| 1. Parshall MB, Schwartzstein RM, Adams L, et al. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012;185(4):435-452. |
Review/Other-Dx |
N/A |
To update the 1999 ATS Consensus Statement on dyspnea. |
Progress has been made in clarifying mechanisms underlying several qualitatively and mechanistically distinct breathing sensations. Brain imaging studies have consistently shown dyspnea stimuli to be correlated with activation of cortico-limbic areas involved with interoception and nociception. Endogenous and exogenous opioids may modulate perception of dyspnea. Instruments for measuring dyspnea are often poorly characterized; a framework is proposed for more consistent identification of measurement domains. |
4 |
| 2. Karnani NG, Reisfield GM, Wilson GR. Evaluation of chronic dyspnea. Am Fam Physician. 2005;71(8):1529-1537. |
Review/Other-Dx |
N/A |
To review the salient features of the history, physical examination, laboratory testing, office spirometry, and imaging in patients with dyspnea, as well as more specialized testing that is required if the cause remains unexplained after initial evaluation. |
Chronic dyspnea is defined as dyspnea lasting more than one month. In approximately two thirds of patients presenting with dyspnea, the underlying cause is cardiopulmonary disease. Establishing an accurate diagnosis is essential because treatment differs depending on the underlying condition. Asthma, congestive HF, chronic obstructive pulmonary disease, pneumonia, cardiac ischemia, interstitial lung disease, and psychogenic causes account for 85% of patients with this principal symptom. The history and physical examination should guide selection of initial diagnostic tests such as electrocardiogram, chest radiograph, pulse oximetry, spirometry, complete blood count, and metabolic panel. If these are inconclusive, additional testing is indicated. Formal pulmonary function testing may be needed to establish a diagnosis of asthma, chronic obstructive pulmonary disease, or interstitial lung disease. High-resolution CT is particularly useful for diagnosing interstitial lung disease, idiopathic pulmonary fibrosis, bronchiectasis, or pulmonary embolism. Echocardiography and BNP levels help establish a diagnosis of congestive HF. If the diagnosis remains unclear, additional tests may be required. These include ventilation perfusion scans, Holter monitoring, cardiac catheterization, esophageal pH monitoring, lung biopsy, and cardiopulmonary exercise testing. |
4 |
| 3. Wahls SA. Causes and evaluation of chronic dyspnea. Am Fam Physician. 2012;86(2):173-182. |
Review/Other-Dx |
N/A
|
To evaluate the causes and evaluation of chronic dyspnea. |
Chronic dyspnea is shortness of breath that lasts more than 1 month. The perception of dyspnea varies based on behavioral and physiologic responses. Dyspnea that is greater than expected with the degree of exertion is a symptom of disease. Most cases of dyspnea result from asthma, HF and myocardial ischemia, chronic obstructive pulmonary disease, interstitial lung disease, pneumonia, or psychogenic disorders. The etiology of dyspnea is multifactorial in about one-third of patients. The clinical presentation alone is adequate to make a diagnosis in 66% of patients with dyspnea. Patients’ descriptions of the sensation of dyspnea may be helpful, but associated symptoms and risk factors, such as smoking, chemical exposures, and medication use, should also be considered. Examination findings (eg, jugular venous distention, decreased breath sounds or wheezing, pleural rub, clubbing) may be helpful in making the diagnosis. Initial testing in patients with chronic dyspnea includes chest radiography, electrocardiography, spirometry, complete blood count, and basic metabolic panel. Measurement of brain natriuretic peptide levels may help exclude HF and D-dimer testing may help rule out pulmonary emboli. Pulmonary function studies can be used to identify emphysema and interstitial lung diseases. CT of the chest is the most appropriate imaging study for diagnosing suspected pulmonary causes of chronic dyspnea. |
4 |
| 4. Kirsch J, Wu CC, Bolen MA, et al. ACR Appropriateness Criteria® Suspected Pulmonary Embolism: 2022 Update. J Am Coll Radiol 2022;19:S488-S501. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected pulmonary embolism. |
No results stated in abstract. |
4 |
| 5. Bolen MA, Bin Saeedan MN, Rajiah P, et al. ACR Appropriateness Criteria® Dyspnea-Suspected Cardiac Origin (Ischemia Already Excluded): 2021 Update. J Am Coll Radiol 2022;19:S37-S52. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for dyspnea-suspected cardiac origin (ischemia already excluded). |
No results stated in abstract. |
4 |
| 6. Sirajuddin A, Mirmomen SM, Henry TS, et al. ACR Appropriateness Criteria® Suspected Pulmonary Hypertension: 2022 Update. J Am Coll Radiol 2022;19:S502-S12. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected pulmonary hypertension. |
No results stated in abstract. |
4 |
| 7. Hobbs SB, Chung JH, Walker CM, et al. ACR Appropriateness Criteria® Diffuse Lung Disease. J Am Coll Radiol 2021;18:S320-S29. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for diffuse lung disease. |
No results stated in abstract. |
4 |
| 8. Hartley RA, Barker BL, Newby C, et al. Relationship between lung function and quantitative computed tomographic parameters of airway remodeling, air trapping, and emphysema in patients with asthma and chronic obstructive pulmonary disease: A single-center study. Journal of Allergy & Clinical Immunology. 137(5):1413-1422.e12, 2016 05. |
Observational-Dx |
171 patients |
To compare QCT parameters of airway remodeling, air trapping, and emphysema between asthmatic patients and patients with COPD and explore their relationship with airflow limitation. |
Proximal airway percentage wall area (%WA) was significantly increased in asthmatic patients (62.5% [SD, 2.2]) and patients with COPD (62.7% [SD, 2.3]) compared with that in healthy control subjects (60.3% [SD, 2.2], P < .001). Air trapping measured based on mean lung density expiratory/inspiratory ratio was significantly increased in patients with COPD (mean, 0.922 [SD, 0.037]) and asthmatic patients (mean, 0.852 [SD, 0.061]) compared with that in healthy subjects (mean, 0.816 [SD, 0.066], P < .001). Emphysema assessed based on lung density measured by using Hounsfield units below which 15% of the voxels lie (Perc15) was a feature of COPD only (patients with COPD: mean, -964 [SD, 19.62] vs asthmatic patients: mean, -937 [SD, 22.7] and healthy subjects: mean, -937 [SD, 17.1], P < .001). Multiple regression analyses showed that the strongest predictor of lung function impairment in asthmatic patients was %WA, whereas in the COPD and asthma subgrouped with postbronchodilator FEV1 percent predicted value of less than 80%, it was air trapping. Factor analysis of QCT parameters in asthmatic patients and patients with COPD combined determined 3 components, with %WA, air trapping, and Perc15 values being the highest loading factors. Cluster analysis identified 3 clusters with mild, moderate, or severe lung function impairment with corresponding decreased lung density (Perc15 values) and increased air trapping. |
1 |
| 9. Song L, Leppig JA, Hubner RH, et al. Quantitative CT Analysis in Patients with Pulmonary Emphysema: Do Calculated Differences Between Full Inspiration and Expiration Correlate with Lung Function? Int J Chron Obstruct Pulmon Dis 2020;15:1877-86. |
Observational-Dx |
172 patients |
To evaluate correlations between parameters of quantitative computed tomography (QCT) analysis, especially the 15th percentile of lung attenuation (P15), and parameters of clinical tests in a large group of patients with pulmonary emphysema. |
CT-measured lung volume in inspiration (TLVIN) correlated strongly with spirometry-measured total lung capacity (TLC) (r=0.81, p<0.001) and moderately to strongly with residual volume (RV), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1)/FVC (r=0.60, 0.56, and -0.49, each p<0.001). Lung volume in expiration (TLVEX) correlated moderately to strongly with TLC, RV and FEV1/FVC ratio (r=0.75, 0.66, and -0.43, each p<0.001). TES and P15 showed stronger correlations with the carbon monoxide transfer coefficient (KCO%) (r= -0.42, 0.44, both p<0.001), when measured during expiration. P15Diff correlated moderately with KCO% and carbon monoxide diffusing capacity (DLCO%) (r= 0.41, 0.40, both p<0.001). The 6MWT and most QCT parameters showed significant differences between COPD GOLD 3 and 4 groups. |
2 |
| 10. Gawlitza J, Trinkmann F, Scheffel H, et al. Time to Exhale: Additional Value of Expiratory Chest CT in Chronic Obstructive Pulmonary Disease. Canadian Respiratory Journal. 2018:9493504, 2018. |
Observational-Dx |
46 patients |
To systematically compare lung function tests with quantified CT parameters in inspiration and expiration. |
For inspiratory scans, a weak-to-moderate correlation with the lung function parameters was found. These correlations significantly improved when adding the expiratory scan (p < 0.05). Moreover, some parameters showed a significant correlation only in expiratory datasets. Calculated delta values showed even stronger correlation with lung function testing. |
2 |
| 11. Solomon JJ, Heyman B, Ko JP, Condos R, Lynch DA. CT of Post-Acute Lung Complications of COVID-19. [Review]. Radiology. 301(2):E383-E395, 2021 11. |
Review/Other-Dx |
N/A |
To discuss the CT of Post-Acute Lung Complications of COVID-19. |
No results stated in the abstract. |
4 |
| 12. Marchetti F, Izzi N, Donatelli A, et al. Mid-term follow-up chest CT findings in recovered COVID-19 patients with residual symptoms. British Journal of Radiology. 96(1141):20220012, 2023 Jan 01. |
Observational-Dx |
407 patients |
To analyze the most frequent lung CT findings in recovered COVID-19 patients at mid-term follow-ups. |
The most frequently observed lung CT alterations, in order of frequency, were ground-glass opacities (81%), linear opacities (74%), bronchiolectases (64.81%), and reticular opacities (63.88%). The most common morphological pattern was the non-specific interstitial pneumonia pattern (63.88%). Features consistent with pulmonary fibrosis were observed in 32 patients (29.62%). |
1 |
| 13. Franquet T, Gimenez A, Ketai L, et al. Air trapping in COVID-19 patients following hospital discharge: retrospective evaluation with paired inspiratory/expiratory thin-section CT. European Radiology. 32(7):4427-4436, 2022 Jul. |
Observational-Dx |
48 patients |
To report our experience with paired inspiration/expiration thin-section computed tomographic (CT) scans in the follow-up of COVID-19 patients with persistent respiratory symptoms. |
Parenchymal abnormality was found in 50% (24/48) of patients and included air trapping (37/48, 77%), ground-glass opacities (19/48, 40%), reticulation (18/48, 38%), parenchymal bands (15/48, 31%), traction bronchiectasis (9/48, 19%), mosaic attenuation pattern (9/48, 19%), bronchial wall thickening (6/48, 13%), and consolidation (2/48, 4%). The absence of air trapping was observed in 11/48 (23%), mild air trapping in 20/48 (42%), moderate in 13/48 (27%), and severe in 4/48 (8%). Independent predictors of air trapping were, in decreasing order of importance, gender (p = 0.0085), and age (p = 0.0182). |
2 |
| 14. Konstantinos Katsoulis K, Kostikas K, Kontakiotis T. Techniques for assessing small airways function: Possible applications in asthma and COPD. [Review]. Respiratory Medicine. 119:e2-e9, 2016 10. |
Review/Other-Dx |
N/A |
To discuss the techniques for assessing small airways function: Possible applications in asthma and COPD |
No results stated in the abstract. |
4 |
| 15. Usmani OS, Singh D, Spinola M, Bizzi A, Barnes PJ. The prevalence of small airways disease in adult asthma: A systematic literature review. [Review]. Respiratory Medicine. 116:19-27, 2016 07. |
Review/Other-Dx |
15 publications |
To determining the prevalence of small airways disease in adult patients with asthma. |
Fifteen publications were identified determining the prevalence of small airways disease in asthma. Methods of assessments included impulse oscillometry, spirometry, body plethysmography, multiple-breath nitrogen washout, and high-resolution computed tomography. These studies used differing inclusion characteristics and recruited patients with a broad range of asthma severity, yet collectively they reported an overall prevalence of small airways disease of 50-60%. Small airways disease was present across all asthma severities, with evidence of distal airway disease even in the absence of proximal airway obstruction. |
4 |
| 16. Lee SM, Seo JB, Hwang HJ, et al. Assessment of regional emphysema, air-trapping and Xenon-ventilation using dual-energy computed tomography in chronic obstructive pulmonary disease patients. European Radiology. 27(7):2818-2827, 2017 Jul. |
Observational-Dx |
52 patients |
To compare the parenchymal attenuation change between inspiration/expiration CTs with dynamic ventilation change between xenon wash-in (WI) inspiration and wash-out (WO) expiration CTs. |
EI, GTI and ATI showed a significant correlation with Xe-WI, Xe-WO and Xe-Dyna (EI R = -.744, -.562, -.737; GTI R = -.621, -.442, -.629; ATI R = -.600, -.421, -.610, respectively, p < 0.01). All CT parameters showed significant correlation with PFTs except forced vital capacity (FVC). There was a significant difference in GTI, ATI and Xe-Dyna in each lung area (p < 0.01). |
2 |
| 17. Svenningsen S, Guo F, McCormack DG, Parraga G. Noncystic Fibrosis Bronchiectasis: Regional Abnormalities and Response to Airway Clearance Therapy Using Pulmonary Functional Magnetic Resonance Imaging. Academic Radiology. 24(1):4-12, 2017 01. |
Observational-Dx |
15 patients |
to evaluate the ability of magnetic resonance imaging (MRI) to detect regional ventilation impairment and response to airway clearance therapy (ACT) in patients with noncystic fibrosis (CF) bronchiectasis, providing a new way to objectively and regionally evaluate response to therapy. |
