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Background and objectives: Epicardial adipose tissue density (EAD) has been associated with coronary arteries calcium score, a higher load of coronary artery disease (CAD) and plaque vulnerability. This effect can be related to endocrine and paracrine effect of molecules produced by epicardial adipose tissue (EAT), that may influence myocardial contractility. Using coronary computed tomography angiography (CCT) the evaluation of EAD is possible in basal scans. The aim of the study is to investigate possible associations between EAD and cardiac function. Material and Methods: 93 consecutive patients undergoing CCT without and with contrast medium for known or suspected coronary CAD were evaluated. EAD was measured on basal scans, at the level of the coronary ostia, the lateral free wall of the left ventricle, at the level of the cardiac apex, and at the origin of the posterior interventricular artery. Cardiac function was evaluated in post-contrast CT scans in order to calculate ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV). Results: A statistically significant positive correlation between EAD and ejection fraction (r = 0.29, p-value < 0.01) was found. Additionally, a statistically significant negative correlation between EAD and ESV (r = -0.25, p-value < 0.01) was present. Conclusion: EAD could be considered a new risk factor associated with reduced cardiac function. The evaluation of this parameter with cardiac CT in patients with low to intermediate cardiovascular risk is possible.
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Cardiomiopatías , Enfermedades Cardiovasculares , Enfermedad de la Arteria Coronaria , Humanos , Ventrículos Cardíacos , Enfermedades Cardiovasculares/complicaciones , Angiografía Coronaria/métodos , Factores de Riesgo , Enfermedad de la Arteria Coronaria/etiología , Pericardio , Tomografía Computarizada por Rayos X , Cardiomiopatías/complicaciones , Factores de Riesgo de Enfermedad Cardiaca , Tejido AdiposoRESUMEN
PURPOSE: To evaluate the diagnostic accuracy of a deep learning (DL) algorithm predicting hemodynamically significant coronary artery disease (CAD) by using a rest dataset of myocardial computed tomography perfusion (CTP) as compared to invasive evaluation. METHODS: One hundred and twelve consecutive symptomatic patients scheduled for clinically indicated invasive coronary angiography (ICA) underwent CCTA plus static stress CTP and ICA with invasive fractional flow reserve (FFR) for stenoses ranging between 30 and 80%. Subsequently, a DL algorithm for the prediction of significant CAD by using the rest dataset (CTP-DLrest) and stress dataset (CTP-DLstress) was developed. The diagnostic accuracy for identification of significant CAD using CCTA, CCTA + CTP stress, CCTA + CTP-DLrest, and CCTA + CTP-DLstress was measured and compared. The time of analysis for CTP stress, CTP-DLrest, and CTP-DLStress was recorded. RESULTS: Patient-specific sensitivity, specificity, NPV, PPV, accuracy, and area under the curve (AUC) of CCTA alone and CCTA + CTPStress were 100%, 33%, 100%, 54%, 63%, 67% and 86%, 89%, 89%, 86%, 88%, 87%, respectively. Patient-specific sensitivity, specificity, NPV, PPV, accuracy, and AUC of CCTA + DLrest and CCTA + DLstress were 100%, 72%, 100%, 74%, 84%, 96% and 93%, 83%, 94%, 81%, 88%, 98%, respectively. All CCTA + CTP stress, CCTA + CTP-DLRest, and CCTA + CTP-DLStress significantly improved detection of hemodynamically significant CAD compared to CCTA alone (p < 0.01). Time of CTP-DL was significantly lower as compared to human analysis (39.2 ± 3.2 vs. 379.6 ± 68.0 s, p < 0.001). CONCLUSION: Evaluation of myocardial ischemia using a DL approach on rest CTP datasets is feasible and accurate. This approach may be a useful gatekeeper prior to CTP stress..
