High-resolution Computed Tomography Research Articles

The characteristics and prognosis of bronchiectasis patients with airflow limitation: a prospective longitudinal study

BackgroundAs bronchiectasis progresses, increasing degrees of airflow limitation can occur.ObjectivesThis study aimed to investigate whether concomitant airflow limitation was associated with poor prognosis in patients with bronchiectasis and to identify the characteristics of patients with airflow limitation in bronchiectasis.DesignA prospective longitudinal study was conducted to determine the characteristics and prognosis of bronchiectasis patients with airflow limitation.MethodsWe conducted a prospective longitudinal study. Patients who failed to complete the follow-up were withdrawn from the trial. High-resolution computed tomography (HRCT) was used for diagnosing bronchiectasis, whereas postbronchodilator forced expiratory volume in one second of the predicted value (post-FEV1%) was employed for grading airflow limitation. The main variables included questionnaires, anthropometric measurements, pulmonary function tests, laboratory tests, and CT findings. The primary outcome was frequent exacerbations. Differences among the groups were evaluated via two-tailed Student’s t test or ANOVA for continuous variables if the data were normally distributed. In the case of a nonnormal distribution, the Mann–Whitney U test and Kruskal–Wallis test were used. The chi-square test or Fisher’s exact test was used for categorical variables. Binary logistic regression analyses were used to identify factors and calculate the odds ratio (OR) for frequent exacerbations.ResultsA total of 189 subjects with bronchiectasis were enrolled in the study, including 97 patients with airflow limitation and 92 patients without airway obstruction. Patients with airflow limitation had greater numbers of exacerbations (1.46 ± 0.83 vs. 1.76 ± 1.10 times, P = 0.013) at 12 months after enrolment and greater numbers of hospitalizations (1.10 ± 0.30 vs. 1.36 ± 0.67 times, P = 0.0016) at 24 months after enrolment. In addition, acute exacerbations lasted longer (8.69 ± 3.78 vs. 13.11 ± 14.03 days, P = 0.0171), and the total number of hospitalizations was greater (1.34 ± 0.77 vs. 1.80 ± 1.67 times, P = 0.0421) for patients with a mean follow-up duration of 32 months (Table 3). Bronchiectasis patients with airflow limitation exhibit more severe manifestations of bronchiectasis both clinically and functionally. Furthermore, the cohort of bronchiectasis patients with airflow limitation had a significantly greater infection rate than did the BE group (P = 0.0244), with a notable disparity observed in the incidence of P. aeruginosa infection (P < 0.0001).ConclusionThe results of our study suggest that patients with airflow limitation are more likely to experience acute exacerbations and hospitalizations than are those without airflow limitation. Patients with bronchiectasis concomitant with airflow limitation should be identified as early as possible, and individualized treatment methods should be formulated.

Unlocking the clinical potential of paired inspiratory and expiratory CT scans in the differential diagnosis of cystic lung diseases: A systematic review.

Currently, high-resolution computed tomography (HRCT) is the imaging of choice for the differential diagnosis of various cystic lung lesions, including true cystic lung diseases (CLD) and lesions that may mimic them. However, the traditionally used inspiratory scan still presents a significant spectrum of overlapping radiological features. Recent studies have demonstrated variation in lesion size between inspiratory and expiratory phases, probably due to cyst-airway communication. In this study, we aimed to conduct a systematic review of paired inspiratory and expiratory HRCT in the assessment of cystic lesions as an additional tool to narrow the differential diagnosis. A systematic search was performed in PubMed, Scopus, EMBASE, BVS, and Cochrane through August 2023. Full-text articles that performed paired inspiratory and expiratory CT scans in adult patients with cystic lung lesions were included, with the outcome measured as the reduction in lesion size according to the respiratory phase. Diagnoses were confirmed through histopathological or radiological features. Out of the 96 records, three studies met the criteria for inclusion and were analyzed, comprising a total of 149 participants and 513 cystic lesions. Pulmonary Langerhans Cell Histiocytosis (PLCH), Lymphangioleiomyomatosis (LAM) honeycombing and cystic bronchiectasis became considerably smaller during expiratory CT scans, while the size of emphysema tended to remain constant during respiratory cycles. This study has suggested that paired inspiratory and expiratory CT scans can be valuable for helping differentiate between emphysema and other diseases with a cystic pattern due to their ability to reveal dynamic properties of the lesions. However, the average reduction in cyst size as a single parameter is not sufficient for further refining diagnostics. Studies exploring advanced metrics to assess the reduction in lesion diameter emerge as potential opportunities to investigate the cyst-airway communication hypothesis and further enhance the diagnostic accuracy of paired methods.

