Diagnostic utility of chest wall vessel involvement sign on ultra-high-resolution CT for primary lung cancer infiltrating the chest wall

Category	Detail
Condition	Primary lung cancer with chest wall infiltration
Key Mechanisms	Chest wall infiltration classified by extent (parietal pleural, endothoracic fascial, rib); tumor invasion may involve chest wall vessels such as intercostal arteries detectable by ultra-high-resolution CT (UHR-CT)
Target Population	Patients with primary lung cancer suspected of chest wall infiltration
Care Setting	Preoperative imaging and surgical planning in hospital radiology and thoracic surgery departments

Chest wall infiltration corresponds to T3 stage in TNM 8th edition and impacts treatment strategy and prognosis
Ultra-high-resolution CT (UHR-CT) enables detection of minute chest wall vessel involvement (CWVI) from intercostal arteries within tumors
CWVI on contrast-enhanced UHR-CT may serve as a diagnostic marker for chest wall infiltration beyond classic CT findings like rib destruction

Use UHR-CT with contrast enhancement to identify chest wall vessel involvement (CWVI) as a sign of chest wall infiltration
Evaluate rib destruction, tumor contact length/angle with chest wall, and pleural invasion extent on imaging
Consider dynamic contrast-enhanced arterial phase imaging with deep-learning reconstruction for optimal visualization

Plan en bloc lung and chest wall resection for lung cancers with confirmed chest wall infiltration
Preoperative imaging assessment is critical to determine resectability and surgical approach

Perform two-phase dynamic CT scans routinely for preoperative lung cancer evaluation
Use consensus reading by experienced radiologists to confirm CWVI and rib destruction findings

Misdiagnosis of chest wall infiltration may lead to inappropriate surgical planning
Invasive angiography is rarely performed; reliance on imaging requires high-resolution techniques and expertise

Patients undergoing preoperative evaluation for primary lung cancer with suspected chest wall involvement

Identification of CWVI on UHR-CT can guide surgical decision-making for en bloc resection and improve prognostic assessment

Utilize UHR-CT with small detector elements and deep-learning reconstruction for high spatial resolution imaging
Apply arterial phase contrast-enhanced imaging with appropriate iodine dosing based on patient weight
Conduct blinded, independent image review by experienced radiologists with consensus resolution
Exclude tumors without chest wall contact or involving diaphragm, mediastinum, or interlobar pl3 for accurate assessment
Incorporate CWVI evaluation alongside traditional CT criteria such as rib destruction and tumor contact metrics

Clinical Scorecard: Evaluating the Role of Chest Wall Vessel Involvement on Ultra-High-Resolution CT for Diagnosing Primary Lung Cancer with Chest Wall Infiltration