Pancreas in Hereditary Syndromes: Cross-sectional Imaging Spectrum.

A wide spectrum of hereditary syndromes predispose patients to distinct pancreatic abnormalities, including cystic lesions, recurrent pancreatitis, ductal adenocarcinoma, nonductal neoplasms, and parenchymal iron deposition. While pancreatic exocrine insufficiency and recurrent pancreatitis are common manifestations in cystic fibrosis and hereditary pancreatitis, pancreatic cysts are seen in von Hippel-Lindau disease, cystic fibrosis, autosomal dominant polycystic kidney disease, and McCune-Albright syndrome. Ductal adenocarcinoma can be seen in many syndromes, including Peutz-Jeghers syndrome, familial atypical multiple mole melanoma syndrome, Lynch syndrome, hereditary breast and ovarian cancer syndrome, Li-Fraumeni syndrome, and familial pancreatic cancer syndrome. Neuroendocrine tumors are commonly seen in multiple endocrine neoplasia type 1 syndrome and von Hippel-Lindau disease. Pancreatoblastoma is an essential component of Beckwith-Wiedemann syndrome. Primary hemochromatosis is characterized by pancreatic iron deposition. Pancreatic pathologic conditions associated with genetic syndromes exhibit characteristic imaging findings. Imaging plays a pivotal role in early detection of these conditions and can positively affect the clinical outcomes of those at risk for pancreatic malignancies. Awareness of the characteristic imaging features, imaging-based screening protocols, and surveillance guidelines is crucial for radiologists to guide appropriate patient management. ©RSNA, 2021.

Role of Clinical and Echocardiographic Findings in Patients with Acute Pulmonary Embolism: Prediction of Adverse Outcomes and Mortality in 180 Days.

BACKGROUND: Pulmonary embolism (PE) can be a possibly mortal disease; therefore, an immediate risk assessment would be imperative to ensure accurate decisions on proper treatment plans. The focus of the present study was to evaluate the prognostic value of clinical, echocardiographic, and helical pulmonary computed tomography angiography findings for adverse outcomes and mortality. MATERIALS AND METHODS: A total of 104 patients with PE were retrospectively entered in the present study. Patients were categorized into five groups, including patients who faced an adverse outcome (group 1), patients who expired in 30 days (group 2), patients who expired in 30-90 days (group 3), patients who expired in 90-180 days (group 4), and patients who survived without facing an adverse outcome (group 5). Comorbidities (e.g., malignancy) were obtained from medical records. Logistic regression analysis was performed to detect mortality predictors. RESULTS: In this study, 16 patients were faced with an adverse outcome. Furthermore, 10, 5, and 2 deaths occurred within 30, 30-90, and 90-180 days, respectively. The most frequent presentation was dyspnea (89%). The mean intensive care unit stay (OR=1.202; P=0.036), the predicted 30-day mortality, and a history of kidney transplantation (OR=0.011; P=0.002) were related to less probability of death within 30 days. CONCLUSION: The results of this study revealed that a history of kidney transplantation is independently accompanied by a lower occurrence of expiration in 30 days. Moreover, there was a significant correlation between the pulmonary embolism severity index, heart rate of > 100 beats per minute, chest pain, hypoxia, and pulmonary arterial pressure with the pulmonary artery obstruction index (PAOI).

Magnetic resonance imaging features of coronavirus disease 2019 (COVID-19) pneumonia: The first preliminary case series.

RATIONALE AND OBJECTIVES: There is a rising onus on understanding the common features of COVID-19 pneumonia on different imaging modalities. In this study, we aimed to review and depict the common MRI features of COVID-19 pneumonia in our laboratory confirmed case series, the first comprehensive reported cohort in the literature. MATERIALS AND METHODS: Upon IRB approval, eight laboratory confirmed COVID-19 patients who presented to our outpatient imaging clinic underwent chest CT and, once various features of COVID-19 pneumonia were identified, a dedicated multisequence chest MRI was performed on the same day with an institutional protocol. Demographic data and the morphology, laterality and location of the lesions were recorded for each case. RESULTS: Five males and three females with the mean age of 40.63 ± 12.64 years old were present in this case series. Five cases had typical CT features with ground glass opacities and consolidations, readily visible on different MRI sequences. Three cases had indeterminate or atypical features which were also easily seen on MRI. The comprehensive review of MRI features for each case and representative images have been illustrated. CONCLUSION: Becoming familiar with typical findings of COVID-19 pneumonia in MRI is crucial for every radiologist. Although MRI is not the modality of choice for evaluation of pulmonary opacities, it has similar capabilities in detection of COVID-19 pneumonia when compared to chest CT.

