Non-Invasive Assessment of Right Ventricle to Arterial Coupling for Prognosis Stratification of Fibrotic Interstitial Lung Diseases.

Background: The coupling of the right ventricle (RV) to the pulmonary circulation is an indicator of RV performance that can be non-invasively estimated by echocardiography. There are no data about its use in patients affected by fibrotic interstitial lung diseases (f-ILD). Methods: Fifty f-ILD patients, including 27 cases with idiopathic pulmonary fibrosis (IPF) (M = 37; mean age 67 ± 7 years), were studied with standard and speckle-tracking echocardiography and compared with 30 age-matched healthy volunteers. The mean patient follow-up was 70 ± 4 months. Results: Fibrotic ILD patients had a larger right ventricle (RV) and worse diastolic function because the RV global longitudinal strain (GLS) was significantly lower and the systolic pulmonary artery pressure (sPAP) estimates were higher in comparison with those of controls. Conversely, tricuspid annular systolic excursion (TAPSE) did not differ between controls and patients. Median values of TAPSE/sPAP and RV GLS/sPAP were significantly reduced in f-ILD patients (p < 0.0001). Patients with an RV GLS/sPAP below the median value had a shorter survival time (61 vs. 74 months, p = 0.01); this parameter was an independent predictor of a worse outcome. Conclusion: Low estimates of RV GLS/sPAP are predictive of worse outcomes in f-ILD patients. RV coupling seems to be a promising surrogate biomarker of RV performance to discriminate the patient phenotype with significant management and prognosis implications.

Chest CT-based Assessment of 1-year Outcomes after Moderate COVID-19 Pneumonia.

BACKGROUND: COVID-19 pneumonia may lead to pulmonary fibrosis in the long term. Chest CT is useful to evaluate changes in the lung parenchyma over time. PURPOSE: To illustrate the temporal change of lung abnormalities on chest CT scans associated with COVID-19 pneumonia over 1 year. MATERIALS AND METHODS: In this prospective study, patients previously hospitalized due to COVID-19 pneumonia who visited the radiology department of a tertiary care center for imaging follow-up were consecutively enrolled between March 2020 and July 2021. Exclusion criteria were acute respiratory distress syndrome, requirement of intubation and/or mechanical ventilation, pulmonary embolism, and any interstitial lung disease. High-resolution volumetric noncontrast chest CT scans were acquired at 3, 6, and 12 months from the first diagnosis and were compared with baseline CT scans. The imaging features analyzed were ground-glass opacity (GGO), consolidation, pleuroparenchymal band, linear atelectasis, bronchiectasis and/or bronchiolectasis, reticulation, traction bronchiectasis and/or bronchiolectasis, and honeycombing. The prevalence distribution of lung abnormalities was recorded at all time points. RESULTS: Eighty-four participants (56 men; mean age, 61 years ± 11 [SD]) were studied. GGOs and consolidations represented the main baseline lung abnormalities, accounting for a median severity score of 9 (IQR, 7-12.7; maximum possible score, 20), which indicates moderate lung involvement. The baseline prevalence of GGOs decreased from 100% to 2% of participants at 1 year, and that of consolidations decreased from 71% to 0% at 6 months. Fibrotic-like abnormalities (pleuroparenchymal bands, linear atelectasis, bronchiectasis and/or bronchiolectasis) were detected at 3 months (50% of participants), 6 months (42% of participants), and 1 year (5% of participants). Among these, pleuroparenchymal bands were the most represented finding. Fibrotic changes (reticulation and traction bronchiectasis and/or bronchiolectasis) were detected at 3-6 months (2%) and remained stable at 1 year, with no evidence of honeycombing. At 1 year, lung abnormalities due to COVID-19 pneumonia were completely resolved in 78 of 84 (93%) participants. CONCLUSION: Residual lung abnormalities in individuals hospitalized with moderate COVID-19 pneumonia were infrequent, with no evidence of fibrosis at 1-year chest CT. © RSNA, 2022.

Performance of a new quantitative computed tomography index for interstitial lung disease assessment in systemic sclerosis.

