Introduction: NLST and NELSON lung cancer screening (LCS) clinical trials with LDCT reduce mortality by >20%, as more early stages are diagnosed. With this stage migration, global treatment costs can be cut. Objectives: To perform a healthcare-provider cost analysis comparing the LCS according to the ILST protocol costs, with the expected reduction in treatment costs of NSCLC patients due to stage migration treated at the Catalan public health system. Methods: The Germans Trias Hospital is participating in the ILST. A cost analysis was based on the following variables: costs of the LCS and the usual care diagnosis, treatments and radiological follow-up based on the standard retail price; reference staging for the LCS obtained from NELSON and NLST (mean: I 63%,II 9%,III 17%,IV 11%); stage distribution (I 14%,II 6%,III 13%,IV 67%), lung cancer detection rate and need of smoking cessation program in our site. Costs were adjusted to survival according to the 8th TNM. Complications, 2nd line treatments and other minor costs were not computed. Results: The observed detection rate in our site was 2.44% (2 stage IA patients out of 82 patients screened). In our sample, 54% of patients required smoking cessation. The baseline LCS cost is 787€ per participant and 1,012€ if smoking cessation is included. With these data, savings would offset the LCS cost by 160%-206% (mean 183%) Conclusions: Baseline LCS costs per patient according to the ILST protocol are low. In the Catalan public health system, a short term mean benefit of 83% of the estimated total cost of LCS program would be achieved based on stage migration. Funded by: ACMCiB, BRN, Fundació Ramon Pla, MINECO, Lung Ambition Alliance, ISCIII

To compare diagnostic accuracy of Ventilation/Perfusion (V/P) single-photon emission computed tomography (SPECT) combined with simultaneous full-dose CT with a hybrid SPECT/CT scanner versus planar ventilation/perfusion (V/P) SPECT and CT angiography (CTA) in patients suspected with acute pulmonary embolism (PE). Between 2009 and 2011, consecutive patients suspected of acute PE were referred for V/P SPECT/CT (reviewed board approved study). A contrast agent was administered to patients who had no contraindications. Non-contrast V/P SPECT/CT was performed on the remaining patients. All patients were followed-up for at least 3 months. A total of 314 patients were available during the study period, with the diagnosis of PE confirmed in 70 (22.29%) of them. The overall population sensitivity and specificity was 90.91% and 92.44%, respectively for V/P SPECT, 80% and 99.15%, respectively, for CTA, and 95.52% and 97.08% for V/P SPECT/CT. SPECT/CT performed better than V/P SPECT (AUC differences = 0.0419, P = 0.0043, 95% CI; 0.0131–0.0706) and CTA (AUC differences = 0.0681, P = 0.0208, 95% CI; 0.0103–0.1259)). Comparing imaging modalities when contrast agent could be administered, sensitivity and specificity increased and V/P SPECT/CT was significantly better than CTA (AUC differences = 0.0681, P = 0.0208, 95% CI; 0.0103–0.1259) and V/P SPECT (AUC differences = 0.0659, P = 0.0052, 95% CI; 0.0197–0.1121). In case of non-contrast enhancement, there was non-significant increase of specificity. Secondary findings on CT impacted patient management in 14.65% of cases. Our study shows that combined V/P SPECT/CT scanning has a higher diagnostic accuracy for detecting acute PE than V/P SPECT and CTA alone. When feasible, V/P SPECT/CT with contrast enhancement is the best option. Valorar la exactitud diagnóstica de la SPECT/TC de ventilación-perfusión (V/P) pulmonar de alta dosis mediante un equipo híbrido SPECT/TC frente a la SPECT de V/P pulmonar y a la angiografía por TC (CTA) en pacientes con sospecha de tromboembolismo pulmonar (TEP) agudo. Entre 2009 y 2011, se estudiaron de forma consecutiva con SPECT/TC de V/P pulmonar los pacientes con sospecha de TEP agudo que acudieron a nuestro centro (estudio aprobado por el comité de ética hospitalaria). A los pacientes que no presentaban contraindicaciones se les administró contraste yodado (CI) por vía intravenosa. En el resto se realizó un estudio SPECT/TC de V/P pulmonar sin CI. Los pacientes fueron seguidos durante un período de 3 meses. Se estudiaron un total de 314 pacientes. En 70 (22,29%) se confirmó el diagnóstico de TEP. La sensibilidad y especificidad para la población global fue: 90,91 y 92,44% respectivamente para la SPECT de V/P; 80 y 99.15% para la CTA; y 95.52 y 97.08% para la SPECT/TC de V/P pulmonar. La SPECT/TC presentaba una exactitud diagnóstica superior a la SPECT de V/P (diferencias AUC = 0,0419; p = 0,0043; IC95%: 0,0131-0,0706) y la CTA (diferencias AUC = 0,0681, p = 0,0208; IC95%: 0,0131-0,1259). Comparando las diferentes modalidades cuando se administró CI, observamos un aumento de la sensibilidad y la especificidad de la SPECT/TC de V/P superior a la CTA (diferencias AUC = 0,0681; p = 0,0208; IC95%: 0,0131-0,1259) y a la SPECT de V/P (diferencias AUC = 0,0659; p = 0,0052; IC95%: 0,0197-0,1121). En el caso de no administrar CI se observó un aumento no estadísticamente significativo de la especificidad. Los hallazgos secundarios de la TC provocaron un cambio en el manejo del paciente en un 14,65% de los casos. Nuestro estudio demuestra que el estudio combinado SPECT/TC de V/P pulmonar tiene una mayor exactitud diagnóstica para detectar el TEP agudo que la SPECT de V/P pulmonar o la CTA por sí solos. Cuando es factible, la SPECT/TC de V/P pulmonar con CI es la mejor opción diagnóstica.

