Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study

PURPOSE: To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS: This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS: Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION: Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19.

Implementation of the analytic hierarchy process (AHP) and Fine-Kinney method (FKM) against risk factors to determine the total cost of occupational health and safety precautions in environmental research laboratories.

A risk assessment method provides the definition of the risks that may be encountered in a laboratory. In order to take safety precautions regarding the in environmental research laboratories, risk assessment studies using Analytic Hierarchy Process (AHP) and Fine-Kinney Method (FKM) were carried out in this study. The environmental research laboratories were selected for the occupational health and safety assessment studies which analyze environmental samples such as wastewater, biological sludge, soil/sediment, and solid waste. Potential risks, accident rates and damages that may arise in an environmental research laboratory could be minimized with the occupational health and safety precautions decided to be taken in the light of this modeling study. Finally, the cost of the safety precautions to be taken on the basis of each risk was calculated according to the used models (AHP and FKM) in environmental research laboratories and determined approximately as 10,000.00 EUR in this study.

The Assessment of Hepatosteatosis in Living-Donor Liver Transplant: Comparison of Liver Attenuation Index and Histopathologic Results.

OBJECTIVES: The purpose of the study was to determine the diagnostic value of computed tomography densitometry in the quantification of hepatosteatosis. MATERIALS AND METHODS: Fifty-one potential liver donors, ranging in age from 19 to 52 years (mean age: 32.4 years ± 10.2), participated in the study. The mean hepatic attenuation and mean splenic attenuation were determined using regions of interest measurements. The difference between the mean hepatic attenuation and mean splenic attenuation (or liver attenuation index), with liver attenuation index = mean hepatic attenuation - mean splenic attenuation were calculated. Computed tomography densitometric parameters were correlated with histopathologic results. RESULTS: From the histopathologic analysis, the degree of macrovesicular hepatosteatosis was 0% to 8% (mean: 1.1% ± 2%). Seven donors (13.7%) had a degree of macrovesicular steatosis of > 5%, and 12 donors (23.5%) had ≥ 2%. Of the 29 normal donors with histopathologic verification, computed tomography densitometry predicted ≤ 5% of the hepatosteatosis in 27 donors, and ≤ 2% hepatosteatosis in 2 subjects. The liver attenuation index was significantly correlated to the histopathologic results. The mathematical relation between liver attenuation index and the degree of histopathologic hepatosteatosis was calculated using the least-squares methods, which provided quadratic polynomials. CONCLUSIONS: Computed tomography densitometry is a rapid, robust, noninvasive technique for the assessment of hepatosteatosis. When used in conjunction with clinically stable reference measurements of spleen, the density measurements of liver correctly predicted the presence of fatty infiltration with significant sensitivity (77%) and specificity (75%). This technique, which was refined during the course of our liver transplant program, minimizes the need for highly invasive percutaneous liver biopsies.

Sudden-onset paraplegia during pregnancy caused by haemorrhage in a spinal cord haemangioblastoma: A case report.

Spinal cord haemangioblastomas are rare central nervous systems tumours, and haemorrhage.It is an uncommon occurance. We report a 28-year-old pregnant patient who presented with paraplegia due to acute haemorrhage of a spinal haemangioblastoma. Magnetic resonance imaging showed extensive syrinx cavities, an intramedullary lesion at the T4-T5 spinal cord level e, and a subarachnoid haemorrhage. Digital subtraction angiography showed the feeding artery and dilated tortuous draining vein within the dural sac. The lesion was deemed a haemangioblastoma. The histopathological examination confirmed the diagnosis. Postoperatively, the paraplegia improved and the patient was able to walk within 2 weeks. Imaging is important for early diagnosis to prevent patients persistent neurological deficits.

Diffusion-weighted imaging (DWI) of the liver in assessing chronic liver disease: effects of the presence and the degree of ascites on ADC values.

PURPOSE: The aim of this study was to determine the correlation between the liver and spleen apparent diffusion coefficient (ADC) values of patients with chronic liver disease and the presence and the degree of ascites. MATERIALS AND METHOD: In this retrospective study, we assessed 107 patients with chronic liver disease and 39 control subjects who underwent upper abdominal MR imaging including echo-planar diffusion-weighted imaging (DWI). Among the 107 cirrhotic patients, 56 were classified as group 1, 25 as group 2, and 26 as group 3 according to the absence, the presence of minimal, and the presence of massive ascites, respectively. The scores of model for end-stage liver disease (MELD) were matched between groups as the standard reference. The liver ADC, spleen ADC, and normalized liver ADC values were compared between the control group and patients' groups. RESULTS: Patients with massive ascites had significantly higher MELD score compared with the other groups. The MELD score was also significantly higher in patient groups than in control group. The liver and normalized liver ADCs of patients' groups were significantly lower than that of the control group. With some overlap among groups, the measured ADC values decreased as the amount of the ascites increased, and these relationships were statistically significant. Furthermore, compared to control group, patients with massive ascites had significantly higher spleen ADCs. CONCLUSION: Our results indicate that the ADC value of the liver and spleen correlates with the presence and the degree of ascites in patients with chronic liver disease, and merits further study.

