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Gutierrez M, Alonso A, Penha D, Ntouskou M, Gosney J, Radike M. Radiological-pathological correlation in diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH): imaging and histopathology. Clin Radiol 2024; 79:133-141. [PMID: 37945436 DOI: 10.1016/j.crad.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 11/12/2023]
Abstract
AIM To review histologically confirmed diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) cases and carry out a detailed pathological-radiological correlation to see if computed tomography (CT) can be used to confidently identify DIPNECH. MATERIALS AND METHODS Twenty-three histologically confirmed DIPNECH patients in the shared database of two NHS Trusts were reviewed. CT images were reviewed by two independent radiologists, each of them with >10 years of experience in thoracic imaging. All histological specimens were reviewed by a single pathologist with >25 years of experience. The diagnosis of DIPNECH was made according to the current World Health Organization (WHO) definition included in the WHO 2015 classification of pulmonary tumours. The results on histology were compared to the presence of nodules and air trapping on CT. Demographic information and, when available, molecular imaging studies and pulmonary function tests were also considered. RESULTS There are prototypal clinical and radiological findings reflecting the presence of underlying histological DIPNECH: middle-aged women with multiple small and scattered nodules due to the clustering and proliferation of neuroendocrine cells. At least one larger, dominant, lung nodule reflecting a carcinoid tumour is very common and mosaic attenuation/air trapping is seen approximately in 50% of cases in inspiratory scans. Airflow obstruction is rarely associated with histological bronchial or peribronchial fibrosis, which suggests other mechanisms must be involved in its development. CONCLUSION CT can be used to predict pathological DIPNECH in the appropriate clinical setting. It is important to consider DIPNECH to avoid overdiagnosis of more sinister conditions such as lung cancer or metastases.
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Affiliation(s)
- M Gutierrez
- Department of Radiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.
| | - A Alonso
- Department of Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - D Penha
- Department of Radiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - M Ntouskou
- Department of Radiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - J Gosney
- Cellular Pathology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - M Radike
- Department of Radiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
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Guedes Pinto E, Penha D, Ravara S, Monaghan C, Hochhegger B, Marchiori E, Taborda-Barata L, Irion K. Factors influencing the outcome of volumetry tools for pulmonary nodule analysis: a systematic review and attempted meta-analysis. Insights Imaging 2023; 14:152. [PMID: 37741928 PMCID: PMC10517915 DOI: 10.1186/s13244-023-01480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/08/2023] [Indexed: 09/25/2023] Open
Abstract
Health systems worldwide are implementing lung cancer screening programmes to identify early-stage lung cancer and maximise patient survival. Volumetry is recommended for follow-up of pulmonary nodules and outperforms other measurement methods. However, volumetry is known to be influenced by multiple factors. The objectives of this systematic review (PROSPERO CRD42022370233) are to summarise the current knowledge regarding factors that influence volumetry tools used in the analysis of pulmonary nodules, assess for significant clinical impact, identify gaps in current knowledge and suggest future research. Five databases (Medline, Scopus, Journals@Ovid, Embase and Emcare) were searched on the 21st of September, 2022, and 137 original research studies were included, explicitly testing the potential impact of influencing factors on the outcome of volumetry tools. The summary of these studies is tabulated, and a narrative review is provided. A subset of studies (n = 16) reporting clinical significance were selected, and their results were combined, if appropriate, using meta-analysis. Factors with clinical significance include the segmentation algorithm, quality of the segmentation, slice thickness, the level of inspiration for solid nodules, and the reconstruction algorithm and kernel in subsolid nodules. Although there is a large body of evidence in this field, it is unclear how to apply the results from these studies in clinical practice as most studies do not test for clinical relevance. The meta-analysis did not improve our understanding due to the small number and heterogeneity of studies testing for clinical significance. CRITICAL RELEVANCE STATEMENT: Many studies have investigated the influencing factors of pulmonary nodule volumetry, but only 11% of these questioned their clinical relevance in their management. The heterogeneity among these studies presents a challenge in consolidating results and clinical application of the evidence. KEY POINTS: • Factors influencing the volumetry of pulmonary nodules have been extensively investigated. • Just 11% of studies test clinical significance (wrongly diagnosing growth). • Nodule size interacts with most other influencing factors (especially for smaller nodules). • Heterogeneity among studies makes comparison and consolidation of results challenging. • Future research should focus on clinical applicability, screening, and updated technology.
