Computed Tomography Differential Diagnosis Research Articles

Pretreatment CT differential diagnosis of tuberculous peritonitis from peritoneal carcinomatosis of advanced epithelial ovarian cancer

Delayed diagnosis of female genital tuberculosis (FGTB) can lead to inappropriate treatment and unnecessary surgical procedures rather than standard anti-TB medication. We tried to evaluate the use of computed tomography (CT) imaging to differentiate TB peritonitis from peritoneal carcinomatosis of advanced epithelial ovarian cancer (AEOC). We investigated women who underwent CT to distinguish between TB peritonitis and peritoneal carcinomatosis of AEOC. We evaluated various CT imaging features to identify differences between the two diseases. In addition, we performed univariate and multivariate logistic regression analyses to identify the independent imaging parameters associated with TB peritonitis and evaluated the diagnostic performance of the combined imaging parameters. We also performed the histopathological analysis of the available salpinx specimens of TB peritonitis. We included 25 women with TB peritonitis and 34 women with peritoneal carcinomatosis of AEOC. A multivariate analysis of the discriminant CT imaging features between the two diseases revealed that changes in fallopian tubes and peritoneal micronodules were independent parameters associated with TB peritonitis (p ≤ 0.012). Combining the two imaging parameters showed an area under the receiver operating characteristic curve of 0.855, a sensitivity of 88.0%, and a specificity of 67.7% for differentiating TB peritonitis from peritoneal carcinomatosis. Furthermore, changes in fallopian tubes were correlated with histopathological abnormalities in salpinx specimens. Pretreatment CT evaluation with useful imaging features could help differentiate TB peritonitis from peritoneal carcinomatosis of AEOC.

POS1228 THE ROLE OF CHEST CT IN UNDERSTANDING INTERSTITIAL LUNG DISEASE (ILD): SYSTEMIC SCLEROSIS (SSc). VERSUS COVID-19

Background:COVID-19 pandemic is a global emergency which may overlap on the clinical and radiological scenario of ILD in SSc. In clinical practice, the striking similarities observed at computed tomography (CT) between the diseases make it difficult to distinguish a COVID-19 superinfection from a progression of SSc-ILD.Objectives:The aim of our study was to identify the main CT features that may help distinguishing SSc-ILD from COVID-19 pneumonia.Methods:22 international readers were included and divided in the radiologist group (RAD) and non-radiologist group (nRAD). The RAD group included non-chest RAD and chest-RAD. A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study.Results:Fibrosis inside focal ground glass opacities (GGO) in the upper lobes; fibrosis in the lower lobe GGO; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT parameters most frequently associated with SSc-ILD. The CT parameters most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p <0.0001) and signs of fibrosis in GGO in the lower lobes (p <0.0001) remained independently associated with COVID-19 pneumonia or SSc-ILD, respectively. These two variables were combined in a predictive score which resulted positively associated with the COVID-19 diagnosis, with 96.1% sensitivity and 83.3% specificity: 3 different risk class for COVID-19 pneumonia may be identified: high risk for COVID-19 pneumonia (5-9 points); probable overlap COVID-19 pneumonia in SSc-ILD (4 points); low risk for COVID-19 pneumonia (0-3 points).Conclusion:The CT differential diagnosis between COVID-19 Pneumonia and SSc-ILD is possible and may be fostered in practice by the use of a radiological score. In the case where an overlap of both diseases is suspected, the presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.

The Role of Chest CT in Deciphering Interstitial Lung Involvement: Systemic Sclerosis Versus COVID-19

