Abdominopelvic CT in COVID-19 patients with abdominal complaints including both waves and controls: reader agreement and overcalls after consensus review.

BACKGROUND: Since many COVID-19 publications lack consensus reviews or controls, interpretive accuracy is unclear; abdominal processes unique or infrequent during the pandemic remain unknown. The incidence and nature of CT findings accounting for abdominal complaints in COVID patients, reader agreement and overcalling will be determined. METHODS: A retrospective study was performed on COVID patients with abdominal complaints from 3/15/2020-5/31/2020 and 11/1/2020-4/15/2021 including matched controls. Reviewers blinded to initial reads interpreted abdominopelvic CT exams, with discordant cases resolved in consensus. Reader agreement was measured by Cohen's Kappa, differences between cohorts by permutation tests and factors affecting false positive/negative rates by Fisher's Exact Test and logistic regression. RESULTS: 116 first wave (average age 65 years [±15.3], 63 [54%] women) and 194 second wave COVID cases (average age 64 years [±16.3], 103 [53%] women) including 116 wave 1 and 194 wave 2 prepandemic controls were included. Concordance was lower among COVID cases than controls (Cohen's Kappa of 0.58 vs. 0.82 [p ≤ 0.001]) and among wave 1 than wave 2 cases (Cohen's Kappa of 0.45 vs. 0.66 [p = 0.052]). With true positives defined as consensus between the initial reader and study reader, false positive rates were higher among COVID cases than controls (OR = 0.42, p = 0.003) and for initial than study reader (OR = 0.36, p ≤ 0.001), but lower in wave 2 than 1 (OR = 0.5, p = 0.028). CONCLUSION: Greater reader disagreement occurred during COVID than prepandemic with no reader bias as both initial and study readers called more false positives among COVID cases than controls. More overcalling occurred during COVID with colitis and cystitis most common.

Imaging features of anorectal proctitis in monkeypox infection.

The monkeypox outbreak of 2022 saw the first community-sustained transmission of the monkeypox virus outside of Africa, and rapidly developed into multi-country spread. A common presenting sign of monkeypox infection during this outbreak has been rectal pain due to proctitis. Proctitis with large hypoattenuated anorectal ulcers on CT scan should invoke consideration for monkeypox infection in young homosexual or bisexual men with associated skin eruptions.

Review of COVID-19, part 2: Musculoskeletal and neuroimaging manifestations including vascular involvement of the aorta and extremities.

The coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has affected almost every country in the world resulting in severe morbidity, mortality and economic hardship, altering the landscape of healthcare forever. Its devastating and most frequent thoracic and cardiac manifestations have been well reported since the start of the pandemic. Its extra-thoracic manifestations are myriad and understanding them is critical in diagnosis and disease management. The role of radiology is growing in the second wave and second year of the pandemic as the multiorgan manifestations of COVID-19 continue to unfold. Musculoskeletal, neurologic and vascular disease processes account for a significant number of COVID-19 complications and understanding their frequency, clinical sequelae and imaging manifestations is vital in guiding management and improving overall survival. The authors aim to provide a comprehensive overview of the pathophysiology of the virus along with a detailed and systematic imaging review of the extra-thoracic manifestation of COVID-19. In Part I, abdominal manifestations of COVID-19 in adults and multisystem inflammatory syndrome in children will be reviewed. In Part II, manifestations of COVID-19 in the musculoskeletal, central nervous and vascular systems will be reviewed.

Review of COVID-19, part 1: Abdominal manifestations in adults and multisystem inflammatory syndrome in children.

