Evaluation of right ventricular volume and mass using retrospective ECG-gated cardiac multidetector computed tomography: comparison with first-pass radionuclide angiography

The purposes of this study were to evaluate the right ventricular (RV) volume and mass using cardiac multidetector computed tomography (MDCT) and to compare the cardiac MDCT results with those from first-pass radionuclide angiography (FPRA). Twenty patients were evaluated for the RV end-diastolic volume (RVEDV), the RV end-systolic volume (RVESV), the RV ejection fraction (RVEF), and RV mass using cardiac MDCT with a two-phase reconstruction method based on ECG. The end-diastolic phase was reconstructed at the starting point of the QRS complex on ECG, and the end-systolic phase was reconstructed at the halfway point of the ascending T-wave on ECG. The RV mass was measured for the end-systole. The RVEF was also obtained by FPRA. The mean RVEF (47±7%) measured by cardiac MDCT was well correlated with that (44±6%) measured by FPRA (r=0.854). A significant difference in the mean RVEF was found between cardiac MDCT and FPRA (p=0.001), with an overestimation of 2.9±5.3% by cardiac MDCT versus FPRA. The interobserver variability was 4.4% for the RVEDV, 6.8% for the RVESV, and 7.9% for the RV mass, respectively. Cardiac MDCT is relatively simple and allows the RV volume and mass to be assessed, and the RVEF obtained by cardiac MDCT correlates well with that measured by FPRA.     

Evaluation of spinal trauma by multi detector computed tomography and magnetic resonance imaging

Aim of work

The aim of this work is to assess the role of multi-detector computed tomography (MDCT) and magnetic resonance imaging (MRI) in evaluation of spinal trauma.

Patients and methods

Between January 2013 and April 2014, 98 patients (78 males and 20 females) with spinal injuries were investigated by MDCT and MRI. Assessment of the radiological findings of spinal injury was performed and the following were investigated: vertebral compression fractures, bursts and dislocations, posterior element fractures, C1 and C2 lesions, vertebral listhesis, bone marrow edema, spinal canal compression, disk herniation, extradural hematoma, spinal cord contusions, spinal cord swelling and posterior ligamentous complex injuries.

Result

A total of 271 lesions were diagnosed as follows: 217 lesions were diagnosed using MRI alone, 1 54 lesions were diagnosed using MDCT alone and 100 lesions were diagnosed using MRI and MDCT conjointly. By using MRI 117 more lesions were detected than using MDCT. MRI was significantly superior to MDCT in the diagnosis of bone marrow edema, posterior ligamentous complex injuries, disk herniations, spinal canal compressions, and spinal cord contusions and edema. In cervical spine injuries, MRI was useful for the evaluation of the supporting ligaments and the spinal cord after the patient has been stabilized. The average times required to perform CT and MRI were 1.38 ± 19.83 and 2.00 ± 19.58 days, respectively; this difference was significant (p?0.05) according to the Mann–Whitney test.

Conclusion

MRI was significantly superior to MDCT in the diagnosis of bone marrow edema, posterior ligamentous complex injuries, disk herniations, spinal canal compressions, and spinal cord contusions and edema. In cervical spine injuries, MRI was useful for the evaluation of the supporting ligaments and the spinal cord after the patient has been stabilized.MDCT and MRI are complementary to each other in evaluation of spine injuries.     

