Pocket-size ultrasound devices may improve the prompt assessment of Covid-19 patients

Abstract Introduction Clinical usefulness of pocket-size ultrasound device [PSUD] was previously confirmed in numerous clinical scenarios. During the previous year Covid-19 patients have become a focal point of the cardiology and internal medicine wards. However, there is no data on the use of PSUD in this scenario. Purpose To asses if PSUD may be useful in providing additional information in Covid-19 patients. Methods In 63 patients (41 men, mean age 63±11) with confirmed Covid-19 the scope of physical examination was expanded with bedside assessment performed with PSUD equipped with dual probe. PSUD examination included: right ventricle measurement, automated LVEF assessment, 4-point compression ultrasound test of lower limbs and lung ultrasound (presence of B-lines, lung consolidations or thickening of pleura). Subsequently, within the next 24 hours all patients underwent chest CT scan, CT pulmonary angiogram and full echocardiographic examination performed on a high-end stationary device. Results Lung lesions typical for Covid-19 were confirmed in CT in 53 (84%) patients. The sensitivity and specificity of bedside PSUD examination for diagnosing lung involvement was 92% and 90%, respectively, when presence of any pathology on lung ultrasound was considered as a positive criterion. Increased number of B-lines had a sensitivity of 81%, specificity 83% for the ground glass symptom in CT detection, (AUC 0,82; p<0,0001). Pleural thickening was diagnosed by PSUD with a 95% sensitivity and 88% specificity (AUC 0,91, p<0,0001), whereas lung consolidations with a 71% sensitivity and 86% specificity (AUC 0,79, p<0,0001). In 20 patients (32%) pulmonary embolism was confirmed by angioCT – in 10 among them embolism was limited to subsegmental arteries. RV was found to be dilated in PSUD examination in 27 patients (43%), CUS was positive in 1 patient. Thus, RV enlargement treated as a marker of PE had low sensitivity and specificity (60% i 65% respectively), AUC=0,62, p=0,06. Mean LVEF in standard echocardiography was 46±12%, but during PSUD examination automated LV function analysis software failed to calculate LVEF in 29 (46%) cases due to suboptimal image quality. Conclusion In Covid-19 patients PSUD is particularly useful for lung ultrasound and the detection of lung pathologies. RV enlargement observed during PSUD examination has relatively low sensitivity and specificity for the detection of pulmonary embolism in Covid-19. Furthermore, due to low quality of images automated LV function assessment failed to provide any result in almost half of patients. FUNDunding Acknowledgement Type of funding sources: None.

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Lung Ultrasound Examination in Patients with SARS-CoV-2 Infection: Multicenter Study

Journal of Clinical Medicine ◽

10.3390/jcm10153255 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3255

Author(s):

Natalia Buda ◽

Jolanta Cylwik ◽

Katarzyna Mróz ◽

Renata Rudzińska ◽

Paweł Dubik ◽

...

Keyword(s):

Interstitial Pneumonia ◽

Sensitivity And Specificity ◽

Lung Ultrasound ◽

High Sensitivity ◽

Hospitalized Patients ◽

Diagnostic Methods ◽

High Resolution Computed Tomography ◽

Diagnostic Modality ◽

Diagnostic Modalities ◽

B Lines

Background: The COVID-19 pandemic has, by necessity, contributed to rapid advancements in medicine. Owing to the necessity of following strict anti-epidemic sanitary measures when taking care of infected patients, the accessibility of standard diagnostic methods may be limited. Consequently, the significance and potential of bedside diagnostic modalities increase, including lung ultrasound (LUS). Method: Multicenter registry study involving adult patients with confirmed COVID-19, for whom LUS was performed. Results: A total of 228 patients (61% males) qualified for the study. The average age was 60 years (±14), 40% were older than 65 years of age. In 130 from 173 hospitalized patients, HRCT (high-resolution computed tomography) was performed. In 80% of patients, LUS findings indicated interstitial pneumonia. In hospitalized patients multifocally located single B-lines, symmetrical B-lines, and areas of white lung were significantly more frequent as compared to ambulatory patients. LUS findings, both those indicating interstitial syndrome and consolidations, were positively correlated with HRCT images. As compared to HRCT, the sensitivity and specificity of LUS in detecting interstitial pneumonia were 97% and 100%, respectively. Conclusions: As compared to HRCT, LUS is characterized by a very high sensitivity and specificity in detecting interstitial pneumonia in COVID-19 patients. Potentially, LUS can be a particularly useful diagnostic modality for COVID-19 patients pneumonia.

