Introduction: Physical inactivity and cognitive impairment in patients with chronic obstructive pulmonary disease (COPD) leads to frailty which is associated with poor prognosis. However, little is known on the impact of the pathophysiology on the human brain. Aims and objectives: We hypothesized that brain structure could change according to frailty in COPD. We aimed to clarify the relationship between frailty and cortical thickness. Methods: Cortical thickness measured MRI and the frailty score assessed using the Kihon Checklist (KCL) which is a self-reporting questionnaire were assessed in 40 stable COPD patients and 20 healthy controls. Results: In 34 cortical regions on each side, 12 on the right and 13 on the left were found to be significantly thinner in the COPD than in the healthy (p＜0.05, respectively). We examined the association between these regions and frailty score. We found 7 regions with significant negative correlations in COPD, but no in the healthy. Even when adjusted by age, one region on the left and 5 regions on the right showed significant correlations. The correlation coefficient between the bilateral superior frontal gyrus and frailty score were the largest (left: ρ = -0.5308, right: ρ = -0.5361) (p＜0.05). Interestingly, among the KCL, question domain including daily activities showed strongest correlation, with a sensitivity of 90% and a specificity of 73% to capture bottom quartile of thinning of the superior frontal gyrus if 2 of the 5 questions were applicable (left: AUC=0.85, right: AUC=0.88). Conclusion: Frailty in COPD is associated with decreased thickness of specific brain cortical regions, and most pronounced in the superior frontal gyrus. Moreover, KCL could be a useful tool to capture brain frailty.
{"title":"Correlation between frailty and reduced cortical thickness in Chronic Obstructive Pulmonary Disease.","authors":"Ayumi Fukatsu-Chikumoto, Tsunahiko Hirano, Shun Takahashi, Takuya Ishida, Tomihiro Donishi, Kazuyoshi Suga, Keiko Doi, Keiji Oishi, Shuichiro Ohata, Yoriyuki Murata, Yoshikazu Yamaji, Maki Asami-Noyama, Nobutaka Edakuni, Tomoyuki Kakugawa, Kazuto Matsunaga","doi":"10.1183/13993003.congress-2023.pa4000","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa4000","url":null,"abstract":"<b>Introduction:</b> Physical inactivity and cognitive impairment in patients with chronic obstructive pulmonary disease (COPD) leads to frailty which is associated with poor prognosis. However, little is known on the impact of the pathophysiology on the human brain. <b>Aims and objectives:</b> We hypothesized that brain structure could change according to frailty in COPD. We aimed to clarify the relationship between frailty and cortical thickness. <b>Methods:</b> Cortical thickness measured MRI and the frailty score assessed using the Kihon Checklist (KCL) which is a self-reporting questionnaire were assessed in 40 stable COPD patients and 20 healthy controls. <b>Results:</b> In 34 cortical regions on each side, 12 on the right and 13 on the left were found to be significantly thinner in the COPD than in the healthy (p＜0.05, respectively). We examined the association between these regions and frailty score. We found 7 regions with significant negative correlations in COPD, but no in the healthy. Even when adjusted by age, one region on the left and 5 regions on the right showed significant correlations. The correlation coefficient between the bilateral superior frontal gyrus and frailty score were the largest (left: ρ = -0.5308, right: ρ = -0.5361) (p＜0.05). Interestingly, among the KCL, question domain including daily activities showed strongest correlation, with a sensitivity of 90% and a specificity of 73% to capture bottom quartile of thinning of the superior frontal gyrus if 2 of the 5 questions were applicable (left: AUC=0.85, right: AUC=0.88). <b>Conclusion:</b> Frailty in COPD is associated with decreased thickness of specific brain cortical regions, and most pronounced in the superior frontal gyrus. Moreover, KCL could be a useful tool to capture brain frailty.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136259314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa3535
Stevan Ivković, Dušan Ivković, Aleksandar Ivković
Purpose: To explore the CT findings and pneumonia progression pattern of the Alpha, Delta, Omicron variants and subtypes of SARS-CoV-2 in asymptomatic patients. Method: In this retrospective comparative study, a total of 15874 patients with COVID-19 were included: 1281 patients with wild type (748 men, 52.6 years), 7945 with Alpha variant (4972 men, 46.2), 4233 with Delta variant (2548 men) and 2415 with Omicron and subtypes (1301 man, 44.2). Chest CT evaluation included opacities and repairing changes as well as lesion distribution and laterality. Chest CT severity score was also calculated. These parameters were statistically compared across the variants. Results: Total of 15874 patients with confirmed covid 19. Ground glass opacity (GGO), crazy paving, subpleural fibrosis with consolidation and repairing changes were calculated. Chest CT severity score was also calculated. There were 162 patients without symptoms, wild strain 12, Alpha strain 37, Delta strain 62, Omicron strain 51. Delta variant showed GGO and crazy paving with consolidation more noticeable than did the others. Wild strain had more unclear CT presentation. Alfa strain was the first strain with sharp CT presentation. Delta strain was with fast development of subpleural fibrosis. Omicron strain had smaller areas of CGO. Total lung CT severity scores were 0-5 (131), 6-10 (21), 11-15 (7), and 16 to 23 (3). There were 3 lethal cases. Post covid complication were found in 35 patients. 38 patients without symptoms were vaccinated. Conclusions: Asymptomatic patients can have severe forms, even lethal. Post covid can be found in asymptomatic patients.
