Background
The recent pandemic of COVID‐19 has thrown the world into chaos due to its high rate of transmissions. Recently viewed neurological manifestations among hospitalized Egyptian patients with ...COVID‐19 in quarantine centres. Ataxia, disturbed consciousness and convulsions should be further evaluated by MRI and MRS for CNS involvement by SARS‐CoV‐2. How COVID-19 targeting the CNS is still under study, as it is difficult to predict which diagnostic neurological tests will be used to identify high-risk COVID19 patients. MR spectroscopy represents a non-invasive in vivo diagnostic technique for evaluation of metabolic profile of the brain and can reveal important information about the underlying pathologies. Multiple recent reports in the medical literature had confirmed the neurological complications in COVID-19 infection, though few studies has reported the MR spectroscopic findings in these patients. This cross-sectional study aimed to use MRI and MR spectroscopic findings for evaluation of the neurological manifestation of Egyptian COVID‐19 patients.
Results
Ninety-one male and twenty-seven female met the inclusion criteria, with a mean age of 52 years ± 10 (SD) (age range; 12–78 years). The commonest neurological manifestations were disturbed conscious level (82.2%). The most common MRI findings were acute ischemic insult with/without haemorrhagic areas (42.3%), demyelinating patches of altered signal intensity (31.3%). Sixty cases who had haemorrhagic areas were excluded to perform MRS due to contamination of the spectra by blood component. However, the remaining 67 patients had NAA reduction, choline elevation, glutamate/glutamine and lactate elevation in short TE35, with mean of NAA/Cr ratio = 1.04 ± 0.14, Choline/Cr = 0.49 ± 0.04 and Glx/Cr = 1.56 ± 0.22.
Conclusions
During the current pandemic of COVID-19, radiologists should be aware of wide spectrum of MRI and MRS findings of COVID-19-related CNS involvement.
Background
After the spread of COVID-19 pneumonia, chest CT examination was used as a substantial non-invasive complement to RT-PCR for diagnosing and as a rapid screening tool when RT-PCR results ...are unavailable. Our study aimed at the analysis of the lung abnormalities detected by chest CT in COVID-19 pneumonia according to the severity and duration of symptoms.
Results
In the early phase (
n
= 60), 32 patients had negative CT findings and 28 patients had positive findings with a mean total lung severity score of 2.13. In the intermediate phase (
n
= 116), 4 patients had negative CT findings and 112 patients had positive findings with a mean total lung severity score of 16.08. In the late phase (
n
= 36), all patients had positive findings with a mean total lung severity score of 17.83. CT lung abnormalities were progressed on follow-up CT studies. We found a high total lung severity score in many patients with mild symptoms with a mean of 14.77 and a low total lung severity score in many patients with moderate to severe symptoms with a mean of 9.14.
Conclusion
Chest CT should be used as a routine examination for diagnosing COVID-19 pneumonia and follow-up of disease advance. The progression of lung abnormalities was related to the duration more than the severity of symptoms.
Background
There is limited data in the literature regarding the role of nonarthrographic MRI for detecting biceps pulley (BP) lesions.
Purpose
To assess the accuracy of nonarthrographic MRI for ...detecting BP lesions, and to evaluate the diagnostic value of various MRI signs (superior glenohumeral ligament discontinuity/nonvisibility, long head of biceps (LHB) displacement sign or subluxation/dislocation, LHB tendinopathy, and supraspinatus and subscapularis tendon lesions) in detecting such lesions.
Study Type
Retrospective.
Population
84 patients (32 in BP‐lesion group and 52 in BP‐intact group‐as confirmed by arthroscopy).
Field Strength/Sequence
1.5‐T, T1‐weighted turbo spin echo (TSE), T2‐weighted TSE, and proton density‐weighted TSE spectral attenuated inversion recovery (SPAIR) sequences.
Assessment
Three radiologists independently reviewed all MRI data for the presence of BP lesions and various MRI signs. The MRI signs and final MRI diagnoses were tested for accuracy regarding detecting BP lesions using arthroscopy results as the reference standard. Furthermore, the inter‐reader agreement (IRA) between radiologists was determined.
Statistical Tests
Student's t‐tests, Chi‐squared, and Fisher's exact tests, and 4‐fold table test were used. The IRA was calculated using Kappa statistics. A P‐value <0.05 was considered statistically significant.
Results
The sensitivity, specificity, and accuracy of nonarthrographic MRI for detecting BP lesions were 65.6%–78.1%, 90.4%–92.3%, and 81%–86.9%, respectively. The highest accuracy was noticed for the LHB displacement sign (84.5%–86.9%), and the highest sensitivity was registered for the LHB tendinopathy sign (87.5%). Furthermore, the highest specificity was observed for the LHB displacement sign and LHB subluxation/dislocation sign (98.1%–100%). The IRA regarding final MRI diagnosis and MRI signs of BP lesions was good to very good (κ = 0.76–0.98).
Data Conclusion
Nonarthrographic shoulder MRI may show good diagnostic accuracy for detecting BP lesions. The LHB displacement sign could serve as the most accurate and specific sign for diagnosis of BP lesions.
Level of Evidence
3
Technical Efficacy
Stage 2
Background
The recent pandemic of COVID‐19 has thrown the world into chaos due to its high rate of transmissions. This study aimed to highlight the encountered CT findings in 910 patients with ...COVID-19 pneumonia in Egypt including the mean severity score and also correlation between the initial CT finding and the short-term prognosis in 320 patients.
