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Objective Myocardial involvement may occur during systemic sclerosis (SSc) and can lead to impaired myocardial contraction and/or arrhythmia. Cardiac magnetic resonance imaging (MRI) is used for noninvasive characterization of the myocardium. The aim of this study was to evaluate the utility of cardiac MRI with intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and longitudinal relaxation time (T1) sequence mapping for assessment of myocardial microvascular and interstitium impairment in SSc. Methods In this single-center prospective cohort study, 40 consecutive patients with SSc and 20 healthy controls were assessed by cardiac MRI with IVIM DWI and T1 mapping sequences on a 3T scanning system. Images were analyzed independently by 2 assessors, and Bland-Altman plots were used to assess interreader concordance and reproducibility. Characteristics of the patients were compared according to quartiles of T1 and perfusion fraction (f-coefficient) values, using exact Cochran-Ermitage trend tests for qualitative variables and analysis of variance for quantitative variables. Kaplan-Meier cardiac events-free survival curves were plotted and compared with a log-rank test for trend. Results T1 values were higher in SSc patients than in healthy controls, and were higher in the diffuse cutaneous SSc (dcSSc) subset (P = 0.02). Higher T1 values were associated with the immunologic pattern seen in patients with the dcSSc form (P = 0.0001), a higher modified Rodnan skin thickness score (MRSS) (P = 0.003), and a higher frequency of interstitial lung disease (P = 0.03). Moreover, higher T1 values were correlated with higher MRSS scores (r = +0.32, P = 0.04) and reduced forced vital capacity (r = -0.34, P = 0.048), and tended to be correlated with reduced total lung capacity (r = -0.30, P = 0.07). Lower f-coefficient values, as a measure of decreased tissue perfusion, were associated with less frequent use of vasodilators (P = 0.02 for angiotensin-converting enzyme inhibitors and P = 0.06 for calcium-channel blockers) and more frequent use of glucocorticoids (P = 0.02). The f-coefficients were inversely correlated with the T1 values (r = -0.31, P = 0.02). Furthermore, higher T1 values were associated with higher incidence of cardiac events (log-rank test for trend P = 0.03). Conclusion Increased T1 values, potentially suggesting microscopic fibrosis, were observed more frequently in patients with dcSSc, and higher T1 values were associated with interstitial lung disease and more frequent cardiac events during follow-up. The results of this study show that cardiac MRI with T1 mapping sequences and IVIM DWI may be useful in assessing myocardial involvement in patients with SSc.

Summary Background Cardiac sarcoidosis (CS) is a severe localization, observed mostly in cardiology departments. Despite appropriate cardiological treatment, CS is a potentially life-threatening condition, and accounts for 13–85% of sarcoidosis-related deaths. Aims This retrospective study aimed to give an overview of CS in a non-cardiac unit, to analyse the effect of first-line immunosuppressive treatment on outcome and survival and to evaluate factors associated with relapses. Methods From 534 cases of sarcoidosis, we selected 59 patients with CS according to “2006 international criteria”. We performed an in-depth analysis regarding symptoms, physical signs and cardiac investigation results. Patients were followed for a median period of 60 months. Results The median age at cardiac signs was 42 years. Echocardiography abnormalities, isotopic defects and abnormal magnetic resonance imaging findings were observed in 81%, 84% and 92% of patients, respectively. First-line treatment included steroids alone in 24 patients and steroids plus immunosuppressive therapy in 35 patients. Forty-seven (80%) patients recovered; 12 stabilized or worsened. The recovery rate was 75% in the steroids alone group versus 83% in the steroids plus immunosuppressive therapy group. Five (9%) patients died during follow-up, with two deaths attributed to CS. The overall 1- and 5-year survival rates were 98% and 92%, respectively. Conclusion Our series of patients with CS who received steroids alone or combined with immunosuppressive therapy had a good prognosis, with an overall 5-year survival rate of 92%. The recovery rate was 85%, with no significant difference between patients treated with steroids alone or plus immunosuppressive therapy.

