1
|
de Frémont GM, Monaya A, Chassagnon G, Bouam S, Canniff E, Cohen P, Casadevall M, Mouthon L, Le Guern V, Revel MP. Lung fibrosis is uncommon in primary Sjögren's disease: A retrospective analysis of computed tomography features in 77 patients. Diagn Interv Imaging 2024; 105:183-190. [PMID: 38262872 DOI: 10.1016/j.diii.2024.01.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE The purpose of this study was to describe lung abnormalities observed on computed tomography (CT) in patients meeting the 2016 American College of Rheumatology/European League Against Rheumatism (EULAR) classification criteria for primary Sjögren's disease (pSD). MATERIALS AND METHODS All patients with pSD seen between January 2009 and December 2020 in the day care centre of our National Reference Center for rare systemic autoimmune diseases, who had at least one chest CT examination available for review and for whom the cumulative EULAR Sjögren's Syndrome Disease Activity Index (cumESSDAI) could be calculated were retrospectively evaluated. CT examinations were reviewed, together with clinical symptoms and pulmonary functional results. RESULTS Seventy-seven patients (73 women, four men) with a median age of 51 years at pSD diagnosis (age range: 17-79 years), a median follow-up time of 6 years and a median cumESSDAI of 7 were included. Sixty-six patients (86%) had anti-SSA antibodies. Thirty-three patients (33/77; 43%) had respiratory symptoms, without significant alteration in pulmonary function tests. Forty patients (40/77; 52%) had abnormal lung CT findings of whom almost half of them had no respiratory symptoms. Abnormalities on chest CT were more frequently observed in patients with anti-SSA positivity and a history of lymphoma. Air cysts (28/77; 36%) and mosaic perfusion (35/77; 35%) were the predominant abnormalities, whereas lung fibrosis was observed in five patients (5/77; 6%). CONCLUSION More than half of patients with pSD have abnormal CT findings, mainly air cysts and mosaic perfusion, indicative of small airways disease, whereas lung fibrosis is rare, observed in less than 10% of such patients.
Collapse
Affiliation(s)
- Grégoire Martin de Frémont
- Université Paris Cité, Faculté de Médecine, 75006 paris, France; Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, AP-HP, 75014 Paris, France
| | | | - Guillaume Chassagnon
- Université Paris Cité, Faculté de Médecine, 75006 paris, France; Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Samir Bouam
- Department of Medical Informatics, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Emma Canniff
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Marion Casadevall
- Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Luc Mouthon
- Université Paris Cité, Faculté de Médecine, 75006 paris, France; Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Véronique Le Guern
- Department of Internal Medicine, Centre de Référence des Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Marie-Pierre Revel
- Université Paris Cité, Faculté de Médecine, 75006 paris, France; Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France.
| |
Collapse
|
2
|
Bennani S, Regnard NE, Ventre J, Lassalle L, Nguyen T, Ducarouge A, Dargent L, Guillo E, Gouhier E, Zaimi SH, Canniff E, Malandrin C, Khafagy P, Koulakian H, Revel MP, Chassagnon G. Erratum for: Using AI to Improve Radiologist Performance in Detection of Abnormalities on Chest Radiographs. Radiology 2024; 311:e249015. [PMID: 38687223 DOI: 10.1148/radiol.249015] [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: 05/02/2024]
|
3
|
Lecomte A, Olejarz N, Canniff E. CT features of isolated pulmonary amyloid light-chain (AL) amyloidosis. Diagn Interv Imaging 2024; 105:121-122. [PMID: 38383279 DOI: 10.1016/j.diii.2024.02.002] [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: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Adrien Lecomte
- Department of Radiology, Hôpital Cochin, AP-HP, Paris 75014, France.
| | - Nicole Olejarz
- Department of Pathology, Hôpital Cochin, AP-HP, Paris 75014, France
| | - Emma Canniff
- Department of Radiology, Hôpital Cochin, AP-HP, Paris 75014, France; Faculté de Médecine, Université Paris Cité, Paris 75006, France
| |
Collapse
|
4
|
Cazier P, Chassagnon G, Dhote T, Da Silva J, Kanaan R, Honore I, Carlier N, Revel MP, Canniff E, Martin C, Burgel PR. Reversal of cylindrical bronchial dilatations in a subset of adults with cystic fibrosis treated with elexacaftor-tezacaftor-ivacaftor. Eur Respir J 2024:2301794. [PMID: 38331460 DOI: 10.1183/13993003.01794-2023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND This study sought to evaluate the impact of elexacaftor-tezacaftor-ivacaftor (ETI) on lung structural abnormalities in adults with cystic fibrosis (awCF) with a specific focus on the reversal of bronchial dilatations. METHODS Chest computed tomography (CT) performed prior to, and ≥12 months after initiation of ETI were visually reviewed for possible reversal of bronchial dilatations. AwCF with and without reversal of bronchial dilatation (the latter served as controls with 3 controls per case) were selected. Visual Brody score, bronchial and arterial diameters, and lung volume were measured on CT. RESULTS Reversal of bronchial dilatation was found in 12/235 (5%) awCF treated with ETI. Twelve awCF with and 36 without reversal of bronchial dilatations were further analyzed (male=56%, mean age=31.6±8.5 years, F508del/F508del CFTR =54% and mean %predicted forced expiratory volume in 1 s=58.8%±22.3). The mean±sd Brody score improved overall from 79.4±29.8 to 54.8±32.3 (p<0.001). Reversal of bronchial dilatations was confirmed by a decrease in bronchial lumen diameter in cases from 3.9±0.9 mm to 3.2±1.1 mm (p<0.001), whereas it increased in awCF without reversal of bronchial dilatation (from 3.5±1.1 mm to 3.6±1.2 mm, p=0.002). Reversal of bronchial dilatations occurred in cylindrical (not varicose or saccular) bronchial dilatations. Lung volumes decreased by -6.6±10.7% in awCF with reversal of bronchial dilatation but increased by +2.3±9.6% in controls (p=0.007). CONCLUSION Although bronchial dilatations are generally considered irreversible, ETI was associated with reversal, which was limited to the cylindrical bronchial dilatations subtype, and occurred in a small subset of awCF. Initiating ETI earlier in life may reverse early bronchial dilatations.
