Application Of Contrast Media Research Articles

Safety and efficiency of multimodal imaging approach of patent foramen ovale closure in patients with cryptogenic stroke

Recent studies have shown a significant superiority of patent foramen ovale (PFO) closure over antithrombotic therapy in stroke recurrence prevention. However, uncertainty about the guidance technique remains. Most centers perform percutaneous closure of PFO using simultaneously fluoroscopic and intra-procedural echocardiography to select the optimal device. While transoesophageal echocardiography (TEE) requires general anaesthesia, intracardiac echocardiography (ICE) is costly and has inherent risks. We report the safety and efficiency data of a simplified technique: local anaesthesia, PFO closure under fluoroscopic guidance, with only pulmonary vein opacification using contrast angiography and transthoracic echocardiography control before releasing the device. Single center retrospective registry enrolling 134 consecutive patients who underwent PFO closure between May 2016 and December 2019 to cryptogenic stroke. The closure decision was taken by multidisciplinary team. All the patients underwent a preprocedure TEE for morphological evaluation of PFO. An echocardiography control was done at 1 month. At 6 and 12 months a bubble test was done. All procedures were successful, regardless PFO complexity (ASA 62.7%), without major procedural complications. Total fluoroscopic time was 5.1 minutes, the dose-area product was 5047.8 mGy/m 2 and the application of contrast medium was 7.2 mL. During a mean follow-up period of 17.2 months, one transient ischemic attack, one deep vein thrombosis and one thrombus on the occluder was reported. Contrast echocardiography at 6 months showed complete closure in 92% of patients, whereas a minimal or moderate residual shunt persisted in 4.6%, 1.8% respectively. At 12 months only 2 patients presented a residual shunt. Percutaneous PFO closure with multimodal imaging approach is a safe and effective procedure and allows a lower radiological exposure and contrast administration.

Developing a system for in vivo imaging of maize roots containing iodinated contrast media in soil using synchrotron XCT and XRF

AimsWe sought to develop a novel experimental system which enabled application of iodinated contrast media to in vivo plant roots intact in soil and was compatible with time-resolved synchrotron X-ray computed tomography imaging. The system was developed to overcome issues of low contrast to noise within X-ray computed tomography images of plant roots and soil environments, the latter of which can complicate image processing and result in the loss of anatomical information.MethodsTo demonstrate the efficacy of the system we employ the novel use of both synchrotron X-ray computed tomography and synchrotron X-ray fluorescence mapping to capture the translocation of the contrast media through root vasculature into the leaves.ResultsWith the application of contrast media we identify fluid flow in root vasculature and visualise anatomical features, which are otherwise often only observable in ex vivo microscopy, including: the xylem, metaxylem, pith, fibres in aerenchyma and leaf venation. We are also able to observe interactions between aerenchyma cross sectional area and solute transport in the root vasculature with depth.ConclusionsOur novel system was capable of successfully delivering sufficient contrast media into root and leaf tissues such that anatomical features could be visualised and internal fluid transport observed. We propose that our system could be used in future to study internal plant transport mechanisms and parameterise models for fluid flow in plants.

Evaluation of a Tube Voltage-Tailored Contrast Medium Injection Protocol for Coronary CT Angiography: Results From the Prospective VOLCANIC Study.

