CT Severity Index Research Articles

Epidemiology, clinical presentation and management of COVID-19 associated mucormycosis: A single centre experience from Pune, Western India.

BackgroundThe second COVID‐19 wave in India has been associated with an unprecedented increase in cases of COVID‐19 associated mucormycosis (CAM), mainly Rhino‐orbito‐cerebral mucormycosis (ROCM).MethodsThis retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all‐cause mortality due to CAM.Results59 patients were diagnosed with CAM. Median duration from the first positive COVID‐19 RT PCR test to diagnosis of CAM was 17 (IQR: 12,22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID‐19. 56% patients were prescribed steroids for non‐hypoxemic, mild COVID‐19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID‐19 CT severity index ≥18 (p = .017), presence of orbital symptoms (p = .002), presence of diabetic ketoacidosis (p = .011) and cerebral involvement (p = .0004) were associated with increased risk of death.ConclusionsCAM is a rapidly progressive, angio‐invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.

Comparative evaluation of BISAP score and computed tomography severity index as a predictor for severity of acute pancreatitis

Background: Acute severe pancreatitis is life threatening condition with organ failure, pancreatic necrosis, infections, and death. Multiple factor scoring systems are used for triage decision to manage of acute pancreatitis according to severity. Our purpose of this study was to assess the efficiency of the bedside index of severity in acute pancreatitis (BISAP) score and computed tomography severity index (CTSI) scoring system to predict severity of acute pancreatitis.Methods: This hospital based observational, prospective study was conducted from 01 March 2019 to May 2020. An inclusion criterion was patients admitted with diagnosis of acute pancreatitis. Comparative analysis was done for BISAP and CTSI in terms of severity and mortality.Results: The mean age was 44.7±16.2 years and male to female ratio was 1.9:1. BISAP score had 91.7% sensitivity and 51.4% specificity in predicting severity of acute pancreatitis with 38.6% positive predictive value (PPV) and 94.9% negative predictive value (NPV). CTSI score had 95.8% sensitivity and 44.4% specificity in predicting severity of acute pancreatitis with 36.5% PPV and 96.9% NPV. The area under curve (AUC) for BISAP and CTSI was 0.853 (95% CI: 0.769–0.937) and 0.901 (95% CI: 0.831– 0.97) respectively.Conclusions: We conclude that BISAP score is better predictor of severity and mortality in acute pancreatitis and can safely be utilized to predict severity of acute pancreatitis in situations where use of CT is limited due to cost factor or availability, especially in rural areas. BISAP score is a scoring system that can be easily calculated with available clinical data even in small hospital setups.

The association between the CT severity index and the pulmonary artery area in COVID-19 pneumonia.

The pulmonary artery area (PAA) is a valuable non-invasive method for the diagnosis of pulmonary hypertension. To compare the change in PAA in patients with COVID-19 with the computed tomography (CT) severity index using follow-up imaging. A total of 81 patients who were followed up and underwent CT assessment more than once at our hospital's pandemic department were evaluated retrospectively. Patients with progression were separated into three groups: progression ranging from mild-to-mild infiltration (Group A, CT severity index of 0-2); progression from mild to severe infiltration (Group B, CT severity index of 0-2 to 3-5); and progression from severe-to-severe infiltration (Group C, CT severity index of 3-5). The PAAs were calculated separately. The mean age was 56 ± 12 years. In terms of those patients showing progression in the CT images, the number of patients in Groups A, B, and C was 29, 40, and 12 in the right lung; 32, 45, and 4 in the left lung; 23, 45, and 13 on both lungs, respectively. There was no significant difference between the main, right, and left PAAs in Group A (P > 0.05). In Group B, there were significant increases in the areas of the main, right, and left PAAs (P < 0.05). There were also significant increases in the areas of the right and main pulmonary arteries in Group C (P < 0.05). PAAs increase as disease involvement advances in cases with COVID-19 pneumonia, which is thought to be correlated with progression.

