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This document from the European Society of Thoracic Imaging (ESTI) and the European Society of Radiology (ESR) discusses the role of imaging in the long-term follow-up of COVID-19 patients, to define which patients may benefit from imaging, and what imaging modalities and protocols should be used. Insights into imaging features encountered on computed tomography (CT) scans and potential pitfalls are discussed and possible areas for future review and research are also included. KEY POINTS: ⢠Post-COVID-19 pneumonia changes are mainly consistent with prior organizing pneumonia and are likely to disappear within 12 months of recovery from the acute infection in the majority of patients. ⢠At present, with the longest series of follow-up examinations reported not exceeding 12 months, the development of persistent or progressive fibrosis in at least some individuals cannot yet be excluded. ⢠Residual ground glass opacification may be associated with persisting bronchial dilatation and distortion, and might be termed "fibrotic-like changes" probably consistent with prior organizing pneumonia.
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COVID-19 , Neumonía , Radiología , Humanos , Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: This study systematically compares the impact of innovative deep learning image reconstruction (DLIR, TrueFidelity) to conventionally used iterative reconstruction (IR) on nodule volumetry and subjective image quality (IQ) at highly reduced radiation doses. This is essential in the context of low-dose CT lung cancer screening where accurate volumetry and characterization of pulmonary nodules in repeated CT scanning are indispensable. MATERIALS AND METHODS: A standardized CT dataset was established using an anthropomorphic chest phantom (Lungman, Kyoto Kaguku Inc., Kyoto, Japan) containing a set of 3D-printed lung nodules including six diameters (4 to 9 mm) and three morphology classes (lobular, spiculated, smooth), with an established ground truth. Images were acquired at varying radiation doses (6.04, 3.03, 1.54, 0.77, 0.41 and 0.20 mGy) and reconstructed with combinations of reconstruction kernels (soft and hard kernel) and reconstruction algorithms (ASIR-V and DLIR at low, medium and high strength). Semi-automatic volumetry measurements and subjective image quality scores recorded by five radiologists were analyzed with multiple linear regression and mixed-effect ordinal logistic regression models. RESULTS: Volumetric errors of nodules imaged with DLIR are up to 50% lower compared to ASIR-V, especially at radiation doses below 1 mGy and when reconstructed with a hard kernel. Also, across all nodule diameters and morphologies, volumetric errors are commonly lower with DLIR. Furthermore, DLIR renders higher subjective IQ, especially at the sub-mGy doses. Radiologists were up to nine times more likely to score the highest IQ-score to these images compared to those reconstructed with ASIR-V. Lung nodules with irregular margins and small diameters also had an increased likelihood (up to five times more likely) to be ascribed the best IQ scores when reconstructed with DLIR. CONCLUSION: We observed that DLIR performs as good as or even outperforms conventionally used reconstruction algorithms in terms of volumetric accuracy and subjective IQ of nodules in an anthropomorphic chest phantom. As such, DLIR potentially allows to lower the radiation dose to participants of lung cancer screening without compromising accurate measurement and characterization of lung nodules.
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Aprendizaje Profundo , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Fantasmas de Imagen , Dosis de Radiación , Tomografía Computarizada por Rayos X , Humanos , Tomografía Computarizada por Rayos X/métodos , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Nódulo Pulmonar Solitario/diagnóstico por imagen , Nódulo Pulmonar Solitario/patología , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Procesamiento de Imagen Asistido por Computador/métodosRESUMEN
This study's aim was to assess whether deep learning image reconstruction (DLIR) techniques are non-inferior to ASIR-V for the clinical task of pulmonary nodule detection in chest computed tomography. Up to 6 (range 3-6, mean 4.2) artificial lung nodules (diameter: 3, 5, 8 mm; density: -800, -630, +100 HU) were inserted at different locations in the Kyoto Kagaku Lungman phantom. In total, 16 configurations (10 abnormal, 6 normal) were scanned at 7.6, 3, 1.6 and 0.38 mGy CTDIvol (respectively 0, 60, 80 and 95% dose reduction). Images were reconstructed using 50% ASIR-V and a deep learning-based algorithm with low (DL-L), medium (DL-M) and high (DL-H) strength. Four chest radiologists evaluated 256 series by locating and scoring nodules on a five-point scale. No statistically significant difference was found among the reconstruction algorithms (p = 0.987, average across readers AUC: 0.555, 0.561, 0.557, 0.558 for ASIR-V, DL-L, DL-M, DL-H).
