Abnormal CT Scan Research Articles

Deep Learning Methods for Detecting Chest X-Ray and CT Scan Abnormalities

Deep learning's quick development has created new opportunities to improve medical image analysis, especially in the identification of anomalies in chest CT and X-ray scans. This work investigates several deep learning techniques designed for this particular purpose to enhance the efficiency and accuracy of diagnosis in medical settings. We explore the use of 3D CNNs, transfer learning, and convolutional neural networks, or CNNs, for the analysis of volumetric CT scan information as well as 2D chest X-ray pictures. Comparative analyses show the benefits and drawbacks of various deep learning architectures for identifying a variety of anomalies, including tumors, tumors in the lungs, pneumonia, and other diseases. We also go over the significance of preprocessing methods, assessment metrics specifically designed for medical picture analysis, and dataset preparation. The results highlight how deep learning has the potential to revolutionize chest imaging diagnostics by facilitating the quicker and more accurate identification of anomalies, which will enhance patient outcomes and the effectiveness of healthcare delivery. To spur additional developments in the deep learning-powered analysis of medical images for chest problems, future research topics, and obstacles in this area are also covered.

Pulmonary sequestration associated with pulmonary actinomycosis: A case report and literature review.

Pulmonary sequestration (PS), a rare pulmonary disease, arises from congenital pulmonary vascular dysplasia. Meanwhile, pulmonary actinomycosis is a purulent infection of lung lesions triggered by the inhalation of actinomycetes, which is also uncommon. Even rarer is the occurrence of pulmonary actinomycete infection secondary to PS. Herein, we present a case report of such a rare occurrence. The 21-year-old female patient had been erroneously diagnosed with pneumonia and tuberculosis, presenting symptoms of cough, sputum, and hemoptysis; however, the implemented anti-infection and antituberculosis treatments proved to be ineffective. The diagnosis of the sequestration in the right lower lung was confirmed through an enhanced chest CT scan and a 3-dimensional reconstruction of the pulmonary vessels. During the surgical video-assisted thoracoscopic resection of the right lower lobe lesion, it was discovered that the isolated lung tissue's blood supply vessel originated from the thoracic aorta. Additionally, the pathological examination revealed that the lung tissue of the right lower lobe lesion was infected with pulmonary actinomycetes. Following thorough evaluation, the patient received a final diagnosis of pulmonary actinomycete infection that occurred secondary to right lower lung sequestration. Consequently, they underwent treatment consisting of high-dose penicillin administered for a period of 6 months post-operation. Over the course of the subsequent 23-month follow-up, no recurrence of the infection or abnormal CT scan findings were observed. Pulmonary sequestration bears clinical resemblance to pulmonary actinomycetes. In cases where recurrent episodes of pneumonia occur at the same location, and chest imaging indicates persistent lesions in the basal segment of the lower lobe near the spine, the possibility of PS should be considered. Prompt chest-enhanced CT and 3-dimensional reconstruction of pulmonary vessels are crucial for a definitive diagnosis. Imaging findings such as mass-like consolidation, cystic lesions, liquefactive necrosis, and pneumonia-like changes, coupled with typical air suspension signs and sulfur-like particles visible under tracheoscopy, suggest a potential pulmonary actinomycete infection. Timely biopsy is essential to confirm the diagnosis and prevent missed or incorrect diagnoses.

Correlation Between the Revised Physiological Trauma Score and CT Scan Results.