{"title":"CT findings in asymptomatic patients with covid 19","authors":"Stevan Ivković, Dušan Ivković, Aleksandar Ivković","doi":"10.1183/13993003.congress-2023.pa3535","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa3535","url":null,"abstract":"<b>Purpose:</b> To explore the CT findings and pneumonia progression pattern of the Alpha, Delta, Omicron variants and subtypes of SARS-CoV-2 in asymptomatic patients. Method: In this retrospective comparative study, a total of 15874 patients with COVID-19 were included: 1281 patients with wild type (748 men, 52.6 years), 7945 with Alpha variant (4972 men, 46.2), 4233 with Delta variant (2548 men) and 2415 with Omicron and subtypes (1301 man, 44.2). Chest CT evaluation included opacities and repairing changes as well as lesion distribution and laterality. Chest CT severity score was also calculated. These parameters were statistically compared across the variants. <b>Results:</b> Total of 15874 patients with confirmed covid 19. Ground glass opacity (GGO), crazy paving, subpleural fibrosis with consolidation and repairing changes were calculated. Chest CT severity score was also calculated. There were 162 patients without symptoms, wild strain 12, Alpha strain 37, Delta strain 62, Omicron strain 51. Delta variant showed GGO and crazy paving with consolidation more noticeable than did the others. Wild strain had more unclear CT presentation. Alfa strain was the first strain with sharp CT presentation. Delta strain was with fast development of subpleural fibrosis. Omicron strain had smaller areas of CGO. Total lung CT severity scores were 0-5 (131), 6-10 (21), 11-15 (7), and 16 to 23 (3). There were 3 lethal cases. Post covid complication were found in 35 patients. 38 patients without symptoms were vaccinated. <b>Conclusions:</b> Asymptomatic patients can have severe forms, even lethal. Post covid can be found in asymptomatic patients.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136260552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.oa4856
Benjamin Welham, Michael Bennett, Kristoffer Ostridge, Matthew Guy, Clint Zvavamwe, Francis Sundram, Tom Wilkinson
Introduction: Multiple inflammatory endotypes exist as targets for therapy in COPD but novel precision medicine approaches are needed to define these. We aim to develop non-invasive imaging methods to quantify specific inflammatory cytokines in the lung as potential targets for therapy. Methods: Using SPECT-CT, we developed techniques to quantify cytokine activity. Five patients with COPD and 5 healthy volunteers were recruited and gave informed consent. They underwent SPECT-CT of the lungs at 6 (+/- 1) and 24 (+/- 4) hours after infusion of 99mTc-anti-TNF-α to quantify TNF-α activity in the lungs. Quantification (figure 1) was normalised to aortic arch signal to account for biological clearance. Results: Isotope signals were quantified at 6 and 24 hours. Median normalised lung SPECT counts (CN) were higher in the healthy group at both time points. However, the increase in CN at 24 hours calculated as a percentage of the 6-hour scan (a measure of tissue bound signal) was higher in the COPD group at 64.88% +/- (SD) 31.04 compared with 35.38% +/- 34.33 in the healthy group - a significant change in the COPD group (p=0.029, paired t-test) but not the healthy. Conclusions: This proof-of-concept study provides early evidence that molecular imaging of inflammatory cytokines is possible in the lungs of patients with COPD.
