The predictive value of preoperative 18F-fluorodeoxyglucose PET for postoperative recurrence in patients with localized primary gastrointestinal stromal tumour.

OBJECTIVES: To assess the potential value of preoperative 18F-FDG PET to predict postoperative recurrence of solitary localized primary gastrointestinal stromal tumour (GIST) after radical resection. METHODS: A total of 46 patients with primary GIST who received preoperative 18F-FDG PET and underwent complete resection without neoadjuvant therapy were retrospectively studied. PET findings, including ring-shaped uptake and intense uptake, were compared with Joensuu risk grades using Fisher's exact test. The prognostic value of the preoperative clinico-imaging variables-age ≥60 years, male, ring-shaped uptake, intense uptake, tumour size >5 cm, heterogeneous CT attenuation and lower gastrointestinal origin-and Joensuu high risk for recurrence-free survival was evaluated using log-rank test and multivariate Cox regression analysis. RESULTS: Ring-shaped uptake and intense uptake were significantly associated with Joensuu high risk. Univariate analysis showed that ring-shaped uptake, intense uptake, size >5 cm and Joensuu high risk were significantly associated with inferior recurrence-free survival. Multivariate analysis showed that ring-shaped uptake (P = 0.004) and Joensuu high risk (P = 0.021) were independent adverse prognostic factors of postoperative recurrence. CONCLUSIONS: Ring-shaped uptake on preoperative 18F-FDG PET may be a potential predictor of postoperative tumour recurrence of localized primary GISTs. KEY POINTS: • Clinical course of resectable solitary localized primary GISTs varies widely. • Ring-shaped uptake is an independent adverse prognostic factor of postoperative recurrence. • Preoperative 18 F-FDG PET may help predict postoperative recurrence of GISTs.

Relation among left ventricular mass, insulin resistance, and hemodynamic parameters in type 2 diabetes.

Increased left ventricular mass (LVM) is an independent cardiovascular risk marker, which often occurs independently of arterial blood pressure in type 2 diabetes. To investigate the factors related to the disproportionate increase in LVM in type 2 diabetes, we conducted a cross-sectional study. We studied 40 male type 2 diabetic patients aged 36 to 70 years with controlled blood pressure. Magnetic resonance imaging was used to measure LVM accurately. Radial arterial waveforms were recorded non-invasively by applanation tonometry to assess the hemodynamic status, radial augmentation index (AI) and time from forward peak to reflection peak (TPP). Glycemic control status and insulin resistance were evaluated by plasma HbA1c and homeostasis model assessment (HOMA) score, respectively. E/E', an echocardiographic parameter for left ventricular (LV) diastolic function, was also analyzed by echocardiography. Univariate analyses showed that HbA1c and TPP had trends toward a positive correlation with LVM indexed for body surface area (LVMI), whereas AI did not. When patients' age, heart rate, and systolic blood pressure were simultaneously included in the linear regression model, the TPP and HOMA score were independently related to LVMI (p<0.05 for each variable). Increased LVMI was accompanied with impaired LV diastolic function assessed by E/E'. In conclusion, the TPP and HOMA score were associated with a modest but clinically relevant increase in LVM in type 2 diabetes independently of arterial blood pressure. Pulse wave analysis may reveal hemodynamic alterations that affect LVM but that cannot be identified using a sphygmomanometer.

Left ventricular functional analysis using 64-slice multidetector row computed tomography: comparison with left ventriculography and cardiovascular magnetic resonance.

OBJECTIVE: The progress in computed tomography (CT) has improved temporal resolution and shortened the acquisition time. We compared cardiac function using 64-slice CT with left ventriculography (LVG) and cardiovascular magnetic resonance (CMR). METHODS: A head-to-head comparison between CT, LVG and CMR was performed in 41 patients. In global LV function, CMR served as the reference. Regional wall motion was compared in a 5-point scoring system. RESULTS: CT had excellent intra- and interobserver reproducibility. Ejection fraction, end-diastolic and end-systolic volumes by CT were closely correlated with CMR (r = 0.95, 0.96 and 0.98, respectively), while LVG underestimated LV volumes (p < 0.01). The standard deviation of ejection fraction difference between CT and CMR was significantly lower than that between LVG and CMR (p = 0.0015). In regional function, there were good agreements of 94.8% (kappa = 0.82) between CT and LVG and 94.5% (kappa = 0.84) between CT and CMR. The intermethod agreements in mild hypokinesis using CT tended to be lower. CONCLUSION: An excellent correlation was observed between CT and CMR in the LV function over a wide range of heart rates. However, even though 64-slice CT tended to be less sensitive in detecting mild hypokinesis, it still showed excellent concordance in advanced regional abnormalities.

