Search

Background/Objectives: Preoperative computed tomography (CT) imaging plays a vital role in accurately diagnosing acute appendicitis and assessing the severity of the condition, as well as the complexity of the surgical procedure. CT imaging provides detailed information on the anatomical and pathological aspects of appendicitis, allowing surgeons to anticipate technical challenges and select the most appropriate surgical approach. This retrospective study aimed to investigate the correlation between preoperative CT findings and the duration of laparoscopic appendectomy (LA) in pediatric patients. Methods: This retrospective study included 104 pediatric patients diagnosed with acute appendicitis via contrast-enhanced CT who subsequently underwent laparoscopic appendectomy (LA) between November 2021 and February 2024. CT images were meticulously reviewed by two experienced radiologists blinded to the clinical and surgical outcomes. The severity of appendicitis was evaluated using a five-point scale based on the presence of periappendiceal fat, fluid, extraluminal air, and abscesses. Results: The average operation time was 51.1 ± 21.6 min. Correlation analysis revealed significant positive associations between operation time and neutrophil count (p = 0.014), C-reactive protein levels (p = 0.002), symptom-to-operation time (p = 0.004), and appendix diameter (p = 0.017). The total CT score also showed a significant correlation with operation time (p < 0.001). Multiple regression analysis demonstrated that a symptom duration of more than 2 days (p = 0.047), time from CT to surgery (p = 0.039), and the presence of a periappendiceal abscess (p = 0.005) were independent predictors of prolonged operation time. In the perforated appendicitis group, the presence of a periappendiceal abscess on CT was significantly associated with prolonged operation time (p = 0.020). In the non-perforated group, the presence of periappendiceal fluid was significantly related to longer operation times (p = 0.026). Conclusions: In our study, preoperative CT findings, particularly the presence of a periappendiceal abscess, were significantly associated with prolonged operation times in pediatric patients undergoing laparoscopic appendectomy. Elevated CRP levels, the time between CT imaging and surgery, and a symptom duration of more than 2 days were also found to significantly impact the procedure's duration. [ABSTRACT FROM AUTHOR]

Background: Traumatic brain injury (TBI) remains a significant cause of morbidity and mortality globally. Decompressive craniectomy (DC) is a lifesaving procedure for managing severe TBI. This study aims to investigate the predictive value of pre-operative neurological status, radiological findings, and post-operative neurological changes on functional outcomes at discharge. Methods: An observational, prospective cohort study was conducted on 174 TBI patients undergoing DC at a tertiary care center. Patients were categorized into early and late DC groups. Data on pre-operative anisocoria, CT findings (side of injury, midline shift, mass effect), post-operative anisocoria, and Glasgow Coma Scale (GCS) scores were collected. The Glasgow Outcome Scale Extended (GOSE) assessed functional outcomes at discharge. Results: Pre-operative anisocoria was significantly associated with outcomes, being absent in 95.40% of the late DC group compared to 27.59% in the early DC group (p<.0001). CT findings indicated a significant relation between the side of injury and surgical outcomes (p<.0001). Post-operative anisocoria persisted significantly in the early group across all days (p<.0001). Improvement in GCS scores at discharge was more pronounced in the early DC group (mean improvement 2.83 ± 3.54) than in the late group (1.45 ± 4.13, p=0.043). The right side of injury was significantly associated with favorable GOSE outcomes in the early decompression group (p=0.033). Conclusion: Pre-operative anisocoria, specific CT findings, and early improvements in GCS scores are significant predictors of functional outcomes at discharge in TBI patients undergoing DC. These findings advocate for a nuanced approach to patient selection and timing for DC. [ABSTRACT FROM AUTHOR]

The purpose of this article is to present and illustrate the computed tomography (CT) findings of splenic emergencies – vascular and infectious – encountered in hematologic malignancies, based on a selection of cases. The CT aspects were classified in vascular – hemorrhagic and ischemic – splenic lesions and infectious (abscesses) lesions. CT evaluation plays a crucial role in the diagnosis of acute splenic lesions in patients with hematologic malignancies. [ABSTRACT FROM AUTHOR]

