Presence Of Ground-glass Opacities Research Articles

Feasibility and potential clinical benefit of dose de-escalation in stereotactic ablative radiotherapy for lung cancer lesions with ground glass opacities

IntroductionTreatment of neoplasic lung nodules with ground glass opacities (GGO) faces two primary challenges. First, the standard practice of treating GGOs as solid nodules, which effectively controls the tumor locally, but might increase associated toxicities. The second is the potential for dose calculation errors related to increased heterogeneity. This study addresses the optimization of a dose de-escalation regime for stereotactic ablative radiotherapy (SABR) for GGO lesions. Materials and MethodsWe used the CT scans of 35 patients (40 lesions) with some degree of GGO component treated at our institution between 2017 and 2021. We first assessed the dose calculation accuracy as a function of the GGO component of the lesion. We then analysed the advantages of a dose de-escalation regime in terms of lung dose reduction (Dmean, V20Gy and V300GyBED3) and plan robustness. ResultsWe found a positive correlation between the presence of GGO and the dose calculation errors in a phantom scenario. These differences are reduced for patient data and in the presence of breathing motion. When using a de-escalation regime, significant reductions were achieved in mean lung dose, V20Gy and V300GyBED3. This study also revealed that lower doses in GGO areas lead to more stable fluence patterns, increasing treatment robustness. ConclusionsThe study lays the foundation for an eventual use of dose de-escalation in SABR for treating lung lesions with GGO, potentially leading to equivalent local control while reducing associated toxicities. These findings lay the groundwork for future clinical trials.

The prognostic value of lymphovascular invasion for stage I lung adenocarcinoma based on the presence of ground-glass opacity.

There is still a debate regarding the prognostic implication of lymphovascular invasion (LVI) in stage I lung adenocarcinoma. Ground-glass opacity (GGO) on CT is known to correlate with a less invasive or lepidic component in adenocarcinoma, which may influence the strength of prognostic factors. This study aimed to explore the prognostic value of LVI in stage I lung adenocarcinoma based on the presence of GGO. Stage I lung adenocarcinoma patients receiving lobectomy between 2010 and 2019 were retrospectively categorized as GGO-positive or GGO-negative (solid adenocarcinoma) on CT. Multivariable Cox regression analyses were performed for disease-free survival (DFS) and overall survival (OS) to evaluate the prognostic significance of pathologic LVI based on the presence of GGO. Of 924 patients included (mean age, 62.5 ± 9.2 years; 505 women), 525 (56.8%) exhibited GGO-positive adenocarcinoma and 116 (12.6%) were diagnosed with LVI. LVI was significantly more frequent in solid than GGO-positive adenocarcinoma (20.1% vs. 6.9%, p < 0.001). Multivariable analysis identified LVI and visceral pleural invasion (VPI) as significant prognostic factors for shorter DFS among solid adenocarcinoma patients (LVI, hazard ratio (HR): 1.89, p = 0.004; VPI, HR: 1.65, p = 0.003) but not GGO-positive patients (p = 0.76 and p = 0.87). In contrast, LVI was not a significant prognostic factor for OS in either group (p > 0.05). In stage I lung adenocarcinoma, pathologic LVI was associated with DFS only in patients with solid lung adenocarcinoma. Lymphovascular invasion (LVI) significantly affects disease-free survival in solid-stage I lung adenocarcinoma patients, but not those with ground-glass opacity (GGO) adenocarcinoma. Risk stratification considering both GGO on CT and LVI may identify patients benefiting from increased surveillance. The presence of ground-glass opacity portends different prognoses for lung adenocarcinoma. In stage I lung adenocarcinoma, lymphovascular invasion (LVI) was significantly more frequent in solid adenocarcinomas than in ground-glass opacity (GGO)-positive adenocarcinomas. LVI was not associated with overall survival in patients with either solid adenocarcinomas or GGO adenocarcinomas.

Distinct pulmonary patterns in ANCA-associated vasculitides: insights from a retrospective single center cohort study.

