Frequent CT Research Articles

Clinical analysis of pulmonary mucosa-associated lymphoid tissue lymphoma coexisting with lung cancer

BackgroundPrimary pulmonary Mucosa-associated lymphoid tissue (MALT) lymphoma is a sporadic disease with a favorable prognosis. Particularly, pulmonary MALT lymphoma coexisting with lung cancer is not only rare but also prone to misdiagnosis. The clinical characteristics and prognostic factors of this co-occurrence, however, remain poorly understood.MethodsWe retrospectively analyzed the clinical, imaging, genetic mutations and pathological data among adult patients with pulmonary MALT lymphoma coexisting with lung cancer who were confirmed by pathological examinations after operation at Shanghai Pulmonary Hospital between 1st January 2013 and 31st May 2024.ResultsAfter exclusions, a total of 14 patients were included in the study, of which eleven patients were women and only 3 were men, with a median age of 57 [IQR: 53–67] years. Pulmonary MALT lymphoma presented a median diameter of 14 mm (IQR: 6–23). Nodule was the most frequent CT feature and existing pattern of pulmonary lesions (n = 8). The lung cancer was with a median diameter of 10.7 [IQR:6,20] mm, with nodules as the predominant CT feature (n = 12). Six patients manifested dual primary malignancies within the same lung lobe, termed collision tumors, whereas the remaining eight had lesions in different lobes. Five cases exhibited EGFR mutant, and one case showed no mutation. 13 patients were pathological confirmed with lung adenocarcinoma and one with microcarcinoma. Postoperatively, all-cause mortality rate was low, indicating a positive prognosis. One patient died 41 months after surgery due to a pulmonary infection, while the remaining 13 patients were in good condition with an average follow-up of 37.92 months.ConclusionsIn patients with pulmonary lesions, particularly multiple lesions, comprehensive preoperative evaluation is crucial to prevent misdiagnosis or missed diagnoses. Besides, surgical resection is desirable when both lung cancer and MALT are at an early stage and can be resected with minimally invasive surgery (minimally lung resection).

A study to correlate the association of Gender, Age, Physiology (GAP) index and radiological patterns in interstitial lung disease

ABSTRACT Background: Interstitial lung disease (ILD) encompasses a heterogeneous group of disorders characterized by inflammation and fibrosis of lung tissue, leading to impaired gas exchange and respiratory failure. The GAP index, based on gender, age, and pulmonary function, predicts mortality and disease severity in patients with ILD. High-resolution computed tomography (HRCT) is a critical diagnostic tool that provides detailed information on lung morphology and disease extent. This study aims to investigate the relationship between HRCT patterns and the GAP index in patients with ILD, enhancing disease staging and prognostication. Objectives: 1. To identify various radiological patterns in ILD patients using HRCT of the thorax. 2) To correlate these radiological patterns with the GAP index and verify the relationship mentioned above. Materials and Methods: This retrospective observational study analyzed data from 154 patients with ILD treated at Victoria Hospital, Bangalore Medical College and Research Institute, from January 2021 to September 2023. The inclusion criteria included patients aged ≥ 18 years diagnosed with ILD based on the ATS/ERS criteria. Thoracic HRCT was performed using a Philips Ingenuity 128-slice CT scanner, and pulmonary function tests (PFTs) were conducted using a Power cube Diffusion Plus spirometer. The GAP score was calculated, and the HRCT patterns were compared with the GAP stages. Statistical analyses were performed using IBM SPSS Statistics software. Results: The study population had a mean age of 55.5 years, consisting of 68 males and 86 females. Shortness of breath (97.4%) and cough (87.7%) were the most common symptoms. Hypertension (31.2%) and diabetes mellitus (28.6%) were the most common comorbidities observed. The prevalence of definitive UIP sharply increased in stage 3 (58.8%) compared to stage 1 (9.5%) and stage 2 (41.5%), with a highly significant P value (<0.0001). In contrast, NSIP was more common in Stage 1 (39.3%) and decreases in later stages, with a significant P value (0.011). Over half of the patients were in GAP Stage 1 (54.5%), with significant correlations found between advancing GAP stages and an increased prevalence of honeycombing (P = 0.0005) and traction bronchiectasis (P = 0.010). The ground-glass opacity decreased with increasing GAP stage (P = 0.035). Conclusion: This study revealed a significant correlation between particular HRCT patterns and GAP index stages in patients with ILD, highlighting the importance of honeycombing and traction bronchiectasis as indicators of advanced disease. This approach is advantageous in both resource-limited settings, where HRCT availability is limited, and in advanced medical centers, as it can help minimize the need for frequent CT scans.

