Publications by authors named "Gianluca Milanese"

45 Publications

Chest x-ray or CT for COVID-19 pneumonia? Comparative study in a simulated triage setting.

Eur Respir J 2021 02 11. Epub 2021 Feb 11.

Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, UK.

Introduction: for the management of patients referred to respiratory triage during the early stages of the SARS-CoV-2 pandemic, either chest radiograph (CXR) or computed tomography (CT) were used as first-line diagnostic tools. The aim of this study was to compare the impact on triage, diagnosis and prognosis of patients with suspected COVID-19 when clinical decisions are derived from reconstructed CXR or from CT.

Methods: we reconstructed CXR (r-CXR) from high-resolution CT (HRCT) scan. Five clinical observers independently reviewed clinical charts of 300 subjects with suspected COVID-19 pneumonia, integrated with either r-CXR or HRCT report in two consecutive blinded and randomised sessions: clinical decisions were recorded for each session. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and prognostic value were compared between r-CXR and HRCT. The best radiological integration was also examined to develop an optimised respiratory triage algorithm.

Results: interobserver agreement was fair (Kendall's =0.365; p<0.001) by r-CXR-based protocol and good (Kendall's =0.654; p<0.001) by CT-based protocol. NPV assisted by r-CXR (31.4%) was lower than that of HRCT (77.9%). In case of indeterminate or typical radiological appearence for COVID-19 pneumonia, extent of disease on r-CXR or HRCT were the only two imaging variables that were similarly linked to mortality by adjusted multivariable models CONCLUSIONS: the present findings suggest that clinical triage is safely assisted by CXR. An integrated algorithm using first-line CXR and contingent use of HRCT can help optimise management and prognostication of COVID-19.
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http://dx.doi.org/10.1183/13993003.04188-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877328PMC
February 2021

Frequency and characterization of ancillary chest CT findings in COVID-19 pneumonia.

Br J Radiol 2021 Feb 20;94(1118):20200716. Epub 2021 Jan 20.

Department of Medicine and Surgery, Unit of "Scienze Radiologiche", University of Parma, Parma, Italy.

Objectives: Ground-glass opacity and consolidation are recognized typical features of Coronavirus disease-19 (COVID-19) pneumonia on Chest CT, yet ancillary findings have not been fully described. We aimed to describe ancillary findings of COVID-19 pneumonia on CT, to define their prevalence, and investigate their association with clinical data.

Methods: We retrospectively reviewed our CT chest cases with coupled reverse transcriptase polymerase chain reaction (rt-PCR). Patients with negative rt-PCR or without admission chest CT were excluded. Ancillary findings included: vessel enlargement, subpleural curvilinear lines, dependent subpleural atelectasis, centrilobular solid nodules, pleural and/or pericardial effusions, enlarged mediastinal lymph nodes. Continuous data were expressed as median and 95% confidence interval (95% CI) and tested by Mann-Whitney test.

Results: Ancillary findings were represented by 106/252 (42.1%, 36.1 to 48.2) vessel enlargement, 50/252 (19.8%, 15.4 to 25.2) subpleural curvilinear lines, 26/252 (10.1%, 7.1 to 14.7) dependent subpleural atelectasis, 15/252 (5.9%, 3.6 to 9.6) pleural effusion, 15/252 (5.9%, 3.6 to 9.6) mediastinal lymph nodes enlargement, 13/252 (5.2%, 3 to 8.6) centrilobular solid nodules, and 6/252 (2.4%, 1.1 to 5.1) pericardial effusion. Air space disease was more extensive in patients with vessel enlargement or centrilobular solid nodules ( < 0.001). Vessel enlargement was associated with longer history of fever ( = 0.035) and lower admission oxygen saturation ( = 0.014); dependent subpleural atelectasis with lower oxygen saturation ( < 0.001) and higher respiratory rate ( < 0.001); mediastinal lymph nodes with shorter history of cough ( = 0.046); centrilobular solid nodules with lower prevalence of cough ( = 0.023), lower oxygen saturation ( < 0.001), and higher respiratory rate ( = 0.032), and pericardial effusion with shorter history of cough ( = 0.015). Ancillary findings associated with longer hospital stay were subpleural curvilinear lines ( = 0.02), whereas centrilobular solid nodules were associated with higher rate of intensive care unit admission ( = 0.01).

Conclusion: Typical high-resolution CT findings of COVID-19 pneumonia are frequently associated with ancillary findings that variably associate with disease extent, clinical parameters, and disease severity.

Advances In Knowledge: Ancillary findings might reflect the broad range of heterogeneous mechanisms in severe acute respiratory syndrome from viral pneumonia, and potentially help disease phenotyping.
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http://dx.doi.org/10.1259/bjr.20200716DOI Listing
February 2021

Association of hepatic steatosis with epicardial fat volume and coronary artery disease in symptomatic patients.

Radiol Med 2021 Jan 3. Epub 2021 Jan 3.

Division of Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy.

Aims: This study aims to investigate whether HS-when associated with an excessive amount of epicardial adipose tissue-correlates with CAD in subjects with symptoms suggestive of CVD.

Methods And Results: CCTA images, demographic and clinical variables of 1.182 individuals were retrieved: semi-automated measurements for EFV, CAC, and MLD were obtained. Individuals were grouped into three categories according to the presence of CAD, resulting in absent (CAD), non-obstructive (CAD) or obstructive (CAD) disease-groups, and into two categories based on the presence of HS (with no HS, named HS, and with HS, named HS). EFV was significantly higher in HS than in HS group (p < 0.001), whereas MLD was lower in CAD than in CAD subjects (p < 0.001). Two predictive models for CAD were tested: the former included clinical risk factors for CAD along with age, gender, EFV and MLD, whereas the latter did not include clinical variables. The logistic regression analysis of the second proposed model reliably discriminated CAD from CAD and CAD (AUC of 0.712, range 0.682-0.742).

Conclusion: Lower MLD was associated with increased EFV, and MLD-as a marker of HS-discriminate symptomatic patients with CAD from whom without.
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http://dx.doi.org/10.1007/s11547-020-01321-9DOI Listing
January 2021

Might EAT composition help to predict coronary artery disease severity?

Int J Cardiol 2021 Mar 8;327:39. Epub 2020 Dec 8.

Unit of "Scienze Radiologiche", Department of Medicine and Surgery, University of Parma, Parma, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.ijcard.2020.12.005DOI Listing
March 2021

Unexpected detection of SARS-CoV-2 antibodies in the prepandemic period in Italy.