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Affiliation(s)
- Erique Guedes Pinto
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal.
| | - Diana Penha
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Dr, Liverpool, L14 3PE, UK
| | - Sofia Ravara
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal
| | - Colin Monaghan
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Dr, Liverpool, L14 3PE, UK
| | | | - Edson Marchiori
- Faculdade de Medicina, Universidade Federal Do Rio de Janeiro, Bloco K - Av. Carlos Chagas Filho, 373 - 2º Andar, Sala 49 - Cidade Universitária da Universidade Federal Do Rio de Janeiro, Rio de Janeiro - RJ, 21044-020, Brasil
- Faculdade de Medicina, Universidade Federal Fluminense, Av. Marquês Do Paraná, 303 - Centro, Niterói - RJ, 24220-000, Brasil
| | - Luís Taborda-Barata
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal
| | - Klaus Irion
- Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL, UK
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Pinto E, Penha D, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. Variability of pulmonary nodule volumetry on coronary CT angiograms. Medicine (Baltimore) 2022; 101:e30332. [PMID: 36107569 PMCID: PMC9439735 DOI: 10.1097/md.0000000000030332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to investigate the variability of pulmonary nodule (PN) volumetry on multiphase coronary CT angiograms (CCTA). Two radiologists reviewed 5973 CCTA scans in this cross-sectional study to detect incidental solid noncalcified PNs measuring between 5 and 8 mm. Each radiologist measured the nodules' diameters and volume, in systole and diastole, using 2 commercially available software packages to analyze PNs. Bland-Altman analysis was applied between different observers, software packages, and cardiac phases. Bland-Altman subanalysis for the systolic and diastolic datasets were also performed. A total of 195 PNs were detected within the inclusion criteria and measured in systole and diastole. Bland-Altman analysis was used to test the variability of volumetry between cardiac phases ([-47.0%; 52.3%]), software packages ([-50.2%; 68.2%]), and observers ([-14.5%; 27.8%]). The inter-observer variability of the systolic and diastolic subsets was [-13.6%; 31.4%] and [-13.9%; 19.7%], respectively. Using diastolic volume measurements, the variability of PN volumetry on CCTA scans is similar to the reported variability of volumetry on low-dose CT scans. Therefore, growth estimation of PNs on CCTA scans could be feasible.
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Affiliation(s)
- Erique Pinto
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
- *Correspondence: Erique Pinto, MD, EBIR, Rua Luís DE Camões, nº 102, lt 8, 3º esq, 1300—356 Lisbon, Portugal. (e-mail: )
| | - Diana Penha
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
- Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Bruno Hochhegger
- Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Colin Monaghan
- Radiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro Faculdade de Medicina, Rio DE Janeiro, RJ, Brazil
- Universidade Federal Fluminense Faculdade de Medicina, Niteroi, RJ, Brazil
| | | | - Klaus Irion
- Imaging Department, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Penha D, Pinto E, Marchiori E, Taborda-Barata L, Irion K. Pulmonary diseases that cause abnormal lung parenchymal density: is this a problem in lung cancer screening? J Bras Pneumol 2022; 48:e20220002. [PMID: 35703672 PMCID: PMC9262443 DOI: 10.36416/1806-3756/e20220002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Diana Penha
- . Universidade da Beira Interior, Covilhã, Portugal
| | - Erique Pinto
- . Universidade da Beira Interior, Covilhã, Portugal
| | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Klaus Irion
- . Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Pinto E, Penha D, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. Incidental chest findings on coronary CT angiography: a pictorial essay and management proposal. J Bras Pneumol 2022; 48:e20220015. [PMID: 35584528 PMCID: PMC9064655 DOI: 10.36416/1806-3756/e20220015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
Abstract
Many health systems have been using coronary CT angiography (CCTA) as a first-line examination for ischaemic heart disease patients in various countries. The rising number of CCTA examinations has led to a significant increase in the number of reported incidental extracardiac findings, mainly in the chest. Pulmonary nodules are the most common incidental findings on CCTA scans, as there is a substantial overlap of risk factors between the population seeking to exclude ischaemic heart disease and those at risk of developing lung cancer (i.e., advanced age and smoking habits). However, most incidental findings are clinically insignificant and actively pursuing them could be cost-prohibitive and submit the patient to unnecessary and potentially harmful examinations. Furthermore, there is little consensus regarding when to report or actively exclude these findings and how to manage them, that is, when to trigger an alert or to immediately refer the patient to a pulmonologist, a thoracic surgeon or a multidisciplinary team. This pictorial essay discusses the current literature on this topic and is illustrated with a review of CCTA scans. We also propose a checklist organised by organ and system, recommending actions to raise awareness of pulmonologists, thoracic surgeons, cardiologists and radiologists regarding the most significant and actionable incidental findings on CCTA scans.
