Value of CMR for the differential diagnosis of cardiac masses.

OBJECTIVES: The goal of this study was to evaluate the diagnostic value of CMR features for the differential diagnosis of cardiac masses. BACKGROUND: Differentiation of cardiac tumors and thrombi and differentiation of benign from malignant cardiac neoplasms is often challenging but important in clinical practice. Studies assessing the value of cardiac magnetic resonance (CMR) in this regard are scarce. METHODS: We reviewed the CMR scans of patients with a definite cardiac thrombus or tumor. Mass characteristics on cine, T1-weighted turbo spin echo (T1w-TSE) and T2-weighted turbo spin echo (T2w-TSE), contrast first-pass perfusion (FPP), post-contrast inversion time (TI) scout, and late gadolinium enhancement (LGE) sequences were analyzed. RESULTS: There were 84 thrombi, 17 benign tumors, and 25 malignant tumors in 116 patients. Morphologically, thrombi were smaller (median area 1.6 vs. 8.5 cm(2); p < 0.0001), more homogeneous (99% vs. 46%; p < 0.0001), and less mobile (13% vs. 33%; p = 0.007) than tumors. Hyperintensity compared with normal myocardium on T2w-TSE, FPP, and LGE were more common in tumors than in thrombi (85% vs. 42%, 70% vs. 4%, and 71% vs. 5%, respectively; all p < 0.0001). A pattern of hyperintensity/isointensity (compared with normal myocardium) with short TI and hypointensity with long TI was very frequent in thrombi (94%), rare in tumors (2%), and had the highest accuracy (95%) for the differentiation of both entities. Regarding the characterization of neoplastic masses, malignant tumors were larger (median area 11.9 vs. 6.3 cm(2); p = 0.006) and more frequently exhibited FPP (84% vs. 47%; p = 0.03) and LGE (92% vs. 41%; p = 0.001). The ability of CMR features to distinguish benign from malignant neoplasms was moderate, with LGE showing the highest accuracy (79%). CONCLUSIONS: CMR features demonstrated excellent accuracy for the differentiation of cardiac thrombi from tumors and can be helpful for the distinction of benign versus malignant neoplasms.

Cocaína em urina: estudo e comparação de técnicas de extração do analito / Cocaine in urine: study and comparison of techniques for extaction of the analyte

The detection of inaltered cacaine in urine is an indicator of recent exposure to the drug and can be useful in some situations. This paper aimed to study the best conditions to isolate cocaine from urine samples using liquid-liquid extraction (LLE) and solid phase extraction C18 (SPE), as well as to compare their performance when applied to analysi of samples from drugs users. The analysis were performed by cappilary ga-chromatography/FID using 5% phenyl/95% menthyliloxane as stationary phase and procaine as internal standard. Good results in LLE were reached when using a single nonpolar solvent, ethyl acetate, tha allowed only nonpolar analytes to be extracted from biological fluid. The method revealed: linearity between 0.25-6.0 ug/mL (r2 = 0.996); equal detection and quantificationlimits 0f 0.25 ug/mL; mean intra-assay precision of 3.9% CV; mean recovery of 99.8%. The better conditioning and elution procedures for SPEC18 were established: sample passed at a flow rate of 2mL/min and use of ethyl acetate/amonium chloride 92:2, without vacuum, for cocaine elution from cartridges gave better cocaine recovery. Some analytical parameters obtained were: linearity between 0.75-8.0 recovery of 91.5%. Cocaine urine samples fron drug users analyzed according to optimized condition by LLE and SPE showed a determination coefficiente 0f 0.8857 when comparing the results. LLE was the most cost-effective and faster method for isolation of unaltered cocaine from urine samples unless SPE was safer but more expensive technique presenting higher quantification limit than LLE. Both of them allowed extraction of cocaine with the exclusion of sometimes unwanted polar metabolites, and no derivatization was need prior to GC/FID analysis...