Comparison of contrast-enhanced MRI with (18)F-FDG PET/201Tl SPECT in dysfunctional myocardium: relation to early functional outcome after surgical revascularization in chronic ischemic heart disease.

UNLABELLED: Revascularization of viable myocardial segments has been shown to improve left ventricular (LV) function and long-term prognosis; however, the surgical risk is comparatively higher in patients with a low ejection fraction (EF). We compared contrast-enhanced MRI with (18)F-FDG PET/(201)Tl SPECT for myocardial viability and prediction of early functional outcome in patients with chronic coronary artery disease (CAD). METHODS: Forty-one patients with chronic CAD and LV dysfunction (mean age +/- SD, 66 +/- 10 y; 32 men; mean EF +/- SD, 38% +/- 13%) referred for (18)F-FDG PET, (201)Tl-SPECT and MRI within 2 wk were included. Twenty-nine subjects underwent coronary artery bypass grafting (CABG), and LV function was reassessed by MRI before discharge (17 +/- 7 d after surgery). Two were excluded from outcome analysis (1 death due to sepsis; 1 perioperative myocardial infarction). The extent of viable myocardium by (18)F-FDG PET/(201)Tl SPECT was defined by the metabolism-perfusion mismatch or ischemia, in comparison with the extent of delayed enhancement (DE) on MRI in a 17-segment model. Segmental functional recovery was defined as improvement in the wall motion score of > or =1 on a 4-point scale. EF and LV volume change were used as global functional outcome. RESULTS: Three hundred ninety-four dysfunctional segments were compared, and the extent of DE on MRI correlated negatively with the viability on (18)F-FDG PET. Of 252 dysfunctional segments that were successfully revascularized, the sensitivity, specificity, positive predictive value, and negative predictive value of PET/SPECT were 60.2%, 98.7%, 76.6%, and 96.7% and of MRI were 92.2%, 44.9%, 72.4%, and 78.6% using the cutoff value of 50% DE on MRI, without significant differences in overall accuracies. In 18 subjects who underwent isolated CABG, improvement of EF (> or =5%) and reverse LV remodeling (> or =10% LV size reduction) was best predicted by the no DE on MRI, and patients with substantial nonviable myocardium on (18)F-FDG/SPECT predicted a poor early functional outcome (all P < 0.001). CONCLUSION: Accurate prediction of early functional outcome by PET/SPECT and contrast-enhanced MRI is possible.

A novel approach to restore atrial function after the maze procedure in patients with an enlarged left atrium.

OBJECTIVE: Left atrial (LA) volume reduction surgery concomitant with the maze procedure has been reported to facilitate sinus rhythm recovery even in patients with refractory atrial fibrillation (AF) with an enlarged LA. However, it is unknown whether the procedures can also restore effective atrial function of the enlarged LA with over-stretched myocardium. METHODS: The maze procedures in association with mitral valve surgery were performed to 57 AF patients with an enlarged LA (LA diameter >or=60mm). Among them, 32 patients had concomitant LA volume reduction surgery (VR group). Another 25 patients did not have the volume reduction (control group). RESULTS: Three months postoperatively LA end-diastolic volume (LAEDV, ml) assessed by magnetic resonance (MR) imaging was larger in the VR group than that in the control group (291+/-117 vs 223+/-81 ml, p<0.05). Postoperatively, sinus rhythm recovery rate was better (84 vs 68%, p<0.05) and LAEDV was drastically smaller (118+/-48 vs 203+/-76 ml, p<0.001) in the VR group than those in the control group. Among the patients with sinus rhythm recovery in both groups, LA contraction ejection fraction (%) improved in the VR group but not in the control group (22.3+/-7.8 vs 10.3+/-4.7%, p<0.001). CONCLUSIONS: The LA volume reduction surgery concomitant with the maze procedure restored contraction of the enlarged LA; however, the maze procedure alone did not restore LA contraction in spite of successful sinus rhythm recovery. LA volume reduction surgery may be desirable to the patients with refractory AF with over-stretched LA.

Evaluation of three-dimensional navigator-gated whole heart MR coronary angiography: the importance of systolic imaging in subjects with high heart rates.

