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Imaging in the COVID-19 era: Lessons learned during a pandemic

Sideris, Georgios Antonios; Nikolakea, Melina; Karanikola, Aikaterini-Eleftheria; Konstantinopoulou, Sofia; Giannis, Dimitrios; Modahl, Lucy
The first year of the coronavirus disease 2019 (COVID-19) pandemic has been a year of unprecedented changes, scientific breakthroughs, and controversies. The radiology community has not been spared from the challenges imposed on global healthcare systems. Radiology has played a crucial part in tackling this pandemic, either by demonstrating the manifestations of the virus and guiding patient management, or by safely handling the patients and mitigating transmission within the hospital. Major modifications involving all aspects of daily radiology practice have occurred as a result of the pandemic, including workflow alterations, volume reductions, and strict infection control strategies. Despite the ongoing challenges, considerable knowledge has been gained that will guide future innovations. The aim of this review is to provide the latest evidence on the role of imaging in the diagnosis of the multifaceted manifestations of COVID-19, and to discuss the implications of the pandemic on radiology departments globally, including infection control strategies and delays in cancer screening. Lastly, the promising contribution of artificial intelligence in the COVID-19 pandemic is explored.
PMCID:8245753
PMID: 34249239
ISSN: 1949-8470
CID: 5111472

Commonwealth Neuroendocrine Tumour Research Collaboration and the North American Neuroendocrine Tumor Society Guidelines for the Diagnosis and Management of Patients With Lung Neuroendocrine Tumors: An International Collaborative Endorsement and Update of the 2015 European Neuroendocrine Tumor Society Expert Consensus Guidelines

Singh, Simron; Bergsland, Emily K; Card, Cynthia M; Hope, Thomas A; Kunz, Pamela L; Laidley, David T; Lawrence, Ben; Leyden, Simone; Metz, David C; Michael, Michael; Modahl, Lucy E; Myrehaug, Sten; Padda, Sukhmani K; Pommier, Rodney F; Ramirez, Robert A; Soulen, Michael; Strosberg, Jonathan; Sung, Arthur; Thawer, Alia; Wei, Benjamin; Xu, Bin; Segelov, Eva
Lung neuroendocrine tumors (LNETs) are uncommon cancers, and there is a paucity of randomized evidence to guide practice. As a result, current guidelines from different neuroendocrine tumor societies vary considerably. There is a need to update and harmonize global consensus guidelines. This article reports the best practice guidelines produced by a collaboration between the Commonwealth Neuroendocrine Tumour Research Collaboration and the North American Neuroendocrine Tumor Society. We performed a formal endorsement and updating process of the 2015 European Neuroendocrine Tumor Society expert consensus article on LNET. A systematic review from January 2013 to October 2017 was conducted to procure the most recent evidence. The stepwise endorsement process involved experts from all major subspecialties, patients, and advocates. Guided by discussion of the most recent evidence, each statement from the European Neuroendocrine Tumor Society was either endorsed, modified, or removed. New consensus statements were added if appropriate. The search yielded 1109 new publications, of which 230 met the inclusion criteria. A total of 12 statements were endorsed, 22 statements were modified or updated, one was removed, and two were added. Critical answered questions for each topic in LNET were identified. Through the consensus process, guidelines for the management of patients with local and metastatic neuroendocrine tumors have been updated to include both recent evidence and practice changes relating to technological and definitional advances. The guidelines provide clear, evidence-based statements aimed at harmonizing the global approach to patients with LNETs, on the basis of the principles of person-centered and LNET-specific care. The importance of LNET-directed research and person-centered care throughout the diagnosis, treatment, and follow-up journey is emphasized along with directions for future collaborative research.
PMID: 32663527
ISSN: 1556-1380
CID: 5111462

High-Yield Imaging Review of Pulmonary Infections

Patino Gonzalez, Angelica; Modahl, Lucy; Kowal, Daniel
Imaging plays a central role in the diagnosis of pulmonary infections with the chest radiograph as the initial study of choice. Computed tomography can further delineate the extent of disease and present key imaging signs that, along with clinical history and laboratory data, can properly guide the differential diagnosis. In this article, we review and illustrate the most relevant computed tomography imaging manifestations of common and less common pulmonary infections, including a section devoted to pulmonary infections in immunosuppressed patients.
PMID: 31964495
ISSN: 1558-5034
CID: 5111452

Tailoring a rapid autopsy protocol to explore cancer evolution: a patient collaboration

Blenkiron, Cherie; Robb, Tamsin; Parker, Kate; Kramer, Nicole; Stables, Simon; Tse, Rexson; Modahl, Lucy; Coats, Esther; Print, Cris; Lawrence, Ben
Genomic analysis of tissues from rapid autopsy programmes has transformed our understanding of cancer. However, these programmes are not yet established in New Zealand. Our neuroendocrine tumour research group, NETwork!, received a request from a patient wishing to donate tumour tissues post-mortem. This viewpoint article summarises the ethical, logistical and social process undertaken to accept this patient's generous donation, and highlights the scientific and educational value of such a gift.
PMID: 31581185
ISSN: 1175-8716
CID: 5111442

