Search

Objectives This study sought to compare myocardial scars depicted by computed tomography (CT) with electrical features from electro-anatomic mapping (EAM), assessing the potential role of CT integration in ventricular tachycardia (VT) and radiofrequency catheter ablation (RFCA) procedures. Background Imaging-based characterization of VT myocardial substrate is required to plan EAM and, potentially, to guide RFCA. Methods Forty-two consecutive patients, 35 of whom had implantable cardioverter-defibrillator, all referred for VT RFCA, underwent pre-procedural CT including an angiographic and a 10-min delayed-enhancement scan. Segmental comparison between scars segmented from CT and low voltages (bipolar voltages

The factors that determine whether disseminated transformed cells in vivo yield neoplastic lesions have only been partially identified. We established an ad hoc model of peritoneal carcinomatosis by injecting colon carcinoma cells in mice. Tumor cells recruit inflammatory leukocytes, mostly macrophages, and generate neoplastic peritoneal lesions. Phagocyte depletion via clodronate treatment reduces neoplastic growth. Colon carcinoma cells release a prototypic damage-associated molecular pattern (DAMP)/alarmin, High Mobility Group Box1 (HMGB1), which attracts leukocytes. Exogenous HMGB1 accelerates leukocyte recruitment, macrophage infiltration, tumor growth and vascularization. Lentiviral-based HMGB1 knockdown or pharmacological interference with its extracellular impair macrophage recruitment and tumor growth. Our findings provide a preclinical proof of principle that strategies based on preventing HMGB1-driven recruitment of leukocytes could be used for treating peritoneal carcinomatosis.

Purpose: To prospectively compare the diagnostic performance of diffusion - weighted magnetic resonance (DW -MR), multidetector computed tomography (MDCT) and endoscopic ultrasound (EUS) in the preoperative loco -regional staging of oesophageal cancer. Methods and Materials: Eighteen patients with biopsy -proved oesophageal tumour (9 directly treated with surgery and 9 addressed t o chemo/radiotherapy before) underwent 1.5 T DW -MRI, 64 -channels MDCT and EUS before and after neoadjuvant treatment. All images were analysed blindly by dedicated operators and two radiologists calculated independently the ADC from the first scan. Results were then compared with surgical findings. Spearman and intraclass correlation coefficients, Mann- Whitney and ROC curves analysis were performed. The population was divided into T1 -2 vs T3 -4 and N0 vs N+. Sensitivity, specificity, accuracy, positive and negative predictive value were calculated and compared for each technique. Results: For T staging, EUS showed the best sensitivity (100%) while MR showed the highest specificity (92%) and accuracy (83%). For N staging, MR and EUS showed the highest sensitivity (100%) but none of the three techniques showed adequate results for specificity. Overall, MR showed the highest accuracy (66%) for N stage. Mean ADC was different between surgery - only and chemo/radiotherapy groups (1.90 vs 1.30 x 10-3 mm2/s, respective ly; p= 0.005), with an optimal cut off for local invasion of 1.33 x 10-3 mm2/s (p=0.05). Conclusion: DW -MR could improve the current preoperative staging workup for oesophageal cancer, showing characteristic advantages for both staging and initial treatment decision -making. Purpose: To prospectively compare the diagnostic performance of diffusion - weighted magnetic resonance (DW -MR), multidetector computed tomography (MDCT) and endoscopic ultrasound (EUS) in the preoperative loco -regional staging of oesophageal cancer. Methods and Materials: Eighteen patients with biopsy -proved oesophageal tumour (9 directly treated with surgery and 9 addressed t o chemo/radiotherapy before) underwent 1.5 T DW -MRI, 64 -channels MDCT and EUS before and after neoadjuvant treatment. All images were analysed blindly by dedicated operators and two radiologists calculated independently the ADC from the first scan. Results were then compared with surgical findings. Spearman and intraclass correlation coefficients, Mann- Whitney and ROC curves analysis were performed. The population was divided into T1 -2 vs T3 -4 and N0 vs N+. Sensitivity, specificity, accuracy, positive and negative predictive value were calculated and compared for each technique. Results: For T staging, EUS showed the best sensitivity (100%) while MR showed the highest specificity (92%) and accuracy (83%). For N staging, MR and EUS showed the highest sensitivity (100%) but none of the three techniques showed adequate results for specificity. Overall, MR showed the highest accuracy (66%) for N stage. Mean ADC was different between surgery - only and chemo/radiotherapy groups (1.90 vs 1.30 x 10-3 mm2/s, respective ly; p= 0.005), with an optimal cut off for local invasion of 1.33 x 10-3 mm2/s (p=0.05). Conclusion: DW -MR could improve the current preoperative staging workup for oesophageal cancer, showing characteristic advantages for both staging and initial treatment decision -making.