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Affiliation(s)
- Erique Pinto
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Diana Penha
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.,. Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Bruno Hochhegger
- . Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Colin Monaghan
- . Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Edson Marchiori
- . Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.,. Faculdade de Medicina, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | - Luís Taborda-Barata
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Klaus Irion
- . Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
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Guedes Pinto E, Penha D, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. The impact of cardiopulmonary hemodynamic factors in volumetry for pulmonary nodule management. BMC Med Imaging 2022; 22:49. [PMID: 35303820 PMCID: PMC8932130 DOI: 10.1186/s12880-022-00774-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The acceptance of coronary CT angiogram (CCTA) scans in the management of stable angina has led to an exponential increase in studies performed and reported incidental findings, including pulmonary nodules (PN). Using low-dose CT scans, volumetry tools are used in growth assessment and risk stratification of PN between 5 and 8 mm in diameter. Volumetry of PN could also benefit from the increased temporal resolution of CCTA scans, potentially expediting clinical decisions when an incidental PN is first detected on a CCTA scan, and allow for better resource management and planning in a Radiology department. This study aims to investigate how cardiopulmonary hemodynamic factors impact the volumetry of PN using CCTA scans. These factors include the cardiac phase, vascular distance from the main pulmonary artery (MPA) to the nodule, difference of the MPA diameter between systole and diastole, nodule location, and cardiomegaly presence. MATERIALS AND METHODS Two readers reviewed all CCTA scans performed from 2016 to 2019 in a tertiary hospital and detected PN measuring between 5 and 8 mm in diameter. Each observer measured each nodule using two different software packages and in systole and diastole. A multiple linear regression model was applied, and inter-observer and inter-software agreement were assessed using intraclass correlation. RESULTS A total of 195 nodules from 107 patients were included in this retrospective, cross-sectional and observational study. The regression model identified the vascular distance (p < 0.001), the difference of the MPA diameter between systole and diastole (p < 0.001), and the location within the lower or posterior thirds of the field of view (p < 0.001 each) as affecting the volume measurement. The cardiac phase was not significant in the model. There was a very high inter-observer agreement but no reasonable inter-software agreement between measurements. CONCLUSIONS PN volumetry using CCTA scans seems to be sensitive to cardiopulmonary hemodynamic changes independently of the cardiac phase. These might also be relevant to non-gated scans, such as during PN follow-up. The cardiopulmonary hemodynamic changes are a new limiting factor to PN volumetry. In addition, when a patient experiences an acute or deteriorating cardiopulmonary disease during PN follow-up, these hemodynamic changes could affect the PN growth estimation.
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Affiliation(s)
| | - Diana Penha
- Universidade da Beira Interior, Covilhã, Portugal.,Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust: Liverpool, Liverpool, UK
| | - Bruno Hochhegger
- Pontifical Catholic University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Colin Monaghan
- Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust: Liverpool, Liverpool, UK
| | - Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Klaus Irion
- Imaging Department, University of Manchester, Manchester, UK
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Penha D, Pinto E, Monaghan C, Hochhegger B, Marchiori E, Taborda-Barata L, Irion K, Ravara S, Kauczor HU. Incidental findings on lung cancer screening: pictorial essay and systematic checklist. J Bras Pneumol 2022; 48:e20210371. [PMID: 35137873 PMCID: PMC8836644 DOI: 10.36416/1806-3756/e20210371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
Lung cancer screening (LCS) programs are increasing worldwide. Incidental findings (IFs) on LCS are defined as low-dose CT findings unrelated to the primary purpose of identifying lung cancer. Most IFs on LCS are benign and clinically insignificant but are being increasingly recognized, and some require urgent referral for further diagnostic workup. Other findings are expected and are known as smoking-related comorbidities, including COPD, cardiovascular disease, emphysema, and interstitial lung disease, and their diagnosis can have a significant impact on patient prognosis. The purpose of this pictorial essay is to illustrate the most common IFs on LCS, organized by organ. We will discuss the current literature on IFs on LCS, focusing on their prevalence, appropriate communication, and triggering of clinical pathway systems.
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Affiliation(s)
- Diana Penha
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.,. Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Erique Pinto
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Colin Monaghan
- . Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Bruno Hochhegger
- . Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil.,. University of Florida. Department of Radiology. Gainesville (FL) USA
| | - Edson Marchiori
- . Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.,. Faculdade de Medicina, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | - Luís Taborda-Barata
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.,. Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior - CICS-UBI - Covilhã, Portugal
| | - Klaus Irion
- . Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Sofia Ravara
- . Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior - CICS-UBI - Covilhã, Portugal.,. Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,. Setor de Pneumologia, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - Hans-Ulrich Kauczor
- . Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany.,. Translational Lung Research Center, Heidelberg, Germany
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Simkus P, Gutierrez Gimeno M, Banisauskaite A, Noreikaite J, McCreavy D, Penha D, Arzanauskaite M. Limitations of cardiothoracic ratio derived from chest radiographs to predict real heart size: comparison with magnetic resonance imaging. Insights Imaging 2021; 12:158. [PMID: 34731329 PMCID: PMC8566609 DOI: 10.1186/s13244-021-01097-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/23/2021] [Indexed: 12/29/2022] Open
Abstract
Background Cardiothoracic ratio (CTR) in chest radiographs is still widely used to estimate cardiac size despite the advent of newer imaging techniques. We hypothesise that a universal CTR cut-off value of 50% is a poor indicator of cardiac enlargement. Our aim was to compare CTR with volumetric and functional parameters derived from cardiac magnetic resonance imaging (MRI). Methods 309 patients with a chest radiograph and cardiac MRI acquired within a month were reviewed to assess how CTR correlates with multiple cardiac MRI variables: bi-ventricular EDV (absolute and indexed to body surface area), EF, indexed total heart volume and bi-atrial areas. In addition, we have also determined CTR accuracy by creating multiple ROC curves with the described variables. Results All cardiac MRI variables correlate weakly but statistically significantly with CTR. This weak correlation is explained by a substantial overlap of cardiac MRI parameters in patients with normal and increased CTR. For all variables, CTR was only mildly to moderately better than a chance to discriminate cardiac enlargement (AUC 0.6–0.7). Large CTR values (> 55%) are specific but not sensitive, while low CTR values (< 45%) are sensitive but not specific. Values in between are not sensitive nor specific. Conclusions CTR correlates weakly with true chamber size assessed by gold standard cardiac MRI and has a weak discriminatory power. Thus, clinical decisions based on intermediate CTRs (45–55%) should be avoided. Large CTRs (> 55%) are likely indicative of true heart chamber enlargement. Low CTRs (< 45%) are likely indicative of normal heart size. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01097-0.
