Inter-reader agreement of high-resolution computed tomography findings in patients with COVID-19 pneumonia: A multi-reader study.

PURPOSE: To investigate the inter-reader agreement in assessing high-resolution computed tomography (HRCT) features of coronavirus disease 2019 (COVID-19) pneumonia. METHOD: Seventy-seven consecutive patients (mean age, 64 ± 15 years) with mild COVID-19 pneumonia that underwent HRCT were retrospectively included. Three radiologists [two devoted to thoracic imaging (R1, R2), and one generalist (R3)] on a per-examination basis independently assessed ground-glass opacity (GGO), consolidation, and crazy-paving pattern. The extent of each feature (total feature score, TFS) was semi-quantitatively assessed, and each TFS summed up to obtain total lung score (TLS). Presence of organizing pneumonia (OP) pattern was also recorded. The inter-reader agreement was calculated with Cohen's Kappa (k) and Free-Marginal Multirater k. Multivariable analysis was run to determine whether imaging features were predictive of short-term evolution to severe disease (need for ventilation). RESULTS: Most features showed substantial inter-reader agreement, including TLS > 6 (k = 0.69), which was an independent predictor of short-term occurrence of severe disease, regardless of the reader (OR 9-53.19). Consolidation TFS > 2 and OP pattern showed substantial and moderate agreement, respectively, only when comparing R1 and R2. Consolidation TFS > 2 and OP pattern were independent predictors of severe disease for R2 (OR 4.87) and R1 (OR 6), respectively. CONCLUSIONS: The inter-reader agreement for most HRCT features of COVID-19 pneumonia ranges moderate-to-substantial, though it depends on readers' experience in the case of consolidation and OP pattern.

Chest high-resolution computed tomography is associated to short-time progression to severe disease in patients with COVID-19 pneumonia.

OBJECTIVE: In patients with mild COVID-19 pneumonia, chest high-resolution computed tomography (HRCT) is advised when risk factors for severe disease (i.e., age > 65 years and/or comorbidities) are present, and can influence management strategy. The objective was to assess whether HRCT is associated to short-time development of severe disease in patients with COVID-19 pneumonia. METHODS: Seventy-seven consecutive patients (mean age, 64 ± 15 years) with mild COVID-19 pneumonia (no or mild respiratory failure) that underwent HRCT were retrospectively identified. Fifty-two on 77 patients had reported risk factors for severe disease. A chest-imaging devoted radiologist recorded, on a per-examination basis, the following HRCT features: ground-glass opacity, crazy-paving pattern, consolidation, organizing pneumonia (OP) pattern, mosaic attenuation, and nodules. The extent of each feature (total feature score, TFS) was semi-quantitatively assessed. Total lung involvement (TLI) was defined as the sum of all TFSs. The study outcome was defined as the occurrence of severe disease (moderate-to-severe respiratory failure) within 15 days from HRCT. Logistic regression analysis was performed to assess if age, comorbidities, and HRCT features were associated to severe disease. RESULTS: On univariable analysis, severe disease was significantly associated with age > 59 years (29/47 patients, 61.7%) (p = 0.013), and not significantly associated with having comorbidities (22/44 patients, 50.0%). On multivariable analysis, TLI >15 and OP pattern >5 were independently associated to severe disease, with odds ratio of 8.380 (p = 0.003), and of 4.685 (p = 0.035), respectively. CONCLUSION: Short-time onset of severe COVID-19 was associated to TLI >15 and OP pattern score > 5. Severe disease was not associated to comorbidities.

Role for contrast-enhanced ultrasound in assessing complications after kidney transplant.

Kidney transplantation (KT) is an effective treatment for end-stage renal disease. Despite their rate has reduced over time, post-transplant complications still represent a major clinical problem because of the associated risk of graft failure and loss. Thus, post-KT complications should be diagnosed and treated promptly. Imaging plays a pivotal role in this setting. Grayscale ultrasound (US) with color Doppler analysis is the first-line imaging modality for assessing complications, although many findings lack specificity. When performed by experienced operators, contrast-enhanced US (CEUS) has been advocated as a safe and fast tool to improve the accuracy of US. Also, when performing CEUS there is potentially no need for further imaging, such as contrast-enhanced computed tomography or magnetic resonance imaging, which are often contraindicated in recipients with impaired renal function. This technique is also portable to patients' bedside, thus having the potential of maximizing the cost-effectiveness of the whole diagnostic process. Finally, the use of blood-pool contrast agents allows translating information on graft microvasculature into time-intensity curves, and in turn quantitative perfusion indexes. Quantitative analysis is under evaluation as a tool to diagnose rejection or other causes of graft dysfunction. In this paper, we review and illustrate the indications to CEUS in the post-KT setting, as well as the main CEUS findings that can help establishing the diagnosis and planning the most adequate treatment.