Toraksın Kesitsel Görüntülemesi
Özet
Toraksın kesitsel görüntülemesi, tanı koyma, tedaviye yön verme ve girişimsel işlemlere kılavuzluk etme hususlarında kritik bir role sahiptir. Bilgisayarlı Tomografi (BT), kısa tetkik süresi, kolay ulaşılabilirliği ve yüksek uzaysal çözünürlüğü sayesinde parankimal hastalıklar, maligniteler, plevral ve mediastinal patolojilerin değerlendirilmesinde sıklıkla tercih edilen temel yöntemdir. Multidedektör BT, dual enerji BT ve BT anjiyografi gibi gelişmiş teknikler, vasküler anatominin, havayollarının ve nodül karakterizasyonunun yüksek doğrulukla incelenmesine olanak tanır. Manyetik Rezonans Görüntüleme (MRG) ise yüksek yumuşak doku çözünürlüğü ile özellikle mediastinal kitleler, timus ve göğüs duvarı hastalıklarında, ayrıca radyasyondan kaçınılan pediatrik veya gebelik gibi durumlarda alternatif bir araçtır. Akciğerin neoplastik ve non-neoplastik fokal lezyonları, enfeksiyonlar (tüberküloz, pnömoni), diffüz interstisyel hastalıklar, plevral efüzyonlar, pulmoner tromboemboli ve konjenital malformasyonlar bu kesitsel modalitelerle detaylıca evrelenip değerlendirilebilir. Soliter pulmoner nodüllere yaklaşımda Fleischner Derneği kılavuzu ve Lung-RADS gibi standart raporlama sistemleri risk analizinde ortak bir dil sağlar. Sonuç olarak, toraks patolojilerinin yönetiminde klinik parametreler ile kesitsel görüntüleme bulgularının birlikte multidisipliner bir yaklaşımla ele alınması doğru tanı ve tedavi takibi için esastır.
Cross-sectional imaging of the thorax plays a critical role in establishing diagnoses, guiding treatment plans, and directing interventional procedures. Computed Tomography (CT) is the most frequently utilized modality due to its short examination duration, accessibility, and high spatial resolution, making it ideal for evaluating parenchymal diseases, malignancies, and pleural or mediastinal pathologies. Advanced techniques such as multidetector CT, dual-energy CT, and CT angiography enable high-accuracy evaluation of vascular structures, central airways, and nodule characterization. Magnetic Resonance Imaging (MRI), with its superior soft-tissue contrast, provides valuable diagnostic information for mediastinal masses, thymic lesions, and chest wall disorders, serving as an alternative in pediatric, obstetric, or radiation-sensitive scenarios. Focal neoplastic and non-neoplastic lung lesions, infections like tuberculosis and pneumonia, diffuse interstitial lung diseases, pleural effusions, pulmonary thromboembolism, and congenital malformations are comprehensively evaluated using these modalities. Furthermore, standardized reporting frameworks like the Fleischner Society guidelines and the Lung-RADS system establish a uniform language for solid and subsolid solitary pulmonary nodule management. Ultimately, integrating cross-sectional imaging findings with clinical data via a multidisciplinary approach remains fundamental for precise diagnosis and therapeutic monitoring.
Referanslar
Laroia AT, Thompson BH, Laroia ST, et al. Modern imaging of the tracheo-bronchial tree. World J Radiol 2010; 2(7): 237-248.
Osborne D, Vock P, Godwin JD, et al. CT identification of bronchopulmonary segments: 50 normal subjects. AJR Am J Roentgenol.1984;142(1):47-52.
Carter BW, Benveniste MF, Madan R, et al. ITMIG classification of mediastinal compartments and multidisciplinary approach to mediastinal masses. Radiographics. 2017;37(2):413-436.
Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest. 1997;111(6):1718-23.
Hallifax RJ, Talwar A, Wrightson JM. State-of-the-art: Radiological investigation of pleural disease. Respir Med. 2017;124:88-99.
Ferretti GR, Bricault I, Coulomb M. Virtual tools for imaging of the thorax, Eur Respir J 2001;18(2):381-92.
Bhalla AS, Das A, Naranje P, et al. Imaging protocols for CT chest: A recommendation Indian J Radiol Imaging. 2019; 29(3): 236–246.
Hu H, He HD, Foley WD, et al. Four multidetector-row helical CT: image quality and volume coverage speed. Radiology 2000;215(1):55-62.
National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409.
