Role Of Multimodality Imaging Research Articles

Early recognition of mitral annular disjunction induced ventricular fibrillation: role of multimodality imaging.

Early recognition of mitral annular disjunction induced ventricular fibrillation: role of multimodality imaging.

The role of multimodality imaging in diagnosing acute perimyocarditis secondary to Crohn\u2019s disease

BackgroundAcute perimyocarditis is a rare extra-intestinal manifestation in Crohn’s disease which required multimodality imaging to confirm the diagnosis. Here we present a case of acute perimyocarditis as the first presentation of Crohn’s disease. To date, this is the first case presentation reporting the use of 18F-FDG PET/CT Scan for diagnosing such condition.Case presentationA 25-year-old male presented to our hospital with severe persistent pleuritic sharp left-sided chest pain. This was his second hospital admission in the past 4 months for chest pain and diarrhea. At the first hospitalization, he was diagnosed with viral perimyocarditis and irritable bowel syndrome. Laboratory findings, electrocardiogram, and cardiac magnetic resonance imaging results confirm the diagnostic of perimyocarditis. Virology, bacteriology, parasitology, and autoimmune evaluations were unremarkable. Colonoscopy, colorectal biopsy, and 18FGD PET findings confirmed manifestation of perimyocarditis, Crohn’s disease, and negative for sarcoidosis.ConclusionsLooking at the overall clinical picture and investigation results of colonoscopy, colorectal biopsy findings, as well as multi-modality imaging with echocardiography, 18FDG PET—scan and CMRI, the patient was diagnosed to have perimyocarditis attending Chron’s disease flare up as a rare extra-intestinal manifestation.

A decade of multi-modality PET and MR imaging in abdominal oncology.

Objectives:To investigate trends observed in a decade of published research on multimodality PET(/CT)+MR imaging in abdominal oncology, and to explore how these trends are reflected by the use of multimodality imaging performed at our institution.Methods:First, we performed a literature search (2009–2018) including all papers published on the multimodality combination of PET(/CT) and MRI in abdominal oncology. Retrieved papers were categorized according to a structured labelling system, including study design and outcome, cancer and lesion type under investigation and PET-tracer type. Results were analysed using descriptive statistics and evolutions over time were plotted graphically. Second, we performed a descriptive analysis of the numbers of MRI, PET/CT and multimodality PET/CT+MRI combinations (performed within a ≤14 days interval) performed during a similar time span at our institution.Results:Published research papers involving multimodality PET(/CT)+MRI combinations showed an impressive increase in numbers, both for retrospective combinations of PET/CT and MRI, as well as hybrid PET/MRI. Main areas of research included new PET-tracers, visual PET(/CT)+MRI assessment for staging, and (semi-)quantitative analysis of PET-parameters compared to or combined with MRI-parameters as predictive biomarkers. In line with literature, we also observed a vast increase in numbers of multimodality PET/CT+MRI imaging in our institutional data.Conclusions:The tremendous increase in published literature on multimodality imaging, reflected by our institutional data, shows the continuously growing interest in comprehensive multivariable imaging evaluations to guide oncological practice.Advances in knowledge:The role of multimodality imaging in oncology is rapidly evolving. This paper summarizes the main applications and recent developments in multimodality imaging, with a specific focus on the combination of PET+MRI in abdominal oncology.

Pair of glomus tumors in thigh – both periosteal and intramuscular: Rare tumor in atypical location

Glomus tumors are benign neoplasms that arise from neuromyoarterial glomus bodies accounting for <2% of soft-tissue tumors. Glomus tumors represent around 1–5% of all soft-tissue tumors and 1–5% of all hand tumors. About 75% of these tumors occur in hand with 75–90% of these occurring in characteristic subungual location. Extradigital location of glomus tumor is very rare. We report an exceptional case of extradigital glomus tumor causing thigh pain, where there were a pair of lesions both in periosteum and intramuscular location. A 47-year-old male with complaints of pain over medial aspect of the left lower thigh for 2 years on ultrasound revealed well-defined solid hypoechoic lesions within the left vastus medialis muscle and cortical-based lesion abutting the periosteum of distal diaphysis of the left femur on medial aspect. These lesions were hypointense on T1W, hyperintense on T2W and showed early homogenous enhancement on MRI. Histopathology revealed glomus tumors, which commonly occur in digits. Glomus tumors located in both periosteal and intramuscular locations in thigh were in very uncommon. Non-specific presentation with pain in such cases remains a diagnostic dilemma. Role of multimodality imaging and histopathology correlation is important in such situation.

A Case Report of Giant Ascending Aortic Aneurysm: Role of Multimodality Imaging.

