Diagnostic Value of the Magnetic Resonance Imaging With Intratympanic Gadolinium Administration (IT-Gd MRI) Versus Audio-Vestibular Tests in Menière's Disease: IT-Gd MRI Makes the Difference.

OBJECTIVE: Our aim was to evaluate the validity and reliability of clinically relevant tests in the diagnosis of Menière's disease (MD) according to the criteria formulated during 2015 as well as their efficacy in detecting endolymphatic hydrops (EH). The focus was on: three-dimensional fluid-attenuated inversion recovery-SPectral Attenuated Inversion Recovery (3D-FLAIR-SPAIR) sequences using 3 Tesla magnetic resonance imaging (3T MRI) performed 24 hours after intratympanic Gadolinium injection (IT-Gd) in comparison with the functional tests pure tone audiometry (PTA), caloric test, video head impulse test (vHIT), and cervical-vestibular-evoked-myogenic-potentials (cVEMP). STUDY DESIGN: Retrospective study. SETTING: Tertiary care center. PATIENTS: Primary eligibility criteria were given clinical suspicion of MD and the performance of an IT-Gd MRI leading to a group of 31 patients and 52 ears to be analyzed separately. MAIN OUTCOME MEASURE (S): Reanalysis of the raw diagnostic data leading to comparability of IT-Gd MRI, PTA, caloric test, vHIT, and cVEMP concerning their valency for clinically diagnosed MD and quantifiability of EH. RESULTS: Considering sensitivity, specificity, and the likelihood-ratio only the IT-Gd MRI displayed results qualifying it as a viable device for MD-diagnostics in regards to the criteria of 2015 (p = 0.01), it even provides direct imaging evidence for the underlying pathology of the disease. Furthermore, the comparison between MRI images and test results of caloric test, vHIT and cVEMP revealed that neither of these diagnostic functional tests serves as a reliable indicator for EH. CONCLUSIONS: It appears that the diagnosing process of MD would benefit from turning IT-Gd MRI into a standard diagnostic procedure in cases of suspected MD, displaying better results than caloric test, vHIT, and cVEMP.

Grading of aortic valve stenosis at 64-slice spiral computed tomography: comparison with transthoracic echocardiography and calibration against cardiac catheterization.

PURPOSE: We sought to determine the accuracy of multislice spiral computed tomography (MSCT) for assessing of aortic valve stenosis and to establish threshold values of the planimetric aortic valve orifice area (AVA) that best separate between different grades of stenosis severity. MATERIALS AND METHODS: A total of 202 patients (among them 160 patients with aortic valve stenosis) underwent MSCT, transthoracic echocardiography (TTE) and cardiac catheterization (CATH). Planimetric AVA measurements at MSCT were compared with calculations based on Doppler flow velocity measurements by TTE (using the continuity equation) and pressure gradient measurements by CATH (using the Gorlin formula). RESULTS: Series of AVA measurements correlated well between MSCT and TTE (r = 0.86) and between MSCT and CATH (r = 0.90). However, AVA at MSCT (0.98 +/- 0.47 cm) was significantly larger than AVA at TTE (0.81 +/- 0.36 cm; P < 0.05) and CATH (0.80 +/- 0.39 cm; P < 0.05). For severity grades 0 through IV the AVAs at MSCT were 2.69 +/- 0.75, 1.86 +/- 0.30, 1.48 +/- 0.17, 0.95 +/- 0.20, and 0.68 +/- 0.20 cm, respectively. For separating, the 5 severity grades optimal thresholds at MSCT were 2.1, 1.6, 1.2, and 0.9 cm. Using these adjusted thresholds there was perfect agreement in classification between MSCT and CATH in 156 (77%), but a mismatch by 1 grade in 43 (21.5%) and 2 grades in 3 (1.5%) patients (kappaw = 0.86). CONCLUSION: Planimetric AVA measurements on MSCT allows for an accurate grading of aortic valve stenosis severity. However, AVA measurements on MSCT are usually larger than measurements on TTE and CATH. Consequently, the thresholds for discriminating between different severity grades have to be adjusted in MSCT.

Quantification of aortic valve stenosis: head-to-head comparison of 64-slice spiral computed tomography with transesophageal and transthoracic echocardiography and cardiac catheterization.