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Ankle brachial index and pneumoplethysmographic pulse-volume recordings for detection of peripheral arterial disease

VASA ◽

10.1024/0301-1526/a000350 ◽

2014 ◽

Vol 43 (3) ◽

pp. 202-208 ◽

Cited By ~ 1

Author(s):

Jürgen Jahn ◽

Werner Zimmermann ◽

Theodoros Moysidis ◽

Knut Kröger

Keyword(s):

Sensitivity And Specificity ◽

Ankle Brachial Index ◽

Small Variation ◽

Arterial Disease ◽

Lower Limbs ◽

Specific Method ◽

Pulse Volume ◽

Straightforward Method ◽

Peripheral Arterial ◽

Low Sensitivity

Background: The measurement of the ankle-brachial index (ABI) is a straightforward method for the detection of atherosclerosis in the lower limbs. Pneumoplethysmographic pulse-volume recordings (PVR) investigations are supposed to be less valid. Thus we compared the sensitivity of ABI and PVR in detection of PAD and its improvement by combining both methods. Patients and methods: 122 consecutive patients admitted for PAD treatment were included. All patients (81 females; mean age 70 ± 15 years) had angiographic imaging of their peripheral arteries, a standardized personal interview and a determination of the ABI based on the highest (ABI high) and lowest (ABI low) ankle pressure. PVR parameters were oscillometric index (OI) and time to normalisation (TN) after exercise. Results: There was a small variation of ABI with different segmental manifestations of PAD. The OI did not vary with different segmental manifestations. TN was longest in iliac artery manifestation and got shorter with more distal manifestation. Correlation of TN and ABI high and ABI low was low. Sensitivity of ABI high in all legs was 78 %, but only 40 % in isolated crural manifestation. ABI low has higher sensitivities with 87 % in all legs, but a much lower specificity. Combining ABI and TN increases both sensitivity and specificity. The best sensitivity and specificity was seen using ABI low + TN in combination in all kinds of manifestations with 94 % and 96 %, respectively. Conclusions: Combined assessment of ABI low and TN in post-exercise PVR seems to be a highly sensitive but also specific method to look for PAD compared to ABI high alone.

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Unusual deep vein thrombosis sites: magnetic resonance venography in patients with negative compression ultrasound and symptomatic pulmonary embolism

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2012.012054 ◽

2012 ◽

Vol 29 (1) ◽

pp. 25-29 ◽

Cited By ~ 2

Author(s):

T Gary ◽

K Steidl ◽

K Belaj ◽

F Hafner ◽

H Froehlich ◽

...

Keyword(s):

Pulmonary Embolism ◽

Risk Factor ◽

Deep Vein Thrombosis ◽

Magnetic Resonance ◽

Venous Thrombosis ◽

Lower Limbs ◽

Mr Venography ◽

Vein Thrombosis ◽

Compression Ultrasound ◽

Deep Vein

Objectives To evaluate the clinical characteristics of patients with pulmonary embolism (PE), negative compression ultrasound (CUS) of the lower limbs and detection of unusual deep vein thrombosis (DVT) sites by means of magnetic resonance (MR) venography. Methods A retrospective data analysis of PE patients hospitalized at our institution from April 2009 to 2011. Results From April 2009 to 2011, a total of 762 PE patients were treated at our institution. In 169 of these patients CUS for DVT was negative. In these patients MR venography was performed for further evaluation. We found venous thrombosis at unusual sites in 12 of these patients. Due to free floating thrombus masses and fear of life-threatening PE progression we inserted an inferior vena cava filter in three of these 12 patients. The leading venous thromboembolism risk factor in our patients was immobilization (5 patients, 41.7%). Conclusions We conclude that especially in patients with PE and negative CUS of the lower limbs a thrombosis of the pelvic veins should be considered in case of symptoms for venous thrombosis in this area. Further diagnostic work-up with MR venography should be scheduled in these patients especially in patients with risk factor immobilization as therapeutic consequences might occur.