Giant ascending aortic aneurysm (AscAA >10 cm) is an uncommon entity with a variable presentation. The size of the aneurysm, rapid expansion, and calcification are associated with an increased risk of rupture. Atherosclerosis is the most common etiology of aortic aneurysm in the elderly population. Multimodality imaging can be wisely used for diagnosis, risk stratification, and follow-up. We herein report a case of successfully repaired giant calcified AscAA with a maximum diameter of 10 cm. We also provide a brief discussion on the role of multimodality imaging.

Role of multimodality imaging in the assessment of mechanical prosthetic heart valve dysfunction

In patients with suspected mechanical prosthetic heart valve (PHV) dysfunction, transthoracic and transesophageal echocardiography are considered as the first-line imaging, but may provide unsatisfactory results related to reverberations and acoustic shadowing. This study assessed the value of ECG-gated multidetector computed tomography (MDCT) as a complementary imaging modality in suspected prosthetic dysfunction. Patients with suspected mechanical PHV dysfunction were prospectively recruited between 2018 and 2020 in the cardiology department of Ariana hospital. All patients underwent transthoracic/transesophageal echocardiography and additional MDCT imaging. We compared the diagnosis based on echocardiography and on MDCT information. Our study enrolled 32 patients (median age was 53.7 years: 26–76). 16 patients had an aortic prosthetic valve (50%), 8 patients had a mitral prosthetic valve (25%), 8 patients had mitro-aortic prosthetic valves (25%). An obstructive dysfonction was noticed in 23 patients (72%): a thrombus in 12 cases, a pannus in 4 cases, a mismatch in 2 cases and a reduction in a leaflet motion in 4 cases, a vegetation in one case. A regurgitation was noticed in 4 patients: two paraprosthetic regurgitation and two paraprosthetic aneurysm. Ultrasound imaging and MDCT found same results for mismatach. Echocardiogram was more performant in the diagnosis of thrombosis ( P = 0,02). The addition of MDCT showed incremental value in detecting pannus ( P = 0,02), leaflet restriction and paraprosthetic aneurysm.The leaflet restriction diagnosed by CT in significantly associated with thrombus ( P = 0,03) ( Fig. 1 ). Mechanical PHV dysfunction is rare but life-threatening. A multimodality imaging assessment (ultrasound and CT) is necessary to precise mechanism and indicate the appropriate treatment. MDCT imaging is superior for detecting pannus and leaflet motion restriction.

Moderate Aortic Stenosis: What is it and When Should We Intervene?

Current guidelines recommend aortic valve replacement in patients with severe aortic stenosis in the presence of symptoms or a left ventricular ejection fraction <50%. However, patients with less than severe aortic stenosis may also experience symptoms and recent literature suggests that the prognosis is not as benign as previously reported. There are no recommendations for patients with moderate aortic stenosis and left ventricular dysfunction, despite the high associated morbidity and mortality. There is also some evidence that these patients may benefit from early aortic valve intervention. It is recognised that aortic stenosis not only affects the valve but also has a complex myocardial response. This review discusses the natural history of moderate aortic stenosis along with the role of multimodality imaging in risk stratification in these patients.

Role of multimodality imaging in a case of heart failure with preserved ejection fraction

A man in his 80s with hypertension presented with progressive shortness of breath and pitting oedema of lower limbs from the last 6 months. He was admitted twice to an...

Avance en el tratamiento de la mastitis granulomatosa idiopática: utilidad de micofenolato de mofetilo

ObjectiveIdiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast with persistent course, even recurrent, that frequently affects parous premenopausal women. It can mimic the appearance of breast cancer, so its diagnosis is of great help to avoid irreversible surgical endeavours. Although multiple treatments have been tried for its management, none have been truly successful and no consensus exists as which the best therapeutic option is. MethodsWe conducted a study with the eight cases of IGM in our institution since 2012 that were refractory to the used treatments for IGM (antibiotics, steroids, methotrexate or observation) seeing their evolution after the use of mycophenolate mofetil. ResultsThey responded well radiologically as well as clinically to the use of mycophenolate mofetil, not needing more invasive course of treatment. ConclusiónIGM is a rare inflammatory condition of the breast. The use of MMF as treatment is successful in the recurrence and disappearance of this disease. Given its differential diagnosis and its benign course, the role of multimodal imaging in recognizing this entity as soon as possible can lead to an improved patient outcome and help preventing any unnecessary overtreatment.

Cardiac Resynchronization Therapy in Non-Ischemic Cardiomyopathy: Role of Multimodality Imaging.