Boiselle PM, Reynolds KF, Ernst A. Multiplanar and three dimensional imaging of the central airways with multidetector CT. AJR Am J Roentgenol 2002; 179(2): 301-8.
Purandare NC, Rangarajan V. Imaging of lung cancer: Implications on staging and management. Indian J Radiol Imaging. 2015;25(2):109-20.
Ma SH, Le HB, Jia BH, et al. Peripheral pulmonary nodules: relationship between multi-slice spiral CT perfusion imaging and tumor angiogenesis d VEGF expression. BMC Cancer. 2008;8:186.
Otrakji A, Digumarthy SR, Lo Gullo R, et al. Dual-Energy CT: Spectrum of Thoracic Abnormalities. Radiographics. 2016;36(1):38-52.
Abbott GF, Vlahos I. CT Diagnosis and Management of Focal Lung Disease. 2019 Feb 20. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Chest, Breast, Heart and Vessels (s 2019-2022): Diagnostic and Interventional Imaging [Internet]. Cham (CH): Springer; 2019
Yankelevitz DF, Reeves AP, Kostis WJ, et al. Small pulmonary nodules: volumetrically determined growth rates based on CT evaluation. Radiology. 2000;217(1):251-6.
Jennings SG, Winer-Muram HT, Tarver RD, et al. Lung tumor growth: assessment with CT--comparison of diameter and cross-sectional area with volume measurements. Radiology. 2004;231(3):866-71.
Biederer J, Beer M, Hirsch W, et al. MRI of the lung (2/3). Why…when…how? Insights Imaging. 2012;3(4):355-71.
Kapur S, Bhalla AS, Jana M. Pediatric chest MRI: A review. Indian J Pediatr 2019;86(9):842-853.
Borczuk AC. Benign tumors and tumorlike conditions of the lung. Arch Pathol Lab Med.2008;132(7):1133-48.
Gimenez A, Franquet T, Prats R. Unusual primary lung tumors: a radiologic pathologic overview. RadioGraphics 2002;22(3):601-19.
England DM, Hochholzer L. Truly benign "bronchial adenoma". Report of 10 cases of mucous gland adenoma with immunohistochemical and ultrastructural findings. Am J Surg Pathol. 1995;19(8):887-99. doi: 10.1097/00000478-199508000-00003
Erasmus JJ, Connolly JE, McAdams HP, et al. Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions. Radiographics. 2000;20(1):43-58.
Rosado-de-Christenson ML, Templeton PA, Moran CA. Bronchogenic carcinoma: radiologic-pathologic correlation. Radiographics. 1994;14(2):429-46; quiz 447-8.
Travis WD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol. 2011;6(2):244-85.
Hutchinson BD, Shroff GS, Truong MT, et al. spectrum of lung adenocarcinoma. Semin Ultrasound CT MR 2019;40(3):255-264.
Rampinelli C, Calloni SF, Minotti M, et al. Spectrum of early lung cancer presentation in low dose screening CT: a pictorial review. Insights Imaging 2016;7(3):449-59. doi: 10.1007/s13244-016-0487-4
Lambe G, Durand M, Buckley A, et al. Adenocarcinoma of the lung: from BAC to the future. Insights Imaging. 2020;11(1):69.
Sokhandon F, Sparschu RA, Furlong JW. Best cases from the AFIP: bronchogenic squamous cell carcinoma. Radiographics. 2003;23(6):1639-43.
Oshiro Y, Kusumoto M, Matsuno Y, et al. CT findings of surgically resected large cell neuroendocrine carcinoma of the lung in 38 patients. AJR Am J Roentgenol. 2004;182(1):87-91.
Carter BW, Glisson BS, Truong MT, et al. Small cell lung carcinoma: staging, ımaging, and treatment considerations. RadioGraphics 2014;34(6):1707-21.
Detterbeck FC, Boffa DJ, Kim AW, et al. The Eighth Edition Lung Cancer Stage Classification. Chest. 2017;151(1):193-203.
Nicholson AG, Chansky K, Crowley J, et al. the international association for the study of lung cancer lung cancer staging project: proposals for the revision of the clinical and pathologic staging of small cell lung cancer in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol 2016;11(3):300-11.
Nicholson AG, Tsao MS, Beasley MB, et al. The 2021 WHO Classification of Lung Tumors: Impact of advances since 2015. J Thorac Oncol. 2021:S1556-0864(21)03316-5.
