[Acute muscle loss and early effects of COVID-19 on skeletal muscle in adult patients: a retrospective cohort study]. / Pérdida muscular aguda y primeros efectos de la COVID-19 en el músculo esquelético de pacientes adultos: estudio de cohortes retrospectivo.

OBJECTIVES: It is known that COVID-19 has multisystemic effects. However, its early effects on muscle tissue have not been clearly elucidated. The aim of this study is to investigate early changes in the pectoral muscle in patients with COVID-19 infection. MATERIALS AND METHODS: The pectoral muscle areas (PMA) and pectoral muscle index (PMI) of 139 patients diagnosed with COVID-19 were measured from chest CTs taken at the time of the first diagnosis and within 6 months after the diagnosis. The effect of the infection on the muscle area was investigated by evaluating whether there was a change between the two measurements. Lung involvement of the infection in the first CT was scored with the CT severity score (CT-SS). In addition, the effects of patients' clinics, CT-SS, length of hospital stay, and intubation history on changes in the muscle area were investigated. RESULTS: When the PMA and PMI values were compared, there was a statistically significant decrease in the values in the control CT group compared to the first diagnosis CT group. The difference was found higher in intubated patients. CT-SS was associated with a decrease in PMI.COVID-19 is one of the causes of acute sarcopenia. Pectoralis muscle is part of the skeletal muscle, and there may be a decrease in the muscle area in the early period of the disease.

Association between mesenteric panniculitis and non-neoplastic disorders.

PURPOSE: To assess the relationship between MP and coexisting non-neoplastic disorders. METHODS: Consecutive abdominal computed tomography (CT) scans of 4674 patients were evaluated retrospectively for CT features of MP between January 2017 and January 2018. Clinical findings of patients were analyzed. Four control patients were selected from our cohort for each MP patient such that they matched for age, gender and CT protocol. Statistical analysis was performed using a t, Mann-Whitney U, χ2, or Fisher's test. RESULTS: 976 patients were excluded from the study due to the exclusion criteria and finally, 102/3698 patients were diagnosed with MP (mean age = 57.2 ± 12.5 years, 52% male). On CT, a hyperattenuated fatty mass (120/120), subcentimeter lymph nodes (117/120), congregation of mesenteric vessels (82/120) within the mass, a fat halo sign (28/120) and a pseudocapsule (88/120) were seen at the mesentery.The intra-observer agreement was almost perfect for the fatty mass and lymph nodes and moderate or substantial for other CT features (p < 0.001). The most prominent disorders were metabolic syndrome (MetS) and urogenital diseases in MP (45%, 37%, respectively) and control groups (31%, 26%, respectively). Between groups, no significant differences were found in the history of abdominal surgery, gastrointestinal and autoimmune diseases (p-value range 0.064-0.663); however, significant differences were found in the rates of vascular, urogenital diseases and MetS (p-value range 0.012-0.036). CONCLUSION: MetS and urolithiasis were significantly more common in patients with MP than in those without MP. Therefore, there may be a clinically relevant association between these disorders. MetS may be a risk factor for MP and urolithiasis, and treatment of metabolic disorders should be undertaken to prevent these diseases.

Predictors of Neoplasia in Colonic Wall Thickening Detected via Computerized Tomography.

Introduction Colonic wall thickening (CWT) is frequently observed incidentally via abdominal computerized tomography (aCT). Although the general approach to evaluating incidental CWT is a colonoscopic examination, there is a lack of definitive recommendation guidelines. Thus, we aimed to determine neoplasia rates and identify the factors predictive of neoplasia via colonoscopic examinations of patients with CWT incidentally diagnosed via aCT. Methods We retrospectively reviewed 5,300 colonoscopy reports. A total of 122 patients who had CWT incidentally observed via aCT were included in the study. CWT was graded as mild (3-5 mm), moderate (6-12 mm), or severe (≥12 mm). A logistic regression model was used to determine the predictive factors for neoplasia. Results The mean age of the patients was 60 years, and abnormal findings were noted in 52% of the colonoscopies. Neoplastic lesions were detected in 24 patients (19.6%), while colon adenocarcinoma was detected in 8 patients (6.5%). Multivariate analysis showed that moderate-severe, focal, and asymmetric CWT were independent factors for predicting neoplasia (p=0.049, p=0.033, and p=0.018, respectively). Conclusion Pathological findings can be noted via colonoscopic examination in cases of incidental CWT; therefore, patients with moderate-severe, focal, or asymmetric CWT require colonoscopic examination for the purpose of detecting neoplasia.

