AREPAS: Anomaly Detection in Fine-Grained Anatomy with Reconstruction-Based Semantic Patch-Scoring

The value of early chest computed tomography (CT) was evaluated among severe community-acquired pneumonia (SCAP) patients. The study population consisted of 65 of 457 SCAP patients with concomitant chest CT and radiograph performed within 48 h of ICU admission. Each image pair was re-evaluated by two radiologists. The type of pneumonia, the presence of pleural fluid and atelectasis were assessed. Therapeutic and diagnostic procedures induced by CT results were analysed together with clinical, microbiological and outcome data. Alveolar pneumonia was observed in 72.3% of patients by radiograph and in 75.4% of patients by CT. Pleural fluid was detected via chest radiograph and CT in 17 (26.2%) and 41 cases (63.1%), (P < 0.001) and atelectasis in 10 (15.4%) and 22 cases (33.8%), (P = 0.002), respectively. In 34 patients (52.3%), the CT revealed 38 new findings (58.5%) not shown in plain chest radiograph. Out of these 34 patients, therapeutic interventions or procedures were performed in 26 (76.5%). The number of infected lobes correlated negatively with the lowest PaO2 /FiO2 ratio (ρ = -0.326, P = 0.008) for chest CT scans. Compared with chest radiograph, chest CT generated new findings in nearly 60% of SCAP patients, leading to new procedures or changes in medical treatment in nearly 75% of those patients. Chest CT better describes the pulmonary involvement and severity of oxygenation disorder compared to a plain chest radiograph.

Should Spinal MRI Be Routinely Performed in Patients With Clinically Isolated Optic Neuritis?

Systematic Screening of COVID-19 Disease Based on Chest CT and RT-PCR for Cancer Patients Undergoing Radiation Therapy in a Coronavirus French Hotspot

This study aimed to explore the diagnostic value of chest computed tomography (CT) based on adaptive statistical iterative reconstruction (ASiR) in the optimal weight range for children with community-acquired pneumonia (CAP) and find the differences between chest CT and ultrasound in the diagnosis of CAP. 106 children who were diagnosed as CAP were selected as the research objects. All objects underwent CT and ultrasound scans to measure the noise of CT images after iterative reconstruction and the contrast-to-noise ratio (CNR) of the thoracic aorta and the back muscles. The correlation between ASiR weight, noise, and CNR was analyzed and compared further. In addition, the differences in imaging manifestations of lung consolidation, abnormal pleural line, alveolar interstitial syndrome, and pleural effusion were observed under the ultrasound and CT scans of the patients. The sensitivity, specificity, positive predicted value (PV), and negative PV of the CT scan and ultrasound were analyzed further for the diagnosis of CAP in children. The results showed that ASiR weight and image noise were extremely and negatively correlated ( P &lt; 0.001 ) and that CNR and ASiR weight were extremely and positively correlated ( P &lt; 0.001 ). 40–60% of ASiR image noise was in the middle position, and the muscle space and subcutaneous fat in CT images were clearer when ASiR was at 40% and 60%. 60.38% of children were diagnosed as CAP. The proportions of children with lung consolidation, interstitial changes, pleural effusion, and atelectasis after ultrasound and CT examination were not greatly different ( P &gt; 0.05 ). After ASiR, the sensitivity of CT in detecting the abnormal pleural line + B-line/consolidation feature was the highest, 93.75%. The results of ultrasound diagnosis were consistent with those of chest CT diagnosis ( P &lt; 0.01 ). This indicated that the sensitivity, specificity, positive PV, and negative PV of ASiR-based chest CT in the diagnosis of CAP were close to those of ultrasound.

Chest computed tomography (CT) can be used to monitor the course of the disease or response to therapy. Therefore, our study was designed to identify chest CT manifestations that can predict the outcome of patients on short term follow-up. This was a retrospective study wherein we reviewed chest CT scans of 112 real-time reverse transcription polymerase chain reaction positive patients admitted to our hospital. All 112 patients underwent follow-up chest CT at a time interval of 4 to 42 days. Our study included 83 male and 29 female who were positive for COVID 19 infection and admitted to the hospital with positive chest CT findings. All patients underwent follow-up chest CT, and the outcomes were categorized as resolution, regression, residual fibrosis, progression, or death. These proportions were 5.4%, 48.2%, 24.1%, 14.3%, and 8%, respectively. The only significant factor in determining the complete resolution of chest CT was oligo-segmental affection (P = .0001). The main CT feature that significantly affected the regression of chest CT manifestations was diffuse nodular shadows (P = .039). The CT features noted in patients with residual fibrosis were interstitial thickening, with a P value of .017. The mono-segmental process significantly affected progression (P = .044). The significant factors for fatality were diffuse crazy paving, pleural effusion, and extra-thoracic complications (P = .033, .029, and .007, respectively). The prognostic value of the first admission CT can help assess disease outcomes in the earliest phases of onset. This can improve resource distribution.