ANCA-associated vasculitides (AAV) comprise granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis. All forms may involve different organ systems, yet kidney and lung involvement are common and fatal in many cases. Here, we aimed to determine the predictive value of pulmonary disease manifestation and individual CT findings in AAV patients. Available CT scans and clinical information on mortality, renal outcomes, occurrence of relapses and damage scores were analysed retrospectively from a tertiary rheumatology center in Germany. We included a total of 94 AAV patients (49 with GPA, 41 with MPA). Forty-four patients had lung involvement with available CT scans, 70.5% of which with GPA and 72.7% with renal involvement. Nodule formation and cavities were more frequent among GPA patients, whereas ground-glass opacities (GGO), ILD and pleural effusion were observed predominantly in MPA patients. Over a median follow-up of 37months, GPA patients had a slightly higher overall mortality, whereas end-stage kidney failure rates were significantly increased in MPA patients. Relapse frequencies were comparable between both entities. The presence of GGO and pleural effusion were associated with higher relapse rates, whereas nodules were negatively correlated with relapses. Notably, RTX-treated patients had less infections as compared to individuals under different therapies. Our data demonstrate the outstanding importance of characteristic CT patterns in AAV diagnosis assessment. Especially certain CTpatterns including GGO and pleura effusion may help to identify patients who are at higher risk for relapsing disease.

Prognostic factors for interstitial lung disease progression in rheumatoid arthritis: May methotrexate protect against progression?

Objective Lung computed tomography (CT) is a valid method for the detection and assessment of the progression of interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients. The objective of this study is to conduct a comparative analysis of the characteristics of individuals with RA-ILD, with and without radiographic progression, determined using lung CT scans. Method In this retrospective observational study, three radiologists re-evaluated CT scans of RA-ILD patients who had at least one follow-up CT. The lungs were divided into upper, middle, and lower zones, with equal slices. Progression was defined as the involvement of more zones in the vertical extent by the same elementary findings or the emergence of more severe findings in the same zones compared to the previous examination. Logistic regression analysis was used to assess the possible factors identified in univariate analysis. Results This study included 104 patients with 215 lung CT scans for analysis. Radiographic progression was seen in 43 patients (41.3%). Male sex, findings compatible with ILD on the last X-ray, age at diagnosis of ILD > 50 years, and presence of ground-glass opacity on CT were more common in the group with progression. In multivariate analysis (adjusted for ILD disease duration), findings consistent with ILD on chest X-ray and male sex were independent risk factors for progression, while taking methotrexate (ever) was an independent protective factor for progression. Conclusion Our findings indicate a negative association between methotrexate use and ILD progression. These results should be confirmed in further studies.

An AI-Based Low-Risk Lung Health Image Visualization Framework Using LR-ULDCT.

In this article, we proposean AI-based low-risk visualization framework for lung health monitoring using low-resolution ultra-low-dose CT (LR-ULDCT). We present a novel deep cascade processing workflow to achieve diagnostic visualization on LR-ULDCT (<0.3 mSv) at par high-resolution CT (HRCT) of 100 mSV radiation technology. To this end, we build a low-risk and affordable deep cascade network comprising three sequential deep processes: restoration, super-resolution (SR), and segmentation. Given degraded LR-ULDCT, the first novel network unsupervisedly learns restoration function from augmenting patch-based dictionaries and residuals. The restored version is then super-resolved (SR) for target (sensor) resolution. Here, we combine perceptual and adversarial losses in novel GAN to establish the closeness between probability distributions of generated SR-ULDCT and restored LR-ULDCT. Thus SR-ULDCT is presented to the segmentation network that first separates the chest portion from SR-ULDCT followed by lobe-wise colorization. Finally, we extract five lobes to account for the presence of ground glass opacity (GGO) in the lung. Hence, our AI-based system provides low-risk visualization of input degraded LR-ULDCT to various stages, i.e., restored LR-ULDCT, restored SR-ULDCT, and segmented SR-ULDCT, and achieves diagnostic power of HRCT. We perform case studies by experimenting on real datasets of COVID-19, pneumonia, and pulmonary edema/congestion while comparing our results with state-of-the-art. Ablation experiments are conducted for better visualizing different operating pipelines. Finally, we present a verification report by fourteen (14) experienced radiologists and pulmonologists.

