Thoracic CT Research Articles

MO137: Sarcoidosis in a Living Kidney Donor Candidate: Case Report and Review of the Literature

Abstract BACKGROUND AND AIMS Sarcoidosis (SCD) is a granulomatous disease that mostly affects young adults, presenting with hilar adenopathy, lung reticular opacities and skin/joint/eye lesions. Incidence varies in Europe between 0.3% and 1.5%, higher in southern countries. Up to one-third of patients have extrathoracic manifestations. Renal involvement varies among different case series. Despite a prevalence of about 13% in autopsies on systemic SCD affected individuals, it is clinically evident in 0.7–4.3% of patients, with a reduced glomerular filtration rate associated with mild or absent urinary anomalies. It usually presents as a tubulointerstitial nephritis at kidney biopsy. Noncaseating granulomas are typical but not always present. Renal injury can also derive from hyperkalcaemia and hypercalciuria (secondary to vitaminD production in granulomas), which cause nephrocalcinosis or nephrolitiasis. A clinical presentation with hyperkalcaemia associates to a better response to therapy (prednisone 1 mg/kg/day for 6–12 weeks, tapered in 6–9 months). An Italian survey on SCD acute kidney injury (AKI) described female sex, hyperkalaemia and absence of granulomas at biopsy as positive prognostic factors, without any correlation between proteinuria and histological damage. SCD AKI evolved to CKD in over 60% of cases (37.5% without comorbidities at onset), with a mean GFR slope of 5 mL/min/year when granulomatous interstitial nephritis was present. METHOD We describe the case of a 55-year-old male, who proposed as a living kidney donor for his wife. His clinical history included a paranoid episode 20 years before, compensated and on psychiatric follow-up at the moment of the screening, dyslipidaemia and normal blood pressure. RESULTS Preoperative screening showed a renal function just above safety threshold for donation (cystatin C-creatinine CKD-EPI 80 mL/min/1.73 m2), a normal urinary sediment and no proteinuria. A thoracic and abdominal CT scan (Figure 1) described numerous aorto-caval adenopathies, stable at a second CT after 3 months. Lungs were unaffected, kidneys and the urinary tract were regular, without calcifications or stones. No infection was detected (negative QuantiFERON, HIV, EBV <1000 copies/mL), suggesting a differential diagnosis between lymphoma and SCD. Serum and urine electrophoresis, immunofixation, light chains, Bence Jones and peripheral blood lymphocyte typing were checked in parallel to ACE dosing; 24-h urine calcium, calcemia, vitamin D, dermatological and ocular examination all normal. An endobronchial ultrasound biopsy was performed, after a PET (Figure 2) to identify the targets with the highest SUV (3.9–6.7). Histology described normal lymphocytes, noncaseating granulomas with sarcoidosis epithelioid histiocytes. CONCLUSION Stage 1 pulmonary SCD without clinical renal involvement was confirmed. Although in a single case of living kidney donation from SCD affected subject was reported, data on GFR deterioration in the long term are lacking. Considering the baseline renal function of the potential donor and the not-quantifiable risk of future AKI, we decided to deem him unfit for donation, despite the absence of markers of disease activity at the moment of the screening. Kidney biopsy will be considered in the future in case of urinary abnormalities or GFR deterioration.

Thoracic Computed Tomography to Assess ARDS and COVID-19 Lungs.

This review was designed to discuss the role of thoracic-computed tomography (CT) in the evaluation and treatment of patients with ARDS and COVID-19 lung disease. Non-aerated lungs characterize the ARDS lungs, compared to normal lungs in the lowermost lung regions, compressive atelectasis. Heterogenous ARDS lungs have a tomographic vertical gradient characterized by progressively more aerated lung tissues from the gravity-dependent to gravity-independent lungs levels. The application of positive pressure ventilation to these heterogeneous ARDS lungs provides some areas of high shear stress, others of tidal hyperdistension or tidal recruitment that increases the chances of appearance and perpetuation of ventilator-induced lung injury. Other than helping to the correct diagnosis of ARDS, thoracic-computed tomography can help to the adjustments of PEEP, ideal tidal volume, and a better choice of patient position during invasive mechanical ventilation. Thoracic tomography can also help detect possible intra-thoracic complications and in the follow-up of the ARDS patients’ evolution during their hospital stay. In COVID-19 patients, thoracic-computed tomography was the most sensitive imaging technique for diagnosing pulmonary involvement. The most common finding is diffuse pulmonary infiltrates, ranging from ground-glass opacities to parenchymal consolidations, especially in the lower portions of the lungs’ periphery. Tomographic lung volume loss was associated with an increased risk for oxygenation support and patient intubation and the use of invasive mechanical ventilation. Pulmonary dual-energy angio-tomography in COVID-19 patients showed a significant number of pulmonary ischemic areas even in the absence of visible pulmonary arterial thrombosis, which may reflect micro-thrombosis associated with COVID-19 pneumonia. A greater thoracic tomography severity score in ARDS was independently related to poor outcomes.

