CT Manifestations Research Articles

Coronavirus disease 2019 in Northeastern Sichuan: clinical characteristics and treatment analysis of 59 cases

To analyze the epidemiological, clinical characteristics and treatment of coronavirus disease 2019 (COVID-19) in Northeastern Sichuan, and summarize experience in time to provide reference for clinical diagnosis and treatment. A retrospective study was conducted. Fifty-nine patients with COVID-19 admitted to Bazhong Central Hospital and Dazhou Central Hospital from January 27th to February 9th, 2020 were selected as the subjects. The data of demography, epidemiology, laboratory examination, chest CT and related clinical treatment were collected. According to the severity of the disease, the patients were divided into three types: mild, general and severe types, and the differences of the above indices among different clinical types were compared. (1) General information and epidemiology: 31 cases (52.5%) were male, 28 cases (47.5%) were female, the average age was (42.0±16.4) years old, and the patients over 40 years old accounted for the largest proportion (35 cases, 59.3%). The proportion of clinical type was 72.9% (43 cases) in general type, and 62.7% (37 cases) were imported type. With the increase of disease severity, the average age of patients also showed a significant increase trend [the age of the mild, general and severe patients were (30.9±13.6), (42.7±15.3), (55.8±18.9) years old, P < 0.01]. The proportion of patients with more than one basic disease in severe patients was significantly higher than those in mild and general patients [66.7% (4/6) vs. 20.0% (2/10), 9.3% (4/43), both P < 0.05]. In the distribution of clinical symptoms, the proportion of severe patients with chest distress/dyspnea was significantly higher than those in mild and general patients [66.7% (4/6) vs. 10.0% (1/10), 11.6% (5/43), both P < 0.05]. (2) Laboratory examination index: the total number of white blood cell count (WBC), neutrophils count (NEU), C-reactive protein (CRP) in severe patients were higher than those in mild patients and general patients [WBC (×109/L): 7.21±4.35 vs. 5.85±1.69, 5.43±2.04; NEU (×109/L): 6.09±4.43 vs. 3.95±1.45, 3.54±1.83; CRP (mg/L): 16.00 (8.20, 46.43) vs. 5.00 (0.00, 16.13), 15.00 (3.13, 28.58)], the albumin (Alb) level in severe patients was lower than those in mild and general patients (g/L: 38.00±5.35 vs. 49.23±5.27, 39.81±2.15, both P < 0.05), while the hemoglobin (Hb) level in mild patients was higher than that in severe and general patients (g/L: 155.2±12.1 vs. 141.3±6.8, 131.1±11.7, both P < 0.05). (3) Chest imaging: the CT manifestations of typical cases were single or multiple ground glass shadows. With the progress of the disease, the focus gradually increased, the scope gradually expanded, and multiple solid shadows of lung lobes were involved. (4) Treatment: all patients received at least 2 kinds of antiviral therapy, and the application rate of Interferon and Ribavirin in severe patients were higher than those in mild and general patients [100.0% (6/6) vs. 80.0% (8/10), 97.7% (42/43); 83.3% (5/6) vs. 0% (0/10), 20.9% (9/43); all P < 0.05]. (5) Prognosis: until March 6th 2020, 50 patients (84.8%) were discharged from the hospital after rehabilitation, and the remaining 9 patients were still under treatment, none deaths. The proportion of severe patients with chest distress/dyspnea is higher, the older the patients are and the more basic diseases are, the more likely they are to develop into severe type. High resolution chest CT could be considered for suspected cases or even fever patients, which may show the progress of the disease.

A Comparative Study of Chest Computed Tomography Findings: 1030 Cases of Drug-Sensitive Tuberculosis versus 516 Cases of Drug-Resistant Tuberculosis