Emergency department CT examinations demonstrate no evidence of early viral circulation at the start of the COVID-19 pandemic—a multicentre epidemiological study

BackgroundBiological studies suggested that the COVID-19 outbreak in France occurred before the first official diagnosis on January 24, 2020. We investigated this controversial topic using a large collection of chest CTs performed throughout French emergency departments within 6 months before the 1st lockdown.ResultsOverall, 49,311 consecutive patients (median age: 60 years, 23,636/49,311 [47.9%] women) with available chest CT images and reports from 61 emergency departments between September 1, 2020, and March 16, 2020 (day before the 1st French lockdown), were retrospectively included in this multicentre study. In the macroscopic analysis of reports automatically (labelled for presence of ground glass opacities [GGOs], reticulations, and bilateral and subpleural abnormalities), we found a significant breakpoint on February 17, 2020, for the weekly time series with 1, 2 and ≥ 3 of these 4 radiological features, with 146/49,311 (0.3%) patients showing bilateral abnormalities and ground glass opacities (GGOs) from that day. According to radiologists, 22/146 (15.1%) CT images showed typical characteristics of COVID-19, including 4/146 (2.7%) before February 2020. According to hospital records, one patient remained without microbial diagnosis, two patients had proven influenza A and one patient had concomitant influenza A and mycoplasma infection.ConclusionThese results suggest that SARS-CoV-2 was not circulating in the areas covered by the 61 emergency departments involved in our study before the official beginning of the COVID-19 outbreak in France. In emergency patients, the strong resemblance among mycoplasma, influenza A and SARS-CoV-2 lung infections on chest CT and the nonspecificity of CT patterns in low prevalence periods is stressed.Critical relevance statementWe proposed here an innovative approach to revisit a controversial ‘real’ start of the COVID-19 pandemic in France based on (1) a population-level approach combining text mining, time series analysis and an epidemiological dataset and (2) a patient-level approach with careful retrospective reading of chest CT scans complemented by analysis of samples performed contemporarily to the chest CT. We showed no evidence that SARS-CoV-2 was actively circulating in France before February 2020.Graphical

Covid 19 Pozitif Hastaların Akciğer ve Göğüs Hacminin Incelenmesi

Background: We aimed to reveal lung volume, lesion volume and thorax diameters in patients with Covid-19 positive in CT images according to gender and presence of ground glass opacity. Materials and Methods: We included CT images of 113 people (male;58, female;55) diagnosed with Covid-19 positive in our study. CT images of each patient were imported the DICOM datasets and thorax diameter measurements were performed by using MicroDicom. Moreover, lung volume and lesion volume parameters were calculated from the CT images using the three-dimensional imaging method (Vitrea). All measurement parameters were compared according to gender and ground glass opacity appearance. Results: The 113 patients (male;58, female;55) with a mean age of 44.57±14.59 diagnosed with Covid-19 were included in our study. There was a significant difference between the gender in the mean values of lung volume (males; 3530.90±1454.99 ml and females; 3149.92±1335.16 ml) and lesion volume (males; 434.59±664.19 ml and females; 557.10±671.99 ml) parameters. In addition, a significant difference in lung volume (p&amp;lt;0.001) and lesion volume (p&amp;lt;0.001) was obtained between the groups with ground glass opacity and without ground glass opacity. Moreover, A significant difference (p=0.001) in thorax anteroposterior diameter length was obtained between the groups the with/without ground glass opacity. However, there was no significant difference (p=0.542) between genders in thorax diameters. Conclussion: In our study, we found that in the females may have more lung damage from Covid-19. We believe that our work in the light of the available data, we believe that the findings of our study will contribute to early stages of the pandemic, in which vaccination has not yet , and the long-term effects of post-covid.

Chest CT findings in community-acquired pneumonia due to Coxiella burnetii (Q fever) compared to Streptococcus pneumoniae, a cross sectional study in French Guiana, 2013–2017

ObjectivesFew and small studies previously examined chest CT-scan characteristics of Coxiella burnetii (Cb) community-acquired pneumonia (CAP). Larger studies are needed to guide physicians towards diagnosis of Q fever in case of pneumonia. MethodsWe conducted a single-center retrospective observational study between 2013 and 2017. All patients with Cb or Streptococcus pneumoniae (Sp) CAP who had a chest CT-scan on admission at Cayenne Hospital (French Guiana) were included. Chest CT-scan were all analyzed by the same expert radiologist. ResultsWe included 75 patients with Cb CAP and 36 with Sp CAP. Fifty-nine percent of all patients were men (n = 66) and median age was 52 [IQR = 38–62]. Chest CT-scans of Cb CAP patients revealed 67 alveolar condensations (89 %), 52 ground-glass opacities (69 %), 30 cases of lymphadenopathy(ies) (40 %) and 25 pleural effusions (33 %). Parenchyma lesions caused by Cb were predominantly unilateral (67 %). We found high numbers of alveolar condensations in both Cb and Sp CAP (89 % and 75 %; respectively), but the presence of ground-glass opacities was significantly associated with Cb CAP (69 % versus 30 %; p < 0.01). Cb CAP were associated with more lymphadenopathies (40 % vs 17 %; p = 0.01) while Sp CAP showed more bronchial thickening (19 % versus 3 %; p < 0.01) and (micro)nodule(s) ≤1 cm (25 % vs 3 %, p < 0.01). ConclusionsThis large study shows that the most typical aspect of chest CT-scan in case of Cb CAP in French Guiana is a unilateral alveolar consolidation associated with ground glass opacities and lymphadenopathies. C. burnetti and S. pneumoniae both most often cause alveolar consolidations, but present some significantly different CT-scan patterns. This could help physicians through therapeutic choices.

