Revistas
Revista:
JOURNAL OF MAGNETIC RESONANCE IMAGING
ISSN:
1053-1807
Año:
2023
Vol.:
58
N°:
1
Págs.:
147 - 156
Background In patients with suspected coronary artery disease (CAD), myocardial perfusion is assessed under rest and pharmacological stress to identify ischemia. Splenic switch-off, defined as the stress to rest splenic perfusion attenuation in response to adenosine, has been proposed as an indicator of stress adequacy. Its occurrence has been previously assessed in first-pass perfusion images, but the use of noncontrast techniques would be highly beneficial. Purpose To explore the ability of pseudo-continuous arterial spin labeling (PCASL) to identify splenic switch-off in patients with suspected CAD. Study Type Prospective. Population Five healthy volunteers (age 24.8 +/- 3.8 years) and 32 patients (age 66.4 +/- 8.2 years) with suspected CAD. Field strength/Sequence A 1.5-T/PCASL (spin-echo) and first-pass imaging (gradient-echo). Assessment In healthy subjects, multi-delay PCASL data (500-2000 msec) were acquired to quantify splenic blood flow (SBF) and determine the adequate postlabeling delay (PLD) for single-delay acquisitions (PLD > arterial transit time). In patients, single-delay PCASL (1200 msec) and first-pass perfusion images were acquired under rest and adenosine conditions. PCASL data were used to compute SBF maps and SBF stress-to-rest ratios. Three observers classified patients into "switch-off" and "failed switch-off" groups by visually comparing rest-stress perfusion data acquired with PCASL and first-pass, independently. First-pass categories were used as reference to evaluate the accuracy of quantitative classification. Statistical Tests Wilcoxon signed-rank, Pearson correlation, kappa, percentage agreement, Generalized Linear Mixed Model, Mann-Whitney, Pearson Chi-squared, receiver operating characteristic, area-under-the-curve (AUC) and confusion matrix. Significance: P value < 0.05. Results A total of 27 patients (84.4%) experienced splenic switch-off according to first-pass categories. Comparison of PCASL-derived SBF maps during stress and rest allowed assessment of splenic switch-off, reflected in a reduction of SBF values during stress. SBF stress-to-rest ratios showed a 97% accuracy (sensitivity = 80%, specificity = 100%, AUC = 85.2%). Data Conclusion This study could demonstrate the feasibility of PCASL to identify splenic switch-off during adenosine perfusion MRI, both by qualitative and quantitative assessments. Evidence Level 2 Technical Efficacy 2
Autores:
van Dinther, M. (Autor de correspondencia); Bennett, J.; Thornton, G. D.; et al.
Revista:
CEREBROVASCULAR DISEASES. EXTRA
ISSN:
1664-5456
Año:
2023
Vol.:
13
Págs.:
18 - 32
Introduction: Microvascular rarefaction, the functional reduction in perfused microvessels and structural reduction of microvascular density, seems to be an important mechanism in the pathophysiology of small blood vessel related disorders including vascular cognitive impairment (VCI) due to cerebral small vessel disease and heart failure with preserved ejection fraction (HFpEF). Both diseases share common risk factors including hypertension, diabetes mellitus, obesity, and ageing; in turn, these co-morbidities are associated with microvascular rarefaction. Our consortium aims to investigate novel non-invasive tools to quantify microvascular health and rarefaction in both organs, as well as surrogate biomarkers for cerebral and/or cardiac rarefaction (via sublingual capillary health, vascular density of the retina, and RNA content of circulating extracellular vesicles), and to determine whether microvascular density relates to disease severity.Methods/design: The clinical research program of CRUCIAL consists of four observational cohort studies. We aim to recruit 75 VCI patients, 60 HFpEF patients, 60 patients with severe aortic stenosis (AS) undergoing surgical aortic valve replacement as a pressure overload HFpEF model, and 200 elderly participants with mixed comorbidities to serve as controls. Data collected will include medical history, physical examination, cognitive testing, advanced brain and cardiac MRI, ECG, echocardiography, sublingual capillary health, optical coherence tomography angiography (OCTa), extracellular vesicles RNA analysis and myocardial remodelling-related serum biomarkers. The AS cohort undergoing surgery will also have myocardial biopsy for histological microvascular assessment. Discussion: CRUCIAL will examine the pathophysiological role of microvascular rarefaction in VCI and HFpEF using advanced brain and cardiac MRI techniques. Furthermore, we will investigate surrogate biomarkers for non-invasive, faster, easier, and cheaper assessment of microvascular density since these are more likely to be disseminated into widespread clinical practice. If microvascular rarefaction is an early marker of developing small vessel diseases, then measuring rarefaction may allow pre-clinical diagnosis, with implications for screening, risk stratification, and prevention. Further knowledge of the relevance of microvascular rarefaction and its underlying mechanisms may provide new avenues for research and therapeutic targets.
Revista:
LIVER TRANSPLANTATION
ISSN:
1527-6465
Año:
2023
Vol.:
29
N°:
10
Págs.:
1100 - 1108
To address the feasibility of implementing a lung cancer screening program in liver transplant recipients (LTR) targeted to detect early-stage lung cancer one hundred twenty-four LTR (89% male, 59.8+/-8.8 y old), who entered the lung cancer screening program at our hospital were reviewed. The results of the diagnostic algorithm using low-dose CT and F-18-fluorodeoxyglycose positron emission tomography (FDG-PET) were analyzed. Lung cancer was detected in 12 LTR (9.7%), most of which corresponded to the non-small cell subtype. Two of the 12 lung cancers were detected in the baseline study (prevalence of 1.6%), whereas 10 patients were diagnosed with lung cancer in the follow-up (incidence of 8.1%). Considering all cancers, 10 of 12 (83.3%) were diagnosed at stage I, one cancer was diagnosed at stage IIIA, and another one at stage IV. The sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values of F-18-fluorodeoxyglycose positron emission tomography to detect malignancy in our cohort were 81.8%,100%, 99.3%, 100%, and 99.3%, respectively. A carefully followed multidisciplinary lung cancer screening algorithm in LTR that includes F-18-fluorodeoxyglycose positron emission tomography and low-dose CT allows lung cancer to be diagnosed at an early stage while reducing unnecessary invasive procedures.
Autores:
Barreiro-Pérez, M. (Autor de correspondencia); Cabeza, B.; Calvo, D.; et al.
Revista:
RADIOLOGÍA (ENGLISH ED.)
ISSN:
2173-5107
Año:
2023
Vol.:
76
N°:
3
Págs.:
183 - 196
Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.
Autores:
Barreiro-Pérez, M.; Cabeza, B.; Calvo, D.; et al.
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2023
Vol.:
65
N°:
3
Págs.:
269 - 284
Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool. (c) 2022 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
Revista:
NMR IN BIOMEDICINE
ISSN:
0952-3480
Año:
2023
Vol.:
36
N°:
2
Págs.:
e4832
Monitoring renal allograft function after transplantation is key for the early detection of allograft impairment, which in turn can contribute to preventing the loss of the allograft. Multiparametric renal MRI (mpMRI) is a promising noninvasive technique to assess and characterize renal physiopathology; however, few studies have employed mpMRI in renal allografts with stable function (maintained function over a long time period). The purposes of the current study were to evaluate the reproducibility of mpMRI in transplant patients and to characterize normal values of the measured parameters, and to estimate the labeling efficiency of Pseudo-Continuous Arterial Spin Labeling (PCASL) in the infrarenal aorta using numerical simulations considering experimental measurements of aortic blood flow profiles. The subjects were 20 transplant patients with stable kidney function, maintained over 1 year. The MRI protocol consisted of PCASL, intravoxel incoherent motion, and T1 inversion recovery. Phase contrast was used to measure aortic blood flow. Renal blood flow (RBF), diffusion coefficient (D), pseudo-diffusion coefficient (D*), flowing fraction ( f$$ f $$), and T1 maps were calculated and mean values were measured in the cortex and medulla. The labeling efficiency of PCASL was estimated from simulation of Bloch equations. Reproducibility was assessed with the within-subject coefficient of variation, intraclass correlation coefficient, and Bland-Altman analysis. Correlations were evaluated using the Pearson correlation coefficient. The significance level was p less than 0.05. Cortical reproducibility was very good for T1, D, and RBF, moderate for f$$ f $$, and low for D*, while medullary reproducibility was good for T1 and D. Significant correlations in the cortex between RBF and f$$ f $$ (r = 0.66), RBF and eGFR (r = 0.64), and D* and eGFR (r = -0.57) were found. Normal values of the measured parameters employing the mpMRI protocol in kidney transplant patients with stable function were characterized and the results showed good reproducibility of the techniques.
Autores:
Cau, R.; Pisu, F.; Suri, J. S.; et al.
Revista:
EUROPEAN JOURNAL OF RADIOLOGY
ISSN:
0720-048X
Año:
2023
Vol.:
166
Págs.:
110980
Objective: The aims of our study were to investigate the sex differences in late gadolinium enhancement (LGE) using cardiovascular magnetic resonance (CMR) in a single-centre cohort of consecutive patients with acute myocarditis (AM). Method: This retrospective study performed CMR scans in 135 consecutive patients with AM that met the Lake Louise criteria. On CMR, LV ventricular strain functions were performed on conventional cine SSFP sequences. Besides myocardial strain measurements, myocardial scar location, extension, and size were assigned and quantified by LGE imaging. Results: There was no difference in age (age 42.51 & PLUSMN; 19.64 years vs 40.92 & PLUSMN; 19.94 years; p = 0.74) and cardiovascular risk profile between women and men. Despite similar comorbidities, women were more like to present with dyspnea (p = 0.001). Women demonstrated higher prevalence of septal LGE (p = 0.004) and increased global circumferential strain parameters (p = 0.008) in comparison with men. In multivariate analysis, female sex remained an independent determinant of septal LGE (& beta; coefficient = -0.520, p = 0.001). Conclusion: This is the first study reporting sex differences in LGE localization in AM. Women have more septal LGE involvement independent of age, cardiovascular risk factors, and CMR parameters. These findings further emphasize the sex-based differences in cardiovascular diseases.
Revista:
ARCHIVOS DE BRONCONEUMOLOGIA
ISSN:
0300-2896
Año:
2022
Vol.:
58
Págs.:
53 - 54
Revista:
FRONTIERS IN MEDICINE
ISSN:
2296-858X
Año:
2022
Vol.:
9
Págs.:
1023583
BackgroundTo better understand the patient's heterogeneity in fatty liver disease (FLD), metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed by international experts as a new nomenclature for nonalcoholic fatty liver disease (NAFLD). We aimed to evaluate the cardiovascular risk, assessed through coronary artery calcium (CAC) and epicardial adipose tissue (EAT), of patients without FLD and patients with FLD and its different subtypes. MethodsCross sectional study of 370 patients. Patients with FLD were divided into 4 groups: FLD without metabolic dysfunction (non-MD FLD), MAFLD and the presence of overweight/obesity (MAFLD-OW), MAFLD and the presence of two metabolic abnormalities (MAFLD-MD) and MAFLD and the presence of T2D (MAFLD-T2D). MAFLD-OW included two subgroups: metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO). The patients without FLD were divided into 2 groups: patients without FLD and without MD (non-FLD nor MD; reference group) and patients without FLD but with MD (non-FLD with MD). EAT and CAC (measured through the Agatston Score) were determined by computed tomography. ResultsCompared with the reference group (non-FLD nor MD), regarding EAT, patients with MAFLD-T2D and MAFLD-MUHO had the highest risk for CVD (OR 15.87, 95% CI 4.26-59.12 and OR 17.60, 95% CI 6.71-46.20, respectively), patients with MAFLD-MHO were also at risk for CVD (OR 3.62, 95% CI 1.83-7.16), and patients with non-MD FLD did not have a significantly increased risk (OR 1.77; 95% CI 0.67-4.73). Regarding CAC, patients with MAFLD-T2D had an increased risk for CVD (OR 6.56, 95% CI 2.18-19.76). Patients with MAFLD-MUHO, MAFLD-MHO and non-MD FLD did not have a significantly increased risk compared with the reference group (OR 2.54, 95% CI 0.90-7.13; OR 1.84, 95% CI 0.67-5.00 and OR 2.11, 95% CI 0.46-9.74, respectively). ConclusionMAFLD-T2D and MAFLD-OW phenotypes had a significant risk for CVD. MAFLD new criteria reinforced the importance of identifying metabolic phenotypes in populations as it may help to identify patients with higher CVD risk and offer a personalized therapeutic management in a primary prevention setting.
