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Hypoxaemia related to COVID-19: vascular and perfusion abnormalities on dual-energy CT [Letter]

Lang, Min; Som, Avik; Mendoza, Dexter P; Flores, Efren J; Reid, Nicholas; Carey, Denston; Li, Matthew D; Witkin, Alison; Rodriguez-Lopez, Josanna M; Shepard, Jo-Anne O; Little, Brent P
PMID: 32359410
ISSN: 1474-4457
CID: 5602902

Implementation of the Radiological Society of North America Expert Consensus Guidelines on Reporting Chest CT Findings Related to COVID-19: A Multireader Performance Study

Som, Avik; Lang, Min; Yeung, Tristan; Carey, Denston; Garrana, Sherief; Mendoza, Dexter P; Flores, Efren J; Li, Matthew D; Sharma, Amita; McDermott, Shaunagh; Shepard, Jo-Anne O; Little, Brent P
BACKGROUND:RSNA expert consensus guidelines provide a framework for reporting CT findings related to COVID-19, but have had limited multireader validation. PURPOSE/OBJECTIVE:To assess the performance of the RSNA guidelines and quantify interobserver variability in application of the guidelines in patients undergoing chest CT for suspected COVID-19 pneumonia. MATERIALS AND METHODS/METHODS:A retrospective search from 1/15/20 to 3/30/20 identified 89 consecutive CT scans whose radiological report mentioned COVID-19. One positive or two negative RT-PCR tests for COVID-19 were considered the gold standard for diagnosis. Each chest CT scan was evaluated using RSNA guidelines by 9 readers (6 fellowship trained thoracic radiologists and 3 radiology resident trainees). Clinical information was obtained from the electronic medical record. RESULTS:There was strong concordance of findings between radiology training levels with agreement ranging from 60 to 86% among attendings and trainees (kappa 0.43 to 0.86). Sensitivity and specificity of "typical" CT findings for COVID-19 per the RSNA guidelines were on average 86% (range 72%-94%) and 80.2% (range 75-93%), respectively. Combined "typical" and "indeterminate" findings had a sensitivity of 97.5% (range 94-100%) and specificity of 54.7% (range 37-62%). A total of 163 disagreements were seen out of 801 observations (79.6% total agreement). Uncertainty in classification primarily derived from difficulty in ascertaining peripheral distribution, multiple dominant disease processes, or minimal disease. CONCLUSION/CONCLUSIONS:The "typical appearance" category for COVID-19 CT reporting has an average sensitivity of 86% and specificity rate of 80%. There is reasonable interreader agreement and good reproducibility across various levels of experience.
PMID: 33778625
ISSN: 2638-6135
CID: 5603082

Intracardiac and aortic thrombi in the setting of SARS-CoV-2 infection

Reid, Nicholas; Carey, Denston; Lang, Min; Som, Avik; Cochran, Rory L; Alkasab, Tarik; Little, Brent P
PMID: 33089049
ISSN: 2514-2119
CID: 5603042

Pulmonary Vascular Manifestations of COVID-19 Pneumonia

Lang, Min; Som, Avik; Carey, Denston; Reid, Nicholas; Mendoza, Dexter P; Flores, Efrén J; Li, Matthew D; Shepard, Jo-Anne O; Little, Brent P
PURPOSE/OBJECTIVE:To investigate pulmonary vascular abnormalities at CT pulmonary angiography (CT-PE) in patients with coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS/METHODS:In this retrospective study, 48 patients with reverse-transcription polymerase chain reaction-confirmed COVID-19 infection who had undergone CT-PE between March 23 and April 6, 2020, in a large urban health care system were included. Patient demographics and clinical data were collected through the electronic medical record system. Twenty-five patients underwent dual-energy CT (DECT) as part of the standard CT-PE protocol at a subset of the hospitals. Two thoracic radiologists independently assessed all studies. Disagreement in assessment was resolved by consensus discussion with a third thoracic radiologist. RESULTS:Of the 48 patients, 45 patients required admission, with 18 admitted to the intensive care unit, and 13 requiring intubation. Seven patients (15%) were found to have pulmonary emboli. Dilated vessels were seen in 41 cases (85%), with 38 (78%) and 27 (55%) cases demonstrating vessel enlargement within and outside of lung opacities, respectively. Dilated distal vessels extending to the pleura and fissures were seen in 40 cases (82%) and 30 cases (61%), respectively. At DECT, mosaic perfusion pattern was observed in 24 cases (96%), regional hyperemia overlapping with areas of pulmonary opacities or immediately surrounding the opacities were seen in 13 cases (52%), opacities associated with corresponding oligemia were seen in 24 cases (96%), and hyperemic halo was seen in 9 cases (36%). CONCLUSION/CONCLUSIONS:© RSNA, 2020.
PMID: 34036264
ISSN: 2638-6135
CID: 5603102