Chest Computed Tomography Examinations Research Articles

Which Body Composition Parameters on Computed Tomography Are More Successful in Predicting the Prognosis of COVID-19 Patients?

The aims of the study are to compare the body composition parameters (BCPs), which have been reported to have a prognostic impact, in COVID-19 patients, and to determine the most influential BCP(s) on the prognosis. Unenhanced chest computed tomography examinations of COVID-19 cases were assessed regarding the severity of pneumonia, pectoralis muscle area and density (PMA, PMD), visceral adipose tissue area (VAA), waist circumference, waist to paravertebral muscle circumference ratio, coronary artery calcification severity, and paravertebral muscle area at the T5 vertebral level. A second observer repeated measurements and an intraclass correlation coefficient score were used for interobserver agreement. The relationship between data and patient outcomes (intubation, death) was investigated using multivariable logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of BCPs in predicting outcomes. A total of 238 (121 males, median age, 48 years [interquartile range, 36-63 years]) consecutive COVID-19 patients with chest computed tomography were investigated. Twenty-four patients (10.08%) were intubated, and 15 patients (6.3%) died during at least 1 month of follow-up. Waist to paravertebral muscle circumference ratio, PMA, PMD, and T5 vertebral level were significantly associated with intubation in the multivariable analysis. Pectoralis muscle density and PMA were significantly associated with death. Pectoralis muscle density showed the highest AUC for the prediction of intubation and death (AUC of 0.814 and 0.871, respectively). There was a good to excellent agreement between observers (intraclass correlation coefficient range, 0.899-0.998). Pectoralis muscle density is the most influential BCP in predicting intubation and death in COVID-19 patients.

Body-Mass Index-Based Effective Dose Determination in Commonly Performed Computed Tomography Examinations in Adults

Purpose: With the widespread application of ionizing radiation in medical practice, concerns have been increased regarding the hazardous effects of radiation. Studies have demonstrated that some variables such as body dimensions affect the absorbed radiation dose. In this study, the association between Body Mass Index (BMI) and absorbed dose in Computed Tomography (CT) is investigated.
 Materials and Methods: A total of 550 adult patients (age ≥ 15 years) were included in the study. The height and weight of the patients were recorded for BMI calculation. Dosimetry data were acquired from digital imaging and communications in medicine dose reports. The patients were categorized into five groups according to their BMI, the categorized information was then imported into ImPACT Dose software for calculation of Size-Specific Dose Estimate (SSDE) and organ and effective doses. The relationship between patient BMI and the effective dose was also determined.
 Results: A higher BMI contributed to increased radiation dose and SSDE in patients who had undergone chest or abdomen-pelvis CT examination (p < 0.05). 
 Conclusion: The radiation dose is related to a patient’s BMI and rises with an increase in BMI. Accordingly, it is suggested that BMI and other variables, such as the type of scan and other body dimensions, which affect the radiation dose, can be used to estimate the radiation dose before performing CT. This estimation can be considered for the justification and optimization of CT examinations.

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.

Selection of dilution material for non-iodinated iodine as an oral contrast agent for esophageal cancer: a preliminary clinical trial

PurposeTo investigate the filling state of the esophagus using different oral contrast agents for the diagnosis of esophageal cancer by computed tomography (CT).Materials and methodsThis preliminary clinical trial enrolled patients with suspected esophageal carcinoma and admitted from January 2015 to January 2018. The patients were randomized into the yogurt (mixed with ioversol), lotus root powder (mixed with ioversol), gas-producing powder, and control (pure iodine water) groups. Chest CT examinations were performed. The degree of esophageal filling and the detection of esophageal lesions were compared.ResultsFinally, 136 participants were enrolled (n = 34/group). There were no significant differences in esophageal filling degree among the yogurt, lotus root powder, and gas-producing powder groups (P = 0.093). There were 30/3/1 and 30/3/1 confirmed/false-negative/false-positive diagnoses in the yogurt and lotus powder groups, respectively, compared with 28/5/1 and 25/8/1 in the gas-producing powder and control groups, respectively. The concordance rates were the highest for the yogurt (88.2%, with 91.7% specificity and 86.4% sensitivity) and lotus root powder groups (88.2%, with 92.3% specificity and 85.7% sensitivity) and the lowest for the control group (73.5%, with 90.0% specificity and 66.7% sensitivity).ConclusionYogurt mixed with ioversol could fill and expand the esophagus with minimal preparation, displaying the structure of the esophageal lumen and wall thickness. This mixture might be used as a positive contrast agent for esophageal CT. Similar results were observed for the lotus root powder mixed with ioversol, but its preparation was more arduous.

