Magnetic Resonance Imaging (MRI)

1H-MR spectra of 3 consecutive patients with COVID-19. Upper row: Axial FLAIR images at the corona radiata level show representative MRS voxels (black squares) from sampled periventricular regions. Lower row: Corresponding spectrum (black) and LCModel fit (red) from each patient acquired at TE = 30 ms (upper row) and TE = 288 ms (lower row). A, A patient with COVID-19-associated multifocal necrotizing leukoencephalopathy shows diffuse patchy WM lesions with markedly increased Cho and decreased NAA, as well as elevated Lac. B, A patient with COVID-19 after recent PEA cardiac arrest with subtle FLAIR hyperintense white matter changes also shows elevated Cho/Cr and decreased NAA/Cr ratios. However, these derangements are less severe than in the patient in A. There is no clear elevation of Lac. C, A patient with COVID-19 without encephalopathy or recent severe hypoxia has normal Cho/Cr, with mildly decreased NAA/Cr and no lactate elevation. Cho, Choline; NAA, N-Acetyl-Aspartate; mI, Myo-Inositol; Lac, Lactate; Glx, Glutamate + Glutamine. Image courtesy of AJNR

(A) The fMRI hyperscanning environment. The clinician (1) and patient (2) were positioned in two different 3T MRI scanners. An audio-video link enabled online communication between the two scanners (3), and video images were used to extract frame-by-frame facial expression metrics. During simultaneous acquisition of blood oxygen level–dependent (BOLD)–fMRI data, the clinician used a button box (4) to apply electroacupuncture (EA) treatment (real/sham, double-blind) to the patient (5) to alleviate evoked pressure pain to the leg (6; Hokanson cuff inflation). Pain and affect related to the treatment were rated after each trial. (B) Study overview. After an initial behavioral visit, each individual participated in a Clinical-Interaction (hyperscan preceded by a clinical intake) and No-Interaction condition (hyperscan without a preceding intake), in a counterbalanced order, with two different partners. (C) Experimental protocol. Each hyperscan was composed of 12 repeated trials (four verum EA, four sham EA, and four no treatment) in a pseudo-randomized order. After a resting period (far left), both participants were shown a visual cue to indicate whether the next pain stimulus would be treated (green frame) or not treated (red frame) by the clinician. These cues prompted clinicians prepare to either apply or not apply treatment while evoking corresponding anticipation for the patient. Following the anticipation cue, moderately painful pressure pain was applied to the patient’s left leg, while the clinician applied or did not apply treatment, respectively. After another resting period, participants rated pain (patients), vicarious pain (clinicians), and affect (both) using a visual analog scale (VAS).

Lesion was originally reported as indeterminate enhancing mass, and outside report recommended biopsy. Classic features of benign hemangioma are shown. Error was attributed to faulty reasoning. A, Axial MR image obtained 5 minutes after contrast agent administration shows peripheral nodular discontinuous enhancement. B, Axial MR image obtained 10 minutes after contrast agent administration shows centripetal progression of enhancement (arrow). C, Axial fast imaging employing steady-state acquisition (FIESTA) MR image shows lesion is homogeneously hyperintense compared with liver parenchyma. Image courtesy of American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR)