• Korean Journal of Radiology
• /
• 제21권5호
• /
• pp.614-619
• /
• 2020

• Korean Journal of Radiology
• /
• 제21권11호
• /
• pp.1265-1272
• /
• 2020

Objective: We investigated the prevalence of pneumonia in novel coronavirus disease 2019 (COVID-19) patients using chest radiographs to identify the characteristics of those with initially negative chest radiographs, who were positive for pneumonia on follow-up. Materials and Methods: Retrospective cohort data of 236 COVID-19 patients were reviewed. Chest radiography was performed on admission, with serial radiographs obtained until discharge. The 'positive conversion group' was defined as patients whose initial chest radiographs were negative but were positive for pneumonia during follow-up. Patients with initially positive chest radiographs were defined as the 'initial pneumonia group.' Patients with negative initial and follow-up chest radiographs were defined as the 'non-pneumonia group.' Clinical and laboratory findings were compared between groups, and predictors of positive conversion were investigated. Results: Among 236 patients, 108 (45.8%) were in the non-pneumonia group, 69 (29.2%) were in the initial pneumonia group, and 59 (25%) were in the positive conversion group. The patients in the 'initial pneumonia group' and 'positive conversion group' were older, had higher C-reactive protein (CRP) and lactate dehydrogenase levels, and lower absolute lymphocyte counts than those in the 'non-pneumonia group' (all p < 0.001). Among patients with negative initial chest radiographs, age ≥ 45 years (odds ratio [OR]: 3.93, 95% confidence interval [CI]: 1.76-8.75, p = 0.001), absolute lymphocyte count < 1500 cells/μL (OR: 2.25, 95% CI: 1.03-4.89, p = 0.041), and CRP > 0.5 mg/dL (OR: 3.91, 95% CI: 1.54-9.91, p = 0.004) were independent predictors for future development of pneumonia. Conclusion: More than a half of COVID-19 patients initially had normal chest radiographs; however, elderly patients (≥ 45 years of age) with abnormal laboratory findings (elevated CRP and low absolute lymphocyte counts) developed pneumonia on follow-up radiographs.

• Pediatric Infection and Vaccine
• /
• 제29권2호
• /
• pp.77-83
• /
• 2022

소아청소년에서 코로나바이러스 감염증(coronavirus disease 2019, COVID-19)은 성인에 비해 증상이 심하지 않은 것으로 알려져 있다. 본 연구는 2021년 8월부터 11월 사이에 COVID-19으로 진단받은 후 고열과 호흡곤란이 동반되어 입원치료를 받았던 18세 미만의 소아청소년 환자 중 산소 공급에도 불구하고 지속적인 호흡곤란과 저산소증으로 항바이러스제인 remdesivir와 스테로이드(dexamethasone) 병합 치료를 시행한 환자를 대상으로 심한 폐렴의 위험인자를 알아보고자 후향적으로 의무 기록을 검토하였다. 소아청소년 8명이 심한 폐렴으로 산소치료, remdesivir와 스테로이드를 투여하였고, 남자 5명, 여자 3명이었다. 중간 나이는 16세(범위: 9-17세)였으며, 8명 중 6명의 체질량지수가 중간값이 30.5 kg/m² (범위: 29.4-38.5 kg/m²)였다. 모든 환자가 고열과 저산소증을 동반한 호흡곤란이 있었다. 흉부 단순 X-ray 검사에서 다양한 폐렴의 양상을 보였다. 7명은 remdesivir와 스테로이드 투여 후 1-2일 이내에 증상 호전되었다. 본 증례 연구에서는 심한 폐렴을 동반한 COVID-19 환자 8명 중 6명에서 비만이 있었다.

• 대한방사성의약품학회지
• /
• 제7권1호
• /
• pp.50-55
• /
• 2021

Low-dose radiotherapy has been known to have anti-inflammatory activity and been used for treatment of pneumonia together with anti-serum and sulfanilamide. However, it rapidly discontinued after the development of various antibiotics showing outstanding effect. Recently, it was re-considered to treat COVID-19 which has very limited treatment such as remdesivir and dexamethasone. So, several studies of COVID-19 therapy using low-dose radiation were reported very recently. They showed that low-dose radiation of 0.5~1.5 Gy were useful for decreasing the oxygen consumption and hospitalization period of COVID-19 patients without adverse reaction. Radiopharmaceuticals such as [⁹⁹mTc]Tc-macroaggregated albumin (MAA) also might be used for low-dose radiotherapy. Administration of vitamin D having anti-inflammatory effect would also be helpful for therapy with synergistic effect.