Tumori 2020 Nov 11:300891620974755. Epub 2020 Nov 11.

Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.

There are no robust data on the real onset of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and spread in the prepandemic period worldwide. We investigated the presence of SARS-CoV-2 receptor-binding domain (RBD)-specific antibodies in blood samples of 959 asymptomatic individuals enrolled in a prospective lung cancer screening trial between September 2019 and March 2020 to track the date of onset, frequency, and temporal and geographic variations across the Italian regions. SARS-CoV-2 RBD-specific antibodies were detected in 111 of 959 (11.6%) individuals, starting from September 2019 (14%), with a cluster of positive cases (>30%) in the second week of February 2020 and the highest number (53.2%) in Lombardy. This study shows an unexpected very early circulation of SARS-CoV-2 among asymptomatic individuals in Italy several months before the first patient was identified, and clarifies the onset and spread of the coronavirus disease 2019 (COVID-19) pandemic. Finding SARS-CoV-2 antibodies in asymptomatic people before the COVID-19 outbreak in Italy may reshape the history of pandemic.
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http://dx.doi.org/10.1177/0300891620974755DOI Listing
November 2020

Qualitative and quantitative chest CT parameters as predictors of specific mortality in COVID-19 patients.

Emerg Radiol 2020 Dec 29;27(6):701-710. Epub 2020 Oct 29.

Department of Radiological Functions, Radiology Unit, "Guglielmo da Saliceto" Hospital, Via Taverna 49, 29121, Piacenza, Italy.

Purpose: To test the association between death and both qualitative and quantitative CT parameters obtained visually and by software in coronavirus disease (COVID-19) early outbreak.

Methods: The study analyzed retrospectively patients underwent chest CT at hospital admission for COVID-19 pneumonia suspicion, between February 21 and March 6, 2020. CT was performed in case of hypoxemia or moderate-to-severe dyspnea. CT scans were analyzed for quantitative and qualitative features obtained visually and by software. Cox proportional hazards regression analysis examined the association between variables and overall survival (OS). Three models were built for stratification of mortality risk: clinical, clinical/visual CT evaluation, and clinical/software-based CT assessment. AUC for each model was used to assess performance in predicting death.

Results: The study included 248 patients (70% males, median age 68 years). Death occurred in 78/248 (32%) patients. Visual pneumonia extent > 40% (HR 2.15, 95% CI 1.2-3.85, P = 0.01), %high attenuation area - 700 HU > 35% (HR 2.17, 95% CI 1.2-3.94, P = 0.01), exudative consolidations (HR 2.85-2.93, 95% CI 1.61-5.05/1.66-5.16, P < 0.001), visual CAC score > 1 (HR 2.76-3.32, 95% CI 1.4-5.45/1.71-6.46, P < 0.01/P < 0.001), and CT classified as COVID-19 and other disease (HR 1.92-2.03, 95% CI 1.01-3.67/1.06-3.9, P = 0.04/P = 0.03) were significantly associated with shorter OS. Models including CT parameters (AUC 0.911-0.913, 95% CI 0.873-0.95/0.875-0.952) were better predictors of death as compared to clinical model (AUC 0.869, 95% CI 0.816-0.922; P = 0.04 for both models).

Conclusions: In COVID-19 patients, qualitative and quantitative chest CT parameters obtained visually or by software are predictors of mortality. Predictive models including CT metrics were better predictors of death in comparison to clinical model.
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http://dx.doi.org/10.1007/s10140-020-01867-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594966PMC
December 2020

Comparison of admission chest computed tomography and lung ultrasound performance for diagnosis of COVID-19 pneumonia in populations with different disease prevalence.

Eur J Radiol 2020 Dec 8;133:109344. Epub 2020 Oct 8.

Department of Radiological Functions, Radiology Unit, "Guglielmo da Saliceto" Hospital, Piacenza, Italy.

Purpose: Chest computed tomography (CT) is considered a reliable imaging tool for COVID-19 pneumonia diagnosis, while lung ultrasound (LUS) has emerged as a potential alternative to characterize lung involvement. The aim of the study was to compare diagnostic performance of admission chest CT and LUS for the diagnosis of COVID-19.

Methods: We included patients admitted to emergency department between February 21-March 6, 2020 (high prevalence group, HP) and between March 30-April 13, 2020 (moderate prevalence group, MP) undergoing LUS and chest CT within 12 h. Chest CT was considered positive in case of "indeterminate"/"typical" pattern for COVID-19 by RSNA classification system. At LUS, thickened pleural line with ≥ three B-lines at least in one zone of the 12 explored was considered positive. Sensitivity, specificity, PPV, NPV, and AUC were calculated for CT and LUS against real-time reverse transcriptase polymerase chain reaction (RT-PCR) and serology as reference standard.

Results: The study included 486 patients (males 61 %; median age, 70 years): 247 patients in HP (COVID-19 prevalence 94 %) and 239 patients in MP (COVID-19 prevalence 45 %). In HP and MP respectively, sensitivity, specificity, PPV, and NPV were 90-95 %, 43-69 %, 96-72 %, 20-95 % for CT and 94-93 %, 7-31 %, 94-52 %, 7-83 % for LUS. CT demonstrated better performance than LUS in diagnosis of COVID-19, both in HP (AUC 0.75 vs 0.51; P < 0.001) and MP (AUC 0.85 vs 0.62; P < 0.001).

Conclusions: Admission chest CT shows better performance than LUS for COVID-19 diagnosis, at varying disease prevalence. LUS is highly sensitive, but not specific for COVID-19.
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http://dx.doi.org/10.1016/j.ejrad.2020.109344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543736PMC
December 2020

Chest X-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.

Eur Radiol 2020 Oct 8. Epub 2020 Oct 8.

Department of Radiology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.

Objectives: To evaluate the inter-rater agreement of chest X-ray (CXR) findings in coronavirus disease 2019 (COVID-19) and to determine the value of initial CXR along with demographic, clinical, and laboratory data at emergency department (ED) presentation for predicting mortality and the need for ventilatory support.

Methods: A total of 340 COVID-19 patients who underwent CXR in the ED setting (March 1-13, 2020) were retrospectively included. Two reviewers independently assessed CXR abnormalities, including ground-glass opacities (GGOs) and consolidation. Two scoring systems (Brixia score and percentage of lung involvement) were applied. Inter-rater agreement was assessed by weighted Cohen's kappa (κ) or intraclass correlation coefficient (ICC). Predictors of death and respiratory support were identified by logistic or Poisson regression.

