Imaging Abnormalities In Patients Research Articles

Neurological involvement in hematopoietic stem cell transplantation-associated thrombotic microangiopathy.

Transplantation-associated thrombotic microangiopathy (TA-TMA) is a well-recognized serious complication of hematopoietic stem cell transplantation (HSCT). The understanding of TA-TMA pathophysiology has expanded in recent years. Dysregulation of the complement system is thought to cause endothelial injury and, consequently, microvascular thrombosis and tissue damage. TA-TMA can affect multiple organs, and each organ exhibits specific features of injury. Central nervous system (CNS) manifestations of TA-TMA include posterior reversible encephalopathy syndrome, seizures, and encephalopathy. The development of neurological dysfunction is associated with a significantly lower overall survival in patients with TA-TMA. However, there are currently no established histopathological or radiological criteria for the diagnosis of CNS TMA. Patients who receive total body irradiation (TBI), calcineurin inhibitors (CNI), and severe acute and chronic graft-versus-host disease (GVHD) are at a high risk of experiencing neurological complications related to TA-TMA and should be considered for directed TA-TMA therapy. However, the incidence and clinical manifestations of TA-TMA neurotoxicity remain unclear. Studies specifically examining the involvement of CNS in TMA syndromes are limited. In this review, we discuss clinical manifestations and imaging abnormalities in patients with nervous system involvement in TA-TMA. We summarize the mechanisms underlying TA-TMA and its neurological complications, including endothelial injury, evidence of complement activation, and treatment options for TA-TMA.

Initial experiences with amyloid‐related imaging abnormalities in patients receiving aducanumab following accelerated approval

AbstractBackgroundAducanumab is the first approved amyloid‐lowering immunotherapy for Alzheimer’s disease (AD). There is little real‐world data to guide the management of amyloid‐related imaging abnormality (ARIA), a potentially serious side‐effect requiring surveillance with serial magnetic resonance imaging (MRI). The current study seeks to characterize the symptoms, clinical course and management of ARIA in memory clinic patients treated with aducanumab.MethodWe conducted a non‐blinded, observational case series of patients who received aducanumab from June 16, 2021 to August 1, 2022 at the Butler Hospital Memory and Aging Program. Inclusion: (1) Clinical diagnosis of mild cognitive impairment (MCI) or mild dementia due to AD, (2) confirmed amyloid positivity (PET/CSF), and (3) Mini Mental State Exam (MMSE) = 20‐30. Exclusions: (1) MRI with > 4 microhemorrhages, > 1 area of superficial siderosis or significant cerebrovascular disease, (2) MRI contraindication, (3) anticoagulation and (4) unstable medical/psychiatric conditions. Participants received monthly aducanumab infusions, titrated to a dose of 10 mg/kg, with ApoE genotyping and enhanced MRI monitoring adapted from the phase 3 trials. The primary outcome of the study was the identification of ARIA‐E by MRI. Secondary outcomes included severity of ARIA, clinical course, and time to resolution.ResultOut of 24 patients treated with aducanumab, we identified ARIA‐E in 6 patients (25%), all ApoE‐ε4 carriers, and 4 of whom had moderate‐severe radiographic severity. Comorbid ARIA‐H occurred in 3 patients, 1 of whom also had new onset of cerebellar metastatic cancer. Symptomatic ARIA occurred in 3 patients and included headache, confusion, gait instability, and word‐finding difficulties. Treatment was discontinued in 4 cases of moderate‐severe ARIA‐E, temporarily held in 1 moderate/asymptomatic case, and dosed through in 1 mild/asymptomatic case. All cases of ARIA‐E resolved without hospitalization or corticosteroids (mean duration = 3 months, range, 1 ‐ 6 months).ConclusionAdditional amyloid‐lowering antibodies, associated with ARIA, may soon become clinically available. These data support the careful patient selection, ApoE genotyping, MRI surveillance and individualized dosing recommended in the updated FDA prescribing information and Appropriate Use Recommendations.

Incidence of Amyloid-Related Imaging Abnormalities in Patients With Alzheimer Disease Treated With Anti-β-Amyloid Immunotherapy: A Meta-analysis.

Incidence of Amyloid-Related Imaging Abnormalities in Patients With Alzheimer Disease Treated With Anti-β-Amyloid Immunotherapy: A Meta-analysis.

Initial Experiences with Amyloid-Related Imaging Abnormalities in Patients Receiving Aducanumab Following Accelerated Approval.

