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Basille D, Auquier MA, Andréjak C, Rodenstein DO, Mahjoub Y, Jounieaux V. Dissociation between the clinical course and chest imaging in severe COVID-19 pneumonia: A series of five cases. Heart Lung 2021; 50:818-824. [PMID: 34271253 PMCID: PMC8241693 DOI: 10.1016/j.hrtlng.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Although an RT-PCR test is the "gold standard" tool for diagnosing an infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), chest imaging can be used to support a diagnosis of coronavirus disease 2019 (COVID-19) - albeit with fairly low specificity. However, if the chest imaging findings do not faithfully reflect the patient's clinical course, one can question the rationale for relying on these imaging data in the diagnosis of COVID-19. AIMS To compare clinical courses with changes over time in chest imaging findings among patients admitted to an ICU for severe COVID-19 pneumonia. METHODS We retrospectively reviewed the medical charts of all adult patients admitted to our intensive care unit (ICU) between March 1, 2020, and April 15, 2020, for a severe COVID-19 lung infection and who had a positive RT-PCR test. Changes in clinical, laboratory and radiological variables were compared, and patients with discordant changes over time (e.g. a clinical improvement with stable or worse radiological findings) were analyzed further. RESULTS Of the 46 included patients, 5 showed an improvement in their clinical status but not in their chest imaging findings. On admission to the ICU, three of the five were mechanically ventilated and the two others received high-flow oxygen therapy or a non-rebreather mask. Even though the five patients' radiological findings worsened or remained stable, the mean ± standard deviation partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2:FiO2) ratio increased significantly in all cases (from 113.2 ± 59.7 mmHg at admission to 259.8 ± 59.7 mmHg at a follow-up evaluation; p=0.043). INTERPRETATION Our results suggest that in cases of clinical improvement with worsened or stable chest imaging variables, the PaO2:FiO2 ratio might be a good marker of the resolution of COVID-19-specific pulmonary vascular insult.
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Affiliation(s)
- Damien Basille
- Pneumology Department, University Hospital Centre, Amiens, France; AGIR Unit - UR4294, University Picardie Jules Verne, Amiens, France.
| | | | - Claire Andréjak
- Pneumology Department, University Hospital Centre, Amiens, France; AGIR Unit - UR4294, University Picardie Jules Verne, Amiens, France
| | - Daniel Oscar Rodenstein
- Pneumology Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Yazine Mahjoub
- Anesthesia and Critical Care. Cardiac, Thoracic, Vascular and Respiratory Intensive Care Unit, University Hospital Centre, Amiens, France
| | - Vincent Jounieaux
- Pneumology Department, University Hospital Centre, Amiens, France; AGIR Unit - UR4294, University Picardie Jules Verne, Amiens, France
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202
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Pezzutti DL, Wadhwa V, Makary MS. COVID-19 imaging: Diagnostic approaches, challenges, and evolving advances. World J Radiol 2021. [DOI: 10.4329/wjr.v13.i6.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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203
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Alqahtani JS, Alghamdi SM, Aldhahir AM, Althobiani M, Raya RP, Oyelade T. Thoracic imaging outcomes in COVID-19 survivors. World J Radiol 2021; 13:149-156. [PMID: 34249236 PMCID: PMC8245750 DOI: 10.4329/wjr.v13.i6.149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/13/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic presents a significant global public health challenge. One in five individuals with COVID-19 presents with symptoms that last for weeks after hospital discharge, a condition termed "long COVID". Thus, efficient follow-up of patients is needed to assess the resolution of lung pathologies and systemic involvement. Thoracic imaging is multimodal and involves using different forms of waves to produce images of the organs within the thorax. In general, it includes chest X-ray, computed tomography, lung ultrasound and magnetic resonance imaging techniques. Such modalities have been useful in the diagnosis and prognosis of COVID-19. These tools have also allowed for the follow-up and assessment of long COVID. This review provides insights on the effectiveness of thoracic imaging techniques in the follow-up of COVID-19 survivors who had long COVID.
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Affiliation(s)
- Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 3431, Saudi Arabia
- Department of Respiratory Medicine, Division of Medicine, University College London, London NW3 2PF, United Kingdom
| | - Saeed M Alghamdi
- Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 21990, Saudi Arabia
| | - Abdulelah M Aldhahir
- Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 4514, Saudi Arabia
| | - Malik Althobiani
- Department of Respiratory Medicine, Division of Medicine, University College London, London NW3 2PF, United Kingdom
- Department of Respiratory Therapy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Reynie Purnama Raya
- Faculty of Science, Universitas 'Aisyiyah Bandung, Bandung 40264, Indonesia
- Institute for Global Health, Division of Medicine, University College London, London NW3 2PF, United Kingdom
| | - Tope Oyelade
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London NW3 2PF, United Kingdom
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204
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Sideris GA, Nikolakea M, Karanikola AE, Konstantinopoulou S, Giannis D, Modahl L. Imaging in the COVID-19 era: Lessons learned during a pandemic. World J Radiol 2021. [DOI: 10.4329/wjr.v13.i6.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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205
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Sideris GA, Nikolakea M, Karanikola AE, Konstantinopoulou S, Giannis D, Modahl L. Imaging in the COVID-19 era: Lessons learned during a pandemic. World J Radiol 2021; 13:192-222. [PMID: 34249239 PMCID: PMC8245753 DOI: 10.4329/wjr.v13.i6.192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/02/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
The first year of the coronavirus disease 2019 (COVID-19) pandemic has been a year of unprecedented changes, scientific breakthroughs, and controversies. The radiology community has not been spared from the challenges imposed on global healthcare systems. Radiology has played a crucial part in tackling this pandemic, either by demonstrating the manifestations of the virus and guiding patient management, or by safely handling the patients and mitigating transmission within the hospital. Major modifications involving all aspects of daily radiology practice have occurred as a result of the pandemic, including workflow alterations, volume reductions, and strict infection control strategies. Despite the ongoing challenges, considerable knowledge has been gained that will guide future innovations. The aim of this review is to provide the latest evidence on the role of imaging in the diagnosis of the multifaceted manifestations of COVID-19, and to discuss the implications of the pandemic on radiology departments globally, including infection control strategies and delays in cancer screening. Lastly, the promising contribution of artificial intelligence in the COVID-19 pandemic is explored.
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Affiliation(s)
- Georgios Antonios Sideris
- Department of Radiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, United States
- Radiology Working Group, Society of Junior Doctors, Athens 11527, Greece
| | - Melina Nikolakea
- Radiology Working Group, Society of Junior Doctors, Athens 11527, Greece
| | | | - Sofia Konstantinopoulou
- Division of Pulmonary Medicine, Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi W13-01, United Arab Emirates
| | - Dimitrios Giannis
- Institute of Health Innovations and Outcomes Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | - Lucy Modahl
- Department of Radiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, United States
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206
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Gündüz Y, Karabay O, Erdem AF, Arık E, Öztürk MH. Evaluation of initial chest computed tomography (CT) findings of COVID-19 pneumonia in 117 deceased patients: a retrospective study. Turk J Med Sci 2021; 51:929-938. [PMID: 33315351 PMCID: PMC8283471 DOI: 10.3906/sag-2009-183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/12/2020] [Indexed: 01/08/2023] Open
Abstract
Background/aim There is no study in the literature in which only chest computed tomography (CT) findings of deceased cases obtained at admission were examined, and the relationship between these findings and mortality was evaluated. Materials and methods In this retrospective study, a total of 117 deceased patients with COVID-19 infection confirmed by positive polymerase chain reaction and undergone chest CT were enrolled. We evaluated initial chest CT findings and their relationship, location, prevalence, and the frequency with mortality. Results The mean age of patients was 73 ±18 years; 71 of all patients were male and 46 were female. The predominant feature was pure ground-glass opacity (GGO) lesion (82.0%), and 59.8% of cases had pure consolidation. There was no cavitation or architectural distorsion. Pericardial effusion was found in 9.4% the patients, and pleural effusions were found in 15.3% of them. Mediastinal lymphadenopathy was only 11.9% in total. Conclusion In deceased patients, on admission CTs, pure consolidation, pleural and pericardial effusion, mediastinal LAP were more common than ordinary cases. It was these findings that should also raise the concern when they were seen on chest CT; therefore, these radiologic features have the potential to represent prognostic imaging markers in patients with COVID-19 pneumonia.
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Affiliation(s)
- Yasemin Gündüz
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Oğuz Karabay
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ali Fuat Erdem
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Erbil Arık
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Mehmet Halil Öztürk
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Pezzutti DL, Wadhwa V, Makary MS. COVID-19 imaging: Diagnostic approaches, challenges, and evolving advances. World J Radiol 2021; 13:171-191. [PMID: 34249238 PMCID: PMC8245752 DOI: 10.4329/wjr.v13.i6.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/15/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
The role of radiology and the radiologist have evolved throughout the coronavirus disease-2019 (COVID-19) pandemic. Early on, chest computed tomography was used for screening and diagnosis of COVID-19; however, it is now indicated for high-risk patients, those with severe disease, or in areas where polymerase chain reaction testing is sparsely available. Chest radiography is now utilized mainly for monitoring disease progression in hospitalized patients showing signs of worsening clinical status. Additionally, many challenges at the operational level have been overcome within the field of radiology throughout the COVID-19 pandemic. The use of teleradiology and virtual care clinics greatly enhanced our ability to socially distance and both are likely to remain important mediums for diagnostic imaging delivery and patient care. Opportunities to better utilize of imaging for detection of extrapulmonary manifestations and complications of COVID-19 disease will continue to arise as a more detailed understanding of the pathophysiology of the virus continues to be uncovered and identification of predisposing risk factors for complication development continue to be better understood. Furthermore, unidentified advancements in areas such as standardized imaging reporting, point-of-care ultrasound, and artificial intelligence offer exciting discovery pathways that will inevitably lead to improved care for patients with COVID-19.
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Affiliation(s)
- Dante L Pezzutti
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Vibhor Wadhwa
- Department of Radiology, Weill Cornell Medical Center, New York City, NY 10065, United States
| | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
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208
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Diagnostic Performance of COVID-19 Reporting and Data System Classification Across Residents and Radiologists: A Retrospective Study. J Comput Assist Tomogr 2021; 45:782-787. [PMID: 34176881 DOI: 10.1097/rct.0000000000001172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the interobserver agreement and diagnostic accuracy of COVID-19 Reporting and Data System (CO-RADS), in patients suspected COVID-19 pneumonia. METHODS Two hundred nine nonenhanced chest computed tomography images of patients with clinically suspected COVID-19 pneumonia were included. The images were evaluated by 2 groups of observers, consisting of 2 residents-radiologists, using CO-RADS. Reverse transcriptase-polymerase chain reaction (PCR) was used as a reference standard for diagnosis in this study. Sensitivity, specificity, area under receiver operating characteristic curve (AUC), and intraobserver/interobserver agreement were calculated. RESULTS COVID-19 Reporting and Data System was able to distinguish patients with positive PCR results from those with negative PCR results with AUC of 0.796 in the group of residents and AUC of 0.810 in the group of radiologists. There was moderate interobserver agreement between residents and radiologist with κ values of 0.54 and 0.57. CONCLUSIONS The diagnostic performance of CO-RADS for predicting COVID-19 pneumonia showed moderate interobserver agreement between residents and radiologists.
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209
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Rosati F, Muneretto C, Baudo M, D'Ancona G, Bichi S, Merlo M, Cuko B, Gerometta P, Grazioli V, Giroletti L, Di Bacco L, Repossini A, Benussi S. A multicentre roadmap to restart elective cardiac surgery after COVID-19 peak in an Italian epicenter. J Card Surg 2021; 36:3308-3316. [PMID: 34173273 PMCID: PMC9292840 DOI: 10.1111/jocs.15776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND During the Italian Phase-2 of the coronavirus pandemic, it was possible to restart elective surgeries. Because hospitals were still burdened with coronavirus disease 2019 (COVID-19) patients, it was focal to design a separate "clean path" for the surgical candidates and determine the possible effects of major surgery on previously infected patients. METHODS From May to July 2020 (postpandemic peak), 259 consecutive patients were scheduled for elective cardiac surgery in three different centers. Our original roadmap with four screening steps included: a short item questionnaire (STEP-1), nasopharyngeal swab (NP) (STEP-2), computed tomography (CT)-scan using COVID-19 reporting and data system (CO-RADS) scoring (STEP-3), and final NP swab before discharge (STEP-4). RESULTS Two patients (0.8%) resulted positive at STEP-2: one patient was discharged home for quarantine, the other performed a CT-scan (CO-RADS: <2), and underwent surgery for unstable angina. Chest-CT was positive in 6.3% (15/237) with mean CO-RADS of 2.93 ± 0.8. Mild-moderate lung inflammation (CO-RADS: 2-4) did not delay surgery. Perioperative mortality was 1.15% (3/259), and cumulative incidence of pulmonary complications was 14.6%. At multivariable analysis, only age and cardiopulmonary bypass (CPB) time were independently related to pulmonary complications composite outcome (age >75 years: odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.25-5.57; p = 0.011; CPB >90 min. OR: 4.3; 95% CI: 1.84-10.16; p = 0.001). At 30 days, no periprocedural contagion and rehospitalization for COVID-19 infections were reported. CONCLUSIONS Our structured roadmap supports the safe restarting of an elective cardiac surgery list after a peak of a still ongoing COVID-19 pandemic in an epicenter area. Mild to moderate CT residuals of coronavirus pneumonia do not justify elective cardiac surgery procrastination.