Chest CT in COVID-19 pneumonia: what are the findings in mid-term follow-up?

PURPOSE: The purposes of this study are to investigate mid-term chest computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) pneumonia, assess the rate of complete resolution, and determine the individuals at risk for residual abnormalities. METHODS: Fifty-two cases of COVID-19 pneumonia with at least two chest CTs and mean 3-month interval between the initial and follow-up CT were enrolled in this retrospective study. Patients were categorized into two groups: complete resolution and residual disease on follow-up CT. Demographic, clinical, laboratory, and therapeutic data as well as initial and follow-up chest CT scans were compared and analyzed. RESULTS: Thirty patients (57.7%) demonstrate complete resolution of pulmonary findings, and 22 patients (42.3%) had residual disease on follow-up CT. The mean time interval between initial and follow-up CT was 91.3 ± 17.2 and 90.6 ± 14.3 days in the complete resolution and residual groups, respectively. The most common radiologic pattern in residual disease was ground-glass opacities (54.5%), followed by mixed ground-glass and subpleural parenchymal bands (31.8%), and pure parenchymal bands (13.7%). Compared to complete resolution group, patients with residual disease had higher CT severity score on initial exam (10.3 ± 5.4 vs. 7.3 ± 4.6, P value = 0.036), longer duration of hospitalization, higher rate of intensive care unit (ICU) admission, more underlying medical conditions, higher initial WBC count, and higher occurrence rate of leukocytosis in the hospitalization time period (all P values < 0.05). CONCLUSION: Extensive lung involvement on initial CT, ICU admission, long duration of hospitalization, presence of underlying medical conditions, high initial WBC count, and development of leukocytosis during the course of disease are associated with more prevalence of chronic lung sequela of COVID-19.

Predictive value of CT in the short-term mortality of Coronavirus Disease 2019 (COVID-19) pneumonia in nonelderly patients: A case-control study.

RATIONALE AND OBJECTIVES: Identifying CT predictors of mortality in nonelderly healthy patients with COVID-19 pneumonia will aid to distinguish the most vulnerable patients in this age group and thus alter the management. We aimed to evaluate the prognostic value of multiple CT features of COVID-19 pneumonia on initial presentation in nonelderly patients without underlying medical conditions. METHODS: In this retrospective case-control study, thirty laboratory-confirmed COVID-19 patients with no known major underlying disease who underwent a chest CT scan and expired of pneumonia within the following 30 days after admission, were included as case group. Sixty control subjects individually matched on their age, gender, without underlying medical conditions, who received same-criteria standard care and were discharged from the hospital in 30-day follow-up were included in the control group. A conditional logistic regression model was applied. RESULTS: Applying a univariate conditional logistic regression model, it was revealed that bilateral lung disease, anterior involvement, central extension, GGO, consolidation, air bronchograms, pleural effusion, BMI ≥ 25 kg/m² and CT severity score were the significant preliminary predictors (all p-values < 0.05). Next, by applying a multivariate conditional logistic regression model, it was determined that the CT severity score is the only statistically significant CT predictor of mortality (Odds Ratio = 1.99, Confidence Interval: 1.01-4.06, p-value < 0.05). The ROC curve analysis revealed a score of 7.5 as the cut-off point of CT severity score with the highest sensitivity (0.83) and specificity (0.87). CONCLUSION: Our study demonstrates that CT severity score is a reliable predictor factor of mortality in nonelderly previously healthy individuals with COVID-19 pneumonia. Assessment of disease extension in addition to the morphological pattern is necessary for CT reports of COVID-19 patients. This may alert the clinicians to alter the management for this specific group of patients, even when they are clinically silent or have a mild presentation.

A low-dose chest CT protocol for the diagnosis of COVID-19 pneumonia: a prospective study.

