Search

BACKGROUND. Transthoracic echocardiography (TTE) is the standard of care for initial evaluation of patients with suspected cardioembolic stroke. Although TTE is useful for assessing certain sources of cardiac emboli, its diagnostic capability is limited in the detection of other sources, including left atrial thrombus and aortic plaques. OBJECTIVE. The purpose of this article was to investigate sensitivity, specificity, and predictive value of cardiac CTA (CCTA), cardiac MRI (CMRI), and TTE for recurrence in patients with suspected cardioembolic stroke. METHODS. We retrospectively included 151 patients with suspected cardioembolic stroke who underwent TTE and either CMRI ( n = 75) or CCTA ( n = 76) between January 2013 and May 2017. We evaluated for the presence of left atrial thrombus, left ventricular thrombus, vulnerable aortic plaque, cardiac tumors, and valvular vegetation as causes of cardioembolic stroke. The end point was stroke recurrence. Sensitivity, specificity, PPV, and NPV for recurrent stroke were calculated; the diagnostic accuracy of CMRI, CCTA, and TTE was compared between and within groups using AUC. RESULTS. Twelve and 14 recurrent strokes occurred in the CCTA and CMRI groups, respectively. Sensitivity, specificity, PPV, and NPV were 33.3%, 93.7%, 50.0%, and 88.2% for CCTA; 14.3%, 80.3%, 14.3%, and 80.3% for CMRI; 14.3%, 83.6%, 16.7%, and 80.9% for TTE in the CMRI group; and 8.3%, 93.7%, 20.0%, and 84.5% for TTE in the CCTA group. Accuracy was not different ( p > .05) between CCTA (AUC = 0.63; 95% CI, 0.49-0.77), CMRI (0.53; 95% CI, 0.42-0.63), TTE in the CMRI group (0.51; 95% CI, 0.40-0.61), and TTE in the CCTA group (0.51; 95% CI, 0.42-0.59). In the CCTA group, atrial and ventricular thrombus were detected by CCTA in three patients and TTE in one patient; in the CMRI group, thrombus was detected by CMRI in one patient and TTE in two patients. CONCLUSION. CCTA, CMRI, and TTE showed comparably high specificity and NPV for cardioembolic stroke recurrence. CCTA and CMRI may be valid alternatives to TTE. CCTA may be preferred given potentially better detection of atrial and ventricular thrombus. CLINICAL IMPACT. CCTA and CMRI have similar clinical performance as TTE for predicting cardioembolic stroke recurrence. This observation may be especially important when TTE provides equivocal findings.

Purpose:  To determine the association of asymptomatic diverticular disease as assessed by magnetic resonance imaging (MRI) with adipose tissue compartments, hepatic steatosis and constitutional risk factors within a cohort drawn from a Western general population., Materials and Methods:  Asymptomatic subjects enrolled in a prospective case-control study underwent a 3 Tesla MRI scan, including an isotropic VIBE-Dixon sequence of the entire trunk. The presence and extent of diverticular disease were categorized according to the number of diverticula in each colonic segment in a blinded fashion. The amount of visceral, subcutaneous, and total adipose tissue (VAT, SAT, and TAT) was quantified by MRI. Additionally, the degree of hepatic steatosis, indicated as hepatic proton density fat fraction (hepatic PDFF) was determined using a multi-echo T1w sequence. Constitutional cardiometabolic risk factors were obtained and univariate and multivariate associations were calculated., Results:  A total of 371 subjects were included in the analysis (58.2 % male, 56.2 ± 9.2 years). Based on MRI, 154 participants (41.5 %) had diverticular disease with 62 cases (17 %) being advanced diverticular disease. Subjects with advanced diverticular disease had a significantly higher body mass index (BMI) (BMI: 29.9 ± 5.1 vs. 27.5 ± 4.6, p < 0.001; respectively). Furthermore, all adipose tissue compartments were increased in subjects with advanced diverticular disease (e. g. VAT: 6.0 ± 2.8 vs. 4.2 ± 2.6 and SAT: 9.2 ± 3.6 vs. 7.8 ± 3.6, all p < 0.001, respectively). Similarly, subjects with advanced diverticular disease had significantly higher hepatic PDFF (4.9 [2.7, 11.4] vs. 6.1 [5.5, 14.6], p = 0.002)., Conclusion:  Advanced diverticular disease is associated with an increased volume of adipose tissue compartments and BMI, which may suggest a metabolic role in disease development., Key Points: · Diverticular disease is associated with constitutional risk factors such as BMI.. · Excess of adipose tissue compartments and hepatic steatosis are associated with the prevalence of diverticular disease.. · Our results suggest a shared pathological pathway of cardiometabolic alterations and the prevalence of diverticular disease.. · MRI is feasible for the assessment of adipose tissue compartments, hepatic steatosis, and diverticular disease and allows identification of patients who are at risk but in an asymptomatic disease state.., Citation Format: · Storz C, Rospleszcz S, Askani E et al. Magnetic Resonance Imaging of Diverticular Disease and its Association with Adipose Tissue Compartments and Constitutional Risk Factors in Subjects from a Western General Population. Fortschr Röntgenstr 2021; 193: 33 - 41., Competing Interests: Fabian Bamberg: Speakers Bureau – Siemens Healthineers, Bayer Healthcare; Unrestricted Research Grants – Siemens Healthineers, Bayer Healthcare., (Thieme. All rights reserved.)