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Affiliation(s)
- Fabrizio Rosati
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Massimo Baudo
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Giuseppe D'Ancona
- Department of Cardiovascular Research, Vivantes Klinikum Urban, Berlin, Germany
| | - Samuele Bichi
- Division of Cardiac Surgery, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Maurizio Merlo
- Division of Cardiac Surgery, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Besart Cuko
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | | | - Laura Giroletti
- Division of Cardiac Surgery, Humanitas Gavazzeni, Bergamo, Italy
| | - Lorenzo Di Bacco
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alberto Repossini
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Stefano Benussi
- Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
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Coronavirus Disease (COVID-19): The Value of Chest Radiography for Patients Greater Than Age 50 Years at an Earlier Timepoint of Symptoms Compared With Younger Patients. Ochsner J 2021; 21:126-132. [PMID: 34239370 PMCID: PMC8238095 DOI: 10.31486/toj.20.0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: A relative paucity of data exists regarding chest radiography (CXR) in diagnosis of coronavirus disease (COVID-19) compared to computed tomography. We address the use of a strict pattern of CXR findings for COVID-19 diagnosis, specifically during early onset of symptoms with respect to patient age. Methods: We performed a retrospective study of patients under investigation for COVID-19 who presented to the emergency department during the COVID-19 outbreak of 2020 and had CXR within 1 week of symptoms. Only reverse transcription polymerase chain reaction (RT-PCR)-positive patients were included. Two board-certified radiologists, blinded to RT-PCR results, assessed 60 CXRs in consensus and assigned 1 of 3 patterns: characteristic, atypical, or negative. Atypical patterns were subdivided into more suspicious or less suspicious for COVID-19. Results: Sixty patients were included: 30 patients aged 52 to 88 years and 30 patients aged 19 to 48 years. Ninety-three percent of the older group demonstrated an abnormal CXR and were more likely to have characteristic and atypical-more suspicious findings in the first week after symptom onset than the younger group. The relationship between age and CXR findings was statistically significant (χ2 [2, n=60]=15.70; P=0.00039). The relationship between negative and characteristic COVID-19 CXR findings between the 2 age cohorts was statistically significant with Fisher exact test resulting in a P value of 0.001. Conclusion: COVID-19 positive patients >50 years show earlier, characteristic patterns of statistically significant CXR changes than younger patients, suggesting that CXR is useful in the early diagnosis of infection. CXR can be useful in early diagnosis of COVID-19 in patients older than 50 years.
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211
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Ramdani H, Allali N, Chat L, El Haddad S. Covid-19 imaging: A narrative review. Ann Med Surg (Lond) 2021; 69:102489. [PMID: 34178312 PMCID: PMC8214462 DOI: 10.1016/j.amsu.2021.102489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/31/2021] [Accepted: 06/05/2021] [Indexed: 01/08/2023] Open
Abstract
Background The 2019 novel coronavirus disease (COVID-19) imaging data is dispersed in numerous publications. A cohesive literature review is to be assembled. Objective To summarize the existing literature on Covid-19 pneumonia imaging including precautionary measures for radiology departments, Chest CT's role in diagnosis and management, imaging findings of Covid-19 patients including children and pregnant women, artificial intelligence applications and practical recommendations. Methods A systematic literature search of PubMed/med line electronic databases. Results The radiology department's staff is on the front line of the novel coronavirus outbreak. Strict adherence to precautionary measures is the main defense against infection's spread. Although nucleic acid testing is Covid-19's pneumonia diagnosis gold standard; kits shortage and low sensitivity led to the implementation of the highly sensitive chest computed tomography amidst initial diagnostic tools. Initial Covid-19 CT features comprise bilateral, peripheral or posterior, multilobar ground-glass opacities, predominantly in the lower lobes. Consolidations superimposed on ground-glass opacifications are found in few cases, preponderantly in the elderly. In later disease stages, GGO transformation into multifocal consolidations, thickened interlobular and intralobular lines, crazy paving, traction bronchiectasis, pleural thickening, and subpleural bands are reported. Standardized CT reporting is recommended to guide radiologists. While lung ultrasound, pulmonary MRI, and PET CT are not Covid-19 pneumonia's first-line investigative diagnostic modalities, their characteristic findings and clinical value are outlined. Artificial intelligence's role in strengthening available imaging tools is discussed. Conclusion This review offers an exhaustive analysis of the current literature on imaging role and findings in COVID-19 pneumonia. Chest computed tomography is a highly sensitive Covid −19 pneumonia's diagnostic tool. Initial Covid-19 CT features are bilateral, multifocal, peripheral or posterior ground-glass opacities, mainly in the lower lobes. Multifocal consolidations, bronchiectasis, pleural thickening, and subpleural bands are late disease stages features. Standardized CT reporting is recommended to guide radiologists. Artificial intelligence could strengthen available imaging tools.
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Affiliation(s)
- Hanae Ramdani
- Radiology Department, Childrens' Hospital - Ibn Sina University Hospital-Rabat, Lamfadel Cherkaoui Street, 10010, Rabat, Morocco
| | - Nazik Allali
- Radiology Department, Childrens' Hospital - Ibn Sina University Hospital-Rabat, Lamfadel Cherkaoui Street, 10010, Rabat, Morocco
| | - Latifa Chat
- Radiology Department, Childrens' Hospital - Ibn Sina University Hospital-Rabat, Lamfadel Cherkaoui Street, 10010, Rabat, Morocco
| | - Siham El Haddad
- Radiology Department, Childrens' Hospital - Ibn Sina University Hospital-Rabat, Lamfadel Cherkaoui Street, 10010, Rabat, Morocco
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212
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Berta L, Rizzetto F, De Mattia C, Lizio D, Felisi M, Colombo PE, Carrazza S, Gelmini S, Bianchi L, Artioli D, Travaglini F, Vanzulli A, Torresin A. Automatic lung segmentation in COVID-19 patients: Impact on quantitative computed tomography analysis. Phys Med 2021; 87:115-122. [PMID: 34139383 PMCID: PMC9188767 DOI: 10.1016/j.ejmp.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/05/2021] [Accepted: 06/04/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose To assess the impact of lung segmentation accuracy in an automatic pipeline for quantitative analysis of CT images. Methods Four different platforms for automatic lung segmentation based on convolutional neural network (CNN), region-growing technique and atlas-based algorithm were considered. The platforms were tested using CT images of 55 COVID-19 patients with severe lung impairment. Four radiologists assessed the segmentations using a 5-point qualitative score (QS). For each CT series, a manually revised reference segmentation (RS) was obtained. Histogram-based quantitative metrics (QM) were calculated from CT histogram using lung segmentationsfrom all platforms and RS. Dice index (DI) and differences of QMs (ΔQMs) were calculated between RS and other segmentations. Results Highest QS and lower ΔQMs values were associated to the CNN algorithm. However, only 45% CNN segmentations were judged to need no or only minimal corrections, and in only 17 cases (31%), automatic segmentations provided RS without manual corrections. Median values of the DI for the four algorithms ranged from 0.993 to 0.904. Significant differences for all QMs calculated between automatic segmentations and RS were found both when data were pooled together and stratified according to QS, indicating a relationship between qualitative and quantitative measurements. The most unstable QM was the histogram 90th percentile, with median ΔQMs values ranging from 10HU and 158HU between different algorithms. Conclusions None of tested algorithms provided fully reliable segmentation. Segmentation accuracy impacts differently on different quantitative metrics, and each of them should be individually evaluated according to the purpose of subsequent analyses.
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Affiliation(s)
- L Berta
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - F Rizzetto
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
| | - C De Mattia
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - D Lizio
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - M Felisi
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - P E Colombo
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - S Carrazza
- Department of Physics, Università degli Studi di Milano, via Giovanni Celoria 16, 20133 Milan, Italy; Department of Physics, INFN Sezione di Milano, via Giovanni Celoria 16, 20133 Milan, Italy
| | - S Gelmini
- Department of Physics, Università degli Studi di Milano, via Giovanni Celoria 16, 20133 Milan, Italy
| | - L Bianchi
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
| | - D Artioli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - F Travaglini
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - A Vanzulli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
| | - A Torresin
- Department of Medical Physics, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; Department of Physics, Università degli Studi di Milano, via Giovanni Celoria 16, 20133 Milan, Italy.
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Le N, Sorensen J, Bui T, Choudhary A, Luu K, Nguyen H. Enhance Portable Radiograph for Fast and High Accurate COVID-19 Monitoring. Diagnostics (Basel) 2021; 11:1080. [PMID: 34204846 PMCID: PMC8231621 DOI: 10.3390/diagnostics11061080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 12/24/2022] Open
Abstract
This work aimed to assist physicians by improving their speed and diagnostic accuracy when interpreting portable CXRs as well as monitoring the treatment process to see whether a patient is improving or deteriorating with treatment. These objectives are in especially high demand in the setting of the ongoing COVID-19 pandemic. With the recent progress in the development of artificial intelligence (AI), we introduce new deep learning frameworks to align and enhance the quality of portable CXRs to be more consistent, and to more closely match higher quality conventional CXRs. These enhanced portable CXRs can then help the doctors provide faster and more accurate diagnosis and treatment planning. The contributions of this work are four-fold. Firstly, a new database collection of subject-pair radiographs is introduced. For each subject, we collected a pair of samples from both portable and conventional machines. Secondly, a new deep learning approach is presented to align the subject-pairs dataset to obtain a pixel-pairs dataset. Thirdly, a new PairFlow approach is presented, an end-to-end invertible transfer deep learning method, to enhance the degraded quality of portable CXRs. Finally, the performance of the proposed system is evaluated by UAMS doctors in terms of both image quality and topological properties. This work was undertaken in collaboration with the Department of Radiology at the University of Arkansas for Medical Sciences (UAMS) to enhance portable/mobile COVID-19 CXRs, to improve the speed and accuracy of portable CXR images and aid in urgent COVID-19 diagnosis, monitoring and treatment.
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Affiliation(s)
- Ngan Le
- Department of CSCE, University of Arkansas, Fayetteville, AR 72701, USA;
| | - James Sorensen
- Department of Radiologist, University of Arkansas for Medical Sciences UAMS, Little Rock, AR 72205, USA; (J.S.); (A.C.)
| | - Toan Bui
- Vin-AI Research, Hanoi 100000, Vietnam;
| | - Arabinda Choudhary
- Department of Radiologist, University of Arkansas for Medical Sciences UAMS, Little Rock, AR 72205, USA; (J.S.); (A.C.)
| | - Khoa Luu
- Department of CSCE, University of Arkansas, Fayetteville, AR 72701, USA;
| | - Hien Nguyen
- Department of CSCE, University of Houston, Houston, TX 77204, USA;
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Born J, Beymer D, Rajan D, Coy A, Mukherjee VV, Manica M, Prasanna P, Ballah D, Guindy M, Shaham D, Shah PL, Karteris E, Robertus JL, Gabrani M, Rosen-Zvi M. On the role of artificial intelligence in medical imaging of COVID-19. PATTERNS (NEW YORK, N.Y.) 2021; 2:100269. [PMID: 33969323 PMCID: PMC8086827 DOI: 10.1016/j.patter.2021.100269] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although a plethora of research articles on AI methods on COVID-19 medical imaging are published, their clinical value remains unclear. We conducted the largest systematic review of the literature addressing the utility of AI in imaging for COVID-19 patient care. By keyword searches on PubMed and preprint servers throughout 2020, we identified 463 manuscripts and performed a systematic meta-analysis to assess their technical merit and clinical relevance. Our analysis evidences a significant disparity between clinical and AI communities, in the focus on both imaging modalities (AI experts neglected CT and ultrasound, favoring X-ray) and performed tasks (71.9% of AI papers centered on diagnosis). The vast majority of manuscripts were found to be deficient regarding potential use in clinical practice, but 2.7% (n = 12) publications were assigned a high maturity level and are summarized in greater detail. We provide an itemized discussion of the challenges in developing clinically relevant AI solutions with recommendations and remedies.
