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Background: As the effects of immunosuppression are not still clear on COVID‐19 patients, we conducted this study to identify clinical and laboratory findings associated with pulmonary involvement in both immunocompromised and immunocompetent patients. Methods: A case‐control of 107 immunocompromised and 107 immunocompetent COVID‐19 patients matched for age and sex with either positive RT‐PCR or clinical‐radiological findings suggestive of COVID‐19 enrolled in the study. Their initial clinical features, laboratory findings, chest CT scans, and short‐term outcomes (hospitalization time and intensive care unit [ICU] admission) were recorded. In addition, pulmonary involvement was assessed with the semi‐quantitative scoring system (0−25). Results: Pulmonary involvement was significantly lower in immunocompromised patients in contrast to immunocompetent patients, especially in RLL (p = 0.001), LUL (p = 0.023), and both central and peripheral (p = 0.002), and peribronchovascular (p = 0.004) sites of lungs. Patchy (p < 0.001), wedged (p = 0.002), confluent (p = 0.002) lesions, and ground glass with consolidation pattern (p < 0.001) were significantly higher among immunocompetent patients. Initial signs and symptoms of immunocompromised patients including dyspnea (p = 0.008) and hemoptysis (p = 0.036), respiratory rate of over 25 (p < 0.001), and spo2 of below 93% (p = 0.01) were associated with higher pulmonary involvement. Total chest CT score was also associated with longer hospitalization (p = 0.016) and ICU admission (p = 0.04) among immunocompromised patients. Conclusions: Pulmonary involvement score was not significantly different among immunocompromised and immunocompetent patients. Initial clinical findings (dyspnea, hemoptysis, higher RR, and lower Spo2) of immunocompromised patients could better predict pulmonary involvement than laboratory findings. [ABSTRACT FROM AUTHOR]

Background. Coronavirus disease 2019 (COVID-19) was initially detected in Wuhan city, China. Chest CT features of COVID-19 pneumonia have been investigated mostly in China, and there is very little information available on the radiological findings occurring in other populations. In this study, we aimed to describe the characteristics of chest CT findings in confirmed cases of COVID-19 pneumonia in an Iranian population, based on a time classification.

BACKGROUND: Diaphragmatic ultrasound is increasingly used to assess patients with Chronic Obstructive Pulmonary Disease (COPD). The present study aims to investigate diaphragmatic dysfunction in COPD patients through a systematic review and meta-analysis. METHODS: In December 2022, The researchers studied four international databases such as Medline/PubMed, ProQuest, ISI/WOS, and Scopus. Joanna Briggs Institute (JBI) checklist was used to review and control the quality of articles. RESULTS: Finally, 6 articles were included in the analysis. Based on the meta-analysis results, forced expiratory volume (FEV1) was significantly lower in COPD patients compared to the control group (Hedges's g= -2.99, 95 % CI -4.78, -1.19; P =0.001). Forced vital capacity (FVC) was significantly lower in COPD patients compared to the control group (Hedges's g= -1.12, 95 % CI -1.91, - 0.33; P =0.005). COPD patients had significantly lower FEV1/FVC than the control group (Hedges's g= -1.57, 95 % CI -2.33, -0.81; P <0.001). CONCLUSION: The present study showed that the diaphragm ultrasound (DUS) method could identify the difference in FEV1, FVC, and FEV1/FVC indices in two groups of COPD patients and healthy people. [ABSTRACT FROM AUTHOR]

The global extent of COVID-19 mutations and the consequent depletion of hospital resources highlighted the necessity of effective computer-assisted medical diagnosis. COVID-19 detection mediated by deep learning models can help diagnose this highly contagious disease and lower infectivity and mortality rates. Computed tomography (CT) is the preferred imaging modality for building automatic COVID-19 screening and diagnosis models. It is well-known that the training set size significantly impacts the performance and generalization of deep learning models. However, accessing a large dataset of CT scan images from an emerging disease like COVID-19 is challenging. Therefore, data efficiency becomes a significant factor in choosing a learning model. To this end, we present a multi-task learning approach, namely, a mask-guided attention (MGA) classifier, to improve the generalization and data efficiency of COVID-19 classification on lung CT scan images. The novelty of this method is compensating for the scarcity of data by employing more supervision with lesion masks, increasing the sensitivity of the model to COVID-19 manifestations, and helping both generalization and classification performance. Our proposed model achieves better overall performance than the single-task (without MGA module) baseline and state-of-the-art models, as measured by various popular metrics. [ABSTRACT FROM AUTHOR]

