A Comparative Study of Chest CT With Lung Ultrasound After SARS-CoV-2 Infection in the Assessment of Pulmonary Lesions in Rhesus Monkeys (Macaca Mulatta)

Lung ultrasound (LUS) is a fast and non-invasive modality for the diagnosis of several diseases. In humans, LUS is nowadays of additional value for bedside screening of hospitalized SARS-CoV-2 infected patients. However, the diagnostic value of LUS in SARS-CoV-2 infected rhesus monkeys, with mild-to-moderate disease, is unknown. The aim of this observational study was to explore correlations of the LUS appearance of abnormalities with COVID-19-related lesions detected on computed tomography (CT). There were 28 adult female rhesus monkeys infected with SARS-CoV-2 included in this study. Chest CT and LUS were obtained pre-infection and 2-, 7-, and 14-days post infection. Twenty-five animals were sub-genomic PCR positive in their nose/throat swab for at least 1 day. CT images were scored based on the degree of involvement for lung lobe. LUS was scored based on the aeration and abnormalities for each part of the lungs, blinded to CT findings. Most common lesions observed on CT were ground glass opacities (GGOs) and crazy paving patterns. With LUS, confluent or multiple B-lines with or without pleural abnormalities were observed which is corresponding with GGOs on CT. The agreement between the two modalities was similar over the examination days. Pleural line abnormalities were clearly observed with LUS, but could be easily missed on CT. Nevertheless, due to the air interface LUS was not able to examine the complete volume of the lung. The sensitivity of LUS was high though the diagnostic efficacy for mild-to-moderate disease, as seen in macaques, was relatively low. This leaves CT the imaging modality of choice for diagnosis, monitoring, and longitudinal assessment of a SARS-CoV-2 infection in macaques.

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Diagnostic value of lung ultrasound versus chest CT in COVID-19

Sechenov Medical Journal ◽

10.47093/2218-7332.2020.11.2.5-18 ◽

2020 ◽

Vol 11 (2) ◽

pp. 5-18

Author(s):

S. S. Petrikov ◽

I. E. Popova ◽

V. M. Abuchina ◽

R. Sh. Muslimov ◽

L. T. Khamidova ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Lung Diseases ◽

Structural Changes ◽

Lung Ultrasound ◽

Ground Glass Opacity ◽

Diagnostic Value ◽

Chest Ct ◽

Ct Scans ◽

Chest Computed Tomography ◽

Ct Data

Lung ultrasound demonstrates a high diagnostic value in the assessment of lung diseases.Aim. To determine the diagnostic accuracy of lung ultrasound compared to chest computed tomography (CT) in the diagnosis of lung changes in COVID-19. Materials and methods. The retrospective study included 45 patients (28 men) aged 37 to 90 years who underwent polypositional lung ultrasound with an assessment of 14 zones. The study compared lung echograms with chest CT data in assessing the prevalence of the process and the nature of structural changes. The diagnostic accuracy, sensitivity, and specificity of lung ultrasound in comparison with CT scans were determined, 95% confidence intervals (CI) were calculated.Results. In 44 patients (98%), CT revealed pathological changes with subpleural localization in both lungs. Of these, in 30 cases, the inflammation was limited only to the subpleural parts, and in 14 cases, the changes spread to the basal parts of the lungs, while ultrasound revealed changes at the depth of the lesion no more than 4 cm. The lesion of 10–11 zones according to lung ultrasound corresponds to CT 1–2 degrees, the lesion of 13–14 zones — CT 3–4 degrees. The sensitivity of ultrasound to detect lung changes of various types was ≥ 92%. The highest sensitivity of 97.9% (95% CI: 92.8–99.8%) was determined for small consolidations on the background of interstitial changes (degree 1A+, 1B+), which corresponded to “crazy-paving” pattern on CT. The specificity depended on the nature of the changes and varied from 46.7 to 70.0%. Diagnostic accuracy was ≥ 81%, the maximum values of 90.6% (95% CI: 85.6–94.2%) were obtained for moderate interstitial changes (grade 1A) corresponding to ground-glass opacity (type one) according to CT data.Conclusion. The sensitivity of ultrasound to detect lung changes in COVID-19 is more than 90%. Lung ultrasound has some limitations: inability to determine the prevalence of the process clearly and identify centrally located areas of changes in the lung tissue.