Alteraciones pulmonares persistentes tras 18 meses de neumonía por SARS-CoV-2

ObjectiveTo describe persistent pulmonary abnormalities detected on HRCT after 18months of SARS-CoV-2 pneumonia, and to determine their extension and correlation with pulmonary function. Patients and methodsA prospective cross-sectional study with an initial cohort of 90 patients in follow-up due to persisting lung abnormalities on imaging, functional respiratory impairment and/or respiratory symptoms. Of these, 31 (34%) were selected for analysis due to the persistence of their lung abnormalities on HRCT at 18 months after infection. A double reading was performed for each HRCT (62 observations). ResultsOf the 31 patients included: 20 (65%) were men; mean age was 67years; 17 (55%) were smokers/ex-smokers. The mean hospitalisation time was 38days. Eighteen (58%) patients were admitted to intensive care units. Five patients (16%) suffered an acute pulmonary thromboembolism and three (9.7%) had a pneumothorax. The mean time between the onset of pneumonia and the follow-up HRCT was 20.34 months. Extension of total pulmonary abnormalities, ground-glass opacities and reticulation was 19%, 12% and 4.5% respectively. The findings of the 62 readings were: ground-glass opacities (100%), reticulation (83%), subpleural curvilinear lines (62%), parenchymal bands (34%), traction bronchiectasis (69%), displacement of vessels/fissures (46%) and honeycombing (4.9%). Pulmonary function 18months after the acute episode revealed a mean FVC of 92% of predicted value, with an FVC <80% of predicted value in 11 patients (35.4%). Mean DLCO was 71% of predicted value, with a DLCO <80% in 22 patients (70%). We observed a statistically significant relationship between total extension of abnormalities on HRCT and FVC (P<.05), and a trend towards statistical significance with DLCO (P=.051); there was a statistically significant relationship between the presence of ground-glass opacities and FEV1/FVC (P<.01). The relationships between reticulation and FVC, FVC%, FEV1, FEV1% and DLCO% were also considered statistically significant (P<.05). ConclusionPersistent interstitial lung abnormalities are seen on HRCT for a subset of patients infected with SARS-CoV-2 pneumonia. Seventy percent of these patients suffered a slight decrease in DLCO.

Prognostic outcomes and recurrence patterns in resected stage I lung adenocarcinoma harbouring atypical epidermal growth factor receptor mutations.

Limited data exist on the characteristics of atypical epidermal growth factor receptor (EGFR) mutations in early-stage lung cancer. Our goal was to elucidate the associations with outcomes and recurrence patterns in resected stage I lung adenocarcinoma harbouring atypical EGFR mutations. Eligible patients between 2014 and 2019 were retrospectively identified and grouped into exon20 insertion mutations and major atypical mutations, which included G719X, L861Q and S768I. Disease-free survival (DFS) was evaluated in the entire cohort and stratified by radiologic characteristics. Recurrence patterns were investigated and compared between groups. A competing risk model was used to estimate the cumulative incidence of recurrence. A total of 710 patients were finally included. Among them, 289 (40.7%) patients had exon 20 insertion mutations and 421 (59.3%) patients had major atypical mutations. There was no significant difference regarding DFS (P = 0.142) between groups in the entire cohort. The interaction between mutation subtype and the presence of ground-glass opacities was significant (hazard ratio 2.00, 95% confidence interval 1.59-2.51, P < 0.001), indicating DFS between exon 20 insertion mutations and major atypical mutations may be different among subsolid and solid tumours. Survival analysis consistently revealed no significant difference in subsolid tumours (P = 0.680), but favourable DFS of exon 20 insertion mutations in solid tumours (P = 0.037). Furthermore, patients with exon 20 insertion mutations had a lower risk of developing bone metastases did those with radiologic solid tumours (Gray's test, P = 0.012). Exon 20 insertion mutations were correlated with favourable DFS and lower incidence of bone metastases in radiologic solid lung adenocarcinomas harbouring atypical EGFR mutations.