Autores:
Ezponda, A; Casanova, C.; Divo, M.; et al.
Revista:
RESPIROLOGY
ISSN:
1323-7799
Año:
2022
Vol.:
27
N°:
4
Págs.:
286 - 293
Background and objective The availability of chest computed tomography (CT) imaging can help diagnose comorbidities associated with chronic obstructive pulmonary disease (COPD). Their systematic identification and relationship with all-cause mortality have not been explored. Furthermore, whether their CT-detected prevalence differs from clinical diagnosis is unknown. Methods The prevalence of 10 CT-assessed comorbidities was retrospectively determined at baseline in 379 patients (71% men) with mild to severe COPD attending pulmonary clinics. Anthropometrics, smoking history, dyspnoea, lung function, exercise capacity, BODE (BMI, Obstruction, Dyspnoea and Exercise capacity) index and exacerbations rate were recorded. The prevalence of CT-determined comorbidities was compared with that recorded clinically. Over a median of 78 months of observation, the independent association with all-cause mortality was analysed. A 'CT-comorbidome' graphically expressed the strength of their association with mortality risk. Results Coronary artery calcification, emphysema and bronchiectasis were the most prevalent comorbidities (79.8%, 62.7% and 33.9%, respectively). All were underdiagnosed before CT. Coronary artery calcium (hazard ratio [HR] 2.09; 95% CI 1.03-4.26, p = 0.042), bronchiectasis (HR 2.12; 95% CI 1.05-4.26, p = 0.036) and low psoas muscle density (HR 2.61; 95% CI 1.23-5.57, p = 0.010) were independently associated with all-cause mortality and helped define the 'CT-comorbidome'. Conclusion This study of COPD patients shows that systematic detection of 10 CT-diagnosed comorbidities, most of which were not detected clinically, provides information of potential use to patients and clinicians caring for them.
Autores:
Bermejo-Peláez, D.; San José Estépar, R.; Fernández-Velilla, M.; et al.
Revista:
SCIENTIFIC REPORTS
ISSN:
2045-2322
Año:
2022
Vol.:
12
N°:
1
Págs.:
9387
The main objective of this work is to develop and evaluate an artificial intelligence system based on deep learning capable of automatically identifying, quantifying, and characterizing COVID-19 pneumonia patterns in order to assess disease severity and predict clinical outcomes, and to compare the prediction performance with respect to human reader severity assessment and whole lung radiomics. We propose a deep learning based scheme to automatically segment the different lesion subtypes in nonenhanced CT scans. The automatic lesion quantification was used to predict clinical outcomes. The proposed technique has been independently tested in a multicentric cohort of 103 patients, retrospectively collected between March and July of 2020. Segmentation of lesion subtypes was evaluated using both overlapping (Dice) and distance-based (Hausdorff and average surface) metrics, while the proposed system to predict clinically relevant outcomes was assessed using the area under the curve (AUC). Additionally, other metrics including sensitivity, specificity, positive predictive value and negative predictive value were estimated. 95% confidence intervals were properly calculated. The agreement between the automatic estimate of parenchymal damage (%) and the radiologists' severity scoring was strong, with a Spearman correlation coefficient (R) of 0.83. The automatic quantification of lesion subtypes was able to predict patient mortality, admission to the Intensive Care Units (ICU) and need for mechanical ventilation with an AUC of 0.87, 0.73 and 0.68 respectively. The proposed artificial intelligence system enabled a better prediction of those clinically relevant outcomes when compared to the radiologists' interpretation and to whole lung radiomics. In conclusion, deep learning lesion subtyping in COVID-19 pneumonia from noncontrast chest CT enables quantitative assessment of disease severity and better prediction of clinical outcomes with respect to whole lung radiomics or radiologists' severity score.
Revista:
ARCHIVOS DE BRONCONEUMOLOGIA
ISSN:
0300-2896
Año:
2022
Vol.:
58
N°:
7
Págs.:
565 - 565
Revista:
MAGNETIC RESONANCE IN MEDICINE
ISSN:
0740-3194
Año:
2022
Vol.:
87
N°:
3
Págs.:
1261 - 1275
Purpose To evaluate the accuracy and reproducibility of myocardial blood flow measurements obtained under different breathing strategies and motion correction techniques with arterial spin labeling. Methods A prospective cardiac arterial spin labeling study was performed in 12 volunteers at 3 Tesla. Perfusion images were acquired twice under breath-hold, synchronized-breathing, and free-breathing. Motion detection based on the temporal intensity variation of a myocardial voxel, as well as image registration based on pairwise and groupwise approaches, were applied and evaluated in synthetic and in vivo data. A region of interest was drawn over the mean perfusion-weighted image for quantification. Original breath-hold datasets, analyzed with individual regions of interest for each perfusion-weighted image, were considered as reference values. Results Perfusion measurements in the reference breath-hold datasets were in line with those reported in literature. In original datasets, prior to motion correction, myocardial blood flow quantification was significantly overestimated due to contamination of the myocardial perfusion with the high intensity signal of blood pool. These effects were minimized with motion detection or registration. Synthetic data showed that accuracy of the perfusion measurements was higher with the use of registration, in particular after the pairwise approach, which probed to be more robust to motion. Conclusion Satisfactory results were obtained for the free-breathing strategy after pairwise registration, with higher accuracy and robustness (in synthetic datasets) and higher intrasession reproducibility together with lower myocardial blood flow variability across subjects (in in vivo datasets). Breath-hold and synchronized-breathing after motion correction provided similar results, but these breathing strategies can be difficult to perform by patients.
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2022
Vol.:
64
N°:
4
Págs.:
317 - 323
Introducción
El objetivo del presente estudio fue evaluar el papel de la tomografía computarizada (TC) de tórax complementaria a la prueba de la reacción en cadena de la polimerasa con transcripción inversa (RT-PCR) en pacientes asintomáticos candidatos a cirugía electiva en el contexto de la pandemia de COVID-19.
Material y métodos
Se incluyeron, de forma prospectiva, 464 pacientes asintomáticos que se sometieron a una triple estrategia de cribado de infección por SARS-CoV-2 (cuestionario de salud, prueba de RT-PCR y TC torácica de baja dosis) durante las 48 horas previas a la realización de una cirugía electiva. Un resultado positivo en la prueba de RT-PCR y/o la identificación de hallazgos tomográficos sugestivos de neumonía COVID-19 (categorías CO-RADS 4 y 5) fueron considerados criterios diagnósticos de infección por SARS-CoV-2.
Resultados
La mayor parte de los pacientes se sometieron a cirugías de otorrinolaringología (64,7%). Ningún paciente presentó un resultado positivo en la prueba de RT-PCR ni síntomas sugestivos de infección por SARS-CoV-2 en el cuestionario de salud. Únicamente 22 (4,7%) mostraron signos compatibles con infección pulmonar; 20 de ellos atípica o indeterminada para COVID-19 (CO-RADS 2, 3) y 2 compatibles con neumonía COVID-19 en resolución. Durante el postoperatorio inmediato no se confirmó ningún caso positivo para SARS-CoV-2.
Conclusión
En nuestra serie, la realización de una TC torácica de baja dosis de radiación en pacientes asintomáticos para el cribado preoperatorio de infección por SARS-CoV-2 no proporcionó un valor diagnóstico adicional a la RT-PCR y el cuestionario de salud.
Revista:
SCIENTIFIC REPORTS
ISSN:
2045-2322
Año:
2022
Vol.:
12
N°:
1
Págs.:
6564
Non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease morbimortality. However, it is not clear if NAFLD staging may help identify early or subclinical markers of cardiovascular disease. We aimed to evaluate the association of liver stiffness and serum markers of liver fibrosis with epicardial adipose tissue (EAT) and coronary artery calcium (CAC) in an observational cross-sectional study of 49 NAFLD patients that were seen at Clínica Universidad de Navarra (Spain) between 2009 and 2019. Liver elastography and non-invasive fibrosis markers were used to non-invasively measure fibrosis. EAT and CAC, measured through visual assessment, were determined by computed tomography. Liver stiffness showed a direct association with EAT (r = 0.283, p-value = 0.049) and CAC (r = 0.337, p-value = 0.018). NAFLD fibrosis score was associated with EAT (r = 0.329, p-value = 0.021) and CAC (r = 0.387, p-value = 0.006). The association of liver stiffness with CAC remained significant after adjusting for metabolic syndrome features (including carbohydrate intolerance/diabetes, hypertension, dyslipidaemia, visceral adipose tissue, and obesity). The evaluation of NAFLD severity through liver elastography or non-invasive liver fibrosis biomarkers may contribute to guide risk factor modification to reduce cardiovascular risk in asymptomatic patients. Inversely, subclinical cardiovascular disease assessment, through Visual Scale for CAC scoring, may be a simple and effective measure for patients with potential liver fibrosis, independently of the existence of other cardiovascular risk factors.
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2021
Vol.:
63
N°:
5
Págs.:
391 - 399
Objective: To analyze the anatomic characteristics of the left atrium and pulmonary veins in individuals undergoing ablation for atrial fibrillation and to identify possible anatomic factors related with recurrence. Material and methods: We retrospectively reviewed the CT angiography studies done to plan radiofrequency ablation for atrial fibrillation in 95 patients (57 men; mean age, 65 +/- 10 y). We reviewed the anatomy of the pulmonary veins and recorded the diameters of their ostia as well as the diameter and volume of the left atrium. We analyzed these parameters according to the type of arrhythmia and the response to treatment. Results: In 71 (74.7%) patients, the anatomy of the pulmonary veins was normal (i.e., two right pulmonary veins and two left pulmonary veins). Compared to patients with paroxysmal atrial fibrillation, patients with persistent atrial fibrillation had slightly larger diameter of the left pulmonary veins (left superior pulmonary vein 17.9 +/- 2.6 mm vs. 16.7 +/- 2.2 mm, p = 0.04; left inferior pulmonary vein 15.3 +/- 2 mm vs. 13.8 +/- 2.2 mm, p = 0.009) and larger left atrial volume (91.9 +/- 24.9 cm(3) vs. 70.7 +/- 20.3 mm(3), p = 0.001). After 22.1 +/- 12.1 months' mean follow-up, 41 patients had sinus rhythm. Compared to patients in whom the sinus rhythm was restored, patients with recurrence had greater left atrial volume (81.4 +/- 23.0 mm(3) vs. 71.1 +/- 23.2 mm(3), p = 0.03). No significant differences in pulmonary vein diameters or clinical parameters were observed between patients with recurrence and those without. Conclusion: The volume of the left atrium is greater in patients with persistent atrial fibrillation and in those who do not respond to ablation.
Revista:
ARCHIVOS DE BRONCONEUMOLOGÍA
ISSN:
2173-5751
Año:
2021
Vol.:
57
N°:
1
Págs.:
36 - 41
Background: Lung Cancer (LC) screening with low dose chest computed tomography (LDCT) in smokers reduces LC mortality. Patients with Obstructive Lung Disease (OLD) are at high risk for LC. The potential effect of LC screening in this population is unknown.
Objective: To determine if screening with LDCT reduces LC mortality in smokers with spirometrically defined OLD.
Methods: The National Lung Screening Trial-American College of Radiology Imaging Network (NLST-ACRIN) study included 13,831 subjects (55-74 years of age with >= 30 pack-year history of smoking) that had a baseline spirometry. Randomly assigned to LDCT or Chest X-ray, all had 3 annual rounds of screening. LC mortality was compared between the LDCT and chest X-ray arms during the 1st year and at 6 years of follow up. Landmark analysis explored LC mortality differences between arms after the first year.
Results: From the 4584 subjects with OLD (FEV1/FVC <0.7), 152 (3.3%) died from LC. Multivariable analysis showed that screening trended to decrease LC mortality at 6 years (HR, 95%CI: 0.75, 0.55-1.04, p = 0.09). During the 1st year no differences were found between arms (p = 0.65). However, after this year, LDCT significantly decreased LC mortality (HR, 95%CI: 0.63, 0.44-0.91, p = 0.01). The number needed to screen to avoid one LC death in these subjects was 108 while in those without OLD was 218.
Conclusions: LC screening with LDCT in smokers with spirometrically diagnosed OLD, showed a trend to reduce lung cancer mortality but a study with a larger number of patients and with a more robust design would be needed to confirm these findings.
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2021
Vol.:
63
N°:
3
Págs.:
218 - 227
Objective: To compare the findings on chest computed tomography (CT) in patients with COVID-19 during different phases of the disease and to evaluate the reproducibility of a visual radiologic score for estimating the extent of lung involvement.
