Nagpal, Prashant

Abstract Rationale Ground-glass opacities (GGOs) in the absence of interstitial lung disease are understudied. Objectives To assess the association of GGOs with white blood cells (WBCs) and progression of quantified chest computed tomography emphysema. Methods We analyzed data of participants in the SPIROMICS study (Subpopulations and Intermediate Outcome Measures in COPD Study). Chest radiologists and pulmonologists labeled regions of the lung as GGOs, and the adaptive multiple feature method (AMFM) trained the computer to assign those labels to image voxels and quantify the volume of the lung with GGOs (%GGOAMFM). We used multivariable linear regression, zero-inflated negative binomial, and proportional hazards regression models to assess the association of %GGOAMFM with WBCs, changes in percentage emphysema, and clinical outcomes. Measurements and Main Results Among 2,714 participants, 1,680 had chronic obstructive pulmonary disease (COPD) and 1,034 had normal spirometry. Among participants with COPD, on the basis of multivariable analysis, current smoking and chronic productive cough were associated with higher %GGOAMFM. Higher %GGOAMFM was cross-sectionally associated with higher WBC and neutrophil concentrations. Higher %GGOAMFM per interquartile range at visit 1 (baseline) was associated with an increase in emphysema at 1-year follow-up visit by 11.7% (relative increase; 95% confidence interval, 7.5–16.1%; P < 0.001). We found no association between %GGOAMFM and 1-year FEV1 decline, but %GGOAMFM was associated with exacerbations and all-cause mortality during a median follow-up of 1,544 days (interquartile interval, 1,118–2,059). Among normal spirometry participants, we found similar results, except that %GGOAMFM was associated with progression to COPD at 1-year follow-up. Conclusions Our findings suggest that GGOAMFM is associated with increased systemic inflammation and emphysema progression.

AbstractFinding a feeding vessel with diameter greater than 0.9 mm during transarterial chemoembolization (TACE) for hepatocellular cancer (HCC) has been shown to predict tumor necrosis on subsequent pathology. However, whether this translates into a useful clinical predictor for post-chemoembolization response and survival is unknown. This study aimed to determine whether the presence of an arterial feeder on pre-TACE cross-sectional imaging is associated with treatment response and survival after TACE for unresectable HCC. Retrospective medical record search for all chemo-embolizations performed for HCC from 2015 to 2016 yielded 138 patients who underwent 275 TACE sessions spanning 2011 to 2017. Patients consisted of 98 males (71%) with mean age of 62 (range, 37–86). Each patient underwent an average of two TACE sessions (range, 1–11). Endpoints included target tumor response and overall response defined by the mRECIST criteria, as well as patient survival. Preprocedural MRI/CT was reviewed for the presence of arterial feeder. Multivariable logistic regressions and Cox proportional hazard regressions were used to assess the effects of arterial feeder presence on treatment response and survival, respectively, adjusting for other covariates. Overall response was seen in 69% of patients. Arterial feeder was present on preprocedural cross-sectional imaging for 28% of TACE sessions. Median survival was 26.5 months (interquartile range, 13.2–38.1). The presence of arterial feeder led to better target tumor response (OR = 11.9, p < 0.0001), overall response (OR = 9.3, p < 0.0001), and improved survival (HR = 0.55, p = 0.02). The presence of an arterial feeder on pre-TACE cross-sectional imaging is associated with target tumor response, overall response, and survival after TACE.

AbstractObjectiveCT pulmonary angiography (CTPA) is one of the most commonly ordered CT imaging tests. It is often believed to be overutilised with few recent studies showing a yield of less than 2%. This study aimed to determine the overall positivity rate of CTPA examinations and understand the factors that affect the yield of the CTPA examination.MethodsWe retrospectively analysed 2713 patients who received the CTPA exam between 2016 and 2018. Type of study ordered (CTPA chest or CTPA chest with abdomen and pelvis CT), patient location (emergency department (ED), outpatient, inpatient, intensive care unit (ICU)) and patient characteristics—age, sex and body mass index (BMI) were recorded. A logistic regression analysis was performed to determine what factors affect the positivity rate of CT scans for pulmonary embolism (PE).ResultsWith 296 positive test results, the overall CTPA positivity was 10.9%. Male sex was associated with higher CTPA positivity, gender difference was maximum in 18-year to 35-year age group. Overweight and obese patients had significantly higher positivity as compared with BMI&lt;25 (p&lt;0.05). Higher positivity rate was seen in the BMI 25–40 group (11.9%) as compared with BMI&gt;40 (10.1%) (p&lt;0.05). Significant difference (p&lt;0.001) was also found in CTPA examination yield from ICU (15.3%) versus inpatients (other than ICU) (12.4%) versus ED (9.6%), and outpatients (8.5%). The difference in CTPA yield based on the type of CT order (CTPA chest vs CTPA chest with CT abdomen and pelvis), patient’s age and sex was not significant.ConclusionCTPA yield of 10.9% in this study is comparable to acceptable positivity rate for the USA and is higher than recent studies showing positivity of &lt;2%. Patient characteristics like obesity and ICU or inpatient location are associated with higher rate of CT positivity.