Hypersensitivity Pneumonitis Radiologic Features in Interstitial Lung Diseases

The radiologic criteria of hypersensitivity pneumonitis (HP) guidelines focus on four HP compatible features (HPCF) in high-resolution computed tomography (HRCT): ground glass opacities, mosaic attenuation, air-trapping, and centrilobular nodules. However, evidence to support these criteria are limited. Consecutive interstitial lung disease (ILD) patients who underwent HRCT between 2016 and 2021 in three medical centers were included. We assessed the prevalence of HPCF in each ILD and their association with HP diagnosis. We evaluated the impact of HPCF amount for HP diagnosis and the performance of the radiologic criteria by the ATS/JRS/ALAT and CHEST HP guidelines. 436 patients with ILD were included (mean age 66, 48% females), of them, 56 (13%) with HP. All four HPCF were more prevalent in HP than in non-HP ILD (p<0.001 for all). In multivariate analysis, air-trapping was the strongest independent predictor (AOR 4.1, 95% CI 2-8.4, p<0.001). Centrilobular nodules were present almost exclusively in HP and smoking-related ILD. The amount of HPCF in HRCT had an excellent predictive ability for HP diagnosis (receiver operating characteristic AUC 0.85, 95% CI 0.80-0.90). The radiologic criteria of both guidelines had high specificity for "typical HP" and high sensitivity for "compatible with HP", although with low positive predictive values. Our findings remained robust even when including only patients that had a diagnostic biopsy. The presence and amount of HPCF in HRCT predicted HP diagnosis in real-life settings. While current HP radiologic criteria demonstrated good diagnostic performance, our findings highlight areas for future improvement.

Thermal performance enhancement for gas turbine blade trailing edge cooling with topology-optimized printable diamond TPMS lattice

The gas turbine blade trailing edge region is a critical concern in the cooling design due to its narrow characteristics, which limit the implementation of cooling structures. With rapid development in additive manufacturing, many complex cooling techniques have been designed to enhance thermal performance and improve flow uniformity for gas turbine blade trailing edges. This study generates a high thermal performance cooling structure for the trailing edge channel using topology optimization and a Diamond-type triply periodic minimal surface (TPMS) structure. The optimized model is obtained by infilling the Diamond structure in the intermediate densities from the topology optimization, where the objective is to maximize heat transfer under constant input power. The flow path constraints are also included to achieve better uniform flow distribution. The optimized models are compared with the baseline circular pin fin and uniform Diamond network at Reynolds numbers of 10,000 to 30,000. The results show that the uniform Diamond structure provides obviously higher heat transfer than the pin fins by up to 314.3 %. The optimized models obtain lower heat transfer but considerably reduce pressure loss by about twice compared to the uniform Diamond case. Even though the pressure loss of the optimized model is higher than in the pin fins, the thermal performance enhancement is increased by 139.7 %-150.2 %. The fluid flow and heat transfer in the optimized model are distributed more uniformly than in the pin fins. Furthermore, a high-resolution CT scan is employed to assess the manufacturability of the proposed design, printed by laser powder bed fusion at a scale of realistic gas turbine blades. The findings show the feasibility of 3D printing for next-generation gas turbine blades.

Diagnostic performance of specific biomarkers for interstitial lung disease: a single center study.

