Normal Chest Chest Computed Tomography Research Articles

Clinical characteristics of juvenile systemic sclerosis in Korea: 31-year single-center study.

To evaluate the clinical and laboratory characteristics, therapeutic drugs, and prognosis of juvenile systemic sclerosis (JSSc) at a single center in Korea. This study was a retrospective analysis of patients with JSSc aged <16 years at disease onset and who were treated at our hospital between January 1992 and April 2023. All patients met the Pediatric Rheumatology European Society/American College of Rheumatology/European League against Rheumatism provisional classification criteria for JSSc, and those with localized scleroderma (morphea) were excluded. Among the 13 patients, proximal skin sclerosis (100%), Raynaud's phenomenon (RP) (84.6%), and sclerodactyly (69.2%) were present at the time of diagnosis. The most common symptom before diagnosis was RP, which was present in 10 patients (76.9%), whereas proximal skin sclerosis was observed in only five patients (38.5%). Thirteen patients had positive anti-nuclear antibody (ANA). At the time of diagnosis, five individuals had findings suggestive of interstitial lung disease (ILD) on a pulmonary function test (PFT) or chest computed tomography (CT), two of whom were asymptomatic. During follow-up, three patients developed ILD, one developed renal dysfunction, one developed heart disease, and none died. This study was the first descriptive analysis of clinical features of JSSc in South Korea. Clinical suspicion is essential for diagnosing JSSc in patients with RP, especially if ANA is positive; however, proximal skin sclerosis, which is crucial for diagnosing JSSc, was unrecognized in the early phase of the disease. PFT should be considered even if a patient is asymptomatic or has normal chest CT.

Screening Chest CT Prior to Allogenic Hematopoietic Stem Cell Transplantation

Pulmonary complications constitute a major cause of morbidity and mortality in the post-allogenic hematopoietic stem cell transplant (alloHSCT) period. While Chest X-ray (CXR) is customarily used for screening, we have utilized chest computed tomography (CT). To characterize the prevalence of abnormalities and explore their impact on alloHSCT eligibility and outcomes post-transplant, we conducted a retrospective analysis utilizing real-world data collected at our center for adult patients who were evaluated for alloHSCT from January 2013 through December 2020 and identified 511 eligible patients. The most common primary disease was acute myeloid leukemia in 49% of patients, followed by myelodysplastic syndrome in 23%, lymphoma in 11%, and acute lymphocytic leukemia in 10%. Abnormal screening chest CT was found in 199 patients (39%). The most frequent detected abnormality was pulmonary nodule in 78 patients (35%), followed by consolidation in 42 (19%), ground-glass opacification in 33 (15%), bronchitis and bronchiolitis in 25 (11%), pleural effusions in 14 (6%), and new primary cancer in 7 (2%). CXR detected abnormalities in only about half of the patients (48%) with an abnormal chest CT. Among 199 patients with abnormal chest CT, 98 patients (49%) underwent further assessment and/or intervention before transplant. The most common work up was pulmonary consultation in 32%, infectious diseases consultation in 24%. Lung biopsy was obtained in 20% and antimicrobial therapy was initiated after confirming an infection diagnosis in 20% of patients. Patients with abnormal chest CT demonstrated worse overall survival (P= 0.032), non-relapse mortality (P=0.015), and pulmonary related death (P < 0.001) compared to those who had normal chest CT. Our study suggests that pre-transplant screening chest CT is beneficial in uncovering invasive infections and underlying malignancies and allows appropriate interventions before alloHSCT to prevent potentially serious post-transplant complications without causing a delay in alloHSCT. Nevertheless, abnormal CT findings prior to transplant may be associated with overall worse prognosis.

Twelve-month clinical, functional and radiological outcomes in patients hospitalized for SARS-CoV-2 pneumonia.

