Structured reporting of chest CT in COVID-19 pneumonia: a consensus proposal.

OBJECTIVES: The need of a standardized reporting scheme and language, in imaging of COVID-19 pneumonia, has been welcomed by major scientific societies. The aim of the study was to build the reporting scheme of chest CT in COVID-19 pneumonia. METHODS: A team of experts, of the Italian Society of Medical and Interventional Radiology (SIRM), has been recruited to compose a consensus panel. They used a modified Delphi process to build a reporting scheme and expressed a level of agreement for each section of the report. To measure the internal consistency of the panelist ratings for each section of the report, a quality analysis based on the average inter-item correlation was performed with Cronbach's alpha (Cα) correlation coefficient. RESULTS: The overall mean score of the experts and the sum of score were 3.1 (std.dev. ± 0.11) and 122 in the second round, and improved to 3.75 (std.dev. ± 0.40) and 154 in the third round. The Cronbach's alpha (Cα) correlation coefficient was 0.741 (acceptable) in the second round and improved to 0.789 in the third round. The final report was built in the management of radiology report template (MRRT) and includes n = 4 items in the procedure information, n = 5 items in the clinical information, n = 16 in the findings, and n = 3 in the impression, with overall 28 items. CONCLUSIONS: The proposed structured report could be of help both for expert radiologists and for the less experienced who are faced with the management of these patients. The structured report is conceived as a guideline, to recommend the key items/findings of chest CT in COVID-19 pneumonia.

Ground-glass opacity of the lung in a patient with melanoma: “The radiological seed of doubt” / Opacidad pulmonar en vidrio esmerilado en un paciente con antecedente de melanoma: “la semilla radiológica de la duda”

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Primary sarcoidosis of the breast: case description and review of the literature.

Sarcoidosis is a systemic granulomatous disease of unknown aetiology. The breast is involved in less than 1% of cases. Breast can be either a primary or a secondary site of presentation. Breast sarcoidosis often mimics carcinomas at clinical examination. We report a case of breast sarcoidosis detected during screening mammography in a 57-year-old woman. The lesion presented as a 1.4 cm nodule located in the right breast. On histology, it was characterized by non-caseating giant cell granulomas. Differential diagnoses included idiopathic granulomatous mastitis, tuberculosis, fungal infection, cat-scratch disease and sarcoid-like reactions to cancer. Further clinical and laboratory investigations were consistent with a diagnosis of sarcoidosis. Specifically, serum levels of angiotensin-converting enzyme (ACE) were elevated and a CT scan showed small bilateral pulmonary nodules distributed along the pleura and bronchovascular bundles (perilymphatic pattern), as well as enlarged bilateral hilar and mediastinal lymph nodes. The patient received corticosteroid treatment, and is presently asymptomatic. Breast involvement by sarcoidosis, although rare, should be considered when dealing with granulomatous lesions of the breast.

Granulomatous lung disease.

Granulomas are a frequent challenge for pathologists, which can be identified both in histological and cytological material in a number of conditions. With regard to interstitial lung diseases, granulomas can be associated with infection (e.g. mycobacterial), immunological conditions (e.g. hypersensitivity pneumonitis), or may be idiopathic (e.g. sarcoidosis). Considering morphology, features that should be identified are the presence of necrosis, the cohesiveness and coalescence of granulomas, the presence of fibrosis and the amount and quality of the associated inflammatory infiltrate. The most interesting approach to granulomatous lung disease is indeed represented by their pattern of distribution within the secondary lobule; in fact, granulomas can be distributed along lymphatic routes (e.g. sarcoidosis), randomly (miliary infections, e.g. mycobacterial and fungal infections), or along the airways (hypersensitivity pneumonitis, hot tub lung, aspiration pneumonia and sometimes infections). We propose a combined radiological-histopathological approach for defining the morphological features and anatomic localization of granulomatous ILDs. In addition, a detailed review of their clinical features is provided, together with a description of the main procedures used to obtain respiratory samples for pathology and microbiology studies in these patients.

High-resolution CT of nontuberculous mycobacteria pulmonary infection in immunocompetent, non-HIV-positive patients.