To measure azygos, portal and aortic flow by two-dimensional cine phase-contrast magnetic resonance imaging (2D-cine PC MRI), and to compare the MRI values to hepatic venous pressure gradient (HVPG) measurements, in patients with cirrhosis. Sixty-nine patients with cirrhosis were prospectively included. All patients underwent HVPG measurements, upper gastrointestinal endoscopy and 2D-cine PC MRI measurements of azygos, portal and aortic blood flow. Univariate and multivariate regression analyses were used to evaluate the correlation between the blood flow and HVPG. The performance of 2D-cine PC MRI to diagnose severe portal hypertension (HVPG ≥ 16 mmHg) was determined by receiver operating characteristic curve (ROC) analysis, and area under the curves (AUC) were compared. Azygos and aortic flow values were associated with HVPG in univariate linear regression model. Azygos flow (p

L’apport de l’IRM cardiaque dans l’approche multimodalite moderne des cardiomyopathies est devenu incontournable.La sequence apportant la plus grande plus-value diagnostique est la sequence de rehaussement tardif myocardique.Les caracteristiques des prises de contraste observees sur cette sequence apportent une orientation etiologique ainsi que des donnees pronostiques que peu d’autres techniques peuvent fournir.

Objectives Specific cardiac involvement in granulomatosis with polyangiitis (GPA) is probably underestimated since many of these conditions are subclinical. The objective of this study was to assess the prevalence and patterns of cardiac abnormalities detected by cardiac MRI (CMRI) in patients with GPA. Methods Thirty-one consecutive patients with newly diagnosed or relapsing GPA underwent CMRI to assess morphological, functional, perfusion at rest and delayed enhancement abnormalities. Results At least one abnormality was observed on CMRI for 19 of 31 patients (61%). Four patients (13%) had an impaired left ventricle ejection fraction (LVEF). LV regional wall motion abnormalities were found in 11 patients (35%). Late gadolinium enhancement (LGE) was detected in 10 of 31 patients (32%). LGE was mostly nodular ( n = 9). Myocardial early contrast enhancement was detected in 5 of the 31 patients (16%), which was systematically associated with LGE in the same territory. CMRI detected pericarditis in eight patients (26%). GPA with

Aims Identification of the cause of out-of-hospital cardiac arrest (OHCA) is of paramount importance. We investigated the ability of our imaging strategy to provide an early etiological diagnosis of OHCA and the influence of this strategy on ICU survival. Methods Retrospective review of a prospectively acquired ICU database (01/2000–12/2010) including all OHCA patients without obvious extracardiac cause, for which an early diagnosis research was conducted (coronary angiography and/or brain and chest CT scan) within 24h after resuscitation. These procedures could be performed separately or be combined, according to a decision algorithm. Results Of the 1274 patients admitted after OHCA during this 10-year period, the imaging strategy was applied in 896 patients. Patients who benefited from coronary angiography and/or CT scan were admitted to our ICU after a median delay of 180 [130–220]min after resuscitation. Seven hundred and forty-five coronary angiographies were performed, of which 452 (61%) identified at least one significant coronary lesion deemed responsible for the OHCA. CT-scan was performed in 355 patients and provided a diagnosis in 72 patients (20%), mainly stroke ( n =38) and pulmonary embolism ( n =19). Overall, this strategy allowed early diagnosis in 524 patients (59%). ICU survival was significantly higher for patients with a diagnosis identified by coronary angiography as compared with CT-scan (43% vs 10%, p Conclusion The use of an early diagnosis protocol with immediate coronary angiography and/or CT scan provided the etiology of nearly two thirds of OHCA cases. In this large retrospective database, coronary angiography yielded a better diagnostic value than brain and/or chest CT-scan.

