Feasibility and accuracy of dual-energy CT multiparameter technique in evaluating myocardial scar in patients with heart failure / 中华放射学杂志

Objective:To evaluate the reliability of cardiac late iodine enhancement dual-energy CT (LIE-DECT) multiparameter post-processing technique for evaluating the presence, location, and extent of cardiac scars in patients with heart failure (HF), using cardiac MR (CMR) late gadolinium enhancement (LGE) as a reference standard.Methods:Thirty-nine HF patients who underwent cardiac LIE-DECT and LGE-CMR examinations in the Second Affiliated Hospital of Nantong University from November 2019 to November 2021 were prospectively collected, all enrolled HF patients underwent LIE-DECT post-processing to reconstruct monoenergetic plus (Mono+) map (40 keV), iodine map and Rho/Z map, to evaluate the enhancement degree, location and extent of left ventricular myocardial LIE on the left ventricular short-axis map, respectively, and compared with LGE-CMR. Cohen′s Kappa test was used to assess the intra-and inter-observer consistency of LIE by DECT multiparameter technique and the consistency of LIE presence and location by DECT multiparameter technique and by CMR. The diagnostic efficacy of DECT multiparameter technique in diagnosing myocardial scar was calculated.Results:Of the 39 patients included, 32 patients were detected by CMR with LGE in 147 segments, including 37 subendocardial patterns, 19 transmural patterns, 74 mid-wall patterns, and 17 epicardial patterns. The intra-observer consistency Kappa values of 40 keV Mono+map, iodine map and Rho/Z map were 0.878, 0.930 and 0.835 ( P all<0.001), respectively. The inter-observer consistency Kappa values were 0.838, 0.892 and 0.808 ( P all<0.001), respectively. The LIE of 40 keV Mono+map, iodine map and Rho/Z map were in good agreement with CMR, Kappa values were 0.903, 0.883 and 0.810 ( P all<0.001), respectively. For the per-patient analysis, the accuracies of 40 keV Mono+map, iodine map and Rho/Z map were 92.3% (36/39), 92.3% (36/39) and 82.1% (32/39), respectively. For the segment-based analysis, the accuracies of 40 keV Mono+map, iodine map and Rho/Z map accuracy were 96.1% (492/512), 95.3% (488/512) and 92.6% (474/512), respectively. In Bland-Altman analysis, the consistency bias between scar extent measured by 40 keV Mono+map, iodine map, Rho/Z map and that measured by LGE-CMR were -2.03%, -2.21%, -2.65%, and the 95% limit of agreement were -12.20%-8.14%, -12.69%-8.28% and -14.85%-9.58%, respectively. Conclusion:LIE-DECT multiparameter technique can detect myocardial scar in HF patients well, which is consistent with LGE-CMR.

Assessment of Left Ventricular Myocardial Diseases with Cardiac Computed Tomography

Rapid advances in cardiac computed tomography (CT) have enabled the characterization of left ventricular (LV) myocardial diseases based on LV anatomical morphology, function, density, and enhancement pattern. Global LV function and regional wall motion can be evaluated using multi-phasic cine CT images. CT myocardial perfusion imaging facilitates the identification of hemodynamically significant coronary artery disease. CT delayed-enhancement imaging is used to detect myocardial scar in myocardial infarction and to measure the extracellular volume fraction in non-ischemic cardiomyopathy. Multi-energy cardiac CT allows the mapping of iodine distribution in the myocardium. This review summarizes the current techniques of cardiac CT for LV myocardial assessment, highlights the key findings in various myocardial diseases, and presents future applications to complement echocardiography and cardiovascular magnetic resonance.

Resonancia Magnética Cardíaca en el diagnóstico de miocarditis / Cardiac Magnetic Resonance in the diagnosis of myocarditis

El uso de la Resonancia Magnética Cardiaca (RMC), se ha convertido en los últimos años en una herramienta fundamental para el diagnóstico de diversas miocardiopatías, entre las cuales sobresale la miocarditis, entidad que cursa con manifestaciones y signos clínicos muy variables y poco específicos en la mayor parte de los casos, lo que la convierte en una patología difícil de reconocer sobre todo en sus episodios de presentación inicial, lo que probablemente conlleve a que sea subdiagnosticada. El desarrollo de nuevas modalidades de imagen ha permitido que ante la sospecha de esta entidad el uso de la RMC se convierta en la técnica ideal para el diagnóstico temprano. A continuación se presenta el caso clínico de un paciente masculino que acude con cuadro de dolor torácico agudo, enzimas cardiacas elevadas, electrocardiograma no concluyente y coronarias normales, mostrando el curso insidioso de esta patología así como de manera resumida el rol de la RMC en su diagnóstico y pronóstico.

