Comparison Between 3D Echocardiography and Cardiac Magnetic Resonance Imaging (CMRI) in the Measurement of Left Ventricular Volumes and Ejection Fraction.

BACKGROUND: Echocardiography and Cardiac Magnetic Resonance Imaging (CMRI) are two noninvasive techniques for the evaluation of cardiac function for patients with coronary artery diseases. Although echocardiography is the commonly used technique in clinical practice for the assessment of cardiac function, the measurement of LV volumes and left ventricular ejection fraction (LVEF) by the use of this technique is still influenced by several factors inherent to the protocol acquisition, which may affect the accuracy of echocardiography in the measurement of global LV parameters. OBJECTIVE: The aim of this study is to compare the end systolic volume (ESV), the end diastolic volume (EDV), and the LVEF values obtained with three dimensional echocardiography (3D echo) with those obtained by CMRI (3 Tesla) in order to estimate the accuracy of 3D echo in the assessment of cardiac function. METHODS: 20 subjects, (9 controls, 6 with myocardial infarction, and 5 with myocarditis) with age varying from 18 to 58, underwent 3D echo and CMRI. LV volumes and LVEF were computed from CMRI using a stack of cine MRI images in a short axis view. The same parameters were calculated using the 3D echo. A linear regression analysis and Bland Altman diagrams were performed to evaluate the correlation and the degree of agreement between the measurements obtained by the two methods. RESULTS: The obtained results show a strong correlation between the 3D echo and CMR in the measurement of functional parameters (r = 0.96 for LVEF values, r = 0.99 for ESV and r= 0.98 for EDV, p < 0.01 for all) with a little lower values of LV volumes and higher values of LVEF by 3D echo compared to CMRI. According to statistical analysis, there is a slight discrepancy between the measurements obtained by the two methods. CONCLUSION: 3D echo represents an accurate noninvasive tool for the assessment of cardiac function. However, other studies should be conducted on a larger population including some complicated diagnostic cases.

Parametric Imaging for the Assessment of Cardiac Motion: A Review.

The assessment of wall motion abnormalities such as hypokinesia or dyskinesia and the identification of their extent as well as their degree of severity allow an accurate evaluation of several ischemic heart diseases and an early diagnosis of heart failure. These dysfunctions are usually revealed by a drop of contraction indicating a regional hypokinesia or a total absence of the wall motion in case of akinesia. The discrimination between these contraction abnormalities plays also a significant role in the therapeutic decision through the differentiation between the infarcted zones, which have lost their contractile function, and the stunned areas that still retain viable myocardial tissues. The lack of a reliable method for the evaluation of wall motion abnormalities in cardiac imaging presents a major limitation for a regional assessment of the left ventricular function. In the past years, several techniques were proposed as additional tools for the local detection of wall motion deformation. Among these approaches, the parametric imaging is likely to represent a promising technique for the analysis of a local contractile function. The aim of this paper is to review the most recent techniques of parametric imaging computation developed in cardiac imaging and their potential contributions in clinical practice.

Left ventricular MRI wall motion assessment by monogenic signal amplitude image computation.

BACKGROUND: Cardiac Magnetic Resonance Imaging (MRI) is the commonly used technique for the assessment of left ventricular (LV) function. Apart manually or semi-automatically contouring LV boundaries for quantification of By visual interpretation of cine images, assessment of regional wall motion is performed by visual interpretation of cine images, thus relying on an experience-dependent and subjective modality. OBJECTIVE: The aim of this work is to describe a novel algorithm based on the computation of the monogenic amplitude image to be utilized in conjunction with conventional cine-MRI visualization to assess LV motion abnormalities and to validate it against gold standard expert visual interpretation. METHODS: The proposed method uses a recent image processing tool called "monogenic signal" to decompose the MR images into features, which are relevant for motion estimation. Wall motion abnormalities are quantified locally by measuring the temporal variations of the monogenic signal amplitude. The new method was validated by two non-expert radiologists using a wall motion scoring without and with the computed image, and compared against the expert interpretation. The proposed approach was tested on a population of 40 patients, including 8 subjects with normal ventricular function and 32 pathological cases (20 with myocardial infarction, 9 with myocarditis, and 3 with dilated cardiomyopathy). RESULTS: The results show that, for both radiologists, sensitivity, specificity and accuracy of cine-MRI alone were similar and around 59%, 77%, and 71%, respectively. Adding the proposed amplitude image while visualizing the cine MRI images significantly increased both sensitivity, specificity and accuracy up to 75%, 89%, and 84%, respectively. CONCLUSION: Accuracy of wall motion interpretation adding amplitude image to conventional visualization was proven feasible and superior to standard image interpretation on the considered population, in inexperienced observers. Adding the amplitude images as a diagnostic tool in clinical routine is likely to improve the detection of myocardial segments presenting a cardiac dysfunction.

