Crazy-paving Pattern Research Articles

Chest CT Scan Features of COVID-19 in a Hospitalized High-Altitude Population

There is a lack of knowledge regarding the type of lung compromise in high-altitude residents with COVID-19. This study aims to evaluate the lung compromise in chest CT scans of high-altitude dwellers hospitalized with COVID-19. Retrospective study that took place in "Daniel Alcides Carrión" Regional Hospital, located 3,250 meters above sea level in the city of Huancayo, Perú. 464 medical charts and chest CT images of hospitalized patients with confirmed COVID-19 from January to March 2021 were reviewed. The mean age was 56 years, 63.1% of the patients were male, and 85.8% of individuals had a CORADS 5. Ground glass infiltrates were found in 93.8% of the patients; alveolar consolidations were present in 86% and were usually bilateral. Thickened septa were described in 46%, lattice pattern in 38.8%, reticular components in 39%, and the crazy paving pattern in 36.9%. Most patients (84.5%) had central and peripheral lesions; only 4% had limited peripheral compromise, and 10% solely central distribution. The left posterior basal segment was the most affected pulmonary segment in 27% of the cases, and the right basal posterior in 26%. Less affected segments were the right and left apical (14% and 13%, respectively). Lung compromise in patients with COVID-19 in this high-altitude population was severe, with mostly bilateral compromise, increased diameter of the pulmonary artery, periaortic and subaortic lymph nodes enlargement, and extensive ground glass and alveolar lesions.

Perbandingan CT-Scan thoraks pasien dengan infeksi COVID-19 varian Delta dan Omicron: sebuah systematic review

Background: During the COVID-19 pandemic, there have been a number of waves of infections that have resulted in a number of variants of concern (VoC), with the majority of the identified variants being the Delta and Omicron variants. A chest CT scan plays an important role in the diagnosis, complications, and prognosis of COVID-19 patients. This systematic review aims to compare chest CT scan images between COVID-19 patients infected with the Delta and Omicron variants. Methods: Study searches were conducted on three databases of electronic scientific journal publications, namely Google Scholar, PubMed, and Wiley Online Library. The study selection method used the PRISMA diagram with inclusion criteria are original study that examined a comparison of CT-scan images of the chest between COVID-19 patients with the Delta and Omicron variants. While the exclusion criteria set were studies in the form of commentaries, literature reviews, and meta-analyses, studies that were not available in Indonesian or English, and not available in full-text. Results: The ten studies included in this systematic review consisted of 10 retrospective cohort studies that compared CT-scan images of the chests of COVID-19 patients with Delta and Omicron variants. Radiological features evaluated from the ten studies included ground glass opacity (GGO), consolidation, crazy paving pattern, vascular dilation, air bronchogram, bronchial wall thickening, bronchiectasis, presence of reticulation, subpleural lines, fibrosis, halo sign, reverse halo sign (Atoll sign), air bubble sign, and presence of pleural effusion. The majority of these radiological features were found to be higher in the Delta variant compared to the Omicron. Whereas for the classification of chest CT scan images based on RSNA, typical images were also found more in the Delta variant. The CT severity score, CO-RADS score, and COV-RADS score were also found to be higher in the Delta variant compared to Omicron. Conclusion: In COVID-19 infection, the Delta variant showed a chest CT-scan showing typical COVID-19 pneumonia, whereas in the Omicron variant, more atypical features were found.

Chest computed tomography severity score is a reliable predictor of mortality in patients with chronic obstructive pulmonary disease co-infected with COVID-19

