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Diagnosis of Coronavirus Infection by Medical Imaging and ALL other Cardiovascular Impacts of Viral Infection

Aviva Lev-Ari, PhD, RN 

• Lead Curator – e–mail Contact: avivalev-ari@alum.berkeley.edu

UPDATED on 11/25/2020

AI can detect COVID-19 quickly, accurately on x-rays

By Erik L. Ridley, AuntMinnie staff writer

A team of researchers from Northwestern University led by senior author Aggelos Katsaggelos, PhD, and cardiologist Dr. Ramsey Wehbe trained their algorithm — called DeepCOVID-XR — on nearly 15,000 chest x-rays acquired earlier this year. In testing on an independent dataset, the algorithm performed comparably to the consensus interpretations by five experienced radiologists and was also 10 times faster.

“We feel that this algorithm has the potential to benefit healthcare systems in mitigating unnecessary exposure to the virus by serving as an automated tool to rapidly flag patients with suspicious chest imaging for isolation and further testing,” the authors wrote.

DeepCOVID-XR is an ensemble of 24 individually trained deep convolutional neural networks (CNNs). First, the algorithm was pretrained using a dataset of over 100,000 chest x-ray images from the U.S. National Institutes of Health (NIH).

Next, DeepCOVID-XR was trained and validated on 14,788 images — including 4,253 COVID-19-positive images — gathered from 20 sites across the Northwestern Memorial Healthcare System between February and April 2020.

After analyzing the images, DeepCOVID-XR yields a final binary prediction of either positive or negative for COVID-19 based on the weighted average of the predictions by the individual CNNs that make up the ensemble. The algorithm also uses a gradient class activation mapping technique to provide “heat maps” on the images. This allows users to see the image features that were most important in arriving at the algorithm’s predictions of a positive COVID-19 result.

SOURCE

https://www.auntminnie.com/index.aspx?sec=sup&sub=aic&pag=dis&ItemID=130926

CO-RADS system helps clinicians assess COVID-19
A COVID-19-specific CT reporting system called CO-RADS can help clinicians quickly diagnose the disease when patients present in the emergency department,…

COVID-19, AI, and dose reduction top RSNA’s CT agenda
In 2020, the COVID-19 pandemic has shaped the practice of imaging across all modalities, and CT is no exception. At the upcoming RSNA 2020 meeting, attendees…

New AI lab at UMass focuses on thoracic imaging
A new research laboratory at the University of Massachusetts (UMass) in Worcester, MA, has launched this week with the goal of developing, testing, and…

Digital x-ray shows value during COVID-19 pandemic
As radiology’s oldest modality, classic radiography sometimes gets overlooked in favor of more glamorous technologies such as CT, MRI, and PET. But the…

Use cases expand, solidify for AI across subspecialties
Our journey on the Road to RSNA continues with a look at artificial intelligence (AI) topics and issues in subspecialty areas such as breast imaging,…

UPDATED on 11/3/2020

What new imaging data tells us about COVID-19 and heart damage

Michael Walter | October 26, 2020 | Cardiovascular Imaging

Cardiac structural abnormalities are common among hospitalized COVID-19 patients who undergo a transthoracic echocardiogram (TTE), according to new findings published in the Journal of the American College of Cardiology.

Prior studies focused on myocardial injury had not included much, if any, insight into medical imaging data, making the results less helpful to clinicians. The team behind this analysis hoped to address that shortcoming by taking a thorough look at the TTE findings of hospitalized COVID-19 patients.

The study included data from 305 patients who were treated in one of seven hospitals from March 5 to May 2, 2020. All patients had a confirmed COVID-19 diagnosis and underwent a TTE. The mean patient age was 63 years old and more than 67% were male. While

Overall, 62.6% of patients showed biomarker evidence of myocardial injury. While 61% of those patients showed signs of myocardial injury when they were initially admitted to the hospital, the other patients developed myocardial injury during the hospitalization.

“Patients with cardiac injury had a substantially greater prevalence of left ventricular, right ventricular and pericardial abnormalities,” wrote lead author Gennaro Giustino, MD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues. “Higher degrees of diastolic dysfunction were also more frequent in patients with myocardial injury, possibly reflecting the higher prevalence of hypertension and chronic kidney disease among these patients. ST-segment changes on the 12-lead electrocardiogram appeared to identify two different patterns of myocardial injury, with diffuse ST-segment changes associated with global biventricular dysfunction (possibly reflecting a diffuse myocardial inflammatory damage) and regional ST-segment changes associated with regional wall motion abnormalities (possibly reflecting regional ischemic damage of the myocardium due to macro- or microvascular thrombosis). Therefore, ECG and echocardiographic abnormalities in the context of the appropriate clinical scenario may help differentiate across the different etiologies of myocardial injury in COVID-19.”