{"title":"Towards precision medicine in COPD: Bioradiomic SPECT-CT quantification of active lung inflammation","authors":"Benjamin Welham, Michael Bennett, Kristoffer Ostridge, Matthew Guy, Clint Zvavamwe, Francis Sundram, Tom Wilkinson","doi":"10.1183/13993003.congress-2023.oa4856","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.oa4856","url":null,"abstract":"<b>Introduction:</b> Multiple inflammatory endotypes exist as targets for therapy in COPD but novel precision medicine approaches are needed to define these. We aim to develop non-invasive imaging methods to quantify specific inflammatory cytokines in the lung as potential targets for therapy. <b>Methods:</b> Using SPECT-CT, we developed techniques to quantify cytokine activity. Five patients with COPD and 5 healthy volunteers were recruited and gave informed consent. They underwent SPECT-CT of the lungs at 6 (+/- 1) and 24 (+/- 4) hours after infusion of <sup>99m</sup>Tc-anti-TNF-α to quantify TNF-α activity in the lungs. Quantification (<i>figure 1</i>) was normalised to aortic arch signal to account for biological clearance. <b>Results:</b> Isotope signals were quantified at 6 and 24 hours. Median normalised lung SPECT counts (C<sub>N</sub>) were higher in the healthy group at both time points. However, the increase in C<sub>N</sub> at 24 hours calculated as a percentage of the 6-hour scan (a measure of tissue bound signal) was higher in the COPD group at 64.88% +/- (SD) 31.04 compared with 35.38% +/- 34.33 in the healthy group - a significant change in the COPD group (p=0.029, paired t-test) but not the healthy. <b>Conclusions:</b> This proof-of-concept study provides early evidence that molecular imaging of inflammatory cytokines is possible in the lungs of patients with COPD.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136193686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa2279
Mathieu Bottier, Andreia Lucia Do Nascimento Pinto, Britt J Van Akker, Oliver Hamilton, Ioannis Katramados, Amelia Shoemark, Claire Hogg, Thomas Burgoyne
Early and accurate diagnosis of Primary Ciliary Dyskinesia (PCD) allows appropriate multidisciplinary management and a reduction in lung function decline. Transmission Electron Microscopy (TEM) is essential in determining ciliary ultrastructural defects, when diagnosing PCD. This requires highly skilled specialists with considerable experience. Machine learning provides an excellent opportunity to reduce the time experts spend assessing cilia (1–2 hours) and improve accuracy of diagnosis. In collaboration with Intel®, we have used an Artificial Intelligence platform (Intel® Geti™), to develop a workflow called PCD-AID (PCD- Artificial Intelligence Diagnosis) that uses computer vision to aid in the diagnosis of PCD. This work is part of an organised ERS Clinical Research Collaboration with BEAT-PCD. The system was tested alongside the PCD diagnostic pathway (n=158) to determine diagnostic accuracy. The model has been trained with TEM images from over 21,000 cilia cross-sections to detect cilia and then classify them based on normal or abnormal ultrastructure or ‘unusable’ for diagnostic purposes (tilted or distorted images). Using retrospective and prospective patient samples, we have found PCD-AID can reliably identify ciliary ultrastructural defects (sensitivity of 0.87 and specificity of 0.88) and assess TEM images in under 1 minute per patient. It has good agreement with diagnostic specialists (> 75%) at identifying a range of ultrastructural defects and strikingly outperforms specialists at identifying subtle central pair defects associated with pathogenic mutations in HYDIN. Implementing computer vision artificial intelligence in the diagnostic pathway improved diagnosis of PCD.
早期和准确的诊断原发性纤毛运动障碍(PCD)允许适当的多学科管理和减少肺功能下降。在诊断PCD时，透射电子显微镜(TEM)在确定纤毛超微结构缺陷方面是必不可少的。这需要具有丰富经验的高技能专家。机器学习提供了一个很好的机会，可以减少专家评估纤毛的时间(1-2小时)，提高诊断的准确性。与英特尔®合作，我们使用人工智能平台(英特尔®Geti™)开发了一个名为PCD- aid (PCD-人工智能诊断)的工作流程，该流程使用计算机视觉来帮助诊断PCD。这项工作是与BEAT-PCD组织的ERS临床研究合作的一部分。该系统与PCD诊断途径(n=158)一起进行测试，以确定诊断准确性。该模型使用来自21,000多个纤毛横截面的TEM图像进行训练，以检测纤毛，然后根据正常或异常的超微结构或“不可用”的诊断目的(倾斜或扭曲的图像)对它们进行分类。通过回顾性和前瞻性患者样本，我们发现PCD-AID可以可靠地识别纤毛超微结构缺陷(灵敏度为0.87，特异性为0.88)，并在每位患者不到1分钟的时间内评估TEM图像。它与诊断专家(>75%)在识别一系列超微结构缺陷方面，在识别与HYDIN致病性突变相关的细微中心对缺陷方面，他们的表现明显优于专家。在诊断路径中实现计算机视觉人工智能，提高了PCD的诊断效果。
{"title":"PCD-AID: artificial intelligence diagnosis of primary ciliary dyskinesia","authors":"Mathieu Bottier, Andreia Lucia Do Nascimento Pinto, Britt J Van Akker, Oliver Hamilton, Ioannis Katramados, Amelia Shoemark, Claire Hogg, Thomas Burgoyne","doi":"10.1183/13993003.congress-2023.pa2279","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa2279","url":null,"abstract":"Early and accurate diagnosis of Primary Ciliary Dyskinesia (PCD) allows appropriate multidisciplinary management and a reduction in lung function decline. Transmission Electron Microscopy (TEM) is essential in determining ciliary ultrastructural defects, when diagnosing PCD. This requires highly skilled specialists with considerable experience. Machine learning provides an excellent opportunity to reduce the time experts spend assessing cilia (1–2 hours) and improve accuracy of diagnosis. In collaboration with Intel®, we have used an Artificial Intelligence platform (Intel® Geti™), to develop a workflow called PCD-AID (PCD- Artificial Intelligence Diagnosis) that uses computer vision to aid in the diagnosis of PCD. This work is part of an organised ERS Clinical Research Collaboration with BEAT-PCD. The system was tested alongside the PCD diagnostic pathway (n=158) to determine diagnostic accuracy. The model has been trained with TEM images from over 21,000 cilia cross-sections to detect cilia and then classify them based on normal or abnormal ultrastructure or ‘unusable’ for diagnostic purposes (tilted or distorted images). Using retrospective and prospective patient samples, we have found PCD-AID can reliably identify ciliary ultrastructural defects (sensitivity of 0.87 and specificity of 0.88) and assess TEM images in under 1 minute per patient. It has good agreement with diagnostic specialists (> 75%) at identifying a range of ultrastructural defects and strikingly outperforms specialists at identifying subtle central pair defects associated with pathogenic mutations in <i>HYDIN</i>. Implementing computer vision artificial intelligence in the diagnostic pathway improved diagnosis of PCD.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa3541