This study aimed to determine the clinical significance of Krebs von den Lungen-6 (KL-6), surfactant proteins A (SP-A) and D (SP-D) in the evaluation and management of interstitial lung disease (ILD). Serum KL-6, SP-A, SP-D levels were measured in122 unique consecutive patients referred for connective tissue disease (CTD) associated ILD (CTD-ILD) autoantibodies and 120"healthy" controls. Patients' charts were retrospectively reviewed and categorized as ILD and non-ILD or CTD-ILD and other ILD. All biomarkers were evaluated for diagnosis and moderate vs. severe ILD based on high-resolution computed tomography (HRCT). ILD was diagnosed in 52 % (n=64) and non-ILD in 48 % (n=58). ILD patients were categorized as other ILD (61 %, n=39) or CTD-ILD (39 %, n=25). Patients with ILD had significantly elevated levels of SP-A (p<0.02), KL-6 or SP-D (both p<0.0001) when compared to those with non-ILD. The mean levels of all biomarkers were significantly elevated levels in the ILD compared to non-ILD group (p<0.0001). No significant difference in biomarker levels between CTD-ILD and other ILD groups (p≥0.900). Biomarkers had comparable specificities (89-93 %) however; sensitivities were variable at 75 , 77 and 17 % for KL-6, SP-D and SP-A, respectively. Combination of KL-6 and SP-D yielded comparable diagnostic accuracy to all biomarkers with median levels significantly higher in patients with severe vs. mild disease. KL-6 and SP-D levels are elevated in ILD and therefore contribute to the diagnosis and risk stratification for patient management.

Asthma-Related Plastic Bronchitis: A Challenging Diagnosis

Plastic bronchitis (PB) is a rare but potentially life-threatening condition characterized by the formation of bronchial casts, leading to airway obstruction. It is associated with several underlying conditions, including congenital heart disease, respiratory infections, and asthma. Due to its non-specific symptoms, PB is often misdiagnosed or underdiagnosed. We present a case of a 10-year-old boy with a one-year history of recurrent productive cough, dyspnea, and fever, unresponsive to albuterol treatment. Chest X-rays revealed atelectasis of the left lower lung, which persisted despite airway clearance techniques. High- resolution computed tomography (HRCT) showed collapse consolidation of the left lung. Bronchoscopy revealed bronchial obstruction by a rubbery cast, which was successfully removed. Pathologic analysis of the cast showed eosinophils, neutrophils, and Charcot-Leyden crystals. The patient was treated with inhaled corticosteroids and short-acting beta-agonists, leading to complete resolution of symptoms. Follow-up after six months showed no recurrence of symptoms. This case highlights the importance of considering PB in patients with recurrent respiratory symptoms and atelectasis, particularly when foreign body aspiration or common respiratory diseases have been ruled out. Early diagnosis and management, including cast removal and treatment of underlying conditions, are crucial to preventing complications.

Relationship between high-resolution computed tomography quantitative imaging analysis and physiological and clinical features in antisynthetase syndrome-related interstitial lung disease

ObjectivesTo explore the association between the extent of CT abnormalities by quantitative imaging analysis (QIA) and clinical/physiological disease parameters in patients with antisynthetase syndrome associated interstitial lung disease (ARS-ILD).MethodsWe analysed...

Differences Between Patients with Probable UIP and Definite UIP on HRCT in Idiopathic Pulmonary Fibrosis: A Real-World Cohort Study

Background: Both a probable usual interstitial pneumonia (UIP) pattern (p-UIP) and a definite UIP pattern (d-UIP) on high-resolution computed tomography (HRCT) are sufficient to establish a diagnosis of idiopathic pulmonary fibrosis (IPF) without the need for a surgical lung biopsy, according to the 2022 IPF guidelines. However, it remains unknown whether patients with p-UIP and d-UIP have similar disease behaviors and clinical courses. Material and Methods: We retrospectively collected clinical data of patients with IPF and divided the patients into two groups according to their HRCT patterns: a p-UIP group and a d-UIP group. The baseline characteristics, survival rates, and pulmonary function tests were compared between the two groups. The risk factors for mortality were determined by Cox regression in p-UIP and d-UIP separately. Results: There were 304 patients in the p-UIP group and 480 patients in the d-UIP group. Patients in the d-UIP group were more likely to have smoking histories (p &lt; 0.001) and had lower baseline FVC% (74% vs. 77%, p = 0.021) and DLCO% (50% vs. 58%, p &lt; 0.001). Survival rates were higher in p-UIP compared with d-UIP (p = 0.004). There were no differences in changes in FVC% or DLCO% between the two groups. Baseline DLCO% was the only independent risk factor for mortality in p-UIP. Baseline FVC% was independently associated with mortality in d-UIP. Symptom of cough was a risk factor for disease progression (OR = 1.2, p = 0.002) in p-UIP, while symptom of dyspnea might be associated with disease progression in d-UIP (OR = 2.7, p = 0.065). Male patients (OR = 1.88, p = 0.002) with a smoking history (OR = 1.16, p = 0.002) were at higher risk of developing d-UIP. Conclusions: We observed the different disease trajectories between p-UIP and d-UIP. P-UIP on HRCT might identify a subgroup of IPF patients who are in the early stage with a better prognosis.

