Which Body Composition Parameters on Computed Tomography Are More Successful in Predicting the Prognosis of COVID-19 Patients?

OBJECTIVES: The aims of the study are to compare the body composition parameters (BCPs), which have been reported to have a prognostic impact, in COVID-19 patients, and to determine the most influential BCP(s) on the prognosis. METHODS: Unenhanced chest computed tomography examinations of COVID-19 cases were assessed regarding the severity of pneumonia, pectoralis muscle area and density (PMA, PMD), visceral adipose tissue area (VAA), waist circumference, waist to paravertebral muscle circumference ratio, coronary artery calcification severity, and paravertebral muscle area at the T5 vertebral level. A second observer repeated measurements and an intraclass correlation coefficient score were used for interobserver agreement. The relationship between data and patient outcomes (intubation, death) was investigated using multivariable logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of BCPs in predicting outcomes. RESULTS: A total of 238 (121 males, median age, 48 years [interquartile range, 36-63 years]) consecutive COVID-19 patients with chest computed tomography were investigated. Twenty-four patients (10.08%) were intubated, and 15 patients (6.3%) died during at least 1 month of follow-up. Waist to paravertebral muscle circumference ratio, PMA, PMD, and T5 vertebral level were significantly associated with intubation in the multivariable analysis. Pectoralis muscle density and PMA were significantly associated with death. Pectoralis muscle density showed the highest AUC for the prediction of intubation and death (AUC of 0.814 and 0.871, respectively). There was a good to excellent agreement between observers (intraclass correlation coefficient range, 0.899-0.998). CONCLUSIONS: Pectoralis muscle density is the most influential BCP in predicting intubation and death in COVID-19 patients.

The prevalence and clinical significance of incidental non-cardiac findings on cardiac magnetic resonance imaging and unreported rates of these findings in official radiology reports.

Purpose: To evaluate the prevalence and significance of incidental non-cardiac findings (NCFs) on cardiac magnetic resonance imaging (MRI). We also aimed to assess the unreported rate and clinical significance of NCFs in official radiological reports. Material and methods: Consecutive cardiac MRI examinations of 400 patients were retrospectively analysed and MR images reviewed by 2 observers blinded to official radiology reports. NCFs were classified as insignificant, significant, and major. In patients with significant and major findings, NCFs were classified as previously known or unknown, based on clinical archive. Moreover, we investigated the clinical follow-up results of patients with major NCF. Results: Of 400 patients, 137 patients (34.3%) had a total of 175 NCFs. Fifty-nine NCFs were considered significant, and 23 were major. Patients with NCFs were significantly older than those without (p < 0.0001). Of 82 significant and major NCFs, 25 were previously unknown. In total, 18 significant and 4 major NCFs were unreported in official MRI reports. The unreported major NCFs were portal vein thrombosis, pulmonary nodule, pulmonary embolism, and liver nodule. The most common unreported findings were pulmonary artery-aorta dilatation and hiatal hernia. No statistical difference was found between official MRI reports and second consensus reading for the detection of major NCFs (p = 0.082). Conclusions: The frequency of significant and major NCFs increases with age. Although no statistical difference was found between official MRI reports and second consensus reading for the detection of major NCFs, extra-cardiac findings should be carefully investigated during assessment.

Central vein sign: comparison of multiple sclerosis and leukoaraiosis.

