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1.
Purpose
Pulmonary hypertension (PH) is associated with a poor outcome in chronic obstructive pulmonary disease (COPD) and is diagnosed invasively. We aimed to assess the diagnostic accuracy and prognostic value of non-invasive cardiovascular magnetic resonance (CMR) models.Methods
Patients with COPD and suspected PH, who underwent CMR and right heart catheter (RHC) were identified. Three candidate models were assessed: 1, CMR-RV model, based on right ventricular (RV) mass and interventricular septal angle; 2, CMR PA/RV includes RV mass, septal angle and pulmonary artery (PA) measurements; 3, the Alpha index, based on RV ejection fraction and PA size.Results
Of 102 COPD patients, 87 had PH. The CMR-PA/RV model had the strongest diagnostic accuracy (sensitivity 92%, specificity 80%, positive predictive value 96% and negative predictive value 63%, AUC 0.93, p<0.0001). Splitting RHC-mPAP, CMR-RV and CMR-PA/RV models by 35mmHg gave a significant difference in survival, with log-rank chi-squared 5.03, 5.47 and 7.10. RV mass and PA relative area change were the independent predictors of mortality at multivariate Cox regression (p=0.002 and 0.030).Conclusion
CMR provides diagnostic and prognostic information in PH-COPD. The CMR-PA/RV model is useful for diagnosis, the RV mass index and PA relative area change are useful to assess prognosis.Key Points
? Pulmonary hypertension is a marker of poor outcome in COPD.? MRI can predict invasively measured mean pulmonary artery pressure.? Cardiac MRI allows for estimation of survival in COPD.? Cardiac MRI may be useful for follow up or future trials.? MRI is potentially useful to assess pulmonary hypertension in patients with COPD.2.
Vivan J. M. Baggen Tim Leiner Marco C. Post Arie P. van Dijk Jolien W. Roos-Hesselink Eric Boersma Jesse Habets Gertjan Tj. Sieswerda 《European radiology》2016,26(11):3771-3780
Objectives
To provide a comprehensive overview of all reported cardiac magnetic resonance (CMR) findings that predict clinical deterioration in pulmonary arterial hypertension (PAH).Methods
MEDLINE and EMBASE electronic databases were systematically searched for longitudinal studies published by April 2015 that reported associations between CMR findings and adverse clinical outcome in PAH. Studies were appraised using previously developed criteria for prognostic studies. Meta-analysis using random effect models was performed for CMR findings investigated by three or more studies.Results
Eight papers (539 patients) investigating 21 different CMR findings were included. Meta-analysis showed that right ventricular (RV) ejection fraction was the strongest predictor of mortality in PAH (pooled HR 1.23 [95 % CI 1.07–1.41], p?=?0.003) per 5 % decrease. In addition, RV end-diastolic volume index (pooled HR 1.06 [95 % CI 1.00–1.12], p?=?0.049), RV end-systolic volume index (pooled HR 1.05 [95 % CI 1.01–1.09], p?=?0.013) and left ventricular end-diastolic volume index (pooled HR 1.16 [95 % CI 1.00–1.34], p?=?0.045) were of prognostic importance. RV and LV mass did not provide prognostic information (p?=?0.852 and p?=?0.983, respectively).Conclusion
This meta-analysis substantiates the clinical yield of specific CMR findings in the prognostication of PAH patients. Decreased RV ejection is the strongest and most well established predictor of mortality.Key Points
? Cardiac magnetic resonance imaging is useful for prognostication in pulmonary arterial hypertension.? Right ventricular ejection fraction is the strongest predictor of mortality.? Serial CMR evaluation seems to be of additional prognostic importance.? Accurate prognostication can aid in adequate and timely intensification of PAH-specific therapy.3.
Gert Klug Sebastian Johannes Reinstadler Hans-Josef Feistritzer Christian Kremser Johannes P. Schwaiger Martin Reindl Johannes Mair Silvana Müller Agnes Mayr Wolfgang-Michael Franz Bernhard Metzler 《European radiology》2016,26(7):1999-2008
Objectives
Phase-contrast CMR (PC-CMR) might provide a fast and robust non-invasive determination of left ventricular function in patients after ST-segment elevation myocardial infarction (STEMI).Methods
Cine sequences in the left-ventricular (LV) short-axis and free-breathing, retrospectively gated PC-CMR were performed in 90 patients with first acute STEMI and 15 healthy volunteers. Inter- and intra-observer agreement was determined. The correlations of clinical variables (age, gender, ejection fraction, NT pro-brain natriuretic peptide [NT-proBNP] with cardiac index (CI) were calculated.Results
For CI, there was a strong agreement of cine CMR with PC-CMR in healthy volunteers (r: 0.82, mean difference: -0.14 l/min/m2, error?±?23 %). Agreement was lower in STEMI patients (r: 0.61, mean difference: -0.17 l/min/m2, error?±?32 %). In STEMI patients, CI measured with PC-CMR showed lower intra-observer (1 % vs. 9 %) and similar inter-observer variability (9 % vs. 12 %) compared to cine CMR. CI was significantly correlated with age, ejection fraction and NT-proBNP values in STEMI patients.Discussion
The agreement of PC-CMR and cine CMR for the determination of CI is lower in STEMI patients than in healthy volunteers. After acute STEMI, CI measured with PC-CMR decreases with age, LV ejection fraction and higher NT-proBNP.Key Points
? Cine CMR and PC-CMR correlate well in healthy volunteers.? Agreement is lower in STEMI patients.? Cardiac Output should be measured with one method longitudinally.? Cardiac output decreases with age after myocardial infarction.4.
Background
Noninvasive estimation of myocardial external efficiency (MEE) requires measurements of left ventricular (LV) oxygen consumption with [11C]acetate PET in addition to LV stroke volume and mass with cardiovascular magnetic resonance (CMR). Measuring LV geometry directly from ECG-gated [11C]acetate PET might enable MEE evaluation from a single PET scan. Therefore, we sought to establish the accuracy of measuring LV volumes, mass, and MEE directly from ECG-gated [11C]acetate PET.Methods
Thirty-five subjects with aortic valve stenosis underwent ECG-gated [11C]acetate PET and CMR. List mode PET data were rebinned into 16-bin ECG-gated uptake images before measuring LV volumes and mass using commercial software and compared to CMR. Dynamic datasets were used for calculation of mean LV oxygen consumption and MEE.Results
LV mass, volumes, and ejection fraction measured by CMR and PET correlated strongly (r = 0.86-0.92, P < .001 for all), but were underestimated by PET (P < .001 for all except ESV P = .79). PET-based MEE, corrected for bias, correlated fairly with PET/CMR-based MEE (r = 0.60, P < .001, bias ?3 ± 21%, P = .56). PET-based MEE bias was strongly associated with LV wall thickness.Conclusions
Although analysis-related improvements in accuracy are recommended, LV geometry estimated from ECG-gated [11C]acetate PET correlate excellently with CMR and can indeed be used to evaluate MEE.5.
Objectives
To determine whether use of a stylus user input device (UID) would be superior to a mouse for CMR segmentation.Methods
Twenty-five consecutive clinical cardiac magnetic resonance (CMR) examinations were selected. Image analysis was independently performed by four observers. Manual tracing of left (LV) and right (RV) ventricular endocardial contours was performed twice in 10 randomly assigned sessions, each session using only one UID. Segmentation time and the ventricular function variables were recorded. The mean segmentation time and time reduction were calculated for each method. Intraclass correlation coefficients (ICC) and Bland-Altman plots of function variables were used to assess intra- and interobserver variability and agreement between methods. Observers completed a Likert-type questionnaire.Results
The mean segmentation time (in seconds) was significantly less with the stylus compared to the mouse, averaging 206±108 versus 308±125 (p<0.001) and 225±140 versus 353±162 (p<0.001) for LV and RV segmentation, respectively. The intra- and interobserver agreement rates were excellent (ICC≥0.75) regardless of the UID. There was an excellent agreement between measurements derived from manual segmentation using different UIDs (ICC≥0.75), with few exceptions. Observers preferred the stylus.Conclusion
The study shows a significant reduction in segmentation time using the stylus, a subjective preference, and excellent agreement between the methods.Key Points
? Using a stylus for MRI ventricular segmentation is faster compared to mouse ? A stylus is easier to use and results in less fatigue ? There is excellent agreement between stylus and mouse UIDs6.
