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2.
Invest Radiol ; 55(5): 257-261, 2020 05.
Artículo en Inglés | MEDLINE | ID: covidwho-684015

RESUMEN

OBJECTIVES: The aim of this study was to investigate the chest computed tomography (CT) findings in patients with confirmed coronavirus disease 2019 (COVID-19) and to evaluate its relationship with clinical features. MATERIALS AND METHODS: Study sample consisted of 80 patients diagnosed as COVID-19 from January to February 2020. The chest CT images and clinical data were reviewed, and the relationship between them was analyzed. RESULTS: Totally, 80 patients diagnosed with COVID-19 were included. With regards to the clinical manifestations, 58 (73%) of the 80 patients had cough, and 61 (76%) of the 80 patients had high temperature levels. The most frequent CT abnormalities observed were ground glass opacity (73/80 cases, 91%), consolidation (50/80 cases, 63%), and interlobular septal thickening (47/80, 59%). Most of the lesions were multiple, with an average of 12 ± 6 lung segments involved. The most common involved lung segments were the dorsal segment of the right lower lobe (69/80, 86%), the posterior basal segment of the right lower lobe (68/80, 85%), the lateral basal segment of the right lower lobe (64/80, 80%), the dorsal segment of the left lower lobe (61/80, 76%), and the posterior basal segment of the left lower lobe (65/80, 81%). The average pulmonary inflammation index value was (34% ± 20%) for all the patients. Correlation analysis showed that the pulmonary inflammation index value was significantly correlated with the values of lymphocyte count, monocyte count, C-reactive protein, procalcitonin, days from illness onset, and body temperature (P < 0.05). CONCLUSIONS: The common chest CT findings of COVID-19 are multiple ground glass opacity, consolidation, and interlobular septal thickening in both lungs, which are mostly distributed under the pleura. There are significant correlations between the degree of pulmonary inflammation and the main clinical symptoms and laboratory results. Computed tomography plays an important role in the diagnosis and evaluation of this emerging global health emergency.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/patología , Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/patología , Adulto , Anciano , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/virología , Tos/virología , Femenino , Fiebre/virología , Humanos , Pulmón/patología , Pulmón/virología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/virología , Estudios Retrospectivos , Tórax/diagnóstico por imagen , Tórax/virología , Tomografía Computarizada por Rayos X/métodos , Adulto Joven
3.
Radiology ; 296(2): E97-E104, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-683271

RESUMEN

Background A categorical CT assessment scheme for suspicion of pulmonary involvement of coronavirus disease 2019 (COVID-19 provides a basis for gathering scientific evidence and improved communication with referring physicians. Purpose To introduce the COVID-19 Reporting and Data System (CO-RADS) for use in the standardized assessment of pulmonary involvement of COVID-19 on unenhanced chest CT images and to report its initial interobserver agreement and performance. Materials and Methods The Dutch Radiological Society developed CO-RADS based on other efforts for standardization, such as the Lung Imaging Reporting and Data System or Breast Imaging Reporting and Data System. CO-RADS assesses the suspicion for pulmonary involvement of COVID-19 on a scale from 1 (very low) to 5 (very high). The system is meant to be used in patients with moderate to severe symptoms of COVID-19. The system was evaluated by using 105 chest CT scans of patients admitted to the hospital with clinical suspicion of COVID-19 and in whom reverse transcription-polymerase chain reaction (RT-PCR) was performed (mean, 62 years ± 16 [standard deviation]; 61 men, 53 with positive RT-PCR results). Eight observers used CO-RADS to assess the scans. Fleiss κ value was calculated, and scores of individual observers were compared with the median of the remaining seven observers. The resulting area under the receiver operating characteristics curve (AUC) was compared with results from RT-PCR and clinical diagnosis of COVID-19. Results There was absolute agreement among observers in 573 (68.2%) of 840 observations. Fleiss κ value was 0.47 (95% confidence interval [CI]: 0.45, 0.47), with the highest κ value for CO-RADS categories 1 (0.58, 95% CI: 0.54, 0.62) and 5 (0.68, 95% CI: 0.65, 0.72). The average AUC was 0.91 (95% CI: 0.85, 0.97) for predicting RT-PCR outcome and 0.95 (95% CI: 0.91, 0.99) for clinical diagnosis. The false-negative rate for CO-RADS 1 was nine of 161 cases (5.6%; 95% CI: 1.0%, 10%), and the false-positive rate for CO-RADS category 5 was one of 286 (0.3%; 95% CI: 0%, 1.0%). Conclusion The coronavirus disease 2019 (COVID-19) Reporting and Data System (CO-RADS) is a categorical assessment scheme for pulmonary involvement of COVID-19 at unenhanced chest CT that performs very well in predicting COVID-19 in patients with moderate to severe symptoms and has substantial interobserver agreement, especially for categories 1 and 5. © RSNA, 2020 Online supplemental material is available for this article.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tomografía Computarizada por Rayos X/normas , Adulto , Anciano , Comunicación , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Países Bajos , Variaciones Dependientes del Observador , Pandemias , Sistemas de Información Radiológica , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Tomografía Computarizada por Rayos X/métodos
4.
Int J Med Sci ; 17(12): 1773-1782, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-680183

