Radiological Imaging
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2021 ◽  
Vol 2 ◽  
Author(s):  
Stephan Vlaminck ◽  
Frederic Acke ◽  
Glenis K. Scadding ◽  
Bart N. Lambrecht ◽  
Philippe Gevaert

Adult chronic rhinosinusitis (CRS) is a chronic inflammation of the mucosa of the nose and paranasal sinuses. According to the latest EPOS guidelines CRS should be regarded as primary or secondary with distinction between diffuse and localized disease. Further pathophysiologic research identified different inflammatory patterns leading to the term “endotyping of CRS.” The primary focus of endotyping is to define a dominant inflammatory type allowing for better orientation of therapy. The current approach proposes the differentiation between type 2 (eosinophilic) and non-type 2 inflammatory responses. In this review pathophysiological concepts of CRS will be discussed, focusing on the different inflammatory endotypes of T cells with special attention to the eosinophilic type 2 inflammatory response. The contribution of innate and adaptive immune system responses is presented. The possibility of endotyping based on sinonasal secretions sampling is brought to attention because it is indicative of corticosteroid responsiveness and available to most ENT surgeons. Furthermore, the clinical aspects of the three distinct phenotypes are analyzed in view of their characteristics, the related endoscopic findings, typical radiological imaging, histopathology findings, their relation toward allergy and obvious therapeutical implications. This overview will enable clinicians to relate pathophysiological patterns with clinical observations by explaining the different inflammatory mechanisms, hence providing a better understanding of therapy.


Author(s):  
Sudhir Bhandari ◽  
Govind Rankawat ◽  
Ajeet Singh

Background: Coronavirus disease 2019 mainly affect the lungs which can complicate into pneumothorax and require hospitalization. We aimed to discuss the presence of pneumothorax and its possible risk factors in vulnerable patients of COVID-19 to establish an effective preventive and therapeutic strategy for this fatal complication. Methods: This retrospective observational study included 30 admitted patients of COVID-19 associated pneumothorax. The patient’s data concerning demography, clinical manifestation, associated medical illness, point of onset of pneumothorax, mode of oxygenation with FiO2 and PEEP, radiological imaging, and outcome were extracted from their medical records. All collected data were tabulated, compiled, and analyzed to establish possible causality of pneumothorax. Results: All patients of the study group exhibited symptomatic presentations, 73% of patients had severe clinical conditions and 24 patients also had associated chronic medical illness. In our study pneumothorax developed 3rd week onwards after symptoms onset with a mean time of pneumothorax was found to be 23.96 days (23.96±8.06). At the point of diagnosis of pneumothorax, 22 patients were on non-invasive ventilation, 6 on high flow mask, and 2 patients on invasive ventilation, these patients required higher FiO2 (77.66%) and higher PEEP (10.83 cmH2O) to maintain PaO2 within normal range. All patients had raised COVID-related inflammatory markers viz. NLR, D-dimer, CRP, IL-6, and these markers showed a positive correlation with the duration of hospital stay in patients of pneumothorax. Conclusion: Pneumothorax can be suspected in COVID-19 infected patients having severe COVID-19 pneumonia of longer duration with assistant ventilation and raised inflammatory markers going to rapid worsening of symptoms.


2021 ◽  
Vol 1 ◽  
Author(s):  
Dingqian Wang ◽  
Cuicui Liu ◽  
Xiuying Wang ◽  
Xuejun Liu ◽  
Chuanjin Lan ◽  
...  