Worldwide differences in surgeon intraoperative practices for cochlear implantation

Objective To characterize practice patterns of intraoperative imaging and/or functional confirmation of cochlear implant electrode location worldwide. Methods A cross-sectional survey of otolaryngologists performing cochlear implantation was conducted between March 1 and May 6, 2023. Participants were recruited worldwide using an international otologic society membership email list and at professional meetings. Ninety-seven of the 125 invited participants (78%) completed the survey. Participants were categorized by continent. Results North American surgeons use intraoperative X-rays more frequently than surgeons in Europe and Asia (p < 0.001). Otolaryngologists in Europe and Asia more frequently use no intraoperative imaging (p = 0.02). There is no regional difference between the intraoperative use of electrophysiologic instruments. European and Asian surgeons implant MED-EL devices (p = 0.012) more frequently than North American surgeons, who more frequently use Cochlear Corporation devices (p = 0.003). MED-EL use is related to less frequent intraoperative X-ray use (p = 0.02). Advanced Bionics use is related to more frequent intraoperative CT use (p = 0.03). No significant association existed between years of practice, number of cochlear implantation surgeries performed yearly, volume of pediatric CI practice, and use of intraoperative tools. Conclusion Intraoperative practice for radiologic and functional verification of cochlear implant electrode positioning varies worldwide. Practice guidelines may help establish a standard of care for cochlear implantation.

Lung Ultrasonography in the Evaluation of Late Sequelae of COVID-19 Pneumonia-A Comparison with Chest Computed Tomography: A Prospective Study.

The onset of the COVID-19 pandemic allowed physicians to gain experience in lung ultrasound (LUS) during the acute phase of the disease. However, limited data are available on LUS findings during the recovery phase. The aim of this study was to evaluate the utility of LUS to assess lung involvement in patients with post-COVID-19 syndrome. This study prospectively enrolled 72 patients who underwent paired LUS and chest CT scans (112 pairs including follow-up). The most frequent CT findings were ground glass opacities (83.3%), subpleural lines (72.2%), traction bronchiectasis (37.5%), and consolidations (31.9%). LUS revealed irregular pleural lines as a common abnormality initially (56.9%), along with subpleural consolidation >2.5 mm ≤10 mm (26.5%) and B-lines (26.5%). A strong correlation was found between LUS score, calculated by artificial intelligence percentage involvement in ground glass opacities described in CT (r = 0.702, p < 0.05). LUS score was significantly higher in the group with fibrotic changes compared to the non-fibrotic group with a mean value of 19.4 ± 5.7 to 11 ± 6.6, respectively (p < 0.0001). LUS might be considered valuable for examining patients with persistent symptoms after recovering from COVID-19 pneumonia. Abnormalities identified through LUS align with CT scan findings; thus, LUS might potentially reduce the need for frequent chest CT examinations.

Chronic interstitial lung disease associated with systemic lupus erythematosus: A multicentric study of 89 cases.

Chronic interstitial lung disease (ILD) occurs rarely with systemic lupus erythematosus (SLE) as compared with other connective tissue diseases. This multicentric retrospective study of patients with SLE-ILD from the OrphaLung and French SLE networks during 2005-2020 aimed to describe the characteristics of patients with SLE-ILD and analyse factors associated with prognosis. We analysed data for 89 patients with SLE-ILD (82 women, 92.1%) (median age at SLE diagnosis: 35 years [interquartile range 27-47]). All patients met the 2019 EULAR/ACR criteria for the diagnosis of SLE. Forty two (47.2%) patients were positive for anti-ribonuclear protein antibodies and 45 (50.6%) for anti SSA/Ro antibodies. A total of 58 (65.2%) patients had another connective tissue disease: Sjögren's syndrome (n = 33, 37.1%), systemic sclerosis (n = 14, 15.7%), inflammatory myopathy (n = 6, 6.7%), or rheumatoid arthritis (n = 6, 6.7%). ILD was diagnosed along with SLE in 25 (28.1%) patients and at a median of 6 (0-14) years after the SLE diagnosis. The most frequent CT pattern was suggestive of non-specific interstitial pneumonia (n = 41, 46.0%) with or without superimposed organizing pneumonia. After a median follow-up of 86.5 [39.5-161.2] months, 18 (20.2%) patients had died and 6 (6.7%) underwent lung transplantation. The median 5-year and 10-year transplantation-free survival were 96% (92-100) and 87% (78-97). In total, 44 (49.4%) patients showed ILD progression. Cutaneous manifestations and Raynaud's phenomenon were associated with better survival. Only forced vital capacity was significantly associated with survival and ILD progression. ILD is a rare manifestation of SLE with good overall prognosis but with possible risk of ILD progression. Patients with SLE-ILD frequently have another connective tissue disease.