Background Trauma-scoring systems are used to triage patients and assist in clinical decision-making. Physiological trauma scores are used for quantitative evaluation of injury severity. However, only a few, such as the Revised Physiological Trauma Score (rPTS), have been proven effective in pre-clinical use. There is a constant need for clinical decision tools that aim to reduce the unnecessary use of CT scans among trauma patients. To our knowledge, no study has directly correlated the rPTS and CT findings. This study aimed to investigate whether the rPTS is correlated with CT scan results and can be used to decrease the use of CT. Methodology This retrospective chart review examined all patients who underwent a pan-CT for trauma in theEmergency Department of King Abdulaziz Medical City, Jeddah, from 2008 to 2012. Results We analyzed 235 patients. There was a significant difference in the mean rPTS between those with negative versus positive pan-CT scans (11.4 ± 1.3 vs. 10.9 ± 1.7, respectively; p = 0.032). Furthermore, the rate of positive CT scans was significantly higher in those with an rPTS <11 than those with an rPTS of 11 or 12 (87% vs. 74.1%, respectively; p = 0.044). However, 72.7% of patients with an rPTS of 12/12 had a positive pan-CT scan. Conclusions Despite the difference in the frequency of abnormal CT scans, too many patients with normal rPTS had abnormal CT findings. Therefore, the rPTS cannot be used to safely reduce the use of CT scans.

Utility of Torso Imaging for Elderly Patients Sustaining Ground-Level Falls

IntroductionComputed tomography (CT) of the torso has become increasingly common for assessment of fall patients in the emergency department. Some data suggest that older adults (≥65) may benefit from torso imaging more than younger patients. We sought to evaluate the usage and utility of CT imaging for elderly patients presenting after ground-level falls (GLFs) from 1 meter or less at our level 1 trauma center. MethodsPatients ≥18 presenting with GLF in 2015-2019 were included. Data were obtained through chart and trauma registry review. Descriptive statistics were used to summarize the use of CT imaging for patients younger than versus older than 65 y old. Three multivariate logistic regression models with age as a continuous, binary (<65 versus ≥65), or categorical (in multiples of 5) variable were used to investigate whether age is associated with an increased identification of traumatic injury not previously suspected or known based on physical exam (PE) or plain radiograph after GLF. ResultsA total of 522 patients <65 and 673 patients ≥65 y old were included. Older patients were significantly more likely to receive screening chest radiograph, screening pelvic radiograph, brain CT, and neck CT (all P < 0.001), but not torso (chest, abdomen, and pelvis) CT (P = 0.144). On multivariate logistic regression, age was not significantly associated with an increased odds of identification of traumatic injury after torso CT (continuous: adjusted odds ratio [aOR] = 1.01, 95% confidence interval [CI] = 0.99-1.03, P = 0.379; binary: aOR = 0.86, 95% CI = 0.46-1.58, P = 0.619; categorical: aOR = 1.03, 95% CI = 0.94-1.14, P = 0.453). A positive PE was the only variable associated with significantly increased odds of having an abnormal torso CT scan in all models. Only two patients ≥65 y old had injuries identified on torso CT in the context of a negative PE and negative screening imaging. ConclusionsThe rate of torso injury identification in patients sustaining GLF is not associated with age, but is strongly associated with positive PE findings. In the subset of elderly GLF patients without positive torso PE findings, more conservative use of CT imaging could decrease health-care utilization costs without compromising patient care.

Study protocol for a prospective, multicentre study of hypercortisolism in patients with difficult-to-control type 2 diabetes (CATALYST): prevalence and treatment with mifepristone

IntroductionEven with recent treatment advances, type 2 diabetes (T2D) remains poorly controlled for many patients, despite the best efforts to adhere to therapies and lifestyle modifications. Although estimates vary, studies...