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Affiliation(s)
- Jannis Born
- IBM Research Europe, Zurich, Switzerland
- Department for Biosystems Science & Engineering, ETH Zurich, Zurich, Switzerland
| | | | | | - Adam Coy
- IBM Almaden Research Center, San Jose, CA, USA
- Vision Radiology, Dallas, TX, USA
| | | | | | - Prasanth Prasanna
- IBM Almaden Research Center, San Jose, CA, USA
- Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Deddeh Ballah
- IBM Almaden Research Center, San Jose, CA, USA
- Department of Radiology, Seton Medical Center, Daly City, CA, USA
| | - Michal Guindy
- Assuta Medical Centres Radiology, Tel-Aviv, Israel
- Ben-Gurion University Medical School, Be'er Sheva, Israel
| | - Dorith Shaham
- Department of Radiology, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Pallav L. Shah
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Chelsea & Westminster Hospital, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Emmanouil Karteris
- College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | - Jan L. Robertus
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Michal Rosen-Zvi
- IBM Research Haifa, Haifa, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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215
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Wang YY, Huang Q, Shen Q, Zi H, Li BH, Li MZ, He SH, Zeng XT, Yao X, Jin YH. Quality of and Recommendations for Relevant Clinical Practice Guidelines for COVID-19 Management: A Systematic Review and Critical Appraisal. Front Med (Lausanne) 2021; 8:630765. [PMID: 34222270 PMCID: PMC8248791 DOI: 10.3389/fmed.2021.630765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/26/2021] [Indexed: 01/15/2023] Open
Abstract
Background: The morbidity and mortality of coronavirus disease 2019 (COVID-19) are still increasing. This study aimed to assess the quality of relevant COVID-19 clinical practice guidelines (CPGs) and to compare the similarities and differences between recommendations. Methods: A comprehensive search was conducted using electronic databases (PubMed, Embase, and Web of Science) and representative guidelines repositories from December 1, 2019, to August 11, 2020 (updated to April 5, 2021), to obtain eligible CPGs. The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to evaluate the quality of CPGs. Four authors extracted relevant information and completed data extraction forms. All data were analyzed using R version 3.6.0 software. Results: In total, 39 CPGs were identified and the quality was not encouragingly high. The median score (interquartile range, IQR) of every domain from AGREE II for evidence-based CPGs (EB-CPGs) versus (vs.) consensus-based CPG (CB-CPGs) was 81.94% (75.00-84.72) vs. 58.33% (52.78-68.06) in scope and purpose, 59.72% (38.89-75.00) vs. 36.11% (33.33-36.11) in stakeholder involvement, 64.58% (32.29-71.88) vs. 22.92% (16.67-26.56) in rigor of development, 75.00% (52.78-86.81) vs. 52.78% (50.00-63.89) in clarity of presentation, 40.63% (22.40-62.50) vs. 20.83% (13.54-25.00) in applicability, and 58.33% (50.00-100.00) vs. 50.00% (50.00-77.08) in editorial independence, respectively. The methodological quality of EB-CPGs were significantly superior to the CB-CPGs in the majority of domains (P < 0.05). There was no agreement on diagnosis criteria of COVID-19. But a few guidelines show Remdesivir may be beneficial for the patients, hydroxychloroquine +/- azithromycin may not, and there were more consistent suggestions regarding discharge management. For instance, after discharge, isolation management and health status monitoring may be continued. Conclusions: In general, the methodological quality of EB-CPGs is greater than CB-CPGs. However, it is still required to be further improved. Besides, the consistency of COVID-19 recommendations on topics such as diagnosis criteria is different. Of them, hydroxychloroquine +/- azithromycin may be not beneficial to treat patients with COVID-19, but remdesivir may be a favorable risk-benefit in severe COVID-19 infection; isolation management and health status monitoring after discharge may be still necessary. Chemoprophylaxis, including SARS-CoV 2 vaccines and antiviral drugs of COVID-19, still require more trials to confirm this.
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Affiliation(s)
- Yun-Yun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Quan Shen
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Hao Zi
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Bing-Hui Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Ming-Zhen Li
- Precision Medicine Center, Second People's Hospital of Huaihua, Huaihua, China
| | - Shao-Hua He
- Precision Medicine Center, Second People's Hospital of Huaihua, Huaihua, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
| | - Xiaomei Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China
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216
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Letter to Editor in response to Chest CT in COVID-19 patients: Structured vs conventional reporting. Eur J Radiol 2021; 141:109814. [PMID: 34120011 PMCID: PMC8180447 DOI: 10.1016/j.ejrad.2021.109814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/05/2021] [Indexed: 12/28/2022]
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217
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Gunduz Y, Karacan A, Karabay O, Erdem AF, Kindir O, Ozturk MH. Could chest CT findings taken on admission in symptomatic patients with COVID-19 be related to the prognosis and clinical outcome of the disease? Curr Med Imaging 2021; 18:658-665. [PMID: 34082689 DOI: 10.2174/1386207324666210603154426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/29/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
AIM Initial chest CT findings of patients were compared by grouping them according to the clinical outcome of the infection and those which could predict clinical outcome, prognosis and mortality were investigated. BACKGROUND Published studies on chest CT in COVID-19 infection do not go beyond describing the characteristics of the current period. Nevertheless, comparative analysis of chest CT findings on hospital admission among patients in different clinical outcomes is scarce. OBJECTIVE 198 consecutive symptomatic patients with COVID-19 infection confirmed by positive polymerase chain reaction (PCR) and who had undergone chest CT were enrolled in this retrospective study. METHOD According to their clinical outcomes, we divided them (n:98) into 3 groups. Group 1 (n: 62) involved patients discharged from the service, group 2 (n: 60) included patients hospitalized in the intensive care unit, and group 3 (n: 76) comprised patients who died despite any treatment. RESULTS Clinical characteristics involving age, dyspnea, hypertension, and chest CT findings of mediastinal lymphadenopathy, pleural effusion, and pericardial effusion, were determined as poor prognosis and mortality predictors, and halo sign in chest CT finding was a good prognosis predictor in multivariate analysis. CONCLUSION It was seen that some CT findings were significantly correlated to the patients' endpoints, such as discharge, hospitalization in the intensive care unit, and as a worst consequence, death. These findings support the role of CT imaging for potentially predicting the clinical outcomes of these patients with COVID-19.
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Affiliation(s)
- Yasemin Gunduz
- Radiology Department, Sakarya University Medical Faculty, Sakarya, Turkey
| | - Alper Karacan
- Radiology Department, Sakarya University Medical Faculty, Sakarya, Turkey
| | - Oguz Karabay
- Infectious diseases and clinical microbiology Department, Sakarya University Medical Faculty, Sakarya, Turkey
| | - Ali Fuat Erdem
- Anesthesiology and reanimation Department, Sakarya University Medical Faculty, Sakarya, Turkey
| | - Osman Kindir
- Radiology Department, Sakarya University Medical Faculty, Sakarya, Turkey
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Gresser E, Reich J, Sabel BO, Kunz WG, Fabritius MP, Rübenthaler J, Ingrisch M, Wassilowsky D, Irlbeck M, Ricke J, Puhr-Westerheide D. Risk Stratification for ECMO Requirement in COVID-19 ICU Patients Using Quantitative Imaging Features in CT Scans on Admission. Diagnostics (Basel) 2021; 11:1029. [PMID: 34205176 PMCID: PMC8228774 DOI: 10.3390/diagnostics11061029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 01/28/2023] Open
Abstract
(1) Background: Extracorporeal membrane oxygenation (ECMO) therapy in intensive care units (ICUs) remains the last treatment option for Coronavirus disease 2019 (COVID-19) patients with severely affected lungs but is highly resource demanding. Early risk stratification for the need of ECMO therapy upon admission to the hospital using artificial intelligence (AI)-based computed tomography (CT) assessment and clinical scores is beneficial for patient assessment and resource management; (2) Methods: Retrospective single-center study with 95 confirmed COVID-19 patients admitted to the participating ICUs. Patients requiring ECMO therapy (n = 14) during ICU stay versus patients without ECMO treatment (n = 81) were evaluated for discriminative clinical prediction parameters and AI-based CT imaging features and their diagnostic potential to predict ECMO therapy. Reported patient data include clinical scores, AI-based CT findings and patient outcomes; (3) Results: Patients subsequently allocated to ECMO therapy had significantly higher sequential organ failure (SOFA) scores (p < 0.001) and significantly lower oxygenation indices on admission (p = 0.009) than patients with standard ICU therapy. The median time from hospital admission to ECMO placement was 1.4 days (IQR 0.2-4.0). The percentage of lung involvement on AI-based CT assessment on admission to the hospital was significantly higher in ECMO patients (p < 0.001). In binary logistic regression analyses for ECMO prediction including age, sex, body mass index (BMI), SOFA score on admission, lactate on admission and percentage of lung involvement on admission CTs, only SOFA score (OR 1.32, 95% CI 1.08-1.62) and lung involvement (OR 1.06, 95% CI 1.01-1.11) were significantly associated with subsequent ECMO allocation. Receiver operating characteristic (ROC) curves showed an area under the curve (AUC) of 0.83 (95% CI 0.73-0.94) for lung involvement on admission CT and 0.82 (95% CI 0.72-0.91) for SOFA scores on ICU admission. A combined parameter of SOFA on ICU admission and lung involvement on admission CT yielded an AUC of 0.91 (0.84-0.97) with a sensitivity of 0.93 and a specificity of 0.84 for ECMO prediction; (4) Conclusions: AI-based assessment of lung involvement on CT scans on admission to the hospital and SOFA scoring, especially if combined, can be used as risk stratification tools for subsequent requirement for ECMO therapy in patients with severe COVID-19 disease to improve resource management in ICU settings.
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Affiliation(s)
- Eva Gresser
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Jakob Reich
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Bastian O. Sabel
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Wolfgang G. Kunz
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Matthias P. Fabritius
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Michael Ingrisch
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Dietmar Wassilowsky
- Department of Anesthesiology, University Hospital, LMU Munich, 81377 Munich, Germany; (D.W.); (M.I.)
| | - Michael Irlbeck
- Department of Anesthesiology, University Hospital, LMU Munich, 81377 Munich, Germany; (D.W.); (M.I.)
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Daniel Puhr-Westerheide
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
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Lieveld AWE, Kok B, Azijli K, Schuit FH, van de Ven PM, de Korte CL, Nijveldt R, van den Heuvel FMA, Teunissen BP, Hoefsloot W, Nanayakkara PWB, Bosch FH. Assessing COVID-19 pneumonia-Clinical extension and risk with point-of-care ultrasound: A multicenter, prospective, observational study. J Am Coll Emerg Physicians Open 2021; 2:e12429. [PMID: 33969350 PMCID: PMC8087918 DOI: 10.1002/emp2.12429] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Assessing the extent of lung involvement is important for the triage and care of COVID-19 pneumonia. We sought to determine the utility of point-of-care ultrasound (POCUS) for characterizing lung involvement and, thereby, clinical risk determination in COVID-19 pneumonia. METHODS This multicenter, prospective, observational study included patients with COVID-19 who received 12-zone lung ultrasound and chest computed tomography (CT) scanning in the emergency department (ED). We defined lung disease severity using the lung ultrasound score (LUS) and chest CT severity score (CTSS). We assessed the association between the LUS and poor outcome (ICU admission or 30-day all-cause mortality). We also assessed the association between the LUS and hospital length of stay. We examined the ability of the LUS to differentiate between disease severity groups. Lastly, we estimated the correlation between the LUS and CTSS and the interrater agreement for the LUS. We handled missing data by multiple imputation with chained equations and predictive mean matching. RESULTS We included 114 patients treated between March 19, 2020, and May 4, 2020. An LUS ≥12 was associated with a poor outcome within 30 days (hazard ratio [HR], 5.59; 95% confidence interval [CI], 1.26-24.80; P = 0.02). Admission duration was shorter in patients with an LUS <12 (adjusted HR, 2.24; 95% CI, 1.47-3.40; P < 0.001). Mean LUS differed between disease severity groups: no admission, 6.3 (standard deviation [SD], 4.4); hospital/ward, 13.1 (SD, 6.4); and ICU, 18.0 (SD, 5.0). The LUS was able to discriminate between ED discharge and hospital admission excellently, with an area under the curve of 0.83 (95% CI, 0.75-0.91). Interrater agreement for the LUS was strong: κ = 0.88 (95% CI, 0.77-0.95). Correlation between the LUS and CTSS was strong: κ = 0.60 (95% CI, 0.48-0.71). CONCLUSIONS We showed that baseline lung ultrasound - is associated with poor outcomes, admission duration, and disease severity. The LUS also correlates well with CTSS. Point-of-care lung ultrasound may aid the risk stratification and triage of patients with COVID-19 at the ED.