PURPOSE: To evaluate the influence of heart rate (HR) on magnetic resonance coronary angiography (MRCA) image quality in diastolic and systolic phases. MATERIALS AND METHODS: Twenty-seven healthy volunteers (9 men; 33+/-9 years, HR 53-110 bpm), were evaluated with the electrocardiography and three-dimensional navigator-gating MRCA in a 1.5-T MR scanner (Avanto, Siemens) in diastolic and systolic phases (steady-state free precession; TR/TE/flip angle=3.2 ms/1.6 ms/90 degrees). The timing of scanning was individually adapted to the cardiac rest periods obtained in the prescanning, by visually identifying when the movement of right coronary artery was minimized during diastole and systole. Images of two phases were side-by-side compared on a four-point scale (from 1=poor to 4=excellent visibility; score of 3 or 4 as diagnostic). RESULTS: Of 13 subjects with HR < or =65 bpm (low HR group, mean 59.8+/-4.9 bpm, range 53-65), the image quality scores were significantly better than that with higher heart rates (73.9+/-9.0 bpm, range 68-110) in diastolic MRCA. The image quality was significantly improved during systole in high HR group. Overall, 91.3% of low HR group had MRCA image of diagnostic quality acquired at diastole, while 88.3% of high HR group had diagnostic images at systole by segmental analysis (p=NS). CONCLUSIONS: MRCA at systole offered superior quality in patients with high heart rates.

Thoracoabdominal-aortoiliac MDCT angiography using reduced dose of contrast material.

OBJECTIVE: The objective of our study was to compare the image quality of MDCT angiography studies obtained by injection of low doses of contrast medium with saline flush versus conventional doses of contrast medium. MATERIALS AND METHODS: Seventy-one patients with pre- or postoperative aortic aneurysms underwent MDCT angiography throughout the thoracoabdominal-aortoiliac system using an 8-MDCT scanner. In 37 patients, 100 mL of contrast medium was injected at a flow rate of 3.0 mL/s (hereafter referred to as the 100-mL group). In 34 patients, 50 mL of contrast medium followed by a 20-mL saline flush was injected at a flow rate of 2.5 mL/s (the 50-mL group). For each group, quantitative analysis involved calculating the mean aortoiliac enhancement, plateau deviation, and contrast enhancement in the pulmonary trunk and superior vena cava (SVC). Qualitative analysis involved assessing the 3D postprocessing images. RESULTS: Significant differences between the groups in mean aortoiliac enhancement (100-mL group vs 50-mL group, 337 +/- 6 H vs 319 +/- 5 H, p < 0.0001) and mean plateau deviation (51 +/- 4 H vs 58 +/- 4 H, p < 0.0001) were found. However, adequate arterial enhancement (>or= 200 H) was observed in 31 of 34 patients in the 50-mL group and uniform aortoiliac enhancement (< 50 H) was seen in 26 patients. Visual analysis showed no difference in contrast material magnitude and homogeneity between the groups. Furthermore, in the 50-mL group, the thoracic aorta was more clearly visualized because of a reduction in the opacity of the main pulmonary artery and SVC. CONCLUSION: In our experience, administration of 50 mL of contrast medium followed by a 20-mL saline flush produces thoracoabdominal-aortoiliac MDCT angiographic examinations of effective quality in most cases.

[Cardiac imaging].

Congestive heart failure is a state of inadequate cardiac function under various etiologies. Cardiac imaging plays an important role for accurate detection of heart failure, assessment of severity of LV function, and precise analysis of tissue function in vivo. Recently, multislice CT(MSCT), magnetic resonance imaging (MRI), and positron emission tomography(PET) have been rapidly developed for clinical use for assessing patients with congestive heart failure. MSCT has been used for accurate assessment of LV function. Due to high spatial resolution, MSCT permits assessment of coronary stenosis without cardiac catheterization. MRI permits assessment of LV function and also tissue function. Particularly, infarcted myocardium is accurately delineated as an area of delayed enhancement by contrast enhancement MRI study. PET has been used for accurate assessment of myocardial viability based on the persistence of myocardial glucose metabolism. In addition, a various new PET tracers permit molecular and cellular function, such as neurotransmission and receptor function in vivo. These new imaging technique has a potential role for assessing risk stratification and providing appropriate treatment strategy.

Comparison of myocardial blood flow induced by adenosine triphosphate and dipyridamole in patients with coronary artery disease.

