Areas Of Ground-glass Opacity Research Articles

A case-control evaluation of pulmonary and extrapulmonary findings of incidental asymptomatic COVID-19 infection on FDG PET-CT.

Objectives:To describe the findings of incidental asymptomatic COVID-19 infection on FDG PET-CT using a case–control design.Methods:Incidental pulmonary findings suspicious of asymptomatic COVID-19 infection on FDG PET-CT were classified as a confirmed (positive RT-PCR test) or suspected case (no/negative RT-PCR test). Control cases were identified using a 4:1 control:case ratio. Pulmonary findings were re-categorised by two reporters using the BSTI classification. SUV metrics in ground glass opacification (GGO)/consolidation (where present), background lung, intrathoracic nodes, liver, spleen and bone marrow were measured.Results:7/9 confirmed and 11/15 suspected cases (COVID-19 group) were re-categorised as BSTI 1 (classic/probable COVID-19) or BSTI 2 (indeterminate COVID-19); 0/96 control cases were categorised as BSTI 1. Agreement between two reporters using the BSTI classification was almost perfect (weighted κ = 0.94). SUVmax GGO/consolidation (5.1 vs 2.2; p < 0.0001) and target-to-background ratio, normalised to liver SUVmean (2.4 vs 1.0; p < 0.0001) were higher in the BSTI 1 & 2 group vs BSTI 3 (non-COVID-19) cases. SUVmax GGO/consolidation discriminated between the BSTI 1 & 2 group vs BSTI 3 (non-COVID-19) cases with high accuracy (AUC = 0.93). SUV metrics were higher (p < 0.05) in the COVID-19 group vs control cases in the lungs, intrathoracic nodes and spleen.Conclusion:Asymptomatic COVID-19 infection on FDG PET-CT is characterised by bilateral areas of FDG avid (intensity > x2 liver SUVmean) GGO/consolidation and can be identified with high interobserver agreement using the BSTI classification. There is generalised background inflammation within the lungs, intrathoracic nodes and spleen.Advances in knowledge:Incidental asymptomatic COVID-19 infection on FDG PET-CT, characterised by bilateral areas of ground glass opacification and consolidation, can be identified with high reproducibility using the BSTI classification. The intensity of associated FDG uptake (>x2 liver SUVmean) provides high discriminative ability in differentiating such cases from pulmonary findings in a non-COVID-19 pattern. Asymptomatic COVID-19 infection causes a generalised background inflammation within the mid-lower zones of the lungs, hilar and central mediastinal nodal stations, and spleen on FDG PET-CT.

MosMedData: data set of 1110 chest CT scans performed during the COVID-19 epidemic

With the ongoing COVID-19 pandemic decreasing availability of polymerase chain reaction with reverse transcription and the snowballing growth of medical imaging, especially the number of chest computed tomography (CT) scans being performed, methods to augment and automate the image analysis, increasing productivity and minimizing human error are of particular importance. The creation of high-quality datasets is essential for the development and validation of artificial intelligence algorithms. Such technologies have sufficient accuracy in diagnosing COVID-19 in medical imaging. The presented large-scale dataset contains anonymized human CT scans with COVID-19 features as well as normal studies. Some studies were tagged by radiologists using binary pixel masks of regions of interest (e.g., characteristic areas of consolidation and ground-glass opacities). CT data were acquired between March 1, 2020, and April 25, 2020, and provided by municipal hospitals in Moscow, Russia. The presented dataset is licensed under Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported (CC BY-NC-ND 3.0).

Differential Diagnosis of Lungs Lesions in a New Coronavirus Infection COVID-19 and Diseases of Non-Viral Etiology on the Clinical Cases by Computed Tomography Scans in Outpatient CT Centers

New coronavirus infection (COVID-19) viral pneumonia diagnosed by a complex assessment of the epidemiological history, clinical symptoms, radiological and laboratory tests. Radiologists often play a leading role in diagnosis of viral pneumonia, since they may encounter suspicious changes according to radiological studies before clinicians. However, in a number of diseases, including diseases of non-infectious non-viral etiology with a corresponding similar clinical symptoms, it may be difficult to correctly assess the changes detected by computed tomography. This study uses clinical cases to show the main differential diagnostic criteria for COVID-19 viral pneumonia and non-infectious lesions such as pulmonary edema, pulmonary embolism, acute hypersensitive pneumonitis, drug-induced pneumonitis, non-specific interstitial pneumonia, and adenocarcinoma. All patients were hospitalized based on the results of computed tomography, where a diagnosis of non-infectious non-viral lung injuries was established based on morphological and/or typical clinical symptoms, laboratory or radiological data. We examined clinical cases with radiological signs similar to viral pneumonia, such as areas of ground glass opacities with the presence or absence of areas of consolidation, as well as thickening of the lung interstitium with decreased lung attenuation (crazy paving symptom). In a difficult epidemiological situation, it is important for a radiologist to suspect the above-mentioned pathological conditions in patients who are urgently admitted to outpatient CT centers.

Clinical characteristics of coronavirus disease 2019 (COVID-19) patients in Kuwait.