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Affiliation(s)
- Paulius Simkus
- Radiology Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | - Manuel Gutierrez Gimeno
- Radiology Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | - Audra Banisauskaite
- Radiology Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK.,Department of Radiology, Lithuanian University of Health Sciences, Eiveniu 2, 50161, Kaunas, Lithuania
| | - Jurate Noreikaite
- Radiology Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | - David McCreavy
- Radiology Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | - Diana Penha
- Radiology Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | - Monika Arzanauskaite
- Radiology Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK. .,Cardiovascular Research Center-ICCC, Hospital de La Santa Creu I Sant Pau, IIB-Sant Pau, Barcelona, Spain.
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Hochhegger B, Marchiori E, Rodrigues R, Mançano A, Jasinowodolinski D, Chate RC, Souza AS, Silva AM, Sawamura M, Furnari M, Araujo-Neto C, Escuissato D, Pinetti R, Nobre LF, Warszawiak D, Szarf G, Telles GBDS, Meirelles G, Santana PR, Antunes V, Capobianco J, Missrie I, Souza LVS, Santos MK, Irion K, Duarte I, Santos R, Pinto E, Penha D. Consensus statement on thoracic radiology terminology in Portuguese used in Brazil and in Portugal. J Bras Pneumol 2021; 47:e20200595. [PMID: 34669832 PMCID: PMC9013533 DOI: 10.36416/1806-3756/e20200595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/27/2021] [Indexed: 11/17/2022]
Abstract
Effective communication among members of medical teams is an important factor for early and appropriate diagnosis. The terminology used in radiology reports appears in this context as an important link between radiologists and other members of the medical team. Therefore, heterogeneity in the use of terms in reports is an important but little discussed issue. This article is the result of an extensive review of nomenclature in thoracic radiology, including for the first time terms used in X-rays, CT, and MRI, conducted by radiologists from Brazil and Portugal. The objective of this review of medical terminology was to create a standardized language for medical professionals and multidisciplinary teams.
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Affiliation(s)
- Bruno Hochhegger
- . Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil.,. Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil.,. Thoracic Imaging Division, College of Medicine, University of Florida, Gainesville (FL) USA
| | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil
| | - Rosana Rodrigues
- . Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | | | | | | | - Arthur Soares Souza
- . Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (SP) Brasil
| | | | | | | | | | | | | | | | | | - Gilberto Szarf
- . Universidade Federal de São Paulo - Unifesp - São Paulo (SP) Brasil
| | | | | | | | | | | | | | | | - Marcel Koeningan Santos
- . Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - USP - Ribeirão Preto (SP) Brasil
| | - Klaus Irion
- . Manchester National Health Service, Manchester, United Kingdom
| | - Isabel Duarte
- . Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | | | - Erique Pinto
- . Universidade da Beira Interior, Covilhã, Portugal
| | - Diana Penha
- . Universidade da Beira Interior, Covilhã, Portugal
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Penha D, Pinto E, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. The impact of lung parenchyma attenuation on nodule volumetry in lung cancer screening. Insights Imaging 2021; 12:84. [PMID: 34170410 PMCID: PMC8233433 DOI: 10.1186/s13244-021-01027-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/02/2021] [Indexed: 11/12/2022] Open
Abstract
Background Recent recommendations for lung nodule management include volumetric analysis using tools that present intrinsic measurement variability, with possible impacts on clinical decisions and patient safety. This study was conducted to evaluate whether changes in the attenuation of the lung parenchyma adjacent to a nodule affect the performance of nodule segmentation using computed tomography (CT) studies and volumetric tools. Methods Two radiologists retrospectively applied two commercially available volumetric tools for the assessment of lung nodules with diameters of 5–8 mm detected by low-dose chest CT during a lung cancer screening program. The radiologists recorded the success and adequacy of nodule segmentation, nodule volume, manually and automatically (or semi-automatically) obtained long- and short-axis measurements, mean attenuation of adjacent lung parenchyma, and presence of interstitial lung abnormalities or disease, emphysema, pleural plaques, and linear atelectasis. Regression analysis was performed to identify predictors of good nodule segmentation using the volumetric tools. Interobserver and intersoftware agreement on good nodule segmentation was assessed using the intraclass correlation coefficient. Results In total, data on 1265 nodules (mean patient age, 68.3 ± 5.1 years; 70.2% male) were included in the study. In the regression model, attenuation of the adjacent lung parenchyma was highly significant (odds ratio 0.987, p < 0.001), with a large effect size. Interobserver and intersoftware agreement on good segmentation was good, although one software package performed better and measurements differed consistently between software packages. Conclusion For lung nodules with diameters of 5–8 mm, the likelihood of good segmentation declines with increasing attenuation of the adjacent parenchyma.
