Georgeann McGuinness, M.D.

Computed tomographic screening for lung cancer: Individualising the benefit of the screening
Henschke C.I.; Yankelevitz D.F.; McCauley D.I.; Sone S.; Hanaoka T.; Markowitz S.; Miller A.; Klingler K.; Scherer T.; Inderbitzi R.; Zulueta J.; Montuenga L.; Bastarrika G.; Giunta S.; Crecco M.; Pugliese P.; Tockman M.; Shaham D.; Rice K.; Aye R.; Roberts H.; Patsios D.; Bauer T.; Lally J.; Austin J.H.M.; Pearson G.D.N.; Naidich D.; McGuinness G.; Rifkin M.; Fiore E.; Kopel S.; Klippenstein D.; Litwin A.; Loud P.A.; Kohman L.J.; Scalzetti E.M.; Khan A.; Shah R.; Smith M.V.; Williams H.T.; Lovett L.; Mendelson D.S.; Thurer R.; Heelan R.T.; Ginsberg M.S.; Sullivan F.; Ottinger M.; Vafai D.; Matalon T.A.S.; Odzer S.-L.; Liu X.; Sheppard B.; Cole E.; Wiernik P.H.; Ray D.; Pass H.; Endress C.; Mullen D.; Kalafer M.; Grannis F.; Rotter A.; Thorsen M.K.; Hansen R.; Camacho E.; Luedke D.
2007 ;30(5):843-847, European respiratory journal
Individuals concerned about their risk of lung cancer are recommended to talk with their physicians about computed tomographic screening for lung cancer. To provide the necessary information, the survival benefit of the screening, specific to a particular person for a particular round of screening, is needed. The probability of survival gain from the first, baseline, round of screening was addressed as the product of: 1) the screening resulting in a diagnosis of lung cancer; 2) not dying from some other cause for a sufficiently long period of time; and 3) cure resulting from pre-symptomatic treatment of lung cancer. These probabilities were estimated using the International Early Lung Cancer Action Program data on individuals aged 40-85 yrs with a cigarette smoking history of 0-150 pack-yrs. The estimated probability of survival gain ranged from 0.4% for a 60-yr-old with a 10-pack-yr smoking history who quit smoking 20 yrs ago, to 3.1% for a 70-yr-old current smoker with a 100 pack-yr history and 2.0% for an 85-yr-old current smoker with a 150-pack-yr history. When seeking counsel about initiation of screening for lung cancer, an estimate of the probability of survival gain from the first round of computed tomographic screening, specific to the person's age and history of smoking, can be provided. CopyrightcopyrightERS Journals Ltd 2007
— id: 76019, year: 2007, vol: 30, page: 843, stat: Journal Article,

The three and one-half year radiology residency
Grossman, Robert I; McGuinness, Georgeann
2006 Oct;27(9):1803-1803, AJNR. American journal of neuroradiology
— id: 70832, year: 2006, vol: 27, page: 1803, stat: Journal Article,

Advantages of parallel imaging in conjunction with hyperpolarized helium--a new approach to MRI of the lung
Lee, Ray F; Johnson, Glyn; Grossman, Robert I; Stoeckel, Bernd; Trampel, Robert; McGuinness, Georgeann
2006 May;55(5):1132-1141, Magnetic resonance in medicine
Hyperpolarized helium (3He) gas MRI has the potential to assess pulmonary function. The non-equilibrium state of hyperpolarized 3He results in the continual depletion of the signal level over the course of excitations. Under non-equilibrium conditions the relationship between the signal-to-noise ratio (SNR) and the number of excitations significantly deviates from that established in the equilibrium state. In many circumstances the SNR increases or remains the same when the number of data acquisitions decreases. This provides a unique opportunity for performing parallel MRI in such a way that both the temporal and spatial resolution will increase without the conventional decrease in the SNR. In this study an analytical relationship between the SNR and the number of excitations for any flip angle was developed. Second, the point-spread function (PSF) was utilized to quantitatively demonstrate the unconventional SNR behavior for parallel imaging in hyperpolarized gas MRI. Third, a 24-channel (24ch) receive and two-channel (2ch) transmit phased-array system was developed to experimentally prove the theoretical predictions with 3He MRI. The in vivo experimental results prove that significant temporal resolution can be gained without the usual SNR loss in an equilibrium system, and that the entire lung can be scanned within one breath-hold (approximately 13 s) by applying parallel imaging to 3D data acquisition
— id: 68279, year: 2006, vol: 55, page: 1132, stat: Journal Article,

Diffusional kurtosis imaging in the lung using hyperpolarized 3He
Trampel, Robert; Jensen, Jens H; Lee, Ray F; Kamenetskiy, Igor; McGuinness, Georgeann; Johnson, Glyn
2006 Oct;56(4):733-737, Magnetic resonance in medicine
Diseases of the small airspaces represent an increasingly important health problem. Asthma is primarily a disease of airway dysfunction, while chronic obstructive pulmonary disease (COPD) is associated with abnormalities in both the small airways and the alveoli. Conventional diffusion magnetic resonance imaging (MRI) of hyperpolarized noble gases, because of the short T(2)* of the gas, is only capable of monitoring diffusion over short times and hence only short distances. Diffusion imaging is therefore only sensitive to changes in small structures of the lung (primarily the alveoli), and will not adequately interrogate diffusion along the longitudinal axes of bronchi and bronchioles. In this communication we present a new method, termed diffusional kurtosis imaging (DKI), that is particularly sensitive to diffusion over longer distances. DKI may therefore be more sensitive to abnormalities in the bronchioles and bronchi than conventional diffusion imaging. Preliminary DKI measurements on healthy human subjects and one patient with symptoms suggestive of small airway disease are presented. Although the apparent diffusion coefficient (ADC) in the patient was similar to that in the normal controls, diffusional kurtosis was markedly reduced. This suggests that DKI measurements may be useful for assessing diseases of the small airways. Magn Reson Med, 2006. (c) 2006 Wiley-Liss, Inc
— id: 68278, year: 2006, vol: 56, page: 733, stat: Journal Article,

Image Interpretation Session: 2004
Drayer, BP; Bisset, GS; McGuinness, G; Brant-Zawadzki, MN; Fishman, EK; Major, NM
2005 JAN-FEB ;25(1):86-86, Radiographics
— id: 63808, year: 2005, vol: 25, page: 86, stat: Journal Article,

A 24-ch Phased-Array System for Hyperpolarized Helium Gas Parallel MRI to Evaluate Lung Functions
Lee, Ray; Johnson, Glyn; Stefanescu, Cornel; Trampel, Robert; McGuinness, Georgeann; Stoeckel, Bernd
2005 ;4:4278-4281, Conference Proceedings (IEEE Engineering in Medicine & Biology Society)
Hyperpolarized 3He gas MRI has a serious potential for assessing pulmonary functions. Due to the fact that the non-equilibrium of the gas results in a steady depletion of the signal level over the course of the excitations, the signal-tonoise ratio (SNR) can be independent of the number of the data acquisitions under certain circumstances. This provides a unique opportunity for parallel MRI for gaining both temporal and spatial resolution without reducing SNR. We have built a 24-channel receive / 2-channel transmit phased array system for 3He parallel imaging. Our in vivo experimental results proved that the significant temporal and spatial resolution can be gained at no cost to the SNR. With 3D data acquisition, eight fold (2x4) scan time reduction can be achieved without any aliasing in images. Additionally, a rigid analysis using the low impedance preamplifier for decoupling presented evidence of strong coupling
— id: 70967, year: 2005, vol: 4, page: 4278, stat: Journal Article,

Image Interpretation Session - Sunday, November 28, 2004
Drayer, BP; Bisset, GS; McGuinness, G; Brant-Zawadzki, MN; Fishman, EK; Major, NM
2004 SEP-OCT ;24(5):1523-1534, Radiographics
— id: 46511, year: 2004, vol: 24, page: 1523, stat: Journal Article,

