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A correlation between the severity of lung lesions on radiographs and clinical findings in patients with severe acute respiratory syndrome.

Wan YL, Tsay PK, Cheung YC, Chiang PC, Wang CH, Tsai YH, Kuo HP, Tsao KC, Lin TY - Korean J Radiol (2007 Nov-Dec)

Bottom Line: Forward stepwise multiple linear regression showed that the mean radiographic score correlated most significantly with the number of hospitalized days (p < 0.001).The second most significant factor was the absolute lymphocyte count (p < 0.001) and the third most significant factor was the number of days of intubation (p = 0.025).The maximal radiographic score correlated best with the percentage of lymphocytes in a leukocyte count (p < 0.001), while the second most significant factor was the number of hospitalized days (p < 0.001) and the third most significant factor was the absolute lymphocyte count (p = 0.013).

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial at Linkou, College of Medicine, Chang Gung University, 5 Fuhsing Rd., Kweishan, Taoyuan, Taiwan. ylw0518@adm.cgmh.org.tw

ABSTRACT

Objective: The purpose of this study was to quantify lesions on chest radiographs in patients with severe acute respiratory syndrome (SARS) and analyze the severity of the lesions with clinical parameters.

Materials and methods: Two experienced radiologists reviewed chest radiographs of 28 patients with SARS. Each lung was divided into upper, middle, and lower zones. A SARS-related lesion in each zone was scored using a four-point scale: zero to three. The mean and maximal radiographic scores were analyzed statistically to determine if the scorings were related to the laboratory data and clinical course.

Results: Forward stepwise multiple linear regression showed that the mean radiographic score correlated most significantly with the number of hospitalized days (p < 0.001). The second most significant factor was the absolute lymphocyte count (p < 0.001) and the third most significant factor was the number of days of intubation (p = 0.025). The maximal radiographic score correlated best with the percentage of lymphocytes in a leukocyte count (p < 0.001), while the second most significant factor was the number of hospitalized days (p < 0.001) and the third most significant factor was the absolute lymphocyte count (p = 0.013). The mean radiographic scores of the patients who died, with comorbidities and without a comorbidity were 11.1, 6.3 and 2.9, respectively (p = 0.032). The corresponding value for maximal radiographic scores were 17.7, 9.7 and 6.0, respectively (p = 0.033).

Conclusion: The severity of abnormalities quantified on chest radiographs in patients with SARS correlates with the clinical parameters.

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Related in: MedlinePlus

Serial radiographic changes in a 34-year-old female with SARS. The patient expired on the tenth day after fever onset.A. A close-up view of a chest radiograph in the posteroanterior projection obtained 3 days after fever onset shows opacity (arrow) mainly in the medial aspect of the right middle lung (radiographic score = 1).B. A close-up view of a chest radiograph in the posteroanterior projection obtained 4 days after fever onset shows progression of the right perihilar opacity (black arrow) in the right middle and right lower lung zone (white arrows) (radiographic score = 3).C. A Follow-up chest radiograph in the anteroposterior projection obtained 8 days after fever onset shows progression of the right perihilar opacity to the right upper zone (white arrow), middle and lower lung zones (black arrows) (radiographic score = 4).D. A follow-up chest radiograph in the anteroposterior projection obtained 9 days after fever onset shows marked progression of lung opacities to the right lung as well as to the middle and lower zones of the left lung (radiographic score = 12).E. A follow-up chest radiograph in anteroposterior projection obtained 10 days after fever onset shows progression of lung opacities to involve mainly the middle and lower zones of bilateral lungs (radiographic score = 14). The patient expired on the tenth day after fever onset.
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Figure 2: Serial radiographic changes in a 34-year-old female with SARS. The patient expired on the tenth day after fever onset.A. A close-up view of a chest radiograph in the posteroanterior projection obtained 3 days after fever onset shows opacity (arrow) mainly in the medial aspect of the right middle lung (radiographic score = 1).B. A close-up view of a chest radiograph in the posteroanterior projection obtained 4 days after fever onset shows progression of the right perihilar opacity (black arrow) in the right middle and right lower lung zone (white arrows) (radiographic score = 3).C. A Follow-up chest radiograph in the anteroposterior projection obtained 8 days after fever onset shows progression of the right perihilar opacity to the right upper zone (white arrow), middle and lower lung zones (black arrows) (radiographic score = 4).D. A follow-up chest radiograph in the anteroposterior projection obtained 9 days after fever onset shows marked progression of lung opacities to the right lung as well as to the middle and lower zones of the left lung (radiographic score = 12).E. A follow-up chest radiograph in anteroposterior projection obtained 10 days after fever onset shows progression of lung opacities to involve mainly the middle and lower zones of bilateral lungs (radiographic score = 14). The patient expired on the tenth day after fever onset.

