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The presence of myocardial fibrosis is associated with adverse outcome in dilated cardiomyopathy (DCM). Delayed contrast-enhanced cardiac magnetic resonance (DE-CMR) currently represents the gold standard in noninvasive evaluation of myocardial scarring. However, a significant number of patients are unable to undergo DE-CMR study for various reasons. We sought to determine the diagnostic accuracy of cardiac CT (CCT) compared with CMR in the investigation of the presence of delayed contrast enhancement (DCE) in subjects with DCM. We prospectively enrolled 17 consecutive patients with DCM, who were initially referred to our institution because of recently manifested heart failure due to unexplained left ventricular systolic dysfunction. In all subjects, CCT and DE-CMR were performed within 1 week. CCT and DE-CMR showed satisfactory agreement in detecting DCE (agreement in 82% cases, κ = 0.56) with 50% sensitivity, 100% specificity, and a positive predictive value of 100%. CCT may be a valuable method for detecting DCE in patients with DCM. CCT thus might be considered as an alternative method to DE-CMR in the assessment of the presence and extent of myocardial fibrosis in subjects who are not suitable for DE-CMR examination.

Bacground: Cardiac magnetic resonance imaging (MRI) represents the gold standard in noninvasive evaluation of myocardial tissue. However, some patients are unable to undergo cardiac MRI due to a variety of reasons. Aims: We sought to determine the diagnostic accuracy of routinely performed contrast‑enhanced computed tomography (CECT) compared with cardiac MRI in the evaluation of myocardial tissue. Methods: We retrospectively evaluated 96 consecutive patients (mean [SD] age, 51 [15] years; 41 women) who underwent both CECT and cardiac MRI within 30 days. All CECT scans that visualized the entire heart were analyzed, regardless of the indication for and protocol of the procedure. The presence of late gadolinium enhancement on cardiac MRI was compared with the finding of myocardial hypoattenuation on computed tomography scans. Results: With cardiac MRI as the gold standard, CECT revealed a per‑patient sensitivity of 66%, specificity of 89%, positive predictive value of 75%, negative predictive value of 84%, and accuracy of 81%. Per‑segment sensitivity was 54%; specificity, 98%; positive predictive value, 76%; negative predictive value, 94%; and accuracy, 92%. Conclusions: Our study suggests that routinely performed CECT has high specificity, but only moderate sensitivity, compared with cardiac MRI in the evaluation of myocardial tissue. This result supports the recommendation that all CECT scans that visualize the entire heart should be analyzed for myocardial tissue pathology.

Lipomatous hypertrophy of the interatrial septum (LHIS) is characterized by excessive accumulation of adipose tissue within some segments of the interatrial septum. Only one published case so far describes fever as a presenting feature of LHIS. On the other hand, systemic symptoms including anemia and fever are well-known clinical presentations of cardiac myxomas. We report an unusual case of a 79-year-old woman who was thoroughly but unsuccessfully investigated for recurrent fever and anemia in several specialized departments over the course of 4 years. Computed tomography scan showed a pathological mass localized in the interatrial septum and spreading to ascending aorta. Histological analysis of the biopsy samples from surgery revealed the unexpected diagnosis of regressively changed LHIS. We discuss the clinical and pathologic features of this lesion suggesting that its regressive changes may be associated with inflammation and can cause systemic symptoms such as fever and anemia.