Myocardial perfusion imaging with adenosine triphosphate (ATP) has been used increasingly to diagnose coronary artery disease (CAD) and assess risk for this disease. This study compared absolute myocardial blood flow (MBF) and myocardial flow reserve index (MFR) with ATP and dipyridamole (DIP) in patients with CAD. MBF was quantified by 15O-H2O PET in 21 patients with CAD (17 male, 4 female), aged 55 to 81 years. MBF was measured at rest, during intravenous injection of ATP (0.16 mg/kg/min), and again after DIP infusion (0.56 mg/kg). Regions of interest were drawn in nonischemic and ischemic segments based on findings from thallium-201 (201T1) scintigraphy and coronary angiography (CAG). Absolute MBF values and indexes of MFR were calculated in nonischemic and ischemic segments. Intravenous injection of ATP and DIP significantly increased MBF in nonischemic (2.4 +/- 0.9 and 2.1 +/- 0.8 ml/g/min, respectively; p < 0.01, for both) and in ischemic segments (1.3 +/- 0.4 and 1.5 +/- 0.4 ml/g/min, respectively; p < 0.01, for both). There was a significant difference in MBF values between ATP and DIP in nonischemic segments (p < 0.05), which was not observed in ischemic segments. In nonischemic segments, ATP produced higher MFR than DIP (2.1 +/- 0.8 and 1.8 +/- 0.7, respectively; p < 0.05), while no significant difference was observed in ischemic segments (1.5 +/- 0.6 and 1.7 +/- 0.3, respectively). ATP produced a greater hyperemia than DIP between the ischemic and nonischemic myocardium in patients with CAD. ATP is as effective as DIP for the diagnosis of CAD.

Effect of caffeine intake on myocardial hyperemic flow induced by adenosine triphosphate and dipyridamole.

UNLABELLED: The aims of this study were (a). to compare absolute myocardial blood flow (MBF) during adenosine triphosphate (ATP) infusion with that after dipyridamole administration without caffeine intake and (b). to evaluate the effect of caffeine intake on the hyperemic flow induced by these coronary vasodilator agents. METHODS: MBF was quantified with (15)O-labeled water and PET at rest, during ATP infusion (0.16 mg/kg/min for 9 min), and after dipyridamole administration (0.56 mg/kg over 4 min) after a 24-h abstinence from caffeine (baseline evaluation) in 10 healthy volunteers. Within 2 wk, the same PET studies were repeated after caffeine intake to evaluate the effect of caffeine on the hyperemic flow induced by these pharmacologic agents (caffeine study). Myocardial flow reserve (MFR), defined as the ratio of hyperemic to resting blood flow, was also evaluated. RESULTS: Resting MBF in baseline and caffeine studies did not differ significantly (0.79 +/- 0.29 vs. 0.75 +/- 0.31 mL/min/g, P = 0.88). Without caffeine intake, MBF during ATP infusion was significantly higher than that after dipyridamole administration (3.70 +/- 0.67 vs. 3.00 +/- 0.79 mL/min/g, P = 0.003), whereas there was no significant difference in MFR between ATP and dipyridamole stress (5.15 +/- 1.64 vs. 4.11 +/- 1.44, P = 0.07). After caffeine intake, the hyperemic flows induced by ATP and dipyridamole were not significantly different (1.68 +/- 0.37 vs. 1.52 +/- 0.40 mL/min/g, P = 0.50). MFR estimated by ATP and dipyridamole also did not differ significantly in the caffeine studies (2.44 +/- 0.88 vs. 2.25 +/- 0.94, P = 0.73). MBF during ATP infusion and after dipyridamole administration were significantly lower in the caffeine studies than that in the baseline evaluation (1.68 +/- 0.37 vs. 3.70 +/- 0.67 mL/min/g, P < 0.0001, and 1.52 +/- 0.40 vs. 3.00 +/- 0.79 mL/min/g, P < 0.0001, respectively). CONCLUSION: This study demonstrates that ATP has the potential to induce greater hyperemia than dipyridamole, whereas hyperemic responses to ATP and dipyridamole are similarly attenuated after caffeine intake. These findings suggest that abstinence from caffeine before ATP stress testing may be needed.

The effect of nitroglycerin on myocardial blood flow in various segments characterized by rest-redistribution thallium SPECT.

