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Li T, Li W, Chen F, Xu Q, Du G, Fu Y, Yuan L, Zhang S, Wu W, He P, Xia M. The chest X-ray score baseline in predicting continuous oxygen therapy failure in low-risk aged patients after thoracic surgery. J Thorac Dis 2024; 16:1885-1899. [PMID: 38617782 PMCID: PMC11009605 DOI: 10.21037/jtd-23-1786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/02/2024] [Indexed: 04/16/2024]
Abstract
Background Radiographic severity assessment can be instrumental in diagnosing postoperative pulmonary complications (PPCs) and guiding oxygen therapy. The radiographic assessment of lung edema (RALE) and Brixia scores correlate with disease severity, but research on low-risk elderly patients is lacking. This study aimed to assess the efficacy of two chest X-ray scores in predicting continuous oxygen therapy (COT) treatment failure in patients over 70 years of age after thoracic surgery. Methods From January 2019 to December 2021, we searched for patients aged 70 years and above who underwent thoracic surgery and received COT treatment, with a focus on those at low risk of respiratory complications. Bedside chest X-rays, RALE, Brixia scores, and patient data were collected. Univariate, multivariate analyses, and 1:2 matching identified risk factors. Receiver operating characteristic (ROC) curves determined score sensitivity, specificity, and predictive values. Results Among the 242 patients surviving to discharge, 19 (7.9%) patients experienced COT failure. COT failure correlated with esophageal cancer surgeries, thoracotomies (36.8% vs. 9%, P=0.003; 26.3% vs. 9.4%, P=0.004), and longer operation time (3.4 vs. 2.8 h, P=0.003). Surgical approach and RALE score were independent risk factors. The prediction model had an area under the curve (AUC) of 0.839 [95% confidence interval (CI), 0.740-0.938]. Brixia and RALE scores predicted COT failure with AUCs of 0.764 (95% CI, 0.650-0.878) with a cut-off value of 6.027 and 0.710 (95% CI, 0.588-0.832) with a cut-off value of 17.134, respectively, after 1:2 matching. Conclusions The RALE score predict the risk of COT failure in elderly, low-risk thoracic patients better than the Brixia score. This simple, cheap, and noninvasive method helps evaluate postoperative lung damage, monitor treatment response, and provide early warning for oxygen therapy escalation. Further studies are required to confirm the validity and applicability of this model in different settings and populations.
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Affiliation(s)
- Tongxin Li
- Department of Thoracic Surgery, First Affiliated Hospital of the Army Medical University, Army Medical University (Third Military Medical University), Chongqing, China
- Department of Digital Medicine, College of Biomedical Engineering and Medical Imaging, Army Medical University (Third Military Medical University), Chongqing, China
| | - Weina Li
- Department of Thoracic Surgery, First Affiliated Hospital of the Army Medical University, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fengxi Chen
- Department of Radiology, First Affiliated Hospital of the Army Medical University, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qianfeng Xu
- Department of Thoracic Surgery, First Affiliated Hospital of the Army Medical University, Army Medical University (Third Military Medical University), Chongqing, China
| | - Gaoli Du
- Department of Thoracic Surgery, First Affiliated Hospital of the Army Medical University, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yong Fu
- Department of Cardiothoracic Surgery, Dianjiang People’s Hospital of Chongqing, Chongqing, China
| | - Lihui Yuan
- Department of Thoracic Surgery, First Affiliated Hospital of the Army Medical University, Army Medical University (Third Military Medical University), Chongqing, China
| | - Sha Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of the Army Medical University, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wei Wu
- Department of Thoracic Surgery, First Affiliated Hospital of the Army Medical University, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ping He
- Department of Cardiac Surgery, First Affiliated Hospital of the Army Medical University, Army Medical University (Third Military Medical University), Chongqing, China
| | - Mei Xia
- Department of Thoracic Surgery, First Affiliated Hospital of the Army Medical University, Army Medical University (Third Military Medical University), Chongqing, China
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Nahar Shaima S, Haque MA, Sarmin M, Nuzhat S, Jahan Y, Bushra Matin F, Shahrin L, Afroze F, Saha H, Timu RT, Kamal M, Shahid ASMSB, Sultana N, Mamun GMS, Chisti MJ, Ahmed T. Performance of chest X-ray scoring in predicting disease severity and outcomes of patients hospitalised with COVID-19 in Bangladesh. SAGE Open Med 2024; 12:20503121231222325. [PMID: 38264406 PMCID: PMC10804927 DOI: 10.1177/20503121231222325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/06/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Evaluation of potential outcomes of COVID-19-affected pneumonia patients using computed tomography scans may not be conceivable in low-resource settings. Thus, we aimed to evaluate the performance of chest X-ray scoring in predicting the disease severity and outcomes of adults hospitalised with COVID-19. Methods This was a retrospective chart analysis consuming data from COVID-19-positive adults who had chest X-ray availability and were admitted to a temporary COVID unit, in Bangladesh from 23rd April 2020 to 15th November 2021. At least one clinical intensivist and one radiologist combinedly reviewed each admission chest X-ray for the different lung findings. Chest X-ray scoring varied from 0 to 8, depending on the area of lung involvement with 0 indicating no involvement and 8 indicating ⩾75% involvement of both lungs. The receiver operating characteristic curve was used to determine the optimum chest X-ray cut-off score for predicting the fatal outcomes. Result A total of 218 (82.9%) out of 263 COVID-19-affected adults were included in the study. The receiver operating characteristic curve demonstrated the optimum cut-off as ⩾3 and ⩾5 for disease severity and death, respectively. In multivariate logistic regression analysis, a chest X-ray score of ⩾3 was found to be independently associated with disease severity (aOR: 8.70; 95% CI: 3.82, 19.58, p < 0.001) and a score of ⩾5 with death (aOR: 16.53; 95% CI: 4.74, 57.60, p < 0.001) after adjusting age, sex, antibiotic usage before admission, history of fever, cough, diabetes mellitus, hypertension, total leukocytes count and C-reactive protein. Conclusion Using chest X-ray scoring derived cut-off at admission might help to identify the COVID-19-affected adults who are at risk of severe disease and mortality. This may help to initiate early and aggressive management of such patients, thereby reducing their fatal outcomes.