OBJECTIVE. The purpose of this study was to prospectively evaluate, using software support, the feasibility and the quantitative and qualitative image quality parameters of a tube voltage-tailored contrast medium (CM) application protocol for patient-specific injection during coronary CT angiography (CCTA). SUBJECTS AND METHODS. In the Voltage-Based Contrast Media Adaptation in Coronary Computed Tomography Angiography (VOLCANIC-CTA) study, a single-center trial, 120 patients referred for CCTA were prospectively assigned to a tube voltage-tailored CM injection protocol. Automated tube voltage levels were selected in 10-kV intervals and ranged from 70 to 130 kV, and the iodine delivery rate (IDR) was adapted to the tube voltage level using dedicated software. The administered CM volume (370 mg I/mL) ranged from 33 mL at 70 kV (IDR, 0.7 g I/s) to 65 mL at 130 kV (IDR, 1.7 g I/s). Attenuation was measured in the aorta and coronary arteries to calculate quantitative signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), and 5-point scales were used to evaluate overall image quality. Radiation metrics were also assessed and compared among the protocols. RESULTS. The mean age of the study patients was 62.5 ± 11.9 (SD) years. Image quality was rated as diagnostic in all patients. Contrast attenuation peaked at 70 kV (p < 0.001), whereas SNR and CNR parameters showed no significant differences between tube voltage levels (p ≥ 0.085). Additionally, no significant differences in subjective image quality parameters were found among the different protocols (p ≥ 0.139). The lowest radiation dose values were observed in the group assigned to the 70-kV protocol, which had a median radiation effective dose of 2.0 mSv (p < 0.001). CONCLUSION. The proposed tube voltage-tailored injection protocol allows individualized scanning of patients undergoing CCTA and significantly reduces CM and radiation dose while maintaining a high diagnostic image quality.

Virtual monoenergetic images preserve diagnostic assessability in contrast media reduced abdominal spectral detector CT.

To investigate if low-keV virtual monoenergetic images (VMI40keV) from abdominal spectral detector CT (SDCT) with reduced intravenous contrast media application (RCM) provide abdominal assessment similar to conventional images with standard contrast media (SCM) dose. 78 patients with abdominal SDCT were retrospectively included: 41 patients at risk for adverse reactions who received 44 RCM examinations with 50 ml and 37 patients who underwent 44 SCM examinations with 100 ml of contrast media (CM) and who were matched for effective body diameters. RCM, SCM images and RCM-VMI40keV were reconstructed. Attenuation and signal-to-noise ratio (SNR) of liver, pancreas, kidneys, lymph nodes, psoas muscle, aorta and portal vein were assessed ROIs-based. Contrast-to-noise ratios (CNR) of lymph nodes vs aorta/portal vein were calculated. Two readers evaluated organ/vessel contrast, lymph node delineation, image noise and overall assessability using 4-point Likert scales. RCM were inferior to SCM images in all quantitative/qualitative criteria. RCM-VMI40keV and SCM images showed similar lymph node and muscle attenuation (p = 0.83,0.17), while for all other ROIs, RCM-VMI40keV showed higher attenuation (p ≤ 0.05). SNR was comparable between RCM-VMI40keV and SCM images (p range: 0.23-0.99). CNR of lymph nodes was highest in RCM-VMI40keV (p ≤ 0.05). RCM-VMI40keV received equivalent or higher scores than SCM in all criteria except for organ contrast, overall assessability and image noise, where SCM were superior (p ≤ 0.05). However, RCM-VMI40keV received proper or excellent scores in 88.6/94.2/95.4% of the referring cases. VMI40keV counteract contrast deterioration in CM reduced abdominal SDCT, facilitating diagnostic assessment. SDCT-derived VMI40keV provide adequate depiction of vessels, organs and lymph nodes even at notable CM reduction.

Application of Contrast-Enhanced Ultrasound to Detect Hepatic Hydrothorax in Patients with Liver Cirrhosis.

Hepatic hydrothorax (HH) is defined as transudate in the pleural cavity in patients with decompensated liver cirrhosis (DC) without concomitant cardiopulmonary or pleural disease. It is associated with high short-term mortality. HH can evolve via translocation through diaphragmatic gaps. The aim of this study was to evaluate the feasibility and safety of injecting ultrasound contrast medium into the peritoneal cavity to detect HH. This study included patients with concomitant ascites and pleural effusion who were admitted to our hospital between March 2009 and February 2019. A peritoneal catheter was inserted and ultrasound contrast medium was injected into the peritoneal cavity. In parallel, the peritoneal and pleural cavities were monitored for up to 10 minutes. Overall, 43 patients were included. The median age was 60 years and the majority of patients were male (n = 32, 74 %). Most patients presented with right-sided pleural effusion (n = 32, 74 %), 3 (7 %) patients with left-sided and 8 (19 %) patients had bilateral pleural effusion. In 12 (28 %) patients ascites puncture was not safe due to low volume ascites. Thus, the procedure could be performed in 31 (72 %) patients. No adverse events occurred. In 16 of 31 (52 %) patients we could visualize a trans-diaphragmic flow of microbubbles. The median time until transition was 120 seconds. Our clinical real-world experience supports the safety and feasibility of intraperitoneal ultrasound contrast medium application to detect HH in patients with DC, as a non-radioactive real-time visualization of HH. Our study comprises the largest cohort and longest experience using this method to date.

