The role of cardiac CT throughout the full cardiac cycle in diagnosing patent foramen ovale in patients with acute stroke.

OBJECTIVES: We explored the hypothesis that the diagnostic performance of cardiac computed tomography (CT) throughout the full cardiac cycle would be superior to single-phase CT and comparable to transesophageal echocardiography (TEE) in diagnosing patent foramen ovale (PFO). METHODS AND RESULTS: From May 2011 to April 2015, 978 patients with stroke were diagnosed with PFO by TEE. In patients with stroke, cardiac CT was performed if the patients had more than two cardiovascular risk factors. We prospectively enrolled 70 patients with an indication for cardiac CT. Cardiac CT images were reconstructed at 10% increments of the R-R interval. The sensitivity of cardiac CT throughout the full cardiac cycle in diagnosing PFO was compared to that for TEE and single-phase cardiac CT. To evaluate the specificity of cardiac CT, we analyzed patients without PFO confirmed by TEE who underwent cardiac CT within 1 month of pre-cardiac surgery. Sixty-six patients with cardiac CT and TEE were included in the final analysis. Throughout the full cardiac cycle, cardiac CT had a sensitivity of 89.4% and a specificity of 92.3% in diagnosing PFO, compared to TEE as a reference. PFO was primarily detected in the 60% and 70% intervals in 10-phase reconstructed images. The sensitivity of PFO diagnosis with cardiac CT was 81.8% when analyzing both the 60% and 70% intervals instead of the full cardiac cycle. CONCLUSION: Cardiac CT throughout the full cardiac cycle outperforms single-phase cardiac CT in detecting PFO. Cardiac CT can be used as an alternative method to TEE for detecting PFO in stroke patients. KEY POINTS: • Throughout the full cardiac cycle, cardiac computed tomography (CT) had a sensitivity of 89.4% and a specificity of 92.3% in diagnosing patent foramen ovale (PFO), compared to transesophageal echocardiography. • The sensitivity of diagnosing patent foramen ovale with cardiac CT was 81.8% when analyzing 60% and 70% R-R intervals instead of the full cardiac cycle. • Cardiac CT with retrospective electrocardiographic gating throughout the full cardiac cycle can increase the detectability of PFO, compared to single-phase cardiac CT.

Mesophilic co-digestion of palm oil mill effluent and empty fruit bunches.

The palm oil mill industry generates palm oil mill effluent (POME) and empty fruit bunches (EFB) as by-products. This study reports the mesophilic co-digestion of POME with EFB. The biochemical methane potential (BMP) of POME and EFB was 0.397 L CH4/g volatile solids (VS) and 0.264 L CH4/g VS, respectively. In a series of batch tests at various EFB to POME ratios, the maximum methane production rate was achieved at an EFB:POME ratio of 0.25-0.31:1. Performance data from lab-scale digesters confirmed the positive synergism by the addition of EFB to POME, which was attributed to the balanced chemical composition, for example the chemical oxygen demand (COD) to total Kjeldahl nitrogen (TKN) ratio. The EFB addition enhanced the acceptable organic loading rate, methane production, COD removal, and microbial activity. The mesophilic co-digestion of POME and EFB promises to be a viable recycling method to alleviate pollution problems and recover renewable energy in the palm oil mill industry.