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Aprendizaje Profundo , Interpretación de Imagen Radiográfica Asistida por Computador , Algoritmos , Fantasmas de Imagen , Dosis de Radiación , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Bronchopulmonary dysplasia (BPD) remains a common complication of preterm birth. Both historically and in current practice, radiologic evaluation of the lungs has an important role in assessing disease severity and complications. AIM: To provide an overview of imaging techniques for detecting lung abnormalities in patients with BPD in all age ranges. METHODS: A systematic literature search was conducted in PubMed, Web of Science and the Cochrane Library. Records were screened by title and abstract and then by full text. A total of 37 records were selected and included in this qualitative literature overview. RESULTS: Computed tomography (CT) was the most commonly used imaging modality, followed by chest radiography and magnetic resonance imaging (MRI). Several qualitative and quantitative scoring systems were presented and most showed good correlation with BPD severity. The association with functional and clinical outcomes was only rarely reported, showing varying correlation with spirometry results and respiratory exacerbations. MRI is an upcoming imaging technique for BPD that is technically feasible, showing clear differences in the lung parenchyma of patients with BPD. CONCLUSION: Several imaging and scoring methods indicate that lung imaging continues to play a role in BPD care. Standardization and correlation with functional and clinical outcomes will become increasingly important for further research.
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Displasia Broncopulmonar/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Progresión de la Enfermedad , Femenino , Humanos , Lactante , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Nacimiento Prematuro , Radiografía Torácica , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: The purpose of this study was to investigate if lesion detection using a single "All-in-One" (AIO) window was non-inferior to lesion detection on conventional window settings in thoracic oncology chest computed tomography (CT) examinations. MATERIALS AND METHODS: In a retrospective study, 50 consecutive chest CT examinations of 50 patients (31 men, 19 women; mean age 64±10 [SD] years, range: 35-82 years) containing 417 lesions, were reviewed by 6 radiologists, subdivided into 2 groups of 3 radiologists each, with similar levels of expertise in each group (senior staff member, junior staff member and radiology resident). All examinations were reviewed in conventional or AIO window settings by one of the groups. A 'lesion' was defined as any abnormality seen on the chest CT examination, including both benign and malignant lesions, findings in chest and upper abdomen, and measurable and non-measurable disease. Lesions were listed as 'missed' when they were not seen by at least two out of three observers. F-tests were used to evaluate the significance of the variables of interest within a mixed model framework and kappa statistics to report interobserver agreement. RESULTS: On a reader level, 54/417 lesions (12.9%) were not detected by the senior staff member reading the studies in conventional window settings and 45/417 (10.8%) by the senior staff member reading the AIO images. For the junior staff member and radiology resident this was respectively 55/417 (13.2%) and 67/417 (16.1%) for the conventional window settings and 43/417 (10.3%) and 61/417 (14.6%) for the AIO window. On a lesion level, 68/417 (16.3%) were defined as 'missed' lesions (lesions not detected by at least 2 readers): 21/68 (30.9%) on the AIO-window, 30/68 (44.1%) on conventional views and 17/68 (25.0%) on both views. The use of the AIO window did not result in an increase of missed lesions (P>0.99). Interobserver agreement in both groups was similar (P=0.46). Regarding lesions that were categorized as 'missed' on the AIO window or on conventional window settings, there was no effect of location (chest or upper abdomen) (P=0.35), window (P=0.97) and organ (P=0.98). CONCLUSIONS: A single AIO-window is non-inferior to multiple conventional window settings for lesion detection on chest CT examinations in thoracic oncology patients.
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Neoplasias Torácicas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes. The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than "simple" mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung. NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE. Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.
