Ruhi Erdem Ergüden

Background/Objectives: Myocarditis is a recognized complication of COVID-19 infection, with potential long-term cardiac sequelae. While acute cardiac involvement has been frequently reported, late-stage myocardial effects remain less well characterized. Cardiac magnetic resonance (CMR) imaging, particularly T1 and T2 mapping, offers non-invasive tissue characterization for myocardial inflammation and fibrosis. This study aimed to evaluate segmental myocardial tissue changes in patients with late-stage COVID-19–related myocarditis using CMR and compare findings with patients with non-COVID-19 myocarditis and healthy controls. Methods: This retrospective, single-center study included 25 patients with clinically suspected COVID-19 myocarditis who underwent CMR between 36 and 565 days post-infection. T1 and T2 mapping values and late gadolinium enhancement (LGE) patterns were assessed and compared with 14 non-COVID-19 myocarditis patients and 19 healthy controls. Subgroup analyses were performed according to vaccination status and left ventricular ejection fraction (LVEF). Results: Patients with reduced LVEF had significantly higher T1 and T2 values in several myocardial segments. Compared to controls, the COVID-19 myocarditis group showed significantly elevated T1 values in all segments except 2 and 3. No significant difference in T2 values was observed. LGE was present in 61% of COVID-19 myocarditis patients, predominantly with a subepicardial pattern. No significant differences were observed between vaccinated and unvaccinated patients. Conclusions: Late-stage COVID-19 myocarditis is associated with persistent segmental myocardial tissue abnormalities, particularly elevated T1 values and subepicardial LGE. Segmental CMR mapping may provide additional diagnostic value in identifying residual myocardial injury in patients with ongoing cardiac symptoms after COVID-19 infection.

Objectives: This study aimed to evaluate whether serum creatine kinase (CK) levels in patients with earthquake-related crush injuries are associated with alterations in renal enhancement patterns on contrast-enhanced computed tomography (CT), in the absence of overt acute kidney injury (AKI). Methods: We retrospectively analyzed contrast-enhanced abdominopelvic CT scans of 45 adult survivors with crush injuries sustained during the 2023 earthquakes. Based on CK levels, patients were stratified into low- and high-risk groups for AKI. A control group with normal renal function and no trauma history was included. Renal perfusion was assessed by calculating enhancement ratios—specifically, the cortex-to-aorta and normalized medulla-to-cortex ratios—derived from attenuation measurements of the renal cortex, medulla, and vascular reference points. Correlation analyses were conducted to assess associations with biochemical parameters. Results: Although none of the trauma patients developed AKI during follow-up, the cortex-to-aorta attenuation ratio was significantly lower in the high-risk group compared to controls (P = .042). A weak negative correlation was observed between serum CK levels and the cortex-to-aorta ratio (r = −0.295, P = .049). The normalized medulla-to-cortex ratio did not significantly differ between groups. Conclusions: Contrast-enhanced CT may detect subclinical reductions in renal cortical perfusion in crush injury patients with elevated CK, even without overt AKI. The cortex-to-aorta attenuation ratio may serve as a noninvasive imaging marker of early renal involvement and warrants further investigation. Advances in knowledge: Renal cortical hypoperfusion can be visualized on contrast-enhanced CT in asymptomatic crush injury patients, highlighting a novel radiologic marker for subclinical renal involvement.

Objective: Sympathetic nervous system hyperactivation in chronic conditions, such as hypertension and metabolic syndrome, can lead to carotid body (CB) hyperplasia, potentially mimicking small carotid body tumours (CBTs) in radiological evaluations. This study aimed to investigate CT angiography (CTA) findings to differentiate CBTs from non-neoplastic CBs. Methods: Patients were categorized into CBT and non-neoplastic CB groups. Demographics (smoking status, hypertension, diabetes mellitus), shape, dimensions, volume, and density (including standard deviations) were assessed. Density ratios were calculated using CB/CBT and ipsilateral common carotid artery density. Diagnostic performance was evaluated via ROC analysis, and logistic regression identified factors associated with increased CBT risk. Results: Significant differences between the CB and CBT groups were found in gender, smoking status, and shape (P < .01), while age, location, hypertension, and diabetes mellitus showed no association (P > .05). The CBT group had significantly higher density, standard deviation, and density ratios (P < .001). Multivariate analysis, adjusted for age, gender, and smoking, showed that saddle shape, standard deviation ≥21.5, and density ratio ≥0.5603 predicted CBT diagnosis with 92.6% sensitivity and 99.3% specificity. Conclusions: Saddle shape, along with increased density and standard deviation values, emerges as findings suggestive of a CBT diagnosis. The proposed imaging features may improve differentiation of small CBTs from non-neoplastic CBs, particularly in cases with enlarged CBs lacking typical tumour features. Advances in knowledge: Specific CTA findings, including saddle shape, increased density, and standard deviation, can effectively differentiate small CBTs from non-neoplastic CBs, offering a novel approach to improving radiological diagnostics in cases with CB hyperplasia.