On Cancer, COVID-19, and CT Scans: A Monocentric Retrospective Study

Background The use of computed tomography (CT) for coronavirus disease 2019 (COVID-19) diagnosis in an area of northern Italy with a high incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have identified more patients with this disease than RT-PCR in the very early onset of the COVID-19 pandemic. Methods We retrospectively reviewed 148 chest CT scans of oncological patients who were referred to the Radiological Unit of Policlinico S. Marco from 1 February 2020 to 30 April 2020, during the COVID-19 outbreak in Bergamo area. In parallel, we analyzed RT-PCR tests of these 148 patients. Results Among 32 patients with a diagnosis of COVID-19, 17 patients were asymptomatic or had mild symptoms (53.1%), while 15 developed severe disease (46.8%). The incidence of SARS-CoV-2 infection was 22.9%, the mortality rate was 18.8%. We did not find any correlation between disease severity and age, sex, smoking, or cardiovascular comorbidities. Remarkably, patients who were on treatment for cancer developed a milder disease than patients who were not on treatment. Conclusions The acceptance of CT-defined diagnoses in COVID-19 high-incidence areas like Bergamo region highlighted a larger oncological population affected by COVID-19 than RT-PCR, in particular, asymptomatic and mildly symptomatic patients, because only symptomatic patients underwent nasopharyngeal swabbing at the onset of the COVID-19 pandemic. We observed that patients actively treated for their cancer had a milder disease, in agreement with previous studies that suggested a protective role of immunosuppression. Admittedly, the sample of patients in our study was heterogeneous regarding the oncological disease, their prognosis, and the type of treatment; therefore, other studies are needed to confirm our data.

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On Cancer, COVID-19 and CT Scan: A Monocentric Retrospective Study

10.20944/preprints202009.0075.v1 ◽

2020 ◽

Author(s):

Francesca Martini ◽

Andrea D'Alessio ◽

Federico Bracchi ◽

Daniela Di Mauro ◽

Anna Fargnoli ◽

...

Keyword(s):

Severe Disease ◽

Protective Role ◽

Northern Italy ◽

Chest Ct ◽

Ct Scans ◽

Rt Pcr ◽

Cardiovascular Comorbidities ◽

Oncological Patients ◽

High Prevalence

Background The acknowledgment of computed tomography (CT) defined diagnosis in high prevalence northern Italy may identify more patients with Coronavirus Disease-2019 (COVID 19) infection, than RT-PCR alone. Methods We retrospectively reviewed 148 chest CT scans of oncological patients who were referred to the Radiological Unit of Policlinico S. Marco from 1st of February 2020 to 30th of April 2020, during the Covid-19 outbreak in Bergamo area. Therefore, we analyzed RT-PCR tests of these 148 patients. Results Among 32 patients with diagnosis of COVID-19 infection: 17 patients were asymptomatic or had mild symptoms (53.1%), while 15 developed severe disease (46.8%). The incidence of COVID-19 infection is 22.9%, the mortality rate is 18.8%. Severe COVID-19 disease is associated with higher median age. We did not find any correlation between disease severity and sex, smoke or cardiovascular comorbidities. Remarkably, patients who were on treatment developed milder disease than cancer patients who were not on treatment. Conclusions The acceptance of CT-defined diagnosis in high prevalence area like Bergamo highlighted a larger number of COVID-19 oncological population than RT-PCR alone, in particular asymptomatic and mild symptomatic patients. We observed that actively treated patients had milder disease, according to previous studies that suggested a protective role of immunosuppression.

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Chest CT texture-based radiomics analysis in differentiating COVID-19 from other interstitial pneumonia

La radiologia medica ◽

10.1007/s11547-021-01402-3 ◽

2021 ◽

Author(s):

Damiano Caruso ◽

Francesco Pucciarelli ◽

Marta Zerunian ◽

Balaji Ganeshan ◽

Domenico De Santis ◽

...

Keyword(s):