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Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Aprendizaje Profundo , Reserva del Flujo Fraccional Miocárdico , Imagen de Perfusión Miocárdica , Humanos , Angiografía por Tomografía Computarizada , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Imagen de Perfusión Miocárdica/métodos , Perfusión , Valor Predictivo de las PruebasAsunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Reflujo Gastroesofágico/diagnóstico por imagen , Fibrosis Pulmonar Idiopática/complicaciones , Tomografía Computarizada por Rayos X/métodos , Tromboembolia Venosa/diagnóstico por imagen , Comorbilidad , Enfermedad de la Arteria Coronaria/complicaciones , Reflujo Gastroesofágico/complicaciones , Humanos , Enfermedades Respiratorias/complicaciones , Enfermedades Respiratorias/diagnóstico por imagen , Tromboembolia Venosa/complicacionesRESUMEN
BACKGROUND: Cardiac computed tomography (CCT) was recently validated to measure extracellular volume (ECV) in the setting of cardiac amyloidosis, showing good agreement with cardiovascular magnetic resonance (CMR). However, no evidence is available with a whole-heart single source, single energy CT scanner in the clinical context of newly diagnosed left ventricular dysfunction. Therefore, the aim of this study was to test the diagnostic accuracy of ECVCCT in patients with a recent diagnosis of dilated cardiomyopathy, having ECVCMR as the reference technique. METHODS: 39 consecutive patients with newly diagnosed dilated cardiomyopathy (LVEF <50%) scheduled for clinically indicated CMR were prospectively enrolled. Myocardial segment evaluability assessment with each technique, agreement between ECVCMR and ECVCCT, regression analysis, Bland-Altman analysis and interclass correlation coefficient (ICC) were performed. RESULTS: Mean age of enrolled patients was 62 â± â11 years, and mean LVEF at CMR was 35.4 â± â10.7%. Overall radiation exposure for ECV estimation was 2.1 â± â1.1 âmSv. Out of 624 myocardial segments available for analysis, 624 (100%) segments were assessable by CCT while 608 (97.4%) were evaluable at CMR. ECVCCT demonstrated slightly lower values compared to ECVCMR (all segments, 31.8 â± â6.5% vs 33.9 â± â8.0%, p â< â0.001). At regression analysis, strong correlations were described (all segments, r â= â0.819, 95% CI: 0.791 to 0.844). On Bland-Altman analysis, bias between ECVCMR and ECVCCT for global analysis was 2.1 (95% CI: -6.8 to 11.1). ICC analysis showed both high intra-observer and inter-observer agreement for ECVCCT calculation (0.986, 95%CI: 0.983 to 0.988 and 0.966, 95%CI: 0.960 to 0.971, respectively). CONCLUSIONS: ECV estimation with a whole-heart single source, single energy CT scanner is feasible and accurate. Integration of ECV measurement in a comprehensive CCT evaluation of patients with newly diagnosed dilated cardiomyopathy can be performed with a small increase in overall radiation exposure.
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Cardiomiopatía Dilatada , Humanos , Persona de Mediana Edad , Anciano , Cardiomiopatía Dilatada/patología , Imagen por Resonancia Cinemagnética/métodos , Valor Predictivo de las Pruebas , Miocardio/patología , Corazón , Medios de Contraste , FibrosisRESUMEN
Ischemic cardiomyopathy (ICM) is one of the most common causes of congestive heart failure. In patients with ICM, tissue characterization with cardiac magnetic resonance imaging (CMR) allows for evaluation of myocardial abnormalities in acute and chronic settings. Myocardial edema, microvascular obstruction (MVO), intracardiac thrombus, intramyocardial hemorrhage, and late gadolinium enhancement of the myocardium are easily depicted using standard CMR sequences. In the acute setting, tissue characterization is mainly focused on assessment of ventricular thrombus and MVO, which are associated with poor prognosis. Conversely, in chronic ICM, it is important to depict late gadolinium enhancement and myocardial ischemia using stress perfusion sequences. Overall, with CMR's ability to accurately characterize myocardial tissue in acute and chronic ICM, it represents a valuable diagnostic and prognostic imaging method for treatment planning. In particular, tissue characterization abnormalities in the acute setting can provide information regarding the patients that may develop major adverse cardiac event and show the presence of ventricular thrombus; in the chronic setting, evaluation of viable myocardium can be fundamental for planning myocardial revascularization. In this review, the main findings on tissue characterization are illustrated in acute and chronic settings using qualitative and quantitative tissue characterization.
