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

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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The halo sign: HRCT findings in 85 patients

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562015000000029 ◽

2016 ◽

Vol 42 (6) ◽

pp. 435-439 ◽

Cited By ~ 12

Author(s):

Giordano Rafael Tronco Alves ◽

◽

Edson Marchiori ◽

Klaus Irion ◽

Carlos Schuler Nin ◽

...

Keyword(s):

Immune Status ◽

Ground Glass Opacity ◽

Diagnostic Value ◽

Chest Ct ◽

Ct Scans ◽

Pulmonary Lesions ◽

Halo Sign ◽

Immunosuppressed Patients ◽

Primary Neoplasm ◽

Immunocompetent Patients

ABSTRACT Objective: The halo sign consists of an area of ground-glass opacity surrounding pulmonary lesions on chest CT scans. We compared immunocompetent and immunosuppressed patients in terms of halo sign features and sought to identify those of greatest diagnostic value. Methods: This was a retrospective study of CT scans performed at any of seven centers between January of 2011 and May of 2015. Patients were classified according to their immune status. Two thoracic radiologists reviewed the scans in order to determine the number of lesions, as well as their distribution, size, and contour, together with halo thickness and any other associated findings. Results: Of the 85 patients evaluated, 53 were immunocompetent and 32 were immunosuppressed. Of the 53 immunocompetent patients, 34 (64%) were diagnosed with primary neoplasm. Of the 32 immunosuppressed patients, 25 (78%) were diagnosed with aspergillosis. Multiple and randomly distributed lesions were more common in the immunosuppressed patients than in the immunocompetent patients (p < 0.001 for both). Halo thickness was found to be greater in the immunosuppressed patients (p < 0.05). Conclusions: Etiologies of the halo sign differ markedly between immunocompetent and immunosuppressed patients. Although thicker halos are more likely to occur in patients with infectious diseases, the number and distribution of lesions should also be taken into account when evaluating patients presenting with the halo sign.

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Using chest CT scan and unsupervised machine learning for predicting and evaluating response to lumacaftor-ivacaftor in people with cystic fibrosis

European Respiratory Journal ◽

10.1183/13993003.01344-2021 ◽

2021 ◽

pp. 2101344

Author(s):

Alienor Campredon ◽

Enzo Battistella ◽

Clémence Martin ◽

Isabelle Durieu ◽

Laurent Mely ◽

...

Keyword(s):

Machine Learning ◽

Cystic Fibrosis ◽

Ct Scan ◽

Structural Changes ◽

Clinical Status ◽

Chest Ct ◽

Ct Scans ◽

Wall Thickening ◽

Unsupervised Machine Learning ◽

One Year

ObjectivesLumacaftor-ivacaftor is a cystic fibrosis transmembrane conductance regulator (CFTR) modulator known to improve clinical status in people with cystic fibrosis (CF). This study aimed to assess lung structural changes after one year of lumacaftor-ivacaftor treatment, and to use unsupervised machine learning to identify morphological phenotypes of lung disease that are associated with response to lumacaftor-ivacaftor.MethodsAdolescents and adults with CF from the French multicenter real-world prospective observational study evaluating the first year of treatment with lumacaftor-ivacaftor were included if they had pretherapeutic and follow-up chest computed tomography (CT)-scans available. CT scans were visually scored using a modified Bhalla score. A k-mean clustering method was performed based on 120 radiomics features extracted from unenhanced pretherapeutic chest CT scans.ResultsA total of 283 patients were included. The Bhalla score significantly decreased after 1 year of lumacaftor-ivacaftor (−1.40±1.53 points compared with pretherapeutic CT; p<0.001). This finding was related to a significant decrease in mucus plugging (−0.35±0.62 points; p<0.001), bronchial wall thickening (−0.24±0.52 points; p<0.001) and parenchymal consolidations (−0.23±0.51 points; p<0.001). Cluster analysis identified 3 morphological clusters. Patients from cluster C were more likely to experience an increase in percent predicted forced expiratory volume in 1 sec (ppFEV1) ≥5 under lumacaftor–ivacaftor than those in the other clusters (54% of responders versus 32% and 33%; p=0.01).ConclusionOne year treatment with lumacaftor-ivacaftor was associated with a significant visual improvement of bronchial disease on chest CT. Radiomics features on pretherapeutic CT scan may help in predicting lung function response under lumacaftor-ivacaftor.