Empty Delta Sign on Unenhanced Postmortem Computed Tomography Scan in Cerebral Venous Thrombosis [Case Report]

Garland, Jack; Kesha, Kilak; Vertes, Dianne; Modahl, Lucy; Milne, David; Ruder, Thomas; Stables, Simon; Tse, Rexson
Cerebral venous thrombosis is a rare condition which constitutes 0.5% to 2% of all types of stroke and carries a mortality of up to 20% to 50%. It leads to cerebral edema, infarction, hemorrhage and venous hypertension. Clinically the diagnosis is confirmed using enhanced computed tomography (CT) angiography which demonstrates an empty delta sign in cerebral veins, particularly in the superior sagittal sinus. However, postmortem CT (PMCT) findings on cerebral venous thrombosis have not been documented in the literature. We present a case report of a 69-year-old man who on unenhanced PMCT scan showed an empty delta sign in the cerebral veins. The empty delta sign was able to be demonstrated in unenhanced PMCT which can be explained by hyper attenuation of the dural veins at postmortem forming an internal contrast highlighting the thrombus.
PMID: 30024432
ISSN: 1533-404x
CID: 5111432

A Rare Case of Isolated Atrial Myocarditis Causing Death With no Post Mortem Computed Tomography Scan Correlation [Case Report]

Tse, Rexson; Garland, Jack; Kesha, Kilak; Triggs, Yvonne; Modahl, Lucy; Milne, David; Yap, Zhi; Stables, Simon
Acute myocarditis is a potentially fatal cardiac pathology that is thought to cause sudden death through arrhythmia and cardiac failure. Of the different subtypes, lymphocytic myocarditis is the most common form. The pathophysiology of myocarditis can be generally diffuse or focally involve the ventricles, but less frequently affects the atria. Although the clinical literature reports isolated atrial myocarditis as a cause of atrial fibrillation and enlargement, there is scant postmortem literature on the findings of this pathology. We report a fatal case of isolated lymphocytic atrial myocarditis affecting only the left atrium in a 56-year-old man, where microscopy of the left atrium confirmed a florid lymphocytic myocarditis. Retrospective postmortem computed tomography scan review did not show any abnormalities on the left atrial wall.
PMID: 29120873
ISSN: 1533-404x
CID: 5111422

A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study

Taylor, Emma; Haven, Kathryn; Reed, Peter; Bissielo, Ange; Harvey, Dave; McArthur, Colin; Bringans, Cameron; Freundlich, Simone; Ingram, R Joan H; Perry, David; Wilson, Francessa; Milne, David; Modahl, Lucy; Huang, Q Sue; Gross, Diane; Widdowson, Marc-Alain; Grant, Cameron C
BACKGROUND:The term severe acute respiratory infection (SARI) encompasses a heterogeneous group of respiratory illnesses. Grading the severity of SARI is currently reliant on indirect disease severity measures such as respiratory and heart rate, and the need for oxygen or intensive care. With the lungs being the primary organ system involved in SARI, chest radiographs (CXRs) are potentially useful for describing disease severity. Our objective was to develop and validate a SARI CXR severity scoring system. METHODS:We completed validation within an active SARI surveillance project, with SARI defined using the World Health Organization case definition of an acute respiratory infection with a history of fever, or measured fever of ≥ 38 °C; and cough; and with onset within the last 10 days; and requiring hospital admission. We randomly selected 250 SARI cases. Admission CXR findings were categorized as: 1 = normal; 2 = patchy atelectasis and/or hyperinflation and/or bronchial wall thickening; 3 = focal consolidation; 4 = multifocal consolidation; and 5 = diffuse alveolar changes. Initially, four radiologists scored CXRs independently. Subsequently, a pediatrician, physician, two residents, two medical students, and a research nurse independently scored CXR reports. Inter-observer reliability was determined using a weighted Kappa (κ) for comparisons between radiologists; radiologists and clinicians; and clinicians. Agreement was defined as moderate (κ > 0.4-0.6), good (κ > 0.6-0.8) and very good (κ > 0.8-1.0). RESULTS:Agreement between the two pediatric radiologists was very good (κ = 0.83, 95% CI 0.65-1.00) and between the two adult radiologists was good (κ = 0.75, 95% CI 0.57-0. 93). Agreement of the clinicians with the radiologists was moderate-to-good (pediatrician:κ = 0.65; pediatric resident:κ = 0.69; physician:κ = 0.68; resident:κ = 0.67; research nurse:κ = 0.49, medical students: κ = 0.53 and κ = 0.56). Agreement between clinicians was good-to-very good (pediatrician vs. physician:κ = 0.85; vs. pediatric resident:κ = 0.81; vs. medicine resident:κ = 0.76; vs. research nurse:κ = 0.75; vs. medical students:κ = 0.63 and 0.66). Following review of discrepant CXR report scores by clinician pairs, κ values for radiologist-clinician agreement ranged from 0.59 to 0.70 and for clinician-clinician agreement from 0.97 to 0.99. CONCLUSIONS:This five-point CXR scoring tool, suitable for use in poorly- and well-resourced settings and by clinicians of varying experience levels, reliably describes SARI severity. The resulting numerical data enables epidemiological comparisons of SARI severity between different countries and settings.
PMID: 26714630
ISSN: 1471-2342
CID: 5111412

