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Background The widespread use of cardiac computed tomography (CT) has increased the incidental discovery of fistulas of the coronary artery (CAF). This condition is rare and can affect hemodynamic parameters, but few reports focus on its hemodynamic effects. We investigated the frequency and types of CAF on CT and compared them with those of transthoracic echocardiography (TTE) to evaluate the detectability of CAF and its hemodynamic effects. Materials and methods We retrospectively evaluated cardiac CT images of 6789 adult patients who underwent imaging from January 1, 2013 through September 30, 2019 at our institution. We assessed the CT images for the presence of CAF and compared our findings with those obtained by TTE in control cases without CAF. Results The prevalence of CAF determined with cardiac CT was 0.91%, with the left anterior descending artery (67.7%) as the most common site of origin and the main pulmonary artery (82.3%) as the most common origin of drainage. The incidence of aneurysm accompanying CAF was 48.4%. Color Doppler in TTE demonstrated abnormal flow that would suggest the presence of CAF of only 23.1%. Echocardiographic findings of hemodynamics did not differ significantly between patients with and without CAF nor between elderly and non-elderly patients with CAF. Conclusions Our study revealed differing prevalence and types of CAF from those reported using coronary angiography and little impact of CAF on hemodynamics. Color Doppler in TTE did not readily depict abnormal flow that might suggest the presence of a fistula, but cardiac CT allowed noninvasive and comprehensive assessment of CAF. Thus, we believe the acquisition of cardiac CT is necessary to establish the cause of continuous murmur that is not identified with TTE.

Anticoagulation in venous thrombosis associated with Behçet disease (BD) is controversial. We herein report a 47-year-old woman with vessel thrombosis and pulmonary artery aneurysm (PAA) associated with BD who died of massive hemoptysis under oral anticoagulant. Although she was initially diagnosed with oral contraceptive-induced venous thromboembolism, a subsequent investigation led to a diagnosis of BD. Follow-up computed tomography (CT) showed persistent thrombus, so anticoagulant was continued for persistent thrombus. She died of massive hemoptysis after the development of PAA was identified on follow-up CT during the period of anticoagulation. Great care to prevent bleeding events is required when administering anticoagulants for BD with vessel thrombosis.

We evaluated possible association of decreased psoas muscle area (PMA) after endovascular aneurysm repair (EVAR) by measuring the area of muscle in computed tomographic (CT) images. We retrospectively reviewed CT images of 201 consecutive patients who underwent EVAR at our institution between April 1, 2015, and November 9, 2018, and compared them with images of 75 consecutive patients with no history of EVAR, who served as controls and underwent thoracic endovascular aortic repair (TEVAR) during the same period. We investigated EVAR and possible associated factors that might be potential predictors of decrease in PMA. Those patients with a history of EVAR demonstrated significantly greater mean decrease in PMA than those with a history of TEVAR after the repair procedure (mean 6.25% (8.5); P

Purpose The aim of this study was to identify possible predictors for findings of left atrial appendage (LAA) filling defects in patients with atrial fibrillation (AF) on cardiac computed tomography (CT). Materials and methods We retrospectively evaluated findings of LAA filling defects on the early phase of cardiac CT of 63 patients with history of AF and compared those images with those of 63 control subjects. We investigated potential predictors for LAA filling defects. Results Filling defects of the LAA correlated significantly with patient history of persistent AF (P = 0.045; odds ratio [OR], 3.17), chicken wing morphology (P = 0.013; OR, 4.12), and with LAA volume (P = 0.0032; OR, 1.19) of 12.53 cm or greater (sensitivity, 87.3%; specificity, 69.8%). Conclusions We observed persistent AF, the chicken wing type of LAA morphology, and LAA volume as independent predictors of LAA filling defects on cardiac CT. These findings might improve cardiac CT scanning protocol.