Ultra-High-b-Value Kurtosis Imaging for Noninvasive Tissue Characterization of Ovarian Lesions.

Background MRI with contrast material enhancement is the imaging modality of choice to evaluate sonographically indeterminate adnexal masses. The role of diffusion-weighted MRI, however, remains controversial. Purpose To evaluate the diagnostic performance of ultra-high-b-value diffusion kurtosis MRI in discriminating benign and malignant ovarian lesions. Materials and Methods This prospective cohort study evaluated consecutive women with sonographically indeterminate adnexal masses between November 2016 and December 2018. MRI at 3.0 T was performed, including diffusion-weighted MRI (b values of 0-2000 sec/mm2). Lesions were segmented on b of 1500 sec/mm2 by two readers in consensus and an additional independent reader by using full-lesion segmentations on a single transversal slice. Apparent diffusion coefficient (ADC) calculation and kurtosis fitting were performed. Differences in ADC, kurtosis-derived ADC (Dapp), and apparent kurtosis coefficient (Kapp) between malignant and benign lesions were assessed by using a logistic mixed model. Area under the receiver operating characteristic curve (AUC) for ADC, Dapp, and Kapp to discriminate malignant from benign lesions was calculated, as was specificity at a sensitivity level of 100%. Results from two independent reads were compared. Histopathologic analysis served as the reference standard. Results A total of 79 ovarian lesions in 58 women (mean age ± standard deviation, 48 years ± 14) were evaluated. Sixty-two (78%) lesions showed benign and 17 (22%) lesions showed malignant histologic findings. ADC and Dapp were lower and Kapp was higher in malignant lesions: median ADC, Dapp, and Kapp were 0.74 µm2/msec (range, 0.52-1.44 µm2/msec), 0.98 µm2/msec (range, 0.63-2.12 µm2/msec), and 1.01 (range, 0.69-1.30) for malignant lesions, and 1.13 µm2/msec (range, 0.35-2.63 µm2/msec), 1.45 µm2/msec (range, 0.44-3.34 µm2/msec), and 0.65 (range, 0.44-1.43) for benign lesions (P values of .01, .02, < .001, respectively). AUC for Kapp of 0.85 (95% confidence interval: 0.77, 0.94) was higher than was AUC from ADC of 0.78 (95% confidence interval: 0.67, 0.89; P = .047). Conclusion Diffusion-weighted MRI by using quantitative kurtosis variables is superior to apparent diffusion coefficient values in discriminating benign and malignant ovarian lesions and might be of future help in clinical practice, especially in patients with contraindication to contrast media application. © RSNA, 2020 Online supplemental material is available for this article.

How to Measure the Aorta Using MRI: A Practical Guide.

How to Measure the Aorta Using MRI: A Practical Guide.

Single-center study: the diagnostic performance of contrast-enhanced ultrasound (CEUS) for assessing renal oncocytoma

Purpose: The aim of the present retrospective single-center study is to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the evaluation of renal oncocytoma.Method: Thirteen patients with histopathologically confirmed renal oncocytoma and 26 patients with histopathologically confirmed renal cell carcinoma were included in this retrospective single-center study on whom CEUS was performed between 2005 and 2015. The applied contrast agent was a second-generation blood pool agent. CEUS examinations were performed and interpreted by a single radiologist with more than 15 years of experience (EFSUMB Level 3).Results: CEUS examinations were successfully performed in all included patients without any adverse effects. Renal oncocytomas showed varying echogenicity (46% hypoechoic, 23% hyperechoic, 8% iso-/hyperechoic, 8% isoechoic). In two cases renal oncocytoma only demarcated upon i.v. application of contrast medium. In bilateral oncocytosis, lesions presented as hyperechoic. Only 23% of renal oncocytomas showed slight vascularization using Color Doppler. No oncocytoma-specific pattern of microperfusion could be elucidated: 85% of the oncocytomas presented hyperenhancing, of whom 50% also showed delayed venous wash-out; 8% of renal oncocytomas showed venous wash-out without early arterial hyperenhancement.Conclusions: Within the frame of the present study and in line with the recent state of knowledge, no specific sonomorphological feature – including CEUS – could be detected allowing for adequate discrimination between oncocytoma and renal cell carcinoma.