Junyang?Luo Mingan?Li Youyong?Zhang Haofan?Wang Mingsheng?Huang Zhengran?Li Junwei?Chen Chun?Wu Jiesheng?Qian Shouhai?Guan Zaibo?Jiang
Objectives
The purpose of this study was to introduce a modified transjugular intrahepatic portosystemic shunt (TIPS), a percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS), and to evaluate its feasibility and efficacy in patients with variceal bleeding with chronic portal vein occlusion (CPVO) after splenectomy.Methods
Twenty-four cirrhotic patients with CPVO after splenectomy who received PTIPS between 2010 and 2015 were included in this retrospective study. The indication was elective control of variceal bleeding. Success rates, effectiveness and complications were evaluated, with comparison of the pre- and post-portosystemic pressure gradient (PPG). Patients’ clinical outcomes and shunt patency were followed periodically.Results
PTIPS was successfully placed in 22 patients (91.7%) and failed in two. The mean PPG fell from 22.0 ± 4.9 mmHg to 10.6 ± 1.6 mmHg after successful PTIPS (p < 0.05). No fatal procedural complications occurred. During the median follow-up of 29 months, shunt dysfunction occurred in five cases and hepatic encephalopathy in four cases. Three patients died because of rebleeding, hepatic failure and pulmonary disease, respectively. The other patients remained asymptomatic and the shunts patent.Conclusions
We conclude that PTIPS, as a modified TIPS procedure with a high success rate, is safe and effective for variceal bleeding with CPVO after splenectomy.Key Points
? Portal vein occlusion used to be contraindication to transjugular intrahepatic portosystemic shunt. ? Portal vein thrombosis is common in patients with previous splenectomy. ? We developed a new method, percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS). ? PTIPS is feasible in patients with portal vein thrombosis and splenectomy. ? PTIPS is effective and safe for these kind of complicated portal hypertension.7.
Objectives
To evaluate the feasibility of myocardial blood flow (MBF) by computed tomography from dynamic CT perfusion (CTP) for detecting myocardial ischemia and infarction assessed by cardiac magnetic resonance (CMR) or single-photon emission computed tomography (SPECT).Methods
Fifty-three patients who underwent stress dynamic CTP and either SPECT (n?=?25) or CMR (n?=?28) were retrospectively selected. Normal and abnormal perfused myocardium (ischemia/infarction) were assessed by SPECT/CMR using 16-segment model. Sensitivity and specificity of CT-MBF (mL/g/min) for detecting the ischemic/infarction and severe infarction were assessed.Results
The abnormal perfused myocardium and severe infarction were seen in SPECT (n?=?90 and n?=?19 of 400 segments) and CMR (n?=?223 and n?=?36 of 448 segments). For detecting the abnormal perfused myocardium, sensitivity and specificity were 80 % (95 %CI, 71-90) and 86 % (95 %CI, 76-91) in SPECT (cut-off MBF, 1.23), and 82 % (95 %CI, 76-88) and 87 % (95 %CI, 80-92) in CMR (cut-off MBF, 1.25). For detecting severe infarction, sensitivity and specificity were 95 % (95 %CI, 52-100) and 72 % (95 %CI, 53-91) in SPECT (cut-off MBF, 0.92), and 78 % (95 %CI, 67-97) and 80 % (95 %CI, 58-86) in CMR (cut-off MBF, 0.98), respectively.Conclusions
Dynamic CTP has a potential to detect abnormal perfused myocardium and severe infarction assessed by SPECT/CMR using comparable cut-off MBF.Key Points
? CT-MBF accurately reflects the severity of myocardial perfusion abnormality. ? CT-MBF provides good diagnostic accuracy for detecting myocardial perfusion abnormalities. ? CT-MBF may assist in stratifying severe myocardial infarction in abnormal perfusion myocardium.8.
