Left ventricular ejection fraction measurement using cardiovascular magnetic resonance imaging in patients with post-myocardial infarction: assessment of reproducibility by a cardiovascular radiologist and a trained technologist.

Background: Cardiovascular magnetic resonance imaging (CMR) has recently been accepted as a preferential method for evaluation left ventricular ejection fraction (LVEF). The LVEF analysis by CMR is usually performed by trained technologists in many institutions of Thailand. Objective: Assess the reproducibility of LVEF measured by a cardiovascular radiologist and a trained technologist using CMR in patients with post-myocardial infarction (MI). Methods: Twenty-one MI patients (18 men and 3 women) were recruited, where nine patients underwent CMR and left ventriculography to follow-up LVEF two times in six months. Both CMR and left ventriculography were examined within two weeks. LVEF from CMR were measured by a cardiovascular radiologist and a trained technologist and the correlation between the left ventriculography and CMR was determined. Results: In 30 CMR studies, interobserver reliability (intraclass correlation coefficient ICC=0.94) and intraobserver reliability (ICC=0.96) was excellent. LVEF measured by left ventriculography was higher compared with that by CMR, and their correlation was moderate (ICC=0.56). Conclusion: The LVEF measurement by a cardiovascular radiologist and a trained technologist using CMR was very reproducible, but the correlation between CMR and left ventriculography was moderate.

Endovascular aortic stent for thoracic and abdominal aortic aneurysm: imaging consequences and complications.

Background: Endovascular stent-graft implantation has been used as an alternative to conventional open surgery in treatment of aortic aneurysm. Computed tomographic angiography (CTA) has been requested for follow-up and evaluation of aortic stent complications. Objective: Find the incidence of endovascular aortic stent complications and analyze the CTA features of postendovascular aortic stent consequences. Methods: Two radiologists reviewed CTA images of 635 patients who attended King Chulalongkorn Memorial Hospital between Sep 1, 2003 and Aug 31, 2008. Thirty-eight patients had endovascular aortic stent installation with 95 CTA images. The incidence of endovascular aortic stent complications, the image appearances including consequences and time-interval of endoleak were analyzed. Results: There were 23 thoracic aortic stents, 10 abdominal aortic stents and five combined stents for thoracic and abdominal aortic aneurysms. Twenty-eight cases had aortic stent complications (73.7%). Two cases had immediately post procedural complication of groin hematomas (7.1%). Ten patients had more than one finding. Findings of the stent-graft complications were as follows: 19 endoleaks, 15 stent thrombosis, five stents without covered-dissection, two stent kinkings, two iatrogenic focal aortic dissection, two air within aneurysm after stent installation and one spreading infected aortitis. The most common complication was endoleaks (53.6%), which could progress, be persistent or resolvable. Time-interval to detect endoleak was between 1 and 464 days. Conclusion: CTA can be used as modality of choice in demonstration of stent location, consequences, and complications. The stent complication was still high in the first five-year experience.

Detection of coronary stenoses in chronic stable angina by multi-detector CT coronary angiography.

OBJECTIVE: To assess the accuracy for detection of coronary stenoses in chronic stable angina patients. MATERIAL AND METHOD: Twenty-four chronic stable angina patients, referred for conventional coronary angiography by the indication of positive stress tests or clinical highly suspicion of coronary artery disease were enrolled. MDCT coronary angiography (MDCTCA) and conventional coronary angiography (144 coronary vessels) were performed within one month. Accuracy of MDCTCA for predicting significant coronary artery stenoses was analyzed. RESULTS: Five patients were excluded due to the total Agaston calcium score more than 500. Therefore, 114 vessels or 209 segments from 19 patients (9 males and 10 females) were available for analysis, and 186 segments were assessable (89%). Of all assessable segments, 13 from 20 significant lesions (65%) and 158 from 167 normal or non-significant lesions (95%) were correctly detected by MDCTCA. The sensitivity, specificity, positive and negative predictive values to detect significant coronary artery stenoses in terms of vessel are 82%, 96%, 79%, and 97% respectively. CONCLUSION: Coronary CT angiography provides accurate assessment of coronary luminal artery narrowing and shows the ability to exclude significant coronary artery stenoses in patients with chronic stable angina.

Reliability of the evaluation for left ventricular ejection fraction by ECG-gated multi-detector CT (MDCT): comparison with biplane cine left ventriculography.

OBJECTIVE: To evaluate the reliability of measurement for left ventricular ejection fraction (LVEF) by ECG-gated multi-detector CT (MDCT) comparing with biplane cine left ventriculography that is current gold standard. MATERIAL AND METHOD: The authors reviewed the data from 15 patients who were referred for coronary CT angiography for clinical indications and underwent cardiac catheterization within 14 days. Coronary CTA studies were performed on MDCT Somatom Sensation 16, Siemens, Germany, Slice thickness 1 mm, Slice collimation 0. 75 mm, and Pitch 0. 3. L VEF were measured with MDCTby Simpson s method and compared with values measured by biplane area length method from cardiac catheterization. The L VEF from both techniques were compared using intraclass correlation power analysis (SPSS analysis software). RESULTS: The study population consisted with six men and nine women with a mean age of 54+/-10 years. The LVEF measured from MDCT and cine ventriculography were 54.7 +/-10% and 56. 3+/-10%, respectively. LVEF measured with MDCT by interpreter I and interpreter 2 was significantly correlated with L VEF measured with biplane cine ventriculography (ICC= 0.99 and 0.98, respectively). The interobserver reliability was excellent with ICC = 0.9. CONCLUSION: LVEF measurement with MDCT during coronary CT angiography can be performed easily, very accurately, and compare well with measures taken from biplane cine left ventriculography.

Hysterosalpingographic accuracy of peritubal adhesion.

The purpose of this study was to determine diagnostic accuracy of hysterosalpingography by using different diagnostic criteria in peritubal adhesion diagnosis. The authors retrospectively reviewed cases in which both hysterosalpingography and laparoscopy were performed. Fifty-nine of 84 cases had laparoscopy proved peritubal adhesion. Five hysterosalpingographic signs (convoluted tube, vertical tube, ampullary dilatation, peritubal halo and loculation of the spillage of contrast material) defined by Karasick and Goldfarb were used to diagnose peritubal adhesion. All cases were analyzed by two different diagnostic criteria: first diagnostic criterion, presence of one or more signs means abnormal; second diagnostic criterion, presence of two or more signs means abnormal. Peritubal adhesion was diagnosed in 70 of 84 cases by using the first diagnostic criterion, 53 of 84 cases by using the second diagnostic criterion. The first diagnostic criterion displayed 94.9 per cent sensitivity, 44 per cent specificity, 80 per cent positive predictive value, 79.76 per cent accuracy and the likelihood ratio of 1.69. The second diagnostic criterion showed 74.6 per cent sensitivity, 64 per cent specificity, 83 per cent positive predictive value, 71.43 per cent accuracy and the likelihood ratio of 2.07. The authors conclude that using the 2nd diagnostic criterion is more appropriate than using the 1st diagnostic criterion in diagnosing peritubal adhesion.