COVID-19's Continued Impact

Welcome to Diagnostic Imaging’s Weekly Scan. I’m Whitney Palmer, Senior Editor. We’re here with you, again, this week with the latest updates on the COVID-19 outbreak and its impact on the radiology industry.

To date, the neurological manifestations of COVID-19 in pediatric patients have not been extensively reported. However, this week, in the journal Radiology, researchers from Iran published a case of pediatric stroke related to the virus. With this case, a previously healthy 12-year-old boy was admitted to the hospital with seizures, but no other symptoms. Tests ruled out herpes simplex 1 and 2 infection, as well as varicella-zoster virus, and no one else in his family had a history of COVID-19 infection. While an RT-PCR test came back positive, low-dose CT, carotid color Doppler ultrasound, and echocardiography came back normal. MRI images, however, indicated stroke. The child was eventually discharged to home, but right-sided paralysis remained.

As the pandemic continues, the role of lung ultrasound is still emerging, particularly with pregnant women who test positive for the virus. In a study, published in the Journal of Ultrasound in Medicine, investigators from Turkey presented findings that showed lung ultrasound can either prompt or change treatment practices in this patient population. In a study of eight pregnant women, seven – 87 percent – had their doctor change their medication after seeing the lung ultrasound findings. The research team determined lung ultrasound is best used under three circumstances: with asymptomatic patients who are positive for the virus but for whom CT has not been planned, patients with mild symptoms who do not give consent for chest CT, and ultrasound surveillance of an asymptomatic patient with negative CT findings or for follow-up of treatment response in symptomatic patients.

Much attention has been paid throughout the pandemic to chest CT and chest X-ray scans. However, other imaging modalities and tools are also playing a role in assessing patients. And, radiologists need to know which modalities will work best in particular situations. In the journal Radiology: Cardiothoracic Imaging, researchers from Ichan School of Medicine at Mount Sinai outlined the uses, benefits, and limitations of chest CT, X-ray, MRI, PET/CT, chest ultrasound, echocardiography, and artificial intelligence tools in managing viral infection.

As imaging services continue to open up, being able to identify which patients need scans most urgently will be critical. To help interventional radiologists most effectively triage patients, a multi-academic medical center team, led by the University of California-Davis, created a five-tier system, in the American Journal of Roentgenology, to help radiologists categorize patients. They recommended providers triage patients based on urgent procedures, procedures that should be performed within two weeks, procedures that can be performed within two months, procedures that can be delayed for two months, and procedures that can be delayed for six months.

Heart researchers also shared news this week that could change how doctors assess a patient’s risk for developing coronary heart disease and experiencing a heart attack or dying. In a study published in JAMA Cardiology, investigators determined pairing coronary computed tomography angiography with exercise electro-echocardiography can provide a more accurate five-year assessment. By evaluating medical data from 3,283 patients, the team determined abnormal exercise ECG results were associated with a 14.5-fold increase in coronary revascularization within one year of evaluation and a 2.6-fold increase in experiencing a non-fatal heart attack or dying within five years. But, coronary CTA is associated with improved prognostic discrimination because patients with obstructive coronary artery disease had a 10.6-fold increased risk for negative outcomes within five years.

Whether you work in an academic department, a private practice, or in an imaging center, there is a high likelihood that you are now familiar with working remotely. For many of you, this might have been your first major foray into remote interactivity. Doing so can present challenges and opportunities both for career providers and trainees. This week, Diagnostic Imaging spoke with Dr. Matthew Barkovich, assistant professor in residence and a neuroradiologist at the University of California at San Francisco about how the department designed and implemented its remote interactivity structure, the challenges they faced, and the solutions they designed. Here’s what he had to say.