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Hipertensión Pulmonar/fisiopatología , Embolia Pulmonar/fisiopatología , Líquido Amniótico/metabolismo , Biopsia , Líquido del Lavado Bronquioalveolar , Equinococosis/complicaciones , Grasas/metabolismo , Femenino , Gases , Enfermedad Trofoblástica Gestacional/metabolismo , Humanos , Hipertensión Pulmonar/terapia , Neoplasias Pulmonares/complicaciones , Masculino , Embarazo , Embolia Pulmonar/terapia , Sepsis/complicaciones , Tomografía Computarizada por Rayos X/métodosRESUMEN
This paper will discuss the value of medical imaging in the detection and follow-up of bone marrow edema (BME), resulting from acute and chronic trauma in sports. MR imaging is the only imaging technique that allows direct evaluation of bone marrow edema in sports medicine. The use of fat suppressed T2-weighted or STIR images is particularly appropriate to detect bone marrow edema. The extent of bone marrow edema reflects the biomechanics of trauma. Compressive forces between two bony structures will result in extensive areas of bone marrow edema, whereas distraction forces provoke more subtle areas of bone marrow edema at the insertion of supporting structures of joints. In most clinical situations, a combination of compression and distraction forces is present, causing a complex pattern of bone marrow edema. A meticulous pattern approach of the distribution of these bone marrow changes around a joint can reveal in most instances the underlying mechanism of trauma. This may be helpful to analyze which joint supporting structures may be at risk. In the acute setting, plain radiography and CT scan may have an additional role in the detection of small avulsion fractures occurring at the site of minor areas of bone marrow edema. The clinical significance and natural history of bone marrow edema is still a matter of debate.
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Traumatismos en Atletas/patología , Enfermedades de la Médula Ósea/diagnóstico , Médula Ósea/patología , Diagnóstico por Imagen , Edema/diagnóstico , Fenómenos Biomecánicos , HumanosRESUMEN
A wide range of vascular disorders can affect the spleen. Although clinical presentation is often nonspecific, early diagnosis and treatment are mandatory in most conditions. Noninvasive imaging techniques are well suited to meet these objectives. Familiarity with normal macroscopic and microscopic vascular anatomy is a prerequisite to understand the pathophysiology of vascular disorders of the spleen. This article deals with diseases of the splenic vasculature (aneurysms, arteriovenous fistula, splenic vein thrombosis, collateral circulation in portal hypertension) as well as vascular disorders affecting the splenic parenchyma (splenic infarct, Gamna-Gandy bodies). Primary vascular tumors and tumor-like conditions of the spleen will be discussed very briefly.
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Bazo/irrigación sanguínea , Enfermedades del Bazo/diagnóstico , Enfermedades Vasculares/diagnóstico , Diagnóstico Diferencial , HumanosRESUMEN
The spleen is considered 'the forgotten organ' among radiologists and clinicians, although it is well visualised on abdominal computed tomography and magnetic resonance imaging. Moreover, the spleen is commonly involved in a wide range of pathologic disorders. These include congenital anomalies, infectious and inflammatory diseases, vascular disorders, benign and malignant tumours, and systemic disorders. In this review, we focus on the key imaging findings of the normal spleen, its variants, as well as relevant congenital and acquired abnormalities. It is of utmost importance to recognise and correctly interpret the variable spectrum of abnormalities that may involve the spleen, in order to avoid unnecessary invasive procedures and to guide adequate treatment.
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Diagnóstico por Imagen/métodos , Bazo/fisiología , Hemangioma/diagnóstico , Humanos , Inflamación , Linfangioma/diagnóstico , Imagen por Resonancia Magnética , Metástasis de la Neoplasia , Bazo/anomalías , Bazo/patología , Enfermedades del Bazo/diagnóstico , Infarto del Bazo/diagnóstico , Neoplasias del Bazo/diagnóstico , Esplenomegalia/patología , Esplenosis/diagnóstico , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
BACKGROUND: A 59-year-old man was referred for CT scan of the abdomen after repair of an eventrated appendectomy wound. The man had a known history of bipolar affective disorder, for which he had been on lithium therapy for many years. As an incidental finding, CT scan showed numerous small hypodense renal lesions. Subsequently a MRI examination was performed to further characterize these renal abnormalities.
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BACKGROUND: A 26-year-old woman presented at the emergency department with a painful abdomen and fever up to 39°C, despite antibiotics. She had given prematurely birth by caesarian section to a twin 8 days earlier. On clinical examination she had a diffuse painful and tender abdomen, especially on the right side and suprapubic region. Laboratory findings showed an increased c-reactive protein of 24 mg/dL (normal < 0,3) and increased white blood cell count of 13 Å~ 10E9/L (normal 4,3-10 Å~ 10E9/L). There was also a decreased hemoglobin level of 8,4 g/dL (normal 12-15 g/dL). An ultrasonography was performed by the gynecologist and revealed a large heterogeneous fluid collection anteriorly of the uterus.
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We report a case of intestinal ileal lipomatosis in a 56-year-old Caucasian male complicated with small bowel obstruction due to ileocolic intussusception with a lipoma serving as lead point. This rare disease is often only discovered incidentally as a consequence of mechanical complications and not well reported in the international literature, compared to intussusception due to an isolated lipoma. Computed tomography is the imaging modality of choice to depict complications of this distinct clinicopathological entity. Density measurements can confirm the fatty content and homogeneity analysis of the lesions can guide the radiologist in the differential diagnosis.
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Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/etiología , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Lipoma/complicaciones , Lipoma/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Íleon/diagnóstico por imagen , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Intestino Delgado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodosRESUMEN
Significant progress has been made with the introduction of the TNM-7 staging system for non-small cell lung cancer (NSCLC). Constituting the first major revision in 12 years, the seventh edition of NSCLC TNM (TNM-7) is based on the recommendations from the International Association for the Study of Lung Cancer (IASLC) Lung Cancer Staging Project of 2007. This new TNM iteration includes a subset analysis on SCLC and carcinoid tumors. A thorough understanding of its principles by the radiologist is helpful to increase efficiency and to improve communication with the referring clinicians.
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Biopsia/normas , Carcinoma de Pulmón de Células no Pequeñas/patología , Diagnóstico por Imagen/normas , Neoplasias Pulmonares/patología , Guías de Práctica Clínica como Asunto , Humanos , Internacionalidad , Estadificación de NeoplasiasRESUMEN
Hypereosinophilia is a phenomenon which is associated with a broad variety of allergic, infectious, paraneoplastic and systemic diseases. Depending on the aetiology, these disorders differ in severity from self-limiting to life-threatening. Although it is well known that hypereosinophilia can occur in association with a solid tumour, exact numbers of incidence are lacking. We describe a patient with respiratory insufficiency and an elevated level of eosinophils in the peripheral blood. A diagnostic work-up revealed the presence of a disseminated non-small-cell carcinoma of the lung; an association not frequently described.
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Carcinoma de Pulmón de Células no Pequeñas/epidemiología , Eosinofilia/epidemiología , Neoplasias Pulmonares/epidemiología , Síndromes Paraneoplásicos/epidemiología , Anciano , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Carcinoma de Pulmón de Células no Pequeñas/patología , Comorbilidad , Humanos , Neoplasias Pulmonares/patología , Masculino , Insuficiencia Respiratoria/etiología , Tomografía Computarizada por Rayos XRESUMEN
The authors report the case of a 21-year-old man who suffered from a blunt abdominal trauma. Initial imaging revealed a liver laceration at the right lobe, a perirenal hematoma of the right kidney and a hematoma of the right adrenal gland. Follow-up MDCT-scan on day 10 after admission showed at the arterial-phase contrast-enhanced study perfusion alterations and two hepatic pseudoaneurysms. The diagnosis of pseudoaneurysm was confirmed and treated angiographically with superselective coil embolization. A follow-up CT-scan on day 17 showed at a nontreated area an arterioportal shunt and a wedge-shaped transient hepatic parenchymal enhancement. This was confirmed angiographically and subsequently treated with coil embolization.
