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International audience; Advances in the diagnosis and management of congenital heart disease have led to a marked improvement in the survival of adult with congenital heart disease (ACHD) patients. However, ACHD patients are a heterogeneous population, with a large spectrum of anatomic substrates even within specific lesions. In addition, the nature of previous surgery and other intervention is highly variable rendering each patient unique and residual anatomic and haemodynamic abnormalities are very common. As the ACHD population continues to age, acquired heart disease will also require cardiac imaging assessment. It is increasingly recognized in ACHD community that the diagnostic utility of a multimodality cardiovascular approach is greater than the sum of individual tests. In ACHD patients, diagnostic information can be obtained using a variety of diagnostic tools. The aims of this document are to describe the role of each diagnostic modality in the care of ACHD patients and to provide guidelines for a multimodality approach. The goal should be to provide the most appropriate and cost-effective diagnostic pathway for each individual ACHD patient.

Spontaneous coronary artery dissection is a rare condition, and diagnosis and treatment are challenging among patients who present with acute coronary syndrome. Typically, the condition affects young females who have no underlying atherosclerotic disease. To date, few cases of bioresorbable scaffold implantation for the treatment of spontaneous coronary artery dissection have been reported. Therefore, we describe the cases of 4 patients whom we treated with scaffolds. We evaluated the long-term results by using intravascular ultrasound and optical coherence tomographic scanning.

International audience; Aims: Assessment of left ventricular (LV) volumes and ejection fraction (LVEF) with cardiac imaging is important in the selection of patients for cardiac resynchronization therapy (CRT). Several observational studies have explored the role of imaging-derived LV dyssynchrony parameters to predict the response to CRT, but have yielded inconsistent results, precluding the inclusion of imaging-derived LV dyssynchrony parameters in current guidelines for selection of patients for CRT. Methods: The EuroCRT is a large European multicentre prospective observational study led by the European Association of Cardiovascular Imaging. We aim to explore if combing the value of cardiac magnetic resonance (CMR) and echocardiography could be beneficial for selecting heart failure patients for CRT in terms of improvement in long-term survival, clinical symptoms, LV function, and volumes. Speckle tracking echocardiography will be used to assess LV dyssynchrony and wasted cardiac work whereas myocardial scar will be assessed with late gadolinium contrast enhanced CMR. All data will be measured in core laboratories. The study will be conducted in European centres with known expertise in both CRT and multimodality cardiac imaging.

Background: Radiolabeled prostate-specific membrane antigen PSMA-based PET/CT or PET/MRI is a whole-body imaging technique currently performed for the detection of prostate cancer lesions. PSMA has been also demonstrated to be expressed by the neovasculature of many other solid tumors. Objective: The aim of this review is to evaluate the possible diagnostic role of radiolabeled PSMA PET/CT or PET/MRI in patients with gliomas and glioblastomas, by summarizing the available literature data. Methods: A comprehensive literature search of the PubMed/MEDLINE, Scopus, Embase and Cochrane library databases was conducted to find relevant published articles about the diagnostic performance of radiolabeled PSMA binding agents in PET/CT or PET/MRI imaging of patients with suspected gliomas or glioblastomas. Results: Seven case reports or case series and 3 studies enrolling more than 10 patients showed that gliomas and glioblastoma are PSMA-avid tumors. Conclusion: Radiolabeled PSMA imaging seems to be useful in analyzing glioma/glioblastoma. Further studies enrolling a wider population are needed to clarify the real clinical and diagnostic role of radiolabeled PSMA in this setting and its possible position in the diagnostic flow-chart.