BackgroundCoronavirus disease 2019 (COVID-19) pandemic is considered a global health crisis. The data related to chronic obstructive pulmonary disease (COPD) patients with COVID-19 are incomplete, especially the findings of the chest computed tomography (CT). The aim of the current study was to investigate the severity of the disease of COVID-19 in patients with COPD based on CT severity score and to evaluate its predictive power in the mortality of patients.MethodsIn a retrospective study, demographic, clinical, and CT scan findings of COPD patients with COVID-19 were extracted from March 2020 to February 2022. CT severity score was determined based on the extent and nature of involvement of lungs in CT scan findings. By performing receiver operating characteristics (ROC) and Kaplan–Meier survival analysis were determined the disease severity and survival probability.ResultsThe most frequent radiological findings in chest CT scan included ground glass opacities (89.3%), consolidations (51.8%), crazy-paving pattern (46.4%), and septal thickening (35.7%). The mean CT severity score of deceased patients (34.61 ± 18.73) was significantly higher than recovered patients (16.71 ± 14.01, p < 0.001). Based on the ROC and Kaplan–Meier survival curves, it was revealed that CT severity score was a valuable criteria in the diagnosis of mortality in COPD patients with COVID-19.ConclusionThe findings of this study revealed that the CT severity scoring in COPD patients with COVID-19 was valuable in identifying poor prognosis, although further studies are needed.

Computed tomography findings in COVID-19 and atypical pneumonia: a comparative study.

Computed tomography (CT) has an important role in the rapid diagnosis, treatment, and management of lower respiratory tract infections. This study aimed to explore different imaging characteristics between Coronavirus disease 2019 (COVID-19) and atypical pneumonia (non-COVID-19) on chest CT of patients admitted to the emergency department. CT features of 120 patients with positive Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase-polymerase chain reaction (RT-PCR) and 83 patients with negative SARS-CoV-2 by RT-PCR but positive respiratory tract sample test results for other respiratory pathogens were retrospectively evaluated, findings were recorded and compared between the two groups. Compared to non-COVID-19, COVID-19 patients were more likely to have a peripheral (60.5% vs. 23.8%, p < 0.001) and bilateral distribution (72.3% vs. 41.3%, p < 0.001), patchy consolidations (45% vs. 28.9%, p = 0.021), ground glass opacity (GGO) (94.2% vs. 83.1%, p = 0.011), crazy paving patterns (55% vs. 31.3%, p < 0.001); but less likely to have centrilobular nodules (15% vs. 62.7%, p < 0.001), pleural effusion (3.3% vs. 10.8%, p = 0.032), multifocal consolidations (7.5% vs. 21.7%, p = 0.003), and random distribution (1.7% vs. 46.3%, p < 0.001). There were significant differences between the CT patterns of patients with COVID-19 and other atypical pneumonia. The presence of patchy consolidations, GGO, crazy paving patterns with typical peripheral, bilateral distribution, and absence of centrilobular nodules, pleural effusion, and multifocal consolidations may help to differentiate COVID-19 from atypical pneumonia.

Caracterización metabólica de los cambios pulmonares estructurales en pacientes con hallazgos incidentales sugestivos de neumonía por COVID-19 en estudios 18F-FDG PET/CT. Perspectivas fisiopatológicas de imágenes multimodales obtenidas durante la pandemia

PurposeTo evaluate the metabolic uptake of different tomographic signs observed in patients with incidental structural findings suggestive of COVID-19 pneumonia through 18F-FDG PET/CT. Material and methodsWe retrospectively analyzed 596 PET/CT studies performed from February 21, 2020 to April 17, 2020. After excluding 37 scans (non-18F-FDG PET tracers and brain studies), we analyzed the metabolic activity of several structural changes integrated in the CO-RADS score using the SUVmax of multimodal studies with 18F-FDG. ResultsForty-three patients with 18F-FDG PET/CT findings suggestive of COVID-19 pneumonia were included (mean age: 68±12.3 years, 22 male). SUVmax values were higher in patients with CO-RADS categories 5–6 than in those with lower CO-RADS categories (6.1±3.0 vs. 3.6±2.1, p=0.004). In patients with CO-RADS 5–6, ground-glass opacities, bilaterality and consolidations exhibited higher SUVmax values (p-values of 0.01, 0.02 and 0.01, respectively). Patchy distribution and crazy paving pattern were also associated with higher SUVmax (p-values of 0.002 and 0.01). After multivariate analysis, SUVmax was significantly associated with a positive structural diagnosis of COVID-19 pneumonia (odds ratio=0.63, 95% confidence interval=0.41–0.90; p=0.02). The ROC curve of the regression model intended to confirm or rule out the structural diagnosis of COVID-19 pneumonia showed an AUC of 0.77 (standard error=0.072, p=0.003). ConclusionsIn those patients referred for standard oncologic and non-oncologic indications (43/559; 7.7%) during pandemic, imaging with 18F-FDG PET/CT is a useful tool during incidental detection of COVID-19 pneumonia. Several CT findings characteristic of COVID-19 pneumonia, specifically those included in diagnostic CO-RADS scores (5–6), were associated with higher SUVmax values.