Application of iodinated contrast media in coronary CT angiography examination and explanation to common problems

冠状动脉CT血管成像（CCTA）检查已成为临床筛查冠状动脉疾病安全、可靠的首选技术之一。随着技术的不断发展、我国心血管病患病率的逐年上升，碘对比剂在CCTA检查中的应用不断增多，如何安全、有效、规范地应用碘对比剂，已成为国内外专家学者关注的重点。本文对领域内的最新指南进行回顾，并梳理出十余个在CCTA检查中应用碘对比剂遇到的常见问题，借助循证医学证据进行深入讨论，以期为放射科医务人员在CCTA检查中规范化应用碘对比剂提供参考意见。

Carbon dioxide (Co2) Angiography in Diabetic Patients with Peripheral Arterial Disease and Chronic Renal Insufficiency as a Standard Procedure

Introduction - The objective of this study is to evaluate the diagnostic and therapeutic carbon dioxide (CO2) angiography in patients with diabetes mellitus, peripheral arterial vascular disease (PAD) and chronic renal insufficiency (CRI) to determine whether to use of carbon dioxide angiography in this type of patients should be a standard. Methods - Lower limb angiographic procedures with CO2 (diagnostic and diagnostic-interventional) were collected from the database of our clinic of 205 consecutive patients between 2012 and 2017 and retrospectively reviewed. Of the 205 patients with PAD undergoing CO2 angiography 196 had a admitting diagnose of CRI≥ stage III(GFR<45, moderate to severe Kidney function loss) and 9 patients had a iodinated contrast medium hypersensitivity Results - Of the 205 patients undergoing CO2 angiography, 122 (60%) had diabetes mellitus. 18% Had PAD Fontaine stage II, 20% stage III and 62% stage IV. Of the patients without known diabetes mellitus at the begin of medical hospitalization, 29 (35%) had a glycated haemoglobin levels above 6.1%. Of the diabetic patients 116 (95%), had CRI≥ stage III (stage III 47%, stage IV 45% and stage V with residual excretion 8%). However of the 116 diabetics with CRI≥ stage III, the CRI was only known at 74%. Of the remainder of the 24% (30 patients) with unknown CRI, 20 had CRI stage III and 10 had stage IV. Lower limb angiographic procedures with CO2 in diabetics, were performed diagnostically at 30% and diagnostically-interventional at 70%. Balloon dilatation was performed in 81% of diagnostic interventional angiographies (30% crural) and in 19% was placed a stent. Postinterventionall, 95% of patients didn’t have any deterioration of the renal parameters. Conclusion - CO2-guided angiographies are technically safe; reduce the need of a iodinated contrast medium(ICM) application, prevent deterioration of renal function in patients with pre-existing renal insufficiency. This study shows diabetic patients with PAD as an increased risk patient for CNI. As shown, 95% of patients with diabetes who also had PAD, had CRI ≥stage.III at the same time. These patients require quickly and low-risk (kidney-safe) lower limb imaging to help preserve the leg. A ICM examination is contraindicated in these patients and CO2 angiography should be used as the standard, so that no comparison group could be produced to compare the results. Despite the CO2 angiography, 30% of the patients were able to undergo a crural balloon dilatation. The study shows the high rate of diabetic patients with PAD with a not necessarily known CRI, in which CO2 angiography should be used as a standard.