Assessment of regional left ventricular function with multidetector-row computed tomography versus magnetic resonance imaging

This study compares quantitative and qualitative information on global and regional left ventricular (LV) function obtained with multidetector-row computed tomography (MDCT) with that obtained with magnetic resonance imaging (MRI) in patients with a high prevalence of LV wall motion abnormalities. Thirty patients (19 male, 63.7+/-15.1 years) with myocardial infarction (n=12), coronary artery disease (n=9), arrhythmogenic right ventricular cardiomyopathy (n=6), and dilation cardiomyopathy (n=3) were included. Segmental LV wall motion (LV-WM) was assessed using a 4-point scale. Wall thickness measurements were calculated in diastolic and systolic short axis images. Two hundred and fifty-two out of 266 (94.7%) normal and 189 out of 214 (88.3%) segments with decreased wall motion were correctly identified by MDCT, yielding a sensitivity of 88% and specificity of 95% for identification of wall motion abnormalities. LV-WM scores were identical in 86.7% of 480 segments (kappa=0.809). MDCT had a tendency to underestimate the degree of wall motion impairment. Interobserver agreement was lower in MDCT (66.5%) than in MRI (89.1%; p<0.01). Normokinetic segments are reliably identified with MDCT. Sensitivity for detection and accurate classification of LV wall motion abnormalities need to be improved. Better temporal resolution of the CT system seems to be the most important factor for enhancing MDCT performance.     

Automated vs. manual assessment of left ventricular function in cardiac multidetector row computed tomography: comparison with magnetic resonance imaging

We compared semiautomatic contour detection and manual contour tracing in cardiac multidetector row computed tomography (MDCT) with magnetic resonance imaging (MRI) for calculation of left-ventricular (LV) volumes. The study included 30 patients who underwent contrast-enhanced cardiac MDCT and cardiac cine-MRI. Were calculated 8 mm short-axis slices from MDCT data using three-dimensional multiphase image reconstruction. LV volumes including peak ejection rate and peak filling rate were calculated from manually and semiautomatically determined contours. Results were compared to those from cine-MRI with manually drawn contours as the standard of reference. We found good agreement for the LV volumes, with an ejection fraction of 47.1±9.4% for manually drawn contours, 47.9±9.9% for semiautomatically detected contours on MDCT, and 48.0±10.2% for MRI. Except for peak-filling rate analysis of variance revealed no difference between any of these techniques. Bland-Altman plots and Lin’s concordance correlation coefficient showed best agreement between MRI and manual contour tracing in MDCT. Calculation of LV volumes using either semiautomatic or manual contour tracing in cardiac MDCT is therefore feasible when compared to MRI. Automated contour detection needs to be improved to equal manual contour tracing.     

Dumbbell-shaped thoracic hibernoma: computed tomography and magnetic resonance imaging findings

Hibernoma is an uncommon, benign soft tissue tumor that arises in brown adipose tissue. The computed tomography (CT) and magnetic resonance imaging (MRI) findings of hibernomas are similar to those of well-differentiated liposarcoma or angiolipoma. We report the unique appearance of a rare thoracic wall hibernoma, which appeared as a dumbbell-shaped lipomatous tumor across an intercostal region. A dynamic contrast-enhanced study on MRI revealed early enhancement, which corresponded to the branching low-signal intensity on T2-weighted images of the mass.     

Primary heart angiosarcoma detected by computed tomography and magnetic resonance imaging

We report a case of primary heart angiosarcoma and its appearance on plain and post-contrast computed tomography and magnetic resonance imaging in 21-year-old woman. The tumour involved the right atrium, expanded superiorly among the superior vena cava, ascending aorta and innominate vein, and infiltrated the pericardium. The tumour was disseminated into lungs, liver and bones at the time of its clinical presentation. Received 24 January 1997; Revision received 13 March 1997; Accepted 28 April 1997     

Assessment of left ventricular myocardial function using 16-slice multidetector-row computed tomography: comparison with magnetic resonance imaging and echocardiography