Souha Kallel, Mohamed Amin Chaabouni, Rim Hammami, Omar Walha, Najla Bahloul, Sirine Ayedi, Elleuch Ahmed Dhiaa, Sami Kammoun, Ilhem Charfeddine
Introduction : Chronic rhinosinusitis with nasal polyps (CRSwNP) is frequently associated with asthma. The computed tomography of paranasal sinuses is performed for the majority of patients who are going to be operated. Objective : This work aims to provide an overview of chronic CRSwNP focusing on its asthma-related radilogical presentations. Materiels and methods : This is a retrospective study about 150 patients operated for CRSwNP during a 9-year period between November 2011 and December 2020. Results : Our series included 70 men (46.7%) and 80 women (53.3%) with a sex ratio of 0.87. Asthma was noted in 62 patients (41.3%). There was no statistically significant correlation between asthma and the clinical stage of nasal polyposis (p>0.05). The mean Lund Mackay score was 21.01 in non-asthmatics and 21.94 in asthmatics. It appears that asthma was not objectively correlated with a higher Lund Mackay radiologic score (p=0.14). There is a more pronounced involvement of the sphenoidal sinuses in asthmatic patients. The involvement of the other sinuses and the ostio meatal complex was almost the same in patients with and without asthma. Conclusion : Asthma-associated CRSwNP is recognized as a more aggressive subtype of CRSwNP. In our population of patients, Asthma is an additional symptom and the radiologic presentation was not a therapeutic indicator for asthmatic patients.
{"title":"Severity and radiological score in nasal polyposis associated with asthma : comparison between asthmatic and non-asthmatic patients","authors":"Souha Kallel, Mohamed Amin Chaabouni, Rim Hammami, Omar Walha, Najla Bahloul, Sirine Ayedi, Elleuch Ahmed Dhiaa, Sami Kammoun, Ilhem Charfeddine","doi":"10.1183/13993003.congress-2023.pa3541","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa3541","url":null,"abstract":"Introduction : Chronic rhinosinusitis with nasal polyps (CRSwNP) is frequently associated with asthma. The computed tomography of paranasal sinuses is performed for the majority of patients who are going to be operated. Objective : This work aims to provide an overview of chronic CRSwNP focusing on its asthma-related radilogical presentations. Materiels and methods : This is a retrospective study about 150 patients operated for CRSwNP during a 9-year period between November 2011 and December 2020. Results : Our series included 70 men (46.7%) and 80 women (53.3%) with a sex ratio of 0.87. Asthma was noted in 62 patients (41.3%). There was no statistically significant correlation between asthma and the clinical stage of nasal polyposis (p>0.05). The mean Lund Mackay score was 21.01 in non-asthmatics and 21.94 in asthmatics. It appears that asthma was not objectively correlated with a higher Lund Mackay radiologic score (p=0.14). There is a more pronounced involvement of the sphenoidal sinuses in asthmatic patients. The involvement of the other sinuses and the ostio meatal complex was almost the same in patients with and without asthma. Conclusion : Asthma-associated CRSwNP is recognized as a more aggressive subtype of CRSwNP. In our population of patients, Asthma is an additional symptom and the radiologic presentation was not a therapeutic indicator for asthmatic patients.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"195 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa3995
Wallace Wee, Brandon Zanette, Samal Munidasa, Sharon Braganza, Daniel Li, Rachel Eddy, Jonathan Rayment, Felix Ratjen, Giles Santyr, Sharon Dell
Background: Primary ciliary dyskinesia (PCD) is a mucociliary clearance disease with significant lung morbidity. Commonly used lung function (LFxn) measures include FEV1pp (spirometry) and LCI (multiple breath washout (MBW)). Hyperpolarized 129Xe MRI (XeMRI) is an emerging approach that uses an inhaled gas to visualize ventilation and measure ventilation defect percent (VDP). It is a sensitive LFxn marker in CF but still under investigation in PCD. Objective: Determine the feasibility and intraday reliability of XeMRI in pediatric PCD across 2 sites. Methods: Participants were recruited from 2 PCD centers, if they had a confirmed PCD diagnosis, >6 years, and able to perform reproducible spirometry. Participants were excluded if medically unstable or on supplemental oxygen. Participants underwent repeat intraday LFxn testing (spirometry, MBW, XeMRI). Results: 12 participants were enrolled. Repeat LFxn testing demonstrated good reliability in FEV1pp, LCI and VDP; intraclass correlations >0.9. VDP had a significant and good correlation with LCI (R2=0.81, p<0.01) but not FEV1pp (R2=0.37, p=0.04). Intraday XeMRI scans showed changing ventilation defects (Figure). Conclusions: In PCD, XeMRI is feasible and harmonizable across institutions. VDP correlates with LCI and is reliable. Intraday scans reveal shifting ventilation defects and ongoing research is needed to understand the mechanisms and significance of this finding.
