Severe COVID-19 and its cardiopulmonary effects 6 and 18 months after hospital discharge.

Introduction: SARS-CoV-2 infection affects the cardiopulmonary system in the acute as well as long-term phase. The aim of the present study was to comprehensively assess symptoms and possible long-term impairments 6 and 18 months after hospitalization for severe COVID-19 infection. Methods: This prospective registry included patients with PCR-confirmed COVID-19 infection requiring hospitalization. Follow-up approximately 6 months post discharge comprised a detailed patient history, clinical examination, transthoracic echocardiography, electrocardiogram, cardiac magnetic resonance imaging (cMRI), chest computed tomography (CT) scan, pulmonary function test (PFT), six-minute walk test (6MWT) and a laboratory panel. At the time of the second follow-up visit at 18 months, patients without pathologic findings during the first study visit were contacted by phone to inquire about the course of their symptoms. In all other patients all initial examinations were repeated. Results: Two hundred Patients, who were hospitalized for COVID-19, were contacted by phone and were recruited for the study. Due to dropouts the second study visit was performed in 170 patients. A comparison between the two study visits at 6 and 18 months post discharge showed the following results: Six months after discharge, 73% and 18 months after discharge 52% fulfilled the criteria for Long COVID with fatigue being the most common symptom (49%). Echocardiography at 6 months post discharge showed an impaired left ventricular function in 8% of which 80% returned to normal. Six months post discharge, cMRI revealed pericardial effusion in 17% which resolved in 47% of the 15 patients who underwent a control cMRI. Signs of peri- or myocarditis were present in 5% of the patients and were resolved in all 4 patients who attended control studies. At 6 months, chest CT scans identified post-infectious residues in 24%. In the 25 repeated chest CT scans 20% showed full recovery. Length of in-hospital stay was identified as a significant predictor for persisting Long COVID (95% CI: 1.005-1.12, p = 0.03). Conclusion: Comparing 6 to 18 months, the prevalence of Long COVID decreased over time, but a high symptom burden remained. Structural and functional abnormalities were less frequent than the portrayed symptoms, and it thus remains a challenge to substantiate the symptoms.

Deep learning analysis provides accurate COVID-19 diagnosis on chest computed tomography.

INTRODUCTION: Computed Tomography is an essential diagnostic tool in the management of COVID-19. Considering the large amount of examinations in high case-load scenarios, an automated tool could facilitate and save critical time in the diagnosis and risk stratification of the disease. METHODS: A novel deep learning derived machine learning (ML) classifier was developed using a simplified programming approach and an open source dataset consisting of 6868 chest CT images from 418 patients which was split into training and validation subsets. The diagnostic performance was then evaluated and compared to experienced radiologists on an independent testing dataset. Diagnostic performance metrics were calculated using Receiver Operating Characteristics (ROC) analysis. Operating points with high positive (>10) and low negative (<0.01) likelihood ratios to stratify the risk of COVID-19 being present were identified and validated. RESULTS: The model achieved an overall accuracy of 0.956 (AUC) on an independent testing dataset of 90 patients. Both rule-in and rule out thresholds were identified and tested. At the rule-in operating point, sensitivity and specificity were 84.4 % and 93.3 % and did not differ from both radiologists (p > 0.05). At the rule-out threshold, sensitivity (100 %) and specificity (60 %) differed significantly from the radiologists (p < 0.05). Likelihood ratios and a Fagan nomogram provide prevalence independent test performance estimates. CONCLUSION: Accurate diagnosis of COVID-19 using a basic deep learning approach is feasible using open-source CT image data. In addition, the machine learning classifier provided validated rule-in and rule-out criteria could be used to stratify the risk of COVID-19 being present.

[Trauma to the thoracic spine and chest]. / Trauma an Brustwirbelsäule und knöchernem Thorax.

BACKGROUND: The assessment of traumatic lesions to the chest and thoracic spine can pose a challenge for the emergency radiologist. Collaboration with the treating clinicians and knowledge of the patients' history and the trauma mechanism are essential. STANDARD RADIOLOGICAL METHODS: In case of minor trauma, digital radiography may be sufficient for diagnosis. For the diagnostic work-up of polytrauma patients, multidetector computed tomography (MDCT) is the most important modality due to its broad availability and higher sensitivity. The chest has to be completely contained within the scan volume to be able to adequately analyze the bony structures and thoracic spine. Reconstruction in three planes and multiplanar reconstruction are prerequisite for a correct diagnosis and further therapy planning. PERFORMANCE: Magnetic resonance imaging (MRI) serves as a third level diagnostic modality in special cases. MRI can demonstrate bone marrow edema of vertebral bodies or other bones. In addition, the myelon and the epidural space are best assessed with MRI. RESULT: In this article, the most relevant knowledge for the diagnostic work-up of traumatic lesions of the bony chest and the thoracic spine is summarized.