Prognostic Performance of Shock Index, Diastolic Shock Index, Age Shock Index, and Modified Shock Index in COVID-19 Pneumonia.

We aimed to compare the prognostic accuracy of shock indexes in terms of mortality in patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia. Hospitalized patients whose COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) test results were positive, had thoracic computed tomography (CT) scan performed, and had typical thoracic CT findings for COVID-19 were included in the study. Eight hundred one patients were included in the study. Chronic obstructive pulmonary disease, congestive heart failure, chronic neurological diseases, chronic renal failure, and a history of malignancy were found to be chronic diseases that were significantly associated with mortality in patients with COVID-19 pneumonia. White blood cell, neutrophil, lymphocyte, C reactive protein, creatinine, sodium, aspartate aminotransferase, alanine aminotransferase, total bilirubin, high sensitive troponin, d-dimer, hemoglobin, and platelet had a statistically significant relationship with in-hospital mortality in patients with COVID-19 pneumonia. The area under the curve (AUC) values of shock index (SI), age shock index (aSI), diastolic shock index (dSI), and modified shock index (mSI) calculated to predict mortality were 0.772, 0.745, 0.737, 0.755, and Youden Index J (YJI) values were 0.523, 0.396, 0.436, 0.452, respectively. The results of this study show that SI, dSI, mSI, and aSI are effective in predicting in-hospital mortality.

Detection of Incidental Nonosseous Thoracic Pathology on State-of-the-Art Ultralow-Dose Protocol Computed Tomography in Pediatric Patients With Pectus Excavatum.

The aim of the study was to compare a pediatric ultralow-dose pectus excavatum computed tomography (CT) protocol versus standard-dose pediatric thoracic CT in terms of radiation dose, subjective and objective image quality, and its ability to detect incidental nonosseous thoracic pathology compared with imaging and clinical reference. A single institution radiology database identified a total of 104 ultralow-dose pediatric thoracic CT cases with an equal number of age-matched standard-dose chest CT cases also selected for retrospective analysis. Objective image quality (contrast-to-noise and signal-to-noise ratios) and radiation dose were assessed. Qualitative Likert scorings of the bone, lung, and soft tissues were performed by 2 expert radiologists. Electronic health records of the ultralow-dose cohort were reviewed for at least 1 year to evaluate for potentially missed thoracic pathology and symptoms. Variables were compared using parametric and nonparametric tests in R software 4.0.5. The ultralow-dose protocol group had statistically significant reductions (P < 0.001) in the volume CT dose index (0.31 ± 0.19 vs 2.20 ± 1.64 mGy), effective radiation dose (0.14 ± 0.08 vs 1.07 ± 0.86 mSv), and size-specific dose estimates (0.50 ± 0.30 vs 3.43 ± 2.56 mGy) compared with the standard protocol, yielding an 86.51% and 85.32% reduction, respectively. The signal-to-noise ratio (20.49 ± 6.19 vs 36.48 ± 10.20), contrast-to-noise (21.65 ± 6.57 vs 38.47 ± 10.59), and subjective measures of image quality (lung parenchyma [3.07 ± 0.92 vs 4.42 ± 0.47], bony structures [3.30 ± 0.86 vs 4.52 ± 0.51], and surrounding soft tissues [2.57 ± 0.63 vs 3.89 ± 0.65]) were also significantly lower in the ultralow-dose protocol (P < 0.001). No differences were seen in the number and size of pulmonary nodules between groups. Clinical and imaging follow of all 104 patients undergoing ultralow-dose CT demonstrated no evidence of missed thoracic pathology causing symptoms. Ultralow-dose thoracic CT is an acceptable modality for imaging pediatric patients with pectus excavatum and other conditions primarily causing osseous pathology, with effective radiation dose comparable to plain radiographs and a moderate increase in image noise that did not significantly reduce its ability to detect incidental nonosseous thoracic pathology.