Low-dose computed tomography scan and biopsy for assessing lung cancer prevalence and related factors in high-risk populations

BackgroundLung cancer is the second most diagnosed cancer and the leading cause of cancer death in 2020, representing approximately one in 10 (11.4 %) cancers diagnosed and one in 5 (18.0 %) deaths. There are currently very few studies evaluating the prevalence and related factors of lung cancer detected using low-dose CT scans. ObjectiveEvaluate the prevalence and related factors of lung cancer using low-dose CT scans in high-risk populations in Vietnam. Materials and methodsA cross-sectional analysis study of 169 high-risk patients was conducted to assess the lung cancer prevalence and related factors. Enrolled patients received a physical examination, low-dose computerized tomography scan, and biopsy if abnormalities were found through the CT scan. Univariable and Multivariable analysis through Odd Ratio (OR) to assess the related risk of lung cancer. ResultsA total of 169 high-risk patients with a mean age of 62.93 ± 9.31 (years), and the majority were male (91.7 %). Of which 4 cases (2.37 %) were recorded with lung cancer, 3 cases of adenocarcinoma, and 1 case of squamous cell carcinoma. A history of smoking and Chronic Obstructive Pulmonary Disease (COPD) were associated with an increased risk of abnormalities on lung CT scans. Multivariate regression analysis revealed that smoking over 30 pack-years and COPD significantly increased the risk of abnormalities on lung CT scans, p < 0.05.100 % of lung cancer-detected cases were male and smoking ≥30 pack – years. ConclusionThe prevalence of lung cancer in the Vietnamese high-risk population was relatively high. Relative factors such as smoking ≥30 pack - years, and COPD had increased risk of CTscan abnormalities.

Multi-center study on mortality in children, and adults with sickle cell anemia-risk factors and causes of death

Sickle cell disease (SCD) is a major public health burden worldwide with increasing morbidity and mortality. The study evaluates the risk factors associated with mortality in SCD patients, between the years 2006 and 2020 at three hospitals in Oman. The analysis includes clinical manifestations, haematological, biochemical, and radiological parameters, use of antibiotics, and blood and exchange transfusions. Our cohort included 123 patients (82 males, 41 females), with a median age of 27 (Interquartile Range 21–35 years). SCD related complications included acute chest syndrome (ACS) in 52.8%, splenic sequestration in 21.1%, right upper quadrant syndrome in 19.5%, more than > 6 VOC/year in 17.9%, and stroke in 13.8%. At the terminal admission, patients had cough, reduced O2 saturation, crepitation and fever in 24.4%, 49.6%, 53.6% and 68.3% respectively. Abnormal chest X-ray and chest CT scan were seen in 57.7%, and 76.4% respectively. Laboratory parameters showed a significant drop in hemoglobin (Hb) and platelet counts from baseline, with a significant rise in WBC, LDH and CRP from baseline (p < 0.05, Wilcoxon Signed Ranks test). All patients received antibiotics, whereas, 95.9% and 93.5% received simple blood transfusions, and exchange transfusions respectively, and 66.6% required non-invasive ventilation. Among the causes of death, ACS is seen in 32 (26%), sepsis in 49 (40%), and miscellaneous in 42 (34%). Sudden death was seen in 32 (26%) of patients. Male gender, with low HbF, rapid drop in Hb and platelet, and increased in WBC, LDH, ferritin, and CRP, correlated significantly with mortality in this cohort.

Abstract 1071: Circulation of rare events in the liquid biopsy for early detection of lung mass lesions

