Publications by authors named "Mary M Salvatore"

22 Publications

  • Page 1 of 1

The impact of the COVID-19 pandemic on neuroimaging volume in New York City.

Neuroradiol J 2022 May 3:19714009221096828. Epub 2022 May 3.

Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA.

Background And Purpose: The COVID-19 pandemic acutely disrupted all facets of healthcare, with future implications that are expected to resonate for many years. We investigated the effect of the pandemic on neuroimaging volume, hypothesizing that all representative studies would experience a reduction in volume, with those typically performed in the inpatient setting (noncontrast enhanced CT head and CTA head/neck) taking longer to recover to pre-pandemic volumes compared to studies typically performed in the outpatient setting (MR brain with and without and MR lumbar spine without).

Materials And Methods: We retrospectively queried our institution's radiology reporting system to collect weekly data for 1 year following the World Health Organization declaration of a pandemic (11 March 2020-9 March 2021) and compared them to imaging volumes from the previous year (11 March 2019-9 March 2020). We subsequently analyzed quarterly data (e.g., first quarter comparison: 3/11/2020-6/9/2020 was compared to 3/11/2019-6/9/2019).

Results: All studies experienced decreased volume during the first quarter of the year following onset of the COVID-19 pandemic, with noncontrast enhanced CT head failing to recover to pre-pandemic volumes. CTA head/neck actually surpassed pre-pandemic volume by the second quarter of the year. MRI brain w/wo and MRI lumbar spine without recovered to baseline volume by the second quarter.

Conclusion: Noncontrast enhanced CT head did not recover pre-pandemic imaging volume. CTA head/neck volume initially decreased, however volume increased above pre-pandemic levels during the second quarter; this finding may be attributable to a prothrombotic state in COVID-19 patients.
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http://dx.doi.org/10.1177/19714009221096828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066275PMC
May 2022

Checkpoint Inhibitor Immune-Related Adverse Events: A Multimodality Pictorial Review.

Acad Radiol 2022 Apr 2. Epub 2022 Apr 2.

Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032.

Cancer immunotherapies are drugs that modulate the body's own immune system as an anticancer strategy. Checkpoint inhibitor immunotherapies interfere with cell surface binding proteins that function to promote self-recognition and tolerance, ultimately leading to upregulation of the immune response. Given the striking success of these agents in early trials in melanoma and lung cancer, they have now been studied in many types of cancer and have become a pillar of anticancer therapy for many tumor types. However, abundant upregulation results in a new class of side effects, known as immune-related adverse events (IRAEs). It is critical for the practicing radiologist to be able to recognize these events to best contribute to care for patients on checkpoint inhibitor immunotherapy. Here, we provide a comprehensive system-based review of immune-related adverse events and associated imaging findings. Further, we detail the best imaging modalities for each as well as describe problem solving modalities. Given that IRAEs can be subclinical before becoming clinically apparent, radiologists may be the first provider to recognize them, providing an opportunity for early treatment. Awareness of IRAEs and how to best image them will prepare radiologists to make a meaningful contribution to patient care as part of the clinical team.
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http://dx.doi.org/10.1016/j.acra.2022.03.007DOI Listing
April 2022

Radiographic features of pneumonitis in patients treated with immunotherapy compared to traditional chemotherapy for non-small cell lung cancer.

Clin Imaging 2022 Mar 9. Epub 2022 Mar 9.

Division of Cardiothoracic Imaging, Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America.

Background: Pneumonitis has been described as a side effect of immunotherapy as well as traditional chemotherapy. Although immune-related adverse event (IRAE) pneumonitis has been extensively characterized, the relationship between IRAE pneumonitis and pneumonitis secondary to chemotherapy is less clear. Here, we present the first analysis of radiographic features of pneumonitis secondary to immunotherapy compared to chemotherapy.

Methods: Using our radiology records system, we searched chest computed tomography (CT) reports for the term "pneumonitis". We evaluated medical records to establish chronicity of pneumonitis occurring after medication administration and excluded cases where radiation therapy appeared to be the cause of pneumonitis. We also obtained information regarding demographic, clinical, and treatment characteristics for comparison.