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The diagnostic value of chest X-ray in coronavirus disease 2019: A comparative study of X-ray and CT

Science Progress ◽

10.1177/00368504211016204 ◽

2021 ◽

Vol 104 (3) ◽

pp. 003685042110162

Author(s):

Fengxia Zeng ◽

Yong Cai ◽

Yi Guo ◽

Weiguo Chen ◽

Min Lin ◽

...

Keyword(s):

Clinical Symptoms ◽

Diagnostic Value ◽

Rapid Identification ◽

Chest Ct ◽

Ct Scans ◽

Ground Glass ◽

X Ray ◽

Chest X Ray ◽

Laboratory Examinations ◽

Sensitivity Specificity

As the coronavirus disease 2019 (COVID-19) epidemic spreads around the world, the demand for imaging examinations increases accordingly. The value of conventional chest radiography (CCR) remains unclear. In this study, we aimed to investigate the diagnostic value of CCR in the detection of COVID-19 through a comparative analysis of CCR and CT. This study included 49 patients with 52 CT images and chest radiographs of pathogen-confirmed COVID-19 cases and COVID-19-suspected cases that were found to be negative (non-COVID-19). The performance of CCR in detecting COVID-19 was compared to CT imaging. The major signatures that allowed for differentiation between COVID-19 and non-COVID-19 cases were also evaluated. Approximately 75% (39/52) of images had positive findings on the chest x-ray examinations, while 80.7% (42/52) had positive chest CT scans. The COVID-19 group accounted for 88.4% (23/26) of positive chest X-ray examinations and 96.1% (25/26) of positive chest CT scans. The sensitivity, specificity, and accuracy of CCR for abnormal shadows were 88%, 80%, and 87%, respectively, for all patients. For the COVID-19 group, the accuracy of CCR was 92%. The primary signature on CCR was flocculent shadows in both groups. The shadows were primarily in the bi-pulmonary, which was significantly different from non-COVID-19 patients ( p = 0.008). The major CT finding of COVID-19 patients was ground-glass opacities in both lungs, while in non-COVID-19 patients, consolidations combined with ground-glass opacities were more common in one lung than both lungs ( p = 0.0001). CCR showed excellent performance in detecting abnormal shadows in patients with confirmed COVID-19. However, it has limited value in differentiating COVID-19 patients from non-COVID-19 patients. Through the typical epidemiological history, laboratory examinations, and clinical symptoms, combined with the distributive characteristics of shadows, CCR may be useful to identify patients with possible COVID-19. This will allow for the rapid identification and quarantine of patients.

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2019 Novel Coronavirus (COVID-19) pneumonia: an unusual lung ultrasound presentation.

10.21203/rs.3.rs-25490/v1 ◽

2020 ◽

Author(s):

Letizia Consoli ◽

Vittorio Bendotti ◽

Sara Cicchinelli ◽

Federico Gaioni ◽

Paola Prandolini ◽

...

Keyword(s):

Case Fatality Rate ◽

Lung Ultrasound ◽

Case Fatality ◽

Ground Glass Opacity ◽

Public Health Emergency ◽

Fatality Rate ◽

Chest Computed Tomography ◽

Ultrasound Findings ◽

The World ◽

Novel Coronavirus

Abstract In December 2019, a novel coronavirus (SARS-Cov-2) was first reported in Wuhan, China, and rapidly spread around the world, leading to an international emerging public health emergency. As reported from Chinese experiences, approximately 20% of patients had a severe course, requiring intensive care, with an overall case fatality rate of 2.3%. In diagnosis, chest computed tomography most commonly showed ground-glass opacity with or without consolidative patterns.Herein we report a case of a patient affected by COVID-19 pneumonia referred in the emergency department of our institution on 4 April 2020 with peculiar lung ultrasound findings.

