Differential Diagnosis of Solitary Pulmonary Inflammatory Lesions and Peripheral Lung Cancers with Contrast-enhanced Computed Tomography

Abstract

OBJECTIVES:To clarify differences between solitary pulmonary inflammatory lesions and peripheral lung cancers with contrast-enhanced computed tomography.METHODS:In total, 64 and 132 patients with solitary pulmonary inflammatory masses/nodules and peripheral lung cancers, respectively, were enrolled in this study. Their computed tomographic findings were summarized and compared retrospectively.RESULTS:Compared with the peripheral lung cancers, the inflammatory lesions were located closer to the pleura (p<0.0001). The majority of the inflammatory lesions were patchy and oval-shaped (82.8%), whereas most of the tumors were lobulated (82.6%). Almost all the inflammatory cases were unclear (93.8%), whereas most of the tumors had spiculated margins (72.7%). Computed tomography values were significantly higher for the inflammatory lesions than for the cancers (p<0.0001). More than half of the inflammatory lesions had defined necrosis (59.3%). Furthermore, 49.2% of the cancers enhanced inhomogeneously, but only 24.6% had ill-defined necrosis or cavities. The peripheral zones of 98.4% of the inflammatory lesions and 72.7% of the tumors were unclear, with peripheral scattered patches (92.2%) and beam-shaped opacity (66.7%) being the most common findings, respectively. Adjacent pleural thickening was more frequent for the inflammatory lesions than the cancers (95.3% vs. 21.1%, p<0.0001), whereas pleural indentation was found in 67.4% of the subjects with cancer. In addition, hilar (p=0.034) and mediastinal (p=0.003) lymphadenopathy were more commonly detected in the cancers than in the inflammatory cases.CONCLUSIONS:Contrast-enhanced computed tomography findings for pulmonary inflammatory lesions and peripheral lung cancers were significantly different in many aspects. Developing a comprehensive understanding of these differences is helpful for directing their management.

Primary solid lung cancerous nodules with different sizes: computed tomography features and their variations

“…Beam-shaped opacity is banded ground glass opacity, which is located on the side of the tumor close to the pleura in different directions. It is common in adenocarcinoma and highly significant in the diagnosis of lung cancer [36]. This sign may be related to the traction of the surrounding lung tissue.…”

Differentiating malignant and benign necrotic lung lesions using kVp-switching dual-energy spectral computed tomography

“…Necrotic pulmonary lesions manifest as relatively low-density internally on contrast-enhanced computed tomography (CT) [ 1 , 2 ]. However, the use of conventional CT to differentiate malignant from benign necrotic pulmonary lesions is challenging as these lesions have similar peripheral enhancements.…”

“…Necrosis evaluation is inarguably part of necrotic lung mass assessment through which quantitative information of the necrotic area can be obtained. Conventional CT has been widely known to provide valuable morphological information regarding pulmonary lesions [ 1 , 3 ], but it is unable to supply sufficient quantitative parameters concerning necrosis, except for conventional CT attenuation values, which are not always helpful in determining whether necrotic lung masses are benign or malignant. Therefore, additional tests such as percutaneous lung biopsy and empirical anti-infective therapy are often required.…”

Primary solid lung cancerous nodules with different sizes: computed tomography features and their variations

“…Beam-shaped opacity is a banded ground glass opacity, which is located at the side of the tumor close to the pleura in different directions. It is common in adenocarcinoma and highly significant in the diagnosis of lung cancer [36]. This sign may be related to the traction of the surrounding lung tissue.…”