1
|
Christensen J, Prosper AE, Wu CC, Chung J, Lee E, Elicker B, Hunsaker AR, Petranovic M, Sandler KL, Stiles B, Mazzone P, Yankelevitz D, Aberle D, Chiles C, Kazerooni E. ACR Lung-RADS v2022: Assessment Categories and Management Recommendations. J Am Coll Radiol 2024; 21:473-488. [PMID: 37820837 DOI: 10.1016/j.jacr.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/08/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
The ACR created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Lung-RADS was updated to version 1.1 in 2019 and revised size thresholds for nonsolid nodules, added classification criteria for perifissural nodules, and allowed for short-interval follow-up of rapidly enlarging nodules that may be infectious in etiology. Lung-RADS v2022, released in November 2022, provides several updates including guidance on the classification and management of atypical pulmonary cysts, juxtapleural nodules, airway-centered nodules, and potentially infectious findings. This new release also provides clarification for determining nodule growth and introduces stepped management for nodules that are stable or decreasing in size. This article summarizes the current evidence and expert consensus supporting Lung-RADS v2022.
Collapse
Affiliation(s)
- Jared Christensen
- Vice Chair and Professor of Radiology, Department of Radiology, Duke University, Durham, North Carolina; Chair, ACR Lung-RADS Committee.
| | - Ashley Elizabeth Prosper
- Assistant Professor and Section Chief of Cardiothoracic Imaging, Department of Radiological Sciences, University of California, Los Angeles, California
| | - Carol C Wu
- Professor of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan Chung
- Professor of Radiology Vice Chair of Quality Section Chief of Cardiopulmonary Imaging, University of Chicago, Chicago, Illinois
| | - Elizabeth Lee
- Clinical Associate Professor, Radiology, Michigan Medicine, Ann Arbor, Michigan
| | - Brett Elicker
- Chief of the Cardiac & Pulmonary Imaging Section, University of California, San Francisco, California
| | - Andetta R Hunsaker
- Brigham and Women's Hospital, Boston, Massachusetts; Associate Professor Harvard Medical School Chief Division of Thoracic Imaging
| | - Milena Petranovic
- Instructor, Radiology, Harvard Medical School Divisional Quality Director, Thoracic Imaging and Intervention, Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kim L Sandler
- Associate Professor, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brendon Stiles
- Professor and Chair, Thoracic Surgery and Surgical Oncology, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Denise Aberle
- Professor of Radiology, Department of Radiological Sciences; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Caroline Chiles
- Professor of Radiology Director, Lung Screening Program, Atrium Health Wake Forest, Winston-Salem, North Carolina
| | - Ella Kazerooni
- Professor of Radiology & Internal Medicine and Associate Chief Clinical Officer for Diagnostics, Michigan Medicine/University of Michigan Medical School, Ann Arbor, Michigan; Clinical Information Management, University of Michigan Medical Group
| |
Collapse
|
2
|
Christensen J, Prosper AE, Wu CC, Chung J, Lee E, Elicker B, Hunsaker AR, Petranovic M, Sandler KL, Stiles B, Mazzone P, Yankelevitz D, Aberle D, Chiles C, Kazerooni E. ACR Lung-RADS v2022: Assessment Categories and Management Recommendations. Chest 2024; 165:738-753. [PMID: 38300206 DOI: 10.1016/j.chest.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
The American College of Radiology created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Lung-RADS was updated to version 1.1 in 2019 and revised size thresholds for nonsolid nodules, added classification criteria for perifissural nodules, and allowed for short-interval follow-up of rapidly enlarging nodules that may be infectious in etiology. Lung-RADS v2022, released in November 2022, provides several updates including guidance on the classification and management of atypical pulmonary cysts, juxtapleural nodules, airway-centered nodules, and potentially infectious findings. This new release also provides clarification for determining nodule growth and introduces stepped management for nodules that are stable or decreasing in size. This article summarizes the current evidence and expert consensus supporting Lung-RADS v2022.
Collapse
Affiliation(s)
- Jared Christensen
- Vice Chair and Professor of Radiology, Department of Radiology, Duke University, Durham, North Carolina; Chair, ACR Lung-RADS Committee.