Aducanumab is the first FDA-approved amyloid-lowering immunotherapy for Alzheimer's disease. There is little real-world data to guide management of amyloid-related imaging abnormalities (ARIA), a potentially serious side-effect which requires surveillance with magnetic resonance imaging. We report our experiences in managing ARIA in patients receiving aducanumab at the Butler Hospital Memory and Aging Program during the year following FDA approval. We followed the Appropriate Use Recommendations for aducanumab to guide patient selection, detection, and management of ARIA (1). ARIA-E occurred in 6 out of 24 participants treated; all APOE-ε4 carriers. Treatment was discontinued in 4 cases of moderate-severe ARIA-E, temporarily held in 1 moderate case, and dosed through in 1 mild case (mean duration = 3 months, range, 1-6 months). No participants required hospitalization or high dose corticosteroids. Participants on anticoagulation were excluded and no macrohemorrhages occurred. These data support the measured approaches to treatment outlined in the Appropriate Use Recommendations.

Arterial transit artifacts observed on arterial spin labeling perfusion imaging of carotid artery stenosis patients: What are counterparts on symptomatology, dynamic susceptibility contrast perfusion, and digital subtraction angiography?

PurposeTo investigate possible relationships between the presence and location of arterial transit artifacts (ATA) and clinical symptoms, digital subtraction angiography (DSA), and dynamic susceptibility contrast (DSC) perfusion imaging abnormalities in patients with carotid artery stenosis (CAS). MethodsForty-seven patients who underwent arterial spin labeling (ASL) and DSC perfusion imaging in the same period diagnosed with > 50% unilateral internal carotid artery (ICA) stenosis by DSA performed 24 h after perfusion imaging were included. The presence of ATA, localization and hypoperfusion were evaluated using ASL interpretation. Maps derived from DSC perfusion, symptomatology, stenosis rates, and collateralization findings observed in DSA were investigated. Probable relationships were evaluated. ResultsATA on ASL were detected in 68.1% (32/47); 40.6% (13/32) of ATAs were observed in the distal middle cerebral artery (MCA) trace, 50% (16/32) in the intracranial ICA and MCA traces, and 9.4% (3/32) in the intracranial ICA trace. When classifications based on the ATA presence and localization was made, qualitative and quantitative CBF, MTT, and TTP abnormalities, symptomatology, stenosis rates, and collateralization findings significantly differed between groups (p < 0.05). ConclusionThe presence and localization of ATA in patients with CAS may provide essential insights into cerebral hemodynamics and the CAS severity. ATAs observed only in the distal MCA trace may represent early-stage perfusion abnormalities and a moderate level of stenosis. ATA in the ICA trace may related to a more advanced level of perfusion abnormalities, critical stenosis rates, symptom or collateralization presence.

Incidence of Amyloid-Related Imaging Abnormalities in Patients With Alzheimer Disease Treated With Anti-β-Amyloid Immunotherapy: A Meta-analysis.

To assess the incidence of amyloid-related imaging abnormalities (ARIA) in clinical trials of anti-β-amyloid (Aβ) immunotherapy and compare the incidence among different agents and clinical characteristics to identify possible predisposing factors for ARIA. The PubMed and Embase databases were searched for clinical trials of anti-Aβ immunotherapy published on or before January 12, 2022. Phase 2 or 3 randomized controlled trials reporting detailed data sufficient to assess the incidence of ARIA were selected. The pooled incidences of ARIA and subgroup analyses according to agent and ApoE-4 carrier status were calculated using the DerSimonian-Liard random-effects model. The proportion of symptomatic ARIA cases was also calculated. In total, 19 eligible studies, including 24 cohorts, were identified and 9,429 patients were analyzed. The overall pooled incidence of ARIA-effusion (E) and ARIA-hemorrhage (H) was 6.5% and 7.8%, respectively. In the subgroup analysis, the incidence of ARIA was different according to the anti-Aβ immunotherapy agent. The cohorts treated with aducanumab had a significantly higher incidence of ARIA-E and ARIA-H (30.7% and 30.0%, respectively; both p < 0.001) compared with cohorts from other drugs. In subgroup analysis according to ApoE-4 carrier status, the incidences of ARIA-E and ARIA-H were higher in the ApoE-4 carrier group than those in the ApoE-4 noncarrier group, but there was no statistical significance (ApoE-4 carrier vs noncarrier, ARIA-E: 8.6% vs 6.9%, p = 0.663, and ARIA-H: 10.5% vs 6.6%, p = 0.398). The pooled proportion of asymptomatic ARIA, detected by routine scheduled MRI surveillances, was 80.4%. The overall incidences of ARIA-E and ARIA-H were 6.5% and 7.8%, respectively, and the pooled proportion of asymptomatic ARIA was 80.4%. The cohorts treated with aducanumab showed a significantly higher incidence of ARIA-E and ARIA-H (30.7% and 30.0%) compared with other drugs.

