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1.
Radiol Cardiothorac Imaging ; 6(3): e230247, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38900026

RESUMO

Purpose To use unsupervised machine learning to identify phenotypic clusters with increased risk of arrhythmic mitral valve prolapse (MVP). Materials and Methods This retrospective study included patients with MVP without hemodynamically significant mitral regurgitation or left ventricular (LV) dysfunction undergoing late gadolinium enhancement (LGE) cardiac MRI between October 2007 and June 2020 in 15 European tertiary centers. The study end point was a composite of sustained ventricular tachycardia, (aborted) sudden cardiac death, or unexplained syncope. Unsupervised data-driven hierarchical k-mean algorithm was utilized to identify phenotypic clusters. The association between clusters and the study end point was assessed by Cox proportional hazards model. Results A total of 474 patients (mean age, 47 years ± 16 [SD]; 244 female, 230 male) with two phenotypic clusters were identified. Patients in cluster 2 (199 of 474, 42%) had more severe mitral valve degeneration (ie, bileaflet MVP and leaflet displacement), left and right heart chamber remodeling, and myocardial fibrosis as assessed with LGE cardiac MRI than those in cluster 1. Demographic and clinical features (ie, symptoms, arrhythmias at Holter monitoring) had negligible contribution in differentiating the two clusters. Compared with cluster 1, the risk of developing the study end point over a median follow-up of 39 months was significantly higher in cluster 2 patients (hazard ratio: 3.79 [95% CI: 1.19, 12.12], P = .02) after adjustment for LGE extent. Conclusion Among patients with MVP without significant mitral regurgitation or LV dysfunction, unsupervised machine learning enabled the identification of two phenotypic clusters with distinct arrhythmic outcomes based primarily on cardiac MRI features. These results encourage the use of in-depth imaging-based phenotyping for implementing arrhythmic risk prediction in MVP. Keywords: MR Imaging, Cardiac, Cardiac MRI, Mitral Valve Prolapse, Cluster Analysis, Ventricular Arrhythmia, Sudden Cardiac Death, Unsupervised Machine Learning Supplemental material is available for this article. © RSNA, 2024.


Assuntos
Prolapso da Valva Mitral , Fenótipo , Aprendizado de Máquina não Supervisionado , Humanos , Prolapso da Valva Mitral/diagnóstico por imagem , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sistema de Registros , Imagem Cinética por Ressonância Magnética/métodos , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/fisiopatologia , Adulto , Imageamento por Ressonância Magnética
3.
Radiology ; 306(1): 112-121, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36098639

RESUMO

Background Patients with mitral valve prolapse (MVP) may develop adverse outcomes even in the absence of mitral regurgitation or left ventricular (LV) dysfunction. Purpose To investigate the prognostic value of mitral annulus disjunction (MAD) and myocardial fibrosis at late gadolinium enhancement (LGE) cardiac MRI in patients with MVP without moderate-to-severe mitral regurgitation or LV dysfunction. Materials and Methods In this longitudinal retrospective study, 118 144 cardiac MRI studies were evaluated between October 2007 and June 2020 at 15 European tertiary medical centers. Follow-up was from the date of cardiac MRI examination to June 2020; the minimum and maximum follow-up intervals were 6 months and 156 months, respectively. Patients were excluded if at least one of the following conditions was present: cardiomyopathy, LV ejection fraction less than 40%, ischemic heart disease, congenital heart disease, inflammatory heart disease, moderate or worse mitral regurgitation, participation in competitive sport, or electrocardiogram suggestive of channelopathies. In the remainder, cardiac MRI studies were reanalyzed, and patients were included if they were aged 18 years or older, MVP was diagnosed at cardiac MRI, and clinical information and electrocardiogram monitoring were available within 3 months from cardiac MRI examination. The end point was a composite of adverse outcomes: sustained ventricular tachycardia (VT), sudden cardiac death (SCD), or unexplained syncope. Multivariable Cox regression analysis was performed. Results A total of 474 patients (mean age, 47 years ± 16 [SD]; 244 women) were included. Over a median follow-up of 3.3 years, 18 patients (4%) reached the study end point. LGE presence (hazard ratio, 4.2 [95% CI: 1.5, 11.9]; P = .006) and extent (hazard ratio, 1.2 per 1% increase [95% CI: 1.1, 1.4]; P = .006), but not MAD presence (P = .89), were associated with clinical outcome. LGE presence had incremental prognostic value over MVP severity and sustained VT and aborted SCD at baseline (area under the receiver operating characteristic curve, 0.70 vs 0.62; P = .03). Conclusion In contrast to mitral annulus disjunction, myocardial fibrosis determined according to late gadolinium enhancement at cardiac MRI was associated with adverse outcome in patients with mitral valve prolapse without moderate-to-severe mitral regurgitation or left ventricular dysfunction. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Gerber in this issue.


