CT Scoring Research Articles

Artificial intelligence-driven volumetric CT outcome score in cystic fibrosis: longitudinal and multicenter validation with/without modulators treatment.

Holistic segmentation of CT structural alterations with 3D deep learning has recently been described in cystic fibrosis (CF), allowing the measurement of normalized volumes of airway abnormalities (NOVAA-CT) as an automated quantitative outcome. Clinical validations are needed, including longitudinal and multicenter evaluations. The validation study was retrospective between 2010 and 2023. CF patients undergoing Elexacaftor/Tezacaftor/Ivacaftor (ETI) or corticosteroids for allergic broncho-pulmonary aspergillosis (ABPA) composed the monocenter ETI and ABPA groups, respectively. Patients from six geographically distinct institutions composed a multicenter external group. All patients had completed CT and pulmonary function test (PFT), with a second assessment at 1 year in case of ETI or ABPA treatment. NOVAA-CT quantified bronchiectasis, peribronchial thickening, bronchial mucus, bronchiolar mucus, collapse/consolidation, and their overall total abnormal volume (TAV). Two observers evaluated the visual Bhalla score. A total of 139 CF patients (median age, 15 years [interquartile range: 13-25]) were evaluated. All correlations between NOVAA-CT to both PFT and Bhalla score were significant in the ETI (n = 60), ABPA (n = 20), and External groups (n = 59), such as the normalized TAV (ρ ≥ 0.76; p < 0.001). In both ETI and ABPA groups, there were significant longitudinal improvements in peribronchial thickening, bronchial mucus, bronchiolar mucus and collapse/consolidation (p ≤ 0.001). An additional reversibility in bronchiectasis volume was quantified with ETI (p < 0.001). Intraclass correlation coefficient of reproducibility was > 0.99. NOVAA-CT automated scoring demonstrates validity, reliability and responsiveness for monitoring CF severity over an entire lung and quantifies therapeutic effects on lung structure at CT, such as the volumetric reversibility of airway abnormalities with ETI. Normalized volume of airway abnormalities at CT automated 3D outcome enables objective, reproducible, and holistic monitoring of cystic fibrosis severity over an entire lung for management and endpoints during therapeutic trials. Visual scoring methods lack sensitivity and reproducibility to assess longitudinal bronchial changes in cystic fibrosis (CF). AI-driven volumetric CT scoring correlates longitudinally to disease severity and reliably improves with Elexacaftor/Tezacaftor/Ivacaftor or corticosteroid treatments. AI-driven volumetric CT scoring enables reproducible monitoring of lung disease severity in CF and quantifies longitudinal structural therapeutic effects.

Evaluation of the Diagnostic Accuracy of a Computed Tomography-Based Scoring System in the Differentiation between Malignant and Benign Pleural Effusion

Abstract Background Pleural effusion in particular is considered a sign of an underlying pathology, so ti is necessary ot search for the cause and determine whether it is a benign cause or a malignant one as they differ in treatment and prognosis. Aim of the Work To assess the accuracy of contrast-enhanced CT chest to predict the nature of pleural effusion whether benign or malignant using the CT-based scoring system developed by Porcel et al.'(1) Patients and Methods This study was a retrospective study that involved reviewing the contrast-enhanced CT chest done at the radiodiagnosis department in Ain Shams University Hospitals of 30 adult patients (age &amp;gt;18 years old) withunilateral or bilateral pleural effusion, and scoring ti according to hte Porcel et al (" CT scoring system while being blinded to the final diagnosis. The total score was then compared to the biopsy or cytology of the patient to determine its accuracy. Results Analyzing the data showed that the highly significant item of the scoring system denoting malignancy was pleural lesion followed by lung masses, liver metastasis, abdominal masses, and absence of pericardial effusion. The cutoff value in our study was found to be total score &amp;gt;7 denoting malignancy with a sensitivity of 94.12%, a specificity of 100%, a PPV (positive predictive value) of 100, a NPV (negative predictive value) of 92.2 and AUC (area under curve) = 0.986. On the other hand, the cutoff value of the study done by Porcel et al ( (27 denotes malignancy) gave a sensitivity of 94.1%, a specificity of 92.3%,a PPV of 94.12, a NPV of 92.31, and an accuracy of 93.33% in our study while in their study gave a sensitivity of 88%, aspecificity of 94%, and AUC = 0.919. Conclusion This is a simple chest CT scan scoring system, which includes the evaluation of pleural nodularity or thickening, liver metastases, abdominal masses, lung nodules or masses, pleural loculations, pericardial effusions, and cardiomegaly. It can be used as a reliable tool that helps determine the differential diagnosis ofpleural effusion yet does not replace cytology/biopsy. Further studies assessing this C T scan score are recommended.

