MRI feature tracking strain is prognostic for all-cause mortality in AL amyloidosis.

OBJECTIVES: Cardiac involvement is a major determinate of mortality in light chain (AL) amyloidosis. Cardiac magnetic resonance imaging (MRI) feature tracking (FT) strain is a new method for measuring myocardial strain. This study retrospectively evaluated the association of MRI FT strain with all-cause mortality in AL amyloidosis. MATERIALS AND METHODS: Seventy-six patients with newly diagnosed AL amyloidosis underwent cardiac MRI. 75 had images suitable for MRI FT strain analysis. MRI delayed enhancement, morphologic and functional evaluation, cardiac biomarker staging and transthoracic echocardiography were also performed. Subjects' charts were reviewed for all-cause mortality. Cox proportional hazards analysis was used to evaluate survival in univariate and multivariate analysis. RESULTS: There were 52 deaths. Median follow-up of surviving patients was 1.7 years. In univariate analysis, global radial (Hazard Ratio (HR) = 0.95, p <.01), circumferential (HR = 1.09, p < .01) and longitudinal (HR = 1.08, p < .01) strain were associated with all-cause mortality. In separate multivariate models, radial (HR = 0.96, p = .02), circumferential (HR = 1.09, p = .03) and longitudinal strain (HR = 1.07, p = .04) remained prognostic when combined with presence of biomarker stage 3. CONCLUSIONS: MRI FT strain is associated with all-cause mortality in patients with AL amyloidosis.

Granulomatous diseases of the breast and axilla: radiological findings with pathological correlation.

OBJECTIVES: This article reviews our experience and describes the literature findings of granulomatous diseases of the breast and axilla. METHODS: After approval of the Institutional Review Board was obtained, the surgical pathological records from January 2000 to January 2017 were searched for the keyword granulomatous. Clinical, imaging and histology findings were reviewed by both a fellowship-trained radiologist and a breast-imaging consultant radiologist, reviewing 127 patients (age range, 32-86 years; 126 women and 1 man). RESULTS: Most common causes of granulomatous lesions of the breast and axilla included silicone granulomas 33% (n = 42), fat necrosis 29% (n = 37) and suture granulomas 11% (n = 14). In 16% (n = 20), no cause could be found and clinical history was consistent with idiopathic granulomatous mastitis. Other granulomatous aetiologies included granulomatous infections, sarcoidosis and Sjögren's syndrome. Causes of axillary granulomatous disease were similar to the breast; however, a case of cat-scratch disease was found that only involved the axillary lymph nodes. They can have a variable appearance on imaging and may mimic malignancy with irregular masses seen on mammography, ultrasound and magnetic resonance imaging. Fistulas to the skin and nipple retraction can suggest chronicity and a granulomatous aetiology. Combination of clinical history, laboratory and imaging findings can be diagnostic. CONCLUSIONS: Granulomatous processes of the breast are rare. The diagnosis can, however, be made if there is relevant history (prior trauma, silicone breast implants, lactation), laboratory (systemic or infectious processes) and imaging findings (fistula, nipple retraction). Recognising these entities is important for establishing pathological concordance after biopsy and for preventing unnecessary treatment. TEACHING POINTS: Breast granulomatous are rare but can mimic breast carcinoma on imaging Imaging with clinical and laboratory findings can correctly diagnosis specific granulomatous breast diseases Recognition of the imaging findings allows appropriate pathological concordance and treatment.

Functional anatomy and pathophysiologic principles in mitral regurgitation: Non-invasive assessment.

Mitral regurgitation (MR) is the most prevalent cause of valvular heart disease (VHD) in western countries. In the Euro Heart Survey on VHD, MR was the second most common heart VHD requiring surgery. It is also the most common form of VHD in community and population-based studies from the United States. The categorization of MR based on causes and mechanisms is a major determinant of clinical outcome, of possible therapies for the MR and of the effectiveness of these therapies. Surgical mitral valve (MV) repair has been shown to improve survival in patients with severe primary MR compared with MV replacement. In addition, new percutaneous repair and replacement procedures have been recently developed. Hence, accurate understanding of the functional anatomy of the MV and the pathophysiologic principles underlying MR is needed to appropriately target valve lesions. Recent advances in cardiac imaging have allowed to deeply strengthen the knowledge of the function of the MV. The present review aims at describing the functional anatomy and pathophysiology of MR through different cardiac imaging modalities.

Air embolism: diagnosis and management.

Air embolism is an uncommon, but potentially life-threatening event for which prompt diagnosis and management can result in significantly improved patient outcomes. Most air emboli are iatrogenic. Arterial air emboli may occur as a complication from lung biopsy, arterial catheterization or cardiopulmonary bypass. Immediate management includes placing the patient on high-flow oxygen and in the right lateral decubitus position. Venous air emboli may occur during pressurized venous infusions, or catheter manipulation. Immediate management includes placement of the patient on high-flow oxygen and in the left lateral decubitus and/or Trendelenburg position. Hyperbaric oxygen therapy is the definitive treatment which may decrease the size of air emboli by facilitating gas reabsorption, while also improving tissue oxygenation and reducing ischemic reperfusion injury.

Multimodality imaging of foreign bodies in and around the heart.

Foreign objects are occasionally seen on computed tomography and could pose a diagnostic challenge to the radiologist and clinicians. It is important to recognize, characterize and localize these objects and determine their clinical significance. Most foreign objects in and around the heart are the result of direct penetrating injury or represent venous embolization to the heart. Foreign objects may cause symptoms and require prompt medical attention or maybe asymptomatic. Clinicians should be familiar with foreign objects that are encountered and understand treatment options. This paper looks at some of foreign objects that can be found and correlates with pathology where possible.