The impact of vertical off-centering on image noise and breast dose in chest CT with organ-based tube current modulation: A phantom study

PurposeTo determine the effects of patient vertical off-centering when using organ-based tube current modulation (OBTCM) in chest computed tomography (CT) with focus on breast dose. Materials and methodsAn anthropomorphic adult female phantom with two different breast attachment sizes was scanned on GE Revolution EVO and Siemens Definition Edge CT systems using clinical chest CT protocols and anterior-to-posterior scouts. Scans with and without OBTCM were performed at different table heights (GE: centered, ±6 cm, and ± 3 cm; Siemens: centered, −6 cm, and ± 3 cm). The dose effects were studied with metal-oxidesemiconductor field-effect transistor dosimeters with complementary Monte Carlo simulations to determine full dose maps. Changes in image noise were studied using standard deviations of subtraction images from repeated acquisitions without dosimeters. ResultsPatient off-centering affected both the behavior of the normal tube current modulation as well as the extent of the OBTCM. Generally, both OBTCM techniques provided a substantial decrease in the breast doses (up to 30% local decrease). Lateral breast regions may, however, in some cases receive higher doses when OBTCM is enabled. This effect becomes more prominent when the patient is centered too low in the CT gantry. Changes in noise roughly followed the expected inverse of the change in dose. ConclusionsPatient off-centering was shown to affect the outcome of OBTCM in chest CT examination, and on some occasions, resulting in higher exposure. The use of modern dose optimization tools such as OBTCM emphasizes the importance of proper centering when preparing patients to CT scans.

Artificial reconstruction for a thymoma invading superior vena cava

Artificial reconstruction for a thymoma invading superior vena cava

PULMONARY MICRONODULES OF PROBABLE VARICELLA ETIOLOGY

Often, during consultations, elements pertaining to the patient’s history are omitted, leading to a diagnostic suspicion far from the truth and to unrequired medical investigations. Herein, we describe the case of a 36-year-old patient who presented himself for a post-COVID evaluation and a second medical opinion regarding the appearance of pulmonary micronodules during the control chest Computed Tomography (CT) scan. From the patient's history, we note that he had a SARS-CoV-2 infection in May 2021 and because he had persistent symptoms of retrosternal discomfort and the feeling of having a "knot in his throat", the patient presented himself for a consultation that recommended CT scan, performed in July 2021. In this CT examination (Fig. 1, A and D), several pulmonary micronodules of uncertain etiology were observed, but according to their appearance, they are most likely sequelae; no other pathological changes were observed. Routine blood tests were normal. The patient was advised to undergo a new CT scan after 6 months, in order to monitor the evolution of the nodules.

Alert Germ Infections: Chest X-ray and CT Findings in Hospitalized Patients Affected by Multidrug-Resistant Acinetobacter baumannii Pneumonia.

Acinetobacter baumannii (Ab) is an opportunistic Gram-negative pathogen intrinsically resistant to many antimicrobials. The aim of this retrospective study was to describe the imaging features on chest X-ray (CXR) and computed tomography (CT) scans in hospitalized patients with multidrug-resistant (MDR) Ab pneumonia. CXR and CT findings were graded on a three-point scale: 1 represents normal attenuation, 2 represents ground-glass attenuation, and 3 represents consolidation. For each lung zone, with a total of six lung zones in each patient, the extent of disease was graded using a five-point scale: 0, no involvement; 1, involving 25% of the zone; 2, 25–50%; 3, 50–75%; and 4, involving >75% of the zone. Points from all zones were added for a final total cumulative score ranging from 0 to 72. Among 94 patients who tested positive for MDR Ab and underwent CXR (males 52.9%, females 47.1%; mean age 64.2 years; range 1–90 years), 68 patients underwent both CXR and chest CT examinations. The percentage of patients with a positive CT score was significantly higher than that obtained on CXR (67.65% > 35.94%, p-value = 0.00258). CT score (21.88 ± 15.77) was significantly (p-value = 0.0014) higher than CXR score (15.06 ± 18.29). CXR and CT revealed prevalent bilateral abnormal findings mainly located in the inferior and middle zones of the lungs. They primarily consisted of peripheral ground-glass opacities and consolidations which predominated on CXR and CT, respectively.

