Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems

Abstract Data on the pathology of COVID-19 are scarce; available studies show diffuse alveolar damage; however, there is scarce information on the chronologic evolution of COVID-19 lung lesions. The primary aim of the study is to describe the chronology of lung pathologic changes in COVID-19 by using a post-mortem transbronchial lung cryobiopsy approach. Our secondary aim is to correlate the histologic findings with computed tomography patterns. SARS-CoV-2-positive patients, who died while intubated and mechanically ventilated, were enrolled. The procedure was performed 30 min after death, and all lung lobes sampled. Histopathologic analysis was performed on thirty-nine adequate samples from eight patients: two patients (illness duration < 14 days) showed early/exudative phase diffuse alveolar damage, while the remaining 6 patients (median illness duration—32 days) showed progressive histologic patterns (3 with mid/proliferative phase; 3 with late/fibrotic phase diffuse alveolar damage, one of which with honeycombing). Immunohistochemistry for SARS-CoV-2 nucleocapsid protein was positive predominantly in early-phase lesions. Histologic patterns and tomography categories were correlated: early/exudative phase was associated with ground-glass opacity, mid/proliferative lesions with crazy paving, while late/fibrous phase correlated with the consolidation pattern, more frequently seen in the lower/middle lobes. This study uses an innovative cryobiopsy approach for the post-mortem sampling of lung tissues from COVID-19 patients demonstrating the progression of fibrosis in time and correlation with computed tomography features. These findings may prove to be useful in the correct staging of disease, and this could have implications for treatment and patient follow-up.

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Efficacy of chest X-ray in the diagnosis of COVID-19 pneumonia: comparison with computed tomography through a simplified scoring system designed for triage

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00541-x ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Akın Çinkooğlu ◽

Selen Bayraktaroğlu ◽

Naim Ceylan ◽

Recep Savaş

Keyword(s):

Computed Tomography ◽

Intensive Care ◽

Intensive Care Units ◽

Scoring System ◽

Imaging Modality ◽

Ground Glass Opacity ◽

Initial Presentation ◽

X Ray ◽

Chest X Ray

Abstract Background There is no consensus on the imaging modality to be used in the diagnosis and management of Coronavirus disease 2019 (COVID-19) pneumonia. The purpose of this study was to make a comparison between computed tomography (CT) and chest X-ray (CXR) through a scoring system that can be beneficial to the clinicians in making the triage of patients diagnosed with COVID-19 pneumonia at their initial presentation to the hospital. Results Patients with a negative CXR (30.1%) had significantly lower computed tomography score (CTS) (p < 0.001). Among the lung zones where the only infiltration pattern was ground glass opacity (GGO) on CT images, the ratio of abnormality seen on CXRs was 21.6%. The cut-off value of X-ray score (XRS) to distinguish the patients who needed intensive care at follow-up (n = 12) was 6 (AUC = 0.933, 95% CI = 0.886–0.979, 100% sensitivity, 81% specificity). Conclusions Computed tomography is more effective in the diagnosis of COVID-19 pneumonia at the initial presentation due to the ease detection of GGOs. However, a baseline CXR taken after admission to the hospital can be valuable in predicting patients to be monitored in the intensive care units.

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Pulmonary pure ground-glass opacity lesions: Use of computed tomography attenuation for predicting tumor progression.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.7548 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 7548-7548

Author(s):

Takashi Eguchi ◽

Ryoichi Kondo ◽

Satoshi Kawakami ◽

Mina Matsushita ◽

Tetsu Takeda ◽

...

