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LESSON 7DIAGNOSTIC RADIOLOGY OF PULMONARY TUMORS.
Chest radiography
Due to its widespread availability, including to primary care physicians, the chest
radiograph is often the first imaging modality to suggest the diagnosis of
bronchogenic carcinoma. Lung cancer may present as a straightforward spiculated
mass but its presence may also be inferred from other appearances such as an
unresolving pneumonia or lobar collapse). In some situations, no further imaging
will be necessary when bulky contralateral mediastinal adenopathy is present or
when an obvious bony lesion is identified. However, CT scanning of the chest is
often needed because of the lack of sensitivity of the chest radiographs in detecting
mediastinal lymph node metastases and chest wall and mediastinal invasion
Computed tomography
CT can identify specific features in lung nodules that are diagnostic, e.g.
arteriovenous fistulae, rounded atelectasis, fungus balls, mucoid impaction and
infarcts. High-resolution scanning further refines this diagnostic process The
ability of CT scanning to evaluate the entire thorax at the time of nodule
assessment is of further benefit.
Spiral or helical CT is advantageous as small nodules are not missed between
slices as may happen on older, nonspiral machines. It also increases the detection
rate of nodules <5 mm in diameter, especially when viewed in cine-format on a
workstation The acquisition of continuous volume data sets permits three-
dimensional image reconstruction and multiplanar (i.e. nonaxial) reformatting The
recent advent of multislice scanners has seen advances in image resolution with a
substantial reduction in both tube loading and scanning time as up to four slices
can be acquired simultaneously Both spiral and multislice machines suffer less
from respiratory motion artefact due to their shorter scanning times.
Slice thickness and interval should be ≤10 mm and extend from the lung apices to
the adrenal glands It is now common practice to perform 5 ‐mm slices through the
hila and aortopulmonary regions to improve delineation of local lymph nodes and
the origins of the lobar bronchi. The field of view should include the contiguous
chest wall
Magnetic resonance imaging
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