status: Published

Background: High resolution chest computed tomography (HRCT) is an established imaging modality that accurately assesses disease processes that are non-specific on conventional chest radiography. Chest Computed Tomography (CT) has proven invaluable in the evaluation of various diseases of the chest providing precise diagnosis that have great impact on the course of management. In this study, our aim is to evaluate the spectrum of radiological findings in all patients that had chest CTs at a tertiary health Institution in a developing Country. Method: This is a 6-year retrospective study of all patients that had Chest CT from 2009 till 2015. All patient data were retrieved and their Chest CT images reviewed and radiological findings and diagnosis documented. Results: Age range of patients was 1 - 84 years with a mean of 52.36 ± 22.9 years. Ten patients were children (12%). There were more males 53 (63.1%) than females 31 (36.9%) in the study. Referral for imaging was predominantly from internal medicine 33 (47.1%) and Surgery 27 (38.6%) departments. Most of the patients, 53 (63.1%) did not have previous chest radiographs. Consolidative changes were the most common parenchymal finding (77.4%). Few mediastinal masses were found in the study population. CT angiography constituted only 10.7% of all chest CTs done in adults. Conclusion: Few chest CT evaluations are performed compared to CTs of other parts of the body done in the same period. Chest CT is generally under-utilized even in a tertiary institution. There is a need to educate chest physicians on the role and advantages of CT use for the management of their patients.

Background Detection of the viral nucleic acid is the cornerstone to diagnose the novel coronavirus disease 2019 (COVID-19). Due to the limited resources, the clinical and laboratory biomarkers will help in the early and differential diagnosis of severe acute respiratory syndrome coronavirus 2 infection and predict the prognosis of the disease. These findings in patients with pneumonia include fatigue, dry cough, low-grade fever, along with normal white blood cell count, decreased lymphocyte count, and high C-reactive protein (CRP) and D-dimer levels. Chest computed tomography (CT) severity score relies on the opacification of lungs as a proof for disease extension. Several studies have settled the importance of CT chest in the diagnosis and follow up of COVID-19 patients. Otherwise, many scientific societies have disclaimed the routine CT screening of these patients. Hence, it is important to correlate the CT severity score in positive PCR COVID-19 patients to their laboratory findings to minimize the need of frequent CT chest as a tool of follow-up. Patients and methods The study included 198 positive PCR for COVID-19 health-care workers including physicians, nurses, employees, and workers of Ain Shams University Hospitals, who sought medical advice at the Chest OPC or the ER triage or through teleconsultations. Patients underwent history taking, laboratory workup including complete blood count with differential, serum ferritin, CRP, D-dimer levels, and high-resolution CT chest. Results The study included 198 health-care workers including physicians, nurses, employees, and workers of Ain Shams University Hospitals with 106 of them being females and 92 males. The age range of the included patients is from 21 years up to 85 years. The cases were classified according to their CT severity score into normal CT chest with 47.5% of cases, mild CT findings representing 21.2%, 34 patients with moderate findings in CT, and those with severe score were 28 patients. A significant relation was found between the age and CT severity score with P value less than 0.001. The severity score was higher in cases with lower total leukocyte count and lymphocytes with significant relation and the P value was less than 0.001. The median CRP and ferritin level show a highly significant relation with the CT severity score. A highly significant relationship was found between severity score and D-dimer level of patients with a P value of less than 0.001. Conclusion This work sets a semiquantitative framework to assess and follow up the severity of COVID-19 disease. This score could be possibly used to facilitate the clinical triage of COVID-19 moderate to severe patients, requiring admission in hospitals in relation to laboratory findings. Also, it could be used to evaluate the severity of lung involvement in patients objectively and quickly. However, it was proposed that the use of laboratory results is of value in the follow up of the cases to limit the exposure to radiations.