Objective To assess functional parameters using multidetector-row computed tomography (MDCT) and echocardiography and to compare the results with magnetic resonance imaging (MRI). Materials and methods End-diastolic-volume (EDV), end-systolic-volume (ESV), stroke-volume (SV), ejection-fraction (EF), and myocardial mass (MM) were calculated based on CT data sets from 52 patients. Echocardiography was performed in 24 of the 52 patients. The results from MDCT and echocardiography were compared with MRI. Results A strong correlation between MDCT and MRI (r=0.66–0.90) was found for all parameters. Echocardiography revealed a low or moderate correlation (0.05–0.59). Compared to MRI the average differences with MDCT were for EDV 15.1 ml, ESV 10.6 ml, SV 4.5 ml, EF 1.8%, and MM 8.2 g, for EDV determined by echocardiography 36.2 ml, ESV 6.8 ml, and EF 13.9%. Bland-Altman analysis revealed acceptable limits of agreement between MRI and MDCT. Conclusions MDCT enables reliable quantification of left ventricular function. Echocardiography was found to have only a moderate agreement of functional parameters with MRI.     

Non-cardiac findings on coronary computed tomography and magnetic resonance imaging

Both multislice computed tomography (CT) and magnetic resonance imaging (MRI) are emerging as methods to detect coronary artery stenoses and assess cardiac function and morphology. Non-cardiac structures are also amenable to assessment by these non-invasive tests. We investigated the rate of significant and insignificant non-cardiac findings using CT and MRI. A total of 108 consecutive patients suspected of having coronary artery disease and without contraindications to CT and MRI were included in this study. Significant non-cardiac findings were defined as findings that required additional clinical or radiological follow-up. CT and MR images were read independently in a blinded fashion. CT yielded five significant non-cardiac findings in five patients (5%). These included a pulmonary embolism, large pleural effusions, sarcoid, a large hiatal hernia, and a pulmonary nodule (>1.0 cm). Two of these significant non-cardiac findings were also seen on MRI (pleural effusions and sarcoid, 2%). Insignificant non-cardiac findings were more frequent than significant findings on both CT (n = 11, 10%) and MRI (n = 7, 6%). Incidental non-cardiac findings on CT and MRI of the coronary arteries are common, which is why images should be analyzed by radiologists to ensure that important findings are not missed and unnecessary follow-up examinations are avoided.     

Detection and characterization of liver metastases: 16--slice multidetector computed tomography versus superparamagnetic iron oxide-enhanced magnetic resonance imaging

The aim of our study was to compare the diagnostic performance of 16--slice multidetector computed tomography with that of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging in the detection of small hepatic metastases and in the differentiation of hepatic metastases from cysts. Twenty-three patients with 55 liver metastases and 14 liver cysts underwent SPIO-enhanced MR imaging and multiphasic CT using 16-MDCT. Two observers independently analyzed each image, in random order. Sensitivity and diagnostic accuracy for lesion detection and differentiation as metastases or cysts for MDCT and SPIO-enhanced MR imaging were calculated using receiver operating characteristic analysis. For all observers, the Az values of SPIO-enhanced MR imaging for lesion detection and differentiation of liver metastases from cysts (mean 0.955, 0.999) were higher than those of MDCT (mean 0.925, 0.982), but not statistically significantly so (P>0.05). Sensitivity of SPIO-enhanced MR imaging with regard to the detection of liver metastases (mean 94.5%) was significantly higher than that of MDCT (mean 80.0%) (P<0.05). SPIO-enhanced MR imaging and 16-MDCT showed similar diagnostic accuracies for detection and differentiation of liver metastases from cysts, but sensitivity of SPIO-enhanced imaging in the detection of liver metastases was superior to that of 16-MDCT.     

