Role Of High Resolution Computed Tomography Research Articles

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

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

Idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is the most common fibrosing lung disease. It is associated with a very poor prognosis. Treatments can delay the progression of IPF, so early diagnosis is fundamental. Radiologists play a fundamental role in the evaluation and accurate diagnosis of IPF. Identifying the characteristic patterns of IPF on high-resolution computed tomography (HRCT) is key in the process of multidisciplinary diagnosis, often obviating the need for surgical lung biopsies. This review describes and illustrates the clinical and imaging findings in IPF in the context of the most recent international guidelines, as well as the differential diagnosis and the role of HRCT in follow-up and assessment of complications.

Fibrosis pulmonar idiopática

Idiopathic pulmonary fibrosis (IPF) is the most common fibrosing lung disease. It is associated with a very poor prognosis. Treatments can delay the progression of IPF, so early diagnosis is fundamental. Radiologists play a fundamental role in the evaluation and accurate diagnosis of IPF. Identifying the characteristic patterns of IPF on high-resolution computed tomography (HRCT) is key in the process of multidisciplinary diagnosis, often obviating the need for surgical lung biopsies. This review describes and illustrates the clinical and imaging findings in IPF in the context of the most recent international guidelines, as well as the differential diagnosis and the role of HRCT in follow-up and assessment of complications.

Etiologic Profile of Older Children With Diffuse Radiological Changes in Eastern China.

Objective:To analyze the etiology of chest diffuse radiological changes (DRC) in children older than 2 years.MethodsA retrospective study was conducted on a primary cohort of children with DRC underwent high resolution computed tomography (HRCT).ResultsDRC mainly included bronchial wall thickening, interlobular septal thickening, pleural thickening, ground glass opacity, mosaic perfusion, reticular & linear opacities, nodular opacity, and tree-in-bud. Of the identified 457 children with DRC, 83 of children older than 2 years with DRC were included in the present study. Ground glass opacity (53, 63.9%) and reticular & linear opacities (44, 53.0%) were frequently identified findings of HRCT, and no tree-in-bud pattern was observed. By contrast, among children with DRC by M. pneumoniae (n = 64), bronchial wall thickening (33, 51.6%), and mosaic perfusion (17, 26.6%) were common patterns of HRCT in addition to ground glass opacity (36, 56.3%). Most of etiologies were connective tissue disease (24, 28.9%), followed by diffuse alveolar hemorrhage syndrome (9, 10.8%), Langerhans cell histiocytosis (7, 8.4%), and recurrent aspiration (6, 7.2%).ConclusionsThis study adds further insights into the role of HRCT in diagnosing childhood interstitial lung diseases, indirectly reflecting disease compositions.

Role of HRCT in Assessing Requirement of Oxygen for COVID-19 Patients: A Retrospective Study from Amalapuram, Andhra Pradesh, India

Introduction: Coronavirus Disease 2019 (COVID-19) infection has affected many countries in the world with its high rate of infectivity and created havoc with its mortality rate. A High Resolution Computed Tomography (HRCT) thorax scan is useful in detection and to assess the involvement of lung which is helpful to plan the management. Aim: To assess the oxygen requirement in COVID-19 patients based on the lung involvement using HRCT scan. Materials and Methods: A retrospective study was conducted from 1st May to 30th June 2021 in the Department of Radiodiagnosis, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India. HRCT thorax scans of 600 patients with COVID-19 infection were included. The patients were categorised based on their lung involvement into three groups (mild, moderate, severe) and then they were followed-up for the oxygen support that each patient received during their stay in hospital. Results: Among the 184 mild COVID-19 infection cases none required Bilevel Positive Airway Pressure (BiPAP)/ intubation. Sixty four out of 340 moderate COVID-19 infection cases required BiPAP and intubation and 28 out 76 severe COVID-19 infection cases required BiPAP and intubation. None in mild cases, 60 (17.6%) in moderate cases, and 32 (42.1%) in severe cases had mortality. The rate of oxygen support and risk of intubation increased as the score increases (p<0.001). The Computed Tomography Severity Index (CTSI) also showed significant difference with the age and co-morbidities of the patients (p<0.01). Conclusion: The HRCT is helpful in assessing the requirement of oxygen support in COVID-19 patients and to plan the management. There is increased non invasive and invasive ventilatory support along with increased morbidity and mortality as the score increases.

