RESUMO
Numerous entities, both structural and pathologic, can manifest as a contrast material- or blood-filled cardiac outpouching at imaging. These outpouchings often resemble one another and are frequently unfamiliar to imagers and clinicians, creating uncertainty when detected. Furthermore, the diagnostic criteria for conditions such as hernia, aneurysm, pseudoaneurysm, and diverticulum have not been consistently applied in studies and reports cited in the literature describing these outpouchings, adding to the confusion among general and cardiothoracic imagers. Pouches and outpouchings are commonly found incidentally on thoracic and abdominal CT scans obtained for other reasons. Many pouches and outpouchings can be confidently diagnosed or ignored at routine imaging, whereas others may require further evaluation with electrocardiographically gated CT, cardiac MRI, or echocardiography for a more definitive diagnosis. It is easiest to group and diagnose these entities on the basis of their cardiac chamber location or their involvement with the interatrial and interventricular septa. Ancillary features, such as motion, morphology, neck and body size, presence or absence of thrombus, and late gadolinium enhancement characteristics, are important in reaching a correct diagnosis. The aim of this article is to provide a practical guide to pouches and outpouchings of the heart. Each entity is defined according to its cause, imaging characteristics, clinical significance, and relevant associated findings. Mimics of cardiac pouches and outpouchings such as the Bachmann bundle, atrial veins, and thebesian vessels also are briefly discussed. Quiz questions for this article are available in the supplemental material. ©RSNA, 2023.
Assuntos
Meios de Contraste , Gadolínio , Humanos , Coração , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE. The purpose of this article is to review the nascent field of radiomics in cardiac MRI. CONCLUSION. Cardiac MRI produces a large number of images in a fairly inefficient manner with sometimes limited clinical application. In the era of precision medicine, there is increasing need for imaging to account for a broader array of diseases in an efficient and objective manner. Radiomics, the extraction and analysis of quantitative imaging features from medical imaging, may offer potential solutions to this need.
Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética , Humanos , Medicina de PrecisãoRESUMO
OBJECTIVE. The objective of this study was to determine if moderate to severe tricuspid regurgitation (TR) can be predicted on routine non-ECG-gated CT images of the chest with contrast agent. MATERIALS AND METHODS. Non-ECG-gated CT images of the chest in 674 people who had undergone echocardiography within 24 hours of CT were retrospectively reviewed. CT images were reviewed, and measurements of the tricuspid annular diameter were recorded. Echocardiogram reports were independently reviewed, and the presence and severity of TR was recorded. TR was graded in a multiparametric approach using a combination of qualitative, quantitative, and objective measures. TR grades of either "moderate" or "severe" were considered significant, and grades reported as "no regurgitation," "trace," "trivial," or "mild" were considered insignificant. RESULTS. The overall prevalence of significant (moderate or severe) TR was 15.0% (10.7% prevalence in men and 19.8% in women). Using ≥ 41 mm as a cut point on CT, the prediction accuracy reached an AUC of 0.92 (95% CI, 0.89-0.96). Specificity was 96.5% (95% CI, 95.0-97.9%), sensitivity was 75.7% (95% CI, 67.6-83.8%), positive predictive value was 80.2%, and negative predictive value was 95.5%. CONCLUSION. Using a cut point of ≥ 41 mm, measurement of the tricuspid valve annulus on routine CT of the chest can predict moderate to severe TR with a specificity of 96.5% and sensitivity of 75.7%. Measurements below threshold had a 95.5% negative predictive value. Tricuspid annular diameter can be measured on routine contrast-enhanced CT images of the chest, and, when above threshold, further evaluation with echocardiography should be recommended.