Background: In clinical practice, the striking similarities observed at computed tomography (CT) between the diseases make it difficult to distinguish a COVID-19 pneumonia from a progression of interstitial lung disease (ILD) secondary to Systemic sclerosis (SSc). The aim of the present study was to identify the main CT features that may help distinguishing SSc-ILD from COVID-19 pneumonia. Methods: This multicentric study included 22 international readers divided in the radiologist group (RAD) and non-radiologist group (nRAD). A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study.Findings: Fibrosis inside focal ground glass opacities (GGO) in the upper lobes; fibrosis in the lower lobe GGO; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT features most frequently associated with SSc-ILD. The CT features most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p Interpretation: The CT differential diagnosis between COVID-19 pneumonia and SSc-ILD is possible through the combination our score and the radiologic expertise. If an overlap of both diseases is suspected, the presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.Funding: No Funding were received for this study.Declaration of Interests: SC reports personal fees from NOVARTIS-SANOFI-LILLY-CELTHER-PFIZER-JANSSEN; MK reports grants and personal fees from Boehringer-Ingelheim, personal fees from Corbus, grants and personal fees from Chugai, grants and personal fees from Ono Pharmeceuticals, personal fees from Tanabe-Mitsubishi, personal fees from Astellas, personal fees from Gilead, personal fees from Mochida; ST reports personal fees from Boehringer Ingelheim, personal fees from Roche, outside the submitted work; GS reports personal fees from Boehringer Ingelheim; CB reports personal fees from Actelion, personal fees from Eli Lilly, grants from European Scleroderma Trial and Research (EUSTAR) group, grants from New Horizon Fellowship, grants from Foundation for Research in Rheumatology (FOREUM), grants from Fondazione Italiana per la Ricerca sull'Artrite (FIRA); CV reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from F. Hoffmann-La Roche Ltd.; FL reports lectures fee from Roche and from Boehringer- Ingelheim; CPD reports grants and personal fees from GSK, personal fees from Boerhinger Ingelheim, grants from Servier, grants and personal fees from Inventiva, grants and personal fees from Arxx Therapeutics, personal fees from Corbus, personal fees from Sanofi, personal fees from Roche; FL reports grants and personal fees from GSK, personal fees from Boehringer Ingelheim, personal fees from Orion Pharma, personal fees from AstraZeneca, grants from MSD, personal fees from HIKMA, personal fees from Trudell International, grants and personal fees from Chiesi Farmaceutici, personal fees from Novartis Pharma; MH reports personal fees from Speaking fees from Actelion, Eli lilly and Pfizer; D K reports personal fees from Actelion, grants and personal fees from Bayer, grants and personal fees from Boehringer Ingelhem, personal fees from CSL Behring, grants and personal fees from Horizon, grants from Pfizer, personal fees from Corbus, grants and personal fees from BMS, outside the submitted work; and Dr Khanna is the Chief Medical officer of Eicos Sciences Inc and has stock options. All the mentioned authors declared previous feed outside the submitted work. All other authors declare no competing interests.Ethics Approval Statement: This retrospective, observational, multicentric, international study was approved by the Institutional Ethics Committee of Florence Careggi hospital (protocol number 17104_oss).

COVID-19 pneumonia: A review of typical CT findings and differential diagnosis

The standard of reference for confirming COVID-19 relies on microbiological tests such as real-time polymerase chain reaction (RT-PCR) or sequencing. However, these tests might not be available in an emergency setting. Computed tomography (CT) can be used as an important complement for the diagnosis of COVID-19 pneumonia in the current epidemic context. In this review, we present the typical CT features of COVID-19 pneumonia and discuss the main differential diagnosis.

Imaging of Elastofibroma: A Rare Forgotten Tumor of Chest Wall

Elastofibroma is a rare benign tumor of chest wall occurring commonly in elderly female and showing abundant elastin fibers. The lesion is usually large at the time of presentation and requires surgical removal only in symptomatic patients. The lesion has a characteristic appearance on imaging especially on computed tomography (CT) scan and usually requires no further intervention. The present article discusses this rare tumor in young adult male with its characteristic CT scan findings, differential diagnosis and review of literature as this tumor is benign and less often recognized by radiologists.