Ridge CA, Huang J, Cardoza S, et al. Comparison of multiplanar reformatted CT lung tumor measurements to axial tumor measurement alone: impact on maximal tumor dimension and T stage. AJR Am J Roentgenol. 2013;201(5):959-63.
Quint LE, Francis IR. Radiologic staging of lung cancer. J Thorac Imaging. 1999;14(4):235-46.
Padovani B, Mouroux J, Seksik L, et al. Chest wall invasion by bronchogenic carcinoma: evaluation with MR imaging. Radiology. 1993;187(1):33-8.
Webb WR, Gatsonis C, Zerhouni EA, et al. CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group. Radiology. 1991;178(3):705-13.
Dales RE, Stark RM, Raman S. Computed tomography to stage lung cancer. Approaching a controversy using meta-analysis. Am Rev Respir Dis. 1990;141(5 Pt 1):1096-101.
Dwamena BA, Sonnad SS, Angobaldo JO, et al. Metastases from non-small cell lung cancer: mediastinal staging in the 1990s--meta-analytic comparison of PET and CT. Radiology. 1999;213(2):530-6.
Borie R, Wislez M, Antoine M, et al. Lymphoproliferative disorders of the lung. Respiration 2017;94(2):157-175.
Crow J, Slavin G, Kreel L. Pulmonary metastases: a pathologic and radiologic study. Cancer. 1981 ;47(11):2595-602.
Coppage L, Shaw C, Curtis AM. Metastatic disease to the chest in patients with extrathoracic malignancy. J Thorac Imaging. 1987;2(4):24-37.
Seo JB, Im JG, Goo JM, et al. Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics. 2001;21(2):403-17.
McHugh K, Blaquiere RM. CT features of rounded atelectasis. AJR Am J Roentgenol. 1989;153(2):257-60.
Duzgun SA, Durhan G, Demirkazik FB, et al. COVID-19 pneumonia: the great radiological mimicker. Insights Imaging. 2020;11(1):118.
Zhao F, Yan SX, Wang GF, et al. CT features of focal organizing pneumonia: an analysis of consecutive histopathologically confirmed 45 cases. Eur J Radiol. 2014;83(1):73-8.
Kim JH, Cho JH, Park MS, et al. Pulmonary ınflammatory pseudotumor a report of 28 cases. Korean J Intern Med. 2002;17(4):252-8.
Parkar AP, Kandiah P. Differential diagnosis of cavitary lung lesions. J Belg Soc Radiol. 2016;100(1):1-8.
Gafoor K, Patel S, Girvin F, et al. Cavitary lung diseases: a clinical-radiologic algorithmic approach. Chest. 2018;153(6):1443-1465.
Gadkowski LB, Stout JE. Cavitaty pulmonary disease. Clinical Microbiol Rev. 2008;21(2):305-33.
Erasmus JJ, McAdams HP, Connolly JE, et al. Solitary pulmonary nodules: Part II. Evaluation of the indeterminate nodule. Radiographics.2000;20(1):59-66.
Wang CW, Teng YH, Huang CC, et al. Intrapulmonary lymph nodes: computed tomography findings with histopathologic correlations. Clin Imaging. 2013;37(3):487-92.
Swensen SJ, Jett JR, Hartman TE, et al. CT screening for lung cancer: five-year prospective experience. Radiology. 2005;235(1):259-65.
Piyavisetpat N, Aquino SL, Hahn PF, et al. Small incidental pulmonary nodules: how useful is short-term interval CT follow-up? J Thorac Imaging. 2005;20(1):5-9.
MacMahon H, Naidich DP, Goo JM, et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 2017;284(1):228-243.
Dyer SC, Bartholmai BJ, Koo CW. Implications of the updated Lung CT Screening Reporting and Data System (Lung-RADS version 1.1) for lung cancer screening. J Thorac Dis 2020;12(11):6966-6977.
Gotway MB, Berger WG, Leung JWT. (2005). Pulmonary infections. In: Webb WR, Higgins CB. (Ed.), Thoracic Imaging (p. 356-405). Philadelphia: LWW
Walker CM, Abbott GF, Greene RE, et al. Imaging pulmonary infection: classic signs and patterns. AJR Am J Roentgenol. 2014;202(3):479-92.
Stark P, Jasmine J. CT of pulmonary edema. Crit Rev Diagn Imaging. 1989;29(3):245-55
Barile M. Pulmonary Edema: A Pictorial Review of Imaging Manifestations and Current Understanding of Mechanisms of Disease. Eur J Radiol Open. 2020;7:100274.
