Diagnostic Accuracy Of High-resolution Computed Tomography Research Articles

Role of HRCT in detection and characterization of pulmonary abnormalities in pediatric patient’s undergone bone marrow transplant

BACKGROUND & OBJECTIVE: Advancements in transplant regimens, alternative grafts, and new indications have improved bone marrow transplant activity with time. Our objective is to determine the pattern of pulmonary abnormalities using High resolution computed tomography (HRCT) chest scan and to determine the diagnostic accuracy (pulmonary abnormalities) and efficacy (in terms of radiation burden) of HRCT and X-rays after bone marrow transplant.
 METHODOLOGY: It was a descriptive case series conducted at the department of Radiology, POF Hospital, Wah Cantt over a duration of 8 months (January 2021-Augest 2021). A sample size of 20 patients was calculated using the WHO calculator. Patients were recruited through non-probability consecutive sampling. Patients were undergone through HRCT and chest X-rays for diagnostic accuracy and radiation burden measurement. Data was analyzed using SPSS version 24. Fisher exact test, Receiver Operating characteristic (ROC) Curve analysis and t-test was applied for statistical analysis. p-value ≤0.05 was considered significant.
 RESULTS: A total of 20 patient’s undergone bone marrow transplants were included in the study. The mean age of patients was 5. 25years.There were 11(55%) male and 9(45%) female in study. Pattern of pulmonary abnormalities was pleural effusion 2(10%) following nodules 1(5%), pneumonia patches 1(5%), ground glass opacities 1(5%) and septal thickening 1(5%). The diagnostic accuracy of HRCT was found to be high as compared to X-rays (88% vs 57% respectively). The mean radiation dose in HRCT and mean radiation dose in X-rays’ indicate a high radiation burden in HRCT (p≤0.001).
 CONCLUSION: Despite of high radiation burden in HRCT, it had high diagnostic accuracy as compared to X-rays.

Diagnosing lung involvement in inflammatory rheumatic diseases-Where do we currently stand?

Lung involvement is the most common and serious organ manifestation in patients with inflammatory rheumatic disease (IRD). The type of pulmonary involvement can differ, but the most frequent is interstitial lung disease (ILD). The clinical manifestations of IRD-ILD and severity can vary from subclinical abnormality to dyspnea, respiratory failure, and death. Consequently, early detection is of significant importance. Pulmonary function test (PFT) including diffusing capacity of the lungs for carbon monoxide (DLCO), and forced vital capacity (FVC) as well as high-resolution computed tomography (HRCT) are the standard tools for screening and monitoring of ILD in IRD-patients. Especially, the diagnostic accuracy of HRCT is considered to be high. Magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) allow both morphological and functional assessment of the lungs. In addition, biomarkers (e.g., KL-6, CCL2, or MUC5B) are being currently evaluated for the detection and prognostic assessment of ILD. Despite the accuracy of HRCT, invasive diagnostic methods such as bronchoalveolar lavage (BAL) and lung biopsy are still important in clinical practice. However, their therapeutic and prognostic relevance remains unclear. The aim of this review is to give an overview of the individual methods and to present their respective advantages and disadvantages in detecting and monitoring ILD in IRD-patients in the clinical routine.

Diagnosis of the Sputum Smear Positive and Sputum Smear Negative Pulmonary Tuberculosis - The Role of High - Resolution Computed Tomography of Chest

BACKGROUND
 Mycobacterium tuberculosis complex causes pulmonary tuberculosis (PT) which is a major public health problem worldwide and endemic in India. PT diagnosis is done by high-resolution computed tomography (HRCT) which has high sensitivity and specificity.
 METHODS
 At a tertiary hospital, this cross-sectional study was conducted for 3 years. Patients presenting with productive cough with or without haemoptysis, shortness of breath, fever with night sweats or weight loss were suspected of having tuberculosis and underwent HRCT. PT was defined as the presence of consolidation, centrilobular nodules, and branching nodules with a tree in bud appearance with or without lymphadenopathy and pleural effusion on HRCT.
 RESULTS
 In this study, a total of 118 patients with a mean age of 51.85 ± 16.86 years were included. 64 (54.2%) were males and 54 (45.76%) were females out of 118 patients. Sputum smear was negative in a total of 66 (55.9%) patients and positive in 52(44.06%) patients. 84.26% was the diagnostic accuracy of HRCT in diagnosing PT with sensitivity, specificity, PPV and NPV of 84.28%, 83.33%, 78.98%, and 99.02%, respectively. HRCT had diagnostic accuracy, sensitivity, specificity, PPV and NPV of 86.40%, 89.46%, 83.42%, 94.14% and 72.43%, respectively in sputum smear positive patients. Whereas it was 83.87%, 91.54%, 75.40%, 64.57%, and 92.14%, respectively in sputum smear negative patients.
 CONCLUSIONS
 In diagnosing sputum smear-positive and sputum smear-negative PT, HRCT has high sensitivity. The specificity of HRCT was high in diagnosing sputum smear-positive PT, whereas in case of sputum smear-negative PT it was slightly low.

