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Nam BD, Hong H, Yoon SH. Diagnostic performance of standardized typical CT findings for COVID-19: a systematic review and meta-analysis. Insights Imaging 2023; 14:96. [PMID: 37222857 DOI: 10.1186/s13244-023-01429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE To meta-analyze diagnostic performance measures of standardized typical CT findings for COVID-19 and examine these measures by region and national income. METHODS MEDLINE and Embase were searched from January 2020 to April 2022 for diagnostic studies using the Radiological Society of North America (RSNA) classification or the COVID-19 Reporting and Data System (CO-RADS) for COVID-19. Patient and study characteristics were extracted. We pooled the diagnostic performance of typical CT findings in the RSNA and CO-RADS systems and interobserver agreement. Meta-regression was performed to examine the effect of potential explanatory factors on the diagnostic performance of the typical CT findings. RESULTS We included 42 diagnostic performance studies with 6777 PCR-positive and 9955 PCR-negative patients from 18 developing and 24 developed countries covering the Americas, Europe, Asia, and Africa. The pooled sensitivity was 70% (95% confidence interval [CI]: 65%, 74%; I2 = 92%), and the pooled specificity was 90% (95% CI 86%, 93%; I2 = 94%) for the typical CT findings of COVID-19. The sensitivity and specificity of the typical CT findings did not differ significantly by national income and the region of the study (p > 0.1, respectively). The pooled interobserver agreement from 19 studies was 0.72 (95% CI 0.63, 0.81; I2 = 99%) for the typical CT findings and 0.67 (95% CI 0.61, 0.74; I2 = 99%) for the overall CT classifications. CONCLUSION The standardized typical CT findings for COVID-19 provided moderate sensitivity and high specificity globally, regardless of region and national income, and were highly reproducible between radiologists. CRITICAL RELEVANCE STATEMENT Standardized typical CT findings for COVID-19 provided a reproducible high diagnostic accuracy globally. KEY POINTS Standardized typical CT findings for COVID-19 provide high sensitivity and specificity. Typical CT findings show high diagnosability regardless of region or income. The interobserver agreement for typical findings of COVID-19 is substantial.
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Affiliation(s)
- Bo Da Nam
- Department of Radiology, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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Roig-Marín N, Roig-Rico P. The deadliest lung lobe in COVID-19: a retrospective cohort study of elderly patients hospitalized for COVID-19. Postgrad Med 2022; 134:533-539. [PMID: 35443140 DOI: 10.1080/00325481.2022.2069356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The relationship between which lung lobe is affected on the chest X-ray (CXR) performed at the Emergency Department (ED) and mortality from COVID-19 has not been studied. With this in mind, the present study aimed to discern which lung lobe was the one with the highest associated mortality rate in the elderly population. METHODS Information was collected from the 2020 hospital admissions records of our hospital. Our cohort consists of 300 admissions. RESULTS The presence of the left lower lobe (RR = 1.6; 95% CI: 1.1-2.4) and right middle lobe involvement (RR =1.8; 95% CI: 1.2-2.7) on CXR at the ED were both predictive factors of in-hospital mortality. Right middle lobe involvement on CXR at the ED was the risk factor with the highest relative risk value (RR = 1.8). Furthermore, right middle lobe involvement on CXR at ED was a predictor for persistent organ failure (RR = 1.7; 95% CI: 1.2-2.3), respiratory failure (RR = 1.7; 95% CI: 1.2-2.4) and acute kidney injury (RR = 1.5; 95% CI: 1.2-2). The isolated right middle lobe involvement on CXR at ED was a risk factor for in-hospital mortality (RR = 2.6; 95% CI = 1.8 - 3.7). However, the affected right middle lobe along with another/other lobe/s was a null factor. CONCLUSION Right middle lobe involvement was an independent predictor of in-hospital mortality.