Collapse
Affiliation(s)
- Paul Cazier
- Radiology department, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- These authors equally contributed to this work
| | - Guillaume Chassagnon
- Radiology department, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- Université Paris Cité and Institut Cochin, Inserm U1016 85 Boulevard Saint-Germain, Paris, France
- These authors equally contributed to this work
| | - Théo Dhote
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
| | - Jennifer Da Silva
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
| | - Reem Kanaan
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
| | - Isabelle Honore
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
| | - Nicolas Carlier
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
| | - Marie-Pierre Revel
- Radiology department, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- Université Paris Cité and Institut Cochin, Inserm U1016 85 Boulevard Saint-Germain, Paris, France
| | - Emma Canniff
- Radiology department, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- Université Paris Cité and Institut Cochin, Inserm U1016 85 Boulevard Saint-Germain, Paris, France
| | - Clémence Martin
- Université Paris Cité and Institut Cochin, Inserm U1016 85 Boulevard Saint-Germain, Paris, France
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
| | - Pierre-Régis Burgel
- Université Paris Cité and Institut Cochin, Inserm U1016 85 Boulevard Saint-Germain, Paris, France
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, Paris, France
- ERN-Lung CF network, Frankfurt, Germany
| |
Collapse
|
5
|
Bennani S, Regnard NE, Ventre J, Lassalle L, Nguyen T, Ducarouge A, Dargent L, Guillo E, Gouhier E, Zaimi SH, Canniff E, Malandrin C, Khafagy P, Koulakian H, Revel MP, Chassagnon G. Using AI to Improve Radiologist Performance in Detection of Abnormalities on Chest Radiographs. Radiology 2023; 309:e230860. [PMID: 38085079 DOI: 10.1148/radiol.230860] [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] [Indexed: 12/18/2023]
Abstract
Background Chest radiography remains the most common radiologic examination, and interpretation of its results can be difficult. Purpose To explore the potential benefit of artificial intelligence (AI) assistance in the detection of thoracic abnormalities on chest radiographs by evaluating the performance of radiologists with different levels of expertise, with and without AI assistance. Materials and Methods Patients who underwent both chest radiography and thoracic CT within 72 hours between January 2010 and December 2020 in a French public hospital were screened retrospectively. Radiographs were randomly included until reaching 500 radiographs, with about 50% of radiographs having abnormal findings. A senior thoracic radiologist annotated the radiographs for five abnormalities (pneumothorax, pleural effusion, consolidation, mediastinal and hilar mass, lung nodule) based on the corresponding CT results (ground truth). A total of 12 readers (four thoracic radiologists, four general radiologists, four radiology residents) read half the radiographs without AI and half the radiographs with AI (ChestView; Gleamer). Changes in sensitivity and specificity were measured using paired t tests. Results The study included 500 patients (mean age, 54 years ± 19 [SD]; 261 female, 239 male), with 522 abnormalities visible on 241 radiographs. On average, for all readers, AI use resulted in an absolute increase in sensitivity of 26% (95% CI: 20, 32), 14% (95% CI: 11, 17), 12% (95% CI: 10, 14), 8.5% (95% CI: 6, 11), and 5.9% (95% CI: 4, 8) for pneumothorax, consolidation, nodule, pleural effusion, and mediastinal and hilar mass, respectively (P < .001). Specificity increased with AI assistance (3.9% [95% CI: 3.2, 4.6], 3.7% [95% CI: 3, 4.4], 2.9% [95% CI: 2.3, 3.5], and 2.1% [95% CI: 1.6, 2.6] for pleural effusion, mediastinal and hilar mass, consolidation, and nodule, respectively), except in the diagnosis of pneumothorax (-0.2%; 95% CI: -0.36, -0.04; P = .01). The mean reading time was 81 seconds without AI versus 56 seconds with AI (31% decrease, P < .001). Conclusion AI-assisted chest radiography interpretation resulted in absolute increases in sensitivity for all radiologists of various levels of expertise and reduced the reading times; specificity increased with AI, except in the diagnosis of pneumothorax. © RSNA, 2023 Supplemental material is available for this article.