Objective: To assess the value of intraoperatory radioguided probe detection to guide surgical resection of malignant lesions previously detected by F-18-FDG PET-CT.Material: Twelve consecutive patients with suspected tumor recurrence detected by F-18-FDG PET-CT considered resectable were enrolled in the study. Ultrasound guided fine needle aspiration (FNA) before surgery was performed in 6 patients and CT guided biopsy was performed in 1 patient. In 5 patients with accessible lesions, a radioguided occult lesion localization (ROLL) technique was performed after injection of Tc-99m-colloid (1.7-2.4 mCi) inside the lesion under ultrasound or CT guidance, pre-operatively. Radioguided surgical detection was then carried out 19-24 hours afterwards using the gamma probe. In 7 patients with non-accessible needle lesions or multiple lesions, 9.5-10.5 mCi of F-18-FDG were injected 3-5 hours before radioguided surgery using a PET-dedicated probe (Gamma locator DXI-GF&E).Results: ROLL technique: All lesions injected with nanocolloid were resected (6 lesions in 5 patients, 1 patient with 2 lesions), and recurrence was histologically confirmed. PET probe: Fourteen out of 16 hypermetabolic lesions detected on the PET-CT were resected. One cervical and one mediastinal lymph node in different patients could not be excised. Histological recurrence was confirmed in 12 out of 14 lesions. In one patient, the 2 lymph nodes excised were inflammatory.Conclusions: F-18-FDG PET-CT can be key in deciding surgical approach and appropriate radioguided protocol. When lesions are solitary and easily accessible, ROLL technique seems the method of choice. PET probe is more adequate for less accessible lesions. (C) 2011 Elsevier Espana, S.L. and SEMNIM. All rights reserved.

The diagnosis of panarteritis nodosa is usually difficult because of the variability of clinical manifestations. Herein is presented a case of occult liver involvement by polyarteritis nodosa. Several biopsies were performed but the diagnosis was made with the contribution of a hepatic arteriography.

