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The prognostic role of increased visceral fat attenuation (VFA) remains underexplored. We investigated the long‐term prognostic implications of computed tomography (CT)‐derived VFA in a health check‐up population. This study included consecutive individuals who had positron‐emission tomography/CT scans for health check‐ups between January 2004 and December 2010. The primary outcome was overall survival (OS), and the secondary outcomes were cancer‐specific survival (CSS) and non‐cancer‐specific survival (NCS). Commercially available body composition analysis software was used to obtain abdominal waist VFA, visceral fat volume index (VFI) and skeletal muscle index (SMI) at the L3 level. Sarcopenia was determined using sex‐specific SMI references. VFA and VFI were dichotomized using the thresholds for the highest quartiles. The relationship between CT‐derived body composition parameters and body mass index (BMI) was evaluated with Pearson correlation coefficients. The prognostic implications of VFA and sarcopenic obesity (SO) defined by VFA were assessed by multivariable Cox regression analysis and Kaplan–Meier plots with log‐rank tests. A total of 2720 individuals (1530 men [56.3%] and 1190 women [43.7%]; median age: 53 years, inter‐quartile range: 47–60 years) were included. During the median follow‐up of 138 months, 128 individuals (5%) died (cancer mortality: 2%; non‐cancer mortality: 3%), with 0.2% (5 of 2720) and 1.1% (30 of 2720) of 1‐ and 5‐year mortality rates. VFA was negatively correlated with BMI (r= −0.62; P< 0.001) and VFI (r= −0.69; P< 0.001). After adjusting for clinical variables, sarcopenia and VFI, high VFA was a negative prognostic factor for OS (hazard ratio [HR]: 1.05 per Hounsfield unit; 95% confidence interval [CI]: 1.02, 1.08; P= 0.001), CSS (HR: 1.07 per Hounsfield unit; 95% CI: 1.02, 1.12; P= 0.006) and NCS (HR: 1.03 per Hounsfield unit; 95% CI: 1.01, 1.06; P= 0.009). Individuals with high VFA had higher high‐sensitivity C‐reactive protein levels than those with low VFA (0.11 vs. 0.03 mg/dL; P< 0.001). Individuals with SO defined by VFA had worse OS (9% vs. 4%; P< 0.001), CSS (3% vs. 2%; P= 0.02) and NCS (6% vs. 3%; P< 0.001) than those without SO, even in the same BMI (underweight‐to‐normal BMI, OS: 8% vs. 4%; overweight‐to‐obese BMI, OS: 38% vs. 4%; P< 0.001 in both) or VFI category (high VFI, OS: 43% vs. 6%; low VFI, OS: 8% vs. 3%; P< 0.001 in both). High VFA was associated with long‐term mortality and low‐grade inflammation. VFA can further stratify the current SO by BMI or VFI, and SO defined by VFA can identify individuals who are most vulnerable to long‐term mortality.

The Omicron SARS-CoV2 variant showed more frequent nontypical CT findings (peribronchovascular predilection, less pulmonary vascular involvement) than did the Delta variant in hospitalized patients with COVID-19 disease with comparable CT severity.

Prognostic prediction of nontuberculous mycobacteria pulmonary disease using a deep learning technique has not been attempted.

In addition to the absence of premedication and repeated use of the culprit gadolinium-based contrast agents (GBCAs), a history of hypersensitivity reactions to iodinated contrast media and GBCAs may increase the risk of hypersensitivity reactions to GBCAs.

Baseline adipopenia at preoperative PET/CT was associated with reduced 5-year overall survival and non–cancer-specific survival rates in patients with early-stage non–small cell lung cancer.

A deep learning model was able to determine the activity of tuberculosis on chest radiographs, reflecting bacilli burden.

Pulmonary embolism (PE) and deep vein thrombosis (DVT) occurred in 16.5% and 14.8% of patients with coronavirus disease 2019, respectively, and more than half of patients with PE lacked DVT.

