Correlation between chest computed tomography findings and pulmonary function test results in the post-recovery phase of COVID-19.

OBJECTIVE: The radiological and functional lung sequelae in COVID-19 survivors remain unclear. We compared the chest computed tomography findings of COVID-19 patients with normal and abnormal pulmonary function test results in the post-recovery phase. METHODS: The data of consecutive patients who underwent pulmonary function tests and chest computed tomography within 14 days after recovery from COVID-19 at two medical centers between May and October 2020 were collected retrospectively. Two thoracic radiologists who were blinded to the clinical information and pulmonary function test results classified the patients according to the computed tomography features, evidence of fibrotic-like changes, and semi-quantitative quantification of the extent of pulmonary abnormalities. The clinical characteristics and computed tomography findings of patients with normal pulmonary function test results were compared with those of patients with abnormal results. RESULTS: A total of 101 COVID-19 survivors, comprising 48 ambulatory and 53 hospitalized patients, were included at a median of 95 days from initial symptom onset. Computed tomography revealed fibrotic-like changes in 10.9% of patients. A reduction in the diffusion capacity of carbon monoxide was the most common lung function abnormality (19.8%). Abnormal diffusion capacity of carbon monoxide was associated with the presence and extension of lung opacities on chest computed tomography scans and fibrotic pulmonary abnormalities. The sensitivity, specificity, and accuracy of reduced diffusion capacity of carbon monoxide for detecting fibrotic-like pulmonary changes on chest computed tomography scans were 72.7%, 87.8%, and 86.1%, respectively. CONCLUSION: Our study suggests that the presence of an abnormal diffusion capacity of carbon monoxide in the post-recovery phase of COVID-19 is associated with a greater risk of long-term parenchymal lung disease, as evidenced by the presence of fibrotic-like changes on chest computed tomography scans, such as traction bronchiectasis and architectural distortion.

Correlation between chest computed tomography findings and pulmonary function test results in the post-recovery phase of COVID-19

ABSTRACT Objective The radiological and functional lung sequelae in COVID-19 survivors remain unclear. We compared the chest computed tomography findings of COVID-19 patients with normal and abnormal pulmonary function test results in the post-recovery phase. Methods The data of consecutive patients who underwent pulmonary function tests and chest computed tomography within 14 days after recovery from COVID-19 at two medical centers between May and October 2020 were collected retrospectively. Two thoracic radiologists who were blinded to the clinical information and pulmonary function test results classified the patients according to the computed tomography features, evidence of fibrotic-like changes, and semi-quantitative quantification of the extent of pulmonary abnormalities. The clinical characteristics and computed tomography findings of patients with normal pulmonary function test results were compared with those of patients with abnormal results. Results A total of 101 COVID-19 survivors, comprising 48 ambulatory and 53 hospitalized patients, were included at a median of 95 days from initial symptom onset. Computed tomography revealed fibrotic-like changes in 10.9% of patients. A reduction in the diffusion capacity of carbon monoxide was the most common lung function abnormality (19.8%). Abnormal diffusion capacity of carbon monoxide was associated with the presence and extension of lung opacities on chest computed tomography scans and fibrotic pulmonary abnormalities. The sensitivity, specificity, and accuracy of reduced diffusion capacity of carbon monoxide for detecting fibrotic-like pulmonary changes on chest computed tomography scans were 72.7%, 87.8%, and 86.1%, respectively. Conclusion Our study suggests that the presence of an abnormal diffusion capacity of carbon monoxide in the post-recovery phase of COVID-19 is associated with a greater risk of long-term parenchymal lung disease, as evidenced by the presence of fibrotic-like changes on chest computed tomography scans, such as traction bronchiectasis and architectural distortion.

COVID-19 pneumonia assessed at a private hospital, a field hospital, and a public-referral hospital: population analysis, chest computed tomography findings, and outcomes.

Objective: To compare a private quaternary referral hospital, a public tertiary hospital, and a field hospital dedicated to patients with COVID-19, regarding patients' characteristics, clinical parameters, laboratory, imaging findings, and outcomes of patients with confirmed diagnosis of COVID-19. Methods: Retrospective multicenter observational study that assessed the association of clinical, laboratory and CT data of 453 patients with COVID-19, and also their outcomes (hospital discharge or admission, intensive care unit admission, need for mechanical ventilation, and mortality caused by COVID-19). Results: The mean age of patients was 55 years (±16 years), 58.1% of them were male, and 41.9% were female. Considering stratification by the hospital of care, significant differences were observed in the dyspnea, fever, cough, hypertension, diabetes mellitus parameters, and CT score (p < 0.05). Significant differences were observed in ward admission rates, with a lower rate in the private hospital (40.0%), followed by the public hospital (74.1%), and a higher rate in the field hospital (89.4%). Regarding intensive care unit admission, there was a higher rate in the public hospital (25.2%), followed by the private hospital (15.5%), and a lower rate in the field hospital (9.9%). In the analysis of the discharge and death outcomes, it was found that there was a higher number of patients discharged from the private hospital (94.2%), compared to the field hospital (90.1%) and public hospital (82.3%) and a higher number of deaths in the public hospital (17.7%) compared to the private hospital and field hospital (5.8 and 0% respectively). Conclusion: The analysis of the data regarding the population treated with COVID-19 during the first wave in different levels of care in the public and private health systems in the city of São Paulo revealed statistically significant differences between the populations, reflecting distinct outcomes.

