Correlation between the initial CT chest findings and short-term prognosis in Egyptian patients with COVID-19 pneumonia

Background The recent pandemic of COVID‐19 has thrown the world into chaos due to its high rate of transmissions. This study aimed to highlight the encountered CT findings in 910 patients with COVID-19 pneumonia in Egypt including the mean severity score and also correlation between the initial CT finding and the short-term prognosis in 320 patients. Results All patients had confirmed COVID-19 infection. Non-contrast CT chest was performed for all cases; in addition, the correlation between each CT finding and disease severity or the short-term prognosis was reported. The mean age was higher for patients with unfavorable prognosis (P < 0.01). The patchy pattern was the most common, found in 532/910 patients (58.4%), the nodular pattern was the least common 123/910 (13.5%). The diffuse pattern was reported in 124 (13.6%). The ground glass density was the most common reported density in the study 512/910 (56.2%). The crazy pavement sign was reported more frequently in patients required hospitalization or ICU and was reported in 53 (56.9%) of patients required hospitalization and in 29 (40.2%) patients needed ICU, and it was reported in 11 (39.2%) deceased patients. Air bronchogram was reported more frequently in patients with poor prognosis than patients with good prognosis (16/100; 26% Vs 12/220; 5.4%). The mean CT severity score for patients with poor prognosis was 15.2. The mean CT severity score for patients with good prognosis 8.7., with statistically significant difference (P = 0.001). Conclusion Our results confirm the important role of the initial CT findings in the prediction of clinical outcome and short-term prognosis. Some signs like subpleural lines, halo sign, reversed halo sign and nodular shape of the lesions predict mild disease and favorable prognosis. The crazy paving sign, dense vessel sign, consolidation, diffuse shape and high severity score predict more severe disease and probably warrant early hospitalization. The high severity score is most important in prediction of unfavorable prognosis. The nodular shape of the lesions is the most important predictor of good prognosis.

TYPICAL AND ATYPICAL PRESENTATION OF COVID-19 INFECTION IN CHILDREN IN THE TOP OF PANDEMIC IN MINIA GOVERNORATE (TWO CENTER EXPERIENCE)

Back ground: A novel coronavirus which is identified as cause of pandemic situation inFebruary2020 and affecting adult and children with variable presentation and outcome. Objective: We studied the typical and atypical clinical and laboratory presentation of COVID-19 during the peak of the first wave in two main referral hospitals, upper Egypt El Minya governorate. Methods: Among 88 children with suspected cases tested for COVID-19, only 22 who proved to be positive. Studied patients were classified into 3 groups based on age. The first group 2–5years,the second for 5–10years and the third one included those aged more than 10 years. All patients met diagnostic guidelines established by Egyptian Ministry of health. Results: out of the positive 22 (25%) patients, 13(59.1%) of them were male, while 9 (40.9%) were females. All enrolled patients have a history of near contact exposure (100%). Thrombocytopenia was the highest presenting symptom in all enrolled patients18(81.8%), while other hematological findings were anemia in 11 (50%), thrombotic symptoms in 2(9.1%), pancytopenia in 2(9.1%) while bleeding was found in 1 patient (4.5%) .Fever 16 (72.7%) the common constitutional symptoms in COVID-19 were not reported in all enrolled patients (0%) while sore throat was reported in only 2 patients (9.1%).Respiratory presentation was only dominant in positive chest CT finding rather than clinical symptoms 17(72.3%) GIT symptom were the dominant presenting feature as vomiting was found in 15 (68.2%), diarrhea in 10 (45.5%), abdominal pain in 11 (50%), jaundice in 9 (40.9%) and dehydration in 6 (27.3%).Neurological symptoms were convulsions in 4(18.2%) while encephalopathy was 2(9.1%).Nephritis was the only renal presentation in the enrolled patients3 (13.6%).Cardiac presentations were only cyanosis 8 (36.4%) and arrhythmias 6 (27.3%) Conclusion: COVID-19 has many clinical classic presentation in children however other non-typical presentation like hematological. CNS and renal presentation has been reported.

