Search

Purpose To investigate the dynamic evolution of image features of COVID-19 patients appearing as a solitary lesion at initial chest CT scan. Materials and methods Twenty-two COVID-19 patients with solitary pulmonary lesion from three hospitals in China were enrolled from January 18, 2020 to March 18, 2020. The clinical feature and laboratory findings at first visit, as well as characteristics and dynamic evolution of chest CT images were analyzed. Among them, the CT score evaluation was the sum of the lung involvement in five lobes (0–5 points for each lobe, with a total score ranging from 0 to 25). Results 22 COVID-19 patients (11 males and 11 females, with an average age of 40.7 ± 10.3) developed a solitary pulmonary lesion within 4 days after the onset of symptoms, the peak time of CT score was about 11 days (with a median CT score of 6), and was discharged about 19 days. The peak of CT score was positively correlated with the peak time and the discharge time (p

Hemoptysis is a common clinical emergency, bronchial arterial embolization is considered to be an effective treatment. The presence of coronary artery-bronchial artery fistula (CBF) may lead to recurrence of hemoptysis after treatment. It is necessary to investigate the imaging characteristics of a CBF and its correlation with the severity of pulmonary disease. With the development of multi-detector computed tomography, our study used the 320-slice CT bronchial artery angiography technology to observe and visualize blood vessels. The image and clinical data of 2015 hemoptysis patients with 320-slice CT bronchial artery angiography were retrospectively reviewed from January 2015 to December 2019. The axial and three-dimensional CT images were analyzed. The incidence, anatomical characteristics of CBF and pulmonary disease severity score were evaluated. A total of 12 CBF vessels were detected in 11 patients. We found that the incidence of CBF in this group was 0.55% (11/2015). Mean CBF diameter was 1.9 mm (1.2-2.5 mm). The course of CBF usually was relatively fixed. The proportions of CBF originated from the left circumflex artery, right coronary artery, and left anterior descending artery were 75%, 16.7% and 8.3%, respectively. Preliminarily analysis of the correlation between the trend of CBF and the pulmonary diseases severity score showed that CBF was more likely to communicate with a bronchial artery on the side with a higher severity score. CBF may occur in patients with chronic pulmonary disease and hemoptysis, and its origin, course and trend are characteristic. Detailed and comprehensive computed tomography angiography image analysis is helpful to improve the clinical treatment of hemoptysis with CBF.

Objective We aimed to investigate the risk factors of invasive pulmonary adenocarcinoma, especially to report and validate the use of our newly identified arc concave sign in predicting invasiveness of pure ground-glass nodules (pGGNs). Methods From January 2015 to August 2018, we retrospectively enrolled 302 patients with 306 pGGNs ≤ 20 mm pathologically confirmed (141 preinvasive lesions and 165 invasive lesions). Arc concave sign was defined as smooth and sunken part of the edge of the lesion on thin-section computed tomography (TSCT). The degree of arc concave sign was expressed by the arc chord distance to chord length ratio (AC-R); deep arc concave sign was defined as AC-R larger than the optimal cut-off value. Logistic regression analysis was used to identify the independent risk factors of invasiveness. Results Arc concave sign was observed in 65 of 306 pGGNs (21.2 %), and deep arc concave sign (AC-R > 0.25) were more common in invasive lesions (P = 0.008). Under microscope, interlobular septal displacements were found at tumour surface. Multivariate analysis indicated that irregular shape (OR, 3.558; CI: 1.374–9.214), presence of deep arc concave sign (OR, 3.336; CI: 1.013–10.986), the largest diameter > 10.1 mm (OR, 4.607; CI: 2.584–8.212) and maximum density > -502 HU (OR, 6.301; CI: 3.562–11.148) were significant independent risk factors of invasive lesions. Conclusions Arc concave sign on TSCT is caused by interlobular septal displacement. The degree of arc concave sign can reflect the invasiveness of pGGNs. Invasive lesions can be effectively distinguished from preinvasive lesions by the presence of deep arc concave sign, irregular shape, the largest diameter > 10.1 mm and maximum density > -502 HU in pGGNs ≤ 20 mm.

