Radiological and functional pulmonary complications in patients recovered from COVID-19

Background: The COVID-19 disease caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which appeared at the end of 2019 in Hubei Province, Wuhan Region of the People's Republic of China. Objective: To determine radiological and functional pulmonary complications in patients recovered from COVID-19. Methods: We included observational studies, studies of radiological and functional pulmonary complications related to COVID-19 in patients discharged from hospital, studies of available text and studies in English and Spanish. A formal narrative synthesis of the collected data was carried out; no formal statistical synthesis was carried out. The synthesis focused on qualitative analysis. The methodological quality of the articles was assessed using the quality assessment tools of the National Heart, Lung, and Blood Institute. Results: In this systematic review it was observed that the functional pulmonary complications that the patients manifested were: 45.05 % of impaired diffusion capacity (DLCO), 30.1 % of restrictive pattern (FEV1) and 20.4 % of obstructive pattern (FEV1/FVC). Radiological complications were: 59.7% ground-glass opacity (GGO), 18.75% consolidation, 9.3% bronchiectasis, 6% thickening of the underlying pleura, 3.9% thickening of the interlobular septum, 3.83% crazy-paving and 0.96% pleural effusion. Conclusion: This review concludes that post-COVID-19 infection patients showed impaired lung and radiological functions, with DLCO and GGO being the most important.

Histologic factors associated with nintedanib efficacy in patients with idiopathic pulmonary fibrosis

Background Histopathologic factors predictive of nintedanib efficacy in idiopathic pulmonary fibrosis have not been studied. We aimed to describe the characteristics, focusing on histopathology, of idiopathic pulmonary fibrosis patients who did and did not respond to nintedanib. Methods This study retrospectively examined the clinicoradiopathologic features of 40 consecutive patients with surgical lung biopsy-confirmed idiopathic pulmonary fibrosis treated with nintedanib. Additionally, we compared the histopathologic scoring of 21 microscopic features between patients with functional or radiological progression and those with non-progression during 12 months of treatment. Results The histopathologic evaluation showed edematous changes in the interlobular septum as the only histologic finding observed more frequently in patients with both functional and radiological progression than in those without (58% vs. 14%, P = 0.007 and 50% vs. 0%, P = 0.003, respectively). Regarding per-year change, patients with edematous changes in the interlobular septum showed greater progression in median changes in spared area (-12%, interquartile range: [-25%–-5%], vs. -3% [-7%–0%], P = 0.004) and reticular shadow (7% [3%–13%], vs. 0% [0%–5%], P = 0.041) on computed tomography. Functional and radiological progression-free survival were shorter in patients with edematous changes in the interlobular septum than in those without (6.6 months, 95% confidence interval: [5.9–25.3], vs. event <50%, [12.1–Not available], P = 0.0009, and 6.1 months, [5.2–6.6] vs. 14.5 months [7.8–not available], P<0.0001). Conclusions Edematous changes in the interlobular septum may indicate poor nintedanib efficacy in idiopathic pulmonary fibrosis. Further studies are needed to validate these findings and address the mechanism behind ECIS.

Pathogenesis clue from early clinical presentation of 300 hospitalized COVID-19 patients

The global spread of COVID-19 has been lasted more than half a year. Except for the gene sequence and virus structure of SARS-CoV-2, its clinical characteristics, pathological mechanism and corresponding measures have not been fully revealed. Objective: To speculate the possible pathological mechanism from the early clinical manifestations of the patients with COVID-19. Methods: The onset symptoms, laboratory examination and CT findings on admission of 300 cases in two wards of Wuhan Third Hospital from January 28 to March 15 were analyzed retrospectively. Results: There was no difference in incidence between men and women, but women were hospitalized later after onset. Upper respiratory symptoms and sputum were seldom. The incidence of fever was 71%. Blood lymphocytes count decreased significantly on admission, which was related to the severity of the disease. In the moderate type of patients, who without hypoxia, thrombocytopenia occurred in 12.37%, CRP rose in 64.43 %, BUN elevated in 20.62 %, creatinine rose in 17.53 %, D-dimer elevated in 74.74%, creatine kinase and α-hydroxybutyrate dehydrogenase elevated in 45.36% and 54.12% patients respectively. The early CT showed a small amount of infiltration in the subpleural, the lateral zone of the lung and thickening of the interlobular septum. About 5 days later, infiltration had been worse in a part of the patients, and the affected lung was negatively correlated with the lymphocyte count. Conclusion: There was no gender difference in patients with SARS-CoV-2 invasion. Alveolar cells and T lymphocytes maybe main targets of the virus and apoptosis maybe primary pathogenesis. The virus entering the lung maybe transmitted through lymph or blood channels, rather than direct diffused in the respiratory tract. Early damage of multiple organs maybe caused by immune response.