ract Purpose: We investigated the diagnostic power of texture analysis (TA) performed on MRI (T2-weighted, gadoliniumenhanced, and diffusion-weighted images) to differentiate between focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA). Material and methods: This was a retrospective single-centre study. Patients referred for liver lesion characterization, who had a definitive pathological diagnosis, were included. MRI images were taken by a 3-Tesla scanner. The values of TA parameters were obtained using the ImageJ platform by an observer blinded to the clinical and pathology judgments. A non-parametric Mann-Whitney U test was applied to compare parameters between the 2 groups. With receiver operating characteristic (ROC) analysis, the area under the curve (AUC), sensitivity, and specificity were calculated. Finally, we performed a binary logistic regression analysis. A p-value <0.05 was reported as statistically significant. Results: A total of 62 patients with 106 lesions were enrolled. T2 hyperintensity, Atoll sign, and intralesional fat were encountered more in HCAs, and central scars were more frequent in FNHs. Multiple TA features showed statistically significant differences between FNHs and HCAs, including skewness on T2W and entropy on all sequences. Skewness on T2W revealed the most significant AUC (0.841, good, p < 0.0001). The resultant model from binary logistic regression was statistically significant (p < 0.0001) and correctly predicted 84.1% of lesions. The corresponding AUC was 0.942 (excellent, 95% CI: 0.892-0.992, p < 0.0001). Conclusion: Multiple first-order TA parameters significantly differ between these lesions and have almost fair to good diagnostic power. They have differentiation potential and can add diagnostic value to routine MRI evaluations. [ABSTRACT FROM AUTHOR]

Purpose: Investigations of the hemodynamic changes of the venous system in patients with multiple sclerosis (MS) have shown contradictory results. Herein, the biomechanical parameters of the internal jugular vein (IJV) and common carotid artery (CCA) of MS patients were extracted and compared to healthy individuals. Methods: B-mode and Doppler sequential ultrasound images of 64 IJVs and CCAs of women including 22 healthy individuals, 22 relapsing-remitting multiple sclerosis (RRMS) patients, and 20 primary-progressive multiple sclerosis (PPMS) patients were recorded and processed. The biomechanical parameters of the IJV and the CCA walls during three cardiac cycles were calculated. Results: The IJV maximum and minimum pressures were higher in the MS patients than in the healthy subjects, by 31% and 19% in RRMS patients and 39% and 24% in PPMS patients. The venous wall thicknesses in RRMS and PPMS patients were 51% and 60% higher than in healthy subjects, respectively. IJV distensibility in RRMS and PPMS patients was 70% and 75% lower, and compliance was 40% and 59% lower than in healthy subjects. The maximum intima-media thicknesses of the CCAs were 38% and 24%, and the minimum intima-media thicknesses were 27% and 23% higher in RRMS and PPMS patients than in healthy individuals, respectively. The shear modulus of CCA walls in RRMS and PPMS patients was 17% and 31%, and the radial elastic moduli were 47% and 9% higher than in healthy individuals. Conclusion: Some physical and biomechanical parameters of the CCA and IJV showed significant differences between MS patients and healthy individuals. [ABSTRACT FROM AUTHOR]

This study reports a 43 years-old man diagnosed with piriformis pyomyositis. A literature review was conducted by searching MEDLINE via Pubmed for English language case reports, published from 8 th December 2019 to 20th January 2020. Patients' symptoms, laboratory tests, imaging, treatment, and other comorbidities were evaluated. Thirty-two cases diagnosed with piriformis pyomyositis, of which 21 patients developed piriformis abscess (including one new patient added by us) of which 52.4% were female, and the mean age was 26.98 ± 17.5. The most common manifestations were fever, lower back pain, and limited ambulation with increased ESR, CRP, or leukocytosis. Staphylococcus aureus was the most prevalent (57.14%) pathogen isolated. The authors suggested gynecologic manipulations, muscle overuse, and other co-infections as probable risk factors. However, we fail to find any association between these factors and abscess formation (p>0.05). Piriformis abscess should be regarded as a probable diagnosis in patients with gluteal pain, fever, and limited ambulation that have raised inflammatory markers or leukocytosis. MRI and CT scans are beneficial in diagnosing pyomyositis in early-stage. Full recovery is expected with timely antibiotic and surgical treatments. [ABSTRACT FROM AUTHOR]

