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Rezk S, Azab N, El-Habashy M, El-Helbawy R, Habib R. Ultrasound assessment of the relation between the quantity of pleural effusion and diaphragmatic functions. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2023. [DOI: 10.4103/ecdt.ecdt_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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Sexauer R, Yang S, Weikert T, Poletti J, Bremerich J, Roth JA, Sauter AW, Anastasopoulos C. Automated Detection, Segmentation, and Classification of Pleural Effusion From Computed Tomography Scans Using Machine Learning. Invest Radiol 2022; 57:552-559. [PMID: 35797580 PMCID: PMC9390225 DOI: 10.1097/rli.0000000000000869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/27/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study trained and evaluated algorithms to detect, segment, and classify simple and complex pleural effusions on computed tomography (CT) scans. MATERIALS AND METHODS For detection and segmentation, we randomly selected 160 chest CT scans out of all consecutive patients (January 2016-January 2021, n = 2659) with reported pleural effusion. Effusions were manually segmented and a negative cohort of chest CTs from 160 patients without effusions was added. A deep convolutional neural network (nnU-Net) was trained and cross-validated (n = 224; 70%) for segmentation and tested on a separate subset (n = 96; 30%) with the same distribution of reported pleural complexity features as in the training cohort (eg, hyperdense fluid, gas, pleural thickening and loculation). On a separate consecutive cohort with a high prevalence of pleural complexity features (n = 335), a random forest model was implemented for classification of segmented effusions with Hounsfield unit thresholds, density distribution, and radiomics-based features as input. As performance measures, sensitivity, specificity, and area under the curves (AUCs) for detection/classifier evaluation (per-case level) and Dice coefficient and volume analysis for the segmentation task were used. RESULTS Sensitivity and specificity for detection of effusion were excellent at 0.99 and 0.98, respectively (n = 96; AUC, 0.996, test data). Segmentation was robust (median Dice, 0.89; median absolute volume difference, 13 mL), irrespective of size, complexity, or contrast phase. The sensitivity, specificity, and AUC for classification in simple versus complex effusions were 0.67, 0.75, and 0.77, respectively. CONCLUSION Using a dataset with different degrees of complexity, a robust model was developed for the detection, segmentation, and classification of effusion subtypes. The algorithms are openly available at https://github.com/usb-radiology/pleuraleffusion.git.
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Affiliation(s)
- Raphael Sexauer
- From the Divisions of Research and Analytical Services
- Cardiothoracic Imaging, Department of Radiology
| | - Shan Yang
- From the Divisions of Research and Analytical Services
| | - Thomas Weikert
- From the Divisions of Research and Analytical Services
- Cardiothoracic Imaging, Department of Radiology
| | | | | | - Jan Adam Roth
- From the Divisions of Research and Analytical Services
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Alexander Walter Sauter
- From the Divisions of Research and Analytical Services
- Cardiothoracic Imaging, Department of Radiology
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Yan G, Li H, Bhetuwal A, McClure MA, Li Y, Yang G, Li Y, Zhao L, Fan X. Pleural effusion volume in patients with acute pancreatitis: a retrospective study from three acute pancreatitis centers. Ann Med 2021; 53:2003-2018. [PMID: 34727802 PMCID: PMC8567956 DOI: 10.1080/07853890.2021.1998594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 10/19/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the value of pleural effusion volume (PEV) quantified on chest computed tomography (CT) in patients with early stage acute pancreatitis (AP). METHODS Data of PEV, and C-reactive protein (CRP) levels as well as Ranson, bedside index of severity in acute pancreatitis (BISAP), Marshall, acute physiology and chronic health evaluation II (APACHE II), CT severity index (CTSI), and extra-pancreatic inflammation on computed tomography (EPIC) scores in patients with AP were collected. Duration of hospitalization, severity of AP, infection, procedure, intensive care unit (ICU) admission, organ failure, or death were included as the outcome parameters. RESULTS In 465 patients, the mean PEV was 98.8 ± 113.2 mL. PEV showed strong and significant correlations with the CRP levels, duration of hospitalization as well as the Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC scores (p < .05). PEV demonstrated significant accuracy in predicting severity, infection, procedure, ICU admission, organ failure, and death (p < .05). CONCLUSION PEV quantified on chest CT positively associated with the duration of hospitalization, CRP levels, Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC scores. It can be a reliable radiologic biomarker in predicting severity and clinical outcomes of AP.KEY MESSAGESPleural effusion is a common chest finding in patients with acute pancreatitis.Pleural effusion volume quantified on chest CT examination positively associated with the duration of hospitalization, CRP level, as well as Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC scoring systems.Pleural effusion volume can be a reliable radiologic biomarker in the prediction of severity and clinical outcomes of acute pancreatitis.