The use of cardiac magnetic resonance (CMR) has become in recent years an essential tool for diagnosing various cardiomyopathies, among which stands myocarditis, an entity that presents with demonstrations and highly variable clinical signs and unspecific in most cases, which makes it a difficult disease to recognize especially in its initial filing episodes, which probably lead to be underdiagnosed. The development of new imaging modalities has allowed suspicion of this entity using the RMC becomes the ideal technique for early diagnosis. Next, the case of a male patient presenting with symptoms of acute chest pain, elevated cardiac enzymes inconclusive electrocardiogram and normal coronary showing insidious course of this disease and in summary the role of the RMC in its presented diagnosis and prognosis.

Comparison of Motion-corrected of Phase Sensitive inversion Recovery and Segmented Phase Sensitivity Inversion Recovery in MRI Myocardial Enhancement / 中国循环杂志

Objective:To compare the image quality between motion-corrected of phase sensitive inversion recovery SSFP (PSIR SSFP MOCO) sequences and segmented phase sensitivity inversion recovery turbo fast low angel shot PSIR (PSIR segmented turbo Flash) sequences in MRI myocardial enhancement.Methods:A total of 56 patients with PSIR segmented and PSIR SSFP MOCO for myocardial enhancement were retrospectively studied.Subjective quality score (gradel-4),signal to noise ratio (SNR) and relative SNR of normal myocardium,abnormal enhancement of myocardium and left ventricular chamber images were paired and compared between 2 different LGE techniques.Results:Subjective quality scores in PSIR segmented group were as 4 points 28.6％,3 points 41.1％,2 points 28.6％,1 point 1.8％ respectively.In PSIR SSFP MOCO group,4 points was 96.4％ which was higher than PSIR segmented group,P＜0.001,3 points 3.6％,2 points and 1 point were both 0％.The following SNRs were higher in PSIR MOCO SSFP group than PSIR segmented group as in normal myocardium (4.70±3.47) vs (3.64±3.2),P=0.074;in abnormal myocardium (52.58±36.58) vs (27.65±18.47),P＜0.001 and in left ventrieular chamber (40.52±33.97) vs (23.14±11.46),P＜0.001 respectively.The following relative SNRs were higher in PSIR MOCO SSFP group than PSIR segmented group as in normal to abnormal myocardium (47.46±33.97) vs (23.75±16.68),P＜0.001;abnormal myocardium to left ventricular chamber (8.53±17.77) vs (4.54±10.10),P=0.181 and left ventricular chamber to normal myocardium (35.82±25.72) vs (19.49±9.44),P＜0.001 respectively.Conclusion:Compared with PSIR segmented sequence,PSIR SSFP MOCO technique can obtain better quality of delay-enhanced myocardial images.

Comparison of Motion-corrected of Phase Sensitive inversion Recovery and Segmented Phase Sensitivity Inversion Recovery in MRI Myocardial Enhancement / 中国循环杂志

Objective:To compare the image quality between motion-corrected of phase sensitive inversion recovery SSFP (PSIR SSFP MOCO) sequences and segmented phase sensitivity inversion recovery turbo fast low angel shot PSIR (PSIR segmented turbo Flash) sequences in MRI myocardial enhancement.Methods:A total of 56 patients with PSIR segmented and PSIR SSFP MOCO for myocardial enhancement were retrospectively studied.Subjective quality score (gradel-4),signal to noise ratio (SNR) and relative SNR of normal myocardium,abnormal enhancement of myocardium and left ventricular chamber images were paired and compared between 2 different LGE techniques.Results:Subjective quality scores in PSIR segmented group were as 4 points 28.6％,3 points 41.1％,2 points 28.6％,1 point 1.8％ respectively.In PSIR SSFP MOCO group,4 points was 96.4％ which was higher than PSIR segmented group,P＜0.001,3 points 3.6％,2 points and 1 point were both 0％.The following SNRs were higher in PSIR MOCO SSFP group than PSIR segmented group as in normal myocardium (4.70±3.47) vs (3.64±3.2),P=0.074;in abnormal myocardium (52.58±36.58) vs (27.65±18.47),P＜0.001 and in left ventrieular chamber (40.52±33.97) vs (23.14±11.46),P＜0.001 respectively.The following relative SNRs were higher in PSIR MOCO SSFP group than PSIR segmented group as in normal to abnormal myocardium (47.46±33.97) vs (23.75±16.68),P＜0.001;abnormal myocardium to left ventricular chamber (8.53±17.77) vs (4.54±10.10),P=0.181 and left ventricular chamber to normal myocardium (35.82±25.72) vs (19.49±9.44),P＜0.001 respectively.Conclusion:Compared with PSIR segmented sequence,PSIR SSFP MOCO technique can obtain better quality of delay-enhanced myocardial images.