Abstract Background Pulmonary sequestration (PS) is a rare congenital lower airway malformation. This study presents the clinical and imaging features and surgical outcomes of PS in adults, and compare the safety and feasibility of minimally invasive surgery versus open thoracotomy for PS. Methods Adult patients with PS treated at our center from July 2011 to September 2021 were included. Information regarding the patient demographics, clinical and CT features, arterial supply and venous drainage, and surgical outcomes were collected. Results Ninety seven patients were included. The most common CT findings were mass lesions (50.5%) and cystic lesions (20.6%). The vast majority of the lesions (96 out of 97) were located close to the spine in the lower lobes (left vs. right: 3.6 vs. 1). Arterial supply was mainly provided by the thoracic aorta (87.4%) and abdominal aorta (10.5%). Intralobar and extralobar PS accounted for 90.7% and 9.3% of the patients, respectively. Three (4.5%) patients who underwent minimally invasive surgery were converted to open thoracotomy due to dense adhesions. Though no significant differences regarding operative time (P = 0.133), the minimally invasive surgery group was significantly better than the open thoracotomy group regarding intraoperative blood loss (P = 0.001), drainage volume (P = 0.004), postoperative hospital days (P = 0.017) and duration of chest drainage (P = 0.001). There were no cases of perioperative mortality. Only four (4.1%) patients developed postoperative complications, and no significant difference existed between the two groups. Conclusion Our study revealed PS can present with a variety of different clinical and radiologic manifestations. Clinicians should consider the possibility of PS when diagnosing a lesion in the lower lobes close to the spine. Moreover, minimally invasive surgery is a safe and effective treatment modality for the treatment of PS in an experienced center.

Mild traumatic brain injury (mTBI) can be accompanied by structural damage to the brain. Here, we investigated how the presence of intracranial traumatic computed tomography (CT) pathologies relates to the global functional outcome in young patients one year after mTBI. All patients with mTBI (Glasgow Coma Scale: 13–15) ≤24 years in the multi-center, prospective, observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study were included. Patient demographics and CT findings were assessed at admission, and the Glasgow Outcome Scale Extended (GOSE) was evaluated at 12 months follow-up. The association between a "positive CT" (at least one of the following: epidural hematoma, subdural hematoma, traumatic subarachnoid hemorrhage (tSAH), intraventricular hemorrhage, subdural collection mixed density, contusion, traumatic axonal injury) and functional outcome (GOSE) was assessed using multi-variable mixed ordinal and logistic regression models. A total of 462 patients with mTBI and initial brain CT from 46 study centers were included. The median age was 19 (17–22) years, and 322 (70%) were males. CT imaging showed a traumatic intracranial pathology in 171 patients (37%), most commonly tSAH (48%), contusions (40%), and epidural hematomas (37%). Patients with a positive CT scan were less likely to achieve a complete recovery 12 months post-injury. The presence of any CT abnormality was associated with both lower GOSE scores (odds ratio [OR]: 0.39 [0.24–0.63]) and incomplete recovery (GOSE <8; OR: 0.41 [0.25–0.68]), also when adjusted for demographical and clinical baseline factors. The presence of intracranial traumatic CT pathologies was predictive of outcome 12 months after mTBI in young patients, which might help to identify candidates for early follow-up and additional care. [ABSTRACT FROM AUTHOR]

Background: Pulmonary sequestration (PS) is a rare congenital lower airway malformation. This study presents the clinical and imaging features and surgical outcomes of PS in adults, and compare the safety and feasibility of minimally invasive surgery versus open thoracotomy for PS. Methods: Adult patients with PS treated at our center from July 2011 to September 2021 were included. Information regarding the patient demographics, clinical and CT features, arterial supply and venous drainage, and surgical outcomes were collected. Results: Ninety seven patients were included. The most common CT findings were mass lesions (50.5%) and cystic lesions (20.6%). The vast majority of the lesions (96 out of 97) were located close to the spine in the lower lobes (left vs. right: 3.6 vs. 1). Arterial supply was mainly provided by the thoracic aorta (87.4%) and abdominal aorta (10.5%). Intralobar and extralobar PS accounted for 90.7% and 9.3% of the patients, respectively. Three (4.5%) patients who underwent minimally invasive surgery were converted to open thoracotomy due to dense adhesions. Though no significant differences regarding operative time (P = 0.133), the minimally invasive surgery group was significantly better than the open thoracotomy group regarding intraoperative blood loss (P = 0.001), drainage volume (P = 0.004), postoperative hospital days (P = 0.017) and duration of chest drainage (P = 0.001). There were no cases of perioperative mortality. Only four (4.1%) patients developed postoperative complications, and no significant difference existed between the two groups. Conclusion: Our study revealed PS can present with a variety of different clinical and radiologic manifestations. Clinicians should consider the possibility of PS when diagnosing a lesion in the lower lobes close to the spine. Moreover, minimally invasive surgery is a safe and effective treatment modality for the treatment of PS in an experienced center. [ABSTRACT FROM AUTHOR]

Topic Importance: The incidence of pulmonary nodules and masses in non-HIV immunocompromised patients has significantly increased due to advancements in hematopoietic stem cell transplantation (HSCT), solid organ transplantation (SOT), and the widespread use of chemotherapy and immunosuppressive therapies. Differentiating between infectious and non-infectious causes is critical for appropriate diagnosis and management, especially as radiological and clinical presentations can be nonspecific., Review Findings: This review provides a practical framework for evaluating pulmonary nodules and masses in non-HIV immunocompromised patients, incorporating clinical, immunological, and radiological features. It emphasizes the importance of differentiating between infectious and non-infectious etiologies based on imaging and clinical context. The review highlights the importance of correlating imaging features with the patient's immune status and underlying clinical conditions to narrow down the differential diagnosis., Summary: Pulmonary nodules and masses in immunocompromised patients represent a diagnostic challenge due to overlapping radiological and clinical presentations. By integrating clinical context, immune status, and imaging findings, clinicians can more accurately diagnose and manage these lesions, improving patient outcomes. This review presents an algorithmic approach for differentiating between various causes of pulmonary nodules and masses in non-HIV immunocompromised individuals, providing a valuable tool for clinical practice., (Copyright © 2024. Published by Elsevier Inc.)