The purpose of this study is to describe an imaging method based on a CT technique, CT antegrade colonography, for the evaluation of low anastomosis and to evaluate the value of CT antegrade colonography before early ileostomy closure after proctectomy in low rectal endometriosis.One hundred ninety-five patients referred for low rectal endometriosis underwent proctectomy and were eligible for early ileostomy closure. All patients underwent standard antegrade fluoroscopy (n=77) or CT antegrade colonography (n=118) 8 days after surgery. The negative predictive values, positive predictive values, sensitivity, specificity, and likelihood ratio of standard antegrade fluoroscopy and CT antegrade colonography in detecting anastomotic leakage and abscesses were assessed. The reference standard for positive and negative examinations was based on clinical follow-up, imaging, surgical, or interventional procedure findings.Negative and positive predictive values for detecting anastomotic leakage were 100% (95% CI, 96.8-100%) and 100% (95% CI, 39.8-100%), respectively, for CT antegrade colonography and 98.6% (95% CI, 92.4-100%) and 100% (95% CI, 54.1-100%), respectively, for standard antegrade fluoroscopy. The negative and positive predictive values for detecting abscess were 100% (95% CI, 96.8-100%) and 100% (95% CI, 47.8-100%), respectively, for CT antegrade colonography and 97.3% (95% CI, 90.8-99.7%) and 100% (95% CI, 2.5-100%), respectively, for standard antegrade fluoroscopy.CT antegrade colonography may play a major role in the evaluation of low anastomosis protected by an ileostomy after proctectomy in low rectal endometriosis, leading to the development of a new strategy with early restoration of the intestinal continuity.

SummaryHeart involvement, including primary myocardial involvement, is very common in systemic sclerosis. There is strong evidence that primary myocardial involvement is related to repeat focal ischaemic injury causing subsequent irreversible myocardial fibrosis. Clinically evident cardiac involvement is recognized to be a poor prognostic factor; thus preclinical identification is highly encouraged. The severity of heart involvement has been confirmed recently. Echocardiography, including pulsed tissue Doppler echocardiography, is the cornerstone of routine heart assessment. Myocardial perfusion may be assessed by single photon emission computed tomography. If available, cardiac magnetic resonance imaging should be considered as it allows simultaneous measurement of ventricular volumes and function and myocardial perfusion, and assessment of possible inflammation and/or fibrosis. Biological variables, such as B-type natriuretic peptides, are highly relevant, valuable markers of global heart involvement in systemic sclerosis and should be considered for screening of patients and/or research purposes.

Acute coronary syndrome, with an estimated prevalence of 300 000 cases annually in France, is one of the principal diagnostic and therapeutic emergencies in atheroma. In cases of atypical chest pain, with or without signs of severity, coronary, aortic and pulmonary CT should allow emergency specialists to rule out rapidly diagnoses of coronary disease, pulmonary embolism, aortic dissection or other chest conditions. Should acute coronary syndrome develop after immediate therapeutic management, a cardiac MRI will provide the cardiologist with the additional data necessary to assess the patient's prognosis--especially by assessing myocardial viability--and decide on subsequent management. In cases of acute coronary syndrome with normal coronary angiography, cardiac MRI can distinguish myocardial infarction from myocarditis or from Tako Tsubo syndrome.

Sinonasal CT must be studied with both soft tissue and bone algorithms. Sinonasal findings in Wegener's granulomatosis are mucosal thickening, subtotal opacification, air-fluid level, bony destruction (mainly of the nasal septum), and sclerosing osteitis. Orbital MRI helps to define the extent of the disease. Contiguous granulomatous infiltration of the orbit appears dark (hypointense signals) on both T2-weighted-and T1-weighted images, but is enhanced after gadolinium administration. Cerebral MRI findings include diffuse linear dural thickening, enhanced by injection, and local dural thickening contiguous with orbital, nasal and paranasal disease. The remote granulomatous lesions in brain parenchyma are the least common form of central nervous system lesion. The pituitary gland and infundibulum can also be involved in Wegener's granulomatosis. These imaging findings of Wegener's granulomatosis are nonspecific. They should be combined with clinical examination and c-ANCA tests to confirm the diagnosis.

