Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases.

Background Chest CT is used in the diagnosis of coronavirus disease 2019 (COVID-19) and is an important complement to reverse-transcription polymerase chain reaction (RT-PCR) tests. Purpose To investigate the diagnostic value and consistency of chest CT as compared with RT-PCR assay in COVID-19. Materials and Methods This study included 1014 patients in Wuhan, China, who underwent both chest CT and RT-PCR tests between January 6 and February 6, 2020. With use of RT-PCR as the reference standard, the performance of chest CT in the diagnosis of COVID-19 was assessed. In addition, for patients with multiple RT-PCR assays, the dynamic conversion of RT-PCR results (negative to positive, positive to negative) was analyzed as compared with serial chest CT scans for those with a time interval between RT-PCR tests of 4 days or more. Results Of the 1014 patients, 601 of 1014 (59%) had positive RT-PCR results and 888 of 1014 (88%) had positive chest CT scans. The sensitivity of chest CT in suggesting COVID-19 was 97% (95% confidence interval: 95%, 98%; 580 of 601 patients) based on positive RT-PCR results. In the 413 patients with negative RT-PCR results, 308 of 413 (75%) had positive chest CT findings. Of those 308 patients, 48% (103 of 308) were considered as highly likely cases and 33% (103 of 308) as probable cases. At analysis of serial RT-PCR assays and CT scans, the mean interval between the initial negative to positive RT-PCR results was 5.1 days ± 1.5; the mean interval between initial positive to subsequent negative RT-PCR results was 6.9 days ± 2.3. Of the 1014 patients, 60% (34 of 57) to 93% (14 of 15) had initial positive CT scans consistent with COVID-19 before (or parallel to) the initial positive RT-PCR results. Twenty-four of 57 patients (42%) showed improvement on follow-up chest CT scans before the RT-PCR results turned negative. Conclusion Chest CT has a high sensitivity for diagnosis of coronavirus disease 2019 (COVID-19). Chest CT may be considered as a primary tool for the current COVID-19 detection in epidemic areas. © RSNA, 2020 Online supplemental material is available for this article. A translation of this abstract in Farsi is available in the supplement. ترجمه چکیده این مقاله به فارسی، در ضمیمه موجود است.

A narrative review of invasive diagnostics and treatment of early lung cancer.

The diagnosis and treatment of early-stage lung cancer remains a clinical challenge. The broadening implementation of lung cancer screening has resulted in positive findings in numerous patients that are mostly non-malignant. Many other patients have indeterminate nodules that are difficult to assess through simple observation. The critical interpretation of such screening results remains a challenge for radiologists and multidisciplinary teams involved in screening for lung cancer. The evaluation and diagnosis of each participant suspected for malignancy should be based on the basic clinical principles such as a carefully collected medical history, physical examination, and detailed analysis of all imaging tests performed. Indeed, the decision to go ahead with more invasive diagnostics requires consideration of the both the risks and benefits, with reflection upon the complete clinical and radiological picture. Although transthoracic needle aspiration biopsy remains the first-choice method of diagnosis, several newer technologies have slowly begun to emerge as potential replacements. The guiding strategy for method selection is to choose the least harmful approach that offers the most relevant potential insights. Transthoracic biopsy is an effective method that allows the collection of cytological and tissue material from small, peripheral tumors, but it carries a moderate risk of complications. Bronchofiberoscopy, especially in combination with electromagnetic navigation, fluoroscopy or radial EBUS, also allows effective diagnosis of the peripheral pulmonary nodules. One of the most important diagnostic methods is the EBUS examination, which allows determining of staging in addition to diagnosis. Anatomical lung lobe resection and lymphadenectomy or sampling of the hilar and mediastinal lymph nodes is currently the treatment of choice for patients with stage I and II non-small cell lung cancer (NSCLC), but sublobar resections are recommended when a patient has limited pulmonary function or other significant comorbidities. Notably, several studies have highlighted the potential utility of more limited resections in small malignant lesions less than 2cm in diameter, with pure AIS histology, when more than 50% of the diameter of pulmonary nodule has ground-glass opacity (GGO) attenuation on CT, or long volume doubling time (VDT). Videothoracoscopy is the preferred surgical approach for resection of early-stage lung cancer. Patients who are not candidates for surgery or do not agree to surgery can be offered radical radiotherapy. Stereotactic body radiation therapy (SBRT) is a type of radical radiotherapy with proven effectiveness, a high rate of local control and an acceptable risk of the development of later complications. Future trials are expected to define the role of SBRT in the treatment of early lung cancer in healthy subjects.

Unique Imaging Findings of Neurologic Phantosmia Following Pfizer-BioNtech COVID-19 Vaccination: A Case Report.

