School of Medicine

Coronavirus Disease 2019 (COVID-19) has had an enormous impact on both the medical community as well as society as a whole. Research on the pathogenesis and the treatment of the disease is rapidly emerging, with new observations and hypotheses appearing daily. One aspect that has been receiving increasing attention is the occurrence of both arterial and venous thrombotic complications in patients with COVID-19. We report three cases of thromboembolic complications in patients affected by COVID-19 and discuss clinical features, pathophysiology, and the proposed approaches to management of vascular complications in these patients. Through our discussion, we also urge physicians to be vigilant for any symptoms or signs suggestive of thrombosis in patients with COVID-19.

Introduction: Evaluation recommendations for patients on anticoagulant and antiplatelet (ACAP) therapy that present after mild traumatic brain injury (TBI) are controversial. At our institution, an initial noncontrast head computed tomography (HCT) is performed, with a subsequent HCT performed six hours later to exclude delayed intracranial hemorrhage (ICH). This study was performed to evaluate the yield and advisability of this approach.

Methods: We performed a retrospective review of subjects undergoing evaluation for ICH after mild TBI in patients on ACAP therapy between January of 2012 and April of 2013. We assessed for the frequency of ICH on both the initial noncontrast HCT and on the routine six-hour follow-up HCT. Additionally, chart review was performed to evaluate the clinical implications of ICH, when present, and to interrogate whether pertinent clinical and laboratory data may predict the presence of ICH prior to imaging. We used multivariate generalized linear models to assess whether presenting Glasgow Coma Score (GCS), loss of consciousness (LOC), neurological or physical examination findings, international normalized ratio, prothrombin time, partial thromboplastin time, platelet count, or specific ACAP regimen predicted ICH.

Results: 144 patients satisfied inclusion criteria. Ten patients demonstrated initial HCT positive for ICH, with only one demonstrating delayed ICH on the six-hour follow-up HCT. This patient was discharged without any intervention required or functional impairment. Presenting GCS deviation (p<0.001), LOC (p=0.04), neurological examination findings (p<0.001), clopidogrel (p=0.003), aspirin (p=0.03) or combination regimen (p=0.004) use were more commonly seen in patients with ICH.

Conclusion: Routine six-hour follow-up HCT is likely not indicated in patients on ACAP therapy, as our study suggests clinically significant delayed ICH does not occur. Additionally, presenting GCS deviation, LOC, neurological examination findings, clopidogrel, aspirin or combination regimen use may predict ICH, and, in the absence of these findings, HCT may potentially be forgone altogether. [West J Emerg Med. 2015;16(1):-0.]

Importance: Millions of children worldwide are experiencing prolonged symptoms after SARS-CoV-2 infection, yet social risk factors for developing long COVID are largely unknown. As child health is influenced by the environment in which they live and interact, adverse social determinants of health (SDOH) may contribute to the development of pediatric long COVID. Objective: To identify whether adverse SDOH are associated with increased odds of long COVID in school-aged children and adolescents in the US. Design, Setting, and Participants: This cross-sectional analysis of a multicenter, longitudinal, meta-cohort study encompassed 52 sites (health care and community settings) across the US. School-aged children (6-11 years; n = 903) and adolescents (12-17 years; n = 3681) with SARS-CoV-2 infection history were included. Those with an unknown date of first infection, history of multisystem inflammatory syndrome in children, or symptom surveys with less than 50% of questions completed were excluded. Participants were recruited via health care systems, long COVID clinics, fliers, websites, social media campaigns, radio, health fairs, community-based organizations, community health workers, and existing research cohorts from March 2022 to August 2024, and surveys were completed by caregivers between March 2022 and August 2024. Exposure: Twenty-four individual social determinant of health factors were grouped into 5 Healthy People 2030 domains: economic stability, social and community context, caregiver education access and quality, neighborhood and built environment, and health care access and quality. Latent classes were created within each domain and used in regression models. Main Outcomes and Measures: Presence of long COVID using caregiver-reported, symptom-based, age-specific research indices. Results: The mean (SD) age among 4584 individuals included in this study was 14 (3) years, and 2330 (51%) of participants were male. The number of latent classes varied by domain; the reference group was the class with the least adversity. In unadjusted analyses, most classes in each domain were associated with higher odds of long COVID. After adjusting for many factors, including age group, sex, timing of infection, referral source, and other social determinant of health domains, economic instability characterized by difficulty covering expenses, poverty, receipt of government assistance, and food insecurity were associated with an increased risk of having long COVID (class 2 adjusted odds ratio [aOR], 1.57; 95% CI, 1.18-2.09; class 4 aOR, 2.39; 95% CI, 1.73-3.30); economic instability without food insecurity (class 3) was not (aOR, 0.93; 95% CI, 0.70-1.23). Poorer social and community context (eg, high levels of discrimination and low social support) was also associated with long COVID (aOR, 2.17; 95% CI, 1.77-2.66). Sensitivity analyses stratified by age group and adjusted for race and ethnicity did not alter or attenuate these results. Conclusions and Relevance: In this study, economic instability that included food insecurity and poor social and community context were associated with greater odds of pediatric long COVID. Those with food security, despite experiencing other economic challenges, did not have greater odds of long COVID. Further study is needed to determine if addressing SDOH factors can decrease the rate of pediatric long COVID.

Ultrasound is the standard first-line imaging modality for hepatocellular carcinoma (HCC) screening; however, in certain patient populations, sensitivity is limited, and thus alternative strategies are needed in these patients. This article will provide an overview of MR imaging and computed tomography (CT) for the screening of HCC, with an emphasis on abbreviated MR imaging protocols and recent advancements in CT technology (dual energy and photon-counting CT).

