Computer-assisted diagnosis for an early identification of lung cancer in chest X rays.

Computer-assisted diagnosis (CAD) algorithms have shown its usefulness for the identification of pulmonary nodules in chest x-rays, but its capability to diagnose lung cancer (LC) is unknown. A CAD algorithm for the identification of pulmonary nodules was created and used on a retrospective cohort of patients with x-rays performed in 2008 and not examined by a radiologist when obtained. X-rays were sorted according to the probability of pulmonary nodule, read by a radiologist and the evolution for the following three years was assessed. The CAD algorithm sorted 20,303 x-rays and defined four subgroups with 250 images each (percentiles ≥ 98, 66, 33 and 0). Fifty-eight pulmonary nodules were identified in the ≥ 98 percentile (23,2%), while only 64 were found in lower percentiles (8,5%) (p < 0.001). A pulmonary nodule was confirmed by the radiologist in 39 out of 173 patients in the high-probability group who had follow-up information (22.5%), and in 5 of them a LC was diagnosed with a delay of 11 months (12.8%). In one quarter of the chest x-rays considered as high-probability for pulmonary nodule by a CAD algorithm, the finding is confirmed and corresponds to an undiagnosed LC in one tenth of the cases.

Influence of using recommended radiological criteria on MDCT-angiography diagnosis of single isolated subsegmental pulmonary embolism.

OBJECTIVES: We assessed the rate of false-positive diagnoses of MDCT-pulmonary angiography (MDCT-A) in patients with single isolated subsegmental pulmonary embolism (SISSPE). METHODS: All patients who underwent MDCT-A between 2006 and 2017 for ruling out acute pulmonary embolism (PE) and received an initial diagnosis of SISSPE were included. The MDCT-A of these patients were reviewed retrospectively by four experienced thoracic radiologists, who applied radiological criteria recommended by the American College of Chest Physicians Antithrombotic Guidelines (ACCP 2016) for the diagnosis of SISSPE. Data extracted from medical records were history of venous thromboembolism (VTE), alternative diagnoses, other diagnostic studies for VTE, anticoagulation, bleeding complications, and VTE over the following 3 months. RESULTS: Of 3839 patients undergoing MDCT-A, PE was found in 1021 (26.6%) and SISSPE in 59 (1.5% overall and 5.8% of all patients with PE). An alternative diagnosis to PE was made on the basis of CT in 33 (55.9%) patients. Forty-one (69.5%) patients received anticoagulants, and major life-threatening bleeding complications occurred in 2, with one death. Recurrent PE was not documented in any patient with SISSPE. In the retrospective assessment of the 59 cases of SISSPE, 21 were negative for PE, with a false-positive rate of 35.6% (21/59); so the percentage of SISSPE cases after the revision was 3.7% of all patients with PE; 11 of these 21 patients received anticoagulation. CONCLUSIONS: Radiologists should be aware of the high rate of false-positives when making the diagnosis of SISSPE on MDCT-A without using strict diagnostic criteria. Misdiagnosis exposes patients to unnecessary anticoagulation. KEY POINTS: • Radiologist should be aware of the high rate of false-positive diagnoses of single isolated subsegmental pulmonary embolism (SISSPE) in MDCT-pulmonary angiography (MDCT-A) performed for ruling out pulmonary embolism. • Misdiagnosis of SISSPE in MDCT-A can be reduced by using strict diagnostic radiological criteria recommended by the American College of Chest Physicians Antithrombotic Guidelines. • Unnecessary anticoagulation therapy with potential severe bleeding complications may result from misdiagnosis of SISSPE.

PLA Electrospun Scaffolds for Three-Dimensional Triple-Negative Breast Cancer Cell Culture.