Can Perinephric Fat Stranding be used as a Predictor of Renal Dysfunction in COVID-19 Patients? A Retrospective Study

Introduction: High Resolution Computed Tomography (HRCT) of the chest is often performed in patients with Coronavirus Disease 2019 (COVID-19) to assess the severity of lung involvement. Multiorgan dysfunction is a well-known complication of COVID-19 infection. Bilateral Perinephric Fat Stranding (PFS) is often observed in cases of COVID-19 infection while reporting the chest Computed Tomography (CT) scans, which might represent associated acute kidney injury. It is still not known whether a correlation exists between the severity of COVID-19 infection and presence of PFS or renal dysfunction. Aim: To determine the association between PFS, Computed Tomography Severity Index (CTSI) and serum creatinine levels in patients with COVID-19 infection. Materials and Methods: This retrospective cohort study was conducted in Department of Radiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India, from April 2021 to June 2021. A total of 90 COVID-19 positive patients of all ages and gender, who underwent HRCT of chest were included in the study. The chest scans were retrospectively reviewed for severity of lung involvement using a CTSI. The cases were divided equally into two groups A (n=45) and B (n=45). Group A included cases showing PFS on CT and group B included cases with no evidence of PFS. Serum creatinine levels (obtained within 24 hrs of the scan) of all patients were noted and analysed to determine any possible association between the PFS, CTSI and serum creatinine levels. Analysis was done using Mann-Whitney U test, for continuous variables and Chi-square test was used for categorical data. Results: The mean age of patients (p-value=0.047) and the male to female ratio (p-value&lt;0.001) was significantly higher in group A than in group B. Statistically significant association was found between PFS and serum creatinine (W=1375.500, p-value=0.003) PFS as an indicator of renal dysfunction had a sensitivity of 73.3%, specificity of 54.7%, Positive Predictive Value (PPV) of 24.4%, Negative Predictive Value (NPV) of 91.1% and a diagnostic accuracy of 57.8%. with an odds ratio of 3.32. Conclusion: Presence of PFS at imaging can serve as a useful screening tool for detecting underlying renal dysfunction in patients with COVID-19 infection.

Computed tomography severity index in nCovid19 pneumonia: Clinicians perspective

Computed tomography severity index in nCovid19 pneumonia: Clinicians perspective

Comparison of Severity of Lung Involvement between Vaccinated and Unvaccinated COVID-19 Patients Assessed using HRCT Scan of Thorax: A Cross-sectional Study

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic, as we all know has wreaked havoc in many countries due to its high rate of infectivity. A High-Resolution Computed Tomography (HRCT) thorax scan is a must to determine the extent of lung involvement, which is helpful in further management. Aim: To compare the severity of lung involvement in COVID- 19 patients with double dose, single dose vaccinated and unvaccinated patients, and thus assess the role of vaccination in limiting the severity of lung involvement in infected patients. Materials and Methods: This was cross-sectional study conducted on 244 patients in the Department of Radiology of Adichunchungiri Institute of Medical Sciences, Bellur, Karnataka, India. The patients were divided into three groups based on their vaccination status. Group A constituted patients who had received two doses of vaccine, group B constituted patients vaccinated with only one dose and group C constituted unvaccinated patients. The Computed Tomography Severity Index (CTSI) score of each patient was assessed. CTSI score of these three groups were compared to know the role of vaccine in preventing or limiting the severity of the disease. The chi-square test, Analysis of Variance (ANOVA) test and t-test were used to compare two means to compare two independent groups. Results: The HRCT scans of a total of 244 patients (166 males and 78 females) were included in the study, analysed and divided into three groups. Group A (n=30) had patients with only mild CTSI score. Group B (n=34) had patients with both mild and moderate CTSI score. Group C (n=180) had patients with mild, moderate and severe CTSI scores. There were no patients with severe lung involvement in group A and group B. The mean CTSI scores in group A, B and C were 0.8, 7.2 and 9.3 respectively (p-value &lt;0.001). Group A and B had less severe lung involvement in comparison to group C. Conclusion: Complete vaccination is essential in preventing severe lung disease due to COVID-19 infection, and to limit complications and long-term sequelae.

