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Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool. Full English text available from: www.revespcardiol.org/en.

Cardiac amyloidosis (CA) is an underdiagnosed disease and, if left untreated, rapidly fatal. Emerging therapies for CA increase the urgency of developing non-invasive diagnostic methods for its early detection and for monitoring therapeutic response. Classic imaging features on echocardiography and cardiac magnetic resonance, although typical for cardiac amyloidosis, are not specific enough to distinguish light chain amyloidosis from transthyretin. Myocardial bone-avid radiotracer uptake is highly specific for transthyretin cardiac amyloidosis when plasma cell dyscrasia has been excluded; it is now replacing the need for biopsy in many patients. Detection of early cardiac amyloidosis, quantitation of its burden, and assessment of response to therapy are important next steps for imaging to advance the evaluation and management of cardiac amyloidosis.

Resumen Objetivo Definir las caracteristicas anatomicas de la auricula izquierda y las venas pulmonares (VP) en sujetos sometidos a ablacion de fibrilacion auricular (FA) e identificar posibles factores anatomicos relacionados con la recurrencia. Material y metodos Se estudiaron de manera retrospectiva los estudios de angio-TC de 95 pacientes (57 hombres, edad media 65 ± 10 anos), realizados para planificacion de ablacion por radiofrecuencia de FA. Se reviso la anatomia de las VP y se recogieron los diametros de sus ostia y los diametros y volumen de la auricula izquierda. Estos parametros fueron comparados con el tipo de arritmia y la respuesta al tratamiento. Resultados La anatomia de las venas pulmonares fue normal (dos venas pulmonares derechas y dos izquierdas) en la mayoria de los pacientes (74,7%). Los pacientes con FA persistente presentaron diametros ligeramente superiores de las venas pulmonares izquierdas (VPSI de 17,9 ± 2,6 mm vs. 16,7 ± 2,2 mm, p = 0,04; VPII de 15,3 ± 2 mm vs. 13,8 ± 2,2 mm, p = 0,009) y mayor volumen de la auricula izquierda (91,9 ± 24,9 cm3 vs. 70,7 ± 20,3 mm3, p = 0,001) que los sujetos con FA paroxistica. Tras un seguimiento medio de 22,1 ± 12,1 meses, el 43% de los pacientes presentaba ritmo sinusal. Los pacientes con recurrencia mostraron mayor volumen de la auricula izquierda (81,4 ± 23 mm3 vs. 71,1 ± 23,2 mm3, p = 0,03). No se objetivaron diferencias significativas en los diametros de las VP ni en los parametros clinicos estudiados en ambos grupos. Conclusion El volumen de la auricula izquierda es mayor en pacientes con FA persistente y en pacientes que no responden al procedimiento de ablacion.

Objective To analyze the anatomic characteristics of the left atrium and pulmonary veins in individuals undergoing ablation for atrial fibrillation and to identify possible anatomic factors related with recurrence. Material and methods We retrospectively reviewed the CT angiography studies done to plan radiofrequency ablation for atrial fibrillation in 95 patients (57 men; mean age, 65 ± 10 y). We reviewed the anatomy of the pulmonary veins and recorded the diameters of their ostia as well as the diameter and volume of the left atrium. We analyzed these parameters according to the type of arrhythmia and the response to treatment. Results In 71 (74.7%) patients, the anatomy of the pulmonary veins was normal (i.e., two right pulmonary veins and two left pulmonary veins). Compared to patients with paroxysmal atrial fibrillation, patients with persistent atrial fibrillation had slightly larger diameter of the left pulmonary veins (left superior pulmonary vein 17.9 ± 2.6 mm vs. 16.7 ± 2.2 mm, p = 0.04; left inferior pulmonary vein 15.3 ± 2 mm vs. 13.8 ± 2.2 mm, p = 0.009) and larger left atrial volume (91.9 ± 24.9 cm3 vs. 70.7 ± 20.3 mm3, p = 0.001). After 22.1 ± 12.1 months’ mean follow-up, 41 patients had sinus rhythm. Compared to patients in whom the sinus rhythm was restored, patients with recurrence had greater left atrial volume (81.4 ± 23.0 mm3 vs. 71.1 ± 23.2 mm3, p = 0.03). No significant differences in pulmonary vein diameters or clinical parameters were observed between patients with recurrence and those without. Conclusion The volume of the left atrium is greater in patients with persistent atrial fibrillation and in those who do not respond to ablation.

