ABSTRACT
We report an unusual case of spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma in an adult, non-pregnant woman. Her condition was triggered by unrecognized primary hypothyroidism, which regressed after thyroid hormone replacement therapy. This case highlights the need for clinicians and radiologists to familiarize themselves with the clinical and imaging features detected in case of these complications of primary hypothyroidism, which are not well known in the medical and radiological profession. Such improved knowledge will help avoid delays in diagnosis, progression to life-threatening complications, and unnecessary surgery.
ABSTRACT
Cardiovascular magnetic resonance (CMR) very early after primary percutaneous coronary intervention (PPCI) may lead to instability or early stent complications. However, CMR in the hyperacute phase of STEMI may improve risk stratification. We investigated feasibility and safety of CMR in the hyperacute phase of STEMI immediately after PPCI. One hundred and twenty eight consecutive patients immediately after PPCI for STEMI. Sixty four underwent CMR <12 h after PPCI versus 64 matched controls. Outcomes were followed over 6 months. CMR in hyperacute STEMI was not associated with in-hospital death, infarct expansion, or urgent revascularization (P = NS). CMR (32 ml gadolinium contrast) immediately after PPCI (180 ml iodine contrast) did not increase nephropathy. CMR did not increase major adverse cardiac events (5 vs. 8%, P = 0.16) or recurrence of angina (6 vs. 8%, P = 0.73) at 6 months. CMR immediately after PPCI is feasible and safe, allowing very early risk stratification in STEMI.
Subject(s)
Angioplasty, Balloon, Coronary , Contrast Media , Gadolinium DTPA , Magnetic Resonance Imaging, Cine , Myocardial Infarction/diagnosis , Adult , Aged , Angioplasty, Balloon, Coronary/adverse effects , Angioplasty, Balloon, Coronary/instrumentation , Angioplasty, Balloon, Coronary/mortality , Case-Control Studies , Contrast Media/adverse effects , Coronary Angiography , Disease-Free Survival , Feasibility Studies , Female , Gadolinium DTPA/adverse effects , Humans , Iohexol , Kaplan-Meier Estimate , Magnetic Resonance Imaging, Cine/adverse effects , Magnetic Resonance Imaging, Cine/mortality , Male , Middle Aged , Myocardial Infarction/mortality , Myocardial Infarction/therapy , Predictive Value of Tests , Prospective Studies , Risk Assessment , Risk Factors , Stents , Time Factors , Treatment Outcome , Triiodobenzoic AcidsABSTRACT
Multidetector-row electrocardiogram (ECG)-gated cardiac computed tomography (CT) will probably be a major noninvasive imaging option in the near future. Recent developments indicate that this new technology is improving rapidly. This article presents an overview of the current concepts, perspectives, and technical capabilities in coronary CT angiography (CTA). We have reviewed the recent literature on the different applications of this technology; of particular note are the many studies that have demonstrated the high negative predictive value (NPV) of coronary CTA, when performed under optimal conditions, for significant stenoses in native coronary arteries. This new technology's level of performance allows it to be used to evaluate the presence of calcified plaques, coronary bypass graft patency, and the origin and course of congenital coronary anomalies. Despite a high NPV, the robustness of the technology is limited by arrhythmias, the requirement of low heart rates, and calcium-related artifacts. Some improvements are needed in the imaging of coronary stents, especially the smaller stents, and in the detection and characterization of noncalcified plaques. Further studies are needed to more precisely determine the role of CTA in various symptomatic and asymptomatic patient groups. Clinical testing of 64-slice scanners has recently begun. As the technology improves, so does the spatial and temporal resolution. To date, this is being achieved through the development of systems with an increased number of detectors and shorter gantry rotation time, as well as the development of systems equipped with 2 X-ray tubes and the eventual development of flat-panel technology. Thus further improvement of image quality is expected.
Subject(s)
Coronary Angiography/methods , Tomography, X-Ray Computed/methods , Calcinosis/diagnostic imaging , Coronary Artery Bypass , Coronary Artery Disease/diagnostic imaging , Coronary Stenosis/diagnostic imaging , Coronary Vessel Anomalies/diagnostic imaging , Humans , Image Processing, Computer-Assisted/methods , Technology, Radiologic , Vascular PatencyABSTRACT
OBJECTIVES: To evaluate CT coronary angiography (CTA) when compared with catheter coronary angiography (CCA), for the detection of coronary artery stenoses and rate of optimal coronary artery segment visualization. METHOD: Retrospective, two-center study enrolling 26 patients who underwent CCA and ECG-gated 16-detector CTA (slice thickness 0.6 mm; rotation 500 ms). RESULTS AND CONCLUSION: 283 segments were available for postprocessing. Sensitivity, specificity, and positive predictive value were, respectively, 80, 100, and 100%, for detecting more than 50% luminal stenoses, when optimally visualized segments were considered, in comparison to CCA. Negative predictive value was excellent (98%). Rate of non-optimally visualized coronary segments was 26%. Most clinical benefits of coronary CT angiography should probably be obtained when it is performed to exclude significant stenoses on selected populations of patients with a low pre-test probability of severe coronary artery disease, and under optimal conditions of controlled heart rate and minimal presence of calcium.