CT screening for lung cancer: suspiciousness of nodules according to size on baseline scans
Henschke, Claudia I; Yankelevitz, David F; Naidich, David P; McCauley, Dorothy I; McGuinness, Georgeann; Libby, Daniel M; Smith, James P; Pasmantier, Mark W; Miettinen, Olli S
2004 Apr;231(1):164-168, Radiology
PURPOSE: To assess the frequency with which a particular, possibly optimal work-up of noncalcified nodules less than 5.0 mm in diameter identified on initial computed tomographic (CT) images at baseline screening leads to a diagnosis of malignancy prior to first annual repeat screening, compared with a possibly optimal work-up of larger nodules. MATERIALS AND METHODS: Two series of baseline CT screenings in high-risk people were retrospectively reviewed. The first series (n = 1,000) was performed in 1993-1998; the second (n = 1,897), in 1999-2002. In each series, cases in which the largest noncalcified nodule detected was less than 5.0 mm in diameter and those in which it was 5.0-9 mm were reviewed to determine whether diagnostic work-up prior to first annual repeat screening showed or would have shown nodule growth and led or would have led to a diagnosis based on biopsy or surgical specimens. RESULTS: The frequency with which malignancy was or could have been diagnosed when the largest noncalcified nodule was less than 5.0 mm in diameter was 0 of 378, whereas when the largest noncalcified nodule was 5.0-9 mm in diameter, the frequency was 13 or 14 of 238. If persons with only nodules smaller than 5.0 mm had merely been referred for first annual repeat screening without immediate further work-up, the referrals for such work-up would have been reduced by 54% (from 817 [28%] to 385 [13%] of 2,897). CONCLUSION: In modern CT screening for lung cancer at baseline, detected noncalcified nodules smaller than 5.0 mm in diameter do not justify immediate work-up but only annual repeat screening to determine whether interim growth has occurred
— id: 44814, year: 2004, vol: 231, page: 164, stat: Journal Article,

CT screening for lung cancer Assessing a regimen's diagnostic performance
Henschke, Claudia I; Yankelevitz, David F; Smith, James P; Libby, Daniel; Pasmantier, Mark; McCauley, Dorothy; McGuinness, Georgeann; Naidich, David P; Farooqi, Ali; Vasquez, Madeline; Miettinen, Olli S
2004 Sep-Oct;28(5):317-321, Clinical imaging
PURPOSE: The purpose of this study was to characterize the diagnostic performance of a regimen of CT screening for lung cancer. METHODS: Using a common protocol/regimen of screening, 2968 asymptomatic persons at high risk for lung cancer were enrolled in two studies [Early Lung Cancer Action Projects (ELCAP) I and II] for baseline and annual repeat screening. A total of 4538 annual repeat screenings were performed. The regimen's diagnostic performance was characterized in terms of frequency of positive result of the initial CT as well as of screen-diagnosis and Stage I screen-diagnosis among all diagnoses (interim-diagnoses included), all separately for baseline and annual repeat screenings. RESULTS: The proportions with positive result of the initial CT were 12% and 6% in the baseline and repeat screenings, respectively. The proportions of screen-diagnoses among all diagnoses (interim-diagnoses included) were 97% and 99% in the baseline and repeat cycles, respectively. The corresponding proportions of pre-surgical Stage I screen-diagnoses were 95% and 93%. CONCLUSION: The performance of the ELCAP regimen is quite satisfactory in avoiding over many positive results of the initial CT, and it produces highly promising diagnostic results as for the attainment of cure by early intervention
— id: 68280, year: 2004, vol: 28, page: 317, stat: Journal Article,

Imaging of thoracic tuberculosis infections
McGuinness G; Rubinowitz AN
Tuberculosis Philadelphia : Lippincott Williams & Wilkins, 2004,
— id: 3969, year: 2004, vol: , page: 395, stat: Chapter,

Small pulmonary nodules: volume measurement at chest CT--phantom study
Ko, Jane P; Rusinek, Henry; Jacobs, Erika L; Babb, James S; Betke, Margrit; McGuinness, Georgeann; Naidich, David P
2003 Sep;228(3):864-870, Radiology
Three-dimensional methods for quantifying pulmonary nodule volume at computed tomography (CT) and the effect of imaging variables were studied by using a realistic phantom. Two fixed-threshold methods, a partial-volume method (PVM) and a variable method, were used to calculate volumes of 40 plastic nodules (largest dimension, <5 mm: 20 nodules with solid attenuation and 20 with ground-glass attenuation) of known volume. Tube current times (20 and 120 mAs), reconstruction algorithms (high and low frequency), and nodule characteristics were studied. Higher precision was associated with use of a PVM with predetermined pure nodule attenuation, high-frequency algorithm, and diagnostic CT technique (120 mAs). A PVM is promising for volume quantification and follow-up of nodules
— id: 43798, year: 2003, vol: 228, page: 864, stat: Journal Article,

Wavelet compression of low-dose chest CT data: effect on lung nodule detection
Ko, Jane P; Rusinek, Henry; Naidich, David P; McGuinness, Georgeann; Rubinowitz, Ami N; Leitman, Barry S; Martino, Jennifer M
2003 Jul;228(1):70-75, Radiology
PURPOSE: To assess the effect of using a lossy Joint Photographic Experts Group standard for wavelet image compression, JPEG2000, on pulmonary nodule detection at low-dose computed tomography (CT). MATERIALS AND METHODS: One hundred sets of lung CT data ('cases') were compressed to 30:1, 20:1, and 10:1 levels by using a wavelet-based JPEG2000 method, resulting in 400 test cases. Each case consisted of nine 1.25-mm sections that had been obtained with 20-40 mAs. Four thoracic radiologists independently interpreted the test case images. Performance was measured by using area under the receiver operating characteristic (ROC) curve (Az) and conventional sensitivity and specificity analyses. RESULTS: There were 51 cases with and 49 without lung nodules. Az values were 0.984, 0.988, 0.972, 0.921, respectively, for original and 10:1, 20:1, and 30:1 compressed images. Az values decreased significantly at 30:1 (P =.014) but not at 10:1 compression, with a trend toward significant decrease at 20:1 (P =.051). Specificity values were unaffected by compression (>98.0% at all compression levels). Sensitivity values were 86.3% (176 of 204 test cases with nodules), 77.9% (159 of 204 cases), 76.5% (156 of 204 cases), and 70.1% (143 of 204 cases), respectively, for original and 10:1, 20:1, and 30:1 compressed images. Results of logistic regression model analysis confirmed the significant effects of compression rate and nodule attenuation, size, and location on sensitivity (P <.05). CONCLUSION: While no reduction in nodule detection at 10:1 compression levels was demonstrated by using ROC analysis, a significant decrease in sensitivity was identified. Further investigation is needed before widespread use of image compression technology in low-dose chest CT can be recommended
— id: 43799, year: 2003, vol: 228, page: 70, stat: Journal Article,

Mechanisms of colchicine effect in the treatment of asbestosis and idiopathic pulmonary fibrosis
Addrizzo-Harris, D J; Harkin, T J; Tchou-Wong, K M; McGuinness, G; Goldring, R; Cheng, D; Rom, D W N
2002 ;180(2):61-72, Lung
The objective of this study was to evaluate the mechanisms of colchicine action in pulmonary fibrosis. The study included 10 patients with pulmonary fibrosis (idiopathic pulmonary fibrosis 5, asbestosis 4, and scleroderma 1) who had been admitted to Bellevue Hospital Center, a tertiary care public hospital in New York City. We administered colchicine 0.6 mg orally for 12 weeks to patients with pulmonary fibrosis. Symptoms, high resolution CT scans, pulmonary function tests, and bronchoalveolar lavage parameters were compared prior to and after treatment. Results showed declines in dyspnea index, selective improvement in several CT scans, but no statistically significant change in BAL cells, cytokines, fibronectin, or hydroxyproline. However, there was a decline in hydroxyproline in the BAL fluid in 8/10 patients. We concluded that colchicine has a mild antifibrotic effect which may be in inhibiting collagen formation since there was no effect on the inflammation that accompanies fibrosis
— id: 34535, year: 2002, vol: 180, page: 61, stat: Journal Article,

Tumor localization and image registration of F-18 FDG coincidence detection scans with computed tomographic scans
Aitken, Candice L; Mahmoud, Faaiza; McGuinness, Georgeann; Kramer, Elissa L; Maguire, Gerald Q Jr; Noz, Marilyn E
2002 Apr;27(4):275-282, Clinical nuclear medicine
PURPOSE: The aim of this study was to determine the feasibility of registering routine clinical F-18 fluorodeoxyglucose (FDG) coincidence detection (CD) scans with computed tomographic (CT) scans for radiation treatment planning and case management. METHODS: F-18 FDG CD and chest CT scans, performed in 10 randomly selected patients with confirmed or possible adenocarcinoma of the lung, were evaluated. The quality of the matches was verified by comparisons of the center-to-center distance between a region of interest (ROI) manually drawn on the CT slice and warped onto the CD slice with an ROI drawn manually directly on the CD slice. In addition, the overlap between the two ROIs was calculated. RESULTS: All 10 F-18 FDG CD and CT scans were registered with good superimposition of soft tissue density on increased radionuclide activity. The center-to-center distance between the ROIs ranged from 0.29 mm to 8.08 mm, with an average center-to-center distance of 3.89 mm +/- 2.42 mm (0.69 pixels +/- 0.34 pixels). The ROI overlap ranged from 77% to 99%, with an average of 90% +/- 5.6%. CONCLUSIONS: Although the use of F-18 FDG CD shows great promise for the identification of tumors, it shares the same drawbacks as those associated with radiolabeled monoclonal antibody SPECT and ligand-based positron emission tomographic scans in that anatomic markers are limited. This study shows that image registration is feasible and may improve the clinical relevance of CD images
— id: 33314, year: 2002, vol: 27, page: 275, stat: Journal Article,

CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules
Henschke, Claudia I; Yankelevitz, David F; Mirtcheva, Rosna; McGuinness, Georgeann; McCauley, Dorothy; Miettinen, Olli S
2002 May;178(5):1053-1057, American journal of roentgenology
OBJECTIVE: In the Early Lung Cancer Action Project (ELCAP), we found not only solid but also part-solid and nonsolid nodules in patients at both baseline and repeat CT screening for lung cancer. We report the frequency and significance of part-solid and nonsolid nodules in comparison with solid nodules. MATERIALS AND METHODS: We reviewed all instances of a positive finding in patients at baseline (from one to six noncalcified nodules) and annual repeat screenings (from one to six newly detected noncalcified nodules with interim growth) to classify each of the nodules as solid, part-solid, or nonsolid. We defined a solid nodule as a nodule that completely obscures the entire lung parenchyma within it. Part-solid nodules are those having sections that are solid in this sense, and nonsolid nodules are those with no solid parts. Chi-square statistics were used to test for differences in the malignancy rates. RESULTS: Among the 233 instances of positive results at baseline screening, 44 (19%) involved a part-solid or nonsolid largest nodule (16 part-solid and 28 nonsolid). Among these 44 cases of positive findings, malignancy was diagnosed in 15 (34%) as opposed to a 7% malignancy rate for solid nodules (p = 0.000001). The malignancy rate for part-solid nodules was 63% (10/16), and the rate for nonsolid nodules was 18% (5/28). Even after standardizing for nodule size, the malignancy rate was significantly higher for part-solid nodules than for either solid ones (p = 0.004) or nonsolid ones (p = 0.03). The malignancy type in the part-solid or nonsolid nodules was predominantly bronchioloalveolar carcinoma or adenocarcinoma with bronchioloalveolar features, contrasting with other subtypes of adenocarcinoma found in the solid nodules (p = 0.0001). At annual repeat screenings, only 30 instances of positive test results have been obtained; seven of these involved part-solid or nonsolid nodules. CONCLUSION: In CT screening for lung cancer, the detected nodule commonly is either only part-solid or nonsolid, but such a nodule is more likely to be malignant than a solid one, even when nodule size is taken into account
— id: 68281, year: 2002, vol: 178, page: 1053, stat: Journal Article,

High-resolution computed tomography: technique and pitfalls
McGuinness, Georgeann
2002 Jan;37(1):5-16, Seminars in roentgenology
— id: 39658, year: 2002, vol: 37, page: 5, stat: Journal Article,

CT of airways disease and bronchiectasis
McGuinness, Georgeann; Naidich, David P
2002 Jan;40(1):1-19, Radiologic clinics of North America
High-resolution CT is accepted as an accurate noninvasive means of diagnosing bronchiectasis. A wide spectrum of abnormalities may be identified at HRCT in patients with airway disease, including various distinctive patterns of bronchiectasis in specific clinical settings, such as ABPA, MAC infection, AIDS, and CF. Characteristic CT findings occasionally suggest a specific diagnosis that may not have been under clinical consideration. HRCT also provides significant clinical use in assessing the degree and extent of airway disease, and allows noninvasive monitoring of disease progression, regression, or response to therapy
— id: 44945, year: 2002, vol: 40, page: 1, stat: Journal Article,

Cough and bronchial responsiveness in firefighters at the World Trade Center site
Prezant, David J; Weiden, Michael; Banauch, Gisela I; McGuinness, Georgeann; Rom, William N; Aldrich, Thomas K; Kelly, Kerry J
2002 Sep 12;347(11):806-815, New England journal of medicine
BACKGROUND: Workers from the Fire Department of New York City were exposed to a variety of inhaled materials during and after the collapse of the World Trade Center. We evaluated clinical features in a series of 332 firefighters in whom severe cough developed after exposure and the prevalence and severity of bronchial hyperreactivity in firefighters without severe cough classified according to the level of exposure. METHODS: 'World Trade Center cough' was defined as a persistent cough that developed after exposure to the site and was accompanied by respiratory symptoms severe enough to require medical leave for at least four weeks. Evaluation of exposed firefighters included completion of a standard questionnaire, spirometry, airway-responsiveness testing, and chest imaging. RESULTS: In the first six months after September 11, 2001, World Trade Center cough occurred in 128 of 1636 firefighters with a high level of exposure (8 percent), 187 of 6958 with a moderate level of exposure (3 percent), and 17 of 1320 with a low level of exposure (1 percent). In addition, 95 percent had symptoms of dyspnea, 87 percent had gastroesophageal reflux disease, and 54 percent had nasal congestion. Of those tested before treatment of World Trade Center cough, 63 percent of firefighters (149 of 237) had a response to a bronchodilator and 24 percent (9 of 37) had bronchial hyperreactivity. Chest radiographs were unchanged from precollapse findings in 319 of the 332 with World Trade Center cough. Among the cohort without severe cough, bronchial hyperreactivity was present in 77 firefighters with a high level of exposure (23 percent) and 26 with a moderate level of exposure (8 percent). CONCLUSIONS: Intense, short-term exposure to materials generated during the collapse of the World Trade Center was associated with bronchial responsiveness and the development of cough. Clinical and physiological severity was related to the intensity of exposure
— id: 42262, year: 2002, vol: 347, page: 806, stat: Journal Article,

Acute eosinophilic pneumonia in a New York City firefighter exposed to World Trade Center dust
Rom, William N; Weiden, Michael; Garcia, Roberto; Yie, Ting An; Vathesatogkit, Pratan; Tse, Doris B; McGuinness, Georgeann; Roggli, Victor; Prezant, David
2002 Sep 15;166(6):797-800, American journal of respiratory & critical care medicine
We report a sentinel case of acute eosinophilic pneumonia in a firefighter exposed to high concentrations of World Trade Center dust during the rescue effort from September 11 to 24. The firefighter presented with a Pa(O2) of 53 mm Hg and responded to oxygen and corticosteroids. Computed tomography scan showed patchy ground glass density, thickened bronchial walls, and bilateral pleural effusions. Bronchoalveolar lavage recovered 70% eosinophils, with only 1% eosinophils in peripheral blood. Eosinophils were not degranulated and increased levels of interleukin-5 were measured in bronchoalveolar lavage and serum. Mineralogic analysis counted 305 commercial asbestos fibers/10(6) macrophages including those with high aspect ratios, and significant quantities of fly ash and degraded fibrous glass. Acute eosinophilic pneumonia is a rare consequence of acute high dust exposure. World Trade Center dust consists of large particle-size silicates, but fly ash and asbestos fibers may be found in bronchoalveolar lavage cells
— id: 39593, year: 2002, vol: 166, page: 797, stat: Journal Article,

Early Lung Cancer Action Project: A summary of the findings on baseline screening
Henschke, CI; McCauley, DI; Yankelevitz, DF; Naidich, DP; McGuinness, G; Miettinen, OS; Libby, D; Pasmantier, M; Koizumi, J; Altorki, N; Smith, JP
2001 Mar;6(2):147-152, Oncologist
Purpose. The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low radiation dose computed tomography (low-dose CT) in persons at high-risk for lung cancer. Methods. Since starting in 1993, the ELCAP has enrolled I W asymptomatic persons, 60 years of age or older, with at least 10 pack-years (1 pack per day for 10 years, or 2 packs per day for 5 years) of cigarette smoking, no prior cancer, and medically fit to undergo thoracic surgery. After a structured interview and informed consent, baseline chest radiographs and low-dose CT were obtained on each subject. The diagnostic work-up of screen-detected noncalcified pulmonary nodules (NCN) was guided by ELCAP recommendations which included short-term high-resolution CT follow-up for the smallest nodules. Baseline Results. On low-dose CT at baseline compared to chest radiography, NCN were detected three times as commonly (23% versus 7%), malignancies four times as commonly (2.7% versus 0.7%), and stage I malignancies six times as commonly (23% versus 0.4%). Of the 27 CT-detected cancers, 96% (26/27) were resectable; 85% (23/27) were stage I, and 83% (19 of the 23 stage 1) were not seen on chest radiography. Following the ELCAP recommendations, biopsies were performed on 28 of the 233 subjects with NCN; 27 had a malignant and one a benign NCN. Another three individuals underwent biopsy outside of the ELCAP recommendations; all had benign NCNs. No one had thoracotomy for a benign nodule. Conclusion. Baseline CT screening for lung cancer provides for detecting the disease at earlier and presumably more commonly curable stages in a cost- effective manner
— id: 27520, year: 2001, vol: 6, page: 147, stat: Journal Article,

