The coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has affected almost every country in the world resulting in severe morbidity, mortality and economic hardship, altering the landscape of healthcare forever. Its devastating and most frequent thoracic and cardiac manifestations have been well reported since the start of the pandemic. Its extra-thoracic manifestations are myriad and understanding them is critical in diagnosis and disease management. The role of radiology is growing in the second wave and second year of the pandemic as the multiorgan manifestations of COVID-19 continue to unfold. Musculoskeletal, neurologic and vascular disease processes account for a significant number of COVID-19 complications and understanding their frequency, clinical sequelae and imaging manifestations is vital in guiding management and improving overall survival. The authors aim to provide a comprehensive overview of the pathophysiology of the virus along with a detailed and systematic imaging review of the extra-thoracic manifestation of COVID-19. In Part I, abdominal manifestations of COVID-19 in adults and multisystem inflammatory syndrome in children will be reviewed. In Part II, manifestations of COVID-19 in the musculoskeletal, central nervous and vascular systems will be reviewed.
Standard radiography of the cervical spine is still the first imaging procedure applied in degenerative disease of the cervical spine. Spondylosis deformans, osteochondrosis and uncovertebral arthrosis are well depicted by such images. Whether or not additional imaging is needed depends on the clinical symptoms. Special projections (anteroposterior oblique radiographs, lateral radiographs in flexion and extension) may be the next step. For many abnormalities, mainly of the intervertebral discs and the myelon, MR imaging has become the standard procedure, largely because of its multiplanar capabilities and its excellent contrast resolution. CT can be used instead of MR imaging if the latter method is not available, and its strength lies in the depiction of bone abnormalities. Scintigraphy is suitable for early detection of abnormalities with unclear clinical symptoms and may then indicate the correct level of the cervical spine for MR imaging or CT. Myelograms and myelo-CT can no longer be considered routine imaging methods. A number of imaging abnormalities are not strictly related to clinical findings and should therefore always be discussed in the clinical context.
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