Ultrafast 3D balanced steady‐state free precession MRI of the lung: Assessment of anatomic details in comparison to low‐dose CT
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To evaluate the anatomical details offered by a new single breath-hold ultrafast 3D balanced steady-state free precession (uf-bSSFP) sequence in comparison to low-dose chest computed tomography (CT).This was an Institutional Review Board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant prospective study. A total of 20 consecutive patients enrolled in a lung cancer screening trial underwent same-day low-dose chest CT and 1.5T MRI. The presence of pulmonary nodules and anatomical details on 1.9 mm isotropic uf-bSSFP images was compared to 2 mm lung window reconstructions by two readers. The number of branching points on six predefined pulmonary arteries and the distance between the most peripheral visible vessel segment to the pleural surface on thin slices and 50 mm maximum intensity projections (MIP) were assessed. Image quality and sharpness of the pulmonary vasculature were rated on a 5-point scale.The uf-bSSFP detection rate of pulmonary nodules (32 nodules visible on CT and MRI, median diameter 3.9 mm) was 45.5% with 21 false-positive findings (pooled data of both readers). Uf-bSSFP detected 71.2% of branching points visible on CT data. The mean distance between peripheral vasculature and pleural surface was 13.0 ± 4.2 mm (MRI) versus 8.5 ± 3.3 mm (CT) on thin slices and 8.6 ± 3.9 mm (MRI) versus 4.6 ± 2.5 mm (CT) on MIPs. Median image quality and sharpness were rated 4 each.Although CT is superior to MRI, uf-bSSFP imaging provides good anatomical details with sufficient image quality and sharpness obtainable in a single breath-hold covering the entire chest.Lung cancer is still a leading cause of cancer mortality in the world. The incidence of lung cancer in developed countries started to decrease mainly due to global anti-smoking campaigns. However, the incidence of lung cancer in women has been increasing in recent decades for various reasons. Furthermore, since the screening of lung cancer is not as yet very effective, clinically applicable molecular markers for early diagnosis are much required. Lung cancer in women appears to have differences compared with that in men, in terms of histologic types and susceptibility to environmental risk factors. This suggests that female lung cancer can be derived by carcinogenic mechanisms different from those involved in male lung cancer. Among female lung cancer patients, many are non-smokers, which could be studied to identify alternative carcinogenic mechanisms independent from smoking-related ones. In this paper, we reviewed molecular susceptibility markers and genetic changes in lung cancer tissues observed in female lung cancer patients, which have been validated by various studies and will be helpful to understand the tumorigenesis of lung cancer.
Genetic predisposition
Epidemiology of cancer
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Parallel and often unrelated developments in health care and technology have all been necessary to bring about early detection of lung cancer and the opportunity to decrease mortality from lung cancer through early detection of the disease by computed tomography. Lung cancer screening programs provide education for patients and clinicians, support smoking cessation as primary prevention for lung cancer, and facilitate health care for tobacco-associated diseases, including cardiovascular and chronic lung diseases. Guidelines for lung cancer screening will need to continue to evolve as additional risk factors and screening tests are developed. Data collection from lung cancer screening programs is vital to the further development of fiscally responsible guidelines to increase detection of lung cancer, which may include small groups with elevated risk for reasons other than tobacco exposure.
Cancer screening
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Objective To evaluate the accuracy of magnetic resonance imaging in assessment of adolescent patients with complex Müllerian anomalies and its contribution towards operative management. Design A retrospective review of magnetic resonance imaging and operative findings. Setting A London teaching hospital that is a tertiary referral centre for complex reproductive tract disorders. Sample All adolescents referred for assessment of complex Müllerian anomalies, from 1996 to 1999, and undergoing both magnetic resonance imaging and surgical assessment. Method In the nine suitable patients magnetic resonance imaging and surgical findings were compared and the role of magnetic resonance imaging in determining the route and type of surgery was evaluated. Main outcome measures Magnetic resonance imaging data on reproductive tract anatomy and surgical findings detailing reproductive tract anatomy. Results There was good correlation of magnetic resonance imaging and operative findings in all cases. The best correlation was with uterine structure. In four cases the magnetic resonance imaging findings were essential for the appropriate choice of the surgical approach and type of procedure. Conclusions Magnetic resonance imaging is a valuable tool in the management of this particular complex group of patients.