Value of HRCT of the chest in evaluation of ankylosing spondylitis: correlation between pleuro-parenchymal abnormalities and disease activity

BackgroundAnkylosing spondylitis (AS) is a chronic inflammatory disorder primarily involving the sacroiliac joints and spine. It is associated with both articular and extra-articular clinical manifestations. Pulmonary involvement is a well-recognized comorbidity of AS, even among patients with early disease. The availability of high-resolution computed tomography (HRCT) has enabled better visualization of the entire lung parenchyma and earlier identification of lung pathologies, ranging from mild to more severe involvement, which were previously missed on X-rays. The aim of the study is to establish the role of HRCT in the detection of pleuro-parenchymal manifestations of AS and to look for correlations between these findings and AS activity.ResultsLung CT scans were done for all our patients and 27 patients (90%) had positive HRCT thoracic findings, while the remaining 3 patients (10%) had a normal HRCT thoracic study. Lower lobe fibrotic changes were the most common finding seen in 20 patients (66.7%) followed by bronchial wall thickening in 13 patients (43.3%) and upper and lower fibrotic changes seen in 9 patients (30%). HRCT thoracic findings were more prominent in late AS (disease duration ≥ 10 years) (13 of 13 patients); while 14 of 17 patients with early AS (disease duration < 10 years) had mildly abnormal HRCT findings. The result of statistical analysis showed that there was negative correlation between thoracic findings and disease activity assessed by BASDAI and this correlation was insignificant (p value = 0.5).ConclusionHRCT offers an accurate and safe method of assessment of lung disease in patients with AS and without respiratory symptoms. Although there was no correlation between pulmonary findings and AS activity assessed by BASDAI, a positive correlation, albeit insignificant, between pulmonary involvement and disease duration had been found.

Assessment of Disease Activity and Complications in Patients of Pulmonary Tuberculosis by High Resolution Computed Tomography

Background: Tuberculosis (TB) is a global health problem and the second most common infectious cause of death. High-resolution computed tomography (HRCT) is far more superior to chest radiography as well as conventional CT for analyzing the pulmonary parenchyma. This study aimed to evaluate the role of HRCT in pulmonary tuberculosis (PTB) with respect to disease activity and complication after anti-tubercular therapy (ATT).&#x0D; Methods: This prospective observational study was conducted in the Department of Radiodiagnosis, Teerthanker Mahaveer Medical College &amp; Research Centre (TMMC&amp;RC) for a period of 1.5 years. A total of 50 cases of newly diagnosed TB were included in the study and a standard six-month ATT was given to the patients. Pulmonary involvement was evaluated by HRCT (128 slice multi-detector PHILIPS INGENUITY CT scanner), twice for each patient (first scan after diagnosis and second after treatment completion). The acquired HRCT images were reconstructed on a highresolution lung algorithm and parenchymal, bronchial, and extra parenchymal findings were recorded systematically.&#x0D; Results: Out of the 50 patients, 5 died within two months of the initiation of treatment and four were lost to follow-up. Thus, post treatment follow-up sample size was reduced to 41 patients. Ill-defined nodules (96%), tree-in-bud pattern (74%), consolidation (86%), cavitary lesions (98%), and ground glass opacities (58%) were the main imaging features of active cases of TB on HRCT. Resolution to thin-walled cavitary lesions (36.5%), bronchiectasis (41.5%), and fibrotic (parenchymal) bands (66%) were common complications or sequelae which were observed after completion of treatment.&#x0D; Conclusion: HRCT thorax is a sensitive modality for evaluation of parenchymal and airway manifestations in cases of PTB and can aid in differentiation of active disease from healed disease. It allows early identification of post-treatment complications and sequelae in patients of PTB.

Interstitial Lung Diseases Associated with Connective Tissue Pathologies: Radiologic Features

Introduction: The high resolution computed tomography (HRCT) is an important part in the diagnostic approach of interstitial lung disease (ILD) associated with connective tissue diseases (CTD) by providing detailed information on the elementary lesion and the radiological pattern of ILD. Aim: to point out the role of HRCT in the diagnosis of ILD associated with CTD (ILD-CTD). Methods: A Retrospective descriptive study was conducted between 2008 and 2017. Data of 24 patients presenting ILD-CTD were collected. A review of HRCT was performed by a radiologist without knowledge of the CTD. Results: Predominant elementary lesion of ILD associated with dermatomyositis (9 cases) was ground glass opacity (n = 9) followed by consolidation (n = 6). Non Specific Interstitial Pneumonia (NSIP) was the most reported pattern (5 cases). Ground glass opacity was also the predominant elementary lesion for the 2 cases of scleroderma and in Sj&#246gren’s syndrome (4 cases/5). NSIP was the predominant radiological presentation in these two CTD. Lymphoid interstitial pneumonia revealed Sj&#246gren’s syndrome in one case. In rheumatoid arthritis (6 cases), the elementary HRCT lesions were irregular interlobular septal thickening (n = 4) and honeycombing (n = 4) consistent with Usual Interstitial Pneumonia (UIP) in 2 cases. Similarly UIP has been described for the 2 patients with lupus and mixed connective tissue disease. Conclusion: HRCT plays an important role in the management of ILD-CTD. Description of the HRCT elementary lesions and the radiological pattern of ILD can be helpful for CTD’s diagnosis.