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Clinical Applicability of Lung Ultrasound Methods in the Emergency Department to Detect Pulmonary Congestion on Computed Tomography

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1021-1470 ◽

2019 ◽

Author(s):

Kristina Cecilia Miger ◽

Andreas Fabricius-Bjerre ◽

Christian Peter Maschmann ◽

Jesper Wamberg ◽

Mathilde Marie Winkler Wille ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Pleural Effusion ◽

Lung Ultrasound ◽

Decompensated Heart Failure ◽

Diagnostic Value ◽

Chest Ct ◽

Chronic Obstructive ◽

Pulmonary Congestion ◽

B Lines

Abstract Background B-lines on lung ultrasound are seen in decompensated heart failure, but their diagnostic value in consecutive patients in the acute setting is not clear. Chest CT is the superior method to evaluate interstitial lung disease, but no studies have compared lung ultrasound directly to congestion on chest CT. Purpose To examine whether congestion on lung ultrasound equals congestion on a low-dose chest CT as the gold standard. Materials and Methods In a single-center, prospective observational study we included consecutive patients ≥ 50 years of age in the emergency department. Patients were concurrently examined by lung ultrasound and chest CT. Congestion on lung ultrasound was examined in three ways: I) the total number of B-lines, II) ≥ 3 B-lines bilaterally, III) ≥ 3 B-lines bilaterally and/or bilateral pleural effusion. Congestion on CT was assessed by two specialists blinded to all other data. Results We included 117 patients, 27 % of whom had a history of heart failure and 52 % chronic obstructive pulmonary disease. Lung ultrasound and CT were performed within a median time of 79.0 minutes. Congestion on CT was detected in 32 patients (27 %). Method I had an optimal cut-point of 7 B-lines with a sensitivity of 72 % and a specificity of 81 % for congestion. Method II had 44 % sensitivity, and 94 % specificity. Method III had a sensitivity of 88 % and a specificity of 85 %. Conclusion Pulmonary congestion in consecutive dyspneic patients ≥ 50 years of age is better diagnosed if lung ultrasound evaluates both B-lines and pleural effusion instead of B-lines alone.

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Lung Ultrasound Findings in a Covid-19 Patient with Negative Chest CT

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1248-9068 ◽

2020 ◽

Author(s):

Yale Tung Chen ◽

Milagros Martí de Gracia ◽

Maria Luz Parra Gordo ◽

Silvia Ossaba Velez ◽

Sergio Agudo-Fernández

Keyword(s):

Lung Ultrasound ◽

Chest Ct ◽

Ultrasound Findings

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The Diagnostic Value of FDG PET/CT and Thin-Slice High-Resolution Chest CT in Pulmonary Intravascular Metastasis

American Journal of Roentgenology ◽

10.2214/ajr.20.23017 ◽

2021 ◽

pp. 1-7

Author(s):

Yu Ji ◽

Chunchun C. Shao ◽

Yong Cui ◽

Kai Cui ◽

Guangrui R. Shao ◽

...

Keyword(s):

High Resolution ◽

Fdg Pet ◽

Diagnostic Value ◽

Chest Ct ◽

Thin Slice ◽

Pet Ct ◽

Fdg Pet Ct

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Lung ultrasound and computed tomography to monitor COVID-19 pneumonia in critically ill patients: a two-center prospective cohort study

Intensive Care Medicine Experimental ◽

10.1186/s40635-020-00367-3 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Micah L. A. Heldeweg ◽

Jorge E. Lopez Matta ◽

Mark E. Haaksma ◽

Jasper M. Smit ◽

Carlos V. Elzo Kraemer ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Lung Ultrasound ◽