Diffuse gliomas are the most common malignant primary brain tumors. Identification of isocitrate dehydrogenase 1 (IDH1) mutations aids the diagnostic classification of these tumors and the prediction of their clinical outcomes. While histology continues to play a key role in frozen section diagnosis, as a diagnostic reference and as a method for monitoring disease progression, recent research has demonstrated the ability of multi-parametric magnetic resonance imaging (MRI) sequences for predicting IDH genotypes. In this paper, we aim to improve the prediction accuracy of IDH1 genotypes by integrating multi-modal imaging information from digitized histopathological data derived from routine histological slide scans and the MRI sequences including T1-contrast (T1) and Fluid-attenuated inversion recovery imaging (T2-FLAIR). In this research, we have established an automated framework to process, analyze and integrate the histopathological and radiological information from high-resolution pathology slides and multi-sequence MRI scans. Our machine-learning framework comprehensively computed multi-level information including molecular level, cellular level, and texture level information to reflect predictive IDH genotypes. Firstly, an automated pre-processing was developed to select the regions of interest (ROIs) from pathology slides. Secondly, to interactively fuse the multimodal complementary information, comprehensive feature information was extracted from the pathology ROIs and segmented tumor regions (enhanced tumor, edema and non-enhanced tumor) from MRI sequences. Thirdly, a Random Forest (RF)-based algorithm was employed to identify and quantitatively characterize histopathological and radiological imaging origins, respectively. Finally, we integrated multi-modal imaging features with a machine-learning algorithm and tested the performance of the framework for IDH1 genotyping, we also provided visual and statistical explanation to support the understanding on prediction outcomes. The training and testing experiments on 217 pathologically verified IDH1 genotyped glioma cases from multi-resource validated that our fully automated machine-learning model predicted IDH1 genotypes with greater accuracy and reliability than models that were based on radiological imaging data only. The accuracy of IDH1 genotype prediction was 0.90 compared to 0.82 for radiomic result. Thus, the integration of multi-parametric imaging features for automated analysis of cross-modal biomedical data improved the prediction accuracy of glioma IDH1 genotypes.


Author(s):  
Osman Öcal ◽  
Michael Ingrisch ◽  
Muzaffer Reha Ümütlü ◽  
Bora Peynircioglu ◽  
Christian Loewe ◽  
...  

Summary Aims To investigate the prognostic value of baseline imaging features for overall survival (OS) and liver decompensation (LD) in patients with hepatocellular carcinoma (HCC). Design Patients with advanced HCC from the SORAMIC trial were evaluated in this post hoc analysis. Several radiological imaging features were collected from baseline computed tomography (CT) and magnetic resonance imaging (MRI) imaging, besides clinical values. The prognostic value of these features for OS and LD (grade 2 bilirubin increase) was quantified with univariate Cox proportional hazard models and multivariate Least Absolute Shrinkage and Selection Operator (LASSO) regression. Results Three hundred and seventy-six patients were included in this study. The treatment arm was not correlated with OS. LASSO showed satellite lesions, atypical HCC, peritumoral arterial enhancement, larger tumour size, higher albumin–bilirubin (ALBI) score, liver–spleen ratio <1.5, ascites, pleural effusion and higher bilirubin values were predictors of worse OS, and higher relative liver enhancement, smooth margin and capsule were associated with better OS. LASSO analysis for LD showed satellite lesions, peritumoral hypointensity in hepatobiliary phase, high ALBI score, higher bilirubin values and ascites were predictors of LD, while randomisation to sorafenib arm was associated with lower LD. Conclusions Imaging features showing aggressive tumour biology and poor liver function, in addition to clinical parameters, can serve as imaging biomarkers for OS and LD in patients receiving sorafenib and selective internal radiation therapy for HCC.


2021 ◽  
Vol 3 (10) ◽  
Author(s):  
Brendan Ryu ◽  
Deepak Khatri ◽  
Avraham Zlochower ◽  
Stephen Maslak ◽  
Randy S. D’Amico

Introduction. Brain abscesses can lead to a diverse array of complications, especially when they are polymicrobial in nature. Multiple underlying pathogens may present with a unique set of clinical symptoms which require an early identification and treatment. Skull base osteomyelitis with sellar floor erosion and pituitary involvement with SIADH are such rare complications of brain abscesses which have never been reported previously in the literature. Case Presentation. We report the case of an immunocompetent 38-year-old male with altered mental sensorium and left hemiparesis due to polymicrobial brain abscess which required surgical evacuation. The post-operative recovery was complicated by severe hyponatremia secondary to SIADH which was treated uneventfully. Radiological imaging demonstrated pituitary enlargement with herniation through an eroded sella turcica without active CSF leak. Patient responded well to the antibiotic therapy based on microbiological susceptibility testing with a complete resolution of the pituitary enlargement on radiological follow-up. Conclusion. Conservative treatment with targeted antibiotics can lead to the resolution of pituitary enlargement secondary to a brain abscess. However, a close clinical follow-up is required to look for a CSF leak considering the sellar floor erosion due to osteomyelitis.