[Acromioclavicular joint : The "forgotten" joint]. / Akromioklavikulargelenk : Das "vergessene" Gelenk.

Besides osteoarthritic changes, traumatic and posttraumatic lesions are the most frequent alterations of the acromioclavicular (AC) joint. The Rockwood classification is used to describe posttraumatic lesions. The most important screening modality is anteroposterior x­ray imaging, preferably with weight bearing and side to side comparison. Magnetic resonance imaging (MRI) without weight bearing is superior to x­rays in analyzing and classifying AC joint dislocations. Postoperative imaging and assessment of arthritic alterations are usually carried out using x­ray images and MRI is used as an additional examination modality. Sonography is only of limited value. Multidetector computed tomography (MDCT) is usually not used as a primary imaging modality for the AC joint; however, it can be analyzed simultaneously whenever the shoulder joint is being investigated with MDCT.

[Abdominal polytrauma and parenchymal organs]. / Abdominelles Polytrauma und Parenchymorgane.

CLINICAL/METHODOLOGICAL ISSUE: The acute radiological diagnostics of polytrauma patients has become an essential part of the interdisciplinary treatment in the emergency room. The incidence of polytrauma patients with an injury severity score (ISS) >16 is approximately 450 cases/million inhabitants/year in Europe. Injuries of the parenchymal organs are of utmost importance for the prognosis and treatment of these patients. The injury patterns are complex and a great deal of experience is necessary to be able to obtain the correct diagnosis within minutes. This review article deals with the radiological diagnostics and grading of the severity of injuries to the spleen, liver, pancreas and kidneys. STANDARD RADIOLOGICAL METHODS: The use of ultrasound for the evaluation of polytraumatized patients will be discussed. The most important trauma-associated findings for the above mentioned organs using multidetector computed tomography (MDCT) will be described and illustrated by dedicated case findings. METHODOLOGICAL INNOVATIONS: Ultrasound contrast agents can supply valuable, additional diagnostic information in the evaluation of polytraumatized patients. Computed tomography has become established as the most relevant imaging modality in severe trauma. Innovative organ-adapted and contrast application protocols improve the diagnostic performance of MDCT. PRACTICAL RECOMMENDATIONS: The use of focused assessment sonography for trauma (FAST) scanning as a screening tool is in agreement with the other clinical disciplines of the trauma team. The use of MDCT is trauma-dependent and the classification of the severity of the different parenchymal organ injuries is ultimately decisive for further treatment and prognosis of trauma victims.

Bone metabolism in patients with primary hyperparathyroidism before and after surgery.

Primary hyperparathyroidism (PHPT) is accompanied with a reduced bone mineral density (BMD) and an increased risk of fracture. Surgery is the only option for cure. It is hypothesized that in patients with PHPT bone metabolism normalizes after parathyroidectomy (PTX) and that BMD gradually increases. Fifty-two patients with PHPT who underwent surgery were prospectively followed for 1 year. Biochemical analyses were performed at baseline and 1, 4, 7 days; 6 weeks; and 3, 6, and 12 months, and BMD before and one year after surgery. Parathyroid hormone (PTH), calcium, and the bone resorption marker dropped immediately, but transiently after PTX, bone formation decreased more slowly. Osteoprotegerin (OPG) as well as cathepsin K did not show significant changes. BMD of the lumbar spine, but not of the femoral neck, increased significantly within one year after surgery. Moderate correlations existed between the changes of total calcium, ionized calcium, as well as bone-specific alkaline phosphatase and changes of the lumbar BMD. Patients who needed postoperative supplementation with calcium and vitamin D had significantly higher PTH levels. Some gender-specific differences in patients with PHPT were observed. In patients with PHPT, males appear to be more severely affected than females. Within the first year after PTX, bone metabolism normalized, and BMD of the lumbar spine increased. Patients who needed a supplementation with calcium and vitamin D after PTX preoperatively had higher serum levels of PTH.

Penile biometry on prenatal magnetic resonance imaging.

