Chest CT Scan Research Articles

Pectoral muscle mass is not a robust prognostic factor for survival after left ventricular assist device (LVAD) implantation

BackgroundLeft ventricular assist devices (LVAD) are an established treatment for end-stage left ventricular heart failure. Parameters are needed to identify the most appropriate patients for LVADs. This study aimed to evaluate pectoral muscle mass and density as prognostic parameters.MethodsThis single-center study included all patients with LVAD implantation between January 2010 and October 2017 and a preoperative chest CT scan. Pectoral muscle mass was assessed using the Pectoralis Muscle Index (PMI, surface area indexed to height, cm2/m2) and pectoral muscle density by Hounsfield Units (HU). Overall mortality was analyzed with Kaplan–Meier survival analysis and 1-year and 3-year mortality with receiver operating characteristic (ROC) curves and Cox regression models.Results57 patients (89.5% male, mean age 57.8 years) were included. 64.9% of patients had end-stage left ventricular failure due to ischemic heart disease and 35.1% due to dilated cardiomyopathy. 49.2% of patients had preoperative INTERMACS profile of 1 or 2 and 33.3% received mechanical circulatory support prior to LVAD implantation. Total mean PMI was 4.7 cm2/m2 (± 1.6), overall HU of the major pectoral muscle was 39.0 (± 14.9) and of the minor pectoral muscle 37.1 (± 16.6). Mean follow-up was 2.8 years (± 0.2). Mortality rates were 37.5% at 1 year and 48.0% at 3 years. Neither PMI nor HU were significantly associated with overall mortality at 1-year or 3-year.ConclusionsThe results of our study do not confirm the association between higher pectoral muscle mass and better survival after LVAD implantation previously described in the literature.

Epidemiology of Schmorl's Node in the Thoracic Spine: A Subtype Analysis.

Retrospective observational study. To describe the epidemiology of Schmorl's nodes (SN) of primarily developmental cause (SNd) and SN of primarily acquired cause (SNa) separately in the thoracic spine in subjects aged 35 to 90 years old. The epidemiology of SN and its relationship with age and gender remain controversial. On the basis of a pathophysiological hypothesis and the different morphologic characteristics, two subtypes of SN may exist and should be considered separately. Chest CT scans of subjects who came to our institution for health checks aged 35 to 90 years old were retrospectively reviewed. The presence or absence of SN was recorded for each thoracic vertebra. The SNs were further classified into SNd and SNa. The prevalence, location, and relationship with age, gender, and bone mineral density (BMD) were evaluated separately for the two subtypes. Of the 848 subjects (407 female, mean age: 53±12.2yr) included, 15.7% had SNs. Of the 303 SNs, 49.2% were SNd, and 48.5% were SNa. Aging increased the prevalence of SNa, while it was not related to the prevalence of SNd. Males had significantly more SNd than females (11.3% vs. 4.7%, P <0.001), while the prevalence of SNa was not different between the two genders (10.2% vs. 9.1%, P =0.666). A similar distribution of SNd and SNa among thoracic vertebral levels was appreciated, with T9 most frequently involved. Subjects with SNa had lower lumbar BMD than controls ( P =0.006), while no significant difference in BMD was found between subjects with SNd and controls ( P =0.166). The clinical characteristics of SN differ based on the developmental and acquired subtypes, including the relationship with age, gender, and BMD. The subtypes may be considered distinct clinical entities as a result.

Performance Analysis in Children of Traditional and Deep Learning CT Lung Nodule Computer-Aided Detection Systems Trained on Adults.

