Pulmonary lesion types of GPA have a wide spectrum, potentially mimicking a high number of diseases including malignancy, infection and noninfectious inflammatory diseases. A spiculated lung lesion invading the fissure, pleura or diaphragm is mostly present in malignancy, but it can be also seen in GPA.
Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) represent a spectrum of malignant neoplasms arising from the lymphoid system with an incidence of around 8% of all malignancies. Although they are generally known as tumors of lymph nodes, 25% to 40% of HD/NHL tumors, especially NHL, arise at extranodal sites along the gastrointestinal tract, head and neck, orbit, central and peripheral nervous system, thorax, bone, skin, breast, testis, thyroid, and genitourinary tract. Extranodal involvement is an important pretreatment prognostic factor for patients with lymphoma and its incidence has increased in the past 2 decades. Imaging plays an important role in the noninvasive pretreatment assessment of patients with extranodal lymphoma. This involvement can be subtle and may be overlooked during computed tomography (CT). Positron emission tomography/CT (PET/CT) has evolved into an important imaging tool for evaluation of lymphomas, facilitating the detection of affected extranodal sites even when CT shows subtle or no obvious lesions. Familiarity with extranodal manifestations and suggestive PET/CT features in different sites is important for accurate evaluation of lymphoma. This article reviews the extranodal PET/CT imaging findings regarding HD and NHL.
Healthy adults can swallow boluses of 20 ml water in a single swallow. Individuals with impaired swallowing, however, may be unable to do so, instead requiring two or more swallows; this phenomenon is called "piecemeal deglutition". The term "dysphagia limit" refers to the volume at which piecemeal deglutition occurs. The aim of our study was to investigate the potential value of scintigraphic evaluation of piecemeal deglutition and dysphagia limit in patients with dysphagia, based on correlation with the results of submental electromyography (SM-EMG) and laryngeal sensor monitoring (LS). The study population comprised 24 patients with dysphagia secondary to neurological disorders and ten normal adults, who formed a control group. In the scintigraphic evaluation, subjects underwent four separate dynamic studies using 5, 10, 15 and 20 ml of water containing 0.5 mCi technetium-99m labelled sulphur colloid, and time-activity curves (TACs) were created for each study. Static thoracic images were also recorded in order to detect airway aspiration Observation of two or more peaks on TACs within the 10-s acquisition period was considered a sign of piecemeal deglutition. If piecemeal deglutition occurred at or below 20 ml, this volume was regarded as the dysphagia limit. Piecemeal deglutition was not found in any normal subjects; by contrast, it was observed in 14 of the 24 (58%) patients on scintigraphy and in 17 (71%) patients on EMG and LS. In three patients, signs of the airway aspiration were observed on static thoracic images. Scintigraphic and electrophysiological findings were in agreement in 19 patients (79%), and the correlation between scintigraphy and the electrophysiological methods for the evaluation of dysphagia was statistically significant (r=0.57, P=0.003). The novel finding of this study is the demonstration of piecemeal deglutition and dysphagia limit on scintigraphic studies in patients with neurogenic dysphagia. Based on this finding we consider that scintigraphic evaluations of piecemeal deglutition and dysphagia limit could be of value especially in centres which do not have electrophysiological test facilities. The technique should be added to the list of standard scintigraphic methods for the evaluation of patients with oropharyngeal dysphagia.
435N on-small cell lung cancer (NSCLC) accounts for approximately 75% to 85% of all newly diagnosed lung cancers (1). The optimal treatment of NSCLC relies on accurate disease staging, which is based on tumor size, regional nodal involvement, and the presence of metastasis. Correct evaluation of the presence or absence of metastases in mediastinal and hilar lymph nodes is a critical factor that may determine operability and long-term survival in patients with NSCLC. Surgical treatment can be expected in 70% of patients with N0 stage and up to 24% of patients with N2 stage; however, surgery is generally not indicated in patients with N3 stage cancer (2).Although computed tomography (CT) is the most commonly used noninvasive imaging modality for the pre-operative evaluation of tumor size and the extent of invasion into adjacent structures, a number of reviews and meta-analyses have shown the limited reliability of CT in lymph node staging (3). The CT criteria for lymph node tumor involvement rely on the size or shape of the lymph nodes. Usually, 1 cm is used as the size criterion predicting tumor involvement in lymph nodes. However, normal sized lymph nodes may show metastases upon histological examination, and nodal enlargement may be due to reactive hyperplasia or other benign conditions (2). Rapid advances in multi-detector CT scanners allow a more detailed analysis of the lung parenchyma and mediastinal structures. As a consequence, nodal staging may be enhanced with CT.Positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (FDG) has been reported to improve identification of nodal metastasis. FDG PET images may be more sensitive than CT because alterations in tissue metabolism generally precede anatomical changes (4). Integrated PET-CT provides information about anatomy and metabolism by combining morphological CT data and functional PET data (5). However, falsepositive PET-CT results in nodal staging have been shown in patients with co-existing inflammatory or infectious diseases, and PET-CT scanning may be unable to identify metastatic deposits in normal-sized lymph nodes because of its suboptimal spatial resolution (6, 7).Several retrospective and prospective studies have investigated the effectiveness of CT and PET-CT in pre-operative nodal staging of NSCLC (8-13). However, conflicting conclusions have been reported in these studies. Thus, the aim of our study was to retrospectively evaluate the effectiveness of integrated PET-CT in pre-operative staging of NSCLC in comparison with contrast enhanced CT (CE-CT) by using surgical and pathological findings as the reference standard. Materials and methods Patient populationFrom RESULTS Forty-eight of the 57 patients (84%) had no lymph node involvement (N0), five (9%) were found to have N1 disease, and four (7%) had N2 disease. There was a significant difference between CE-CT and PET-CT for nodal staging of N0 disease (P < 0.05). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of hilar and mediastina...
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