Antibody Cocktail in Moderate to Severe COVID-19 Infection: A Series of 10 Cases

In the wake of the Coronavirus Disease 2019 (COVID-19) pandemic, scientists all over the world are in a relentless search for a cure. None of the therapies advised till date have shown significant benefit in treating COVID-19 infection. An antibody cocktail consisting of a combination of casirivimab and imdevimab is the newest weapon in the armamentarium against the disease. Currently, it has shown great promise in treating mild non hospitalized cases. The authors present the results of a series of 10 cases aged 18-70 years that demonstrate the efficacy of this cocktail in treating moderate to severe cases as well. All the patients received Roche’s Antibody cocktail© on admission and standard treatment protocol comprising of remdesivir, methylprednisolone and low molecular weight heparin was given. Oxygen supplementation was titrated to achieve a target SpO2 of 88-92%. Majority (70%) of the patients demonstrated an improvement in SpO2 /FiO2 ratio and a decline in the inflammatory marker levels 3-5 days after receiving the cocktail. Eight out of the 10 patients could be discharged home after 10-14 days of admission. The remaining two had severe disease with Computed Tomography Severity Index (CTSI) &gt;17/25 and died despite receiving all the available therapies. Antibody cocktail is an effective adjuvant therapy against moderate to severe COVID-19 pneumonitis, demonstrating rapid improvement in SpO2 /FiO2 ratio, inflammatory markers and a shortened duration of hospital stay.

Role of HRCT in Assessing Requirement of Oxygen for COVID-19 Patients: A Retrospective Study from Amalapuram, Andhra Pradesh, India

Introduction: Coronavirus Disease 2019 (COVID-19) infection has affected many countries in the world with its high rate of infectivity and created havoc with its mortality rate. A High Resolution Computed Tomography (HRCT) thorax scan is useful in detection and to assess the involvement of lung which is helpful to plan the management. Aim: To assess the oxygen requirement in COVID-19 patients based on the lung involvement using HRCT scan. Materials and Methods: A retrospective study was conducted from 1st May to 30th June 2021 in the Department of Radiodiagnosis, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India. HRCT thorax scans of 600 patients with COVID-19 infection were included. The patients were categorised based on their lung involvement into three groups (mild, moderate, severe) and then they were followed-up for the oxygen support that each patient received during their stay in hospital. Results: Among the 184 mild COVID-19 infection cases none required Bilevel Positive Airway Pressure (BiPAP)/ intubation. Sixty four out of 340 moderate COVID-19 infection cases required BiPAP and intubation and 28 out 76 severe COVID-19 infection cases required BiPAP and intubation. None in mild cases, 60 (17.6%) in moderate cases, and 32 (42.1%) in severe cases had mortality. The rate of oxygen support and risk of intubation increased as the score increases (p&lt;0.001). The Computed Tomography Severity Index (CTSI) also showed significant difference with the age and co-morbidities of the patients (p&lt;0.01). Conclusion: The HRCT is helpful in assessing the requirement of oxygen support in COVID-19 patients and to plan the management. There is increased non invasive and invasive ventilatory support along with increased morbidity and mortality as the score increases.

Operative Pancreas Debridement in 2021: Who and When?

