The time course of chest computed tomography (CT) scan changes during recovery from COVID-19 has been described (1Yang X. Yu Y. Xu J. et al.Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study.Lancet Respir Med. 2020; Abstract Full Text Full Text PDF Scopus (6892) Google Scholar). Previous studies using repeat chest CT scans have shown that different stages could be presumed for changes in CT scan findings (2Pan F. Ye T. Sun P. et al.Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia.Radiology. 2020; 200370Crossref PubMed Scopus (1844) Google Scholar). In the early course of COVID-19 pneumonia, pulmonary CT scans could either be normal or show subtle findings. The initial CT findings in patients include bilateral, multilobar ground glass opacification with a peripheral or posterior distribution, most commonly in the lower lobes and less frequently in the middle lobe. These changes mainly occur during the early stage of disease, which is 0–4 days after the onset of initial symptoms (3Salehi S. Abedi A. Balakrishnan S. et al.Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients.Am J Roentgenol. 2020; : 1-7Crossref PubMed Scopus (998) Google Scholar). In the progressive stage (days 5–8), crazy-paving pattern, extension of ground glass opacification, and the initial development of consolidation are the main radiologic features on CT. In the peak stage (days 9–13), dense consolidations become more prevalent and the air bronchogram sign is seen more commonly. Finally, in the absorption stage (14 days or more after the onset of initial symptoms) after the patients have recovered and the infection is controlled, consolidations gradually absorb. No crazy paving is evident at this stage, while fibrotic streaks, tractional bronchiectasis, bronchus distortion, and subpleural fibrotic lines become more prominent (2Pan F. Ye T. Sun P. et al.Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia.Radiology. 2020; 200370Crossref PubMed Scopus (1844) Google Scholar). Recently, the Fleischner Society published a consensus about the role of chest imaging (mainly CT scan) in patient management during the COVID-19 pandemic and discussed different clinical scenarios, including the severity of respiratory disease, pretest probability, risk factors for disease progression, and critical resource constraints. The results were then aggregated, resulting in recommendations intended to provide guidance for medical practitioners in the use of CXR and CT in COVID-19 management (4Rubin G.D. Ryerson C.J. Haramati L.B. et al.The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement from the Fleischner Society.Chest. 2020; Abstract Full Text Full Text PDF PubMed Scopus (517) Google Scholar).They clearly stated the indications of using chest imaging during the COVID-19 pandemic; however, as far as we are concerned, there is currently no general consensus regarding the role of repeat chest imaging (CT scan) in patients suspected, diagnosed or treated as COVID-19. In February 2020, with the increasing number of cases diagnosed with the novel COVID-19 and the fear of a serious outbreak in Iran, a central committee was established on behalf of the Iranian Radiology Society to provide consultations for physicians dealing with known or suspected cases of COVID-19. To reach this goal, the radiologic imaging (including both chest X-ray and chest CT scan) of all patients are collected from across the country and sent to this group via social media or Picture Archiving and Communication system. After interpretation of the imaging findings by a group of experienced academic radiologists (Iranian Society of Radiology COVID-19 Consultant Group), reports are integrated to reach a final conclusion (5Mahdavi A. Khalili N. Davarpanah A.H. et al.Radiologic management of COVID-19: preliminary experience of the Iranian Society of Radiology COVID-19 Consultant Group (ISRCC).Iranian J Radiol. 2020; (In Press)Crossref Scopus (57) Google Scholar,6Davarpanah A.H. Mahdavi A. Sabri A. et al.Novel screening and triage strategy in Iran during deadly Coronavirus disease 2019 (COVID-19) epidemic: value of humanitarian teleconsultation service.J Am Coll Radiol. 2020; Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar).Until now, we have offered consultation on more than 3000 chest imaging reports from COVID-suspected patients. According to our experience during the last 2 months of disease outbreak in Iran, we observed that some patients may benefit from repeat CT scan; however, number of repeat chest CT scan should be minimized and we need local expert consensus regarding indications of repeat chest CT scan in each health care system. Herein, we propose some of the potential indications for repeat CT scan in the COVID-19 pandemic. Note that these proposed indications should be approved in larger global consensus before routine clinical use:1-Worsening of respiratory symptoms in outpatients or hospitalized patients: The natural course of COVID-19 pneumonia varies greatly from patient to patient; occasionally during patient management we are confronted with worsening of the respiratory status of patients or treatment resistant hypoxia lasting for few days. Clearly, in addition to clinical and laboratory examinations, repeat chest CT could be very helpful in searching for complications of COVID-19 pneumonia (7Sun R. Liu H. Wang X. Mediastinal emphysema, giant bulla, and pneumothorax developed during the course of COVID-19 pneumonia.Korean J Radiol. 