High-resolution CT phenotypes in pulmonary sarcoidosis: a multinational Delphi consensus study.

One view of sarcoidosis is that the term covers many different diseases. However, no classification framework exists for the future exploration of pathogenetic pathways, genetic or trigger predilections, patterns of lung function impairment, or treatment separations, or for the development of diagnostic algorithms or relevant outcome measures. We aimed to establish agreement on high-resolution CT (HRCT) phenotypic separations in sarcoidosis to anchor future CT research through a multinational two-round Delphi consensus process. Delphi participants included members of the Fleischner Society and the World Association of Sarcoidosis and other Granulomatous Disorders, as well as members' nominees. 146 individuals (98 chest physicians, 48 thoracic radiologists) from 28 countries took part, 144 of whom completed both Delphi rounds. After rating of 35 Delphi statements on a five-point Likert scale, consensus was achieved for 22 (63%) statements. There was 97% agreement on the existence of distinct HRCT phenotypes, with seven HRCT phenotypes that were categorised by participants as non-fibrotic or likely to be fibrotic. The international consensus reached in this Delphi exercise justifies the formulation of a CT classification as a basis for the possible definition of separate diseases. Further refinement of phenotypes with rapidly achievable CT studies is now needed to underpin the development of a formal classification of sarcoidosis.

COVID-protected pathways for image-guided lung cancer intervention during the COVID-19 pandemic: A cohort study.

OBJECTIVES: To compare the experience of COVID-protected and mixed cohort pathways in COVID-19 transmission at a tertiary referral hospital for elective CT-guided lung biopsy and ablation during the COVID-19 pandemic. METHODS: From September 2020 to August 2021, patients admitted for elective thoracic intervention were treated at a tertiary hospital (Site 1). Site 1 received patients for extracorporeal membrane oxygenation (ECMO) and invasive ventilation in the treatment of COVID-19. Shared imaging, theater, and hallway facilities were used.From April 2020 to August 2020, patients admitted for elective thoracic intervention were treated at a COVID-protected hospital (Site 2). No patients with suspected or confirmed COVID-19 were treated at Site 2.Patients were surveyed for clinical and laboratory signs of COVID-19 infection up to 30 days post-procedure. RESULTS: At Sites 1 and 2, patients (2.4%) were tested positive for COVID-19 at 10 and 14 days post-procedure.At Site 2, there were no COVID-19 positive cases within 30 days of undergoing elective thoracic intervention. CONCLUSION: A mixed-site method for infection control could represent a pragmatic approach to the management of elective procedures during the COVID-19 pandemic or for similar illnesses. ADVANCES IN KNOWLEDGE: Mixed-cohort infection control is possible in the prevention of nosocomial COVID-19 infection.

Imaging of Lung Disease Associated with Connective Tissue Disease.

There is a well-known association between the connective tissue disorders (CTDs) and lung disease. In addition to interstitial lung disease, the CTDs may affect the air spaces and pulmonary vasculature. Imaging tests are important not only in diagnosis but also in management of these complex disorders. In the present review, key aspects of the imaging of CTD-reated diseases are discussed.

Short-term lung function changes predict mortality in patients with fibrotic hypersensitivity pneumonitis.

BACKGROUND AND OBJECTIVE: A proportion of patients with fibrotic hypersensitivity pneumonitis (fHP) follow a progressive disease course despite immunosuppressive treatment. Little is known about predictors of mortality in fHP. We aimed to investigate the impact of short-term lung function changes in fHP on mortality. METHODS: Baseline demographics for 145 consecutive patients with a multi-disciplinary team diagnosis of fHP, as well as baseline and 1-year follow-up of lung function, baseline echocardiographic findings, bronchoalveolar lavage (BAL) cellularity and all-cause mortality were recorded. Changes in forced vital capacity (FVC) ≥ 5% and ≥10%, and diffusion capacity of the lung for carbon monoxide (DLCO) ≥ 10% and ≥15% at 1 year were calculated. Cox proportional hazards analysis was performed to test for associations with mortality. RESULTS: Baseline lung function severity, age, presence of honeycombing on computed tomography (CT) and echocardiographic pulmonary arterial systolic pressure (PASP) ≥ 40 mm Hg were associated with early mortality, while BAL lymphocytosis was associated with improved survival. A decline in FVC ≥ 5% (hazard ratio [HR]: 3.10, 95% CI: 2.00-4.81, p < 0.001), FVC ≥ 10% (HR: 3.11, 95% CI: 1.94-4.99, p < 0.001), DLCO ≥ 10% (HR: 2.80, 95% CI: 1.78-4.42, p < 0.001) and DLCO ≥ 15% (HR: 2.92, 95% CI: 1.18-4.72, p < 0.001) at 1 year was associated with markedly reduced survival on univariable and multivariable analyses after correcting for demographic variables, disease severity, honeycombing on CT and treatment, as well as BAL lymphocytosis and PASP ≥ 40 mm Hg on echocardiography, in separate models. CONCLUSION: Worsening in FVC and DLCO at 1 year, including a marginal decline in FVC ≥ 5% and DLCO ≥ 10%, is predictive of markedly reduced survival in fHP.

Head and neck manifestations of granulomatosis with polyangiitis.