CT presentations of colorectal cancer with chronic schistosomiasis: A comparative study with pathological findings

ObjectiveTo clarify pathological basis of computed tomography (CT) presentations of colorectal cancer (CRC) with schistosomiasis for the purpose of improving the accuracy of CT diagnosis and differential diagnosis of the condition. Materials and methods130 patients (87 male and 43 female; age range 49–86 years, mean 71.1) were selected whose diagnoses were pathologically confirmed as CRC with schistosomiasis. All the patients underwent abdominal plain CT and contrast enhanced scanning. The location, morphology, size, calcification features and enhancement modalities (patterns) were evaluated and compared with the pathological findings by two radiologists in a blind way. ResultsCT showed that in 130 patients, the tumors occurred in the large intestine, among which 109 (83.9%) were solitary and 21 (16.1%) were multifocal. The intestinal wall was irregularly thickened in 123 patients, with soft tissue masses in 7 patients. Linear, spotty and small patchy calcifications were seen in 104 (80.0%) patients, with unclear margins in 96 patients. The tumors were markedly unevenly enhanced in 92 patients. Pathological examination revealed adenocarcinoma in 114 patients and in 104 patients, calcified Shistosoma japonicum (S. japonicum) ova inside the tumors, 15 patients were mucinous adenocarcinoma, and one patient was that of adenosquamous carcinoma. ConclusionIrregular thickening of the intestinal wall, soft tissue masses, multiple S. japonicum ova calcifications inside the tumor with obscured margins and multiple intestinal masses in some patients are important CT features of CRC with schistosomiasis.

CT signs, patterns and differential diagnosis of solitary fibrous tumors of the pleura.

First described by Klemperer and Rabin in 1931, solitary fibrous tumour of the pleura (SFTP) is a mesenchymal tumour that tends to involve the pleura, although it has also been described in other thoracic areas (mediastinum, pericardium and pulmonary parenchyma) and in extrathoracic sites (meninges, epiglottis, salivary glands, thyroid, kidneys and breast). SFTP usually presents as a peripheral mass abutting the pleural surface, to which it is attached by a broad base or, more frequently, by a pedicle that allows it to be mobile within the pleural cavity. A precise preoperative diagnosis can be arrived at with a cutting-needle biopsy, although most cases are diagnosed with postoperative histology and immunohistochemical analysis of the dissected sample. SFTP, owing to its large size or unusual locations (paraspinal, paramediastinal, intrafissural), can pose interpretation problems or, indeed, point towards a diagnosis of diseases of a totally different nature. We present computed tomography (CT) features of SFTP in patients who had had surgical resection in order to discover any specific CT findings that might help in the diagnosis of these tumors.

CT diagnosis of rib anomalies, tumors, and infection in children

The computed tomography (CT) findings of 3 patients with Ewing's sarcoma and 10 patients with a variety of benign rib lesions including osteomyelitis, hemangiomatosis, eosinophilic granuloma, aneurysmal bone cyst, neurofibromatosis, enchondroma, and Jarcho-Levin syndrome are presented. CT is of great value in demonstrating characteristic findings of several benign rib lesions. Also, CT accurately shows the destructive pattern of the rib lesion, the presence of pleural effusion, and the local spread of the soft tissue mass. When an aggressive rib lesion with pleural effusion is encountered in an infant or child, Ewing's sarcoma must be excluded unless this lesion has characteristic radiographic findings and a strong clinical history that suggest another diagnosis. The CT findings and differential diagnosis of rib lesions are discussed. Three-dimensional CT well demonstrated the appearance of congenital rib anomalies.

Magnetic resonance imaging of arachnoid cysts

A retrospective review of magnetic resonance imaging (MRI)—computed tomography (CT) correlation was performed in 29 patients with arachnoid cysts. Short TR, short TE spin echo (SE) pulse sequences provided the best anatomic definition whereas multiple echo long TR, TE sequences allowed comparison of the signal intensity of the cyst with that of cerebrospinal fluid (CSF). Simple arachnoid cysts were isointense while neoplastic, hemorrhagic or inflammatory cysts were hyperintense relative to CSF. The CT differential diagnosis of an arachnoid cyst (depending upon its location) may include other cystic collections such as craniopharyngioma, epidermoid, astrocytoma, and chronic subdural hematoma. However, on MRI the combination of extraaxial location, morphological features, and signal intensity matching that of CSF allows one to make the diagnosis of an uncomplicated arachnoid cyst with confidence.