Prevalence and distribution of coronary calcium in asymptomatic Japanese subjects in lung cancer screening computed tomography.

BACKGROUND: Coronary artery calcium (CAC) is associated with a risk of coronary heart disease. The prevalence and distribution of the CAC score have been examined in Western countries, but few studies have been performed in Asia, and especially in Japan. The goal of this study was to investigate CAC scores in an asymptomatic Japanese population. METHODS: CAC score and risk factors were analyzed in 1834 asymptomatic subjects who underwent lung cancer screening computed tomography. RESULTS: CAC was present in 26.9% of all the subjects, 29.8% of the males, and 17.1% of the females. In all age groups, the CAC score was higher in males. In multivariate analysis, male gender [odds ratio (OR) 2.461, 95% confidence interval (CI) 1.361-4.452, p=0.002], aging (OR 1.102, 95% CI 1.081-1.123, p<0.001), dyslipidemia (OR 1.740, 95% CI 1.216-2.490, p=0.002), and fasting glucose (OR 1.008, 95% CI 1.002-1.015, p=0.012) were significantly associated with a CAC score >100. CONCLUSION: The results of this study provide a pattern of CAC distribution based on age and gender in asymptomatic Japanese subjects. This pattern was similar to that in Western countries, although the absolute CAC scores were lower. High CAC scores were associated with male gender, aging, dyslipidemia, and fasting glucose.

Non-contrast myocardial perfusion using a novel 4D magnetic resonance arterial spin labeling technique: initial experience.

The aim of this study is to develop a novel non-contrast 4-dimensional MR arterial spin labeling (4D-ASL) technique (3D acquisition and time) and to investigate myocardial perfusion on healthy volunteers without administration of contrast materials. A non-contrast 4D-ASL technique was developed using the time-spatial labeling inversion pulse (Time-SLIP) to obtain myocardium perfusion of eight volunteers at 1.5 T. The tagging slab was placed on the proximal ascending aorta to invert the blood magnetization and mid-ventricle 3D images at diastolic phase were acquired with multiple tagging delays. The time resolved 3D images with various inversion times (TI) were registered and segmented for the visualization of myocardial signal changes along the TI, and perfusion curves were generated to identify the perfusion peaks. Blood flow from basal to apical slices was observed in all volunteers. Peak flow at the mid-ventricle was observed 200-400 ms after the blood was tagged at the aortic root blood. After the perfusion peak, all signals returned to the base line. The 4D Time-SLIP technique permits non-contrast perfusion images with high temporal resolution, which may potentially differentiate normal from diseased myocardium.

Clinical application of an automatic slice-alignment method for cardiac MR imaging.

PURPOSE: We evaluated the usefulness of an automatic slice-alignment method to simplify planning of cardiac magnetic resonance (MR) scans with a 3-tesla scanner. METHODS: We obtained 2-dimensional (2D) axial multislice images using steady-state free precession (SSFP) sequences covering the whole heart at the end-diastole phase with electrocardiography (ECG) gating in 38 patients. We detected several anatomical feature points of the heart and calculated all planes required for cardiac imaging based on those points. We visually evaluated the acceptability of an acquired imaging plane and measured the angular differences of each view between the results obtained by this method and by a conventional manual pointing approach. RESULTS: The average visual scores were 3.4 ± 1.0 for short-axis images, 3.2 ± 0.9 for 4-chamber images, 3.2 ± 0.8 for 2-chamber images, and 3.3 ± 0.8 for 3-chamber images; average angular differences were 5.8 ± 5.1 (short axis), 7.7 ± 5.7 (4-chamber), 11.5 ± 6.7 (2-chamber), and 9.1 ± 4.6 degrees (3-chamber). Processing time was within 1.8 s in all subjects. CONCLUSION: The proposed method can provide planes within the clinically acceptable range and within a short time in cardiac imaging of patients with various cardiac shapes and diseases without the need for high level operator proficiency in performing the examination and interpreting results.

Deep vein thrombosis risk stratification.