The coronavirus disease 2019 (COVID -19) pandemic caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has affected almost every country in the world, resulting in severe morbidity, mortality and economic hardship, and altering the landscape of healthcare forever. Although primarily a pulmonary illness, it can affect multiple organ systems throughout the body, sometimes with devastating complications and long-term sequelae. As we move into the second year of this pandemic, a better understanding of the pathophysiology of the virus and the varied imaging findings of COVID-19 in the involved organs is crucial to better manage this complex multi-organ disease and to help improve overall survival. This manuscript provides a comprehensive overview of the pathophysiology of the virus along with a detailed and systematic imaging review of the extra-thoracic manifestation of COVID-19 with the exception of unique cardiothoracic features associated with multisystem inflammatory syndrome in children (MIS-C). In Part I, extra-thoracic manifestations of COVID-19 in the abdomen in adults and features of MIS-C will be reviewed. In Part II, manifestations of COVID-19 in the musculoskeletal, central nervous and vascular systems will be reviewed.

CT Colonography: Improving Interpretive Skill by Avoiding Pitfalls.

An earlier incorrect version of this article appeared online. This article was corrected on December 20, 2019.

Colostomy on CT and fluoroscopy: What the radiologist needs to know.

Colostomies are commonly created in conjunction with colorectal surgery performed for both malignant and benign indications. Familiarity with the different types of colostomies and their normal imaging appearance will improve radiologic detection and characterization of colostomy complications. The radiologist plays a large role in assessment of colostomy patients either via fluoroscopic technique or multidetector computed tomography (CT) in order to help identify ostomy complications or to aid the surgeon prior to colostomy reversal. In this article, we will review: (1) the types of colostomies and indications for their creation; (2) the proper radiographic technique of ostomy evaluation; and (3) the potential complications of colostomies and their imaging manifestations.

Comparison of extracolonic findings and clinical outcomes in a screening and diagnostic CT colonography population.

PURPOSE: To compare the distribution of extracolonic findings and clinical outcomes between screening and diagnostic CT colonography (CTC) populations. METHODS: 388 consecutive patients (369 men, 19 women; mean ± SD age 67.8 ± 10 years) who underwent first-time CTC (4/2011-4/2017) at a Veteran's Affairs Medical Center were divided into screening (asymptomatic) or diagnostic (symptomatic) cohorts based on CTC indication. CTC reporting and data system E-scores for extracolonic findings were retrospectively assigned based on prospective CTC radiologic reports. Multinomial logistic regression was used to examine the association between E-scores and CTC indication. Electronic medical records of all patients with E3 or E4 scores were reviewed (median follow-up 2.8 years) to determine clinical outcomes. RESULTS: 68% (262/388) underwent screening and 32% (126/388) diagnostic CTC. 7.2% (28/388) had extracolonic findings considered potentially significant (E4), 4.4% (17/388) had indeterminate but likely unimportant findings (E3), and 88.4% (347/388) had normal or unimportant findings (E1 or E2). E-scores were not significantly different between screening and diagnostic CTC when adjusted for age, gender, and prior imaging (p = 0.44). 4.6% (12/262) of patients with E3/E4 findings in the screening cohort demonstrated clinically significant outcomes, compared with 4.0% (5/126) in the diagnostic cohort, including a total of three extracolonic malignancies (0.8%) and three abdominal aortic aneurysms (0.8%). 4.6% (18/388) underwent follow-up imaging studies to confirm a benign outcome after detection of a category E3/E4 finding. CONCLUSIONS: The distribution of extracolonic findings and clinical outcomes were not statistically significantly different between screening and diagnostic CTC populations.

TLR8 ligation induces apoptosis of monocytic myeloid-derived suppressor cells.