In patients with suspected coronary artery disease (CAD), myocardial perfusion is assessed under rest and pharmacological stress to identify ischemia. Splenic switch-off, defined as the stress to rest splenic perfusion attenuation in response to adenosine, has been proposed as an indicator of stress adequacy. Its occurrence has been previously assessed in first-pass perfusion images, but the use of noncontrast techniques would be highly beneficial.To explore the ability of pseudo-continuous arterial spin labeling (PCASL) to identify splenic switch-off in patients with suspected CAD.Prospective.Five healthy volunteers (age 24.8 ± 3.8 years) and 32 patients (age 66.4 ± 8.2 years) with suspected CAD.A 1.5-T/PCASL (spin-echo) and first-pass imaging (gradient-echo).In healthy subjects, multi-delay PCASL data (500-2000 msec) were acquired to quantify splenic blood flow (SBF) and determine the adequate postlabeling delay (PLD) for single-delay acquisitions (PLD arterial transit time). In patients, single-delay PCASL (1200 msec) and first-pass perfusion images were acquired under rest and adenosine conditions. PCASL data were used to compute SBF maps and SBF stress-to-rest ratios. Three observers classified patients into "switch-off" and "failed switch-off" groups by visually comparing rest-stress perfusion data acquired with PCASL and first-pass, independently. First-pass categories were used as reference to evaluate the accuracy of quantitative classification.Wilcoxon signed-rank, Pearson correlation, kappa, percentage agreement, Generalized Linear Mixed Model, Mann-Whitney, Pearson Chi-squared, receiver operating characteristic, area-under-the-curve (AUC) and confusion matrix.P value 0.05.A total of 27 patients (84.4%) experienced splenic switch-off according to first-pass categories. Comparison of PCASL-derived SBF maps during stress and rest allowed assessment of splenic switch-off, reflected in a reduction of SBF values during stress. SBF stress-to-rest ratios showed a 97% accuracy (sensitivity = 80%, specificity = 100%, AUC = 85.2%).This study could demonstrate the feasibility of PCASL to identify splenic switch-off during adenosine perfusion MRI, both by qualitative and quantitative assessments.2 TECHNICAL EFFICACY: 2.

Monitoring renal allograft function after transplantation is key for the early detection of allograft impairment, which in turn can contribute to preventing the loss of the allograft. Multiparametric renal MRI (mpMRI) is a promising noninvasive technique to assess and characterize renal physiopathology; however, few studies have employed mpMRI in renal allografts with stable function (maintained function over a long time period). The purposes of the current study were to evaluate the reproducibility of mpMRI in transplant patients and to characterize normal values of the measured parameters, and to estimate the labeling efficiency of Pseudo-Continuous Arterial Spin Labeling (PCASL) in the infrarenal aorta using numerical simulations considering experimental measurements of aortic blood flow profiles. The subjects were 20 transplant patients with stable kidney function, maintained over 1 year. The MRI protocol consisted of PCASL, intravoxel incoherent motion, and T1 inversion recovery. Phase contrast was used to measure aortic blood flow. Renal blood flow (RBF), diffusion coefficient (D), pseudo-diffusion coefficient (D*), flowing fraction (

Presentamos un caso de paciente de 68 años de edad que fue remitido a cardiología para estudio en el contexto de una trombosis venosa profunda porque presentaba dilatación de cavidades derechas en el TAC torácico. En el ecocardiograma se confirmó la dilatación de cavidades derechas. Además el ecocardiograma tranesofágico mostró un septo auricular aneurismático y un foramen oval no competente con un shunt izquierda-derecha. El Qp/Qs estimado por RM cardiaca fue de 1.6. A pesar de una anatomía no del todo favorable se consiguió cerrar el defecto de forma percutánea.

