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1.
J Laryngol Otol ; 135(3): 255-258, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33648615

RESUMO

BACKGROUND: There is a paucity of Asian-based data regarding the diagnostic yield of computed tomography imaging in the initial assessment of idiopathic unilateral vocal fold palsy. OBJECTIVES: To investigate the diagnostic yield of computed tomography in idiopathic unilateral vocal fold palsy cases in an Asian tertiary hospital, and to determine the causative pathologies and positive predictive factors. METHOD: A retrospective chart review was conducted of patients (between 2010 and 2018) with a clinical diagnosis of idiopathic unilateral vocal fold palsy who underwent contrast-enhanced computed tomography of the neck and chest at Tan Tock Seng Hospital, Singapore. RESULTS: The overall computed tomography diagnostic yield was 21 per cent, with malignancy accounting for 63.6 per cent of diagnoses. Degree of vocal fold weakness was the only significant predictor of positive computed tomography findings (11.5 per cent in vocal fold paresis vs 29.1 per cent in vocal fold paralysis, p = 0.025). None of the patients with negative computed tomography findings went on to develop disease after a mean follow up of 14.3 months. CONCLUSION: Computed tomography is a useful initial investigation for idiopathic unilateral vocal fold palsy, particularly in cases with vocal fold paralysis.


Assuntos
Tomografia Computadorizada por Raios X/estatística & dados numéricos , Paralisia das Pregas Vocais/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Singapura , Prega Vocal/diagnóstico por imagem
2.
Cochrane Database Syst Rev ; 3: CD013639, 2021 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-33724443

RESUMO

BACKGROUND: The respiratory illness caused by SARS-CoV-2 infection continues to present diagnostic challenges. Our 2020 edition of this review showed thoracic (chest) imaging to be sensitive and moderately specific in the diagnosis of coronavirus disease 2019 (COVID-19). In this update, we include new relevant studies, and have removed studies with case-control designs, and those not intended to be diagnostic test accuracy studies. OBJECTIVES: To evaluate the diagnostic accuracy of thoracic imaging (computed tomography (CT), X-ray and ultrasound) in people with suspected COVID-19. SEARCH METHODS: We searched the COVID-19 Living Evidence Database from the University of Bern, the Cochrane COVID-19 Study Register, The Stephen B. Thacker CDC Library, and repositories of COVID-19 publications through to 30 September 2020. We did not apply any language restrictions. SELECTION CRITERIA: We included studies of all designs, except for case-control, that recruited participants of any age group suspected to have COVID-19 and that reported estimates of test accuracy or provided data from which we could compute estimates. DATA COLLECTION AND ANALYSIS: The review authors independently and in duplicate screened articles, extracted data and assessed risk of bias and applicability concerns using the QUADAS-2 domain-list. We presented the results of estimated sensitivity and specificity using paired forest plots, and we summarised pooled estimates in tables. We used a bivariate meta-analysis model where appropriate. We presented the uncertainty of accuracy estimates using 95% confidence intervals (CIs). MAIN RESULTS: We included 51 studies with 19,775 participants suspected of having COVID-19, of whom 10,155 (51%) had a final diagnosis of COVID-19. Forty-seven studies evaluated one imaging modality each, and four studies evaluated two imaging modalities each. All studies used RT-PCR as the reference standard for the diagnosis of COVID-19, with 47 studies using only RT-PCR and four studies using a combination of RT-PCR and other criteria (such as clinical signs, imaging tests, positive contacts, and follow-up phone calls) as the reference standard. Studies were conducted in Europe (33), Asia (13), North America (3) and South America (2); including only adults (26), all ages (21), children only (1), adults over 70 years (1), and unclear (2); in inpatients (2), outpatients (32), and setting unclear (17). Risk of bias was high or unclear in thirty-two (63%) studies with respect to participant selection, 40 (78%) studies with respect to reference standard, 30 (59%) studies with respect to index test, and 24 (47%) studies with respect to participant flow. For chest CT (41 studies, 16,133 participants, 8110 (50%) cases), the sensitivity ranged from 56.3% to 100%, and specificity ranged from 25.4% to 97.4%. The pooled sensitivity of chest CT was 87.9% (95% CI 84.6 to 90.6) and the pooled specificity was 80.0% (95% CI 74.9 to 84.3). There was no statistical evidence indicating that reference standard conduct and definition for index test positivity were sources of heterogeneity for CT studies. Nine chest CT studies (2807 participants, 1139 (41%) cases) used the COVID-19 Reporting and Data System (CO-RADS) scoring system, which has five thresholds to define index test positivity. At a CO-RADS threshold of 5 (7 studies), the sensitivity ranged from 41.5% to 77.9% and the pooled sensitivity was 67.0% (95% CI 56.4 to 76.2); the specificity ranged from 83.5% to 96.2%; and the pooled specificity was 91.3% (95% CI 87.6 to 94.0). At a CO-RADS threshold of 4 (7 studies), the sensitivity ranged from 56.3% to 92.9% and the pooled sensitivity was 83.5% (95% CI 74.4 to 89.7); the specificity ranged from 77.2% to 90.4% and the pooled specificity was 83.6% (95% CI 80.5 to 86.4). For chest X-ray (9 studies, 3694 participants, 2111 (57%) cases) the sensitivity ranged from 51.9% to 94.4% and specificity ranged from 40.4% to 88.9%. The pooled sensitivity of chest X-ray was 80.6% (95% CI 69.1 to 88.6) and the pooled specificity was 71.5% (95% CI 59.8 to 80.8). For ultrasound of the lungs (5 studies, 446 participants, 211 (47%) cases) the sensitivity ranged from 68.2% to 96.8% and specificity ranged from 21.3% to 78.9%. The pooled sensitivity of ultrasound was 86.4% (95% CI 72.7 to 93.9) and the pooled specificity was 54.6% (95% CI 35.3 to 72.6). Based on an indirect comparison using all included studies, chest CT had a higher specificity than ultrasound. For indirect comparisons of chest CT and chest X-ray, or chest X-ray and ultrasound, the data did not show differences in specificity or sensitivity. AUTHORS' CONCLUSIONS: Our findings indicate that chest CT is sensitive and moderately specific for the diagnosis of COVID-19. Chest X-ray is moderately sensitive and moderately specific for the diagnosis of COVID-19. Ultrasound is sensitive but not specific for the diagnosis of COVID-19. Thus, chest CT and ultrasound may have more utility for excluding COVID-19 than for differentiating SARS-CoV-2 infection from other causes of respiratory illness. Future diagnostic accuracy studies should pre-define positive imaging findings, include direct comparisons of the various modalities of interest in the same participant population, and implement improved reporting practices.


Assuntos
/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X , Ultrassonografia , Adolescente , Adulto , Idoso , Viés , Criança , Intervalos de Confiança , Humanos , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Radiografia Torácica/normas , Radiografia Torácica/estatística & dados numéricos , Padrões de Referência , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/normas , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ultrassonografia/normas , Ultrassonografia/estatística & dados numéricos , Adulto Jovem
3.
Medicine (Baltimore) ; 100(12): e25217, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761708

RESUMO

ABSTRACT: Lung ultrasound (LUS) has recently been used to identify interstitial lung disease (ILD). However, data on the role of LUS in the detection of ILD remain limited. The aim of this study was to investigate the diagnostic value of LUS compared with high-resolution computed tomography (HRCT) in patients with ILD.The retrospective study was carried out by reviewing the medical records of patients with respiratory signs and symptoms discharged from the respiratory ward. Only patients with suspected ILD who underwent HRCT and LUS within a week were selected. ILD was identified with a semi-quantitative score of B-lines >5 and a Warrick score >0 points. The endpoints of LUS in diagnosing ILD (i.e., sensitivity, specificity, positive likelihood ratio [PLR], negative likelihood ratio [NLR], positive predictive value [PPV], and negative predictive value [NPV], and receiver operating characteristic [ROC] curve) was compared with that of HRCT. The reference standard used for the diagnosis of ILD was based on history, clinical findings and examination, and laboratory and instrumental tests, including pulmonary function tests, lung histopathology, and HRCT (without LUS findings).The final clinical diagnosis of ILD was 55 in 66 patients with suspected ILD. HRCT was positive in 55 patients, whereas LUS detected ILD in 51 patients. Four patients with negative LUS findings were positive on HRCT. The results showed 93% sensitivity, 73% specificity, 3.40 PLR, 0.10 NLR, 94% PPV, and 67% NPV for LUS, whereas 100% sensitivity, 82% specificity, 5.49 PLR, 0.01 NLR, 97% PPV, and 100% NPV for HRCT. Comparison of the 2 ROC curves revealed significant difference in the diagnostic value of the 2 methods for the diagnosis of ILD (P = .048).Our results indicated that LUS is a useful technique to identify ILD. Considering its non-radiation, portable and non-invasive advantages, LUS should be recommended as a valuable screening tool in patients with suspected ILD.


Assuntos
Doenças Pulmonares Intersticiais , Pulmão/diagnóstico por imagem , Ultrassonografia , China/epidemiologia , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/epidemiologia , Masculino , Programas de Rastreamento/métodos , Registros Médicos Orientados a Problemas , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Testes de Função Respiratória , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos
4.
Medicine (Baltimore) ; 100(10): e25005, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725880

RESUMO

ABSTRACT: The role of thoracic CT (computerized tomography) in monitoring disease course of COVID-19 is controversial. The purpose of this study is to investigate the risk factors and predictive value of deterioration on repeatedly performed CT scan during hospitalization.All COVID-19 patients treated in our isolation ward, from January 22, 2020 to February 7, 2020, were reviewed. Patients included were categorized into RD (Radiological Deterioration) group or NRD (No Radiological Deterioration) group according to the manifestation on the CT routinely performed during the hospitalization. All clinical data and CT images were analyzed.Forty three patients were included in our study. All are moderate cases with at least 4 CT scans each. Eighteen (42.9%) patients had radiological deteriorations which were all identified in CT2 (the first CT after admission). Patients in RD group had lower leukocyte count (P = .003), lymphocyte count (P = .030), and higher prevalence (P = .012) of elevated C-reactive protein (CRP) at admission. NRD patients had a lower prevalence of reticulations (P = .034) on baseline CT (CT1, performed within 2 days before admission) and a longer duration between symptom onset and the time of CT2 (P < .01). There was no significant difference in hospital stay or fibrotic change on CT4 (follow-up CT scan performed 4 weeks after discharge) between 2 groups. Shorter duration between symptom onset and CT2 time (odds ratio [OR], 0.436; 95% confidence interval: 0.233-0.816; P < .01) and lower leukocyte count in baseline evaluation (OR, 0.316; 95% CI: 0.116-0.859; P < .05) were associated with increased odds of radiological deterioration on CT image during hospitalization.For moderate COVID-19 patients, the value of routinely performed CT during the treatment is limited. We recommend avoiding using CT as a routine monitor in moderate COVID-19 patients.


Assuntos
/diagnóstico por imagem , Progressão da Doença , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Adulto , Idoso , Proteína C-Reativa/análise , Deterioração Clínica , Feminino , Humanos , Tempo de Internação , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Tempo para o Tratamento , Adulto Jovem
5.
Medicine (Baltimore) ; 100(5): e24271, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592870

RESUMO

ABSTRACT: Recent reports have documented an unchanged rate of occurrence of colorectal cancer (CRC) and have publicised doubts regarding the benefit of prompt colonoscopy procedures after an episode of acute diverticulitis (AD). These reports mandate further evaluation of colonoscopy yield and timing in this regard. The current study aims to determine whether the rate of advanced colonic neoplasia after AD differs from that of average-risk patients, and to identify risk factors that are associated with their development.In this retrospective study, we included all patients who had been hospitalized to the surgery ward in the years 2008 to 2016 with radiographically confirmed AD, and had completed colonoscopies within one year of index hospitalization. Patients who were referred for screening colonoscopies during the same years were included as a control group. We compared the rates of diagnosis of CRC and advanced polyps for both groups before and after adjustment for multiple confounders. Moreover, we investigated risk factors that were associated with increased rate of advanced neoplasia diagnosis.A total of 350 patients were included in the AD group and 1502 patients in the screening colonoscopy control group. The CRC diagnosis rates (1.7% vs 0.3%; P = .09) and overall diagnosis rates of advanced neoplasia (12.3% vs 9.6%; P = .19) were not significantly different when findings were compared between the AD and control groups, respectively. Cases of complicated diverticulitis, however, were associated with increased risk of advanced neoplasia diagnosis (odds ratio (OR) 3.729, 95% confidence interval (CI) 1.803-7.713; P = .01).The diagnosis rate for advanced neoplasia after AD was not significantly different from that of average-risk populations. A course of complicated AD, however, was a potential risk factor.


Assuntos
Colonoscopia , Neoplasias Colorretais/diagnóstico , Doença Diverticular do Colo , Detecção Precoce de Câncer , Neoplasias , Exacerbação dos Sintomas , Colonoscopia/métodos , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Correlação de Dados , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/epidemiologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos
6.
Clin Exp Hypertens ; 43(4): 341-348, 2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-33583283

RESUMO

OBJECTIVE: There is not enough data on the effect of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) on lung involvement in patients with COVID-19 pneumonia and hypertension (HT). Our aim was to compare the lung involvement of the HT patients hospitalized for COVID-19 using ACEIs/ARBs with the patients taking other anti-HT medications. METHODS: : Patients who have a diagnosis of HT among the patients treated for laboratory-confirmed COVID-19 between 31 March 2020 and 28 May 2020 were included in the study. One hundred and twenty-four patients were divided into two as ACEIs/ARBs group (n = 75) and non-ACEIs/ARBs group (n = 49) according to the anti-HT drug used. The chest CT involvement areas of these two groups were evaluated quantitatively by two observers including all lobes, and total severity score (TSS) was calculated. These TSS values were compared between drug groups and clinical groups. RESULTS: In clinical classification; there were 4 (%3.2) asymptomatic, 5 (4.0%) mild type, 92 (74.1%) common type, 14 (11.3%) severe type, 9 (7.3%) critical type patients. ACEI/ARB group's TSS (mean±SD, 7.74 ± 3.54) was statistically higher than other anti-HT medication group (mean±SD, 4.40 ± 1.89) (p < .001). Likewise, severe-critical clinical type's TSS (mean±SD, 9.17 ± 3.44) was statistically higher than common type (mean±SD, 5.76 ± 3.07) (p < .001). Excellent agreement was established between the two blinded observers in the TSS measurements. CONCLUSIONS: Quantitative evaluation of CT and TSS score can give an idea about the clinical classification of the patient. TSS is higher in ACEI/ARB group than non-ACEIs/ARBs group.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Hipertensão , Pulmão , /diagnóstico , /fisiopatologia , Correlação de Dados , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Pulmão/virologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Turquia/epidemiologia
7.
Radiology ; 299(1): E204-E213, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33399506

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic is a global health care emergency. Although reverse-transcription polymerase chain reaction testing is the reference standard method to identify patients with COVID-19 infection, chest radiography and CT play a vital role in the detection and management of these patients. Prediction models for COVID-19 imaging are rapidly being developed to support medical decision making. However, inadequate availability of a diverse annotated data set has limited the performance and generalizability of existing models. To address this unmet need, the RSNA and Society of Thoracic Radiology collaborated to develop the RSNA International COVID-19 Open Radiology Database (RICORD). This database is the first multi-institutional, multinational, expert-annotated COVID-19 imaging data set. It is made freely available to the machine learning community as a research and educational resource for COVID-19 chest imaging. Pixel-level volumetric segmentation with clinical annotations was performed by thoracic radiology subspecialists for all COVID-19-positive thoracic CT scans. The labeling schema was coordinated with other international consensus panels and COVID-19 data annotation efforts, the European Society of Medical Imaging Informatics, the American College of Radiology, and the American Association of Physicists in Medicine. Study-level COVID-19 classification labels for chest radiographs were annotated by three radiologists, with majority vote adjudication by board-certified radiologists. RICORD consists of 240 thoracic CT scans and 1000 chest radiographs contributed from four international sites. It is anticipated that RICORD will ideally lead to prediction models that can demonstrate sustained performance across populations and health care systems.


Assuntos
/diagnóstico por imagem , Bases de Dados Factuais/estatística & dados numéricos , Saúde Global/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos , Internacionalidade , Radiografia Torácica , Radiologia , Sociedades Médicas , Tomografia Computadorizada por Raios X/estatística & dados numéricos
8.
Medicine (Baltimore) ; 100(2): e24133, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466186

RESUMO

ABSTRACT: To analyze the correlation between aneurysm wall enhancement (AWE) values and early and late sac shrinkage after endovascular aneurysm repair (EVAR).We retrospectively analyzed 28 patients who underwent EVAR for abdominal aortic aneurysms (AAA) using a bifurcated main body stent graft. The value of AWE in the slice of the maximum AAA diameter was measured using a volumetric analysis of computed tomography images. Sac measurements before EVAR and more than 10 months after EVAR were compared, and the maximum sac shrinkage rate was calculated.The AWE value immediately after (4 to 7 days) EVAR correlated positively with the sac shrinkage rate (R2 = 0.0139). The AWE value at 6 months after EVAR was also strongly correlated with the sac shrinkage rate (R2 = 0.4982).Higher AWE values at 6 months after EVAR were strongly associated with the sac volume shrinkage rate. High AWE values may be a predictive factor for sac shrinkage and may aid in the selection of the appropriate clinical strategy after EVAR.


Assuntos
Aorta/diagnóstico por imagem , Aorta/fisiopatologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Procedimentos Endovasculares/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/classificação , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Pesos e Medidas/instrumentação
9.
J Transl Med ; 19(1): 29, 2021 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413480

RESUMO

BACKGROUND: Limited data was available for rapid and accurate detection of COVID-19 using CT-based machine learning model. This study aimed to investigate the value of chest CT radiomics for diagnosing COVID-19 pneumonia compared with clinical model and COVID-19 reporting and data system (CO-RADS), and develop an open-source diagnostic tool with the constructed radiomics model. METHODS: This study enrolled 115 laboratory-confirmed COVID-19 and 435 non-COVID-19 pneumonia patients (training dataset, n = 379; validation dataset, n = 131; testing dataset, n = 40). Key radiomics features extracted from chest CT images were selected to build a radiomics signature using least absolute shrinkage and selection operator (LASSO) regression. Clinical and clinico-radiomics combined models were constructed. The combined model was further validated in the viral pneumonia cohort, and compared with performance of two radiologists using CO-RADS. The diagnostic performance was assessed by receiver operating characteristics curve (ROC) analysis, calibration curve, and decision curve analysis (DCA). RESULTS: Eight radiomics features and 5 clinical variables were selected to construct the combined radiomics model, which outperformed the clinical model in diagnosing COVID-19 pneumonia with an area under the ROC (AUC) of 0.98 and good calibration in the validation cohort. The combined model also performed better in distinguishing COVID-19 from other viral pneumonia with an AUC of 0.93 compared with 0.75 (P = 0.03) for clinical model, and 0.69 (P = 0.008) or 0.82 (P = 0.15) for two trained radiologists using CO-RADS. The sensitivity and specificity of the combined model can be achieved to 0.85 and 0.90. The DCA confirmed the clinical utility of the combined model. An easy-to-use open-source diagnostic tool was developed using the combined model. CONCLUSIONS: The combined radiomics model outperformed clinical model and CO-RADS for diagnosing COVID-19 pneumonia, which can facilitate more rapid and accurate detection.


Assuntos
/métodos , /diagnóstico , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , /estatística & dados numéricos , China/epidemiologia , Feminino , Ensaios de Triagem em Larga Escala/métodos , Ensaios de Triagem em Larga Escala/estatística & dados numéricos , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Nomogramas , Pandemias , Pneumonia Viral/epidemiologia , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/estatística & dados numéricos , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Pesquisa Médica Translacional
10.
J Comput Assist Tomogr ; 45(2): 248-252, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33512854

RESUMO

OBJECTIVE: To evaluate the accuracy of initial computed tomography (CT) interpretations made by radiology residents during nightshifts in the emergency department. METHODS: Preliminary CT reports performed by radiology residents during 120 consecutive nightshifts (08:30 pm to 08:30 am) were reviewed, attendings' final interpretation being the reference standard. Nightshifts were divided into four consecutive periods of 3 hours. Major misinterpretations were related to potentially life-threatening conditions if not treated immediately after CT. The rate of misinterpretations was calculated for all CT examinations, separately for nightshift's periods and for residents' training years. RESULTS: Misinterpretations were recorded in 155 (7.4%) of 2102 CT examinations, 0.6% (13/2102) were major. There were 2.2% (4/186) major misinterpretations that occurred during the last period of the nightshift versus 0.4% (9/1916) during the first periods of the night (P < 0.05). Of all misinterpretations, 8.5% (130/1526) were made by third- and fourth-year residents and 4.3% (25/576) by fifth-year residents (P < 0.005). CONCLUSIONS: Major misinterpretations occur at the end of the nightshift, which may be explained by the fatigue effect. The rate of misinterpretations is lower among fifth-year residents, which may be related to their prior experience in reading emergency cases.


Assuntos
Serviço Hospitalar de Emergência , Radiologistas , Jornada de Trabalho em Turnos , Tomografia Computadorizada por Raios X , Humanos , Internato e Residência , Variações Dependentes do Observador , Radiologistas/educação , Radiologistas/normas , Radiologistas/estatística & dados numéricos , Estudos Retrospectivos , Inquéritos e Questionários , Tomografia Computadorizada por Raios X/normas , Tomografia Computadorizada por Raios X/estatística & dados numéricos
11.
J Surg Res ; 257: 529-536, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32919343

RESUMO

BACKGROUND: Previous investigation has shown that the combined predictive value of white blood cell count and ultrasound (US) findings to be superior to either alone in children with suspected appendicitis. The purpose of this study was to evaluate the impact of a diagnostic clinical pathway (DCP) leveraging the combined predictive value of these tests on computed tomography (CT) utilization and resource utilization. METHODS: Retrospective cohort study comparing 8 mo of data before DCP implementation to 18 mo of data following implementation. The pathway incorporated decision-support for disposition (operative intervention, observation, or further cross-sectional imaging) based on the combined predictive value of laboratory and US data (stratifying patients into low, moderate, and high-risk groups). Study measures included CT and magnetic resonance imaging utilization, imaging-related cost, time to appendectomy, and negative appendectomy rate. RESULTS: Ninety-seven patients in the preintervention period were compared with 319 patients in the postintervention period. Following DCP implementation, CT utilization decreased by 86% (21% versus 3%, P < 0.001). Mean time to appendectomy decreased from 8.5 to 7.2 h (P < 0.001), and the negative appendectomy rate remained unchanged (5% versus 4%, P = 0.54). Magnetic resonance imaging utilization increased following pathway implementation (1% versus 7%, P = 0.02); however, median imaging-related cost was significantly lower in the postimplementation period ($283/case to $270/case, P = 0.002) CONCLUSIONS: In children with suspected appendicitis, implementation of a DCP leveraging the combined predictive value of white blood cell and US data was associated with a reduction in CT utilization, time to appendectomy, and imaging-related cost.


Assuntos
Apendicectomia/estatística & dados numéricos , Apendicite/diagnóstico por imagem , Procedimentos Clínicos/estatística & dados numéricos , Exposição à Radiação/prevenção & controle , Ultrassonografia , Adolescente , Apendicite/sangue , Apendicite/cirurgia , Criança , Feminino , Humanos , Contagem de Leucócitos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Tempo para o Tratamento , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Procedimentos Desnecessários/economia , Procedimentos Desnecessários/estatística & dados numéricos , Adulto Jovem
12.
Br J Radiol ; 94(1117): 20200473, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33058736

RESUMO

OBJECTIVES: The American Association of Physicists in Medicine (AAPM) Task Groups (TG) 204 and 220 introduced a method to estimate patient dose by introducing the Size-Specific Dose Estimate (SSDE). They provided patient size-specific conversion factors that could be applied to volumetric CT Dose Index CTDIvol to estimate patient dose in terms of SSDE based on either effective diameter (Deff) or water equivalent diameter (Dw). Our study presented an alternative method to manually estimate SSDE for the everyday clinical routine chest CT that can be readily used and does not require sophisticated computer programming. METHODS: For 16 adult patients undergoing chest CT, the method employed an average relative electron density (ρelung = 0.3) for the lung tissue and a ρetissue of 1.0 for the other tissues to scale the lateral thickness and compute the effective lateral thickness on the patient's axial image. The proposed method estimated a "corrected" Deff (Deffcorr) to replace Dw and compared results with TG220 and a second method proposed by Huda et al, for the same set of CT studies. RESULTS: The results showed comparable behavior for all methods. There is overall agreement especially between this study and TG220. Largest differences were +13.3% and+15.9% from TG220 and Huda values, respectively. Patient size correlation showed strong correlation with the TG220 and Huda et al methods. CONCLUSIONS: A simple, quick manual method to estimate CT patient radiation dose in terms of SSDE was proposed as an alternative where sophisticated computer programming is not available. It can be readily used during any clinical chest CT scanning. ADVANCES IN KNOWLEDGE: The paper is novel as it presents simple, quick manual method to estimate CT patient radiation dose in chest imaging. The process can be used as alternative in cases no sophisticated computer programming is available.


Assuntos
Pulmão/anatomia & histologia , Doses de Radiação , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Humanos , Radiografia Torácica/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Água
14.
BMC Infect Dis ; 20(1): 953, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33308183

RESUMO

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic is a world-wide health crisis. Limited information is available regarding which patients will experience more severe disease symptoms. We evaluated hospitalized patients who were initially diagnosed with moderate COVID-19 for clinical parameters and radiological feature that showed an association with progression to severe/critical symptoms. METHODS: This study, a retrospective single-center study at the Central Hospital of Wuhan, enrolled 243 patients with confirmed COVID-19 pneumonia. Forty of these patients progressed from moderate to severe/critical symptoms during follow up. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records and compared between moderate- and severe/critical-type symptoms. Univariable and multivariable logistic regressions were used to identify the risk factors associated with symptom progression. RESULTS: Patients with severe/critical symptoms were older (p < 0.001) and more often male (p = 0.046). A combination of chronic obstructive pulmonary disease (COPD) and high maximum chest computed tomography (CT) score was associated with disease progression. Maximum CT score (> 11) had the greatest predictive value for disease progression. The area under the receiver operating characteristic curve was 0.861 (95% confidence interval: 0.811-0.902). CONCLUSIONS: Maximum CT score and COPD were associated with patient deterioration. Maximum CT score (> 11) was associated with severe illness.


Assuntos
/diagnóstico por imagem , Radiografia Torácica/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Progressão da Doença , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Curva ROC , Radiografia Torácica/métodos , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
15.
Medicine (Baltimore) ; 99(47): e23407, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33217886

RESUMO

Coronavirus diseases 2019 (COVID-19) has become a global pandemic. To add to the scarce information on this disease, here, we investigated the epidemiological and clinical characteristics of 93 hospitalized patients with COVID-19 in Jilin, China from January 22 to March 15, 2020.We retrospectively investigated the demographic information, recent exposure history, clinical symptoms or signs, comorbidity, chest computed tomographic (CT) scan or X-ray results, laboratory test results, diagnostic classification, treatment, length of hospitalization, complications, and outcomes.Of the 93 patients, 54 were male and 39 female. More than half of these patients had a history of exposure to infected patients. The mean incubation period was 10.4 days in 87 patients, where the data was available. The 5 most common symptoms of illness onset were fever, cough, expectoration, fatigue, and dyspnea. One patient was asymptomatic. The imaging results were abnormal in majority of the patients. Almost one-third of the patients had lymphopenia. All patients received antiviral therapy, 84 patients were treated with antibiotics and 54 received different doses of the hormone for methylprednisolone. In addition, 72 patients used traditional Chinese medicine. Oxygen therapy, high nasal flow oxygen, non-invasive ventilator, invasive ventilator and extracorporeal membrane oxygenation (ECMO) were used symptomatically in different patients. Except 1 patient who died during treatment, all others were discharged.The average incubation time is prolonged in the present analysis, as compared to that in other reports. A few patients symptoms improved but CT exacerbated. Therefore, we suggest that close follow-up observation is still required after discharge.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Hospitalização/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , China/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Tosse/epidemiologia , Tosse/virologia , Fadiga/epidemiologia , Fadiga/virologia , Feminino , Febre/epidemiologia , Febre/virologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/virologia , Linfopenia/epidemiologia , Linfopenia/virologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto Jovem
16.
Medicine (Baltimore) ; 99(45): e23057, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157961

RESUMO

To investigate the use of abdominal CT scanning in the management of pediatric blunt abdominal trauma in pediatric and non-pediatric departments.In this observational cohort study, anonymized data were extracted from 2 large German statutory health insurances (∼5.9 million clients) in a 7-year period (2010-2016). All patients with inpatient International Classification of Diseases (ICD) codes S36.- and S37.- (injury of intra-abdominal organs; injury of urinary and pelvic organs) aged ≤18 years were included. Demographic and clinical data were analyzed by logistic regression analysis for associations with the use of abdominal CT.A total of 524 children with blunt abdominal trauma (mean age 11.0 ±â€Š5.2 years; 62.6% males) were included; 164 patients (31.3%) received abdominal CT-imaging. There were no significant differences in traumatic non-intraabdominal comorbidity patterns (injuries of external causes; injuries to the head or thorax). There was substantial variability in the rate of abdominal CT imaging among different medical disciplines ranging from 11.6% to 44.5%. Patients admitted to pediatric departments (Pediatrics and Pediatric Surgery) underwent abdominal CT imaging significantly less frequently (19.7%; N = 55) compared to patients treated in non-pediatric departments (General/Trauma Surgery: 44.5%; N = 109) irrespective of concomitant injuries. The estimated OR for the use of abdominal CT by General/Trauma Surgery was 6.2-fold higher (OR: 6.15 [95-%-CI:3.07-13.21]; P < .001) compared to Pediatric Surgery. Other risk factors associated with the use of abdominal CT were traumatic extra-abdominal comorbidities, increasing age, male gender, and admission to a university hospital.Abdominal CT imaging was significantly less frequently used in pediatric departments. The substantial variability of the abdominal CT rate among different medical disciplines and centers indicates a potential for reduction of CT imaging by implementation of evidence-based guidelines. Furthermore, our study underlines the need for centralization of pediatric trauma care in Germany not only to improve patient outcome but to avoid radiation-induced cancer mortality.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Pediatria/normas , Tomografia Computadorizada por Raios X/métodos , Ferimentos não Penetrantes/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Comorbidade , Feminino , Alemanha/epidemiologia , Hospitalização , Humanos , Masculino , Pediatria/estatística & dados numéricos , Fatores de Risco , Tomografia Computadorizada por Raios X/estatística & dados numéricos
17.
Medicine (Baltimore) ; 99(45): e23114, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157987

RESUMO

To investigate the value of percentile base on computed tomography (CT) histogram analysis for distinguishing invasive adenocarcinoma (IA) from adenocarcinoma in situ (AIS) or micro invasive adenocarcinoma (MIA) appearing as pure ground-glass nodules.A total of 42 cases of pure ground-glass nodules that were surgically resected and pathologically confirmed as lung adenocarcinoma between January 2015 and May 2019 were included. Cases were divided into IA and AIS/MIA in the study. The percentile on CT histogram was compared between the 2 groups. Univariate and multivariate logistic regression were used to determine which factors demonstrated a significant effect on invasiveness. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) was used to evaluate the predictive ability of individual characteristics and the combined model.The 4 histogram parameters (25th percentile, 55th percentile, 95th percentile, 97.5th percentile) and the combined model all showed a certain diagnostic value. The combined model demonstrated the best diagnostic performance. The AUC values were as follows: 25th percentile = 0.693, 55th percentile = 0.706, 95th percentile = 0.713, 97.5th percentile = 0.710, and combined model = 0.837 (all P < .05).The percentile of histogram parameters help to improve the ability to radiologically determine the invasiveness of lung adenocarcinoma appearing as pure ground-glass nodules.


Assuntos
Adenocarcinoma in Situ/diagnóstico por imagem , Adenocarcinoma in Situ/patologia , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Área Sob a Curva , Diagnóstico Diferencial , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/estatística & dados numéricos
19.
Emerg Radiol ; 27(6): 791-797, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33025216

RESUMO

PURPOSE: To determine the impact of the Coronavirus disease-2019 (COVID-19) pandemic on the volume, indications, and results of CT heads performed in the emergency department (ED) at Canadian tertiary academic centers in Ontario. METHODS: A retrospective review of consecutive CT head examinations ordered through the ED during the early stages of the COVID-19 pandemic in Canada (March 12-April 8, 2020) was performed and compared with that during the pre-COVID-19 period (February 12-March 10, 2020). CT reports were reviewed for the exam indication and the presence of predefined acute findings. A two-sample t test was utilized to compare the cohorts. Daily averages were calculated for all measures to control for the sample size difference between each period. A p value < 0.05 was considered significant. RESULTS: Of the total 751 CT head reports, 290 (38.6%) were ordered during the pandemic and 461 (61.4%) were ordered pre-pandemic. The average daily volume of CT head orders decreased significantly during COVID-19 compared with that during pre-COVID-19 (10.4 scans/day vs 16.5 scans/day; p = 0.001). In terms of indications, the frequency of "non-traumatic ICH" was significantly lower during COVID-19 compared with that during pre-COVID-19 (p = 0.01). Also, there was a significant increase in acute findings on CT during COVID-19 compared with that during pre-COVID-19 (p = 0.001). CONCLUSION: The decreased volume of emergency CT heads performed during the COVID-19 pandemic was associated with a significant increase in the proportion of cases with acute findings. This could be a result of the pandemic's influence on the health-seeking behavior of patients as well as the decision-making process of ordering clinicians.


Assuntos
Infecções por Coronavirus/epidemiologia , Cabeça/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Centros Médicos Acadêmicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Pandemias , Estudos Retrospectivos , Revisão da Utilização de Recursos de Saúde
20.
Emerg Radiol ; 27(6): 773-780, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33111154

RESUMO

PURPOSE: This study examined the impact of the COVID-19 pandemic on emergency department CT use for acute nontraumatic abdominal pain, to better understand why imaging volume so drastically decreased during the COVID-19 pandemic. METHODS: This was a retrospective review of emergency imaging volumes from January 5 to May 30, 2020. Weekly volume data were collected for total imaging studies, abdominopelvic CT, and abdominopelvic CTs positive for common causes of acute nontraumatic abdominal pain. Two emergency radiology attendings scored all diverticulitis cases independently, and weekly volume data for uncomplicated and complicated diverticulitis cases was also collected. Volume data prior to and during the COVID-19 pandemic was compared, using 2019 volumes as a control. RESULTS: During the COVID-19 pandemic, overall emergency imaging volume decreased 30% compared to 2019 (p = 0.002). While the number of emergency abdominopelvic CTs positive for appendicitis and small bowel obstruction did not significantly change during the COVID-19 pandemic, the number of cases of diverticulitis decreased significantly compared to 2019 (p = 0.001). This reduction can be specifically attributed to decreased uncomplicated diverticulitis cases, as the number of uncomplicated diverticulitis cases dropped significantly (p = 0.002) while there was no significant difference in the number of complicated diverticulitis cases (p = 0.09). CONCLUSIONS: Reduced emergency abdominopelvic CT volume during the COVID-19 pandemic can partially be explained by decreased imaging of lower acuity patients. This data may help formulate future strategies for imaging resource utilization with an improved understanding of the relationship between perceived imaging risk and symptom acuity.


Assuntos
Infecções por Coronavirus/epidemiologia , Diverticulite/diagnóstico por imagem , Serviço Hospitalar de Emergência , Pneumonia Viral/epidemiologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Betacoronavirus , Feminino , Humanos , Masculino , Massachusetts/epidemiologia , Pandemias , Estudos Retrospectivos , Revisão da Utilização de Recursos de Saúde
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