ABSTRACT
Objective@#This study aimed to evaluate the effect of implementing the consensus statement from the Asian Society of Cardiovascular Imaging-Practical Tutorial 2020 (ASCI-PT 2020) on the reliability of cardiac MR with late gadolinium enhancement (CMR-LGE) myocardial viability scoring between observers in the context of ischemic cardiomyopathy. @*Materials and Methods@#A total of 17 cardiovascular imaging experts from five different countries evaluated CMR obtained in 26 patients (male:female, 23:3; median age [interquartile range], 55.5 years [50–61.8]) with ischemic cardiomyopathy. For LGE scoring, based on the 17 segments, the extent of LGE in each segment was graded using a five-point scoring system ranging from 0 to 4 before and after exposure according to the consensus statement. All scoring was performed via webbased review. Scores for slices, vascular territories, and total scores were obtained as the sum of the relevant segmental scores. Interobserver reliability for segment scores was assessed using Fleiss’ kappa, while the intraclass correlation coefficient (ICC) was used for slice score, vascular territory score, and total score. Inter-observer agreement was assessed using the limits of agreement from the mean (LoA). @*Results@#Interobserver reliability (Fleiss’ kappa) in each segment ranged 0.242–0.662 before the consensus and increased to 0.301–0.774 after the consensus. The interobserver reliability (ICC) for each slice, each vascular territory, and total score increased after the consensus (slice, 0.728–0.805 and 0.849–0.884; vascular territory, 0.756–0.902 and 0.852–0.941; total score, 0.847 and 0.913, before and after implementing the consensus statement, respectively. Interobserver agreement in scoring also improved with the implementation of the consensus for all slices, vascular territories, and total score. The LoA for the total score narrowed from ± 10.36 points to ± 7.12 points. @*Conclusion@#The interobserver reliability and agreement for CMR-LGE scoring for ischemic cardiomyopathy improved when following guidance from the ASCI-PT 2020 consensus statement.
ABSTRACT
This document is the third part of the guidelines for the interpretation and post-processing of cardiac magnetic resonance (CMR) studies. These consensus recommendations have been developed by a Consensus Committee of the Korean Society of Cardiovascular Imaging (KOSCI) to standardize the requirements for image interpretation and post-processing of CMR. This third part of the recommendations describes tissue characterization modules, including perfusion, late gadolinium enhancement, and T1- and T2 mapping. Additionally, this document provides guidance for visual and quantitative assessment, consisting of “What-to-See,” “How-To,” and common pitfalls for the analysis of each module. The Consensus Committee hopes that this document will contribute to the standardization of image interpretation and post-processing of CMR studies.
ABSTRACT
The clinical manifestation of pericardial disease is similar to that of coronary artery disease and aortic disease. Therefore, a timely and accurate diagnosis is necessary. The pericardium is a 2-layered membrane that envelops the heart and great vessels, and there are numerous anatomic variations and pathologic conditions. Large or unusually located pericardial recesses can be easily mistaken for abnormal findings. Additionally, primary pericardial diseases resulting from infections, tumors, and injuries are possible; further, diseases can quickly spread along the pericardium. Echocardiography is generally the first imaging tool used to evaluate the pericardium. However, it has limited windows and poor resolution. Besides, the evaluation of postoperative echocardiography is sometimes limited. Currently, CT and MR imaging are useful for evaluating pericardial diseases. Detailed knowledge of the pericardium is important for interpreting the images and clinical results.
ABSTRACT
The clinical manifestation of pericardial disease is similar to that of coronary artery disease and aortic disease. Therefore, a timely and accurate diagnosis is necessary. The pericardium is a 2-layered membrane that envelops the heart and great vessels, and there are numerous anatomic variations and pathologic conditions. Large or unusually located pericardial recesses can be easily mistaken for abnormal findings. Additionally, primary pericardial diseases resulting from infections, tumors, and injuries are possible; further, diseases can quickly spread along the pericardium. Echocardiography is generally the first imaging tool used to evaluate the pericardium. However, it has limited windows and poor resolution. Besides, the evaluation of postoperative echocardiography is sometimes limited. Currently, CT and MR imaging are useful for evaluating pericardial diseases. Detailed knowledge of the pericardium is important for interpreting the images and clinical results.