• Tuberculosis and Respiratory Diseases
• /
• 제85권4호
• /
• pp.349-357
• /
• 2022

Background: The most consistently identified mortality determinants for the new coronavirus 2019 (COVID-19) infection are aging, male sex, cardiovascular/respiratory diseases, and cancer. They were determined from heterogeneous cohorts that included patients with different disease severity and previous conditions. The main goal of this study was to determine if activities of daily living (ADL) dependence measured by Barthel's index could be a predictor for COVID-19 mortality. Methods: A prospective cohort study was performed with a consecutive sample of 340 COVID-19 patients representing patients from all over the northern region of Portugal from October 2020 to March 2021. Mortality risk factors were determined after controlling for demographics, ADL dependence, admission time, comorbidities, clinical manifestations, and delay-time for diagnosis. Central tendency measures were used to analyze continuous variables and absolute numbers (proportions) for categorical variables. For univariable analysis, we used t test, chi-square test, or Fisher exact test as appropriate (α=0.05). Multivariable analysis was performed using logistic regression. IBM SPSS version 27 statistical software was used for data analysis. Results: The cohort included 340 patients (55.3% females) with a mean age of 80.6±11.0 years. The mortality rate was 19.7%. Univariate analysis revealed that aging, ADL dependence, pneumonia, and dementia were associated with mortality and that dyslipidemia and obesity were associated with survival. In multivariable analysis, dyslipidemia (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.17-0.71) was independently associated with survival. Age ≥86 years (pooled OR, 2.239; 95% CI, 1.100-4.559), pneumonia (pooled OR, 3.00; 95% CI, 1.362-6.606), and ADL dependence (pooled OR, 6.296; 95% CI, 1.795-22.088) were significantly related to mortality (receiver operating characteristic area under the curve, 82.1%; p<0.001). Conclusion: ADL dependence, aging, and pneumonia are three main predictors for COVID-19 mortality in an elderly population.

• 대한영상의학회지
• /
• 제81권3호
• /
• pp.591-603
• /
• 2020

목적 본 연구는 Coronavirus disease 2019 (이하 COVID-19) 폐렴 환자의 임상 양상과 흉부 전산화단층촬영(이하 CT) 소견을 분석하고자 하였다. 대상과 방법 IRB의 승인을 받은 연구로, 51명의 COVID-19 확진 환자들을 후향적으로 분석하였다. 환자들을 임상 양상에 따라 경증과 중증으로 나누어 두 그룹 간에 임상 양상과 흉부 CT 소견을 비교하였다. 결과 총 51명의 환자(남자 22명, 여자 29명, 평균 56.5 ± 16세, 범위 22~88세) 중 37명(72.5%)은 경증, 14명(27.5%)은 중증이었다. 중증 환자들의 평균 연령(68.7 ± 12.5세)은 경증 환자들(51.8 ± 14.9세)보다 많았다(p < 0.001). 중증 환자가 기저질환을 가지고 있는 경우가 많았으며(71% vs. 41%, p = 0.049), 혈액검사에서 림프구 백분율 감소를 보이는 경우가 많았다(86% vs. 32%, p = 0.001). 흉부 CT 소견은 대부분의 환자들에서 간유리음영과 폐경화가 혼합된 양상이거나(76%) 간유리음영으로(22%) 나타났고, 양측 폐 하부, 후방, 변연부에 나타나는 경우가 많았다. 중증 환자에서 병변이 더 많은 수의 폐엽을 침범했고, CT 위중도 점수도 높았다. 결론 COVID-19 폐렴 확진 환자의 특징적인 흉부 CT 소견을 숙지하는 것이 빠른 진단과 적절한 치료에 도움이 될 것이다.

• 대한방사선기술학회지:방사선기술과학
• /
• 제43권5호
• /
• pp.397-404
• /
• 2020

Coronavirus disease(COVID-19) is highly infectious disease that directly affects the lungs. To observe the clinical findings from these lungs, the Chest Radiography(CXR) can be used in a fast manner. However, the diagnostic performance via CXR needs to be improved, since the identifying these findings are highly time-consuming and prone to human error. Therefore, Artificial Intelligence(AI) based tool may be useful to aid the diagnosis of COVID-19 via CXR. In this study, we explored various Deep learning(DL) approach to classify COVID-19, other viral pneumonia and normal. For the original dataset and lung-segmented dataset, the pre-trained AlexNet, SqueezeNet, ResNet18, DenseNet201 were transfer-trained and validated for 3 class - COVID-19, viral pneumonia, normal. In the results, AlexNet showed the highest mean accuracy of 99.15±2.69% and fastest training time of 1.61±0.56 min among 4 pre-trained neural networks. In this study, we demonstrated the performance of 4 pre-trained neural networks in COVID-19 diagnosis with CXR images. Further, we plotted the class activation map(CAM) of each network and demonstrated that the lung-segmentation pre-processing improve the performance of COVID-19 classifier with CXR images by excluding background features.