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Aneurisma Falso/diagnóstico por imagen , Fístula Arteriovenosa/diagnóstico por imagen , Arteria Hepática/lesiones , Tomografía Computarizada por Rayos X/métodos , Accidentes por Caídas , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Angiografía , Fístula Arteriovenosa/etiología , Fístula Arteriovenosa/terapia , Embolización Terapéutica , Arteria Hepática/diagnóstico por imagen , Humanos , Masculino , Adulto JovenRESUMEN
OBJECTIVE: The objective of this study was to describe the angiographic findings of late spontaneous hemarthrosis after total joint arthroplasty and to illustrate the therapeutic role of angiography. MATERIALS AND METHODS: A retrospective multicenter study was performed looking for patients who underwent an angiography for spontaneous hemarthrosis occurring at least 1 month after total joint arthroplasty. Eight patients were included, all suffering from spontaneous hemarthrosis. One patient had an additional large extra-articular hematoma. RESULTS: Angiography in eight cases revealed hypertrophic vascular synovium in seven patients with an additional false aneurysm in one patient. Hypervascularization with pooling of contrast spots was seen in one patient. Five patients underwent selective arterial particulate embolization. Three patients were successfully embolized after one session, one was successful after two sessions, and one patient needed surgery after two embolization sessions. CONCLUSION: Angiography for late spontaneous hemarthrosis is very effective to exclude or establish vascular malformations and to establish the diagnosis of hypertrophic vascular synovium. Selective arterial embolization seems to be a good therapeutic option as alternative to open or arthroscopic synovectomy.
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Artroplastia de Reemplazo , Embolización Terapéutica/métodos , Hemartrosis/diagnóstico por imagen , Hemartrosis/terapia , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/terapia , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
Pneumatosis intestinalis is an unusual entity in which subserosal or submucosal collections of gas occur in the bowel wall. We present a case of asymptomatic linear pneumatosis intestinalis and free abdominal air in a 67-year-old man with acquired immunodeficiency syndrome (AIDS) who improved spontaneously following conservative management. Pneumatosis intestinalis is a late-stage phenomenon in patients with AIDS that characteristically involves the cecum, ascending and transverse colon or the rectum with sparing of the descending colon and the sigmoid. For these patients, non-operative management is appropriate.
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Síndrome de Inmunodeficiencia Adquirida/complicaciones , Neumatosis Cistoide Intestinal/complicaciones , Neumatosis Cistoide Intestinal/diagnóstico por imagen , Anciano , Antifúngicos/administración & dosificación , Aspergillus fumigatus/aislamiento & purificación , Diagnóstico Diferencial , Fatiga/etiología , Humanos , Intestino Grueso/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Masculino , Debilidad Muscular/etiología , Aspergilosis Pulmonar/complicaciones , Aspergilosis Pulmonar/diagnóstico por imagen , Aspergilosis Pulmonar/tratamiento farmacológico , Remisión Espontánea , Tomografía Computarizada por Rayos X , Pérdida de PesoRESUMEN
Magnetic resonance imaging has become the imaging modality of choice for evaluation of internal derangements of the knee. Anatomical variants are often an incidental finding on these examinations. Knowledge and recognition of variants is important, not only to avoid misdiagnosis but also to avoid additional imaging and over-treatment. This pictorial essay provides an overview of variants encountered during a review of 1,873 magnetic resonance imaging examinations of the knee. Emphasis is laid on these variants that are clinically important.
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Diagnóstico por Imagen/métodos , Articulación de la Rodilla/patología , Rodilla/anatomía & histología , Rodilla/patología , Imagen por Resonancia Magnética/métodos , Adolescente , Adulto , Médula Ósea/patología , Femenino , Humanos , Traumatismos de la Rodilla/diagnóstico , Traumatismos de la Rodilla/patología , Ligamentos/patología , Masculino , Persona de Mediana Edad , Modelos Anatómicos , Músculos/patología , Rótula/patologíaRESUMEN
Gorlin-Goltz syndrome is a rare autosomal dominant disorder that involves multiple organ systems, including the skin, skeleton and jaws. We report the case of a mild mentally retarded 7-year-old boy who was referred with a swelling of his left mandible. Imaging studies showed a unilocular well-defined lytic mandibular lesion, calcifications of the falx, bifid ribs and fusion anomalies of the ribs. The mandibular lesion was treated with surgical decompression and proved to represent a keratocyst on histological examination. Further clinical examination revealed cutaneous lesions, Sprengel deformity, pectus excavatum and facial dysmorphism. Based on the combination of imaging and clinical findings the diagnosis of Gorlin-Goltz syndrome was made. This was confirmed by genetic tests. During three-year follow-up the boy presented with recurrent and multiple odontogenic keratocysts. The occurrence of multiple and recurrent keratocysts at young age, should alert the radiologist to the potential diagnosis of an underlying Gorlin-Goltz syndrome. This paper reviews the imaging findings in Gorlin-Goltz syndrome, with emphasis on maxillofacial imaging.