Objective To determine the diagnostic and prognostic significance of cardiac magnetic resonance imaging (CMRI) in a cohort of patients with eosinophilic granulomatosis with polyangiitis (EGPA). Methods We conducted a monocentric retrospective study including 42 EGPA patients who had consecutively undergone CMRI at diagnosis or during follow-up, independently of signs of cardiac involvement. Results Forty-two patients (male 59.5%, mean age at diagnosis 46.5 years) were included. ANCA was positive in 26.2%, and median EGPA duration before the 1st CMRI screening was 5 months. Seventeen (40.5%) were diagnosed with cardiomyopathy, independently of CMRI findings. CMRI showed myocardial late gadolinium enhancement (LGE) in 82.4% patients with cardiomyopathy vs. 44% without cardiomyopathy (P = 0.024). Using LGE as the sole criterion, CMRI sensitivity and specificity for diagnosing cardiomyopathy were 82.4% and 56%, respectively. Among the 15 patients with cardiomyopathy who underwent additional CMRI during follow-up, CMRI-detected cardiac lesions had improved in 7 patients, while those of 8 patients worsened or stabilized despite treatment. These latter patients presented with significantly more cardiac events during follow-up (P = 0.026). No differences were found between non-cardiomyopathic patients with or without CMRI anomalies concerning EGPA cardiac manifestations and outcomes. Conclusion The diagnostic significance of myocardial LGE in EGPA patients remains uncertain and should not be the only criterion for cardiomyopathy diagnosis. For patients with no other signs of cardiomyopathy, CMRI-detected anomalies do not seem to adversely affect prognosis or outcome. For patients with cardiomyopathy, CMRI reassessment seems promising in detecting patients with a less favorable cardiac outcome.

TECHNOLOGICAL PROGRESS: Although cardiac magnetic resonance imaging (MRI) is now recognised as the imaging method of choice for the morphological study of the heart, recent technological progress have widened its indications to functional analysis of the heart rate, perfusion and contractility. FUNCTIONAL ASSESSMENT: The possibility of conducting pharmacological stress tests enhances the functional exploration of cardiac perfusion and contractility. The rapid sequences in apnea, tissue marking and injection of contrast products are all elements that help to refine the study of the locoregional consequences of an ischemia: does the myocardial tissue contract normally? Is it sufficiently perfused? Is it still viable? THE BENEFITS OF A NON-INVASIVE TECHNIQUE: The MRI offers clinicians a non-invasive and non-radiating imaging technique that is the perfect supplement to echocardiography. A reliable angio-coronary LRI technique would, for the first time, permit exploration of the coronary vascularisation, tissue perfusion and resulting contractility.

This study aimed to determine the value of CT, endoscopic sonography, and a combined protocol for preoperative detection of insulinomas.All patients treated in our institution for surgically proven insulinoma between 1987 and 2000 were retrospectively reviewed. Thirty patients with 32 pancreatic insulinomas underwent preoperative CT and endoscopic sonography and were included in the study. These 30 patients also underwent dual-phase thin-section multidetector CT (group 1: n = 15), dual-phase multidetector CT without thin sections (group 2: n = 8), or sequential CT (group 3: n = 7). CT scans were interpreted separately and retrospectively by three radiologists in consensus. Sensitivity values for CT, endoscopic sonography, and a combined protocol were determined.The overall diagnostic sensitivity for dual-phase helical CT was 94.4% for group 1, 57.1% for group 2, and 28.6% for group 3. Endoscopic sonography showed proven insulinomas in 30 of 32 cases (sensitivity, 93.8%). Differences between dual-phase thin-section CT and endoscopic sonography were not statistically significant. The overall diagnostic sensitivity for combined biphasic thin-section helical CT and endoscopic sonography was 100%.The most effective method for revealing insulinomas is a combined imaging protocol that consists of both dual-phase thin-section multidetector CT and endoscopic sonography.