Background: The seizure incidence in hydrocephalic children has been acknowledged in a lot of studies previously; nonetheless, seizure pathogenesis in these children remains unclear. Its high proportion of hydrocephalic children who underwent shunt surgery suggests that the seizure might be associated with the protocol of shunt placement and/or the shunt existence intracranially; however, this hypothesis could not explain the pre-shunt seizure incidence in hydrocephalic children. Objective: This study aims to evaluate the patients' characteristics and CT findings in pre-shunt hydrocephalic children to identify the possible seizure etiology in these patients. Methods: Three hundred and thirty-four children with hydrocephalus were included in this study, including 147 hydrocephalic children with the pre-shunt seizure history and 187 hydrocephalic children presented without the pre-shunt seizure history. The following information was retrieved from the patients' medical records: gender, age, pediatric Glasgow Coma Scale (pGCS) upon admission, and hydrocephalus diagnoses. CT findings were re-evaluated to assess the compression association of sulci and gyri, Sylvian fissures, cisterns, FH/ID ratio, Evan's ratio, and periventricular hypodensity with pre-shunt seizure. Results: The results show that the pre-shunt seizure incidence is significantly higher in hydrocephalic children aged 1 to 5 years old (63/113 (55%), p = 0.0001), diagnosed with communicating hydrocephalus (97/163 (59%), p = 0.0001) or infectious hydrocephalus (80/109 (73%), p = 0.0001). The presence of periventricular hypodensity is significantly associated with the pre-shunt seizure incidence (132/205 (64.3%), p = 0.0001). Results from univariate analyses suggest significant association between periventricular hypodensity in every location and pre-shunt seizure (p < 0.0001). Multivariate analyses identify that temporal horn in the right lateral ventricle as the location of periventricular hypodensity has the strongest association with the pre-shunt seizure. Conclusion: The presence of periventricular hypodensity in head CT scan is significantly associated with the pre-shunt seizure incidence. Further investigation to confirm this finding and evaluate the possible roles of inflammation in the pre-shunt seizure in hydrocephalic children is important to seek its possible implication on the treatment of pre-shunt seizure in these children. [ABSTRACT FROM AUTHOR]

Abstract Background The gold standard for verifying COVID-19 mostly depends on microbiological tests like real-time polymerase chain reaction (RT-PCR). However, the availability of RT-PCR kits can be known as a problem and false negative results may be encountered. Although CT scan is not a screening tool for the diagnosis of COVID-19 pneumonia, given the widespread acquisition of it in the pandemic state, familiarity with different CT findings and possible differential diagnosis is essential in this regard. Main text In this review, we introduced the typical and atypical CT features of COVID-19 pneumonia, and discussed the main differential diagnosis of COVID-19 pneumonia. Conclusions The imaging findings in this viral pneumonia showed a broad spectrum, and there are no pathognomonic imaging findings for COVID-19 pneumonia. Although CT scan is not a diagnostic and screening tool, familiarity with different imaging findings and their differential diagnosis can be helpful in a rapid and accurate decision-making.

Background: Globally, adults presenting with seizures account for 1% - 2% of visits to emergency departments (EDs), of which 25% are new-onset seizures. Neuroimaging is essential as part of the initial workup. Multiple studies have demonstrated abnormal CT brain (CTB) findings in these patients. Objectives: To review the CTB findings in adults presenting with new-onset seizures in a resource restricted setting. Method: A retrospective review of 531 CTBs was conducted at a tertiary hospital in Gauteng on adults presenting to the ED with new-onset seizures. Results: The mean age of the patients was 45.6 ± 17.1 years, and the male to female ratio was 1.2:1. Generalised and focal seizure types were almost equally represented. Of the total 531 patients, 168 (31.6%) were HIV positive. The CTB findings were abnormal in 257 (48.4%) patients, albeit vascular pathology accounted for 21.9%. Infective pathology accounted for 14.1% with a statistically significant association with HIV (p = 0.003). Trauma related pathology was 2.4%, whilst neoplastic pathology was seen in 3.0%. Other causes included congenital pathology, calcifications, atrophy and gliosis. Clinical factors associated with abnormal CTB findings were age ≥ 40 years, HIV infection, hypertension, focal seizures, low Glasgow Coma Scale (GCS), raised cerebrospinal fluid (CSF) protein and presence of lymphocytes. Conclusion: A high yield of abnormal CTB findings was noted in adult patients who presented with new-onset seizures, supporting the use of urgent CTB in patients with certain clinical risk factors. Patients without these risk factors can be scanned within 24--48 h in a resource restricted setting. [ABSTRACT FROM AUTHOR]