CT findings as predictive factors for treatment failure in Mycobacterium abscessus complex lung disease: a retrospective cohort study

PurposeMycobacterium abscessus complex (MABC) commonly causes lung disease (LD) and has a high treatment failure rate of around 50%. In this study, our objective is to investigate specific CT patterns for predicting treatment prognosis and monitoring treatment response, thus providing valuable insights for clinical physicians in the management of MABC-LD treatment.MethodsWe retrospectively assessed 34 patients with MABC-LD treated between January 2015 and December 2020. CT scores for bronchiectasis, cellular bronchiolitis, consolidation, cavities, and nodules were measured at initiation and after treatment. The ability of the CT scores to predict treatment outcomes was analyzed in logistic regression analyses.ResultsThe CT scoring system had excellent inter-reader agreement (all intraclass correlation coefficients, > 0.82). The treatment failure (TF) group (17/34; 50%) had higher cavitation diameter (p = 0.049) and extension (p = 0.041) at initial CT and higher cavitation diameter (p = 0.049) and extension (p =0 .045), consolidation (p = 0.022), and total (p = 0.013) scores at follow-up CT than the treatment success (TS) group. The changes of total score and consolidation score (p = 0.049 and 0.024, respectively) increased in the TF group more than the TS group between the initial and follow-up CT. Multivariable logistic regression analysis showed initial cavitation extension, follow-up consolidation extension, and change in consolidation extension (adjusted odds ratio: 2.512, 2.495, and 9.094, respectively, per 1-point increase; all p < 0.05) were significant predictors of treatment failure.ConclusionsA high pre-treatment cavitation extension score and an increase in the consolidation extension score during treatment on CT could be alarm signs of treatment failure requiring tailor the treatment of MABC-LD carefully.

Automatic assessment of DWI-ASPECTS for acute ischemic stroke based on deep learning.

Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is a standardized semi-quantitative method for early ischemic changes in acute ischemic stroke. However, ASPECTS is still affected by expert experience and inconsistent results between readers in clinical. This study aims to propose an automatic ASPECTS scoring model based on diffusion-weighted imaging (DWI) mode to help clinicians make accurate treatment plans. Eighty-two patients with stroke were included in the study. First, we designed a new deep learning network for segmenting ASPECTS scoring brain regions. The network is improved based on U-net, which integrates multiple modules. Second, we proposed using hybrid classifiers to classify brain regions. For brain regions with larger areas, we used brain grayscale comparison algorithm to train machine learning classifiers, while using hybrid feature training for brain regions with smaller areas. The average DICE coefficient of the segmented hindbrain area can reach 0.864. With the proposed hybrid classifier, our method performs significantly on both region-level ASPECTS and dichotomous ASPECTS. The sensitivity and accuracy on the test set are 95.51% and 93.43%, respectively. For dichotomous ASPECTS, the intraclass correlation coefficient (ICC) between our automated ASPECTS score and the expert reading was 0.87. This study proposed an automated model for ASPECTS scoring of patients with acute ischemic stroke based on DWI images. Experimental results show that the method of segmentation first and then classification is feasible. Our method has the potential to assist physicians in the Alberta Stroke Program with early CT scoring and clinical stroke diagnosis.

The diagnostic impact of fractional exhaled nitric oxide for asthmatic cough in nontuberculous mycobacterial pulmonary disease.

