Volume-of-Interest Aware Deep Neural Networks for Rapid Chest CT-Based COVID-19 Patient Risk Assessment.

Since December 2019, the world has been devastated by the Coronavirus Disease 2019 (COVID-19) pandemic. Emergency Departments have been experiencing situations of urgency where clinical experts, without long experience and mature means in the fight against COVID-19, have to rapidly decide the most proper patient treatment. In this context, we introduce an artificially intelligent tool for effective and efficient Computed Tomography (CT)-based risk assessment to improve treatment and patient care. In this paper, we introduce a data-driven approach built on top of volume-of-interest aware deep neural networks for automatic COVID-19 patient risk assessment (discharged, hospitalized, intensive care unit) based on lung infection quantization through segmentation and, subsequently, CT classification. We tackle the high and varying dimensionality of the CT input by detecting and analyzing only a sub-volume of the CT, the Volume-of-Interest (VoI). Differently from recent strategies that consider infected CT slices without requiring any spatial coherency between them, or use the whole lung volume by applying abrupt and lossy volume down-sampling, we assess only the "most infected volume" composed of slices at its original spatial resolution. To achieve the above, we create, present and publish a new labeled and annotated CT dataset with 626 CT samples from COVID-19 patients. The comparison against such strategies proves the effectiveness of our VoI-based approach. We achieve remarkable performance on patient risk assessment evaluated on balanced data by reaching 88.88%, 89.77%, 94.73% and 88.88% accuracy, sensitivity, specificity and F1-score, respectively.

Chest CT in patients with a moderate or high pretest probability of COVID-19 and negative swab.

OBJECTIVES: We aimed to assess the diagnostic performance of CT in patients with a negative first RT-PCR testing and to identify typical features of COVID-19 pneumonia that can guide diagnosis in this case. METHODS: Patients suspected of COVID-19 with a negative first RT-PCR testing were retrospectively revalued after undergoing CT. CT was reviewed by two radiologists and classified as suspected COVID-19 pneumonia, non-COVID-19 pneumonia or negative. The performance of both first RT-PCR result and CT was evaluated by using sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) and by using the second RT-PCR test as the reference standard. CT findings for confirmed COVID-19 positive or negative were compared by using the Pearson chi-squared test (P values < 0.05) RESULTS: Totally, 337 patients suspected of COVID-19 underwent CT and nasopharyngeal swabs in March 2020. Eighty-seven out of 337 patients had a negative first RT-PCR result; of these, 68 repeated RT-PCR testing and were included in the study. The first RT-PCR test showed SE 0, SP = 100%, PPV = NaN, NPV = 70%, AUC = 50%, and CT showed SE = 70% SP = 79%, PPV = 86%, NPV = 76%, AUC = 75%. The most relevant CT variables were ground glass opacity more than 50% and peripheral and/or perihilar distribution. DISCUSSION: Negative RT-PCR test but positive CT features should be highly suggestive of COVID-19 in a cluster or community transmission scenarios, and the second RT-PCR test should be promptly requested to confirm the final diagnosis.

Comparison between 1.5 and 3.0 Tesla magnetic resonance enterography for the assessment of disease activity and complications in ileo-colonic Crohn's disease.

BACKGROUND: Magnetic resonance imaging (MRI) can assess disease activity and severity in Crohn's disease (CD). Three-Tesla magnetic resonance (3T) increases signal-to-noise ratio (SNR) and reduces time of image acquisition (IAT). Whether 3T increases the accuracy of MRI in CD compared to 1.5T is unknown. AIM: We aimed to compare prospectively the accuracy of 3 and 1.5T in ileo-colonic CD patients. METHODS: Twenty-six patients with ileo-colonic CD underwent 1.5 and 3T MR enterography at the same time. Ileocolonoscopy was the reference standard for luminal disease. Sensitivity, specificity and accuracy of MRI in evaluating six signs of active and complicated disease (localization, thickening, enhancement, strictures, entero-enteric fistulas, and ulcers) were calculated for both techniques. RESULTS: Three-Tesla resulted as sensitive, specific, and accurate as 1.5T in detecting disease location (accuracy 0.93 vs. 0.86), bowel wall thickening and enhancement (accuracy 0.92 vs. 0.80 for both parameters), strictures (accuracy 0.90 vs. 0.80) and entero-enteric fistulas (accuracy 0.92 vs. 0.92). 3T was superior to 1.5T in detecting ulcers (0.76 vs. 0.42, P < 0.05). SNR resulted higher in 3T, and IAT resulted shorter than 1.5. CONCLUSIONS: We found that 3T is equally accurate as 1.5T in evaluating ileo-colonic CD. Because of superiority in detecting mucosal ulcers, 3T should be preferred in patients with ileo-colonic CD.