3D CT-Inclusive Deep-Learning Model to Predict Mortality, ICU Admittance, and Intubation in COVID-19 Patients.

Chest CT is a useful initial exam in patients with coronavirus disease 2019 (COVID-19) for assessing lung damage. AI-powered predictive models could be useful to better allocate resources in the midst of the pandemic. Our aim was to build a deep-learning (DL) model for COVID-19 outcome prediction inclusive of 3D chest CT images acquired at hospital admission. This retrospective multicentric study included 1051 patients (mean age 69, SD = 15) who presented to the emergency department of three different institutions between 20th March 2020 and 20th January 2021 with COVID-19 confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR). Chest CT at hospital admission were evaluated by a 3D residual neural network algorithm. Training, internal validation, and external validation groups included 608, 153, and 290 patients, respectively. Images, clinical, and laboratory data were fed into different customizations of a dense neural network to choose the best performing architecture for the prediction of mortality, intubation, and intensive care unit (ICU) admission. The AI model tested on CT and clinical features displayed accuracy, sensitivity, specificity, and ROC-AUC, respectively, of 91.7%, 90.5%, 92.4%, and 95% for the prediction of patient's mortality; 91.3%, 91.5%, 89.8%, and 95% for intubation; and 89.6%, 90.2%, 86.5%, and 94% for ICU admission (internal validation) in the testing cohort. The performance was lower in the validation cohort for mortality (71.7%, 55.6%, 74.8%, 72%), intubation (72.6%, 74.7%, 45.7%, 64%), and ICU admission (74.7%, 77%, 46%, 70%) prediction. The addition of the available laboratory data led to an increase in sensitivity for patient's mortality (66%) and specificity for intubation and ICU admission (50%, 52%, respectively), while the other metrics maintained similar performance results. We present a deep-learning model to predict mortality, ICU admittance, and intubation in COVID-19 patients. KEY POINTS: • 3D CT-based deep learning model predicted the internal validation set with high accuracy, sensibility and specificity (> 90%) mortality, ICU admittance, and intubation in COVID-19 patients. • The model slightly increased prediction results when laboratory data were added to the analysis, despite data imbalance. However, the model accuracy dropped when CT images were not considered in the analysis, implying an important role of CT in predicting outcomes.

Cardiac Masses and Pseudomasses: An Overview about Diagnostic Imaging and Clinical Background.

A cardiac lesion detected at ultrasonography might turn out to be a normal structure, a benign tumor or rarely a malignancy, and lesion characterization is very important to appropriately manage the lesion itself. The exact relationship of the mass with coronary arteries and the knowledge of possible concomitant coronary artery disease are necessary preoperative information. Moreover, the increasingly performed coronary CT angiography to evaluate non-invasively coronary artery disease leads to a rising number of incidental findings. Therefore, CT and MRI are frequently performed imaging modalities when echocardiography is deemed insufficient to evaluate a lesion. A brief comprehensive overview about diagnostic radiological imaging and the clinical background of cardiac masses and pseudomasses is reported.

"Reversible cytotoxic lesion of the corpus callosum following SARS-CoV-2 mRNA vaccine administration: a finding to be aware of".

Cytotoxic lesions of the corpus callosum (CLOCCs) are a clinical-radiological spectrum of disorders secondary to several etiopathogeneses. Cytotoxic lesions of the corpus callosum are typically associated with mild clinical symptoms including fever, headache, confusion, and altered mental status. We present a case of a 51-year-old Caucasian woman who developed a reversible lesion of the splenium of the corpus callosum associated with small round-shaped white matter hyperintensities after the first dose of SARS-CoV-2 mRNA vaccine. Magnetic resonance imaging is fundamental for diagnosis and no treatment is generally required.

Cine-MR in a patient with suspected normal pressure hydrocephalus.

The case of a patient with predominant short-term memory and CT pattern suggestive of of normal pressure hydrocephalus, is discussed. Clinical and CT findings did not allow to predict the clinical response to a possible ventriculoperitoneal shunt. On MRI more accurate morphological evaluation with cine-MR functional assessment was obtained. Calculated CSF flow indexes evidenced hyperdynamia usually associated with a good outcome after ventriculoperitoneal shunting.

IHE: integrating the healthcare enterprise, towards complete integration of healthcare information systems.

Information systems of a modern hospital govern extremely important functions as patient management, control of work flows, administration etc. However a great variety of recommended standards are used while in most cases no effective coordination and intercommunication is possible. Some years ago to simplify and resolve this problem IHE was created; it is a technical framework which identifies a number of components of the healthcare enterprise (the "actors") whose interactions are defined in terms of "transactions", that should be implemented according to HL7 and DICOM standards. Attempting an in-depth understanding of IHE structure and its principles of function, those transactions that can occur among the various actors, which of these are supported and which require specific actors, are analyzed. IHE is continuously evolving, therefore open to the factual contribution of all health professionals who can point out the main instances that emerge daily from their activity in the field. While its origin was specific for the field of radiology, the true soul and driving force of the project lay on the type of approach used: to get together medical specialists and information technology professionals in order to identify and solve the difficulties which hindered an effective and functional integration of healthcare information systems.