Metabolic characterization of structural lung changes in patients with findings suggestive of incidental COVID-19 pneumonia on 18F-FDG PET/CT. Pathophysiological insights from multimodal images obtained during the pandemic

PurposeTo evaluate the metabolic uptake of different tomographic signs observed in patients with incidental structural findings suggestive of COVID-19 pneumonia through 18F-FDG PET/CT. Materials and Methods: We retrospectively analyzed 596 PET/CT studies performed from February 21, 2020 to April 17, 2020. After excluding 37 scans (non-18F-FDG PET tracers and brain studies), we analyzed the metabolic activity of several structural changes integrated in the CO-RADS score using the SUVmax of multimodal studies with 18F-FDG. ResultsForty-three patients with 18F-FDG PET/CT findings suggestive of COVID-19 pneumonia were included (mean age: 68±12.3 years, 22 male). SUVmax values were higher in patients with CO-RADS categories 5−6 than in those with lower CO-RADS categories (6.1±3.0 vs. 3.6±2.1, p=0.004). In patients with CO-RADS 5−6, ground-glass opacities, bilaterality and consolidations exhibited higher SUVmax values (p-values of 0.01, 0.02 and 0.01, respectively). Patchy distribution and crazy paving pattern were also associated with higher SUVmax (p-values of 0.002 and 0.01). After multivariate analysis, SUVmax was significantly associated with a positive structural diagnosis of COVID-19 pneumonia (odds ratio=0.63, 95% confidence interval=0.41−0.90; p=0.02). The ROC curve of the regression model intended to confirm or rule out the structural diagnosis of COVID-19 pneumonia showed an AUC of 0.77 (standard error=0.072, p=0.003). ConclusionsIn those patients referred for standard oncologic and non-oncologic indications (43/559; 7.7%) during pandemic, imaging with 18F-FDG PET/CT is a useful tool during incidental detection of COVID-19 pneumonia. Several CT findings characteristic of COVID-19 pneumonia, specifically those included in diagnostic CO-RADS scores (5−6), were associated with higher SUVmax values.

Comparison between original SARS-CoV-2 strain and omicron variant on thin-section chest CT imaging of COVID-19 pneumonia.

We investigated different computed tomography (CT) features between Omicron-variant and original-strain SARS-CoV‑2 pneumonia to facilitate the clinical management. Medical records were retrospectively reviewed to select patients with original-strain SARS-CoV‑2 pneumonia from February22 to April22, 2020, or Omicron-variant SARS-CoV‑2 pneumonia from March26 to May31, 2022. Data on the demographics, comorbidities, symptoms, clinical types, and CT features were compared between the two groups. There were 62 and 78patients with original-strain or Omicron-variant SARS-CoV‑2 pneumonia, respectively. There were no differences between the two groups in terms of age, sex, clinical types, symptoms, and comorbidities. The main CT features differed between the two groups (p = 0.003). There were37 (59.7%) and 20 (25.6%) patients with ground-glass opacities (GGO) in the original-strain and Omicron-variant pneumonia, respectively. Aconsolidation pattern was more frequently observed in the Omicron-variant than original-strain pneumonia (62.8% vs. 24.2%). There was no difference in crazy-paving pattern between the original-strain and Omicron-variant pneumonia (16.1% vs. 11.6%). Pleural effusion was observed more often in Omicron-variant pneumonia, while subpleural lesions were more common in the original-strain pneumonia. The CT score in the Omicron-variant group was higher than that in the original-strain group for critical-type (17.00, 16.00-18.00 vs. 16.00, 14.00-17.00, p = 0.031) and for severe-type (13.00, 12.00-14.00 vs 12.00, 10.75-13.00, p = 0.027) pneumonia. The main CT finding of the Omicron-variant SARS-CoV‑2 pneumonia included consolidations and pleural effusion. By contrast, CT findings of original-strain SARS-CoV‑2 pneumonia showed frequent GGO and subpleural lesions, but without pleural effusion. The CT scores were also higher in the critical and severe types of Omicron-variant than original-strain pneumonia.