Pericardial computed tomography imaging findings in the setting of coccidioidomycosis

BackgroundPericardial disease can be a manifestation of infection and imaging can have a role in its diagnosis. coccidioidomycosis endemic fungal infection has been more frequently reported over the past few decades. Other than case reports or series, there has been no systemic study evaluating pericardial imaging findings in patients with coccidioidomycosis to the best of our knowledge. The purpose of this study was to evaluate intrathoracic computed tomographic (CT) imaging abnormalities in patients with coccidioidal infection with specific emphasis on the pericardium.MethodsRetrospective review of radiology reports and clinical chart review was performed to identify patients with coccidioidomycosis between January 2000 and September 2021 at our medical center. Diagnosis of infection was confirmed predominately with serology. Patients were excluded if a CT was not performed within 3 months of confirmed diagnosis date and if there was concomitant additional granulomatous or fungal infection. Chest CT was reviewed for pericardial and additional intrathoracic findings.ResultsThe final retrospective cohort consisted of 37 patients. Imaging findings included lung nodules (N = 33/37), consolidation (N = 25/37), mediastinal or hilar lymphadenopathy (N = 20/37) and pleural effusions (N = 13/37). Eleven of 37 patients (30%) had either trace pericardial fluid (N = 3/37) or small pericardial effusions (N = 8/37). One patient had pericardial enhancement/thickening and history of pericardial tamponade. No other patient had clinical pericarditis or pericardial tamponade. Pericardial calcifications were not seen in any patient. Pericardial effusion was statistically associated with presence of pleural effusion as 9/13 patients with pleural effusion had pericardial effusion versus 2/26 patients without pleural effusion had pericardial effusion (p < 0.001). Otherwise patients with and without pericardial imaging findings were similar in terms of demographics, comorbidities and other imaging findings.ConclusionPulmonary parenchymal pathology is a common manifestation of coccidioidal infection. Most patients with coccidioidomycosis do not have pericardial imaging abnormalities on CT.

Magnetic resonance imaging in the evaluation of idiopathic frequent premature ventricular complexes with normal ventricular function

Abstract Background The role of cardiac magnetic resonance (CMR) imaging in the diagnostic evaluation of patients with frequent premature ventricular complexes (PVCs) and normal left ventricular ejection fraction (LVEF) remains unclear. Existing data has been predominantly derived from highly selected populations, that may overestimate the true prevalence of abnormal findings on CMR in this patient population. Purpose The aim of this study was 2-fold: 1) to establish the prevalence of CMR imaging abnormalities in a cohort with normal LVEF and high PVC burden; 2) to identify predictors of CMR imaging abnormalities in patients with frequent PVCs and normal LVEF. Methods In this cohort study, 211 patients (age 53.2±19 years; 41% male) with frequent PVCs (≥5%/24 h), of normal LVEF (≥50% by echocardiography) and no known underlying structural heart disease were prospectively enrolled from 2016–2020. Of these, 166 (79%) patients were symptomatic from their PVCs in the form of palpitations, fatigue, chest pain, dizziness, and/or dyspnea. Patients underwent CMR imaging (1.5 Tesla) with a late gadolinium enhancement (LGE) protocol at the time of enrollment for the detection of scarring and/or fibrosis. Results Patients had a median baseline echocardiographic LVEF of 60% (± 5%) with 195 (92%) of patients having a normal native QRS morphology. Median PVC burden of the study cohort was 16% (± 14%). CMR LGE abnormalities were found in 19 (9%) patients including 17 scans with non-ischemic LGE and 2 with ischemic LGE. Age &amp;gt;60 (odds ratio [OR]: 3.20, 95% confidence interval [CI]: 1.20–8.51, p=0.020), male sex (OR: 4.67, 95% CI: 1.61–13.50, p=0.004), history of hypertension (OR: 3.43, 95% CI: 1.31–8.97, p=0.012), native QRS duration (OR: 1.03, 95% CI: 1.00–1.05, p=0.031), and history of non-sustained ventricular tachycardia (OR: 2.81, 95% CI: 1.03–7.68, p=0.044) were significantly associated with the presence of imaging abnormalities on CMR. Dominant PVC origin from the left ventricle had a positive trend (OR: 2.60, 95% CI: 0.99–7.66, p=0.083) to association with CMR imaging abnormalities. On multivariate analysis, male sex (OR: 4.10, 95% CI: 1.40–12.04, p=0.010) and history of hypertension (OR: 2.89, 95% CI: 1.08–7.75, p=0.035) remained significantly associated with the presence of CMR abnormalities. There was no association between CMR imaging abnormalities and the burden of PVCs or the number of PVC morphologies. Conclusion In this cohort, only 9% of patients with apparently idiopathic frequent PVCs and normal LVEF had concealed myocardial abnormalities on CMR imaging. Male sex and history of hypertension were associated with a higher rate of CMR abnormalities. Funding Acknowledgement Type of funding sources: None.