Interstitial Pneumonia ◽

Potential Role ◽

Texture Features ◽

Roc Curves ◽

Chest Ct ◽

Preliminary Evaluation ◽

Rt Pcr ◽

Mean Intensity ◽

Polymerase Chain

Abstract Purpose To evaluate the potential role of texture-based radiomics analysis in differentiating Coronavirus Disease-19 (COVID-19) pneumonia from pneumonia of other etiology on Chest CT. Materials and methods One hundred and twenty consecutive patients admitted to Emergency Department, from March 8, 2020, to April 25, 2020, with suspicious of COVID-19 that underwent Chest CT, were retrospectively analyzed. All patients presented CT findings indicative for interstitial pneumonia. Sixty patients with positive COVID-19 real-time reverse transcription polymerase chain reaction (RT-PCR) and 60 patients with negative COVID-19 RT-PCR were enrolled. CT texture analysis (CTTA) was manually performed using dedicated software by two radiologists in consensus and textural features on filtered and unfiltered images were extracted as follows: mean intensity, standard deviation (SD), entropy, mean of positive pixels (MPP), skewness, and kurtosis. Nonparametric Mann–Whitney test assessed CTTA ability to differentiate positive from negative COVID-19 patients. Diagnostic criteria were obtained from receiver operating characteristic (ROC) curves. Results Unfiltered CTTA showed lower values of mean intensity, MPP, and kurtosis in COVID-19 positive patients compared to negative patients (p = 0.041, 0.004, and 0.002, respectively). On filtered images, fine and medium texture scales were significant differentiators; fine texture scale being most significant where COVID-19 positive patients had lower SD (p = 0.004) and MPP (p = 0.004) compared to COVID-19 negative patients. A combination of the significant texture features could identify the patients with positive COVID-19 from negative COVID-19 with a sensitivity of 60% and specificity of 80% (p = 0.001). Conclusions Preliminary evaluation suggests potential role of CTTA in distinguishing COVID-19 pneumonia from other interstitial pneumonia on Chest CT.

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Ligustrazine activate the PPAR-γ pathway and play a protective role in vascular calcification

Vascular ◽

10.1177/17085381211051477 ◽

2021 ◽

pp. 170853812110514

Author(s):

Hui Li ◽

Min Yang

Keyword(s):

Vascular Calcification ◽

Chondrogenic Differentiation ◽

Calcium Content ◽

Protective Role ◽

Peroxisome Proliferation ◽

Rt Pcr ◽

Alizarin Red ◽

Ppar Γ ◽

Related Proteins

Objective The purpose of this study was to explore the role of ligustrazine in vascular calcification. Methods After β-GP stimulation, vascular smooth muscle cells (VSMCs) were detected by Alizarin Red Staing staining. Calcium content and alkaline phosphatase (ALP) activity were detected by intracellular calcium assay kit and ALP assay kit, respectively. The expression of peroxisome proliferation-activated receptor (PPAR-γ) pathway–related proteins was detected by Western blot. PPAR-γ, MSX2, osteopontin (OPN), sclerostin, and BGP were detected by RT-PCR. Results β-GP induced the decreased activity and expression of PPAR-γ and ALP in VSMCs, while ligustrazine activated the expression of PPAR-γ. Through activation of PPAR-γ, ligustrazine decreased β-GP–induced VSMC calcification, decreased the expression of markers of osteogenesis and chondrogenic differentiation, and increased the expression of VSMC markers. Conclusion Ligustrazine activates the PPAR-γ pathway and plays a protective role in vascular calcification.

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DIAGNOSTIC ROLE OF CHEST CT USING CO-RADS CATEGORIZATION IN SARS-COV-2 INFECTION WITH EMPHASIS ON IMPACT OF CT IN PATIENTS WITH DELAYED OR NEGATIVE INITIAL RTPCR TEST

10.36106/ijar/9301921 ◽

2021 ◽

pp. 51-52

Author(s):

Tharani Putta ◽

Kaushik Deconda

Keyword(s):

Diagnostic Performance ◽

Virus Disease ◽

Vital Role ◽

Chest Ct ◽

Lung Involvement ◽

Test Results ◽

Rt Pcr ◽

Diagnostic Role ◽

Pcr Test

BACKGROUND AND OBJECTIVE: Role of chest CT in diagnosis of corona virus disease 2019 (COVID-19) has been controversial. The purpose of this study is to evaluate the diagnostic performance of chest CT when utilizing COVID-19 Reporting and Data System (CO-RADS). METHODOLOGY: Retrospective study including consecutive patients with positive SARS-CoV-2 RT-PCR test (initial or repeat test) and chest CT done in our institute between June and September 2020. Spectrum of CT ndings, CO-RADS score and 25 point CT severity score (CTSS) were recorded. RESULTS: A total of 300 consecutive patients with SARS-CoV-2 infection were included in the analysis. Out of the 168 patients who underwent CT prior to positive RT-PCR result, 125 (74.4%) had CO-RADS 3, 4 or 5 score on chest CT. 32 study patients (10.6%) had initial negative RT-PCR of which 24 (75%) had CO-RADS 4 or 5 score. Of the total patients with CO-RADS 3 to 5 score (227), 20 (8.8%) had severe lung involvement (CTSS 18-25), 83 (36.6%) had moderate lung involvement (CTSS 8-17) and 124 (54.6%) had mild lung involvement (CTSS 1-7). The mean CTSS was 7.9 with mean lobar score being higher in lower lobes (RLL=1.82, LLL=1.78) compared to the upper and middle lobes (RUL=1.61, RML=1.19, LUL=1.53). CONCLUSION:CT using CO-RADS scoring system has good diagnostic performance. In addition to assessing disease severity, it plays a vital role in triage of patients with suspected COVID-19 especially when there is limited availability of SARS-CoV-2 RT-PCR tests, delay in RT-PCR test results or in negative RT-PCR cases when there is high index of clinical suspicion.

