Dynamic contrast enhanced magnetic resonance lymphangiography: Categorization of imaging findings and correlation with patient management.

OBJECTIVE: To review the technical aspects and categorize the imaging findings of dynamic contrast enhanced magnetic resonance lymphangiography (DCMRL) and correlate the findings with patient management options. MATERIALS AND METHODS: A retrospective review of patients who underwent DCMRL between June 2012 and August 2017 at a tertiary care paediatric hospital was performed. Twenty-five DCMRL studies were performed in 23 patients (9 males, 13 females, 1 ambiguous gender) with a median age of 4 years (range: 1 month-29 years). DCMRL imaging findings were reviewed, categorized and the impact on patient management was studied. RESULTS: DCMRL was technically successful in 23/25 (92%) studies. DCMRL findings were categorized based on the status of central conducting lymphatics (CCL) and alternate lymphatic pathways as follows: Type 1 - normal CCL with no alternate lymphatic pathways, Type 2 - partial (2a) or complete (2b) non-visualization of CCL with reflux of contrast into alternate pathways and Type 3 - normal CCL with additional filling of alternate pathways. Type 1 DCMRL patients (n = 5) were reassured and conservative management was continued, Type 2 patients (n = 10) had evidence of CCL obstruction hence thoracic duct ligation or embolization was avoided and other options such as lymphatic fluid diversion using Denver® shunt or lympho-venous anastomosis were used, and Type 3 patients (n = 8) were evaluated for elevated central venous pressure as a cause of lymphatic backflow in addition to Denver® shunt, lympho-venous anastomosis, thoracic duct ligation or embolization. CONCLUSION: DCMRL is an evolving imaging technique for understanding abnormalities of the central conducting lymphatics. Categorization of imaging findings may be helpful in guiding selection of management options.

Evaluación de la ansiedad en pacientes ante pruebas diagnósticas de patología cardiovascular / Assessment of anxiesty in patient with cardiovascular disease diagnostic test

Se realizó un estudio para indagar el nivel de ansiedad que presentan los pacientes ante pruebas diagnosticas cardiovasculares durante el año 2011. El trabajo fue de tipo descriptivo, transversal. La muestra fue de 161 pacientes que asistieron a un servicio de medicina nuclear. Se utilizó la esacala de ansiedad Estado Rasgo A/E STAI (inventario de ansiedad estado y rasgo) Entre los resultados se destaca el nivel de A/E medio en el 45,34% de los pacientes, y A/R en el 50,31%. Niveles altos de ansiedad en el 22,36%. Las mujeres presentaron mayores porcentajes que los varones de A/E con 24,46% de nivel medio y 14,91% de nivel alto. Se puede concluir que los niveles de ansiedad media fueron los de mayor frecuencia, mientras que las mujeres mostraron mayores porcentajes en los niveles de ansiedad que los varones.

Fast 3D cine steady-state free precession imaging with sensitivity encoding for assessment of left ventricular function in a single breath-hold.

OBJECTIVE: This study compares single breath-hold 3D cine steady-state free precession (SSFP) MRI using sensitivity encoding (SENSE) with standard 2D cine SSFP imaging in the quantitative evaluation of global left ventricular (LV) function. MATERIALS AND METHODS: The LV function of 22 healthy volunteers and 15 patients was evaluated using a standard 2D SSFP sequence and a 3D SSFP sequence with SENSE at 1.5 T. Ventricular volume, ejection fraction, and LV mass were calculated with each method, and signal-to-noise ratios (SNRs) and myocardium-to-blood contrast-to-noise ratios (CNRs) were measured. Agreement between the two methods was assessed using Bland-Altman analysis, and results were compared using a paired Student's t test (p < 0.05). The local institutional review board approved the study protocol, and all participants gave signed informed consent. The study complied with the Health Insurance Portability and Accountability Act. RESULTS: Both techniques produced similar estimates of ejection fraction (mean bias +/- SD, -1.2% +/- 3.6%) and LV mass (mean bias, +/- SD-1.2 +/- 10.9 g). No significant differences were found in calculated volumes, ejection fraction, or LV mass between the two methods. Acquisition time was reduced by 82%, to a single breath-hold (18 +/- 3 seconds), with the 3D SSFP technique. SNR and CNR were significantly lower with the 3D method than with the standard method. CONCLUSION: Three-dimensional SSFP imaging with SENSE can reduce acquisition time to a single breath-hold and can provide LV function quantification comparable to that obtained with conventional 2D SSFP imaging.

