Visualization Of Right Ventricle Research Articles

Incidental visualization of right ventricle on F-18 FDG PET/CT as an early indicator of heart failure

A 55 year hypertensive man presented with shortness of breath, productive cough and loss of weight. To rule out underlying malignancy, he underwent F-18 FDG PET/CT which showed bronchiectatic changes and tree-in bud nodules in bilateral lung fields with no definitive of evidence of metabolically active disease to suggest malignancy. There was no organomegaly and pulmonary to aorta ratio was also normal (0.73). However, diffuse FDG uptake was seen in the right ventricle which is uncommon due to less muscular mass in comparison to the left ventricle. The serum NT- pro BNP was raised to 265 pg/ml (upper limit less than 125 pg/ml) confirming heart failure.

The improvement of cardiac multispiral computed tomography protocol for planning interventional arrhythmia management

Purpose. Comparison of computer tomography (СT) contrast enhancement (CE) protocols for optimal visualization of cardiac chamber, definition it’s influence on results of non-invasive superficial cardiac mapping.Materials and methods. The study included 93 patients with heart rhythm disorders who planned catheter ablation of arrhythmia. Noninvasive cardiac mapping was made for topical diagnostics. It includes multichannel ECG-registration and CT with intravenous СE (1st group monophasic (50 patients), 2nd group split-bolus (18 patients), 3rd group with pre-bolus (25 patients). Qualitative and quantitative (measurement of mean blood attenuation in four chambers, calculation of ventricular-myocardial contrast-to-noise ratio VM-LV и VM-RV for left ventricle (LV) and right ventricle (RV), respectively) parameters were compared between groups. Fusion of ECG and CT data was made semi-automatic with diagnostic complex «Amycard 01К».Results. Regardless of CE technique was noted sufficient and homogeneous contrast attenuation of left atrium (LA) and LV (mean blood attenuation in LA more than 278 HU, LV 250 HU, VM-LV 0,582). Enhancement of right heart was insufficient with monophasic protocol, in most cases the average CT density was lower than 200 HU, VM-RV 0,256. Split-bolus protocol improves visualization of right atrium (RA) and RV (blood density in RA 258HU, RV 227HU, VM-RV 0,541), however there was heterogeneity of RA cavity because of artifacts from superior vena cava (VC) and unenhanced blood from inferior inferior VC. Using of pre-bolus increases contrast ratio between RA myocardium and blood due to increasing CT density of blood in inferior VC (blood density 294 HU). Quality of right ventricle CE was similar to 2nd group (blood density 264 HU, VM-RV 0,565).Conclusion. CE protocols split-bolus and with pre-bolus improve visualization of right ventricle, supporting the high level enhancement of left heart. Protocol with pre-bolus is preferable for exact differentiation of right atrial endocardial contour.

Etiopathologies Associated with Intercostal Muscle Hypermetabolism and Prominent Right Ventricle Visualization on 2-Deoxy-2[F-18]fluoro-d-glucose-Positron Emission Tomography: Significance of an Incidental Finding and in the Setting of a Known Pulmonary Disease

The present study was undertaken to investigate the significance of 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) uptake in the intercostal muscles (ICM) and prominent visualization of right ventricle (RV) in FDG-positron emission tomography (PET) scans and its implications. Patients identified to have FDG uptake in the ICM with or without prominent visualization of the RV either incidentally or in the background of an existing explanatory cause at the time of FDG-PET studies were included in this retrospective study. These patients had undergone FDG-PET either for ruling out malignancy or for disease monitoring purposes in setting a proven malignancy. We reviewed the clinical and investigational records (including computed tomography [CT] thorax, chest X-ray, 2-D echo and pulmonary function tests, and arterial blood gas analysis) of the group with incidental FDG uptake for revelation of a pathology explaining such uptake. A total of 14 cases with 16 FDG-PET studies were identified from the retrospective examination of case records. One patient had three FDG-PET at different time points of his disease course. The patient population included 13 males and one female with age range 46-88 years. The patients were classified into two groups: (1) cases with isolated ICM uptake (n=10); (2) cases with both ICM and RV uptake (n=4). Among 10 patients with isolated ICM uptake, in six patients it was a serendipitous observation, whereas four patients had existing explanatory cause at the time of FDG-PET. The causes found to be associated included COPD, asthma, recent heart failure, interstitial lung disease (post external radiotherapy) and pulmonary embolism, atelectasis with pleural effusion. In all four cases with associated RV uptake, there was evidence of pulmonary hypertension (PH). Among these, in one patient this was a serendipitous observation. He had evidence of interstitial lung disease (ILD) in CT thorax, and 2-D echo showed moderate PH. The remaining three patients had cor pulmonale secondary to COPD, pneumoconiosis, and Swyer James Syndrome with associated severe PH. The SUVmax ratio of the RV-to-LV free wall ranged from 0.53 to 1.04 in the cases with prominent RV uptake. One patient had multiple FDG-PET studies and have shown reduction of RV uptake in the last scan consistent with the clinical impression of improvement of cor pulmonale. Both intercostal muscle and prominent RV uptake in FDG-PET can be associated with a spectrum of causes (including both obstructive and restrictive airway diseases) that lead to breathing exertion. These are important markers, which could signify underlying pulmonary disease and pulmonary hypertension, respectively. Associated prominent RV uptake strongly indicates presence of pulmonary hypertension and the uptake in the right heart can subserve a valuable surrogate marker in the treatment-monitoring scenario of a known PH.

Evaluation with Fourier analysis on radionuclide angiography of viable but stunned myocardium in patients with right ventricular myocardial infarction.

Stunned myocardium of right ventricle was studied by radionuclide angiography (RNA) and Thallium myocardial scintigraphy (TL) in 39 patients with inferior myocardial infarction with and without right ventricular myocardial infarction (RVMI). RNA was performed within 1 week of the onset (acute phase) and after 1 month, when exercise cardiac scintigraphy (EX-TL) was also performed. The ejection fraction (EF) of each ventricle calculated from RNA and the phase and amplitude evaluated visually and quantitatively by Fourier analysis were compared between the acute phase and 1 month after the onset of myocardial infarction. The degree of visualization of right ventricle was examined in EX-TL 1 month after the onset. (1) In RNA obtained in the acute myocardial infarction, abnormalities in the right ventricle (delayed phase or low amplitude image) were observed in 18 (46%) but not in 21 (54%) of the 39 patients (N group). Of those 18 patients, the abnormalities in the right ventricle alleviated in 11 (RVMI-A group) but persisted in 7 (RVMI-B group) in RNA obtained 1 month after the onset. (2) In the acute phase, the right ventricular ejection fraction (RVEF) was 39.4 +/- 10.4% in N group, 30.8 +/- 5.3% in RVMI-A group, and 29.6 +/- 8.9% in RVMI-B group, with significant differences between N group and the other two groups (P less than 0.05) but no significant difference between RVMI-A and RVMI-B groups. (3) After 1 month, RVEF was 40.1 +/- 10.1% in N group, 42.2 +/- 8.4% in RVMI-A group, and 32.2 +/- 9.8% in RVMI-B group, being improved in RVMI-A group and showing a significant difference as compared with RVMI-B group (p less than 0.05). (4) In EX-TL of RVMI-A group, the right ventricle was visible although the uptake of TL was reduced in the entire right ventricle. In RVMI-B group, only part of the right ventricular free wall was visible with defects in the other areas of right ventricle. The sign of RVMI showed improvements in many of the patients after the acute phase, and their condition was considered to have been so-called stunned myocardium, which is a complex of symptoms of reversible myocardial ischemia, rather than RVMI.