PurposeCardiac computed tomography (CT) depiction of the relationship between spontaneous echocardiographic contrast (SEC) and findings of the left atrial appendage (LAA) has not been reported. We evaluated predictors of SEC within the LAA using findings of cardiac CT in patients with atrial fibrillation (AF).MethodsWe retrospectively analyzed cardiac CT findings of the LAA, including morphology, volume, and filling defects, of 641 patients who underwent Transesophageal echocardiography (TEE) prior to pulmonary vein isolation (PVI) from January 6, 2013 through December 16, 2019 at our institution. We investigated potential associated factors that might be predictors of SEC and computed a receiver operator characteristic,choosing a threshold value at which the likelihood of SEC could be predicted based on the LAA volume indexed for body size.ResultsSEC correlated significantly with history of persistent AF (PP =0.003; OR, 2.83; 95% CI, 1.43–5.62), LAAFV (PP = 0.001; OR, 1.18; 95% CI, 1.07–1.30) of 8.04 cm3/m2 or greater (sensitivity, 75.0%; specificity, 48.7%).The addition of LAAFV to indexed LAA volume increased the area under the receiver operator characteristic curve from 0.642 to 0.724 (P< 0.001).ConclusionFindings of LAA in cardiac CT might allow the noninvasive estimation of SEC and additional information for risk stratification and management of thromboembolic events in patients with AF.

Filling defects within the left atrial appendage (LAA) restricted to the early phase of computed tomography (CT) are not highly specific to the presence of thrombosis. The true significance of LAA early filling defects without thrombus remains uncertain. We evaluated the predictors of LAA early filling defects on echocardiography and cardiac CT findings in patients with atrial fibrillation (AF).Cardiac CT findings of 641 patients with AF who underwent transesophageal echocardiography prior to pulmonary vein isolation from 6 January 2013 to 16 December 2019 at our institution were retrospectively analyzed. We investigated potential predictors of LAA early filling defects and computed the receiver operator characteristics, choosing a threshold value at which the likelihood of LAA early filling defects could be predicted.Early filling defects within the LAA correlated significantly with a history of persistent AF [p = 0.014; odds ratio (OR), 2.36; 95% confidence interval (CI), 1.19-4.66), low left ventricular ejection fraction (p = 0.009; OR, 2.62; 95% CI, 1.28-5.38), diminished LAA flow velocity (p0.001; OR, 0.97; 95% CI, 0.96-0.99) below 45.3 cm/s (sensitivity, 63.6%; specificity, 72.4%), and increased indexed LAA volume (p = 0.001; OR, 1.18; 95% CI, 1.07-1.30) ≥7.64 cm3/m2 (sensitivity, 70.5%; specificity, 69.0%).Early filling defects within the LAA on cardiac CT were associated with LAA function including risk factors for thrombus development, which could lead to noninvasive estimation of LAA function and additional information for risk stratification of thromboembolic events in patients with AF.

The purpose of this study was to identify critical technical points that lead to increased ball speed in a maximal toe kick with no run-up (a 'static kick') in blind football. Six visually impaired male players and eight sighted male players participated in the experiment. All participants wore a blindfold to fully remove visual information and performed the static kick. The motion was captured three-dimensionally using an optical motion analysis system. Our results demonstrated that ball speed, maximum linear velocity of the kicking-side thigh, and maximum angular velocity of the kicking-side shank for the sighted player group were significantly greater than those for the visually impaired player group. The sighted players tended to perform the static kick in a similar motion pattern, which was characterised by a backwards rotation of the torso to adequately extend the kicking-side hip joint during the back-swing phase and a stable posture of the lower torso on the frontal plane during the forward-swing phase. This motion pattern is critical to both acceleration of the kicking-side foot and orientation of the foot for a more precise ball contact position.

