Recently, software has been used for quantification of lung PBV, which can be evaluated objectively; however, this technique is yet to be validated. The purpose was to investigate the clinical feasibility of the quantification of lung perfusion blood volume (lung PBV) by dual-energy CT in patients with pulmonary embolism (PE).

MATERIALS AND METHODS: One hundred thirteen patients with clinical suspicion of PE underwent dual-energy CT angiography with a standard injection protocol. Patients were divided into each two groups with and without PE based on the presence of endoluminal clots on transverse diagnostic scans. We evaluated the quantification of lung PBV using a workstation. Associations between lung PVB and the numbers of pulmonary segments with PE were also evaluated.

RESULTS: Thirty three of 113 (29%) patients were found to have endoluminal clots in the right and/or left lungs. The remaining 80 patients did not have endoluminal clots. In 33 patients, the mean number of segments with endoluminal clots was 5.2±3.3. For patient (whole lung)-based analysis, in patients with and without PE, mean lung PBVs were 20.8±2.3 and 28.7±6.8Hounsfield Unit (HU), respectively, with a significant difference between the two groups (p<0.0001). In patients with PE, there was a significant correlation between lung PBV and the numbers of pulmonary segments with PE (R=0.57, p=0.0005).

CONCLUSION: The findings of this preliminary study suggest that quantification of lung PBV may reflect the pulmonary artery perfusion, which is useful to evaluate pulmonary blood flow in patients with PE.

Sarcoidosis is a multisystem disorder that is characterized by noncaseous epithelioid cell granulomas, which may affect almost any organ. Thoracic involvement is common and accounts for most of the morbidity and mortality associated with the disease.

Thoracic radiologic abnormalities are seen at some stage in approximately 90% of patients with sarcoidosis, and an estimated 20% develop chronic lung disease leading to pulmonary fibrosis. Although chest radiography is often the first diagnostic imaging study in patients with pulmonary involvement, computed tomography (CT) is more sensitive for the detection of adenopathy and subtle parenchymal disease. Pulmonary sarcoidosis may manifest with various radiologic patterns: Bilateral hilar lymph node enlargement is the most common finding, followed by interstitial lung disease. At high-resolution CT, the most typical findings of pulmonary involvement are micronodules with a perilymphatic distribution, fibrotic changes, and bilateral perihilar opacities. Atypical manifestations, such as masslike or alveolar opacities, honeycomb-like cysts, miliary opacities, mosaic attenuation, tracheobronchial involvement, and pleural disease, and complications such as aspergillomas, also may be seen.

To achieve a timely diagnosis and help reduce associated morbidity and mortality, it is essential to recognize both the typical and the atypical radiologic manifestations of the disease, take note of features that may be suggestive of diseases other than sarcoidosis, and correlate imaging features with pathologic findings to help narrow the differential diagnosis. © RSNA, 2010.

Standard second-line chemotherapies for non-small cell lung cancer (NSCLC) have been established but have limited clinical relevance. S-1 is a recently developed agent with potential activity against NSCLC.

METHODS:: Patients with confirmed NSCLC recurrence after previous single- or two-regimen chemotherapy with platinum, performance status of 0 to 1, adequate organ functions, and measurable lesions were treated with S-1 (60 mg/m/d, twice a day) on days 1 to 14 and gemcitabine (1000 mg/m) on days 8 and 15, which were repeated every 3 weeks until tumor progression.

RESULTS:: Treatment was administered for a median of 4 courses (range, 1-13) over a median of 125-day period in 34 patients. The overall response rate was 23.5% (no complete response and eight partial response; 95% confidence interval: 9.1-38.0%). The median progression-free and overall survival times were 6.6 and 19.9 months, respectively. The 1- and 2-year survival rates were 58.8 and 30.9%, respectively. Toxicity was mild during the entire treatment period, except for three grade 3 interstitial pneumonia.

CONCLUSION:: The primary end point was met with the relatively high overall response rate. Randomized phase III studies for elucidating survival outcome of the regimen are warranted.

Blockade of the epidermal growth factor receptor (EGFR) by monoclonal antibodies is a strategy to improve outcome in patients with non-small cell lung cancer.

Cetuximab, a chimeric anti-EGFR monoclonal antibody, has been studied in combination with different chemotherapy protocols in both phase II and phase III trials in patients with advanced NSCLC.

• In the phase III FLEX trial, cetuximab added to cisplatin/vinorelbine resulted in an absolute overall survival benefit of 1.2 months compared to the same chemotherapy alone in patients with advanced EGFR-expressing NSCLC.
• In the second phase III trial, cetuximab added to carboplatin plus paclitaxed failed to improve progression-free survival but suggested a survival benefit similar to that seen in the FLEX trial. However, the benefit in survival reached statistical significance only in the FLEX trial.

A meta-analysis that included patients from four randomized trials confirmed the efficacy of cetuximab when added to chemotherapy. Thus addition of cetuximab to platinum-based chemotherapy represents a new treatment option for patients with advanced NSCLC.

Matuzumab and panitumumab have also been evaluated in phase II trials. Necitumumab is currently evaluated in combination with chemotherapy in two randomized phase III trials.