Purpose: To investigate the influence of ADC in the diagnostic performance of MRI in the preoperative staging of gastric cancer. Methods a nd Materials: Between October 2009 and October 2014 a total of 88 patients with biopsy -proved gastric cancer underwent 1.5 T MRI with T1, T2 and DWI sequences and then treated with radical surgery. Two radiologists independently measured minimum ADC from tumour and assessed T and N staging by MRI. All findings were then compared with final histology, considering T1- 3 vs T4a -b and N0 vs N+ (according to 7th TNM staging). Results: Minimum pathological ADC was significantly different both for T and N staging ( p < 0.01). An optimal cut -off of 1.28 x 10 -3 mm2/s could distinguish between patients with local invasion (area under the curve: 0.91; p < 0.001). For T staging, MR showed a sensitivity of 70% and a specificity of 68%, which increased to 87% and 88% respectively, when adding our ADC cut -off. For N staging, the sensitivity increased from 68% to 77% with similar results in terms of accuracy (69% and 70%, respectively), when adding our ADC cut -off. Conclusion: ADC is different according to local invasion and nodal involvement in gastric cancer. Adding ADC to morphological T and N staging by MRI helps in the prediction of postoperative staging. Purpose: To investigate the influence of ADC in the diagnostic performance of MRI in the preoperative staging of gastric cancer. Methods a nd Materials: Between October 2009 and October 2014 a total of 88 patients with biopsy -proved gastric cancer underwent 1.5 T MRI with T1, T2 and DWI sequences and then treated with radical surgery. Two radiologists independently measured minimum ADC from tumour and assessed T and N staging by MRI. All findings were then compared with final histology, considering T1- 3 vs T4a -b and N0 vs N+ (according to 7th TNM staging). Results: Minimum pathological ADC was significantly different both for T and N staging ( p < 0.01). An optimal cut -off of 1.28 x 10 -3 mm2/s could distinguish between patients with local invasion (area under the curve: 0.91; p < 0.001). For T staging, MR showed a sensitivity of 70% and a specificity of 68%, which increased to 87% and 88% respectively, when adding our ADC cut -off. For N staging, the sensitivity increased from 68% to 77% with similar results in terms of accuracy (69% and 70%, respectively), when adding our ADC cut -off. Conclusion: ADC is different according to local invasion and nodal involvement in gastric cancer. Adding ADC to morphological T and N staging by MRI helps in the prediction of postoperative staging.

Islet transplantation is one of the most promising and effective therapies for restoring normoglycemia in type 1 diabetes (T1D) patients, but islet engraftment is one of the main obstacles hampering long-term success. Monitoring graft loss, caused either by immunological or nonimmunological events, occurring in the first phase after transplantation and at later stages of a patient's life is a very important issue. Among the imaging approaches previously applied, magnetic resonance imaging (MRI) monitoring of islet fate following labeling with superparamagnetic iron oxide agents yielded promising results. The aim of this study was to translate into patients the method of islet labeling and MRI monitoring developed in our preclinical setting and to compare imaging results with graft clinical outcome. Three T1D patients and one nondiabetic patient undergoing autotransplantation following subtotal pancreatectomy received Endorem®-labeled islets. Patients were monitored by MRI and metabolically (HbA1c, exogenous insulin requirement, and C-peptide, TEF) at 1, 3, and 7 days following transplantation and once a month up to 10 months. Labeled transplanted islets appeared as hypointense areas scattered within the liver parenchyma, whose absolute number at 24 h after transplantation reflected the labeling efficiency. In patients #1 and #3 with good midterm graft function, MRI follow-up showed an important early loss of hypointense spots followed by a slow and progressive disappearance at later timepoints. Graft loss of function in patient #2 4 weeks after transplantation was associated with the complete disappearance of all hypointense signals. The autotransplanted patient, stably insulin free, showed no significant signal reduction during the first 3 days, followed by loss of spots similar to a patient with good midterm graft function. These results suggest that MRI monitoring of islet transplantation at early time points could represent a meaningful readout for helping in predicting transplant failure or success, but its relevance for mid/long-term islet function assessment appears evanescent.