Vaccine effectiveness in preventing severe clinical outcomes and severe pneumonia from SARS-CoV-2 infection gradually declined over time, with increased odds of both severe clinical outcomes and severe pneumonia in patients vaccinated more than 240 days before diagnosis.

IntroductionConflicting results exist regarding whether preoperative transthoracic biopsy increases the risk of pleural recurrence in early lung cancer. We conducted a systematic, patient-level meta-analysis to evaluate the risk of pleural recurrence in stage I lung cancer after percutaneous transthoracic lung biopsy.MethodsA systematic search of OVID-MEDLINE, Embase and the Cochrane Database of Systematic Reviews was performed through October 2018. Eligible studies were original articles on the risk of pleural recurrence in stage I lung cancer after transthoracic biopsy. We contacted the corresponding authors of eligible studies to obtain individual patient-level data. We used the Fine-Gray model for time to recurrence and lung cancer-specific survival and a Cox proportional hazards model for overall survival.ResultsWe analysed 2394 individual patient data from 6 out of 10 eligible studies. Compared with other diagnostic procedures, transthoracic biopsy was associated with a higher risk for ipsilateral pleural recurrence, which manifested solely (subdistribution HR (sHR), 2.58; 95% CI 1.15 to 5.78) and concomitantly with other metastases (sHR 1.99; 95% CI 1.14 to 3.48). In the analysis of secondary outcomes considering a significant interaction between diagnostic procedures and age groups, reductions of time to recurrence (sHR, 2.01; 95% CI 1.11 to 3.64), lung cancer-specific survival (sHR 2.53; 95% CI 1.06 to 6.05) and overall survival (HR 2.08; 95% CI 1.12 to 3.87) were observed in patients younger than 55 years, whereas such associations were not observed in other age groups.DiscussionPreoperative transthoracic lung biopsy was associated with increased pleural recurrence in stage I lung cancer and reduced survival in patients younger than 55 years.

Chest CT scans for the primary screening or diagnosis of coronavirus disease 2019 would not be beneficial in a low-prevalence region because of the substantial rate of false-positive results.

The global coronavirus disease 2019 pandemic continues to escalate at a rapid pace inundating medical facilities and creating substantial challenges globally. The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with cancer seems to be higher, especially as they are more likely to present with an immunocompromised condition, either from cancer itself or from the treatments they receive. A major consideration in the delivery of cancer care during the pandemic is to balance the risk of patient exposure and infection with the need to provide effective cancer treatment. Many aspects of the SARS-CoV-2 infection currently remain poorly characterized and even less is known about the course of infection in the context of a patient with cancer. As SARS-CoV-2 is highly contagious, the risk of infection directly affects the cancer patient being treated, other cancer patients in close proximity, and health care providers. Infection at any level for patients or providers can cause considerable disruption to even the most effective treatment plans. Lung cancer patients, especially those with reduced lung function and cardiopulmonary comorbidities are more likely to have increased risk and mortality from coronavirus disease 2019 as one of its common manifestations is as an acute respiratory illness. The purpose of this manuscript is to present a practical multidisciplinary and international overview to assist in treatment for lung cancer patients during this pandemic, with the caveat that evidence is lacking in many areas. It is expected that firmer recommendations can be developed as more evidence becomes available.

Supplemental digital content is available in the text.

Differentiating between multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IPM) is critical for developing a therapeutic strategy to treat multiple lung cancers with multiple pulmonary sites of involvement.

Family history and previous individual history of hypersensitivity reaction to iodinated contrast media were risk factors for new hypersensitivity occurrence. Premedication and change of iodinated contrast media type were useful measures to prevent recurrent hypersensitivity reaction.

Supplemental digital content is available in the text.

The nondiagnostic results from percutaneous transthoracic needle lung biopsies show that malignancy risk differs in each nondiagnostic lung lesion category with the highest risk among atypical cells, followed by insufficient specimen and nonspecific benign categories.