Methods: We retrospectively reviewed chest CT studies from 182 patients with RT-PCR findings positive for SARS-CoV-2. Patients were classified according to the time elapsed from the onset of symptoms, as follows: early (0-4 days), intermediate/progressive (5-9 days), or advanced (>= 10 days). We analyzed the frequency of each radiologic finding, as well as the pattern, appearance, and predominant distribution of lung involvement. A visual tomographic score (range, 0-25) was used to estimate the extent of involvement in each lobe and in the total lung volume.
Results: The predominant CT finding was the ground-glass pattern (n=110; 60.4%), the most common distribution was peripheral (n = 116; 66.7%), and the most prevalent appearance was typical (n=112; 61.5%). The halo sign was seen most frequently in the early phase (25%), whereas ground-glass opacities were more common in the intermediate/progressive and advanced phases. The median severity score was 10 (IQR: 5-13), and the scores increased as the disease progressed. The interobserver agreement (kappa) was 0.92 for the appearance, 0.84 for the distribution, 0.70 for the predominant pattern, and 0.89 for the visual score.
Conclusion: The CT findings in patients with COVID-19 vary with the course of the infection. The proposed visual radiologic score is a simple, reproducible, and reliable tool for assessing lung involvement in COVID-19 pneumonia. (C) 2021 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
Revista:
ANNALS OF BIOMEDICAL ENGINEERING
ISSN:
0090-6964
Año:
2021
Vol.:
49
N°:
2
Págs.:
746 - 756
Imaging of small laboratory animals in clinical MRI scanners is feasible but challenging. Compared with dedicated preclinical systems, clinical scanners have relatively low B(0)field (1.5-3.0 T) and gradient strength (40-60 mT/m). This work explored the use of wireless inductively coupled coils (ICCs) combined with appropriate pulse sequence parameters to overcome these two drawbacks, with a special emphasis on the optimization of the coil passive detuning circuit for this application. A Bengal rose photothrombotic stroke model was used to induce cortical infarction in rats and mice. Animals were imaged in a 3T scanner using T2 and T1-weighted sequences. In all animals, the ICCs allowed acquisition of high-quality images of the infarcted brain at acute and chronic stages. Images obtained with the ICCs showed a substantial increase in SNR compared to clinical coils (by factors of 6 in the rat brain and 16-17 in the mouse brain), and the absence of wires made the animal preparation workflow straightforward.
Revista:
AMERICAN JOURNAL OF ROENTGENOLOGY
ISSN:
0361-803X
Año:
2021
Vol.:
216
N°:
5
Págs.:
1216 - 1221
OBJECTIVE. This study aimed to evaluate the long-term prognostic value of coronary CTA (CCTA) in heart transplant recipients. MATERIALS AND METHODS. The records of 114 patients who had undergone a heart transplant (mean age, 61.7 +/- 11.1 [SD] years; 83.3% men) and who underwent CCTA for the surveillance of coronary allograft vasculopathy (CAV) from June 2007 to December 2017 were retrospectively evaluated for the occurrence of major adverse cardiovascular events (MACEs) (cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, coronary revascularization, cardiac arrhythmias, stroke, and retransplant). Patients were classified according to the presence of nonobstructive CAV (lumen reduction < 50%) or obstructive disease (lumen reduction >= 50%) and using a coronary segment involvement score (SIS). Differences in MACE rate between groups were compared. RESULTS. Obstructive CAV was observed in 12 heart transplant recipients (10.5%). During a mean follow-up of 67.5 +/- 41.4 months the overall rates of MACE were 50% and 14.7% in patients with obstructive and nonobstructive CAV, respectively (p < .05), resulting in an odds ratio for MACE of 6 (95% CI, 1.7-21.2). Comparison of event-free survival showed a hazard ratio (HR) of 5 (95% CI, 1.95-13; p =. 004) for patients with obstructive disease. The presence of four or more stenotic coronary segments (SIS = 4) was associated with a higher rate of events (HR, 3.46; 95% CI, 1.46-8.23). CONCLUSION. In patients who have undergone a heart transplant, CCTA offers a significant long-term prognostic impact on the prediction of MACEs.
Autores:
Mortani Barbosa, E. J. (Jr.) (Autor de correspondencia); Georgescu, B.; Chaganti, S.; et al.
Revista:
EUROPEAN RADIOLOGY
ISSN:
0938-7994
Año:
2021
Vol.:
31
N°:
11
Págs.:
8775 - 8785
Objectives To investigate machine learning classifiers and interpretable models using chest CT for detection of COVID-19 and differentiation from other pneumonias, interstitial lung disease (ILD) and normal CTs. Methods Our retrospective multi-institutional study obtained 2446 chest CTs from 16 institutions (including 1161 COVID-19 patients). Training/validation/testing cohorts included 1011/50/100 COVID-19, 388/16/33 ILD, 189/16/33 other pneumonias, and 559/17/34 normal (no pathologies) CTs. A metric-based approach for the classification of COVID-19 used interpretable features, relying on logistic regression and random forests. A deep learning-based classifier differentiated COVID-19 via 3D features extracted directly from CT attenuation and probability distribution of airspace opacities. Results Most discriminative features of COVID-19 are the percentage of airspace opacity and peripheral and basal predominant opacities, concordant with the typical characterization of COVID-19 in the literature. Unsupervised hierarchical clustering compares feature distribution across COVID-19 and control cohorts. The metrics-based classifier achieved AUC = 0.83, sensitivity = 0.74, and specificity = 0.79 versus respectively 0.93, 0.90, and 0.83 for the DL-based classifier. Most of ambiguity comes from non-COVID-19 pneumonia with manifestations that overlap with COVID-19, as well as mild COVID-19 cases. Non-COVID-19 classification performance is 91% for ILD, 64% for other pneumonias, and 94% for no pathologies, which demonstrates the robustness of our method against different compositions of control groups. Conclusions Our new method accurately discriminates COVID-19 from other types of pneumonia, ILD, and CTs with no pathologies, using quantitative imaging features derived from chest CT, while balancing interpretability of results and classification performance and, therefore, may be useful to facilitate diagnosis of COVID-19.
Revista:
JOURNAL OF CLINICAL MEDICINE
ISSN:
2077-0383
Año:
2021
Vol.:
10
N°:
3
Págs.:
489
Background: Pulmonary artery enlargement (PAE) detected using chest computed tomography (CT) is associated with poor outcomes in chronic obstructive pulmonary disease (COPD). It is unknown whether nocturnal hypoxemia occurring in smokers, with or without COPD, obstructive sleep apnoea (OSA) or their overlap, may be associated with PAE assessed by chest CT. Methods: We analysed data from two prospective cohort studies that enrolled 284 smokers in lung cancer screening programs and completing baseline home sleep studies and chest CT scans. Main pulmonary artery diameter (PAD) and the ratio of the PAD to that of the aorta (PA:Ao ratio) were measured. PAE was defined as a PAD >= 29 mm in men and >= 27 mm in women or as a PA:Ao ratio > 0.9. We evaluated the association of PAE with baseline characteristics using multivariate logistic models. Results: PAE prevalence was 27% as defined by PAD measurements and 11.6% by the PA:Ao ratio. A body mass index >= 30 kg/m(2) (OR 2.01; 95%CI 1.06-3.78), lower % predicted of forced expiratory volume in one second (FEV1) (OR 1.03; 95%CI 1.02-1.05) and higher % of sleep time with O-2 saturation < 90% (T90) (OR 1.02; 95%CI 1.00-1.03), were associated with PAE as determined by PAD. However, only T90 remained significantly associated with PAE as defined by the PA:Ao ratio (OR 1.02; 95%CI 1.01-1.03). In the subset group without OSA, only T90 remains associated with PAE, whether defined by PAD measurement (OR 1.02; 95%CI 1.01-1.03) or PA:Ao ratio (OR 1.04; 95%CI 1.01-1.07). Conclusions: In smokers with or without COPD, nocturnal hypoxemia was associated with PAE independently of OSA coexistence.
Revista:
MAGNETIC RESONANCE IN MEDICINE
ISSN:
0740-3194
Año:
2021
Vol.:
85
N°:
3
Págs.:
1507 - 1521
Purpose To evaluate labeling efficiency of pseudo-continuous arterial spin labeling (PCASL) and to find the gradient parameters that increase PCASL robustness for renal perfusion measurements. Methods Aortic blood flow was characterized in 3 groups: young healthy volunteers (YHV1), chronic kidney disease (CKD) patients (CKDP), and healthy controls (HCO). PCASL inversion efficiency was evaluated through numeric simulations considering the measured pulsatile flow velocity profiles and off-resonance effects for a wide range of gradient parameters, and the results were assessed in vivo. The most robust PCASL implementation was used to measure renal blood flow (RBF) in CKDP and HCO. Results Aortic blood velocities reached peak values of 120 cm/s in YHV1, whereas for elderly subjects values were lower by approximately a factor of 2. Simulations and experiments showed that by reducing the gradient average (G(ave)) and the selective to average gradient ratio (G(max)/G(ave)), labeling efficiency was maximized and PCASL robustness to off-resonance was improved. The study in CKDP and HCO showed significant differences in RBF between groups. Conclusion An efficient and robust PCASL scheme for renal applications requires aG(max)/G(ave)ratio of 6-7 and aG(ave)value that depends on the aortic blood flow velocities (0.5 mT/m being appropriate for CKDP and HCO).
Autores:
Ezponda, A; Casanova, C.; Cabrera, C.; et al.
Revista:
ARCHIVOS DE BRONCONEUMOLOGIA
ISSN:
0300-2896
Año:
2021
Vol.:
57
N°:
8
Págs.:
533 - 539
Rationale: Poor muscle quality in COPD patients relates to exercise intolerance and mortality. Muscle quality can be estimated on computed tomography (CT) by estimating psoas density (PsD). We tested the hypothesis that PsD is lower in COPD patients than in controls and relates to all-cause mortality.
Methods: At baseline, PsD was measured using axial low-dose chest CT images in 220 COPD patients, 80% men, who were 65 +/- 8 years old with mild to severe airflow limitation and in a control group of 58 subjects matched by age, sex, body mass index (BMI) and body surface area (BSA). COPD patients were prospectively followed for 76.5 (48-119) months. Anthropometrics, smoking history, BMI, dyspnoea, lung function, exercise capacity, BODE index and exacerbations history were recorded. Cox proportional risk analysis determined the factors more strongly associated with long-term mortality.
Results: PsD was lower in COPD patients than in controls (40.5 vs 42.5, p = 0.045). During the follow-up, 54 (24.5%) deaths occurred in the COPD group. PsD as well as age, sex, pack-year history, FEV1%, 6MWD, mMRC, BODE index, were independently associated with mortality. Multivariate analysis showed that age (HR 1.06; 95% CI 1.02-1.12, p = 0.006) and CT-assessed PsD (HR 0.97; 95%CI 0.94-0.99, p = 0.023) were the variables independently associated with all-cause mortality.
Conclusions: In COPD patients with mild to severe airflow limitation, chest CT-assessed psoas muscle density was lower than in matched controls and independently associated with long-term mortality. Muscle quality using the easy to evaluate psoas muscle density from chest CT may provide clinicians with important prognostic information in COPD. (C) 2021 SEPAR. Published by Elsevier Espana, S.L.U. All rights reserved.