Results: GGO admixed with consolidation (n = 235, 69%) was the most common CXR finding. The inter-rater agreement was almost perfect for type of parenchymal opacity (κ = 0.90), Brixia score (ICC = 0.91), and percentage of lung involvement (ICC = 0.95). The Brixia score (OR: 1.19; 95% CI: 1.06, 1.34; p = 0.003), age (OR: 1.16; 95% CI: 1.11, 1.22; p < 0.001), PaO/FiO ratio (OR: 0.99; 95% CI: 0.98, 1; p = 0.002), and cardiovascular diseases (OR: 3.21; 95% CI: 1.28, 8.39; p = 0.014) predicted death. Percentage of lung involvement (OR: 1.02; 95% CI: 1.01, 1.03; p = 0.001) and PaO/FiO ratio (OR: 0.99; 95% CI: 0.99, 1.00; p < 0.001) were significant predictors of the need for ventilatory support.

Conclusions: CXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO/FiO ratio, and SpO values to early predict mortality and the need for ventilatory support.

Key Points: • Chest X-ray is a reproducible tool for assessing COVID-19 pneumonia. • The Brixia score and percentage of lung involvement on chest X-ray integrate with patient history, PaO/FIO ratio, and SpO values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.
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http://dx.doi.org/10.1007/s00330-020-07270-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543667PMC
October 2020

COVID-19 outbreak in Italy: Clinical-radiological presentation and outcome in three oncologic patients.

J Infect Chemother 2021 Jan 10;27(1):99-102. Epub 2020 Sep 10.

Department of Radiological Functions, Radiology Unit, "Guglielmo da Saliceto" Hospital, Piacenza, Italy.

We present three patients affected by pulmonary squamous cell carcinoma, metastatic esophageal cancer and advanced non-Hodgkin lymphoma, who incurred in coronavirus 2019 (COVID-19) infection during the early phase of epidemic wave in Italy. All patients presented with fever. Social contact with subject positive for COVID-19 was declared in only one of the three cases. In all cases, laboratory findings showed lymphopenia and elevated C-reactive protein (CRP). Chest x-ray and computed tomography showed bilateral ground-glass opacities, shadowing, interstitial abnormalities, and "crazy paving" pattern which evolved with superimposition of consolidations in one patient. All patients received antiviral therapy based on ritonavir and lopinavir, associated with hydroxychloroquine. Despite treatment, two patients with advanced cancers died after 39 and 17 days of hospitalization, while the patient with lung cancer was dismissed at home, in good conditions.
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http://dx.doi.org/10.1016/j.jiac.2020.09.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834326PMC
January 2021

Lung cancer screening by nodule volume in Lung-RADS v1.1: negative baseline CT yields potential for increased screening interval.

Eur Radiol 2020 Sep 30. Epub 2020 Sep 30.

Department of Thoracic Surgery, IRCCS Istituto Nazionale dei Tumori, Milan, Italy.

Objectives: The 2019 Lung CT Screening Reporting & Data System version 1.1 (Lung-RADS v1.1) introduced volumetric categories for nodule management. The aims of this study were to report the distribution of Lung-RADS v1.1 volumetric categories and to analyse lung cancer (LC) outcomes within 3 years for exploring personalized algorithm for lung cancer screening (LCS).

Methods: Subjects from the Multicentric Italian Lung Detection (MILD) trial were retrospectively selected by National Lung Screening Trial (NLST) criteria. Baseline characteristics included selected pre-test metrics and nodule characterization according to the volume-based categories of Lung-RADS v1.1. Nodule volume was obtained by segmentation with dedicated semi-automatic software. Primary outcome was diagnosis of LC, tested by univariate and multivariable models. Secondary outcome was stage of LC. Increased interval algorithms were simulated for testing rate of delayed diagnosis (RDD) and reduction of low-dose computed tomography (LDCT) burden.

Results: In 1248 NLST-eligible subjects, LC frequency was 1.2% at 1 year, 1.8% at 2 years and 2.6% at 3 years. Nodule volume in Lung-RADS v1.1 was a strong predictor of LC: positive LDCT showed an odds ratio (OR) of 75.60 at 1 year (p < 0.0001), and indeterminate LDCT showed an OR of 9.16 at 2 years (p = 0.0068) and an OR of 6.35 at 3 years (p = 0.0042). In the first 2 years after negative LDCT, 100% of resected LC was stage I. The simulations of low-frequency screening showed a RDD of 13.6-21.9% and a potential reduction of LDCT burden of 25.5-41%.

Conclusions: Nodule volume by semi-automatic software allowed stratification of LC risk across Lung-RADS v1.1 categories. Personalized screening algorithm by increased interval seems feasible in 80% of NLST eligible.

Key Points: • Using semi-automatic segmentation of nodule volume, Lung-RADS v1.1 selected 10.8% of subjects with positive CT and 96.87 relative risk of lung cancer at 1 year, compared to negative CT. • Negative low-dose CT by Lung-RADS v1.1 was found in 80.6% of NLST eligible and yielded 40 times lower relative risk of lung cancer at 2 years, compared to positive low-dose CT; annual screening could be preference sensitive in this group. • Semi-automatic segmentation of nodule volume and increased screening interval by volumetric Lung-RADS v1.1 could retrospectively suggest a 25.5-41% reduction of LDCT burden, at the cost of 13.6-21.9% rate of delayed diagnosis.
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http://dx.doi.org/10.1007/s00330-020-07275-wDOI Listing
September 2020

Longitudinal change during follow-up of systemic sclerosis: correlation between high-resolution computed tomography and pulmonary function tests.

Clin Rheumatol 2021 Jan 3;40(1):213-219. Epub 2020 Sep 3.

Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Parma, Italy.