BACKGROUND. Although primary lung cancer is rare in children, chest CT is commonly performed to assess for lung metastases in children with cancer. Lung nodule computer-aided detection (CAD) systems have been designed and studied primarily using adult training data, and the efficacy of such systems when applied to pediatric patients is poorly understood. OBJECTIVE. The purpose of this study was to evaluate in children the diagnostic performance of traditional and deep learning CAD systems trained with adult data for the detection of lung nodules on chest CT scans and to compare the ability of such systems to generalize to children versus to other adults. METHODS. This retrospective study included pediatric and adult chest CT test sets. The pediatric test set comprised 59 CT scans in 59 patients (30 boys, 29 girls; mean age, 13.1 years; age range, 4-17 years), which were obtained from November 30, 2018, to August 31, 2020; lung nodules were annotated by fellowship-trained pediatric radiologists as the reference standard. The adult test set was the publicly available adult Lung Nodule Analysis (LUNA) 2016 subset 0, which contained 89 deidentified scans with previously annotated nodules. The test sets were processed through the traditional FlyerScan (github.com/rhardie1/FlyerScanCT) and deep learning Medical Open Network for Artificial Intelligence (MONAI; github.com/Project-MONAI/model-zoo/releases) lung nodule CAD systems, which had been trained on separate sets of CT scans in adults. Sensitivity and false-positive (FP) frequency were calculated for nodules measuring 3-30 mm; nonoverlapping 95% CIs indicated significant differences. RESULTS. Operating at two FPs per scan, on pediatric testing data FlyerScan and MONAI showed significantly lower detection sensitivities of 68.4% (197/288; 95% CI, 65.1-73.0%) and 53.1% (153/288; 95% CI, 46.7-58.4%), respectively, than on adult LUNA 2016 subset 0 testing data (83.9% [94/112; 95% CI, 79.1-88.0%] and 95.5% [107/112; 95% CI, 90.0-98.4%], respectively). Mean nodule size was smaller (p < .001) in the pediatric testing data (5.4 ± 3.1 [SD] mm) than in the adult LUNA 2016 subset 0 testing data (11.0 ± 6.2 mm). CONCLUSION. Adult-trained traditional and deep learning-based lung nodule CAD systems had significantly lower sensitivity for detection on pediatric data than on adult data at a matching FP frequency. The performance difference may relate to the smaller size of pediatric lung nodules. CLINICAL IMPACT. The results indicate a need for pediatric-specific lung nodule CAD systems trained on data specific to pediatric patients.

Prevalence of Covid-19 infection among healthcare workers in Central Hospitals of Covid-19 vs non-Covid-19 hospitals in Khuzestan Province, Iran.

Healthcare workers (HCWs) are at high risk of contracting Covid-19 due to their frontline roles and close interactions with infected patients. Understanding the prevalence of Covid-19 infection among HCWs and the factors contributing to it is crucial for informing mitigation strategies. However, the available data on Covid-19 infection rates among Iranian HCWs is limited. The primary objective of this study was to compare the prevalence of Covid-19 infection among HCWs working in hospitals dedicated to Covid-19 care versus HCWs in other non-Covid-19 hospitals in Khuzestan province, Iran. Additionally, the study aimed to identify potential risk factors associated with Covid-19 transmission and symptom severity in this population. This cohort study recruited 3,012 HCWs from 35 hospitals in Khuzestan province. Covid-19 diagnosis was made using RT-PCR testing, chest CT scans, and clinical examination. Overall, 96% (n=2,918) of the 3,012 HCWs were infected with Covid-19. The prevalence was significantly higher among HCWs from Covid-19 hospitals (59.83%, n=1,746) compared to those from non-Covid-19 hospitals (5.75%, n=168). The capital city of Ahvaz had the highest proportion of Covid-19 cases at 28%. HCWs, especially those working in hospitals dedicated to Covid-19 care, face a substantial risk of contracting the virus. The high infection rates observed may be attributed to factors like weakened immune systems, non-compliance with precautions, and delayed diagnosis. These findings underscore the critical need to strengthen infection control measures, improve access to personal protective equipment, and enhance surveillance of Covid-19 among frontline HCWs in Iran.

Pneumocystose

AbstractThe Pneumocystis genus includes some species belonging to Ascomycota phylum. These micromycetes are atypical because they are presently uncultivable, resistant to amphotericin B and azoles but sensitive to sulfonamides and echinocandins. They have a strong pulmonary tropism and are airborne transmitted between host mammals of the same species. Pneumocystis jirovecii (P. jirovecii) is the species infecting humans. It is responsible for severe pneumonia in patients infected with human immunodeficiency virus (HIV). Pneumocystis pneumonia (PCP) remains the most common AIDS defining opportunistic infection in metropolitan France. However, PCP is currently more commonly observed in immunocompromised patients not infected with HIV The symptoms of PCP include the triad, fever, dyspnea and dry cough associated with ground-glass pictures at the chest CT-scan in relation to bilateral alveolar-interstitial pneumonia.The biological diagnosis of PCP is based on the detection of P. jirovecii by microscopy and PCR in lung samples, with broncho-alveolar lavage fluid remaining the reference sample. β-1,3-D-glucan detection in serum is an additional useful diagnostic tool. The sulfamethoxazole-trimethoprim combination is the first-line treatment while pentamidine, atovaquone, dapsone, and echinocandins represent second-line treatments.