CT evidence of bronchiectasis and abnormal VDP (14 ± 7%) was observed for all bronchiectasis patients and no healthy volunteers. There was CT evidence of bronchiectasis in all lobes for 3 patients and in 3 ± 1 lobes (range = 1-4) for 12 patients. VDP in lobes with CT evidence of bronchiectasis (19 ± 12%) was significantly higher than in lobes without CT evidence of bronchiectasis (8 ± 5%, P = .001). For patients, VDP in lung lobes with (P < .0001) and without CT evidence of bronchiectasis (P = .006) was higher than in healthy volunteers (3 ± 1%). For all patients, mean PEQ-ease-bringing-up-sputum (P = .048) and PEQ-patient-global-assessment (P = .01) were significantly improved post-oscillatory positive expiratory pressure. An improvement in regional VDP greater than the minimum clinical important difference was observed for 8 of the 14 patients evaluated. |
2 |
| 18. Petousi N, Talbot NP, Pavord I, Robbins PA. Measuring lung function in airways diseases: current and emerging techniques. [Review]. Thorax. 74(8):797-805, 2019 08. |
Observational-Dx |
N/A |
To discuss the measuring lung function in airways diseases: current and emerging techniques. |
No results stated in the abstract. |
2 |
| 19. Sheikh K, Coxson HO, Parraga G. This is what COPD looks like. [Review]. Respirology. 21(2):224-36, 2016 Feb. |
Review/Other-Dx |
N/A |
To discuss MR and CT imaging approaches for generating reproducible and sensitive measurements of COPD phenotypes related to pulmonary ventilation and perfusion as well as airway and parenchyma anatomical and morphological features. |
No results stated in the abstract. |
4 |
| 20. Kooner HK, McIntosh MJ, Matheson AM, et al. Postacute COVID-19 Syndrome: 129Xe MRI Ventilation Defects and Respiratory Outcomes 1 Year Later. Radiology. 307(2):e222557, 2023 04. |
Observational-Dx |
53 patients |
To measure and compare pulmonary function, exercise capacity, quality of life, and 129Xe MRI ventilation defect percent (VDP) in individuals with PACS evaluated 3 and 15 months after COVID-19 infection. |
Overall, 53 participants (mean age, 55 years ± 18 [SD]; 27 women) attended both 3- and 15-month visits and were included in the analysis. The mean values for 129Xe MRI VDP (5.8% and 4.2%; P = .003), forced expiratory volume in the 1st second of expiration percent predicted (84% and 90%; P = .001), Dlco percent predicted (86% and 99%; P = .002), and SGRQ score (35 and 25; P < .001) improved between the 3- and 15-month visit. VDP measured 3 months after COVID-19 infection predicted the change in 6MWD (ß = -0.643, P = .006), while treatment with respiratory medication at 3 months predicted an improved quality-of-life score at 15 months (OR, 4.0; 95% CI: 1.2, 13.8; P = .03). Conclusion Pulmonary function, gas exchange, exercise capacity, quality of life, and 129Xe MRI ventilation defect percent (VDP) improved in participants with postacute COVID-19 syndrome at 15 months compared with 3 months after infection. VDP measured at 3 months after infection correlated with improved exercise capacity, while treatment with respiratory medication was associated with an improved quality-of-life score 15 months after infection. |
2 |
| 21. Matheson AM, McIntosh MJ, Kooner HK, et al. Longitudinal follow-up of postacute COVID-19 syndrome: DLCO, quality-of-life and MRI pulmonary gas-exchange abnormalities. Thorax. 78(4):418-421, 2023 04. |
Observational-Dx |
21 patients |
To discuss longitudinal follow-up of postacute COVID-19 syndrome: DLCO, quality-of-life and MRI pulmonary gas-exchange abnormalities. |
We evaluated 21 participants with PACS, 7±4 months (baseline) and 14±4 months (follow-up) postinfection. Significantly improved diffusing capacity of the lung for carbon monoxide (DLCO, ?=14%pred ;95%CI 7 to 21, p<0.001), postexertional dyspnoea (?=-0.7; 95%CI=-0.2 to -1.2, p=0.019), St George's Respiratory Questionnaire-score (SGRQ ?=-6; 95% CI=-1 to -11, p=0.044) but not RBC:TP (?=0.03; 95% CI=0.01 to 0.05, p=0.051) were observed at 14 months. DLCO correlated with RBC:TP (r=0.60, 95% CI=0.22 to 0.82, p=0.004) at 7 months. While DLCO and SGRQ measurements improved, these values did not normalise 14 months post-infection. |
2 |
| 22. Matheson AM, McIntosh MJ, Kooner HK, et al. Persistent 129Xe MRI Pulmonary and CT Vascular Abnormalities in Symptomatic Individuals with Post-acute COVID-19 Syndrome. Radiology. 305(2):466-476, 2022 11. |
Observational-Dx |
40 patients |
To determine the relationship of persistent symptoms and exercise limitation with xenon 129 (129Xe) MRI and CT pulmonary vascular measurements in individuals with PACS. |
Forty participants were evaluated, including six controls (mean age ± SD, 35 years ± 15, three women) and 34 participants with PACS (mean age, 53 years ± 13, 18 women), of whom 22 were never hospitalized. The 129Xe MRI RBC:barrier ratio was lower in ever-hospitalized participants (P = .04) compared to controls. BV5 correlated with RBC AUC (? = .44, P = .03). The 129Xe MRI RBC:barrier ratio was related to DLco (r = .57, P = .002) and forced expiratory volume in 1 second (? = .35, P = .03); RBC AUC was related to dyspnea (? = -.35, P = .04) and International Physical Activity Questionnaire score (? = .45, P = .02). |
2 |
| 23. Tan S, Saffar B, Wrobel J, Laycock A, Melsom S. Air trapping in small airway diseases: A review of imaging technique and findings with an overview of small airway diseases. [Review]. Journal of Medical Imaging & Radiation Oncology. 67(5):499-508, 2023 Aug. |
Review/Other-Dx |
N/A |
To review of imaging technique and findings with an overview of small airway diseases. |
No results stated in the abstract. |
4 |
| 24. Lee GM, Carroll MB, Galvin JR, Walker CM. Mosaic Attenuation Pattern: A Guide to Analysis with HRCT. [Review]. Radiologic Clinics of North America. 60(6):963-978, 2022 Nov. |
Review/Other-Dx |
N/A |
To discuss mosaic Attenuation Pattern- a guide to Analysis with HRCT. |
No results stated in the abstract. |
4 |
| 25. Buda N, Mendrala K, Skoczynski S, et al. Basics of Point-of-Care Lung Ultrasonography. N Engl J Med 2023;389:e44. |
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| 26. Oelsner EC, Lima JA, Kawut SM, et al. Noninvasive tests for the diagnostic evaluation of dyspnea among outpatients: the Multi-Ethnic Study of Atherosclerosis lung study. Am J Med. 128(2):171-180.e5, 2015 Feb. |
Observational-Dx |
1969 participants |
To assess which diagnostic tests were associated with dyspnea among participants without diagnosed cardiac or pulmonary disease from a large panel of tests that were performed in a multiethnic, population-based cohort. |
Among 1969 participants without known cardiopulmonary disease, 9% had dyspnea. The forced expiratory volume in 1 second (FEV1) (P < .001), NT-proBNP (P = .004), and percent emphysema on CT (P = .004) provided independent information on the probability of self-reported dyspnea. Associations with the FEV1 were stronger among smokers and participants with other recent respiratory symptoms or seasonal allergies; associations with NT-proBNP were present only among participants with coexisting symptoms of lower-extremity edema. Only the FEV1 provided a significant improvement in the receiver operating curve. |
3 |
| 27. Zompatori M, Bna C, Poletti V, et al. Diagnostic imaging of diffuse infiltrative disease of the lung. Respiration. 2004; 71(1):4-19. |
Review/Other-Dx |
N/A |
Review the role of chest radiography and HRCT in the diagnosis and assessment of diffuse infiltrative lung disease. |
The initial diagnostic approach to imaging of diffuse lung disease is the chest radiograph. However, because of chest radiography’s limitations in sensitivity, specificity and diagnostic accuracy, HRCT is required especially for symptomatic patients with normal or nonspecific chest radiographic findings. HRCT is considered the best imaging tool for diffuse lung disease. |
4 |
| 28. Pratter MR, Abouzgheib W, Akers S, Kass J, Bartter T. An algorithmic approach to chronic dyspnea. Respir Med. 2011;105(7):1014-1021. |
Observational-Tx |
123 patients |
To prospectively evaluate an algorithmic approach to the cause(s) of chronic dyspnea. |
Cause(s) was(were) diagnosed in 122/123 patients (99%); 97 patients had one diagnosis and 25 two diagnoses. Fifty-three percent of diagnoses were respiratory and 47% were non-respiratory. Following therapy, dyspnea improved in 63% of patients. |
2 |
| 29. Pratter MR, Curley FJ, Dubois J, Irwin RS. Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. Arch Intern Med. 1989; 149(10):2277-2282. |
Observational-Dx |
85 patients |
Prospectively study patients with chronic dyspnea to determine whether findings based on objective testing (including chest radiograph) were superior to clinical impression alone. |
Objective testing was more accurate than clinical impression alone (cause of dyspnea identified in 100% vs 66%). Chest radiograph most useful for identification of interstitial lung disease. |
3 |
| 30. Zanforlin A, Tursi F, Marchetti G, et al. Clinical Use and Barriers of Thoracic Ultrasound: A Survey of Italian Pulmonologists. Respiration. 99(2):171-176, 2020. |
Review/Other-Dx |
2010 patients |
To explore the clinical use of thoracic ultrasound and the barriers to the diffusion of the technique in Italy. |
Of the 2010 physicians invited, 514 completed the survey (26% response rate). According to 99% of responders, thoracic ultrasound had a relevant clinical role. Seventy-nine percent of the responders used thoracic ultrasound at least once a month. The main settings were: 53% pulmonology ward, 15% outpatient clinic, 15% interventional pulmonology room, 10% internal medicine ward, 4% respiratory intensive care units, and 9% other. Thoracic ultrasound was primarily used: (1) with both diagnostic and interventional aims (72%), (2) as diagnostic imaging (17%), and (3) as guidance for interventional procedures (11%). The main clinical applications were: (1) diagnosis and management of pleural effusion, (2) pneumothorax, (3) pneumonia, (4) cardiac failure, and (5) acute dyspnea. Twenty-one percent of the responders do not use thoracic ultrasound. The main reported bar-riers were: (1) availability of an ultrasound system (52%), (2) lack of protected time and training (22%), and (3) use of the technique by other specialists (15%). |
4 |
| 31. Gundersen EA, Juhl-Olsen P, Bach A, et al. PrehospitaL Ultrasound in Undifferentiated DyspnEa (PreLUDE): a prospective, clinical, observational study. Scandinavian Journal of Trauma, Resuscitation & Emergency Medicine. 31(1):6, 2023 Feb 05. |
Observational-Dx |
214 patients |
To hypothesized that prehospital point-of-care ultrasound (POCUS) can improve diagnostic accuracy. |
In total, 214 patients were included. The diagnosis of acute heart failure was suspected in 64/214 (30%) of patients before POCUS and 64/214 (30%) patients after POCUS, but POCUS led to reclassification in 53/214 (25%) patients. The endpoint committee adjudicated the diagnosis of acute heart failure in 87/214 (41%) patients. The sensitivity for the diagnosis of acute heart failure was 58% (95% CI 46%-69%) before POCUS compared to 65% (95% CI 53%-75%) after POCUS (p = 0.12). ROC AUC for the diagnosis acute heart failure was 0.72 (95% CI 0.66-0.78) before POCUS compared to 0.79 (0.73-0.84) after POCUS (p < 0.001). ROC AUC for the diagnosis acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) or asthma was 0.87 (0.82-0.91) before POCUS and 0.93 (0.88-0.97) after POCUS (p < 0.001). A POCUS finding of any of severely reduced left ventricular function, bilateral B-lines or bilateral pleural effusion demonstrated the highest sensitivity for acute heart failure at 88% (95% CI 79%-94%), whereas the combination of all of these three findings yielded the highest specificity at 99% (95% CI 95%-100%). |
2 |
| 32. Rogoza K, Kosiak W. Usefulness of lung ultrasound in diagnosing causes of exacerbation in patients with chronic dyspnea. [Review]. Pneumonologia i Alergologia Polska. 84(1):38-46, 2016. |
Review/Other-Dx |
N/A |
To outlines the current knowledge on the subject of transthoracic lung ultrasound (TLUS), particularly in respect of its clinical usefulness in distinction of causes of dyspnea exacerbation. |
No results stated in the abstract. |
4 |
| 33. Hwang HJ, Hoffman EA, Lee CH, et al. The role of dual-energy computed tomography in the assessment of pulmonary function. [Review]. European Journal of Radiology. 86:320-334, 2017 Jan. |
Review/Other-Dx |
N/A |
To discuss the role of dual-energy computed tomography in the assessment of pulmonary function. |
No results stated in the abstract. |
4 |
| 34. Lynch DA, Austin JH, Hogg JC, et al. CT-Definable Subtypes of Chronic Obstructive Pulmonary Disease: A Statement of the Fleischner Society. Radiology. 2015;277(1):192-205. |
Review/Other-Dx |
N/A |
To describe and define the phenotypic abnormalities that can be identified on visual and quantitative evaluation of computed tomographic (CT) images in subjects with chronic obstructive pulmonary disease (COPD), with the goal of contributing to a personalized approach to the treatment of patients with COPD. |
No results stated in abstract. |
4 |
| 35. Okajima Y, Come CE, Nardelli P, et al. Luminal Plugging on Chest CT Scan: Association With Lung Function, Quality of Life, and COPD Clinical Phenotypes. Chest. 158(1):121-130, 2020 07. |
Observational-Dx |
111 patients |
To examine the associations of chest CT scan-identified luminal plugging with lung function, health-related quality of life, and COPD phenotypes. |
Overall, 111 subjects (22%) had luminal plugging. The prevalence of luminal plugging was higher in subjects with COPD than those without COPD (25% vs 10%, respectively; P = .001). In subjects with COPD, luminal plugging was significantly associated with FEV1 % predicted (estimate, -6.1; SE, 2.1; P = .004) and SGRQ score (estimate, 4.9; SE, 2.4; P = .04) in adjusted models. Although luminal plugging was associated with log %LAA-950 (estimate, 0.43; SE, 0.16; P = .007), its relationship with chronic bronchitis did not reach statistical significance (P = .07). Seventy-three percent of subjects with COPD with luminal plugging at baseline had it 5 years later. |