We considered cardiac computed tomography (CT) as a possible alternative modality to echocardiography in the assessment of infective endocarditis (IE). We evaluated the diagnostic capability of preoperative CT. We retrospectively evaluated the depiction of vegetations and perivalvular complications in preoperative cardiac CT images of 14 patients diagnosed with IE who required surgical intervention, who were seen at our institution from May 30, 2008 to February 3, 2017. We compared the CT findings with those of TTE and TEE assessments, and intraoperative findings. Cardiac CT correctly identified intraoperatively proven vegetations in 12 out of 13 (92.3%) patients and demonstrated 100% sensitivity and positive predictive value in depicting vegetations in the aortic valve and 100% sensitivity, specificity, positive predictive value, and negative predictive value in depicting pseudoaneurysm as perivalvular complications. CT offered superior identification of pseudoaneurysm to that with echocardiography and detected vegetations as small as 6 mm in maximal length. Vegetation size correlated well between TEE and CT. Favorable comparison of CT and echocardiography in detecting vegetations and perivalvular complications in patients diagnosed with IE suggested potential for expansion in the use of CT for evaluating organic lesions in patients suspected or diagnosed with IE.

When chronic aortic dissection (CAD) is associated with aortic dilatation, the risk of aortic rupture increases. We report a case of CAD complicated by acute aortitis that was depicted in contrast-enhanced magnetic resonance imaging (MRI). Contrast-enhanced MRI allows early detection of subtle changes in the aortic wall as well as disease activity. Inflammation of aortic wall in the aortic dissection can be at higher risk of the dissected aortic expansion and rupture. When we recognize inflammation of unknown origin with CAD, contrast-enhanced MRI should be performed to rule out CAD complicated by acute aortitis may lead to catastrophic complications.

Background Fabry disease is one of the causes of left ventricular hypertrophy (LVH) and can be treated with enzyme replacement therapy or pharmacological chaperone therapy. Late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) can identify myocardial fibrosis and be used for the stratification in LVH. However, the details of the prevalence and characteristics of LGE in Japanese Fabry patients have not been reported. Methods We evaluated myocardial involvement in 26 Fabry patients (10 males, 16 females) using gadolinium-enhanced CMR. LGE areas were analyzed using the previously reported scoring method. Echocardiography was also performed to evaluate the left ventricular function and left ventricular mass. Results LGE on CMR images was positive in 5 out of 26 patients, and all patients with LGE-positive findings suffered from LVH (2 out of 5 male patients and 3 out of 4 female patients with LVH on echocardiography). LGE was specifically localized at the mid-wall in the infero-lateral area of the left ventricle. LGE-positive patients seemed to be older, and tended to have a larger left ventricular mass index and higher B-type natriuretic peptide level than LGE-negative patients. Conclusions These results revealed that specific localization of LGE was present in Fabry patients.

Nonatherosclerotic coronary artery disease is rare but often produces severe and life-threatening complications, including coronary artery aneurysm, spasm, dissections, stenosis, or intraluminal thrombosis, that may occur at a young age and are often silent in the early stages of disease. Accurate diagnosis and proper patient management require the recognition by clinicians of the CT findings associated with these complications.

Filling defects of the left atrial appendage (LAA) on multidetector computed tomography (MDCT) are known to occur, not only due to LAA thrombi formation, but also due to the disturbance of blood flow in the LAA of patients with atrial fibrillation (AF). The purpose of this study was to evaluate the impact of the maintenance of sinus rhythm via ablation on the incidence of LAA filling defects on MDCT in patients with AF. A total of 459 consecutive patients were included in the present study. Prior to ablation, MDCT and transesophageal echocardiography (TEE) were performed. AF ablation was performed in patients without LAA thrombi confirmed on TEE. The LAA filling defects were evaluated on MDCT at 3 months after ablation. LAA filling defects were detected on MDCT in 51 patients (11.1 %), among whom the absence of LAA thrombi was confirmed in 42 patients using TEE. The LAA Doppler velocity in patients with LAA filling defects was lower than that of patients without filling defects (0.61 ± 0.19 vs. 0.47 ± 0.21 m/s; P