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Affiliation(s)
- Diana Penha
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal. .,Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.
| | - Erique Pinto
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
| | - Bruno Hochhegger
- Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Colin Monaghan
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro Faculdade de Medicina, Rio de Janeiro, RJ, Brazil.,Universidade Federal Fluminense Faculdade de Medicina, Niterói, RJ, Brazil
| | - Luís Taborda-Barata
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
| | - Klaus Irion
- Manchester University NHS Foundation Trust, Manchester, UK
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11
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Stockdale AJ, Fyles F, Farrell C, Lewis J, Barr D, Haigh K, Abouyannis M, Hankinson B, Penha D, Fernando R, Wiles R, Sharma S, Santamaria N, Chindambaram V, Probert C, Ahmed MS, Cruise J, Fordham I, Hicks R, Maxwell A, Moody N, Paterson T, Stott K, Wu MS, Beadsworth M, Todd S, Joekes E. Sensitivity of SARS-CoV-2 RNA polymerase chain reaction using a clinical and radiological reference standard. J Infect 2021; 82:260-268. [PMID: 33892014 PMCID: PMC8057690 DOI: 10.1016/j.jinf.2021.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Diagnostic tests for SARS-CoV-2 are important for epidemiology, clinical management, and infection control. Limitations of oro-nasopharyngeal real-time PCR sensitivity have been described based on comparisons of single tests with repeated sampling. We assessed SARS-CoV-2 PCR clinical sensitivity using a clinical and radiological reference standard. METHODS Between March-May 2020, 2060 patients underwent thoracic imaging and SARS-CoV-2 PCR testing. Imaging was independently double- or triple-reported (if discordance) by blinded radiologists according to radiological criteria for COVID-19. We excluded asymptomatic patients and those with alternative diagnoses that could explain imaging findings. Associations with PCR-positivity were assessed with binomial logistic regression. RESULTS 901 patients had possible/probable imaging features and clinical symptoms of COVID-19 and 429 patients met the clinical and radiological reference case definition. SARS-CoV-2 PCR sensitivity was 68% (95% confidence interval 64-73), was highest 7-8 days after symptom onset (78% (68-88)) and was lower among current smokers (adjusted odds ratio 0.23 (0.12-0.42) p < 0.001). CONCLUSIONS In patients with clinical and imaging features of COVID-19, PCR test sensitivity was 68%, and was lower among smokers; a finding that could explain observations of lower disease incidence and that warrants further validation. PCR tests should be interpreted considering imaging, symptom duration and smoking status.
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Affiliation(s)
- Alexander J Stockdale
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom.
| | - Fred Fyles
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Catriona Farrell
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Joe Lewis
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom
| | - David Barr
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom
| | - Kathryn Haigh
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom
| | - Michael Abouyannis
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Beth Hankinson
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Diana Penha
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Rashika Fernando
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Rebecca Wiles
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Sheetal Sharma
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Nuria Santamaria
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Vijay Chindambaram
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Cairine Probert
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Muhammad Shamsher Ahmed
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - James Cruise
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Imogen Fordham
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Rory Hicks
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Alice Maxwell
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Nick Moody
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Tamsin Paterson
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Katharine Stott
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom
| | - Meng-San Wu
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Michael Beadsworth
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Stacy Todd
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Elizabeth Joekes
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
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12
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Penha D, Pinto EG, Matos F, Hochhegger B, Monaghan C, Taborda-Barata L, Irion K, Marchiori E. CO-RADS: Coronavirus Classification Review. J Clin Imaging Sci 2021; 11:9. [PMID: 33767901 PMCID: PMC7981938 DOI: 10.25259/jcis_192_2020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/24/2021] [Indexed: 01/03/2023] Open
Abstract
In mid-January of 2021, there were over 95 million diagnosed coronavirus disease 2019 (COVID-19) cases and approximately 2 million deaths worldwide. COVID-19 cases requiring hospitalization or intensive care show changes in computed tomography of the chest with improved sensitivity. Several radiology societies have attempted to standardize the reporting of pulmonary involvement by COVID-19. The COVID-19 Reporting and Data System (CO-RADS) builds on lessons learned during the peak of the first wave of the pandemic and shows good inter-observer reliability and good performance in predicting moderate to severe disease. We illustrate the application of the CO-RADS classification with imaging from confirmed cases of COVID-19 and discuss differences to other COVID-19 classifications.
