The Diagnostic Utility of Artificial Intelligence-Guided Computed Tomography-Based Severity Scores for Predicting Short-Term Clinical Outcomes in Adults with COVID-19 Pneumonia.

Chest computed tomography (CT) imaging with the use of an artificial intelligence (AI) analysis program has been helpful for the rapid evaluation of large numbers of patients during the COVID-19 pandemic. We have previously demonstrated that adults with COVID-19 infection with high-risk obstructive sleep apnea (OSA) have poorer clinical outcomes than COVID-19 patients with low-risk OSA. In the current secondary analysis, we evaluated the association of AI-guided CT-based severity scores (SSs) with short-term outcomes in the same cohort. In total, 221 patients (mean age of 52.6 ± 15.6 years, 59% men) with eligible chest CT images from March to May 2020 were included. The AI program scanned the CT images in 3D, and the algorithm measured volumes of lobes and lungs as well as high-opacity areas, including ground glass and consolidation. An SS was defined as the ratio of the volume of high-opacity areas to that of the total lung volume. The primary outcome was the need for supplemental oxygen and hospitalization over 28 days. A receiver operating characteristic (ROC) curve analysis of the association between an SS and the need for supplemental oxygen revealed a cut-off score of 2.65 on the CT images, with a sensitivity of 81% and a specificity of 56%. In a multivariate logistic regression model, an SS > 2.65 predicted the need for supplemental oxygen, with an odds ratio (OR) of 3.98 (95% confidence interval (CI) 1.80-8.79; p < 0.001), and hospitalization, with an OR of 2.40 (95% CI 1.23-4.71; p = 0.011), adjusted for age, sex, body mass index, diabetes, hypertension, and coronary artery disease. We conclude that AI-guided CT-based SSs can be used for predicting the need for supplemental oxygen and hospitalization in patients with COVID-19 pneumonia.

Changes in computed tomography findings of COVID-19 pneumonia: Less extensive lung involvement with decreasing disease prevalence.

It has been observed that the degree of pulmonary involvement shown in chest computed tomography (CT) scans tended to decrease as the prevalence of coronavirus disease 2019 (COVID-19) infection decreased in the Turkish population. The purpose of this study was to investigate the relationship between the disease severity based on chest CT scans and the temporal evolution of the epidemic. This study recruited 179 patients with confirmed COVID-19 disease who had received a chest CT scan between March 14 and April 28, 2020. The participants were divided into three successive temporal groups based on their date of CT examination. The early (March 14-29), mid (March 30-April 13), and late (April 14-28) groups were compared regarding the presence and extent of pulmonary involvement and CT characteristics of lesions. COVID-19 pneumonia was less extensive in participants under 45 years of age and patients presenting late in the course of epidemic (i.e., the late group) compared those presenting earlier. When each group was subcategorized on the basis of age, older patients in the late group had less extensive lung involvement than older patients in the early group. However, there was no significant difference in the extent of lung involvement in younger patients between the late and early groups. The severity of COVID-19 pneumonia appears to be variable at different temporal windows of the epidemic curve and decreases in patients presenting in the later weeks compared to the earlier weeks, particularly in older patients.

Radiological approach to COVID-19 pneumonia with an emphasis on chest CT.

Coronavirus disease 2019 (COVID-19) has recently become a worldwide outbreak with several millions of people infected and more than 160.000 deaths. A fast and accurate diagnosis in this outbreak is critical to isolate and treat patients. Radiology plays an important role in the diagnosis and management of the patients. Among various imaging modalities, chest CT has received attention with its higher sensitivity and specificity rates. Shortcomings of the real-time reverse transcriptase-polymerase chain reaction test, including inappropriate sample collection and analysis methods, initial false negative results, and limited availability has led to widespread use of chest CT in the diagnostic algorithm. This review summarizes the role of radiology in COVID-19 pneumonia, diagnostic accuracy of imaging, and chest CT findings of the disease.