RESUMEN

Rationale: Acute respiratory distress syndrome (ARDS) is one of the major reasons for ventilation and intubation management of COVID-19 patients but there is no noninvasive imaging monitoring protocol for ARDS. In this study, we aimed to develop a noninvasive ARDS monitoring protocol based on traditional quantitative and radiomics approaches from chest CT. Methods: Patients diagnosed with COVID-19 from Jan 20, 2020 to Mar 31, 2020 were enrolled in this study. Quantitative and radiomics data were extracted from automatically segmented regions of interest (ROIs) of infection regions in the lungs. ARDS existence was measured by Pa02/Fi02 <300 in artery blood samples. Three different models were constructed by using the traditional quantitative imaging metrics, radiomics features and their combinations, respectively. Receiver operating characteristic (ROC) curve analysis was used to assess the effectiveness of the models. Decision curve analysis (DCA) was used to test the clinical value of the proposed model. Results: The proposed models were constructed using 352 CT images from 86 patients. The median age was 49, and the male proportion was 61.9%. The training dataset and the validation dataset were generated by randomly sampling the patients with a 2:1 ratio. Chi-squared test showed that there was no significant difference in baseline of the enrolled patients between the training and validation datasets. The areas under the ROC curve (AUCs) of the traditional quantitative model, radiomics model and combined model in the validation dataset was 0.91, 0.91 and 0.94, respectively. Accordingly, the sensitivities were 0.55, 0.82 and 0.58, while the specificities were 0.97, 0.86 and 0.98. The DCA curve showed that when threshold probability for a doctor or patients is within a range of 0 to 0.83, the combined model adds more net benefit than "treat all" or "treat none" strategies, while the traditional quantitative model and radiomics model could add benefit in all threshold probability. Conclusions: It is feasible to monitor ARDS from CT images using radiomics or traditional quantitative analysis in COVID-19. The radiomics model seems to be the most practical one for possible clinical use. Multi-center validation with a larger number of samples is recommended in the future.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Pulmón/diagnóstico por imagen , Modelos Teóricos , Pandemias , Neumonía Viral/complicaciones , Síndrome de Dificultad Respiratoria del Adulto/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Algoritmos , Área Bajo la Curva , China/epidemiología , Infecciones por Coronavirus/epidemiología , Conjuntos de Datos como Asunto , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Curva ROC , Síndrome de Dificultad Respiratoria del Adulto/etiología , Estudios Retrospectivos , Muestreo , Sensibilidad y Especificidad , Investigación en Medicina Traslacional/métodos , Flujo de Trabajo
5.
J Immunother Cancer ; 8(2)2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-662488

RESUMEN

Pneumonitis is a rare but serious adverse event caused by cancer immunotherapy. The diagnosis between COVID-19-induced pneumonia and immunotherapy-induced pneumonitis may be challenging in the era of COVID-19 outbreak. Some clinical symptoms and radiological findings of pneumonitis can be attributed to the coronavirus infection as well as to an immune-related adverse event. Identifying the exact cause of a pneumonitis in patients on treatment with immunotherapy is crucial to promptly start the most appropriate treatment. The proper management of immune checkpoint inhibitors for the risk of pneumonia must take into account a series of parameters. Accurate attention should be payed to symptoms like cough, fever and dyspnea during immunotherapy.


