Neurocysticercosis is a neurologic parasitic disease caused by the encysted larva of the tapeworm Taenia solium and is the most important parasitic disease of the human central nervous system. It is ...the most common cause of acquired epilepsy in endemic settings and constitutes a public health challenge for most of the developing world. Nowadays, however, as a result of globalization, neurocysticercosis is being seen more frequently in developed countries as well. Neurocysticercosis is acquired through fecal-oral contamination, and the disease course is complex, with two intermediate hosts (ie, pigs and humans) and a definitive host (humans). Traditionally, it has been classified into active and nonactive forms according to disease location. Radiologists must be aware of its imaging appearance, which is quite variable, as is the differential diagnosis. Imaging findings depend on several factors, including the stage of the life cycle of T solium at presentation; the number and location (ie, subarachnoid, cisternal, or intraventricular) of parasites; and associated complications such as vascular involvement (ie, arteritis with or without infarction), inflammatory response (ie, edema, gliosis, or arachnoiditis), and, in ventricular forms, degree of obstruction. Thus, the diagnostic approach, management, and prognosis for neurocysticercosis differ widely depending on the type of infection.
Coronary artery dilatations-aneurysms and ectasia-are an uncommon and frequently unrecognized incidental finding in patients with coronary artery disease. Aneurysms and ectasia are associated with a ...vast group of disorders, and the evaluation and characterization of coronary aneurysms and ectasia represent a great diagnostic task with clinical and therapeutic implications. The underlying etiology is variable and includes degenerative, congenital, inflammatory, infectious, toxic, and traumatic causes. Unlike aneurysms, ectasia is more frequently seen in association with atherosclerosis or as a compensatory mechanism in those cases in which a proximal stenosis is noted in the opposite coronary artery; ectasia is also seen in some coronary artery anomalies, such as anomalous origin from the pulmonary artery, or as a result of a high-flow state, as seen in coronary artery fistulas. The diagnostic approach depends on the clinical scenario, and nowadays, noninvasive evaluation with multidetector computed tomography is possible. Imaging assessment should include evaluation of (a) the distribution, (b) maximal diameter, (c) presence or absence of intraluminal thrombi, (d) number, (e) extension, and (f) associated complications such as myocardial infarction. This article presents an overview of the definition, classification, etiology, clinical manifestations, and potential complications of coronary artery aneurysms and ectasia.
Aim
To evaluate the stiffness of parotid and submandibular glands using elastography ultrasound and to correlate it with B‐mode ultrasonographical, clinical and serological features, salivary ...profibrotic and inflammatory chemokines, and salivary gland fibrosis.
Methods
We performed B‐mode and elastography ultrasound of major salivary glands of 26 patients with primary Sjögren's syndrome. We registered the shear wave velocity (SWV) and correlated it with the morphologic ultrasonographic changes assessed by the Hocevar scale. We assessed the European League Against Rheumatism (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), non‐stimulated whole salivary flow rate (NSWSF), C3 and C4 levels, anti‐Ro/La antibodies, salivary inflammatory (C‐X‐C motif ligand 13 CXCL13, CXCL10, CXCL8, C‐C motif ligand 2 CCL2, interleukin 10 IL‐10 and IL‐6) and pro‐fibrotic (CXCL14, CCL28, tumor necrosis factor‐related apoptosis‐inducing ligand and transforming growth factor β) chemokines and cytokines and evaluated the presence of fibrosis in the minor salivary gland.
Results
Ninety‐two percent of patients were women; mean age was 51.1 ± 11 years; median disease duration was 6.1 years; 92.3% had oral symptoms and 26.9% fibrosis. The median B‐mode score was 22.2 points and the median SWV 2.5 m/s (τ = 0.53, P = 0.001). The SWV correlated with the NSWSF (τ = –0.53, P = 0.001), ESSDAI (τ = 0.31, P = 0.03), glandular ESDDAI domain (τ = 0.36, P = 0.02), C4 levels (τ = –0.32, P = 0.04), salivary CXCL13 (τ = 0.29, P = 0.03) and CXCL10 (τ = 0.30, P = 0.003), but not with age and fibrosis.
Conclusion
WV correlated with the B‐mode ultrasound score, systemic and glandular activity and in a large degree with CXCL10, an inflammatory chemokine, but not with fibrosis. An increased SWV might represent chronic glandular inflammation rather than fibrotic changes in these patients.
