Chest-Informal Scientific Presentationconplus.co.kr/~kcr2015/down/abstract_book/Scientific...

Scientific Exhibitions 427C

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Chest-Informal Scientific Presentation

Presenting Final Abstract Presenting Page No. No.

TitleAuthor No.

ISP 01_CH 01 SE 04 CH-18Pulmonary complications in tyrosine kinase

Hee Kang 428inhibitor treatment for non-small cell lung cancer

A Look into Lung-RADS (Lung Imaging Reporting

ISP 01_CH 02 SE 04 CH-30and Data System): Applying Lung-RADS,

Jeong Myeong Kim 428Evaluating Performance, and Reviewing the Lung Cancer Screening Protocol

Distinct pattern of recurrence of lung mucinous ISP 01_CH 03 SE 04 CH-38 adenocarcinoma after surgical resection: Dong Hyun Lee

428Implication for postoperative surveillance strategy

Chest CT Findings of Thoracic Extranodal

ISP 01_CH 04 SE 04 CH-41Lymphoma (Primary or Secondary) Mimicking

Gunsoo Kim 428Other Intra-thoracic Disease: Review of Imaging Spectrum and Differential Diagnosis

Fluoroscopy-guided percutaneous needle biopsy ISP 04_CH 01 SE 04 CH-09 of malignant lung lesions : Is it necessary to Seungeun Lee 429

perform the conventional second needle pass?

ISP 04_CH 02 SE 04 CH-31Implementation of Low Dose CT:

Somin Park 430Five W’s and One H

ISP 04_CH 03 SE 04 CH-10All about pulmonary edema: clinical, physiological

Jae Hong Yoon 430and radiological review

Planning of CT-guided Percutaneous Lung Biopsy ISP 04_CH 04 SE 04 CH-32 Trajectory: Comparison Using Axial Image with Sung Shick Jou 430

Sagittal Image

ISP 05_CH 01 SE 04 CH-50 Chest CT findings of Influenza Virus Infection Gyeonggyun Na 431

ISP 05_CH 02 SE 04 CH-22 Chest CT findings after cardiac or respiratory arrest Soo Jung Lee 431

ISP 05_CH 03 SE 04 CH-36“Lobular geographic”pattern in nonfatal drowning

Seul bi Lee 432at multidetector CT of the lung

ISP 05_CH 04 SE 04 CH-28High lying azygos arch, cases and embryological

Jeehye Kim 432review

Chest CT Findings of Thoracic Extramedullary ISP 06_CH 01 SE 04 CH-40 Plasmacytomas Beyond Multiple Osteolytic Hoon Noh 433

Multiple Myelomas

Role of CT in siting and post procedural following ISP 06_CH 02 SE 04 CH-06 of central venous catheter: anatomical review and Jihyun Lee 433

strategy for preventing complication

Relationship between emphysema severity and ISP 06_CH 03 SE 04 CH-23 the location of lung cancer in patients with chronic Min A Lee 433

obstructive lung disease

Chest-Informal Scientific Presentation15:40-16:00 B2 Hall

Chairperson(s)Dae Hee Han The Catholic University of Korea, Seoul

St. Mary’s Hospital, Korea

ISP 01_CH 01 15:40Pulmonary complications in tyrosine kinaseinhibitor treatment for non-small cell lung cancerHee Kang, Sam Yun, Jae Chun Park, Beom Su Kim Kosin University Gospel Hospital, Korea. [email protected]

The use of epidermal growth factor receptor tyrosinekinase inhibitors (EGFR-TKIs), gefitinib and erlotinib hasbeen increased in treatment of non-small cell lung cancerpatients for the past few years. These drugs have uniquemechanism of action compared with conventionalcytotoxic drugs. The common adverse effects of thesedrugs are rash, diarrhea and nausea which are usuallywell tolerated. However, the pulmonary complicationsincluding interstitial lung disease (ILD) which is rare butsometimes fatal have emerged as a major interest. Wereviewed the mechanism of drug action, incidence, clini-cal and radiological presentation and prognostic factors ofpulmonary complications of EGFR-TKIs in non-small celllung cancer patients. Recognizing the radiological find-ings and their changes according the clinical progress isessential for diagnosis and management of TKI-inducedILD.

ISP 01_CH 02 15:45A look into Lung-RADS (Lung Imaging Reportingand Data System): applying Lung-RADS,evaluating performance, and reviewing the lungcancer screening protocolJeong Myeong Kim, Ji Won Lee, Yeon Joo Jeong,Geewon Lee Pusan National University Hospital, Korea. [email protected]

PURPOSE: To provide an illustrated overview of therecently released Lung-RADS, discuss the effect and pit-falls of using Lung-RADS criteria in clinical practice, andreview the lung cancer screening protocol.TABLE OF CONTENTS: 1. Background of Lung-RADS: The American College of

Radiology (ACR) recently released Lung-RADs, a clas-sification system for low-dose CT lung cancer screen-ing.

2. Comprehensive overview of Lung-RADS: Each catego-ry is associated with a risk of primary lung malignancyand specific recommendations for workup.

3. Performance of Lung-RADS in lung cancer screening:Literature review of Lung-RADS demonstrates sub-stantial reduction in the false-positive rate.

4. Pitfalls of Lung-RADS: Application of Lung-RADS isreported to decrease the sensitivity of lung cancer.

5. Review of the Lung Cancer Screening Protocol: ACRrecommends a high-quality, low-radiation exposure low

dose CT for lung cancer screening. Therefore, scantechnical factors and variable iterative reconstructionsare discussed.

ISP 01_CH 03 15:50Distinct pattern of recurrence of lung mucinousadenocarcinoma after surgical resection:implication for postoperative surveillancestrategyKyung Min Shin, Jae Kwang Lim, Dong Hyun LeeKyungpook National University Hospital, Korea. [email protected]

PURPOSE: Although mucinous adenocarcinoma (MA) isknown to show a characteristic behavior with multicentric-ity and intrapulmonary spread, little data is available toshow whether these characteristics have impact on recur-rence pattern in surgically treated patients. The aim of thisstudy was to characterize the distinctive recurrence pat-tern of surgically resected MA.MATERIALS AND METHODS: Of 1102 consecutivepatients with adenocarcinoma undergoing completeresection over 10 years, 49 patients revealed MA. Allresected specimens were pathologically diagnosedaccording to the International Association for the Study ofLung Cancer classification. We retrospectively reviewedthin-section CT and clinicopathologic features.Multivariate analysis was performed for variables whichwere considered to be influential in univariate analysis.RESULTS: The lesions in 37, 11, and 1 patient wereclassified as pathologic stage I, II, and III, respectively.Eight patients had minimally invasive adenocarcinoma,and 41 patients had invasive MA. Ten patients showedrecurrence which were classified as intrapulmonary nod-ules in 9 patients and pleural seeding in 1 patient. Thevalue of SUVmax on FDG-PET was significantly associat-ed recurrence by multivariate analysis (p = 0.049).CONCLUSION: MA showed a distinct recurrence patternwith a predilection for ipsilateral or contralateral lung, sug-gesting aerogenous spread. Therefore, lung parenchymashould be especially scrutinized in the postoperative sur-veillance CT.

ISP 01_CH 04 15:55Chest CT findings of thoracic extranodallymphoma (primary or secondary) mimickingother intra-thoracic disease: review of imagingspectrum and differential diagnosisGunsoo Kim1, Hyun Ju Seon2, Yunhong Yoon1, Soo Hyun Kim2, Sung Min Moon1, Yun Hyeon Kim1

1Chonnam National University Hospital, 2ChonnamNational University Hwasun Hospital, Korea. [email protected]

TEACHING POINTS: 1. To illustrate the various chest CT findings of thoracic

extranodal lymphoma mimics other intra-thoracic dis-ease.

2. To emphasize the importance of comprehensive evalu-ation of chest CT to find out the clue images can facili-tate differential diagnosis of extranodal lymphoma.

3. Awareness of the spectrum of various extranodal lym-

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phomas at the thorax can facilitate differential diagno-sis of extranodal lymphoma.

TABLE OF CONTENTS: 1. Pathologic and clinical classification of lymphoma with

comprehensive review of thoracic lymphoma2. Characteristics of extranodal lymphoma3. The spectrum of pulmonary involvements of lymphoma

mimics other pulmonary disease 1) Diffuse and smooth interstitial thickening in both

lungs - mimics pulmonary edema2) Diffuse patchy and nodular areas of ground glass

opacities (GGO), crazy-paving lesions, and smoothinterstitial thickening in both lungs - mimics acuteeosinophilic pneumonia

3) A single mass-like consolidation containing patentair-bronchogram mimics peripheral adenocarcinomain left lower lobe

4) Multifocal nodular consolidations associated withtree-in-bud appearances in right lung - mimics multi-focal bronchopneumonias

5) Multiple peripheral patchy areas of GGOs and retic-ulations in both lungs - mimics interstitial lung dis-ease

6) Multiple variable sized nodules in both lungs withGGO halo in many nodules - mimics hemorrhagicmetastasis

4. Air-way and pulmonary involvements of lymphomamimics other disease 1) Diffuse and concentric wall thickening and luminal

narrowing of trachea and bronchi with central peri-bronchovascular consolidations and military nod-ules/tree-in-bud appearances in both lungs - mimicsgranulomatous inflammation such as tuberculosis orsarcoidosis

2) Multiple endotracheal and endobronchial noduleswith multiple pulmonary nodules - mimics respirato-ry papillomatosis

5. Pleural involvements of lymphoma mimics other dis-ease 1) Mimics pleural metastasis.2) Mimics complicated acute empyema and pneumo-

nia6. Cardiac lymphoma manifesting as a single mass in

right atrium - mimics myxoma7. Skeletal lymphoma with multiple osteolytic lesions and

compression fracture in thoracic spines - mimics bonemetastasis

8. Subcutaneous lymphoma - mimics focal inflammationor fat necrosis


Chairperson(s)Tae Jung Kim Samsung Medical Center,

Sungkyunkwan University School ofMedicine, Korea

ISP 04_CH 01 13:40Fluoroscopy-guided percutaneous needlebiopsy of malignant lung lesions: is it necessaryto perform the conventional second needlepass?Seungeun Lee, Jae Beom Hong, Jae Kyo Lee, Mi Soo Hwang Yeungnam University Medical Center, Korea. [email protected]

PURPOSE: To evaluate the diagnostic accuracy of fluo-roscopy-guided percutaneous needle biopsy (PCNB) oflung according to the number of needle pass for confir-mation of malignancy.MATERIALS AND METHODS: From 2012 to 2014, weretrospectively reviewed the medical records of 486patients who underwent fluoroscopy-guided PCNB withpathologically confirmed malignancy. The patients weredivided into two groups according to the total number ofneedle passes (n = 1, n = 2). We excluded the patientswho underwent more than 3 times of needle passes.Diagnostic accuracy and post-biopsy complication rate(pneumothorax or hemoptysis) between two groups wereanalyzed.RESULTS: 88 (83.8%) of 105 lesions were histopatho-logically diagnosed malignancy under only one needlepass. 338 (88.7%) of 381 lesions were correctly diag-nosed by PCNB under two times of needle passes. Therewas no statistically significant difference of diagnosticaccuracy between two groups (p = 0.176). Post-biopsypneumothorax was detected in 6.7% (7/105) and 3.4%(13/381) of patients of each group. Hemoptysis wasdetected in 1.9% (2/105) and 2.4% (9/381) of patients ofeach group. There was no significant difference in fre-quency of pneumothorax and hemoptysis between thetwo groups (p = 0.163, p = 1.000).CONCLUSION: There was no significant difference of thediagnostic accuracy and the complication rate betweenthe first and second needle pass group. The result of thisstudy suggests that conventional routine second needlepass may not be necessary, if the operator successfullyobtained sufficient tissue specimen during the first needlepass.


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ISP 04_CH 02 13:45Implementation of low dose CT: five W’s and oneHYeon Joo Jeong, Ji Won Lee, Geewon Lee, Somin ParkPusan National University Hospital, Korea. [email protected]

PURPOSE: There is increasing clinical application of lowdose CT, resulting in a considerable reduction of radiationdose, yet problems such as indications and image qualityremain a challenge. Therefore, in this review, we explorethe five W’s and one H in the implementation of low doseCT.TABLE OF CONTENTS: 1. Why: Why is a low dose CT an issue? Background on

the development of low dose CT includes increasingmedical radiation exposure and improvement of tech-nology.