PO-714-02 RIGHT VENTRICULAR EPICARDIAL ACTIVATION DELAY IN ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY PATIENTS AND GENE CARRIERS UNMASKED BY BODY SURFACE MAPPING SYSTEM

ARVC is afflicted by life-threatening ventricular arrhythmias even before the manifestations of right ventricular (RV) structural abnormalities. Therefore, an early diagnosis is crucial albeit still challenging. To investigate whether a 252-leads noninvasive Body Surface Mapping (BSM) system could detect epicardial conduction delays in ARVC patients and unaffected gene-carrying family members (GC). Twelve ARVC patients, 20 GC and 8 gene-negative family members serving as controls (C) underwent 12-lead ECG, signal-averaged-electrocardiogram (SAECG), echocardiography, 252-lead BSM recordings and thoracic CT scan. Reconstructed epicardial signals were analysed using the Activation Time Editing tool of the activation map. Local depolarisation was defined as the steepest negative dV/dt of the unipolar local epicardial signal. The time from the earliest start of RV epicardial activation to the earliest local depolarisation (ELD) and to the latest local depolarisation (LLD), respectively, were measured separately for the RV free wall (RFW), inferior wall (RIW) and the whole RV. The activation duration, defined as LLD-ELD, was calculated for RFW, RIW and the whole RV. The ELD was similar in all study groups whereas the LLD in the RFW and whole RV was significantly longer among ARVC patients compared to C, but similar in the RIW. Similarly, the activation durations in the RFW and whole RV were significantly longer in ARVC patients but did not differ in the RIW among the groups. A 43ms LLD cut off in the RV and 20 msec activation duration cut off in the RV discriminated ARVC patients from C with highest sensitivity and specificity. Based on these cut-offs, 40% of GC group had longer LLD times and 20 % had also longer activation duration (figure 1). ARVC patients demonstrated prolonged LLD and activation duration times in the RFW and whole RV compared to C. The finding that prolonged conductions could be demonstrated in the GC group as well suggest that the 252-leads noninvasive BSM system may be used as screening tool for the detection of early delays of the RV epicardial activation. Larger studies are required to confirm our results.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

COVID -19 CHEZ LES PATIENTS DIABETIQUES : PRISE EN CHARGE EN UNITE DE SOINS INTENSIFS

Context :The presence of diabetes has been identified as a factor associated with severe forms and increased mortality during SARS-COV 2 infection. On the other hand, it has been suggested that infection with COVID 19 would be susceptible to induce Novo diabetes. Managing diabetes during COVID 19 infection is an important part of managing this infection. Goal :The aim of this work is to describe the characteristics of diabetic patients infected with COVID -19 and to share our experience in their management. Materials and methods: retrospective study of 104 patients admitted to the intensive care unit at Ibn Tofails company hospital. Results: The mean age of our patients was 64.47 years. Diabetes was discovered during infection in 22% of patients, while 78% of patients were known to have diabetes. Ketosis decompensation was demonstrated in 16.3% of patients. On admission, 32% were on oral antidiabetics and 38% patients were on insulin. Thoracic CT showed more than 50% of the pulmonary parenchyma in 43% of patients. 12.5% ​​of our patients were hemodynamically and respiratory unstable and were transferred to medical intensive care. Conclusion: our study had shown that diabetes was associated with severe forms of COVID 19 with significant inflammatory syndrome and extensive lung damage.

FDG PET/CT Features of Polysaccharide-Based Hemostatic Agent: Chronic Inflammatory Changes Can Mimic Metastatic Lesions.

To prevent hemorrhagic complications, hemostatic agents (HAs) have been widely used in recent years. The use of HAs can lead to false-positive results on postoperative imaging. There exists only 1 study in the literature evaluating these applications during surgical procedures. Therefore, we aimed to evaluate the postoperative imaging features of polysaccharide-based HAs in thoracic surgery patients who have had 18F-FDG PET/CT scans. Two hundred nine consecutive patients who underwent thoracic surgery were enrolled in this study. A topical polysaccharide-based HA was applied to the surgical bed for all of the patients. The patients diagnosed with cancer were followed up with subsequent thoracic CT scans, and 42 of these patients were also imaged with 18F-FDG PET/CT, which then comprised the main study group. Due to suspicion of metastasis, 19/42 patients were reoperated or rebiopsied. The latest histopathological findings were accepted as criterion standard, and previous FDG PET/CT images were retrospectively reevaluated. Polysaccharide-based HAs that appear as amorphous basophilic material were identified in histopathological samples of 11/19 patients. Lymphocytes, plasma cells, and histiocytes, which formed foreign body reaction and/or foreign body granuloma, indicating the presence of chronic inflammation, were seen in all of the samples. 18F-FDG PET/CT showed increased FDG uptake in all of these lesions. Despite the inconsistency of the literature, polysaccharide-based HAs can be demonstrated in human surgical specimens as amorphous basophilic materials even after a long time from the initial surgical procedure. These agents almost always cause chronic inflammatory changes. In addition, these agents may mimic "false-positive" findings on postoperative FDG PET/CT scans.

