Spectrum of intracranial complications of rhino-orbito-cerebral mucormycosis — resurgence in the era of COVID-19 pandemic: a pictorial essay

Emergency Radiology - Rhino-orbito-cerebral mucormycosis (ROCM) has regained significance following its resurgence in the second wave of the COVID-19 pandemic in India. Rapid and progressive...     

Systemic arterio-venous thrombosis in COVID-19: A pictorial review

Coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Systemic complications include cardiovascular, neurological, hepatic, renal and altered coagulation. Derangements in haemostasis with SARS-CoV-2 infection have been termed COVID-19 associated coagulopathy (CAC). CAC is postulated to be one of the significant causes for sudden deaths in this pandemic, with infection of endothelial cells and subsequent endotheliitis through angiotensin-converting enzyme-2 receptors playing a key role in the pathogenesis. In this pictorial review, we describe the imaging findings in a multitude of extrapulmonary arterial (aorta, cerebral, mesenteric, renal and peripheral arterial system) and venous thrombotic phenomena detected on contrast-enhanced computed tomography and magnetic resonance imaging of COVID-19 patients which could not be attributed to any other causes. Knowledge of incidence of these complications, lowering the threshold for diagnostic imaging in symptomatic patients and timely radiological detection can play a vital role in subsequent management of these critically ill patients.     

Core curriculum illustration: invasive fungal sinusitis

This is the 27th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at http://www.erad.org/?page=CCIP_TOC.     

Cervicofacial tissue infarction in patients with acute invasive fungal sinusitis: prevalence and characteristic MR imaging findings

Introduction

Tissue infarction is known as one of the characteristic features of invasive fungal sinusitis (IFS). The purpose of this study was to investigate the prevalence and characteristic MR imaging findings of cervicofacial tissue infarction (CFTI) associated with acute IFS.

Methods

We retrospectively reviewed MR images in 23 patients with histologically or microbiologically proven acute IFS. CFTI was defined as an area of lack of enhancement in and around the sinonasal tract on contrast-enhanced T1-weighted images. We divided CFTI into two groups, i.e., intrasinonasal and extrasinonasal. Particular attention was paid to the location of extrasinonasal CFTI and the signal intensity of CFTI on T1- and T2-weighted images. The presence of bone destruction on CT scans was also recorded.

Results

CFTI was found in 17 (74 %) of 23 patients. All of these 17 patients had intrasinonasal CFTI, and 13 patients also had extrasinonasal CFTI. All 13 patients with extrasinonasal CFTI died of disease directly related to IFS. Various locations were involved in the 13 patients with extrasinonasal CFTI, including the orbit (n?=?8), infratemporal fossa (n?=?7), intracranial cavity (n?=?3), and oral cavity and/or facial soft tissue (n?=?4). Various signal intensities were noted at the area of CFTI on T1- and T2-weighted images. Bone destruction was found on CT scans in only 3 of 17 patients with CFTI.

Conclusion

CFTI with preservation of the bony wall of the involved sinonasal tract may be a characteristic MR imaging finding of acute IFS. The mortality is very high once the lesion extends beyond the sinonasal tract.     

慢性侵袭性真菌性鼻窦炎的CT和MRI诊断

目的探讨慢性侵袭性真菌性鼻窦炎的CT和MRI表现及诊断价值。方法回顾性分析经手术、组织病理学证实的10例慢性侵袭性真菌性鼻窦炎的影像学资料。结果慢性侵袭性真菌性鼻窦炎发生于蝶窦5例，上颌窦3例，筛窦2例。CT表现：受累窦腔内充以软组织影，其中1例伴斑点状钙化；窦壁骨质破坏，同时伴周围骨质增生肥厚。MRI表现：T1WI为低信号（与脑实质比较，以下相同）2例，等信号7例；T2WI信号不均匀，7例以低信号为主，2例以高信号为主；增强后病变明显强化。侵犯邻近结构：眼眶9例，其中6例累及眶尖区，可见不规则软组织肿块影，与邻近眼外肌分界不清楚，7例包绕视神经；6例侵犯海绵窦，可见形态不一的软组织影；脑膜增厚、强化5例，3例侵犯脑实质，表现为水肿1例，肉芽肿2例；4例侵犯翼腭窝及颞下窝；3例鼻咽部软组织增厚；2例上颌神经和1例下颌神经明显增粗、强化；3例面颊部软组织肿胀；1例硬腭骨质破坏。结论窦壁骨质破坏伴硬化、MR T2WI低信号、易侵犯眶尖及海绵窦为本病特征性影像学表现。结合CT和MRI2种检查方法能够对本病的诊断、鉴别和治疗提供更可靠的信息。     

Posttransplantation lymphoproliferative disorder of the paranasal sinuses mimicking invasive fungal sinusitis: case report

Posttransplantation lymphoproliferative disorder (PTLD) is a challenging complication associated with organ transplantation and is usually fatal if untreated. We describe the case of a transplant recipient who presented with rapidly progressive cranial nerve palsies due to PTLD that originated in the sphenoid sinus. In this case, the clinical and radiologic presentation of PTLD mimicked invasive fungal disease. Because the management of PTLD and the management of invasive fungal infection are vastly different, prompt pathologic diagnosis is required.     

