ABSTRACT
Purpose To study the spectrum of chest dual-energy computed tomography (DECT) imaging findings in severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) or COVID-19 infected Indian patients and classify them on the basis of the Radiological Society of North America CT classification. Method A total of 110 reverse transcription-polymerase chain reaction (RT-PCR)-positive patients (subjects) in which noncontrast chest DECT was done in our COVID-19 care center (CCC) were enrolled in this study. The prevalence of various abnormalities of lung parenchyma due to SARS-COV-2 and their distribution with extent was recorded. Various types of lung parenchyma abnormalities due to COVID-19 were evaluated in all patients. Data were analyzed and various prevalent abnormalities were calculated as a percentage for each type. All the cases were also sorted into four major groups on the basis of the Radiological Society of North America CT classification of COVID patients. Result Among the total 110 patients that were enrolled in this study, 80 (72.7%) were males and 30 (27.3%) were females with a mean age of 40.5 ± 7 years (range 24-84). Out of this, we observed that 59 (53.6%) cases had abnormalities of lung parenchyma and were designated as DECT positive, whereas 51 (46.3%) cases had completely normal DECT. Only 14 (12.7%) of the patients (cases) presented with dyspnoea, 10 (9%) had hyperpnoea, whereas 12 (10.8%) had other associated comorbidities. Among the patients having abnormal DECT findings, multilobar (86%), bilateral lung field involvement (72.8%) with the ascendancy of peripheral and posterior distribution was most commonly noted. With respect to the different types of opacities noted in various patients, we found that ground-glass opacity (GGO) was the common abnormality found in almost all cases for the greatest part. Pure GGO was reported in 16 (28%), GGO admixed with a crazy-paving pattern were elicited in 17 (28.8%) and GGO mixed with consolidation was noted in 25 (42.3%) cases. Thirty-eight (64.4%) cases were having peri-lesional or intra-lesional segments or involving a small segment enlargement of the pulmonary vessel. Among the cases showing DECT positivity, the typical pattern on the basis of the Radiological Society of North America (RSNA) classification was noted in 71.2% of cases, whereas the atypical pattern was found in 1.2% percent of cases and the intermediate type was depicted in 25.4% percent of cases. Forty-six point three percent (46.3%) of the total cases that were enrolled in the study were grouped as the no pneumonia category. Conclusion The result of this study proved that the maximum number of RT-PCR-positive COVID-19 patients had mild symptoms and few comorbidities with normal chest DECT and fell under the no pneumonia category of the RSNA CT classification of COVID patients. However, out of the remaining patients, the majority of patients had GGO on DECT as a typical finding mixed with other patterns in a bilateral distribution and peripheral predominance. A preponderance of patients presented with the typical appearance of pneumonia followed by an intermediate type.
ABSTRACT
OBJECTIVES: Peripheral arterial disease (PAD) leads to narrowing and hardening of arteries which leads to increased risk of lower extremity amputation. Hence, the accuracy of non-invasive diagnostic methods such as calcium scoring and color Doppler needs to be assessed in comparison to the gold standard dual-energy computed tomography (DECT) angiography. This study aims to evaluate the accuracy of color Doppler and calcium scoring when compared to DECT angiography in the assessment of PAD of the lower limb. It is a cross- sectional retrospective study. MATERIAL AND METHODS: The study included 55 patients aged between 40 and 70 years. All the patients with symptoms suggestive of PAD underwent color Doppler study of lower limb arterial system. Afterward, the patient underwent CT angiography. The first plain images were taken for calcium scoring following which contrast was given and further images were taken. RESULTS: As compared to CT angiography assessment, Doppler assessment was 88.1% sensitive but only 69.2% specific with diagnostic accuracy of 83.6%. For angiographically detected atheromatous changes, color Doppler had sensitivity and specificity of 86.2% and 76.9%. The derived cutoff value >149.1 of calcium score in lower limb arteries was in 100% agreement with CT angiography detected PAD, whereas, for atheromatous changes, total calcium score at a cutoff value of >842.2 had sensitivity and specificity of 75.9% and 80.8%. CONCLUSION: Calcium scoring as compared to color Doppler has a higher diagnostic efficacy for the detection of DECT angiography confirmed PAD, whereas calcium score lacks adequate sensitivity at projected cutoff in the evaluation of atheromatous changes.
ABSTRACT
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a rare CNS inflammatory disorder involving the pons and other parts of the brainstem. It is characterised by a combination of brainstem symptoms and classical magnetic resonance imaging (MRI) features of bilateral, symmetrical punctate, perivascular enhancement of pontine lesions. Another hallmark feature of this rare disease is the responsiveness to corticosteroid treatment. As the corticosteroid treatment is tapered, the symptoms exacerbate and worsen the clinical outcome. Clinicians and radiologists should be aware of this infrequent inflammatory disorder and should always be considered as a differential diagnosis. Herein, we report the case of a 17-year-old female with a similar clinicoradiological spectrum as CLIPPERS.