Brain Magnetic Resonance Imaging Abnormalities in Patients with Hereditary Hemorrhagic Telangiectasia.

Brain Magnetic Resonance Imaging Abnormalities in Patients with Hereditary Hemorrhagic Telangiectasia.

Association between clinical parameters and size of three-dimensionally reconstructed anatomical abnormalities in patients with lateral epicondylitis: a cross-sectional study

BackgroundThe association of the severity of clinical symptoms and level of functional performance with the degree of magnetic resonance imaging abnormalities in patients with lateral epicondylitis has not been fully elucidated. This study aimed to investigate the association between the degree of anatomical abnormalities by evaluating three-dimensional magnetic resonance imaging models of the common extensor tendon and clinical parameters in patients with lateral epicondylitis.Materials and methodsA total of 61 patients (24 men and 37 women) with lateral epicondylitis were included in this study. 3-Tesla magnetic resonance imaging was performed for all patients, and clinical parameters, including pain visual analog scale score, Quick Disabilities of Arm, Shoulder and Hand questionnaire score, elbow range of motion, and demographic factors, were evaluated. The proportion of lesion volume of common extensor tendon was adopted for three-dimensional model analysis. To determine the factors associated with clinical parameters, univariate, and multivariate linear regression analyses were performed.ResultsThe proportion of lesion volume of common extensor tendon was not associated with clinical parameters. Gender and muscle edema were independently associated with pain visual analog scale scores. However, demographic factors and magnetic resonance imaging abnormalities were not associated with the Quick Disabilities of Arm, Shoulder, and Hand questionnaire score or elbow range of motion.ConclusionsThe three-dimensional volumetric lesion size of common extensor tendon was not associated with clinical symptoms and functional performance in patients with lateral epicondylitis. The clinical parameters of lateral epicondylitis may be influenced by several factors.

Value of thoracic and abdominal screening in dogs with neurological signs.

To detect the incidence of clinically important thoracic and abdominal imaging abnormalities in patients with neurological signs but with no clinical signs or laboratory findings consistent with thoracic or abdominal disease. Review of imaging findings in dogs with neurological signs but no thoracic or abdominal signs that underwent thoracic, or thoracic and abdominal screening during the same hospitalisation as the neurological investigation. Two hundred and six dogs were included in the thoracic study. Of those, only eight (3.9%) had clinically important findings and in only five cases (2.4%) were the findings related to pathology identified on MRI. One hundred and forty-seven dogs were included in the abdominal study. Abnormalities were found in 23 dogs (15.6%), but in only eight (5.4%) were they considered to be of current clinical importance and in only three (2%) were they related to the pathology identified on MRI. Ultrasonography provided valuable additional information in 22 cases (15%) but this was only considered important in four (2.7%) and related to the neurological condition in one (0.7%). As expected, abdominal ultrasonography often provided more information than radiography alone in the abdominal screening but this was rarely clinically relevant or related to the reason for referral. Thoracic and abdominal screening of neurological patients with no clinically evident thoracic or abdominal clinical signs only infrequently identified occult but clinically important pathology which changed the current management plan, regardless of neurolocalisation or age.