BackgroundSmall hard macular drusen can be observed in the retina of adults as young as 18 years of age. Here, we seek to describe the in vivo topography and geometry of these drusen.MethodsRetinal images were acquired in young, healthy adults using colour fundus photography, spectral domain optic coherence tomography (SD-OCT), reflectance flood-illuminated adaptive optic ophthalmoscopy (AO flood) and reflectance adaptive optic scanning light ophthalmoscopy (AOSLO) in both confocal and non-confocal split-detection modalities. Small bright yellow hard drusen within a 10 degree radius from the foveal centre were characterised.ResultsSmall hard drusen were seen on colour photographs in 21 out of 97 participants and 26 drusen in 12 eyes in 11 participants were imaged using the full protocol. Drusen were easily identifiable in all modalities, except a few very small ones, which were not visible on SD-OCT. On AOSLO images, these drusen appeared as round, oval or lobular areas (up to three lobules) of diameter 22–61 µm where cone photoreceptor reflectivity and density was decreased (p=0.049). This was usually associated with discrete thickening of the retinal pigment epithelium (RPE) complex.ConclusionHigh lateral resolution imaging of small lobular hard retinal drusen suggests formation through the confluence of two or more smaller round lesions. The outline and size of these smaller lesions corresponds to 1–4 RPE cells. Prospective longitudinal studies are needed to determine the ultimate fate of small hard drusen and their potential relation to age-related macular degeneration.

Recent studies have shown that it is feasible to record simultaneously intracerebral EEG (icEEG) and functional magnetic resonance imaging (fMRI) in patients with epilepsy. While it has mainly been used to explore the hemodynamic changes associated with epileptic spikes, this approach could also provide new insight into human cognition. However, the first step is to ensure that cognitive EEG components, that have lower amplitudes than epileptic spikes, can be appropriately detected under fMRI. We compared the high frequency activities (HFA, 50–150[Formula: see text]Hz) elicited by a reading task in icEEG-only and subsequent icEEG-fMRI in the same patients ([Formula: see text]), implanted with depth electrodes. Comparable responses were obtained, with 71% of the recording sites that responded during the icEEG-only session also responding during the icEEG-fMRI session. For all the remaining sites, nearby clusters (distant of 7[Formula: see text]mm or less) also demonstrated significant HFA increase during the icEEG-fMRI session. Significant HFA increases were also observable at the single-trial level in icEEG-fMRI recordings. Our results show that low-amplitude icEEG signal components such as cognitive-induced HFAs can be reliably recorded with simultaneous fMRI. This paves the way for the use of icEEG-fMRI to address various fundamental and clinical issues, notably the identification of the neural correlates of the BOLD signal.

BACKGROUND: This study aimed to determine if delayed (18)F-fluorodeoxyglucose ((18)FDG) PET/CT imaging improves quantitation of atherosclerotic plaque inflammation. Blood-pool activity can disturb the arterial (18)FDG signal. With time, blood-pool activity declines. Therefore, delayed imaging can potentially improve quantitation of vascular inflammation.METHODS AND RESULTS: 40 subjects were prospectively assessed by dual-time-point PET/CT imaging at approximately 90 and 180 minutes after (18)FDG administration. For both time-points, global uptake of (18)FDG was determined in the carotid arteries and thoracic aorta by calculating the blood-pool corrected maximum standardized uptake value (cSUVMAX). A target-to-background ratio (TBR) was calculated to determine the contrast resolution at 90 and 180 minutes. Furthermore, we assessed whether the acquisition time-point affected the relation between cSUVMAX and the estimated 10-year risk for fatal cardiovascular disease (SCORE %). A significant increase in carotid cSUVMAX (23%, P < .0001), carotid TBR (20%, P < .0001), aortic cSUVMAX (14%, P < .0001), and aortic TBR (20%, P < .0001) was observed with time. At 90 minutes, cSUVMAX did not relate to SCORE %, whereas at 180 minutes significant positive relations were observed between SCORE % and carotid (τ = 0.25, P = .045) and aortic (τ = 0.33, P = .008) cSUVMAX.CONCLUSIONS: Delayed (18)FDG PET/CT imaging at 180 minutes improves quantitation of atherosclerotic plaque inflammation over imaging at 90 minutes. Therefore, the optimal acquisition time-point to assess atherosclerotic plaque inflammation lies beyond the advocated time-point of 90 minutes after (18)FDG administration.