Revista:
JOURNAL OF MAGNETIC RESONANCE IMAGING
ISSN:
1053-1807
Año:
2021
Vol.:
53
N°:
3
Págs.:
777 - 788
Background Myocardial perfusion is evaluated in first-pass MRI using a gadolinium-based contrast agent, which limits its repeatability and restricts its use in patients with abnormal kidney function. Arterial spin labeling (ASL) is a promising technique for measuring myocardial perfusion without contrast injection. The ratio of stress to rest perfusion, termed myocardial perfusion reserve (MPR), is an indicator of the severity of stenosis in patients with coronary artery disease (CAD). Purpose To quantify perfusion increases with pharmacological vasodilation, explore MPR differences between segments with and without perfusion defects, and examine the correlations between quantitative ASL and semiquantitative first-pass measurements. Study Type Prospective. Subjects Sixteen patients with suspected CAD: 10 classified as "healthy," having normal perfusion on first-pass and no enhancement on late gadolinium enhancement (LGE), and six as "nonhealthy," having hypoperfused segments including ischemic and infarcted. Field Strength/Sequence Flow-sensitive alternating inversion recovery (FAIR) rest-stress cardiac ASL with balanced steady-state free precession (bSSFP), rest-stress first-pass imaging using gradient-echo and LGE using a phase-sensitive inversion-recovery bSSFP at 1.5T. Assessment For healthy subjects, rest-stress perfusion data were compared in global, coronary artery territory, and segment regions of interest (ROIs). A segmental MPR comparison was performed between normal segments from healthy subjects and abnormal segments from nonhealthy subjects. Correlations between ASL and first-pass parameters were explored. Statistical Tests Wilcoxon-signed-rank test, nonparametric factorial analysis of variance (ANOVA), and Pearson's/Spearman's correlations. Results Perfusion increases were significant globally (P= 0.005), per coronary artery territory (P= 0.015), and per segment (P= 0.03 for all segments in ASL and first-pass, except anteroseptal in ASLP= 0.04). MPR differences between normal and abnormal segments were significant (P= 0.0028: ASL,P= 0.033: first-pass). ASL and first-pass measurements were correlated (MPR:r =0.64,P= 0.008 and perfusion:rho= 0.47,P= 0.007). Data Conclusion This study demonstrates the feasibility of ASL to detect hyperemia, the potential to differentiate segments with and without perfusion defects, and significant correlations between ASL and semiquantitative first-pass. Level of Evidence 2 Technical Efficacy Stage 1
Revista:
ARCHIVOS DE BRONCONEUMOLOGIA
ISSN:
0300-2896
Año:
2021
Vol.:
57
N°:
2
Págs.:
101 - 106
(2021);57(2):101?106
Revista:
JOURNAL OF THORACIC IMAGING
ISSN:
0883-5993
Año:
2020
Vol.:
35
N°:
1
Págs.:
64 - 70
Purpose: Routine manual tracing of cardiac contours is time-consuming and subject to variability. A fully automated software tool may improve reading efficiency. This study was performed to assess the accuracy, reliability, and time-efficiency of a fully automated left ventricular (LV) segmentation software tool to calculate LV volumes and function compared with conventional manual contouring. Materials and Methods: Sixty-seven consecutive patients (53 male, mean age 62.5 +/- 10.9 y) underwent adenosine stress/rest perfusion cardiac magnetic resonance examination to rule out myocardial ischemia. Double-oblique short-axis 6-mm slice thickness steady-state free precession cine images were acquired to assess LV ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV) using manual contour tracing and a recently developed fully automated software tool. The length of time needed to obtain LV volumes with each segmentation method was also compared. Results: Compared with manual contouring, the fully automated software tool minimally underestimated LV-EF (mean difference of 2.9%+/- 3.9%) and SV (mean difference of 4.4 +/- 8.5 mL) and slightly overestimated ESV (mean difference of -6.4 +/- 10.8 mL) and LV mass (mean difference of -14 +/- 20.4 g). EDV quantification did not statistically differ. Reliability for EF (concordance correlation coefficient [CCC]=0.92, 95% confidence interval [CI], 0.88-0.95), EDV (CCC=0.98, 95% CI, 0.97-0.99), ESV (CCC=0.96, 95% CI, 0.94-0.97), SV (CCC=0.93, 95% CI, 0.89-0.95), and LV mass (CCC=0.84, 95% CI, 0.76-0.89) was very good. The evaluated software allowed to quantify LV parameters with a 79% reduction in the time required for manual contouring (414.7 +/- 91 s vs. 85 +/- 16.1 s, respectively, P<0.001). Conclusion: Quantification of LV volumes using the evaluated fully automated segmentation software is accurate and time-efficient.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGÍA
ISSN:
0300-8932
Año:
2020
Vol.:
73
N°:
10
Págs.:
863-864
Revista:
ARCHIVOS DE BRONCONEUMOLOGIA
ISSN:
0300-2896
Año:
2020
Vol.:
56
Págs.:
31 - 32
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2020
Vol.:
62
N°:
2
Págs.:
131 - 138
Objective: To determine the incidence of immune-mediated adverse reactions with and without radiologic manifestations and to correlate them with the response to immunotherapy.
Material and methods: We retrospectively included 79 patients with stage IV lung carcinomas (n=24), renal carcinomas (n=11), or melanoma (n=44) treated with immunotherapy. We evaluated the occurrence of immune-mediated adverse reactions, their radiologic manifestations, and the response pattern according to the immune-related response criteria (irRC). We correlated the presence of immune-mediated adverse reactions with the response pattern.
Results: Immune-mediated adverse reactions occurred in 27.8%, being most common in patients with melanoma (40.9%). In 59.1% of patients with adverse reactions, there were radiologic manifestations such as pneumonitis, colitis, hypophysitis, thyroiditis, or myocarditis. Pneumonitis was the most common radiologic manifestation of immune-mediated adverse reactions, even in asymptomatic patients. The rate of response to immunotherapy was higher among patients who developed immune-mediated adverse reactions than in those who did not (68.2% vs. 38.6%, respectively, ¿2 5.58; p=0.018). The rate of favorable responses was higher in patients with radiologic manifestations of immune-mediated adverse reactions than in those without radiologic manifestations (84.6% vs. 44.4%, respectively; p=0.023).
Conclusions: The presence of immune-mediated adverse reactions is associated with a better response to immunotherapy. The association with a favorable response is even stronger in patients with radiologic manifestations of the immune-mediated adverse reactions.
Revista:
HEPATOBILIARY SURGERY AND NUTRITION
ISSN:
2304-3881
Año:
2020
Vol.:
9
N°:
3
Págs.:
379 - 381
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2020
Vol.:
15
N°:
4
Págs.:
e0231204
Introduction: The prevalence of bronchiectasis in the general population and in individuals undergoing lung cancer screening with low dose computed tomography (LDCT) is unknown. The aim of this study is to estimate the prevalence and impact of bronchiectasis in a screening lung cancer program.
Methods: 3028 individuals participating in an international multicenter lung cancer screening consortium (I-ELCAP) were selected from 2000 to 2012. Patients with bronchiectasis on baseline CT were identified and compared to selected controls. Detection of nodules, need for additional studies and incidence of cancer were analyzed over the follow-up period.
Results: The prevalence of bronchiectasis was 11.6%(354/3028). On the baseline LDCT, the number of subjects with nodules identified was 189(53.4%) in patients with bronchiectasis compared to 63(17.8%) in controls (p<0.001). The occurrence of false positives was higher in subjects with bronchiectasis (26%vs17%;p = 0.003). During follow-up, new nodules were more common among subjects with bronchiectasis (17%vs.12%; p = 0.008). The total number of false positives during follow-up was 29(17.06%) for patients with bronchiectasis vs. 88(12.17%) for controls (p = 0.008).The incidence rate of lung cancer during follow-up was 6.8/1000 and 5.1/1000 person-years for each group respectively (p = 0.62).
Conclusions: Bronchiectasis are common among current and former smokers undergoing lung cancer screening with LDCT. The presence of bronchiectasis is associated with greater incidence of new nodules and false positives on baseline and follow-up screening rounds. This leads to an increase need of diagnostic tests, although the lung cancer occurrence is not different.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2020
Vol.:
73
N°:
3
Págs.:
241 - 247
Introduction and objectives: Several trials have tested the diagnostic and prognostic value of stress cardiac magnetic resonance (CMR) in ischemic heart disease. However, scientific evidence is lacking in the older population, and the available techniques have limitations in this population. The aim of this study was to evaluate the usefulness of stress CMR in the elderly.
Methods: We prospectively studied consecutive patients referred for stress CMR to rule out myocardial ischemia. The cutoff age for the elderly population was 70 years. Stress CMR study was performed according to standardized international protocols. Hypoperfusion severity was classified according to the number of affected segments: mild (1-2 segments), moderate (3-4 segments), or severe (> 4 segments). We analyzed the occurrence of major events during follow-up (death, acute coronary syndrome, or revascularization). Survival was studied with the Kaplan-Meier method and multivariate Cox regression models.
Results: Of an initial cohort of 333 patients, 110 were older than 70 years. In 40.9% patients, stress CMR was positive for ischemia. The median follow-up was 26 [18-37] months. In elderly patients there were 35 events (15 deaths, 10 acute coronary syndromes, and 10 revascularizations). Patients with moderate or severe ischemia were at a higher risk of events, adjusted for age, sex, and cardiovascular risk (HR, 3.53 [95%CI, 1.41-8.79]; P=.01).
Conclusions: Moderate to severe perfusion defects in stress CMR strongly predict cardiovascular events in people older than 70 years, without relevant adverse effects.
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2020
Vol.:
62
N°:
2
Págs.:
131 - 138
Objective: To determine the incidence of immune-mediated adverse reactions with and without radiologic manifestations and to correlate them with the response to immunotherapy.
Material and methods: We retrospectively included 79 patients with stage IV lung carcinomas (n=24), renal carcinomas (n=11), or melanoma (n=44) treated with immunotherapy. We evaluated the occurrence of immune-mediated adverse reactions, their radiologic manifestations, and the response pattern according to the immune-related response criteria (irRC). We correlated the presence of immune-mediated adverse reactions with the response pattern.
Results: Immune-mediated adverse reactions occurred in 27.8%, being most common in patients with melanoma (40.9%). In 59.1% of patients with adverse reactions, there were radiologic manifestations such as pneumonitis, colitis, hypophysitis, thyroiditis, or myocarditis. Pneumonitis was the most common radiologic manifestation of immune-mediated adverse reactions, even in asymptomatic patients. The rate of response to immunotherapy was higher among patients who developed immune-mediated adverse reactions than in those who did not (68.2% vs. 38.6%, respectively, ¿2 5.58; p=0.018). The rate of favorable responses was higher in patients with radiologic manifestations of immune-mediated adverse reactions than in those without radiologic manifestations (84.6% vs. 44.4%, respectively; p=0.023).
Conclusions: The presence of immune-mediated adverse reactions is associated with a better response to immunotherapy. The association with a favorable response is even stronger in patients with radiologic manifestations of the immune-mediated adverse reactions.
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2020
Vol.:
62
N°:
3
Págs.:
213 - 221
Objective: To determine the safety of regadenoson for vasodilation in cardiac MRI stress tests to detect myocardial ischemia. Material and methods: We retrospectively analyzed cardiac MRI studies done in 120 patients (mean age, 67 11.6 years; 88 men) with suspected ischemic heart disease or known coronary disease who had clinical indications for cardiac MRI stress tests. All studies were done on a 1.5 T scanner (MAGNETOM Aera, Siemens Healthineers) using regadenoson (5 ml, 0.4 mg) for vasodilation. We recorded cardiovascular risk factors, medications, and indications for the test as well as vital signs at rest and under stress and the symptoms and adverse effects induced by the drug. Results: No symptoms developed in 52.6% of patients. The most common symptoms were central chest pain (25%) and dyspnea (12%). At peak stress, the mean increase in heart rate was 23.9 + 11.4 beats per minute and the mean decreases in systolic and diastolic blood pressure were 7.1+18.8 mmHg and 5.3 9.2 mmHg, respectively (p '0.O01). The response to regadenoson was less pronounced in obese and diabetic patients. The increase in heart rate was greater in symptomatic patients (27.4 11.2 bpm vs. 20.6 + 10.7 bpm in asymptomatic patients, p =0.001). No severe adverse effects were observed. Conclusion: Regadenoson is welt tolerated and can be safety used for cardiac MRI stress tests. 0Z0/9 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
Revista:
CIRCULATION
ISSN:
0009-7322
Año:
2020
Vol.:
142
N°:
19
Págs.:
1831 - 1847
BACKGROUND: Cardiac fibroblasts (CFs) have a central role in the ventricular remodeling process associated with different types of fibrosis. Recent studies have shown that fibroblasts do not respond homogeneously to heart injury. Because of the limited set of bona fide fibroblast markers, a proper characterization of fibroblast population heterogeneity in response to cardiac damage is lacking. The purpose of this study was to define CF heterogeneity during ventricular remodeling and the underlying mechanisms that regulate CF function. METHODS: Collagen1 alpha 1-GFP (green fluorescent protein)-positive CFs were characterized after myocardial infarction (MI) by single-cell and bulk RNA sequencing, assay for transposase-accessible chromatin sequencing, and functional assays. Swine and patient samples were studied using bulk RNA sequencing. RESULTS: We identified and characterized a unique CF subpopulation that emerges after MI in mice. These activated fibroblasts exhibit a clear profibrotic signature, express high levels of Cthrc1 (collagen triple helix repeat containing 1), and localize into the scar. Noncanonical transforming growth factor-beta signaling and different transcription factors including SOX9 are important regulators mediating their response to cardiac injury. Absence of CTHRC1 results in pronounced lethality attributable to ventricular rupture. A population of CFs with a similar transcriptome was identified in a swine model of MI and in heart tissue from patients with MI and dilated cardiomyopathy. CONCLUSIONS: We report CF heterogeneity and their dynamics during the course of MI and redefine the CFs that respond to cardiac injury and participate in myocardial remodeling. Our study identifies CTHRC1 as a novel regulator of the healing scar process and a target for future translational studies.