Background Computed tomography (CT) colonography is a well established modality for the examination of symptomatic patients as well as in screening. Recent technical advances in improving image quality by iterative reconstruction contribute to the reduction of the radiation dose which is a major concern in CT imaging. Purpose To evaluate image quality of ultralow-dose submilisievert CT colonography using hybrid iterative reconstruction technique. Material and Methods Sixteen patients underwent contrast-enhanced CT colonography with standard protocol in supine position and ultralow-dose protocol in prone position. Ultralow-dose datasets were reconstructed with filtered back projection and an advanced hybrid iterative reconstruction technique. Two radiologists independently evaluated 96 colonic segments for image quality in the endoluminal view and axial thin sections. Colonic distension, smoothness of colonic wall and distortion of folds in the endoluminal view, sharpness of colonic wall delineation, perceived image noise, and presence of photon starvation artifact were rated on a five-point scale. Intraluminal noise expressed as standard deviation of Hounsfield density was measured in all segments. Results The mean radiation dose was 0.42 mSv and 5.48 mSv in prone and supine scans, respectively. All distended segments were rated evaluable in standard dose and ultralow-dose series reconstructed with the iterative reconstruction technique, whereas in 61% segments image quality was rated poor or unacceptable in ultralow-dose series where filtered back projection was used with worst ratings in the rectum and the sigmoid colon. Conclusion This pilot study shows that iterative reconstruction technique is a feasible method to decrease the radiation dose from CT colonography for both positions below 1mSv. Further investigations of larger scale need to be done to clarify, whether such a low radiation dose would influence the detection of polyps.

BACKGROUND AND PURPOSE: Potential differences between primary progressive and relapsing remitting multiple sclerosis are the subject of ongoing controversial discussions. The aim of this work was to determine whether and how primary-progressive and relapsing-remitting multiple sclerosis subtypes differ regarding conventional MR imaging parameters, cerebral iron deposits, and their association with clinical status. MATERIALS AND METHODS: We analyzed 24 patients with primary-progressive MS, 80 with relapsing-remitting MS, and 20 healthy controls with 1.5T MR imaging for assessment of the conventional quantitative parameters: T2 lesion load, T1 lesion load, brain parenchymal fraction, and corpus callosum volume. Quantitative susceptibility mapping was performed to estimate iron concentration in the deep gray matter. RESULTS: Decreased susceptibility within the thalamus in relapsing-remitting MS compared with primary-progressive MS was the only significant MR imaging difference between these MS subtypes. In the relapsing-remitting MS subgroup, the Expanded Disability Status Scale score was positively associated with conventional parameters reflecting white matter lesions and brain atrophy and with iron in the putamen and caudate nucleus. A positive association with putaminal iron and the Expanded Disability Status Scale score was found in primary-progressive MS. CONCLUSIONS: Susceptibility in the thalamus might provide additional support for the differentiation between primary-progressive and relapsing-remitting MS. That the Expanded Disability Status Scale score was associated with conventional MR imaging parameters and iron concentrations in several deep gray matter regions in relapsing-remitting MS, while only a weak association with putaminal iron was observed in primary-progressive MS suggests different driving forces of disability in these MS subtypes.

Ventricular outpouchings include acquired abnormalities (aneurysms and pseudoaneurysms) and congenital ventricular diverticula (CVD). CVD represent rare cardiac pathologies. Although CVD is often associated with other cardiac and extracardiac congenital anomalies, it can also be incidentally observed in otherwise healthy subjects. CVD may lead to significant morbidity and even have lethal consequences. We describe a case of arrhythmogenic left ventricle (LV) apical CVD revealed by cardiac magnetic resonance imaging (CMRI) after being initially overlooked by echocardiography. The paper includes the review of the literature also. This clinical case highlights the possible association of this pathology with recurrent ventricular tachycardia and stroke, and illustrates the importance of multimodal imaging approach in differential diagnosis.

Kasuistika dokumentuje klinický průběh, výsledky zobrazovacich vysetřeni a pitevni nalez nemocneho s metastatickým postiženim vsech srdecnich struktur jako prvni manifestaci plicniho adenokarcinomu.