Results: Patients treated with immunotherapy demonstrated more specific features of pneumonitis including consolidation, ground glass opacities, septal thickening, traction bronchiectasis, and pulmonary nodules compared to those treated with chemotherapy. Immunotherapy treatment correlated with the development of pulmonary nodules (p = 0.048), and administration of more than one immunotherapy agent correlated with a greater incidence of development of nodules (p = 0.050). Radiographic features in patients treated with immunotherapy all decreased over time. Conversely, in patients treated with chemotherapy the incidence of ground glass opacities, traction bronchiectasis, pulmonary nodules, and mediastinal/hilar adenopathy increased over time.

Conclusions: IRAE-pneumonitis has distinct features and a distinct clinical course compared to pneumonitis secondary to chemotherapy. Importantly, IRAE-pneumonitis features decreased over time, suggesting that careful consideration of the benefit-risk ratio may allow for continuation of immunotherapy in some patients who develop pneumonitis.
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http://dx.doi.org/10.1016/j.clinimag.2022.03.006DOI Listing
March 2022

COVID-19-induced pulmonary sarcoid: A case report and review of the literature.

Clin Imaging 2022 Mar 13;83:152-158. Epub 2022 Jan 13.

Division of Cardiothoracic Imaging, Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America.

Background: The COVID-19 pandemic has resulted in dramatic loss of life worldwide, but as the large number of acutely ill patients subsides, the emerging group of "COVID-19 long-haulers" present a clinical challenge. Studies have shown that many of these patients suffer long-term pulmonary disease related to residual fibrosis. Prior studies have shown that while many patients have non-specific findings of fibrotic-like changes, others develop specific patterns of interstitial lung disease.

Case Report: Here, we present the first case of a patient developing pulmonary sarcoidosis one year after critical illness from COVID-19. He developed numerous non-necrotizing and well-formed granulomas in mediastinal lymph nodes and pulmonary nodules, compatible radiographically and pathologically with sarcoid.

Conclusions: While the pathophysiology of sarcoid is incompletely understood, inflammation is mediated through the dysregulation of a number of different cytokines (IFNγ, IL-2, IL-12, IL-17, IL-22). This case provides valuable clues for better understanding of the shared pathophysiology of cytokine dysregulation seen in COVID-19 and other interstitial lung diseases such as sarcoidosis.
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http://dx.doi.org/10.1016/j.clinimag.2021.12.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8755635PMC
March 2022

Immunotherapy related pericardial effusion on chest CT.

Clin Imaging 2022 Feb 6;82:204-209. Epub 2021 Dec 6.

Division of Cardiothoracic Imaging, Department of Radiology, Columbia University Irving Medical Center, NY, New York, United States of America.

Background: Immunotherapy has become a critical class of anticancer therapy in recent years, functioning by releasing brakes on the immune system that ultimately results in immune cell activation which eliminates cancer cells. Immune related adverse events (IRAEs) are a specific type of adverse event described in patients taking checkpoint inhibitor immunotherapy which results from unrestrained immune activation. Immune related pericardial effusion has been described however has not been comprehensively characterized. Here, we present the most extensive report to date detailing this adverse event.

Methods: We queried our medical record system to retrospectively identify patients on checkpoint inhibitor therapy for lung cancer who subsequently developed pericardial effusion. We analyzed the clinical and radiographic characteristics, prior therapies, treatment for the effusion, and outcomes in patients with immune related pericardial effusion and compared them to similar patients with pericardial effusion not attributable to checkpoint inhibitor therapy.

Results: Our data demonstrate that most of these pericardial effusions were small and not clinically significant. The majority were successfully treated with steroids or resolved spontaneously. Anti-PD-1 inhibitors were the most common checkpoint inhibitor preceding pericardial effusion, and a significant number of patients who went on to develop IRAE pericardial effusion previously had treatment with carboplatin for their cancer.

