Coronary artery calcium score on low-dose computed tomography for lung cancer screening

AIM: To evaluate the feasibility of coronary artery calcium score(CACS) on low-dose non-gated chest CT(ngCCT).METHODS: Sixty consecutive individuals(30 males; 73 ± 7 years) scheduled for risk stratification by means of unenhanced ECG-triggered cardiac computed to-mography(gCCT) underwent additional unenhanced ngCCT. All CT scans were performed on a 64-slice CT scanner(Somatom Sensation 64 Cardiac, Siemens, Germany). CACS was calculated using conventional methods/scores(Volume, Mass, Agatston) as previ-ously described in literature. The CACS value obtained were compared. The Mayo Clinic classification was used to stratify cardiovascular risk based on Agatston CACS. Differences and correlations between the two methods were compared. A P-value < 0.05 was considered sig-nificant.RESULTS: Mean CACS values were significantly higher for gCCT as compared to ngCCT(Volume: 418 ± 747 vs 332 ± 597; Mass: 89 ± 151 vs 78 ± 141; Agatston: 481 ± 854 vs 428 ± 776; P < 0.05). The correlation between the two values was always very high(Volume: r = 0.95; Mass: r = 0.97; Agatston: r = 0.98). Of the 6 patients with 0 Agatston score on gCCT, 2(33%) showed an Agatston score > 0 in the ngCCT. Of the 3 patients with 1-10 Agatston score on gCCT, 1(33%) showed an Agatston score of 0 in the ngCCT. Overall, 23(38%) patients were reclassified in a different car-diovascular risk category, mostly(18/23; 78%) shifting to a lower risk in the ngCCT. The estimated radiation dose was significantly higher for gCCT(DLP 115.8 ± 50.7 vs 83.8 ± 16.3; Effective dose 1.6 ± 0.7 mSv vs 1.2 ± 0.2 mSv; P < 0.01).CONCLUSION: CACS assessment is feasible on ngCCT; the variability of CACS values and the associated re-stratification of patients in cardiovascular risk groups should be taken into account.

Review on radiological evolution of COVID-19 pneumonia using computed tomography

BACKGROUND Pneumonia is the main manifestation of coronavirus disease 2019(COVID-19)infection.Chest computed tomography is recommended for the initial evaluation of the disease;this technique can also be helpful to monitor the disease progression and evaluate the therapeutic efficacy.AIM To review the currently available literature regarding the radiological follow-up of COVID-19-related lung alterations using the computed tomography scan,to describe the evidence about the dynamic evolution of COVID-19 pneumonia and verify the potential usefulness of the radiological follow-up.METHODS We used pertinent keywords on PubMed to select relevant studies;the articles we considered were published until October 30,2020.Through this selection,69 studies were identified,and 16 were finally included in the review.RESULTS Summarizing the included works’findings,we identified well-defined stages in the short follow-up time frame.A radiographic deterioration reaching a peak roughly within the first 2 wk;after the peak,an absorption process and repairing signs are observed.At later radiological follow-up,with the limitation of little evidence available,the lesions usually did not recover completely.CONCLUSION Following computed tomography scan evolution over time could help physicians better understand the clinical impact of COVID-19 pneumonia and manage the possible sequelae;a longer follow-up is advisable to verify the complete resolution or the presence of long-term damage.

Differential diagnosis of COVID-19 at the chest computed tomography scan:A review with special focus on cancer patients

BACKGROUND Given the several radiological features shared by coronavirus disease 2019 pneumonia and other infective or non-infective diseases with lung involvement,the differential diagnosis is often tricky,and no unequivocal tool exists to help the radiologist in the proper diagnosis.Computed tomography is considered the gold standard in detecting pulmonary illness caused by severe acute respiratory syndrome coronavirus 2.AIM To conduct a systematic review including the available studies evaluating computed tomography similarities and discrepancies between coronavirus disease 2019 pneumonia and other pulmonary illness,then providing a discussion focus on cancer patients.METHODS Using pertinent keywords,we performed a systematic review using PubMed to select relevant studies published until October 30,2020.RESULTS Of the identified 133 studies,18 were eligible and included in this review.CONCLUSION Ground-glass opacity and consolidations are the most common computed tomography lesions in coronavirus disease 2019 pneumonia and other respiratory diseases.Only two studies included cancer patients,and the differential diagnosis with early lung cancer and radiation pneumonitis was performed.A single lesion associated with pleural effusion and lymphadenopathies in lung cancer and the onset of the lesions in the radiation field in the case of radiation pneumonitis allowed the differential diagnosis.Nevertheless,the studies were heterogeneous,and the type and prevalence of lesions,distributions,morphology,evolution,and additional signs,together with epidemiological,clinical,and laboratory findings,are crucial to help in the differential diagnosis.

Incidental vertebral compression fractures in imaging studies:Lessons not learned by radiologists

AIM:To assess radiologists reporting rates of incidental vertebral compression fractures in imaging studies. METHODS:We performed a review of the current literature on the prevalence and reporting rates of incidental vertebral compression fractures in radiologic examinations. RESULTS:The bibliographic search revealed 12 studies:7 studies using conventional radiology and 5 using multidetector computed tomography(MDCT).The lossof height cut-off to define a vertebral fracture varied from 15%to 25%.Fracture prevalence was high (mean 21.1%;range 9.5%-35%)in both radiographic and MDCT studies(mean 21.6%and 20.2%,respectively).Reporting rates were low with a mean value of 27.4%(range 0%-66.3%)and were significantly lower in MDCT than in radiographic studies(mean 8.1%vs 41.1%).Notably,recent studies showed lower reporting rates than older studies. CONCLUSION:Many scientific studies have confirmed a high prevalence of vertebral compression fractures as incidental findings on imaging studies.However,the underreporting of these fractures,as determined in our study,may negatively affect patient care.