{"title":"Multisite Hyperpolarized 129Xe MRI Study of Pediatric Primary Ciliary Dyskinesia","authors":"Wallace Wee, Brandon Zanette, Samal Munidasa, Sharon Braganza, Daniel Li, Rachel Eddy, Jonathan Rayment, Felix Ratjen, Giles Santyr, Sharon Dell","doi":"10.1183/13993003.congress-2023.pa3995","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa3995","url":null,"abstract":"<b>Background:</b> Primary ciliary dyskinesia (PCD) is a mucociliary clearance disease with significant lung morbidity. Commonly used lung function (LFxn) measures include FEV<sub>1</sub>pp (spirometry) and LCI (multiple breath washout (MBW)). Hyperpolarized <sup>129</sup>Xe MRI (XeMRI) is an emerging approach that uses an inhaled gas to visualize ventilation and measure ventilation defect percent (VDP). It is a sensitive LFxn marker in CF but still under investigation in PCD. <b>Objective:</b> Determine the feasibility and intraday reliability of XeMRI in pediatric PCD across 2 sites. <b>Methods:</b> Participants were recruited from 2 PCD centers, if they had a confirmed PCD diagnosis, >6 years, and able to perform reproducible spirometry. Participants were excluded if medically unstable or on supplemental oxygen. Participants underwent repeat intraday LFxn testing (spirometry, MBW, XeMRI). <b>Results:</b> 12 participants were enrolled. Repeat LFxn testing demonstrated good reliability in FEV<sub>1</sub>pp, LCI and VDP; intraclass correlations >0.9. VDP had a significant and good correlation with LCI (R<sup>2</sup>=0.81, <i>p<0.01</i>) but not FEV<sub>1</sub>pp (R<sup>2</sup>=0.37, <i>p=0.04</i>). Intraday XeMRI scans showed changing ventilation defects (Figure). <b>Conclusions:</b> In PCD, XeMRI is feasible and harmonizable across institutions. VDP correlates with LCI and is reliable. Intraday scans reveal shifting ventilation defects and ongoing research is needed to understand the mechanisms and significance of this finding.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa3529
Robert Sykes, Andrew J Morrow, Kenneth Mangion, Alex Mcconnachie, Alasdair Mcintosh, Giles Roditi, Claire Rooney, Katherine Scott, David Stobo, Colin Berry, Colin Church, Hannah Bayes
The radiological trajectory of post-COVID-19 is uncertain. Ongoing convalescent respiratory symptoms are frequently reported. We present a prospective, observational, multicentre cohort study utilising multimodality imaging to describe the pulmonary sequalae of patients hospitalised with COVID-19 (ClinicalTrials.gov ID:NCT04403607). As part of a prospective multi-system imaging study (CISCO-19) in survivors of COVID-19, we performed convalescent CTPA and HRCT imaging, with serial blood biomarkers and patient-reported outcomes 28-60 days following hospital discharge. Compared to controls(n = 29), 88(56%) of the COVID-19 cohort (n = 159; mean age, 55 years; 43% female) had persisting radiological abnormalities; including ground-glass opacification (45%), reticulation (30%), or mixed pattern (19%). The majority(68%) had less than 20% persisting radiological abnormalities, with 67% demonstrating overall improvement compared to admission imaging. Older age, pre-morbid performance status, typical acute COVID-19 radiological features, markers of severe acute COVID-19, and convalescent ICAM-1 were associated with persisting abnormalities(all P<0.05). Patients with persisting abnormalities had lower physical activity levels and predicted maximal oxygen utilization (derived VO2)(both P<0.05). Higher percentage of abnormal lung was associated with lower patient-assessed quality of life (EQ-5D-5L) score(P=0.03). This study demonstrated that persistent radiological abnormalities post-COVID-19 were common at 28-60 days post-discharge from hospital, although the overall trajectory in majority is one of improvement. Persisting abnormalities are associated with health impairment.