Assessment of COVID-19 RT-PCR Positive Symptomatic Patients With Clinical, Hematological, and Radiological Parameters Among Three Groups: A Comparative Study.

Nearly 70.1 million individuals have been infected by the pandemic viral disease known as coronavirus disease 2019 (COVID-19), which was first discovered in China and is caused by a novel coronavirus known as severe acute respiratory syndrome coronavirus 2(SARS‑CoV‑2). This disease is responsible for the deaths of 6 million people. India ranks third in the total number of cases. The purpose of this study was to classify COVID-19 patients according to several criteria and to determine which clinical, hematological, and radiological indicators were most important in their care. An analytical cross-sectionalstudy was conducted on a total of 70 symptomatic patients who tested positive for COVID-19 reverse transcription polymerase chain reaction(RT-PCR)and were hospitalized at the Saveetha Medical College and Hospital in Chennai, Tamil Nadu, India, for the duration of the study. Comorbidities and oxygen reliance were taken into consideration while classifying patients into one of three categories. Initial symptoms, as well as hematological (interleukin-6 (IL-6),erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), D-dimer, serum ferritin, and total cell counts) and radiographic (X-ray and computed tomography (CT) of the thorax) characteristics, were taken and analyzed among the different groups. According to our research, the symptom of fever was the most common, accounting for 84.3% of all cases. This was followed by breathlessness (55.7%), myalgia (31.4%), dry cough (27.1%), sore throat (24.3%), cough with expectoration (20%), loose stools (12.9%), loss of taste (12.9%), and smell (11.4%). Although there was a large amount of variation in D-dimer, with Category C having the highest values, there was only a minor amount of variation in ESR and CRP. The X-ray and CT scans of the chest showed substantial differences between the groups, with CT findings such as COVID-19 Reporting and Data System(CO-RADS)and CT severity score, consolidation, crazy paving pattern, and vascular dilatation showing a wide range of differences between the groups. To facilitate easier treatment and place more attention on radiological characteristics using D-dimer, treating physicians are required to categorize COVID-19 patients into several groups. Patients who need oxygen support were included in this category.

The importance of chest CT severity score and lung CT patterns in risk assessment in COVID-19-associated pneumonia: a comparative study.

Chest computed tomography (CT) is suitable to assess morphological changes in the lungs. Chest CT scoring systems (CCTS) have been developed and use in order to quantify the severity of pulmonary involvement in COVID-19. CCTS has also been correlated with clinical outcomes. Here we wished to use a validated, relatively simple CTSS to assess chest CT patterns and to correlate CTSS with clinical outcomes in COVID-19. Altogether 227 COVID-19 cases underwent chest CT scanning using a 128 multi-detector CT scanner (SOMATOM Go Top, Siemens Healthineers, Germany). Specific pathological features, such as ground-glass opacity (GGO), crazy-paving pattern, consolidation, fibrosis, subpleural lines, pleural effusion, lymphadenopathy and pulmonary embolism were evaluated. CTSS developed by Pan et al. (CTSS-Pan) was applied. CTSS and specific pathologies were correlated with demographic, clinical and laboratory data, A-DROP scores, as well as outcome measures. We compared CTSS-Pan to two other CT scoring systems. The mean CTSS-Pan in the 227 COVID-19 patients was 14.6 ± 6.7. The need for ICU admission (p < 0.001) and death (p < 0.001) were significantly associated with higher CTSS. With respect to chest CT patterns, crazy-paving pattern was significantly associated with ICU admission. Subpleural lines exerted significant inverse associations with ICU admission and ventilation. Lymphadenopathy was associated with all three outcome parameters. Pulmonary embolism led to ICU admission. In the ROC analysis, CTSS>18.5 significantly predicted admission to ICU (p = 0.026) and CTSS>19.5 was the cutoff for increased mortality (p < 0.001). CTSS-Pan and the two other CTSS systems exerted similar performance. With respect to clinical outcomes, CTSS-Pan might have the best performance. CTSS may be suitable to assess severity and prognosis of COVID-19-associated pneumonia. CTSS and specific chest CT patterns may predict the need for ventilation, as well as mortality in COVID-19. This can help the physician to guide treatment strategies in COVID-19, as well as other pulmonary infections.