Early Chest Imaging in Patients with Puumala Hantavirus Infection

Purpose:To describe early chest imaging abnormalities in patients with acute Puumala virus infection.Materials and Methods:This retrospective study (2005–2017) comprised 64 patients who were admitted to the emergency department of a Belgian hospital. These patients were diagnosed with serologically confirmed acute Puumala virus infection and had at least one chest X-ray (CRX). Imaging studies were evaluated by two experienced chest radiologists reaching agreement by consensus, and abnormalities were reported according to the Fleischner Society glossary of terms for thoracic imaging. When a patient underwent multiple CRX, only the findings of the first were recorded. Six patients underwent chest high-resolution computed tomography (HRCT).Results:CRX showed abnormal findings in 33 patients (51.5%). Most common findings were linear atelectasis (29.7%) and small pleural effusion (20.3%). HRCT showed interlobular septal thickening in four patients and crazy-paving pattern with consolidations in one patient with adult respiratory distress syndrome.Conclusions:Early CRX commonly showed linear atelectasis and small pleural effusion in Puumala virus infected patients above 30 years of age. Chest HRCT most frequently showed atelectasis and smooth interlobular septal thickening. While uncommon, early and severe pulmonary involvement can be associated with Puumala virus infection, albeit these findings are not specific.

Comparison of simultaneous 18F-2-[18F] FDG PET/MR and PET/CT in the follow-up of patients with differentiated thyroid cancer

18F-FDG PET/CT is the most accurate imaging modality in differentiated thyroid cancer (DTC) patients with either an aggressive histology, an absence of radioiodine uptake in neoplastic foci, or in the absence of imaging abnormalities in patients with an elevated serum thyroglobulin (Tg) level that progresses with time. We evaluated the diagnostic performance of FDG PET/MR in comparison with that of PET/CT. Following the injection of a single 18F-FDG activity, PET/MR and PET/CT were sequentially performed in 40 consecutive patients with DTC previously treated with total thyroidectomy and radioiodine ablation. All patients were then followed up for at least 6months. PET/MR was positive in 11 patients and PET/CT in 10. PET/MR detected 33 tumor foci and PET/CT 30. During the follow-up of the 12 patients with negative initial PET studies and with a detectable serum Tg, only one patient had a neck recurrence and the administration of an empiric high activity of 131I in the other 11 patients did not reveal any tumor focus. In the 17 patients with an initial serum Tg level < 2ng/mL, no recurrence occurred. This study confirms the high diagnostic accuracy of FDG PET studies in DTC patients with elevated serum Tg levels and shows that PET/MR brings similar information as compared to PET/CT imaging.

Abstract WP487: Retinal Vessel Tortuosity Correlates With White Matter Hyperintensities and Cerebral Microbleeds in Subjects With Cognitive Decline

Objective: Retinal microvasculature analysis is suitable to study cognitive disorders given retinal and brain vessels share similar properties. Using novel automated technologies, we aimed to investigate whether automatically-quantified retinal vascular changes from retinal fundus photographs predict brain imaging abnormalities in patients with cognitive impairment; and what specific retinal vascular parameters are more predictive of dementia. Methods: In this cross-sectional study, 34 subjects with cognitive complaints underwent neuropsychometric cognitive testing, retinal fundus photography and brain MRI. Retinal vessel tortuosity index (VTI), inflection index (VII) and length (VL) were automatically computed. The number and volume of cerebral microbleeds (CMB) and white matter hyperintensities (WMHI) were measured using SPIN Software (SpinTech, Bingham Farms, MI). The diagnostic groups were compared for demographic, cognitive, retinal and brain imaging parameters using analysis of variance. The association between brain (intracranial volume (ICV), hippocampal volume (HV), lateral ventricle volume (LVV), WMHI and CMB (volume, number), Fazekas scores) and retinal vascular parameters were assessed by using multiple linear regression models. Results: Nine subjects were cognitively normal (CN) and 25 cognitively impaired (CI) (22 with mild cognitive impairment and 3 with dementia). VTI was the only retinal parameter and HV and LVV were the brain parameters that were significantly different between CN and CI subjects (p=0.02). VTI correlated with VL (p=0.02, r=0.33) and branching angle (p=0.004, r=-0.45). The cognitive domains predicted by VTI were abstraction and orientation. VTI correlated with total intracranial volume (p=0.04, r=-0.12). A significant association was demonstrated for VII and WMHI volume (p=0.03, r=0.007), but not Fazekas score. VII and VTI significantly correlated with CMB volume (p=0.04 and 0.03, respectively). Conclusion: Automatically-detected retinal vessel tortuosity indexes predict neuroimaging markers of microvascular disease and total intracranial volume in cognitively impaired individuals. Retinal imaging may be used to screen patients with cognitive disorders.

Prevalence and significance of cranial nerve imaging abnormalities in patients with hereditary neuropathies: Clinical implications at the skull base.