Objective
In patients with aortic regurgitation (AR), the effect of static exercise (SE) on global ventricular function and AR severity has not been previously studied.Methods
Resting and SE cardiovascular magnetic resonance (CMR) were prospectively performed in 23 asymptomatic patients with AR.Results
During SE, we observed a decrease in regurgitant volume in both end-diastolic (EDV) and end-systolic (ESV) volume in both ventricles, as well as a slight decrease in LV ejection fraction (EF). Interestingly, responses varied depending on the degree of LV remodelling. Among patients with a greater degree of LV remodelling, we observed a decrease in LVEF (56?±?4 % at rest vs 48?±?7 % during SE, p?=?0.001) as a result of a lower decrease in LVESV (with respect to LVEDV. Among patients with a lower degree of LV remodelling, LVEF remained unchanged. RVEF remained unchanged in both groups.Conclusions
In patients with AR, SE provoked a reduction in preload, LV stroke volume, and regurgitant volume. In those patients with higher LV remodelling, we observed a decrease in LVEF, suggesting a lower LV contractile reserve.Key points
? In patients with aortic regurgitation, static exercise reduced preload volume.? In patients with aortic regurgitation, static exercise reduced stroke volume.? In patients with aortic regurgitation, static exercise reduced regurgitant volume.? In patients with greater remodelling, static exercise unmasked a lower contractile reserve.? Effect of static exercise on aortic regurgitation was assessed by cardiac MR.9.
Yasukazu Kako Koichiro Yamakado Wataru Jomoto Toshiya Nasada Koichiro Asada Haruyuki Takaki Kaoru Kobayashi Takashi Daimon Shozo Hirota 《Japanese journal of radiology》2017,35(7):366-372
Purpose
To evaluate changes in liver perfusion after occlusion of spontaneous portosystemic shunt and to analyze mechanisms of liver profile improvement.Materials and methods
Liver function changes and portal venous and hepatic arterial blood flow were evaluated using perfusion CT before and after shunt occlusion in 23 patients who underwent percutaneous occlusion of spontaneous portosystemic shunt because of gastric varices (n = 15) or hepatic encephalopathy (n = 8).Results
Portal venous blood flow was significantly higher at 1 week (278.7 ml/min, 92.7–636.7, p = 0.012), 1 month (290.0 ml/min, 110.1–560.1, p < 0.001) and 3 months (299.6 ml/min, 156.7–618.5, p = 0.033) after shunt occlusion than the baseline (220.9 ml/min, 49.5–566.7). Hepatic arterial liver blood flow became lower than the baseline (132.3 ml/min, 47.9–622.3) after shunt occlusion, but a significant decrease was observed only at 1 month later (107.9 ml/min, 45.8–263.6 p = 0.027). Serum albumin concentration became significantly higher than the baseline (3.4 mg/dl, 1.9–4.5) at 1 month (3.8 mg/dl, 2.3–4.3, p = 0.018) and 3 months (3.9 mg/dl, 2.6–4.3, p = 0.024) after shunt occlusion.Conclusion
Shunt occlusion increases portal venous blood flow and decreases hepatic arterial blood flow, thereby improving the liver profile.10.
Sachiko Achiwa Shozo Hirota Yasukazu Kako Haruyuki Takaki Kaoru Kobayashi Koichiro Yamakado 《Japanese journal of radiology》2017,35(4):206-214
Purpose
We evaluated anatomical variations of spontaneous splenorenal shunt (SSRS) and the prevalence of portosystemic shunts in patients with chronic liver disease by CT.Materials and methods
A total of 451 patients with chronic liver disease underwent contrast-enhanced computed tomography between October 2010 and April 2011. The prevalence of portosystemic shunts including SSRS and gastrorenal shunt, and the frequency of hepatic encephalopathy were examined. The course of the shunt and the point of confluence with the renal vein of the SSRS were analyzed.Results
SSRSs or gastrorenal shunts were found in 11.1 and 5.0% of the patients, respectively. Anatomical variations were classified into three types according to the point of confluence as follows: type 1 = the SSRS joined the inferior phrenic vein (n = 33), type 2 = the SSRS joined the gonadal vein (n = 7), and type 3 = the SSRS joined the left renal vein (n = 14). The course of the SSRS from the splenic hilum was classified as medial (n = 46), posterior (n = 2), or anterolateral (n = 2).Conclusions
SSRSs were classified into three types depending on the confluence point with the renal vein, and into three types of course. These findings are useful for preoperative information.11.