Epicardial adipose tissue (EAT) is implicated in the development of coronary atherosclerosis by secretion of inflammatory adipocytokines. Recent studies have shown significantly higher EAT volume in psoriatic patients compared with that in control subjects, but this has not been validated in Japanese patients. We enrolled 86 Japanese patients with moderate to severe psoriasis vulgaris and 31 control subjects, and evaluated EAT volume and coronary artery calcification (CAC) by retrospectively assessing non-enhanced computed tomography obtained through routine examinations. Both mean EAT volume and mean CAC score were not significantly different between the two groups. Interestingly, however, a subanalysis with those of 50 years of age or less (28 psoriatic patients and seven non-psoriatic subjects) showed significantly higher mean EAT volume in psoriatic patients. Similarly, the ratio of the presence of at least one CAC was significantly higher in this group. Our findings suggest that Japanese psoriatic patients should also be aware of the cardiovascular risk, and EAT volume and CAC may be useful tools to predict such risk.

The aim of this study was to analyze the frequency and appearances of coronary sinus (CS) anomalies on cardiac computed tomography (CT) of adult patients and to compare them with transthoracic echocardiography (TTE) findings. We retrospectively evaluated cardiac CT images for the presence of CS anomalies in 6936 adult patients who underwent imaging from April 1 2008 to March 31 2015 at our institution. We also reviewed and compared with TTE findings for the cases of CS anomalies. CS anomalies were diagnosed in 23 of the 6936 (0.33 %) and included persistence of the left superior vena cava (PLSVC) in 19 cases, unroofed CS (UCS) in two, coronary artery-CS fistula in two, and CS atresia in one. TTE revealed CS dilatation in only five of the 16 cases of PLSVC and suggested CS anomaly in the two cases of coronary artery-CS fistula. The other cases of CS anomaly were detected incidentally on CT. The incidence of CS anomalies was 0.33 %. Precise diagnosis of CS anomalies with TTE and the original transverse images on cardiac CT alone was difficult for some conditions. We should be alert for the presence of CS anomalies which can cause clinical or procedural complications.

Objectives A diagnostic technique to objectively determine coronary in-stent stenosis was developed with multi(16)-slice computed tomography (MSCT), and it was compared with coronary angiography (CAG) in clinical cases. Background MSCT is expected to replace coronary angiography as a new non-invasive examination. Evaluation of highly calcified or in-stent lesions with CT is generally thought to be difficult. Methods Twenty lesions among 16 consecutive patients that were implanted with coronary stents were examined with both MSCT and CAG at follow-up. The minor axis cross sections of the stents were reconstructed at intervals of 1.5 mm with multiplanar reformation (MPR). The pixel with a higher CT value than the lowest CT value in the standard cross section at the proximal site out of stent was counted to determine the presence/absence of a stenotic lesion. Results Among 20 lesions, one case was not able to be evaluated with MSCT. MSCT correctly detected 3 of 4 cases with in-stent stenosis (sensitivity 75%), and 14 of 16 cases with no in-stent stenosis (specificity 88%, negative predictive value 93%, positive predictive value 75%). If analysis was made per-artery, sensitivity and specificity were 100% (3 of 3) and 87% (13 of 15), respectively, for detection of in-stent stenosis. Conclusions This study was performed to examine a unique diagnostic technique: pixel count method, for coronary in-stent stenosis with MSCT. It showed that the coronary in-stent stenosis could be determined when stent struts were clearly imaged. Further examination is required with various stents, especially those with a diameter of 3.0 mm or smaller.