PurposeTo investigate the CT features of drug-resistant pulmonary tuberculosis (DR-PTB) and the diagnostic value of CT in DR-PTB diagnosis to provide imaging evidence for the timely detection of drug-resistant Mycobacterium tuberculosis.Materials and MethodsA total of 1546 cases of pulmonary tuberculosis (PTB) with complete clinical data, chest CT images and defined drug sensitivity testing results were consecutively enrolled; 516 cases of DR-PTB were included in the drug-resistant group, and 1030 cases of drug-sensitive pulmonary tuberculosis (DS-PTB) were included in the drug-sensitivity group. Comparative analyses of clinical symptoms and imaging findings were conducted. Univariate and logistic regression analyses were performed, a regression equation model was developed, and the receiver operating characteristic (ROC) curve was constructed.ResultsIn the univariate analysis, some features, including whole-lung involvement, multiple cavities, thick-walled cavities, collapsed lung, disseminated lesions along the bronchi, bronchiectasis, emphysema, atelectasis, calcification, proliferative lesions, encapsulated effusion, etc., were observed more frequently in the DR-PTB group than in the DS-PTB group, and the differences were statistically significant (p<0.05). Exudative lesions and pneumoconiosis were observed more frequently in the drug-sensitivity group than in the drug-resistant group (p<0.05). Logistic regression analysis indicated that whole-lung involvement, multiple cavities, thick-walled cavities, disseminated lesions along the bronchi, bronchiectasis, and emphysema were independent risk factors for DR-PTB, and exudative diseases were protective factors. The total prediction accuracy of the regression model was 80.6%, and the area under the ROC curve (AUC) was 82.6%.ConclusionChest CT manifestations of DR-PTB had certain characteristics that significantly indicated the possibility of drug resistance in tuberculosis patients, specifically when multifarious imaging findings, including multiple cavities, thick-walled cavities, disseminated lesions along the bronchi, whole-lung involvement, etc., coexisted simultaneously. These results may provide imaging evidence for timely drug resistance detection in suspected drug-resistant cases and contribute to the early diagnosis of DR-PTB.

Chinese Herbal Medicine Used With or Without Conventional Western Therapy for COVID-19: An Evidence Review of Clinical Studies.

Objective: To present the evidence of the therapeutic effects and safety of Chinese herbal medicine (CHM) used with or without conventional western therapy for COVID-19. Methods: Clinical studies on the therapeutic effects and safety of CHM for COVID-19 were included. We summarized the general characteristics of included studies, evaluated methodological quality of randomized controlled trials (RCTs) using the Cochrane risk of bias tool, analyzed the use of CHM, used Revman 5.4 software to present the risk ratio (RR) or mean difference (MD) and their 95% confidence interval (CI) to estimate the therapeutic effects and safety of CHM. Results: A total of 58 clinical studies were identified including RCTs (17.24%, 10), non-randomized controlled trials (1.72%, 1), retrospective studies with a control group (18.97%, 11), case-series (20.69%, 12) and case-reports (41.38%, 24). No RCTs of high methodological quality were identified. The most frequently tested oral Chinese patent medicine, Chinese herbal medicine injection or prescribed herbal decoction were: Lianhua Qingwen granule/capsule, Xuebijing injection and Maxing Shigan Tang. In terms of aggravation rate, pooled analyses showed that there were statistical differences between the intervention group and the comparator group (RR 0.42, 95% CI 0.21 to 0.82, six RCTs; RR 0.38, 95% CI 0.23 to 0.64, five retrospective studies with a control group), that is, CHM plus conventional western therapy appeared better than conventional western therapy alone in reducing aggravation rate. In addition, compared with conventional western therapy, CHM plus conventional western therapy had potential advantages in increasing the recovery rate and shortening the duration of fever, cough and fatigue, improving the negative conversion rate of nucleic acid test, and increasing the improvement rate of chest CT manifestations and shortening the time from receiving the treatment to the beginning of chest CT manifestations improvement. For adverse events, pooled data showed that there were no statistical differences between the CHM and the control groups. Conclusion: Current low certainty evidence suggests that there maybe a tendency that CHM plus conventional western therapy is superior to conventional western therapy alone. The use of CHM did not increase the risk of adverse events.

