Diagnostics

Research

14 pages, 4490 KiB

Open AccessArticle

Impact of Simulated Reduced-Dose Chest CT on Diagnosing Pulmonary T1 Tumors and Patient Management

by Alan Arthur Peters, Jaro Munz, Jeremias Bendicht Klaus, Ana Macek, Adrian Thomas Huber, Verena Carola Obmann, Njood Alsaihati, Ehsan Samei, Waldo Valenzuela, Andreas Christe, Johannes Thomas Heverhagen, Justin Bennion Solomon and Lukas Ebner

Diagnostics 2024, 14(15), 1586; https://doi.org/10.3390/diagnostics14151586 - 23 Jul 2024

Viewed by 752

Abstract

To determine the diagnostic performance of simulated reduced-dose chest CT scans regarding pulmonary T1 tumors and assess the potential impact on patient management, a repository of 218 patients with histologically proven pulmonary T1 tumors was used. Virtual reduced-dose images were simulated at 25%- [...] Read more.

To determine the diagnostic performance of simulated reduced-dose chest CT scans regarding pulmonary T1 tumors and assess the potential impact on patient management, a repository of 218 patients with histologically proven pulmonary T1 tumors was used. Virtual reduced-dose images were simulated at 25%- and 5%-dose levels. Tumor size, attenuation, and localization were scored by two experienced chest radiologists. The impact on patient management was assessed by comparing hypothetical LungRADS scores. The study included 210 patients (41% females, mean age 64.5 ± 9.2 years) with 250 eligible T1 tumors. There were differences between the original and the 5%—but not the 25%—dose simulations, and LungRADS scores varied between the dose levels with no clear trend. Sensitivity of Reader 1 was significantly lower using the 5%-dose vs. 25%-dose vs. original dose for size categorization (0.80 vs. 0.85 vs. 0.84; p = 0.007) and segmental localization (0.81 vs. 0.86 vs. 0.83; p = 0.018). Sensitivities of Reader 2 were unaffected by a dose reduction. A CT dose reduction may affect the correct categorization and localization of pulmonary T1 tumors and potentially affect patient management. Full article

(This article belongs to the Special Issue Imaging and Chest Diseases)

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14 pages, 1239 KiB

Open AccessArticle

Comparative Evaluation of Chest Ultrasonography and Computed Tomography as Predictors of Malignant Pleural Effusion: A Prospective Study

by Samah M. Shehata, Yassir Edrees Almalki, Mohammad Abd Alkhalik Basha, Rasha Mohamed Hendy, Eman M. Mahmoud, Marwa Elsayed Abd Elhamed, Sharifa Khalid Alduraibi, Mervat Aboualkheir, Ziyad A. Almushayti, Alaa K. Alduraibi, Ahmed M. Abdelkhalik Basha and Maha E. Alsadik

Diagnostics 2024, 14(10), 1041; https://doi.org/10.3390/diagnostics14101041 - 17 May 2024

Viewed by 1181

Abstract

Malignant pleural effusion (MPE) is a manifestation of advanced cancer that requires a prompt and accurate diagnosis. Ultrasonography (US) and computed tomography (CT) are valuable imaging techniques for evaluating pleural effusions; however, their relative predictive ability for a malignant origin remains debatable. This [...] Read more.

Malignant pleural effusion (MPE) is a manifestation of advanced cancer that requires a prompt and accurate diagnosis. Ultrasonography (US) and computed tomography (CT) are valuable imaging techniques for evaluating pleural effusions; however, their relative predictive ability for a malignant origin remains debatable. This prospective study aimed to compare chest US with CT findings as predictors of malignancy in patients with undiagnosed exudative pleural effusion. Fifty-four adults with undiagnosed exudative pleural effusions underwent comprehensive clinical evaluation including chest US, CT, and histopathologic biopsy. Blinded radiologists evaluated the US and CT images for features suggestive of malignancy, based on predefined criteria. Diagnostic performance measures were calculated using histopathology as a reference standard. Of the 54 patients, 33 (61.1%) had MPEs confirmed on biopsy. No significant differences between US and CT were found in detecting parietal pleural abnormalities, lung lesions, chest wall invasion, or liver metastasis. US outperformed CT in identifying diaphragmatic pleural thickening ≥10 mm (33.3% vs. 6.1%, p < 0.001) and nodularity (45.5% vs. 3%, p < 0.001), whereas CT was superior for mediastinal thickening (48.5% vs. 15.2%, p = 0.002). For diagnosing MPE, diaphragmatic nodularity detected by US had 45.5% sensitivity and 100% specificity, whereas CT mediastinal thickening had 48.5% sensitivity and 90.5% specificity. Both US and CT demonstrate reasonable diagnostic performance for detecting MPE, with particular imaging findings favoring a malignant origin. US may be advantageous for evaluating diaphragmatic pleural involvement, whereas CT is more sensitive to mediastinal abnormalities. Full article

