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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 , Pneumonia , Radiologia , Humanos , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosRESUMO
Acute pulmonary embolism (PE) is a life-threatening condition that requires prompt diagnosis and treatment. Recent advances in imaging allow acute and rapid recognition even by the non-specialist radiologist. Most acute emboli resolve on anticoagulation without sequelae; however, some emboli fail to fully resolve becoming endothelialised with the development of chronic thromboembolic disease (CTED). Increased pulmonary vascular resistance arising from CTED may lead to chronic thromboembolic pulmonary hypertension (CTEPH) a debilitating disease affecting up to 5% of survivors of acute PE. Diagnostic evaluation is more complex in CTEPH/CTED than acute PE with subtle imaging features often being overlooked or misinterpreted. Differentiation of acute from chronic PE and from other forms of pulmonary hypertension has profound therapeutic implications. Diverse imaging techniques are available to diagnose and monitor PEs both in the acute and chronic setting. Broadly they include techniques that provide data on lung parenchymal perfusion (ventilation-perfusion [VQ] scintigraphy), angiographic techniques (computed tomography [CT], magnetic resonance imaging [MRI], and invasive angiography) or a combination of both (MR angiography and time-resolved angiography or dual-energy CT angiography). This review aims to describe state of the art imaging highlighting the strength and weaknesses of individual techniques in the diagnosis of acute and chronic PE.
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Imageamento por Ressonância Magnética/métodos , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Angiografia/métodos , Doença Crônica , Humanos , Pulmão/diagnóstico por imagemRESUMO
BACKGROUND: Lung cancer screening using low-dose CT (LDCT) was shown to reduce lung cancer mortality by 20% in the National Lung Screening Trial. METHODS: The pilot UK Lung Cancer Screening (UKLS) is a randomised controlled trial of LDCT screening for lung cancer versus usual care. A population-based questionnaire was used to identify high-risk individuals. CT screen-detected nodules were managed by a pre-specified protocol. Cost effectiveness was modelled with reference to the National Lung Cancer Screening Trial mortality reduction. RESULTS: 247â 354 individuals aged 50-75â years were approached; 30.7% expressed an interest, 8729 (11.5%) were eligible and 4055 were randomised, 2028 into the CT arm (1994 underwent a CT). Forty-two participants (2.1%) had confirmed lung cancer, 34 (1.7%) at baseline and 8 (0.4%) at the 12-month scan. 28/42 (66.7%) had stage I disease, 36/42 (85.7%) had stage I or II disease. 35/42 (83.3%) had surgical resection. 536 subjects had nodules greater than 50â mm(3) or 5â mm diameter and 41/536 were found to have lung cancer. One further cancer was detected by follow-up of nodules between 15 and 50â mm(3) at 12â months. The baseline estimate for the incremental cost-effectiveness ratio of once-only CT screening, under the UKLS protocol, was £8466 per quality adjusted life year gained (CI £5542 to £12â 569). CONCLUSIONS: The UKLS pilot trial demonstrated that it is possible to detect lung cancer at an early stage and deliver potentially curative treatment in over 80% of cases. Health economic analysis suggests that the intervention would be cost effective-this needs to be confirmed using data on observed lung cancer mortality reduction. TRIAL REGISTRATION: ISRCTN 78513845.
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Detecção Precoce de Câncer/métodos , Neoplasias Pulmonares/diagnóstico , Programas de Rastreamento/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prevalência , Prognóstico , Reprodutibilidade dos Testes , Inquéritos e Questionários , Reino Unido/epidemiologiaRESUMO
Chronic thromboembolic pulmonary hypertension (CTEPH) is a debilitating disease caused by chronic obstruction of pulmonary artery branches following episodes of pulmonary embolism and incomplete thrombus resolution. The prognosis of patients with CTEPH is poor unless an early diagnosis is made and treatment is initiated. Chest radiography and echocardiography are used in the initial assessment of suspected pulmonary hypertension. A diagnosis of CTEPH may be confirmed by the presence of a mismatched wedge-shaped perfusion deficit during ventilation/perfusion scintigraphy or characteristic findings during multi-slice computed tomography (CT) angiography, including a mosaic perfusion pattern, dilatation of proximal pulmonary arteries and right heart chambers, and the presence of vascular stenosis or obstruction. Prior to possible surgery, pulmonary angiography remains the definitive diagnostic technique, indicating the site and accessibility of the obstruction. However, many centres utilise CT and magnetic resonance imaging following recent advances in these noninvasive techniques. Haemodynamic evaluation via right heart catheterisation is also mandatory, as pulmonary vascular resistance is the most important determinant of both prognosis and the risk associated with pulmonary endarterectomy surgery. Accurate CTEPH diagnosis and characterisation of its extent and distribution are imperative to allow the prompt initiation of treatment, particularly surgical pulmonary endarterectomy in eligible patients.