Imaging Findings and Changes in Discharged Moderate Novel Coronavirus Pneumonia Patients with Positive Nucleic Acid Retest

The clinical and imaging data belonging to 52 discharged novel coronavirus pneumonia (NCP) patients with positive nucleic acid retesting results during the follow-up period were collected from the First People’s Hospital, Xiaogan, Hubei Province, China, for analysis. These moderate NCP patients underwent a plain CT scan before the admission, at the time of discharge, and at re-admission due to the positive result of their COVID-19 nucleic acid retesting. The CT signs of these patients were analyzed in this study and a total of 32 (61.54%) patients presented with 123 lesions with patchy fuzzy shadows. In addition, 24 (75%) and 8 (25%) patients out of the 32 patients, had lesions distributed in both lungs and single lung, respectively. It is worth mentioning that the CT manifestations varied in discharged moderate NCP patients whose COVID-19 nucleic acid retest was positive in the follow-up period. Most patients presented with patchy fuzzy shadows and ground-glass opacity (GGO) lesions distributed in the lower lobe of both lungs. The results of the study indicated that some discharged moderate NCP patients with positive COVID-19 nucleic acid retest developed new patchy fuzzy shadows and GGO lesions. Moreover, the recurrence of NCP needs to be verified once patchy fuzzy shadows and GGO lesions appear and are not absorbed during the follow-up period. This study provided a reference for the follow-up NCP evaluation.

Pulmonary Benign Ground-Glass Nodules: CT Features and Pathological Findings.

BackgroundSome pulmonary ground-glass nodules (GGNs) are benign and frequently misdiagnosed due to lack of understanding of their CT characteristics. This study aimed to reveal the CT features and corresponding pathological findings of pulmonary benign GGNs to help improve diagnostic accuracy.Patients and MethodsFrom March 2016 to October 2019, patients with benign GGNs confirmed by operation or follow-up were enrolled retrospectively. According to overall CT manifestations, GGNs were classified into three types: I, GGO with internal high-attenuation zone; II, nodules lying on adjacent blood vessels; and other type, lesions without obvious common characteristics. CT features and pathological findings of each nodule type were evaluated.ResultsAmong the 40 type I, 25 type II, and 14 other type GGNs, 24 (60.0%), 19 (76.0%), and 10 (71.4%) nodules were resected, respectively. Type I GGNs were usually irregular (25 of 40, 62.5%) with only one high-attenuation zone (38 of 40, 95.0%) (main pathological components: thickened alveolar walls with inflammatory cells, fibrous tissue, and exudation), which was usually centric (24 of 40, 60.0%), having blurred margin (38 of 40, 95.0%), and connecting to blood vessels (32 of 40, 80.0%). The peripheral GGO (main pathological component: a small amount of inflammatory cell infiltration with fibrous tissue proliferation) was usually ill-defined (28 of 40, 70.0%). Type II GGNs (main pathological components: focal interstitial fibrosis with or without inflammatory cell infiltration) lying on adjacent vessel branches were usually irregular (19 of 25, 76.0%) and well defined (16 of 25, 64.0%) but showed coarse margins (15 of 16, 93.8%). Other type GGNs had various CT manifestations but their pathological findings were similar to that of type II.ConclusionFor subsolid nodules with CT features manifested in type I or II GGNs, follow-up should be firstly considered in further management.

Genotype and clinical phenotype analysis of 42 patients with delayed nonsyndromic hearing loss

Objective:The aim of this study is to analyze the mutation characteristics of GJB2 and SLC26A4 gene in patients with delayed non-syndromic hearing loss, which is beneficial to the early detection and intervention of delayed deafness. Methods:Sanger sequencing technology was used to detect two common genes in 139 patients with non-syndromic deafness, six hot spot mutations in GJB2 gene and SLC26A4 gene, and single heterozygous mutations found in GJB2 gene and SLC26A4 gene were detected by whole exome sequencing. Results:Among the 25 patients with deafness caused by GJB2 gene mutation, 12 of them passed universal newborn hearing screening and then developed delayed extremely severe hearing loss. The onset time of hearing loss was 6-48 months. All the genotypes were homozygous or compound heterozygous mutation of c. 235delC, especially genotype of GJB2 c. 235delC homozygous and c. 235delC/c. 299-300 delAT compound heterozygous mutations, and the CT manifestations were normal. Among the 42 patients with deafness caused by SLC26A4 gene mutation, 30 of them passed universal newborn hearing screening and developed delayed deafness. The onset time of hearing loss was three months to ten years old. Among them, the genotypes of 21 patients were compound heterozygous mutation, and 9 patients were homozygous mutation of c. 919-2A>G, especially genotypes were SLC26A4 c. 919-2A>G/c. 665G>T and c. 919-2A>G /c. 2027T>A compound heterozygous mutation. The CT findings of 19 cases showed single enlarged vestibular aqueduct, and 11 cases showed enlarged vestibular aqueduct with Mondini malformation. Conclusion:For the children who have passed universal newborn hearing screening, the genotypes detected are GJB2 c. 235delC homozygous, SLC26A4 c. 919-2A>G homozygous or compound heterozygous mutations, especially genotypes GJB2 c. 235delC homozygous, c. 235delC/c. 299-300delAT compound heterozygous mutations and SLC26A4 c. 919-2A>G/c. 665G>T and c. 919-2A>G/c. 2027T>A compound heterozygous mutation. Attention should be paid to the hearing problems of children all the time, and the possibility of delayed deafness in the future should be considered.