2020; 21Crossref Scopus (210) Google Scholar). Also signs and symptoms of suspected pulmonary emboli or superimposed bacterial infection could be a proper indication to repeat chest CT scan.2-Patients clinically suspected to have moderate-to-severe COVID-19 infection with negative RT-PCR results and normal or subtle nonspecific findings on initial chest CT scan: Due to the low sensitivity of the time-consuming PCR test, patients who have moderate-to-severe symptoms but a normal chest CT scan, which is not unusual in the first 4 days of the disease, could benefit from repeat CT scan after 4 days from symptom onset (8Ai T. Yang Z. Hou H. et al.Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases.Radiology. 2020; 200642Crossref PubMed Scopus (3880) Google Scholar). Such patients include elective surgery candidates, cancer patients who are waiting for chemoradiation therapy, and those who need to be quarantined as soon as possible.3-High-risk hospitalized patients with comorbidities, such as malignancies, need close observation to detect early changes, which may require advanced health care support, such as an ICU admission, due to the high mortality rates in these patients. We proposed that a timely repeat chest CT scan may be beneficial in these high-risk patient groups.4-Post-treatment and postquarantine: We believe that chest CT scans could be helpful in evaluating pulmonary complications in recovered individuals.5-Assessment of treatment response: Long-term repeat chest CT scans should be considered in clinical trials of patients treated with off-label drugs.6-Inconsistency between clinical symptoms and imaging findings: Repeat chest CT could be helpful in investigating other comorbidities or complications.7-Individuals with a compromised immune system: Recent data has shown that these patients might be subject to a longer incubation period and thus, performing a repeat chest CT scan might be useful before considering the use of invasive therapies (9Yang J. Zheng Y. Gou X. et al.Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis.Int J Infect Dis. 2020; Abstract Full Text Full Text PDF Scopus (2676) Google Scholar).8-Research purposes: For the follow-up of post-COVID infection complications and patients' pulmonary status.
ackground and aims: Congenital heart disease (CHD) is described as an abnormality in the heart structure or intra-thoracic great vessels that leads to functional problems. Since most of these disorders require medical and surgical interventions identifying concomitant disorders such as renal and urinary tract abnormalities is of great importance in the management of these patients. The present study aimed to investigate the relative frequency of abnormal kidney and urinary tract findings in abdominal cineangiography during cardiac catheterization of patients with CHD in Shahid Modarres Cardiovascular Medical and Research Center.The present study was performed prospectively on 545 patients aged < 18 years with CHD who underwent cardiac catheterization and concurrent abdominal cineangiography in Shahid Modarres Cardiovascular, Medical and Research Center, Tehran, Iran during a three-year period. The required data were extracted using a researcher-made questionnaire from patients' electronic medical files.Of a total of 545 patients in this study, 26 had both CHD and renal or urinary tract malformation. Patent ductus arteriosus was the most common CHD in patients with renal or urinary tract malformations (odds ratio: 1.2, 95%, CI: 2.25-11.63). In this study, the most common renal and urinary malformations among CHD patients was partial duplication of the kidney followed by Ureteropelvic Junction Obstruction.Since the prevalence of renal and urinary tract malformations is higher in CHD patients, performance of concurrent abdominal cineangiography during cardiac catheterization may lead to early diagnosis and treatment as well as better pre- and post-operative management of patients.
Background. Many insurance companies require obese patients to lose weight prior to gastric bypass. From a previous study by the same authors, preoperative weight at surgery is strongly predictive of weight loss up to one year after surgery. This review aims to determine whether preoperative weight loss is also correlated with weight loss up to one year after surgery. Methods. Of the 186 results screened using PubMed, 12 studies were identified. A meta-analysis was performed to further classify studies (A class, B class, regression, and rejected). Results. Of all 12 studies, one met the criteria for A class, six were B class, four were regression, and one was rejected. Six studies supported our hypothesis, five were inconclusive, and no study refuted. Conclusions. Preoperative weight loss is additive to postsurgery weight loss as predicted from the weight at the time of surgery.
The Mesopotamian Spiny-tailed Lizard Saara loricata (Blanford, 1874) (Figure S1) is distributed in Iran and Iraq (Papenfuss et al., 2009). In Iran it is found in the Bushehr, Fars, Kohgiluyeh and B...