Correlation of computed tomography, echo-planar diffusion-weighted magnetic resonance imaging and surgical outcomes in middle ear cholesteatoma

Conclusion: Echo-planar diffusion-weighted magnetic resonance imaging (DW MRI) is more reliable than high-resolution computed tomography (HRCT) in predicting the presence and localization of cholesteatoma before tympanomastoid surgery. Objectives: To evaluate the diagnostic accuracy of HRCT and echo-planar DW MRI in the detection and localization of cholesteatoma. Methods: Fifty-nine patients were prospectively included in this study. Patients with suspected primary cholesteatoma were evaluated by HRCT and echo-planar DW MRI before tympanomastoid surgery. Radiological findings were correlated with intraoperative findings. Results: HRCT and echo-planar DW MRI accurately predicted the presence or absence of cholesteatoma in 40/59 (67.8%) and 52/59 (88.1%) patients, respectively. The sensitivity, specificity, and positive and negative predictive values of HRCT were 68.97%, 66.67%, 66.67%, and 68.97%, respectively. However, sensitivity, specificity, and positive and negative predictive values of echo-planar DW MRI were 85.71%, 90.32%, 88.89%, and 87.50%, respectively.

SAT0217 High Resolution Computed Tomography as A Diagnostic Determinant of Fibrotic Lung Changes in Connective Tissue Diseases

BackgroundInterstitial pneumonia (IP) may precede the clinical onset of connective tissue diseases (CTD). Idiopathic pulmonary fibrosis (IPF) is fibrosing pneumonia of an unknown cause, and has a poor prognosis. The...

Update in Diffuse Parenchymal Lung Diseases 2005

CLINICAL ADVANCES A number of publications have shed light on important clinical concepts surrounding the clinical evaluation and management of diffuse parenchymal lung diseases (DPLDs). These include approaches to idiopathic interstitial pneumonias (IIPs), including nonspecific interstitial pneumonia (NSIP) and idiopathic pulmonary fibrosis (IPF; idiopathic usual interstitial pneumonia [UIP]), connective tissue–associated DPLD, hypersensitivity pneumonitis (HP), and lymphangioleiomyomatosis (LAM). IIPs A series of sentinel observations have addressed diagnostic issues, staging approaches, unique phenotypes, and management strategies for IIPs. Diagnostic approach. The approach to diagnosis in patients with DPLDs has continued to evolve over the past decade. A recent centennial review described the major impact of highresolution computed tomography (HRCT) in guiding the diagnostic approach to patients with suspected IIP (1). It is evident that stereotypical imaging features have been described for many DPLDs, including some of the IIPs (2). The diagnostic accuracy of the radiological features of UIP has been demonstrated in well-designed clinical studies (3–5). Despite these data, there remains diagnostic confusion regarding the separation of UIP from other IIPs, particularly NSIP (6). On the other hand, increasing data have suggested that predominance of ground-glass opacity with no honeycombing is more common in NSIP. In a recent series, such a pattern was seen in 96% of patients with NSIP and 59% of patients with UIP (7). Unfortunately, the overall diagnostic accuracy of HRCT for separating these two disorders was 70% in this series. The contrast between expert and less experienced radiologists in applying HRCT criteria to the diagnosis of IPF has recently been reported in data from a landmark clinical therapeutic trial (8). As part of this trial, HRCT scans were interpreted by clinical site radiologists and an expert radiology core using predefined criteria. The core radiologists agreed with a diagnosis of IPF in 99% of those diagnosed by site radiologists; little difference was found if the clinical site was an “academic” center or a community-based practice. A survey of American College of Chest Physician members (52.6% responses to the survey) suggested that 67% of respondents accepted HRCT diagnosis for IPF (9). Interestingly, one investigative group has demonstrated that interaction between expert clinicians and radiologists improves the interobserver agreement of the former in evaluating patients with IIPs (10). It is evident that a consensus is developing that typical features of UIP in the appropriate clinical setting can be used to accurately diagnose IPF. In other IIPs, particularly

The Roles of HRCT and Clinical Parameters in Assessing Activity of Suspected Smear Negative Pulmonary Tuberculosis

Smear-negative pulmonary tuberculosis (SNPTB) constitutes a major problem in countries with a moderate or high TB prevalence. The value of high-resolution computed tomography (HRCT), chest x-ray and other clinical findings in determining activity of SNPTB were investigated. The study population consisted of 85 patients with suspected SNPTB, of whom 52 were confirmed as active pulmonary TB according to either culture positivity for Mycobacteriun tuberculosis or demonstration of caseous granulomatous inflammation. The remaining 33 patients accepted inactive TB sequel. Cough and expectoration were significantly frequent in inactive group whereas chest pain was detected higher in active patients. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of HRCT in detecting disease activity were 88, 88, 92, 83 and 88%, respectively. Centrilobular nodules, other non-calcified nodules, consolidation and cavity were significantly higher on HRCT in active group. Chest x-ray scores that were graded 1 to 3 showed a linear trend for the disease activity. HRCT has good diagnostic value in detecting activity of SNPTB, and some clinical findings may help in predicting the activity.