Lithium Iron Phosphate Battery Failure Under Vibration

The failure mechanism of square lithium iron phosphate battery cells under vibration conditions was investigated in this study, elucidating the impact of vibration on their internal structure and safety performance using high-resolution industrial CT scanning technology. Various vibration states, including sinusoidal, random, and classical impact modes, were tested to simulate real-world usage scenarios. The findings demonstrate that different vibration conditions exert varying degrees of influence on the battery cells. Despite experiencing slight deformation and displacement after exposure to vibrations, their overall performance remains stable, with no significant safety hazards detected. Moreover, it was observed that while the side gap increases due to the partial absorption of impact load by both the battery cells and connection components, the bottom gap remains unchanged. This study holds immense significance in enhancing electric vehicle safety and reliability, while providing a scientific foundation for future optimization designs of lithium iron phosphate batteries.

Congenital Internal Auditory Canal Stenosis

A 3-year-old boy underwent evaluation for possible cochlear implantation. He had failed a neonatal otoacoustic emission (OAE) hearing screen. A combined auditory brainstem response/auditory steady-state response (ABR/ASSR) test battery confirmed the presence of a severe hearing loss on the right and a profound hearing loss on the left. No Joint Committee on Infant Hearing (JCIH) risk factors for early childhood hearing loss1 were identified. Rehabilitation via hearing aid amplification and auditory-verbal speech therapy was unsuccessful. Computerized tomographic (CT) imaging of the temporal bone was performed to identify the presence of any inner ear abnormalities. No abnormalities of the cochlea, vestibule and semicircular canals on both sides were identified by the radiologist. The internal auditory canals were described as “fairly symmetrical without widening”, and the study was officially reported as an “unremarkable study of the temporal bones”. Independent review of the CT imaging revealed the presence of seemingly narrow internal auditory canals (IAC) on both sides. (Figure1A) The width of the IACs on the axial plane were measured by drawing a perpendicular line starting from the posterior wall of the IAC, 2 mm inside the posterior lip of the internal auditory meatus, and ending on the anterior canal wall, as described by McClay et al.2 Measurements taken utilizing the length measurement tool in the DICOM imaging software (RadiAnt DICOM Viewer, Version 2024.1, Medixant) indicated an IAC width of 1.78 mm on the right (with severe hearing loss) and 1.37 mm on the left (with profound hearing loss). (Figure 1B) These measurements confirmed the presence of bilateral internal auditory canal stenosis, a diagnosis defined by a canal of 2 mm or less on highresolution CT.3

Resolution-dependent MRI-to-CT translation for orthotopic breast cancer models using deep learning

Objective.This study aims to investigate the feasibility of utilizing generative adversarial networks (GANs) to synthesize high-fidelity computed tomography (CT) images from lower-resolution MR images. The goal is to reduce patient exposure to ionizing radiation while maintaining treatment accuracy and accelerating MR image acquisition. The primary focus is to determine the extent to which low-resolution MR images can be utilized to generate high-quality CT images through a systematic study of spatial resolution-dependent magnetic resonance imaging (MRI)-to-CT image conversion.Approach.Paired MRI-CT images were acquired from healthy control and tumor models, generated by injecting MDA-MB-231 and 4T1 tumor cells into the mammary fat pad of nude and BALB/c mice to ensure model diversification. To explore various MRI resolutions, we downscaled the highest-resolution MR image into three lower resolutions. Using a customized U-Net model, we automated region of interest masking for both MRI and CT modalities with precise alignment, achieved through three-dimensional affine paired MRI-CT registrations. Then our customized models, Nested U-Net GAN and Attention U-Net GAN, were employed to translate low-resolution MR images into high-resolution CT images, followed by evaluation with separate testing datasets.Main Results.Our approach successfully generated high-quality CT images (0.142mm2) from both lower-resolution (0.282mm2) and higher-resolution (0.142mm2) MR images, with no statistically significant differences between them, effectively doubling the speed of MR image acquisition. Our customized GANs successfully preserved anatomical details, addressing the typical loss issue seen in other MRI-CT translation techniques across all resolutions of MR image inputs.Significance.This study demonstrates the potential of using low-resolution MR images to generate high-quality CT images, thereby reducing radiation exposure and expediting MRI acquisition while maintaining accuracy for radiotherapy.

