1
|
Henning MK, Gunn C, Arenas-Jiménez J, Johansen S. Strategies for calculating contrast media dose for chest CT. Eur Radiol Exp 2023; 7:29. [PMID: 37303003 DOI: 10.1186/s41747-023-00345-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/13/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Total body weight (TBW) is a frequently used contrast media (CM) strategy for dose calculation in enhanced CT, yet it is suboptimal as it lacks consideration of patient characteristics, such as body fat percentage (BFP) and muscle mass. Alternative CM dosage strategies are suggested by the literature. Our objectives were to analyze the CM dose impact when adjusting to body composition using methods of obtaining lean body mass (LBM) and body surface area (BSA) along with its correlation with demographic factors in contrast enhanced chest CT examinations. METHODS Eighty-nine adult patients referred for CM thoracic CT were retrospectively included, categorized as either normal, muscular, or overweight. Patient body composition data was used to calculate the CM dose according to LBM or BSA. LBM was calculated with the James method, Boer method, and bioelectric impedance (BIA). BSA was calculated using the Mostellar formula. We then correlated the corresponding CM doses with demographic factors. RESULTS BIA demonstrated the highest and lowest calculated CM dose in muscular and overweight groups respectively, compared to other strategies. For the normal group, the lowest calculated CM dose was achieved using TBW. The calculated CM dose was more closely correlated with BFP using the BIA method. CONCLUSIONS The BIA method is more adaptive to variations in patient body habitus especially in muscular and overweight patients and is most closely correlated to patient demographics. This study could support utilizing the BIA method for calculating LBM for a body-tailored CM dose protocol for enhanced chest CT examinations. RELEVANCE STATEMENT The BIA-based method is adaptive to variations in body habitus especially in muscular and overweight patients and is closely correlated to patient demographics for contrast-enhanced chest CT. KEY POINTS • Calculations based on BIA showed the largest variation in CM dose. • Lean body weight using BIA demonstrated the strongest correlation to patient demographics. • Lean body weight BIA protocol may be considered for CM dosing in chest CT.
Collapse
Affiliation(s)
- Mette Karen Henning
- Faculty of Health Sciences, Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Catherine Gunn
- School of Health Sciences, Dalhousie University, Halifax, Canada
| | - Juan Arenas-Jiménez
- Department of Radiology, Dr. Balmis General University Hospital, Alicante, Spain
- Department of Pathology and Surgery, Miguel Hernández University, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Safora Johansen
- Faculty of Health Sciences, Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway.
- Department of Cancer Treatment, Oslo University Hospital, Oslo, Norway.
| |
Collapse
|
2
|
Ramos-Rincon JM, Herrera-García C, Silva-Ortega S, Portilla-Tamarit J, Alenda C, Jaime-Sanchez FA, Arenas-Jiménez J, Fornés-Riera FE, Scholz A, Escribano I, Pedrero-Castillo V, Muñoz-Miguelsanz C, Orts-Llinares P, Martí-Pastor A, Amo-Lozano A, García-Sevila R, Ribes-Mengual I, Moreno-Perez O, Concepcion-Aramendía L, Merino E, Sánchez-Martínez R, Aranda I. Pathological Findings Associated With SARS-CoV-2 on Postmortem Core Biopsies: Correlation With Clinical Presentation and Disease Course. Front Med (Lausanne) 2022; 9:874307. [PMID: 35872778 PMCID: PMC9301383 DOI: 10.3389/fmed.2022.874307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/30/2022] [Indexed: 12/31/2022] Open
Abstract
Background Autopsies can shed light on the pathogenesis of new and emerging diseases. Aim To describe needle core necropsy findings of the lung, heart, and liver in decedents with COVID-19. Material Cross-sectional study of needle core necropsies in patients who died with virologically confirmed COVID-19. Histopathological analyses were performed, and clinical data and patient course evaluated. Results Chest core necropsies were performed in 71 decedents with a median age of 81 years (range 52–97); 47 (65.3%) were men. The median interval from symptoms onset to death was 17.5 days (range 1–84). Samples of lung (n = 62, 87.3%), heart (n = 48, 67.6%) and liver (n = 39, 54.9%) were obtained. Fifty-one lung samples (82.3%) were abnormal: 19 (30.6%) showed proliferative diffuse alveolar damage (DAD), 12 (19.4%) presented exudative DAD, and 10 (16.1%) exhibited proliferative plus exudative DAD. Of the 46 lung samples tested for SARS-CoV-19 by RT-PCR, 39 (84.8%) were positive. DAD was associated with premortem values of lactate dehydrogenase of 400 U/L or higher [adjusted odds ratio (AOR) 21.73; 95% confidence interval (CI) 3.22–146] and treatment with tocilizumab (AOR 6.91; 95% CI 1.14–41.7). Proliferative DAD was associated with an onset-to-death interval of over 15 days (AOR 7.85, 95% CI 1.29–47.80). Twenty-three of the 48 (47.9%) heart samples were abnormal: all showed fiber hypertrophy, while 9 (18.8%) presented fibrosis. Of the liver samples, 29/39 (74.4%) were abnormal, due to steatosis (n = 12, 30.8%), cholestasis (n = 6, 15.4%) and lobular central necrosis (n = 5, 12.8%). Conclusion Proliferative DAD was the main finding on lung core needle necropsy in people who died from COVID-19; this finding was related to a longer disease course. Changes in the liver and heart were common.