Prediction of abdominal CT body composition parameters by thoracic measurements as a new approach to detect sarcopenia in a COVID-19 cohort

As most COVID-19 patients only receive thoracic CT scans, but body composition, which is relevant to detect sarcopenia, is determined in abdominal scans, this study aimed to investigate the relationship between thoracic and abdominal CT body composition parameters in a cohort of COVID-19 patients. This retrospective study included n = 46 SARS-CoV-2-positive patients who received CT scans of the thorax and abdomen due to severe disease progression. The subcutaneous fat area (SF), the skeletal muscle area (SMA), and the muscle radiodensity attenuation (MRA) were measured at the level of the twelfth thoracic (T12) and the third lumbar (L3) vertebra. Necessity of invasive mechanical ventilation (IMV), length of stay, or time to death (TTD) were noted. For statistics correlation, multivariable linear, logistic, and Cox regression analyses were employed. Correlation was excellent for the SF (r = 0.96) between T12 and L3, and good for the respective SMA (r = 0.80) and MRA (r = 0.82) values. With adjustment (adj.) for sex, age, and body-mass-index the variability of SF (adj. r2 = 0.93; adj. mean difference = 1.24 [95% confidence interval (95% CI) 1.02–1.45]), of the SMA (adj. r2 = 0.76; 2.59 [95% CI 1.92–3.26]), and of the MRA (adj. r2 = 0.67; 0.67 [95% CI 0.45–0.88]) at L3 was well explained by the respective values at T12. There was no relevant influence of the SF, MRA, or SMA on the clinical outcome. If only thoracic CT scans are available, CT body composition values at T12 can be used to predict abdominal fat and muscle parameters, by which sarcopenia and obesity can be assessed.

Radio-Histological Correlation of Lung Features in Severe COVID-19 Through CT-Scan and Lung Ultrasound Evaluation.

BackgroundPatients with coronavirus disease 2019 (COVID-19) can develop severe bilateral pneumonia leading to respiratory failure. Lung histological samples were scarce due to the high risk of contamination during autopsies. We aimed to correlate histological COVID-19 features with radiological findings through lung ultrasound (LU)-guided postmortem core needle biopsies (CNBs) and computerized tomography (CT) scans.MethodologyWe performed an observational prospective study, including 30 consecutive patients with severe COVID-19. The thorax was divided into 12 explorations regions to correlate LU and CT-scan features. Histological findings were also related to radiological features through CNBs.ResultsMean age was 62.56 ± 13.27 years old, with 96.7% male patients. Postmortem LU-guided CNBs were performed in 13 patients. Thirty patients were evaluated with both thoracic LU and chest CT scan, representing a total of 279 thoracic regions explored. The most frequent LU finding was B2-lines (49.1%). The most CT-scan finding was ground-glass opacity (GGO, 29%). Pathological CT-scan findings were commonly observed when B2-lines or C-lines were identified through LU (positive predictive value, PPV, 87.1%). Twenty-five postmortem echo-guided histological samples were obtained from 12 patients. Histological samples showed diffuse alveolar damage (DAD) (75%) and chronic interstitial inflammation (25%). The observed DAD was heterogeneous, showing multiple evolving patterns of damage, including exudative (33.3%), fibrotic (33.3%), and organizing (8.3%) phases. In those patients with acute or exudative pattern, two lesions were distinguished: classic hyaline membrane; fibrin “plug” in alveolar space (acute fibrinous organizing pneumonia, AFOP). C-profile was described in 33.3% and presented histological signs of DAD and lung fibrosis. The predominant findings were collagen deposition (50%) and AFOP (50%). B2-lines were identified in 66.7%; the presence of hyaline membrane was the predominant finding (37.5%), then organizing pneumonia (12.5%) and fibrosis (37.5%). No A-lines or B1-lines were observed in these patients.ConclusionLU B2-lines and C-profile are predominantly identified in patients with severe COVID-19 with respiratory worsening, which correspond to different CT patterns and histological findings of DAD and lung fibrosis.

Computed tomographic assessment of principal bronchial anatomy in dogs of various thoracic conformations: 93 cases (2012-2017).

