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Volumetric Assessment of Pulmonary Nodules with ECG-Gated MDCT

¹ All authors: Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106-5056.

View larger version (104K): [in a new window]   Fig. 1A. —Upper pulmonary lobe in 31-year-old man with pulmonary nodules. S1, S2, and S3 = segments 1, 2, and 3, respectively. Transverse ECG-gated CT images (A and C) with segmental separations (white lines) and corresponding subtraction images (B and D, respectively) emphasize differences in where pulmonary structures are located during 25% and 83% cardiac R-R intervals. In right upper lobe, two axes of motion can be identified: aortic arch and superior vena cava (arrowhead, B) convey cardiovascular motion to segment 1; and aortic arch and trachea (arrow, B) convey cardiovascular motion to segment 2. In left upper lobe, cardiovascular motion that conveyed to pulmonary parenchyma originated homogeneously from aortic arch (arrowheads, D). Black lines delineate chest wall.

View larger version (126K): [in a new window]   Fig. 1B. —Upper pulmonary lobe in 31-year-old man with pulmonary nodules. S1, S2, and S3 = segments 1, 2, and 3, respectively. Transverse ECG-gated CT images (A and C) with segmental separations (white lines) and corresponding subtraction images (B and D, respectively) emphasize differences in where pulmonary structures are located during 25% and 83% cardiac R-R intervals. In right upper lobe, two axes of motion can be identified: aortic arch and superior vena cava (arrowhead, B) convey cardiovascular motion to segment 1; and aortic arch and trachea (arrow, B) convey cardiovascular motion to segment 2. In left upper lobe, cardiovascular motion that conveyed to pulmonary parenchyma originated homogeneously from aortic arch (arrowheads, D). Black lines delineate chest wall.

View larger version (125K): [in a new window]   Fig. 1C. —Upper pulmonary lobe in 31-year-old man with pulmonary nodules. S1, S2, and S3 = segments 1, 2, and 3, respectively. Transverse ECG-gated CT images (A and C) with segmental separations (white lines) and corresponding subtraction images (B and D, respectively) emphasize differences in where pulmonary structures are located during 25% and 83% cardiac R-R intervals. In right upper lobe, two axes of motion can be identified: aortic arch and superior vena cava (arrowhead, B) convey cardiovascular motion to segment 1; and aortic arch and trachea (arrow, B) convey cardiovascular motion to segment 2. In left upper lobe, cardiovascular motion that conveyed to pulmonary parenchyma originated homogeneously from aortic arch (arrowheads, D). Black lines delineate chest wall.

View larger version (133K): [in a new window]   Fig. 1D. —Upper pulmonary lobe in 31-year-old man with pulmonary nodules. S1, S2, and S3 = segments 1, 2, and 3, respectively. Transverse ECG-gated CT images (A and C) with segmental separations (white lines) and corresponding subtraction images (B and D, respectively) emphasize differences in where pulmonary structures are located during 25% and 83% cardiac R-R intervals. In right upper lobe, two axes of motion can be identified: aortic arch and superior vena cava (arrowhead, B) convey cardiovascular motion to segment 1; and aortic arch and trachea (arrow, B) convey cardiovascular motion to segment 2. In left upper lobe, cardiovascular motion that conveyed to pulmonary parenchyma originated homogeneously from aortic arch (arrowheads, D). Black lines delineate chest wall.

View larger version (99K): [in a new window]   Fig. 2A. —Middle pulmonary lobe and lingula in 31-year-old man with pulmonary nodules. S4 and S5 = segments 4 and 5, respectively. Curved multiplanar reformatted ECG-gated CT images (A and C) with segmental separations (white lines) and corresponding subtraction images (B and D, respectively) emphasize differences between pulmonary structures during cardiac R-R intervals with minimal and maximal shift. Pulmonary structures in segment 5 adjacent to myocardial wall (arrowhead, B) shift significantly during cardiac phase. Significant structural shift is observed in ventroapical portions of segment 4 (arrowhead, D). Black lines delineate pulmonary fissures.

View larger version (71K): [in a new window]   Fig. 2C. —Middle pulmonary lobe and lingula in 31-year-old man with pulmonary nodules. S4 and S5 = segments 4 and 5, respectively. Curved multiplanar reformatted ECG-gated CT images (A and C) with segmental separations (white lines) and corresponding subtraction images (B and D, respectively) emphasize differences between pulmonary structures during cardiac R-R intervals with minimal and maximal shift. Pulmonary structures in segment 5 adjacent to myocardial wall (arrowhead, B) shift significantly during cardiac phase. Significant structural shift is observed in ventroapical portions of segment 4 (arrowhead, D). Black lines delineate pulmonary fissures.