Purpose: Our aim was to prospectively analyze the use of contrast-enhanced ultrasound (CEUS) in the quantitative assessment of the response of uveal melanoma (UM) to gamma-knife radiosurgery (GKR), investigating whether changes in tumor vascularization precede thickness reduction, which on average occurs at 12 months after GKR. Methods: Ten patients with UM treated with GKR underwent sonography (US) and CEUS at baseline and at 3, 6, and 12 months after GKR. The transverse diameter, thickness, and quantitative parameters of the UM (ie, area under the curve in the wash-in phase, wash-in perfusion index, peak enhancement, and wash-in rate) were calculated by using dedicated software and compared by using Wilcoxon's signed-rank test. Results: The mean tumor thickness on US was significantly less at both 6 (6.6 mm) and 12 months after GKR (5.8 mm) than it was at baseline (8.3 mm; p

Inflammatory myopathies comprise heterogeneous disorders. Their etiopathogenesis is poorly understood, because of the paucity of informative experimental models and of approaches for the noninvasive study of inflamed tissues. Magnetic resonance imaging (MRI) provides information about the state of the skeletal muscle that reflects various facets of inflammation and remodeling. This technique has been scarcely used in experimental models of inflammatory myopathies. We characterized the performance of MRI in a well-established mouse model of myositis and the antisynthetase syndrome, based on the immunization of wild-type mice with the amino-terminal fragment of histidyl-tRNA synthetase (HisRS). Over an eight-week period following myositis induction, MRI enabled precise identification of pathological events taking place in muscle tissue. Areas of edema and of active inflammation identified by histopathology paralleled muscle modifications detected noninvasively by MRI. Muscles changes were chronologically associated with the establishment of autoimmunity, as reflected by the development of anti-HisRS antibodies in the blood of immunized mice. MR imaging easily appreciated muscle damage and remodeling even if actual disruption of myofiber integrity (as assessed by serum concentrations of creatinine phosphokinase) was limited. Thus, MR imaging represents an informative and noninvasive analytical tool for studyingin vivoimmune-mediated muscle involvement.

Aims We present clinical, electroanatomical mapping (EAM), imaging, and catheter ablation (CA) strategies in patients with myocarditis-related ventricular tachycardia (VT). Methods and results Between January 2010 and July 2012, 26 consecutive patients underwent imaging-guided CA of myocarditis-related ventricular arrhythmias, 23 of 26 using a combined endo–epicardial approach. Segment per segment correspondence of late enhanced (LE) scar localization with EAM scar was assessed in all patients with available uni/bipolar maps ( n = 19). Induced VTs were targeted prior to substrate modification. Late potentials (LPs) abolition constituted a procedural endpoint independently from VT inducibility. Clinical monomorphic VT was induced in 15 of 26 patients (57.7%) and was associated with epicardial LPs in 10 of 15, completely abolished in 7 of 10 patients. Of the 10 patients rendered non-inducible VTs were ablated epicardially in 7. Late potentials were also detected in 7 of 11 initially non-inducible patients and completely abolished in 4. After a median follow-up of 23 (15–31) months, 20 of 26 patients (76.9%) remained free from VT recurrence. Bipolar mapping revealed low-voltage scar (

Cardiac surgery can have severe neurologic complications. The noninvasive monitoring of intracranial circulation during heart surgery is usually performed with transcranial Doppler ultrasonography. We present the case of a 66-year-old man who underwent elective cardiac surgery for aortic valve replacement and coronary artery bypass graft, in whom monitoring was performed by simultaneously assessing blood flow velocity in the central retinal artery and vein

The aim of this study was to investigate liver microvascular adaptation following the intraportal infusion of pancreatic islets (pancreatic islet transplantation [islet-tx]) in diabetic patients using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). DCE-MRI was performed before and 7 days after islet-tx in six diabetic patients. Initial area under curve (AUC60) and volume transfer coefficient (Ktrans) were assessed as markers of liver perfusion. Clinical and metabolic monthly follow-up was performed in all patients, considering fasting C-peptide and β-score as main indices of graft function. High variability in the response of liver microvasculature to islet infusion was observed: two patients showed a significant reduction in liver perfusion after transplantation (pt.2: AUC60 = −23.4%, Ktrans = −31.7%; pt.4: AUC60 = −23.7%, Ktrans = −27.9%); three patients did not show any significant variation of liver perfusion and one patient showed a significant increase (pt.3: AUC60 = +31%, Ktrans = +42.8%). Interestingly, a correlation between DCE-MRI parameters and indices of graft function was observed and, in particular, both patients with DCE-MRI evidence of posttransplantation liver perfusion reduction experienced premature graft failure. Our preliminary study demonstrated that DCE-MRI may identify different adaptive responses of liver microvasculature in patients submitted to islet-tx. These different responses could have an impact on islet engraftment, although reported findings need confirmation from larger studies.