Pancreatitis: computed tomography and magnetic resonance imaging

The value of CT in management of severe acute pancreatitis is well established. Some, but not all, experimental studies suggest a detrimental effect of intravenous iodinated contrast agents in acute pancreatitis, but although initial clinical data tends to support this, the positive advantages of enhanced CT outweigh the possible risks. Magnetic resonance imaging has been shown to be as effective as CT in demonstrating the presence and extent of pancreatic necrosis and fluid collections, and probably superior in indicating the suitability of such collections for percutaneous drainage. Image-guided intervention remains a key approach in the management of severely ill patients, and the indications, techniques and results of radiological intervention are reviewed herein. Both CT and MRI can be used to diagnose advanced chronic pancreatitis, with the recent addition of MRCP as a viable alternative to diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Both MRCP and CT/MR imaging of the pancreatic parenchyma still have limitations in the recognition of the earliest changes of chronic pancreatitis – for which ERCP and tests of pancreatic function remain more sensitive – but the clinical significance of these minor changes remains contentious. Received: 12 February 1998; Revision received: 17 June 1998; Accepted: 22 June 1998     

Evaluation of primary adrenal insufficiency secondary to tuberculous adrenalitis with computed tomography and magnetic resonance imaging: Current status

As one kind of infectious diseases of adrenal gland, adrenal tuberculosis can result in a life-threatening disorder which is called primary adrenal insufficiency (PAI) due to the destruction of adrenal cortex. Computed tomography (CT) and magnetic resonance imaging (MRI) play significant roles in the diagnosis of this etiology of PAI based on the CT and MRI appearances of the adrenal lesions. In this mini-review, we intend to study the CT and MRI features of adrenal tuberculosis, which could be helpful to both endocrinologist and radiologist to establish a definitive diagnosis for adrenal tuberculosis resulting in PAI.     

Semi-quantitative assessment of right ventricular function in comparison to a 3D volumetric approach: A cardiovascular magnetic resonance study

Right ventricular (RV) volume measurements with cardiovascular magnetic resonance (CMR) is considered the gold standard, but acquisition and analysis remain time-consuming. The aim of our study was therefore to investigate the accuracy and performance of a semi-quantitative assessment of RV function in CMR, compared to the standard quantitative approach. Seventy-five subjects with pulmonary hypertension (15), anterior myocardial infarction (15), inferior myocardial infarction (15), Brugada syndrome (15) and normal subjects (15) underwent cine CMR. RV end-systolic and end-diastolic volumes were determined to calculate RV ejection fraction (EF). Four-chamber cine images were used to measure tricuspid annular plane systolic excursion (TAPSE). RV fractional shortening (RVFS) was calculated by dividing TAPSE by the RV end-diastolic length. RV EF correlated significantly with TAPSE (r = 0.62, p < 0.01) and RVFS (r = 0.67, p < 0.01). Sensitivity to predict RV dysfunction was comparable between TAPSE and RVFS, with higher specificity for RVFS, but comparable areas under the ROC curve. Intra- and inter-observer variability of RV EF was better than TAPSE (3%/4% versus 7%/15%, respectively). For routine screening in clinical practice, TAPSE and RVFS seem reliable and easy methods to identify patients with RV dysfunction. The 3D volumetric approach is preferred to assess RV function for research purposes or to evaluate treatment response.     

Hepatocellular adenoma: findings at state-of-the-art magnetic resonance imaging, ultrasound, computed tomography and pathologic analysis

The purpose of this paper is to describe the most recent concepts and pertinent findings of hepatocellular adenomas, including clinical presentation, gross pathology and histology, pathogenesis and transformation into hepatocellular carcinoma (HCC), and imaging findings at ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging.     

Evaluation of global left ventricular myocardial function with electrocardiogram-gated multidetector computed tomography: comparison with magnetic resonance imaging