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Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia , Embolia Pulmonar/complicações , Idoso , Angiografia , Cateterismo Cardíaco , Doença Crônica , Endarterectomia , Humanos , Hipertensão Pulmonar/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Respiratory disease is a significant cause of morbidity and mortality amongst patients with primary immunodeficiency disorders. Computed tomography (CT) plays an important role in the multidisciplinary approach to these conditions, in detecting, characterizing, and quantifying the extent of lung damage and in directing treatment. The aim of this review is to classify the primary immunodeficiency disorders and describe the thoracic complications and the associated CT findings whilst discussing the role of radiology in diagnosis and surveillance.
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Imunodeficiência de Variável Comum/diagnóstico por imagem , Doenças Respiratórias/diagnóstico por imagem , Adulto , Imunodeficiência de Variável Comum/complicações , Diagnóstico Diferencial , Feminino , Humanos , Síndromes de Imunodeficiência/complicações , Síndromes de Imunodeficiência/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Doenças Respiratórias/complicações , Tomografia Computadorizada por Raios X/métodosRESUMO
Myocardial infarction (MI) secondary to coronary artery disease remains the leading cause of death in the western world. The advent of early reperfusion therapy has substantially decreased in-hospital mortality and has improved the outcome in survivors of the acute phase of MI. Complications of MI include ischaemic, mechanical, arrhythmic, embolic and inflammatory disturbances. Although some of these complications may be infrequent, their importance is underscored because of the potential ability to correct them with early diagnosis and appropriate treatment. The majority of these complications will be detected on clinical examination and confirmed by echocardiography. Some patients may undergo non-electrocardiogram (ECG)-gated thoracic multidetector-row computed tomography (MDCT) due to non-specific presentation. In this group, it is imperative for the radiologist to be aware of and be confident in diagnosing the complications secondary to MI. This review illustrates the spectrum and imaging features of acute and chronic complications of MI that can be visualized on both ECG-gated cardiac and non-ECG-gated thoracic MDCT.
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Infarto do Miocárdio/complicações , Angiografia Coronária , Eletrocardiografia/métodos , Mortalidade Hospitalar , Humanos , Infarto do Miocárdio/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosAssuntos
Hipertensão Pulmonar/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doença Crônica , Feminino , Humanos , Hipertensão Pulmonar/complicações , Pessoa de Meia-Idade , Embolia Pulmonar/complicaçõesRESUMO
Atrial septal defects are associated with significant morbidity and mortality. Echocardiography is the first-line imaging modality, but MR and CT imaging can provide complimentary information, especially for the detection of associated anomalies and for assessing changes in the pulmonary vasculature. The aim of this pictorial essay is to review the spectrum of atrial septal defects, with particular reference to their cross-sectional imaging appearances and issues pertaining to management.
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Ecocardiografia/métodos , Comunicação Interatrial/diagnóstico , Aumento da Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , HumanosRESUMO
The aortic root links the left ventricle and ascending aorta and functions as a support structure for the aortic valve. It can be affected by a variety of congenital and acquired conditions, some of which are potentially life threatening. Echocardiography and cardiac magnetic resonance imaging are established non-invasive imaging techniques for assessing the aortic root. Recent technological advances have allowed multidetector computed tomography to emerge as an alternative means of assessing this aortic segment. This pictorial essay reviews the anatomy of the aortic root and illustrates the salient computed tomography imaging features of a range of congenital and acquired conditions that may affect it.
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Aorta/anormalidades , Doenças da Aorta/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doenças da Aorta/congênito , Doenças da Aorta/etiologia , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Aortografia/métodos , Humanos , Ilustração Médica , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagemRESUMO
Multidetector computed tomography (MDCT) is widely used in the assessment of cardiothoracic disease and provides high-resolution images of the heart, great vessels, and lungs. A range of cardiothoracic conditions can precipitate stroke, including intracardiac thrombus, right-to-left shunts, and diseases of the thoracic aorta. Many of these conditions may be identified on non-electrocardiogram (ECG)-gated studies, but the advent of high temporal resolution ECG-gated MDCT provides superior anatomical delineation. Radiologists should be familiar with the pathogenesis and CT features of cardiothoracic conditions that can precipitate stroke as their early identification to enables appropriate management and prognostic decisions.
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Cardiopatias/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto , Idoso , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico por imagem , Meios de Contraste , Embolia Paradoxal/complicações , Embolia Paradoxal/diagnóstico por imagem , Endocardite/complicações , Endocardite/diagnóstico por imagem , Feminino , Cardiopatias/complicações , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/complicações , Mixoma/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Acidente Vascular Cerebral/etiologia , Trombose/complicações , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagemAssuntos
Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Idoso , Doença Crônica , Meios de Contraste , Feminino , Humanos , Compostos de Iodo , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por ComputadorRESUMO
Heart failure is the leading cause of hospitalisation in the UK, and its prevalence is expected to increase further in the future due partly to an aging population. Although pharmacological agents remain the mainstay of therapy, an increasing number of surgical and novel minimally invasive interventions have been developed for the treatment of both acute and chronic heart failure. Imaging is essential for diagnosis, guiding therapeutic options, and monitoring therapy and its complications. As a result, radiologists should be familiar with the pathogenesis, treatment options, and imaging-related issues pertaining to the management of these patients.
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Diagnóstico por Imagem/métodos , Insuficiência Cardíaca/diagnóstico , Disfunção Ventricular Esquerda/diagnóstico , Idoso , Estimulação Cardíaca Artificial , Doença Crônica , Ecocardiografia/métodos , Feminino , Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Marca-Passo Artificial , Ventriculografia com Radionuclídeos/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Reino Unido , Disfunção Ventricular Esquerda/cirurgiaAssuntos
Antirreumáticos/efeitos adversos , Imunoglobulina G/efeitos adversos , Pneumopatias/induzido quimicamente , Nódulo Reumatoide/induzido quimicamente , Artrite Reumatoide/tratamento farmacológico , Diagnóstico Diferencial , Etanercepte , Feminino , Humanos , Pessoa de Meia-Idade , Receptores do Fator de Necrose Tumoral , Tuberculose Pulmonar/diagnóstico , Fator de Necrose Tumoral alfa/antagonistas & inibidoresAssuntos
Aneurisma Roto/diagnóstico por imagem , Artérias Torácicas/diagnóstico por imagem , Medicina Aeroespacial , Idoso , Aeronaves , Dispneia/etiologia , Hematoma/etiologia , Humanos , Masculino , Doenças Pleurais/etiologia , Ruptura Espontânea/diagnóstico por imagem , Dor de Ombro/etiologia , Tomografia Computadorizada por Raios X , ViagemRESUMO
The aim of the current study was to investigate the prevalence and clinical associations of nontuberculous mycobacteria (NTM) in a well-characterised cohort of patients with adult-onset bronchiectasis. The sputum of all patients attending a tertiary referral bronchiectasis clinic between April 2002 and August 2003 was examined for mycobacteria as part of an extensive diagnostic work-up. NTM-positive patients subsequently had further sputa examined. A modified bronchiectasis scoring system was applied to all high-resolution computed tomography (HRCT) scans from NTM-positive patients, and a matched cohort without NTM. Out of 98 patients attending the clinic, 10 had NTM in their sputum on first culture; of those, eight provided multiple positive cultures. Three patients were treated for NTM infection. A higher proportion of NTM-positive than -negative patients were subsequently diagnosed with cystic fibrosis (two out of nine versus two out of 75). On HRCT scoring, more patients in the NTM-positive group had peripheral mucus plugging than in the NTM-negative group. In the current prospective study of a large cohort of patients with bronchiectasis, 10% cultured positive for nontuberculous mycobacteria in a random clinic sputum sample. Few clinical parameters were helpful in discriminating between groups, except for a higher prevalence of previously undiagnosed cystic fibrosis and of peripheral mucus plugging on high-resolution computed tomography in the nontuberculous mycobacteria group.
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Bronquiectasia/microbiologia , Infecções por Mycobacterium/microbiologia , Micobactérias não Tuberculosas/isolamento & purificação , Tuberculose Pulmonar/microbiologia , Idoso , Idoso de 80 Anos ou mais , Bronquiectasia/complicações , Bronquiectasia/diagnóstico por imagem , Estudos de Coortes , Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mutação/genética , Infecções por Mycobacterium/diagnóstico por imagem , Infecções por Mycobacterium/fisiopatologia , Prevalência , Estudos Prospectivos , Escarro/microbiologia , Tomografia Computadorizada Espiral/métodos , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/patologiaRESUMO
BACKGROUND: Cigarette smoking causes accelerated facial wrinkling and predisposes to chronic obstructive pulmonary disease (COPD). However, it has long been recognised that there is a subgroup of susceptible smokers who are at increased risk of developing airflow obstruction. We have tested the hypothesis that there is a common susceptibility for the development of COPD and facial wrinkling in cigarette smokers. METHODS: One hundred and forty nine current and ex-smokers were recruited from a family based study of COPD genetics, 68 (45.6%) of whom fulfilled the definition of COPD. 124 (83.2%) had no or minor facial wrinkling (Daniell
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Doença Pulmonar Obstrutiva Crônica/etiologia , Envelhecimento da Pele , Fumar/efeitos adversos , Suscetibilidade a Doenças , Face/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/patologia , Envelhecimento da Pele/patologiaRESUMO
Imaging plays a pivotal role in the selection of patients for the surgical treatment of emphysema. In this article, the imaging features of emphysema are reviewed along with the surgical options for treatment. Particular emphasis is given to lung volume reduction surgery as this technique has gained wide acceptance within the thoracic surgical community in recent years. Radiologists need to have an understanding of which patients may be potentially suitable for this technique.