Background: The various clinical manifestations of COVID-19 with RT-PCR positive patients have been reported. However, the differences in the clinical presentation between children and adults were unclear. Thus, we aimed to investigate the differences in the clinical manifestations and imaging characteristics between Chinese children and adults with COVID-19 by systematically analyzing the data derived from some latest literatures. Methods: An extensive search of COVID-19 papers was conducted in PubMed and Chinese medical journal network, and relevant articles were selected based on some standard requirements. The included papers were analyzed for differences in clinical manifestation between children and adults with COVID-19 after the quality evaluation with the QUADAS-2 tool. The differences in the clinical features and CT findings were analyzed using a Pearson χ2 test or Fisher's exact test. Patients who underwent CT examination were divided into the initial examination (0–4days) and follow-up examination groups (5–14 days). Results: A total of 345patients (70 children and 275 adults) with RT- PCR (+) were included in our study (5 papers for children and 5 papers for adult groups). Significant differences between children and adults were found in exposure history (p < 0.001, χ2 = 166.890), fever (p = 0.016, χ2 = 5.757), white cell count (p < 0.001, χ2 = 14.043), and CT features in the initial (p < 0.001, χ2 = 60.653) and follow-up stages (p < 0.001, χ2 = 52.924); and the involved lung in the follow-up stage (p ＜ 0.001, χ2 = 16.776). Conclusions: Some differences have been presented between children and adults with RT-PCR positive COVID-19, which are helpful in the management and protection of children with COVID-19.

2019 novel coronavirus disease (COVID-19, previously known as novel coronavirus pneumonia) was first discovered in December 2019 and spread widely in China and all over the world in 2020. The initial symptoms of most patients include fever, cough, and fatigue. Dyspnea may occur with the progress of the disease, and acute respiratory distress syndrome may occur in severe cases. The CT manifestations of this disease are mainly ground-glass opacity (GGO) in the lung, which may be accompanied by patchy consolidation, and fibrous changes may appear in the lung at the later stage of the disease. Combined with typical clinical and imaging findings and positive nucleic acid test results, the disease can be diagnosed. We report the first case of novel coronavirus disease (COVID-19) in Heilongjiang Province, China. The patient was seriously ill, who felt that he suffered from fever, fatigue, cough, and expectoration and sought medical treatment, with a history of contact with Wuhan. The leukocyte count was normal, and the lymphocyte count was decreased. CT imaging showed large GGO and partial patchy consolidation in both lungs. The patient recovered and was discharged after 26 days of treatment. This study is helpful for early diagnosis and timely clinical management by mastering the typical imaging of novel coronavirus disease (COVID-19).

Background: Globally, adults presenting with seizures account for 1% – 2% of visits to emergency departments (EDs), of which 25% are new-onset seizures. Neuroimaging is essential as part of the initial workup. Multiple studies have demonstrated abnormal CT brain (CTB) findings in these patients. Objectives: To review the CTB findings in adults presenting with new-onset seizures in a resource restricted setting. Method: A retrospective review of 531 CTBs was conducted at a tertiary hospital in Gauteng on adults presenting to the ED with new-onset seizures. Results: The mean age of the patients was 45.6 ± 17.1 years, and the male to female ratio was 1.2:1. Generalised and focal seizure types were almost equally represented. Of the total 531 patients, 168 (31.6%) were HIV positive. The CTB findings were abnormal in 257 (48.4%) patients, albeit vascular pathology accounted for 21.9%. Infective pathology accounted for 14.1% with a statistically significant association with HIV (p = 0.003). Trauma related pathology was 2.4%, whilst neoplastic pathology was seen in 3.0%. Other causes included congenital pathology, calcifications, atrophy and gliosis. Clinical factors associated with abnormal CTB findings were age ≥ 40 years, HIV infection, hypertension, focal seizures, low Glasgow Coma Scale (GCS), raised cerebrospinal fluid (CSF) protein and presence of lymphocytes. Conclusion: A high yield of abnormal CTB findings was noted in adult patients who presented with new-onset seizures, supporting the use of urgent CTB in patients with certain clinical risk factors. Patients without these risk factors can be scanned within 24–48 h in a resource restricted setting.