The objective of this study was to determine the correlation between functional and radiological longitudinal change in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD), and to test the OMERACT definition of clinically meaningful progression of pulmonary function tests (PFTs) for the prediction of ILD radiological evolution. We retrospectively retrieved high-resolution computed tomography (HRCT) studies and PFTs including DLco, both available at two time-points and performed within 6 months of each other, in SSc patients. A subset of patients was selected using a 12-24-month clinically oriented interval (n = 58). The extent of ILD at HRCT was scored according to a visual semi-quantitative method (SQCT). The correlation of absolute change (Δ) in the SQCT score with change in FVC and DLco was examined using Pearson's correlation coefficient. The concordance between the OMERACT criteria (≥ 10% FVC relative decline; or 5-10% FVC and ≥ 15% DLco relative decline) and SQCT categorical change (5% and 10%) was investigated. A total of 129 patients were enrolled. During 12-24-month follow-up, ΔSQCT was negatively correlated with ΔFVC (r = - 0.487, p = 0.0001) and ΔDLco (r = - 0.298, p = 0.023). Ten patients demonstrated CT progression ΔSQCT > 5%, among whom 5 with ΔSQCT > 10%. OMERACT criteria identified 25 patients with progressive SSc-ILD, of whom only 5 presented ΔSQCT > 5 and 3 presented ΔSQCT > 10%. In conclusion, change in radiological extent of SSc-ILD was correlated to functional decline in a limited time-frame. Repeated HRCT after 12-24 months may be useful for the longitudinal characterization of ILD evolution in patients with stable pulmonary function. Conversely, functional changes are suggestive of a concurrent radiological progression only after this interval. Key Points • In SSc patients, chest HRCT performed every 12-24 months can detect minimal but significant changes in ILD extent, even in subjects with stable pulmonary function. • PFT changes in 12-24 months are related to the radiological ILD progression. • OMERACT criteria might overlook patients with radiological progression. • Repeated chest HRCT may be useful for monitoring SSc-ILD when performed within 12 to 24 months from baseline in order to promptly detect progression and possibly impact on prognosis.
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http://dx.doi.org/10.1007/s10067-020-05375-yDOI Listing
January 2021

Multimodality imaging in chronic heart failure.

Radiol Med 2021 Feb 16;126(2):231-242. Epub 2020 Jul 16.

Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.

The prevalence of heart failure (HF) is approximately 1-2% of the adult population in developed countries, rising to  ≥ 10% among people over 70. The common symptoms of HF include shortness of breath, ankle swelling and fatigue, determined by a reduced cardiac output. Multimodality imaging is crucial to define HF etiology, determine prognosis and guiding tailored treatments. Echocardiography is the most widely used imaging modality and maintains a pivotal role in the initial diagnostic work-up and in the follow-up of HF patients. Cardiac magnetic resonance (CMR) may support the morpho-functional assessment provided by echocardiography when the acoustic window is limited or a gold standard evaluation is required. Furthermore, CMR is frequently used due to the unmatched capability to characterize myocardial structure. Coronary computed tomography angiography has become the non-invasive imaging of choice to diagnose or rule-out coronary artery disease, acquiring remarkable importance in the management of HF patients. Moreover, emerging capabilities of CT-based tissue characterization may be useful, especially when CMR is contraindicated. Finally, chest CT may contribute to precisely define the framework of HF patients, revealing new insight about cardiopulmonary pathophysiological interactions with potential high prognostic value.
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http://dx.doi.org/10.1007/s11547-020-01245-4DOI Listing
February 2021

Lung Ultrasound in COVID-19 Pneumonia: Correlations with Chest CT on Hospital admission.

Respiration 2020 22;99(7):617-624. Epub 2020 Jun 22.

Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy,

Background: Lung ultrasound (LUS) is an accurate, safe, and cheap tool assisting in the diagnosis of several acute respiratory diseases. The diagnostic value of LUS in the workup of coronavirus disease-19 (COVID-19) in the hospital setting is still uncertain.

Objectives: The aim of this observational study was to explore correlations of the LUS appearance of COVID-19-related pneumonia with CT findings.

Methods: Twenty-six patients (14 males, age 64 ± 16 years) urgently hospitalized for COVID-19 pneumonia, who underwent chest CT and bedside LUS on the day of admission, were enrolled in this observational study. CT images were reviewed by expert chest radiologists, who calculated a visual CT score based on extension and distribution of ground-glass opacities and consolidations. LUS was performed by clinicians with certified competency in thoracic ultrasonography, blind to CT findings, following a systematic approach recommended by ultrasound guidelines. LUS score was calculated according to presence, distribution, and severity of abnormalities.

Results: All participants had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 43 ± 24%. LUS identified 4 different possible -abnormalities, with bilateral distribution (average LUS score 15 ± 5): focal areas of nonconfluent B lines, diffuse confluent B lines, small subpleural microconsolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (r = 0.65, p < 0.001) and oxygen saturation in room air (r = -0.66, p < 0.001).

Conclusion: When integrated with clinical data, LUS could represent a valid diagnostic aid in patients with suspect COVID-19 pneumonia, which reflects CT findings.
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http://dx.doi.org/10.1159/000509223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360505PMC
September 2020

Dataset on the identification of a prognostic radio-immune signature in surgically resected Non Small Cell Lung Cancer.

Data Brief 2020 Aug 2;31:105781. Epub 2020 Jun 2.

Department of Medicine and Surgery, University of Parma, Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy.

The immune regulation of cancer growth and regression has been underscored by the recent success of immunotherapy. The possibility that immune microenvironmental factors may impact on clinical outcome and treatment response still requires intense investigations. Hereby, supporting data of the research article "Integrated CT Imaging and Tissue Immune Features Disclose a Radio-Immune Signature with High Prognostic Impact on Surgically Resected NSCLC" [1], are presented. With the ultimate aim to provide non-invasive prognostic scores, we report on our approach to correlate different Tumor Immune Microenvironment (TIME) profiles with CT imaging-derived qualitative (semantic, CT-SFs) and quantitative (radiomic, CT-RFs) features in a cohort of 60 surgically resected NSCLC. The renowned characterization of TIME, essentially based on the score evaluation of Programme Death Ligand-1 (PD-L1) and Tumor Infiltrating Lymphocytes (TILs), was implemented here by the assessment of effector and suppressor phenotypes including the analysis of Programme Death receptor 1 (PD-1). Thus, we defined two main TIME categories: hot inflamed (PD-L1, CD8/CD3 and PD-1/CD8) as opposed to cold inactive (PD-L1, CD8/CD3and PD-1/CD8). Importantly, as reported in the extended publication [1], these distinctive immune contextures identified different prognostic classes and were decoded by radiomics. To corroborate our radiomic approach, a comparative estimation of CT-RFs extracted from 60 NSCLC and 13 non neoplastic tissues was undertaken, documenting high discrimination ability. Moreover, we tested the potential association of qualitative radiologic features with clinico-pathological and TIME parameters. Taken together, our findings suggest that CT-SFs and CT-RFs may underlay specific patterns of lung cancer.
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http://dx.doi.org/10.1016/j.dib.2020.105781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286984PMC
August 2020

The role of the radiologist in diagnosing the COVID-19 infection. Parma experiences.