Conclusions: These data suggest that IRAE pericardial effusion is not a clinically significant adverse event however it sometimes leads to permanent discontinuation of checkpoint inhibitor therapy which is not necessary.
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http://dx.doi.org/10.1016/j.clinimag.2021.11.029DOI Listing
February 2022

Hypersensitivity pneumonitis: Airway-centered pulmonary fibrosis on chest CT.

Respir Investig 2021 Nov 6;59(6):845-848. Epub 2021 Aug 6.

Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA. Electronic address:

Background: To evaluate the chest CT appearance of patients with a clinicopathologic diagnosis of hypersensitivity pneumonia.

Methods: IRB approval was obtained for a retrospective review of patients with a preoperative CT scan, a surgical pathology report from a transbronchial biopsy or wedge resection consistent with hypersensitivity pneumonitis, and a pulmonary consultation, which also supported the diagnosis. The pathology report was evaluated for granulomas, airway-centered fibrosis, microscopic honeycombing, and fibroblast foci. The medical records were reviewed for any known antigen exposure. Patients were separated into two groups; those with and without a known antigen exposure. The CT scans were assessed for distribution of fibrosis: upper lobe or lower lobe predominance, airway-centered versus peripheral distribution, three-density pattern, and honeycombing.

Results: 264 pathology reports included the term chronic hypersensitivity pneumonitis (CHP). Thirty-eight of the patients had a pulmonologist who gave the patient a working diagnosis of CHP. The average age of these patients was 64 years, and 21/38 were women. Seventeen of the 38 patients had at least one antigen exposure described in the medical records. All the patients had fibrosis along the airways on chest CT. Both known antigen exposure and no known antigen patients had upper and lower lung-predominant fibrosis. There were more patients with hiatal hernias in the unknown antigen group. Honeycombing was an uncommon finding.

Conclusion: Airway-centered fibrosis was present on chest CT in all 38 patients with CHP (100%), with or without known antigen exposure.
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http://dx.doi.org/10.1016/j.resinv.2021.06.011DOI Listing
November 2021

Pulmonary infarcts in COVID-19.

Authors:
Mary M Salvatore

Clin Imaging 2021 12 23;80:158-159. Epub 2021 Jul 23.

Department of Radiology, Columbia University Medical Center, New York, NY, United States of America. Electronic address:

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http://dx.doi.org/10.1016/j.clinimag.2021.07.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299289PMC
December 2021

Acute pulmonary function decline and radiographic abnormalities: chronic cause?

Breathe (Sheff) 2021 Mar;17(1):200286

Dept of Radiology, Columbia University Irving Medical Center, New York, NY, USA.

https://bit.ly/3v2m29h.
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http://dx.doi.org/10.1183/20734735.0286-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8291918PMC
March 2021

Quantifying normal lung in pulmonary fibrosis: CT analysis and correlation with %DLCO.

Clin Imaging 2021 Sep 18;77:287-290. Epub 2021 Jun 18.

Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America. Electronic address:

Background: Chest CT scans are routinely obtained to monitor disease progression in pulmonary fibrosis. However, radiologists do not employ a standardized system for quantitative description of the severity of the disease. Development and validation of a grading system offers potential for enhancing the information that radiologists provide clinicians.

Study Design And Methods: Our retrospective review analyzed 100 sequential patients with usual interstitial pneumonitis (UIP) on HRCT scans from 2018 and 2019. A radiologic scoring system evaluated the percent of normal lung on the basis of a 0-5 point scale per lobe (findings for the right middle lobe were included in the right upper lobe score), yielding an overall additive numerical score on a scale of 20 (completely normal lung) to 0 (no normal lung). Two radiologists quantified the percentage of normal lung by consensus agreement. Percent DLCO as well as demographic data were obtained from the medical record. Statistical analysis was performed using Spearman correlation to assess correlation between grade and percent DLCO.

Results: 96 patients met the inclusion criteria; average age was 71, 68% were male. Score on CT scan ranged from 18 to 4; average 10.9, SD 3.58. The single-breath diffusing capacity (percent DLCO) ranged from 88% to 17%; mean 44.5%, SD 14.3%. Spearman's correlation for CT score and percent DLCO was 0.622, P < 0.001.

