BackgroundDetection of foreign bodies (FBs) is challenging. Selection of a fast and affordable imaging modality to locate the FB with minimal patient radiation dose is imperative.ObjectivesThis study sought to compare four commonly used imaging modalities namely cone beam computed tomography (CBCT), magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound (US) for detection of FBs in the head and neck region.Materials and MethodsIn this in vitro study, iron, glass, stone, wood, asphalt, and tooth samples measuring 0.1 × 0.5 × 0.5 cm were placed in the tongue muscle, soft tissue-bone interface and nasal cavity in a fresh sheep’s head and subjected to MRI, US, CT and CBCT. A total of 20 images were captured by each imaging system from the six materials in the afore-mentioned locations. The images were observed by an expert oral and maxillofacial radiologist and a general radiologist. To assess reliability, 20 images were randomly observed by the observers in two separate sessions. The images were classified into three groups of good visibility, bad visibility and invisible. The data were analyzed using SPSS version 18, Wilcoxon Signed Rank, Pearson chi square, and Fisher’s exact tests.ResultsAll FBs in the tongue and at the soft tissue-bone interface had good visibility on US (P = 1.00). Also, CBCT and CT had significantly different performance regarding FB detection (P < 0.001). All wooden samples in the nasal cavity were invisible on CT scans; while, only 20% of them were invisible on CBCT scans. MRI showed significant differences for detection of FBs in the three locations (P < 0.001). MRI could not locate iron samples due to severe artifacts and only showed their presence (bad visibility) but other FBs except for wood and tooth in the nasal cavity (100% invisible) had good visibility on MRI.ConclusionsUltrasound is recommended as the first choice when FB is located within the superficial soft tissues with no bone around it. In case of penetration of FB into deeper tissues or beneath bone, CT or CBCT are recommended. Otherwise, considering lower dose, CBCT is preferred over CT. We can use MRI if the FB is not ferromagnetic. However, CT is the first choice in emergency situations because of higher sensitivity.

ImportanceThe optimal treatment of intermediate-high–risk pulmonary embolism (PE) remains unknown.ObjectiveTo assess the effect of conventional catheter-directed thrombolysis (cCDT) plus anticoagulation vs anticoagulation monotherapy in improving echocardiographic measures of right ventricle (RV) to left ventricle (LV) ratio in acute intermediate-high–risk PE.Design, Setting, and ParticipantsThe Catheter-Directed Thrombolysis vs Anticoagulation in Patients with Acute Intermediate-High–Risk Pulmonary Embolism (CANARY) trial was an open-label, randomized clinical trial of patients with intermediate-high–risk PE, conducted in 2 large cardiovascular centers in Tehran, Iran, between December 22, 2018, through February 2, 2020.InterventionsPatients were randomly assigned to cCDT (alteplase, 0.5 mg/catheter/h for 24 hours) plus heparin vs anticoagulation monotherapy.Main Outcomes and MeasuresThe proportion of patients with a 3-month echocardiographic RV/LV ratio greater than 0.9, assessed by a core laboratory, was the primary outcome. The proportion of patients with an RV/LV ratio greater than 0.9 at 72 hours after randomization and the 3-month all-cause mortality were among secondary outcomes. Major bleeding (Bleeding Academic Research Consortium type 3 or 5) was the main safety outcome. A clinical events committee, masked to the treatment assignment, adjudicated clinical outcomes.ResultsThe study was prematurely stopped due to the COVID-19 pandemic after recruiting 94 patients (mean [SD] age, 58.4 [2.5] years; 27 women [29%]), of whom 85 patients completed the 3-month echocardiographic follow-up. Overall, 2 of 46 patients (4.3%) in the cCDT group and 5 of 39 patients (12.8%) in the anticoagulation monotherapy group met the primary outcome (odds ratio [OR], 0.31; 95% CI, 0.06-1.69; P = .24). The median (IQR) 3-month RV/LV ratio was significantly lower with cCDT (0.7 [0.6-0.7]) than with anticoagulation (0.8 [0.7-0.9); P = .01). An RV/LV ratio greater than 0.9 at 72 hours after randomization was observed in fewer patients treated with cCDT (13 of 48 [27.0%]) than anticoagulation (24 of 46 [52.1%]; OR, 0.34; 95% CI, 0.14-0.80; P = .01). Fewer patients assigned to cCDT experienced a 3-month composite of death or RV/LV greater than 0.9 (2 of 48 [4.3%] vs 8 of 46 [17.3%]; OR, 0.20; 95% CI, 0.04-1.03; P = .048). One case of nonfatal major gastrointestinal bleeding occurred in the cCDT group.Conclusions and RelevanceThis prematurely terminated randomized clinical trial of patients with intermediate-high–risk PE was hypothesis-generating for improvement in some efficacy outcomes and acceptable rate of major bleeding for cCDT compared with anticoagulation monotherapy and provided support for a definitive clinical outcomes trial.Trial RegistrationClinicalTrials.gov Identifier: NCT05172115

The Coronavirus disease 2019 (COVID-19) presents open questions in how we clinically diagnose and assess disease course. Recently, chest computed tomography (CT) has shown utility for COVID-19 diagnosis. In this study, we developed Deep COVID DeteCT (DCD), a deep learning convolutional neural network (CNN) that uses the entire chest CT volume to automatically predict COVID-19 (COVID+) from non-COVID-19 (COVID−) pneumonia and normal controls. We discuss training strategies and differences in performance across 13 international institutions and 8 countries. The inclusion of non-China sites in training significantly improved classification performance with area under the curve (AUCs) and accuracies above 0.8 on most test sites. Furthermore, using available follow-up scans, we investigate methods to track patient disease course and predict prognosis.

Pheochromocytoma is a rare, catecholamine-secreting tumor of neuroendocrine cells. It has been documented to present atypically as myocardial ischemia, arrhythmias, or congestive heart failure. We present the case of a patient who had transient cardiomyopathy with hypokinesia of the basal portions of the left ventricle and hyperkinesia of the apex triggered by a pheochromocytoma crisis similar to that of tako-tsubo cardiomyopathy, but with an inverse left ventricular contractile pattern ('inverted tako-tsubo'). (Cardiol J 2012; 19, 5: 527-531)