To better understand spatial relationships between principal bronchi and other intrathoracic structures by use of CT images of dogs of various somatotypes. 93 dogs that underwent thoracic CT. Information was collected from medical records regarding signalment and physical examination and echocardiographic findings. Two investigators recorded multiple measurements on a thoracic axial CT image from each dog. Thoracic height-to-width ratio (H:W) was associated with left principal bronchus (LPB) and right principal bronchus (RPB) H:W, aortic-LPB separation, focal LPB narrowing, and aortic-vertebral overlap. Thoracic H:W was not associated with dog age, weight, sex, or brachycephalic breed. Twenty-five (27%) dogs had focal LPB narrowing, compared with 5 (5%) dogs with focal RPB narrowing (P < 0.001). Ten of 25 dogs had overlap or contact between vertebrae, aorta, LPB, and heart, suggesting a cumulative compressive effect on the LPB, while 15 had LPB-aorta contact and lack of contact between the aorta and thoracic vertebrae, suggesting an aortic constrictive effect on the LPB. None had LPB narrowing without contact from surrounding structures. Inter-rater agreement was high. In dogs that underwent CT and were not selected for clinical suspicion of bronchial disease, principal bronchial morphology was associated with thoracic conformation. Focal LPB narrowing occurred more often than RPB narrowing. Focal LPB narrowing occurred with evidence of extraluminal compression, with or without contact between aorta and vertebrae. Brachycephalic breed could not be used for predicting thoracic H:W.

Detecting Multiple Myeloma Infiltration of the Bone Marrow on CT Scans in Patients with Osteopenia: Feasibility of Radiomics Analysis

It is difficult to detect multiple myeloma (MM) infiltration of the bone marrow on computed tomography (CT) scans of patients with osteopenia. Our aim is to determine the feasibility of using radiomics analysis to detect MM infiltration of the bone marrow on CT scans of patients with osteopenia. The contrast-enhanced thoracic CT scans of 104 patients with MM and 104 age- and sex-matched controls were retrospectively evaluated. All individuals had decreased bone density on radiography. The study group was divided into development (n = 160) and temporal validation sets (n = 48). The radiomics model was developed using 805 texture features extracted from the bone marrow for a development set, using a Random Forest algorithm. The developed models were applied to evaluate a temporal validation set. For comparison, three radiologists evaluated the CTs for the possibility of MM infiltration in the bone marrow. The diagnostic performances were assessed and compared using an area under the receiver operating characteristic curve (AUC) analysis. The AUC of the radiomics model was not significantly different from those of the radiologists (p = 0.056–0.821). The radiomics analysis results showed potential for detecting MM infiltration in the bone marrow on CT scans of patients with osteopenia.

Thoracic Spine CT Hidden Treasures: Lung Assessment and Extraspinal Findings in Patients with Vertebral Fractures Studied with Full FOV during Breath Hold: Technical Note.

Thoracic spine CTs are usually performed during free breathing and with a narrow field of view; this common practice systematically excludes the assessment of lungs and other extraspinal structures, even if these have been irradiated during the examination. At our institution we perform thoracic spine CT during breath hold with additional full FOV reconstructions; this allows us to also evaluate lungs and extraspinal pathologies in the same examination with no added costs or further radiation exposure. If this simple and costless technical change is routinely applied to thoracic spine CT many concomitant extraspinal pathologies can be ruled out, from neoplasms to pneumonia; the suggested modification also allows an early diagnosis and avoids recalling and re-irradiating the patient in case these findings are partially included in the study. This practice can be further useful during the current pandemic in order to screen any lung opacities suspicious for COVID-19.

Computed Tomography Assessment of Tidal Lung Overinflation in Domestic Cats Undergoing Pressure-Controlled Mechanical Ventilation During General Anesthesia.

ObjectiveThis study aimed to evaluate lung overinflation at different airway inspiratory pressure levels using computed tomography in cats undergoing general anesthesia.Study DesignProspective laboratory study.AnimalsA group of 17 healthy male cats, aged 1.9–4.5 years and weighing 3.5 ± 0.5 kg.MethodsSeventeen adult male cats were ventilated in pressure-controlled mode with airway pressure stepwise increased from 5 to 15 cmH2O in 2 cmH2O steps every 5 min and then stepwise decreased. The respiratory rate was set at 15 movements per min and end-expiratory pressure at zero (ZEEP). After 5 min in each inspiratory pressure step, a 4 s inspiratory pause was performed to obtain a thoracic juxta-diaphragmatic single slice helical CT image and to collect respiratory mechanics data and an arterial blood sample. Lung parenchyma aeration was defined as overinflated, normally-aerated, poorly-aerated, and non-aerated according to the CT attenuation number (−1,000 to −900 HU, −900 to −500 HU, −500 to −100 HU, and −100 to +100 HU, respectively).ResultAt 5 cmH2O airway pressure, tidal volume was 6.7± 2.2 ml kg−1, 2.1% (0.3–6.3%) of the pulmonary parenchyma was overinflated and 84.9% (77.6%−87.6%) was normally inflated. Increases in airway pressure were associated with progressive distention of the lung parenchyma. At 15 cmH2O airway pressure, tidal volume increased to 31.5± 9.9 ml kg−1 (p < 0.001), overinflated pulmonary parenchyma increased to 28.4% (21.2–30.6%) (p < 0.001), while normally inflated parenchyma decreased 57.9% (53.4–62.8%) (p < 0.001). Tidal volume and overinflated lung fraction returned to baseline when airway pressure was decreased. A progressive decrease was observed in arterial carbon dioxide partial pressure (PaCO2) and end-tidal carbon dioxide (ETCO2) when the airway pressures were increased above 9 cmH2O (p < 0.001). The increase in airway pressure promoted an elevation in pH (p < 0.001).Conclusions and Clinical RelevanceVentilation with 5 and 7 cmH2O of airway pressure prevents overinflation in healthy cats with highly compliant chest walls, despite presenting acidemia by respiratory acidosis. This fact can be controlled by increasing or decreasing respiratory rate and inspiratory time.