Early Lung Cancer Action Project - Initial findings on repeat screening
Henschke, CI; Naidich, DP; Yankelevitz, DF; McGuinness, G; McCauley, DI; Smith, JP; Libby, D; Pasmantier, M; Vazquez, M; Koizumi, J; Flieder, D; Altorki, N; Miettinen, OS
2001 JUL 1 ;92(1):153-159, Cancer
BACKGROUND. The Early Lung Cancer Action Project (ELCAP) was designed to evaluate the usefulness of annual computed tomography (CT) screening for lung carcinoma. With the baseline results having been reported previously, the focus of the current study was on the early results of the repeat screenings. METHODS. A cohort of 1000 high-risk individuals was recruited for baseline and annual repeat CT screening. At last follow-up, a total of 1184 annual repeat screenings had been performed. A positive result from the screening test was defined as newly detected, one to six noncalcified pulmonary nodules with interim growth. The diagnostic workup of the individuals was guided by recommendations supplied by the ELCAP investigators to the collaborating clinicians. RESULTS. Of the 1184 repeat CT screenings, the test result was positive in 30 (2.5%). In 2 of these 30 cases, the individual died (of an unrelated cause) before diagnostic workup and the nodule(s) resolved in another 12 individuals. In the remaining 16 individuals, the absence of further growth was documented by repeat CT in 8 individuals and further growth was documented in the remaining 8 individuals. All eight individuals with further nodular growth underwent biopsy and malignancy was diagnosed in seven. Six of these seven malignancies were nonsmall cell carcinomas (five of which were Stage IA and one of which was Stage IIIA) and the one small cell carcinoma was found to be of limited stage. The median size dimension of these malignancies was 8 mm. In another two subjects, symptoms prompted the interim diagnosis of lung carcinoma. Neither of these malignancies was nodule-associated but rather were endobronchial; one was a Stage IIB nonsmall cell carcinoma and the other was a small cell carcinoma of limited stage. CONCLUSIONS. False-positive screening test results are uncommon and usually manageable without biopsy; compared with no screening, such screenings permit diagnosis at substantially earlier and thus more curable stages. Annual repetition of CT screening is sufficient to minimize symptom-prompted interim diagnoses of nodule-associated malignancies. Cancer 2001;92:153-9. (C) 2001 American Cancer Society
— id: 55014, year: 2001, vol: 92, page: 153, stat: Journal Article,

Volume quantitation of small pulmonary nodules on low-dose chest
Ko, JP; Rusinek, H; Chandra, R; McGuinness, G; Betke, M; Naidich, DP
2001 NOV ;221(2):312-312, Radiology
— id: 73267, year: 2001, vol: 221, page: 312, stat: Journal Article,

The normal CT appearances of the second carina and bronchial stump after left upper lobectomy
Gruden JF; Campagna G; McGuinness G
2000 Apr;15(2):138-143, Journal of thoracic imaging
We retrospectively evaluated the computed tomography (CT) appearance of the bronchial stump and second carina (left upper lobe spur) after left upper lobectomy. There were 69 CT examinations in 38 patients; all were free of recurrent or metastatic disease. The spur was graded as a) sharp (wedge-shaped tip configuration with <90 degrees angulation), b) lobulated (bulbous tip with <90 degrees angulation), or c) widened (>90 degrees angulation regardless of tip configuration). The bronchial stump was evaluated for the presence or absence of soft tissue in proximity to the surgical staples. The spur had a sharp appearance in 33 of 38 patients (87%) and was lobulated in 5 of 38 (13%). No patient had soft tissue at the bronchial stump. Serial examinations showed no change in the appearance of either structure. The spur remains sharp after left upper lobectomy in most patients; lobulation occurs in 13%. No changes occur over time. Interval change, widening of the spur, or soft tissue at the bronchial stump may suggest abnormality. Knowledge of normal and potentially abnormal appearances is essential to proper CT interpretation, particularly in the setting of postoperative surveillance for recurrent or metastatic disease
— id: 11717, year: 2000, vol: 15, page: 138, stat: Journal Article,

Tumor localization and image registration of 18-FDG SPECT scans with CT scans
Aitken, CL; McGuinness, G; Siddiqui, F; Ton, A; Kramer, EL; Maguire, GQ; Noz, ME
1999 MAY abstract #1281;40(5):290P-290P, Journal of nuclear medicine
— id: 33365, year: 1999, vol: 40, page: 290P, stat: Journal Article,

Multinodular disease: anatomic localization at thin-section CT--multireader evaluation of a simple algorithm
Gruden JF; Webb WR; Naidich DP; McGuinness G
1999 Mar;210(3):711-720, Radiology
PURPOSE: To evaluate the interobserver variability and accuracy of an algorithm for anatomic localization of small nodules evident on thin-section computed tomographic (CT) images of the lungs. MATERIALS AND METHODS: Four experienced chest radiologists independently evaluated thin-section CT images in 58 patients by using an algorithm and a standard score sheet. Nodules were placed into four possible anatomic locations or categories: perilymphatic, random, associated with small airways disease, or centrilobular. Algorithm accuracy was assessed by comparing the localization by the observers to that expected for each specific disease in the study group on the basis of reports in the literature. Interobserver variability was assessed by placing cases into one of three groups: (a) complete concordance, (b) triple concordance, and (c) discordant. RESULTS: All observers agreed in 79% (46 of 58) of the cases with regard to nodule localization; three of the four concurred in an additional 17% (10 of 58). The observers were correct in 218 (94%) of 232 localizations in the 58 cases. There were no apparent differences in the number of either discordant or incorrect localizations between the observers. The most noteworthy source of error and of disagreement between observers was the confusion of perilymphatic and small airways disease-associated nodules in a small number of cases. CONCLUSION: The proposed algorithm is reproducible and accurate in the majority of cases and facilitates nodule localization at thin-section CT
— id: 38849, year: 1999, vol: 210, page: 711, stat: Journal Article,

Early Lung Cancer Action Project: overall design and findings from baseline screening
Henschke, CI; McCauley, DI; Yankelevitz, DF; Naidich, DP; McGuinness, G; Miettinen, OS; Libby, DM; Pasmantier, MW; Koizumi, J; Altorki, NK; Smith, JP
1999 JUL 10 ;354(9173):99-105, Lancet
Background The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low-radiation-dose computed tomography (low-dose CT) in people at high risk of lung cancer. We report the baseline experience. Methods ELCAP has enrolled 1000 symptom-free volunteers, aged 60 years or older, with at least 10 pack years of cigarette smoking and no previous cancer, who were medically fit to undergo thoracic surgery. After a structured interview and informed consent, chest radiographs and low-dose CT were done for each participant. The diagnostic investigation of screen-detected non-calcified pulmonary nodules was guided by ELCAP recommendations, which included short-term high-resolution CT follow-up for the smallest non-calcified nodules. Findings Non-calcified nodules were detected in 233 (23% [95%; CI 21-26]) participants by low-dose CT at baseline, compared with 68 (7% [5-9]) by chest radiography. Malignant disease was detected in 27 (2.7% [1.8-3.8]) by CT and seven (0.7% [0.3-1.3]) by chest radiography, and stage malignant disease in 23 (2.3% [1.5-3.3]) and four (0.4% [0.1-0.9]), respectively. Of the 27 CT-detected cancers, 26 were resectable. Biopsies were done on 28 of the 233 participants with non-calcified nodules; 27 had malignant non-calcified nodules and one had a benign nodule. Another three individuals underwent biopsy against the ELCAP recommendations; all had benign non-calcified nodules. No participant had thoracotomy for a benign nodule. Interpretation low-dose CT can greatly improve the likelihood of detection of small non-calcified nodules, and thus of lung cancer at an earlier and potentially more curable stage. Although false-positive CT results are common. they can be managed with little use of invasive diagnostic procedures
— id: 54006, year: 1999, vol: 354, page: 99, stat: Journal Article,