Asunto(s)
Antineoplásicos Inmunológicos/efectos adversos , Infecciones por Coronavirus/diagnóstico , Neoplasias/tratamiento farmacológico , Neumonía Viral/diagnóstico , Neumonía/inducido químicamente , Neumonía/diagnóstico , Betacoronavirus , Antígeno CTLA-4/antagonistas & inhibidores , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/terapia , Diagnóstico Diferencial , Reacciones Falso Negativas , Glucocorticoides/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Pulmón/diagnóstico por imagen , Pandemias , Neumonía/tratamiento farmacológico , Neumonía/inmunología , Neumonía Viral/inmunología , Neumonía Viral/terapia , Receptor de Muerte Celular Programada 1/antagonistas & inhibidores , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Tomografía Computarizada por Rayos X
6.
J Xray Sci Technol ; 28(3): 383-389, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-661071

RESUMEN

PURPOSE: To analyze clinical and thin-section computed tomographic (CT) data from the patients with coronavirus disease (COVID-19) to predict the development of pulmonary fibrosis after hospital discharge. MATERIALS AND METHODS: Fifty-nine patients (31 males and 28 females ranging from 25 to 70 years old) with confirmed COVID-19 infection performed follow-up thin-section thorax CT. After 31.5±7.9 days (range, 24 to 39 days) of hospital admission, the results of CT were analyzed for parenchymal abnormality (ground-glass opacification, interstitial thickening, and consolidation) and evidence of fibrosis (parenchymal band, traction bronchiectasis, and irregular interfaces). Patients were analyzed based on the evidence of fibrosis and divided into two groups namely, groups A and B (with and without CT evidence of fibrosis), respectively. Patient demographics, length of stay (LOS), rate of intensive care unit (ICU) admission, peak C-reactive protein level, and CT score were compared between the two groups. RESULTS: Among the 59 patients, 89.8% (53/59) had a typical transition from early phase to advanced phase and advanced phase to dissipating phase. Also, 39% (23/59) patients developed fibrosis (group A), whereas 61% (36/59) patients did not show definite fibrosis (group B). Patients in group A were older (mean age, 45.4±16.9 vs. 33.8±10.2 years) (P = 0.001), with longer LOS (19.1±5.2 vs. 15.0±2.5 days) (P = 0.001), higher rate of ICU admission (21.7% (5/23) vs. 5.6% (2/36)) (P = 0.061), higher peak C-reactive protein level (30.7±26.4 vs. 18.1±17.9 mg/L) (P = 0.041), and higher maximal CT score (5.2±4.3 vs. 4.0±2.2) (P = 0.06) than those in group B. CONCLUSIONS: Pulmonary fibrosis may develop early in patients with COVID-19 after hospital discharge. Older patients with severe illness during treatment were more prone to develop fibrosis according to thin-section CT results.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Pulmón/diagnóstico por imagen , Alta del Paciente , Neumonía Viral/complicaciones , Fibrosis Pulmonar/complicaciones , Fibrosis Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos
9.
Swiss Med Wkly ; 150: w20312, 2020 06 28.
Artículo en Inglés | MEDLINE | ID: covidwho-653052

RESUMEN

We present the case of an oncology patient admitted to our hospital during the current COVID-19 pandemic with clinical and radiological features strongly suggestive of interstitial pneumonia. Multiple laboratory tests were negative for SARS-CoV-2 (polymerase chain reaction testing of nasopharyngeal swabs, and of induced sputum and stool samples, investigation of serum immunoglobulins G and M). In the setting of an immunocompromised status due to recent chemotherapy cycles for lung adenocarcinoma and prolonged corticosteroid therapy (due to frequent exacerbations of chronic obstructive pulmonary disease in recent months), we actively searched for the pathological agent and found it to be Pneumocystis jirovecii. The patient started specific antibiotic treatment but finally had a negative outcome due to the progression of the lung adenocarcinoma. The importance of differential diagnostics in clinical practice should be a given, especially during times of pandemic. The novel coronavirus infection introduced new guidelines for and approaches to the investigation of immunocompromised patients, so it is especially important not to forget the basis of differential diagnosis, to and adopt a thorough approach when assessing these complex patients. We want to stress the importance of thorough investigation to avoid misdiagnosis of atypical pathogens in the current setting of SARS-CoV-2 pandemic.