Collapse
Affiliation(s)
- Souhail Bennani
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Nor-Eddine Regnard
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Jeanne Ventre
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Louis Lassalle
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Toan Nguyen
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Alexis Ducarouge
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Lucas Dargent
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Enora Guillo
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Elodie Gouhier
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Sophie-Hélène Zaimi
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Emma Canniff
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Cécile Malandrin
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Philippe Khafagy
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Hasmik Koulakian
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Marie-Pierre Revel
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| | - Guillaume Chassagnon
- From the Department of Thoracic Imaging, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France (S.B., L.D., E. Guillo, E. Gouhier, S.H.Z., E.C., M.P.R., G.C.); Gleamer, Paris, France (S.B., N.E.R., J.V., L.L., T.N., A.D.); Réseau d'Imagerie Sud Francilien, Lieusant, France (N.E.R., L.L., C.M.); Department of Pediatric Radiology, Armand Trousseau Hospital, AP-HP, Paris, France (T.N.); HFR Fribourg, Fribourg, Switzerland (P.K.); and Centre d'Imagerie Médicale de l'Ouest Parisien, Paris, France (H.K.)
| |
Collapse
|
6
|
Chassagnon G, Billet N, Rutten C, Toussaint T, Cassius de Linval Q, Collin M, Lemouchi L, Homps M, Hedjoudje M, Ventre J, Gregory J, Canniff E, Regnard NE, Bennani S, Revel MP. Learning from the machine: AI assistance is not an effective learning tool for resident education in chest x-ray interpretation. Eur Radiol 2023; 33:8241-8250. [PMID: 37572190 DOI: 10.1007/s00330-023-10043-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES To assess whether a computer-aided detection (CADe) system could serve as a learning tool for radiology residents in chest X-ray (CXR) interpretation. METHODS Eight radiology residents were asked to interpret 500 CXRs for the detection of five abnormalities, namely pneumothorax, pleural effusion, alveolar syndrome, lung nodule, and mediastinal mass. After interpreting 150 CXRs, the residents were divided into 2 groups of equivalent performance and experience. Subsequently, group 1 interpreted 200 CXRs from the "intervention dataset" using a CADe as a second reader, while group 2 served as a control by interpreting the same CXRs without the use of CADe. Finally, the 2 groups interpreted another 150 CXRs without the use of CADe. The sensitivity, specificity, and accuracy before, during, and after the intervention were compared. RESULTS Before the intervention, the median individual sensitivity, specificity, and accuracy of the eight radiology residents were 43% (range: 35-57%), 90% (range: 82-96%), and 81% (range: 76-84%), respectively. With the use of CADe, residents from group 1 had a significantly higher overall sensitivity (53% [n = 431/816] vs 43% [n = 349/816], p < 0.001), specificity (94% [i = 3206/3428] vs 90% [n = 3127/3477], p < 0.001), and accuracy (86% [n = 3637/4244] vs 81% [n = 3476/4293], p < 0.001), compared to the control group. After the intervention, there were no significant differences between group 1 and group 2 regarding the overall sensitivity (44% [n = 309/696] vs 46% [n = 317/696], p = 0.666), specificity (90% [n = 2294/2541] vs 90% [n = 2285/2542], p = 0.642), or accuracy (80% [n = 2603/3237] vs 80% [n = 2602/3238], p = 0.955). CONCLUSIONS Although it improves radiology residents' performances for interpreting CXRs, a CADe system alone did not appear to be an effective learning tool and should not replace teaching. CLINICAL RELEVANCE STATEMENT Although the use of artificial intelligence improves radiology residents' performance in chest X-rays interpretation, artificial intelligence cannot be used alone as a learning tool and should not replace dedicated teaching. KEY POINTS • With CADe as a second reader, residents had a significantly higher sensitivity (53% vs 43%, p < 0.001), specificity (94% vs 90%, p < 0.001), and accuracy (86% vs 81%, p < 0.001), compared to residents without CADe. • After removing access to the CADe system, residents' sensitivity (44% vs 46%, p = 0.666), specificity (90% vs 90%, p = 0.642), and accuracy (80% vs 80%, p = 0.955) returned to that of the level for the group without CADe.
Collapse
Affiliation(s)
- Guillaume Chassagnon
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
- Université de Paris, 27 Rue du Faubourg Saint-Jacques, 85 Boulevard Saint-Germain, 75006, Paris, France.
