Learning from pathophysiological aspects of COVID-19 clinical, laboratory, and high-resolution CT features: a retrospective analysis of 128 cases by disease severity.

BACKGROUND: The classic chest CT imaging features of COVID-19 pneumonia have low specificity due to their similarity with a number of other conditions. So, the goal of the present study is to learn from the pathophysiology of COVID-19 clinical features, laboratory results, and high-resolution CT manifestations in different stages of disease severity to provide significant reference values for diagnosis, prevention, and treatment. METHODS: This was a multicentered study that included 128 patients. Demographic, clinical, and laboratory data, in addition to chest HRCT findings, were evaluated. According to chest HRCT features, radiologic scoring were grade 1 and 2 for mild grades of the disease, 3 and 4 for moderate grades of the disease, and 5 and 6 for severe grades of the disease. RESULTS: Patient clinical symptoms ranged between fever, dry cough, muscle ache (myalgia)/fatigue, dyspnea, hyposomia, sore throat, and diarrhea. Lymphocytes and WBCs were significantly lower in patients with severe COVID-19. A significant negative correlation was found with WBCs (r = - 0.245, P = 0.005), lymphocytes% (r = - 0.586, P < 0.001), RBCs (r = - 0.2488, P = 0.005), Hb (gm/dl) (r = - 0.342, P < 0.001), and HCT (r = - 0.377, P < 0.001). Transferrin and CRP were significantly higher in moderate and severe COVID-19 than mild degree and showed a significant positive correlation with CT score (r = 0.356, P < 0.001) and (r = 0.429, P < 0.001), respectively. The most common CT features were peripheral pulmonary GGO and air space consolidation. CONCLUSION: Clinical features, laboratory assessment, and HRCT imaging had their characteristic signs and performances. Correlating them can make it possible for physicians and radiologists to quickly obtain the final diagnosis and staging of the COVID-19 pneumonia.

Outcome of Laparoscopic Assisted Percutaneous Microwave Ablation for Exophytic Versus Non-exophytic Hepatocellular Carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common malignancies and is the third cause of cancer-related death worldwide. Surgery is the optimal treatment for early HCC; however, the majority of cases are not suitable for curative resection at the time of diagnosis. Surgical resection difficulties may be related to size, site, number of tumors, extrahepatic involvement, and patient general condition. Exophytic tumors were considered as relative contraindication for thermal ablation because of the risk of incomplete ablation or major complications as hemorrhage and seeding. AIM OF THIS STUDY: to evaluate the safety and efficacy of microwave ablation (MWA) of exophytic HCC in comparison with non-exophytic HCC. METHODS: Prospective comparative study carried on 30 patients having 30 exophytic (six of those patients had another non-exophytic lesion) and 32 patients having 44 non-exophytic HCC lesions (22 had single lesion, 8 patients had 2 lesions, and 2 patients had 3 lesions) within Milan criteria. All patients were child A or B, they were subjected to full clinical assessment, laboratory investigations, and radiological investigations. Laparoscopic assisted percutaneous MWA was the procedure of choice in our study for all patients either having exophytic or non-exophytic lesions using no-touch wedge technique for exophytic lesions and direct puncture for non-exophytic lesions. RESULTS: Technical success was 100% in both groups, all lesions were completely ablated as confirmed by LIOUS. There were no major complications or perioperative mortality and low incidence of local tumor progression in both exophytic and non-exophytic groups. CONCLUSION: Laparoscopic assisted MWA of exophytic HCC is safe and effective with comparable results to non-exophytic HCC. Exophytic HCC is not contraindication for MWA with proper technique selection.

The Role of Magnetic Resonance Cholangiopancreatography in Diagnosis of Hepatobiliary Lesions.

INTRODUCTION: Magnetic resonance cholangiopancreatography (MRCP) has achieved widespread success as a diagnostic tool for hepatobiliary lesions. MRCP offers an effective method of hepatobiliary diagnosis that is safer than the use of invasive procedures, namely endoscopic retrograde cholangiopancreatography, and is more accurate than ultrasound. AIM: The aim of the study was to assess the diagnostic quality and overall accuracy of MRCP for the evaluation of hepatobiliary lesions. PATIENTS AND METHODS: Eighty patients (42 male, 38 female; mean age, 38.3 years) suspected for hepatobiliary lesions were enrolled in this study. MRCP protocols applied for imaging of the hepatobiliary system were T2-weighted fast spin echo sequence on axial and coronal planes; three-dimensional, fat suppressed, heavily T2-weighted fast spin echo sequence with multislab acquisition mode; two-dimensional thick single slab projectional images, and three-dimensional reconstruction algorithms. RESULTS: Among the patients, jaundice and biliary colic were the commonest clinical complaints. MRCP has detected different pathologic entities among congenital anomalies, inflammatory conditions, neoplastic disorders, and postoperative and post-traumatic complications. The MRCP diagnosis was compared with the final diagnosis reached by endoscopic retrograde cholangiopancreatography, surgical, or histopathologic data. MRCP has a high overall diagnostic accuracy of 97%, sensitivity of 98%, and specificity of 93%. CONCLUSIONS: MRCP provides a safe, noninvasive, accurate diagnostic tool in detection of the presence and level of biliary obstruction and also denotes its cause with high accuracy.