Rationale Poor muscle quality in COPD patients relates to exercise intolerance and mortality. Muscle quality can be estimated on computed tomography (CT) by estimating psoas density (PsD). We tested the hypothesis that PsD is lower in COPD patients than in controls and relates to all-cause mortality. Methods At baseline, PsD was measured using axial low-dose chest CT images in 220 COPD patients, 80% men, who were 65 ± 8 years old with mild to severe airflow limitation and in a control group of 58 subjects matched by age, sex, body mass index (BMI) and body surface area (BSA). COPD patients were prospectively followed for 76.5 (48–119) months. Anthropometrics, smoking history, BMI, dyspnoea, lung function, exercise capacity, BODE index and exacerbations history were recorded. Cox proportional risk analysis determined the factors more strongly associated with long-term mortality. Results PsD was lower in COPD patients than in controls (40.5 vs 42.5, p = 0.045). During the follow-up, 54 (24.5%) deaths occurred in the COPD group. PsD as well as age, sex, pack-year history, FEV1%, 6MWD, mMRC, BODE index, were independently associated with mortality. Multivariate analysis showed that age (HR 1.06; 95% CI 1.02–1.12, p = 0.006) and CT-assessed PsD (HR 0.97; 95%CI 0.94–0.99, p = 0.023) were the variables independently associated with all-cause mortality. Conclusions In COPD patients with mild to severe airflow limitation, chest CT-assessed psoas muscle density was lower than in matched controls and independently associated with long-term mortality. Muscle quality using the easy to evaluate psoas muscle density from chest CT may provide clinicians with important prognostic information in COPD.

Objectives To investigate machine learning classifiers and interpretable models using chest CT for detection of COVID-19 and differentiation from other pneumonias, interstitial lung disease (ILD) and normal CTs. Methods Our retrospective multi-institutional study obtained 2446 chest CTs from 16 institutions (including 1161 COVID-19 patients). Training/validation/testing cohorts included 1011/50/100 COVID-19, 388/16/33 ILD, 189/16/33 other pneumonias, and 559/17/34 normal (no pathologies) CTs. A metric-based approach for the classification of COVID-19 used interpretable features, relying on logistic regression and random forests. A deep learning–based classifier differentiated COVID-19 via 3D features extracted directly from CT attenuation and probability distribution of airspace opacities. Results Most discriminative features of COVID-19 are the percentage of airspace opacity and peripheral and basal predominant opacities, concordant with the typical characterization of COVID-19 in the literature. Unsupervised hierarchical clustering compares feature distribution across COVID-19 and control cohorts. The metrics-based classifier achieved AUC = 0.83, sensitivity = 0.74, and specificity = 0.79 versus respectively 0.93, 0.90, and 0.83 for the DL-based classifier. Most of ambiguity comes from non-COVID-19 pneumonia with manifestations that overlap with COVID-19, as well as mild COVID-19 cases. Non-COVID-19 classification performance is 91% for ILD, 64% for other pneumonias, and 94% for no pathologies, which demonstrates the robustness of our method against different compositions of control groups. Conclusions Our new method accurately discriminates COVID-19 from other types of pneumonia, ILD, and CTs with no pathologies, using quantitative imaging features derived from chest CT, while balancing interpretability of results and classification performance and, therefore, may be useful to facilitate diagnosis of COVID-19. Key Points • Unsupervised clustering reveals the key tomographic features including percent airspace opacity and peripheral and basal opacities most typical of COVID-19 relative to control groups. • COVID-19-positive CTs were compared with COVID-19-negative chest CTs (including a balanced distribution of non-COVID-19 pneumonia, ILD, and no pathologies). Classification accuracies for COVID-19, pneumonia, ILD, and CT scans with no pathologies are respectively 90%, 64%, 91%, and 94%. • Our deep learning (DL)–based classification method demonstrates an AUC of 0.93 (sensitivity 90%, specificity 83%). Machine learning methods applied to quantitative chest CT metrics can therefore improve diagnostic accuracy in suspected COVID-19, particularly in resource-constrained environments. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07937-3.

Objetivo: Comparar los hallazgos radiológicos mediante tomografía computarizada (TC) torácica en pacientes con COVID-19 en diferentes fases de la enfermedad y evaluar la reproducibilidad de un score radiológico visual para estimar la extensión de la afectación pulmonar. Métodos: Se evaluaron retrospectivamente las tomografías computarizadas de tórax de 182 pacientes con RT-PCR positiva para SARS-CoV-2. En función del tiempo de evolución de la infección, los pacientes fueron clasificados en tres grupos/estadios: fase precoz (0-4 días), intermedia/progresiva (5-9 días) y avanzada (≥10 días). Se analizó la frecuencia de cada hallazgo radiológico, así como el patrón, la apariencia y la distribución predominantes de la afectación pulmonar. La extensión de la afectación pulmonar se estimó para cada lóbulo pulmonar y para el volumen pulmonar total mediante un score tomográfico visual (rango 0-25). Resultados: El hallazgo tomográfico predominante fue el patrón en vidrio deslustrado (n = 110, 60,4%), la distribución más frecuente, la periférica (n = 116, 66,7%) y la apariencia más prevalente, la típica (n = 112, 61,5%). El “signo del halo” se encontró más frecuentemente en la fase precoz (25%), mientras que las opacidades en vidrio deslustrado, el patrón en empedrado y las líneas subpleurales fueron más frecuentes en las fases intermedia/progresiva y avanzada. La mediana del score de gravedad fue de 10 (RIQ: 5-13), aumentando los valores con la progresión de la enfermedad. El acuerdo interobservador (kappa, k) para la apariencia, la distribución y el patrón predominante, así como para el score visual fueron de 0,92; 0,84; 0,70, y 0,89; respectivamente. Conclusión: Los hallazgos tomográficos en la COVID-19 varían con el curso de la infección. El score radiológico sugerido es una herramienta sencilla, reproducible y fiable para evaluar la afectación pulmonar en la neumonía COVID-19.