Patients with myocardial injury, the authors added, tended to be older and were more likely to have hypertension, diabetes or chronic kidney disease.

Among patients without myocardial injury, the in-hospital mortality rate was 5.2%. For patients with myocardial injury and no TTE-detected cardiac structural abnormalities, that rate increased to 18.6%. And for patients with myocardial injury and TTE-detected abnormalities, it jumped all the way to 31.7%.

After adjusting for certain variables and running numerous calculations, the team concluded that myocardial injury with TTE-detected abnormalities was associated with an increased risk of in-hospital mortality. Myocardial injury and no TTE-detected abnormalities, however, was not associated with such a risk.

SOURCE

https://www.cardiovascularbusiness.com/topics/cardiovascular-imaging/new-imaging-data-tells-us-covid-19-heart-damage?utm_source=newsletter&utm_medium=cvb_cardio_imaging

UPDATED on 10/11/2020

Tiny biologic drug to fight COVID-19 show promise in animal models

Reporters: Irina Robu, PhD

https://pharmaceuticalintelligence.com/2020/10/11/tiny-biologic-drug-to-fight-covid-19-show-promise-in-animal-models

UPDATED on 10/11/2020

Llama-inspired “AeroNabs” to strangle COVID-19 with an inhaler

Reporters: Irina Robu, PhD

https://pharmaceuticalintelligence.com/2020/10/11/llama-inspired-aeronabs-to-strangle-covid-19-with-an-inhaler

UPDATED on 9/29/2020

Precision Cardiology to Benefit from New Atlas of Cells of the Adult Human Heart

Reporters: Justin D. Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2020/09/29/precision-cardiology-to-benefit-from-new-atlas-of-cells-of-the-adult-human-heart/

The Impact of COVID-19 on the Human Heart

Reporters: Justin D. Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2020/09/29/the-impact-of-covid-19-on-the-human-heart/

UPDATED on 9/2/2020

UPDATED on 7/12/2020

Combining PCR and CT testing for COVID Chen Shen∗ , Ron Mark MD DABR† , Nolan J. Kagetsu MD DABR‡ , Anton S. Becker MD PhD, Yaneer Bar-Yam∗

∗New England Complex Systems Institute,

†Mark Medical Care PLLC, ‡Mt. Sinai Hospital May 26, 2020

http://pharmaceuticalintelligence.com/wp-content/uploads/2020/03/7b0a4-ct_and_pcr_f1.pdf

UPDATED on 5/18/2020

TOP STORIES

Use CTA to evaluate obese COVID-19 patients for PE risk CT angiography (CTA) is an effective way to evaluate the risk of pulmonary embolism (PE) in patients with COVID-19, especially those who are obese or who have high levels of inflammation when they present at the hospital, according to a study published May 14 in Radiology.  Ultrasound scoring aids COVID-19 decisions A risk-stratification system that includes scores from lung ultrasound scans may help emergency clinicians quickly make care decisions for patients with COVID-19, according to an article published on May 9 in Emergency Medicine Australasia.  CT angio images show stroke in COVID-19 patient Some of the first CT angiography images documenting the rapid progression of acute ischemic stroke in a patient with COVID-19 were published on May 14 in the American Journal of Neuroradiology.  ISMRM annual meeting goes virtual The International Society for Magnetic Resonance in Medicine (ISMRM), along with the Society for MR Radiographers and Technologists, have announced that their annual meeting will be turned into a virtual conference this year due to safety concerns surrounding the COVID-19 pandemic.

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Use CTA to evaluate obese COVID-19 patients for PE risk CT angiography (CTA) is an effective way to evaluate the risk of pulmonary embolism (PE) in patients with COVID-19, especially those who are obese or who have high levels of inflammation when they present at the hospital, according to a study published May 14 in Radiology.  CT angio images show stroke in COVID-19 patient Some of the first CT angiography images documenting the rapid progression of acute ischemic stroke in a patient with COVID-19 were published on May 14 in the American Journal of Neuroradiology.