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Affiliation(s)
- Arthur W. E. Lieveld
- Section General and Acute Internal MedicineDepartment of Internal MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Bram Kok
- Section Acute Internal Medicine, Department of Internal MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Kaoutar Azijli
- Section Emergency MedicineEmergency DepartmentAmsterdam Public Health Research Institute, Amsterdam University Medical CenterAmsterdamThe Netherlands
| | - Frederik H. Schuit
- Section General and Acute Internal MedicineDepartment of Internal MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Peter M. van de Ven
- Department of Epidemiology and Data ScienceAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Chris L. de Korte
- Medical UltraSound Imaging CenterDepartment of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Robin Nijveldt
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Bernd P. Teunissen
- Department of Radiology & Nuclear MedicineAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Wouter Hoefsloot
- Radboudumc Center for Infectious DiseasesDepartment of Pulmonary DiseasesRadboud University Medical CenterNijmegenThe Netherlands
| | - Prabath W. B. Nanayakkara
- Section General and Acute Internal MedicineDepartment of Internal MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Frank H. Bosch
- Section Acute Internal Medicine, Department of Internal MedicineRadboud University Medical CenterNijmegenThe Netherlands
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Shatzkes DR, Zlochower AB, Steinklein JM, Pramanik BK, Filippi CG, Azhar S, Wang JJ, Sanelli PC. Impact of SARS-CoV-2 Pandemic on "Stroke Code" Imaging Utilization and Yield. AJNR Am J Neuroradiol 2021; 42:1017-1022. [PMID: 33541898 PMCID: PMC8191682 DOI: 10.3174/ajnr.a7038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/18/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Indirect consequences of the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) pandemic include those related to failure of patients to seek or receive timely medical attention for seemingly unrelated disease. We report our experience with stroke code imaging during the early pandemic months of 2020. MATERIALS AND METHODS Retrospective review of stroke codes during the 2020 pandemic and both 2020 and matched 2019 prepandemic months was performed. Patient variables were age, sex, hospital location, and severity of symptoms based on the NIHSS. We reviewed the results of CT of the head, CTA, CTP, and MR imaging examinations and classified a case as imaging-positive if any of the imaging studies yielded a result that related to the clinical indication for the study. Both year-to-year and sequential comparisons were performed between pandemic and prepandemic months. RESULTS A statistically significant decrease was observed in monthly stroke code volumes accompanied by a statistically significant increased proportion of positive imaging findings during the pandemic compared with the same months in the prior year (P < .001) and prepandemic months in the same year (P < .001). We also observed statistically significant increases in average NIHSS scores (P = .045 and P = .03) and the proportion of inpatient stroke codes (P = .003 and P = .03). CONCLUSIONS During our pandemic period, there was a significantly decreased number of stroke codes but simultaneous increases in positivity rates, symptom severity, and inpatient codes. We postulate that this finding reflects the documented reluctance of patients to seek medical care during the pandemic, with the shift toward a greater proportion of inpatient stroke codes potentially reflecting the neurologic complications of the virus itself.
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Affiliation(s)
- D R Shatzkes
- Departments of Radiology and Otolaryngology (D.R.S.), Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Northwell Health, New York, New York
| | - A B Zlochower
- Department of Radiology (A.B.Z., J.M.S., B.K.P., C.G.F., P.C.S.), Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Northwell Health, New York, New York
| | - J M Steinklein
- Department of Radiology (A.B.Z., J.M.S., B.K.P., C.G.F., P.C.S.), Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Northwell Health, New York, New York
| | - B K Pramanik
- Department of Radiology (A.B.Z., J.M.S., B.K.P., C.G.F., P.C.S.), Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Northwell Health, New York, New York
| | - C G Filippi
- Department of Radiology (A.B.Z., J.M.S., B.K.P., C.G.F., P.C.S.), Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Northwell Health, New York, New York
| | - S Azhar
- Department of Neurology (S.A.), Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Northwell Health, New York, New York
| | - J J Wang
- Institute for Health Innovations and Outcomes Research (J.J.W.), Feinstein Institutes for Medical Research, and Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York
| | - P C Sanelli
- Department of Radiology (A.B.Z., J.M.S., B.K.P., C.G.F., P.C.S.), Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, Northwell Health, New York, New York
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Carlicchi E, Gemma P, Poerio A, Caminati A, Vanzulli A, Zompatori M. Chest-CT mimics of COVID-19 pneumonia-a review article. Emerg Radiol 2021; 28:507-518. [PMID: 33646498 PMCID: PMC7917172 DOI: 10.1007/s10140-021-01919-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/15/2021] [Indexed: 01/02/2023]
Abstract
Coronavirus disease 2019 (COVID-19) emerged in early December 2019 in China, as an acute lower respiratory tract infection and spread rapidly worldwide being declared a pandemic in March 2020. Chest-computed tomography (CT) has been utilized in different clinical settings of COVID-19 patients; however, COVID-19 imaging appearance is highly variable and nonspecific. Indeed, many pulmonary infections and non-infectious diseases can show similar CT findings and mimic COVID-19 pneumonia. In this review, we discuss clinical conditions that share a similar imaging appearance with COVID-19 pneumonia, in order to identify imaging and clinical characteristics useful in the differential diagnosis.
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Affiliation(s)
- Eleonora Carlicchi
- Post-graduate School in Radiodiagnostic, Università degli Studi di Milano, Milan, Italy.
| | - Pietro Gemma
- Post-graduate School in Radiodiagnostic, Università degli Studi di Milano, Milan, Italy
| | - Antonio Poerio
- Radiology Unit, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Antonella Caminati
- Respiratory Medicine and Semi-Intensive Therapy Unit, Respiratory Physiopathology and Pulmonary Haemodynamics Services, San Giuseppe Hospital Multimedica, Milan, Italy
| | - Angelo Vanzulli
- Radiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Oncology and Hemato-Oncology Unit, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
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Benmalek E, Elmhamdi J, Jilbab A. Comparing CT scan and chest X-ray imaging for COVID-19 diagnosis. BIOMEDICAL ENGINEERING ADVANCES 2021; 1:100003. [PMID: 34786568 PMCID: PMC7992299 DOI: 10.1016/j.bea.2021.100003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022] Open
Abstract
People suspected of having COVID-19 need to know quickly if they are infected, so they can receive appropriate treatment, self-isolate, and inform those with whom they have been in close contact. Currently, the formal diagnosis of COVID-19 requires a laboratory test (RT-PCR) on samples taken from the nose and throat. The RT-PCR test requires specialized equipment and takes at least 24 h to produce a result. Chest imaging has demonstrated its valuable role in the development of this lung disease. Fast and accurate diagnosis of COVID-19 is possible with the chest X-ray (CXR) and computed tomography (CT) scan images. Our manuscript aims to compare the performances of chest imaging techniques in the diagnosis of COVID-19 infection using different convolutional neural networks (CNN). To do so, we have tested Resnet-18, InceptionV3, and MobileNetV2, for CT scan and CXR images. We found that the ResNet-18 has the best overall precision and sensitivity of 98.5% and 98.6%, respectively, the InceptionV3 model has achieved the best overall specificity of 97.4%, and the MobileNetV2 has obtained a perfect sensitivity for COVID-19 cases. All these performances have occurred with CT scan images.
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Affiliation(s)
| | - Jamal Elmhamdi
- Laboratory LRGE, ENSET, Mohammed V University, Rabat, Morocco
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223
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Frid-Adar M, Amer R, Gozes O, Nassar J, Greenspan H. COVID-19 in CXR: From Detection and Severity Scoring to Patient Disease Monitoring. IEEE J Biomed Health Inform 2021; 25:1892-1903. [PMID: 33769939 PMCID: PMC8545163 DOI: 10.1109/jbhi.2021.3069169] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/24/2020] [Accepted: 03/18/2021] [Indexed: 11/10/2022]
Abstract
This work estimates the severity of pneumonia in COVID-19 patients and reports the findings of a longitudinal study of disease progression. It presents a deep learning model for simultaneous detection and localization of pneumonia in chest Xray (CXR) images, which is shown to generalize to COVID-19 pneumonia. The localization maps are utilized to calculate a "Pneumonia Ratio" which indicates disease severity. The assessment of disease severity serves to build a temporal disease extent profile for hospitalized patients. To validate the model's applicability to the patient monitoring task, we developed a validation strategy which involves a synthesis of Digital Reconstructed Radiographs (DRRs - synthetic Xray) from serial CT scans; we then compared the disease progression profiles that were generated from the DRRs to those that were generated from CT volumes.
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Xie Q, Lu Y, Xie X, Mei N, Xiong Y, Li X, Zhu Y, Xiao A, Yin B. The usage of deep neural network improves distinguishing COVID-19 from other suspected viral pneumonia by clinicians on chest CT: a real-world study. Eur Radiol 2021; 31:3864-3873. [PMID: 33372243 PMCID: PMC7769567 DOI: 10.1007/s00330-020-07553-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/28/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Based on the current clinical routine, we aimed to develop a novel deep learning model to distinguish coronavirus disease 2019 (COVID-19) pneumonia from other types of pneumonia and validate it with a real-world dataset (RWD). METHODS A total of 563 chest CT scans of 380 patients (227/380 were diagnosed with COVID-19 pneumonia) from 5 hospitals were collected to train our deep learning (DL) model. Lung regions were extracted by U-net, then transformed and fed to pre-trained ResNet-50-based IDANNet (Identification and Analysis of New covid-19 Net) to produce a diagnostic probability. Fivefold cross-validation was employed to validate the application of our model. Another 318 scans of 316 patients (243/316 were diagnosed with COVID-19 pneumonia) from 2 other hospitals were enrolled prospectively as the RWDs to testify our DL model's performance and compared it with that from 3 experienced radiologists. RESULTS A three-dimensional DL model was successfully established. The diagnostic threshold to differentiate COVID-19 and non-COVID-19 pneumonia was 0.685 with an AUC of 0.906 (95% CI: 0.886-0.913) in the internal validation group. In the RWD cohort, our model achieved an AUC of 0.868 (95% CI: 0.851-0.876) with the sensitivity of 0.811 and the specificity of 0.822, non-inferior to the performance of 3 experienced radiologists, suggesting promising clinical practical usage. CONCLUSIONS The established DL model was able to achieve accurate identification of COVID-19 pneumonia from other suspected ones in the real-world situation, which could become a reliable tool in clinical routine. KEY POINTS • In an internal validation set, our DL model achieved the best performance to differentiate COVID-19 from non-COVID-19 pneumonia with a sensitivity of 0.836, a specificity of 0.800, and an AUC of 0.906 (95% CI: 0.886-0.913) when the threshold was set at 0.685. • In the prospective RWD cohort, our DL diagnostic model achieved a sensitivity of 0.811, a specificity of 0.822, and AUC of 0.868 (95% CI: 0.851-0.876), non-inferior to the performance of 3 experienced radiologists. • The attention heatmaps were fully generated by the model without additional manual annotation and the attention regions were highly aligned with the ROIs acquired by human radiologists for diagnosis.
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Affiliation(s)
- Qiuchen Xie
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Yiping Lu
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Xiancheng Xie
- Shanghai Yidan Information Technology Co., Ltd; Shanghai Key Laboratory of Data Science, Shanghai Institute for Advanced Communication and Data Science, School of Computer Science, Fudan University, Shanghai, China
| | - Nan Mei
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Yun Xiong
- Shanghai Key Laboratory of Data Science, Shanghai Institute for Advanced Communication and Data Science, School of Computer Science, Fudan University, Shanghai, China
| | - Xuanxuan Li
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China
| | - Yangyong Zhu
- Shanghai Key Laboratory of Data Science, Shanghai Institute for Advanced Communication and Data Science, School of Computer Science, Fudan University, Shanghai, China
| | - Anling Xiao
- Department of Radiology, Fuyang No. 2 People's Hospital, 450 Linquan Road, Fuyang, Anhui Province, China
| | - Bo Yin
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd., Jing'an District, Shanghai, 200040, China.
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Validation of Remote Dielectric Sensing (ReDS) in Monitoring Adult Patients Affected by COVID-19 Pneumonia. Diagnostics (Basel) 2021; 11:diagnostics11061003. [PMID: 34072716 PMCID: PMC8226514 DOI: 10.3390/diagnostics11061003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022] Open
Abstract
Remote dielectric sensing (ReDS) is a non-invasive electromagnetic wave technology which provides an accurate reading of lung fluid content, and it has been reported as a valid tool in monitoring heart failure patients. Considering that morphological alterations in COVID-19 include pulmonary edema, the purpose of the present study was to evaluate the reliability of ReDS technology in assessing the excess of lung fluid status in COVID-19 pneumonia, as compared to CT scans. In this pilot single center study, confirmed COVID-19 patients were enrolled on admission to an intermediate care unit. Measurements with the ReDS system and CT scans were performed on admission and at weeks 1 and 2. Eleven patients were recruited. The average change in ReDS was −3.1 ± 1.7 after one week (p = 0.001) and −4.6 ± 2.9 after two weeks (p = 0.006). A similar trend was seen in total CT score (−3.3 ± 2.1, p = 0.001). The level of agreement between ReDS and CT changes yielded a perfect result. Statistically significant changes were observed in lactate dehydrogenase, lymphocytes, and c-reactive protein over 2 weeks. This pilot study shows that ReDS can track changes in lung involvement according to the severity of COVID-19. Further studies to detect early clinical deterioration are needed.