Because of a recent increase in survival rates and life expectancy of patients with congenital heart disease (CHD), radiologists are facing new challenges when imaging the peculiar anatomy of individuals with repaired CHD. Cardiac computed tomography and magnetic resonance are paramount noninvasive imaging tools that are useful in assessing patients with repaired CHD, and both techniques are increasingly performed in centers where CHD is not the main specialization. This review provides general radiologists with insight into the main issues of imaging patients with repaired CHD, and the most common findings and complications of each individual pathology and its repair., Competing Interests: Disclosure C.N. De Cecco receives institutional research support and/or honorarium as speaker from Siemens and Bayer. F. Sardanelli received institutional research support and honorarium as speaker from Bracco, Bayer, and General Electric. The other authors have no conflicts of interest to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Prevalence of patients with congenital heart disease (CHD) is rapidly increasing due to continuous advancements in diagnostic techniques and medical or surgical treatment approaches. Along with cardiac computed tomography angiography, cardiac magnetic resonance (CMR) serves as a fundamental imaging modality for pre-surgical planning in patients with CHD, as CMR allows for the evaluation of cardiac and great vessel anatomy, biventricular function, flow dynamics, and tissue characterization. This information is essential for risk-assessment and optimal timing of surgical interventions. This article discusses the current role of pediatric cardiac MR imaging as a practical preoperative assessment tool in the pediatric population., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective:: Some recent studies have explored how the experience in the observers change their performance in the endometriosis detection using MRI but the effects of the clinical information remains uncertain. The purpose of this study was to assess the effect of the clinical information in the diagnostic confidence in the MRI diagnosis of endometriosis., Methods and Materials:: Institutional Review Board was obtained. This study is compliant to STARD method. 80 patients (mean age 32 years; range 19 - 46 years) who had undergone MRI study and surgery for suspected endometriosis were retrospectively evaluated. MRI exams were performed with a 1.5 T scanner and the following five locations were assessed: ovary, anterior compartment, vaginal fornix, utero-sacral ligaments, and Rectum\Sigmoid\Pouch of Douglas. Data sets were evaluated twice on a 5-point scale by four radiologists with different level of expertise; the first time blinded to the clinical information and the second time, after 3 months together with the clinical chart. Statistical analysis included receiver operating characteristics curve analysis, the Cohen weighted test and sensitivity, specificity, positive predictive value, negative predictive value, accuracy, LR+ and LR-., Results:: A total of 140 localization of endometriosis (47 endometriomas and 93 endometriotic nodules) were found. The pairwise comparison demonstrated that in all cases the presence of clinical information improved the Az value. The concordance analysis indicated a mixed pattern from modest agreement (weighted κ value 0.556 for anterior compartment) to excellent agreement values (weighted κ value 0.867 for ovarian endometriomas)., Conclusion:: The results of our study suggest that clinical information is useful in diagnosing endometriosis in general anterior compartment, but not in other locations. Less experienced radiologists (resident) may benefit from it at utero-sacral ligaments or Rectum\Sigmoid\Pouch of Douglas., Advances in Knowledge:: In this era of sometimes indiscriminate use of diagnostic methods, it is important to emphasis the context for interpretation of diagnostic results. Our paper confirms that clinical information is useful in diagnosing endometriosis.