Infrapopliteal Carbon Dioxide (CO2) Angiography in Diabetic Patients with Critical Limb Ischemia. Limb Rescue and Prevent Kidney Failure

Introduction: The objective of this study is to evaluate the diagnostic and therapeutic carbon dioxide (CO2) angiography below the knee in patients with diabetes mellitus and peripheral arterial vascular disease (PAD). To determine efficacy and diagnostic accuracy of carbon dioxide angiography below the knee Methods: Lower limb angiography below the knee with CO2 (diagnostic and diagnostic-interventional) were collected from the database of our clinic of 129 consecutive patients between 2012 and 2018 and retrospectively reviewed. Of the 129 patients with PAD undergoing CO2 angiography 128 had a admitting diagnose of CRI≥ stage III(GFR< 45, moderate tosevere Kidney function loss) and PAD stage IV. Results: Of the 128 patients undergoing CO2 angiography and CLI, 122 (95%) had diabetes mellitus. Of the patients without known diabetes mellitus at the begin of medical hospitalization, 6 (5%) had a glycated haemoglobin levels above 6.4%. The admitting renal insufficiency was: stage III 62%, stage IV 29% and stage V 9%( with residual excretion). All of them had a necrosis or ulceration in the foot area. Lower limb angiographic procedures with CO2 in diabetics, were performed diagnostically at 9 patients(7%) and diagnostically-interventional at 119 (93%). From the 128 angiography in 36 patients(28%) we did under CO2 at least one crural artery revascularization. Balloon dilatation of 2 crural vessels in the same intervention was performed in 24%. The anterior tibial artery was dilated 63 times, posterior 33 and fibular 49. Postinterventionall, 95% of patients didn't have any deterioration of the renal Parameters. Conclusion: CO2-guided angiographies are technically safe; reduce the need of a iodinated contrast medium(ICM) application. Early and late limb salvage can be achieved based on CO2 endovascular revascularisation of infrapopliteal arteries. This method can be an important treatment option in diabetic patients to prevent deterioration of renal function in patients with pre-existing renal insufficiency. These patients require quickly and low-risk (kidney-safe) lower limb imaging to help preserve the leg Disclosure: No conflict interset

Upward movement of cerebrospinal fluid in obstructive hydrocephalus-revision of an old concept.

The specific pathophysiological processes in many forms of obstructive hydrocephalus (HC) are still unclear. Current concepts of cerebrospinal fluid (CSF) dynamics presume a constant downward flow from the lateral ventricles towards subarachnoid spaces, which are in contrast to neurosurgical observations and findings of MRI flow studies. The aim of our study was to analyze CSF movements in patients with obstructive HC by neuroendoscopic video recordings, X-ray studies, and MRI. One hundred seventeen pediatric patients with obstructive HC who underwent neuroendoscopy in our center were included. Video recordings were analyzed in 85 patients. Contrast-enhanced X-rays were conducted during surgery prior to intervention in 75 patients, and flow void signals on pre-operative MRI could be evaluated in 110 patients. In 83.5% of the video recordings, CSF moved upwards synchronous to inspiration superimposed by cardiac pulsation. Application of contrast medium revealed a flow delay in 52% of the X-ray studies prior to neurosurgery, indicating hindered CSF circulation. The appearances and shapes of flow void signals in 88.2% of the pre-operative MRI studies suggested valve-like mechanisms and entrapment of CSF. Neuroendoscopic observations in patients with obstructive HC revealed upward CSF movements and the corresponding MRI signs of trapped CSF in brain cavities. These observations are in contrast to the current pathophysiological concept of obstructive HC. However, recent real-time flow MRI studies demonstrated upward movement of CSF, hence support our clinical findings. The knowledge of cranial-directed CSF flow expands our understanding of pathophysiological mechanisms in HC and is the key to effective treatment.

From Xrays to PET/MR, and then? - Future imaging in pediatric radiology

Significant changes can be expected in modern pediatric radiology. New imaging techniques are progressively added to basic modalities like Xrays and ultrasound. This essay summarizes recent advances and technical innovations in pediatric radiology, which are supposed to gain further importance in the future. Thus, CT dose reduction techniques including artificial intelligence as well as advances in the fields of magnetic resonance and molecular imaging are presented. KEY POINTS: · Technical innovations will lead to significant changes in pediatric radiology.. · CT dose reduction is crucial for pediatric patient collectives.. · New MR-techniques will lower the need for sedation and contrast media application.. · Functional MR-imaging might gain further importance in patients with chronic lung disease.. · Molecular imaging enables detection, characterization and quantification of molecular processes in tumors.. CITATION FORMAT: · Staatz G, Daldrup-Link HE, Herrmann J et al. From Xrays to PET/MR, and then? - Future imaging in pediatric radiology. Fortschr Röntgenstr 2019; 191: 357 - 366.