1 |
| 36. Diaz AA, Orejas JL, Grumley S, et al. Airway-Occluding Mucus Plugs and Mortality in Patients With Chronic Obstructive Pulmonary Disease. JAMA. 329(21):1832-1839, 2023 06 06. |
Observational-Dx |
4483 participants |
To determine whether airway mucus plugs identified on chest computed tomography (CT) were associated with increased all-cause mortality. |
Among the 4483 participants with COPD, 4363 were included in the primary analysis (median age, 63 years [IQR, 57-70 years]; 44% were women). A total of 2585 (59.3%), 953 (21.8%), and 825 (18.9%) participants had mucus plugs in 0, 1 to 2, and 3 or more lung segments, respectively. During a median 9.5-year follow-up, 1769 participants (40.6%) died. The mortality rates were 34.0% (95% CI, 32.2%-35.8%), 46.7% (95% CI, 43.5%-49.9%), and 54.1% (95% CI, 50.7%-57.4%) in participants who had mucus plugs in 0, 1 to 2, and 3 or more lung segments, respectively. The presence of mucus plugs in 1 to 2 vs 0 and 3 or more vs 0 lung segments was associated with an adjusted hazard ratio of death of 1.15 (95% CI, 1.02-1.29) and 1.24 (95% CI, 1.10-1.41), respectively. |
1 |
| 37. Regan EA, Lynch DA, Curran-Everett D, et al. Clinical and Radiologic Disease in Smokers With Normal Spirometry. JAMA Intern Med. 2015;175(9):1539-1549. |
Observational-Dx |
10192 smokers; 108 non-smokers |
To identify clinical and radiologic evidence of smoking-related disease in a cohort of current and former smokers who did not meet spirometric criteria for chronic obstructive pulmonary disease (COPD), for whom we adopted the discarded label of Global Initiative for Obstructive Lung Disease (GOLD) 0. |
One or more respiratory-related impairments were found in 54.1% (2375 of 4388) of the GOLD 0 group. The GOLD 0 group had worse quality of life (mean [SD] St George's Respiratory Questionnaire total score, 17.0 [18.0] vs 3.8 [6.8] for the never smokers; P < .001) and a lower 6-minute walk distance, and 42.3% (127 of 300) of the GOLD 0 group had computed tomography (CT) evidence of emphysema or airway thickening. The forced expiratory volume in the first second of expiration [FEV1] percent predicted distribution and mean for the GOLD 0 group were lower but still within the normal range for the population. Current smoking was associated with more respiratory symptoms, but former smokers had greater emphysema and gas trapping. Advancing age was associated with smoking cessation and with more CT findings of disease. Individuals with respiratory impairments were more likely to use respiratory medications, and the use of these medications was associated with worse disease. |
2 |
| 38. Woodruff PG, Barr RG, Bleecker E, et al. Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function. New England Journal of Medicine. 374(19):1811-21, 2016 May 12. |
Observational-Dx |
2736 patients |
To discuss the clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function. |
Respiratory symptoms were present in 50% of current or former smokers with preserved pulmonary function. The mean (±SD) rate of respiratory exacerbations among symptomatic current or former smokers was significantly higher than the rates among asymptomatic current or former smokers and among controls who never smoked (0.27±0.67 vs. 0.08±0.31 and 0.03±0.21 events, respectively, per year; P<0.001 for both comparisons). Symptomatic current or former smokers, regardless of history of asthma, also had greater limitation of activity, slightly lower FEV1, FVC, and inspiratory capacity, and greater airway-wall thickening without emphysema according to HRCT than did asymptomatic current or former smokers. Among symptomatic current or former smokers, 42% used bronchodilators and 23% used inhaled glucocorticoids. |
2 |
| 39. Raoof S, Shah M, Make B, et al. Lung Imaging in COPD Part 1: Clinical Usefulness. [Review]. Chest. 164(1):69-84, 2023 07. |
Review/Other-Dx |
N/A |
To discuss the clinical usefulness of the Lung Imaging in COPD Part 1 |
No results stated in the abstract |
4 |
| 40. Labaki WW, Han MK. Improving Detection of Early Chronic Obstructive Pulmonary Disease. [Review]. Annals of the American Thoracic Society. 15(Suppl 4):S243-S248, 2018 12. |
Review/Other-Dx |
N/A |
To discuss improving Detection of Early Chronic Obstructive Pulmonary Disease. |
No results stated in the abstract. |
4 |
| 41. Kasuga I, Maezawa H, Gamo S, et al. Evaluation of chest radiography and low-dose computed tomography as valuable screening tools for thoracic diseases. Medicine. 101(29):e29261, 2022 Jul 22. |
Observational-Dx |
4317 patients |
To clarify the usefulness of the veridical method in the screening of various thoracic diseases. |
A total of 47 and 124 cases had abnormal opacity on CR and LDCT, respectively. Among these, 41 cases in which the abnormal opacity was identified by both methods contained 20 treated cases. Six cases had abnormalities only on CR, and none of the cases required further treatment. Eighty-three cases were identified using LDCT alone. Of these, many cases, especially those over the age of 50 years, were diagnosed with thoracic tumors and chronic obstructive pulmonary disease, which required early treatment. In contrast, many cases of pulmonary infections have improved spontaneously, without any treatment. |
2 |
| 42. Klein JS, Gamsu G, Webb WR, Golden JA, Muller NL. High-resolution CT diagnosis of emphysema in symptomatic patients with normal chest radiographs and isolated low diffusing capacity. Radiology. 182(3):817-21, 1992 Mar. |
Review/Other-Dx |
470 HRCT studies |
To determine the prevalence of “nonobstructive” (impairment of gas transfer) emphysema in a select population of smokers with dyspnea, a retrospective study of patients with emphysema evident at HRCT was undertaken. |
In 47 cases, centrilobular emphysema was the dominant parenchymal abnormality. Concomitant chest radiographs were available in 41 of these cases; 16 of the 41 lacked radiographic findings of emphysema. Among these 16 patients, pulmonary function testing revealed 10 to have normal flow rates (ratio of FEV in 1 second to FVC and FEV in 1 second greater than 80% predicted) and impaired gas transfer (single-breath carbon monoxide diffusing capacity <80% predicted). With the exclusion of one patient with congestive heart failure from the group of 10, the severity of emphysema at HRCT correlated inversely with single-breath carbon monoxide diffusing capacity (r = -.643). Results indicate that HRCT allows detection of emphysema in symptomatic patients when chest radiographs and pulmonary function tests are nondiagnostic. |
4 |
| 43. Kim SS, Seo JB, Lee HY, et al. Chronic obstructive pulmonary disease: lobe-based visual assessment of volumetric CT by Using standard images--comparison with quantitative CT and pulmonary function test in the COPDGene study. Radiology. 2013;266(2):626-635. |
Observational-Dx |
200 participants |
To provide a new detailed visual assessment scheme of computed tomography (CT) for chronic obstructive pulmonary disease (COPD) by using standard reference images and to compare this visual assessment method with quantitative CT and several physiologic parameters. |
The type of emphysema, determined by four readers, showed good agreement (kappa = 0.63). The extent of the emphysema in each lobe showed good agreement (mean weighted kappa = 0.70) and correlated with findings at quantitative CT (r = 0.75), forced expiratory volume in 1 second (FEV(1)) (r = -0.68), FEV(1)/forced vital capacity (FVC) ratio (r = -0.74) (P < .001). Agreement for airway wall thickening was fair (mean kappa = 0.41), and the number of lobes with thickened bronchial walls correlated with FEV(1) (r = -0.60) and FEV(1)/FVC ratio (r = -0.60) (P < .001). |
2 |
| 44. Boes JL, Hoff BA, Bule M, et al. Parametric response mapping monitors temporal changes on lung CT scans in the subpopulations and intermediate outcome measures in COPD Study (SPIROMICS). Acad Radiol. 2015;22(2):186-194. |
Observational-Dx |
89 subjects |
To demonstrate the utility of parametric response mapping (PRM), a computed tomography (CT)-based biomarker, for monitoring regional disease progression in chronic obstructive pulmonary disease (COPD) patients, linking expiratory- and inspiratory-based CT metrics over time. |
PRM metrics varied by approximately 6.5% of total lung volume for normal parenchyma (PRM(Normal)) and functional small airways disease (PRM(fSAD)) and 1% for emphysema (PRM(Emph)) when testing 30-day repeatability. Over a 1-year interval, only PRM(Emph) in severe COPD subjects produced significant change (19%-21%). However, 11 of 76 subjects showed changes in PRM(fSAD) greater than variations observed from analysis of 30-day data. Mathematical model simulations agreed with experimental PRM results, suggesting fSAD is a transitional phase from normal parenchyma to emphysema. |
3 |
| 45. Gu S, Leader J, Zheng B, et al. Direct assessment of lung function in COPD using CT densitometric measures. Physiol Meas. 2014;35(5):833-845. |
Observational-Dx |
600 subjects |
To investigate whether lung function in patients with chronic obstructive pulmonary disease (COPD) can be directly predicted using computed tomography (CT) densitometric measures and assess the underlying prediction errors as compared with the traditional spirometry-based measures. |
The averaged percentage errors in prediction of forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC)%, total lung capacity (TLC), residual volume (RV)/TLC% and lung diffusion capacity by single breath carbon monoxide (DLCO)% predicted were 33%, 17%, 9%, 18% and 23%, respectively. When classifying the exams in terms of disease severity grades using the CT measures, 37% of the subjects were correctly classified with no error and 83% of the exams were either correctly classified or classified into immediate neighboring categories. The linear weighted kappa and quadratic weighted kappa were 0.54 (moderate agreement) and 0.72 (substantial agreement), respectively. |
3 |
| 46. Lee YK, Oh YM, Lee JH, et al. Quantitative assessment of emphysema, air trapping, and airway thickening on computed tomography. Lung. 2008; 186(3):157-165. |
Observational-Dx |
34 patients |
To evaluate the correlation between the parameters measured on volumetric CT, including the extent of emphysema, air trapping, and airway thickening, and clinical parameters. In-house software was used to measure CT parameters, including volume fraction of emphysema (V(950)), mean lung density, CT air trapping index, segmental bronchial wall area, lumen area, and wall area percent. |
CT parameters were correlated with the pulmonary function test results, BMI, the modified Medical Research Council Dyspnea scale (MMRC scale), the six-minute-walk distance, and the BODE index. V(950) correlated to the BMI, FEV1, six-minute-walk distance, and the BODE index. The CT air trapping index correlated with the physiologic air trapping index (VC-FVC) (R=0.345, P=0.045) and the MMRC scale (R=0.532, P=0.001). There was a positive correlation between the wall area percent and the BMI (R=0.563, P<0.001). Mean lung density showed the strongest correlation with the BODE index (R= -0.756, P<0.001). Study concludes that the severity of emphysema and air trapping measured on CT correlated with the pulmonary function test parameters six-minute-walk distance and BMI. |
3 |
| 47. Wang G, Wang L, Ma Z, Zhang C, Deng K. Quantitative emphysema assessment of pulmonary function impairment by computed tomography in chronic obstructive pulmonary disease. J Comput Assist Tomogr. 2015;39(2):171-175. |
Observational-Dx |
46 patients |
To determine the capability of quantitative emphysema by computed tomography (CT) to assess pulmonary function impairment in a population of current smokers with and without airflow limitation. |
Quantitative CT measurements of emphysema were moderately, negatively correlated to airflow limitation (forced expiratory volume in 1 second [FEV1] and ratio of FEV1 to forced vital capacity) (r = -0.68 to -0.52, P < 0.001). Except for right middle and lower lobes, all the quantitative CT measurements showed moderate, negative correlations with diffusing capacity (DLCO) (r = -0.63 to -0.54, P </= 0.001) and weak to moderate correlations with residual volume to total lung capacity(RV) (RV/TLC) (r = 0.36-0.41, P < 0.01). As compared with control samples, the low attenuation volume (%LAVs) of whole lung, right lung, left lung, and each lobe was increased in patients with GOLD stages 2, 3, and 4 disease (P < 0.05), and the % LAV of whole lung, right lung and right upper lobe was increased in patients with GOLD stage 1 (P < 0.05). |
3 |
| 48. Yahaba M, Kawata N, Iesato K, et al. The effects of emphysema on airway disease: correlations between multi-detector CT and pulmonary function tests in smokers. Eur J Radiol. 2014;83(6):1022-1028. |
Observational-Dx |
124 subjects |
To determine whether emphysematous changes alter the relationships between airflow limitation and airway dimensions as measured by inspiratory and expiratory multi-detector computed tomography (MDCT). |
In patients without emphysema, airway luminal area (Ai) and wall area percentage (WA%) from both the inspiratory and expiratory scans were significantly correlated with forced expiratory volume in 1 second (FEV1). No correlation was detected in patients with emphysema. In addition, emphysematous Chronic obstructive pulmonary disease (COPD) patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 or 2 disease had significantly lower changes in B8 Ai than non-emphysematous patients. |
3 |
| 49. Lee JS, Lee SM, Seo JB, et al. Clinical utility of computed tomographic lung volumes in patients with chronic obstructive pulmonary disease. Respiration. 2014;87(3):196-203. |
