Insights Into MRI Neuroimaging Patterns of COVID-19 in Children: A Retrospective Comprehensive Analysis.

RATIONALE AND OBJECTIVES: Neurological complications associated with coronavirus disease (COVID-19) have been reported in children; however, data on neuroimaging findings remain limited. This study aimed to comprehensively examine neuroimaging patterns of COVID-19 in children and their relationship with clinical outcomes. MATERIALS AND METHODS: This retrospective cross-sectional study involved reviewing the medical records and MRI scans of 95 children who developed new neurological symptoms within 2-4 weeks of clinical and laboratory confirmation of COVID-19. Patients were categorized into four groups based on guidelines approved by the Centers for Disease Control and Prevention (CDC). Initial brain/spinal MRI was performed. Images were reviewed by three blinded radiologists, and the findings were analyzed and categorized based on the observed patterns in the brain and spinal cord. Follow-up MRI was performed and analyzed to track lesion progression. RESULTS: Encephalopathy was the most common neurological symptom (50.5%). The most common initial MRI involvement patterns were non-confluent multifocal hyperintense white matter (WM) lesions (36.8%) and ischemia (18.9%). Most patients who underwent follow-up MRI (n = 56) showed complete resolution (69.9%); however, some patients developed encephalomalacia and myelomalacia (23.2% and 7.1%, respectively). Non-confluent hyperintense WM lesions were associated with good outcomes (45.9%, P = 0.014), whereas ischemia and hemorrhage were associated with poor outcomes (44.1%, P < 0.001). CONCLUSION: This study revealed diverse neuroimaging patterns in pediatric COVID-19 patients. Non-confluent WM lesions were associated with good outcomes, whereas ischemia and hemorrhage were associated with poorer prognoses. Understanding these patterns is crucial for their early detection, accurate diagnosis, and appropriate management.

Biceps Pulley Lesions: Diagnostic Accuracy of Nonarthrographic Shoulder MRI and the Value of Various Diagnostic Signs.

BACKGROUND: There is limited data in the literature regarding the role of nonarthrographic MRI for detecting biceps pulley (BP) lesions. PURPOSE: To assess the accuracy of nonarthrographic MRI for detecting BP lesions, and to evaluate the diagnostic value of various MRI signs (superior glenohumeral ligament discontinuity/nonvisibility, long head of biceps (LHB) displacement sign or subluxation/dislocation, LHB tendinopathy, and supraspinatus and subscapularis tendon lesions) in detecting such lesions. STUDY TYPE: Retrospective. POPULATION: 84 patients (32 in BP-lesion group and 52 in BP-intact group-as confirmed by arthroscopy). FIELD STRENGTH/SEQUENCE: 1.5-T, T1-weighted turbo spin echo (TSE), T2-weighted TSE, and proton density-weighted TSE spectral attenuated inversion recovery (SPAIR) sequences. ASSESSMENT: Three radiologists independently reviewed all MRI data for the presence of BP lesions and various MRI signs. The MRI signs and final MRI diagnoses were tested for accuracy regarding detecting BP lesions using arthroscopy results as the reference standard. Furthermore, the inter-reader agreement (IRA) between radiologists was determined. STATISTICAL TESTS: Student's t-tests, Chi-squared, and Fisher's exact tests, and 4-fold table test were used. The IRA was calculated using Kappa statistics. A P-value <0.05 was considered statistically significant. RESULTS: The sensitivity, specificity, and accuracy of nonarthrographic MRI for detecting BP lesions were 65.6%-78.1%, 90.4%-92.3%, and 81%-86.9%, respectively. The highest accuracy was noticed for the LHB displacement sign (84.5%-86.9%), and the highest sensitivity was registered for the LHB tendinopathy sign (87.5%). Furthermore, the highest specificity was observed for the LHB displacement sign and LHB subluxation/dislocation sign (98.1%-100%). The IRA regarding final MRI diagnosis and MRI signs of BP lesions was good to very good (κ = 0.76-0.98). DATA CONCLUSION: Nonarthrographic shoulder MRI may show good diagnostic accuracy for detecting BP lesions. The LHB displacement sign could serve as the most accurate and specific sign for diagnosis of BP lesions. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

MRI-Based Classification for Tibial Spine Fracture: Detection Efficacy, Classification Accuracy, and Reliability.