Viral and Pneumocystis carinii infections of the lung in the immunocompromised host
McGuinness G; Gruden JF
1999 Jan;14(1):25-36, Journal of thoracic imaging
Viruses and Pneumocystis carinii are significant causes of pneumonia in immunocompromised patients, particularly patients with impaired cell-mediated immunity. They are often simultaneously considered in the differential diagnosis of diffuse pneumonitis in these patients and, because radiographic appearances and the periods of vulnerability to these infections may overlap, may be difficult to differentiate. This article will correlate radiographic findings to evolving histopathologic changes in select specific infections, as they affect three different immune impaired populations: (a) acquired immunodeficiency syndrome, (b) immunosuppression secondary to therapy for underlying malignancy or with solid organ transplantation, and (c) immune impairment in the bone marrow transplant patient. Appreciation of the specific clinical setting in which to consider these infections will be emphasized
— id: 7403, year: 1999, vol: 14, page: 25, stat: Journal Article,

Primary multifocal tuberculous osteomyelitis with involvement of the ribs
Chang DS; Rafii M; McGuinness G; Jagirdar JS
1998 Nov;27(11):641-645, Skeletal radiology
Two cases of primary multifocal tuberculous osteomyelitis with involvement of the rib cage are presented. The lungs were normal and the appearance of the skeletal lesions did not suggest tuberculosis. These lesions were predominantly lytic, with minimal soft tissue involvement. Tuberculosis should be high in the differential diagnosis of multiple destructive bone lesions, especially in patients from regions where tuberculosis is endemic
— id: 7530, year: 1998, vol: 27, page: 641, stat: Journal Article,

Epstein-Barr-virus-associated lymphoproliferative disease of the lung: CT and histologic findings
Collins J; Muller NL; Leung AN; McGuinness G; Mergo PJ; Flint JD; Warner TF; Poirier C; Theodore J; Zander D; Yee HT
1998 Sep;208(3):749-759, Radiology
PURPOSE: To assess the computed tomographic (CT) and histologic findings of intrathoracic lymphoproliferative disease (LPD) associated with the Epstein-Barr virus (EBV). MATERIALS AND METHODS: The authors retrospectively reviewed the CT scans of the chest and the pathologic specimens obtained in 24 patients with histologically proved intrathoracic LPD and with positive serologic findings or immunohistochemical staining for EBV. Five patients had acquired immunodeficiency syndrome (AIDS); one had common variable immune deficiency; and 18 were receiving immunosuppressive therapy for heart, lung, or heart-lung (n =15) or bone marrow (n = 2) transplantation and vasculitis (n = 1). RESULTS: Final diagnoses included malignant lymphoma (n = 15), polyclonal LPD (n = 8), and hyperplasia of bronchus-associated lymphoid tissue (n = 1). CT findings included multiple nodules (n = 21), lymphadenopathy (n = 9), areas of groundglass opacification (n = 8), septal thickening (n = 7), consolidation (n = 5), pleural effusion (n = 4), and solitary endobronchial lesion (n = 2). The nodules were 2-4 cm in diameter, involved mainly the middle and lower lung zones, and frequently had a predominantly peribronchovascular (n = 15) or subpleural (n = 14) distribution. CONCLUSION: EBV-associated LPD may range from benign lymphoid hyperplasia to high-grade lymphoma. The most common CT manifestation consists of multiple nodules, frequently in a predominantly peribronchovascular or subpleural distribution
— id: 7535, year: 1998, vol: 208, page: 749, stat: Journal Article,

Thoracic complications of AI
McGuinness, G; Gruden, JF; Garay, SM; Naidich, DP
1998 AUG ;19(5):543-560, Seminars in respiratory & critical care medicine
Despite encouraging recent treatment advances, HIV and AIDS-related pulmonary complications will continue to present a diagnostic and therapeutic challenge. Streamlined, cost-effective management of these patients is increasingly important in the current medical economic environment. This article presents an approach to the diagnosis of AIDS-related pulmonary disease, emphasizing optimal integration of imaging modalities into specific, practical, cost-effective pathways. The imaging findings of common diseases, both infectious and noninfectious, are summarized, The importance of clinical and demographic information to accurate radiographic interpretation and diagnostic evaluation is emphasized
— id: 53684, year: 1998, vol: 19, page: 543, stat: Journal Article,

Pulmonary nodule detection: low-dose versus conventional CT
Rusinek H; Naidich DP; McGuinness G; Leitman BS; McCauley DI; Krinsky GA; Clayton K; Cohen H
1998 Oct;209(1):243-249, Radiology
PURPOSE: To quantitate the effectiveness of low-dose computed tomography (CT) in the identification of pulmonary nodules while controlling for anatomic nodule characteristics and to establish what factors lead to reduced diagnostic sensitivity at low-dose CT. MATERIALS AND METHODS: Each of six participating radiologist independently rated 200 image panels by using a four-point confidence scale. Conventional images were obtained at 200 mAs; low-dose images were obtained at 20 mAs. To fully control their characteristics, nodules were simulated with a given diameter, shape, and section thickness while preserving the resolution, noise level, and reconstruction artifacts of the original images. Panels were matched so that nodules on low-dose and conventional images had equivalent sizes, locations, and relationships to blood vessels. RESULTS: Among 864 positive panels, 259 (60%) of 432 low-dose panels and 272 (63%) of 432 conventional panels were correctly interpreted (P = .259). Lowering the x-ray dose significantly reduced the detectability of peripheral nodules (P = .019) and nodules separated from blood vessels (P = .044). Surprisingly, 3-mm nodules were detected with approximately equal sensitivity (P = .181) at conventional and low-dose CT. The specificity of low-dose images was 88% (148 of 168 panels) versus 91% (153 of 168 panels) for conventional images (P = .372). CONCLUSION: Low-dose CT is acceptable for pulmonary nodule identification, making it suitable for primary screening. These results confirm the strong effect of size, location, and angiocentricity on the sensitivity of nodule detection with conventional CT
— id: 7773, year: 1998, vol: 209, page: 243, stat: Journal Article,

Pulmonary aspergilloma and AIDS. A comparison of HIV-infected and HIV-negative individuals
Addrizzo-Harris DJ; Harkin TJ; McGuinness G; Naidich DP; Rom WN
1997 Mar;111(3):612-618, Chest
OBJECTIVE AND METHODS: While pulmonary aspergilloma has been well described in immunocompetent hosts, to date and to our knowledge, there has not been a description of pulmonary aspergilloma in the HIV-infected individual. A retrospective review of cases seen by the Bellevue Hospital Chest Service from January 1992 through June 1995 identified 25 patients with aspergilloma. To investigate the impact of HIV status on pulmonary aspergilloma, we compared clinical presentation, progression of disease, treatment, and outcome in the HIV-infected patient vs the HIV-negative patient with aspergilloma. RESULTS: Of the 25 patients identified, 10 were HIV-infected and 15 were HIV-negative. Predisposing diseases included tuberculosis (18/25, 72%), sarcoidosis (4/25, 16%), and Pneumocystis carinii pneumonia (3/25, 12%). All 25 patients had evidence of aspergilloma on chest CT. In addition, 17 of 25 patients had evidence of Aspergillus species in fungal culture, pathologic specimens, or immunoprecipitins. Hemoptysis was present in 15 of 25 (60%) (11/15 [73%] of the HIV-negative group vs 4/10 [40%] of the HIV-infected group). Severe hemoptysis (> 150 mL/d) occurred in 5 of 15 (33%) of the HIV-negative group vs 1 of 10 (10%) of the HIV-infected group. Disease progression occurred more frequently among the HIV-infected group (4/8, 50% vs 1/13, 8% in HIV-negative individuals). All patients with disease progression had lymphocyte subset CD4+ < 100 cells per microliter. Four of eight (50%) of the HIV-infected group vs 1 of 13 (8%) of the HIV-negative group died. SUMMARY AND CONCLUSIONS: We conclude the following: (1) although tuberculosis and sarcoidosis are the most prevalent predisposing diseases, P carinii pneumonia in the HIV-infected individual is a risk factor for pulmonary aspergilloma; (2) HIV-infected individuals with CD4+ < 100 cells per microliter are more likely to have disease progression despite treatment; and (3) HIV-negative patients are more likely to have hemoptysis requiring intervention
— id: 12362, year: 1997, vol: 111, page: 612, stat: Journal Article,

Changing trends in the pulmonary manifestations of AIDS
McGuinness G
1997 Sep;35(5):1029-1082, Radiologic clinics of North America
This article reviews the changing trends observed in AIDS patients over the course of the epidemic. The spectrum of diseases of the chest associated with HIV infection is vast and varied. To generate a useful differential diagnosis based on imaging findings, the radiologist must appreciate shifts in disease prevalence and epidemiology and appreciate changing radiographic manifestations of many of these diseases. Imaging findings, both with chest radiography and CT scan, are summarized and the importance of integration of clinical information in interpreting these images and generating a reasonable differential diagnosis is emphasized
— id: 56970, year: 1997, vol: 35, page: 1029, stat: Journal Article,