Observational-Dx |
75 patients |
To evaluate the clinical utility of the computed tomography (CT) expiratory-to-inspiratory lung volume ratio (CT Vratio) by assessing the relationship with clinically relevant outcomes. |
The CT Vratio correlated significantly with Body Mass Index (BMI) (r = -0.528, p < 0.001). The CT Vratio was also significantly associated with Medical Research Council (MMRC) dyspnea (r = 0.387, p = 0.001), 6-min walk distance (6MWD) (r = -0.459, p < 0.001), and St. George's Respiratory Questionnaire (SGRQ) (r = 0.369, p = 0.001) scores. Finally, the CT Vratio had significant correlations with the BMI, airflow obstruction, dyspnea, and exercise capacity index (BODE) and airflow obstruction (ADO) multidimensional chronic obstructive pulmonary disease (COPD) severity indices (r = 0.605, p < 0.001; r = 0.411, p < 0.001). |
2 |
| 50. Martinez CH, Chen YH, Westgate PM, et al. Relationship between quantitative CT metrics and health status and BODE in chronic obstructive pulmonary disease. Thorax. 2012;67(5):399-406. |
Observational-Dx |
1200 patients |
To identify chronic obstructive pulmonary disease (COPD) phenotypes is increasingly appreciated. |
In separate models predicting St George's Respiratory Questionnaire (SGRQ) score, a 1 unit standard deviation (SD) increase in each airway measure predicted higher SGRQ scores (for wall thickness (WT), 1.90 points higher, p=0.002; for wall area percentage (WA%0, 1.52 points higher, p=0.02; for pi10, 2.83 points higher p<0.001). The comparable increase in SGRQ for a 1 unit SD increase in emphysema percentage in these models was relatively weaker, significant only in the pi10 model (for emphysema percentage, 1.45 points higher, p=0.01). In separate models predicting Body-Mass Index, Airflow Obstruction, Dyspnea and Exercise Capacity Index (BODE), a 1 unit SD increase in each airway measure predicted higher BODE scores (for WT, 1.07-fold increase, p<0.001; for WA%, 1.20-fold increase, p<0.001; for pi10, 1.16-fold increase, p<0.001). In these models, emphysema more strongly influenced BODE (range 1.24-1.26-fold increase, p<0.001). |
3 |
| 51. Nambu A, Zach J, Schroeder J, et al. Quantitative computed tomography measurements to evaluate airway disease in chronic obstructive pulmonary disease: Relationship to physiological measurements, clinical index and visual assessment of airway disease. [Review]. Eur J Radiol. 85(11):2144-2151, 2016 Nov. |
Observational-Dx |
188 subjects |
To correlate currently available quantitative computed tomography (CT) measurements for airway disease with physiological indices and the body-mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index in patients with chronic obstructive pulmonary disease (COPD). |
Quantitative CT measurements had significant correlations with physiological indices. Among them, expiratory to inspiratory ratio of mean lung density(E/I-ratio MLD) had the strongest correlations with FEF25-75% (r=-0.648, <0.001) and specific airway conductance (sGaw) (r=-0.624, <0.001) while in the subjects with mild emphysema subsegmental WA% and segmental airway wall area percent (WA%) had the strongest correlation with forced expiratory flow (FEF)25-75% (r=-0.669, <0.001) and sGaw (r=-0.638, <0.001), respectively. The multiple variable analyses showed that RVC-856 to -950 was an independent predictor of the body-mass index, airflow obstruction, dyspnea, and exercise capacity index (BODE) index showing the highest R2 (0.468) as an independent variable among the Quantitative CT (QCT) measurements. |
3 |
| 52. Bodduluri S, Puliyakote ASK, Gerard SE, et al. Airway fractal dimension predicts respiratory morbidity and mortality in COPD. Journal of Clinical Investigation. 128(12):5374-5382, 2018 12 03. |
Observational-Dx |
8,135 patients |
To analyzed segmented airway trees of 8,135 participants enrolled in the COPDGene cohort. |
AFD was significantly associated with forced expiratory volume in one second (FEV1; P < 0.001) and FEV1/forced vital capacity (FEV1/FVC; P < 0.001) after adjusting for age, race, sex, smoking status, pack-years of smoking, BMI, CT emphysema, air trapping, airway thickness, and CT scanner type. On multivariable analysis, AFD was also associated with respiratory quality of life and 6-minute walk distance, as well as exacerbations, lung function decline, and mortality on longitudinal follow-up. We identified a subset of participants with AFD below the median and peribronchial emphysema above the median who had worse survival compared with participants with high AFD and low peribronchial emphysema (adjusted hazards ratio [HR]: 2.72; 95% CI: 2.20-3.35; P < 0.001), a substantial number of whom were not identified by traditional spirometry severity grades. |
2 |
| 53. Han MK, Bartholmai B, Liu LX, et al. Clinical significance of radiologic characterizations in COPD. COPD. 2009; 6(6):459-467. |
Observational-Dx |
156 patients |
To describe a comprehensive, correlative study in patients who underwent extensive clinical, physiological and radiological evaluation prior to surgical resection. The authors assessed the relationship between HRCT defined emphysema severity and airway abnormalities and clinically relevant outcomes including health status as measured by SF12 and St. George’s Respiratory Questionnaire (SGRQ), self-reported exacerbation frequency and BODE. |
HRCT provides unique COPD phenotyping information. Radiographic quantification of emphysema and bronchial thickness are independently associated with SGRQ and physical component score of the SF-12. Bronchial thickness but not emphysema is associated with exacerbation frequency, whereas emphysema is a stronger predictor of BODE and its systemic components modified MMRC, 6-min walk test, and BMI. |
3 |
| 54. Ostridge K, Williams NP, Kim V, et al. Relationship of CT-quantified emphysema, small airways disease and bronchial wall dimensions with physiological, inflammatory and infective measures in COPD. Respiratory Research. 19(1):31, 2018 02 20. |
Observational-Dx |
122 patients |
To explore the relationships between quantitative CT analysis with functional, inflammatory and infective assessments of disease to identify the utility of imaging to stratify disease to better predict outcomes and disease response. |
122 subjects were included in this analysis. Emphysema and small airways disease had independent associations with airflow obstruction (ß = - 0.34, p < 0.001 and ß = - 0.56, p < 0.001). %LAA<- 950 had independent associations with gas transfer (ß = - 0.37, p < 0.001) and E/I MLD with RV/TLC (ß = 0.30, p =0.003). The distance walked during the 6MWT was not associated with CT parameters, but exertional desaturation was independently associated with emphysema (ß = 0.73, p < 0.001). Pi10 did not show any independent associations with lung function or functional parameters. No CT parameters had any associations with sputum inflammatory cells. Greater emphysema was associated with lower levels of systemic inflammation (CRP ß = - 0.34, p < 0.001 and fibrinogen ß = - 0.28, p =0.003). There was no significant difference in any of the CT parameters between subjects where potentially pathogenic bacteria were detected in sputum and those where it was not. |
1 |
| 55. Van Tho N, Ogawa E, Trang le TH, et al. A mixed phenotype of airway wall thickening and emphysema is associated with dyspnea and hospitalization for chronic obstructive pulmonary disease. Ann Am Thorac Soc. 12(7):988-96, 2015 Jul. |
Observational-Dx |
240 patients |
To propose a method of phenotyping chronic obstructive pulmonary disease (COPD) based on quantitative computed tomography (CT) and to compare clinically relevant outcomes between patients with COPD with the mixed phenotype and those with other CT-based phenotypes. |
Of 240 patients with COPD, 52 (21.7%) were classified as CT-normal phenotype, 39 (16.3%) as airway-dominant phenotype, 103 (42.9%) as emphysema-dominant phenotype, and 46 (19.2%) as mixed phenotype. Patients with COPD with the mixed phenotype were associated with more severe dyspnea than those with each of the remaining CT-based phenotypes (P < 0.01 for all comparisons). The number of hospitalizations for COPD exacerbations during the preceding year was 2.0 to 3.6 times higher in patients with the mixed phenotype than in those with each of the remaining CT-based phenotypes (P < 0.05 for all comparisons). Findings persisted after adjustment for age, pack-years of smoking, smoking status, body mass index, and forced expiratory volume (FEV1). |
3 |
| 56. Zulueta JJ, Wisnivesky JP, Henschke CI, et al. Emphysema scores predict death from COPD and lung cancer. Chest. 2012;141(5):1216-1223. |
Observational-Dx |
9,047 subjects |
To assess the usefulness of emphysema scores in predicting death from Chronic Obstructive Pulmonary Disease (COPD) and lung cancer. |
Median age was 65 years, 4,433 (49%) were men, and 4,133 (46%) were currently smoking or had quit within 5 years. Emphysema was identified in 2,637 (29%) and was a significant predictor of death from COPD (HR, 9.3; 95% CI, 4.3-20.2; P < .0001) and from lung cancer (HR, 1.7; 95% CI, 1.1-2.5; P = .013), even when adjusted for age and smoking history. |
2 |
| 57. Camiciottoli G, Bartolucci M, Maluccio NM, et al. Spirometrically gated high-resolution CT findings in COPD: lung attenuation vs lung function and dyspnea severity. Chest. 2006; 129(3):558-564. |
Observational-Dx |
51 patients |
To examine the relationship between HRCT lung attenuation measurements acquired under spirometric control of inspiratory and expiratory lung volume and pulmonary dysfunction as well as dyspnea severity in patients with COPD. |
Inspiratory measurements assess the extent of emphysematous tissue loss. Expiratory measurements reflect airflow limitation and lung hyperinflation and correlate better with dyspnea perception. Both modalities should be utilized in HRCT. |
3 |
| 58. Capaldi DP, Zha N, Guo F, et al. Pulmonary Imaging Biomarkers of Gas Trapping and Emphysema in COPD: (3)He MR Imaging and CT Parametric Response Maps. Radiology. 2016;279(2):597-608. |
Experimental-Dx |
58 participants |
To directly compare magnetic resonance (MR) imaging and computed tomography (CT) parametric response map (PRM) measurements of gas trapping and emphysema in ex-smokers both with and without chronic obstructive pulmonary disease (COPD). |
Ventilation defect percent (VDP), apparent diffusion coefficient (ADC), and parametric response map (PRM) gas trapping and emphysema (ANOVA, P < .001) measurements were significantly different in healthy ex-smokers than they were in ex-smokers with COPD. In all ex-smokers, VDP was correlated with PRM gas trapping (r = 0.58, P < .001) and with PRM emphysema (r = 0.68, P < .001). VDP was also significantly correlated with PRM in ex-smokers with COPD (gas trapping: r = 0.47 and P = .03; emphysema: r = 0.62 and P < .001) but not in healthy ex-smokers. In a multivariate model that predicted PRM gas trapping, the forced expiratory volume in 1 second normalized to the forced vital capacity (standardized coefficients [betaS] = -0.69, P = .001) and airway wall area percent (betaS = -0.22, P = .02) were significant predictors. PRM emphysema was predicted by the diffusing capacity for carbon monoxide (betaS = -0.29, P = .03) and VDP (betaS = 0.41, P = .001). Helium 3 ADC values were significantly elevated in PRM gas-trapping regions (P < .001). The spatial relationship for ventilation defects was significantly greater with PRM gas trapping than with PRM emphysema in patients with mild (for gas trapping, spatial overlap coefficient (SOC)= 36% +/- 28; for emphysema, SOC = 1% +/- 2; P = .001) and moderate (for gas trapping, SOC = 34% +/- 28; for emphysema, SOC = 7% +/- 15; P = .006) COPD. For severe COPD, the spatial relationship for ventilation defects with PRM emphysema (SOC = 64% +/- 30) was significantly greater than that for PRM gas trapping (SOC = 36% +/- 18; P = .01). |
3 |
| 59. Ohno Y, Koyama H, Yoshikawa T, et al. Comparison of capability of dynamic O(2)-enhanced MRI and quantitative thin-section MDCT to assess COPD in smokers. Eur J Radiol. 2012;81(5):1068-1075. |
Observational-Dx |
186 patients |
To directly and prospectively compare the capability of dynamic Oxygen-enhanced Magnetic Resonance Imaging (MRI) and quantitatively assessed thin-section multi dimensional computed tomography (MDCT) to assess smokers' Chronic obstructive pulmonary disease (COPD) in a large prospective cohort. |
All indexes had significant correlations with functional parameters (p<0.0001). All indexes except computed tomography-based functional lung volume (CT-based FLV) in all groups had significant differences each other (p<0.05). |
2 |
| 60. Zhang WJ, Hubbard Cristinacce PL, Bondesson E, et al. MR Quantitative Equilibrium Signal Mapping: A Reliable Alternative to CT in the Assessment of Emphysema in Patients with Chronic Obstructive Pulmonary Disease. Radiology. 2015;275(2):579-588. |
Observational-Dx |
24 patients; 12 healthy subjects |
To compare magnetic resonance (MR) quantitative equilibrium signal (qS0) mapping with quantitative computed tomography (CT) in the estimation of emphysema in patients with chronic obstructive pulmonary disease (COPD). |
Whole-lung mean qS0 and 15th percentile of qS0 were significantly lower, whereas relative lung area with a qS0 value below 0.20 (RA0.20) and standard deviation of qS0 were significantly higher in patients with COPD than in healthy control subjects (P = .014, P = .002, P = .005, and P < .001, respectively). Whole-lung mean qS0, the 15th percentile of qS0, and RA0.20 strongly correlated with RA-950 (r = -0.78, r = -0.81, and r = 0.86, respectively; P < .001) and PA15 (r = 0.78, r = 0.79, and r = -0.71, respectively; P < .001) and moderately correlated with the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (r = 0.63, r = 0.67, and r = -0.60, respectively; P < .001) and percentage predicted FEV1 (r = 0.54, r = 0.62, and r = -0.56, respectively; P </= .001). Good reproducibility of qS0 readouts was found in both groups (ICC range, 0.89-0.98). |