OBJECTIVES: We sought to evaluate the accuracy of multislice computed tomography (MSCT) with 64 detector rows for determination of the aortic valve area (AVA) compared with transesophageal and transthoracic echocardiography (TEE and TTE) and cardiac catheterization (CATH). MATERIALS AND METHODS: MSCT, TEE, TTE, and CATH were performed in 36 patients with aortic valve stenosis. AVA was determined by planimetry on MSCT and TEE and calculated using the continuity equation on Doppler TTE and the Gorlin formula on CATH. RESULTS: The mean AVA on MSCT (0.88 +/- 0.39 cm2) was not significantly different from TEE (0.94 +/- 0.41 cm2; P > 0.05) but significantly larger than TTE (0.74 +/- 0.28 cm2; P < 0.001) and CATH (0.75 +/- 0.31 cm2; P < 0.001). A good correlation with acceptable limits of agreement was found between MSCT and TTE (r = 0.91, limits +/-0.35 cm2) and between MSCT and CATH (r = 0.91, limits +/-0.32 cm2). An inferior correlation with wider limits of agreement was found between MSCT and TEE (r = 0.82, limits +/-0.48 cm2), but this applied also between TEE and TTE (r = 0.79, limits +/-0.51 cm2) and between TEE and CATH (r = 0.78, limits +/-0.52 cm2). CONCLUSIONS: AVA determined by MSCT correlated well with TTE and CATH, but a systematic difference must be taken into account when using MSCT findings for therapeutic decision-making. Validation against both TTE and CATH revealed a superior correlation and narrower limits of agreement for MSCT than for TEE suggesting that AVA planimetry with MSCT is more reliable than with TEE.

Precision of forty slice spiral computed tomography for quantifying aortic valve stenosis: comparison with echocardiography and validation against cardiac catheterization.

OBJECTIVES: We evaluated the precision of multislice spiral computed tomography (MSCT) for the quantification of aortic valve stenosis in comparison with echocardiography and cardiac catheterization. MATERIALS AND METHODS: An electrocardiogram-gated MSCT scan (detector collimation 40 x 6.25 mm, gantry rotation time 420 milliseconds, pitch 0.2, tube voltage 120 KV, tube current 333 mA) was performed in 32 patients with known aortic valve stenosis. In each patient the aortic valve orifice area (AVA) was determined by planimetry on MSCT and compared with the results obtained from transthoracic Doppler echocardiography (using the continuity equation) and cardiac catheterization (using the Gorlin formula). RESULTS: Planimetry of the AVA on MSCT was feasible in all cases. The AVA on MSCT (1.11 +/- 0.49 cm2) was significantly larger compared with echocardiography (0.81 +/- 0.37 cm2, P < 0.001) and cardiac catheterization (0.87 +/- 0.45 cm2, P < 0.001). The correlations between MSCT and echocardiography (r = 0.86, limits of agreement +/-0.52 cm2) and also between MSCT and cardiac catheterization (r = 0.90, limits of agreement +/-0.44 cm2) were good, but inferior to the correlation between echocardiography and cardiac catheterization (r = 0.94, limits of agreement +/-0.32 cm2). Using an AVA of 1.0 cm at cardiac catheterization as reference standard, the best cut-off level for detecting severe-to-critical stenosis at MSCT was an AVA of 1.20 cm, resulting in a sensitivity, specificity, and accuracy of 91%, 100%, and 94%, respectively. CONCLUSIONS: AVA determined by MSCT correlates well with echocardiography and cardiac catheterization. However, AVA derived from MSCT is consistently larger, requiring an adjustment of cut-off values for the classification of stenosis severity and therapeutic decision making.

Contrast enhancement in electron beam tomography of the heart: comparison of a monomeric and a dimeric iodinated contrast agent in 59 patients.

RATIONALE AND OBJECTIVES: The aim of the study is to determine whether intravascular time-density course and visualization of the coronary arteries differ with use of a hyperosmolar monomeric versus an iso-osmolar dimeric contrast agent in electron beam tomography (EBT) of the heart. MATERIALS AND METHODS: Fifty-nine patients underwent EBT of the coronary arteries using the monomeric ioversol or the dimeric iodixanol at the same concentration of 320 mg I/mL. Contrast volume was determined relative to body surface area and injected over 40 seconds. Intravascular time-density curves were created for quantitative analysis. For qualitative assessment, visualization of coronary arteries on axial scans and three-dimensional reconstructions was scored. Patients were matched for contrast flow, transit time, and mean pulse rate for statistical analysis. RESULTS: Ioversol produced a significantly greater increase in intravascular density for up to 30 seconds after injection (P < .01) compared with iodixanol. No difference between the two contrast media was seen in the qualitative assessment. CONCLUSION: Monomeric and dimeric contrast media differ in their time-density curves at coronary EBT, a reason for which is not apparent. Qualitative evaluation of coronary arteries is not affected by this difference.