Objectives: Diverticular disease represents an increasing pathology and healthcare burden worldwide. Our aim was to study the prevalence, extent and distribution of asymptomatic diverticular disease assessed by magnetic resonance imaging (MRI) in a sample of a Western population., Methods: Subjects from a population-based cohort study who underwent 3-T MRI were analyzed for the prevalence and extent of diverticula of the colon using an isotropic VIBE-Dixon gradient-echo sequence. The extent of diverticular disease was categorized according to the number of diverticula in each colonic segment. Univariate and adjusted analyses were performed to assess associated characteristics and risk factors., Results: Among 393 subjects included in the analysis (56.4 ± 9.2 years, 57.5% males), 164 (42%) had diverticular disease, with the highest prevalence in the left-sided colonic segments (93% diverticular disease in the descending and sigmoid segment). Subjects with advanced diverticular disease were older (62.1 vs. 54.4 years) and had a higher body mass index (BMI), LDL cholesterol levels and systolic blood pressure (30.2 ± 5.1 vs. 27.8 ± 4.9 kg/m 2 , 149.8 ± 29.3 vs. 135.2 ± 32.9 mg/dl and 128.2 ± 14.1 vs. 118.4 ± 16.1 mmHg, respectively; all p > 0.003) compared with subjects without diverticular disease. In contrast, no significant correlation could be found for gender, physical activity, smoking status and alcohol consumption (all p > 0.31). Intra-rater reliability was excellent for all colonic segments (intra-class correlation [ICC] = 0.99-1.00), and inter-rater reliability was excellent for left- and right-sided colonic segments (ICC = 0.84-0.97)., Conclusions: These findings provide insights into the disease mechanism of asymptomatic diverticular disease and may help to improve prevention of diverticulosis and its associated complications., Key Points: • Overall prevalence of asymptomatic diverticular disease assessed by MRI was 42%, affecting predominantly the left-sided colon. • Asymptomatic diverticular disease was associated with age and cardiometabolic risk factors. • Magnetic resonance imaging reveals insights into the pathophysiologic mechanism of asymptomatic diverticular disease.

To develop a quantitative T1-mapping-based synthetic inversion recovery (IR synth ) approach to calculate the optimal inversion time (TI 0 ) for late gadolinium enhancement (LGE) imaging. Prospectively enrolled patients (n = 130, 58 ± 16 years) underwent cardiac MRI on a 1.5T system including Look-Locker TI-scout (LL), modified LL IR (MOLLI)-based T1-mapping, and LGE acquisitions. Patients were randomized into two groups: LL group (TI-scout followed T1-mapping) or MOLLI group (T1-mapping followed TI-scout). In both groups, the second acquisition was used to determine the TI 0 for LGE. IR synth images were generated from T1-maps between TI = 200-400 ms in 5 ms increments. Image quality was rated on a 3-point scale and the remote/background signal intensity ratio (SIR) was calculated. In the LL group (n = 53), the TI-scout-based TI 0 was significantly shorter compared to IR synth [230 ms (219-242) vs. 280 ms (263-297), P < 0.0001]. The TI 0 used for LGE was set 30-40 ms longer [261 ms (247-276), P < 0.0001] than the TI-scout-based TI 0 , resulting in a TI 0  ~ 20 ms shorter than what was obtained by IR synth (P = 0.0156). In the MOLLI group (n = 63), IR synth -based TI 0 was significantly longer than the TI-scout-based TI 0 [298 ms (262-334) vs. 242 ms (217-267), P = 0.0313]. The quality of myocardial nulling was rated higher [2.4 (2.2-2.5) vs. 2.0 (1.8-2.1), P = 0.0042] and the remote/background SIR was found to be more optimal (1.6 [1.1-2.1] vs. 2.6 [1.8-3.3], P = 0.0256) in the MOLLI group. T1-based IR synth selects TI 0 for LGE more accurately than conventional TI-scout imaging. IR synth improves TI 0 selection by providing excellent visualization of the representative image contrast for LGE images, reducing operator dependence in LGE acquisition.