3 |
| 61. Cleverley JR, Muller NL. Advances in radiologic assessment of chronic obstructive pulmonary disease. Clin Chest Med. 2000;21(4):653-663. |
Review/Other-Dx |
N/A |
To review the advances in radiologic assessment of chronic obstructive pulmonary disease. |
No results stated in abstract. |
4 |
| 62. Wallace GM, Winter JH, Winter JE, Taylor A, Taylor TW, Cameron RC. Chest X-rays in COPD screening: are they worthwhile? Respir Med. 2009; 103(12):1862-1865. |
Review/Other-Dx |
546 consecutive chest X-ray reports |
Retrospective study to determine clinical utility of chest x-rays in COPD screening. |
Considerable benign and malignant pathology is detected by chest X-ray performed at initial COPD assessment. Clinical management is changed in the majority with a potentially treatable abnormality. This evidence suggests that the National Institute for Health and Clinical Excellence (NICE) guideline to perform chest X-ray at initial COPD evaluation should be elevated from a grade D to grade C recommendation. |
4 |
| 63. Rittayamai N, Chuaychoo B, Tscheikuna J, Dres M, Goligher EC, Brochard L. Ultrasound Evaluation of Diaphragm Force Reserve in Patients with Chronic Obstructive Pulmonary Disease. Annals of the American Thoracic Society. 17(10):1222-1230, 2020 10. |
Observational-Dx |
100 patients |
To compare diaphragm activity, function, and force reserve among patients with COPD and healthy control subjects. |
The tidal thickening fraction of the diaphragm during resting breathing (TFdi-tidal) was higher in patients with COPD than in control subjects (P = 0.002); it was approximately twice as high in patients with severe COPD than in control subjects. Patients with COPD had poorer diaphragm function than control subjects as assessed by the maximal thickening fraction of the diaphragm during Muller maneuver (P < 0.01). Diaphragm force reserve ratio assessed by 1-(tidal thickening fraction of the diagphragm during resting breathing/maximal thickening fraction of the diaphragm) was lower in patients with COPD than in control subjects, and it fell with increasing Global Initiative for Chronic Obstructive Lung Disease stages (P < 0.001); it correlated with inspiratory capacity (r = 0.46) and the body mass index, airflow obstruction, dyspnea, exercise capacity (BODE) index, a multidimensional scoring system (r = -0.49). Patients who developed exacerbation during the following 2 years had less force reserve than patients without exacerbation (P = 0.024) |
1 |
| 64. Kumar R, Spalgais S, Ranga V. Hypersensitivity pneumonitis: clinical, radiological and pathological profile of 103 patients from North India. Monaldi Archives for Chest Disease. 90(3), 2020 Aug 03. |
Review/Other-Dx |
103 patients |
To presenting clinical, radiological and bronchoscopic finding of 103 Hypersensitivity pneumonitis (HP) patients. |
The diagnosis of HP was considered with following criteria: i) known exposure to an inciting antigen; ii) presence of respiratory symptoms; iii) radiologic evidence of diffuse lung disease; iv) no other identifiable cause; v) lung biopsy specimen that demonstrated features of HP; and vi) bronchoalveolar lavage lymphocytosis (=30%). The mean ±SD age was 47±12.8 years; 67% were female. The common symptoms were cough (97%) and dyspnea (91%). History of exposure to inciting agent was present in 61% with pigeon exposure being the most common (56%). Majority of patients (86%) were having chronic symptoms for >6 months. On 6MWT oxygen desaturation >4% was seen in 57% patients. Centrilobular nodules (61%) and ground glass opacity (47.5%) were common finding on HRCT chest. Bronchoalveolar lavage (BAL) lymphocytosis >30% was present in 48.5% and histopathological diagnosis HP on transbronchial lung biopsy (TBLB) and/or endobronchial lung biopsy (EBLB) was in 50% patients. HP is exposure related environmental disease, as it can occur without any occupational history. Bronchoscopy with BAL and lung biopsy should do in all suspected cases to confirm diagnosis in our country as it is less invasive, day care procedure with less complication. |
4 |
| 65. Urisman A, Jones KD. Small Airway Disease: A Step Closer to Etiology-Based Classification of Bronchiolitis. [Review]. Surgical pathology clinics. 13(1):189-196, 2020 Mar. |
Review/Other-Dx |
N/A |
To discuss the Etiology-Based Classification of Bronchiolitis. |
No results stated in the abstract. |
4 |
| 66. Wang Y, Jin C, Wu CC, et al. Organizing pneumonia of COVID-19: Time-dependent evolution and outcome in CT findings. PLoS ONE [Electronic Resource]. 15(11):e0240347, 2020. |
Observational-Dx |
106 patients |
To delineate the evolution of CT findings and outcome in OP of COVID-19. |
79 (74.5%) patients were non-severe and 103 (97.2%) were discharged at median day 25 (range, day 8-50) after symptom-onset. Of 67 patients with revisit CT at 2-4 weeks after discharge, 20 (29.9%) had complete absorption of lesions at median day 38 (range, day 30-53) after symptom-onset. Significant differences between complete absorption and residuals groups were found in percentages of consolidation (1.5% vs. 13.8%, P = 0.010), number of involved lobe > 3 (40.0% vs. 72.5%, P = 0.030), CT score > 4 (20.0% vs. 65.0%, P = 0.010) at day 8-14. |
2 |
| 67. Wei J, Yang H, Lei P, et al. Analysis of thin-section CT in patients with coronavirus disease (COVID-19) after hospital discharge. Journal of X-Ray Science & Technology. 28(3):383-389, 2020. |
Observational-Dx |
59 patients |
To analyze clinical and thin-section computed tomographic (CT) data from the patients with coronavirus disease (COVID-19) to predict the development of pulmonary fibrosis after hospital discharge. |
Among the 59 patients, 89.8% (53/59) had a typical transition from early phase to advanced phase and advanced phase to dissipating phase. Also, 39% (23/59) patients developed fibrosis (group A), whereas 61% (36/59) patients did not show definite fibrosis (group B). Patients in group A were older (mean age, 45.4±16.9 vs. 33.8±10.2 years) (P = 0.001), with longer LOS (19.1±5.2 vs. 15.0±2.5 days) (P = 0.001), higher rate of ICU admission (21.7% (5/23) vs. 5.6% (2/36)) (P = 0.061), higher peak C-reactive protein level (30.7±26.4 vs. 18.1±17.9 mg/L) (P = 0.041), and higher maximal CT score (5.2±4.3 vs. 4.0±2.2) (P = 0.06) than those in group B. |
2 |
| 68. Singh SJ, Baldwin MM, Daynes E, et al. Respiratory sequelae of COVID-19: pulmonary and extrapulmonary origins, and approaches to clinical care and rehabilitation. [Review]. The Lancet Respiratory Medicine. 11(8):709-725, 2023 08. |
Review/Other-Dx |
N/A |
To highlight extrapulmonary features of long COVID that might contribute to breathlessness and breathing pattern disorders and could be targeted as part of comprehensive therapeutic and rehabilitative strategies. |
No results stated in the abstract. |
4 |
| 69. Bocchino M, Rea G, Capitelli L, Lieto R, Bruzzese D. Chest CT Lung Abnormalities 1 Year after COVID-19: A Systematic Review and Meta-Analysis. Radiology. 308(1):e230535, 2023 07. |
Meta-analysis |
14 studies |
To perform a systematic review and meta-analysis of the prevalence and type of COVID-19 residual lung abnormalities at 1-year chest CT. |
Of 22 709 records, 21 studies were reviewed (20 prospective, 9 from China, and 7 in radiology journals).The meta-analysis included 14 studies with chest CT data in 1854 of 2043 individuals (M/F: 1109/934). Estimates of lung sequelae were highly heterogeneous (7.1-96.7%), with a pooled frequency of 43.5% (I2=94%; 95% PI: 5.9%, 90.4%). This also applied to single non-fibrotic changes, including ground glass opacity, consolidations, nodules/masses, parenchymal bands, and reticulations. The prevalence range of fibrotic traction bronchiectasis/bronchiolectasis was 1.6-25.7% (I2=93%; 95% PI: 0.0%, 98.6%;); honeycombing was unremarkable (0-1.1%; I2=58%; 95% PI: 0%, 60%). Lung sequelae were unrelated to any characteristics of interest. Conclusion The prevalence of COVID-19 lung sequelae at 1-year chest CT is highly heterogeneous among studies. Heterogeneity determinants remain unknown suggesting caution in data interpretation with no convincing evidence |
Good |
| 70. Vural A, Kahraman AN. Pulmonary fibrotic-like changes on follow-up chest CT exam in patients recovering from COVID-19 pneumonia. Tuberkuloz ve Toraks. 69(4):492-498, 2021 Dec. |
Observational-Dx |
84 patients |
To investigate fibrotic changes observed as sequelae in lung tissue in 3-6-month control thorax computerized tomography (CT) scans of moderate-to-severe COVID-19 pneumonia survivors. |
On follow-up CTs, fibrotic-like changes were observed in 29 (35%) of the 84 participants (Group 1), while the remaining 55 (65%) showed complete radiological recovery (Group 2). With logistic regression analysis, hospital stay of 22 days or longer (OR: 4.9; 95% CI: 20, 32; p< 0.05) and a CT score of 15 or more at diagnosis (OR: 2.2; 95% CI: 13.5, 18; p< 0.05) were found to be an independent predictor for sequelae fibrotic changes in lung tissue. |
2 |
| 71. Guler SA, Ebner L, Aubry-Beigelman C, et al. Pulmonary function and radiological features 4 months after COVID-19: first results from the national prospective observational Swiss COVID-19 lung study. European Respiratory Journal. 57(4), 2021 04. |
Observational-Dx |
113 patients |
To report on initial follow-up 4 months after mild/moderate or severe/critical COVID-19 according to the World Health Organization severity classification. |
113 COVID-19 survivors were included (mild/moderate n=47, severe/critical n=66). We confirmed several comorbidities as risk factors for severe/critical disease. Severe/critical disease was associated with impaired pulmonary function, i.e. diffusing capacity of the lung for carbon monoxide (D LCO) % predicted, reduced 6-min walk distance (6MWD) and exercise-induced oxygen desaturation. After adjustment for potential confounding by age, sex and body mass index (BMI), patients after severe/critical COVID-19 had a D LCO 20.9% pred (95% CI 12.4-29.4% pred, p=0.01) lower at follow-up. D LCO % pred was the strongest independent factor associated with previous severe/critical disease when age, sex, BMI, 6MWD and minimal peripheral oxygen saturation at exercise were included in the multivariable model (adjusted odds ratio per 10% predicted 0.59, 95% CI 0. 37-0.87; p=0.01). Mosaic hypoattenuation on chest computed tomography at follow-up was significantly associated with previous severe/critical COVID-19 including adjustment for age and sex (adjusted OR 11.7, 95% CI 1.7-239; p=0.03). |
2 |
| 72. Nunez-Fernandez M, Ramos-Hernandez C, Garcia-Rio F, et al. Evolution and long-term respiratory sequelae after severe COVID-19 pneumonia: nitric oxide diffusion measurement value. Respiratory Research. 24(1):48, 2023 Feb 13. |
Observational-Dx |
194 patients |
To evolution and long-term respiratory sequelae after severe COVID-19 pneumonia: nitric oxide diffusion measurement value. Respiratory |
194 patients, age 62 years (P25-75, 51.5-71), 59% men, completed the study. 17% required admission to the intensive care unit. An improvement in the patients' exercise tolerance, the extent of the areas of ground-glass opacity, and the LFTs between 3 and 12 months following their hospital discharge were found, but without a decrease in their degree of dyspnea or their self-perceived health condition. DLNO was the most significantly altered parameter at 12 months (19.3%). The improvement in DLNO-DLCO mainly occurred at the expense of the recovery of alveolar units and their vascular component, with the membrane factor only improving in patients with more severe infections. |
2 |
| 73. Bardakci MI, Ozturk EN, Ozkarafakili MA, Ozkurt H, Yanc U, Yildiz Sevgi D. Evaluation of long-term radiological findings, pulmonary functions, and health-related quality of life in survivors of severe COVID-19. Journal of Medical Virology. 93(9):5574-5581, 2021 Sep. |
Observational-Dx |
65 patients |
To evaluate long-term radiological changes in severe coronavirus disease 2019 (COVID-19) patients, to investigate pulmonary function, exercise capacities, and health-related quality of life results. |
Forty-nine male and 16 female patients were included in the study. Forced expiratory volume in 1 s (FEV1)% values of 18 patients (30.5%), forced vital capacity (FVC)% values of 27 patients (45.8%), and 6MWT of 13 patients (23.2%) were found lower than expected in the sixth month. On the SF-36 scale, physical function, energy-vitality, social functionality, pain, and general health parameters were found lower than normal. Minimal interstitial changes in chest CT were seen in 26 patients. Nine patients had lung area involvement between 10% and 50% of the surface, there was a correlation between FEV1% and FVC% values in this group. There was severe pulmonary fibrosis in four patients. There was a correlation between pulmonary function and physical function and general perception of health from SF-36 scale subparameters. |
2 |
| 74. Wu X, Liu X, Zhou Y, et al. 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. The Lancet Respiratory Medicine. 9(7):747-754, 2021 07. |
Observational-Dx |
135 patients |
To describe the temporal trends in respiratory outcomes over 12 months in patients hospitalised for severe COVID-19 and to investigate the associated risk factors. |
Between Feb 1, and March 31, 2020, of 135 eligible patients, 83 (61%) patients participated in this study. The median age of participants was 60 years (IQR 52-66). Temporal improvement in pulmonary physiology and exercise capacity was observed in most patients; however, persistent physiological and radiographic abnormalities remained in some patients with COVID-19 at 12 months after discharge. We found a significant reduction in DLCO over the study period, with a median of 77% of predicted (IQR 67-87) at 3 months, 76% of predicted (68-90) at 6 months, and 88% of predicted (78-101) at 12 months after discharge. At 12 months after discharge, radiological changes persisted in 20 (24%) patients. Multivariate logistic regression showed increasing odds of impaired DLCO associated with female sex (odds ratio 8·61 [95% CI 2·83-26·2; p=0·0002) and radiological abnormalities were associated with peak HRCT pneumonia scores during hospitalisation (1·36 [1·13-1·62]; p=0·0009). |