La presencia de una masa en la aurícula izquierda en un paciente con una prótesis mecánica mitral es relativamente frecuente y supone un reto diagnóstico. Presentamos el caso de una paciente que, tras ser intervenida de una sustitución valvular mitral, presentó insuficiencia cardíaca hallándose en el ecocardiograma una masa de gran tamaño dependiente del techo de la aurícula. La asociación del ecocardiograma transtorácico con otras técnicas de imagen cardíaca, ayuda tanto a caracterizar la lesión y determinar de forma precisa su localización, como su repercusión y posible afectación de estructuras vecinas.

Objective Lung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. Methods We conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. Results Ninety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64 ± 9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2 ± 7.6 mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n = 39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n = 17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%–98%) and 83% (95% CI: 65%–92%), respectively. Conclusion Lung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively.

La miocardiopatía de estrés o enfermedad de Tako-tsubo es una cardiopatía aguda cuya presentación clínica habitual suele ser en forma de síndrome coronario agudo (SCA). Un porcentaje no despreciable de pacientes que ingresan con sospecha de SCA en los que la coronariografía ha descartado enfermedad arterial coronaria tienen infarto agudo de miocardio (IAM) no demostrado. El diagnóstico diferencial debe ser esencial para asegurar un correcto tratamiento. La resonancia magnética cardiaca emerge como una herramienta diagnóstica no invasiva de primera línea para diferenciar entre IAM y Tako-tsubo.

Background: Cardiac fibroblasts (CFs) have a central role in the ventricular remodeling process associated with different types of fibrosis. Recent studies have shown that fibroblasts do not respond homogeneously to heart injury. Because of the limited set of bona fide fibroblast markers, a proper characterization of fibroblast population heterogeneity in response to cardiac damage is lacking. The purpose of this study was to define CF heterogeneity during ventricular remodeling and the underlying mechanisms that regulate CF function. Methods: Collagen1α1–GFP (green fluorescent protein)–positive CFs were characterized after myocardial infarction (MI) by single-cell and bulk RNA sequencing, assay for transposase-accessible chromatin sequencing, and functional assays. Swine and patient samples were studied using bulk RNA sequencing. Results: We identified and characterized a unique CF subpopulation that emerges after MI in mice. These activated fibroblasts exhibit a clear profibrotic signature, express high levels of Cthrc1 (collagen triple helix repeat containing 1), and localize into the scar. Noncanonical transforming growth factor–β signaling and different transcription factors including SOX9 are important regulators mediating their response to cardiac injury. Absence of CTHRC1 results in pronounced lethality attributable to ventricular rupture. A population of CFs with a similar transcriptome was identified in a swine model of MI and in heart tissue from patients with MI and dilated cardiomyopathy. Conclusions: We report CF heterogeneity and their dynamics during the course of MI and redefine the CFs that respond to cardiac injury and participate in myocardial remodeling. Our study identifies CTHRC1 as a novel regulator of the healing scar process and a target for future translational studies.