Risk stratification in COVID -19 629 the COVID -19 mortality risk to be 3.4%.2 The median time from symptom onset to radiological confirmation of this viral pneumonia is 5 days, whereas the median time from symptom onset to ICU admission is approximately 9.5 days. 3To identify predictors of clinical outcomes in patients with COVID -19 is essential in helping healthcare facilities in pandemic planning and INTROduCTION Coronavirus disease 2019 (COVID -19), caused by the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS -CoV -2), has recently been announced a global pandemic by the World Health Organization. 1 This infection can lead to severe respiratory distress requiring intensive care unit (ICU) admission.The World Health Organization estimated
This prospective study tested the hypothesis that the apparent diffusion coefficient (ADC) value and tumor volume (TV) measured in diffusion-weighted magnetic resonance imaging (DW-MRI) before, during, and after the treatment are quantitative imaging markers to assess tumor response in muscle-invasive bladder cancer (MIBC) patients undergoing neoadjuvant chemotherapy (NAC). Multi-parametric MRI was prospectively done for MIBC patients at 3 time points. Pre-treatment ADC value, pre-treatment TV, as well as, percent of changes (ΔADC%, and ΔTV%) in these parameters at mid- and post-treatment relative to baseline were calculated and compared between the patients with and without clinical complete response (CR). Also, further analysis was carried out based on the groups of patients with and without overall response (OR). Two different methods of ADC estimation including single-slice ADC measurement (ADCsingle-slice) and whole-lesion ADC measurement (ADCwhole-lesion) were used. A total of 50 eligible patients were included in the analysis. Of these, 20 patients (40%) showed clinical CR to treatment, while 30 (60%) did not. Our results showed that although there was no significant difference between the two groups of patients with and without CR in terms of mid-treatment ΔADC% and mid-treatment ΔTV%, significant differences were observed in terms of the pre-treatment ADC (p < 0.01), pre-treatment TV (p < 0.001), post-treatment ΔADC% (p < 0.05), and post-treatment ΔTV% (p < 0.05). The results of the OR-based analysis were in line with the CR-based results. There was also a strong and significant correlation between ADCsingle-slice and ADCwhole-lesion measurements (r > 0.9, P < 0.001). Pre-treatment ADC, pre-treatment TV, post-treatment ΔADC%, and post-treatment ΔTV% could be considered as promising quantitative imaging markers of tumor response in MIBC patients undergoing NAC. Moreover, mid-treatment ΔADC% and mid-treatment ΔTV% should not be used as predictors of tumor response in these patients. Further larger studies are required to confirm these results.
Abstract Background: Different clinical and radiologic factors predict poor outcomes in patients with Coronavirus Disease 2019 (COVID-19). Thus, we aimed to investigate the performance of two separate clinical and radiologic (CT) scoring systems in detecting the prognosis of patients with COVID-19 using a low-dose protocol for CT imaging. Methods: Eighty-six patients with confirmed COVID-19 were included in this prospective study. All patients underwent low-dose chest CT at the initial workup. By evaluating the extent of lung involvement on patients’ initial CT scan, scores from 0 to 4 were assigned to the five lobes and the lingula. Clinical score was based on the following factors: age, sex, presence of comorbidities, respiratory rate, and oxygen saturation. After at least 15 days of follow-up, the disease outcome was classified as either severe (intensive care unit admission, intubation, or death) or favorable. ROC analysis was used to evaluate the ability of each scoring system to predict patients' outcomes. Results: After follow-up, 80.2% and 15.1% of cases had developed favorable and severe outcomes (respectively), and 4.7% were lost to follow-up. Those with severe outcomes had a significantly higher clinical score and CT score than patients with favorable outcomes (p < 0.001 and p= 0.012, respectively). The intra-class correlation coefficient value for the CT score was 0.95. The optimal threshold of the CT score for identifying patients with severe outcomes was 7.5 (area under curve= 0.721) with 77% sensitivity and 65% specificity; the clinical score cut-off was 9.25 (area under curve= 0.832) with 92.3% sensitivity and 72.1% specificity. Conclusions: Both CT and clinical scoring systems displayed a quick, safe, and objective method for predicting outcomes in patients with COVID-19. However, compared with imaging, stratification of patients based on clinical factors seems to be a stronger predictor of outcome.
Functional magnetic resonance imaging (fMRI) has been widely used for pre-neurosurgical planning and may eventually become a routine pre-surgical imaging modality. The validity of fMRI for clinical application depends on various factors such as proper task selection, correct statistical analysis and threshold setting with appropriate patient cooperation. This study was performed on 40 patients with different types of brain mass lesions or hippocampal sclerosis to assess the role of appropriate patient selection for achieving a reliable fMRI result. Accurate and reproducible fMRI strongly depends on the patient’s cooperation. In this study we observed that a pre-test mock fMRI session held by a radiologist may help to predict which patients are more or less suitable candidates for fMRI.
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