2 |
| 75. Aul DR, Gates DJ, Draper DA, et al. Complications after discharge with COVID-19 infection and risk factors associated with development of post-COVID pulmonary fibrosis. Respiratory Medicine. 188:106602, 2021 11. |
Observational-Dx |
898 patients |
To investigate the prevalence and risk factors associated with PCF and other complications in patients discharged after COVID-19 infection. |
A large number of patients had persistent fatigue (45.1%), breathlessness (36.5%), myalgia (20.5%) and psychological symptoms (19.5%). PCF was seen in 9.5% of the patients and was associated with persistent breathlessness at 6 weeks and inpatient ventilation [adjusted OR 5.02(1.76-14.27) and 4.45(1.27-15.58)] respectively. It was more common in men and in patients with peak CRP >171.5 mg/L, peak WBC count =12 × 10 9/L, severe inpatient COVID-19 CXR changes and CT changes. Ventilation was also a risk factor for persisting fatigue and myalgia, the latter was also more common in those with severe cytokine storm and severe COVID-19 inpatient CXR changes. |
1 |
| 76. Balbi M, Conti C, Imeri G, et al. Post-discharge chest CT findings and pulmonary function tests in severe COVID-19 patients. European Journal of Radiology. 138:109676, 2021 May. |
Observational-Dx |
91 patients |
To evaluate chest computed tomography (CT) and pulmonary function test (PFT) findings in severe COVID-19 patients after discharge and correlate CT pulmonary involvement with PFT results |
At a median of 105 days from symptom onset, 74/91 (81 %) patients had CT abnormalities. The most common CT pattern was combined ground-glass opacity and reticular pattern (46/74, 62 %) along with architectural distortion (68/74, 92 %) and bronchial dilatation (66/74, 89 %). Compromised lung volume had a median value of 15 % [11-23], was higher in dyspneic patients, and negatively correlated with the percentage of predicted DLCO, VA, and FVC values (r = -0.39, -0.5, and -0.42, respectively). These PFT parameters were significantly lower in patients with CT abnormalities. Impairment of DLCO and KCO was found in 12 (13 %) cases, possibly implying an underlying pulmonary vasculopathy in this subgroup of patients. |
4 |
| 77. Van Zeller C, Anwar A, Ramos-Bascon N, Barnes N, Madden B. Pulmonary function, computerized tomography features and six-minute walk test at three months in severe COVID-19 patients treated with intravenous pulsed methylprednisolone: a preliminary report. Monaldi Archives for Chest Disease. 91(4), 2021 Jul 19. |
Observational-Dx |
15 patients |
To perform a retrospective analysis of all patients treated with high-dose methylprednisolone for COVID-19 ARDS and three-month lung function, 6-minutes walking test (6MWT), and computerized tomography (CT) findings. |
Fifteen patients were treated of which 10 survived to discharge. Reduced diffusion capacity for carbon monoxide (DLCO) was the commonest abnormality in lung function tests and had the lowest mean value. Parenchymal bands were the commonest CT finding and 50% of patients had fibrosis at three months. Mean 6-minutes walk distance (6MWD) was 65.4% predicted and was abnormal in 62.5% of patients. In this cohort of patients with COVID-19 ARDS treated with high-dose methylprednisolone pulses, CT, lung function, and 6MWT abnormalities were unsurprisingly common at three months, although all 10 patients treated early in their disease course survived, a possible therapeutic effect. Further randomised controlled trials are needed to assess the benefits of this treatment. |
2 |
| 78. Han X, Fan Y, Alwalid O, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 299(1):E177-E186, 2021 04. |
Observational-Dx |
114 patients |
To prospectively assess pulmonary sequelae and explore the risk factors for fibrotic-like changes in the lung at 6-month follow-up chest CT of survivors of severe COVID-19 pneumonia. Materials and Methods A total of 114 patients (80 [70%] men; mean age, 54 years ± 12) were studied prospectively |
At follow-up CT, evidence of fibrotic-like changes was observed in 40 of the 114 participants (35%) (group 1), whereas the remaining 74 participants (65%) showed either complete radiologic resolution (43 of 114, 38%) or residual ground-glass opacification or interstitial thickening (31 of 114, 27%) (group 2). Multivariable analysis identified age of greater than 50 years (odds ratio [OR]: 8.5; 95% CI: 1.9, 38; P = .01), heart rate greater than 100 beats per minute at admission (OR: 5.6; 95% CI: 1.1, 29; P = .04), duration of hospital stay greater than or equal to 17 days (OR: 5.5; 95% CI: 1.5, 21; P = .01), acute respiratory distress syndrome (OR: 13; 95% CI: 3.3, 55; P < .001), noninvasive mechanical ventilation (OR: 6.3; 95% CI: 1.3, 30; P = .02), and total CT score of 18 or more (OR: 4.2; 95% CI: 1.2, 14; P = .02) at initial CT as independent predictors for fibrotic-like changes in the lung at 6 months. Conclusion Six-month follow-up CT showed fibrotic-like changes in the lung in more than one-third of patients who survived severe coronavirus disease 2019 pneumonia. These changes were associated with an older age, acute respiratory distress syndrome, longer hospital stays, tachycardia, noninvasive mechanical ventilation, and higher initial chest CT score. |
1 |
| 79. Miwa M, Nakajima M, Kaszynski RH, et al. Abnormal pulmonary function and imaging studies in critical COVID-19 survivors at 100 days after the onset of symptoms. Respiratory Investigation. 59(5):614-621, 2021 Sep. |
Review/Other-Dx |
17 patients |
To investigate the pulmonary function and computed tomography (CT) findings of critical COVID-19 patients approximately 100 days after symptom onset. |
We extracted 17 patients whose median age was 63 (interquartile range [IQR], 59-67) years. The median lengths of hospitalization and mechanical ventilation were 23 (IQR, 18-38) and 9 (IQR, 6-13) days, respectively. At 100 days after symptom onset, the following pulmonary function abnormalities were noted in 8 (47%) patients: a diffusion capacity of the lung for carbon monoxide (%DLCO) of <80% for 6 patients (35%); a percent vital capacity (%VC) of <80% for 4 patients (24%); and a forced expiratory volume in one second/forced vital capacity (FEV1%) of <70% for 1 patient (6%) who also presented with %DLCO and %VC abnormalities. Twelve (71%) patients reported residual respiratory symptoms and 16 (94%) showed abnormalities on CT. |
4 |
| 80. Chen L, Wang Q, Wu H, Hu J, Zhang J. Repeat Chest Ct Scans in Moderate-to-Severe Patients' Management during the Covid-19 Pandemic: Observations from a Single Centre in Wuhan, China. Radiat Prot Dosimetry 2020;190:269-75. |
Observational-Dx |
394 patients |
To observe the rates of repeated computed tomographic scans (CTs) in a cohort of patients with coronavirus disease-2019 (COVID-19) and to assess the validity of repeat CTs. |
The 394 patients underwent a total of 1493 CTs. Of the 394 patients, 260 received at least one non-value-added CT. Both the total number of CTs (median, 4; interquartile range (IQR), 3-5) and non-value-added CTs (median, 1; IQR, 0-1) per patient were strongly related to the disease duration (R2 = 0.566 for total CTs, R2 = 0.432 for non-value-added CTs, p < 0.001). The proportion of non-value-added CTs was potentially higher after 3 weeks from symptom onset (>35%). |
2 |
| 81. Stylemans D, Smet J, Hanon S, et al. Evolution of lung function and chest CT 6 months after COVID-19 pneumonia: Real-life data from a Belgian University Hospital. Respiratory Medicine. 182:106421, 2021 06. |
Observational-Dx |
79 patients |
To conducted a real-life follow-up study assessing the evolution in lung function, chest CT and ventilation distribution between 10 weeks and 6 months after diagnosis of COVID-19 pneumonia. |
Seventy-nine patients were assessed at 6 months of whom 63 had chest CT at both follow-up visits and 46 had multiple breath washout testing to obtain lung clearance index (LCI). The study group was divided into a restrictive (n = 39) and a non-restrictive subgroup (n = 40) based on TLC z-score. Restriction was associated with a history of intubation, neuromuscular blockade use and critical illness polyneuropathy. Restriction significantly improved over time, but was not resolved by 6 months (median TLC z-score of -2.2 [IQR: -2.7; -1.5] at 6 months versus -2.7 [IQR: -3.1; -2.1] at 10 weeks). LCI did not evolve between both follow-up visits. Symptoms and chest CT score improved irrespective of restriction. |
2 |
| 82. Garg M, Lamicchane S, Maralakunte M, et al. Role of MRI in the Evaluation of Pulmonary Sequel Following COVID-19 Acute Respiratory Distress Syndrome (ARDS). Current Problems in Diagnostic Radiology. 52(2):117-124, 2023 Mar-Apr. |
Observational-Dx |
25 patients |
To evaluate the role of magnetic resonance imaging (MRI) chest as an alternative modality to CT chest for follow-up of patients recovered from severe COVID-19 acute respiratory distress syndrome (ARDS). |
A total of 25 subjects (16 [64%] men; mean age 54.84 years ± 12.35) who survived COVID-19 ARDS and fulfilled the inclusion criteria were enrolled prospectively. All the patients underwent CT and MRI chest (on the same day) at 6-weeks after discharge. MRI chest was acquired on 1.5T MRI using HASTE, BLADE, VIBE, STIR, and TRUFI sequences and evaluated for recognition of GGOs, consolidation, reticulations/septal thickening, parenchymal bands, and bronchial dilatation with CT chest as the gold standard. The differences were assessed by independent-sample t-test and Mann-Whitney U test. P-value of less than 0.05 was taken significant. There was a strong agreement (k = 0.8-1, P<0.01) between CT and MRI chest. On CT, the common manifestations were: GGOs (n=24, 96%), septal thickening/reticulations (n=24, 96%), bronchial dilatation (n=16, 64%), parenchymal bands (n=14, 56%), pleural thickening (n=8, 32%), consolidation (n=4, 16%) and crazy-paving (n=4, 16%). T2W HASTE, T2W BLADE, and T1 VIBE sequences showed 100% (95% CI, 40-100) sensitivity and 100% (95% CI, 3-100) specificity for detecting GGOs, septal thickening/reticulations, pleural thickening, consolidation, and crazy-paving. The overall sensitivity of MRI for detection of bronchial dilatation and parenchymal bands were 88.9% (95% CI, 77-100) and 92.9% (95% CI, 66-100), respectively; and specificity was 100% (95% CI, 29-100) for both findings. MRI chest, being radiation-free imaging modality can act as an alternative to CT chest in the evaluation of lung changes in patients recovered from COVID-19 pneumonia. |
2 |
| 83. Pecoraro M, Cipollari S, Marchitelli L, et al. Cross-sectional analysis of follow-up chest MRI and chest CT scans in patients previously affected by COVID-19. Radiologia Medica. 126(10):1273-1281, 2021 Oct. |
Observational-Dx |
52 patients |
To prospectively evaluate the agreement between chest magnetic resonance imaging (MRI) and computed tomography (CT) and to assess the diagnostic performance of chest MRI relative to that of CT during the follow-up of patients recovered from coronavirus disease 2019. |
The agreement between CT and MRI was almost perfect for consolidation (k = 1.00) and change from prior CT (k = 0.857); substantial for predominant pattern (k = 0.764) and interlobular septal thickening (k = 0.734); and poor for GGOs (k = 0.339), fibrosis (k = 0.224), pleural indentation (k = 0.231), and vessel enlargement (k = 0.339). Meanwhile, the sensitivity of MRI was high for GGOs (1.00), interlobular septal thickening (1.00), and consolidation (1.00) but poor for fibrotic changes (0.18), pleural indentation (0.23), and vessel enlargement (0.50) and the specificity was overall high. DWI was positive in 46.0% of cases. |
1 |
| 84. Eksombatchai D, Wongsinin T, Phongnarudech T, Thammavaranucupt K, Amornputtisathaporn N, Sungkanuparph S. Pulmonary function and six-minute-walk test in patients after recovery from COVID-19: A prospective cohort study. PLoS ONE [Electronic Resource]. 16(9):e0257040, 2021. |
Observational-Dx |
97 patients |
To study abnormality of spirometry, six-minute walk distance, and chest radiograph among patients recovered from Coronavirus Disease 2019 (COVID-19). |
There were 35 men and 52 women, with a mean age of 39.6±11.8 years and the mean body mass index (BMI) was 23.8±4.3 kg/m2. Of all, 45 cases had mild symptoms; 35 had non-severe pneumonia, and 7 had severe pneumonia. Abnormality in spirometry was observed in 15 cases (17.2%), with 8% of restrictive defect and 9.2% of obstructive defect. Among the patients with an abnormal spirometry, the majority of the cases were in the severe pneumonia group (71.4%), compared with 15.6% in the non-severe pneumonia group, and 10.2% in the mild symptom group (p = 0.001). The mean six-minute-walk distance (6MWD) in the mild symptom and non-severe pneumonia groups was 538±56.8 and 527.5±53.5 meters, respectively. Although the severe pneumonia group tended to have a shorter mean 6-min walking distance, but this was not statistically significant (p = 0.118). Twelve patients (13.8%) had abnormal chest radiographs that showed residual fibrosis. This abnormality was more common in the severe pneumonia group (85.7%) and in others (7.5%) (p<0.001). |
2 |
| 85. Mandal S, Barnett J, Brill SE, et al. 'Long-COVID': a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19. Thorax. 76(4):396-398, 2021 04. |
Review/Other-Dx |
384 patients |
To discuss the cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation. sectional |