To assess long-term clinical, radiological and functional follow-up of patients hospitalized for SARS-CoV-2 pneumonia of different grade of severity. Two-hundred-thirty-three patients (Group 1, patients needed invasive mechanical ventilation -IMV-, n=69; Group 2, patients needed NIMV, n=78; Group 3, patients needed < 12 l/min of O2 supply, n=96) with a post-discharge follow-up>12 months were studied. Follow-up visits, chest CT scan and pulmonary function tests (DLCO, 6-minutes walking tests -6MWT-, spirometry) were done at 3, 6 and 12 months after discharge. Male sex was more frequent in Group 1 (n=50, 72.5%) compared to Group 2 (n=49, 62.5%) and Group 3 (n=44, 51.2%), p=0.024. Group 2 patients had more co-morbidities and higher BMI compared to others. At month 12, the main reported symptoms were fatigue (mainly in Group 3) and dyspnea; most symptoms resolved during follow-up, except brain fog, memory loss and anosmia/dysgeusia that, when present at month 3, usually persisted at month 12. DLCO and 6MWT normalized at month 12 in almost all patients. Only 9 patients (13%) in Group 1 had a normal chest CT at month 12, whilst 20 (29%) had >3 abnormalities, compared to 14 (17.9%) in Group 2 and 11 (11.4%) in Group 3, respectively (p=0.04). Different clinical symptoms persist up to 12 months in patients hospitalized for SARS-CoV-2 pneumonia. Despite the persistence of abnormalities at chest CT scan after 12 months, an impairment of pulmonary function persists only in a minority of subjects. A longer follow-up is needed to assess the evolution of radiological abnormalities in COVID-19 population. This article is protected by copyright. All rights reserved.

HRCT Spectrum in Initially COVID-19 RT-PCR Negative Patients

Objective: To analyze radiological spectrum of HRCT in COVID-19 patients, clinically symptomatic but initially having negative RT-PCR.&#x0D; Study Design: Prospective cross sectional descriptive study.&#x0D; Place and Duration of Study: Radiology and Medicine Department, DHQ Hospital Rawalpindi, from June to November 2020&#x0D; Methodology: The study included 90 patients presenting with clinical symptoms of COVID-19 but with negative RT-PCR. All patients underwent chest computed tomography (CT). Patients with positive COVID-19 RT-PCR test or serology on subsequent repeat test were included in the study. Patients having non COVID-19 HRCT features with negative RT-PCR were excluded from the study.&#x0D; Results: Out of 90 symptomatic, RT-PCR negative patients, 7 had normal chest CT. According to BSTI classification, 50 patients showed classic, 11 had probable and 22 had indeterminate features. Despite supportive clinical and CT features, 17 (18.89%) patients had negative RT-PCR tests on subsequent testing. Unilateral changes were in 8 (8.9%) and bilateral in 75 (83.3%). Most common finding was mixed pattern of peripherally distributed GGN and bronchocentric nodules in 37 (41.1%) patients. Consolidations were in 19 (21.1%), pure ground glass haze in 13 (14.4%), crazy paving in 4 (4.4%), fuzzy bands and arcades in 7 (7.8%), and subtle gravitational GGH in 3 (3.3%) patients. CT-SS classified 69 (76.7%) patients as mild, 10 (11.1%) as moderate and 4 (4.4%) as severe disease.&#x0D; Conclusions: HRCT with CTSS is an important tool for diagnosing and prognosticating COVID-19 infection despite negative RT-PCR, timely identifying and isolating COVID-19 cohorts preventing cross infection and also aiding in prompt symptomatic management.

Critical analysis of spirometric patterns in correlation to chest computed tomography among adult Indigenous Australians with chronic airway diseases

ABSTRACT Background: There is sparse literature evidence in the spirometric patterns of adult Indigenous Australians with and without chest computed tomography (CT)-proven chronic airway diseases (CADs).Methods: Participants spirometry testing graded as acceptable for quality and had a chest CT scan showing radiographic evidence of CADs were included for analysis.Results: Of the 1350 spirometric tests performed between 2012 and 2020, a total of 212 patients with a mean age of 53 years and 54% females were eligible to be included. One-third (30%) had normal chest CT (without CADs), 35% had predominant COPD, 19% bronchiectasis and 16% combined COPD and bronchiectasis. Percentage predicted values for forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) both pre- and post- bronchodilator were significantly reduced for all participants – FVC: CT-normal 64%, 65%; COPD 58%, 62%; bronchiectasis 54%, 54%; combined COPD and bronchiectasis 50%, 53%. FEV1: CT-normal 62%, 65%; COPD 46%, 49%; bronchiectasis 48%,51%; combined COPD and bronchiectasis 36%,40%. FEV1/FVC was only reduced for CT abnormality patients – CT-normal 96%,98%; COPD 77%,77%; bronchiectasis 87%,89%; combined COPD and bronchiectasis 71%,72%.Conclusions: Restrictive spirometric pattern is common and an obstructive pattern with COPD, in isolation or when COPD coexists with bronchiectasis.