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Affiliation(s)
- Shamsun Nahar Shaima
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Md Ahshanul Haque
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Monira Sarmin
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Clinical and Diagnostic Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Sharika Nuzhat
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Clinical and Diagnostic Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Yasmin Jahan
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Fariha Bushra Matin
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Farzana Afroze
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Haimanti Saha
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Rehnuma Tabassum Timu
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Mehnaz Kamal
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | | | - Nadia Sultana
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Gazi Md. Salahuddin Mamun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Clinical and Diagnostic Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Clinical and Diagnostic Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Office of Executive the Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
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Karanth Marsur Prabhakar S, Ramaswamy S, Basavarajachar V, Chakraborty A, Shivananjiah A, Chikkavenkatappa N. Clinical and Laboratory Predictors of Mortality in Severe COVID-19 Pneumonia: A Retrospective Study from India. THORACIC RESEARCH AND PRACTICE 2023; 24:53-60. [PMID: 37503640 PMCID: PMC10332473 DOI: 10.5152/thoracrespract.2023.22029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 10/05/2022] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Wide arrays of laboratory parameters have been proposed by many studies for prognosis in COVID-19 patients. In this study, we wanted to determine if the International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score in addition to certain clinical and laboratory parameters would help in predicting mortality. We wanted to determine if a greater severity score on chest x-ray at presentation translated to poor patient outcomes using the COVID-19 chest radiography score. MATERIAL AND METHODS This retrospective study was conducted at SDS TRC and Rajiv Gandhi Institute of chest diseases, Bangalore from March 2021 to June 2021. This study included 202 real-time-polymerase chain reaction-positive COVID-19 patients aged above 18 years admitted to the intensive care unit of our hospital. Demographic characteristics and baseline hematological and inflammatory markers (serum C-reactive protein, lactate dehydrogenase, troponin-I, ferritin, and d-dimer) were collected. Radiological severity on a chest x-ray was assessed using the validated COVID-19 chest radiography score. The International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score was assigned to each patient within 24 hours of intensive care unit admission. Outcome studied was in-hospital mortality. RESULTS The overall mortality was 54.9% (111 cases). Age more than 50 years, >4 days of symptoms, peripheral oxygen saturation/ fraction of inspired oxygen ratio less than 200, elevated serum lactate dehydrogenase >398.5 IU/L, and hypoalbuminemia (<2.95 g/dL) were detected as independent predictors of mortality. A significant correlation of risk stratification with mortality (P = .057) was seen with International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score. There was no significant correlation between the COVID-19 chest radiography score and mortality. CONCLUSION Age >50 years, peripheral oxygen saturation/fraction of inspired oxygen ratio <200, mean symptom duration of >4 days, elevated serum lactate dehydrogenase, and hypoalbuminemia are independent predictors of mortality in severe COVID-19 pneumonia. International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score was different in the survivors and deceased.
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Affiliation(s)
- Swathi Karanth Marsur Prabhakar
- Department of Pulmonary Medicine, Shanthabai Devarao Shivaram Tuberculosis Research Center & Rajiv Gandhi Institute of Chest Diseases, Bangalore, Karnataka
| | - Swapna Ramaswamy
- Department of Pulmonary Medicine, Shanthabai Devarao Shivaram Tuberculosis Research Center & Rajiv Gandhi Institute of Chest Diseases, Bangalore, Karnataka
| | - Vanitha Basavarajachar
- The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) Projects, Swami Vivekananda Youth Movement, Bangalore, Karnataka
| | - Anushree Chakraborty
- Department of Pulmonary Medicine, Shanthabai Devarao Shivaram Tuberculosis Research Center & Rajiv Gandhi Institute of Chest Diseases, Bangalore, Karnataka
| | - Akshata Shivananjiah
- Department of Pulmonary Medicine, Shanthabai Devarao Shivaram Tuberculosis Research Center & Rajiv Gandhi Institute of Chest Diseases, Bangalore, Karnataka
| | - Nagaraja Chikkavenkatappa
- Shanthabai Devarao Shivaram Tuberculosis Research Center & Rajiv Gandhi Institute of Chest Diseases, Bangalore, Karnataka
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Prediction of oxygen requirement in patients with COVID-19 using a pre-trained chest radiograph xAI model: efficient development of auditable risk prediction models via a fine-tuning approach. Sci Rep 2022; 12:21164. [PMID: 36476724 PMCID: PMC9729627 DOI: 10.1038/s41598-022-24721-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Risk prediction requires comprehensive integration of clinical information and concurrent radiological findings. We present an upgraded chest radiograph (CXR) explainable artificial intelligence (xAI) model, which was trained on 241,723 well-annotated CXRs obtained prior to the onset of the COVID-19 pandemic. Mean area under the receiver operating characteristic curve (AUROC) for detection of 20 radiographic features was 0.955 (95% CI 0.938-0.955) on PA view and 0.909 (95% CI 0.890-0.925) on AP view. Coexistent and correlated radiographic findings are displayed in an interpretation table, and calibrated classifier confidence is displayed on an AI scoreboard. Retrieval of similar feature patches and comparable CXRs from a Model-Derived Atlas provides justification for model predictions. To demonstrate the feasibility of a fine-tuning approach for efficient and scalable development of xAI risk prediction models, we applied our CXR xAI model, in combination with clinical information, to predict oxygen requirement in COVID-19 patients. Prediction accuracy for high flow oxygen (HFO) and mechanical ventilation (MV) was 0.953 and 0.934 at 24 h and 0.932 and 0.836 at 72 h from the time of emergency department (ED) admission, respectively. Our CXR xAI model is auditable and captures key pathophysiological manifestations of cardiorespiratory diseases and cardiothoracic comorbidities. This model can be efficiently and broadly applied via a fine-tuning approach to provide fully automated risk and outcome predictions in various clinical scenarios in real-world practice.
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Goel S, Kipp A, Goel N, Kipp J. COVID-19 vs. Influenza: A Chest X-ray Comparison. Cureus 2022; 14:e31794. [DOI: 10.7759/cureus.31794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
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Elia D, Mozzanica F, Caminati A, Giana I, Carli L, Ambrogi F, Zompatori M, Harari S. Prognostic value of radiological index and clinical data in patients with COVID-19 infection. Intern Emerg Med 2022; 17:1679-1687. [PMID: 35596103 PMCID: PMC9122253 DOI: 10.1007/s11739-022-02985-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/05/2022] [Indexed: 01/08/2023]
Abstract
During the Coronavirus-19 pandemic, chest X-ray scoring system have been validated by Al-Smadi and Toussie in this group of patients and even RALE score, previously designed for ARDS, have been used to estimate correlation with mortality. The aim of this study was to evaluate the prognostic value of As-Smadi, Tuossie and RALE scores in predicting death in the same population of patients when associated to clinical data. In this retrospective clinical study, data of patients with COVID-19, admitted to our hospital from 1st October 2020 to 31st December 2020 were collected. CXR images of each patient were analyzed with the three different scores above mentioned. 144 patients (male 96 aged 68.5 years) were included in the study. 93 patients reported a least 1 comorbidity and 36 died. The association with increasing age, presence of comorbidities, and lower hemoglobin was significantly associated with risk of death for all the regression models. When considering the radiological score, a significant effect was found for the Al Smadi and RALE scores, while no evidence of association was found for the Toussie score. The fraction of new information is 16.7% for the Al Smadi score, 12.9% for the RALE and 5.1% for the Toussie score. The improvement in the prognostic usefulness with respect to the base model is particularly interesting for the Al Smadi score. The highest c-index was also obtained by the model with the Al Smadi score.