2. What: What is a low dose CT? A comprehensivedescription about the definition and approach to quan-tification of low dose CT will be reviewed.

3. When: When should we use a low dose CT? Clinicalindications of low dose CT include lung cancer screen-ing, oncologic follow-up, trauma, and infection.

4. Who: Who controls the protocols? Equipment is con-stantly evolving and radiologists, technologists, andphysicists are responsible for standardization of lowdose CT protocols across different scanners.

5. Where: Where are we now in the era of low dose CT?Current issue and debate on appropriateness of furtherreduction of the radiation dose and iterative reconstruc-tion are discussed.

6. How: How do we modify protocols for low dose CT?Poor understanding of protocols and equipment leadsto inadequate image quality and possibly misdiagnosis.Scan technical factors, reconstruction kernels, and iter-ative reconstruction will be reviewed.

ISP 04_CH 03 13:50All about pulmonary edema: clinical,physiological and radiological reviewJae Hong Yoon, Jihyun Lee, Kyung-Jae Lim, Eun-Ju Kang, Won Jin Choi, Ki-Nam Lee Dong-A University Hospital, Korea. [email protected]

BACKGROUND: Pulmonary edema is quite familiar dis-ease to clinician and radiologist in routine clinical practice.Whereas, sometimes it is hard to diagnosis or interpreta-tion of pulmonary edema; because it has a many faces inradiological images according to the various causes, alsothe clinical manifestation may be uncertain at times.Understanding pulmonary edema in a view point ofpathophysiology will be helpful for not only clinician butalso radiologist. So this educational exhibition is madewith the purpose of calling attention to a pathophysiologyof pulmonary edema and characteristic radiologic findingaccording to each classification. This report contains defi-nition, classification, pathophysiology and radiologic find-ings of pulmonary edema and some interesting cases.CONTENT ORGANIZATION: 1. Definition of pulmonary edema

2. Pathophysiology of pulmonary edema3. Clinical manifestation of pulmonary edema4. Classification and radiologic finding of each categories

1) Hydrostatic edema2) Increased permeability edema with diffuse alveolar

damage- Acute lung injury and acute respiratory distress

syndrome3) Increased permeability edema without diffuse alveo-

lar damage4) Mixed edema

5. Criteria of acute lung injury & acute respiratory distresssyndrome (ALI & ARDS)

6. Some interesting casesPURPOSE: 1. To review the definition, pathophysiology, clinical mani-

festation of pulmonary edema.2. To classify pulmonary edema, acute lung injury and

acute respiratory distress syndrome.3. By apply characteristic radiologic finding to some

cases, it can help diagnosis when encountering somecases of pulmonary edema.

ISP 04_CH 04 13:55Planning of CT-guided percutaneous lungbiopsy trajectory: comparison using axial imagewith sagittal imageSung Shick Jou1, Youngtong Kim2, Jongkyo Han2

1Soonchunhyang University College of Medicine,2Soonchunhyang University Cheonan Hospital, Korea. [email protected]

PURPOSE: Percutaneous transthoracic lung biopsy(PTNB) is a commonly practiced procedure for obtaininglung tissue. The Shortest intercostal route is chosen dur-ing lung biopsies. Anatomically upper portion of lung isdome shape. So, caudal angular approach to lung lesionin upper lobes would be considered shorter than axialvertical approach. This study is to evaluate the advantageof planning biopsy trajectory with additional sagittal imagecompared with only axial image for the lesion in upperlobes during CT-guided PTNB.MATERIALS AND METHODS: From August 2013 toDecember 2014, CT-guided PTNB was performed in 322patients. Patients with upper lobe lesion which wasapproached by vertical or z-axis angular course wereincluded. Those with lesions that could not beapproached by both vertical and z-axis angular coursewere excluded. Patients with lesions that wereapproached with oblique course were excluded. Patientswere in supine or prone position according to the locationof lesion. For biopsy, needle trajectory was obtained onaxial image and measured the depth from skin and pleu-ra, needle trajectory angle on axial and sagittal plane.And then the other needle trajectory was obtained onsagittal image referring axial image. Same parametersand z-axis angle were measured. To analyze the differ-ence between 2 trajectories, paired T test was used.Correlations of z-axis angles with the differences of depthfrom skin and pleura, and the difference of needle trajec-tory angle on axial and sagittal plane was assessed. RESULTS: Eighty two patients were included in thisstudy. The difference of depth from skin and pleura and

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the difference of needle trajectory angle on sagittal planebetween trajectory on axial and sagittal image were sta-tistically significant (p < 0.05). The z-axis angle was corre-lated with the differences of depth from pleura and trajec-tory angle on sagittal plane but not with the differences ofdepth from skin and trajectory angle on axial plane (p <0.05). DISCUSSION: For biopsy of upper lobe lesion, the depthof biopsy could decrease and trajectory angle on sagittalplane could increase by planning trajectory with sagittalimage compared with axial image.CLINICAL RELEVANCE: Sagittal image is obtained onCT console instantly. So, CT-guided biopsy of upper lobelesions should be planned with axial and sagittal image.




ISP 05_CH 01 15:40Chest CT findings of influenza virus infectionMi-Sook Lee, Gyeonggyun Na, Hee-Jun Kim,Myung-Jin Seol Presbyterian Medical Center, Korea. [email protected]

PURPOSE: Presenting the Chest CT features ofInfluenza virus infection patients.MATERIALS AND METHODS: This study included 105patients with Influenza virus A or B infection and havingchest CT scan between January 2010 and February2015. And we excluded the influenza virus infectionpatients who already had underlying conditions such asCOPD, idiopathic interstitial lung disease, lung cancer,CKD, and heart disease.RESULTS: The number of patients was 70 females and35 males, ranging 21 months to 91-year-old. The mostcommon finding was non-specific seen from 33 patients(33/105). In 20 patients, bronchial wall thickening wasseen. There were focal GGO (18/105), diffuse GGO(3/105), bronchial wall thickening and GGO (9/105),bronchial wall thickening and consolidation (7/105), con-solidation and GGO (11/105), and consolidation (3/105).The one patient had GGO with interlobular septa andbronchial wall thickening. 2 patients were expired due toARDS and sepsis and the other 103 patients were sur-vived.CONCLUSION: Among patients with influenza A or Bvirus infection, the most common chest CT finding wasnon-specific (33/105), but there were bronchial wall thick-ening (20/105), focal GGO (18/105), diffuse GGO (3/105),bronchial wall thickening and GGO (9/105), bronchial wallthickening and consolidation (7/105), consolidation andGGO (11/105), and consolidation (3/105).

ISP 05_CH 02 15:45Chest CT findings after cardiac or respiratoryarrestSung Jin Kim, Soo Jung Lee, Kil Sun Park, Sang Hoon Cha, Bum Sang Cho, Min Ho Kang,Kyung Sik Yi, Ji Sun Lee, Woo Young Kang Chungbuk National University Hospital, Korea. [email protected]

PURPOSE: Ground glass opacity (GGO) and consolida-tion are frequent chest CT findings in patients who hadarrest and undergone cardiopulmonary resuscitation(CPR). There were difficulties to make differential diagno-sis of these findings with CPR related lung contusion,pneumonia, pulmonary edema, aspiration or etc. Thereare a few related publications and most of them arefocused on CPR associated lung injury. So in this article,we will evaluate the chest CT findings of cardiac or respi-ratory arrest patients and discuss about the common find-ings.MATERIALS AND METHODS: Total 58 patients (50patients with sudden cardiac arrest and 8 patients withoutself-respiration) who underwent chest CT were includedin study population. Among cardiac arrest patients, 44patients had out-of hospital arrest and only 6 patients hadin-hospital arrest. All cardiac arrest patients underwentCPR and 8 patients with respiratory arrest did notreceived cardiac compression. We reviewed chest CT ofthese patients to evaluate the findings after cardiac orrespiratory arrest. Initial and follow up chest radiographswere also reviewed for evaluation of clear up time.RESULTS: Mean CPR time was 21 minutes and meanreturn of spontaneous circulation (ROSC) to CT time was2 hours and 13 minutes. The most common chest CTpatterns were bilateral (n = 47), diffuse (n = 34), GGOand consolidation (n = 55), distributed with gradient pat-tern (n = 19). Many cases spare lateral area (n = 32).Thickening of interlobular septa (ILS) (n = 26) and pleuraleffusion (n = 20) were also noted. Findings in cases withonly dependent density were six. Mean clear up time ofchest plain radiograph of 34 patients was 27.5 hours. 8patients showed normal in initial and follow up chest plainradiographs and rest of 12 patients did not underwent fol-low up radiographs.CONCLUSION: The most common imaging findings ofchest CT after arrest were bilateral consolidation andGGO with gradient pattern, sparing peripheral area.Thickening of ILS was an additional common finding.Previous studies mentioned that these findings to be apulmonary contusion after CPR. However, there aresame findings in patients who did not undergone CPR orthere are non-specific findings in patients who hadreceived CPR. So we think that these common findingsare not only because of CPR related lung injuries, butfrom cardiac or respiratory failure by mechanism of pul-monary edema, reperfusion injury or aspiration.


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ISP 05_CH 03 15:50“Lobular geographic” pattern in nonfataldrowning at multidetector CT of the lungSeul bi Lee, Kyung won Doo, Jong woon Song,Hong dae Kim Inje University Haeundae Paik Hospital, Korea. [email protected]

PURPOSE: Lung injury is very common consequence inpatient of submersion accident, and usually occurred withradiologic abnormality. The aim of this study was to iden-tify the characteristic image findings of nonfatal drowningin multidetector computed tomography (CT).MATERIALS AND METHODS: The study included 16patients who had experienced nonfatal drowning andcontrol group of 23 consecutive subjects who had experi-enced aspiration after alcohol or drug intoxication, or car-diac arrest. All patients in both groups had bilateral lungparenchymal opacities on chest CT performed within 24hours of episodes. Chest CT scans were reviewed by tworadiologists with respect to the presence and distributionof parenchymal abnormalities including ground-glassopacity (GGO), consolidation, centrilobular nodules andcrazy-paving appearance, and decision was reached byconsensus. The “lobular geographic” pattern of GGO wasalso assessed, which was defined as multifocal areas ofGGO mainly centered in secondary pulmonary lobule andmarginated by septal anatomy.RESULTS: Between drowning and nondrowning group,there were no significant differences in patients’ age, sex,and the presence of hypoxemia at admission (p > 0.05).The lobular geographic pattern of GGO was shown in75% (12/16) of drowning group and 25% (4/23) ofnondrowning group. Drowning lung injury showed lobulargeographic pattern more frequently (p < 0.05). Other CTfindings included GGO, consolidation, centrilobular nod-ules and crazy-paving appearance, and distribution pat-terns were not significant discriminators of drowning lunginjury.CONCLUSION: Drowning patients have a significantlyhigher frequency of lobular geographic pattern of GGO onMDCT than nondrowning patients. The lobular geograph-ic pattern is highly suggestive of nonfatal drowning andmay be helpful in evaluating nearly drowned patients.CLINICAL APPLICATION: Multidetector CT can demon-strate characteristic radiologic finding in nonfatal drowningand may be useful to differentiate from respiratory dis-tress by any other manner.

ISP 05_CH 04 15:55High lying azygos arch, cases andembryological reviewSJ Kim, Jeehye Kim, Soojung Lee, Kilsun Park,Bumsang Cho, SangHoon Cha, Minho Kang,Kyungsik Yi, Jisun Lee, Wooyoung Kang Chungbuk National University Hospital, Korea. [email protected]

PURPOSE: To suggest a hypothesis on embryologicalorigin of azygos vein by evaluating Chest CT of patientswith high lying azygos vein.BACKGROUND: Embryologically, the azygos arch maybe formed from the right supracardinal vein (azygos vein)superiorly, the right posterior cardinal vein (azygos arch)inferiorly, and the right anterior cardinal vein (superiorvena cava). The azygos vein is formed by the union ofright ascending lumbar and subcostal veins, and ascendsin the posterior mediastinum arching ventrally just cephal-ad to the right main bronchus at the level of T4 or T5 anddrains into the superior vena cava.MATERIALS AND METHODS: From April 2012 toNovember 2014, the 10 cases of high lying azygos archwere found in our institute. The 107 cases of trachealbronchus were collected from May 2006 to November2014, then assessed by two experienced radiologists anda resident.RESULTS: All of 10 cases of high lying azygos arch werelocated just below the union of both brachiocephalic vein.And all of 107 cases of tracheal bronchus showed Highlying azygos arch.CONCLUSION: In the light of that all patient with trachealbronchus have high lying azygos arch, we hypothesizethat high azygos arch is the result of incomplete down-ward migration of the right posterior cardinal vein, in thesame vein as azygos lobe of the lung develops due tofailure of migration over the apex of right lung to its nor-mal medial position in the mediastinum.