Quantification of Interstitial Lung Diseases, From the AJR Special Series on Quantitative Imaging.

High-resolution CT (HRCT) plays an important role in diagnosing and monitoring interstitial lung diseases (ILDs). Despite advances, predicting disease progression and treatment response remains challenging. HRCT enables noninvasive visualization and classification of patterns of lung injury and assessment of disease extent. Visual estimation of CT extent of fibrotic lung disease is an independent predictor of mortality and progression, but is subjective, with only modest interobserver agreement for radiologic interpretation of ILD. Machine learning-based textural analysis of fibrosis extent on baseline and serial HRCT scans shows robust correlations with physiologic measures and strong association with risk of disease progression or mortality across various fibrosing ILDs. In idiopathic pulmonary fibrosis, quantitative CT (QCT) assessment is associated with physiologic impairment and risk of progression and death, and increasing severity of fibrosis on longitudinal evaluation is associated with increased risk of progression and death. Similar results have been noted for fibrotic hypersensitivity pneumonitis and connective tissue disease. This review focuses on QCT techniques for ILDs. We describe the clinical need for quantification of lung disease and illustrate the role of conventional visual evaluation and of QCT approaches in defining disease severity, prognosis, and longitudinal progression, both in established disease and in preclinical interstitial abnormality.

Outcome Variation of CO 2 Laser and MicrodrillAssisted Stapedotomy in Otosclerosis

Background: CO2 laser and microdrill-assisted stapedotomy are widely performed procedures in otolaryngology practice. However, definite information regarding surgical advances, postoperative results, complications and how and in which patients these surgical techniques should be exclusively used is a source of continuous discussion. Aim: To compare the outcome of CO2 laser and microdrill-assisted stapedotomy in patients with otosclerosis. Methodology: We enrolled 26 cases as study sample on the basis of selection criteria. All these patients were evaluated by a complete clinical head and neck examination, preoperative oto-microscopic evaluation,pure tone audiometry (PTA) and a high-resolution CT scan.One group of patientswere treated by CO2 laser stapedotomy, and another group by microdrill-assisted stapedotomy. Fisher’s Exact test and Student’s t-test were done as appropriate, and a p-value &lt;0.05 was considered as the level of significance. Results: Maximum patients 9(69.2%) and 7(53.8%) were in the age group of 20-30 years in Group A (CO2 laser stapedotomy) and Group B (Microdrill assisted stapedotomy), respectively. The difference in the mean postoperative air–bone gap was not statistically significant (p=0.679) between the groups. All surgical procedures compared in our study showed the surgical success of &gt; 90%. In present study, 8(61.5%) and 9(69.2%) of the study subjects presented with tinnitus in the CO2 and Microdrill groups, respectively. 1(7.7%) and 1(7.7%) of the study subjects presented with dizziness in both groups, respectively. At 3 months postoperative follow-up, only 1(7.7%) case in the CO 2 laser group and 4(30.8%) cases in the Microdrill group developed complications. Among them, 1 (7.7%) and 2(15.4%) cases developed permanent vertigo in CO2 and Microdrill groups, respectively. 1(7.7%) case developed chorda tympani injury, and 1(7.7%) case developed worsened tinnitus in the Microdrill group. No significant (p&gt;0.05) difference was observed between the groups regarding postoperative complications at 3 months. Conclusion: After analyzing the results of the present study, it can be concluded that there is no significant difference between CO2 laser and microdrill-assisted stapedotomy in terms of hearing outcome and complication. Bangladesh J Otorhinolaryngology 2024; 30(1): 15-23

The specialized inner ear labyrinth of worm-lizards (Amphisbaenia: Squamata).