ObjectiveTo estimate the prevalence and significance of cranial nerve (CN) imaging abnormalities in patients with hereditary neuropathy and discuss clinical implications.MethodsWe retrospectively analyzed data from patients at four tertiary academic medical centers with hereditary neuropathy diagnoses who had undergone gadolinium‐enhanced magnetic resonance imaging (MRI) of the brain or skull base between 2004 and 2018. MRI scans, as well as computed tomography imaging when available, were reviewed and bivariable analysis was performed to identify predictors of CN abnormalities on imaging.ResultsAmong 39 patients meeting study criteria, 11 had clinical CN deficits (28%) and 8 had CN abnormalities on imaging (21%). Of the patients with CN abnormalities on imaging, half had CN deficits (4/8) and only a quarter had imaging abnormalities of the CNs with the deficits (2/8). Imaging abnormalities were found in varied CNs, including CNs III, V, VII, and the VII/VIII complex in the internal auditory canal. MRI obtained for the purpose of evaluating CN deficits had a statistically significant increased likelihood of containing CN imaging abnormalities. However, CN deficits themselves were not predictive of imaging abnormalities.ConclusionThickening and enhancement of CNs on MRI may be found in approximately 1/5 of patients with hereditary neuropathies and are inconsistently associated with clinical deficits. These imaging findings should not be mistaken for neoplastic and infectious processes as they may be manifestations of the patients' underlying genetic neuropathy.Level of Evidence4.

“The post-pulmonary syndrome - results of echocardiographic driven follow up after acute pulmonary embolism”

IntroductionThe concept of post Pulmonary Embolism syndrome includes various combinations of functional, haemodynamic or imaging abnormalities in patients after pulmonary embolism (PE). Although residual obstruction of pulmonary vascular bed is suggested to be a major cause of post Pulmonary Embolism syndrome (post-PE syndrome) other cardiopulmonary abnormalities can be responsible for functional impairment. Therefore, we analyzed the frequency of post-PE syndrome and its potential causes. Material and methodsWe report data of consecutive 845 PE survivors (468 F, aged 62 ± 18 yrs) who were anticoagulated, and followed for at least 6 months. All symptomatic subjects at follow up underwent diagnostic workup. Results35% (290/845) of PE survivors recovered functionally, while 65% patients reported a decreased exercise tolerance compatible with post-PE syndrome. One hundred and five symptomatic cases were lost to follow up. After diagnostic workup, chronic thromboembolic pulmonary hypertension (CTEPH) was diagnosed in 38 of 450 (8.4%) symptomatic subjects and chronic thromboembolic pulmonary disease (CTED) was diagnosed in 15/450 (3.3%) of them. Chronic heart failure with reduced ejection fraction (EF) was found in 6.9% (31/450) of patients and 154 patients (34.2%) had leftsided diastolic dysfunction. Valve heart disease was detected in 6.2% (28/450), atrial fibrillation in 31/450 (6.9%), Other causes of reduced exercise tolerance include coronary artery disease in 31/450 (6.9%), pulmonary disease 42/450 (9.3%), morbid obesity 15/450 (3.3%), neoplasms 15/450 (3.3%), psychiatric disorders 1%, rheumatoid disease 1%, anemia 1%. ConclusionsApproximately 65% of PE survivors report functional impairment, despite at least 6 months of anticoagulation. Persistent pulmonary artery thromboemboli resulting in CTEPH or CTED were detected in 7.2% of PE survivors and 11.8% of symptomatic patients. Leftsided diastolic dysfunction was the most prevalent echocardiographic abnormality, and remained the most common cause of functional limitation affected 34.2% of symptomatic cases.

P2768Post-PE impairment is mostly related to newly diagnosed heart failure with preserved ejection fraction