| | - Nicolas Billet
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Caroline Rutten
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Thibault Toussaint
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | | | - Mégane Collin
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Leila Lemouchi
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Margaux Homps
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Mohamed Hedjoudje
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | | | - Jules Gregory
- Université de Paris, 27 Rue du Faubourg Saint-Jacques, 85 Boulevard Saint-Germain, 75006, Paris, France
- Radiology Department, FHU MOSAIC, Hôpital Beaujon, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Emma Canniff
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Nor-Eddine Regnard
- Gleamer, 117 Quai de Valmy, 75010, Paris, France
- Réseau d'Imagerie Sud Francilien, 254 Ter Avenue Henri Barbusse, 91210, Draveil, France
| | - Souhail Bennani
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
- Gleamer, 117 Quai de Valmy, 75010, Paris, France
| | - Marie-Pierre Revel
- Radiology Department, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université de Paris, 27 Rue du Faubourg Saint-Jacques, 85 Boulevard Saint-Germain, 75006, Paris, France
| |
Collapse
|
7
|
Girardet R, Dubois M, Manasseh G, Jreige M, Du Pasquier C, Canniff E, Gulizia M, Bonvin M, Aleman Y, Taouli B, Fraga M, Dromain C, Vietti Violi N. The combination of non-contrast abbreviated MRI and alpha foetoprotein has high performance for hepatocellular carcinoma screening. Eur Radiol 2023; 33:6929-6938. [PMID: 37464111 PMCID: PMC10511584 DOI: 10.1007/s00330-023-09906-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/09/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES This study aimed to compare two abbreviated MRI (AMRI) protocols to complete MRI for HCC detection: non-contrast (NC)-AMRI without/with alpha foetoprotein (AFP) and dynamic contrast-enhanced (Dyn)-AMRI. METHODS This retrospective single-center study included 351 patients (M/F: 264/87, mean age: 57y) with chronic liver disease, who underwent MRI for HCC surveillance between 2014 and 2020. Two reconstructed AMRI sets were obtained based on complete MRI: NC-AMRI (T2-weighted imaging (WI) + diffusion-WI) and Dyn-AMRI (T2-WI + dynamic T1-WI) and were assessed by 2 radiologists who reported all suspicious lesions, using LI-RADS/adapted LI-RADS classification. The reference standard was based on all available patient data. Inter-reader agreement was assessed and MRI diagnostic performance was compared to the reference standard. RESULTS The reference standard demonstrated 83/351 HCC-positive patients (prevalence: 23.6%, median size: 22 mm, and positive MRIs: 83/631). Inter-reader agreement was substantial for all sets. Sensitivities of Dyn-AMRI and complete MRI (both 92.8%) were similar, higher than NC-AMRI (72.3%, p < 0.001). Specificities were not different between sets. NC-AMRI + AFP (92.8%) had similar sensitivity to Dyn-AMRI and complete MRI. In patients with small size HCCs (≤ 2 cm), sensitivities of Dyn-AMRI (85.3%) and complete MRI (88.2%) remained similar (p = 0.564), also outperforming NC-AMRI (52.9%, p < 0.05). NC-AMRI + AFP had similar sensitivity (88.2%) to Dyn-AMRI and complete MRI (p = 0.706 and p = 1, respectively). CONCLUSIONS Dyn-AMRI has similar diagnostic performance to complete MRI for HCC detection, while both outperform NC-AMRI, especially for small size HCCs. NC-AMRI + AFP demonstrates similar sensitivity to Dyn-AMRI and complete MRI. CLINICAL RELEVANCE STATEMENT Due to the low sensitivity of ultrasound for hepatocellular screening, new screening methods are needed. Abbreviated MRI (AMRI) is a candidate, especially non-contrast AMRI with serum alpha foetoprotein as the acquisition time is low, without the need for contrast medium injection. KEY POINTS • Dynamic contrast-enhanced abbreviated MRI using extracellular gadolinium-based contrast agent and complete MRI have similar diagnostic performance for hepatocellular carcinoma detection in an at-risk population. • Non-contrast abbreviated MRI with alpha foetoprotein has similar diagnostic performance to dynamic contrast-enhanced abbreviated MRI and complete MRI, including when considering small size hepatocellular carcinoma ≤ 2 cm. • Non-contrast abbreviated MRI and dynamic contrast-enhanced abbreviated MRI can be performed in 7 and 10 min, excluding patient setup time.
Collapse
Affiliation(s)
- Raphaël Girardet
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Margaux Dubois
- Department of Gastro-enterology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Gibran Manasseh
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Mario Jreige
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Céline Du Pasquier
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Emma Canniff
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Marianna Gulizia
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Melissa Bonvin
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Yasser Aleman
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Bachir Taouli
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Montserrat Fraga
- Department of Gastro-enterology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Clarisse Dromain
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Naik Vietti Violi
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
| |
Collapse
|
8
|
Chassagnon G, El Hajjam M, Boussouar S, Revel MP, Khoury R, Ghaye B, Bommart S, Lederlin M, Tran Ba S, De Margerie-Mellon C, Fournier L, Cassagnes L, Ohana M, Jalaber C, Dournes G, Cazeneuve N, Ferretti G, Talabard P, Donciu V, Canniff E, Debray MP, Crutzen B, Charriot J, Rabeau V, Khafagy P, Chocron R, Leonard Lorant I, Metairy L, Ruez-Lantuejoul L, Beaune S, Hausfater P, Truchot J, Khalil A, Penaloza A, Affole T, Brillet PY, Roy C, Pucheux J, Zbili J, Sanchez O, Porcher R. Strategies to safely rule out pulmonary embolism in COVID-19 outpatients: a multicenter retrospective study. Eur Radiol 2023; 33:5540-5548. [PMID: 36826504 PMCID: PMC9951833 DOI: 10.1007/s00330-023-09475-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 11/30/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES The objective was to define a safe strategy to exclude pulmonary embolism (PE) in COVID-19 outpatients, without performing CT pulmonary angiogram (CTPA). METHODS COVID-19 outpatients from 15 university hospitals who underwent a CTPA were retrospectively