Ultrasound assessment of elbow enthesitis in patients with seronegative arthropathies.

BACKGROUND: Enthesopathy is an evolving area for applied clinical research. MRI is the gold standard in the diagnosis of elbow joint pathology, but recent reports indicate that ultrasound imaging is more sensitive and accurate than MRI in detecting enthesopathy of the heels and knees. Too many patients are under-diagnosed and/or misdiagnosed because the early pathological changes of enthesitis in the different types of seronegative arthropathies are not detected. OBJECTIVES: This study was undertaken to describe the ultrasound features of elbow enthesitis in patients with seronegative arthropathies. METHODS: We studied 38 diseased elbows in 38 patients with spondyloarthropathies (26 men and 12 women, mean age 32 years). All had elbow enthesopathy without typical conventional radiographic findings. Patients with histories of degenerative changes and/or local steroid injections were excluded. An HDI 3000 ATL ultrasound machine was used with a 5-12 MHz linear transducer to examine the affected elbow joints. The elbows of 10 normal healthy individuals were examined as normal controls. The patients were examined in the supine position with the elbow flexed 30°-50°. Longitudinal and transverse scans were obtained of the radiohumeral joint, the ulnahumeral joint, and the olecranon fossa. Two independent observers unaware of the clinical diagnosis read the ultrasound images and assessed the collateral ligaments, intratendinous echogenicity, tendon calcification, tendon thickness, presence of fluid, synovial proliferation, and bony changes. The reliability of the sonographic images was assessed by review of video recordings of the ultrasound examinations. RESULTS: Ultrasound revealed loss of the fibrillar echopattern (100 %), lack of a homogenous pattern with loss of the tightly packed echogenic dots (100 %), peritendinous edema with flaring of the tendon margins (84.2 %), irregular fusiform tendon thickening (100 %), and hyperechoic intratendinous lesions with ill-defined focal defects (18.4 %). Ultrasound also detected intratendinous calcifications of both the common extensor and common flexor tendons (52.6 %). Bony erosions were seen at the tendon insertions into the lateral epicondyles (13.15 %). CONCLUSION: Ultrasonographic features of elbow enthesitis differed from those described in knee and heel enthesitis. Ultrasound clearly showed early signs of tendon calcification, tendon edema, peritendinitis, and bony entheseal erosions. However, in elbow enthesitis the early bone erosion was associated with bone marrow edema, and the common extensor tendon was diffusely thickened. Ultrasound is a reliable, reproducible bedside imaging procedure. It improves the documentation of disease activity, progression, and treatment responses in patients with spondyloarthropathies. We recommend its use for the diagnosis and post-treatment follow-up of patients with enthesitis and seronegative spondyloarthropathies.

MR cholangiopancreatography of the pancreas and biliary system: a review of the current applications.

MR cholangiopancreatography (MRCP) is still a rapidly evolving technique, but it has been already accepted as clinically useful and is widely used to evaluate biliary or pancreatic diseases. The advantages of this technique are that it does not use contrast media or ionizing radiation, it is noninvasive and complication free, and the examination is relatively short. MRCP has high sensitivity and specificity for diagnosing biliary dilatation and for determining the site and cause of stenosis. With further improvements of hardware and technique, MRCP is expected to replace diagnostic endoscopic retrograde cholangiopancreatography to examine the biliary and pancreatic ducts in the near future. The other applications include evaluation of primary sclerosing cholangitis, stenosis after liver transplantation, and bilioenteric anastomoses. This article reviews the current applications of MRCP in the evaluation of the pancreas and the biliary system.

High impact of FDG-PET/CT in diagnostic strategies for ovarian cancer.

BACKGROUND: Ovarian cancer has the highest mortality of all gynecologic malignancies. FDG-PET/CT was proven to be accurate for identification of primary ovarian tumors, regional lymph nodes, and distant metastases. PURPOSE: To evaluate ovarian masses at FDG-PET/CT in correlation with histopathologic findings. MATERIAL AND METHODS: Ninety-eight patients underwent whole body FDG-PET/CT examination. Eighty-six patients with primary ovarian cancer and 12 patients with metastatic disease to the ovaries were included. RESULTS: PET/CT imaging was true-positive in 87/94 patients with malignant tumors. In 4/4 patients with benign tumors, PET/CT results were true-negative, with sensitivity of 92.6%, specificity 100%, total test accuracy 92.9%. Fifty-seven patients were diagnosed as stage IV ovarian cancer with distant metastasis. CONCLUSION: The anatomical/functional examination by FDG-PET/CT was proven to be valuable in increasing the diagnostic accuracy that can help improve patient management.