Prevalence of cutaneous manifestations and myositis-specific antibodies in COVID-19 patients and Anti-PL7 antibodies association with pulmonary radiological severity: A retrospective study.

Dermatomyositis (DM) is an idiopathic immune-mediated myopathy, and may involve many organs, including muscles, skin and lungs. Myositis-specific autoantibodies (MSAs) are a useful aid in diagnosis DM and identifying its clinical subtype. During the COVID-19 pandemic, several studies found clinical similarities regarding lung involvement in both COVID-19 and DM. Such similarities have prompted speculation of a common pathogenetic mechanism. Indeed, viral infections are well-known triggers of autoimmune diseases. This prompted us to investigate whether circulating MSAs could be markers of the severity of lung involvement and of clinical outcome in COVID-19 patients. Moreover, we investigated the presence of cutaneous signs of DM in COVID-19 patients. We conducted a retrospective cohort study on 178 hospitalized patients affected by COVID-19. The diagnosis was confirmed by naso-pharyngeal swab positivity for SARS-CoV-2. The severity of lung involvement was assessed by assigning to each patient a radiological score ranging from 1 to 4, based on chest imaging (chest X-rays or CT scans). Serum samples were tested for MSAs. Anti-PL-7 antibodies were detected in 10.1% of patients and were found to be associated with an increased risk of severe pulmonary involvement (p = 0.019) and a worse prognosis in COVID-19 patients. Cutaneous lesions were observed in 26.4% of patients. However, none were cutaneous manifestations of DM. The detection of anti-PL7 antibodies might predict severe pulmonary involvement and a worse prognosis in COVID-19 patients.

Folliculin gene-negative Birt-Hogg-Dube syndrome: a case report

Introduction and importance: Birt-Hogg-Dube (BHD) is a rare genetic disorder that results from a mutation in the folliculin (FLCN) gene. Manifestations include pulmonary cysts, fibrofolliculomas, renal tumors, and pneumothoraces. Genetic testing can be used to confirm the diagnosis when suspected. BHD syndrome is diagnosed in patients with negative FLCN gene results using diagnostic criteria. Case presentation: A male in his 20s presented with recurrent pneumothoraces. A physical examination revealed bumps on his face and upper body. A chest computed tomography scan revealed cystic lesions. Blood tests, ESR, and CRP levels were unremarkable. Punch skin biopsy revealed fibrofolliculomas. Genetic testing for the FLCN mutation returned negative. His history, physical exam, imaging, and histopathology suggested BHD syndrome despite having a negative family history and genetic analysis. Eventually, the patient was diagnosed with FLCN gene-negative BHD syndrome. Clinical discussion: More than a hundred families have been identified to have BHD worldwide. There are a few cases in the literature describing patients phenotypically presenting with BHD despite having a negative genetic analysis. One study in Japan found 16 out of 157 individuals having a clinical presentation of BHD with no mutations. Also, decreased expression of the FLCN mRNA may lead to BHD. Conclusion: BHD syndrome can present with a negative FLCN gene mutation; however, patients must meet the known diagnostic criteria such as criteria made by Menko et al., Gupta et al., and Schmidt et al. in order to have a diagnosis of BHD syndrome. Also, a qualitative decrease of FLCN with the absence of mutations may also lead to BHD.

Integrating artificial intelligence into lung cancer screening: a randomised controlled trial protocol

IntroductionLung cancer (LC) is the most common cause of cancer-related deaths worldwide. Its early detection can be achieved with a CT scan. Two large randomised trials proved the efficacy of...

Immune checkpoint inhibitors in cancer: the increased risk of atherosclerotic cardiovascular disease events and progression of coronary artery calcium