Hydatid cyst is one of the predominantly cystic liver lesions and is also a zoonotic disease that is highly endemic in the Mediterranean region. This condition has extensive differential diagnoses, such as hepatic mesenchymal hamartoma, a rare benign hepatic tumor, which commonly occurs in infants and children, and is extremely rare in adults. Its imaging findings vary from a cystic tumor to a solid mass occupying one or both lobes of the liver. We report an unusual case of a purely cystic mesenchymal hamartoma of the liver in a 60-year-old female patient. The patient had been treated with albendazole for several years; however, the final histopathology revealed mesenchymal hamartoma. [ABSTRACT FROM AUTHOR]

Background: The outcome and complications of liver hydatid cyst surgeries with new and old techniques are not well determined. We intended to present the results of operations done for patients with hepatic hydatid cyst in an endemic area. Methods: Data of 112 patients referred and operated for liver hydatid cyst, in Imam Khomeini Hospital complex, Tehran, Iran, from 2015 to 2018, were collected including demographic characteristics, operation parameters and complication related statistics. The variables were presented for different surgical methods including operations with and without omentoplasty. Results: Patients aged 39. 3 ± 13. 9 yr (70 females; 63. 5%). Most frequent clinical complaint was vague abdominal pain (n=45; 40. 2%). The most prevalent comorbidity was hypertension (18; 16.0%). Conservative methods were chosen more frequently including omentoplasty (44; 39. 3%), cyst drainage (27; 24. 1%), cyst resection (19; 17%) and marsupialization (3; 2. 7%). Overall, 56 patients (50%) were operated with omentoplasty as the single method or in combination with segmentectomy. Complications occurred less in patients operated with omentoplasty (41. 1 vs. 23. 2%; P=0. 043); particularly, biloma was more frequent in surgeries without omentoplasty (7. 1 vs 0. 0%; P=0. 042). Persistence and recurrence rates were 12. 5% and 3. 6% with relative predilection in, respectively, segmentectomy and lobectomy surgical methods compared to Omentoplasty. No mortality was recorded. Conclusion: In our case series of hepatic hydatid cyst patients, omentoplasty was safe with less complication and similar long-term recurrence rate. [ABSTRACT FROM AUTHOR]

Purpose: Cholangiocarcinomas (CCs) are rare and highly malignant cancers. Although there are different treatment protocols for treatment of cholangiocarcinoma, we aimed to investigate a survival rate of patients with unresectable extrahepatic CCs (ECCs) receiving multimodality therapeutic protocol (MTP) (biliary drainage + external beam radiotherapy [EBRT] + brachytherapy and systemic chemotherapy). Similarly, we aimed to identify a relationship between survival time and associated factors in treatment outcome. Material and methods: This retrospective study was performed on patients with ECC, who were referred to our university hospital between 2012 and 2015, and their imaging were diagnosed as unresectable. Patients underwent MTP including internal-external drainage catheter (F10-12) with insertion under fluoroscopy guidance, EBRT with 25-28 fractions and concurrent chemotherapy using capecitabine (Xeloda) 825 mg/m2 at the days of radiotherapy, followed by brachytherapy (BT) with iridium-192 (192Ir) or cobalt-60 (60Co) sources for 21 Gy in 3 consecutive days. Demographic variables, complications, laboratory tests, imaging findings, and survival time (OS - overall survival after diagnosis; CS - survival after catheter placement) were recorded. Results: A total of 38 patients, with mean SD age = 58.08 (9.80) years, male = 22 (57.9%), were evaluated. According to Bismuth-Corlette classification, 15 (39.5%) were in stage IIIA, 5 (13.2%) were in stage IIIB, 10 (26.3%) were in stage IV, and 8 (21.2%) were undefined. Of those, 21 (55.3%), 15 (39.5%), and 17 (44.7%) were involved with liver parenchyma, great vessels, and regional lymph nodes, respectively. Mean SD of OS was 15.11 (8.10) months (median = 15; 95% CI: 13.25-16.69), and CS was 2-29 months (mean SD = 11.71 (7.29); median = 10; 95% CI: 10.05-13.37). Further analysis revealed a considerable decrease in OS and CS in those with an involvement of liver parenchyma, great vessels, regional lymph nodes, and Bismuth type IV. Conclusions: Multimodality therapeutic approach in patients with inoperable ECCs could definitely improve their survival time and decrease complications. Survival time is significantly depending on tumor staging, gender, and involvement of liver parenchyma, great vessels, and regional lymph nodes. [ABSTRACT FROM AUTHOR]