2021 ◽  
pp. 014556132110534
Author(s):  
Min-Sik Kim ◽  
Minhyung Lee ◽  
Jin-Choon Lee ◽  
Eui-Suk Sung

Epidermoid cysts are generally benign lesions surrounded by squamous epithelium with cystic contents. The lining of the cysts produce keratin, which resemble a cheese-like material. They typically occur in the skin and mucous membranes and are congenital in origin; iatrogenic epidermoid cysts are rare. Epidermoid cysts are usually painless and asymptomatic, and their diagnosis is based on histological examination. This paper aims to present the case report of a 23-year-old patient with an iatrogenic epidermoid cyst that occurred following tracheostomy. The importance of preoperative radiological imaging in the diagnosis of epidermoid cysts is also highlighted.


2021 ◽  
Vol 12 ◽  
Author(s):  
Lijun Xu ◽  
Handan Zhao ◽  
Minghan Zhou ◽  
Guanjing Lang ◽  
Haiyan Lou

Background: The clinical relevance of single or repeated episodes of Candida spp. in cerebrospinal fluid (CSF) in adult patients is debatable.Methods: Forty-two patients with positive Candida episodes in CSF were enrolled in this retrospective study.Results: A total of 42.9% (18/42) were determined to have probable Candida meningitis (PCM). Neurosurgery [odds ratio (OR) (95% confidence interval), OR: 14.4 (1.6–126.1), P = 0.004], lumbar drainage [OR: 5.8 (1.5–23.3), P = 0.009], VP shunt [(OR: 5.6 (1.2–25.8), P = 0.020)], external ventricular drainage [OR: 4.7 (1.3–17.7), P = 0.018], CRP ≥ 10.0 mg/L [OR: 4.9 (1.3–18.1), P = 0.034], and postsurgical broad-spectrum antibiotics [OR: 9.5 (1.8–50.5), P = 0.004] were risk factors associated with PCM. A single CSF Candida episode for the diagnosis of PCM had 7.7% (0.4–37.9%) sensitivity and 20.7% (8.7–40.3%) specificity, whereas repeated episodes of Candida had 66.7% (41.2–85.6%) sensitivity and 95.8% (76.9–99.8%) specificity. No significant difference was found in radiological imaging or CSF profiles between PCM and non-PCM patients. A total of 37.5% (9/24) of patients without PCM received empirical antifungal treatment, and 88.9% (16/18) of patients with PCM received preemptive antifungal treatment. PCM patients had hospitalized mortality rates of 50.0% (9/18). The odds ratio of mortality was 23.0 (2.5–208.6) for PCM patients compared with non-PCM patients (P = 0.001).Conclusion: Both single and repeated positive CSF samples have low validity for the diagnosis of PCM, suggesting that novel strategies for diagnosis algorithms of PCM are urgently needed. Empirical antifungal treatment should be started immediately for suspicious patients with risk factors.


2021 ◽  
Vol 11 ◽  
Author(s):  
Cristina Gurizzan ◽  
Rebecca Pedersini ◽  
Carla Fornaro ◽  
Chiara Sardini ◽  
Manuel Zamparini ◽  
...  

ObjectiveTo evaluate the efficacy of clinical triage of oncological patients for safe continuation of cancer therapy implemented during the first SARS-CoV-2 outbreak.MethodsBetween 25 February and 21 April 2020, patients attending the Medical Oncology Unit, Spedali Civili Hospital, Brescia (Italy) for cancer therapy underwent triage to identify those with no signs and symptoms suspicious for SARS-CoV-2 infection in which antineoplastic treatment could be continued as scheduled. Triage questions investigated common symptoms (e.g., fever, cough, dyspnea, anosmia, dysgeusia, headache, nasal congestion, conjunctival congestion, sore throat, diarrhea, nausea and vomiting); body temperature and pulse oximetry were also recorded. All patients were followed-up for overt SARS-CoV-2 through to 18th May 2020.ResultsOverall, 1180 patients (median age 65 years) underwent triage during the study period. The most frequent primary malignances were breast (32%), gastrointestinal (18%), and lung (16.5%) cancer. Thirty-one (2.5%) presented with clinically evident SARS-CoV-2 infection and tested positive on nasopharyngeal swab testing and/or radiological imaging. Triage identified 69 (6%) grey zone patients with symptoms suspicious for SARS-CoV-2; 5 (7.2%) subsequently developed symptomatic disease. Neither the symptomatic nor the grey zone patients received their scheduled treatment; instead, they were referred for hospitalization or home quarantine.ConclusionTriage of oncological patients at our Unit provided for safe continuation of scheduled cancer treatment in 91.5% of patients during the initial SARS-CoV-2 outbreak.