Acta Biomed 2020 May 11;91(2):169-171. Epub 2020 May 11.

Division of Radiology, University of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new virus responsible for the coronavirus disease 2019 (COVID-19), a respiratory disease that ranges from an asymptomatic or mild flu-like illness to severe pneumonia, multiorgan failure, and death. Imaging might play an important role in clinical decision making by supporting rapid triage of patients with suspected COVID-19 and assessing supervening complications, such as super-added bacterial infection and thrombosis. Further studies will clarify the real impact of imaging on COVID-19 patients' management and the potential role of radiology in future outbreaks.
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http://dx.doi.org/10.23750/abm.v91i2.9564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569662PMC
May 2020

Pneumothorax and pulmonary hemorrhage after CT-guided lung biopsy: incidence, clinical significance and correlation.

Radiol Med 2021 Jan 6;126(1):170-177. Epub 2020 May 6.

Department of Medicine and Surgery, Unit of Radiology, University of Parma, Parma, Italy.

Objectives: To evaluate the incidence and clinical significance of pneumothorax (PTX) and pulmonary hemorrhage (PH) after CT-guided lung biopsy (CT-LB). To test correlations of PTX and chest tube insertion (CTI) with PH and other imaging and procedural parameters.

Methods: Pre-procedural CT and CT-LB scans of 904 patients were examined. Incidence of PTX and PH and PH location (type-1 along needle track; type-2 perilesional) and severity according to its thickness (low grade < 6 mm; high grade > 6 mm) were recorded. PTX was considered clinically significant if treated with CTI, PH if treated with endoscopic/endovascular procedure. Binary logistic regression analyses were used to determine the effects of different imaging and procedural parameters on the likelihood to develop PTX, CTI and PH and to define their correlation.

Results: PTX occurred in 306/904 cases (33.8%); CTI was required in 18/306 (5.9%). PH occurred in 296/904 cases (32.7%), and no case required treatment. Nodule-to-pleura distance (OR = 1.052; OR = 1.046; OR 1.077), emphysema (OR = 1.287; OR = 0.573), procedure time (OR = 1.019; OR = 1.039; OR = 1.019), target size (OR = 0.982; OR = 0.968) and needle gauge (OR = 0.487; OR = 4.311; OR = 2.070) showed statistically significant correlation to PTX, CTI and PH. Type-1 PH showed a protective effect against PTX and CTI (OR = 0.503; OR = 0.416).

Conclusion: PTX and PH have similar incidence after CT-guided lung biopsy. PH along needle track may represent a protective factor against development of PTX and against PTX requiring CTI.
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http://dx.doi.org/10.1007/s11547-020-01211-0DOI Listing
January 2021

Integrated CT imaging and tissue immune features disclose a radio-immune signature with high prognostic impact on surgically resected NSCLC.

Lung Cancer 2020 06 21;144:30-39. Epub 2020 Apr 21.

Department of Medicine and Surgery, University of Parma, Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy. Electronic address:

Objectives: Qualitative and quantitative CT imaging features might intercept the multifaceted tumor immune microenvironment (TIME), providing a non-invasive approach to design new prognostic models in NSCLC patients.

Materials And Methods: Our study population consisted of 100 surgically resected NSCLC patients among which 31 served as a validation cohort for quantitative image analysis. TIME was classified according to PD-L1 expression and the magnitude of Tumor Infiltrating Lymphocytes (TILs) and further defined as hot or cold by the tissue analysis of effector (CD8-to-CD3/PD-1-to-CD8) or inert (CD8-to-CD3/PD-1-to-CD8) phenotypes. CT datasets acted as source for qualitative (semantic, CT-SFs) and quantitative (radiomic, CT-RFs) features which were correlated with clinico-pathological and TIME profiles to determine their impact on survival outcome.

Results: Specific CT-SFs (texture [TXT], effect [EFC] and margins [MRG]) strongly correlated to PD-L1 and TILs status and showed significant impact on survival outcome (TXT, HR:3.39, 95 % CI 1.12-10-27, P < 0.05; EFC, HR:0.41, 95 % CI 0.18-0.93, P < 0.05; MRG, HR:1.93, 95 % CI 0.88-4.25, P = 0.09). Seven CT derived radiomic features were able to sharply discriminate cases with hot (inflamed) vs cold (desert) TIME, which also exhibited opposite OS (long vs short, HR:0.09, 95 % CI 0.04-0.23, P < 0.001) and DFS (long vs short, HR:0.31, 95 % CI 0.16-0.58, P < 0.001). Moreover, we identified 6 prognostic radiomic features among which ClusterProminence displayed the highest statistical significance (HR:0.13, 95 % CI 0.06-0.31, P < 0.001). These findings were independently validated in an additional cohort of NSCLC (HR:0.11, 95 % CI 0.03-0.40, P = 0.001). Finally, in our training cohort we developed a multiparametric prognostic model, interlacing TIME and clinico-pathological characteristics with CT-SFs (ROC curve AUC:0.83, 95 % CI 0.71-0.92, P < 0.001) or CT-RFs (AUC: 0.91, 95 % CI 0.83-0.99, P < 0.001), which appeared to outperform pTNM staging (AUC: 0.66, 95 % CI 0.51-0.80, P < 0.05) in the risk assessment of NSCLC.

Conclusion: Higher order CT extracted features associated with specific TIME profiles may reveal a radio-immune signature with prognostic impact on resected NSCLC.
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http://dx.doi.org/10.1016/j.lungcan.2020.04.006DOI Listing
June 2020

Validity of epicardial fat volume as biomarker of coronary artery disease in symptomatic individuals: Results from the ALTER-BIO registry.

Int J Cardiol 2020 09 13;314:20-24. Epub 2020 Apr 13.

Division of Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy. Electronic address:

Background: To determine if an increased epicardial fat volume (EFV) is associated with coronary artery disease (CAD) in individuals with symptoms of cardiovascular (CV) disease.