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Lung Ultrasound Findings Compared to Chest CT Scan in Patients with COVID-19 Associated Pneumonia: A Pilot Study

Frontiers in Emergency Medicine ◽

10.18502/fem.v5i2.5612 ◽

2021 ◽

Author(s):

Hamidreza Hatamabadi ◽

Majid Shojaee ◽

Mohammad Bagheri ◽

Masoomeh Raoufi

Keyword(s):

Pilot Study ◽

Ct Scan ◽

Sensitivity And Specificity ◽

Lung Ultrasound ◽

Demographic Data ◽

Ground Glass Opacity ◽

Chest Ct ◽

Clinical Value ◽

Ultrasound Evaluation ◽

Chest Ct Scan

Introduction: Lung US has been reported to be as useful as a chest CT scan and much better than a chest x-ray for the evaluation of pneumonia. Objective: This study aimed to compare the findings of lung ultrasound (US) and chest CT scan of patients with COVID-19-associated pneumonia in the Emergency Department (ED). Methods: This retrospective observational pilot study was carried out on confirmed COVID-19 patients in the isolation corona ward of the Imam Hussein Hospital ED from March 15 to March 22, 2020. After obtaining demographic data, the patients underwent a pulmonary bedside US examination, with the patients in the sitting position, turning their back to the examiner. A 10-point lung US was performed. Each lung was divided into two areas: posterior (three zones) and lateral (two zones). The patients’ lung ultrasound and chest CT scan as the standard imaging were blindly reviewed and recorded. The clinical value of ultrasound was evaluated with different severity of lung involvement according to CT severity score. Results: Nineteen patients (38 zones), including 13 males, were evaluated with a mean age of 62.5±16.8 years. B2 lines and consolidation observed in the US examinations were significantly correlated with ground-glass opacity and consolidation observed in CT scan examinations, respectively (p <0.0001). US sensitivity and specificity of finding B2 lines were 90% and 100%, respectively. Also, the sensitivity and specificity of US in identifying consolidation were 82% and 100%, respectively. In the lungs with moderate and severe lobar involvement, US findings were significantly correlated (p <0.05) with CT scan findings. Conclusions: Ultrasound evaluation is a safe, fast, and rapid technique for the evaluation of patients with moderate to severe COVID-19-associated pneumonia. It is a reproducible procedure and can be implemented by the operator after a short course of training.

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Clinical outcomes of hemodialysis patients infected with severe acute respiratory syndrome coronavirus 2 and impact of proactive chest computed tomography scans

Clinical Kidney Journal ◽

10.1093/ckj/sfaa086 ◽

2020 ◽

Vol 13 (3) ◽

pp. 328-333 ◽

Cited By ~ 3

Author(s):

Rui Wang ◽

Hong He ◽

Cong Liao ◽

Hongtao Hu ◽

Chun Hu ◽

...

Keyword(s):

Computed Tomography ◽

Invasive Mechanical Ventilation ◽

Case Series ◽

Ground Glass Opacity ◽

High Sensitivity ◽

Chest Ct ◽

Maintenance Hemodialysis ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Reactive Protein

Abstract Background Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that first manifested in humans in Wuhan, Hubei Province, China, in December 2019, and has subsequently spread worldwide. Methods We conducted a retrospective, single-center case series of the seven maintenance hemodialysis (HD) patients infected with COVID-19 at Zhongnan Hospital of Wuhan University from 13 January to 7 April 2020 and a proactive search of potential cases by chest computed tomography (CT) scans. Results Of 202 HD patients, 7 (3.5%) were diagnosed with COVID-19. Five were diagnosed by reverse transcription polymerase chain reaction (RT-PCR) because of compatible symptoms, while two were diagnosed by RT-PCR as a result of screening 197 HD patients without respiratory symptoms by chest CT. Thirteen of 197 patients had positive chest CT features and, of these, 2 (15%) were confirmed to have COVID-19. In COVID-19 patients, the most common features at admission were fatigue, fever and diarrhea [5/7 (71%) had all these]. Common laboratory features included lymphocytopenia [6/7 (86%)], elevated lactate dehydrogenase [3/4 (75%)], D-dimer [5/6 (83%)], high-sensitivity C-reactive protein [4/4 (100%)] and procalcitonin [5/5 (100%)]. Chest CT showed bilateral patchy shadows or ground-glass opacity in the lungs of all patients. Four of seven (57%) received oxygen therapy, one (14%) received noninvasive and invasive mechanical ventilation, five (71%) received antiviral and antibacterial drugs, three (43%) recieved glucocorticoid therapy and one (14%) received continuous renal replacement therapy. As the last follow-up, four of the seven patients (57%) had been discharged and three patients were dead. Conclusions Chest CT may identify COVID-19 patients without clear symptoms, but the specificity is low. The mortality of COVID-19 patients on HD was high.

