Ground-glass Opacity Appearance Research Articles

Covid 19 Pozitif Hastaların Akciğer ve Göğüs Hacminin Incelenmesi

Background: We aimed to reveal lung volume, lesion volume and thorax diameters in patients with Covid-19 positive in CT images according to gender and presence of ground glass opacity. Materials and Methods: We included CT images of 113 people (male;58, female;55) diagnosed with Covid-19 positive in our study. CT images of each patient were imported the DICOM datasets and thorax diameter measurements were performed by using MicroDicom. Moreover, lung volume and lesion volume parameters were calculated from the CT images using the three-dimensional imaging method (Vitrea). All measurement parameters were compared according to gender and ground glass opacity appearance. Results: The 113 patients (male;58, female;55) with a mean age of 44.57±14.59 diagnosed with Covid-19 were included in our study. There was a significant difference between the gender in the mean values of lung volume (males; 3530.90±1454.99 ml and females; 3149.92±1335.16 ml) and lesion volume (males; 434.59±664.19 ml and females; 557.10±671.99 ml) parameters. In addition, a significant difference in lung volume (p<0.001) and lesion volume (p<0.001) was obtained between the groups with ground glass opacity and without ground glass opacity. Moreover, A significant difference (p=0.001) in thorax anteroposterior diameter length was obtained between the groups the with/without ground glass opacity. However, there was no significant difference (p=0.542) between genders in thorax diameters. Conclussion: In our study, we found that in the females may have more lung damage from Covid-19. We believe that our work in the light of the available data, we believe that the findings of our study will contribute to early stages of the pandemic, in which vaccination has not yet , and the long-term effects of post-covid.

Cerebral Toxoplasmosis in an Immunocompetent Patient With Confirmed Covid-19 Positive

A case of a 30 years-old male patient, diagnosed with cerebral toxoplasmosis, confirmed HIV, with positive COVID-19. Once he came to the emergency department with a chief complaint of left upper and lower limbs weakness progressing for two days. The patient appeared malnourished and was afebrile and assessed to be well hydrated. He was alert but drowsy and had speech difficulty. A focused neurologic examination was performed and revealed a loss of nasolabial fold indicating facial nerve palsy. Neck stiffness was present and there was reduced motoric power in the left upper and lower limb of 2/5, with positive Babinski sign and Chaddock sign. According to brain CT, showed vasogenic cerebral edema and midline shift. Further laboratory exams showed positive IgG antibodies for Toxoplasma, with a titer exceeding 300 IU/ml, positive serum HIV, with CD4 cell count below 200cell/mm3. Complete blood count study highlighted low haemoglobin and elevated white cell count. He tested positive for COVID-19 by nasopharyngeal swab RT-PCR. Chest CT were done and revealed features of viral pneumonia with ground glass opacity appearance. In summary, we present a patient with cerebral involvement of toxoplasmosis possibly facilitated by pre-existing immunodeficiency as an opportunistic infections of HIV, and with COVID-19 complicated as acute infections. This case report reinforces a potential role for other comorbidities, rather than HIV infection as regards SARS-CoV-2 infection outcomes. For better assessment we need to do MRI.

COVID-19 detection and classification for machine learning methods using human genomic data