Conclusion: This scoring system quantifying the amount of normal lung on chest CT of patients with UIP correlated significantly with percent DLCO (P < 0.001) and appears to offer a promising quantitative measure to assess severity of disease.
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http://dx.doi.org/10.1016/j.clinimag.2021.06.021DOI Listing
September 2021

Pulmonary fibrosis 4 months after COVID-19 is associated with severity of illness and blood leucocyte telomere length.

Thorax 2021 12 29;76(12):1242-1245. Epub 2021 Apr 29.

Medicine/PACC, Columbia University Irving Medical Center, New York, New York, USA

The risk factors for development of fibrotic-like radiographic abnormalities after severe COVID-19 are incompletely described and the extent to which CT findings correlate with symptoms and physical function after hospitalisation remains unclear. At 4 months after hospitalisation, fibrotic-like patterns were more common in those who underwent mechanical ventilation (72%) than in those who did not (20%). We demonstrate that severity of initial illness, duration of mechanical ventilation, lactate dehydrogenase on admission and leucocyte telomere length are independent risk factors for fibrotic-like radiographic abnormalities. These fibrotic-like changes correlate with lung function, cough and measures of frailty, but not with dyspnoea.
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http://dx.doi.org/10.1136/thoraxjnl-2021-217031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103561PMC
December 2021

Added benefits of early detection of other diseases on low-dose CT screening.

Transl Lung Cancer Res 2021 Feb;10(2):1141-1153

Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Low-dose CT screening for lung cancer provides images of the entire chest and upper abdomen. While the focus of screening is on finding early lung cancer, radiology leadership has embraced the fact that the information contained in the images presents a new challenge to the radiology profession. Other findings in the chest and upper abdomen were not the reason for obtaining the screening CT scan, nor symptom-prompted, but still need to be reported. Reporting these findings and making recommendations for further workup requires careful consideration to avoid unnecessary workup or interventions while still maximizing the benefit that early identification of these other diseases provided. Other potential findings, such as cardiovascular disease and chronic pulmonary obstructive diseases actually cause more deaths than lung cancer. Existing recommendations for workup of abnormal CT findings are based on symptom-prompted indications for imaging. These recommendations may be different when the abnormalities are identified in asymptomatic people undergoing CT screening for lung cancer. I-ELCAP, a large prospectively collected multi-institutional and multi-national database of screenings, was used to analyze CT findings identified in screening for lung cancer. These analyses and recommendations were made by radiologists in collaboration with clinicians in different medical specialties.
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http://dx.doi.org/10.21037/tlcr-20-746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947380PMC
February 2021

Diaphragmatic excursion: Quantitative measure to assess adequacy of expiratory phase CT chest images.

Eur J Radiol 2021 Mar 8;136:109527. Epub 2021 Jan 8.

Department of Radiology, Icahn School of Medicine at Mount Sinai, United States; Department of Radiology, Columbia University Medical Center, United States.

Objective: To evaluate diaphragmatic excursion as a quantitative metric for change in lung volume between inspiratory and expiratory chest computed tomography (CT) images.

Methods: A 12-month retrospective review identified 226 chest CT exams with inspiratory and expiratory phase imaging, 63 in individuals referred with diagnosis of asthma by ICD9/10 code. Exams acquired in the supine position at 1.25 mm slice thickness in each phase were included (n = 30, mean age = 62, M = 15, F = 15). Diaphragmatic excursion was calculated as the difference between axial slices through the lungs on inspiration and expiration, using the lung apex as the cranial bound, and the hemidiaphragm caudally. Inspiratory and expiratory lung and tracheal volumes were calculated through volumetric segmentation. Tracheal morphology was assessed at 1 cm above the level of the aortic arch, and 1 cm above the carina.

