Resonant Emission Research Articles

Long Axial Field-of-View PET/CT Could Answer Unmet Needs in Gynecological Cancers.

Gynecological malignancies currently affect about 3.5 million women all over the world. Imaging of uterine, cervical, vaginal, ovarian, and vulvar cancer still presents several unmet needs when using conventional modalities such as ultrasound, computed tomography (CT), magnetic resonance, and standard positron emission tomography (PET)/CT. Some of the current diagnostic limitations are represented by differential diagnosis between inflammatory and cancerous findings, detection of peritoneal carcinomatosis and metastases <1 cm, detection of cancer-associated vascular complications, effective assessment of post-therapy changes, as well as bone metabolism and osteoporosis assessment. As a result of recent advances in PET/CT instrumentation, new systems now offer a long-axial field-of-view (LAFOV) to image between 106 cm and 194 cm (i.e., total-body PET) of the patient's body simultaneously and feature higher physical sensitivity and spatial resolution compared to standard PET/CT systems. LAFOV PET could overcome the forementioned limitations of conventional imaging and provide valuable global disease assessment, allowing for improved patient-tailored care. This article provides a comprehensive overview of these and other potential applications of LAFOV PET/CT imaging for patients with gynecological malignancies.

ASSESSMENT OF RISK FACTORS BETWEEN PREMENOPAUSALAND POSTMENOPAUSAL WOMEN PRESENTING WITH ACUTE MYOCARDIAL INFARCTION TO TERTIARY CARE HOSPITAL IN KAKINADA: A CASE CONTROL STUDY

Background: Acute myocardial infarction is a major public health problem in both in developing and developed countries despite impressive strides in the diagnosis and management. Effect of hormone replacement therapy in post-menopausal women is uncertain. Some observational studies suggest that estrogen replacement protects against the incidence of coronary artery disease. Prospective control trials have not yet conrmed the benecial effect of hormone replacement therapy. Hormone replacement therapy shows no benecial effect in reducing the morbidity and mortality both in western and Indian studies. Materials and Methods: This is a case control study conducted by the Department of cardiology, Government General Hospital (tertiary care hospital) Kakinada District, Andhra Pradesh. 200 female patients of Acute Myocardial Infarction were included in the study conducted between December 2021 to November 2022. Results: The mean (Standard deviation) age of patients was 51.05 ± 5.92. peak age of incidence between 51-60 years 60%. Out of 200, 68 were pre-menopausal and 132 were post-menopausal. In pre-menopausal group 77.9% had Unstable Angina, 14.7% with Non ST elevation MI and 7.4% with ST Elevation MI. In post-menopausal group, 27.3% had STEMI, 21.2% had NSTEMI and 51.5% had Unstable Angina. 27.9% in pre-menopausal group and 42.4% in post-menopausal group were having dyslipidemia. Conclusions: Identication of co-morbidities and risk factors of CAD in women will lead us to the correct diagnosis and early appropriate management. Noninvasive tests such as stress echocardiography and perfusion testing with cardiac magnetic resonance or single-photon emission computed tomography imaging should be used in identifying patients at risk, followed by further risk stratication by appropriate invasive testing such as CAG

Hypersatellite Kα Production in Trapped Ar Ions at KK Trielectronic Recombination Energies

We report measurements of hypersatellite radiation of argon ions in the electron energy region of 5200 eV to 7500 eV. Here, we observed a strong enhancement of this hypersatellite Kαh production. Trielectronic recombination (TR) is discussed as a possible channel for Kαh production leading to this enhancement where main TR resonances are expected to occur. Data analysis was mainly based on the extracted intensity ratio of hypersatellite Kαh to Kα lines (Kαh/Kα). In addition, the collisional excitation and the collisional ionisation of the K-shell ions were modeled as main background processes of the Kα X-ray production. The Kαh/Kα intensity ratio shows a significant rise around 6500 eV electron energy by a factor of about two above the background level. This observation is compared with calculations of the expected electron energies for the resonant Kαh emission due to the KK TR process. The observed rise as a function of the electron collision energy, which occurs in the vicinity of the predicted TR resonances, is significantly stronger and energetically much wider than the results of theoretical calculations for the TR process. However, the experimental evidence of this process is not definitive.