PURPOSE: The objective of this study was to demonstrate that nontuberculous mycobacteria (NTM) pulmonary infections are not so infrequent and that the diagnosis may be suggested on the basis of the high-resolution computed tomography (HRCT) pattern alone. MATERIALS AND METHODS: We retrospectively reviewed HRCT scans of 29 patients (9 men, 18 women; mean age 63 years, range 38-88 years) with positive culture from bronchial wash. Mycobacterium avium complex (MAC) was present in all (with the exception of one in whom the NTM was indistinct). In six patients, MAC was associated with M. chelonae, M. kansasii, M. fortuitum or M. xenopi. In one of these patients, MAC was associated with both M. fortuitum and M. chelonae. All patients had had nonspecific symptoms of pulmonary infection for a time ranging from 6 months to 12 years. Previous tuberculous infection was present in five patients (18.5%). Eleven patients had other pulmonary diseases (40.8%), and 12 had associated systemic diseases (44.4%). RESULTS: HRCT findings were apical fibrotic scarring (n=8; 29.6%), consolidations (n=16; 59.2%), single/multiple nodules >1 cm (n=8, multiple; 29.6%), cavitations (n=7; 25.9%), ground glass appearance (n=3; 11.1%), reticular/reticulonodular pattern (n=6; 22.2%), bronchiectasis (n=25; 92.5%), centrilobular nodules (tree in bud) (n=24; 88.8%), air trapping (n=8; 29.6%), lymphadenopathy >1 cm, also with calcification (n=13, 3 with calcification; 48.1%) and pleural effusion (n=2; 7.4%). In 3/7 patients with nodules >1 cm and with cavitations, the "feeding bronchus sign" (a patent bronchus running into a cavitation) was present. Lesions were in the upper lobes in 23 (85.1%), middle lobe/lingula in 25 (92.5%) and lower lobes in 18 (66.6%) patients. The findings were diffuse in 13 (48.1%) cases and patchy in 17 (62.9%). CONCLUSIONS: HRCT findings are essential for the diagnosis of NTM pulmonary infection. The presence of bronchiectasis, cavitary nodules with feeding bronchus sign and tree-in-bud nodules in the middle lobe and lingula are suggestive of NTM infection, thus assisting the physician in the diagnostic workup of these patients.

Organizing pneumonia: typical and atypical HRCT patterns.

Organizing pneumonia (OP) is a clinical-pathological entity that, if idiopathic, makes part of the idiopathic interstitial pneumonias classification of the American Thoracic Society/European Respiratory Society (ATS/ERS) of 2002 (50% of the cases, called cryptogenic organizing pneumonia, or COP). In the remaining 50% it is secondary, representing one modality of response of the lung to various forms of injury. Typical computed tomography (CT) pattern has been widely described and consists of peripheral parenchymal consolidations with air bronchogram with or without surrounding ground-glass-like opacities. The purpose of this article is to describe the less frequent imaging pattern of this disease represented by single or multiple focal lesions (nodules or masses that place diagnostic problems with malignancy), bronchocentric pattern (parenchymal consolidations with peribronchovascular distribution), atoll sign (central area of ground-glass-like density and peripheral area of consolidation), nodular lesions (poorly defined micronodular pattern), linear and band-like opacities (subpleural linear opacities that can have disposition parallel or perpendicular in relation to the pleura), perilobular pattern (thickening of the interlobular septa with reticular pattern) and progressive fibrotic pattern (irregular thickening of the interlobular septa with associated ground-glass-like appearance and consolidations).

[Potential of ultrasonography and ultrasonography-guided biopsy in the diagnosis of local recurrence following radical prostatectomy]. / Possibilità dell'ecografia e della biopsia ecoguidata nella diagnosi delle recidive locali dopo prostatectomia radicale.

INTRODUCTION: [corrected] We investigated the diagnostic role of combined transrectal US (TRUS) and biopsy to detect recurrent cancer after radical prostatectomy, in patients with negative bone scintigraphy and elevated prostate specific antigen (PSA) levels. MATERIALS AND METHODS: From March, 1997, to May, 1998, we examined 12 patients with persistently detectable serum PSA levels and negative bone scintigraphy. At the time of diagnosis, an average 36 months had elapsed since prostatectomy. Digital rectal examination (DRE) and disease stage at the time of surgery were also considered. Patients age ranged 47 to 83 years (mean: 65). All patients underwent TRUS with a 7.5 MHz biplane probe; biopsy was performed with a 16 G cutting needle. TRUS findings were considered suspicious if the scan showed any unusual hypoechoic tissue adjacent to the bladder neck, in retrotrigone or peri-retroanastomotic site. In these cases a transperineal US-guided biopsy was performed. RESULTS: The biopsy proved cancer in 10/12 cases (in 12 cases after two biopsies), showing a better diagnostic accuracy than DRE, which poorly distinguished postoperative changes from recurrent or residual cancer. CONCLUSIONS: The early detection of recurrences after radical prostatectomy in patients with negative bone scintigraphy is feasible when the above examinations are performed in the same order as described: PSA levels, if altered, indicate the patients to be submitted to TRUS. The latter may be falsely negative in some cases because small recurrences may exhibit no findings at US, and therefore US-guided biopsy of peri-retro-anastomotic regions should be always performed too. The recurrence must be confirmed at histology because histologic findings help choose adjuvant treatment and/or radical irradiation.