Pleuroparenchymal Fibroelastosis in Chronic Graft-versus-Host-Disease

<h3>Purpose</h3> Pleuroparenchymal fibroelastosis (PPFE) is a rare entity of interstitial lung disease previously reported in both lung and hematopoietic stem cell transplant (HCT) recipients. The association between PPFE and chronic Graft-versus-Host Disease (cGVHD) has not been established. <h3>Methods</h3> Patients on cGVHD protocols (NCT00092235; NCT02669251) between 10/01/2004 and 01/31/2020 were included. An independent committee of two transplant hematologists, one cardiothoracic radiologist, and three transplant pulmonologists reviewed patients' demographic and HCT information, pulmonary function tests (PFT), and thoracic CT scans. The diagnosis of PPFE was adapted from the 2013 ATS/ERS Interstitial Lung Disease Consensus Statement (Table 1). <h3>Results</h3> PPFE was diagnosed in 0.8% (3/374) of patients (Table 2). All were female with body mass index (BMI) <18.5kg/m². Patients 2 and 3 had classical Hodgkin lymphoma (cHL) with intrathoracic involvement, received bleomycin (patient 2 and 3) and mediastinal radiation (patient 2) prior to HCT. All had severe cGVHD, requiring 1-5 lines of systemic immunosuppressive therapy. Before the development of PPFE, Patients 2 and 3 had viral pneumonia, while patient 1 had no documented pulmonary infection. Lung biopsies in all patients showed non-specific inflammation and fibrosis; of note, all were performed before the definition of PPFE as a clinical entity in 2013, and did not include the pleura or subpleural parenchyma. At data cut-off (April 2021), all patients were alive. Median time from HCT to PPFE diagnosis was 5.5 years (range, 2-6.5), and median survival post-PPFE diagnosis was 7.5 years (range, 5.5-12). <h3>Conclusion</h3> PPFE is a rare, delayed complication of HCT which can be seen with concurrent cGVHD. The pathogenesis of PPFE is unclear but may be associated with the immune-mediated lung injury in cGVHD, infection, preexisting malignancy and lung-toxic treatment. Heightened clinical awareness for PPFE among the cGVHD population warrants further study.

The Effectiveness of Bisphosphonate to Reduce Pain in Lung Cancer Patients with Bone Metastasis

Background: Bisphosphonates (BPs) are commonly used as supportive therapy to prevent skeletal-related events in lung cancer patients with bone metastasis, including severe bone pain, hypercalcemia, and pathological fractures. The purpose of this study was to assess the effectiveness of bisphosphonate therapy to reduce pain in non-small cell lung cancer (NSCLC) patients with bone metastasis. &#x0D; Methods: This was a cross-sectional study carried on 38 patients diagnosed with lung cancer based on cytology or histopathology findings. Radiological examination such as thoracic CT scan, bone survey, and bone scan was performed to determine bone metastasis. Multimodality therapy is carried out for lung cancer palliative therapy including chemotherapy, radiotherapy, and bisphosphonate therapy (zoledronic acid and ibandronate) as supportive therapy to reducing cancer pain. Pain was assessed using the Visual Analog Scale (VAS) determined by patients themselves. Statistical tests were performed by paired T-test in which p&lt; 0.05 was considered significant. &#x0D; Results: As many as 38 patients enrolled in this study consisting of 29 men (76.3%) and 9 women (23.7%). The subtype of adenocarcinoma was mostly found in 31 cases (81.58%) and 7 cases (18.42%) was Squamous Cell Carcinoma. Cancer pain was found in all patients. Measurement of pain prior to treatment showed that most patients had VAS level of 7-10. After bisphosphonate therapy, the VAS level significantly decreased to 1-3 (p&lt;0.01). &#x0D; Conclusion: Bisphosphonate therapy was proven to effectively decrease the severity level of cancer pain in lung cancer patients with bone metastasis.