Measurement of exhaled nitric oxide (FeNO) is a potentially useful diagnostic test for asthma. However, no study has explored the relationship between FeNO and respiratory symptoms of nontuberculous mycobacterial pulmonary disease (NTM-PD) complicated with asthma. The objective of this study was to assess the utility of measuring FeNO levels in patients with NTM-PD complicated by asthma. In this single-center retrospective cohort study, 140 NTM-PD patients with FeNO measured were enrolled. We selected NTM-PD patients who complicated with asthma as the NTM+BA group, defined using the following criteria: NTM patients with symptoms consistent with asthma, and NTM patients with symptomatic improvement after diagnostic therapy with ICS ± a long-acting beta 2-agonist (LABA). We then calculated a diagnostic cutoff point to distinguish between the NTM+BA groups and the NTM groups (all others). High-resolution computed tomography (HRCT) images were evaluated using the CT scoring system and their association with FeNO was examined. A total of 89 patients were included in the study. (31 in the NTM+BA group and 58 in the NTM group). Compared with the NTM group, the NTM+BA group had higher rates of allergic disease (51.6% vs. 22.4%; p=0.0085) and higher FeNO values (median, 23 [interquartile range {IQR}, 15.0-43.0] ppb vs. median, 17 [IQR, 11.8-23.0] ppb; p=0.015). With diagnostic asthma care using mainly ICS/LABA with reference to the FeNO, most patients (91.0%, 20/22) in the NTM-preceding subgroup in the NTM+BA group demonstrated a prompt improvement of their symptoms and AFB culture findings did not worsen (Culture positive rate (%): Pre-treatment: 59.1% vs. Post-treatment: 40.9%, p=0.3660) at 6 months after starting diagnostic therapy. The optimal diagnostic cutoff point of FeNO to distinguish between the two groups was calculated as 21.5 ppb by the ROC curve (sensitivity 75%, specificity 71.93%, p<0.0001; area under the curve: 0.7989). No significant correlation was observed between FeNO and the severity of CT images in the patients. A certain number of patients with NTM-PD showed exacerbated respiratory symptoms due to asthmatic complications. Elevated FeNO levels suggest asthma complications, even in patients with NTM.

(957) - Comparison of CT Scoring in Chronic Thromboembolic Pulmonary Disease (CTED) versus Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

(957) - Comparison of CT Scoring in Chronic Thromboembolic Pulmonary Disease (CTED) versus Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

Automatic Segmentation of Abdominal Aortic Aneurysms from Time-Resolved 3D Ultrasound Images Using Deep Learning.

Abdominal aortic aneurysms (AAAs) are rupture-prone dilatations of the aorta. In current clinical practice, the maximal diameter of AAAs is monitored with 2D ultrasound to estimate their rupture risk. Recent studies have shown that 3-dimensional and mechanical AAA parameters might be better predictors for aneurysm growth and rupture than the diameter. These parameters can be obtained with time-resolved 3D ultrasound (3D+t US), which requires robust and automatic segmentation of AAAs from 3D+t US. This study proposes and validates a deep learning (DL) approach for automatic segmentation of AAAs. 500 AAA patients were included for follow-up 3D+t US imaging, resulting in 2495 3D+t US images. Segmentation masks for model training were obtained using a conventional automatic segmentation algorithm ('nonDL'). Four different DL models were trained and validated by (1) comparison to CT and (2) reader scoring. Performance of the nonDL and different DL segmentation strategies were evaluated by comparing Hausdorff distance, Dice scores, accuracy, sensitivity, and specificity with a sign test. All DL models had higher median Dice scores, accuracy, and sensitivity (all p < 0.003) compared to nonDL segmentation. The full image-resolution model without data augmentation showed the highest median Dice score and sensitivity (p < 0.001). Applying the DL model on an independent test group produced fewer poor segmentation scores of 1 to 2 on a five-point scale (8% for DL, 18% for nonDL). This demonstrates that a robust and automatic segmentation algorithm for segmenting abdominal aortic aneurysms from 3D+t US images was developed, showing improved performance compared to conventional segmentation.

