Differentiation of central lung tumor from postobstructive lobar collapse by rapid sequence computed tomography

When central lung tumor is associated with lobar collapse, discrimination of tumor from atelectasis is important for determining operability or for field planning should radiation therapy be utilized. Because tumor and collapsed lung have similar attenuation values, they cannot always be distinguished with usual contrast-enhanced CT. The article describes separation of tumor from collapsed lung by means of RSCT with bolus injection of nonionic contrast medium. With this technique collapsed lung is appreciably enhanced, but tumor enhancement is slow and minimal. The difference is most marked from 40 seconds to 2 minutes after scanning begins. This phenomenon is probably related to the marked increase in blood flow per unit area of collapsed lung due to crowding of relatively large pulmonary arteries compared to tumor blood supply through small bronchial arteries. Tumor can also be delineated from atelectasis by differences in internal structure with this technique.