Pulmonary nodule imaging

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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

Calcification

• Calcification patterns are commonly seen in granulomatous disease and hamartomas
• Characteristic calcification patterns of pulmonary nodule, include:

• Diffuse
• Central
• Laminated
• Popcorn

Size

• Different size ranges of pulmonary nodule, include:
• Nodules less than 4mm
• Nodules between 4mm and 7mm
• Nodules between 8mm and 20mm
• Nodules more than 20mm

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

References

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