Methods: Coronary Computed Tomographic Angiography (CCTA), demographic and clinical variables of 1344 individuals were retrieved: semi-automated measurements for EFV and coronary artery calcifications (CAC) were obtained. Individuals were grouped into three categories according to the presence of CAD, resulting in absent (CAD), non-obstructive (CAD) or obstructive (CAD) disease-groups. Relation of EFV with CAD was assessed with two approaches: 1) presence of any CAD; 2) each individual CAD category.

Results: Median EFV was 90.52 ml (range 11.27-442.21 ml); median CAC was 56.5 (range 0-10,144); 848 individuals (63.1%) were categorized as CAD, 326 (24.3%) as CAD, 170 (12.6%) as CAD. EFV was lower in subjects without CAC (EFV = 66.5 ml), as compared to those with CAC 0.1-100 (EFV = 91.47), CAC 100.1-400 (EFV = 97.46) and CAC >400 (EFV = 109.48) (p < 0.001). EFV was lower in CAD (EFV = 87.21 ml), as compared to CAD (EFV = 93.89 ml) and CAD (EFV = 102.98 ml) individuals (p < 0.001). A logistic regression model built by including demographic and clinical variables showed inconsistent predictive value of EFV for either CAD or CAD (p > 0.05).

Conclusions: In the setting of symptomatic individuals, an increased amount of epicardial fat was associated with larger amount of coronary artery calcifications and was observed in individuals with obstructive CAD, however without predictive value to confidently determine CAD presence and severity.
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http://dx.doi.org/10.1016/j.ijcard.2020.04.031DOI Listing
September 2020

Well-aerated Lung on Admitting Chest CT to Predict Adverse Outcome in COVID-19 Pneumonia.

Radiology 2020 08 17;296(2):E86-E96. Epub 2020 Apr 17.

From the Department of Radiological Functions, Radiology Unit, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121, Piacenza, Italy (D.C., F.C.B., M.P., G. Maffi, N.M., E.M.); and Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (G. Milanese, M.S., N.S.).

Background CT of patients with severe acute respiratory syndrome coronavirus 2 disease depicts the extent of lung involvement in coronavirus disease 2019 (COVID-19) pneumonia. Purpose To determine the value of quantification of the well-aerated lung (WAL) obtained at admission chest CT to determine prognosis in patients with COVID-19 pneumonia. Materials and Methods Imaging of patients admitted at the emergency department between February 17 and March 10, 2020 who underwent chest CT were retrospectively analyzed. Patients with negative results of reverse-transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 at nasal-pharyngeal swabbing, negative chest CT findings, and incomplete clinical data were excluded. CT images were analyzed for quantification of WAL visually (%V-WAL), with open-source software (%S-WAL), and with absolute volume (VOL-WAL). Clinical parameters included patient characteristics, comorbidities, symptom type and duration, oxygen saturation, and laboratory values. Logistic regression was used to evaluate the relationship between clinical parameters and CT metrics versus patient outcome (intensive care unit [ICU] admission or death vs no ICU admission or death). The area under the receiver operating characteristic curve (AUC) was calculated to determine model performance. Results The study included 236 patients (59 of 123 [25%] were female; median age, 68 years). A %V-WAL less than 73% (odds ratio [OR], 5.4; 95% confidence interval [CI]: 2.7, 10.8; < .001), %S-WAL less than 71% (OR, 3.8; 95% CI: 1.9, 7.5; < .001), and VOL-WAL less than 2.9 L (OR, 2.6; 95% CI: 1.2, 5.8; < .01) were predictors of ICU admission or death. In comparison with clinical models containing only clinical parameters (AUC = 0.83), all three quantitative models showed better diagnostic performance (AUC = 0.86 for all models). The models containing %V-WAL less than 73% and VOL-WAL less than 2.9 L were superior in terms of performance as compared with the models containing only clinical parameters ( = .04 for both models). Conclusion In patients with confirmed coronavirus disease 2019 pneumonia, visual or software quantification of the extent of CT lung abnormality were predictors of intensive care unit admission or death. ©  RSNA, 2020
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http://dx.doi.org/10.1148/radiol.2020201433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233411PMC
August 2020

Integrated Radiologic Algorithm for COVID-19 Pandemic.

J Thorac Imaging 2020 Jul;35(4):228-233

Unit of Radiological Sciences, Department of Medicine and Surgery, University of Parma, Parma.

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http://dx.doi.org/10.1097/RTI.0000000000000516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253044PMC
July 2020

CT angiography for pulmonary embolism in the emergency department: investigation of a protocol by 20 ml of high-concentration contrast medium.

Radiol Med 2020 Feb 28;125(2):137-144. Epub 2019 Oct 28.

Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Pad. Barbieri, via Gramsci 14, 43126, Parma, Italy.

Objectives: To retrospectively compare semi-qualitative and quantitative CT pulmonary angiography (CTPAs) image metrics testing diagnostic performance between protocols performed by 20 or 40 ml of contrast medium (CM) in patients with suspected pulmonary embolism (PE).

Methods: A total of 102 CTPAs performed by 20 ml (ultra-low volume: ULV) and 74 CTPAs performed by 40 ml (low volume: LV) protocol for the diagnosis of clinically suspected PE performed between October 2012 and September 2013 were retrieved. High-concentration CM (Iomeprol 400 mgI/ml) was injected at 3 ml/s (iodine delivery rate 1.2 mgI/s). Two radiologists (blinded and independent) semi-qualitatively scored vascular enhancement and image noise according to a five-point visual scoring system. Quantitative analysis was performed by regions of interest quantifying densitometric parameters, such as central and peripheral pulmonary arteries vascular contrast enhancement (CE, threshold for diagnostic CE ≥ 250 HU), and metrics for image noise. Continuous variables were compared by the Student's t test between groups if normally distributed while categorical variables were analyzed with the Chi-squared test. Interobserver agreement was calculated by the weighted kappa test; correlation coefficients were calculated using Pearson's correlation tests.

Results: The semi-qualitative scores for central and peripheral pulmonary arteries vascular CE were sufficient by ULV, yet inferior than LV (p < 0.001). Semi-qualitative image noise was comparable between ULV and LV, and the interobserver agreement was only fair for quality of peripheral vessels. Agreement on nondiagnostic semi-qualitative parameters was seen in 9/102 (8.8%) ULV CTPAs, in particular associated with massive PE (2/9), pleuro-pulmonary abnormalities (5/9) or without major abnormalities (2/9). Quantitative analysis showed that mean CE was lower in ULV group (p < 0.001), though greater than the diagnostic threshold of 250 HU in both groups.

