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Biomedical subjects

N L Müller

Publications and source records attributed to N L Müller.

At least 91 records · Page 5Linked to original sources
PubMed1997

Cylindrical bronchiectasis: diagnostic findings on thin-section CT.

OBJECTIVE: The aim of this study was to determine the frequency of diagnostic findings of bronchiectasis on thin-section CT and the usefulness of those findings in distinguishing patients with cylindrical bronchiectasis from healthy subjects. MATERIALS AND METHODS: The study was retrospective and included 26 healthy adults, 10 consecutive patients with surgically proven cylindrical bronchiectasis, and 49 patients who had been prospectively diagnosed at three institutions as having cylindrical bronchiectasis. All patients had 1.0- to 1.5-mm-collimation CT scans obtained at 10-mm intervals through the chest. The CT scans were independently reviewed in random order by two chest radiologists. RESULTS: Findings in patients with bronchiectasis that were not seen by either observer in any of the healthy subjects included visualization of a bronchus within 1 cm of the costal pleura and visualization of a bronchus abutting the mediastinal pleura. The two observers saw these findings on 96 (81%) and 63 (53%) of 118 CT scans in the 59 patients with bronchiectasis, respectively. Lack of tapering of bronchi was seen in five (10%) of 52 reviews in healthy subjects compared with 95% of reviews in patients with bronchiectasis. Bronchoarterial ratios greater than 1 were identified in 11 (21%) of 52 reviews in healthy subjects compared with 95% of reviews in patients with bronchiectasis. We calculated good agreement between the two observers (kappa values equal to or greater than .63). CONCLUSION: In most cases, thin-section CT allows reliable distinction of patients with cylindrical bronchiectasis from healthy subjects.

Adult↗
PubMed1997

Pulmonary nodules: differential diagnosis using 18F-fluorodeoxyglucose single-photon emission computed tomography.

OBJECTIVE: The objective of this study was to prospectively evaluate the feasibility and efficacy of single-photon emission computed tomography (SPECT) with 18F-fluorodeoxyglucose (FDG) for differentiating malignant from benign pulmonary nodules. SUBJECTS AND METHODS: Twenty-six patients with 28 radiologically indeterminate focal pulmonary lesions were examined. Fasting patients were injected with 5 MBq/kg of FDG (maximum dose, 370 MBq). Imaging was performed with dual-head SPECT cameras equipped with 511-keV collimators. RESULTS: Seventeen of 21 pathologically malignant nodules showed FDG uptake on SPECT imaging (sensitivity, 81%). None of the seven benign modules showed uptake (specificity, 100%). SPECT imaging with FDG was positive in all 16 malignant nodules that were larger than or equal to 2 cm in diameter. However, only one (20%) of five nodules smaller than 2 cm in diameter showed positive on SPECT imaging. CONCLUSION: Using current technology, we found FDG SPECT imaging useful for distinguishing benign from malignant pulmonary nodules that were larger than or equal to 2 cm in diameter. However, because of the relatively low sensitivity of SPECT, smaller malignant nodules were not adequately revealed.

Deoxyglucose↗
PubMed1997

High-resolution CT of pediatric lung disease: imaging findings.

The HRCT findings of diseases of the pulmonary parenchyma and airways in children are often similar to those seen in adults. However, some conditions, particularly IPF, pulmonary fibrosis associated with scleroderma, and Langerhans histiocytosis, may have different presentations and a more rapid progression in children than in adults. HRCT may be helpful for assessing patients with suspected diseases of the pulmonary parenchyma or airways, particularly when radiographic findings are normal or nonspecific.

Adolescent↗
PubMed1997

Bronchiolitis obliterans after lung transplantation: high-resolution CT findings in 15 patients.

