[Anomalous left coronary artery from pulmonary artery revealed by acute bronchiolitis]. / Anomalie de naissance de la coronaire gauche à partir de l'artère pulmonaire révélée par une bronchiolite.

UNLABELLED: Despite its common occurrence bronchiolitis can reveal many disorders such as malformations or immunological diseases. We report a rare and serious cause of bronchiolitis in the newborn: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). CASE REPORT: A four-month-old infant was admitted with hypoxic bronchiolitis. Congenital heart disease was suspected in view of the severity of symptoms and the association of poor weight gain and cardiomegaly. Transthoracic Doppler echocardiography performed by an experienced team and coronary multislice spiral computed tomography led to the diagnosis of a left coronary artery arising from the proximal left side of the pulmonary artery trunk. DISCUSSION: ALCAPA is a rare congenital anomaly that can be revealed by intercurrent infection such as bronchiolitis in infancy. Only early diagnosis and surgery to restore a system with two normally arising coronary arteries can produce a satisfactory outcome, possibly leading to progressive myocardial recovery.

[Role of MSCT and MRI in the diagnosis of congenital heart disease]. / Place du scanner multicoupes (SMC) et de l'IRM dans la stratégie diagnostique des cardiopathies congénitales.

Initial diagnosis of congenital heart disease traditionally relies upon clinical examination and ultrasound. Development of non-invasive imaging, multislice CT (MSCT) and magnetic resonance imaging (MRI) has changed the way those patients are evaluated for diagnosis or follow-up. Cardiac catheterization is no longer the step two and in many clinical situations, non-invasive imaging is the method of choice, either before or instead of invasive angiography examination. Cross-sectional cardiovascular imaging brings thorough examination of the thorax, heart and great vessels, leading to three-dimensional volumes imaging, allowing diagnosis of the cardiopathy, evaluation of the anatomy and associated abnormalities. For each imaging technique advantages and drawbacks are discussed. X-ray use is the main disadvantage of MSCT, although it is a fast, easy and efficient technique, especially in babies because of its high spatial and temporal resolutions. Beside a precise 3D evaluation of the heart and great vessels, MSCT allows evaluation of small structures, like coronary arteries in routine, including in neonates and infants, at a fast cardiac rhythm, and in a short examination time. The air-filled structures are well-depicted with MSCT, and 3D imaging is helpful in evaluation of tracheal and bronchi compression as compared to MRI. MR imaging brings, aside from the morphologic evaluation, helpful functional information for the left and right ventricles, and evaluation of valvular disease (stenosis and regurgitation). Those are critical data in the follow-up of patients treated for tetralogy of fallot or after atrial switch for transposition of the great vessels. The technique is also very powerful in evaluating aortic disease, e.g. aortic coarctation and restenosis, and Marfan's disease. Disadvantages are mainly the accessibility and the examination time, which in young patients may require sedation or general anaesthesia. Cross-sectional cardiovascular imaging, MSCT and MRI, have considerably changed the diagnosis and follow-up of patients suffering of congenital cardiopathy. The techniques are complementary, and the choice will depend on the age, the clinical condition and the diagnosis of the patient.

Comparison of delayed enhancement patterns on multislice computed tomography immediately after coronary angiography and cardiac magnetic resonance imaging in acute myocardial infarction.

OBJECTIVE: Recent experimental and limited clinical studies have demonstrated the usefulness of delayed enhancement multislice computed tomography (MSCT) for assessing myocardial infarct size (IS) and transmurality. The aim of this study is to compare MSCT enhancement patterns immediately after coronary angiography (CAG) in an acute myocardial infarction (AMI) setting with cardiac magnetic resonance (CMR) enhancement during the second week follow-up. METHODS: 26 patients admitted for an AMI were evaluated by MSCT immediately after CAG without iodine re-injection. All but three were reperfused. The same patients had delayed enhancement CMR imaging at 10 (SD 4)-day follow-up. Myocardial enhancement was considered transmural (non-viable) when involving >75% of myocardial thickness, subendocardial (1 - < or =75%) or normal (viable for the two latter). Two or more >75% enhanced segments were required to define transmurality on patient-level or culprit artery-level analysis. A semi-quantitative scale score was defined for the 17 left ventricular segments. IS was computed from these scores. RESULTS: On segment analysis, sensitivity, specificity, accuracy, positive and negative predictive values of MSCT for transmurality assessment were 84%, 96%, 94%, 85% and 96%, respectively, compared to CMR. On patient analysis, these respective values were 90%, 80%, 88%, 95% and 67%. IS assessed by the two methods were highly correlated (r = 0.94, p<0.0001) and the regression line did not statistically differ from the identity line. CONCLUSION: MSCT enhancement immediately following CAG without iodine re-injection for an AMI is a reliable method for evaluating transmurality and IS. This very early evaluation could be an interesting alternative to CMR.

[Patient information and iodized contrast media]. / Information des patients et produits de contraste iodés.