Introduction: Treatment of necrotizing pancreatitis (NP) has shifted in favor of a minimally invasive step-up approach rather than primary operative pancreatic debridement (OPD). We evaluated the contemporary role of OPD in NP treatment. Methods: Single institution retrospective review of 468 NP patients treated between 2011-2019. Operative pancreatic debridement included video-assisted retroperitoneal debridement (VARD), open and minimally invasive transgastric debridement, and open debridement with external drainage. NP patients whose treatment included OPD were compared with patients treated definitively without OPD. Results: Since 2011, 256/468 (55%) of patients were treated with OPD. Gender and comorbidity profile were similar between groups. Necrotizing pancreatitis etiology was more likely biliary (52% vs 32%) and less likely secondary to alcohol (19% vs 35%) in patients treated with OPD (p<0.001). Computed tomography severity index (CTSI) of pancreatic necrosis was similar between groups; however, infected necrosis was more common in patients who underwent OPD (68% versus 33%, p <0.001). Patients treated with OPD were more likely to have disconnected pancreatic duct syndrome (DPDS) (53% vs 29%, p <0.001). Among patients who underwent OPD during their treatment, 73% underwent OPD as their initial intervention at 73 ± 6 days after disease onset while 27% underwent OPD as salvage therapy at 95 ± 16 days after disease onset, p=0.1. Conclusions: Operative pancreatic debridement remains an important treatment modality in patients with pancreatic necrosis. OPD is employed as either primary or salvage therapy most frequently in patients with NP of biliary etiology, infected necrosis, and patients with disconnected pancreatic duct.

Investigating the correlation between severe acute pancreatitis and pancreatic necrosis with some serum parameters.

Acute pancreatitis (AP) is a disease related to significant morbidity and even mortality. Various factors are involved in the etiology, especially gallstones and excessive alcohol consumption. Although, the course of the disease in most of the cases is generally mild, in some cases, the disease can be severe and lead to pancreatic or peripancreatic necrosis. Radiologically, 'Balthazar computed tomography severity index' (CTSI) is used to assess the severity and presence of necrosis in pancreatitis. In this study, we classified the severity of AP in patients with Balthazar CTSI and investigated whether there is a correlation between some serum parameters and AP severity and which serum parameters can be used as a safe marker to predict the AP severity and the development of pancreatic necrosis (PN). A total of 341 patients diagnosed with AP and hospitalized in our general surgery clinic between the years 2012 and 2018 were included in this study. Hematological and biochemical parameters of the patients were recorded. Abdominal CT's of the patients were evaluated according to the Balthazar CTSI. The correlation between these parameters and AP severity evaluated by Balthazar CTSI was investigated. PN was detected in 19.4% of 341 patients who participated in the study. Patients whose PN detected in their abdominal CT's by Balthazar CTSI; neutrophil counts, neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio, plateletlymphocyte ratio, and neutrophil/monocyte ratio (NMR) were significantly higher and the serum albumin was significantly lower than patients with PN. Neutrophil count, serum albumin levels, NLR, LR, and NMR can be used as predictive markers to determine AP severity.

Comparison of Demographic Profile and CT Findings in COVID-19 Pneumonia between First and Second Waves of COVID-19 Pandemic: A Retrospective Study

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has affected the world in two waves. The human civilisation took a heavy toll in the two waves of pandemic in terms of human deaths, loss of livelihood and socioeconomic regression. Aim: To present the Computed Tomography (CT) thorax findings of COVID-19 pneumonia during peak three months of first and second waves of COVID-19 pandemic and compare the demographic profile, radiological patterns and CT severity scores to document if significant difference exists between the two waves. Materials and Methods: The present observational, retrospective and single-centric study included all Real-time Reverse Transcription-polymerase Chain Reaction (RT-PCR) tests proven COVID-19 patients who underwent CT scan during the peak three months of first (August to October 2020) and second (April to June 2021) waves of COVID-19 pandemic at TRIHMS, Naharlagun, Arunachal Pradesh, India. A total of 93 and 120 patients were included from the first and second waves, respectively. The demographic profile, radiological pattern based on the Radiological Society of North America (RSNA) consensus statement and CT severity index in COVID- 19 pneumonia were compared during the peak three months of first and second waves of the pandemic. Chi-squared and t-test were used for statistical analysis. Results: The patients affected during the second wave were younger compared to the first wave (mean age of 43 vs 49, p=0.001). The patients having moderate or severe COVID-19 pneumonia during the second wave were significantly younger compared to the first wave (mean age of 42 vs 55, p&lt;0.001). More females were affected with moderate or severe COVID-19 pneumonia during the second wave compared to the first wave (p=0.017). However, the overall sex difference in COVID-19 pneumonia (including mild category) was not significant with p-value of 0.127. There was same prevalence of radiological patterns in the two waves (p=0.981). The difference in the prevalence of CT severity score was not significant in the two waves (p=0.256). Conclusion: Similar radiological patterns were observed in the two waves of the pandemic. Younger patients were significantly more affected during the second wave of the pandemic.