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Affiliation(s)
- Davide Elia
- Unità Di Pneumologia E Terapia Semi-Intensiva Respiratoria, Servizio Di Fisiopatologia Respiratoria Ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy
| | - Francesco Mozzanica
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy
| | - Antonella Caminati
- Unità Di Pneumologia E Terapia Semi-Intensiva Respiratoria, Servizio Di Fisiopatologia Respiratoria Ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy.
| | - Ilaria Giana
- Unità Di Pneumologia E Terapia Semi-Intensiva Respiratoria, Servizio Di Fisiopatologia Respiratoria Ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy
| | - Leonardo Carli
- Unità Di Pneumologia E Terapia Semi-Intensiva Respiratoria, Servizio Di Fisiopatologia Respiratoria Ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy
| | - Federico Ambrogi
- Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy
| | - Maurizio Zompatori
- U.O. Di Radiologia Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
| | - Sergio Harari
- Unità Di Pneumologia E Terapia Semi-Intensiva Respiratoria, Servizio Di Fisiopatologia Respiratoria Ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Kolahdouzan K, Chavoshi M, Bayani R, Darzikolaee NM. Low-Dose Whole Lung Irradiation for Treatment of COVID-19 Pneumonia: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2022; 113:946-959. [PMID: 35537577 PMCID: PMC9077801 DOI: 10.1016/j.ijrobp.2022.04.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE Studies dating back to a century ago have reported using low-dose radiation therapy for the treatment of viral and bacterial pneumonia. In the modern era, since the COVID-19 pandemic began, several groups worldwide have researched the applicability of whole lung irradiation (WLI) for the treatment of COVID-19. We aimed to bring together the results of these experimental studies. METHODS AND MATERIALS We performed a systematic review and meta-analysis searching PubMed and Scopus databases for clinical trials incorporating WLI for the treatment of patients with COVID-19. Required data were extracted from each study. Using the random-effects model, the overall pooled day 28 survival rate, survival hazard ratio, and intubation-free days within 15 days after WLI were calculated, and forest plots were produced. RESULTS Ten studies were identified, and eventually, 5 were included for meta-analysis. The overall survival hazard ratio was calculated to be 0.85 (0.46-1.57). The pooled mean difference of intubation-free days within 15 days after WLI was 1.87, favoring the WLI group (95% confidence interval, -0.02 to 3.76). The overall day 28 survival rate of patients receiving WLI for the 9 studies with adequate follow-up data was 74% (95% confidence interval, 61-87). Except for 2 studies, the other 8 studies were assessed to have moderate to high risk of bias, and there were many differences among the designs of the studies, included patients, primary endpoints, outcome measurement methods, and reporting of the results. CONCLUSIONS Despite a mild improvement in intubation-free days, WLI had no significant effect on patients' overall survival. Currently, we cannot recommend routine use of WLI for the treatment of patients with moderate-to-severe COVID-19.
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Affiliation(s)
- Kasra Kolahdouzan
- Department of Radiation Oncology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran,Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Chavoshi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Bayani
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran,Department of Radiation Oncology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nima Mousavi Darzikolaee
- Department of Radiation Oncology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran,Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran,Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran,Corresponding author: Nima Mousavi Darzikolaee, MD
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Liu J, Qi J, Chen W, Nian Y. Multi-branch fusion auxiliary learning for the detection of pneumonia from chest X-ray images. Comput Biol Med 2022; 147:105732. [PMID: 35779478 PMCID: PMC9212341 DOI: 10.1016/j.compbiomed.2022.105732] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/23/2022] [Accepted: 06/11/2022] [Indexed: 11/26/2022]
Abstract
Lung infections caused by bacteria and viruses are infectious and require timely screening and isolation, and different types of pneumonia require different treatment plans. Therefore, finding a rapid and accurate screening method for lung infections is critical. To achieve this goal, we proposed a multi-branch fusion auxiliary learning (MBFAL) method for pneumonia detection from chest X-ray (CXR) images. The MBFAL method was used to perform two tasks through a double-branch network. The first task was to recognize the absence of pneumonia (normal), COVID-19, other viral pneumonia and bacterial pneumonia from CXR images, and the second task was to recognize the three types of pneumonia from CXR images. The latter task was used to assist the learning of the former task to achieve a better recognition effect. In the process of auxiliary parameter updating, the feature maps of different branches were fused after sample screening through label information to enhance the model’s ability to recognize case of pneumonia without impacting its ability to recognize normal cases. Experiments show that an average classification accuracy of 95.61% is achieved using MBFAL. The single class accuracy for normal, COVID-19, other viral pneumonia and bacterial pneumonia was 98.70%, 99.10%, 96.60% and 96.80%, respectively, and the recall was 97.20%, 98.60%, 96.10% and 89.20%, respectively, using the MBFAL method. Compared with the baseline model and the model constructed using the above methods separately, better results for the rapid screening of pneumonia were achieved using MBFAL.