Myeloid-derived suppressor cells (MDSCs) accumulate in tumors and the peripheral blood of cancer patients and demonstrate cancer-promoting activity across multiple tumor types. A limited number of agents are known to impact MDSC activity. TLR8 is expressed in myeloid cells. We investigated expression of TLR8 on MDSC and the effect of a TLR8 agonist, motolimod, on MDSC survival and function. TLR8 was highly expressed in monocytic MDSC (mMDSC) but absent in granulocytic MDSC (gMDSC). Treatment of human PBMC with motolimod reduced the levels of mMDSC in volunteers and cancer donors versus control (P < 0.001). Motolimod did not impact levels of gMDSC. The reduction of mMDSC was due to induced cell death by TLR8 ligation. Pretreatment of PBMC with a FAS neutralizing antibody inhibited motolimod-induced reduction of mMDSC (P < 0.001). Finally, we demonstrated that mMDSC impeded IL-2 secretion by CD3/CD28-activated T cells; IL-2 secretion was partially restored when cells were cocultured with motolimod (142 ± 36 pg/ml vs. 59 ± 13 pg/ml; P = 0.03). There is increasing evidence that MDSCs contribute to the progression of cancer by inhibiting tumor-directed T cells. TLR8 agonists may synergize with cancer immunotherapeutic approaches to enhance the antitumor effects of the adaptive immune response.

Improving diagnosis of atraumatic splenic lesions, part II: benign neoplasms/nonneoplastic mass-like lesions.

Focal atraumatic splenic lesions often pose a diagnostic challenge on cross-sectional imaging. They can be categorized based on etiology as nonneoplastic, benign neoplastic (discussed in Part II), and malignant neoplastic lesions or on prevalence as common, uncommon, and rare lesions. Familiarity with pertinent clinical parameters, etiology, pathology, prevalence and ancillary features such as splenomegaly, concomitant hepatic involvement, and extrasplenic findings, in addition to knowledge of imaging spectra of the lesions, can improve diagnostic confidence. Consideration of these factors together can arm the radiologist with the necessary tools to render a more confident diagnosis and, thus, better aid management.

Hollow organ abdominal ischemia, part II: clinical features, etiology, imaging findings and management.

Acute hollow organ ischemia commonly presents with acute pain prompting radiologic evaluation and almost always requires urgent treatment. Despite different risk factors and anatomic differences, ischemia is commonly due to low flow states but can also be due to arterial and venous occlusion. Radiologic diagnosis is critical as many present with nonspecific symptoms. Contrast-enhanced computed tomography (CT) is the modality of choice. Magnetic resonance imaging (MRI) is preferred in suspected appendicitis in pregnant patients and is superior in biliary necrosis. This article provides a pictorial review of the CT/MRI features of hollow abdominal organ ischemia while highlighting key clinical features, pathogenesis, and management.

Improving diagnosis of atraumatic splenic lesions, part I: nonneoplastic lesions.

Focal atraumatic splenic lesions often pose a diagnostic challenge on cross-sectional imaging. They can be categorized based on etiology as nonneoplastic (reviewed in Part I), benign neoplastic, and malignant neoplastic lesions. Lesions can also be characterized based on prevalence as common, uncommon, and rare. Familiarity with pertinent clinical parameters, etiology, pathology, prevalence, and ancillary features such as splenomegaly, concomitant hepatic involvement, and extrasplenic findings, in addition to knowledge of imaging spectra of these lesions, can improve diagnostic confidence. Since the nonneoplastic lesions are usually easily recognized, it is critical that the radiologist identifies them avoiding unnecessary work up.

Solid organ abdominal ischemia, part I: clinical features, etiology, imaging findings, and management.

Solid organ abdominal ischemia commonly presents with acute pain prompting radiologic evaluation and often requires urgent treatment. Despite different risk factors and anatomic differences, most solid organ ischemia is due to arterial or venous occlusion and, less frequently, a low-flow state. Radiologic diagnosis is critical, as clinical presentations are often nonspecific. Contrast-enhanced computed tomography (CT) is the modality of choice (except in adnexal torsion) with magnetic resonance imaging (MRI) useful in equivocal cases or follow-up of ischemic disease. This article will provide a pictorial review of the CT and MRI features of solid abdominal organ ischemia while highlighting key clinical features, etiology, and management.

Improving diagnosis of atraumatic splenic lesions, Part III: malignant lesions.