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226
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Borrelli M, Corcione A, Castellano F, Fiori Nastro F, Santamaria F. Coronavirus Disease 2019 in Children. Front Pediatr 2021; 9:668484. [PMID: 34123972 PMCID: PMC8193095 DOI: 10.3389/fped.2021.668484] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/28/2021] [Indexed: 01/08/2023] Open
Abstract
Since its appearance in Wuhan in mid-December 2019, acute respiratory syndrome coronavirus 2 (SARS-CoV-2) related 19 coronavirus disease (COVID-19) has spread dramatically worldwide. It soon became apparent that the incidence of pediatric COVID-19 was much lower than the adult form. Morbidity in children is characterized by a variable clinical presentation and course. Symptoms are similar to those of other acute respiratory viral infections, the upper airways being more affected than the lower airways. Thus far, over 90% of children who tested positive for the virus presented mild or moderate symptoms and signs. Most children were asymptomatic, and only a few cases were severe, unlike in the adult population. Deaths have been rare and occurred mainly in children with underlying morbidity. Factors as reduced angiotensin-converting enzyme receptor expression, increased activation of the interferon-related innate immune response, and trained immunity have been implicated in the relative resistance to COVID-19 in children, however the underlying pathogenesis and mechanism of action remain to be established. While at the pandemic outbreak, mild respiratory manifestations were the most frequently described symptoms in children, subsequent reports suggested that the clinical course of COVID-19 is more complex than initially thought. Thanks to the experience acquired in adults, the diagnosis of pediatric SARS-CoV-2 infection has improved with time. Data on the treatment of children are sparse, however, several antiviral trials are ongoing. The purpose of this narrative review is to summarize current understanding of pediatric SARS-CoV-2 infection and provide more accurate information for healthcare workers and improve the care of patients.
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Affiliation(s)
| | | | | | | | - Francesca Santamaria
- Section of Pediatrics, Pediatric Pulmonology Unit, Department of Translational Medical Sciences, Università di Napoli Federico II, Naples, Italy
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227
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Role of Chest Computed Tomography versus Real Time Reverse Transcription Polymerase Chain Reaction for Diagnosis of COVID-19: A Systematic Review and Meta-Analysis. Interdiscip Perspect Infect Dis 2021; 2021:8798575. [PMID: 34194491 PMCID: PMC8184322 DOI: 10.1155/2021/8798575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/31/2020] [Accepted: 02/01/2021] [Indexed: 01/08/2023] Open
Abstract
Background The current global pandemic of COVID-19 is considered a public health emergency. The diagnosis of COVID-19 depends on detection of the viral nucleic acid by real time reverse transcription polymerase chain reaction (RT-PCR). However, false-negative RT-PCR tests are reported and could hinder the control of the pandemic. Chest computed tomography could achieve a more reliable diagnosis and represent a complementary diagnostic tool. Aim To perform a meta-analysis and systematic review to find out the role of chest computed tomography versus RT-PCR for precise diagnosis of COVID-19 infection. Methods We searched three electronic databases (PubMed, ScienceDirect, and Scopus) from April 1 to April 20, 2020, to find out articles including the accuracy of chest computed tomography scan versus RT-PCR for diagnosis of SARS-CoV-2 infection. Observational studies, case series, and case reports were included. Results A total of 238 articles were retrieved from the search strategy. Following screening, 39 articles were chosen for full text assessment and finally 35 articles were included for qualitative and quantitative analysis. Chest computed tomography showed a wide range of sensitivity varied from 12%–100%. Conclusion Chest computed tomography is playing a key role for diagnosis and detection of COVID-19 infection. Computed tomography image findings may precede the initially positive RT-PCR assay.
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228
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Ceylan N, Çinkooğlu A, Bayraktaroğlu S, Savaş R. Atypical chest CT findings of COVID-19 pneumonia: a pictorial review. ACTA ACUST UNITED AC 2021; 27:344-349. [PMID: 33032981 DOI: 10.5152/dir.2020.20355] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Coronavirus disease 2019 (COVID-19) first emerged in China and rapidly spread in the world causing a pandemic. Chest computed tomography (CT) continues to play an important role in the diagnosis and follow-up of the disease due to shortcomings of the real-time reverse transcription-polymerase chain reaction test, which is the gold standard in the diagnosis of this disease. Typical chest CT findings of COVID-19 pneumonia have been widely reported in the literature. However, atypical findings such as central involvement, peribronchovascular involvement, isolated upper lobe involvement, nodular involvement, lobar consolidation, solitary involvement, pleural and pericardial fluid, and subpleural sparing can also be seen. Knowing these atypical findings is important to avoid misdiagnosis. This review summarizes the atypical findings that can be seen in the course of the disease and may be confused with other diseases.
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Affiliation(s)
- Naim Ceylan
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Akın Çinkooğlu
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | | | - Recep Savaş
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
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229
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Argentieri G, Bellesi L, Pagnamenta A, Vanini G, Presilla S, Del Grande F, Marando M, Gianella P. Diagnostic yield, safety, and advantages of ultra-low dose chest CT compared to chest radiography in early stage suspected SARS-CoV-2 pneumonia: A retrospective observational study. Medicine (Baltimore) 2021; 100:e26034. [PMID: 34032725 PMCID: PMC8154470 DOI: 10.1097/md.0000000000026034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT To determine the role of ultra-low dose chest computed tomography (uld CT) compared to chest radiographs in patients with laboratory-confirmed early stage SARS-CoV-2 pneumonia.Chest radiographs and uld CT of 12 consecutive suspected SARS-CoV-2 patients performed up to 48 hours from hospital admission were reviewed by 2 radiologists. Dosimetry and descriptive statistics of both modalities were analyzed.On uld CT, parenchymal abnormalities compatible with SARS-CoV-2 pneumonia were detected in 10/12 (83%) patients whereas on chest X-ray in, respectively, 8/12 (66%) and 5/12 (41%) patients for reader 1 and 2. The average increment of diagnostic performance of uld CT compared to chest X-ray was 29%. The average effective dose was, respectively, of 0.219 and 0.073 mSv.Uld CT detects substantially more lung injuries in symptomatic patients with suspected early stage SARS-CoV-2 pneumonia compared to chest radiographs, with a significantly better inter-reader agreement, at the cost of a slightly higher equivalent radiation dose.
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Affiliation(s)
| | | | | | - Gianluca Vanini
- Internal Medicine Department
- Allergology, Internal Medicine Department
| | | | | | | | - Pietro Gianella
- Internal Medicine Department
- Pneumology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland
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230
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Buckley AM, Griffith-Richards S, Davids R, Irusen EM, Nyasulu PS, Lalla U, Allwood BW, Louw EH, Nortje A, Pitcher RD, Koegelenberg CFN. Relative Sparing of the Left Upper Zone on Chest Radiography in Severe COVID-19 Pneumonia. Respiration 2021; 100:811-815. [PMID: 34044399 PMCID: PMC8247838 DOI: 10.1159/000516325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/08/2021] [Indexed: 11/19/2022] Open
Abstract
The radiological findings of COVID-19 are well-described, including its evolution. In an earlier report of admission chest radiographs of patients with COVID-19, we anecdotally noted relative sparing of the left upper zone (LUZ). We subsequently aimed to describe the main chest radiograph findings in another cohort, focusing on zonal predominance. The admission chest radiographs of 111 patients with CO-VID-19 pneumonia requiring intensive care admission were reviewed by 2 thoracic radiologists and categorized according to the predominant pattern into either ground-glass opacities (GGOs), alveolar infiltrates and/or consolidation, or reticular and/or nodular infiltrates or an equal combination of both, and the extent of disease involvement of each of the zones using a modified Radiologic Assessment of Lung Edema (RALE) score. Parenchymal changes were detected in all. In total, 106 radiographs showed GGOs, alveolar infiltrates, and/or consolidation, and 5 had a combination of reticular/nodular infiltrates as well as GGOs, alveolar infiltrates, and/or consolidation. The LUZ had a significant lower grading score than the right upper zone: 1 versus 2 (p < 0.001). Likewise, the upper zones had a significant lower score than the mid and lower zones (p < 0.001). Our findings confirmed the relative sparing of the LUZ in severe COVID-19 pneumonia.
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Affiliation(s)
- Alexandra M Buckley
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Stephanie Griffith-Richards
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Razaan Davids
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Elvis M Irusen
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Peter S Nyasulu
- Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town, South Africa
| | - Usha Lalla
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Brian W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Elizabeth H Louw
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Andre Nortje
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Richard D Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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231
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M. Bahgat W, Magdy Balaha H, AbdulAzeem Y, Badawy MM. An optimized transfer learning-based approach for automatic diagnosis of COVID-19 from chest x-ray images. PeerJ Comput Sci 2021; 7:e555. [PMID: 34141886 PMCID: PMC8176553 DOI: 10.7717/peerj-cs.555] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/29/2021] [Indexed: 05/09/2023]
Abstract
Accurate and fast detection of COVID-19 patients is crucial to control this pandemic. Due to the scarcity of COVID-19 testing kits, especially in developing countries, there is a crucial need to rely on alternative diagnosis methods. Deep learning architectures built on image modalities can speed up the COVID-19 pneumonia classification from other types of pneumonia. The transfer learning approach is better suited to automatically detect COVID-19 cases due to the limited availability of medical images. This paper introduces an Optimized Transfer Learning-based Approach for Automatic Detection of COVID-19 (OTLD-COVID-19) that applies an optimization algorithm to twelve CNN architectures to diagnose COVID-19 cases using chest x-ray images. The OTLD-COVID-19 approach adapts Manta-Ray Foraging Optimization (MRFO) algorithm to optimize the network hyperparameters' values of the CNN architectures to improve their classification performance. The proposed dataset is collected from eight different public datasets to classify 4-class cases (COVID-19, pneumonia bacterial, pneumonia viral, and normal). The experimental result showed that DenseNet121 optimized architecture achieves the best performance. The evaluation results based on Loss, Accuracy, F1-score, Precision, Recall, Specificity, AUC, Sensitivity, IoU, and Dice values reached 0.0523, 98.47%, 0.9849, 98.50%, 98.47%, 99.50%, 0.9983, 0.9847, 0.9860, and 0.9879 respectively.
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Affiliation(s)
- Waleed M. Bahgat
- Information Technology Department, Faculty of Computer and Information, Mansoura University, Mansoura, Egypt
| | - Hossam Magdy Balaha
- Computers and Systems Engineering Department, Faculty of Engineering, Mansoura University, Mansoura, Egypt
| | - Yousry AbdulAzeem
- Computer Engineering Department, Misr Higher Institute for Engineering and Technology, Mansoura, Egypt
| | - Mahmoud M. Badawy
- Computers and Systems Engineering Department, Faculty of Engineering, Mansoura University, Mansoura, Egypt
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232
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Zitek T, Fraiman JB. Ending the Pandemic: Are Rapid COVID-19 Tests a Step Forward or Back? West J Emerg Med 2021; 22:543-546. [PMID: 34125024 PMCID: PMC8202993 DOI: 10.5811/westjem.2021.2.50550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/19/2021] [Indexed: 11/11/2022] Open
Abstract
Some experts have promoted the use of rapid testing for COVID-19. However, with the current technologies available, continuing to replace laboratory-based, real-time reverse transcription polymerase chain reaction tests with rapid (point-of-care) tests may lead to an increased number of false negative tests. Moreover, the more rapid dissemination of false negative results that can occur with the use of rapid tests for COVID-19 may lead to increased spread of the novel coronavirus if patients do not understand the concept of false negative tests. One means of combatting this would be to tell patients who have a "negative" rapid COVID-19 test that their test result was "indeterminate."
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Affiliation(s)
- Tony Zitek
- Herbert Wertheim College of Medicine, Florida International University, Department of Emergency Medicine, Miami, Florida
| | - Joseph B Fraiman
- Lallie Kemp Regional Medical Center, Department of Emergency Medicine, Independence, Louisiana
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233
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Samanci C, Saylan B, Gulsen G, Akkaya Y, Yesildal M, Akkaya Isik S, Ustabasioglu FE. CT visual quantitative evaluation of hypertensive patients with coronavirus disease (COVID-19): Potential influence of angiotensin converting enzyme inhibitors / angiotensin receptor blockers on severity of lung involvement. Clin Exp Hypertens 2021; 43:341-348. [PMID: 33583283 PMCID: PMC7885720 DOI: 10.1080/10641963.2021.1883051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/31/2020] [Accepted: 01/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is not enough data on the effect of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) on lung involvement in patients with COVID-19 pneumonia and hypertension (HT). Our aim was to compare the lung involvement of the HT patients hospitalized for COVID-19 using ACEIs/ARBs with the patients taking other anti-HT medications. METHODS : Patients who have a diagnosis of HT among the patients treated for laboratory-confirmed COVID-19 between 31 March 2020 and 28 May 2020 were included in the study. One hundred and twenty-four patients were divided into two as ACEIs/ARBs group (n = 75) and non-ACEIs/ARBs group (n = 49) according to the anti-HT drug used. The chest CT involvement areas of these two groups were evaluated quantitatively by two observers including all lobes, and total severity score (TSS) was calculated. These TSS values were compared between drug groups and clinical groups. RESULTS In clinical classification; there were 4 (%3.2) asymptomatic, 5 (4.0%) mild type, 92 (74.1%) common type, 14 (11.3%) severe type, 9 (7.3%) critical type patients. ACEI/ARB group's TSS (mean±SD, 7.74 ± 3.54) was statistically higher than other anti-HT medication group (mean±SD, 4.40 ± 1.89) (p < .001). Likewise, severe-critical clinical type's TSS (mean±SD, 9.17 ± 3.44) was statistically higher than common type (mean±SD, 5.76 ± 3.07) (p < .001). Excellent agreement was established between the two blinded observers in the TSS measurements. CONCLUSIONS Quantitative evaluation of CT and TSS score can give an idea about the clinical classification of the patient. TSS is higher in ACEI/ARB group than non-ACEIs/ARBs group.