Quantitative high resolution computed tomography (HRCT) may objectively assess systemic sclerosis (SSc)-interstitial lung disease (ILD) extent, using three basic densitometric measures: mean lung attenuation (MLA), skewness, and kurtosis. This prospective study aimed to develop a composite index - computerized integrated index (CII) - that accounted for MLA, skewness, and kurtosis by means of Principal Component Analysis over HRCTs of 83 consecutive SSc subjects, thus eliminating redundancies. Correlations among CII, cardiopulmonary function and immune-inflammatory biomarkers (e.g. sIL-2Rα and CCL18 serum levels) were explored. ILD was detected in 47% of patients at visual HRCT assessment. These patients had worse CII values than patients without ILD. The CII correlated with lung function at both baseline and follow-up, and with sIL-2Rα and CCL18 serum levels. The best discriminating CII value for ILD was 0.1966 (AUC = 0.77; sensitivity = 0.81 [95%CI:0.68-0.92]; specificity = 0.66 [95%CI:0.52-0.80]). Thirty-four percent of patients without visual trace of ILD had a CII lower than 0.1966, and 67% of them had a diffusing lung capacity for CO <80% of predicted. We showed that this new composite CT index for SSc-ILD assessment correlates with both lung function and immune-inflammatory parameters and could be sufficiently sensitive for capturing early lung density changes in visually ILD-free patients.

Assessment of thoracic ultrasound in complementary diagnosis and in follow up of community-acquired pneumonia (cap).

BACKGROUND: Chest X-ray (CXR) is the primary diagnostic tool for community-acquired pneumonia (CAP). Some authors recently proposed that thoracic ultrasound (TUS) could valuably flank or even reliably substitute CXR in the diagnosis and follow-up of CAP. We investigated the clinical utility of TUS in a large sample of patients with CAP, to challenge the hypothesis that it may be a substitute for CXR. METHODS: Out of 645 consecutive patients with a CXR-confirmed CAP diagnosed in the emergency room of our hospital over a three-years period, 510 were subsequently admitted to our department of Internal Medicine. These patients were evaluated by TUS by a well-trained operator who was blinded of the initial diagnosis. TUS scans were performed both at admission and repeated at day 4-6th and 9-14th during stay. RESULTS: TUS identified 375/510 (73.5%) of CXR-confirmed lesions, mostly located in posterior-basal or mid-thoracic areas of the lungs. Pleural effusion was detected in 26.9% of patients by CXR and in 30.4% by TUS. TUS documented the change in size of the consolidated areas as follows: 6.3 ± 3.4 cm at time 0, 2.5 ± 1.8 at 4-6 d, 0.9 ± 1.4 at 9-14 d. Out of the 12 patients with delayed CAP healing, 7 of them turned out to have lung cancer. CONCLUSIONS: TUS allowed to detect lung consolidations in over 70% of patients with CXR-confirmed CAP, but it gave false negative results in 26.5% of cases. Our longitudinal results confirm the role of TUS in the follow-up of detectable lesions. Thus, TUS should be regarded as a complementary and monitoring tool in pneumonia, instead of a primary imaging modality.

Imaging assessment and clinical significance of pneumatosis in adult patients.

Gas detection in the bowel wall and in portomesenteric venous vessels in adults has long been related to intestinal infarction and poor outcome; many case reports have shown that pneumatosis may be associated with a large variety of pathological situations, ranging from absolutely benign and asymptomatic forms to abdominal catastrophes. Several studies have been conducted on this topic with different conclusions, probably due to differences in population so that the clinical value of these signs is still questioned. Intestinal pneumatosis, especially if presenting with a band-like pattern and if associated with portomesenteric vein gas, when observed in an acute abdominal setting should raise the suspicion of mesenteric infarct and prompt a careful search for other signs of intestinal involvement, so as not to miss cases of life-threatening intestinal infarct or allow them to further evolve into extensive necrosis with worse prognosis. In this review we illustrate the most relevant aspects of these debated but significant radiological signs.