2021 ◽  
Author(s):  
Sook-Yoong Chia ◽  
Ashwati Vipin ◽  
Kok-Pin Ng ◽  
Haitao Tu ◽  
Ananth Bommakanti ◽  
...  

Abstract Background: There is an urgent need for non-invasive, cost-effective biomarkers for Alzheimer’s disease (AD), such as blood-based biomarkers. It is not only to support clinical diagnosis of dementia, but also to allow for timely pharmacological and non-pharmacological interventions evaluation. The aim of this study is to identify and validate a novel blood-based microRNA (miRNA) biomarker for dementia of Alzheimer’s disease type (DAT). The miRNA correlations with AD pathology and AD clinical-radiological imaging were conducted.Methods: We conducted miRNA-sequencing (miRNA-Seq) using peripheral blood mononuclear cells (PBMCs) isolated from a discovery cohort comprising DAT, mild cognitive impairment (MCI), and healthy subject (HS). Identified miRNA was validated in an independent cohort. Correlation analysis evaluated the relationships between miRNA expression and DAT clinical measures, including Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores, CSF Aβ1-42 and tau levels, and AD pattern cerebral atrophy. Furthermore, we conducted bioinformatics analysis and cell-based assay to identify miRNA target genes. Results: MiRNA-seq identified a distinct miRNA (miR-328-3p, miR-7706, and miR-150-5p) expression signature differentiating DAT from MCI and HS. qPCR analysis reveals that miR-150-5p was consistent with the miRNA-seq data and was further validated. Specifically, we found that miR-150-5p expression was significantly upregulated in DAT compared to MCI and HS, and discriminated DAT from MCI and HS with a high accuracy with AUC of 0.86 and 0.86, respectively. We further found that higher miR-150-5p levels correlated with clinical measures of DAT, including lower global cognitive scores of MMSE and MoCA, lower CSF Aβ1-42, and higher CSF tau. Interestingly, we observed that higher miR-150-5p levels is associated with the lower grey matter volumes in the medial temporal lobe, posterior cingulate cortex and precuneus. These regions implicated default mood network and executive control network regions that are important for AD brain atrophy. Furthermore, pathway analysis identified the targets of miR-150-5p to be enriched in the Wnt signalling pathway, including programmed cell death 4 (PDCD4). We further found that PDCD4 was downregulated in DAT blood and was downregulated by miR-150-5p at both transcriptional and protein levels.Conclusions: Our findings demonstrated that miR-150-5p is a reliable clinical blood-based biomarker for DAT.


2021 ◽  
Author(s):  
Şeref Barbaros Arik ◽  
Elif Gunaydin ◽  
Celal İsmail Bİlgiç ◽  
İnanç Güvenç

Objective: In this study, we aimed to emphasize the role of radiological imaging in determining the treatment of a patient, who tested positive for COVID-19 and diagnosed with acute appendicitis during the pandemic. Methods: A 31-year-old patient presented to the emergency department due to abdominal pain. Ultrasound examination, thoracic and pelvic CT scan were performed. Results: Non-complicated appendicitis can be treated conservatively with antibiotics. Treatment can be maintained by starting with IV antibiotics and bridging therapy with oral antibiotics. Conclusion: This study aims to summarize how radiological follow-up can be used to decide on the suitability of the patient for appropriate medical treatment as an alternative to surgery in a patient, whose gold standard treatment is emergency surgical intervention, which is frequently encountered in the emergency department during the COVID-19 pandemic.


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