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The effect of troponin values on prognosis in acute pulmonary embolism

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20204479 ◽

2020 ◽

Vol 7 (4) ◽

pp. 229

Author(s):

Gulay Dasdemir Ilkhan ◽

Hakan Celikhisar

Keyword(s):

Pulmonary Embolism ◽

Sensitivity And Specificity ◽

Significant Relationship ◽

Roc Analysis ◽

Operating Characteristic ◽

Area Under The Curve ◽

Survivor Group ◽

Acute Pulmonary Thromboembolism ◽

Auc Value ◽

Low Sensitivity

Background: The objective of this study is to evaluate the clinical usefulness of cardiac troponin levels in acute pulmonary thromboembolism (PTE) prognosis.Methods: Thorax computed tomography (CT) angiography was performed and reported by the radiologist as pulmonary embolism and 193 patients older than 18 years of age who were considered PTE by the physician of chest diseases were included in the study. Patients diagnosed with PTE were divided into two groups as those who died within 30 days and did not die within 30 days. As a result of the statistically significant relationship between troponin and mortality, receiver operating characteristic (ROC) analysis was performed to determine the prognosis level of troponin and appropriate sensitivity and specificity cut-off values were determined.Results: We determined that troponin levels of patients diagnosed with PTE in the emergency department were statistically significantly higher in the group with mortality (p=0.031). Since the area under the curve (AUC) value was calculated as 0.636, troponin value was found to have a weak-medium significance in terms of predicting 30-day mortality.Conclusions: Troponin values are statistically significantly higher in patients with a one-month period than the survivor group in this period. However, we concluded that troponin values are not clinically usable as mortality markers due to their low sensitivity and specificity rates. However, due to its significant relationship with increased mortality, patients with PTE with high troponin values should be hospitalized and monitored closely.

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Extracellular Vesicles in Tumor Diagnosis: A Mini-Review

Current Molecular Medicine ◽

10.2174/1573405616666201209103154 ◽

2020 ◽

Vol 20 ◽

Author(s):

Si Yu ◽

Menglin Huang ◽

Jingyu Wang ◽

Yongchang Zheng ◽

Haifeng Xu

Keyword(s):

Clinical Diagnosis ◽

Sensitivity And Specificity ◽

Cancer Diagnosis ◽

Cancer Biomarkers ◽

Related Substances ◽

Physiological Processes ◽

Cancer Pathogenesis ◽

Limited Application ◽

Low Sensitivity ◽

Shed Light

: Widely exploration of noninvasive tumor/cancer biomarkers has shed light on clinical diagnosis. However, many under-investigated biomarkers showed limited application potency due to low sensitivity and specificity, while extracellular vehicles (EVs) were gradually recognized as promising candidates. EVs are small vesicles transporting bioactive cargos between cells in multiple physiological processes and also in tumor/cancer pathogenesis. This review aimed to offer recent studies of EVs on structure, classification, physiological functions, as well as changes in tumor initiation and progression. Furthermore, we focused on advances of EVs and/or EV-related substances in cancer diagnosis, and summarized ongoing studies of promising candidates for future investigations.

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The (Absence of a) Role of Venous Duplex Scan in the Diagnosis of Pulmonary Embolism after Severe Trauma

The American Surgeon ◽

10.1177/000313480607200102 ◽

2006 ◽

Vol 72 (1) ◽

pp. 7-10

Author(s):

George C. Velmahos ◽

Carlos V. Brown ◽

Demetrios Demetriades

Keyword(s):