Background Because there is limited information concerning the vascular pattern and the role of vessels in patients with proximal femoral focal deficiency, the vascular supply of the lower extremities was studied systematically with use of computed tomographic angiography in order to identify vascular changes, relate any vascular changes to the classification of the deficiency, and establish that there are no major changes in the topographical anatomy of the vessels. Methods Standardized computed tomographic techniques were used in twenty-one patients (thirteen boys and eight girls who ranged from one to nineteen years old) with proximal femoral focal deficiency types I through IV and VII, VIII, and IX, according to the Pappas classification. Results A common anatomical vascular pattern, in which the hypoplastic extremity was supplied through the femoral artery, was detected in nineteen patients. In patients with Pappas type-I through IV disease, the external iliac, femoral, and deep femoral arteries were substantially reduced in length and diameter and the deep femoral artery arose more proximally in comparison with that in the contralateral extremity; however, in the patients with Pappas type-VII, VIII, or IX disease, the diameters of the arteries and the origin of the deep femoral artery were similar to those of the contralateral extremity. In two patients with Pappas type-III disease, atypical anatomy of the vessels was found. The anterior part of the thigh and the pseudarthrosis were supplied through the femoral artery (the external iliac artery) as a terminal branch, while the remainder of the extremity was supplied from the internal iliac artery, which entered the thigh posterior to the hip as the inferior gluteal artery and continued as the artery to the sciatic nerve to the popliteal artery. No substantial anastomoses were found between the femoral and the posterior arteries in these vascular patterns. Conclusions Computed tomographic-angiographic reconstruction can be used to depict the spatial configuration of the pseudarthrosis and the vascular pattern of the extremity in patients with proximal femoral focal deficiency. We found distinct vascular changes in the majority of the involved thighs, but there were no typical changes related to the Pappas classification. Because we found atypical vascular patterns in two patients, evaluation of the vessels with use of various diagnostic methods is recommended in patients with severe types of proximal femoral focal deficiency.

In the last decade, there has been increasing evidence that comprehensive evaluation of the left atrium is of utmost importance. Numerous studies have clearly demonstrated the prognostic value of left atrial volume for long-term outcome. Furthermore, advances in catheter ablation procedures used for the treatment of drug-refractory atrial fibrillation require the need for detailed knowledge of left atrial and pulmonary venous morphology as well of atrial wall characteristics. This review article discusses the role of cardiac magnetic resonance and computed tomography in assessment of left atrial size, its normal and abnormal morphology, and function. Special interest is paid to the utility of these rapidly involving noninvasive imaging methods before and after atrial fibrillation ablation.

Summary Background The non-invasive assessment of amyloid heart disease may be challenging. Cardiac magnetic resonance (CMR) represents a method of choice for assessment of left ventricular (LV) morphology and function, and it also provides a unique possibility to evaluate the presence of amyloid deposition by the late gadolinium enhancement (LGE) technique. However, so far, published studies have not been consistent in terms of described LGE patterns associated with amyloid cardiomyopathy. Aims To compare echocardiographic and CMR assessment of LV morphology and function and to evaluate the presence and pattern of LGE in a population of patients with AL amyloid cardiomyopathy. Methods Twenty-two consecutive patients with newly diagnosed AL amyloid cardiomyopathy and without contraindications to CMR were comprehensively examined by echocardiography and CMR. Results Echocardiography and CMR did not differ in the evaluation of interventricular septal thickness, LV end-diastolic diameter and ejection fraction. Significant differences were found between echocardiographic and CMR estimates of LV end-diastolic volume (P

Aims: The objective was to correlate the change in the lesion load (LL) and brain atrophy in patients with multiple sclerosis (MS) with progression of clinical disability, represented by the Expanded Disability Status Scale (EDSS), and to test if stratification of patients according to magnetic resonance imaging (MRI) criteria can increase the predictive ability of MRI for MS clinical development. Methods: 181 patients with clinically definite relapsing-remitting MS underwent MRI for a period of up to 5 years. Grouping of patients according to the LL value at the study entry revealed a substantial increase in the Spearman rank correlation coefficient R. Results: For the low LL cohort of patients, we found a statistically significant correlation (R up to –0.71 with p < 0.01) of a later increase in the EDSS score (years 4 and 5) with increased brain atrophy in the first 2 years. For the high LL group, we found a statistically significant correlation (R up to 0.72 with p < 0.01) of a later increase in the EDSS score (years 4 and 5) with an increase in the LL value in the first year. Conclusions: We conclude that stratification of patients according to the MRI criterion (LL) can increase the predictive ability of MRI.