Autores:
Divo, M. J. (Autor de correspondencia); Marin Oto, Marta; Macario, C. C.; et al.
Revista:
ERJ OPEN RESEARCH
ISSN:
2312-0541
Año:
2020
Vol.:
6
N°:
3
Págs.:
00122-2020
Rationale: Chronic obstructive pulmonary disease (COPD) comprises distinct phenotypes, all characterised by airflow limitation. Objectives: We hypothesised that somatotype changes - as a surrogate of adiposity - from early adulthood follow different trajectories to reach distinct phenotypes. Methods: Using the validated Stunkard's Pictogram, 356 COPD patients chose the somatotype that best reflects their current body build and those at ages 18, 30, 40 and 50 years. An unbiased group-based trajectory modelling was used to determine somatotype trajectories. We then compared the current COPD-related clinical and phenotypic characteristics of subjects belonging to each trajectory. Measurements and main results: At 18 years of age, 88% of the participants described having a lean or medium somatotype (estimated body mass index (BMI) between 19 and 23 kg.m(-2)) while the other 12% a heavier somatotype (estimated BMI between 25 and 27 kg.m(-2)). From age 18 onwards, five distinct trajectories were observed. Four of them demonstrating a continuous increase in adiposity throughout adulthood with the exception of one, where the initial increase was followed by loss of adiposity after age 40. Patients with this trajectory were primarily females with low BMI and D-LCO (diffusing capacity of the lung for carbon monoxide). A persistently lean trajectory was seen in 14% of the cohort. This group had significantly lower forced expiratory volume in 1 s (FEV1), D-LCO, more emphysema and a worse BODE (BMI, airflow obstruction, dyspnoea and exercise capacity) score thus resembling the multiple organ loss of tissue (MOLT) phenotype. Conclusions: COPD patients have distinct somatotype trajectories throughout adulthood. Those with the MOLT phenotype maintain a lean trajectory throughout life. Smoking subjects with this lean phenotype in early adulthood deserve particular attention as they seem to develop more severe COPD.
Revista:
AMERICAN JOURNAL OF ROENTGENOLOGY
ISSN:
0361-803X
Año:
2020
Vol.:
215
N°:
4
Págs.:
828 - 833
OBJECTIVE. The purpose of this study was to evaluate the feasibility, image quality, and radiation dose of high-pitch coronary CT angiography (CCTA) in orthotopic heart transplant (OHT) recipients. SUBJECTS AND METHODS. Twenty-two consecutive OHT recipients (16 men, six women; median age, 66.5 years [interquartile range, 51.3-70.3 years]; median heart rate, 91 beats/min [interquartile range, 79.3-97.3 beats/min]) underwent CCTA with a third-generation dual-source CT scanner in high-pitch mode to rule out coronary allograft vasculopathy. Data acquisition was triggered at 30% of the R-R interval. Two independent observers blindly assessed image quality on a per-segment, per-vessel, and per-patient basis using a 4-point scale (4, excellent; 1, not evaluative). Scores 2-4 indicated diagnostic quality. Studies were compared with previously performed retrospective ECG-gated examinations, when available. Interobserver agreement on the image quality was assessed with kappa statistics. Radiation dose was recorded. RESULTS. A total of 322 coronary segments were evaluated. Diagnostic image quality was observed in 97.5% of the segments. Interobserver agreement for image quality assessment was very good on a per-patient (kappa = 0.82), per-vessel (kappa = 0.83), and per-segment basis (kappa = 0.89). The median per-patient image quality score was 4.0 (3.0-4.0) for the entire coronary tree. A comparison of image quality scores between high-pitch and retrospective ECG-gated CCTA examinations showed no significant differences, but the estimated mean radiation dose was significantly lower for the high-pitch mode (median dose-length product, 31.6 mGy x cm [interquartile range, 23.1-38.8 mGy x cm] vs 736.5 mGy x cm [interquartile range, 655.5-845.7 mGy x cm], p < 0.001). CONCLUSION. Performing single-heartbeat high-pitch CCTA during the systolic phase of the cardiac cycle in OHT recipients results in diagnostic image quality in coronary angiograms at very low radiation dose.
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2020
Vol.:
62
N°:
6
Págs.:
493 - 501
Objective: To compare the myocardial perfusion reserve index (MPRI) measured during stress cardiac magnetic resonance imaging (MRI) with regadenoson in patients with heart transplants versus in patients without heart transplants. Material and methods: We retrospectively compared 20 consecutive asymptomatic heart transplant patients without suspicion of microvascular disease who underwent stress cardiac MRI with regadenoson and coronary computed tomography angiography (CTA) to rule out cardiac alto graft vasculopathy versus 16 patients without transplants who underwent clinically indicated stress cardiac MRI who were negative for ischemia and had no signs of structural heart disease. We estimated MPRI semiquantitatively after calculating the up-slope of the first-pass enhancement curve and dividing the value obtained during stress by the value obtained at rest. We compared MPRI in the two groups. Patients with positive findings for ischemia on stress cardiac MRI or significant coronary stenosis on coronary CTA were referred for conventional coronary angiography. Results: More than half the patients remained asymptomatic during the stress test. Stress cardiac MRI was positive for ischemia in two heart transplant patients; these findings were confirmed at coronary CTA and at conventional coronary angiography. Patients with transplants had lower end-diastolic volume index (59.3 +/- 15.2 ml/m(2) vs. 71.4 +/- 15.9 ml/m(2) in those without transplants, p = 0.03), lower MPRI (1.35 +/- 0.19 vs. 1.6 +/- 0.28 in those without transplants, p = 0.003), and a less pronounced hemodynamic response to regadenoson (mean increase in heart rate 13.1 +/- 5.4 bpm vs. 28.5 +/- 8.9 bpm in those without transplants, p<0.001). Conclusion: Stress cardiac MRI with regadenoson is safe. In the absence of epicardial coronary artery disease, patients with heart transplants have lower MPRI than patients without transplants, suggesting microvascular disease. The hemodynamic response to regadenoson is less pronounced in patients with heart transplants than in patients without heart transplants. (C) 2020 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
Revista:
INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING
ISSN:
1569-5794
Año:
2019
Vol.:
35
N°:
4
Págs.:
675 - 682
Abstract
To evaluate the vasodilator effect of adenosine triphosphate (ATP) compared with adenosine in stress perfusion cardiac magnetic resonance (CMR) examinations. A total of thirty-three patients underwent clinically indicated stress/rest perfusion CMR examination following intravenous injection of a total dose of 0.2 mmol/kg of gadobutrol. Individuals were randomly assigned to ATP (160 mcg/kg/min) or adenosine (140 mcg/kg/min). The vasodilator effect of both drugs was analyzed by comparing differences in heart rate, symptoms during stress, and semiquantitative myocardial and splenic perfusion parameters, including time, time to peak, upslope, myocardial perfusion reserve index, tissue perfusion values, splenic and myocardial signal intensity ratios, and splenic-to-myocardial signal intensity ratios. No significant difference was found in heart rate variation between the stressors (26.1¿±¿19.1 bpm for ATP vs. 21.7¿±¿17.3 bpm for adenosine, p¿=¿0.52). Patients receiving ATP referred less pronounced clinical symptoms. Semiquantitative myocardial perfusion parameters were comparable, and patients in the adenosine and ATP groups showed similar myocardial perfusion reserve index values (2.34 [1.62-2.73] vs 1.63 [1.29-2.10], p¿=¿0.07). Splenic switch off was visually confirmed in all patients and estimated spleen to myocardium ratio was similar (0.92 [0.53-1.09] vs 0.81 [0.53-0.86] with ATP and adenosine, respectively, p¿=¿0.12). Both ATP and adenosine are potent coronary vasodilators that can be safely employed in stress-CMR. Both stressor cause similar hyperemic response. Splenic switch-off can be used to assess stress adequacy in patients undergoing stress-CMR with either adenosine or ATP.
Autores:
Sullivan, J. L.; Bagevalu, B.; Glass, C.; et al.
Revista:
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
ISSN:
1073-449X
Año:
2019
Vol.:
200
N°:
11
Págs.:
1434 - 1439
Revista:
PLOS ONE
ISSN:
1932-6203
Background To assess the relationship between lung cancer and emphysema subtypes. Objective Airflow obstruction and emphysema predispose to lung cancer. Little is known, however, about the lung cancer risk associated with different emphysema phenotypes. We assessed the risk of lung cancer based on the presence, type and severity of emphysema, using visual assessment. Methods Seventy-two consecutive lung cancer cases were selected from a prospective cohort of 3,477 participants enrolled in the Clinica Universidad de Navarra's lung cancer screening program. Each case was matched to three control subjects using age, sex, smoking history and body mass index as key variables. Visual assessment of emphysema and spirometry were performed. Logistic regression and interaction model analysis were used in order to investigate associations between lung cancer and emphysema subtypes. Results Airflow obstruction and visual emphysema were significantly associated with lung cancer (OR = 2.8, 95%CI: 1.6 to 5.2; OR = 5.9, 95%CI: 2.9 to 12.2; respectively). Emphysema severity and centrilobular subtype were associated with greater risk when adjusted for confounders (OR = 12.6, 95%CI: 1.6 to 99.9; OR = 34.3, 95%CI: 25.5 to 99.3, respectively). The risk of lung cancer decreases with the added presence of paraseptal emphysema (OR = 4.0, 95%CI: 3.6 to 34.9), losing this increased risk of lung cancer when it occurs alone (OR = 0.7, 95%CI: 0.5 to 2.6). Conclusions Visual scoring of emphysema predicts lung cancer risk. The centrilobular phenotype is associated with the greatest risk.
Revista:
NMR IN BIOMEDICINE
ISSN:
0952-3480
Año:
2019
Vol.:
32
N°:
5
Págs.:
e4077
The aim of this study was to improve the scan efficiency of ASL in the myocardium. Free breathing FAIR-ASL scans with different TRs were compared, while keeping the acquisition time constant. Scans were named by the trigger pulse that started each acquisition: every two (TP1), four (TP2) and six (TP3) cardiac cycles. TP2 offered the best alternative with a coefficient of variation of 17.15% intrasession and 36.85% intersession. Mean MBF increased by 0.22 +/- 0.41 ml/g/min with mild stress.
Autores:
Rodriguez-Manero, M.; Azcarate-Aguero, P. (Autor de correspondencia); Kreidieh, B. ; et al.
Revista:
ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES
ISSN:
0742-2822
Año:
2019
Vol.:
36
N°:
2
Págs.:
306 - 311
Introduction: We evaluate the ability of 2D non-contrast-enhanced echocardiography (CE-echo), 2DCE-echo, 3D-echo, 3D non-CE-echo, and 3DCE-echo to evaluate allograft function and dimensions in orthotropic heart transplantation (OHT). Cardiac resonance (CMR) was used as reference. Methods: Twenty six consecutive OHT-recipients were prospectively recruited. Bland-Altman, Spearman rank, and concordance-correlation coefficients (CCC) were determined. Results: Good CCCs were found between the four modalities and CMR for ejection fraction (r >= 0.72/P < 0.001; r >= 0.77/ P < 0.001; r >= 0.51/ P < 0.23; r >= 0.75/P < 0.001, respectively). Highest intraclass correlation coefficient (ICC) was for 2D CE-echo(CCC = 0.77). End-diastolic volume(EDV) measurements statistically differed when 2D non-CE-echo, 2DCE-echo, and 3D non-CE-echo were compared with the cross-sectional imaging modalities, but they did not differ significantly from 3DCE-echo. End-systolic volume (ESV) and stroke volume (SV) differed statistically between the four modalities; however, SV measured by CMR and 3DCE-echo were comparable. Overall, 2D non-CE-echo, 2DCE-echo, and 3D non-CE-echo showed lower mean EDV, ESV, and SV than CMR. ICC was that of the ESV variable in the 4 techniques, with the values of the ICC of the 3DCE-echo technique superior to the rest. Overall, the best CCC were found for 3DCE(r = 0.88, 0.92 and 0.76 for EDV, ESV and SV, respectively). Conclusion: Routine use of 3DCE-echo may allow more comprehensive cardiac assessment in cardiac transplant recipients.
