Relationship between maxillary sinus mucosal cyst and sinus ostium 2D area in three-dimensional volumetric paranasal CT ımages

OBJECTIVE

To investigate the relationship between the maxillary sinus ostium 2D area (SOA) and the development of mucosal cysts of the maxillary sinus (MMC).

METHODS

Thirty patients (≥ 18 years) with unilateral MMC who underwent paranasal sinus CT (PNsCT) were included in this single-center retrospective study. Non-MMC sinus was used as the control group. Cyst and air volume of the maxillary sinuses, diameter, and 2-dimensional area of the ostium of the patients were calculated in the 3-dimensional volumetric analysis program. Both correlation and linear regression model analyses were performed for the relationship between MMC and SOA.

RESULTS

Thirty patients were included (mean age of 42.30 ± 17.62 years). A total of 15/30 (50%) were male. The mean SOA in patients with MMC (8.91 ± 1.10 mm2) was lower than in patients without MMC (12.94 ± 1.35 mm2), which was statistically significant (p < 0.001). The mean sinus ostium diameter in patients with MMC (2.12 ± 0.71 mm) was higher than in patients without MMC (1.91 ± 0.82 mm), which was statistically insignificant (p = 0.295). There was a statistically significant, good level of negative linear correlation between SOA and total cyst volume (TCV) [correlation coefficient (r) = - 0.680, p < 0.001]). As a result, the regression model consisting of "Age, Sinus air volume, and TCV" variables is a good model and has statistically significant relations with SOA.

CONCLUSION

In conclusion, small SOAs contribute to the development of MMC. There was a negative correlation between SOA and TCV. In addition, 2D area measurement may be a more accurate method instead of diameter measurement.

Effects of coronary artery calcified plaque and stent on severity and survival of COVID-19 patients: a decision tree model study

AIM

We aimed to investigate the relationship between the presence of calcified plaques and stents in coronary arteries as evaluated by the chest computed tomography severity score (CT-SS) and mortality rates in patients with COVID-19.

MATERIAL AND METHODS

A single-center retrospective analysis was conducted of 492 patients (≥18 yrs) who were hospitalized between March and June 2020. All included patients had RT-PCR tests positive for COVID-19. A radiologist recorded pulmonary imaging findings and the presence of coronary calcified plaque and / or stent, sternotomy wires, and cardiac valve replacement on initial non-contrast chest CT. Also, cardiothoracic ratios (CTR) were calculated on chest CTs. Data were analyzed using univariate and multivariate analyses and a chi-squared automatic interaction detection (CHAID) tree analysis, which was developed as a predictive model for survival of COVID-19 patients according to chest CT findings.

RESULTS

The mean CT-SS value of the patients with coronary plaque was 11.88±7.88, and a significant relationship was found between CT-SS with coronary calcified plaque (p&lt;0.001). No statistical difference was found between CT-SS and coronary stent (p=0.296). In multivariate analysis, older age was associated with 1.69‑fold (p&lt; 0.001), the presence of coronary calcified plaque 1.943‑fold (p=0.034) and higher CT-SS 1.038‑fold (p=0.042) higher risk of mortality. In the CHAID tree analysis, the highest mortality rate was seen in patients with coronary plaque and CTR&gt;0.57.

CONCLUSION

The presence of coronary artery calcified plaque and cardiomegaly were high risks for severe prognosis and mortality in COVID-19 patients and may help to predict the survival of patients.

Effects of Patient-Based Imaging Artifacts On CT Diagnosis of COVID-19 and Its Severity

PURPOSE

To investigate the effects of patient-induced artifacts on the diagnostic performance of the COVID-19 Reporting and Data System (CO-RADS) and the computed tomography chest severity score (CT-SS).

METHODS

A single-center retrospective analysis of patients aged 18 years and older who were admitted to the authors' hospital with laboratory-confirmed COVID-19 and underwent chest CT between July and November 2021 was conducted. Patients' chest CT scans were examined by 3 radiologists for CT-SS and CO-RADS classifications. Patient-based artifacts, including metal artifacts, incomplete projection artifacts, motion artifacts, and insufficient inspiration, were identified by 3 readers who were unaware of each other. For statistical analysis, interreader agreement was investigated using Fleiss kappa () agreement analysis.

RESULTS

The study population included 549 patients with a median age of 66 years (IQR, 55-75 years), 321 (58.5%) of whom were men. According to the overall CO-RADS classification, the highest interreader agreement was in patients without CT artifacts ( = 0.924), while the lowest interreader agreement was in patients with motion artifacts ( = 0.613). For the CO-RADS 1 and 2 patient groups, insufficient inspiration decreased the interreader agreement most ( = 0.712 and = 0.250, respectively). For the CO-RADS 3, 4, and 5 patient groups, motion artifacts reduced the interreader agreement most ( = 0.464, = 0.453, and = 0.705, respectively). For total CT-SS, the highest kappa value was in patients without artifacts ( = 0.574), while the lowest kappa value was in patients with motion artifacts ( = 0.374).