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Gharaibeh M, Elheis M, Khasawneh R, Al-Omari M, Jibril M, Dilki K, El-Obeid E, Altalhi M, Abualigah L. Chest Radiograph Severity Scores, Comorbidity Prevalence, and Outcomes of Patients with Coronavirus Disease Treated at the King Abdullah University Hospital in Jordan: A Retrospective Study. Int J Gen Med 2022; 15:5103-5110. [PMID: 35620646 PMCID: PMC9128829 DOI: 10.2147/ijgm.s360851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/12/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Hospitalized patients with coronavirus disease (COVID-19) often undergo chest x-ray (CXR). Utilizing CXR findings could reduce the cost of COVID-19 treatment and the resultant pressure on the Jordanian healthcare system. Methods We evaluated the association between the CXR severity score, based on the Radiographic Assessment of Lung Edema (RALE) scoring system, and outcomes of patients with COVID-19. The main objective of this work is to assess the role of the RALE scoring system in predicting in-hospital mortality and clinical outcomes of patients with COVID-19. Adults with a positive severe acute respiratory syndrome COVID-19 two reverse-transcription polymerase chain reaction test results and a baseline CXR image, obtained in November 2020, were included. The RALE severity scores were calculated by expert radiologists and categorized as normal, mild, moderate, and severe. Chi-square tests and multivariable logistic regression were used to assess the association between the severity category and admission location and clinical characteristics. Results Based on the multivariable regression analysis, it has been found that male sex, hypertension, and the RALE severity score were significantly associated with in-hospital mortality. The baseline RALE severity score was associated with the need for critical care (P<0.001), in-hospital mortality (P<0.001), and the admission location (P=0.002). Discussion The utilization of RALE severity scores helps to predict clinical outcomes and promote prudent use of resources during the COVID-19 pandemic.
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Affiliation(s)
- Maha Gharaibeh
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 2210, Jordan
| | - Mwaffaq Elheis
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 2210, Jordan
| | - Ruba Khasawneh
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 2210, Jordan
| | - Mamoon Al-Omari
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 2210, Jordan
| | - Mohammad Jibril
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 2210, Jordan
| | - Khalid Dilki
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 2210, Jordan
| | - Eyhab El-Obeid
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 2210, Jordan
| | - Maryam Altalhi
- Department of Management Information System, College of Business Administration, Taif University, Taif, 21944, Saudi Arabia
| | - Laith Abualigah
- Faculty of Computer Sciences and Informatics, Amman Arab University, Amman, 11953, Jordan
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Inoue A, Takahashi H, Ibe T, Ishii H, Kurata Y, Ishizuka Y, Batsaikhan B, Hamamoto Y. Application of the advanced lung cancer inflammation index for patients with coronavirus disease 2019 pneumonia: Combined risk prediction model with lung cancer inflammation index, computed tomography and chest radiograph. Exp Ther Med 2022; 23:388. [PMID: 35495600 PMCID: PMC9019768 DOI: 10.3892/etm.2022.11315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022] Open
Abstract
The purpose of the present study was to evaluate the feasibility of applying the advanced lung cancer inflammation index (ALI) in patients with coronavirus disease 2019 (COVID-19) and to establish a combined ALI and radiologic risk prediction model for disease exacerbation. The present study included patients diagnosed with COVID-19 infection in our single institution from March to October 2020. Patients without clinical information and/or chest computed tomography (CT) upon admission were excluded. A radiologist assessed the CT severity score and abnormality on chest radiograph. The combined ALI and radiologic risk prediction model was developed via random forest classification. Among 79 patients (age, 43±19 years; male/female, 45:34), 72 experienced improvement and seven patients experienced exacerbation after admission. Significant differences were observed between the improved and exacerbated groups in the ALI (median, 47.6 vs. 13.2; P=0.011), frequency of chest radiograph abnormality (24.7 vs. 83.3%; P<0.001), and chest CT score (CCTS; median, 1 vs. 9; P<0.001). For the accuracy of predicting exacerbation, the receiver-operating characteristic curve analysis demonstrated an area under the curve of 0.79 and 0.92 for the ALI and CCTS, respectively. The combined ALI and radiologic risk prediction model had a sensitivity of 1.00 and a specificity of 0.81. Overall, ALI alone and CCTS alone modestly predicted the exacerbation of COVID-19, and the combined ALI and radiologic risk prediction model exhibited decent sensitivity and specificity.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science Seta, Otsu, Shiga 520‑2192, Japan
| | | | - Tatsuya Ibe
- Department of Plumonary Medicine, National Hospital Organization Nishisaitama‑Chuo National Hospital, Tokorozawa, Saitama 359‑1151, Japan
| | - Hisashi Ishii
- Department of Plumonary Medicine, National Hospital Organization Nishisaitama‑Chuo National Hospital, Tokorozawa, Saitama 359‑1151, Japan
| | - Yuhei Kurata
- Department of Plumonary Medicine, National Hospital Organization Nishisaitama‑Chuo National Hospital, Tokorozawa, Saitama 359‑1151, Japan
| | - Yoshikazu Ishizuka
- Department of Radiology, National Hospital Organization Nishisaitama‑Chuo National Hospital, Tokorozawa, Saitama 359‑1151, Japan
| | - Bolorkhand Batsaikhan
- Department of Radiological Science, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo 116‑8551, Japan
| | - Yoichiro Hamamoto
- Department of Plumonary Medicine, National Hospital Organization Nishisaitama‑Chuo National Hospital, Tokorozawa, Saitama 359‑1151, Japan
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11
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Tracking and predicting COVID-19 radiological trajectory on chest X-rays using deep learning. Sci Rep 2022; 12:5616. [PMID: 35379856 PMCID: PMC8978501 DOI: 10.1038/s41598-022-09356-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 03/22/2022] [Indexed: 12/29/2022] Open
Abstract
Radiological findings on chest X-ray (CXR) have shown to be essential for the proper management of COVID-19 patients as the maximum severity over the course of the disease is closely linked to the outcome. As such, evaluation of future severity from current CXR would be highly desirable. We trained a repurposed deep learning algorithm on the CheXnet open dataset (224,316 chest X-ray images of 65,240 unique patients) to extract features that mapped to radiological labels. We collected CXRs of COVID-19-positive patients from an open-source dataset (COVID-19 image data collection) and from a multi-institutional local ICU dataset. The data was grouped into pairs of sequential CXRs and were categorized into three categories: ‘Worse’, ‘Stable’, or ‘Improved’ on the basis of radiological evolution ascertained from images and reports. Classical machine-learning algorithms were trained on the deep learning extracted features to perform immediate severity evaluation and prediction of future radiological trajectory. Receiver operating characteristic analyses and Mann-Whitney tests were performed. Deep learning predictions between “Worse” and “Improved” outcome categories and for severity stratification were significantly different for three radiological signs and one diagnostic (‘Consolidation’, ‘Lung Lesion’, ‘Pleural effusion’ and ‘Pneumonia’; all P < 0.05). Features from the first CXR of each pair could correctly predict the outcome category between ‘Worse’ and ‘Improved’ cases with a 0.81 (0.74–0.83 95% CI) AUC in the open-access dataset and with a 0.66 (0.67–0.64 95% CI) AUC in the ICU dataset. Features extracted from the CXR could predict disease severity with a 52.3% accuracy in a 4-way classification. Severity evaluation trained on the COVID-19 image data collection had good out-of-distribution generalization when testing on the local dataset, with 81.6% of intubated ICU patients being classified as critically ill, and the predicted severity was correlated with the clinical outcome with a 0.639 AUC. CXR deep learning features show promise for classifying disease severity and trajectory. Once validated in studies incorporating clinical data and with larger sample sizes, this information may be considered to inform triage decisions.
