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Indeterminate Solitary Pulmonary Nodules Revealed at Population-Based CT Screening of the Lung: Using First Follow-Up Diagnostic CT to Differentiate Benign and Malignant Lesions

Shodayu Takashima1, Shusuke Sone2, Feng Li1, Yuichiro Maruyama1, Minoru Hasegawa1 and Masumi Kadoya1

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.



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  		Fig. 1. —Diagram of transverse CT scan of lesion shows method described by Schwartz [16] for calculating volume doubling time (VDT): VDT = t log 2 / (3 log Dt / D0), where t is interval between two CT scans, D0 is mean diameter at initial CT ([A + B] / 2), Dt is mean diameter at second CT, A is maximum transverse diameter of lesion, and B is perpendicular transverse diameter of lesion (b1 + b2).

 


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  		Fig. 2A. —Localized bronchioloalveolar carcinoma with predominantly ground-glass-opacity pattern in 64-year-old woman. Transverse high-resolution CT scan shows 8.5-mm nodule (mean diameter) of predominantly ground-glass-opacity lesion (arrow).

 


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  		Fig. 2B. —Localized bronchioloalveolar carcinoma with predominantly ground-glass-opacity pattern in 64-year-old woman. Transverse high-resolution CT scan obtained 118 days after A shows interim lesion growth of 0.5 mm in mean diameter. Pathologic diagnosis was localized bronchioloalveolar carcinoma.

 


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  		Fig. 3A. —Adenocarcinoma with bronchioloalveolar carcinoma components and predominantly solid pattern in 70-year-old woman. Transverse high-resolution CT scan shows slightly lobulated 12.5-mm predominantly solid lesion (arrow).

 


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  		Fig. 3B. —Adenocarcinoma with bronchioloalveolar carcinoma components and predominantly solid pattern in 70-year-old woman. Transverse high-resolution CT scan obtained 83 days after A shows interim lesion growth of 2.5 mm. Small cavities (arrowheads) are seen. Pathologic diagnosis was adenocarcinoma with bronchioloalveolar carcinoma components.

 


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  		Fig. 4A. —Inflammatory pseudotumor in 67-year-old man. Transverse high-resolution CT scan shows spiculated 14-mm predominantly solid lesion (arrow).

 


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  		Fig. 4B. —Inflammatory pseudotumor in 67-year-old man. Transverse high-resolution CT scan obtained 78 days after A shows interim growth of lesion by 2 mm. Pathologic diagnosis was inflammatory pseudotumor.

 


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  		Fig. 5A. —Clinically benign lesion in 69-year-old woman. Transverse high-resolution CT scan shows spiculated 14-mm predominantly solid lesion. Concave margins (arrows) are seen.

 


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  		Fig. 5B. —Clinically benign lesion in 69-year-old woman. Transverse high-resolution CT scan obtained 108 days after A shows interim regression of lesion by 4 mm.

 


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  		Fig. 6A. —Clinically benign lesion in 61-year-old man. Transverse high-resolution CT scan shows 8.5-mm lesion of predominantly ground-glass opacity (arrow).

 


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  		Fig. 6B. —Clinically benign lesion in 61-year-old man. Lesion (arrow) is largely resolved on transverse high-resolution CT scan obtained 99 days after A.

 


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  		Fig. 7. —Clinically benign lesion with polygonal shape in 67-year-old woman. Transverse high-resolution CT scan shows spiculated 7-mm predominantly solid nodule (arrow) that is surrounded by concave margins only. Lesion remained same size on follow-up high-resolution CT (not shown) obtained 88 days after initial CT.

 

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