Tissue characterization of myocardial infarction using T1rho: influence of contrast dose and time of imaging after contrast administration.

PURPOSE: To determine whether contrast between acutely infarcted and normal myocardia in T1-rho-weighted cine TFE (T1rho-TFE) and delayed-enhancement (DE) images (measured using a metric percent enhancement (PE)) varied with the dose or time of imaging after contrast administration. MATERIALS AND METHODS: Eighteen patients with acute myocardial infarction (AMI) were randomly divided into three groups according to the dose of gadoversetamide (0.1, 0.2, or 0.3 mmol/kg) administered. After contrast administration, T1rho-TFE images were acquired at five and 40 minutes, and DE images were acquired at 10 and 30 minutes. RESULTS: For T1rho-TFE imaging the PE values at 40 minutes were 70+/-14, 98+/-14, and 105+/-41 at 0.1, 0.2, and 0.3 mmol/kg dose levels, which were significantly greater than the corresponding PEs at five minutes after contrast administration (44+/-12, 71+/-14, and 36+/-13). For DE and T1rho-TFE imaging the dose of contrast agent did not significantly affect the PE. However, with DE the PE tended to increase with the dose. At all dose levels, irreversible injury was more conspicuous in T1rho-TFE images acquired at 40 minutes than at five minutes after contrast. CONCLUSION: In T1rho-TFE, acute infarction was more conspicuous in images acquired at a later time point, and the PE did not vary with the contrast dose.

Quantitative assessment of left ventricular function: steady-state free precession MR imaging with or without sensitivity encoding.

Quantitative left ventricular (LV) function was assessed with magnetic resonance imaging in 20 patients by using standard multisection multiphase steady-state free precession (SSFP) imaging and sensitivity encoding (SENSE)-accelerated cine SSFP imaging with identical spatial, contrast, and temporal resolution. The local institutional review board approved the protocol, and all patients gave signed informed consent prior to imaging. The study complied with the Health Insurance Portability and Accountability Act. Results of Bland-Altman analysis showed that both techniques produced similar estimates of LV ejection fraction, LV mass, and blood-to-muscle contrast and demonstrated minimal interobserver variability. The authors showed that it is possible, by combining SENSE with cine SSFP imaging, to reduce acquisition time by 50% without compromising spatial resolution, temporal resolution, or blood-to-muscle contrast-to-noise ratio compared with those achieved by using SSFP imaging without SENSE for quantitative LV function assessment.

Perfil del usuario y características de la utilización del Sistema Público de Salud / User profile and the characterictics in the use of the Public Health System

La presente investigación se orienta al conocimiento de las características del perfil de los usuarios de los servicios de salud en seis centros asistenciales de Salta. Sus resultados permiten advertir la necesidad de la relación interpersonal como derecho y reclamo de los usuarios que aporta a la calidad de las prestaciones sanitarias

Perfil del usuario y características de la utilización del Sistema Público de Salud / User profile and the characterictics in the use of the Public Health System

La presente investigación se orienta al conocimiento de las características del perfil de los usuarios de los servicios de salud en seis centros asistenciales de Salta. Sus resultados permiten advertir la necesidad de la relación interpersonal como derecho y reclamo de los usuarios que aporta a la calidad de las prestaciones sanitarias (AU)