Abstract Introduction Recently, the concept of post-PE impairment (PPEI) was proposed which includes various combinations of functional, haemodynamic or imaging abnormalities in patients after acute pulmonary embolism (PE). Chronic residual obstruction of pulmonary vascular bed, despite adequate anticoagulation, is suggested to be a major cause of PPEI. Material and methods We report data of consecutive 700 PE survivors (390 F, aged 62±18 yrs). In all patients PE was diagnosed and treated according to ESC recommendations. Patients were anticoagulated and followed for at least 6 months in outpatient clinic (median 6, 6–18 months). All symptomatic subjects underwent detailed diagnostic workup which included standardized echocardiography, lung scintigraphy, pulmonary functional tests, and chest CT, RHC and coronary angiography when appropriate. Results 207/700 (29,6%) of PE survivors completely recovered functionally. However, when compared to prePEperiod 493/700 (70,4%) patients reported functional limitation compatible with PPEI. Exertional dyspnoea was present in 36,5% of symptomatic patients, then 25,5% others presented effort angina with or without dyspnoea, 11% of symptomatic patients reported palpitations and 27% complained of reduced exercise tolerance. After diagnostic workup, CTEPH was diagnosed in 38 of 493 (7,7%) symptomatic subjects (5,4% of all survivors) and chronic thromboembolic pulmonary disease (CTED) in 12/493 (2,4%) of them. 52,9% pts have chronic heart failure with reduced ejection fraction (EF) 4,2% and 37,2% with preserved EF; valve heart disease was detected in 8,9% and significant arrhythmia, mostly atrial fibrillation, in 2,6%. Breathlessness and reduce exercise tolerance in the others were caused by coronary artery diseases or non-cardiovascular pathologies (e.g. anaemia, pulmonary disease). Conclusions Follow-up demonstrated that after an episode of PE, approximately 70% of patients report functional impairment. Although persistent pulmonary artery thromboemobli resulting in CTEPH or CTED were detected in 7,1% of PE survivors and 10% of symptomatic patients. Left ventricular diastolic dysfunction is the most common cause of PPEI.

Differentiating Lung Involvement in Adult T-Cell Leukemia Lymphoma (ATLL) Versus HTLV Infection: Results from a Large Single-Center Cohort with Implications for Staging and Response Criteria

Introduction: Human T-cell lymphotropic virus (HTLV) is a retrovirus that has been associated with adult-T cell leukemia/lymphoma (ATLL) and other inflammatory conditions. Pulmonary involvement has not been widely associated to HTLV infection; however, high rates of imaging abnormalities in patients with and without ATLL have been reported. Okada reported 30%, 69% and 94% of abnormalities in HTLV1 carriers, ATLL and patients that transformed into ATLL. Whether these abnormalities follow a pattern related to each condition individually has not been defined. Hence, we undertook a retrospective study in ATLL and HTLV infected patients to determine the lung abnormalities which could be due to ATLL involvement rather than HTLV infection.Objectives: To compare the CT pulmonary findings among patients with HTLV infection with and without ATLL diagnosed at Montefiore Medical Center between 2004 and 2017.Methods: Patients diagnosed with HTLV infection by ICD9 were identified using the software Clinical Looking Glass and those with an available chest CT scan were selected. Data regarding demographics, smoking history, prior pulmonary conditions, HTLV and ATLL-associated characteristics was collected by chart review. CT chest was reviewed by an expert radiologist who was unaware of the patient diagnosis (ATLL versus non-ATLL) and findings were compared among groups. The staging CT scan was used to determine baseline pulmonary findings in patients with ATLL and the first CT chest around HTLV diagnosis was used for HTLV patients.Results: A total of 97 patients (72 with ATLL and 25 with HTLV alone) were identified. Mean age at HTLV diagnosis was 58.4 years (range: 33-88), 54.6% were females, 72.2% were Black Non-Hispanics while 27.8% were Hispanic. 88.3% were from Caribbean origin. Smoking history was similar between ATLL and non-ATLL groups (12% vs 8%, p=0.07) with no cases of prior active TB infection. Abnormal CT chest findings were present in 92.8%, 94.4% and 88% for the total cohort, ATLL and non-ATLL patients.Among patients with ATLL, 52.1% had acute and 43.7% had lymphomatous types; while only 1.4% and 2.8% had smoldering and chronic type. The most common CT chest findings were lymphadenopathy (50, 69.4%); followed by 3-10 mm nodules (32, 44.4%), ground-glass opacity, pleural effusion (31, 43.1% each), centrilobular nodules (28, 39.4%), thickening of interlobular septum (23, 31.9%) and bronchiectasis (18, 25%). Compared to the acute subtype, patients with lymphomatous subtype had higher rates of lymphadenopathy (83.9% vs 64.9, p=0.07) and lower rates of bronchiectasis (16.1% vs 35.1%, p=0.07).Among patients with non-ATLL, HTLV infection was diagnosed at an older age (63.8 vs. 56.6 years, p=0.03); HTLV-associated comorbidities were found in 16 cases (64%). Of these, myelopathy was the most frequent (10, 40%), followed by strongyloides (4, 16%). After HTLV diagnosis, CT chest was indicated in 28% patients for otherwise unexplained respiratory symptoms and to evaluate lung nodules or other chest X-ray abnormalities in 24% of cases. Bronchiectasis was the most common finding (12, 48%) followed by pleural thickening (11, 44%), ground-glass opacity and thickening of interlobular septum (10, 40%, each). Persistent abnormalities on follow-up imaging were present in 86.7% of the cases. Among patients with HTLV infection, those with ATLL were more likely to have nodules and lymphadenopathy (41.7% vs 20%, p=0.05 and 69.4% vs 24%, p<0.001, respectively) while bronchiectasis and pleural thickening was more likely in patients without ATLL (48% vs 25%, p=0.03 and 44% vs 23.6%, p=0.05; respectively).Conclusions: Pulmonary findings are highly prevalent in CT chest of patients with HTLV infection with and without ATLL. Bronchiectasis and pleural thickening was more frequently encountered in non-ATLL patients while lymphadenopathy and nodules were common finding in patients with ATLL. Pulmonary involvement in lymphoma is usually characterized by nodules and lymphadenopathy but patients with ATLL had a higher incidence of findings including ground glass opacities, bronchiectasis and interlobular septal thickening possibly due to their underlying HTLV infection. Based on this data, nodules and lymphadenopathy should be classified as ATLL involvement of the lung while other findings described here could be due to HTLV infection. These findings are important in staging and response criteria for ATLL. [Display omitted] DisclosuresJanakiram:Seatle Genetics: Membership on an entity's Board of Directors or advisory committees.