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Affiliation(s)
- Cesur Samanci
- Department of Radiology, MD Radiology Associate Professor Istanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine
| | - Bengu Saylan
- Department of Pulmonary Medicine, MD Pulmonary Medicine Specialist Haydarpaşa Sultan Abdülhamidhan Training and Research Hospital, Turkey
| | - Gokce Gulsen
- Department of Radiology, MD Radiology Specialist Haseki Training and Research Hospital, Turkey
| | - Yuksel Akkaya
- Department of Microbiology and Clinical Microbiology, MD Microbiology and Clinical Microbiology Specialist Haydarpaşa Sultan Abdülhamidhan Training and Research Hospital, Turkey
| | - Melike Yesildal
- Department of Radiology, MD Radiology Assistant, Haydarpaşa Sultan Abdülhamidhan Training and Research Hospital, Turkey
| | - Sinem Akkaya Isik
- Department of Infectious Diseases, MD Haydarpaşa Sultan Abdülhamidhan Training and Research Hospital, Turkey
| | - Fethi Emre Ustabasioglu
- Department of Radiology, MD Radiology Assistant Professor Trakya University Medical Faculty, Turkey
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234
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Finance J, Zieleskewicz L, Habert P, Jacquier A, Parola P, Boussuges A, Bregeon F, Eldin C. Low Dose Chest CT and Lung Ultrasound for the Diagnosis and Management of COVID-19. J Clin Med 2021; 10:jcm10102196. [PMID: 34069557 PMCID: PMC8160936 DOI: 10.3390/jcm10102196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has provided an opportunity to use low- and non-radiating chest imaging techniques on a large scale in the context of an infectious disease, which has never been done before. Previously, low-dose techniques were rarely used for infectious diseases, despite the recognised danger of ionising radiation. METHOD To evaluate the role of low-dose computed tomography (LDCT) and lung ultrasound (LUS) in managing COVID-19 pneumonia, we performed a review of the literature including our cases. RESULTS Chest LDCT is now performed routinely when diagnosing and assessing the severity of COVID-19, allowing patients to be rapidly triaged. The extent of lung involvement assessed by LDCT is accurate in terms of predicting poor clinical outcomes in COVID-19-infected patients. Infectious disease specialists are less familiar with LUS, but this technique is also of great interest for a rapid diagnosis of patients with COVID-19 and is effective at assessing patient prognosis. CONCLUSIONS COVID-19 is currently accelerating the transition to low-dose and "no-dose" imaging techniques to explore infectious pneumonia and their long-term consequences.
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Affiliation(s)
- Julie Finance
- IRD, APHM, MEPHI, IHU Méditerranée Infection, Aix Marseille University, 13005 Marseille, France; (J.F.); (F.B.)
- Service des Explorations Fonctionnelles Respiratoires, APHM, 13005 Marseille, France
| | - Laurent Zieleskewicz
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, APHM, Aix Marseille Université, 13005 Marseille, France;
- INRA, INSERM, Centre for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, 13005 Marseille, France;
| | - Paul Habert
- Service de Radiologie Cardio-Thoracique, Hôpital La Timone, APHM, 13005 Marseille, France; (P.H.); (A.J.)
- LIIE, Aix Marseille University, 13005 Marseille, France
| | - Alexis Jacquier
- Service de Radiologie Cardio-Thoracique, Hôpital La Timone, APHM, 13005 Marseille, France; (P.H.); (A.J.)
- CNRS, CRMBM-CEMEREM (Centre de Résonance Magnétique Biologique et Médicale—Centre d’Exploration Métaboliques par Résonance Magnétique), APHM, Aix-Marseille University, UMR 7339, 13005 Marseille, France
| | - Philippe Parola
- IRD, APHM, SSA, VITROME, Aix Marseille University, 13005 Marseille, France;
- IHU-Méditerranée Infection, Aix Marseille University, 13005 Marseille, France
| | - Alain Boussuges
- INRA, INSERM, Centre for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, 13005 Marseille, France;
| | - Fabienne Bregeon
- IRD, APHM, MEPHI, IHU Méditerranée Infection, Aix Marseille University, 13005 Marseille, France; (J.F.); (F.B.)
- Service des Explorations Fonctionnelles Respiratoires, APHM, 13005 Marseille, France
| | - Carole Eldin
- IRD, APHM, SSA, VITROME, Aix Marseille University, 13005 Marseille, France;
- IHU-Méditerranée Infection, Aix Marseille University, 13005 Marseille, France
- Correspondence:
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235
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Shamout FE, Shen Y, Wu N, Kaku A, Park J, Makino T, Jastrzębski S, Witowski J, Wang D, Zhang B, Dogra S, Cao M, Razavian N, Kudlowitz D, Azour L, Moore W, Lui YW, Aphinyanaphongs Y, Fernandez-Granda C, Geras KJ. An artificial intelligence system for predicting the deterioration of COVID-19 patients in the emergency department. NPJ Digit Med 2021; 4:80. [PMID: 33980980 PMCID: PMC8115328 DOI: 10.1038/s41746-021-00453-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/19/2021] [Indexed: 12/23/2022] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, rapid and accurate triage of patients at the emergency department is critical to inform decision-making. We propose a data-driven approach for automatic prediction of deterioration risk using a deep neural network that learns from chest X-ray images and a gradient boosting model that learns from routine clinical variables. Our AI prognosis system, trained using data from 3661 patients, achieves an area under the receiver operating characteristic curve (AUC) of 0.786 (95% CI: 0.745-0.830) when predicting deterioration within 96 hours. The deep neural network extracts informative areas of chest X-ray images to assist clinicians in interpreting the predictions and performs comparably to two radiologists in a reader study. In order to verify performance in a real clinical setting, we silently deployed a preliminary version of the deep neural network at New York University Langone Health during the first wave of the pandemic, which produced accurate predictions in real-time. In summary, our findings demonstrate the potential of the proposed system for assisting front-line physicians in the triage of COVID-19 patients.
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Affiliation(s)
| | - Yiqiu Shen
- Center for Data Science, New York University, New York, NY, USA
| | - Nan Wu
- Center for Data Science, New York University, New York, NY, USA
| | - Aakash Kaku
- Center for Data Science, New York University, New York, NY, USA
| | - Jungkyu Park
- Department of Radiology, NYU Langone Health, New York, NY, USA
- Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, New York, NY, USA
| | - Taro Makino
- Center for Data Science, New York University, New York, NY, USA
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Stanisław Jastrzębski
- Center for Data Science, New York University, New York, NY, USA
- Department of Radiology, NYU Langone Health, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, NYU Langone Health, New York, NY, USA
| | - Jan Witowski
- Department of Radiology, NYU Langone Health, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, NYU Langone Health, New York, NY, USA
| | - Duo Wang
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Ben Zhang
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Siddhant Dogra
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Meng Cao
- Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Narges Razavian
- Center for Data Science, New York University, New York, NY, USA
- Department of Radiology, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - David Kudlowitz
- Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Lea Azour
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - William Moore
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Yvonne W Lui
- Department of Radiology, NYU Langone Health, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, NYU Langone Health, New York, NY, USA
| | | | - Carlos Fernandez-Granda
- Center for Data Science, New York University, New York, NY, USA
- Department of Mathematics, Courant Institute, New York University, New York, NY, USA
| | - Krzysztof J Geras
- Center for Data Science, New York University, New York, NY, USA.
- Department of Radiology, NYU Langone Health, New York, NY, USA.
- Center for Advanced Imaging Innovation and Research, NYU Langone Health, New York, NY, USA.
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236
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Besutti G, Ottone M, Fasano T, Pattacini P, Iotti V, Spaggiari L, Bonacini R, Nitrosi A, Bonelli E, Canovi S, Colla R, Zerbini A, Massari M, Lattuada I, Ferrari AM, Giorgi Rossi P. The value of computed tomography in assessing the risk of death in COVID-19 patients presenting to the emergency room. Eur Radiol 2021; 31:9164-9175. [PMID: 33978822 PMCID: PMC8113019 DOI: 10.1007/s00330-021-07993-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 03/22/2021] [Accepted: 04/09/2021] [Indexed: 01/08/2023]
Abstract
Objective The aims of this study were to develop a multiparametric prognostic model for death in COVID-19 patients and to assess the incremental value of CT disease extension over clinical parameters. Methods Consecutive patients who presented to all five of the emergency rooms of the Reggio Emilia province between February 27 and March 23, 2020, for suspected COVID-19, underwent chest CT, and had a positive swab within 10 days were included in this retrospective study. Age, sex, comorbidities, days from symptom onset, and laboratory data were retrieved from institutional information systems. CT disease extension was visually graded as < 20%, 20–39%, 40–59%, or ≥ 60%. The association between clinical and CT variables with death was estimated with univariable and multivariable Cox proportional hazards models; model performance was assessed using k-fold cross-validation for the area under the ROC curve (cvAUC). Results Of the 866 included patients (median age 59.8, women 39.2%), 93 (10.74%) died. Clinical variables significantly associated with death in multivariable model were age, male sex, HDL cholesterol, dementia, heart failure, vascular diseases, time from symptom onset, neutrophils, LDH, and oxygen saturation level. CT disease extension was also independently associated with death (HR = 7.56, 95% CI = 3.49; 16.38 for ≥ 60% extension). cvAUCs were 0.927 (bootstrap bias-corrected 95% CI = 0.899–0.947) for the clinical model and 0.936 (bootstrap bias-corrected 95% CI = 0.912–0.953) when adding CT extension. Conclusions A prognostic model based on clinical variables is highly accurate in predicting death in COVID-19 patients. Adding CT disease extension to the model scarcely improves its accuracy. Key Points • Early identification of COVID-19 patients at higher risk of disease progression and death is crucial; the role of CT scan in defining prognosis is unclear. • A clinical model based on age, sex, comorbidities, days from symptom onset, and laboratory results was highly accurate in predicting death in COVID-19 patients presenting to the emergency room. • Disease extension assessed with CT was independently associated with death when added to the model but did not produce a valuable increase in accuracy. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07993-9.
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Affiliation(s)
- Giulia Besutti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy. .,Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Via Risorgimento 80, 42123, Reggio Emilia, Italy.
| | - Marta Ottone
- Epidemiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Tommaso Fasano
- Clinical Chemistry and Endocrinology Laboratory, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pierpaolo Pattacini
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Via Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Valentina Iotti
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Via Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Lucia Spaggiari
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Via Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Riccardo Bonacini
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Via Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Andrea Nitrosi
- Medical Physics Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Efrem Bonelli
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Via Risorgimento 80, 42123, Reggio Emilia, Italy.,Clinical Chemistry and Endocrinology Laboratory, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simone Canovi
- Clinical Chemistry and Endocrinology Laboratory, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rossana Colla
- Clinical Chemistry and Endocrinology Laboratory, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Zerbini
- Autoimmunity, Allergology and Innovative Biotechnology Laboratory, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Massari
- Infectious Diseases Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ivana Lattuada
- Emergency Department, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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237
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Abdelsalam M, Althaqafi RMM, Assiri SA, Althagafi TM, Althagafi SM, Fouda AY, Ramadan A, Rabah M, Ahmed RM, Ibrahim ZS, Nemenqani DM, Alghamdi AN, Al Aboud D, Abdel-Moneim AS, Alsulaimani AA. Clinical and Laboratory Findings of COVID-19 in High-Altitude Inhabitants of Saudi Arabia. Front Med (Lausanne) 2021; 8:670195. [PMID: 34055842 PMCID: PMC8149591 DOI: 10.3389/fmed.2021.670195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/23/2021] [Indexed: 01/08/2023] Open
Abstract
Background: SARS-CoV-2, the causative agent of COVID-19, continues to cause a worldwide pandemic, with more than 147 million being affected globally as of this writing. People's responses to COVID-19 range from asymptomatic to severe, and the disease is sometimes fatal. Its severity is affected by different factors and comorbidities of the infected patients. Living at a high altitude could be another factor that affects the severity of the disease in infected patients. Methods: In the present study, we have analyzed the clinical, laboratory, and radiological findings of COVID-19-infected patients in Taif, a high-altitude region of Saudi Arabia. In addition, we compared matched diseased subjects to those living at sea level. We hypothesized that people living in high-altitude locations are prone to develop a more severe form of COVID-19 than those living at sea level. Results: Age and a high Charlson comorbidity score were associated with increased numbers of intensive care unit (ICU) admissions and mortality among COVID-19 patients. These ICU admissions and fatalities were found mainly in patients with comorbidities. Rates of leukocytosis, neutrophilia, higher D-dimer, ferritin, and highly sensitive C-reactive protein (CRP) were significantly higher in ICU patients. CRP was the most independent of the laboratory biomarkers found to be potential predictors of death. COVID-19 patients who live at higher altitude developed a less severe form of the disease and had a lower mortality rate, in comparison to matched subjects living at sea level. Conclusion: CRP and Charlson comorbidity scores can be considered predictive of disease severity. People living at higher altitudes developed less severe forms of COVID-19 disease than those living at sea level, due to a not-yet-known mechanism.