Granulomatosis with polyangiitis is a rare autoimmune condition which causes respiratory tract granulomas, small to medium vessel vasculitis and renal disease. Head and neck manifestations are some of the most common presentations of the condition, with a significant proportion of patients experiencing sinonasal disease alone. The recognition of suggestive imaging findings, in combination with clinical history and serology, aids the diagnosis and appropriate treatment. This pictorial review describes and illustrates the head and neck imaging features of granulomatosis with polyangiitis, highlighting the range of CT and MRI findings of upper aerodigestive tract, orbital and skull-base disease. Recognition of the radiological appearances is of importance, since clinical presentations may be non-specific and limited disease may have negative serology. Imaging features may overlap with other pathologies so important differential diagnoses will be considered, and these are particularly relevant in the context of treatment resistance.

MRI findings in vestibular paroxysmia - An observational study.

BACKGROUND/OBJECTIVES: Vestibular paroxysmia (VP) presents as episodic vertigo believed to be caused by neurovascular cross-compression (NVCC) of the vestibulocochlear nerve. We investigated whether NVCC occurred at a higher rate in VP, compared with controls and whether angulation of the nerve, the vessel involved and location of the point of contact were significant features. METHODS: Retrospective analysis was conducted of MR imaging performed in patients with VP and also patients with unilateral tinnitus (in whom the asymptomatic side was used as a control). Two independent, blinded reviewers assessed each case. RESULTS: Nine patients with VP and 20 patients with unilateral tinnitus were included. NVCC was demonstrated in all 9 VP patients (100%), compared with 9 of the controls (45%), p = 0.0049. NVCC was mostly caused by a branch of the anterior inferior cerebellar artery (AICA). Nerve angulation at the point of contact occurred in 5 of the cases (44%), but in none of the controls (specificity = 100%), p = 0.0053. There was no correlation between site of contact and VP. CONCLUSION: Our study supports the concept of NVCC in VP and additionally suggests that nerve angulation may be a specific feature. Neurovascular contact remains a common phenomenon in asymptomatic patients and therefore correlation with neuro-otology assessment remains essential.

Added Value of Contrast-Enhanced T1-Weighted and Diffusion-Weighted Sequences for Characterization of Incidental Findings on Whole Body Magnetic Resonance Imaging in Plasma-Cell Disorders.

BACKGROUND: Whole body magnetic resonance imaging (WBMRI) is currently recommended by guidelines for the assessment of myeloma. This will inevitably result in incidental findings. We aimed to assess the frequency of extraskeletal incidental findings and the added value of contrast-enhanced (CE) T1-weighted (T1-W) and diffusion-weighted (DWI) sequences for their characterization in a single WBMRI examination. PATIENTS AND METHODS: We performed 1.5 T WBMRI in 100 patients (53 female; median age, 65 years) with plasma-cell disorders from January 2014 to July 2017. T2-weighted sequences were reviewed initially for incidental findings, followed by sequential review of T1-W, CE T1-W, and DWI sequences for lesion characterization. Descriptive statistics were undertaken. RESULTS: A total of 348 incidental findings were detected in 97 (97%) of 100 patients; only 38 (10.9%) of 348 findings were indeterminate. T1-W sequences increased diagnostic confidence in the characterization of 12 (31.6%) of 38; CE T1-W sequences in the characterization of 16 (50%) of 32; and DWI increased diagnostic confidence in 21 (55.3%) of 38 compared to the T2-weighted sequence alone. CONCLUSION: Incidental findings are common, but the majority are of no clinical consequence. No additional cancers were noted in our series. DWI and CE T1-W sequences increased diagnostic confidence in 50% of indeterminate findings and may reduce the need for further investigation.

Abdominal manifestations of IgG4-related disease: a pictorial review.

In the last decade, autoimmune pancreatitis has become recognised as part of a wider spectrum of IgG4-related disease, typically associated with elevated serum IgG4 levels and demonstrating a response to corticosteroid therapy. Radiologically, there is imaging overlap with other benign and neoplastic conditions. This pictorial review discusses the intra-abdominal manifestations of this disease on cross-sectional imaging before and after steroid treatment and the main radiological features which help to distinguish it from other key differentials. TEACHING POINTS: • Autoimmune pancreatitis is part of a spectrum of IgG4-related disease. • Diagnosis is based on raised serum IgG4, clinical, radiological and histopathological findings. • Cross-sectional imaging can demonstrate the typical findings of abdominal IgG4-related disease. • Cross-sectional imaging can be used to monitor response to corticosteroid treatment.

Role of aspirin in chemoprevention of esophageal adenocarcinoma: a meta-analysis.

OBJECTIVE: To identify whether regular aspirin use protects against esophageal adenocarcinoma (EA) and if so, the effect of the duration and frequency of drug exposure. METHODS: Studies were selected from five journal/trial databases based on defined inclusion and exclusion criteria; most notably, the provision of multivariate EA odds ratios (ORs) in those taking regular aspirin. A subgroup analysis was then performed by stratifying the results according to the frequency and duration of aspirin use. The reliability of these investigations was assessed by calculating study heterogeneity and observing any elements of publication bias. RESULTS: Nine studies were selected for the main analysis, of which five were included in the frequency analysis and three assessed the duration of aspirin use. Data pooling revealed a statistically significant EA OR of 0.671 (95% CI 0.526-0.856, P = 0.001) among all aspirin users, suggesting a protective effect. The results for duration and frequency did not reach statistical significance but nonetheless suggested possible benefits of longer, more frequent drug regimens that may be statistically confirmed by studies of larger sample sizes. Funnel plots and statistical tests demonstrated a minimal impact of publication bias on our results. CONCLUSION: Aspirin use confers a significant protective effect against EA with a suggestion that the degree of protection may be increased by the longer duration and higher frequency of usage.