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12
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O'Shea A, Li MD, Mercaldo ND, Balthazar P, Som A, Yeung T, Succi MD, Little BP, Kalpathy-Cramer J, Lee SI. Intubation and mortality prediction in hospitalized COVID-19 patients using a combination of convolutional neural network-based scoring of chest radiographs and clinical data. BJR Open 2022; 4:20210062. [PMID: 36105420 PMCID: PMC9459864 DOI: 10.1259/bjro.20210062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To predict short-term outcomes in hospitalized COVID-19 patients using a model incorporating clinical variables with automated convolutional neural network (CNN) chest radiograph analysis. Methods A retrospective single center study was performed on patients consecutively admitted with COVID-19 between March 14 and April 21 2020. Demographic, clinical and laboratory data were collected, and automated CNN scoring of the admission chest radiograph was performed. The two outcomes of disease progression were intubation or death within 7 days and death within 14 days following admission. Multiple imputation was performed for missing predictor variables and, for each imputed data set, a penalized logistic regression model was constructed to identify predictors and their functional relationship to each outcome. Cross-validated area under the characteristic (AUC) curves were estimated to quantify the discriminative ability of each model. Results 801 patients (median age 59; interquartile range 46-73 years, 469 men) were evaluated. 36 patients were deceased and 207 were intubated at 7 days and 65 were deceased at 14 days. Cross-validated AUC values for predictive models were 0.82 (95% CI, 0.79-0.86) for death or intubation within 7 days and 0.82 (0.78-0.87) for death within 14 days. Automated CNN chest radiograph score was an important variable in predicting both outcomes. Conclusion Automated CNN chest radiograph analysis, in combination with clinical variables, predicts short-term intubation and death in patients hospitalized for COVID-19 infection. Chest radiograph scoring of more severe disease was associated with a greater probability of adverse short-term outcome. Advances in knowledge Model-based predictions of intubation and death in COVID-19 can be performed with high discriminative performance using admission clinical data and convolutional neural network-based scoring of chest radiograph severity.
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Affiliation(s)
- Aileen O'Shea
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Matthew D Li
- Department of Radiology and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, United States
| | - Nathaniel D Mercaldo
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Patricia Balthazar
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Avik Som
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | | | - Marc D Succi
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Brent P Little
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, MGH and BWH Center for Clinical Data Science, Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
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13
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D'souza MM, Kaushik A, Dsouza JM, Kanwar R, Lodhi V, Sharma R, Mishra AK. Does the initial chest radiograph severity in COVID-19 impact the short- and long-term outcome? - a perspective from India. Infect Dis (Lond) 2021; 54:335-344. [PMID: 34961400 DOI: 10.1080/23744235.2021.2018135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The chest radiograph (CXR) is among the most widely used investigations in coronavirus disease 2019 (COVID-19) patients. Little is known about its predictive role on the long-term outcome. The purpose of this study was to explore its association with the short and long-term outcome in COVID-19 patients. METHODS A total of 1530 patients were assessed for the presence, radiographic pattern and distribution of lung lesions observed on baseline chest radiographs obtained at admission. The Brixia scoring system was applied for semiquantitative assessment of lesion severity. Short-term outcome was determined by clinical severity, duration of hospitalization and mortality. The 1415 survivors in this group were assessed after 5-6 months for the presence of residual symptoms. RESULTS About 67% patients had an abnormal baseline CXR. Bilateral involvement with a basal preponderance was observed and ground-glass opacification was the most frequent finding. The Brixia score ranged from 0 to 16, median 2, interquartile range (IQR) [0-6]. About 36% patients were symptomatic on 5-6-month follow-up, with fatigability being the commonest symptom. A good correlation was observed between the CXR score and disease severity as well as duration of hospitalization. On multivariate analysis, the CXR score was found to be a significant independent predictor of in-patient mortality as well as presence of long-term residual symptoms in survivors. CONCLUSIONS Disease severity as seen on the chest radiograph appears to play an important role in driving the short and long-term consequences of COVID-19 and could serve as a prognostic indicator, which influences short-term management and long-term follow-up.
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Affiliation(s)
- Maria M D'souza
- Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Aruna Kaushik
- Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | | | - Ratnesh Kanwar
- Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Vivek Lodhi
- Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Rajnish Sharma
- Institute of Nuclear Medicine and Allied Sciences, Delhi, India
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14
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Adarve Castro A, Díaz Antonio T, Cuartero Martínez E, García Gallardo MM, Bermá Gascón ML, Domínguez Pinos D. Usefulness of chest X-rays for evaluating prognosis in patients with COVID-19. RADIOLOGIA 2021; 63:476-483. [PMID: 34801180 PMCID: PMC8596881 DOI: 10.1016/j.rxeng.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/19/2021] [Indexed: 12/11/2022]
Abstract
Background and aims The pandemia caused by SARS-CoV-2 (COVID-19) has been a diagnostic challenge in which chest X-rays have had a key role. This study aimed to determine whether the Radiological Scale for Evaluating Hospital Admission (RSEHA) applied to chest X-rays of patients with COVID-19 when they present at the emergency department is related with the severity of COVID-19 in terms of the need for admission to the hospital, the need for admission to the intensive care unit (ICU), and/or mortality. Material and methods This retrospective study included 292 patients with COVID-19 who presented at the emergency department between March 16, 2020 and April 30, 2020. To standardize the radiologic patterns, we used the RSEHA, categorizing the radiologic pattern as mild, moderate, or severe. We analyzed the relationship between radiologic severity according to the RSEHA with the need for admission to the hospital, admission to the ICU, and mortality. Results Hospital admission was necessary in 91.4% of the patients. The RSEHA was significantly associated with the need for hospital admission (p = 0.03) and with the need for ICU admission (p < 0.001). A total of 51 (17.5%) patients died; of these, 57% had the severe pattern on the RSEHA. When we analyzed mortality by grouping patients according to their results on the RSEHA and their age range, the percentage of patients who died increased after age 70 years in patients classified as moderate or severe on the RSEHA. Conclusions Chest X-rays in patients with COVID-19 obtained in the emergency department are useful for determining the prognosis in terms of admission to the hospital, admission to the ICU, and mortality; radiologic patterns categorized as severe on the RSEHA are associated with greater mortality and admission to the ICU.