Purpose: To assess the follow-up of patients with sarcoidosis and myocardial MRI abnormalities. Materials and methods: Twelve patients with histologically proven sarcoidosis and highly suspected cardiac involvement underwent initial and 12-month follow-up cardiac assessment including cardiac MRI (T2-weighted, functional gradient echo, and T1-weighted gadoliniumdiethylenetriamine penta-acetic acid-enhanced sequences). MRI abnormalities and clinical and MRI progression were scored by two observers. Results: Six patients receiving corticosteroid therapy (including three patients with clinical cardiac involvement) were scored as having cleared or improved at MRI follow-up, while others were seen to have worsened or remained stable. The stability, improvement, or clearing of MRI findings were correlated with clinically stable, improved or cleared sarcoidosis, while a worsening at MRI follow-up was correlated with a worsening of sarcoidosis and, in one patient, was predictive of clinical cardiac involvement. Conclusion: Cardiac MRI is a useful noninvasive method for the early diagnosis and follow-up of cardiac sarcoidosis. (CHEST 2002; 122:1895–1901)

To prospectively determine whether a relationship exists between magnetic resonance (MR) imaging abnormalities of the right ventricle (RV) and intracardiac electrophysiologic (EP) test results in patients with myotonic dystrophy.Conventional T1-weighted single-shot black-blood fast spin-echo and gradient-echo MR imaging of the heart was prospectively performed in 32 patients with myotonic dystrophy who required EP testing. Patients were divided into two groups according to EP test results: (a) inducible (n = 15), indicating inducible ventricular tachyarrhythmias, and (b) noninducible (n = 17). Morphologic and functional MR data were analyzed by two independent investigators. Nonparametric statistical methods and kappa statistics were used.No morphologic or functional abnormalities of the RV wall were observed in noninducible patients. Increased signal intensity of the RV wall, indicative of fatty replacement, was identified in 13 inducible patients. Myocardial thinning of the RV was observed in six inducible patients. An overlap of morphologically abnormal areas and areas of hypo- or dyskinesis were present in 11 inducible patients. RV outflow tract diameter was larger and RV ejection fraction was smaller in inducible patients than in noninducible patients, although differences were not significant. Interobserver agreement for MR findings was good (increased signal intensity: kappa = 0.87, P.30 [pairwise Wilcoxon signed rank test]; myocardial thinning: kappa = 0.87, P.30; hypo- or dyskinesis: kappa = 1.00, P.99). There was a strong relationship between MR abnormalities and inducibility during EP testing (increased signal intensity, P.001; myocardial thinning, P.01; hypo- or dyskinesis, P.01).The relationship between MR morphologic and functional RV abnormalities and EP testing suggests potential for the use of MR imaging as a noninvasive method to estimate the individual risk of arrhythmia in patients with myotonic dystrophy.

At liver magnetic resonance (MR) imaging in 38 patients, a breath-hold T2-weighted fast spin-echo (SE) pulse sequence optimized with fast recovery was compared with a conventional respiratory-triggered fast SE sequence and a breath-hold single-shot fast SE sequence. Mean signal-to-noise ratios for liver and contrast-to-noise ratios for hepatic lesions were higher with the breath-hold fast-recovery fast SE sequence than with the respiratory-triggered fast SE sequence (P < .05). Breath-hold fast-recovery images displayed better lesion clarity than did single-shot fast SE images (P < .05) and fewer image artifacts than did respiratory-triggered fast SE images (P < .05). The ability to determine lesion size and the overall image quality was best with the breath-hold fast-recovery sequence (P < .05). These results may justify use of the breath-hold fast-recovery fast SE pulse sequence for first-line T2-weighted MR imaging of the liver. © RSNA, 2002