Coronavirus is a disease connected to coronavirus. World Health Organization has declared COVID-19 a pandemic. It has an impact on 212 nations and territories worldwide. Examining and identifying patterns in X-Ray pictures of the lungs is still necessary. Early diagnosis may help to lessen a person's virus exposure and prevent it. Manual diagnosis is a time- and labor-intensive process. Since the COVID-19 virus has the potential to infect individuals all around the world, its finding is extremely concerning. The purpose of this study is to apply machine learning to identify and classify coronaviruses. The COVID-19 is anticipated to be discriminated and categorized in CT-Lung screening and computer-aided diagnosis (CAD). Several machine learning methods, including Decision Tree, Support Vector Machine, K-means clustering, and Radial Basis Function, were utilised in conjunction with clinical samples from patients who had contracted corona. While some medical professionals think an RT-PCR test is the most reliable and economical way to detect Covid-19 patients, others think a lung CT scan is more precise and less expensive. Serum samples, respiratory secretions, and whole blood samples are examples of clinical specimens. As a result of the earlier clinical evaluations, these tissues are used to assess 15 different parameters. As part of the proposed four-phase CAD system, the CT lungs screening collection is followed by a pre-processing step that enhances the appearance of ground-glass opacities (GGOs) nodules, which are initially extremely fuzzy and poorly contrasting due to the absence of contrast. These zones will be found and segmented using a modified K-means technique. Support vector machines (SVM) and radial basis functions (RBF) will be used as the input and target data for machine learning classifiers with a 50x50 pixel resolution to categorise the contaminated zones found during the detection phase (RBF). The 15 input items gathered from clinical specimens may be entered into a graphical user interface (GUI) tool that has been created to help doctors receive accurate findings.

Post covid lung recovery through physiotherapy: A case report

SARS COV 2 infection causes lung lesions characterized by the appearance of ground glass opacities, and a significant percentage of patients present persistent symptoms and changes in CT scan represented by fibrotic lesions, traction bronchiectasis, persistence of ground glass images. Laser therapy has anti-inflammatory effects, stabilizes the vascular endothelium, has antifibrotic effects, being a useful therapy both in the acute phase of SARS COV2 pneumonia, as well as in the post-acute and chronic phase, rapidly reducing the symptomatology and being able to prevent the appearance of sequelae.

Computed tomography findings of COVID-19 in pediatric patients

In this study, we aimed to evaluate the thorax Computed Tomography (CT) findings of pediatric patients diagnosed with coronavirus disease-19 (COVID-19) and to discuss these findings in light of the results of adult patients from the literature. The CT scans of pediatric patients (1-18 years old) with a diagnosis of COVID-19 by reverse transcriptase-polymerase chain reaction (RT-PCR) in our hospital between March 2020 and January 2021 were retrospectively reviewed. The scans were interpreted regarding the distribution and localization features, and involvement patterns including ground-glass opacity, consolidation, halo/reversed halo sign, interlobular septal thickening, air bronchograms and bronchiectasis. The frequencies of these findings in pediatric cases in our study were recorded. A total of 95 patients with a mean age of 13±4.6 years were included in this study. Among them, 34 (36%) had lesions associated with COVID-19 on CT scans. Bilateral involvement was detected in 15 (44%) while unilateral in 19 (56%) patients. Eighteen (53%) patients had single lobe involvement. In 16 (47%) patients a solitary lesion was detected and in 18 (53%) multiple lesions were present. Ground-glass opacity appearance was observed in 28 (82%), consolidation in 9 (26%), and ground-glass opacity with consolidation in 8 (24%), halo sign in 9 (26%), reversed halo sign in 2 (6%), interlobular septal thickening (interstitial thickening) in 1 (3%) patients. As symptoms are relatively milder in children with COVID-19, CT findings are less extensive than in adults. It is essential to know the thorax CT findings that aid in the diagnosis and follow-up of the disease.

Characteristics of primary Sjögren's syndrome related lymphocytic interstitial pneumonia.