Correlation Between Radiologic Severity Assessment by Lung CT and Clinical Scoring Using Pneumonia Severity Index In COVID-19 Patients

Correlation Between Radiologic Severity Assessment by Lung CT and Clinical Scoring Using Pneumonia Severity Index In COVID-19 Patients

Correlation between CT Score and KL-6: A Severity Assessing in Juvenile Dermatomyositis Associated Interstitial Lung Disease.

There is no radiological measurement to estimate the severity of pediatrics juvenile dermatomyositis (JDM) with interstitial lung disease (ILD). We validated the effectiveness of CT scoring assessment in JDM patients with ILD. To establish a CT scoring system and calculate CT scores in JDM patients with ILD and to determine its reliability and the correlation with Krebs von den Lungen-6 (KL-6). The study totally enrolled 46 JDM-ILD patients and 16 JDM without ILD (non-ILD, NILD) patients. The chest CT images (7.0 ± 3.6 years; 32 male and 30 female) were all analyzed. CT scores of six lung zones were retrospectively calculated, included image pattern score and distribution range score. Image pattern score was defined as follows: increased broncho-vascular bundle (1 point); ground glass opacity (GGO) (2 points); consolidation (3 points); GGO with bronchiectasis (4 points); consolidation with bronchiectasis (5 points); and honeycomb lung (6 points). Distribution range score was defined as no infiltrate (0 point); <30% (1 point); 30%-60% (2 points); and ≥60% (3 points). Two pediatric radiologists reviewed all CT images independently. The ROC curve was established, and the optimal cutoff score for severity discrimination was set. The agreement between two observers was excellent, and the ICC was 0.930 (95% CI 0.882-0.959, p < 0.01). CT score and KL-6 level had a positive linear correlation (r = 0.784, p < 0.01). However, the correlation between CT scores of different lung zone and KL-6 level was different. The KL-6 cut off level suggested for JDM with ILD was 209.0 U/ml, with 73.9% sensitivity and 87.5% specificity, and the area under curve was (AUC) 0.864 (p < 0.01). The CT scoring system we established, as a semiquantitative method, can effectively evaluate ILD in JDM-PM patients and provide reliable evidence for treatment.

Effect of medical treatment on eradication of biofilms in chronic rhinosinusitis

Background: Long-term macrolides and intranasal corticosteroids have evidence-based recommendations. It has been reported that macrolide therapy caused objective and subjective improvements which correlated to the duration of therapy. Topical nasal steroids are the mainstay of treatment in CRS. It is proposed that intranasal steroid may increase the restoration of normal epithelium. Methods: Sample size of 24 in each group is sufficient to detect the difference between positivity rate with 80% power and 5% level of significance clinically diagnosed cases of CRS with nasal polyps in age group of 18-60 years were taken. Outcome was measured with multiple scoring systems like SNOT-20, CT scoring, endoscopic scoring system. Results: Significant improvement was seen in the SNOT-20 scores with p value of 0.011 and endoscopic scores with p value of 0.001 in group having macrolides along with steroids pre-operatively however the scores post-surgery didn’t show any significant change in both groups. The efficacy of macrolide with nasal steroidal spray or nasal spray alone showed no further benefit in the subjective outcome measures post operatively. Also, no statistically significant eradication of biofilms or decrease in density could be appreciated in both groups. Furthermore, there was no significant difference in recurrence rate. Conclusions: Our result demonstrated the subjective improvement in patients of macrolide group post treatment which could be attributed to its anti-inflammatory effect. Even though macrolides in combination with nasal spray reflected some improvement in the secondary outcomes but the primary outcome of eradication of biofilms couldn’t be achieved.

De Novo Lower Urinary Tract Symptoms in COVID-19 Patients.