High-resolution computed tomography (HRCT) has become a widely used tool for studying the inner ear morphology of vertebrates. Amphisbaenians are one of the most specialized groups of fossorial reptiles but are poorly understood relative to other squamate reptile. In this paper we survey the anatomy of the inner and middle ear of these fossorial reptiles using HRCT models and we describe qualitatively and quantitatively (using 3D morphometrics) the anatomy of the inner ear. Amphisbaenians are diverse in skull anatomy, especially in the configuration of the snout, which correlates with digging modes. We demonstrate that the ear also exhibits a diversity of configurations, which are independent of phylogenetic relationships. Results from morphological analyses also allow us to describe 11 new potentially informative phylogenetic characters including some that help to diagnose amphisbaenians, such as: 1) the globular vestibule, ii) semicircular canals arranged in a circular trajectory, and iii) an extensive area of interaction between the columella footplate and the lagenar recess. Among extant amphisbaenians, Rhineura floridana has the most unusual inner ear configuration, including a horizontal semicircular canal that is in the same orientation as the inclined snout. The new morphological information helps us to better understand the morphology of headfirst-burrowing fossorial reptiles and contributes new data for resolution of phylogenetic relationships among amphisbaenians.

Numerical prediction and experiments for 3D crack propagation in brittle materials based on 3D-generalized maximum tangential strain criterion

Accurately predicting and tracing the three-dimensional (3D) propagation and fracture trajectory of a crack inside brittle materials is challenging. One difficulty is that the 3D crack propagation exhibits complex I/II/III mixed-mode expansion, and there is a lack of accurate crack initiation criteria and effective simulation methods. In our previous studies, the 3D-generalized maximum tangential strain (3D-GMTSN) criterion was proposed to determine the direction and onset of 3D fracture initiation. In this study, a Python program based on the 3D-GMTSN criterion is developed and integrated into FRANC3D to predict the 3D propagation trajectory of an arbitrary crack inside brittle solids. To verify the reliability of the new method, three different types of 3D crack modes, namely Internal Inclined Cracks Cuboid (IICC), Edge Notched Disc Bend (ENDB), and Three-Point Bending (TPB), are used for fracture experiments. The 3D crack propagation morphology is identified using high-resolution CT imaging techniques. The IICC, ENDB, and TPB models are simulated using the new method and the conventional numerical method based on the maximum shear stress (MSS), maximumtensile stress (MTS), and maximum energy release rate (MERR) criteria. Comparisons indicate that the proposed method based on the 3D-GMTSN criterion can predict the 3D crack propagation trajectory more accurately than the conventional methods.

Assessing the Severity of Connective Tissue-Related Interstitial Lung Disease Using Computed Tomography Quantitative Analysis Parameters

Objectives The aims of the study are to predict lung function impairment in patients with connective tissue disease (CTD)-associated interstitial lung disease (ILD) through computed tomography (CT) quantitative analysis parameters based on CT deep learning model and density threshold method and to assess the severity of the disease in patients with CTD-ILD. Methods We retrospectively collected chest high-resolution CT images and pulmonary function test results from 105 patients with CTD-ILD between January 2021 and December 2023 (patients staged according to the gender-age-physiology [GAP] system), including 46 males and 59 females, with a median age of 64 years. Additionally, we selected 80 healthy controls (HCs) with matched sex and age, who showed no abnormalities in their chest high-resolution CT. Based on our previously developed RDNet analysis model, the proportion of the lung occupied by reticulation, honeycombing, and total interstitial abnormalities in CTD-ILD patients (ILD% = total interstitial abnormal volume/total lung volume) were calculated. Using the Pulmo-3D software with a threshold segmentation method of −260 to −600, the overall interstitial abnormal proportion (AA%) and mean lung density were obtained. The correlations between CT quantitative analysis parameters and pulmonary function indices were evaluated using Spearman or Pearson correlation coefficients. Stepwise multiple linear regression analysis was used to identify the best CT quantitative predictors for different pulmonary function parameters. Independent risk factors for GAP staging were determined using multifactorial logistic regression. The area under the ROC curve (AUC) differentiated between the CTD-ILD groups and HCs, as well as among GAP stages. The Kruskal-Wallis test was used to compare the differences in pulmonary function indices and CT quantitative analysis parameters among CTD-ILD groups. Results Among 105 CTD-ILD patients (58 in GAP I, 36 in GAP II, and 11 in GAP III), results indicated that AA% distinguished between CTD-ILD patients and HCs with the highest AUC value of 0.974 (95% confidence interval: 0.955–0.993). With a threshold set at 9.7%, a sensitivity of 98.7% and a specificity of 89.5% were observed. Both honeycombing and ILD% showed statistically significant correlations with pulmonary function parameters, with honeycombing displaying the highest correlation coefficient with Composite Physiologic Index (CPI, r = 0.612). Multiple linear regression results indicated honeycombing was the best predictor for both the Dlco% and the CPI. Furthermore, multivariable logistic regression analysis identified honeycombing as an independent risk factor for GAP staging. Honeycombing differentiated between GAP I and GAP II + III with the highest AUC value of 0.729 (95% confidence interval: 0.634–0.811). With a threshold set at 8.0%, a sensitivity of 79.3% and a specificity of 57.4% were observed. Significant differences in honeycombing and ILD% were also noted among the disease groups (P &lt; 0.05). Conclusions An AA% of 9.7% was the optimal threshold for differentiating CTD-ILD patients from HCs. Honeycombing can preliminarily predict lung function impairment and was an independent risk factor for GAP staging, offering significant clinical guidance for assessing the severity of the patient's disease.