Photon-Counting CT: High Resolution, Less Radiation

Why Is This an Important Area of Interest?&#x0D; &#x0D; CT scanners play an essential role as medical imaging devices for screening, diagnosis, and monitoring of various health conditions. Photon-counting CT (PCCT) is an emerging medical technology that can improve image quality with less radiation exposure.&#x0D; Although Health Canada has licensed certain PCCT scanners for use, it remains unclear whether PCCT currently has a place in care.&#x0D; &#x0D; What Is the Technology?&#x0D; &#x0D; PCCT uses a semiconductor material to directly convert each incident photon into an electrical signal. The detector can quickly read out and “count” each individual photon. By directly detecting each X-ray photon and its energy level, PCCT scans can provide a clearer image.&#x0D; &#x0D; What Is the Potential Impact?&#x0D; &#x0D; PCCT is intended to function like conventional CT (i.e., scanning various anatomical structures for the purpose of screening, diagnosing, and monitoring health conditions). Any person requiring a CT scan could potentially be eligible for a PCCT scan.&#x0D; PCCT requires less time to complete a scan versus a conventional system. This could increase the number of CT scans a health care organization can conduct per day, if there are resources available to operationalize the additional capacity (e.g., health care personnel).&#x0D; We identified evidence that suggests, with a few exceptions, PCCT can provide similar or improved image quality and reduced image noise with often reduced radiation doses compared to conventional CT. It remains unclear whether this results in improvements in key health outcomes. The increased image quality may also increase incidental findings (e.g., incidentalomas), most of which are not clinically relevant.&#x0D; Compared to conventional CT, trends indicate higher or similar diagnostic confidence among clinicians and improved comfort for patients with PCCT. Trends also suggest PCCT may be valuable at improving the ability to diagnose or detect key markers of certain health conditions or diseases, especially for lung conditions.&#x0D; PCCT may offer particular benefits to children, people who require frequent CT scans, and people living with overweight or obesity.&#x0D; &#x0D; What Else Do We Need to Know?&#x0D; &#x0D; PCCT scanners cost 3 to 5 times more than conventional CT scanners. Additional clinical trials to investigate whether the higher resolution and lower radiation doses result in downstream improvements in key health outcomes are imperative to determine if the additional cost of PCCT scanners is justified.&#x0D; To comprehensively assess whether PCCT should be implemented for clinical use in Canada, additional information on certain implementation factors — such as training requirements and implications of dual-machine exposure, user perceptions, accessibility, and its overall place in care — is needed.&#x0D;

Evaluation of imaging findings in gastrointestinal anisakiasis in emergency CT and ultrasound