ABSTRACT: Olfactory dysfunction related to SARS-CoV-2 infection and COVID-19 disease is now well established in the literature. In December 2020, the FDA approved the Pfizer-BioNTech and Moderna vaccines for use in preventing COVID-19 in the United States. To the best of our knowledge, this is the first report of a phantosmia post-Pfizer COVID-19 vaccination, with positive magnetic resonance imaging radiographic findings in a patient with documented absence of infection by SARS-CoV-2 virus or concomitant sinonasal disease.

Impact of Viral PCR Positive Nasal Swabs (Non Covid-19) on Outcomes Following Cardiac Surgery.

Viral bronchiolitis is a relative contraindication to elective pediatric cardiac surgery. Nasopharyngeal swab utilizing polymerase chain reaction (PCR) screening for viruses known to cause bronchiolitis are commonly available. The objective of this study was to evaluate clinical outcomes in patients with nasopharyngeal viral PCR positive findings at the time of cardiac surgery. Retrospective review from January 2013 to May 2019 for patients with virus detected by PCR on nasopharyngeal swabs at the time of cardiac surgery. Single ventricle and two ventricle patients were compared to control group of age and procedure matched patients viral negative at the time of surgery. Outcome measures included OR extubation, reintubation, hospital length of stay, and mortality. For two ventricle patients (n = 81; control group = 165), there was no statistical difference in any outcome variable (OR extubation 74% vs 72%; p = 0.9; reintubation 9% vs 11% vs; p = 0.7; hospital length of stay 5 days (1-46) vs 4 days (2-131); p = 0.4; mortality 2 vs 1; p = 0.3). For single ventricle patients, there was no statistical difference in any outcome variable (OR extubation 81% vs 76%; p = 0.6; reintubation 14% vs 21% vs; p = 0.5; hospital length of stay 9.5 days (3-116) vs 15 days (2-241); p = 0.1; mortality 0 vs 3; (p = 0.6)). PCR is a sensitive test that fails to predict which patients will proceed to have a clinically significant infection. Viral bronchiolitis remains a relative risk factor for cardiac surgery; presence of detectable virus via nasopharyngeal swab with limited clinical symptoms may not be a contraindication to cardiac surgery.

Neuroimaging Findings of Hospitalized Covid-19 Patients: A Canadian Retrospective Observational Study.

PURPOSE: Coronavirus disease (COVID-19) has been associated with neurologic sequelae and neuroimaging abnormalities in several case series previously. In this study, the neuroimaging findings and clinical course of adult patients admitted with COVID-19 to a tertiary care hospital network in Canada were characterized. METHODS: This is a retrospective observational study conducted at a tertiary hospital network in Ontario, Canada. All adult patients with PCR-confirmed COVID-19 admitted from February 1, 2020 to July 22, 2020 who received neuroimaging related to their COVID-19 admission were included. CT and MR images were reviewed and categorized by fellowship-trained neuroradiologists. Demographic and clinical data were collected and correlated with imaging findings. RESULTS: We identified 422 patients admitted with COVID-19 during the study period. 103 (24.4%) met the inclusion criteria and were included: 30 ICU patients (29.1%) and 73 non-ICU patients (70.9%). A total of 198 neuroimaging studies were performed: 177 CTs and 21 MRIs. 17 out of 103 imaged patients (16.8%) had acute abnormalities on neuroimaging: 10 had macrohemorrhages (58.8%), 9 had acute ischemia (52.9%), 4 had SWI abnormalities (23.5%), and 1 had asymmetric sulcal effacement suggesting possible focal encephalitis (5.8%). ICU patients were more likely to have positive neuroimaging findings, more specifically acute ischemia and macrohemorrhages (P < 0.05). Macrohemorrhages were associated with increased mortality (P < 0.05). CONCLUSION: Macrohemorrhages, acute ischemia and SWI abnormalities were the main neuroimaging abnormalities in our cohort of hospitalized COVID-19 patients. Acute ischemia and hemorrhage were associated with worse clinical status.

Differences in Clinical and Imaging Presentation of Pediatric Patients with COVID-19 in Comparison with Adults.