Fat embolism syndrome causing a crazy-paving pattern on CT.

Fat embolism syndrome causing a crazy-paving pattern on CT.

Post-COVID-19 Pulmonary Alveolar Proteinosis Treated Successfully with Whole Lung Lavage: A Rare Case Report.

Pulmonary alveolar proteinosis (PAP) is an uncommon disease and its diagnosis remains challenging. During the COVID-19 pandemic, it has been difficult to distinguish between PAP and post-COVID-19 pulmonary sequelae. Here we present a case of a 44-year-old male patient who experienced exertional dyspnea after recovering from COVID-19. He was initially diagnosed with post-COVID-19 syndrome and treated with systemic corticosteroid without improvement. Chest computed tomography (CT) showed crazy-paving pattern with ground-glass opacities. Fibreoptic bronchoscopy with bronchial lavage fluid (BLF) analysis confirmed the final diagnosis of PAP. The patient underwent left lung lavage in combination with conventional therapy and experienced significant improvement in his respiratory condition and overall health during follow-up. Hence, PAP could occur after a COVID-19 infection. This case highlights the importance of considering PAP as a potential diagnosis in patients with persistent respiratory symptoms after COVID-19. The high suspicion indicators of PAP revealed by chest-CT and BLF may be a key to differentiating PAP from post-COVID-19 pulmonary sequelae. Moreover, it is plausible that SARS-CoV-2 plays a role in the development of proteinosis, either by inducing a flare-up or by directly causing the condition.

ROLE OF FOLLOW UP HIGH RESOLUTION COMPUTED TOMOGRAPHY LUNG IN POST COVID 19 INFECTION.

Background: The novel Coronavirus disease 2019 (COVID-19) is an illness caused due to SARS-CoV-2 and are primarily related to the pulmonary system. High resolution computed tomography is used to radiological pattern and manifestation of post covid-19 infection after 1 and 6 months. On High resolution computed tomography small patchy, ground-glass opacity (GGO), and consolidations , interlobular septal thickening, crazy-paving pattern, parenchymal bands , traction bronchiectasis and coarse reticulation were more common in patients. Material &amp; Methods: This was prospective observational study time bound study conducted in a tertiary care center in 160 patients of clinically diagnosed covid 19. HRCT was done at admission, after 1 month and at 6month with radiological nding studied and interpreted in detail. 1) Follow up Results: HRCT lung at one month has shown that most common nding was parenchymal bands in 97 (60.63%) cases followed by interlobular septal thickening in 93 (58.13%), ground glass opacity in 60 (37.5%), tractional bronchiectasis in 54 (33.75%), honeycombing/coarse reticular pattern/brotic changes in 37 (23.13%), consolidation in 25 (15.63%), air bronchogram in 05 (3.13%) &amp; emphysematous changes in 1 (0.6%) case. 2)Follow up HRCT lung at six months has shown that most common nding was interlobular septal thickening in 42 (26.25%) followed by parenchymal bands in 40 (25%) cases, tractional bronchiectasis in 41 (26.63%), honeycombing/coarse reticular pattern/brotic changes in 20 (12.5%), GGO in 15 (9.38%), consolidation in 06 (3.75%) &amp; emphysematous changes in 1 (0.6%) case. Conclusion: 1)HRCT is the modality which diagnoses the severity of disease and post covid 19 disease manifestation. 2)At one month there was persistence of honeycombing/coarse reticular pattern/brotic changes, interlobular septal thickening, parenchymal bands, tractional bronchiectasis &amp; emphysematous changes. 3)At six months there was persistence of tractional bronchiectasis &amp; emphysematous changes indicating persistence &amp; irreversibility of these changes

Pulmonary computed tomographic manifestations of COVID-19 in vaccinated and non-vaccinated patients

