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T1 and T2 mapping techniques on cardiovascular magnetic resonance (CMR) provide insights into the myocardial tissue characterisation. We sought to establish the normal reference values of native T1 and T2 mapping in Indian population which can be used subsequently in clinical practice for addressing various cardiac pathologies. This prospective study included consecutive healthy volunteers (18-60 years) who underwent CMR on a 1.5 Tesla scanner using standard protocol. T1 mapping sequence was performed using MOLLI sequence with two different flip angles (FA) (35° and 50°). T2 mapping was performed using a hybrid gradient and spin-echo sequence sequence with two different FA (70° and 12°). Images were analysed with ROIs drawn in all the 16 AHA myocardial segments. 50 volunteers (average age-34 years, males-72%) were included. All the scans were normal. The mean T1 value at 35-degree FA was 946.86 + 14.16 ms and at 50-degree FA was 941.60 + 11.89 ms. The mean T2 mapping value at 70-degree FA was 45.67 + 1.39 ms and at 12-degree FA was 45.61 + 1.47 ms. The mapping values were not statistically different between males and females (all p 0.2). The T1 and T2 mapping values did not show any significant correlation with LVEF, age, BMI or heart rate (all r 0.33). The T1 mapping values significantly differ at 35- and 50-degree FAs (p = 0.002). The results establish the normal reference T1 and T2 mapping value for Indian population in institutes using the same protocol and parameters at 1.5 Tesla and may guide future research.

PURPOSE: We aimed to determine the prevalence rate and radiological characteristics of intra-atrial right coronary artery (IARCA) in an adult population undergoing computed tomography coronary angiography (CTCA) on a dual-source CT scanner. METHODS: Overall, 7114 consecutive CTCAs acquired using a dual-source CT scanner in a high-volume, specialized cardiac care facility were retrospectively analyzed for the presence of IARCA. We scrutinized the CTCA datasets to determine the prevalence rate of IARCA and also to characterize its various imaging features including its length, depth from right atrial wall, segment involved, and presence and absence of atherosclerosis within the involved segment and in the rest of the right coronary artery (RCA). RESULTS: The prevalence of IARCA was 0.29% (21/7114) in our study population. The mean length and depth of the intra-atrial segment was 14.85 mm and 2.57 mm, respectively. The mid-RCA was the most common segment to be involved, and no significant atherosclerosis was noted either in the intra-atrial segment or the rest of the RCA. CONCLUSION: The prevalence rate of the incidental IARCA in the adult subjects undergoing CTCA is higher than previously reported for anatomical series, as seen in our study using a dual-source scanner. This under-reported anomaly must be explicitly assessed in patients undergoing ablative and other electrophysiological procedures, where it can have important implications.

Objective: We aimed to evaluate the diagnostic accuracy (DA) of dual-source CT coronary angiography (DSCTCA) against invasive coronary angiography (ICA) in assessing stenotic cardiac allograft vasculopathy (CAV) in heart transplant (HTX) recipients. Methods: Consecutive HTX recipients(n = 38) on annual surveillance, underwent DSCTCA prior to ICA on a 192-detector 384-slice DSCT scanner. Cases were classified as no CAV (no stenosis), any CAV (any degree of stenosis) or significant CAV (>50% stenosis). Results: Mean age was 33.66 ± 11.45 years (M:F = 27:11, median time from HTX-23.5 months). Prevalence of any CAV on DSCTCA and ICA was 44.7%(n = 17) and 39.5%(n = 15), respectively and that of significant CAV was 21.1%(n = 8) and 15.8%(n = 6), respectively. 557 (96.7%) segments were interpretable on DSCTCA. Mean radiation dose was 4.24 ± 2.15 mSv. At patient-level, the sensitivity, specificity, positive-predictive value, negative-predictive value (NPV), and DA of DSCTCA for detection of any CAV and significant CAV were 100%, 91.3%, 88.2%, 100%, 94.73% and 100%, 94%, 75%, 100%, 95% respectively. The same on segment-based analysis were 96%, 97.6%, 80%, 99.6%, 97.5% and 100%, 99.6%,86.7%,100%, 99.6%, respectively. There was excellent agreement between the two modalities for detection of any CAV and significant CAV [κ = 0.892 and 0.826 (patient-level), 0.859 and 0.927 (segment-level)]. CAC score correlated significantly with the presence of any CAV on both modalities. A diagnosis of rejection on biopsy did not correlate with any/significant CAV on DSCTCA or ICA. Conclusion: High sensitivity and NPV of DSCTCA in the evaluation of stenotic CAV suggests that it can be an accurate and non-invasive alternative to ICA for routine surveillance of HTX recipients. Advances in knowledge: DSCTCA detects the stenotic CAV non-invasively in transplant recipients with high sensitivity, specificity and NPV when compared with catheter coronary angiography, at lower radiation doses. There is excellent agreement between CT angiography and catheter coronary angiography for detection of any CAV and significant CAV. A diagnosis of rejection on biopsy does not correlate with any/significant CAV on CT angiography or catheter angiography.