{"title":"Persisting radiological abnormalities following covid-19 are common and correlate with impaired Quality of Life","authors":"Robert Sykes, Andrew J Morrow, Kenneth Mangion, Alex Mcconnachie, Alasdair Mcintosh, Giles Roditi, Claire Rooney, Katherine Scott, David Stobo, Colin Berry, Colin Church, Hannah Bayes","doi":"10.1183/13993003.congress-2023.pa3529","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa3529","url":null,"abstract":"The radiological trajectory of post-COVID-19 is uncertain. Ongoing convalescent respiratory symptoms are frequently reported. We present a prospective, observational, multicentre cohort study utilising multimodality imaging to describe the pulmonary sequalae of patients hospitalised with COVID-19 (ClinicalTrials.gov ID:NCT04403607). As part of a prospective multi-system imaging study (CISCO-19) in survivors of COVID-19, we performed convalescent CTPA and HRCT imaging, with serial blood biomarkers and patient-reported outcomes 28-60 days following hospital discharge. Compared to controls(n = 29), 88(56%) of the COVID-19 cohort (n = 159; mean age, 55 years; 43% female) had persisting radiological abnormalities; including ground-glass opacification (45%), reticulation (30%), or mixed pattern (19%). The majority(68%) had less than 20% persisting radiological abnormalities, with 67% demonstrating overall improvement compared to admission imaging. Older age, pre-morbid performance status, typical acute COVID-19 radiological features, markers of severe acute COVID-19, and convalescent ICAM-1 were associated with persisting abnormalities(all P<0.05). Patients with persisting abnormalities had lower physical activity levels and predicted maximal oxygen utilization (derived VO2)(both P<0.05). Higher percentage of abnormal lung was associated with lower patient-assessed quality of life (EQ-5D-5L) score(P=0.03). This study demonstrated that persistent radiological abnormalities post-COVID-19 were common at 28-60 days post-discharge from hospital, although the overall trajectory in majority is one of improvement. Persisting abnormalities are associated with health impairment.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136201772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa3997
A. K. A. L. Kwee, T. Van Der Veer, L. Gallardo Estrella, Eleni Rosalina Andrinopoulou, Jean-Paul Charbonnier, Harm A. W. M. Tiddens, Stephen M. Humphries, David A. Lynch, Pim A. De Jong, E. Pompe
Aim: In chronic obstructive pulmonary disease (COPD), emphysema can lead to microscopic artery loss and pulmonary hypertension. Left heart dysfunction can lead to enlargement of distal pulmonary veins. Aims: To evaluate pulmonary artery/vein volume on CT and associate this with clinical parameters and mortality. Methods: The artery-vein phenotyping analysis (AVX) was performed using the AI-based lung quantification platform LungQ (Thirona, The Netherlands). For this analysis we quantified large artery volume (diameter ≥2mm, AVXLA) and small vein volume (diameter <2mm, AVXSV) in participants in the COPDGene study, normalized for body height. Normal AVXLA and AVXSV volumes were determined using never smokers (95th percentile). Baseline characteristics were compared between normal and abnormal groups using independent T-tests. Results: 7980 subjects included 77 never smokers. AVXSV>97.5 mm3/cm and AVXLA>263.9 mm3/cm were defined as abnormal. Subjects with increased AVXSV or AVXLA had higher 10y mortality compared to subjects with normal AVXSV and AVXLA (41.4% and 39.4% vs. 28.0%). Results on clinical parameters are shown in the table. *p<.001 as compared to normal group **Overlap in 536 subjects Conclusions: High AVXSV and AVXLA in subjects with COPD are associated with male gender, more emphysema, higher CAC scores and higher mortality. This may reflect left heart dysfunction and pulmonary artery hypertension.
目的:在慢性阻塞性肺疾病(COPD)中，肺气肿可导致显微动脉丢失和肺动脉高压。左心功能障碍可导致远端肺静脉扩张。目的:评价CT上的肺动脉/静脉体积，并将其与临床参数和死亡率联系起来。方法:使用基于人工智能的肺量化平台LungQ (Thirona, The Netherlands)进行动静脉表型分析(AVX)。在这项分析中，我们量化了COPDGene研究参与者的大动脉体积(直径≥2mm, AVXLA)和小静脉体积(直径<2mm, AVXSV)，并根据身高归一化。正常AVXLA和AVXSV体积用从不吸烟者测定(95%百分位)。使用独立t检验比较正常组和异常组的基线特征。结果:7980名受试者中包括77名从不吸烟者。avxsv97.5 mm3/cm、avxla263.9 mm3/cm为异常。与AVXSV和AVXLA正常的受试者相比，AVXSV或AVXLA升高的受试者的10岁死亡率更高(41.4%和39.4%对28.0%)。临床参数结果见表。*术;。结论:COPD患者的高AVXSV和AVXLA与男性、更多肺气肿、更高CAC评分和更高死亡率相关。这可能反映了左心功能障碍和肺动脉高压。
