Baseline Computed Tomography Scan Research Articles

Can the presence of aortic or coronary artery calcifications in the standard of care baseline CT or PET-CT scan of patients with Hodgkin or non-Hodgkin lymphoma be used as a predictor of MACE?

Abstract Background Major adverse cardiovascular events (MACE), commonly defined as acute myocardial infarction, acute coronary syndrome/ischemic heart disease requiring revascularization, stroke, and heart failure, represent a significant cause of mortality among patients with cancer. With increased rates of both cancer and cancer survivorship, the identification of new predictive markers for the development of MACE in this population is crucial for implementing effective preventive and risk-mitigation strategies. Purpose To determine whether the presence of calcifications in the coronary arteries (CAC) or aorta (CA) of lymphoma patients, as reported in standard-of-care PET-CT (Positron Emission Tomography-Computed Tomography) or chest CT (Computed Tomography) scan, can predict the occurrence of MACE. Methods A Retrospective analysis was conducted on a cohort of patients diagnosed with Hodgkin or non-Hodgkin lymphoma and treated with anthracycline-based chemotherapy. Patients were diagnosed from January 1, 2013, and followed through to June 30, 2023. The reference point for the study was the radiologist’s report of the PET-CT or chest CT conducted before the initiation of anthracycline therapy. Patients who did not undergo a PET-CT or CT before the start of treatment, and/or developed MACE before treatment initiation were excluded. Univariate and multivariate adjusted Cox regression models were employed to assess whether the presence of CA and CAC was associated with the development of MACE. Associations with outcomes were evaluated using the Kaplan-Meier method and Cox regression. Results 326 patients were included with a mean age of 55 years (range: 52-60), predominantly male 201 (61%) and white 314 (96%), CAC was reported in 75 patients (23%) and CA in 18 (6%). In the univariate regression model, a statistically significant association was found between the presence of both CA and CAC with the risk of MACE. CAC showed a stronger association with the development of MACE than CA (HR: 3.7 [1-7.9], p=0.0005 vs HR: 2.9 [1- 8.5], p=0.050). In multivariable analysis CAC emerged as the strongest predictor of MACE (HR: 2.9 [1.3 – 6.4], p=0.01), after accounting for hypertension, diabetes, dyslipidemia, and GFR <60 (Table 1), while the association with CA attenuated (HR: 2.01 [0.7-6.5], p=0.2010) and was no longer significant (Table 2). Conclusion CAC in the standard-of-care PET/-CT scans was a predictor of MACE in lymphoma patients treated with anthracyclines, while the association with CA weakened in multivariable analyses and was likely underpowered given the small number of patients with CA. If replicated, this finding warrants closer surveillance of this group of patients and can be considered as a non-invasive cardiovascular risk marker.

Early temporal changes on CT chest in patients with COVID-19 pneumonia

Introduction: Computed tomography (CT) scan of the chest helps in the evaluation, prognostication, and follow-up of patients with Corona virus disease-19 (COVID-19) pneumonia.Objectives: To study the early temporal evolution of findings on CT chest in patients with COVID-19 pneumonia at 6 weeks follow up.Material and methods: A retrospective analysis was performed on 40 patients with confirmed COVID-19 pneumonia who underwent baseline chest CT scans followed by a repeat scan at six weeks. Patients were quantitatively assessed using an objective CT severity score and qualitatively assessed using imaging parameters like consolidation, ground glass opacities (GGOs), parenchymal bands, septal thickening, nodules and crazy paving pattern.Results: Mean age of our study population was 58.5 ± 10.2 years with 80% being males. The baseline CT scan revealed a total median CT severity score interquartile range (IQR) of 16/25 (range: 14-20) while the follow-up scan after six weeks revealed a median score (IQR) of 14/25 (range: 8-19). This difference was statistically significant (p=0.04). The difference in CT severity scores of bilateral upper lobes was statistically significant (p=0.04 on right side and p=0.009 on left side); however, the difference in scores of bilateral lower lobes was not statistically significant (p>0.05). The common imaging patterns on baseline imaging were GGO (97.5%), con-solidation (85%), septal thickening (85%), parenchymal bands (60%) and nodules (32.5%), which showed an interval resolution in the follow-up CT scan.Conclusion: Most of the patients with COVID-19 pneumonia showed interval resolution of lung findings seen on short-term follow-up CT scan.

Detection of Traumatic Ankle Arthrotomies: Computed Tomography Scan Versus Saline Load Test.