Assuntos
Cardiomiopatias , Insuficiência da Valva Mitral , Prolapso da Valva Mitral , Disfunção Ventricular Esquerda , Humanos , Feminino , Pessoa de Meia-Idade , Prolapso da Valva Mitral/complicações , Estudos Retrospectivos , Meios de Contraste , Gadolínio , Valva Mitral , Imageamento por Ressonância Magnética , Fibrose , Morte Súbita Cardíaca
7.
Monaldi Arch Chest Dis ; 92(4)2022 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-35225444

RESUMO

A 26-weeks pregnant woman presented with progressively worsening dyspnoea and poor general conditions. Using low-dose radiation multi-imaging techniques and thoracic biopsy a primary mediastinal large B cell was diagnosed. A multidisciplinary approach identified the correct hemodynamic management, the best therapeutic strategy and the timing for delivery.


Assuntos
Linfoma Difuso de Grandes Células B , Neoplasias do Mediastino , Dispneia/etiologia , Feminino , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/terapia , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/terapia , Mediastino/patologia , Gravidez
8.
Eur Heart J Acute Cardiovasc Care ; 9(7): NP3-NP7, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27221956

RESUMO

We report the case of a 23-year-old man who developed an acute ST-elevation myocardial infarction secondary to acute thrombotic occlusion of the proximal left anterior descending coronary artery five years after undergoing chemotherapy, radiotherapy, haematopoietic stem cell transplantation for acute lymphoblastic leukaemia and bulky mediastinal mass involving the pleura and pericardium. His medical history also included Graft versus Host Disease developed 13 months after transplantation and acute myocarditis three months before the actual hospital admission. To the best of our knowledge, coronary artery disease as a complication of haematopoietic stem cell transplantation and low-dose mediastinal radiation therapy in young patients has been rarely reported in the medical literature. Clinicians should have a high degree of suspicion of coronary artery disease in patients treated with allogeneic haematopoietic stem cell transplantation, especially in patients previously treated with target mediastinal radiotherapy, as a group at risk of premature and significantly accelerated atherosclerosis, in order to make a timely and correct diagnosis.


Assuntos
Aterosclerose/complicações , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/cirurgia , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Aterosclerose/diagnóstico , Angiografia Coronária , Eletrocardiografia , Humanos , Masculino , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Adulto Jovem
9.
Am J Cardiol ; 125(1): 146-151, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31711636

RESUMO

Cardiac magnetic resonance (CMR) offers the capability to objectively detect pericarditis by identifying pericardial thickening, edema/inflammation by Short-TI Inversion Recovery-T2 weighted (STIR-T2w) imaging, edema/inflammation or fibrosis by late gadolinium enhancement (LGE), and presence of pericardial effusion. This is especially helpful for the diagnosis of recurrent pericarditis. Aim of the present paper is to assess the diagnostic accuracy of CMR findings as well as their potential prognostic value for the diagnosis of recurrent pericarditis. Multicenter cohort study of consecutive patients with recurrent pericarditis evaluated by CMR. We included 128 consecutive cases (60 males, 47%; mean age 48 ± 14 years). CMR was performed at a mean time of 12 days (95% confidence interval 15 to 21) after the clinical diagnosis. We evaluated the diagnostic accuracy and areas under the receiver operating characteristic (ROC) curve for CMR diagnostic criteria and complications (additional recurrences, cardiac tamponade, and constrictive pericarditis). Areas under the ROC curve were respectively 64% for pericardial thickening, 84% for pericardial edema, 82% for pericardial LGE, and 71% for pericardial effusion. After a mean follow-up of 34 months, recurrences occurred in 52% of patients, tamponade in 6%, and constrictive pericarditis in 11%. Using a multivariable Cox model, elevation of CRP and presence of CMR pericardial thickening were predictors of adverse events, whereas the presence of CMR LGE was associated with a lower risk. The prognostic model for adverse events using gender, age, CRP level, and all CMR variables showed a C-index of 0.84. In conclusion, CMR findings show high diagnostic accuracy and may help identifying patients at higher risk of complications.