Asunto(s)
Adenocarcinoma del Pulmón/complicaciones , Enfermedades Pulmonares Intersticiales/diagnóstico , Pulmón/diagnóstico por imagen , Pneumocystis carinii/aislamiento & purificación , Neumonía por Pneumocystis , Neumonía Viral/diagnóstico , Anciano , Betacoronavirus , Deterioro Clínico , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Pandemias , Neumonía por Pneumocystis/complicaciones , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/fisiopatología , Neumonía por Pneumocystis/terapia , Neumonía Viral/complicaciones , Evaluación de Síntomas/métodos , Tomografía Computarizada por Rayos X/métodos
12.
Korean J Intern Med ; 35(4): 771-781, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-646244

RESUMEN

BACKGROUND/AIMS: Current evidence supports lung ultrasound as a point-ofcare alternative diagnostic tool for various respiratory diseases. We sought to determine the utility of lung ultrasound for early detection of pneumonia and for assessment of respiratory failure among patients with coronavirus disease 2019 (COVID-19). METHODS: Six patients with confirmed COVID-19 by reverse transcription-polymerase chain reaction were enrolled. All had undergone chest X-ray and chest computed tomography (CT) on the day of admission and underwent multiple point-of-care lung ultrasound scans over the course of their hospitalization. RESULTS: Lung ultrasound detected early abnormal findings of representative B-lines in a patient with a normal chest X-ray, corresponding to ground-glass opacities on the chest CT scan. The ultrasound findings improved as her clinical condition improved and her viral load decreased. In another minimally symptomatic patient without significant chest X-ray findings, the ultrasound showed B-lines, an early sign of pneumonia before abnormalities were detected on the chest CT scan. In two critically ill patients, ultrasound was performed to assess for evaluation of disease severity. In both patients, the clinicians conducted emergency rapid sequence intubation based on the ultrasound findings without awaiting the laboratory results and radiological reports. In two children, ultrasound was used to assess the improvement in their pneumonia, thus avoiding further imaging tests such as chest CT. CONCLUSION: Lung ultrasound is feasible and useful as a rapid, sensitive, and affordable point-of-care screening tool to detect pneumonia and assess the severity of respiratory failure in patients hospitalized with COVID-19.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Ultrasonografía , Adulto , Anciano de 80 o más Años , Betacoronavirus/aislamiento & purificación , Niño , Infecciones por Coronavirus/virología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/virología , Síndrome de Dificultad Respiratoria del Adulto/diagnóstico por imagen , Síndrome de Dificultad Respiratoria del Adulto/virología , Estudios Retrospectivos
13.
Medicine (Baltimore) ; 99(28): e21240, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: covidwho-646231