{"title":"Higher pulmonary artery and vein volumes are associated with disease severity and mortality in smokers with and without COPD","authors":"A. K. A. L. Kwee, T. Van Der Veer, L. Gallardo Estrella, Eleni Rosalina Andrinopoulou, Jean-Paul Charbonnier, Harm A. W. M. Tiddens, Stephen M. Humphries, David A. Lynch, Pim A. De Jong, E. Pompe","doi":"10.1183/13993003.congress-2023.pa3997","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa3997","url":null,"abstract":"<b>Aim:</b> In chronic obstructive pulmonary disease (COPD), emphysema can lead to microscopic artery loss and pulmonary hypertension. Left heart dysfunction can lead to enlargement of distal pulmonary veins. <b>Aims:</b> To evaluate pulmonary artery/vein volume on CT and associate this with clinical parameters and mortality. <b>Methods:</b> The artery-vein phenotyping analysis (AVX) was performed using the AI-based lung quantification platform LungQ (Thirona, The Netherlands). For this analysis we quantified large artery volume (diameter ≥2mm, AVX<sub>LA</sub>) and small vein volume (diameter <2mm, AVX<sub>SV</sub>) in participants in the COPDGene study, normalized for body height. Normal AVX<sub>LA</sub> and AVX<sub>SV</sub> volumes were determined using never smokers (95<sup>th</sup> percentile). Baseline characteristics were compared between normal and abnormal groups using independent T-tests. <b>Results:</b> 7980 subjects included 77 never smokers. AVX<sub>SV</sub>>97.5 mm<sup>3</sup>/cm and AVX<sub>LA</sub>>263.9 mm<sup>3</sup>/cm were defined as abnormal. Subjects with increased AVX<sub>SV</sub> or AVX<sub>LA</sub> had higher 10y mortality compared to subjects with normal AVX<sub>SV</sub> and AVX<sub>LA</sub> (41.4% and 39.4% vs. 28.0%). Results on clinical parameters are shown in the table. *p<.001 as compared to normal group **Overlap in 536 subjects <b>Conclusions:</b> High AVX<sub>SV</sub> and AVX<sub>LA</sub> in subjects with COPD are associated with male gender, more emphysema, higher CAC scores and higher mortality. This may reflect left heart dysfunction and pulmonary artery hypertension.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136259662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa4006
Sophie Edgell, John Harrington, Vineeth George
Introduction: Correct placement of indwelling pleural catheters (IPCs) is often confirmed on chest x-ray (CXR). Recent anecdotal reports suggest a brand of IPCs (Rocket) may be difficult to visualise due to a thinner barium stripe. This study aims to evaluate the sensitivity of CXR for detecting these IPCs. Methods: Medical records of patients who underwent IPC insertion at a regional Australian tertiary centre in the 15 months to January 2023 were retrospectively reviewed. Records were reviewed for patient demographics, mention of an IPC or drain in the CXR request and/or by the radiologist in their final report. Subsequent identification on thoracic ultrasound, computed-tomography (CT) scan or uncomplicated drainage by nurses was considered evidence that the IPC was correctly sited. Results: 13 (Rocket) IPCs were inserted into 11 patients. 35 CXRs were performed with a median of 2 (IQR 1-4) CXRs per patient. IPCs were identified on 16/35 occasions, giving a sensitivity of 46% (95% CI 26-62%). This rose to 69% (11/16) when the IPC was mentioned in the request. On one occasion the IPC was incorrectly reported as extra-thoracic. No adverse events occurred due to the IPC not being seen on CXR. All the relevant IPCs came from specific lots which had a thinner barium stripe. Conclusions: This study suggests that at least a subgroup of (Rocket) IPCs are poorly seen on CXR. This may have implications for the detection of complications, compromise clinical decision making, or require additional imaging. (Rocket) has withdrawn the relevant devices from the market, but these catheters remain in-situ for many patients worldwide and radiology and pleural services should be aware of this issue.
导读:胸腔留置导尿管(IPCs)的正确放置通常在胸部x线片(CXR)上得到证实。最近的轶事报告显示，由于钡条纹较薄，IPCs品牌(Rocket)可能难以可视化。本研究旨在评价CXR检测这些IPCs的敏感性。方法:回顾性分析截至2023年1月的15个月内在澳大利亚某区域性三级中心接受IPC插入的患者病历。对患者人口统计、急诊请求和/或放射科医生在最终报告中提及的IPC或引流进行了记录审查。随后的胸部超声、计算机断层扫描(CT)扫描或护士的简单引流被认为是IPC正确定位的证据。结果:11例患者共植入13枚(Rocket) IPCs。35例cxr，平均每例患者2例(IQR 1-4) cxr。IPCs在16/35次中被识别，灵敏度为46% (95% CI 26-62%)。当请求中提到IPC时，这一比例上升到69%(11/16)。有一次IPC被错误地报告为胸外。未发生因未在CXR上看到IPC而导致的不良事件。所有相关的ipc都来自具有较薄钡条纹的特定批次。结论:本研究表明，至少有一个亚群(Rocket) IPCs在CXR上表现不佳。这可能会影响并发症的发现，影响临床决策，或需要额外的影像学检查。(Rocket)已经从市场上撤回了相关设备，但这些导管仍然存在于世界各地的许多患者中，放射学和胸膜服务应该意识到这个问题。
{"title":"Sensitivity of chest x-ray for visualisation of one brand of indwelling pleural catheter","authors":"Sophie Edgell, John Harrington, Vineeth George","doi":"10.1183/13993003.congress-2023.pa4006","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa4006","url":null,"abstract":"<b>Introduction:</b> Correct placement of indwelling pleural catheters (IPCs) is often confirmed on chest x-ray (CXR). Recent anecdotal reports suggest a brand of IPCs (Rocket) may be difficult to visualise due to a thinner barium stripe. This study aims to evaluate the sensitivity of CXR for detecting these IPCs. <b>Methods:</b> Medical records of patients who underwent IPC insertion at a regional Australian tertiary centre in the 15 months to January 2023 were retrospectively reviewed. Records were reviewed for patient demographics, mention of an IPC or drain in the CXR request and/or by the radiologist in their final report. Subsequent identification on thoracic ultrasound, computed-tomography (CT) scan or uncomplicated drainage by nurses was considered evidence that the IPC was correctly sited. <b>Results:</b> 13 (Rocket) IPCs were inserted into 11 patients. 