We hereby present a case in which we used gadolinium as contrast medium for thoracic endovascular aortic repair in a patient with iodine hypersensitivity.

Aims To explore the impact of incorporating a faster cardiac magnetic resonance (CMR) imaging protocol in a low–middle-income country (LMIC) and using the result to guide chelation in transfusion-dependent patients. Methods and results A prospective UK–India collaborative cohort study was conducted in two cities in India. Two visits 13 months apart included clinical assessment and chelation therapy recommendations based on rapid CMR results. Participants were recruited by the local patient advocate charity, who organized the patient medical camps. The average scanning time was 11.3 ± 2.5 min at the baseline and 9.8 ± 2.4 min (P Conclusion For thalassaemia patients in an LMIC, a simplified CMR protocol linked to therapeutic recommendation via the patient camp model led to enhanced chelation therapy and a reduction in cardiac iron in 1 year.

Cardiac outpouchings pose a diagnostic challenge when encountered in practice, as the signs, symptoms, and initial investigations, such as radiographs and electrocardiogram, are nonspecific. They may remain asymptomatic and be incidentally detected. However, a few may present with progressive shortness of breath, thromboembolic complications, arrhythmias, pressure effects, rupture, or even death. Imaging is of paramount importance in establishing an accurate diagnosis, delineating morphology and extent of the lesion along with its hemodynamic significance, planning management, and in the follow-up.

Integrating interventional radiology (IR) into clinical practice faces challenges in emerging countries in Asia and Africa. Overcoming them requires innovative solutions customized to local needs. After an in-depth gap analysis of these challenges, we began an organized skill development initiative in late 2015 offering radiologists and their supporting staff fully paid scholarships for IR training. Its concept, structure, and progress are reported here. This initiative covered 8 countries, IR specialists (n = 51), senior residents (n = 24), and 15 educational events (training institute [n = 3]; participating countries [n = 12]). This initiative is intended to develop a global network of trained personnel who can support IR programs in challenging locations of emerging countries.

Background: Survival in transfusion dependent thalassemia is closely linked to iron overload with severe cardiac iron causing heart failure. MRI guided chelation improves survival in high income countries. We explored the use of rapid MRI to guide therapy in a Lower Middle Income Country (LMIC), India, via locally organized thalassemia patient medical camps. Methods: Rapid cardiac MRI (rCMR) was implemented at two sites with clinical assessment and therapy recommendations based on rCMR findings. Investigations and clinical reassessment were repeated at 13 months. Findings: The baseline visit was attended by 103 patients, the second by 86. Average time of scanning was 10 minutes. At baseline 29% had a cardiac T2* = 17ms). At 13 months more patients were taking 2 oral chelators (21% to 37%, p