Elemental fractionation in aerosol laser-induced breakdown spectroscopy with nanosecond and femtosecond laser ablation

For the purpose of realizing atmospheric radiation plume tracking, laser-induced breakdown spectroscopy (LIBS) was performed to characterize Cs atomic emissions from airborne nanoparticles in a binary particle matrix using nanosecond and femtosecond laser ablation. As a surrogate to multi-element nuclear fallout particulates, both Cs and Na solutions were mixed with Cu at a 1:1.45 M concentration ratio and aerosolized to study elemental fractionation in atomic emissions, revealing Na I resonance emissions are enhanced whereas Cs I resonance emissions are reduced with Cu present despite sharing similar electronic and chemical properties. Femtosecond laser ablation reduced elemental fractionation effects by more than 50% while retaining the same temporal fractionation trends for Cs and Na. The origin of elemental fractionation in aerosol LIBS was further investigated using Al and Ti aerosols which revealed that the particle matrix induces changes to the local plasma temperature, population of atomic states, and subsequent molecular association and emission.

Cerebral Venous Reflux and Cerebral Amyloid Angiopathy: An Magnetic Resonance Imaging/Positron Emission Tomography Study.

Cerebral venous outflow alterations contribute to central nervous system pathology in aging and neurodegenerative disorders and are potentially linked to underlying cerebral microangiopathy. We investigated whether cerebral venous reflux (CVR) is more closely associated with cerebral amyloid angiopathy (CAA) than hypertensive microangiopathy in intracerebral hemorrhage (ICH) survivors. This cross-sectional study included 122 patients of spontaneous ICH with magnetic resonance and positron emission tomography imaging studies (2014-2022) in Taiwan. The presence of CVR was defined as abnormal signal intensity in the dural venous sinus or internal jugular vein on magnetic resonance angiography. Cerebral amyloid load was measured using the Pittsburgh compound B standardized uptake value ratio. Clinical and imaging characteristics associated with CVR were evaluated in univariable and multivariable analyses. In the subset of patients with CAA, we applied univariable and multivariable linear regression analyses to evaluate the association between CVR and cerebral amyloid retention. Compared with patients without CVR (n=84, 64.5±12.1 years), patients with CVR (n=38, 69.4±11.5 years) were significantly more likely to have CAA-ICH (53.7% versus 19.8%; P<0.001) and had a higher cerebral amyloid load (standardized uptake value ratio [interquartile range], 1.28 [1.12-1.60] versus 1.06 [1.00-1.14]; P<0.001). In a multivariable model, CVR was independently associated with CAA-ICH (odds ratio, 4.81 [95% CI, 1.74-13.27]; P=0.002) after adjustment for age, sex and conventional small vessel disease markers. In CAA-ICH, higher PiB retention was observed in patients with CVR than patients without CVR (standardized uptake value ratio [interquartile range], 1.34 [1.08-1.56] versus 1.09 [1.01-1.26]; P<0.001). In multivariable analysis after adjustment for potential confounders, the presence of CVR was independently associated with a higher amyloid load (standardized β=0.40; P=0.001). In spontaneous ICH, CVR is associated with CAA and a higher amyloid burden. Our results suggest venous drainage dysfunction potentially plays a role in CAA and cerebral amyloid deposition.