In 384 patients (mean age 59.9 years; 62% male) followed a median 54 days post-discharge, 53% reported persistent breathlessness, 34% cough and 69% fatigue. 14.6% had depression. In those discharged with elevated biomarkers, 30.1% and 9.5% had persistently elevated d-dimer and CRP respectively. 38% of chest radiographs remained abnormal with 9% deteriorating. |
4 |
| 86. Altersberger M, Goliasch G, Khafaga M, et al. Echocardiography and Lung Ultrasound in Long COVID and Post-COVID Syndrome, a Review Document of the Austrian Society of Pneumology and the Austrian Society of Ultrasound in Medicine. [Review]. Journal of Ultrasound in Medicine. 42(2):269-277, 2023 Feb. |
Review/Other-Dx |
N/A |
To study the follow-up care of patients after COVID-19 with persistent clinical symptoms should include serial echocardiographic scans, serial lung function testing, and imaging of the lung with computerized tomography (CT) scans |
No results stated in the abstract |
4 |
| 87. Burkert J, Jarman R, Deol P. Evolution of Lung Abnormalities on Lung Ultrasound in Recovery From COVID-19 Disease-A Prospective, Longitudinal Observational Cohort Study. Journal of Ultrasound in Medicine. 42(1):147-159, 2023 Jan. |
Observational-Dx |
24 patients |
To investigate how the recovery process from COVID-19 respiratory disease can be monitored using 12-zone lung ultrasound. |
Lung ultrasound showed that the lung recovers significantly over 20 weeks postdisease. Individual lung abnormalities also resolved at different rates. The entire rib space occupied by confluent B-lines wane after the acute phase, whereas irregular pleura and subpleural consolidations resolved more gradually. Separate wide B-lines moving with the pleura during respiration may represent more stable features, indicating residual fibrotic changes. Small, localized effusions appear transiently after the initial acute phase of the disease, peaking at approximately 10 weeks after infection. The measured lung abnormalities were strong predictors of perceived shortness of breath during ambulation. |
2 |
| 88. Barbieri G, Gargani L, Lepri V, et al. Long-term lung ultrasound follow-up in patients after COVID-19 pneumonia hospitalization: A prospective comparative study with chest computed tomography. European Journal of Internal Medicine. 110:29-34, 2023 04. |
Observational-Dx |
232 patients |
To prospectively evaluate 232 subjects who underwent a 3-month-FU program after hospitalization for COVID-19 at the University Hospital of Pisa. |
Patients with LUS scores above both these thresholds were older and with longer hospital stay. Patients with a LUS score =3 had more comorbidities. LUS and chest CT showed a high agreement in identifying residual pathological findings, using both cut-off scores of 3 (OR 14,7; CL 3,6-64,5, Sensitivity 91%, Specificity 49%) and 7 (OR 5,8; CL 2,3-14,3, Sensitivity 65%, Specificity 79%). Our data suggest that LUS is very sensitive in identifying pathological findings at FU after a hospitalization for COVID-19 pneumonia, compared to CT. Given its low cost and safety, LUS could replace CT in selected cases, such as in contexts with limited resources or it could be used as a gate-keeper examination before more advanced techniques. |
2 |
| 89. Fortini A, Torrigiani A, Sbaragli S, et al. COVID-19: persistence of symptoms and lung alterations after 3-6 months from hospital discharge. Infection. 49(5):1007-1015, 2021 Oct. |
Observational-Dx |
59 patients |
To evaluate the results of a follow-up program for patients discharged from a nonintensive COVID-19 ward. |
22% of patients reported no residual symptoms, 28.8% 1 or 2 symptoms and 49.2% 3 or more symptoms. The most frequently symptoms were fatigue, exertional dyspnea, insomnia, and anxiety. Among the inflammatory and coagulation parameters, only the median value of fibrinogen was slightly above normal. A deep vein thrombosis was detected in 1 patient (1.7%). Thoracic US detected mild pulmonary changes in 15 patients (25.4%), 10 of which reported exertional dyspnea. DLCO was mildly or moderately reduced in 19 patients (37.2%), 13 of which complained of exertional dyspnea. |
2 |
| 90. Russo G, Flor N, Casella F, et al. Lung ultrasound in the follow-up of severe COVID-19 pneumonia: six months evaluation and comparison with CT. Internal & Emergency Medicine. 17(8):2261-2268, 2022 11. |
Observational-Dx |
74 patients |
To assess the potential of LUS in detecting the presence of computed tomography (CT) fibrotic-like changes after 6 months from COVID-19 pneumonia. |
Seventy-four patients were enrolled in the study. Twenty-four (32%) showed lung abnormalities suitable for fibrotic-like changes. At multivariate logistic regression analysis LUS score after 6 months from acute disease was significantly associated with fibrotic-like pattern on CT scan. The second logistic model showed that D-dimer value was the only baseline predictive variable of fibrotic-like changes at multivariate analysis. LUS performed after 6 months from severe COVID-19 pneumonia may be a promising tool for detection and follow-up of pulmonary fibrotic sequelae. |
1 |
| 91. Hallifax RJ, Haris M, Corcoran JP, et al. Role of CT in assessing pleural malignancy prior to thoracoscopy. Thorax. 2015;70(2):192-193. |
Review/Other-Dx |
370 patients |
To assess the sensitivity and specificity of computed tomography (CT) in detecting pleural malignancy prior to definitive histology obtained via thoracoscopy in a large cohort of patients with suspected malignant pleural disease. |
211 (57%) of 370 patients included in the analysis had malignant disease: CT scans were reported as 'malignant' in 144, giving a sensitivity of 68% (95% CI 62% to 75%). Of the 159 patients with benign disease, 124 had CT scans reported as benign: specificity 78% (72% to 84%). The positive predictive value of a malignant CT report was 80% (75% to 86%), with a negative predictive value of 65% (58% to 72%). A significant proportion of patients being investigated for malignant disease will have malignancy despite a negative CT report. |
4 |
| 92. Tsujimoto N, Saraya T, Light RW, et al. A Simple Method for Differentiating Complicated Parapneumonic Effusion/Empyema from Parapneumonic Effusion Using the Split Pleura Sign and the Amount of Pleural Effusion on Thoracic CT. PLoS ONE. 10(6):e0130141, 2015. |
Observational-Dx |
83 patients |
To develop a simple method to distinguish complicated parapneumonic effusion (CPPE)/empyema from parapneumonic effusion (PPE) using computed tomography (CT) focusing on the split pleura sign, fluid attenuation values (HU: Hounsfield units), and amount of fluid collection measured on thoracic CT prior to diagnostic thoracentesis. |
On univariate analysis, the split pleura sign (odds ratio (OR), 12.1; p<0.001), total amount of pleural effusion (>/=30 mm) (OR, 6.13; p<0.001), HU value>/=10 (OR, 5.94; p=0.001), and the presence of septum (OR, 6.43; p=0.018), atelectasis (OR, 6.83; p=0.002), or air (OR, 9.90; p=0.002) in pleural fluid were significantly higher in the CPPE/empyema group than in the PPE group. On multivariate analysis, only the split pleura sign (hazard ratio (HR), 6.70; 95% confidence interval (CI), 1.91-23.5; p=0.003) and total amount of pleural effusion (>/=30 mm) on thoracic CT (HR, 7.48; 95%CI, 1.76-31.8; p=0.006) were risk factors for empyema. Sensitivity, specificity, positive predictive value, and negative predictive value of the presence of both split pleura sign and total amount of pleural effusion (>/=30 mm) on thoracic CT for CPPE/empyema were 79.4%, 80.9%, 75%, and 84.4%, respectively, with an area under the curve of 0.801 on receiver operating characteristic curve analysis. |
2 |
| 93. Kuhlman JE, Singha NK. Complex disease of the pleural space: radiographic and CT evaluation. Radiographics. 1997;17(1):63-79. |
Review/Other-Dx |
N/A |
To review Complex disease of the pleural space. |
No results stated in abstract. |
4 |
| 94. McLoud TC, Flower CD. Imaging the pleura: sonography, CT, and MR imaging. AJR Am J Roentgenol. 1991;156(6):1145-1153. |
Review/Other-Dx |
N/A |
To evaluate the pleura and the pleural space. |
No results stated in abstract. |
4 |
| 95. Inan N, Sarisoy HT, Cam I, Sakci Z, Arslan A. Diffusion-weighted Magnetic Resonance Imaging in the Differential Diagnosis of Benign and Metastatic Malignant Pleural Thickening. J Thorac Imaging. 2016;31(1):37-42. |
Observational-Dx |
42 patients |
To investigate the value of diffusion-weighted (DW) imaging in the differential diagnosis of benign and metastatic malignant pleural thickening. |
Quantitatively, differences in signal intensities on DW trace images with b factors of 650 and 1000 mm/s were not statistically significant. The apparent diffusion coefficient (ADC)1 and ADC2 of the metastatic malignant thickening were significantly lower than those of benign ones [mean ADC1 was 1.37+/-0.65x10 mm/s for metastatic malignant thickening and 2.11+/-0.69x10 mm/s for benign thickening (P=0.045); ADC2 was 1.06+/-0.56x10 mm/s for metastatic malignant thickening and 1.56+/-0.71x10 mm/s for benign thickening (P=0.038)]. However, because of the ADC overlap between malignant and benign disease, a sufficiently discriminative cutoff value could not be defined by the receiver operating characteristic curve analysis. |
2 |
| 96. Rinaldi P, Parapatt GK, Giuliani M, et al. Chest and breast MRI: the added value of a fast imaging for a new diagnostic approach in the planning of augmentation surgery in patients with thoracic asymmetries. Eur Rev Med Pharmacol Sci. 2015;19(13):2359-2367. |
Observational-Dx |
13 patients |
To evaluate breast and chest wall asymmetry, and considers the feasibility of preoperative measurements which are useful for performing an objective preoperative evaluation. |
All patients showed some degree of left-right side asymmetry on specific thoracic, breast and implant measurements. Magnetic Resonance Imaging (MRI) provided detailed and objective data. |
3 |
| 97. Blackmore CC, Black WC, Dallas RV, Crow HC. Pleural fluid volume estimation: a chest radiograph prediction rule. Acad Radiol. 1996;3(2):103-109. |
Observational-Dx |
16 patients |
To estimate pleural effusion volume on the basis of posteroanterior and lateral chest radiographs. |
For the test and validation sets, the weighted accuracies of the prediction rule were 86% and 85%, respectively. The respective weighted interobserver agreements were 97% and 88%. Pleural effusions became visible as a meniscus on the lateral chest radiograph at a volume of approximately 50 ml; at a volume of 200 ml, the meniscus could be identified on the posteroanterior radiograph. At a volume of about 500 ml, the meniscus obscured the hemidiaphragm. |
3 |
| 98. Svigals PZ, Chopra A, Ravenel JG, Nietert PJ, Huggins JT. The accuracy of pleural ultrasonography in diagnosing complicated parapneumonic pleural effusions. Thorax. 72(1):94-95, 2017 01.Thorax. 72(1):94-95, 2017 01. |
Observational-Dx |
66 patients |
To determine radiographic complexity in predicting a complicated parapneumonic effusion (CPPE) defined by pleural fluid analysis. |
Pleural ultrasound had a sensitivity of 69.2% (95% CI 48.2% to 85.7%) and specificity of 90.0% (95% CI 76.3% to 97.2%). Chest computed tomography (CT) had a sensitivity of 76.9% (95% CI 56.3% to 91.0%) and specificity of 65.0% (95% CI 48.3% to 79.4%). Chest radiograph (CXR) had a sensitivity of 61.5% (95% CI 40.6% to 79.8%) and specificity of 60.0% (95% CI 43.3% to 75.1%). |
3 |
| 99. Tsai T-H, Jerng J-S, Yang P-C. Clinical Applications of Transthoracic Ultrasound in Chest Medicine. Journal of Medical Ultrasound 2008;16:7-25. |
Review/Other-Dx |
N/A |
To discuss the Clinical Applications of Transthoracic Ultrasound in Chest Medicine. |
No results stated in the abstract. |
4 |
| 100. Sukkasem W, Moftah SG, Kicska G, Godwin JD, Pipavath S, Stern E. Crus Atrophy: Accuracy of Computed Tomography in Diagnosis of Diaphragmatic Paralysis. J Thorac Imaging 2017;32:383-90. |
Observational-Dx |
90 patients |
To measure the association between crus atrophy as depicted by computed tomography (CT) and fluoroscopic diagnosis of hemidiaphragmatic paralysis in patients with suspected diaphragmatic dysfunction. |
Hemidiaphragmatic paralysis caused significant crus thinning at the celiac artery level (mean±SD, 1.7±0.6 vs. 3.6±1.3 mm, P=0.017, on the right; 1.1±0.4 vs. 3.0±1.4 mm, P=0.001, on the left) and the L1 vertebral level (mean±SD, 1.5±0.7 vs. 4.4±1.6 mm, P=0.018, on the right; 1.5±0.6 vs. 3.6+1.7 mm, P=0.017, on the left). On axial CT, thinning to =2.5 mm at the celiac artery level identified paralysis of the hemidiaphragm with a sensitivity of 100% and a specificity of 86% on the right and with a sensitivity of 100% and a specificity of 64% on the left. On coronal CT, thinning to =2.5 mm at the L1 vertebral level identified paralysis of the hemidiaphragm with a sensitivity of 100% and a specificity of 88% on the right and with a sensitivity of 100% and a specificity of 77% on the left. |
2 |
| 101. Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD. Imaging of the diaphragm: anatomy and function. Radiographics. 2012;32(2):E51-70. |
Review/Other-Dx |
N/A |
To review the Imaging of the diaphragm: anatomy and function |
No results stated in abstract. |
4 |
| 102. Saltiel RV, Grams ST, Pedrini A, Paulin E. High reliability of measure of diaphragmatic mobility by radiographic method in healthy individuals. Braz J Phys Ther. 2013;17(2):128-136. |
Observational-Dx |
42 patients |
To analyze the reliability of radiographic measurement as a method for assessing the mobility of the left and right hemidiaphragms. |
In the analysis of intra-observer reproducibility in radiographic evaluations of the left and right hemidiaphragms, ICC[2,1] indicated a "very high correlation" for both observer A (ICC[2,1] = 0.99, p <0.001 and ICC[2,1] = 0.97, p <0.001, respectively) and observer B (ICC[2,1] = 0.99, p <0.001 and ICC[2,1] = 0.99 p <0.001, respectively). In the analysis of interobserver reproducibility, the ICC[2,1] indicated a "very high correlation" for the 1st and 2nd radiographic evaluations of the right hemidiaphragm (ICC[2,1] = 0.98 and ICC[2,1] = 0,99, respectively, p <0.001) and left hemidiaphragm (ICC[2,1] = 0.98 and ICC[2,1] = 0.99, respectively, p <0.001). |