The rate of mild hypersensitivity reaction at reexposure to low-osmolar iodinated contrast media was significantly reduced when the culprit contrast agent was changed. However, recurrence rates vary according to the specific combinations of iodinated contrast media used in the index reaction and at reexposure.

The aim of this study was to investigate the prevalence and characteristics of nodular lesions in the anterior mediastinum that had been found incidentally on screening chest computed tomography (CT) in asymptomatic subjects.

Histogram and texture parameters varied after contrast material injection; the 120–180-second window after contrast material injection was optimal for MR imaging–derived texture parameter and entropy at dynamic contrast material–enhanced MR imaging.

Understanding integrated radiologic and pathologic findings of epithelial and endothelial injuries in COVID-19 pneumonia can facilitate timely and appropriate patient management strategies.

A deep learning–based model estimated total lung capacity from frontal chest radiographs and demographic variables and accurately predicted survival in idiopathic pulmonary fibrosis.

PET/MR imaging, a new hybrid modality, is thought to have great potential in oncologic imaging because it provides advantages of both PET, which allows functional imaging capability, and MR imaging, which allows high spatial resolution imaging without radiation exposure. Despite the inherent weakness of MR imaging in lung imaging, initial studies on lung cancer revealed that PET/MR imaging showed highly correlated standardized uptake values of lesions and equivalent performance in terms of lesion detection and staging compared with PET/computed tomography (CT). Thus, to affirm the actual clinical benefits of dedicated PET/MR imaging over PET/CT, prospective studies with more patients are warranted.

Various designs of positron emission tomographymagnetic resonance imaging (PETMRI) systems have been recently introduced to clinical practice, which have overcome preexisting technical challenges concerning the fusion of PET and MRI systems. Although further improvements are still necessary especially for bony lesions, quantification using current MRI-based attenuation correction techniques has been shown to be comparable to that of PETcomputed tomography (CT) systems. On the basis of the results of previous whole-body MRI studies, PETMRI is expected to show even better performance than PETCT in M-staging especially for brain and liver metastases. Another advantage of PETMRI over PETCT, in addition to good soft tissue contrast, is the potential reduction in radiation dose. The next important hurdle to overcome for its clinical application is the development of time-efficient protocols for lung cancer evaluation and interpretation of discordant results from both modalities. Multiparametric imaging through PETMRI will help radiologists better understand tumor biology and better evaluate treatment response.

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To prospectively evaluate the image quality and diagnostic performance of a compact flat-panel detector (FD) scanner for thoracic diseases compared to a clinical CT scanner.

Background: We conducted a meta-analysis to determine a practical observation time for detecting a biphasic reaction after resolution of the initial anaphylactic reaction., Methods: A systematic literature search identified studies on adult patients with anaphylaxis and a subsequent biphasic reaction due to various causes that contained sufficient data to extract outcomes. The outcomes were pooled using a random-effects model., Results: Twelve studies with a total of 2,890 adult patients with anaphylaxis and 143 patients with a biphasic reaction were included. In terms of the pooled negative predictive value, 1 h of observation achieved a 95.0% negative predictive value and ≥6 h of observation provided a 97.3% negative predictive value (95% CI: 95.0-98.5). The negative predictive value for a biphasic reaction increased with a longer observation time after initial anaphylaxis, and the increasing trend slowed down from 6 h of observation time. The pooled additional incidence rates of biphasic reactions per 100 person-hours after 1- and 4-h observations were 0.45 (95% CI: 0.20-1.04) and 0.41 (95% CI: 0.19-0.87), respectively. After > 8-12 h of postanaphylactic observation, the negative predictive value reached > 98%, while the additional incidence per 100 person-hours was < 0.10., Conclusions: An observation time of ≥6 h after resolution of an initial anaphylaxis symptom can exclude recurrence of a secondary reaction in > 95% of patients. Although longer observation periods resulted in the detection of more biphasic reactions, 6-12 h of observation time would be practical, supporting current relevant guidelines., (© 2019 S. Karger AG, Basel.)