Second-Line Myocardial Perfusion Imaging to Detect Obstructive Stenosis: Head-to-Head Comparison of CMR and PET

BackgroundGuidelines recommend verification of myocardial ischemia by selective second-line myocardial perfusion imaging (MPI) following a coronary computed tomography angiography (CTA) with suspected obstructive coronary artery disease (CAD). Head-to-head data on the diagnostic performance of different MPI modalities in this setting are sparse. ObjectivesThe authors sought to compare, head-to-head, the diagnostic performance of selective MPI by 3.0-T cardiac magnetic resonance (CMR) and 82rubidium positron emission tomography (RbPET) in patients with suspected obstructive stenosis at coronary CTA using invasive coronary angiography (ICA) with fractional flow reserve (FFR) as reference. MethodsConsecutive patients (n = 1,732, mean age: 59.1 ± 9.5 years, 57.2% men) referred for coronary CTA with symptoms suggestive of obstructive CAD were included. Patients with suspected stenosis were referred for both CMR and RbPET and subsequently ICA. Obstructive CAD was defined as FFR ≤0.80 or >90% diameter stenosis by visual assessment. ResultsIn total, 445 patients had suspected stenosis on coronary CTA. Of these, 372 patients completed both CMR, RbPET and subsequent ICA with FFR. Hemodynamically obstructive CAD was identified in 164 of 372 (44.1%) patients. Sensitivities for CMR and RbPET were 59% (95% CI: 51%-67%) and 64% (95% CI: 56%-71%); P = 0.21, respectively, and specificities 84% (95% CI: 78%-89%) and 89% (95% CI: 84%-93%]); P = 0.08, respectively. Overall accuracy was higher for RbPET compared with CMR (73% vs 78%; P = 0.03). ConclusionsIn patients with suspected obstructive stenosis at coronary CTA, CMR, and RbPET show similar and moderate sensitivities but high specificities compared with ICA with FFR. This patient group represents a diagnostic challenge with frequent mismatch between advanced MPI tests and invasive measurements. (Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease 2 [Dan-NICAD 2]; NCT03481712)

The Effects of Mono- and Bivalent Linear Alkyl Interlayer Spacers on the Photobehavior of Mn(II)-Based Perovskites.

Mn(II)-based perovskite materials are being intensively explored for lighting applications; understanding the role of ligands regarding their photobehavior is fundamental for their development. Herein, we report on two Mn (II) bromide perovskites using monovalent (perovskite 1, P1) and bivalent (perovskite 2, P2) alkyl interlayer spacers. The perovskites were characterized with powder X-ray diffraction (PXRD), electron spin paramagnetic resonance (EPR), steady-state, and time-resolved emission spectroscopy. The EPR experiments suggest octahedral coordination in P1 and tetrahedral coordination for P2, while the PXRD results demonstrate the presence of a hydrated phase in P2 when exposed to ambient conditions. P1 exhibits an orange-red emission, while P2 shows a green photoluminescence, as a result of the different types of coordination of Mn(II) ions. Furthermore, the P2 photoluminescence quantum yield (26%) is significantly higher than that of P1 (3.6 %), which we explain in terms of different electron-phonon couplings and Mn-Mn interactions. The encapsulation of both perovskites into a PMMA film largely increases their stability against moisture, being more than 1000 h for P2. Upon increasing the temperature, the emission intensity of both perovskites decreases without a significant shift in the emission spectrum, which is explained in terms of an increase in the electron-phonon interactions. The photoluminescence decays fit two components in the microsecond regime-the shortest lifetime for hydrated phases and the longest one for non-hydrated phases. Our findings provide insights into the effects of linear mono- and bivalent organic interlayer spacer cations on the photophysics of these kinds of Mn (II)-based perovskites. The results will help in better designs of Mn(II)-perovskites, to increase their lighting performance.

Quantifying Myocardial Blood Flow and Resistance Using 4D-Flow Cardiac Magnetic Resonance Imaging.