Periarticular wounds present a common diagnostic dilemma for emergency providers and orthopedic surgeons because traumatic arthrotomies (TA) often necessitate different management from superficial soft tissue wounds. Historically, TA have been diagnosed with the saline load test (SLT). Computed tomography (CT) scan has been studied as an alternative to SLT in diagnosing TA in several joints, but there are limited data specifically pertaining to the ankle. This study aimed to compare the ability of a CT scan to identify an ankle TA versus a traditional SLT. The hypothesis was that there would be no significant difference between a CT scan and SLT in diagnosing ankle TA in a cadaveric model. This cadaveric study used 10 thawed fresh-frozen cadaveric ankles. A baseline CT scan was performed to ensure no intra-articular air existed before simulated TA. After the baseline CT, a 1 cm TA was created in the anterolateral arthroscopy portal site location. The ankles then underwent a postarthrotomy CT scan to evaluate for the presence of intra-articular air. After the CT scan, a 30 mL SLT was performed using the anteromedial portal site location. After arthrotomy, intra-articular air was visualized in 7 of 10 cadavers in the postarthrotomy CT scan. All the ankles had fluid extravasation during the SLT with <10 mL of saline. The sensitivity of the SLT for TA was 100% versus 70% for the CT scan. The SLT was more sensitive in diagnosing 1-cm ankle TA than a CT scan in a cadaveric model.

Regression of Necrotic Lesions after Methotrexate Withdrawal in Patients with Methotrexate-Associated Lymphoproliferative Disorders: A Retrospective CT Study.

This retrospective study investigated whether necrotic lesions detected on a computed tomography (CT) scan are more regressive than non-necrotic lesions after methotrexate withdrawal in patients pathologically diagnosed with methotrexate-associated lymphoproliferative disorders (MTX-LPD). In total, 89 lesions extracted from 24 patients on CT scans were included in the analysis. All patients had been evaluated for the presence of necrosis within lesions via CT scan upon first suspicion of MTX-LPD (baseline CT scan). The percentage lesion size reduction between the baseline and initial follow-up CT scan was calculated. The association between necrosis within lesions and size changes was estimated via linear regression analyses using both crude and adjusted models. Necrosis was significantly more common in extranodal lesions (27 out of 30 lesions, 90%) than in nodal lesions (9 out of 59 lesions, 15%, p<0.001). In the crude model, the regression of necrotic lesions was 58.5% greater than that of non-necrotic lesions; the difference was statistically significant (p<0.001). Additionally, the longest diameter of necrotic lesions at the baseline CT scan was significantly greater than that of non-necrotic lesions (p<0.001). Based on the adjusted model, necrotic lesions showed 49.3% greater regression than non-necrotic lesions (p=0.017). Necrosis detected on a CT scan was found to be an independent predictor of regression after MTX withdrawal in patients with MTX-LPD.

Early Natural Menopause Is Associated With Poor Lung Health and Increased Mortality Among Female Smokers

ABSTRACT Menopause results from the decline of estrogen levels and is driven by ovarian aging. Some tissues, including the lung, may contribute to local estrogen synthesis in the postmenopausal state. Cigarette smoking is the most established factor for early menopause, and previous studies have shown that the menopause transition accelerated age-related decline of lung function following a restrictive disease pattern. In addition, studies have supported a potential synergistic effect of cigarette smoking and menopause on lung function. Delineating the effect of menopause timing and estrogen exposure on subsequent disease development may have important benefits for health maintenance and disease prevention in older women. This study aimed to assess the associations between early menopause and lung biomarkers, lung cancer risk, and cause-specific mortality. Data were obtained from the Pittsburg Lung Screening Study, a community-based research cohort of current and former smokers screened with low-dose computed tomography (CT) at baseline and 1 year later. Menstrual and reproductive history and data on respiratory symptoms were collected through questionnaires. Radiographic emphysema score was calculated from the baseline CT scan. Early menopause was defined as age at menopause of &lt;45 years. The study cohort included female Pittsburg Lung Screening Study participants who reported natural (n = 1038) or surgical (n = 628) menopause at study entry. A total of 1064 participants (63.9%) were current smokers with an average pack-years of 46.1 ± 19.8 at baseline. Early menopause was associated with several pathologies including self-reported wheezing (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.18–2.30; P &lt; 0.01), chronic bronchitis (OR, 1.73; 95% CI, 1.19–2.53; P &lt; 0.01), cardiovascular diseases (OR, 1.87; 95% CI, 1.13–3.11; P = 0.02), radiographic emphysema (OR, 1.70; 95% CI, 1.25–2.31; P &lt; 0.001), and incident airway obstruction (OR, 2.02; 95% CI, 1.03–3.96; P = 0.04) in women with natural menopause, but not surgical menopause except for physician-diagnosed cardiovascular diseases (OR, 4.03; 95% CI, 1.78–9.14; P &lt; 0.001). Trend tests for each of these outcomes in women with natural menopause identified monotonically increasing risk associated with younger age at menopause. Early menopause was associated with lower measurements of the lung function measurements forced expiratory volume in 1 second (FEV1; −104.8 ± 36.7 mL/s; P &lt; 0.01), forced vital capacity (FVC; −78.6 ± 38.2 mL; P = 0.04), and FEV1-to-FVC ratio (−2.1% ± 0.8%; P = 0.01) at baseline in women with natural menopause but not surgical menopause. The use of hormone therapy at any point was associated with higher baseline FEV1 levels and higher FEV1-to-FVC ratio at baseline among women with natural menopause. Early natural menopause was associated with a 40% increased risk of all-cause death with respiratory diseases (hazard ratio [HR], 2.32; 95% CI, 1.52–3.52; P &lt; 0.001), and early menopause was associated with twice the risk of lung cancer-specific mortality (HR, 1.94; 95% CI, 1.05–3.58; P = 0.03). This association was exacerbated by continuous cigarette smoking, with HRs of 4.65 (95% CI, 2.55–8.49; P &lt; 0.001) and 4.61 (95% CI, 2.63–8.07; P &lt; 0.001) for lung cancer and cancer mortality, respectively, among continuous smokers with early menopause compared with women with noncontinuous smoking and nonearly menopause. The results of this study demonstrate that among a postmenopausal cohort of middle-aged and older smokers, natural early menopause is associated with worse lung health and accelerated lung aging.