ABSTRACT
Cardiac magnetic resonance (CMR) imaging is widely used in many areas of cardiovascular disease assessment. This is a practical, standard CMR protocol for beginners that is designed to be easy to follow and implement. This protocol guideline is based on previously reported CMR guidelines and includes sequence terminology used by vendors, essential MR physics, imaging planes, field strength considerations, MRI-conditional devices, drugs for stress tests, various CMR modules, and disease/symptom-based protocols based on a survey of cardiologists and various appropriate-use criteria. It will be of considerable help in planning and implementing tests. In addressing CMR usage and creating this protocol guideline, we particularly tried to include useful tips to overcome various practical issues and improve CMR imaging. We hope that this document will continue to standardize and simplify a patient-based approach to clinical CMR and contribute to the promotion of public health.
Subject(s)
Cardiovascular Diseases , Commerce , Exercise Test , Heart , Hope , Magnetic Resonance Imaging , Public HealthABSTRACT
Cardiovascular magnetic resonance imaging (CMR) is expected to be increasingly used in Korea due to technology advances and the expanded national insurance coverage of these tests. For improved patient care, it is crucial not only that CMR images are properly acquired but that they are accurately interpreted by well-trained personnel. In response to the increased demand for CMR, the Korean Society of Cardiovascular Imaging (KOSCI) has issued interpretation guidelines in conjunction with the Korean Society of Radiology (KSR). KOSCI has also created a formal Committee on CMR Guidelines to write updated practices. The members of this Committee review previously published interpretation guidelines and discuss the patterns of CMR use in Korea.
Subject(s)
Angiography , Heart , Insurance Coverage , Korea , Magnetic Resonance Imaging , Patient CareABSTRACT
This document is the third part of the guidelines for the protocol, the interpretation and post-processing of cardiac magnetic resonance (CMR) studies. These consensus recommendations have been developed by the Consensus Committee of the Korean Society of Cardiovascular Imaging to standardize the requirements for image interpretation and post-processing of CMR. This third part of the recommendations describes tissue characterization modules, including perfusion, late gadolinium enhancement, and T1- and T2 mapping. Additionally, this document provides guidance for visual and quantitative assessment consisting of “What-to-See,” “How-To,” and common pitfalls for the analysis of each module. The Consensus Committee hopes that this document will contribute to the standardization of image interpretation and post-processing of CMR studies.
Subject(s)
Consensus , Gadolinium , Hope , Magnetic Resonance Imaging , PerfusionABSTRACT
Cardiac magnetic resonance (CMR) imaging is widely used in many areas of cardiovascular disease assessment. This is a practical, standard CMR protocol for beginners that is designed to be easy to follow and implement. This protocol guideline is based on previously reported CMR guidelines and includes sequence terminology used by vendors, essential MR physics, imaging planes, field strength considerations, MRI-conditional devices, drugs for stress tests, various CMR modules, and disease/symptom-based protocols based on a survey of cardiologists and various appropriate-use criteria. It will be of considerable help in planning and implementing tests. In addressing CMR usage and creating this protocol guideline, we particularly tried to include useful tips to overcome various practical issues and improve CMR imaging. We hope that this document will continue to standardize and simplify a patient-based approach to clinical CMR and contribute to the promotion of public health.
Subject(s)
Cardiovascular Diseases , Commerce , Exercise Test , Heart , Hope , Magnetic Resonance Imaging , Public HealthABSTRACT
Cardiovascular magnetic resonance imaging (CMR) is expected to be increasingly used in Korea due to technological advances and the expanded national insurance coverage of CMR assessments. For improved patient care, proper acquisition of CMR images as well as their accurate interpretation by well-trained personnel are equally important. In response to the increased demand for CMR, the Korean Society of Cardiovascular Imaging (KOSCI) has issued interpretation guidelines in conjunction with the Korean Society of Radiology. KOSCI has also created a formal Committee on CMR guidelines to create updated practices. The members of this committee review previously published interpretation guidelines and discuss the patterns of CMR use in Korea.