Assuntos
Tomografia Computadorizada por Raios X , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Idoso , Meios de Contraste , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
Treatment of thoracic aortic dissection remains highly challenging and is rapidly evolving. Common classifications of thoracic aortic dissection include the Stanford classification (types A and B) and the DeBakey classification (types I to III), as well as a new supplementary classification geared toward endovascular decision making. By using various imaging techniques, the extent of the dissection, the location of the primary intimal tear, the shape of the aortic arch, and the zonal involvement of the aortic arch-factors that affect the treatment strategy-can easily be identified. Thoracic endovascular aortic repair (TEVAR) is generally performed in two groups of patients: (a) those with a surgically repaired type A dissection, and (b) those with a complicated type B dissection. Several imaging findings can help predict the course of remodeling of the dissected aorta after a repaired type A dissection and TEVAR. A spectrum of imaging findings exist with regard to favorable (positive) or failing (negative) remodeling. A schematic model with imaging support allows the classification of important causes of failing remodeling into proximal and distal groups, on the basis of the origin of the refilling of the false lumen and the underlying pathophysiology of pressurization. Refilling of the false lumen of the aorta after repair of a type A dissection is usually secondary to a persistent intimal tear at the aortic arch, a leak of the distal graft anastomosis, or refilling from the false lumen of a dissected aortic arch vessel. After TEVAR, false lumen refilling is most commonly due to an incomplete seal of the proximal landing related to the aortic tortuosity, an arch branch stump, a supra-arch chimney stent, or the TEVAR technique. Online supplemental material is available for this article. ©RSNA, 2018.
Assuntos
Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Procedimentos Endovasculares , Dissecção Aórtica/classificação , Aneurisma da Aorta Torácica/classificação , Humanos , Resultado do TratamentoRESUMO
Knowledge of the anatomy of the membranous septum, as a surrogate to the location of the atrioventricular conduction axis, is a prerequisite for those undertaking transcatheter implantation of the aortic valve (TAVI). Equally important is its relationship of the virtual basal ring. This feature, however, has yet to be adequately described in the living heart. We analyzed computed tomographic angiographic datasets from 107 candidates (84.1 ± 5.2 years, 68% women) for TAVI. Using multiplanar reconstructions, we measured the height and width of the membranous septum, and the distances of its superior and inferior margins from the virtual basal ring plane. We also assessed the extent of wedging of the aortic root between the mitral valve and the ventricular septum. Mean heights and widths of the membranous septum were 6.6 ± 2.0, and 10.2 ± 3.1 mm, respectively, with its size significantly associated with that of the aortic root (P < 0.05). Its superior and inferior margins were 4.5 ± 2.3 and 2.1 ± 2.1 mm, respectively, from the plane of the basal ring. The inferior distance, the surrogate for the adjacency of the atrioventricular conduction axis, was ≤ 5mm in 91% of the patients. Deeper wedging of the aortic root was independently correlated with a shorter inferior distance (ß = 0.0569, P = 0.0258). The membranous septum is appreciably closer to the virtual basal ring than previously appreciated. These findings impact on estimations of the risk of damage to the atrioventricular conduction axis during TAVI. Clin. Anat. 31:525-534, 2018. © 2018 Wiley Periodicals, Inc.
Assuntos
Aorta/anatomia & histologia , Sistema de Condução Cardíaco/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Aorta/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Estudos Retrospectivos , Substituição da Valva Aórtica TranscateterRESUMO
Acute coronary syndrome (ACS) is a frequent cause of hospitalization and coronary interventions. Cardiac magnetic resonance (MR) imaging is an increasingly used technique for initial work-up of chest pain and early post-reperfusion and follow-up evaluation of ACS to identify patients at high risk of further cardiac events. Cardiac MR imaging can evaluate with accuracy a variety of prognostic indicators of myocardial damage, including regional myocardial dysfunction, infarct distribution, infarct size, myocardium at risk, microvascular obstruction, and intramyocardial hemorrhage in both acute setting and later follow-up examinations. In addition, MR imaging is useful to rule out other causes of acute chest pain in patients admitted to the emergency department. In this article, a brief explanation of the pathophysiology, classification, and treatment options for patients with ACS will be introduced. Indications of cardiac MR imaging in ACS patients will be reviewed and specific cardiac MR protocol, image interpretation, and potential diagnostic pitfalls will be discussed. © RSNA, 2017 Online supplemental material is available for this article.
Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/terapia , Biomarcadores/análise , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Medição de RiscoRESUMO
PURPOSE: Cardiac motion is a dominant source of physiological noise (PN) in myocardial arterial spin labeled (ASL) perfusion imaging. This study investigates the sensitivity to heart rate variation (HRV) of double-gated myocardial ASL compared with the more widely used single-gated method. METHODS: Double-gating and single-gating were performed on 10 healthy volunteers (n = 10, 3F/7M; age, 23-34 years) and eight heart transplant recipients (n = 8, 1F/7M; age, 26-76 years) at rest in the randomized order. Myocardial blood flow (MBF), PN, temporal signal-to-noise ratio (SNR), and HRV were measured. RESULTS: HRV ranged from 0.2 to 7.8 bpm. Double-gating PN did not depend on HRV, while single-gating PN increased with HRV. Over all subjects, double-gating provided a significant reduction in global PN (from 0.20 ± 0.15 to 0.11 ± 0.03 mL/g/min; P = 0.01) and per-segment PN (from 0.33 ± 0.23 to 0.21 ± 0.12 mL/g/min; P < 0.001), with significant increases in global temporal SNR (from 11 ± 8 to 18 ± 8; P = 0.02) and per-segment temporal SNR (from 7 ± 4 to 11 ± 12; P < 0.001) without significant difference in measured MBF. CONCLUSION: Single-gated myocardial ASL suffers from reduced temporal SNR, while double-gated myocardial ASL provides consistent temporal SNR independent of HRV. Magn Reson Med 77:1975-1980, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
Assuntos
Circulação Coronária , Transplante de Coração , Coração/diagnóstico por imagem , Coração/fisiologia , Imagem de Perfusão do Miocárdio/métodos , Miocárdio/patologia , Adulto , Idoso , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Movimento (Física) , Razão Sinal-Ruído , Marcadores de Spin , Adulto JovemRESUMO
PURPOSE: To determine the feasibility of measuring increases in myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) on a per-segment basis using arterial spin labeled (ASL) magnetic resonance imaging (MRI) with adenosine vasodilator stress in normal human myocardium. MATERIALS AND METHODS: Myocardial ASL scans at rest and during adenosine infusion were incorporated into a routine 3T MR adenosine-induced vasodilator stress protocol and were performed in 10 healthy human volunteers. Myocardial ASL was performed using single-gated flow-sensitive alternating inversion recovery (FAIR) tagging and balanced steady-state free precession (bSSFP) imaging at 3T. A T2 -prep blood oxygen level-dependent (BOLD) SSFP sequence was used to concurrently assess segmental myocardial oxygenation with BOLD signal intensity (SI) percent change in the same subjects. RESULTS: There was a statistically significant difference between MBF measured by ASL at rest (1.75 ± 0.86 ml/g/min) compared to adenosine stress (4.58 ± 2.14 ml/g/min) for all wall segments (P < 0.0001), yielding a per-segment MPR of 3.02 ± 1.51. When wall segments were divided into specific segmental myocardial perfusion territories (ie, anteroseptal, anterior, anterolateral, inferolateral, inferior, and inferoseptal), the differences between rest and stress regional MBF for each territory remained consistently statistically significant (P < 0.001) after correcting for multiple comparisons. CONCLUSION: This study demonstrates the feasibility of measuring MBF and MPR on a segmental basis by single-gated cardiac ASL in normal volunteers. Second, this study demonstrates the feasibility of performing the ASL sequence and T2 -prepared SSFP BOLD imaging during a single adenosine infusion. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:413-420.