This study was performed to evaluate the feasibility of intra-procedural visualization of optimal pacing sites and image-guided left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT). In fifteen patients (10 males, 68 ± 11 years, 7 with ischemic cardiomyopathy and ejection fraction of 26 ± 5%), optimal pacing sites were identified pre-procedurally using cardiac imaging. Cardiac magnetic resonance (CMR) derived scar and dyssynchrony maps were created for all patients. In six patients the anatomy of the left phrenic nerve (LPN) and coronary sinus ostium was assessed via a computed tomography (CT) scan. By overlaying the CMR and CT dataset onto live fluoroscopy, aforementioned structures were visualized during LV lead implantation. In the first nine patients, the platform was tested, yet, no real-time image-guidance was implemented. In the last six patients real-time image-guided LV lead placement was successfully executed. CRT implant and fluoroscopy times were similar to previous procedures and all leads were placed close to the target area but away from scarred myocardium and the LPN. Patients that received real-time image-guided LV lead implantation were paced closer to the target area compared to patients that did not receive real-time image-guidance (8 mm [IQR 0-22] vs 26 mm [IQR 17-46], p = 0.04), and displayed marked LV reverse remodeling at 6 months follow up with a mean LVESV change of -30 ± 10% and a mean LVEF improvement of 15 ± 5%. Real-time image-guided LV lead implantation is feasible and may prove useful for achieving the optimal LV lead position.

PURPOSE: To investigate the feasibility of using deformable registration in clinical practice to fuse MR and CT images of the head and neck for treatment planning.METHOD AND MATERIALS: A state-of-the-art deformable registration algorithm was optimized, evaluated, and compared with rigid registration. The evaluation was based on manually annotated anatomic landmarks and regions of interest in both modalities. We also developed a multiparametric registration approach, which simultaneously aligns T1- and T2-weighted MR sequences to CT. This was evaluated and compared with single-parametric approaches.RESULTS: Our results show that deformable registration yielded a better accuracy than rigid registration, without introducing unrealistic deformations. For deformable registration, an average landmark alignment of approximatively 1.7 mm was obtained. For all the regions of interest excluding the cerebellum and the parotids, deformable registration provided a median modified Hausdorff distance of approximatively 1 mm. Similar accuracies were obtained for the single-parameter and multiparameter approaches.CONCLUSIONS: This study demonstrates that deformable registration of head-and-neck CT and MR images is feasible, with overall a significanlty higher accuracy than for rigid registration.

In this paper the Working Group on Myocardial and Pericardial Disease proposes a revised definition of dilated cardiomyopathy (DCM) in an attempt to bridge the gap between our recent understanding of the disease spectrum and its clinical presentation in relatives, which is key for early diagnosis and the institution of potential preventative measures. We also provide practical hints to identify subsets of the DCM syndrome where aetiology directed management has great clinical relevance.

Hamartoma is a nodular malformation, with a single or multiple malformations, it is a recognized prenatal developmental abnormality. This benign tumor lesion has the same histological components of normal parenchyma, but these components are arranged haphazardly which disrupts normal function. Hamartomas usually remain connected with the tissue of origin; as is the case with pulmonary hamartoma or the splenic hamartoma. The exact incidence of retinal astrocytic hamartoma (RAH) is not well known, but it is estimated at one case per 100 000 births per year [1]. The astrocytic hamartoma is a neuroglial tissue and produces astrocytes within the optic nerve [2], and consequently it often appears within papillary region.

Item does not contain fulltext This paper presents the first European appropriateness criteria for the use of cardiovascular imaging in heart failure, derived from voting of the European National Imaging Societies representatives. The paper describes the development process and discusses the results.

In this literature review, an update is provided on the role of [(18)F]fluorodeoxyglucose PET/computed tomography in different clinical settings of the 4 most frequent female-specific cancer types: breast, endometrial, ovarian, and cervical cancer. The most recent knowledge regarding primary diagnosis, staging, response evaluation, prognostic and predictive values, recurrence detection, and radiotherapy planning is evaluated, including, when clinically relevant, considerations with respect to the epidemiology, treatment, and course of the diseases.

Background and Purpose— We investigated whether uptake of 18 fluoro-2-deoxy-d-glucose (18FDG) positron emission tomography–computed tomography (PET-CT) correlated to clinical symptoms and presence of microembolic signals (MES) detected by transcranial Doppler in patients with carotid stenosis. Methods— 18FDG-PET-CT and MES detection was performed in consecutive patients with 50% to 99% symptomatic or asymptomatic carotid stenoses. Uptake index was defined by a target to background ratio (TBR) between maximum standardized uptake value of the carotid plaque and the mean standardized uptake value of the jugular veins. End points for analysis were presence of symptoms and presence of MES. Results— We included 123 stenosis derived from 110 patients, 60 symptomatic and 63 asymptomatic. MES positive (+) lesions were found in 16%. TBR values were higher in symptomatic compared with asymptomatic (median 2.07 versus 1.78; P P P ρ 0.26; P =0.0043). Conclusions— 18FDG-PET-CT accurately detected high-risk carotid plaques. Also given its strong correlation to MES, 18FDG-PET-CT may be a useful tool in clinical practice.