Chronic Lung Allograft Dysfunction: Review of CT and Pathologic Findings.

Chronic lung allograft dysfunction (CLAD) is the most common cause of mortality in lung transplant recipients after the 1st year of transplantation. CLAD has traditionally been classified into two distinct obstructive and restrictive forms: bronchiolitis obliterans syndrome and restrictive allograft syndrome. However, CLAD may manifest with a spectrum of imaging and pathologic findings and a combination of obstructive and restrictive physiologic abnormalities. Although the initial CT manifestations of CLAD may be nonspecific, the progression of findings at follow-up should signal the possibility of CLAD and may be present on imaging studies prior to the development of functional abnormalities of the lung allograft. This review encompasses the evolution of CT findings in CLAD, with emphasis on the underlying pathogenesis and pathologic condition, to enhance understanding of imaging findings. The purpose of this article is to familiarize the radiologist with the initial and follow-up CT findings of the obstructive, restrictive, and mixed forms of CLAD, for which early diagnosis and treatment may result in improved survival. Supplemental material is available for this article. © RSNA, 2021.

Radiological perspective of COVID-19 pneumonia: The early features and progressive behaviour on high-resolution CT.

SummarySince the outbreak of Coronavirus disease 2019 (COVID‐19) in China, many researchers have reported the chest CT manifestations of COVID‐19 pneumonia. High‐resolution CT (HRCT) of the lung can provide important clues to understand the progressive behaviour of COVID‐19 pneumonia. This pictorial essay discusses the early features and potential progressive behaviour of COVID‐19 on HRCT of the lung.

Immunotherapy-induced pneumonitis in non-small cell lung cancer patients: current concern in treatment with immune-check-point inhibitors.

Purpose Immune-related adverse events (IrAEs) are auto-immune reactions associated with immune checkpoint inhibitor-based therapy (ICI). To date, little is known about immunotherapy-induced pneumonitis (IIP). In this study, we investigated the clinical and CT features of IIP in non-small cell lung cancer (NSCLC) patients treated with ICI. Methods CT images and clinical data of 98 NSCLC patients in our hospital were retrospectively analyzed after ICI therapy, and the incidence, onset time, CT findings, grade, treatment and prognosis of IIP were recorded. Results Nineteen patients developed IIP, which occurred 42∼210 days after ICI therapy, and the median time was 97 days. The CT findings for IIP showed multifocal ground-glass opacity (GGO) in 5 cases, patchy shadows in 6 cases, mixed distribution of patchy and strip-like shadows in 4 cases, and patchy shadows with honeycomb lung in 4 cases. The mean age and proportions of smokers, CD3+ and CD4+ of T lymphocyte subset in patients with IIP were significantly higher than those in patients without IIP (all p < 0.05). Among 19 patients with IIP, there were 10 patients with grade 1 ~ 2 and 9 patients with grade 3 ~ 4; 13 patients received hormone therapy, 12 of them were improved or stable, and 1 patient got worse after hormone therapy. No deaths from IIP were found. Conclusion IIP is a relatively rare but serious adverse event, and it is sensitive to hormone therapy. Its CT manifestations are diverse, and timely detection and treatment are the keys to reduce IIP.

Learning from pathophysiological aspects of COVID-19 clinical, laboratory, and high-resolution CT features: a retrospective analysis of 128 cases by disease severity.