Wells score, D-dimer testing and computer tomographic pulmonary angiography appropriateness in the Auckland Hospital Adult Emergency Department [Letter]

Tarr, Greg P; Modahl, Lucy; Jones, Peter
PMID: 26101126
ISSN: 1175-8716
CID: 5111402

Emergency department abdominal computed tomography for nontraumatic abdominal pain: optimizing utilization

Modahl, Lucy; Digumarthy, Subba R; Rhea, James T; Conn, Alasdair K; Saini, Sanjay; Lee, Susanna I
OBJECTIVES/OBJECTIVE:To identify predictors of positive computed tomographic (CT) yield and to measure the impact of CT yield on the disposition of patients referred for computed tomography after presenting to an emergency department with nontraumatic abdominal pain. MATERIALS AND METHODS/METHODS:Computed tomographic reports, laboratory data, and emergency department and hospital records were retrospectively analyzed in 604 consecutive patients undergoing CT examinations. Computed tomographic yield was correlated to age, gender, leukocyte count, specified precomputed-tomography clinical diagnosis, and patient disposition. RESULTS:Forty-eight percent of CT scans (298 of 621) had positive results. Computed tomographic results were positive in 76% of children (13 of 17) and 47% of adults (285 of 604) (P < .03) and in 45% of female patients (155 of 343) and 51% of male patients (143 of 278) (P < .2). Fifty-two percent of CT scans (223 of 426) with and 38% (75 of 195) without specified precomputed-tomography clinical diagnoses had positive results (P < .01). Fifty-eight percent of CT scans (161 of 278) with elevated and 40% of CT scans (135 of 336) with normal patient leukocyte counts had positive results (P < .001). Sixty-seven percent of patients (171 of 256) admitted and 35% of patients (127 of 365) discharged had positive CT results (P < .001). Computed tomography revealed unsuspected diagnoses in 27% of patients (165 of 621). Thirteen percent of patients (12 of 93) without any clinical predictors for positive CT yield were admitted after positive CT results. Thirty-eight percent of patients (104 of 273) with clinically suspected diagnoses requiring admission were discharged after negative CT results. CONCLUSION/CONCLUSIONS:Clinical indicators of positive CT yield include pediatric age, leukocytosis, and a specified precomputed-tomography diagnosis. Positive CT results are a predictor for hospital admission. In one quarter of cases, computed tomography identifies clinically unsuspected diagnoses and thereby adds information important for patient management, even after clinical evaluation.
PMID: 17412185
ISSN: 1558-349x
CID: 5111392

Rolling circle replication of hepatitis delta virus RNA is carried out by two different cellular RNA polymerases

Macnaughton, Thomas B; Shi, Stephanie T; Modahl, Lucy E; Lai, Michael M C
Hepatitis delta virus (HDV) contains a viroid-like circular RNA that is presumed to replicate via a rolling circle replication mechanism mediated by cellular RNA polymerases. However, the exact mechanism of rolling circle replication for HDV RNA and viroids is not clear. Using our recently described cDNA-free transfection system (L. E. Modahl and M. M. Lai, J. Virol. 72:5449-5456, 1998), we have succeeded in detecting HDV RNA replication by metabolic labeling with [32P]orthophosphate in vivo and obtained direct evidence that HDV RNA replication generates high-molecular-weight multimeric species of HDV RNA, which are processed into monomeric and dimeric forms. Thus, these multimeric RNAs are the true intermediates of HDV RNA replication. We also found that HDV RNA synthesis is highly temperature sensitive, occurring most efficiently at 37 to 40 degrees C and becoming virtually undetectable at temperatures below 30 degrees C. Moreover, genomic HDV RNA synthesis was found to occur at a rate roughly 30-fold higher than that of antigenomic RNA synthesis. Finally, in lysolecithin-permeabilized cells, the synthesis of full-length antigenomic HDV RNA was completely resistant to high concentrations (100 microg/ml) of alpha-amanitin. In contrast, synthesis of genomic HDV RNA was totally inhibited by alpha-amanitin at concentrations as low as 2.5 microg/ml. Thus, these results suggest that genomic and antigenomic HDV RNA syntheses are performed by two different host cell enzymes. This observation, combined with our previous finding that hepatitis delta antigen mRNA synthesis is likely performed by RNA polymerase II, suggests that the different HDV RNA species are synthesized by different cellular transcriptional machineries.
PMCID:136092
PMID: 11907231
ISSN: 0022-538x
CID: 5111382