Myocardial iron overload (MIO) in thalassemia major (TM) may cause subclinical left ventricular (LV) dysfunction which manifests with abnormal strain parameters before a decrease in ejection fraction (EF). Early detection of MIO using cardiovascular magnetic resonance (CMR)-T2* is vital. Our aim was to assess if CMR feature-tracking (FT) strain correlates with T2*, and whether it can identify early contractile dysfunction in patients with MIO but normal EF. One hundred and four consecutive TM patients with LVEF > 55% on echocardiography were prospectively enrolled. Those fulfilling the inclusion criteria underwent CMR, with T2* being the gold standard for detecting MIO. Group 1 included patients without significant MIO (T2* > 20 ms) and group 2 with significant MIO (T2* < 20 ms). Eighty-six patients (mean age, 17.32 years, 59 males) underwent CMR. There were 68 (79.1%) patients in group 1 and 18 (20.9%) in group 2. Fourteen patients (16.3%) had mild-moderate MIO, and four (4.6%) had severe MIO. Patients in group 2 had significantly lower global radial strain (GRS). Global longitudinal strain (GLS) and global circumferential strain (GCS) did not correlate with T2*. T1 mapping values were significantly lower in patients with T2* < 10 ms than those with T2* of 10–20 ms; however, FT-strain values were not significantly different between these two groups. CMR-derived GRS, but not GLS and GCS, correlated with CMR T2*. GRS is significantly decreased in TM patients with MIO and normal EF when compared with those without. FT-strain may be a useful adjunct to CMR T2* and maybe an early marker of myocardial dysfunction in TM. • A global radial strain of < 29.3 derived from cardiac MRI could predict significant myocardial iron overload in patients with thalassemia, with a sensitivity of 76.5% and specificity of 66.7%. • Patients with any myocardial iron overload have significantly lower GRS, compared to those without, suggesting the ability of CMR strain to identify subtle myocardial contractile disturbances. • T1 and T2 mapping values are significantly lower in those with severe myocardial iron than those with mild-moderate iron, suggesting a potential role of T1 and T2 mapping in grading myocardial iron.

Cross-sectional imaging plays an essential role in the diagnosis and management of various structural and functional changes that occur in the postoperative period after palliative or corrective surgical procedures performed for congenital heart diseases (CHD). Although echocardiography is the mainstay for the evaluation of CHD, it is limited by poor acoustic window post-surgery in addition to being operator dependent. Computed tomography (CT) allows for the comprehensive evaluation of the post-surgical anatomy and complications after repair for cyanotic CHD. Radiologists and cardiac imagers should be familiar with these expected changes after surgeries performed for various cyanotic CHDs, to obtain diagnostic quality cardiac CT images and to promptly recognise the abnormal post-operative appearances in this patient population. In this review, we describe the various CT features of complications that can be encountered after repair of cyanotic CHDs.

Objectives There is wide variation in the practice of IVC filter placement and retrievals. We conducted a retrospective study to identify the trends in placement and retrievals of IVC filters in a tertiary referral centre in India. Methods The data of patients obtained from our hospital records, in whom IVC filter was placed between 2010 and 2018, were analysed for demographics, indications for placement of IVC filter, underlying comorbidities, characteristics of the filters as well as the retrieval rates. Results IVC filters were placed in 50 patients, and data was retrieved for 31 patients (mean - 51.24 years, 67.74% males). According to ACCP/AHA guidelines, 24 (77.42%) had an absolute indication for IVC filter. All 31 IVC filters were temporary, 23 (74.19%) of which were placed via femoral access. 29(93.55%) patients had infrarenal IVC filter placement. The average tilt at deployment was 3.71°, whereas it was 5.3° at retrieval. There were no periprocedural complications or filter migrations during placement or retrieval. Retrieval was attempted in 11 (35.48%) patients and was successful in 10. The mean indwelling time in this group was 158.55 days (range 55–366 days). Conclusion Our study reveals low IVC filter implantation rates which are predominantly for absolute rather than relative indications. Though in sync with the worldwide trend, the poor retrieval rates reflect the urgent need for better patient and physician awareness. Periodic follow up is imperative to improve the IVC filter retrieval rate and to prevent complication rates.

We present a case of rare double drainage of total anomalous pulmonary venous connection, which was diagnosed on a dual-source CT scanner. This case also highlights the critical role of volume-rendered images for preoperative planning.