BACKGROUND: We aimed to find out whether systematic reading of chest radiography (CRx) by radiologists in the emergency unit might lead to a higher diagnostic efficiency and improve health care.MATERIAL AND METHOD: Descriptive study of consecutive admissions during 3 months in an internal medicine department. We registered the CRx interpretation by the emergency unit physician first, and a radiologist the next day. In cases with different interpretations we assessed whether these differences would have modified the treatment.RESULTS: The overall disagreement between the emergency room physician and the radiologist was 13.7%. In 19 of 29 cases with different readings, the radiologist interpretation was in agreement with the final diagnosis. In 7 of these 19 cases, the radiologist reading of CRx would have led to a positive change of treatment. However, differences between both physicians were not statistically significant.CONCLUSIONS: There seems to be a higher diagnostic efficiency when the emergency room physician interpretation of CRx is complemented by a radiologist.

We aimed to find out whether systematic reading of chest radiography (CRx) by radiologists in the emergency unit might lead to a higher diagnostic efficiency and improve health care.Descriptive study of consecutive admissions during 3 months in an internal medicine department. We registered the CRx interpretation by the emergency unit physician first, and a radiologist the next day. In cases with different interpretations, we assessed whether these differences would have modified the treatment.The overall disagreement between the emergency room physician and the radiologist was 13.7%. In 19 of 29 cases with different readings, the radiologist interpretation was in agreement with the final diagnosis. In 7 of these 19 cases, the radiologist reading of CRx would have led to a positive change of treatment. However, differences between both physicians were not statistically significant.There seems to be a higher diagnostic efficiency when the emergency room physician interpretation of CRx is complemented by a radiologist.

A right subclavian artery pseudoaneurysm caused by blunt trauma is described. CT and digital subtraction angiography helped us to establish a correct diagnosis. Radiologic features of subclavian artery aneurysms and relevant literature are briefly discussed.

Pancoast's syndrome is characterized by pain in the shoulders and upper extremities, Horner's syndrome, bone loss and hand muscle atrophy. Bronchogenic carcinoma is the most common cause, although other neoplasms or lung infection are occasionally responsible. An apical mass on the chest film can be seen in over 90% of cases, although apical pleural thickening is sometimes the only radiographic finding. We describe a patient whose clinical picture was highly suggestive of Pancoast's syndrome but whose chest film was normal. Magnetic resonance imaging disclosed a cervical mass adjacent to the brachial plexus that proved to be cervical metastasis from an unknown primary tumor. We emphasize the need to consider the possibility of a metastatic cervical tumor compromising the brachial plexus in patients with a normal chest X-ray but clinical signs highly suggestive of Pancoast's syndrome.

Radiographic features of 71 patients (48 men, 23 women) with nosocomial Legionella pneumophila pneumonia were assessed and compared with those of other nosocomial series of L pneumophila pneumonia. Sixteen patients were assessed retrospectively and 55 prospectively. Chest radiographs were assessed at the onset of the illness, 10 days later, and at 3 months. Erythromycin was given to 67 patients at the time of the diagnosis and to the remaining four at a later stage. Forty eight patients were over the age of 60. On the initial chest radiograph 53 of the 71 patients had unilateral shadowing (23 of them in the right lung); 35 had unilobar shadowing and the remaining 36 had more than one affected lobe. Pleural effusion was present in 24 cases and cavitation in 2. One patient had evidence of a pericardial effusion. At 10 days 21 patients had evidence of radiographic progression (14 ipsilateral), but 28 had improved. At 3 months 36 patients had an abnormal radiograph, 30 showing residual scarring, 15 loss of volume, six pleural shadows and two cavitation. Our series shows a lesser incidence of unilateral shadowing and pleural effusion than other nosocomial series and a lesser tendency to progression, but more patients had radiographic abnormalities at long term follow up.

We suggest that real-time B-mode US should be considered as the method of choice in patients with suspected DVT, mainly in those cases (as in pregnant women) in whom extrinsic compression may induce false-positive results with the remainder noninvasive methods