Oncological characteristics of epidermal growth factor receptor–mutated clinical stage IA lung adenocarcinoma with radiologically pure-solid appearance

ObjectivesWe evaluated the clinicopathological and oncological characteristics of epidermal growth factor receptor–mutated clinical stage IA radiological pure-solid lung adenocarcinoma and compared them with those of a ground-glass opacity component. MethodsBetween 2008 and 2020, data from 1014 surgically resected clinical stage 0-IA epidermal growth factor receptor–mutated lung adenocarcinomas were evaluated. Oncological outcomes were assessed using multivariable analysis. Overall survival was estimated using Kaplan–Meier analysis and the log-rank test. The cumulative incidence of recurrence was estimated using the Gray's test. ResultsOf these, 233 (23%) were radiologically pure-solid tumors, which demonstrated a higher proportion of nodal metastasis, micropapillary component, spread through alveolar space, and Ex19 subtype compared with those of tumors with ground-glass opacity (P < .001). Multivariable analysis revealed that the presence of ground-glass opacity was an independently significant factor for overall survival (P = .037) and cumulative incidence of recurrence (P < .001). In cases where the oncological outcomes were stratified by the presence of ground-glass opacity component, the 5-year overall survival was excellent at more than 90% in tumors with ground-glass opacity despite clinical-T categories (P = .2044); however, tumor size significantly affected survival only in pure-solid tumors (T1a, 100%; T1b, 77.7%; T1c, 68.5%; P = .0056). Furthermore, the cumulative incidence of recurrence was low in tumors with ground-glass opacity despite the clinical-T categories, whereas tumor size significantly affected the cumulative incidence of recurrence only in pure-solid tumors (5-year cumulative incidence of recurrence: T1a-b, 18.9%; T1c, 41.3%; P < .001). ConclusionsOncologic behavior and prognosis of radiologically pure-solid tumors were significantly poorer than those of tumors with ground-glass opacity among patients with epidermal growth factor receptor–mutated early-stage lung adenocarcinoma. These findings imply distinct tumorigenesis based on the presence of ground-glass opacity, even in tumors with epidermal growth factor receptor mutations.

The relationship between thorax computed tomography findings and prognosis in patients diagnosed with COVID-19.

This study aimed to demonstrate the relationship between thorax computed tomography (CT) findings at the time of admission and prognosis using a semiquantitative CT severity scoring system in patients diagnosed with coronavirus disease 2019 (COVID-19) who tested positive for reverse transcriptase polymerase chain reaction (RT-PCR). A total of 305 patients aged 18 years and older who were diagnosed with COVID-19 confirmed by RT-PCR and underwent thorax CT at the time of admission, were included in the study between March and July 2020. The demographic data of the patients, their presenting complaints at the time of admission, RT-PCR results, and thorax CT images were scanned retrospectively from electronic medical records. Lesions on thorax CT were evaluated for the presence of ground glass opacity, consolidation, and septal thickening and scoring. No significant relationship was found between mortality and CT score or other parameters. A significant relationship was found between admission to the intensive care unit and CT scoring (p=0.014), aortic diameter (p=0.032), chronic pulmonary disease (p=0.004), halo sign (p=0.031), mortality (p<0.001), fever (p=0.038), and dyspnea (p=0.031). A statistically significant difference was detected in the score parameter between discharged patients and intensive care unit patients who survived and those who died (p<0.001). In the parameter of the number of lobes, a statistically significant difference was found only between discharged patients and intensive care unit patients who survived (p=0.016). Thorax CT is an advisor for early diagnosis, treatment, and prognosis assessment of the disease. Semiquantitative CT severity scoring can provide valuable information about the prognosis of the patient.

Quantitative evaluation of CT scan images to determinate the prognosis of COVID-19 patient using deep learning.

