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ObjectivesTo compare the chest computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) to other non-COVID viral pneumonia.MethodsMEDLINE, EMBASE, and Cochrane databases were searched through April 04, 2020, for published English language studies. Studies were eligible if they included immunocompetent patients with up to 14 days of viral pneumonia. Subjects had a respiratory tract sample test positive for COVID-19, adenovirus, influenza A, rhinovirus, parainfluenza, or respiratory syncytial virus. We only included observational studies and case series with more than ten patients. The pooled prevalence of each chest CT pattern or finding was calculated with 95% confidence intervals (95% CI).ResultsFrom 2263 studies identified, 33 were eligible for inclusion, with a total of 1911 patients (COVID-19, n = 934; non-COVID, n = 977). Frequent CT features for both COVID-19 and non-COVID viral pneumonia were a mixed pattern of ground-glass opacity (GGO) and consolidation (COVID-19, 0.37; 0.17–0.56; non-COVID, 0.46; 0.35–0.58) or predominantly GGO pattern (COVID-19, 0.42; 0.28–0.55; non-COVID 0.25; 0.17–0.32), bilateral distribution (COVID-19, 0.81; 0.77–0.85; non-COVID, 0.69; 0.54–0.84), and involvement of lower lobes (COVID-19, 0.88; 0.80–0.95; non-COVID, 0.61; 0.50–0.82). COVID-19 pneumonia presented a higher prevalence of peripheral distribution (COVID-19 0.77; 0.67–0.87; non-COVID 0.34; 0.18–0.49), and involvement of upper (COVID-19, 0.77; 0.65–0.88; non-COVID 0.18; 0.10–0.27) and middle lobes (COVID-19, 0.61; 0.47–0.76; non-COVID 0.24; 0.11–0.38).ConclusionExcept for a higher prevalence of peripheral distribution, involvement of upper and middle lobes, COVID-19, and non-COVID viral pneumonia had overlapping chest CT findings.Key Points• Most common CT findings of coronavirus disease 2019 (COVID-19) were a predominant pattern of ground-glass opacity (GGO), followed by a mixed pattern of GGO and consolidation, bilateral disease, peripheral distribution, and lower lobe involvement.• Most frequent CT findings of non-COVID viral pneumonia were a predominantly mixed pattern of GGO and consolidation, followed by a predominant pattern of GGO, bilateral disease, random or diffuse distribution, and lower lobe involvement.• COVID-19 pneumonia presented a higher prevalence of peripheral distribution, and involvement of upper and middle lobes compared with non-COVID viral pneumonia

Our purpose was to evaluate the effect of glycemia on 18 F-FDG uptake in normal organs of interest. The influences of other confounding factors, such as body mass index (BMI), diabetes, age, and sex, on the relationships between glycemia and organ-specific standardized uptake values (SUVs) were also investigated. We retrospectively identified 5623 consecutive patients who had undergone clinical PET/CT for oncological indications. Patients were stratified into groups based on glucose levels, measured immediately before 18 F-FDG injection. Differences in mean SUVmax values among glycemic ranges were clinically significant only when >10% variation was observed. The brain was the only organ that presented a significant inverse relationship between SUVmax and glycemia (p < 0.001), even after controlling for diabetic status. No such difference was observed for the liver or lung. After adjustment for sex, age, and BMI, the association of glycemia with SUVmax was significant for the brain and liver, but not for the lung. In conclusion, the brain was the only organ analyzed showing a clinically significant relationship to glycemia after adjustment for potentially confounding variables. The lung was least affected by the variables in our model, and may serve as an alternative background tissue to the liver.