OBJECTIVE: The purpose of this study was to compare the high-resolution CT findings in patients with pathologically proven bronchiolitis obliterans after lung transplantation with high-resolution CT findings in control subjects. MATERIALS AND METHODS: High-resolution CT examinations of 15 patients with pathologically proven bronchiolitis obliterans after lung transplantation and 18 control subjects were retrospectively evaluated by two independent observers who were unaware of the diagnosis in each case. All 33 subjects underwent inspiratory high-resolution CT. Five patients with bronchiolitis obliterans and 16 control subjects underwent expiratory CT. RESULTS: Findings in patients with bronchiolitis obliterans included bronchial dilatation in 80%, mosaic perfusion in 40%, bronchial wall thickening in 27%, and air trapping in 80%, compared with the control subjects with bronchial dilatation in 22%, mosaic perfusion in 22%, and air trapping in 6%. The combination of bronchial dilatation on the inspiratory CT scan and air trapping on the expiratory CT scan was seen only in patients with bronchiolitis obliterans. We calculated good agreement between the two observers (kappa > or = .63). CONCLUSION: Air trapping and bronchial dilatation were the two most sensitive and specific findings on high-resolution CT scans of patients with bronchiolitis obliterans. The combination of these two findings was seen exclusively in patients with bronchiolitis obliterans.

Adult↗
PubMed1997

Pulmonary carcinosarcoma: radiologic and pathologic findings in three patients.

OBJECTIVE: The purpose of this study was to describe the radiologic and pathologic features of pulmonary carcinosarcoma in three patients. CONCLUSION: The tumors measured 9-14 cm in diameter, had inhomogeneous contrast enhancement, and in two cases had invaded the mediastinum or chest wall extensively. Carcinosarcomas are rare tumors that tend to be large, necrotic, enhancing, and locally invasive.

Adult↗
PubMed1996

CT in blunt chest trauma: pulmonary, tracheobronchial, and diaphragmatic injuries.

Routine use of CT in the initial evaluation of blunt chest trauma is controversial. CT however, has been shown to be useful in the diagnosis of unsuspected chest injuries and in directing therapeutic interventions. This review discusses the CT findings in patients with pulmonary, tracheobronchial, and diaphragmatic injuries after blunt chest trauma.

Adult↗
PubMed1996

Hypersensitivity pneumonitis: correlation of individual CT patterns with functional abnormalities.

PURPOSE: To correlate the pattern and extent of abnormalities on thin-section computed tomographic (CT) scans with pulmonary function test results in subacute and chronic hypersensitivity pneumonitis. MATERIALS AND METHODS: Thin-section scans (1-3 mm collimation) obtained in 22 patients were assessed for pattern of abnormality and extent of disease. CT scores were correlated with functional parameters by using Spearman rank correlation and forward stepwise regression analysis. RESULTS: The most common CT patterns were decreased attenuation and mosaic perfusion (n = 19), ground-glass opacification (n = 18), small nodules (n = 12), and a reticular pattern (n = 8). Areas of decreased attenuation correlated with severity of air trapping indicated by residual volume (r = .58, P < .01), whereas ground-glass opacification and reticulation correlated independently with restrictive lung function. CONCLUSION: Areas of decreased attenuation and mosaic perfusion are an important ancillary CT finding in hypersensitivity pneumonitis, and obstructive functional abnormalities indicate that this phenomenon is caused by bronchiolitis.

Alveolitis, Extrinsic Allergic↗
PubMed1996

Thymus in myasthenia gravis: comparison of CT and pathologic findings and clinical outcome after thymectomy.

PURPOSE: To correlate computed tomographic (CT) appearance of the thymus with results from histologic examination of thymic tissue and clinical outcome in patients with generalized myasthenia gravis who underwent thymectomy. MATERIALS AND METHODS: Forty-five patients with myasthenia gravis underwent CT of the thorax and thymectomy. Findings at clinical follow-up were available in all patients. RESULTS: Twenty-six patients had normal CT findings, seven had a diffusely enlarged thymus, and 12 had a focal mass. The results of histologic examination showed that 16 of 26 patients with normal CT findings had normal thymic tissue and 10 had lymphoid follicular hyperplasia; all seven patients with an enlarged thymus had lymphoid hyperplasia. Five of 12 patients with a focal mass at CT had lymphoid hyperplasia, and seven had thymoma. Clinical improvement following thymectomy was observed in 27 (93%) of 29 patients with lymphoid hyperplasia or thymoma and 11 (69%) of 16 patients with normal histologic examination (P < .03, chi(2) test). CONCLUSION: The presence of an enlarged thymus or a focal mass in patients with myasthenia gravis indicates lymphoid hyperplasia or thymoma. However, CT is of limited value in distinguishing lymphoid follicular hyperplasia from a normal thymus or thymoma and in predicting clinical outcome.

Adolescent↗
PubMed1996

Contribution of emphysema and small airways in COPD.