RESUMEN

RATIONALE: Chest computed tomography (CT) scans play a key role in diagnosing and managing of COVID-19 pneumonia. The typical manifestations of COVID-19 pneumonia on a chest CT scan are ground glass opacities, consolidation, nodules, and linear opacities. It can be accompanied by a "crazy-paving" pattern, air bronchograms, pleural hypertrophy, and pleural effusion. However, no literature has reported a case with cavities in the lungs. PATIENT CONCERNS: A 34-year-old male patient complained of fever, cough, fatigue, myalgia, diarrhea, headache, and dizziness for 2 weeks. This patient is living in Xiaogan, a city around Wuhan, and he had contact with a patient with COVID-19 pneumonia from Wuhan <14 days before he had fever. DIAGNOSIS: A nucleic acid test by rRT-PCR returned positive on a pharyngeal swab, confirming the diagnosis of COVID-19 pneumonia. INTERVENTIONS: Isolation antiviral treatment. OUTCOMES: After 19 days of isolation and antiviral treatment, his temperature returned to normal and the symptoms were relieved. The laboratory results also were returning to normal levels. The chest CT scan showed that the acute inflammation had subsided significantly. With 2 consecutive novel coronavirus nucleic acid tests had returned negative, the patient was discharged from the hospital and sent to a government designated hotel for quarantine observation. The unique chest CT manifestation in this case was the small cavities in both lungs during the absorption phase of this disease. These small cavities developed into consolidated nodules with clear edges and gradually shrank or disappeared. LESSONS: Although 2 consecutive nucleic acid tests returned negative in this patient, the small cavity changes in the lungs were observed, so the patient was quarantined for 14 days. However, follow-up CT after the first 14 days' quarantine showed new small cavity changes on the lungs, a further 14 days of quarantine was recommended. Therefore, in some COVID-19 cases, even if the nucleic acid tests turns negative, the disappearance of lung lesions may take a long time. The repeated chest CT scan plays an important role in the diagnosis and evaluation of the recovery of COVID-19.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral/diagnóstico por imagen , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/cirugía , Infecciones por Coronavirus/terapia , Humanos , Masculino , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/cirugía , Neumonía Viral/terapia , Cuarentena/métodos , Recuperación de la Función , Evaluación de Síntomas/métodos , Resultado del Tratamiento
14.
Medicine (Baltimore) ; 99(28): e21046, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: covidwho-646088

RESUMEN

RATIONALE: Although there have been several studies describing clinical and radiographic features about the novel coronavirus (COVID-19) infection, there is a lack of pathologic data conducted on biopsies or autopsies. PATIENT CONCERNS: A 56-year-old and a 70-year-old men with fever, cough, and respiratory fatigue were admitted to the intensive care unit and intubated for respiratory distress. DIAGNOSIS: The nasopharyngeal swab was positive for COVID-19 and the chest Computed Tomography (CT) scan showed the presence of peripheral and bilateral ground-glass opacities. INTERVENTIONS: Both patients developed pneumothoraces after intubation and was managed with chest tube. Due to persistent air leak, thoracoscopies with blebs resection and pleurectomies were performed on 23rd and 16th days from symptoms onset. OUTCOMES: The procedures were successful with no evidence of postoperative air-leak, with respiratory improvement. Pathological specimens were analyzed with evidence of diffuse alveolar septum disruption, interstitium thickness, and infiltration of inflammatory cells with diffuse endothelial dysfunction and hemorrhagic thrombosis. LESSONS: Despite well-known pulmonary damages induced by the COVID-19, the late-phase histological changes include diffused peripheral vessels endothelial hyperplasia, in toto muscular wall thickening, and intravascular hemorrhagic thrombosis.


Asunto(s)
Infecciones por Coronavirus/patología , Endotelio Vascular/patología , Pulmón , Pandemias , Pleura , Neumonía Viral/patología , Trombosis/patología , Trombosis/parasitología , Anciano , Betacoronavirus/aislamiento & purificación , Biopsia/métodos , Tubos Torácicos/efectos adversos , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Humanos , Pulmón/irrigación sanguínea , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/cirugía , Masculino , Persona de Mediana Edad , Pleura/patología , Pleura/cirugía , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Neumotórax/etiología , Neumotórax/terapia , Respiración Artificial/métodos , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Toracoscopía/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
15.
J Infect Dis ; 222(2): 194-197, 2020 06 29.
Artículo en Inglés | MEDLINE | ID: covidwho-641903

RESUMEN

We report a case series of 6 patients with confirmed coronavirus disease 2019 (COVID-19) in Wakayama prefecture, Japan. All 6 of the patients tested positive via pharyngeal swab polymerase chain reaction (PCR) tests, and 2 of the 6 were still positive at 3 weeks after onset. All of the patients exhibited bilateral ground glass opacities on computed tomography (CT). This article also reports narrative information on the spectrum of symptoms collected directly from the patients. It would be difficult to triage patients with COVID-19 based on the typical symptoms of fever and/or cough, although PCR and CT are definitive in diagnosis.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Adulto , Anciano , Anciano de 80 o más Años , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/fisiopatología , Tos , Femenino , Fiebre , Humanos , Japón , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Faringe/virología , Neumonía Viral/diagnóstico , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/fisiopatología , Reacción en Cadena de la Polimerasa , Tomografía Computarizada por Rayos X
16.
Med Sci Monit ; 26: e924582, 2020 Jul 12.
Artículo en Inglés | MEDLINE | ID: covidwho-641223