| | - Ashley Elizabeth Prosper
- Assistant Professor and Section Chief of Cardiothoracic Imaging, Department of Radiological Sciences, University of California, Los Angeles, California
| | - Carol C Wu
- Professor of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan Chung
- Professor of Radiology Vice Chair of Quality Section Chief of Cardiopulmonary Imaging, University of Chicago, Chicago, Illinois
| | - Elizabeth Lee
- Clinical Associate Professor, Radiology, Michigan Medicine, Ann Arbor, Michigan
| | - Brett Elicker
- Chief of the Cardiac & Pulmonary Imaging Section, University of California, San Francisco, California
| | - Andetta R Hunsaker
- Brigham and Women's Hospital, Boston, Massachusetts; Associate Professor Harvard Medical School Chief Division of Thoracic Imaging
| | - Milena Petranovic
- Instructor, Radiology, Harvard Medical School Divisional Quality Director, Thoracic Imaging and Intervention, Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kim L Sandler
- Associate Professor, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brendon Stiles
- Professor and Chair, Thoracic Surgery and Surgical Oncology, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Denise Aberle
- Professor of Radiology, Department of Radiological Sciences; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Caroline Chiles
- Professor of Radiology Director, Lung Screening Program, Atrium Health Wake Forest, Winston-Salem, North Carolina
| | - Ella Kazerooni
- Professor of Radiology & Internal Medicine and Associate Chief Clinical Officer for Diagnostics, Michigan Medicine/University of Michigan Medical School, Ann Arbor, Michigan; Clinical Information Management, University of Michigan Medical Group
| |
Collapse
|
3
|
Hunsaker AR. Editorial Comment: Pulmonary Arterial Thrombosis Due to Embolic Events-or In Situ Thrombosis? AJR Am J Roentgenol 2023:12. [PMID: 37162164 DOI: 10.2214/ajr.23.29291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
|
4
|
Hammer MM, Hunsaker AR. Strategies for Reducing False-Positive Screening Results for Intermediate-Size Nodules Evaluated Using Lung-RADS: A Secondary Analysis of National Lung Screening Trial Data. AJR Am J Roentgenol 2022; 219:397-405. [PMID: 35319912 PMCID: PMC9398972 DOI: 10.2214/ajr.22.27595] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND. Lung-RADS version 1.1 (v1.1) classifies all solid nodules less than 6 mm as category 2. Lung-RADS v1.1 also classifies solid intermediate-size (6 to < 10 mm) nodules as category 2 if they are perifissural and have a triangular, polygonal, or ovoid shape (indicative of intrapulmonary lymph nodes). Additional category 2 criteria could reduce false-positive results of screening examinations. OBJECTIVE. The purpose of this study was to evaluate the impact of proposed strategies for reducing false-positive results for intermediate-size nodules on lung cancer screening CT evaluated using Lung-RADS v1.1. METHODS. This retrospective study entailed secondary analysis of National Lung Screening Trial (NLST) data. Of 1387 solid nodules measuring 6.0-9.5 mm on baseline screening CT examinations in the NLST, all 38 nodules in patients who developed cancer and a random sample of 200 nodules in patients who did not develop cancer were selected for further evaluation. Cancers were required to correspond with the baseline nodule on manual review. After exclusions, the sample included 223 patients (median age, 62 years; 143 men, 80 women; 196 benign nodules, 27 malignant nodules). Two thoracic radiologists independently reviewed baseline examinations to record nodule diameter and volume using semiautomated software and to determine whether nodules had perifissural location; other subpleural location; and triangular, polygonal, or ovoid shape. Different schemes for category 2 assignment were compared. RESULTS. Across readers, standard Lung-RADS v1.1 had sensitivity of 89-93% and specificity of 26-31%. A modification assigning nodules less than 10 mm with triangular, polygonal, or ovoid shape in other subpleural locations (vs only perifissural location) as category 2 had sensitivity of 85-93% and specificity of 47-51%. Lung-RADS v1.1 using volume cutoffs had sensitivity of 89-93% and specificity of 37% (both readers). The sensitivity of both modified Lung-RADS v1.1 and Lung-RADS v1.1 with volume cutoffs was not significantly different from standard Lung-RADS v1.1 (all p > .05). However, both schemes' specificity was significantly better than standard Lung-RADS v1.1 (all p < .05). Combining the two strategies yielded sensitivity of 85-93% and specificity of 58-59%. CONCLUSION. Classifying intermediate-size nodules with triangular, polygonal, or ovoid shape in any subpleural (not just perifissural) location as category 2 and using volume- rather than diameter-based measurements improves Lung-RADS specificity without decreased sensitivity. CLINICAL IMPACT. The findings can help reduce false-positive results, decreasing 6-month follow-up examinations for benign findings.