This study aimed to analyze computed tomographic (CT) imaging features of vaccinated and non-vaccinated COVID-19 patients. The study population of this retrospective single-center cohort study consisted of hospitalized COVID-19 patients who received a chest CT at the study site between July 2021 and February 2022. Qualitative scoring systems (RSNA, CO-RADS, COV-RADS), imaging pattern analysis and semi-quantitative scoring of lung changes were assessed. 105 patients (70,47% male, 62.1 ± 16.79 years, 53.3% fully vaccinated) were included in the data analysis. A significant association between vaccination status and the presence of the crazy-paving pattern was observed in univariate analysis and persisted after step-wise adjustment for possible confounders in multivariate analysis (RR: 2.19, 95% CI: [1.23, 2.62], P = 0.024). Scoring systems for probability assessment of the presence of COVID-19 infection showed a significant correlation with the vaccination status in univariate analysis; however, the associations were attenuated after adjustment for virus variant and stage of infection. Semi-quantitative assessment of lung changes due to COVID-19 infection revealed no association with vaccination status. Non-vaccinated patients showed a two-fold higher probability of the crazy-paving pattern compared to vaccinated patients. COVID-19 variants could have a significant impact on the CT-graphic appearance of COVID-19.

Spectrum of CT-Scan Findings in Symptomatic and Asymptomatic Patients of SARS-CoV-2 Disease: An African Series

In this paper, we studied retrospectively the Chest CT-scan chest of 118 SARS-CoV-2 disease cases confirmed by Polymerase Chain Reaction (PCR). We identified and characterized the most common CT findings, and compared such findings in the asymptomatic patients with those patients that presented with findings in patients with mild form of the disease. Bilateral pulmonary parenchyma ground-glass and consolidative pulmonary opacities, sometimes with a rounded morphology and a peripheral lung distribution were the most common CT findings. These were often associated with reticular and crazy paving pattern. Pleural and pericardial effusions were rare and mainly present in diffuse lung involvement. Most of our patient showed minimal lung involvement. There was no statistical significant difference in CT findings between asymptomatic patients and those with mild symptoms.

Variation of Chest Computed Tomographic Findings in Coronavirus Disease-19 (COVID-19) Positive Patients in a Tertiary Care Hospital, Bangladesh

Background: We aimed to report different patterns of chest computed tomographic (CT) findings in coronavirus disease-19 (COVID-19) infected patients in Bangladesh.&#x0D; Methods: This was a cross-sectional descriptive study of 200 consecutive reverse transcriptase polymerase chain reaction (RT-PCR) positive patients who underwent CT chest. Distribution, type of abnormal lung findings and Prevalence were recorded.&#x0D; Result: Among the total study cohort of 200 patients, 148(74 %) were males and 52 (26 %) were females with mean age of 53.9 ± 16.7 years (range 20–92 years). We observed lung parenchymal abnormalities in 125 (62.0 %) cases whereas 75 (37.5 %) RT-PCR positive cases had a normal chest CT. Common symptom was cough in 108 (54%), Only 18.0% of the patients were dyspneic. Among the patients with abnormal CT findings bilateral involvement was commonest 98/125 (78.4 %), multilobar (54.0 %) lung involvement with a predominant peripheral and posterior distribution was more commonly observed. With regards to the type of opacity, ground glass opacity (GGO) was the predominant abnormality found in 122/125 cases. Pure GGO was observed in 29 (23.2 %), most common pattern was GGO mixed with consolidation was noted in 52(41.6 %). GGO with crazy paving pattern was seen in 33 (26.4 %) and sub pleural linear and curvilinear lines were seen in 23(18.4%). Peri-lesional or intralesional segmental or subsegmental pulmonary vessel enlargement was observed in 36 (70.6 %) cases.&#x0D; Conclusion: In this study population, we found a high proportion of symptomatic laboratory-confirmed SARS-CoV-2 patients had positive chest CT findings. Patients with a positive CT showed typical findings of predominant GGOs in a bilateral and multilobar distribution with peripheral predilection.&#x0D; AKMMC J 2021; 12(1) : 38-44

Radiological Evolution of Patients with COVID-19 Pneumonia Treated with Low-Dose Radiotherapy