Keyword(s):

Computed Tomography ◽

Ground Glass Opacity ◽

Attenuation Value ◽

Kaplan Meier ◽

Ct Attenuation ◽

Long Term Follow Up ◽

The Difference ◽

Ct Attenuation Value

7548 Background: Cases with pure ground-glass opacity (GGO) are increasing with the use of computed tomography (CT). In some cases, pure GGO on follow-up CT may represent tumor enlargement or the presence of solid components. We evaluated the natural progression of pure GGO lesions during a long-term follow-up period of more than 2 years. Methods: We retrospectively investigated 95 patients with pure GGO lesions detected between February 2003 and December 2010, in whom these lesions were monitored using CT for more than 2 years. Results: The median follow-up period was 64.7 months (range, 24–114 months). During the follow-up period, areas showing GGO increased in size or appeared to have solid components in 49 patients (group 1) and showed no change in 46 patients (group 2). We compared patient characteristics and tumor properties between the 2 groups. Mean CT attenuation values of the tumors differed significantly between groups 1 (-639.9 ± 88.9 HU) and 2 (-709.2 ± 60.9 HU). In contrast, no significant differences were noted with regard to age, gender, smoking history, lung cancer history, tumor size, and total numbers of GGO lesions between the 2 groups. The difference in the time to tumor growth according to the initial mean CT attenuation value was estimated using the Kaplan–Meier method. The growth incidence at 114 months for lesions with a mean CT attenuation value of -650 HU or more (n = 35) and less than -650 HU (n = 60) were estimated to be 96% and 48%, respectively. The difference between the 2 Kaplan–Meier curves was statistically significant (p < 0.0001). The usefulness of the mean CT attenuation value in predicting the growth of GGO lesions was evaluated using receiver operating characteristic analysis. The sensitivity and specificity was 63% and 87%, respectively, for a mean CT attenuation cutoff value of -650 HU. The area under the curve was 0.76. Conclusions: Many pure GGO lesions have potential for growth as seen during long-term follow-up. CT attenuation is useful in predicting the growth of GGO lesions.

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Computed tomography manifestations in super early stage 2019 novel coronavirus pneumonia

Acta Radiologica ◽

10.1177/0284185120924806 ◽

2020 ◽

pp. 028418512092480

Author(s):

Shan Hu ◽

Zhen Li ◽

Xu Chen ◽

Chang-Hong Liang

Keyword(s):

Computed Tomography ◽

Early Stage ◽

Ground Glass Opacity ◽

Chest Ct ◽

Ground Glass ◽

Reticular Pattern ◽

Initial Stage ◽

Pr China ◽

Novel Coronavirus

Background The recent outbreak of pneumonia cases in Wuhan, PR China, was caused by a novel beta coronavirus, the 2019 novel coronavirus (COVID-19). Purpose To summarize chest computed tomography (CT) manifestations of the early stage of COVID-19 infection and provide a piece of reliable imaging evidence for initial screening and diagnosis. Material and Methods From 10 January 2020 to 10 February 2020, we continuously observed chest CT imaging of 14 patients with clinically suspected new coronavirus infection in the two weeks after onset of symptoms. Ground-glass opacity (GGO), consolidation, reticular pattern, and ground-glass mimic nodules in each patient’s chest CT image were recorded. Results We enrolled 14 patients, of which nine patients had the infection confirmed by reverse transcription polymerase chain reaction (RT-PCR). Five patients were highly suspected of infection. All cases had epidemiological evidence. GGO was a dominant imaging manifestation in the initial days of infection. GGO performance accounts for 40% in 1– 2 days, 90% in 3– 6 days, and 85% in 7– 10 days. With disease progression, consolidation appeared on follow-up CT. Consolidation performance accounts for 0% in 1– 2 days, 40% in 3– 6 days, and 71% in 7– 10 days. The lesions are mostly near the pleura. The number of lesions and the extent of the lesions increased as the disease progressed. Conclusion Patients with novel coronavirus pneumonia have characteristic CT features in the initial stage of infection, which can be used as an essential supplement for nucleic acid examination.