Multislice computed tomography for preoperative evaluation of right ventricular volumes and function: comparison with magnetic resonance imaging.

BACKGROUND: This study was performed to validate preoperative right ventricular measurements obtained from multislice spiral computed tomography data sets in comparison with magnetic resonance imaging. METHODS: Before cardiac surgery, 25 patients (among them 12 patients with compromised right ventricular function) underwent contrast-enhanced retrospectively electrocardiogram-gated multislice spiral computed tomography and cine magnetic resonance imaging in a standardized fashion. Right ventricular end-diastolic, end-systolic and stroke volume, ejection fraction, and myocardial mass were calculated according to the slice summation method. Measurements obtained with both modalities were compared using Pearson's correlation coefficient (r), Student's t test for paired samples, and Bland-Altman analysis. RESULTS: The right ventricle was completely visualized with invariably adequate image quality on all multislice spiral computed tomography and magnetic resonance images. For all measurements a close correlation between multislice spiral computed tomography and magnetic resonance imaging was found (end-diastolic volume, r = 0.93; end-systolic volume, r = 0.95; stroke volume, r = 0.91; ejection fraction, r = 0.96; mass, r = 0.94). Mean values of all measurements did not differ significantly between both modalities, and limits of agreement were in an acceptable range. CONCLUSIONS: When compared with magnetic resonance imaging as a reference method, multislice spiral computed tomography seems to be an accurate and reliable noninvasive technique for evaluating right ventricular measurements.

Comparison of electron beam computed tomography with magnetic resonance imaging in assessment of right ventricular volumes and function.

OBJECTIVE: Intraindividual comparison of right ventricular volumes and function using electron beam computed tomography (EBT) and magnetic resonance imaging (MRI). METHODS: Twenty-seven patients with a known cardiac history were referred for evaluation of ventricular function parameters. The following standardized protocols were used: contrast-enhanced multislice mode EBT and gradient echo sequence MRI. Right ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) were calculated using a slice summation method. Interobserver variability was calculated. RESULTS: The correlation between the 2 methods was: r = 0.901 for EDV, r = 0.938 for ESV, r = 0.823 for SV, and r = 0.953 for EF. Electron beam computed tomography overestimated EDV and ESV slightly when compared with MRI (P < 0.05). No significant differences (P > 0.05) were found between SV and EF. Mean values determined by EBT and MRI were as follows: 168.6 +/- 62.3 mL and 153.7 +/- 59.1 mL for EDV, 104.7 +/- 60.4 mL and 95.1 +/- 54.8 mL for ESV, 63.2 +/- 19.3 mL and 58.7 +/- 19.8 mL for SV, and 40.2% +/- 14.1% and 40.2% +/- 13.6% for EF, respectively. Interobserver variability ranged between 1.0% and 3.2%. CONCLUSION: Electron beam computed tomography shows good agreement with a close correlation and an acceptable interobserver variability for right ventricular volumes and global function, with a small but significant overestimation of EDV and ESV when compared with MRI.

MRI of cardiac rhabdomyoma in the fetus.

Primary cardiac tumors are rarely diagnosed in utero and are usually seen on prenatal echocardiography. Cardiac rhabdomyomata can be associated with tuberous sclerosis. Prenatal MRI can be performed to assess associated malformations. This case report illustrates the ability of fetal MRI to image cardiac rhabdomyata and compares it with prenatal and postnatal echocardiography.

Quantification of mitral valve regurgitation by left ventricular volume and flow measurements using electron beam computed tomography: comparison with magnetic resonance imaging.

PURPOSE: This study was designed to evaluate electron beam computed tomography (CT) for quantifying mitral regurgitation in comparison with magnetic resonance (MR) imaging as a reference method. METHOD: Forty-three patients, among them 33 with known mitral regurgitation, underwent electron beam CT and MR imaging. Total left ventricular stroke volume (TSV), antegrade stroke volume (ASV), and mitral regurgitation volume (MRV) and fraction (MRF) were determined and compared between the two modalities. Additionally electron beam CT measurements were compared with the corresponding echocardiographic findings. RESULTS: Significant differences between electron beam CT and MR imaging were found for measurements of TSV and MSV but not for ASV and MRF. There was a close linear correlation between both modalities for all parameters. Furthermore, there was good agreement between electron beam CT and echocardiography, although electron beam CT shows a tendency to overestimate mitral regurgitation slightly. CONCLUSION: The results indicate that electron beam CT offers an additional procedure for quantifying mitral regurgitation and that it may be used as an alternative to MR imaging.