BackgroundTo assess the frequency of appearance of various signs (isolated and grouped) in emergency imaging tests in patients with anisakiasis, according to the location of gastrointestinal tract involvement.MethodsRetrospective review by two experienced radiologists of emergency ultrasounds and CTs performed on patients admitted in the Emergency Department of our hospital with later confirmed anisakiasis (2010–2021), assessing the presence of signs suggesting anisakiasis. Calculation of the frequency of appearance according to the gastric or intestinal location, as well as the most common grouped signs.ResultsOut of 231 total patients with anisakiasis, imaging studies were performed in 144: abdominopelvic ultrasound in 43 cases and CT in 111 (both techniques in 31). In cases with gastric occurrence (34), in CT the wall stratification (100%), wall thickening (97%), fat stranding (91%) and ascitic fluid (82%) were predominant. In the intestinal cases (105), in CT (95) the wall thickening (100%), fat stranding (92%) and mesenteric vessel engorgement (83%) were usual; in ultrasound (40), ascitic fluid and wall thickening (70% in both cases) were frequently observed. The frequency of grouped appearance of the mentioned signs was 82% in gastric cases, 80% in intestinal cases and 50% in ultrasounds. Multisegment involvement in CT reached 28% (gastric + intestinal) and 11% (only intestinal) of cases.ConclusionsThe most frequent CT findings in patients with gastric anisakiasis are wall stratification and thickening, fat stranding and ascitic fluid. In the intestinal cases, wall thickening, fat oedema and vessel engorgement are the most often observed findings.Critical relevance statementThe presence of different radiological signs makes it advisable to include anisakiasis in the differential diagnosis of acute abdomen. Intestinal and multifocal involvement rates are greater than previously reported.Key points• In gastric anisakiasis, CT frequently shows wall stratification and thickening, fat stranding and ascitic fluid.• In intestinal anisakiasis, CT often presents wall thickening, fat stranding and vessel engorgement.• In intestinal anisakiasis, ultrasounds most frequently show ascitic fluid and wall thickening.Graphical

Computed Tomography Imaging of COVID-19 Vaccination–related Axillary Lymphadenopathy: Updated Review of Literature

As of September 2022, approximately 606 million cases of COVID-19 have been reported and 6.5 million deaths have occurred worldwide [1]. COVID-19 vaccination programs are in progress around the world to control the pandemic [2]. Till September 2022 approximately 12.6 billion doses of the vaccine have been globally administered [3]. It has been found that reactive hyperplasia of the ipsilateral axillary nodes and sometimes contralateral node is a side effect of vaccination [4]. The frequency of imaging-detected lymphadenopathy ranged between 14.5 to 53% [5]. Cancer patients undergoing active treatment or follow-up surveillance undergo frequent cross-sectional imaging which incidentally detects vaccine-related lymphadenopathy. A Chest CT scan is the most used imaging modality for lung cancer monitoring and lung screening for metastasis of other malignancies. Thus, incidentally detected COVID-19-associated axillary lymph node enlargement is seen in these patients who undergo frequent chest CT scans including the axilla. It is difficult to differentiate lymph node enlargement due to Covid vaccination from lymph node metastasis on imaging. This can lead to unnecessary fine needle aspiration cytology or biopsy thus increasing the patient’s cost and public health burden [6][7][8]. This systematic review aims to evaluate the published literature evidence of axillary lymphadenopathy after COVID-19 vaccination and its imaging features on Chest CT.

Pneumonia pattern recognition on ultra-low-dose CT does not allow for a reliable differentiation between viral and bacterial pneumonia: A multicentre observer study

PurposeWhile a reliable differentiation between viral and bacterial pneumonia is not possible with chest X-ray, this study investigates whether ultra-low-dose chest-CT (ULDCT) could be used for this purpose. MethodsIn the OPTIMACT trial 281 patients had a final diagnosis of pneumonia, and 96/281 (34%) had one or more positive microbiology results: 60 patients viral pathogens, 48 patients bacterial pathogens. These 96 ULDCT’s were blindly and independently evaluated by two chest radiologists, who reported CT findings, pneumonia pattern, and most likely type of pathogen. Differences between groups were analysed for each radiologist separately, diagnostic accuracy was evaluated by calculating sensitivity. ResultsThe dominant CT finding significantly differed between the viral and bacterial pathogen groups (p = 0.04; p = 0.04). Consolidation was the most frequent dominant CT finding in both patients with viral and bacterial pathogens, but was observed significantly more often in those with a bacterial pathogen: 32/60 and 22/60 versus 38/48 and 31/48 (p = 0.005; p = 0.004).The lobar pneumonia pattern was more frequently observed in patients with a bacterial pathogen: 23/48 and 18/48, versus 10/60 and 8/60 for viral pathogens (p < 0.001; p = 0.004). For the bronchopneumonia and interstitial pneumonia patterns the proportions of viral and bacterial pathogens were not significantly different.Both radiologists suggested a viral pathogen correctly (sensitivity) in 6/60 (10%), for a bacterial pathogen this was 34/48 (71%). ConclusionReliable differentiation between viral and bacterial pneumonia could not be made by pattern recognition on ULDCT, although a lobar pneumonia pattern was significantly more often observed in bacterial infection.