Three-dimensional (3D) systems provide a suitable environment for cells cultured in vitro since they reproduce the physiological conditions that traditional cell culture supports lack. Electrospinning is a cost-effective technology useful to manufacture scaffolds with nanofibers that resemble the extracellular matrix that surround cells in the organism. Poly(lactic acid) (PLA) is a synthetic polymer suitable for biomedical applications. The main objective of this study is to evaluate electrospun (ES)-PLA scaffolds to be used for culturing cancer cells. Triple-negative breast cancer (TNBC) is the most aggressive breast cancer subtype with no validated targeted therapy and a high relapse rate. MDA-MB-231 TNBC cells were grown in scaffolds from two different PLA concentrations (12% and 15% w/v). The appropriateness of ES-PLA scaffolds was evaluated using a cell proliferation assay. EGFR and STAT3 gene expression and protein levels were compared in cells grown in 2D versus in 3D cultures. An increase in STAT3 activation was shown, which is related to self-renewal of cancer stem cells (CSCs). Therefore, the enrichment of the breast CSC (BCSC) population was tested using a mammosphere-forming assay and gene expression of BCSC-related stemness and epithelial-to-mesenchymal transition markers. Based on the results obtained, ES-PLA scaffolds are useful for 3D cultures in short culture periods with no BCSC-enrichment.

Incidence of airway complications in patients using endotracheal tubes with continuous aspiration of subglottic secretions.

BACKGROUND: Continuous aspiration of subglottic secretions is effective in preventing ventilator-associated pneumonia, but it involves a risk of mucosal damage. The main objective of our study was to determine the incidence of airway complications related to continuous aspiration of subglottic secretions. METHODS: In consecutive adult patients with continuous aspiration of subglottic secretions, we prospectively recorded clinical airway complications during the period after extubation. A multidetector computed tomography of the neck was performed during the period of 5 days following extubation to classify subglottic and tracheal lesions as mucosal thickening, cartilage thickening or deep ulceration. RESULTS: In the 86 patients included in the study, 6 (6.9%) had transient dyspnea, 7 (8.1%) had upper airway obstruction and 18 (20.9%) had dysphonia at extubation. Univariate analysis identified more attempts required for intubation (2.3 ± 1.1 vs. 1.2 ± 0.5; p = 0.001), difficult intubation (71.4 vs. 10.1%, p = 0.001) and Cormack score III-IV (71.4 vs. 8.8%; p < 0.001) as risk factors for having an upper airway obstruction at extubation. The incidence of failed extubation among patients after planned extubation was 18.9% and 11 patients (12.7%) required tracheostomy. A multidetector computed tomography was performed in 37 patients following extubation, and injuries were observed in 9 patients (24.3%) and classified as tracheal injuries in 2 patients (1 cartilage thickening and 1 mild stenosis with cartilage thickening) and as subglottic mucosal thickenings in 7 patients. CONCLUSIONS: The incidence of upper airway obstruction after extubation in patients with continuous aspiration of subglottic secretions was 8.1%, and the injuries observed by computed tomography were not severe and located mostly in subglottic space.

The borderscape of Punta Tarifa: concurrent invisibilisation practices at Europe's ultimate peninsula.

This contribution aims to provide a cultural-geographical reading of the borderscape of Punta Tarifa: the southernmost point of so-called continental Europe and a key site vis-a-vis material and representational Euro-African (dis)connections. It is argued that Punta Tarifa harbours a complex process of symbolic and functional invisibilisation that turns this border landscape into a highly significant scenario within the ongoing European Union bordering process. This invisibilisation process is twofold. On the one hand, it lies with the selective public neglecting/ignoring of a crucial historical episode which challenges mainstream readings of Europe's cultural heritage (the arrival of Tarif and Islam to Tarifa in the year 710). On the other hand, it concerns the veiling of the implemented migration management practices and, more precisely, the opacity surrounding the Migrant Detention Centre situated by Punta Tarifa. Having explored the case of Punta Tarifa, we suggest that a cultural-geographical reading - and hence the shedding of some light - on these and other similar invisibilisation processes is paramount in order to neutralise symbolic and functional exclusionary practices which lie at the heart of current European Union external bordering dynamics.

Prevalence of bronchiectasis in asthma according to oral steroid requirement: influence of immunoglobulin levels.