Assuntos
Artérias/diagnóstico por imagem , Circulação Coronária/fisiologia , Coração/diagnóstico por imagem , Imageamento por Ressonância Magnética , Imagem de Perfusão do Miocárdio , Miocárdio/patologia , Adenosina/química , Adulto , Pressão Sanguínea , Estudos de Viabilidade , Feminino , Voluntários Saudáveis , Humanos , Masculino , Oxigênio/análise , Oxigênio/sangue , Reprodutibilidade dos Testes , Razão Sinal-Ruído , Marcadores de Spin , Vasodilatadores/química , Adulto JovemRESUMO
The pulmonary veins carry oxygenated blood from the lungs to the heart, but their importance to the radiologist extends far beyond this seemingly straightforward function. The anatomy of the pulmonary veins is variable among patients, with several noteworthy variant and anomalous patterns, including supernumerary pulmonary veins, a common ostium, anomalous pulmonary venous return, and levoatriocardinal veins. Differences in pulmonary vein anatomy and the presence of variant or anomalous anatomy can be of critical importance, especially for preoperative planning of pulmonary and cardiac surgery. The enhancement or lack of enhancement of the pulmonary veins can be a clue to clinically important disease, and the relationship of masses to the pulmonary veins can herald cardiac invasion. The pulmonary veins are also an integral part of thoracic interventions, including lung transplantation, pneumonectomy, and radiofrequency ablation for atrial fibrillation. This fact creates a requirement for radiologists to have knowledge of the pre- and postoperative imaging appearances of the pulmonary veins. Many of these procedures are associated with important potential complications involving the pulmonary veins, for which diagnostic imaging plays a critical role. A thorough knowledge of the pulmonary veins and a proper radiologic approach to their evaluation is critical for the busy radiologist who must incorporate the pulmonary veins into a routine "search pattern" at computed tomography (CT) and magnetic resonance imaging. This article is a comprehensive CT-based imaging review of the pulmonary veins, including their embryology, anatomy (typical and anomalous), surgical implications, pulmonary vein thrombosis, pulmonary vein stenosis, pulmonary vein pseudostenosis, and the relationship of tumors to the pulmonary veins. Online supplemental material is available for this article. ©RSNA, 2017.
Assuntos
Veias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Variação Anatômica , Meios de Contraste , Humanos , Planejamento de Assistência ao Paciente , Cuidados Pré-Operatórios , Veias Pulmonares/anormalidades , Veias Pulmonares/embriologiaRESUMO
The fibrous skeleton is concentrated at the base of the ventricular mass. It provides electrical insulation at the atrioventricular level and fibrous continuity for the leaflets of the mitral, aortic, and tricuspid valves. Its components include the fibrous trigones, the fibrous area of aortic-mitral continuity, the subvalvar collar of the mitral valve, the membranous septum, the interleaflet triangles, the tendon of Todaro, and likely the conus ligament. The majority of the mitral annulus is fibrous, but the only true fibrous part of the tricuspid annulus is where the valvar leaflets are attached to the central fibrous body. At the aortic annulus, the fibrous elements support only the noncoronary aortic sinus and parts of the right and left coronary sinuses. The ring-shaped annulus of the arterioventricular valves as localized with imaging techniques (imaging annulus) differs from the crown-shaped hemodynamic annulus of the arterial valves. The imaging annulus corresponds to the plane passing through the nadirs of the hinge-lines of the leaflets. The hinges of the pulmonary valve are not part of the fibrous skeleton. Computed tomography (CT) and magnetic resonance (MR) imaging are excellent modalities for evaluation of the anatomy, physiologic variations, and pathologic conditions of the fibrous skeleton. The submillimeter isotropic three-dimensional datasets obtained with CT and the high contrast resolution of MR imaging are the main advantages of these modalities in assessing anatomy. The function of the valves and associated annuli can best be studied with MR imaging. Pathologic conditions involving the area, including paravalvar leaks, abscesses, perforation, and pseudoaneurysms, usually occur as a complication of infective endocarditis or extensive calcifications after valvar surgery. MR imaging and CT can demonstrate these lesions equally well. CT is the preferred technique for showing the extent of calcifications in the fibrous skeleton. Large calcifications involving the central fibrous body can cause heart block by interfering with the normal function of the His bundle and its branches. ©RSNA, 2017.