Diagnosis of spinal metastasis: are MR images without contrast medium application sufficient?

ObjectiveTo determine the usefulness of adding contrast-enhanced (CE) magnetic resonance imaging (MRI) to conventional MRI for evaluation of spinal metastases. Materials and methodsOne-hundred-and-two whole spine MR examinations, obtained for metastasis work-up within a 2-month period, from 65 men and 37 women (mean age, 64 years) with extra-spinal tumor, who also underwent CE-MRI, were retrospectively evaluated by three radiologists. The number of spine segments with bone marrow involvement was interpreted using a 3-point confidence scale (probable metastasis, equivocal, probably benign) during session 1 (conventional imaging) and session 2 (addition of CE-MRI to conventional imaging). The patients were assigned to 14 categories based on the changes in confidence rating between sessions 1 and 2; these were aggregated to four groups indicating the degree of usefulness of CE-MRI: definitely useful, equivocal, not useful, and presumed non-metastatic groups. Clinical information, metastatic bone type, the number of probably metastatic segments, and anatomical level and position were compared among the former three groups. ResultsThe readers assigned 39–53% of cases to the definitely useful group. The number of probably metastatic segments differed significantly among the three groups for all readers (p ≤ 0.046). Age, sex, primary cancer, metastatic bone type, and anatomical level and position were similar. ConclusionAdding CE-MRI to conventional MRI was useful for objectively detecting and characterizing spinal segments with metastases in 39–53% of cases. However, there were no clinical or radiological factors that could predict the usefulness of CE-MRI in evaluating spinal metastases, except for the number of metastatic segments.

Individually Body Weight-Adapted Contrast Media Application in Computed Tomography Imaging of the Liver at 90 kVp.

The aim of the present study was to evaluate the attenuation and image quality (IQ) of a body weight-adapted contrast media (CM) protocol compared with a fixed injection protocol in computed tomography (CT) of the liver at 90 kV. One hundred ninety-nine consecutive patients referred for abdominal CT imaging in portal venous phase were included. Group 1 (n = 100) received a fixed CM dose with a total iodine load (TIL) of 33 g I at a flow rate of 3.5 mL/s, resulting in an iodine delivery rate (IDR) of 1.05 g I/s. Group 2 (n = 99) received a body weight-adapted CM protocol with a dosing factor of 0.4 g I/kg with a subsequent TIL adapted to the patients' weight. Injection time of 30 seconds was kept identical for all patients. Therefore, flow rate and IDR changed with different body weight. Patients were divided into 3 weight categories; 70 kg or less, 71 to 85 kg, and 86 kg or greater. Attenuation (HU) in 3 segments of the liver, signal-to-noise ratio, and contrast-to-noise ratio were used to evaluate objective IQ. Subjective IQ was assessed by a 5-point Likert scale. Differences between groups were statistically analyzed (P < 0.05 was considered statistically significant). No significant differences in baseline characteristics were found between groups. The CM volume and TIL differed significantly between groups (P < 0.01), with mean values in group 1 of 110 mL and 33 g I, and in group 2 of 104.1 ± 21.2 mL and 31.2 ± 6.3 g I, respectively. Flow rate and IDR were not significantly different between groups (P > 0.05). Body weight-adapted protocoling led to more homogeneous enhancement of the liver parenchyma compared with a fixed protocol with a mean enhancement per weight category in group 2 of 126.5 ± 15.8, 128.2 ± 15.3, and 122.7 ± 21.2 HU compared with that in group 1 of 139.9 ± 21.4, 124.6 ± 24.8, and 116.2 ± 17.8 HU, respectively. Body weight-adapted CM injection protocols result in more homogeneous enhancement of the liver parenchyma at 90 kV in comparison to a fixed CM volume with comparable objective and subjective IQ, whereas overall CM volume can be safely reduced in more than half of patients.