UNLABELLED: The use of nitrates is reported to be effective in viability detection in scintigraphic perfusion imaging. The purpose of the study was to evaluate the effect of nitroglycerin (NTG) on myocardial blood flow (MBF) and coronary vascular resistance (CVR) in various segments characterized by rest-redistribution (201)Tl SPECT. METHODS: Twenty-three patients with coronary artery disease underwent rest-redistribution (201)Tl SPECT and (15)O-labeled water PET at rest and after NTG spray (0.3 mg). In addition, 11 healthy volunteers were also studied using PET. RESULTS: NTG did not change global MBF in the volunteers or in the patients. In segments with normal (201)Tl uptake and in those with a severe irreversible (201)Tl defect, NTG significantly reduced MBF without changing CVR. NTG reduced CVR in segments with a reversible (201)Tl defect (141 +/- 50 to 114 +/- 29 mm Hg/[mL/min/g], P = 0.004) and in those with a mild-to-moderate irreversible (201)Tl defect (165 +/- 64 to 149 +/- 60 mm Hg/[mL/min/g], P = 0.003), while maintaining MBF. CONCLUSION: NTG preferentially reduces CVR in the viable myocardium with ischemia. After NTG, tracer uptake in the ischemic myocardium will be relatively increased compared with that in the nonviable and nonischemic myocardium, leading to improvements in viability detection.

Composite arterial Y graft has less coronary flow reserve than independent grafts.

BACKGROUND: It is not known whether a composite Y graft of the left internal thoracic artery can provide sufficient blood flow to the whole left coronary system. The aim of this study was to compare regional myocardial blood flow (MBF) and coronary flow reserve after coronary artery bypass grafting using arterial composite Y graft or independent arterial grafts. METHODS: Positron emission tomography was performed at rest and after dipyridamole infusion using oxygen-15-labeled water 2 weeks after coronary artery bypass grafting. Regional MBF was calculated in seven segments of the left ventricle. Coronary flow reserve was defined as the ratio of MBF after dipyridamole infusion to MBF at rest. In the Y graft group (n = 22), a free arterial graft to obtuse marginal arteries was anastomosed to the proximal side of in situ left internal thoracic artery, which was anastomosed to the left anterior descending artery. In the independent graft group (n = 13), left anterior descending and obtuse marginal arteries were independently revascularized using in situ left internal thoracic artery and a free arterial graft. RESULTS: There was no difference between the groups in MBF at rest. Coronary flow reserve in the Y graft group was lower than that in the independent group in the anterobasal (1.43 +/- 0.07 versus 1.90 +/- 0.13, p = 0.038), apical (1.24 +/- 0.06 versus 1.64 +/- 0.12, p = 0.003), septal (1.34 +/- 0.05 versus 1.75 +/- 0.13, p = 0.023), and lateral regions (1.19 +/- 0.04 versus 1.66 +/- 0.09, p = 0.001). CONCLUSIONS: Although arterial composite Y graft improved MBF at rest, it was not as effective as independent grafts for improving coronary flow reserve soon after coronary artery bypass grafting.

Impact of left atrial volume reduction concomitant with atrial fibrillation surgery on left atrial geometry and mechanical function.

OBJECTIVE: Left atrial geometry and mechanical functions exert a profound effect on left ventricular filling and overall cardiovascular performance. We sought to investigate the perioperative factors that influence left atrial geometry and mechanical functions after the Maze procedure in patients with refractory atrial fibrillation and left atrial enlargement. METHODS: Seventy-four patients with atrial fibrillation and left atrial enlargement (diameter > or = 60 mm) underwent the Maze procedure in association with mitral valve surgery. The maximum left atrial volume and left atrial mechanical functions (booster pump, reservoir, and conduit function [%]) were calculated from the left atrial volume-cardiac cycle curves obtained by magnetic resonance imaging. A stepwise multiple regression analysis was performed to determine the independent variables that influenced the postoperative left atrial geometry and function. RESULTS: The multivariate analysis showed that left atrial reduction surgery concomitant with the Maze procedure and the postoperative maintenance of sinus rhythm were predominant independent variables for postoperative left atrial geometry and mechanical functions. Among the 58 patients who recovered sinus rhythm, the postoperative left atrial geometry and function were compared between patients with (VR group) and without (control group) left atrial volume reduction. At a mean follow-up period of 13.8 months, sinus rhythm recovery rate was better (85% vs 68%, P < .05) in the VR group and maximum left atrial volume was less (116 +/- 25 mL vs 287 +/- 73 mL, P < .001) than in the control group. The maximum left atrial volume reduced with time only in the VR group (reverse remodeling). Postoperative booster pump and reservoir function in the VR group were better than in the control group (25% +/- 6% vs 11% +/- 4% and 34% +/- 7% vs 16% +/- 4%, respectively, P < .001), whereas the conduit function in the VR group was lower than in the control group, indicating that the improvement of the booster pump and reservoir function compensated for the conduit function to left ventricular filling. CONCLUSION: Left atrial reduction concomitant with the Maze procedure helped restore both contraction (booster pump) and compliance (reservoir) of the left atrium and facilitated left atrial reverse remolding. Left atrial volume reduction and postoperative maintenance of sinus rhythm may be desirable in patients with refractory AF and left atrial enlargement.