The purpose of this research is to evaluate the accuracy of AI-assisted quantification in comparison to conventional CT parameters reviewed by a radiologist in predicting the severity, progression, and clinical outcome of disease. The current study is a cross-sectional study that was conducted on patients with the diagnosis of COVID-19 and underwent a pulmonary CT scan between August 23th, 2021 to December 21th, 2022. The initial CT scan on admission was used for imaging analysis. The presence of ground glass opacity (GGO), and consolidation were visually evaluated. CT severity score was calculated according to a semi-quantitative method. In addition, AI based quantification of GGO and consolidation volume were also performed. 291 patients (mean age: 64.7 ± 7; 129 males) were included. GGO + consolidation was more frequently revealed in progress-to-severe group whereas pure GGO was more likely to be found in non-severe group. Compared to non-severe group, patients in progress-to-severe group had larger GGO volume percentage (40.6%± 11.9%versus 21.7%± 8.8%, p ˂0.001) as well as consolidation volume percentage (4.8% ± 2% versus 1.9% ± 1%, p < 0.001). Among imaging parameters, consolidation volume percentage and the largest area under curve (AUC) in discriminating non-severe from progress-to-severe group (AUC = 0.91, p < 0.001). According to multivariate regression, consolidation volume was the strongest predictor for disease progression. In conclusion, the consolidation volume measured on the initial chest CT was the most accurate predictor of disease progression, and a larger consolidation volume was associated with a poor clinical outcome. In patients with COVID-19, AI-assisted lesion quantification was useful for risk stratification and prognosis evaluation.

Arsenic exposure associated with lung interstitial changes in non-smoking individuals living near a petrochemical complex: A repeated cross-sectional study

Arsenic exposure is associated with airway inflammation and decreased lung function tests. Whether arsenic exposure associated with lung interstitial changes remains unknown. We conducted this population-based study in southern Taiwan during 2016 and 2018. Our study recruited individuals aged over 20 years, residing in the vicinity of a petrochemical complex and with no history of cigarette smoking. In both the 2016 and 2018 cross-sectional studies, we conducted chest low-dose computed tomography (LDCT) scans, as well as urinary arsenic and blood biochemistry analyses. Lung interstitial changes included lung fibrotic changes that were defined as the presence of curvilinear or linear densities, fine lines, or plate opacity in specific lobes; additionally, other interstitial changes were defined as the presence of ground-glass opacity (GGO) or bronchiectasis on the LDCT images. In both cross-sectional studies conducted in 2016 and 2018, participants with lung fibrotic changes exhibited a statistically significant increase in the mean urinary arsenic concentrations compared to those without fibrotic changes (geometric mean = 100.1 vs. 82.8 μg/g creatinine, p < 0.001 for cross-sectional study 2016, and geometric mean = 105.6 vs. 71.0 μg/g creatinine, p < 0.001 for cross-sectional study 2018). After controlling for age, gender, body mass index, platelet counts, hypertension, aspartate aminotransferase, cholesterol, HbA1c, and educational levels, we observed a significant positive association between a unit increase in log urinary arsenic concentrations and the risk of lung fibrotic changes in both cross-sectional study 2016 (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.04–1.90, p = 0.028) and cross-sectional study 2018 (OR = 3.03, 95% CI = 1.38–6.63, p = 0.006). Our study did not find a significant association between arsenic exposure and bronchiectasis or GGO. It is imperative for the government to take significant measures to reduce arsenic exposure levels among individuals living near petrochemical complexes.

Tumor-associated prognostic factors extractable from chest CT scans in patients with lung cancer.

Accurately predicting the prognosis of patients with lung cancer before or at the time of treatment would offer clinicians an opportunity to tailor management plans more precisely to individual patients. Considering that chest computed tomography (CT) scans are universally acquired in patients with lung cancer for clinical staging or response evaluation, fully extracting and utilizing the prognostic information embedded in this modality would be a reasonable approach. Herein, we review tumor-related prognostic factors that are extractable from CT scans, including the tumor dimensions, presence of ground-glass opacity (GGO), margin characteristics, tumor location, and deep learning-based features. Tumor dimensions include diameter and volume, which are among the most potent prognostic factors in lung cancer. In lung adenocarcinomas, the solid component size on CT scans as well as the total tumor size is associated with the prognosis. The areas of GGO indicate the lepidic component and are associated with better postoperative survival in early-stage lung adenocarcinomas. As for the margin characteristics, which represent the CT manifestation of fibrotic stroma or desmoplasia, tumor spiculation should be evaluated. The tumor location in the central lung is associated with occult nodal metastasis and is a worse prognostic factor per se. Last but not least, deep learning analysis enables prognostic feature extraction beyond the human eyes.

Recurrence Patterns and Patient Outcomes in Resected Lung Adenocarcinoma Differ according to Ground-Glass Opacity at CT.