Adult Computed Tomography examinations in Uganda: Towards determining the National Diagnostic Reference Levels

IntroductionDiagnostic Reference Levels (DRLs), typically set at the 75th percentile of the dose distribution from surveys conducted across a broad user base using a specified dose-measurement protocol, are recommended for radiological examinations. There is a need to develop and implement DRLs as a standardisation and optimisation tool for the radiological protection of patients at Computed Tomography (CT) facilities.MethodsThis was a retrospective cross-sectional study conducted in seven (7) different CT scan facilities in which participants were recruited by systematic random sampling. The study variables were dose length product (DLP) and volume-weighted CTDI (CTDIvol) for the radiation doses for head, chest, abdomen and lumbar spine CT examinations. The DRLs for CTDIvol and DLP were obtained by calculating the 3rd quartiles of the radiation doses per study site by anatomical region. The national diagnostic reference levels were determined by computation of DRLs using the 75th centile of the median values.ResultsA total of 574 patients were examined with an average age of 47.1 years. For CTDIvol estimates; there was a strong positive significant relationship between the CTDIvol and examination mAs (rs = 0.9017, p-value < 0.001), and reference mAs (rs = 0.0.7708, p-value < 0.001). For DLP estimates; there was a moderate positive significant relationships between DLP and total mAs (rs = 0.6812, p-value < 0.001), reference mAs (rs = 0.5493, p-value < 0.001). The DRLs were as follows; for head CT scan – the average median CTDIvol was 56.02 mGy and the DLP was 1260.3 mGy.cm; for Chest CT, the CTDI volume was 7.82 mGy and the DLP was 377.0 mGy.cm; for the abdomen CT, the CTDI volume 12.54 mGy and DLP 1418.3 mGy.cm and for the lumbar spine 19.48 mGy and the DLP was 843 mGy.cm, respectively.ConclusionThis study confirmed the need to optimize the CT scan parameters in order to lower the national DRLs. This can be achieved by extensive training of all the CT scan radiographers on optimizing the CT scan acquisition parameters. Continuous dose audits are also advised with new equipment or after every three years to ensure that values out of range are either justified or further investigated.

French Imaging Database Against Coronavirus (FIDAC): A large COVID-19 multi-center chest CT database

PurposeDuring the first wave of the COVID-19 pandemic, the French Society of Radiology and the French College of Radiology, in partnership with NEHS Digital, have set up a system to collect chest computed tomography (CT) examinations with clinical, virological and radiological metadata, from patients clinically suspected of COVID-19 pneumonia. This allowed the constitution of an anonymized multicenter database, named FIDAC (French Imaging Database Against Coronavirus). The aim of this report was to describe the content of this public database. Materials and methodsTwenty-two French radiology centers participated to the data collection. The data collected were chest CT examinations in DICOM format associated with the following metadata: patient age and sex, originating facility identifier, originating facility region, time from symptom onset to CT examination, indication for CT examination, reverse transcription-polymerase chain reaction (RT-PCR) results and normalized CT report performed by a senior radiologist. All the data were anonymized and sent through a NEHS Digital system to a centralized data center. ResultsA total of 5944 patients were included from the 22 centers aggregated into 8 regions with a mean number of patients of 743 ± 603.3 [SD] per region (range: 102–1577 patients). Reasons for CT examination and normalized CT reports were provided for all patients. RT-PCR results were provided in 5574 patients (93.77%) with a positive result of RT-PCR in 44.6% of patients. ConclusionThe FIDAC project allowed the creation of a large database of chest CT images and metadata available, under conditions, in open access through the CERF-SFR website.

ESTABLISHMENT OF REGIONAL DIAGNOSTIC REFERENCE LEVELS IN ADULT COMPUTED TOMOGRAPHY FOR FOUR AFRICAN COUNTRIES: A PRELIMINARY SURVEY.