Subject(s)
Angiography , Heart , Insurance Coverage , Korea , Magnetic Resonance Imaging , Patient CareABSTRACT
This is to report the technique of reversed iliac leg stent-graft in endovascular treatment for isolated internal iliac artery (IIA) aneurysm, which had significant size discrepancy between the common iliac artery (CIA) and external iliac artery (EIA) in 3 patients from different hospitals. Three patients were a 85- and two 82-year-old men. Treated were right IIA aneurysms, sized 6.5x6.2 cm, 5.0x4.0 cm, and 4.1 cm in longest diameter, respectively. The diameters of the right CIA and right EIA measured 21 mm/11 mm, 15 mm/11 mm, and 20 mm/10 mm, respectively. In all cases, reversed iliac leg stent-grafts were prepared on-site; unsheathed and mounted upside-down manually, and deployed in each right CIA. Post-stent-graft angiograms showed complete exclusion of the aneurysms, except for minimal type 1 endoleak in one case. This technique is a useful treatment option in patients with isolated IIA aneurysm.
Subject(s)
Aged, 80 and over , Humans , Male , Aneurysm , Endoleak , Endovascular Procedures , Iliac Aneurysm , Iliac Artery , LegABSTRACT
Spontaneous pneumomediastinum is an uncommon disorder, and usually affects young men and has a benign course. Common triggers are asthma, the smoking of illicit drugs, the Valsalva maneuver, and respiratory infections. Most cases are usually due to alveolar rupture into the pulmonary interstitium caused by excess pressure. The air dissects to the hilum along the peribronchovascular sheaths and spreads into the mediastinum. However, pneumomediastinum following pharyngeal perforation is very rare, and has only been reported in relation to dental procedures, head and neck surgery, or trauma. We report a case of pneumomediastinum that developed in a 43-year-old patient with pharyngeal perforation after shouting. His course was complicated by mediastinitis and parapneumonic effusions.
Subject(s)
Adult , Humans , Male , Mediastinal Emphysema/diagnosis , Mediastinitis/diagnosis , Pharynx/injuriesABSTRACT
PURPOSE: To report our clinical experience with cardiac 3.0 T MRI in patients compared with 1.5 T using individually optimized imaging protocols. MATERIALS AND METHODS: We retrospectively reviewed 30 consecutive patients and 20 consecutive patients who underwent 1.5 T and 3 T cardiac MRI within 10 months. A comparison study was performed by measuring the signal-to-noise ratio (SNR), the contrast-to-noise ratio (CNR) and the image quality (by grading each sequence on a 5-point scale, regarding the presence of artifacts). RESULTS: In morphologic and viability studies, the use of 3.0 T provided increase of the baseline SNRs and CNRs, respectively (T1: SNR 29%, p < 0.001, CNR 37%, p < 0.001; T2-SPAIR: SNR 13%, p = 0.068, CNR 18%, p = 0.059; viability imaging: SNR 45%, p = 0.017, CNR 37%, p = 0.135) without significant impairment of the image quality (T1: 3.8 +/- 0.9 vs. 3.9 +/- 0.7, p = 0.438; T2-SPAIR: 3.8 +/- 0.9 vs. 3.9 +/- 0.5, p = 0.744; viability imaging: 4.5 +/- 0.8 vs. 4.7 +/- 0.6, p = 0.254). Although the image qualities of 3.0 T functional cine images were slightly lower than those of 1.5 T images (3.6 +/- 0.7 vs. 4.2 +/- 0.6, p < 0.001), the mean SNR and CNR at 3.0 T were significantly improved (SNR 143% increase, CNR 108% increase, p < 0.001). With our imaging protocol for 3.0 T perfusion imaging, there was an insignificant decrease in the SNR (11% decrease, p = 0.172) and CNR (7% decrease, p = 0.638). However, the overall image quality was significantly improved (4.6 +/- 0.5 vs. 4.0 +/- 0.8, p = 0.006). CONCLUSION: With our experience, 3.0 T MRI was shown to be feasible for the routine assessment of cardiac imaging.
Subject(s)
Humans , Perfusion Imaging , Retrospective Studies , Signal-To-Noise RatioABSTRACT
A 60-year-old man visited our hospital because of the incidentally found mass of the rib on chest radiography. Chest X-ray showed expansile bony hypertrophy on left 5th rib and bone setting of the computed tomography scan of chest revealed 4.2x2.5 cm sized, elongated bony expansion with geographic radiolucent lesion in the medullary cavity and cortical thinning. Technetium-99m bone scintigraphy showed diffusely increased radioactivity along the left 5th rib. We present this case to discuss about a possible differential diagnosis in this type of lesion.