Background Although lung adenocarcinoma with ground-glass opacity (GGO) is known to have distinct characteristics, limited data exist on whether the recurrence pattern and outcomes in patients with resected lung adenocarcinoma differ according to GGO presence at CT. Purpose To examine recurrence patterns and associations with outcomes in patients with resected lung adenocarcinoma according to GGO at CT. Materials and Methods Patients who underwent CT followed by lobectomy or pneumonectomy for lung adenocarcinoma between July 2010 and December 2017 were retrospectively included. Patients were divided into two groups based on the presence of GGO: GGO adenocarcinoma and solid adenocarcinoma. Recurrence patterns at follow-up CT examinations were investigated and compared between the two groups. The effects of patient grouping on time to recurrence, postrecurrence survival (PRS), and overall survival (OS) were evaluated using Cox regression. Results Of 1019 patients (mean age, 62 years ± 9 [SD]; 520 women), 487 had GGO adenocarcinoma and 532 had solid adenocarcinoma. Recurrences occurred more frequently in patients with solid adenocarcinoma (36.1% [192 of 532 patients]) than in those with GGO adenocarcinoma (16.2% [79 of 487 patients]). Distant metastasis was the most common mode of recurrence in the group with solid adenocarcinoma and all clinical stages. In clinical stage I GGO adenocarcinoma, all regional recurrences appeared as ipsilateral lung metastasis (39.2% [20 of 51]) without regional lymph node metastasis. Brain metastasis was more frequent in patients with clinical stage I solid adenocarcinoma (16.5% [16 of 97 patients]). The presence of GGO was associated with time to recurrence and OS (adjusted hazard ratio [HR], 0.6 [P < .001] for both). Recurrence pattern was an independent risk factor for PRS (adjusted HR, 2.1 for distant metastasis [P < .001] and 3.9 for brain metastasis [P < .001], with local-regional recurrence as the reference). Conclusion Recurrence patterns, time to recurrence, and overall survival differed between patients with and without ground-glass opacity at CT, and recurrence patterns were associated with postrecurrence survival. © RSNA, 2023 Supplemental material is available for this article.

Cystic and Cavitary Lung Cancer: Its Characteristic Features on CT and FDG-PET Scans

Background: Cystic and cavitary lung cancer (CCLC) is infrequently observed on computed tomography (CT) scans; however, its diagnosis is often overlooked or delayed. Objectives: The current study aimed to investigate the CT and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) features of CCLC. Patients and Methods: A total of 809 patients who underwent lung tumor resection were examined in this study, and the presence of cystic and cavitary lesions on CT scans was investigated. Based on the CT scans, CCLC was identified in 102 consecutive patients. The diameters of the whole nodule and the airspace portion of the lesion, morphological patterns of cystic and cavitary lesions, presence of ground glass opacity (GGO), and loculation pattern (including the presence of a septum) were evaluated. The positron emission tomography (PET) scans of CCLC were also assessed visually and semi-quantitatively. Results: A total of 104 CCLC lesions were evaluated in this study. The histological analysis indicated 85 cases of adenocarcinoma (AD) and 19 cases of squamous cell carcinoma (SCC). The morphological patterns of cystic and cavitary lesions were classified into four types. The presence of GGO, type 4 morphological pattern (a soft-tissue-density structure intermixed within clusters of a cavitary lesion), and multilocular with septum (MS) loculation pattern were significantly different according to the histological type. The maximum standardized uptake value (SUVmax) on PET scans was significantly lower in AD compared to SCC (P = 0.002). In the solid nodule part of cystic and cavitary lesions, the MS pattern was significantly more common in AD (P = 0.044). Conclusion: When cystic and cavitary lesions are observed on CT scans, the presence of GGO and the MS pattern should be considered, as it may help differentiate the histological findings.

Antisynthetase syndrome-related interstitial lung disease (ASyS-ILD): longitudinal imaging findings.