RATIONALE AND OBJECTIVES: Recently, a new MRI-based classification for evaluating tibial spine fractures (TSFs) was developed to aid in treating these injuries. Our objective was to assess the detection efficacy, classification accuracy, and reliability of this classification in detecting and grading TSFs, as well as its impact on treatment strategy, compared to the Meyers and McKeever (MM) classification. MATERIALS AND METHODS: A retrospective study included 68 patients with arthroscopically confirmed TSFs. All patients had plain radiography and conventional MRI of the affected knee before arthroscopy. Three experienced radiologists independently reviewed all plain radiographs and MRI data and graded each patient according to MM and MRI-based classifications. The detection efficacy, classification accuracy, and inter-rater agreement of both classifications were evaluated and compared, using arthroscopic findings as the gold standard. RESULTS: The final analysis included 68 affected knees. Compared to the MM classification, the MRI-based classification produced 22.0% upgrade of TSFs and 11.8% downgrade of TSFs. According to the reviewers, the fracture classification accuracy of the MRI-based classification (91.2-95.6%) was significantly higher than that of the MM classification (73.5-76.5%, p = 0.002-0.01). The fracture detection rate of MRI-based classification (94.1-98.5%) was non-significantly higher than that of the MM classification (83.8-89.7%, p = 0.07-0.4). The soft tissue injury detection accuracy for MRI-based classification was 91.2-94.1%. The inter-rater reliability for grading TSFs was substantial for both the MM classification (κ = 0.69) and MRI-based classification (κ = 0.79). CONCLUSION: MRI-based classification demonstrates greater accuracy and reliability compared to MM classification for detecting and grading TSFs and associated soft tissue injuries.

Efficacy of Bladder Ultrasound in Prediction of Resolution of Vesicoureteral Reflux After Endoscopic Subureteral Hyaluronic Acid/Dextranomer (Deflux) Injection.

OBJECTIVE: To evaluate the efficacy of bladder ultrasound (US) in predicting the resolution of vesicoureteral reflux (VUR) after subureteral endoscopic Deflux injection in low-grade vs high-grade VUR patients. MATERIALS AND METHODS: Between 2014 and 2020, 160 children (220 ureters) were administered subureteral Deflux injection for treatment of primary VUR. The mean age at surgery was 72 months. Low-grade reflux (grades II-III) was observed in 190 ureters and high-grade reflux (grades IV-V) was observed in 30 ureters. Bilateral surgery was performed in 60 patients. All patients had follow-up using bladder US and voiding cystourethrography (VCUG) at 3 months and 12 months. Outcome included identification of Deflux mounds by bladder US and correlation of Deflux mounds identified with radiographic success rates of VUR on VCUG. RESULTS: Single Deflux injection showed radiographic success rates in 98% of low grade reflux patients and 26.7% of high grade reflux patients at last follow-up. Bladder US was able to detect Deflux mounds in 89% of low grade reflux and 43.3% of high grade reflux patients at last follow up. Our study demonstrated higher sensitivity, Positive predictive value and accuracy in Deflux detection by bladder US in low grade reflux vs high grade reflux patients. CONCLUSION: Bladder-US was highly sensitive for detection of Deflux implants. Bladder-US could be adjusted in follow-up of patients with low-grade reflux treated by Deflux injection, while VCUG could be preserved for follow-up of high-grade reflux, this will lead to reduction of unnecessary radiation exposure during VCUG for children with low grade reflux.

Anterior Ethmoidal Artery: A Computed Tomography Analysis and New Classifications.

Objective to determine the anterior ethmoidal artery (AEA) anatomy and variations by computed tomography (CT) in adult and their relations to and presents new AEA classifications. Methods One hundred and fifty paranasal CT scans (300 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes. Results One hundred and forty-four AEAs canal (48%), 293 AEAs foramen (97.7%), and 229 AEAs sulcus could be detected (76.3%). The mean AEA intranasal length was 6.7 ± 1.27 mm (range: 4.24-10.6 mm). The mean angle between AEA and lamina papyracea was 105.49 ± 9.28 degrees (range: 76.41-129.76 degrees). Of them, 95.8% AEAs had an angle with lamina >90 degrees, while 4.2% had angle <90 degrees. The mean angle between AEA and lateral lamella of cribriform plate was 103.95 ± 13.08 degrees (range: 65.57-141.36 degrees). Of them, 87.5% AEAs had an angle >90 degrees and 12.5% had an angle <90 degrees. The mean distance between AEA and skull base was 1.37 ± 1.98 mm (range: 0-8.35 mm). The AEA types in relation to skull base was type 1 (0-2 mm from skull base; 64.6%), type 2 (2-4 mm; 22.2%), type 3 (4-6 mm; 11.1%), and type 4 (>6 mm; 2.1%). The mean distance between the AEA and frontal sinus ostium was 9.17 ± 4.72 mm (range: 0-25.36 mm). AEA classification according to distance from AEA to frontal sinus ostium was 17.4% type 1 (<5 mm), 41.7% type 2 (5-10 mm), 31.9% type 3 (10-15 mm), and 9% type 4 (>15 mm). Conclusion Provided AEA details improve surgeons' awareness of AEA variations in the endoscopic field and can help residents in training.

