Search

PURPOSE: To assess if dual-energy computed tomographic pulmonary angiography (DECTPA) derived lobar iodine quantification can provide an accurate estimate of lobar perfusion in patients with severe emphysema, and offer an adjunct to single-photon emission CT perfusion scintigraphy (SPECT-PS) in assessing suitability for lung volume reduction (LVR). MATERIALS AND METHODS: Patients with severe emphysema (forced expiratory volume in 1 s

PurposeTo describe the incidence of pulmonary artery thrombosis in COVID-19 versus influenza pneumonia using CT angiography and to assess whether it may increase the risk of pulmonary hypertension.Materials and MethodsSingle and dual energy CT pulmonary angiography of age- and gender-matched patients with influenza and COVID-19 pneumonia, referred for extra-corporeal membrane oxygenation (ECMO) and/or mechanical ventilation from January 2016 to January 2021, were retrospectively evaluated. Two independent observers qualitatively and quantitively assessed clot burden and Qanadli CT Obstruction Index. Two consensus observers calculated pulmonary artery volume and right to left ventricular diameter ratio (Terarecon, California, USA) to diagnose pulmonary hypertension. Pulmonary infarct volume and perfused blood volume relative enhancement were also calculated (Syngo via, Siemens Healthineers, Forchheim, Germany). All radiologic parameters were correlated with clinical data. To assess if in situ thrombosis could be visualised on CT, isolated segmental and subsegmental filling defects were used as an imaging surrogate. For statistical analyses, Graphpad Prism9 and IBM SPSS v27.0 software were used.ResultsThe incidence of either central PE or DVT was equal between patients with COVID-19 and influenza pneumonia (20%). The incidence of isolated segmental and subsegmental filling defects was higher in COVID-19 but without statistical significance (44% vs 32%;p=0.5607). Right to left ventricular diameter and pulmonary artery to aorta ratios were higher in COVID-19 compared to influenza (1.01 vs 0.866 and 1.04 vs 0.904;p=0.0071 and p=0.0023, respectively).ConclusionIn a comparable group of patients with severe COVID-19 and influenza pneumonia, CT features of pulmonary hypertension are more often present in patients with COVID-19 pneumonia despite an equal clot burden on CT. This is not attributable to pulmonary thrombosis visible on CT and supports the hypothesis that micro- rather than macrovascular obstruction is the cause of severe hypoxia in COVID-19 pneumonia.

Extracorporeal membrane oxygenation (ECMO) is a form of cardiopulmonary support primarily used in cardiothoracic and intensive care unit (ICU) settings. The purpose of this review is to familiarise radiologists with the imaging features of ECMO devices, their associated complications and appropriate imaging protocols for contrast-enhanced CT imaging of ECMO patients. This paper will provide a brief introduction to ECMO and the imaging modalities utilised in ECMO patients, followed by a description of the types of ECMO available and cannula positioning. Indications and contraindications for ECMO will be outlined followed by a description of the complications associated with ECMO, which radiologists should recognise. Finally, the imaging protocol and interpretation of contrast-enhanced CT imaging in ECMO patients will be discussed. In the current clinical climate with millions of COVID-19 cases around the world and tens of thousands of critically ill patients, many requiring cardiopulmonary support in intensive care units, the use of ECMO in adults has increased, and thus so has the volume of imaging. Radiologists need to be familiar with the types of ECMO available, the correct positioning of the catheters depending on the type of ECMO being utilised, and the associated complications and imaging artefacts.

Background Pilot lung cancer screening programmes in England have utilised a lung health check (LHC) model, comprising a nurse-led respiratory consultation, spirometry and a lung cancer risk calculation. We report the short-term outcomes of recommendations made to primary care for management of non-cancer incidental findings in a screening pilot. Methods 1542 participants from 17 general practice (GP) surgeries attended for a LHC between August 2018 and April 2019. Lung nodules, significant incidental lung findings on computed tomography (CT), unexplained respiratory symptoms, and suspected non-lung malignancies were managed within the screening programme. Participants with: i) ‘red-flag’ symptoms without lung cancer, ii) unexplained obstructive spirometry and respiratory symptoms, iii) significant coronary artery calcification (CAC) on CT, who were not known to have previously undergone cardiovascular risk stratification, and iv) significant, but non-urgent, non-lung incidental findings on CT, were referred to primary care. GP records were evaluated to establish outcomes. Results 165 primary care recommendations were made in 157/1542 (10.2%) individuals. Results below are from 16 GP practices and will be updated at the time of presentation. 49/1542 (3.2%) were referred to their GP for suspected undiagnosed chronic obstructive pulmonary disease (COPD), of whom 19/49 (38.8%) had a community-based respiratory review. 12/49 (24.5%) were newly diagnosed with COPD, and 5/49 (10.2%) commenced inhaler therapy. Of 52/1145 (4.5%) scanned participants with heavy CAC but without known ischaemic heart disease, 26/52 (50.0%) had a QRISK2 score (all >10%). Lipid-lowering therapy was commenced in 21/52 (40.4%). Echocardiography was recommended for 22/1542 (1.4%) participants with suspected cardiac disease, largely aortic valve calcification. 7/22 (31.8%) underwent echocardiography. Only 1/22 (4.5%) was deemed to require intervention for significant aortic stenosis. 7/1542 (0.5%) recommendations were made for other non-urgent/non-cardiothoracic incidental findings; none required further intervention. Conclusions A minority of participants required primary care management for incidental findings based on the West London lung screening study protocol. Although not all recommendations were implemented, incidental findings infrequently led to changes to patient management overall. Changes to patient management most commonly occurred as a result of recommendations for assessment for COPD and cardiovascular risk.

What are the diff erential diagnoses for never smokers who present with ground glass opacities on CT? What are the management options? How are CT detected lung nodules classifi ed at present? What has changed in the classifi cation of lung adenocarcinoma? What are the clinical implications for personalised molecular targeted treatments in lung cancer? Test your diagnostic and management skills in Grand Rounds from the Royal Brompton Hospital and listen to experts inform and discuss the new issues that are raised.