To the Editor, Transcatheter aortic valve implantation (TAVI) can trigger significant conduction disorders due to the mechanical compression caused by the transcatheter heart valve. This is because ...of the proximity between the aortic annulus, the atrioventricular node, and the membranous septum (MS) of the left ventricular outflow tract. The rate of pacemaker implantation after TAVI ranges from 4% to 33%.1 This retrospective analytical study included symptomatic patients with severe aortic stenosis referred for multidetector computed tomography as part of the TAVI protocol from December 2012 through October 2022. Written informed consent was obtained from all patients prior to the tomography scan. We excluded patients with bicuspid aortic valve anatomy, pacemaker carriers, and those with biological bioprosthetic valves. The aim of this study was to determine whether MS length is associated with the need for pacemaker implantation after TAVI. MS length was measured as the maximum distance from the plane of the aortic annulus to the top of the muscular portion of the ventricular septum in the coronal plane during systole (figure 1A,B).2 Qualitative variables were analyzed using the chi-square test or Fisher exact test, while quantitative variables were analyzed using the Mann-Whitney U test. P values < .005 were considered statistically significant...
State-of-the-art multidetector computed tomographic (CT) technology has replaced invasive angiography for evaluation of patients suspected to have aortic disease. Although most aortic disease is ...associated with atherosclerosis (ie, aneurysms and dissection), the spectrum of aortic disease is vast and includes various congenital and acquired entities. Radiologists should also be familiar with uncommon aortic diseases, which are divided into those that are congenital in origin and acquired disorders, and with their findings at multidetector CT. The first group includes patent ductus arteriosus, aortic hypoplasia, aortic coarctation, interrupted aortic arch, aortopulmonary window, common arterial trunk, supravalvular aortic stenosis, and vascular rings. The acquired disorders include aortic dissection due to extension of a coronary artery dissection, Marfan syndrome, large-vessel vasculitis such as Takayasu arteritis, and mycotic aneurysms. Finally, specific conditions associated with therapeutic maneuvers--such as recoarctation, stent-graft rupture, and endoleaks--can also be assessed with multidetector CT. Multidetector CT is an alternative tool helpful in establishing the primary diagnosis, defining anatomic landmarks and their relationships, and identifying associated cardiovascular anomalies. It is also an adjunct in the evaluation of complications during follow-up.
Background and Aim
Hepatic steatosis (HS) is associated with diabetes, hypertension, and obesity, comorbidities recently related to COVID‐19 severity. Here, we assessed if tomographic HS is also a ...risk factor for severe COVID‐19 pneumonia.
Methods
We included 213 patients with a positive real time polymerase chain reaction (RT‐PCR) test and chest computed tomography (CT) from an out‐hospital facility and a hospital. We obtained information on demographics; weight; height; smoking history; diabetes; hypertension; and cardiovascular, lung, and renal disease. Two radiologists scored the CO‐RADs system (COVID‐19 Reporting and Data System) (1 = normal, 2 = inconsistent, 3–4 = indeterminate, and 5 = typical findings) and the chest CT severity index (≥20 of 40 was considered severe disease). They evaluated the liver‐to‐spleen ratio (CTL/S) and defined tomographic steatosis as a CTL/S index ≤0.9. We used descriptive statistics, χ2 and t student tests, logistic regression, and reported odds ratio (OR) with 95% confidence interval (CI).
Results
Of the patients, 61% were men, with a mean age of 51.2 years, 48.3% were CO‐RADs 1 and 51.7% CO‐RADs 2–5. Severe tomographic disease was present in 103 patients (48.4%), all CO‐RADs 5. This group was older; mostly men; and with a higher prevalence of obesity, hypertension, diabetes, and HS (69.9 vs 29%). On multivariate analysis, age (OR 1.058, 95% CI 1.03–1.086, P < 0.0001), male gender (OR 1.9, 95% CI 1.03–3.8, P = 0.04), and HS (OR 4.9, 95% CI 2.4–9.7, P < 0.0001) remained associated.
Conclusion
HS was independently associated with severe COVID pneumonia. The physiopathological explanation of this finding remains to be elucidated. CTL/S should be routinely measured in thoracic CT scans in patients with COVID‐19 pneumonia.