OBJECTIVE To compare prospective electrocardiogram (ECG)-triggered high-voltage coronary computed tomography (CT) angiography (CTA; 140-kVp P-cCTA) with retrospective ECG-gated standard-voltage cCTA (120-kVp R-cCTA), in patients with coronary stents. METHODS Fifty-two patients with coronary stents were studied with 64-slice multidetector scanner. Ninety-three stents were analyzed: 55 with 140-kVp P-cCTA and 38 with 120-kVp R-cCTA. Image quality (IQ), diagnostic confidence (DC), in-stent assessable lumen, artificial narrowing, and effective radiation dose were compared between techniques. RESULTS Image quality and DC were significantly better for the 140-kVp P-cCTA in comparison with the 120-kVp R-cCTA (IQ, 1.1 ± 0.36 vs 1.7 ± 0.60, respectively; P < 0.00001. Diagnostic confidence: 1.1 ± 0.29 vs 1.5 ± 0.65 respectively; P < 0.0001). In-stent assessable lumen and artificial narrowing were comparable between the techniques. Effective dose was lower for the 140-kVp P-cCTA (6.7 ± 2.07 mSv vs 15.8 ± 6.89 mSv; P < 0.0001). CONCLUSIONS High voltage combined with axial prospective ECG-triggered scan improved IQ and DC in stent cCTA imaging but failed to improve the diameter of in-stent assessable lumen and to reduce the artificial narrowing compared with the 120-kVp R-cCTA. Effective dose was 60% lower for the 140-kVp P-cCTA.

"Skeletal muscle remodeling in response to various noxae physiologically includes structural changes and inflammatory events. The possibility to study those phenomena in-vivo has been hampered by the lack of validated imaging tools. In our study, we have relied on multiparametric magnetic resonance imaging for quantitative monitoring of muscle changes in mice experiencing age-related sarcopenia or active regeneration after sterile acute injury of tibialis anterior muscle induced by cardiotoxin (CTX) injection. The extent of myofibrils' necrosis, leukocyte infiltration, and regeneration have been evaluated and compared with parameters from magnetic resonance imaging: T2-mapping (T2 relaxation time; T2-rt), diffusion-tensor imaging (fractional anisotropy, F.A.) and diffusion weighted imaging (apparent diffusion coefficient, ADC). Inflammatory leukocytes within the perimysium and heterogeneous size of fibers characterized aged muscles. They displayed significantly increased T2-rt (P

Beta-blockers have been shown to improve left ventricular (LV) function in patients with heart failure. The aim of this study is to non-invasively assess, by means of in vivo 31P-magnetic resonance spectroscopy (31P-MRS), the effects of beta-blockers on LV cardiac phosphocreatine and adenosine triphosphate (PCr/ATP) ratio in patients with heart failure. Ten heart failure patients on full medical therapy were beta-blocked by either carvedilol or bisoprolol. Before and after 3months of treatment, exercise testing, 2D echocardiography, MRS, New York Heart Association (NYHA) class, ejection fraction (EF), maximal rate-pressure product and exercise metabolic equivalent system (METS) were evaluated. Relative concentrations of PCr and ATP were determined by cardiac 31P-MRS. After beta-blockade, NYHA class decreased (from 2.2±0.54 to 1.9±0.52, P=0.05), whereas EF (from 33±7 to 44±6%, P=0.0009) and METS (from 6.74±2.12 to 8.03±2.39, P=0.01) increased. Accordingly, the mean cardiac PCr/ATP ratio increased by 33% (from 1.48±0.22 to 1.81±0.48, P=0.03). Beta-blockade-induced symptomatic and functional improvement in patients with heart failure is associated to increased PCr/ATP ratio, indicating preservation of myocardial high-energy phosphate levels. © 2012 Société Française de Pharmacologie et de Thérapeutique. Published by John Wiley & Sons Ltd