COVID-19
Purpose. The research goal comprises primary analysis of CT examinations results and their interpretation by comparing with the data already available in the literature.
Material and methods. During the period from April 17, 2020 to May 18, 2020, 830 chest CT scans were performed and results of 123 CDs with CT scans made by other institutions were interpreted. Follow-up examinations were carried out every 3–4 days or when clinical presentation changed. At the primary stage, we have analysed in a more detail way a group of 69 patients, who were diagnosed with CT-3 or CT-4 volume of lung damage at least once during hospitalization. The patients underwent PCR analysis three times during hospitalization. Among 69 patients, 34 patients had a positive PCR test at least once, the remaining 35 patients had a clinic, corresponding with this disease.
Results. At the initial examination, ground-glass opacity prevailed, as it was observed in 44 cases (64%), and lung tissue consolidation was observed in 25 cases (36%) in a group of 69 patients. When comparing the two groups, the average age of the patients with consolidation changes was statistically significantly lower than one of the group where ground-glass opacity prevailed – 51.7 and 59.4 years, respectively (p = 0.01) In the group of patients with pulmonary tissue consolidation, there were fewer concomitant diseases, fatal outcomes, positive PCR test results, a shorter hospitalization period, and fewer cases of tocilizumab administration were noted.
At the initial examination the average percentage of pulmonary parenchyma involvement in the group of patients with lung tissue consolidation was higher (63.3%; p = 0.04), follow-up examinations showed c statistically significantly lower average values of the increase in the percentage of involvement of the parenchyma, which acquired negative values after the third CT scan (8.3 after the 2nd CT and −5.2 after the 3rd CT versus 18.5 and 3 in the GGO glass group; p = 0.02 and 0.03, respectively). No visible differences in CT between the period from the onset of the disease and the predominant symptom in CT were revealed. Meanwhile, on the 5th day (the day of the check-up CT examination) the largest number of patients was determined in both groups.
Conclusion. An analysis of our experience during the first month of operation of Covid-19 Hospital is presented. According to our data, the appearance of consolidation at the initial CT examination is probably not related to the period, when the disease has been in progress, and may be associated with a more favorable course of the process.
Aim. This publication is devoted to a brief review of the unresolved questions of medical imaging and treatment of COVID-19.
Materials and methods. The analysis of publications for the first quarter of 2020 on radiation diagnosis and treatment of COVID-19 with an emphasis on morpho-radiological comparisons was performed.
Results. It was established that CT can be used for the initial “sorting” of patients in determining the need and conditions of hospitalization, but in the future, often leads to disagreement among pulmonologists and radiologists in assessing the dynamics of the development of the disease. In most patients with COVID-19, the pathomorphological and radiological patterns indicate the formation of the acute phase of diffuse alveolar damage, transforming into organizing pneumonia with typical CT manifestations. However, to date there are no established opinions on the management of patients with corresponding lung lesions.
Conclusion. The literature data on the peculiarities of the pathomorphological and radiological patterns of COVID-19 COVID-19 justify the advisability of using corticosteroids in the treatment of this disease.
The purpose of the study was the estimation of lung ultrasound examination characteristic in patients with a new COVID-19 virus infection in the infectious Department.
Materials and methods. 52 patients (male 29, middle age 51.2 ± 3.4) with an established coronavirus infection caused by the COVID-19 virus were participated in the research. The severity of the patients’ clinical condition was assessed by the NEWS scale. An ultrasound lungs examination was performed on the 1st day an ESAOTE MyLab 70 (Italy) device with S 3–5 MHz Probe. Ultrasound scanning was performed along the main topographic lines (midthoracic, anterior, middle and posterior axillary, scapular lines in the longitudinal and transverse planes).
Results. Pathological ultrasound signs of lung tissue damage were determined in COVID–19 patients. Multiple B-lines were detected in all patients (100%): in 34 cases – merging B-lines, in 18 cases – scattered B-lines. Changes of the pleural line structure were visualized in all cases: thickening of more than 2 mm – in 33 cases, and discontinuous contours – in 25 cases. Нydrothorax was determined in 39 cases (75%); marginal zones of lung consolidation – in all patients (100%): homogeneous consolidations were observed in 38 cases (73.0%); heterogeneous consolidations (26%) – in 14 cases.
Conclusions. Ultrasound lung scanning is an assistive method viral pneumonia diagnosing caused by the new COVID-19 coronavirus. The method can be applied in clinical situations where there is a mild course of the disease, if it is impossible to perform the research and to monitor patients who are on a ventilator. The advantages of the method include the ability to obtain a dynamic image in online mode, the ability to conduct research in the patient's bed. In addition, ultrasound scanning of lung tissue, in contrast to CT of the lungs, has an advantage in recognizing interstitial lesions and displays the distribution of blood flow in tissues with an assessment of the degree of angiogenesis in inflammatory viral lung lesions.