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Affiliation(s)
- Mostafa Abdelsalam
- Alameen Hospital, Taif, Saudi Arabia.,Mansoura Nephrology and Dialysis Unit, Internal Medicine Department, College of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Sara A Assiri
- College of Medicine, Taif University, Taif, Saudi Arabia
| | | | - Saleh M Althagafi
- General Department of Medical Services, Security Forces Hospital, Mecca, Saudi Arabia
| | - Ahmed Y Fouda
- Alameen Hospital, Taif, Saudi Arabia.,Anesthesiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Ramadan
- Alameen Hospital, Taif, Saudi Arabia.,Radiology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohammed Rabah
- Alameen Hospital, Taif, Saudi Arabia.,Radiology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Reham M Ahmed
- Alameen Hospital, Taif, Saudi Arabia.,Albbassia Chest Hospital, Cairo, Egypt
| | - Zein S Ibrahim
- Department of Physiology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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238
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Sustainable Closed-Loop Mask Supply Chain Network Design Using Mathematical Modeling and a Fuzzy Multi-Objective Approach. SUSTAINABILITY 2021. [DOI: 10.3390/su13105353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The outbreak of the deadly coronavirus, which is increasing the number of victims every day, has created many changes in today’s world. The use of various masks is the most important social tool against this virus. Given the importance of rapid and quality supply of masks in the current situation, it is necessary to study supply chain in particular. In this research, the design of a closed chain supply chain network for different types of masks is assessed. The studied supply chain includes suppliers, manufacturers, distributors, and retailers in the forward flow and collection centers, separate centers, recycling centers, and disposal centers in the backward flow. In this regard, a multi-objective mathematical model with the objectives of increasing the total profit and reducing the total environmental impact, and maximizing social responsibility is presented. The optimization of this mathematical model has been done using a fuzzy optimization approach in GAMS software. The results of this study show that maximizing the total profit and minimizing the environmental effects and maximizing social responsibility are in contrast to each other. In addition, the sensitivity analysis indicated that the customers’ demand can affect all aspects of the sustainable supply chain simultaneously.
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239
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Helwan A, Ma'aitah MKS, Hamdan H, Ozsahin DU, Tuncyurek O. Radiologists versus Deep Convolutional Neural Networks: A Comparative Study for Diagnosing COVID-19. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:5527271. [PMID: 34055034 PMCID: PMC8112196 DOI: 10.1155/2021/5527271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/20/2021] [Accepted: 04/05/2021] [Indexed: 01/19/2023]
Abstract
The reverse transcriptase polymerase chain reaction (RT-PCR) is still the routinely used test for the diagnosis of SARS-CoV-2 (COVID-19). However, according to several reports, RT-PCR showed a low sensitivity and multiple tests may be required to rule out false negative results. Recently, chest computed tomography (CT) has been an efficient tool to diagnose COVID-19 as it is directly affecting the lungs. In this paper, we investigate the application of pre-trained models in diagnosing patients who are positive for COVID-19 and differentiating it from normal patients, who tested negative for coronavirus. The study aims to compare the generalization capabilities of deep learning models with two thoracic radiologists in diagnosing COVID-19 chest CT images. A dataset of 3000 images was obtained from the Near East Hospital, Cyprus, and used to train and to test the three employed pre-trained models. In a test set of 250 images used to evaluate the deep neural networks and the radiologists, it was found that deep networks (ResNet-18, ResNet-50, and DenseNet-201) can outperform the radiologists in terms of higher accuracy (97.8%), sensitivity (98.1%), specificity (97.3%), precision (98.4%), and F1-score (198.25%), in classifying COVID-19 images.
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Affiliation(s)
- Abdulkader Helwan
- Lebanese American University, School of Engineering, Department of ECE, Byblos, Lebanon
| | | | - Hani Hamdan
- Université Paris-Saclay, CentraleSupélec, CNRS, Laboratoire des Signaux et Systèmes (L2S UMR CNRS 8506), Gif-sur-Yvette, France
| | - Dilber Uzun Ozsahin
- Near East University, Nicosia/TRNC, Mersin-10, 99138, Turkey
- University of Sharjah, College of Health Science, Medical Diagnostic Imaging Department, Sharjah, UAE
| | - Ozum Tuncyurek
- Near East University, Faculty of Medicine, Department of Radiology, Nicosia/TRNC, Mersin-10, 99138, Turkey
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240
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Larici AR, Cicchetti G, Marano R, Bonomo L, Storto ML. COVID-19 pneumonia: current evidence of chest imaging features, evolution and prognosis. ACTA ACUST UNITED AC 2021; 4:229-240. [PMID: 33969266 PMCID: PMC8093598 DOI: 10.1007/s42058-021-00068-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/05/2021] [Accepted: 04/13/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 pneumonia represents a global threatening disease, especially in severe cases. Chest imaging, with X-ray and high-resolution computed tomography (HRCT), plays an important role in the initial evaluation and follow-up of patients with COVID-19 pneumonia. Chest imaging can also help in assessing disease severity and in predicting patient’s outcome, either as an independent factor or in combination with clinical and laboratory features. This review highlights the current knowledge of imaging features of COVID-19 pneumonia and their temporal evolution over time, and provides recent evidences on the role of chest imaging in the prognostic assessment of the disease.
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Affiliation(s)
- Anna Rita Larici
- Department of Radiological and Hematological Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Giuseppe Cicchetti
- Department of Radiological and Hematological Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Riccardo Marano
- Department of Radiological and Hematological Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Lorenzo Bonomo
- Department of Radiological and Hematological Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Maria Luigia Storto
- Bracco Diagnostics Inc., Global Medical and Regulatory Affairs, Monroe Twp, NJ USA
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241
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Stasiak CES, Nigri DH, Cardoso FR, de Mattos RSDAR, Gonçalves Martins PA, Carvalho ARS, Altino de Almeida S, Rodrigues RS, Rosado-de-Castro PH. Case Report: Incidental Finding of COVID-19 Infection after Positron Emission Tomography/CT Imaging in a Patient with a Diagnosis of Histoplasmosis and Recurring Fever. Am J Trop Med Hyg 2021; 104:1651-1654. [PMID: 33798100 PMCID: PMC8103480 DOI: 10.4269/ajtmh.20-0952] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/28/2021] [Indexed: 12/14/2022] Open
Abstract
This is a case report of a 37-year-old woman evaluated with 18F-fludeoxyglucose (18F-FDG) positron emission computed tomography/CT with recurrent fever after treatment with itraconazole for 6 weeks for histoplasmosis. The examination demonstrated a decrease in the dimensions of the pulmonary opacities previously identified in the left lower lobe and attributed to histoplasmosis. In addition to these pulmonary opacities, increased FDG uptake was also observed in lymph nodes present in the cervical region, mediastinum, left lung hilum, and hepatic hilum. Notably, other pulmonary opacities with ground-glass pattern that were not present in the previous computed tomography were detected in the right lower lobe, with mild 18F-FDG uptake. Nasal swab performed shortly after the examination was positive for COVID-19. In this case, the 18F-FDG positron emission computed tomography/CT study demonstrated findings consistent with active COVID-19 infection coexisting with inflammatory changes associated with histoplasmosis infection.
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Affiliation(s)
| | | | - Fabrícius Rocha Cardoso
- Department of Radiology, D’Or Institute for Research and Education, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Alysson Roncally Silva Carvalho
- Cardiovascular R&D Centre (UnIC), Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal;,Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luiz Coimbra Institute of Post-Graduation, Research in Engineering, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil;,Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sérgio Altino de Almeida
- Department of Radiology, D’Or Institute for Research and Education, Botafogo, Rio de Janeiro, Brazil
| | | | - Paulo Henrique Rosado-de-Castro
- Department of Radiology, D’Or Institute for Research and Education, Botafogo, Rio de Janeiro, Brazil;,Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;,Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil,Address correspondence to Paulo Henrique Rosado-de-Castro, D’Or Institute for Research and Education, Rua Diniz Cordeiro 30, Botafogo, 22281-100, Rio de Janeiro/RJ, Brazil. E-mail:
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242
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Capaccione KM, Yang H, West E, Patel H, Ma H, Patel S, Fruauff A, Loeb G, Maddocks A, Borowski A, Lala S, Nguyen P, Lignelli A, D'souza B, Desperito E, Ruzal-Shapiro C, Salvatore MM. Pathophysiology and Imaging Findings of COVID-19 Infection: An Organ-system Based Review. Acad Radiol 2021; 28:595-607. [PMID: 33583712 PMCID: PMC7859715 DOI: 10.1016/j.acra.2021.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND COVID-19 commonly presents with upper respiratory symptoms; however, studies have shown that SARS-CoV-2 infection affects multiple organ systems. Here, we review the pathophysiology and imaging characteristics of SARS-CoV-2 infection in organ systems throughout the body and explore commonalities. OBJECTIVE Familiarity with the underlying pathophysiology and imaging characteristics is essential for the radiologist to recognize these findings in patients with COVID-19 infection. Though pulmonary findings are the most prevalent presentation, COVID-19 may have multiple manifestations and recognition of the extrapulmonary manifestations is especially important because of the potential serious and long-term effects of COVID-19 on multiple organ systems.
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Affiliation(s)
- K M Capaccione
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032.
| | - H Yang
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - E West
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - H Patel
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - H Ma
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - S Patel
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Fruauff
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - G Loeb
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Maddocks
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Borowski
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - S Lala
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - P Nguyen
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Lignelli
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - B D'souza
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - E Desperito
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - C Ruzal-Shapiro
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - M M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
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243
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Lan L, Sun W, Xu D, Yu M, Xiao F, Hu H, Xu H, Wang X. Artificial intelligence-based approaches for COVID-19 patient management. INTELLIGENT MEDICINE 2021; 1:10-15. [PMID: 34447600 PMCID: PMC8189732 DOI: 10.1016/j.imed.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/27/2021] [Accepted: 05/21/2021] [Indexed: 01/08/2023]
Abstract
During the highly infectious pandemic of coronavirus disease 2019 (COVID-19), artificial intelligence (AI) has provided support in addressing challenges and accelerating achievements in controlling this public health crisis. It has been applied in fields varying from outbreak forecasting to patient management and drug/vaccine development. In this paper, we specifically review the current status of AI-based approaches for patient management. Limitations and challenges still exist, and further needs are highlighted.
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244
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Yim J, Lim HH, Kwon Y. COVID-19 and pulmonary fibrosis: therapeutics in clinical trials, repurposing, and potential development. Arch Pharm Res 2021; 44:499-513. [PMID: 34047940 PMCID: PMC8161353 DOI: 10.1007/s12272-021-01331-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023]
Abstract
In 2019, an unprecedented disease named coronavirus disease 2019 (COVID-19) emerged and spread across the globe. Although the rapid transmission of COVID-19 has resulted in thousands of deaths and severe lung damage, conclusive treatment is not available. However, three COVID-19 vaccines have been authorized, and two more will be approved soon, according to a World Health Organization report on December 12, 2020. Many COVID-19 patients show symptoms of acute lung injury that eventually leads to pulmonary fibrosis. Our aim in this article is to present the relationship between pulmonary fibrosis and COVID-19, with a focus on angiotensin converting enzyme-2. We also evaluate the radiological imaging methods computed tomography (CT) and chest X-ray (CXR) for visualization of patient lung condition. Moreover, we review possible therapeutics for COVID-19 using four categories: treatments related and unrelated to lung disease and treatments that have and have not entered clinical trials. Although many treatments have started clinical trials, they have some drawbacks, such as short-term and small-group testing, that need to be addressed as soon as possible.
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Affiliation(s)
- Joowon Yim
- College of Pharmacy, Ewha Womans University, 120-750, Seoul, Republic of Korea
| | - Hee Hyun Lim
- College of Pharmacy, Ewha Womans University, 120-750, Seoul, Republic of Korea
| | - Youngjoo Kwon
- College of Pharmacy, Ewha Womans University, 120-750, Seoul, Republic of Korea.
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245
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Hizal M, Aykac K, Yayla BCC, Yilmaz A, Altun D, Akkaya HE, Bayhan GI, Kurt ANC, Karakaya J, Ozsurekci Y, Ceyhan M. Diagnostic value of lung ultrasonography in children with COVID-19. Pediatr Pulmonol 2021; 56:1018-1025. [PMID: 33085218 DOI: 10.1002/ppul.25127] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/10/2020] [Accepted: 10/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) has been successfully used in the diagnosis of different pulmonary diseases. Present study design to determine the diagnostic value of LUS in the evaluation of children with novel coronavirus disease 2019 (COVID-19). METHODS AND OBJECTIVES Prospective multicenter study, 40 children with confirmed COVID-19 were included. LUS was performed to all patients at admission. The chest X-ray and computed tomography (CT) were performed according to the decision of the primary physicians. LUS results were compared with chest X-ray and CT findings and diagnostic performance was determined. RESULTS Of the 40 children median (range) was 10.5 (0.4-17.8) years. Chest X-ray and LUS were performed on all and chest CT was performed on 28 (70%) patients at the time of diagnosis. Sixteen (40%) patients had no apparent chest CT abnormalities suggestive of COVID-19, whereas 12 (30%) had abnormalities. LUS confirmed the diagnosis of pulmonary involvement in 10 of 12 patients with positive CT findings. LUS demonstrated normal lung patterns among 15 of 16 patients who had normal CT features. The sensitivity and the area under the receiver operating characteristics (ROC) curve (area under the ROC curve) identified by the chest X-ray and LUS tests were compared and statistically significantly different (McNemar's test: p = .016 and p = .001 respectively) detected. Chest X-ray displayed false-negative results for pulmonary involvement in 75% whereas for LUS it was 16.7%. CONCLUSIONS LUS might be a useful tool in the diagnostic steps of children with COVID-19. A reduction in chest CT assessments may be possible when LUS is used in the initial diagnostic steps for these children.