A Comparative Study of Target Reconstruction of Ultra-High-Resolution CT for Patients with Corona-Virus Disease 2019 (COVID-19)

BackgroundThe corona-virus disease 2019 (COVID-19) pandemic has caused a serious public health risk. Compared with conventional high-resolution CT (C-HRCT, matrix 512), ultra-high resolution CT (U-HRCT, matrix 1024) can increase the effective pixel per unit volume by about 4 times. Our study is to evaluate the value of target reconstruction of U-HRCT in the accurate diagnosis of COVID-19.MethodsA total of 13 COVID-19 cases, 44 cases of other pneumonias, and 6 cases of ground-glass nodules were retrospectively analyzed. The data were categorized into groups A (C-HRCT) and B (U-HRCT), following which iDose4-3 and iDose4-5 were used for target reconstruction, respectively. CT value, noise, and signal-to-noise ratio (SNR) in different reconstructed images were measured. Two senior imaging doctors scored the image quality and the structure of the lesions on a 5-point scale. Chi-square test, variance analysis, and binarylogistic regression analysis were used for statistical analysis.ResultsU-HRCT image can reduce noise and improve SNR with an increase of the iterative reconstruction level. The SNR of U-HRCT image was lower than that of the C-HRCT image of the same iDose4level, and the noise of U-HRCT was higher than that of C-HRCT image; the difference was statistically significant (P< 0.05). Logistic regression analysis showed thatperipleural distribution, thickening of blood vessels and interlobular septum, and crazy-paving pattern were independent indictors of the COVID-19 on U-HRCT. U-HRCT was superior to C-HRCT in showing the blood vessels, bronchial wall, and interlobular septum in the ground-glass opacities; the difference was statistically significant (P < 0.05).ConclusionsPeripleural distribution, thickening of blood vessels and interlobular septum, and crazy-paving pattern on U-HRCT are favorable signs for COVID-19. U-HRCT is superior to C-HRCT in displaying the blood vessels, bronchial walls, and interlobular septum for evaluating COVID-19.

A Comparative Study of Target Reconstruction of Ultra-High-Resolution CT for Patients with Corona-Virus Disease 2019 (COVID-19)

Background: The corona-virus disease 2019 (COVID-19) pandemic has caused a serious public health risk. Compared with conventional high-resolution CT (C-HRCT, matrix 512), ultra-high resolution CT (U-HRCT, matrix 1024) can increase the effective pixel per unit volume by about 4 times. Our study is to evaluate the value of target reconstruction of U-HRCT in the accurate diagnosis of COVID-19. Methods: A total of 13 COVID-19 cases, 44 cases of other pneumonias, and 6 cases of ground-glass nodules were retrospectively analyzed. The data were categorized into groups A (C-HRCT) and B (U-HRCT), following which iDose4-3 and iDose4-5 were used for target reconstruction, respectively. CT value, noise, and signal-to-noise ratio (SNR) in different reconstructed images were measured. Two senior imaging doctors scored the image quality and the structure of the lesions on a 5-point scale. Chi-square test, variance analysis, and binary logistic regression analysis were used for statistical analysis. Results: U-HRCT image can reduce noise and improve SNR with an increase of the iterative reconstruction level. The SNR of U-HRCT image was lower than that of the C-HRCT image of the same iDose4 level, and the noise of U-HRCT was higher than that of C-HRCT image; the difference was statistically significant (P < 0.05). Logistic regression analysis showed that peripleural distribution, thickening of blood vessels and interlobular septum, and crazy-paving pattern were independent indictors of the COVID-19 on U-HRCT. U-HRCT was superior to C-HRCT in showing the blood vessels, bronchial wall, and interlobular septum in the ground-glass opacities; the difference was statistically significant (P < 0.05). Conclusions: Peripleural distribution, thickening of blood vessels and interlobular septum, and crazy-paving pattern on U-HRCT are favorable signs for COVID-19. U-HRCT is superior to C-HRCT in displaying the blood vessels, bronchial walls, and interlobular septum for evaluating COVID-19.