This is a retrospective single-center study of 417 consecutive patients with coronavirus disease 2019 (COVID-19) admitted to Jaber Al-Ahmad Hospital in Kuwait between February 24, 2020 and May 24, 2020. In total, 39.3% of patients were asymptomatic, 41% were symptomatic with mild/moderate symptoms, 19.7% were admitted to the intensive care unit (ICU). Most common symptoms in cohort patients were fever (34.3%) and dry cough (32.6%) while shortness in breath was reported in (75.6%) of ICU admissions. Reported complications requiring ICU admission included Sepsis (68.3%), acute respiratory distress syndrome (95.1%) and heart failure (63.4%). ICU patients were more likely to have comorbidities, in comparison to non-ICU patients, including diabetes (35.4% vs 20.3%) and hypertension (40.2% vs 26.9%). Mortality rate of cohort was 14.4% and mean age of death was 54.20 years (± 11.09) and 90% of death cases were males. Chest high-resolution computed tomography for ICU cases reveled multifocal large patchy areas of ground glass opacification mixed with dense consolidation. Cases admitted to ICU showed abnormal levels of markers associated with infection, inflammation, abnormal blood clotting, heart problems and kidney problems. Mean hospital stay for asymptomatic cases was 20.69 days ±8.57 and for mild/moderate cases was 21.4 days ±8.28. Mean stay in ICU to outcome for survivors was 11.95 days ±8.96 and for death cases 13.15 days ±10.02. In this single-center case series of 417 hospitalized COVID-19 patients in Kuwait 39.3% were asymptomatic cases, 41% showed mild/moderate symptoms and 18.7% were admitted to ICU with a mortality rate of 14.4%.

A PICTURE IS NOT ALWAYS WORTH 1,000 WORDS: A CASE OF DIP MASQUERADING AS UIP

SESSION TITLE: Medical Student/Resident Diffuse Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Desquamative Interstitial Pneumonia (DIP) is a rare idiopathic interstitial pneumonia which has findings of pigmented macrophages and giant cells on histopathology and is often associated with smoking tobacco. Radiographically, DIP is commonly described as widespread patchy ground glass opacities with a predilection for lower lung zones.[1] Here we present a unique case of DIP which initially presented as probable interstitial pulmonary fibrosis with usual interstitial pneumonia (UIP) pattern on CT imaging in a former smoker. CASE PRESENTATION: The patient is a 68-year-old Vietnamese male with no known past medical history who initially presented with 3 months of worsening dyspnea and dry cough associated with 5lbs weight loss. He immigrated to the United States ten years ago and had been treated for latent tuberculosis at that time. He was a 20 pack year smoker but had quit ten years prior to presentation. He works in a nail salon with exposures to polish and chemicals, but otherwise denied other occupational exposures. He has no pets and has been living in the same home for more than five years. On initial presentation the patient was found to be hypoxic with resting oxygen saturation of 86%. High resolution CT (HRCT) had findings consistent with fibrosing interstitial lung disease in a probable UIP pattern with some small areas of ground glass opacities in bibasilar lung fields (Image A & B). PFTs were performed which showed a TLC of 62% of predicted consistent with severe restriction. Rheumatic panel was unremarkable aside from a mildly elevated CRP at 2.0 mg/dL. He underwent surgical lung biopsy which confirmed a diagnosis of DIP. He was started on prednisone 60mg daily with improvement in his PFTs and clearance of ground glass opacities on imaging (Images C & D) at 1-month follow up. He experienced undesirable side effects due to prednisone. Therefore, mycophenolate mofetil 500mg twice daily was started and his prednisone was reduced to 40mg daily. At 3-month follow-up he continued to have symptomatic improvement and has been weaned off supplemental oxygen. DISCUSSION: DIP is a rare idiopathic interstitial pneumonia with radiographic findings of bilateral patchy ground glass opacification in a mid to lower lung zone distribution. Infrequently limited honeycombing or traction bronchiectasis can be seen.[2] DIP was very low on the initial differential diagnosis for this patient with initial CT imaging consistent with probable UIP. Surprisingly, surgical biopsy confirmed findings of DIP and the patient has done remarkably well after starting immunosuppressive therapy. CONCLUSIONS: This case demonstrates that there can be a large discrepancy between what imaging suggests and what biopsy confirms. This example further supports the ATS guidelines on obtaining a surgical biopsy for probable radiographic UIP as it can have major ramifications in terms of treatment strategy.[3] Reference #1: Godbert B, Wissler MP, Vignaud JM. Desquamative interstitial pneumonia: an analytic review with an emphasis on aetiology. Eur Respir Rev. 2013;22(128):117-123. doi:10.1183/09059180.00005812 Reference #2: Wells AU, Hirani N. Interstitial lung disease guidelines: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax 2008; 63: Suppl. 5, v1–v58 Reference #3: Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. 2018;198(5):e44-e68. doi:10.1164/rccm.201807-1255ST DISCLOSURES: No relevant relationships by Michael Morris, source=Web Response No relevant relationships by Taj Rahman, source=Web Response

COMMON VARIABLE IMMUNODEFICIENCY-ASSOCIATED GRANULOMATOUS-LYMPHOCYTIC INTERSTITIAL LUNG DISEASE DIAGNOSED ON TRANSBRONCHIAL LUNG CRYOBIOPSY

