Radiologic Imaging of Lung Cancer

  • Palmi Shah
  • James L. Mulshine
Part of the Medical Radiology book series (MEDRAD)


Recent advances in technology like faster, high resolution CT scanners, new data in lung cancer screening combined with many changes in the classification, staging and novel therapies for lung cancer are redefining the role imaging plays in detection, staging and management of the disease. This chapter describes the utility and limitations of the different radiological modalities in various stages of the disease. Since it is the mainstay in lung cancer management emphasis is placed on the application of CT imaging. PET-CT has been discussed separately in this volume.


Lung Cancer Solitary Pulmonary Nodule Lung Cancer Screening Early Lung Cancer Adrenal Nodule 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. AJCC Cancer Staging Handbook - Springer Seventh Edition (2010) 253–270Google Scholar
  2. Akata S, Kajiwara N, Park J et al (2008) Evaluation of chest wall invasion by lung cancer using respiratory dynamic MRI. J Med Imaging Radiat Oncol 52(1):36–39PubMedCrossRefGoogle Scholar
  3. Aoki T, Nakata H, Watanabe H et al (2000) Evolution of peripheral lung adenocarcinomas CT findings correlated with histology and tumor doubling time. AJR Am J Roentgenol 174:763–768PubMedCrossRefGoogle Scholar
  4. Aoki T, Tomoda Y, Watanabe H (2001) Peripheral lung adenocarcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival. Radiology 220:803–809PubMedCrossRefGoogle Scholar
  5. Arita T, Matsumoto T, Kuramitsu T et al (1996) Is it possible to differentiate malignant mediastinal nodes from benign nodes by size? Reevaluation by CT, transesophageal echocardiography, and nodal specimen. Chest 110(4):1004–1008PubMedCrossRefGoogle Scholar
  6. Awai K, Murao K, Ozawa A et al (2004) Pulmonary nodules at chest CT: effect of computer-aided diagnosis on radiologists’ detection performance. Radiology 230:347–352PubMedCrossRefGoogle Scholar
  7. Bittner RC, Felix R (1998) Magnetic resonance (MR) imaging of the chest: state-of-the art. Eur Respir J 11:1392–1404PubMedCrossRefGoogle Scholar
  8. Cascade N, Gross BH, Kazerooni EA, Quint LE, Francis IR, Strawderman M, Korobkin M (1998) Variability in the detection of enlarged mediastinal lymph nodes in staging lung cancer: a comparison of contrast-enhanced and unenhanced CT. Am J Roentgenol 170:927–931CrossRefGoogle Scholar
  9. Detterbeck FC, Jantz M, Wallace M et al (2007) Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132(Suppl 3):202S–220SPubMedCrossRefGoogle Scholar
  10. Erasmus JJ, Sabloff BS (2008) CT, positron emission tomography, and MRI in staging lung cancer. Clin Chest Med 29(1):39–57PubMedCrossRefGoogle Scholar
  11. Gorlova O, Peng B, Yankelevitz D, Henschke C, Kimmel M (2005) Estimating the growth rates of primary lung tumours from samples with missing measurements. Stat Med 24(7):1117–1134, 4/2005. PMID: 15568189Google Scholar
  12. Gu P, Zhao YZ, Jiang LY et al (2009) Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and metaanalysis. Eur J Cancer 45:1389–1396PubMedCrossRefGoogle Scholar
  13. Hansell DM, Lynch DA, Page McAdams H, Bankier AA (2010) Imaging of diseases of the chest, 5th edn. Elsevier publications, PhiladelphiaGoogle Scholar
  14. Heelan RT, Demas BE, Caravelli JF et al (1989) Superior sulcus tumors: CT and MR imaging. Radiology 170(3 Pt 1):637–641PubMedGoogle Scholar
  15. Henschke CI, Yankelevitz DF, Mirtchev R et al (2002) The ELCAP group, CT screening for lung cancer frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol 178:1053–1057PubMedCrossRefGoogle Scholar
  16. Henschke CI, Boffetta P, Gorlova O, et al (2010) Assessment of lung-cancer mortality reduction from CT screening. Lung Cancer 16 (PubMed PMID:21168236)Google Scholar
  17. Hierholzer J, Luo L, Bittner RC et al (2000) MRI and CT in the differential diagnosis of pleural disease. Chest 118:604–660PubMedCrossRefGoogle Scholar
  18. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer Statistics. CA Cancer J Clin [Epub ahead of print]Google Scholar
  19. Johnson BE (1998) Second lung cancers in patients after treatment for an initial lung cancer. J Natl Cancer Inst 90(18):1335–1345PubMedCrossRefGoogle Scholar
  20. Klein JS, Braff S (2008a) Imaging evaluation of the solitary pulmonary nodule. Clin Chest Med 29(1):15–38PubMedCrossRefGoogle Scholar
  21. Klein JS, Braff S (2008b) Imaging evaluation of the solitary pulmonary nodule. Clin Chest Med 29:15–38PubMedCrossRefGoogle Scholar
  22. Kundel HL (1981) Predictive value and threshold of detectability of lung tumors. Radiology 139:25–29PubMedGoogle Scholar
  23. Kuriyama K, Tateishi R, Doi O, Higashiyama M, Kodama K et al (1991) Prevalence of air bronchograms in small peripheral carcinomas of the lung on thin-section CT: comparison with benign tumors. AJR, Am J Roentgenol 156:921–924CrossRefGoogle Scholar