18F-fluoro-deoxy-glucose-positron emission tomography/computed tomography-scan (PET/CT) is used increasingly for detection of cancer. Precise diagnostic assessment of tumour extension in head and neck squamous cell carcinoma (HNSCC) is of critical importance for ensuring that patients receive proper treatment. Preliminary studies have shown divergent results of PET/CT in diagnosis and staging of HNSCC. The aims of this study were (1) to systematically review and meta-analyse published data about the diagnostic accuracy of PET/CT for diagnosing patients with HNSCC and (2) to compare the diagnostic accuracy of PET/CT with that of standard conventional imaging (SCI).METHODS: A systematic literature search in the PubMed, Embase and Cochrane databases on publications of PET/CT diagnostics of HNSCC from January 2005 to July 2013 was carried out. All retrieved studies were reviewed and qualitatively analysed. Along with the calculated pooled sensitivity and specificity of PET/CT and SCI, bubble- and summary receiver operating characteristics (SROC) plots were created.FINDINGS: Two meta-analyses of diagnostic accuracy were conducted. The first, on PET/CT, included 987 patients distributed across nine studies. The second, on SCI, included 517 patients participating in a total of six studies among those comparing PET/CT to SCI. The meta-analyses showed a pooled sensitivity of 89.3% (95% confidence interval [95% CI]: 83.4-93.2%) and specificity of 89.5% (95% CI: 82.9-93.7%) for PET/CT and correspondingly, a pooled sensitivity and specificity of 71.6% (95% CI: 44.3-88.9%) and 78.0% (95%CI: 30.2-96.7%) for SCI. A graphical comparison to SCI showed a clear difference in favour of PET/CT.INTERPRETATION: PET/CT is highly accurate in diagnosing patients suffering from HNSCC.

Fusion of information from PET and MR imaging can increase the diagnostic value of both modalities. This work sought to improve 18F FDG PET image quality by using MR Dixon fat-constrained images to constrain PET image reconstruction to low-fat regions, with the working hypothesis that fatty tissue metabolism is low in glucose consumption. Methods: A novel constrained PET reconstruction algorithm was implemented via a modification of the system matrix in list-mode time-of-flight ordered-subsets expectation maximization reconstruction, similar to the way time-of-flight weighting is incorporated. To demonstrate its use in PET/MR imaging, we modeled a constraint based on fat/water-separating Dixon MR images that shift activity away from regions of fat tissue during PET image reconstruction. PET and MR imaging scans of a modified National Electrical Manufacturers Association/International Electrotechnical Commission body phantom simulating body fat/water composition and in vivo experiments on 2 oncology patients were performed on a commercial time-of-flight PET/MR imaging system. Results: Fat-constrained PET reconstruction visibly and quantitatively increased resolution and contrast between high-uptake and fatty-tissue regions without significantly affecting the images in nonfat regions. Conclusion: The incorporation of MR tissue information, such as fat, in image reconstruction can improve the quality of PET images. The combination of a variety of potential other MR tissue characteristics with PET represents a further justification for merging MR data with PET data in hybrid systems.