Myocardial T1-mapping has become feasible over the past decade as emerging technological magnetic resonance imaging advances enable increasingly rapid and reliable acquisition techniques. A variety of T1-mapping sequences are in development, with most allowing for the acquisition of a single-slice T1-map in a single breath-hold. The development of these protocols has spurred investigation into a wide range of potential clinical uses, including the characterization of cardiomyopathies. Although native T1-mapping provides superior tissue characterization, postcontrast T1-mapping is still indispensable for extracellular volume quantification. Ongoing and future studies should investigate the reliability, reproducibility, accuracy, and precision of available techniques and establish disease-specific reference values for T1-mapping-based parameters.

Objectives: To evaluate the influence of inversion time (TI) on the precision of myocardial late gadolinium enhancement (LGE) quantification using synthetic inversion recovery (IR) imaging in patients with myocardial infarction (MI)., Methods: Fifty-three patients with suspected prior MI underwent 1.5-T cardiac MRI with conventional magnitude (MagIR) and phase-sensitive IR (PSIR) LGE imaging and T1 mapping at 15 min post-contrast. T1-based synthetic MagIR and PSIR images were calculated with a TI ranging from -100 to +150 ms at 5-ms intervals relative to the optimal TI (TI 0 ). LGE was quantified using a five standard deviation (5SD) and full width at half-maximum (FWHM) thresholds. Measurements were compared using one-way analysis of variance., Results: The MagIR sy technique provided precise assessment of LGE area at TIs ≥ TI 0 , while precision was decreased below TI 0 . The LGE area showed significant differences at ≤ -25 ms compared to TI 0 using 5SD (P < 0.001) and at ≤ -65 ms using the FWHM approach (P < 0.001). LGE measurements did not show significant difference over the analysed TI range in the PSIR sy images using either of the quantification methods., Conclusions: T1 map-based PSIR sy images provide precise quantification of MI independent of TI at the investigated time point post-contrast. MagIR sy -based MI quantification is precise at TI 0 and at longer TIs while showing decreased precision at TI values below TI 0 ., Key Points: • Synthetic IR imaging retrospectively generates LGE images at any theoretical TI • Synthetic IR imaging can simulate the effect of TI on LGE quantification • Fifteen minutes post-contrast MagIR sy accurately quantifies infarcts from TI 0 to TI 0   + 150 ms • Fifteen minutes post-contrast PSIR sy provides precise infarct size independent of TI • Synthetic IR imaging has further advantages in reducing operator dependence.

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.

Purpose: To evaluate a new dark-blood late gadolinium enhancement (LGE) technique called "T(Rho) And Magnetization transfer and INvErsion Recovery" (TRAMINER) for the ability to detect myocardial LGE versus standard "bright-blood" inversion recovery (SIR) imaging., Materials and Methods: This Institutional Review Board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant prospective study included 40 patients (62 ± 14 years [mean ± standard deviation (SD)], 29 males) with suspected myocardial infarction (MI) referred for the assessment of myocardial viability. The patients underwent a 1.5T cardiac magnetic resonance imaging (MRI) including postcontrast SIR and TRAMINER acquisitions. Normalized images were evaluated by two readers. Subjective (3-point Likert scale) and objective image qualities were compared using Mann-Whitney U-test and paired t-test, respectively. Interobserver agreement, LGE detection rate, and level of certainty were compared using Cohen's kappa, Wilcoxon-test, and Mann-Whitney U-test, respectively. Results are reported as mean ± SD or mean [95% confidence interval]., Results: Overall, image quality was rated similar between TRAMINER and SIR; however, TRAMINER performed better on a visual assessment of the ability to differentiate LGE from blood (Likert scale: 3.0 [3.0-3.0] vs. 2.0 [1.7-2.2], P < 0.0001). TRAMINER provided significantly higher signal intensity range (69.8 ± 10.2 vs. 9.6 ± 7.6, P < 0.0001) and a 4-fold higher signal intensity ratio (4.2 ± 1.9 vs. 1.1 ± 0.1, P < 0.0001) between LGE and blood signals. TRAMINER detected more patients (19/40 vs. 17/40) and segments (91/649 vs. 79/649) with LGE with higher level of certainty (2.9 [2.8-3.0] vs. 2.7 [2.5-2.8], P = 0.0185). Interobserver agreement was good to excellent for LGE detection., Conclusion: TRAMINER provides better contrast between LGE and blood and consequently may have increased ability to discriminate thin subendocardial and papillary muscle enhancement from the blood signal, which can have an indistinct appearance using SIR., Level of Evidence: 2 J. MAGN. RESON. IMAGING 2017;45:1429-1437., (© 2016 International Society for Magnetic Resonance in Medicine.)