Relationship between acute phase reactants and prognosis in patients with or without COVID-19 pneumonia.

ABSTRACTIn December 2019, several cases of pneumonia of unknown origin were reported in the city of Wuhan, province of Hubei, China. The pathogen was named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease was named coronavirus disease 2019 (COVID-19). Acute phase reactans (APRs) are critical in the early diagnosis, treatment, and for monitoring the progression of COVID-19. Seventy two patients were included in the study and infections confirmed by real-time reverse transcription polymerase chain reaction. Clinical parameters, the level of APFs and D-dimer were assessed and results were retrived from the patients’ medical records. Chest computed tomography (CT) findings were described for each patient and they were divided into two groups, with or without COVID-19 pneumonia. The correlation between APRs and CT findings and the patients’ prognosis were evaluated. Twenty eight (38.8%) of the 72 patients were female and 44 (61.2%) were male. The most common symptom was cough (43%) and the most common associated chronic disease was hypertension (12.5%). Thirty (41.6%) patients had completely normal chest CT, while 42 (58.4%) patients had typical findings in terms of COVID-19 pneumonia. C reactive protein (CRP), lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), ferritin, procalcitonin and D-Dimer levels were statistically significantly higher in patients with pneumonia than in those without pneumonia and these parameters were also statistically significantly higher in patients with severe illness. In conclusion, CRP, LDH, ESR, ferritin, and D-Dimer were associated with severe COVID-19 pneumonia. These biomarkers can be used to evaluate the prognosis to predict the clinical course of disease, allowing a proper management and treatment of the patients.

Prognostic Implications of CT Feature Analysis in Patients with COVID-19: a Nationwide Cohort Study.

BackgroundFew studies have classified chest computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) and analyzed their correlations with prognosis. The present study aimed to evaluate retrospectively the clinical and chest CT findings of COVID-19 and to analyze CT findings and determine their relationships with clinical severity.MethodsChest CT and clinical features of 271 COVID-19 patients were assessed. The presence of CT findings and distribution of parenchymal abnormalities were evaluated, and CT patterns were classified as bronchopneumonia, organizing pneumonia (OP), or diffuse alveolar damage (DAD). Total extents were assessed using a visual scoring system and artificial intelligence software. Patients were allocated to two groups based on clinical outcomes, that is, to a severe group (requiring O2 therapy or mechanical ventilation, n = 55) or a mild group (not requiring O2 therapy or mechanical ventilation, n = 216). Clinical and CT features of these two groups were compared and univariate and multivariate logistic regression analyses were performed to identify independent prognostic factors.ResultsAge, lymphocyte count, levels of C-reactive protein, and procalcitonin were significantly different in the two groups. Forty-five of the 271 patients had normal chest CT findings. The most common CT findings among the remaining 226 patients were ground-glass opacity (98%), followed by consolidation (53%). CT findings were classified as OP (93%), DAD (4%), or bronchopneumonia (3%) and all nine patients with DAD pattern were included in the severe group. Uivariate and multivariate analyses showed an elevated procalcitonin (odds ratio [OR], 2.521; 95% confidence interval [CI], 1.001–6.303, P = 0.048), and higher visual CT scores (OR, 1.137; 95% CI, 1.042–1.236; P = 0.003) or higher total extent by AI measurement (OR, 1.048; 95% CI, 1.020–1.076; P < 0.001) were significantly associated with a severe clinical course.ConclusionCT findings of COVID-19 pneumonia can be classified into OP, DAD, or bronchopneumonia patterns and all patients with DAD pattern were included in severe group. Elevated inflammatory markers and higher CT scores were found to be significant predictors of poor prognosis in patients with COVID-19 pneumonia.

Clinical progression and changes of chest CT findings among asymptomatic and pre-symptomatic patients with SARS-CoV-2 infection in Wuhan, China

ABSTRACT Objectives To analyze characteristics of asymptomatic/pres-ymptomatic patients with SARS-CoV-2 infection. Methods Chest computed tomography(CT), indicators for organ and coagulation function, inflammation cytokines, of asymptomatic/pre-symptomatic patients with SARS-CoV-2 infection were retrospectively analyzed in Zhongnan Hospital of Wuhan University from 20 December 2019, to 8 March 2020. Results The proportion of normal chest CT in asymptomatic and pre-symptomatic patients with SARS-CoV-2 infection were 35.4% (17/48) and 3.3%(2/61), respectively (P< 0.001). In 17 asymptomatic patients, their images of chest CT maintained normal during the whole course of diseases, while the normal images of chest CT in 2 pre-symptomatic patients progressed to abnormal later (P< 0.001). All the six asymptomatic patients with SARS-CoV-2 infection maintained unilateral lesion, while the proportion was 29.4%(5/17) in pre-symptomatic patients(P= 0.003). Compared with asymptomatic patients, pre-symptomatic COVID-19 patients had worse levels of Lymphocyte count (P= 0.001), Albumin (P= 0.045), Aspartate aminotransferase (P= 0.044), γ-glutamyl transpeptadase (P= 0.016), Globulin (P= 0.036), Creatinine (P= 0.021), Lactate dehydrogenase (P= 0.008), C-reactive protein (P< 0.001), Serum amyloid A (P< 0.001), and Erythrocyte sedimentation rate (P< 0.001). Except for above indicators, Alkaline phosphatase (P= 0.009), Procalcitonin (P= 0.010), and D-dimer(P< 0.001) increased further during periods of symptoms compared with those levels in pre-symptomatic period. Conclusion In early stage after SARS-CoV-2 infection, images of chest CT and blood tests of asymptomatic patients were different from pre-symptomatic patients.

Rheumatoid arthritis-related lung disease detected on clinical chest computed tomography imaging: Prevalence, risk factors, and impact on mortality

ObjectiveWe aimed to determine the real-world prevalence and investigate risk factors for rheumatoid arthritis (RA)-related lung disease on chest computed tomography (CT) imaging. We also investigated the impact of RA-related lung disease on mortality. MethodsWe studied chest CT imaging abnormalities among RA patients. We determined the presence and type of abnormalities using the chest CT imaging radiologic report. RA-related lung disease was defined as interstitial lung disease (ILD), bronchiectasis, or pleural disease. We examined whether demographics and RA characteristics were associated with RA-related lung disease using logistic regression. RA-related lung disease and mortality was described using survival curves and Cox regression. ResultsWe analyzed 190 patients who had chest CT imaging performed for clinical indications. Mean age was 64.2 years (SD 11.8), 80.0% were female, and 75.3% were seropositive. RA-related lung disease was detected in 54 patients (28.4%); 30 (15.8%) had ILD, 27 (14.2%) had bronchiectasis, and 18 (9.5%) had pleural disease. RA-related lung disease was reported in both seropositive and seronegative RA (28.7% vs. 27.7%, p = 1.00). Male sex (OR 2.62, 95%CI 1.17–5.88) and current methotrexate use (OR 2.73, 95%CI 1.27–5.61 vs. not current) were associated with RA-related lung disease. Twenty-four (44.4%) patients with RA-related lung disease died during mean 7.0 years of follow-up. RA-related lung disease had HR of 5.35 (95%CI 0.72–39.9) for mortality compared to normal chest CT. ConclusionsIn this real-world study, RA-related lung disease was commonly detected on chest CT imaging regardless of RA serostatus. RA-related lung disease had high mortality, emphasizing the importance in close monitoring of these patients.

How to Manage Pediatric Orthopaedic Patients: Strategies to Provide Safer Care During the COVID-19 Outbreak in Wuhan, People's Republic of China.

How to Manage Pediatric Orthopaedic Patients: Strategies to Provide Safer Care During the COVID-19 Outbreak in Wuhan, People's Republic of China.

Characterization of an Asymptomatic Cohort of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infected Individuals Outside of Wuhan, China.