Subject(s)
Bone Neoplasms , Diagnosis, Differential , Hypertrophy , Radioactivity , Ribs , ThoraxABSTRACT
We report the case of a 68-year-old man with a stromal tumor of uncertain malignant potential (STUMP), which had metastasized to the lung. The patient complained of an enlarged mass in the anterior chest. Chest computed tomography (CT) showed a sternal abscess with multiple nodules in both lungs. A thoracoscopic lung biopsy of the nodules and incision/drainage of the sternal mass were performed simultaneously. CT of the pelvis revealed an enlarged prostate with irregular cystic lesions in the pelvis. Prostate biopsy was done and demonstrated hypercellular stroma with minimal cytological atypia, a distinct pattern of STUMP. The sternal abscess proved to be tuberculosis and the lung lesion was consistent with STUMP, which had spread from the prostate. However, to our knowledge, the tuberculous abscess might not be assoicated with STUMP in the lung. The patient refused surgical prostatectomy and was discharged with anti-tuberculosis medication. On one-year follow up, the patient had no evidence of disease progression.
Subject(s)
Aged , Humans , Abscess , Biopsy , Disease Progression , Follow-Up Studies , Lung , Neoplasm Metastasis , Pelvis , Prostate , Prostatectomy , Prostatic Neoplasms , Stromal Cells , Thorax , TuberculosisABSTRACT
A 39-year-old woman was admitted to our hospital because of her chronic cough. She had undergone modified radical mastectomy for breast cancer 7 year before admission. A chest radiograph showed collapse of the left upper lobe (LUL) and computed tomography of the chest revealed a mass in the proximal portion of the LUL bronchus and distal atelectasis. Bronchoscopy showed obstruction of the LUL bronchus. The microscopic examination showed findings consistent with breast cancer with the same immunohistochemical features for the hormone receptors, as compared to those features of the previously resected tumor. Positron emission tomography showed increased fluorodeoxyglucose uptake only in the LUL. Left upper lobectomy was performed and she is now undergoing systemic chemotherapy. We report here on this rare case to emphasize that when a patient with a history of breast cancer complains of respiratory symptoms, and even though the patient was treated curatively a long time ago, we should suspect the possibility of endobronchial metastasis.
Subject(s)
Adult , Female , Humans , Breast , Breast Neoplasms , Bronchi , Bronchoscopy , Cough , Lung Neoplasms , Mastectomy, Modified Radical , Neoplasm Metastasis , Positron-Emission Tomography , Pulmonary Atelectasis , ThoraxABSTRACT
PURPOSE: Recently as ultrasonography is increasingly used to evaluate lower urinary tract symptoms (LUTS) in the elderly patients, prostatic calculi are more often revealed; however, the mechanism of formation of prostatic calculi is not clearly known, and their impacts on LUTS are controversial. We investigated whether the type and location of prostatic calculi might influence LUTS in benign prostatic hyperplasia (BPH) patients. MATERIALS AND METHODS: From July 2003 to January 2008, 1,437 consecutive patients underwent transrectal ultrasonography. Of these patients 383 with clinical BPH were retrospectively studied. According to the type (type A: a discrete small reflection; type B: a large mass of multireflection; type M: mixed) and location (periurethral vs. non-periurethral) of prostatic calculi, the serum prostate-specific antigen (PSA) levels, volume of prostate, maximum urinary flow rate and residual urine volume, and International Prostate Symptom Score (IPSS) were compared. RESULTS: Prostatic calcification was found in 70% (268/383), and type A in 38%, type B in 46% and type M in 16%. There was no significant difference according to the presence or types of prostatic calcification, comparing serum PSA levels, volume of prostate, maximum urinary flow rate and residual urine volume. And there was no significant correlation between the types of prostatic calcificaton and each item of IPSS. Periurethral and non-periurethral prostatic calcification failed to show the significant difference in each items of IPSS. CONCLUSIONS: There is no significant difference in LUTS according to presence, types, or locations of prostatic calculi in clinical BPH patients.
Subject(s)
Aged , Humans , Calculi , Lower Urinary Tract Symptoms , Prostate , Prostate-Specific Antigen , Prostatic Hyperplasia , Retrospective Studies , UltrasonographyABSTRACT
Malignant mesothelioma is the most common primary malignant tumor involving pleura, but its diagnosis is difficult to determine by pathology in addition to the fact that it is rare. We present an unusual case of malignant mesothelioma, which initially presented as large neck mass contrary to the more common presentation of a rind like growth along the pleura demonstrated on imaging and by pathologic findings.