BackgroundImmune checkpoint inhibitors (ICIs) have contributed to a significant advancement in the treatment of cancer, leading to improved clinical outcomes in many individuals with advanced disease. Both preclinical and clinical investigations have shown that ICIs are associated with atherosclerosis and other cardiovascular events; however, the exact mechanism underlying this relationship has not been clarified.MethodsPatients diagnosed with stages III or IV non-small cell lung cancer (NSCLC) at the Wuhan Union Hospital from March 1, 2020, to April 30, 2022, were included in this retrospective study. Coronary artery calcium (CAC) volume and score were assessed in a subset of patients during non-ECG-gated chest CT scans at baseline and 3, 6, and 12 months after treatment. Propensity score matching (PSM) was performed in a 1:1 ratio to balance the baseline characteristics between the two groups.ResultsOverall, 1458 patients (487 with ICI therapy and 971 without ICI therapy) were enrolled in this cardiovascular cohort study. After PSM, 446 patients were included in each group. During the entire period of follow-up (median follow-up 23.1 months), 24 atherosclerotic cardiovascular disease (ASCVD) events (4.9%) occurred in the ICI group, and 14 ASCVD events (1.4%) in the non-ICI group, before PSM; 24 ASCVD events (5.4%) occurred in the ICI group and 5 ASCVD events (1.1%) in the non-ICI group after PSM. The CAC imaging study group comprised 113 patients with ICI therapy and 133 patients without ICI therapy. After PSM, each group consisted of 75 patients. In the ICI group, the CAC volume/score increased from 93.4 mm3/96.9 (baseline) to 125.1 mm3/132.8 (at 12 months). In the non-ICI group, the CAC volume/score was increased from 70.1 mm3/68.8 (baseline) to 84.4 mm3/87.9 (at 12 months). After PSM, the CAC volume/score was increased from 85.1 mm3/76.4 (baseline) to 111.8 mm3/121.1 (12 months) in the ICI group and was increased from 74.9 mm3/76.8 (baseline) to 109.3 mm3/98.7 (12 months) in the non-ICI group. Both cardiovascular events and CAC progression were increased after the initiation of ICIs.ConclusionsTreatment with ICIs was associated with a higher rate of ASCVD events and a noticeable increase in CAC progression.

Lung Involvement Patterns in COVID-19: CT Scan Insights and Prognostic Implications From a Tertiary Care Center in Southern India.

Background COVID-19, caused by the SARS-CoV-2 virus, has presented an unparalleled challenge and a profound learning curve globally. Among the myriad of investigative tools, CT scans of the chest have become instrumental in assessing the magnitude of lung involvement in the pathogenesis of this disease. Objectives This study aimed to evaluate the distribution and patterns of lung involvement depicted in the CT chest scans of COVID-19 patients admitted to a specialized tertiary care center located in a southern state of India. Methods With clearance secured from the Institutional Ethics Committee, an analytical cross-sectional study was conducted. It encompassed CT chest images from all symptomatic COVID-19 patients within the designated study center during the specified study timeline. Subsequent data analysis ensued. Results Among the 1066 COVID-19 patients evaluated, ground-glass opacities (GGO) were the predominant lung involvement pattern. Distinct patterns, such as GGOs combined with solid consolidation or atelectasis, were noted, with the highest mortality linked to GGOs paired with pneumomediastinum (PM). Data underscored a direct correlation between the extent of lung involvement and patient prognosis, with specific lung regions, namely the right apical, right posterior, right superior basal, left superior lingular, and left inferior lingular segments, showing frequent involvement. Conclusion Amidst the pandemic, our study emphasizes that ground-glass opacities on CT scans are robust indicators of COVID-19 in RT-PCR-positive patients. Early identification can enhance patient management, with findings highlighting a strong link between lung involvement and prognosis. This insight aids in refining patient triage, while further research is warranted to delve deeper into variations in lung involvement and guide treatment advancements.

Asthma exacerbation complicated by pneumomediastinum: Case report

Spontaneous pneumomediastinum is a rare entity that can complicate an asthma attack and can occur in young adults or adolescents. The abrupt onset of pneumomediastinum is usually associated with dyspnea, cough and chest pain. We report a case of severe asthma attack complicated by spontaneous pneumomediastinum in a 25-year-old female patient. Chest X-ray and CT scan confirmed the diagnosis. Progression was favorable within 6 days of treatment

Multi-kernel driven 3D convolutional neural network for automated detection of lung nodules in chest CT scans.

The accurate position detection of lung nodules is crucial in early chest computed tomography (CT)-based lung cancer screening, which helps to improve the survival rate of patients. Deep learning methodologies have shown impressive feature extraction ability in the CT image analysis task, but it is still a challenge to develop a robust nodule detection model due to the salient morphological heterogeneity of nodules and complex surrounding environment. In this study, a multi-kernel driven 3D convolutional neural network (MK-3DCNN) is proposed for computerized nodule detection in CT scans. In the MK-3DCNN, a residual learning-based encoder-decoder architecture is introduced to employ the multi-layer features of the deep model. Considering the various nodule sizes and shapes, a multi-kernel joint learning block is developed to capture 3D multi-scale spatial information of nodule CT images, and this is conducive to improving nodule detection performance. Furthermore, a multi-mode mixed pooling strategy is designed to replace the conventional single-mode pooling manner, and it reasonably integrates the max pooling, average pooling, and center cropping pooling operations to obtain more comprehensive nodule descriptions from complicated CT images. Experimental results on the public dataset LUNA16 illustrate that the proposed MK-3DCNN method achieves more competitive nodule detection performance compared to some state-of-the-art algorithms. The results on our constructed clinical dataset CQUCH-LND indicate that the MK-3DCNN has a good prospect in clinical practice.