PURPOSE: To establish the prevalence of bronchiectasis in asthma in relation to patients' oral corticosteroid requirements and to explore whether the increased risk is due to blood immunoglobulin (Ig) concentration. METHODS: Case-control cross-sectional study, including 100 sex- and age-matched patients, 50 with non-steroid-dependent asthma (NSDA) and 50 with steroid-dependent asthma (SDA). STUDY PROTOCOL: (a) measurement of Ig and gG subclass concentration; (b) forced spirometry; and (c) high-resolution thoracic computed tomography. When bronchiectasis was detected, a specific etiological protocol was applied to establish its etiology. RESULTS: The overall prevalence of bronchiectasis was 12/50 in the SDA group and 6/50 in the NSDA group (p = ns). The etiology was documented in six patients (four NSDA and two SDA). After excluding these patients, the prevalence of bronchiectasis was 20% (10/50) in the SDA group and 2/50 (4%) in the NSDA group (P < 0.05). Patients with asthma-associated bronchiectasis presented lower FEV1 values than patients without bronchiectasis, but the levels of Ig and subclasses of IgG did not present differences. CONCLUSIONS: Steroid-dependent asthma seems to be associated with a greater risk of developing bronchiectasis than non-steroid-dependent asthma. This is probably due to the disease itself rather than to other influencing factors such as immunoglobulin levels.

Imaging findings in pulmonary vasculitis.

Vasculitis is a destructive inflammatory process affecting blood vessels. Pulmonary vasculitis may develop secondary to other conditions or constitute a primary idiopathic disorder. Thoracic involvement is most common in primary idiopathic large-vessel vasculitides (Takayasu arteritis, giant cell arteritis, Behçet disease) and primary antineutrophil cytoplasmic autoantibody-associated small-vessel vasculitides (Wegener granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome). Primary pulmonary vasculitides are rare, and their signs and symptoms are nonspecific, overlapping with those of infections, connective tissue diseases, and malignancies. The radiologic findings in primary pulmonary vasculitis vary widely and can include vessel wall thickening, nodular or cavitary lesions, ground-glass opacities, and consolidations, among others. Diffuse alveolar hemorrhage usually results from primary small-vessel vasculitis in the lungs. To diagnose vasculitis, medical teams must recognize characteristic combinations of clinical, radiologic, laboratory, and histopathologic features.

When to suspect pulmonary vasculitis: radiologic and clinical clues.

Vasculitis is an inflammatory destructive process affecting blood vessels. Pulmonary vasculitis may be secondary to other conditions or constitute a primary, and in most cases idiopathic, disorder. Underlying conditions in the secondary vasculitides are infectious diseases, connective tissue diseases, malignancies, and hypersensitivity disorders. The most widely used approach to classifying the primary vasculitides is based on the size of the affected vessels (large, medium, small). Thoracic involvement is most commonly seen with primary idiopathic large-vessel vasculitides (Takayasu arteritis, giant cell arteritis, Behçet disease) and primary small-vessel antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitides (Wegener granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome). The radiologic manifestations of primary pulmonary vasculitis are extremely variable and include vessel wall thickening, nodular or cavitary lesions, ground-glass opacities, and consolidations. Diffuse alveolar hemorrhage is a clinical syndrome that usually results from primary small-vessel vasculitis in the lungs. Although chest radiography is often the first imaging study performed in patients with pulmonary involvement by vasculitis, chest radiographs often fail to show the exact pattern and extent of thoracic involvement and CT is more useful in assessment of the thoracic findings. The pulmonary primary vasculitides are rare disorders, and their diagnoses are among the most demanding challenges in medicine because their signs and symptoms are nonspecific and overlap with those of infections, connective tissue diseases, and malignancies; thus, diagnosis of vasculitis relies on recognition of characteristic combinations of particular clinical, radiologic, laboratory, and histopathologic features.

Utility of pneumococcal urinary antigen detection in diagnosing exacerbations in COPD patients.

The aim of this study was to evaluate the utility of pneumococcal urinary antigen detection (Binax Now Streptococcus pneumoniae Antigen Test) in diagnosing pneumococcal exacerbation of chronic obstructive pulmonary disease (COPD). Forty-six patients with S. pneumoniae isolation in sputum culture were studied (29 collected in stable period and 17 collected during exacerbation). In the 29 patients with samples collected in a stable period the antigen was detected in 3 cases (10.3%) using nonconcentrated urine (NCU), and in 12 cases (41.4%) using concentrated urine (CU). Regarding patients recruited during an exacerbation period, the antigen was detected in 3 cases (17.6%) using NCU, and in 13 cases (76.5%) when CU was used. For the evaluation of the specificity of the ICT test we also tested 72 cases in which pneumococcus was not isolated in the sputum sample. ICT was positive in 1NCU and 9CU of these patients. To have had at least one previous exacerbation (P=0.024), at least one exacerbation that required hospitalization (P=0.027), and a pneumonia episode in the year before (P=0.010) had statistically significant associated with the detection of specific antigen in CU. Using NCU, the only significant association was found when a previous pneumonia in the year before had occurred (P=0.006). In summary, a positive result of pneumococcal urinary antigen from a COPD patient, in both bronchial exacerbation and pneumonia, should be evaluated with caution because the antigen detected could be related with previous infectious episode.