Ischaemia with nonobstructive coronary arteries is most commonly caused by coronary microvascular dysfunction but remains difficult to diagnose without invasive testing. Myocardial blood flow (MBF) can be quantified noninvasively on stress perfusion cardiac magnetic resonance (CMR) or positron emission tomography but neither is routinely used in clinical practice due to practical and technical constraints. Quantification of coronary sinus (CS) flow may represent a simpler method for CMR MBF quantification. 4D flow CMR offers comprehensive intracardiac and transvalvular flow quantification. However, it is feasibility to quantify MBF remains unknown. Patients with acute myocardial infarction (MI) and healthy volunteers underwent CMR. The CS contours were traced from the 2-chamber view. A reformatted phase contrast plane was generated through the CS, and flow was quantified using 4D flow CMR over the cardiac cycle and normalised for myocardial mass. MBF and resistance (MyoR) was determined in ten healthy volunteers, ten patients with myocardial infarction (MI) without microvascular obstruction (MVO), and ten with known MVO. MBF was quantified in all 30 subjects. MBF was highest in healthy controls (123.8 ± 48.4 mL/min), significantly lower in those with MI (85.7 ± 30.5 mL/min), and even lower in those with MI and MVO (67.9 ± 29.2 mL/min/) (P < 0.01 for both differences). Compared with healthy controls, MyoR was higher in those with MI and even higher in those with MI and MVO (0.79 (±0.35) versus 1.10 (±0.50) versus 1.50 (±0.69), P=0.02). MBF and MyoR can be quantified from 4D flow CMR. Resting MBF was reduced in patients with MI and MVO.

A von Hamos full-cylindrical spectrometer based on striped Si/Ge crystal for advanced x-ray spectroscopy.

High-energy resolution core-level spectroscopies, including a group of different techniques to obtain element-specific information of the electronic structure around an absorption site, have become powerful tools for studying the chemical state, local geometric structure, and the nature of chemical bonding. High-resolution x-ray absorption and x-ray emission spectroscopies are well-established experimental techniques but have always been limited by the number of emitted photons and the limited acceptance of solid angles, as well as requiring high energy stability and repeatability for the whole experimental setup. A full-cylindrical x-ray spectrometer based on flexible HAPG (highly annealed pyrolitic graphite) mosaic crystals is an effective solution for the above issues. However, large-area HAPG remains expensive and is often not easy to access. Here, we present an alternative approach by using segmented single crystals (Si and Ge) with different orientations instead of the HAPG as a dispersive element. The proposed method drastically improved the energy resolution up to 0.2-2eV in the range of 2-10keV. High-pressure x-ray emission and resonant x-ray emission spectra are presented to demonstrate the capabilities of the instrument. The new design is particularly suitable for high-resolution spectroscopy applications at fourth-generation synchrotron radiation sources or free-electron lasers.

Sulfur-Ligated [2Fe-2C] Clusters as Synthetic Model Systems for Nitrogenase.

Metal clusters featuring carbon and sulfur donors have coordination environments comparable to the active site of nitrogenase enzymes. Here, we report a series of di-iron clusters supported by the dianionic yldiide ligands, in which the Fe sites are bridged by two μ2-C atoms and four pendant S donors.The [L2Fe2] (L = {[Ph2P(S)]2C}2-) cluster is isolable in two oxidation levels, all-ferrous Fe2II and mixed-valence FeIIFeIII. The mixed-valence cluster displays two peaks in the Mössbauer spectra, indicating slow electron transfer between the two sites. The addition of the Lewis base 4-dimethylaminopyridine to the Fe2II cluster results in coordination with only one of the two Fe sites, even in the presence of an excess base. Conversely, the cluster reacts with 8 equiv of isocyanide tBuNC to give a monometallic complex featuring a new C-C bond between the ligand backbone and the isocyanide. The electronic structure descriptions of these complexes are further supported by X-ray absorption and resonant X-ray emission spectroscopies.

Diagnosis of cardiac sarcoidosis in patients presenting with cardiac arrest or life-threatening arrhythmias

ObjectiveCardiac sarcoidosis (CS) may present with cardiac arrest or life-threatening arrhythmias. There are limited data on this subgroup of patients with CS. Advanced imaging including cardiovascular magnetic resonance (CMR) and...

A compact von Hámos spectrometer for parallel X-ray Raman scattering and X-ray emission spectroscopy at ID20 of the European Synchrotron Radiation Facility.

A compact spectrometer for medium-resolution resonant and non-resonant X-ray emission spectroscopy in von Hámos geometry is described. The main motivation for the design and construction of the spectrometer is to allow for acquisition of non-resonant X-ray emission spectra while measuring non-resonant X-ray Raman scattering spectra at beamline ID20 of the European Synchrotron Radiation Facility. Technical details are provided and the performance and possible use of the spectrometer are demonstrated by presenting results of several X-ray spectroscopic methods on various compounds.

Clinical Utilization of Multimodality Imaging for Myocarditis and Cardiac Sarcoidosis

Myocarditis is defined as inflammation of the myocardium according to clinical, histological, biochemical, immunohistochemical, or imaging findings. Inflammation can be categorized histologically by cell type or pattern, and many causes have been implicated, including infectious, most commonly viral, systemic autoimmune diseases, vaccine-associated processes, environmental factors, toxins, and hypersensitivity to drugs. Sarcoid myocarditis is increasingly recognized as an important cause of cardiomyopathy and has important diagnostic, prognostic, and therapeutic implications in patients with systemic sarcoidosis. The clinical presentation of myocarditis may include an asymptomatic, subacute, acute, fulminant, or chronic course and may have focal or diffuse involvement of the myocardium depending on the cause and time point of the disease. For most causes of myocarditis except sarcoidosis, myocardial biopsy is the gold standard but is limited due to risk, cost, availability, and variable sensitivity. Diagnostic criteria have been established for both myocarditis and cardiac sarcoidosis and include clinical and imaging findings particularly the use of cardiac magnetic resonance and positron emission tomography. Beyond diagnosis, imaging findings may also provide prognostic value. This case-based review focuses on the current state of multimodality imaging for the diagnosis and management of myocarditis and cardiac sarcoidosis, highlighting multimodality imaging approaches with practical clinical vignettes, with a discussion of knowledge gaps and future directions.

The CLEAR X-ray emission spectrometer available at the CLAESS beamline of ALBA synchrotron.

The CLEAR X-ray emission spectrometer installed at the CLAESS beamline of the ALBA synchrotron is described. It is an energy-dispersive spectrometer based on Rowland circle geometry with 1 m-diameter circle. The energy dispersion is achieved by the combination of a diced analyzer crystal and a unidimensional detector. A single unconventional dynamically bent analyzer crystal (Si 111) permits a wide energy range to be covered, just by exploiting its different reflections (333, 444, 555, 777, 888): 6-22 keV, with a spectrometer efficiency that decreases above 11 keV because of the Si detector thickness (Mythen, 350 µm), while the relative scattering intensities for the Si 333, 444, 555, 777 and 888 reflections correspond to 36, 40, 21, 13 and 15, respectively. The provided energy resolution is typically below 1-2 eV and depends on the beam size, working Bragg angle and reflection exploited. In most cases the energy dispersion ranges from 10 to 20 eV and can be enlarged by working in the out-of-Rowland geometry up to 40 eV. The spectrometer works in full backscattering geometry with the beam passing through the two halves of the analyzer. The vacuum beam path and the particular geometry allow a typical average noise of only 0.5 counts per second per pixel. The spectrometer is mainly used for measuring emission lines and high-resolution absorption spectra, with a typical scanning time for highly concentrated systems of around half an hour, including several repeats. The intrinsic energy dispersion allows systematic collection of resonant X-ray emission maps by measuring high-resolution absorption spectra. Moreover, it allows spectra to be measured on a single-shot basis. Resonant inelastic X-ray scattering experiments to probe electronic excitations are feasible, although the spectrometer is not optimized for this purpose due to the limited energy resolution and scattering geometry provided. In that case, to minimize the quasi-elastic line, the spectrometer is able to rotate along the beam path. Advantages and disadvantages with respect to other existing spectrometers are highlighted.