Impact of microvascular obstruction and infarct size on left ventricular remodeling in reperfused myocardial infarction: a contrast-enhanced cardiac magnetic resonance imaging study.

Infarct size (IS) and microvascular obstruction (MO) following ST-elevation myocardial infarction (STEMI) reperfusion may affect left ventricular (LV) remodeling. We evaluated the impact of extent and transmurality of IS and MO in LV remodeling using contrast-enhanced cardiac magnetic resonance imaging (MRI). Thirty-six consecutive patients presenting with a first STEMI and undergoing contrast-enhanced cardiac MRI within 5 days of successful primary percutaneous coronary intervention (PPCI) were enrolled. Gadolinium-enhanced MRI at first passage and in delayed imaging was performed to assess MO and IS. LV remodeling was evaluated by echocardiography at 6-month-follow-up and defined as a percent increase in the LV end-diastolic volume >20%. Thirteen patients (36%) developed LV remodeling. IS and MO extent score was associated with LV remodeling (OR 1.5, 95% CI 1.02-2.38, P = 0.04, and OR 3.1, 95% CI 1.45-6.64, P = 0.003, respectively), along with IS and MO trasmurality (OR 1.4, 95% CI 1.007-2.12, P = 0.046, and OR 3.1, 95% CI 1.24-7.89, P = 0.016, respectively). Importantly, IS and MO extent score combination gave an OR of 3.4 (95% CI 1.4-7.9, P = 0.004) and the combination of IS and MO transmurality increased the OR to 4.8 (95% CI 1.5-15.2, P = 0.007). Finally, when combining simultaneously IS and MO extent score and transmurality the OR reached 5.3 (95% CI 3.34-18.2, P = 0.0008). The evaluation of both IS and MO extent and transmurality by MRI is of prognostic utility in patients undergoing PPCI. Importantly, IS and MO transmurality significantly increases the risk of adverse remodeling and should be routinely assessed in post-STEMI patients.

Hepatitis B virus genotypes and precore and core mutants in Brazilian patients.

A method for genotyping hepatitis B virus by partial HBsAg gene sequencing with primers common to all known genotypes was developed. Mutations related to anti-HBs resistance are also detected with this method. Samples from 103 Brazilian patients were analyzed. Precore and core region of these viruses were also sequenced in 101 patients. Genotypes A, B, C, D, and F were found with frequencies of 49.5, 2.9, 13.6, 24.3, and 9.7%, respectively. Genotypes B and C were found only in Asian patients, whereas genotypes A, D, and F were more common in patients without an Asian background. Precore mutants were found in 32 (31.7%) of 101 patients, with a higher frequency in those infected with genotype D (22 of 25 [88.0%]). Analysis of nucleotide 1858 showed presence of thymine in all patients with genotypes B, C, and D and in a few patients with genotypes A (10.0%) and F (30.0%), who showed more frequently the presence of cytosine. This nucleotide was closely related to the presence of precore mutants. Mutations in the basal core promoter were found in 64 of 101 (63.4%) samples. These mutations were more frequent in patients infected with genotype F (90.0%) and less frequent in patients infected with genotype B (33.3%). Deletions in this region were found in two genotype C-infected patients.

Transfusion-transmited virus (TTV) in Brazil: preliminary report

TTV e um virus DNA recentemente descoberto no Japao a partir de um paciente portador de hepatite pos-transfusional de origem desconhecida. Neste estudo, avaliamos a presenca deste virus em pacientes com hepatopatias cronicas dos estados de Sao Paulo e do Para, representando duas regioes geograficamente diferentes. O DNA do TTV foi encontrado em 21/105 (20 por cento) e 9/20 (45 por cento) dos casos de Sao Paulo e do Para, respectivamente. O sequenciamento do DNA amplificado confirmou a presenca dos genotipos 1a e 2a, bem como de outros genotipos ainda nao descritos ate o momento. Em conclusao, TTV esta presente em casos de hepatopatias cronicas do Sudeste e do Norte do Brasil. por outro lado, maiores estudos ainda sao necessarios antes de se estabelecer relacao causal entre o TTV e a hepatite em seres humanos

Trombose portal: complicaçäo precose da desconexäo azigo-portal no tratamento das varizes esofagianas sangrantes / Portal thrombosis: early complication of azygo-portal disconnection in the treatment of bleeding esophageal varices

Os autores estudaram 30 pacientes portadores de varizes esofagianas com sangramento recente, por hipertensäo portal de diversas etiologias, submetidas à desconexäo ázigo-portal com esplenectomia (D.A.P.E.). As principais complicaçöes pós-operatórias precoces, foram: trombose portal - 4 (13,3%); absecesso subfrénico - 2 (6,6%); embolia pulmonar - 1 (3,3%) e perfuraçäo esofagiana 1 (3,3%). O quadro clínico da trombose portal manifestou-se com febre diária, sem leucocitose e com ascite que, em um caso, foi refratária ao tratamento clínico, havendo necessidade de colocaçäo de válvula peritónio jugular para seu controle. Em virtude das limitaçöes impostas ao doente pela trombose portal no pós-operatório, os autores propöem o estudo quantitativo do fluxo sangüíneo portal pré-operatório para melhor análise das indicaçöes cirúrgicas da D.A.P.E., na hipertensäo portal