Breast cancer with low FDG uptake: characterization by means of dual-time point FDG-PET/CT.

BACKGROUND: Malignant breast lesions usually are differentiated by FDG-PET with a semiquantitative FDG standardized uptake value (SUV) of 2.5. However, the frequency of breast cancer with an SUV of less than or equal to 2.5 is noteworthy, and often present diagnostic challenges. This study was undertaken to evaluate the accuracy of dual-time point FDG-PET/CT with FDG standardized uptake value (SUV) calculation in the characterization of such breast tumors. METHODS: Forty-nine female patients with newly diagnosed breast cancer were found to have primary breast cancer with minimally increased FDG uptake and met the criteria for inclusion in this study by having borderline levels of increased FDG uptake (SUV max less than or equal to 2.5) in the initial FDG-PET/CT images. Consequently, they underwent further delayed phase FDG-PET/CT scan for better evaluation of the disease. RESULTS: Of the 49 cancer lesions; the majority were found to have rising or unvarying dual-time changes in SUV max (75.5%). The median value of SUV max increases by 25% between the early and delayed scan. The means+/-S.D. of the SUV max1, the SUV max2, and the Delta SUV max% were 1.2+/-0.6%, 1.3+/-0.9%, and 5.1+/-22.4%, respectively. The receiver-operating-characteristic (ROC) analysis proved that the highest accuracy for characterization of malignant breast lesions was obtained when a Delta SUV max% cut-off value 0.0% was used as criteria for malignant FDG uptake-change over time with sensitivity 75.5%, and false-positive rate 20.4%. CONCLUSION: These results suggested that dual-time FDG-PET/CT imaging with standardized uptake value (SUV) estimation can improve the accuracy of the test in the evaluation of breast cancer with low FDG uptake.

Positron emission tomography and breast lesions: low FDG activity in early phase imaging is not essentially benign.

The frequency of malignancy with low FDG uptake is significant and often presents diagnostic challenges. The usefulness of dual-time point FDG-PET/CT imaging (including early "after 45 minutes" and delayed "after 100 minutes," phases after radionuclide administration) for detection of such tumors has been documented. The authors present 2 cases of pathologically proven breast cancer with minimally increased FDG uptake on the initial scan (maximum standardized uptake value; SUVmax <2.5). Detection was improved by performing a dynamic PET study with early and delayed scans. Patients with a poorly visualized breast lesion due to minimal FDG uptake on the initial FDG-PET images should not be considered as benign and deserves further delayed phase imaging.

Recurrence-free survival after radiofrequency ablation of hepatocellular carcinoma. A registry report of the impact of risk factors on outcome.

BACKGROUND: Despite the high complete necrosis rate of radiofrequency ablation (RFA), tumor recurrence, either local tumor recurrence or new tumor formation, remains a significant problem. Purpose of this study is to evaluate the pattern and risk factors for intrahepatic recurrence after percutaneous RFA for hepatocellular carcinoma (HCC). METHODS: We studied 40 patients with 48 HCCs (< or = 3.5 cm) who were treated with percutaneous RFA. The mean follow-up period was 24.1 +/- 15.7 months. We evaluated the cumulative disease-free survival of overall intrahepatic recurrence, local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Thirty host, tumoral and therapeutic risk factors were reviewed for significant tie-in correlation with recurrence: age; gender; whether RFA was the initial treatment for HCC or not; severity of liver disease; cause of liver cirrhosis; contact of tumor to major hepatic vessels and liver capsule; degree of approximation of tumor to the liver hilum; ablation time; degree of benign pre-ablational enhancement; sufficient safety margin; tumor multinodularity; tumor histological differentiation; tumor segmental location; maximum tumor diameter; degree of tumor pre-ablational enhancement at arterial phase CT, MRI or CT-angiography; and laboratory markers pre- and post-ablation (AFP, PIVKA II, TP, AST, ALT, ALP and TB). RESULTS: The incidence of overall recurrence, LTP and IDR was 65, 23 and 52.5%, respectively. The cumulative disease-free survival rates were 54.6, 74.8 and 78.3% at 1 year, 27.3, 71.9 and 46.3% at 2 years and 20, 71.9 and 29.4 at 3 years, respectively. Univariate and multivariate analysis showed that the significant risk factors for LTP were: tumor size > or = 2.3 cm, insufficient safety margin, multinodular tumor, tumors located at segments 8 and 5, and patient's age > 65 years (P < 0.05). No significant risk factor relationship for IDR could be detected. CONCLUSION: Our results would have clinical implications for advance warning and appropriate management of patients scheduled for RFA. Patients at risk of LTP should be closely monitored in the first year. Furthermore, regular long-term surveillance is essential for early detection and eradication of IDR.