UNLABELLED: Prior information to patients concerning the risks associated with intravenous injection of contrast media for diagnostic imaging is rarely performed in France. PURPOSE: Evaluate patients' desire for information about risks of intravenous injection of contrast material and its impact on their level of confidence. MATERIAL AND METHODS: Two hundred and twenty seven adult patients, while awaiting a CT scan with injection, read an information form reviewing the risks associated with intravenous injection of contrast material. They filled out an answer sheath concerning their desire to be informed and the impact of that information on their level of confidence. Two levels of risk were evaluated, one where the risk of death was included and one where the risk of death was not included. RESULTS: Eighty six percent of patients wished to be informed about the risks; eleven per cent felt they became more anxious after being informed, irrespective of the mention or not of the risk of death. CONCLUSION: Patients wish to be informed about the risks associated with the intravenous injection of contrast material. This information seems to create only mild anxiety.

MR imaging of coarctation of the aorta and its postoperative complications in adults: assessment with spin-echo and cine-MR imaging.

To evaluate the ability of ECG-gated spin-echo (SE)-MR imaging vs. cine-MR imaging to assess coarctation of the aorta, 11 patients aged 15-45 years, with known or suspected coarctation of the aorta, and five patients suspected of re-stenosis or postoperative false-aneurysms after coarctation repair were examined by multisection SE-MR imaging and single-section multiphase cine-MR imaging on a 1.0 Tesla device. Aortography was performed in 15, and surgery in 14 of these 16 patients. Qualitatively, the location, severity, and length of the coarctation were shown in all cases with MR imaging, as well as the relationship with the arteries arising from the aortic arch. The respective sensitivities and specificities in the assessment of severity of stenoses were 86% and 100% for SE MR images, and 100% and 100% for cine-MR images. Cine-MR imaging was superior to SE imaging in stenosis diameter assessment with contrast angiography as reference, as well as to identify the site of leakage in cases of postoperative pseudoaneurysm. Pre-stenotic dilation or post-stenotic aneurysm, collateral channels, and associated malformations were better identified on SE images. Quantitatively, a better stenosis diameter correlation was found between cine-MR images and angiography than between SE-MR images and angiography (r=0.99 vs. r=0.78; p=0.001 vs. p=0.004), related to overestimation of stenoses with SE-MR imaging. The use of a combination of spin-echo and cine-MR imaging correlates well with conventional angiographic findings in this small series of patients with coarctation of aorta or postoperative pseudoaneurysmal complications. Cine-MRI can provide anatomic information that is equivalent to angiography for surgical planning.

Mycobacterium tuberculosis versus nontuberculous mycobacterial infection of the lung in AIDS patients: CT and HRCT patterns.

PURPOSE: The aim of this study was to determine discriminating CT and HRCT features between mycobacterial pulmonary tuberculosis and nontuberculous mycobacterial (NTMB) pulmonary infections in patients with AIDS. METHOD: CT and HRCT scans of 52 AIDS patients with culture-proven mycobacterial infection [29 with Mycobacterium tuberculosis (MTB) and 23 with NTMB] without concomitant pulmonary infection were reviewed by two observers. RESULTS: Nodular opacities, mainly centrilobular in distribution, were the most common finding, seen in 21 (72%) and 15 (65%) of patients with MTB and NTMB, respectively. A lower lobe predominance of centrilobular nodules was seen more commonly in NTMB (p < 0.03). Ground-glass attenuation was seen in 5 (17%) and 11 (48%) of patients with MTB and NTMB, respectively (p = 0.03). Ground-glass opacities and bronchial wall thickening affected a larger number of lobes in NTMB (p < 0.01), while centrilobular nodules involved more lobes in MTB (p < 0.01). A higher prevalence of unilateral lung involvement was seen in MTB (12 patients, 44%) than NTMB (1 patient, 5%) (p < 0.01). Enlarged lymph nodes were more frequent in patients with MTB than in those with NTMB (22, 76% vs. 10, 43%, respectively) (p < 0.02). CONCLUSION: NTMB infection and pulmonary tuberculosis display different CT and HRCT patterns in AIDS patients, but there is considerable overlap in CT findings.

Assessment of deep venous thrombosis in the lower limbs and pelvis: MR venography versus duplex Doppler sonography.