Purpose To compare the reproducibility of left ventricular (LV) mass measurements using a black-blood half-Fourier single-shot fast spin-echo (SSFSE) and a segmented gradient echo magnetic resonance (MR) pulse sequence. Material and Methods Breath-hold SSFSE and segmented gradient echo cardiac MR examinations were performed twice in 32 patients and manual detection of the LV endocardium and epicardium was applied by two blinded reviewers. The SSFSE pulse sequence allowed whole-heart coverage in a single breath hold, while multiple breath holds were required using the segmented gradient echo sequence. Spatial presaturation slabs were used with the SSFSE pulse sequence to reduce the field of view (FOV) and thereby achieve higher spatial resolution. Results Intraclass correlation coefficients were higher with the SSFSE pulse sequence than with the segmented gradient echo pulse sequence: intraobserver reproducibility reached 0.999 vs. 0.991; interobserver reproducibility: 0.997 vs. 0.981; and interstudy reproducibility: 0.998 vs. 0.936. These higher levels of reproducibility were confirmed on Bland and Altman plots. Conclusion LV mass measurements can be assessed more reproducibly with the single breath-hold SSFSE technique than with the standard multiple breath-hold segmented gradient echo method. J. Magn. Reson. Imaging 2002;15:654–660. © 2002 Wiley-Liss, Inc.

Summary Background Because cadaveric organ donors are in short supply, living donors are increasingly being used in transplantations. We have developed a safe and reproducible method for laparoscopic liver resection. Methods Left hepatic lobectomy (resection of segments 2and 3) was done by laparoscopy in one woman aged 27years and one man aged 31 years. The grafts were prepared under laparoscopy, without any vascular clamping, and were externalised through a suprapubic Pfannenstiel incision. Both grafts were transplanted conventionally to the patients' respective sons, who were both aged 1 year and had biliary atresia. Findings Donor operations lasted 7 h for the woman and 6 h for the man, and warm ischaemia times were 4 and 10 min, respectively. Blood loss was 150 and 450 mL, respectively, and no transfusions were required. Neither patient had complications during or after sugery; and hospital stay was 7 and 5 days, respectively. Both recipients are alive and have excellent graft function. Interpretation We have shown the feasibility of laparoscopic living donor hepatectomy from parent to child. If the safety and feasbility of this procedure can be shown in larger series, laparoscopic donor left lobectomy could become a new option for paediatric living donor liver transplantation.

We report a case of severe mitral stenosis caused by Libman-Sacks endocarditis, as an initial manifestation of systemic lupus erythematosus (SLE) in a 20-year-old woman. Cardiac magnetic resonance imaging (MRI) demonstrated a thickening of the mitral valve with basal endocardial thickening exhibiting defect on first-pass perfusion short-axis acquisition and delayed enhancement in keeping with extensive fibrous endocarditis. The patient underwent successful mechanical mitral valve replacement. This case illustrates that MRI is useful in diagnosing this recognised but uncommon cardiac complication of SLE and excluding differential diagnosis such as valve tumour and infective endocarditis with perivalvular abscesses.

A 63-year-old woman was referred to our center for the workup of a 6-month history of diffuse myalgia and severe proximal weakness. Physical examination did not find any sign of heart failure. The patient had a medical history of diabetes mellitus. Serum creatine kinase and aldolase levels were increased at 2262 U/L (normal

Cardiac involvement is frequent in myotonic dystrophy type 2 (DM2) with dilated cardiomyopathy and severe arrhythmias having been reported. Left ventricular non-compaction is a cardiomyopathy often associated with neuromuscular disorders. We report the case of a 61-year-old man with DM2 treated for 5 years for a suspected dilated cardiomyopathy. Echocardiography showed left ventricular non-compaction typical pattern, with prominent apical trabeculations and intertrabecular spaces perfused from ventricular cavity. MRI confirmed the diagnosis. Physicians should be aware of the risk of severe cardiac complications in DM2 patients. Left ventricular non-compaction diagnosis is often overlooked. Neurological examination should be performed in all patients with left ventricular non-compaction.