Purpose: To compare the accuracy of detection and quantification of myocardial late gadolinium enhancement (LGE) with a synthetic inversion-recovery (IR) approach with that of conventional IR techniques., Materials and Methods: This prospective study was approved by the institutional review board and compliant with HIPAA. All patients gave written informed consent. Between June and November 2014, 43 patients (25 men; mean age, 54 years ± 16) suspected of having previous myocardial infarction underwent magnetic resonance (MR) imaging, including contrast material-enhanced LGE imaging and T1 mapping. Synthetic magnitude and phase-sensitive IR images were generated on the basis of T1 maps. Images were assessed by two readers. Differences in the per-patient and per-segment LGE detection rates between the synthetic and conventional techniques were analyzed with the McNemar test, and the accuracy of LGE quantification was calculated with the paired t test and Bland-Altman statistics. Interreader agreement for the detection and quantification of LGE was analyzed with κ and Bland-Altman statistics, respectively., Results: Seventeen of the 43 patients (39%) had LGE patterns consistent with myocardial infarction. The sensitivity and specificity of synthetic magnitude and phase-sensitive IR techniques in the detection of LGE were 90% and 95%, respectively, with patient-based analysis and 94% and 99%, respectively, with segment-based analysis. The area of LGE measured with synthetic IR techniques showed excellent agreement with that of conventional techniques (4.35 cm(2) ± 1.88 and 4.14 cm(2)± 1.62 for synthetic magnitude and phase-sensitive IR, respectively, compared with 4.25 cm(2) ± 1.92 and 4.22 cm(2) ± 1.86 for conventional magnitude and phase-sensitive IR, respectively; P > .05). Interreader agreement was excellent for the detection (κ > 0.81) and quantification (bias range, -0.34 to 0.40; P > .05) of LGE., Conclusion: The accuracy of the T1 map-based synthetic IR approach in the detection and quantification of myocardial LGE in patients with previous myocardial infarction was similar to that of conventional IR techniques. The use of T1 mapping to derive synthetic LGE images may reduce imaging times and operator dependence in future T1 mapping protocols with full left ventricular coverage., (© RSNA, 2015.)

Transcatheter aortic valve replacement (TAVR) has become an alternative to surgical intervention for symptomatic or severe aortic valve stenosis in patients with high surgical risk. Successful TAVR requires a multimodality imaging approach for appropriate patient selection and prosthesis sizing. Here, we describe individual imaging modalities and report their respective roles in this emerging field. To date, echocardiography remains the traditional test for determining patient candidacy and prosthesis selection, but computed tomography (CT) has been taking on an increasingly important role in the evaluation of both the aortic root anatomy and aortoiliofemoral vessels as a single examination. Cardiac magnetic resonance (CMR) is useful in grading the severity of aortic stenosis and should be considered a reasonable alternative to CT for the evaluation of the aortic annulus, e.g., when the administration of contrast media is contraindicated.