Results
All patients had confirmed COVID-19 infection. Non-contrast CT chest was performed for all cases; in addition, the correlation between each CT finding and disease severity or the short-term prognosis was reported. The mean age was higher for patients with unfavorable prognosis (
P
< 0.01). The patchy pattern was the most common, found in 532/910 patients (58.4%), the nodular pattern was the least common 123/910 (13.5%). The diffuse pattern was reported in 124 (13.6%). The ground glass density was the most common reported density in the study 512/910 (56.2%). The crazy pavement sign was reported more frequently in patients required hospitalization or ICU and was reported in 53 (56.9%) of patients required hospitalization and in 29 (40.2%) patients needed ICU, and it was reported in 11 (39.2%) deceased patients. Air bronchogram was reported more frequently in patients with poor prognosis than patients with good prognosis (16/100; 26% Vs 12/220; 5.4%). The mean CT severity score for patients with poor prognosis was 15.2. The mean CT severity score for patients with good prognosis 8.7., with statistically significant difference (
P
= 0.001).
Conclusion
Our results confirm the important role of the initial CT findings in the prediction of clinical outcome and short-term prognosis. Some signs like subpleural lines, halo sign, reversed halo sign and nodular shape of the lesions predict mild disease and favorable prognosis. The crazy paving sign, dense vessel sign, consolidation, diffuse shape and high severity score predict more severe disease and probably warrant early hospitalization. The high severity score is most important in prediction of unfavorable prognosis. The nodular shape of the lesions is the most important predictor of good prognosis.
Background
Cardiomyopathy is a myocardial disease, which usually demonstrates improper ventricular morphology, function, or both. It is classified into two classes based on the organ involved. ...Primary cardiomyopathy is confined mainly to the myocardium and can be genetic, non-genetic, or acquired. Secondary cardiomyopathy is caused by generalized systemic disorder. Myocardial fibrosis produces abnormal myocardial stiffness and increases arrhythmias risk. Native T1-mapping is an innovative technique that provides quantitative assessment of edema, diffuse myocardial fibrosis, and inflammation in a number of disease states. Furthermore native T1 mapping provides a future method for quantifying myocardial fibrosis in advanced chronic kidney disease and dialysis patients without the use of gadolinium-based contrast agents. So our aim is to assess the potential value of segmental quantification of myocardial fibrosis using native T1 mapping in different types of cardiomyopathy in comparison to late gadolinium enhancement (LGE) imaging.
Results
The native T1 values of a total 1152 segments (16 segments in 72 patients of cardiomyopathy), 192 segments in 12 patients with hypertrophic cardiomyopathy (HCM), 800 segments in 50 patients with dilated cardiomyopathy (DCM), 80 segments in 5 patients with infiltrative cardiomyopathy, and 80 segments in 5 patients with non-compaction were assessed. These were compared with 160 segments of 10 healthy volunteers. Native T1 values were significantly higher in most of myocardial segments with LGE than in those without including the control group; non-contrast T1 values in mid LV septal segments were found the most significant (1130.85 ± 79.79 ms vs 1047.74 ± 42.74 ms;
P
= 0.001). Also the current study showed T1 values were significantly higher than normal even in segments unaffected by LGE (
P
<0.01) in both HCM and DCM groups. A receiver operating characteristic (ROC) analysis revealed the required cutoff value of 1070 ms for detecting myocardial fibrosis with a sensitivity 66% and specificity of 68%.
Conclusion
Contrast-free T1-mapping is a new technique for detecting myocardial fibrosis objectively with a high diagnostic performance especially in patients who cannot afford gadolinium contrast agents as patients with end-stage renal disease.
Objective
To determine prognostic value of bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) measured on baseline dual-phase
18
F-FDG PET/CT in a series of newly diagnosed ...patients with diffuse large B-cell lymphoma (DLBCL) treated homogeneously with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy.
Patients and methods
This prospective study enrolled 135 patients with newly diagnosed DLBCL. All patients underwent dual-phase
18
F-FDG PET/CT. The following PET parameters were calculated for both tumor and bone marrow: maximum standardized uptake value (SUVmax) at both time points (SUVmax early and SUVmax delayed), SUVmax increment (SUVinc), RI, and BLR. Patients were treated with R-CHOP regimen and response at end of treatment was assessed.
Results
The final analysis included 98 patients with complete remission. At a median follow-up of 22 months, 57 patients showed no relapse, 74 survived, and 24 died. The 2-year relapse-free survival (RFS) values for patients with higher and lower RI-bm were 20% and 65.1%, respectively (p < 0.001), and for patients with higher and lower BLR were 30.2% and 69.6%, respectively (
p
< 0.001). The 2-year overall survival (OS) values for patients with higher and lower RI-bm were 60% and 76.3%, respectively (
p
= 0.023), and for patients with higher and lower BLR were 57.3% and 78.6%, respectively (p = 0.035). Univariate analysis revealed that RI-bm and BLR were independent significant prognostic factors for both RFS and OS (hazard ratio HR = 4.02,
p
< 0.001, and HR = 3.23,
p
< 0.001, respectively) and (HR = 2.83,
p
= 0.030 and HR = 2.38,
p
= 0.041, respectively).
Conclusion
Baseline RI-bm and BLR were strong independent prognostic factors in DLBCL patients.
Clinical relevance statement
Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) could represent suitable and noninvasive positron emission tomography/computed tomography (PET/CT) parameters for predicting pretreatment risk in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy.
Key Points
•
Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) are powerful prognostic variables in diffuse large B-cell lymphoma (DLBCL) patients
.
•
High BLR and RI-bm are significantly associated with poor overall survival (OS) and relapse-free survival (RFS)
.
•
RI-bm and BLR represent suitable and noninvasive risk indicators in DLBCL patients
.
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