Abstract Lung cancer screening with low-dose CT scans (LDCT) has reduced mortality for patients with high-risk smoking histories. However, this method of screening remains imperfect. High rates of false positive scans expose patients to additional morbidity as they pursue subsequent diagnostic evaluation. Real-world application of screening LDCT remains low. Finally, current screening guidelines exclude those without smoking histories, a population which comprises up to a quarter of lung cancer patients. We sought to explore the utility of liquid biopsy (LBx) in lung cancer patients and its use in early cancer screening and diagnosis. Using the third generation High-Definition Single Cell Assay (HDSCA3.0) workflow, we analyzed 99 peripheral blood samples divided into three cohorts: Normal Donors (ND, n=50) who were healthy volunteers with no known pathology, Screening CT patients (CT, n=25) who underwent standard LDCT screening with resultant Lung-RADS 1-2, Biopsy patients (BX, n=24) who had abnormal CT scans requiring tissue biopsy. The ND group was used to characterize baseline epithelial, mesenchymal, endothelial, and immune cells, alongside acellular events (oncosomes). For the CT and BX patients, demographic information including age, gender, and average BMI was roughly equivalent, however average pack-years smoked differed owing to 10 (42%) patients in the BX group who had no prior smoking history. A total of 14 (58%) BX patients were diagnosed with primary lung cancer (BX+), of which 11(75%) were adenocarcinoma, 2 (19%) were squamous cell carcinoma and 1 (6%) was small cell. Across the cohorts we observed intra- and interpatient heterogeneity of rare events including multiple phenotypic rare cell populations and oncosomes. The comparison of the rare event enumerations between the ND, CT, BX+, and BX- cohorts revealed a greater incidence of total events, total rare cells and oncosomes, as well as specific cellular phenotypes in the CT and BX cohorts compared to the ND cohort. LBx analytes were detected at a significant elevation in the BX samples compared to the CT samples, but there was no significant difference between BX+ and BX- samples. The data supports the utility of the LBx in distinguishing patients with an alveolar mass lesion from those without, providing a mechanism for screening prior to LDCT to better inform clinical workup and avoid unnecessary radiation exposure and biopsy. Citation Format: Anya Shah, Karen Resnick, Jeremy Mason, Peter Kuhn, Jorge Nieva, Stephanie Shishido. Circulation of rare events in the liquid biopsy for early detection of lung mass lesions [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1071.

Accuracy of Chest Xray in Hospitalized COVID-19 Patients

Introduction: At the end of the year 2019 a novel virus named SARS-CoV-2 caused Coronavirus Disease 19 (COVID-19), manifesting as lung infection which can result in severe pneumonia. The gold standard for diagnosis of the virus is the detection of viral RNA through reverse transcriptase PCR (RT-PCR). Materials and Methods: This study is a retrospective analysis of diagnostic yield of chest imaging modalities in the diagnosis of COVID-19 in patients admitted to the Imam Khomeini hospital, Tehran, Iran during march 2020 until July 2020. Results: 204 hospitalized patients with a mean age of 58.5 years, diagnosed with COVID-19 were enrolled in this study, who had their disease confirmed by PCR. About 20% of patients had normal O2 Saturation (above 93%) and 80% had low O2 Saturation. Also 70% of patients were hospitalized to the ICU. Among investigated patients, 87.6% had abnormal findings in their CXR. Also, 97.1% of patients had abnormal CT-Scan. In this study, the sensitivity of the CXR in the diagnosis of COVID-19 was 87.5% (CI 95%, 83 to 91) and the sensitivity of the chest CT-Scan was 97.1% (CI 95%, 94.8 to 99). Discussion: Utilizing CXR as a first-line imaging modality is recommended in many countries and clinical settings and chest CT-Scan is mainly reserved for other additional roles. This study reveals a CXR sensitivity of 87.5% which is in accordance with the recent literature (69-90%).

COVID-19 and cancer risk arising from ionizing radiation exposure through CT scans: a cross-sectional study