Congenital Agenesis of Right Internal Carotid Artery: A Report of Two Cases.

Congenital unilateral agenesis of the internal carotid artery (ICA) is a rare anomaly. Due to proper sufficient collateral circulation via the circle of Willis most cases are asymptomatic, but patients can also present with ischemic or hemorrhagic cerebrovascular insults. The absence of the bony carotid canal is essential to differentiate this anomaly from chronic ICA occlusion. Awareness of this situation by clinicians and radiologists is essential because these patients have an increased incidence of various intracranial pathologies. We report two cases of this rare developmental congenital abnormality occurring in two young patients and describe the presentation, diagnosis, determined developmental causes, imaging findings, and complications.

Effects of acute exercise on the diameter of the spermatic vein, and duration of reflux in patients with varicocele.

OBJECTIVE: The aim of this study was to investigate the effects of acute exercise on the diameter of the spermatic vein, and on the duration of reflux in patients with varicocele. MATERIAL AND METHODS: The study included 38 patients with complaints of infertility and scrotal pain between 2009 and 2010. The diagnoses were made by physical examination and colour Doppler ultrasound, with both performed before and after exercise tests. RESULTS: The mean age of the participants was 25.7 ± 4.9 years. During the first examination, the grades of the varicoceles detected were as follows: grade I, n = 7; II, n = 10; and III, n = 21. The diameters of veins in patients with grades I, II and III varicocele were 2.1 mm, 2.9 mm and 4.2 mm, respectively, before exercise, whereas they were 2.6 mm, 3.2 mm and 4.3 mm, respectively, after exercise. In patients with grade I varicoceles, compared with pre-exercise values, the diameter of the left spermatic vein and duration of reflux measured during Valsalva manoeuvres were increased significantly after exercise (p = 0.042 and p = 0.034, respectively); similar results were obtained for the patients with grade II varicoceles (p = 0.007 and p = 0.008, respectively). However, the minimal relative increase in cases with grade III varicoceles was not statistically significant (p > 0.05). CONCLUSIONS: This study demonstrates that acute exercise increases the spermatic vein diameter and reflux time in patients with varicoceles. These outcomes demonstrate that acute exercise may be an aggravating factor for varicocele, as seen in chronic exercise.

Synovial chondromatosis of the temporomandibular joint: radiologic and histopathologic findings.

Synovial chondromatosis is a formation of multiple intrasynovial nodules resembling osteochondromas, resulting from proliferative changes in the synovial linings of joints; as the disorder progresses, nodules increasingly withdraw from the intrasynovial areas for the joint cavities. This is a relatively unusual case that can arise at unilateral large joints, such as knee, hip, and elbow, with the temporomandibular joint being the rarest one of them. Early recognition of the signs and symptoms with resultant accurate diagnosis, as well as proper surgical treatment, offers patients the best hope of recovery and improved quality of life. We report a conventional radiologic film, computed tomography, magnetic resonance imaging, and histopathologic findings of the synovial chondromatosis presenting as a large right preauricular mass arising from the temporomandibular joint without bone destruction.

The role of MRS in the differentiation of benign and malignant soft tissue and bone tumors.

OBJECTIVE: The aim of our study was to investigate the value of choline in the discrimination of benign and malignant soft tissue and bone tumors. MATERIALS AND METHODS: The study group consisted of thirty subjects with bone or soft tissue tumors larger than 1.5 cm in diameter. The experiments were performed in a 1.5T MR scanner. Coils were selected according to specific locations. A single-voxel MRS was performed for three different TE (time to echo) (31, 136, 272 ms). The volume of interest was positioned on the brightest enhancement. The presence of a cholin peak on at least 2 of these spectrums was considered as the marker of malignancy. The sensitivity, specificity and accuracy of the MRS in the detection and diagnosis of malignant lesions were calculated. The reproducibility of MRS and histopathological results were tested with kappa statistics. RESULTS: Histopathologically, 18 (60%) of the lesions were classed as malignant whereas 12 (40%) were classed as benign. With MRS, 15 (50%) of these lesions were classed as malignant and 15 (50%) as benign. Two patients who were found spectroscopically to have malignant tumors were shown histopathologically to have benign types. Five patients with an MRS showing a benign type were classed with malignant types in histopathological examinations. MRS had a sensitivity rate of 72.2%, specificity of 83.3%, and an accuracy rate of 76.6% in detecting malignant bone and soft tissue tumors. The interrater reliability of both techniques had a kappa value of 0.533. CONCLUSIONS: MRS may help in the differentiation of benign and malignant soft tissue and bone tumors.

