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Background Pilocytic astrocytoma, medulloblastoma, and ependymoma are the most common pediatric CNS tumors seen at posterior cranial fossa and final diagnosis obtained by histopathology after surgical excision. Routine MRI study gives an idea about site and extension of the tumors but provide a little information about type and grade of tumors. ADC ratio had high sensitivity and specificity in differentiation between these tumors as regard type and grade according to tumor cellularity. Patients and methods Prospective study conducted on thirty pediatric patients (11 males and 19 females) with CNS posterior fossa masses, their ages ranged from 2 to 17 years (mean age of 8.7 years), conventional MRI, DWI, ADC value, and ADC ratio were done for all patients. Results ADC values were significantly different between pilocytic astrocytomas (1.43 ± 0.28 × 10−3) and medulloblastomas (0.71 ± 0. 21 × 10−3) with a P value < 0.001, also there was a significant difference when comparing medulloblastomas (0.71 ± 0.21 × 10−3) with ependymomas (1.04 × 10−3 ± 0.21) with a P value < 0.001. ADC ratio at a cutoff > 1.7 showed significant good power of discrimination of astrocytoma (AUC = 0.85) from ependymoma with 87.5% sensitivity and 93.3% specificity. Similarly, at cutoff ≤ 1.6-> 1.2 was a significant good predictor of ependymoma (AUC = 0.85) with 87.8% sensitivity and 99.5% specificity. While, ADC ratio ≤ 1.2 was significant excellent discriminator of medulloblastoma (AUC = 0.99) with 100% sensitivity and 90% specificity. Conclusion ADC ratio is a simple way used in distinguishing juvenile pilocytic astrocytoma, ependymoma, and medulloblastoma, which are the most frequent pediatric posterior fossa tumors. Cutoff ADC ratio of more than 1.7 characteristic of JPA with 87.5% sensitivity and 93.3% specificity, ADC ratio less than 1.1 characteristic of medulloblastoma with 100% sensitivity and 90% specificity. ADC ratios more than 1.1 and less than 1.7 characteristic of ependymoma with 87.8% sensitivity and 99.5% specificity. We recommended ADC ratio as a routine study in evaluation of pediatric CNS posterior fossa tumors.

Introduction: Multifocal fatty liver infiltrations are not uncommon ultrasonographic finding; they are explained by the presence of aberrant vascular supply independent of the portal circulation or insulin resistance. Aim: To study the significance of this ultrasonographic finding. Methods: A study group ( n = 96) with multifocal fatty liver and two control groups: healthy subjects ( n = 100) and patients with diffuse fatty liver disease ( n = 100) were enrolled. They were tested for fasting blood glucose, lipid profile, transaminases, serum insulin, glycated hemoglobin, Homeostatic Model Assessment of Insulin Resistance, high-sensitivity C-reactive protein and liver stiffness in Fibroscan. Results: Patients with multifocal fatty liver showed a statistically significant higher values of serum transaminases, markers of insulin resistance, high-sensitivity C-reactive protein, and neutrophil lymphocyte ratio ( p <0.05). Lipid profile parameters were significantly higher ( p <0.05). Mean liver stiffness (9.8 ± 1.2 kPa) and carotid intima media thickness (1.16 ± 0.2 mm) were significantly higher when compared to healthy subjects and patients with diffuse fatty liver disease. Independent predictors of insulin resistance and premature carotid atherosclerosis in patients with multifocal fatty liver disease were: serum gamma-glutamyl transferase (odds ratio 1.69), high-sensitivity C-reactive protein (odds ratio 1.62), uric acid (odds ratio 1.55), very low-density lipoprotein (odds ratio 1.74), total cholesterol/high-density lipoprotein (odds ratio 1.58) and severity of liver stiffness measured by Fibroscan (odds ratio 1.9). Conclusions: Multifocal fatty liver is an aggressive form of nonalcoholic fatty liver disease and should be considered a radiological sign of insulin resistance that needs special attention and management.

Background After the spread of COVID-19 pneumonia, chest CT examination was used as a substantial non-invasive complement to RT-PCR for diagnosing and as a rapid screening tool when RT-PCR results are unavailable. Our study aimed at the analysis of the lung abnormalities detected by chest CT in COVID-19 pneumonia according to the severity and duration of symptoms. Results In the early phase (n = 60), 32 patients had negative CT findings and 28 patients had positive findings with a mean total lung severity score of 2.13. In the intermediate phase (n = 116), 4 patients had negative CT findings and 112 patients had positive findings with a mean total lung severity score of 16.08. In the late phase (n = 36), all patients had positive findings with a mean total lung severity score of 17.83. CT lung abnormalities were progressed on follow-up CT studies. We found a high total lung severity score in many patients with mild symptoms with a mean of 14.77 and a low total lung severity score in many patients with moderate to severe symptoms with a mean of 9.14. Conclusion Chest CT should be used as a routine examination for diagnosing COVID-19 pneumonia and follow-up of disease advance. The progression of lung abnormalities was related to the duration more than the severity of symptoms.

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