Assuntos
Cardiopatias/diagnóstico por imagem , Cardiopatias/patologia , Coração/anatomia & histologia , Coração/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Calcinose/diagnóstico por imagem , Coração/embriologia , HumanosRESUMO
The septal atrioventricular junction is a centrally located region of the heart where the septal components of the atria and ventricles meet the aortic, mitral, and tricuspid valves. Important structures in this region include the membranous septum, the central fibrous body, the Koch triangle, the inferior pyramidal space, and the base of the interventricular septum. This small area is the home of the atrioventricular node and the atrioventricular conduction axis and has enormous importance to electrophysiologists owing to its prime role in the conduction system of the heart. The atrioventricular node lies within the triangle of Koch; and the atrioventricular bundle, or bundle of His, exits the atrioventricular node and penetrates the right fibrous trigone and runs underneath the membranous septum. The septal atrioventricular junction is a common location for intracardiac shunts such as membranous and perimembranous septal defects. Imaging classification of these defects can have important implications before surgical closure, because the atrioventricular conduction axis passes along the posteroinferior margin of most perimembranous defects. Extracardiac inflammatory and malignant pathologic conditions can extend from the mediastinum toward the inferior pyramidal space in this region through the epicardial fat planes. Although the anatomic structures are complicated, the components can be shown in exquisite detail with computed tomography (CT). In this review, the anatomic boundaries and important anatomic landmarks are examined with CT and magnetic resonance imaging. Also described are the anatomic variants of the membranous septum pertinent to percutaneous aortic valve implantation, the vascular anatomic variants, and commonly encountered pathologic conditions related to the septal atrioventricular junction. ©RSNA, 2016.
Assuntos
Pontos de Referência Anatômicos/diagnóstico por imagem , Nó Atrioventricular/diagnóstico por imagem , Técnicas de Imagem Cardíaca/métodos , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Diagnóstico Diferencial , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Aumento da Imagem/métodosRESUMO
This case report demonstrates development and progressive enlargement of multiple pancreaticoduodenal arcade pseudoaneurysms using computed tomography angiographies over a period of 5 weeks after abdominal trauma. The mechanism of pseudoaneurysm formation, as shown by serial imaging, attributed to preexisting celiac axis stenosis by the median arcuate ligament, posttraumatic celiac artery dissection, and secondary occlusion of proper hepatic artery resulting in elevation of pressure and flow in the pancreaticoduodenal arcade and rupture of small arterial branches. Successful pseudoaneurysm occlusion was achieved through arterial embolization.
Assuntos
Traumatismos Abdominais/etiologia , Falso Aneurisma/etiologia , Artérias/lesões , Duodeno/irrigação sanguínea , Pâncreas/irrigação sanguínea , Lesões do Sistema Vascular/etiologia , Ferimentos não Penetrantes/etiologia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/terapia , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Artérias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/terapiaRESUMO
The levoatriocardinal vein is a very rare but clinically important intrathoracic venous anomaly that connects the systemic (cardinal) and pulmonary venous channels. We report 4 adults with pulmonary-systemic venous communications that can explain the morphology of the extracardiac interatrial shunting through the persistent levoatriocardinal vein. We discuss the imaging features of the 2 types of such communications: direct connection of the levoatriocardinal vein (1) with the left atrium and (2) with the left superior pulmonary vein in the absence of obstructive left heart disease. Accurate characterization of these diagnostically challenging cases is important because in addition to hemodynamic imbalance they are at risk of paradoxical embolism. Computed tomography and magnetic resonance imaging are noninvasive imaging techniques that should play increasingly important roles in the evaluation of these anomalies.