Intensive Care Unit ◽

Pulmonary Embolism ◽

Intensive Care ◽

Sensitivity And Specificity ◽

Clinical Suspicion ◽

Severely Injured ◽

Duplex Scan ◽

Severely Injured Patients ◽

High Level ◽

Injured Patients

Venous duplex scan (VDS) has been used for interim bedside diagnosis of pulmonary embolism (PE) in severely injured patients deemed to be at risk if transported out of the intensive care unit. In combination with the level of clinical suspicion for PE, VDS helps select patients for temporary treatment until definitive diagnosis is made. We evaluate the sensitivity and specificity of VDS in critically injured patients with a high level of clinical suspicion for PE. We performed a prospective observational cohort study at the surgical intensive care unit of an academic level 1 trauma center. Patients were 59 critically injured patients suspected to have PE over a 30-month period. The level of clinical suspicion for PE was classified as low or high according to preset criteria. Interventions were VDS and a PE outcome test (conventional or computed tomographic pulmonary angiography). The sensitivity and specificity of VDS to detect PE in all patients and in patients with high level of clinical suspicion was calculated against the results of the outcome test. PE was diagnosed in 21 patients (35.5%). The sensitivity and specificity of VDS was 33 per cent and 89 per cent, respectively. Among the 28 patients who had a high level of clinical suspicion for PE, the sensitivity of VDS was 23 per cent and the specificity 93 per cent. In this latter population, 1 of the 4 (25%) positive VDS was of a patient without PE and 10 of the 24 (42%) negative VDS were of patients who had PE. VDS does not accurately predict PE in severely injured patients, even in the presence of a high level of clinical suspicion.

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Challenges in the diagnosis of peripartum cardiomyopathy: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab001 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Fabio Chirillo ◽

Anna Baritussio ◽

Umberto Cucchini ◽

Ermanno Toniolli ◽

Angela Polo ◽

...

Keyword(s):

Heart Failure ◽

Multimodality Imaging ◽

Systolic Dysfunction ◽

Case Series ◽

Left Ventricular ◽

Peripartum Cardiomyopathy ◽

Lv Function ◽

Prognostic Information ◽

Clinical Scenarios ◽

Anterolateral Wall

Abstract Background Peripartum cardiomyopathy (PPCM) is usually characterized by overt heart failure, but other clinical scenarios are possible, sometimes making the diagnosis challenging. Case summary We report a case series of four patients with PPCM. The first patient presented with acute heart failure due to left ventricular (LV) systolic dysfunction. Following medical treatment, LV function recovered completely at 1 month. The second patient had systemic and pulmonary thromboembolism, secondary to severe biventricular dysfunction with biventricular thrombi. The third patient presented with myocardial infarction with non-obstructed coronary arteries and evidence of an aneurysm of the mid-anterolateral LV wall. The fourth patient, diagnosed with PPCM 11 years earlier, presented with sustained ventricular tachycardia. A repeat cardiac magnetic resonance, compared to the previous one performed 11 years earlier, showed an enlarged LV aneurysm in the mid-LV anterolateral wall with worsened global LV function. Discussion Peripartum cardiomyopathy may have different clinical presentations. Attentive clinical evaluation and multimodality imaging can provide precise diagnostic and prognostic information.

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POS0842 LUNG ULTRASOUND TO ASSESS THE SEVERITY OF INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1350 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 675.1-675

Author(s):

C. Bruni ◽

L. Mattolini ◽

L. Tofani ◽

L. Gargani ◽

N. Landini ◽

...

Keyword(s):

Systemic Sclerosis ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Quantitative Methods ◽

