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

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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Chest X-ray findings in a large cohort of 1117 patients with SARS-CoV-2 infection: a multicenter study during COVID-19 outbreak in Italy

Internal and Emergency Medicine ◽

10.1007/s11739-020-02561-3 ◽

2020 ◽

Author(s):

Valentina Vespro ◽

Maria Carmela Andrisani ◽

Stefano Fusco ◽

Letizia Di Meglio ◽

Guido Plensich ◽

...

Keyword(s):

Interstitial Pneumonia ◽

Ground Glass Opacity ◽

Large Cohort ◽

Frequent Pattern ◽

Categorical Variables ◽

Paired Data ◽

X Ray ◽

Lombardy Region ◽

Chest X Ray

AbstractTo describe radiographic key patterns on Chest X-ray (CXR) in patients with SARS-CoV-2 infection, assessing the prevalence of radiographic signs of interstitial pneumonia. To evaluate pattern variation between a baseline and a follow-up CXR. 1117 patients tested positive for SARS-CoV-2 infection were retrospectively enrolled from four centers in Lombardy region. All patients underwent a CXR at presentation. Follow-up CXR was performed when clinically indicated. Two radiologists in each center reviewed images and classified them as suggestive or not for interstitial pneumonia, recording the presence of ground-glass opacity (GGO), reticular pattern or consolidation and their distribution. Pearson’s χ2 test for categorical variables and McNemar test (χ2 for paired data) were performed. Patients mean age 63.3 years, 767 were males (65.5%). The main result is the large proportion of positive CXR in COVID-19 patients. Baseline CXR was positive in 940 patients (80.3%), with significant differences in age and sex distribution between patients with positive and negative CXR. 382 patients underwent a follow-up CXR. The most frequent pattern on baseline CXR was the GGO (66.1%), on follow-up was consolidation (53.4%). The most common distributions were peripheral and middle-lower lung zone. We described key-patterns and their distribution on CXR in a large cohort of COVID-19 patients: GGO was the most frequent finding on baseline CXR, while we found an increase in the proportion of lung consolidation on follow-up CXR. CXR proved to be a reliable tool in our cohort obtaining positive results in 80.3% of the baseline cases.

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COVID-19 Assessment with Bedside Lung Ultrasound in a Population of Intensive Care Patients Treated with Mechanical Ventilation and ECMO

Diagnostics ◽

10.3390/diagnostics10070447 ◽

2020 ◽

Vol 10 (7) ◽

pp. 447 ◽

Cited By ~ 5

Author(s):

Hasse Møller-Sørensen ◽

Jakob Gjedsted ◽

Vibeke Lind Jørgensen ◽

Kristoffer Lindskov Hansen

Keyword(s):

Intensive Care ◽

Lung Ultrasound ◽

Imaging Modality ◽

Point Of Care ◽

X Ray ◽

Intensive Care Patients ◽

Reactive Protein ◽

Extracorporal Membrane Oxygenation ◽

Accessible Point ◽

Chest X Ray

The COVID-19 pandemic has increased the need for an accessible, point-of-care and accurate imaging modality for pulmonary assessment. COVID-19 pneumonia is mainly monitored with chest X-ray, however, lung ultrasound (LUS) is an emerging tool for pulmonary evaluation. In this study, patients with verified COVID-19 disease hospitalized at the intensive care unit and treated with ventilator and extracorporal membrane oxygenation (ECMO) were evaluated with LUS for pulmonary changes. LUS findings were compared to C-reactive protein (CRP) and ventilator settings. Ten patients were included and scanned the day after initiation of ECMO and thereafter every second day until, if possible, weaned from ECMO. In total 38 scans adding up to 228 cineloops were recorded and analyzed off-line with the use of a constructed LUS score. The study indicated that patients with a trend of lower LUS scores over time were capable of being weaned from ECMO. LUS score was associated to CRP (R = 0.34; p < 0.03) and compliance (R = 0.60; p < 0.0001), with the strongest correlation to compliance. LUS may be used as a primary imaging modality for pulmonary assessment reducing the use of chest X-ray in COVID-19 patients treated with ventilator and ECMO.