Collapse
Affiliation(s)
- Mark M Hammer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Andetta R Hunsaker
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| |
Collapse
|
5
|
Hunsaker AR. Emphysema as a Predictor of Lung Cancer: Implications for Lung Cancer Screening. Radiology 2022; 304:331-332. [PMID: 35503019 DOI: 10.1148/radiol.220697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andetta R Hunsaker
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| |
Collapse
|
6
|
Hunsaker AR. Deep Learning and Risk Assessment in Acute Pulmonary Embolism. Radiology 2021; 302:185-186. [PMID: 34581632 DOI: 10.1148/radiol.2021211897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andetta R Hunsaker
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| |
Collapse
|
7
|
Minhas J, Nardelli P, Hassan SM, Al-Naamani N, Harder E, Ash S, Sánchez-Ferrero GV, Mason S, Hunsaker AR, Piazza G, Goldhaber SZ, Waxman AB, Kawut SM, Estépar RSJ, Washko GR, Rahaghi FN. Loss of Pulmonary Vascular Volume as a Predictor of Right Ventricular Dysfunction and Mortality in Acute Pulmonary Embolism. Circ Cardiovasc Imaging 2021; 14:e012347. [PMID: 34544259 DOI: 10.1161/circimaging.120.012347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In acute pulmonary embolism, chest computed tomography angiography derived metrics, such as the right ventricle (RV): left ventricle ratio are routinely used for risk stratification. Paucity of intraparenchymal blood vessels has previously been described, but their association with clinical biomarkers and outcomes has not been studied. We sought to determine if small vascular volumes measured on computed tomography scans were associated with an abnormal RV on echocardiography and mortality. We hypothesized that decreased small venous volume would be associated with greater RV dysfunction and increased mortality. METHODS A retrospective cohort of patients with intermediate risk pulmonary embolism admitted to Brigham and Women's Hospital between 2009 and 2017 was assembled, and clinical and radiographic data were obtained. We performed 3-dimensional reconstructions of vasculature to assess intraparenchymal vascular volumes. Statistical analyses were performed using multivariable regression and cox proportional hazards models, adjusting for age, sex, lung volume, and small arterial volume. RESULTS Seven hundred twenty-two subjects were identified of whom 573 had documented echocardiography. A 50% reduction in small venous volume was associated with an increased risk of RV dilation (relative risk: 1.38 [95% CI, 1.18-1.63], P<0.001), RV dysfunction (relative risk: 1.62 [95% CI, 1.36-1.95], P<0.001), and RV strain (relative risk: 1.67 [95% CI, 1.37-2.04], P<0.001); increased cardiac biomarkers, and higher 30-day and 90-day mortality (hazard ratio: 2.50 [95% CI, 1.33-4.67], P=0.004 and hazard ratio: 1.84 [95% CI, 1.11-3.04], P=0.019, respectively). CONCLUSIONS Loss of small venous volume quantified from computed tomography angiography is associated with increased risk of abnormal RV on echocardiography, abnormal cardiac biomarkers, and higher risk of 30- and 90-day mortality. Small venous volume may be a useful marker for assessing disease severity in acute pulmonary embolism.
Collapse
Affiliation(s)
- Jasleen Minhas
- Division of Pulmonary, Allergy and Critical Care (J.M., N.A.-N., S.M.K.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Pietro Nardelli
- Department of Radiology (P.N., G.V.S.-F., A.R.H., R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Syed Moin Hassan
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Nadine Al-Naamani
- Division of Pulmonary, Allergy and Critical Care (J.M., N.A.-N., S.M.K.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Eileen Harder
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Samuel Ash
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Gonzalo Vegas Sánchez-Ferrero
- Department of Radiology (P.N., G.V.S.-F., A.R.H., R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Stefanie Mason
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Andetta R Hunsaker
- Department of Radiology (P.N., G.V.S.-F., A.R.H., R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Gregory Piazza
- Division of Cardiovascular Medicine (G.P., S.Z.G.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Samuel Z Goldhaber
- Division of Cardiovascular Medicine (G.P., S.Z.G.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Aaron B Waxman
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Steven M Kawut
- Division of Pulmonary, Allergy and Critical Care (J.M., N.A.-N., S.M.K.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Raúl San José Estépar
- Department of Radiology (P.N., G.V.S.-F., A.R.H., R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - George R Washko
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Farbod N Rahaghi
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
| |
Collapse
|
8
|