ObjectiveThis paper is aimed at investigating the clinical characteristics of primary Sjogren’s syndrome (pSS) with lymphocytic interstitial pneumonia (LIP).MethodsThe demographic data, clinical manifestations, laboratory and radiological findings, treatment, and prognosis from 15 cases of pSS-LIP patients were retrospectively analyzed. The data were compared with t test, χ 2 test, and Pearson/Spearman correlation analysis.Results(1) Fifteen cases of patients with pSS-LIP are all females (100%). Compared with pSS with interstitial lung disease(pSS-ILD) patients, the incidence of dry cough, dental caries is higher in pSS-LIP patients. The incidence of shortness of breath, weight loss, and crackles is lower in pSS-LIP patients than that of pSS-ILD patients. (2) Compared with pSS-ILD patients, pSS-LIP patients had higher percentage of patients with ANA, anti-SSA52KD antibody, anti-SSA60KD antibody, and anti-SSB antibody, and the higher concentration of serum globulin. (3) Compared with pSS-ILD patients, the frequency of obstructive ventilation dysfunction is significantly higher and the frequency of diffusion dysfunction is significantly lower in pSS-LIP patients. (4) The most frequent HRCT findings in patients with pSS-LIP is cysts (100%), followed by ground-glass opacities (73.3%), nodular shadow (73.3%) among the pSS-LIP patients. Compared with PSS-ILD patients, the incidence of pulmonary nodule shadow is significantly higher in PSS-LIP patients, while that of grid shadow was significantly lower. (5) Compared with the baseline, the sum of the number, maximum diameter, and diameter of cysts in three levels of pSS-LIP patients showed an increasing trend after treatment. (6) Correlation analysis: The changes of ground-glass opacities were positively correlated with using GC or not, and those were negatively correlated with the dose of GC treatment. Besides, there is a positive correlation between the annual change rate of the maximum diameter of cysts (△Ømax1/t) and the use of CTX; there is a positive correlation between the annual change rate of the total diameter of cysts (△Øsum1/t) and the use of CTX.ConclusionTo the patients of pSS-LIP, female were more common than male, and the onset of LIP was usually more insidious. Hyperglobulinemia and anti-SSA antibody were more prominent in patients with pSS-LIP. Pulmonary function showed the higher rate of obstructive ventilation dysfunction and the lower rate of diffusion dysfunction. The appearance of ground-glass opacities in pSS-LIP patients suggests that the infiltration of inflammatory cells increases, which may cause airway compression, the expansion of terminal bronchioles, and the formation of cysts. The more ground-glass opacities appear earlier, and the more appearance of new cysts later. Therapy with glucocorticoid may be effective on the ground-glass opacity during acute stage, and therapy with cyclophosphamide may be effective on the cysts during chronic stage. The heavier ground-glass opacity is at baseline, the more likely it will recur during maintenance treatment. So follow-up closely is needed.Key Points• It is the first clinical study with more cases of patients with pSS-LIP.• Female and hyperglobulinemia and anti-SSA antibody were more prominent in patients with pSS-LIP.• Pulmonary function showed the higher rate of obstructive ventilation dysfunction and the lower rate of diffusion dysfunction.• Therapy with glucocorticoid may be effective on the ground-glass opacity during acute stage, and therapy with cyclophosphamide may be effective on the cysts during chronic stage.

Vascular Leaking, a Pivotal and Early Pathogenetic Event in Systemic Sclerosis: Should the Door Be Closed?

The early phase of systemic sclerosis (SSc) presents edema as one of the main features: this is clinically evident in the digital swelling (puffy fingers) as well as in the edematous skin infiltration of the early active diffuse subset. Other organs could be affected by this same disease process, such as the lung (with the appearance of ground glass opacities) and the heart (with edematous changes on cardiac magnetic resonance imaging). The genesis of tissue edema is tightly linked to pathological changes in the endothelium: various reports demonstrated the effect of transforming growth factor β, vascular endothelial growth factor and hypoxia-reperfusion damage with reactive oxygen species generation in altering vascular permeability and extravasation, in particular in SSc. This condition has an alteration in the glycocalyx thickness, reducing the protection of the vessel wall and causing non-fibrotic interstitial edema, a marker of vascular leak. Moreover, changes in the junctional adhesion molecule family and other adhesion molecules, such as ICAM and VCAM, are associated with an increased myeloid cells' extravasation in the skin and increased myofibroblasts transformation with further vascular leak and cellular migration. This mini-review examines current knowledge on determinants of vascular leak in SSc, shedding light on the role of vascular protection. This could enhance further studies in the light of drug development for early treatment, suggesting that the control of vascular leakage should be considered in the same way that vasodilation and inflammation reduction, as potential therapeutic targets.