BackgroundThe classic chest CT imaging features of COVID-19 pneumonia have low specificity due to their similarity with a number of other conditions. So, the goal of the present study is to learn from the pathophysiology of COVID-19 clinical features, laboratory results, and high-resolution CT manifestations in different stages of disease severity to provide significant reference values for diagnosis, prevention, and treatment.MethodsThis was a multicentered study that included 128 patients. Demographic, clinical, and laboratory data, in addition to chest HRCT findings, were evaluated. According to chest HRCT features, radiologic scoring were grade 1 and 2 for mild grades of the disease, 3 and 4 for moderate grades of the disease, and 5 and 6 for severe grades of the disease.ResultsPatient clinical symptoms ranged between fever, dry cough, muscle ache (myalgia)/fatigue, dyspnea, hyposomia, sore throat, and diarrhea. Lymphocytes and WBCs were significantly lower in patients with severe COVID-19. A significant negative correlation was found with WBCs (r = − 0.245, P = 0.005), lymphocytes% (r = − 0.586, P < 0.001), RBCs (r = − 0.2488, P = 0.005), Hb (gm/dl) (r = − 0.342, P < 0.001), and HCT (r = − 0.377, P < 0.001). Transferrin and CRP were significantly higher in moderate and severe COVID-19 than mild degree and showed a significant positive correlation with CT score (r = 0.356, P < 0.001) and (r = 0.429, P < 0.001), respectively. The most common CT features were peripheral pulmonary GGO and air space consolidation.ConclusionClinical features, laboratory assessment, and HRCT imaging had their characteristic signs and performances. Correlating them can make it possible for physicians and radiologists to quickly obtain the final diagnosis and staging of the COVID-19 pneumonia.

Asymptomatic COVID-19 in pregnant woman with typical chest CT manifestation: a case report

We report a case of maternal asymptomatic COVID-19 in a patient with typical CT image of pneumonia in the third trimester, and both the mother and baby were well. The patient, a 30-year-old female, was transferred to Yichun People's Hospital at 37+3 gestational weeks because of a positive 2019 novel coronavirus nucleic acid result over seven hours. Her husband and mother-in-law were diagnosed with COVID-19 eight days before her admission and on the same day, respectively. The patient reported no discomfort before admission, and there were no abnormalities in the prenatal course during her pregnancy. On February 13 (the second day of admission), a patchy blurred shadow was observed in the lower lobe of the right lung in chest CT scan, and a live baby girl was delivered by a precaution-based emergent cesarean section because of suspected fetal distress shown in electrical fetal heart monitoring. Both the mother and the newborn were isolated separately after the operation without etiological examination of amniotic fluid, umbilical cord blood, placenta, etc. All the medical staff involved in the cesarean section were isolated as well. The mother was healthy and remained asymptomatic after delivery, while antiviral and anti-inflammatory treatment was offered. COVID-19 nucleic acid tests of pharyngeal swab were negative on the 4th and 6th day after operation. Chest CT on the 5th day after delivery showed inflammation in the lower lobe of the right lung, and reexamination on the 8th day showed a slight absorption of the inflammation. Samples of peripheral blood and pharynx swab were obtained from the newborn on the day of birth and four and seven days after birth and novel coronavirus nucleic acid test were all negative. The mother and baby dyad were discharged nine days after operation. And novel coronavirus nucleic acid tests were all negative in all medical staff involved. Key words: Coronavirus; Coronavirus infections; COVID-19; Pregnancy complications, infectious

Initial chest CT imaging features of COVID-19 and their relation to clinical types

Objective: To investigate the initial chest CT imaging features and clinical types of patients with COVID-19. Methods: A total 165 patients with COVID-19 were retrospectively analyzed according to different age groups and different clinical classifications. Results: There were statistically significant differences in involvement sites, involvement range, lesion distribution and largest diameter of the lesions in COVID-19 patients among different age groups. Logistic regression analysis of age between normal type group and severe type group showed statistical significance (P<0.05). The maximum sensitivity and specificity were 64.20% and 69.00%. The corresponding age threshold was 50.5 years old. Conclusion: The main manifestations of initial chest CT in COVID-19 patients were ground-glass opacities, most often involving the posterior basal segment of the lower lung. Single site involvement was more common in 17-35 years patients. Most of the lesions were distributed around the subpleural and bronchovascular bundle in 36-90 years patients, involving both lungs and reaching more than two pulmonary lobes. For the COVID-19 patients with diabetes, hypertension, or older than 50.5 years, early diagnosis, isolation and treatment are necessary, and the changes of their conditions should be closely mornitored. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.