RATIONALE AND OBJECTIVES: Electrocardiogram-gated 3D volume data from multidetector computed tomography coronary angiography (MDCT-CA) enable image reconstruction in any phase of the cardiac cycle. The objective was to determine left ventricular (LV) function parameters by MDCT in comparison to cine magnetic resonance imaging (MRI). METHOD: Thirty patients with known or suspected coronary artery disease (CAD) underwent MDCT-CA. From multiplanar reformations in short axis orientation end-diastolic and end-systolic LV volumes (LVEDV, LVESV) were determined to calculate LV stroke volume and ejection fraction (LVSV, LVEF) and compared with MRI measurements. RESULTS: LVEDV (147 +/- 27 mL) and LVESV (65 +/- 22 mL) determined by MDCT correlated well to the respective MRI measurements (LVEDV 133 +/- 27 mL, r = 0.80, P < 0.001; LVESV 48 +/- 19 mL, r = 0.89, P < 0.001). LVSV (MDCT 82 +/- 15 mL; MRI 85 +/- 17 mL; r = 0.77, P < 0.001) and LVEF (MDCT 56 +/- 9%; MRI 65 +/- 8%; r = 0.85, P < 0.001) showed a good correlation as well. LVEF was significantly underestimated by MDCT (-8.5 +/- 4.7%, P < 0.001). CONCLUSIONS: Initial experience in patients evaluated for CAD shows that spiral MDCT studies may provide LV functional data in good correlation to Cine MRI.     

Evaluation of a semiautomatic software tool for left ventricular function analysis with 16-slice computed tomography

The purpose of the study was to evaluate a semiautomatic analysis tool for assessing global left ventricular myocardial function with multislice computed tomography (MSCT). We examined 33 patients with MSCT using 16×0.5 mm detector collimation and magnetic resonance imaging (MRI) on a 1.5-T scanner. MSCT data were analyzed using semiautomatic volumetric analysis software (ANET, CSCF-001A, Toshiba). This software tool automatically creates endo- and epicardial contours that can be manually corrected on all short-axis slices at all reconstructed time points within the cardiac cycle, based on a contour-detection and density-threshold algorithm. All global left ventricular function parameters assessed with the semiautomatic MSCT software were highly correlated with the results of MRI. Bland-Altman analysis showed minor systematic overestimation of end-diastolic (10.7 ml) and end-systolic volumes (5.6 ml) and underestimation of ejection fraction (2.1%) with MSCT as compared with MRI. The post-processing time was moderately but significantly longer with the MSCT software (15.9±2.8 min) than necessary for MRI (14.0±2.5 min, P<0.01), mainly as a result of the longer time required for uploading of the MSCT datasets, which were on average 54 times larger (1.3 GByte). In conclusion, it appears feasible to accurately assess global left ventricular function with MSCT in a reasonable post-processing time using a semiautomatic software tool.     

Quantitative assessment of regional left ventricular wall thickness and thickening using 16 multidetector-row computed tomography: comparison with cine magnetic resonance imaging

Purpose The purpose of this study was to investigate the feasibility of retrospective electrocardiography-gated multidetector-row computed tomography (MDCT) in the assessment left ventricular (LV) wall thickness and thickening and to test its validity compared to cine magnetic resonance imaging (MRI) as a standard of reference. Materials and methods We enrolled 19 patients who underwent both cardiac MDCT and cine MRI. End-diastolic wall thickness (EDWT) and end-systolic wall thickness (ESWT) were measured in 16 myocardial segments. Percent systolic wall thickening (%SWT) was generated from the EDWT and ESWT. Nondiagnostic myocardial segments were excluded. Correlation and agreement between MDCT and cine MRI were analyzed. Results Segmental assessability values were 86.2% (262/304) and 92.1% (280/304) for MDCT and cine MRI, respectively. In assessable segments by both modalities (80.9%, 246/304), a significant correlation between MDCT and MRI was found (r = 0.89, 0.85, and 0.61, for EDWT, ESWT, and %SWT, respectively; all P < 0.05). Mean EDWT and ESWT values by MDCT were slightly lower than those by cine MRI (9.8 ± 3.6 vs. 10.0 ± 3.7 mm and 13.8 ± 4.4 vs. 14.1 ± 4.3 mm, respectively; both P < 0.01). Bland-Altman analysis revealed acceptable limits of agreement between MDCT and Cine MRI. Conclusion MDCT is a feasible method to assess regional LV wall thickness and systolic thickening. Part of this study was presented at the 1st Annual Meeting of the Society of Cardiovascular CT in cooperation with the 7th International Conference on Cardiac CT, Washington, DC, July 13–16, 2006     