Resonant Kushi-comb-like multi-frequency radiation of oscillating two-color soliton molecules

Nonlinear waveguides with two distinct domains of anomalous dispersion can support the formation of molecule-like two-color pulse compounds. They consist of two tightly bound subpulses with frequency loci separated by a vast frequency gap. Perturbing such a two-color pulse compound triggers periodic amplitude and width variations, reminiscent of molecular vibrations. With increasing strength of perturbation, the dynamics of the pulse compound changes from harmonic to nonlinear oscillations. The periodic amplitude variations enable coupling of the pulse compound to dispersive waves, resulting in the resonant emission of multi-frequency radiation. We demonstrate that the location of the resonances can be precisely predicted by phase-matching conditions. If the pulse compound consists of a pair of identical subpulses, inherent symmetries lead to degeneracies in the resonance spectrum. Weak perturbations lift existing degeneracies and cause a splitting of the resonance lines into multiple lines. Strong perturbations result in more complex emission spectra, characterized by well separated spectral bands caused by resonant Cherenkov radiation and additional four-wave mixing processes.

Bacteremia and adrenal gland abscess due to Nocardia cyriacigeorgica: a case report and review

BackgroundNocardia cyriacigeorgica is one of the most common Nocardia species found in human infections, recently reclassified. Even though Nocardia may affect all organs by hematogenous dissemination, bacteremia are uncommon. Among all possible dissemination sites, the involvement of the adrenal glands is particularly rare.Case presentationWe report here a rare case of Nocardia disseminated infection with notably bacteremia and adrenal gland abscess, in a 77-years-old immunocompetent man. Adrenal gland abscess diagnosis was made by imaging (computerized tomography, magnetic resonance and positron emission tomography scan). A complete regression of all lesions including the left adrenal gland was obtained after 6 months of antibiotics. A review of literature was also performed.ConclusionNocardia bacteremia is a rare event but blood cultures may help to improve detection of Nocardia spp. in a non-invasive way. Adrenal abscess due to Nocardia spp. is very rare with only fourteen cases reported in the literature, but it is a true cause of adrenal masses. Our report suggests that clinician should be aware of this rare location and prioritize a non-invasive diagnosis strategy.

Efficient and compact source of tuneable ultrafast deep ultraviolet laser pulses at 50 kHz repetition rate.

Deep ultraviolet (DUV) laser pulses with tuneable wavelength and very short duration are a key enabling technology for next-generation technology and ultrafast science. Their generation has been the subject of extensive experimental effort, but no technique demonstrated thus far has been able to meet all requirements in one light source. Here we demonstrate a bright, efficient, and compact source of tuneable DUV ultrafast laser pulses based on resonant dispersive wave emission in hollow capillary fiber. In a total footprint of only 120cm×75cm, including the ytterbium-based drive laser, we generate pulses between 208nm and 363nm at 50kHz repetition rate with a total efficiency of up to 3.6%. Down-scaling of the DUV generation reduces the required energy sufficiently to enable the generation of two-color few-femtosecond DUV pulses.

Magnetic resonance imaging for characterization of hepatocellular carcinoma metabolism.

With a better understanding of the pathophysiological and metabolic changes in hepatocellular carcinoma (HCC), multiparametric and novel functional magnetic resonance (MR) and positron emission tomography (PET) techniques have received wide interest and are increasingly being applied in preclinical and clinical research. These techniques not only allow for non-invasive detection of structural, functional, and metabolic changes in malignant tumor cells but also characterize the tumor microenvironment (TME) and the interactions of malignant tumor cells with the TME, which has hypoxia and low pH, resulting from the Warburg effect and accumulation of metabolites produced by tumor cells and other cellular components. The heterogeneity and complexity of the TME require a combination of images with various parameters and modalities to characterize tumors and guide therapy. This review focuses on the value of multiparametric magnetic resonance imaging and PET/MR in evaluating the structural and functional changes of HCC and in detecting metabolites formed owing to HCC and the TME.