• 대한영상의학회지
• /
• 제82권2호
• /
• pp.359-370
• /
• 2021

목적 증상이 있는 123명의 coronavirus disease 2019 (이하 COVID-19) 환자에서 흉부 CT 병변의 소견과 일련의 변화를 분석하였다. 대상과 방법 2020년 2월 19일부터 4월 7일까지 총 123명의 COVID-19 환자(남성, 44명; 여성, 79명; 평균 연령 59.2 ± 18.6)를 후향적으로 연구하였다. 총 234개의 CT 스캔을 검토하여 패턴[급성 폐포 손상(acute alveolar insult) 패턴: 간유리음영, 돌조각보도모양, 혼합된 패턴, 또는 폐경화; 기질화 폐렴(organizing pneumonia) 패턴: 소엽주위 패턴, 띠 음영, 곡선형 음영, 역달무리 음영, 또는 소결절경화; 호전형 패턴: 순수 간유리음영, 잔존 곡선형 음영, 또는 소결절경화]과 폐 이상의 연속적인 변화를 분석하였다. 피어슨 카이 제곱 검정과 피셔의 정확 검정을 사용하여 시간 경과에 따른 급성 폐포 손상 패턴, 기질화 폐렴 패턴, 호전형 패턴의 비율을 비교하고, 패턴과 질병 심각도 간의 연관성을 분석하였다. 결과 초기 입원군(증상 발병 후 0~10일)의 CT 패턴은 급성 폐포 손상 패턴(87%) 이 가장 많았고, 후기 입원군(10일 이상)에서는 기질화 폐렴 패턴(45.7%), 퇴원군(퇴원 시 및 퇴원 후)에서는 호전형 패턴(47.2%; 84.8%)이 가장 많았다. 시간 경과에 따른 우세한 CT 패턴에 대한 비율의 차이는 통계적으로 유의하였다(p < 0.001, 피어슨 카이 제곱 검정). 패턴과 질병 중증도 간에 통계적으로 유의한 연관성은 발견되지 않았다(p = 0.055, 피셔의 정확 검정). 후속 CT 스캔에서 병변의 섬유화는 관찰되지 않았다. 결론 COVID-19 환자의 연속적 CT 스캔은 COVID 폐렴의 폐 손상 및 복구의 단계로서 다양한 CT 영상 소견을 보여주었다.

• 전자통신동향분석
• /
• 제36권5호
• /
• pp.42-50
• /
• 2021

A rapidly spreading unidentified type of pneumonia was initially reported in China in December 2019. On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a global pandemic. The world is making efforts to overcome COVID-19 using the experience of each country. From the beginning, Korea has been relatively successful in managing COVID-19 according to the "3T principle," that is, test-trace-treat. To share these experiences with the international community, in June 2020, Korea launched 18 projects in an attempt to standardize the COVID-19 response technology. This paper introduces the standardization trend of Korea's response to COVID-19.

• Korean Journal of Radiology
• /
• 제21권11호
• /
• pp.1256-1264
• /
• 2020

Objective: Lung segmentation using volumetric quantitative computed tomography (CT) analysis may help predict outcomes of patients with coronavirus disease (COVID-19). The aim of this study was to investigate the relationship between CT volumetric quantitative analysis and prognosis in patients with COVID-19. Materials and Methods: CT images from patients diagnosed with COVID-19 from February 18 to April 15, 2020 were retrospectively analyzed. CT with a negative finding, failure of quantitative analysis, or poor image quality was excluded. CT volumetric quantitative analysis was performed by automated volumetric methods. Patients were stratified into two risk groups according to CURB-65: mild (score of 0-1) and severe (2-5) pneumonia. Outcomes were evaluated according to the critical event-free survival (CEFS). The critical events were defined as mechanical ventilator care, ICU admission, or death. Multivariable Cox proportional hazards analyses were used to evaluate the relationship between the variables and prognosis. Results: Eighty-two patients (mean age, 63.1 ± 14.5 years; 42 females) were included. In the total cohort, male sex (hazard ratio [HR], 9.264; 95% confidence interval [CI], 2.021-42.457; p = 0.004), C-reactive protein (CRP) (HR, 1.080 per mg/dL; 95% CI, 1.010-1.156; p = 0.025), and COVID-affected lung proportion (CALP) (HR, 1.067 per percentage; 95% CI, 1.033-1.101; p < 0.001) were significantly associated with CEFS. CRP (HR, 1.164 per mg/dL; 95% CI, 1.006-1.347; p = 0.041) was independently associated with CEFS in the mild pneumonia group (n = 54). Normally aerated lung proportion (NALP) (HR, 0.872 per percentage; 95% CI, 0.794-0.957; p = 0.004) and NALP volume (NALPV) (HR, 1.002 per mL; 95% CI, 1.000-1.004; p = 0.019) were associated with a lower risk of critical events in the severe pneumonia group (n = 28). Conclusion: CRP in the mild pneumonia group; NALP and NALPV in the severe pneumonia group; and sex, CRP, and CALP in the total cohort were independently associated with CEFS in patients with COVID-19.