Non-ischemic cardiomyopathy encompasses a heterogeneous group of diseases, with a generally unfavorable long-term prognosis. Cardiac resynchronization therapy (CRT) is a useful therapeutic option for patients with symptomatic heart failure, currently recommended by all available guidelines, with outstanding benefits, especially in non-ischemic dilated cardiomyopathy. Still, in spite of clear indications based on identifying a dyssynchronous pattern on the electrocardiogram (ECG,) a great proportion of patients are non-responders. The idea that multimodality cardiac imaging can play a role in refining the selection criteria and the implant technique and help with subsequent system optimization is promising. In this regard, predictors of CRT response, such as apical rocking and septal flash have been identified. Promising new data come from studies using cardiac magnetic resonance and nuclear imaging for showcasing myocardial dyssynchrony. Still, to date, no single imaging predictor has been included in the guidelines, probably due to lack of validation in large, multicenter cohorts. This review provides an up-to-date synthesis of the latest evidence of CRT use in non-ischemic cardiomyopathy and highlights the potential additional value of multimodality imaging for improving CRT response in this population. By incorporating all these findings into our clinical practice, we can aim toward obtaining a higher proportion of responders and improve the success rate of CRT.

Primary squamous cell carcinoma of the urinary bladder presenting as an inguinal mass

This report involves a rare case of a 74-year-old man who presented with a progressively increasing swelling in the right groin, which represented a squamous cell bladder carcinoma herniating into the right inguinal canal. The manuscript discusses the role of multimodality imaging in bladder carcinoma presenting as an inguinoscrotal hernia. The patient subsequently underwent treatment with a chemotherapy regimen consisting of 5-fluorouracil and mitomycin, which was extrapolated from squamous cell carcinoma of the anal canal, and responded well.

Metastatic tumor of the interventricular septum mimicking myocardial calcification: The role of multimodality imaging.

Metastatic tumor of the interventricular septum mimicking myocardial calcification: The role of multimodality imaging.

Severe ischemic retinopathy with vasculitis and role of multimodal imaging in asymptomatic patient with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a systemic disease with multiorgan involvement including eyes. We report a 37-year-old female, a known SLE case for 4 years, who came to our clinic to screen for hydroxychloroquine toxicity. Fundus showed changes of ischemic retinopathy, confirmed on optical coherence tomography angiography and fundus fluorescein angiography. Our case illustrates the importance of multimodal imaging and its correlation with systemic disease activity in SLE patients.

The role of multimodal imaging and vision function testing in ABCA4-related retinopathies and their relevance to future therapeutic interventions.

The aim of this review article is to describe the specific features of Stargardt disease and ABCA4 retinopathies (ABCA4R) using multimodal imaging and functional testing and to highlight their relevance to potential therapeutic interventions. Standardised measures of tissue loss, tissue function and rate of change over time using formal structured deep phenotyping in Stargardt disease and ABCA4R are key in diagnosis, and prognosis as well as when selecting cohorts for therapeutic intervention. In addition, a meticulous documentation of natural history will be invaluable in the future to compare treated with untreated retinas. Despite the familiarity with the term Stargardt disease, this eponymous classification alone is unhelpful when evaluating ABCA4R, as the ABCA4 gene is associated with a number of phenotypes, and a range of severity. Multimodal imaging, psychophysical and electrophysiologic measurements are necessary in diagnosing and characterising these differing retinopathies. A wide range of retinal dystrophy phenotypes are seen in association with ABCA4 mutations. In this article, these will be referred to as ABCA4R. These different phenotypes and the existence of phenocopies present a significant challenge to the clinician. Careful phenotypic characterisation coupled with the genotype enables the clinician to provide an accurate diagnosis, associated inheritance pattern and information regarding prognosis and management. This is particularly relevant now for recruiting to therapeutic trials, and in the future when therapies become available. The importance of accurate genotype-phenotype correlation studies cannot be overemphasised. This approach together with segregation studies can be vital in the identification of causal mutations when variants in more than one gene are being considered as possible. In this article, we give an overview of the current imaging, psychophysical and electrophysiological investigations, as well as current therapeutic research trials for retinopathies associated with the ABCA4 gene.

The Role of Multimodality Imaging in Cardiac Sarcoidosis.

The etiology and the progression of sarcoidosis remain unknown. However, cardiac sarcoidosis (CS) is significantly associated with a poor prognosis due to the associated congestive heart failure, arrhythmias (such as an advanced atrioventricular block), and ventricular tachyarrhythmia. Novel imaging modalities are now available to detect CS lesions secondary to active inflammation, granuloma formation, and fibrotic changes. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and cardiac magnetic resonance imaging (CMR) play essential roles in diagnosing and monitoring patients with confirmed or suspected CS. The following focused review will highlight the emerging role of non-invasive cardiac imaging techniques, including FDG PET/CT and CMR.

Role of multimodal imaging in the preparation for surgery to correct left atrial myxoma.