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This pilot study conducted in Switzerland aims to assess the implementation, execution, and performance of low-dose CT lung cancer screening (LDCT-LCS). With lung cancer being the leading cause of cancer-related deaths in Switzerland, the study seeks to explore the potential impact of screening on reducing mortality rates. However, initiating a lung cancer screening program poses challenges and depends on country-specific factors. This prospective study, initiated in October 2018, enrolled participants meeting the National Lung Cancer Study criteria or a lung cancer risk above 1.5% according to the PLCOm2012 lung cancer risk-model. LDCT scans were assessed using Lung-RADS. Enrollment and follow-up are ongoing. To date, we included 112 participants, with a median age of 62 years (IQR 57–67); 42% were female. The median number of packs smoked each year was 45 (IQR 38–57), and 24% had stopped smoking before enrollment. The mean PLCOm2012 was 3.7% (±2.5%). We diagnosed lung cancer in 3.6% of participants (95%, CI:1.0–12.1%), with various stages, all treated with curative intent. The recall rate for intermediate results (Lung-RADS 3,4a) was 15%. LDCT-LCS in Switzerland, using modified inclusion criteria, is feasible. Further analysis will inform the potential implementation of a comprehensive lung cancer screening program in Switzerland.
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Nodule (geology)
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Tumor-associated autoantibodies are considered promising markers for early lung cancer detection; so far, however, their capacity to detect cancer has been tested mostly in a clinical context, but not in population screening settings. This study evaluates the early detection accuracy, in terms of sensitivity and specificity, of EarlyCDT®-Lung-a test panel of seven tumor-associated autoantibodies optimized for lung cancer detection-using blood samples originally collected as part of the German Lung Cancer Screening Intervention Trial.The EarlyCDT®-Lung test was performed for all participants with lung cancer detected via low-dose computed tomography and with available blood samples taken at detection, and for 180 retrospectively selected cancer-free participants at the end of follow-up: 90 randomly selected from among all cancer-free participants (baseline controls) and 90 randomly selected from among cancer-free participants with suspicious imaging findings (suspicious nodules controls). Sensitivity and specificity of lung cancer detection were estimated in the case group and the two control groups, respectively.In the case group, the test panel showed a sensitivity of only 13.0% (95% CI: 4.9-26.3%). Specificity was estimated at 88.9% (95% CI: 80.5-94.5%) in the baseline control group, and 91.1% (95% CI: 83.2-96.1%) among controls presenting CT-detected nodules.The test panel showed insufficient sensitivity for detecting lung cancer at an equally early stage as with low-dose computed tomography screening.
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Screening for lung cancer is somewhat controversial in that very few evaluations of the screening process have been made, and even fewer have involved the use of concomitant, unscreened controls.This report of the Mayo Lung Project provides evaluation of a randomly selected 4500 clinic patients, offered screening for lung cancer at four-month intervals for six years.Another 4500 randomly selected controls not offered screening were merely observed.Good screening is defined, the Mayo project is evaluated, and puzzling results are presented and discussed.From the screened group, 98 new cases of lung cancer have been detected, 67 by study screening and 31 by spontaneous reporting of symptoms (15) or by x-ray examinations (16) done in other than study circumstances.From the controls, 64 new lung cancer cases have been detected, 43 by symptoms and 21 by other methods.Lung cancer mortality is 39 for study patients and 41 for controls.There is thus no evidence at this time that early case finding has decreased mortality from lung cancer.