Development and Validation of a Risk Model for Predicting Contrast-Associated Acute Kidney Injury in Patients With Cancer: Evaluation in Over 46,000 CT Examinations.

BACKGROUND. Patients with cancer undergo frequent CT examinations with iodinated contrast media and may be uniquely predisposed to contrast-associated acute kidney injury (CA-AKI). OBJECTIVE. The purpose of this study was to develop and validate a model for predicting the risk of CA-AKI after contrast-enhanced CT in patients with cancer. METHODS. This retrospective study included 25,184 adult patients (12,153 men, 13,031 women; mean age, 62.3 ± 13.7 [SD] years) with cancer who underwent 46,593 contrast-enhanced CT examinations between January 1, 2016, and June 20, 2020, at one of three academic medical centers. Information was recorded regarding demographics, malignancy type, medication use, baseline laboratory values, and comorbid conditions. CA-AKI was defined as a 0.3-mg/dL or greater increase in serum creatinine level from baseline within 48 hours after CT or a 1.5-fold or greater increase in the peak measurement within 14 days after CT. Multivariable models accounting for correlated data were used to identify risk factors for CA-AKI. A risk score for predicting CA-AKI was generated in a development set (n = 30,926) and tested in a validation set (n = 15,667). RESULTS. CA-AKI occurred after 5.8% (2682/46,593) of CT examinations. The final multivariable model for predicting CA-AKI included hematologic malignancy, diuretic use, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, chronic kidney disease (CKD) stage 3a, CKD stage 3b, CKD stage 4 or 5, serum albumin level less than 3.0 g/dL, platelet count less than 150 × 103/μL, 1+ or greater proteinuria on baseline urinalysis, diabetes mellitus, heart failure, and contrast medium volume 100 mL or greater. A risk score (range, 0-53 points) was generated with these variables. The most points (13) were for CKD stage 4 or 5 and for albumin level less than 3 g/dL. The frequency of CA-AKI progressively increased in higher risk categories. For example, in the validation set, CA-AKI occurred after 2.2% of CT examinations in the lowest risk category (score ≤ 4) and after 32.7% of CT examinations in the highest risk category (score ≥ 30). The Hosmer-Lemeshow test result indicated that the risk score was a good fit (p = .40). CONCLUSION. A risk model in which readily available clinical data are used to predict the likelihood of CA-AKI after contrast-enhanced CT in patients with cancer was developed and validated. CLINICAL IMPACT. The model may help facilitate appropriate implementation of preventive measures in the care of patients at high risk of CA-AKI.

Role of sex and gender in concussion outcome differences among patients presenting to the emergency department: a systematic review

ObjectiveThis systematic review aimed to identify research involving adults presenting to the emergency department (ED) with a concussion to document the reporting of sex and/or gender according to the Canadian...

Quantitative Analysis of the Clinical Reasons Influencing the Frequency of Pediatric Head CT Examinations: A Single-Center Observation Study.

Epidemiological studies on radiation exposure from pediatric CT scans have attracted attention in terms of radiological protection. These studies have not taken into account the reasons why CT examinations were performed. It is presumed that there are clinical reasons that justify more frequent CT examinations in children. The purpose of this study was to characterize the clinical reasons why relatively high numbers of head CT examinations (NHCT) are frequently performed and to conduct a statistical analysis to determine the factors governing the NHCT. Patient information, the date of examination, and medical conditions for examination data stored on the radiology information system were used to investigate the reasons for undergoing CT examinations. The target facility was National Children's Hospital; data were obtained from March 2002 to April 2017, and the age of the study population was less than 16 years old. Quantitative analysis of the factors associated with frequent examinations was conducted by Poisson regression analysis. Among all patients who had a CT scan, 76.6% had head CT examinations, and 43.4% of children were under 1 year old at the time of the initial examination. There were marked differences in the number of examinations depending on the disease. The average NHCT was higher for children younger than 5 days of age. Among children less than 1 year of age with surgery, there was a marked difference between hydrocephalus, with a mean = 15.5 (95% CI 14.3,16.8), and trauma, with a mean = 8.3 (95% CI 7.2,9.4). In conclusion, this study revealed that NHCT was significantly higher in children who had undergone surgery than in those who had not been to the hospital. The clinical reasons behind patients with higher NHCT should be considered in investigating a causal relationship between CT exposure and brain tumors.