Reentrance of Azygos Vein into Azygos Fissure After Pneumothorax.

Empty azygos fissure implies dislocation of the azygos vein to the mediastinal side of the right upper lobe from azygos fissure, which is usually secondary to pneumothorax, pleural effusion, parenchymal fibrosis, vertebral collapse or persistent vomiting. We are presenting here a case where a separated azygos vein in CT and radiography images was noted. Moreover, in the follow-up images, it appeared that the complete reexpansion of the right lung resulted in reentrance of the azygos vein into azygos fissure in its native position.

Expansion of the Rib Head: A Novel Computed Tomographic Feature of Supernumerary Intrathoracic Ribs.

Intrathoracic ribs are very rare congenital anomalies. Approximately 50 cases have been reported in the literature till date. They are usually present on the right side, between the third and eighth ribs without sex predominance. They may originate from a vertebral body or the proximal or distal part of a rib. In most cases, they are asymptomatic, but they may be associated with developmental abnormalities of ribs and vertebrae. The diagnosis is important to prevent further investigation or intervention. Here we present two rare cases with supernumerary intrathoracic rib and describe a novel sign, namely expansion of the rib head. To the best of our knowledge, this is the shortest supernumerary intrathoracic rib, reported in the literature, on the left side originating from the head of the second rib, which could have been misdiagnosed as osteochondroma due to its atypical features.

Nonthrombotic Pulmonary Artery Embolism: Imaging Findings and Review of the Literature.

OBJECTIVE: The purpose of this article is to emphasize the imaging findings encountered in the setting of nonthrombotic pulmonary embolism. CONCLUSION: Nonthrombotic pulmonary embolism refers to a spectrum of clinical and radiologic disorders caused by embolization of the pulmonary artery vasculature by various cell types, microorganism, and foreign bodies. Awareness of the imaging and clinical features of the nonthrombotic pulmonary embolism may facilitate prompt diagnosis.

Circumaortic doubled left brachiocephalic vein: a rare confusing variation.

Left brachiocephalic vein (LBCV), one of the major veins draining upper extremity, head and neck region, has rare anatomic variations. Circumaortic type, an extremely uncommon variation, is presented here; this was incidentally detected on computed tomography images. In this case, circumaortic LBCV had two branches; one was normally placed brachiocephalic vein anterior to the aortic arch, and the other one was the anomalous branch with a retroaortic course.

Sacroiliac joint vacuum phenomenon--underreported finding.

BACKGROUND AND PURPOSE: Vacuum phenomenon (VP) is commonly found in sacroiliac joints, and its significance in patients with back pain has been debated. We investigated the prevalence of sacroiliac joint vacuum phenomenon (SJVP) and the rate at which it is reported on abdominopelvic and lumbosacral spine computed tomography (CT) images by body imagers and neuroradiologists. We hypothesized that it would be more common than not and that neuroradiologists would identify it more frequently than body imagers and on spine images more commonly than abdominopelvic studies due to the search for the source of back pain in the former. MATERIALS AND METHODS: CT images of the pelvis and lumbar spine from January to February 2009 were retrospectively reviewed. Six hundred fifty-two patients were studied during this period. Axial thin-section images were reviewed under default lung and bone window settings. Age, sex, and radiologist reports were assessed from electronic medical records. RESULTS: The prevalence of SJVP on CT imaging was 34%, with higher rates found in female (41%, P<.001) and older (39%, P<.05) patients. Eighty-five percent of the phenomena were present bilaterally. Among the 223 patients with SJVP, only 17% were reported. There were no statistically significant differences between reporting rates for body radiologists and neuroradiologists. CONCLUSION: SJVP is a prevalent condition with higher rates among older and female individuals. The phenomenon is underreported on CT images whether the studies performed are abdominopelvic scans or spine studies and whether they are interpreted by body imagers or neuroradiologists.