.) Small Vessel Vasulitis: Granulomatous
polyangitis Eosinophilic granulomatous polyangitis Microscopic polyangitis5.) Pitfalls: Vasculitis mimickers6.) Diagnostic Algorithm