Serial chest radiography sensitivity for detection of novel 2019 coronavirus infection approaches chest CT, suggesting utility of chest radiography as an adjunctive diagnostic tool for COVID-19 patients. ABBREVIATIONS AUC (area under the curve), ROC (receiver operating characteristic curve), COVID-19 (novel coronavirus 2019 infection), COVID-19+ (positive for novel coronavirus 2019 infection), COVID-19-(negative for novel coronavirus 2019 infection), GGO (ground-glass opacity), DA (diffuse airspace opacity), IA (interstitial and airspace opacities), FN (false negative)

A 12‐year‐old male was admitted to the Medical Intensive Care Unit for respiratory failure requiring temporary tracheostomy secondary to an extensive necrotizing methicillin‐resistant Staphylococcus aureus pneumonia. Imaging revealed destructive bronchiectasis and multifocal lung abscesses, more advanced in the right lung. He was discharged home after 42‐day hospital admission. 3.5 months after his discharge, he re‐presented to the Emergency Department with a large right pneumothorax and a pneumatocele measuring 10.2 × 6.2 cm2. He was admitted to the hospital and while his pneumothorax resolved in 2 days, the size of the pneumatocele was noted to fluctuate with different phases of respiration. A computed tomography scan of the chest demonstrated a fistula between the pneumatocele and right upper lobe bronchus. Following discussion between Pulmonary medicine and Interventional radiology, transbronchial closure of the air leak was planned. Intubation was done with a dual‐lumen endotracheal tube. Bronchography was performed using a diagnostic catheter. A large air leak was noted from the anterior segment of the right upper lobe bronchus. Embolization of the fistula was performed using n‐butyl cyanoacrylate (nBCA, glue) injected through a second catheter under fluoroscopic guidance. The residual pneumatocele slowly resolved over 2 months. Endobronchial embolization has been described in the literature as a treatment strategy for air leaks, largely in adult patients. Endobronchial embolization of large pneumatoceles and bronchopleural fistulas may offer an alternative treatment option with less morbidity than the classic surgical approach.

Background Diffusion‐weighted MRI (DW‐MRI) of the kidneys is a technique that provides information about the microstructure of renal tissue without requiring exogenous contrasts such as gadolinium, and it can be used for diagnosis in cases of renal disease and assessing response‐to‐therapy. However, physiological motion and large geometric distortions due to main B0 field inhomogeneities degrade the image quality, reduce the accuracy of quantitative imaging markers, and impede their subsequent clinical applicability. Purpose To retrospectively correct for geometric distortion for free‐breathing DW‐MRI of the kidneys at 3T, in the presence of a nonstatic distortion field due to breathing and bulk motion. Study Type Prospective. Subjects Ten healthy volunteers (ages 29–38, four females). Field Strength/Sequence 3T; DW‐MR dual‐echo echo‐planar imaging (EPI) sequence (10 b‐values and 17 directions) and a T2 volume. Assessment The distortion correction was evaluated subjectively (Likert scale 0–5) and numerically with cross‐correlation between the DW images at b = 0 s/mm2 and a T2 volume. The intravoxel incoherent motion (IVIM) and diffusion tensor (DTI) model‐fitting performance was evaluated using the root‐mean‐squared error (nRMSE) and the coefficient of variation (CV%) of their parameters. Statistical Tests Statistical comparisons were done using Wilcoxon tests. Results The proposed method improved the Likert scores by 1.1 ± 0.8 (P < 0.05), the cross‐correlation with the T2 reference image by 0.13 ± 0.05 (P < 0.05), and reduced the nRMSE by 0.13 ± 0.03 (P < 0.05) and 0.23 ± 0.06 (P < 0.05) for IVIM and DTI, respectively. The CV% of the IVIM parameters (slow and fast diffusion, and diffusion fraction for IVIM and mean diffusivity, and fractional anisotropy for DTI) was reduced by 2.26 ± 3.98% (P = 6.971 × 10−2), 11.24 ± 26.26% (P = 6.971 × 10−2), 4.12 ± 12.91% (P = 0.101), 3.22 ± 0.55% (P < 0.05), and 2.42 ± 1.15% (P < 0.05). Data Conclusion The results indicate that the proposed Di + MoCo method can effectively correct for time‐varying geometric distortions and for misalignments due to breathing motion. Consequently, the image quality and precision of the DW‐MRI model parameters improved. Level of Evidence 2 Technical Efficacy Stage 1

Background: A multidisciplinary team approach to the management of esophageal cancer patients leads to better clinical decisions. Purpose: The contribution of CT, endoscopic and laparoscopic ultrasound to clinical staging and treatment selection by multidisciplinary tumor boards (MTB) in patients with esophageal cancer is well documented. However, there is a paucity of data addressing the role that FDG-PET/CT (PET/CT) plays to inform the clinical decision-making process at MTB conferences. The aim of this study was to assess the impact and contribution of PET/CT to clinical management decisions and to the plan of care for esophageal cancer patients at the MTB conferences held at our institution. Materials and methods: This IRB approved study included all the cases discussed in the esophageal MTB meetings over a year period. The information contributed by PET/CT to MTB decision making was grouped into four categories. Category I, no additional information provided for clinical management; category II, equivocal and misguiding information; category III, complementary information to other imaging modalities, and category IV, information that directly changed clinical management. The overall impact on management was assessed retrospectively from prospectively discussed clinical histories, imaging, histopathology, and the official minutes of the MTB conferences. Results: 79 patients (61 males and 18 females; median age, 61 years, range, 33-86) with esophageal cancer (53 adenocarcinomas and 26 squamous cell carcinomas) were included. The contribution of PET/CT-derived information was as follows: category I in 50 patients (63%); category II in 3 patients (4%); category III in 8 patients (10%), and category IV information in 18 patients (23%). Forty-five patients (57%) had systemic disease, and in 5 (11%) of these, metastatic disease was only detected by PET/CT. In addition, PET/CT detected previously unknown recurrence in 4 (9%) of 43 patients. In summary, PET/CT provided clinically useful information to guide management in 26 of 79 esophageal cancer patients (33%) discussed at the MTB. Conclusion: The study showed that PET/CT provided additional information and changed clinical management in 1 out of 3 (33%) esophageal cancer cases discussed at MTB conferences. These results support the inclusion whenever available, of FDG-PET/CT imaging information to augment and improve the patient management decision process in MTB conferences.

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