Assuntos
Cardiopatias Congênitas , Hemodinâmica , Circulação Pulmonar , Veias Pulmonares/anormalidades , Adulto , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Embolia Paradoxal/etiologia , Embolização Terapêutica , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Tromboembolia/etiologia , Resultado do TratamentoRESUMO
OBJECTIVE. In this article, we review the histopathologic classification of coronary atherosclerotic plaques and describe the possibilities and limitations of CT regarding the evaluation of coronary artery plaques. CONCLUSION. The composition of atherosclerotic plaques in the coronary arteries displays substantial variability and is associated with the likelihood for rupture and downstream ischemic events. Accurate identification and quantification of coronary plaque components on CT is challenging because of the limited temporal, spatial, and contrast resolutions of current scanners. Nonetheless, CT may provide valuable information that has potential for characterization of coronary plaques. For example, the extent of calcification can be determined, lipid-rich lesions can be separated from more fibrous ones, and positive remodeling can be identified.
Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/patologia , Tomografia Computadorizada por Raios X , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/patologia , Doença da Artéria Coronariana/classificação , Humanos , Placa Aterosclerótica/classificaçãoRESUMO
OBJECTIVE: In this article we show the morphologic detail of the tricuspid valve (TV) apparatus and discuss the spectrum of diagnostic information that CT and MRI can provide regarding pathologic processes. We also compare the strengths and limitations of these modalities with currently established echocardiographic diagnostic parameters. CONCLUSION: The TV plays an important role in a number of pathologic states, and its abnormality can directly or indirectly influence morbidity and mortality in different cardiac disorders. However, the importance of the role of the TV has been overlooked primarily because TV malfunction may remain less symptomatic for a long time. Along with rapid development in imaging technology, improvement in postoperative management, and better understanding of the pathophysiologic mechanisms of TV dysfunction, more attention is being given to careful imaging analysis of this "forgotten valve."
Assuntos
Doenças das Valvas Cardíacas/diagnóstico , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Valva Tricúspide/patologia , Diagnóstico Diferencial , HumanosRESUMO
OBJECTIVE: Fat deposits in the left ventricle (LV) myocardium are uncommon and usually indicate scar due to chronic myocardial infarction. The purpose of this study was to determine the incidence of fatty lesions in the LV of patients with sarcoidosis. MATERIALS AND METHODS: Review of noncontrast computed tomographic images (2-mm thickness) in 133 patients with documented extracardiac sarcoidosis (age, 35-82 years, 55 ± 10 years, 67% female) with no history of significant coronary artery disease (clinical and coronary calcium) was performed. A control group included noncontrast computed tomographies with no coronary calcium in 133 patients with age/sex (59 ± 6 years, 73% female) similar to the sarcoid target group. Locations and morphology (linear vs bulky) of fat deposits (-30 to -180 Hounsfield units) and relevant intrathoracic findings were recorded. RESULTS: We found 35 fat deposits in 19 (14.3%) of sarcoid patients (target group: age, 59 ± 7 years, 78% female). Lesions were mainly at the LV apical level (n = 14). In the control group, 15 lesions in 13 (9.7%) patients were found. Numbers of fatty lesions in sarcoid targets were significantly higher than those in the control group (P = 0.015). The number of bulky lesions was significantly higher in sarcoid (n = 9) than in control (n = 1; P < 0.05). No significant difference was found for the rate of linear lesions. Interstitial lung disease was seen in 9 and enlarged lymph nodes in 9 of the sarcoid target group. There was no significant correlation between the severity of interstitial lung disease and the number of fatty lesions. CONCLUSIONS: Sarcoid patients demonstrate a higher chance of having LV fat deposits with a characteristic bulky morphology.
