Radiology of Infectious Diseases

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OBJECTIVE: To analyze the clinical characteristics, pathological characteristics, and prognostic factors of AIDS-related lymphoma (ARL). MATERIALS AND METHODS: This was a retrospective study of the clinical characteristics, diagnosis and treatment process, and survival status of 32 patients with ARL. The patients were divided into a survival group and nonsurvival group according to their prognosis, and the factors affecting survival were analyzed. The patients' clinical characteristics were analyzed according to symptoms, sex, age, and laboratory indicators such as the lactate dehydrogenase (LDH) concentration, number of CD4+ T cells, Ann Arbor stage, pathological typing, and international prognostic index (IPI) score. A univariate regression analysis was performed to compare the clinical characteristics of the treatment group and nontreatment group. The impact of chemotherapy and combined antiviral therapy on survival time was assessed. RESULTS: Thirty-two patients were included in the study; 31 were male and 23 were aged >40 years. The average LDH concentration was 639.8 U/L, and the average CD4+ lymphocyte count was 167 cells/μL. Diffuse large B-cell lymphoma was present in 40.6% (13/32) of the patients; a B-lymphocyte source accounted for 90.6% (29/32) of cases, and a T-lymphocyte source accounted for 9.4% (3/32). The proportion of patients who received anti-lymphoma treatment was 84.4% (27/32). Twenty-three patients died during follow-up and nine survived. Univariate analysis showed that the prognostic factors were age, the CD4+ T-lymphocyte count, and the IPI score. The average progression-free survival (PFS) time in the highly active antiretroviral therapy (HAART) group before chemotherapy was 4.81 months, while the average PFS time without antiviral therapy before chemotherapy was about 1.91 months. This difference was statistically significant. The median 2-year survival time in patients who received antiviral therapy before chemotherapy was 33.3 months, while that in patients who did not receive antiviral therapy was 27.3 months. Early HAART therapy combined with standardized chemotherapy was shown to improve the patients' prognosis. It also improved the overall survival (OS) rate and PFS time. However, there was no significant difference in the OS rates between 1 and 2 years. CONCLUSION: The CD4+ T-cell count and IPI score were key factors affecting the prognosis of patients with ARL. An increased LDH concentration was also a prognostic factor. A certain correlation between the disease severity and prognosis was found. The use of standard anti-lymphoma treatment can effectively improve the survival rate of patients.

Parasites are an important cause of human diseases. With the increase in global population migration, the decline of population immunity, and changes in living habits, parasitic diseases have been increasing year by year. Because the liver has a unique blood supply system and a biliary system that communicates with the intestinal tract, it is relatively more vulnerable to a variety of parasitic infections. Imaging examinations play an important role in the early detection, characterization, evaluation, and treatment of hepatic parasitic diseases. Various imaging methods can not only detect hepatic parasitic diseases accurately but also evaluate liver injury, liver fibrosis, abnormal blood perfusion, metabolic changes, and malignant tumors caused by parasitic infection. Familiarity with the imaging features of hepatic parasitic diseases is helpful for the early diagnosis and treatment. This article reviews the progress in imaging research on common hepatic parasitic diseases.

Despite global efforts to eradicate tuberculosis (TB), 10 million new cases are reported each year. Indigenous communities are at greater risk of developing TB. We report a 7-year-old indigenous boy who presented with neurological symptoms. An intracranial neoplasm was suspected based on imaging findings and he underwent neurosurgical resection. The final diagnosis was intracranial tuberculoma. Anti-TB therapy was administered and the patient recovered completely.

The COVID-19 pandemic has created worldwide change in screening, management, and deadlines for the treatment of tuberculosis, among other latent diseases. Safe access to health-care structures, drug interactions, and ongoing changes in treatment guidelines are the main challenges. The first published cohort of 45 patients with both tuberculosis and SARS-CoV-2 infection presented three different scenarios regarding the timing of these diagnoses, both diagnoses being made within the same week in only nine of these patients. Thus far, tuberculosis has not been shown to influence the pathophysiology of SARS-CoV-2 infection. The association between these two diseases may be incidental. Tuberculosis remains the leading lethal infection worldwide. ²In patients with preexisting pulmonary tuberculosis and COVID-19, management priorities, drug interactions, and optimal frequency of clinical, biological, and radiological check-ups require clarification. We here report an asymptomatic young patient who had both COVID-19 and pulmonary tuberculosis, raising challenging questions regarding diagnostic tools, treatment, and follow-up.

OBJECTIVE: The objective of the study is to explore the feasibility of Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) T1 mapping for evaluating liver damage caused by Clonorchis sinensis infection in rabbit models. MATERIALS AND METHODS: Forty-two rabbits were randomly divided into a control group (n = 10), mild infection group (n = 12), moderate infection group (n = 9), and severe infection group (n = 11). All rabbits underwent an magnetic resonance imaging scan and pathological examination to obtain the relaxation time before Gd-EOB-DTPA enhancement and the relaxation time after Gd-EOB-DTPA enhancement at intervals of 10, 15, 20, 25, 30, 35, and 40 min. The Ishak score was used to evaluate the inflammation and fibrosis of the liver. RESULTS: The severity of C. sinensis infection was positively correlated with liver inflammation. The T1 relaxation time of liver increased with increasing inflammation. The highest correlation was recorded between inflammation and the T1 relaxation time at 30 min (P = 0.001). After enhancement, The T1 relaxation time has a significant difference between the severe infection group and control group and between the severe infection group and mild infection group. The area under the receiver operating characteristics curve showed that the T1 relaxation time was the most effective parameter for diagnosing the degree of inflammation at 30 min. CONCLUSIONS: Gd-EOB-DTPA-enhanced T1 mapping can be used to evaluate the liver damage caused by C. sinensis infection.

OBJECTIVE: Since the coronavirus disease 2019 (COVID-19) outbreak in Wuhan in 2019, the virus has spread rapidly. We investigated the clinical and computed tomography (CT) characteristics of different clinical types of COVID-19. MATERIALS AND METHODS: We retrospectively analyzed clinical and chest CT findings of 89 reverse transcription polymerase chain reaction confirmed cases from five medical centers in China. All the patients were classified into the common (n = 65), severe (n = 18), or fatal (n = 6) type. CT features included lesion distribution, location, size, shape, edge, density, and the ratio of lung lesions to extra-pulmonary lesions. A COVID-19 chest CT analysis tool (uAI-discover-COVID-19) was used to calculate the number of infections from the chest CT images. RESULTS: Fatal type COVID-19 is more common in older men, with a median age of 65 years. Fever was more common in the severe and fatal type COVID-19 patients than in the common type patients. Patients with fatal type COVID-19 were more likely to have underlying diseases. On CT examination, common type COVID-19 showed bilateral (68%), patchy (83%), ground-glass opacity (48%), or mixed (46%) lesions. Severe and fatal type COVID-19 showed bilateral multiple mixed density lesions (56%). The infection ratio (IR) increased in the common type (2.4 [4.3]), severe type (15.7 [14.3]), and fatal type (36.9 [14.2]). The IR in the inferior lobe of both lungs was statistically different from that of other lobes in common and severe type patients (P < 0.05). However, in the fatal type group, only the IR in the right inferior lung (RIL) was statistically different from that in the right superior lung(RUL), right middle lung (RML), and the left superior lung (LSL) (P < 0.05). CONCLUSION: The CT findings and clinical features of the various clinical types of COVID-19 pneumonia are different. Chest CT findings have unique characteristics in the different clinical types, which can facilitate an early diagnosis and evaluate the clinical course and severity of COVID-19.

Online since 17^th September 2021