Rahaghi FN, Nardelli P, Harder E, Singh I, Sanchez-Ferrero GV, Ross JC, San José Estépar R, Ash SY, Hunsaker AR, Maron BA, Leopold JA, Waxman AB, San José Estépar R, Washko GR. Quantification of Arterial and Venous Morphological Markers in Pulmonary Arterial Hypertension Using Computed Tomography. Chest 2021; 160:2220-2231. [PMID: 34270966 PMCID: PMC8692106 DOI: 10.1016/j.chest.2021.06.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/25/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Pulmonary hypertension is a heterogeneous disease, and a significant portion of patients at risk for it have CT imaging available. Advanced automated processing techniques could be leveraged for early detection, screening, and development of quantitative phenotypes. Pruning and vascular tortuosity have been previously described in pulmonary arterial hypertension (PAH), but the extent of these phenomena in arterial vs venous pulmonary vasculature and in exercise pulmonary hypertension (ePH) have not been described. Research Question What are the arterial and venous manifestations of pruning and vascular tortuosity using CT imaging in PAH, and do they also occur in ePH? Study Design and Methods A cohort of patients with PAH and ePH and control subjects with available CT angiograms were retrospectively identified to examine the differential arterial and venous presence of pruning and tortuosity in patients with precapillary pulmonary hypertension not confounded by lung or thromboembolic disease. The pulmonary vasculature was reconstructed, and an artificial intelligence method was used to separate arteries and veins and to compute arterial and venous vascular volumes and tortuosity. Results A total of 42 patients with PAH, 12 patients with ePH, and 37 control subjects were identified. There was relatively lower (median [interquartile range]) arterial small vessel volume in subjects with PAH (PAH 14.7 [11.7-16.5; P < .0001]) vs control subjects (16.9 [15.6-19.2]) and venous small vessel volume in subjects with PAH and ePH (PAH 8.0 [6.5-9.6; P < .0001]; ePH, 7.8 [7.5-11.4; P = .004]) vs control subjects (11.5 [10.6-12.2]). Higher large arterial volume, however, was only observed in the pulmonary arteries (PAH 17.1 [13.6-23.4; P < .0001] vs control subjects 11.4 [8.1-15.4]). Similarly, tortuosity was higher in the pulmonary arteries in the PAH group (PAH 3.5 [3.3-3.6; P = .0002] vs control 3.2 [3.2-3.3]). Interpretation Lower small distal pulmonary vascular volume, higher proximal arterial volume, and higher arterial tortuosity were observed in PAH. These can be quantified by using automated techniques from clinically acquired CT scans of patients with ePH and resting PAH.
Collapse
Affiliation(s)
- Farbod N Rahaghi
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US.
| | - Pietro Nardelli
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Eileen Harder
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Inderjit Singh
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | | | - James C Ross
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Rubén San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Samuel Y Ash
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Andetta R Hunsaker
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Bradley A Maron
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Aaron B Waxman
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Raúl San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - George R Washko
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| |
Collapse
|
9
|
Hammer MM, Hunsaker AR, Gooptu M, Hatabu H. Frequency of Pulmonary Embolism in Patients With COVID-19. JACC Cardiovasc Imaging 2020; 13:2478-2479. [PMID: 33153537 PMCID: PMC7532758 DOI: 10.1016/j.jcmg.2020.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 01/23/2023]
|
10
|
Stephanie S, Shum T, Cleveland H, Challa SR, Herring A, Jacobson FL, Hatabu H, Byrne SC, Shashi K, Araki T, Hernandez JA, White CS, Hossain R, Hunsaker AR, Hammer MM. Determinants of Chest X-Ray Sensitivity for COVID- 19: A Multi-Institutional Study in the United States. Radiol Cardiothorac Imaging 2020; 2:e200337. [PMID: 33778628 PMCID: PMC7605075 DOI: 10.1148/ryct.2020200337] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose To evaluate the sensitivity, specificity, and severity of chest x-rays (CXR) and chest CTs over time in confirmed COVID-19+ and COVID-19- patients and to evaluate determinants of false negatives. Methods In a retrospective multi-institutional study, 254 RT-PCR verified COVID-19+ patients with at least one CXR or chest CT were compared with 254 age- and gender-matched COVID-19- controls. CXR severity, sensitivity, and specificity were determined with respect to time after onset of symptoms; sensitivity and specificity for chest CTs without time stratification. Performance of serial CXRs against CTs was determined by comparing area under the receiver operating characteristic curves (AUC). A multivariable logistic regression analysis was performed to assess factors related to false negative CXR. Results COVID-19+ CXR severity and sensitivity increased with time (from sensitivity of 55% at ≤2 days to 79% at >11 days; p<0.001 for trends of both severity and sensitivity) whereas CXR specificity decreased over time (from 83% to 70%, p=0.02). Serial CXR demonstrated increase in AUC (first CXR AUC=0.79, second CXR=0.87, p=0.02), and second CXR approached the accuracy of CT (AUC=0.92, p=0.11). COVID-19 sensitivity of first CXR, second CXR, and CT was 73%, 83%, and 88%, whereas specificity was 80%, 73%, and 77%, respectively. Normal and mild severity CXR findings were the largest factor behind false-negative CXRs (40% normal and 87% combined normal/mild). Young age and African-American ethnicity increased false negative rates. Conclusion CXR sensitivity in COVID-19 detection increases with time, and serial CXRs of COVID-19+ patients has accuracy approaching that of chest CT.
