scholarly journals High Resolution Computed Tomography of Thorax- Is it an Early Predictor of Hypoxaemia in COVID-19 Patients?

Author(s):  
Ajay Sharawat ◽  
Kamal Kumar Sen ◽  
Sangram Panda ◽  
Sudhansu Sekhar Mohanty ◽  
Darsana Bhuyan ◽  
...  

Introduction: Novel Coronavirus-2019 (nCoV-2019) is capable of human-to-human transmission and can lead to acute respiratory distress syndrome similar to Middle East Respiratory Syndrome (MERS) due to lung parenchyma destruction. Some patients with COVID-19 consistently demonstrated no hypoxaemia, however, some patients develop sense of difficulty in breathing due to increased airway resistance. Aim: To assess the potential of High Resolution Computed Tomography (HRCT) thorax as an early predictor of hypoxaemia in COVID-19 patients. Materials and Methods: A prospective longitudinal cohort study of 1000 Reverse Transcription Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 and HRCT thorax positive patients, who were monitored simultaneously for SpO2 levels, were undertaken. HRCT findings were graded into Computerised Tomography Severity Index (CTSI) and correlated with patient’s SpO2 levels, at the time of scan on admission. Patients, who had normal SpO2 levels (≥95%) at the time of initial scan, were monitored upto five days. Pearson’s correlation test was used to find correlation between CTSI and SpO2 levels. Results: In present study group there was male predominance (4:1). Fever was the most common clinical presentation followed by cough. HRCT thorax features were categorised as Typical 769 (76.9%), Indeterminate 176 (17.6%) and atypical 55 (5.5%). 371 (82.8%) patients with SpO2 >95% were having CTSI between 0-7, similarly 189 (54.4%) patients with SpO290-94% were having CTSI between 8-15 and 133 (64.8%) patients with SpO2 <90% were having CTSI between 16-25. So, the present study categorised the patients into three groups- Category 1 (CTSI 0-7), Category 2 (CTSI 8-15) and Category 3 (CTSI 16-25) for better and prompt identification of clinical severity and their management. Majority of patients in CTSI category 1, 2 and 3 were having SpO2 levels ≥95%, 90-94% and <90%, respectively. Statistical correlation between CTSI and SpO2 levels at the time of initial scan was significant (Pearson’s correlation coefficient (r)=-0.261 and p-value <0.01). Number of patients who developed hypoxaemia (SpO2 <95%) on follow-up in CTSI Category 1, 2 and 3 were 42 (11.32%), 10 15.87%) and 2 (14.28%), respectively. The association between CTSI and development of hypoxaemia based on follow-up SpO2 levels was statistically found to be insignificant (chi-square value=1.21, degree of freedom (d.f.) 2 and p-value=0.570). Conclusion: In present study group, a negative correlation was established between CTSI and SpO2 levels. The association between CTSI and development of hypoxaemia on follow-up SpO2 monitoring was found to be non-significant statistically. So, HRCT thorax cannot be relied upon as an early predictor of hypoxaemia in COVID-19 patients.

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095099
Author(s):  
Chengyang Chen ◽  
Xing Wang ◽  
Jia Dong ◽  
Dianer Nie ◽  
Qianlan Chen ◽  
...  

Objective To evaluate temporal lung changes in coronavirus disease 2019 (COVID-19) in high-resolution computed tomography (HRCT) and to determine the appropriate computed tomographic (CT) follow-up time. Methods Eighty-six patients with two or more HRCT scans who were diagnosed with COVID-19 were included. The CT score and major CT findings were evaluated. Results Eighty-two (95.3%) patients had lesions on the initial HRCT scans. Most scans showed bilateral, multifocal lung lesions, with multiple lobes involved and diffuse distribution. For fifty-seven patients with type I (progress compared with the initial CT score), the CT score reached a peak at 12 days and the nadir at 36 days. For twenty-nine patients with type II (no progress compared with the initial CT score), the lowest CT score was reached at 23 days. On the final HRCT scans (>21 days), patients with a reticular pattern were older than those without a reticular pattern. Conclusion The appropriate follow-up time of CT scans is during the second week (approximately 12 days) and the fourth to fifth weeks (approximately 23–36 days) from the onset of illness. These times could help reduce the CT radiation dose and show timely changes in the course of the disease by CT.


2009 ◽  
Vol 124 (1) ◽  
pp. 37-43 ◽  
Author(s):  
J-P Vercruysse ◽  
B De Foer ◽  
T Somers ◽  
J Casselman ◽  
E Offeciers