To review the CT findings and complications of small bowel diverticulitis (SBD) and discuss clinical presentations and outcomes. A text search of radiology reports within our health system for cases of small bowel diverticulitis yielded 95 cases. All cases were reviewed by an abdominal radiologist with equivocal cases reviewed by a second abdominal radiologist for consensus. Retrospective analysis of CT imaging findings was performed on 67 convincing cases of SBD. Small bowel diverticulitis most often affected the jejunum (58%) and the duodenum (26%). The most common imaging feature was peridiverticular inflammation manifested by peridiverticular edema, diverticular wall thickening, bowel wall thickening, and fascial thickening. Edema was typically seen along the mesenteric border of the bowel with relative sparing of the anti-mesenteric side. When a prior CT was available, the affected diverticulum was identified in 95% of cases. Fecalized content within the affected diverticulum was observed in 51% of cases. Perforation (6%) and abscess (6%) were the most common complications. Small bowel diverticulitis is an uncommon cause of abdominal pain which can mimic an array of abdominal pathologies, although the reported mortality rate of 40–50% may no longer be accurate. The "fecalized diverticulum" sign can be helpful in identifying the culprit diverticulum and aid diagnosing SBD. Findings of perforation and or abscess formation are critical as they may impact management. • Acute small bowel diverticulitis is an uncommon cause of abdominal pain which can mimic an array of abdominal pathologies • Complications include perforation, abscess, bowel obstruction, volvulus, cholangitis, and obstructive jaundice • Key CT findings include normal diverticulum on prior exams, additional unaffected diverticula, fecalized diverticular content [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of the study was to analyze spatiotemporal changes of CT manifestations in patients with COVID-19 pneumonia. PATIENTS AND METHODS: In this retrospective review, 110 patients with confirmed COVID-19 by RT-PCR form February 16, 2020, to March 28, 2020 were included. A total of 449 CT scans were reviewed. We analyze the type and distribution of lung abnormalities, and CT general assessment and lesion area statistics were performed. Patients were divided into mild, moderate, and severe disease based on Chinese guidelines: mild (patients with minimal symptoms, CT scans showed no pneumonia or a small area of pneumonia infection), moderate (different extent of clinical manifestations and CT scans showed multiple pneumonia infections in both lungs), severe disease (respiratory distress, CT scans lesion area exceeds 50%, and the lesion contains consolidation). The proportion of patients with mild, moderate and severe diseases was counted. RESULTS: The CT score and the area involved reached a peak (median 10) on illness days 7-12, and then, continued to be at a high level. The main abnormal pattern after symptoms appeared GGO (36/94 [36%] to 40/65 [62%] in different periods). The proportion of mixed reached its peak on illness days 13-18 (36/93 [39%]). Pure GGO was the most common subtype of GGO (24 of 60 CT scans [40%] to 23 of 33 CT scans [70%]) after symptoms onset. The ratio of GGO with irregular lines and interfaces peaked on illness days 7-12 (6/34 [18%]). The lesions are mainly distributed on both sides and under the pleura. 76/84 (90%) of discharged patients had residual lesions on the final CT scans. 4 confirmed patients' CT scans did not show lesions (on illness days 1-24 days). There were 47 mild cases (42.7%), 46 moderate cases (41.8%), and 7 severe cases (6.3%). CONCLUSIONS: The degree of lung abnormality on the CT of the patients reached the peak on the 7th to 12th days of the disease. CT performance changes with time have a certain regularity, which may indicate the progress and recovery of the disease. 90% of patients still observed residual lung abnormalities in CT images at the time of discharge. There were 4 confirmed cases where the CT images did not show the lesion; hence, CT cannot be used as a basis for judging COVID-19 as a single tool. [ABSTRACT FROM AUTHOR]

At the end of 2019, the World Health Organization (WHO) reported pneumonia that started in Wuhan, China, as a global emergency problem. Researchers quickly advanced in research to try to understand this COVID-19 and sough solutions for the front-line professionals fighting this fatal disease. One of the tools to aid in the detection, diagnosis, treatment, and prevention of this disease is computed tomography (CT). CT images provide valuable information on how this new disease affects the lungs of patients. However, the analysis of these images is not trivial, especially when researchers are searching for quick solutions. Detecting and evaluating this disease can be tiring, time-consuming, and susceptible to errors. Thus, in this study, we aim to automatically segment infections caused by COVID19 and provide quantitative measures of these infections to specialists, thus serving as a support tool. We use a database of real clinical cases from Pedro Ernesto University Hospital of the State of Rio de Janeiro, Brazil. The method involves five steps: lung segmentation, segmentation and extraction of pulmonary vessels, infection segmentation, infection classification, and infection quantification. For the lung segmentation and infection segmentation tasks, we propose modifications to the traditional U-Net, including batch normalization, leaky ReLU, dropout, and residual block techniques, and name it as Residual U-Net. The proposed method yields an average Dice value of 77.1% and an average specificity of 99.76%. For quantification of infectious findings, the proposed method achieves results like that of specialists, and no measure presented a value of ρ < 0.05 in the paired t-test. The results demonstrate the potential of the proposed method as a tool to help medical professionals combat COVID-19. fight the COVID-19. [ABSTRACT FROM AUTHOR]