Role of multimodal imaging in the preparation for surgery to correct left atrial myxoma.

Multimodality imaging for preprocedural planning of percutaneous mitral valve repair: a comprehensive review

New transcatheter mitral valve (MV) therapies are now available as alternatives to surgical and medical treatments in patients at high or prohibitive operative risk. Multimodality imaging including echocardiography, cardiac magnetic resonance, and cardiac computed tomography provide complementary information to guide patient and device selection. Morphology and functional anatomy of the MV should be carefully evaluated to determine the feasibility of percutaneous treatment; to identify the best therapeutic approach, either leaflet or annulus or combined; and to predict the probability of procedural success that is crucial for subsequent outcome and should be integrated by comprehensive preprocedural assessment of chamber size, biventricular systolic and diastolic function, valvopathy hemodynamic impact and aortic or peripheral vascular disease. The spectrum of transcatheter options is now wide and encompasses leaflet repair, direct or indirect annuloplasty, and cordal implantation. The aim of this review is to provide an overview on the role of multimodality imaging in the patient selection and preprocedural planning of percutaneous mitral valve repair.

Anomalous Left Coronary Artery from the Pulmonary Artery: The Role of Multimodal Imaging—A Case Report

Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) is a rare coronary artery anomaly which accounts for 0.25–0.5% of all congenital cardiac diseases, where most die within the first year of life. We present a case report of a 50-year-old lady who presented to hospital with persistent palpitations. Her admission electrocardiogram found her to be in Atrial Fibrillation (AF). She was rate-controlled and subsequently discharged. Despite that, she represented with further episodes of AF and was referred for an outpatient transthoracic echocardiogram. This revealed a dilated right coronary artery, retrograde flow in the left coronary artery and collateral flow in the myocardium. To investigate, the patient had undergone further imaging which confirmed the diagnosis. As such, she was later shortlisted for surgical intervention. Conclusively, our case exemplifies the role of multimodal imaging to identify the features of ALCAPA and may be useful for the purposes of surgical intervention.

The Role of Multi-modality Imaging in the Diagnosis of Cardiac Amyloidosis: A Focused Update.

Cardiac amyloidosis (CA) is a unique disease entity involving an infiltrative process, typically resulting in a restrictive cardiomyopathy with diastolic heart failure that ultimately progresses to systolic heart failure. The two most common subtypes are light-chain and transthyretin amyloidosis. Early diagnosis of this disease entity, especially light-chain CA subtype, is crucial, as it portends a poorer prognosis. This review focuses on the clinical utility of the various imaging modalities in the diagnosis and differentiation of CA subtypes. This review also aims to highlight the key advances in each of the imaging modalities in the diagnosis and prognostication of CA.

The Role of Multimodality Imaging in Monitoring Disease Activity and Therapeutic Response to Tocilizumab in Giant Cell Arteritis.

Introduction Giant cell arteritis (GCA) is a large vessel (LV) vasculitis, mainly affecting elder patients. Monitoring GCA activity during tocilizumab (TCZ) treatment is an unmet need, since low serum levels of C-reactive protein (CRP) during treatment may underestimate disease activity. To date, few data are available on the role of different imaging techniques in monitoring GCA activity and response to treatment. We report herein a cohort of GCA patients treated with TCZ and followed up with multimodal imaging. Patients and Methods. We collected clinical, laboratory, and imaging data of 11 GCA patients treated with TCZ 162 mg subcutaneously every week. Disease activity was assessed at baseline and within 12 months from the start of treatment using different imaging techniques such as color Doppler ultrasonography (CDUS), magnetic resonance imaging/angiography (MRI/MRA), computed tomography angiography (CTA), and/or positron emission tomography (PET). Results Four patients were affected by cranial and 7 by LV-GCA. All patients were treated with oral glucocorticoids (GCs) (mean dose 55.68 mg ± 8.19 of prednisone or equivalent) in combination with TCZ. Treatment was preceded in 5 cases by 3 intravenous boluses of 1000 mg methylprednisolone. A significant decrease of the mean dose of oral GCs was observed between baseline and the last follow-up visit (4.65 ± 3.69 mg) (p = 0.003). TCZ treatment significantly decreased erythrocyte sedimentation rate (p < 0.01) and CRP levels (p < 0.01). At follow-up (mean 8.18 ± 3.63 months), all patients were in clinical and serological remission. Moreover, PET, CDUS, MRI/MRA, and CTA did not show any LVV finding. Conclusions Our study highlights TCZ efficacy in inducing GCA remission and its steroid-sparing effect. We highlighted a reliability of imaging procedures in the evaluation of disease activity and treatment response. A close disease monitoring with imaging techniques should be taken into account in GCA patients during TCZ treatment.