Evaluation of Effect of Fatty Liver on the Severity of Acute Pancreatitis Using Computed Tomography- A Retrospective Study

Introduction: Fatty Liver (FL) disease is commonly encountered in clinical practice and is frequently seen in patients with Acute Pancreatitis (AP) due to common risk factors such as obesity, alcohol abuse, and insulin resistance among others. Aim: To evaluate the effect of FL on the severity of AP radiologically using Computed Tomography (CT). Materials and Methods: This was a retrospective study, conducted from June 2021 to July 2021 in which plain CT images of patients with AP were reviewed to measure the mean attenuation values of the liver and spleen. A ratio of mean hepatic/splenic Hounsfield Units (HU) &lt;1 was considered as FL. The severity of AP was assessed using the Modified CT Severity Index (CTSI) on Contrast Enhanced Computed Tomography (CECT) scan. Data collected was entered into Microsoft Excel datasheet and frequency (n) and percentages were calculated. Chi-square test was used to calculate the level of significance. Results: A total of 50 patients (44 males and 6 females; mean age 35.58±13.792 years) with AP were included in this study amongst whom FL was found in 23 patients (46%) and non FL in 27 patients (54%). The severity of pancreatitis was significantly greater in patients with FL than patients without FL. AP patients with FL had higher rates of local complications like acute Peripancreatic Fluid Collections (PPFC) (56.5% vs 22.2% p&lt;0.001) and Acute Necrotic Collections (ANC) (26.1% vs 3.7% p&lt;0.001) than those without FL. Conclusion: Fatty liver plays a significant role in the severity acute pancreatitis and can be used as an indicator for the same. Combined plain and contrast CT scans can be used to assess FL and diagnose and predict the severity of AP

Chest wall muscle mass depletion is related to certain pulmonary functions and diseases in patients with bronchiectasis.

Background and objectiveMany bronchiectasis patients suffer dyspnea, decreased exercise tolerance, and low body mass index. Chest wall muscles play a special role in respiratory movement and make up parts of skeletal muscles. This study aimed to examine the chest wall muscle thickness and their relationship with disease severity in bronchiectasis.MethodsWe retrospectively included 166 patients with bronchiectasis and 62 patients with pneumonia as comparators. The thickness of chest wall muscle as determined in chest CT, pulmonary function, and Bronchiectasis Severity Index (BSI) score were recorded. We compared the thickness of the chest wall muscle in two groups and assessed the relationships among chest wall muscle thickness, pulmonary function, and BSI score.ResultsChest wall muscle thickness of the anterior midclavicular line and posterior exterior scapula were thinner in bronchiectasis patients than comparators both above the aortic arch level and at the aortic arch window level. Muscle thickness of the posterior interior scapula above the aortic arch level was significantly thinner in bronchiectasis patients. Chest wall muscle thickness at the anterior midclavicular line both the above aortic arch level and at the level of the aortic arch window were related to diffuse capacity in bronchiectasis patients. Anterior chest wall muscle thickness above the aortic arch was found to be a risk factor of disease severity.ConclusionAnterior chest wall muscles in the upper and middle chest were thinner in bronchiectasis patients than in comparators, and had relationship with spirometry and diffuse compacity factors. We provide another method to conveniently assess bronchiectasis severity.