BACKGROUND: Leukoaraiosis produces white matter lesions (WML) similar to multiple sclerosis (MS) on brain magnetic resonance imaging (MRI), and the distinction between these two conditions is difficult radiologically. This study aimed to investigate the role of the central vein sign (CVS) in susceptibility-weighted imaging (SWI) sequence in distinguishing MS lesions from leukoaraiosis lesions in Turkish population. METHODS: In this prospective study, axial SWI and sagittal three-dimensional fluid-attenuated inversion recovery (3DFLAIR) were obtained in 374 consecutive patients. The study consisted of 169 (89 MS patients, 80 patients with leukoaraiosis) patients according to the inclusion and exclusion criteria. Two observers evaluated MR images by consensus, and observers were unaware of the patient's clinical findings. Locations (periventricular, juxtacortical, and deep white matter) and the presence of CVS were investigated for each of the lesions. Differences between patients in the leukoaraiosis and MS groups were investigated using the Mann-Whitney U test or chi-square analysis. In addition, receiver operating characteristic (ROC) analysis was used to analyze the diagnostic performance of CVS. RESULTS: A total of 1908 WMLs (1265 MS lesions, 643 leukoaraiosis) were detected in 169 patients. The CVS was significantly higher in the MS lesions (p < 0.001). The CVS positivity rate in periventricular WMLs was higher than in juxtacortical WMLs or deep WMLs, both for all patients and for patients with MS (p < 0.001). The area under the curve (AUC) of the ROC analysis was 0.88 (95% confidence interval 0.83-0.93) for CVS in the distinction of MS lesions and leukoaraiosis. DISCUSSION: The presence of CVS in the SWI sequence can be used as an auxiliary finding for the diagnosis of MS in the differentiation of MS and leukoaraiosis lesions.

An unusual cause of spontaneous pneumothorax: Post-COVID-19 pulmonary fibrosis.

Spontaneous pneumothorax (SP) is characterized by the escape of broncho-alveolar air into presence of air in the pleural space without preceding blunt or penetrating trauma. SP requires prompt diagnosis and treatment. SP is divided into two groups as primary and secondary. Primary SP is usually seen in tall and thin patients with no clinically evident underlying lung disease (especially in tall and thin subjects), whereas secondary SP cases have an underlying lung disease, such as cystic lung disease, cavitary lung lesions, severe asthma, emphysema or pneumonia. Patients with Coronavirus-2019 (COVID-19) may experience the SP during the diagnosis and treatment processes, and it is a significant cause of morbidity. However, late-onset SP after recovering from COVID-19 is unusual. Herein we present a case with post-COVID-19 pulmonary fibrosis-like changes and subsequent late onset spontaneous pneumothorax (SP). We also present the patient's radiological findings.

Multiparametric MRI Evaluation of Developmental Venous Anomalies in the Brain: Association with Signal Changes on FLAIR in Patients with Multiple Sclerosis.

BACKGROUND: Developmental venous anomalies (DVAs) can be determined on magnetic resonance imaging (MRI), and they may be associated with multiple sclerosis (MS) lesions. PURPOSE: The objective was to evaluate the MRI findings of DVAs in the brain, to compare the prevalence of them between MS patients and control subjects, and to investigate the correlation of DVA-associated fluid-attenuated inversion recovery (FLAIR) hyperintensities and MRI-derived parameters between MS patients and control subjects having DVA. METHODS: Total 160 patients with a mean age of 45 ± 16 years who underwent multiparametric MRI including susceptibility-weighted imaging (SWI), diffusion-weighted imaging, 3D FLAIR, and contrast-enhanced imaging were included in this retrospective study. First, the presence of DVA was compared between the MS and control groups using the Chi-square test. Then, among the subjects having DVA, age, gender, and MRI-derived parameters such as the signal increase of DVA on FLAIR, location, and drainage of DVA were compared between the MS and control groups using Chi-square test. RESULTS: The presence of DVA did not differ between the MS and control groups (P = 0.828). Signal increase around DVA on FLAIR (P = 0.03) and the age of less than 45 years demonstrated a significant correlation with MS group (P = 0.022). CONCLUSION: In our study, DVAs were effectively detected using SWI and 3D contrast-enhanced T1-weighted imaging on MRI. The signal increase of DVA was better revealed on 3D FLAIR on MRI, and it was the only significant MRI-derived parameter in patients with MS.

A Rare Cause of Recurrent Spontaneous Pneumothorax: Birt-Hogg-Dube Syndrome.

Birt-Hogg-Dube (BHD) syndrome is an unusual disorder characterized by the triad of cutaneous lesions, renal tumors and lung cysts. In cases with BHD syndrome, the frequency of recurrent pneumothorax is increased due to presence of multiple lung cysts. It is important to evaluate the BHD syndrome in differential diagnosis of recurrent pneumothorax especially with multiple lung cysts predominating in the lung base. In these patients, the presence of accompanying kidney and other tumors should be investigated. Herein, we report a case of BHD syndrome presenting with recurrent pneumothorax.