Examination of clinical conditions and chest CT images of Covid-19 cases in Turkey; single center study

Background: In this study, we aim to study the clinical features and chest CT findings of the patients, COVID-19 diagnosis of which are verified. Methods: This retrospective study was conducted on RT-PCR (+) COVID-19 patients who were examined in our hospital's emergency department between March 11, 2020 and June 30, 2020. Results: 326 patients were included in this retrospective study in total. Of the patients, 53.1% and 46.9% are males and females, respectively. The patients applied to the service with the symptoms of shortness of breath at the rate of 21.8% and cough at the rate of 20.6%. The study found that the most frequent abnormal CT finding is ground glass opacity at the rate of 26.7% and it is followed by atelectasis at the rate of 12.3%. Patients in the> 65 age group and patients with COPD comorbidities have significantly higher rates of admission to the intensive care unit. Conclusions: The most frequent findings in examination of pathological chest CT findings are ground glass opacity. The rate of length of intensive care unit stay and mortality is significantly higher in the patients above 65 years old compared to those below 65 years old. Keywords: COVID-19; SARS-CoV-2; Chest CT; Ground Glass Opacity; Dyspnea; Cough

Bone metastases with post-treatment intralesional fatty content of the spine: imaging features from T1-weighted imaging with CT finding correlations

Background Despite post-treatment intralesional fatty content (PIFAT) in bone metastases indicating a healing processes after treatment, the imaging features of PIFAT have not been studied in detail. Purpose To analyze imaging features from T1-weighted (T1W) imaging with computed tomography (CT) finding correlations in bone metastases with PIFAT of the spine. Material and Methods A total of 29 bone metastases with PIFAT were analyzed with T1W and CT images before and after treatment. On T1W imaging after treatment, the lesions were categorized into three types according to fat distribution patterns. CT attenuation changes after treatment were also evaluated. According to the MD Anderson (MDA) criteria, response types for all lesions were obtained on magnetic resonance (MR) and CT images. Results The types from T1W imaging in bone metastases with PIFAT were as follows: 14 with a return to totally normal marrow signal intensity within the lesion; 13 with an inhomogeneous patchy pattern in the lesion; and two with a peripheral halo of fatty marrow or peripheral fat signal intensity foci in the lesion. Among bone metastases with PIFAT, 93.1% showed osteosclerotic changes in this study. According to the MDA criteria, the concordance between the response types of the MR and CT images was 57.2%. Conclusion Knowledge of imaging features from T1W imaging with CT correlation in bone metastases with PIFAT is important for the accurate interpretation of post-treatment MR and CT studies. Both MR and CT images have a complementary value regarding the post-treatment evaluation of bone metastases with PIFAT.

Demographic and Clinical Features Associated with in-Hospital Mortality in Egyptian COVID-19 Patients: A Retrospective Cohort Study

Aim: We evaluated in this study the demographic and clinical characteristics of COVID-19 disease in Egyptian population with special consideration for its mortality predictors. Methods: 8162 participants (mean age 48.7±17.3 years,54.5% males) with RT-PCR positive COVID-19 were included. The electronic medical records were reviewed for demographic, clinical, laboratory, and radiologic features. The primary outcome was the in-hospital mortality rate. Results: The in-hospital mortality was 11.2%. There was a statistically significant strong association of in-hospital mortality with age >60 years old (OR:4.7; 95% CI 4.1-5.4;p<0.001), diabetes mellitus (OR:4.6; 95% CI 3.99-5.32;p<0.001), hypertension (OR:3.9; 95% CI 3.4-4.5;p<0.001), coronary artery disease (OR:2.7; 95% CI 2.2-3.2;p<0.001), chronic obstructive pulmonary disease (OR:2.1; 95% CI 1.7-2.5;p<0.001), chronic kidney disease (OR:4.8; 95% CI 3.9-5.9;p<0.001), malignancy (OR:3.7; 95% CI 2.3-5.75;p<0.001), neutrophil-lymphocyte ratio >3.1 (OR:6.4; 95% CI 4.4-9.5;P< 0.001), and ground glass opacities (GGOs) in CT chest (OR:3.5; 95% CI 2.84-4.4;P<0.001), respectively. There was a statistically significant moderate association of in-hospital mortality with male gender (OR:1.6; 95% CI 1.38-1.83;p<0.001) and smoking (OR:1.6; 95% CI 1.3-1.9;p<0.001). GGOs was reported as the most common CT finding (occurred in 73.1% of the study participants). Conclusion: This multicenter, retrospective study ascertained the higher in-hospital mortality rate in Egyptian COVID-19 patients with different comorbidities.