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Cardiomiopatías , Isquemia Miocárdica , Cardiomiopatías/diagnóstico por imagen , Medios de Contraste , Gadolinio , Humanos , Imagen por Resonancia Magnética , Imagen por Resonancia Cinemagnética , Espectroscopía de Resonancia Magnética , Isquemia Miocárdica/diagnóstico por imagen , MiocardioRESUMEN
Transcatheter procedures for heart valve repair or replacement represent a valid alternative for treating patients who are inoperable or at a high risk for open-heart surgery. The transcatheter approach has become predominant over surgical intervention for aortic valve disease, but it is also increasingly utilized for diseases of the 'other valves', that is the mitral and, to a lesser extent, tricuspid and pulmonary valve. Preprocedural imaging is essential for planning the transcatheter intervention and computed tomography has become the main imaging modality by providing information that can guide the type of treatment and choice of device as well as predict outcome and prevent complications. In particular, preprocedural computed tomography is useful for providing anatomic details and simulating the effects of device implantation using 3D models. Transcatheter mitral valve replacement is indicated for the treatment of mitral regurgitation, either primary or secondary, and computed tomography is crucial for the success of the procedure. It allows evaluating the mitral valve apparatus, the surrounding structures and the left heart chambers, identifying the best access route and the landing zone and myocardial shelf, and predicting obstruction of the left ventricular outflow tract, which is the most frequent postprocedural complication. Tricuspid valve regurgitation with or without stenosis and pulmonary valve stenosis and regurgitation can also be treated using a transcatheter approach. Computer tomography provides information on the tricuspid and pulmonary valve apparatus, the structures that are spatially related to it and may be affected by the procedure, the right heart chambers and the right ventricular outflow tract.
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Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Cateterismo Cardíaco , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
AIMS: Unruptured aortic root pseudoaneurysm (UARP) is a rare complication of aortic valve endocarditis. Infectious spread to the valvular annulus or myocardium can cause septic complications that manifest as wall thickening, and spontaneous abscess drainage leads to pseudoaneurysm formation. We report the first patient series in which transcatheter aortic valve implantation (TAVI) using a single valve-resolved aortic valvulopathy associated with UARP was performed. METHODS: At our center, from December 2017 to October 2019, 138 patients underwent TAVI for aortic valve stenosis and/or regurgitation, 20 of whom (12 female patients, 8 male patients) had associated incidental UARP and were considered as our study population. The average age of these patients was 76.9â±â5.2âyears. All patients were assessed using preprocedural and postprocedural multimodality imaging, including transthoracic echocardiography, transesophageal echocardiography, and cardiac computed tomography angiography (CCTA). RESULTS: In all cases, the final angiographic examination showed correct valve positioning with complete coverage of the false aneurysm. Post-TAVI CCTA showed presence of total or subtotal UARP thrombosis. The mean follow-up period was 17.5âmonths (12-23âmonths). During follow-up, imaging showed normal prosthetic valve function, no significant leakage (trace or mild), and complete UARP exclusion in all patients, without any complications. CONCLUSION: In conclusion, percutaneous valve positioning can simultaneously solve pseudoaneurysm complications by excluding the sac and promoting thrombosis.
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Aneurisma Falso/complicaciones , Aneurisma de la Aorta Torácica/complicaciones , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas , Anciano , Anciano de 80 o más Años , Aneurisma Falso/diagnóstico , Aneurisma de la Aorta Torácica/diagnóstico , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico , Angiografía por Tomografía Computarizada , Ecocardiografía Transesofágica , Femenino , Humanos , Masculino , Diseño de Prótesis , Reemplazo de la Válvula Aórtica TranscatéterRESUMEN
BACKGROUND AND PURPOSE: Cervical discogenic pain originates from degenerated intervertebral discs and is a common condition in the middle-aged population. Cervical discs may herniate and give compressions to cervical nerves, with pain and functional limitation of the arms. DiscoGel is a device that can be useful in the treatment of cervical disc herniation, with very short operating time and low radiation dose. MATERIAL AND METHODS: Between March 2018 and April 2019 we performed this procedure on 38 patients with non-fissurated cervical herniation using 0.3-0.4 mL of DiscoGel injected under fluoroscopic guidance. The most common discs affected were C5-C6, C6-C7 and C4-C5. Outcomes were evaluated with Visual Analogue Scale (VAS) and Neuropathic Pain Symptom Inventory (NPSI) scores at 3, 6 and 12 months follow-up. A magnetic resonance imaging (MRI) scan of the cervical spine was performed 3 months after the procedure. RESULTS: Postoperative examinations showed: VAS 2.15 ± 1.34 and NPSI 2.29 ± 0.71.Postoperative MRI performed 3 months after the procedure showed a good improvement of cervical disc herniation or bulging or protrusion. The mean dose area product (DAP) was 2803 mGy/cm2 with a mean fluoroscopy time of 4 minutes 22 seconds.Conclusion DiscoGel is a suitable approach for non-fissurated cervical disc herniations, especially in patients that are not suitable for open surgery, with excellent postoperative results, fast recovery and a low radiation dose.