This preliminary study aims towards the establishment of regional diagnostic reference levels (DRLs) for routine adult computed tomography (CT) examinations. The study was performed on 54 CT facilities from four African countries (Ghana, Kenya, Namibia and Senegal) and the results compared with international DRLs. Data were collected from facilities using a structured questionnaire provided by the International Atomic Energy Agency. Dose descriptors (volume computed tomography dose index [CTDIvol] and dose length product [DLP]) evaluations were performed on CT head and body phantoms for head, chest and abdomen CT examination protocols using standard methods. The estimated dose indices were compared with console-displayed dose values. Experienced radiologists accepted the diagnostic image quality of the images as per departmental imaging requirements. Median CTDIvol and DLP data from each facility were compiled to estimate the typical dose in each country. National DRLs were established based on the 75th percentile of median values, whereas the regional DRLs were based on the median of the national DRLs. Comparison of measured CTDIvol with console values of all facilities in all four countries was within 20% as recommended. The established CTDIvol DRLs for head CT, chest CT and abdomen CT were 60.9mGy, 15.2mGy and 15.7mGy, respectively. Similarly, that of DLP, DRLs were 1259mGy.cm, 544mGy.cm and 737mGy.cm, respectively for head CT, chest CT and abdomen CT. The established DRLs from this study were comparable to DRLs from other countries with some variations. This study would serve as baseline for establishment of a more generalized regional adult CT DRLs for Africa.

Coronavirus disease-2019: Changes in computed tomography radiation burden across Moscow medical facilities

BACKGROUND: The spread of coronavirus disease-2019 (COVID-19) in Moscow has significantly increased the number of chest computed tomography examinations to establish a diagnosis and assess the treatment efficacy. In Moscow, the new approach to diagnostic imaging associated with COVID-19 caused divergent shifts in the volume and structure of the population radiation burden. This study aimed to bridge the gap in data, as no reliable information about the changes in the structure of diagnostic imaging and the current radiation burden due to COVID-19 in the Moscow population has been reported.&#x0D; AIMS: To evaluate the impact of the pandemic on the computed tomography radiation doses in Moscow medical facilities between 2017 and 2020.&#x0D; MATERIALS AND METHODS: We collected and analyzed the following data: forms No. 3-DOZ completed by the public and private Moscow medical facilities in 20172020; forms No. 30 completed in 20172020; data from the Unified Radiological Information Service for 2020. The study provides details about the annual population radiation exposure and the average individual radiation doses, with a breakdown by anatomic region.&#x0D; RESULTS: The statistical form evaluation elucidated the boost of computed tomography imaging in Moscow, accounting for 31% higher than anticipated. In 2020, the number of chest imaging studies increased almost two-fold compared to the previous periods. Thereby, causing a corresponding increase in the mean effective dose by over two times.&#x0D; CONCLUSION: The results show that the epidemiological situation of 2020 had a profound effect on the changes in the computed tomography-related radiation exposure, which helped us get insight into the diagnostic effect of certain types of computed tomography studies applied to various anatomic regions. The analysis contributed to a better understanding of the strengths and weaknesses of various statistical forms.

Evaluation of AI-Based Segmentation Tools for COVID-19 Lung Lesions on Conventional and Ultra-low Dose CT Scans.

A reliable diagnosis and accurate monitoring are pivotal steps for treatment and prevention of COVID-19. Chest computed tomography (CT) has been considered a crucial diagnostic imaging technique for the injury assessment of the viral pneumonia. Furthermore, the automatization of the segmentation methods for lung alterations helps to speed up the diagnosis and lighten radiologists’ workload. Considering the assiduous pathology monitoring, ultra-low dose (ULD) chest CT protocols have been implemented to drastically reduce the radiation burden. Unfortunately, the available AI technologies have not been trained on ULD-CT data and validated and their applicability deserves careful evaluation. Therefore, this work aims to compare the results of available AI tools (BCUnet, CORADS AI, NVIDIA CLARA Train SDK and CT Pneumonia Analysis) on a dataset of 73 CT examinations acquired both with conventional dose (CD) and ULD protocols. COVID-19 volume percentage, resulting from each tool, was statistically compared. This study demonstrated high comparability of the results on CD-CT and ULD-CT data among the four AI tools, with high correlation between the results obtained on both protocols (R > .68, P < .001, for all AI tools).