Collapse
Affiliation(s)
- Stephanie Stephanie
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Thomas Shum
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Heather Cleveland
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Suryanarayana R Challa
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Allison Herring
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Francine L Jacobson
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Hiroto Hatabu
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Suzanne C Byrne
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Kumar Shashi
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Tetsuro Araki
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Jose A Hernandez
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Charles S White
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Rydhwana Hossain
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Andetta R Hunsaker
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| | - Mark M Hammer
- Department of Internal Medicine, University of Maryland School of Medicine, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201 (S.S., T.S., S.R.C.); Department of Physician Assistant Studies, Massachusetts General Hospital Institute of Health Professions, 55 Fruit St, Boston, MA 02114 (H.C.); Department of Radiology, University of Maryland School of Medicine, Downtown Campus, 22 S Greene St, Baltimore, MD 21201 (A.H., C.S.W., R.H.); Department of Pediatric Radiology, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030 (J.A.H.); and Department of Radiology, The Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 (F.L.J., H.H., S.C.B., K.S., T.A., A.R.H., M.M.H.)
| |
Collapse
|
11
|
Hammer MM, Zhao AH, Hunsaker AR, Mendicuti AD, Sodickson AD, Boland GW, Khorasani R. Radiologist Reporting and Operational Management for Patients With Suspected COVID-19. J Am Coll Radiol 2020; 17:1056-1060. [PMID: 32590015 PMCID: PMC7287462 DOI: 10.1016/j.jacr.2020.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to evaluate the adoption and outcomes of locally designed reporting guidelines for patients with possible coronavirus disease 2019 (COVID-19). METHODS A departmental guideline was developed for radiologists that specified reporting terminology and required communication for patients with imaging findings suggestive of COVID-19, on the basis of patient test status and imaging indication. In this retrospective study, radiology reports completed from March 1, 2020, to May 3, 2020, that mentioned COVID-19 were reviewed. Reports were divided into patients with known COVID-19, patients with "suspected" COVID-19 (having an order indication of respiratory or infectious signs or symptoms), and "unsuspected patients" (other order indications, eg, trauma or non-chest pain). The primary outcome was the percentage of COVID-19 reports using recommended terminology; the secondary outcome was percentages of suspected and unsuspected patients diagnosed with COVID-19. Relationships between categorical variables were assessed using the Fisher exact test. RESULTS Among 77,400 total reports, 1,083 suggested COVID-19 on the basis of imaging findings; 774 of COVID-19 reports (71%) used recommended terminology. Of 574 patients without known COVID-19 at the time of interpretation, 345 (60%) were eventually diagnosed with COVID-19, including 61% (315 of 516) of suspected and 52% (30 of 58) of unsuspected patients. Nearly all unsuspected patients (46 of 58) were identified on CT. CONCLUSIONS Radiologists rapidly adopted recommended reporting terminology for patients with suspected COVID-19. The majority of patients for whom radiologists raised concern for COVID-19 were subsequently diagnosed with the disease, including the majority of clinically unsuspected patients. Using unambiguous terminology and timely notification about previously unsuspected patients will become increasingly critical to facilitate COVID-19 testing and contact tracing as states begin to lift restrictions.
Collapse
Affiliation(s)
- Mark M Hammer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Anna H Zhao
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andetta R Hunsaker
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alejandra Duran Mendicuti
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aaron D Sodickson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Giles W Boland
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Chair, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Vice Chair for Quality and Safety, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
12
|
Hammer MM, Palazzo LL, Kong CY, Hunsaker AR. Cancer Risk in Subsolid Nodules in the National Lung Screening Trial. Radiology 2019; 293:441-448. [PMID: 31526256 PMCID: PMC6823608 DOI: 10.1148/radiol.2019190905] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/20/2019] [Accepted: 07/30/2019] [Indexed: 01/03/2023]
Abstract
Background Subsolid pulmonary nodules, comprising pure ground-glass nodules (GGNs) and part-solid nodules (PSNs), have a high risk of indolent malignancy. Lung Imaging Reporting and Data System (Lung-RADS) nodule management guidelines are based on expert opinion and lack independent validation. Purpose To evaluate Lung-RADS estimates of the malignancy rates of subsolid nodules, using nodules from the National Lung Screening Trial (NLST), and to compare Lung-RADS to the NELSON trial classification as well as the Brock University calculator. Materials and Methods Subsets of GGNs and PSNs were selected from the NLST for this retrospective study. A thoracic radiologist reviewed the baseline and follow-up CT images, confirmed that they were true subsolid nodules, and measured the nodules. The primary outcome for each nodule was the development of malignancy within the follow-up period (median, 6.5 years). Nodules were stratified according to Lung-RADS, NELSON trial criteria, and the Brock model. For analyses, nodule subsets were weighted on the basis of frequency in the NLST data set. Nodule stratification models were tested by using receiver operating characteristic curves. Results A total of 622 nodules were evaluated, of which 434 nodules were subsolid. At baseline, 304 nodules were classified as Lung-RADS category 2, with a malignancy rate of 3%, which is greater than the 1% in Lung-RADS (P = .004). The malignancy rate for GGNs smaller than 10 mm (two of 129, 1.3%) was smaller than that for GGNs measuring 10-19 mm (11 of 153, 6%) (P = .01). The malignancy rate for Lung-RADS category 3 was 14% (13 of 67), which is greater than the reported 2% in Lung-RADS (P < .001). The Brock model predicted malignancy better than Lung-RADS and the NELSON trial scheme (area under the receiver operating characteristic curve = 0.78, 0.70, and 0.67, respectively; P = .02 for Brock model vs NELSON trial scheme). Conclusion Subsolid nodules classified as Lung Imaging Reporting and Data System (Lung-RADS) categories 2 and 3 have a higher risk of malignancy than reported. The Brock risk calculator performed better than measurement-based classification schemes such as Lung-RADS. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Kauczor and von Stackelberg in this issue.
