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Background Magnetic resonance imaging (MRI) is largely used in the diagnosis of central nervous system involvement of tuberculosis (CNSTB), yet there is no MRI comparison study between HIV+ and HIV− patients with CNSTB. The aim of the present study was to identify MRI differences in CNSTB between HIV+ and HIV− patients and possibly find early characteristics that could raise the suspect of this disease. Methods We included all patients admitted in our institution between 2011 and 2018 with confirmed diagnosis of CNSTB, and MRI performed in the first week. Patients with preexisting brain pathology or immunodeficiency not HIV related were excluded. We compared CNSTB MRI features between the two groups. Results Sixty-nine patients were included (19 HIV+; 50 HIV−). Findings in HIV+ group: 6 lung TB, 5 hydrocephalus, 4 meningeal enhancement, 6 stroke, 2 hemorrhages, and 10 tuberculomas. HIV− group: 22 lung tuberculosis, 15 hydrocephalus, 21 meningeal enhancement, 5 stroke, 4 hemorrhages, 20 tuberculomas. The only statistically significant difference between the two groups was in the stroke occurrence, more frequent in the HIV+ group (P = .028), all involving the basal ganglia. Conclusions Stroke involving the basal ganglia best differentiates CNSTB patients who are HIV+ from those HIV−. This finding was not correlated with meningeal enhancement suggesting that small arteries involvement might precede it. Therefore, we think that HIV+ patients with a new onset of stroke should be evaluated for CNSTB. Follow-up MRI should also be planned since meningeal enhancement might appear in later stages of the disease.

Purpose: To analyze the vaccine effect by comparing five groups: unvaccinated patients with Alpha variant, unvaccinated patients with Delta variant, vaccinated patients with Delta variant, unvaccinated patients with Omicron variant, and vaccinated patients with Omicron variant, assessing the “gravity” of COVID-19 pulmonary involvement, based on CT findings in critically ill patients admitted to Intensive Care Unit (ICU). Methods: Patients were selected by ICU database considering the period from December 2021 to 23 March 2022, according to the following inclusion criteria: patients with proven Omicron variant COVID-19 infection with known COVID-19 vaccination with at least two doses and with chest Computed Tomography (CT) study during ICU hospitalization. Wee also evaluated the ICU database considering the period from March 2020 to December 2021, to select unvaccinated consecutive patients with Alpha variant, subjected to CT study, consecutive unvaccinated and vaccinated patients with Delta variant, subjected to CT study, and, consecutive unvaccinated patients with Omicron variant, subjected to CT study. CT images were evaluated qualitatively using a severity score scale of 5 levels (none involvement, mild: ≤25% of involvement, moderate: 26–50% of involvement, severe: 51–75% of involvement, and critical involvement: 76–100%) and quantitatively, using the Philips IntelliSpace Portal clinical application CT COPD computer tool. For each patient the lung volumetry was performed identifying the percentage value of aerated residual lung volume. Non-parametric tests for continuous and categorical variables were performed to assess statistically significant differences among groups. Results: The patient study group was composed of 13 vaccinated patients affected by the Omicron variant (Omicron V). As control groups we identified: 20 unvaccinated patients with Alpha variant (Alpha NV); 20 unvaccinated patients with Delta variant (Delta NV); 18 vaccinated patients with Delta variant (Delta V); and 20 unvaccinated patients affected by the Omicron variant (Omicron NV). No differences between the groups under examination were found (p value > 0.05 at Chi square test) in terms of risk factors (age, cardiovascular diseases, diabetes, immunosuppression, chronic kidney, cardiac, pulmonary, neurologic, and liver disease, etc.). A different median value of aerated residual lung volume was observed in the Delta variant groups: median value of aerated residual lung volume was 46.70% in unvaccinated patients compared to 67.10% in vaccinated patients. In addition, in patients with Delta variant every other extracted volume by automatic tool showed a statistically significant difference between vaccinated and unvaccinated group. Statistically significant differences were observed for each extracted volume by automatic tool between unvaccinated patients affected by Alpha variant and vaccinated patients affected by Delta variant of COVID-19. Good statistically significant correlations among volumes extracted by automatic tool for each lung lobe and overall radiological severity score were obtained (ICC range 0.71–0.86). GGO was the main sign of COVID-19 lesions on CT images found in 87 of the 91 (95.6%) patients. No statistically significant differences were observed in CT findings (ground glass opacities (GGO), consolidation or crazy paving sign) among patient groups. Conclusion: In our study, we showed that in critically ill patients no difference were observed in terms of severity of disease or exitus, between unvaccinated and vaccinated patients. The only statistically significant differences were observed, with regard to the severity of COVID-19 pulmonary parenchymal involvement, between unvaccinated patients affected by Alpha variant and vaccinated patients affected by Delta variant, and between unvaccinated patients with Delta variant and vaccinated patients with Delta variant.