Background: The gold standard for verifying COVID-19 mostly depends on microbiological tests like real-time polymerase chain reaction (RT-PCR). However, the availability of RT-PCR kits can be known as a problem and false negative results may be encountered. Although CT scan is not a screening tool for the diagnosis of COVID-19 pneumonia, given the widespread acquisition of it in the pandemic state, familiarity with different CT findings and possible differential diagnosis is essential in this regard. Main text: In this review, we introduced the typical and atypical CT features of COVID-19 pneumonia, and discussed the main differential diagnosis of COVID-19 pneumonia. Conclusions: The imaging findings in this viral pneumonia showed a broad spectrum, and there are no pathognomonic imaging findings for COVID-19 pneumonia. Although CT scan is not a diagnostic and screening tool, familiarity with different imaging findings and their differential diagnosis can be helpful in a rapid and accurate decision-making. [ABSTRACT FROM AUTHOR]

Introduction In modern emergency service systems, patients are often treated with sedation, intubation, and ventilation at the accident site. But neurosurgical assessment before all these emergency services is important. Thus, this study was designed to investigate the relationships between various parameters of initial CT scan findings and the outcomes of the patients. Methodology A total of 56 adult patients of traumatic acute subdural hematoma (SDH) whose computed tomography (CT) scan was performed within 8 hours of injury were recruited. The patients with prolonged hypotension, open head injury or depressed skull fracture, bilateral side acute SDH, or contusions/hematoma/extradural hematoma on the contralateral side were excluded. Six separate CT findings were analyzed and recorded, including hematoma, midline shift, subarachnoid hemorrhage (SAH), presence of basal cistern obliteration (BCO), intraparenchymal hematoma/contusion in the same hemisphere, and presence of effacement of the sulcal spaces, and were followed up for three months for outcome analysis. Results The overall mortality and functional recovery rate were 27 and 50%, respectively. The patients with obliterated basal cisterns and the presence of underlying SAH in patients with acute SDH had statistically significant poorer outcomes as compared with others. However, the extent of midline shift, SDH thickness, and the presence of underlying contusions and sulcal effacement on initial CT scan showed no statistically significant correlation with patients' outcomes. Conclusions BCO and presence of subarchnoid hemorrhage underlying acute SDH on the earliest scan in head injury patients signify the severity of brain parenchymal injury. Along with the initial Glasgow Coma Scale score after resuscitation, these two factors should be considered as the most significant ones for predicting the outcomes in traumatic acute SDH patients. [ABSTRACT FROM AUTHOR]

The various clinical manifestations of COVID-19 with RT-PCR positive patients have been reported. However, the differences in the clinical presentation between children and adults were unclear. Thus, we aimed to investigate the differences in the clinical manifestations and imaging characteristics between Chinese children and adults with COVID-19 by systematically analyzing the data derived from some latest literatures. An extensive search of COVID-19 papers was conducted in PubMed and Chinese medical journal network, and relevant articles were selected based on some standard requirements. The included papers were analyzed for differences in clinical manifestation between children and adults with COVID-19 after the quality evaluation with the QUADAS-2 tool. The differences in the clinical features and CT findings were analyzed using a Pearson χ2 test or Fisher's exact test. Patients who underwent CT examination were divided into the initial examination (0–4days) and follow-up examination groups (5–14 days). A total of 345patients (70 children and 275 adults) with RT- PCR (+) were included in our study (5 papers for children and 5 papers for adult groups). Significant differences between children and adults were found in exposure history (p < 0.001, χ2 = 166.890), fever (p = 0.016, χ2 = 5.757), white cell count (p < 0.001, χ2 = 14.043), and CT features in the initial (p < 0.001, χ2 = 60.653) and follow-up stages (p < 0.001, χ2 = 52.924); and the involved lung in the follow-up stage (p ＜ 0.001, χ2 = 16.776). Some differences have been presented between children and adults with RT-PCR positive COVID-19, which are helpful in the management and protection of children with COVID-19. [ABSTRACT FROM AUTHOR]

Purpose: To identify computed tomography (CT) features of epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma in Canadian population and whether imaging-based surrogate markers of EGFR mutation in our population were similar to those found in the Asian population. Materials and Methods: Pretreatment CT scans of 223 patients with adenocarcinoma of the lung (112 with EGFR mutation and 111 without mutation) were retrospectively assessed for 20 specific CT features by 2 radiologists, who were blinded to the status of EGFR mutation. Univariate and multivariate logistic regression analyses as well as areas under the receiver operating characteristic curve were performed to discriminate characteristics of EGFR-activating mutation features. Results: Epidermal growth factor receptor mutation-positive adenocarcinomas were more frequently found in female (P <.03), less than 20 pack-year smoking history (P <.001), smaller tumor (P <.01), spiculated margins (P <.05), without centrilobular emphysema (P <.001), and without lymphadenopathy (P <.05), similarly to the Asian population. Multivariate logistic regression analyses of combined clinical and radiological features identified less than 20 pack-year smoking history, smaller tumor diameter, fine or coarse spiculations, noncentral location of the tumor, and lack of centrilobular emphysema and pleural attachment as the strongest independent prognostic factors for the presence of an EGFR mutation. These combined features improved prognostic ability area under the curve to 0.879, compared to 0.788 for clinical features only. Conclusion: Several CT findings may help predict the presence of an activating mutation in EGFR in lung adenocarcinomas in our Canadian population. Combining clinical and radiological features improves prognostic ability to determine the EGFR mutation status compared to clinical features alone. [ABSTRACT FROM AUTHOR]