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Affiliation(s)
- Diana Penha
- Department of Radiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Covilhã, Portugal
| | | | - Fernando Matos
- Department of Radiology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Bruno Hochhegger
- Department of Radiology, Hospital São Lucas da Pontificia Universidade Catolica do Rio Grande do Sul, Escola de Medicina, Porto Alegre, Brazil
- Department of Radiology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Colin Monaghan
- Department of Radiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Covilhã, Portugal
| | - Luís Taborda-Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Klaus Irion
- Department of Radiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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13
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Marchiori E, Penha D, Nobre LF, Hochhegger B, Zanetti G. Differences and Similarities between the Double Halo Sign, the Chest CT Target Sign and the Reversed Halo Sign in Patients with COVID-19 Pneumonia. Korean J Radiol 2021; 22:672-676. [PMID: 33660464 PMCID: PMC8005353 DOI: 10.3348/kjr.2020.1150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 09/21/2020] [Accepted: 10/08/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
- Edson Marchiori
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Diana Penha
- Universidade da Beira Interior, Covilhã, Portugal
| | - Luiz Felipe Nobre
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Glaucia Zanetti
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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14
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Penha D, Pinto E, Taborda-Barata L, Irion K, Marchiori E. Lung cancer associated with cystic airspaces: a new radiological presentation of lung cancer. J Bras Pneumol 2020; 46:e20200156. [PMID: 32965296 PMCID: PMC7567613 DOI: 10.36416/1806-3756/e20200156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Diana Penha
- . Universidade da Beira Interior, Covilhã, Portugal
| | - Erique Pinto
- . Universidade da Beira Interior, Covilhã, Portugal
| | | | - Klaus Irion
- . Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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15
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Abelian K, Akano OI, Penha D, Guedes-Pinto E, Ntouskou M. Carcinoid tumor of the anterior mediastinum in a 38-year-old woman. Radiol Case Rep 2020; 15:2018-2021. [PMID: 32874403 PMCID: PMC7452075 DOI: 10.1016/j.radcr.2020.07.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022] Open
Abstract
Mediastinal neuroendocrine tumors (NETs) are very rare. They have been estimated to account for approximately 2%-4% of all anterior mediastinal neoplasms. Carcinoid tumors are a type of NET that can occur in a number of locations. They arise from endocrine amine precursor uptake and decarboxylation cells that can be found in organs such as the lungs. In general, they are slow growing tumors but are nevertheless capable of metastasizing. We present the case of a carcinoid tumor of the anterior mediastinum in a 38-year-old woman presented to our hospital with a 4-month history of worsening breathless and cough. Definitive diagnosis was based on histopathological examination and immunophenotypic markers.
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Affiliation(s)
| | | | - Diana Penha
- Liverpool Heart and Chest Hospital NHS FT, UK.,Universidade da Beira Interior, Portugal
| | - Erique Guedes-Pinto
- Aintree University Hospital NHS FT, UK.,Universidade da Beira Interior, Portugal
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16
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Affiliation(s)
- Erique Guedes Pinto
- Consultant Radiologist, PhD Student, Universidade da Beira Interior, Covilhã, Portugal
| | - Diana Penha
- Consultant Radiologist, PhD Student, Universidade da Beira Interior, Covilhã, Portugal
| | - Klaus L. Irion
- Honorary Professor of Thoracic Imaging, The University of Manchester, Co-lead for Thoracic Imaging, Department of Radiology, Manchester University NHS Foundation Trust
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17
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Pinto EG, Penha D, Irion K. CT-based radiomics of benign and malignant features in multiple cavitary pulmonary lesions. J Bras Pneumol 2020; 46:e20200061. [PMID: 32402015 PMCID: PMC7462690 DOI: 10.36416/1806-3756/e20200061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Diana Penha
- Department of Radiology, Manchester Royal Infirmary, Manchester, Lancashire, United Kingdom
| | - Klaus Irion
- NHS Foundation Trust, Manchester University, Manchester, United Kingdom
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18
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Adlan AM, Campbell T, Fairbairn T, Aggarwal S, Nawaytou O, Penha D, Todd D, Mahida S. Retrograde aortic access during ventricular tachycardia ablation: Indications, techniques, and challenges. J Cardiovasc Electrophysiol 2019; 30:2629-2639. [PMID: 31502368 DOI: 10.1111/jce.14163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/30/2019] [Accepted: 08/26/2019] [Indexed: 11/27/2022]
Abstract
The retrograde aortic (RA) route is a widely used access route for mapping and ablation of ventricular tachycardias (VT) arising from the left ventricular endocardium. With the expanding role of VT ablation in patients with significant comorbidity, the choice between the RA and transseptal access routes is an increasingly important consideration. An individualized decision based on the location of the arrhythmogenic substrate, vascular anatomy, aortic valve morphology, and operator experience is necessary when deciding on the optimal access route. Among patients with challenging vascular anatomy, growing experience from structural interventions such as transcatheter aortic valve replacements and peripheral vascular interventions has provided valuable insights into techniques for safe retrograde access. The present review focuses on patient selection for RA access, potential complications associated with the technique, and optimal approaches for access in patients with challenging vascular or aortic valve anatomy.