Surgical management of mediastinal mature cystic teratoma of the elderly remaining asymptomatic

BackgroundMediastinal teratoma is an uncommon disease, nevertheless they represent the most common mediastinal germ cell tumors. It may grow silently for several years and remain undiagnosed until the occurrence of a complication.AimThe main aim of this article is to illustrate the silent evolution of an anterior mediastinal teratoma for over 70 years without presenting any notable complications.Case presentationWe present the case of a 70-year-old female, treated for hypertension referred to our department for managing a voluminous mediastinal mass, discovered fortuitously by a general practitioner in a chest X-ray. The anamnesis didn’t relate any chest pain, cough, dyspnea nor hemoptysis. The clinical examination, in particular pleuropulmonary, was unremarkable. The workup (Chest X-Ray and CT scan) demonstrated a voluminous pleural mass at the expense of the right mediastinal pleura, rounded in shape, with calcified wall and fluid content. Blood tests did not demonstrate eosinophilia, and hydatid IgG serology was negative. serum human chorionic gonadotropin (hCG) and alpha fetoprotein (AFP) levels were found to be normal. The patient subsequently underwent a right posterolateral thoracotomy with resection of the lesion. The mass was dissected very carefully and then resected in toto. The macroscopic and microscopic histological examination demonstrated a mature cystic teratoma. Surgical resection was an adequate treatment and the prognosis was excellent for the patient.ConclusionCystic mature teratomas are rare thoracic tumors, often recognized by radiological examination. This article relates the silent evolution that a teratoma could have, and the late appearance of symptoms that it could have.

Evaluasi Nilai Diagnostic Reference Level (DRL) pada pemeriksaan CT Scan Thorax Kontras klinis tumor paru di RS X Jakarta

A contrast thorax CT scan is a CT scan procedure in the chest area (thorax) that uses a contrast agent to improve visualization of organs and structures in the chest. Lung tumors are the growth of abnormal lumps in lung tissue which can be benign or malignant. Awareness of the potential and increasing radiation dose in all CT scan examinations encourages radiographers to want and be able to minimize radiation exposure as the main goal in radiological examinations and also strive for radiation protection during examinations. CT scan radiation dose accounts for 70% of the total dose received from medical imaging. High or low doses of radiation received can increase the risk of cancer. The large dose of radiation received by a patient during a CT scan, therefore regulations are needed that will guarantee monitoring of the radiation dose received by the patient to ensure that the dose received is commensurate with medical purposes. The radiation dose to the patient needs to be optimized by applying the Diagnostic Reference Level (DRL) to optimize medical exposure protection for the patient. Dosage evaluation in clinical contrast chest CT scan examinations for lung tumors and the application of DRL in these examinations have never been carried out at RS X Jakarta. Objective: This study aims to determine the DRL value in clinical contrast thorax CT scan examination of lung tumors at RS CTDIvol and DLP values from clinical contrast Thorax CT Scan examination of lung tumors. The DRL value is calculated at Quartile 3 (75 percentile) using the descriptive frequency test and Wilcoxon test in the SPSS application, then compared with the latest IDRL value. Results: Quartile 3 value (75 percentile) from CTDIvol and DLP CT scan chest contrast clinical lung tumors, namely The CTDIvol value was 12.55 mGy and the DLP was 439 mGy.cm. Conclusion: The DRL value in the clinical contrast thorax CT scan for lung tumors at Hospital X Jakarta. is still below the recommended standard, which shows that the radiation output dose in this examination practice is within normal limits and is classified as safe.

