Diagnostic Imaging for Thoracic Surgery: A Manual for Surgeons and Radiologists

353 Pages·2018·30.18 MB·English

by  Michele Anzidei

Diagnostic Imaging
for Thoracic Surgery
A Manual for Surgeons
and Radiologists
Michele Anzidei
Marco Anile
Editors
123
Diagnostic Imaging for Thoracic Surgery
Michele Anzidei · Marco Anile
Editors
Diagnostic Imaging
for Thoracic Surgery
A Manual for Surgeons
and Radiologists
Editors
Michele Anzidei Marco Anile
Sapienza Università di Roma Department of Thoracic Surgery
Policlinico Umberto I University of Rome Sapienza
Rome Policlinico Umberto I
Italy Rome
Italy
ISBN 978-3-319-89892-6 ISBN 978-3-319-89893-3 (eBook)
https://doi.org/10.1007/978-3-319-89893-3
Library of Congress Control Number: 2018946700
© Springer International Publishing AG, part of Springer Nature 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, express or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Printed on acid-free paper
This Springer imprint is published by the registered company Springer International Publishing AG
part of Springer Nature
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Foreword
Today, medical imaging is no longer the same as twenty or even ten years
ago. The slice war in CT, the race to higher magnetic fields in MR and the
development of novel contrast agents represent challenges of the past. The
future of medical imaging now lies in artificial intelligence, machine learn-
ing, data mining and automation of diagnosis and interventions. And this is
not a far future, rather the very next present.
To preserve our role in medicine, we will be called to reshape our profes-
sional skills and compensate automation rigidity with human adaptability. In
this scenario, cross-specialty contamination is one of the human strength
points as well as one of the daily challenges in clinical practice: the often
over-animated debate between medical specialists in multidisciplinary teams
represents in most of the cases the key to achieve optimal results for patients
and will never be replaced by any software.
This is the inspiring concept at the very base of Diagnostic Imaging for
Thoracic Surgery, in which the editors and authors aimed at conjoining
shared points of view on non-vascular thoracic diseases with a large amount
of high-quality images and line art, tables and updated guidelines, including
latest 8th TNM for thoracic cancers and updated thoracic imaging
guidelines.
Mostly written by enthusiastic and extremely competent radiologists, the
aim of the book of providing an open and clear view on the role of medical
imaging to thoracic surgeons, oncologists and pulmonologists is clearly and
successfully reached, encouraging informed discussion in the daily clinical
practice. As long as this continues to happen in our hospitals, we will be a
step ahead of any machine.
Rome, Italy Carlo Catalano
Department of Radiology
Sapienza University of Rome
v
Contents
1 Preoperative and Postoperative Chest X-Ray . . . . . . . . . . . . . . . 1
Michele Anzidei, Vincenzo Noce, and Carola Palla
2 Indications to the Use of Computed Tomography in Thoracic
Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Francesco Lavra and Luca Saba
3 PET Hybrid Imaging of the Thorax . . . . . . . . . . . . . . . . . . . . . . . 47
Deena Neriman, Ali Vahedi, Stefan Voo, James Connelly,
and Francesco Fraioli
4 MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Angelo Iannarelli, Stefano Badia, and Marco Rengo
5 Interventional Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Claudio Pusceddu, Francesco Allegra, and Luca Saba
6 Normal Radiologic Anatomy and Anatomical
Variants of the Chest Relevant to Thoracic Surgery . . . . . . . . . . 115
Cheng Ting Lin and Elliot K. Fishman
7 Pulmonary Nodules: Detection and Risk Evaluation . . . . . . . . . 127
Fabrizio Andrani, Roberto Scipione, Andrea Porfiri,