The Added Diagnostic Value of the Bright Rim Sign to Conventional MRI Assessment of Anterior Talofibular Ligament Disruption.

RATIONALE AND OBJECTIVES: The bright rim sign (BRS) was used as a reliable indicator of anterior talofibular ligament (ATFL) disruption beside other well-known diagnostic criteria. Although this sign can improve accuracy of conventional magnetic resonance imaging (MRI) in diagnosis of ATFL disruption, it was not adequately discussed in the literature. This study aimed to confirm the added diagnostic value of BRS to conventional MRI assessment of ATFL disruption. MATERIALS AND METHODS: A prospective study included 62 patients (47 males and 15 females; mean age, 36.9 ± 12.1 years; range, 17-52 years) with clinically suspected ATFL disruption. All patients underwent MRI and arthroscopy of ankle. MRI images were evaluated for the presence of ligament disruption sign (LDS) and BRS. The patients were classified into 3 groups: group 1 included patients with acute lateral ankle ligament sprain; group 2 included patients with chronic ankle instability; and group 3 included patients with recurring ankle sprain. The diagnostic value of the BRS was evaluated using arthroscopy as reference standard. RESULTS: The diagnostic value of both signs together increased overall sensitivity in detecting ATFL disruption to 86.7% compared to 60% when considering LDS alone (p < 0.0001). In group 1 and 3, the sensitivity increased when both signs were considered together compared to LDS alone (p = 0.004 and 0.025, respectively). In group 2, there was a trend toward significance in sensitivity when both signs were considered compared to LDS alone (p = 0.08). CONCLUSION: BRS is a very helpful diagnostic sign in assessment of ATFL disruption when considered conjointly with the LDS.

Diagnostic accuracy of ultrasonography in the assessment of anterior knee pain.

BACKGROUND: Anterior knee pain (AKP) is a problematic complaint, considered to be the most frequent cause of orthopedic consultancy for knee problems. This study aimed to highlight diagnostic accuracy of ultrasonography as a fast imaging technique in assessment of patients with AKP. METHODS AND RESULTS: A prospective study was conducted on 143 patients with clinically confirmed AKP. All patients underwent ultrasonography and MRI examinations of the knee. The diagnostic accuracy of ultrasonography compared to MRI for evaluating different findings of possible causes of AKP were analyzed using receiver operating characteristic (ROC) curve and judged by area under curve (AUC). A total of 155 knees were included in the study; 26 knees showed no abnormalities, 19 knees showed positive MRI only, and 110 knees showed positive ultrasonography and MRI. Ultrasonography and MRI reported 11 different findings of possible causes of AKP or related to it. Joint effusion was the most common finding (38%) followed by trochlear cartilage defect (20.6%) and superficial infrapatellar subcutaneous edema (20%). The overall accuracy of ultrasonography was 85.3% sensitivity and 100% specificity. The ultrasonography provided the highest sensitivity (100%) in detecting bipartite patella, followed by 91.5% for joint effusion, and 87.5% for quadriceps tendinopathy. The ROC curve analysis of overall accuracy of ultrasonography showed an AUC of 0.93. The overall Kappa agreement between ultrasonography and MRI was good (k = 0.66). CONCLUSION: Ultrasonography can be used to make a swift screening and assessment of painful anterior knee and as an alternative to MRI when it is unavailable or contraindicated.

Eustachian Tube: Computed Tomography Analysis.