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Affiliation(s)
- Mina Hizal
- Department of Pediatric Pulmonology, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | | | - Burcu C C Yayla
- Department of Pediatric Infectious Disease, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Arzu Yilmaz
- Department of Pediatric, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Demet Altun
- Department of Pediatrics, Faculty of Medicine, Ufuk University, Ankara, Turkey
| | - Habip E Akkaya
- Department of Radiology, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Gulsum I Bayhan
- Department of Pediatric Infectious Disease, Yenimahalle Training and Educational Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Aysegul N C Kurt
- Department of Pediatrics, Yenimahalle Training and Educational Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Yasemin Ozsurekci
- Department of Pediatric Infectious Disease, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Ceyhan
- Department of Pediatric Infectious Disease, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Correlation between Chest X-Ray Severity in COVID-19 and Age in Mexican-Mestizo Patients: An Observational Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5571144. [PMID: 33997012 PMCID: PMC8090453 DOI: 10.1155/2021/5571144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/22/2021] [Indexed: 02/05/2023]
Abstract
Introduction Chest X-ray (CXR) is used for the initial triage of patients with suspected COVID-19. Studies of CXR scoring in the European population found a higher score in males than in females and significantly correlated with age. Because there have not been studies in the Mexican-mestizo community, we aimed to compare the differences in CXR scores between males and females and their correlation with age after controlling comorbidities like diabetes and hypertension. Materials and Methods A retrospective study of 1000 CXR of Mexican-mestizo patients with SARS-CoV-2 infection, confirmed by RT-PCR. Significant differences between age, age groups, symptoms, comorbidities, and CXR scores between males and females used the Mann-Whitney U, Chi-square tests (χ 2), and Kruskal-Wallis tests. The relationship between the total CXR score and age was measured with the Spearman rank correlation coefficient (Rs); partial correlation analysis controlled the effect of symptoms, risk factors, and comorbidities. Results The total CXR score did not show a difference between males and females grouped by age. There was a positive, low correlation between the total CXR score and age in males, Rs = 0.260, p < 0.001 (N = 616), and in females, Rs = 0.170, p = 0.001 (N = 384). Age only explained a <9% variance of CXR severity. Rs decreased its magnitude (from Rs = 0.152 to Rs = 0.046) and lost its significance (change in p value from p < 0.001 to p = 0.145) after controlling the effect of hypertension. Conclusions There is no significant difference in CXR score between males and females in the Mexican-mestizo population grouped by age. Hypertension cancels the significance of CXR severity with age pointing to its role in the pathophysiology of COVID-19. Further research using stratified groups by age and gender in other populations needs to be published.
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247
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Tello-Mijares S, Woo L. Computed Tomography Image Processing Analysis in COVID-19 Patient Follow-Up Assessment. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:8869372. [PMID: 33968356 PMCID: PMC8083830 DOI: 10.1155/2021/8869372] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/19/2021] [Accepted: 04/08/2021] [Indexed: 01/17/2023]
Abstract
The rapid worldwide spread of the COVID-19 pandemic has infected patients around the world in a short space of time. Chest computed tomography (CT) images of patients who are infected with COVID-19 can offer early diagnosis and efficient forecast monitoring at a low cost. The diagnosis of COVID-19 on CT in an automated way can speed up many tasks and the application of medical treatments. This can help complement reverse transcription-polymerase chain reaction (RT-PCR) diagnosis. The aim of this work is to develop a system that automatically identifies ground-glass opacity (GGO) and pulmonary infiltrates (PIs) on CT images from patients with COVID-19. The purpose is to assess the disease progression during the patient's follow-up assessment and evaluation. We propose an efficient methodology that incorporates oversegmentation mean shift followed by superpixel-SLIC (simple linear iterative clustering) algorithm on CT images with COVID-19 for pulmonary parenchyma segmentation. To identify the pulmonary parenchyma, we described each superpixel cluster according to its position, grey intensity, second-order texture, and spatial-context-saliency features to classify by a tree random forest (TRF). Second, by applying the watershed segmentation to the mean-shift clusters, only pulmonary parenchyma segmentation-identified zones showed GGO and PI based on the description of each watershed cluster of its position, grey intensity, gradient entropy, second-order texture, Euclidean position to the border region of the PI zone, and global saliency features, after using TRF. Our classification results for pulmonary parenchyma identification on CT images with COVID-19 had a precision of over 92% and recall of over 92% on twofold cross validation. For GGO, the PI identification showed 96% precision and 96% recall on twofold cross validation.
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Affiliation(s)
- Santiago Tello-Mijares
- Postgraduate Department, Instituto Tecnológico Superior de Lerdo, 35150 Lerdo DGO, Mexico
| | - Luisa Woo
- Medical Familiar Unit, Instituto de Seguridad y Servicios Sociales de Los Trabajadores del Estado, 27268 Torreón COAH, Mexico
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Wong A, Lin ZQ, Wang L, Chung AG, Shen B, Abbasi A, Hoshmand-Kochi M, Duong TQ. Towards computer-aided severity assessment via deep neural networks for geographic and opacity extent scoring of SARS-CoV-2 chest X-rays. Sci Rep 2021; 11:9315. [PMID: 33927239 PMCID: PMC8085167 DOI: 10.1038/s41598-021-88538-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 04/13/2021] [Indexed: 01/08/2023] Open
Abstract
A critical step in effective care and treatment planning for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause for the coronavirus disease 2019 (COVID-19) pandemic, is the assessment of the severity of disease progression. Chest x-rays (CXRs) are often used to assess SARS-CoV-2 severity, with two important assessment metrics being extent of lung involvement and degree of opacity. In this proof-of-concept study, we assess the feasibility of computer-aided scoring of CXRs of SARS-CoV-2 lung disease severity using a deep learning system. Data consisted of 396 CXRs from SARS-CoV-2 positive patient cases. Geographic extent and opacity extent were scored by two board-certified expert chest radiologists (with 20+ years of experience) and a 2nd-year radiology resident. The deep neural networks used in this study, which we name COVID-Net S, are based on a COVID-Net network architecture. 100 versions of the network were independently learned (50 to perform geographic extent scoring and 50 to perform opacity extent scoring) using random subsets of CXRs from the study, and we evaluated the networks using stratified Monte Carlo cross-validation experiments. The COVID-Net S deep neural networks yielded R[Formula: see text] of [Formula: see text] and [Formula: see text] between predicted scores and radiologist scores for geographic extent and opacity extent, respectively, in stratified Monte Carlo cross-validation experiments. The best performing COVID-Net S networks achieved R[Formula: see text] of 0.739 and 0.741 between predicted scores and radiologist scores for geographic extent and opacity extent, respectively. The results are promising and suggest that the use of deep neural networks on CXRs could be an effective tool for computer-aided assessment of SARS-CoV-2 lung disease severity, although additional studies are needed before adoption for routine clinical use.
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Affiliation(s)
- A Wong
- Systems Design Engineering, University of Waterloo, Waterloo, Canada.
- DarwinAI Corp., Waterloo, Canada.
| | - Z Q Lin
- Systems Design Engineering, University of Waterloo, Waterloo, Canada.
- DarwinAI Corp., Waterloo, Canada.
| | - L Wang
- Systems Design Engineering, University of Waterloo, Waterloo, Canada
- DarwinAI Corp., Waterloo, Canada
| | | | - B Shen
- Department of Radiology, Stony Brook School of Medicine, Stony Brook, NY, USA
| | - A Abbasi
- Department of Radiology, Stony Brook School of Medicine, Stony Brook, NY, USA
| | - M Hoshmand-Kochi
- Department of Radiology, Stony Brook School of Medicine, Stony Brook, NY, USA
| | - T Q Duong
- Department of Radiology, Stony Brook School of Medicine, Stony Brook, NY, USA
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Kumar H, Fernandez CJ, Kolpattil S, Munavvar M, Pappachan JM. Discrepancies in the clinical and radiological profiles of COVID-19: A case-based discussion and review of literature. World J Radiol 2021; 13:75-93. [PMID: 33968311 PMCID: PMC8069347 DOI: 10.4329/wjr.v13.i4.75] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
The current gold standard for the diagnosis of coronavirus disease-19 (COVID-19) is a positive reverse transcriptase polymerase chain reaction (RT-PCR) test, on the background of clinical suspicion. However, RT-PCR has its limitations; this includes issues of low sensitivity, sampling errors and appropriate timing of specimen collection. As pulmonary involvement is the most common manifestation of severe COVID-19, early and appropriate lung imaging is important to aid diagnosis. However, gross discrepancies can occur between the clinical and imaging findings in patients with COVID-19, which can mislead clinicians in their decision making. Although chest X-ray (CXR) has a low sensitivity for the diagnosis of COVID-19 associated lung disease, especially in the earlier stages, a positive CXR increases the pre-test probability of COVID-19. CXR scoring systems have shown to be useful, such as the COVID-19 opacification rating score which helps to predict the need of tracheal intubation. Furthermore, artificial intelligence-based algorithms have also shown promise in differentiating COVID-19 pneumonia on CXR from other lung diseases. Although costlier than CXR, unenhanced computed tomographic (CT) chest scans have a higher sensitivity, but lesser specificity compared to RT-PCR for the diagnosis of COVID-19 pneumonia. A semi-quantitative CT scoring system has been shown to predict short-term mortality. The routine use of CT pulmonary angiography as a first-line imaging modality in patients with suspected COVID-19 is not justifiable due to the risk of contrast nephropathy. Scoring systems similar to those pioneered in CXR and CT can be used to effectively plan and manage hospital resources such as ventilators. Lung ultrasound is useful in the assessment of critically ill COVID-19 patients in the hands of an experienced operator. Moreover, it is a convenient tool to monitor disease progression, as it is cheap, non-invasive, easily accessible and easy to sterilise. Newer lung imaging modalities such as magnetic resonance imaging (MRI) for safe imaging among children, adolescents and pregnant women are rapidly evolving. Imaging modalities are also essential for evaluating the extra-pulmonary manifestations of COVID-19: these include cranial imaging with CT or MRI; cardiac imaging with ultrasonography (US), CT and MRI; and abdominal imaging with US or CT. This review critically analyses the utility of each imaging modality to empower clinicians to use them appropriately in the management of patients with COVID-19 infection.
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Affiliation(s)
- Hemant Kumar
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, United Kingdom
| | | | - Sangeetha Kolpattil
- Department of Radiology, University Hospitals of Morecambe Bay NHS Trust, Lancaster LA1 4RP, United Kingdom
| | - Mohamed Munavvar
- Department of Pulmonology & Chest Diseases, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
| | - Joseph M Pappachan
- Department of Medicine & Endocrinology, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, United Kingdom
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Jalaber C, Chassagnon G, Hani C, Dangeard S, Babin M, Launay O, Revel MP. Is COVID-19 pneumonia differentiable from other viral pneumonia on CT scan? Respir Med Res 2021; 79:100824. [PMID: 33971431 PMCID: PMC8078041 DOI: 10.1016/j.resmer.2021.100824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/20/2021] [Indexed: 01/08/2023]
Affiliation(s)
- C Jalaber
- Department of radiology, University Hospital of Saint-Etienne, University Jean Monnet, Avenue Albert Raimond, 42270 Saint Priest en Jarez, France.
| | - G Chassagnon
- Department of radiology, Cochin Hospital, AP-HP, University Paris 5 Descartes, Rue de l'école de médecine, 75006 Paris, France
| | - C Hani
- Department of radiology, Cochin Hospital, AP-HP, University Paris 5 Descartes, Rue de l'école de médecine, 75006 Paris, France
| | - S Dangeard
- Department of radiology, Cochin Hospital, AP-HP, University Paris 5 Descartes, Rue de l'école de médecine, 75006 Paris, France
| | - M Babin
- Department of radiology, Cochin Hospital, AP-HP, University Paris 5 Descartes, Rue de l'école de médecine, 75006 Paris, France
| | - O Launay
- Department of Infectious Diseases, Cochin Hospital, AP-HP, University Paris 5 Descartes, Rue de l'école de médecine, 75006 Paris, France
| | - M-P Revel
- Department of radiology, Cochin Hospital, AP-HP, University Paris 5 Descartes, Rue de l'école de médecine, 75006 Paris, France
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