Background and objective Since early 2020, the novel coronavirus disease 2019 (COVID-19) has turned into a global healthcare concern. The usual clinical presentation of COVID-19 infection includes myalgia, headache associated with pyrexia, and sore throat. Our study aimed to assess the severity of lower urinary tract symptoms (LUTS) in COVID-19patients and determineits correlation with the prognosis of the disease. Methods We conducted an observational study in the COVID-19 care unit at a tertiary care teaching center in Rajasthan on patients diagnosed as COVID-19-positive. The overactive bladder (OAB) symptom scoring system for LUTS and the CTscoring system for lung involvement in COVID-19 patients were used to evaluate the sample population. Results While our findings showed a non-significant association between OAB and CT score(p>0.05), correlation analysis revealed that the length of hospital stay was significantly longer and oxygen needs weresignificantly more frequent with severe LUTS. Conclusions Based on our findings, de novo LUTS, particularly storage symptoms, may be present in COVID-19-positive cases, and the severity of these symptoms may have an impact on the patient's length of stay in the hospital. Hence, doctors and other medical professionalsshould consider COVID-19-related bladder dysfunctions such as de novo LUTSas part ofCOVID-19 symptomatology.

Added value of a chest multidetector computed tomography scoring system in the assessment of chronic lung disease among pediatric patients

BackgroundPediatric chronic lung disease (CLD) represents a heterogeneous group of several distinct clinical entities, with its prevalence increasing over the last decade. The current study aimed to identify the role of chest multidetector computed tomography (MDCT) using modified Bhalla scoring for the early diagnosis of CLD in pediatric patients and determine the most common chest MDCT findings. This prospective study involved 45 pediatric patients with chronic respiratory symptoms, all of whom underwent MDCT. Thereafter, data were analyzed using the modified Bhalla score.ResultsChronic lung diseases were classified according to their radiological and clinical criteria. The total CT score, which was the most significant factor for chronic inhalation and chronic recurrent inflammatory lung diseases, varied between 2 and 21 points, with those having autoimmune diseases exhibiting the largest value for the mean CT score. The clinical severity of symptoms was not correlated with CT score.ConclusionOur findings showed that MDCT was a useful tool for diagnosing pediatric CLD and assessing disease extent, severity, and superimposed complications. The modified Bhalla CT scoring system allowed for systematic primary and follow-up assessments of various lung lesions in cases with varying CLD etiologies.

Prevalence of incidental humeral intracondylar fissures in brachycephalic breed dogs in CT studies.

Humeral intracondylar fissures (HIF) have been predominantly reported in spaniel breeds and proposed to be possible risk factors for humeral condyle fractures (HCF). We hypothesized that the prevalence of incidental HIF in French Bulldogs may be greater than that of other brachycephalic breeds. A retrospective, observational, prevalence study was performed using CT examinations of French bulldogs and other brachycephalic breed dogs presenting for an unrelated condition. Two European College of Veterinary Diagnostic and Imaging-certified radiologists reviewed the images of the humeral condyles of these dogs. A classification system was devised to grade the findings. We considered a Score 1 to be normal, Score 2 to have centralised sclerosis, Score 3 to have a partial fissure and Score 4 to have a complete fissure. A total of 228 elbows were reviewed from 122 dogs. Of this population, 145 elbows were from French Bulldogs, 54 were from Pugs, and the remainder were from a mix of other brachycephalic breeds. The prevalence of HIF (score 3 or 4) in elbows of the French bulldog, pug and other breed groups was 6.9% (CI 2.8-11%), 5.6% (CI 0-11.7%), and 3.4% (CI 0-10.15%), respectively. At a dog level, the prevalence of HIF (score 3 or 4 present in at least one elbow) was found to be 11.8% (CI 4.6-19%) in French Bulldogs, 11.1% (CI 0-22.9%) in Pugs, and 5.26% (CI 0-15%) in the other breed group. There was no significant difference between the breed groups. The inter-reviewer reliability for CT scoring of HIF based on Cohen's weighted kappa was low at 0.19.

Results of using multiplanar reconstructed CT images for assessing elbow joint osteoarthritis in dogs are consistent with results of radiographic assessment.