Growth Regularity of Pulmonary Ground Glass Nodules Based on 3D Reconstruction Technology

Since the popularization of computed tomography (CT) technology, the detection rate of pulmonary ground glass nodules (GGNs) with imaging follow-up as the main management method has increased significantly. The purpose of this study is to quantitatively analyze the changes of pulmonary GGNs during the follow-up process with three-dimensional reconstruction technology, explore the natural progression of pulmonary GGNs, and provide effective basis for clinical guidance for patients to conduct reasonable management of nodules. A total of 115 cases of pulmonary GGNs with regular follow-up in the Combined Outpatient Department of Zhoushan Hospital from March 2015 to November 2022 were enrolled. Quantitative imaging features of nodules were extracted by semi-automatic segmentation of 3D Slicer software to evaluate the growth of nodules and clinical intervention during follow-up. The average baseline age of the patients was (56.9±10.1) yr. The mean follow-up time was (48.8±18.9) months. The two-dimensional diameter of baseline CT scan was (7.9±2.9) mm, and the maximum three-dimensional diameter was (10.1±3.4) mm. The two-dimensional diameter of the last CT scan was (9.9±4.7) mm, and the maximum three-dimensional diameter was (11.4±5.1) mm. A total of 27 cases (23.5%) showed an increase during follow-up, with a median volume doubling time of 822 days and a median mass doubling time of 1,007 days. 32 cases were surgically resected, including 6 cases of invasive adenocarcinoma (IAC), 16 cases of minimally invasive adenocarcinoma (MIA), 8 cases of adenocarcinoma in situ (AIS) and 2 cases of atypical adenomatous hyperplasia (AAH). Five nodules underwent surgical intervention due to the progression of two-dimensional diameter, which was pathologically confirmed as pre-invasive lesions, but their three-dimensional maximum diameter showed no significant change. Nodular morphology, lobulated sign, spiculated sign and vacuole signs all promoted the growth of nodules in univariate analysis. There were significant differences in age, baseline diameter, mean CT value, median CT value, 10% and 90% percentile CT number between the growth group and the stable group (P<0.05). Multivariate Logistic regression analysis showed that age and average CT value were risk factors for nodule growth (P<0.05). Receiver-operating characteristic (ROC) curve analysis results indicated that the age ≥63 years old, the baseline three-dimensional maximum diameter ≥9.2 mm, and the average CT value ≥-507.8 HU were more likely to accelerate the growth of GGNs. The maximum three-dimensional diameter ≥14.4 mm and the average CT value ≥-495.7 HU may be a higher malignant probability. GGNs show an inert growth process, and the use of three-dimensional measurements during follow-up is of greater significance. For persistent glass grinding nodules ≥63 years old, the baseline three-dimensional maximum diameter ≥9.2 mm, and the average CT value ≥-507.8 HU are more likely to increase. However, most nodules still have good prognosis after progression, and long-term follow-up is safe.

Bridging Thrombolysis and ASPECTS in Patients With Stroke Treated With Endovascular Thrombectomy