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ISP 06_CH 01 09:40Chest CT findings of thoracic extramedullaryplasmacytomas beyond multiple osteolyticmultiple myelomasHoon Noh1, Hyun Ju Seon1, Yunhong Yoon2, Soo Hyun Kim1, Sung Min Moon2, Yun Hyeon Kim2

1Chonnam National University Hwasun Hospital,2Chonnam National University Hospital, Korea. [email protected]

TEACHING POINTS: 1. To illustrate the various chest CT findings of thoracic

extramedullay plasmacytomas including pulmonaryinvolvement.

2. To overview the clinical manifestation and radiologicfindings of extramedullay plasmacytomas beyond mul-tiple osteolytic multiple myelomas.

3. To understand helpful imaging findings for differentia-tion of extramedullay plasmacytomas from other malig-nancies regardless of involving organs.

TABLE OF CONTENTS:1. Definition and clinical characteristics of extramedullay

plasmacytomas2. Diagnostic approach of extramedullay plasmacytomas3. Imaging findings of thoracic extramedullay plasmacy-

toma according to involving organs1) Pulmonary involvement2) Air-way involvement3) Pleural and/or chest wall involvement4) Osseous and peri-osseous involvement

4. Management of extramedullary plasmacytomas

ISP 06_CH 02 09:45Role of CT in siting and post proceduralfollowing of central venous catheter: anatomicalreview and strategy for preventing complicationJihyun Lee1, Eun-Ju Kang2, Won Jin Choi2, Jae hong Yoon2, Dong-Ho Ha2, Ki-Nam Lee2

1Dong-A University Medical Center, 2Dong-A UniversityHospital, Korea. [email protected]

BACKGROUND: Large numbers of central venouscatheters (CVCs) are placed each year and centralvenous catheterization is an essential skill for manyphysicians. However, variable complications may occur inclinical routine practice. Conventionally, chest radi-ographs used to predict catheter position and detect fre-quent complication such as pneumothorax after CVCplacement. However, there are limitations to such imag-ing for assessment of true catheter position. CT scanscan provide information about catheter, central vein,artery, adjacent structure and help to detect variable com-

plications after CVCs insertion. In this educational exhibi-tion, we are going to describe normal and abnormalanatomy of central vein in relation to CVCs insertion,anatomical correlation of CT and possible complicationsof CVCs to minimize them.CONTENT ORGANIZATION: 1. Normal and abnormal anatomy of central veins with CT

correlation2. Indications for CVCs and various types of CVCs3. Central venous catheterization method and ideal

catheter tip placement4. CVCs-related complication

1) Chest wall injury2) Vascular injury

(1) Catheter misplacement with normal venousanatomy

(2) Anatomic abnormalities predisposing to CVCmisplacement; acquired and congenital cause

3) Pleural or lung parenchyma injury5. Strategy for preventing complications of central venous

catheterizationPURPOSE: 1. To review the normal and abnormal anatomy of central

veins with CT correlation in relation to the placement ofCVCs

2. To categorize various complications of CVCs insertionby anatomic consideration

3. To discuss how to minimize the CVCs related compli-cations

ISP 06_CH 03 09:50Relationship between emphysema severity andthe location of lung cancer in patients withchronic obstructive lung diseaseMin A Lee, Kyung Min Shin, Jae Kwang Lim Kyungpook National University Hospital, Korea. [email protected]

PURPOSE: New phenotypes of chronic obstructive pul-monary disease (COPD) based on emphysema severityhas been recognized recently. The purpose of this studywas to determine the relationship between emphysemaseverity (phenotype) and lung cancer location in patientswith COPD.MATERIALS AND METHODS: Four hundred patientswith 405 primary lung cancers confirmed pathologicallybetween January 2010 and March 2014 were included inthe study. Of these, 193 patients were diagnosed withCOPD according to the Global Initiative for ObstructiveLung Disease guidelines. We scored emphysema severi-ty (0-4) on thin-section computed tomography andassigned the anatomical tumor location of lung cancer asperipheral or central.RESULTS: COPD patients had a higher proportion ofcentral location of lung cancer compared with those with-out COPD (36.4% vs. 17.4%, p < 0.001). In COPDpatients, lower emphysema grades (odd ratio [OR], 0.67;95% confidence interval [CI], 0.50-0.89, p = 0.007) andreduced forced expiratory volume in one second/forcedvital capacity (FEV1/FVC) (OR, 0.95; 95% CI, 0.90-1.00,p = 0.047) were associated with central location. Afteradjusting for age, smoking, and spirometry results, theproportion of central location was approximately four


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times higher in lower emphysema grades (0-2, < 25%)than in severe grades (grade 4, > 51%).CONCLUSION: Lower emphysema grades and reducedFEV1/FVC seemed to be independent predictors of cen-tral location of lung cancer in COPD. Therefore, in COPDpatients with lower grade emphysema and airway-pre-dominant disease, additional screening tools may have tobe considered for central lung cancer detection, alongwith thin-section computed tomography.

SE 04 CH-01Radiologic findings in COPD patients:comparison of the patients with and withoutconsistent clinical symptom and pulmonaryfunction result Boda Nam1, Jung Hwa Hwang1, Sujiin Ko1, Young Mok Lee2, Jai-soung Park3, Sung sik Jou4,Youngbae Kim5

1Soonchunhyang University Hospital Seoul, 2BangbaeGF Allergy Clinic, 3Soonchunhyang University BucheonHospital, 4Soonchunhyang University CheonanHospital, 5Soonchunhyang University College ofMedicine, Korea. [email protected]

PURPOSE: We compared clinical and quantitative CTmeasurement parameters between COPD patients withand those without consistent clinical symptom and pul-monary function result.MATERIALS AND METHODS: This study included 60patients with clinical diagnosis of COPD who underwentchest CT scan and pulmonary functional tests. We classi-fied 60 patients with typical and atypical groups andwhich were subclassified according to dyspnea score andthe result of pulmonary functional test. Quantitative mea-surements of the CT data for emphysema, bronchial wallthickness and air-trapping were performed with softwareanalysis. Statistical analysis with comparison was per-formed between the groups.RESULTS: CT emphysema index and air-trapping indexwere revealed as significant parameters between the typi-cal and atypical groups. CT emphysema index well corre-lated with the result of pulmonary functional test andbronchial wall area ratio was well correlated with the dys-pnea score. CT air-trapping index well correlated with theresult of pulmonary functional test and which wasrevealed as significant parameter between the typical andatypical groups.CONCLUSION: Quantitative CT measurements foremphysema and airways well correlated with clinicalsymptom and pulmonary function result in patients withCOPD. Air-trapping was the most significant parameterbetween the COPD patients with and those without con-sistent clinical symptom and pulmonary function result.

SE 04 CH-02CT basics of lung basesSunyoung Park1, Myeong Im Ahn1, Kyongmin Beck2

1School of Medicine, The Catholic University of Korea,2The Catholic University of Korea, Seoul St. Mary’sHospital, Korea. [email protected]

There exist many kinds of normal anatomic structuresand variants in lung bases that might be easily over-looked or misread on chest CT scan. The educationalgoals of this exhibit are to review the basic CT anatomy oflung bases and to suggest the interpretative points of nor-mal CT findings of lung bases. CT images of followingstructures and findings in lung bases are to be presentedwith suggestion of interpretative points and review of liter-atures; pulmonary ligaments, intersegmental (intersublo-bar) septum, phrenic nerve and vessels, intrafissural fat,juxtaphrenic peak, inferior accessory fissure, normal lobu-lar air trapping, dependent atelectasis, posterior subpleur-al nodular atelectasis, focal interstitial fibrosis associatedwith spinal osteophytes, cisterna chyli, pericaval fat col-lection, nodular diaphragmatic crus, small diaphragmaticdefect with abdominal fat herniation, pericardial fat pad,intercostal stripe, prominent extrapleural fat.

SE 04 CH-03A highway across all - cutaneous-broncho-pleural-esophageal fistulaSee Yin Wong1, Heng Tee Khor2

1Queen Elizabeth II Hospital Sabah, 2Queen ElizabethHospital, Kota Kinabalu, Sabah, Malaysia. [email protected]

PURPOSE: Fistulous communication between skin, res-piratory or gastrointestinal tracts can be benign or malig-nant. Benign cutaneous esophageal, cutaneous bronchialand bronchoesophageal fistula (BEF) is very rare. Thereare scarce reports on benign esophageal respiratory fistu-la. However, a report on fistula, which communicates allthese structures, to my best knowledge, has not beenreported yet. CASE DESCRIPTION: A 17-year-old boy presented toour casualty with fever, cough, constitutional symptomsand shortness of breath, associated with pleuritic chestpain for 1 week. Since 2012, there was a persistent ante-rior chest wall wound, which occurred post incision anddrainage for chest wall abscess. He defaulted follow upafter several visits for wound dressing. Clinically, he wasemaciated and tachypnoeic. There was a 3 × 3 cm ulcerat the left anterior chest wall that was actively dischargingpus. Sputum smear showed presence of acid-fast bacilli.Blood investigations showed malnutrition and active infec-tion. Chest X-ray showed scattered consolidations bilater-ally. Intravenous contrast enhanced computed tomogra-phy (CT) fistulogram of the thorax was performed.Contrast was administered via an 18G cannula into theanterior chest wall opening. CT showed contrast outliningthe subcutaneous tract, and tracked into the lower esoph-agus, pleural space and segmental branch of left lowerlobe bronchus. The stomach and duodenum were alsoopacified. There were cavitating consolidations involvingthe left hemithorax and right upper lobe. Tree-in-bud

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changes in the right lower lobe. An enlarged subcarinallymph node with necrotic center. Patient was started onantituberculous treatment and enteral feeds. Surgicalmanagement was planned. Unfortunately, he succumbedfive days later. DISCUSSION: In this patient, reduced left lung volumewith pleural thickening suggests previous severe chestinfection. Presence of dense consolidation involving theadjacent left lower lobe and left lung empyema most likelyhave produced inflammatory reaction, facilitating exten-sive fistulization between the pre-existing left anteriorchest wall non healing ulcer to the pleural space, leftlower lobe bronchi and lower esophagus. Hence fistulasinvolving these structures formed over time. The sinusesand fistulae can heal with anti-tuberculosis treatment.However, for those who fail medical treatment, surgerymay be required.