COVID-19-associated severe acute pancreatitis: A rare presentation

As the knowledge about coronavirus disease 2019 (COVID-19) is increasing day by day, we are learning about various manifestations of COVID-19. The disease is a systemic illness that also involves the gastrointestinal system including the pancreas. Here, we report the case of a 14-year-old girl who presented with a pancreatic type of pain abdomen. She was diagnosed with acute pancreatitis (AP) based on clinical symptoms, ≥3 times the elevation of serum amylase, and imaging evidence of AP. Her Bedside Index of Severity in AP was 2/5 and the Modified Computed Tomography Severity Index was 10/10. She had positive reverse transcriptase-polymerase chain reaction for COVID-19. Her workup for common and rare causes of AP was negative. She was managed conservatively as per standard protocol for the management of AP. The aim of this case is to highlight the importance of causal association of COVID-19 with AP.

BETTER PREDICTION OF SEVERITY IN ACUTE PANCREATITIS USING RADIOLOGICAL CRITERIA.

Background: Acute pancreatitis is inflammation of the pancreas. Severe cases can lead to multi-organ dysfunction. So accurate prediction of severity is of great importance to improve survival. For the prediction of severity, there are several criteria. In this study, we have compared clinical criteria and imaging criteria to detect the severity of acute pancreatitis. In clinical criteria, we have taken Ranson criteria and BISAP(Bedside Index for Severity of Acute Pancreatitis) score. In imaging, we have taken MCTSI(Modified Computed Tomography Severity Index). Method: 50 patients (45 males &amp; 05 females) in the age group of 15-65 years with a diagnosis of acute pancreatitis, admitted to a tertiary government hospital from July 2017 to June 2019 were included. BISAP score, Ranson criteria, and MCTSI were calculated for all the cases. Then Ranson and BISAP criteria were compared with MCTSI, deciding optimum cut-offs for these scorings, by obtaining the area under the curve analysis. Results: As per Atlanta classification, 31 cases were mild, 8 cases categorized as severe and 11 were grouped as moderately severe acute pancreatitis. Out of 50 cases, Pancreatic necrosis was found in 13 cases. Similarly, 15 patients landed in organ failure. The AUC for MCTSI was found to be consistently higher for predicting severe acute pancreatitis (0.958), pancreatic necrosis (0.942), organ failure (0.941) than Ranson criteria and BISAP criteria. The AUC for Ranson and BISAP criteria in predicting severe acute pancreatitis was 0.904 and 0.874, predicting pancreatic necrosis was 0.876 and 0.896 &amp; in predicting organ failure was 0.881 and 0.880 respectively. Conclusion: MCTSI is more effective in detecting severe acute pancreatitis, organ failure, and pancreatic necrosis. So, the CECT scan is a better and simpler tool to detect the severity objectively for acute pancreatitis.

Correlations of Triglyceride with Type, Severity and Clinical Prognosis of Acute Pancreatitis.

The aim of this study was to explore the correlations of triglyceride (TG) with type, severity, and prognosis of acute pancreatitis (AP). A total of 184 AP patients treated from January 2017 to June 2019 were selected. The severity and prognosis were assessed through modified computed tomography severity index (MCTSI) score and sequential organ failure assessment (SOFA) score, respectively. They were divided into biliary AP (BAP) and hyperlipidemic AP (HLAP) groups, and their blood lipid levels were compared. According to TG level, they were divided into normal and elevation groups (> 1.70 mmol/L), and the general data, severity, and prognosis were compared. The elevation group was further divided into mild, moderate, and severe elevation groups, and severity and prognosis were compared. Logistic regression analysis was performed with presence or absence of severe AP (SAP) and systemic inflammatory response syndrome (SIRS) as dependent variables. The levels of TG, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (Apo-A1), and Apo-B in the HLAP group were significantly higher than those in the BAP group (p < 0.05). Age, gender ratio, and body mass index had significant differences between normal and elevation groups (p < 0.05). Compared with the normal group, the numbers of cases of SAP, SIRS and pleural effusion, MCTSI score and SOFA score significantly rose, and the relief time of abdominal pain and length of hospital stay were significantly prolonged in the elevation group (p < 0.05). The number of cases of SAP, SIRS, and pleural effusion was significantly greater in the severe elevation group than that in the other three groups (p < 0.05), and the number of SIRS cases was significantly greater in the mild and moderate elevation groups than that in the normal group (p < 0.05). TG was an independent risk factor for SAP and SIRS (p < 0.05). Patients with TG elevation mostly suffer from HLAP. Higher TG level meant higher tendency of SAP, higher incidence rate of SIRS and worse prognosis of AP patients.