Currently, high-resolution computed tomography (HRCT) is the imaging of choice for the differential diagnosis of various cystic lung lesions, including true cystic lung diseases (CLD) and lesions that may mimic them. However, the traditionally used inspiratory scan still presents a significant spectrum of overlapping radiological features. Recent studies have demonstrated variation in lesion size between inspiratory and expiratory phases, probably due to cyst-airway communication. In this study, we aimed to conduct a systematic review of paired inspiratory and expiratory HRCT in the assessment of cystic lesions as an additional tool to narrow the differential diagnosis. A systematic search was performed in PubMed, Scopus, EMBASE, BVS, and Cochrane through August 2023. Full-text articles that performed paired inspiratory and expiratory CT scans in adult patients with cystic lung lesions were included, with the outcome measured as the reduction in lesion size according to the respiratory phase. Diagnoses were confirmed through histopathological or radiological features. Out of the 96 records, three studies met the criteria for inclusion and were analyzed, comprising a total of 149 participants and 513 cystic lesions. Pulmonary Langerhans Cell Histiocytosis (PLCH), Lymphangioleiomyomatosis (LAM) honeycombing and cystic bronchiectasis became considerably smaller during expiratory CT scans, while the size of emphysema tended to remain constant during respiratory cycles. This study has suggested that paired inspiratory and expiratory CT scans can be valuable for helping differentiate between emphysema and other diseases with a cystic pattern due to their ability to reveal dynamic properties of the lesions. However, the average reduction in cyst size as a single parameter is not sufficient for further refining diagnostics. Studies exploring advanced metrics to assess the reduction in lesion diameter emerge as potential opportunities to investigate the cyst-airway communication hypothesis and further enhance the diagnostic accuracy of paired methods.

ObjectivesTo evaluate the diagnostic test accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), whole-body magnetic resonance imaging (WB-MRI), and whole-body diffusion-weighted imaging (WB-DWI) for the detection of metastases in patients with non–small cell lung cancer (NSCLC).MethodsMEDLINE, Embase, and Cochrane Library databases were searched up to June 2019. Studies were selected if they reported data that could be used to construct contingency tables to compare 18F-FDG PET/CT, WB-MRI, and WB-DWI. Two authors independently extracted data on study characteristics and assessed methodological quality using the Quality Assessment of Diagnostic Accuracy Studies. Forest plots were generated for sensitivity and specificity of 18F-FDG PET/CT, WB-MRI, and whole-body diffusion-weighted imaging (WB-DWI). Summary receiver operating characteristic plots were created.ResultsThe 4 studies meeting inclusion criteria had a total of 564 patients and 559 lesions, 233 of which were metastases. In studies of 18F-FDG PET/CT, the pooled estimates of sensitivity and specificity were 0.83 (95% confidence interval [CI], 0.54–0.95) and 0.93 (95% CI, 0.87–0.96), respectively. For WB-MRI, pooled sensitivity was 0.92 (95% CI, 0.18–1.00) and pooled specificity was 0.93 (95% CI, 0.85–0.95). Pooled sensitivity and specificity for WB-DWI were 0.78 (95% CI, 0.46–0.93) and 0.91 (95% CI, 0.79–0.96), respectively. There was no statistical difference between the diagnostic odds ratio of WB-MRI and WB-DWI compared with that of PET/CT (p = 0.186 for WB-DWI; p = 0.638 for WB-MRI).ConclusionWB-MRI and DWI are radiation-free alternatives with comparable diagnostic performance to 18F-FDG PET/CT for M staging of NSCLC.Key Points• Whole-body MRI with or without diffusion-weighted imaging has a high accuracy for the diagnostic evaluation of metastases in patients with non–small cell lung cancer.• Whole-body MRI may be used as a non-invasive and radiation-free alternative to positron emission tomography with CT with similar diagnostic performance.