and Michele Anzidei
8 Staging of Non-small Cell Lung Cancer . . . . . . . . . . . . . . . . . . . . 147
Gregor Sommer and Mark N. Wiese
9 Staging of Small-Cell Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . 175
Girish S. Shroff, Neda Kalhor, Reza J. Mehran,
Patricia M. de Groot, and Brett W. Carter
10 Staging of Malignant Pleural Mesothelioma . . . . . . . . . . . . . . . . 189
Patricia M. de Groot, Girish S. Shroff, Carol C. Wu,
David R. Rice, and Brett W. Carter
11 Imaging of Nonneoplastic Lung Diseases Requiring
a Surgical Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
S. Piciucchi and A. Carloni
vii
viii Contents
12 Lung and Airway Surgical Procedures . . . . . . . . . . . . . . . . . . . . . 215
Marco Anile, Sara Mantovani, Massimiliano Bassi,
Carolina Carillo, Daniele Diso, and Federico Venuta
13 Imaging and Staging of Thymic Tumors. . . . . . . . . . . . . . . . . . . . 223
Benjamin Peters, Charlotte De Fré, Annemie Snoeckx,
and Robin Peters
14 Imaging of Non-thymic Anterior Mediastinal Tumors . . . . . . . . 235
Roy A. Raad
15 Mediastinal Non-neoplastic Conditions . . . . . . . . . . . . . . . . . . . . 253
Beatrice Sacconi, Giada Valente, and Mariaelena Occhipinti
16 Imaging and Staging of Esophageal Cancers . . . . . . . . . . . . . . . . 263
Tae Jung Kim
17 Imaging of Nonneoplastic Esophageal Pathologies . . . . . . . . . . . 279
Elena Lucia Indino, Alessandro di Gaeta,
Gianmarco Andreoli, Maurizio Del Monte,
and Valeria Panebianco
18 Diagnostic Imaging of Chest Wall Tumors . . . . . . . . . . . . . . . . . . 295
Ukihide Tateishi, Yusuke Ogihara, Yoshio Kitazume,
Mitsuhiro Kishino, and Bae Hyeyeol
19 Imaging of Nonneoplastic Chest Wall Pathologies . . . . . . . . . . . . 311
Justin Stowell and Santiago Martínez-Jiménez
20 Pulmonary Imaging Findings After Surgery,
Chemotherapy and Radiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . 343
Roberto Scipione, Fabrizio Boni, Renato Argirò,
and Michele Anzidei
1
Preoperative and Postoperative
Chest X-Ray
Michele Anzidei, Vincenzo Noce, and Carola Palla
Abstract Keywords
CXR is a first-line diagnostic tool for many Chest X-Ray · Radiology · Chest imaging ·
clinical scenarios, since it is available in every Thoracic surgery · Cardiac surgery
hospital unit and is cheap in terms of costs and
patients dose. Furthermore, it represents a
wide-ranging point of view for the thoracic
surgeon, allowing either pre-interventional Chest radiograph, or chest X-ray (CXR) in col-
evaluation and post-surgical monitoring. loquial language, is the most frequently per-
Principal indication of chest X-Ray in the formed radiographic examination.
field of thoracic surgery include: CXR is a first-line diagnostic tool for many
clinical scenarios, since it is available in every
– Pre-operative assessment, the utility of which hospital unit and is cheap in terms of costs and
has been validated only for patients that pres- patient dose. Furthermore, it represents a wide-
ent new\unstable cardiopulmonary disease; ranging point of view for the thoracic surgeon,
– Post-operative follow-up, in order to evaluate allowing either pre-interventional evaluation or
surgery complications such as persistent air postsurgical monitoring [1].
leakage, pneumonia, parenchymal atelectasis, This chapter briefly reviews CXR technique
empyema; and addresses the pathological conditions assess-
– Monitoring medical devices (pleural, esopha- able through chest radiograph which are consid-
geal, tracheal etc.) ered of surgical interest.
By knowing specific chest X-Ray semiol-
ogy, the physician is able to interpret the 1.1 Technical Considerations
images obtaining clinical information.
Radiography utilizes electromagnetic high-
frequency X-radiations, generated by a so-called
X-ray tube (or generator) and captured by a pho-
tosensitive film or a digital detector.
