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Small Solitary Pulmonary Nodules (1 cm) Detected at Population-Based CT Screening for Lung Cancer: Reliable High-Resolution CT Features of Benign Lesions

¹ Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
² Department of Radiology, JA Azumi General Hospital, 3207-1 Ikeda, Nagano 399-8695, Japan.

View larger version (110K): [in a new window]   Fig. 1A. —Method of measurement in clinically benign lesions. Transverse section in which greatest diameter of lesion was included was selected; diameter was used as maximum transverse diameter (A) of lesion. Minimum transverse diameter (B) of lesion was measured as sum of line segments drawn perpendicular to maximum transverse diameter that reached edges of nodule furthest from line segment corresponding to maximum transverse diameter. Two-dimensional ratio was defined as ratio of A to B.

View larger version (86K): [in a new window]   Fig. 1B. —Method of measurement in clinically benign lesions. Three to five coronal multiplanar reformations were acquired at 1-mm intervals through each lesion. Longitudinal dimension of lesion was measured as difference between cephalad extent and caudal extent of lesion in each coronal reformation, and greatest value was used as maximum longitudinal dimension (C) of lesion. Three-dimensional ratio was defined as ratio of A to C.

View larger version (17K): [in a new window]   Fig. 2A. —Correlation between number of benign (white), atypical adenomatous hyperplasia (black), and malignant (gray) lesions and three-dimensional ratios of lesion. Bar graphs show correlation between number of benign, atypical adenomatous hyperplasia, and malignant lesions and three-dimensional ratios of lesion for reviewers 1 (A) and 2 (B). In general, benign lesions had plural peaks, whereas malignant lesions had only one peak in 1.00–1.24. Three-dimensional ratios in malignant lesions did not exceed 1.78.

View larger version (17K): [in a new window]   Fig. 2B. —Correlation between number of benign (white), atypical adenomatous hyperplasia (black), and malignant (gray) lesions and three-dimensional ratios of lesion. Bar graphs show correlation between number of benign, atypical adenomatous hyperplasia, and malignant lesions and three-dimensional ratios of lesion for reviewers 1 (A) and 2 (B). In general, benign lesions had plural peaks, whereas malignant lesions had only one peak in 1.00–1.24. Three-dimensional ratios in malignant lesions did not exceed 1.78.

View larger version (124K): [in a new window]   Fig. 3. —Nodular fibrosis with concave margins in 67-year-old man. Both reviewers interpreted lesion as having concave margins (arrow), air bronchograms (arrowheads), and predominantly ground-glass appearance on transverse high-resolution CT images. Lesion size was measured 8 mm by reviewer 1 and 8.5 mm by reviewer 2. Pathologic diagnosis was nodular fibrosis.

View larger version (127K): [in a new window]   Fig. 4A. —Localized bronchioloalveolar carcinoma with concave margins in 73-year-old woman. Both reviewers interpreted lesion as having concave margins (arrow), being 9 mm, and being predominantly solid on transverse high-resolution CT images. Pathologic diagnosis was localized bronchioloalveolar carcinoma.

View larger version (65K): [in a new window]   Fig. 4B. —Localized bronchioloalveolar carcinoma with concave margins in 73-year-old woman. Coronal reformation shows spherical lesion (arrow). Calculated three-dimensional ratio was 1.38 for reviewer 1 and 1.29 for reviewer 2.

View larger version (129K): [in a new window]   Fig. 5. —Nodular fibrosis with polygonal shape in 72-year-old man. Both reviewers interpreted lesion (arrow) as having coarse spiculation, pleural tag, and polygonal shape, and as being predominantly solid on transverse high-resolution CT images. Lesion size was measured as 8 mm by reviewer 1 and 9 mm by reviewer 2. Pathologic diagnosis was nodular fibrosis.

View larger version (125K): [in a new window]   Fig. 6A. —Intrapulmonary lymph node that showed peripheral subpleural lesion in 53-year-old woman. Both reviewers regarded lesion (arrow) as predominantly solid lesion attached to major fissure on transverse high-resolution CT images. Lesion size was measured 9 mm by both reviewers. Pathologic diagnosis was intrapulmonary lymph node.

View larger version (38K): [in a new window]   Fig. 6B. —Intrapulmonary lymph node that showed peripheral subpleural lesion in 53-year-old woman. Coronal reformation shows flat lesion (arrow). Calculated three-dimensional ratio was 2.57 for both reviewers.

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