Comparison of Application Value of Different Radiation Dose Evaluation Methods in Evaluating Radiation Dose of Adult Thoracic and Abdominal CT Scan.

ObjectiveTo explore the differences among volumetric CT dose index (CTDIvol), body-specific dose assessment (SSDEED) based on effective diameter (ED), and SSDEWED based on water equivalent diameter (WED) in evaluating the radiation dose of adult thoracic and abdominal CT scanning.MethodsFrom January 2021 to October 2021, enhanced chest CT scans of 100 patients and enhanced abdomen CT scans of another 100 patients were collected. According to the body mass index (BMI), they can be divided into groups A and D (BMI < 20 kg/m2), groups B and E (20 kg/m2 ≤ BMI ≤ 24.9 kg/m2), and groups C and F (BMI > 24.9 kg/m2). The CTDIvol, anteroposterior diameter (AP), and the left and rght diameter (LAT) of all the patients were recorded, and the ED, water equivalent diameter (WED), the conversion factor (fsize,ED), (fsize, WED), SSDEED, and SSDEWED were calculated. The differences were compared between the different groups.ResultsThe AP, LAT, ED, and WED of groups B, E, C, and F were higher than those of groups A and D, and those of groups C and F were higher than those of groups B and E (P < 0.05). The fsize,ED and fsize, WED of groups B, E, C, and F are lower than those of groups A and D, and those of groups C and F are lower than those of groups B and E (P < 0.05). CTDIvol, SSDEED, and SSDEWED in groups B, E, C, and F are higher than those in groups A and D, and those in groups C and F are higher than those in groups B and E (p < 0.05). In the same group, patients with chest- and abdomen-enhanced have higher SSDEWED and SSDEED than CTDIvol, patients with chest-enhanced CT scans have higher SSDEWED than SSDEED, and patients with abdomen-enhanced CT scans have higher SSDEED than SSDEWED (P < 0.05).ConclusionCTDIvol and ED-based SSDEED underestimated the radiation dose of the subject exposed, where the patient was actually exposed to a greater dose. However, SSDEWED based on WED considers better the difference in patient size and attenuation characteristics, and can more accurately evaluate the radiation dose received by patients of different sizes during the chest and abdomen CT scan.

Cross-sectional area of erector spinae muscles is associated with activities of daily living at discharge in middle- to older-aged patients with coronavirus disease 2019.

ObjectivesMeasurement of skeletal muscle wasting using computed tomography (CT) is widely known to be useful in predicting prognosis. Although some reports have been found in patients with coronavirus disease 2019 (COVID-19), few reports have focused on the ability to perform activities of daily living (ADLs). This study retrospectively investigated the relationship between the erector spinae muscle area measured from CT images and ADL at the time of hospital discharge in patients with COVID-19.MethodsAmong patients aged 40 years or older, 271 patients (median age, 65 years; 180/271 male patients) who had CT cross-sectional images of the 12th thoracic vertebral level on admission were included. The Katz index was used to assess ADLs, and patients who were not completely independent were defined as dependent. Multivariable logistic and Poisson regression analyses were applied to examine the relationship between the cross-sectional area of the erector spinae muscles and the onset of ADL dependence at discharge.ResultsA total of 75 (27.7%) patients became dependent on ADL at the time of hospital discharge. Decreased erector spinae muscle area was significantly related to dependent ADL at discharge (adjusted odds ratio: 0.886, 95% confidence interval: 0.805–0.975). In addition, the erector spinae muscle area was significantly related to the number of ADL items for which independence was not achieved (adjusted incidence rate ratio: 0.959, P < 0.001).ConclusionsThe cross-sectional area of the erector spinae muscles from the thoracic CT image was associated with the ability to perform basic ADL at hospital discharge.

Role of visceral fat areas defined by thoracic CT in acute pulmonary embolism.

Visceral adipose tissue (VAT) has been established as an important parameter of body composition. It can be assessed by imaging modalities like computed tomography (CT). The purpose of the present study was to analyse the prognostic role of VAT derived from thoracic CT in patients with acute pulmonary embolism (PE). The clinical database of our center was retrospectively screened for patients with acute PE between 2014 and 2017. Overall, 184 patients were included into the analysis. VAT was assessed on axial slices of the thoracic CT at the level of the first lumbar vertebra. Clinical scores, serological parameters, need for intubation, ICU admission and 30 days mortality were assessed. Using the previously reported threshold of 100 cm² for visceral obesity definition 136 (73.9%), patients were considered as visceral obese. There was a moderate correlation between VAT and BMI (r = 0.56, p < 0.0001). There was also a moderate correlation between VAT and body height (r = 0.41, p =< 0.0001). Of all investigated clinical scores relating to acute PE, only the GENEVA score correlated weakly with VAT (r = 0.15, p = 0.04). There were significant correlations between VAT and creatinine (r = 0.38, p < 0.0001) and Glomerular filtration rate (r = -0.21, p = 0.005). No associations were identified for VAT and mortality or visceral obesity and mortality. VAT was not associated with mortality in patients with acute pulmonary embolism. Visceral obesity is frequent in patients with acute pulmonary embolism but it is not associated with mortality.