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Granulomatous-Lymphocytic Interstitial Lung Disease (GLILD) is a rare entity involving granulomatous and lymphoproliferative inflammation of the small airways and pulmonary interstitium. Imaging reveals lower lung predominant ground glass and/or consolidative opacities and nodules. Histopathology may have features of lymphocytic interstitial pneumonia, follicular bronchiolitis and/or organizing pneumonia. GLILD is often seen as a manifestation of common variable immunodeficiency (CVID). Diagnosis requires lung biopsy as imaging findings are nonspecific. Surgical lung biopsy (SLB) is the gold standard in diagnosing interstitial lung disease. However, the relatively new, less invasive approach of transbronchial lung cryobiopsy (TBLC) has been increasingly considered for diagnostic purposes for diffuse parenchymal lung disease (DPLD). CASE PRESENTATION: A 58 year old male with a history of idiopathic thrombocytopenic purpura status-post splenectomy and rituximab presented with dyspnea on exertion, chest pressure and a chronic cough. CT chest revealed areas of consolidation and ground glass opacities in a lower lung distribution on a background of pulmonary fibrosis. Pulmonary function tests showed mild restriction and low diffusing capacity. He underwent outpatient TBLC with histopathologic findings of organizing pneumonia, patchy chronic inflammation, fibrosis and peribronchial lymphoid hyperplasia. Labs revealed low IgG and IgA, absence of member B cells, and deficiency of T cells. The patient was diagnosed with GLILD in setting of CVID. He was started on prednisone and IVIG with improvement in imaging findings and symptoms. DISCUSSION: GLILD is a granulomatous and lymphoproliferative disorder that occurs in 8-25% of patients with CVID. Patients may have shortness of breath and cough, as well as splenomegaly, cytopenia, and adenopathy. The constellation of signs and imaging findings are suggestive but not specific. Biopsy is needed for diagnosis. SLB is associated with relatively higher morbidity and mortality compared to TBLC, and necessitates hospitalization. TBLC has been proposed as a less invasive alternative to SLB. Advantages include lower mortality and complication rate, and no requirement for hospitalization. In this case, we demonstrate the utility of TBLC done as an outpatient in obtaining a diagnostic tissue sample, with clinical improvement on steroids and IVIG. There is no standard treatment for GLILD, but corticosteroids are recommended as first line therapy. Success has also been shown with azathioprine, ritxumab and IVIG. CONCLUSIONS: Transbronchial lung cryobiopsy is emerging as a less invasive alternative modality for obtaining tissue with less morbidity, less mortality and the advantage of being performed in the outpatient setting. Further studies regarding safety, diagnostic accuracy and yield in SLB versus TBLC are required to establish TBLC as common practice. Reference #1: Granulomatous-lymphocytic interstitial lung disease (GLILD) in common variable immunodeficiency (CIVD). Park JH, Levinson AI. Clin Immunol. 2010; 134(2):97. Reference #2: Transbronchial Lung Cryobiopsy in Idiopathic Pulmonary Fibrosis: A State of the Art Review. Adv Ther (2019) 36:2193-2204. Reference #3: British Lung Foundation/United Kingdom Primary Immunodeficiency Network Consensus Statement on the Definition, Diagnosis, and Management of Granulomatous-Lymphocytic Interstitial Lung Disease in Common Variable Immunodeficiency Disorders. Hurst JR, Verma N. Lowe D, Daxendale HE, Jolles S, Kelleher P, Longhurst HJ, Patel Sy, Renzoni EA, Sander CR, Avery GR, Babar JL, Buckland MS, Burns S, Egner W, Gompels MM, Gordins P, Haddock JA, Hart SP, Hayman GR, Herriot R, Hoyles RK, Huissoon AP, Jacob J, Nicholson AG, Rassl DM, Sargur RB, Savic S, Seneviratne SL, Sheaff M, Vaailta PM, Walters GI, Whitehouse JL, Wright PA, Condliffe AM. J Allergy Clin Immunol Pract. 2017;5(4):938. Epub 2017 Mar 25. DISCLOSURES: No relevant relationships by Lawrence Benjamin, source=Web Response Speaker/Speaker's Bureau relationship with Boehringer-Ingelheim Pharmaceuticals Please note: $5001 - $20000 Added 04/07/2020 by Jaime Betancourt, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Vapotherm, Inc Please note: $5001 - $20000 Added 04/07/2020 by Jaime Betancourt, source=Web Response, value=Honoraria No relevant relationships by Houda Boucekkine, source=Web Response No relevant relationships by Scott Oh, source=Web Response

Comparison Between Lung Ultrasound and Computed Tomographic Findings in Patients With COVID-19 Pneumonia.

ObjectivesThe aim of this study was to describe findings from lung ultrasound (LUS) and computed tomography (CT) in health professionals with coronavirus disease 2019 pneumonia and to evaluate the associations of the findings of both tests.MethodsThis cross‐sectional observational study evaluated 45 health professionals who were initially seen in screening tents and had a diagnosis of coronavirus disease 2019 as confirmed by a reverse transcription polymerase chain reaction and lung involvement diagnosed by LUS. Subsequently, these individuals were admitted to the hospital, where chest CT was performed. Aeration scores were obtained for the LUS examinations based on the following findings: more than 2 B‐lines, coalescent B‐lines, and subpleural consolidations. A subjective assessment of the extent of lung disease on CT was performed on the basis of the percentage of lung parenchyma involvement as follows: 25% or less, 25% to 50%, and greater than 50%.ResultsRegarding LUS signs, more than 2 B‐lines, coalescent B‐lines, and subpleural consolidations were present in 73.3%, 68.2%, and 24.4% of cases, respectively. The main findings on CT were ground glass opacities, a crazy‐paving pattern, and consolidations (66.7%, 20%, and 20% of cases); 17.8% of cases had examinations without abnormalities. Patients with more than 2 B‐lines on LUS had more ground glass opacity areas on CT (P = .0007), whereas patients with subpleural consolidations on LUS had more consolidations on CT (P < .0001). In addition, patients with higher LUS aeration scores had more extensive disease on CT (P < .0001).ConclusionsLung ultrasound can detect lung injury even in the presence of normal CT results. There are associations between the abnormalities detected by both methods, and a relationship also exists between LUS aeration scores and the disease extent on CT.

"Mosaic Perfusion Pattern" on Dual-Energy CT in COVID-19 Pneumonia: Pulmonary Vasoplegia or Vasoconstriction?