Background In patients with stroke with large‐vessel occlusion and extensive ischemic change denoted by low Alberta Stroke Programme Early Computed Tomography Score (ASPECTS), the role of bridging thrombolysis before endovascular thrombectomy (EVT) is still to be determined. We aimed to examine the impact of ischemic change on clinical outcomes and how this is modified by bridging thrombolysis in patients treated with EVT. Methods Consecutive patients undergoing anterior circulation EVT from a prospectively collected registry were included in this retrospective analysis. ASPECTS was evaluated from baseline noncontrast computed tomography scans with lower scores indicating larger areas of ischemic change. Outcome measures included symptomatic intracranial hemorrhage and functional independence (modified Rankin Scale score, 0–2) at day 90. Multivariable logistic regression models with interaction terms between ASPECTS and bridging thrombolysis were created. ASPECTS was treated as numeric variable in the primary analysis and trichotomized (ASPECTS ≤5, 6–8, 9–10) in a sensitivity analysis. Results A total of 872 patients undergoing EVT (384 women, mean±SD age of 67±15, baseline National Institute of Health Stroke Scale 16 [interquartile range, 11–20]) were included. A total of 549 (63%) patients were transferred from primary stroke centers for EVT and 436 (50%) received bridging intravenous thrombolysis with alteplase. On baseline computed tomography scan, median [interquartile range] ASPECTS was 8 [7–9], with 408 (47%) having minimal (ASPECTS 9–10), 376 (43%) moderate (ASPECTS 6–8), and 88 (10%) extensive (ASPECTS ≤5) ischemic change. With decreasing numeric ASPECTS, the probability of functional independence reduced (ASPECTS main effect adjusted odds ratio, 1.36 [95% CI, 1.23–1.52]; P &lt;0.001), but this was attenuated in those with bridging thrombolysis (interaction P =0.046). This interaction was significant for patients transferred to the EVT center after thrombolysis (interaction P =0.03) but not for patients presenting directly to the EVT center (interaction P =0.46). The interaction between ASPECTS and bridging thrombolysis was not significant when ASPECTS was split into the 3 categories ( P =0.35). Conclusion In a cohort of patients undergoing EVT where most were transferred from a primary stroke center, ischemic change was associated with decreased probability functional independence, but this effect was attenuated with bridging thrombolysis. These results suggest that patients with large areas of ischemic change may still benefit from the earliest possible reperfusion afforded by bridging thrombolysis.

Computed Tomography Scan vs Saline Load Test in the Detection of Traumatic Arthrotomies of the Ankle: A Cadaveric Study

Category: Trauma Introduction/Purpose: The diagnosis of traumatic arthrotomy is typically made through a saline load test (SLT), though there has been a growing base of literature regarding the use of computed tomography (CT) scan in various joints for diagnosis. To date, there has been little data supporting the use of CT to diagnose traumatic arthrotomy of the ankle. Through simulated arthrotomies of the ankle in cadavers, we aim to assess the sensitivity and ability of CT for diagnosing traumatic arthrotomy. SLT were also performed in each specimen to determine the volume of saline needed for diagnosis. Methods: Six fresh-frozen cadavers with twelve ankles were initially included in this study. The presence of intra-articular air prior to arthrotomy was excluded with a baseline CT scan. Ankles underwent arthrotomy at the anterolateral, anteromedial, posteromedial, posterolateral portals with fluoroscopic guidance. A subsequent CT scan was obtained to identify the presence of intra-articular air. Ankles then underwent SLT and volumes resulting in extravasation were recorded. Results: Eleven ankles were included, with one exclusion due to the presence of implants. Arthrotomies were made in three ankles at the anterolateral portal, three at the anteromedial portal, two at the posteromedial portal, and three at the posterolateral portal. Following arthrotomy, intra-articular air was detected in all eleven ankles by CT scan. All eleven ankles were subjected to SLT, with each demonstrating extravasation through the arthrotomy site. The mean volume of saline needed for extravasation was 7.7 mL, with a range of 3 to 22 mL and a standard deviation of 5.4. Conclusion: CT scan was demonstrated to be sensitive and effective in diagnosing traumatic arthrotomy in a cadaveric model.

Time Course and Clinical Significance of Hematoma Expansion in Moderate-to-Severe Traumatic Brain Injury: An Observational Cohort Study

BackgroundPreventing intracranial hematoma expansion has been advertised as a possible treatment opportunity in traumatic brain injury (TBI). However, the time course of hematoma expansion, and whether the expansion affects outcome, remains poorly understood. In light of this, the aim of this study was to use 3D volume rendering to determine how traumatic intracranial hematomas expand over time and evaluate its impact on outcome.MethodsSingle-center, population-based, observational cohort study of adults with moderate-to-severe TBI. Hematoma expansion was defined as the change in hematoma volume from the baseline computed tomography scan until the lesion had stopped progressing. Volumes were calculated by using semiautomated volumetric segmentation. Functional outcome was measured by using the 12 month Glasgow outcome scale (GOS).ResultsIn total, 643 patients were included. The mean baseline hematoma volume was 4.2 ml, and the subsequent mean hematoma expansion was 3.8 ml. Overall, 33% of hematomas had stopped progressing within 3 h, and 94% of hematomas had stopped progressing within 24 h of injury. Contusions expanded significantly more, and for a longer period of time, than extra-axial hematomas. There was a significant dose–response relationship between hematoma expansion and 12 month GOS, even after adjusting for known outcome predictors, with every 1-ml increase in hematoma volume associated with a 6% increased risk of 1-point GOS deduction.ConclusionsHematoma expansion is a driver of unfavorable outcome in TBI, with small changes in hematoma volume also impacting functional outcome. This study also proposes a wider window of opportunity to prevent lesion progression than what has previously been suggested.

