• Artificial intelligence
• Emergency service (hospital)
• Multiple pulmonary nodules
• Solitary pulmonary nodules
• Tomography (x-ray computed)

• Humans
• Deep Learning
• Tomography, X-Ray Computed/methods
• Male
• Emergency Service, Hospital
• Female
• Retrospective Studies
• Multiple Pulmonary Nodules/diagnostic imaging
• Middle Aged
• Radiation Dosage
• Aged
• Lung Neoplasms/diagnostic imaging
• Algorithms
• Artificial Intelligence
• Prospective Studies
• Solitary Pulmonary Nodule/diagnostic imaging

• 843001806 ZonMw
• Amsterdam University Medical Centers

• covid-19
• covid-19 infection
• ct chest
• interstitial lung disease
• lung incidentalomas
• lung lesion

• COVID-19
• Incidental
• Pandemic
• Thyroid nodules

• Humans
• Thyroid Nodule/diagnostic imaging
• Thyroid Nodule/pathology
• Thyroid Nodule/epidemiology
• COVID-19/diagnostic imaging
• COVID-19/epidemiology
• Male
• Female
• Incidental Findings
• Middle Aged
• Retrospective Studies
• Adult
• Aged
• Tomography, X-Ray Computed
• SARS-CoV-2
• Biopsy, Fine-Needle
• Ultrasonography
• Thyroid Gland/diagnostic imaging
• Thyroid Gland/pathology
• Thyroid Neoplasms/diagnostic imaging
• Thyroid Neoplasms/pathology
• Thyroid Neoplasms/epidemiology

• Dual energy CT
• Spectral detector computed tomography
• Thyroid imaging reporting and data system
• Thyroid nodule

• Humans
• Thyroid Nodule/diagnostic imaging
• Retrospective Studies
• Ultrasonography/methods
• Tomography, X-Ray Computed/methods
• Iodine

• COVID-19
• CT scans
• Incidentalomas

• PTC
• artificial intelligence
• machine learning
• radiomics
• thyroid nodules

• Education Department of Jilin Province

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of mediastinal and hilar lymph is poorly studied in patients with extrathoracic malignancies.

To evaluate the value of EBUS-TBNA for the diagnosis of enlarged intrathoracic lymph nodes in patients with extrathoracic malignancies.

This was a retrospective study of patients with extrathoracic malignancies who were referred to Peking University Cancer Hospital from January 2013 to December 2018 for EBUS-TBNA due to intrathoracic lymphadenopathy. The specimens were defined as positive for malignancy, negative for non-malignancy (tuberculosis, sarcoidosis, etc.), and without a definitive diagnosis. Sensitivity, negative predictive value (NPV) for malignancy, and overall accuracy were calculated. Complications were recorded.

A total of 80 patients underwent EBUS-TBNA and had a final diagnosis, among which 50 (62.5%) were diagnosed with extrathoracic malignancy with intrathoracic lymph nodes metastasis, 14 (17.5%) were diagnosed with primary lung cancer with nodal involvement, and 16 (20.0%) exhibited benign behavior including tuberculosis, sarcoidosis and reactive lymphadenitis or who had benign follow-up. The diagnostic sensitivity, NPV, and accuracy of EBUS-TBNA for intrathoracic lymphadenopathy in patients with extrathoracic malignancy were 93.8% (n = 60/64), 80.0% (n = 16/20), and 95.0% (n = 76/80), respectively. In the multivariate analysis, longer short axis of the lymph node (OR: 1.200, 95%CI: 1.024-1.407; P = 0.024) and synchronous lung lesion (OR: 19.449, 95%CI: 1.875-201.753; P = 0.013) were independently associated with malignant intrathoracic lymphadenopathy. No characteristics of the lymph nodes and EBUS-TBNA were associated with the location of malignant intrathoracic lymphadenopathy, and no major complication was observed.

EBUS-TBNA is a simple and accurate procedure for the diagnosis of intrathoracic lymphadenopathy with extrathoracic malignancy.

• Endobronchial ultrasound
• Intrathoracic lymphadenopathy
• Extrathoracic malignancy
• Transbronchial needle aspiration
• Diagnosis

• Nomogram
• lung nodule
• mediastinal/hilar lymphadenopathy
• prediction model

3D planning software for shoulder arthroplasty recently emerged for aiding in intraoperative determination of native glenoid. These protocols often require increased scan resolution, however, raising the question of an increased prevalence and clinical impact of incidental findings (IFs) from preoperative imaging.

A retrospective review of preoperative shoulder CT reports was conducted for 333 consecutive patients planning anatomic or reverse total shoulder arthroplasties. Patients with thin-sliced CT scans (1.25 mm) were compared with those with standard CT scans (2.5 mm). Poisson regression was performed with baseline characteristics and potentially pathologic IFs (PPIFs).

IFs were present in 131 of the 333 scans (39.3%), and 38 of the 333 scans (11.4%) included PPIFs. Only 8 of the 333 scans (2.4%) required workup, with 2 of the 333 (0.6%) leading to new cancer diagnoses. Thin-sliced CT scans detected a higher mean number of IFs (1.12 versus 0.22, P < 0.001) while the mean number of PPIFs remained similar (0.13 versus 0.10, P = 0.43).

IFs are frequent; however, only 0.6% scans led to new cancer diagnoses. Comparison of thin-sliced with standard CT scans revealed a higher frequency of IFs but similar PPIFs, indicating increased burden of IFs without the benefit of identifying additional malignancies. As demand rises for shoulder arthroplasties, surgeons should consider the potential hidden costs of IFs when using 3D planning programs.