Composite Endpoint ◽

Pulmonary Involvement ◽

Chest Ct ◽

Secondary Outcome ◽

Icu Stay ◽

Academic Hospitals ◽

Ultrasound Score

Abstract Background Lung ultrasound can adequately monitor disease severity in pneumonia and acute respiratory distress syndrome. We hypothesize lung ultrasound can adequately monitor COVID-19 pneumonia in critically ill patients. Methods Adult patients with COVID-19 pneumonia admitted to the intensive care unit of two academic hospitals who underwent a 12-zone lung ultrasound and a chest CT examination were included. Baseline characteristics, and outcomes including composite endpoint death or ICU stay > 30 days were recorded. Lung ultrasound and CT images were quantified as a lung ultrasound score involvement index (LUSI) and CT severity involvement index (CTSI). Primary outcome was the correlation, agreement, and concordance between LUSI and CTSI. Secondary outcome was the association of LUSI and CTSI with the composite endpoints. Results We included 55 ultrasound examinations in 34 patients, which were 88% were male, with a mean age of 63 years and mean P/F ratio of 151. The correlation between LUSI and CTSI was strong (r = 0.795), with an overall 15% bias, and limits of agreement ranging − 40 to 9.7. Concordance between changes in sequentially measured LUSI and CTSI was 81%. In the univariate model, high involvement on LUSI and CTSI were associated with a composite endpoint. In the multivariate model, LUSI was the only remaining independent predictor. Conclusions Lung ultrasound can be used as an alternative for chest CT in monitoring COVID-19 pneumonia in critically ill patients as it can quantify pulmonary involvement, register changes over the course of the disease, and predict death or ICU stay > 30 days. Trial registration: NTR, NL8584. Registered 01 May 2020—retrospectively registered, https://www.trialregister.nl/trial/8584

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Diagnostic Value of C-Reactive Protein in Discrimination between Uncomplicated and Complicated Parapneumonic Effusion

Diagnostics ◽

10.3390/diagnostics10100829 ◽

2020 ◽

Vol 10 (10) ◽

pp. 829

Author(s):

Yana Kogan ◽

Edmond Sabo ◽

Majed Odeh

Keyword(s):

Area Under The Curve ◽

Diagnostic Value ◽

Parapneumonic Effusion ◽

C Reactive Protein ◽

Diagnostic Efficacy ◽

Reactive Protein ◽

Significant Difference ◽

Study Population ◽

Complicated Parapneumonic Effusion

Objectives: The role of serum C-reactive protein (CRPs) and pleural fluid CRP (CRPpf) in discriminating uncomplicated parapneumonic effusion (UCPPE) from complicated parapneumonic effusion (CPPE) is yet to be validated since most of the previous studies were on small cohorts and with variable results. The role of CRPs and CRPpf gradient (CRPg) and of their ratio (CRPr) in this discrimination has not been previously reported. The study aims to assess the diagnostic efficacy of CRPs, CRPpf, CRPr, and CRPg in discriminating UCPPE from CPPE in a relatively large cohort. Methods: The study population included 146 patients with PPE, 86 with UCPPE and 60 with CPPE. Levels of CRPs and CRPpf were measured, and the CRPg and CRPr were calculated. The values are presented as mean ± SD. Results: Mean levels of CRPs, CRPpf, CRPg, and CRPr of the UCPPE group were 145.3 ± 67.6 mg/L, 58.5 ± 38.5 mg/L, 86.8 ± 37.3 mg/L, and 0.39 ± 0.11, respectively, and for the CPPE group were 302.2 ± 75.6 mg/L, 112 ± 65 mg/L, 188.3 ± 62.3 mg/L, and 0.36 ± 0.19, respectively. Levels of CRPs, CRPpf, and CRPg were significantly higher in the CPPE than in the UCPPE group (p < 0.0001). No significant difference was found between the two groups for levels of CRPr (p = 0.26). The best cut-off value calculated by the receiver operating characteristic (ROC) analysis for discriminating UCPPE from CPPE was for CRPs, 211.5 mg/L with area under the curve (AUC) = 94% and p < 0.0001, for CRPpf, 90.5 mg/L with AUC = 76.3% and p < 0.0001, and for CRPg, 142 mg/L with AUC = 91% and p < 0.0001. Conclusions: CRPs, CRPpf, and CRPg are strong markers for discrimination between UCPPE and CPPE, while CRPr has no role in this discrimination.

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Lung Ultrasound Patterns and Clinical-Laboratory Correlates during COVID-19 Pneumonia: A Retrospective Study from North East Italy

Journal of Clinical Medicine ◽

10.3390/jcm10061288 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1288

Author(s):

Riccardo Senter ◽

Federico Capone ◽

Stefano Pasqualin ◽

Lorenzo Cerruti ◽

Leonardo Molinari ◽

...