PURPOSE: To characterize and compare the initial clinical and imaging features of coronavirus disease 2019 (COVID-19) in pediatric and adult patients undergoing chest CT. MATERIALS AND METHODS: A total of 61 patients, consisting of 47 adults (aged 18 years or older) and 14 pediatric patients (aged younger than 18 years) with laboratory-confirmed COVID-19 confirmed by real-time reverse-transcription polymerase chain reaction between January 25 and February 15, 2020, were enrolled in this study. All patients underwent chest CT within 3 days after the initial reverse transcription polymerase chain reaction test. The clinical presentation, serum markers, and CT findings were assessed and compared between the adult and pediatric patients. RESULTS: Fever was less common in pediatric patients than in adults (six of 14, 42.9% vs 39 of 47, 83%; P = .008). Leukopenia or normal, lymphopenia or normal, and increased or normal C-reactive protein level were common in both groups with no difference (P > .05). Compared with the adults, pediatric patients had a lower rate of positive CT findings and a milder clinical grade (P = .004 and P = .001, respectively). At chest CT, the number of pulmonary lobes involved was found to be reduced in pediatric patients when compared with adults (P = .012). Subpleural distribution of lung opacities was a dominant feature in both groups, whereas bronchial distribution was more common in the pediatric group (P = .048). Among the CT features in adults, ground-glass opacities (GGOs) were the most common finding (24 of 43, 53.5%), followed by GGO with consolidation (14 of 43, 27.9%). In pediatric patients, GGOs accounted for 42.9% (three of seven), bronchial wall thickening occurred in 28.6% (two of seven), and GGOs with consolidations and nodular opacities occurred in 14.3% (one of seven). However, these CT features did not differ in the two groups, except for bronchial wall thickening, which was more commonly found in pediatric patients (P = .048). In addition, the semiquantitative scores of lung involvement were higher in adults than in pediatric patients (8.89 ± 4.54 vs 1.86 ± 2.41; P < .001). CONCLUSION: Compared with adults, pediatric patients with COVID-19 showed distinctive clinical and CT features. Pediatric patients tend to have milder clinical symptoms, fewer positive results at CT, and less extensive involvement at imaging. Bronchial wall thickening was relatively more frequent on CT images from pediatric patients with COVID-19 in comparison with adults.Supplemental material is available for this article.© RSNA, 2020.

Self-sampling for high-risk human papillomavirus as a follow-up alternative after treatment of high-grade cervical intraepithelial neoplasia.

Women treated for high-grade cervical-intraepithelial-neoplasia (CIN) require long-term follow-up with high-risk human-papillomavirus (HPV) testing. Self-sampling for HPV is well-accepted among these patients, but its role in follow-up for this group requires investigation. The present study examined how well HPV findings from self-sampled vaginal (VSS) and urine specimens correctly identified women from this cohort with recurrent CIN2+ compared with samples collected by clinicians. At 1st post-conization follow-up, 531 patients (99.8% participation) gave urine samples, performed VSS, underwent colposcopy with punch biopsy of visible lesions and clinician-collected cervical sampling for HPV analysis and liquid-based cytology. A total of 113 patients with positive HPV and/or abnormal cytology at 1st follow-up underwent 2nd follow-up. At 1st follow-up, all patients with recurrent CIN3 had positive HPV results by all methods. Clinician sampling and VSS revealed HPV16 positivity in 50% of recurrent cases and urine sampling revealed HPV16 positivity in 25% of recurrent cases. At 2nd follow-up, all 7 newly-detected CIN2/3 recurrences were associated with HPV positivity on VSS and clinician-samples. Only clinician-collected samples detected HPV positivity for two adenocarcinoma-in-situ recurrences, and both were HPV18 positive. A total of 77 patients had abnormal cytology at 1st follow-up, for which HPV positivity via VSS yielded highest sensitivity. The HPV findings were positive from VSS in 12 patients with high-grade squamous-intraepithelial-lesions (HSIL), and 11 patients with HSIL had positive HPV findings in clinician-collected and urine samples. All methods for assessing HPV presence yielded significant age-adjusted odds ratios for predicting abnormal lesions at 1st follow-up. For overall HPV results, Cohen's kappa revealed substantial agreement between VSS and clinician sampling, and moderate agreement between urine and clinician sampling. Clinician sampling and VSS were highly concordant for HPV16. Insofar as the pathology was squamous (not glandular), VSS appeared as sensitive as clinician sampling for HPV in predicting outcome among the present cohort. Since VSS can be performed at home, this option can maximize participation in the required long-term follow-up for these women at high-risk.

Considerations in imaging interpretations for colitis in critically ill patients during the COVID-19 era.