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Affiliation(s)
- A Adarve Castro
- MIR-2 de Radiodiagnóstico, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
| | - T Díaz Antonio
- FEA. Radiodiagnóstico. Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - E Cuartero Martínez
- FEA. Radiodiagnóstico. Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - M M García Gallardo
- FEA. Radiodiagnóstico. Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - M L Bermá Gascón
- FEA. Radiodiagnóstico. Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - D Domínguez Pinos
- FEA. Radiodiagnóstico. Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
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15
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Au-Yong I, Higashi Y, Giannotti E, Fogarty A, Morling JR, Grainge M, Race A, Juurlink I, Simmonds M, Briggs S, Cruikshank S, Hammond-Pears S, West J, Crooks CJ, Card T. Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19. Radiology 2021; 302:460-469. [PMID: 34519573 PMCID: PMC8475750 DOI: 10.1148/radiol.2021210986] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Radiographic severity may help predict patient deterioration and
outcomes from COVID-19 pneumonia. Purpose To assess the reliability and reproducibility of three chest radiograph
reporting systems (radiographic assessment of lung edema [RALE], Brixia,
and percentage opacification) in patients with proven SARS-CoV-2
infection and examine the ability of these scores to predict adverse
outcomes both alone and in conjunction with two clinical scoring
systems, National Early Warning Score 2 (NEWS2) and International Severe
Acute Respiratory and Emerging Infection Consortium: Coronavirus
Clinical Characterization Consortium (ISARIC-4C) mortality. Materials and Methods This retrospective cohort study used routinely collected clinical data
of patients with polymerase chain reaction–positive SARS-CoV-2
infection admitted to a single center from February 2020 through July
2020. Initial chest radiographs were scored for RALE, Brixia, and
percentage opacification by one of three radiologists. Intra- and
interreader agreement were assessed with intraclass correlation
coefficients. The rate of admission to the intensive care unit (ICU) or
death up to 60 days after scored chest radiograph was estimated. NEWS2
and ISARIC-4C mortality at hospital admission were calculated. Daily
risk for admission to ICU or death was modeled with Cox proportional
hazards models that incorporated the chest radiograph scores adjusted
for NEWS2 or ISARIC-4C mortality. Results Admission chest radiographs of 50 patients (mean age, 74 years ±
16 [standard deviation]; 28 men) were scored by all three radiologists,
with good interreader reliability for all scores, as follows: intraclass
correlation coefficients were 0.87 for RALE (95% CI: 0.80, 0.92), 0.86
for Brixia (95% CI: 0.76, 0.92), and 0.72 for percentage opacification
(95% CI: 0.48, 0.85). Of 751 patients with a chest radiograph, those
with greater than 75% opacification had a median time to ICU admission
or death of just 1–2 days. Among 628 patients for whom data were
available (median age, 76 years [interquartile range, 61–84
years]; 344 men), opacification of 51%–75% increased risk for ICU
admission or death by twofold (hazard ratio, 2.2; 95% CI: 1.6, 2.8), and
opacification greater than 75% increased ICU risk by fourfold (hazard
ratio, 4.0; 95% CI: 3.4, 4.7) compared with opacification of
0%–25%, when adjusted for NEWS2 score. Conclusion Brixia, radiographic assessment of lung edema, and percentage
opacification scores all reliably helped predict adverse outcomes in
SARS-CoV-2 infection. © RSNA, 2021 Online supplemental material is available for this
article. See also the editorial by Little in this issue.
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Affiliation(s)
- Iain Au-Yong
- Department of Radiology, Nottingham University Hospitals NHS Trust, NG7 2UH
| | - Yutaro Higashi
- Department of Radiology, Nottingham University Hospitals NHS Trust, NG7 2UH
| | | | - Andrew Fogarty
- Nottingham University Hospitals NHS Trust.,Population and Lifespan Sciences, School of Medicine, University of Nottingham, NG5 1PB.,NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, NG7 2UH
| | - Joanne R Morling
- Nottingham University Hospitals NHS Trust.,Population and Lifespan Sciences, School of Medicine, University of Nottingham, NG5 1PB.,NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, NG7 2UH
| | - Matthew Grainge
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, NG5 1PB
| | | | | | | | | | | | | | - Joe West
- Nottingham University Hospitals NHS Trust.,Population and Lifespan Sciences, School of Medicine, University of Nottingham, NG5 1PB.,NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, NG7 2UH.,East Midlands Academic Health Science Network, University of Nottingham, Nottingham, NG7 2TU
| | - Colin J Crooks
- Nottingham University Hospitals NHS Trust.,Translational Medical Sciences, School of Medicine, University of Nottingham, NG7 2UH.,NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, NG7 2UH
| | - Timothy Card
- Nottingham University Hospitals NHS Trust.,Population and Lifespan Sciences, School of Medicine, University of Nottingham, NG5 1PB.,NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, NG7 2UH
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16
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Nabavi S, Ejmalian A, Moghaddam ME, Abin AA, Frangi AF, Mohammadi M, Rad HS. Medical imaging and computational image analysis in COVID-19 diagnosis: A review. Comput Biol Med 2021; 135:104605. [PMID: 34175533 PMCID: PMC8219713 DOI: 10.1016/j.compbiomed.2021.104605] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 12/11/2022]
Abstract
Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. The disease presents with symptoms such as shortness of breath, fever, dry cough, and chronic fatigue, amongst others. The disease may be asymptomatic in some patients in the early stages, which can lead to increased transmission of the disease to others. This study attempts to review papers on the role of imaging and medical image computing in COVID-19 diagnosis. For this purpose, PubMed, Scopus and Google Scholar were searched to find related studies until the middle of 2021. The contribution of this study is four-fold: 1) to use as a tutorial of the field for both clinicians and technologists, 2) to comprehensively review the characteristics of COVID-19 as presented in medical images, 3) to examine automated artificial intelligence-based approaches for COVID-19 diagnosis, 4) to express the research limitations in this field and the methods used to overcome them. Using machine learning-based methods can diagnose the disease with high accuracy from medical images and reduce time, cost and error of diagnostic procedure. It is recommended to collect bulk imaging data from patients in the shortest possible time to improve the performance of COVID-19 automated diagnostic methods.