Revista:
PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY
ISSN:
1546-3222
Año:
2019
Vol.:
16
N°:
5
Págs.:
641 - 644
Revista:
RADIOLOGIA MEDICA
ISSN:
0033-8362
Año:
2019
Vol.:
124
Págs.:
1199 - 1211
Background There is a growing awareness that prevention and early diagnosis may reduce the high mortality associated with cancer, cardiovascular and other diseases. The role of whole-body computed tomography (WB-CT) in self-referred and asymptomatic patients has been debated. Aim To determine frequency and spectrum of WB-CT findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups. Materials and methods We retrospectively reviewed 6516 subjects who underwent WB-CT (June 2004/February 2015). All were > 40 years and referred by Medical-Check-Up-Unit of our hospital. The main findings were categorized and classified as normal or not. Its distribution according to sex and age-groups was evaluated using Chi-square test and linear-by-linear association test, respectively. Number of recommendations, type and interval of follow-up were recorded. Descriptive statistics were used. Results WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4 years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49 years: 95.65%; 50-59 years: 98.33%; 60-69 years: 99.47%; > 69 years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mai
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2018
Vol.:
60
N°:
5
Págs.:
387-393
Revista:
INDIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
ISSN:
0970-9134
Año:
2018
Vol.:
34
N°:
2
Págs.:
161 - 163
Left main coronary artery aneurysm is an extremely uncommon coronary pathology that can present with angina, myocardial infarction, pericardial tamponade, or sudden death, and whose treatment still remains controversial. Here, we present a 64-year-old woman admitted due to angina with a previous mitral and aortic valve replacement. Transthoracic echocardiogram revealed an aortic prosthesis dysfunction and preoperative angiogram showed a large left main coronary artery aneurysm. Surgical aneurysm exclusion with concomitant coronary artery bypass grafting and aortic prosthesis replacement were performed after defining the aneurysm's anatomical details and relationship using contrast-enhanced computed tomography.
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2018
Vol.:
13
N°:
4
Págs.:
e0195640
In this prospective observational study of COPD patients with mild to moderate airflow limitation, PAE was the best predictor of long-term survival along with age.
Revista:
ANNALS OF TRANSLATIONAL MEDICINE
ISSN:
2305-5839
Año:
2018
Vol.:
6
N°:
Supl. 1
Págs.:
S51
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2018
Vol.:
60
N°:
5
Págs.:
387 - 393
Objective: Advances in clinical applications of computed tomography have been accompanied by improvements in advanced post-processing tools. In addition to multiplanar reconstructions, curved planar reconstructions, maximum intensity projections, and volumetric reconstructions, very recently kinematic reconstruction has been developed. This new technique, based on mathematical models that simulate the propagation of light beams through a volume of data, makes it possible to obtain very realistic three dimensional images. This article illustrates examples of kinematic reconstructions and compares them with classical volumetric reconstructions in patients with cardiovascular disease in a way that makes it easy to establish the differences between the two types of reconstruction. Conclusion: Kinematic reconstruction is a new method for representing three dimensional images that facilitates the explanation and comprehension of the findings. (C) 2018 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2018
Vol.:
60
N°:
6
Págs.:
493 - 495
Objective: To assess the usefulness of cardiac stress magnetic resonance imaging (MRI) with adenosine in the detection of ischemic heart disease in patients with a low pretest probability of disease. Material and methods: We used the probability ratio to analyze the usefulness of cardiac stress MRI in a selection of patients with a low pretest probability of ischemic heart disease (low or moderate cardiovascular risk, atypical chest pain, or absence of prior ischemic heart disease). Results: We included 295 patients followed up for a median of 28 (19-36) months. A total de 60 patients had an event. Cardiac stress MRI was more useful in patients with a low pretest probability: atypical chest pain (probability ratio [PR] positive 8.56), absence of prior ischemic heart disease (PR positive 4.85), and low or moderate cardiovascular risk (PR positive 3.87). Conclusions: Cardiac stress MRI can be useful in the diagnosis of ischemic heart disease in patients with a low pretest probability. (C) 2018 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
Revista:
CHEST
ISSN:
0012-3692
Año:
2017
Vol.:
151
N°:
2
Págs.:
358 - 365
BACKGROUND: The clinical characteristics of patients with emphysema but without airway limitations remain unknown. The goal of this study was to compare the clinical features of current and former smokers without airflow limitation who have radiologic emphysema on chest CT scans vs a control group of current and ex-smokers without emphysema. METHODS: Subjects enrolled had anthropometric characteristics recorded, provided a medical history, and underwent low-dose chest CT scanning. The following parameters were also evaluated: pulmonary function tests including diffusion capacity for carbon monoxide (D-LCO), the modified Medical Research Council dyspnea score, COPD assessment test (CAT), and 6-min walk test (6MWT). Acomparison was conducted between those with and withoutCT-confirmedemphysema. RESULTS: Of the 203 subjects, 154 had emphysema, and 49 did not. Adjusted group comparisons revealed that a higher proportion of patients with emphysema according to low-dose chest CT scanning had an abnormal DLCO value (< 80%) (46% vs 19%; P = .02), a decrease in percentage of oxygen saturation > 4% during the 6MWT (8.5% vs 0; P = .04), and an altered quality of life (CAT score >= 10) (32% vs 14%; P = .01). A detailed analysis of the CAT questionnaire items revealed that more patients with emphysema had a score >= 1 in the "chest tightness" (P = .05) and "limitation when doing activities at home" (P < .01) items compared with those with no emphysema. They also experienced significantly more exacerbations in the previous year (0.19 vs 0.04; P = .02). CONCLUSIONS: A significant proportion of smokers with emphysema according to low-dose chest CT scanning but without airway limitation had alterations in their quality of life, number of exacerbations, DLCO values, and oxygen saturation during the 6MWT test.
Revista:
ACTA RADIOLOGICA
ISSN:
0284-1851
Año:
2017
Vol.:
58
N°:
7
Págs.:
809 - 815
Background: Diffuse myocardial fibrosis can be quantified by calculating extra-cellular volume (ECV) from native and post-contrast T1 values using dedicated single bolus contrast medium injection protocols. Purpose: To evaluate differences in T1 maps and myocardial ECV measurements in routine stress/rest perfusion cardiovascular magnetic resonance (CMR) examinations after injection of single and double dose of contrast medium. Material and Methods: Thirty-seven consecutive patients (30 men; mean age, 62 +/- 13 years) underwent clinically indicated adenosine stress/rest perfusion CMR examination to rule out myocardial ischemia following a conventional split-dose contrast medium injection strategy. Native and post-contrast T1 mapping was performed 15 min after the first (0.1 mmol/kg) and second (0.1 mmol/kg) dose of contrast medium using a breath-held Modified Look-Locker Inversion recovery (MOLLI) sequence. Student's t-test for paired samples, Bland-Altman plots, and concordance-correlation coefficients (CCC) for agreement between T1 and ECV calculations after single and double dose of contrast medium were calculated. Intra- and inter-observer agreement for measurements was also analyzed. Results: Myocardial T1 values after single and double dose of contrast medium significantly differed (mean difference of 114.1 +/- 19.9 ms, P< 0.01). A single dose of contrast agent provided slightly higher ECV values (mean difference of 2.3 +/- 1.1%). CCC for ECV calculations was 0.66. Intra- and inter-observer agreement for all measurements was excellent (CCC >= 0.83). Conclusion: Quantification of myocardial ECV on conventional stress/rest perfusion CMR examination is feasible. T1 maps obtained 15 min after 0.1 mmol/kg of contrast medium provide slightly higher myocardial T1 measurements and ECV values compared with T1 maps obtained after a total dose of 0.2 mmol/kg.
Revista:
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY
ISSN:
1051-0443
Año:
2017
Vol.:
28
N°:
6
Págs.:
877-885
Percutaneous CT-guided sympathicolysis is a safe and effective technique for the treatment of PPHH and can be considered as a second choice in patients in whom other nonsurgical therapeutic options have failed, despite the compensatory hyperhidrosis rates.
Revista:
JOURNAL OF THORACIC IMAGING
ISSN:
0883-5993
Año:
2017
Vol.:
32
N°:
4
Págs.:
217 - 232
The survival rate of patients with congenital heart disease (CHD) has dramatically improved over the last 2 decades because of technological and surgical advances in diagnosis and treatment, respectively. The vast majority of CHD patients are, in fact, amenable to treatment by either device closure or surgery. Considering the wide spectrum of surgical procedures and complex native and derived anatomy, continuous and detailed follow-up is of paramount importance. Cardiac magnetic resonance and cardiac computed tomography angiography are the cornerstones of diagnosis and follow-up of CHD, allowing for comprehensive noninvasive assessment of the heart, coronary tree, and intrathoracic great vessels, along with both morphological and functional evaluation. The aim of this pictorial review is to provide an overview of the most common CHDs and their related surgical procedures as familiarity with the radiological findings of grown-up congenital heart disease patients is crucial for proper diagnostic and follow-up pathways.
Revista:
RESPIRATORY RESEARCH
ISSN:
1465-993X
Año:
2017
Vol.:
18
N°:
1
Págs.:
175
Background: Chronic Obstructive Pulmonary Disease (COPD) is an independent risk factor for cardiovascular (CV) disease, one of the most frequent causes of death in COPD patients. The goal of the present study was to evaluate the prognostic value of non-invasive CV risk markers in COPD patients. Methods: CV risk was prospectively evaluated in 287 COPD patients using non-invasive markers including the Framingham score, the Systematic Coronary Risk Evaluation (SCORE) charts, coronary arterial calcium (CAC), epicardial adipose tissue (EAT), as well as clinical, biochemical and physiological variables. The predictive power of each parameter was explored using CV events as the main outcome. Results: During a median follow up of 65 months (ICR: 36-100), 44 CV events were recorded, 12 acute myocardial infarctions (27.3%), 10 ischemic heart disease/angina (22.7%), 12 peripheral artery disease events requiring surgery (27.3%) and 10 strokes (22.7%). A total of 35 CV deaths occurred during that period. Univariable analysis determined that age, hypertension, CRP, total Cholesterol, LDL-Cholesterol, Framingham score and CAC were independently associated with CV events. Multivariable analysis identified CAC as the best predictor of CV events (HR; 95%CI: 1.32; 1.19-1.46, p < 001). Conclusions: In COPD patients attending pulmonary clinics, CAC was the best independent non-invasive predictor of CV events. This tool may help evaluate the risk for a CV event in patients with COPD. Larger studies should reproduce and validate these findings.
Revista:
EUROPEAN RESPIRATORY JOURNAL
ISSN:
0903-1936
Año:
2017
Vol.:
49
N°:
1
Págs.:
1601521
Revista:
LUNG CANCER
ISSN:
0169-5002
Año:
2016
Vol.:
97
Págs.:
81-86
A major drawback of lung cancer screening programs is the high frequency of false-positive findings on computed tomography (CT). We investigated the accuracy of selective 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (FDG) Positron Emission Tomography/Computed Tomography (PET/CT) scan in assessing radiologically indeterminate lung nodules detected in lung cancer screening. Methods: FDG PET/CT was performed to characterize 64 baseline lung nodules >10 mm and 36 incidence nodules detected on low-dose CT screening in asymptomatic current or former smokers (83 men, age range 40¿83 years) at high risk for lung cancer. CT images were acquired without intravenous contrast. Nodules were analyzed by size, density, and metabolic activity and visual scored on a 5-point scale for FDG uptake. Nodules were classified as negative for malignancy when no FDG uptake was observed, or positive when focal uptake was observed in the visual analysis, and the maximum standardized uptake value (SUVmax) was measured. Final diagnosis was based on histopathological evaluation or at least 24 months of follow-up. Results: A total of 100 nodules were included. The prevalence of lung cancer was 1%. The sensitivity, specificity, NPV and PPV of visual analysis to detect malignancy were 84%, 95%, 91%, and 91%, respectively, with an accuracy of 91% (AUC 0.893). FDG PET/CT accurately detected 31 malignant tumors (diameters 9¿42 mm, SUVmax range 0.6¿14.2) and was falsely negative in 6 patients. With SUVmax threshold
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2016
Vol.:
58
N°:
6
Págs.:
444 - 453
Objective: Radiofrequency ablation is an efficacious alternative in patients with symptomatic atrial fibrillation who do not respond to or are intolerant to at least one class I or class III antiarrhythmic drug. Although radiofrequency ablation is a safe procedure, complications can occur. Depending on the location, these complications can be classified into those that affect the pulmonary veins themselves, cardiac complications, extracardiac intrathoracic complications, remote complications, and those that result from vascular access. The most common complications are hematomas, arteriovenous fistulas, and pseudoaneurysms at the puncture site. Some complications are benign and transient, such as gastroparesis or diaphragmatic elevation, whereas others are potentially fatal, such as cardiac tamponade. Conclusion: Radiologists must be familiar with the complications that can occur secondary to pulmonary vein ablation to ensure early diagnosis and treatment. (C) 2016 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
Revista:
ARCHIVOS DE BRONCONEUMOLOGIA
ISSN:
0300-2896
Año:
2015
Vol.:
51
N°:
4
Págs.:
169 - 176
The experience in Spain's longest lung cancer screening program is comparable to what has been described in the rest of Europe, and confirms the feasibility and efficacy of lung cancer screening using LDCT.