Keyword(s):

Lung Ultrasound ◽

Clinical Laboratory ◽

Imaging Modality ◽

Case Series ◽

Severity Index ◽

Disease Stage ◽

Retrospective Case ◽

North East ◽

High Flow Oxygen ◽

B Lines

Background and Aim. Lung ultrasound (LUS) is a convenient imaging modality in the setting of coronavirus disease-19 (COVID-19) because it is easily available, can be performed bedside and repeated over time. We herein examined LUS patterns in relation to disease severity and disease stage among patients with COVID-19 pneumonia. Methods. We performed a retrospective case series analysis of patients with confirmed SARS-CoV-2 infection who were admitted to the hospital because of pneumonia. We recorded history, clinical parameters and medications. LUS was performed and scored in a standardized fashion by experienced operators, with evaluation of up to 12 lung fields, reporting especially on B-lines and consolidations. Results. We included 96 patients, 58.3% men, with a mean age of 65.9 years. Patients with a high-risk quick COVID-19 severity index (qCSI) were older and had worse outcomes, especially for the need for high-flow oxygen. B-lines and consolidations were located mainly in the lower posterior lung fields. LUS patterns for B-lines and consolidations were significantly worse in all lung fields among patients with high versus low qCSI. B-lines and consolidations were worse in the intermediate disease stage, from day 7 to 13 after onset of symptoms. While consolidations correlated more with inflammatory biomarkers, B-lines correlated more with end-organ damage, including extrapulmonary involvement. Conclusions. LUS patterns provide a comprehensive evaluation of patients with COVID-19 pneumonia that correlated with severity and dynamically reflect disease stage. LUS patterns may reflect different pathophysiological processes related to inflammation or tissue damage; consolidations may represent a more specific sign of localized disease, whereas B-lines seem to be also dependent upon generalized illness due to SARS-CoV-2 infection.

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Diagnostic value of research methods in diagnostics of chronic pancreatitis

Kazan medical journal ◽

10.17816/kmj2021-528 ◽

2021 ◽

Vol 102 (4) ◽

pp. 528-536

Author(s):

G R Aliyeva

Keyword(s):

Chronic Pancreatitis ◽

Early Stage ◽

Imaging Modality ◽

Magnetic Resonance Cholangiopancreatography ◽

Clinical History ◽

Diagnostic Value ◽

Diagnostic Tools ◽

Invasive Approach ◽

Pancreas Function ◽

Function Testing

Chronic pancreatitis remains an unsolved problem for clinicians. One of the biggest dilemmas is to establish a clear diagnosis. Diagnosis can be particularly elusive in patients with early chronic pancreatitis. Many studies have been undertaken to improve diagnostics in chronic pancreatitis, but this has been significantly limited by the lack of a gold standard. The evaluation of patients with suspected chronic pancreatitis should follow a progressively non-invasive to more invasive approach. Computed tomography is the best primary imaging modality to obtain as it has good sensitivity for severe chronic pancreatitis and may exclude the need for other diagnostic tests. When ambiguous results are obtained, a magnetic resonance cholangiopancreatography may require for a more detailed evaluation of both the pancreatic parenchyma and ducts. If the diagnosis remains in doubt, endoscopic ultrasound with or without pancreas function testing becomes the preferred method. Endoscopic retrograde cholangiopancreatography remains a last line diagnostic test and generally should be used only for diagnostic purposes. Future researches in the field of diagnosis of early-stage chronic pancreatitis should purpose optimizing current diagnostic tools. A definitive diagnosis of chronic pancreatitis may not be made simply by clinical history, imaging or function testing alone, but rather by the data gathered by a combination of these diagnostic tools.

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Cone Beam Computed Tomography (CBCT) in Periodontal Diseases: A Systematic Review Based on the Efficacy Model

10.21203/rs.2.18385/v4 ◽

2020 ◽

Author(s):

Hassan Assiri ◽

Ali Dwasaz ◽

Ahmad AA Alahmari ◽

Zuhair A Asiri

Keyword(s):

