ASCI 2010 standardized practice protocol for cardiac magnetic resonance imaging: a report of the Asian society of cardiovascular imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group

These practice guidelines are recommended by the Asian Society of Cardiovascular Imaging (ASCI), the sole society in Asia designated for cardiovascular imaging, to provide a framework to healthcare providers for suggested essential elements in cardiac magnetic resonance (CMR) examinations of different disease spectra. The guideline is composed of recommendations on the general technique, acquisition of some basic modules, and protocols on stress tests. The protocols for specific diseases are provided in a table format for quick reference to be easily utilized for everyday clinical CMR.     

Prospective ECG-gated 320 row detector computed tomography: implications for CT angiography and perfusion imaging

Cardiac multidetector computed tomography has evolved from early four detector systems that first demonstrated the feasibility of non-invasive angiography to today’s wide-area detector computed tomography systems, such as 320-row detector computed tomography. As detector arrays have widened, there have been great improvements in image quality that have improved test accuracy. In addition, wider detector arrays have allowed for the application of prospective ECG-gating for CT angiography, although the current 64-row detector systems have some limitations. 320-row detector computed tomography with full cardiac coverage allows for cardiac imaging in a single heart beat. This technology has realized some of the great advantages provided by full cardiac coverage in regards to image quality (elimination of step artifacts and variation in contrast enhancement), patient safety (reductions in overall radiation and contrast dose), and the prospects for combined CT angiography and myocardial perfusion imaging are very promising. We will review the technical aspects of 320-row detector computed tomography and their implications for coronary angiography and perfusion imaging.     

Quantitative analysis of first‐pass contrast‐enhanced myocardial perfusion MRI using a patlak plot method and blood saturation correction

The objectives of this study were to develop a method for quantifying myocardial K₁ and blood flow (MBF) with minimal operator interaction by using a Patlak plot method and to compare the MBF obtained by perfusion MRI with that from coronary sinus blood flow in the resting state. A method that can correct for the nonlinearity of the blood time–signal intensity curve on perfusion MR images was developed. Myocardial perfusion MR images were acquired with a saturation‐recovery balanced turbo field‐echo sequence in 10 patients. Coronary sinus blood flow was determined by phase‐contrast cine MRI, and the average MBF was calculated as coronary sinus blood flow divided by left ventricular (LV) mass obtained by cine MRI. Patlak plot analysis was performed using the saturation‐corrected blood time–signal intensity curve as an input function and the regional myocardial time–signal intensity curve as an output function. The mean MBF obtained by perfusion MRI was 86 ± 25 ml/min/100 g, showing good agreement with MBF calculated from coronary sinus blood flow (89 ± 30 ml/min/100 g, r = 0.74). The mean coefficient of variation for measuring regional MBF in 16 LV myocardial segments was 0.11. The current method using Patlak plot permits quantification of MBF with operator interaction limited to tracing the LV wall contours, registration, and time delays. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

Semi-Quantitative Scoring of Late Gadolinium Enhancement of the Left Ventricle in Patients with Ischemic Cardiomyopathy: Improving Interobserver Reliability and Agreement Using Consensus Guidance from the Asian Society of Cardiovascular Imaging-Practical Tutorial (ASCI-PT) 2020

ObjectiveThis study aimed to evaluate the effect of implementing the consensus statement from the Asian Society of Cardiovascular Imaging-Practical Tutorial 2020 (ASCI-PT 2020) on the reliability of cardiac MR with late gadolinium enhancement (CMR-LGE) myocardial viability scoring between observers in the context of ischemic cardiomyopathy.Materials and MethodsA total of 17 cardiovascular imaging experts from five different countries evaluated CMR obtained in 26 patients (male:female, 23:3; median age [interquartile range], 55.5 years [50–61.8]) with ischemic cardiomyopathy. For LGE scoring, based on the 17 segments, the extent of LGE in each segment was graded using a five-point scoring system ranging from 0 to 4 before and after exposure according to the consensus statement. All scoring was performed via web-based review. Scores for slices, vascular territories, and total scores were obtained as the sum of the relevant segmental scores. Interobserver reliability for segment scores was assessed using Fleiss’ kappa, while the intraclass correlation coefficient (ICC) was used for slice score, vascular territory score, and total score. Inter-observer agreement was assessed using the limits of agreement from the mean (LoA).ResultsInterobserver reliability (Fleiss’ kappa) in each segment ranged 0.242–0.662 before the consensus and increased to 0.301–0.774 after the consensus. The interobserver reliability (ICC) for each slice, each vascular territory, and total score increased after the consensus (slice, 0.728–0.805 and 0.849–0.884; vascular territory, 0.756–0.902 and 0.852–0.941; total score, 0.847 and 0.913, before and after implementing the consensus statement, respectively. Interobserver agreement in scoring also improved with the implementation of the consensus for all slices, vascular territories, and total score. The LoA for the total score narrowed from ± 10.36 points to ± 7.12 points.ConclusionThe interobserver reliability and agreement for CMR-LGE scoring for ischemic cardiomyopathy improved when following guidance from the ASCI-PT 2020 consensus statement.     