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Amiodarone-induced pulmonary toxicity

Chest Disease Reports ◽

10.4081/cdr.2011.e6 ◽

2011 ◽

Vol 1 (1) ◽

pp. 6

Author(s):

Junichi Ochi ◽

Minoru Ohkouchi ◽

Yoshikazu Tsukada ◽

Shinichiro Tominaga ◽

Satoshi Takayama ◽

...

Keyword(s):

Computed Tomography ◽

Medical Records ◽

Lung Biopsy ◽

Pulmonary Toxicity ◽

Ground Glass Opacity ◽

Chest Ct ◽

Chest Computed Tomography ◽

Ct Findings ◽

The Mean ◽

Foamy Macrophages

Amiodarone-induced pulmonary toxicity is a critical and potentially fatal side effect of amiodarone. Our study was designed to reveal its clinical features, including KL-6, as an interstitial marker. The medical records of eight patients (five men and three women) with amiodarone-induced pulmonary toxicity, who had been referred to our hospital, were examined. The mean age at the initiation of amiodarone was 48 years (range, 54-87 years) and mean duration of medication prior to the development of pulmonary toxicity was 18 months (range, 7-33 months). Serum KL-6 was elevated in six of the eight patients with a range of 525-2915 U/mL. Chest computed tomography (CT) findings showed non-segmental consolidation and/or ground glass opacity. Foamy macrophages were found in bronchoalveolar lavage (BAL) fluids of all examined patients and in transbronchial lung biopsy (TBLB) specimens in half of the examined patients. We concluded that serum KL-6, chest CT findings, and foamy macrophages in BAL fluids and TBLB specimens will be helpful for the diagnosis of amiodarone-induced pulmonary toxicity.

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Chest Computed Tomography Findings in Asymptomatic Patients with COVID-19

Respiration ◽

10.1159/000509334 ◽

2020 ◽

Vol 99 (9) ◽

pp. 748-754 ◽

Cited By ~ 3

Author(s):

Min Cheol Chang ◽

Wonho Lee ◽

Jian Hur ◽

Donghwi Park

Keyword(s):

Computed Tomography ◽

South Korea ◽

Respiratory System ◽

Ground Glass Opacity ◽

Chest Ct ◽

Effective Management ◽

Radiographic Findings ◽

Chest Computed Tomography ◽

Asymptomatic Patients ◽

The Right

Background: Little is known about the damage to the respiratory system in asymptomatic patients with coronavirus disease (COVID-19). Objective: Herein, we evaluate the findings of chest computed tomography (CT) and radiography in patients with COVID-19 who were asymptomatic. Methods: We retrospectively investigated patients with a confirmed diagnosis of COVID-19 but who did not show any symptoms. Among the 139 patients with COVID-19 who were hospitalized in Yeungnam University Hopistal in Daegu, South Korea, 10 (7.2%) were asymptomatic. Their chest CT and radiographic findings were analyzed. Results: In the results, all patients (100%) had ground-glass opacity (GGO) on chest CT. Further, the GGO lesions were predominantly distributed peripherally and posteriorly in all patients. In 9 (90%) patients, the GGO lesions were combined with reticular opacity. Air bronchogram due to bronchiolectasis surrounded by GGO was observed in 8 patients (80%). Additionally, the lung lesions were dominant on the right side in all patients. Conclusions: In conclusion, considering our results that the lung is affected in asymptomatic patients, it will be necessary to extend the indications of COVID-19 testing for effective management of COVID-19 during the pandemic.