Radiological manifestations and complications of lung and brain in Egyptian COVID-19 patients

BackgroundCoronavirus disease COVID-19 is a viral illness, currently affecting millions of people worldwide. Pneumonia is the most common extreme presentation of COVID-19 infection, manifesting by fever, dry cough, difficulty of breathing or shortness of breath and mainly ground-glass infiltrates in radiological images. Chest computed tomography (CT) has a potential role in the diagnosis, detection of complications and prognostication of coronavirus disease COVID-19. In addition to severe respiratory manifestations, there are a wide range of neurological manifestations ranging from nonspecific symptoms to necrotizing encephalopathies and stroke. Our study aimed to review lung and neurological manifestations in recent and post-COVID-19 Egyptian patients and to be familiar with magnetic resonance imaging (MRI) findings of Neuro-COVID patients.ResultsThe present study included eighty COVID-19 patients with age ranged from 28 to 78 years (mean age 57.84 + 12.58 years) who were 54 males (mean age 56.64 + 12.50) and 26 females (mean age 48.65 + 14.24). All our patients were with recent or previous history of COVID-19 infection and subjected to careful history taking, thorough clinical examination, routine laboratory investigations and CT examination. The reported lung manifestations included normal lung shadows, ground-glass opacifications (GGOs), consolidations, reticulation, reticulation and GGOs (crazy paving) and fibrotic-like changes. Out of eighty COVID-19 patients, twenty showed neurological manifestations ranging from nonspecific symptoms to necrotizing encephalopathies and stroke. Patients with neurological manifestation were in addition to CT submitted to magnetic resonance imaging (MRI) as appropriate. MRI done to neuro-COVID patients showed that 8/20 (40%) had no abnormalities and 12/20 (60%) had abnormalities. The most common abnormalities are infarction, major or lacunar infarction, followed by acute disseminated encephalomyelitis (ADEM), posterior reversible encephalopathy syndrome (PRES) and meningoencephalitis.ConclusionOld age patients, especially males, were more affected than females. Lung manifestations are common in COVID-19 patients than neurological manifestations. The presence of fibrotic changes in the lung could predict severe COVID-19 affection and bad prognosis. There might be an association between appearance of neurological manifestations and poor outcome in COVID-19 patients.

Radiological Findings on Chest Computed Tomography in Patients With the Primary Diagnosed Chronic Lymphoproliferative Diseases.

IntroductionThe presence of concomitant respiratory pathology complicates the process of treatment and recovery of patients with chronic lymphoproliferative diseases (CLDs). Therefore, the diagnosis of lung injury is an important step in the management of such patients.ObjectivesThe aim of this study was to determine the prevalence, nature, extent, and location of changes diagnosed by high-resolution chest computed tomography (CT) in patients with CLDs at the initial examination.MethodsMedical records of inpatients who were hospitalized in 2018-2019 to the City Hematology Center of the Public Non-Profit Enterprise “City Clinical Hospital #4” of Dnipro City Council with a confirmed clinical diagnosis of CLDs were included in the retrospective study. The results of initial high-resolution chest CT were studied and analyzed.ResultsOut of 1,004 hospitalized patients with confirmed CLDs, 119 patients were primarily diagnosed. Among them, 81 patients underwent chest CT examination (68.1%) before the beginning of specific therapy. The average age was 65 (56;68) years, 46 (56.8%) were men. 23 (28.4%) patients were diagnosed with chronic lymphocytic leukemia, 28 (34.6%) patients with multiple myeloma, 24 (29.6%) patients with lymphoma, and six patients (7.4%) had other CLDs. It was found that both central and peripheral lymphadenopathy had about a third of the studied cohort of patients (33.3 and 29.6%, respectively), and these symptoms dominated in patients with chronic lymphocytic leukemia (43.5 and 50%, respectively), lymphoma (50 and 52.2%, respectively), and other CLDs (45.8 and 16.7%, respectively), in contrast to patients with multiple myeloma (7.1 and 0%, respectively). Lesions of the lung parenchyma were found in 45.7% of the studied cohort and were met more often in patients with multiple myeloma (67.9%). However, when comparing the prevalence of their categories, no statistically significant differences were found. Predictable bone-destructive changes were statistically significantly more common in patients with multiple myeloma than in other groups of patients with CLDs (P=0.0003).ConclusionsSigns of pulmonary diseases during initial chest CT were found almost in half of the patients with CLDs. It potentially may affect the frequency of treatment complications in such patients. Lymphadenopathy was the most common finding on chest CT, especially in patients with chronic lymphocytic leukemia and lymphoma. And enlarged intrathoracic lymph nodes possibly could lead to pulmonary functions disorders. Among the types of lung parenchyma lesions, pneumofibrosis and foci of consolidation in the lower lung lobes were the most often diagnosed. Chest CT is informative at the stage of the initial examination of patients with CLDs not only for clinical diagnosis but also for the diagnosis of respiratory comorbidities and prediction of the disease outcome and treatment complications.