Imaging features of neurotoxoplasmosis: A multiparametric approach, with emphasis on susceptibility-weighted imaging

BackgroundNeurotoxoplasmosis is a common opportunistic infection in HIV/AIDS patients. Imaging identification of neurotoxoplasmosis assists in timely treatment. PurposeTo delineate the frequency of imaging abnormalities in patients with neurotoxoplasmosis on different MR sequences with a particular focus on SWI, and NCCT. Material and methodsThe PACS database was retroactively searched over a 5-year period for patients with neurotoxoplasmosis who underwent MRI with SWI. Included patients had imaging features of neurotoxoplasmosis based on consensus review by two neuroradiologists, a clinical diagnosis of neurotoxoplasmosis at the time of MRI, and diagnostic confirmation based on positive serum or CSF serology or histopathology; 15 patients were included. The number of abnormal foci with restricted diffusion, increased FLAIR signal, intrinsic T1 hyperintensity, abnormal enhancement (CE-T1WI), and intrinsic hyperdensity on CT were recorded. ResultsIntralesional susceptibility signal (ISS) foci on SWI were observed in 93.3% of patients with neurotoxoplasmosis (mean size 5.2 ± 3.8 mm). The average number of ISS foci was 3.9 per patient; 3/15 (20.0%) had a single ISS. Amongst other MR sequences, hyperintense FLAIR foci were the most common abnormalities observed (12.4 lesions/patient), followed by enhancing foci (8.2 lesions/patient), foci of restricted diffusion (7.1 lesions/patient), and intrinsic T1 hyperintense foci (3.4 lesions/patient). Abnormalities were least frequently observed on NCCT: abnormalities were identified in 5/15 (33.3%) patients, at a rate of 0.4 lesions/patient. ConclusionISS foci are present in the vast majority of neurotoxoplasmosis patients, likely representing hemorrhage. The incidence and frequency of other abnormal foci are highest on FLAIR, and lowest on NCCT.

Changes in the soleus H-reflex test and correlations between its results and dynamic magnetic resonance imaging abnormalities in patients with Hirayama disease

ObjectiveTo investigate changes in soleus H-reflex tests in patients with Hirayama disease (HD) and to analyse correlations between these changes and forward-shifting of the cervical cord during neck flexion. MethodsThe amplitude of the soleus H-reflex with and without vibration on the Achilles tendon was recorded bilaterally in 81 HD patients and 34 controls to measure both the vibratory inhibition index (VII) and the Hmax/Mmax ratio. The maximum forward-shifting degree of cervical cord during neck flexion was measured using dynamic magnetic resonance imaging in all HD patients. ResultsSignificantly higher VII was recorded in 6/81 (7.4%) HD patients, along with abnormal Hmax/Mmax ratios in 5 of 6 cases. Compared to illness duration (r = 0.29–0.36, p < 0.05), the maximum forward-shifting degree of the cervical cord was more strongly correlated with both VII and the Hmax/Mmax ratio (r = 0.51–0.81, p < 0.05). ConclusionsHD patients may develop cervical spinal cord injury with disease progression, and these lesions may be more likely to occur in cases with relatively severe cervical-flexion structural abnormalities even during early stages. SignificanceMore caution should be taken when managing HD patients with severe cervical-flexion abnormalities because of the possible early occurrence of upper motor neuron lesions.