Chest Radiology

Thank You for Attending!

Thank you to all who attended our recent session on Interstitial Lung Abnormalities and Lung Cancer Staging. We appreciate your enthusiasm and commitment to continuous learning. Below is a bite-sized recap of the presentation

Interstitial Lung Abnormalities (ILA): Understanding Clinical Relevance

We explored Interstitial Lung Abnormalities (ILA), a significant incidental finding on CT scans that can indicate early lung disease. These abnormalities affect over 5% of the cross-sectional lung area, showing up as ground-glass opacities, reticulations, or honeycombing, among other features.

Key Insights:

• ILA Subcategories: Classified into non-subpleural, subpleural nonfibrotic, and subpleural fibrotic. Subpleural fibrotic ILA is associated with a higher risk of progression, and the presence of fibrosis correlates with increased mortality.
• Imaging Examples:
  • Axial CT scans showing ground-glass opacities (image A), traction bronchiectasis (image C), and honeycombing (image D).

• CT comparison between subpleural nonfibrotic ILA (B) and subpleural fibrotic ILA (C), highlighting the presence of architectural distortion.

Clinical Importance: ILAs are often associated with an increased risk of lung cancer, particularly among smokers. This connection emphasizes the need for regular monitoring, especially in high-risk groups. Routine follow-up CT scans are recommended to monitor progression, along with efforts to minimize risk factors like smoking.

Lung Cancer: Staging and Modern Imaging Techniques

The session then transitioned into an in-depth look at Lung Cancer Staging, focusing on the TNM-8 system and modern imaging modalities such as 18F-FDG PET/CT and MRI.

Key Highlights:

• TNM Staging:
  • T-stage: Tumor size and spread, with examples of CT scans displaying tumors ranging from T1b (small tumors under 3 cm) to T4 (tumors over 8 cm).
  • N-stage: Lymph node involvement, where PET/CT was emphasized as essential for mapping nodal disease and identifying appropriate treatment paths.
  • M-stage: Identification of metastases, crucial for determining treatment options.

Imaging and Treatment Response:

• CT and PET/CT:
  • CT remains the first-line modality for screening and initial staging.
  • PET/CT, with its superior sensitivity, is essential for detecting nodal involvement and unanticipated metastasis, particularly in Stage IV disease.
  • However, limitations exist: false negatives in small nodules (<10mm) and false positives in patients with conditions like TB or sarcoidosis.
• Response to Treatment (RECIST 1.1): RECIST criteria focus on changes in tumor burden post-treatment, but newer imaging techniques (like diffusion-weighted MRI and dual-energy CT) are improving the accuracy of response assessments.

Artificial Intelligence in Radiology: The growing role of AI and deep learning was discussed, particularly in lung cancer screening and prognosis. AI-driven radiomics can identify complex patterns and enhance personalized treatment decisions. Examples included a deep-learning system that performs as well as radiologists in detecting pulmonary nodules during low-dose CT scans.

Conclusion

Both presentations underlined the pivotal role of imaging in diagnosing, staging, and managing lung diseases, especially with advancing technologies like AI. As radiology continues to evolve, the integration of these advanced techniques into routine practice is essential for enhancing patient outcomes.

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Thank you once again for your participation and enthusiasm. We look forward to seeing you at our next event!