To compare osteoarthritis scores assigned through radiographic evaluation of 18 anatomic regions in the elbow joint with scores assigned through evaluation of 3-D maximum intensity projection (MIP), 3-D surface rendering (TSR), and multiplanar reconstructed (MPR) CT images, and to evaluate intraobserver and interobserver agreement of radiographic and CT scoring. Radiographic and CT images of 39 elbow joints in 20 dogs. Images were anonymized and graded independently by 5 observers. One observer graded 12 elbow joints 3 times. Intraobserver consistency and repeatability, interobserver agreement, consistency among methods, and bias between methods were calculated. The most severe changes were observed at the proximal aspect of the anconeal process, and the medial and cranial aspects of the medial coronoid process. Intraobserver consistency was moderate or better for 11/16 regions with MIP images, 11/16 regions with TSR images, 17/18 regions with MPR images, and 14/18 regions with radiographic images. Interobserver agreement was moderate or better for 5/16 regions with MIP images, 9/16 regions with TSR images, 12/18 regions with MPR images, and 6/18 regions with radiographic images. Mean scores from CT-based methods were higher than mean radiographic scores. Assessments of osteoarthritis severity in the elbow joints of dogs obtained by examining radiographic images were generally consistent with assessments obtained by examining CT scans. MPR scores were more consistent and more comparable to radiographic scores than were MIP or TSR scores.

TU7.9 Validation and comparison of new scoring clinical systems to predict uncomplicated versus complicated appendicitis

Abstract Aims Methods This was a retrospective review of a sample of patients whom underwent appendicectomy between 2018 and 2021 in a tertiary university teaching hospital. Inclusion criteria consisted of CT imaging prior to surgery to confirm diagnosis, along with clinical and laboratory data needed to analyse the two scoring systems. Final histological diagnosis of complicated versus uncomplicated appendicitis was employed as the gold standard. Positive predictive (PPV) and negative predictive values (NPV) were calculated for CT, Atema and APSI scoring systems. Results In total, 92 patients were included in the study, whereby 55 patients (59.8%) presented with uncomplicated and 37 patients (40.2%) with complicated appendicitis. With regards to predicting complicated appendicitis: Atema score had a PPV of 47.5% and a NPV of 73%. APSI had a PPV of 43.9% and a NPV of 62.7%. CT had a PPV of 50% and NPV of 65.5%. Conclusion The accurate diagnosis of uncomplicated versus complicated appendicitis may aid in selection of patients to conservative versus surgical management of acute appendicitis. Our study has shown that radiological findings alone have low positive and negative predictive values. The use of the new Atema scoring system was found to have a higher NPV when compared to radiology findings and the APSI scoring system. This may improve accuracy in discriminating uncomplicated versus complicated appendicitis when selecting treatment pathway.

Quantitative CT evaluation after two cycles of induction chemotherapy to predict prognosis of patients with locally advanced oesophageal squamous cell carcinoma before undergoing definitive chemoradiotherapy/radiotherapy

ObjectiveTo investigate the performance of quantitative CT analysis in predicting the prognosis of patients with locally advanced oesophageal squamous cell carcinoma (ESCC) after two cycles of induction chemotherapy before definitive chemoradiotherapy/radiotherapy.MethodsA total of 110 patients with locally advanced ESCC were retrospectively analysed. Baseline chest CT and CT after two cycles of induction chemotherapy were analysed. A multivariate Cox proportional-hazard regression model was used to identify independent prognostic markers for survival analysis. Then, a CT scoring system was established. Time-dependent receiver operating characteristic (ROC) curve analysis and the Kaplan-Meier method were employed for analysing the prognostic value of the CT scoring system.ResultsBody mass index, treatment strategy, change ratios of thickness (ΔTHmax), CT value of the primary tumour (ΔCTVaxial) and the short diameter (ΔSD-LN), and the presence of an enlarged small lymph node (ESLN) after two cycles of chemotherapy were noted as independent factors for predicting overall survival (OS). The specificity of the presence of ESLN for death after 12 months was up to 100%. Areas under the curve value of the CT scoring system for predicting OS and progression-free survival (PFS) were higher than that of the RECIST (p < 0.05). Responders had significantly longer OS and PFS than non-responders.ConclusionQuantitative CT analysis after two cycles of induction chemotherapy could predict the outcome of locally advanced ESCC patients treated with definitive chemoradiotherapy/radiotherapy. The CT scoring system could contribute to the development of an appropriate strategy for patients with locally advanced ESCC.Key Points• Quantitative CT evaluation after two cycles of induction chemotherapy can predict the long-term outcome of locally advanced oesophageal cancer treated with definitive chemoradiotherapy/radiotherapy.• A CT scoring system provides valuable imaging support for indicating the prognosis at the early stage of therapy.• Quantitative CT evaluation can assist clinicians in personalising treatment plans.