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Affiliation(s)
- Noel Roig-Marín
- Universidad Miguel Hernández, Campus de San Juan de Alicante, Spain
| | - Pablo Roig-Rico
- Universidad Miguel Hernández, Campus de San Juan de Alicante, Spain.,Hospital de San Juan de Alicante, Unidad de Enfermedades Infecciosas, Spain
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Chamberlin JH, Aquino G, Schoepf UJ, Nance S, Godoy F, Carson L, Giovagnoli VM, Gill CE, McGill LJ, O'Doherty J, Emrich T, Burt JR, Baruah D, Varga-Szemes A, Kabakus IM. An Interpretable Chest CT Deep Learning Algorithm for Quantification of COVID-19 Lung Disease and Prediction of Inpatient Morbidity and Mortality. Acad Radiol 2022; 29:1178-1188. [PMID: 35610114 PMCID: PMC8977389 DOI: 10.1016/j.acra.2022.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 12/23/2022]
Abstract
Rationale and Objectives The burden of coronavirus disease 2019 (COVID-19) airspace opacities is time consuming and challenging to quantify on computed tomography. The purpose of this study was to evaluate the ability of a deep convolutional neural network (dCNN) to predict inpatient outcomes associated with COVID-19 pneumonia. Materials and Methods A previously trained dCNN was tested on an external validation cohort of 241 patients who presented to the emergency department and received a chest computed tomography scan, 93 with COVID-19 and 168 without. Airspace opacity scoring systems were defined by the extent of airspace opacity in each lobe, totaled across the entire lungs. Expert and dCNN scores were concurrently evaluated for interobserver agreement, while both dCNN identified airspace opacity scoring and raw opacity values were used in the prediction of COVID-19 diagnosis and inpatient outcomes. Results Interobserver agreement for airspace opacity scoring was 0.892 (95% CI 0.834-0.930). Probability of each outcome behaved as a logistic function of the opacity scoring (25% intensive care unit admission at score of 13/25, 25% intubation at 17/25, and 25% mortality at 20/25). Length of hospitalization, intensive care unit stay, and intubation were associated with larger airspace opacity score (p = 0.032, 0.039, 0.036, respectively). Conclusion The tested dCNN was highly predictive of inpatient outcomes, performs at a near expert level, and provides added value for clinicians in terms of prognostication and disease severity.
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Jin KN, Do KH, Nam BD, Hwang SH, Choi M, Yong HS. [Korean Clinical Imaging Guidelines for Justification of Diagnostic Imaging Study for COVID-19]. TAEHAN YONGSANG UIHAKHOE CHI 2022; 83:265-283. [PMID: 36237918 PMCID: PMC9514447 DOI: 10.3348/jksr.2021.0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 06/16/2023]
Abstract
To develop Korean coronavirus disease (COVID-19) chest imaging justification guidelines, eight key questions were selected and the following recommendations were made with the evidence-based clinical imaging guideline adaptation methodology. It is appropriate not to use chest imaging tests (chest radiograph or CT) for the diagnosis of COVID-19 in asymptomatic patients. If reverse transcription-polymerase chain reaction testing is not available or if results are delayed or are initially negative in the presence of symptoms suggestive of COVID-19, chest imaging tests may be considered. In addition to clinical evaluations and laboratory tests, chest imaging may be contemplated to determine hospital admission for asymptomatic or mildly symptomatic unhospitalized patients with confirmed COVID-19. In hospitalized patients with confirmed COVID-19, chest imaging may be advised to determine or modify treatment alternatives. CT angiography may be considered if hemoptysis or pulmonary embolism is clinically suspected in a patient with confirmed COVID-19. For COVID-19 patients with improved symptoms, chest imaging is not recommended to make decisions regarding hospital discharge. For patients with functional impairment after recovery from COVID-19, chest imaging may be considered to distinguish a potentially treatable disease.
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Inui S, Gonoi W, Kurokawa R, Nakai Y, Watanabe Y, Sakurai K, Ishida M, Fujikawa A, Abe O. The role of chest imaging in the diagnosis, management, and monitoring of coronavirus disease 2019 (COVID-19). Insights Imaging 2021; 12:155. [PMID: 34727257 PMCID: PMC8561360 DOI: 10.1186/s13244-021-01096-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/22/2021] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic has posed a major public health crisis all over the world. The role of chest imaging, especially computed tomography (CT), has evolved during the pandemic paralleling the accumulation of scientific evidence. In the early stage of the pandemic, the performance of chest imaging for COVID-19 has widely been debated especially in the context of comparison to real-time reverse transcription polymerase chain reaction. Current evidence is against the use of chest imaging for routine screening of COVID-19 contrary to the initial expectations. It still has an integral role to play, however, in its work up and staging, especially when assessing complications or disease progression. Chest CT is gold standard imaging modality for COVID-19 pneumonia; in some situations, chest X-ray or ultrasound may be an effective alternative. The most important role of radiologists in this context is to be able to identify those patients at greatest risk of imminent clinical decompensation by learning to stratify cases of COVID-19 on the basis of radiologic imaging in the most efficient and timely fashion possible. The present availability of multiple and more refined CT grading systems and classification is now making this task easier and thereby contributing to the recent improvements achieved in COVID-19 treatment and outcomes. In this article, evidence of chest imaging regarding diagnosis, management and monitoring of COVID-19 will be chronologically reviewed.
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Affiliation(s)
- Shohei Inui
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Radiology, Japan Self-Defense Forces Central Hospital, 1-2-24, Ikejiri, Setagaya-ku, Tokyo, 154-0001, Japan.
