Pulmonary nodule imaging: Difference between revisions

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==Imaging==
==Imaging==


===Plain Radiograph===
===Plain Radiograph===
Line 15: Line 17:
===CT===
===CT===


'''Calcification'''


*Calcification patterns are commonly seen in granulomatous disease and hamartomas
===MRI===
*Characteristic calcification patterns of pulmonary nodule, include:
:*Diffuse
:*Central
:*Laminated
:*Popcorn


'''Size'''


*Different size ranges of pulmonary nodule, include:
{|style="border: 5px; font-size: 90%; margin: 5px; width: 1000px" align=center
* Nodules less than 4mm
!style="padding: 5px 5px; background: #4479BA; font-weight: bold; text-align:center;" colspan="3"|{{fontcolor|#FFF|''' Radiologic Features Suggestive of Benign or Malignant Solitary Pulmonary Nodules''' <br><SMALL> Adapted from American Academy of Family Physicians <ref name="CDC"> Solitary Pulmonary Nodule: Morphological Evaluation. http://pubs.rsna.org/doi/pdf/10.1148/radiographics.20.1.g00ja0343 Accessed on March 15, 2016 </ref></SMALL>}}
* Nodules between 4mm and 7mm
|valign=top|
* Nodules between 8mm and 20mm
|+
* Nodules more than 20mm
|-
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Radiologic feature'''}} 
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Benign'''}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Malignant'''}}
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Size
|style="padding: 5px 5px; background: #F5F5F5;"|< 5 mm
|style="padding: 5px 5px; background: #F5F5F5;"|> 10 mm
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Border
|style="padding: 5px 5px; background: #F5F5F5;"| Smooth
|style="padding: 5px 5px; background: #F5F5F5;"| Irregular or spiculated
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Density
|style="padding: 5px 5px; background: #F5F5F5;"| Dense, solid
|style="padding: 5px 5px; background: #F5F5F5;"| Nonsolid, “ground glass”
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Calcification
|style="padding: 5px 5px; background: #F5F5F5;"| Typically a benign feature, especially in “concentric,” “central,” “popcorn-like,” or “homogeneous” patterns
|style="padding: 5px 5px; background: #F5F5F5;"| Typically noncalcified, or “eccentric” calcification
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"| Doubling time
|style="padding: 5px 5px; background: #F5F5F5;"| Less than one month; more than one year
|style="padding: 5px 5px; background: #F5F5F5;"| One month to one year
|}


'''Growth'''
'''Shape'''
*Polygonal
*Circular
:*Spherical
'''Margins'''
*Lobulated or scalloped margins
:*Intermediate malignancy probability
*Smooth margins
*:Associated with nodule benignancy 
'''Attenuation'''
*Solid pulmonary nodules
:*Malignancy rate of only 7%
*Calcified pulmonary nodules
*Partly solid pulmonary nodules
:*Malignancy rate of 63%
*Ground glass pulmonary nodules
:*Malignancy rate of 18%
'''Contrast enhancement'''
* Contrast enhancement of pulmonary nodules may be useful to determine benign or malignant features
* Benign pulmonary nodules usually have a contrast enhancement less than 15 HU
On CT, radiological signs of pulmonary nodule, include:
*Corona radiata sign
:*Highly associated with malignancy
*Air bronchogram sign
:*Non-specific sign
===MRI===




Revision as of 15:32, 21 March 2016

Pulmonary Nodule Microchapters

Home

Patient Information

Overview

Classification

Causes

Differentiating Pulmonary Nodule from Other Diseases

Epidemiology and Demographics

Screening

Natural history, Complications and Prognosis

Diagnosis

Evaluation of Solitary Pulmonary Nodule

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Pulmonary nodule imaging On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Pulmonary nodule imaging

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pulmonary nodule imaging

CDC on Pulmonary nodule imaging

Pulmonary nodule imaging in the news

Blogs on Pulmonary nodule imaging

Directions to Hospitals Treating Solitary pulmonary nodule

Risk calculators and risk factors for Pulmonary nodule imaging

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Conventional radiography is the initial method of choice for the evaluation of solitary pulmonary nodule. The evaluation and risk assessment of solitary pulmonary nodule will depend on several characteristics, such as: size, growth, shape, margin, air bronchogram sign, and attenuation. Further evaluation of solitary pulmonary lung nodule, should include enhanced CT scan or MRI imaging. Other imaging studies include PET scanning, which may be useful as a staging modality, detection of occult disease, and malignancy assessment.

Imaging

Plain Radiograph

  • Conventional radiography is the initial method of choice for the evaluation of pulmonary nodule
  • Conventional chest radiograph may also be helpful in the diagnosis of pulmonary nodule

CT

MRI

Radiologic Features Suggestive of Benign or Malignant Solitary Pulmonary Nodules
Adapted from American Academy of Family Physicians [1]
Radiologic feature Benign Malignant
Size < 5 mm > 10 mm
Border Smooth Irregular or spiculated
Density Dense, solid Nonsolid, “ground glass”
Calcification Typically a benign feature, especially in “concentric,” “central,” “popcorn-like,” or “homogeneous” patterns Typically noncalcified, or “eccentric” calcification
Doubling time Less than one month; more than one year One month to one year


Gallery

Plain Radiograph

CT

MRI

References

  1. ↑ Solitary Pulmonary Nodule: Morphological Evaluation. http://pubs.rsna.org/doi/pdf/10.1148/radiographics.20.1.g00ja0343 Accessed on March 15, 2016


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