Assuntos
Imagem Cinética por Ressonância Magnética/métodos , Pericardite/diagnóstico , Pericárdio/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença
10.
G Ital Cardiol (Rome) ; 20(1): 8-19, 2019 Jan.
Artigo em Italiano | MEDLINE | ID: mdl-30638211

RESUMO

Cardiac magnetic resonance is an accurate and versatile tool for multiparametric morphologic and functional evaluation of the heart and great vessels, with a wide range of clinical applications: from acute and chronic ischemic heart disease to the assessment of the substrate of complex ventricular arrhythmias and the follow-up of patients with valvular and congenital heart disease. The accuracy in cardiac volume and ejection fraction quantification, tissue characterization, valvular regurgitant fraction and cardiac shunt assessment, pharmachologic stress myocardial perfusion and three-dimensional reconstruction of great vessels are the points of strength that have made Cardiac magnetic resonance an invaluable tool for diagnostic, classification and follow-up of patients with various cardiac diseases.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Volume Cardíaco/fisiologia , Doenças Cardiovasculares/fisiopatologia , Humanos , Imageamento Tridimensional/métodos , Reprodutibilidade dos Testes , Volume Sistólico/fisiologia
11.
G Ital Cardiol (Rome) ; 19(12): 679-691, 2018 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-30520882

RESUMO

Cardiac magnetic resonance (CMR) has proved to be a powerful tool in the assessment of several cardiac diseases, thanks to its capability to offer multiparametric morphologic and functional evaluation of the heart and great vessels, using neither ionizing radiations nor nephrotoxic contrast medium. The accuracy in quantification of cardiac volumes and ejection fraction (gold standard) together with native and post-contrast myocardial tissue characterization have made CMR an invaluable tool for the diagnosis, prognosis and therapeutic planning in patients with heart failure and cardiomyopathy.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Humanos , Prognóstico , Reprodutibilidade dos Testes
12.
Clin Cardiol ; 41(4): 494-501, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29663442

RESUMO

BACKGROUND: Late gadolinium enhancement (LGE) assessed with cardiovascular magnetic resonance (CMR) correlates with ventricular arrhythmias and survival in patients with structural heart disease. Whether some LGE characteristics may specifically improve prediction of arrhythmic outcomes is unknown. HYPOTHESIS: We sought to evaluate scar characteristics assessed with CMR to predict implantable cardioverter-defibrillator (ICD) interventions in dilated cardiomyopathy of different etiology. METHODS: 96 consecutive patients evaluated with CMR received an ICD. Biventricular volumes, ejection fraction, and myocardial LGE were evaluated. LGE was defined as "complex" (Cx-LGE) in presence of ≥1 of the following: ischemic pattern, involving ≥2 different coronary territories; epicardial pattern; global endocardial pattern; and presence of ≥2 different patterns. The primary endpoint was occurrence of any appropriate ICD intervention. A composite secondary endpoint of cardiovascular death, cardiac transplantation, or ventricular assist device implantation was also considered. RESULTS: During a median follow-up of 75 months, 30 and 25 patients reached the primary and secondary endpoints, respectively. Cx-LGE was correlated with a worse primary endpoint survival (log-rank P < 0.001). Cx-LGE and right ventricular end-diastolic volume were independently associated with the primary endpoint (HR: 3.22, 95% CI: 1.56-6.65, P = 0.002; and HR: 1.06, 95% CI: 1.00-1.12, P = 0.045, respectively), but not with the secondary endpoint. CONCLUSIONS: Cx-LGE identified at CMR imaging seems promising as an independent and specific prognostic factor of ventricular arrhythmias requiring ICD therapy in dilated cardiomyopathy of different etiologies.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Cardiomiopatia Dilatada/diagnóstico por imagem , Cicatriz/diagnóstico por imagem , Tomada de Decisão Clínica , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Imagem Cinética por Ressonância Magnética , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Dilatada/terapia , Cicatriz/etiologia , Cicatriz/fisiopatologia , Cicatriz/terapia , Meios de Contraste/administração & dosagem , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Progressão da Doença , Intervalo Livre de Doença , Feminino , Gadolínio DTPA/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
G Ital Cardiol (Rome) ; 18(2): 164-168, 2017 Feb.
Artigo em Italiano | MEDLINE | ID: mdl-28398370

RESUMO

Pheochromocytoma is a rare tumor, usually benign, potentially lethal in case of crisis with acute release of catecholamines. The heart is a target and the clinical presentation can mimic various cardiac conditions, thus rendering diagnosis elusive. Cardiac magnetic resonance is a valuable non-invasive diagnostic tool for the evaluation of cardiomyopathies; it allows the identification of catecholamine-induced myocarditis pattern and, in some cases, it can detect the primary tumor. The definitive treatment of pheochromocytoma is surgical, while the acute crisis may require mechanical support to circulation. We here report a case of pheochromocytoma in a 25-year-old man complicated by catecholamine-induced myocarditis and heart failure.