Results: Inspiratory and expiratory lung volumes were higher in men (mean I = 5 + 1.6 L, E = 3.1 + 1.2 L) than women (mean I = 3.6 + 0.8 L, E = 2.4 + 0.7 L), p = .005 and p = .047, respectively. Average inspiratory and expiratory tracheal volumes were higher in men (I = 61 + 17 mL, E = 43 + 14) than women (I = 44 + 14, E = 30 + 8), p = .006 and p = .005. Average change in lung and tracheal volume between inspiratory and expiratory scans did not significantly differ between men and women. Average diaphragmatic excursion was 2.5 cm between inspiratory and expiratory scans (2.7 cm in men, 2.3 cm in women; p = .5). There was a strong positive correlation between diaphragmatic excursion and change in lung (r = .84) and tracheal volume (r = .79). A moderate correlation was also found between change in tracheal volume and change in lung volume (r = 0.67). Change in tracheal morphology between inspiratory and expiratory imaging was associated with change in tracheal volume at both 1 cm above the aortic arch (p = .04) and 1 cm above the carina (p = .008); there was no association with diaphragmatic excursion or lung volume.

Conclusions: Diaphragmatic excursion is a quantitative measure of expiratory effort as validated by both lung and tracheal volumes in asthma patients, and may be more accurate than qualitative assessment based on tracheal morphology.
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http://dx.doi.org/10.1016/j.ejrad.2021.109527DOI Listing
March 2021

Pneumothorax rate in intubated patients with COVID-19.

Acute Crit Care 2021 Feb 21;36(1):81-84. Epub 2020 Dec 21.

Division of Cardiothoracic Imaging, Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA.

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http://dx.doi.org/10.4266/acc.2020.00689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940104PMC
February 2021

Acute myocardial infarction secondary to COVID-19 infection: A case report and review of the literature.

Clin Imaging 2021 Apr 14;72:178-182. Epub 2020 Nov 14.

Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America.

Background: Thrombotic complications of COVID-19 infection have become increasingly apparent as the disease has infected a growing number of individuals. Although less common than upper respiratory symptoms, thrombotic complications are not infrequent and may result in severe and long-term sequelae. Common thrombotic complications include pulmonary embolism, cerebral infarction, or venous thromboembolism; less commonly seen are acute myocardial injury, renal artery thrombosis, and mesenteric ischemia. Several case reports and case series have described acute myocardial injury in patients with COVID-19 characterized by elevations in serum biomarkers.

Case Report: Here, we report the first case to our knowledge of a patient with acute coronary syndrome confirmed on catheter angiography and cardiac MRI. This patient was found to additionally have a left ventricular thrombus and ultimately suffered an acute cerebral infarction. Recognition of thrombotic complications in the setting of COVID-19 infection is essential for initiating appropriate therapy.

Conclusions: In acute myocardial injury, given the different treatment strategies for myocarditis versus acute myocardial infarction secondary to coronary artery thrombus, imaging can play a key role in clinical decision making for patients.
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http://dx.doi.org/10.1016/j.clinimag.2020.11.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666611PMC
April 2021

Pulmonary embolism rate in patients infected with SARS-CoV-2.

Blood Res 2020 Dec;55(4):275-278

Division of Cardiothoracic Imaging, Department of Radiology, Columbia University Irving Medical Center.

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http://dx.doi.org/10.5045/br.2020.2020168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784133PMC
December 2020

Teleradiology: An opportunity to improve outcomes in pulmonary fibrosis.

Clin Imaging 2020 04 13;60(2):263-264. Epub 2019 Jun 13.

Department of Radiology, Columbia University Medical Center, New York, NY. Electronic address:

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http://dx.doi.org/10.1016/j.clinimag.2019.05.011DOI Listing
April 2020

Pulmonary fibrosis: a disease of alveolar collapse and collagen deposition.

Expert Rev Respir Med 2019 07 5;13(7):615-619. Epub 2019 Jun 5.

a Department of Radiology , Columbia University Medical Center , New York , NY , USA.