Prospective evaluation of the alterations in the morphology and vascular resistance of the renal parenchyma with color Doppler ultrasonography after percutaneous nephrolithotomy.

PURPOSE: To evaluate the kidneys with color Doppler ultrasonography (CDUS) to determine whether percutaneous nephrolithotomy (PNL) causes renal parenchymal damage. PATIENTS AND METHODS: In 24 patients who underwent unilateral PNL with single renal pole access, cortical thickness, echogenicity, and resistive index (RI) were measured in each pole of the operated and contralateral kidney separately before and at postoperative day (POD) 1, and at 3, 6, and 12 months after PNL. RESULTS: The mean age of the patients was 36.67 +/- 14.68 years. The serum creatinine level increased significantly immediately after PNL but diminished to the preoperative level at POD 1. Changes in serum blood urea nitrogen and electrolyte levels were insignificant. Mean cortical thickness increased significantly in the access pole and contralateral kidney and insignificantly in the nonaffected pole. No statistically significant change was recorded in parenchymal echogenicitiy. Statistically significant differences in cortical thickness between the access pole and the contralateral kidney and between the nonaffected pole and the contralateral kidney disappeared 3 months later. Differences in mean cortical thickness between the access pole and the nonaffected pole were insignificant at all examination periods. Echogenicity was greater in the access pole and the nonaffected pole than in the contralateral kidney only at POD 1. No significant difference was noted in the echogenicity between the access pole and the nonaffected pole. Mean RIs were lower than the universally accepted pathologic RI level (0.70) at all periods. There was no statistically significant difference between the mean RI values of the access pole, nonaffected pole, and contralateral kidney. CONCLUSION: PNL does not cause obvious renal dysfunction and significant parenchymal scarring, which is indicated by the decrease in cortical thickness and increases in cortical echogenicity and intrarenal RI.

1H magnetic resonance spectroscopy of the normal testis: preliminary findings.

PURPOSE: The purpose of this study was to determine the pre- and postpubertal 1H magnetic resonance spectroscopic characteristics of the normal testis to establish baseline values for further clinical studies. MATERIALS AND METHODS: The subjects consisted of male volunteers, of whom 19 were prepubertal with ages between 7 and 13 years and 24 were postpubertal with ages between 19 and 39 years. Their testes were evaluated at 1.5 T with magnetic resonance spectroscopy; in addition, testis volumes were measured. Major metabolite peaks were identified and their ratios were calculated. Metabolite differences of testis between pre- and postpubertal age were analyzed. RESULTS: Major constituents of spectra were 3.21 ppm choline and 0.9-1.3 ppm lipid peaks. At the echo time (TE) spectrum of 31 ms, choline/lipid ratios ranged from 0.35 to 8.30 (mean=1.87) in postpubertal males and from 0.06 to 5.45 (mean=0.88) in prepubertal males (P<.013). At the TE spectrum of 136 ms, choline/lipid ratios ranged from 0.66 to 15.42 (mean=4.09) in postpubertal males and from 0.05 to 4.91 (mean=0.9) in prepubertal males (P<.016). CONCLUSIONS: Choline/lipid ratio was higher in the postpubertal period. The existence of higher choline peak in that age group should be due to the initiation of spermatogenesis. The decrease in the lipid peak may represent the effect of testosterone on testicular tissue or may be due to histochemical changes initiated by puberty. The significant decrease in choline/lipid ratio noted after puberty could represent the presence of spermatogenesis. This hypothesis should be evaluated by further studies on postpubertal subjects with impaired spermatogenesis.

[Dynamic contrast-enhanced magnetic resonance imaging findings of mass lesions of the pontocerebellar angle]. / Pontoserebellar köse tümörlerinde dinamik kontrastli manyetik rezonans görüntüleme bulgulari.