Value of computed tomography scores in complicated acute diverticulitis.

Diverticular disease remains one of the most common conditions in the western world. Up to 25% of patients with diverticular disease require hospitalization, 15-30% of those of which require surgical intervention. CT scoring systems have been proposed as means to drive assessment and stratify patients necessitating hospital intervention. To assess and correlate CT scoring systems with clinical and surgical outcomes. Retrospective cohort analysis at a single institution. Single institutional assessment with patients presenting to emergency with a CT diagnosed episode of acute diverticulitis. One hundred and eighty-nine patients were included in the study, 61% of which were male. Patient demographics, comorbidities, medications, biochemistry and inflammatory markers, type of complication following acute diverticulitis, operative/procedural intervention, hospital outcome and mortality were measured. CT scoring systems assessed included modified Hinchey, modified Neff, World Society of Emergency Surgery (WSES) and modified Siewert scoring systems. Majority of patients had left-sided diverticulitis (91%) with localized air (88%) and pericolic abscess (49%) the most common radiological findings. 28% of patients required radiological and/or surgical management with 12% requiring intensive care unit (ICU) admission. There was a general trend for surgical/radiological intervention as the scores increased in severity. The four scoring systems were found to be statistically significant predictors of any intervention and of ICU admission with minimal statistical differences across the different scoring systems. Radiological CT scores for complicated diverticulitis are at best, moderate predictors of clinical and surgical outcomes and may serve to guide management with minimal statistical differences across different scores.

Prediction of Quality of Life by Helsinki CT Scoring System in Patients with Traumatic Brain Injury

Introduction: Traumatic brain injury (TBI) is an alteration in normally maintained homeostasis and function of the brain owing to any external forces. It is one of the major causes leading to increased disability and morbidity among patients suffering trauma. Hence, we aim to study the association between Helsinki computed tomography CT score on admission to patient’s Quality of Life (QoL) following traumatic brain injury in Dhulikhel Hospital, Nepal. Methods and Materials A prospective observational study was conducted among 44 patients who suffered traumatic brain injury. Eligible patients over 18 years of age diagnosed with traumatic brain injury which is confirmed with a computed tomography scan on admission were included. Outcomes were assessed using the quality of life scale “Project for the Epidemiological Analysis of Critical Care Patients scale (PAEEC)”. Results: Among 44 participants suffering from TBI owing to various modes of injury, male to female ratio was 2.3:1. The mean age among participants was 41.07 years with standard deviation of ± 20.13 (Range 18 – 90 years). Correlation analysis showed that QoL, up to 6 months post-TBI, was significantly associated with Helsinki CT classification. Group 1 and group 2 encompassed subjects who sustained TBI and are in their scheduled 3 monthly and 6 monthly follow up. And significant correlation was noted between two variables r1 = 0.536, p-value = 0.027 and r2 = 0.565, p-value = 0.001 respectively. Conclusion: The present study showed that patients with TBI experience significant quality of life deterioration up to 3-6 months post-TBI. And such deterioration can be predicted by use of Helsinki CT score on admission.