Collapse
Affiliation(s)
- Mark M. Hammer
- From the Department of Radiology, Brigham and Women’s
Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.,
A.R.H.); and Institute for Technology Assessment, Massachusetts General
Hospital, Boston, Mass (L.L.P., C.Y.K.)
| | - Lauren L. Palazzo
- From the Department of Radiology, Brigham and Women’s
Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.,
A.R.H.); and Institute for Technology Assessment, Massachusetts General
Hospital, Boston, Mass (L.L.P., C.Y.K.)
| | - Chung Yin Kong
- From the Department of Radiology, Brigham and Women’s
Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.,
A.R.H.); and Institute for Technology Assessment, Massachusetts General
Hospital, Boston, Mass (L.L.P., C.Y.K.)
| | - Andetta R. Hunsaker
- From the Department of Radiology, Brigham and Women’s
Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.,
A.R.H.); and Institute for Technology Assessment, Massachusetts General
Hospital, Boston, Mass (L.L.P., C.Y.K.)
| |
Collapse
|
13
|
Tai R, Dunne RM, Trotman-Dickenson B, Jacobson FL, Madan R, Kumamaru KK, Hunsaker AR. Frequency and Severity of Pulmonary Hemorrhage in Patients Undergoing Percutaneous CT-guided Transthoracic Lung Biopsy: Single-Institution Experience of 1175 Cases. Radiology 2016; 279:287-96. [DOI: 10.1148/radiol.2015150381] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
14
|
Yu S, Kumamaru KK, George E, Dunne RM, Bedayat A, Neykov M, Hunsaker AR, Dill KE, Cai T, Rybicki FJ. Classification of CT pulmonary angiography reports by presence, chronicity, and location of pulmonary embolism with natural language processing. J Biomed Inform 2014; 52:386-93. [PMID: 25117751 DOI: 10.1016/j.jbi.2014.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/01/2014] [Accepted: 08/01/2014] [Indexed: 11/17/2022]
Abstract
In this paper we describe an efficient tool based on natural language processing for classifying the detail state of pulmonary embolism (PE) recorded in CT pulmonary angiography reports. The classification tasks include: PE present vs. absent, acute PE vs. others, central PE vs. others, and subsegmental PE vs. others. Statistical learning algorithms were trained with features extracted using the NLP tool and gold standard labels obtained via chart review from two radiologists. The areas under the receiver operating characteristic curves (AUC) for the four tasks were 0.998, 0.945, 0.987, and 0.986, respectively. We compared our classifiers with bag-of-words Naive Bayes classifiers, a standard text mining technology, which gave AUC 0.942, 0.765, 0.766, and 0.712, respectively.
Collapse
Affiliation(s)
- Sheng Yu
- Partners HealthCare Personalized Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States.