Chest X-rays are less sensitive than multiple breath washout examinations when it comes to detecting early cystic fibrosis lung disease.

AimAnnual chest X‐ray is recommended as routine surveillance to track cystic fibrosis (CF) lung disease. The aim of this study was to investigate the clinical utility of chest X‐rays to track CF lung disease.MethodsChildren at Gothenburg's CF centre who underwent chest X‐rays, multiple breath washouts and chest computed tomography examinations between 1996 and 2016 were included in the study. Chest X‐rays were interpreted with Northern Score (NS). We compared NS to lung clearance index (LCI) and structural lung damage measured by computed tomography using a logistic regression model.ResultsA total of 75 children were included over a median period of 13 years (range: 3.0‐18.0 years). The proportion of children with abnormal NS was significantly lower than the proportion of abnormal LCI up to the age of 4 years (p < 0.05). A normal NS and a normal LCI at age 6 years were associated with a median (10‐90th percentile) total airway disease of 1.8% (0.4‐4.7%) and bronchiectasis of 0.2% (0.0‐1.5%).ConclusionChest X‐rays were less sensitive than multiple breath washout examinations to detect early CF lung disease. The combined results from both methods can be used as an indicator to perform chest computed tomography less frequently.

Value Comparison of Iterative Reconstruction Algorithm-Based Chest CT and Ultrasound in the Diagnosis of Community-Acquired Pneumonia in Children

This study aimed to explore the diagnostic value of chest computed tomography (CT) based on adaptive statistical iterative reconstruction (ASiR) in the optimal weight range for children with community-acquired pneumonia (CAP) and find the differences between chest CT and ultrasound in the diagnosis of CAP. 106 children who were diagnosed as CAP were selected as the research objects. All objects underwent CT and ultrasound scans to measure the noise of CT images after iterative reconstruction and the contrast-to-noise ratio (CNR) of the thoracic aorta and the back muscles. The correlation between ASiR weight, noise, and CNR was analyzed and compared further. In addition, the differences in imaging manifestations of lung consolidation, abnormal pleural line, alveolar interstitial syndrome, and pleural effusion were observed under the ultrasound and CT scans of the patients. The sensitivity, specificity, positive predicted value (PV), and negative PV of the CT scan and ultrasound were analyzed further for the diagnosis of CAP in children. The results showed that ASiR weight and image noise were extremely and negatively correlated ( P &lt; 0.001 ) and that CNR and ASiR weight were extremely and positively correlated ( P &lt; 0.001 ). 40–60% of ASiR image noise was in the middle position, and the muscle space and subcutaneous fat in CT images were clearer when ASiR was at 40% and 60%. 60.38% of children were diagnosed as CAP. The proportions of children with lung consolidation, interstitial changes, pleural effusion, and atelectasis after ultrasound and CT examination were not greatly different ( P &gt; 0.05 ). After ASiR, the sensitivity of CT in detecting the abnormal pleural line + B-line/consolidation feature was the highest, 93.75%. The results of ultrasound diagnosis were consistent with those of chest CT diagnosis ( P &lt; 0.01 ). This indicated that the sensitivity, specificity, positive PV, and negative PV of ASiR-based chest CT in the diagnosis of CAP were close to those of ultrasound.

Early identification of novel coronavirus (COVID-19) pneumonia using clinical and radiographic findings