Staging chest computed tomography and positron emission tomography in patients with pancreatic adenocarcinoma: utility or futility?

Introduction: Chest computed tomography (CT) is used for the screening and diagnosis of COVID-19 pneumonia. The aim of the study is to study the prevalence of residual lung parenchymal CT changes in COVID-19 patients and its association with common predictors. Methods: Longitudinal study conducted at Shree Birendra Hospital in which diagnosed COVID-19 patients with initial CT scan showing COVID-19 related changes were retrospectively enrolled after ethics approval. The study period was from 15 February 2020 to 15 November 2021. Chest CT changes were evaluated and CT scan severity score (CT SS) assigned. Data was entered in Microsoft Excel and analysed in SPSS (Statistical Package for Social Sciences) version 16. Results: Males were more common (72.6%) among the 62 enrolled participants with the mean age 53.63 ± 15.05 years. Median interval between two scans was 137 days. Residual lung parenchymal CT changes were seen in 43 (69.4%) participants. Hypertension (25, 40.3%) and GGO (55, 88.7%) were the most common comorbidity and CT features respectively. The mean initial and final CT SS was 10.84 ± 5.87 and 3.55 ± 4.58 respectively (Total score 25, p = 0.001). Age was significantly associated with severity of CT score (p = 0.04). Conclusions: A large percentage of COVID-19 patients have chest CT changes after three months of initial chest CT scan. CT SS reduced significantly in the second scan. Similar studies with long term serial CT follow up of patients is recommended to be carried out in future.

BACKGROUND: Speech recognition is becoming increasingly common in the national healthcare system. One of the first specialties to implement this technology on a large scale was radiology. However, the efficiency of voice input and its effect on the length of time required to complete medical records remain unresolved.&#x0D; AIM: To assess the efficiency of speech recognition in generating radiological protocols of different modalities and types.&#x0D; METHODS: The retrospective study was conducted at the Moscow Reference Center of the Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Department of Health. A total of 12,912 radiological reports on fluorography, mammography, chest computed tomography (CT), contrast-enhanced magnetic resonance imaging (MRI) of the brain, and contrast-enhanced CT of the abdomen and pelvis were included in the study by simple random sampling. The size of all samples exceeded 766 reports, calculated with regard to the size of the general population of over 100,000 reports. The Voice2Med software was used to fill in the radiological protocols. Intergroup comparison was performed using the MannWhitney U-test with a statistical significance level of 0.05.&#x0D; RESULTS: The average duration of generating fluorographic protocols in the keyboard and voice input groups was 189.9 s (0:03:09) and 236.2 s (0:03:56), respectively (p 0.0001). For mammographic reports, the duration was 387.1 s (0:06:27) and 444.8 s (0:07:24), respectively (p 0.0001). For radiographic reports, it amounted to 247.8 s (0:04:07) and 189.0 s (0: 03:09), respectively (p 0.0001), and for chest CT, it was 379.7 s (0:06:19) and 382.7 s (0:06:22), respectively (p=0.12). For MRI of the brain, the protocols were generated for 709.9 s (0:11:49) and 559.9 s (0: 09:19), respectively (p 0.0001), and for contrast-enhanced chest, abdominal, and pelvic CT scans, it took 2714.6 s (0:45:15) and 1778.4 s (0:29:38), respectively. Voice input slowed down the preparation time of mammographic and fluorographic protocols. This is due to the use of a structured electronic medical document in medical facilities to describe the results of the examinations. Speech recognition showed the greatest efficiency in generating MRI and CT protocols. Such reports contain a large number of pathological changes, both target and incidental findings, which requires a detailed description by the radiologist in the examination protocol.&#x0D; CONCLUSIONS: Speech recognition in generating radiological protocols showed different efficiency depending on the modality and type of the radiological protocol filled in using the voice input system. This approach is optimal for describing CT and MRI scans.