Copyright of CT Theory & Applications is the property of Editorial Department of CT Theory & Applications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

2019 novel coronavirus disease (COVID-19, previously known as novel coronavirus pneumonia) was first discovered in December 2019 and spread widely in China and all over the world in 2020. The initial symptoms of most patients include fever, cough, and fatigue. Dyspnea may occur with the progress of the disease, and acute respiratory distress syndrome may occur in severe cases. The CT manifestations of this disease are mainly ground-glass opacity (GGO) in the lung, which may be accompanied by patchy consolidation, and fibrous changes may appear in the lung at the later stage of the disease. Combined with typical clinical and imaging findings and positive nucleic acid test results, the disease can be diagnosed. We report the first case of novel coronavirus disease (COVID-19) in Heilongjiang Province, China. The patient was seriously ill, who felt that he suffered from fever, fatigue, cough, and expectoration and sought medical treatment, with a history of contact with Wuhan. The leukocyte count was normal, and the lymphocyte count was decreased. CT imaging showed large GGO and partial patchy consolidation in both lungs. The patient recovered and was discharged after 26 days of treatment. This study is helpful for early diagnosis and timely clinical management by mastering the typical imaging of novel coronavirus disease (COVID-19). [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate computed tomography (CT) findings of radicular cysts with a focus on location, size, and condition of the surrounding bone. Subjects comprised 60 men and 86 women (mean age 47.2 years) with histopathologically confirmed radicular cysts who underwent CT examination between 2012 and 2014. Mesiodistal and buccolingual diameters were measured at the location where the lesion appeared to be largest on CT axial images. Of the 146 cases, 103 lesions were in the maxilla and 43 were in the mandible. Mesiodistal diameter of the maxillary lesions was significantly larger than that of the mandibular lesions. However, the ratio of mesiodistal diameter to buccolingual diameter in the mandible was significantly larger than that in the maxilla. Bone expansion was more significant in the maxilla than in the mandible. Mesiodistal and buccolingual diameters in only the maxilla and perilesional sclerotic radiolucency in images of both jaws were significantly associated with the severity of clinical symptoms. The findings suggest that radicular cysts in the maxilla are accompanied by bone expansion in the mesiodistal and buccolingual directions and those in the mandible progress in the mesiodistal direction without bone expansion. Clinical acute symptoms (pain and swelling) are correlated with lesion size in the maxilla; such a correlation is not clear for mandibular lesions, and discovery of mandibular lesions may, therefore, be delayed. [ABSTRACT FROM AUTHOR]

Abstract This is the first report of a case of COVID‐19 after allogeneic stem cell transplantation. Our case suggests that COVID‐19 may exist without characteristic CT images, especially in immunocompromised hosts, such as patients after transplantation.