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Desplazamiento del Disco Intervertebral , Neuralgia , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/cirugía , Persona de Mediana Edad , Cuello , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIM: Pre-transcatheter aortic valve implantation (TAVI) computed tomography (CT) has proven to be crucial in identifying pre- and post-procedural predicting factors predisposing the onset of major arrhythmias that require permanent pacemaker (PPM) implantation caused by the compressive effects of the prostheses on the conduction system at the membranous septum (MS) and the muscular crest of the interventricular septum.Our analysis aims to verify if the pre-TAVI assessment of the angle between the MS and the aortic annulus (SVA) might be a predictive factor for the onset of arrhythmias that requires PPM. METHODS: Two cardiovascular specialist radiologists retrospectively and double-blind evaluated a randomized list of preprocedural CT of 57 patients who underwent TAVI with a self-expandable valve from April 2019 to February 2020. Two anatomical features were measured by readers: width of the SVA and MS length (MSL). RESULTS: A PPM was implanted in 18 patients (31%) after the procedure. There was no significant difference in the anatomical measurements performed between the two observers, regarding both anatomical measurements (intraclass correlation coefficient was 0.944 for the SVA and 0.774 for the MSL]. Receiver-operating characteristic curves (ROC) performed for both measurements have documented: for the SVA sensitivity 94% and Negative predictive value (NPV) 96% (area under the curve: 0.77; 95% confidence interval 0.66-0.90). The MSL ROC was not significant. The mean SVA value stratified for patients who did not undergo PPM implantation and patients who did resulted as significant (Pâ<â0.005). CONCLUSION: Measurement of the SVA performed in preprocedural CT scans has proven to be related to the onset of major arrhythmias after TAVI requiring permanent pacemaker implantation with high sensitivity (94%) and NPV (96%).
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Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Arritmias Cardíacas , Tabiques Cardíacos/diagnóstico por imagen , Marcapaso Artificial , Complicaciones Posoperatorias , Tomografía Computarizada por Rayos X/métodos , Reemplazo de la Válvula Aórtica Transcatéter , Anciano , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiología , Arritmias Cardíacas/terapia , Femenino , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/terapia , Valor Predictivo de las Pruebas , Pronóstico , Implantación de Prótesis/instrumentación , Implantación de Prótesis/estadística & datos numéricos , Estudios Retrospectivos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/métodosRESUMEN
In this paper, we describe a rare case of coronary artery aneurysms occasionally found on a pre interventional Coronary Computed Tomography Angiography performed on a 67-year-old man with a history of aneurysm of the ascending aorta previously treated with Bentall surgery, who arrived at our hospital to have a percutaneous valve-in-valve implantation procedure. Even though the patient was considered not eligible for the procedure, due to his many comorbidities, and conservatively managed, at 1-year followup his angiographic condition remained stable.
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Infective endocarditis can have peri-annular spread and involve the valvular annulus and adjacent cardiac structures, leading to tissue necrosis and peri-annular abscess. This process may cause pseudoaneurysm formation and other rare and potentially life-threatening complications, so their identification and correct diagnosis are crucial. We describe a case of an 81-year-old woman, with a history of aortic valve replacement and worsening of symptoms, that presents at the imaging a pseudoaneurysm of the aortic root complicated at the same time by 2 life-threatening conditions: fistulization in the Right Ventricular Outflow Tract (RVOT) and the compression of Right Coronary Artery (RCA). This case underlines the importance of imaging, especially Coronary Computed Tomography Angiography (CCTA), in the diagnosis and follow-up of infective endocarditis and its complications, especially in a patient not eligible for surgery.