: Idiopathic pulmonary fibrosis (IPF) is a relentless form of fibrotic lung disease with a median survival of approximately 3 years after diagnosis and a mortality rate that surpasses that of many types of cancer. The pathophysiology of IPF is complex as there are likely different stages of disease occurring simultaneously in the lung. : Some scientists consider IPF as primarily an epithelial driven disease in which dysfunctional surfactant-producing cells take an etiological precedent. Others focus on the augmented deposition of collagen within the interstitium as the primary inciting event causing fibrosis. An increase in collagen deposition augmenting the tensile strength of the pulmonary interstitium fits with the well-known restrictive nature of fibrotic lung diseases; however, it fails to explain the creation of cystic 'honeycombing' lesions and the preference of such lesions for the peripheral and basilar lung parenchyma. : In this paper, we will review both ideas and propose incorporating them into a single pathophysiological chain-of-events that could account for all the features that characterize IPF, allowing us to envision new therapeutic approaches to improve patient outcomes.
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http://dx.doi.org/10.1080/17476348.2019.1623028DOI Listing
July 2019

Updating the role of FDG PET/CT for evaluation of lung cancer manifesting in nonsolid nodules.

Clin Imaging 2018 Nov - Dec;52:157-162. Epub 2018 Jul 6.

Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA. Electronic address:

Purpose: To assess the feasibility of using CT to correct specific uptake values (SUVs) for fluorodeoxyglucose (FDG) in patients with nonsolid nodules.

Methods: Patients with FDG-PET/CT and thin-section CT were included in this pilot study. Thirty-five adenocarcinomas manifesting as nonsolid nodules were classified into two groups; 90-100% and 1-89% lepidic component. SUVmax was corrected based on the CT determination of the proportion of soft tissue component within the cancer (SUVatt).

Results: Both SUVmax and SUVatt increased as the percentage of the lepidic component decreased. SUVmax and SUVatt were significantly different between the groups.

Conclusion: Extent of invasiveness of nonsolid cancers (as a marker of aggressiveness) can potentially be quantified by PET/CT using a correction method that accounts for the proportion of soft tissue within the tumor.
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http://dx.doi.org/10.1016/j.clinimag.2018.07.004DOI Listing
January 2019

Causative factors, imaging findings, and CT course of round atelectasis.

Clin Imaging 2018 Jul - Aug;50:250-257. Epub 2018 Apr 23.

Department of Thoracic Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.

Objective: To assess causative factors, associated imaging findings, and CT course of round atelectasis (RA).

Materials And Methods: We retrospectively reviewed CT reports for "round" or "rounded atelectasis" over a 5-year time frame. Patients with at least 2 CT scans a minimum of 6 months apart were included. Electronic medical records and clinical and imaging follow-up was reviewed for all cases.

Results: Study population included 50 individuals with mean age of 63 years, and 59 unique instances of RA. The most commonly associated etiologies were hepatic hydrothorax (26%, n = 13) and asbestos exposure (26%), followed by post-infectious pleural inflammation (22%), congestive heart failure (12%), and end stage renal disease (8%). RA was found in the right lower lobe in over half of cases (n = 30). Association with one or more pleural abnormality was identified in all cases, including thickening (88%), fluid (60%), or calcification (40%). Nearly one third (n = 19) demonstrated intra-lesional calcification. In those who underwent PET/CT (20%), lesions demonstrated an average SUV of 2.2 (range 0-7.8). CT course over mean follow up of 32 months (range 6-126 months), demonstrated RA to remain stable (n = 26) or decrease (n = 26) in size in the majority (88%) of cases.

Conclusion: Round atelectasis may arise from diverse etiologies beyond asbestos, and will most often decrease or remain stable in size over serial exams. Accurate identification may obviate the need for added diagnostic interventions.
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http://dx.doi.org/10.1016/j.clinimag.2018.04.008DOI Listing
October 2018

CT Screening for Lung Cancer: Part-Solid Nodules in Baseline and Annual Repeat Rounds.

AJR Am J Roentgenol 2016 Dec 11;207(6):1176-1184. Epub 2016 Oct 11.

1 Department of Radiology, Mount Sinai School of Medicine, 1 Gustave Levy Pl, New York, NY 10029.

Objective: The purpose of this study was to assess the frequencies of identifying participants with part-solid nodules, of diagnostic pursuit, of diagnoses of lung cancer, and long-term lung cancer survival in baseline and annual repeat rounds of CT screening in the International Early Lung Cancer Action Project.