Delayed Enhancement Magnetic Resonance Imaging Findings in Cardiac Amyloidosis

PURPOSE: To evaluate late gadolinium enhancement (LGE) pattern of left ventricular (LV) myocardium and presence or absence of LGE in other regions of the heart on cardiac magnetic resonance (CMR) imaging in patients diagnosed with cardiac amyloidosis. MATERIALS AND METHODS: From 2009 to 2011, 9 patients who were suspected cardiac amyloidosis underwent CMR. We retrospectively analyzed the presence or absence of LGE and enhancement pattern in LV myocardium, and the presence or absence of LGE in other chambers as well. Also we measured interatrial septal thickness (IST), relative signal intensities of atrial septum and epicardial fat over the left atrial (LA) cavity on delayed enhanced images. MRI parameters in these patients were compared to those of control group of patients with ischemic heart disease by Wilcoxon rank sum test. RESULTS: Of nine patients, LGE were found in 8; subendocardial circumferential pattern in 4 and diffuse pattern in 4. LGE in right ventricle was observed in 7. IST was significantly increased in patients with cardiac amyloidosis (P = 0.02). Ratio of atrial septum to LA cavity and ratio of epicardial fat to LA cavity showed a significant difference (P = 0.0002 and P = 0.0006, respectively). CONCLUSION: In LGE CMR, subendocardial or diffuse enhancement pattern is a typical finding for patients with cardiac amyloidosis. Atrial septum and epicardial fat show relatively increased signal intensities over LA blood cavity.

Evaluation of Reperfused Myocardial Infarction by Low-Dose Multidetector Computed Tomography Using Prospective Electrocardiography (ECG)-Triggering: Comparison with Magnetic Resonance Imaging

PURPOSE: To evaluate the potential of prospective electrocardiography (ECG)-gated 64-slice multidetector computed tomography (MDCT) for evaluation of myocardial enhancement, infarct size, and stent patency after percutaneous coronary intervention (PCI) with stenting in patients with myocardial infarction. MATERIALS AND METHODS: Seventeen patients who were admitted with acute myocardial infarction were examined with prospective ECG-gated 64-slice cardiac MDCT and magnetic resonance (MR) imaging after reperfusion using PCI with stenting. Cardiac MDCT was performed with two different phases: arterial and delayed phases. We evaluated the stent patency on the arterial phase, and nonviable myocardium on the delayed phase of computed tomography (CT) image, and they were compared with the results from the delayed MR images. RESULTS: Total mean radiation dose was 7.7 +/- 0.5 mSv on the two phases of CT images. All patients except one showed good patency of the stent at the culprit lesion on the arterial phase CT images. All patients had hyperenhanced area on the delayed phase CT images, which correlated well with those on the delayed phase MR images, with a mean difference of 1.6% (20 +/- 10% vs. 22 +/- 10%, r = 0.935, p = 0.10). Delayed MR images had a better contrast-to-noise ratio (CNR) than delayed CT images (27.1 +/- 17.8% vs. 4.3 +/- 2.1%, p < 0.001). CONCLUSION: Prospective ECG-gated 64-slice MDCT provides the potential to evaluate myocardial viability on delayed phase as well as for stent patency on arterial phase with an acceptable radiation dose after PCI with stenting in patients with myocardial infarction.

Diagnostic value of MR mammography in breast ductal carcinoma / 吉林大学学报(医学版)

Objective To study the diagnostic value of MR mammography(MRM) in judging the nature of breast disease.Methods 145 cases with breast disease were retrospectively studied to investigate the relationships between two parameters(early-phase enhancement rate and the type of the delayed enhancement) and different breast diseases.All patients underwent MRM examination before surgical operation.Results ①Strengthen multiple in early stage larger than 3 times was inclined to malignant lesion;Strengthen multiple smaller than 1 time was inclined to benign lesion.②Drop type of delayed enhancement was the important parameter in diagnosis of ductal carcinoma.If drop type of delayed enhancement was viewed as the diagnosis standard of the ductal carcinoma of breast only:81% cases with invasive type of the ductal carcinoma,65% cases with noninvasive type of the ductal carcinoma had been diagnosed correctly;14% cases with benign breast lesions had been diagnosed exaggeratedly.③If strengthen multiple in early stage larger than 2.5 times in rising type of delayed enhancement and drop type of delayed enhancement was viewed as the diagnosis standard of the ductal carcinoma of breast,87.9% cases with invasive ductal carcinoma,73.1% cases with noninvasive ductal carcinoma had been diagnosed correctly;21.4% cases within benign breast lesions had been diagnosed exaggeratedly.Conclusion Compared with differential of disease nature by the type of the delayed enhancement only,the correct rate of diagnosis of breast ductal carcinoma mentioned above is raised if two parameters are combined.But the correct diagnosis rate of benign lesions is decreased.