SE 04 CH-04Asbestos-related pleural plaques: radiographicand CT correlationYookyung Kim, Jeong Kyong Lee Ewha Womans University Medical Center, Korea. [email protected]

PURPOSE: To assess the chest radiographic (CR) andCT characteristics of asbestos-related pleural plaquesand evaluate diagnostic sensitivity of CR for the diagnosisof pleural plaques.MATERIALS AND METHODS: A total of 310 asbestosworkers were diagnosed to have pleural and/or parenchy-mal abnormalities consistent with asbestos exposure byhigh-resolution chest CT scan from January 2011 toDecember 2014. Among them, this study enrolled 46workers who had isolated pleural plaques and underwentboth CR and CT scan. Subjects who had asbestosis wereexcluded. CRs and CT scans were analyzed for the mor-phologic characteristics, numbers, and distribution ofpleural plaques in the thorax. Diagnostic accuracy of CRwere assessed with a reference standard of CT findings.RESULTS: The sensitivity of CR for the diagnosis ofpleural plaques were 71.7% (33/46). Calcification wasnoted in plaques in 84.8% on CR and 93.9% on CT. Thenumber of plaques was 1 in 9.1% on CR and 0% on CT,2-5 in 41.3% on CR and 13.0% on CT, and > 5 in 23.9%on CR and 87.0% on CT. Unilateral and bilateral hemitho-rax involvement were noted in 21.7% and 50.0% on CRrespectively, while in 2.2% and 97.8% on CT.Diaphragmatic plaques were noted in 43.5% on CR and78.3% on CT and the right diaphragm was more frequent-ly involved (right: CR, 34.8%; CT, 76.1% vs. left: CR,28.3%; CT 50.0%). Mediastinal pleural plaques wereobserved in 15.2% on CR and 47.8% on CT with morefrequent involvement of the left (right: CR, 2.2%; CT,15.2% vs. left: CR, 13.0%; CT 45.6%). The maximumthickness (CR, 4.6 ± 3.2 mm vs. CT, 7.3 ± 2.3 mm, p =0.025) and width (CR, 39.2 ± 39.5 mm vs. CT, 55.7 ±32.3 mm, p = 0.011) of plaques were significantly under-estimated on CR compared to CT.CONCLUSION: Chest radiograph showed low diagnosticsensitivity for the diagnosis of isolated pleural plaqueswith significant underestimation in numbers and maxi-mum widths of plaques compared to CT. Pleural plaques

were variable in number and size, and showed a predom-inant distribution in the lower chest walls, right diaphragm,and left mediastinum.

SE 04 CH-05CT characteristics of pleural plaques related tooccupational or environmental asbestosexposure from Korean asbestos minesYookyung Kim, Sung Shine Shim Ewha Womans University Medical Center, Korea. [email protected]

PURPOSE: We evaluated the CT characteristics of pleur-al plaques in asbestos-exposed individuals and com-pared occupational and environmental exposure groups.MATERIALS AND METHODS: This study enrolled 181subjects with occupational exposure and 98 with environ-mental exposure from chrysotile asbestos mines, whohad pleural plaques confirmed by chest CT. CT scanswere analyzed for morphological characteristics, num-bers, and distribution of pleural plaques and combinedpulmonary fibrosis, and CT findings were comparedbetween occupational and environmental exposuregroups.RESULTS: Among the 279 subjects, pleural plaqueswere single in 2.2% and unilateral in 3.6%, and showedvariable widths (range, 1-20 mm; mean, 5.4 ± 2.7 mm)and lengths (5-310 mm; 72.6 ± 54.8 mm). The chestwall was most commonly involved (98.6%), with an upperpredominance on the ventral side (upper, 77.8% vs.lower, 55.9%, p < 0.0001) and a lower predominance onthe dorsal side (upper, 74.9% vs. lower, 91.8%, p =0.0207). Diaphragmatic involvement (78.1%) showed aright-side predominance (right, 73.8% vs. left, 55.6%, p <0.0001) while mediastinal plaques (42.7%) were morefrequent on the left (right, 17.6% vs. left: 39.4%, p <0.0001). The extent and maximum length of plaques, andpresence and severity of combined asbestosis, were sig-nificantly higher in the occupational exposure group (p <0.05).CONCLUSION: Pleural plaques were variable in numberand size, and showed a predominant distribution in theupper ventral and lower dorsal chest walls, rightdiaphragm, and left mediastinum. Asbestos mine workershad higher extents of plaques and pulmonary fibrosis ver-sus environmentally exposed individuals.

SE 04 CH-07Postoperative complication after lung surgery:importance of serial chest radiographDong Wook Kim, Eun Jin Chae, Sang Young Oh,Kyoung-Hyun Do, Hyun Ju Lee, Sang Min Lee,Sang Min Lee, Mi Young Kim, Joon Beom Seo, Jae Woo Song, Koun Sik Song Asan Medical Center, Korea. [email protected]

PURPOSE:1. To review the expected post-surgical change which

could be differentiated from complication.2. To review broad spectrum of imaging features of early

and late postoperative complications after lung surgery.


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3. To stress the importance of serial chest radiograph fordetecting postoperative complication earlier.

CONTENT ORGANIZATION:1. Type of lung surgery2. Expected post-surgical changes3. Postoperative complications

1) Early complications (during hospitalization)- Atelectasis- Persistent air leak- Pulmonary edema- ARDS or acute lung injury- Pneumonia- Bronchopleural fistula- Empyema- Hemothorax/chylothorax- Cardiac hernia- Lung torsion

2) Late complications (OPD Follow-up)- Postpneumonectomy syndrome- Bronchopleural/esophagopleural fistula

4. Summary: Important clues for detecting complicationson serial chest radiograph.

SUMMARY: There are various postoperative complica-tions which occurred after lung surgery. Interpretation ofserial chest radiograph is important for early detection ofthese complications which are differentiated from expect-ed post-surgical changes.

SE 04 CH-08Comparative study on bleomycin-induced andpolyhexamethylene guanidine phosphate (PHMGphosphate)-induced lung fibrosis model in miceusing micro-CTSeong hyun Wee1, Seong-Hoon Park2, Gyu Mok Lee1, Tae Yeong Heo1, Young-Hwan Lee2,Seon-Kwan Juhng2

1Wonkwang University Hospital, 2Wonkwang UniversitySchool of Medicine, Korea. [email protected]

PURPOSE: To identify the imaging features ofbleomycin-induced and polyhexamethylene guanidinephosphate (PHMG phosphate)-induced lung fibrosis inmice model over time using micro-computed tomography(CT).MATERIALS AND METHODS: Mice model of inhaledPHMG-induced lung fibrosis was used to evaluate themicro-CT imaging features, comparing with mice model ofinhaled bleomycin-induced lung fibrosis and mice modelof inhaled saline. A single PHMG (0.0375%) was inhaledto three mice, bleomycin (1.5 mg/kg) was inhaled toanother three mice and saline was inhaled to the otherthree mice at same day. Micro-CT lung imaging studywas performed for nine mice at day 9 to 70 every 1 week.Two readers evaluated the micro-CT images of the day 9,30, 51 twice independently.RESULTS: On micro-CT findings, ground glass opacity(GGO, 58%), consolidation (31%) and bronchial dilatation(11%) were observed predominantly at day 9 after theinhalation of bleomycin, and in PHMG-inhaled mice,ground glass opacity (45%), consolidation (31%) andbronchial dilatation (18%) were observed predominantlyat day 9, and the radiologic features became more com-

plicated at day 30 and 51. Ground glass opacity was pre-dominant radiologic features in bleomycin-inhaled mice atday 30 and 51 (50% and 47%, respectively), and consoli-dation was predominant radiologic features in PHMG-inhaled mice at day 30 and 51 (48% and 41%) on micro-CT. Bronchial dilatation was most frequently observed inPHMG-inhaled mice at day 51 (33%) among all micegroups.CONCLUSION: These results indicate that inhaledPHMG may cause significant pulmonary inflammationand fibrosis in mice and that its radiologic features forlung injury is similar to inhaled bleomycin-induced lungfibrosis model and that the visualization of PHMG-induced pulmonary fibrosis using micro-CT may be valu-able to assess the toxicities of PHMG. It implies thatmicro-CT can be applied to evaluate inflammatory andfibrotic changes of a variety of toxic agents for lung dis-eases.

SE 04 CH-11Role of CT quantification of central airway onfollow-up after medical treatment intracheobronchomalaciaWon Hyeong Im, Gong Yong Jin, Young Min Han,Eun Young Kim Chonbuk National University Hospital, Korea. [email protected]

PURPOSE: To know which factors of central airway areimproved in tracheobronchomalacia (TBM) patients onmedical managementMATERIALS AND METHODS: From April 2013 to July2014, among 21 patients diagnosed as TBM on CT, 10patients (69.5 ± 8.5, M:F = 2:8) underwent follow-up CTand were managing by medical therapy. All subjectsunderwent CT with deep inspiration and expiration. Toquantified analysis of central airway, airway parametersof trachea and both main bronchus at inspiration andexpiration were assessed using software (VIDA diagnos-tic). Airway parameters of TBM on inspiration and expira-tion CT that underwent at diagnosed time were comparedwith those of follow-up CT using the Wilcoxon signedrank test.RESULTS: In inspiration CT, there was no difference ofairway parameters between CT underwent at diagnosedtime and CT underwent at follow up time (trachea, the for-mer vs. the latter, average inner area, 234.35 ± 95.11mm2 vs. 199.38 ± 101.86 mm2, average wall perimeter,54.44 ± 10.65 mm vs. 51.10 ± 11.85 mm, average wallthickness, 2.44 mm ± 0.58 mm vs. 2.24 ± 0.72 mm,average wall to total area ratio, 0.40 ± 0.05 vs. 0.53 ±0.66, p < 0.05). Also, in expiration CT, there was no differ-ence of airway parameters between CT underwent atdiagnosed time and CT underwent at follow up time (tra-chea, average inner area 134.79 ± 57.11 mm2 vs.147.47 ± 96.69 mm2, average wall perimeter, 45.17 ±8.21 mm vs. 45.53 ± 11.32 mm, average wall thickness,1.84 ± 0.69 mm vs. 1.89 ± 0.74 mm, average wall tototal area ratio, 0.40 ± 0.08 vs. 0.39 ± 0.03, p < 0.05).CONCLUSION: In TBM patients, none of central airwayparameters through CT quantification were improved onfollow up in spite of medical management.

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SE 04 CH-12Radiographic findings of intrapulmonaryhemorrhage as a complication of clopidogreluse in a patient with acute coronary syndromeEun Jung Shim, Dong Wook Sung, Kyung-Mi Lee,Soo Yeon Shin Kyung Hee University Medical Center, Korea. [email protected]

PURPOSE: Clopidogrel is an effective antiplatelet agentthat is used as an adjuvant to percutaneous coronaryintervention (PCI) with promising antithrombotic effects.Intrapulmonary hemorrhage following PCI is a rare com-plication. We report a case of bleeding in a patient treatedwith a clopidogrel immediately after PCI.MATERIALS AND METHODS: A 53-year-old man visit-ed the emergency department with continuous, severesubsternal chest pain associated with sweating, radiatingto both shoulders and the back. Laboratory tests revealedelevated heart and liver enzymes. An emergency coro-nary angiogram showed total occlusion in the middle seg-ment of the left anterior descending (LAD) artery, severestenosis of the proximal segment of the LAD, severestenosis of the mid to distal segment of the left circumflexartery and proximal segment of the right coronary artery(RCA), and moderate stenosis of the middle segment ofthe RCA. Percutaneous transluminal coronary angioplas-ty (PTCA) was done and followed by maintenance dosesof aspirin 100 mg and clopidogrel 75 mg. Three dayslater, the patient presented with hemoptysis and nasalbleeding with dyspnea.RESULTS: The chest radiograph obtained at admissionshowed haziness of the central lung zones and blurring ofthe hilar shadows, suggesting mild pulmonary edema. Afollow-up chest radiograph revealed worse bilateral alveo-lar infiltration in both lungs, prominent upper lobes, andbilateral pleural effusion. In a chest radiograph obtained 5days after PTCA, the bilateral infiltrations and pleural effu-sions were increased slightly. Chest computed tomogra-phy revealed diffuse patchy ground-glass opacity with acrazy-paving pattern in both lungs and relative sparing ofboth lower lobes. Focal areas of airspace consolidationwere seen in both upper lobes.CONCLUSION: Patients who undergo PTCA and aregiven antiplatelet agents such as clopidogrel can develophemoptysis and dyspnea. If alveolar infiltrates are seenon chest radiographs, the possibility of intrapulmonaryhemorrhage must be considered. Clinicians and radiolo-gists need to be aware of this life-threatening bleedingcomplication of clopidogrel.