Tips for Computed Tomography Angiographic Imaging of Pulmonary Embolism.

BACKGROUND: To measure parameters suggesting right heart failure on computed tomography angiography (CTA) taken in pulmonary embolism (PE) and to evaluate their possible contribution to the diagnosis. To investigate the changes in the parameters of PE cases at the 6th month-1 year and to evaluate the importance of these values in prognosis. PE is a disease which may be difficult to diagnose because of its different symptoms and can be fatal. The evaluation of right heart failure findings with CTA is very important in diagnosis and follow-up. METHODS: The mean pulmonary artery (PA) diameter, the ratio of the right ventricle to the left ventricle diameter (RV/LV), contrast material reflux to vena cava inferior and the elapsed time (ET), which was the time required to reach the targeted contrast threshold of 95 patients were measured at the first visit and under treatment. RESULTS: RV/LV, ET and contrast medium reflux at PE group were significantly higher than those without embolism (P=0.009, P=0.001, P=0.014). In the first CTAs of the PE group, these parameters were significantly reduced in the control CTAs (P=0.005, P = 0.013, P=0.016). CONCLUSION: It can be said that the values we measured are important in terms of prognosis of PE by assisting in diagnosis and in evaluating post-treatment recovery.

Use of computed tomography and diffusion weighted imaging in children with ventricular shunt.

PURPOSE: To evaluate the indications, number, and imaging results of brain computed tomography (CT) and diffusion weighted imaging (DWI) in children with ventriculoperitoneal shunt, to estimate the radiation dose, and to evaluate the effectiveness of DWI. METHODS: This retrospectively study included 54 consecutive patients (boys/girls = 30/24, mean age, 3 ± 4.1 years) with shunt that were placed due to congenital abnormalities-hypoxic ischemic encephalopathy between January 2015 and March 2018. The presence of shunt-related complications (SRC) was assessed using clinical and neuroimaging findings, and the standard reference was accepted as the shunt revision. Size comparisons of ventricles were performed using Evans index and the frontal and occipital horn ratio, and each measurement made by the observers were compared using Bland-Altman analysis. A kappa coefficient and the intraclass correlation coefficient were calculated to assess the agreement between observers. RESULTS: The mean number of hospital admission, number of CT scans, and DWI were 5.8, 4.8, and 1.1, respectively per patient. A significant linear correlation was observed between hospital admission and CT scans (r = 0.288, p = 0.035). The number of CT scans and the cumulative effective dose per patient were higher in patients with SRC than in those without (p < 0.001). The mortality rate due to radiation-induced neoplasia has increased by 0.33% in the study period. The inter-observer agreement was perfect or substantial for the catheter visualization, assessment of the ventricular system on DWI, and for the image quality of DWI between observers (κ = 0.704-1, p ≤ 0.001). No significant difference was found between CT and DWI in the measurements of Evans index and the frontal and occipital horn ratio (p > 0.05). Inter-observer agreements between observers were almost perfect for the Evans index and the frontal and occipital horn ratio (ICC = 0.94-0.99, p < 0.001). CONCLUSIONS: An awareness of the use of CT in children is still inadequate and difficulties in the diagnosis of SRC probably cause the overuse of CT. DWI should be preferred in the diagnosis of SRC and the follow-up of patients. Otherwise, the increase in the prevalence of several diseases, particularly neoplasia, may be inevitable because of the over use of CT.

Cervico-medullary compression ratio: A novel radiological parameter correlating with clinical severity in Chiari type 1 malformation.