AbstractObjective:The canal wall up bony obliteration technique lowers the incidence of recurrent cholesteatoma, but carries the potential risk of obliterating residual cholesteatoma. The objective of this study was to report long-term follow-up radiological findings after performing a canal wall up bony obliteration technique procedure, in order to detect residual and/or recurrent cholesteatoma.Patients:Fifty-one patients presenting with a cholesteatoma or a troublesome cavity were operated upon using the canal wall up bony obliteration technique, and were evaluated by follow-up imaging a mean of 76.4 months post-operatively (range, 53.8–113.6 months).Intervention:All patients were evaluated with high resolution computed tomography and magnetic resonance imaging (including delayed contrast, T1-weighted imaging and non-echo-planar, diffusion-weighted imaging).Results:Imaging revealed the presence of one residual, one recurrent and one congenital petrosal apex cholesteatoma. On high resolution computed tomography, completely obliterated mastoid filled with bone was observed in 74.5 per cent (38/51) of patients, and an aerated middle-ear cavity in 64.7 per cent (33/51). High resolution computed tomography clearly detected any associated soft tissue present in the middle-ear cavity (18/51) and in the obliterated mastoids (13/51), but could not characterise this tissue. Non-echo-planar, diffusion-weighted magnetic resonance imaging clearly identified all three cholesteatomas, and differentiated them from other associated soft tissues. No cholesteatoma was found within the obliterated mastoids.Conclusion:Long-term follow up indicated that the canal wall up bony obliteration technique is a safe method with which to treat primary and recurrent cholesteatoma and to reconstruct unstable cavities. Soft tissue was found quite often in the middle ear and obliterated mastoids. High resolution computed tomography identified its presence but could not further characterise it. However, non-echo-planar, diffusion-weighted magnetic resonance imaging succeeded in differentiating soft tissues, enabling detection of residual or recurrent cholesteatoma after a canal wall up bony obliteration technique procedure.


2000 ◽  
Vol 161 (4) ◽  
pp. 1264-1273 ◽  
Author(s):  
KENZO SOEJIMA ◽  
KAZUHIRO YAMAGUCHI ◽  
EIICHI KOHDA ◽  
KEI TAKESHITA ◽  
YOKO ITO ◽  
...  

2004 ◽  
Vol 45 (1) ◽  
pp. 44-52 ◽  
Author(s):  
J. Vikgren ◽  
M. Boijsen ◽  
K. Andelid ◽  
A. Ekberg‐Jansson ◽  
S. Larsson ◽  
...  

2021 ◽  
pp. 239719832110244
Author(s):  
Ramya Janardana ◽  
Aparna Irodi ◽  
Pramod P Chebbi ◽  
Ruchika Goel ◽  
Leena R Vimala ◽  
...  

Introduction: There is a paucity of real-world data on mycophenolate mofetil/mycophenolate sodium in systemic sclerosis-related interstitial lung disease. Aim: To study the efficacy of mycophenolate mofetil/ mycophenolate sodium in systemic sclerosis-related interstitial lung disease. Methods: In this single-centre study, clinical, laboratory and imaging details of consecutive patients with systemic sclerosis-related interstitial lung disease receiving mycophenolate mofetil/mycophenolate sodium from rheumatology and pulmonology clinics between January 2008 and March 2017 were retrospectively retrieved. The change in percentage of predicted normal forced vital capacity at last follow-up visit as compared with baseline was studied. In addition, high-resolution computed tomography scans at baseline and 2-year follow-up visit were scored as either stable/improved or worsened by experienced thoracic radiologists blinded to the clinical details of patients. Results: Altogether, 88 patients (85.2% females) with mean age (SD) of 33.8 years (± 11.3) and median (interquartile range) duration of disease since non-Raynaud’s symptoms of 36 months (13.5–60) were studied. Diffuse systemic sclerosis comprised 85.2% of them. The mean baseline forced vital capacity was 61.2 ± 17.9% and median scores for ground glass opacities and fibrosis in high-resolution computed tomography were 0.5 (0–1.3) and 1 (0–1.3), respectively. At a median follow-up duration of 30 months (interquartile range = 16.5–49), the percentage of forced vital capacity improved by 1.8% (–3.82 to 9.07) as compared with baseline visit ( p = 0.02). In the 2-year follow-up, the ground glass opacity and fibrosis scores in high-resolution computed tomography improved in 17.3% and 7.7% of patients and stabilized in 63.5% and 78.8% patients, respectively. Conclusion: Mycophenolate mofetil/mycophenolate sodium was efficacious in improving /stabilizing forced vital capacity irrespective of the baseline high-resolution computed tomography lung scores in our patients with systemic sclerosis-related interstitial lung disease during the ⩾ 2-year follow-up period.


2017 ◽  
Vol 26 (144) ◽  
pp. 170008 ◽  
Author(s):  
Brett M. Elicker ◽  
Kimberly G. Kallianos ◽  
Travis S. Henry

High-resolution computed tomography (HRCT) of the lung is a key component of the multidisciplinary approach to diagnosis in diffuse lung disease (DLD). HRCT also plays an important role in the follow-up of patients with established DLD. In this respect, serial HRCT examinations may provide valuable information that cannot be determined from clinical history and other diagnostic tests, such as pulmonary function tests. Important roles of HRCT in this context include assisting in determining prognosis, monitoring for the efficacy of treatment, detecting progression of disease or complications, and evaluating patients with worsening or acute symptoms. Both clinicians and radiologists should be aware of the expected evolution of HRCT changes in a variety of DLDs. The goals of this paper are to discuss: 1) the expected evolution of HRCT findings over time in common DLDs; 2) the role of serial HRCT examinations in formulating an initial diagnosis; and 3) the role of HRCT in the follow-up of patients with known DLD.


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