| | - Kanako K Kumamaru
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States
| | - Elizabeth George
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States
| | - Ruth M Dunne
- Thoracic Imaging, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States
| | - Arash Bedayat
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States; Department of Radiology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Matey Neykov
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, United States
| | - Andetta R Hunsaker
- Thoracic Imaging, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States
| | - Karin E Dill
- Department of Radiology, University of Chicago, Chicago, IL, United States
| | - Tianxi Cai
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, United States
| | - Frank J Rybicki
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States
| |
Collapse
|
15
|
Kumamaru KK, Rybicki FJ, Madan R, Gill R, Wake N, Hunsaker AR. Incidental findings detection using low tube potential for CT pulmonary angiography. Int J Cardiovasc Imaging 2014; 30:1579-88. [DOI: 10.1007/s10554-014-0484-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
|
16
|
Kumamaru KK, Hunsaker AR, Kumamaru H, George E, Bedayat A, Rybicki FJ. Correlation between early direct communication of positive CT pulmonary angiography findings and improved clinical outcomes. Chest 2014; 144:1546-1554. [PMID: 23828207 DOI: 10.1378/chest.13-0308] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite a general consensus that rapid communication of critical radiology findings from radiologists to referring physicians is imperative, a possible association with superior patient outcomes has not been confirmed. The objective of this study was to evaluate the correlation between early direct communication of CT image findings by radiologists to referring physicians and better clinical outcomes in patients with acute pulmonary embolism (PE). METHODS This was a retrospective, single-institution, cohort study that included 796 consecutive patients (February 2006 to March 2010) who had acute PE confirmed by CT pulmonary angiography (CTPA) and whose treatment had not been initiated at the time of CTPA acquisition. The time from CTPA to direct communication of the diagnosis was evaluated for its association with time from CTPA to treatment initiation and with 30-day mortality. Cox regression analysis was performed with inverse probability weighting by propensity scores calculated using 20 potential confounding factors. RESULTS In 93.4% of patients whose first treatment was anticoagulation, the referring physicians started treatment after receiving direct notification of the diagnosis from the radiologist. Late communication (> 1.5 h after CTPA; n = 291) was associated with longer time to treatment initiation (adjusted hazard ratio [HR], 0.714; 95% CI, 0.610-0.836; P < .001) and higher all-cause and PE-related 30-day mortality (HR, 1.813; 95% CI, 1.163-2.828; P = .009; and HR, 2.625; 95% CI, 1.362-5.059; P = .004, respectively). CONCLUSIONS Delay (> 1.5 h of CTPA acquisition) in direct communication of acute PE diagnosis from radiologists to referring physicians was significantly correlated with a higher risk of delayed treatment initiation and death within 30 days.
Collapse
Affiliation(s)
- Kanako K Kumamaru
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Andetta R Hunsaker
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA
| | - Hiraku Kumamaru
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Elizabeth George
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA
| | - Arash Bedayat
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA
| | - Frank J Rybicki
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA.
| |
Collapse
|
17
|
George E, Hunsaker AR, Rybicki FJ, Kumamaru KK. Effect of Lower Tube Voltage on the Reproducibility of Right-to-Left Ventricular Diameter Ratio Measurements on Computed Tomographic Pulmonary Angiography Images. J Comput Assist Tomogr 2013; 37:737-42. [DOI: 10.1097/rct.0b013e3182994f37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
Kumamaru KK, Hunsaker AR, Bedayat A, Soga S, Signorelli J, Adams K, Wake N, Lu MT, Rybicki FJ. Subjective assessment of right ventricle enlargement from computed tomography pulmonary angiography images. Int J Cardiovasc Imaging 2011; 28:965-73. [PMID: 21670986 DOI: 10.1007/s10554-011-9903-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 05/27/2011] [Indexed: 11/25/2022]
Abstract
To retrospectively evaluate prognostic accuracy of subjective assessment of right ventricle (RV) enlargement on CT pulmonary angiography (CTPA) images in comparison with objective measures of RV enlargement in patients with acute pulmonary embolism (PE). For 200 consecutive patients with acute PE, two readers blinded to patient outcomes subjectively determined whether the maximum RV diameter was greater than that of the left ventricle (LV) using axial CTPA images. For the objective measurements, RV/LV diameter ratios were calculated using axial images and 4-chamber reformatted images. For all assessments, sensitivities and specificities for predicting PE-related death within 30-days and a composite outcome including PE-related death or the need for intensive therapies were compared. The agreement between two readers was 91.5% (kappa = 0.83) and all other assessments had pair-wise agreement over 75% (kappa = 0.53-0.72). There was no significant difference in sensitivity between the subjective and objective methods for predicting both outcomes. The specificity for subjective RV enlargement (55.4-67.7%) was significantly higher than objective measures (45.8-53.1%), except for the 4-chamber views where, for one reader, the specificity of the subjective evaluation was higher but did not reach statistical significance. Complex measurements of RV/LV diameter ratios may not be needed to maximize the prognostic value from CTPA. The radiologist who interprets the CTPA images should report RV enlargement when the RV diameter subjectively appears larger than the LV.