Objective: To evaluate the accuracy, reliability and time saving potential of a novel cardiac CT (CCT)-based, automated software for the assessment of segmental left ventricular function compared to visual and manual quantitative assessment of CCT and cardiac magnetic resonance (CMR)., Methods: Forty-seven patients with suspected or known coronary artery disease (CAD) were enrolled in the study. Wall thickening was calculated. Segmental LV wall motion was automatically calculated and shown as a colour-coded polar map. Processing time for each method was recorded., Results: Mean wall thickness in both systolic and diastolic phases on polar map, CCT, and CMR was 9.2 ± 0.1 mm and 14.9 ± 0.2 mm, 8.9 ± 0.1 mm and 14.5 ± 0.1 mm, 8.3 ± 0.1 mm and 13.6 ± 0.1 mm, respectively. Mean wall thickening was 68.4 ± 1.5 %, 64.8 ± 1.4 % and 67.1 ± 1.4 %, respectively. Agreement for the assessment of LV wall motion between CCT, CMR and polar maps was good. Bland-Altman plots and ICC indicated good agreement between CCT, CMR and automated polar maps of the diastolic and systolic segmental wall thickness and thickening. The processing time using polar map was significantly decreased compared with CCT and CMR., Conclusion: Automated evaluation of segmental LV function with polar maps provides similar measurements to manual CCT and CMR evaluation, albeit with substantially reduced analysis time., Key Points: • Cardiac computed tomography (CCT) can accurately assess segmental left ventricular wall function. • A novel automated software permits accurate and fast evaluation of wall function. • The software may improve the clinical implementation of segmental functional analysis.

Minimally invasive mitral valve (MV) repair and replacement techniques have evolved as increasingly used alternatives to open heart surgery especially in patients unsuitable for surgery or at high perioperative risk. The vast majority of these techniques are still under development, and only a limited number of devices are approved for clinical use; however, they do show promising results in terms of minimizing complications and improving clinical outcome. The complex anatomy of the MV and the annulus complicates not only the development of devices for minimally invasive MV repair or replacement but also complicates preprocedural planning, which is mandatory for minimization of postprocedural complications. Although echocardiography still plays a crucial clinical role, cross-sectional imaging modalities such as coronary computed tomography (CCT) and cardiac magnetic resonance imaging (CMR) are increasingly gaining importance for preprocedural planning. Specifically, CCT seems to be more practicable for preinterventional planning and device sizing, whereas CMR has been shown useful in detecting increased risk for adverse clinical outcomes through delayed gadolinium enhancement and the monitoring of cardiac morphology and function in the framework of follow-up examinations. This article describes recent techniques currently available or under development for minimally invasive repair or replacement of the MV and reviews the current state of CCT and CMR imaging for preinterventional and postinterventional diagnostic workup.

Today's noninvasive imaging of the cardiovascular system has revolutionized the approach to various diseases and has substantially affected prognostic information. Cardiovascular magnetic resonance (MR) and computed tomographic (CT) imaging are at center stage of these approaches, although 5 decades ago, these technologies were unheard of. Both modalities had their inception in the 1970s with a primary focus on noncardiovascular applications. The technical development of the various decades, however, substantially pushed the envelope for cardiovascular MR and CT applications. Within the past 10-15 years, MR and CT technologies have pushed each other in cardiac applications; and without the "rival" modality, neither one would likely not have reached its potential today. This view on the history of MR and CT in the field of cardiovascular applications provides insight into the story of success of applications that once have been ideas only but are at prime time today.

Objective: The aim of this study was to determine whether texture features of rectal cancer on T2-weighted (T2w) magnetic resonance images can predict tumoral response in patients treated with neoadjuvant chemoradiotherapy (CRT)., Materials and Methods: We prospectively enrolled 15 consecutive patients (6 women, 63.2 ± 13.4 years) with rectal cancer, who underwent pretreatment and midtreatment 3-T magnetic resonance imaging. Treatment protocol consisted of neoadjuvant CRT with oxaliplatin and 5-fluorouracile. Texture analysis using a filtration-histogram technique was performed using a commercial research software algorithm (TexRAD Ltd, Somerset, England, United Kingdom) on unenhanced axial T2w images by manually delineating a region of interest around the tumor outline for the largest cross-sectional area. The technique selectively filters and extracts textures at different anatomic scales followed by quantification of the histogram using kurtosis, entropy, skewness, and mean value of positive pixels. After CRT, all patients underwent complete surgical resection and the surgical specimen served as the gold standard., Results: Six patients showed pathological complete response (pCR), and 4 patients, partial response (PR). Five patients were classified as nonresponders (NRs). Pretreatment medium texture-scale quantified as kurtosis was significantly lower in the pCR subgroup in comparison with the PR + NR subgroup (P = 0.01). Midtreatment kurtosis without filtration was significantly higher in pCR in comparison with PR + NR (P = 0.045). The change in kurtosis between midtreatment and pretreatment images was significantly lower in the PR + NR subgroup compared with the pCR subgroup (P = 0.038). Pretreatment area under the receiver operating characteristic curves, to discriminate between pCR and PR + NR, was significantly higher for kurtosis (0.907, P < 0.001) compared with all other parameters. The optimal cutoff value for pretreatment kurtosis was 0.19 or less. Using this value, the sensitivity and specificity for pCR prediction were 100% and 77.8%, respectively., Conclusion: Texture parameters derived from T2w images of rectal cancer have the potential to act as imaging biomarkers of tumoral response to neoadjuvant CRT.