Role of HRCT and MRI of the Temporal Bone in Predicting and Grading the Degree of Difficulty of Cochlear Implant Surgery.

This study proposes a grading system based on a 10-point scoring chart of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) imaging findings in patients being assessed preoperatively for cochlear implantation. This system helps in objectively assessing the degree of difficulty of the surgical procedure and alerts the surgeons to any potential intraoperative complications. This is a prospective study carried out at a tertiary referral center where 55 patients with bilateral profound sensorineural hearing loss were evaluated by HRCT and MRI and subsequently underwent cochlear implantation. HRCT examinations were performed on a 64 slice multidetector CT scanner. MRI examinations were performed on a 3.0 Tesla MRI scanner. A 10-point scoring chart was devised based on specific imaging findings and all patients were assigned potential difficulty scores (PDS) based on HRCT and MRI findings. Surgical times were documented in each case and each imaging point on the scoring chart was correlated with the surgical times. Eight out of theó ten points in the scoring chart proved to be statistically significant in predicting the degree of difficulty of the surgical procedure. After grading the pre-operative imaging examinations based on the 10-point scoring chart we concluded that patients who have PDS between 0 and 3 (Grade 1) have uneventful and uncomplicated surgery with the lowest intraoperative times. Patients with PDS between 4 and 7 alert the surgeon to moderate surgical difficulty and longer intraoperative times. PDS of 8 and above indicate prolonged and difficult surgery.

Pulmonary hypertension and systemic sclerosis: the role of high-resolution computed tomography

This study sought to evaluate, by means of a retrospective analysis, the relationship between pulmonary hypertension (PH) and fibrotic interstitial lung disease (ILD) in a population of 43 patients affected by systemic sclerosis. In addition, we assessed the role of high-resolution computed tomography (HRCT) in the diagnostic and therapeutic pathway for such patients. Forty-three patients affected by progressive systemic sclerosis (PSS) and PH underwent functional, haemodynamic and HRCT evaluations between November 2001 and May 2011. Functional evaluation was performed through respiratory function testing and spirometry. Haemodynamic assessment was done with transthoracic echocardiogram (ECG) and right heart catheterisation. Semiquantitative evaluation of radiological involvement was performed using different measures: visual score, Goh's score, Wells' score and Warrick's score. Of 43 patients, 16 showed fibrotic ILD after a HRCT evaluation. The main pattern of ILD was identified with nonspecific interstitial pneumonia (NSIP). Our study also evaluated the relationship among radiological, functional and haemodynamic indexes; different correlations were found to be significant, in particular, Wells' and visual scores ≥40% correlated significantly with diffusion capacity for carbon monoxide (DLCO); Wells' score also correlated significantly with percentage of predicted forced vital capacity (FVC), percentage of predicted forced expiratory volume in 1 s (FEV1) and composite physiologic index (CPI). If presence of Inoesophagopathy evaluated with HRCT was included, this sign correlated significantly both with DLCO (p=0.03) and mean pulmonary arterial pressure (mPAP) (p=0.03), considering total population. Our findings confirm the diagnostic role of HRCT in evaluating the extent of lung damage in systemic sclerosis. Furthermore, a significant correlation between mPAP and esophagopathy suggests a possible positive predictive value of this sign in identifying a subphenotypic category of patients affected by systemic sclerosis in whom we can find a more severe visceral impairment and a more frequent vascular involvement.

Role of HRCT in detection and characterization of pulmonary abnormalities in patients with febrile neutropenia