2 |
| 103. Chen Y, Li P, Wang J, Wu W, Liu X. Assessments and Targeted Rehabilitation Therapies for Diaphragmatic Dysfunction in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review. [Review]. International Journal of Copd. 17:457-473, 2022. |
Observational-Dx |
1513 patients (articles-122) |
To summarize the characteristics, assessment methods, and targeted rehabilitation therapies of diaphragm dysfunction in patients with chronic obstructive pulmonary disease (COPD). |
Under the influence of oxidative stress, inflammation, and other factors, the diaphragm function of patients with COPD changes in mobility, muscle strength, thickness, and thickening. In patients with COPD, diaphragm mobility can be assessed using ultrasound, X-ray fluoroscopy, and magnetic resonance imaging. Diaphragmatic strength can be measured by transdiaphragmatic pressure and maximal inspiratory pressure. Diaphragmatic thickness and thickening can be assessed using ultrasound. Rehabilitation therapies targeting the diaphragm include diaphragmatic breathing, diaphragm-related manual therapy, and phrenic nerve electrical stimulation. Diaphragmatic breathing is safe, simple, and not limited by places. Diaphragmatic manual therapies, which require patient cooperation and one-on-one operation by a professional therapist, are effective. Phrenic nerve electrical stimulation is suitable for patients with severe conditions. These therapies improve the diaphragmatic function, lung function, dyspnea, and exercise capacity of patients with COPD. |
1 |
| 104. Kiryu S, Loring SH, Mori Y, Rofsky NM, Hatabu H, Takahashi M. Quantitative analysis of the velocity and synchronicity of diaphragmatic motion: dynamic MRI in different postures. Magn Reson Imaging. 24(10):1325-32, 2006 Dec. |
Observational-Dx |
8 healthy men |
To assess the relationship between right and left hemidiaphragmatic motions during breathing in normal subjects and to investigate alterations in lung motion with changes in posture, using dynamic magnetic resonance (MR) imaging. |
Excursion was greater in the right hemidiaphragm in most postures, except the left lateral decubitus. In supine and prone postures, both hemidiaphragms moved synchronously in both inspiratory and expiratory phases. In both lateral decubitus postures, the hemidiaphragms moved asynchronously with different velocities in the expiratory phase but with the same velocities in the inspiratory phase. |
3 |
| 105. Mogalle K, Perez-Rovira A, Ciet P, et al. Quantification of Diaphragm Mechanics in Pompe Disease Using Dynamic 3D MRI. PLoS One. 2016;11(7):e0158912. |
Observational-Dx |
10 Pompe patients; 6 controls |
To investigate the suitability of dynamic magnetic resonance (MR) imaging in combination with state-of-the-art image analysis methods to assess respiratory muscle weakness. |
Results in 16 3D+t MRI scans (10 Pompe patients and 6 controls) of a slow expiratory maneuver show that kinematic analysis from dynamic 3D images reveals important additional information about diaphragm mechanics and respiratory muscle involvement when compared to conventional pulmonary function tests. Pompe patients with severely reduced pulmonary function showed severe diaphragm weakness presented by minimal motion of the diaphragm. In patients with moderately reduced pulmonary function, cranial displacement of posterior diaphragm parts was reduced and the diaphragm dome was oriented more horizontally at full inspiration compared to healthy controls. |
3 |
| 106. Verhey PT, Gosselin MV, Primack SL, Kraemer AC. Differentiating diaphragmatic paralysis and eventration. Acad Radiol. 2007;14(4):420-425. |
Observational-Dx |
32 patients |
To qualitatively and quantitatively measure the utility of chest radiography in determining the presence or absence of diaphragmatic paralysis in patients with an elevated diaphragm. |
Of 32 patients with elevated diaphragm on chest radiograph, 17 had diaphragmatic paralysis confirmed with fluoroscopic sniff test. Our results indicate that the radius of curvature or shape of the diaphragm on lateral chest radiograph is the most important factor for detection of the presence or absence of diaphragmatic paralysis. HH/APD > 0.28 suggests against paralysis. |
2 |
| 107. Noh DK, Lee JJ, You JH. Diaphragm breathing movement measurement using ultrasound and radiographic imaging: a concurrent validity. Biomed Mater Eng. 2014;24(1):947-952. |
Observational-Dx |
14 patients |
To validate the accuracy of ultrasound imaging measurements of diaphragm movements by concurrently comparing these measurements to the gold standard of radiographic imaging measurements. |
Pearson correlation analysis showed strong correlations, ranging from r=0.78 to r=0.83, between ultrasound and radiographic imaging measurements of the diaphragm during inhalation, exhalation, and excursion. These findings suggest that ultrasound imaging measurement is useful to accurately evaluate diaphragm movements during tidal breathing. |
3 |
| 108. Sarwal A, Walker FO, Cartwright MS. Neuromuscular ultrasound for evaluation of the diaphragm. Muscle Nerve. 2013;47(3):319-329. |
Review/Other-Dx |
N/A |
To review different techniques for assessing the diaphragm using neuromuscular ultrasound and the application of these techniques to enhance diagnosis and prognosis by neuromuscular clinicians. |
No results stated in abstract. |
4 |
| 109. Boon AJ, Sekiguchi H, Harper CJ, et al. Sensitivity and specificity of diagnostic ultrasound in the diagnosis of phrenic neuropathy. Neurology. 83(14):1264-70, 2014 Sep 30. |
Observational-Dx |
82 patients |
To determine the sensitivity and specificity of B-mode ultrasound in the diagnosis of neuromuscular diaphragmatic dysfunction, including phrenic neuropathy. |
Of 82 patients recruited over a 2-year period, 66 were enrolled in the study. Sixteen patients were excluded because of inconclusive or insufficient reference testing. One hemidiaphragm could not be adequately visualized; therefore, hemidiaphragm assessment was conducted in a total of 131 hemidiaphragms in 66 patients. Of the 82 abnormal hemidiaphragms, 76 had abnormal sonographic findings (atrophy or decreased contractility). Of the 49 normal hemidiaphragms, none had a false-positive ultrasound. Diaphragmatic ultrasound was 93% sensitive and 100% specific for the diagnosis of neuromuscular diaphragmatic dysfunction. |
2 |
| 110. Fantini R, Mandrioli J, Zona S, et al. Ultrasound assessment of diaphragmatic function in patients with amyotrophic lateral sclerosis. Respirology. 2016;21(5):932-938. |
Observational-Dx |
41 patients |
To assess whether diaphragmatic thickness measured by ultrasound (US) correlates with lung function impairment in Amyotrophic Lateral Sclerosis (ALS) patients. The secondary aim was then to compare US diaphragm thickness index (DeltaTdi) with a new parameter (DeltaTmax index). |
DeltaTdiTLC (p <0.001) and DeltaTmax (p = 0.007), but not DeltaTdiVt, differed between patients and controls. Significant correlation (p < 0.05) was found between DeltaTdiTLC, DeltaTmax and forced vital capacity (FVC). The ROC curve analysis for comparison of individual testing showed better accuracy with Deltatmax than with DeltatdiTLC for FVC (AUC 0.76 and 0.27) and sniff nasal inspiratory pressure (SNIP) (AUC 0.71 and 0.25). |
2 |
| 111. Hiwatani Y, Sakata M, Miwa H. Ultrasonography of the diaphragm in amyotrophic lateral sclerosis: clinical significance in assessment of respiratory functions. Amyotroph Lateral Scler Frontotemporal Degener. 2013;14(2):127-131. |
Observational-Dx |
36 patients |
To evaluate diaphragm thicknesses during respiration by ultrasonography, and compare with conventional measurements of respiratory functions in patients with amyotrophic lateral sclerosis (ALS). |
The diaphragm was clearly identifiable by ultrasonography. Maximal diaphragm thickness during the maximal inspiratory effort (DTmax) , minimum diaphragm thickness at the end expiratory position (DTmin) and the thickening ratio (TR) were all significantly decreased in ALS patients with %VC (vital capacity) < 80, compared with those in either ALS patients with %VC >/= 80 or healthy controls. DTmax, DTmin and the TR were all significantly correlated with %VC. In addition, significant inverse correlations were found between all three parameters and pCO(2). The inter-observer reliability of measurements of diaphragm thickness was high. |
3 |
| 112. O'Gorman CM, O'Brien T G, Boon AJ. Utility Of diaphragm ultrasound in myopathy. Muscle Nerve. 2017;55(3):427-429. |
Observational-Dx |
19 cases |
To evaluate ultrasound (US) of diaphragm thickness and contractility is an effective tool in neurogenic diaphragm dysfunction. |
There were 19 eligible cases, of which 14 (73.7%) had abnormal US findings. Mean diaphragm thickness was 0.12 cm (SD 0.10), and the mean thickening ratio was 1.29 (SD 0.35). In all cases with abnormal US evaluation, the thickening ratio was abnormal. There were no cases with abnormal thickness alone. |
3 |
| 113. Baria MR, Shahgholi L, Sorenson EJ, et al. B-mode ultrasound assessment of diaphragm structure and function in patients with COPD. Chest. 2014;146(3):680-685. |
Observational-Dx |
50 COPD patients; 150 control subjects |
To determine the diaphragm muscle thickness and thickening ratio in patients with chronic obstructive pulmonary disease(COPD)compared with normal control subjects. |
There was no significant difference in diaphragm thickness or thickening ratio between sides within groups (control subjects or patients with COPD) or between groups, with the exception of the subgroup with severe air trapping (residual volume > 200%), in which the only difference was that the thickening ratio was higher on the left (P = .0045). |
3 |
| 114. Carrie C, Bonnardel E, Vally R, Revel P, Marthan R. Vital Capacity Impairment due to Neuromuscular Disease and its Correlation with Diaphragmatic Ultrasound: A Preliminary Study. Ultrasound Med Biol. 2016;42(1):143-149. |
Observational-Dx |
47 patients |
To evaluate the correlation between diaphragmatic excursion measured by a right sub-costal ultrasound approach and forced vital capacity in patients with amyotrophic lateral sclerosis (ALS) or myotonic dystrophy (MD). |
There was a significant correlation between EDEmax values and forced vital capacity (FVC) values (r = 0.68 [0.46-0.90], p < 0.0001) and between EDEmax values and percentage of predicted FVC values (r = 0.75 [0.55-0.95], p < 0.0001). At a threshold of EDEmax < 5.5 cm, the sensitivity and specificity of ultrasonic diaphragmatic excursion in predicting FVC </= 50% of theoretical values were 100% [66%-100%] and 69% [52%-84%] respectively, without any significant difference between males and females. There was no statistical correlation between maximal inspiratory pressure and Esniff. |
2 |
| 115. Noda Y, Sekiguchi K, Kohara N, Kanda F, Toda T. Ultrasonographic diaphragm thickness correlates with compound muscle action potential amplitude and forced vital capacity. Muscle Nerve. 2016;53(4):522-527. |
Observational-Dx |
36 patients; 10 controls |
To determine the utility of ultrasonography (USG) for evaluating diaphragm dysfunction in patients with neuromuscular disorders such as motor neuron disease, myopathy, and other disorders of varying etiology. |
Diaphragm thickness was significantly correlated with forced vital capacity (FVC) (r = 0.74) and compound muscle action potentials (CMAP) amplitude (r = 0.53). |
3 |
| 116. Pinto S, Alves P, Pimentel B, Swash M, de Carvalho M. Ultrasound for assessment of diaphragm in ALS. Clin Neurophysiol. 2016;127(1):892-897. |
Observational-Dx |
42 patients |
To evaluate the correlation between diaphragm thickness assessed by ultrasound (US) with respiratory function tests and the diaphragm motor responses, in patients with amyotrophic lateral sclerosis (ALS). |
The mean age at disease onset was 58.4 +/- 11.1 years and with a mean disease duration of 17.8 +/- 13.6 months. Ultrasound studies of diaphragm thickness in full inspiration correlated with diaphragm compound muscle action potential (CMAP) in the whole population and in spinal-onset patients; and were similar in the two groups. Multiple linear modelling showed that forced vital capacity (FVC), SNIP and maximal voluntary ventilation (MVV) were dependent on the change of thickness (p=0.001, 0.001 and 0.020, respectively) and that maximal inspiratory (MIP) and maximal expiratory (MEP) were related to diaphragm CMAP p=0.003 and p=0.025, respectively). |
2 |
| 117. Santana PV, Prina E, Albuquerque AL, Carvalho CR, Caruso P. Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease: the utility of ultrasound imaging. J Bras Pneumol. 2016;42(2):88-94. |
Observational-Dx |
40 ILD patients; 16 healthy volunteers |
To investigate the applicability of ultrasound imaging of the diaphragm in interstitial lung disease (ILD). |
Between the ILD patients (n = 40) and the controls (n = 16), mean diaphragmatic mobility was comparable during quiet breathing, although it was significantly lower in the patients during deep breathing (4.5 +/- 1.7 cm vs. 7.6 +/- 1.4 cm; p < 0.01). The patients showed greater diaphragm thickness at functional residual capacity (FRC) (p = 0.05), although, due to lower diaphragm thickness at total lung capacity (TLC), they also showed a lower thickening fraction (TF) (p < 0.01). The forced vital capacity (FVC) as a percentage of the predicted value (FVC%) correlated with diaphragmatic mobility (r = 0.73; p < 0.01), and an FVC% cut-off value of < 60% presented high sensitivity (92%) and specificity (81%) for indentifying decreased diaphragmatic mobility. |
3 |
| 118. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. |
Review/Other-Dx |
N/A |
Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. |
No abstract available. |
4 |
| 119. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