Objectives
To prospectively estimate the mean axon diameter (MAD) and extracellular space of the posterior limb of the internal capsule (PLIC) in patients with idiopathic normal pressure hydrocephalus (iNPH) before and after a lumboperitoneal (LP) shunting operation using q-space diffusion MRI analysis.Methods
We studied 12 consecutive patients with iNPH and 12 controls at our institution. After conventional magnetic resonance imaging (MRI), q-space image (QSI) data were acquired with a 3-T MRI scanner. The MAD and extra-axonal space of the PLIC before and after LP shunting were calculated using two-component q-space imaging analyses; the before and after values were compared.Results
After LP shunt surgery, the extracellular space of the PLIC was significantly higher than that of the same patients before the operation (one-way analysis of variance (ANOVA) with Scheffé’s post-hoc test, P?=?0.024). No significant differences were observed in the PLIC axon diameters among normal controls or in patients before and after surgery.Conclusion
Increases in the root mean square displacement in the extra-axonal space of the PLIC in patients with iNPH after an LP shunt procedure are associated with the microstructural changes of white matter and subsequent abatement of patient symptoms.Key Points
? Q-space diffusion MRI provides information on microstructural changes in the corticospinal tract ? Lumboperitoneal (LP) shunting operation is useful for idiopathic normal pressure hydrocephalus ? Q-space measurement may be a biomarker for the effect of the LP shunt procedure12.
Massimo?Imbriaco Teresa?Pellegrino Valentina?Piscopo Mario?Petretta Andrea?Ponsiglione Carmela?Nappi Marta?Puglia Serena?Dell’Aversana Eleonora?Riccio Letizia?Spinelli Antonio?Pisani Alberto?Cuocolo
Purpose
Cardiac sympathetic denervation may be detectable in patients with Anderson-Fabry disease (AFD), suggesting its usefulness for early detection of the disease. However, the relationship between sympathetic neuronal damage measured by 123I–metaiodobenzylguanidine (MIBG) imaging with myocardial fibrosis on cardiac magnetic resonance (CMR) is still unclear.Methods
Cardiac sympathetic innervation was assessed by 123I–MIBG single-photon emission computed tomography (SPECT) in 25 patients with genetically proved AFD. Within one month from MIBG imaging, all patients underwent contrast-enhanced CMR. MIBG defect size and fibrosis size on CMR were measured for the left ventricle (LV) and expressed as %LV.Results
Patients were divided into three groups according to MIBG and CMR findings: (1) matched normal, without MIBG defects and without fibrosis on CMR (n = 10); (2) unmatched, with MIBG defect but without fibrosis (n = 5); and (3) matched abnormal, with MIBG defect and fibrosis (n = 10). The three groups did not differ with respect to age, gender, α-galactosidase, proteinuria, glomerular filtration rate, and troponin I, while New York Heart Association class (p = 0.008), LV hypertrophy (p = 0.05), and enzyme replacement therapy (p = 0.02) were different among groups. Although in patients with matched abnormal findings, there was a significant correlation between MIBG defect size and area of fibrosis at CMR (r2 = 0.98, p < 0.001), MIBG defect size was larger than fibrosis size (26 ± 23 vs. 18 ± 13%LV, p = 0.02).Conclusion
Sympathetic neuronal damage is frequent in AFD patients, and it may precede myocardial damage, such as fibrosis. Thus, 123I–MIBG imaging can be considered a challenging technique for early detection of cardiac involvement in AFD.13.