evaluated. D-Dimers, variables of the revised Geneva and Wells scores, as well as laboratory findings and clinical characteristics related to COVID-19 pneumonia, were collected. CTPA reports were reviewed for the presence of PE and the extent of COVID-19 disease. PE rule-out strategies were based solely on D-Dimer tests using different thresholds, the revised Geneva and Wells scores, and a COVID-19 PE prediction model built on our dataset were compared. The area under the receiver operating characteristics curve (AUC), failure rate, and efficiency were calculated. RESULTS In total, 1369 patients were included of whom 124 were PE positive (9.1%). Failure rate and efficiency of D-Dimer > 500 µg/l were 0.9% (95%CI, 0.2-4.8%) and 10.1% (8.5-11.9%), respectively, increasing to 1.0% (0.2-5.3%) and 16.4% (14.4-18.7%), respectively, for an age-adjusted D-Dimer level. D-dimer > 1000 µg/l led to an unacceptable failure rate to 8.1% (4.4-14.5%). The best performances of the revised Geneva and Wells scores were obtained using the age-adjusted D-Dimer level. They had the same failure rate of 1.0% (0.2-5.3%) for efficiency of 16.8% (14.7-19.1%), and 16.9% (14.8-19.2%) respectively. The developed COVID-19 PE prediction model had an AUC of 0.609 (0.594-0.623) with an efficiency of 20.5% (18.4-22.8%) when its failure was set to 0.8%. CONCLUSIONS The strategy to safely exclude PE in COVID-19 outpatients should not differ from that used in non-COVID-19 patients. The added value of the COVID-19 PE prediction model is minor. KEY POINTS • D-dimer level remains the most important predictor of pulmonary embolism in COVID-19 patients. • The AUCs of the revised Geneva and Wells scores using an age-adjusted D-dimer threshold were 0.587 (95%CI, 0.572 to 0.603) and 0.588 (95%CI, 0.572 to 0.603). • The AUC of COVID-19-specific strategy to rule out pulmonary embolism ranged from 0.513 (95%CI: 0.503 to 0.522) to 0.609 (95%CI: 0.594 to 0.623).
Collapse
Affiliation(s)
- Guillaume Chassagnon
- Radiology Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Mostafa El Hajjam
- Radiology Department, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay, 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Samia Boussouar
- Cardiothoracic Imaging Unit, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne UniversitéLaboratoire d'imagerie Biomédicale, INSERM, ICAN Institute of Cardiometabolism and Nutrition, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Marie-Pierre Revel
- Radiology Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Ralph Khoury
- Radiology Department, Hôpital Bichat, AP-HP, Université Paris Cité, 46 Rue Henri Huchard, 75018, Paris, France
| | - Benoît Ghaye
- Radiology Department, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium
| | - Sebastien Bommart
- Radiology Department, Hôpital Arnaud de Villeneuve, PHYMEDEXP - INSERM U1046 - CNRS UMR 9214, Université de Montpellier, 371 Avenue Doyen Gaston Giraud, 34090, Montpellier, France
| | - Mathieu Lederlin
- Radiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Stephane Tran Ba
- Radiology Department, Hôpital Avicenne, AP-HP, Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Constance De Margerie-Mellon
- Radiology Department, Hôpital Saint-Louis, AP-HP, Université Paris Cité, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Laure Fournier
- Radiology Department, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France
| | - Lucie Cassagnes
- Radiology Department, CHU Gabriel Montpied, Institut Pascal, TGI, UMR6602 CNRS SIGMA UCA, Université Clermont Auvergne, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Mickael Ohana
- Radiology Department, Nouvel Hôpital Civil, CHU de Strasbourg, Université de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Carole Jalaber
- Radiology Department, CHU Saint Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
| | - Gael Dournes
- Department of Cardio-Thoracic Imaging, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, 1 Avenue Magellan, 33600, Pessac, France
| | - Nicolas Cazeneuve
- Radiology Department, Hôpital Trousseau, CHU Tours, Avenue de La République, 37170, Chambray-Lès-Tours, France
| | - Gilbert Ferretti
- Radiology Department, CHU de Grenoble Alpes, Université Grenoble Alpes, avenue des Maquis du Grésivaudan, 38700 La Tronche, 38043, Grenoble, France
| | - Pauline Talabard
- Radiology Department, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay, 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Victoria Donciu
- Radiology Department, Hôpital Pitié Salpêtrière, AP-HP, Sorbonne Université 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Emma Canniff
- Radiology Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Marie-Pierre Debray
- Radiology Department, Hôpital Bichat, AP-HP, Université Paris Cité, 46 Rue Henri Huchard, 75018, Paris, France
| | - Bernard Crutzen
- Radiology Department, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium
| | - Jeremy Charriot
- Pulmonology Department, Hôpital Arnaud de Villeneuve, CHU Montpellier, 371 Avenue Doyen Gaston Giraud, 34090, Montpellier, France
| | - Valentin Rabeau
- Radiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Philippe Khafagy
- Radiology Department, Hôpital Avicenne, AP-HP, Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Richard Chocron
- Emergency Department, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France
| | - Ian Leonard Lorant
- Radiology Department, Nouvel Hôpital Civil, CHU de Strasbourg, Université de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Loic Metairy
- Radiology Department, Hôpital Trousseau, CHU Tours, Avenue de La République, 37170, Chambray-Lès-Tours, France
| | - Lea Ruez-Lantuejoul
- Radiology Department, CHU de Grenoble Alpes, Université Grenoble Alpes, avenue des Maquis du Grésivaudan, 38700 La Tronche, 38043, Grenoble, France
| | - Sébastien Beaune
- Emergency Department, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Pierre Hausfater
- Emergency Department, Hôpital Pitié Salpêtrière, AP-HP, GRC-14 BIOSFAST Sorbonne Université, UMR INSERM 1166, IHU ICAN, Sorbonne Université, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Jennifer Truchot
- Emergency Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Antoine Khalil
- Radiology Department, Hôpital Bichat, AP-HP, Université Paris Cité, 46 Rue Henri Huchard, 75018, Paris, France
| | - Andrea Penaloza
- Services Des Urgences, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium
| | - Thibaut Affole
- Radiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Pierre-Yves Brillet