105P A model of workflow for radiomics signature of stage III non-small cell lung cancer (NSCLC) patients (pts)

Radiomics is a quantitative approach to medical imaging consisting in the extraction of a large number of features (fts) from diagnostic images that can be associated with tumour pathophysiology and converted into mineable high-dimensional data. We define a model of workflow for extraction and selection of radiomics fts from the baseline computed tomography scan images of stage III NSCLC pts, thus creating a radiomics profile to guide the clinical decision-making process. We retrospectively collected data of stage III NSCLC pts referred to Veneto Institute of Oncology from 2012 to 2021. The radiomics pipeline includes (1) the definition of inclusion/exclusion criteria based on image quality and clinico-pathological data, (2) data selection for training and validation cohorts, (3) image segmentation and annotation of target lesions, (4) fts extraction, (5) fts reduction and selection, (6) radiomics signature building. Image segmentation and fts extraction were performed with a commercial software (HealthMyne® Platform), radiomics analysis using the open-source package RadAR (Radiomics Analysis with R) for the statistical language R. On a training cohort of 60 stage III NSCLC pts, we performed the volume segmentation of a maximum of 4 target lesions for each patient. 517 fts were extracted and categorized into morphology-, intensity-, texture- and filter-based fts. A first stage univariate analysis of the primitive lung target lesion was performed. The features selection was made combining different approaches: a principal component analysis to reduce fts redundancy, an outlier analysis to exclude fts whose distribution showed far outliers, and a further selection on the basis of concordance with clinical data performed with the criterion of minimum redundancy maximum relevance. The correlation of the 10 fts resulting from this pipeline with each relevant clinical data can then be quantitatively evaluated through Spearman's non-parametric coefficient. A radiomic workflow for Stage III NSCL data has been studied. A validation cohort study is warranted in order to combine tumor phenotype characteristics through artificial intelligence applications into predictive and prognostic models.

Clinical and Kidney Structural Characteristics of Living Kidney Donors With Nephrolithiasis and Their Long-term Outcomes.

Background.Nephrolithiasis in living kidney donors is concerning due to the potential impact on long-term postdonation kidney function.Methods.We performed a cohort study of living kidney donors from 2 centers with a baseline computed tomography scan and implantation renal biopsy. Donors (>5 y since donation) completed a follow-up survey or underwent chart review to assess eGFR and incident hypertension. Stone formers were classified as symptomatic if they had a past symptomatic episode or asymptomatic if only incidental radiographic kidney stones were identified during donor evaluation. We compared baseline clinical, imaging, and biopsy characteristics by stone former status including review of metabolic evaluations in stone formers. Long-term risks of renal complications (low eGFR and hypertension) by stone former status were evaluated.Results.There were 12 symptomatic and 76 asymptomatic stone formers among 866 donors. Overall, baseline clinical characteristics and implantation biopsy findings were similar between stone formers and non-stone formers. After a median follow-up of 10 y, stone former status was not associated with eGFR <60 mL/min/1.73 m2, eGFR <45 mL/min/1.73 m2, or hypertension.Conclusions.Both asymptomatic and symptomatic SF have favorable histology findings at baseline. Long-term kidney outcomes were favorable in select stone formers with no evident increased long-term risk for decreased kidney function or hypertension after donation.

CT Scan versus Saline Load Test for Detection of Traumatic Wrist Arthrotomy

Background Traumatic arthrotomy of the wrist is most commonly detected using the saline load test (SLT); however, little data exists on the effectiveness of the SLT to this specific joint. The use of computed tomography (CT) scan has been validated as an alternative method to detect traumatic arthrotomy of the knee, as the presence of intra-articular air can be seen when there is violation of the joint capsule. Question/Purpose The purpose of this study was to determine the ability of CT scan to identify arthrotomy of the wrist capsule and compare the diagnostic performance of CT versus traditional SLT. Materials and Methods Ten fresh frozen cadavers which had undergone transhumeral amputation were initially used in this study. A baseline CT scan was performed to ensure no intra-articular air existed prior to intervention. After baseline CT, an arthrotomy was created at the 6R radiocarpal portal site. The wrists then underwent a postarthrotomy CT to identify the presence or absence of intra-articular air. Following CT, the wrists were subjected to the SLT to detect the presence of extravasation from the arthrotomy. Results Nine cadavers were included following baseline CT scan. Following arthrotomy, intra-articular air was visualized in eight of the nine cadavers in the postarthrotomy CT scan. Air was seen in the radiocarpal joint in eight of the nine wrists; midcarpal joint in seven of the nine wrists; and distal radioulnar joint in six of the nine wrists. All wrists (nine of the nine) demonstrated extravasation during the SLT. The mean volume of extravasation occurred at 3.7 mL (standard deviation = 2.6 mL), with a range of 1 to 7 mL. Conclusion CT scan correctly identified eight of the nine simulated traumatic arthrotomies. Injection of 7 mL during the SLT was necessary to identify 100% of the arthrotomies. Clinical Relevance CT scan is a sensitive modality for detection of traumatic arthrotomy of the wrist in a cadaveric model.