BackgroundThe surge in the utilization of CT scans for COVID-19 diagnosis and monitoring during the pandemic is undeniable. This increase has brought to the forefront concerns about the potential long-term health consequences, especially radiation-induced cancer risk. This study aimed to quantify the potential cancer risk associated with CT scans performed for COVID-19 detection.MethodsIn this cross-sectional study data from a total of 561 patients, who were referred to the radiology center at Imam Hossein Hospital in Shahroud, was collected. CT scan reports were categorized into three groups based on the radiologist’s interpretation. The BEIR VII model was employed to estimate the risk of radiation-induced cancer.ResultsAmong the 561 patients, 299 (53.3%) were males and the average age of the patients was 49.61 ± 18.73 years. Of the CT scans, 408 (72.7%) were reported as normal. The average age of patients with normal, abnormal, and potentially abnormal CT scans was 47.57 ± 19.06, 54.80 ± 16.70, and 58.14 ± 16.60 years, respectively (p-value < 0.001). The average effective dose was 1.89 ± 0.21 mSv, with 1.76 ± 0.11 mSv for males and 2.05 ± 0.29 mSv for females (p-value < 0.001). The average risk of lung cancer was 3.84 ± 1.19 and 9.73 ± 3.27 cases per 100,000 patients for males and females, respectively. The average LAR for all cancer types was 10.30 ± 6.03 cases per 100,000 patients.ConclusionsThis study highlights the critical issue of increased CT scan usage for COVID-19 diagnosis and the potential long-term consequences, especially the risk of cancer incidence. Healthcare policies should be prepared to address this potential rise in cancer incidence and the utilization of CT scans should be restricted to cases where laboratory tests are not readily available or when clinical symptoms are severe.

Indicators of abnormal CT Scan findings in clinically mild traumatic brain injury patients

Background &amp; Objective: Various clinical guidelines have been developed to predict intracranial findings and minimize the unnecessary head CT scans in mild traumatic brain injury (MTBI) patients. However, the most appropriate guideline for routine practices might be highly dependent on the emergency department policies, qualifications of medical staff, and the level of infrastructure availability. This study aims to identify various indicators that can predict abnormal CT scan findings in clinically MTBI patients. Methods: Our retrospective analytical study included patients diagnosed with MTBI admitted to the Emergency Department of Prof. Dr. R. D. Kandou General Hospital, Manado, Indonesia, from November 2022 to February 2023, age ≥18 years, and having undergone a brain CT scan. Multivariate analyses of several indicators were performed to identify the strongest indicators of abnormal CT scan findings. Results: Among 112 subjects, abnormal CT scan findings were identified in 38 subjects (33.9%). The proportion of men is greater (63.4%), with a median age of 33 (18-88) years. The most common mechanism was traffic accidents (83.0%). Logistic regression analysis revealed that skull fracture (OR 8.144, 95% CI 3.110-21.326) and signs of skull base fracture (OR 7.059, 95% CI 2.217- 22.475) were the two strongest indicators in predicting abnormal CT scan findings. Conclusions: Skull fracture and signs of skull base fracture were the two strongest indicators of abnormal CT scan findings in clinically MTBI patients. Therefore, skull X-rays in the setting of limited CT scans and thorough clinical examination are recommended.

Abnormal CT Scan in a Patient with Hematuria.

Abnormal CT Scan in a Patient with Hematuria.

EPS1.07 Impact of elexacaftor/tezacaftor/ivacaftor (ETI) therapy on Aspergillus fumigatus serology in adults with cystic fibrosis

Objectives: Aspergillus fumigatus is the commonest fungi to colonise the airways of people with cystic fibrosis (CF). Colonisation, both with or without the presence of allergic bronchopulmonary aspergillosis (AGPA), has been found to be associated with increased respiratory exacerbations, hospitalisations, reduced pulmonary function and CT scan abnormalities. Management with anti-fungal agents has shown limited clinical benefit, as well as issues with side effects and drug resistance. The effect of CFTR modulator therapies; revolutionary in the management of CF in recent years, on Aspergillus related disease in CF has yet to be established. We aimed to assess whether elexacaftor-tezacaftor-ivacaftor (ETI) therapy impacted on Asp. fumigatus serology in a population of adults with CF.