Patient Outcomes ◽

Imaging Modality ◽

Periodontal Diseases ◽

Systematic Search ◽

Cone Beam ◽

Inclusion Criteria ◽

Diagnostic Efficacy ◽

Computed Tomographic ◽

Quality Assessments ◽

Relevant Level

Abstract Objectives The aim of this study was to address the diagnostic efficacy of cone beam computed tomographic (CBCT) imaging in periodontics based on a systematic search and analysis of the literature using the hierarchical efficacy model. Methods A systematic search of the electronic databases such as PubMed, Scopus, Web of Science, and Cochrane was conducted until February 2019 to identify studies addressing the efficacy of CBCT imaging in Periodontics. The identified studies were subjected to pre-identified inclusion criteria followed by an analysis using a hierarchical model of efficacy (model) designed for an appraisal of the literature on a diagnostic imaging modality. Two examiners performed the eligibility and quality assessment of relevant studies, and consensus was reached where disagreement was found. Results The search resulted in 64 studies. Of these, 35 publications were allocated to the relevant level of efficacy and quality assessments wherever applicable. The overall diagnostic accuracy studies showed the risk of bias and applicability concerns in the use of CBCT to be low to moderate. In addition, CBCT is accurate in identifying periodontal defects when compared to other modalities. The studies on the level of patient outcomes agreed that CBCT is a reliable tool for the assessment of the outcomes after the treatment of periodontal defects. Conclusion CBCT was found to be beneficial and accurate in cases of infra-bony defects and furcation involvements.

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CEA and ADA in Pleural Fluid for Differential Malignant Pleural Effusion and Tuberculous Pleural Effusion

10.21203/rs.3.rs-757795/v1 ◽

2021 ◽

Author(s):

Jianhong Yu ◽

Qirui Cai

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Roc Curve ◽

Malignant Pleural Effusion ◽

Diagnostic Value ◽

Diagnostic Model ◽

Diagnostic Efficacy ◽

Tuberculous Pleural Effusion ◽

Diagnostic Models ◽

Independent Risk Factors

Abstract Objective This study aimed to establish a predictive model based on the clinical manifestations and laboratory findings in pleural fluid of patients with pleural effusion for the differential diagnosis of malignant pleural effusion (MPE) and tuberculous pleural effusion (TPE). Methods Clinical data and laboratory indices of pleural fluid were collected from patients with malignant pleural effusion and tuberculous pleural effusion in Zigong First People's Hospital between January 2019 and June 2020，and were compared between the two groups. Independent risk factors or Independent protective factors for malignant pleural effusion were investigated using multivariable logistic regression analysis. Receiver operating characteristic curve (ROC) analysis was performed to assess the diagnostic performance of factors with independent effects, and combined diagnostic models were established based on two or more factors with independence effect. ROC curve was used to evaluate the diagnostic ability of each model, and the fit of the eath model was measured using Hosmer-Lemeshow goodness-of-fit test. Results Patients with MPE were older than those with TPE, the rate of fever of patients with MPE was lower than that of patients with TPE, and these differences were statistically significant (p < 0.05). Carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin-19 fragment antigen (CYFRA21-1), cancer antigen 125 (CA125), and glucose (GLU) levels in the pleural fluid were higher, but total protein (TP), albumin (ALB) and Adenosine deaminase (ADA) levels in the pleural fluid were lower in MPE patients than in TPE patients, and the differences were statistically significant (P<0.05). In multivariate logistic regression analysis, CEA and NSE levels in the pleural fluid were independent risk factors for MPE, whereas ADA levels in pleural fluid and fever were independent protective factors for MPE. The differential diagnostic value of pleural fluid CEA and pleural fluid ADA for MPE and TPE were higher than that of pleural fluid NSE（p<0.05） and the area under the ROC curve was 0.901, 0.892, and 0.601, respectively. Four different binary logistic diagnostic models were established based on pleural fluid CEA combined with pleural fluid NSE, pleural fluid ADA or ( and ) fever. Among them, the model established with the combination of pleural fluid CEA and pleural fluid ADA (logit (P) = 0.513 + 0.457*CEA-0.101*ADA) had the highest diagnostic value for malignant pleural effusion, and its predictive accuracy was high with an area under the ROC curve of 0.968 [95% confidence interval (0.947, 0.988)]. But the diagnostic efficacy of the diagnostic model could not be improved by adding pleural fluid NSE and fever. Conclusion The model established with the combination of CEA and ADA in the pleural fluid has a high differential diagnostic value for malignant pleural effusion and tuberculous pleural effusion, and NSE in the pleural fluid and fever cannot improve the diagnostic efficacy of the diagnostic model.

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