FREE AIR FROM WHERE? SPONTANEOUS PNEUMOMEDIASTINUM AND SUBCUTANEOUS EMPHYSEMA IN A PATIENT WITH ULCERATIVE COLITIS IN THE ABSENCE OF COLONIC OR ESOPHAGEAL PERFORATION

Abstract INTRODUCTION The development of Spontaneous Pneumomediastinum and Subcutaneous Emphysema in patients with Inflammatory Bowel Disease (IBD) has often been associated with perforation related to toxic megacolon or prior endoscopic procedures. We describe a case of Ulcerative Colitis complicated by Clostridium difficile (C diff) colitis in which Spontaneous Pneumomediastinum and Subcutaneous Emphysema developed without any evidence of perforation. CASE REPORT A 20-year-old male with a past medical history of recently diagnosed Ulcerative Colitis presented for evaluation of rectal pain, dysphagia, hematochezia, fecal incontinence, and urinary hesitancy. He endorsed dysphagia with the inability to tolerate solids or liquids for 4 days. He was diagnosed with Ulcerative Colitis 5 months prior to presentation and had unintentionally lost 90 lbs over the past 2 months. His home medication regimen included infliximab started 2 weeks prior, mesalamine PO tablets and suppositories, and a prednisone taper initiated at 10 mg TID. Laboratory tests confirmed anemia, leukocytosis, thrombocytosis, and elevated ESR and CRP levels. Chest X-ray and CT scans of the neck and chest showed moderate pneumomediastinum and subcutaneous emphysema. Given the symptoms of dysphagia along with the imaging findings of pneumomediastinum and subcutaneous emphysema, there was concern for esophageal perforation. However, an Esophagram and Upper GI series were both unremarkable. Abdominal CT revealed colitis of the descending and sigmoid colon without any evidence of free air or free fluid. Fecal Occult Blood Test and C diff antigen and toxin assays were positive. He was treated with oral vancomycin, IV fluids, IV methylprednisolone, and total parenteral nutrition (TPN). His symptoms significantly improved with a decrease in stool frequency and bloody stools. TPN was weaned and he was able to tolerate an oral diet. A repeat CT scan of the chest showed a complete resolution of the pneumomediastinum. CONCLUSION There are only a few reported cases in the literature of spontaneous pneumomediastinum and subcutaneous emphysema in patients with IBD in the absence of colonic or esophageal perforation. The spontaneous isolated presentation of air leaking from a chronically diseased hollow organ remains rare. In our patient there was no evidence of perforation, therefore the pneumomediastinum and subcutaneous emphysema likely resulted from the release of free air from colonic micro-perforations caused by the severe inflammation related to his Ulcerative Colitis flare and C. diff infection. CT Chest demonstrating pneumomediastinum and subcutaneous emphysema of the neck CT Neck demonstrating subcutaneous emphysema

P1111 Prevalence and risk factors for active tuberculosis in Tunisian IBD patients

Abstract Background IBD patients are at risk of active tuberculosis,given the use of immunosuppressive treatments.Our country is an endemic region for tuberculosis,which may increase this risk. The aim of our study was to estimate the prevalence of active tuberculosis in IBD patients with prior screening and to investigate associated risk factors. Methods This was a retrospective and descriptive study,including all IBD patients admitted in the department,who had a screening for latent tuberculosis,over a 10-year period[2012-2022].Patients with less than 12 months' follow-up were excluded. Results We included 100 patients, 52 men and 48 women.Crohn's disease(CD)was present in 86% of cases,and ulcerative colitis in 14%.CD was predominantly ileocolic (47%).The phenotype of luminal CD was inflammatory, stenosing and fistulizing in 36.6%,28% and 35.4% of cases respectively.Anoperineal involvement was present in 41.9% of CD patients.At the time of screening, patients were on salicylates, steroids and thiopurines in 13%,27% and 22% of cases respectively.Body mass index median was 22.7kg/m².Two-thirds of patients(65%)were in a flare-up at the time of screening,with 50.8% in moderate severity, and 3.1% in severe acute colitis.Ninety patients had a negative TST.The quantiFERON test was positive in 9 patients and indeterminate in one,in four of them, the TST was also positive. There were no abnormalities on chest X-rays in all patients.Fifteen patients received chemoprophylaxis, mainly because of suspected latent tuberculosis, but also because of severe undernutrition despite a negative workup in 3 patients.Chemoprophylaxis was isoniazid monotherapy for 9 months,except for 3 patients who received isoniazid and rifampicin dual therapy for 3 months.The prevalence of active tuberculosis in our patients was 11%.The median time from onset of tuberculosis to screening was 12 months.Almost all patients were on anti-TNFα monotherapy(n=4) or combotherapy(n=6).One patient was on azathioprine only. Chest CT scans showed signs suggestive of tuberculosis in only 2 patients.Among patients who developed active tuberculosis, 2 had previously received chemoprophylaxis for a positive TST. In a univariate study,we analyzed all variables for risk factors associated with the occurrence of tuberculosis in our patients.Apart from the use of anti-TNF drugs(p=0.03),no statistically significant associations were found:severity of relapse during screening(p=0.3),undernutrition as evidenced by a low BMI(p=0.92),albuminemia(p=0.77),C reactive protein(p=0.8). Conclusion The median delay to onset of active tuberculosis suggests post-screening transmission.This is further evidence of the need to shorten the time required for systematic updating of the tuberculosis work-up in endemic countries.