BACKGROUND: The contribution and role of emphysema and small airways disease in causing expiratory airflow limitation in COPD is controversial. METHODS: We obtained high-resolution thin-section 2-mm CT scans of the lung for emphysema grading and lung function in 116 consecutively seen COPD outpatients with fixed expiratory airflow limitation. In this group, inflated whole lung(s) were subsequently obtained in 24 patients (23 autopsy, 1 surgery) for morphologic studies and results compared with lung CT. Airway histologic condition was studied in 17 of the 24 patients. RESULTS: There was fair to weak negative correlation between CT emphysema score and either FEV1/FVC percent (r = -0.51, p = 0.001) or FEV1 percent predicted (r = -0.31, p = 0.001). In only 24 of the 81 patients (30%) with FEV1 less than 50% predicted, the CT emphysema score was 60 or more, indicating severe emphysema. In the 24 patients studied, there was a good correlation (r = 0.86, p = 0.001) between CT and pathologic grade of emphysema. While respiratory bronchioles (RBs) and membranous bronchioles (MBs) demonstrated marked morphologic abnormalities, there was a weak correlation with emphysema grade (for RB, r = 0.36, p = 0.16; for MB, r = 0.41, p = 0.10) or with FEV1 percent predicted (for RB, r = -0.21, p = 0.42; for MB, r = -0.28, p = 0.28). There was no correlation between emphysema and FEV1 percent predicted (r = -0.13, p = 0.54). CONCLUSIONS: High-resolution CT lung scans are an in vivo surrogate to quantitate moderate to severe morphologic emphysema. Emphysema does not appear to be primarily responsible for severe expiratory airflow limitation in most patients with severe COPD. There was no correlation between severity of small airway histologic condition and emphysema or FEV1 percent predicted. The causes of the lesions responsible for small airways obstruction need to be identified.

Aged↗
PubMed1996

Miliary tuberculosis. Diagnostic accuracy of chest radiography.

STUDY OBJECTIVE: To assess the efficacy of the chest radiograph in identifying patients with miliary tuberculosis. DESIGN: Retrospective case-controlled review by three independent blinded chest radiologists. SETTING: Provincial tuberculosis control center. PATIENTS: Population-based sample, including all proved cases of miliary tuberculosis diagnosed in the Province of British Columbia, Canada, between November 1982 and November 1992. One hundred cases of miliary tuberculosis were identified, of which 71 had chest radiographs available for review. Forty-four normal chest radiographs and 20 chest radiographs of patients with localized pulmonary tuberculosis were also included as controls. MAIN OUTCOME MEASURES: The primary outcome of measurements was the sensitivity and interobserver variability of the chest radiograph in the diagnosis of miliary tuberculosis. The observers were also asked to describe the pattern and extent of pulmonary abnormalities based on the International Labor Organization (ILO) classification of pneumoconioses. RESULTS: The three independent observers identified 42, 44, and 49 of the 71 cases of miliary tuberculosis, respectively (sensitivity, 59 to 69%). The three observers incorrectly diagnosed miliary tuberculosis in 2, 0, and 2 of the 64 controls, respectively (specificity, 97 to 100%). There was good interobserver agreement (90%, kappa = 0.77). The nodules measured less than 3 mm in diameter in 90% of cases in which miliary tuberculosis was correctly identified. In 10% of cases, the nodules measured greater than 3 mm in diameter. The ILO profusion scores ranged from mild (profusion score 1) in 45% of cases, through moderate (profusion score 2) in 27%, and severe (profusion score 3) in 28%. CONCLUSIONS: The chest radiograph allowed identification of 59 to 69% of cases of miliary tuberculosis with a high specificity and good interobserver agreement.

Adolescent↗
PubMed1996

Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia. Assessment with serial CT.