Clinical and CT Manifestations of 56 COVID-19 Patients

Objective: To analyze the clinical manifestations and lung CT findings of patients infected with the 2019 coronavirus disease (COVID-19). Methods: The clinical manifestations and lung CT image data of 56 confirmed COVID-19 patients were retrospectively analyzed. These data were collected in the Fourth People’s Hospital of Huai’an from January 23-February 13, 2020. All 56 patients were confirmed cases with positive nucleic acid test. Results: The main clinical manifestations of 56 patients were fever, cough, sputum, and some patients were accompanied by headache, sore throat, nasal congestion and runny nose, fatigue, muscle aches and other symptoms. 42 patients had the symptoms of moderate or low fever, with an average body temperature of 38.0 ±0.7 °C, and 41 patients had the symptoms of dry cough. Of 56 patients with chest CT examination, 50 cases showed ground glass opacity (GGO) in the lungs, 38 cases showed varying degrees of consolidation in the GGO, 49 cases showed the vascular enhancement sign (VES) in the lung lesions, 28 cases showed the pavement stone sign, and 17 cases had the lungs of fiber stripes. Only 1 of the 56 patients had a little pleural effusion, and there was no mediastinal lymphadenopathy. The frequency of ground glass opacity and vascular enhancement sign was the highest, however, there were no significant differences among the three groups in the early stage, progression stage and recovery stage. In the early stage, the occurrence rate of pavement stone signs and air bronchi signs were significantly lower than that of the progression stage and recovery stage. The occurrence rate of fiber stripes was the highest in the recovery period, which was obviously higher than that in the first and second stages. Conclusion: Combined with epidemiological history and clinical symptoms, chest CT abnormalities and routine blood examination can be used as an important reference before nucleic acid detection so as to screen the risky population, which is helpful for early clinical treatment.

Application of CT Image Based on Three-Dimensional Image Segmentation Algorithm in Diagnosis of Osteoarthritis

Objective: To investigate the application of multi-slice spiral CT in degenerative changes of lumbar facet joints using the LOG algorithm. Methods: The CT findings of 100 cases of degenerative vertebral facet joint disease were reviewed and analyzed in this paper. Results: The main CT manifestations of facet disease are osteophyte formation, articular hyperplasia and hypertrophy, osteosclerosis, narrowing of joint space, articular surface destruction, joint capsule calcification, joint gas accumulation, joint subluxation, and lateral recesses and vertebrae. Signs such as narrow mesopores. Conclusion: The multi-slice spiral CT (MSCT) and multi-planar reconstruction (MPR) techniques are analyzed by the LOG operator algorithm. It is found that the two techniques can fully display the anatomical structure and pathological changes of the vertebral facet joints, and are useful for the diagnosis of facet joint disease. Provide enough imaging evidence.

Chest CT Features from 58 Patients with COVID-19 Pneumonia from the Perspective of ACE2.

Chest CT is important for the diagnosis of Corona Virus Disease 2019, which is caused by SARS-CoV-2 via the receptor angiotensin-converting enzyme 2. This study aimed to present special chest CT changes in the detection and management of COVID-19. From February 20 to March 6, 2020, clinical data and chest CT of patients with COVID-19 being treated by the Hubei Medical Team were retrospectively analyzed with a time-interval of 2 weeks. In addition, the expressions of ACE2 in different parts of the respiratory system were detected by immunohistochemical staining to explain the special chest CT features of COVID-19 by ACE2 expression. Of 58 patients, the main respiratory manifestations were fever and cough. Spherical or patchy GGO was the initial CT manifestation of COVID-19 pneumonia. CT findings manifested as rapid evolution from focal unilateral to diffuse bilateral ground-glass opacities (GGO) that progressed to or co-existed with consolidations in chest CT scans. Lung consolidation increased as the disease progressed, accounting for 63.2%, 76.3%, and 87.5% in group 1 (disease course with 0 - 2 weeks), group 2 (2 - 4 weeks), and group 3 (> 4 weeks). Fibrous lesions (72.3%), high density vascular shadow (69.2%), reticular pattern (63.1%), and subpleural parallel sign (61.5%) were common signs of chest CT of COVID-19. IHC results showed that ACE2-expression in the pulmonary alveoli was significantly higher than that in the bronchial mucosa and pleura (p < 0.001). The special change of CT features in the lung of COVID-19 pneumonia patients have a connection with ACE2 expression patterns in the respiratory system.