PurposeWe aimed to further clarify the epidemiological and clinical characteristics of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.MethodsWe identified close contacts of confirmed coronavirus disease 2019 (COVID-19) cases in northeast Chongqing, China, who were confirmed by real-time reverse transcription polymerase chain reaction-positive (RT-PCR+). We stratified this cohort by normal vs abnormal findings on chest computed tomography (CT) and compared the strata regarding comorbidities, demographics, laboratory findings, viral transmission and other factors.ResultsBetween January 2020 and March 2020, we identified and hospitalized 279 RT-PCR+ contacts of COVID-19 patients. 63 (23%) remained asymptomatic until discharge; 29 had abnormal and 34 had normal chest CT findings. The mean cohort age was 39.3 years, and 87.3% had no comorbidities. Mean time to diagnosis after close contact with a COVID-19 index patient was 16.0 days, and it was 13.4 days and 18.7 days for those with abnormal and normal CT findings, respectively (P < .05). Nine patients (14.3%) transmitted the virus to others; 4 and 5 were in the abnormal and normal CT strata, respectively. The median length of time for nucleic acid to turn negative was 13 days compared with 10.4 days in those with normal chest CT scans (P < .05).ConclusionsA portion of asymptomatic individuals were capable of transmitting the virus to others. Given the frequency and potential infectiousness of asymptomatic infections, testing of traced contacts is essential. Studies of the impact of treatment of asymptomatic RT-PCR+ individuals on disease progression and transmission should be undertaken.

Long-term Pulmonary Consequences of Coronavirus Disease 2019 (COVID-19): What We Know and What to Expect.

Long-term Pulmonary Consequences of Coronavirus Disease 2019 (COVID-19): What We Know and What to Expect.

Risk factors associated with disease progression in a cohort of patients infected with the 2019 novel coronavirus.

The emerging infection of the 2019 novel coronavirus (2019-nCoV) in late December, 2019 in Wuhan, China, has caused an extreme health concern, with many patients having progressed to acute respiratory disease or other complications in a short period. Meanwhile, the risk factors associated with the disease progression still remain elusive. A cohort of 17 patients with laboratory-confirmed 2019-nCoV infections who were admitted to the Ninth Hospital of Nanchang between January 28 and February 6, 2020, were enrolled in this study. All the patients received standardized treatment. The disease progression was evaluated every 7 days after admission. The clinical, radiologic, and laboratory characteristics were retrospectively analyzed, and the factors associated with the disease progression were screened by binary logistic regression analysis. The cohort comprised 11 women (64.7%) and 6 men (35.3%) between the ages of 18 to 70 years old. All patients had a reported history of contact with infection-confirmed patients. Fever (11/64.7%) and cough (8/47.1%) were the most common symptoms, whereas dyspnea (2/11.8%) and fatigue (3/17.6%) were rare, and there was no patient with diarrhea symptoms. There were 5 patients with aggravated disease at the first disease progression evaluation, and no patient received mechanical ventilation, transferred to the intensive care unit (ICU), or progressed to acute respiratory distress syndrome, septic shock, refractory metabolic acidosis, coagulation dysfunction, or death. Based on the disease progression, patients were divided into the non-aggravation group (12 cases) and the aggravation group (5 cases). There were no significant differences between the 2 groups with respect to their clinical characteristics. Chest computed tomography (CT) on admission revealed there were 8 patients (47.1%) with invasive lesions found bilaterally on the lungs on multiple lobes, 4 patients (23.5%) with invasive lesions on 1 lobe, and 5 patients (29.4%) with normal chest CT. The aggravation group had1 patient (20.0%) with invasive lesions on one lobe, 3 (60.0%) with invasive lesions on multiple lobes, bilaterally, and 1 (20.0%) with normal chest CT; meanwhile, the nonaggravation group had 3 patients (25.0%) with invasive lesions on one lobe, 5 (41.7%) with invasive lesions on multiple lobes, bilaterally, and 4 (33.3%) with normal chest CT. No significant difference was found between the 2 groups. In the aggravation group, the total lymphocyte counts significantly decreased in comparison to that in the non-aggravation group. Further analysis showed that the CD4+ T cell count but not the CD8+ T cell count of the aggravation group was significantly lower than that of the non-aggravation group. Correlation analysis indicated total lymphocyte count was positively correlated with CD4+ T cell count, and no significant differences were found between the 2 groups in other laboratory measurements, including those of white blood cell (WBC) count, C-reactive protein (CRP), albumin, lactate dehydrogenase (LDH), and D-dimer. Finally, a binary logistic regression model was used to identify the factors associated with the disease progression. It was found that total lymphocyte count was a risk factor associated with disease progression in patients infected with 2019-nCoV. A higher cell count of total lymphocytes may indicate a better outcome of the disease, and immune response may be a vital factor for directing disease progression in the early stage of 2019-nCoV infection.