Mentions: Two radiologists who had 15 and 26 years of professional experience, respectively, reviewed the radiographs together. The radiographic findings were recorded without the knowledge of the clinical data but with the knowledge that the patients were victims of suspicious or probable cases of SARS. Any differences in opinion were resolved by consensus. On each radiograph, each lung was divided into upper, middle and lower lung zones transversely, with each zone spanning one-third of the craniocaudal length of the lung. The severity of the SARS-related lesions within each lung zone was evaluated by scoring the radiographs with a four-point scale based on visual assessment, as follows: 0 = normal, 1 = up to one-third of lung zone involved, 2 = between one-third and two-thirds of lung zone involved, and 3 = more than two-thirds of lung zone involved. The scores for all 6 zones on each radiograph were added to provide a cumulative score that had a range from zero to 18 (Figs. 1, 2). In addition, data collected from all available chest radiographs included the following: whether the SARS-related lesions were unilateral or bilateral; were associated with radiographically identifiable pleural effusion (defined as increased pleural density with obscuration of the costophrenic sinuses and the hemidiaphragm with meniscus-shaped or horizontal upper border); mediastinal or hilar lymphadenopathy (defined as widening or increased opacity of the mediastinum and pulmonary hila); cavitary lung lesions. The mean radiographic score for each patient during hospitalization was obtained by summation of the radiographic score on each radiograph divided by the total number of radiograph obtained. The maximal radiographic score for each patient represented the worst condition of lung opacities during the clinical course.


A correlation between the severity of lung lesions on radiographs and clinical findings in patients with severe acute respiratory syndrome.

Wan YL, Tsay PK, Cheung YC, Chiang PC, Wang CH, Tsai YH, Kuo HP, Tsao KC, Lin TY - Korean J Radiol (2007 Nov-Dec)

Serial radiographic changes in a 34-year-old female with SARS. The patient expired on the tenth day after fever onset.A. A close-up view of a chest radiograph in the posteroanterior projection obtained 3 days after fever onset shows opacity (arrow) mainly in the medial aspect of the right middle lung (radiographic score = 1).B. A close-up view of a chest radiograph in the posteroanterior projection obtained 4 days after fever onset shows progression of the right perihilar opacity (black arrow) in the right middle and right lower lung zone (white arrows) (radiographic score = 3).C. A Follow-up chest radiograph in the anteroposterior projection obtained 8 days after fever onset shows progression of the right perihilar opacity to the right upper zone (white arrow), middle and lower lung zones (black arrows) (radiographic score = 4).D. A follow-up chest radiograph in the anteroposterior projection obtained 9 days after fever onset shows marked progression of lung opacities to the right lung as well as to the middle and lower zones of the left lung (radiographic score = 12).E. A follow-up chest radiograph in anteroposterior projection obtained 10 days after fever onset shows progression of lung opacities to involve mainly the middle and lower zones of bilateral lungs (radiographic score = 14). The patient expired on the tenth day after fever onset.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627448&req=5