OBJECTIVE: In view of the implementation of magnetic resonance imaging (MRI) as an adjunct to ultrasonography in prenatal diagnosis, this study sought to demonstrate normal penile growth on prenatal MRI. METHODS: This was a retrospective study of MRI of 194 male fetuses (18-34 weeks' gestation) with normal anatomy or minor abnormalities. On sagittal T2-weighted MRI sequences, we measured penile length from the glans tip to the scrotal edge (outer length) and from the glans tip to the symphyseal border (total length). Descriptive statistics, as well as correlation and regression analysis, were used to evaluate penile length in relation to gestation. T-tests were calculated to compare mean outer/total length on MRI with published ultrasound data. RESULTS: Mean length values, including 95% CIs and percentiles, were defined. Penile length as a function of gestational age was expressed by the following regression equations: outer mean length = - 5.514 + 0.622 × gestational age in weeks; total mean length = - 8.865 + 1.312× gestational age in weeks. The correlation coefficients, r = 0.532 and r = 0.751, respectively, were statistically significant (P < 0.001). Comparison of outer penile length on MRI with published ultrasound penile length data showed no significant differences, while total penile length on MRI was significantly greater than ultrasound penile length (P < 0.001). CONCLUSION: Our MRI results provide a reference range of fetal penile length, which, in addition to ultrasonography, may be helpful in the identification of genital anomalies. Outer penile length on MRI is equivalent to penile length measured on ultrasound, whereas total length is significantly greater.

Female external genitalia on fetal magnetic resonance imaging.

OBJECTIVES: To characterize the normal development of the female external genitalia on fetal magnetic resonance imaging (MRI). METHODS: This retrospective study included MRI examinations of 191 female fetuses (20-36 gestational weeks) with normal anatomy or minor abnormalities, following suspicion of anomalies on prenatal ultrasound examination. Using a 1.5-Tesla unit, the bilabial diameter was measured on T2-weighted sequences. Statistical description, as well as correlation and regression analyses, was used to evaluate bilabial diameter in relation to gestational age. MRI measurements were compared with published ultrasound data. The morphological appearance and signal intensities of the external genitalia were also assessed. RESULTS: Mean bilabial diameters, with 95% CIs and percentiles, were defined. The bilabial diameter as a function of gestational age was expressed by the regression equation: bilabial diameter = - 11.336 + 0.836 × (gestational age in weeks). The correlation coefficient, r = 0.782, was statistically significant (P < 0.001). Bilabial diameter on MRI was not significantly different from that on ultrasound (P < 0.001). In addition, on MRI we observed changes in morphology of the external genitalia and in signal intensities with increasing gestational age. CONCLUSIONS: We have provided a reference range of fetal bilabial diameter on MRI, which, in addition to ultrasound findings, may be helpful in the identification of genital anomalies.

Male sexual development in utero: testicular descent on prenatal magnetic resonance imaging.

OBJECTIVE: To visualize in utero male fetal testicular descent on magnetic resonance imaging (MRI) and to correlate it with gestational age. METHODS: This retrospective study included 202 MRI examination results of 199 male fetuses (17-39 gestational weeks) with normal anatomy or minor congenital abnormalities, following suspicion of anomalies on prenatal ultrasound examination. Using a 1.5-Tesla unit, multiplanar T2-weighted sequences were applied using a standard protocol to image and identify the scrotal content. The relative frequencies of unilateral and bilateral testicular descent were calculated and correlated with gestational age. RESULTS: Between 17 and 25 gestational weeks, neither unilateral nor bilateral testicular descent was visualized on MRI. Testicular descent was first observed at 25 + 4 weeks, in 7.7% of cases. 12.5% of 27-week fetuses showed unilateral descent and 50% showed bilateral descent. Bilateral descent was observed in 95.7% of cases, on average, from 30 to 39 weeks. CONCLUSIONS: Our results chart the time course of testicular descent on prenatal MRI, which may be helpful in the identification of normal male sexual development and in the diagnosis of congenital abnormalities, including the early detection of cryptorchidism.

[Pathological changes of the hypopharynx in the focus of imaging]. / Pathologische Veränderungen des Hypopharynx im Brennpunkt der Bildgebung.

The spectrum of pathological changes in anatomical sections of the hypopharynx ranges from benign pathologies to hypopharyngeal carcinoma. Beside the clinical status and the endoscopic evaluation performed by ear, nose and throat specialists, imaging techniques play an important role in pre-therapeutic and post-therapeutic diagnostics and in the follow-up of pharyngeal disease patterns, especially for malignant lesions. A conventional x-ray swallow examination, contrast-enhanced multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI), as well as positron emission tomography (PET) and positron emission tomography computed tomography (PET-CT) are applied depending on the medical question and disease. Especially in radiological oncology, it is extremely important in regions which are clinically difficult to assess to determine the exact localization and extent of hypopharyngeal pathologies to plan the optimal therapy for the patient. This article demonstrates the radiological appearance of pathological changes of the hypopharynx and discusses in particular the hypopharynx carcinoma in the focus of pre-therapeutic and post-therapeutic imaging.