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Descriptive study of chest x-ray examination in mandatory annual health examinations at the workplace in Japan

PLoS ONE ◽

10.1371/journal.pone.0262404 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262404

Author(s):

Yuya Watanabe ◽

Toru Nakagawa ◽

Kota Fukai ◽

Toru Honda ◽

Hiroyuki Furuya ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Detection Rate ◽

Low Dose ◽

Care Center ◽

Stage I ◽

X Ray ◽

Health Care Center ◽

Chest X Ray

The utility of chest x-ray examination (CXR) in mandatory annual health examinations for occupational health is debatable in Japan. This study aimed to provide basic data to consider future policies for mandatory annual health examinations in the workplace. A nationwide descriptive survey was performed to determine the rate of detection of tuberculosis, lung cancer, and other diseases through CXR in organizations associated with National Federation of Industrial Health Association. The rate of finding on CXR conducted during annual health examinations in FY2016 was evaluated. Data regarding diagnosis based on follow-up examination findings were obtained and compared with the national statistics. In addition, CXR findings were compared with the results of low-dose lung computed tomography performed at the Hitachi Health Care Center. From 121 surveyed institutions, 88 institutions with 8,669,403 workers were included. For all ages, 1.0% of examinees required follow-up examination. Among 4,764,985 workers with diagnosis data, the tuberculosis detection rate was 1.8–5.3 per 100,000 persons. For Lung cancer, 3,688,396 workers were surveyed, and 334 positive cases were detected. The lung cancer detection rate using CXR was 9.1–24.4 per 100,000 persons. From 164 cases with information regarding the clinical stage, 72 (43.9%) had Stage I lung cancer. From 40,045 workers who underwent low-dose computed tomography multiple times, 31 lung cancer cases, all with Stage I disease, were detected (detection rate: 77.4 per 100,000 persons). Our findings suggest that CXR plays a little role in the detection of active tuberculosis. With regard to LC screening, the detection rate of LC by CXR was lower, approximately 50%, than the expected rate (41.0 per 100,000 persons) of LC morbidity based on the age–sex distribution of this study population. However, the role of CXR for LC screening cannot be mentioned based on this result, because assessment of mortality reduction is essential to evaluate the role.

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A Successful Resection of Two Giant Mediastinal Neurogenic Tumors

Polish Journal of Surgery ◽

10.1515/pjs-2015-0007 ◽

2015 ◽

Vol 86 (12) ◽

Author(s):

Daniel Brzeziński ◽

Mariusz łochowski ◽

Józef Kozak

Keyword(s):

Computed Tomography ◽

Pleural Cavity ◽

Middle Age ◽

Postoperative Treatment ◽

X Ray ◽

Neurogenic Tumors ◽

Chest X Ray

AbstractWe reported two cases of the giant mediastinal neurogenic tumors. Patients were women in middle age. In both cases the chest X-ray and CT (computed tomography) demonstrated the huge mass in a pleural cavity without intraspinal invasion. Radical procedures with removal of the giant tumors were performed. The postoperative treatment course was uneventful. The pathology showed schwannoma and neurofibroma. The follow up examination (6-24 months) showed no recurrence of the disease.

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Computed tomography follow-up identifies radically treatable new primaries after resection for lung cancer

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz284 ◽

2019 ◽

Cited By ~ 1

Author(s):

Jenny Mitchell ◽

Rachel Benamore ◽

Fergus Gleeson ◽

Elizabeth Belcher

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Early Stage ◽

Primary Lung Cancer ◽

Negative Likelihood Ratio ◽

University Hospitals ◽

Early Stage Lung Cancer ◽

X Ray ◽

Chest X Ray

Abstract OBJECTIVES The optimal imaging programme for the follow-up of patients who have undergone resection of primary lung cancer is yet to be determined. We investigated the incidence and patterns of new and recurrent malignancy after resection for early-stage lung cancer in patients enrolled into a computed tomography (CT) follow-up programme. METHODS We reviewed the outcomes of consecutive patients who underwent CT follow-up after resection of early-stage primary lung cancer at the Oxford University Hospitals NHS Foundation Trust, between 2013 and 2017. RESULTS Four hundred and sixty-six consecutive patients underwent resection of primary lung cancer between 1 January 2013 and 31 March 2017. Three hundred and thirty-one patients (71.0%) were enrolled in CT follow-up. The median follow-up was 98 weeks (range 26–262). Sixty patients (18.2%) were diagnosed with programme-detected malignancy. Recurrence was diagnosed in 36 patients (10.9%), new primary lung cancer in 16 patients (4.8%) and non-lung primary tumours in 8 patients (2.4%). A routine CT scan identified the majority of new primary lung cancers (84.2%) and those with disease recurrence (85.7%). The majority of programme-detected malignancies were radically treatable (55%). The median survival of programme-detected cancers was 92.4 versus 23.0 weeks for patients with clinically detected tumours (P < 0.0001). Utilizing the CT scout image as a surrogate for chest X-ray, the sensitivity of this modality was 16.95% (8.44–28.97%) and specificity was 89.83% (79.17–96.18%). Negative likelihood ratio was 0.92 (0.8–1.07). CONCLUSIONS CT follow-up of surgically treated primary lung cancer patients identifies malignancy at a stage where radical treatment is possible in the majority of patients. Chest X-ray follow-up may not be of benefit following lung cancer resection.