Aim:To clarify the epidemiological findings and characteristics of ground glass lesions on chest computed tomography (CT) after blunt trauma.Setting and Design:A medical college hospital and retrospective study.Materials and Methods:We retrospectively investigated all blunt chest trauma patients who were admitted from January 2004 to December 2010. The inclusion criteria were patients with: (1) chest CT examination on arrival, (2) intrathoracic traumatic lesions confirmed by initial CT, and (3) a second chest CT examination within 7 days from admission. We divided the subjects into two groups. A GG group included subjects who had ground glass lesions on initial chest CT and a control group included subjects who did not have the ground glass appearance.Results:The average age in the GG group was significantly lesser than that in the control group. The ratio of improvement for the value of SpO2/FiO2 between on arrival and the second hospital day and ratio of improvement for CT findings between on arrival and the second CT examination in the GG group was greater than in the control group.Conclusion:The ground glass appearance on chest CT after blunt trauma was not rare, and the patients with ground glass lesions were younger and tended to have a better improvement of oxygenation and CT images in comparison with the patients without these characteristic lesions.

Coronavirus disease (COVID-19) is an infectious disease that can lead to pneumonia, pulmonary oedema, acute respiratory distress syndrome, multiple organ and system dysfunction, and death. This study aimed to verify the efficacy of chest computed tomography (CT) for the initial diagnosis of COVID-19. This observational, retrospective, cross-sectional study included 259 individuals who underwent clinical evaluation, blood collection, chest CT, and a reverse transcription polymerase chain reaction (RT-PCR) diagnostic test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during their course of treatment at a reference hospital in Belém, Pará, Brazil between April and June 2020. Inclusion criteria were flu-like symptoms in adults of both sexes. Individuals with an inconclusive COVID-19 molecular test or who had artifacts in the chest CT images were excluded. Parametric data were analyzed using Student-t-test and non-parametric data were analyzed using average test and Fisher exact test. Participants were divided into two groups: Group 1 (COVID-19 positive), n = 211 (124 males, 87 females), 51.8 ± 17.9 years old and Group 2 (COVID-19 negative), n = 48 (22 males, 26 females), 47.6 ± 18.6 years old. Most frequent symptoms were cough [Group 1 n = 199 (94%)/Group 2 n = 46 (95%)], fever [Group 1 n = 154 (72%)/Group 2 n = 28 (58%)], myalgia [Group 1 n = 172 (81%)/Group 2 n = 38 (79%)], dyspnoea [Group 1 n = 169 (80%) / Group 2 n = 37 (77%)], headache [Group 1 n = 163 (77%)/Group 2 n = 32 (66%)], and anosmia [Group 1 n = 154 (73%)/Group 2 n = 29 (60%)]. Group 1 had a higher proportion of ground-glass opacity [Group 1 n = 175 (83%)/Group 2 n = 24 (50%), 0.00], vascular enhancement sign [Group 1 n = 128 (60%)/Group 2 n = 15 (31%), 0.00], septal thickening [Group 1 n = 99 (47%)/Group 2 n = 13 (27%), 0.01], crazy-paving pattern [Group 1 n = 98 (46%) / Group 2 n = 13 (27%), 0.01], consolidations [Group 1 n = 92 (43%)/Group 2 n = 8 (16%), 0.00], and CO-RADS 4 and 5 [Group 1 n = 163 (77.25%)/Group 2 n = 24 (50%), 0.00] categories in chest CT. Chest CT, when available, was found to be an efficient method for the initial diagnosis and better management of individuals with COVID-19.