Assuntos
Neoplasias das Glândulas Suprarrenais/metabolismo , Catecolaminas/efeitos adversos , Catecolaminas/biossíntese , Insuficiência Cardíaca/induzido quimicamente , Miocardite/induzido quimicamente , Feocromocitoma/metabolismo , Neoplasias das Glândulas Suprarrenais/complicações , Adulto , Humanos , Masculino , Feocromocitoma/complicações
14.
Int J Cardiol ; 231: 216-221, 2017 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-27913009

RESUMO

BACKGROUND: The presence of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has diagnostic and prognostic value in patients with acute myocarditis (AM). Aim of our study was to quantify the changes in LGE extension (LGE%) early after AM and evaluate its relations with biventricular function and morphology. METHODS: We investigated 76 consecutive patients with AM (acute onset of chest pain/heart failure/ventricular arrhythmias not explained by other causes, and raised troponin) that met CMR criteria based on myocardial oedema at T2-weighted images and LGE on post-contrast images at median time of 6days from onset of symptoms. We quantified LGE% at baseline and after 148days in 49 patients. RESULTS: Median left ventricular (LV)-ejection fraction (EF) was 64% (interquartile range [Q1-Q3]: 56-67%), and LGE% 9.4% (Q1-Q3: 7.5-13.2%). LGE% was correlated with LV end-systolic volume index (LV-ESVi; r=+0.34; p=0.003). LGE% was inversely correlated with LV-EF (r=-0.31; p=0.009) and time to CMR scan (r=-0.25; p=0.028). In the 49 patients with a second CMR scan, despite no significant variations in LV-EF, a significant decrease of LGE% was observed (p<0.0001) with a relative reduction of 42% compared with baseline. Patients showing increased LV-ESVi at follow up had a lower decrease of LGE% (p=0.038). CONCLUSIONS: In the acute phase of AM the LGE extension is a dynamic process that reflects impairment of LV function and is time dependent. LGE% appears one of the CMR parameters with the largest relative variations in the first months after AM.


Assuntos
Ventrículos do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Miocardite/diagnóstico , Compostos Organometálicos/farmacologia , Doença Aguda , Adulto , Meios de Contraste/farmacologia , Progressão da Doença , Feminino , Seguimentos , Gadolínio , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Miocardite/fisiopatologia , Miocárdio/patologia , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Volume Sistólico , Fatores de Tempo , Função Ventricular Esquerda/fisiologia
15.
J Cardiovasc Med (Hagerstown) ; 18(4): 244-248, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27136700

RESUMO

BACKGROUND: Type 1 Gaucher disease (GD1) is the most common lysosomal disorder, characterized by the accumulation of beta-glucocerebroside into the macrophages of several organs. Cardiac involvement is rare and referred to as restrictive cardiomyopathy, pulmonary hypertension, and calcifications of the valves and the aortic arch. AIM: To assess the cardiovascular status by cardiac magnetic resonance, including evaluation of tissue characterization, in GD1 patients. METHODS: Nine GD1 patients were recruited at the Tertiary Care Centre for Rare Diseases at Ca' Granda Foundation IRCCS Hospital, Milan. The patients' records were available for a mean time of 6 ±â€Š3 years. Medical history of cardiac disease and cardiovascular risk factors were surveyed by direct interview. Patients were scanned with a 1.5 Avanto Siemens using a comprehensive cardiovascular evaluation protocol, including morphologic and functional sequences with gadolinium contrast media, to assess early and late enhancement (late gadolinium enhancement). Echocardiography was performed to study the cardiac morphology and function, including the measurement of pulmonary pressure. RESULTS: Three patients showed left atrial enlargement, one patient showed moderate aortic stenosis in bicuspid valve with mild aortic dilatation, and one patient showed moderate mitral regurgitation. No evidence of myocardial late gadolinium enhancement was detected after gadolinium contrast media. Seven patients received enzyme replacement therapy for a median of 1 year, and two patients were evaluated at diagnosis. CONCLUSION: Although cardiac disease in Gaucher disease is considered rare and associated with particular genotypes, we have found two valvular diseases and mild left atrial enlargement in three out of nine patients. Further studies to evaluate the prognostic value of these findings are warranted.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Cardiomegalia/diagnóstico por imagem , Doença de Gaucher/complicações , Imagem Cinética por Ressonância Magnética , Insuficiência da Valva Mitral/diagnóstico por imagem , Adulto , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/fisiopatologia , Cardiomegalia/etiologia , Cardiomegalia/fisiopatologia , Meios de Contraste/administração & dosagem , Ecocardiografia , Terapia de Reposição de Enzimas , Feminino , Doença de Gaucher/diagnóstico , Doença de Gaucher/tratamento farmacológico , Glucosilceramidase/uso terapêutico , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Compostos Organometálicos/administração & dosagem , Valor Preditivo dos Testes , Volume Sistólico , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda , Função Ventricular Direita
17.
Congenit Heart Dis ; 11(4): 365-8, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27237845