OBJECTIVES: The differential diagnosis of mass lesions of the pontocerebellar angle is not always possible by conventional magnetic resonance imaging (MRI). In this study, we investigated the role of dynamic contrast-enhanced MRI in the differential diagnosis of acoustic neurinoma, meningioma, and paraganglioma. PATIENTS AND METHODS: Twelve patients (8 females, 4 males; mean age 47.5 years; range 8 to 71 years) whose diagnoses were acoustic neurinoma (n=3), paraganglioma (n=5), and meningioma (n=4) were evaluated by simultaneous conventional and dynamic contrast-enhanced MRI. Prior to postcontrast T1-weighted images, dynamic MRI was obtained. On these images, maximum contrast enhancement (Cmax) and time to peak enhancement (Tmax) were calculated at 15 different time points. Time-signal intensity curve patterns of the lesions were compared. RESULTS: According to the four main time-signal intensity curve patterns described in the literature, acoustic neurinomas, meningiomas, and paragangliomas exhibited type C, type A-B, and type A curve patterns, respectively. CONCLUSION: Our results suggest that dynamic contrast MRI may have an additional but limited role in the differential diagnosis of extra-axial intracranial tumors such as those of the pontocerebellar angle.

Unilateral reverse ocular bobbing caused by tuberous sclerosis.

A female aged 12 months with developmental delay and left-sided reverse ocular bobbing (rapid deviation of the eye upward and a slow return to the horizontal position) was observed. At birth, an upper left gingival mass, pathologically diagnosed as a benign granular cell tumour, was removed. On computed tomography (CT), left middle cerebral pedincular and midpontine lesions were seen. Magnetic resonance imaging revealed additional white matter hamartomas, corticosubcortical tubers, and subependymal nodules. The patient was re-examined at 36 months. Her general developmental quotient was equivalent to 23 months of age. Third cranial nerve functions and auditory brainstem response were normal. Her abnormal eye movements were still present. Reverse bobbing is usually observed in patients who are unconscious and who have significant pontine pathology and disruption of the reticular formation. This case is the first tuberous sclerosis-related ocular bobbing case to our knowledge and is interesting as the causative lesion was relatively mild, and ocular horizontal movements were preserved.

Renal interlobar artery parameters with duplex Doppler sonography and correlations with age, plasma renin, and aldosterone levels in healthy children.

OBJECTIVE: The objectives of this study were to compare and make correlations between age and Doppler parameters of the interlobar arteries, including synchronously obtained plasma renin and aldosterone levels and to obtain new normative data regarding acceleration time in healthy children from neonates to 16 years. SUBJECTS AND METHODS: One hundred sixty-nine healthy children (72 girls and 97 boys) were classified into four groups: group 1 (< 1 year; n = 34), group 2 (range, 1-6 years; n = 48), group 3 (range, 6-12 years; n = 50), and group 4 (range, 12-16 years; n = 37). Blood samples from the renin and aldosterone were collected in the morning after bed rest and fasting. The resistive index (RI), pulsatility index (PI), and the acceleration time of the renal interlobar arteries with duplex Doppler sonography, including both kidney longitudinal lengths with grayscale sonography, were evaluated. One-way analysis of variance with the least significant difference post-hoc test and Pearson's correlation test were used to compare the differences between groups and to make correlations, respectively. An independent-sample t test was used to evaluate the differences between all parameters based on sex and to compare the left and right kidney longitudinal lengths in each group. RESULTS: The RI, PI, and acceleration time were statistically significant in between-group comparisons. Only in group 4 was acceleration time not statistically significant compared with groups 2 and 3. Plasma renin levels were significantly higher in group 1 compared with groups 2 (p < 0.03) and 4 (p < 0.0001); in group 2 compared with group 4 (p < 0.05); and in group 3 compared with group 4 (p < 0.01). The plasma aldosterone levels were significantly higher only in group 1 compared with groups 2 (p < 0.001), 3 (p < 0.008), and 4 (p < 0.0001). The RI correlated linearly with the PI, plasma renin levels, and aldosterone levels and correlated inversely with acceleration time. Age had a negative correlation with the RI, PI, plasma renin levels, and aldosterone levels and correlated positively with acceleration time. There were no statistically significant differences between all parameters based on sex and no significant difference found between the right and left kidney longitudinal lengths in each group. CONCLUSION: The RI in children up to 54 months old is higher than in adults. Therefore, the adult mean renal RI criterion of 0.70 should be applicable to children 54 months old and older. We showed that the age dependency of the RI was directly related to that of plasma renin and aldosterone levels in healthy children in whom Doppler parameters and blood analysis were evaluated synchronously.

Spontaneous intracranial hypotension with pituitary adenoma.

Spontaneous intracranial hypotension (SIH) is an unusual syndrome that is characterised by positional headache, neck rigidity, nausea and vomiting. The characteristic magnetic resonance imaging (MRI) findings are diffuse smooth pachymeningeal thickening and enhancement, downward displacement of posterior fossa structures and pituitary gland enlargement. An unusual case of SIH with pituitary macro-adenoma and subsequent subdural haemorrhage is presented, and its clinical picture, MRI findings and possible pathophysiological mechanism are discussed.