SOURCE

From: AuntMinnie’s Letter from the Editor <letters@auntminnie.com>

Reply-To: <do-not-reply@auntminnie.com>

Date: Monday, May 18, 2020 at 7:50 AM

To: Aviva Lev-Ari <AvivaLev-Ari@alum.berkeley.edu>

Subject: Use CTA to evaluate obese COVID-19 patients for PE risk

UPDATED on 5/6/2020

SOURCE

From: Science News from the American Heart Association <email@heartemail.org>

Reply-To: American Heart Association <reply-71896937-7991033_HTML-1648404797-10171707-0@heartemail.org>

Date: Wednesday, May 6, 2020 at 12:32 PM

To: Aviva Lev-Ari <AvivaLev-Ari@alum.berkeley.edu>

Subject: Family caregiving and SDOH in HF care; CVD during pregnancy; COVID-19 health disparities

UPDATED ON 4/2/2020

SOURCE

From: Diagnostic and Interventional Cardiology <mail@sgc-editorial.com>

Reply-To: Diagnostic and Interventional Cardiology <DoNotReply@sgc-editorial.com>

Date: Tuesday, April 21, 2020 at 3:46 PM

To: Aviva Lev-Ari <AvivaLev-Ari@alum.berkeley.edu>

Subject: VIDEO: 9 Cardiologists share COVID-19 takeaways from across the U.S.

UPDATED ON 4/16/2020

“Every ER physician I know recognizes the power of these scans,” said Joseph Fraiman, an emergency medicine physician at hospitals in the New Orleans area who does two or three chest CTs on suspected Covid-19 patients every shift. “Aggressive disease identification would involve both [swab tests] and CT to ensure the highest sensitivity, missing the fewest cases possible.”

But despite China’s experience, the use of chest CT to diagnose Covid-19 in the U.S. remains very limited (no one has data on how many have been done). That’s due in large part of the CDC and the American College of Radiology recommendations.

One of their objections is that CT scanners will become contaminated with the coronavirus. China, whose fever clinics routinely scanned 200 patients per day per machine, managed to clean the machines between patients well enough to avoid infecting health care workers or subsequent patients, however. Researchers there reported last month that CT scanning is far safer for health care workers than the swabs that reach the throat via the nose, and often trigger explosive coughing that can spew virus particles into the air. Thanks to staff training and between-patient scanner cleaning, after 3,340 CT scans for suspected Covid-19, another group of physicians in China reported, “none of the staff of the radiology department was infected with Covid-19.”

“It’s not like China has a monopoly on the technology to clean CT scanners,” said the Louisiana emergency medicine physician who asked not to be identified, so as not to anger colleagues. “Are you really going to say that your cleaning protocol is why you’re willing to kill 1 million people?” if the test/isolate/trace strategy fails because of faulty swab tests.

Fraiman said he is able to do chest CTs for his suspected Covid-19 cases by getting the technicians and cleaning crews on board: “I tell them, you are the guys who are going to save us!”

Another objection is that CT scans cannot easily distinguish between Covid-19, SARS, MERS, and other viral pneumonias, including from influenza. “They’re not specific enough,” said Sanjat Kanjilal, an infectious disease physician at Brigham and Women’s Hospital in Boston.

Although SARS, which is caused by a coronavirus related to the one causing Covid-19, was eliminated, and MERS (also from a coronavirus) is extremely rare outside the Middle East, viral pneumonia looks a lot like Covid-19 in a chest CT. “That makes me skeptical that it can have a big role to play,” Kanjilal said.

The rate of false positives from misidentifying other viral pneumonias as Covid-19 might be as high as 30%, said radiologist Paras Lakhani of Thomas Jefferson University Hospital in Philadelphia. But it would be much lower outside of flu season, which is ending. Reading scans during a time of year when flu and therefore pneumonia is rare, he said, “would give us more confidence in interpreting a scan.”

To be sure, chest CTs are no panacea. They, too, can miss Covid-19 cases; just two-fifths of the Diamond Princess passengers who had positive swab tests had lung opacities, researchers reported last month.

“There is evidence that a large fraction of Covid-19 patients have normal CTs,” said radiologist Mark Hammer of Brigham and Women’s Hospital in Boston. “Using CT to screen patients would let a lot of people go who may be infectious.”

Absent more accurate Covid-19 tests of any kind, whether swabs or CT or a combination, states’ tentative “re-opening” plans will be inefficient at best and failures at worst. The many Covid-19 cases that swab tests miss, said BU’s Galea, “is why the proposed Massachusetts contact tracing plan I have seen will quarantine people for 14 days even if they test negative” — a fortnight that someone could have been safely back at work and in the community if only a negative result on the molecular tests were more credible.

SOURCE

https://www.statnews.com/2020/04/16/ct-scans-alternative-to-inaccurate-coronavirus-tests/?utm_source=STAT+Newsletters&utm_campaign=fffd3e2a6e-Daily_Recap&utm_medium=email&utm_term=0_8cab1d7961-fffd3e2a6e-150237109

UPDATED ON 3/27/2020