CT diagnosis of chronic pulmonary thromboembolism.

Chronic pulmonary thromboembolism is mainly a consequence of incomplete resolution of pulmonary thromboembolism. Increased vascular resistance due to obstruction of the vascular bed leads to pulmonary hypertension. Chronic thromboembolic pulmonary hypertension is clearly more common than previously was thought, and misdiagnosis is common because patients often present with nonspecific symptoms related to pulmonary hypertension. Computed tomography (CT) is a useful alternative to conventional angiography not only for diagnosing chronic pulmonary thromboembolism but also for determining which cases are treatable with surgery and confirming technical success postoperatively. The vascular CT signs include direct pulmonary artery signs (complete obstruction, partial obstruction, eccentric thrombus, calcified thrombus, bands, webs, poststenotic dilatation), signs related to pulmonary hypertension (enlargement of main pulmonary arteries, atherosclerotic calcification, tortuous vessels, right ventricular enlargement, hypertrophy), and signs of systemic collateral supply (enlargement of bronchial and nonbronchial systemic arteries). The parenchymal signs include scars, a mosaic perfusion pattern, focal ground-glass opacities, and bronchial anomalies. The presence of one or more of these radiologic signs arouses suspicion and allows diagnosis of this entity. Early recognition of chronic pulmonary thromboembolism may help improve the outcome, since the condition is potentially curable with pulmonary thromboendarterectomy.

Nodular pattern at lung computed tomography in fat embolism syndrome: a helpful finding.

The purpose of this study is to describe the computed tomography (CT) findings in pulmonary fat embolism syndrome (FES). The chest radiographs and CT scans of 5 patients with the diagnosis of FES as determined by the presence of at least 1 major and 4 minor criteria were reviewed. The radiologic features included ground-glass opacities, with different patterns of presentation seen in all patients. Three patients presented with alveolar opacities, and small (<1 cm) ill-defined nodules were seen in 4 of 5 patients. In the context of a patient with previous trauma and the clinical suspicion of FES, the presence of nodules at CT examination may be a helpful finding in the diagnosis of this entity. The chest radiographs and CT scans of 5 patients with the diagnosis of FES as determined by the presence of at least 1 major and 4 minor criteria as defined by Gurd and Wilson were reviewed.

Congenital and acquired pulmonary artery anomalies in the adult: radiologic overview.

Various congenital and acquired anomalies may affect the pulmonary arteries in adult patients. Congenital anomalies (proximal interruption, anomalous origin of the left pulmonary artery [pulmonary artery sling], and idiopathic dilatation of the pulmonary trunk) are usually found incidentally at chest radiography or computed tomography (CT). Acquired anomalies include diffuse or focal enlargement of the arteries because of pulmonary hypertension, aneurysm, and intravascular pulmonary metastasis; decreased arterial diameter because of bronchial carcinoma, mediastinal fibrosis, and Takayasu arteritis; and intraluminal filling defects due to pulmonary thromboembolism and pulmonary artery sarcoma. An awareness of the radiologic manifestations of the disease entities and potential pulmonary artery complications secondary to infection or vasculitis may enable an early diagnosis. CT angiography is becoming the standard method for evaluating patients in whom the presence of pulmonary embolism is suspected. CT assessment of the extent of heart effects in patients with pulmonary hypertension and pulmonary embolism is particularly important because such effects largely determine the prognosis.

Diseases affecting the peribronchovascular interstitium: CT findings and pathologic correlation.