Summary Introduction Cardiac involvement is a rare manifestation of Wegener granulomatosis (WG). Because its prognosis can be poor, it must be diagnosed early to be treated adequately. We report the disease course of a patient who received rituximab to treat cardiac involvement documented by contrast-enhanced cardiac magnetic resonance imaging (ceCMR). Case This WG patient developed myocarditis with atrioventricular block. CeCMR proved useful in the diagnosis and follow-up of cardiac involvement. Several unsuccessful regimens preceded the prescription of rituximab. Two months later, regression of the myocarditis shown by ceCMR images was correlated with electrophysiological improvement. Discussion CeCMR assessment of a heart conduction defect in a patient with WG showed that this tool was useful for the diagnosis and follow-up of cardiac involvement in this vasculitis. Rituximab was an effective treatment in this patient.

We diagnosed transient left ventricular apical wall motion abnormalities after surgery in a patient presenting with a clinical and electrocardiographic picture of acute myocardial infarction in the absence of significant coronary disease. These angiographic, clinical, and electrocardiographic features satisfied the criteria of the recently described tako-tsubo-like left ventricular dysfunction.

Pancreatic exocrine insufficiency and a reduction in the volume of the pancreas on computed tomography developed in two patients after more than 24 months of sorafenib therapy.

Vignaux O ardiac involvement produces symptoms in only 5% of patients with sarcoidosis, although it has been found to be present as noncaseating granulomatous infiltration of the myocardium at autopsy in 20–50% of these patients [1]. The early initiation of corticosteroid therapy prevents malignant arrhythmia (sudden death accounts for ≤ 60% of the fatalities from cardiac sarcoidosis) and improves left ventricular function. Drawbacks of achieving a diagnosis via biopsy of a myocardial granuloma include risks associated with an invasive technique and the possibility of obtaining a false-negative specimen because of the patchy infiltration of the heart muscle. Therefore, the diagnosis is generally confirmed by histologic proof of sarcoidosis along with clinical and imaging features that are highly suggestive of cardiac involvement. The value of T2-weighted and gadopentetate dimeglumine–enhanced MRI for diagnosing cardiac sarcoidosis has been recently emphasized [2– 6], whereas the usefulness of other noninvasive imaging methods such as echocardiography and thallium myocardial scanning is limited because of either low sensitivity or specificity.

Purpose To assess myocardial magnetic resonance imaging (MRI) findings in sarcoidosis. Methods Cardiac assessment was prospectively performed in patients with sarcoidosis and included physical examination, electrocardiogram, echocardiography, thallium-201 myocardial scintigraphy, and coronary angiography if coronary disease was suspected. T2-weighted black-blood single-shot and inversion recovery fast spin echo, functional gradient echo, and T1-weighted gadolinium-DTPA-enhanced cardiac MRI examinations were performed in 40 patients while other cardiac disease was excluded. Results Results of the MRI images were normal in cardiac-asymptomatic stage I or Lofgren syndrome patients (n = 4). Among the patients with cardiac-asymptomatic multiple organ sarcoidosis, 17 of 31 patients (54%) had MRI myocardial abnormalities similar to those observed in five patients with cardiac symptoms: nodular peripheral increased intramyocardial signal intensity on both T2-weighted and contrast-enhanced images (n = 5), focal or patchy increased signal on contrast-enhanced images with or without myocardial thickening (n = 10), and focal increased signal only on T2-weighted images with or without myocardial thinning (n = 2). Focal contractility abnormalities were noticed in nine patients. Conclusions These preliminary results emphasize the occurrence of subclinical myocardial MRI abnormalities in patients with ongoing systemic sarcoidosis.

A conventional T1-weighted spin-echo (SE) magnetic resonance (MR) imaging sequence was compared with breath-hold and non–breath-hold half- Fourier single-shot fast SE MR sequences with black-blood preparation and high spatial resolution for imaging of various cardiac diseases. The optimized single-shot fast SE sequence provided better or equal image quality in less time. Breath-hold and non–breath-hold single-shot fast SE sequences may replace the conventional T1-weighted SE sequence for first-line cardiac MR imaging.