Introduction: Chest Computed Tomography (CT) plays an important role in the diagnosis and management of Corona Virus Disease (COVID-19) infection. A better understanding of the chest CT imaging findings in COVID-19 disease may help in accurate diagnosis and staging of the disease. The temporal changes in the chest CT imaging findings follows a specific pattern which helps in identification of disease progression or recovery from the illness. Aim: To evaluate the chest CT imaging findings of COVID-19 patients during the course of disease. Materials and Methods: This was a retrospective observational study in which 110 hospitalised patients with COVID-19 disease were evaluated for chest CT imaging findings and severity of the infection. Chest CT findings with respect to duration of symptoms onset were divided into early phase disease (&lt;5 days of symptom onset), intermediate phase (5-12 days) and late phase disease (&gt;12 days of symptom onset). Based on visual assessment, CT severity score was given depending on the percentage of each lobe involved in bilateral lung parenchyma. Descriptive statistics were expressed using percentage, range, means and Standard Deviation (mean±SD). Results: A total of 110 COVID-19 positive patients (79 males and 31 females) with mean age of 48.33±9.18 years (range between 22-84 years) were included in the study. CT chest was performed during the different time periods of hospital stay ranging from 2 to 16 days. Early phase disease constituted 53 (48.18%) patients, 21 (19.09%) patients in the intermediate phase and 36 (32.72%) patients were in the late phase. Nineteen (17.27%) patients in the early phase disease (&lt;5 days) had a normal scan. Out of 91 chest CT positive patients, 13 patients (14.28%) were asymptomatic and 78 patients were symptomatic (85.71%). Among the CT positive patients, early phase disease constituted 34 (37.36%) patients, 21 (23.07%) patients were in the intermediate phase and 36 (39.56%) patients in the late phase disease. Early phase disease was predominantly characterised by Ground Glass Opacities (GGOs) which were seen in 27 patients (79.41%), gradual conversion of these GGOs into consolidations during the intermediate phase. Consolidations with fibrotic bands were predominant imaging patterns during the late phase disease seen in 21 patients (58.33%). Mean CT severity score during the early, intermediate and late phase diseases were 4.14±2.12, 14.71±4.80 and 11.08±4.68, respectively. Along with few existing signs described in COVID-19 disease, two signs during the late phase disease were observed such as target sign in 5 patients (13.88%) and centipede sign in 13 patients (36.11%). Splenomegaly was an additional extrapulmonary finding seen in 27 patients (24.5%) which has not been described previously. Conclusion: Specific imaging patterns during the course of COVID- 19 illness provide an information regarding the stage of the illness and disease severity. Ideal timing of chest CT is found to be during the intermediate phase of disease (5-12 days of symptom onset), since most of the lesions evolve in this period and provide accurate disease severity which in turn helps in treatment planning.

BackgroundThe coronavirus disease 2019 (COVID-19) has a wide range of severity. Chest computed tomography (CT) had high sensitivity and specificity to identify COVID-19 pneumonia. However, chest CT was not available in almost all hospitals in pandemic settings, including developed countries. This study is to evaluate the potential role of conventional inflammatory biomarkers to predict COVID-19 pneumonia.MethodsAll 155 RT-PCR-confirmed COVID-19 patients were evaluated for pneumonia by chest CT from April 10, 2021 to May 3, 2021 in the outpatient unit, a Thai university hospital. The inflammatory biomarkers were evaluated the sensitivity, specificity, LR+, LR-, and ROC to predict COVID-19 pneumonia.ResultsOf all 155 patients, pneumonia was diagnosed by chest CT in 117 patients. The pneumonia patients had a median (IQR) age of 38 (30, 55) years old. The BMI was higher in pneumonia than mild illness in 25.5 (22.0, 29.5) and 22.9 (19.4, 26.9) kg/m2, respectively (p=0.031). In univariate analysis, serum high-sensitivity C-reactive protein (hsCRP), lactate dehydrogenase (LDH), ferritin, total lymphocyte count (TLC), and albumin were associated with pneumonia, but the only hsCRP demonstrated association by multivariate analysis. The area under the ROC curves (AUC) was 0.82, 0.74, 0.68, 0.38, and 0.37 in hsCRP, LDH, ferritin, TLC, and albumin, respectively. The optimal cut-off level for CRP to diagnose COVID-19 pneumonia was 2.00 mg/L given sensitivity, specificity, LR+, LR- of 81.9%, 70.3%, 2.75, and 0.26 respectively (Figure 1 and Table 1).Table 1.Demonstrated sensitivity, specificity, LR+, and LR- for each specific cut-off value of hsCRPCut-off for hsCRP (≥ mg/L)Sensitivity (%)Specificity (%)LR+LR-1.9081.964.92.330.281.9581.967.62.530.272.00*81.970.32.750.262.0580.270.32.700.282.1080.270.32.700.28*Indicated optimal cut-off value for hsCRP to predict chest CT-confirmed pneumonia.ROC Curve of hsCRP to Diagnose of COVID-19 PneumoniaThis figure shows ROC curve for hsCRP to diagnose of chest CT-confirmed COVID-19 pneumonia. The area under the ROC curve is 0.82. The optimal cut-off value for hsCRP is 2.00 given sensitivity of 81.9% and specificity of 70.3%.ConclusionThe hsCRP was the conventional biomarker that had an excellent performance in predicting COVID-19 pneumonia lead to early anti-SARS-CoV-2 treatment. This study demonstrated the potential role of hsCRP combined with clinical assessment in negative chest X-rays to replace chest CT in a high burden COVID-19 country during pandemic situations.DisclosuresAll Authors: No reported disclosures