Assuntos
Tecido Adiposo/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
With rapid advancements in imaging technology, cardiac computed tomography (CT) and magnetic resonance (MR) imaging are increasingly being used for anatomic evaluation, functional assessment, and pathologic diagnosis of the pulmonary valve and right ventricle. MR imaging is especially helpful in evaluating postoperative pulmonary valve function and grading of pulmonary regurgitation. On the other hand, CT has the advantage of high-resolution isovolumetric whole-chest coverage and is able to depict anatomic detail of the pulmonary valve, perivalvular structures, and pulmonary artery branches.
Assuntos
Doenças das Valvas Cardíacas/diagnóstico , Aumento da Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Valva Pulmonar/anormalidades , Valva Pulmonar/patologia , Tomografia Computadorizada por Raios X/métodos , Humanos , Valva Pulmonar/diagnóstico por imagemRESUMO
Paradoxical embolism (PDE) is an uncommon cause of acute arterial occlusion that may have catastrophic sequelae. The possibility of its presence should be considered in all patients with an arterial embolus in the absence of a cardiac or proximal arterial source. Despite advancements in radiologic imaging technology, the use of various complementary modalities is usually necessary to exclude other possibilities from the differential diagnosis and achieve an accurate imaging-based diagnosis of PDE. In current practice, the imaging workup of a patient with symptoms of PDE usually starts with computed tomography (CT) and magnetic resonance (MR) imaging to identify the cause of the symptoms and any thromboembolic complications in target organs (eg, stroke, peripheral arterial occlusion, or visceral organ ischemia). Additional imaging studies with modalities such as peripheral venous Doppler ultrasonography (US), transcranial Doppler US, echocardiography, and CT or MR imaging are required to detect peripheral and central sources of embolism, identify cardiac and/or extracardiac shunts, and determine whether arterial disease is present. To guide radiologists in selecting the optimal modalities for use in various diagnostic settings, the article provides detailed information about the imaging of PDE, with numerous radiologic and pathologic images illustrating the wide variety of features that may accompany and contribute to the pathologic process. The roles of CT and MR imaging in the diagnosis and exclusion of PDE are described, and the use of imaging for planning surgical treatment and interventional procedures is discussed.
Assuntos
Diagnóstico por Imagem , Embolia Paradoxal/diagnóstico , Diagnóstico Diferencial , Embolia Paradoxal/terapia , HumanosRESUMO
OBJECTIVE: MRI and CT have become the ideal methods for assessing the complex morphology of the conotruncal region, including the right ventricular outflow tract (RVOT). Detailed information about the embryology and anatomy of the RVOT provides a better understanding of the spectrum of diseases of this region and helps to narrow the differential diagnoses of abnormalities involving this important structure. In this review, we focus on the role of CT and MRI to evaluate morphology in relation to developmental malformation of the RVOT. CONCLUSION: A spectrum of conotruncal anomalies with abnormally positioned great arteries may arise from a perturbation of RVOT formation. Complications after surgery are common, and many patients need follow-up imaging for diagnosis and surgical planning. In this regard, the spectrum of diseases, differential diagnoses, and postoperative findings are briefly described. With CT and MRI, the relationship of the RVOT to critical structures, such as the coronary arteries, can be revealed.
Assuntos
Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Obstrução do Fluxo Ventricular Externo/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/cirurgiaRESUMO
OBJECTIVE: MRI and CT have become the ideal methods for assessing the complex function of the conotruncal region, including the right ventricular outflow tract (RVOT). In this review, we focus on the role of CT and MRI to evaluate RVOT function in relation to developmental malformations. CONCLUSION: We discuss the role of imaging pertinent to electrophysiologic assessment for cardiac arrhythmias. The RVOT is an important ablation target for radiofrequency ablation of ventricular tachycardia. Architectural changes of the myocardial strands in the RVOT, scar, and fibrofatty tissue may play a role in the development of RVOT ventricular arrhythmias. With CT and MRI, some of these changes can be revealed.