Several imaging options are available today to diagnose endometriosis. Currently, the two techniques most used are sonography and magnetic resonance imaging (MRI). Three-dimensional (3D) sonography has proved to be particularly sensitive in the diagnosis of endometriosis. In recent years, MRI has emerged as a high reproducible method to explore endometriosis; moreover, its capability to evaluate tissue signal is an extremely powerful system in the differential diagnosis with other pathologies and for the identification of malignant degeneration. The purpose of this paper is to present the state-of-the-art of MRI of endometriosis by performing a review of the literature and showing the epidemiology, pathogenesis, and classification of endometriosis. In this work, the technique that should be used, MR findings of endometriosis and the principles of differential diagnosis are explained., (© The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Purpose: The aim of this study was to evaluate and compare the diagnostic confidence of multiphase computed tomography (CT) and magnetic resonance (MR) after administration of gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) in the diagnosis of malignant-benign neoplasm of the liver in operators with different levels of experience., Materials and Methods: Forty patients underwent multiphase CT and MR after administration of Gd-EOB-DTPA. All exams were evaluated by two experienced observers independently; they rated their diagnostic confidence on a five-degree scale: 1 (certainly benign), 2 (probably benign), 3 (uncertain), 4 (probably malignant) and 5 (certainly malignant). Receiver operating characteristic curve analysis and area under the curve (AUC) were carried out for each observer and their difference was tested according to the different methodologies used., Results: In our population, there were 15 malignant neoplasms and 25 benign neoplasms. For the CT analysis, AUC was 0.792 [SE=0.088; 95% confidence interval (CI) 0.634-0.903] and 0.701 (SE=0.099; 95% CI 0.535-0.835) for observers 1 and 2, respectively, whereas for the MR analysis, AUC was 0.923 (SE=0.058; 95% CI 0.793-0.983) and 0.934 (SE=0.054; 95% CI 0.808-0.987). For both observers, a statistically significant difference was found in diagnostic confidence between the AUC of CT and MR (P<0.05)., Conclusion: Our results indicate that, for expert and intermediate experience observers, the diagnostic confidence using MR with Gd-EOB-DTPA is statistically significantly superior to CT with a multiphase technique.

Background: Growing evidence suggests that late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) is an additive marker of disease severity, and possibly of arrhythmic risk, in hypertrophic cardiomyopathy (HCM). We investigated the possible relationship between LGE and markers of myocardial repolarization dispersion in HCM., Methods and Results: Eighty-five HCM outpatients underwent CMR and short-period electrocardiogram analysis to calculate the temporal myocardial repolarization dispersion through the QT variance normalized for QT mean (QTVN) and the QT variability index (QTVI). The QT dispersion in the spatial domain was also obtained. Patients with LGE (62%) had higher left atrial volume, maximum wall thickness, and left ventricular mass (P<0.0001), as well as a greater prevalence of non-sustained ventricular tachycardia (P<0.0001) and hypotensive blood pressure response (P=0.044). Both QTVN and QTVI were higher in the group with LGE (P<0.0001). At multivariate analysis, using QTVI as the dependent variable, %LGE (P<0.0001), age (P<0.0001), left ventricular outflow obstruction (P=0.038), and sudden cardiac death risk factor burden (P=0.020) reached statistical significance. Otherwise, only %LGE (P=0.005) and left ventricular mass index (P=0.015) remained associated with QTVN., Conclusions: Temporal myocardial repolarization dispersion correlates with LGE extent. Whether these variables could be useful in HCM clinical management warrants confirmation by larger prospective studies.