Prognostic role of sarcopenia in metastatic colorectal cancer patients during first-line chemotherapy: A retrospective study.

BACKGROUNDSarcopenia is a condition characterized by decreased skeletal muscle mass due to physiological ageing or to a concomitant disease such as neoplasia. In cancer patients, a low lean body mass is suggested to be a negative prognostic factor for survival and for the development of dose-limiting chemotherapy toxicities irrespective of disease stage. AIMTo evaluate the prognostic role of sarcopenia in patients with metastatic colorectal cancer (mCRC) undergoing first-line chemotherapy.METHODSOur retrospective analysis included 56 mCRC patients who received first-line chemotherapy from 2014 to 2017 at the Medical Oncology Unit of our hospital. Computerized scans were performed before starting chemotherapy and at the first disease reassessment. Sarcopenia was assessed using the skeletal mass index = muscle area in cm2/(height in m2) calculated at the L3 vertebra. Overall survival and objective response rate were evaluated. Toxicities were analyzed during the first four cycles of therapy and graded according to Common Terminology Criteria for Adverse Events version 4.0. A loss of skeletal muscle mass ≥ 5% was considered indicative of deterioration in muscle condition.RESULTSMedian age was 67 years and 35.7% of patients were ≥ 70 years old. Fourteen patients (25%) were sarcopenic at baseline computed tomography (CT) scan (7/33 men; 7/23 women); 5/14 sarcopenic patients were ≥ 70 years old. Median follow-up was 26.8 mo (3.8-66.8 mo) and median overall survival was 27.2 mo (95%CI: 23.3-37.3). Sarcopenia was not correlated to overall survival (P = 0.362), to higher toxicities reported during the first 4 cycles of chemotherapy (P = 1.0) or to response to treatment (P = 0.221). At the first disease reassessment, a skeletal muscle loss (SML) ≥ 5% was found in 17 patients (30.3%) 3 of whom were already sarcopenic at baseline CT scan, while 7 patients became sarcopenic. SML was not correlated to overall survival (P = 0.961). No statistically significant correlation was found between baseline sarcopenia and age (P = 1.0), body mass index (P = 0.728), stage at diagnosis (P = 0.355) or neutrophil/lymphocyte ratio (P = 0.751).CONCLUSIONNeither baseline sarcopenia nor SML affected survival. In addition, baseline sarcopenia was not related to worse treatment toxicity. However, these results must be interpreted with caution due to the limited sample size.

Relationship Between Non-contrast Computed Tomography Imaging Markers and Perihemorrhagic Edema Growth in Intracerebral Hemorrhage.

Perihemorrhagic edema (PHE) growth has been gradually considered as predictor for outcome of Intracerebral hemorrhage (ICH) patients. The aim of our study was to investigate correlation between non-contrast computed tomography (CT) markers and early PHE growth. ICH patients between July 2011 and March 2017 were included in this retrospective analysis. ICH and PHE volumes were measured by using a validated semiautomatic volumetric algorithm. Nonparametric test was used for comparing PHE volume at different time points of non-contrast computed tomography (NCCT) imaging markers. Multivariable linear regression was constructed to study the relationship between NCCT imaging markers and PHE growth over 36h. A total of 214 patients were included. Nonparametric test showed that PHE volume was significantly different between patients with and without NCCT imaging markers. (all p < 0.05) In multivariable linear regression analysis adjusted for ICH characteristics, blend sign (p = 0.011), black hole sign (p = 0.002), island sign (p < 0.001), and expansion-prone hematoma (p < 0.001) were correlated with PHE growth. Follow-up PHE volume within 36h after baseline CT scan was associated with blend sign (p = 0.001), island sign (p < 0.001), and expansion-prone hematoma (p < 0.001). NCCT imaging markers of hematoma expansion are associated with PHE growth. This suggests that early PHE growth can be predicted using radiology markers on admission CT scan.

Ground glass opacity featured lung adenocarcinoma in teenagers.