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Affiliation(s)
- Ahmed M Adlan
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Timothy Fairbairn
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Suneil Aggarwal
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Omar Nawaytou
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Diana Penha
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Derick Todd
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Saagar Mahida
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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19
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Todd J, Frost F, Penha D, Yioe V. P180 Computed tomography and the Houndsfield unit of density of bronchoceles in patients with cystic fibrosis cannot be reliably used to predict microbial status. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Fronza M, Penha D, Pinto EG. Subtle sings of contained cardiac rupture following myocardial infarction. J Cardiovasc Comput Tomogr 2019; 14:e56-e57. [PMID: 30733115 DOI: 10.1016/j.jcct.2019.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Matteo Fronza
- Radiology Department Liverpool Heart and Chest Hospital, UK.
| | - Diana Penha
- Radiology Department Liverpool Heart and Chest Hospital, UK.
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21
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Di Mango AL, Zanetti G, Penha D, Menna Barreto M, Marchiori E. Endemic pulmonary fungal diseases in immunocompetent patients: an emphasis on thoracic imaging. Expert Rev Respir Med 2019; 13:263-277. [PMID: 30668231 DOI: 10.1080/17476348.2019.1571914] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Systemic endemic mycoses are prevalent in specific geographical areas of the world and are responsible for high rates of morbidity and mortality in these populations, and in immigrants and travelers returning from endemic regions. The most common fungal infections that can affect the lungs of immunocompetent patients include histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis, sporotrichosis, aspergillosis, and cryptococcosis. Diagnosis and management of these diseases remain challenging, especially in non-endemic areas due to the lack of experience. Therefore, recognition of the various radiologic manifestations of pulmonary fungal infections associated with patients' clinical and epidemiologic history is imperative for narrowing the differential diagnosis. Areas covered: This review discusses the clinical and radiological findings of the main endemic fungal diseases affecting the lungs in immunocompetent patients. Specific topics discussed are their etiology, epidemiology, pathogenesis, clinical manifestations, methods of diagnosis, pathology and main imaging findings, especially in computed tomography. Expert commentary: Imaging plays an important role in the diagnosis and management of pulmonary fungal infection and may reveal useful signs. Although definitive diagnosis cannot be made based on imaging features alone, the use of a combination of epidemiologic, clinical and imaging findings may permit the formulation of an adequate differential diagnosis.
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Affiliation(s)
- Ana Luiza Di Mango
- a Department of Radiology , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Gláucia Zanetti
- a Department of Radiology , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Diana Penha
- b Cardiothoracic Consultant and Intervention , Liverpool Heart and Chest Hospital , Liverpool , UK
| | - Miriam Menna Barreto
- a Department of Radiology , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Edson Marchiori
- a Department of Radiology , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
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22
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Hochhegger B, Zanon M, Altmayer S, Pacini GS, Balbinot F, Francisco MZ, Dalla Costa R, Watte G, Santos MK, Barros MC, Penha D, Irion K, Marchiori E. Advances in Imaging and Automated Quantification of Malignant Pulmonary Diseases: A State-of-the-Art Review. Lung 2018; 196:633-642. [DOI: 10.1007/s00408-018-0156-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
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23
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Marchiori E, Penha D, Zanetti G. The Role of Computed Tomography in the Diagnosis of Relapsing Polychondritis. Archivos de Bronconeumología (English Edition) 2017; 53:654. [DOI: 10.1016/j.arbr.2017.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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24
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Souza LVS, Zanon M, Souza AS, Irion K, Penha D, Alves GRT, Marchiori E, Hochhegger B. "Pulmonary Vein Sign" for Pulmonary Embolism Diagnosis in Computed Tomography Angiography. Lung 2017; 195:769-774. [PMID: 29032479 DOI: 10.1007/s00408-017-0057-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
PURPOSES Considering that pulmonary arterial obstruction decreases venous flow, we hypothesized that filling defects in pulmonary veins can be identified in areas adjacent to pulmonary embolism (PE). This sign was named the "pulmonary vein sign" (PVS), and we evaluated its prevalence and performance for PE diagnosis in computed tomography pulmonary angiography (CTPA). METHODS This retrospective study enrolled consecutive patients with clinical suspicion of PE who underwent CTPA scan. The PVS was defined by the following criteria: (a) presence of a homogeneous filling defect of at least 2 cm in a pulmonary vein; (b) attenuation of the left atrium > 160 Hounsfield units. Using the cases that presented PE on CTPA as reference, sensitivity, specificity, and positive and negative predictive values were calculated for PVS. RESULTS In total, 119 patients (73 female; mean age, 62 years) were included in this study. PE was diagnosed in 44 (35.8%) patients. The PVS was present in 16 out of 44 patients with PE. Sensitivity was 36.36% (95% confidence interval (CI) 22.83-52.26%); specificity, 98.67% (95% CI 91.79-99.93%); positive predictive value, 94.12% (95% CI 69.24-99.69%); negative predictive value, 72.55% (95% CI 62.67-80.70%). The Kappa index for the PVS was good (0.801; 95% CI 0.645-0.957). PVS was correlated with lobar and segmental pulmonary embolism (p < 0.01). CONCLUSION Despite a low sensitivity, presence of the pulmonary vein sign was highly specific for PE, with a good agreement between readers. This sign could contribute for PE diagnosis on CTPA studies.