Collapse
Affiliation(s)
- Jose-Manuel Ramos-Rincon
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.,Clinical Medicine Department, Miguel Hernandez University of Elche, Elche, Spain
| | - Cristian Herrera-García
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Sandra Silva-Ortega
- Pathology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Julia Portilla-Tamarit
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Cristina Alenda
- Pathology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.,Pathology and Surgery Department, Miguel Hernández University of Elche, Elche, Spain
| | - Francisco-Angel Jaime-Sanchez
- Clinical Medicine Department, Miguel Hernandez University of Elche, Elche, Spain.,Intensive Care Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Juan Arenas-Jiménez
- Pathology and Surgery Department, Miguel Hernández University of Elche, Elche, Spain.,Radiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Francisca-Eugenia Fornés-Riera
- Anesthesiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Alexander Scholz
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Isabel Escribano
- Microbiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Víctor Pedrero-Castillo
- Pathology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Carlos Muñoz-Miguelsanz
- Anesthesiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Pedro Orts-Llinares
- Intensive Care Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Ana Martí-Pastor
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Antonio Amo-Lozano
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Raquel García-Sevila
- Pneumology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Isabel Ribes-Mengual
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Oscar Moreno-Perez
- Clinical Medicine Department, Miguel Hernandez University of Elche, Elche, Spain.,Endocrinology and Nutrition Department, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Luis Concepcion-Aramendía
- Radiology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Esperanza Merino
- Infectious Diseases Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| | - Rosario Sánchez-Martínez
- Internal Medicine Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain.,Clinical Medicine Department, Miguel Hernandez University of Elche, Elche, Spain
| | - Ignacio Aranda
- Pathology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Spain
| |
Collapse
|
3
|
Moreno-Pérez O, Merino E, Leon-Ramirez JM, Andres M, Ramos JM, Arenas-Jiménez J, Asensio S, Sanchez R, Ruiz-Torregrosa P, Galan I, Scholz A, Amo A, González-delaAleja P, Boix V, Gil J. Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study. J Infect 2021; 82:378-383. [PMID: 33450302 PMCID: PMC7802523 DOI: 10.1016/j.jinf.2021.01.004] [Citation(s) in RCA: 345] [Impact Index Per Article: 115.0] [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: 10/25/2020] [Revised: 12/15/2020] [Accepted: 01/07/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study aims to analyze the incidence of Post-acute COVID-19 syndrome (PCS) and its components, and to evaluate the acute infection phase associated risk factors. METHODS A prospective cohort study of adult patients who had recovered from COVID-19 (27th February to 29th April 2020) confirmed by PCR or subsequent seroconversion, with a systematic assessment 10-14 weeks after disease onset. PCS was defined as the persistence of at least one clinically relevant symptom, or abnormalities in spirometry or chest radiology. Outcome predictors were analyzed by multiple logistic regression (OR; 95%CI). RESULTS Two hundred seventy seven patients recovered from mild (34.3%) or severe (65.7%) forms of SARS-CoV-2 infection were evaluated 77 days (IQR 72-85) after disease onset. PCS was detected in 141 patients (50.9%; 95%CI 45.0-56.7%). Symptoms were mostly mild. Alterations in spirometry were noted in 25/269 (9.3%), while in radiographs in 51/277 (18.9%). No baseline clinical features behaved as independent predictors of PCS development. CONCLUSIONS A Post-acute COVID-19 syndrome was detected in a half of COVID19 survivors. Radiological and spirometric changes were mild and observed in less than 25% of patients. No baseline clinical features behaved as independent predictors of Post-acute COVID-19 syndrome development.