First printed 3D heart model based on cardiac magnetic resonance imaging data in Slovakia.

To present our experience with initial fabrication of 3D printed model of heart from cardiac magnetic resonance (CMR) imaging data. A20-year-old patient with a congenital heart defect after a surgical correction underwent CMR imaging. A novel whole-heart CMR imaging sequence, not requiring gadolinium contrast material application, was performed. Image data from this CMR sequence were used for 3D heart model printing. Alife-like 3D printed copy of the heart with a congenital defect with superior visualization of cardiovascular anatomical details was successfully fabricated. 3D printing of the heart copies from novel whole heart CMR imaging data is feasible and harmless to patients. These models can be used for operative planning of complex congenital heart defects (Fig. 4, Ref. 14).

Cardiac Magnetic Resonance Quantitative Tissue Markers in the Clinical Application Value for the Diagnosis of Acute Myocarditis

Objectives: To determine the value of cardiac magnetic resonance (CMR) quantitative tissue markers in the diagnosis of acute myocarditis, compared with the traditional Lake-Louise criteria (LLC). Methods: Totally 35 cases of patients diagnosed as acute myocarditis in Beijing Anzhen Hospital and 35 healthy volunteers were enrolled in our study, from May 2014 to August 2016. CMR protocol included quantitative assessment of T1 relaxation times using modified Look-Locker inversion recovery (MOLLI), extracellular volume fraction (ECV), T2 relaxation times. Established Lake-Louise criteria (LLC) consisting of T2-weighted signal intensity ratio (T2-ratio), early gadolinium enhancement ratio (EGEr), and late gadolinium enhancement (LGE) were assessed. Receiver operating characteristics analysis was performed to compare diagnostic performance. Results: T2-ratio (1.85±0.21 vs. 1.58±0.15; P = 0.002) and EGEr (3.87±1.62 vs. 2.15±1.36; P =0.024) were significantly higher in myocarditis subjects than in control subjects. Non-ischemic LGE was found in 27/35 (77.1%) of all myocarditis patients. Regional myocardial edema was found in 23/35 (65.7%) of all myocarditis patients. Myocardial T1 and T2 relaxation times and ECV were significantly prolonged in the myocarditis group compared with the control group (T1 native relaxation time: 1310±62 vs. 1247±27 ms, T2 native relaxation time: 65.46±8.49 vs. 55.17±3.59 ms; ECV: 34.47±8.52 vs. 27.68±5.82, P &lt; 0.001, respectively). Areas under the curve of native T1 (0.94) and T2 relaxation times (0.91) were higher compared with those of the other CMR parameters (T2-ratio: 0.73, EGEr: 0.72, LGE: 0.88, LLC: 0.90, ECV: 0.79). Combined with LGE, each native mapping technique outperformed the diagnostic performance of LLC (P &lt; 0.01, respectively). A combination of native parameters (T1, T2 relaxation times) significantly increased the diagnostic performance of CMR compared with LLC without need of contrast media application (0.99 vs. 0.90; P &lt; 0.05). Conclusion: CMR quantitative tissue markers has good diagnostic efficiency for acute myocarditis, it may be potential to replace the Lake-Louise criteria in the future in patients with contraindications for the use of gadolinium-based contrast agents.

Ultrasound and contrast enhanced ultrasound imaging in the diagnosis of acute aortic pathologies.

Conventional ultrasound is worldwide the first-line imaging modality for the prompt diagnosis in the daily practice because it is a cost-effective and easy to perform technique. The additional application of contrast media has been used to enhance the intravascular contrast and to improve the imaging diagnostic accuracy in the detection, classification and follow-up of vascular pathologies. Contrast-enhanced ultrasound has the advantage of being a safe, fast and dynamic non-invasive imaging tool with excellent results in the diagnosis of acute aortic pathologies, especially the detection of endoleaks after endovascular aneurysm repair. This review describes the diagnostic and therapeutic roles of ultrasound and contrast-enhanced ultrasound imaging in the most common vascular pathologies such as aortic dissections, aneurysms and endoleaks. Keywords: Endoleak, contrast media, ultrasonography, aorta.