Subject(s)
Mesothelioma , Neck , PleuraABSTRACT
A traumatic pulmonary pseudocyst is a rare complication of blunt thoracic trauma. The clinical symptoms and signs are similar to other respiratory diseases, such as pulmonary tuberculosis. Therefore, a trauma history with the resulting radiologic and clinical findings is important for making a diagnosis. A 26-year-old male was admitted to our hospital due to cough for 3 days. The chest x-ray revealed diffuse infiltrations and a cavitary lesion at the left lung. His left chest had hit a tree as a result of motorcycle accident one day before admission. Initially, it was assumed that his symptoms and chest X-ray might be due to a tuberculosis infection. However, bronchoscopy revealed old blood clots at both lungs, particularly in the left lower lobe bronchus. A transbronchial lung biopsy showed alveolar hemorrhage. A traumatic pulmonary pseudocyst was diagnosed from his trauma history and these findings. Computed tomography of the chest performed 4 months later showed regression of the cavitary lesion.
Subject(s)
Adult , Humans , Male , Biopsy , Bronchi , Bronchoscopy , Cough , Hemorrhage , Lung , Lung Injury , Motorcycles , Thorax , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
Anomalous origin of the right or left coronary artery from the contralateral sinus of Valsalva is often asymptomatic, but many patients, particularly young ones, present with sudden death or myocardial ischemia without symptoms. The mechanism of sudden death in this entity is unclear and has not been fully evaluated. These anomalies are rare, and many cardiologists and radiologists are unfamiliar with them. Surgical repair is recommended, especially with anomalous origin of the left coronary artery (LCA). However, there is controversy concerning the treatment of anomalous right coronary artery (RCA) with interarterial course due to its relatively high incidence and the fact that it leads to few, if any, clinical problems.
Subject(s)
Humans , Coronary Sinus , Coronary Vessels , Death, Sudden , Incidence , Myocardial Ischemia , Sinus of ValsalvaABSTRACT
BACKGROUND: Although echocardiography is usually used for quantitative assessment of left ventricular function, the recently developed 16-slice multidetector computed tomography (MDCT) is not only capable of evaluating the coronary arteries but also left ventricular function. Therefore, the objective of our study was to compare the values of left ventricular function quantified by MDCT to those by echocardiography for evaluation of its regards to clinical applications. MATERIAL AND METHOD: From 49 patients who underwent MDCT in our hospital from November 1, 2003 to January 31, 2005, we enrolled 26 patients who underwent echocardiography during the same period for this study. Left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), stroke volume index (SVI), left ventricular mass index (LVMI), and ejection fraction (EF) were analyzed. RESULT: Average LVEDVI (80.86+/-34.69 mL for MDCT vs 60.23+/-29.06 mL for Echocardiography, p<0.01), average LVESVI (37.96+/-24.52 mL for MDCT vs 25.68+/-16.57 mL for Echocardiography, p<0.01), average SVI (42.90+/-15.86 mL for MDCT vs 34.54+/-17.94 mL for Echocardiography, p<0.01), average LVMI (72.14+/-25.35 mL for MDCT vs 130.35+/-53.10 mL for Echocardiography, p<0.01), and average EF (55.63+/-12.91 mL for MDCT vs 59.95+/-12.75 mL for Echocardiography, p<0.05) showed significant difference between both groups. Average LVEDVI, average LVESVI, and average SVI were higher in MDCT, and average LVMI and average EF were higher in echocardiogram. Comparing correlation for each parameters between both groups, LVEDVI (r(2)=0.74, p<0.0001), LVESVI (r(2)=0.69, p<0.0001) and SVI (r(2)=0.55, p<0.0001) showed high relevance, LVMI (r(2)=0.84, p<0.0001) showed very high relevance, and EF (r(2)=0.45, p=0.0002) showed relatively high relevance. CONCLUSION: Quantitative assessment of left ventricular volume and function using 16-slice MDCT showed high relevance compared with echocardiography, therefore may be a feasible assessment method. However, because the average of each parameters showed significant difference, the absolute values between both studies may not be appropriate for clinical applications. Furthermore, considering the future development of MDCT, we expect to be able to easily evaluate the assessment of coronary artery stenosis along with left ventricular function in coronary artery disease patients.