Collapse
Affiliation(s)
- Oscar Moreno-Pérez
- Endocrinology and Nutrition department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine department, Miguel Hernández University, Elche, Spain.
| | - Esperanza Merino
- Unit of Infectious Diseases, Alicante General University Hospital, Alicante Institute of Health and Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Jose-Manuel Leon-Ramirez
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Mariano Andres
- Clinical Medicine department, Miguel Hernández University, Elche, Spain; Rheumatology department, Alicante General University Hospital Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Jose Manuel Ramos
- Clinical Medicine department, Miguel Hernández University, Elche, Spain; Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Juan Arenas-Jiménez
- Radiology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Santos Asensio
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Rosa Sanchez
- Neurology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Paloma Ruiz-Torregrosa
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Irene Galan
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Alexander Scholz
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Antonio Amo
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pilar González-delaAleja
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Vicente Boix
- Clinical Medicine department, Miguel Hernández University, Elche, Spain; Unit of Infectious Diseases, Alicante General University Hospital, Alicante Institute of Health and Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Joan Gil
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| |
Collapse
|
6
|
Bernabé-García JM, García-Espasa C, Arenas-Jiménez J, Sánchez-Payá J, de la Hoz-Rosa J, Carreres-Polo JO. Has "respiratory coaching" before deep inspiration an impact on the incidence of transient contrast interruption during pulmonary CT angiography? Insights Imaging 2012; 3:505-11. [PMID: 22773364 PMCID: PMC3443274 DOI: 10.1007/s13244-012-0182-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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] [Received: 03/03/2012] [Revised: 05/16/2012] [Accepted: 06/11/2012] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate if respiratory coaching performed prior to CT pulmonary angiography (CTPA) image acquisition has an impact on the occurrence of transient interruption of contrast (TIC) phenomenon. Materials and methods Two hundred and thirty-one consecutive patients with suspected pulmonary embolism (PE) were referred for CTPA. They were randomised into two groups, with or without respiratory coaching (groups A and B, respectively). Those patients who were deemed not able to be coached were not randomised and were assigned to a third group (C). Two radiologists evaluated the degree of enhancement of the pulmonary arteries and the presence and grade of TIC. The χ2 test was used to compare differences among groups in occurrence and grade of this phenomenon. Results There were no significant differences in the presence of any grade of TIC among the three groups, with 30 positive cases (32%) in group A, 33 (35%) in group B, and 12 (27%) in group C (P = 0.61). When TIC was graded and divided into significant or not, the different groups also did not differ significantly. Conclusion Performing respiratory coaching before CTPA had no statistically significant effect on the incidence and severity of TIC in this prospective randomised study. Main Messages • Significant transient interruption of contrast appears in 12% of pulmonary CT angiograms. • Severe transient interruption of contrast leading to nondiagnostic tests appears in 2% of studies. • In our study respiratory coaching has no impact on the incidence of transient interruption of contrast.