P1.03-023 Ground-Glass Opacity (GGO) with Semi-Consolidation: Clinicopathological and Radiological Correlations Compared to Pure-GGOs of the Lung

There has been a great advancement in understanding natural history of ground-glass opacity (GGO), which represents histological lepidic growth in early stage pulmonary adenocarcinoma. Among them, some GGO lesions reveal increased density of GGOs without obvious consolidation on thin-section computed tomography (TSCT), i.e., GGO with semi-consolidation. However, little is known regarding clinicopathological and radiological relationship of this new entity. During 2004 and 2016, we underwent AAA (2327) surgical resections for clinical-stage IA lung cadenocarcinoma. Among them, 286 (12.3%) GGO lesions without any consolidations were identified based on the findings on TSCT. They were categorized into two groups; pure-GGO (PG) and GGO with semi-consolidation (SC) according to the radiological findings. Semi-consolidation is defined as GGO with increased homogenous density without consolidation on TSCT. Clinicopathological factors were analyzed between these two groups. Survivals were calculated by Kaplan-Meier estimation methods. Of the cases, 172 (60.1%) showed PG and 114 (39.8%) showed SC. Significant or marginal differences were clinically observed between PG and SG groups regarding age (59.4y vs. 63.0y, p=0.02), pack-year smoking status (10.2 vs. 11.6, p=0.084), tumor size (12.2cm vs. 13.9cm, p=0.06), respectively. Noninvasive lesions including atypical adenomatous hyperplasia, adenocarcinoma in situ or minimally invasive adenocarcinoma were observed in 144 patients (83.7%) of PG and 74 (64.9%) of SC, however, the frequency of invasive adenocarcinoma or lymph-vascular invasions were significantly higher in SC group compared to PG group (15.7% vs 33.9%, p=0.001: 4.3% vs 0.5%, p=0.040) despite their GGO appearances. There was no lymph node metastasis in both PG and SC groups. Overall lung-cancer specific survival is 100% to date in both PG/SC groups with mean follow-up period of 97months. Despite the conventionally same category as a native GGO appearance on TSCT, invasive adenocarcinoma was frequently observed in radiologically dense GGO lesions, indicating that PG might progress to SC over time. Surgical outcome for both groups are excellent. Therefore, more studies regarding optimal surgical procedures and long-term outcome of these two groups should be warranted.

Early prediction of tumor recurrence based on CT texture changes after stereotactic ablative radiotherapy (SABR) for lung cancer

Benign computed tomography (CT) changes due to radiation induced lung injury (RILI) are common following stereotactic ablative radiotherapy (SABR) and can be difficult to differentiate from tumor recurrence. The authors measured the ability of CT image texture analysis, compared to more traditional measures of response, to predict eventual cancer recurrence based on CT images acquired within 5 months of treatment. A total of 24 lesions from 22 patients treated with SABR were selected for this study: 13 with moderate to severe benign RILI, and 11 with recurrence. Three-dimensional (3D) consolidative and ground-glass opacity (GGO) changes were manually delineated on all follow-up CT scans. Two size measures of the consolidation regions (longest axial diameter and 3D volume) and nine appearance features of the GGO were calculated: 2 first-order features [mean density and standard deviation of density (first-order texture)], and 7 second-order texture features [energy, entropy, correlation, inverse difference moment (IDM), inertia, cluster shade, and cluster prominence]. For comparison, the corresponding response evaluation criteria in solid tumors measures were also taken for the consolidation regions. Prediction accuracy was determined using the area under the receiver operating characteristic curve (AUC) and two-fold cross validation (CV). For this analysis, 46 diagnostic CT scans scheduled for approximately 3 and 6 months post-treatment were binned based on their recorded scan dates into 2-5 month and 5-8 month follow-up time ranges. At 2-5 months post-treatment, first-order texture, energy, and entropy provided AUCs of 0.79-0.81 using a linear classifier. On two-fold CV, first-order texture yielded 73% accuracy versus 76%-77% with the second-order features. The size measures of the consolidative region, longest axial diameter and 3D volume, gave two-fold CV accuracies of 60% and 57%, and AUCs of 0.72 and 0.65, respectively. Texture measures of the GGO appearance following SABR demonstrated the ability to predict recurrence in individual patients within 5 months of SABR treatment. Appearance changes were also shown to be more accurately predictive of recurrence, as compared to size measures within the same time period. With further validation, these results could form the substrate for a clinically useful computer-aided diagnosis tool which could provide earlier salvage of patients with recurrence.