The purpose of this study was to determine hepatic and vascular enhancement, clinical tolerance, and iconographic quality of Iobitridol (300 mg/ml) at dual-phase helical CT and to compare it with Iohexol (300 mg/ml). One hundred forty-six patients were randomly divided into two groups. Each group received 120 ml of Iohexol (group A) or Iobitridol (group B). Mean enhancement of liver, aorta and portal vein was obtained at the arterial phase and at the portal-venous phase. Overall image quality was assessed by two independent blinded investigators. Adverse reactions were recorded. There were no significant differences in demographic characteristics and distribution of patient intrinsic parameters between the two groups, except for blood pressure but without statistical correlation between the difference in blood pressure and the impact on enhancement measurements. There was no significant difference in clinical tolerance and image quality. Mean liver as well as aortic and portal vein enhancement measurements did not show any significant difference. Iobitridol compares favorably with Iohexol. Both products have similar safety, tolerance, and efficacy. Both contrast media have equivalent blood pool concentration and interstitial compartment diffusion.

Peliosis hepatis is an uncommon liver condition characterized by blood-filled cavities. We report the CT, angiographic and MR features of a case of peliosis hepatis with no obvious etiology and spontaneously regressing hemorrhagic necrosis. Helical CT showed multiple peripheral low-density regions with foci of spontaneous high density suggesting the presence of blood component. On MR imaging, the multiple peripheral lesions were hypointense on T1-weighted and hyperdense on T2-weighted images, with bright foci on all sequences suggesting subacute blood. Angiography showed no evidence of tumor or vascular malformation; multiple nodular vascular lesions filling in the parenchymal phase and persisting in the venous phase suggested blood-filled cavities. Pathological examination showed blood-filled spaces with no endothelial lining, characteristic of the parenchymal type of peliosis. Knowledge of the imaging features of hemorrhagic necrosis due to peliosis hepatis is important since it can be responsive to antibiotic therapy. Furthermore, differentiating hemorrhagic necrosis from hepatic abscess avoids dangerous and sometimes fatal percutaneous drainage.

The purpose of this study was to compare dual-phase helical CT and endosonography for the diagnosis and staging of pancreatic tumors.Thirty patients with suspected pancreatic tumors underwent endosonography and dual-phase helical CT. A pathologic diagnosis was obtained in all cases with surgery (n = 23) or biopsy (n = 7), resulting in 27 neoplasms. Dual-phase helical CT and endosonographic findings were correlated with surgical and pathologic findings to determine diagnosis and resectability of pancreatic tumors.Overall diagnostic sensitivity was 92% for dual-phase helical CT and 100% for endosonography (p = .45). Overall accuracy for staging of pancreatic tumors was 93% for both dual-phase helical CT and endosonography. Overall accuracy for predicting resectability was 90% for both dual-phase helical CT and endosonography. Accuracy of predicting unresectability was 100% for dual-phase helical CT and 86% for endosonography (p.80). Differences were not considered statistically significant.Dual-phase helical CT and endoscopic sonography do not differ significantly for diagnosis and assessment of resectability of pancreatic tumors.

The diagnosis of cardiac sarcoidosis (CS) (56 female-74 male; 73 White- 36 Black; age at CS: 40.5±11.7 years) was defined by clinical signs (20%) and/or evidence of at least two procedures abnormalities: ECG (64%), echocardiography (71%), Magnetic Resonance Imaging (MRI) (58%) and myocardial scintigraphy (72%). With a 54 month-median follow-up, 124 patients were evaluable. The first line therapy was steroids alone in 57% of cases, steroids with immunosuppressive (IS) drug in 43%. A relapse of the CS was noted in 35 patients, a median time of 27 months.The RR of relapsing at any time was 3.1 times higher in Black (P=0.008) and 4 times more when baseline abnormal myocardial MRI (P=0.008). A recovery was achieved by 91 patients (73%), a stabilisation in 23% and 3% worsened. The relative risk (RR) of not recovering at any time was 5.4 times higher in patients who had a steroids treatment duration of less than 24 months (P