Endomyocardial fibrosis usually is an end-stage cardiomyopathy. We present a case which was picked up early in a stage with active thrombosis and inflammation using magnetic resonance imaging and DOTANOC scans and treated leading to regression of inflammation and thrombus. We advocate aggressive investigation of all cardiomyopathies to look for treatable causes.

This is a case of a young man who underwent preoperative computed tomography evaluation for sinus venosus type of atrial septal defect, and was found to have associated chronic constrictive pericarditis. Association of these two entities is rare and changes the management approach.

Imaging of repaired tetralogy of Fallot (TOF) is one of the common indications for cardiac magnetic resonance (CMR) examinations. With advances in CMR imaging techniques like phase contrast imaging and functional imaging, it has superseded investigations like echocardiography for anatomical and functional assessment of the pathophysiological changes in repaired TOF. Common repair procedures for TOF include infundibulectomy, transannular patch repair and right ventricle to pulmonary artery (RV-PA) conduit. While each of these procedures cause dynamic changes in heart and pulmonary arteries resulting in some expected imaging findings, CMR also helps in diagnosing the complications associated with these repair procedures like pulmonary stenosis, right ventricular outflow tract aneurysm, pulmonary regurgitation, RV-PA conduit stenosis, tricuspid regurgitation, right ventricular failure, and residual ventricular septal defects. Hence, it is imperative for a radiologist to be familiar with the expected changes on CMR in repaired TOF along with some of the common complications that may be encountered on imaging in such patients.

Takotsubo cardiomyopathy (TC) is a reversible condition in which there is transient left ventricular (LV) dysfunction characterised most commonly by basal hyperkinesis and mid-apical LV ballooning and hypokinesia. It is said to be triggered by stress and mimics, such as acute coronary syndrome (ACS) clinically. Diagnosis is usually suspected on echocardiography due to the characteristic contraction pattern in a patient with symptoms and signs of ACS but normal coronary arteries on catheter angiography. Cardiac magnetic resonance (CMR), with its latest advancements, is the diagnostic modality of choice for diagnosis, prognosis and follow-up of patients. The advances in CMR (including T1, T2, ECV mapping and threshold-based late gadolinium enhancement (LGE) measurements have revolutionised the role of CMR in tissue characterisation and prognostication in patients with TC. In this review, we highlight the current role of CMR in management of TC and enumerate the CMR findings in TC as well the current advances in the field of CMR, which could help in prognosticating these patients.

CT angiography in a 45-year-old woman with atypical chest pain revealed two left anterior descending (LAD) arteries in the anterior interventricular sulcus (AIS). The longer LAD (white arrowhead in [figure 1A–D][1]) was arising from the left main coronary artery (LMCA) and was coursing up to the

Non-invasive diagnosis of cardiac amyloidosis may obviate the need for biopsy. The aim of our study was to determine the utility of identifying the type of nulling pattern on TI Scout sequence in diagnosis of cardiac amyloid infiltration. Materials and Methods-This retrospective observational study

Echocardiography in a 64-year-old patient with dyspnoea revealed coarctation of aorta with an aneurysm in the region of ascending aorta. CT angiography (CTA) showed juxtaductal coarctation of aorta ([figure 1A,B][1]). Additionally, a large saccular peripherally calcified aneurysm ([figure 1A,C][1])

A 48-year-old man diagnosed with left gingivobuccal sulcus carcinoma was started on chemotherapy for which a peripherally inserted central catheter (PICC) was placed via the right antecubital vein. The position of the catheter tip in the superior vena cava was confirmed on a chest radiograph. After

A 45-year-old man presented in the outpatient clinic with occasional atypical chest pain. ECG was normal, and echocardiography did not reveal any wall motion abnormality. The patient was referred to us for CT angiography (CTA) to rule out coronary artery disease. The CTA, done on 192(×2)-slice

Anomalous origin of left main coronary artery from non-coronary sinus (LCANCS) is an extremely rare anomaly. Aortic coarctation in association with LCANCS has not been previously described in literature.