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BACKGROUND: An ascending aortic pseudoaneurysm is a severe and rare complication following cardiothoracic surgery. This case report demonstrates its possible misinterpretation and the consequent importance of multidisciplinary evaluation. CASE PRESENTATION: We present a case of an 18-year-old Caucasian man with Marfan syndrome who developed an ascending aortic pseudoaneurysm about 1 year after undergoing cardiac surgery with the Bentall procedure. Computed tomographic examination of the thoracic aorta and positron emission tomography-computed tomography initially suggested a lymphomatous pathology. However, these imaging results were in contrast to the transesophageal echocardiogram and the laboratory data that showed negative results for hematological pathology. A second computed tomographic scan redirected the diagnosis toward a pseudoaneurysm. CONCLUSION: This case demonstrates the utility of close communication and interdisciplinary consultation between cardiovascular radiologists and the cardiac surgery team, which are mandatory in order to maximize their diagnostic skills in identifying postoperative complications.
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Aneurisma Falso , Linfoma , Adolescente , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aorta/diagnóstico por imagen , Errores Diagnósticos , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND AIMS: Coronary computed tomography (CT) allows calculating coronary artery calcium score (CACS). However, other CT features might be more strongly related to plaque vulnerability and risk of future coronary events. This study investigated the association of plaque calcification pattern and attenuation with plaque instability features, coronary artery disease (CAD) grade and CACS. METHODS: One-hundred patients with coronary stenosis associated with calcified plaques were considered for this analysis. CACS, CAD grade, calcification pattern and attenuation, features of plaque instability, and epicardial adipose tissue (EAT) thickness and attenuation were assessed with non-contrast and contrast-enhanced CT angiography. RESULTS: Of 373 calcified plaques, 131 were responsible for the highest degree of coronary stenosis (1.31 ± 0.53 per patient). Participants were stratified according to the features of the highest-grade lesion(s) into patients with large (35%), spotty (52%) or mixed (13%) calcification pattern and tertiles of plaque calcification attenuation (using the mean value for multiple lesions). Patients with large calcification pattern or higher plaque calcification attenuation had higher stenosis and CACS grade (and EAT attenuation), but lower plaque instability score, whereas those with spotty calcification pattern or lower plaque calcification attenuation had lower stenosis and CACS grade (and EAT attenuation), but higher plaque instability score. Among the instability features, low attenuation and napkin-ring sign, but not positive remodeling, were associated with a spotty pattern and a lower calcification attenuation. CONCLUSIONS: Both the pattern and attenuation of calcification should be considered, in addition to CACS, for risk stratification of heavily calcified high-risk patients with non-critical coronary stenosis.
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Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Placa Aterosclerótica , Calcificación Vascular , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Estenosis Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Humanos , Placa Aterosclerótica/diagnóstico por imagen , Valor Predictivo de las Pruebas , Factores de Riesgo , Calcificación Vascular/diagnóstico por imagenRESUMEN
: Since 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the treatment and prognosis of patients with aortic stenosis. A preprocedural assessment of the patient is vital for achieving optimal outcomes from the procedure. Retrospective ECG-gated cardiac computed tomography (CT) today it is the gold-standard imaging technique that provides three-dimensional images of the heart, thus allowing a rapid and complete evaluation of the morphology of the valve, ascending aorta, coronary arteries, peripheral access vessels, and prognostic factors, and also provides preprocedural coplanar fluoroscopic angle prediction to obtain complete assessment of the patient. The most relevant dimension in preprocedural planning of TAVI is the aortic annulus, which can determine the choice of prosthesis size. CT is also essential to identify patients with increased anatomical risk for coronary artery occlusion in Valve in Valve (ViV) procedures.Moreover, CT is very useful in the evaluation of late complications, such as leakage, thrombosis and displacements. At present, CT is the cornerstone imaging modality for the extensive and thorough work-up required for planning and performing each TAVI procedure, to achieve optimal outcomes. Both the CT procedure and analysis should be performed by trained and experienced personnel, with a radiological background and a deep understanding of the TAVI procedure, in close collaboration with the implantation team. An accurate pre-TAVI CT and post-processing for the evaluation of all the points recommended in this review allow a complete planning for the choice of the valve dimensions and type (balloon or self-expandable) and of the best percutaneous access.