OBJECTIVE: The study aims to demonstrate risk factors for colitis in intensive care unit patients with and without coronavirus disease 2019 (COVID-19). METHODS: Retrospective review was performed to identify intensive care unit (ICU) patients with the diagnosis of COVID-19 with computed tomography (CT) between March 20 and December 31, 2020. ICU patients without COVID-19 diagnosis with CT between March 20 and May 10, 2020 were also identified. CT image findings of colitis or terminal ileitis as well as supportive treatment including ventilator, vasopressors, or extracorporeal membrane oxygenation (ECMO) were recorded. Statistical analysis was performed to determine if clinical factors differed in patients with and without positive CT finding. RESULTS: Total 61 ICU patients were selected, including 32 (52%) COVID-19-positive patients and 29 (48%) non-COVID-19 patients. CT findings of colitis or terminal ileitis were identified in 27 patients (44%). Seventy-four percent of the patients with positive CT findings (20/27) received supportive therapies prior to CT, while 56% of the patients without abnormal CT findings (19/34) received supportive therapies. Vasopressor treatment was significantly associated with development of colitis and/or terminal ileitis (p = 0.04) and COVID-19 status was not significantly different between these groups (p = 0.07). CONCLUSIONS: In our study, there was significant correlation between prior vasopressor therapy and imaging findings of colitis or terminal ileitis in ICU patients, independent of COVID-19 status. Our observation raises a possibility that the reported COVID-19-related severe gastrointestinal complications and potential poor outcome could have been confounded by underlying severe critically ill status, and warrants a caution in diagnosis of gastrointestinal complication.

Does CT help in reducing RT-PCR false negative rate for COVID-19?

BACKGROUND: Early detection is the key to contain the ongoing pandemic. The current gold standard to detect SARS CoV2 is RT-PCR. However, it has a high false negative rate and long turnaround time. PURPOSE: In view of the high sensitivity of CT in detection of lower respiratory tract pathologies, a study of 2581 patients comparing RT-PCR status with CT findings was undertaken to see if it augments the diagnostic performance. MATERIALS AND METHODS: A multi centre prospective study of consecutive cases was conducted. All CT studies suggestive of COVID 19 pneumonia were collated and evaluated independently by three Radiologists to confirm the imaging diagnosis of COVID-19 pneumonia. The RT-PCR values were retrospectively obtained, based on the RT-PCR values, CT studies were categorised into three subgroups, positive, negative and unknown. CT features from all three groups were compared to evaluate any communality or discordance. RESULTS: Out of the 2581 patients with positive CT findings for COVID pneumonia, 825 were females and 1,756 were males in a wide age group of 28-90 years. Predominant CT features observed in all the subgroups were Ground glass densities 94.8%, in mixed distribution (peripheral and central) (59.12%), posterior segments in 92% and multilobar involvement in 70.9%. The CT features across the three subgroups were statistically significant with a P value <0.001. CONCLUSION: There was a communality of CT findings regardless of RT-PCR status. In a pandemic setting ground glass densities in a subpleural, posterior and basal distribution are indicative of COVID 19. Thus CT chest in conjunction to RT PCR augments the diagnosis of COVID 19 pneumonia; utilization of CT chest may just be the missing link in closing this pandemic.

HRCT chest in COVID-19 patients: An initial experience from a private imaging center in western India.

The COVID-19 pandemic began in late December in 2019 and has now reached to 216 countries with 1,08,42,028 confirmed cases and 5,21,277 deaths according to the WHO reports and 6,49,666 confirmed cases in india alone with 18,679 deaths (as on 04th july 2020). RT-PCR has been considered the standard test for diagnosis of COVID 19. However, there has been reported a high false negative rate. This high false negative rate increases the risk of further transmission as well as delays the timely management of suspected cases. We have conducted HRCT chest of various (200 patient case study) proven and suspected cases of COVID-19 infection in the months of April, May and June 2020. Out of 200 scanned patients with clinical complains and suspicion, positive HRCT chest findings were seen in 196 patients, showing clinical-radiological correlation and an accuracy of 98%. The sensitivity of chest CT in suggesting COVID-19 was 98.6% (146/148patients) based on positive RT-PCR results. In patients with negative RT-PCR results and high clinical suspicion, 90% (18/20) had positive chest CT findings. HRCT chest is very sensitive and accurate in picking up lung parenchymal abnormalities in laboratory negative RT-PCR cases with high clinical suspicion of COVID-19 infection and also in all symptomatic patients where RT-PCR was not done. HRCT can also be very sensitive, cost effective and time effective in screening patients with high clinical suspicion. HRCT scores over RT-PCR in giving immediate results, assessing severity of disease and prediction of prognosis. We suggest HRCT chest for detection of early parenchymal abnormalities, assessing severity of disease in all patients with clinical symptoms and suspicion of COVID infection irrespective of laboratory RT-PCR status.

Severity of Chest Imaging is Correlated with Risk of Acute Neuroimaging Findings among Patients with COVID-19.