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Affiliation(s)
- Gaowu Yan
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Hongwei Li
- Department of Radiology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Anup Bhetuwal
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Morgan A. McClure
- Department of Radiology and Imaging, Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guoqing Yang
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Yong Li
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Linwei Zhao
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Xiaoping Fan
- Department of Radiology, Suining Central Hospital, Suining, China
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Diagnostic performance of lung ultrasound compared to CT scan in the diagnosis of pulmonary lesions of COVID-19 induced pneumonia: a preliminary study. Virusdisease 2021; 32:674-680. [PMID: 34426793 PMCID: PMC8372226 DOI: 10.1007/s13337-021-00736-w] [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: 04/25/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022] Open
Abstract
Chest CT scan is currently used to assess the extent of lung involvement in patients with the coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the diagnostic performance of lung ultrasound in the diagnosis of COVID-19 pulmonary manifestations in comparison to CT scan. Thirty-three symptomatic patients with suspected COVID-19 pneumonia were evaluated by lung ultrasound and then, at a short interval, chest CT scan. In the anterior chest, each hemithorax was divided into four areas. In the posterior chest, eight zones similar to the anterior part were examined. The axillary areas were also divided into upper and lower zones (20 zones were determined per patient). Mean age of the patients was 58.66 years. The sensitivity (95% CI) and specificity (95% CI) of lung ultrasound for the diagnosis of parenchymal lesions were 90.5% (69.6–98.8%) and 50% (21.1–78.9%), respectively. In the evaluation of pleural lesions, the sensitivity (95% CI) and specificity (95% CI) of lung ultrasound were 100% (71.5–100%) and 22.7% (7.8–45.4%), respectively. Owing to the high sensitivity of ultrasound in identifying lung lesions in patients with COVID-19 pneumonia, it can be recommended to use lung ultrasound as a tool for initial screening of patients with high clinical suspicion for SARS-CoV-2 infection during the pandemic.
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Recommendations for Lung Ultrasound in Internal Medicine. Diagnostics (Basel) 2020; 10:diagnostics10080597. [PMID: 32824302 PMCID: PMC7460159 DOI: 10.3390/diagnostics10080597] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022] Open
Abstract
A growing amount of evidence prompts us to update the first version of recommendations for lung ultrasound in internal medicine (POLLUS-IM) that was published in 2018. The recommendations were established in several stages, consisting of: literature review, assessment of literature data quality (with the application of QUADAS, QUADAS-2 and GRADE criteria) and expert evaluation carried out consistently with the modified Delphi method (three rounds of on-line discussions, followed by a secret ballot by the panel of experts after each completed discussion). Publications to be analyzed were selected from the following databases: Pubmed, Medline, OVID, and Embase. New reports published as of October 2019 were added to the existing POLLUS-IM database used for the original publication of 2018. Altogether, 528 publications were systematically reviewed, including 253 new reports published between September 2017 and October 2019. The new recommendations concern the following conditions and issues: pneumonia, heart failure, monitoring dialyzed patients' hydration status, assessment of pleural effusion, pulmonary embolism and diaphragm function assessment. POLLUS-IM 2020 recommendations were established primarily for clinicians who utilize lung ultrasound in their everyday clinical work.