Prevalencia y significado pronóstico de las alteraciones pulmonares intersticiales precoces en TC de pacientes diagnosticados de enfermedad pulmonar intersticial tratados con antifibróticos

ObjectivesTo describe the prevalence and characteristics of interstitial lung abnormalities (ILA) in CT scans performed prior to the initiation of antifibrotics in a series of patients with interstitial lung disease (ILD), and to identify characteristics apparent on early CT scans that could help to predict outcomes. MethodsWe conducted a retrospective observational study. The original cohort consisted of 101 patients diagnosed with ILD and treated with antifibrotics in a tertiary hospital. Patients were included if they had a thoracic CT scan performed at least one year before initiation of therapy. They were classified radiologically in three groups: without ILA, with radiological ILA and extensive abnormalities. ILA were classified as subpleural fibrotic, subpleural non-fibrotic and non-subpleural. The initial scan and the latest CT scan performed before treatment were read for assessing progression. The relationship between CT findings of fibrosis and the radiological progression rate and mortality were analyzed. ResultsWe included 50 patients. Only1 (2%) had a normal CT scan, 25 (50%) had extensive alterations and 24 (48%) had radiological criteria for ILA, a median of 98.2months before initiation of antifibrotics, of them 18 (75%) had a subpleural fibrotic pattern. Significant bronchiectasis and obvious honeycombing in the lower zones were associated with shorter survival (P=.04). Obvious honeycombing in the lower zones was also significantly (P<.05) associated with a faster progression rate. ConclusionsFibrotic ILAs are frequent in remote scans of patients with clinically relevant ILD, long before they require antifibrotics. Findings of traction bronchiectasis and honeycombing in the earliest scans, even in asymptomatic patients, are related to mortality and progression later on.

A Patient-Centered Model of Fast-Track Lung Cancer Diagnosis

IntroductionDespite the increasing importance of digital resources in modern life over the past decades, little is known about the impact of internet-based solutions on patient's health. We aimed to study the potential benefit of a digital platform helping patients to deal with abnormal chest CT scan revealing possible lung cancer. MethodsWe set up a fast-track lung cancer diagnosis pathway through a secure online platform. Patient-generated information combined with online review of their imaging enables preplanning of further investigations ahead of clinical assessment. We compared outcomes of “self-referred” patients (patient group), who directly fill out the online questionnaire, to general practitioner-driven patients (GP group), who were referred by their GP. ResultsFrom June 2021 to June 2022, we included 125 patients (61% males, median age 67 years, IQR 56.9-72.5): 41% in the patient group and 59% in the GP group. No difference was found between groups in terms of time from contact to first appointment (median 5 days in both groups, P = .6), percentage of pathways including prebooked tests (94% vs. 92%, P = .6), number of scheduled invasive procedures (median 1, IQR 1-2 vs. 2, IQR 1-2, P = .4) and in final cancer diagnosis (76% vs. 78%, P = .4). ConclusionA lung cancer diagnosis pathway directly accessible by patients through a secure online platform was feasible and as efficient as the usual general practitioner pathway. It demonstrated the benefit of leaning on new digital tools in order to answer to the new challenges of a patient-centered health care system.

Comparison of Lung CT Scan Findings upon Admission and Three Months after the Discharge of Patients with COVID-19

Background and Objective: There is not enough information about the long-term pulmonary complications of patients with COVID-19. This prospective study aimed to compare the findings of lung CT scan upon admission and three months after the discharge of patients with COVID-19. Materials and Methods: This prospective study was conducted on 60 patients with COVID-19 hospitalized in Shahid Beheshti and Sina hospitals in Hamadan, Iran, in 2020-2021. The lung CT scan results of the patients upon admission and three months later were assessed and compared by an experienced radiologist quantitatively and qualitatively after obtaining and recording the demographic characteristics, risk factors, and clinical findings. Results: The mean score of lung involvement upon hospitalization of the patients was 3.7±1.4, and three months after discharge, it was determined at 1.1±1.2. The most frequent findings in the initial CT scan of the patients were ground-glass opacification, mixed GGO, and bands with frequencies of 60%, 36.7%, and 18.3%, respectively. After three months, CT scan results of 32 (53.3%) patients showed lung involvement and an abnormal finding in the lung, the most common of which were ground-glass opacification, mixed GGO, and bands with frequencies of 30%, 13.3%, and 10.0%, respectively. Patients who had pulmonary involvement three months after discharge had a higher average lung involvement score during hospitalization (4.4±1.5 vs. 2.9±0.7, P=0.001). Conclusion: Abnormal CT scan results of the lung three months after discharge is common in COVID-19 patients, among whom patients with more pulmonary involvement during hospitalization have more abnormal findings

