Prevalence of left atrial appendage pseudothrombus filling defects in patients with atrial fibrillation undergoing coronary computed tomography angiography

Background

Previous reports have shown that computed tomography (CT) is a useful, noninvasive test for detecting atrial thrombi. However, blood stasis in the left atrial appendage (LAA) of patients with atrial fibrillation (AF) may be a common cause for false-positive results.

Objectives

We retrospectively evaluated the prevalence of filling defects that may simulate thrombus in the LAA of patients with AF during routine coronary CT angiography (CTA).

Methods

The LAA of 7 patients with AF was studied for the presence of filling defects and compared with 250 healthy persons. LAA volume in the patients with AF was measured at 10 different cardiac phases and compared with 30 healthy patients.

Results

Of the 7 patients with AF studied with CTA, 5 were positive for LAA filling defects. Follow-up imaging studies, including transesophageal echocardiogram, contrast-enhanced magnetic resonance angiography, or delayed-CT, were negative for LAA thrombus. Of 250 patients without AF, CTA showed no evidence of LAA filling defects. Patients with AF had significantly larger LAA volumes at all cardiac phases measured compared with patients without AF (15.2 ± 6.93 mL compared with 6.85 ± 3.01 mL at atrial contraction [P = 0.0187], 17.4 ± 7.76 mL compared with 9.46 ± 3.43 mL at ventricular systole [P = 0.0351], and 14.5 ± 5.87 mL compared with 8.48 ± 3.10 mL at mid-diastole [P = 0.0341]). Compared with the healthy persons, the patients with AF showed reduced percentages of change in LAA volume when the atrial contraction phase was compared with other phases: 44.0% ± 25.6% compared with 16.5% ± 12.2% compared with ventricular systole (P = 0.0004) and 29.5% ± 23.7% compared with −1.63% ± 8.84% at mid-diastole (P < 0.0001).

Conclusions

Pseudothrombus filling defects are common in the LAA of patients with AF undergoing coronary CTA and should not be mistaken for real thrombus.     

Effects of tumor necrosis factor-α blockade on metabolic syndrome components in psoriasis and psoriatic arthritis and additional lessons learned from rheumatoid arthritis

Psoriasis (PsO) and psoriatic arthritis (PsA) are chronic T cell-mediated inflammatory diseases that manifest not only in the skin and joints but also in the form of cardiometabolic disturbances, which include insulin resistance, dyslipidemia, and obesity. Thus, PsO and PsA patients are predisposed to metabolic syndrome (MetS), diabetes, and cardiovascular disease. In recent years, the introduction of targeted therapy in the form of tumor necrosis factor-α (TNF-α) antagonists, such as infliximab, etanercept, and adalimumab has been an important and effective addition to the treatment armamentarium for PsO and PsA. Although TNF-α antagonists have produced promising results clinically in reducing cutaneous and joint manifestations of PsO and PsA, their effects on MetS components in these patients are presently unclear. This review summarizes the current limited evidence on the effects of TNF-α antagonists on MetS components in PsO and PsA patients and extrapolates from related literature in rheumatoid arthritis, which is also a T cell-mediated inflammatory disease, for additional information.     

Enhancements in hepatobiliary imaging: the spectrum of gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid usages in hepatobiliary magnetic resonance imaging

Gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) is a unique hepatocyte-specific contrast agent approved for clinical use in the United States in 2008. Gd-EOB-DTPA-enhanced MR has shown to improve detection and characterization of hepatic lesions. Gd-EOB-DTPA is now being routinely used in daily clinical practice worldwide. Therefore, it is important for radiologists to be familiar with the potential uses and pitfalls of Gd-EOB-DTPA, which extends beyond the assessment of focal hepatic lesions. The purpose of this article is to review the various usages of Gd-EOB-DTPA in hepatobiliary MR imaging.