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Chest CT as a Complement to RT-PCR to Confirm and Follow-up COVID-19 Patients

Medicinus ◽

10.19166/med.v8i1.3122 ◽

2021 ◽

Vol 8 (1) ◽

pp. 31

Author(s):

Aziza Ghanie Icksan ◽

Muhammad Hafiz ◽

Annisa Dian Harlivasari

Keyword(s):

Chest Ct ◽

Rt Pcr ◽

High Resolution Computed Tomography ◽

X Ray ◽

First Case ◽

Chest X Ray ◽

Polymerase Chain

Background : The first case of COVID-19 in Indonesia was recorded in March 2020. Limitation of reverse-transcription polymerase chain reaction (RT-PCR) has put chest CT as an essential complementary tool in the diagnosis and follow up treatment for COVID-19. Literatures strongly suggested that High-Resolution Computed Tomography (HRCT) is essential in diagnosing typical symptoms of COVID-19 at the early phase of disease due to its superior sensitivity (97%) compared to chest x-ray (CXR).The two cases presented in this case study showed the crucial role of chest CT with HRCT to establish the working diagnosis and follow up COVID-19 patients as a complement to RT-PCR, currently deemed a gold standard.

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The Role of Chest CT Scans in the Management of Empyema

Tuberculosis and Respiratory Diseases ◽

10.4046/trd.1994.41.4.397 ◽

1994 ◽

Vol 41 (4) ◽

pp. 397

Author(s):

Jeong Suk Heo ◽

Oh Yong Kwun ◽

Jeong Ho Sohn ◽

Won Il Choi ◽

Jae Seok Hwang ◽

...

Keyword(s):

Chest Ct ◽

Ct Scans

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CO-RADS versus CT-SS scores in predicting severe COVID-19 patients: retrospective comparative study

Egyptian Journal of Bronchology ◽

10.1186/s43168-021-00060-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Niveen E. Zayed ◽

Manar A. Bessar ◽

Samah Lutfy

Keyword(s):

Comparative Study ◽

Severe Disease ◽

Scoring Systems ◽

Rt Pcr ◽

C Reactive Protein ◽

Reactive Protein ◽

Polymerase Chain ◽

Retrospective Comparative Study ◽

Rule Out

Abstract Background The role of CT in assessing and plotting viral pulmonary affection land marking is its potential among other investigation tools, and the aim of the study was to compare the ability of two different CT-based scoring systems in discriminating severe COVID-19 disease. Results Retrospective comparative study included 142 confirmed COVID-19 patients by real-time polymerase chain reaction (RT-PCR) test, with different degrees of disease (mild to severe), the data of patients collected from medical records, and patients with their first CT chest read for calculating CO-RADS and severity scoring system (CT-SS) score. The patients with severe COVID-19 disease were significantly older and had different comorbidities. The level of C-reactive protein, ESR, ferritin, and LDH were significantly higher in severe disease, P < 0.001. The ability of CT chest and its score bases (CT-SS and CO-RADS) were accurate in differentiation between mild/moderate and severe disease; AUC were 89% and 97%, respectively. The cutoff value of less than 7.5 and 4.5 for CT-SS and CO-RADS, respectively, can rule out severe COVID-19 by 90% and 97%, respectively. Conclusions CT chest play a segregate role in COVID-19 disease, add on an advantage in clinical data in triage, and highlight the decision of hospital admission.

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Diagnosis of Coronavirus Disease 2019 (COVID-19): Neither Chest CT nor RT-PCR Fits All

10.21203/rs.3.rs-27336/v1 ◽

2020 ◽

Author(s):

Yue Teng ◽

Hui Dai ◽

Yalei Shang ◽

Jianguo Xia ◽

Yuehua Chen ◽

...

Keyword(s):