(This article belongs to the Special Issue Imaging and Chest Diseases)

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10 pages, 1787 KiB

Open AccessArticle

Association of Late Radiographic Assessment of Lung Edema Score with Clinical Outcome in Patients with Influenza-Associated Acute Respiratory Distress Syndrome

by Hsiao-Chin Shen, Chun-Chia Chen, Wei-Chih Chen, Wen-Kuang Yu, Kuang-Yao Yang and Yuh-Min Chen

Diagnostics 2023, 13(23), 3572; https://doi.org/10.3390/diagnostics13233572 - 30 Nov 2023

Viewed by 1107

Abstract

Background: Influenza virus infection leads to acute pulmonary injury and acute respiratory distress syndrome (ARDS). The Radiographic Assessment of Lung Edema (RALE) score has been proposed as a reliable tool for the evaluation of the opacity of chest X-rays (CXRs). This study aimed [...] Read more.

Background: Influenza virus infection leads to acute pulmonary injury and acute respiratory distress syndrome (ARDS). The Radiographic Assessment of Lung Edema (RALE) score has been proposed as a reliable tool for the evaluation of the opacity of chest X-rays (CXRs). This study aimed to examine the RALE scores and outcomes in patients with influenza-associated ARDS. Methods: Patients who were newly diagnosed with influenza-associated ARDS from December 2015 to March 2016 were enrolled. Two independent reviewers scored the CXRs obtained on the day of ICU admission and on days 2 and 7 after intensive care unit (ICU) admission. Results: During the study, 47 patients had influenza-associated ARDS. Five died within 7 days of ICU admission. Of the remaining 42, non-survivors (N = 12) had higher Sequential Organ Failure Assessment scores (SOFA) at ICU admission and higher day 7 RALE scores than survivors (N = 30). The day 7 RALE score independently related to late in-hospital mortality (aOR = 1.121, 95% CI: 1.014–1.240, p = 0.025). Conclusions: The RALE score for the evaluation of opacity on CXRs is a highly reproducible tool. Moreover, RALE score on day 7 was an independent predictor of late in-hospital mortality in patients with influenza-associated ARDS. Full article

(This article belongs to the Special Issue Imaging and Chest Diseases)

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14 pages, 2112 KiB

Open AccessArticle

Longitudinal Chest X-ray Scores and their Relations with Clinical Variables and Outcomes in COVID-19 Patients

by Beiyi Shen, Wei Hou, Zhao Jiang, Haifang Li, Adam J. Singer, Mahsa Hoshmand-Kochi, Almas Abbasi, Samantha Glass, Henry C. Thode, Jeffrey Levsky, Michael Lipton and Tim Q. Duong

Diagnostics 2023, 13(6), 1107; https://doi.org/10.3390/diagnostics13061107 - 15 Mar 2023

Cited by 4 | Viewed by 9435

Abstract

Background: This study evaluated the temporal characteristics of lung chest X-ray (CXR) scores in COVID-19 patients during hospitalization and how they relate to other clinical variables and outcomes (alive or dead). Methods: This is a retrospective study of COVID-19 patients. CXR scores of [...] Read more.

Background: This study evaluated the temporal characteristics of lung chest X-ray (CXR) scores in COVID-19 patients during hospitalization and how they relate to other clinical variables and outcomes (alive or dead). Methods: This is a retrospective study of COVID-19 patients. CXR scores of disease severity were analyzed for: (i) survivors (N = 224) versus non-survivors (N = 28) in the general floor group, and (ii) survivors (N = 92) versus non-survivors (N = 56) in the invasive mechanical ventilation (IMV) group. Unpaired t-tests were used to compare survivors and non-survivors and between time points. Comparison across multiple time points used repeated measures ANOVA and corrected for multiple comparisons. Results: For general-floor patients, non-survivor CXR scores were significantly worse at admission compared to those of survivors (p < 0.05), and non-survivor CXR scores deteriorated at outcome (p < 0.05) whereas survivor CXR scores did not (p > 0.05). For IMV patients, survivor and non-survivor CXR scores were similar at intubation (p > 0.05), and both improved at outcome (p < 0.05), with survivor scores showing greater improvement (p < 0.05). Hospitalization and IMV duration were not different between groups (p > 0.05). CXR scores were significantly correlated with lactate dehydrogenase, respiratory rate, D-dimer, C-reactive protein, procalcitonin, ferritin, SpO2, and lymphocyte count (p < 0.05). Conclusions: Longitudinal CXR scores have the potential to provide prognosis, guide treatment, and monitor disease progression. Full article

