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1 Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi,
Matsumoto 390-8621, Japan.
2 Department of Surgery, Shinshu University School of Medicine, Matsumoto
390-8621, Japan.
3 Department of Laboratory Medicine, Shinshu University School of Medicine,
Matsumoto 390-8621, Japan.
4 Department of Radiology, JA Azumi General Hospital, 3207-1 Ikeda, Nagano
399-8695, Japan.
OBJECTIVE. We investigated the imaging findings and progression of replacement lung neoplasms that were revealed on thin-section CT and serial CT.
MATERIALS AND METHODS. We evaluated the age of patients and thin-section CT findings (lesion size; percentage of ground-glass opacity areas; and presence or absence of solid portions, lobulation, coarse spiculation, air bronchogram, cavity, multiplicity, and pleural tags) in 73 lesions (11 atypical adenomatous hyperplasias, 17 type A [Noguchi's classification], 18 type B, and 27 type C small peripheral adenocarcinomas). We compared the serial findings of 48 of 73 lesions on low-dose screening CT (n = 21) or thin-section CT (n = 27) obtained at a mean interval of 450 days (range, 85-951 days). Progression from atypical adenomatous hyperplasia through type A to type B and then to type C tumor was studied using trend tests.
RESULTS. A significant linear trend was seen for lesion size (r = 0.55; p < 0.001), percentages of ground-glass opacity areas (r = 0.75; p < 0.001), and the prevalence of lobulation (p < 0.001), spiculation (p = 0.001), air bronchogram (p = 0.023), cavity (p = 0.046), pleural tag (p < 0.001), and solid portions (p < 0.001). In general from serial CT assessment, lesions were recognized first as a ground-glass opacity nodule (56% of 48 lesions) with subsequent increase in size (75%), then solid portions appeared in the nodule (17%), and finally solid portions increased (23%) with occasional augmentation of tissue contraction (6%).
CONCLUSIONS. CT analysis revealed stepwise progression of replacement-type lung neoplasms.
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