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Pulmonary Pathology of End-Stage COVID-19 Disease in Explanted Lungs and Outcomes After Lung Transplantation

Flaifel, Abdallah; Kwok, Benjamin; Ko, Jane; Chang, Stephanie; Smith, Deane; Zhou, Fang; Chiriboga, Luis A; Zeck, Briana; Theise, Neil; Rudym, Darya; Lesko, Melissa; Angel, Luis; Moreira, Andre; Narula, Navneet
OBJECTIVES/OBJECTIVE:Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop end-stage lung disease requiring lung transplantation. We report the clinical course, pulmonary pathology with radiographic correlation, and outcomes after lung transplantation in three patients who developed chronic respiratory failure due to postacute sequelae of SARS-CoV-2 infection. METHODS:A retrospective histologic evaluation of explanted lungs due to coronavirus disease 2019 was performed. RESULTS:None of the patients had known prior pulmonary disease. The major pathologic findings in the lung explants were proliferative and fibrotic phases of diffuse alveolar damage, interstitial capillary neoangiogenesis, and mononuclear inflammation, specifically macrophages, with varying numbers of T and B lymphocytes. The fibrosis varied from early collagen deposition to more pronounced interstitial collagen deposition; however, pulmonary remodeling with honeycomb change was not present. Other findings included peribronchiolar metaplasia, microvascular thrombosis, recanalized thrombi in muscular arteries, and pleural adhesions. No patients had either recurrence of SARS-CoV-2 infection or allograft rejection following transplant at this time. CONCLUSIONS:The major pathologic findings in the lung explants of patients with SARS-CoV-2 infection suggest ongoing fibrosis, prominent macrophage infiltration, neoangiogenesis, and microvascular thrombosis. Characterization of pathologic findings could help develop novel management strategies.
PMID: 34999755
ISSN: 1943-7722
CID: 5118212

PE MIMICS: a structured approach for the emergency radiologist in the evaluation of chest pain

Dempsey, P J; Yates, A; Power, J W; Murphy, M C; Ko, J P; Hutchinson, B
Chest pain is a common reason for presentation to the emergency department. In many cases, a CTPA or CT thoracic aorta is performed during work up to assess for pulmonary embolism and aortic pathology, critical diagnoses that can be difficult to out rule clinically. However, the causes of chest pain are myriad. It is therefore crucial for the interpreting radiologist to be cognizant of other potential etiologies when interpreting these studies. The purpose of this pictorial essay is to highlight the causes of non-PE or aortic-related chest pain and provide radiologists with a structured approach to interpreting these studies, ensuring a comprehensive search strategy so that important pathologies are not missed.
PMID: 35102473
ISSN: 1438-1435
CID: 5153452

Inter-Reader Variability of Volumetric Subsolid Pulmonary Nodule Radiomic Features

Azour, Lea; Moore, William H; O'Donnell, Thomas; Truong, Mylene T; Babb, James; Niu, Bowen; Wimmer, Andreas; Kiumehr, Saman; Ko, Jane P
OBJECTIVE:To evaluate the inter-observer consistency for subsolid pulmonary nodule radiomic features. MATERIALS AND METHODS/METHODS:Subsolid nodules were selected by reviewing radiology reports of CT examinations performed December 1, 2015 to April 1, 2016. Patients with CTs at two time points were included in this study. There were 55 patients with subsolid nodules, of whom 14 had two nodules. Of 69 subsolid nodules, 66 were persistent at the second time point, yielding 135 lesions for segmentation. Two thoracic radiologists and an imaging fellow segmented the lesions using a semi-automated volumetry algorithm (Syngo.via Vb20, Siemens). Coefficient of variation (CV) was used to assess consistency of 91 quantitative measures extracted from the subsolid nodule segmentations, including first and higher order texture features. The accuracy of segmentation was visually graded by an experienced thoracic radiologist. Influencing factors on radiomic feature consistency and segmentation accuracy were assessed using generalized estimating equation analyses and the Exact Mann-Whitney test. RESULTS:Mean patient age was 71 (38-93 years), with 39 women and 16 men. Mean nodule volume was 1.39mL, range .03-48.2mL, for 135 nodules. Several radiomic features showed high inter-reader consistency (CV<5%), including entropy, uniformity, sphericity, and spherical disproportion. Descriptors such as surface area and energy had low consistency across inter-reader segmentations (CV>10%). Nodule percent solid component and attenuation influenced inter-reader variability of some radiomic features. The presence of contrast did not significantly affect the consistency of subsolid nodule radiomic features. Near perfect segmentation, within 5% of actual nodule size, was achieved in 68% of segmentations, and very good segmentation, within 25% of actual nodule size, in 94%. Morphologic features including nodule margin and shape (each p <0.01), and presence of air bronchograms (p = 0.004), bubble lucencies (p = 0.02) and broad pleural contact (p < 0.01) significantly affected the probability of near perfect segmentation. Stroke angle (p = 0.001) and length (p < 0.001) also significantly influenced probability of near perfect segmentation. CONCLUSIONS:The inter-observer consistency of radiomic features for subsolid pulmonary nodules varies, with high consistency for several features, including sphericity, spherical disproportion, and first and higher order entropy, and normalized non-uniformity. Nodule morphology influences the consistency of subsolid nodule radiomic features, and the accuracy of subsolid nodule segmentation.
PMID: 33610452
ISSN: 1878-4046
CID: 4794062