High Resolution Computed Tomography findings and Computed Tomography severity index in COVID-19 Infection Correlated with Age and Gender

Introduction: The new coronavirus disease -19 (COVID-19) is caused by SARS-CoV2 strain of coronavirus. The Computed tomography (CT) severity index is a scoring system used to assess the lung changes and involvement by COVID-19 based on approximate estimation of pulmonary involved areas. This study was done to identify the spectrum of CT chest findings and CT severity index in COVID-19 infection and its correlation with age and gender.&#x0D; Methods: Patients with COVID-19 infection with positive PCR results and positive pulmonary CT findings were included in the study. All these patients underwent high-resolution computed tomography (HRCT) of the chest. The CT scan severity score in all of these patients was calculated and the results were analyzed by SPSS version 21.&#x0D; Results: A total of 104 patients with confirmed COVID-19 infection were included in this study. There were 59 males (56.73%) and 45 females (43.3%) in this study. There was a higher chest severity score in males compared to females. However, there was no significant correlation between the age and CT chest severity score.&#x0D; Conclusion: HRCT chest can help in the early identification of the patients who need intensive care. Early admission and intensive care of the patients with high CT severity scores may help to reduce the mortality of COVID-19 patients.

Clinicoradiological Correlation of Covid19 Patients in Western Uttar Pradesh, India: A Descriptive Study

Abstract: A pilot study of 150 patients at premier medical institute of western Uttar Pradesh, INDIA. The purpose of this pictorial review article is to describe the most common manifestations and patterns of lung abnormality on CXR in COVID-19 in order to equip the medical community in its efforts to combat this pandemic. The varied spectra of COVID-19 presentation included fever, cough, shortness of breath, sore throat etc. Diabetes mellitus, hypertension, COPD/K-Chest and CAD were found as major comorbid conditions. Symptomatic presentation of COVID-19 was observed to be higher in patients with co morbid disease, especially if multiple. HRCT chest in COVID-19 patients had a major diagnostic and prognostic importance as positive CT findings were more prominent in symptomatic patients and co-morbid patients. Clinical symptoms of patients directly correlated with CT severity index. CT imaging was found to be useful in predicting clinical recovery of patients or progression of disease. Introduction: COVID-19 (coronavirus disease 2019) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), declared as a pandemic on 11th March 2020. The chest imaging findings are nonspecific and most commonly show atypical or organizing pneumonia, often with a bilateral, peripheral and bi-basal predominant distribution. Our study is concerned with the data of COVID positive patients admitted in the institute for the period of March 16- May 17, 2020. Aims and Objectives 1) To correlate clinical and radiological spectra of covid positive patients and their final outcome. 2) To describe the spectrum of lung parenchyma changes in the symptomatic as well as asymptomatic in COVID- 19 patients. Review of literature: This case report series presents a summary of key findings frequently associated with COVID-19, which will assist radiologists and clinicians in preliminary clinical evaluation (PCE). Materials and Methods: The data for the study is sourced from clinically suspected patients from the Covid Ward, LLRM Medical College, Meerut,(U.P.),INDIA which were subjected to chest radiography on 60mAh portable X-Ray machine. The patients are followed up to correlate the findings with clinical outcome. The study has been conducted on a minimum of 150 patients with portable Chest X-Ray machine. Observations &amp; Discussion: The most frequent findings encountered are airspace opacities are viz- Hazy pulmonary opacities, Bilateral lower lobe consolidations, Peripheral air space opacities, Uncommon CXR findings, Diffuse air space disease. Conclusion: Based on our study, few inferences have been deduced; A significant proportion of the clinically symptomatic cases shows characteristic radiological changes on chest X-ray and also how chest radiography can be used as a tool not to substitute but supplement RTPCR in evaluation of COVID positive cases. Keywords: Patchy areas of consolidation, shortness of breath, high resolution CT Scan, RTPCR.

