Morphological assessment of the aortic valve using coronary computed tomography angiography, cardiovascular magnetic resonance, and transthoracic echocardiography: comparison with intraoperative findings.

To compare the diagnostic accuracies of coronary computed tomography angiography (CCTA), cardiovascular magnetic resonance (CMR), and transthoracic echocardiography (TTE) in aortic valve (AV) morphological assessments with operative findings. We retrospectively enrolled 262 patients who underwent CCTA, CMR, and TTE before AV surgery. Two independent blinded observers assessed AV morphology as being tricuspid, bicuspid, or quadricuspid using three imaging modalities. Interobserver and intermodality agreements were obtained with kappa statistics. The diagnostic accuracies of CCTA, CMR, and TTE for identifying AV morphology (tricuspid vs. non-tricuspid) were compared with intraoperative findings as the reference standard. At surgery, tricuspid AV, bicuspid AV, and quadricuspid AV were present in 179, 80, and 3 patients, respectively. The CCTA and CMR image qualities were all diagnostic. Thirteen cases of TTE were not evaluable due to severe AV calcification. An excellent correlation between CMR and CCTA was seen for the identification of AV morphology (κ = 0.97). Good correlations existed between CCTA and TTE (κ = 0.72) and between CMR and TTE (κ = 0.74). CCTA, CMR, and TTE had an excellent or good interobserver agreement (κ = 0.90, 0.95, and 0.72, respectively). Sensitivity, specificity, and positive and negative predictive values for AV morphology assessment (tricuspid vs. non-tricuspid) were: 97, 95, 98, and 94 % with CCTA (n = 262); 98, 96, 98, and 95 % with CMR (n = 262); and 98, 88, 95, and 96 % with TTE (n = 249). CCTA and CMR are highly accurate for identifying AV morphology.

Cervical epidural lymphangioma presenting as a hemorrhagic cyst: a case report.

STUDY DESIGN: A case report. OBJECTIVE: We report a case of epidural lymphangioma in the cervical spine, and it manifested as a hemorrhagic cyst. SUMMARY OF BACKGROUND DATA: Intraspinal lymphangioma is an uncommon tumor with only a few cases reported in the literature. Epidural lymphangioma presenting as a hemorrhagic cyst is extremely rare. METHODS: The patient chosen was a 43-year-old woman with the chief complaint of neck pain and right upper extremity numbness of 2-month duration. RESULTS: Cervical spine magnetic resonance (MR) imaging revealed an epidural cystic mass extending to the right C6-C7 neural foramen. The mass showed fluid-fluid levels on T2-weighted image and high-signal intensity on diffusion-weighted image. Surgical resection and histologic analysis confirmed the diagnosis of epidural lymphangioma with internal hemorrhage. CONCLUSION: Epidural lymphangioma is a rare benign tumor. However, it should be included in the differential diagnosis of hemorrhagic cystic mass in the epidural space, which presented with fluid-fluid levels on MR imaging and high-signal intensity on diffusion weighted imaging.