DISCUSSION

The CT technologist can avoid patient-induced artifacts by placing patients carefully on the CT table, giving patients necessary instructions before CT acquisition, and selecting optimal scanning parameters. The authors are not aware of another study in the literature investigating the effects of patient-based artifacts on interreader agreement of CO-RADS classification and CT-SS for COVID-19.

CONCLUSION

CT artifacts degrade image quality and might lead to interreader disagreement of CO-RADS classification and CT-SS for patients with COVID-19.

Effects of nonsteroidal anti-inflammatory drugs on ultrasound findings of mRNA COVID-19 vaccine-related lymphadenopathy

BACKGROUND

Previous studies reported axillary lymphadenopathy (LAP) as a side effect of the anti-COVID-19 vaccine. However, the effects of nonsteroidal anti-inflammatory drug (NSAID)s on mRNA COVID-19 vaccine-related LAP have not been investigated.

PURPOSE

We aimed to investigate the effects of NSAIDs on temporal changes in sonographic findings of COVID-19 vaccine-associated LAP.

METHODS

Our single-center retrospective cohort study was conducted between October 2021 and April 2022. We included patients (aged ≥ 18 years) who applied with complaints of swelling in the ipsilateral axillary region after the COVID-19 vaccine and had axillary region ultrasound (US) scans in electronic medical records within 30 days pre-vaccination. The serial US was performed on the third, 10th, and 30th days post-vaccination.

RESULTS

Our study included 38 patients with a median age of 36 (IQR, 32-43) years. In 18 (47.4%) patients used NSAIDs in the early post-vaccination period. Measurements of LAPs on ultrasound scans increased at day 3 post-vaccination compared with pre-vaccination both in NSAID users and non-users. On the 10th day, a statistically insignificant decrease in LAP diameters and cortical thickness was observed in NSAID users compared to non-users. On the post-vaccination 30th day, axillary LAPs regressed similarly in both groups.

CONCLUSION

In our study, post-vaccine NSAID use had no statistically significant effect on the course of axillary LAPs.

The impact of obesity on ocular hemodynamics and choroidal thickness

Background

Obesity affects microvascular structures. The effect of obesity on the ocular vascular system can be evaluated by changes in the choroidal thickness (CT) and retrobulbar blood flow (RBF).

Objectives

To evaluate the CT and RBF parameters in obese patients with various body mass index (BMI) values and compare these parameters with normal weight, healthy subjects.

Design

A prospective study.

Methods

The study included 102 eyes of 102 female patients. Patients were divided into three groups according to BMI as group 1 with a BMI of 18.5-24.99 (n = 32), normal weight group; group 2 with a BMI of 30-34.99 (n = 35), as obese class I; and group 3 with a BMI of 35-39.99 (n = 35), as obese class II. The peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index, and pulsatility index values of the central retinal artery (CRA) and ophthalmic artery (OA) were evaluated with color Doppler ultrasonography. CT was measured at the subfoveal area and at 500-µm intervals nasal and temporal to the fovea up to a distance of 1500 µm by using the enhanced depth imaging technique of optical coherence tomography. Intraocular pressure (IOP) was measured with a Goldmann applanation tonometry.

Results

There was a significant difference in IOP values within the groups with the highest values in group 3 (17.6 ± 2.1 mmHg) and the lowest in group 1 (12.4 ± 1.7 mmHg). The CT in groups 2 and 3 was found to be statistically significantly lower than that in group 1 at all measurement points (p < 0.001). There was a statistically significant negative correlation between CT at all measurement points and BMI (p < 0.001). The mean CRA PSV, EDV, and OA EDV values were statistically significantly lower in each obese group than those values in group 1 (p < 0.001). The OA PSV values were significantly lower in group 3 (36.5 ± 5.9 cm/s) than those in group 2 (43.8 ± 4 cm/s) and group 1 (44.6 ± 5.2 cm/s) (p < 0.001). Also, significant associations were found between BMI and CRA PSV, CRA EDV, and OA PSV values (p < 0.001).

Conclusion

Obesity may predispose to eye pathologies by changing the ocular vascular circulation.

Investigation of comorbidities of COVID-19 patients with hepatosteatosis using latent class analysis

Introduction

Coronavirus Disease 2019 (COVID-19) disease first appeared in Wuhan, China in December 2019. Subsequently, the pandemic spread rapidly throughout the entire world. The number of people who died from COVID-19 is rising daily due to the growing number cases. This retrospective study aims to classify patients with hepatosteatosis (HS) who had COVID-19, depending on additional disease characteristics and to compare survival times and death rates.

Material and methods

The study included 433 individuals with COVID-19 and HS at Amasya University Sabuncuoglu Serefeddin Education and Research Hospital. Additional disease characteristics of patients with HS were analyzed using latent class analysis (LCA) and the patients were divided into two groups.

Results

The study results indicate that the survival time of the first group, which was formed as a result of the LCA, was significantly lower than that of the second group (p = 0.038). The rate of diabetes, coronary artery disease, chronic rhythm disorder, chronic obstructive pulmonary disease (COPD) and chronic kidney disease was significantly higher in group 1 than in group 2 (respectively p < 0.001; p < 0.001; p < 0.001; p < 0.001; p = 0.015).