IntroductionAlthough lung cancer remains the leading cause of cancer deaths in the US, recent advances in early detection and treatment have led to improvements in survival. However, there is a considerable risk of recurrence or second primary lung cancer (SPLC) following curative-intent treatment in patients with early-stage non-small cell lung cancer (NSCLC). Professional societies recommend routine surveillance with CT to optimise the detection of potential recurrence and SPLC at a localised stage. However, no definitive evidence demonstrates the effect of imaging surveillance on survival in patients with NSCLC. To close these research gaps, the Advancing Precision Lung Cancer Surveillance and Outcomes in Diverse Populations (PLuS2) study will leverage real-world electronic health records (EHRs) data to evaluate surveillance outcomes among patients with and without guideline-adherent surveillance. The overarching goal of the PLuS2 study is to assess the long-term effectiveness of surveillance strategies in real-world settings.Methods and analysisPLuS2 is an observational study designed to assemble a cohort of patients with incident pathologically confirmed stage I/II/IIIA NSCLC who have completed curative-intent therapy. Patients undergoing imaging surveillance will be followed from 2012 to 2026 by linking EHRs with tumour registry data in the OneFlorida+ Clinical Research Consortium. Data will be consolidated into a unified repository to achieve three primary aims: (1) Examine the utilisation and determinants of CT imaging surveillance by race/ethnicity and socioeconomic status, (2) Compare clinical endpoints, including recurrence, SPLCs and survival of patients who undergo semiannual versus annual CT imaging and (3) Use the observational data in conjunction with validated microsimulation models to simulate imaging surveillance outcomes within the US population. To our knowledge, this study represents the first attempt to integrate real-world data and microsimulation models to assess the long-term impact and effectiveness of imaging surveillance strategies.Ethics and disseminationThis study involves human participants and was approved by the University of Florida Institutional Review Board (IRB), University of Florida IRB 01, under approval number IRB202300782. The results will be disseminated through publications and presentations at national and international conferences. Safety considerations encompass ensuring the confidentiality of patient information. All disseminated data will be de-identified and summarised.

The aim of this study was to assess percentage respiratory changes (δ) in the size of pulmonary cysts of different smoking-related etiologies. Retrospectively, we measured the cystic lesions due to histopathological-confirmed honeycombing from interstitial pulmonary fibrosis, pulmonary Langerhans cell histiocytosis (PLCH), and paraseptal emphysema, using paired inspiratory and expiratory CT scans. In a sample of 72 patients and 216 lesions, the mean diameter of PLCH and honeycombing decreased during expiration (PLCH, δ  = 60.9%; p  = 0.001; honeycombing, δ  = 47.5%; p  = 0.014). Conversely, paraseptal emphysema did not show any changes ( δ  = 5.2%; p  = 0.34). In summary, our results demonstrated that cysts in smokers with PLCH and honeycombing fibrosis get smaller during expiratory CT scans, whereas the size of cystic-like lesions due to paraseptal emphysema and bullae tend to remain constant during respiratory cycles. These results support the hypothesis of cyst-airway communication in some cystic diseases, which could assist in the differential diagnosis in smoking-related lung diseases.

PurposeTo evaluate the impact of the addition of quantitative apparent diffusion coefficient (ADC) data into the diagnostic performance of the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) scoring system to predict clinically significant prostate cancer (CSPCa).MethodsWe retrospectively included 91 consecutive patients who underwent prostate multiparametric magnetic resonance imaging (mp-MRI) and histopathological evaluation. Mp-MRI images were reported by the PI-RADSv2 scoring system and patients were divided into groups considering the likelihood of CSPCa. ADC value and ratio were obtained. Findings were correlated with histopathological data.ResultsCSPCa was found in 41.8% of cases (n = 38). PI-RADSv2 score 3–5 yielded a sensitivity of 97.4% (95% confidence intervals 86.5–99.5), a specificity of 50.9% (37.9–63.9), and AUC of 0.74 (0.67–0.81) to predict CSPCa. ADC value < 750 µm2/s and an ADC ratio < 0.62 were the most accurate thresholds for differentiation of CSPCa, with AUC of 0.81 and 0.76, respectively. Combined PI-RADSv2 score 3–5 and ADC value < 750 µm2/s yielded a specificity of 84.9 (72.9–92.2), sensitivity of 70.3 (54.2–82.5), and AUC of 0.77 (0.68–0.86). Combined PI-RADSv2 score 3–5 and ADC ratio < 0.62 yielded a specificity of 86.5 (74.7–93.3), sensitivity of was 64.9 (48.8–78.2), and AUC of 0.75 (0.66–0.84).ConclusionQuantitative ADC data might not be beneficial to be used routinely in mp-MR imaging as criteria to detect clinically significant lesions due to the reduced sensitivity. Instead, when prostate lesions present a PI-RADSv2 score ≥ 3, additional quantitative ADC criteria can be helpful to increase the PI-RADS score specificity.