Background: The main objective of this work is to describe the findings and radiological evolution on chest CT of 27 patients with COVID-19 pneumonia after being treated with LD-RT in a prospective study. We also evaluated the interobserver agreement in assessing the extent of lung involvement. Patients and Methods: 3 CTs were compared: day of treatment, one week later, and at 4-7 months. In each CT the following radiological findings were evaluated in each lobe: extension score (0: none, 0%; 1: minimal, 1-5%; 2: mild, 5-25%, 3: mild-moderate, 26-50%; 4: moderate, 51-75%; 5: severe, 76-100%), GGO, consolidation, crazy-paving pat-tern, subpleural lines, parenchymal bands, and pulmonary fibrosis. Results: A statistically significant decrease in the number of affected lobes with consolidations and GGO was found between the second and third CT (p=0.023 and p=0.003, respectively) and between the first and third CT (p=0.012 and p=0.006). No significant changes were identified regarding the presence of fibrosis. There was a significant decrease of the extension score when comparing the three studies (1st vs 2nd p=0.029, 2nd vs 3rd p&lt;0.001, and 1st vs 3rd p&lt;0.001). A very good concordance was found in the evaluation of the extension score and the presence of consolidations, there was a moderate agreement when assessing the fibrosis and only a mild agreement on the GGO. Conclusions: Our study suggests that patients with COVID-19 pneumonia treated with LD-RT show radiological improvement of consolidations and GGO on long-term follow-up chest CT, with no significant increase in pulmonary fibrosis identified.

Ultra-Low Dose CT Chest in Acute COVID-19 Pneumonia: A Pilot Study from India.

The rapid increase in the number of CT acquisitions during the COVID-19 pandemic raised concerns about increased radiation exposure to patients and the resultant radiation-induced health risks. It prompted researchers to explore newer CT techniques like ultra-low dose CT (ULDCT), which could improve patient safety. Our aim was to study the utility of ultra-low dose CT (ULDCT) chest in the evaluation of acute COVID-19 pneumonia with standard-dose CT (SDCT) chest as a reference standard. This was a prospective study approved by the institutional review board. 60 RT-PCR positive COVID-19 patients with valid indication for CT chest underwent SDCT and ULDCT. ULDCT and SDCT were compared in terms of objective (noise and signal-to-noise ratio) and subjective (noise, sharpness, artifacts and diagnostic confidence) image quality, various imaging patterns of COVID-19, CT severity score and effective radiation dose. The sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of ULDCT for detecting lung lesions were calculated by taking SDCT as a reference standard. The mean age of subjects was 47.2 ± 10.7 years, with 66.67% being men. 90% of ULDCT scans showed no/minimal noise and sharp images, while 93.33% had image quality of high diagnostic confidence. The major imaging findings detected by SDCT were GGOs (90%), consolidation (76.67%), septal thickening (60%), linear opacities (33.33%), crazy-paving pattern (33.33%), nodules (30%), pleural thickening (30%), lymphadenopathy (30%) and pleural effusion (23.33%). Sensitivity, specificity and diagnostic accuracy of ULDCT for detecting most of the imaging patterns were 100% (p < 0.001); except for GGOs (sensitivity: 92.59%, specificity: 100%, diagnostic accuracy: 93.33%), consolidation (sensitivity: 100%, specificity: 71.43%, diagnostic accuracy: 93.33%) and linear opacity (sensitivity: 90.00%, specificity: 100%, diagnostic accuracy: 96.67%). CT severity score (range: 15-25) showed 100% concordance on SDCT and ULDCT, while effective radiation dose was 4.93 ± 1.11 mSv and 0.26 ± 0.024 mSv, respectively. A dose reduction of 94.38 ± 1.7% was achieved with ULDCT. Compared to SDCT, ULDCT chest yielded images of reasonable and comparable diagnostic quality with the advantage of significantly reduced radiation dose; thus, it can be a good alternative to SDCT in the evaluation of COVID-19 pneumonia.

COVID-19 chest CT and laboratory features of B.1.617.2 (Delta variant) vs B.1.1.7 (Alpha variant) surge: a single center case-control study.

