Studies have shown that some patients with coronavirus disease 2019 (COVID-19) and acute hypoxaemic respiratory failure have preserved lung compliance, suggesting that processes other than alveolar ...damage might be involved in hypoxaemia related to COVID-19 pneumonia.1 The typical imaging features of COVID-19 pneumonia, including peripheral ground-glass opacities with or without consolidation, are also non-specific and can be seen in many other diseases.2 There has been increasing attention on microvascular thrombi as a possible explanation for the severe hypoxaemia related to COVID-19.3,4 Dual-energy CT imaging can be used to characterise lung perfusion and is done as part of the standard protocol for imaging pulmonary embolism at our institution. Three patients with COVID-19, as confirmed by nasopharyngeal RT-PCR at our hospital, who did not have a history of smoking, asthma, chronic obstructive pulmonary disease, or other pulmonary conditions, underwent dual-energy CT imaging for elevated concentrations of D-dimer (>1000 ng/mL) and clinical suspicion of pulmonary emboli. Additionally, the mosaic perfusion pattern did not correspond to findings of bronchial wall thickening or secretions, making airway disease as the main underlying cause of hypoxaemia unlikely. ...these perfusion abnormalities, combined with the pulmonary vascular dilation we observed, are suggestive of intrapulmonary shunting toward areas where gas exchange is impaired, resulting in a worsening ventilation–perfusion mismatch and clinical hypoxia.
Reports are rising of patients with unilateral axillary lymphadenopathy, visible on diverse imaging examinations, after recent coronavirus disease 2019 vaccination. With less than 10% of the US ...population fully vaccinated, we can prepare now for informed care of patients imaged after recent vaccination. The authors recommend documenting vaccination information (dates of vaccinations, injection site left or right, arm or thigh, type of vaccine) on intake forms and having this information available to the radiologist at the time of examination interpretation. These recommendations are based on three key factors: the timing and location of the vaccine injection, clinical context, and imaging findings. The authors report isolated unilateral axillary lymphadenopathy (i.e., no imaging findings outside of visible lymphadenopathy), which is ipsilateral to recent (prior 6 weeks) vaccination, as benign with no further imaging indicated. Clinical management is recommended, with ultrasound if clinical concern persists 6 weeks after the final vaccination dose. In the clinical setting to stage a recent cancer diagnosis or assess response to therapy, the authors encourage prompt recommended imaging and vaccination (possibly in the thigh or contralateral arm according to the location of the known cancer). Management in this clinical context of a current cancer diagnosis is tailored to the specific case, ideally with consultation between the oncology treatment team and the radiologist. The aim of these recommendations is to (1) reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged nodes in the setting of recent vaccination and (2) avoid further delays in vaccinations and recommended imaging for best patient care during the pandemic.
To develop an automated measure of COVID-19 pulmonary disease severity on chest radiographs (CXRs), for longitudinal disease tracking and outcome prediction.
A convolutional Siamese neural ...network-based algorithm was trained to output a measure of pulmonary disease severity on CXRs (pulmonary x-ray severity (PXS) score), using weakly-supervised pretraining on ∼160,000 anterior-posterior images from CheXpert and transfer learning on 314 frontal CXRs from COVID-19 patients. The algorithm was evaluated on internal and external test sets from different hospitals (154 and 113 CXRs respectively). PXS scores were correlated with radiographic severity scores independently assigned by two thoracic radiologists and one in-training radiologist (Pearson r). For 92 internal test set patients with follow-up CXRs, PXS score change was compared to radiologist assessments of change (Spearman ρ). The association between PXS score and subsequent intubation or death was assessed. Bootstrap 95% confidence intervals (CI) were calculated.
PXS scores correlated with radiographic pulmonary disease severity scores assigned to CXRs in the internal and external test sets (r=0.86 (95%CI 0.80-0.90) and r=0.86 (95%CI 0.79-0.90) respectively). The direction of change in PXS score in follow-up CXRs agreed with radiologist assessment (ρ=0.74 (95%CI 0.63-0.81)). In patients not intubated on the admission CXR, the PXS score predicted subsequent intubation or death within three days of hospital admission (area under the receiver operating characteristic curve=0.80 (95%CI 0.75-0.85)).