Effect of partial left ventriculectomy on left and right ventricular volumes and function as assessed with electron beam tomography: preliminary results.

Our objective was to determine if left ventricular reduction surgery affects left and right ventricular volumes and function. Twenty-three patients with end-stage heart failure underwent contrast-enhanced electron beam tomographic function studies before and twice after partial left ventriculectomy (PLV). The PLV was combined with other cardiosurgical procedures in 20 of 23 patients. Left and right ventricular enddiastolic volume (LVEDV, RVEDV), stroke volume (LVSV, RVSV), ejection fraction (LVEF, RVEF), and enddiastolic diameter (LVEDD, RVEDD) were determined by manual tracing of endo- and epicardial borders at enddiastole and endsystole. Patients were scanned 31 days (+/-34) before and 18 days (+/-13) and 8 months (+/-4) after PLV. Mean pre- and early and late postoperative values for LVEDV, LVSV, LVEF, and LVEDD were 387.9 ml (+/-125.5 ml), 255.6 ml (+/-79.3 ml; p<0.01), and 253.7 ml (+/-97.8 ml; p<0.05), 79.7 ml (+/-25.2 ml), 74.8 ml (+/-17.9; n.s.), and 79.1 ml (+/-26.5 ml; n.s.), 21.6% (+/-7.3%), 31.9% (+/-13.4%; p<0.05), and 34.1% (+/-14.1%; p<0.05), and 72.0 mm (+/-10.6 mm), 64.3 mm (+/-8.5 mm; p<0.05), and 63.5 mm (+/-9.4 mm; p<0.05), respectively. Mean pre- and postoperative values for RVEDV, RVSV, RVEF, and RVEDD were 177.7 ml (+/-72.8 ml), 172.4 ml (+/-59.2 ml; n.s.), and 178.9 ml (+/-60.8 ml; n.s.), 60.3 ml (+/-21.6 ml), 68.8 ml (+/-19.9 ml; n.s.), and 78.3 ml (+/-25.3 ml; n.s.), 38.1% (+/-15.4%), 43.7% (+/-16.3%; p<0.05), and 45.1% (+/-11.2%; n.s.), and 50.4 mm (+/-10.9 mm), 48.1 mm (+/-8.7 mm; n.s.), and 48.5 mm (+/-9.8 mm; n.s.), respectively. The PLV may induce a significant early reduction of left ventricular volumes and improvement of biventricular function; however, our results must be judged carefully as the majority of patients in this study underwent additional cardiosurgical procedures, the contributory effect of which on the overall outcome remains unclear.

Prenatal diagnosis of partial agenesis of the corpus callosum in a fetus with thanatophoric dysplasia type 2.

A fetus with thanatophoric dysplasia type 2 (TD2) associated with cloverleaf skull and abnormal development of the corpus callosum is reported. This case represents the first prenatal direct visualization of a partial agenesis of the corpus callosum (ACC) using high-resolution ultrasonography and colour power Doppler, which was confirmed by post-mortem magnetic resonance imaging (MRI). The causal link between cloverleaf skull in TD and partial ACC is discussed.

Electron beam tomography of interpulmonary saddle embolism: extent and vascular distribution.

PURPOSE: The purpose of this work was to assess morphology and secondary signs of interpulmonary emboli extending across the bifurcation of the main pulmonary artery (PA). METHOD: Retrospective evaluation of 780 electron beam tomographic studies of the chest yielded 17 cases of interpulmonary saddle embolism. Length, diameter, vascular distribution of the emboli, and secondary findings were prospectively assessed by two blinded reviewers. Follow-up studies were carried out in 12 of 17 patients (71%). RESULT: Mean total length of the emboli was 46.6 cm (range 20.9-81.5 cm). The mean diameter of the saddle embolus was significantly smaller at the level of the bifurcation than in the left or right PA (4.5, 7.7, and 7.4 mm, respectively; p < 0.01). Dilatation of the right heart was found in 10 of 17 cases (59%). At follow-up, the saddle state was no longer present in 8 of 12 patients (67%). CONCLUSION: Interpulmonary saddle emboli appear to be a transient form of acute pulmonary embolism, the site of predilection for rupture of the embolus being the level of the bifurcation. Their frequency may therefore be underestimated.