Correlazioni clinico radiologiche nella diagnosi di fibrosi polmonare idiopatica: il ruolo degli score di valutazione nelle nuove linee guida Fleischner.

La fibrosi polmonare idiopatica (IPF) \ue8 definita come una forma specifica di fibrosi polmonare ad andamento progressivo ad eziologia sconosciuta. Nel 2018 la Fleischner Society ha modificato la classificazione diagnostica della malattia introducendo quattro categorie di possibilit\ue0 diagnostica con livelli di specificit\ue0 e confidenza diversi, rivalutando il valore predittivo delle alterazioni HRTC fibrosanti quali reticoli e bronchiectasie anche in assenza di honeycombing. Le linee guida definiscono l\u2019HRTC come una componente essenziale e fondamentale per la diagnosi che nell\u2019adeguato setting clinico e laboratoristico permette di evitare al paziente la biopsia chirurgica o alternativamente la criobiopsia transbonchiale. Le linee guida Fleischner confermano il ruolo centrale della biopsia chirurgica, definita il gold standard per la diagnosi, ed in attesa di raccogliere maggiori evidenze scientifiche in merito riservano tale metodica a centri esperti L\u2019obiettivo di questo studio \ue8 di valutare la correlazione tra lo studio HRTC e i dati spirometrici in al fine di determinare la capacit\ue0 della diagnostica per immagini di determinare la severit\ue0 della malattia in pazienti sottoposti a terapia antifibrotica per IPF alla prima rivalutazione dopo la terapia (media di 6 mesi di terapia). Sono stati inclusi nello studio 30 pazienti di cui 17 uomini e 13 donne, et\ue0 media di 60,7 anni, tra gennaio 2016 e giugno 2019 sono stati sottoposti presso il Policlinico San Martino di Genova a valutazione multidisciplinare e successivo iter diagnostico per confermare la diagnosi di IPF. Alla valutazione HRTC la totalit\ue0 dei pazienti (100%) presentava come segno di fibrosi, di grado variabile, la presenza di alterazioni subpleuriche a reticolo, a seguite il 99% dei pazienti presentava bronchiectasie da trazione nel contesto di tali alterazioni fibrotiche. A seguire l\u2019honeycombing (86%) a piccole cisti, presente nel 96% dei pazienti. Nel gruppo di studio abbiamo riscontrato un aumento del rapporto FEF25-75/FCV, come aspetto funzionale di fibrosi, in accordo con quanto riportato in letteratura. L\u2019indice TID correla positivamente con i valori di FEF25-75/FCV. Nell\u2019esaminare le correlazioni nella totalit\ue0 della popolazione di studio secondo il coefficiente di correlazione dei Karl Pearson si \ue8 stabilita una correlazione significativa tra l\u2019indice TID e la DLCO (correlazione negativa) (p=0.001). Non si sono riscontrate correlazioni significative tra il FIB score, i diametri di PA e gli indici funzionali. I limiti del nostro studio sono dettati dalla singola valutazione retrospettiva delle HRTC, la valutazione e quantificazione delle alterazioni degli score proprio a tutti gli score semiquantitativi. Per quanto si tratti di una valutazione retrospettiva il TID score pu\uf2 essere considerato un indice surrogato di monitoraggio della malattia e di valutazione della gravit\ue0.Idiopathic pulmonary fibrosis (IPF) is defined as a specific form of progressive pulmonary fibrosis of unknown etiology. In 2018 the Fleischner Society modified theclassification of the disease by introducing four categories of diagnostic possibilities with different levels of specificity and confidence, re-evaluating the predictive value of HRTC findings such bronchiectasis even in the absence of honeycombing. The guidelines define HRTC as an essential and fundamental component for the diagnosis which, in the appropriate clinical and laboratory setting. The objective of this study is to evaluate the correlation between the study HRTC and spirometric data in order to determine the ability of imaging to determine disease severity in patients undergoing antifibrotic therapy for IPF at the first reassessment after therapy (average of 6 months of therapy). Thirty patients (17 men and 13 women, average age of 60.7 years), were included in the study between January 2016 and June 2019 underwent a multidisciplinary evaluation at the Policlinico San Martino in Genoa and subsequent diagnostic procedure to confirm the diagnosis of IPF. At the HRTC assessment, all patients (100%) presented signs of fibrosis of varying degrees but 99% of the patients presented traction bronchiectasis in the context of these fibrotic alteration followed by small-cyst honeycombing (86%). In the study group we found an increase in the FEF25-75 / FCV ratio, as a functional aspect of fibrosis. The TID index correlates positively with the values \u200b\u200bof FEF25-75 / FCV. In examining the correlations in the whole study population according a significant correlation was established between the TID index and the DLCO (negative correlation) (p = 0.001). The limits of our study are the retrospective evaluation of the HRTC, and the use of semi-quantitative score, although, the TID score can be considered a surrogate index of disease monitoring and severity assessment

Non-fibrotic lung diseases on high resolution computed tomography: imaging and differential diagnosis

The possibility of distinguishing fibrosing from non-fibrosing lung diseases on high resolution computed tomography (HRCT) is very important in order to be able to establish the appropriate therapy early in the course of the disease and, in some pathologies, to avoid the evolution towards a fibrosing irreversible pattern. For this reason, this article will deal with non-fibrosing pulmonary parenchymal diseases, with an acute or subacute course, which occur on HRCT with a prevalent pattern of diffuse density increase (ground glass opacities and consolidations). Since these alterations, especially ground glass opacities, are often the early sign of the onset of diseases that evolve towards fibrosis, it is important to be able to recognize them and to propose a correct differential diagnosis