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Affiliation(s)
- Shahabedin Nabavi
- Faculty of Computer Science and Engineering, Shahid Beheshti University, Tehran, Iran.
| | - Azar Ejmalian
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ahmad Ali Abin
- Faculty of Computer Science and Engineering, Shahid Beheshti University, Tehran, Iran
| | - Alejandro F Frangi
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK
| | - Mohammad Mohammadi
- Department of Medical Physics, Royal Adelaide Hospital, Adelaide, South Australia, Australia; School of Physical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Hamidreza Saligheh Rad
- Quantitative MR Imaging and Spectroscopy Group (QMISG), Tehran University of Medical Sciences, Tehran, Iran
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17
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Adarve Castro A, Díaz Antonio T, Cuartero Martínez E, García Gallardo MM, Bermá Gascón ML, Domínguez Pinos D. Usefulness of chest X-rays for evaluating prognosis in patients with COVID-19. RADIOLOGIA 2021; 63:S0033-8338(21)00106-5. [PMID: 34243977 PMCID: PMC8260821 DOI: 10.1016/j.rx.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS The pandemia caused by SARS-CoV-2 (COVID-19) has been a diagnostic challenge in which chest X-rays have had a key role. This study aimed to determine whether the Radiological Scale for Evaluating Hospital Admission (RSEHA) applied to chest X-rays of patients with COVID-19 when they present at the emergency department is related with the severity of COVID-19 in terms of the need for admission to the hospital, the need for admission to the intensive care unit (ICU), and/or mortality. MATERIAL AND METHODS This retrospective study included 292 patients with COVID-19 who presented at the emergency department between March 16, 2020 and April 30, 2020. To standardize the radiologic patterns, we used the RSEHA, categorizing the radiologic pattern as mild, moderate, or severe. We analyzed the relationship between radiologic severity according to the RSEHA with the need for admission to the hospital, admission to the ICU, and mortality. RESULTS Hospital admission was necessary in 91.4% of the patients. The RSEHA was significantly associated with the need for hospital admission (p=0.03) and with the need for ICU admission (p<0.001). A total of 51 (17.5%) patients died; of these, 57% had the severe pattern on the RSEHA. When we analyzed mortality by grouping patients according to their results on the RSEHA and their age range, the percentage of patients who died increased after age 70 years in patients classified as moderate or severe on the RSEHA. CONCLUSIONS Chest X-rays in patients with COVID-19 obtained in the emergency department are useful for determining the prognosis in terms of admission to the hospital, admission to the ICU, and mortality; radiologic patterns categorized as severe on the RSEHA are associated with greater mortality and admission to the ICU.
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Affiliation(s)
- A Adarve Castro
- MIR-2 de Radiodiagnóstico, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España.
| | - T Díaz Antonio
- FEA. Radiodiagnóstico. Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - E Cuartero Martínez
- FEA. Radiodiagnóstico. Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - M M García Gallardo
- FEA. Radiodiagnóstico. Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - M L Bermá Gascón
- FEA. Radiodiagnóstico. Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | - D Domínguez Pinos
- FEA. Radiodiagnóstico. Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
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18
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de Carvalho LS, da Silva Júnior RT, Oliveira BVS, de Miranda YS, Rebouças NLF, Loureiro MS, Pinheiro SLR, da Silva RS, Correia PVSLM, Silva MJS, Ribeiro SN, da Silva FAF, de Brito BB, Santos MLC, Leal RAOS, Oliveira MV, de Melo FF. Highlighting COVID-19: What the imaging exams show about the disease. World J Radiol 2021; 13:122-136. [PMID: 34141092 PMCID: PMC8188839 DOI: 10.4329/wjr.v13.i5.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/16/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), a global emergency, is caused by severe acute respiratory syndrome coronavirus 2. The gold standard for its diagnosis is the reverse transcription polymerase chain reaction, but considering the high number of infected people, the low availability of this diagnostic tool in some contexts, and the limitations of the test, other tools that aid in the identification of the disease are necessary. In this scenario, imaging exams such as chest X-ray (CXR) and computed tomography (CT) have played important roles. CXR is useful for assessing disease progression because it allows the detection of extensive consolidations, besides being a fast and cheap method. On the other hand, CT is more sensitive for detecting lung changes in the early stages of the disease and is also useful for assessing disease progression. Of note, ground-glass opacities are the main COVID-19-related CT findings. Positron emission tomography combined with CT can be used to evaluate chronic and substantial damage to the lungs and other organs; however, it is an expensive test. Lung ultrasound (LUS) has been shown to be a promising technique in that context as well, being useful in the screening and monitoring of patients, disease classification, and management related to mechanical ventilation. Moreover, LUS is an inexpensive alternative available at the bedside. Finally, magnetic resonance imaging, although not usually requested, allows the detection of pulmonary, cardiovascular, and neurological abnormalities associated with COVID-19. Furthermore, it is important to consider the challenges faced in the radiology field in the adoption of control measures to prevent infection and in the follow-up of post-COVID-19 patients.
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Affiliation(s)
- Lorena Sousa de Carvalho
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Bruna Vieira Silva Oliveira
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Yasmin Silva de Miranda
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Nara Lúcia Fonseca Rebouças
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Matheus Sande Loureiro
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Samuel Luca Rocha Pinheiro
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Regiane Santos da Silva
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Maria José Souza Silva
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Sabrina Neves Ribeiro
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Filipe Antônio França da Silva
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Breno Bittencourt de Brito
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Maria Luísa Cordeiro Santos
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Márcio Vasconcelos Oliveira
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Department of Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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19
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Abdelsalam M, Althaqafi RMM, Assiri SA, Althagafi TM, Althagafi SM, Fouda AY, Ramadan A, Rabah M, Ahmed RM, Ibrahim ZS, Nemenqani DM, Alghamdi AN, Al Aboud D, Abdel-Moneim AS, Alsulaimani AA. Clinical and Laboratory Findings of COVID-19 in High-Altitude Inhabitants of Saudi Arabia. Front Med (Lausanne) 2021; 8:670195. [PMID: 34055842 PMCID: PMC8149591 DOI: 10.3389/fmed.2021.670195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/23/2021] [Indexed: 01/08/2023] Open
Abstract
Background: SARS-CoV-2, the causative agent of COVID-19, continues to cause a worldwide pandemic, with more than 147 million being affected globally as of this writing. People's responses to COVID-19 range from asymptomatic to severe, and the disease is sometimes fatal. Its severity is affected by different factors and comorbidities of the infected patients. Living at a high altitude could be another factor that affects the severity of the disease in infected patients. Methods: In the present study, we have analyzed the clinical, laboratory, and radiological findings of COVID-19-infected patients in Taif, a high-altitude region of Saudi Arabia. In addition, we compared matched diseased subjects to those living at sea level. We hypothesized that people living in high-altitude locations are prone to develop a more severe form of COVID-19 than those living at sea level. Results: Age and a high Charlson comorbidity score were associated with increased numbers of intensive care unit (ICU) admissions and mortality among COVID-19 patients. These ICU admissions and fatalities were found mainly in patients with comorbidities. Rates of leukocytosis, neutrophilia, higher D-dimer, ferritin, and highly sensitive C-reactive protein (CRP) were significantly higher in ICU patients. CRP was the most independent of the laboratory biomarkers found to be potential predictors of death. COVID-19 patients who live at higher altitude developed a less severe form of the disease and had a lower mortality rate, in comparison to matched subjects living at sea level. Conclusion: CRP and Charlson comorbidity scores can be considered predictive of disease severity. People living at higher altitudes developed less severe forms of COVID-19 disease than those living at sea level, due to a not-yet-known mechanism.
