Author of

• 12791

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  P3.19 - Poster Session 3 - Imaging (ID 181)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Imaging, Staging & Screening
  • Presentations: 2
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

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    P3.19-006 - Pseudopathologic Vertebral Body Enhancement in the Presence of Superior Vena Cava Obstruction on Computed Tomography (ID 1519)

    09:30 - 09:30  |  Author(s): Y.K. Kim
    • Abstract

    Background
    Superior vena cava (SVC) obstruction can cause development of collateral vessels. During contrast-enhanced thoracic CT, contrast material may reflux into the collaterals such as paravertebral venous plexus. However, unusual pseudopathologic vertebral body enhancement on CT in the presence of SVC obstruction has not been studied previously. So, the aim of this study was to demonstrate clinical presentation and imaging findings of pseudopathologic vertebral body enhancement in patients with SVC obstruction.

    Methods
    From March 2009 to September 2012, a retrospective radiologic database review was performed to identify patients with obstruction of SVC causing contrast reflux into collateral vessels and presented with unusual vertebral body enhancement on thoracic CT. Thirteen patients (eleven men, mean age 51.4 years) with vertebral body enhancement were enrolled. The underlying diseases that caused SVC obstruction were adenocarcinoma of the lung in four, non-small cell lung cancer in two, large cell neuroendocrine carcinoma, small cell lung cancer, thymic carcinoma, sarcomatoid carcinoma, diffuse large B-cell lymphoma, Hodgkin’s lymphoma and metastatic lymphadenopathy from pancreatic cancer in one patient each. Enhancement patterns, locations and the presence of a connection between vertebral body enhancement and the paravertebral venous plexus were evaluated. Enhancement patterns of vertebral bodies were classified as nodular enhancement with round shape that occupying < 1/3 of vertebral body or polygonal enhancement that occupying ≥ 1/3 of vertebral body on axial image. The locations of enhanced areas within vertebral bodies were described using right lateral/central/left lateral, anterior/posterior, and upper/middle/lower in the x-, y-, or z-axis directions, respectively.

    Results
    A total of 39 vertebral body enhancements were found in the 13 patients, involving cervical (n = 12), thoracic (n = 25), or lumbar (n = 2) vertebrae. Vertebral body enhancements showed a nodular (n = 19) or a polygonal (n = 20) pattern. The central portions of vertebral bodies were more frequently involved. The connection to the paravertebral venous plexus was observed in 34 lesions (87.2%).

    Conclusion
    Patients with SVC obstruction with extensive collateral vessels might exhibit a pseudopathologic vertebral enhancement. They tended to involve the central portion of the vertebral body and most of them showed connection to the paravertebral venous plexus.

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    P3.19-007 - Reliability Analysis of Visual Ranking of Coronary Artery Calcification on Low-Dose CT of the Thorax for Lung Cancer Screening: Comparison with ECG-gated Calcium Scoring CT (ID 2244)

    09:30 - 09:30  |  Author(s): Y.K. Kim
    • Abstract

    Background
    Coronary artery calcification (CAC) is frequently detected on low-dose CT of the thorax (LDCT). Concurrent assessment of CAC and lung cancer screening using LDCT is beneficial in terms of cost and radiation dose reduction. The aim of our study was to evaluate the reliability of visual ranking of CAC on LDCT compared to Agatston score on ECG-gated calcium scoring CT.

    Methods
    The subjects were 576 patients who were consecutively registered for health screening and undergoing both LDCT and ECG-gated calcium scoring CT. We excluded subjects with a calcium score of zero. The final study cohort included 117 patients with CAC (97 men; mean age, 53.4±8.5). Agatston score on ECG-gated calcium scoring CT was used as the gold standard (mean score, 166.0; range, 0.4-3719.3). Two board-certified radiologists and two radiology residents participated in an observer performance study. Visual ranking of CAC was performed according to four categories (1-10, 11-100, 101-400, and 401 or higher) for coronary artery disease (CAD) risk stratification. Weighted kappa statistics was used to measure the degree of reliability on visual ranking of CAC on LDCT: kappa values between 0 and 0.40 were considered to indicate positive but poor agreement; between 0.40 and 0.75, good agreement; greater than 0.75, excellent agreement.

    Results
    The degree of reliability on visual ranking of CAC on LDCT compared to ECG-gated calcium scoring CT was excellent for board-certified radiologists and good for radiology residents. A high degree of association was observed with 71.6% of visual rankings in exactly the same category as the Agatston category and 98.9% varying by no more than one category.

    Conclusion
    Visual ranking of CAC on LDCT is reliable for prediction of categorization of Agatston score ranks. LDCT is useful for both CAD risk stratification and lung cancer screening.