OBJECTIVE. The purpose of this study was to investigate differences in CT manifestations of coronavirus disease (COVID-19) pneumonia and those of influenza virus pneumonia. MATERIALS AND METHODS. We conducted a retrospective study of 52 patients with COVID-19 pneumonia and 45 patients with influenza virus pneumonia. All patients had positive results for the respective viruses from nucleic acid testing and had complete clinical data and CT images. CT findings of pulmonary inflammation, CT score, and length of largest lesion were evaluated in all patients. Mean density, volume, and mass of lesions were further calculated using artificial intelligence software. CT findings and clinical data were evaluated. RESULTS. Between the group of patients with COVID-19 pneumonia and the group of patients with influenza virus pneumonia, the largest lesion close to the pleura (i.e., no pulmonary parenchyma between the lesion and the pleura), mucoid impaction, presence of pleural effusion, and axial distribution showed statistical difference (p 0.05). In addition, no significant difference was seen in CT score, length of the largest lesion, mean density, volume, or mass of the lesions between the two groups (p > 0.05). CONCLUSION. Most lesions in patients with COVID-19 pneumonia were located in the peripheral zone and close to the pleura, whereas influenza virus pneumonia was more prone to show mucoid impaction and pleural effusion. However, differentiating between COVID-19 pneumonia and influenza virus pneumonia in clinical practice remains difficult.

Background: The coronavirus disease-19 (COVID-19) is a highly infectious disease. Moreover, 14% of the discharged patients tested virus positive again. However, the underlying clinical mechanisms are still under investigation. Case presentation: The current study summarized the clinical course, radiological features and laboratory test results of two COVID-19 patients who tested positive again during the quarantine after hospital discharge. We found that while all symptoms were relieved, their lesions in lungs were not fully recovered, and both of them had slight coughs. In addition, when the lesions were further recovered and the cough symptoms were further remitted, they tested virus negative again. Conclusions: These results implied that the positive result is unlikely caused by the reinfection from others or the remained virus. Rather, it may derive from the remained virus transferred from the lower respiratory tract to the throat or nose with coughs. Accordingly, we proposed some suggestions regarding the discharge management. This study enhances our knowledge of the progress of COVID-19 and benefit the control of this disease.

Objective: To retrospectively analyze the correlation between CT findings and duration of initial symptoms in young and middle-aged patients with novel coronavirus pneumonia.Materials and methods: From January 17, 2020 to February 4, 2020, of the 54 SARS-COV-2 infection cases, 48 cases (48/54,88.8%) were young and middle-aged patients under 60 years old. Finally, thirty-three patients under 60 years old with CT imaging were enrolled in this study, including 20 men and 13 women. Patients’ clinical data, including gender, age, infection exposure history, heating temperature, the initial symptoms and the duration, were recorded. The CT imaging features of pneumonia was scored. The number of lung lobe involvement and the length of the largest lesion were recorded. All above CT findings and clinical data were evaluated.Results: The median duration of initial symptoms was 3 days (range 0-7 days). The CT score and the length of the largest lesion showed statistically significant between the groups of initial symptom duration < 3 days and initial symptom duration ≥3 days (P0.05). The duration of the initial symptom was positively correlated with both the CT score of pneumonia (r=0.502, P=0.003) and the length of the largest pneumonia lesion in the lung (r=0.506, P=0.003).Conclusion: The severity of pneumonia and the size of lesions were positively correlated with the duration of the initial symptom in young and middle-aged patients.

Purpose We aim to investigate the risk factors influencing the growth of residual nodule (RN) in surgical patients with adenocarcinoma presenting as multifocal ground-glass nodules (GGNs). Method From January 2014 to June 2018, we enrolled 238 patients with multiple GGNs in a retrospective review. Patients were categorized into growth group 63 (26.5%), and non-growth group 175 (73.5%). The median follow-up time was 28.2 months (range, 6.3-73.0 months). To obtain the time of RN growth and find the risk factors for growth, data such as age, gender, history of smoking, history of malignancy, type of surgery, pathology and radiological characteristics were analyzed to use Kaplan-Meier method with the log-rank test and Cox regression analysis. Results The median growth time of RN was 56.0 months (95% CI, 45.0-67.0 months) in all 238 patients. Roundness (HR 4.62, 95% CI 2.20-9.68), part-solid nodule (CTR ≥ 50%) (HR 4.39, 95% CI 2.29-8.45), vascular convergence sign (HR 2.32, 95% CI 1.36-3.96) of RN, and age (HR 1.04, 95% CI 1.01-1.07) were independent predictors of further nodule growth. However, radiological characteristics and pathology of domain tumour (DT) cannot be used as indicators to predict RN growth. Conclusions RN showed an indolent growth pattern in surgical patients with multifocal GGNs. RN with a higher roundness, presence of vascular convergence sign, more solid component, and in the elder was likely to grow. However, the growth of RN showed no association with the radiological features and pathology of DT.