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Carvajal Revuelta E, García Álvarez R. Methods of estimation of pleural effusion by ecography. ACTA ACUST UNITED AC 2020; 67:521-526. [PMID: 32622476 DOI: 10.1016/j.redar.2020.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/26/2020] [Indexed: 11/26/2022]
Abstract
Pleural effusion is a frequent pathology in intensive care units. The diagnosis has improved after the introduction of pulmonary ultrasound, an accessible method at the bedside, which allows not only the diagnosis but also the treatment of this entity. The aim of our study is to determine the accuracy of published mathematical equations to calculate the volume of pleural effusion from ultrasound measurements. After doing a systematic review, seven articles were selected that each proposed a mathematical equation. In all of them the results were statistically significant. However, there is no ideal formula among those studied.
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Affiliation(s)
- E Carvajal Revuelta
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital 12 de Octubre, Madrid, España.
| | - R García Álvarez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital 12 de Octubre, Madrid, España
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Peng R, Zhang L, Zhang ZM, Wang ZQ, Liu GY, Zhang XM. Chest computed tomography semi-quantitative pleural effusion and pulmonary consolidation are early predictors of acute pancreatitis severity. Quant Imaging Med Surg 2020; 10:451-463. [PMID: 32190570 DOI: 10.21037/qims.2019.12.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background To study the predictive value of semi-quantitative pleural effusion and pulmonary consolidation for acute pancreatitis (AP) severity. Methods Thorax-abdominal computed tomography (CT) examinations were performed on 309 consecutive AP patients in a single center. Among them, 196 were male, and 113 were female, and the average age was 50±16 years. The etiology of AP was biliary in 43.7% (n=135), hyperlipidemia in 22.0% (n=68), alcoholic in 7.4% (n=23), trauma in 0.6% (n=2), and postoperative status in 1.6% (n=5) cases; 24.6% (n=76) of patients did not have specified etiologies. The prevalence of pleural effusion and pulmonary consolidation was noted. The pleural effusion volume was quantitatively derived from a CT volume evaluation software tool. The pulmonary consolidation score was based on the number of lobes involved in AP. Each patient's CT severity index (CTSI), acute physiology and chronic health evaluation II (APACHE II) scoring system, and bedside index for severity in acute pancreatitis (BISAP) scores were obtained. The semi-quantitative pleural effusion and pulmonary consolidation were compared to these scores and clinical outcomes by receiver operator characteristic (ROC) curve and area under the curve (AUC) analysis. Results In the 309 patients, 39.8% had pleural effusion, and 47.9% had pulmonary consolidation. The mean pleural effusion volume was 41.7±38.0 mL. The mean pulmonary consolidation score was 1.0±1.2 points. The mean CTSI was 3.7±1.8 points, the mean APACHE II score was 5.8±5.1 points, and the mean BISAP score was 1.3±1.0 points; 5.5% of patients developed severe AP, and 13.9% of patients developed organ failure. Pleural effusion volume and pulmonary consolidation scores correlated to the scores for the severity of AP. In predicting severe AP, the accuracy (AUC 0.839) of pleural effusion volume was similar to that of the CTSI score (P=0.961), APACHE II score (P=0.757), and BISAP score (P=0.906). The accuracy (AUC 0.805) of the pulmonary consolidation score was also similar to that of the CTSI score (P=0.503), APACHE II score (P=0.343), and BISAP score (P=0.669). In predicting organ failure, the accuracy (AUC 0.783) of pleural effusion volume was similar to that of the CTSI score (P=0.473), APACHE II score (P=0.119), and BISAP score (P=0.980), and the accuracy (AUC 0.808) of the pulmonary consolidation score was also similar to that of the CTSI score (P=0.236), APACHE II score (P=0.293), and BISAP score (P=0.612). Conclusions Pleural effusion and pulmonary consolidation are common in AP and correlated to the severity of AP. Furthermore, the pleural effusion volume and pulmonary consolidation lobes can provide early prediction of severe AP and organ failure.