Hepatic steatosis is an independent risk factor for chest computed tomography ?(CT)?severe ?COVID‐19? infection (odds ratio 4.9, 95% confidence interval 2.4–?9.7, P < 0.0001). Liver CT density should be measured and reported in all chest CT scans in patients with ?COVID‐19? pneumonia.
Background Left ventricular noncompaction (LVNC) is a cardiomyopathy characterized by a noncompacted myocardial layer in the left ventricle, primarily diagnosed by echocardiographic and magnetic ...resonance criteria. Multidetector computed tomography (MDCT) is an imaging method that has been increasingly used in cardiac evaluation. However, tomographic criteria to diagnose LVNC have not been determined. Objectives We assessed the structural characteristics of LVNC with MDCT and proposed tomographic criteria that may differentiate LVNC from healthy subjects and patients with other cardiomyopathies that might be associated with increased myocardial trabeculation. Methods Between March 2007 and June 2009 we studied 10 consecutive patients with LVNC diagnosed by echocardiogram and/or magnetic resonance imaging who underwent electrocardiogram-gated coronary CT angiography. We evaluated the ratio of noncompacted to compacted myocardium (NC/C ratio) in end diastole in each of the 17 segments established by the American Heart Association (excluding the apex). The results were compared with 9 healthy subjects, 14 patients with hypertrophic cardiomyopathy, and 17 patients with dilated cardiomyopathy to determine the cutoff that would distinguish patients with LVNC. Results When considering involvement of more than 1 segment, the NC/C ratio of 2.2 distinguished pathologic noncompaction, with sensitivity and specificity of 100% and 95%, respectively. In addition, the involvement of ≥2 segments allows the distinction of all patients with LVNC from other cardiomyopathies and from healthy subjects. Conclusions LVNC can be accurately diagnosed with MDCT when using a cutoff NC/C ratio of 2.2 at end diastole involving ≥2 segments.
ABCA1 genetic variation is known to play a role in HDL-C levels and various studies have also implicated ABCA1 variation in cardiovascular risk. The functional ABCA1/R230C variant is frequent in the ...Mexican population and has been consistently associated with low HDL-C concentrations. Although it has been associated with other cardiovascular risk factors such as obesity and type 2 diabetes mellitus, it is not known whether it is associated with coronary artery disease (CAD).
The purpose of the study was to analyze whether the ABCA1/R230C variant is associated with premature CAD in a case-control association study (GEA or Genetics of Atherosclerotic Disease), and to explore whether BMI modulates the effect of the C230 allele on other metabolic traits using a population-based design.
The C230 allele was significantly associated with both lower HDL-C levels and a lower risk of premature CAD as compared to controls (OR = 0.566; P(add) = 1.499×10(-5)). In addition, BMI modulated the effect of R230C on body fat distribution, as the correlation between BMI and visceral to subcutaneous adipose tissue (a metric of the propensity to store fat viscerally as compared to subcutaneously) was negative in RR homozygous individuals, but positive in premenopausal women bearing the C230 allele, with a statistically significant interaction (P = 0.005). BMI-R230C interaction was also significant for triglyceride levels in women regardless of their menopausal status (P = 0.036).
This is the first study assessing the effect of the R230C/ABCA1 variant in remature CAD. C230 was associated with both decreased HDL-C levels and a lower risk of premature CAD, and gender-specific BMI-R230C interactions were observed for different metabolic traits. These interactions may help explain inconsistencies in associations, and underscore the need to further analyze interactions of this functional and frequent variant with diet, exercise and other environmental factors.
Dental computed tomography (CT) is a diagnostic examination for the preoperative evaluation of patients who will undergo placement of oral implants. It can be performed with multidetector CT or more ...recently with cone-beam CT. The growing older population and the consequent development of edentulism have increased the number of imaging studies performed for preoperative evaluation of dental implantation. Thus, radiologists are becoming more frequently involved in this type of testing. Dental CT is superior to conventional x-ray techniques because superimposition and distortion are eliminated; therefore, possible complications such as injury of the neurovascular bundle and perforation of the maxillary sinuses can be avoided. This noninvasive and fast method provides accurate information about the positions of important structures to allow one to determine the implant required. Dental CT enables analysis of the state, quality, and quantity of bone on two-dimensional and three-dimensional reformatted images, and its high spatial resolution allows exact measurements of the length and width of the alveolar ridge. Inclusion of all this information in the radiology report facilitates achievement of a successful implantation.
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