Does this lung nodule need urgent review? A discrete choice experiment of Australian general practitioners

BackgroundLung cancer is the leading cause of cancer mortality in Australia. Guidelines suggest that patients with suspected lung cancer on thoracic imaging be referred for urgent specialist review. However, the term “suspected” is broad and includes the common finding of lung nodules, which often require periodic surveillance rather than urgent invasive investigation. The British Thoracic Society recommends that a lung nodule with a PanCan risk > 10% be considered for invasive investigation. This study aimed to assess which factors influence general practitioners (GPs) to request urgent review for a lung nodule and if these factors concur with PanCan risk prediction model variables.MethodsA discrete choice experiment was developed that produced 32 individual case vignettes. Each vignette contained eight variables, four of which form the parsimonious PanCan risk prediction model. Two additional vignettes were created that addressed haemoptysis with a normal chest computed tomography (CT) scan and isolated mediastinal lymphadenopathy. The survey was distributed to 4160 randomly selected Australian GPs and they were asked if the patients in the vignettes required urgent (less than two weeks) specialist review. Multivariate logistic regression identified factors associated with request for urgent review.ResultsCompleted surveys were received from 3.7% of participants, providing 152 surveys (1216 case vignettes) for analysis. The factors associated with request for urgent review were nodule spiculation (adj-OR 5.57, 95% CI 3.88–7.99, p < 0.0001), larger nodule size, presentation with haemoptysis (adj-OR 4.79, 95% CI 3.05–7.52, p < 0.0001) or weight loss (adj-OR 4.87, 95% CI 3.13–7.59, p < 0.0001), recommendation for urgent review by the reporting radiologist (adj-OR 4.68, 95% CI 2.86–7.65, p < 0.0001) and female GP gender (adj-OR 1.87, 95% CI 1.36–2.56, p 0.0001). In low risk lung nodules (PanCan risk < 10%), there was significant variability in perceived sense of urgency. Most GPs (83%) felt that a patient with haemoptysis and a normal chest CT scan did not require urgent specialist review but that a patient with isolated mediastinal lymphadenopathy did (75%).ConclusionFuture lung cancer investigation pathways may benefit from the addition of a risk prediction m9odel to reduce variations in referral behavior for low risk lung nodules.

Is a normal chest radiograph sufficient to exclude pulmonary abnormalities potentially associated with chronic cough?

There are few original studies on the true role of normal chest radiograph (CXR) in exclusion of pulmonary conditions that may be associated with chronic cough. Thus, the aim of the study was to assess whether a plain CXR is a sufficient tool to exclude relevant pulmonary causes of chronic cough. A retrospective analysis of chest computed tomography (CT) scans in non-smoking patients with chronic cough and normal CXR was performed. The percentage of individuals in whom chest CT revealed relevant abnormalities was compared with the percentage of patients with irrelevant findings or normal chest CT scans. The negative predictive value (NPV) of the CXR in diagnosing the causes of chronic cough was calculated as a proportion of true negative CXRs (normal CXR AND irrelevant CT findings OR normal CT scan) to all negative CXRs (all patients, who had both a CXR and CT scan). The study group consisted of 59 adult patients with chronic cough, normal CXR and CT scan performed to diagnose the cause of chronic cough. In 21 patients (21/59, 36%), chest CT revealed abnormalities that were classified as relevant to chronic cough. The most frequent were: bronchiectasis (7/59, 11.9%), bronchial wall thickening (6/59, 10.2%) and mediastinal lymphadenopathy (5/59, 8.5%). The NPV of a CXR in diagnosing the causes of chronic cough was 64%. In conclusion, the NPV of CXR in diagnosing pulmonary causes of chronic cough is relatively low. Thus, plain CXR seems to be insufficient to exclude pulmonary diseases potentially associated with chronic cough.

CT Quantification of Lungs and Airways in Normal Korean Subjects.