(This article belongs to the Special Issue Imaging and Chest Diseases)

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15 pages, 2297 KiB

Open AccessArticle

Ultra-Low Dose CT Chest in Acute COVID-19 Pneumonia: A Pilot Study from India

by Mandeep Garg, Shritik Devkota, Nidhi Prabhakar, Uma Debi, Maninder Kaur, Inderpaul S. Sehgal, Sahajal Dhooria, Ashish Bhalla and Manavjit Singh Sandhu

Diagnostics 2023, 13(3), 351; https://doi.org/10.3390/diagnostics13030351 - 18 Jan 2023

Cited by 5 | Viewed by 2252

Abstract

The rapid increase in the number of CT acquisitions during the COVID-19 pandemic raised concerns about increased radiation exposure to patients and the resultant radiation-induced health risks. It prompted researchers to explore newer CT techniques like ultra-low dose CT (ULDCT), which could improve [...] Read more.

The rapid increase in the number of CT acquisitions during the COVID-19 pandemic raised concerns about increased radiation exposure to patients and the resultant radiation-induced health risks. It prompted researchers to explore newer CT techniques like ultra-low dose CT (ULDCT), which could improve patient safety. Our aim was to study the utility of ultra-low dose CT (ULDCT) chest in the evaluation of acute COVID-19 pneumonia with standard-dose CT (SDCT) chest as a reference standard. This was a prospective study approved by the institutional review board. 60 RT-PCR positive COVID-19 patients with valid indication for CT chest underwent SDCT and ULDCT. ULDCT and SDCT were compared in terms of objective (noise and signal-to-noise ratio) and subjective (noise, sharpness, artifacts and diagnostic confidence) image quality, various imaging patterns of COVID-19, CT severity score and effective radiation dose. The sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of ULDCT for detecting lung lesions were calculated by taking SDCT as a reference standard. The mean age of subjects was 47.2 ± 10.7 years, with 66.67% being men. 90% of ULDCT scans showed no/minimal noise and sharp images, while 93.33% had image quality of high diagnostic confidence. The major imaging findings detected by SDCT were GGOs (90%), consolidation (76.67%), septal thickening (60%), linear opacities (33.33%), crazy-paving pattern (33.33%), nodules (30%), pleural thickening (30%), lymphadenopathy (30%) and pleural effusion (23.33%). Sensitivity, specificity and diagnostic accuracy of ULDCT for detecting most of the imaging patterns were 100% (p < 0.001); except for GGOs (sensitivity: 92.59%, specificity: 100%, diagnostic accuracy: 93.33%), consolidation (sensitivity: 100%, specificity: 71.43%, diagnostic accuracy: 93.33%) and linear opacity (sensitivity: 90.00%, specificity: 100%, diagnostic accuracy: 96.67%). CT severity score (range: 15–25) showed 100% concordance on SDCT and ULDCT, while effective radiation dose was 4.93 ± 1.11 mSv and 0.26 ± 0.024 mSv, respectively. A dose reduction of 94.38 ± 1.7% was achieved with ULDCT. Compared to SDCT, ULDCT chest yielded images of reasonable and comparable diagnostic quality with the advantage of significantly reduced radiation dose; thus, it can be a good alternative to SDCT in the evaluation of COVID-19 pneumonia. Full article

(This article belongs to the Special Issue Imaging and Chest Diseases)

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Review

Jump to: Research, Other

17 pages, 20249 KiB

Open AccessReview

Computed Tomography of Contemporary Occupational Lung Disease: A Pictorial Review

by Jimin Lee, Marie Bambrick, Ambrose Lau, Susan M. Tarlo and Micheal McInnis

Diagnostics 2024, 14(16), 1786; https://doi.org/10.3390/diagnostics14161786 - 16 Aug 2024

Viewed by 500

Abstract

Occupational lung disease remains one of the most common work-related illnesses and accounts for most deaths from occupational illness. Occupational lung diseases often have delayed manifestation over decades and nonspecific clinical presentations, making it challenging for clinicians to promptly identify the disease and [...] Read more.