BACKGROUND AND PURPOSE: Severe respiratory distress in patients with COVID-19 has been associated with higher rate of neurologic manifestations. Our aim was to investigate whether the severity of chest imaging findings among patients with coronavirus disease 2019 (COVID-19) correlates with the risk of acute neuroimaging findings. MATERIALS AND METHODS: This retrospective study included all patients with COVID-19 who received care at our hospital between March 3, 2020, and May 6, 2020, and underwent chest imaging within 10 days of neuroimaging. Chest radiographs were assessed using a previously validated automated neural network algorithm for COVID-19 (Pulmonary X-ray Severity score). Chest CTs were graded using a Chest CT Severity scoring system based on involvement of each lobe. Associations between chest imaging severity scores and acute neuroimaging findings were assessed using multivariable logistic regression. RESULTS: Twenty-four of 93 patients (26%) included in the study had positive acute neuroimaging findings, including intracranial hemorrhage (n = 7), infarction (n = 7), leukoencephalopathy (n = 6), or a combination of findings (n = 4). The average length of hospitalization, prevalence of intensive care unit admission, and proportion of patients requiring intubation were significantly greater in patients with acute neuroimaging findings than in patients without them (P < .05 for all). Compared with patients without acute neuroimaging findings, patients with acute neuroimaging findings had significantly higher mean Pulmonary X-ray Severity scores (5.0 [SD, 2.9] versus 9.2 [SD, 3.4], P < .001) and mean Chest CT Severity scores (9.0 [SD, 5.1] versus 12.1 [SD, 5.0], P = .041). The pulmonary x-ray severity score was a significant predictor of acute neuroimaging findings in patients with COVID-19. CONCLUSIONS: Patients with COVID-19 and acute neuroimaging findings had more severe findings on chest imaging on both radiographs and CT compared with patients with COVID-19 without acute neuroimaging findings. The severity of findings on chest radiography was a strong predictor of acute neuroimaging findings in patients with COVID-19.

Chest computed tomographic findings of patients with COVID-19-related pneumonia.

BACKGROUND: In December 2019, pneumonia cases of unknown cause were announced in Wuhan, China. The causative agent of pneumonia was identified as coronavirus 2 (SARS-CoV-2), and the disease was named coronavirus disease 2019 (COVID-19). PURPOSE: To evaluate the usefulness of computed thoracic tomography (CT) and postero anterior (PA) thoracic radiography in patients with COVID-19. MATERIAL AND METHODS: Between March and June 2020, the patients who arrived at our hospital with suspicion of COVID-19 were retrospectively analyzed. Thorax CT findings of the 281 patients (142 females and 139 males; age range 3-91 years) with positive PCR tests were evaluated. Lesions in the lung parenchyma were examined according to their number, localization, and distribution. PA chest radiograms were classified into two groups, positive and negative for the lung parenchymal lesions. RESULTS: Of the total 281 patients with PCR-positive COVID-19, CT examinations were normal in 107 (38.1%), and positive CT findings for pneumonia were found in 174 patients (61.9%). Bilateral involvement was observed in 100 (57.5%) of the 174 patients with positive CT findings, and unilateral involvement was observed in 74 (42.5%) of them. According to the localization of the lesions, peripheral subpleural distribution occurred in 160 of the 174 patients (91.9). The most common lesion was the ground glass opacities (GGO). In 77 of 281 PCR-positive patients (27.4), pulmonary lesions were found on PA chest radiograms. CONCLUSION: The presence of bilateral posterior subpleural GGO, nodule, and consolidation in thoracic CT are significant in terms of COVID-19 pneumonia.

Chest CT Evaluation of 11 Persistent Asymptomatic Patients with SARS-CoV-2 Infection.

In total, 11 asymptomatic carriers who underwent nasal or oropharyngeal swab tests for SARS-CoV-2 after being in close contact with patients who developed symptomatic 2019 coronavirus disease (COVID-19) were enrolled in this study. The chest multidetector computed tomography (CT) images of the enrolled patients were qualitatively and quantitatively analyzed. The findings of the first chest CT were normal in 3 (27.3%) patients, 2 of whom were aged below 15 years. The lesions of 2 (18.2%) patients involved 1 lobe with unifocal presence. Subpleural lesions were observed in 7 (63.6%) patients. Ground glass opacity (GGO) was the most common sign observed in 7 (63.6%) patients. Crazy-paving pattern and consolidation were detected in 2 (18.2%) and 4 (36.4%) patients, respectively. Based on deep learning and quantitative analysis, the mean volume of intrapulmonary lesions in the first CT image was 85.73 ± 84.46 cm3. In patients with positive findings on CT images, the average interval between positive real-time reverse transcriptase polymerase chain reaction assay and peak volume on CT images was 5.1 ± 3.1 days. In conclusion, typical CT findings can be detected in over 70% of asymptomatic SARS-CoV-2 carriers. The initial presentation is typically GGO along the subpleural regions and bronchi, which absorbs in approximately 5 days.