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Diagnostic value of chest CT in outpatient for COVID-19 compare with RT-PCR

10.21203/rs.3.rs-41757/v1 ◽

2020 ◽

Author(s):

Weiwei Zhang ◽

Meifen Zhu ◽

Min Zhang

Keyword(s):

Laboratory Test ◽

Ground Glass Opacity ◽

Diagnostic Value ◽

Chest Ct ◽

Test Results ◽

Imaging Data ◽

Rt Pcr ◽

Spider Web ◽

Lesion Location ◽

Laboratory Test Results

Abstract ObjectivesThe pneumonia caused by the 2019 novel coronavirus recently break out in Wuhan, China, and was named as COVID-19. With the spread of the disease, it bring numbers of casualties,so now we need a way could fast and accuracy diagnose the disease.This paper aims to compare two way for diagnose COVID-19 in outpatient :Chest CT and RT-PCR.Materials and methodsThe study picked 248 patients who treated in fever clinical of GanZhou people's hospital,their complete clinical and imaging data were analysed retrospectively.Epidemiological data,symoptoms,laboratory test results include RT-PCR and the CT results include CT features,lesion location,lesion distribution of suspected COVID-19 infected patients were gathered.ResultsAll of 248 patients,at last 20 patients confirmed COVID-19,15 patients were confirmed in outpatient.More than 200 cases has laboratory test results disnormal.Only 15/248 patients had initial positive RT-PCR for COVID-19,5 patients had COVID-19 confirmed by two or more RT-PCR.50 cases(20.2%) had Ground glass opacity,42 cases(16.9%) had Consolidation,39 cases(15.7%) had Spider web pattern,38 cases(15.3%) had Interlobular septal thickening.For lesion location,22 cases(8.9%) involved Single lobe of one lung,13 cases(5.2%) involved Multiple lobes of one lung,174 cases(70.2%) involved Multiple lobes of both lungs,9 cases(3.6%) involved Bilateral lower lungs,25 cases(10.1%) involved Bilateral middle and lower lungs.Regarding the distribution of the lesions in the lung lobes,119 cases(47.98%) involved Subpleural distribution,19 cases(7.7%) involved Diffuse distribution,7 cases(2.8%) involved Peribronchial distribution,81 cases(32.7%) involved Mixed distribution.ConclusionChest CT can be applied in outpatient to make early diagnosis with sensitivity and accuracy better than that of nucleic acid detection.Trial registrationChiCTR2000032574. Registered 3 May 2020. retrospectively registered

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Early chest computed tomography to diagnose COVID-19 from suspected patients: A multicenter retrospective study

10.1101/2020.03.24.20042432 ◽

2020 ◽

Cited By ~ 3

Author(s):

Congliang Miao ◽

Mengdi Jin ◽

Li Miao ◽

Xinying Yang ◽

Peng Huang ◽

...

Keyword(s):

Ground Glass Opacity ◽

High Specificity ◽

Diagnostic Value ◽

Chest Ct ◽

Imaging Features ◽

Rt Pcr ◽

Polymerase Chain ◽

Low Sensitivity ◽

Chest Ct Scan ◽

Ct Features

AbstractObjectiveThe purpose of this study is to distinguish the imaging features of COVID-19 with other chest infectious diseases and evaluate diagnostic value of chest CT for suspected patients.MethodsAdult suspected patients aged>18 years within 14 days who underwent chest CT scan and reverse-transcription polymerase-chain-reaction (RT-PCR) tests were enrolled. The enrolled patients were confirmed and grouped according to results of RT-PCR tests. The data of basic demographics, single chest CT features, and combined chest CT features were analyzed for confirmed and non-confirmed groups.ResultsA total of 130 patients were enrolled with 54 cases positive and 76 cases negative. The typical CT imaging features of positive group were ground glass opacity (GGO), crazy-paving pattern and air bronchogram. The lesions were mostly distributed bilaterally, close to the lower lungs or the pleura. When features combined, GGO with bilateral pulmonary distribution and GGO with pleural distribution were more common, of which were 31 cases (57.4%) and 30 cases (55.6%) respectively. The combinations were almost presented statistically significant (P<0.05) except for the combination of GGO with consolidation. Most combinations presented relatively low sensitivity but extremely high specificity. The average specificity of these combinations is around 90%.ConclusionsThe combinations of GGO could be useful in the identification and differential diagnosis of COVID-19, which alerts clinicians to isolate patients for treatment promptly and repeat RT-PCR tests until incubation ends.

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