The association between PTPN22 C1858T gene polymorphism and type 1 diabetes mellitus: an Indonesian study

Background Type 1 diabetes mellitus (T1DM) is disease caused by the destruction of β pancreatic cells. The activation of T-lymphocyte and proliferation inhibitor are induced by protein tyrosine phosphatase non-receptor type 22 (PTPN22). However, the link between PTPN22 C1858T gene polymorphism and T1DM is still controversy. This study aimed to analyse the C1858T gene polymorphism in Indonesian children with T1DM. Materials and methods This case-control study was conducted from March 2021 to May 2022 in the Endocrinology Outpatient Clinic at Dr. Soetomo Hospital and Tropical Disease Center Universitas Airlangga. Patients with controlled T1DM during the study period were included. The PTPN22 analysis used polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method. Results Sixty-two children voluntarily participated in this study, and were equally divided into the T1DM and control groups. Most of the patients (94%, 58/62) are Javanese. This study revealed a more frequent CC genotype (9.4%) and allele-C (54.6%) polymorphism in the T1DM group, while more frequent CT genotype (100%) and allele-T (50%) polymorphism were in the control group. The C- and T-allele frequency was 54.6% and 45.4% in the T1DM group, respectively. The T1DM and control groups did not significantly differ (p= .2381). Conclusions PTPN22 homozygous genotype-CC and allele-C polymorphisms are more frequent in patients with T1DM. However, the PTPN22 C1858T gene polymorphism did not significantly correlate to T1DM children in this study. Key Messages: The PTPN22 C1858T gene polymorphism does not significantly affect the susceptibility of T1DM in Indonesian children. PTPN22 homozygous genotype-CC polymorphism was more observed in the T1DM group; thus, this genotype may play as a risk factor for T1DM children in the Indonesian population.

CT characteristics and clinical implications of acute type A aortic intramural hematoma.

Computed tomography (CT) has been increasingly used in the diagnosis of acute aortic syndrome, and a number of high-risk CT imaging features have been reported. We aimed to identify CT imaging findings suggesting high-risk for acute aortic syndrome by examining clinical outcomes of patients with acute type A aortic intramural hematoma (TAIMH). This retrospective study analyzed the relationship of clinical patient characteristics and imaging features with mortality and aortic events in 63 patients receiving initial medical treatment for TAIMH. Multivariate regression analysis was used to determine the predictors of aortic events, and the Kaplan-Meier method was used to analyze survival and aortic events. During a median follow-up of 4.2 years, 25 patients experienced aortic events and 40% of these occurred within 7 days of admission. In total, 12 patients experienced aortic death and 12 patients underwent open aortic surgery or endovascular stenting for aortic disease. In multivariate regression analysis, penetrating atherosclerotic ulcers (PAUs) or ulcer-like projections (ULPs) (P = 0.04) and pericardial effusion (P = 0.03) were independent predictors of aortic events. In the Cox regression model, PAUs/ULPs (P = 0.04) and pericardial effusion (P = 0.04) were independently associated with lower aortic event-free survival. Identification of high-risk CT features is important for clinical decision-making during TAIMH treatment. Early and frequent CT imaging follow-up is required in patients receiving medical treatment. PAUs/ULP and pericardial effusion were the strongest predictors of adverse aortic events.

Mid-term follow-up chest CT findings in recovered COVID-19 patients with residual symptoms.

More than a year has passed since the initial outbreak of SARS-CoV-2, which caused many hospitalizations worldwide due to COVID-19 pneumonia and its complications. However, there is still a lack of information detailing short- and long-term outcomes of previously hospitalized patients. The purpose of this study is to analyze the most frequent lung CT findings in recovered COVID-19 patients at mid-term follow-ups. A total of 407 consecutive COVID-19 patients who were admitted to the Fondazione IRCCS Policlinico San Matteo, Pavia and discharged between February 27, 2020, and June 26, 2020 were recruited into this study. Out of these patients, a subset of 108 patients who presented with residual asthenia and dyspnea at discharge, altered spirometric data, positive lung ultrasound and positive chest X-ray was subsequently selected, and was scheduled to undergo a mid-term chest CT study, which was evaluated for specific lung alterations and morphological patterns. The most frequently observed lung CT alterations, in order of frequency, were ground-glass opacities (81%), linear opacities (74%), bronchiolectases (64.81%), and reticular opacities (63.88%). The most common morphological pattern was the non-specific interstitial pneumonia pattern (63.88%). Features consistent with pulmonary fibrosis were observed in 32 patients (29.62%). Our work showed that recovered COVID-19 patients who were hospitalized and who exhibited residual symptoms after discharge had a slow radiological recovery with persistent residual lung alterations. This slow recovery process should be kept in mind when determining the follow-up phases in order to improve the long-term management of patients affected by COVID-19.