Solitary Pulmonary Nodule Evaluation: Pearls and Pitfalls

Ko, Jane P.; Bagga, Barun; Gozansky, Elliott; Moore, William H.
Lung nodules are frequently encountered while interpreting chest CTs and are challenging to detect, characterize, and manage given they can represent both benign or malignant etiologies. An understanding of features associated with malignancy and causes of interpretive pitfalls is helpful to avoid misdiagnoses. This review addresses pertinent topics related to the etiologies for missed lung nodules on radiography and CT. Additionally, CT imaging technical pitfalls and challenges in addition to issues in the evaluation of nodule morphology, attenuation, and size will be discussed. Nodule management guidelines will be addressed as well as recent investigations that further our understanding of lung nodules.
ISSN: 0887-2171
CID: 5188532

Pitfalls and Pearls of Imaging Non-traumatic Thoracic Aortic Disease

Shmukler, Anna; Alis, Jonathan; Patel, Smita; Latson, Larry; Ko, Jane P.
Imaging of the thoracic aorta is a common request in both the acute and outpatient settings, playing a crucial role in diagnosis and treatment planning of aortic disease. The findings of aortic pathology may be obvious or occult on imaging. Recognizing subtle changes is essential and may lead to early detection and prevention of serious morbidity and mortality. Knowledge of the anatomy and understanding the pathophysiology of aortic disease, as well as selecting the appropriate imaging modality and protocol will enable prompt diagnosis and early intervention of aortic pathology. Currently, computed tomography angiography and magnetic resonance angiography of the aorta are the most commonly used imaging modalities to evaluate the aorta. This review focuses on a spectrum of aortic pathology manifestations on computed tomography and magnetic resonance, including atherosclerosis and acute aortic syndromes, highlighting diagnostic challenges and approaches to aid in image interpretation.
ISSN: 0887-2171
CID: 5188582

Evidence for Continuity of Interstitial Spaces Within and Outside the Human Lung [Meeting Abstract]

Ordner, Jeffrey; Chiriboga, Luis; Zeck, Briana; Majd, Mariam; Zhou, Fang; Moreira, Andre; Ko, Jane; Imam, Rami; Wells, Rebecca; Theise, Neil; Narula, Navneet
ISSN: 0023-6837
CID: 5243252

Evidence for Continuity of Interstitial Spaces Within and Outside the Human Lung [Meeting Abstract]

Ordner, Jeffrey; Chiriboga, Luis; Zeck, Briana; Majd, Mariam; Zhou, Fang; Moreira, Andre; Ko, Jane; Imam, Rami; Wells, Rebecca; Theise, Neil; Narula, Navneet
ISSN: 0893-3952
CID: 5243392

Pearls and Pitfalls in Postsurgical Imaging of the Chest

Strange, Chad D; Vlahos, Ioannis; Truong, Mylene T; Shroff, Girish S; Ahuja, Jitesh; Wu, Carol C; Ko, Jane P
A variety of surgical procedures are utilized to treat a spectrum of cardiopulmonary diseases. In the imaging of patients in the post-operative period, it is important to have an understanding of surgical techniques including invasive and minimally invasive procedures and the expected postsurgical findings. Knowledge of certain patient risk factors, various complications associated with specific surgical procedures, and a keen attention to detail are essential to avoid misinterpretation and delay diagnosis. Prompt detection of potential complications allows timely intervention, thereby, optimizing patient outcomes in the post-operative period.
PMID: 34895612
ISSN: 1558-5034
CID: 5088912

Managing Incidental Findings on Thoracic CT: Lung Findings. A White Paper of the ACR Incidental Findings Committee

Munden, Reginald F; Black, William C; Hartman, Thomas E; MacMahon, Heber; Ko, Jane P; Dyer, Debra S; Naidich, David; Rossi, Santiago E; McAdams, H Page; Goodman, Eric M; Brown, Kathleen; Kent, Michael; Carter, Brett W; Chiles, Caroline; Leung, Ann N; Boiselle, Phillip M; Kazerooni, Ella A; Berland, Lincoln L; Pandharipande, Pari V
The ACR Incidental Findings Committee presents recommendations for managing incidentally detected lung findings on thoracic CT. The Chest Subcommittee is composed of thoracic radiologists who endorsed and developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address commonly encountered incidental findings in the lungs and are not intended to be a comprehensive review of all pulmonary incidental findings. The goal is to improve the quality of care by providing guidance on management of incidentally detected thoracic findings.
PMID: 34246574
ISSN: 1558-349x
CID: 5039232

CT of Postacute Lung Complications of COVID-19

Solomon, Joshua J; Heyman, Brooke; Ko, Jane P; Condos, Rany; Lynch, David A
The acute course of coronavirus disease 2019 (COVID-19) is variable and ranges from asymptomatic infection to fulminant respiratory failure. Patients recovering from COVID-19 can have persistent symptoms and computed tomography (CT) abnormalities of variable severity. At 3 months after acute infection, a subset of patients will have CT abnormalities that include ground glass abnormalities (GGO) and subpleural bands with concomitant pulmonary function abnormalities. At 6 months after acute infection, some patients have persistent CT changes to include the resolution of GGOs seen in the early recovery phase and the persistence or development of changes suggestive of fibrosis such as reticulation with or without parenchymal distortion. Predictors of post-COVID lung disease include need for intensive care unit (ICU) admission, mechanical ventilation, higher inflammatory markers, longer hospital stay and a diagnosis of acute respiratory distress syndrome (ARDS). Treatments of post-COVID lung disease are being investigated with anti-fibrotic agents being investigated for the prevention of post-COVID lung fibrosis. The etiology of post-COVID lung disease may be a sequela of prolonged mechanical ventilation, COVID-induced ARDS or direct injury from the virus. Future research is needed to determine the long-term persistence of post-COVID lung disease, its impact on patients and ways to prevent or treat it.
PMID: 34374591
ISSN: 1527-1315
CID: 4988832