• CT attenuation correction
• Incidental findings
• Myocardial perfusion imaging
• Pulmonary nodules

• Humans
• Incidental Findings
• Myocardial Perfusion Imaging/methods
• Prevalence
• Retrospective Studies
• Tomography, X-Ray Computed/methods

• Delay
• Head and neck cancer
• Incidental findings
• Overall survival
• Time-to-treatment initiation

Computed tomography pulmonary angiography (CTPA) is the diagnostic standard for pulmonary embolism (PE), but is unavailable in many low resource settings. We evaluated the evidence for point of care ultrasound as an alternative diagnostic.

Using a PROSPERO-registered, protocol-driven strategy (https://www.crd.york.ac.uk/PROSPERO, ID = CRD42018099925), we searched MEDLINE, EMBASE, and CINHAL for observational and clinical trials of cardiopulmonary ultrasound (CPUS) for PE. We included English-language studies of adult patients with acute breathlessness, reported according to PRISMA guidelines published in the last two decades (January 2000 to February 2020). The primary outcome was diagnostic accuracy of CPUS compared to reference standard CTPA for detection of PE in acutely breathless adults.

We identified 260 unique publications of which twelve met all inclusion criteria. Of these, seven studies (N = 3872) were suitable for inclusion in our meta-analysis for diagnostic accuracy (two using CTPA and five using clinically derived diagnosis criterion). Meta-analysis of data demonstrated that using cardiopulmonary ultrasound (CPUS) was 91% sensitive and 81% specific for pulmonary embolism diagnosis compared to diagnostic standard CTPA. When compared to clinically derived diagnosis criterion, CPUS was 52% sensitive and 92% specific for PE diagnosis. We observed substantial heterogeneity across studies meeting inclusion criteria (I² = 73.5%).

Cardiopulmonary ultrasound may be useful in areas where CTPA is unavailable or unsuitable. Interpretation is limited by study heterogeneity. Further methodologically rigorous studies comparing CPUS and CTPA are important to inform clinical practice.

• I01 HX000940 HSRD VA

• Computed tomography attenuation correction
• incidental findings
• low-dose computed tomography
• lung carcinoma
• myocardial perfusion scintigraphy

The diagnosis of pneumonia is challenging. Our objective was to assess whether low-dose computed tomography (LDCT) modified the probability of diagnosing pneumonia in elderly patients.

We prospectively included patients aged over 65 years with a suspicion of pneumonia treated with antimicrobial therapy (AT). All patients had a chest radiograph and LDCT within 72 h of inclusion. The treating clinician assessed the probability of pneumonia before and after the LDCT scan using a Likert scale. An adjudication committee retrospectively rated the probability of pneumonia and was considered as the reference for diagnosis. The main outcome was the difference in the clinician's pneumonia probability estimates before and after LDCT and the proportion of modified diagnoses which matched the reference diagnosis (the net reclassification improvement (NRI)).

A total of 200 patients with a median age of 84 years were included. After LDCT, the estimated probability of pneumonia changed in 90 patients (45%), of which 60 (30%) were downgraded and 30 (15%) were upgraded. The NRI was 8% (NRI event (−6%) + NRI non-event (14%)).

LDCT modified the estimated probability of pneumonia in a substantial proportion of patients. It mostly helped to exclude a diagnosis of pneumonia and hence to reduce unnecessary AT.

Low-dose CT modified the estimated probability of pneumonia in a substantial proportion (45%) of elderly patientshttp://ow.ly/V1ha30jvOMk

• Aged, 80 and over
• Aortic Valve Stenosis/complications
• Aortic Valve Stenosis/mortality
• Aortic Valve Stenosis/surgery
• Cause of Death/trends
• Computed Tomography Angiography/methods
• Female
• Follow-Up Studies
• Humans
• Incidence
• Incidental Findings
• Kaplan-Meier Estimate
• Male
• Neoplasms/complications
• Neoplasms/diagnosis
• Neoplasms/epidemiology
• Netherlands/epidemiology
• Postoperative Period
• Prognosis
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Survival Rate/trends
• Time Factors
• Transcatheter Aortic Valve Replacement/mortality

In our daily experience, the differentiation between a cold and hot nodule is a very important factor for further clinical management of the patient.

In this study, we compared the characteristics of incidentally found thyroid nodules detected on computed tomography (CT) to thyroid scintigraphy (TS).

Diagnostic reports from chest CT with intravenous contrast and TS examinations performed from January 2013 to January 2016 were analyzed retrospectively. We identified 70 subjects: 50 with thyroid nodules and 20 control subjects without thyroid nodules. The examination time of the TS was a minimum of two to four months after a chest CT. Chest CTs were performed in the arterial phase after the application of contrast media.

Patients with a cold nodule had a significantly lower Hounsfield Unit (HU) Nodule(N)/Parenchyma (P) ratio values than the patients with a hot or warm nodule (P < 0.05). The cut-off HU N/P ratio value with the highest sum of sensitivity and specificity for the prediction of a functioning nodule was 69 (95% CI: 0.79–0.95).

Our results imply that the HU N/P ratio of the thyroid nodule on the chest CT should be taken into account to assess the functionality of the nodule. A lower HU N/P ratio should alert the radiologist or nuclear medicine physician to the possibility that the nodule might be cold and thus more prone to malignancy.

• Computed tomography
• Incidentaloma
• Technetium thyroid uptake
• Thyroid nodule
• Thyroid scintigraphy

• SPECT
• low-resolution CT
• myocardial perfusion imaging

• Fine needle aspiration biopsy
• Incidental thyroid nodule
• Thyroid cancer
• Ultrasound