Figure 2: Serial radiographic changes in a 34-year-old female with SARS. The patient expired on the tenth day after fever onset.A. A close-up view of a chest radiograph in the posteroanterior projection obtained 3 days after fever onset shows opacity (arrow) mainly in the medial aspect of the right middle lung (radiographic score = 1).B. A close-up view of a chest radiograph in the posteroanterior projection obtained 4 days after fever onset shows progression of the right perihilar opacity (black arrow) in the right middle and right lower lung zone (white arrows) (radiographic score = 3).C. A Follow-up chest radiograph in the anteroposterior projection obtained 8 days after fever onset shows progression of the right perihilar opacity to the right upper zone (white arrow), middle and lower lung zones (black arrows) (radiographic score = 4).D. A follow-up chest radiograph in the anteroposterior projection obtained 9 days after fever onset shows marked progression of lung opacities to the right lung as well as to the middle and lower zones of the left lung (radiographic score = 12).E. A follow-up chest radiograph in anteroposterior projection obtained 10 days after fever onset shows progression of lung opacities to involve mainly the middle and lower zones of bilateral lungs (radiographic score = 14). The patient expired on the tenth day after fever onset.
Mentions: Two radiologists who had 15 and 26 years of professional experience, respectively, reviewed the radiographs together. The radiographic findings were recorded without the knowledge of the clinical data but with the knowledge that the patients were victims of suspicious or probable cases of SARS. Any differences in opinion were resolved by consensus. On each radiograph, each lung was divided into upper, middle and lower lung zones transversely, with each zone spanning one-third of the craniocaudal length of the lung. The severity of the SARS-related lesions within each lung zone was evaluated by scoring the radiographs with a four-point scale based on visual assessment, as follows: 0 = normal, 1 = up to one-third of lung zone involved, 2 = between one-third and two-thirds of lung zone involved, and 3 = more than two-thirds of lung zone involved. The scores for all 6 zones on each radiograph were added to provide a cumulative score that had a range from zero to 18 (Figs. 1, 2). In addition, data collected from all available chest radiographs included the following: whether the SARS-related lesions were unilateral or bilateral; were associated with radiographically identifiable pleural effusion (defined as increased pleural density with obscuration of the costophrenic sinuses and the hemidiaphragm with meniscus-shaped or horizontal upper border); mediastinal or hilar lymphadenopathy (defined as widening or increased opacity of the mediastinum and pulmonary hila); cavitary lung lesions. The mean radiographic score for each patient during hospitalization was obtained by summation of the radiographic score on each radiograph divided by the total number of radiograph obtained. The maximal radiographic score for each patient represented the worst condition of lung opacities during the clinical course.

Bottom Line: Forward stepwise multiple linear regression showed that the mean radiographic score correlated most significantly with the number of hospitalized days (p < 0.001).The second most significant factor was the absolute lymphocyte count (p < 0.001) and the third most significant factor was the number of days of intubation (p = 0.025).The maximal radiographic score correlated best with the percentage of lymphocytes in a leukocyte count (p < 0.001), while the second most significant factor was the number of hospitalized days (p < 0.001) and the third most significant factor was the absolute lymphocyte count (p = 0.013).

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial at Linkou, College of Medicine, Chang Gung University, 5 Fuhsing Rd., Kweishan, Taoyuan, Taiwan. ylw0518@adm.cgmh.org.tw

ABSTRACT

Objective: The purpose of this study was to quantify lesions on chest radiographs in patients with severe acute respiratory syndrome (SARS) and analyze the severity of the lesions with clinical parameters.

Materials and methods: Two experienced radiologists reviewed chest radiographs of 28 patients with SARS. Each lung was divided into upper, middle, and lower zones. A SARS-related lesion in each zone was scored using a four-point scale: zero to three. The mean and maximal radiographic scores were analyzed statistically to determine if the scorings were related to the laboratory data and clinical course.

Results: Forward stepwise multiple linear regression showed that the mean radiographic score correlated most significantly with the number of hospitalized days (p < 0.001). The second most significant factor was the absolute lymphocyte count (p < 0.001) and the third most significant factor was the number of days of intubation (p = 0.025). The maximal radiographic score correlated best with the percentage of lymphocytes in a leukocyte count (p < 0.001), while the second most significant factor was the number of hospitalized days (p < 0.001) and the third most significant factor was the absolute lymphocyte count (p = 0.013). The mean radiographic scores of the patients who died, with comorbidities and without a comorbidity were 11.1, 6.3 and 2.9, respectively (p = 0.032). The corresponding value for maximal radiographic scores were 17.7, 9.7 and 6.0, respectively (p = 0.033).

Conclusion: The severity of abnormalities quantified on chest radiographs in patients with SARS correlates with the clinical parameters.

Show MeSH
Related in: MedlinePlus