The COVID-19 pandemic caused an unprecedented effect on national radiological investigations. Since the World Health Organization officially declared the COVID-19 as a global pandemic, health policies have been rapidly organized to limit the spread of the virus and decrease the risk of exposure. These restrictions, in combination with home-stay arrangements and the onset of economic recession. As a result of public policies, financial difficulties and patient fear, many radiology departments have suffered a significant reduction in diagnostic examinations with important implications for their economic stability. The aim of this work is to evaluate the economic impact of the COVID-19 pandemic in the Radiology Department of an infectious disease hospital.

Background: critically ill patients with SARS-CoV-2 infection present a hypercoagulable condition. Anticoagulant therapy is currently recommended to reduce thrombotic risk, leading to potentially severe complications like spontaneous bleeding (SB). Percutaneous transcatheter arterial embolization (PTAE) can be life-saving in critical patients, in addition to medical therapy. We report a major COVID-19 Italian Research Hospital experience during the pandemic, with particular focus on indications and technique of embolization. Methods: We retrospectively included all subjects with SB and with a microbiologically confirmed SARS-CoV-2 infection, over one year of pandemic, selecting two different groups: (a) patients treated with PTAE and medical therapy, (b) patients treated only with medical therapy. Computed tomography (CT) scan findings, clinical conditions, and biological findings were collected. Results: 21/1075 patients presented soft tissue SB with an incidence of 1.95%. 10/21 patients were treated with PTAE and medical therapy with a 30-days survival of 70%. Arterial blush, contrast late enhancement, and dimensions at CT scan were found discriminating for the embolization (p &lt, 0.05). Conclusions: PTAE is an important tool in severely ill, bleeding COVID-19 patients. The decision for PTAE of COVID-19 patients must be carefully weighted with particular attention paid to the clinical and biological condition, hematoma location and volume.

To evaluate the effect of dose reduction with iterative reconstruction (IR) on image quality of chest CT scan comparing two protocols. Fifty-nine patients were enrolled. The two CT protocols were applied using Iterative Reconstruction (ASIR™) 40% but different noise indexes, recording dose-length product (DLP) and volume computed tomography dose index (CTDIvol). The subjective IQ was rated based on the distinction of anatomic details using a 4-point Likert scale based on the European Guidelines on Quality Criteria for CT. For each patient, two single CTs, at enrollment (group 1) and at follow-up after lowering the dose (group 2), were evaluated by two radiologists evaluating, for each examination, five different lung regions (central zone—CZ; peripheral zone—PZ; sub-pleural region—SPR; centrilobular region—CLR; and apical zone—AZ). An inter-observer agreement was expressed by weighted Cohen’s kappa statistics (k) and intra-individual differences of subjective image analysis through visual grading characteristic (VGC) analysis. An average 50.4% reduction in CTDIvol and 51.5% reduction in DLP delivered were observed using the dose-reduced protocol. An agreement between observers evaluating group 1 CTs was perfect (100%) and moderate to good in group 2 examinations (k-Cohen ranging from 0.56 for PZ and AZ to 0.70 for SPR). In the VGC analysis, image quality ratings were significantly better for group 1 than group 2 scans for all regions (AUCVGC ranging from 0.56 for CZ to 0.62). However, disagreement was limited to a score 4 (excellent)-to-score 3 (good) IQ transition; apart from a single case in PZ, both the observers scored the IQ at follow-up as 2 (sufficient) starting from a score 4 (excellent). Dose reduction achieved in the follow-up CT scans, although a lower IQ still allows a good diagnostic confidence.

Objectives: To investigate the association between sex hormones and the severity of coronavirus disease 2019 (COVID-19). Furthermore, associations between sex hormones and systemic inflammation markers, viral shedding and length of hospital stay were studied. Design and methods: This case–control study included a total of 48 male patients with COVID-19 admitted to an Italian reference hospital. The 24 cases were patients with PaO2/FiO2 300 mmHg at all times and who may have required low-flow oxygen supplementation during hospitalization (mild COVID-19). For each group, sex hormones were evaluated on hospital admission. Results: Patients with severe COVID-19 (cases) had a significantly lower testosterone level compared with patients with mild COVID-19 (controls). Median total testosterone (TT) was 1.4 ng/mL in cases and 3.5 ng/mL in controls (P = 0.005); median bioavailable testosterone (BioT) was 0.49 and 1.21 in cases and controls, respectively (P = 0.008); and median calculated free testosterone (cFT) was 0.029 ng/mL and 0.058 ng/mL in cases and controls, respectively (P = 0.015). Low TT, low cFT and low BioT were correlated with hyperinflammatory syndrome (P = 0.018, P = 0.048 and P = 0.020, respectively) and associated with longer length of hospital stay (P = 0.052, P = 0.041 and P = 0.023, respectively). No association was found between sex hormone level and duration of viral shedding, or between sex hormone level and mortality rate. Conclusions: A low level of testosterone was found to be a marker of clinical severity of COVID-19.

Background Few data about predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS) are available. Methods Retrospective study including all patients admitted with COVID-19 in an Italian reference hospital for infectious diseases between March 1 and July 1, 2020. Predictors of viral clearance (VC) and prolonged VS from upper respiratory tract were assessed by Poisson regression and logistic regression analyses. The causal relation between duration of VS and probability of clinical outcomes was evaluated through inverse probability weighted Cox model. Results 536 subjects were included. Median duration of VS from symptoms onset was 18 days (IQR 12-26). The estimated 30-day probability of VC was 70.2% (95%CI:65-75). At multivariable analysis, patients with comorbidities (aIRR = 0.88, p = 0.004), lymphopenia at hospital admission (aIRR = 0.75, p = 0.032) and with moderate/severe respiratory disease (aIRR = 0.42, p 1000 ng/mL at admission (aOR = 1.76, p = 0.035) independently predicted prolonged VS. The achievement of VC doubled the chance of clinical recovery (aHR = 2.17, p

Objective: To investigate two commercial software and their efficacy in the assessment of chest CT sequelae in patients affected by COVID-19 pneumonia, comparing the consistency of tools. Materials and Methods: Included in the study group were 120 COVID-19 patients (56 women and 104 men, 61 years of median age, range: 21–93 years) who underwent chest CT examinations at discharge between 5 March 2020 and 15 March 2021 and again at a follow-up time (3 months, range 30–237 days). A qualitative assessment by expert radiologists in the infectious disease field (experience of at least 5 years) was performed, and a quantitative evaluation using thoracic VCAR software (GE Healthcare, Chicago, Illinois, United States) and a pneumonia module of ANKE ASG-340 CT workstation (HTS Med &amp, Anke, Naples, Italy) was performed. The qualitative evaluation included the presence of ground glass opacities (GGOs) consolidation, interlobular septal thickening, fibrotic-like changes (reticular pattern and/or honeycombing), bronchiectasis, air bronchogram, bronchial wall thickening, pulmonary nodules surrounded by GGOs, pleural and pericardial effusion, lymphadenopathy, and emphysema. A quantitative evaluation included the measurements of GGOs, consolidations, emphysema, residual healthy parenchyma, and total lung volumes for the right and left lung. A chi-square test and non-parametric test were utilized to verify the differences between groups. Correlation coefficients were used to analyze the correlation and variability among quantitative measurements by different computer tools. A receiver operating characteristic (ROC) analysis was performed. Results: The correlation coefficients showed great variability among the quantitative measurements by different tools when calculated on baseline CT scans and considering all patients. Instead, a good correlation (≥0.6) was obtained for the quantitative GGO, as well as the consolidation volumes obtained by two tools when calculated on baseline CT scans, considering the control group. An excellent correlation (≥0.75) was obtained for the quantitative residual healthy lung parenchyma volume, GGO, consolidation volumes obtained by two tools when calculated on follow-up CT scans, and for residual healthy lung parenchyma and GGO quantification when the percentage change of these volumes were calculated between a baseline and follow-up scan. The highest value of accuracy to identify patients with RT-PCR positive compared to the control group was obtained by a GGO total volume quantification by thoracic VCAR (accuracy = 0.75). Conclusions: Computer aided quantification could be an easy and feasible way to assess chest CT sequelae due to COVID-19 pneumonia, however, a great variability among measurements provided by different tools should be considered.

The CT manifestation of COVID-19 patients is now well known and essentially reflects pathological changes in the lungs. Actually, there is insufficient knowledge on the long-term outcomes of this new disease, and several chest CTs might be necessary to evaluate the outcomes. The aim of this study is to evaluate the radiation dose for chest CT scans in COVID-19 patients compared to a cohort with pulmonary infectious diseases at the same time of the previous year to value if there is any modification of exposure dose. The analysis of our data shows an increase in the overall mean dose in COVID-19 patients compared with non-COVID-19 patients. In our results, the higher dose increase occurs in the younger age groups (+86% range 21–30 years and +67% range 31–40 years). Our results show that COVID-19 patients are exposed to a significantly higher dose of ionizing radiation than other patients without COVID infectious lung disease, and especially in younger age groups, although some authors have proposed the use of radiotherapy in these patients, which is yet to be validated. Our study has limitations: the use of one CT machine in a single institute and a limited number of patients.

We present the case of 35 years old female patient who came to our Institute with an unspecified abdominal pain, hepatosplenomegaly and a previous alleged diagnosis of Budd-Chiari syndrome. Magnetic resonance imaging (MRI) was crucial to identify a diffuse and infiltrating mass involving the liver in a misleading diagnosis. A discussion about the imaging findings and differential diagnosis of a rare case of diffuse epithelioid hemangioendothelioma (EHE) is provided as follows. MRI was the most important instrument to guide the diagnostic and therapeutic path, helping to define the typical signal intensity of EHE, mainly with a hepatobiliary contrast agent. The differentiating between other primary tumors, however, remains a complicated issue. Our purpose was to highlight the radiologic and MR characteristics of this rare tumor in order to evaluate the diffuse EHE in the diagnostic process.