Abstract Submission Form All abstracts must be submitted to the AOCR by September 15 th. All information included must be the original work of the author(s) and be in typed form. Incomplete or handwritten abstracts will not be considered. At least one (1) author of the work or a designated representative must be present at the AOCR Annual Convention. Subsolid Pulmonary Nodule Contrast Enhancement Characteristics Primary Author and Affiliation: Val Smalley DO and Randolph Scott MD Additional Contributors: Kevin Klayman DO and Gerard Buffo MD Submission Category: Scientific Subspecialty Area: Thoracic Imaging Trainees Only Training Program: Arnot Ogden Medical Center Elmira, New York Supervising Faculty: Kevin Klayman DO and Gerard Buffo MD Please state any related disclosures or conflicts of interest: None Learning Objectives (3-5): 1. Understand the imaging difference between solid and subsolid pulmonary nodules. 2. Be familiar with the differential for solid pulmonary nodules (infection/absess, granuloma, vascular, congenital; neoplastic benign and malignant including metastasis). 3. Be familiar with the differential for subsolid pulmonary nodules (infectious, inflammatory, hemorrhage, infarction, and malignancy including metastasis). 4. Be familiar with the Fleischner criteria for both solid and subsolid pulmonary nodules. 5. Be familiar with contrast enhancement of solid and subsolid pulmonary nodules (described herein). this form: Narrative Abstract ( ) Five (5) PowerPoint slides with representative content that will be included in the exhibit. o The PowerPoint slides must contain images, but no more than two (2) tables/charts and five (5) embedded images. Please submit your form, narrative, and PowerPoint slides to Mary Lentz at the AOCR by emailing mary@aocr.org.
Title: Subsolid Pulmonary Nodule Contrast Enhancement Characteristics Authors: Val Smalley DO and Randolph Scott MD Contributors: Kevin Klayman DO, Gerard Buffo MD Objective: The purpose of this feasibility study is to characterize the post intravenous contrast enhancement of pulmonary subsolid (ground glass, part solid and part ground glass) nodules which is currently not known. Materials and Methods: IRB-approved study including ten patients with a subsolid pulmonary nodule (mediastinal windows: <1cm in diameter overall, solid component >5mm; meeting ACR Lung-RADS 4B nodule criteria) with planned biopsy or resection. Pre and post iodinated contrast imaging (1, 2, 3, and 4 minutes) with limited field of view including the examined nodule. Pattern of contrast enhancement (none diffuse, peripheral, heterogeneous) described and maximal post-contrast attenuation calculated. Subsequent biopsy/resection histopathology (infectious, inflammatory, benign, and malignant) correlated with post contrast enhancement characteristics and maximal attenuation increases (if any). Pattern and extent of post contrast enhancement correlated with malignant histopathology and respective sensitivities and specificities calculated at the 95%confidence level. Results: Subsolid pulmonary nodule enhancement is complex. The subsolid pulmonary nodule ground glass component with inflammatory or infectious etiology demonstrated a consistent lesser degree of enhancement (relative to malignant histopathology). The subsolid solid pulmonary nodule component demonstrated primarily diffuse contrast enhancement paralleling larger (9mm >) solid pulmonary nodule enhancement described in the Literature. Cut-off values with respective sensitivities and specificities were determined for both ground glass and solid pulmonary nodule components (p=0.5). Necrotic pulmonary nodule components did not demonstrate post contrast enhancement. Conclusion: Relatively smaller subsolid pulmonary nodule (ACR Lung-RADS 4B) post contrast enhancement is complex which is not surprising given PET/CT results in the Literature (not recommended by ACR or Fleischner criteria). This limited evaluation of subsolid pulmonary nodule post contrast enhancement provides additional information as to what histopathology may likely demonstrate. This information combined with patient risk factors (pulmonary nodule location-upper lobe, lobulated/speculated borders, indeterminate pattern of calcification if present, age, tobacco exposure, known malignancy,) and patient-specific procedural risk will provide the multidisciplinary approach with a more-informed treatment plan.
Authors: Val Smalley DO, Randolph Scott MD Contributors: Kevin Klayman DO, Gerard Buffo MD
GROUND GLASS PART SOLID AND PART GROUND GLASS