The diagnostic performance of deep-learning-based CT severity score to identify COVID-19 pneumonia

Objective:

To determine the diagnostic accuracy of a deep-learning (DL)-based algorithm using chest computed tomography (CT) scans for the rapid diagnosis of coronavirus disease 2019 (COVID-19), as compared to the reference standard reverse-transcription polymerase chain reaction (RT-PCR) test.

Methods:

In this retrospective analysis, data of COVID-19 suspected patients who underwent RT-PCR and chest CT examination for the diagnosis of COVID-19 were assessed. By quantifying the affected area of the lung parenchyma, severity score was evaluated for each lobe of the lung with the DL-based algorithm. The diagnosis was based on the total lung severity score ranging from 0 to 25. The data were randomly split into a 40% training set and a 60% test set. Optimal cut-off value was determined using Youden-index method on the training cohort.

Results:

A total of 1259 patients were enrolled in this study. The prevalence of RT-PCR positivity in the overall investigated period was 51.5%. As compared to RT-PCR, sensitivity, specificity, positive predictive value, negative predictive value and accuracy on the test cohort were 39.0%, 80.2%, 68.0%, 55.0% and 58.9%, respectively. Regarding the whole data set, when adding those with positive RT-PCR test at any time during hospital stay or “COVID-19 without virus detection”, as final diagnosis to the true positive cases, specificity increased from 80.3% to 88.1% and the positive predictive value increased from 68.4% to 81.7%.

Conclusion:

DL-based CT severity score was found to have a good specificity and positive predictive value, as compared to RT-PCR. This standardized scoring system can aid rapid diagnosis and clinical decision making.

Advances in knowledge:

DL-based CT severity score can detect COVID-19-related lung alterations even at early stages, when RT-PCR is not yet positive.

The Predictive Role of Artificial Intelligence-Based Chest CT Quantification in Patients with COVID-19 Pneumonia

We sought to analyze the prognostic value of laboratory and clinical data, and an artificial intelligence (AI)-based algorithm for Coronavirus disease 2019 (COVID-19) severity scoring, on CT-scans of patients hospitalized with COVID-19. Moreover, we aimed to determine personalized probabilities of clinical deterioration. Data of symptomatic patients with COVID-19 who underwent chest-CT-examination at the time of hospital admission between April and November 2020 were analyzed. COVID-19 severity score was automatically quantified for each pulmonary lobe as the percentage of affected lung parenchyma with the AI-based algorithm. Clinical deterioration was defined as a composite of admission to the intensive care unit, need for invasive mechanical ventilation, use of vasopressors or in-hospital mortality. In total 326 consecutive patients were included in the analysis (mean age 66.7 ± 15.3 years, 52.1% male) of whom 85 (26.1%) experienced clinical deterioration. In the multivariable regression analysis prior myocardial infarction (OR = 2.81, 95% CI = 1.12–7.04, p = 0.027), immunodeficiency (OR = 2.08, 95% CI = 1.02–4.25, p = 0.043), C-reactive protein (OR = 1.73, 95% CI = 1.32–2.33, p < 0.001) and AI-based COVID-19 severity score (OR = 1.08; 95% CI = 1.02–1.15, p = 0.013) appeared to be independent predictors of clinical deterioration. Personalized probability values were determined. AI-based COVID-19 severity score assessed at hospital admission can provide additional information about the prognosis of COVID-19, possibly serving as a useful tool for individualized risk-stratification.

Liver displacement caused by distended stomach in Parkinsonian patient

Gastroparesis, a form of gastrointestinal dysfunction and the increased risk for aspiration pneumonia are well known complications in patients with Parkinson’s disease. In our case report we demonstrate the case of an 83-year-old, bedridden male patient with Parkinson’s disease, who had a slowly progressing stomach dilation, gradually pushing the otherwise normal liver to a highly unusual craniodorsally rotated position.

Comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and outcomes-a prospective single-centre study

Purpose

New guidelines recommend thrombectomy up to 24 h in selected patients; however, the workload and benefit of extending time window are not known. We conducted a prospective single-centre study to determine the caseload, imaging and interventional need of extended time window.

Methods

All consecutive ischemic stroke patients within 24 h from onset in an 11-month period were included. Thrombectomy eligibility in the 0–6 h time window was based on current guidelines; in the 6–24 h time window, it was based on a combination of DEFUSE 3 and DAWN study criteria using MRI to identify target mismatch. Clinical outcome in treated patients was assessed at 3 months.

Results

Within 24 h of onset, 437 patients were admitted. In the 0–6 h time window, 238 patients (54.5%) arrived of whom 221 (92.9%) underwent CTA or MRA, 82 (34.5%) had large vessel occlusion (LVO), 30 (12.6%) had thrombectomy and 11 (36.6%) became independent (mRS ≤ 2). In the extended 6–24 h time window, 199 patients (45.5%) arrived of whom 127 (63.8%) underwent CTA or MRA, 44 (22.1%) had LVO, 8 (4%) had thrombectomy and 4 (50%) became independent.

Conclusion

Extending the time window from 6 to 24 h results in a 26.7% increase in patients receiving thrombectomy and a 36.4% increase of independent clinical outcome in treated patients at the price of a significantly increased burden of clinical and imaging screening due to the similar caseload but a smaller proportion of treatment eligible patients in the extended as compared with the standard time window.

Electronic supplementary material

The online version of this article (10.1007/s00234-020-02531-8) contains supplementary material, which is available to authorized users.

[Functional outcome of arthroscopic rotator cuff repair]

INTRODUCTION

Functional outcome after rotator cuff reconstruction is influenced by several factors of which re-rupture is probably the most important.

AIM

The aim of the study was to evaluate the postoperative outcome including re-rupture rate after arthroscopic rotator cuff reconstruction.

METHOD

23 shoulders of 22 patients were examined prospectively. Physical examination, ultrasound and radiography were performed. Quality of life and functional outcome were evaluated using Constant Score and Visual Analog Scale.

RESULTS

Excellent or good results were found in 80% of the patients. The Constant Score has increased from 45 to 79, and the level of pain decreased from 6.6 to 2.5. Full-thickness rotator cuff tear was absent, but partial tear occurred in 7 cases (30%). Average acromiohumeral distance in the operated side was 8.5 mm compared to 9.5 mm measured on the contralateral shoulder.

CONCLUSIONS

Arthroscopic rotator cuff repair is a safe and reliable procedure that provides good results.

Cerebral iodized lipid embolization via a pulmonary arteriovenous shunt: rare complication of transcatheter arterial embolization for hepatocellular carcinoma

We report the first European case of cerebral iodized lipid embolism post transcatheter arterial embolization for hepatocellular carcinoma. Lipiodol emboli and corresponding multifocal brain ischemia were documented with computed tomography (CT) and magnetic resonance (MR) in the acutely symptomatic patient. Transcranial Doppler sonography with contrast indicated a right-to-left shunt, while on a follow-up CT scan lipiodol embolization was detected in both lungs. Dilated pulmonary vessels and thick vascular channels were seen in the vicinity of the right diaphragm suggestive of pulmonary arteriovenous shunt. The patient symptoms regressed with supportive care alone, but he died 5 months later due to hepatic failure unrelated to the procedure.