Conclusions: Diagnostic vascular CE (> 250 HU) was obtained in both 20 ml and 40 ml CTPAs. CTPA by 20 ml of CM rendered diagnostic CE for the assessment of pulmonary arteries in patients with clinical suspicion of acute PE. Decreased image quality was mostly associated with massive PE or concomitant pleuro-parenchymal abnormalities.
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http://dx.doi.org/10.1007/s11547-019-01098-6DOI Listing
February 2020

Lung cancer screening: tell me more about post-test risk.

J Thorac Dis 2019 Sep;11(9):3681-3688

Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy.

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http://dx.doi.org/10.21037/jtd.2019.09.28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790433PMC
September 2019

Volumetric assessment of solid pulmonary nodules on ultralow-dose CT: a phantom study.

J Thorac Dis 2019 Aug;11(8):3515-3524

Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.

Background: To reduce the radiation exposure from chest computed tomography (CT), ultralow-dose CT (ULDCT) protocols performed at sub-millisievert levels were previously tested for the evaluation of pulmonary nodules (PNs). The purpose of our study was to investigate the effect of ULDCT and iterative image reconstruction on volumetric measurements of solid PNs.

Methods: CT datasets of an anthropomorphic chest phantom containing solid microspheres were obtained with a third-generation dual-source CT at standard dose, 1/8th, 1/20th and 1/70th of standard dose [CT volume dose index (CTDI): 0.03-2.03 mGy]. Semi-automated volumetric measurements were performed on CT datasets reconstructed with filtered back projection (FBP) and advanced modelled iterative reconstruction (ADMIRE), at strength level 3 and 5. Absolute percentage error (APE) evaluated measurement accuracy related to the effective volume. Scan repetition differences were evaluated using Bland-Altman analysis. Two-way analysis of variance (ANOVA) assessed influence of different scan parameters on APE. Proportional differences (PDs) tested the effect of dose settings and reconstruction algorithms on volumetric measurements, as compared to the standard protocol (standard dose-FBP).

Results: Bland-Altman analysis revealed small mean interscan differences of APE with narrow limits of agreement (-0.1%±4.3% to -0.3%±3.8%). Dose settings (P<0.001), reconstruction algorithms (P<0.001), nodule diameters (P<0.001) and nodule density (P=0.011) had statistically significant influence on APE. Post-hoc Bonferroni tests showed slightly higher APE when scanning with 1/70th of standard dose [mean difference: 3.4%, 95% confidence interval (CI): 2.5-4.3%; P<0.001], and for image reconstruction with ADMIRE5 (mean difference: 1.8%, 95% CI: 1.0-2.5%; P<0.001). No significant differences for scanning with 1/20th of standard dose (P=0.42), and image reconstruction with ADMIRE3 (P=0.19) were found. Scanning with 1/70th of standard dose and image reconstruction with FBP showed the widest range of PDs (-16.8% to 23.4%) compared to standard dose-FBP.

Conclusions: Our phantom study showed no significant difference between nodule volume measurements on standard dose CT (CTDI: 2 mGy) and ULDCT with 1/20th of standard dose (CTDI: 0.10 mGy).
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http://dx.doi.org/10.21037/jtd.2019.08.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753441PMC
August 2019

Prognostic and predictive value of histogram analysis in patients with non-small cell lung cancer refractory to platinum treated by nivolumab: A multicentre retrospective study.

Eur J Radiol 2019 Sep 17;118:251-256. Epub 2019 Jul 17.

University of Brescia, Department of Radiology, P.le Spedali Civili 1, 25123, Brescia, Italy. Electronic address:

Purpose: The aim of this study was to assess computed-tomography histogram analysis (CTHA) as prognostic and predictive factor in platinum-refractory non-small cell lung carcinoma (NSCLC) treated with immune checkpoint inhibitor Nivolumab.

Method: One hundred and four patients were enrolled from 3 different centers. CT was performed using similar parameters among different scanners. CTHA was performed with the proprietary software TexRAD, which extracts histogram features at different spatial scale (spatial scale filters, SSF) producing 30 CTHA features per patients. Cross-validated Least Absolute Shrinkage and Selection Operator LASSO was used to select those features which were related to overall and progression-free survival (OS and PFS, respectively). High- and low-risk subgroups were identified using the best cutoff.

Results: Median follow-up was 13.8 weeks. Median OS and PFS were 7.3 and 3 months, respectively. LASSO selected kurtosis obtained by SSF = 4 mm as the single feature related to OS, leading to an hazard ratio (HR) of 0.476 (95%CI 0.29-0.77). PFS was related with kurtosis SSF = 6 mm, with HR of 0.556 (95%CI 0.36-0.86).

Conclusion: Despite its limitations, this study is the first which suggests that CTHA could play a role in stratifying prognosis and treatment response in patients with NSCLC treated with Nivolumab.
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http://dx.doi.org/10.1016/j.ejrad.2019.07.019DOI Listing
September 2019

Quantitative CT texture analysis for diagnosing systemic sclerosis: Effect of iterative reconstructions and radiation doses.

Medicine (Baltimore) 2019 Jul;98(29):e16423

Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse, Zurich, Switzerland.

To test whether texture analysis (TA) can discriminate between Systemic Sclerosis (SSc) and non-SSc patients in computed tomography (CT) with different radiation doses and reconstruction algorithms.In this IRB-approved retrospective study, 85 CT scans at different radiation doses [49 standard dose CT (SDCT) with a volume CT dose index (CTDIvol) of 4.86 ± 2.1 mGy and 36 low-dose (LDCT) with a CTDIvol of 2.5 ± 1.5 mGy] were selected; 61 patients had Ssc ("cases"), and 24 patients had no SSc ("controls"). CT scans were reconstructed with filtered-back projection (FBP) and with sinogram-affirmed iterative reconstruction (SAFIRE) algorithms. 304 TA features were extracted from each manually drawn region-of-interest at 6 pre-defined levels: at the midpoint between lung apices and tracheal carina, at the level of the tracheal carina, and 4 between the carina and pleural recesses. Each TA feature was averaged between these 6 pre-defined levels and was used as input in the machine learning algorithm artificial neural network (ANN) with backpropagation (MultilayerPerceptron) for differentiating between SSc and non-SSc patients.Results were compared regarding correctly/incorrectly classified instances and ROC-AUCs.ANN correctly classified individuals in 93.8% (AUC = 0.981) of FBP-LDCT, in 78.5% (AUC = 0.859) of FBP-SDCT, in 91.1% (AUC = 0.922) of SAFIRE3-LDCT and 75.7% (AUC = 0.815) of SAFIRE3-SDCT, in 88.1% (AUC = 0.929) of SAFIRE5-LDCT and 74% (AUC = 0.815) of SAFIRE5-SDCT.Quantitative TA-based discrimination of CT of SSc patients is possible showing highest discriminatory power in FBP-LDCT images.
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http://dx.doi.org/10.1097/MD.0000000000016423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709180PMC
July 2019

Comparison of ultra-low dose chest CT scanning protocols for the detection of pulmonary nodules: a phantom study.