Discussion

In patients with HS, the presence of diabetes, coronary artery disease, chronic rhythm problem, COPD, and chronic renal disorders contributes to an increase in death rates due to COVID-19.

Mediastinal lymph node enlargement in COVID-19: Relationships with mortality and CT findings

BACKGROUND

The presence of mediastinal lymph node enlargement (MLNE) in computed tomography (CT) of Coronavirus disease 2019 (COVID-19) patients can be associated with disease severity.

OBJECTIVES

To investigate the relationship between MLNE with intensive care unit admission (ICU), mortality rates, and CT findings, especially in early-stage COVID-19 patients.

METHODS

This single-center retrospective case-control study, included aged ≥18 years, 250 COVID-19 patients with positive RT-PCR tests. We included two patient groups, 125/250 with and without MLNE. Demographic information of the patients, laboratory findings, length of stay in hospital or ICU, mortality rates, initial CT imaging findings and CT severity scores (CT-SS) were recorded and their relationship with MLNE was investigated.

RESULTS

Patients with MLNE were older (69.61 ± 11.16; p < 0.001) and had a higher CT-SS (14.67 ± 7.55; p < 0.001). There was a significant difference between the presence of MLNE with mortality (58/77, 75.3%; p < 0.001) and ICU admission (49/61, 80.3%; p < 0.001). Also, a statistical association was found between MLNE with ICU admission (p = 0.001) and (p < 0.001) mortality rates in patients with CORADS≤2 CT findings. In multivariate logistic regression analysis, MLNE was 8.8-fold (95% CI: 1.62-47.86, p =  0.01) more correlated with linear opacity and 0.25-fold with bronchial wall thickening (95% CI: 0.07-0.92, p =  0.04).

CONCLUSION

Mediastinal lymph node enlargement is an important CT finding that can predict the severe prognosis of COVID-19 patients. Even in patients without lung involvement on initial CT, the presence of MLNE should be carefully examined as it is associated with disease severity.

Retrobulbar Ocular Blood Flow and Choroidal Vascular Changes in Patients Recovering from COVID-19 Infection

Background

To evaluate the effects of COVID-19 infection on the ocular vascular structure including choroidal thickness and retrobulbar blood flow values in comparison with healthy subjects.

Methods

Ninety eyes of 90 patients were included in this study. Participants were divided into Group 1 (n = 30) with mild COVID-19 infection, Group 2 (n = 31) with moderate disease, and Group 3 with age- and sex-matched healthy subjects (n = 29). Choroidal thickness was measured at the subfoveal area and at 500-µm intervals nasal and temporal to the fovea up to a distance of 1500 µm, using the enhanced depth imaging (EDI) technique of spectral coherence tomography (SD-OCT). The peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI), and pulsatility index (PI) values of the central retinal artery (CRA) and ophthalmic artery (OA) were evaluated with color Doppler ultrasonography (CDU).

Results

The choroidal thickness was significantly thinner in Group 1 and Group 2 than in Group 3 at all measurement points (p <0.001). This difference was not present between Group 1 and Group 2 who had COVID-19 disease of different severity (p>0.05).Among the retrobulbar blood flow parameters, OA PSV value was significantly lower in Group 1 and Group 2 compared to Group 3 (p = 0.025, p = 0.016, respectively). However, the CRA PSV and EDV and OA EDV values, and the CRA and OA PI and RI values were not statistically different between the groups (p> 0.05).

Conclusion

COVID-19 infection may predispose patients to ocular vascular pathologies by affecting both choroidal and retrobulbar blood flow.

Angiographic Morphology of Anterior Communicating Artery Aneurysms and Their Association with Rupture Risk

AIM

To estimate the rupture risk of anterior communicating artery (AComA) and AComA-related aneurysms according to their localization, angiographic architecture, and morphological features.

MATERIAL AND METHODS

In this study, 124 patients with AComA and AComA-related anterior system aneurysms were retrospectively evaluated. The aneurysms were classified according to their morphological appearance and angiographic architecture. The size, size ratio, angiographic architecture, and aneurysmal dome orientation of ruptured and non-ruptured aneurysms were compared using digital subtraction angiography (DSA) 3D images.

RESULTS

There was a significant relationship between rupture risk and the size ratio (p=0.043), morphological properties of the aneurysm (p < 0.001), aneurysm dome orientation (OR 1.29, 95% CI 1.32-6.818), and aneurysm type according to the angiographical architecture (p < 0.005).

CONCLUSION

In determining the rupture risk of AComA and AComA-related aneurysms, size alone is not a sufficient parameter with aneurysm morphology proving to be more efficacious. Grouping of aneurysms according to angioarchitecture, and its significant correlation with aneurysm rupture, may help to understand the underlying mechanisms in the formation and rupture of aneurysms. From this, more specific treatment protocols can be created, helping to improve the clinical evaluation of AComA aneurysms.