Background: To assess the long-term patency of the biologic prosthetic conduit used for reconstruction of the superior vena cava (SVC) by magnetic resonance imaging (MRI)., Methods: Patients undergoing oncologic resection and reconstruction of the SVC by a bovine pericardial prosthesis (January 2003 to April 2010) have been studied after 1 year (if surviving) by MRI for the assessment of the conduit long-term patency. Results were compared with those of a control group of patients with normal SVC. Blood flow and area of lumen section at 3 different levels (proximal, middle, distal) were analyzed., Results: Sixteen consecutive patients surviving after 1 year from surgery out of 17 (9 lung cancer, 8 mediastinal malignancy) undergoing SVC reconstruction were included. One patient died postoperatively and was not included. Sixteen patients with similar demographic characteristics were studied in the control group. Mean blood flow was 18.4±3.5 mL/sec (range 14.3 to 25.7) in patients with reconstructed SVC and 20.8±4.1 mL/sec (range 15.3 to 27.7) in the control group. Mean area of the conduit lumen section was 2.2±0.6 cm2 (range 1.6 to 3.6) at proximal level, 2.9±1.3 cm2 at middle level (range 1.3 to 5.7), and 2.1±0.9 cm2 (range 0.5 to 4) at distal level in the reconstructed group, and 2.6±0.7 cm2 (range 1.8 to 4.2), 2.7±0.7 cm2 (range 1.9 to 4.3), and 2.4±0.3 cm2 (range 1.8 to 3.1), respectively, at proximal, middle, and distal levels in the control group. Differences between the 2 groups were not significant (p>0.05)., Conclusions: The MRI assessment in terms of blood flow and area of lumen section at 3 different levels confirms that bovine pericardial conduit used for SVC replacement shows an optimal patency over the long term., (Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

A 55-year-old woman referred to Radiology Department, with abdominal mass and chronic indefinite and vague abdominal pain, most severe in right hypochondrium and accentuated during menstruation. A history of two cesarean sections was revealed. The patient underwent an ultrasound and Computed Tomography with intravenous contrast media revealing the presence of gallbladder and abdominal wall hyperenhancing masses. Finally, Magnetic Resonance study with intravenous administration of paramagnetic contrast media confirmed the involvement of gallbladder by a solid tissue and the presence of a solid nodule on the abdominal wall. Considering imaging features and the contrast enhancement of the nodules, the patient was sent to surgery. Surgical removal of both gallbladder and abdominal solid implant was performed and histology confirmed the diagnosis of gallbladder and abdominal wall endometriosis.

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., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To compare the accuracy of cardiac dual-source CT (DSCT) reconstructions obtained at 5% and 10% of the cardiac cycle and MRI for quantifying global left ventricular (LV) function and mass in heart transplant recipients., Material and Methods: We prospectively included 23 heart transplant recipients (21 male, mean age 60±11.7 years) who underwent cardiac DSCT and MRI examinations. We compared LV parameters on cardiac DSCT reconstructions obtained at 5% (0%-95%) and 10% (0%-90%) intervals of the cardiac cycle and on double-oblique short-axis MR images. We determined ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and myocardial mass using commercially available semiautomated segmentation analysis software for DSCT datasets and conventional manual contour tracing for MR studies., Results: Using different reconstruction intervals to quantify LV parameters at DSCT resulted in non-significant differences (P>.05). Compared to MRI, DSCT slightly overestimated LV-EDV, ESV, and mass when both 5% (11.5±25.1ml, 6.8±10.9ml, and 28.3±21.6g, respectively) and 10% (mean difference 15.3±26.3ml, 7.4±11.5ml, and 29.3±18.7g, respectively) reconstruction intervals were used. DSCT and MRI estimates of EF and SV were not significantly different., Conclusion: In heart transplant recipients, DSCT allows reliable quantification of LV function and mass compared with MRI, even using 10% interval reconstructions., (Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.)

A case of an intrapericardial cyst causing heart failure due to right ventricular compression is presented. Characterization of the lesion and its repercussion on right ventricular function by means of state-of-the-art dual source computed tomography (DSCT) and magnetic resonance imaging (MRI) is shown. The diagnosis of intrapericardial cyst was confirmed after surgical excision and biopsy. Usefulness of these noninvasive techniques for the diagnosis of this rare entity is emphasized.