[Radiological normal anatomy of the larynx and pharynx and imaging techniques]. / Radiologische Normalanatomie des Larynx und Pharynx sowie bildgebende Techniken.

The larynx and the pharynx represent anatomically as well as functionally a very complex organ which serves as an airway and a nutrition channel. Knowledge of anatomy and anatomical topography is therefore a fundamental basis for the evaluation of any pathological process. Beside the clinical examination and endoscopy performed by ear, nose and throat specialists, imaging techniques play a crucial role in pre-therapeutic and post-therapeutic diagnostics. The radiologist employs a conventional x-ray swallow examination, as well as contrast-enhanced multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), positron emission tomography (PET) and positron emission tomography-computed tomography (PET-CT), depending on the medical problem in question. The following article demonstrates the functional and especially the structural anatomy of the larynx and the pharynx. Furthermore, the broad range of imaging techniques in clinical use is discussed.

Effect of teriparatide on early bone loss after kidney transplantation.

Kidney transplantation is associated with bone loss and a high risk of fractures. Prophylactic treatment of bone is therefore recommended in the early posttransplant period. As a large number of transplant recipients develop adynamic renal osteodystrophy, recombinant parathyroid hormone (rPTH) could be a promising therapeutic option. In a 6-month double-blind, randomized trial, 26 kidney transplant recipients were treated with daily subcutaneous injections of 20 microg teriparatide (PTH 1-34) or placebo. Bone mineral density (BMD) of the femoral neck, lumbar spine and radial bone was measured at transplantation and after 6 months. Paired bone biopsies for histomorphometric analysis were obtained in six, and for measurement of bone matrix mineralization in five patients of each group. Serologic bone markers were measured at baseline and every 3 months. A total of 24 out of 26 patients completed the study. Femoral neck BMD was stable in the teriparatide group, but decreased significantly in the placebo group. Lumbar spine and radial BMD, histomorphometric bone volume and bone matrix mineralization status remained unchanged in both groups. Serologic bone markers were similarly reduced in both groups throughout the study. We conclude that teriparatide does not improve BMD early after kidney transplantation. Neither histological analysis nor bone markers provide evidence of improved bone turnover or mineralization.

[Radiological diagnostics of malignant tumors of the musculoskeletal system in childhood and adolescence]. / Radiologische Diagnostik maligner Tumoren des Muskuloskelettalsystems im Kindes- und Adoleszentenalter.

Rhabdomyosarcoma, osteosarcoma and Ewing's sarcoma are the most common malignant tumors of the musculoskeletal system in childhood and adolescence representing about 10% of newly diagnosed cancers in children and adolescents.In the last two decades the prognosis of patients with such malignancies improved significantly. On the one hand because of the advances in chemotherapy and orthopedic surgery, on the other hand also because of the innovations in radiological diagnostics. The precise pre-therapeutical staging of tumors of the musculoskeletal system provides important prognostic information and has impact on the entire therapy management. During respectively after therapy, imaging is extremely important in the follow-up and in diagnosing a possible recurrent disease.Modern imaging diagnostics of musculoskeletal tumors basically consist of conventional X-ray, of computed tomography (CT) and magnetic resonance imaging (MRI), and of modalities of nuclear medicine such as szintigraphy, positron emission tomography (PET) and PET CT.

Vertebral morphometry: current methods and recent advances.

Vertebral fractures are the hallmark of osteoporosis and are associated with increased morbility and mortality. Because a majority of vertebral fractures often occur in absence of specific trauma and are asymptomatic, their identification is radiographic. The two most widely used methods to determine the severity of vertebral fractures are the visual semiquantitative (SQ) assessment and the morphometric quantitative approach, involving the measurements of vertebral body heights. The measurements may be made on conventional spinal radiographs (MRX: morphometric X-ray radiography) or on images obtained from dual X-ray absorptiometry (DXA) scans (MXA: morphometric X-ray absorptiometry).The availability of a rapid, low-dose method for assessment of vertebral fractures, using advanced fan-beam DXA devices, provides a practical method for integrated assessment of BMD and vertebral fracture status. The visual or morphometric assessment of lateral DXA spine images may have a potential role for use as a prescreening tool, excluding normal subjects prior to performing conventional radiographs.

Modern imaging lymph node staging of the head and neck region.

The aim of this paper is to describe the modern imaging methods, their techniques, ability, and performance in staging head and neck lymph nodes. Also, the imaging morphologies of benign and malignant lymph nodes according to the different imaging techniques will be delineated. The imaging techniques of ultrasound including contrast-enhanced ultrasound, computed tomography and magnetic resonance imaging (MRI) including diffusing weighted imaging and contrast-enhanced iron oxide MRI are explained. Imaging examples of the different modalities of benign and malignant transformed lymph nodes will be demonstrated. Furthermore, the diagnostic sensitivity of each modality will be delineated and further aspects of modern lymph node staging of the head and neck region such as those with special contrast agents will be described. These modern imaging modalities have sensitivity rates of 70-80% depending on the technical equipment and ability and on the experience of the investigator. The technique of near-infrared-imaging will be mentioned in another article in this journal. Also the value of biopsy techniques including recently developed ultrasonography guided needle biopsy with molecular analysis of the cells of about 97-100% accuracy in diagnosing benign from malignant lymph nodes will be mentioned. Overall, the reader will get an overview of the present imaging modalities to potentially stage correctly lymph nodes in the head and neck region to facilitate the therapeutic procedure.

[Benign and malignant lesions in the region of the inner ear and cerebellopontine angle]. / Benigne und maligne Veränderungen der Innenohr- und Kleinhirnbrückenwinkelregion.

Tumorous lesions in the region of the inner ear and cerebellopontine angle are very rare and can be classified into benign and malignant disease forms. This contribution presents and explains the CT and MRI characteristics of these tumors.High-resolution computed tomography (HRCT) in the axial projection is applied for evaluation in the high-resolution bone window. The coronary slices can be reconstructed from the axial datasets or in individual cases examined in the coronary plane.HRCT excellently demonstrates osseous lesions and in individual cases - e.g., exostoses - it can simply suffice to perform HRCT of the temporal bone, while HRCT is also excellent for detecting osseous lesions to determine whether the tumor is benign or malignant.MRI, on the other hand, excellently shows the extent of tumor spread because of its superb soft tissue contrast. Consequently, HRCT and MRI images of the inner ear and cerebellopontine angle provide meaningful information for visualization and classification of tumorous lesions. The two methods should not be considered as competing but rather as complementary and among other aspects exert considerable influence on the therapeutic approach.

Matrix-based autologous chondrocyte implantation for cartilage repair with HyalograftC: two-year follow-up by magnetic resonance imaging.

OBJECTIVE: Monitoring of articular cartilage repair after matrix-associated autologous chondrocyte implantation with HyalograftC by a new grading system based on non-invasive high-resolution magnetic resonance imaging. PATIENTS AND METHODS: In 23 patients, postoperative magnetic resonance imaging (MRI) was performed between 76 and 120 weeks. In nine of these patients, five MRI examinations were performed at 4, 12, 24, 52 and 104 weeks after HyalograftC implant. The repair tissue was described with separate variables: degree of defect repair in width and length, signal intensity of the repair tissue and status of the subchondral bone. For these variables a grading system with point scale evaluation was applied. CONCLUSION: High-resolution MRI provides a non-invasive tool for monitoring the development of cartilage repair tissue following HyalograftC technology, shows a good correlation with clinical outcome and may help to differentiate abnormal repair tissue from a normal maturation process.

[Ultrasound contrast agents: substance classes, pharmacokinetics, clinical applications, safety aspects]. / Ultraschallkontrastmittel: Substanzklassen, Pharmakokinetik, klinische Anwendungen, Sicherheitsaspekte.

Ultrasound contrast agents (UCA) have undergone constant development and improvement in recent years. Greater mechanical stability and improved acoustic properties, combined with new contrast-specific ultrasound sequences, have broadened the potential fields for investigation considerably. Contrast-enhanced ultrasound studies will no longer be complementary investigations, but will be considered as primary techniques. This review article provides a survey of the different drugs used, their chemical properties, and their pharmacokinetic aspects. Summarized are the most important established and published indications for the use of UCA together with an outlook for future applications. Finally this paper discusses the safety profile of these agents, which has become important due to the increasing use of these agents.

Tumors and tumor-like lesions of the neck: from childhood to adult.

In childhood, tumors and tumor-like lesions of the neck are rare and tend to be benign. Very common are congenital cystic lesions (thyroglossal duct cysts, branchial cysts, dermoid cysts, lymphangiomas, cystic hygromas). Common neoplastic lesions are hemangiomas and papillomas. The most common malignant tumors in the head and neck region are lymphomas and rhabdomyosarcomas. Lymph node enlargements, reactive or/and infectious, account also for a significant amount of cervical masses.