Revista:
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
ISSN:
1073-449X
Año:
2015
Vol.:
191
N°:
8
Págs.:
924 - 931
Rationale: Lung cancer (LC) screening using low-dose chest computed tomography is now recommended in several guidelines using the National Lung Screening Trial (NLST) entry criteria (age, 55-74; ¿30 pack-years; tobacco cessation within the previous 15 yr for former smokers). Concerns exist about their lack of sensitivity. Objectives: To evaluate the performance of NLST criteria in two different LC screening studies from Europe and the United States, and to explore the effect of using emphysema as a complementary criterion. Methods: Participants from the Pamplona International Early Lung Action Detection Program (P-IELCAP; n = 3,061) and the Pittsburgh Lung Screening Study (PLuSS; n = 3,638) were considered. LC cumulative frequencies, incidence densities, and annual detection rates were calculated in three hypothetical cohorts, including subjects whometNLST criteria alone, those withcomputed tomography-detected emphysema, and those who met NLST criteria and/or had emphysema. Measurements and Main Results: Thirty-six percent and 59% of P-IELCAP and PLuSS participants, respectively, met NLST criteria. Among these, higher LC incidence densities and detection rates were observed. However, applying NLST criteria to our original cohorts would miss asmany as 39% of all LC. Annual screening of subjects meeting either NLST criteria or having emphysema detected most cancers (88% and 95% of incident LC of P-IELCAP and PLuSS, respectively) despite reducing the number of screened participants by as much as 52%. Conclusions: LC screening based solely on NLST criteria could miss a significant number of LC cases. Combining NLST criteria and emphysema to select screening candidates results in higher LC detection rates and a lower number of cancers missed.
Revista:
CLINICAL BIOCHEMISTRY
ISSN:
0009-9120
Año:
2014
Vol.:
47
N°:
18
Págs.:
272-8
This study shows that OPG may potentially be a biomarker for cardiovascular risk/damage in the MS and identifies adipose tissue as a potential source of OPG.
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2013
Vol.:
8
N°:
6
Págs.:
e65593
Revista:
MEDICAL IMAGE ANALYSIS
ISSN:
1361-8423
Año:
2013
Vol.:
17
N°:
8
Págs.:
1095-1105
We present and evaluate an automatic and quantitative method for the complex task of characterizing individual nodule volumetric progression in a longitudinal mouse model of lung cancer. Fourteen A/J mice received an intraperitoneal injection of urethane. Respiratory-gated micro-CT images of the lungs were acquired at 8, 22, and 37 weeks after injection. A radiologist identified a total of 196, 585 and 636 nodules, respectively. The three micro-CT image volumes from every animal were then registered and the nodules automatically matched with an average accuracy of 99.5%. All nodules detected at week 8 were tracked all the way to week 37, and volumetrically segmented to measure their growth and doubling rates. 92.5% of all nodules were correctly segmented, ranging from the earliest stage to advanced stage, where nodule segmentation becomes more challenging due to complex anatomy and nodule overlap. Volume segmentation was validated using a foam lung phantom with embedded polyethylene microspheres. We also correlated growth rates with nodule phenotypes based on histology, to conclude that the growth rate of malignant tumors is significantly higher than that of benign lesions. In conclusion, we present a turnkey solution that combines longitudinal imaging with nodule matching and volumetric nodule segmentation resulting in a powerful tool for preclinical research.
Revista:
ANNALS OF TRANSPLANTATION
ISSN:
1425-9524
Año:
2013
Vol.:
18
Págs.:
587 - 592
Background: The prognosis of non-cutaneous malignancies after liver transplantation is dismal, mainly because most cases are diagnosed at advanced stages. In the last decade, studies have shown the potential role of screening for lung cancer with low-radiation dose computed tomography.
Material/Methods: Fifty-nine liver transplant recipients with a cumulative dose of smoking greater than 10 pack-years were enrolled in a lung cancer screening program using yearly low-radiation dose computed tomography.
Results: Lung cancer was diagnosed in 7 patients (11.8%), 5 of which were in stage Ia at diagnosis. Patients with lung cancer were significantly older (median age 66 vs. 58 years), had a higher cumulative history of smoking, and had emphysema more frequently than patients without cancer.
Conclusions: Screening for lung cancer with low-radiation dose computed tomography in liver transplant recipients results in the diagnosis of lung cancer in early stages.
Revista:
ANNALS OF VASCULAR SURGERY
ISSN:
0890-5096
Año:
2013
Vol.:
27
N°:
7
Págs.:
974.e1 - 974.e6
In the last 20 years, endovascular procedures have radically altered the treatment of diseases of the aorta. The objective of endovascular treatment of dissections is to close the entry point to redirect blood flow toward the true lumen, thereby achieving thrombosis of the false lumen. In extensive chronic dissections that have evolved with the formation of a large aneurysm, the dissection is maintained from the end of the endoprosthesis due to multiple orifices, or reentries, that communicate with the lumens. In addition, one of the primary limitations of this technique is when the visceral arteries have disease involvement. In this report we present a case where, despite having treated the entire length of the descending thoracic aorta, the dissection was maintained distally, leading to progression of the diameter of the aneurysm. After reviewing the literature, and to the best of our knowledge, we describe the first case in which renal autotransplant was performed to allow for subsequent exclusion of the aorta at the thoracoabdominal level using a fenestrated endoprosthesis for the celiac trunk and the superior mesenteric artery.
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2013
Vol.:
8
N°:
4
Págs.:
e60260
Current or former smokers expressing a well-defined disease characteristic such as emphysema, has a specific plasma cytokine profile. This includes a decrease of cytokines mainly implicated in activation of apoptosis or decrease of immunosurveillance. This information should be taken into account when evaluated patients with tobacco respiratory diseases
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN:
1130-0108
Año:
2013
Vol.:
105
N°:
8
Págs.:
500 - 501
Revista:
RADIOLOGY
ISSN:
0033-8419
Año:
2012
Vol.:
54
N°:
5
Págs.:
432-441
Autores:
Wilson, RB; Schoepf, UJ; Lee, YS; et al.
Revista:
JOURNAL OF THORACIC IMAGING
ISSN:
0883-5993
Año:
2012
Vol.:
27
N°:
2
Págs.:
W32 - 34
Revista:
EUROPEAN JOURNAL OF RADIOLOGY
ISSN:
0720-048X
Año:
2012
Vol.:
81
N°:
11
Págs.:
3282-3288
Objectives: To establish the accuracy and reliability of cardiac dual-source CT (DSCT) and two-dimensional contrast-enhanced echocardiography (CE-Echo) in estimating left ventricular (LV) parameters with respect to cardiac magnetic resonance imaging (CMR) as the reference standard. Methods: Twenty-five consecutive heart transplant recipients (20 male, mean age 62.7 +/- 10.4 years, mean time since transplantation 8.1 +/- 5.9 years) were prospectively recruited. Two blinded readers independently assessed LV ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV) for each patient after manual tracing of the endo-and epicardial contours in DSCT, CE-Echo and CMR cine images. Student's t-test for paired samples for differences, and Bland and Altman plots and Lin's concordance-correlation coefficients (CCC) for agreement were calculated. Results: There was no statistical difference between left ventricular parameters determined by DSCT and CMR. CE-Echo resulted in significant underestimation of left ventricular volumes (mean difference EDV: 15.94 +/- 14.19 ml and 17.1 +/- 17.06 ml, ESV: 8.5 +/- 9.3 and 7.32 +/- 9.14 ml with respect to DSCT and CMR), and overestimation of EF compared with the cross-sectional imaging modalities (3.78 +/- 8.47% and 2.14 +/- 8.35% with respect to DSCT and CMR). Concordance correlation coefficients for LV parameters using DSCT and CMR were higher (CCC >= 0.75) than CCC values observed between CE-Echo and DSCT- or CMR-derived data (CCC >= 0.54 and CCC >= 0.49, respectively). Interobserver agreement was higher for DSCT and CMR values (CCC >= 0.72 and CCC >= 0.87, respectively). Conclusion: In orthotopic heart transplantation cardiac DSCT allows accurate and reliable estimation of LV parameters compared with CMR, whereas CE-Echo seems to be insufficient to obtain precise measurements. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
Revista:
INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
ISSN:
1569-9293
Año:
2012
Vol.:
14
N°:
4
Págs.:
457-462
Despite a more physiological morphology of atrial anastomosis in the bicaval technique with respect to standard biatrial anastomosis in orthotopic heart transplantation (OHT), the impact on the long-term outcome is still not clear. In this retrospective study, we sought to investigate the morphology and function of the atria through magnetic resonance imaging (MRI) and transthoracic echocardiography (TIE). Moreover, we aimed to analyse the accuracy of TIE with respect to MRI. Cox regression analysis of 216 consecutive patients receiving OHT between August 1987 and January 2010 identified only recipient age at the time of transplant to be an independent predictor of mortality (P = 0.048, odds ratio = 1.04). After a mean follow-up of 96.6 +/- 77.7 months, 108 patients were alive, of which 35 were found to be eligible for MRI assessment. In this analysis, left and right atrial volumes were found to be significantly larger in the standard group in comparison with the bicaval group (P = 0.001), and no significant difference between the two techniques was observed in left and right atrio-ventricular output. Moreover, a significantly reduced accuracy was observed (CCC < 0.3) when TIE results were compared with MRI assessment in evaluating atrial dimensions. Although left and right atrial volumes are significantly larger in the standard group in comparison with the bicaval group, we concluded that no significant difference in the atrial output and survival between the two techniques could be demonstrated.
Revista:
ACTA RADIOLOGICA
ISSN:
0284-1851
Año:
2012
Vol.:
53
N°:
5
Págs.:
536-540
Background: Epicardial adipose tissue (EAT) is an important indicator of cardiovascular risk. This parameter is generally assessed on ECG-gated computed tomography (CT) images. Purpose: To evaluate feasibility and reliability of EAT quantification on non-gated thoracic low-radiationdose CT examinations with respect to prospectively ECG-gated cardiac CT acquisition. Material and Methods: Sixty consecutive asymptomatic smokers (47 men; mean age 64 +/- 9.8 years) underwent low-dose CT of the chest and prospectively ECG-gated cardiac CT acquisitions (64-slice dual-source CT). The two examinations were reconstructed with the same range, field of view, slice thickness, and convolution algorithm. Two independent observers blindly quantified EAT volume using commercially available software. Data were compared with paired sample Student t-test, concordance correlation coefficients (CCC), and Bland-Altman plots. Results: No statistically significant difference was observed for EAT volume quantification with low-dose-CT (141.7 +/- 58.3 mL) with respect to ECG-gated CT (142.7 +/- 57.9 mL). Estimation of CCC showed almost perfect concordance between the two techniques for EAT-volume assessment (CCC, 0.99; mean difference, 0.98 +/- 5.1 mL). Inter-observer agreement for EAT volume estimation was CCC: 0.96 for low-dose-CT examinations and 0.95 for ECG-gated CT. Conclusion: Non-gated low-dose CT allows quantifying EAT with almost the same concordance and reliability as using dedicated prospectively ECG-gated cardiac CT acquisition protocols.
Revista:
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
ISSN:
1010-7940
Año:
2012
Vol.:
41
N°:
1
Págs.:
134 - 136
Left atrial appendage (LAA) plays a crucial role as a source of atrial thrombus in patients with atrial fibrillation (AF). Thus, the need to close LAA becomes evident in patients with AF who undergo concomitant mitral valve surgery. Unfortunately, it has been reported a high rate of unsuccessful LAA occlusion, regardless of the technique employed. We propose a safe and simple method for LAA occlusion consisting in invagination of the appendage into the left atrium, followed by two sutures (purse string suture around the base of the LAA and a reinforce running suture).
Autores:
Takx, RA; Moscariello, A; Schoepf, UJ; et al.