Purpose
To investigate the prognostic value of posttreatment 18F-FDG PET/CT in patients with locally advanced cervical cancer (LACC) treated with concomitant chemoradiation therapy (CCRT). The secondary aim was to assess the possible role of intensity-based and volume-based PET parameters including SUVmax, SUVmean, MTV and TLG, and clinical parameters including age, pathology, FIGO stage and nodal involvement as factors predicting response to treatment.Methods
This retrospective study included 82 patients affected by LACC treated with CCRT. All patients underwent 18F-FDG PET/CT both before and after treatment. The posttreatment PET/CT scans were used to classify patients as complete metabolic responders (CMR) or non-complete metabolic responders (N-CMR) according to the EORTC criteria. Kaplan-Meier analysis was used to evaluate differences in overall survival (OS) between the CMR and N-CMR groups. Student’s t test, Pearson’s chi-squared test and logistic regression were used to investigate the possible value of PET and clinical parameters as predictors of metabolic response to therapy.Results
KaplanMeier analysis showed a highly significant difference in OS between the CMR and N-CMR groups (log-rank test p?<?0.0001). Significant independent predictors of response to therapy were MTV (p?=?0.019, odds ratio?=?1.015, 95% CI?=?1.002–1.028, Nagelkerke R2?=?0.110), TLG (p?=?0.045, odds ratio?=?1.001, 95% CI?=?1.000–1.002, Nagelkerke R2?=?0.081) and nodal involvement (p?=?0.088, odds ratio?=?2.361, 95% CI?=?0.879–6.343, Nagelkerke R2?=?0.051).Conclusion
18F-FDG PET/CT-based response assessment using the EORTC criteria reliably predicts OS in LACC patients treated with CCRT. In our cohort of patients, pretreatment MTV and TLG and nodal involvement were predictors of response to therapy. MTV was the best predictor of response. However, its additional risk value seems to be low (MTV odds ratio?=?1.015).14.
Bin Xu Guoping Jiang Jingjing Ye Jin He Wangfang Xie 《Japanese journal of radiology》2016,34(11):738-746
Purpose
To evaluate the renal cortex stiffness in children with glomerular disease by shear wave based elastography point quantification (ElastPQ), and to investigate the association between shear wave velocity (SWV) in the renal cortex and age in normal children, and the inter-gender differences.Materials and methods
One hundred and five children who were pathologically confirmed with glomerular diseases were selected as the disease group. Meanwhile, 120 healthy children were selected as the control group. Effective values were measured 5 times at the same kidney sites on each side.Results
Comparisons of SWV measurements between left and right kidneys in the disease and control groups all showed significant differences (left kidney t = 6.896, P = 0.004; right kidney t = 7.415, P = 0.001). In the control group, left and right kidney SWV measurements were all positively correlated with age (left kidney r = 0.792, P = 0.003; right kidney r = 0.794, P = 0.004). Moreover, inter-gender difference was present in the right kidney measurements.Conclusions
ElastPQ technology has certain advantages in predicting pediatric glomerular disease compared to conventional ultrasound. ElastPQ technology contributes to the early diagnosis of the disease.15.
Objectives
To evaluate the diagnostic value of delayed contrast-enhanced computed tomography (DE-CT) for cardiac sarcoidosis (CS) in patients with or without implantable devices, including a quantitative comparison with late gadolinium enhancement cardiac magnetic resonance (LGE-CMR).Methods
Twenty-four patients (mean age, 64?±?9 years; 17 women) with known or suspected CS underwent retrospective electrocardiogram-gated DE-CT at 80 kV with knowledge-based iterative model reconstruction. Fourteen patients without implantable devices also underwent LGE-CMR, while ten with pacemakers or implantable cardioverter-defibrillators did not. The presence of hyperenhanced myocardium was assessed visually and quantitatively using a 5-standard deviation threshold above the mean of remote myocardium.Results
Inter-observer agreement for visual detection of hyperenhanced segments on DE-CT was excellent in patients with implantable devices and in those without (κ?=?0.91 and κ?=?0.94, respectively). Comparisons of the percent area of hyperenhanced myocardium between DE-CT and LGE-CMR on both per-patient and per-segment analyses showed good correlations (r?=?0.96 and r?=?0.83, respectively; p?<?0.001). The sensitivity and specificity of DE-CT for the diagnosis of CS were 94% and 33%.Conclusions
The extent of hyperenhanced lesion with DE-CT showed good agreement with LGE-CMR results. DE-CT showed high sensitivity for detecting CS and may be useful particularly in patients with contraindications to CMR.Key Points
? Delayed contrast-enhanced CT (DE-CT) can be applied to patients with implantable devices. ? DE-CT can detect cardiac sarcoidosis (CS) lesions similarly to cardiac MRI. ? DE-CT shows high sensitivity for detecting CS. ? DE-CT may be useful particularly in patients with contraindications to cardiac MRI.16.