RESUMEN

In December 2019, an outbreak of coronavirus infection emerged in Wuhan, Hubei Province of China, which is now named Coronavirus Disease 2019 (COVID-19). The outbreak spread rapidly within mainland China and globally. This paper reviews the different imaging modalities used in the diagnosis and treatment process of COVID-19, such as chest radiography, computerized tomography (CT) scan, ultrasound examination, and positron emission tomography (PET/CT) scan. A chest radiograph is not recommended as a first-line imaging modality for COVID-19 infection due to its lack of sensitivity, especially in the early stages of infection. Chest CT imaging is reported to be a more reliable, rapid, and practical method for diagnosis of COVID-19, and it can assess the severity of the disease and follow up the disease time course. Ultrasound, on the other hand, is portable and involves no radiation, and thus can be used in critically ill patients to assess cardiorespiratory function, guide mechanical ventilation, and identify the presence of deep venous thrombosis and secondary pulmonary thromboembolism. Supplementary information can be provided by PET/CT. In the absence of vaccines and treatments for COVID-19, prompt diagnosis and appropriate treatment are essential. Therefore, it is important to exploit the advantages of different imaging modalities in the fight against COVID-19.


Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico por imagen , Pandemias , Neumonía Viral/diagnóstico por imagen , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , China/epidemiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Diagnóstico Diferencial , Progresión de la Enfermedad , Estudios de Seguimiento , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/etiología , Neumonía/diagnóstico por imagen , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiografía Torácica , Síndrome de Dificultad Respiratoria del Adulto/diagnóstico por imagen , Síndrome de Dificultad Respiratoria del Adulto/etiología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X , Ultrasonografía
17.
Theranostics ; 10(16): 7231-7244, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-640066

RESUMEN

Rationale: Given the rapid spread of COVID-19, an updated risk-stratify prognostic tool could help clinicians identify the high-risk patients with worse prognoses. We aimed to develop a non-invasive and easy-to-use prognostic signature by chest CT to individually predict poor outcome (death, need for mechanical ventilation, or intensive care unit admission) in patients with COVID-19. Methods: From November 29, 2019 to February 19, 2020, a total of 492 patients with COVID-19 from four centers were retrospectively collected. Since different durations from symptom onsets to the first CT scanning might affect the prognostic model, we designated the 492 patients into two groups: 1) the early-phase group: CT scans were performed within one week after symptom onset (0-6 days, n = 317); and 2) the late-phase group: CT scans were performed one week later after symptom onset (≥7 days, n = 175). In each group, we divided patients into the primary cohort (n = 212 in the early-phase group, n = 139 in the late-phase group) and the external independent validation cohort (n = 105 in the early-phase group, n = 36 in the late-phase group) according to the centers. We built two separate radiomics models in the two patient groups. Firstly, we proposed an automatic segmentation method to extract lung volume for radiomics feature extraction. Secondly, we applied several image preprocessing procedures to increase the reproducibility of the radiomics features: 1) applied a low-pass Gaussian filter before voxel resampling to prevent aliasing; 2) conducted ComBat to harmonize radiomics features per scanner; 3) tested the stability of the features in the radiomics signature by several image transformations, such as rotating, translating, and growing/shrinking. Thirdly, we used least absolute shrinkage and selection operator (LASSO) to build the radiomics signature (RadScore). Afterward, we conducted a Fine-Gray competing risk regression to build the clinical model and the clinic-radiomics signature (CrrScore). Finally, performances of the three prognostic signatures (clinical model, RadScore, and CrrScore) were estimated from the two aspects: 1) cumulative poor outcome probability prediction; 2) 28-day poor outcome prediction. We also did stratified analyses to explore the potential association between the CrrScore and the poor outcomes regarding different age, type, and comorbidity subgroups. Results: In the early-phase group, the CrrScore showed the best performance in estimating poor outcome (C-index = 0.850), and predicting the probability of 28-day poor outcome (AUC = 0.862). In the late-phase group, the RadScore alone achieved similar performance to the CrrScore in predicting poor outcome (C-index = 0.885), and 28-day poor outcome probability (AUC = 0.976). Moreover, the RadScore in both groups successfully stratified patients with COVID-19 into low- or high-RadScore groups with significantly different survival time in the training and validation cohorts (all P < 0.05). The CrrScore in both groups can also significantly stratify patients with different prognoses regarding different age, type, and comorbidities subgroups in the combined cohorts (all P < 0.05). Conclusions: This research proposed a non-invasive and quantitative prognostic tool for predicting poor outcome in patients with COVID-19 based on CT imaging. Taking the insufficient medical recourse into account, our study might suggest that the chest CT radiomics signature of COVID-19 is more effective and ideal to predict poor outcome in the late-phase COVID-19 patients. For the early-phase patients, integrating radiomics signature with clinical risk factors can achieve a more accurate prediction of individual poor prognostic outcome, which enables appropriate management and surveillance of COVID-19.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , China/epidemiología , Estudios de Cohortes , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Cuidados Críticos , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Modelos Biológicos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Pronóstico , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/estadística & datos numéricos , Respiración Artificial , Estudios Retrospectivos , Factores de Riesgo , Nanomedicina Teranóstica , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Resultado del Tratamiento
19.
Sci Rep ; 10(1): 11336, 2020 07 09.
Artículo en Inglés | MEDLINE | ID: covidwho-638242