PURPOSE: The increasing trend of chest CT utilization during the COVID-19 pandemic necessitates novel protocols with reduced dose and maintained diagnostic accuracy. We aimed to investigate the diagnostic accuracy of 30-mAs chest CT protocol in comparison with a 150-mAs standard-dose routine protocol for imaging of COVID-19 pneumonia. METHODS: Upon IRB approval, consecutive laboratory-confirmed positive COVID-19 patients aged 50 years or older who were referred for chest CT scan and had same-day normal CXR were invited to participate in this prospective study. First, a standard-dose chest CT scan (150 mAs) was performed. Only if typical COVID-19 pneumonia features were identified, then a low-dose CT (30 mAs) was done immediately. Diagnostic accuracy of low-dose and standard-dose CT in the detection of typical COVID-19 pneumonia features were compared. RESULTS: Twenty patients with a mean age of 64.20 ± 13.8 were enrolled in the study. There was excellent intrareader agreement in detecting typical findings of COVID-19 pneumonia between low-dose and standard-dose (intraclass correlation coefficient [ICC] = 0.98-0.99, P values < 0.001 all readers). The mean effective dose values in standard- and low-dose groups were 6.60 ± 1.47 and 1.80 ± 0.42 mSv, respectively. Also, absolute cancer risk per mean cumulative effective dose values obtained from the standard- and low-dose CT examinations were 2.71 × 10-4 and 0.74 × 10-4, respectively. CONCLUSIONS: According to our study, it was found that proposed low-dose CT chest protocol is reliable in detecting COVID-19 pneumonia in daily practice with significant reduction in radiation dose and estimated cancer risk.

CT Features and Short-term Prognosis of COVID-19 Pneumonia: A Single-Center Study from Kashan, Iran.

PURPOSE: To assess whether certain CT chest features of patients with confirmed coronavirus disease 2019 (COVID-19) may have short-term prognostic value. MATERIALS AND METHODS: One hundred-twenty consecutive symptomatic patients with COVID-19 infection who had undergone chest CT were enrolled in this retrospective study. Patients were categorized into three groups: routine inward hospitalization, intensive care unit admission, and deceased based on a short-term follow-up. Detailed initial CT features and distributional evaluation were recorded. RESULTS: The mean age in the deceased group was 70.7 years, significantly higher than the other two groups (P < .05). Ninety-four percent (113/120) of the patients had ground-glass opacities (GGO). Peripheral and lower zone predilection was present in most patients. Subpleural sparing and pleural effusion were seen in approximately 23% (28/120) and 17% (20/120) of the patients, respectively. The combined intensive care unit group and deceased patients had significantly more consolidation, air bronchograms, crazy paving, and central involvement of the lungs compared with routinely hospitalized patients (all P < .05). CONCLUSION: This study supports the previously described typical CT appearance of COVID-19 pneumonia with bilateral GGO, in peripheral distribution and lower lung zone predilection. Subpleural sparing and pleural effusion were seen approximately in one-fifth and one-sixth of the patients with COVID-19, respectively. Consolidation, air bronchograms, central lung involvement, crazy paving and pleural effusion on initial CT chest have potential prognostic values, the features more commonly observed in critically ill patients.© RSNA, 2020.

Genetics and imaging of pheochromocytomas and paragangliomas: current update.

Pheochromocytomas (PCCs) and paragangliomas (PGLs) are rare, heterogeneous neuroendocrine neoplasms of the autonomous nervous system of chromaffin cell origin that may arise within the adrenal medulla (PCCs) or the sympathetic and parasympathetic paraganglia (PGLs). Currently referred to by the umbrella term pheochromocytomas-paragangliomas (PPGLs), these distinct tumors are characterized by specific histopathology as well as biological and clinical profiles. PPGLs may occur as part of hereditary syndromes (40% of cases) or as sporadic tumors. Currently, there are 12 different hereditary syndromes with characteristic genetic abnormalities, at least 15 well-characterized driver genes and distinct tumor metabolic pathways. Based on the Cancer Genome Atlas (TCGA) taxonomic schemata, PPGLs have been classified into three main clusters of specific genetic mutations and tumor pathways with clinical, biochemical, and prognostic implications. Imaging plays a pivotal role in the initial diagnosis, tumor characterization, evaluation of treatment response, and long-term surveillance. While MDCT and MRI help in the anatomic localization, SPECT, and PET using different radiotracers are crucial in the functional assessment of these tumors. Surgery, chemotherapy, and radiotherapy are currently available treatment options for PPGLs; antiangiogenic drugs are also being used in treating metastatic disease. Evolving knowledge regarding the different genetic abnormalities involved in the pathogenesis of PPGLs has identified potential therapeutic targets that may be utilized in the discovery of novel drugs.

Short-term mortality of patients with saddle pulmonary embolism: A single-center study.