HomeRadiology: Cardiothoracic ImagingVol. 2, No. 5 PreviousNext Letters to the EditorFree Access“Mosaic Perfusion Pattern” on Dual-Energy CT in COVID-19 Pneumonia: Pulmonary Vasoplegia or Vasoconstriction?Amit Jain* , D. John Doyle*, Ramesh Mangal†Amit Jain* , D. John Doyle*, Ramesh Mangal†Author AffiliationsAnesthesiology Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates*Radiology Institute, Mednext, Ahmedabad, India†e-mail: [email protected]Amit Jain* D. John Doyle*Ramesh Mangal†Published Online:Sep 10 2020https://doi.org/10.1148/ryct.2020200433MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack Citations ShareShare onFacebookTwitterLinked In Editor:Finding dilated subsegmental vessels at dual-energy CT (DECT), Dr Lang and colleagues (1) proposed inflammatory-mediated impaired hypoxic pulmonary vasoconstriction (HPV) with overactive regional vasodilation to explain coronavirus disease 2019 (COVID-19) hypoxemia in their article in the June issue of Radiology: Cardiothoracic Imaging. However, this was not associated with increased pulmonary blood volume (PBV) in consolidated areas; instead, most (96%) patients had decreased peripheral perfusion corresponding to peripheral lung opacities, and only one-third demonstrated a halo of increased perfusion surrounding peripheral opacities. If HPV loss occurs in consolidated regions, PBV should have increased, producing hyperemia rather than oligemia. We instead propose an angiotensin II–mediated, nonimmune, noninflammatory mechanism to explain the mosaic perfusion pattern.Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection of alveolar epithelium results in downregulation of angiotensin-converting enzyme 2 (ACE-2) and ACE-angiotensin II-angiotensin II type 1 receptor pathway overactivity, producing heterogeneous small vessel vasoconstriction (2) and recruitment of segmental/subsegmental vessels with relatively less vasoconstriction, causing regional overperfusion, reduced diffusion capacity, increased shunt and hypoxia, even in the absence of radiologically evident lesions. Where precapillary constriction is intense (due to high local concentration of angiotensin II), PBV would decrease, reducing perfusion even in normal lung or may produce wedge-shaped areas of pulmonary deficit on DECT (3). In areas of ineffective constriction due to lower concentrations of angiotensin II, capillary filtration pressure would increase, resulting in capillary stress failure and hydrostatic interstitial edema with patchy ground-glass opacities (GGOs) on CT. Disruption of the alveolocapillary membrane develops, with SARS-CoV-2 directly infecting endothelial cells. Endothelialitis with intracapillary fibrin-microthrombi blocks alveolar capillaries and further decreases perfusion within the areas of GGOs and consolidation but, with dilatation of proximal subsegmental arterioles, along with a halo of increased perfusion surrounding regions of consolidation. Thus, in COVID-19 pneumonia as the GGOs worsens to consolidation, oligemia or hyperemia in the area of consolidation is largely determined by the balance between the endothelialitis-mediated capillary obstruction (in consolidation regions) versus angiotensin II-mediated regional vasoconstriction (in healthy lung regions) (3,4).Our theory is supported by high incidence of raised PVR and right ventricular dysfunction in early COVID-19 disease (5) and reports of lung perfusion deficits that do not overlap with GGOs or consolidation and are not associated with major vessel occlusion (3). We believe determining the predominant pathophysiology—heterogeneous pulmonary vasoconstriction versus pulmonary vasoplegia—has treatment implications: pulmonary vasoconstrictors versus vasodilators.Disclosures of Conflicts of Interest: A.J. disclosed no relevant relationships. D.J.D. disclosed no relevant relationships. R.M. disclosed no relevant relationships.

Airway Obstruction and Patchy Parenchymal Infiltrations Related to Tear Gas Exposure

A 50 year old nonsmoker female patient with respiratory complaints including phlegm and effort-related dyspnea admitted to the hospital. Anamnesis pointed out neither occupational nor hobby-related exposures. However, she mentioned several intense tear gas exposures, and describe dyspnea and wheezing right after these exposures. Computed tomography of the lung showed patchy areas of consolidation and ground glass opacity. Pulmonary function tests revealed an FEV1/FVC ratio of 67%. Chlorobenzylidene malononitrile (CS) gas related pulmonary involvement was evident due to the lack of lesions on previous radiographs, improvement of her complaints and respiratory function test, and regression of the parenchymal lesions after ceasing the exposure. This case is presented to emphasize the importance of taking detailed anamnesis of the patient and to demonstrate the negative impacts of physical and social environment on human health, and more specifically to suggest that the riot control gases used are not as harmless as believed.

Lung and kidney perfusion deficits diagnosed by dual-energy computed tomography in patients with COVID-19-related systemic microangiopathy.

ObjectivesThere is increasing evidence that thrombotic events occur in patients with coronavirus disease (COVID-19). We evaluated lung and kidney perfusion abnormalities in patients with COVID-19 by dual-energy computed tomography (DECT) and investigated the role of perfusion abnormalities on disease severity as a sign of microvascular obstruction.MethodsThirty-one patients with COVID-19 who underwent pulmonary DECT angiography and were suspected of having pulmonary thromboembolism were included. Pulmonary and kidney images were reviewed. Patient characteristics and laboratory findings were compared between those with and without lung perfusion deficits (PDs).ResultsDECT images showed PDs in eight patients (25.8%), which were not overlapping with areas of ground-glass opacity or consolidation. Among these patients, two had pulmonary thromboembolism confirmed by CT angiography. Patients with PDs had a longer hospital stay (p = 0.14), higher intensive care unit admission rates (p = 0.02), and more severe disease (p = 0.01). In the PD group, serum ferritin, aspartate aminotransferase, fibrinogen, D-dimer, C-reactive protein, and troponin levels were significantly higher, whereas albumin level was lower (p < 0.05). D-dimer levels ≥ 0.485 μg/L predicted PD with 100% specificity and 87% sensitivity. Renal iodine maps showed heterogeneous enhancement consistent with perfusion abnormalities in 13 patients (50%) with lower sodium levels (p = 0.03).ConclusionsWe found that a large proportion of patients with mild-to-moderate COVID-19 had PDs in their lungs and kidneys, which may be suggestive of the presence of systemic microangiopathy with micro-thrombosis. These findings help in understanding the physiology of hypoxemia and may have implications in the management of patients with COVID-19, such as early indications of thromboprophylaxis or anticoagulants and optimizing oxygenation strategies.Key Points • Pulmonary perfusion abnormalities in COVID-19 patients, associated with disease severity, can be detected by pulmonary DECT. • A cutoff value of 0.485 μg/L for D-dimer plasma levels predicted lung perfusion deficits with 100% specificity and 87% sensitivity (AUROC, 0.957). • Perfusion abnormalities in the kidney are suggestive of a subclinical systemic microvascular obstruction in these patients. Electronic supplementary materialThe online version of this article (10.1007/s00330-020-07155-3) contains supplementary material, which is available to authorized users.