Pulmonary thromboembolism (PTE) is a life-threatening disease which always presents in patients with deep vein thrombosis (DVT). There are few statements in guidelines regarding indications for anticoagulation based on the location of DVT. We investigated whether the relative risk of PTE depends on thrombus location and bleeding complications with anticoagulation therapy. Between January 1 and July 10, 2007, 461 patients underwent lower extremity venous ultrasound studies, and 129 patients were diagnosed as DVT (60 males, 66.9 ± 13.3 years). We retrospectively studied the incidence of PTE and bleeding complications associated with anticoagulation therapy. Average follow-up period was 536 ± 324 days. Above and below knee thrombosis was present in 60 and 69 patients, respectively. Warfarin was administered in 60 patients. Nine patients developed PTE. Multivariate analysis showed the absence of anticoagulation therapy and location of DVT (above knee) to be significantly correlated with onset of PTE (anticoagulation; P < 0.01, location; P = 0.02). However, the incidence of bleeding was not significantly different between above knee and below knee vein thrombosis (P = 0.72). In conclusion, below knee vein thrombosis carries a relatively low risk of PTE, but the incidence of bleeding complications does not depend on thrombosis location. This suggests that the indication of anticoagulation therapy should be based on DVT location.

Giant coronary artery aneurysms associated with Kawasaki disease detected on whole-heart magnetic resonance coronary angiographic screening.

Kawasaki disease (KD) is one of the most important causes of coronary artery aneurysms in children and young adults. However, the natural course of the disease and the patient prognosis remain obscure. A 72-year-old asymptomatic man with undiagnosed KD underwent whole-heart magnetic resonance coronary angiography during a health checkup. The imaging disclosed giant aneurysms in the proximal portion of the right coronary artery and the left anterior descending artery. The patient was successfully treated with coronary artery bypass grafting. The present case suggests that there may be a substantial number of patients who have attained middle to old age with undiagnosed KD.

Automatic slice alignment method for cardiac magnetic resonance imaging.

OBJECTIVES: Automatic slice alignment is important for easier operation and shorter examination times in cardiac magnetic resonance imaging (MRI) examinations. We propose a new automatic slice alignment method for six cardiac planes (short-axis, vertical long-axis, horizontal long-axis, 4-chamber, 2-chamber, and 3-chamber views). MATERIALS AND METHODS: ECG-gated 2D steady-state free precession axial multislice images were acquired using a 1.5-T MRI scanner during a single breath-hold. The scanning time was set to <20 s in 23 volumes from 23 healthy volunteers. In this method, the positions of the mitral valve, cardiac apex, left ventricular outflow tract, tricuspid valve, anterior wall of the heart, and right ventricular corner are detected to determine the positions of six reference planes by combining knowledge-based recognition and image processing techniques. In order to evaluate the results of automatic slice alignment for the short-axis, 4-chamber, 2-chamber, and 3-chamber views, the angular and positional errors between the results obtained by our proposed method and by manual annotation were measured. RESULTS: The average angular errors for the short-axis, 4-chamber, 2-chamber, and 3-chamber views were 3.05°, 4.52°, 7.28°, and 5.79°, respectively. The average positional errors for the short-axis (base), short-axis (apex), 4-chamber, 2-chamber, and 3-chamber views were 6.61°, 3.80°, 1.55°, 1.52°, and 1.48°, respectively. CONCLUSION: The experimental results showed that our proposed method can detect the cardiac planes quickly and accurately. Our method is therefore beneficial to both patients and operators.

Two cases of acute coronary syndrome that occurred by preoperative discontinuation of antiplatelet therapy in the chronic phase after stent implantation.

After stent implantation in the coronary arteries, patients sometimes have to undergo invasive examination or treatments that mandate discontinuation of antiplatelet therapy for several days. We encountered two cases of acute coronary syndrome that occurred after preoperative discontinuation of antiplatelet agents in the chronic phase after stent implantation. In the first case, antiplatelet agents were temporarily stopped 5 months after the implantation of a bare metal stent (BMS) in preparation for a kidney transplant. In the second case, antiplatelet agents were stopped 1.5 months after BMS implantation in preparation for esophageal bypass surgery. In both cases, acute myocardial infarction occurred just after the invasive operation, despite the fact that they had continued dual antiplatelet therapy for the period recommended by the American Heart Association/American College of Cardiology guideline. This report provides a warning about the temporary discontinuation of antiplatelet agents even in the chronic stage of coronary stent implantation.