IntroductionGround glass opacity (GGO) nodules were found incidentally by computed tomography (CT) scan in some teenagers, which turned out to be lung cancer. The purpose of this study is to summarize the characteristics of teenage patients with GGO featured lung adenocarcinoma.MethodsPatients aging from 13 to 20 who were incidentally diagnosed with lung cancer were reviewed between February 2015 to December 2020. The clinical, radiological and pathological characteristics were analyzed.ResultsTotally 12 patients were included. All of them were diagnosed as GGO featured lung cancer through CT scan, with no presenting symptom. The median surveillance before surgery was 5.5 months, and none of these GGO lesions enlarged or altered in the property during the surveillance. The mean tumor diameter was 0.93 ± 0.25 cm. Ten patients underwent wedge resection by video-assisted thoracoscopic surgery (VATS), 9 of which were minimally invasive adenocarcinoma (MIA) and 1 of which were invasive adenocarcinoma (IAC) in the pathological analysis. One patient underwent VATS left-upper sublobectomy, pathologically diagnosed as MIA and 1 patient underwent VATS left-upper lobectomy with systematic mediastinal lymphadenectomy, pathologically diagnosed as IAC. The median postoperative hospital stay was 3 days. All patients survived without recurrence during a median follow-up of 12.5 months.ConclusionsGGO nodules could be a sign of early-stage teenage lung adenocarcinoma. We proposed a screening strategy with long intervals based on a baseline CT scan for the teenage population, and a treatment strategy for diagnosed teenage patients.

Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

ObjectiveTo determine the incidence, predictors, and outcome of pneumothorax (PNX)/pneumomediastinum (PMD) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS).DesignObservational study.SettingTertiary-care university hospital.ParticipantsOne hundred sixteen consecutive critically ill, invasively ventilated patients with COVID-19 ARDS.InterventionsThe authors collected demographic, mechanical ventilation, imaging, laboratory, and outcome data. Primary outcome was the incidence of PNX/PMD. Multiple logistic regression analyses were performed to identify predictors of PNX/PMD.Measurements and Main ResultsPNX/PMD occurred in a total of 28 patients (24.1%), with 22 patients developing PNX (19.0%) and 13 developing PMD (11.2%). Mean time to development of PNX/PMD was 14 ± 11 days from intubation. The authors found no significant difference in mechanical ventilation parameters between patients who developed PNX/PMD and those who did not. Mechanical ventilation parameters were within recommended limits for protective ventilation in both groups. Ninety-five percent of patients with PNX/PMD had the Macklin effect (linear collections of air contiguous to the bronchovascular sheaths) on a baseline computed tomography scan, and tended to have a higher lung involvement at intensive care unit (ICU) admission (Radiographic Assessment of Lung Edema score 32.2 ± 13.4 v 18.7 ± 9.8 in patients without PNX/PMD, p = 0.08). Time from symptom onset to intubation and time from total bilirubin on day two after ICU admission were the only independent predictors of PNX/PMD. Mortality was 60.7% in patients who developed PNX/PMD versus 38.6% in those who did not (p = 0.04).ConclusionPNX/PMD occurs frequently in COVID-19 patients with ARDS requiring mechanical ventilation, and is associated with increased mortality. Development of PNX/PMD seems to occur despite use of protective mechanical ventilation and has a radiologic predictor sign.

Comparison of Fast-Progression, Hyperprogressive Disease, and Early Deaths in Advanced Non-Small-Cell Lung Cancer Treated With PD-1/PD-L1 Inhibitors or Chemotherapy.

Hyperprogressive disease (HPD), fast progression (FP), and early death (ED) have been described in 13.8%, 4.7%, and 5.6% and in 5.1%, 2.8%, and 6.8%, respectively, of patients with non-small-cell lung cancer (NSCLC) treated with single-agent programmed cell death ligand 1 inhibitors (ICI) or chemotherapy, respectively. Whether FP/ED and HPD represent overlapping patterns is unknown. FP, ED, and HPD were retrospectively assessed in patients with NSCLC treated with single-agent ICI or chemotherapy. Eligibility required 2 computed tomography (CT) scans before and 1 CT scan during treatment. (1) HPD, (2) FP, (3) ED were defined as (1) RECIST version 1.1 progression at first CT scan and tumor growth rate variation per month > 50%, (2) ≥ 50% increase in the sum of the longest diameters of target lesions within 6 weeks from baseline, and (3) death as a result of radiologic progression within 12 weeks from baseline CT scan, respectively. Of 406 ICI-treated NSCLC, 56 patients (13.8%), 9 patients (2.2%), and 36 patients (8.8%) were HPD, FP, and ED, respectively. Eight (14.2%) and 20 (35.7%) of 56 patients with HPD were also FP and ED. ED significantly correlated with baseline Eastern Cooperative Oncology Group performance status ≥ 2 compared with HPD (33% v 13%, P = .02). Overall survival was significantly longer for HPD (3.4 months [95% CI, 2.7 to 4.0 months]) compared with FP (0.7 months [95% CI, 0.6 to 0.8 months]); HR, 0.18 [95% CI, 0.08 to 0.42]; P < .0001) and ED (1.4 months [95% CI, 1.3 to 1.6 months]); HR, 0.19 [95% CI, 0.11 to 0.34]); P < .0001), whereas it did not differ between FP and ED (HR, 1.3 [95% CI, 0.56 to 3.0]; P = .55). Of 59 patients with NSCLC treated with single-agent chemotherapy, the HPD, FP, and ED rates were 5.1%, 1.7%, and 6.7%, respectively. FP, ED, and HPD represent distinct progression patterns with limited overlap and different survival outcomes.