Tumori 2019 Oct 1;105(5):394-403. Epub 2019 May 1.

Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy.

Purpose: To test ultra-low-dose computed tomography (ULDCT) scanning protocols for the detection of pulmonary nodules (PN).

Methods: A chest phantom containing 19 solid and 11 subsolid PNs was scanned on a third-generation dual-source computed tomography (CT) scanner. Five ULDCT scans (Sn100kVp and 120, 70, 50, 30, and 20 reference mAs, using tube current modulation), reconstructed with iterative reconstruction (IR) algorithm at strength levels 2, 3, 4, and 5, were compared with standard CT (120kVp, 150 reference mAs, using tube current modulation). PNs were subjectively assessed according to a 4-point scale: 0, nondetectable nodule; 1, detectable nodule, very unlikely to be correctly measured; 2, detectable nodule, likely to be correctly measured; 3, PN quality equal to standard of reference. PN scores were analysed according to the Lung Imaging Reporting and Data System (Lung-RADS), simulating detection of nodules at baseline and incidence screening round.

Results: For the baseline round, there were 17 Lung-RADS 2, 4 Lung-RADS 3, 8 Lung-RADS 4A, and 1 Lung-RADS 4B PNs. They were detectable in any ULDCT protocol, with the exception of 1 nondetectable part-solid nodule in 1 scanning protocol (120 reference mAs; IR strength: 3). For the incidence round, there were 4 Lung-RADS 2, 14 Lung-RADS 3, 2 Lung-RADS 4A, and 10 Lung-RADS 4B PNs. Ten were nondetectable in at least one ULDCT dataset; however, they were at least detectable in ULDCT with 70 reference mAs (IR strength: 4 and 5).

Conclusions: ULDCT scanning protocols allowing the detection of PNs can be proposed for the purpose of lung cancer screening.
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http://dx.doi.org/10.1177/0300891619847271DOI Listing
October 2019

Spread through air spaces in lung adenocarcinoma: is radiology reliable yet?

J Thorac Dis 2019 Mar;11(Suppl 3):S256-S261

Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy.

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http://dx.doi.org/10.21037/jtd.2019.01.96DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424723PMC
March 2019

Computed Tomography Pulmonary Angiography during Pregnancy: Radiation Dose of Commonly Used Protocols and the Effect of Scan Length Optimization.

Korean J Radiol 2019 02;20(2):313-322

Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.

Objective: To evaluate the radiation dose for pregnant women and fetuses undergoing commonly used computed tomography of the pulmonary arteries (CTPA) scan protocols and subsequently evaluate the simulated effect of an optimized scan length.

Materials And Methods: A total of 120 CTPA datasets were acquired using four distinctive scan protocols, with 30 patients per protocol. These datasets were mapped to Cristy phantoms in order to simulate pregnancy and to assess the effect of an effective radiation dose (in mSv) in the first, second, or third trimester of pregnancy, including a simulation of fetal dose in second and third trimesters. The investigated scan protocols involved a 64-slice helical scan at 120 kVp, a high-pitch dual source acquisition at 100 kVp, a dual-energy acquisition at 80/140 kVp, and an automated-kV-selection, high pitch helical scan at a reference kV of 100 kV. The effective dose for women and fetuses was simulated before and after scan length adaptation. The original images were interpreted before and after scan length adaptations to evaluate potentially missed diagnoses.

Results: Large inter-scanner and inter-protocol variations were found; application of the latest technology decreased the dose for non-pregnant women by 69% (7.0-2.2 mSv). Individual scan length optimization proved safe and effective, decreasing the fetal dose by 76-83%. Nineteen (16%) cases of pulmonary embolism were diagnosed and, after scan length optimization, none were missed.

Conclusion: Careful CTPA scan protocol selection and additional optimization of scan length may result in significant radiation dose reduction for a pregnant patient and her fetus, whilst maintaining diagnostic confidence.
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http://dx.doi.org/10.3348/kjr.2017.0779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342764PMC
February 2019

Quantification of epicardial fat with cardiac CT angiography and association with cardiovascular risk factors in symptomatic patients: from the ALTER-BIO (Alternative Cardiovascular Bio-Imaging markers) registry.

Diagn Interv Radiol 2019 Jan;25(1):35-41

Cardiovascular Imaging Center SDN IRCCS, Naples, Italy.

Purpose: We aimed to assess the association between features of epicardial adipose tissue and demographic, morphometric and clinical data, in a large population of symptomatic patients with clinical indication to cardiac computed tomography (CT) angiography.

Methods: Epicardial fat volume (EFV) and adipose CT density of 1379 patients undergoing cardiac CT angiography (918 men, 66.6%; age range, 18-93 years; median age, 64 years) were semi-automatically quantified. Clinical variables were compared between diabetic and nondiabetic patients to assess potential differences in EFV and adipose CT density. Multiple regression models were calculated to find the clinical variables with a significant association with EFV and adipose CT density.

Results: The median EFV in diabetic patients (112.87 mL) was higher compared with nondiabetic patients (82.62 mL; P < 0.001). The explanatory model of the multivariable analysis showed the strongest associations between EFV and BMI (β=0.442) and age (β=0.365). Significant yet minor association was found with sex (β=0.203), arterial hypertension (β=0.072), active smoking (β=0.068), diabetes (β=0.068), hypercholesterolemia (β=0.046) and cardiac height (β=0.118). The mean density of epicardial adipose tissue was associated with BMI (β=0.384), age (β=0.105), smoking (β=0.088), and diabetes (β=0.085).

Conclusion: In a large population of symptomatic patients, EFV is higher in diabetic patients compared with nondiabetic patients. Clinical variables are associated with quantitative features of epicardial fat.
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http://dx.doi.org/10.5152/dir.2018.18037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339622PMC
January 2019