Patients with a stoma have 5% chance of developing parastomal varices, which tend to repetitive massive and life-threatening hemorrhages. Treatment of choice in parastomal varices have not been established, while Transjugular Intrahepatic Portosystemic Shunt (TIPS) has been revealed as the most successful measure. We report a hemodynamically unstable patient with a history of Ulcerative Colitis (UC) and Primary Sclerosing Cholangitis (PSC) with colostomy, because of colon cancer who presented with massive parastomal bleeding. Non-operative treatments and TIPS failed to control the symptoms. Color Doppler ultrasound showed a hepato-fugal flow. The direct antegrade technique, using Sodium Tetradecyl Sulfate (STS 1%) and glue-Lipiodol, was applied under ultrasonography guidance, and complete stoppage of bleeding was achieved. No immediate or late complication or follow-up recurrence were noted after 8 months. In case of hepatofugal flow, direct percutaneous mesenteric parastomal venous access and sclerotherapy is a rapid and relatively safe procedure for parastomal variceal bleeding. [ABSTRACT FROM AUTHOR]

Solitary fibrous tumors (SFTs) are mesenchymal tumors that mostly occur in the pleural cavity. Extra-thoracic location is rare and hepatic origin is extremely rare. Most lesions are benign, 10% - 15% show aggressive behavior and few metastasizing SFTs have been reported. Imaging features of solitary fibrous tumors of the liver (SFTLs) are nonspecific and definite diagnosis usually needs histopathological and immunohistochemistry evaluation. We report ultrasound, CT and MRI features of such a rare malignant SFTL in a 47-year-old man who came with vague abdominal symptoms in detail along with reviewing literature considering imaging features which is valuable for radiologists. The lesion seen as a huge dominantly cystic lesion on ultrasound was initially misinterpreted as hydatid. On CT scan it was seen as a large encapsulated mass with arterial hyper-enhancement and delayed contrast retention and multiple cystic spaces. On MRI, solid components showed iso-intensity to adjacent liver on T1 and T2 images, small areas of restriction on diffusion weighted imaging (DWI) and few hemorrhagic cystic components beside enhancement pattern and multiple large cystic components similar to CT scan. Our patient was admitted for resection of huge hepatic mass and experienced an episode of altered mental status due to hypoglycemia during hospital admission, which is a rare finding in SFTL. The patient underwent right hepatectomy and solitary fibrous tumor was confirmed on pathologic examination of the resected tumor. Hypoglycemic episodes were resolved and the patient was asymptomatic in 28 months follow-up. [ABSTRACT FROM AUTHOR]

Acute lymphocytic leukemia (ALL) is one of the frequent malignancies in pediatrics and involves bone marrow and extramedullary sites. Proptosis as extramedullary involvement of leukemia usually present in acute and chronic myeloid leukemia. It is extremely rare for ALL to present initially as proptosis. Here, a-21-month-old boy was presented with proptosis without any associated symptoms except lymphadenopathy. He was referred with the impression of malignancy from an ophthalmologist. After bone marrow biopsy which showed 33% blast cells, all positive for CD10, CD19, and CD79, the diagnosis of pre-B cell ALL was finally made. His symptoms were improved completely 16 days after starting standard protocol for ALL.Afterone-year follow-up, he was free of any symptoms. According to this initial presentation of ALL and no typical associated symptoms, it is important to make rapid diagnosis and start the treatment in the childhood. [ABSTRACT FROM AUTHOR]

Polycythemia vera (PV) is classified as a myeloproliferative disorder (MPD). Such patients are prone to both thrombotic and hemorrhagic events. Although gastrointestinal (GI) bleeding is not a prominent manifestation of PV, it would be life threatening and necessitating hospital admission and blood transfusion if it occurs. GI hemorrhage in these patients may be due to Aspirin usage, peptic ulcer disease (PUD), acquired Von Willbrand disease, Dieulafoy lesion (DL), Mallory Weiss tear, and esophageal and gastric varices. DL is an enlarged, thick-walled artery in the muscularis mucosa with a small submucosal defect. In this case report, we describe a 65-year-old man with history of PV presented with a massive upper GI bleeding. After a therapeutic endoscopic hemostasis failure and reoccurrence of bleeding during hospital admission, an abdominal computed tomography (CT) was ordered, which revealed an aberrant artery originated from aorta directly into the stomach. An angiographic embolization was considered for the patient, which was successfully performed. Our patient was complicated by splenic infarction due to splenic collateral arteries embolization and the overwhelming thrombotic tendency of the patient himself due to the history of PV. Fortunately, our patient's signs and symptoms responded to supportive therapies and eventually he discharged well. [ABSTRACT FROM AUTHOR]