RESUMEN

This study aimed to compare the chest computed tomography (CT) findings between survivors and non-survivors with Coronavirus Disease 2019 (COVID-19). Between 12 January 2020 and 20 February 2020, the records of 124 consecutive patients diagnosed with COVID-19 were retrospectively reviewed and divided into survivor (83/124) and non-survivor (41/124) groups. Chest CT findings were qualitatively compared on admission and serial chest CT scans were semi-quantitively evaluated between two groups using curve estimations. On admission, significantly more bilateral (97.6% vs. 73.5%, p = 0.001) and diffuse lesions (39.0% vs. 8.4%, p < 0.001) with higher total CT score (median 10 vs. 4, p < 0.001) were observed in non-survivor group compared with survivor group. Besides, crazy-paving pattern was more predominant in non-survivor group than survivor group (39.0% vs. 12.0%, p < 0.001). From the prediction of curve estimation, in survivor group total CT score increased in the first 20 days reaching a peak of 6 points and then gradually decreased for more than other 40 days (R2 = 0.545, p < 0.001). In non-survivor group, total CT score rapidly increased over 10 points in the first 10 days and gradually increased afterwards until ARDS occurred with following death events (R2 = 0.711, p < 0.001). In conclusion, persistent progression with predominant crazy-paving pattern was the major manifestation of COVID-19 in non-survivors. Understanding this CT feature could help the clinical physician to predict the prognosis of the patients.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Infecciones por Coronavirus/mortalidad , Progresión de la Enfermedad , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Pronóstico , Estudios Retrospectivos , Sobrevivientes , Resultado del Tratamiento
20.
Epidemiol Infect ; 148: e145, 2020 07 07.
Artículo en Inglés | MEDLINE | ID: covidwho-635331

RESUMEN

We report a family cluster of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection involving five patients in a family cluster in Dazhou, China, including the epidemiological, clinical, laboratory and radiological findings. Three-generation transmission was observed. Through epidemiological investigation, we observed asymptomatic transmission to a cohabiting family member, as well as person-to-person transmission of SARS-CoV-2 outside Wuhan city. The asymptomatic transmission demonstrated here provides evidence that there could be a greater risk of Coronavirus Disease 2019 (COVID-19) spread. This cluster also demonstrated that COVID-19 is transmissible during the incubation period of an asymptomatic person. Early isolation and treatment, stressing prevention of cluster outbreaks, could help prevent further spread of the epidemic.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/transmisión , Neumonía Viral/transmisión , Adulto , Anciano de 80 o más Años , Infecciones Asintomáticas , China , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Salud de la Familia , Femenino , Humanos , Recuento de Leucocitos , Pulmón/diagnóstico por imagen , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Viaje
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