Lung Ultrasound ◽

Significant Negative Correlation ◽

High Resolution Computed Tomography ◽

Quantitative Score ◽

Quantitative Scoring ◽

B Lines

Background:Interstitial lung disease (ILD) is one of the most common complications and one of the main causes of morbidity and mortality in Systemic Sclerosis (SSc). High-resolution computed tomography (HRCT) is the gold standard for the diagnosis of ILD and it allows its quantification. Among semi-quantitative methods, Goh et al proposed a semi-quantitative scoring system to visually quantify ILD extent, with categorical cut-off of 20% to distinguish limited and extensive parenchymal involvement with prognostic implications. More recently, the use of radiomics has allowed the objective quantification of ILD through the use of dedicated software, which calculate different parameters of lung density.Given the exposure to ionizing radiation that the procedure entails, other methods of ILD evaluation are being studied, among which lung ultrasound (LUS) identifies the B-lines as a main feature of ILD. So far, different evidences have proposed the use of LUS for the screening of ILD, even in the early phases of the disease and in subclinical lung involvement.Objectives:the aim of this study is to test the role of LUS in quantifying the severity of SSc-ILD, evaluated with both semi-quantitative visual radiological and quantitative radiomic scores.Methods:Adult SSc patients classified according to the ACR/EULAR 2013 criteria patients were assessed with pulmonary function test (PFTs), lung ultrasound and HRCT over 60 days. CT images were analysed qualitatively (by presence/absence of ILD), semi-quantitatively (categorical Goh score <20% vs> 20% of extent and the continuous extent Goh score made from 5 levels’ assessment– 0 to 100%) and quantitatively [with the densitometric radiomic data obtained through the Horos software - Mean lung attenuation (MLA), Standard Deviation (SD), Kurtosis, Skewness and Lung volume (LV)]. LUS was used to quantify the B-lines detected in each patient by scanning a total of 13 intercostal spaces, on both anterior and posterior chest wall.Results:Among 59 SSc patients (81% women, mean age 48±14 years, 45% anti-Scl70 positive), 23 (39%) presented ILD on HRCT, of which 14 limited and 9 extensive. The mean visual semi-quantitative score was 6%, ranging from 0 to 66%. Our data showed a significantly different number of B-Lines in ILD vs non-ILD patients (median 38 vs 9, p <.005), a result which was further confirmed among non-ILD vs ILD> 20% (median 47 vs 9, p=.001) and ILD <20% (median 36 vs 9, p=.001) patients. Conversely, the number of B-lines was not statistically different between patients with ILD <20% and >20% (median 47 vs 36, p=.78). We observed a significant negative correlation between the number of B-lines and FVC (r=-.472, p<.05) TLC (r=-.436, p=.003), DLco (r=-.515, p<.001), DLCO/VA (r=.-306, p=.03). Finally, the number of B-lines showed a statistically significant correlation with the Goh score on 5 levels (r=.437, p=.001), MLA (r=.571, p<.001), kurtosis (r=-.285, p=.028), skewness (r=-.370, p = .004) and LV (r=-.277, p=.033). All data were confirmed analysing anterior and posterior B-Lines separately.Conclusion:Our study confirms that LUS represents a useful tool for the identification of SSc-ILD. In addition, we showed that LUS may be useful also for the quantification of the severity of SSc-ILD, by correlating with PFT parameters, radiomics parameters and visual radiological evaluation. Together with the PFTs, LUS could be used to increase the accuracy of the screening and, potentially, of the follow-up of SSc-ILD patients.Disclosure of Interests:Cosimo Bruni: None declared, Lavinia Mattolini: None declared, Lorenzo Tofani: None declared, Luna Gargani Consultant of: GE Healthcare, Philips Healthcare and Caption Health, Nicholas Landini: None declared, Gemma Lepri: None declared, Martina Orlandi: None declared, Serena Guiducci: None declared, Silvia Bellando Randone: None declared, Marco Matucci-Cerinic: None declared

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Deep learning for pulmonary embolism detection on computed tomography pulmonary angiogram: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-95249-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shelly Soffer ◽

Eyal Klang ◽

Orit Shimon ◽

Yiftach Barash ◽

Noa Cahan ◽

...

Keyword(s):

Systematic Review ◽

Pulmonary Embolism ◽

Deep Learning ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Risk Of Bias ◽

Future Research ◽

Learning Models ◽

Summary Receiver Operating Characteristic ◽

Pulmonary Angiogram

AbstractComputed tomographic pulmonary angiography (CTPA) is the gold standard for pulmonary embolism (PE) diagnosis. However, this diagnosis is susceptible to misdiagnosis. In this study, we aimed to perform a systematic review of current literature applying deep learning for the diagnosis of PE on CTPA. MEDLINE/PUBMED were searched for studies that reported on the accuracy of deep learning algorithms for PE on CTPA. The risk of bias was evaluated using the QUADAS-2 tool. Pooled sensitivity and specificity were calculated. Summary receiver operating characteristic curves were plotted. Seven studies met our inclusion criteria. A total of 36,847 CTPA studies were analyzed. All studies were retrospective. Five studies provided enough data to calculate summary estimates. The pooled sensitivity and specificity for PE detection were 0.88 (95% CI 0.803–0.927) and 0.86 (95% CI 0.756–0.924), respectively. Most studies had a high risk of bias. Our study suggests that deep learning models can detect PE on CTPA with satisfactory sensitivity and an acceptable number of false positive cases. Yet, these are only preliminary retrospective works, indicating the need for future research to determine the clinical impact of automated PE detection on patient care. Deep learning models are gradually being implemented in hospital systems, and it is important to understand the strengths and limitations of these algorithms.

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