PURPOSE: Solid tubular carcinoma of the breast is a recognizable histologic type of invasive ductal carcinoma, characterized by rare axillary lymph nodal metastases and a good prognosis. The purpose of this study is to describe the magnetic resonance (MR) characteristics of solid tubular carcinoma and to emphasize the spotty appearance on the MR subtraction images. MATERIALS AND METHODS: We reviewed the MR findings of seven patients with biopsy-proven solid tubular carcinoma. Two of the 7 cases were of the pure type (more than 85% solid tubular component) and the remaining 5 were of the mixed type (50% to 85% solid tubular component). The mean age of the patients was 56 years. RESULTS: The mean size of the lesions was 28 mm. On T1-weighted images four of the lesions were visible and three were not identified. After Gd-DTPA all the lesions were enhanced. On the subtraction images, g" popcorn" appearence areas were noted in the stained mass. CONCLUSION: Our preliminary results suggest that solid tubular carcinomas have a characteristic apperarence on the subtraction MR images.

Summary Background Late gadolinium enhancement (LGE) of cardiac magnetic resonance imaging (MRI) represents myocardial fibrosis and may be related to the clinical outcome of various heart diseases. This study evaluated the relationship between LGE and cardiac events in hypertrophic cardiomyopathy (HCM) using a new scoring method. Methods and results This study retrospectively followed 46 HCM patients without heart failure symptoms for 3.8 ± 1.8 years. Gadolinium-enhanced cardiac MRI was performed in all patients. Cardiac events including newly developed heart failure or ventricular tachyarrhythmia were evaluated during the follow-up period. We evaluated the predictive factors to identify the patients with cardiac events. None of the risk factors reported to be related to poor outcome or the existence of LGE alone could predict cardiac events, which might be due to the small number of subjects investigated in this study. A new scoring method for LGE-positive areas (LGE score) was applied and higher LGE score can predict cardiac events in this study population. Conclusions The proposed LGE score for cardiac MRI is considered to be a potentially valid method for assessing cardiac events in HCM patients.

Background Although oxidative stress by accumulation of reactive oxygen species (ROS) in diabetes has become evident, it remains unclear what genes, involved in redox balance, would determine susceptibility for development of atherosclerosis in diabetes. This study evaluated the effect of genetic polymorphism of enzymes producing or responsible for reducing ROS on coronary artery calcification in type 2 diabetes (T2D). Methods An index for coronary-arteriosclerosis, coronary artery calcium score (CACS) was evaluated in 91 T2D patients using a multi-slice computed tomography. Patients were genotyped for ROS-scavenging enzymes, Glutathione peroxidase-1 (GPx-1), Catalase, Mn-SOD, Cu/Zn-SOD, as well as SNPs of NADPH oxidase as ROS-promoting elements, genes related to onset of T2D (CAPN10, ADRB3, PPAR gamma, FATP4). Age, blood pressure, BMI, HbA1c, lipid and duration of diabetes were evaluated for a multivariate regression analysis. Results CACS with Pro/Leu genotype of the GPx-1 gene was significantly higher than in those with Pro/Pro (744 ± 1,291 vs. 245 ± 399, respectively, p = 0.006). In addition, genotype frequency of Pro/Leu in those with CACS ≥ 1000 was significantly higher than in those with CACS < 1000 (45.5% vs. 18.8%; OR = 3.61, CI = 0.97–13.42; p = 0.045) when tested for deviation from Hardy-Weinberg's equilibrium. Multivariate regression analyses revealed that CACS significantly correlated with GPx-1 genotypes and age. Conclusion The presence of Pro197Leu substitution of the GPx-1 gene may play a crucial role in determining genetic susceptibility to coronary-arteriosclerosis in T2D. The mechanism may be associated with a decreased ability to scavenge ROS with the variant GPx-1.

Kawasaki disease is an acute febrile illness, causing mucosal inflammation, skin rash, and cervical lymphadenopathy, recognized most often in children younger than 4 yr of age. It was first described by Dr. Tomisaku Kawasaki in Japanese literature in 1967 (1), and then in English in 1974 (2). The disease is of unknown etiology that produces a systemic vasculitis, which is most severe in the medium-sized arteries, and especially prominent in the coronary arteries. This can be associated with considerable morbidity and mortality, mostly the result of myocardial involvement and coronary artery complications such as aneurysm, calcification, and stenosis. In Japan as well as in North America, Kawasaki disease is presently a leading cause of acquired heart disease in children (3).