Abdominal gastrointestinal imaging findings on computed tomography in patients with COVID-19 and correlation with clinical outcomes.

PURPOSE: Pulmonary imaging finding of Coronavirus disease 2019 (COVID-19) has been widely described, but until now few studies have been published about abdominal radiological presentation. The aim of this study was to provide an overview of abdominal imaging findings in patients with COVID-19 in a multicenter study and correlate them with worse clinical outcomes. MATERIALS AND METHODS: This retrospective study included adult COVID-positive patients with abdominal CT performed from 4/1/2020 to 5/1/2020 from two institutions. Demographic, laboratory and clinical data were recorded, including clinical outcomes. RESULTS: Of 81 COVID-positive patients, the average age was 61 years, 42 (52%) women and 45 (55%) had positive abdominopelvic findings. The most common abdominal imaging features were intestinal imaging findings (20/81, 24%), including colorectal (4/81, 5%) and small bowel thickening (10/81, 12%), intestinal distension (15/81, 18%), pneumatosis (1/81, 1%) and intestinal perforation (1/81, 1%). On multivariate analysis, intestinal imaging findings were associated with higher risk of worse outcome (death or invasive mechanical ventilation) (RR = 2.6, p = 0.04) and higher risk of invasive mechanical ventilation alone (RR = 6.2, p = 0.05). CONCLUSION: Intestinal abnormalities were common findings in COVID-19 patients who underwent abdominal CT and were significantly correlated to worse outcomes in the clinical follow-up.

Cerebrospinal fluid in COVID-19: A systematic review of the literature.

OBJECTIVE: We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2. METHODS: We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom. RESULTS: We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 304 patients whose CSF was tested for SARS-CoV-2 PCR, there were 17 (6%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (13/17, 76%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 77 patients tested for autoimmune antibodies in the CSF, 4 (5%) had positive findings. CONCLUSION: Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS- CoV-2 are unlikely to be related to direct viral neuroinvasion.

Progression of Disease in COVID-19 Patients Evaluated by Chest CT Imgaing and Correlated with Clinical Parameters.

The objective of the study was to investigate and quantify the severity of COVID-19 infection by high resolution computed tomography (CT) of chest and to determine its relationship with clinical parameters. This study also aimed to see CT changes with clinical recovery or progression of disease. This cross sectional study was performed from July 20 to August 20, 2020, where both chest HRCT and clinical features were included in laboratory confirmed COVID-19, 100 patients, attending the depertment of Radiology & Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. This study included clinical symptoms, comorbidities of patients, HRCT chest characteristics, CT severity score. After collection of all required data and careful medical chest review, the clinical data of laboratory confirmed patients was compiled and tabulated. In this study group out of 100 patients, most of the patients were in 5th & 6th dacades with a mean age of 53.7 years. In this study out of 100 patients 72% were male and 28% were female with an average sex ratio of male : female being 2.5:1. Prevalance of various clinical presentation in this study sample population distributed as fever in 76% cough in 77.4%, shortness of breath in 55%, sore throat in 17% were the most common clinical manifestations while a few patients (13.2%) also had other symptoms like headache, chest tightnes, anosmia and diarrhoea. Major comorbid conditions were diabets mellitus, hypertension, bronchial asthma and Chronic kidney disease (CKD). Patient with comorbid disease, especially if multiple had higher symptomatic presentation. Out of 100 patients 75.5% patient had co-morbidity where as 24.5% ptaients did not have any co-existing disease. According to HRCT imaging severity score the lung pathological changes were evaluated, when typical covid findings in 80%, intermediate in 10%, atypical in 2% and normal chest CT findings in 8% patients. Symptomatic presentation had found higher (85.21%) who had CT severity index >15/25 while sympotomatic presentation lesser (14.79%) who had CT severity index <15/25. CT severity index of 1-5 was seen in 20(21.73%) patients, 6-10 in 38(41.30%) patients, 11-15 in 22(23.91% patients, 16-20 in 10(10.86%) patients and 21-25 in 2(2.17%). As positive CT findings were more prominent in symptomatic and co-morbid patients HRCT chest in COVID-19 patient had a major diagnostic and prognostic importance. Clinical symptoms of patients directly correlated with CT severity score. Therefore, CT imaging was found to be useful in predicting clinical recovery of patient or progression of disease.

Thoracic computerised tomography scans in one hundred eighteen orthopaedic patients during the COVID-19 pandemic: identification of chest lesions; added values; help in managing patients; burden on the computerised tomography scan department.