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A pragmatic approach and treatment of coronavirus disease 2019 (COVID-19) in intensive care unit

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.66.8.1157 ◽

2020 ◽

Vol 66 (8) ◽

pp. 1157-1163

Author(s):

Sergio Henrique Loss ◽

Diego Leite Nunes ◽

Oellen Stuani Franzosi ◽

Cassiano Teixeira

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

Ventilatory Support ◽

Pragmatic Approach ◽

Chest Computed Tomography ◽

X Ray ◽

Global Pandemic ◽

Chest X Ray ◽

Different Populations

SUMMARY There is a new global pandemic that emerged in China in 2019 that is threatening different populations with severe acute respiratory failure. The disease has enormous potential for transmissibility and requires drastic governmental measures, guided by social distancing and the use of protective devices (gloves, masks, and facial shields). Once the need for admission to the ICU is characterized, a set of essentially supportive therapies are adopted in order to offer multi-organic support and allow time for healing. Typically, patients who require ventilatory support have bilateral infiltrates in the chest X-ray and chest computed tomography showing ground-glass pulmonary opacities and subsegmental consolidations. Invasive ventilatory support should not be postponed in a scenario of intense ventilatory distress. The treatment is, in essence, supportive.

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Intermediate Results (01/2011) of the Prospective Multicentre DEGUM-/ÖGUM-Study "Role of Chest Ultrasound in Diagnosing and Follow-Up of Pneumonia.” Prospective Comparison to Chest X-Ray in Two Planes and Low-Dose Spiral Computed Tomography”

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2011.05.152 ◽

2011 ◽

Vol 37 (8) ◽

pp. S30-S31

Author(s):

A. Reißig ◽

C. Mempel ◽

R. Copetti ◽

A. Schuler ◽

S. Aliberti ◽

...

Keyword(s):

Computed Tomography ◽

Low Dose ◽

Spiral Computed Tomography ◽

Spiral Computed ◽

X Ray ◽

Chest Ultrasound ◽

Prospective Comparison ◽

Chest X Ray

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Value of Multidetector Computed Tomography in the Assessment of Achalasia Subtypes and Detection of Pulmonary and Thoracic Complications

Medical Principles and Practice ◽

10.1159/000501057 ◽

2019 ◽

Vol 28 (6) ◽

pp. 539-546

Author(s):

Sanja Jovanovic ◽

Aleksandra Djuric-Stefanovic ◽

Aleksandar Simić ◽

Ognjan Skrobic ◽

Predrag Pesko

Keyword(s):

Computed Tomography ◽

Multidetector Computed Tomography ◽

Wall Thickness ◽

Imaging Modality ◽

Correlation Coefficients ◽

Observer Agreement ◽

Esophageal Wall ◽

X Ray ◽

Chest X Ray ◽

Diagnostic Work

Objective: To evaluate multidetector computed tomography (MDCT) findings in patients with achalasia, to assess its role in differentiating subtypes in detecting lung involvement and extra-esophageal thoracic complications. Subjects and Methods: This clinical retrospective study included 51 patients with manometrically confirmed achalasia who underwent chest X-ray and MDCT in diagnostic work-up. Esophageal wall thickness and morphology, luminal dilatation, lung changes, and extra-esophageal manifestations were analyzed on MDCT by 2 readers. Wilcoxon, Kruskal-Wallis and Mann-Whitney test were used for assessing the differences among the achalasia subtypes, and intra-class correlation coefficients (ICC) assessing the inter-observer agreement between the measurements of 2 readers. Results: Fourteen (27.5%) patients had achalasia subtype I, 21 (60.8%) had subtype II while 6 (11.8%) had subtype III. Esophageal wall thickness of the esophageal body (EB) and distal esophageal segment (DES) as well as nodular/lobulated appearance of DES were found significantly more often in subtype III (p = 0.024, p < 0.001, p = 0.009, respectively). Esophageal dilatation gradually decreased from subtype I to III (p = 0.006). Chest X-ray revealed lung changes in 9 (17%) and MDCT in 21 (41%) patients (p = 0.001), most frequently in subtype I, with predominance of ground-glass opacities. Tracheal/carinal compression was detected in 27 (52.9%) and left atrial compression in 17 (33.3%) patients. Excellent inter-observer agreement was observed in measuring the EB and DES wall thickness, and diameter of EB (ICC 0.829, 0.901, and 0.922). Conclusion: MDCT is a useful tool for detecting lung and extra-esophageal thoracic complications in patients with achalasia, and could be a valuable additional imaging modality in the differentiation of achalasia subtypes.

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