Background: Prior work with speckle tracking echocardiography (STE) has demonstrated that changes in myocardial strain can precede declines in left ventricular (LV) systolic function in infiltrative heart disease. The purpose of this study is to evaluate CMR-derived strain parameters using bright blood cine imaging in a cohort of patients with cardiac amyloidosis, comparing CMR LV strain parameters with those from STE. Methods: Retrospective analysis of 16 consecutive patients (12 males, avg age 62 years) with systemic amyloidosis, 7 (44%) of which with a confirmatory cardiac biopsy. All subjects had CMR findings diagnostic of cardiac amyloidosis. All patients were imaged on a 1.5T scanner (Magnetom Avanto or Aera, Siemens Healthcare, Erlangen, Germany). Balanced steady state free precession (bSSFP) cine short axis and four-chamber images (TR/TE 42/1.2, FA 79 degrees, BW 930, 1.7 x 1.7 x 6 mm3, parallel imaging factor 2) were analyzed using prototype software (Siemens Corp., Corporate Technology, Princeton, New Jersey). As with speckle tracking, the spatio-temporal deformation of LV muscle on cine images was used to derive deformation fields and quantify radial, circumferential, and longitudinal strain indices. Peak CMR and STE values were compared by correlation analysis. Results: Strain analyses were successful on all CMR datasets. Peak CMR systolic strain values, by heart segment and slice, for each direction are shown in Figure 1. CMR peak circumferential, radial, and longitudinal strains demonstrated modest to good correlation with STE (r = 0.57, 0.36, and 0.64) respectively, although the technique significantly underestimated the value of peak strain compared to STE (-7.8% vs. -21.7%, 15.6% vs 34.7%, and -4.3% vs -12.4%, respectively). Mean (standard deviation) peak radial (A), circumferential (B), and longitudinal (C) strain (%) by segment. Mean (standard deviation) peak radial (A), circumferential (B), and longitudinal (C) strain (%) by segment.
Coronary artery fistulas are uncommon but clinically important entities that may produce symptoms and significant complications such as angina, myocardial infarction, coronary artery aneurysm formation, and congestive heart failure. Multiple fistula types have been recognized, and classification uses factors such as etiology, coronary artery origin, and drainage site. Both invasive and noninvasive imaging play an important role in the management and treatment of these patients, and often times, more than one modality is necessary for comprehensive evaluation of coronary fistulas. Recent advances in both functional and anatomic imaging will likely also play a growing role in fistula evaluation. The purpose of this article is to review the classification, pathophysiology, clinical presentations, imaging findings, treatment, and future imaging directions of coronary artery fistulas.
There is a sparsity of data evaluating outcomes of patients with Liver Imaging Reporting and Data System (LI-RADS) (LR)-M lesions.To compare overall survival (OS) and progression free survival (PFS) between hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) meeting LR-M criteria and to evaluate factors associated with prognosis.Retrospective.Patients at risk for HCC with at least one LR-M lesion with histologic diagnosis, from 8 academic centers, yielding 120 patients with 120 LR-M lesions (84 men [mean age 62 years] and 36 women [mean age 66 years]).A 1.5 and 3.0 T/3D T1 -weighted gradient echo, T2 -weighted fast spin-echo.The imaging categorization of each lesion as LR-M was made clinically by a single radiologist at each site and patient outcome measures were collected.OS, PFS, and potential independent predictors were evaluated by Kaplan-Meier method, log-rank test, and Cox proportional hazard model. A P value of <0.05 was considered significant.A total of 120 patients with 120 LR-M lesions were included; on histology 65 were HCC and 55 were iCCA. There was similar median OS for patients with LR-M HCC compared to patients with iCCA (738 days vs. 769 days, P = 0.576). There were no significant differences between patients with HCC and iCCA in terms of sex (47:18 vs. 37:18, P = 0.549), age (63.0 ± 8.4 vs. 63.4 ± 7.8, P = 0.847), etiology of liver disease (P = 0.202), presence of cirrhosis (100% vs. 100%, P = 1.000), tumor size (4.73 ± 3.28 vs. 4.75 ± 2.58, P = 0.980), method of lesion histologic diagnosis (P = 0.646), and proportion of patients who underwent locoregional therapy (60.0% vs. 38.2%, P = 0.100) or surgery (134.8 ± 165.5 vs. 142.5 ± 205.6, P = 0.913). Using multivariable analysis, nonsurgical compared to surgical management (HR, 4.58), larger tumor size (HR, 1.19), and higher MELD score (HR, 1.12) were independently associated with worse OS.There was similar OS in patients with LR-M HCC and LR-M iCCA, suggesting that LR-M imaging features may more closely reflect patient outcomes than histology.3 TECHNICAL EFFICACY: Stage 5.
Chronic airspace diseases are commonly encountered by chest, body or general radiologists in everyday practice. Even though there is significant overlap in the imaging findings of different causes of chronic airspace disease, some key clinical, laboratory and imaging findings can be used to guide the radiologist to the correct diagnosis. The goal of this article is to review and compare these features.
Abstract: Cardiac computed tomography (CT) is increasingly used in the evaluation of cardiomyopathies, particularly in patients who are not able to undergo other non-invasive imaging tests such as magnetic resonance imaging (MRI) due to the presence of MRI-incompatible pacemakers/defibrillators or other contraindications or due to extensive artifacts from indwelling metallic devices. Advances in scanner technology enable acquisition of CT images with high spatial resolution, good temporal resolution, wide field of view and multi-planar reconstruction capabilities. CT is useful in cardiomyopathies in several ways, particularly in the evaluation of coronary arteries, characterization of cardiomyopathy phenotype, quantification of cardiac volumes and function, treatment-planning, and post-treatment evaluation. In this article, we review the imaging techniques and specific applications of CT in the evaluation of cardiomyopathies.