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Medium-term chest computed tomography (CT) follow-up of COVID-19 pneumonia patients after recovery to assess the rate of resolution and determine the potential predictors of persistent lung changes

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00434-z ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Arshed Hussain Parry ◽

Abdul Haseeb Wani ◽

Naveed Nazir Shah ◽

Majid Jehangir

Keyword(s):

Computed Tomography ◽

Ground Glass Opacity ◽

Study Cohort ◽

Medium Term ◽

Chest Computed Tomography ◽

Imaging Characteristics ◽

Lung Abnormalities ◽

Wbc Count ◽

Mixed Pattern

Abstract Background The data on medium-term follow-up of coronavirus disease-19 (COVID-19) pneumonia survivors is scarce. Medium-term follow-up will generate knowledge and help in devising a structured follow-up plan and to facilitate enrolment in clinical trials assessing the role of antifibrotic drugs in modifying the course of disease in order to avert long-term pulmonary sequelae of disease. The study was aimed to evaluate the lung findings on a medium-term follow-up (3 months or more) chest computed tomography (CT) in COVID-19 pneumonia survivors, assess the rate of resolution or persistence of lung abnormalities and to identify the initial demographic, clinical, and imaging characteristics that could potentially predict the persistence of lung abnormalities on follow-up. Results Out of the total study cohort of 81 patients, 46 (56.8%) demonstrated complete resolution of lung findings and the remaining 35 (43.2%) had residual lung opacities on follow-up CT. The most common type of residual abnormality was ground glass opacity (GGO) (16/35; 45.7%), followed by parenchymal bands (9/35; 25.7%), mixed pattern of GGO and parenchymal bands (6/35; 17.2%), bronchiectasis (6/35; 17.2%), and interlobular septal thickening (4/35; 11.4%). Patients with residual abnormalities were older, had higher BMI, more comorbidities, lower SpO2, longer hospital stay, higher rate of intensive care unit (ICU) admission, higher WBC count, a higher CT severity score, and lower rate of steroid administration with all p values < 0.05. Conclusion Nearly half of post-COVID-19 survivors had residual lung abnormalities after ≥ 3 months of follow-up. Certain clinico-radiological characteristics have the potential to identify the individuals at risk of having residual lung abnormalities on medium-term follow-up.

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P1127Occurrence, management and outcomes of iatrogenic aortic dissections as a complication of catheter ablation. A multicenter study

EP Europace ◽

10.1093/europace/euaa162.011 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

P R Futyma ◽

T Aksu ◽

J M Cooper ◽

R Schaller ◽

J Winterfield ◽

...

Keyword(s):

Computed Tomography ◽

Catheter Ablation ◽

Early Recognition ◽

Accessory Pathway ◽

Post Mortem ◽

Ablation Catheter ◽

Conventional Angiography ◽

Descending Aorta ◽

Aortic Dissections

Abstract Background Data on occurrence, management and outcomes of iatrogenic aortic dissections (IAD) as a complication of catheter ablation (CA) do not exist. Purpose To evaluate multicenter data on occurrence, management and outcomes of IAD as a complication of CA. Methods Data on occurrence, management and outcomes of documented vascular dissections from 10 centers were evaluated. Results IADs occurred in 7 patients (2 females, age 63 ± 8 years). Indications for CA were frequent premature ventricular complexes (PVC)/ventricular tachycardia (VT) in 6 patients (86%) and left-sided accessory pathway in the remaining one (14%). Hypertension was most frequent comorbidity (4 pts, 57%). All IADs occurred during retrograde advancement of ablation catheter. In the vast majority of patients creation of IAD during catheter advancement was not associated with any symptoms (6 pts, 86%). IAD was initially detected using trans-luminal angiogram in 5 (71%) and further confirmed using computed tomography (CT) (5 pts, 71%), conventional angiography (2 pts, 28%) and ultrasound (2 pts, 28%). One IAD was detected during CT scan performed for other indication after CA. There was one IAD-related death and IAD was evaluated post-mortem. Follow-up lasted 10 ± 19 months. Four patients were treated conservatively, one patient underwent descending aorta stenting and one femoral artery stenting. Conclusions IAD during CA is a rare but can be devastating. Early recognition can be difficult. Conservative management of IAD is an option of treatment.