Background:Cell-free DNA (cfDNA) circulating in the blood holds a possible prognostic value in malignant diseases. Under malignant conditions, the level of cfDNA increases but the biological mechanism remains to be fully understood. We aimed to examine the correlation between cfDNA and total tumour burden defined by positron emission tomography (PET) parameters.Methods:Patients with advanced non-small cell lung cancer (NSCLC) were enrolled into a prospective biomarker trial. Before treatment, plasma was extracted and the level of cfDNA was determined by qPCR. An (18)F-fluorodeoxyglucose ((18)F-FDG) PET/computed tomography (CT) scan was performed and evaluated in terms of metabolic tumour volume (MTV) and total lesion glycolysis (TLG). Tumour contours were delineated semi-automatically by a threshold standardised uptake value (SUV) of 2.5. The primary end point was correlation among cfDNA, MTV and TLG. The secondary end point was overall survival (OS) according to cfDNA, MTV and TLG.Results:Fifty-three patients were included. There were no correlations between cfDNA and MTV (r=0.1) or TLG (r=0.1). cfDNA >75th percentile was correlated with shorter OS (P=0.02), confirmed in a multivariate analysis. MTV>the median was associated with a significantly shorter OS (P=0.02). There was no significant difference in OS according to TLG (P=0.08).Conclusion:Cell-free DNA may not be a simple measure of tumour burden, but seems to reflect more complex mechanisms of tumour biology, making it attractive as an independent prognostic marker.British Journal of Cancer advance online publication 14 November 2013; doi:10.1038/bjc.2013.705 www.bjcancer.com.

PURPOSE: (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and MRI are used for detecting liver metastases from uveal melanoma. The introduction of new treatment options in clinical trials might benefit from early response assessment. Here, we determine the value of FDG-PET/CT with respect to MRI at diagnosis and its potential for monitoring therapy. MATERIAL AND METHODS: Ten patients with biopsy-proven liver metastases of uveal melanoma enrolled in a randomized phase III trial (NCT00110123) underwent both FDG-PET coupled with unenhanced CT and gadolinium-diethylene triamine pentaacetic acid-enhanced liver MRI within 4 weeks. FDG-PET and MRI were evaluated blindly and then compared using the ratio of lesion to normal liver parenchyma PET-derived standardized uptake value (SUV). The influence of lesion size and response to chemotherapy were studied. RESULTS: Overall, 108 liver lesions were seen: 34 (31%) on both modalities (1-18 lesions/patient), four (4%) by PET/CT only, and 70 (65%) by MRI only. SUV correlated with MRI lesion size (r=0.81, P

Purpose: The outcome of a detailed assessment of various strategies for atlas-based whole-body bone segmentation from magnetic resonance imaging (MRI) was exploited to select the optimal parameters and setting, with the aim of proposing a novel one-registration multi-atlas (ORMA) pseudo-CT generation approach. Methods: The proposed approach consists of only one online registration between the target and reference images, regardless of the number of atlas images (N), while for the remaining atlas images, the pre-computed transformation matrices to the reference image are used to align them to the target image. The performance characteristics of the proposed method were evaluated and compared with conventional atlas-based attenuation map generation strategies (direct registration of the entire atlas images followed by voxel-wise weighting (VWW) and arithmetic averaging atlas fusion). To this end, four different positron emission tomography (PET) attenuation maps were generated via arithmetic averaging and VWW scheme using both direct registration and ORMA approaches as well as the 3-class attenuation map obtained from the Philips Ingenuity TF PET/MRI scanner commonly used in the clinical setting. The evaluation was performed based on the accuracy of extracted whole-body bones by the different attenuation maps and by quantitative analysis of resulting PET images compared to CT-based attenuation-corrected PET images serving as reference. Results: The comparison of validation metrics regarding the accuracy of extracted bone using the different techniques demonstrated the superiority of the VWW atlas fusion algorithm achieving a Dice similarity measure of 0.82 ± 0.04 compared to arithmetic averaging atlas fusion (0.60 ± 0.02), which uses conventional direct registration. Application of the ORMA approach modestly compromised the accuracy, yielding a Dice similarity measure of 0.76 ± 0.05 for ORMA-VWW and 0.55 ± 0.03 for ORMA-averaging. The results of quantitative PET analysis followed the same trend with less significant differences in terms of SUV bias, whereas massive improvements were observed compared to PET images corrected for attenuation using the 3-class attenuation map. The maximum absolute bias achieved by VWW and VWW-ORMA methods was 06.4 ± 5.5 in the lung and 07.9 ± 4.8 in the bone, respectively. Conclusions: The proposed algorithm is capable of generating decent attenuation maps. The quantitative analysis revealed a good correlation between PET images corrected for attenuation using the proposed pseudo-CT generation approach and the corresponding CT images. The computational time is reduced by a factor of 1/N at the expense of a modest decrease in quantitative accuracy, thus allowing us to achieve a reasonable compromise between computing time and quantitative performance.