Collapse
Affiliation(s)
- Juan M. Bernabé-García
- Department of Radiology, General Universitary Hospital of Alicante, Avda. Pintor Baeza 12, 03010 Alicante, Spain
| | - Cristina García-Espasa
- Department of Radiology, General Universitary Hospital of Alicante, Avda. Pintor Baeza 12, 03010 Alicante, Spain
| | - Juan Arenas-Jiménez
- Department of Radiology, General Universitary Hospital of Alicante, Avda. Pintor Baeza 12, 03010 Alicante, Spain
| | - José Sánchez-Payá
- Department of Public Health, General Universitary Hospital of Alicante, Avda. Pintor Baeza 12, 03010 Alicante, Spain
| | - Javier de la Hoz-Rosa
- Department of Radiology, General Universitary Hospital of Alicante, Avda. Pintor Baeza 12, 03010 Alicante, Spain
| | - Joan O. Carreres-Polo
- Department of Radiology, General Universitary Hospital of Alicante, Avda. Pintor Baeza 12, 03010 Alicante, Spain
| |
Collapse
|
7
|
Arenas-Jiménez J, Alonso-Charterina S, Sánchez-Payá J, Fernández-Latorre F, Gil-Sánchez S, Lloret-Llorens M. Evaluation of CT findings for diagnosis of pleural effusions. Eur Radiol 2000; 10:681-90. [PMID: 10795555 DOI: 10.1007/s003300050984] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [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: 11/27/2022]
Abstract
Computed tomography studies are usually used to assess patients with pleural effusions, and radiologists should be aware of the significance of different CT findings for the diagnosis of the effusion. The purpose of this study was to evaluate CT findings for etiological diagnosis of pleural effusions. Contrast-enhanced CT of the chest of 211 patients with pleural effusion of definite diagnosis were evaluated. The CT images were evaluated for the presence and extent of pleural effusion, thickening or nodules, extrapleural fat and other changes in the mediastinum or lung. The CT scans were read by two independent observers and correlation between them was evaluated. Comparison of CT findings between benign and malignant effusions, between exudates and transudates, and between empyemas and the other parapneumonic effusions were carried out. Kappa values for most CT findings were > 0.85. Loculation, pleural thickening, pleural nodules, and extrapleural fat of increased density were only present in exudative effusions. Multiple pleural nodules and nodular pleural thickening were the only pleural findings limited to malignant pleural effusions. The signs were also more frequently seen in empyemas than in other parapneumonic effusions. Computed tomography findings can help to distinguish between transudates and exudates. Although there is some overlap between benign and malignant pleural effusions, pleural nodules and nodular pleural thickening were present almost exclusively in the latter. Although differences between CT findings of empyemas and the other parapneumonic effusions exist, there is no finding which can definitely differentiate between them.
Collapse
Affiliation(s)
- J Arenas-Jiménez
- Department of Radiology, Hospital General Universitario de Alicante, Spain
| | | | | | | | | | | |
Collapse
|
8
|
Fernández-Latorre F, Menor-Serrano F, Alonso-Charterina S, Arenas-Jiménez J. Langerhans' cell histiocytosis of the temporal bone in pediatric patients: imaging and follow-up. AJR Am J Roentgenol 2000; 174:217-21. [PMID: 10628482 DOI: 10.2214/ajr.174.1.1740217] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [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: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to review the initial clinical and radiologic manifestations and the follow-up of pediatric patients with Langerhans' cell histiocytosis affecting the temporal bone. MATERIALS AND METHODS We retrospectively studied 14 patients with Langerhans' cell histiocytosis affecting the temporal bone. All patients were examined initially and sequentially with CT. In six patients, MR imaging was also done. RESULTS Temporal bone involvement was the initial form of presentation in 12 patients. In eight patients, temporal bone involvement presented as an isolated manifestation, and in four it was associated with multisystemic involvement. In the remaining two patients, temporal bone involvement appeared during the course of the Langerhans' cell histiocytosis. Bilateral involvement was seen in four patients. In two patients, the temporal bone was affected only at the petrous apex. CT showed destruction of bone in all 14 patients and an associated soft-tissue homogeneous mass after injection of i.v. contrast material in 12 patients. CT showed a heterogeneous appearance of the soft-tissue mass in two patients. The average period of follow-up was 5 years. In seven of the 14 patients, the disease had a satisfactory evolution in which the bony lesions of the temporal bone reossified and remodeled over the course of a year. CONCLUSION In Langerhans' cell histiocytosis, involvement of the temporal bone is usually seen on radiographs as extensive lytic lesions associated with soft-tissue masses. The lesions that remit show early disappearance of the soft-tissue mass, followed by reossification and remodeling of the involved bone. Patients with limited initial involvement of the temporal bone have a better prognosis on long-term follow-up than do patients with the multisystemic form.
Collapse
|