Occupational lung disease remains one of the most common work-related illnesses and accounts for most deaths from occupational illness. Occupational lung diseases often have delayed manifestation over decades and nonspecific clinical presentations, making it challenging for clinicians to promptly identify the disease and implement preventive measures. Radiologists play a crucial role in identifying and diagnosing occupational lung diseases, allowing for removal of the exposure and early medical intervention. In this review, we share our clinical and radiologic approach to diagnosing occupational lung disease and its subtypes. A collection of sample cases of occupational lung diseases commonly encountered in the modern era at a large Canadian university hospital is included to facilitate understanding. This review will provide radiologists with valuable insights into recognizing and diagnosing occupational lung diseases. Full article

(This article belongs to the Special Issue Imaging and Chest Diseases)

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12 pages, 1184 KiB

Open AccessReview

A Systematic Review of the Relationship between Chest CT Severity Score and Laboratory Findings and Clinical Parameters in COVID-19 Pneumonia

by Naif A. Majrashi, Rakan A. Alhulaibi, Ibrahim H. Nammazi, Mohammed H. Alqasi, Ali S. Alyami, Wael A. Ageeli, Nouf H. Abuhadi, Ali A. Kharizy, Abdu M. Khormi, Mohammed G. Ghazwani, Ali A. Alqasmi and Turkey A. Refaee

Diagnostics 2023, 13(13), 2223; https://doi.org/10.3390/diagnostics13132223 - 29 Jun 2023

Cited by 3 | Viewed by 2222

Abstract

The COVID-19 virus has infected millions of people and became a global pandemic in 2020. The efficacy of laboratory and clinical parameters in the diagnosis and monitoring of COVID-19 has been established. The CT scan has been identified as a crucial tool in [...] Read more.

The COVID-19 virus has infected millions of people and became a global pandemic in 2020. The efficacy of laboratory and clinical parameters in the diagnosis and monitoring of COVID-19 has been established. The CT scan has been identified as a crucial tool in the prognostication of COVID-19 pneumonia. Moreover, it has been proposed that the CT severity score can be utilized for the diagnosis and prognostication of COVID-19 disease severity and exhibits a correlation with laboratory findings such as inflammatory markers, blood glucose levels, and clinical parameters such as endotracheal intubation, oxygen saturation, mortality, and hospital admissions. Nevertheless, the correlation between the CT severity score and clinical or laboratory parameters has not been firmly established. The objective of this study is to provide a comprehensive review of the aforementioned association. This review used a systematic approach to collate and assess the existing literature that investigates the correlation between CT severity score and laboratory and clinical parameters. The search was conducted using Embase Ovid, MEDLINE Ovid, and PubMed databases, covering the period from inception to 20 May 2023. This review identified 20 studies involving more than 8000 participants of varying designs. The findings showed that the CT severity score is positively associated with laboratory and clinical parameters in COVID-19 patients. The findings indicate that the CT severity score exhibits a satisfactory level of prognostic accuracy in predicting mortality among patients with COVID-19. Full article

(This article belongs to the Special Issue Imaging and Chest Diseases)

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Other

Jump to: Research, Review

11 pages, 11056 KiB

Open AccessCase Report

Early Presentation of Boerhaave Syndrome in the Emergency Department: A Case Report and Review of the Literature

by Irina-Anca Eremia, Cătălin-Alexandru Anghel, Florina-Alexandra Cofaru and Silvia Nica

Diagnostics 2024, 14(15), 1592; https://doi.org/10.3390/diagnostics14151592 - 24 Jul 2024

Viewed by 529

Abstract

We present the case of a 46-year-old patient who arrived at the emergency department with chest pain following an episode of vomiting. The diagnosis was Boerhaave syndrome and acute mediastinitis. Due to the prompt presentation and the location of the rupture in the [...] Read more.

We present the case of a 46-year-old patient who arrived at the emergency department with chest pain following an episode of vomiting. The diagnosis was Boerhaave syndrome and acute mediastinitis. Due to the prompt presentation and the location of the rupture in the lower esophagus, emergency surgical intervention was performed, including esophageal suturing, mediastinal drainage, and jejunostomy for feeding. Postoperatively, the patient was transferred to the intensive care unit for advanced monitoring and support. The patient’s condition improved favorably in the intensive care unit, allowing for extubation. Progress continued positively, and the patient was discharged 12 days postoperatively with a functional jejunostomy. At regular follow-ups, the patient’s recovery remained favorable, and the jejunostomy was removed 30 days after the surgery. This case highlights the importance of rapid diagnosis and early surgical intervention in Boerhaave syndrome, demonstrating the successful management of a severe condition through a multidisciplinary effort. Full article

(This article belongs to the Special Issue Imaging and Chest Diseases)

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