PURPOSE: Ultrashort echo time (UTE) MRI enables direct imaging of cortical bone and quantification of its water compartments via bicomponent T₂* modeling. However, conventional approaches require multiple separate dual-echo scans due to limitations in gradient power. This approach is prone to inter-scan inconsistencies such as motion and signal drift, which degrade fitting accuracy. This study proposes an interleaved dual-echo acquisition sequence that acquires multiple echo time (TE) images in a single scan to improve bicomponent T₂* quantification in cortical bone. METHODS: The proposed UTE sequence utilizes interleaved dual-echo acquisitions with flexible TE spacings. This sequence was tested on five healthy subjects' tibial midshafts and compared to conventional separate dual-echo scans with and without image registration. Bicomponent T₂* modeling was performed, and fitting accuracy was evaluated using normalized-root-mean-squared error (NRMSE). Three subjects were scanned three times to evaluate the scan repeatability. RESULTS: The interleaved method significantly reduced NRMSE (3.2% ± 2.3% vs. 6.2% ± 3.1%, p = 0.0231) and yielded lower and more stable T₂* (T_2s*; 0.50 ± 0.10 ms vs. 0.76 ± 0.13 ms, p < 0.0001) and fraction (F_s; 78.2 ± 5.1 vs. 84.2% ± 7.1%, p = 0.0006) of short T₂ components compared to separate scans without registration. Image registration had a minimal improvement on mapping results for separate scans. Parameter maps from the interleaved scans confirmed more homogeneous distributions of T_2s* and F_s with lower fitting errors. The much lower coefficients of variance of the interleaved scans demonstrated improved repeatability compared with separate scans. CONCLUSION: The proposed interleaved UTE dual-echo sequence improves the robustness of bicomponent T₂* mapping of the cortical bone by reducing inter-scan inconsistencies.

Cholangiocarcinoma, a primary epithelial malignancy originating in the biliary tree, can be classified based on anatomical location into intrahepatic and extrahepatic cholangiocarcinoma. Extrahepatic cholangiocarcinoma (eCCA) is the more common of the two. CT and MRI play a central role in the diagnosis, staging, and management of eCCA, yet radiological reporting of eCCA often lacks uniformity and completeness which can hamper optimal treatment decision-making. Standardized reporting including standardized terminology and structured reports can address these shortcomings. Standardization produces clear, concise, and accurate terminology to facilitate communication between radiologists, surgeons, oncologists, pathologists, and interventionalists, which can be particularly important in complex cases where treatment hinges on discerning fine anatomical details. Structured report templates organize reporting elements in ordered sections to ensure consistency and completeness when conveying relevant imaging findings. In this manuscript, we aim to provide guidance on eCCA reporting, discussing the relevance of each proposed reporting element and presenting a recommended and structured eCCA reporting template. The proposed structured report, adapted from the template proposed by the Korean Society of Abdominal Radiology, is tailored particularly to North American clinical practice and addresses additional reporting elements such as background liver information and radial dimension.

Background: Comorbid anxiety disorders (ANX) and major depression (MD) have worse clinical outcomes than either disorder alone. Analysis of genomic data based on comorbidity status may reveal more precise biological pathways and causal relationships with potential clinical implications. We investigated the genetic relationship between ANX and MD with and without mutual comorbidity. Methods: We leveraged data from UK Biobank to perform disorder-specific genome-wide association studies (GWAS) of ANX-only (n=189,422) and MD-only (n=194,339) and generate polygenic risk scores (PRS). The Norwegian Mother, Father, and Child Cohort (MoBa, n = 130,992) served to test the associations of PRS with diagnoses. MD and ANX GWAS, including comorbidities (MD-comorbid and ANX-comorbid), were used for comparison. Genetic correlations were compared by comorbidity status, and Mendelian randomization was employed to assess causal relationships. Results: The MD-only PRS showed a stronger association with MD-only compared to ANX-only cases (Z=3.74; P_adjusted=0.002); however, MD-comorbid PRS did not show a significant difference (Z=2.71; P_adjusted=0.08). The genetic correlation between ANX-only and MD-only was 0.53, lower than between ANX-comorbid and MD-comorbid (0.90). ANX-only showed a causal relationship with MD-only (P_adjusted=0.015), but not vice versa, and contrasted the bidirectional causal relationship (P_adjusted=2.9e-12, and P_adjusted=9.3e-06) when comorbidity was included. Gene sets of MD-comorbid, ANX-comorbid, and MD-only, but not of ANX-only, were enriched for immune regulation pathways such as interleukin production. Conclusions: ANX and MD show more distinct genetics when comorbid cases are excluded, and ANX may be causal for MD. Disorder-specific genetic studies help uncover more relevant biological mechanisms and guide tailored clinical interventions.

Littre hernia is an inguinal or abdominal wall herniation that contains a Meckel’s diverticulum alone or with other intestinal loops. The diagnosis is usually made at surgery, but its pre-operative radiological recognition has been a challenge due to inherent difficulties in detecting the Meckel’s diverticulum within hernial content. The aim of this article is to present 8 adults in whom a Meckel’s diverticulum protruding into their inguinal, umbilical or incisional hernia had been demonstrated by barium examination of the small bowel or colon, or on computed tomography and magnetic resonance imaging of the abdomen and pelvis. This series included 7 men and 1 woman, who ranged in age from 34 to 78 years (mean age:57 years). Seven patients had subsequent hernia repair, when the diverticulum was visualized and resected. This report highlights the imaging features of these 8 Littre hernias since only 5% of published cases had been diagnosed pre-operatively because the Meckel’s diverticulum had resulted in complications. It also reviews the pertinent literature regarding the prevalence and clinical implications of this rare entity.Graphical abstract

“Just Accepted” papers have undergone full peer review and have been accepted for publication in Radiology. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content.