Imaging in the COVID-19 era: Lessons learned during a pandemic

The first year of the coronavirus disease 2019 (COVID-19) pandemic has been a year of unprecedented changes, scientific breakthroughs, and controversies. The radiology community has not been spared from the challenges imposed on global healthcare systems. Radiology has played a crucial part in tackling this pandemic, either by demonstrating the manifestations of the virus and guiding patient management, or by safely handling the patients and mitigating transmission within the hospital. Major modifications involving all aspects of daily radiology practice have occurred as a result of the pandemic, including workflow alterations, volume reductions, and strict infection control strategies. Despite the ongoing challenges, considerable knowledge has been gained that will guide future innovations. The aim of this review is to provide the latest evidence on the role of imaging in the diagnosis of the multifaceted manifestations of COVID-19, and to discuss the implications of the pandemic on radiology departments globally, including infection control strategies and delays in cancer screening. Lastly, the promising contribution of artificial intelligence in the COVID-19 pandemic is explored.     

MR imaging of acute bowel pathology: a pictorial review

The purpose of this pictorial essay is to describe magnetic resonance (MR) imaging features of acute processes involving the bowel. While computed tomography (CT) is likely to remain the modality of choice in this setting, the advantages of MR include high soft tissue contrast, lack of ionizing radiation, and the ability to administer gadolinium in patients with a history of allergic reaction to iodinated contrast material. With the increasing utilization of abdominal/pelvic MR, radiologists must recognize the MR features of acute bowel pathology. Key MR findings of a variety of causes of acute abdominal pain are illustrated.     

A cautionary note on altered pace of aging in the COVID-19 era

Coronavirus disease 2019 (COVID-19) is highly age-dependent due to hi-jacking the molecular control of the immune cells by the severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2) leading to aberrant DNA methylation (DNAm) pattern of blood in comparison to normal individuals. These epigenetic modifications have been linked to perturbations to the epigenetic clock, development of long COVID-19 syndrome, and all-cause mortality risk. I reviewed the effects of COVID-19 on different molecular age markers such as the DNAm, telomere length (TL), and signal joint T-cell receptor excision circle (sjTREC). Integrating the accumulated clinical research data, COVID-19 and novel medical management may alter the pace of aging in adult individuals (<60 years). As such, COVID-19 might be a confounder in epigenetic age estimation similar to life style diversities, pathogens and pathologies which may influence the interpretation of DNAm data. Similarly, the SARS-CoV-2 affects T-lymphocyte function with possible influence on sjTREC levels. In contrast, TL measurements performed years before the SARS-CoV-2 pandemic proved that short TL predisposes to severe COVID- 19 independently from chronological age. However, the persistence of COVID-19 epigenetic scars and the durability of the immune response after vaccination and their effect on the ongoing pace of aging are still unknown. In the light of these data, the heterogeneous nature of the samples in these studies mandates a systematic evaluation of the currrent methods. SARS-CoV-2 may modify the reliability of the age estimation models in real casework because blood is the most common biological sample encountered in forensic contexts.     

Management of cervical cancer during the corona virus disease-19 (COVID-19) era

COVID-19 pandemic has had a catastrophic impact on the society, economy and heath-care system all over the globe with virus showing no signs of losing potency. As the situation appears to worsen, extra burden on other specialities like oncology seems to increase. Specific recommendations are necessary for management of cervical cancer in the current context. All concerned specialities must work together in the best interest of the patient. Attempts should be made at managing cervical cancer while limiting the viral spread among the patients and health-care workers without the loss of opportunity. Surgical intervention for early cervical cancer should be postponed or alternative modalities be considered. In a locally advanced disease, concurrent chemoradiation is the treatment of choice. In addition, the following under mentioned suggestions aim to discuss ways of minimizing infection spread, workload rationalization and providing guidance for management of cervical cancer in the presence of COVID-19 infection.     

Future scenarios and opportunities for interventional radiology in the post COVID-19 era

Pandemic outbreak has led health systems worldwide into a rapid reorganization in response to coronavirus infections, forcing interventional radiology units to adapt. Interventional procedures have evolved in number, type and setting and have arguably been optimized as a direct consequence of this pandemic; a result that will undoubtedly lead to radical change within the specialty. This paper explores the future of interventional radiology from various perspectives, and forecasts the new opportunities that will be presented, from the adaptation of the interventional radiology staff and angiography suite, to the immunological environment, and through to digital medical education. We analyze the economic impact and the future relationship we can expect with the rest of the medical industry.

Rapid outbreak of the coronavirus disease 2019 (COVID-19) has led to an unprecedented knockdown of health systems worldwide. During the first weeks of the pandemic, a rapidly growing number of patients required immediate hospitalization, and many of them were admitted to intensive care units (ICU). Human, economic, and medical resources have been redistributed to fight against the pandemic spread. Widely varied rates of virus evolution in terms of time and severity have been observed between the nations, and whilst this allows us to theorize on the course of the disease, many uncertainties remain as how the disease will evolve in the short- to midterm (1).Narrowing to the field of interventional radiology (IR), we have been forced to adapt our practices to this situation in a very short period of time. An abrupt stop was made to daily practices, with priority being given to only the most urgent oncologic and trauma procedures, and other basic services necessary to fight against the disease on the front line.The purpose of this article is to explore how IR may evolve over the next 1–3 years. The authors do not pretend to predict or fix ideas about what will happen, rather, they share hypothesis on what may occur, with the aim to spark meaningful reflection and debate. This article has been designed to inspire bold thinking about this inevitable era of change and opportunity, always with the conviction that our “resilient” specialty will prevail as it has done for generations.