Comprehensive Study of Compression and Texture Integration for Digital Imaging and Communications in Medicine Data Analysis

In response to the COVID-19 pandemic and its strain on healthcare resources, this study presents a comprehensive review of various techniques that can be used to integrate image compression techniques and statistical texture analysis to optimize the storage of Digital Imaging and Communications in Medicine (DICOM) files. In evaluating four predominant image compression algorithms, i.e., discrete cosine transform (DCT), discrete wavelet transform (DWT), the fractal compression algorithm (FCA), and the vector quantization algorithm (VQA), this study focuses on their ability to compress data while preserving essential texture features such as contrast, correlation, angular second moment (ASM), and inverse difference moment (IDM). A pivotal observation concerns the direction-independent Grey Level Co-occurrence Matrix (GLCM) in DICOM analysis, which reveals intriguing variations between two intermediate scans measured with texture characteristics. Performance-wise, the DCT, DWT, FCA, and VQA algorithms achieved minimum compression ratios (CRs) of 27.87, 37.91, 33.26, and 27.39, respectively, with maximum CRs at 34.48, 68.96, 60.60, and 38.74. This study also undertook a statistical analysis of distinct CT chest scans from COVID-19 patients, highlighting evolving texture patterns. Finally, this work underscores the potential of coupling image compression and texture feature quantification for monitoring changes related to human chest conditions, offering a promising avenue for efficient storage and diagnostic assessment of critical medical imaging.

AZUR-2, a phase III, open-label, randomized study of perioperative dostarlimab monotherapy vs standard of care in previously untreated patients with T4N0 or stage III dMMR/MSI-H resectable colon cancer.

TPS240 Background: Emerging evidence suggests neoadjuvant therapy may benefit patients (pts) with advanced colon cancer. Neoadjuvant immunotherapy has shown promising efficacy for early-stage mismatch repair deficient (dMMR) colon cancer [1,2]. Evidence from other immunogenic tumors suggests that a perioperative approach with immunotherapy may further improve survival outcomes [3,4]. Dostarlimab (anti-PD-1) has shown a favorable benefit:risk profile in previously untreated dMMR locally advanced rectal cancer [5] and in advanced dMMR/microsatellite instability-high (MSI-H) solid tumors [6]. AZUR-2 (NCT05855200) will evaluate the efficacy and safety of perioperative dostarlimab monotherapy vs standard of care (SOC) in pts with previously untreated T4N0 or Stage III dMMR/MSI-H resectable colon adenocarcinoma. Methods: AZUR-2 is a global, multicenter, randomized, open-label Phase III study. Approximately 711 pts will be enrolled. Key eligibility criteria include age ≥18 years, no prior therapy or surgery for colon cancer, ECOG PS 0–1, and no symptomatic bowel obstruction. Central prescreening is available at sites without local dMMR/MSI-H testing (not required if dMMR/MSI-H already determined). Pts stratified by clinical tumor/node (TN) staging will be randomized 2:1 to receive dostarlimab pre- and post-surgery, or surgery followed by SOC (adjuvant FOLFOX/CAPEOX for 3–6 months or watch and wait approach per physician’s discretion). Primary endpoint is event-free survival (EFS) (events: recurrence based on radiological assessment by blinded independent central review or pathological assessment of new lesions, disease progression precluding surgery, treatment (tx)-related toxicity precluding surgery, or death). Secondary endpoints include pathological response, OS, and safety. Disease assessments will consist of CT scans of chest, abdomen, and pelvis. Pts will undergo safety follow-up at end of tx and at 30 and 90 days after last dose. Efficacy will be assessed in all pts randomized (intent-to-treat) and safety in all pts who receive surgery or ≥1 dose of study tx. A stratified log-rank test will be used for primary analysis. The primary analysis for EFS with &gt;90% power will be conducted after all pts have been followed for ≥3 years. An interim EFS analysis will be conducted ~12 months earlier. Exploratory endpoints include pt-reported outcomes to evaluate health-related quality of life.