OBJECTIVE: Although hemodynamic instability has been identified as the most established mortality predictor in acute pulmonary embolism (PE), the debate is still open about the prognostic significance of saddle pulmonary embolism (SPE). This study determined the in-hospital mortality rate of SPE patients diagnosed via computed tomographic pulmonary angiography (CTPA) and compared these cases with non-SPE patients. METHODS: The presence of SPE observed on CTPA was used to classify 492 consecutive patients into SPE and non-SPE groups. Different features were compared between the 2 groups, and independent predictors of in-hospital mortality in acute PE were identified. RESULTS: A total of 70 patients (14.2%) had SPE. In univariate analysis, the SPE group was seen to have a higher in-hospital mortality rate, as well as a lower oxygen saturation level and systolic and diastolic blood pressure in comparison with the non-SPE group (all p values <0.005). Multivariate analysis revealed that SPE was an independent predictor of in-hospital mortality in acute PE patients (Odds ratio: 9.21, 95% confidence interval: 3.40-24.89; p value <0.001). CONCLUSION: The results of this study indicated that SPE had a statistically significant importance in predicting in-hospital mortality and adverse events in PE patients. These findings were not consistent with many prior studies.

Computed tomography pulmonary angiography for acute pulmonary embolism: prediction of adverse outcomes and 90-day mortality in a single test.

PURPOSE: Pulmonary embolism (PE) is a potentially fatal cardiopulmonary disease; therefore, rapid risk stratification is necessary to make decisions of appropriate management strategies. The aim of this study was to assess various computed tomography (CT) findings in order to find new prognostic factors of adverse outcome and mortality. MATERIAL AND METHODS: The study enrolled 104 patients with acute PE. Based on their outcome, patients were categorised into four groups. Comorbidities such as ischaemic heart disease were obtained from their medical records. Patients CT angiography were reviewed for recording variables such as main pulmonary artery diameter and right ventricle (RV)/left ventricle (LV) ratio. Patient deaths up to three months since diagnosis of PE had been registered. Logistic regression analysis was performed to find predictors. RESULTS: Based on multiple logistic regression, RV/LV ratio, LV diameter, and right-sided pulmonary infarction are predictors of mortality in 30 days. An RV/LV ratio of 1.19 could successfully discriminate patients who died within 30 days and those who did not. CONCLUSIONS: RV/LV ratio, LV diameter, right-sided pulmonary infarction, assessed with helical CT, can help predict 30-day mortality.

Index of Theta/Alpha Ratio of the Quantitative Electroencephalogram in Alzheimer's Disease: A Case-Control Study.

Alzheimer's disease (AD) is a devastating neurodegenerative disorder in human beings associated with cognitive, behavioral and motor impairments. The main symptom of AD is dementia, which causes difficulties in carrying out daily practices. Brain waves are altered in people with AD. Relative indices of brain waves can be beneficial in the diagnosis of AD. In this case-control study, 50 patients with AD and 50 matched healthy individuals were enrolled in case and control groups respectively. With recording and analyzing of brain waves with the utilization of quantitative electroencephalogram (QEEG), index of theta/alpha ratio was assessed in both groups. The index of theta/alpha ratio was significantly higher in patients with AD in comparison to healthy individuals (P<0.05). Index of theta/alpha ratio obtained by QEEG provides a non-invasive diagnostic marker of AD, which may be helpful in identification of non-advanced disease in susceptible individuals.

Vitamin D Deficiency among Female Nurses of Children's Medical Center Hospital and Its Related Factors.

Vitamin D deficiency is one of the most preventable challenges worldwide. The aim of this study was to determine the prevalence of vitamin D deficiency among female nurses working at Children's Medical Center Hospital in Tehran, Iran, due to the risk factor of being a notably long period indoors and the fact that their health status may have consequences on the process of patients' treatment. A total of 114 female nurses who were at least 20 years old entered the study voluntarily, and a questionnaire was applied to collect information on lifestyle and other factors associated with vitamin D deficiency. A sample of blood was taken to measure 25-hydroxyvitamin D (25-OHD) and cut off value to indicate deficiency was considered below 10 ng/ml, and the amounts of 10-29 ng/ml were declared insufficient. The mean of 25-OHD was 11.7±9.3 ng/ml. A total of 79 subjects (69.3%) had a deficient level of vitamin D, 28 subjects (24.6%) had an insufficient level and only 7 subjects (6.1%) had sufficient level of vitamin D. The deficiency was more noticeable in the age group of 26-35 years old. Prevalence of vitamin D deficiency had a significant correlation with younger subjects (P<0.001). There was no significant association among other factors such as body mass index (BMI), health status complications, regular exercise, and duration of sun exposure. High prevalence of vitamin D deficiency in the study population leads to emphasise the need to screen health care workers for vitamin D levels.