AIDS-related airway disease
McGuinness G; Gruden JF; Bhalla M; Harkin TJ; Jagirdar JS; Naidich DP
1997 Jan;168(1):67-77, American journal of roentgenology
To our knowledge, the importance of airway disease in HIV-positive patients has been infrequently noted. This deficit likely reflects a combination of factors including lack of familiarity with recent changes in clinical and epidemiologic patterns of pulmonary manifestations of HIV infection and documented limitations of chest radiography for identifying and differentiating airway disease from other causes of pulmonary disease in HIV-positive patients. Familiarity with the imaging findings for these various entities should facilitate prompt diagnosis and treatment. The accuracy of CT in detecting airway disease [55-59] is well established and should be of value in excluding more common diseases that may be initially confused with airway abnormalities [60, 61]. Small airways disease, in particular, which may be occult or mimic an interstitial infiltrate on chest radiography, can be recognized with CT as likely representing infectious bronchitis or bronchiolitis. Patients with findings suggesting bacterial infections may benefit from empiric antibiotic therapy. CT also may be valuable for differentiating between various noninfectious pulmonary diseases, allowing a presumptive diagnosis of parenchymal Kaposi's sarcoma in the appropriate clinical context. In distinction, by detecting localized endobronchial or parenchymal abnormalities in patients with mycobacterial or fungal infections or lymphoma, CT may be valuable for deciding between various invasive methods of obtaining either histologic or bacteriologic diagnoses
— id: 7082, year: 1997, vol: 168, page: 67, stat: Journal Article,

Volumetric (helical/spiral) CT (VCT) of the airways
Naidich DP; Gruden JF; McGuinness G; McCauley DI; Bhalla M
1997 Jan;12(1):11-28, Journal of thoracic imaging
Volumetric computed tomography (VCT) represents an important improvement over conventional CT for assessing most airway abnormalities. Elimination of misregistration due to variations in respiration coupled with decreased motion artifact and the ability to obtain routine overlapping sections allow a more confident estimation of the presence and extent of disease. Recently, attention has focused on newer reconstruction techniques including: multiplanar reconstructions (MPRs), including curved multiplanar reformations; multiplanar volume reconstructions (MPVRs) using ray projection techniques, such as maximum and minimum projection imaging; external rendering, or 3D-shaded surface displays; and, most recently, internal rendering or so-called 'virtual bronchoscopy'. Given the often redundant nature of many of these methodologies determining indications for their use remains to be established, especially by comparison to axial imaging. The purpose of this article is to review these various reconstruction techniques and, based on current knowledge, place them in an appropriate clinical context
— id: 12432, year: 1997, vol: 12, page: 11, stat: Journal Article,

Diffuse lung disease: assessment with helical CT--preliminary observations of the role of maximum and minimum intensity projection images [see comments]
Bhalla M; Naidich DP; McGuinness G; Gruden JF; Leitman BS; McCauley DI
1996 Aug;200(2):341-347, Radiology
PURPOSE: To evaluate assessment of diffuse lung disease with helical computed tomography (CT) and maximum intensity projection (MIP) and minimum intensity projection images. MATERIALS AND METHODS: Six patients with suspected lung disease (the control group) and 20 patients with documented disease underwent axial helical CT through the upper and lower lung fields. Findings on the MIP and minimum intensity projection images of each helical data set were compared with findings on the thin-section scan obtained at the midplane of the series. RESULTS: Owing to markedly improved visualization of peripheral pulmonary vessels (n = 26) and improved spatial orientation, MIP images were superior to helical scans to help identify pulmonary nodules and characterize them as peribronchovascular (n = 2) or centrilobular (n = 7). Minimum intensity projection images were more accurate than thin-section scans to help identify lumina of central airways (n = 23) and define abnormal low (n = 15) and high (ground-glass) (n = 8) lung attenuation. Conventional thin-section scans depicted fine linear structures more clearly than either MIP or minimum intensity projection images, including the walls of peripheral, dilated airways (n = 3) and interlobular septa (n = 3). MIP and minimum intensity projection images added additional diagnostic findings to those on thin-section scans in 13 (65%) of 20 cases. CONCLUSION: MIP and minimum intensity projection images of helical data sets may help diagnosis of a wide spectrum of diffuse lung diseases
— id: 6982, year: 1996, vol: 200, page: 341, stat: Journal Article,

Subjective pitfalls in HRCT interpretation
Gruden JF; McGuinness G
1996 Oct;37(5):349-434, Critical reviews in diagnostic imaging
High-resolution computed tomography (HRCT) allows a detailed assessment of the anatomy and pathology of the pulmonary parenchyma. However, numerous potential pitfalls exist that can hinder or preclude accurate interpretation of HRCT images. These sources of potential diagnostic error can be systematically evaluated with respect to the major categories of HRCT abnormalities: (1) increased parenchymal attenuation, (2) linear opacities and interstitial disease, (3) nodular lung disease, and (4) holes in the lung. Accurate HRCT interpretation depends on the correct recognition and characterization of imaging abnormalities. Technical factors that enhance or limit scan interpretation, HRCT features of subtle disease, and imaging mimics of commonly observed pathology are addressed in detail with regard to each of the above categories of disease. Common pitfalls are illustrated and explained in an effort to increase general awareness of these sources of real and potential diagnostic confusion
— id: 12522, year: 1996, vol: 37, page: 349, stat: Journal Article,

Differentiation of the ILO boundary chest roentgenograph (0/1 to 1/0) in asbestosis by high-resolution computed tomography scan, alveolitis, and respiratory impairment
Harkin TJ; McGuinness G; Goldring R; Cohen H; Parker JE; Crane M; Naidich DP; Rom WN
1996 Jan;38(1):46-52, Journal of occupational & environmental medicine
High-resolution computed tomography (HRCT) scans have been advocated as providing greater sensitivity in detecting parenchymal opacities in asbestos-exposed individuals, especially in the presence of pleural fibrosis, and having excellent inter- and intraobserver reader interpretation. We compared the 1980 International Labor Organization (ILO) International Classification of the Radiographs of the Pneumoconioses for asbestosis with the high-resolution CT scan using a grid scoring system to better differentiate normal versus abnormal in the ILO boundary 0/1 to 1/0 chest roentgenograph. We studied 37 asbestos-exposed individuals using the ILO classification, HRCT grid scores, respiratory symptom questionnaires, pulmonary function tests, and bronchoalveolar lavage. We used Pearson correlation coefficients to evaluate the linear relationship between outcome variables and each roentgenographic method. The normal HRCT scan proved to be an excellent predictor of 'normality,' with pulmonary function values close to 100% for forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), total lung capacity (TLC), and carbon monoxide diffusing capacity (DLCO) and no increase in BAL inflammatory cells. Concordant HRCT/ILO abnormalities were associated with reduced FEV1/FVC ratio, reduced diffusing capacity, and alveolitis consistent with a definition of asbestosis. In our study, the ILO classification and HRCT grid scores were both excellent modalities for the assessment of asbestosis and its association with impaired physiology and alveolitis, with their combined use providing statistical associations with alveolitis and reduced diffusing capacity
— id: 56819, year: 1996, vol: 38, page: 46, stat: Journal Article,

Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia - Assessment with serial CT
Hartman, TE; Primack, SL; Kang, EY; Swensen, SJ; Hansell, DM; McGuinness, G; Muller, NL
1996 AUG ;110(2):378-382, Chest
Objective: To determine the outcome of areas of ground-glass attenuation and assess disease progression on serial high-resolution CT (HRCT) scans of patients with biopsy specimen-proved usual interstitial pneumonia (UIP) and desquamative interstitial pneumonia (DIP). Materials and methods: Twelve patients with biopsy specimen-proved UIP and 11 patients with biopsy specimen-proved DIP who had initial and follow-up HRCT scans (median interval, 10 months) were reviewed, Eleven patients with UIP and 11 with DIP received treatment between the initial and follow-up CT scans, The scans were evaluated for the presence and extent of ground-glass attenuation, irregular linear opacities and honeycombing, and overall extent of parenchymal involvement. Results: On initial CT scans, all 12 patients with UIP had areas of ground-glass attenuation (mean+/-SD extent, 30+/-16%) and irregular lines (mean+/-SD extent, 17+/-7%) and 10 patients had honeycombing (mean+/-SD extent, 10+/-6%). All 11 patients with DIP had areas of ground-glass attenuation on initial HRCT scans (mean+/-SD extent, 51+/-26%), 5 patients had irregular linear opacities (mean+/-SD extent, 5+/-5%), and 1 patient had honeycombing. Nine of the 12 patients with UIP showed increase in the extent of ground-glass attenuation (n=6) or progression to irregular lines (n=2) or honeycombing (n=4) on follow-up as compared with only 2 patients with DIP who showed progression to irregular lines (n=1) or honeycombing (n=1) (p<0.01, chi(2) test). Conclusion: In patients with UIP, areas of ground-glass attenuation usually increase in extent or progress to fibrosis despite treatment, Areas of ground-glass attenuation in most patients with DIP remain stable or improve with treatment
— id: 52836, year: 1996, vol: 110, page: 378, stat: Journal Article,