Revista:
EUROPEAN JOURNAL OF RADIOLOGY
ISSN:
0720-048X
Año:
2012
Vol.:
81
N°:
4
Págs.:
e598 - 604
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2012
Vol.:
35
N°:
2
Págs.:
323 - 327
Penetrating aortic ulcer (PAU) has been defined as an atherosclerotic plaque ulceration that breaks the internal elastic lamina of the aorta, which may progress to a wall hematoma or aortic dissection in case of blood seeping into the middle layer. Although PAU is commonly located in the descending aorta, the involvement of the ascending aorta can be fatal. Therefore, surgery is indicated even in asymptomatic patients presenting an ascending PAU. We report on an asymptomatic patient with ascending PAU referred for replacement of the ascending aorta with a composite prosthetic graft.
Revista:
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
ISSN:
1873-734X
Año:
2011
Vol.:
40
N°:
1
Págs.:
62 - 66
Revista:
ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN:
1137-6627
Año:
2011
Vol.:
34
N°:
2
Págs.:
295 - 300
The right aberrant subclavian artery or "arteria lusoria" is the most common anatomical variant of the embryonic development of the aorta and its branches, with a presence in 0.5-2% of the population. Less frequently, a right aortic arch with aberrant left subclavian artery may be present. These anatomical variations should be included in the differential diagnosis of superior mediastinal widening seen on chest radiographs. In this report, we present a right aortic arch with left aberrant subclavian artery dilated at its origin (Kommerell's diverticulum) as a cause of superior mediastinal widening detected incidentally on a chest radiograph.
Autores:
Kang, DK; Thilo, C; Schoepf, UJ; et al.
Revista:
JACC-CARDIOVASCULAR IMAGING
ISSN:
1936-878X
Año:
2011
Vol.:
8
N°:
4
Págs.:
841 - 849
Autores:
Blackmon, KN; Florin, C; Bogoni, L; et al.
Revista:
European Radiology
ISSN:
0938-7994
Año:
2011
Vol.:
21
N°:
6
Págs.:
1214 - 1223
Autores:
Nance, JW; Bamberg, F; Schoepf, UJ; et al.
Revista:
RADIOLOGY
ISSN:
0033-8419
Año:
2011
Vol.:
260
N°:
2
Págs.:
373 - 380
Revista:
CHEST
ISSN:
0012-3692
Año:
2011
Vol.:
139
N°:
1
Págs.:
36 - 42
Phenotypic characterization of patients with COPD may have potential prognostic and therapeutic implications. Available information on the relationship between emphysema and the clinical presentation in patients with COPD is limited to advanced stages of the disease. The objective of this study was to describe emphysema presence, severity, and distribution and its impact on clinical presentation of patients with mild to moderate COPD. METHODS: One hundred fifteen patients with COPD underwent clinical and chest CT scan evaluation for the presence, severity, and distribution of emphysema. Patients with and without emphysema and with different forms of emphysema distribution (upper/lower/core/peel) were compared. The impact of emphysema severity and distribution on clinical presentation was determined. RESULTS: Fifty percent of the patients had mild homogeneously distributed emphysema (1.84; 0.76%-4.77%). Upper and core zones had the more severe degree of emphysema. Patients with emphysema were older, more frequently men, and had lower FEV(1)%, higher total lung capacity percentage, and lower diffusing capacity of the lung for carbon monoxide. No differences were found between the clinical or physiologic parameters of the different emphysema distributions. CONCLUSIONS: In patients with mild to moderate COPD, although the presence of emphysema has an impact on physiologic presentation, its severity and distribution seem to have little impact on clinical presentation.
Revista:
European Radiology
ISSN:
0938-7994
Año:
2011
Vol.:
21
N°:
5
Págs.:
954-962
Revista:
JOURNAL OF BRONCHOLOGY & INTERVENTIONAL PULMONOLOGY
ISSN:
1944-6586
Año:
2011
Vol.:
18
N°:
1
Págs.:
7 - 14
Objective: The objective of our study was to investigate whether fluorodeoxyglucose (FDG) positron emission tomography scanning uptake impacts the yield of transbronchial needle aspiration (TBNA).
Methods: We carried out a retrospective analysis of data from 140 consecutive patients (178 lymph nodes) undergoing positron emission tomography-computed tomography scanning and subsequent TBNA with rapid onsite cytologic evaluation of the specimen. Patient and lymph node characteristics, including nodal station, size, FDG uptake, number of passes with the needle, sample adequacy, and the final diagnosis were recorded.
Results: The diagnostic yield of TBNA was 75%. Themean short axis lymph node diameter was 18.7+/-9 mm and mean maximum standardized uptake value (SUVmax) was 7.7+/-4. The diagnostic yield depended on the lymph node size [odds ratio (OR)=1.07 (1.00-1.14); P=0.04], clinical suspicion of malignancy [OR=5.13 (1.95-13.52); P=0.001], malignant diagnosis [OR=4.91 (1.71-14.09); P=0.003], and FDG uptake [for SUVmax cutoff of 3.0: OR=33.8 (9.2-124); P<0.001]. Only clinical suspicion of cancer [OR=6.2 (2.2-17.2); P=0.001] and FDG uptake [for SUVmax cutoff of 3.0: OR=33.8 (9.2-123.8); P<0.001] remained significant on multivariate analysis. Receiver operating characteristic curves combining 3 key variables (lymph node size, clinical suspicion of malignancy, and SUVmax) showed an area of 0.83 under the curve for a 2.5 SUVmax cutoff and 0.84 for a 3.0 cutoff.
Conclusions: FDG uptake is the single most important variable impacting the TBNA yield. TBNA of lymph nodes with an SUVmax less than 3.0 is rarely diagnostic.
Revista:
JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY
ISSN:
0363-8715
Año:
2011
Vol.:
35
N°:
1
Págs.:
119 - 125
Revista:
INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
ISSN:
1569-9293
Año:
2011
Vol.:
12
N°:
3
Págs.:
490 - 491
We report a case of an unusual congenital triad consisting of absence of coronary sinus, persistent left superior vena cava and scimitar syndrome incidentally found in a CT-scan performed on a female complaining of exertional dyspnea
Revista:
Cardiology Review
ISSN:
1092-6607
Año:
2011
Vol.:
18
N°:
5
Págs.:
219 - 229
Revista:
Academic Radiology
ISSN:
1076-6332
Año:
2011
Vol.:
18
N°:
11
Págs.:
1382-1390
Revista:
European Radiology
ISSN:
0938-7994
Año:
2011
Vol.:
21
N°:
9
Págs.:
1887 - 1894
Revista:
Journal of Cardiovascular computed tomography
ISSN:
1934-5925
Año:
2010
Vol.:
4
N°:
2
Págs.:
127 - 135
Revista:
Investigative Radiology
ISSN:
0020-9996
Año:
2010
Vol.:
45
N°:
6
Págs.:
306 - 313
Revista:
Investigative Radiology
ISSN:
0020-9996
Año:
2010
Vol.:
45
N°:
2
Págs.:
72 - 76
Introduction: To compare left atrial performance with dual-source CT (DSCT) with respect to magnetic resonance imaging (MRI) in orthotopic heart transplant recipients.
Methods: Twenty-nine consecutive heart transplant recipients (27 male,mean age 64.1 +/- 13 years; mean time from transplantation 122.8 +/- 69.7 months) referred for exclusion of cardiac allograft vasculopathy underwent cardiac DSCT and MRI. Standard biatrial technique was employed in 13 subjects whereas 16 were transplanted after the bicaval technique. Axial 5-mm slice-thickness DSCT datasets reconstructed in 5% steps of the cardiac cycle and axial 5-mm SSFP-MRI images were analyzed. Two blinded readers manually traced left atrial contours in random order to estimate end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF). Parameters were compared with a paired sample Student t test. Concordance correlation coefficient (CCC) was calculated to determine measurement agreement between techniques and observers.
Results: Left atrial volumes were significantly higher with cardiac DSCT (EDV: 170.9 +/- 78.1 mL; ESV: 139.5 +/- 76.6 mL) than with MRI (EDV: 158.2 +/- 72.5 mL; ESV: 124.2 +/- 68.2 mL), whereas left atrial EF was lower with DSCT (EF: 20.8% +/- 7.5% vs. 23.6% +/- 7.7%) (P < 0.05). Measurement agreement between DSCT and MRI was excellent for all parameters (CCC >= 0.82). Individuals operated with the biatrial anastomosis technique presented significantly higher left atrial volumes and lower EF compared with subjects with bicaval anastomosis. Interobserver agreement was excellent for all parameters (CCC >= 0.80).
Conclusion: Even if DSCT slightly overestimates left atrial volumes with respect to MRI, results remain clinically valid. Bicaval surgical technique offers improved left atrial performance compared with standard biatrial anastomosis. DSCT may be used as a reliable tool to estimate left atrial parameters in orthotopic heart transplant recipients.
Revista:
JOURNAL OF THORACIC IMAGING
ISSN:
0883-5993
Año:
2010
Vol.:
25
N°:
3
Págs.:
221 - 230
Revista:
Radiologia
ISSN:
0033-8338
Año:
2010
Vol.:
52
N°:
5
Págs.:
469 - 472
Revista:
CHEST
ISSN:
0012-3692
Año:
2010
Vol.:
138
N°:
6
Págs.:
1316 - 1321
Revista:
SEMIN ULTRASOUND CT
ISSN:
0887-2171
Año:
2010
Vol.:
31
N°:
4
Págs.:
276 - 291
Revista:
Radiologic clinics of North America
ISSN:
0033-8389
Año:
2010
Vol.:
48
N°:
4
Págs.:
729 - 744
Revista:
INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
ISSN:
1569-9293
Año:
2010
Vol.:
11
N°:
4
Págs.:
499 - 500
Revista:
AMERICAN JOURNAL OF ROENTGENOLOGY
ISSN:
0361-803X
Año:
2010
Vol.:
194
Págs.:
W244-W245
Revista:
JOURNAL OF THORACIC IMAGING
ISSN:
0883-5993
Año:
2010
Vol.:
25
N°:
4
Págs.:
115 - 117
Anomalies of the course of the right coronary artery are relatively rare but are diagnosed with increasing frequency by noninvasive coronary computed tomography angiography. Although most findings of right coronary artery anomalies are inconsequential, there are certain variants that can result in catastrophic complications during surgical or interventional procedures if not recognized. We present a case of intra-atrial course of the right coronary artery noninvasively diagnosed by dual-source computed tomography coronary angiography
Revista:
European Radiology
ISSN:
0938-7994
Año:
2010
Vol.:
20
N°:
11
Págs.:
2600 - 2608
Objectives
To evaluate the feasibility of using automatic quantitative analysis of breath hold gated micro-CT images to detect and monitor disease in a mouse model of chronic pulmonary inflammation, and to compare image-based measurements with pulmonary function tests and histomorphometry.
Material and methods
Forty-nine A/J mice were used, divided into control and inflammation groups. Chronic inflammation was induced by silica aspiration. Fourteen animals were imaged at baseline, and 4, 14, and 34 weeks after silica aspiration, using micro-CT synchronized with ventilator-induced breath holds. Lung input impedance was measured as well using forced oscillation techniques. Five additional animals from each group were killed after micro-CT for comparison with histomorphometry.
Results
At all time points, micro-CT measurements show statistically significant differences between the two groups, while first differences in functional test parameters appear at 14 weeks. Micro-CT measurements correlate well with histomorphometry and discriminate diseased and healthy groups better than functional tests.
Conclusion
Longitudinal studies using breath hold gated micro-CT are feasible on the silica-induced model of chronic pulmonary inflammation, and automatic measurements from micro-CT images correlate well with histomorphometry, being more sensitive than functional tests to detect lung damage in this model.
Revista:
American Journal Roentgenology
ISSN:
0361-803X
Año:
2010
Vol.:
194
N°:
3
Págs.:
599 - 603
Autores:
Henzler, T.; Hanley, M.; Arnoldi, E.; et al.
Revista:
JOURNAL OF THORACIC IMAGING
ISSN:
0883-5993
Año:
2010
Vol.:
25
N°:
3
Págs.:
213 - 220
Revista:
JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY
ISSN:
1748-6815
Año:
2010
Vol.:
63
N°:
2
Págs.:
298 - 304
Revista:
Academic Radiology
ISSN:
1076-6332
Año:
2010
Vol.:
17
N°:
6
Págs.:
727 - 734
Autores:
Schutt, DJ; Swindle, MM; Helke, KL; et al.
Revista:
IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING
ISSN:
0018-9294
Año:
2010
Vol.:
57
N°:
3
Págs.:
746 - 753