Background:Fever is of grave concern in the management of patients with neutropenia with early detection of a focus of infection being the major goal. As lungs are the most common focus, chest imaging is of vital importance. This Institute Review Board approved prospective study was undertaken to assess the usefulness of high resolution computed tomography (HRCT) in early detection and characterization of pulmonary abnormalities in febrile neutropenia.Materials and Methods:A total of 104 consecutive patients (M:F:75:29, age range 11–66 years) with fever of 38.2°C or more with an absolute neutrophil count <500/μl underwent HRCT chest. HRCT diagnosis was compared with final diagnosis based on ancillary investigations.Results:HRCT could detect pulmonary abnormalities in 93 patients (89.4%) with air space consolidation being the predominant finding (n = 57), followed by ground-glass opacities (Ground glass opacity (GGO), n = 49) and nodules (n = 39). HRCT could correctly characterize the infective lesions in 76 patients (81.7%). Presence of random or pleural-based nodules >10 mm with or without surrounding GGO or cavitations was sensitive (95.23%) and specific (96.7%) for fungal infection, while small (1–4 mm) random or centrilobular nodules with tree-in-bud appearance was sensitive (90%) and highly specific (97.02%) for tuberculosis. Diagnosis of pyogenic infection based on presence of air-space consolidation, pleural effusion, GGO or centrilobular nodules showed a sensitivity of 84.78% and specificity of 93.84%, whereas patchy or diffuse GGO, interstitial thickening and/or air-space consolidation showed high sensitivity (86.7%) and specificity (96.8%) for Pneumocystis jiroveci pneumonia.Conclusion:HRCT chest is an excellent modality in the diagnostic work-up of patients with febrile neutropenia allowing early detection and characterization of pulmonary abnormalities.

The role of HRCT and three-dimensional VR CT findings in patients of congenital atresia combined with microtia

ObjectiveTo determine the anatomic differences in patients of atresia by using high-resolution computed tomography (HRCT) and 3D volume rendered (VR) CT. MethodsHigh-resolution computed tomography (HRCT) was performed in 43 atresia patients including 34 unilateral atresia patients (n=34, 26 males, 8 females, mean age 13.82 years, range 8–19 years) and 9 bilateral atresia patients (6 males, 3 females, mean age 13.2 years, range 9–19 years). HRCT and 3D VR findings were compared with those in 43 normal ears of the unilateral atresia patients with normal PTA results (n=34, 26 males, 8 females, mean age 13.82 years, range 8–19 years) and 11 patients with sensorineural hearing loss but with no associated aplasia of the middle and inner ear (n=22, 7 males and 4 females, range 8–20.8 years, median age of 13.4 years) by using the independent one sample T test. ResultsOn the HRCT images, the angle between the basic line and the tympanic segment of the facial nerve is more acute. And the area of the malleus-incus-joint or the malleus-incus-complex in the diseased ears is smaller than that in the control subjects (P<0.05). The tympanic segment is shorter and the area of the tympanic cavity is smaller in the atresia group, while the diameter of the oval window is also smaller in atresia group than that in the control group (P<0.05). The morphologic differences of the small ossicles and the entire length of the tympanic and mastoid segments can be depicted on a single 3D VR CT image. ConclusionsThe facial nerve demonstrates abnormal lateral and anterior displacement in the CAA patients and the area of the Malleus-incus-joint and the tympanic cavity are significantly smaller, and the oval window is much narrower in the control group. HRCT and 3D VR CT provide valuable information about preoperative planning of patients with CAA. Measurements of all the angles and length serve as useful adjunct measurements in determining surgical candidacy.

Role of high-resolution computed tomography in the detection of early cystic fibrosis lung disease

High-resolution computed tomography (HRCT) has been demonstrated to be sensitive at detecting early lung disease in cystic fibrosis (CF), often before it is apparent clinically. There is emerging evidence that structural changes in the lung occur earlier in life than previously appreciated. Despite this, the role of HRCT in young children with CF has yet to be defined, principally because the repeated exposure of children to X-ray doses several multiples that of a standard chest X-ray raises the concern of the long-term risks of ionizing radiation. With the challenges of acquiring HRCT images in young children in mind, we review scanning protocols and settings specific to young children, and review the best available evidence that describes early structural lung disease in young children with CF. The role of CT scoring and quantitative measures of CF lung disease are reviewed. The challenge for the future is to develop techniques that provide clinically useful information at the lowest possible radiation risk.

HRCT in small and large airways diseases.

High-resolution computed tomography (HRCT) is being increasingly used in the diagnostic work-up of paediatric patients with large and small airways disease due to its ability to provide valuable information far beyond that of other non-invasive investigations. This article highlights the key HRCT appearances of a range of conditions involving the airways in children, and where relevant, the role of HRCT in assessment of disease severity and monitoring of disease progression.

Review article: current indications for high resolution computed tomography scanning of the lungs.

High resolution computed tomography (HRCT) is an effective technique for demonstrating the lung parenchyma in detail and overcomes many of the inadequacies of chest radiography in the diagnosis of diffuse lung disease. This article reviews the role of HRCT in the management of patients with chronic infiltrative lung disease, occupational lung disease, airways disease and acute and sub-acute lung disease.