Estimation of global and regional cardiac function using 64-slice computed tomography: a comparison study with echocardiography, gated-SPECT and cardiovascular magnetic resonance.

BACKGROUND: Sixty-four-slice multidetector spiral computed tomography (CT) has improved temporal resolution and reduced acquisition time. We aimed to evaluate the functional analysis using 64-slice CT comparing with echocardiography, electrocardiographically gated single-photon emission tomography (SPECT) and cardiovascular magnetic resonance (CMR). METHODS: Six-three patients (77.4+/-18.6 bpm) underwent 64-slice CT and CMR (echocardiography in 55; SPECT in 33) within 2 weeks were retrospectively reviewed. The left ventricular volumetric data from different methods were compared with CMR. Regional wall motion was compared between CT and CMR in a 17-segment and 4-point system (1=normal to 4=akinesis/dyskinesis). RESULTS: Ejection fraction (EF), end-diastolic volume (EDV) and end-systolic volume (ESV) by CT agreed well with CMR (bias+/-SD, -0.22%+/-4.18, r=0.97;-0.59 mL+/-15.21, r=0.98; 1.09 mL+/-10.61, r=0.99) over a wide range of left ventricular (LV) function (EF 18-76% by CMR). Our results also showed good correlation of EF measured by CT and echocardiography (r=0.87) or SPECT (r=0.91, all P<0.0001); however, standard deviation of EF difference between CT and CMR was significantly less than echocardiography or SPECT (P<0.005). For regional wall motion, an exact agreement of 97% (kappa=0.91) was found between CT and CMR. CONCLUSION: Sixty-four-slice CT agreed well with CMR in LV function assessment, and had a superior accuracy than echocardiography and SPECT on EF estimation. Sixty-four-slice CT is considered a clinically acceptable and robust method to evaluate LV function.

Complementary appearance of glucose and lipid metabolism in cardiac sarcoidosis.

Sarcoidosis is a non-caseating granulomatous systemic disease of unknown pathogenesis, and cardiac involvement is the most important prognostic factor. We have evaluated the value of the combined study of F-18 fluoro-2-deoxyglucose positron emission tomography and iodine-123 labeled 15-(p-iodophenyl)-3R,S-methylpentadecanoic acid single-photon emission tomography for the assessment of cardiac involvement of sarcoidosis, by comparing the findings with gadolinium magnetic resonance in a patient with histologically-proven cardiac sarcoidosis.

Structural and functional assessment of arrhythmogenic right ventricular dysplasia/cardiomyopathy by multi-slice computed tomography: comparison with cardiovascular magnetic resonance.

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an uncommon inheritable cardiomyopathy involving predominant right ventricle with progressive fibrofatty tissue replacement. An integrated assessment of electrical, functional and anatomic abnormalities, in addition to personal and family history would be used to diagnose this disease entity. We present the case of a 69-year-old man with a history of sustained ventricular tachycardia. Fatty infiltration and regional wall motion abnormalities over biventricular myocardium were clearly demonstrated by cardiac 64-slice computed tomography (CT), as consistent with magnetic resonance imaging. Thus, multi-slice CT may have a significant role in the assessment and follow-up of patients with ARVD/C by providing excellent structural, functional assessment and tissue characterization.

Identification of lipomatous metaplasia in old infarcted myocardium by cardiovascular magnetic resonance and computed tomography.

Lipomatous metaplasia of myocardium after myocardial infarction (MI) is less reported, and the exact prevalence and clinical implications of this phenomenon are unclear. A case of lipomatous metaplasia after MI evaluated with cardiovascular magnetic resonance (CMR) and computed tomography (CT) is presented. The presence of lipomatous metaplasia could not be easily differentiated from scar simply by the delayed-enhanced images. Loss of signal on TrueFISP cine MRI can be a hint. A pre-contrast T1-weighted image with or without frequency-selective fat suppression is useful in order to verify the existence of lipomatous metaplasia on CMR.