Materials And Methods: Screenings were performed under a common protocol. Participants with solid, nonsolid, and part-solid nodules and the diagnoses of lung cancer were documented.

Results: Part-solid nodules were identified in 2892 of 57,496 (5.0%) baseline screening studies; 567 (19.6%) of these nodules resolved or decreased in size. Diagnostic pursuit led to the diagnosis of adenocarcinoma in 79 cases, all clinical stage I. At resection, one nodule (12-mm solid component) had a single N2 metastasis. A new part-solid nodule was identified in 541 of 64,677 (0.8%) annual repeat screenings; 377 (69.7%) of these nodules resolved or decreased in size. In eight cases among the 541, the diagnosis of adenocarcinoma manifesting as a part solid nodule was made; on retrospective review the nodule originally had been a nonsolid nodule. In another 20 cases, the cancer originally had manifested as a nonsolid nodule but had progressed to become part-solid at annual repeat screening before any diagnosis was pursued. These 28 annual repeat cases of lung cancer were all pathologic stage IA. Of the 107 cases of lung cancer (79 baseline cases and 28 annual repeat cases), 106 were surgically resected, and one baseline case was followed up with imaging for 4 years. The lung cancer survival rate was 100% with a median follow-up period from diagnosis of 89 months (interquartile range, 52-134 months).

Conclusion: Lung cancers manifesting as part-solid nodules at repeat screening studies all started as nonsolid nodules. Among 107 cases of adenocarcinoma manifesting as a part-solid nodule, a single lymph node metastasis was found in a single case (solid component, 12 mm).
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http://dx.doi.org/10.2214/AJR.16.16043DOI Listing
December 2016

CT Screening for Lung Cancer: Nonsolid Nodules in Baseline and Annual Repeat Rounds.

Radiology 2015 Nov 23;277(2):555-64. Epub 2015 Jun 23.

From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.).

Purpose: To address the frequency of identifying nonsolid nodules, diagnosing lung cancer manifesting as such nodules, and the long-term outcome after treatment in a prospective cohort, the International Early Lung Cancer Action Program.

Materials And Methods: A total of 57,496 participants underwent baseline and subsequent annual repeat computed tomographic (CT) screenings according to an institutional review board, HIPAA-compliant protocol. Informed consent was obtained. The frequency of participants with nonsolid nodules, the course of the nodule at follow-up, and the resulting diagnoses of lung cancer, treatment, and outcome are given separately for baseline and annual repeat rounds of screening. The χ(2) statistic was used to compare percentages.

Results: A nonsolid nodule was identified in 2392 (4.2%) of 57,496 baseline screenings, and pathologic pursuit led to the diagnosis of 73 cases of adenocarcinoma. A new nonsolid nodule was identified in 485 (0.7%) of 64,677 annual repeat screenings, and 11 had a diagnosis of stage I adenocarcinoma; none were in nodules 15 mm or larger in diameter. Nonsolid nodules resolved or decreased more frequently in annual repeat than in baseline rounds (322 [66%] of 485 vs 628 [26%] of 2392, P < .0001). Treatment of the cases of lung cancer was with lobectomy in 55, bilobectomy in two, sublobar resection in 26, and radiation therapy in one. Median time to treatment was 19 months (interquartile range [IQR], 6-41 months). A solid component had developed in 22 cases prior to treatment (median transition time from nonsolid to part-solid, 25 months). The lung cancer-survival rate was 100% with median follow-up since diagnosis of 78 months (IQR, 45-122 months).

Conclusion: Nonsolid nodules of any size can be safely followed with CT at 12-month intervals to assess transition to part-solid. Surgery was 100% curative in all cases, regardless of the time to treatment.
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http://dx.doi.org/10.1148/radiol.2015142554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4627436PMC
November 2015

WITHDRAWN: Digital breast arterial calcium score is predictive of coronary calcium score.

Clin Imaging 2015 Mar 5. Epub 2015 Mar 5.

Department of Radiology, Icahn School of Medicine at Mount Sinai. Electronic address:

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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http://dx.doi.org/10.1016/j.clinimag.2015.02.016DOI Listing
March 2015
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