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Affiliation(s)
| | - Matheus Zanon
- LABIMED - Medical Imaging Research Lab, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia of Porto Alegre - Av. Independência, 75, Porto Alegre, 90020-160, Brazil. .,Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre - R. Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil.
| | - Arthur Soares Souza
- Rio Preto Radiodiagnostic Intitute - Rua Cila, 3033, Sao Jose Do Rio Preto, 15015-800, Brazil
| | - Klaus Irion
- Department of Radiology, Liverpool Heart and Chest Hospital, NHS Foundation Trust - Thomas Drive, Broadgreen, Liverpool, L143PE, UK
| | - Diana Penha
- Department of Radiology, Liverpool Heart and Chest Hospital, NHS Foundation Trust - Thomas Drive, Broadgreen, Liverpool, L143PE, UK
| | - Giordano Rafael Tronco Alves
- Department of Radiology, Federal University of Rio de Janeiro Medical School - Av. Carlos Chagas Filho, 373, Rio De Janeiro, 21941-902, Brazil
| | - Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro Medical School - Av. Carlos Chagas Filho, 373, Rio De Janeiro, 21941-902, Brazil
| | - Bruno Hochhegger
- LABIMED - Medical Imaging Research Lab, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia of Porto Alegre - Av. Independência, 75, Porto Alegre, 90020-160, Brazil.,Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre - R. Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil
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25
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Sasso AAD, Zanetti G, Souza CA, Escuissato DL, Irion KL, Guimarães MD, Soares Souza A, Penha D, Marchiori E. High resolution computed tomography of the chest in the evaluation of patients with Birt-Hogg-Dubé syndrome. Rev Port Pneumol (2006) 2017; 23:162-164. [PMID: 28330623 DOI: 10.1016/j.rppnen.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/05/2017] [Accepted: 02/09/2017] [Indexed: 06/06/2023] Open
Affiliation(s)
- A A D Sasso
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - G Zanetti
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - C A Souza
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | - K L Irion
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Royal Liverpool University Hospital NHS Trusts., Liverpool, United Kingdom
| | | | - A Soares Souza
- Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | - D Penha
- Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | - E Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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26
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Penha D. Tuberous sclerosis complex: imaging the pieces of the puzzle. Radiol Bras 2017; 50:IX-X. [PMID: 28298741 PMCID: PMC5347512 DOI: 10.1590/0100-3984.2017.50.1e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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27
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Penha D, Guedes Pinto E, Costa A. Scrotal Cystocele by Computed Tomography and Ultrasound. ACTA MEDICA PORT 2017; 30:81. [PMID: 28501044 DOI: 10.20344/amp.7513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 06/06/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Diana Penha
- Serviço de Radiologia. Hospital Prof. Dr. Fernando Fonseca. Amadora. Portugal
| | - Erique Guedes Pinto
- Serviço de Radiologia. Lincoln County Hospital. United Lincolnshire Hospitals NHS Trust. Lincoln. Reino Unido
| | - Ana Costa
- Serviço de Radiologia. Hospital Prof. Dr. Fernando Fonseca. Amadora. Portugal
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28
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Penha D, Pinto EG, Marchiori E, Costa A, Neto WE, Irion KL. Mesothelial cyst of the pulmonary ligament: An uncommon lesion. Rev Port Pneumol (2006) 2017; 23:49-51. [PMID: 27956031 DOI: 10.1016/j.rppnen.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/12/2016] [Accepted: 10/23/2016] [Indexed: 06/06/2023] Open
Affiliation(s)
- D Penha
- Radiology Department, Hospital Prof. Dr. Fernando Fonseca, Lisbon, Portugal
| | - E G Pinto
- Radiology Department, Lincoln County Hospital, Lincoln, United Kingdom.
| | - E Marchiori
- Radiology Department, The Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A Costa
- Radiology Department, Hospital Prof. Dr. Fernando Fonseca, Lisbon, Portugal
| | - W E Neto
- Radiology Department, The Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - K L Irion
- Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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29
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Penha D, Pinto EG, Costa A, Binukrishnan S, Marchiori E. [Hemorrhagic lung metastases]. Medicina (B Aires) 2017; 77:74. [PMID: 28140315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- Diana Penha
- Servicio de Radiología, Hospital Prof. Dr. Fernando Fonseca, E.P.E., Portugal
| | - Erique G Pinto
- Servicio de Radiología, United Lincolnshire Hospitals NHS Trust, Reino Unido
| | - Ana Costa
- Servicio de Radiología, Hospital Prof. Dr. Fernando Fonseca, E.P.E., Portugal
| | - Sukumaran Binukrishnan
- Servicio de Radiología, Liverpool Heart and Chest Hospital NHS Foundation Trust, Reino Unido
| | - Edson Marchiori
- Servicio de Radiologia, Universidade Federal do Rio de Janeiro, Brasil
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Affiliation(s)
| | - Diana Penha
- Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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