ABSTRACT
A 49-year-old man presented with chest pain, dyspnea, and lactic acidosis. Left ventricular hypertrophy and myocardial fibrosis were detected. The sequencing of mitochondrial genome (mtDNA) revealed the presence of A to G mtDNA point mutation at position 3243 (m.3243A>G) in tRNALeu(UUR) gene. Diagnosis of cardiac involvement in a patient with Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes syndrome (MELAS) was made. Due to increased risk of sudden cardiac death, cardioverter defibrillator was implanted.
ABSTRACT
Tras su introducción hace unos 15 años, la angiografía por tomografía computarizada se ha convertido actualmente en el instrumento clínico más exacto para la evaluación no invasiva de la aterosclerosis coronaria. Los importantes avances técnicos han conducido a un torrente continuo de nuevas aplicaciones clínicas junto con una reducción significativa de la dosis de exposición a la radiación. Los escáneres de tomografía computarizada de última generación (≥ 64 cortes) brindan la posibilidad de obtener imágenes de perfusión estáticas o dinámicas durante la aplicación de estrés mediante vasodilatadores coronarios (adenosina, dipiridamol o regadenosón), combinando la información funcional y anatómica en la misma exploración. En este artículo se examina el papel emergente y el estado actual de las imágenes de perfusión miocárdica con tomografía computarizada, y se ilustra con casos clínicos de la propia experiencia con un escáner de segunda generación de 128 cortes y doble fuente (Somatom Definition Flash, Siemens; Erlangen, Alemania). Se examinan los aspectos técnicos, el análisis de los datos, la exactitud diagnóstica, la dosis de radiación y las perspectivas futuras (AU)
Since its introduction about 15 years ago, coronary computed tomography angiography has become today the most accurate clinical instrument for noninvasive assessment of coronary atherosclerosis. Important technical developments have led to a continuous stream of new clinical applications together with a significant reduction in radiation dose exposure. Latest generation computed tomography scanners (≥ 64 slices) allow the possibility of performing static or dynamic perfusion imaging during stress by using coronary vasodilator agents (adenosine, dipyridamole, or regadenoson), combining both functional and anatomical information in the same examination. In this article, the emerging role and state-of-the-art of myocardial computed tomography perfusion imaging are reviewed and are illustrated by clinical cases from our experience with a second-generation dual-source 128-slice scanner (Somatom Definition Flash, Siemens; Erlangen, Germany). Technical aspects, data analysis, diagnostic accuracy, radiation dose and future prospects are reviewed (AU)
Subject(s)
Humans , Myocardial Perfusion Imaging/methods , Tomography, X-Ray Computed/methods , Myocardial Ischemia/diagnosis , AngiographyABSTRACT
Since its introduction about 15 years ago, coronary computed tomography angiography has become today the most accurate clinical instrument for noninvasive assessment of coronary atherosclerosis. Important technical developments have led to a continuous stream of new clinical applications together with a significant reduction in radiation dose exposure. Latest generation computed tomography scanners (≥ 64 slices) allow the possibility of performing static or dynamic perfusion imaging during stress by using coronary vasodilator agents (adenosine, dipyridamole, or regadenoson), combining both functional and anatomical information in the same examination. In this article, the emerging role and state-of-the-art of myocardial computed tomography perfusion imaging are reviewed and are illustrated by clinical cases from our experience with a second-generation dual-source 128-slice scanner (Somatom Definition Flash, Siemens; Erlangen, Germany). Technical aspects, data analysis, diagnostic accuracy, radiation dose and future prospects are reviewed.