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Computed Tomography Image Processing Analysis in COVID-19 Patient Follow-Up Assessment

Journal of Healthcare Engineering ◽

10.1155/2021/8869372 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Santiago Tello-Mijares ◽

Luisa Woo

Keyword(s):

Computed Tomography ◽

Clustering Algorithm ◽

Cross Validation ◽

Mean Shift ◽

Ground Glass Opacity ◽

Ct Images ◽

Second Order ◽

Border Region ◽

Pulmonary Parenchyma

The rapid worldwide spread of the COVID-19 pandemic has infected patients around the world in a short space of time. Chest computed tomography (CT) images of patients who are infected with COVID-19 can offer early diagnosis and efficient forecast monitoring at a low cost. The diagnosis of COVID-19 on CT in an automated way can speed up many tasks and the application of medical treatments. This can help complement reverse transcription-polymerase chain reaction (RT-PCR) diagnosis. The aim of this work is to develop a system that automatically identifies ground-glass opacity (GGO) and pulmonary infiltrates (PIs) on CT images from patients with COVID-19. The purpose is to assess the disease progression during the patient’s follow-up assessment and evaluation. We propose an efficient methodology that incorporates oversegmentation mean shift followed by superpixel-SLIC (simple linear iterative clustering) algorithm on CT images with COVID-19 for pulmonary parenchyma segmentation. To identify the pulmonary parenchyma, we described each superpixel cluster according to its position, grey intensity, second-order texture, and spatial-context-saliency features to classify by a tree random forest (TRF). Second, by applying the watershed segmentation to the mean-shift clusters, only pulmonary parenchyma segmentation-identified zones showed GGO and PI based on the description of each watershed cluster of its position, grey intensity, gradient entropy, second-order texture, Euclidean position to the border region of the PI zone, and global saliency features, after using TRF. Our classification results for pulmonary parenchyma identification on CT images with COVID-19 had a precision of over 92% and recall of over 92% on twofold cross validation. For GGO, the PI identification showed 96% precision and 96% recall on twofold cross validation.

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Clinical, Pathological and Radiologic Features of Minute Pulmonary Meningothelial-like Nodules

10.21203/rs.3.rs-315906/v1 ◽

2021 ◽

Author(s):

Zhexu Wen ◽

Yang Zhang ◽

Fangqiu Fu ◽

Zelin Ma ◽

Chaoqiang Deng ◽

...

Keyword(s):

Computed Tomography ◽

Ground Glass Opacity ◽

Ground Glass ◽

Cancer Center ◽

Computed Tomography Scan ◽

Pulmonary Surgery ◽

Tomography Scan ◽

Over Time ◽

Radiologic Features

Abstract Objectives: Reports about the radiologic features of minute pulmonary meningothelial-like nodules are sparse. This study aims to investigate the radiologic features of minute pulmonary meningothelial-like nodules. Method: From January 2016 to April 2019, 7589 patients underwent pulmonary resections at Fudan University Shanghai Cancer Center. Postoperative pathology records were reviewed retrospectively. Fifty-nine patients with minute pulmonary meningothelial-like nodule were included. The identification of minute pulmonary meningothelial-like nodules in pathology specimen included pathologically confirmed in resected nodules, and discovery in the peripheral tissue of other resected nodules incidentally. We went back and checked all the pre-operative scans of patients to analyze surgical decision and observe any change of visible minute pulmonary meningothelial-like nodule over time. Clinic, radiologic and pathological features were collected.Result: 59 patients included 10 men and 49 women, with a mean age of 57.7. 5 patients had history while 54 patients were non-smokers. 79 minute pulmonary meningothelial-like nodules was found. Of them, 36 nodules were not visible on computed tomography scan. 43 nodules were visible on computed tomography scan, with an average size of 5.3mm in 29 patients. Computed tomography appearance included pure ground-glass opacity in 36, mixed in 2 and solid nodules in 5. Nearly half of patients had a pre-operative follow-up more than 6 months (13/29, 44.8%). The median pre-operative radiologic follow-up was 4.9 months. Approximately 90% of patients underwent pulmonary surgery because of other malignant nodule on chest computed tomography scan (52/59, 88.1%). Conclusion: Most minute pulmonary meningothelial-like nodules tend to present as ground-glass opacity, especially pure ground-glass opacity. Continuous computed tomography monitoring revealed no radiologic change over time. Continuous computed tomography monitoring was necessary part of management of minute pulmonary meningothelial-like nodule.

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