Detection and differential diagnosis of pulmonary infections and tumors in patients with AI
Kang, EY; Staples, CA; McGuinness, G; Primack, SL; Muller, NL
1996 JAN ;166(1):15-19, American journal of roentgenology
OBJECTIVE, The purpose of this study was to compare the sensitivity and specificity of chest radiography with those of CT in the detection of pulmonary infections and tumors in patients with AIDS, MATERIALS AND METHODS. The study was retrospective and included the radiographs and CT scans of 139 patients, Eighty-nine had one proven thoracic complication, 17 had two proven thoracic complications, and 33 had no active intrathoracic disease at the time of the examinations, The radiographs and CT scans were interpreted blindly by two independent observers from different institutions, The observers assessed for the presence or absence of intrathoracic disease and recorded the most likely diagnosis and the degree of confidence in that diagnosis. RESULTS, The patients were more commonly correctly identified as having or not having intrathoracic disease on the basis of CT findings than on the basis of radiographic findings (p < .01, chi-square test). Of the 106 patients with intrathoracic complications, 90% (191 of 212 interpretations) were correctly identified by the two observers on the radiograph and 96% (204 of 212 interpretations) at CT, Of 33 patients without intrathoracic disease, 73% (48 of 66 interpretations) were correctly identified at radiography and 86% (57 of 66 interpretations) at CT. Of 89 patients with one proved thoracic complication, the observers were confident in their first-choice diagnosis in 34% of the cases (61 of 178 interpretations) at chest radiography and in 47% (83 of 178 interpretations) at CT. This diagnosis was correct in 67% (41 of 61) of confident radiographic interpretations as compared with 87% (72 of 83) of interpretations at CT (p < .01,chi-square test). CONCLUSION. CT is superior to chest radiography in allowing identification of patients with and without thoracic disease and in the differential diagnosis of pulmonary complications of patients with AIDS, However, the improvement in differential diagnosis is modest. Because in most cases the radiographs and CT scans were obtained as part of the clinical evaluation, the study is probably biased toward problematic clinical cases, In the majority of patients, the chest radiograph provides adequate information and CT is not warranted
— id: 53114, year: 1996, vol: 166, page: 15, stat: Journal Article,

Bronchiectasis: CT/clinical correlations [published erratum appears in Semin Ultrasound CT MR 1996 Apr;17(2):92]
McGuinness G; Naidich DP
1995 Oct;16(5):395-419, Seminars in ultrasound CT & MR
The association between bronchiectasis and human immunodeficiency virus infection, the resurgence of tuberculosis, especially in urban and immunocompromised patients, and the recognition of bronchiectasis as a manifestation of rejection in the transplant population are emerging clinical settings in which establishing the diagnosis of bronchiectasis is becoming increasingly important. High-resolution CT, by virtue of its well-established accuracy, is currently accepted as the optimal noninvasive means of diagnosing bronchiectasis. However, reliable diagnosis requires meticulous attention to technique and a thorough knowledge of potential pitfalls. These include, among others, respiratory and cardiac motion artifacts as well as effects of collimation and electronic windowing. It also is important to recognize diseases that may mimic the appearance of bronchiectasis as well as unusual manifestations of bronchiectasis that may obscure the diagnosis
— id: 7215, year: 1995, vol: 16, page: 395, stat: Journal Article,

Unusual lymphoproliferative disorders in nine adults with HIV or AIDS: CT and pathologic findings
McGuinness G; Scholes JV; Jagirdar JS; Lubat E; Leitman BS; Bhalla M; McCauley DI; Garay SM; Naidich DP
1995 Oct;197(1):59-65, Radiology
PURPOSE: To identify characteristic computed tomographic (CT) findings in unusual pulmonary lymphoproliferative disorders seen in adults with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: The authors retrospectively reviewed the CT scans and pathologic specimens from nine patients with pulmonary lymphoproliferative disorders. CT scans were evaluated for nodules, reticulation, areas of ground-glass attenuation, consolidation, and bronchial disease. Changes seen in pathologic specimens were classified as consistent with classic lymphocytic interstitial pneumonitis (LIP), mucosa-associated lymphoid tissue lymphoma (MALTOMA), or atypical lymphoproliferative disorder (ALD). Immunopathologic results were reviewed when available. RESULTS: Eight patients had AIDS. Five patients had classic LIP. One patient had MALTOMA, and three patients had ALD. Altogether, 2-4-mm-diameter nodules were the predominant CT finding in eight patients; these were peribronchovascular in four patients. The presence of interstitial nodules correlated with the pathologic finding of nodular disease in seven patients. CONCLUSION: Familiarity with these AIDS-related disorders and their CT appearance should assist in the differential diagnosis
— id: 6844, year: 1995, vol: 197, page: 59, stat: Journal Article,

Hemoptysis: prospective high-resolution CT/bronchoscopic correlation [see comments]
McGuinness G; Beacher JR; Harkin TJ; Garay SM; Rom WN; Naidich DP
1994 Apr;105(4):1155-1162, Chest
The precise roles of fiberoptic bronchoscopy (FOB) and computed tomography (CT) of the chest in the evaluation of patients presenting with hemoptysis have not been clearly defined. On the assumption that both procedures would likely provide unique and complementary information, a prospective study with blinded interpreters using a modified high-resolution CT technique (HRCT) and FOB was designed to evaluate 57 consecutive patients admitted to Bellevue Hospital with hemoptysis. Etiologies included bronchiectasis (25 percent), tuberculosis (16 percent), lung cancer (12 percent), aspergilloma (12 percent), and bronchitis (5 percent): in an additional 5 percent of cases, hemoptysis proved to be due miscellaneous causes, while in 19 percent hemoptysis proved to be cryptogenic. Patients with lung cancer all were at least 50 years old, smoked an average of 78 pack-years, and had less severe hemoptysis but of longer duration. All had conditions diagnosed both by HRCT and FOB. High-resolution CT proved of particular value in diagnosing bronchiectasis and aspergillomas, while FOB was diagnostic of bronchitis and mucosal lesions such as Kaposi's sarcoma. Fiberoptic bronchoscopy localized bleeding in only 51 percent of cases. The high sensitivity of CT in identifying both the intraluminal and extraluminal extent of central lung cancers in conjunction with its value in diagnosing bronchiectasis suggest that CT should be obtained prior to bronchoscopy in all patients presenting with hemoptysis
— id: 6451, year: 1994, vol: 105, page: 1155, stat: Journal Article,

Cytomegalovirus pneumonitis: spectrum of parenchymal CT findings with pathologic correlation in 21 AIDS patients
McGuinness G; Scholes JV; Garay SM; Leitman BS; McCauley DI; Naidich DP
1994 Aug;192(2):451-459, Radiology
PURPOSE: To identify characteristic features of cytomegalovirus (CMV) pneumonitis at computed tomography (CT), particularly markers that may help differentiate CMV from Pneumocystis carinii pneumonia. MATERIALS AND METHODS: Bronchoalveolar lavage (BAL) and biopsy results in 21 patients with acquired immunodeficiency syndrome, cytopathologic evidence of CMV infection without other infections, and available CT scans were retrospectively evaluated. CT findings were correlated with radiographic and pathologic findings when available. RESULTS: BAL findings were positive for CMV in only six cases, 13 patients had extrathoracic CMV infection, and 10 had Kaposi sarcoma. CT findings included ground-glass attenuation, dense consolidation, bronchial wall thickening or bronchiectasis, and interstitial reticulation without air-space disease (12 patients had discrete pulmonary nodules or masses). Biopsy revealed air-space disease as the dominant process in eight cases. Histopathologic findings correlated well with CT appearances. CONCLUSION: CMV pneumonitis should be suspected in patients with either extrathoracic CMV or documented Kaposi sarcoma, especially when radiographic or CT evidence of pulmonary nodules or masses exists
— id: 6452, year: 1994, vol: 192, page: 451, stat: Journal Article,

