Evolving role of multidetector computed tomography in evaluation of arrhythmogenic right ventricular dysplasia/cardiomyopathy

The purpose of this study was to report 1 center's experience with multidetector computed tomography (MDCT) in the evaluation of patients suspected to have arrhythmogenic right ventricular (RV) dysplasia/cardiomyopathy (ARVD/C). RV dilatation/dysfunction is 1 of the most important criteria for establishing the diagnosis of ARVD/C. Cardiac magnetic resonance imaging (MRI) is the most preferred imaging modality for the diagnosis of ARVD/C. However, many patients with suspected ARVD/C have implantable cardioverter-defibrillators, prohibiting the use of MRI. Thirty-one patients (19 men; mean age 41 +/- 12 years) referred for evaluation of known or suspected ARVD/C had a complete reevaluation including contrast-enhanced cardiac MDCT at the center. Two patients underwent both cardiac MRI and MDCT. Seventeen of 31 patients met Task Force criteria for ARVD/C and were confirmed to have ARVD/C. Multidetector computed tomographic images were analyzed for qualitative and quantitative characteristic findings of ARVD/C. Increased RV trabeculation (p <0.001), RV intramyocardial fat (p <0.001), and scalloping (p <0.001) were significantly associated with the final diagnosis of ARVD/C. RV volumes, RV inlet dimensions, and RV outflow tract surface area were increased in patients with ARVD/C compared with patients who did not meet the criteria. RV and left ventricular functional analysis was performed in 2 patients. In conclusion, cardiac MDCT has a strong potential to detect many qualitative and quantitative abnormalities of the right ventricle in patients with ARVD/C. Limitations include implantable cardioverter-defibrillators and motion artifacts, along with well-known radiation and contrast-induced reaction.     

Breast MRI: state of the art

Magnetic resonance imaging (MRI) of the breast has emerged as a useful adjunct in evaluation of breast disease. For the past 25 years its use has been explored extensively in the literature and specific clinical indications have been developed. This review will address the current state of the art of breast MRI, including image acquisition, interpretation, limitations, and current applications. We also will discuss briefly emerging techniques that may further advance the practice of breast MRI evaluation.     

Real‐time single‐heartbeat fast strain‐encoded imaging of right ventricular regional function: Normal versus chronic pulmonary hypertension

Patients with pulmonary hypertension and suspected right ventricular (RV) dysfunction often have dyspnea at rest, making reliable assessment of RV function using traditional breath‐holding methods difficult to perform. Using single‐heartbeat fast strain encoding (Fast‐SENC) imaging, peak systolic RV circumferential and longitudinal strains were measured in 11 healthy volunteers and 11 pulmonary hypertension patients. Fast‐SENC RV longitudinal strain and circumferential strain measurements were compared to conventional SENC and MR tagging, respectively. Fast‐SENC circumferential and longitudinal RV shortening correlated closely with SENC measurements (r = 0.86, r = 0.90, P < 0.001 for all). Circumferential strain, by conventional tagging, showed moderate correlation with Fast‐SENC in pulmonary hypertension patients only (r = 0.5, P = 0.003). A nonuniform pattern of RV circumferential shortening was depicted in both groups. Peak systolic circumferential strain was significantly reduced at the basal RV in pulmonary hypertension patients (?18.06 ± 3.3 versus ?21.9 ± 1.9, P < 0.01) compared to normal individuals, while peak systolic longitudinal strain was significantly reduced at all levels (P < 0.01 for all). Fast‐SENC is a feasible and reliable technique for rapid quantification of RV regional function in a single‐heartbeat acquisition. Information derived from Fast‐SENC allows characterization of RV regional function in normal individuals and in pulmonary hypertension patients. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

CT evaluation following Whipple procedure: potential pitfalls in interpretation.

A series of 41 CT examinations in 14 patients who had undergone a Whipple procedure for pancreatic cancer followed by adjuvant chemotherapy and radiation therapy were reviewed to determine the spectrum of CT findings, as well as to identify potential sources of error in interpretation. Thickening of the wall of the gastric antrum and proximal duodenum from 5 to 10 mm (9 of 14 patients) occurred as early as 1 month after completion of radiotherapy and simulated recurrent tumor. Unopacified anastomotic bowel loops in the porta hepatis in 23 of 41 examinations (56%) also mimicked recurrent tumor or adenopathy. Five of 14 patients showed liver metastases and 4 of 14 had recurrent disease in the pancreatic bed. Pneumobilia (33 of 41 examinations) was a frequent normal finding.