SE 04 CH-13Rhodococcus pneumonia: evolution of imagingmanifestation in immunocompromised patient:Hospital Sungai Buloh experienceAida Abdul Aziz, Yun Si ingHospital Sungai Buloh, Malaysia. [email protected]

PURPOSE: To discuss the radiographic features, imag-ing manifestations and outcome of Rhodococcus pneu-monia, especially in immunocompromised patients.DISCUSSION: Rhodococcus equi primarily causes

zoonotic infections which rarely infects immunocompetenthumans, it is emerging as an important pathogen inimmunocompromised persons. Thus, as an InfectiousDisease Center, we’ve observed total number of 26 num-ber of cases which mostly are immunocompromisedpatients contracted rhodococcus infection. Hence, wehoped to share the typical radiographic patterns, radi-ographic manifestations and outcomes. A prominent alve-olar pattern characterized by ill-defined regional consoli-dation is the most common radiographic abnormality. Theconsolidated lesions are often seen as more discretenodular and cavitary lesions compatible with pulmonaryabscessation. The cavitating changes are more frequent-ly observed in those with acquired immunodeficiency syn-drome (AIDS). These radiographic features are also pre-sent in pulmonary tuberculosis and lung abscesses.Thus, few differentiating factors are outlined in this article.The diagnosis should be considered as in our experiencethese patients are usually diagnosed as pulmonary tuber-culosis or staphylococcus pneumonia at first. However, inview of worsening or non-resolution of symptoms with nobiochemical or positive culture supporting the diagnosis ofPTB or Staph pneumonia, this pathogen is then consid-ered. Blood and/or sputum cultures are confirmatory.Apart from these, we also outlined the outcomes of theseinfections, with hope to share the expected disease evo-lution.CONCLUSION: Rhodococcus pneumonia should beadded in the list of differential diagnosis of the cavitatingpneumonias, especially in an immunocompromisedpatients. Recognition of this entity is important sinceantibiotic therapy is different from that conventionallyused in pneumonias in AIDS patients and must be pro-longed.

SE 04 CH-14Cases of silicosis among workers of Bor-Undurfluoride miningBolormaa Damdinsuren1, Zultsetseg Chinsuren2,Oyuntogos Batdelger3, Burmaa Ganjuur4, Delgermaa Vanya5

1Department of Radiology Center of Labour HealtStudy, Mongol, 2Centre for Health Development,Mongolia, 3Resident of Radiology, Mongolian NationalUniversity of Medical Sciences, 4Center of LabourHealth Study, Mongolia, 5World Health OrganizationMongolia, Mongolia. [email protected]

Silica is a common, naturally-occurring crystal. It is foundin most rock beds and forms dust during mining, quarry-ing, tunneling, and working with many metal ores. Silica isa main part of sand, so glass workers and sand-blastersare also exposed to silica.Silicosis is a kind of pneumoconiosis caused by breathingin silica dust. Silicosis is the most common occurredoccupational respiratory disease especially, in developingcountries. In the period of 1991-1995, 24000 workersdied due to this disease in China every year. In USA 1million workers have been exposed to silica dust and59000 of them had gotten silicosis.Silicosis is also the most prevalent disease among minersand workers who have been suffering from occupational


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diseases in Mongolia. Especially there were many caseswere diagnosed among miners of Bor-Undur fluoride min-ing. Main findings were that clinical and X-ray changeswere detected in short period of time after dust exposureand the majority of them were drillers of the undergroundmine.

SE 04 CH-15Volume of the chest wall muscles measured bychest CT: correlation with COPD severitySung Shine Shim, Yookyung Kim, Yon Ju Ryu Ewha Womans University Mokdong Hospital, Korea. [email protected]

PURPOSE: Chronic obstructive pulmonary disease(COPD) is characterized by progressive respiratory func-tion impairment and respiratory muscle dysfunction. Wehypothesized that the chest wall muscle volume (CMV)correlated with COPD severity.MATERIALS AND METHODS: Ninety-two male patientswith COPD underwent chest tomography (CT) andspirometry. The entire chest walls including internal andexternal intercostalis and latissimus dorsi muscles wereassessed and post-processing of muscles in chest wallfor CMV was performed. As clinical indices PFT parame-ters, age, BMI and COPD severity were evaluated foreach patient. Spearman correlation analysis was per-formed to evaluate the relationship between CMV andclinical parameters and COPD severity.RESULTS: CMV was significantly positive correlated withFVC (r = 0.525, p < 0.001), FEV1 (r = 0.500, p < 0.001),FEV1/FVC (r = 0.208, p = 0.047) and FEF (r = 0.383, p <0.001) whereas BMI was only correlated with FEV1 (r =0.233, p = 0.025). CMV and BMI was significantly nega-tive correlated with COPD severity (r = -0.209, p = 0.046;r = -262, p = 0.012, respectively). CMV and BMI weresignificantly higher in Gold 1 than G3 (p = 0.05, p = 0.05,respectively).CONCLUSION: A decrease in chest wall muscle volumeand BMI are associated with worsening of COPD severi-ty.

*p < 0.05 compared to GOLD 1.

*p < 0.05 compared to GOLD 1.

SE 04 CH-16“It’s hard to breathe!”: evaluation oftracheobronchial lesion using CTHyun Jung Koo, Mi Young Kim, Chang-Min Choi,Tai Sun Park Asan Medical Center, Korea. [email protected]

LEARNING POINTS: 1. Multimodality diagnostic approaches and treatment

planning of various tracheobronchial lesions2. Step-by step evaluation methods of tracheobronchial

lesions that may cause airway obstruction or aspirationby using CT and three-dimensional (3-D) printing

3. Various cases of tracheobronchial lesionsCONTENTS: 1. Evaluation of tracheobronchial lesion

- Obstruction degree, disease extent, or fistula forma-tion

1) Tracheobronchial CT2) Bronchoscopy3) 3-D printing

2. Treatment Planning1) Bronchoscopic biopsy, ablation, or stent insertion2) Surgery3) Radiation therapy

3. Various Cases1) Non-tumorous conditions

- Foreign body- Benign airway stenosis- Tracheobronchial fistula- Endobronchial tuberculosis- Trauma

2) Tumorous conditions(1) Benign tumor

- Papilloma, hamartoma, lipoma (2) Malignant tumor

- Squamous cell carcinoma- Adenoid cystic carcinoma- Mucoepidermoid carcinoma- Carcinoid- Tracheal lymphoma

(3) Airway invasion or endobronchial metastasis - Lung cancer - Esophageal cancer- Sarcoma

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- Renal cell carcinoma- Breast cancer

SE 04 CH-17The association between the grade andfrequency of thoracic duct dilatation with portalhypertension and variables in advanced livercirrhosisSoo-Youn Ham, Soon Ho Eum, Seung Eun Park Korea University Anam Hospital, Korea. [email protected]

PURPOSE: As chronic liver disease progresses, hepaticlymph production is expected to increase, and theincrease in hepatic lymph causes dilatation of thoracicduct. This study aimed to evaluate the degree and fre-quency of thoracic duct dilatation and to determine theclinical factors associated with thoracic duct dilatation.MATERIALS AND METHODS: We enrolled 64advanced liver cirrhosis (LC) patients who had takenchest computed tomography (CT) and hepatic veinangiography. The hepatic venous pressure gradient(HVPG) was calculated as the three times average of dif-ference between free hepatic venous pressure andwedge hepatic venous pressure. Patients were dividedinto 3 groups, according to transverse dimension of tho-racic duct. Thoracic duct was graded as grade 0, 1, 2,when it was invisible, less than 5 mm, and over 5 mm,respectively. Also, patients were divided into 4 groupssuch as site 0, 1, 2, and 3, according to the number offoci of dilatation, representing the frequency of thoracicduct dilatation.RESULTS: A total of 64 advanced LC patients wereenrolled. The mean age was 59.7 ± 10.5 years and pro-portion of male gender was 67.2%. Mean HVPG was13.5 ± 4.7. Mean damping index was 0.53 ± 0.32.Ascites was observed in 44 (68.8%) patients. Out of 64patients, thoracic duct dilatation was found in 54 patients(84.4%). The grade of thoracic duct dilatation was signifi-cantly associated with PT prolongation, degree ofsplenomegaly, and Damping index (all ps < 0.05) (Table1). However, HVPG, severity of ascites, varix size, andhistory of variceal bleeding were not significant.Furthermore, the frequency of thoracic duct dilatation wasnot associated with any variable.CONCLUSION: In advanced LC patients, the grade ofthoracic duct dilatation is associated with severity of LC-represented by INR, severity of splenomegaly, andincreased Damping index. A further study with largersample size is warranted.

SE 04 CH-19Attenuation profile matching: novel techniquefor accurate measurement of small airway wallthicknessZepa Yang1, Hyeongmin Jin2, Jong Hyo Kim3

1Seoul National University, Graduate School ofConvergence School, 2Seoul National University,Graduate School of Convergence Science andTechnology, 3Seoul National University College ofMedicine, Korea. [email protected]

PURPOSE: Thickness of the small airway is an importantbiomarker for evaluation of pulmonary diseases, such asasthma, COPD, etc. We present a novel method, attenu-ation profile matching (APM) technique, which providesaccurate determination the wall thickness of small air-ways.MATERIALS AND METHODS: Point spread functions(PSF) of a commercial CT (Sensation 16, Siemens) wereacquired by using a wire phantom for 120 KVp, 25 mAsand various reconstruction kernels (B10s-B80s). Sets ofCOPDgene phantom CT data were created for varyingFOVs and reconstruction kernels. Line profiles wereobtained across the airway walls with varying sizes (0.6-1.5 mm), and compared with synthetic line profiles whichwere generated by taking convolution of the PSF with athe numerical airway wall phantoms derived from the vari-ation of COPDgene phantom design data. Wall thicknessof a given airway was determined as that of the numericalmodel yielding minimum error. Next, we applied this tech-nique to 5 asthmatic and normal subjects. Thicknesses offourth-branch airways were selected and measured usingproposed APM method and FWHM method.


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RESULTS: Measurement error for the phantom tubes of0.6, 1.2 mm wall thickness was shown 0.12 mm, 0.11mm (20.0%, 9.1%,) in the proposed method, whereasthat of the FWHM method was showed 0.88 to 0.34 mm(146.6%, 28.3%), consequently, for varying reconstruc-tion kernels. Average error of APM method was markedlylower (p < 0.01) than that of FWHM methods. In clinicalcase, Measurement difference between normal and asth-matic subjects was shown in 0.57 mm to 1.20 mm in theproposed method, while FWHM method resulted 0.1 mmto 0.4 mm.CONCLUSION: Our proposed APM technique coulddetermine the airway wall thickness accurately even forthe small airways less than 1 mm. Our technique mayallow detection of early change of airway wall thickeningin early diagnosis, patient sub-typing, and therapeuticmonitoring in the management of COPD disease.

SE 04 CH-20Preoperative chest CT for prediction ofadvanced pleural adhesion in lung cancerpatientsYe Ra Choi, Kwang-Nam Jin, Yong Won Sung,Hyun Jong Moon SMG-SNU Boramae Medical Center, Korea. [email protected]

PURPOSE: To evaluate preoperative chest CT for theprediction of advanced pleural adhesion in lung cancerpatients.MATERIALS AND METHODS: This study included 124patients who underwent video-assisted thoracoscopicsurgery (VATS) (n = 91) or open thoracotomy (n = 33).We investigated age, smoking, forced vital capacity(FVC), predicted percentage of forced expiratory volumein one second (FEV1% predicted), and FEV1/FVC %.Localized pleural thickening, pleural calcification, fibrotho-rax, presence or amount of pulmonary calcified nodules,active pulmonary inflammation, severity of emphysema,interstitial pneumonitis, and bronchiectasis were evaluat-ed on CT. Advanced pleural adhesion was defined asadhesion requiring adhesiolysis of ≥ 30 min or near totalinvolvement of the hemithorax.RESULTS: Localized pleural thickening was found in 8patients (6.5%), pleural calcification in 8 (6.5%), pul-monary calcified nodules in 28 (22.6%), and active pul-monary inflammation in 22 (17.7%). The amount of pul-monary calcified nodules was 0.5 ± 1.7 cm. Trivial, mild,or moderate emphysema was found in 31 (25.0%), 21(16.9%), and 12 (9.7%) patients, respectively. Advancedpleural adhesion was found in 31 (25.0%) patients. Theamount of pulmonary calcified nodules and emphysemaseverity were significant predictors in a univariate analysis(p = 0.045 and 0.005, respectively). Independent vari-ables in a multivariate analysis were FEV1% predicted(coefficient of 0.964, p = 0.044), FVC (coefficient of 0.219,p = 0.002), and moderate emphysema (coefficient of19.213, p = 0.002).CONCLUSION: Chest CT can help anticipate advancedpleural adhesion in lung cancer patients with the investi-gation of calcified pulmonary nodules or emphysema

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severity.