Background: One of the greatest challenges in the diagnosis of acute mesenteric ischemia (AMI) is the lack of specific laboratory tests that support multidetector computed tomography (CT). Our aim is to investigate the diagnostic value of electrocardiographic QT parameters in AMI and their relationship with CT findings., Materials and Methods: Patients who were admitted to the emergency department with abdominal pain were recruited retrospectively from the hospital information system. Grouping was carried out on the basis of AMI (n=78) and non-AMI (n=78). In both groups, the corrected QT (QTc) and QT dispersion (QTD) were measured on electrocardiographs, and the qualitative and quantitative CT findings were evaluated on CT examinations., Results: The QTc and QTD values were higher in the AMI group. The median QTc values were 456.16 (IQR: 422.88-483.16) for the AMI group and 388.83 (IQR: 359.74-415.83) for the control group (p<0.001), and the median QTD values were 58 (IQR: 50.3-68.25) for the AMI group and 46 (IQR: 42-50) for the control group (p<0.001). In the CT analysis, the QTc values were significantly higher among AMI patients, with images of paper-thin bowel walls and the absence of bowel wall enhancement (p=0.042 and p=0.042, respectively). Meanwhile, the QTD values were significantly higher among patients with venous pneumatosis findings on CT (p=0.005). In the regression analysis, a significant relationship was found between the QT parameters and AMI (p<0.001). For QTc, an AUC of 0.903 (95% CI: 0.857-0.950, p<0.001), a sensitivity of 80.8%, and a specificity of 82.3% were found. For QTD, an AUC of 0.821 (95% CI: 0.753-0.889, p<0.001), a sensitivity of 73.1%, and a specificity of 82.3% were found., Conclusion: We found the QTc and QTD values to be significantly higher among AMI patients. Furthermore, we found a significant relationship between the CT findings and QTc and QTD and a significant relationship between survival and QTc in the AMI group., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: A bone tumor is a neoplastic growth of tissue in bone. Abnormal growths found in the bone can be either benign (noncancerous) or malignant (cancerous). Aims and objectives: The purpose of this study was to evaluate the role of MRI in cases of primary malignant bone tumors and MRI characteristics of different primary malignant bone tumors, to compare the imaging findings with surgical and gross pathological findings, Staging of tumor on MRI, correlating them with operative and histopathological findings. Materials and methods: This was a prospective study done in Department of Radiodiagnosis of NRIGH comprising of 40 patients 21 male and 19 female who were suspected or proven cases of the malignant bone tumor. Plain radiographs in AP and Lateral views (including the adjacent joint) were taken in all cases. The primary pulse sequences included T1 and T2 WI using spine echo and gradient echo techniques with TR of 600 msec. and TE 30msec. for T1WI and TR of 2740 msec. and TE of 85 msec. for T2 WI . The MR morphology was correlated with surgical and histopathological features. Results: The study “Multiplanar MR Imaging of primary malignant bone tumors with surgical and histopathological correlation” comprised of 40 patients in a two year period starting from august 2010 to September 2012 the age ranged from 8 years to 71 years (mean 40 years). There were 21 males and 19 females. Conclusion: MRI in combination with plain radiography is an excellent modality for evaluation of the musculoskeletal pathologies especially differentiating a malignant from a benign lesion. The multiplanar imaging capabilities place a major role in delineation of tumour extent in to the bone and soft tissues with high contrast and resolution with additional information of neurovascular bundle involvement, joint involvement and staging. [ABSTRACT FROM AUTHOR]

Purpose: To determine how the reduction of medial and anteromedial cortices using CT findings in 31-A2 intertrochanteric fractures treated with the intramedullary nail could affect the clinical outcomes and complication rates of the fractures.Methods: We retrospectively analyzed the data of 43 patients with 31-A2 intertrochanteric fractures who underwent closed reduction and intramedullary internal fixation (CRIF) between January 2010 and December 2013. Patients were classified into two groups based on the post-operative CT scans taken from the sagittal and coronal planes, respectively. Five radiographic parameters and three clinical parameters were used to evaluate the post-operative functional states and mobilization levels in this study. Post-operative complications were also recorded.Results: The mean loss of the femoral neck-shaft angle (FNSA) was significantly smaller in Group C1 than that in Group C2. There were significant differences in the sliding distance of the cephalic nail and the loss of femoral head height between the two groups. In terms of the reduction conditions shown on the sagittal planes, the FNSA, sliding distance of the cephalic nail, and the loss of FHH were significantly different, although differences in TCD were not significant. Patients in groups C1 (3.6%) and S1 (0.0%) had lower complication rates compared to patients in groups C2 (26.7%) and S2 (27.8%).Conclusion: Patients with good reduction quality of the medial and anteromedial sustainable cortices had better clinical outcomes and lower complication rates. The sustainable stability and anti-rotational function of these validated reductions might play a critical role in maintaining the fragment positions and reducing the incidence of complications in patients. [ABSTRACT FROM AUTHOR]

Introduction: Demographic and clinical profile of traumatic brain injury (TBI) of a particular place is very crucial for strengthening the guidelines. The details of same are scant from a tertiary institute, Nellore district. The present study aims to explore the demographic, injury and clinical aspects of cerebro-cranial injury patients from an institute setup. Methods: The study consists of two years retrospective data and one year prospective data. The study was approved by institute ethical committee. The patient data was entered on pre designed proforma that includes the desired variables. The data analysis was done using StatsDirect software. Both prospective and retrospective data was merged for analysis. Percentages for categorical data and mean values for continuous data were calculated. Results: There were total of 336 patients. Patients in age group of 21 to 50 years constituted 67% and males were four times higher than females. Nearly one fourth of patients were influenced by alcohol. Three fourth of accidents were due to road traffic accidents (RTAs) followed by falls (17%) and assault (6%). About one tenth of patients were pedestrians. One fourth of patients had associated injuries other than head and brain. On CT findings majority of patients had cerebral contusion (46%) followed by skull fracture (40%), SDH (28%) and EDH (23%). Twenty two patients died in the study period. Conclusion: Knowledge of injury and its later consequences to public is very important. Strict rules to consider safety precautions and compulsory family insurances should be encouraged. Rules to prevent paediatric drive.