Focal atraumatic splenic lesions often pose a diagnostic challenge on cross-sectional imaging. They can be categorized based on etiology, as nonneoplastic, benign neoplastic, and malignant neoplastic (discussed in Part III) lesions, or on prevalence, as common, uncommon, and rare lesions. Familiarity with pertinent clinical parameters, etiology, pathology, prevalence, and ancillary features such as splenomegaly, concomitant hepatic involvement, and extrasplenic findings, in addition to knowledge of imaging spectra of the lesions, can improve diagnostic confidence. Consideration of these factors together can arm the radiologist with the necessary tools to render a more confident diagnosis and thus better aid management.

The recognition of Dendropsophus minusculus () (Hylidae, Dendropsophini) as a highly polymorphic, multi-domain distributed species / O reconhecimento de Dendropsophus minusculus () (Hylidae, Dendropsophini) como espécie polimórfica e de ocorrência em distintos domínios morfoclimáticos

Herein we present new occurrences of sites of Dendropsophus minusculus in Brazil adding information about reproductive biology and colour patterns of the species. Such information is fundamental for characterising the species that we believe has been neglected due to its morphological similarity with other congeneric species. Dendropsophus minusculus may be found in different morphoclimatic domains, being one of the most generalist species of the genus in this aspect. The species plasticity is not restricted to its occurrence, but also related to aspects of its reproductive biology, and we hypothesised that the latter feature could explain the wide geographical range of the species. We highlight the importance of further in-depth studies and the use of D. minusculus as a model to understand the historical events responsible for the current geographical distribution of the morphoclimatic domains in Brazil.

No presente estudo relatamos novos locais de ocorrência para Dendropsophus minusculus no Brasil e acrescentamos informações sobre a biologia reprodutiva e padrões de coloração da espécie. Essas informações são de fundamental importância para a caracterização da espécie, que acreditamos ter sido negligênciada em virtude de sua semelhança morfológica com outras espécies congenéricas. Dendropsophus minusculus pode ser encontrada em diversos domínios morfoclimáticos, sendo, neste aspecto, uma das espécies mais generalistas de seu gênero. A plasticidade da espécie não se restringe a sua ocupação territorial, mas também a aspectos relativos a sua biologia reprodutiva e especulamos que esta seja a razão de sua amplitude territorial. Destacamos ainda a importância de estudos mais aprofundados e o uso da espécie como modelo para o entendimento de eventos pretéritos responsáveis pela distribuição de domínios morfoclimáticos no Brasil.

The recognition of Dendropsophus minusculus () (Hylidae, Dendropsophini) as a highly polymorphic, multi-domain distributed species

Herein we present new occurrences of sites of Dendropsophus minusculus in Brazil adding information about reproductive biology and colour patterns of the species. Such information is fundamental for characterising the species that we believe has been neglected due to its morphological similarity with other congeneric species. Dendropsophus minusculus may be found in different morphoclimatic domains, being one of the most generalist species of the genus in this aspect. The species plasticity is not restricted to its occurrence, but also related to aspects of its reproductive biology, and we hypothesised that the latter feature could explain the wide geographical range of the species. We highlight the importance of further in-depth studies and the use of D. minusculus as a model to understand the historical events responsible for the current geographical distribution of the morphoclimatic domains in Brazil.

No presente estudo relatamos novos locais de ocorrência para Dendropsophus minusculus no Brasil e acrescentamos informações sobre a biologia reprodutiva e padrões de coloração da espécie. Essas informações são de fundamental importância para a caracterização da espécie, que acreditamos ter sido negligênciada em virtude de sua semelhança morfológica com outras espécies congenéricas. Dendropsophus minusculus pode ser encontrada em diversos domínios morfoclimáticos, sendo, neste aspecto, uma das espécies mais generalistas de seu gênero. A plasticidade da espécie não se restringe a sua ocupação territorial, mas também a aspectos relativos a sua biologia reprodutiva e especulamos que esta seja a razão de sua amplitude territorial. Destacamos ainda a importância de estudos mais aprofundados e o uso da espécie como modelo para o entendimento de eventos pretéritos responsáveis pela distribuição de domínios morfoclimáticos no Brasil.

The recognition of Dendropsophus minusculus (Rivero, 1971) (Hylidae, Dendropsophini) as a highly polymorphic, multi-domain distributed species.

Herein we present new occurrences of sites of Dendropsophus minusculus in Brazil adding information about reproductive biology and colour patterns of the species. Such information is fundamental for characterising the species that we believe has been neglected due to its morphological similarity with other congeneric species. Dendropsophus minusculus may be found in different morphoclimatic domains, being one of the most generalist species of the genus in this aspect. The species plasticity is not restricted to its occurrence, but also related to aspects of its reproductive biology, and we hypothesised that the latter feature could explain the wide geographical range of the species. We highlight the importance of further in-depth studies and the use of D. minusculus as a model to understand the historical events responsible for the current geographical distribution of the morphoclimatic domains in Brazil.

Misprocessing and functional arrest of microRNAs by miR-Pirate: roles of miR-378 and miR-17.

miRNAs (microRNAs) are short non-coding RNAs that can regulate gene expression in cancer development, which makes them valuable targets for therapeutic intervention. In the present study we report on an approach that can not only arrest the functions of mature miRNAs by binding to them, but it can also induce the 'mis-processing' of the target miRNA, producing a non-functional truncated miRNA. This approach involves generating an expression construct that produces an RNA fragment with 16 repeat sequences. The construct is named miR-Pirate (miRNA-interacting RNA-producing imperfect RNA and tangling endogenous miRNA). The transcript of the construct contained mismatches to the seed region, and thus it would not target the potential targets of the miRNA under study. The homology of the construct is sufficiently high, allowing the transcript to block miRNA functions. The functions of the construct were validated in cell cultures, in tumour formation assays and in transgenic mice stably expressing this construct. To explore the possibility of adopting this approach in gene therapy, we transfected cells with synthetic miR-Pirate and obtained the results we expected. The miR-Pirate, expressed by the construct or synthesized chemically, was found to be able to specifically pirate and silence a mature miRNA through its dual roles and thus could be clinically applied for miRNA intervention.

Efficacy of contrast-enhanced CT in assessing the endometrium.

OBJECTIVE: The purpose of our study was to determine the efficacy of contrast-enhanced CT in detecting a thickened endometrium. We used transvaginal sonography as the reference standard. MATERIALS AND METHODS: Between March 2005 and January 2007, data from 259 patients (mean age, 47 years; age range, 18-90 years) who underwent transvaginal sonography and contrast-enhanced CT of the pelvis were analyzed retrospectively. The endometrium was quantitatively measured in millimeters on sonography. On CT it was qualitatively categorized as normal, thickened, indeterminate, or not visualized and compared with the sonography findings and original radiology reports. When the endometrium was indeterminate (thickened or triangular in shape on axial images), sagittal reconstructions were performed for final categorization. Two reviewers evaluated the CT scans and sonograms jointly with differences resolved by consensus. Kappa, Wilcoxon's rank sum test, and intraclass correlation statistics were derived. RESULTS: The overall sensitivity and specificity of CT in detecting the thickened endometrium was 53.1% and 93.5%, respectively, relative to transvaginal sonography. The positive and negative predictive values were 66.7% and 89.1%, respectively. Kappa, the statistical measure of agreement between CT and sonography data, was 0.5049. All cases of a triangular endometrium were normal in size on sagittal reconstruction images. CONCLUSION: Routine pelvic CT correctly identifies a normal endometrium in most patients. Sagittal reconstruction images are helpful to further evaluate the endometrium on CT in cases with a prominent or triangular endometrium because these are often related to uterine version. CT is relatively insensitive in detecting the thickened endometrium but better able to identify gross rather than subtle thickening, which must be further characterized by transvaginal sonography.