Central bronchi and pulmonary arteries are surrounded and enveloped by a strong connective-tissue sheath termed the peribronchovascular interstitium, extending from the level of the pulmonary hila into the peripheral lung. Thickening of the peribronchovascular interstitium can be seen in a wide variety of diseases. The CT appearance can be smooth, nodular, or irregular depending on the underlying cause. Many of the diseases affecting the peribronchovascular interstitium are entities that show a predilection for lymphatic routes, such as sarcoidosis, pulmonary lymphangitic carcinomatosis, silicosis, and lymphoproliferative disorders. There are other entities that mainly affect the peribronchovascular interstitium without a predominant perilymphatic distribution, such as hydrostatic pulmonary edema, cryptogenic organizing pneumonia, Kaposi's sarcoma, interstitial pulmonary emphysema, and interstitial hemorrhage. Although there is an overlap in radiologic features, some CT findings are useful in differentiating among these entities. When CT shows mainly peribronchovascular abnormality, the differential diagnosis is considerably reduced, and it is generally possible to reach the correct diagnosis by considering the clinical context. We illustrate the CT findings and pathologic correlation for a number of different disorders that mainly affect the peribronchovascular interstitium.

Radiologic approach to the diagnosis of infectious pulmonary diseases in patients infected with the human immunodeficiency virus.

Nearly all patients infected with HIV experience respiratory infection at some point in the course of their illness. The spectrum of infections is varied and in order to generate a useful differential diagnosis based on imaging findings it is imperative for the radiologist to be aware of changing trends in disease prevalence and epidemiology, and the possible pathology related to new therapies. The characterization of the radiographic pattern in correlation with clinical findings and laboratory values (in particular the degree of immunosuppression as reflected in the CD4 level) would be helpful in narrowing the differential diagnosis of infectious pulmonary disease in HIV-positive patients. The most common radiologic patterns considered include areas of ground-glass, consolidation, nodules, and lymphadenopathy. We also include airways diseases and cavitary/cystic lesions because their prevalence has increased over recent years, and we also mention the significance of a normal chest radiograph in the suspicion of a lung infection. In most cases, the clinical and radiographic findings are sufficient for confident diagnosis. The radiologic diagnosis of thoracic infections in patients with AIDS has improved with the use of CT. The greatest value of CT is in excluding lung disease when the radiographic findings are equivocal and in confirming the presence of clinically suspected disease when the radiograph is normal.

CT in nontraumatic acute thoracic aortic disease: typical and atypical features and complications.

Thoracic aortic dissection is the most frequent cause of aortic emergency, and unless it is rapidly diagnosed and treated, the result is death. Helical computed tomography (CT) permits the diagnosis of acute aortic dissection with a sensitivity and specificity of nearly 100%. This imaging modality also enables differentiation between proximal aortic dissection (type A in the Stanford classification) and distal aortic dissection (Stanford type B), which are treated differently and have different prognoses. In 70% of patients in whom nontraumatic acute thoracic aortic dissection is diagnosed after evaluation with helical CT, scans show the typical signs of aortic dissection, with rupture and displacement of the intima. CT also can depict other pathologic entities with similar clinical manifestations, such as intramural hematoma and penetrating atherosclerotic ulcer. Awareness of the different radiologic appearances of these disease entities is essential for differential diagnosis. More than one-third of patients with aortic dissection show signs and symptoms indicative of systemic involvement. Because branch-vessel involvement may increase morbidity and mortality, in this group of patients it is important to evaluate the entire aorta so as to determine the distal extent of the dissection and detect any systemic involvement.

Hallazgos por TC en la sarcoidosis torácica / CT findings in sarcoidosis with thoracic involvement

Objetivo: La sarcoidosis es una enfermedad sistémica idiopática, caracterizada por la presencia de granulomas epitelioides no caseificantes en múltiples órganos. La afectación intratorácica ocurre en el curso de la enfermedad en casi todos los pacientes. Describimos los hallazgos en nuestros pacientes por TC convencional y TCAR de esta enfermedad.Material y método: Se ha realizado un análisis retrospectivo de los estudios mediante TC realizados en nuestro servicio a 43 pacientes diagnosticados de sarcoidosis mediante biopsia y/o lavado broncoalveolar.Resultados: Hemos dividido los hallazgos según su localización en intra y extraparenquimatosos, resaltando hallazgos poco frecuentes como el engrosamiento pleural y pericárdico, adenopatías calcificadas o en localizaciones inusuales y esplenomegalia, patrón alveolar, patrón en panal y atrapamiento de aire.Conclusión: La TC convencional y la TCAR en la sarcoidosis, son técnicas más útiles que la radiología convencional en la detección y estudio de la extensión de las lesiones intra y extraparenquimatosas, así como en la valoración de la evolución. Permite, además, guiar la biopsia torácica en caso de ser necesaria (AU)