IntroductionThe Japanese Respiratory Society (JRS) scoring system is a useful tool for identifying Mycoplasma pneumoniae pneumonia. Most COVID-19 pneumonia in non-elderly patients (aged <60 years) are classified as atypical pneumonia using the JRS scoring system. We evaluated whether physicians could distinguish between COVID-19 pneumonia and M. pneumoniae pneumonia using chest computed tomography (CT) findings. In addition, we investigated chest CT findings if there is a difference between the variant and non-variant strain. MethodsThis study was conducted at five institutions and assessed a total of 823 patients with COVID-19 pneumonia (335 had lineage B.1.1.7.) and 100 patients with M. pneumoniae pneumonia. ResultsIn COVID-19 pneumonia, at the first CT examination, peripheral, bilateral ground-glass opacity (GGO) with or without consolidation or crazy-paving pattern was observed frequently. GGO frequently had a round morphology (39.2%). No differences were observed in the radiological findings between the non-B.1.1.7 groups and B.1.1.7 groups. The frequency of pleural effusion, lymphadenopathy, bronchial wall thickening and nodules (tree-in-bud and centrilobular) was low. In contrast to COVID-19 pneumonia, bronchial wall thickening (84%) was observed most frequently, followed by nodules (81%) in M. pneumoniae pneumonia. These findings were significantly higher in M. pneumoniae pneumonia than COVID-19 pneumonia. ConclusionsOur results demonstrated that a combination of the JRS scoring system and chest CT findings is useful for the rapid presumptive diagnosis of COVID-19 pneumonia in patients aged <60 years. However, this clinical and radiographic diagnosis is not adapted to elderly people.

Diagnosis of Bronchial and Pulmonary Fungal Infection Using Gradient Weighted Denoising Algorithm-Based CT Images

Based on computed tomography (CT) with a gradient weighted denoising algorithm, the image denoising technique was applied to diagnose bronchial and pulmonary fungal infection to discuss the features of CT images and the efficiency of the denoising algorithm. Therefore, it could assist clinicians in disease treatment. The clinical data and imaging data of 100 patients with invasive pulmonary fungal infection were collected in the hospital. All of them were rolled into a natural denoising CT group (routine group) and gradient weighted denoising algorithm-based image denoising group (algorithm group). The images from the routine group were processed by the routine natural denoising method, and the images from the algorithm group were denoised with the gradient weighted denoising algorithm. The results showed that the algorithm group had greater denoising efficiency and less denoising time compared with the routine group ( P &lt; 0.05 ). The diagnostic sensitivity, specificity, and accuracy of the denoised images from the algorithm group were higher markedly than the above three indicators of the routine group ( P &lt; 0.05 ). For bronchopulmonary infections, the sensitivity, specificity, and accuracy of the PDE model for CT denoised images were 99.00%, 96.87%, and 98.33%, the positive rate of chest CT examination was 86.2%, which was higher markedly than the rate of ordinary CT examination (70.5%), and the difference was statistically substantial ( P &lt; 0.05 ). Besides, the mean absolute error (MAE), peak signal to noise ratio (PSNR), and mean structural similarity index measure (MSSIM) of the algorithm group were better than those of the unprocessed images and the routine group ( P &lt; 0.05 ). Moreover, the algorithm group had a good visual effect. In conclusion, the gradient weighted denoising algorithm could effectively remove the noise and bar artifacts in CT images and well retain the edge details of CT images, thereby improving the quality of CT images. Therefore, it was suitable for clinical diagnosis and had practical application value.

The value of CT-based radiomics in early assessment of chemotherapeutic effect in patients with advanced lung adenocarcinoma: a preliminary study.

Computed tomography (CT) is the preferred method for evaluating the therapeutic effect of lung cancer. Radiomics parameters can provide a lot of supplementary information for clinical diagnosis and treatment. To investigate the value of radiomics features of CT imaging to predict and evaluate the early efficacy of chemotherapy in patients with advanced lung adenocarcinoma. A total of 101 patients with advanced lung adenocarcinoma were enrolled. Patients were classified into a response group and non-response group according to RECIST 1.1 standard. All patients underwent chest CT examination before and after two cycles of chemotherapy. A total of 293 radiomics features were calculated. The features between response group and non-response group were compared before and after chemotherapy. The diagnostic efficacy was evaluated using the receiver operating characteristic curve. The six pre-chemotherapy radiomics features were selected, with area under the curve (AUC), sensitivity, and specificity at 0.720, 68.3%, and 69.0% in the training group and 0.573, 50.0%, and 76.9% in the test group, respectively. The eleven post-chemotherapy radiomics features were selected, with AUC, sensitivity, specificity at 0.789, 75.6%, and 75.9% in the training group and 0.718, 61.1%, and 76.9% in the test group, respectively. The prognostic value of △f8, △f16, %f8, and %f16 were higher than the other features with AUCs of 0.787, 0.837, 0.763, and 0.877, respectively. Radiomics is expected to provide more valuable information for evaluating the chemotherapy efficacy of lung adenocarcinoma.