Postpneumonectomy Radical Accelerated (Re-)irradiation and Concurrent Chemotherapy for Patients With Contralateral Central Lung Cancer Relapses

Materials/Methods: Pts with stage III NSCLC treated at a large cancer center 1997-2009 with radical radiation (RT) (50Gy or more) (+/chemo), but no surgery, were retrospectively identified. Pt, tumor and treatment characteristics were extracted from an existing database or from electronic pt records. Acute toxicity, (esophagitis (RE) and pneumonitis (RP)), were graded with CTC AE V3. To investigate associations between cohort and time-to-event outcomes, including loco-regional failure (LRF) and distant failure free survival (DFFS), Gray’s test and multivariable competing risks models were employed. Both cohorts were correlated with disease-free survival (DFS) and overall survival (OS), by the log rank test and Cox proportional hazards models. In the multivariable analyses, N3 disease, stage , weight loss, age , sex, ECOG score, comorbidity score, use of PET and chemotherapy were assessed. Toxicity was correlated with cohort, chemotherapy, N3, larger field disease and RT dose using logistic regression analysis techniques. Results: Three hundred twenty-four pts were identified: 217 in the ‘3DCRT Cohort’ and 107 in the IMRT Cohort’. The only differences in demographic and tumor characteristics between the two cohorts were the N-stage (pZ0.002) and PET staging (p ZG2 RP between the groups (23.5% 3DCRT vs 17.78% IMRT pZ0.248). Conclusions: Although the IMRT cohort had more pts with N3 disease, their toxicity and distant relapse rates were comparable to the 3DCRT cohort, and the OS was better. Higher rate of LRF may be due to longer OS or increased use of cross-sectional imaging in follow-up. Author Disclosure: P.M. McCloskey: None. S. Atallah: None. L. Coate: None. A. Albert-Green: None. A.J. Hope: E. Research Grant; Elekta. J. Cho: None. A.M. Brade: None. A. Sun: None. F.A. Shepherd: None. A. Bezjak: None.

Epidermal Growth Factor Receptor Mutation and Pathologic-Radiologic Correlation Between Multiple Lung Nodules with Ground-Glass Opacity Differentiates Multicentric Origin from Intrapulmonary Spread

No standard guidelines detailing recommendations for the selection and treatment for multiple lung nodules with ground-glass opacity (GGO) have been established. For treatment decision, we analyzed epidermal growth factor receptor (EGFR)/K-ras somatic aberrations and pathologic-radiologic correlation in multiple lung nodules presented as GGO to differentiate multifocal lesions from intrapulmonary spread. Twenty-four patients with multiple lung nodules presented as GGO were identified to investigate somatic mutations of EGFR (exon 18-21) and K-ras (codons 2, 13, and 61). This series included 18 atypical adenomatous hyperplasias (AAH), 15 bronchioloalveolar carcinomas (BAC), and 23 adenocarcinomas (ADC) obtained from 24 patients. High frequency of discordant EGFR mutations (17 of 24, 70.8%) could discriminate tumor clonality (18 of 24, 75%) of multiple lung neoplastic nodules presented as GGO. EGFR mutations were common in AAH (38.9%), BAC (46.7%), and ADC (39.1%). In case 4, AAH and BAC had different mutational changes, and in case 10, the BAC lesion contains EGFR mutation that is not in the invasive ADC. In case 17, the BAC had more mutational changes than the carcinoma. The pure GGO appearance in the radiologic examination corresponded preinvasive pathologic change. This study showed that synchronous BAC and/or ADC can have different EGFR or K-ras mutational profiles suggesting these lesions arise as independent events rather than intrapulmonary spread or systemic metastasis. This has significant implication in staging and treatment. These findings might be a clue to establish guidelines of the multiple neoplastic lung nodules with GGO.