Purpose of the study. To evaluate the practical significance of MRI in the primary diagnosis of inflammatory lung diseases, as well as in follow-up control of treatment, also in comparison with the results of CT of the chest.
Material and Methods. In 25 patients with acute pneumonia, six of them with acute myocardial infarction developed as complication of it, the MRI of the chest organs was performed in T1 - and T2-weighted (-w.) modes, also with fat signal suppression, with slice thickness of 2.5 to 5 mm, in a matrix of 256 × 256 or 256 ×392 pixels, with a scanning field of view as large as 40 x 40 cm. In T1-w. mode TR = 390–650 ms, TE = 10–15 ms. When T2-w. scanning, respectively, TR = 2900 -4000 ms, TE = 20–25 ms. Paramagnetic contrast enhancement was also carried out in 16 of 24 patients, at a dosage of 0.1 mmol/kg of body weight. Post-contrast images were acquired 12-17 minutes after the introduction of paramagnetic agent. In 17 out of 25 of our patients, chest CT was also performed.
Results. The minimal cross-dimension of focal inflammatory lesions for community-acquired pneumonia, imaged with MRI chest scanning was as little as 9 х 21 mm. The dimensions of lung lesion obtained from the MRI scanning did correlate significantly with results of the CT (r = 0.96, p < 0.001). Also MRI of the lung did prove the successful cure of pneumonia. Also in six cases the MRI verified the acute myocardial infarction occurred as complication of severe pneumonia. Based on the results of MRI of the lungs and chest, the treatment strategy was supplemented in 16 cases and significantly changed in 9 cases.
Conclusion. MRI of the lungs employing the T1- and T2-weighted protocols with fat suppression, diffusionweighted imaging and use of contrast enhancement delivers highly efficient technique of imaging of nodal, segment and lobe inflammation. MRI of the chest should be reasonably employed for diagnosis and follow-up of treatment in hospitals and diagnostic units possessing high- and middle-field MRI scanners able toacquire the images in breath-synchronised mode.
Due to the current epidemiological situation caused by the spread of the new SARS-CoV-2 coronavirus, in March 2020 several Moscow hospitals were completely or partially redesigned to receive patients with community- acquired pneumonia.
Purpose. The aim of the survey is to analyze clinical, laboratory and radiological data in patients with coronavirus infection at the early stages of its spread in Russia, and to clarify diseases for differential diagnosis mainly based on CT evidence.
Materials and methods. We studied data from 21 patients with verified coronavirus infection admitted to the hospital for community-acquired pneumonia. Clinical symptoms, laboratory and physical indicators, as well as typical lung changes on the CT were evaluated.
Results. Major clinical symptoms in coronavirus patients are fever (100%), cough (90.5%), shortness of breath (76.1%). Laboratory indicators showed increases in CRP (85.7%), leukocytosis (66.6%), and LDG (84.6%). According to CT, 95.2% of lung changes involved both sides, and 66.7% occurred in all lung fields. The sign of “ground glass” was observed in a 100% of the cases, its combination with the “paving stone” – in 61,9%, “ground glass” coupled with small areas of consolidations were detected in 33,3% of the cases. Changes such as nodules, cavities and massive areas of consolidation were not identified.
Conclusion. On the basis of our own data we confirmed the main trends of diagnostics and clinical features, which were identified by authors from Asia and Europe, who faced this infection earlier, and also considered important CT characteristics useful for differential diagnosis of coronavirus lung damage and other lung diseases.
Purpose. Review and analysis of the available foreign literature about CT findings in patients with COVID-19 pneumonia after treatment with tocilizumab.
Material and methods. 6 publications were analyzed that were available for the keywords “COVID-19”, “radiology”, “CT”, “tocilizumab”, “cytokine release syndrome”, “interleukin 6”, “IL-6”. Search was limited only to English language manuscripts with no time limit. The literature search was last done on 3rd June 2020.
Results. There is a small number of studies on CT findings of COVID-19 pneumonia during the treatment of actemra (tocilizumab). At the request of “COVID-19”, “radiology”, “CT”, “tocilizumab”, “cytokine release syndrome”, “interleukin 6”, “IL-6” in the database of medical and biological publications “PubMed” on 03.06.2020 can be found only 8 publications that would satisfy the search query. At the time of writing this article we were able to locate only 1 full text articles in English which was the study of CT findings in patients with COVID-19 pneumonia after treatment with tocilizumab. It is important to note that new data is being shared regularly and so far, it consists mostly of pre-prints, case reports, small case series.
Conclusion. After analyzing the available literature, it can be concluded that the majority of authors confirm the positive effect associated with taking tocilizumab, as evidenced by a very rapid improvement in the condition of patients, however, the CT-findings often does not correlate with the clinical course of the disease and does not always show improvement in lung tissue, which should not be regarded as negative dynamics, but as a natural regression of pathological changes in lung tissue.