  24. Lau CL, Harpole DH Jr (2000) Noninvasive clinical staging modalities for lung cancer. Semin Surg Oncol 18(2):116–123PubMedCrossRefGoogle Scholar
  25. Libby DM, Smith JP, Altorki NK et al (2004) Managing the small pulmonary nodule discovered by CT. Chest 125:1522–1529PubMedCrossRefGoogle Scholar
  26. Marom EM, McAdams HP, Erasmus JJ et al (1999) Staging non–small cell lung cancer with whole-body PET. Radiology 212:803–809PubMedGoogle Scholar
  27. Muhm JR, Miller WE, Fontana RS, Sanderson DR, Uhlenhopp MA (1983) Lung cancer detected during a screening program using four month chest radiographs. Radiology 148:609–615PubMedGoogle Scholar
  28. National cancer Institute. NSLT Lung cancer trial results show mortality benefit with low-dose CT Twenty percent fewer lung cancer deaths seen among those who were screened with low-dose spiral CT than with chest X-ray (Posted: 11/04/2010)
  29. O’Connor J, Jackson A, Asselin M, Buckley D, Parker G, Jayson G (2008) Quantitative imaging biomarkers in the clinical development of targeted therapeutics: current and future perspectives. Lancet Oncol 9(8):766–776PubMedCrossRefGoogle Scholar
  30. Padhani AR, Ollivier L (2001) The RECIST criteria: implications for diagnostic radiologists. Br J Radiol 74:983–986PubMedGoogle Scholar
  31. Patz EF Jr, Erasmus JJ, McAdams HP et al (1999) Lung cancer staging and management: comparison of contrast-enhanced and nonenhanced helical CT of the thorax. Radiology 212:56–60PubMedGoogle Scholar
  32. Primack SL, Lee KS, Logan PM et al (1994) Bronchogenic carcinoma: utility of CT in the evaluation of patients with suspected lesions. Radiology 193:795–800PubMedGoogle Scholar
  33. Ravenel JG, Mohammed TLH, Movsas B, Ginsburg ME et al (2010) ACR Appropriateness criterias noninvasive clinical staging of bronchogenic carcinoma. J Thorac Imaging 25(4):W107–W111PubMedCrossRefGoogle Scholar
  34. Revel M, Lefort C, Bissery A et al (2004) Pulmonary nodules: preliminary experience with three-dimensional evaluation. Radiology 231:459–466PubMedCrossRefGoogle Scholar
  35. Rusch V et al (2009) The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol 4(5):568–577PubMedCrossRefGoogle Scholar
  36. Sieren JC, Ohno Y, Koyama H et al (2010) Recent technological and application developments in computed tomography and magnetic resonance imaging for improved pulmonary nodule detection and lung cancer staging. J Magn Resonance Imaging 32:1353–1369CrossRefGoogle Scholar
  37. Simon GR, Turrisi A (2007) American College of Chest Physicians, Management of small cell lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132(3 Suppl):324S–339SPubMedCrossRefGoogle Scholar
  38. The National Lung Screening Trial: Overview and Study Design Published online before print November 2, 2010, doi: 10.1148/radiol.10091808, January 2011 Radiology 258:243–253
  39. Toh CK (2009) The changing epidemiology of lung cancer. Methods Mol Biol 472:397–411PubMedCrossRefGoogle Scholar
  40. Travis WD, Brambilla E, Müller-Hermelink HK, Harris CC (eds) (2004) World Health Organization lung, pleura, thymus and heart. Pathology & Genetics tumours of the lung, pleura thymus and heart. IARC Press, LyonGoogle Scholar
  41. Travis WD, Brambilla E, Noguchi M, Nicholson AG (2011) International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 6(2):244–285PubMedCrossRefGoogle Scholar
  42. UyBico SJ, Wu CC, Suh RD, Le NH, Brown K, Krishnam MS (2010) Lung cancer staging essentials: the new TNM Staging system and potential imaging pitfalls. Radiographics 30:1163–1181  doi:10.1148/rg.305095166 PubMedCrossRefGoogle Scholar
  43. van Klaveren RJ, Oudkerk M, Prokop M (2009) Management of lung nodules detected by volume CT scanning. N Engl J Med 361:2221–2229PubMedCrossRefGoogle Scholar
  44. Vansteenkistel J, Dooms C, De Leyn P (2010) Early stage non-small-cell lung cancer: challenges in staging and adjuvant treatment: evidence-based staging. Ann Oncol 21(Supplement 7):vii189–vii195PubMedCrossRefGoogle Scholar
  45. Walsh GL et al (1995) Is follow-up of lung cancer patients after resection medically indicated and cost-effective? Ann Thorac Surg 60(6):1563–1570 discussion 1570-2, 12/1995PubMedCrossRefGoogle Scholar
  46. Yankelevitz DF, Henschke CI et al (1997) Does 2-year stability imply that pulmonary nodules are benign? AJR Am J Roentgenol 168(2):325–328PubMedCrossRefGoogle Scholar
  47. Zerhouni EA, Stitik FP, Siegelman SS et al (1986) CT of the pulmonary nodule: a cooperative study. Radiology 160:319–327PubMedGoogle Scholar
  48. Zwirewich C, Vedal S, Miller R, Muller N (1991) Solitary pulmonary nodule:High-resolution CT and radiologic-pathologic correlation. Radiology 179:469PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Department of RadiologyRush UniversityChicagoUSA
  2. 2.Department of Internal MedicineRush UniversityChicagoUSA

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