Resumen Objetivo Comparar el indice de reserva de perfusion miocardica (IRPM) medido por resonancia magnetica cardiaca de estres (RMC-estres) con regadenoson en sujetos trasplantados frente a no trasplantados. Material y metodos Se compararon, de forma retrospectiva, 20 trasplantados cardiacos consecutivos, asintomaticos y sin sospecha clinica de enfermedad microvascular, a quienes se realizo RMC-estres con regadenoson y coronariografia por TC (CTC) para descartar enfermedad vascular del injerto (EVI) respecto a 16 sujetos no trasplantados, con RMC-estres realizada por indicacion clinica, negativa para isquemia y sin signos de cardiopatia estructural. El IRPM se estimo de forma semicuantitativa tras calcular el valor de la pendiente durante la perfusion de primer paso y dividir el valor obtenido en estres respecto al reposo. Se comparo IRPM en ambos grupos. Los pacientes con RMC-estres positiva para isquemia o CTC con estenosis coronaria significativa fueron derivados a coronariografia convencional. Resultados Mas de la mitad de los sujetos permanecieron asintomaticos durante la prueba de estres. La RMC-estres resulto positiva para isquemia en dos trasplantados, que se confirmo mediante CTC y coronariografia convencional. Los pacientes trasplantados presentaron menor volumen telediastolico indexado (59,3 ± 15,2 ml/m2 frente a 71,4 ± 15,9 ml/m2, p = 0,03), menor IRPM (1,35 ± 0,19 vs. 1,6 ± 0,28, p = 0,003 y menor respuesta hemodinamica al regadenoson que los no trasplantados (incremento medio de la frecuencia cardiaca de 13,1 ± 5,4 lpm frente a 28,5 ± 8,9 lpm, p Conclusion La RMC-estres con regadenoson es una tecnica segura. En ausencia de enfermedad coronaria epicardica significativa, los trasplantados presentan menor IRPM que los no trasplantados, lo que sugiere enfermedad microvascular. En pacientes trasplantados, la respuesta hemodinamica esperable al regadenoson es menor que en no trasplantados.

Background Myocardial perfusion is evaluated in first-pass MRI using a gadolinium-based contrast agent, which limits its repeatability and restricts its use in patients with abnormal kidney function. Arterial spin labeling (ASL) is a promising technique for measuring myocardial perfusion without contrast injection. The ratio of stress to rest perfusion, termed myocardial perfusion reserve (MPR), is an indicator of the severity of stenosis in patients with coronary artery disease (CAD). Purpose To quantify perfusion increases with pharmacological vasodilation, explore MPR differences between segments with and without perfusion defects, and examine the correlations between quantitative ASL and semiquantitative first-pass measurements. Study type Prospective. Subjects Sixteen patients with suspected CAD: 10 classified as "healthy," having normal perfusion on first-pass and no enhancement on late gadolinium enhancement (LGE), and six as "nonhealthy," having hypoperfused segments including ischemic and infarcted. Field strength/sequence Flow-sensitive alternating inversion recovery (FAIR) rest-stress cardiac ASL with balanced steady-state free precession (bSSFP), rest-stress first-pass imaging using gradient-echo and LGE using a phase-sensitive inversion-recovery bSSFP at 1.5T. Assessment For healthy subjects, rest-stress perfusion data were compared in global, coronary artery territory, and segment regions of interest (ROIs). A segmental MPR comparison was performed between normal segments from healthy subjects and abnormal segments from nonhealthy subjects. Correlations between ASL and first-pass parameters were explored. Statistical tests Wilcoxon-signed-rank test, nonparametric factorial analysis of variance (ANOVA), and Pearson's/Spearman's correlations. Results Perfusion increases were significant globally (P = 0.005), per coronary artery territory (P = 0.015), and per segment (P = 0.03 for all segments in ASL and first-pass, except anteroseptal in ASL P = 0.04). MPR differences between normal and abnormal segments were significant (P = 0.0028: ASL, P = 0.033: first-pass). ASL and first-pass measurements were correlated (MPR: r = 0.64, P = 0.008 and perfusion: rho = 0.47, P = 0.007). Data conclusion This study demonstrates the feasibility of ASL to detect hyperemia, the potential to differentiate segments with and without perfusion defects, and significant correlations between ASL and semiquantitative first-pass. Level of evidence 2 TECHNICAL EFFICACY STAGE: 1.