SE 04 CH-21Normal anatomy and disease spectrum ofdiaphragmDajung Kim1, Ki Yeol Lee1, Ji Young Choo1, Eun Young Kang2, Yu Whan Oh3, Sung Ho Whang3

1Korea University Ansan Hospital, 2Korea UniversityGuro Hospital, 3Korea University Anam Hospital,Korea. [email protected]

PURPOSE: A wide spectrum of disease processes issubject to affect the diaphragm. But radiologists oftenhave difficulty to find diaphragmatic disease includingcongenital anomalies, motion abnormalities, tumors andtraumatic injury. The purpose of this exhibit is to providepictorial review of radiologic imaging in patients withdiaphragmatic disease and practical image findings ofdiaphragmatic diseases on plain radiograph and CTimaging.CONTENT ORGANIZATION: Development of thediaphragm. Normal anatomy of the diaphragm.Diaphragmatic hernias: hiatus hernia, Bochdalek hernia,Morgagni hernia, traumatic hernia. Abnormalities ofdiaphragmatic motion and position: paralysis and even-tration. Tumors involving the diaphragm: lung cancer withdiaphragmatic invasion, metastatic tumor in diaphragm.CONCLUSION: There are wide spectrum of diaphrag-matic diseases. So familiarity with the characteristic plainradiograph and CT findings of diaphragmatic diseasesmay be helpful to diagnosis and localize the diseases.

SE 04 CH-24Radiologic findings of asbestos-related pleuraldisease: a pictorial reviewYoon Ki Cha, Jeung Sook Kim Dongguk University Ilsan Hospital, Korea. [email protected]

Asbestos-related pleural disease range from benign dis-eases to malignant mesothelioma with diverse radiologicfindings. Benign asbestos-related pleural disease mani-fests on imaging as pleural effusion, pleural plaque, dif-fuse pleural thickening and round atelectasis. Familiarityof imaging findings of asbestos-related pleural disease isimportant to diagnose and differentiate between benignand malignant conditions. The purpose of this exhibitionis to demonstrate, review and discuss the various imag-ing features of asbestos-related pleural diseases.Familiarity of their imaging features and clinical signifi-cances will be helpful for accurate diagnosis and appro-priate management.

SE 04 CH-25Acute respiratory distress syndrome versusacute interstitial pneumonia: current conceptsand CT findingsEun-Young Kang1, Hwan Seok Yong1, Bong Kyung Shin1, Ki Yeol Lee2, Yu-Whan Oh3

1Korea University Guro Hospital, 2Korea UniversityAnsan Hospital, 3Korea University Anam Hospital,Korea. [email protected]

PURPOSE: There are many common features betweenacute respiratory distress syndrome (ARDS) and acuteinterstitial pneumonia (AIP). AIP is defined as an idiopath-ic ARDS. The purpose of this exhibit is to review of thecurrent definitions and CT findings of ARDS and AIP.MATERIALS AND METHODS: Current clinical criteria ofARDS and evolution of definition since 1967. Current defi-nition and evolution of AIP since 1944. Relationshipbetween ARDS and AIP. Diffuse alveolar damage (DAD)pattern as a pathologic feature of ARDS and AIP.Comparison of CT finding of ARDS and AIP.RESULTS: ARDS is defined by clinical criteria, whereasAIP require both clinical and pathological input. There are


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many common features between ARDS and AIP; acutesymptoms, severe hypoxia, bilateral opacities on chestradiographs, respiratory failure requiring mechanical ven-tilation, poor prognosis with high mortality, and DAD pat-tern on histology. CT findings of ARDS and AIP consist ofextensive ground-glass opacity and/or consolidation inboth lungs; interlobular septal thickening, less commonly;traction bronchiectasis, reticular opacities, and cysticchanges in late stage. AIP shows more low lungs andbilateral symmetric in distribution than ARDS.CONCLUSION: AIP requires a histologic diagnosis ofDAD and exclusion of known etiologies. Significant over-lap exists in CT findings of ARDS and AIP.

SE 04 CH-26Feasibility of single scan for simultaneousevaluation of pulmonary ventilation andperfusion with dual-energy CT: an experimentalstudySaerom Hong1, Hye-Jeong Lee2, Suyon Chang2,Dong Jin Lim2, Hyunsik Jang2

1H+ Yang Ji Hospital, 2Severance Hospital, Korea. [email protected]

PURPOSE: To evaluate the feasibility of simultaneoussingle scan of krypton ventilation and iodine perfusionusing dual-energy CT (DECT).MATERIALS AND METHODS: The study was approvedby institutional animal experimental committee. For 10beagle dogs, we first made an airway obstruction andthen, a pulmonary arterial occlusion after one week. Foreach animal model, 3 sessions of DECT (Single staticscan at the end of 80% krypton ventilation without iodineenhancement [krypton CT], 80% krypton ventilation withiodine enhancement [mixed contrast CT], iodineenhancement after a 30-minute washout with O2 [iodineCT]) were performed. Krypton maps were made for kryp-ton CT and mixed contrast CT, and iodine maps weremade for mixed contrast CT and iodine CT. Two radiolo-gists assessed the presence of krypton or iodine defectson each map, and measured the overlay HU in the dis-eased segment and contralateral control segment.Results were compared between krypton maps of kryptonCT and mixed contrast CT, and between iodine maps ofiodine CT and mixed contrast CT using the Wilcoxonsigned-rank test.RESULTS: In airway obstruction models, krypton defects

were visually distinguishable only in the diseased seg-ment on the krypton map of krypton CT, but not in mixedcontrast CT. However, measured overlay HU values ofthe diseased segment (3.5 ± 1.4 and 39.9 ± 1.4,respectively) on krypton maps were significantlydecreased compared to the contralateral segment (17.7± 2.6 and 46.3 ± 4.4, respectively) in both krypton CTand mixed contrast CT (p = 0.002 for both). In all pul-monary arterial occlusion models, iodine defects werenoted in the diseased segment on the iodine map eitherfrom iodine CT or mixed contrast CT. In iodine maps ofthe pulmonary arterial occlusion model, measured over-lay HU values were significantly lower in the diseasedsegment (9.51 ± 4.72 and 13.78 ± 4.49, respectively)than in the contralateral segment (86.7 ± 10.4 and 90.2± 6.6, respectively) in both iodine CT and mixed contrastCT (p = 0.002 for both).CONCLUSION: Although some qualitative limitationsmay exist, it might be feasible to analyze pulmonary venti-lation and perfusion simultaneously using DECT.

SE 04 CH-27Variability of texture features in chest CT: impactof reconstruction kernels and normalizationHyeongmin Jin, Jong Hyo Kim, Chang Yong Heo Seoul National University Hospital, Korea. [email protected]

Texture features are often used in the analysis of chestCT scans for characterization of pathologic lesions suchas tumor heterogeneity and diffuse lung diseases.Especially, a recent paper reported a certain subset ofintratumoral texture patterns represented likelihood oftumor metastasis and patient survival in NSCLC.However, the texture features are known to be sensitiveto noise pattern which are affected by reconstruction ker-nels. This study investigates the variability of texture fea-tures in chest CTs depending on reconstruction kernelsand the impact of a normalization technique. Sixty twosets of CT data were selected from the lung cancer data-base of our institution which were acquired with eight dif-ferent reconstruction kernels (B30f, B50f, B60f, B, C, D,YA, and YC) of two CT vendors (Siemens, Philips). Fourimage texture descriptors based on Gray Level Co-occur-rence Matrix (GLCM) such as GLCM contrast, GLCM cor-relation, GLCM energy, and GLCM homogeneity werecalculated within a homogeneous region. To assess the

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variability of the texture features, the coefficient of varia-tion (CoV) of texture features were calculated. Then, weapplied a kernel normalization technique which is basedon power spectrum conversion to the original CT data setand produced a kernel-normalized CT data set. Finally,we compared the CoV of texture features from the origi-nal and kernel-normalized CT data set. The CoV of tex-ture features from original vs. kernel-normalized CTdatasets were 0.631 vs. 0.463 for the GLCM contrast,0.548 vs. 0.128 for the GLCM correlation, 0.717 vs. 0.572for the GLCM energy, and 0.161 vs. 0.091 for the GLCMhomogeneity. Overall, the CoV of texture featuresreduced by 20% to 76% after applying the kernel normal-ization technique. Our study revealed the texture featuressuffer significant variability depending on reconstructionkernels in chest CT dataset. Application of an appropriatenormalization technique could reduce the kernel-inducedvariability and thus provide improved reliability in the char-acterization of pathologic lesions using texture features.

SE 04 CH-29Can we model the confounding physiophysicalfactors in quantitative CT emphysema index?Chang Yong Heo1, Chang Hyun Lee2, Jong Hyo Kim1

1Seoul National University College of Medicine, 2SeoulNational University Hospital, Korea. [email protected]

PURPOSE: Quantitative emphysema index measuredwith CT has a potential to detect and assess the progres-sion of emphysema noninvasively, and yet is known tosuffer significant variability due to physiological and physi-cal (physiophysical) confounding factors. We investigated

the impact of various confounding physiophysical factorson CT Emphysema Indices (EIs).MATERIALS AND METHODS: We collected 335 CTscans from normal subjects (non-smoker, age 30-60years) from a lung cancer screening database of our insti-tution. Scan parameters were 40 mAs, 120 kVp, 1.0 mmthickness, B30f with Siemens Sensation 16. We dividedthem into 325 training and 10 test data set. We obtained10 additional scans of mild emphysema patients withidentical scan parameters. The lungs, airways, and pul-monary vessels were automatically segmented, and EIs,RA950 and Perc15, were extracted from the segmentedlungs using a software tool (SNU ImagePrism Pulmo).Extracted from CT scans were two physiological factorssuch as total lung volume (TLV) and mode of lung attenu-ation (MoA) to reflect the inspiration level; and four physi-cal factors such as effective body diameter and area(EBD, EBA), water equivalent body diameter and area(WBD, WBA) to reflect the body size-induced CT noise.RESULTS: The association of each physiophysical factorwith EIs were obtained by correlation coefficients in train-ing dataset. Then, we created a composite model reflect-ing the confounding relations of physiophysical factorswith EIs using a logarithmic transform and multivariateregression. The correlation coefficient of physiophysicalfactors were 0.65 for TLV, 0.94 for MoA, 0.12 for WBD,0.13 for WBA, 0.29 for EBD, and 0.28 for EBA, respec-tively in RA950, and 0.66 for TLV, 0.98 for MoA, 0.02 forWBD, 0.03 for WBA, 0.20 for EBD, 0.20 for EBA, respec-tively in Perc15. Our composite model produced muchhigher correlation coefficient of 0.976 for RA950 and0.993 for Perc15. In test data set of 10 normal and 10mild emphysema cases which could not be distinguishedinitially, our model produced Z-scores of 4.03 ± 2.13 forthe mild emphysema group, and 0.32 ± 1.57 for the nor-


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mal test group.CONCLUSION: Our study identified a combination ofphysiological and physical factors causing the variabilityin CT EIs, and could successfully model the compositetheir relationship. Our composite model has a potential tocompensate the confounding physiophysical factors inquantitative emphysema assessment.

SE 04 CH-33Imaging spectrum of congenital anomaliesinvolving the pulmonary vessels and thethoracic aortaDarae Kim1, Jeong Joo Woo1, Yookyung Kim2, Jin Kyung An1

1Eulji Hospital, Eulji University, 2Ewha WomansUniversity Mokdong Hospital, Korea. [email protected]

LEARNING OBJECTIVES: 1. To illustrate the features of congenital anomalies

involving the pulmonary artery, vein and the thoracicaorta in adult patients detected on chest radiographsand MDCT.

2. To compare the imaging findings of each congenitalvascular anomalies manifesting as a unilateral smalllung on chest radiography.