Fetal bile acids in congenital biliary atresia —production in the liver and clinical significance

The 1-hydroxy bile acids have been said to be fetal bile acids. These bile acids were evaluated in eight patients with congenital biliary atresia (CBA) using gas chromatography-mass spectrometry. At the time of operation 1,3,7,12-tetrahydroxy-5-cholan-24-oic acid (CA-1-ol) and 1,3,7-trihydroxy-5-cholan-24-oic acid (CDCA-1-ol) were 0.46 ± 34 g/ml and 0.72 ± 0.45 g/ml, respectively, which was significantly higher than in the control group. The percentage CA-1-ol of total bile acids showed a tendency to decrease as age advanced. The grade of hepatic fibrosis ranged from F₂ to F₃ and the values and percentages of CA-1-ol and CDCA-1-ol were relatively higher in F₂ than F₃ patients. The percentage of total bile acids gradually increased in patients without sufficient bile flow but fell sharply after Kasai's procedure in the patients with sufficient bile flow. It appears that fetal bile acids are produced in the livers of CBA patients in the same way as in fetal liver, and that production continues in patients without good bile secretion even after Kasai's procedure. These results suggest that these hydroxylases are reactivated in CBA patients.     

Prospective ECG-gated 320 row detector computed tomography: implications for CT angiography and perfusion imaging

Cardiac multidetector computed tomography has evolved from early four detector systems that first demonstrated the feasibility of non-invasive angiography to today’s wide-area detector computed tomography systems, such as 320-row detector computed tomography. As detector arrays have widened, there have been great improvements in image quality that have improved test accuracy. In addition, wider detector arrays have allowed for the application of prospective ECG-gating for CT angiography, although the current 64-row detector systems have some limitations. 320-row detector computed tomography with full cardiac coverage allows for cardiac imaging in a single heart beat. This technology has realized some of the great advantages provided by full cardiac coverage in regards to image quality (elimination of step artifacts and variation in contrast enhancement), patient safety (reductions in overall radiation and contrast dose), and the prospects for combined CT angiography and myocardial perfusion imaging are very promising. We will review the technical aspects of 320-row detector computed tomography and their implications for coronary angiography and perfusion imaging.     

High Prevalence of Obstructive Sleep Apnea and Its Association with Renal Function among Nondialysis Chronic Kidney Disease Patients in Japan: A Cross-Sectional Study

Summary

Background and objectives

Obstructive sleep apnea (OSA) affects one of five adults in the general population. Although a high prevalence of OSA has been reported among dialysis patients, the association between nondialysis chronic kidney disease (CKD) and OSA has not been fully investigated. This cross-sectional study aimed to investigate the prevalence of OSA among nondialysis CKD patients in Japan and the association between renal function and OSA.

Design, setting, participants, & measurements

Consecutive nondialysis CKD patients hospitalized mainly for CKD educational program, regardless of their sleep complaints, were enrolled. The diagnosis of OSA and its severity were measured using a type 3 portable monitor.

Results

Overall (n = 100, 68.0% male, median age 66.5 years, body mass index [BMI] 23.1 kg/m², estimated GFR [eGFR] 28.5 ml/min per 1.73 m²), 65% were diagnosed as OSA: mild OSA (apnea-hypopnea index [AHI] 5.0 to 14.9) in 32%, moderate OSA (AHI 15.0 to 29.9) in 25%, and severe OSA (AHI ≥ 30.0) in 8%. Multivariate logistic regression analysis revealed that a 10-ml/min per 1.73 m² decrease in eGFR was associated with a 42% increased odds of OSA after adjustment for age, BMI, and diabetes mellitus. Moreover, in a generalized linear model, eGFR was inversely correlated with AHI after adjustment for covariates.

Conclusions

This study demonstrated a high prevalence of OSA among nondialysis CKD patients in Japan and that the increased risk of OSA was significantly associated with decreased GFR among these patients. Further investigations are warranted to determine OSA''s direct influence on cardiovascular disease.     

Utilization of the iPad application: Aid for Decision-making in Occupation Choice

The purpose of the study was to develop and evaluate an iPad (Apple) application, Aid for Decision-making in Occupation Choice (ADOC), so as to promote shared decision-making in an occupation-based goal setting. This application involves the client choosing from 94 illustrations describing daily activities related to the category of "activities and participation". One hundred occupational therapy clients evaluated the ADOC for goal setting; the clients and 37 occupational therapists underwent a survey to determine their perceptions of decision-making in the goal setting. More than 90% of the clients felt that they could give their opinions using the ADOC regarding goal setting. The majority of the occupational therapists (>90%) felt that ADOC would be useful in their clinical practice for setting client goals. The results indicated that ADOC is a useful and acceptable tool for both clients and occupational therapists in shared decision-making in occupation-based goal setting.