Objectives
The blind portal vein puncture remains the most challenging step during transjugular intrahepatic portosystemic shunt (TIPS) creation. We performed a prospective randomised clinical trial to compare three-dimensional (3D) roadmap with CO2 wedged hepatic vein portography for portal vein puncture guidance.Methods
Between March 2017 and May 2017, 30 patients were enrolled and randomly allocated to the study group (3D roadmap) or the control group (CO2 wedged hepatic vein portography).Results
Technical success of TIPS procedures was achieved in all 30 patients. The mean number of needle passes was significantly lower in the study group (2.0 ± 1.0) compared to the control group (3.7 ± 2.5; p = 0.021). A total of six (40%) patients in the study group and three (20%) in the control group required only one puncture for the establishment of TIPS. There were no significant differences in total fluoroscopy time (p = 0.905), total procedure time (p = 0.199) and dose-area product (p = 0.870) between the two groups.Conclusions
3D roadmap is a safe and technically feasible means for portal vein puncture guidance during TIPS creation, equivalent in efficacy to CO2 wedged hepatic vein portography. This technique could reduce the number of needle passes, thereby simplifying the TIPS procedure.Key Points
? 3D roadmap can be used to guide portal vein puncture. ? Compared with CO 2 venography, 3D roadmap reduced the number of needle passes. ? 3D roadmap has a potential to simplify the TIPS procedure.17.
Takayuki Katsuura Kazuhiro Kitajima Masayuki Fujiwara Tomonori Terada Nobuhiro Uwa Kazuma Noguchi Hiroshi Doi Yukihisa Tamaki Rika Yoshida Tatsuya Tsuchitani Masahiro Fujita Koichiro Yamakado 《Annals of nuclear medicine》2018,32(7):453-462
Purpose
To evaluate therapeutic response to chemoradiotherapy and prediction of recurrence and death in patients with head and neck squamous cell carcinoma (HNSCC) using Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST).Materials and methods
Forty-two patients (mean 63.4, range 20–79 years) with nasopharyngeal (n?=?10), oropharyngeal (n?=?13), hypopharyngeal (n?=?11), or laryngeal (n?=?8) cancer underwent fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) before and approximately 3 months (mean 95.0, range 70–119 days) after undergoing concurrent chemoradiotherapy. The effect of PERCIST regarding progression-free survival (PFS) and overall survival (OS) was examined using log-rank and Cox methods.Results
Complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), and progressive metabolic disease shown by PERCIST were seen in 30 (71.4%), 9 (21.4%), 3 (7.1%), and 0 patients, respectively. Fourteen (33.3%) developed recurrent disease (median follow-up 27.2, range 8.7–123.1 months) and 9 (21.4%) died (median follow-up 43.6, range 9.6–132.6 months). Furthermore, 4 (13.3%) of 30 patients with CMR developed recurrence, while 7 (77.8%) of 9 with PMR and all 3 (100%) with SMD developed recurrence. Two (6.7%) of 30 patients with CMR, 4 (44.4%) of 9 with PMR, and all 3 (100%) with SMD died. Patients who achieved CMR showed significantly longer PFS and OS as compared to those who did not (PMR and SMD) (both, p?<?0.0001).Conclusion
PERCIST is useful for evaluating therapeutic response to chemoradiotherapy and predicting recurrence and death in HNSCC patients.18.
