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Malignant and Benign Tracheobronchial Neoplasms: Comprehensive Review with Radiologic, Bronchoscopic, and Pathologic Correlation

Girvin, Francis; Phan, Alexander; Steinberger, Sharon; Shostak, Eugene; Bessich, Jamie; Zhou, Fang; Borczuk, Alain; Brusca-Augello, Geraldine; Goldberg, Margaret; Escalon, Joanna
Tracheobronchial neoplasms are much less common than lung parenchymal neoplasms but can be associated with significant morbidity and mortality. They include a broad differential of both malignant and benign entities, extending far beyond more commonly known pathologic conditions such as squamous cell carcinoma and carcinoid tumor. Airway lesions may be incidental findings at imaging or manifest with symptoms related to airway narrowing or mucosal irritation, invasion of adjacent structures, or distant metastatic disease. While there is considerable overlap in clinical manifestation, imaging features, and bronchoscopic appearances, an awareness of potential distinguishing factors may help narrow the differential diagnosis. The authors review the epidemiology, imaging characteristics, typical anatomic distributions, bronchoscopic appearances, and histopathologic findings of a wide range of neoplastic entities involving the tracheobronchial tree. Malignant neoplasms discussed include squamous cell carcinoma, malignant salivary gland tumors (adenoid cystic carcinoma and mucoepidermoid carcinoma), carcinoid tumor, sarcomas, primary tracheobronchial lymphoma, and inflammatory myofibroblastic tumor. Benign neoplasms discussed include hamartoma, chondroma, lipoma, papilloma, amyloidoma, leiomyoma, neurogenic lesions, and benign salivary gland tumors (pleomorphic adenoma and mucous gland adenoma). Familiarity with the range of potential entities and any distinguishing features should prove valuable to thoracic radiologists, pulmonologists, and cardiothoracic surgeons when encountering the myriad of tracheobronchial neoplasms in clinical practice. Attention is paid to any features that may help render a more specific diagnosis before pathologic confirmation. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
PMID: 37561643
ISSN: 1527-1323
CID: 5595432

Current Imaging of Idiopathic Pulmonary Fibrosis

Gruden, James F; Green, Daniel B; Girvin, Francis G; Naidich, David P
The major role of imaging (CT) in usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF) is in the initial diagnosis. We propose several modifications to existing guidelines to help improve the accuracy of this diagnosis and to enhance interobserver agreement. CT detects the common complications and associations that occur with UIP/IPF including acute exacerbation, lung cancer, and dendriform pulmonary ossification and is useful in informing prognosis based on baseline fibrosis severity. Serial CT imaging is a topic of great interest; it may identify disease progression before FVC decline or clinical change.
PMID: 36202475
ISSN: 1557-8275
CID: 5360732

CT features of electronic-cigarette or vaping-associated lung injury (EVALI); our experience during the recent outbreak [Case Report]

Girvin, Francis; Naidich, David
As an emerging clinical syndrome, our knowledge of the clinical, pathologic and radiologic features of electronic-cigarette or vaping-associated lung injury is evolving. CT appearances are described in six cases imaged at our institution (NYU Langone Health, New York) in the cluster of 2019.
PMCID:7465747
PMID: 32922848
ISSN: 2055-7159
CID: 4629822

Atypical appearance of elastofibroma dorsi at thoracotomy sites: a case series and review of the literature [Case Report]

Girvin, Francis; Hoda, Syed; Kim, Stacy
Thus far, only a single case describing an atypical appearance of elastofibroma dorsi at a prior thoracotomy site has been published in the literature. We describe a series of three cases recently imaged at our institution with the same atypical appearance, in order to highlight and increase recognition of this more unusual morphology in post-operative patients.
PMCID:7527012
PMID: 33029376
ISSN: 2055-7159
CID: 4629972

How I Do It: An Algorithmic Approach to the Interpretation of Diffuse Lung Disease on Chest CT Imaging

Gruden, James F; Naidich, David P; Machnicki, Stephen C; Cohen, Stuart L; Girvin, Francis; Raoof, Suhail
PMID: 31704148
ISSN: 1931-3543
CID: 4184552

Lung Hyperlucency - A Clinical-Radiologic Algorithmic Approach to Diagnosis

Cherian, Sujith V; Girvin, Francis; Naidich, David P; Machnicki, Stephen; Brown, Kevin K; Ryu, Jay H; Gupta, Nishant; Mehta, Vishisht; Estrada-Y-Martin, Rosa M; Narasimhan, Mangala; Oks, Margarita; Raoof, Suhail
Areas of diminished lung density are frequently identified both on routine chest radiographs and chest CT examinations. Colloquially referred to as "hyperlucent" foci of lung, a broad range of underlying pathophysiologic mechanisms and differential diagnoses account for these changes. Despite this, the spectrum of etiologies can be categorized into underlying parenchymal, airway and vascular related entities, respectively. The purpose of this review is to provide a practical diagnostic algorithmic approach to pulmonary hyperlucencies incorporating clinical history and characteristic imaging patterns to narrow the differential.
PMID: 31356811
ISSN: 1931-3543
CID: 4015192

Approach to Peribronchovascular Disease on CT

Ko, Jane P; Girvin, Francis; Moore, William; Naidich, David P
Diseases that are predominantly peribronchovascular in distribution on computed tomography by definition involve the bronchi, adjacent vasculature, and associated lymphatics involving the central or axial lung interstitium. An understanding of diseases that can present with focal peribronchovascular findings is useful for establishing diagnoses and guiding patient management. This review will cover clinical and imaging features that may assist in differentiating amongst the various causes of primarily peribronchovascular disease.
PMID: 31200868
ISSN: 1558-5034
CID: 3930282