432. A CASE OF ADVANCED ESOPHAGEAL CARCINOSARCOMA DIAGNOSED LATE DUE TO SEVERE STENOSIS AFTER CHEMORADIOTHERAPY

Abstract Radiochemotherapy (CRT) is one of the curative treatment options next to surgery in the treatment of esophageal squamous cell carcinoma. However, CRT may cause esophageal stenosis or obstruction during the healing process. Therefore, in such cases, follow up of early recurrence detection becomes an issue for those patients. We report a case of severe stenosis after CRT, in which recurrence could not detected until advanced cancer developed on the anal side of stenosis. The case is a 73-year-old male. He was diagnosed with upper thoracic esophageal cancer (T4N2M0StageIVa) and had undergone radical chemoradiotherapy 5 years ago. The treatment effect achieved a complete response, but the primary tumor site caused severe esophageal stenosis. Therefore, biannual CT follow up had been done instead of endoscopic follow up. During follow-up, CT revealed a new neoplastic lesion in the lower thoracic esophagus, and endoscopy inserted through a gastrostomy revealed a bulky tumor on the anorectal side of the stenotic lesion. Biopsy revealed carcinosarcoma and robot-assisted thoracoscopic esophagectomy was performed. Malignant neoplasms can be developed not only the same site of primary tumor after CRT. Especially in case of carcinosarcoma, detection would be delayed because of rapid growing. But when the severe esophageal stenosis occurred after CRT, the examination of anal side become difficult. Therefore, it is necessary to observe by frequent CT or PET examination, or endoscopy from gastrostomy for early detection of recurrence or newly malignant neoplasm.

Oxidative-Stress Related Gene Polymorphism in Endometriosis-Associated Infertility.

Background and Objectives: Endometriosis is a benign inflammatory disease associated with infertility and chronic pelvic pain, estimated to affect 7–10% of reproductive-age women, with the possibility of malignant transformation. Recent studies focus on oxidative stress and genetic mutations as risk factors in the pathophysiology of endometriosis-associated infertility. Materials and Methods: This case-control study is the first in Eastern European women that aimed to investigate four genes’ genetic polymorphisms that encode antioxidant enzymes involved in oxidative stress (glutathione peroxidase 1, GPX1 198Pro > Leu, catalase CAT-262C > T, glutathione S-transferase M1, and T1 null genotype) and their association with endometriosis-related infertility. We compared 103 patients with endometriosis-associated infertility with 102 post-partum women as the control group. Results: The endometriosis group had a mean age of 34.5 +/− 6.12 years, while the control group’s mean age was 35.03 +/− 5.95 years. For CAT-262C > T polymorphism, the variant genotypes were significantly more frequent in the endometriosis group. Moreover, for the GPX1 198Pro > Leu, the endometriosis group had significantly more frequent CT and TT genotypes. The null genotype of GSTM1 was detected significantly higher in the endometriosis group. No significant differences were found in the frequency of GSTT1 between the two groups. This study suggests that GPX1 198Pro > Leu, CAT-262C > T, and GSTM1 polymorphisms may be risk factors and that the association between the GSTM1-GSTT1 null genotype may play a significant role in endometriosis-associated infertility. Moreover, this study suggests that the GSTT1 null genotype does not influence the disease. Visual identification of endometriotic lesions with microscopic confirmation is the accepted gold standard for diagnosing endometriosis, but general anesthesia and laparoscopy are required. Conclusions: In this regard, a panel of genetic or laboratory markers is needed for the early diagnostics of this prevalent disease, especially in the case of young patients with future pregnancy intention.