Purpose To evaluate labeling efficiency of pseudo-continuous arterial spin labeling (PCASL) and to find the gradient parameters that increase PCASL robustness for renal perfusion measurements. Methods Aortic blood flow was characterized in 3 groups: young healthy volunteers (YHV1), chronic kidney disease (CKD) patients (CKDP), and healthy controls (HCO). PCASL inversion efficiency was evaluated through numeric simulations considering the measured pulsatile flow velocity profiles and off-resonance effects for a wide range of gradient parameters, and the results were assessed in vivo. The most robust PCASL implementation was used to measure renal blood flow (RBF) in CKDP and HCO. Results Aortic blood velocities reached peak values of 120 cm/s in YHV1, whereas for elderly subjects values were lower by approximately a factor of 2. Simulations and experiments showed that by reducing the gradient average (Gave ) and the selective to average gradient ratio (Gmax /Gave ), labeling efficiency was maximized and PCASL robustness to off-resonance was improved. The study in CKDP and HCO showed significant differences in RBF between groups. Conclusion An efficient and robust PCASL scheme for renal applications requires a Gmax /Gave ratio of 6-7 and a Gave value that depends on the aortic blood flow velocities (0.5 mT/m being appropriate for CKDP and HCO).

OBJECTIVE. The purpose of this study was to evaluate the feasibility, image quality, and radiation dose of high-pitch coronary CT angiography (CCTA) in orthotopic heart transplant (OHT) recipients....

Imaging of small laboratory animals in clinical MRI scanners is feasible but challenging. Compared with dedicated preclinical systems, clinical scanners have relatively low B0 field (1.5-3.0 T) and gradient strength (40-60 mT/m). This work explored the use of wireless inductively coupled coils (ICCs) combined with appropriate pulse sequence parameters to overcome these two drawbacks, with a special emphasis on the optimization of the coil passive detuning circuit for this application. A Bengal rose photothrombotic stroke model was used to induce cortical infarction in rats and mice. Animals were imaged in a 3T scanner using T2 and T1-weighted sequences. In all animals, the ICCs allowed acquisition of high-quality images of the infarcted brain at acute and chronic stages. Images obtained with the ICCs showed a substantial increase in SNR compared to clinical coils (by factors of 6 in the rat brain and 16-17 in the mouse brain), and the absence of wires made the animal preparation workflow straightforward.

La disección coronaria espontánea (DCE) es una causa infrecuente de síndrome coronario agudo (SCA) que precisa una aproximación diagnóstica y terapéutica específica. La coronariografía invasiva es la técnica de elección para el diagnóstico de la DCE. Sin embargo, la incapacidad para caracterizar la pared arterial hace necesario, en algunos casos, utilizar otras técnicas diagnósticas, como la imagen intracoronaria o la coronariografía por TC. Se presenta el caso de una mujer joven, puérpera, con diagnóstico de preeclampsia, que desarrolla un SCA secundario a una DCE donde se demuestra la utilidad de las distintas técnicas diagnósticas.

La coronariografía por tomografía computarizada (C-TC) es un método diagnóstico no invasivo para la valoración de enfermedad arterial coronaria. A pesar de su alta sensibilidad y valor predictivo negativo, su especificidad es baja, en especial para valorar la repercusión funcional de las lesiones obstructivas. El cálculo de la reserva fraccional de flujo mediante C-TC (FFR-TC) es un método innovador que permite, en un mismo estudio, la combinación de características anatómicas y hemodinámicas. Su uso en la práctica clínica habitual puede ser decisivo para orientar el manejo terapéutico, reducir la tasa de pruebas invasivas innecesarias y los costes en salud.

Puntos para una lectura rapida • La resonancia cardiaca de estres permite detectar defectos de perfusion miocardica en una etapa precoz de la cascada isquemica. • Normalmente se utiliza un vasodilatador (adenosina o regadenoson) para poner de manifiesto los defectos de perfusion. • En el estudio de resonancia cardiaca se puede, ademas, estudiar la viabilidad miocardica, caracterizando la existencia de zonas necroticas (realce tardio). • Es muy util en los diferentes perfiles de pacientes, sobre todo en pacientes con probabilidad intermedia-alta de cardiopatia isquemica. • Ademas, es una tecnica segura, con una muy baja tasa de complicaciones. Su principal limitacion es la necesidad de personal entrenado y su disponibilidad en los centros hospitalarios.