OBJECTIVE: To determine the outcome of areas of ground-glass attenuation and assess disease progression on serial high-resolution CT (HRCT) scans of patients with biopsy specimen-proved usual interstitial pneumonia (UIP) and desquamative interstitial pneumonia (DIP). MATERIALS AND METHODS: Twelve patients with biopsy specimen-proved UIP and 11 patients with biopsy specimen-proved DIP who had initial and follow-up HRCT scans (median interval, 10 months) were reviewed. Eleven patients with UIP and 11 with DIP received treatment between the initial and follow-up CT scans. The scans were evaluated for the presence and extent of ground-glass attenuation, irregular linear opacities and honeycombing, and overall extent of parenchymal involvement. RESULTS: On initial CT scans, all 12 patients with UIP had areas of ground-glass attenuation (mean +/- SD extent, 30 +/- 16%) and irregular lines (mean +/- SD extent, 17 +/- 7%) and 10 patients had honeycombing (mean +/- SD extent, 10 +/- 6%). All 11 patients with DIP had areas of ground-glass attenuation on initial HRCT scans (mean +/- SD extent, 51 +/- 26%), 5 patients had irregular linear opacities (mean +/- SD extent, 5 +/- 5%), and 1 patient had honeycombing. Nine of the 12 patients with UIP showed increase in the extent of ground-glass attenuation (n = 6) or progression to irregular lines (n = 2) or honeycombing (n = 4) on follow-up as compared with only 2 patients with DIP who showed progression to irregular lines (n = 1) or honeycombing (n = 1) (p < 0.01 chi 2 test). CONCLUSION: In patients with UIP, areas of ground-glass attenuation usually increase in extent or progress to fibrosis despite treatment. Areas of ground-glass attenuation in most patients with DIP remain stable or improve with treatment.

Adult↗
PubMed1996

Detection and differential diagnosis of pulmonary infections and tumors in patients with AIDS: value of chest radiography versus CT.

OBJECTIVE: The purpose of this study was to compare the sensitivity and specificity of chest radiography with those of CT in the detection of pulmonary infections and tumors in patients with AIDS. MATERIALS AND METHODS: The study was retrospective and included the radiographs and CT scans of 139 patients. Eighty-nine had one proven thoracic complication, 17 had two proven thoracic complications, and 33 had no active intrathoracic disease at the time of the examinations. The radiographs and CT scans were interpreted blindly by two independent observers from different institutions. The observers assessed for the presence or absence of intrathoracic disease and recorded the most likely diagnosis and the degree of confidence in that diagnosis. RESULTS: The patients were more commonly correctly identified as having or not having intrathoracic disease on the basis of CT findings than on the basis of radiographic findings ( p < .01, chi-square test). Of the 106 patients with intrathoracic complications, 90% (191 of 212 interpretations) were correctly identified by the two observers on the radiograph and 96% (204 of 212 interpretations) at CT. Of 33 patients without intrathoracic disease, 73% (48 of 66 interpretations) were correctly identified at radiography and 86% (57 of 66 interpretations) at CT. Of 89 patients with one proved thoracic complication, the observers confident in their first-choice diagnosis in 34% of the cases (61 of 178 interpretations) at chest radiography and in 47% (83 of 178 interpretations) at CT. This diagnosis was correct in 67% (41 of 61) of confident radiographic interpretations as compared with 87% (72 of 83) of interpretations at CT (p < .01, chi-square test). CONCLUSION: CT is superior to chest radiography in allowing identification of patients with and without thoracic disease and in the differential diagnosis of pulmonary complications of patients with AIDS. However, the improvement in differential diagnosis is modest. Because in most cases the radiographs and CT scans were obtained as part of the clinical evaluation, the study is probably biased toward problematic clinical cases. In the majority of patients, the chest radiograph provides adequate information and CT is not warranted.

AIDS-Related Opportunistic Infections↗
PubMed1996

CT manifestations of pulmonary aspergillosis.

The clinical and radiologic manifestations of pulmonary aspergillosis depend on the underlying status of the patients' lung parenchyma and the patients' immunologic response to the infecting agent, most commonly Aspergillus fumigatus. Thus, many different manifestations of pulmonary aspergillosis have been described, with distinct clinical, pathological, and radiological characteristics. Aspergillomas (mycetomas) result from Aspergillus colonization of preexisting lung cavities. Allergic bronchopulmonary aspergillosis results from a hypersensitivity reaction to the fungus in asthmatic patients. Invasive aspergillosis occurs in immunocompromised patients and can take one of many forms, depending on the degree and etiology of the patients' immunosuppression. CT is currently the best imaging modality for the assessment of pulmonary parenchymal disease. In the correct clinical setting, the CT findings frequently suggest a specific diagnosis. The aim of this review is to discuss and illustrate the various CT manifestations of pulmonary aspergillus infection.

Aspergillosis↗