Effect of Enalapril-folic acid tablet on development of contrast-induced nephropathy after percutaneous coronary intervention in elderly patients with coronary heart diseases complicated with mild renal insufficiency

Objective To explore the impact of Enalapril-folic acid tablet on development of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in elderly patients with coronary heart diseases(CHD) complicated with mild renal insufficiency. Methods A total of 935 old patients (≥60 years) undergoing selective PCI at our hospital from January 2013 to June 2016 were enrolled in this retrospective study.Based on treatments during the perioperative phase, the 935 patients were divided into Enalapril-folic acid tablet intervention group (n=296, 31.7%), and other RAS blocker control group with Angiotensin eonverting-enzyme inhibitor (ACEI) or Angiotensin Ⅱ receptor blocker (ARB) (n=639, 68.3%). The levels of serum creatinine for 72 hours after operation were monitored and evaluated.Baseline data and CIN incidence were compared between two groups.The clinical events within 1 month after contrast media application were recorded.Multivariate Logistic regression analysis was used to analyze independent risk factors for CIN after PCI. Results The incidence of CIN after PCI was lower in the intervention group than in the control group with no statistical significance[7.1% (21/296) vs.11.1% (71/639), χ2=3.679, P=0.059]. Multivariate regression analysis showed that age (OR=1.103, P=0.001), hypertension (OR=3.362, P=0.017), and hyper-homocysteinemia (OR=3.528, P=0.003) were independent risk factors, but the treatment with Enalapril-folic acid tablet might be a protective factor for development of CIN after PCI (OR=0.443, P=0.042). During the 1-month follow-up, the rate of recurrent angina pectoris was lower in the intervention group than in the control group (P 0.05). Conclusions The treatment with enalapril-folic acid tablet may prevent the occurrence of CIN after PCI in elderly patients with coronary heart disease and mild renal insufficiency. Key words: Enalapril; Folic acid; Cysteine; Nephrosis; Contrast media

Does gadoxetate disodium affect MRE measurements in the delayed hepatobiliary phase?

ObjectivesTo assess if the administration of gadoxetate disodium (Gd-EOB-DTPA) significantly affects hepatic magnetic resonance elastography (MRE) measurements in the delayed hepatobiliary phase (DHBP).MethodsA total of 47 patients (15 females, 32 males; age range 23–78 years, mean 54.28 years) were assigned to standard hepatic magnetic resonance imaging (MRI) with application of Gd-EOB-DTPA and hepatic MRE. MRE was performed before injection of Gd-EOB-DTPA and after 40–50 min in the DHBP. Liver stiffness values were obtained before and after contrast media application and differences between pre- and post-Gd-EOB-DTPA values were evaluated using a Bland-Altman plot and the Mann-Whitney-Wilcoxon test. In addition, the data were compared with regard to the resulting fibrosis classification.ResultsMean hepatic stiffness for pre-Gd-EOB-DTPA measurements was 4.01 kPa and post-Gd-EOB-DTPA measurements yielded 3.95 kPa. We found a highly significant individual correlation between pre- and post-Gd-EOB-DTPA stiffness values (Pearson correlation coefficient of r = 0.95 (p < 0.001) with no significant difference between the two measurements (p =0.49)). Bland-Altman plot did not show a systematic effect for the difference between pre- and post-stiffness measurements (mean difference: 0.06 kPa, SD 0.81). Regarding the classification of fibrosis stages, the overall agreement was 87.23% and the intraclass correlation coefficient was 96.4%, indicating excellent agreement.ConclusionsAdministration of Gd-EOB-DTPA does not significantly influence MRE stiffness measurements of the liver in the DHBP. Therefore, MRE can be performed in the DHBP.Key Points• MRE of the liver can reliably be performed in the delayed hepatobiliary phase.• Gd-EOB-DTPA does not significantly influence MRE stiffness measurements of the liver.• MRE performed in the delayed hepatobiliary-phase is reasonable in patients with reduced liver function.