Resuming Breast Imaging Services in the Aftermath of the COVID-19 Pandemic: Safety and Beyond.

As the Coronavirus disease 2019 (COVID-19) epidemic begins to stabilize, different medical imaging facilities not directly involved in the COVID-19 epidemic face the dilemma of how to return to regular operation. We hereby discuss various fields of concern in resuming breast imaging services. We examine the concerns for resuming functions of breast imaging services in 2 broad categories, including safety aspects of operating a breast clinic and addressing potential modifications needed in managing common clinical scenarios in the COVID-19 aftermath. Using a stepwise approach in harmony with the relative states of the epidemic, health care system capacity, and the current state of performing breast surgeries (and in compliance with the recommended surgical guidelines) can ensure avoiding pointless procedures and ensure a smooth transition to a fully operational breast imaging facility.

Evaluation of the relationship between inpatient COVID-19 mortality and chest CT severity score.

OBJECTIVES: There is scarce data available on the prognostic application of chest CT. The main purpose of this study was to evaluate the performance of a semi-quantitative CT severity score in identifying the risk of mortality in COVID-19 patients. METHODS: This retrospective cohort study was performed on 262 hospitalized COVID-19 patients. The CT severity score was assessed by two independent radiologists using a method previously used to score the severity of acute respiratory distress syndrome on thin slice lung CT. RESULTS: Multivariate regression analysis showed increasing odds of in-hospital death associated with older age, and the presence of coronary artery disease at the time of admission. The mean CT severity score was 7.5 in the survivor group and 14.5 in the deceased group. Overall, the lower zones were the most frequently affected sites in COVID-19. There was significant difference between the survivor and deceased groups regarding CT severity scores. Multivariate regression analysis showed increasing odds of in-hospital death associated with higher CT severity score at admission. CONCLUSIONS: Our results show that mortality was significantly higher in patients with higher CT severity score even after adjustment for clinical, demographics and laboratory parameters. However, this study is performed retrospectively and needs to be validated in a prospective study.

Chest CT scan in patients with contusion and COVID-19, a comparative study with pure lung contusion (preprint)

Background: Resource allocation for traumatic patients who are positive/negative for COVID-19 challenges the diagnosis. We designed this study to compare the chest CT appearances of COVID-19 patients associated with lung contusion versus patients with lung contusion only, to determine the differentiation capability of CT scan concerning the two conditions. Methods: CT-scans of 9 RT-PCR positive patients of lung contusion due to motor-vehicle-accident (COVID-19 with contusion group) and 16 consecutive patients with lung contusions of comparable severity scores from the pre-COVID-19 era (contusion only group) were revaluated retrospectively and blindly by three radiologists in consensus. The distribution and characteristics of presenting CT-scan findings; including presence, shape and distribution of Ground Glass Opacities and consolidations, presence of subpleural sparing, crazy-paving and Atoll sign. In addition, presence of effusions and cavities were compared between the two groups. Time course of the opacities was compared. Results: Bilateral distribution of opacities was noted in 100% of COVID-19 with contusion and 87.5% of contusion only group. There was no significant difference between Ground Glass Opacities or consolidation shapes (P=0.44 and P=0.66). Both Ground Glass Opacities and consolidations were more diffusely distributed in COVID-19 with contusion, while a predominantly peripheral distribution was more commonly seen in the contusion only group (P=0.03 and P=0.01 respectively). Subpleural sparing was noted in 93.8% of contusion only as compared to 44% of CC group (p=0.04). Appearance resembling Atoll sign was noted in 12.5% of the contusion only groups and none of the COVID-19 with contusion group (P=0.01). Time to resolution was significantly longer in COVID-19 with contusion (15±6 days) comparing to contusion only patients (P=0.02). Conclusion: 'Typical' chest CT findings including bilateral peripheral Ground Glass Opacities and consolidations, also crazy-paving and Atoll signs, as well as less typical findings such as subpleural sparing is seen in both lung contusion and COVID-19 pneumonitis. Time course of the lesions might be a better radiologic discriminator between the two entities.