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Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Tomografía Computarizada por Rayos X , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Técnicas de Imagen Sincronizada Cardíacas , Toma de Decisiones Clínicas , Electrocardiografía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Hemodinámica , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Valor Predictivo de las Pruebas , Diseño de Prótesis , Falla de Prótesis , Recuperación de la Función , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND/AIM: This study investigated the correlation of chest computed tomography (CT), findings, graded using two different scoring methods, with clinical and laboratory features and disease outcome, including a novel clinical predictive score, in patients with novel coronavirus-infected pneumonia (NCIP). PATIENTS AND METHODS: In this retrospective, observational study, CT scan of 92 NCIP patients admitted to Policlinico Tor Vergata, were analyzed using a quantitative, computed-based and a semiquantitative, radiologist-assessed scoring system. Correlations of the two radiological scores with clinical and laboratory features, the CALL score, and their association with a composite adverse outcome were assessed. RESULTS: The two scores correlated significantly with each other (ρ=0.637, p<0.0001) and were independently associated with age, LDH, estimated glomerular filtration rate, diabetes, and with the composite outcome, which occurred in 24 patients. CONCLUSION: In NCIP patients, two different radiological scores correlated with each other and with several clinical, laboratory features, and the CALL score. The quantitative score was a better independent predictor of the composite adverse outcome than the semiquantitative score.
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Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Neumonía/diagnóstico por imagen , Tórax/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Betacoronavirus/patogenicidad , COVID-19 , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Femenino , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía/mortalidad , Neumonía/fisiopatología , Neumonía/virología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Neumonía Viral/virología , SARS-CoV-2 , Tórax/fisiopatología , Tórax/virología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Cardiac magnetic resonance is a valuable tool in the diagnosis of acute myocarditis, but dyspnea or chest pain often reduce patient's compliance, so definition of faster magnetic resonance protocols is of paramount importance. METHODS: Short tau inversion recovery (STIR) and phase sensitive inversion recovery images for the assessment of late gadolinium enhancement (LGE)of 22 patients with clinical suspicion of acute myocarditis were retrospectively evaluated. Signal intensity in STIR images was measured by 2 readers by placing region of interests (ROIs) within the area of maximal signal intensity in each myocardial segment derived from the ACC/AHA segmental scheme. Segmental T2 ratio was assessed with the formula: signal intensity of myocardium/signal intensity of muscle. Receiver operating characteristic (ROC) curves were used to compare diagnostic performance of T2 Signal intensity and T2 ratio in predicting the presence of LGE in each myocardial segment. Bland-Altman analysis was used to assess inter reader agreement. RESULTS: Signal intensity in STIR images showed an area under the curve (AUC) of 0.54 (95% CI: 0.44-0.63) for reader 1 and 0.53(95% CI: 0.44-0.63) for reader 2. Segmental T2 ratio showed an AUC of 0.8 (95% CI: 0.73-0.87) for reader 1 and 0.77 (95% CI: 0.71-0.84) for reader 2. Bland-Altman analysis showed good agreement for both T2 signal intensity (mean difference =-18.5 reader1 vs. reader 2 and 2SD=247.3) and T2 ratio (mean difference=0.03 vs. reader2 and 2SD=0.9). CONCLUSIONS: Segmental T2 ratio showed a good diagnostic accuracy in predicting the presence of LGE in patients with clinical suspicion of acute myocarditis and might be a promising approach in reducing scan times with no reduction in diagnostic accuracy.
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Gadolinio , Miocarditis , Medios de Contraste , Estudios de Factibilidad , Humanos , Imagen por Resonancia Magnética , Miocarditis/diagnóstico por imagen , Miocardio , Estudios RetrospectivosRESUMEN
Nowadays tuberculosis has become a reemerging infectious disease due to the many forms of immunodeficiency. Patients with eating disorders like anorexia nervosa and bulimia are a susceptible group due to the immune impairment correlated with severe malnutrition and their prevalence and incidence is growing. We describe the case of a 31-year-old woman, with long-standing history of anorexia nervosa and bulimia, diagnosed with advanced pulmonary tuberculosis. This case underlines the importance on never neglecting even the slightest symptoms in patients with malnutrition and never excluding this pathology without a proper investigation.
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Osteoid osteoma represents 10%-12% of all benign bone tumors, and is composed by osteoid tissue and reticular and immature bone tissue. Acetabular involvement is very rare (≤1%). In this case report, we describe the treatment of an osteoid osteoma of the acetabulum of a young man using cryotherapy under fluoroscopic guide with the new XperGuide system which is used to reduce X-ray radiation dose and to have a more accurate localization of the lesion compared to computed tomography-guided or surgical ablation.