Magnetic resonance imaging and 67Ga scan versus computed tomography in the staging and in the monitoring of mediastinal malignant lymphoma: a prospective pilot study.

PURPOSE: To assess the potential value of magnetic resonance imaging (MRI) combined with 67Ga single-photon emission computed tomography (SPECT) versus computed tomography (CT) in the staging and in the monitoring of mediastinal malignant lymphoma. MATERIALS AND METHODS: Twenty-three patients, referred to our institute for the evaluation of lymphoma, underwent CT, 67Ga scan, and MRI between April 1993 and February 1996 at sequential intervals. The tests studied (MRI, 67Ga, and CT) were performed according to the following schedule: 1) before start of therapy; 2) after four courses of chemotherapy; and 3) 2, 6, 12, and 18 months after the end of treatment. RESULTS: All patients studied at the time of diagnosis had abnormal gallium accumulation in the mediastinum as well as pathologic CT and pathologic signal intensity at MRI. Six months after the end of treatment full consistency was found between the results of MRI and SPECT, whereas during treatment and 2 months after the end of therapy MRI and 67Ga scan were not in agreement in nine patients. In the 23 patients in follow-up, in CT there were nine false-positive and three false-negative findings; in SPECT three false negatives; in MRI one false positive and one false negative. CONCLUSION: MRI can give morphologic information similar to CT, even superior due to multiplanarity and with major precision in the distinction between fibrosis and active disease. MRI is thus an alternative to CT. The association with SPECT allows a great diagnostic accuracy in the positive and negative predictive value.

[The use of automatic devices for ultrasonography-guided histologic biopsy of breast lesions]. / Impiego di dispositivi automatici per biopsia istologica ecoguidata delle lesioni mammarie.

The authors report their experience with the use of biopsy guns for the histologic sampling of breast lesions. Cytologic sampling by means of FNAB has been preferred so far because it was thought to be simpler, less risky and more reliable. Nevertheless, cytologic sampling exhibits several drawbacks--e.g., the need of repeated punctures to get sufficient cell material, frequent problems in diagnosing benign lesions and the decisive influence of the operator's skills. The use of biopsy guns for histologic sampling solves the above problems, because the value of the sample is not affected by the operator's skills; moreover, fewer punctures are needed and their value does not depend on lesion nature. Our series of cases includes 65 patients who underwent histologic sampling for suspected lesions over 10 months. A hundred and seventy-two samples were collected and 77 lesions were diagnosed, 47 of them malignant and 30 benign (fibroadenomas, fibrocystic changes, epitheliosis). Sensitivity, specificity and diagnostic accuracy of the method were 93.6%, 100% and 96.1%, respectively, with 6.4% false negative due to 3 cases where the lesion was not centred due to misguidance.

[Results of the use of the Strecker and Palmaz stents in the iliac artery region. Two years' experience]. / Risultati dell'impiego degli stent di Strecker e di Palmaz nel distretto arterioso iliaco. Esperienza di due anni.

Our personal experience is reported with the use of vascular endoprostheses (Strecker and Palmaz stents) in the non-surgical treatment of iliacofemoral steno-occlusive arteriopathy. Over a 15-month period, 56 PTAs were performed in 40 patients; 20 vascular endoprostheses were positioned--17 Strecker and 3 Palmaz stents--in 16 patients, to correct such PTA complications as dissections or to improve the results of a suboptimal PTA maneuver. Venous DSA follow-up was performed at 30 days, and serial color-Doppler US studies were performed every fourth month. Immediate and satisfying clinical results were observed in 15/16 patients (93.7%): only one case of acute thrombosis following the procedure was observed, which could not be treated with intraarterial fibrinolytic therapy and was therefore operated on. Overall long-term patency rate is 100%, mean follow-up is 13.8 months. Finally, the indications for the use of such devices in iliacofemoral arteriopathies are critically discussed, together with the criteria of choice of a type of stent over another one, the immediate and long-term results and the best follow-up protocols.