Predictive value of initial CT scan for various adverse outcomes in patients with COVID-19 pneumonia

BackgroundChest computed tomography (CT) scan is frequently used in the diagnosis of COVID-19 pneumonia. ObjectivesThis study investigates the predictive value of CT severity score (CSS) for length-of-stay (LOS) in hospital, initial disease severity, ICU admission, intubation, and mortality. MethodsIn this retrospective study, initial CT scans of consecutively admitted patients with COVID-19 pneumonia were reviewed in a tertiary hospital. The association of CSS with the severity of disease upon admission and the final adverse outcomes was assessed using Pearson's correlation test and logistic regression, respectively. ResultsTotal of 121 patients (60±16 years), including 54 women and 67 men, with positive RT-PCR tests were enrolled. We found a significant but weak correlation between CSS and qSOFA, as a measure of disease severity (r: 0.261, p = 0.003). No significant association was demonstrated between CSS and LOS. Patients with CSS>8 had at least three-fold higher risk of ICU admission, intubation, and mortality. ConclusionsCSS in baseline CT scan of patients with COVID-19 pneumonia can predict adverse outcomes and is weakly correlated with initial disease severity.

Aneurysm Growth After Endovascular Sealing of Abdominal Aortic Aneurysms (EVAS) with the Nellix Endoprosthesis

The aim of this study was to measure the incidence of post endovascular aneurysm sealing (EVAS) abdominal aortic aneurysm (AAA) growth, and its association with stent migration, in a cohort of patients with differing compliance to old and new Instructions For Use (IFU). A retrospective single centre study was conducted to review the computed tomography (CT) and clinical data of elective, infrarenal EVAS cases, performed as a primary intervention, between December 2013 and March 2018. All included patients had a baseline post-operative CT scan at one month and at least one year follow up. The primary outcome measure was the incidence of AAA growth and its association with stent migration. AAA growth was defined as a ≥5% increase in aortic volume between the lowermost renal artery and the aortic bifurcation post EVAS at any time during follow up, in comparison to the baseline CT scan. Migration was defined according to the ESVS guidelines, as > 10mm downward movement of either Nellix stent frame in the proximal zone. Seventy-six patients were eligible for inclusion in the study (mean age 76±7.4 years; 58 men). AAA growth was identified in 50 of 76 patients (66%); adherence to IFU did not affect its incidence (mean growth within IFU-2016 compliant cohort vs. non-compliant: 16% vs. 13%, p=.33). Over time, the incidence of AAA growth increased, from 32% at one year to 100% at four years. AAA growth by volume was progressive (p<.001), as its extent increased over time. Migration was detected in 16 patients and there was a statistically significant association with AAA growth (13 patients displayed migration and AAA growth, p=.036). Patients treated with EVAS are prone to AAA growth, irrespective of whether their aortic anatomy is IFU compliant. AAA growth by volume is associated with stent migration. Clinicians should continue close surveillance post EVAS, regardless of whether patients are treated within IFU.

Neoadjuvant chemotherapy in locally advanced colon cancer: a systematic review.

Preoperative or neoadjuvant chemotherapy (NAC) has emerged as a novel alternative to treat locally advanced colon cancer (LACC), as in other gastrointestinal malignancies. However, evidence of its efficacy and safety has not yet been gathered in the literature. The aim of the present study was to perform an extensive review of the scientific evidence for NAC in patients with LACC. PubMed, EMBASE, MEDLINE and Cochrane Library were searched for a systematic review of the literature from 2010 to 2019. Six eligible studies were included, with a total of 27,937 patients, 1232 of them (4.4%) treated with NAC. There were only one randomized controlled trial, three phase II non-randomized single arm studies and two retrospective studies. The baseline computed tomography scan showed that most of patients had a T3 tumor. The completion rate of the planned neoadjuvant treatment ranged from 52.5 to 93.8%. Between 97.2 and 100% of patients had the scheduled surgery. The median tumor volume reduction after NAC ranged from 62.5 to 63.7%. The anastomotic leak rate in the NAC group ranged from 0 to 7%, with no cases of postoperative mortality. There was major pathological tumor regression in 4-34.7% of cases. Between 84 and 100% of NAC patients had R0-surgery. Survival after NAC seems to be encouraging although significant improvement has only been proven in T4b tumours. According to our systematic review, the NAC may be a safe and effective emerging therapeutic alternative for treating LACC. This approach, which is still being tested, increases the reliance on accurate radiological staging.