Emergency department CT examinations demonstrate no evidence of early viral circulation at the start of the COVID-19 pandemic—a multicentre epidemiological study

BackgroundBiological studies suggested that the COVID-19 outbreak in France occurred before the first official diagnosis on January 24, 2020. We investigated this controversial topic using a large collection of chest CTs performed throughout French emergency departments within 6 months before the 1st lockdown.ResultsOverall, 49,311 consecutive patients (median age: 60 years, 23,636/49,311 [47.9%] women) with available chest CT images and reports from 61 emergency departments between September 1, 2020, and March 16, 2020 (day before the 1st French lockdown), were retrospectively included in this multicentre study. In the macroscopic analysis of reports automatically (labelled for presence of ground glass opacities [GGOs], reticulations, and bilateral and subpleural abnormalities), we found a significant breakpoint on February 17, 2020, for the weekly time series with 1, 2 and ≥ 3 of these 4 radiological features, with 146/49,311 (0.3%) patients showing bilateral abnormalities and ground glass opacities (GGOs) from that day. According to radiologists, 22/146 (15.1%) CT images showed typical characteristics of COVID-19, including 4/146 (2.7%) before February 2020. According to hospital records, one patient remained without microbial diagnosis, two patients had proven influenza A and one patient had concomitant influenza A and mycoplasma infection.ConclusionThese results suggest that SARS-CoV-2 was not circulating in the areas covered by the 61 emergency departments involved in our study before the official beginning of the COVID-19 outbreak in France. In emergency patients, the strong resemblance among mycoplasma, influenza A and SARS-CoV-2 lung infections on chest CT and the nonspecificity of CT patterns in low prevalence periods is stressed.Critical relevance statementWe proposed here an innovative approach to revisit a controversial ‘real’ start of the COVID-19 pandemic in France based on (1) a population-level approach combining text mining, time series analysis and an epidemiological dataset and (2) a patient-level approach with careful retrospective reading of chest CT scans complemented by analysis of samples performed contemporarily to the chest CT. We showed no evidence that SARS-CoV-2 was actively circulating in France before February 2020.Graphical

Comparison of lung cancer occurring in fibrotic versus non-fibrotic lung on chest CT

PurposeEvaluate the behavior of lung nodules occurring in areas of pulmonary fibrosis and compare them to pulmonary nodules occurring in the non-fibrotic lung parenchyma.MethodsThis retrospective review of chest CT scans and electronic medical records received expedited IRB approval and a waiver of informed consent. 4500 consecutive patients with a chest CT scan report containing the word fibrosis or a specific type of fibrosis were identified using the system M*Model Catalyst (Maplewood, Minnesota, U.S.). The largest nodule was measured in the longest dimension and re-evaluated, in the same way, on the follow-up exam if multiple time points were available. The nodule doubling time was calculated. If the patient developed cancer, the histologic diagnosis was documented.ResultsSix hundred and nine patients were found to have at least one pulmonary nodule on either the first or the second CT scan. 274 of the largest pulmonary nodules were in the fibrotic tissue and 335 were in the non-fibrotic lung parenchyma. Pathology proven cancer was more common in nodules occurring in areas of pulmonary fibrosis compared to nodules occurring in areas of non-fibrotic lung (34% vs 15%, p < 0.01). Adenocarcinoma was the most common cell type in both groups but more frequent in cancers occurring in non-fibrotic tissue. In the non-fibrotic lung, 1 of 126 (0.8%) of nodules measuring 1 to 6 mm were cancer. In contrast, 5 of 49 (10.2%) of nodules in fibrosis measuring 1 to 6 mm represented biopsy-proven cancer (p < 0.01). The doubling time for squamous cell cancer was shorter in the fibrotic lung compared to non-fibrotic lung, however, the difference was not statistically significant (p = 0.24). 15 incident lung nodules on second CT obtained ≤ 18 months after first CT scan was found in fibrotic lung and eight (53%) were diagnosed as cancer.ConclusionsNodules occurring in fibrotic lung tissue are more likely to be cancer than nodules in the nonfibrotic lung. Incident pulmonary nodules in pulmonary fibrosis have a high likelihood of being cancer.