Imaging features of the initial chest thin-section CT scans from 110 patients after admission with suspected or confirmed diagnosis of COVID-19

BackgroundIn December 2019, an outbreak of a novel coronavirus pneumonia, now called COVID-19, occurred in Wuhan, Hubei Province, China. COVID-19, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread quickly across China and the rest of the world. This study aims to evaluate initial chest thin-section CT findings of COVID-19 patients after their admission at our hospital.MethodsRetrospective study in a tertiary referral hospital in Anhui, China. From January 22, 2020 to February 16, 2020, 110 suspected or confirmed COVID-19 patients were examined using chest thin-section CT. Patients in group 1 (n = 51) presented with symptoms of COVID-19 according to the diagnostic criteria. Group 2 (n = 29) patients were identified as a high degree of clinical suspicion. Patients in group 3 (n = 30) presented with mild symptoms and normal chest radiographs. The characteristics, positions, and distribution of intrapulmonary lesions were analyzed. Moreover, interstitial lesions, pleural thickening and effusion, lymph node enlargement, and other CT abnormalities were reviewed.ResultsCT abnormalities were found only in groups 1 and 2. The segments involved were mainly distributed in the lower lobes (58.3%) and the peripheral zone (73.8%). The peripheral lesions, adjacent subpleural lesions, accounted for 51.8%. Commonly observed CT patterns were ground-glass opacification (GGO) (with or without consolidation), interlobular septal thickening, and intralobular interstitial thickening. Compared with group 1, patients in group 2 presented with smaller lesions, and all lesions were distributed in fewer lung segments. Localized pleural thickening was observed in 51.0% of group 1 patients and 48.2% of group 2 patients. The prevalence of lymph node enlargement in groups 1 and 2 combined was extremely low (1 of 80 patients), and no significant pleural effusion or pneumothorax was observed (0 of 80 patients).ConclusionThe common features of chest thin-section CT of COVID-19 are multiple areas of GGO, sometimes accompanied by consolidation. The lesions are mainly distributed in the lower lobes and peripheral zone, and a large proportion of peripheral lesions are accompanied by localized pleural thickening adjacent to the subpleural region.

CT in coronavirus disease 2019 (COVID-19): a systematic review of chest CT findings in 4410 adult patients.

ObjectiveThe objective of this systematic review was to evaluate the key imaging manifestations of COVID-19 on chest CT in adult patients by providing a comprehensive review of the published literature.MethodsWe performed a systematic literature search from the PubMed, Google Scholar, Embase, and WHO databases for studies mentioning the chest CT imaging findings of adult COVID-19 patients.ResultsA total of 45 studies comprising 4410 patients were included. Ground glass opacities (GGO), in isolation (50.2%) or coexisting with consolidations (44.2%), were the most common lesions. Distribution of GGOs was most commonly bilateral, peripheral/subpleural, and posterior with predilection for lower lobes. Common ancillary findings included pulmonary vascular enlargement (64%), intralobular septal thickening (60%), adjacent pleural thickening (41.7%), air bronchograms (41.2%), subpleural lines, crazy paving, bronchus distortion, bronchiectasis, and interlobular septal thickening. CT in early follow-up period generally showed an increase in size, number, and density of GGOs, with progression into mixed areas of GGOs plus consolidations and crazy paving, peaking at 10–11 days, before gradually resolving or persisting as patchy fibrosis. While younger adults more commonly had GGOs, extensive/multilobar involvement with consolidations was prevalent in the older population and those with severe disease.ConclusionThis review describes the imaging features for diagnosis, stratification, and follow-up of COVID-19 patients. The most common CT manifestations are bilateral, peripheral/subpleural, posterior GGOs with or without consolidations with a lower lobe predominance. It is pertinent to be familiar with the various imaging findings to positively impact the management of these patients.Key Points • Ground glass opacities (GGOs), whether isolated or coexisting with consolidations, in bilateral and subpleural distribution, are the most prevalent chest CT findings in adult COVID-19 patients. • Follow-up CT shows a progression of GGOs into a mixed pattern, reaching a peak at 10–11 days, before gradually resolving or persisting as patchy fibrosis. • Younger people tend to have more GGOs. Older or sicker people tend to have more extensive involvement with consolidations. Electronic supplementary materialThe online version of this article (10.1007/s00330-020-06975-7) contains supplementary material, which is available to authorized users.

Exogenous lipoid pneumonia: when radiologist makes the difference.