Collapse
Affiliation(s)
- Kanako K Kumamaru
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA 02115, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Affiliation(s)
- Andetta R Hunsaker
- Applied Imaging Science Laboratory, the Thoracic Imaging Section, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | |
Collapse
|
20
|
Hatabu H, Hunsaker AR. The cost and consequence of "uncertainty". Acad Radiol 2009; 16:1307-8. [PMID: 19835788 DOI: 10.1016/j.acra.2009.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 09/03/2009] [Accepted: 09/04/2009] [Indexed: 01/25/2023]
|
21
|
Abstract
Recent development of MR techniques has overcome many problems, such as susceptibility artifacts or motion artifact, allowing both static and dynamic MR lung imaging and providing quantitative information of pulmonary function, including perfusion, ventilation, and respiratory motion. Dynamic contrast-enhanced MR perfusion imaging is suitable for the evaluation of angiogenesis of pulmonary solitary nodules. (129)Xe MR imaging is potentially a robust technique for the evaluation of various pulmonary function and may replace (3)He. The information provided by these new MR imaging methods is proving useful in research and in clinical applications in various lung diseases.
Collapse
Affiliation(s)
- Shin Matsuoka
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | | | | | | | | | | | | |
Collapse
|
22
|
Affiliation(s)
- Rachna Madan
- Department of Radiology, Thoracic Radiology Division, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.
| | | | | |
Collapse
|
23
|
Abstract
Angiosarcoma is a rare soft tissue sarcoma that usually occurs in deep soft tissues, breast, spleen, liver, and bone. Primary thoracic parietal localization of angiosarcoma is rare and prognosis is poor. In this report, we present the CT and PET features of a patient with pseudomesotheliomatous angiosarcoma of the chest wall and pleura, which, to the best of our knowledge, have not previously been described.
Collapse
Affiliation(s)
- Chiara Del Frate
- Department of Radiology, Abdominal Imaging Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | | | | |
Collapse
|
24
|
Hunsaker AR, Reilly JJ. Images in clinical medicine. Centrilobular emphysema with predominantly upper-lobe involvement. N Engl J Med 2003; 348:2091. [PMID: 12761366 DOI: 10.1056/nejmicm030318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
25
|
Affiliation(s)
- Andetta R Hunsaker
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| |
Collapse
|
26
|
Hunsaker AR, Ingenito EP, Reilly JJ, Costello P. Lung volume reduction surgery for emphysema: correlation of CT and V/Q imaging with physiologic mechanisms of improvement in lung function. Radiology 2002; 222:491-8. [PMID: 11818618 DOI: 10.1148/radiol.2222010462] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the relationship between computer-derived and visually assessed ventilation-perfusion (V/Q) scintigraphy and computed tomographic (CT) scores in evaluating disease severity and distribution in identifying optimal candidates for lung volume reduction surgery (LVRS) and to correlate these radiologic indices with physiologic measures of outcome. MATERIALS AND METHODS In 39 patients, preoperative V/Q and CT scans were visually scored by two radiologists for disease severity and distribution. Results were compared with computer-derived scores for the same cohort. These indices were correlated with clinical improvement measured with forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), and ratio of FEV(1) to FVC. RESULTS The disease distribution scores measured with the different methods correlated closely: computer-based and visually assessed CT scores (r = 0.89, P <.001), computer-based and visually assessed V/Q scores (r = 0.83, P <.001), visually assessed CT and V/Q scores (r = -0.50, P <.001), and computer-derived CT and V/Q scores (r = -0.57, P =.015). Similarly, a statistically significant correlation was noted between each of the radiologic methods and clinical outcome measurements (P <.001). CONCLUSION CT and V/Q preoperative assessment, with either visual scoring or computer-based algorithms, are nearly equivalent in their utility in predicting improvement in FEV(1) measures.
Collapse
Affiliation(s)
- Andetta R Hunsaker
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
| | | | | | | |
Collapse
|
27
|
Abstract
PURPOSE To determine the radiologic features, pathogenesis, and prognostic importance of sarcoidlike reaction in patients with malignancy. MATERIALS AND METHODS Radiographs and computed tomographic (CT) scans of the chests of 10 patients with known malignancy and either concurrent or subsequent development of noncaseating granulomas (NCG) were reviewed and correlated with histopathologic reports and pertinent clinical data. RESULTS Ten patients with malignancy were found to have either mediastinal or hilar lymph node enlargement (n = 4) or parenchymal lung disease (n = 6). The presumptive diagnosis was metastatic disease. In eight of 10 histopathologic specimens, no tumor was found, but innumerable NCGs were present. They were thought to be consistent with sarcoidlike reaction. In the other two specimens, only a small focus of tumor cells was found amidst innumerable NCGs. On CT scans of the chests, parenchymal lung disease took the form of either ground-glass attenuation (n = 1) or nodules following perivascular and peribronchial distributions (n = 5). CONCLUSION Lymph node enlargement and parenchymal lung nodules may not indicate metastatic disease. Sampling of all abnormal areas may be helpful in staging the disease and in treating and determining the prognosis of patients. Likewise, the discovery of NCG does not necessarily indicate sarcoidosis and may represent sarcoidlike reaction.
Collapse
Affiliation(s)
- A R Hunsaker
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | | | | | | |
Collapse
|