948 MULTIMODALITY IMAGING IN CARDIAC MASSES

Abstract Background Cardiac masses (CM) are an extremely heterogeneous clinical scenario, including benign and malignant neoformations. After a first echocardiographic assessment, Cardiac Computed Tomography (CCT) together with Cardiac Magnetic Resonance (CMR) and 18-Fluorodeoxyglucose Positron Emission Tomography (18-FDG-PET) represent second-line and third-line imaging techniques to determine the nature of the mass. However, data regarding their diagnostic performance and a standardized imaging algorithm are lacking. Purpose To evaluate the different roles of CCT, CMR, and PET in defining the nature of CMs and to propose an evidence-based, stepwise, diagnostic approach. Materials and methods Out of 312 patients with suspected mass from January 2000 and August 2022, we enrolled 87 patients who underwent CCT, CMR and 18-FDG-PET within a month from the initial evaluation. A definitive diagnosis was achieved by histological examination or, in case of cardiac thrombi, with radiological evidence of thrombus resolution after an appropriate anticoagulant treatment. For each imaging technique, we identified a model with the strongest predictors of malignancy at multivariate analysis and evaluated their ability to discriminate between benign and malignant neoformations. A multiple model with forwarding selection was performed to identify the strongest predictors of malignancy at CCT, CMR and 18-FDG-PET. Results CCT model included 4 variables (irregular margins, mass dimension, invasiveness and not-hypodense lesion) with an Area Under the Curve (AUC) of 0.972, 95% Confidence Interval (CI) 0.94-1.0; CMR model included 3 parameters (invasiveness, pericardial effusion and irregular margins, AUC 0.976 with 95% CI 0.95-1.0); PET model included only cardiac maximum Standardized Uptake Value (SUVmax), with an AUC 0.87 (95% IC 0.74-0.971). When implemented with SUVmax, CCT and CMR models showed only a slight improvement in their discrimination ability (AUC 0.975 and 0.986, respectively). No statistical difference was observed between CCT and CMR models regarding their discrimination ability (AUC 0.972 vs 0.976, p=0.26). However, on a multiple model with forwarding selection evaluating CCT, CMR and PET variables, only the 3 MR parameters remained significant predictors of malignancy. Conclusion After a first echocardiographic assessment, the application of the CMR model may be the most accurate second-level investigation to discriminate between benign and malignant lesions. When CMR is not available, or the patient has contraindications to CMR, the CCT model performs similarly, and 18-FDG-PET provides a negligible advantage.

704 STRESS TEST STRATEGY WITH CMR AND SPECT-MPI REDUCES CARDIAC EVENTS IN CANDIDATES TO NON-CARDIAC SURGERIES

Abstract Introduction . Cardiac complications related to non-cardiac surgery have a variable incidence, from less than 1% to more than 5% with a great variability depending on type of intervention, patient's risk factors and results from tests performed during the pre-operative evaluation. The aim of our single centre retrospective study was to evaluate the prognostic role of stress cardiac magnetic resonance (sCMR) and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in relation to 30 days post-surgery cardiac events. Method Clinical data of patients from January 2015 to December 2021 were retrospectively collected from review of electronical medical records. Only intermediate and high risk surgeries were included. All patients underwent to cardiologic, electrocardiographic and echocardiographic evaluation before surgery. Stress test was performed according to cardiologist judgment. Primary endpoint was a composite endpoint of myocardial infarction, unstable angina, cardiac death, cardiogenic shock, pulmonary oedema and life threatening cardiac arrythmias. Secondary endpoint were the research of ischemia predictors and the rate of revascularization. Results One-thousand-five-hundred-ninety patients were included, 669 stress tests were performed (287 sCMR, 382 SPECT-MPI). Rate of 30-days cardiac events was lower in the stress test group vs non-stress test group (1,2% vs 3,4%; p 0,006). Imaging stress test strategy showed a significant reduction of composite endpoint at multivariate analysis (OR: 0.334, IC: 0.155–0.766, p 0.009). Predictors of ischemia were hypertension, coronary artery disease and diastolic dysfunction. SCMR was non inferior to SPECT with regard the risk of cardiac events, while showed a greater accuracy to predict coronary revascularization (AUC for sCMR: 0.94). Conclusions Stress test strategy reduces cardiac events in high risk patients candidate to moderate- to high- risk surgeries. Stress CMR is non-inferior to SPECT with regards to the risk of cardiac events, but has a greater accuracy to predict the need for revascularization.