To report high-resolution CT (HRCT) findings in our group of patients with exogenous lipoid pneumonia (ELP), confirmed with histopathological findings and clinical-anamnestic data, in order to describe the most common radiological patterns of this rare disorder. In this retrospective study, HRCT of 10 patients with ELP were evaluated by three radiologists. Diagnosis of ELP was made through CT, bronchiolo-alveolar lavage (BAL) and a pneumological examination associated with an accurate medical anamnesis. Five patients had a histologically proven ELP, through lung biopsy. All patients had a chronic exposition to substances made of animal fat or mineral/vegetable oils. In our cohort of patients with ELP, the following parenchymal patterns were observed: 8/10 patients had lung consolidation with adipose density (attenuation values < - 40 HU); 10/10 patients had multiple areas of ground glass opacity; 6/10 patients had smooth thickening of interlobular septa and ground glass opacities ("crazy-paving" pattern); 2/10 patients presented nodules > 2.5cm with spiculated margins (tumor-like); 5/10 patients showed reactive lymph nodes enlargement. The oldest lesions were characterized by bronchiectasis and fibrosis around the lipidic consolidations. Pulmonary alterations found in HRCT exams can be confused with other lung diseases (especially lung tumors) and they are always a challenge even for the most experienced radiologist. In our experience, although non-specific, consolidation areas with low HU values and crazy-paving pattern are frequently associated in ELP. These characteristics should alert the radiologist to consider ELP among the possible differential diagnoses, always correlating the results of CT examination with appropriate clinical-laboratory evaluations and an accurate anamnesis.

Effectiveness of Cone Beam Computed Tomography Imaging During Radiation Therapy for the Detection of Initial Coronavirus Lung Disease 2019

In this unique historic period afflicted by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, radiation therapy treatments cannot be delayed or suspended. We report the case of a 73-year-old woman with recently diagnosed extensive-stage small cell lung cancer with metastatic liver and bone lesions. A SARS-CoV-2 test was performed upon hospital admission and was negative. After 5 days she underwent radiation therapy on T6 and T11 with single fractions of 8 Gy each. Before treatment a cone beam computed tomography (CBCT) scan was performed to check the setup of the patient. Some suspected lung areas of ground glass opacities (GGOs) were clearly visible in the CBCT without any counterpart in the previous computed tomography (CT) simulation scan 3 days before. A new high-quality chest CT scan confirmed the previously suspected GGOs. The exam revealed multiple bilateral areas of subpleural GGOs, which are the primary findings on CT scan in the early phases of coronavirus disease 2019 (COVID-19) lung infection, in addition to pleural effusions, a finding that may occur as a complication of COVID-19. The patient then urgently repeated the SARS-CoV-2 test, which was positive and confirmed the infection. In conclusion, daily CBCT can be effective for early detection of COVID-19 lung disease in asymptomatic or mildly symptomatic patients.

Cryptogenic Organizing Pneumonia: Evolution of Morphological Patterns Assessed by HRCT.

To evaluate the radiological findings in patients with cryptogenic organizing pneumonia (COP) before steroid treatment and their behavior after therapy, we retrospectively evaluated a total of 22 patients with a diagnosis of COP made by bronchoalveolar lavage (BAL), biopsy or clinical/radiological features, and the patients were followed between 2014 and 2018 at the hospital; the demographic data, symptoms, radiologic findings, diagnostic methods and treatment plans of patients were collected from patients’ hospital records. At least two CT scans of 22 patients (16 female and six men) were evaluated, the first one before starting steroid therapy and the others after therapy. At baseline CT scans, the most common radiological finding was the presence of consolidations (18/22 patients, 81.8%); ground-glass opacities were also very common (15/25, 68.1%). The other findings were as follows: nodules and masses (5/22, 22.7%), atoll sign (4/22, 18.1%), perilobular pattern (3/22, 13.6%) and parenchymal bands (3/22, 13.6%). Two patients had a significant relapse after reducing/interrupting therapy, while three had a complete resolution and are not currently under therapy (maintenance of clinical remission with no oral corticosteroid (OCS)). In High-resolution computed tomography (HRCT) scans after therapy, consolidations were still observable in seven patients (five in new areas of the lung-migratory infiltrates), while most of them disappeared, leaving a residual area of ground glass opacity in two patients. One patient had a residual of the perilobular pattern, with the disappearing of the other findings (consolidations and ground-glass opacities). Two patients developed a fibrosing pattern despite the therapy (9.5%). Cryptogenic organizing pneumonia tends to respond to oral corticosteroid treatment, but some patients may have a null or partial response. We highlight the behavior of this disease after proper therapy.

The role of imaging in 2019 novel coronavirus pneumonia (COVID-19).

Almost the entire world, not only China, is currently experiencing the outbreak of a novel coronavirus that causes respiratory disease, severe pneumonia, and even death. The outbreak began in Wuhan, China, in December of 2019 and is currently still ongoing. This novel coronavirus is highly contagious and has resulted in a continuously increasing number of infections and deaths that have already surpassed the SARS-CoV outbreak that occurred in China between 2002 and 2003. It is now officially a pandemic, announced by WHO on the 11th of March. Currently, the 2019 novel coronavirus (SARS-CoV-2) can be identified by virus isolation or viral nucleic acid detection; however, false negatives associated with the nucleic acid detection provide a clinical challenge and thus make the imaging examination crucial. Imaging exams have been a main clinical diagnostic criteria for the 2019 novel coronavirus disease (COVID-19) in China. Imaging features of multiple patchy areas of ground glass opacity and consolidation predominately in the periphery of the lungs are characteristic manifestations on chest CT and extremely helpful in the early detection and diagnosis of this disease, which aids prompt diagnosis and the eventual control of this emerging global health emergency.Key Points • In December 2019, China, an outbreak of pneumonia caused by a novel, highly contagious coronavirus raised grave concerns and posed a huge threat to global public health. • Among the infected patients, characteristic findings on CT imaging include multiple, patchy, ground-glass opacity, crazy-paving pattern, and consolidation shadows, mainly distributed in the peripheral and subpleural areas of both lungs, which are very helpful for the frontline clinicians. • Imaging examination has become the indispensable means not only in the early detection and diagnosis but also in monitoring the clinical course, evaluating the disease severity, and may be presented as an important warning signal preceding the negative RT-PCR test results. Electronic supplementary materialThe online version of this article (10.1007/s00330-020-06827-4) contains supplementary material, which is available to authorized users.