Artificial intelligence can detect left ventricular dilatation on contrast-enhanced thoracic computer tomography relative to cardiac magnetic resonance imaging.

To assess the diagnostic accuracy of an automated algorithm to detect left ventricular (LV) dilatation on non-ECG gated CT, using cardiac magnetic resonance (CMR) as reference standard. Consecutive patients with contrast-enhanced CT thorax and CMR within 31 days (2016-2020) were analysed (n = 84). LV dilatation was defined against age-, sex- and body surface area-specific values for CMR. CTs underwent automated artificial intelligence(AI)-derived analysis that segmented ventricular chambers, presenting maximal LV diameter and volume. Area under the receiver operator curve (AUC-ROC) analysis identified CT thresholds with ≥90% sensitivity and highest specificity and ≥90% specificity with highest sensitivity. Youden's Index was used to identify thresholds with optimised sensitivity and specificity. Automated diameter analysis was feasible in 92% of cases (77/84; 45 men, age 61 ± 14 years, mean CT to CMR interval 10 ± 8 days). Relative to CMR as a reference standard, 45% had LV dilatation. In males, an automated LV diameter measurement of ≥55.5 mm was ≥90% specific for CMR-defined LV dilatation (positive predictive value (PPV) 85.7%, negative predictive value (NPV) 61.2%, accuracy 68.9%). In females, an LV diameter of ≥49.7 mm was ≥90% specific for CMR-defined LV dilatation (PPV 66.7%, NPV 73.1%, accuracy 71.9%). AI CT volumetry data did not significantly improve AUC performance. Fully automated AI-derived analysis LV dilatation on routine unselected non-gated contrast-enhanced CT thorax studies is feasible. We have defined thresholds for the detection of LV dilatation on CT relative to CMR, which could be used to routinely screen for dilated cardiomyopathy at the time of CT. We show, for the first time, that a fully-automated AI-derived analysis of maximal LV chamber axial diameter on non-ECG-gated thoracic CT is feasible in unselected real-world cases and that the derived measures can predict LV dilatation relative to cardiac magnetic resonance imaging, the non-invasive reference standard for determining cardiac chamber size. We have derived sex-specific cut-off values to screen for LV dilatation on routine contrast-enhanced thoracic CT. Future work should validate these thresholds and determine if technology can alter clinical outcomes in a cost-effective manner.

Definition of Castrate Resistant Prostate Cancer: New Insights.

The term castrate resistant prostate cancer (CRPC) was initially proposed by the Prostate Cancer Working Group 2 in 2008 to define the state of clinical and/or biochemical progression of prostate cancer (PCa) in an environment with very low serum testosterone concentration. Clinical progression is based on the radiological imaging proposed by the Response Evaluation Criteria in Solid Tumors (RECIST) adapted to PCa. Biochemical progression is defined as an over 25% increase in serum prostate-specific antigen within two consecutive measurements separated by at least one week, and an absolute value above 2.0 ng/mL. Finally, the castrate environment is usually defined as a serum testosterone concentration maintained below 50 ng/dL or 1.7 nmol/dL. This definition does not incorporate the new and more accurate imaging modalities to assess clinical progression and the capability of the new biochemical measurements to assess the true castration environment. Ga-68-PSMA-11 PET CT/MRI and whole-body MRI are the new imaging modalities that should replace the classic thoracic CT scan, abdomino-pelvic CT scan, and technetium 99-m bone scintigraphy. In addition, Ga-68-PSMA-11 PET is the current basis for the new therapies targeting metastatic sites. Moreover, the current methods for measuring the very low serum testosterone concentrations in clinical laboratories are the widespread chemiluminescent assays, which are inappropriate, while LC-MSMS is the only method recommended to assess the castrate environment. In addition, recent research shows that serum luteinising hormone concentration associates better than serum testosterone with the castration environment, even when it is measured with LC-MSMS. In summary, the current definition of CRPC seems outdated. An extensive update to diagnose true CRPC is also needed to differentiate CRPC men with M0 (non-metastatic) from those with M1 (metastatic) CRPC. WC: 277.