A Siamese neural network-based severity score automatically measures radiographic COVID-19 pulmonary disease severity, which can be used to track disease change and predict subsequent intubation or death.
Burnout, Wellness, and Social Media Mendoza, Dexter P; Esfahani, Shadi A; Bunch, Paul M
Radiographics,
2022 Mar-Apr, Letnik:
42, Številka:
2
Journal Article
Lung cancer (LC) associated with cystic airspaces is an uncommon presentation that is underrecognized on imaging. Additionally, understanding of its underlying pathology and risk factors is limited, ...which can contribute to delays in diagnosis.
The purpose of this analysis was to systematically review, analyze, and synthesize the medical literature to determine the imaging features of LC associated with cystic airspaces.
In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included published research reporting the clinical, pathologic, and imaging features of LC associated with cystic airspaces. We then performed a pooled analysis of continuous and categoric data with respect to patient clinical characteristics, tumor pathologic features, underlying driver mutation, CT features, and evolution of these features over time.
The analysis included eight original observational studies with a combined total of 341 patients with LC associated with cystic airspaces (weighted mean age, 61.8 years; range, 30-87 years; 135 women and 206 men). Most patients were current or previous smokers (127/192 66.1%). The most common histologic finding was adenocarcinoma (289/328 88.1%) followed by squamous cell carcinoma (30/328 9.1%). The most common driver mutations were
(46/122 37.7%) and
(21/122 17.2%). The cysts in LC associated with cystic airspaces commonly had nonuniform (104/114 91.2%) and thick (83/222 37.4%) walls, irregular margins (53/142 37.3%), and were unilocular (173/272 63.6%). Most cysts had a nodular component (210/328 64.0%). Over time, most cysts showed development or enlargement of the nodular component (61/89 68.5%), approximately half showed wall thickening (43/89 48.3%), and a minority evolved into completely solid lesions (11/89 12.4%). The size of the cystic component increased in 36 of 89 patients (40.4%), decreased in 28 (31.5%), and remained stable in 24 (27.0%).
LC associated with cystic airspaces occurs most commonly as adeno-carcinoma and is seen in both smokers and nonsmokers. The cysts associated with LC show wall thickening and mural nodularity, which may evolve over time. LC associated with cystic airspaces can be indolent, and long-term surveillance with imaging should be considered if cysts are not resected.
Familiarity with the imaging features and temporal evolution of LC associated with cystic airspaces can minimize delays in LC diagnosis. Future management guidelines should include protocols for follow-up and management of cystic lung lesions identified during diagnostic and LC screening CT.
To quantify the association between computed tomography abdomen and pelvis with contrast (CTAP) findings and chest radiograph (CXR) severity score, and the incremental effect of incorporating CTAP ...findings into predictive models of COVID-19 mortality.
This retrospective study was performed at a large quaternary care medical center. All adult patients who presented to our institution between March and June 2020 with the diagnosis of COVID-19 and had a CXR up to 48 hours before a CTAP were included. Primary outcomes were the severity of lung disease before CTAP and mortality within 14 and 30 days. Logistic regression models were constructed to quantify the association between CXR score and CTAP findings. Penalized logistic regression models and random forests were constructed to identify key predictors (demographics, CTAP findings, and CXR score) of mortality. The discriminatory performance of these models, with and without CTAP findings, was summarized using area under the characteristic (AUC) curves.
One hundred ninety-five patients (median age, 63 years; 119 men) were included. The odds of having CTAP findings was 3.89 times greater when a CXR score was classified as severe compared with mild (P = 0.002). When CTAP findings were included in the feature set, the AUCs for 14-day mortality were 0.67 (penalized logistic regression) and 0.71 (random forests). Similar values for 30-day mortality were 0.76 and 0.75. When CTAP findings were omitted, all AUC values were attenuated.
The CTAP findings were associated with more severe CXR score and may serve as predictors of COVID-19 mortality.
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