Introduction: Hepatic epithelioid hemangioendothelioma (HEHE) is a discrete vascular tumor with an unpredictable natural course. This rare tumor is commonly found incidentally and not too often is mistaken radiologically and histologically for another tumor. No single treatment strategy has yet been established for it, partly due to its variable clinical course, ranging from an indolent tumor with prolonged survival to an aggressive, fatal disease. Case Presentation: Among 1,029 liver transplantation cases performed at our hospital between January 2001 and November 2019, three were done for HEHE. In this study, we present these three cases and review their clinical and histopathologic characteristics. Conclusions: Epithelioid hemangioendothelioma (EHE) of the liver is a low-grade malignant tumor with different presentations, treatment strategies, and outcomes. The histopathologic characteristics of HEHE can hide its vascular nature, thus leading to its confusion with other lesions. This tumor is unique in that its clinical and histopathologic features do not always correlate with its biologic behavior. There are no reliable criteria in predicting the clinical outcome of HEHE, which needs further research. [ABSTRACT FROM AUTHOR]

Background: We studied the clinical characteristics and outcomes of 905 hospitalized coronavirus disease 2019 (COVID-19) patients admitted to Imam Khomeini Hospital Complex (IKHC), Tehran, Iran. Methods: COVID-19 patients were recruited based on clinical symptoms and patterns of computed tomography (CT) imaging between February 20 and March 19. All patients were tested for the presence of COVID-19 RNA. The Poisson regression model estimated the incidence rate ratio (IRR) for different parameters. Results: The average age (± standard deviation) was 56.9 (±15.7) years and 61.77% were male. The most common symptoms were fever (93.59%), dry cough (79.78%), and dyspnea (75.69%). Only 43.76% of patients were positive for the RT-PCR COVID-19 test. Prevalence of lymphopenia was 42.9% and more than 90% had elevated lactate dehydrogenase (LDH) or C-reactive protein (CRP). About 11% were severe cases, and 13.7% died in the hospital. The median length of stay (LOS) was 3 days. We found higher risks of mortality in patients who were older than 70 years (IRR = 11.77, 95% CI 3.63--38.18), underwent mechanical ventilation (IRR = 7.36, 95% CI 5.06--10.7), were admitted to the intensive care unit (ICU) (IRR = 5.47, 95% CI 4.00--8.38), tested positive on the COVID-19 test (IRR = 2.80, 95% CI 1.64--3.55), and reported a history of comorbidity (IRR = 1.76, 95% CI 1.07--2.89) compared to their corresponding reference groups. Hydroxychloroquine therapy was not associated with mortality in our study. Conclusion: Older age, experiencing a severe form of the disease, and having a comorbidity were the most important prognostic factors for COVID-19 infection. Larger studies are needed to perform further subgroup analyses and verify high-risk groups. [ABSTRACT FROM AUTHOR]

Neurobrucellosis is an uncommon serious complication of brucellosis. Diagnosis of neurobrucellosis could be difficult due to non-specific clinical and radiological findings. So, in endemic regions, neurobrucellosis should be included in the differential diagnosis list of patients with recent neurological disorders. We report an unusual case of neurobrucellosis with neurologic deficits in the central and peripheral nervous system and MRI lesions in the brainstem, spinal cord, and nerve roots Also, related articles are reviewed in the discussion section., (Copyright Journal of Radiology Case Reports.)

Pancreatic neuroendocrine tumors are rare neoplasms that comprise 1-2% of all pancreatic tumors. However, they are the second most common solid pancreatic neoplasms. They have a wide range of imaging appearances and they can show common to very rare imaging presentations. Most of the time they are solitary well-marginated enhancing solid mass arising in a certain aspect of the pancreas. We present a case report of a 41-year-old female who underwent clinical work-up for abdominal pain, loss of appetite and weight loss for the past year. Ultrasound, computed tomography, and magnetic resonance imaging show diffuse homogenous pancreatic enlargement without contour deformity or a focal mass. Lymphoma and autoimmune pancreatitis were suggested based on imaging findings but IGg4 level and other lab data were normal. Endoscopic ultrasonography confirmed the diffuse enlargement of the pancreas without peripheral structures involvement. The pathological results of multiple fine-needle aspiration biopsy from all parts of the enlarged pancreas revealed a low-grade neuroendocrine tumor., (Copyright Journal of Radiology Case Reports.)