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI, 48109, USA
| | - Yudai Nakai
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yusuke Watanabe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keita Sakurai
- Department of Radiology, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, 474-8511, Japan
| | - Masanori Ishida
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akira Fujikawa
- Department of Radiology, Japan Self-Defense Forces Central Hospital, 1-2-24, Ikejiri, Setagaya-ku, Tokyo, 154-0001, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Yurdaisik I, Nurili F, Aksoy SH, Agirman AG, Aktan A. IONIZING RADIATION EXPOSURE IN PATIENTS WITH COVID-19: MORE THAN NEEDED. RADIATION PROTECTION DOSIMETRY 2021; 194:135-143. [PMID: 34151376 PMCID: PMC8344538 DOI: 10.1093/rpd/ncab092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/13/2021] [Accepted: 05/25/2021] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the ionizing radiation exposure in patients with Coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS This was a retrospective study in which all patients presented with suggestive symptoms of COVID-19 were included. The study was carried out in a university-affiliated private hospital in Istanbul, Turkey. Biological radiation dose exposure (cumulative effective dose: CED) was evaluated in millisievert (mSv) units. RESULTS A total of 1410 patients were included in the study. Of all study subjects, 804 patients (57%) underwent only one chest computed tomography (CT) procedure. Six hundred and six patients (43%) had two or more chest CT procedures. Median CED was 6.02 (min-max:1.67-16.27) mSv. The number of patients who were exposed to ≤ 5 mSv were 149 (24.6%), whereas 457 patients (75.4%) were exposed to >5 mSv. CONCLUSION The radiation exposure in COVID-19 patients seems unjustifiably high. Awareness should be increased as to the proper use of chest CT in COVID-19 as per to the society recommendations.
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Affiliation(s)
- Isil Yurdaisik
- Department of Radiology, Istinye University, Gaziosmanpasa Medical Park Hospital, 34250 Istanbul, Turkey
| | - Fuat Nurili
- Department of Radiology, Memorial Sloan Ketteting Cancer Center, Interventional Radiology, New York, NY 10065, USA
| | - Suleyman Hilmi Aksoy
- Department of Radiology, Galata University, Hisar Intercontinental Hospital, 34768 Istanbul, Turkey
| | - Ayse Gul Agirman
- Department of Radiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, 34668 Istanbul, Turkey
| | - Ahmet Aktan
- Department of Radiology, Yalova Private Hospital, 77100 Yalova, Turkey
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Borghesi A, Sverzellati N, Polverosi R, Balbi M, Baratella E, Busso M, Calandriello L, Cortese G, Farchione A, Iezzi R, Palmucci S, Pulzato I, Rampinelli C, Romei C, Valentini A, Grassi R, Larici AR. Impact of the COVID-19 pandemic on the selection of chest imaging modalities and reporting systems: a survey of Italian radiologists. Radiol Med 2021; 126:1258-1272. [PMID: 34196908 PMCID: PMC8245660 DOI: 10.1007/s11547-021-01385-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/15/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE Chest imaging modalities play a key role for the management of patient with coronavirus disease (COVID-19). Unfortunately, there is no consensus on the optimal chest imaging approach in the evaluation of patients with COVID-19 pneumonia, and radiology departments tend to use different approaches. Thus, the main objective of this survey was to assess how chest imaging modalities have been used during the different phases of the first COVID-19 wave in Italy, and which diagnostic technique and reporting system would have been preferred based on the experience gained during the pandemic. MATERIAL AND METHODS The questionnaire of the survey consisted of 26 questions. The link to participate in the survey was sent to all members of the Italian Society of Medical and Interventional Radiology (SIRM). RESULTS The survey gathered responses from 716 SIRM members. The most notable result was that the most used and preferred chest imaging modality to assess/exclude/monitor COVID-19 pneumonia during the different phases of the first COVID-19 wave was computed tomography (51.8% to 77.1% of participants). Additionally, while the narrative report was the most used reporting system (55.6% of respondents), one-third of participants would have preferred to utilize structured reporting systems. CONCLUSION This survey shows that the participants' responses did not properly align with the imaging guidelines for managing COVID-19 that have been made by several scientific, including SIRM. Therefore, there is a need for continuing education to keep radiologists up to date and aware of the advantages and limitations of the chest imaging modalities and reporting systems.
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Affiliation(s)
- Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
| | - Nicola Sverzellati
- Radiological Sciences, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | | | - Maurizio Balbi
- Radiological Sciences, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Marco Busso
- Department of Radiology, Department of Oncology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Lucio Calandriello
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Giancarlo Cortese
- Department of Radiology, Maria Vittoria Hospital, ASL Città Di Torino, Turin, Italy
| | - Alessandra Farchione
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Roberto Iezzi
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy.,Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies G.F. Ingrassia- Radiology I Unit, University Hospital Policlinico G. Rodolico-San Marco, University of Catania, Catania, Italy
| | - Ilaria Pulzato
- Department of Radiology, San Martino Hospital, University of Genoa, Genoa, Italy
| | - Cristiano Rampinelli
- Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Romei
- Department of Diagnostic and Imaging, University Hospital of Pisa, Pisa, Italy
| | - Adele Valentini
- Department of Radiology, San Matteo Polyclinic Foundation IRCCS, Pavia, Italy
| | - Roberto Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.,Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
| | - Anna Rita Larici
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy.,Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Roma, Italy
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