OBJECTIVE: This study was designed to compare the diagnostic value of MR venography and color Doppler sonography in the assessment of deep venous thrombosis. SUBJECTS AND METHODS: MR venograms and color Doppler examinations were obtained in 37 patients either with suspected deep venous thrombosis of the lower limbs or pelvis or with pulmonary embolism. Two-dimensional time-of-flight venography was used for all studies. MR and color Doppler data were collected prospectively and analyzed in a blinded manner. In a subset of 21 patients, MR venography and color Doppler sonography were prospectively compared with contrast-enhanced venography. RESULTS: When compared with contrast-enhanced venography, MR venography was 100% sensitive and 100% specific in the diagnosis of deep venous thrombosis above the knee. Color Doppler imaging depicted 13 of 15 cases of deep venous thrombosis and 5 of 6 venous examinations that had normal results, yielding a sensitivity and a specificity of 87% and 83%, respectively. The differences in sensitivity and specificity between MR venography and color Doppler sonography were not statistically significant. MR venography was 95% sensitive and 99% specific in detecting the extension of deep venous thrombosis, compared with the 46% sensitivity and 100% specificity of color Doppler sonography (differences in sensitivity, p < .01). MR images showed 29 collateral vessels, whereas only 21 were detected by contrast-enhanced venography (p < .04). CONCLUSION: MR venography seems to be more accurate than color Doppler sonography in detecting the extension of deep venous thrombosis. The positive diagnosis and extent of deep venous thrombosis can be easily detected and monitored by a noninvasive technique such as MR venography.

[Magnetic resonance angiography of the cervical and superior mediastinal veins]. / Angiographie par résonance magnétique des veines cervicales et du médiastin supérieur.

PURPOSE: To evaluate magnetic resonance venography (MRV) in the detection of cervical/mediastinal venous thrombosis (CMVT). METHODS: MR venograms were performed in 20 patients suspected for CMVT. 2D-TOF MR venography was used for all studies. MR and conventional venographic/surgical data were collected prospectively and analyzed in a blinded manner comparatively to other corroborative studies: venography (n = 8), color-Doppler studies (n = 15), CT (n = 12), and/or surgery (n = 6). RESULTS: MRV was 100% sensitive and 100% specific in the diagnosis of venous thrombosis (VT) of the cervical/mediastinal veins, present in fourteen patients, and 93% accurate in grading the extension of CMVT. MR images showed a greater number of collateral vessels than detected by contrast venography in case of complete cervical/mediastinal venous thrombosis. CONCLUSION: The positive diagnosis and extent of CMVT can be accurately diagnosed by a non-invasive method such as MRV.

Screening of renal artery stenosis: assessment with magnetic resonance angiography at 1.0 T.

The results of MR angiography at 1.0 T with digital intraarterial angiography in the screening of patients with suspected renal hypertension were compared. In this first phase of the study, 10 volunteers underwent examination with both two-dimensional (2D) with traveling saturation time-of-flight (TOF) magnetic resonance angiography (MRA) with various parameters to develop a protocol for evaluation of the renal arteries. In the second phase, 36 patients with suspected renovascular hypertension underwent both 2D TOF MRA and intraarterial digital angiography to evaluate the clinical value of MRA. The degree of stenosis was graded with a two-point scale. In volunteers, using 2D acquisitions C/N ratios indicated the best flip angle as being 55 degrees (p = .02). MRA showed 100% (70/70) of all main arteries and 86% (6/7) of all accessory renal arteries seen on angiography. MRA had a sensitivity of 94% (15/16) and a specificity of 98% (60/61) for detection of stenoses of greater than 50% present in 14 patients. 2D-TOF MRA at 1.0 T shows promise in the noninvasive diagnosis of patients with suspected renovascular hypertension.

Helical CT angiography with multiplanar reformation: techniques and clinical applications.

The technique and potential clinical applications of multiplanar reformation (MPR) of imaging data from helical computed tomography (CT) to display images of the blood vessels in the abdomen and the thorax are described. Helical CT was performed following bolus intravenous contrast material enhancement in patients with suspected tumor involvement of vessels in various regions of the body. The axial images were stacked to form a volume of imaging data from which a plane could be selected to display the desired vascular image in a two-dimensional format. Various techniques were used to change the image plane so that different vessels in different regions of the body could be displayed, including the splanchnic vessels around the pancreas, the portal veins and hepatic artery in the porta hepatis, the renal vessels, and the venae cavae and aorta. Rotation from a coronal or sagittal plane was necessary to display most vessels. The technique is practical and reproducible, but it requires that the operator be knowledgeable about vascular anatomy. Helical CT angiography with MPR has the potential to display vascular images that are similar to angiograms.

[Different methods of percutaneous desobstruction of peripheral arteries]. / Les différentes méthodes de désobstruction des artères périphériques par voie percutanée.

Chronic arterial occlusion of the iliac and femoro-popliteal vessels has been considered, until recently, to be a contraindication to percutaneous transluminal angioplasty. However, recent advances in radiological and catheterisation equipment and the introduction of new methods of recanalisation (laser, mechanical devices) have increased the therapeutic possibilities. The immediate and long-term results of iliac recanalisation are usually excellent with conventional angioplasty methods. The success rate of recanalisation of the femoro-popliteal segments is about 80% irrespective of the method used, the failure rate increasing with the length of the occlusion. However, the long-term patency rate is poor, about 50%. These methods of percutaneous recanalisation are technically difficult and require special training and sophisticated equipment. The indications should be carefully evaluated in a pluridisciplinary manner taking into account the potential clinical benefits, the technical difficulties, the risks and other therapeutic possibilities.