BACKGROUND: Eustachian tube has a major role in ventilation, drainage, and protection of the middle ear. High resolution computed tomography magnifies the role of preoperative imaging for detailed inner and middle ear anatomical information. The aim of this study was to find an applicable way by computed tomography imaging for assessment of Eustachian tube. The goal was to provide improved understanding of the Eustachian tube measurements and the relationship with middle ear in Egyptian population. Computed tomography measurements for Eustachian tube were done including; length of the bony and cartilaginous portions, Total length of Eustachian tube, as well as the width and height of the tympanic orifice of the Eustachian tube. Also, tubotympanic and Reid plane- Eustachian tube angles were measured. RESULTS: Within 200 studied ears in 100 subjects, the mean total Eustachian tube length was 40.19 ±â€Š3.05 mm, mean length of the bony Eustachian tube was 11.69 ±â€Š1.8 mm with significant longer Eustachian tube on left side, The mean length of the cartilaginous Eustachian tube was 28.5 ±â€Š2.95 mm with significantly longer cartilaginous and total length in male (P < 0.0001). The mean width and height of the tympanic orifice of the Eustachian tube was 5.4 ±â€Š0.79 and 4.85 ±â€Š0.75 mm, respectively. The mean tubotympanic angle of the Eustachian tube was 148.11 ±â€Š2.82°. The mean Reid plane- Eustachian tube angle was 27.69 ±â€Š2.08° with significantly wider angle in males (P < 0.022). CONCLUSION: The Eustachian tube measurements can easily be obtained on computed tomography images, and are representative for the Eustachian tube anatomy. There is importance of extending computed tomography examinations beyond the middle ear cavity and the mastoids to the Eustachian tube in order to have more data on its condition and relations with different pathological conditions. Computed tomography provides improved understanding of the Eustachian tube measurements and relationship with middle ear structures.

Sphenopalatine Foramen Computed Tomography Landmarks.

OBJECTIVE: The aim of the study was to assess different radiologic bony landmarks for endoscopic localization of the sphenopalatine foramen (SPF). METHODS: Paranasal computed tomography (CT) scans of adults without sinonasal pathology were included. On axial cuts, the anteroposterior distances from the SPF to maxillary line, anterior head of the middle turbinate, basal lamella of the middle turbinate, choanal arch, and posterior fontanel of the maxillary sinus ostium were measured. While on coronal cuts, the vertical distances from the SPF to the nasal floor was measured. The registered measurements were then studied and statistically analyzed. RESULTS: In 70 patients (140 sides, 840 measurements), the mean distances from the SPF to nasal floor, choanal arch, maxillary line, anterior head of the middle turbinate, basal lamella, and posterior fontanel were 25.6 ±â€Š2.4, 8.5 ±â€Š1.38, 36.4 ±â€Š2.6, 34.6 ±â€Š4.26, 8.1 ±â€Š1.27, and 13.7 ±â€Š1.7 mm, respectively, without significant differences between right and left sides. Females showed significantly shorter mean distances between SPF and the nasal floor (P = 0.0011), choanal arch (P = 0.0459), and posterior fontanel (P < 0.0001) than males. While no significant differences were detected between both sexes as regard distances from SPF to maxillary line (P = 0.5579), anterior head of middle turbinate (P = 0.8581), and basal lamella (P = 0.0638). CONCLUSION: Preoperative CT can provide multiple easily detected, reliable, and simple bony landmarks that can help SPF endoscopic localization. Thus the authors recommend adding these measurements to the preoperative CT checklist for patients scheduled for sphenopalatine artery ligation and/or excision of vascular lesions.

Lamina papyracea position in patients with nasal polypi: A computed tomography analysis.

OBJECTIVE: This study aimed to describe the positions of the lamina papyracea (LP) in patients who had nasal polypi, by computed tomography (CT) analysis. METHODS: Paranasal CT scans of patients diagnosed to have nasal polypi were included in the study. CT images were acquired with multiplanar reformates to obtain delicate details in coronal planes for all subjects. Positions of the LP were registered then analyzed in relation to nasal polypi grading. RESULTS: Forty seven subjects (94 nasal sides) were included in the current study. Grade I lamina detected in 50% or more of all cases. Patients who had larger polypi (polyp grade 3, 4) were associated with significantly more medial LP (grade II) than smaller polypi (polyp grade 0, 1, 2) (P=0.00386). CONCLUSION: The current study improves surgeons' awareness of LP position in different grades of nasal polypi and highlights that larger polypi are significantly associated with more medial LP than smaller polypi. This may be one of the causes of the higher incidence of complication in larger polypi and can help for safer surgery.