Multimodality imaging assessment of a caseous calcification of the mitral valve annulus.

Caseous calcification of the mitral annulus (CCMA) is a rare echocardiographic finding. It is commonly misdiagnosed as an abscess, tumor or infective vegetation on the mitral valve. Since it is a benign process, differentiating it from malignant intra-cardiac mass is primordial to avoid unnecessary surgery. Various imaging modalities can be complimentary for definitive diagnosis. We present a case of CCMA in a 71-year-old female patient. Her medical history revealed hypertension, diabetes mellitus, hyperlipidaemia and coronary artery disease. She was referred to our department for coronary catheterization because of angina symptoms upon minimal exertion. The lesion was detected during echocardiography and was defined as a mass of heterogeneous content with calcification points, located at the posterior side of the mitral valve annulus. Restricted motion of the posterior leaflet and the mass effect caused only minimal mitral regurgitation. To establish the correct diagnosis, we performed the full spectrum of noninvasive cardiac imaging modalities. Transesophageal echocardiography identified well-organized, composite lesion with regular edges, markedly calcified margins and more echolucent central portion. A computed tomography (CT) was performed, showing a hyperdense mass with hypodense center and a calcified peripheral rim located at the posterior mitral ring. Cardiac magnetic resonance imaging (MRI) showed that the mass was hypointense with respect to the myocardium in the T1 and T2-weighted sequences and only presented late-phase enhancement in the surrounding capsule. Based on the CT and MRI findings, the diagnosis of CCMA was established. The patient was managed conservatively.

[Utility of joint distension during arthrography in treatment of adhesive capsulitis of the shoulder in a study of 20 patients]. / Apport de l'arthrodistension dans le traitement des capsulites retractiles de l'epaule: a propos de 20 cas.

AIM: The aim of our study is to evaluate the efficacy of joint distension during arthrography followed by an intra articular corticosteroid injection. METHODS: This procedure associated to a physical therapy started immediately after joint distension and performed during 3 months in the treatment of 20 patients suffering from adhesive capsulitis of the shoulder were assessed. RESULTS: Patients were evaluated on D 90:90 % of them have regression of pain, 70 % have an improvement of deficiency and ranges of motion of the shoulder. Adhesive capsulitis of the shoulder is a disabling pathology but, generally, with good evolution. It is a clinical diagnosis. CONCLUSION: Joint distension associated to physical therapy has an interest in treatment because of therapeutic and antalgic effect and also restoration of range of movement.

[Solitary fibrous tumor of the pancreas. A case report]. / Tumeur fibreuse solitaire du pancréas. A propos d'un cas.

Solitary fibrous tumour (SFT), a rare mesenchymal neoplasm usually arising from the pleura, may also occur in many other extra pleural sites. It has exceptionally been described in the pancreas. This report describes the case of a benign SFT of the pancreas occurring in a 41-year-old man who presented with a solid epigastric mass. Pathological and immunohistochemical findings are presented. Imaging features on ultrasonography, CT, MRI, and arteriography are widely detailed. Surgical resection of the tumour was performed, and the patient died from postoperative complications.

[Retroiliac ureter imaging. A case report]. / Apport de l'imagerie dans l'uretère rétroiliaque. A propos d'un cas.

The retroiliac ureter is a rare congenital anomaly with no specific clinical and biologic signs. The authors reports a case of right retroiliac ureter diagnosed in a 41-year-old male with an isolated renal colic. Diagnosis was confirmed by abdominal CT-scan. The different investigations did not show other associated congenital abnomaly. Therapeutic decision was to establish a clinical, biologic and sonographic surveillance.

[Imaging of neuro-Behcet]. / Apport de l'imagerie au cours des manifestations neurologiques de la maladie de Behcet.

Behcet's disease is a vasculitis affecting predominantly the venous system. It's characterized by a classical triad of recurrent uveitis, oral and genital ulceration. Behcet's disease is more frequent in Japan, the Middle East and some Mediterranean countries. Its pathogenesis is still uncertain. Neurological manifestations in Behcet's disease are not rare and are associated with poor prognosis. These manifestations can be inaugural in 5% of cases and they are polymorphous. We report 15 new cases of neuro Behcet's disease explored by magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA).