Evaluation of novel coronavirus disease (COVID-19) using quantitative lung CT and clinical data: prediction of short-term outcome.

BACKGROUND: Computed tomography (CT) enables quantification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, helping in outcome prediction. METHODS: From 1 to 22 March 2020, patients with pneumonia symptoms, positive lung CT scan, and confirmed SARS-CoV-2 on reverse transcription-polymerase chain reaction (RT-PCR) were consecutively enrolled. Clinical data was collected. Outcome was defined as favourable or adverse (i.e., need for mechanical ventilation or death) and registered over a period of 10 days following CT. Volume of disease (VoD) on CT was calculated semi-automatically. Multiple linear regression was used to predict VoD by clinical/laboratory data. To predict outcome, important features were selected using a priori analysis and subsequently used to train 4 different models. RESULTS: A total of 106 consecutive patients were enrolled (median age 63.5 years, range 26-95 years; 41/106 women, 38.7%). Median duration of symptoms and C-reactive protein (CRP) was 5 days (range 1-30) and 4.94 mg/L (range 0.1-28.3), respectively. Median VoD was 249.5 cm3 (range 9.9-1505) and was predicted by lymphocyte percentage (p = 0.008) and CRP (p < 0.001). Important variables for outcome prediction included CRP (area under the curve [AUC] 0.77), VoD (AUC 0.75), age (AUC 0.72), lymphocyte percentage (AUC 0.70), coronary calcification (AUC 0.68), and presence of comorbidities (AUC 0.66). Support vector machine had the best performance in outcome prediction, yielding an AUC of 0.92. CONCLUSIONS: Measuring the VoD using a simple CT post-processing tool estimates SARS-CoV-2 burden. CT and clinical data together enable accurate prediction of short-term clinical outcome.

Diagnostic value of retrospectively fused 64CuCl2 PET/MRI in biochemical relapse of prostate cancer: comparison with fused 18F-Choline PET/MRI, 64CuCl2 PET/CT, 18F-Choline PET/CT, and mpMRI.

PURPOSE: To assess the diagnostic value of retrospectively fused PET/MRI by comparing the detection rates (DRs) of fused 64CuCl2 PET/MRI vs. fused 18F-Choline PET/MRI in patients with suspected prostatic cancer (PCa) recurrence. The secondary objective was to compare the DRs of fused PET/MRI vs. those of the separate imaging modalities. METHODS: We retrospectively evaluated 50 PCa patients with biochemical relapse after radical prostatectomy (RP) or radiotherapy (RT). All patients underwent 64CuCl2 PET/CT, 18F-Choline PET/CT, and multiparametric magnetic resonance imaging (mpMRI) within 15 days. Fused 64CuCl2-PET/MRI and fused 18F-Choline PET/MRI images were obtained by retrospective co-registration of MRI and PET images. Experienced readers interpreted the images, and the DRs of each imaging modality were assessed. RESULTS: In the patient-based analysis, overall DRs of fused 64CuCl2 PET/MRI, fused 18F-Choline PET/MRI, 64CuCl2 PET/CT, 18F-Choline PET/CT, and mpMRI were 88%, 68%, 82%, 56%, and 74%, respectively. In the lesion-based analysis, overall DRs of fused 64CuCl2 PET/MRI, fused 18F-Choline PET/MRI, 64CuCl2 PET/CT, 18 F-Choline PET/CT, and mpMRI were 95%, 66%, 87%, 58%, and 71%, respectively. CONCLUSIONS: Retrospectively fused PET/MRI is able to overcome the limitations of the separate interpretation of the individual imaging modalities. Fused 64CuCl2 PET/MRI provided the highest diagnostic performance in the detection of PCa local relapse.

Breast ultrasound: automated or hand-held? Exploring patients' experience and preference.

BACKGROUND: Our aim was to compare women's experience with automated breast ultrasound (ABUS) versus breast hand-held ultrasound (HHUS) and to evaluate their acceptance rate. METHODS: After ethical approval, from October 2017 to March 2018, 79 consecutive patients were enrolled in this prospective study. On the same day, patients underwent HHUS followed by ABUS. Each patient's experience was assessed using the modified testing morbidities index (TMI) (the lower the score, the better is the experience). Nine items were assessed for both techniques: seven directly related to the examination technique (pain or discomfort immediately before (preparation), during and after testing, fear or anxiety immediately before (preparation) and during testing, physical and mental function after testing) and two indirectly related to the examination technique (embarrassment during testing and overall satisfaction). Finally, we asked patients to choose between the two techniques for a potential next breast examination. Wilcoxon signed ranks test was used. RESULTS: The median TMI score for the seven items was found to be significantly better for HHUS (8, interquartile range [IQR] 7-11) compared to ABUS (9, IQR 8-12) (p = 0.003). The item 'pain/discomfort during the test' (p < 0.001) was significantly higher for ABUS compared to HHUS. Instead, the item 'fear/anxiety before the test' was higher for HHUS (p = 0.001). Overall, 40.5% of the patients chose HHUS, 29.1% chose ABUS, and 30.4% were unable to choose. CONCLUSIONS: ABUS and HHUS exams were well tolerated and accepted. However, HHUS was perceived to be less painful than ABUS.