Ikuko Anan,1 Kenichi Hongo,1 Makoto Kawai,1 Kazuo Ogawa,1 Toru Sakuma,2 Kunihiko Fukuda,2 Ikuo Taniguchi,1 Michihiro Yoshimura1 1Division of Cardiology, Department of Internal Medicine, 2Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan Objective: Recent advances in multidetector row computed tomography (MDCT) have made it possible to diagnose coronary stenosis with high sensitivity. However, coronary arterial tonus has not been considered when reading MDCT. We hypothesized that MDCT can document fluctuant tonus of the coronary arteries. Methods: The study population consisted of 39 consecutive patients who underwent MDCT twice in our institution with 64-row dual-source MDCT. Measurements were performed with stretched multiplanar reconstruction images using the full width at half maximum method. The coronary arteries were measured at each segment, and the same measurement was performed in the ascending aorta and the left internal thoracic artery (ITA). The percent diameter changes between the first and second measurements were examined in each segment of the coronary arteries and compared with those in the aorta or the ITA. Results: The average percent diameter changes were statistically equivalent between the coronary arteries and the aorta or the ITA. On the other hand, the percent diameter changes in distribution were significantly larger in the coronary arteries than those in the aorta or the ITA. This suggests that the diameter of the coronary arteries is liable to show variation compared to that of other arteries. Conclusion: This study confirmed for the first time that coronary arteries can fluctuate substantially and that these changes can be documented by MDCT. Changes in coronary arterial tonus should therefore be considered when reading MDCT. Keywords: coronary spastic angina, coronary arterial tonus, false positive study

The urinary acylcarnitine profiles of two mothers whose first children were diagnosed to have glutaric aciduria type 2 (multiple acyl-CoA dehydrogenation deficiency, electron transfer flavoprotein (ETF) deficiency) were analysed in the second pregnancy. Large volumes of tigrylcarnitine and isovalerylcarnitine and a little glutarylcarnitine were detected. Each fetus was also diagnosed to be abnormal by enzyme activity and immunoassay of ETF protein. The acylcarnitines in the mothers' urine disappeared in 1 week after labour or artificial abortion. Acylcarnitines were never detected in the urine of controls.

SAKUMA, T., ASAI, K., ICHIKI, T., SUGIYAMA, N., KIDOUCHI, K. and WADA, Y. Identification of Benzoylcarnitine in the Urine of a Patient of Hyperammonemia. Tohoku J. Exp. Med., 1989, 159 (2), 147-151-Benzoylcarnitine was identified in the urine of a patient with a carbamoyl-phosphate synthase I deficiency for whom sodium benzoate and L-carnitine had been used to treat hyperammonemia. This is a newly identified metabolite of benzoate. Its excretion in the urine was increased day by day at the administration of both sodium benzoate and L- carnitine from 0.10 to 2.25mmol/g creatinine. Since there is the possibility of a secondary carnitine deficiency and an increase of benzoyl toxicity after long-term therapy with benzoate supplementation and protein restriction, it is important to monitor the urinary excretion of benzoylcarnitine.

Two conclusions regarding staphylococcal infections appear to be increasingly clear. One is that staphylococci are producing significant numbers of infections among hospitalized patients in all parts of the civilized world, and the other is that the control of this problem requires more than good medical care of the individually infected patient by his personal physician. The increased concern over staphylococcal disease is evidenced by the number of reports of hospital outbreaks appearing in the medical literature. 1-8 In some hospitals the incidence of infections has reached epidemic proportions, and in others there has been an insidious but definite increase in the number of infections following surgical procedures, complicating viral infections and chronic pulmonary diseases, and associated with the parenteral administration of fluids and drugs. Hospital personnel have contracted infections from patients and in turn spread infection to other patients and members of their families. The relative importance of the various