Differential diagnoses of acute ground-glass opacity in chest computed tomography: pictorial essay.

Ground-glass opacity is a very frequent and unspecified finding in chest computed tomography. Therefore, it admits a wide range of differential diagnoses in the acute context, from viral pneumonias such as influenza virus, coronavirus disease 2019 and cytomegalovirus and even non-infectious lesions, such as vaping, pulmonary infarction, alveolar hemorrhage and pulmonary edema. For this diagnostic differentiation, ground glass must be correlated with other findings in imaging tests, with laboratory tests and with the patients' clinical condition. In the context of a pandemic, it is extremely important to remember the other pathologies with similar findings to coronavirus disease 2019 in the imaging exams.

Differential diagnoses of acute ground-glass opacity in chest computed tomography: pictorial essay / Diagnósticos diferenciais de opacidade em vidro fosco aguda na tomografia computadorizada de tórax: ensaio pictórico

ABSTRACT Ground-glass opacity is a very frequent and unspecified finding in chest computed tomography. Therefore, it admits a wide range of differential diagnoses in the acute context, from viral pneumonias such as influenza virus, coronavirus disease 2019 and cytomegalovirus and even non-infectious lesions, such as vaping, pulmonary infarction, alveolar hemorrhage and pulmonary edema. For this diagnostic differentiation, ground glass must be correlated with other findings in imaging tests, with laboratory tests and with the patients' clinical condition. In the context of a pandemic, it is extremely important to remember the other pathologies with similar findings to coronavirus disease 2019 in the imaging exams.

RESUMO A opacidade em vidro fosco é uma alteração muito frequente e pouco específica na tomografia computadorizada de tórax. Ela admite grande leque de diagnósticos diferenciais no contexto agudo, desde pneumonias virais, como as causadas pelo vírus influenza, pela doença do coronavírus 2019 e pelo citomegalovírus, até mesmo lesões de origem não infecciosa, como vaping , infarto pulmonar, hemorragia alveolar e edema pulmonar. Para essa diferenciação diagnóstica, deve-se correlacionar o vidro fosco com os demais achados nos exames de imagem, exames laboratoriais e quadro clínico do paciente. É de suma importância, no contexto de pandemia, recordar as demais patologias com os achados semelhantes aos da doença do coronavírus 2019 nos exames de imagem.

Anatomical variations and congenital anomalies of the ribs revisited by multidetector computed tomography.

As they are asymptomatic or have a nonspecific, anatomical variations of the ribs are usually detected as incidental findings on imaging studies. They may be isolated changes or can be related to anomalies or clinical syndromes. Such variations are easily overlooked on conventional radiography and computed tomography if they are not actively investigated, mainly because most indications for a chest X-ray studies aim to evaluate the lung parenchyma and mediastinal structures. The objective of this pictorial essay was to use multislice computed tomography images to illustrate the imaging aspects of the main anatomical variations and congenital anomalies of the ribs.

As variantes anatômicas dos arcos costais são, geralmente, achados incidentais nos exames de imagem, em razão do seu comportamento assintomático ou quadro inespecífico, podendo constituir alterações isoladas ou relacionadas a anomalias e síndromes clínicas. Essas alterações são facilmente negligenciadas na radiografia convencional e na tomografia computadorizada se não forem investigadas ativamente, principalmente quando a maioria das indicações do estudo radiológico do tórax tem como objetivo a avaliação do parênquima pulmonar e das estruturas mediastinais. O objetivo deste artigo é demonstrar, por meio da tomografia computadorizada multidetectores, os aspectos de imagem das principais variantes anatômicas e anomalias congênitas dos arcos costais.

LDCT lung cancer screening in populations at different risk for lung cancer.

INTRODUCTION: The improvement of low-dose CT (LDCT) lung cancer screening selection criteria could help to include more individuals who have lung cancer, or in whom lung cancer will develop, while avoiding significant cost increase. We evaluated baseline results of LDCT lung cancer screening in a population with a heterogeneous risk profile for lung cancer. METHODS: LDCT lung cancer screening was implemented alongside a preventive health programme in a private hospital in Brazil. Individuals older than 45 years, smokers and former smokers, regardless of tobacco exposure, were included. Patients were classified according to the National Lung Screening Trial (NLST) eligibility criteria and to PLCOm2012 6-year lung cancer risk. Patient characteristics, CT positivity rate, detection rate of lung cancer and false-positive rate were assessed. RESULTS: LDCT scans of 472 patients were evaluated and three lung adenocarcinomas were diagnosed. CT positivity rate (Lung-RADS 3/4) was significantly higher (p=0.019) in the NLST group (10.1% (95% CI, 5.9% to 16.9%)) than in the non-NLST group (3.6% (95% CI, 2.62% to 4.83%)) and in the PLCOm2012 high-risk group (14.3% (95% CI, 6.8% to 27.7%)) than in the PLCOm2012 low-risk group (3.7% (95% CI, 2.9% to 4.8%)) (p=0.016). Detection rate of lung cancer was also significantly higher (p=0.018) among PLCOm2012 high-risk patients (5.7% (95% CI, 2.5% to 12.6%)) than in the PLCOm2012 low-risk individuals (0.2% (95% CI, 0.1% to 1.1%)). The false-positive rate for NLST criteria (16.4% (95% CI, 13.2% to 20.1%)) was higher (p<0.001) than for PLCOm2012 criteria (7.6 (95% CI, 5.3% to 10.5%)). DISCUSSION: Our study indicates a lower performance when screening low-risk individuals in comparison to screening patients meeting NLST criteria and PLCOm2012 high-risk patients. Also, incorporating PLCOm2012 6-year lung cancer risk ≥0.0151 as an eligibility criterion seems to increase lung cancer screening effectiveness.

Anatomical variations and congenital anomalies of the ribs revisited by multidetector computed tomography / Variantes anatômicas e anomalias congênitas dos arcos costais revisitadas por meio da tomografia computadorizada de multidetectores

Abstract As they are asymptomatic or have a nonspecific, anatomical variations of the ribs are usually detected as incidental findings on imaging studies. They may be isolated changes or can be related to anomalies or clinical syndromes. Such variations are easily overlooked on conventional radiography and computed tomography if they are not actively investigated, mainly because most indications for a chest X-ray studies aim to evaluate the lung parenchyma and mediastinal structures. The objective of this pictorial essay was to use multislice computed tomography images to illustrate the imaging aspects of the main anatomical variations and congenital anomalies of the ribs.

Resumo As variantes anatômicas dos arcos costais são, geralmente, achados incidentais nos exames de imagem, em razão do seu comportamento assintomático ou quadro inespecífico, podendo constituir alterações isoladas ou relacionadas a anomalias e síndromes clínicas. Essas alterações são facilmente negligenciadas na radiografia convencional e na tomografia computadorizada se não forem investigadas ativamente, principalmente quando a maioria das indicações do estudo radiológico do tórax tem como objetivo a avaliação do parênquima pulmonar e das estruturas mediastinais. O objetivo deste artigo é demonstrar, por meio da tomografia computadorizada multidetectores, os aspectos de imagem das principais variantes anatômicas e anomalias congênitas dos arcos costais.

COVID-19 findings identified in chest computed tomography: a pictorial essay.

The disease caused by the new coronavirus, or COVID-19, has been recently described and became a health issue worldwide. Its diagnosis of certainty is given by polymerase chain reaction. High-resolution computed tomography, however, is useful in the current context of pandemic, especially for the most severe cases, in assessing disease extent, possible differential diagnoses and searching complications. In patients with suspected clinical symptoms and typical imaging findings, in which there is still no laboratory test result, or polymerase chain reaction is not available, the role of this test is still discussed. In addition, it is important to note that part of the patients present false-negative laboratory tests, especially in initial cases, which can delay isolation, favoring the spread of the disease. Thus, knowledge about the COVID-19 and its imaging manifestations is extremely relevant for all physicians involved in the patient care, clinicians or radiologists.

Presentation of pulmonary infection on CT in COVID-19: initial experience in Brazil.

The disease caused by the new coronavirus (SARS-CoV-2), designated COVID-19, emerged in late 2019 in China, in the city of Wuhan (Hubei province), and showed exponential growth in that country. It subsequently spread to all continents, and infection with SARS-CoV-2 is now classified as a pandemic. Given the magnitude achieved, scientific interest in COVID-19 has also grown in the international literature, including its manifestations on imaging studies, particularly on CT. To date, no case series have been published in Brazil. Therefore, our objective was to describe the CT findings in an initial series of 12 patients.