Interstitial lung disease (ILD) impacts mortality in antisynthetase syndrome (ASyS). Computed tomographic (CT) patterns and evolution in ASyS ILD are not well described. We report longitudinal CT patterns in ASyS-ILD and their impact on survival. This is a monocentric retrospective study of 47 patients with ASyS-ILD. Longitudinal CT patterns and fibrosis severity (severity of radiographic features indicating fibrosis) were analyzed by two radiologists in consensus. The association between imaging features and survival was examined using univariate Cox regression analysis. In total, 211 CT scans were analyzed with an average of 4 ± 2 CT scans/patient with a median follow-up of 79months in 47 patients. Non-fibrotic patterns were present initially in 63.8% (n = 30) of patients, while fibrotic patterns occurred in 36.2% (n = 17). The initial non-fibrotic patterns/abnormalities resolved in 23.3% (n = 7), evolved in 6.7% (n = 2), persisted in 13.3% (n = 4), and progressed in 56.7% (n = 17), while initial fibrotic patterns persisted in 82.4% (n = 14) and progressed in 17.6% (n = 3). Radiographic progression of ILD (progression in CT pattern or increased fibrosis severity) occurred in 53.2% (n = 25) of patients. Advanced age and radiographic progression were associated with decreased survival (all p < 0.05). The presence of ground-glass opacities (GGO) and predominant lower lung distribution of abnormalities on initial CTs were associated with increased survival (all p < 0.05). Progression occurred in 56.7% of ASyS-ILD patients presenting with non-fibrotic patterns. Fibrotic patterns tended to persist. Age and radiographic progression were associated with reduced survival while the initial presence of GGO and predominant lower lobe distribution were associated with increased survival. • In ASyS-ILD, initial non-fibrotic patterns such as OP, cNSIP, or OP-cNSIP tended to progress to fNSIP. • Fibrotic patterns such as fNSIP or UIP in ASyS-ILD tended to persist without pattern changes. • GGO and lower lung predominance on initial CT were associated with better survival while advanced baseline age and radiographic ILD progression during follow-up were associated with decreased survival.

Chest computed tomography of suspected COVID-19 pneumonia in the Emergency Department: comparative analysis between patients with different vaccination status.

To identify differences in chest computed tomography (CT) of the symptomatic coronavirus disease 2019 (COVID-19) population according to the patients' severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination status (non-vaccinated, vaccinated with incomplete or complete vaccination cycle). CT examinations performed in the Emergency Department (ED) in May-November 2021 for suspected COVID-19 pneumonia with a positive SARS-CoV-2 test were retrospectively included. Personal data were compared for vaccination status. One 13-year experienced radiologist and two 4th-year radiology residents independently evaluated chest CT scans according to CO-RADS and ACR COVID classifications. In possible COVID-19 pneumonia cases, defined as CO-RADS 3 to 5 (ACR indeterminate and typical) by each reader, high involvement CT score (≥ 25%) and CT patterns (presence of ground glass opacities, consolidations, crazy paving areas) were compared for vaccination status. 184 patients with known vaccination status were included in the analysis: 111 non-vaccinated (60%) for SARS-CoV-2 infection, 21 (11%) with an incomplete vaccination cycle, and 52 (28%) with a complete vaccination cycle (6 different vaccine types). Multivariate logistic regression showed that the only factor predicting the absence of pneumonia (CO-RADS 1 and ACR negative cases) for the 3 readers was a complete vaccination cycle (OR = 12.8-13.1compared to non-vaccinated patients, p ≤ 0.032). Neither CT score nor CT patterns of possible COVID-19 pneumonia showed any statistically significant correlation with vaccination status for the 3 readers. Symptomatic SARS-CoV-2-infected patients with a complete vaccination cycle had much higher odds of showing a negative CT chest examination in ED compared to non-vaccinated patients. Neither CT involvement nor CT patterns of interstitial pneumonia showed differences across different vaccination status.

The role of computed tomography pulmonary angiography in COVID-19 patients with suspected pulmonary embolism.

This study is aimed to determine the location and distribution of pulmonary embolism (PE) and presence of signs potentially indicative of right heart overload on computed tomography pulmonary angiography (CTPA) in COVID-19 and non-COVID-19 patients. We also evaluated the extent and severity of COVID-19-associated lung changes in relation to PE. The total number of 1,698 patients with CTPA included in the study were divided into 2 groups according to their COVID-19 status and each group was divided into 2 subgroups based on their PE status. These groups and subgroups were compared in terms of location of PE, diameter of pulmonary artery, right heart strain, ground-glass opacities (GGO), consolidations and other imaging features. In COVID-19 patients, there was a significant predominance of PE in peripheral branches of pulmonary artery (p < 0.001). There was an increased right-to-left ratio of ventricular diameters in cases with PE (p = 0.032 in patients with COVID-19 and p < 0.001 in non-COVID-19 patients). There was no association between the extent and severity of the disease and distribution of PE. COVID-19 is associated with a higher incidence of peripheral location of PE and presence of GGO. There were signs indicative of right heart overload in cases with PE regardless of COVID-19 (Tab. 3, Fig. 1, Ref. 29) Keywords: COVID-19, computed tomography, CTPA, pneumonia, pulmonary embolism.