Minimally Invasive Approach to Early, Peripheral Adenocarcinoma with Ground-Glass Opacity Appearance

Owing to the advent of refined chest computed tomography (CT) images with high resolution and CT screening programs, smaller and faint lung cancers are being discovered [1, 2]. Most of them have a characteristic appearance on high-resolution CT image known as ground-glass opacity (GGO), which is characterized by a mild-to-intermediate increase in CT density. These images are localized and homogeneous, and do not obscure the images of preexisting bronchovascular structures within the nodule. Some of them typically have a solid part in the center, and their appearance mimics a fried egg [3, 4].

Multiple Lung Adenocarcinomas Showing Ground-Glass Opacities on Thoracic Computed Tomography

It is difficult to distinguish multiple primary lung cancers from pulmonary metastasis. We experienced a case of surgically resected lung tumors that showed multiple ground-glass opacities on thoracic computed tomographic scan. There were eight nonsolid and two part-solid ground-glass opacities in the bilateral lungs. Surgical resection was performed because all tumors had a ground-glass opacity appearance on computed tomographic scan, which is compatible with a finding of primary lung adenocarcinoma. The postoperative pathologic diagnoses were two cases of invasive adenocarcinoma, six cases of bronchioloalveolar carcinoma, and eight cases of atypical adenomatous hyperplasia. The patient remains alive without any evidence of recurrence 40 months after surgery. A ground-glass opacity appearance on computed tomographic scan could be interpreted as supportive evidence for multiple primary lung adenocarcinoma rather than pulmonary metastases.

Pathologic and Biological Assessment of Lung Tumors Showing Ground-Glass Opacity

We evaluated the pathologic and biological aspects of lung tumors 3.0 cm or less in diameter with the appearance of ground-glass opacity (GGO). Of 988 patients with non-small cell lung cancer who underwent operations at our institute between January 1994 and December 2004, 87 resected lung tumor specimens that showed GGO appearance on helical computed tomography were obtained from 81 patients. Forty-four lesions were pure GGO with no solid component in the tumor and 43 lesions were mixed GGO consisting of areas of attenuation with a solid component. Together with histological features, MIB1 and nm23 expression within tumors were examined immunohistochemically. The mean tumor size in the pure GGO group was significantly smaller than that in the mixed GGO group. The composition of pathologic subtypes and biological characteristics were clearly different between the two groups. Although atypical adenomatous hyperplasia and localized bronchioloalveolar cell carcinoma of Noguchi's A and B were the predominant pathologic subtypes and nm23 negativity was rare in the pure GGO group, a high score for expression of MIB1 was often found in pure GGO tumors even though the tumors were less than 10 mm in diameter. If the tumor is 2 cm or less in diameter, the ability of invasion and metastasis seems to be low in pure GGO tumors. However, the proliferation ability of these tumors suggests the necessity of a careful follow-up schedule if the tumor is greater than 5 mm in diameter. For mixed GGO tumors, surgical resection instead of observation is justified.

Spontaneous disappearance of focal ground-glass opacity in the lung detected on the high-resolution computed tomography

We report a case of a 52-year-old female with spontaneous disappearance of focal ground-glass opacity (GGO) detected on high-resolution computed tomography (HRCT). She initially was found to have a focal GGO lesion on follow-up computed tomography five years after left lower lobectomy for primary lung adenocarcinoma. Two months later, this lesion spontaneously disappeared in spite of the suspicion of subsequent lung cancer. A GGO appearance on HRCT can be found in a variety of diseases with partial air-space filling or interstitial thickening. Lung cancer, especially bronchioloalveolar carcinoma, is also included in the differential diagnosis for GGO lesions. However, there is little definite evidence about the management of lesions showing a GGO appearance. When we detect a GGO lesion, initial monitoring for several months may be useful for excluding the presence of lung neoplasms.