Coronavirus-HKU1 Pneumonia and Differential Diagnosis with COVID-19.

HomeRadiology: Cardiothoracic ImagingVol. 2, No. 2 PreviousNext Case SeriesFree AccessPulmonary ImagingCoronavirus-HKU1 Pneumonia and Differential Diagnosis with COVID-19Elisa Pianura, Federica Di Stefano , Massimo Cristofaro, Ada Petrone, Nicoletta Fusco, Fabrizio Albarello, Daniele Lapa, Stefania Cicalini, Paolo Campioni, Vincenzo SchininàElisa Pianura, Federica Di Stefano , Massimo Cristofaro, Ada Petrone, Nicoletta Fusco, Fabrizio Albarello, Daniele Lapa, Stefania Cicalini, Paolo Campioni, Vincenzo SchininàAuthor AffiliationsFrom the IRCCS National Institute for Infectious Diseases (INMI) Lazzaro Spallanzani, Via Portuense 292, Rome 00149, Italy.Address correspondence to F.D.S. (e-mail: [email protected]).Elisa PianuraFederica Di Stefano Massimo CristofaroAda PetroneNicoletta FuscoFabrizio AlbarelloDaniele LapaStefania CicaliniPaolo CampioniVincenzo SchininàPublished Online:Apr 23 2020https://doi.org/10.1148/ryct.2020200162MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack Citations ShareShare onFacebookTwitterLinked In A 74-year-old woman, residing in Rome, was admitted on March 4, 2020, with fever and dry cough for 5 days. She had an epidemiologic link with her sister, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laboratorial studies revealed elevated C-reactive protein and normal white cell count with neutrophilia. Chest CT studies obtained at admission showed multiple ground-glass opacities in both upper and left lower lobes, with small pleural effusions (Fig 1a). The patient was negative for SARS-CoV-2 on three polymerase chain reaction (PCR) nasopharyngeal swab tests. Serological tests for SARS-CoV-2 were also negative. A subsequent analysis for other respiratory viruses was positive for human coronavirus HKU1 (HKU1-CoV), and follow-up CT performed after 2 weeks of therapy showed almost complete radiologic resolution (Fig 1b).Figure 1a: Images in 74-year-old woman with HKU1 coronavirus pneumonia. (a) CT scan performed at admission shows a large area of peripheral ground-glass opacity (arrow) in the lower left lobe and small pleural effusions (star). (b) The CT scan performed after 14 days shows almost complete resolution of the imaging findings.Figure 1a:Download as PowerPointOpen in Image Viewer Figure 1b: Images in 74-year-old woman with HKU1 coronavirus pneumonia. (a) CT scan performed at admission shows a large area of peripheral ground-glass opacity (arrow) in the lower left lobe and small pleural effusions (star). (b) The CT scan performed after 14 days shows almost complete resolution of the imaging findings.Figure 1b:Download as PowerPointOpen in Image Viewer Although chest CT has been used for diagnosing coronavirus disease 2019 (COVID-19) (Fig 2), it relies on relatively nonspecific signs, such as multifocal and peripheral ground-glass opacities, consolidations, and crazy paving, which can be also found in other viral pneumonias (1–3). We illustrate a case of HKU1-CoV pneumonia, a novel group 2 coronavirus discovered in January 2004, which has been also associated with community-acquired pneumonia (4). Given the pandemic setting of COVID-19, the current case underscores the confirmatory role of PCR and the need for considering alternative diagnoses, especially when the full clinical, laboratorial, and radiologic picture does not fit into the most common presentation. Noticeably, neutrophilia and pleural effusions have been infrequently seen at the initial presentation of COVID-19 (5).Figure 2a: Images in patient with coronavirus disease 2019 (COVID-19) pneumonia. (a, b) Typical CT aspect of COVID-19 pneumonia: initial phase of disease with areas of ground-glass opacity peripherally (arrow in a); severe phase of disease with diffuse crazy paving pattern (arrow in b). Pleural effusions are absent.Figure 2a:Download as PowerPointOpen in Image Viewer Figure 2b: Images in patient with coronavirus disease 2019 (COVID-19) pneumonia. (a, b) Typical CT aspect of COVID-19 pneumonia: initial phase of disease with areas of ground-glass opacity peripherally (arrow in a); severe phase of disease with diffuse crazy paving pattern (arrow in b). Pleural effusions are absent.Figure 2b:Download as PowerPointOpen in Image Viewer Disclosures of Conflicts of Interest: E.P. disclosed no relevant relationships. F.D.S. disclosed no relevant relationships. M.C. disclosed no relevant relationships. A.P. disclosed no relevant relationships. N.F. disclosed no relevant relationships. F.A. disclosed no relevant relationships. D.L. disclosed no relevant relationships. S.C. disclosed no relevant relationships. P.C. disclosed no relevant relationships. V.S. disclosed no relevant relationships.AcknowledgmentsCOVID 19 INMI Study Group.Author ContributionsAuthor contributions: Guarantors of integrity of entire study, E.P., F.D.S., M.C., A.P., N.F., F.A., P.C., V.S.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, E.P., F.D.S., M.C., A.P., N.F., F.A., D.L., P.C., V.S.; clinical studies, E.P., F.D.S., M.C., A.P., F.A., D.L., S.C., P.C., V.S.; experimental studies, E.P., F.D.S., M.C., A.P., F.A., D.L., P.C.; statistical analysis, E.P., F.D.S., M.C., A.P., F.A., P.C.; and manuscript editing, E.P., F.D.S., M.C., A.P., N.F., F.A., S.C., P.C., V.S.Keywords: Adults and Pediatrics, CT, Lung, Thorax Authors declared no funding for this work.