Diffuse alveolar hemorrhage (DAH) represents a syndrome that can complicate many clinical conditions and may be life-threatening, requiring prompt treatment. It is recognized by the signs of acute- or subacute-onset cough, hemoptysis, diffuse radiographic pulmonary infiltrates, anemia, and hypoxemic respiratory distress. DAH is characterized by the accumulation of intra-alveolar red blood cells originating most frequently from the alveolar capillaries. It must be distinguished from localized pulmonary hemorrhage, which is most commonly due to chronic bronchitis, bronchiectasis, tumor, or localized infection. Hemoptysis, the major sign of DAH, may develop suddenly or over a period of days to weeks; this sign may also be initially absent, in which case diagnostic suspicion is established after sequential bronchoalveolar lavage reveals worsening red blood cell counts. The causes of DAH can be divided into infectious and noninfectious, the latter of which may affect immunocompetent or immunodeficient patients. Pulmonary infections are rarely reported in association with DAH, but they should be considered in the diagnostic workup because of the obvious therapeutic implications. In immunocompromised patients, the main infectious diseases that cause DAH are cytomegalovirus, adenovirus, invasive aspergillosis, Mycoplasma , Legionella , and Strongyloides . In immunocompetent patients, the infectious diseases that most frequently cause DAH are influenza A (H1N1), dengue, leptospirosis, malaria, and Staphylococcus aureus infection. Based on a search of the PubMed and Scopus databases, we review the infectious diseases that may cause DAH in immunocompetent patients.

Health systems worldwide are implementing lung cancer screening programmes to identify early-stage lung cancer and maximise patient survival. Volumetry is recommended for follow-up of pulmonary nodules and outperforms other measurement methods. However, volumetry is known to be influenced by multiple factors. The objectives of this systematic review (PROSPERO CRD42022370233) are to summarise the current knowledge regarding factors that influence volumetry tools used in the analysis of pulmonary nodules, assess for significant clinical impact, identify gaps in current knowledge and suggest future research. Five databases (Medline, Scopus, Journals@Ovid, Embase and Emcare) were searched on the 21st of September, 2022, and 137 original research studies were included, explicitly testing the potential impact of influencing factors on the outcome of volumetry tools. The summary of these studies is tabulated, and a narrative review is provided. A subset of studies (n = 16) reporting clinical significance were selected, and their results were combined, if appropriate, using meta-analysis. Factors with clinical significance include the segmentation algorithm, quality of the segmentation, slice thickness, the level of inspiration for solid nodules, and the reconstruction algorithm and kernel in subsolid nodules. Although there is a large body of evidence in this field, it is unclear how to apply the results from these studies in clinical practice as most studies do not test for clinical relevance. The meta-analysis did not improve our understanding due to the small number and heterogeneity of studies testing for clinical significance.Critical relevance statementMany studies have investigated the influencing factors of pulmonary nodule volumetry, but only 11% of these questioned their clinical relevance in their management. The heterogeneity among these studies presents a challenge in consolidating results and clinical application of the evidence.Key points• Factors influencing the volumetry of pulmonary nodules have been extensively investigated.• Just 11% of studies test clinical significance (wrongly diagnosing growth).• Nodule size interacts with most other influencing factors (especially for smaller nodules).• Heterogeneity among studies makes comparison and consolidation of results challenging.• Future research should focus on clinical applicability, screening, and updated technology.