ObjectiveTo measure and compare the quantitative parameters of the lungs and airways in Korean never-smokers and current or former smokers (“ever-smokers”).Materials and MethodsNever-smokers (n = 119) and ever-smokers (n = 45) who had normal spirometry and visually normal chest computed tomography (CT) results were retrospectively enrolled in this study. For quantitative CT analyses, the low attenuation area (LAA) of LAAI-950, LAAE-856, CT attenuation value at the 15th percentile, mean lung attenuation (MLA), bronchial wall thickness of inner perimeter of a 10 mm diameter airway (Pi10), total lung capacity (TLCCT), and functional residual capacity (FRCCT) were calculated based on inspiratory and expiratory CT images. To compare the results between groups according to age, sex, and smoking history, independent t test, one way ANOVA, correlation test, and simple and multiple regression analyses were performed.ResultsThe values of attenuation parameters and volume on inspiratory and expiratory quantitative computed tomography (QCT) were significantly different between males and females (p < 0.001). The MLA and the 15th percentile value on inspiratory QCT were significantly lower in the ever-smoker group than in the never-smoker group (p < 0.05). On expiratory QCT, all lung attenuation parameters were significantly different according to the age range (p < 0.05). Pi10 in ever-smokers was significantly correlated with forced expiratory volume in 1 second/forced vital capacity (r = −0.455, p = 0.003). In simple and multivariate regression analyses, TLCCT, FRCCT, and age showed significant associations with lung attenuation (p < 0.05), and only TLCCT was significantly associated with inspiratory Pi10.ConclusionIn Korean subjects with normal spirometry and visually normal chest CT, there may be significant differences in QCT parameters according to sex, age, and smoking history.

Automatic Detection and Quantification of Tree-in-Bud (TIB) Opacities From CT Scans

This study presents a novel computer-assisted detection (CAD) system for automatically detecting and precisely quantifying abnormal nodular branching opacities in chest computed tomography (CT), termed tree-in-bud (TIB) opacities by radiology literature. The developed CAD system in this study is based on 1) fast localization of candidate imaging patterns using local scale information of the images, and 2) Möbius invariant feature extraction method based on learned local shape and texture properties of TIB patterns. For fast localization of candidate imaging patterns, we use ball-scale filtering and, based on the observation of the pattern of interest, a suitable scale selection is used to retain only small size patterns. Once candidate abnormality patterns are identified, we extract proposed shape features from regions where at least one candidate pattern occupies. The comparative evaluation of the proposed method with commonly used CAD methods is presented with a dataset of 60 chest CTs (laboratory confirmed 39 viral bronchiolitis human parainfluenza CTs and 21 normal chest CTs). The quantitative results are presented as the area under the receiver operator characteristics curves and a computer score (volume affected by TIB) provided as an output of the CAD system. In addition, a visual grading scheme is applied to the patient data by three well-trained radiologists. Interobserver and observer–computer agreements are obtained by the relevant statistical methods over different lung zones. Experimental results demonstrate that the proposed CAD system can achieve high detection rates with an overall accuracy of 90.96%. Moreover, correlations of observer–observer n}{}(R^2=0.8848, n}{}p< 0.01) and observer–CAD agreements n}{}(R^2=0.824, n}{}p< 0.01) validate the feasibility of the use of the proposed CAD system in detecting and quantifying TIB patterns.

Impact of Toxocariasis in Patients with Unexplained Patchy Pulmonary Infiltrate in Korea

Toxocariasis is one of the causes of pulmonary eosinophilic infiltrate that is increasing in Korea. This study was designed to identify the prevalence of toxocara seropositivity in patients with unexplained pulmonary patchy infiltrate and to evaluate associated factors. We evaluated 102 patients with unexplained pulmonary patchy infiltrate on chest computed tomography (CT) scan. As a control set, 116 subjects with normal chest CT were also evaluated. History of allergic disease, drug use, parasitic disease and raw cow liver intake were taken. Blood eosinophil count and total IgE level were measured. Specific serum IgG antibody to Toxocara canis larval antigen and specific IgG antibodies to 4 other parasites were measured by enzyme-linked immunosorbent assay (ELISA). In the infiltrate group, 66.7% subjects were toxocara seropositive whereas 22.4% of the control group were seropositive (p<0.001). In the infiltrate group, patients with a history of eating raw cow liver (odds ratio [OR], 7.8) and patients with eosinophilia (OR, 5.2) had a higher incidence of toxocara seropositivity. Thirty-five percent of toxocara seropositive patients with infiltrate exhibited migrating infiltrate and 48% had decreased infiltrate on the follow-up CT. We recommend that toxocara ELISA should be performed in patients with unexplained pulmonary patchy infiltrate, and that the eating of raw cow liver should be actively discouraged.