View larger version (112K): [in a new window]   Fig. 2B. —Middle pulmonary lobe and lingula in 31-year-old man with pulmonary nodules. S4 and S5 = segments 4 and 5, respectively. Curved multiplanar reformatted ECG-gated CT images (A and C) with segmental separations (white lines) and corresponding subtraction images (B and D, respectively) emphasize differences between pulmonary structures during cardiac R-R intervals with minimal and maximal shift. Pulmonary structures in segment 5 adjacent to myocardial wall (arrowhead, B) shift significantly during cardiac phase. Significant structural shift is observed in ventroapical portions of segment 4 (arrowhead, D). Black lines delineate pulmonary fissures.

View larger version (82K): [in a new window]   Fig. 2D. —Middle pulmonary lobe and lingula in 31-year-old man with pulmonary nodules. S4 and S5 = segments 4 and 5, respectively. Curved multiplanar reformatted ECG-gated CT images (A and C) with segmental separations (white lines) and corresponding subtraction images (B and D, respectively) emphasize differences between pulmonary structures during cardiac R-R intervals with minimal and maximal shift. Pulmonary structures in segment 5 adjacent to myocardial wall (arrowhead, B) shift significantly during cardiac phase. Significant structural shift is observed in ventroapical portions of segment 4 (arrowhead, D). Black lines delineate pulmonary fissures.

View larger version (127K): [in a new window]   Fig. 3A. —Lower pulmonary lobe in 31-year-old man with pulmonary nodules. Curved multiplanar reformatted ECG-gated CT images (A and C) with segmental separations (white lines) and corresponding subtraction images (B and D, respectively) of lower pulmonary lobe emphasize difference between pulmonary structures during cardiac R-R intervals with minimal and maximal shift. In both lower lobes, structural shift is most significant in segments 6 and 8 situated alongside major pulmonary fissures, whereas additional significant shift is detected in left segment 10, which is located directly adjacent to thoracic aorta. Black lines delineate pulmonary fissures.

View larger version (131K): [in a new window]   Fig. 3B. —Lower pulmonary lobe in 31-year-old man with pulmonary nodules. Curved multiplanar reformatted ECG-gated CT images (A and C) with segmental separations (white lines) and corresponding subtraction images (B and D, respectively) of lower pulmonary lobe emphasize difference between pulmonary structures during cardiac R-R intervals with minimal and maximal shift. In both lower lobes, structural shift is most significant in segments 6 and 8 situated alongside major pulmonary fissures, whereas additional significant shift is detected in left segment 10, which is located directly adjacent to thoracic aorta. Black lines delineate pulmonary fissures.

View larger version (130K): [in a new window]   Fig. 3C. —Lower pulmonary lobe in 31-year-old man with pulmonary nodules. Curved multiplanar reformatted ECG-gated CT images (A and C) with segmental separations (white lines) and corresponding subtraction images (B and D, respectively) of lower pulmonary lobe emphasize difference between pulmonary structures during cardiac R-R intervals with minimal and maximal shift. In both lower lobes, structural shift is most significant in segments 6 and 8 situated alongside major pulmonary fissures, whereas additional significant shift is detected in left segment 10, which is located directly adjacent to thoracic aorta. Black lines delineate pulmonary fissures.

View larger version (133K): [in a new window]   Fig. 3D. —Lower pulmonary lobe in 31-year-old man with pulmonary nodules. Curved multiplanar reformatted ECG-gated CT images (A and C) with segmental separations (white lines) and corresponding subtraction images (B and D, respectively) of lower pulmonary lobe emphasize difference between pulmonary structures during cardiac R-R intervals with minimal and maximal shift. In both lower lobes, structural shift is most significant in segments 6 and 8 situated alongside major pulmonary fissures, whereas additional significant shift is detected in left segment 10, which is located directly adjacent to thoracic aorta. Black lines delineate pulmonary fissures.

View larger version (40K): [in a new window]   Fig. 4. —Graph of regression analysis focuses on magnitude of nodular changes and sizes of pulmonary nodules. Logarithmic regression plot reveals intercept of 0.318 mm3 and slope of -0.084. Volume of pulmonary nodules is listed on logarithmic axis.

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