Simultaneous Evaluation of Lung Anatomy and Ventilation Using 4D Respiratory-Motion-Resolved Ultrashort Echo Time Sparse MRI

Feng, Li; Delacoste, Jean; Smith, David; Weissbrot, Joseph; Flagg, Eric; Moore, William H; Girvin, Francis; Raad, Roy; Bhattacharji, Priya; Stoffel, David; Piccini, Davide; Stuber, Matthias; Sodickson, Daniel K; Otazo, Ricardo; Chandarana, Hersh
BACKGROUND:Computed tomography (CT) and spirometry are the current standard methods for assessing lung anatomy and pulmonary ventilation, respectively. However, CT provides limited ventilation information and spirometry only provides global measures of lung ventilation. Thus, a method that can enable simultaneous examination of lung anatomy and ventilation is of clinical interest. PURPOSE/OBJECTIVE:To develop and test a 4D respiratory-resolved sparse lung MRI (XD-UTE: eXtra-Dimensional Ultrashort TE imaging) approach for simultaneous evaluation of lung anatomy and pulmonary ventilation. STUDY TYPE/METHODS:Prospective. POPULATION/METHODS:In all, 23 subjects (11 volunteers and 12 patients, mean age = 63.6 ± 8.4). FIELD STRENGTH/SEQUENCE/UNASSIGNED:3T MR; a prototype 3D golden-angle radial UTE sequence, a Cartesian breath-hold volumetric-interpolated examination (BH-VIBE) sequence. ASSESSMENT/RESULTS:All subjects were scanned using the 3D golden-angle radial UTE sequence during normal breathing. Ten subjects underwent an additional scan during alternating normal and deep breathing. Respiratory-motion-resolved sparse reconstruction was performed for all the acquired data to generate dynamic normal-breathing or deep-breathing image series. For comparison, BH-VIBE was performed in 12 subjects. Lung images were visually scored by three experienced chest radiologists and were analyzed by two observers who segmented the left and right lung to derive ventilation parameters in comparison with spirometry. STATISTICAL TESTS/UNASSIGNED:Nonparametric paired two-tailed Wilcoxon signed-rank test; intraclass correlation coefficient, Pearson correlation coefficient. RESULTS:XD-UTE achieved significantly improved image quality compared both with Cartesian BH-VIBE and radial reconstruction without motion compensation (P < 0.05). The global ventilation parameters (a sum of the left and right lung measures) were in good correlation with spirometry in the same subjects (correlation coefficient = 0.724). There were excellent correlations between the results obtained by two observers (intraclass correlation coefficient ranged from 0.8855-0.9995). DATA CONCLUSION/UNASSIGNED:Simultaneous evaluation of lung anatomy and ventilation using XD-UTE is demonstrated, which have shown good potential for improved diagnosis and management of patients with heterogeneous lung diseases. LEVEL OF EVIDENCE/METHODS:2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
PMID: 30252989
ISSN: 1522-2586
CID: 3314262

Quality versus Quantity in Cardiothoracic Imaging: Limitations of the Relative Value Unit (RVU)

Girvin, Francis
PMID: 30668702
ISSN: 1522-9645
CID: 3609922

Image Quality on Dual-energy CTPA Virtual Monoenergetic Images: Quantitative and Qualitative Assessment

Dane, Bari; Patel, Hersh; O'Donnell, Thomas; Girvin, Francis; Brusca-Augello, Geraldine; Alpert, Jeffrey B; Niu, Bowen; Attia, Mariam; Babb, James; Ko, Jane P
RATIONALE AND OBJECTIVES/OBJECTIVE:This study aims to determine the optimal photon energy for image quality of the pulmonary arteries (PAs) on dual-energy computed tomography (CT) pulmonary angiography (CTPA) utilizing low volumes of iodinated contrast. MATERIALS AND METHODS/METHODS:The study received institutional review board exemption and was Health Insurance Portability and Accountability Act compliant. Adults (n = 56) who underwent dual-energy CTPA with 50-60 cc of iodinated contrast on a third-generation dual-source multidetector CT were retrospectively and consecutively identified. Twelve virtual monoenergetic kiloelectron volt (keV) image data sets (40-150 keV, 10-keV increments) were generated with a second-generation noise-reducing algorithm. Standard regions of interest were placed on main, right, left, and right interlobar pulmonary arteries; pectoralis muscle; and extrathoracic air. Attenuation [mean CT number (Hounsfield unit, HU)], noise [standard deviation (HU)], signal to noise (SNR), and contrast to noise ratio were evaluated. Three blinded chest radiologists rated (from 1 to 5, with 5 being the best) randomized monoenergetic and weighted-average images for attenuation and noise. P <.05 was considered significant. RESULTS:Region of interest mean CT number increased as keV decreased, with 40 keV having the highest value (P < .001). Mean SNR was highest for 40-60 keV (P <.05) (14.5-14.7) and was higher (P <.05) than all remaining energies (90-150 keV) for all vessel regions combined. Contrast to noise ratio was highest for 40 keV (P <.001) and decreased as keV increased. SNR was highest at 60 and 70 keV, only slightly higher than 40-50 keV (P <.05). Reader scores for 40-50 keV were greater than other energies and weighted-average images (P <.05). CONCLUSIONS:Kiloelectron volt images of 40-50 keV from the second-generation algorithm optimize attenuation on dual-energy CTPA and can potentially aid in interpretation and avoiding nondiagnostic examinations.
PMID: 29398436
ISSN: 1878-4046
CID: 2979202