Egg ingestion in adults with type 2 diabetes: effects on glycemic control, anthropometry, and diet quality-a randomized, controlled, crossover trial.

BACKGROUND: The inclusion of eggs as part of a healthful diet for adults with diabetes is controversial. We examined the effects of including eggs in the diet of adults with type 2 diabetes on cardiometabolic risk factors. METHODS: Randomized, controlled, single-blind, crossover trial of 34 adults (mean age 64.5 years; 14 postmenopausal women, 20 men) with type 2 diabetes assigned to one of two possible sequence permutations of two different 12-week treatments (two eggs/day inclusion or egg exclusion), with 6-week washout periods. For the egg inclusion phase, participants received advice from a dietitian on how to preserve an isocaloric condition relative to the egg exclusion phase. The primary outcome was glycemic control as measured by glycated hemoglobin. Secondary measures included anthropometry, blood pressure, and diet quality. RESULTS: Compared with the exclusion of eggs in the habitual diet, the inclusion of eggs did not measurably affect glycated hemoglobin (0.01±0.5% vs -0.24±0.7%; p=0.115) and systolic blood pressure (-0.8±13.0 vs -3.0±10.0 mm Hg; p=0.438); and significantly reduced body mass index (0.06±0.8 vs -0.4±0.8 kg/m²; p=0.013) and visceral fat rating (0.2±1.1 vs -0.4±1.0; p=0.016). The inclusion of eggs in the habitual diet of diabetics significantly reduced waist circumference (-0.4±1.2 cm; p=0.004) and percent body fat (-0.7±1.8; p=0.033) from baseline. CONCLUSIONS: Short-term daily inclusion of eggs in the habitual diet of adults with type 2 diabetes does not improve glycemic control but can improve anthropometric measures. TRIAL REGISTRATION NUMBER: NCT02052037; results.

The debate is still open; benign or malignant: a case report of a multifocal epithelioid haemangioma of fibula.

In this case, we report an epithelioid haemangioma (EH) of the fibula with ill-defined multifocal lesions and a resultant pathologic fracture. Based on radiographic appearance, these lesions were initially thought to represent a malignant process, such as primary malignant bone tumour, metastases or multiple myeloma. Osseous EHs are rare. Although they can present as multifocal lesions, the majority of bony EHs are solitary and arise in the diaphysis or metaphysis of long tubular bones, with a predilection for the lower extremity. Non-specific radiological findings, debatable cytological appearance and unpredictable clinical growth patterns commonly cause misdiagnosis of malignancy. To the best of our knowledge, a case of EH with multiple growing lesions of the fibula has not yet been reported in the literature.

Ankylosing spondylitis: A state of the art factual backbone.

Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects 1% of the general population. As one of the most severe types of spondyloarthropathy, AS affects the spinal vertebrae and sacroiliac joints, causing debilitating pain and loss of mobility. The goal of this review is to provide an overview of AS, from the pathophysiological changes that occur as the disease progresses, to genetic factors that are involved with its onset. Considering the high prevalence in the population, and the debilitating life changes that occur as a result of the disease, a strong emphasis is placed on the diagnostic imaging methods that are used to detect this condition, as well as several treatment methods that could improve the health of individuals diagnosed with AS.

Optimizing Common Femoral Artery Access.

Common femoral artery (CFA) access is an important step of many vascular interventional procedures such as peripheral arterial, aortic, and endovascular oncologic interventions. The anatomical location of the CFA as it crosses over the femoral head provides a unique location to establish a relatively large arterial access to a vessel that is conveniently located near the aorta and its major branches. A proper access helps the interventionist with the remainder of the procedure and diminishes the risk of severe complications leading to surgery, thrombolysis, patient morbidity, or occasionally mortality. On the contrary, a suboptimal access can jeopardize the entire procedure and may lead to limb and life-threatening complications. With the introduction of ultrasonography-assisted CFA access, the process has become more predictable and possibly less adventurous; however, there remain tips and tricks that can guarantee a safe and proper start for any arterial procedure. We review the preprocedural evaluation, procedural techniques, and postprocedural care to optimize CFA access.