Atypical CT manifestations of pulmonary sarcoidosis

SummarySarcoidosis is a granulomatous disease of unknown etiol-ogy that affects different organs and tissues. Pulmonary, mediastinal, and intrathoracic lymph nodes involvement occur in about 90% of patients with sarcoidosis. Radio-logical manifestations of pulmonary sarcoidosis vary sig-nificantly. This article describes focal and reticulonodu-lar changes, as well as consolidation zones and fibroticchanges. Isolated reticular changes due to thickening of intra-, and interlobular septa occur in approximately 50% of sarcoid patients. However, this CT pattern pre-vails only in 15–20% of patients. As a rule, in 80% of sar-coid patients changes in lung parenchyma are combined with intrathoracic lymphadenopathy. In the majority of cases, these changes are bilateral. In 10–13% of patients, foci 89–12 mm in diameter are detected. These foci have a homogenous structure and a well-defined outline. They locate mainly along costal and interlobar pleura, in interlobular septa, and may resemble metastases. In 2.4–4% of patients, these small foci, typical for sarcoid-osis are absent, while the changes are presented by larger nodular masses (&gt;2 cm in diameter) or by masses with fuzzy outlines. Often sarcoidosis mimicking interstitial pneumonia is manifested by the ground-glass opacity of spot-like shape. Abnormalities are located in the up-per lobes. This sign occurs in 16–83% of sarcoidotic pa-tients, mainly at the onset of the disease. It usually com-bines with focal changes in the lungs and intrathoracic lymphadenopathy. Cavitary forms of sarcoidosis are also described. Conclusion. There are multiple pulmonary sarcoidosis manifestations on CT, and they vary a lot. The former allows suspecting the diagnosis, which is later confirmed clinically, morphologically, or by lab meth-ods. Аtypical radiological forms of lung sarcoidosis often mimic other pulmonary diseases. These forms require in-vasive diagnostic methods including abdominal surgery.

Longitudinal changes in COVID-19 clinical measures and correlation with the extent of CT lung abnormalities

Rationale: To assess the longitudinal changes and relationships of clinical measures and extent of CT lung abnormalities in COVID-19.Methods: 81 patients with COVID-19 were prospectively enrolled and followed until discharge. CT scores were quantified on a basis of a CT scoring system where each lung was divided into 3 zones: upper (above the carina), middle, and lower (below the inferior pulmonary vein) zones; each zone was evaluated for percentage of lung involvement on a scale of 0-4 (0, 0%; 1, 0-24%; 2, 25% - 49%; 3, 50% -74%; 4, >74%).Temporal trends of CT scores and the laboratory parameters characteristic of COVID-19 were analyzed. Correlations between the two were determined at three milestones (initial presentation, worst CT manifestation, and recovery finding before discharge). Their correlations with duration to worst CT manifestation and discharge from symptom onset were evaluated.Results: CT scores peaked during illness days 6-11 (median: 5), and stayed steady. C-reactive protein and lactate dehydrogenase increased, peaked on illness days 6-8 and 8-11 (mean: 23.5 mg/L, 259.9 U/L), and gradually declined. Continual decrease and increase were observed in hemoglobin and lymphocyte count, respectively. Albumin reduced and remained at low levels with a nadir on illness days 12-15 (36.6 g/L). Both initial (r = 0.58, 0.64, p < 0.05) and worst CT scores (r = 0.47, 0.65, p < 0.05) were correlated with C-reactive protein and lactate dehydrogenase; and CT scores before discharge, only with albumin (r = -0.41, p < 0.05). Duration to worst CT manifestation was associated with initial and worst CT scores (r = 0.33, 0.29, p < 0.05). No parameters were related to timespan to discharge.Conclusion: Our results illustrated the temporal changes of characteristic clinical measures and extent of CT lung abnormalities in COVID-19. CT scores correlated with some important laboratory parameters, and might serve as prognostic factors.