35 CXRs were performed with a median of 2 (IQR 1-4) CXRs per patient. IPCs were identified on 16/35 occasions, giving a sensitivity of 46% (95% CI 26-62%). This rose to 69% (11/16) when the IPC was mentioned in the request. On one occasion the IPC was incorrectly reported as extra-thoracic. No adverse events occurred due to the IPC not being seen on CXR. All the relevant IPCs came from specific lots which had a thinner barium stripe. <b>Conclusions:</b> This study suggests that at least a subgroup of (Rocket) IPCs are poorly seen on CXR. This may have implications for the detection of complications, compromise clinical decision making, or require additional imaging. (Rocket) has withdrawn the relevant devices from the market, but these catheters remain in-situ for many patients worldwide and radiology and pleural services should be aware of this issue.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136260227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-09DOI: 10.1183/13993003.congress-2023.pa4009
Raja Muthusami, Shiva Bikmalla, Imran Hussain, Helen Stone
Introduction: Lung cancer screening (LCS) using computed tomography (CT) scans was introduced to identify lung cancers early, however can potentially identify other abnormalities including interstitial lung diseases (ILD) or abnormalities (ILA) similarly. Aims: We aim to investigate the impact our LCS programme has had on our regional ILD service. Methods: Data of patients identified with ILA was obtained from our local LCS database from July 2021 to November 2022. Electronic patient records were used to identify outcomes and impact after CT scans were done. CT scans were reported as having ‘5-10% ILA’ or ‘>10% ILA’. Results: 5927 patients had CT scans for LCS from July 2021 to November 2022, of which 64 (1%) were reported to have ILA. 37 (58%) of them had 5-10% ILA and 27 (42%) had >10% ILA. 17 (27%) were referred to the ILD service and another 7 (11%) to a General Respiratory clinic. No further respiratory referrals were made for 37 (58%) and the remaining 3 were already under our ILD service. Just one-tenth (4) of those with 5-10% ILA were referred to the ILD service, whereas half (13) of those with >10% ILA were referred to us and a further quarter (7) were referred to a General Respiratory clinic for further care. Conclusion: Lung cancer screening programmes are able to identify a small, but potentially significant number of patients with ILAs at an earlier stage, that may require input from ILD teams. We are working to formalize a pathway for onward referral of such patients with >10% ILA locally to allow for a standardised approach to their management and earlier treatment, as appropriate.
{"title":"Assessing the impact of local lung cancer screening on our regional interstitial lung diseases service","authors":"Raja Muthusami, Shiva Bikmalla, Imran Hussain, Helen Stone","doi":"10.1183/13993003.congress-2023.pa4009","DOIUrl":"https://doi.org/10.1183/13993003.congress-2023.pa4009","url":null,"abstract":"<b>Introduction:</b> Lung cancer screening (LCS) using computed tomography (CT) scans was introduced to identify lung cancers early, however can potentially identify other abnormalities including interstitial lung diseases (ILD) or abnormalities (ILA) similarly. <b>Aims:</b> We aim to investigate the impact our LCS programme has had on our regional ILD service. <b>Methods:</b> Data of patients identified with ILA was obtained from our local LCS database from July 2021 to November 2022. Electronic patient records were used to identify outcomes and impact after CT scans were done. CT scans were reported as having ‘5-10% ILA’ or ‘>10% ILA’. <b>Results:</b> 5927 patients had CT scans for LCS from July 2021 to November 2022, of which 64 (1%) were reported to have ILA. 37 (58%) of them had 5-10% ILA and 27 (42%) had >10% ILA. 17 (27%) were referred to the ILD service and another 7 (11%) to a General Respiratory clinic. No further respiratory referrals were made for 37 (58%) and the remaining 3 were already under our ILD service. Just one-tenth (4) of those with 5-10% ILA were referred to the ILD service, whereas half (13) of those with >10% ILA were referred to us and a further quarter (7) were referred to a General Respiratory clinic for further care. <b>Conclusion:</b> Lung cancer screening programmes are able to identify a small, but potentially significant number of patients with ILAs at an earlier stage, that may require input from ILD teams. We are working to formalize a pathway for onward referral of such patients with >10% ILA locally to allow for a standardised approach to their management and earlier treatment, as appropriate.","PeriodicalId":34850,"journal":{"name":"Imaging","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136260424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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