Noninvasive liver fibrosis assessment in chronic viral hepatitis C: agreement among 1D transient elastography, 2D shear wave elastography, and magnetic resonance elastography.

PURPOSE: To assess the agreement of one-dimensional transient elastography (1D-TE), two-dimensional shear wave elastography (2D-SWE), and magnetic resonance elastography (MRE) in a consecutive cohort of patients affected by hepatitis C virus (HCV) and to understand which patient-related factors are associated with disagreement. METHODS: Ninety-one consecutive patients with current or previous chronic HCV infection were enrolled between March 2017 and September 2018. We assessed the correlation between stiffness measurements expressed in kilopascals (kPa). After converting kPa values in three groups of increasing fibrosis burden using validated cut-off values, we assessed the agreement among the different techniques. Factors influencing inter-modality disagreement were examined by employing multivariate logistic regression analysis. RESULTS: Seventy-seven patients met the inclusion criteria and had reliable measurements by all stiffness imaging techniques. At the quantitative analysis, a strong correlation between stiffness measurements was found (Spearman's rho values ranging from 0.7 to 0.89 in all pairs of techniques). Complete concordance among MRE, 1D-TE, and 2D-SWE was found in 64.9% of patients, and the agreement was highest between MRE and 1D-TE, with κ value of 0.801. In only 2/77 patients (2.6%), there was complete disagreement. High body mass index (BMI) was the only factor significantly associated with inter-modality discordance. CONCLUSIONS: MRE, 1D-TE, and 2D-SWE assigned the majority of patients to the same fibrosis group. The agreement was at least good, and there was a strong correlation between kPa values in all three pairs of techniques. Highest agreement was found between MRE and 1D-TE. High BMI was associated with discordance among the techniques.

Small Bowel Adenocarcinoma of Ileal Ureter 40 Years After Ureteral Reconstructive Surgery.

Malignant neoplasm arising from ileal ureter used for ureteral reconstructive surgery is an exceedingly rare event. Ureteroileoplasty was being performed since the beginning of the last century, but it was described more extensively in literature during the 1950s.1,2 Recurrent urinary infections, chronic renal failure, urolithiasis, anastomotic stricture, metabolic acidosis, and chronic dilation of the graft had been described as late complications of ureteroileoplasty.3,4 Herein, we describe history, imaging and pathologic findings of a small bowel adenocarcinoma arising from ileal ureter in a woman of 78-year-old, subjected to ureteroileoplasty about 40 years earlier.

A giant spinal schwannoma mimicking a renal mass: A case report.

Spinal schwannomas arise from the cells covering the nerves within the spinal canal. In most cases, they remain confined within the intradural extramedullary space, but occasionally they extend into the extradural space resembling abdominal masses. We present a case of very large spinal schwannoma mimicking a renal mass at ultrasound exam. Using contrast-enhanced computed tomography and magnetic resonance imaging we were able to detect and characterize the lesion and consequently assign a preoperative diagnosis later confirmed by the histopathology report. In this paper, we review computed tomography and magnetic resonance imaging features of spinal schwannomas and attempt a summary of possible differential diagnoses.

Bladder cancer presenting with acrometastases: a different cause of foot pain.

Acrometastasis means tumor seeding distally to the elbow or the knee and is an uncommon event. Foot acrometastases occur in 0.58% of patients with skeletal metastases overall, and only about 10% of these are caused by bladder cancer. We present a case of bladder cancer manifesting with insidious foot pain, caused by multiple lytic lesions located solely at the left foot. It was suspected after whole-body CT and later confirmed by biopsy result. We enumerate the differential diagnosis of distal extremity lytic lesions for educational purposes and review the literature listing similar published cases.

Extensor pollicis longus (EPL) tendon rupture as a complication of distal radius fracture: the role of ultrasound examination.

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Masson's tumor and calcifying aponeurotic fibroma: two rare softtissue lesions in the same finger. High-resolution ultrasound features with histopathological correlations.

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