Takotsubo cardiomyopathy in patients suffering from acute non-traumatic subarachnoid hemorrhage—A single center follow-up study

Takotsubo cardiomyopathy (TTC) is an important complication of subarachnoid hemorrhage (SAH), that may delay surgical or endovascular treatment and may influence patient outcome. This prospective follow-up study intended to collect data on the prevalence, severity, influencing factors and long-term outcome of TTC in patients suffering from non-traumatic SAH. Consecutive patients admitted with the diagnosis of non-traumatic SAH were included. Intitial assessment consisted of cranial CT, Hunt-Hess, Fisher and WFNS scoring, 12-lead ECG, transthoracic echocardiography (TTE), transcranial duplex sonography and collecting laboratory parameters (CK, CK-MB, cardiac troponin T, NT-proBNP and urine metanephrine and normetanephrine). Diagnosis of TTC was based on modified Mayo criteria. TTC patients were dichotomized to mild and severe forms. Follow-up of TTE, Glasgow Outcome Scale assessment, Barthel's and Karnofsky scoring occurred on days 30 and 180. One hundred thirty six patients were included. The incidence of TTC in the entire cohort was 28.7%; of them, 20.6% and 8.1% were mild and severe, respectively. TTC was more frequent in females (30/39; 77%) than in males (9/39; 23%) and was more severe. The occurrence of TTC was related to mFisher scores and WFNS scores. Although the severity of TTC was related to mFisher score, Hunt-Hess score, WFNS score and GCS, multivariate analysis showed the strongest relationship with mFisher scores. Ejection fraction differences between groups were present on day 30, but disappeared by day 180, whereas wall motion score index was still higher in the severe TTC group at day 180. By the end of the follow-up period (180 days), 70 (74.5%) patients survived in the non-TTC, 22 (81.5%) in the mild TTC and 3 (27%) in the severe TTC group (n = 11) (p = 0.002). At day 180, GOS, Barthel, and Karnofsky outcome scores were higher in patients in the control (non-TTC) and the mild TTC groups than in the severe TTC group. Takotsubo cardiomyopathy is a frequent finding in patients with SAH, and severe TTC may be present in 8% of SAH cases. The severity of TTC may be an independent predictor of mortality and outcome at 6 months after disease onset. Therefore, a regular follow-up of ECG and TTE abnormalities is warranted in patients with subrachnoid hemorrhage for early detection of TTC. The study was registered at the Clinical Trials Register under the registration number of NCT02659878 (date of registration: January 21, 2016).

Role of Computed Tomography in Diagnosis and Assessment of Disease Severity in Covid 19; Trends in Pakistan

Objective: To observe and compare relationship of High Resolution Computed Tomography severity score with presenting symptoms of COVID-19 positive patients in mild, moderate and severe disease and to analyze the trends of morbidity and mortality in Pakistan. Study Design: Retrospective Observational study Subjects and Methods: All OPD and admitted adult male and female patients serially presented to Fatima Memorial and Sir Ganga Ram Hospital Lahore with positive COVID PCR test or clinical symptoms were included in the study. These patients were classified in three groups; Group I: Mild disease, i.e. symptomatic patients who didn’t need hospital admission or oxygen support. Group II: Moderate disease, i.e. patients having oxygen saturation more than 90% &amp; needing oxygen support at times, and Group III: severe disease, i.e. patients needing hospital admission or ventilator support and having oxygen saturation less than 90%. High resolution chest CT scan was the approach in all cases. CT severity score was used to assess the severity of lung parenchymal involvement by COVID-19 on all the HRCT. Data collected was entered and analysis made using SPSS v 25. Results: Total number of patients were 200(100%) with age ranging from 14-85 years and mean age was 49.5+ 5 years, out of which 135(67%) were males and 65(32%) were females with male to female ratio 2:1. HRCT scans of all patients were done with COVID PCR test positive in 146(73%) patients. Group I had 98(49%) patients, 87(43.5%) patients were included in Group II and 15(7.5%) patients in Group III. Oxygen was required in 78(39%) patients from group II and 14(7%) patients from severe disease required ventilator. Conclusion: Our research work presented the trends of CT severity scoring having positive correlation to clinical symptoms of patients. Moreover, most of the patients in our country were having mild and moderate disease and only 7% patients showed severe disease symptoms and CT scoring in our study. Out of those severe disease patients, mortality was only 1% as compared to 2.89% mortality reported in Iran. Keywords: COVID-19 infection, HRCT Chest, Severity score