Clinical Outcomes and Prognostic Significance of Early vs. Late Computed Tomography in Acute Pancreatitis

Background and Aim: The prevalence of acute pancreatitis is still high with a mortality rate of 10-20% for the past two decades. Acute pancreatitis can be prognosis with computed tomography (CT) which correlates clinical outcomes, complications, and associated mortality rate. The current study aims were to evaluate the clinical outcomes and prognostic significance of early vs. late computed tomography in acute pancreatitis. Methodology: A cross-sectional study was carried out on 136 consecutive acute pancreatitis patients in the department of Gastroenterology and Radiology, Bahawal Victoria Hospital, Bahawalpur for duration of one year from August 2020 to July 2021. Patients with no abdominal CT due to pregnancy and CT performed after 14 days of pain onset were excluded. All the patients were categorized into two groups; Group-I where CT was performed after 4-5 days of pain onset and Group-II CT performed after 6-14 days of pain onset. The CT findings such as prognostic information, CT severity index and local complications were compared in both group. For data collection and analysis, SPSS version 21 was used. Results: Of the total 136 acute appendicitis patients, 92 (67.6%) were male and 44 (32.4%) were females with an age range of 18 to 60 years. The overall mean age was 42.45± 11.62 years. Group-I had 72 patients (early CT performed) and Group-II had 64 (47.1%) patients of late CT performed. The mean severity index of CT performed in early and late was 5.43±2.31 and 6.59±2.6; p=0.005). The severity index of CT was higher in late-performed computed tomography compared to early perform CT. The persistent organ failure had an almost similar incidence in both early and late CT performed (37.4% versus 48.7%; p&lt;0.125). Late CT performed group majority patients had local complications 82.6% compared to 67.4%; p&lt;0.021. No significant variance was found in surgery, percutaneous drainage need, and mortality (p&gt;0.05). Conclusion: Our study found that early CT does not have a negative impact on the outcome of acute pancreatitis. However, local complications were detected with the onset of symptoms in computed tomography after 5-days. Performing computed tomography before the hospitalization sixth day does not result in earlier intervention. Keywords: Computed tomography, Acute pancreatitis, Clinical outcomes

Evaluation of Pancreatic Lesions by Computed Tomography Scan: A Study Protocol

Background: The pancreas is a hidden organ and was one of the last organs in the abdomen to be analyzed by anatomists, physiologists, physicians, and surgeons. Pancreatic lesions may range from mild inflammation to malignancy. Ultrasound was the first cross-sectional technique that permitted direct imaging of the pancreas. It permitted precise visualization of pancreatic parenchyma, pancreatic ducts and bile ducts. This study aims to evaluate various pancreatic lesions using CT scan and assess their correlation with histopathological findings.&#x0D; Methodology: This will be an observational study conducted at department of radiodiagnosis, AVBRH, Wardha. Total 180 patients with pancreatic disease confirmed by clinical, laboratory and ultrasonography will be enrolled in the study. All 180 patients will undergo plain and contrast enhanced CT scan. Results will be judged, based on the observations and finding on CT scan, biochemical and histopathological reports whenever possible. Modified CT Severity Index / Mortele Modified CTSI Scoring will be used to assess severity of acute pancreatitis and acute exacerbation of chronic pancreatitis.&#x0D; Results: We expect to explore on the common etiological factors, gender and age distribution of various pancreatic diseases. Correlation between grade of acute pancreatitis according to modified CT severity index and clinical outcome of patients. In case of chronic will be evaluated. &#x0D; Conclusion: CECT is excellent diagnostic modality to stage severity of inflammatory process and staging of neoplastic lesions. Severity grading in acute exacerbation of chronic pancreatitis will be meticulously observed and significant conclusive findings will be found. CECT imaging with its postprocessing techniques represents the image of choice for diagnosis and predicting pancreatic masses.