Riccardo Faletti Marco Gatti Ilaria Baralis Laura Bergamasco Rodolfo Bonamini Francesca Ferroni Massimo Imazio Silvia Stola Fiorenzo Gaita Paolo Fonio 《La Radiologia medica》2017,122(4):273-279
Aims
To analyse the clinical and magnetic resonance evolution of myocarditis in patients with an “infarct-like” presentation pattern.Methods
The study is a retrospective analysis of 52 patients with clinical diagnosis of “infarct-like” myocarditis confirmed by CMR as acute myocarditis according to Lake Louise criteria and 6 months follow-up. The CMR protocol included T2-weighted (oedema), early (hyperaemia) and late (fibrosis/necrosis) gadolinium enhancement sequences, according to Lake Louise criteria. Clinical and radiological follow-up by CMR was performed after a median time interval of 6 months (interquartile range 5–8). Quantitative outcomes were checked for normality and compared with the non-parametric Wilcoxon’s test for matched data.Results
At the clinical follow-up all patients were free of symptoms and reported no cardiac complications. The CMR follow-up evidenced a significant increase of the ejection fraction (from 53 ± 6 to 55 ± 4%, p = 0.03), a decrease of the ventricular mass [from 67.0 (58.8–79.0) to 61.0 (54.0–67.0), p < 0.0001] without significant modification of the cardiac volume index (p = 0.26). No patient had residual oedema or capillary leakage: the T2 ratio decreased from 3.94 (3.00–4.86) to 0.98 (0.75–1.17) with p < 0.0001 and the Early gadolinium enhancement (EGE) ratio from 5.7 (4.8–6.5) to 2.9 (2.4–3.2) with p < 0.0001. Late gadolinium enhancement (LGE) persisted over the course of the follow-up in 48/52 patients, but with a significant reduction in every patient (LGE % from 34.3 ± 9.1 to 19.4 ± 6.6%; p < 0.0001).Conclusion
Patients diagnosed with “infarct-like” myocarditis, according to both clinical and CMR examinations may look forward to a positive evolution with a good prognosis.19.
Barbara?Geeroms Wim?Laleman Annouschka?Laenen Sam?Heye Chris?Verslype Schalk?van der?Merwe Frederik?Nevens Geert?Maleux
Purpose
To retrospectively analyse long-term patency and overall survival of cirrhotic patients treated with TIPSS using e-PTFE-covered stents. Additionally, prognostic factors for better patency and survival were analysed.Materials and methods
Two hundred and eighty-five consecutive cirrhotic patients with severe portal hypertension-related symptoms were included. Follow-up, including clinical assessment and duplex ultrasound, was analysed up to end of study, patient’s death, liver transplantation or TIPSS-reduction. Patency rates and overall survival were estimated by the Kaplan-Meier method; potential differences in outcome between subgroups were calculated using the Pepe and Mori test.Results
The 1-, 2- and 5-year primary patencies were 91.5 %, 89.2 % and 86.2 %, respectively, with no new shunt dysfunctions after 5 years’ follow-up. TIPSS revision was performed more often in ascites patients (P?=?0.02). The 1-, 4- and 10-year survival rates were 69.2 %, 52.1 % and 30.7 %, respectively. Survival was higher in Child-Pugh class A-B (P?=?0.04), in the recurrent bleeding group (P?=?0.008) and in patients with underlying alcoholic cirrhosis (P?=?0.01).Conclusion
Long term, primary patency of e-PTFE-covered TIPSS stents remains very high (>80 %); shunt revision was required more frequently in ascites patients. Overall survival was better in Child-Pugh A-B patients with recurrent variceal bleeding and alcoholic liver cirrhosis.Keypoints
? Long-term primary patency rate of e-PTFE-covered TIPSS stents remains very high. ? No new shunt dysfunction was found after 5 years of follow-up. ? Shunt revision was required more frequently in ascites patients. ? Four and 10 years’ overall survival was 50 and 30 %, respectively.20.
Tianyue Wang Shumei Li Guihua Jiang Chulan Lin Meng Li Xiaofen Ma Wenfeng Zhan Jin Fang Liming Li Cheng Li Junzhang Tian 《European radiology》2016,26(5):1292-1300