DESQUAMATIVE INTERSTITIAL PNEUMONIA - THIN-SECTION CT FINDINGS IN 22 PATIENTS
HARTMAN, TE; PRIMACK, SL; SWENSEN, SJ; HANSELL, D; MCGUINNESS, G; MULLER, NL
1993 JUN ;187(3):787-790, Radiology
To evaluate the findings on thin-section computed tomographic (CT) scans in desquamative interstitial pneumonia (DIP), the CT scans from 22 patients aged 22-71 years (mean age, 43 years) were reviewed. In all patients, DIP was proved with open-lung biopsy performed 1 day to 17 months before or after examination with CT (median interval, 1.5 months). The lungs were divided into three zones (upper, middle, and lower); each zone was evaluated separately. The predominant finding was the presence of areas of ground-glass attenuation that involved the middle and lower lung zones in all patients and the upper lung zones in 18 patients (82%). Such areas had a lower lung zone predominance in 16 patients (73%) and a predominantly peripheral distribution in 13 patients (59%). Irregular lines of attenuation suggestive of fibrosis were seen in 11 patients (50%) and cystic changes, in seven patients (32%). The distribution of abnormalities in DIP is similar to that seen in usual interstitial pneumonia (UIP), but the greater extent of ground-glass attenuation and the paucity of cystic changes in DIP should enable distinction from UIP in most patients
— id: 54140, year: 1993, vol: 187, page: 787, stat: Journal Article,

AIDS associated bronchiectasis: CT features
McGuinness G; Naidich DP; Garay S; Leitman BS; McCauley DI
1993 Mar-Apr;17(2):260-266, Journal of computer assisted tomography
The occurrence of bronchiectasis has only rarely been noted among the protean manifestations of HIV infection in the lungs. We retrospectively identified bronchiectasis on CT scans in 12 HIV + and/or AIDS patients in the absence of either documented mycobacterial infection or a history of prior recurrent pyogenic infection. Pneumonitis was documented in 10 of 12 cases. In eight cases, bronchiectasis was associated with episodes of pyogenic infection; four of these patients also had documented opportunistic infections, including three cases of Pneumocystis carinii pneumonia (PCP). Two patients had infection due solely to PCP. In two cases, bronchiectasis was found in association with one case each of lymphocytic interstitial pneumonitis and nonspecific interstitial pneumonitis, respectively. Although the true incidence of bronchiectasis in this population remains to be established, in our experience bronchiectasis should be considered among the varied pulmonary manifestations of HIV infection. Furthermore, the seemingly rapid development and extent of bronchiectasis in this population suggest an accelerated form of the disease
— id: 8061, year: 1993, vol: 17, page: 260, stat: Journal Article,

Accessory cardiac bronchus: CT features and clinical significance
McGuinness G; Naidich DP; Garay SM; Davis AL; Boyd AD; Mizrachi HH
1993 Nov;189(2):563-566, Radiology
PURPOSE: The accessory cardiac bronchus is a rare congenital anomaly of the tracheobronchial tree that arises from the medial wall of the bronchus intermedius. This report documents the computed tomographic (CT) appearance of this anomaly. MATERIALS AND METHODS: Six patients with this anomaly were identified. All six underwent CT; three underwent correlative bronchoscopy, and one had both bronchoscopic and surgical confirmation. RESULTS: In all six cases, a distinct airway could be identified originating from the medial wall of the bronchus intermedius. Associated lung parenchymal tissue was identified in four cases, while in three cases a discrete soft-tissue mass was seen, presumably representing vascularized bronchial or vestigial parenchymal tissue. In two cases, the lumen of the airway was filled with debris. CONCLUSION: Recognition of this anomaly is important, as associated clinical complications, including recurrent episodes of both infection and hemoptysis, may be anticipated in a small percentage of patients
— id: 6450, year: 1993, vol: 189, page: 563, stat: Journal Article,

Bronchiectasis: CT evaluation
McGuinness G; Naidich DP; Leitman BS; McCauley DI
1993 Feb;160(2):253-259, American journal of roentgenology
CT is the imaging method of choice after standard chest radiography for examining patients with suspected bronchiectasis. In most institutions throughout the world, CT has largely eliminated the need for bronchography in the diagnosis of bronchiectasis. Nonetheless, controversy persists concerning the overall accuracy of CT. In an effort to improve overall diagnostic accuracy, we review the wide range of CT appearances of this protean disorder, and emphasize potential problems and technical pitfalls that may arise in routine clinical imaging
— id: 13274, year: 1993, vol: 160, page: 253, stat: Journal Article,

Variables affecting pulmonary nodule detection with computed tomography: evaluation with three-dimensional computer simulation
Naidich DP; Rusinek H; McGuinness G; Leitman B; McCauley DI; Henschke CI
1993 Fall;8(4):291-299, Journal of thoracic imaging
To meaningfully evaluate factors determining the overall accuracy of computed tomography (CT) for identifying pulmonary nodules, computer-generated nodules were superimposed on normal CT scans and interpreted independently by three experienced chest radiologists. Variables evaluated included nodule size, shape, number, density, location, edge characteristics, and relationship to adjacent vessels, as well as technical factors, including slice thickness and electronic windowing. The overall sensitivity in identifying nodules was 62% and the specificity was 80%. On average, the observers identified 56, 67, and 63% of nodules on 1.5-, 5-, and 10-mm-thick sections, respectively (p = 0.037). Nodules were more difficult to identify on 1.5-mm-thick sections. On average, observers identified 1, 48, 82, and 91% of nodules < 1.5, < 3, < 4.5, and < 7 mm in diameter, respectively (p < 0.001). Other factors that made a significant contribution (p < 0.01) in identifying nodules, as determined by linear discriminant function analysis, included nodule location, angiocentricity, and density. We concluded that computer-generated nodules can be used to assess a large number of imaging variables. We anticipate that this approach will be of considerable utility in assessing the accuracy of interpretation of a wide range of pathologic entities as well as in optimizing three-dimensional scan protocols within the thorax
— id: 56568, year: 1993, vol: 8, page: 291, stat: Journal Article,

The left atrial catheter: its uses and complications
Leitman BS; Naidich DP; McGuinness G; McCauley DI
1992 Nov;185(2):611-612, Radiology
The authors describe the radiographic appearance of the left atrial catheter, a widely used postsurgical intracardiac device. Recognition of the characteristic appearance of this catheter should be of value in detection of potential complications, including line fracture with resultant retention and/or embolization, infection, prosthetic valve dysfunction, and even cardiac tamponade
— id: 13380, year: 1992, vol: 185, page: 611, stat: Journal Article,

High resolution CT findings in miliary lung disease
McGuinness G; Naidich DP; Jagirdar J; Leitman B; McCauley DI
1992 May-Jun;16(3):384-390, Journal of computer assisted tomography
High-resolution CT (HRCT) and chest radiographs were compared in nine patients with miliary lung disease. In all cases, miliary disease was documented to be infectious in etiology; six of these patients proved to be human immunodeficiency virus (HIV) positive. A mixture of both sharply and poorly defined 1-3 mm nodules was seen in all cases, many of the latter having an appearance indistinguishable from airspace nodules. Other features attributable to the presence of nodules included nodular interlobular septae, nodular irregularity of vessels, subpleural dots, and studded fissures. Diffuse intra- and interlobular septal thickening also proved common, seen in all but one case (91%). Based on limited HRCT-pathologic correlation, CT findings appear primarily to be due to granulomatous foci developing in a seemingly random distribution involving both pulmonary airspaces as well as the interstitium. It is concluded that in the appropriate clinical setting this constellation of findings is characteristic of miliary disease; the role of HRCT especially in the early diagnosis of miliary disease in HIV positive patients remains to be determined prospectively
— id: 13608, year: 1992, vol: 16, page: 384, stat: Journal Article,

Pulmonary manifestations of AIDs. CT and radiographic correlations
Naidich DP; McGuinness G
1991 Sep;29(5):999-1017, Radiologic clinics of North America
To date, few reports have attempted to correlate plain radiographic findings with computed tomography (CT) in assessing pulmonary disease in patients who have acquired immunodeficiency syndrome (AIDS). This report focuses on the most common pulmonary manifestations, with particular emphasis placed on those entities for which there is a potential role for CT. This includes identification of occult disease, especially the early diagnosis of Pneumocystis carinii pneumonia, as well as identification of unsuspected lung abscesses and cavities; characterization of diffuse parenchymal disease in patients who have abnormal radiographs; identification and characterization of mediastinal lymphadenopathy, especially in differentiating between neoplastic and non-neoplastic causes; and finally, use of CT to perform CT-guided transthoracic needle biopsies
— id: 13920, year: 1991, vol: 29, page: 999, stat: Journal Article,