Comparison of Cine-MRI and Transthoracic Echocardiography for the Assessment of Aortic Root Diameters in Patients with Suspected Marfan Syndrome.

PURPOSE: Patients with Marfan syndrome require repeated imaging for monitoring of aortic root aneurysms. Therefore, we evaluated the agreement and reproducibility of cine-MRI and echocardiography measurements of the sinuses of Valsalva in patients with suspected Marfan syndrome. MATERIALS AND METHODS: 51 consecutive patients with suspected Marfan syndrome were prospectively examined using cine-MRI and echocardiography. Two readers independently measured aortic root diameters at the level of the sinuses of Valsalva in both cine-MRI and echocardiography. Statistics included intraclass correlation coefficient, Pearson correlation coefficient, Bland-Altman analysis, and two-sided t-test. RESULTS: In 38 of the 51 individuals (74.5 %), the diagnosis of Marfan syndrome was established according to the criteria of the Ghent-2 nosology. Cine-MRI measurements of the sinuses of Valsalva revealed a strong correlation with echocardiography (r = 0.929), but a statistically significant bias of -1.0  mm (p < 0.001). The mean absolute diameter for sinuses of Valsalva obtained by cine-MRI was 32.3  ±  5.8 mm as compared to 33.4  ±  5.4 mm obtained by echocardiography. Interobserver agreement of measurements of the sinuses of Valsalva was higher for cine-MRI than for echocardiography (p = 0.029). CONCLUSION: Despite small, but statistically significant differences in terms of agreement and reproducibility, cine-MRI and echocardiographic measurements of aortic root diameters provide comparable results without a significant clinical difference. Therefore both techniques may be used for monitoring of the aortic root in patients with Marfan syndrome.

[A study on chest radiographs in medical check-ups for over-staying foreigners].

During the past nine years from 1991 to 1999, Minatomachi Medical Center and other organizations have provided free medical check-ups for foreigners in Kanagawa, Tokyo and Chiba. Eighty-five percent of the total of the 2370 examined were over-staying foreigners who were not covered by national health insurance system. The ratio of male to female was two to one and the most of them were in the twenties and thirties. As for their ethnic origins from forty-three countries, the Filipinos were the largest numbers, followed by Koreans, Iranians, Bangladeshi, and Chinese/Taiwanese. As a result of chest radiographs, 82% were normal, 8.3% mostly normal, 9.6% tuberculosis shadow (TBS) including active, non active and previous, 0.09% suspected pneumonia, 0.05% suspected cardiac disease, and 0.05% suspected sarcoidosis. The TBS and active tuberculosis (ATB) rates of all examined were 9.6% and 0.69% respectively. There was no significant difference in each TBS and ATB rate between the two sexes. Seen from the age group, it was found that the more aged they were, the higher the TBS and the ATB rates were. The TBS and the ATB rates were 24.6% and 2.73% in the Koreans, 10.7% and 0% in the Chinese/Taiwanese, 10.2% and 0.65% in the Filipinos, 11.3% and 1.44% in the South-East Asians, 6.3% and 0.25% in the South Asians, 2.3% and 0% in the Iranians, 3.7% and 0% in the sub-Saharan Africans, 8.5% and 0.61% in the Latin Americans, and 0% and 0% in the Europeans/North Americans. Based on a presumed ATB rate of 0.75%, approximately two thousand cases with ATB could be calculated to exist among the estimated 270,000 over-staying foreigners. It is, therefore, important to give them more frequent medical check-ups for early detection of latent cases with ATB.

[A prospective study of access to medical services following a community-based screening program].

Participants in a multiphasic screening program, 454 men and 767 women, were followed up for a period of several months (117 days on the average) in order to evaluate their needs for medical services after screening. Five hundred sixty-two (47.1%) visited outpatient clinics in the study area; 185 as continuing visits for existing diseases (prevalent), 167 because of symptoms which developed after the screening (clinical), and 65 for further investigations of abnormal findings from the screening (screened). The ratio of prevalent to incident (= clinical + screened) cases, which is related to the duration of clinical phase, was the highest in hypertensive, thyroid, ophthalmologic disorders. This indicates that health services for prevalent cases of those diseases are needed in addition to primary and secondary preventive efforts. The proportion of screened cases in the incident cases, which reflects the ability of the screening program to detect diseases in the preclinical phase, was the highest for anemia, disorders of lipid metabolism, and hypertensive disorders. The smaller proportions in dermatologic, urologic and orthopedic disorders indicate that preventive methods for these disorders should be considered in the future. In conclusion, monitoring of screening participants by prospective follow-up and analysis by two measures proposed in this study seem promising for continuing evaluation of the effectiveness of an on-going screening program. A network system of hospitals and physicians' offices should be developed, by which the information on the visits to outpatient clinics after screening is collected and analyzed periodically for monitoring.