Chest MRI with CT in the assessment of interstitial lung disease progression in patients with systemic sclerosis.

OBJECTIVE: To describe the performance of CT and MRI in the assessment of the progression of interstitial lung disease (ILD) associated with SSc and demonstrate the correlations of MRI with pulmonary function test (PFT) and CT scores. METHODS: This prospective single-centre observational study included patients with SSc diagnoses, and magnetic resonance (MR) images were assessed visually using the Scleroderma Lung Study (SLS) I system. Differences in the median scores were assessed with Student's t-test and the Wilcoxon rank-sum test. Pearson's and Spearman's rank correlation coefficients were calculated to correlate imaging scores and PFT results. Using disease progression as the gold standard, we calculated the area under the curve (AUC) of the CT and MRI scores with Harrel's c-index. The best thresholds for the prediction of disease progression were determined by receiver operating characteristic curve analysis with maximum Youden's Index (P < 0.05). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the scores were calculated. RESULTS: The AUCs for MRI and CT scores were 0.86 (0.72-0.98; P = 0.04) and 0.83 (0.70-0.99; P = 0.05), respectively. CT and MRI scores correlated with Forced vital capacity (%FVC) (MRI: r = -0.54, P = 0.0045; CT: r = -0.44; P = 0.137) and diffusing capacity of the lung for carbon monoxide (MRI: r = -0.39, P = 0.007; CT r = -0.36, P = 0.006). The sensitivity, specificity, PPV and NPV were 85%, 87.5%, 88.34% and 86.11% (MRI score) and 84.21%, 82.35%, 84.14% and 82.4% (CT score), respectively. CONCLUSIONS: MRI scores from patients with SSc may be an alternative modality for the assessment of ILD progression in patients with SSc.

The International Association for the Study of Lung Cancer Early Lung Imaging Confederation Open-Source Deep Learning and Quantitative Measurement Initiative.

INTRODUCTION: With global adoption of computed tomography (CT) lung cancer screening, there is increasing interest to use artificial intelligence (AI) deep learning methods to improve the clinical management process. To enable AI research using an open-source, cloud-based, globally distributed, screening CT imaging data set and computational environment that are compliant with the most stringent international privacy regulations that also protect the intellectual properties of researchers, the International Association for the Study of Lung Cancer sponsored development of the Early Lung Imaging Confederation (ELIC) resource in 2018. The objective of this report is to describe the updated capabilities of ELIC and illustrate how this resource can be used for clinically relevant AI research. METHODS: In this second phase of the initiative, metadata and screening CT scans from two time points were collected from 100 screening participants in seven countries. An automated deep learning AI lung segmentation algorithm, automated quantitative emphysema metrics, and a quantitative lung nodule volume measurement algorithm were run on these scans. RESULTS: A total of 1394 CTs were collected from 697 participants. The LAV950 quantitative emphysema metric was found to be potentially useful in distinguishing lung cancer from benign cases using a combined slice thickness more than or equal to 2.5 mm. Lung nodule volume change measurements had better sensitivity and specificity for classifying malignant from benign lung nodules when applied to solid lung nodules from high-quality CT scans. CONCLUSIONS: These initial experiments revealed that ELIC can support deep learning AI and quantitative imaging analyses on diverse and globally distributed cloud-based data sets.

Computed tomography on lung cancer screening is useful for adjuvant comorbidity diagnosis in developing countries.

Purpose: The aim of this study was to analyse and quantify the prevalence of six comorbidities from lung cancer screening (LCS) on computed tomography (CT) scans of patients from developing countries. Methods: For this retrospective study, low-dose CT scans (n=775) were examined from patients who underwent LCS in a tertiary hospital between 2016 and 2020. An age- and sex-matched control group was obtained for comparison (n=370). Using the software, coronary artery calcification (CAC), the skeletal muscle area, interstitial lung abnormalities, emphysema, osteoporosis and hepatic steatosis were accessed. Clinical characteristics of each participant were identified. A t-test and Chi-squared test were used to examine differences between these values. Interclass correlation coefficients (ICCs) and interobserver agreement (assessed by calculating kappa coefficients) were calculated to assess the correlation of measures interpreted by two observers. p-values <0.05 were considered significant. Results: One or more comorbidities were identified in 86.6% of the patients and in 40% of the controls. The most prevalent comorbidity was osteoporosis, present in 44.2% of patients and in 24.8% of controls. New diagnoses of cardiovascular disease, emphysema and osteoporosis were made in 25%, 7% and 46% of cases, respectively. The kappa coefficient for CAC was 0.906 (p<0.001). ICCs for measures of liver, spleen and bone density were 0.88, 0.93 and 0.96, respectively (p<0.001). Conclusions: CT data acquired during LCS led to the identification of previously undiagnosed comorbidities. The LCS is useful to facilitate comorbidity diagnosis in developing countries, providing opportunities for its prevention and treatment.

N-Acetylcysteine Reverses Anxiety and Oxidative Damage Induced by Unpredictable Chronic Stress in Zebrafish.

There is accumulating evidence on the use of N-acetylcysteine (NAC) in the treatment of patients with neuropsychiatric disorders. As a multi-target drug and a glutathione precursor, NAC is a promising molecule in the management of stress-related disorders, for which there is an expanding field of research investigating novel therapies targeting oxidative pathways. The deleterious effects of chronic stress in the central nervous system are a result of glutamatergic hyperactivation, glutathione (GSH) depletion, oxidative stress, and increased inflammatory response, among others. The aim of this study was to investigate the effects of NAC in zebrafish submitted to unpredictable chronic stress (UCS). Animals were initially stressed or not for 7 days, followed by treatment with NAC (1 mg/L, 10 min) or vehicle for 7 days. UCS decreased the number of entries and time spent in the top area in the novel tank test, which indicate increased anxiety levels. It also increased reactive oxygen species (ROS) levels and lipid peroxidation (TBARS) while decreased non-protein thiols (NPSH) and superoxide dismutase (SOD) activity. NAC reversed the anxiety-like behavior and oxidative damage observed in stressed animals. Additional studies are needed to investigate the effects of this agent on glutamatergic modulation and inflammatory markers related to stress. Nevertheless, our study adds to the existing body of evidence supporting the clinical evaluation of NAC in mood disorders, anxiety, post-traumatic stress disorder, and other conditions associated with stress.

Achados tomográficos incidentais de calcificações coronarianas: um estudo de prevalência na região sul do Brasil / Incidental tomographic findings of coronary artery calcifications: a prevalence study in southern Brazil

Fundamento: As calcificações de artérias coronárias (CAC) mostram-se como fator preditivo de doenças cardiovasculares (DCV). A tomografia computadorizada (TC) de tórax com protocolo de aquisição de baixa dose apresenta acurácia na identificação de CAC e propicia achados incidentais dessas calcificações, que são comumente negligenciados. Este estudo analisará a prevalência de achados incidentais de calcificação em artérias coronárias em indivíduos não cardiopatas submetidos à TC de tórax. Métodos: Estudo transversal consecutivo de caráter analítico e descritivo. Foram incluídos indivíduos de ambos os sexos que realizaram TC de tórax por encaminhamento, acima de 18 anos e não cardiopatas. A coleta de dados foi realizada por meio de prontuários e ficha de anamnese auto aplicada. As variáveis referentes às CAC e à extensão do comprometimento foram obtidas a partir da reavaliação das imagens de TC de tórax disponíveis no sistema da instituição. Os exames foram anonimizados e avaliados por dois médicos radiologistas experientes. Considerou-se como estatisticamente significativo p≤0,05. Resultados: Foram analisados 397 exames. Encontrou-se prevalência de calcificações em 176 (44%) dos casos. A existência dessas calcificações coronárias está relacionada à idade (p<0,001). As calcificações possuem relação com o sexo (p = 0,03) com maior razão de chance de desenvolvimento em homens (odds ratio [OR] = 1,55). O tabagismo (p<0,001), o sedentarismo (p<0,001), a hipertensão arterial sistêmica (p<0,001), o diabetes mellitus (p = 0,04) e as dislipidemias (p<0,001) mostraram associação positiva. Conclusão: A prevalência de achados incidentais de CAC foi de 44%; variam em maior número entre leve e grave; maior razão de chance no sexo masculino e aumento da prevalência com a idade. Portanto, a TC de tórax mostra-se um efetivo método para avaliar as CAC, e juntamente com a história clínica do paciente pode ser utilizada para medir os fatores de risco para doenças cardiovasculares e intervir no desfecho do quadro.(AU)

Introduction: Coronary artery calcifications (CAC) are shown to be a predictive factor of cardiovascular diseases. Computed tomography (CT) of the chest with a low-dose acquisition protocol is accurate in identifying CAC and provides incidental findings of these calcifications, which are commonly overlooked. This study will analyze the prevalence of incidental findings of calcification in coronary arteries in non-cardiac individuals undergoing chest CT. Methods: Consecutive cross-sectional study of an analytical and descriptive nature. Individuals of both genders who underwent chest CT by referral, over 18 years of age and without heart disease were included. Data collection was carried out using medical records and a self-applied anamnesis form. The variables referring to the CAC and the extension of the impairment were obtained from the reassessment of the chest CT images available in the institution's system. The exams were anonymized and evaluated by two experienced radiologists. P≤0.05 was considered statistically significant. Results: 397 exams were analyzed. A prevalence of calcifications was found in 176 (44%) of the cases. The existence of these coronary calcifications is related to age (p<0.001). Calcifications are related to gender (p = 0.03) with a higher odds ratio of development in men (odds ratio [OR] = 1.55). Smoking (p<0.001), sedentary lifestyle (p<0.001), systemic arterial hypertension (p<0.001), Diabetes Mellitus (p = 0.04), and dyslipidemia (p<0.001) showed a positive association. Conclusion: The prevalence of incidental CAC findings was 44%; vary in greater numbers between mild and severe; higher odds ratio in males and increased prevalence with age. Therefore, chest CT proves to be an effective method to assess CAC, and together with the patient's clinical history, it can be used to measure risk factors for CVD and intervene in the outcome of the condition.(AU)