To assess clinical, laboratory and radiological differences between Delta and Alpha SARS-CoV-2 variants. Twenty SARS-CoV-2 patients admitted from 30th of August to 30th of October 2021 (period with estimated highest prevalence of Delta variant circulation in Italy) were enrolled. Patients were matched in a 1:1 ratio with same gender and same age +/- 2 years controls admitted from 1st of September 2020 to 30th of January 2021 (predominant circulation of Alpha variant). Chest computed tomography (CT) were retrospectively evaluated. Main clinical parameters, radiological and laboratory findings were compared between two groups. Patients with probable Delta variant had significantly higher CT severity scores, lower PaO2/FiO2 ratio and higher C-reactive protein and lactate dehydrogenase levels at admission. On multivariate analysis, probable Delta variant infection was associated with higher CT severity score. Ground glass opacities and crazy paving patterns were more frequently noticed than consolidation, with the latter being more frequent in Delta cohort, even though not significantly. According to prevalent imaging pattern, the consolidation one was significantly associated with pregnancy (p=0.008). Patients admitted during predominance of Delta variant circulation had a more severe lung involvement compared to patients in infected when Alpha variant was predominant. Despite imaging pattern seems to be not influenced by viral variant and other clinical variables, the consolidative pattern was observed more frequently in pregnancy.

Can a chest HRCT-based crash course on COVID-19 cases make inexperienced thoracic radiologists readily available to face the next pandemic?

ObjectiveTo test the inter-reader agreement in assessing lung disease extent, HRCT signs, and Radiological Society of North America (RSNA) categorization between a chest-devoted radiologist (CR) and two HRCT-naïve radiology residents (RR1 and RR2) after the latter attended a COVID-19-based chest high-resolution computed tomography (HRCT) “crash course”. MethodsThe course was built by retrospective inclusion of 150 patients who underwent HRCT for COVID-19 pneumonia between November 2020 and January 2021. During a first 10-days-long “training phase”, RR1 and RR2 read a pool of 100/150 HRCTs, receiving day-by-day access to CR reports as feedback. In the subsequent 2-days-long “test phase”, they were asked to report 50/150 HRCTs with no feedback. Test phase reports of RR1/RR2 were then compared with CR using unweighted or linearly-weighted Cohen's kappa (k) statistic and intraclass correlation coefficient (ICC). ResultsWe observed almost perfect agreement in assessing disease extent between RR1-CR (k = 0.83, p < 0.001) and RR2-CR (k = 0.88, p < 0.001). The agreement between RR1-CR and RR2-CR on consolidation, crazy paving pattern, organizing pneumonia (OP) pattern, and pulmonary artery (PA) diameter was substantial (k = 0.65 and k = 0.68), moderate (k = 0.42 and k = 0.51), slight (k = 0.10 and k = 0.20), and good-to-excellent (ICC = 0.87 and ICC = 0.91), respectively. The agreement in providing RSNA categorization was moderate for R1 versus CR (k = 0.56) and substantial for R2 versus CR (k = 0.67). ConclusionHRCT-naïve readers showed an acceptable overall agreement with CR, supporting the hypothesis that a crash course can be a tool to readily make non-subspecialty radiologists available to cooperate in reading high burden of HRCT examinations during a pandemic/epidemic.

Challenges in the Differential Diagnosis of COVID-19 Pneumonia: A Pictorial Review.

COVID-19 pneumonia represents a maximum medical challenge due to the virus's high contagiousness, morbidity, and mortality and the still limited possibilities of the health systems. The literature has primarily focused on the diagnosis, clinical-radiological aspects of COVID-19 pneumonia, and the most common possible differential diagnoses. Still, few studies have investigated the rare differential diagnoses of COVID-19 pneumonia or its overlap with other pre-existing lung pathologies. This article presents the main radiological features of COVID-19 pneumonia and the most common alternative diagnoses to establish the vital radiological criteria for a differential diagnosis between COVID-19 pneumonia and other lung pathologies with similar imaging appearance. The differential diagnosis of COVID-19 pneumonia is challenging because there may be standard radiologic features such as ground-glass opacities, crazy paving patterns, and consolidations. A multidisciplinary approach is crucial to define a correct final diagnosis, as an overlap of COVID-19 pneumonia with pre-existing lung diseases is often possible and suggests possible differential diagnoses. An optimal evaluation of HRTC can help limit the clinical evolution of the disease, promote therapy for patients and ensure an efficient allocation of human and economic resources.