Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new virus recently isolated from humans. SARS-CoV-2 was discovered to be the pathogen responsible for a cluster of pneumonia cases associated with severe respiratory disease that occurred in December 2019 in China. This novel pulmonary infection, formally called Coronavirus Disease 2019 (COVID-19), has spread rapidly in China and beyond. On 8 March 2020, the number of Italians with SARS-CoV-2 infection was 7375 with a 48% hospitalization rate. At present, chest-computed tomography imaging is considered the most effective method for the detection of lung abnormalities in early-stage disease and quantitative assessment of severity and progression of COVID-19 pneumonia. Although chest X-ray (CXR) is considered not sensitive for the detection of pulmonary involvement in the early stage of the disease, we believe that, in the current emergency setting, CXR can be a useful diagnostic tool for monitoring the rapid progression of lung abnormalities in infected patients, particularly in intensive care units. In this short communication, we present our experimental CXR scoring system that we are applying to hospitalized patients with COVID-19 pneumonia to quantify and monitor the severity and progression of this new infectious disease. We also present the results of our preliminary validation study on a sample of 100 hospitalized patients with SARS-CoV-2 infection for whom the final outcome (recovery or death) was available.

Purpose To improve the risk stratification of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an experimental chest X-ray (CXR) scoring system for quantifying lung abnormalities was introduced in our Diagnostic Imaging Department. The purpose of this study was to retrospectively evaluate correlations between the CXR score and the age or sex of Italian patients infected with SARS-CoV-2. Materials and methods Between March 4, 2020, and March 18, 2020, all CXR reports containing the new scoring system were retrieved. Only hospitalized patients with SARS-CoV-2 infection were enrolled. For each patient, age, sex, and the CXR report containing the highest score were considered for the analysis. Patients were also divided into seven groups according to age. Nonparametric statistical tests were used to examine the relationship between the severity of lung disease and the age or sex. Results 783 Italian patients (532 males and 251 females) with SARS-CoV-2 infection were enrolled. The CXR score was significantly higher in males than in females only in groups aged 50 to 79 years. A significant correlation was observed between the CXR score and age in both males and females. Males aged 50 years or older and females aged 80 years or older with coronavirus disease 2019 showed the highest CXR score (median ≥ 8). Conclusions Males aged 50 years or older and females aged 80 years or older showed the highest risk of developing severe lung disease. Our results may help to identify the highest-risk patients and those who require specific treatment strategies.

This study aimed to assess the usefulness of a new chest X-ray scoring system - the Brixia score - to predict the risk of in-hospital mortality in hospitalized patients with coronavirus disease 2019 (COVID-19). Between March 4, 2020 and March 24, 2020, all CXR reports including the Brixia score were retrieved. We enrolled only hospitalized Caucasian patients with COVID-19 for whom the final outcome was available. For each patient, age, sex, underlying comorbidities, immunosuppressive therapies, and the CXR report containing the highest score were considered for analysis. These independent variables were analyzed using a multivariable logistic regression model to extract the predictive factors for in-hospital mortality. 302 Caucasian patients who were hospitalized for COVID-19 were enrolled. In the multivariable logistic regression model, only Brixia score, patient age, and conditions that induced immunosuppression were the significant predictive factors for in-hospital mortality. According to receiver operating characteristic curve analyses, the optimal cutoff values for Brixia score and patient age were 8 points and 71 years, respectively. Three different models that included the Brixia score showed excellent predictive power. Patients with a high Brixia score and at least one other predictive factor had the highest risk of in-hospital death.

Objective: The aim of the study was to evaluate the CT and fluorine-18-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) imaging findings of lung mucosa associated lymphoid tissue (MALT) lymphoma. Methods: 28 patients with histologically confirmed pulmonary MALT lymphoma who underwent a chest CT and 18F-FDG PET/CT for staging were retrospectively analysed. The CT images were evaluated to determine morphological pattern of appearance, laterality, localization, number, size, presence of thoracic lymphadenopaties and secondary/combined findings. PET images were analysed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax), lesion-to-liver SUVmax ratio and lesion-to-blood pool SUVmax ratio. The relationship between qualitative and semi-quantitative features at 18F-FDG PET/CT and CT findings were also analysed. Results: A total of 57 pulmonary lesions were identified by CT: 37 areas of consolidation, 4 masses, 12 nodules and 4 ground-glass opacities. Solitary and multiple lesions were detected in 10 and 18 patients, respectively; among patients with multiple lesions, 16 were bilateral and 2 unilateral. 18F-FDG PET/CT revealed increased 18F-FDG uptake in 47/57 lesions, in 26/28 patients. 18F-FDG avidity was significantly associated only with tumour size. Conclusions: Pulmonary MALT lymphoma is 18F-FDG avid in most cases and 18F-FDG avidity is correlated with tumour size. Consolidation is the most frequent morphological pattern of disease presentation. Advances in knowledge: This study demonstrated that lung MALT lymphoma are 18F-FDG avid in most cases depending on tumour size. Single or multiple areas of consolidation are the most common pattern of presentation of lung MALT lymphoma at CT.

The much-heralded second wave of coronavirus disease (COVID-19) has arrived in Italy. Right now, one of the main questions about COVID-19 is whether the second wave is less severe and deadly than t...

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