False Negative ◽

Ground Glass Opacity ◽

Chest Ct ◽

Ct Scans ◽

Imaging Features ◽

Rt Pcr ◽

Negative Results ◽

Halo Sign ◽

Solid Nodule ◽

Ct Findings

Abstract BackgroundComputed tomography (CT) and reverse-transcription polymerase chain reaction (RT-PCR) are the recommended tools for the diagnosis of coronavirus disease 2019 (COVID-19). The present study aimed to investigate the correlation between chest CT and RT-PCR while describing the atypical CT imaging features of COVID-19.MethodsIn this study, 418 patients in Jiangsu, China, clinically diagnosed with COVID-19 from January 10 to February 17, 2020, were included. Patients who fulfilled the following conditions were evaluated further: (1) Patients had positive RT-PCR and negative CT; (2) Patients had initial negative RT-PCR and positive CT, and follow-up PT-PCR tests were positive; (3) Patients had atypical CT findings.ResultsOf the 418 initial chest CT scans, 30 (7.2%) patients had normal CT presentation, and 6 (1.4%) patients had initial negative RT-PCR results and positive CT scans. Next, 10 (2.4%) cases of patients showed atypical CT findings, including 2 case of solid nodule, 4 cases of halo sign (solid nodule or mass surrounded by ground glass opacity), and 4 cases of predominant fibrous stripes.ConclusionsFalse-negative results can be found on both chest CT and RT-PCR; hence, the diagnosis of COVID-19 should consider both CT and RT-PCR. CT manifestations, such as solitary nodule, halo sign, and pulmonary fibrous stripes, might indicate the possibility of COVID-19 to the radiologists.

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The Diagnostic Value of CT scans in the Process of Diagnosing COVID-19 in medical Centers

Health Technology Assessment in Action ◽

10.18502/htaa.v4i1.5866 ◽

2021 ◽

Author(s):

Afshin Ostovar ◽

Elham Ehsani-Chimeh ◽

Zeinab Fakoorfard

Keyword(s):

Ct Scan ◽

Sensitivity And Specificity ◽

Clinical Decision Making ◽

Diagnostic Value ◽

Chest Ct ◽

Rapid Review ◽

Ct Scans ◽

Rt Pcr ◽

Medical Centers ◽

Pcr Test

Background: Coronavirus disease (COVID-19) has spread around the world since the beginning of 2020. The definitive diagnosis of COVID-19 is the RT-PCR laboratory test. However, because of low sensitivity, the chest CT scan has become important for the rapid diagnosis and clinical decision-making. Objectives: This study aims to define CT scan’ diagnostic value in diagnosing COVID-19 in medical centers. Methods: This study is a rapid health technology assessment (HTA) and had two major phases. In phase 1, a rapid review was done for defining the sensitivity and specificity rate of CT. During this phase, studies related to the diagnostic and technical data on the use of CT in the diagnosis of COVID-19 were reviewed, and the sensitivity and specificity of CT in these studies were extracted. In phase 2, sequential testing was run to evaluate the diagnostic value of chest CT to diagnose COVID-19 according to two scenarios before and after adding RT-PCR test results. Results: CT scan has a high sensitivity for diagnosing cases of COVID-19. Due to its low specificity, relying on CT scans to diagnose COVID-19 alone in medical centers can lead to a significant proportion of false-positive cases. This study showed that if the probability of COVID-19 before the CT scan were about 50%, with a positive CT scan, this probability would be between 60 and 70% depending on the CT specificity. Conclusions: With the available evidence, the use of a CT scan alone is not sufficient for diagnosis. The RT-PCR test is also necessary to improve the diagnosis and continue the treatment and isolation of patients.

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COVID-19 pandemic: CT chest in COVID-19 infection and prediction of patient’s ICU needs

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00515-z ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Ahmed M. Osman ◽

Ahmed M. Abdrabou ◽

Reham M. Hashim ◽

Faisal Khosa ◽

Aya Yasin

Keyword(s):

Severity Score ◽

Gradual Increase ◽

Rt Pcr ◽

Chain Reaction ◽

Icu Patients ◽

Dominant Feature ◽

High Incidence ◽

Polymerase Chain ◽

Ct Features

Abstract Background With the tremendous rise in COVID-19 infection and the shortage of real-time reverse transcription-polymerase chain reaction (RT-PCR) testing, we aimed to assess the role of CT in the detection of COVID-19 infection and the correlation with the patients’ management. A retrospective study was conducted on 600 patients who presented with symptoms suspicious for COVID-19 infection between March and the end of June 2020. The current study followed the RSNA recommendations in CT reporting and correlated with the RT-PCR. CT was reviewed and the severity score was correlated with the patient’s management. Results Four hundred sixty-six patients were included with a mean age of 46 + 14.8 years and 63.3 % were males. Three hundred forty patients were confirmed positive by RT-PCR. CT sensitivity was 92.6% while the RT-PCR was the reference. The CT specificity showed a gradual increase with the CT probability reaching 97.6% with high probability CT features. Ground-glass opacities (GGO) was the commonest findings 85.9% with a high incidence of bilateral, peripheral, and multilobar involvement (88%, 92.8%, and 92.8% respectively). Consolidation was found in 81.5% of the ICU patients and was the dominant feature in 66.7% of the ICU cases. CT severity score was significantly higher in ICU patients with a score of ≥ 14. Conclusions COVID-19 infection showed typical CT features which can be used as a rapid and sensitive investigation. Two CT phenotypes identified with the predominant consolidation phenotype as well as severity score can be used to determine infection severity and ICU need.

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