Cytokine correlations in childhood-onset rheumatic diseases with pulmonary involvement.

There was less research about cytokines in lung involvement of childhood-onset rheumatic diseases (RD) patients. In this investigation, blood levels of 12 cytokines were tested in order to explore their associations with lung involvement in newly diagnosed childhood-onset RD patients. High-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) were performed on 53 newly diagnosed RD patients without any treatment in our department between July 2021 and December 2023. Patients were separated into groups based on whether their lungs were involved or not according to abnormalities found on HRCT or PFTs. We examined the serum cytokines with 41 healthy, age and gender-matched controls. The majority of serum cytokine levels were statistically different between the RD group with lung involvement and the control group. The RD group with lung involvement had considerably higher serum IL-6 and IFN-γ levels than the RD group without lung involvement or control group. The median serum IL-6 levels were 19 pg/ml [interquartile range (IQR) 6.9, 27.6], 4.4 pg/ml (IQR 2.0, 10.5), and 2.0 pg/ml (IQR 2.0, 2.0) in RD group with lung involvement, RD group without lung involvement, and control group, respectively. Similarly, the median serum IFN-γ levels were 6.0 pg/ml (IQR 5.0, 15), 5.0 pg/ml (IQR 5.0, 5.0), and 5.0 pg/ml (IQR 5.0, 5.0) in RD group with lung involvement, RD group without lung involvement, and control group, respectively. The receiver operating characteristic (ROC) curve study showed that IL-6 and IFN-γ had area under the curve (AUC) values of 0.782 and 0.742, respectively, indicating their significant diagnostic potential for lung involvement in RD patients. Our findings imply that IL-6 and IFN-γ may be associated with the development of lung illnesses and may be involved in the pathophysiology of RD. Thus, in individuals with RD, elevated levels of IFN-γ over 5.42 pg/ml or IL-6 above 6.25 pg/ml may warrant suspicion of lung involvement.

Prognostic Implications of Initial Radiological Findings of Pulmonary Fibrosis in Patients with Acute SARS-CoV-2 Infection: A Prospective Multicentric Study.