CONTENT ORGANIZATION:1. Introduction: normal anatomy and vascular system of

the lung.2. Illustrate radiologic findings of congenital anomalies

involving the pulmonary vessels and the thoracic aorta.1) Anomalies of pulmonary vessels: interruption of a

main pulmonary artery, pulmonary artery sling, aor-tic origin of pulmonary artery, anomalous systemicarterial supply to lung without sequestration, pul-monary vein atresia, partial anomalous pulmonaryvenous return, pulmonary vein varix, pulmonaryarteriovenous malformation and idiopathic dilatationof the pulmonary trunk

2) Anomaly of thoracic aorta: double aortic arch3. Variable vascular anomalies with a small lung on chest

radiographsCONCLUSION: Several congenital anomalies involvingthe pulmonary artery, vein, and the aorta show abnormalfindings on the chest radiograph, although these anom-alies are optimally evaluated with CT. Therefore, it isimportant to recognize the characteristic findings of thethoracic vascular anomalies seen on the radiograph aswell as CT for early and accurate diagnosis.

SE 04 CH-34Pulmonary embolism: from pathophysiology toradiologic findingsSung-joon Park1, Ji Yung Choo1, Ki Yeol Lee1, Eun-Young Kang2, Hwan suk Yong2, Sung Ho Hwang3


TEACHING POINTS: 1. To understand the pathophysiology of various types of

pulmonary embolism.2. To review images of the various types of nonthrombot-

ic pulmonary embolism.

TABLE OF CONTENTS: Our exhibit will be divided into 3sections with1. Pathophysiology of embolism

1) Traveling routes of embolic material2) Pathologic process of embolism in the pulmonary

vessels and lungs2. Thrombotic pulmonary embolism3. Non thrombotic pulmonary embolism

1) Iatrogenic pulmonary embolism- vertebroplasty related cement embolism- chemoembolization associated Lipiodol embolism- catheter, acupuncture needle, radioactive seed

embolism- cosmetic injection material: hyaluronic acid / fat/

silicon- air embolism

2) Trauma-related fat embolism3) Septic pulmonary embolism4) Tumor embolism

SE 04 CH-35Review of recent techniques and complicationsof radiation therapy in the thoraxEun Kyoung Hong, Chang Hyun Lee, Sang Min Lee,Soon Ho Yoon, Ye Ra Choi, Roh-Eul Yoo, Hyun-ju Lim, Jin Mo Goo Seoul National University Hospital, Korea. [email protected]

In this exhibition, we will review the differences of the con-ventional radiation therapy and stereotactic body radiationtherapy (SBRT), which utilizes multiple arrangements ofbeams to apply high dose radiation to the targetedregions and create sharp dose slope to reduce the irradi-ation of surrounding structures. We will also discuss thedifferent patterns of imaging findings of radiation pneu-monitis after SABR and conventional radiation therapy.Imaging findings of radiation pneumonitis after SABR canappear different according to the time after SABR.Understanding the diverse patterns of radiation pneu-monitis would be helpful in therapeutic planning andassessment. In addition, distinguishing the imaging find-ings of radiation pneumonitis from that of local recurrenceof tumor is important in surveillance of recurrence inpatients with malignancy. Moreover, acknowledging radi-ation therapy related chest complications would be bene-

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ficial in making differential diagnosis in patients whounderwent radiation therapy.TABLE OF CONTENTS:1. Radiation therapy in the thorax

- Indications- Purposes - curative, adjuvant, palliative- Methods - conventional, 3D CRT, IMRT, SBRT or

SABR2. RT pneumonitis

1) Imaging findings of conventional RT2) CT findings of radiation pneumonitis after SABR

i. Early post SBRT findings (< 6 months)ii. Late post SBRT findings (> 6 months)

3) Differential diagnosis between tumor recurrence andradiation pneumonitis after SABR

4) Various imaging findings of RT pneumonitis in thespecific malignancies(Lung ca, Breast ca, Head and neck ca, Esophagealca, Thymic carcinoma, Bone or spinal metastasis,etc.)

3. RT-related chest complications1) Lung - COP, pneumothorax, parenchymal necrosis,

etc.2) Mediastinum - constrictive pericarditis, etc.3) Esophagus - esophagitis etc.4) Chest wall - rib fracture and necrosis, skin thicken-

ing etc.5) Secondary malignancy - lung cancer, breast cancer,

sarcoma, etc.

SE 04 CH-37Pulmonary cryptococcosis: can we make thatdiagnosis at first impression?Jun Ho Kim, Taeg Ki Lee, Youn Jeong Kim, Ha Young Lee, Yeo Ju Kim, Kyung Hee Lee Inha University Hospital, Korea. [email protected]

PURPOSE: The incidence of pulmonary cryptococcosishas increased with advance in the diagnosis and treat-ment of disease. Because the clinical presentations, radi-ographic features, and laboratory finding are non-specific,so it may be misdiagnosed. We illustrated various radi-ographic features of pulmonary cryptococcosis with CTimages.CONTENT ORGANIZATION: To review pulmonary cryp-tococcosis. To illustrate CT imaging finding of pulmonarycryptococcosis. Solitary nodule or mass. Multiple nodularpattern. Clustered, scattered, bronchopneumonia pattern,associated radiographic findingsSUMMARY: Pulmonary cryptococcosis may appear withvarious image patterns; however the knowledge of rela-tively frequent image finding may be helpful for differentialdiagnosis.


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SE 04 CH-39CT findings of small cell lung cancer: canrecognizable features be found?Dongjun Lee, Ji Young Rho Bundang CHA General Hospital, Korea. [email protected]

PURPOSE: Chest CT has been used for the standardstaging of small cell lung cancer (SCLC). However, to ourknowledge, scant focused review of the CT finding exists.The aim of this study was to demonstrate the CT findingsof SCLC and to find recognizable features.MATERIALS AND METHODS: Enhanced CT findingswere retrospectively reviewed in 144 patients with patho-logically proven SCLC for 10 years. CT scans were ana-lyzed for the tumor extent, airway involvement, vascularinvasion, concomitant lesions (hematolymphangiticspread; obstructive consolidation or atelectasis), pleuralmetastasis, and IPF. We also classified into four CTtypes: type I hilar mass only, type IIa hilar mass with ipsi-lateral mediastinal lymphadenopathy (LAP), type IIb hilarand ipsilateral mediastinal conglomerate mass, type IIIahilar mass with bilateral mediastinal LAP, type IIIb hilarand ipsilateral mediastinal conglomerate mass with con-tralateral mediastinal LAP, type IIIc hilar and bilateralmediastinal conglomerate mass, and type IV peripheralmass with or without mediastinal LAP. When mediastinalLAP was indistinguishable from the hilar mass, wedefined as hilar and mediastinal conglomerate mass thatinclude the type IIb, type IIIb, and type IIIc.RESULTS: Type I (n = 8), type IIa (n = 34), type IIb (n =26), type IIIa (n = 13), type IIIb (n = 20), type IIIc (n = 22),and type IV (n = 21) were observed. 122 of 123 patientswith hilar mass had evidence of bronchial stenosis and/orobstruction. 53 patients had a single airway involvementand 69 patients had two or more involvement. Hilar andmediastinal conglomerate masses were found in 68(47.3%) out of 144 patients. Vascular invasion was in 96patients. Concomitant lesions (n = 90, 63%) were ipsilat-eral (n = 24)/contralateral (n = 10) nodules, lymphangiticspread (n = 21), contiguous consolidation or nodule ormass (n = 45), obstructive consolidation (n = 14) oratelectasis (n = 14). Pleural metastasis (n = 21) and IPF(n = 22) were found.

Type n(%) Airway involvement Vascular involvement (n=122,85%) (n=96,67%)

single multiple PA SVC PA+SVC

I 8(5.6%) 6 2 4 0 0IIa 34(23.6%) 17 17 19 1 1IIb 26(18.1%) 13 13 14 0 9IIIa 13(9.0%) 8 5 6 0 1IIIb 20(13.9%) 6 13 13 0 5IIIc 22(15.3%) 3 19 3 1 18IV 21(14.5%) 0 0 0 0 0

Total 144 53 69 59 2 34(100%) (43.4%) (56.6%) (62.5%) (2.1%) (35.4%)

CONCLUSION: Recognizable feature of SCLC is a cen-tral hilar and mediastinal conglomerate mass. Most of thepatients with hilar mass show two or more airway steno-sis/obstruction. Vascular invasion and concomitantlesions are common.

SE 04 CH-42Characteristic ring galaxy sign in high resolutionchest CT of active tuberculosis in 15immunocompetent adultsMinjae Kim, Mi Young Kim, Sang Young Oh Asan Medical Center, Korea. [email protected]

We aim to present the characteristic ring galaxy sign inhigh resolution CT of active tuberculosis in 15 immuno-competent patients. Ring galaxy sign is characterized byinnumerable coalescent parenchymal opacities of varyingsize surrounded by several tiny satellite lesions. Thereare various mimickers of galaxy sign including that of sar-coidosis, and comparison is made between “tuberculosisring galaxy sign” and “sarcoid galaxy sign”. Other rarediseases that may also manifest with a galaxy signinclude coal worker’s pneumoconiosis or silicosis withprogressive massive fibrosis, lymphangitic metastasis,BALT lymphoma, intravascular tumor emboli, vasculitissuch as Wegener’s granulomatosis, and fungal infectionsuch as cryptococcosis. This characteristic radiologicalfinding may be particularly useful in diagnosing activetuberculosis when sputum culture and TB-PCR are nega-tive in patients with intact immunity.

SE 04 CH-43Airway diseases: characterization of obstructiveairway diseasesDo hyung Lee1, Ki Yeol Lee1, Ji Yung Choo1, Eun Young Kang2, Hwan Suk Yong2, Yu Whan Oh3


PURPOSE: We are going to review the clinical, patholog-ic and imaging findings of air way diseases that result innarrowing or increasing diameters of the trachea orbronchi. So, we target to help narrow the differential diag-nosis.CONTENT ORGANIZATION: 1. Neoplastic

1) Benign tumor: harmartoma, inflammatory pseudotu-mor, tracheobronchial papillomatosis...etc.

2) Malignant tumor: lung cancer, MALT lymphoma...etc.

2. Infectious or inflammatoryEndobronchial TB, actinomycosis, aspergillosis, sar-coidosis, granulomatosis with polyangiitis, relapsingpolychondritis, allergic bronchopulmonary aspergillosis… etc.

3. OthersTracheobronchopathic osteochondroplasia, amyloido-sis, anthracofibrosis, tracheobronchomalacia,bronchial fracture, bronchial torsion...etc.

4. Reviewing key points for the differential diagnosis ofseveral airway diseases

CONCLUSION: Various diseases can result in airwaynarrowing or dilatation. Knowing various appearance ofthe airway diseases may be helpful for differential diagno-sis and treatment.

SE 04 CH-44Preinvasive and invasive lung adenocarcinomamanifesting as small subsolid nodules: CT andpathologic correlationYu-Whan Oh1, Sung Ho Hwang1, Soo Youn Ham1,Eun-Young Kang2, Ki Yeol Lee3

1Korea University Anam Hospital, 2Korea UniversityGuro Hospital, 3Korea University Ansan Hospital,Korea. [email protected]

According to IASLC/ATS/ERS classification of lung ade-nocarcinoma reported in 2011, adenocarcinomas areclassified into preinvasive lesion, minimally invasive ade-nocarcinoma, and invasive adenocarcinoma. Preinvasivelesion is subdivided into atypical adenomatous hyperpla-sia (AAH) and adenocarcinoma in situ (AIS), which aredefined as atypical or neoplastic cells that demonstratelepidic growth (i.e., they purely grow along the alveolarsurface without invasion). Typically, AAH and AIS aresmall nodular lesion with pure ground-glass attenuationon CT. AAH commonly measures less than 1 cm, but AISis usually larger in size than AAH.Minimally invasive adenocarcinoma (MIA) is a small, soli-tary adenocarcinoma (3 cm or less), with a predominantlylepidic pattern and invasion of 5 mm or less in greatestdimension. MIA is usually seen as a pure ground-glassnodule or part-solid ground-glass nodule on CT. Invasiveadenocarcinoma is further classified on the basis of itshistologic characteristics as having a predominantly lep-idic, acinar, papillary, micropapillary, or solid pattern.Lepidic predominant adenocarcinoma is especiallydefined as a lepidic lesion that may have necrosis, invadelymphatics or blood vessels, and have a focus of stromalinvasion larger than 5 mm. On CT, invasive adenocarci-nomas typically appear as irregular solid nodules or part-solid ground-glass nodule. At our institution, we encoun-tered various cases of preinvasive and small invasiveadenocarcinomas (less than 2 cm) appearing as pureGGN or part-solid nodules on CT. In this exhibit, we pre-sent CT imaging and pathologic features of preinvasiveand small invasive adenocarcinomas in surgically resect-ed cases. The acquaintance with the pathologic andimaging features of these lesions may be helpful in theapproach to the diagnosis and management for patientswith preinvasive and small invasive adenocarcinomamanifesting as small subsolid nodules.