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Affiliation(s)
- Mostafa Abdelsalam
- Alameen Hospital, Taif, Saudi Arabia.,Mansoura Nephrology and Dialysis Unit, Internal Medicine Department, College of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Sara A Assiri
- College of Medicine, Taif University, Taif, Saudi Arabia
| | | | - Saleh M Althagafi
- General Department of Medical Services, Security Forces Hospital, Mecca, Saudi Arabia
| | - Ahmed Y Fouda
- Alameen Hospital, Taif, Saudi Arabia.,Anesthesiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Ramadan
- Alameen Hospital, Taif, Saudi Arabia.,Radiology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohammed Rabah
- Alameen Hospital, Taif, Saudi Arabia.,Radiology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Reham M Ahmed
- Alameen Hospital, Taif, Saudi Arabia.,Albbassia Chest Hospital, Cairo, Egypt
| | - Zein S Ibrahim
- Department of Physiology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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20
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SARS-CoV-2 reinfection: "New baseline" imaging concept in the era of COVID-19. Clin Imaging 2021; 78:142-145. [PMID: 33813316 PMCID: PMC7997162 DOI: 10.1016/j.clinimag.2021.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/02/2021] [Accepted: 03/18/2021] [Indexed: 01/06/2023]
Abstract
Recent reports have suggested COVID-19 relapse or reinfection may lead to readmission, which may cause a diagnostic challenge between recently infected patients and reinfections. Compounding this problem is the post-viral lung sequela that may be expected after COVID-19 pneumonia, similar to both SARS and MERS. Although chest imaging may play a role in the diagnosis of primary SARS-CoV-2 infection, reinfection or relapse of COVID-19 will have similar imaging findings. A “new-baseline” imaging can be obtained from COVID-19 patients at the time of hospital discharge or clinical recovery. This new reference can not only determine if readmissions are from relapse or reinfection of COVID-19, resolving COVID-19 or potentially a different viral infection (influenza), but also for long term sequela of COVID-19 lung infection. Strategic use of imaging before discharge may be helpful in the subset of the population at the highest risk of a secondary viral infection such as influenza. Determining the residual abnormalities in post-discharge imaging can guide us in the long-term management of patients for many years to come.
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21
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Pagano A, Finkelstein M, Overbey J, Steinberger S, Ellison T, Manna S, Toussie D, Cedillo MA, Jacobi A, Gupta YS, Bernheim A, Chung M, Eber C, Fayad ZA, Concepcion J. Portable Chest Radiography as an Exclusionary Test for Adverse Clinical Outcomes During the COVID-19 Pandemic. Chest 2021; 160:238-248. [PMID: 33516703 PMCID: PMC7844357 DOI: 10.1016/j.chest.2021.01.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/28/2022] Open
Abstract
Background Chest radiography (CXR) often is performed in the acute setting to help understand the extent of respiratory disease in patients with COVID-19, but a clearly defined role for negative chest radiograph results in assessing patients has not been described. Research Question Is portable CXR an effective exclusionary test for future adverse clinical outcomes in patients suspected of having COVID-19? Study Design and Methods Charts of consecutive patients suspected of having COVID-19 at five EDs in New York City between March 19, 2020, and April 23, 2020, were reviewed. Patients were categorized based on absence of findings on initial CXR. The primary outcomes were hospital admission, mechanical ventilation, ARDS, and mortality. Results Three thousand two hundred forty-five adult patients, 474 (14.6%) with negative initial CXR results, were reviewed. Among all patients, negative initial CXR results were associated with a low probability of future adverse clinical outcomes, with negative likelihood ratios of 0.27 (95% CI, 0.23-0.31) for hospital admission, 0.24 (95% CI, 0.16-0.37) for mechanical ventilation, 0.19 (95% CI, 0.09-0.40) for ARDS, and 0.38 (95% CI, 0.29-0.51) for mortality. Among the subset of 955 patients younger than 65 years and with a duration of symptoms of at least 5 days, no patients with negative CXR results died, and the negative likelihood ratios were 0.17 (95% CI, 0.12-0.25) for hospital admission, 0.09 (95% CI, 0.02-0.36) for mechanical ventilation, and 0.09 (95% CI, 0.01-0.64) for ARDS. Interpretation Initial CXR in adult patients suspected of having COVID-19 is a strong exclusionary test for hospital admission, mechanical ventilation, ARDS, and mortality. The value of CXR as an exclusionary test for adverse clinical outcomes is highest among young adults, patients with few comorbidities, and those with a prolonged duration of symptoms.
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Affiliation(s)
- Andrew Pagano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Mark Finkelstein
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Hospital, New York, NY
| | - Jessica Overbey
- Department of Population Health Science and Policy, Mount Sinai Hospital, New York, NY
| | | | - Trevor Ellison
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Hospital, New York, NY
| | - Sayan Manna
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY
| | - Danielle Toussie
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Hospital, New York, NY
| | - Mario A Cedillo
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Hospital, New York, NY
| | - Adam Jacobi
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Hospital, New York, NY
| | - Yogesh S Gupta
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Hospital, New York, NY
| | - Adam Bernheim
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Hospital, New York, NY
| | - Michael Chung
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Hospital, New York, NY
| | - Corey Eber
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Hospital, New York, NY
| | - Zahi A Fayad
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Hospital, New York, NY; BioMedical Engineering and Imaging Institute, Mount Sinai Hospital, New York, NY
| | - Jose Concepcion
- Department of Diagnostic, Molecular, and Interventional Radiology, Mount Sinai Hospital, New York, NY
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