PURPOSE: Based on the recent literature, chest computed tomography (CT) examination could aid for management of patients during COVID-19 pandemic. However, the role of chest CT in management of COVID-19 patients is not exactly the same for medical or surgical specialties. In orthopaedic or trauma emergency, abdomen, pelvis, cervical, dorsal, and lumbar spine CT are performed to investigate patients; the result is a thoracic CT scan incorporating usually the thorax; however, information about lung parenchyma can be obtained on this thorax CT, and manifestations of COVID-19 can be diagnosed. The objective of our study was to evaluate this role in orthopedic patients to familiarize orthopaedists with the value and limits of thoracic CT in orthopaedic surgery. MATERIALS AND METHODS: Among the 1397 chest CT scans performed during the pandemic period from 1 March 2020 to 10 May 2020, in two centres with orthopaedic surgery, we selected all the 118 thoracic or chest CT performed for patients who presented to the Emergency Department of the hospital with a diagnosis of trauma for orthopaedic surgical treatment. Thirty-nine of these 118 patients were tested with PCR for the diagnosis of COVID-19 infection. Depending on clinical status (symptomatic or non-symptomatic), the information useful for the orthopaedist surgeon and obtained from the Chest CT scan according to the result of the PCR (gold standard) was graded from 0 (no or low value) to 3 (high value). The potential risks of chest CT as exposure to radiation, and specific pathway were analyzed and discussed. A group of patients treated during a previous similar period (1 March 2018 to 15 April 2018) was used as control for evaluation of the increase of CT scanning during the COVID-19 pandemic. RESULTS: Among the 118 patients with chest CT, there were 16 patients with positive COVID-19 chest CT findings, and 102 patients with negative chest CT scan. With PCR results as reference, the sensitivity, specificity, positive predictive value of chest CT in indicating COVID-19 infection were 81%, 93%, and 86%, respectively (p = 0.001). A useful information for the orthopaedic surgeon (graded as 1 for 71 cases, as 2 for 5 cases, and as 3 for 11 cases) was obtained from 118 chest CT scans for 87 (74%) patients, while the CT was no value in 30 (25%) cases, and negative value in one (1%) case. Roughly 20% of the total number of CT scanner performed over the pandemic period was dedicated to COVID-19, but only 2% were for orthopaedic or trauma patients. However, this was ten times higher than during the previous control period of comparison. CONCLUSION: Although extremely valuable for surgery management, these results should not be overstated. The CT findings studied are not specific for COVID-19, and the positive predictive value of CT will be low unless disease prevalence is high, which was the case during this period.

Early Orthopaedic Trauma Outcomes in COVID-19 Infected Patients: A Case Series.

Orthopaedic trauma presents a unique and complex challenge in the initial phase of the coronavirus 2019 (COVID-19) global crisis. Little is currently known about the surgical practices in orthopaedic emergencies in the early days of the COVID-19 outbreak (1). This is a retrospective case series of 10 orthopaedic trauma patients who underwent fracture fixation in March 2020. Of the 10 patients testing COVID-19 positive, there were a total of 16 long bone fractures, 5 pelvic ring fractures, and 1 lumbar burst fracture. There were 7 (70%) males in this cohort. Two (20%) of the COVID-positive patients did not develop fever, leukocytosis, respiratory insufficiency, or positive imaging findings and were younger (average age 25.5 years) with fewer comorbidities (average 0.5) compared with the 8 symptomatic COVID-19-positive patients (56.6 years with 1.88 comorbidities). Advancement of COVID-19 pathogenesis with lung opacities and prolonged intubation occurred in all 5 patients who remained on ventilation postoperatively (range 9 hours-11 days). At the time of most recent follow-up, all patients survived, 1 continues to require ventilation support, 1 remains admitted without ventilation support, and 8 (80%) were discharged to home. LEVEL OF EVIDENCE:: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Chest CT scan features from 302 patients with COVID-19 in Jordan.