OBJECTIVES: Chiari malformation type 1 (CM-1) is associated with cough headache, intracranial hypertension, cerebellar and spinal cord symptoms/signs. Herniated cerebellar tonsil length (HCTL) is widely used radiological parameter to determine the severity of CM-1, but with limited utility due to its weak correlation with some clinico-radiological findings. In this study, we aimed to evaluate a novel, practical parameter (cervico-medullary compression ratio; "CMCR") for its relationship with clinico-radiological findings in CM-1. PATIENTS AND METHODS: Thirty-five adult patients (17 F, 18 M) with CM-1 were included in this retrospective study. Head CT and craniospinal MR images were assessed. CMCR was calculated as the ratio of herniated cerebellar tonsil surface area to foramen magnum surface area, and HCTL was measured. These two parameters were correlated with clinical and radiological findings. RESULTS: The mean CMCR was 0.60 ± 0.15 and mean HCTL was 8.91 ± 3.4 mm with no significant difference between gender and age groups for both parameters. For cough headache (0.64 ± 0.14 vs 0.52 ± 0.15, p = 0.043) and syringomyelia (0.67 ± 0.11 vs 0.56 ± 0.16, p = 0.039), only CMCR; for intracranial hypertension (CMCR: 0.64 ± 0.14 vs 0.55 ± 0.16, p = 0.049; HCTL: 9.66 ± 3.59 mm vs 7.79 ± 3.03 mm; p = 0.045) and cerebellar symptoms (CMCR: 0.65 ± 0.14 vs 0.54 ± 0.16, p = 0.048; HCTL: 10.4 ± 3.5 mm vs 7.4 ± 2.8 mm, p = 0.041), both CMCR and HTCL were significantly different between patients with and without respective findings. However, neither CMCR nor HTCL was different between patients with and without spinal cord symptoms and hydrocephalus. CONCLUSION: CMCR is a superior numerical parameter than HCTL for the assessment of clinical severity in CM-1 cases and needs further validation with larger studies.

The correlation between laboratory markers and computed tomography severity index in acute appendicitis.

A M: This study aimed to evaluate and to investigate the association of some laboratory markers with the stage of the acute appendicitis. MATER AL AND METHODS: The hematological parameters (white blood cell count, red cell distribution width, platellet distribution width, mean corpuscular volume, and mean platelet volume values) and tomography scans of 200 patients who admitted to the emergency department with abdominal pain were retrospectively reviewed. Computed tomography grading about the severity of the cases was carried out by two radiologists, as grade 0 for normal appendix to grade 3 for perforated appencities. The hematological results of the patients were recorded for each severity group and were compared to detect whether there was a change in the hematological parameters as the severity in CT increases. RESULTS: There was no difference in white blood cell count and red cell distribution width levels but mean platelet volume seemed to decrease as the tomography severity index increased. CONCLUS ONS: Our data suggests that the most reliable instrument to detect appendicitis in the emergency environment is the computed tomography. KEY WORDS: Acute appencitis, Computed tomography, RDW, PDW, MPV, MCV.

Determination of splenomegaly by coronal oblique length on CT.

PURPOSE: The aims of this study were (a) to determine whether a coronal oblique length (COL) > 12 cm, which is often used to detect splenomegaly (SM) on ultrasound, can be used as a marker of SM on computed tomography (CT), (b) to compare the diagnostic accuracy of COL with other unidimensional linear measurements (ULM) in identifying SM, (c) to determine which ULM most closely correlates with splenic volume (SVol) according to the splenic index on CT, (d) to assess the relationship between SVol and patient's gender, age and body parameters (height, weight), and (e) to determine whether there is a difference between non-contrast-enhanced and contrast-enhanced CT images in identifying SM. MATERIALS AND METHODS: The body parameters and ULM (width, length, thickness, COL) were obtained from patients who underwent CT for various indications from April 2016 to April 2017. SVol and body mass indexes were calculated for each patient. RESULTS: Of the 1078 patients [male/female = 526/552; 47.57 (mean) ± 19.21 (standard deviation) years], 392 patients had SM. The sensitivity, specificity, positive and negative predictive values of COL > 12 cm for diagnosing SM were 44.6, 95.6, 85.3 and 75.1%, respectively (p < 0.001). SVol correlated with all ULM (p < 0.001). In the non-SM group (n = 686), the mean SVol was 331.7 ± 92.2 cm3 and females had smaller spleens than males (p < 0.001). SVol showed correlation with gender, age and height (p < 0.001). CONCLUSION: COL > 12 cm is not superior to other ULM for the detection of SM, but it is very successful in determining normal spleens. The unidimensional measurements and volume of the spleen should be calculated by taking gender and body parameters into account for different ethnic populations. Non-contrast-enhanced CT can also be used to detect SM.

A rib abnormality mimicking pulmonary nodule: a pitfall in the plain chest x-ray.

The ribs show a wide range of normal and pathologic radiographic appearences as well as congenital variations. Intrathoracic ribs are isolated and rare anomalies. They are usually super-numerary, more often right-sided, and involve the middle part of the thorax. We describe a case with intrathorasic rib abnormality mimicking a peripheral metastatic lung nodule in the plain chest x-ray and emphasize the use of coronal and sagittal reformatted images in thorasic imaging. Utilisation of multiplanar reformatted images in chest computerised tomography increase diagnostic quality.