Differentiating Lung Involvement in Adult T-Cell Leukemia Lymphoma (ATLL) Versus HTLV Infection: Results from a Large Single-Center Cohort with Implications for Staging and Response Criteria

Introduction: Human T-cell lymphotropic virus (HTLV) is a retrovirus that has been associated with adult-T cell leukemia/lymphoma (ATLL) and other inflammatory conditions. Pulmonary involvement has not been widely associated to HTLV infection; however, high rates of imaging abnormalities in patients with and without ATLL have been reported. Okada reported 30%, 69% and 94% of abnormalities in HTLV1 carriers, ATLL and patients that transformed into ATLL. Whether these abnormalities follow a pattern related to each condition individually has not been defined. Hence, we undertook a retrospective study in ATLL and HTLV infected patients to determine the lung abnormalities which could be due to ATLL involvement rather than HTLV infection. Objectives: To compare the CT pulmonary findings among patients with HTLV infection with and without ATLL diagnosed at Montefiore Medical Center between 2004 and 2017. Methods: Patients diagnosed with HTLV infection by ICD9 were identified using the software Clinical Looking Glass and those with an available chest CT scan were selected. Data regarding demographics, smoking history, prior pulmonary conditions, HTLV and ATLL-associated characteristics was collected by chart review. CT chest was reviewed by an expert radiologist who was unaware of the patient diagnosis (ATLL versus non-ATLL) and findings were compared among groups. The staging CT scan was used to determine baseline pulmonary findings in patients with ATLL and the first CT chest around HTLV diagnosis was used for HTLV patients. Results: A total of 97 patients (72 with ATLL and 25 with HTLV alone) were identified. Mean age at HTLV diagnosis was 58.4 years (range: 33-88), 54.6% were females, 72.2% were Black Non-Hispanics while 27.8% were Hispanic. 88.3% were from Caribbean origin. Smoking history was similar between ATLL and non-ATLL groups (12% vs 8%, p=0.07) with no cases of prior active TB infection. Abnormal CT chest findings were present in 92.8%, 94.4% and 88% for the total cohort, ATLL and non-ATLL patients. Among patients with ATLL, 52.1% had acute and 43.7% had lymphomatous types; while only 1.4% and 2.8% had smoldering and chronic type. The most common CT chest findings were lymphadenopathy (50, 69.4%); followed by 3-10 mm nodules (32, 44.4%), ground-glass opacity, pleural effusion (31, 43.1% each), centrilobular nodules (28, 39.4%), thickening of interlobular septum (23, 31.9%) and bronchiectasis (18, 25%). Compared to the acute subtype, patients with lymphomatous subtype had higher rates of lymphadenopathy (83.9% vs 64.9, p=0.07) and lower rates of bronchiectasis (16.1% vs 35.1%, p=0.07). Among patients with non-ATLL, HTLV infection was diagnosed at an older age (63.8 vs. 56.6 years, p=0.03); HTLV-associated comorbidities were found in 16 cases (64%). Of these, myelopathy was the most frequent (10, 40%), followed by strongyloides (4, 16%). After HTLV diagnosis, CT chest was indicated in 28% patients for otherwise unexplained respiratory symptoms and to evaluate lung nodules or other chest X-ray abnormalities in 24% of cases. Bronchiectasis was the most common finding (12, 48%) followed by pleural thickening (11, 44%), ground-glass opacity and thickening of interlobular septum (10, 40%, each). Persistent abnormalities on follow-up imaging were present in 86.7% of the cases. Among patients with HTLV infection, those with ATLL were more likely to have nodules and lymphadenopathy (41.7% vs 20%, p=0.05 and 69.4% vs 24%, p<0.001, respectively) while bronchiectasis and pleural thickening was more likely in patients without ATLL (48% vs 25%, p=0.03 and 44% vs 23.6%, p=0.05; respectively). Conclusions: Pulmonary findings are highly prevalent in CT chest of patients with HTLV infection with and without ATLL. Bronchiectasis and pleural thickening was more frequently encountered in non-ATLL patients while lymphadenopathy and nodules were common finding in patients with ATLL. Pulmonary involvement in lymphoma is usually characterized by nodules and lymphadenopathy but patients with ATLL had a higher incidence of findings including ground glass opacities, bronchiectasis and interlobular septal thickening possibly due to their underlying HTLV infection. Based on this data, nodules and lymphadenopathy should be classified as ATLL involvement of the lung while other findings described here could be due to HTLV infection. These findings are important in staging and response criteria for ATLL. Disclosures Janakiram: Seatle Genetics: Membership on an entity's Board of Directors or advisory committees.