Computed Tomographic Findings in Children with Cerebral Palsy in a Developing Country

Background: Cerebral palsy (CP) is one of the most common causes of chronic childhood disability. To know the aetiopathogenesis, severity and prognosis of CP, neuroimaging is an important modality of investigation. Objective: This study was done to observe the findings in CT scan of brain in children with CP. Materials and Methods: This is a cross-sectional descriptive study. One hundred and ten patients who were clinically diagnosed as cerebral palsy were enrolled in the study. After selection of the subjects, demographic and clinical characteristics were recorded. All other comorbidities including visual and hearing impairments were identified. CT scan of brain was done in all children and reporting had been done by a single qualified radiologist. Results: The mean age of the studied children was 2.6±2.2 years (1 to 14 years). Seven types of CP were found in the study group. Among them quadriplegic CP were the most common (39.1%). History of perinatal asphyxia was found in 81.8% children. Cognitive delay was found in 90% children, speech delay was found in 88.2% children, visual impairment was found in 35.5% children and hearing impairment in 31.8% cases. Epilepsy was found in 44.4% among studied subjects. Most common finding on CT scan of brain was cerebral atrophy (62.7%), followed by encephalomalacia (15.5%), calcification (13.6%), and brain malformations (11.8%). Abnormal CT scan findings were found in 88.2% of study population. Conclusion: This study showed that most common type of CP was quadriplegic CP. Maximum children had abnormal CT scan findings. Most common CT scan finding was cerebral atrophy. J Enam Med Col 2021; 11(1): 18-23

Does the Severity of Vocal Fold Paresis on Laryngeal Electromyography Correlate With Radiographic Findings on Cross Sectional Imaging?

Unilateral vocal fold paresis or paralysis (UVFP) is a condition for which radiographic evaluation and laryngeal electromyography (LEMG) are valuable to evaluate severity of injury and direct treatment plans. Despite extensive research involving findings suggestive of UVFP with radiographic imaging, no study has attempted to determine which findings suggestive of UVFP on imaging are clinically significant and suggest a need for intervention. The purpose of this study was to evaluate whether the severity of vocal fold paresis/paralysis affects the likelihood of encountering radiographic findings suggestive of UVFP. We also aimed to determine which findings suggestive of UVFP on imaging were clinically significant and were associated with surgical intervention. A retrospective chart review was conducted of patients who had been diagnosed with unilateral vocal fold paresis or paralysis and had been evaluated by CT scan and/or magnetic resonance imaging and laryngeal electromyography (EMG) between the dates of January 1, 2017 and January 9, 2018. Fisher's exact testing with Monte Carlo Simulation was utilized to determine statistical significance of identified relationships.Univariate analysis was conducted to assess for individual relationships between imaging results and the potential predictor variables. Chi square analysis was conducted with the various categorical variables to assess for any potential relationships to imaging results. Statistical significance was determined utilizing chi square analysis. After data collection, 130 patients were included in the study population. Of the 112 patients with documented MRI results, 17% had a reported imaging abnormality suggestive of true vocal fold paresis or paralysis (VFP). Of the 71 patients with documented CT Neck results, 15.4% had an abnormality potentially concerning for true VFP. The average decrease in recruitment of the right and left SLN was 23.8% and 26.1%, respectively. The average decrease in recruitment of the right and left RLN was 37.3% and 57.78%, respectively. Seventy four percent of patients who exhibited abnormal MRI were found to have isolated SLN weakness, and 21% of patients were found to have a combined SLN and ipsilateral RLN weakness. In patients with abnormal CT scans 45% were found to have isolated SLN weakness, and 35% were found to have a combined SLN and RLN weakness. MRI imaging again failed to display any significant degree of paresis. However, abnormal CT results displayed severe CN X paresis in 36.84% vs 1.96% in normal scans. The chance of an abnormal MRI and CT result was 2.78 and 5.55 times greater, respectively, for each increase in the degree of severity of CN X paresis. When looking at the ability of imaging to predict the chance of a patient undergoing surgery, 34.8% of patients with an abnormal MRI underwent surgery compared to just 14.61% of those with normal scans. For CT scans, 35% of patients with an abnormal scan underwent surgery, compared with only 15.69% with normal imaging. When pooled, over 33% of patients with any abnormal imaging underwent a laryngeal procedure compared to 13% of patients with normal imaging. There is a relationship between severity of vocal fold paresis found on laryngeal EMG and likelihood of detection on imaging. While CT was more likely to find characteristics of UVFP than MRI, patients who had an abnormal finding on either modality were more likely to undergo surgical intervention. These findings highlight the importance of early referral of patients with abnormal laryngeal imaging to an otolaryngologist for evaluation and possible intervention.

Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

IntroductionCritical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors. MethodsMulticenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit. ResultsThe median [p25–p75] time from discharge to follow-up was 3.57 [2.77–4.92] months. Median age was 60 [53–67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO<80% and 24% having DLCO<60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO<60% were chronic lung disease (CLD) (OR: 1.86 (1.18–2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37–1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18–1.63)), urea (OR: 1.16 (0.97–1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73–1.06)). Bacterial pneumonia (1.62 (1.11–2.35)) and duration of ventilation (NIMV (1.23 (1.06–1.42), IMV (1.21 (1.01–1.45)) and prone positioning (1.17 (0.98–1.39)) were associated with fibrotic lesions. ConclusionAge and CLD, reflecting patients’ baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities.

Brain CT-Scan Features in Methanol Toxicity and Their Association with Clinical Manifestations and Outcome; a Cross-Sectional Study

Purpose: Early month of the COVID-19 pandemic. The belief of alcoholic beverages as a protective factor against the virus was got viral. We experienced a methanol toxicity outbreak by illegally produced beverages. We had insufficient data about Imaging and clinical finding in Methanol poisoning. We aimed to determine the frequency and importance of each brain finding its clinical manifestation with the prognosis of patients. Methods: in this cross-sectional study, we retrospectively assessed methanol toxicity patients in March and April 2020 at Shiraz Teaching Hospitals. We recorded demographic data, clinical manifestations, vital signs, duration, Lab data, and outcomes. Brain CT scan was reviewed by three clinical radiologists, independently. Brain CT scan results, including hemorrhage, hypodensity, and location of findings, had collected. All data analyzed by chi2 , T-test, and Pearson test was used for assessing correlation. Results: 306 patients had entered. There were 268 (88.88%) male patients. The total mean age of 32.10±9.9 years. 65 (21.8 %) with GCS< 8 were hospitalized mean duration of 2.72±2.46 days. 60(19.9%) patients passed away. about 75.9% (223) blindness, 128 (49.2%) Chronic alcohol users 46(15%) cases with abnormal findings. 30(50%) dead persons had normal imaging. There were 5(1.6 %) ICH Hypo Putamen 34 (11.11%) and diffused cerebral edema 23(7.5%), cerebellum nucleus hypoattenuation, and hemorrhage were the poorest prognosis findings in the CT scan. Conclusion: about 15% of patients had abnormal CT scans, Putamen hypodensity, Cerebellum nucleus hypodensity, and diffused cerebral edema were the most finding. Cerebellum nucleus hypodensity, diffused cerebral edema and ICH are the most faithful brain findings. Blindness, Renal failure, GCS<8, and pH<7.2 were the most faithful findings in the final prognosis.