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lung cancer screening: lung cancer screeningNew research finds that low-dose computed tomography (LDCT) lung cancer screening and lung nodule detection and reporting programs are complementary. Combining the two could expand access to early lung cancer detection and curative treatment to different-risk populations, as well as alleviate emerging disparities in access to early lung cancer detection. In a study recently published in the Journal of Clinical Oncology, researchers evaluated two approaches to early lung cancer detection—LDCT and program-based management of incidentally detected lung nodules (2022; doi: 10.1200/JCO.21.02496). “Although lung cancer screening saves lives, implementing low-dose CT lung cancer screenings has been very challenging,” noted Raymond Osarogiagbon, MD, Chief Scientist and Director of the Multidisciplinary Thoracic Oncology Program at Baptist Memorial Health Care, and lead author of the study. Osarogiagbon and his colleagues hypothesized that program-based establishment of guideline-concordant management of incidental lung nodules provides an alternative pathway to early diagnosis of lung cancer. They also noted that the characteristics of lung cancer diagnosed through such programs would be similar to LDCT-detected lung cancer, but “there would be synergy between programs by providing access to different-risk populations.” The authors also hypothesized that lung cancer diagnosed through the two early detection programs—LDCT and incidental lung nodule—would have earlier stage and better outcomes than lung cancer diagnosed outside them, according to Osarogiagbon. He noted that the researchers used Baptist Memorial's multidisciplinary thoracic oncology program to provide lung cancer patients with diagnosis outside these early-detection programs. Study Details The authors conducted a prospective observational study that enrolled patients in the early detection programs. For context, the researchers compared them with patients managed in a multidisciplinary care program, comparing clinical stage distribution, surgical resection rates, 3- and 5-year survival rates, and eligibility for LDCT screening of patients diagnosed with lung cancer. From 2015 to May 2021, 22,886 patients were enrolled in the study, with nearly 5,700 in LDCT, more than 15,000 in lung nodule, and close to 1,800 in multidisciplinary care. Overall, the researchers found that less than half of patients diagnosed with lung cancer (46%) would have been eligible to receive LDCT based on the U.S. Preventive Services Task Force (USPSTF) 2013 criteria. Fifty-four percent would have been eligible using the 2021 criteria. Still, the team found that the lung nodule program would have been able to identify 20 percent of Stage I and Stage II lung cancer cases among all participating patients diagnosed with the disease, even if all patients deemed eligible for LDCT according to the USPSTF's 2021 recommendation had received the exam. In comparison to those undergoing LDCT, patients diagnosed with lung cancer who participated in the lung nodule program were more likely to be Black, uninsured, and have given up smoking. And, eligibility for lung cancer screening increased across all three programs with the 2021 USPSTF recommendations. There has been a steep rise in the CT scans for diagnostics across North America and Europe since the 1970s, noted Osarogiagbon, adding that these scans often reveal lesions, some of which turn out to be lung cancer. By starting from the point of lesion detection, incidental lung nodule programs avoid several barriers that impair access to LDCT, including limitations of the eligibility criteria, recruitment of eligible patients, and insurance barriers, he noted. “A lot of the patients enrolled into the lung nodule program, for example, had their lesion-detecting CT scan performed in the ED for other reasons. A high proportion of such patients may never otherwise have presented for preventive care services,” Osarogiagbon stated. Ultimately, these results help illustrate the way in which LDCT screening and lung nodule programs can work together to increase patient access to early lung cancer detection and treatment, as well as impact how radiology teams provide care for these patients, he noted. “In terms of sheer volume of diagnosis, for every one lung cancer diagnosed through the LDCT program, five were diagnosed through the lung nodule program; 60 percent of patients in both programs had Stage I/II lung cancer,” Osarogiagbon said. Noting that fewer than 50 percent of the patients diagnosed with lung cancer in the nodule program would have been eligible for LDCT even by the new 2021 USPSTF criteria, “the key intervention with the incidental lung nodule program was to develop an automated means of using the electronic health record system to capture the radiology reports in which the radiologist expressed concern about the presence of a potentially malignant or premalignant lesion,” he explained. “This digital health approach improved the probability of guideline-concordant care, overcoming human errors in the hand off from radiologist to subsequent care delivery teams.” Mark McGraw is a contributing writer.
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To determine the diagnostic performances of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents we compared them with arthroscopic findings in a consecutive series of pediatric patients (≤16 years old). Stratification effects by patient age and magnetic resonance imaging center were examined. There were 139 lesions diagnosed clinically, 128 diagnosed by magnetic resonance imaging, and 135 diagnosed arthroscopically. There was no significant difference between clinical examination and magnetic resonance imaging with respect to agreement with arthroscopic findings (clinical examination, 70.3%; magnetic resonance imaging, 73.7%), overall sensitivity (clinical examination, 71.2%; magnetic resonance imaging, 72.0%), and overall specificity (clinical examination, 91.5%; magnetic resonance imaging, 93.5%). Stratified analysis by diagnosis revealed significant differences only for sensitivity of lateral discoid meniscus (clinical examination, 88.9%; magnetic resonance imaging, 38.9%) and specificity of medial meniscal tears (clinical examination, 80.7%; magnetic resonance imaging, 92.0%). For magnetic resonance imaging, children younger than 12 years old had significantly lower overall sensitivity (61.7% versus 78.2%) and lower specificity (90.2% versus 95.5%) compared with children 12 to 16 years old. There was no significant effect of magnetic resonance imaging center. In conclusion, selective magnetic resonance imaging does not provide enhanced diagnostic utility over clinical examination, particularly in children, and should be used judiciously in cases where the clinical diagnosis is uncertain and magnetic resonance imaging input will alter the treatment plan.
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