- Radiology Department, Hôpital Avicenne, AP-HP, UMR U1272 Hypoxie Et Poumon INSERM, Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Catherine Roy
- Radiology Department, Nouvel Hôpital Civil, CHU de Strasbourg, Université de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Julien Pucheux
- Radiology Department, Hôpital Trousseau, CHU Tours, Avenue de La République, 37170, Chambray-Lès-Tours, France
| | - Jordan Zbili
- Radiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Olivier Sanchez
- Pulmonology Department, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France
| | - Raphael Porcher
- Center for Clinical Epidemiology, Hôtel Dieu, AP-HP, Université Paris Cité, 1 Place du Parvis de, 75004, Paris, France
| |
Collapse
|
9
|
Revel MP, Abdoul H, Chassagnon G, Canniff E, Durand-Zaleski I, Wislez M. Lung CAncer SCreening in French women using low-dose CT and Artificial intelligence for DEtection: the CASCADE study protocol. BMJ Open 2022; 12:e067263. [PMID: 36600392 PMCID: PMC9743404 DOI: 10.1136/bmjopen-2022-067263] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Lung cancer screening (LCS) using low-dose CT has been demonstrated to reduce lung cancer-related mortality in large randomised controlled trials. Moving from trials to practice requires answering practical questions about the level of expertise of CT readers, the need for double reading as in trials and the potential role of artificial intelligence (AI). In addition, most LCS studies have predominantly included male participants with women being under-represented, even though the benefit of screening is greater for them. Thus, this study aims to compare the performance of a single CT reading by general radiologists trained in LCS using AI as a second reader to that of a double reading by expert thoracic radiologists, in a campaign for low-dose CT screening in high-risk women. METHODS AND ANALYSIS This observational cohort study will recruit 2400 asymptomatic women aged between 50 and 74 years, current or former smokers with at least a 20 pack-year smoking history, in 4 different French district areas. Assistance with smoking cessation will be offered to current smokers. An initial low-dose CT scan will be performed, with subsequent follow-ups at 1 year and 2 years. The primary objective is to compare CT scan readings by a single LCS-trained, AI-assisted radiologist to that of an expert double reading. The secondary objectives are: to evaluate the performance of AI as a stand-alone reader; the adherence to screening of female participants; the influence on smoking cessation; the psychological consequences of screening; the detection of chronic obstructive pulmonary disease (COPD), coronary artery disease and osteoporosis on low-dose CT scans and the costs incurred by screening. ETHICS AND DISSEMINATION Ethics approval was obtained from the Comité de Protection des Personnes Sud-Est 1 (ethics approval number: 2021-A02265-36 with an amendment on 15 July 2022). Trial results will be disseminated at conferences, through relevant patient groups and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05195385.
Collapse
Affiliation(s)
- Marie-Pierre Revel
- Université Paris Cité, Paris, France
- Assistance Publique- Hopitaux de Paris, Cochin hospital Radiology department, Paris, France
| | - Hendy Abdoul
- Assistance Publique-Hopitaux de Paris, URC Necker/Cochin, Paris, France
| | - Guillaume Chassagnon
- Université Paris Cité, Paris, France
- Assistance Publique- Hopitaux de Paris, Cochin hospital Radiology department, Paris, France
| | - Emma Canniff
- Assistance Publique- Hopitaux de Paris, Cochin hospital Radiology department, Paris, France
| | - Isabelle Durand-Zaleski
- Université Paris Cité, Paris, France
- Assistance Publique- Hopitaux de Paris, Cochin hospital, Pulmonology Department, Paris, France
| | - Marie Wislez
- Université Paris Cité, Paris, France
- Pulmonology department, Cochin hospital, Assistance Publique - Hopitaux de Paris, Paris, France
| |
Collapse
|
10
|
Jalaber C, Puéchal X, Saab I, Canniff E, Terrier B, Mouthon L, Cabanne E, Mghaieth S, Revel MP, Chassagnon G. Differentiating tracheobronchial involvement in granulomatosis with polyangiitis and relapsing polychondritis on chest CT: a cohort study. Arthritis Res Ther 2022; 24:241. [PMID: 36307863 PMCID: PMC9615207 DOI: 10.1186/s13075-022-02935-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background In patients with tracheobronchial involvement, the differential diagnosis between granulomatosis with polyangiitis (GPA) and relapsing polychondritis (RP) can be challenging. The aim of this study was to describe the characteristics of airway abnormalities on chest computed tomography (CT) in patients with GPA or RP and to determine whether specific imaging criteria could be used to differentiate them. Methods GPA and RP patients with tracheobronchial involvement referred to a national referral center from 2008 to 2020 were evaluated. Their chest CT images were reviewed by two radiologists who were blinded to the final diagnosis in order to analyze the characteristics of airway involvement. The association between imaging features and a diagnosis of GPA rather than RP was analyzed using a generalized linear regression model. Results Chest CTs from 26 GPA and 19 RP patients were analyzed. Involvement of the subglottic trachea (odds ratio for GPA=28.56 [95% CI: 3.17; 847.63]; P=0.001) and extensive airway involvement (odds ratio for GPA=0.02 [95% CI: 0.00; 0.43]; P=0.008) were the two independent CT features that differentiated GPA from RP in multivariate analysis. Tracheal thickening sparing the posterior membrane was significantly associated to RP (odds ratio for GPA=0.09 [95% CI: 0.02; 0.39]; P=0.003) but only in the univariate analysis and suffered from only moderate interobserver agreement (kappa=0.55). Tracheal calcifications were also associated with RP only in the univariate analysis (odds ratio for GPA=0.21 [95% CI: 0.05; 0.78]; P=0.045). Conclusion The presence of subglottic involvement and diffuse airway involvement are the two most relevant criteria in differentiating between GPA and RP on chest CT. Although generally considered to be a highly suggestive sign of RP, posterior tracheal membrane sparing is a nonspecific and an overly subjective sign. • The presence of subglottic involvement is in favor of GPA. • Extensive airway involvement is in favor of RP. • Posterior tracheal membrane sparing is a nonspecific and an overly subjective sign.
Collapse
|
11
|
Gouhier E, Canniff E, Fournel L, Revel MP, Chassagnon G. Pulmonary vein occlusion with parenchymal infarction: A misdiagnosed entity. Diagn Interv Imaging 2022; 103:440-442. [PMID: 35843837 DOI: 10.1016/j.diii.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022]
Affiliation(s)
| | - Emma Canniff
- Department of Radiology, Hôpital Cochin, AP-HP, 75014,Paris, France
| | - Ludovic Fournel
- Department of Thoracic Surgery, Hôpital Cochin, AP-HP, 75014,Paris, France; Université Paris Cité, Faculté de Médecine, 75006,Paris, France
| | | | - Guillaume Chassagnon
- Department of Radiology, Hôpital Cochin, AP-HP, 75014, Paris, France; Université Paris Cité, Faculté de Médecine, 75006,Paris, France.
| |
Collapse
|
12
|
Tual A, Revel MP, Canniff E, Garin A, Chassagnon G. Risk of pleural and diaphragmatic complications following percutaneous radiofrequency ablation of basal lung nodules. Diagn Interv Imaging 2022; 103:324-326. [DOI: 10.1016/j.diii.2022.03.004] [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] [Received: 02/14/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 11/26/2022]
|
13
|
Poitevineau T, Chassagnon G, Bouam S, Jaubert P, Cheurfa C, Regard L, Canniff E, Dinh-Xuan AT, Revel MP. Computed tomography after severe COVID-19 pneumonia: findings at 6 months and beyond. ERJ Open Res 2021; 7:00488-2021. [PMID: 34703831 PMCID: PMC8474481 DOI: 10.1183/23120541.00488-2021] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects the alveolar epithelial cells causing coronavirus disease (COVID-19) pneumonia of varying severity [1, 2]. 15–30% of patients develop acute respiratory distress syndrome (ARDS) requiring hospitalisation in intensive care units (ICU) and mechanical ventilation [2, 3]. At 3 months, there are persisting computed tomography (CT) abnormalities in 17 to 91% of discharged COVID-19 patients [4–8], mainly consistent with an organising pneumonia (OP) pattern. These anomalies are more frequently reported in patients who were admitted to ICU [9]. Pulmonary fibrosis has been reported at autopsy of patients deceased from COVID-19 pneumonia, along with pulmonary microvascular thrombosis [10]. Parenchymal bands and ground-glass opacities consistent with a pattern of late organising pneumonia are frequently observed 6 months after ICU admission for #COVID19, whereas fibrotic changes of limited extent are only observed in about 1/3 of patientshttps://bit.ly/2UGOsbr
Collapse
Affiliation(s)
| | - Guillaume Chassagnon
- Service de Radiologie, Hôpital Cochin, AP-HP Centre, Paris, France.,Université de Paris, Paris, France
| | - Samir Bouam
- Département d'informatique médicale, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Paul Jaubert
- Université de Paris, Paris, France.,Service de médecine intensive-réanimation, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Chérifa Cheurfa
- Université de Paris, Paris, France.,Service de réanimation chirurgicale, Hôpital Cochin, Paris, France
| | - Lucile Regard
- Université de Paris, Paris, France.,Service de pneumologie, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Emma Canniff
- Service de Radiologie, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Anh Tuan Dinh-Xuan
- Université de Paris, Paris, France.,Département de physiologie, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Marie-Pierre Revel
- Service de Radiologie, Hôpital Cochin, AP-HP Centre, Paris, France.,Université de Paris, Paris, France
| |
Collapse
|
14
|
Keane NA, Lane LM, Canniff E, Hare D, Doran S, Wallace E, Hutchinson S, Healy ML, Hennessy B, Meaney J, Chiodini P, O'Connell B, Beausang A, Vandenberghe E. A Surviving Case of Acanthamoeba Granulomatous Amebic Encephalitis in a Hematopoietic Stem Cell Transplant Recipient. Am J Case Rep 2020; 21:e923219. [PMID: 32603318 PMCID: PMC7347033 DOI: 10.12659/ajcr.923219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acanthamoeba are free-living amoebae with potential to infect immunocompromised hosts. The mortality rate of granulomatous amebic encephalitis (GAE) due to Acanthamoeba exceeds 90% and there are currently no reports of survival of this infection in recipients of hematopoietic stem cell transplant. CASE REPORT We report herein the case of a 32-year-old man presenting to our service with abrupt neurological deterioration and seizures 5 months after allogeneic stem cell transplantation for Hodgkin lymphoma. Clinical and imaging findings were non-specific at presentation. Multiple circumscribed, heterogenous, mass-like lesions were identified on MRI. Brain biopsy was performed and revealed multiple cysts and trophozoites suggesting a diagnosis of granulomatous amebic encephalitis. PCR testing confirmed Acanthamoeba. Treatment with miltefosine, metronidazole, azithromycin, fluconazole, pentamidine isethionate, and co-trimoxazole was instituted and the patient survived and shows continued improvement with intensive rehabilitation. CONCLUSIONS We report the first successful outcome in this setting. The diagnosis would have been missed on cerebrospinal fluid analysis alone, but was rapidly made by histological analysis of brain biopsy. This diagnostically challenging infection is likely under-recognized. Early brain biopsy and commencement of a prolonged miltefosine-containing anti-ameba regimen can be curative.