Wittram C, Mark EJ, McLoud TC. CT-histologic correlation of the ATS/ERS 2002 classification of idiopathic interstitial pneumonias. Radiographics. 2003;23(5):1057-71.
Souza CA, Müller NL, Flint J, et al. Idiopathic pulmonary fibrosis: spectrum of high-resolution CT findings. AJR Am J Roentgenol. 2005;185(6):1531-9.
Mueller-Mang C, Grosse C, Schmid K, et al. What every radiologist should know about idiopathic interstitial pneumonias. Radiographics. 2007;27(3):595-615.
McGuinness G, Naidich DP, Leitman BS, et al. Bronchiectasis: CT evaluation. AJR Am J Roentgenol. 1993;160(2):253-9.
Webb WR. (2005). Airway Disease: Bronchiectasis, chronic bronchitis, and bronchiolitis. In: Webb WR, Higgins CB. (Ed.), Thoracic Imaging (p. 527-552). Philadelphia: LWW
Francis IR, Glazer GM, Bookstein FL, et al. The thymus: reexamination of age-related changes in size and shape. AJR Am J Roentgenol. 1985;145(2):249-54.
Inaoka T, Takahashi K, Mineta M, et al. Thymic hyperplasia and thymus gland tumors: differentiation with chemical shift MR imaging. Radiology. 2007;243(3):869-76.
Ackman JB, Wu CC. MRI of the thymus. AJR Am J Roentgenol. 2011;197(1):W15-20.
Shahrzad M, Le TSM, Silva M, et al. Anterior mediastinal masses. AJR Am J Roentgenol. 2014;203(2):W128-38. doi: 10.2214/AJR.13.11998
Juanpere S, Cañete N, Ortuño P, et al. A diagnostic approach to the mediastinal masses. Insights Imaging. 2013;4(1):29-52.
Ackman JB. MR imaging of mediastinal masses. Magn Reson Imaging Clin N Am. 2015 May;23(2):141-64.
Marini T, Desai A, Kaproth-Joslin K, et al. Imaging of the esofagus: beyond cancer. Insights Imaging. 2017;8(3):365-376.
Qureshi NR, Gleeson FV. Imaging of pleural disease. Clin Chest Med. 2006;27(2):193-213.
Wang ZJ, Reddy GP, Gotway MB, et al. Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET RadioGraphics. 2004;24(1):105-19.
Carter BW, Benveniste MF, Betancourt SL, et al. Imagıng evaluation of malign chest wall neoplasms. Radiographics 2016;36(5):1285-306.
Shah AA, D'Amico TA. Primary chest wall tumors. J Am Coll Surg. 2010;210(3):360-6.
Jeung MY, Gangi A, Gasser B, et al. Imaging of chest wall disorders. Radiographics.1999;19(3):617-37.
Nason NK, Walker CM, McNeeley MF, et al. Imaging of the diaphragm: anatomy and function. RadioGraphics. 2012;32(2):E51-70.
Eren S, Çiriş F. Diaphragmatic hernia: diagnostic approaches with review of the literature. Eur J Radiol. 2005;54(3):448-59.
Kaewlai R, Avery LL, Asrani AV, et al. Multidetector CT of blunt thoracic trauma. Radiographics. 2008;28(6):1555-70.
Rivas LA, Fishman JE, Múnera F, et al. Multislice CT in thoracic trauma. Radiol Clin North Am. 2003;41(3):599-616.
Moore AJE, Wachsmann J, Chamarthy MR, et al. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther. 2018;8(3):225-243. doi: 10.21037/cdt.2017.12.01
Wittram C, Maher MM, Yoo AJ, et al. CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics.2004;24(5):1219-38.
Greaves SM, Hart EM, Brown K, et al. Pulmonary thromboembolism: spectrum of findings on CT. AJR Am J Roentgenol. 1995;165(6):1359-63.
Newman B. Congenital bronchopulmonary foregut malformations: concepts and controversies. Pediatr Radiol. 2006;36(8):773-91.
Abbey P, Narula MK, Anand R. Congenital malformations and developmental anomalies of the lung. Curr Radiol Rep 2, 71 (2014).
Lee EY, Boiselle PM, Cleveland RH. Multidetector CT evaluation of congenital lung anomalies. Radiology. 2008;247(3):632-48.
Castañer E, Gallardo X, Rimola J, et al. Congenital and acquired pulmonary artery anomalies in the adult: radiologic overview. Radiographics.2006;26(2):349-71.