Impact of the COVID-19 pandemic on the selection of chest imaging modalities and reporting systems: a survey of Italian radiologists

Purpose Chest imaging modalities play a key role for the management of patient with coronavirus disease (COVID-19). Unfortunately, there is no consensus on the optimal chest imaging approach in the evaluation of patients with COVID-19 pneumonia, and radiology departments tend to use different approaches. Thus, the main objective of this survey was to assess how chest imaging modalities have been used during the different phases of the first COVID-19 wave in Italy, and which diagnostic technique and reporting system would have been preferred based on the experience gained during the pandemic. Material and Methods The questionnaire of the survey consisted of 26 questions. The link to participate in the survey was sent to all members of the Italian Society of Medical and Interventional Radiology (SIRM). Results The survey gathered responses from 716 SIRM members. The most notable result was that the most used and preferred chest imaging modality to assess/exclude/monitor COVID-19 pneumonia during the different phases of the first COVID-19 wave was computed tomography (51.8% to 77.1% of participants). Additionally, while the narrative report was the most used reporting system (55.6% of respondents), one-third of participants would have preferred to utilize structured reporting systems. Conclusion This survey shows that the participants' responses did not properly align with the imaging guidelines for managing COVID-19 that have been made by several scientific, including SIRM. Therefore, there is a need for continuing education to keep radiologists up to date and aware of the advantages and limitations of the chest imaging modalities and reporting systems

Impact of the COVID-19 pandemic on the selection of chest imaging modalities and reporting systems: a survey of Italian radiologists

17noPurpose Chest imaging modalities play a key role for the management of patient with coronavirus disease (COVID-19). Unfortunately, there is no consensus on the optimal chest imaging approach in the evaluation of patients with COVID-19 pneumonia, and radiology departments tend to use different approaches. Thus, the main objective of this survey was to assess how chest imaging modalities have been used during the different phases of the first COVID-19 wave in Italy, and which diagnostic technique and reporting system would have been preferred based on the experience gained during the pandemic. Material and Methods The questionnaire of the survey consisted of 26 questions. The link to participate in the survey was sent to all members of the Italian Society of Medical and Interventional Radiology (SIRM). Results The survey gathered responses from 716 SIRM members. The most notable result was that the most used and preferred chest imaging modality to assess/exclude/monitor COVID-19 pneumonia during the different phases of the first COVID-19 wave was computed tomography (51.8% to 77.1% of participants). Additionally, while the narrative report was the most used reporting system (55.6% of respondents), one-third of participants would have preferred to utilize structured reporting systems. Conclusion This survey shows that the participants' responses did not properly align with the imaging guidelines for managing COVID-19 that have been made by several scientific, including SIRM. Therefore, there is a need for continuing education to keep radiologists up to date and aware of the advantages and limitations of the chest imaging modalities and reporting systems.nonenoneBorghesi, Andrea; Sverzellati, Nicola; Polverosi, Roberta; Balbi, Maurizio; Baratella, Elisa; Busso, Marco; Calandriello, Lucio; Cortese, Giancarlo; Farchione, Alessandra; Iezzi, Roberto; Palmucci, Stefano; Pulzato, Ilaria; Rampinelli, Cristiano; Romei, Chiara; Valentini, Adele; Grassi, Roberto; Larici, Anna RitaBorghesi, Andrea; Sverzellati, Nicola; Polverosi, Roberta; Balbi, Maurizio; Baratella, Elisa; Busso, Marco; Calandriello, Lucio; Cortese, Giancarlo; Farchione, Alessandra; Iezzi, Roberto; Palmucci, Stefano; Pulzato, Ilaria; Rampinelli, Cristiano; Romei, Chiara; Valentini, Adele; Grassi, Roberto; Larici, Anna Rit

Use of Aspergillus fumigatus real-time PCR in bronchoalveolar lavage samples (BAL) for diagnosis of invasive aspergillosis, including azole-resistant cases, in high risk haematology patients: the need for a combined use with galactomannan

Diagnosis of invasive aspergillosis (IA) is challenging, particularly in high-risk patients with lung lesions other than typical according to 2008-EORTC/MSG criteria. Even if microbiology is positive, they still remain unclassified according to 2008-EORTC/MSG. Quantitative polymerase chain reaction (qPCR) provides new mycological documentation of IA. This retrospective study assessed Aspergillus fumigatus real time qPCR (MycoGENIE (R)) in BAL to diagnose IA and identify azole-resistant strains. Clinical, radiological, and microbiological data from 114 hematology patients (69% HSCT recipients; 29% on mould active agents) from years 2012-2017 were collected; and 123 BAL samples were tested with qPCR (cutoff: Ct < 40) and galactomannan (GM, Platelia (R), cutoff: 0.5 ODI). Patients were classified as proven/probable, possible, and no-IA. "Atypical-IA" referred to patients with lesions other than typical according to 2008-EORTC/MSG and positive mycology. Proven IA was diagnosed in two cases (1.6%), probable in 28 (22.8%), possible in 27 (22%), atypical in 14 (11.4%). qPCR was positive in 39 samples (31.7%). Sensitivity and specificity of qPCR for proven/probable IA (vs no-IA; atypical-IA excluded) were 40% (95% confidence interval [CI]: 23-59) and 69% (95%CI: 55-81), respectively. Sensitivity of qPCR was higher when combined with GM (83%, 95%CI: 65-94) and in those receiving mould-active agents at BAL (61%, 95%CI: 32-86). One sample had TR34/L98H mutation. In conclusion, in high-risk hematology patients with various lung lesions, A. fumigatus qPCR in BAL contributes to diagnosing IA, particularly if combined with GM and in patients receiving mould-active agents might allow detecting azole-resistant mutations in culture negative samples