Collapse
Affiliation(s)
- Niamh A Keane
- Department of Hematology, St. James's Hospital, Dublin, Ireland
| | | | - Emma Canniff
- Department of Radiology, St. James's Hospital, Dublin, Ireland
| | - Daniel Hare
- Department of Microbiology, St. James's Hospital, Dublin, Ireland
| | - Simon Doran
- Department of Radiology, St. James's Hospital, Dublin, Ireland
| | - Eugene Wallace
- Department of Rehabilitation Medicine, St. James's Hospital, Dublin, Ireland
| | | | | | - Brian Hennessy
- Department of Hematology, Waterford University Hospital, Waterford, Ireland
| | - Jim Meaney
- Department of Radiology, St. James's Hospital, Dublin, Ireland
| | - Peter Chiodini
- Hospital for Tropical Diseases, University College London, London, United Kingdom
| | - Brian O'Connell
- Department of Microbiology, St. James's Hospital, Dublin, Ireland
| | - Alan Beausang
- Department of Histopathology, Beaumont Hospital, Dublin, Ireland
| | | |
Collapse
|
15
|
Concannon E, Fitzgerald L, Canniff E, Birrane J, Harbison J, Shelley O. Neuroimaging provides relevant clinical information in patients with burn injuries. Burns 2019; 46:552-560. [PMID: 31787472 DOI: 10.1016/j.burns.2019.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/08/2019] [Revised: 08/05/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Neurological assessment of patients with burn injuries may be complicated by a variety of factors including artificial ventilation and sedation, cerebral hypoxia and intoxication. Medically unstable intubated patients present logistical challenges for radiological imaging. The role of neuroimaging as an adjunct to clinical assessment of burn injured patients has not yet been determined. AIM This study aims to investigate the indications, findings and outcomes of neuroimaging studies performed for burn injured patients. METHODS A retrospective case series study of adult burn patients admitted over an 8 year period was completed in the National Burns Centre at St James's Hospital, Dublin. Neuroimaging studies carried out for patients admitted during the study period were reviewed by a Consultant Radiologist and Consultant Stroke Physician. Outcomes included neuroimaging findings, prevalence of white matter disease (Fazekas scale), length of stay, discharge destination, predicted and observed mortality. RESULTS 1328 consecutive patients with burn injuries were admitted during the study period. 56 patients underwent neuroimaging studies with computerised tomography, magnetic resonance imaging or both. 46 out of 56 neuroimaged patients (82.1%) had significant radiological findings, including 14 patients (25%) with acute findings. There was a high prevalence of white matter disease (mean total Fazekas score: 3.59) and acute cerebral infarction (7 patients). Patients with radiological findings required additional in-patient rehabilitation and had increased length of stay (Median 47.0 days vs. 27.5 days, p < 0.027). Patients with resuscitation burns or associated inhalation injury were significantly more likely to undergo neuroimaging (p < 0.0001) and to have positive radiological findings. Predicted mortality was higher in patients with positive neuroimaging findings compared to patients with normal neuroimaging studies, although there was no significant difference in observed mortality between these two groups. CONCLUSION Neuroimaging is used appropriately in patients admitted with burns and provides valuable applicable clinical information when indicated.
Collapse
Affiliation(s)
- Elizabeth Concannon
- Department of Plastic and Reconstructive Surgery, St James's Hospital, Dublin, Ireland.
| | - Louise Fitzgerald
- Department of Plastic and Reconstructive Surgery, St James's Hospital, Dublin, Ireland.
| | - Emma Canniff
- Department of Radiology, St James's Hospital, Dublin, Ireland.
| | - John Birrane
- Department of Plastic and Reconstructive Surgery, St James's Hospital, Dublin, Ireland.
| | - Joseph Harbison
- Department of Medicine for the Elderly, St James's Hospital, Dublin, Ireland.
| | - Odhran Shelley
- Department of Plastic and Reconstructive Surgery, St James's Hospital, Dublin, Ireland.
| |
Collapse
|