RESUMO

INTRODUCTION: Partial anomalous pulmonary venous return (PAPVR) is an uncommon cause of right ventricular dilation. It may be difficult to identify and often remains undiagnosed. METHODS: We reviewed the database of the Cardiac Magnetic Resonance (CMR) Laboratory of Niguarda Hospital, in order to identify the cases of PAPVR between 2008 and 2014. RESULTS: On a total number of 7832 CMR scans, we identified 24 patients with PAPVR (14 male, age 41 ± 18 y) corresponding to 0.31% of the total population. Only 30% of patients had been referred for known or suspected PAPVR, 33% of patients had been referred for suspected right ventricular arrhythmogenic dysplasia and 37% had been referred for other cardiac disease. PAPVR involved mainly the right pulmonary veins (18 patients, 75%) and in 62% of our cases was associated with an atrial septal defect. Eight patients underwent corrective surgery in our institution, which confirmed and successfully repaired the anomalies. CONCLUSIONS: PAPVR is a rare congenital cardiac pathology which should be suspected in case of unexplained right chambers enlargement. CMR imaging allows an accurate anatomic and functional definition of this pathology and associated abnormalities. Early correction has an excellent prognosis and prevents long term complications like pulmonary hypertension, right ventricular failure and atrial fibrillation.


Assuntos
Cardiopatias Congênitas/complicações , Hipertrofia Ventricular Direita/etiologia , Veias Pulmonares/anormalidades , Adulto , Procedimentos Cirúrgicos Cardíacos , Bases de Dados Factuais , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/cirurgia , Humanos , Hipertrofia Ventricular Direita/diagnóstico por imagem , Hipertrofia Ventricular Direita/fisiopatologia , Itália , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Veias Pulmonares/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
18.
J Cardiol Cases ; 12(2): 33-36, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30524534

RESUMO

A 47-year-old male was admitted to hospital for severe pericardial effusion; he had undergone surgical removal of cutaneous melanoma 10 years before. Echocardiography-guided pericardiocentesis revealed the presence of intramyocardial masses, which were better defined and characterized, together with pericardial involvement, by cardiac magnetic resonance. Pericardial fluid drained was negative for malignant cells, so video-assisted thoracoscopy was performed and pathologic tissue was biopsied, leading to the diagnosis of metastatic melanoma. Multidisciplinary approach and multimodality imaging played a key role in allowing the diagnostic workup in this complex case. .

19.
J Comput Assist Tomogr ; 39(1): 128-33, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25279849

RESUMO

OBJECTIVE: The aim of this study was to compare myocardial T2* assessment with region-based (RB) T2* multiecho technique (CMRtools) with the pixel-wise (PW) inline myocardial T2* mapping (Siemens) in patients with thalassemia major for myocardial iron characterization. MATERIALS AND METHODS: Forty-three thalassemia major patients were examined on a 1.5-T scanner using conventional gradient multiecho sequence. All the images were analyzed using both RB and PW T2* mapping. Coefficients of reproducibility (CRs) were used to assess the interoperator and intraobserver variability of each software. RESULTS: The mean (SD) myocardial T2* values using RB and PW software resulted significantly different (30.7 [15] milliseconds [range, 4.8-52.6 milliseconds] vs 24.3 [10.5] milliseconds [range 4.6-38.2 milliseconds]; P < 0.0001). Interestingly, we found that SD had exponential relationship with T2* with evidence of increase in SD for T2* values greater than 20 milliseconds. For myocardial T2* values less than 20 milliseconds, intraobserver CR was 1.2 milliseconds for RB and 1.8 milliseconds for PW T2* mapping, and the interoperator CR was 3.4 and 1.6 milliseconds for RB and PW T2* mapping, respectively. Comparing iron overload classification by both software, we found that 7 patients (16%) were differently categorized using the standard T2* thresholds. CONCLUSIONS: Our data show that RB and PW T2* mapping can be used interchangeably to measure severe myocardial and hepatic iron overload, whereas for borderline T2* values, we observed differences among the 2 methods causing different categorization.


Assuntos
Algoritmos , Cardiomiopatias/patologia , Interpretação de Imagem Assistida por Computador/métodos , Sobrecarga de Ferro/patologia , Hepatopatias/patologia , Imageamento por Ressonância Magnética/métodos , Talassemia beta/patologia , Adulto , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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