OBJECTIVE: To study non-enhanced computer tomographic features of chest imaging in 302 patients with Corona Virus Disease 2019 (COVID-19) in Jordan. MATERIAL AND METHOD: A retrospective analysis of non-enhanced computer tomographic scans has been performed in the main center for patients diagnosed with COVID-19 in Prince Hamzah Hospital for those scanned from 13th of March 2020 to 13th of May 2020. Included scans were routinely performed during 24-hs of admission apart from having respiratory complaint. CT protocol included non-enhanced 1 mm slice thickness by Philips Brilliance Big Bore scanner (Philips; Amsterdam, Netherlands).All computer tomographic scans were reviewed by two senior radiologists with more than 8 years of experience each and senior registrar.Several factors have been thoroughly studied including patient age, gender, positive versus negative pulmonary findings, laterality of lung involvement, lobar distribution, pattern of pulmonary changes on initial and follow-up scans. RESULTS: The total number of patients evaluated was 302. There were 188 men and 114 women studied. Among the totally studied 302 cases; 181 cases (59.9 %) showed no pulmonary changes.Positive findings were present in 121 patients with a total number of 191 computer tomographic scans including initial and follow-up scans. Positive findings were present in 51 female and 70 male patients (age range, 12-87 years; mean age ± standard deviation, 46.1 ± 16.5).Bilateral disease was more frequently encountered presented in 86 cases (71.1 %), while unilateral disease showed two times more predilection for the right lung compared to the left. The incidence of lobar involvement in descending order: right lower (75.2 %), left lower (71.9 %), right upper (62.8 %), left upper (60.3 %) and right middle (50.4 %). The incidence of the affected lobes on the initial scans were as follow: one lobe (24 %), two lobes (10.7 %), three lobes (9.1 %), four lobes (16.5 %) five lobes (36.4 %). In cases with single lobar involvement (24 %); the left upper and right middle lobes showed lowest incidence of involvement accounting for 10.3 % & 13.8 %, respectively; on the other hand, in cases with four lobar involvement (16.5 %); the right middle lobe was most commonly spared in two third of cases (63.2 %).Several initial patterns of the pulmonary changes resulting from Corona Virus Disease 2019 (COVID-19) were present with a descending order; ground-glass pattern (96.7 %), lenticular pattern (32.2 %), Halo sign (15.7 % %), rounded (14.9 %), nodular (10.7 %), ground-glass with consolidation (8.3 %), tree-in-bud (1.7 %) and pleural effusion (1.7 %). Pathologically-enlarged lymph node was not a feature of COVID-19.The total number of patients with positive findings having follow-up scans was 57 including single (45 patients) versus two (12 patients) follow-up scans. Initial follow up scans showed regression and progression of the pulmonary changes in 35 and 22 patients, respectively.A remarkable pattern was seen in almost all regressed cases that showed patchy reticular pattern changes with septal thickening which was referred to "pulmonary synapses" (34 patients) with only one patient showed complete resolution of the parenchymal changes. Patterns seen in progressed cases were lenticular ground-glass (63.6 %) vs patchy ground-glass (36.4 %) patterns. CONCLUSION: Computer tomographic scan of the chest is a principal diagnostic measure for Corona Virus Disease 2019 (COVID-19). The pulmonary changes showed more propensity being bilateral disease and affecting the lower lobes, while the right middle lobe was the least likely involvement. Several pattern of pulmonary changes can be seen on initial scans including ground glass, consolidation, Halo sign, lenticular, nodular, pleural effusion and tree-in-bud patterns. The tree-in-bud is first-time described pattern of COVID-19 in the current article and thought to be an excluding criterion. In follow-up scans; the lenticular and patchy ground-glass patterns were present in cases with disease progression, compared with "pulmonary synapses" pattern encountered in cases with disease regression.

Chest CT features of coronavirus disease-19 (COVID-19) pneumonia: which findings on initial CT can predict an adverse short-term outcome?

OBJECTIVE: To study the spectrum of chest CT features in coronavirus disease-19 (COVID-19) pneumonia and to identify the initial CT findings that may have the potential to predict a poor short-term outcome. METHODS: This was a retrospective study comprising 211 reverse transcriptase-polymerase chain reaction (RT-PCR) positive patients who had undergone non-contrast chest CT. Prevalence, extent, pattern, distribution and type of abnormal lung findings were recorded. Patients with positive CT findings were divided into two groups; clinically stable (requiring in-ward hospitalization) and clinically unstable [requiring intensive care unit (ICU) admission or demised] based on short-term follow-up. RESULTS: Lung parenchymal abnormalities were present in 42.2% (89/211) whereas 57.8% (122/211) cases had a normal chest CT. The mean age of clinically unstable patients (63.6 ± 8.3 years) was significantly different from the clinically stable group (44.6 ± 13.2 years) (p-value < 0.05). Bilaterality, combined involvement of central-peripheral and anteroposterior lung along with a higher percentage of the total lung involvement, presence of crazy paving, coalescent consolidations with air bronchogram and segmental pulmonary vessel enlargement were found in a significantly higher proportion of clinically unstable group (ICU/demised) compared to the stable group (in-ward hospitalization) with all p values < 0.05. CONCLUSION: Certain imaging findings on initial CT have the potential to predict short-term outcome in COVID-19 pneumonia. Extensive pulmonary abnormalities, evaluated by combined anteroposterior, central-peripheral and a higher percentage of the total lung involvement, indicate a poor short-term outcome. Similarly, the presence of crazy paving pattern, consolidation with air bronchogram and segmental vascular changes are also indicators of poor short-term outcome. ADVANCES IN KNOWLEDGE: Certain findings on initial CT can predict an adverse short-term prognosis in COVID-19 pneumonia.