Resumen Objetivo Describir la seguridad del regadenoson como farmaco vasodilatador en estudios de resonancia magnetica cardiaca (RMC) de estres realizados para detectar isquemia miocardica. Material y metodos Se analizaron de manera retrospectiva los estudios de 120 pacientes (88 varones, edad media 67 ± 11,6 anos) con sospecha de cardiopatia isquemica o con enfermedad coronaria conocida e indicacion clinica para RMC de estres. Los estudios se realizaron en un equipo de 1,5 Tesla (MAGNETOM Aera, Siemens Healthineers) empleando regadenoson (5 ml, 0,4 mg) como agente vasodilatador. En todos los pacientes se recogieron los factores de riesgo cardiovascular, farmacos que tomaban e indicacion de la prueba, ademas de las constantes vitales en situacion de reposo y bajo estres y los sintomas y efectos adversos inducidos por el farmaco. Resultados El 52,6% de los pacientes permanecieron asintomaticos. Los sintomas mas frecuentes fueron la opresion centrotoracica (25%) y la disnea (12%). Durante el pico de estres, el incremento medio de la frecuencia cardiaca fue de 23,9 ± 11,4 lpm y el descenso medio de la presion arterial sistolica y diastolica de 7,1 ± 18,8 mmHg y 5,3 ± 9,2 mmHg, respectivamente (p Conclusion El regadenoson es un farmaco bien tolerado que se puede utilizar con seguridad en RMC de estres.

Resumen Introduccion y objetivos Diferentes estudios han demostrado el valor diagnostico y pronostico de la resonancia magnetica cardiaca (RMC) de estres en pacientes con cardiopatia isquemica. No obstante, la evidencia en ancianos es escasa, en parte por las limitaciones de las tecnicas diagnosticas disponibles para esta poblacion. El objetivo de este estudio es evaluar la utilidad de la RMC de estres en pacientes ancianos. Metodos Se estudio de manera prospectiva a los pacientes remitidos a una RMC de estres para descartar isquemia miocardica. Se considero paciente anciano a los mayores de 70 anos. El estudio de RMC de estres se realizo conforme a los protocolos internacionales. La gravedad de la hipoperfusion se clasifico en funcion de los segmentos afectados: ligera (1-2 segmentos), moderada (3-4 segmentos) o grave (> 4 segmentos). Se analizo la aparicion de eventos mayores durante el seguimiento (muerte, sindrome coronario agudo o revascularizacion). La supervivencia se analizo con el metodo de Kaplan-Meier y un modelo de regresion multivariante de Cox. Resultados De la cohorte inicial de 333 pacientes, 110 eran mayores de 70 anos. En el 40,9% de estos, la RMC de estres fue positiva para isquemia. La mediana de seguimiento fue de 26 [18-37] meses. En los pacientes ancianos se registraron 35 eventos: 15 fallecimientos, 10 sindromes coronarios agudos y 10 revascularizaciones. Los pacientes con isquemia moderada o grave tenian mayor riesgo de eventos ajustado por edad, sexo y riesgo cardiovascular (HR = 3,53; IC95%, 1,41-8,79; p = 0,01). Conclusiones La presencia de hipoperfusion moderada o grave detectada mediante RMC de estres predice de manera significativa la aparicion de eventos en mayores de 70 anos, sin que aparezcan efectos adversos relevantes.

The availability of chest computed tomography (CT) imaging can help diagnose comorbidities associated with chronic obstructive pulmonary disease (COPD). Their systematic identification and relationship with all-cause mortality have not been explored. Furthermore, whether their CT-detected prevalence differs from clinical diagnosis is unknown.The prevalence of 10 CT-assessed comorbidities was retrospectively determined at baseline in 379 patients (71% men) with mild to severe COPD attending pulmonary clinics. Anthropometrics, smoking history, dyspnoea, lung function, exercise capacity, BODE (BMI, Obstruction, Dyspnoea and Exercise capacity) index and exacerbations rate were recorded. The prevalence of CT-determined comorbidities was compared with that recorded clinically. Over a median of 78 months of observation, the independent association with all-cause mortality was analysed. A 'CT-comorbidome' graphically expressed the strength of their association with mortality risk.Coronary artery calcification, emphysema and bronchiectasis were the most prevalent comorbidities (79.8%, 62.7% and 33.9%, respectively). All were underdiagnosed before CT. Coronary artery calcium (hazard ratio [HR] 2.09; 95% CI 1.03-4.26, p = 0.042), bronchiectasis (HR 2.12; 95% CI 1.05-4.26, p = 0.036) and low psoas muscle density (HR 2.61; 95% CI 1.23-5.57, p = 0.010) were independently associated with all-cause mortality and helped define the 'CT-comorbidome'.This study of COPD patients shows that systematic detection of 10 CT-diagnosed comorbidities, most of which were not detected clinically, provides information of potential use to patients and clinicians caring for them.