WITHDRAWN: Covid-19: Round and oval areas of ground-glass opacity

The Publisher regrets that this article is an accidental duplication of an article that has already been published, DOI of original article: https://doi.org/10.1016/j.pulmoe.2020.04.011The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

High-resolution computed tomography enhances the diagnosis and follow-up of influenza A (H1N1) virus-associated pneumonia.

We present the findings on high-resolution computed tomography (HRCT) of influenza A (H1N1) virus-associated pneumonia of 140 patients with acute and post-acute pneumonia, totaling 189 exams in a retrospective observational study evaluating the importance of HRCT as a diagnostic imaging method in the acute phase and in the follow-up of pneumonia. We performed a retrospective observational study evaluating the HRCT findings of 140 adult patients with confirmed diagnosis of influenza A (H1N1) pneumonia and without other associated infectious processes. Chest X-ray exams were also performed in these patients. The main HRCT findings of lung involvement were airspace consolidation (57 cases), ground-glass opacities (40 cases) and an association of both aspects (43 cases), with a predominantly bilateral and peripheral distribution. HRCT is able to distinguish small lesions, such as small areas of consolidation or ground glass opacities, with little increase in lung attenuation, when chest X-rays was normal, allowing a prompt diagnosis and treatment after imaging.

Longitudinal Assessment of COVID-19 Using a Deep Learning-based Quantitative CT Pipeline: Illustration of Two Cases.

HomeRadiology: Cardiothoracic ImagingVol. 2, No. 2 PreviousNext Images in Cardiothoracic ImagingFree AccessPulmonary ImagingLongitudinal Assessment of COVID-19 Using a Deep Learning–based Quantitative CT Pipeline: Illustration of Two CasesYukun Cao, Zhanwei Xu, Jianjiang Feng, Cheng Jin, Xiaoyu Han, Hanping Wu, Heshui Shi Yukun Cao, Zhanwei Xu, Jianjiang Feng, Cheng Jin, Xiaoyu Han, Hanping Wu, Heshui Shi Author AffiliationsFrom the Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China (Y.C., X.H., H.S.); Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Y.C., X.H., H.S.); Department of Automation, Tsinghua University, Beijing, China (Z.X., J.F., C.J.); and Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Mich (H.W.).Address correspondence to H.S. (e-mail: [email protected]).Yukun CaoZhanwei XuJianjiang FengCheng JinXiaoyu HanHanping WuHeshui Shi Published Online:Mar 23 2020https://doi.org/10.1148/ryct.2020200082MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Coronavirus disease 2019, COVID-19, has recently gained global proportions (1–3). This short report illustrates the use of voxel-level deep learning–based CT segmentation of pulmonary opacities (4) for improving quantification of the disease. A separate set of CT images from 10 cases of COVID-19 confirmed by real-time reverse transcriptase polymerase chain reaction test results was selected for training purposes. Expert manual segmentation of the lungs and pulmonary opacities was used as reference. A convolutional neural network based on U-Net architecture (5) was developed to predict the expert segmentation. We used this pipeline to analyze the contrasting evolution of two confirmed cases of COVID-19 from Wuhan, China, that were receiving similar supportive therapy. Figure 1 shows the favorable evolution of a 48-year-old woman imaged at four time points across an interval of 16 days, while Figure 2 shows the case of a 44-year-old man with disease progression over 12 days, especially between the second and third studies. These examples illustrate the potential of deep learning–based quantitative CT for providing objective assessment of pulmonary involvement and therapy response in COVID-19, but further studies are still necessary to determine the performance of such an approach in this scenario.Figure 1: Evolution of COVID-19 in a 48-year-old woman across 16 days of treatment. A, Axial unenhanced chest CT images at four time points (dates annotated in each panel) show peripheral ground-glass opacities and consolidation. B, Color overlay of voxel-level segmentation at the same level and time points as in A show pulmonary opacities displayed in yellow and normal lung in blue. C, Coronal reconstructions at the same time points as in A show progressive improvement of the lung opacities. D, Three-dimensional volume-rendered reconstructions at the same time points as in A show pulmonary opacities displayed in yellow, normal lung and vessels in light gray, and tracheobronchial tree in green. The volumetric assessment of the pulmonary opacities derived from the deep learning–based quantitative CT analysis is annotated at different time points on the volume-rendered images. LOV = lung opacification volume.Figure 1:Download as PowerPointOpen in Image Viewer Figure 2: Evolution of COVID-19 in a 44-year-old man across 12 days of treatment. A, Axial unenhanced chest CT images at four time points (dates annotated in each panel) show a small nodular opacity in the right upper lobe on the initial CT, progressing to a larger area of ground-glass opacity and consolidation, especially at time points 2 and 3. B, Color overlay of voxel-level segmentation at the same level and time points as in A show pulmonary opacities displayed in yellow and normal lung in blue. C, Coronal reconstructions at the same time points as in A show progression of the lung opacities, especially across first and third time points. D, Three-dimensional volume-rendered reconstructions at the same time points as in A show pulmonary opacities displayed in yellow, normal lung and vessels in light gray, and tracheobronchial tree in green. The volumetric assessment of the pulmonary opacities derived from the deep learning–based quantitative CT analysis is annotated at different time points on the volume-rendered images. LOV = lung opacification volume.Figure 2:Download as PowerPointOpen in Image Viewer Disclosures of Conflicts of Interest: Y.C. disclosed no relevant relationships. Z.X. disclosed no relevant relationships. J.F. disclosed no relevant relationships. C.J. disclosed no relevant relationships. X.H. disclosed no relevant relationships. H.W. disclosed no relevant relationships. H.S. disclosed no relevant relationships.Keywords: Adults, CT, Infection, Lung, Thorax Authors declared no funding for this work.