Towards the establishment of national diagnostic reference levels in Tunisia: a multicentre survey in paediatric CT

This work focuses on the determination of the radiation doses for a total sample of 916 children, categorised into four age groups (<1, 1–5, <5–10, <10–15 years) undergoing the most frequent paediatric CT scans performed in different scan facilities in Tunisia in order to establish the national diagnostic reference levels (DRLs). Dose evaluation concerned the dosimetric indicators: volume computed tomography dose index (CTDIvol) and dose–length product (DLP). The different paediatric CT protocols and practices were also evaluated. The results show a large variation in doses between different radiology departments. For head scans, the respective DRLs for children aged <1, 1–5, 5–10 and 10–15 years were 26, 38, 51 and 51 mGy, respectively, for CTDIvol and 384, 664, 873 and 978 mGy cm, respectively, for DLP. For the chest, the equivalent respective DRLs were 8, 10, 12 and 15 mGy for CTDIvol and 118, 330, 442 and 526 mGy cm for DLP. For the abdomen, the respective DRLs were 9, 13, 19 and 18 mGy for CTDIvol and 353, 485, 592 and 1073 mGy cm for DLP. This study shows that the optimisation of paediatric CT procedures should be a priority, especially within regional hospitals. The implementation of corrective actions will take place after the initial DRLs. These actions, including recommendations and guidelines to good practice, should be a joint effort of all stakeholders, including health authorities, the radiation protection regulator, professional societies and universities.

Single-center retrospective analysis of Pneumocystis jirovecii pneumonia in patients after deceased donor renal transplantation

ObjectiveTo investigate the clinical features, early diagnosis, and treatment methods of Pneumocystis jirovecii pneumonia (PJP) after renal transplantation (RT). MethodsWe retrospectively analyzed the clinical data of 80 patients with confirmed PJP who underwent RT between 2018 and 2021 in our hospital. ResultsIn the present study, the incidence of PJP was 6.2% (80/1300). A 50% of cases (40 out of 80 patients) had developed a PJP infection during the first 6 months after RT and 81.3% (65 out of 80 patients) within 12 months. The median onset time of PJP was 6.5 months after RT. The most common symptom was fever (73.8%), followed by progressive dyspnea (51.3%) and dry cough (31.3%). In the initial phase of PJP, the most frequent CT finding was the presence of diffuse ground-grass shadows. In all, 27.5%, 37.5%, and 35% patients were diagnosed by induced sputum metagenomic next-generation sequencing (mNGS), peripheral blood mNGS, and characteristic clinical diagnostic features, respectively. The median 1,3-β-D-glucan level was 500 pg/mL, while the median C-reactive protein level was 63.4 mg/L. In most patients (83.8%), the procalcitonin levels were negative. The mean serum creatinine level was 171.9 ± 87.4 μmol/L. Of the 80 patients, 37 (46.2%) had coexisting cytomegalovirus (CMV) infection. All patients were treated with trimethoprim-sulfamethoxazole and third generation cephalosporin to prevent bacterial infection. The methylprednisolone dose (40–120 mg/d) varied according to illness. ConclusionPJP usually occurs within 1 year after RT, typically within 6 months. Fever, dry cough, and progressive dyspnea are the most common clinical symptoms. PJP should be highly suspected if the patient has clinical symptoms and diffuse, patchy, ground-glass opacities on CT in both lungs after RT within 1 year. Peripheral blood or induced sputum mNGS is helpful for early diagnosis of PJP. Trimethoprim-sulfamethoxazole is still the first choice for the treatment of PJP. Combined use of caspofungin can reduce the dose and adverse reactions of trimethoprim-sulfamethoxazole in theory.

Examination of clinical conditions and chest CT images of Covid-19 cases in Turkey; single center study.

In this study, we aim to study the clinical features and chest CT findings of the patients, COVID-19 diagnosis of which are verified. This retrospective study was conducted on RT-PCR (+) COVID-19 patients who were examined in our hospital's emergency department between March 11, 2020 and June 30, 2020. 326 patients were included in this retrospective study in total. Of the patients, 53.1% and 46.9% are males and females, respectively. The patients applied to the service with the symptoms of shortness of breath at the rate of 21.8% and cough at the rate of 20.6%. The study found that the most frequent abnormal CT finding is ground glass opacity at the rate of 26.7% and it is followed by atelectasis at the rate of 12.3%. Patients in the> 65 age group and patients with COPD comorbidities have significantly higher rates of admission to the intensive care unit. The most frequent findings in examination of pathological chest CT findings are ground glass opacity. The rate of length of intensive care unit stay and mortality is significantly higher in the patients above 65 years old compared to those below 65 years old.