SE 04 CH-45MDCT findings of interstitial pneumonia with ageand sex-related seasonal incidenceBatkhishig Byambaa1, Nomuundari Ganbat1, Fransk Eduardo Sanchez Caprio1, Namnan Nariya1,Tuvshinjargal Dashjamts2

1Ulaanbaatar Songdo Hospital, 2Mongolian NationalUniversity of Medical Sciences, Ulaanbaatar SongdoHospital, Mongolia. [email protected]

PURPOSE: Multidetector computed tomography (MDCT)is essential for the detection and grading of interstitialpneumonias. There are few data on incidence of IP inMongolia, therefore we aimed to investigate imaging find-

ings at the initial MDCT examination and evaluatewhether there is a seasonal difference of IP incidenceamong different age and sex groups.MATERIALS AND METHODS: We retrospectivelyreviewed MDCTs performed in 2011 and chose thoseexaminations where IP was diagnosed. MDCT examina-tions were performed at 64-MDCT Siemens Somatomscanner at the Ulaanbaatar Songdo Hospital. We evaluat-ed their pulmonary findings according to the ATS/ERS2012 classification.RESULTS: From totally 1175 chest CT exams, we foundtotally 72 patients where MDCT findings and clinicalcourse the clinical diagnosis of IP. From 9 cases in 20-29age group, 3 were female, 5 cases were admitted in sum-mer months. From 2 cases in 30-39 age group, 1 wasdiagnosed in fall and 1 in summer. In group of 40-49aged, from 10 cases 7 were males,4 cases were detectedin autumn and 3 cases in fall. In 50-59 age group, 10were males, 6 were admitted in spring and autumn. In 60-69 age group, from 18 cases 15 were male, 6 cases wereadmitted in autumn. In age group of 70-79, from 18cases 8 were male, 6 were admitted in winter, 5 in fall. In80-89 group, from 4 cases 2 were detected in summer.Only 1 case was diagnosed in age group over 90.CONCLUSION: The highest incidence was found in agegroups of 60-69 and 70-79. There was mild male pre-dominance in all age groups. In younger age groups, thehighest incidence was found in spring or summer, wherein older groups we detect even seasonal distribution.

SE 04 CH-46Quantification of epicardial and paracardialadipose tissue in low dose chest CT: correlationwith abdominal visceral fat amount andmetabolic parametersChaehun Lim1, Kyongmin Beck2, Jung Im Jung2,Myeong Im Ahn2

1MediCheck Health Care Gangnam Center, 2TheCatholic University of Korea, Seoul St. Mary’s Hospital,Korea. [email protected]

PURPOSE: Epicardial fat volume is an emerging impor-tant parameter for cardiovascular risk stratification.However, its application is difficult and limited, because ofcomplexity of measurement of fat volume and narrowedselective range of the population performing ECG-gatedcoronary calcium CT. Our aim is to assess the reliabilityof the axial dimension of epicardial and paracardial fat onlow dose chest CT, in correlation with abdominal visceralfat amount, which is also one of major factors in predict-ing cardiovascular disease.MATERIALS AND METHODS: We retrospectivelyenrolled consecutive 200 asymptomatic patients (M:F =142:58; 25-78 years; mean age, 43 years), who visited ahealth preventive care center and underwent both lowdose chest CT and abdominal visceral CT on the sameday from August 2013 to April 2015. Two experiencedradiologists measured mean axial dimension of threespecified epicardial fat pockets; RCA (right coronaryartery), LM-LAD (left main and anterior descending coro-nary arteries), and CS (coronary sinus) pockets, and two(right and left) paracardial fat pads on low dose chest CT.


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In addition, we collected lipid profile, fasting blood sugar(FBS), blood pressure, body mass index (BMI).Correlation between three epicardial pockets and twoparacardial fat pads, and visceral fat area and metabolicparameters were statistically analyzed.RESULTS: The sums of mean axial dimensions of threeepicardial fat pockets and two paracardial fat pads were59.1 mm and 48.1 mm, respectively, which were moder-ately correlated with abdominal visceral fat area (r = 0.59,p < 0.001, and r = 0.69, p < 0.001, respectively). Singleright paracardial fat dimension showed most strong corre-lation with abdominal visceral fat area (r = 0.714, p <0.001). Waist circumference and BMI were moderatelycorrelated with sums of three epicardial fat pocket dimen-sions (r = 0.60, p < 0.001 and r = 0.62, p < 0.001) and twoparacardial fat pads (r = 0.68, p < 0.001 and r = 0.65, p <0.001). FBS and lipid profile (total cholesterol, TG andLDL) showed low correlation with pericardial fat (r = 0.2-0.3, p < 0.01). Interobserver agreements were good forthree epicardial pockets and two paracardial fat pads (k =0.845 and 0.736, respectively).CONCLUSION: Axial dimensions of epicardial andparacardial fats were well correlated with abdominal vis-ceral fat amount, and can be a potential easy-to-measureparameter for stratification of metabolic syndrome andcardiovascular disease.

SE 04 CH-47CT and PET findings of primary pulmonarysynovial sarcoma: in a tertiary referral centerGun Ha Kim, Mi Young Kim, Hyun Jung Koo, Chang-Min Choi, Joon Seon Song Asan Medical Center, Korea. [email protected]

PURPOSE: To describe the patients’ characteristics,computed tomography (CT) and 18F-fluorodeoxy glucosepositron emission tomography (FDG PET) findings, andclinical outcomes of primary pulmonary synovial sarcoma(PPSS) with pathologic correlation.MATERIALS AND METHODS: The medical records of14 patients (eight women; median age, 37 years; range,18-65 years) with PPSS pathologically proven in a ter-tiary hospital from January 1997 to December 2014 wereretrospectively reviewed. The CT findings, including thetumor size, location, number, margin, and internal fea-tures (presence of necrosis or cystic portion, enhancingsolid portion, intratumoral vessels, and calcification),external features (tumor rupture, pleural or chest wallextension, and pleural effusion), and presence of lym-phadenopathy were evaluated. The median maximumstandardized uptake value (maxSUV) of the tumor wasalso obtained. The clinical outcome with respect to thetumor recurrence or mortality was shown using Kaplan-Meier analysis.RESULTS: The median tumor size was 10.2 cm (range,2.5-13.2 cm). The most common anatomic location wasthe lung (n = 6, 43%), followed by the pleura or chest wall(n = 5, 36%) and the mediastinum (n = 3, 21%). Most ofthe tumors appeared as a single lesion (n = 11, 79%) andshowed a circumscribed margin (n = 12, 86%). All thecases showed heterogeneous enhancement with necro-sis or cystic portions, and intratumoral vessels were com-

monly detected (n = 13, 93%). Half of the tumors hadintratumoral calcification (n = 7, 50%). Tumor rupture (n =8, 57%), pleural or chest wall extension (n = 9, 64%), andpleural effusion (n = 7, 50%) frequently occurred.However, lymphadenopathy (n = 1, 7%) was rare. Themedian maxSUV of the tumor was 4.35. The patients’outcomes with respect to the tumor recurrence (n = 8,57%) and death (n = 3, 21%) were poor despite theiryoung age, and the mean follow-up period was 28.5months.CONCLUSION: PPSS usually occurs in young adults,commonly in the lung, presents as a large, circumscribedmass, and may present tumor rupture or extension of thepleura or chest wall. It often shows intratumoral calcifica-tion and vessels that may exhibit triple attenuation onenhanced CT images.

SE 04 CH-48Can we predict the presence of myastheniagravis with CT findings?Kyongmin Beck, Myeong Im Ahn, Dae Hee Han,Jung Im Jung The Catholic University of Korea, Seoul St. Mary’sHospital, Korea. [email protected]

PURPOSE: To correlate the presence of myastheniagravis (MG) with CT and PET-CT findings and WorldHealth Organization (WHO) histologic types in patientswith thymoma.MATERIALS AND METHODS: CT and PET-CT findingswere retrospectively analyzed in 97 patients with patho-logically confirmed thymic epithelial tumors betweenJanuary 2004 and December 2014. Patients’ medicalrecords were reviewed for presence of MG and pathologyresults (WHO histologic types). Two radiologists reviewedthe CT findings in terms of contour, shape, and enhance-ment pattern of the tumors and presence of necrosis orcystic portion and calcification within the tumor, mediasti-nal fat or great vessel invasion, pleural or pericardialseeding, and lymph node involvement. Maximum stan-dardized uptake value (SUVmax) of the tumor was alsoreviewed when the patient had undergone PET-CTexams. CT findings, SUVmax, and WHO histologic typeswere then compared in patients with and without MG.RESULTS: Of 97 patients with thymoma, 24 had MG(24.7%). High risk (WHO type B2 and B3) thymomaswere significantly more frequent in patients with MG(11/24, 45.8%) than those without (28/97, 28.9%) (p =0.013). Great vessel invasion (6/24, 25% in MG vs. 7/73,9.6% in non-MG; p = 0.056) tended to be more frequentin patients with MG. Pleural or pericardial seeding (7/24,29.2% in MG vs. 10/73, 13.7% in non-MG) and LNinvolvement (3/24, 12.5% in MG vs. 3/73, 4.1% in non-MG) were also more frequently seen in patients with MG.Size, contour, shape, presence of necrosis or cystic por-tion, calcification, enhancement pattern, mediastinal fatinvasion, and SUVmax were not significantly differentbetween MG and non-MG groups.CONCLUSION: CT findings of thymoma suggestinggreat vessel involvement and pleural or pericardial seed-ing tend to be associated with presence of MG, and highrisk (WHO type B2 and B3) thymoma is significantly

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associated with MG.

SE 04 CH-49Role of dynamic volume perfusion CT indifferentiation of histopathological subtypes ofNSCLCSudhir Bhimaniya, Ashu Bhalla, Raju Sharma,Devasenathipathy Kandasamy, Atin Kumar, Sanjay Thulkar, Anant Mohan, Sandeep Mathur,Vishnu Sreenivas, Deepali Jain All India Institute of Medical Sciences, New Delhi,India. [email protected]

PURPOSE: To obtain the CT Perfusion characteristics indifferent histopathological subtypes of NSCLC in patientsbefore undergoing chemotherapy.MATERIALS AND METHODS: A total of 88 treatmentnal̈ ve patients with histopathologically proved NSCLCunderwent baseline perfusion CT prior to receivingchemotherapy. Tumor PEI, BF, BV, TTP, PMB and MTTwere obtained for each patient. Histopathological sub-types were determined and CT Perfusion parameterswere compared among the different subtypes.

RESULTS: Out of 88 patients, histopathology revealedadenocarcinoma in 40, squamous cell carcinoma in 29,large cell carcinoma in 1, NSCLC-NOS in 14 and poorlydifferentiated NSCLC in 4 patients. The mean PEI of ade-nocarcinoma (118.48 HU) was significantly higher thanthe mean PEI (103.75 HU) of squamous cell carcinoma(p = 0.001). The mean MTT of adenocarcinoma (11.09 s)was higher than that of Squamous cell carcinoma (9.22 s)and this difference was marginally significant (p = 0.053).The mean BF, mean BV and mean PMB ofAdenocarcinoma were higher than the mean BF, meanBV and mean PMB of Squamous cell carcinoma, howev-er these differences were statistically not significant (p =0.142, p = 0.708 and p = 0.069,respectively). The meanTTP of Squamous cell carcinoma was higher than themean TTP of Adenocarcinoma and this difference wasstatistically not significant (p = 0.844).CONCLUSION: Baseline perfusion characteristics weresignificantly different for PEI between Adenocarcinomaand Squamous cell carcinoma. Other parameters werenot significantly different among the two types. Furtherstudies with large sample size are advocated before anyfinal conclusions about the role of Perfusion CT in sub-type differentiation can be drawn.


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