Pulmonary fibrosis detected during the acute phase of SARS-CoV-2 infection may significantly influence patient prognosis. This study aimed to evaluate the prognostic value of initial high-resolution computed tomography (HRCT) findings of pulmonary fibrosis in hospitalized COVID-19 patients and to examine how these findings relate to disease severity and clinical outcomes, with a particular focus on the development and validation of predictive scoring systems. In this multicentric prospective cohort study from January 2023 to January 2024, 120 adult patients with confirmed SARS-CoV-2 infection requiring hospitalization were enrolled from two Romanian university hospitals. Patients were categorized based on the presence (n = 60) or absence (n = 60) of pulmonary fibrosis signs on admission HRCT scans, identified by reticular opacities, traction bronchiectasis, honeycombing, and architectural distortion. Biochemical analyses, severity scores (SOFA, APACHE II, NEWS 2), and novel compound scores combining clinical and radiological data were assessed. Patients with HRCT evidence of pulmonary fibrosis had significantly higher severity scores and worse clinical outcomes. The HRCT score alone was a strong predictor of severe COVID-19 (area under the ROC curve [AUC] = 0.885), with a best cutoff value of 9.72, yielding 85.7% sensitivity and 79.8% specificity. Compound Score 1, integrating SOFA, APACHE II, and HRCT scores, demonstrated excellent predictive performance with an AUC of 0.947, sensitivity of 92.5%, and specificity of 88.9%. Compound Score 2, combining systemic inflammation markers (SIRI, SII) and NEWS 2, also showed a strong predictive capability (AUC = 0.913), with 89.2% sensitivity and 85.7% specificity at the optimal cutoff. Regression analysis revealed that Compound Score 1 had the highest hazard ratio for severe COVID-19 outcomes (HR = 4.89; 95% CI: 3.40-7.05), indicating its superior prognostic value over individual markers and traditional severity scores. Initial HRCT findings of pulmonary fibrosis are significantly associated with increased disease severity in hospitalized COVID-19 patients. The HRCT score is a valuable prognostic tool, and, when combined with clinical severity scores into Compound Score 1, it enhances the prediction of severe COVID-19 outcomes with high sensitivity and specificity. These compound scores facilitate the early identification of high-risk patients, guiding clinical decision-making and optimizing patient management to improve outcomes.

Detailed Images of Deep Brain Stimulation Leads Using Micro-CT

Introduction: One of the challenges in directional deep brain stimulation (DBS) is to determine the orientation of implanted electrodes relative to targeted regions. Post-operative images must be aligned with a model of the implanted lead, usually a computer-based model provided by the manufacturer. This paper shows that models can alternatively be obtained by capturing images of individual leads using micro-CT, a high-resolution CT technique. Contrary to computer-aided design models, lead models generated this way provide realistic X-ray contrast and finer details. Methods: We scanned DBS leads from various vendors using a Bruker SkyScan 1276 micro-CT system. To reduce beam-hardening artefacts, samples were scanned at maximum X-ray tube voltage (100 kV) and with copper filtering. Images were made publicly available for download and 3D visualisation. Conclusion: Detailed images of single DBS leads can be generated using standard micro-CT systems. Their use as reference models could improve lead orientation algorithms, in particular those dedicated to X-ray modalities. Furthermore, the possibility to share models online could broaden access for clinical research.

Endoscopic surgical outcomes of meningoencephalocele and cerebrospinal fluid leaks of frontal sinus: a single medical center retrostpective analysis

Objective: To analyze the efficacy of endoscopic surgery for frontal sinus meningoencephalocele and cerebrospinal fluid (CSF) leaks, and to explore endoscopic surgical strategy. Methods: A total of 35 patients with frontal sinus meningoencephalocele and CSF leaks who underwent endoscopic transnasal surgery at Beijing Tongren Hospital, Capital Medical University between May 2007 and December 2023 were enrolled in this retrospective case series, including 29 males and 6 females, with the age of (35.23±15.76) years. High-resolution sinus CT and magnetic resonance cisternography were undertaken before surgery. The primary outcome measure was the success rate of endoscopic surgical repair. Statistical analysis was conducted using SPSS 27 and GraphPad Prism 8 software. Results: Of the 35 cases, 21 (60.0%) were traumatic, and 14 (40.0%) were non-traumatic. The most common defect was in the posterior frontal sinus wall (24 cases, 68.6%), with a defect size of (10.4±4.8) mm2. Twenty-six cases (74.3%) underwent endoscopic transnasal Draf Ⅱa-Ⅲ frontal sinusotomy, and 9 cases (25.7%) underwent endoscopic transnasal Darf Ⅱb-Ⅲ frontal sinusotomy combined with frontal trephination. The average follow-up time was (84.72±57.42) months. The success rate of one-time endoscopic repair was 97.1% (34/35). One patient required a second procedure, resulting in an overall success rate of 100%. Thirty-three patients had a widely patent frontal sinus ostium postoperatively, while two experienced stenosis. Conclusions: Endoscopic surgery is effective for treating frontal meningoencephalocele and CSF leaks while preserving frontal sinus drainage. Combined frontal trephination is recommended for defects that are difficult to repair using the conventional transnasal approach.