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Affiliation(s)
- Rong Peng
- Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Panzhihua 617000, China
| | - Ling Zhang
- Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Panzhihua 617000, China
| | - Ze-Ming Zhang
- Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Panzhihua 617000, China
| | - Zhi-Qing Wang
- Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Panzhihua 617000, China
| | - Guang-Yu Liu
- Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Panzhihua 617000, China
| | - Xiao-Ming Zhang
- Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
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Mathis G. [Use of lung and pleural ultrasonography in emergency and intensive care medicine]. Med Klin Intensivmed Notfmed 2019; 114:504-508. [PMID: 31392352 PMCID: PMC7096083 DOI: 10.1007/s00063-019-0596-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 01/18/2023]
Abstract
Bedside lung ultrasound (LUS) in emergency rooms and intensive care units can serve as a tool to diagnose common lung pathologies, monitor their course and guide clinical management. LUS requires only a few minutes and is a useful extension of the physical examination. Fractures of the ribs as well as the sternum are seen well on ultrasound. Minute pleural fluids (effusion, hemtothorax) are detectable. LUS is able to detect the sound of lung water and thus to differentiate a cardiogenic pulmonary edema from chronic obstructive lung disease. Inflammatory lung diseases such as pleuritis and pneumonia are better seen than on chest X‑ray. LUS should replace chest X‑ray in the diagnosis of ambulant acquired pneumonia. In ventilator-associated pneumonia and atelectasis, LUS measures the presence of lung consolidation as well as dynamic changes und reventilation. A heart-lung-vessel integrated triple ultrasonography according to clinical findings can help with the diagnosis of pulmonary embolism and should be a necessary weapon for the physicians, especially in emergency departments.
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Mayo PH, Copetti R, Feller-Kopman D, Mathis G, Maury E, Mongodi S, Mojoli F, Volpicelli G, Zanobetti M. Thoracic ultrasonography: a narrative review. Intensive Care Med 2019; 45:1200-1211. [PMID: 31418060 DOI: 10.1007/s00134-019-05725-8] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/30/2019] [Indexed: 01/18/2023]
Abstract
This narrative review focuses on thoracic ultrasonography (lung and pleural) with the aim of outlining its utility for the critical care clinician. The article summarizes the applications of thoracic ultrasonography for the evaluation and management of pneumothorax, pleural effusion, acute dyspnea, pulmonary edema, pulmonary embolism, pneumonia, interstitial processes, and the patient on mechanical ventilatory support. Mastery of lung and pleural ultrasonography allows the intensivist to rapidly diagnose and guide the management of a wide variety of disease processes that are common features of critical illness. Its ease of use, rapidity, repeatability, and reliability make thoracic ultrasonography the "go to" modality for imaging the lung and pleura in an efficient, cost effective, and safe manner, such that it can largely replace chest imaging in critical care practice. It is best used in conjunction with other components of critical care ultrasonography to yield a comprehensive evaluation of the critically ill patient at point of care.
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Affiliation(s)
- P H Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, Hempstead, NY, 11549, USA.
| | - R Copetti
- Department of Emergency Medicine, Latisana Hospital, 33053, Latisana, Italy
| | - D Feller-Kopman
- Division of Pulmonary, Critical Care, and Sleep Medicine, Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7-125, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - G Mathis
- 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830, Rankweil, Austria
| | - E Maury
- 7 Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Saint-Antoine, Paris, France
- 8 INSERM U 1136, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, 75012, Paris, France
- 9 Sorbonne University, UPMC Univ Paris 06, Paris, France
| | - S Mongodi
- Anesthesia and Intensive Care, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - F Mojoli
- Anesthesia and Intensive Care, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - G Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Orbassano, 10043, Turin, Italy
| | - M Zanobetti
- Emergency Department, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
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