HEAD
Aim. To study the role of CT perfusion in the differential diagnosis of histological subtypes of supratentorial malignant gliomas and to determine the degree of their malignancy.
Materials and methods. The study included 34 patients (20 men and 14 women, with an average age of 52 years) with newly detected supratenorial glial tumors, who subsequently underwent neurosurgical treatment in the NMIC of neurosurgery with histological verification of the diagnosis. Depending on the histological diagnosis, three groups of patients were identified: 1) anaplastic astrocytomas, 2) glioblastomas, 3) anaplastic oligodendrogliomas.
The CT-perfusion protocol was performed on a 64-slice Optima 660 (GE) scanner and consisted of three separate parts: a low-dose axial CT of the brain with a slice thickness of 5 mm (90 kV), a perfusion protocol performed according to a prolonged scheme, with two consecutive continuous series of scans, and a post-contrast series of CT images in a spiral scanning mode. In addition, all patients underwent an MRI examination (using a Signa Hdxt 3.0 T (GE) MR scanner, in T2, T2-FLAIR, SWAN, DWI, and T1 modes before and after contrast enhancement).
Results. The study demonstrated that anaplastic astrocytomas are characterized by significantly low absolute and normalized hemodynamics parameters (BF, BV, PS) when compared with glioblastomas, and significantly low absolute maximum values of blood flow (BF) and blood volume (BV) when compared with the group of anaplastic oligodendrogliomas. CT perfusion using the normalized permeability index (PS) can reliably differentiate glioblastomas and anaplastic oligodendrogliomas. Perfusion parameters, both absolute and normalized, did not show statistically significant differences in the differential diagnosis of various molecular and genetic subtypes of anaplastic astrocytomas.
Conclusion. CT perfusion using all hemodynamic parameters demonstrated high reliability and efficacy in distinguishing between glioblastomas and anaplastic astrocytomas. Further research is required to evaluate the effectiveness of the method in distinguishing glioblastomas from anaplastic oligodendrogliomas.
Aim: to explore functional connectivity of the normal brain during Stroop test modification and new suggested counting test performance.
Materials and methods. Data were acquired from 18 healthy volunteers who underwent fMRI examination on 3T scanner with Stroop test modification and new suggested counting test used as block paradigms.
Results. Functional connectivity analysis showed involvement of similar regions but with different distribution of positive correlations between them: interhemispheric significant positive correlations during Stroop test modification performance were found between anterior insular cortex, interhemispheric significant positive correlations during counting test performance were found between dorsolateral prefrontal cortices bilaterally and inferior parietal cortices bilaterally. Different distribution of significant correlations could be due to specificity of tasks. Comparative analysis showed significantly higher positive correlations with occipital cortex during Stroop test performance.
Conclusions. Received data allow alternative use of the abovementioned paradigms for executive functions investigation, with preference for counting test paradigm in patients with vision disturbances.
Mild traumatic brain injury (mTBI) is the most common neurological damage in children that's why it is extremely important to identify and analyze biomarkers that can help in predicting patient's treatment and recovery in period of mTBI. Aim of this study is to verify a hypothesis that functional connectivity disturbances between intact cerebellum and DMN nodes are included in symptomatic manifestation of mTBI.
Methods. 28 MR negative patients with mTBI were studied in age from 12 to 17 years (mean age – 14.7 years). The control group consisted of 23 healthy children. All MRI studies wereperformed on a Philips AchievadStream 3.0 T scanner equipped with a 32-channelPhilips dStream head coil. A 4 min rsfMRI gradient-echo echo planar imaging (EPI)sequence was acquired (TR = 3000 ms, echo time (TE) = 30 ms, 80 dynamics withdynamic scan time = 3 s). fMRI data were processed using functional connectivitytoolbox CONN.
Results. No statistically significant differences in correlation strengths between control group and group of patients were detected as a result of DMN analysis. Intergroup seed-basedcorrelation ROI analysis revealed statistically significant (p < 0.05) differencein links between DMN regions and vermis (cerebellum): positive link in control group and negative link in groupof patients.
Conclusions. The revealed changes in DMN neuronal connection and cerebellar regions in acute stage of mTBI patients can be an initial step of damages leading to cognitive deficit which can be developed in future.
ABDOMEN
NEW TECHNOLOGIES IN RADIOLOGY
This article provides an overview of the main literature data of biochemical basics and the clinical application of positron emission tomography, one of the promising technologies of radiation imaging in oncology.
In the final part, the biokinetics of radiopharmaceuticals that display the proliferative activity of malignant cells and the degree of hypoxia in the tumor focus are examined in detail. The results of studies devoted to assessing their effectiveness, the main indications for their use, the features of preparation for the study, as well as promising scientific developments in this industry are presented.
ISSN 2408-9516 (Online)