Application of Computed Tomography Image Information Technology Based on Optimized Discrete Cosine Transform Filtering Algorithm in Diagnosis of Gastric Neuroendocrine Tumors

Objective: To investigate the clinicopathological characteristics and CT manifestations of gastric neuroendocrine tumors using an optimized DCT filtering algorithm. Methods: An optimized DCT filtering algorithm was used to retrospectively analyze the CT image data and clinical pathological data of 31 patients with gastric neuroendocrine tumors. Results: Of the 31 patients, 23 were male and 8 were female, with a median age of 63 years. There were 4 cases of clinical type I, the lesions were located on the major curve side in 3 cases, and the minor curve side in 1 case; 3 cases had CT with polypoid moderately enhanced nodules, and 1 case was missed; pathological grades were all G1 grade; the maximum diameter of the lesion was 1.7∼6.3 cm, average 1.1 cm. There were 2 cases of clinical type II, 1 case was polypoid on the gastric fundus, grade G1; 1 case was on the gastric antrum, CT showed mild gastric wall thickening, grade G2, with liver metastasis. There were 25 cases of clinical type III, 14 cases of cardia gastric fundus, 4 cases of small curvature of the gastric body, 3 cases of large curvature of the gastric body, and 4 cases of gastric antrum; CT signs showed localized thickening of the gastric wall and 3 cases of gastric wall focal 15 cases were irregularly thickened gastric wall with or without soft tissue masses, 6 of which had ulcers on the surface; the largest diameter of the lesions was 1.7 to 6.3 cm with an average of 4.5 cm; the density of the lesions was 11 and 14 were uneven; The enhanced scan showed significant enhancement in 16 cases, moderate enhancement in 9 cases, uniform enhancement in 8 cases, and uneven enhancement in 17 cases, of which the enhancement peak was located in the arterial phase; 25 cases were all grade G3, 10 were local lymph node metastases, and 4 were liver metastases. There were 4 cases of liver metastasis with local lymph node metastasis, and 1 case of intraperitoneal implantation with local lymph node metastasis. Conclusion: The optimized DCT filtering algorithm can enumerate the CT features of gastric neuroendocrine tumors with different clinical and pathological types. The combination of clinical and CT data is valuable for preoperative diagnosis.

Spectrum of chest CT manifestations of coronavirus disease (COVID-19): A pictorial essay in rural population

Spectrum of chest CT manifestations of coronavirus disease (COVID-19): A pictorial essay in rural population

The Spectrum of CT Findings of COVID-19 Pneumonia: Acute Alveolar Insult and Organizing Pneumonia as Different Phases of Lung Injury and Repair.

PurposeTo analyze the findings and serial changes in chest CT lesions in 123 symptomatic patients with coronavirus disease 2019 (COVID-19).Materials and MethodsFrom February 19 to April 7, 2020, a total of 123 confirmed COVID-19 patients (male, 44; female, 79; mean age, 59.2 ± 18.6) were enrolled in this retrospective study. A total of 234 CT scans were reviewed for the following patterns: acute alveolar insult (AAI) patterns: ground-glass opacity (GGO), crazy-paving appearance, mixed pattern, and consolidation; organizing pneumonia (OP) patterns: perilobular patterns, band opacity, curvilinear opacity, reversed halo opacity, and small nodular consolidation; resolving patterns: pure GGO, remnant curvilinear, small nodular consolidation, and serial changes of lung abnormalities. We compared the proportions of AAI pattern, OP pattern, or resolving pattern with time progression and analyzed the association between the patterns and disease severity using Pearson chi-square and Fisher's exact test.ResultsPredominant CT patterns were AAI pattern (87%) in the early hospital period group (0–10 days, after the onset of symptoms), OP pattern (45.7%) in the later hospital period group (after 10 days), and resolving pattern in discharge and follow-up group (47.2% and 84.8%, respectively). The difference in the proportions of predominant CT patterns with time progression was statistically significant (p < 0.001, Pearson's chi-square test). No statistically significant association was observed between the patterns and disease severity (p = 0.055, Fisher's exact test). No fibrous changes in the lesions were observed on follow-up CT scans.ConclusionThe serial CT scans of COVID-19 patients showed the spectrum of COVID pneumonia CT manifestations as different phases of lung injury and repair.