How Often MRI Would Change the Fracture Classification or Decision-making in Thoracolumbar Fractures Compared to CT Alone?

Introduction: This study aimed at analyzing the frequency and predictor of the change in classification of TLFs after performing MRI compared with CT alone. Methodology: This retrospective review included 235 consecutive patients with acute TLFs (T1-L5) who presented at a single level-1 trauma center between 2014 and 2021 and underwent both CT and MRI. Patients with translation injury, neurologic deficit, or osteoporotic fracture were excluded. Three reviewers independently classified all fractures according to AOSpine and Thoracolumbar Injury classification (TLISS) by CT and then MRI. A fourth reviewer only looked at the MRI images. Posterior ligamentous complex Injury was diagnosed on CT and MRI by two positive CT findings and black stripe discontinuity. Mc-Nemar test was used to evaluate the difference in the proportions of AO type A and B. Result: The AO classification by CT was type A in 181 patients (77%) and type B in 54 patients (23%). The addition of MRI after CT changed AO classification in 25/235 patients (10.6%, P < 0.0001) due to an 8.5% (20/235) upgrade from type A to type B and 2.1% (5/235) downgrade from type B to type A. When PLC injury in CT was defined by one positive CT finding and in MRI by high signal intensity, it significantly increased the rate of fracture reclassification by MRI compared to default analysis (22% and 33% vs 11%, respectively; P < 0.0001). The best predictor of upgrade from type A to type B and downgrade from type B to type A was a single positive CT finding, and the presence of only two CT signs as opposed to three signs, respectively (reclassification rate 26% vs 4.6%, P < 0.0001 and 17% vs 0%, P = 0.03, respectively). Thoracic and thoracolumbar fractures showed a significantly higher reclassification rate than low lumbar (20% and 10% vs 0%, respectively, P = 0.07). Conclusion: Using appropriate CT/MRI criteria of PLC injury, the rate of fracture reclassification by MRI can be as low as 10%. The use of alternative CT/MRI criteria or inaccurate image interpretation could significantly increase the rate of fracture reclassification up to 20–30%. The rate of change of fracture classification by MRI could be predicted by the number of positive CT findings on CT or fracture level.

Differentiation Between the Aalignant Mesothelioma of Pleura and Pleural Metastasis with Contrast Enhanced CT, Is It Possible?

Objective: To compare CT findings between malignant pleural mesothelioma (MPM) and metastatic pleuraldisease (MPD).Materials and Methods: CT chest images of 157 cases of pathologically-proven malignant pleural disease(21 MPM, 136 MPD) were retrospectively reviewed by two radiologists who were blinded to the diagnosis. Findingsof interest included pleural effusion, pleural thickening, organ invasion, lymphadenopathy, dominant lung nodule,pulmonary or extra-thoracic organ metastasis, and asbestos-related disease.Results: Findings commonly found in MPM compared with MPD are circumferential pleural thickening (52.4%vs 14.0%, p<0.001), pleural mass (33.3% vs 7.4%, p<0.001), organs invasion (57.1% vs 9.6%, p<0.001), and asbestosrelated disease (19% vs 0%, p<0.001).Conclusions: Circumferential pleural thickening, pleural mass, presence of organ invasion, and CT finding ofasbestos-related pleural disease were the CT findings that raise the possibility of MPM.

The “K-Sign”—A Novel CT Finding Suggestive before the Appearance of Pancreatic Cancer

Pancreatic invasive ductal adenocarcinoma (PDAC) has a poor prognosis, and the detection of PDAC during the early stage is thought to improve prognosis. In this study, we retrospectively investigated pancreatic morphological abnormalities that lead to the early diagnosis of PDAC with computed tomography (CT) imaging. In total, 41 out of 308 patients diagnosed with pancreatic cancer between 2011 and 2017 in our institution were enrolled. As a control group for the group with pancreatic cancer, 4277 patients without pancreato-biliary diseases were enrolled. We retrospectively reviewed and analyzed the clinical data including patient characteristics, the clinical course and preoperative CT imaging with pancreatic morphological features. Out of 41 patients, 24 patients (58.5%) showed local K-shaped constriction of the pancreatic parenchyma “K-sign” on preoperative CT images. Eight patients (19.5%) showed localized fatty change. Out of 4277 control patients, seven patients (0.16%) showed K-sign. “K-sign” may be used for the early diagnosis of PDAC by CT imaging.