Quantification of global left ventricular function: comparison of multidetector computed tomography and magnetic resonance imaging. a meta-analysis and review of the current literature

Cardiac morbidity and mortality are closely related to cardiac volumes and global left ventricular (LV) function, expressed as left ventricular ejection fraction. Accurate assessment of these parameters is required for the prediction of prognosis in individual patients as well as in entire cohorts. The current standard of reference for left ventricular function is analysis by short-axis magnetic resonance imaging. In recent years, major extensive technological improvements have been achieved in computed tomography. The most marked development has been the introduction of the multidetector CT (MDCT), which has significantly improved temporal and spatial resolutions. In order to assess the current status of MDCT for analysis of LV function, the current available literature on this subject was reviewed. The data presented in this review indicate that the global left ventricular functional parameters measured by contemporary multi-detector row systems combined with adequate reconstruction algorithms and post-processing tools show a narrow diagnostic window and are interchangeable with those obtained by MRI.     

Low-grade fibromyxoid sarcoma of the small bowel mesentery: computed tomography and magnetic resonance imaging findings

Low-grade fibromyxoid sarcoma (LGFMS) is a rare tumor that commonly arises in the lower extremities but rarely in the mesentery. We report computed tomography (CT) and magnetic resonance imaging (MRI) findings of LGFMS of the small bowel mesentery. On CT, the mass was composed of two components. One component, on its right side, appeared to have isointense attenuation relative to muscle, whereas the other component, on its left side, appeared to have low attenuation. On MRI the mass on the right side showed hypointensity similar to muscle on both T1-and T2-weighted images as well as mostly slight enhancement on contrast-enhanced T1-weighted images. On the other hand, the mass on the left side showed relative hypointensity on T1-weighted images and hyperintensity on T2-weighted images as well as intense enhancement on contrast-enhanced T1-weighted images, suggesting that the tumor contained myxoid tissue. The myxoid area of LGFMS may have a tendency to reveal intense enhancement on contrast-enhanced images.     

Sixty-four-slice multidetector computed tomography for preoperative evaluation of left ventricular function and mass in patients with mitral regurgitation: comparison with magnetic resonance imaging and echocardiography

Quantitative values of left ventricular (LV) function and muscle mass in patients with mitral regurgitation are independent predictors of cardiac morbidity and mortality. The aim of this study was to prospectively evaluate whether 64-MDCT can assess the LV function in patients with mitral regurgitation with high accuracy when compared with the MRI and echocardiography results. Fifty-one patients with mitral regurgitation underwent retrospectively ECG-gated 64-MDCT, echocardiography, and MRI for assessing the global ventricular function. End-diastolic and end-systolic volume, stroke volume, ejection fraction, and mass were measured on 64-MDCT and echocardiography, and compared with the results measured on MRI which served as the reference standard. Intertechnique agreement was tested by using Pearson’s correlation and Bland–Altman analyses. No significant differences were revealed in calculated LV function and mass between the 64-MDCT and MRI (paired t test, p = 0.07–0.53). Pearson’s correlation analysis showed the functional parameters and mass correlated closely between the 64-MDCT and MRI (r = 0.89–0.96, p < 0.001). When compared with MRI, echocardiography underestimated the volumetric parameters of LV (paired t test, p = 0.0003–0.004), but significantly overestimated the EF values (p = 0.003), and moderate correlations of functional parameters were obtained (r = 0.78, 0.60, 0.81, and 0.62, respectively). ECG-gated 64-MDCT allows for accurate and reliable assessment of LV function in patients with mitral regurgitation, whereas LV volumes measured by two-dimensional echocardiography were underestimated and the ejection fraction was overestimated when compared with those achieved by using MRI.