High-voltage radiations (120–130 kVp) are
M. Anzidei (*) · V. Noce · C. Palla
Department of Radiological, Oncological and advised to guarantee proper contrast resolution
Anatomopatological Sciences, Sapienza, University and to assure correct visualization of areas with
of Rome, Rome, Italy
complex anatomical structure (e.g., retro-cardiac
e-mail: [email protected]
© Springer International Publishing AG, part of Springer Nature 2018 1
M. Anzidei, M. Anile (eds.), Diagnostic Imaging for Thoracic Surgery,
https://doi.org/10.1007/978-3-319-89893-3_1
2 M. Anzidei et al.
region). Since high kVp significantly increases monitoring; on the other hand, portable CXR has
image noise, filtering devices integrated to X-ray lower diagnostic accuracy. In fact, anteroposte-
generator have been introduced. rior view (AP) holds projective defects, espe-
A chest radiographic exam may possibly com- cially regarding cardiac shape visualization
prehend many projections. (Fig. 1.2).
The classical ones are a posteroanterior view To better realize this issue, remind that cardiac
(PA) and a laterolateral view (LL), both obtained shadow represents a significant part in CXR
in end-inspiratory breath-hold (Fig.  1.1). For image and, if acquired on AP projection, it
optimal reproduction of anatomical proportions, appears considerably magnified covering other
the more suitable distance between source and structures and leading to misinterpretation of car-
object should be at least 180 cm. diac size (false cardiomegaly).
Inpatient radiographs are often performed Furthermore, the absence of LL view makes
bedside with portable X-ray tubes. This technol- accurate localization of lung findings extremely
ogy has significantly increased imaging feasibil- difficult and actually blinds radiologist’s eye to
ity for acutely ill subjects and posttreatment some areas, as posterior pleural recesses.
a b
Fig. 1.1 Standard chest X-Ray PA (a) and LL (b) projections
a b c
Fig. 1.2 Chest X-Ray projections: PA (a), LL (b) and AP (c)
1 Preoperative and Postoperative Chest X-Ray 3
a b
Fig. 1.3 Technical adequacy of CXR: uncorrect (a) and correct (b) image acquisition, with optimal visualization of
bony structures, thoracic vessels and lung apices
As general principle, in routine imaging a 1.2 Lung Cancer Detection
double-view standard chest X-ray should always
be preferred to a AP single-view exam. Portable Lung cancer is one of the leading causes of
radiographs are of basic importance in emer- mortality in the world and its early diagnosis
gency and intensive care units, but in post-s urgery has demonstrated to relate with better progno-
patients a standard exam should be performed as sis; in light of this, screening programs of pop-
possible. ulation at risk (heavy smokers) have been
Some dedicated projections comprehend: proposed by CXR and computed tomography
(CT) imaging.
– “Expiratory view” (Fig. 1.3), acquired in end- Chest radiograph has poor sensitivity on
expiratory breath-hold to better evaluate the lung nodule detection (54%) despite its low
presence of pneumothorax. cost and wide availability; on the other hand,
– “Apical view,” with superoinferior direction volumetric CT, even with low-dose acquisi-
of X-radiation to show more clearly apical tion, encountered significantly higher sensitiv-
areas. ity but still no evidence has pointed towards
– “Oblique view,” with 45° rotation of the reduction of mortality for the populations
patient between X-ray beam and cassette, use- screened by CT.
ful for sternum and rib evaluation. In modern practice, a negative CXR alone
should not be interpreted as absence of neo-
Technical adequacy of CXR exams is assessed, plastic disease to lungs. In fact, pulmonary
apart from a complete inclusion of the rib cage in cancer detection on radiographs depends on
the radiogram, by evaluation of X-ray’s effective some factors: lesion size, tumor localization,
penetration across the thoracic structures (bony and density and secondary parenchymal
structures and pulmonary vessels are used as ref- changes.
erences), patient’s rotation (clavicle heads should The most challenging presentation of lung
be equidistant to vertebral bodies), and inspira- cancer in chest X-ray is as solitary nodule, the
tion (8th–10th posterior costal arches should be detection of which is deeply related to lesion
seen). location and volume. The main perceptive