Cardiac MR Imaging in the Evaluation of Rheumatic Valvular Heart Diseases.

INTRODUCTION: Rheumatic heart disease is the most common cause of valvular heart disease throughout the world. Echocardiography is the dominant imaging investigation in the assessment of cardiac valvular disease and the role of Magnetic Resonance Imaging (MRI) is so far limited. However, due to rapid improvements in the cardiac MRI technology in past few years, this non invasive technique is gaining interest in the examination of cardiac valves. AIM: Our study was undertaken to define the role of MRI in the evaluation of Rheumatic valvular heart disease and to compare the role of MRI with transthoracic echocardiography with regard to quantity of stenosis and volume regurgitation. MATERIALS AND METHODS: ECG gated Cardiac MRI was performed with a 1.5-Tesla system (MAGNETOM SYMPHONY- Model 2005) using basic cardiac software (Argus viewer) by a phased-array multicoil on 50 subjects who were known cases of Rheumatic valvular heart disease. A chest radiograph and echocardiography were done in all patients before MR examination. Informed consent was taken from all patients. RESULTS: Mitral stenosis either as an isolated valvular abnormality or in combination with other valvular abnormalities constituted the major bulk of Rheumatic valvular heart disease in our study population. The average ejection fraction by ECHO is 64.94±7.11 and by MRI 67.52±7.84. The average mitral valve area by ECHO is 1.79±0.43 cm(2) and by MRI 1.82±0.47 cm(2). The average aortic valve area by ECHO is 1.10±0.21 cm(2) and by MRI 1.12±0.25 cm(2). The Coefficient of Correlation (r) is 0.82 for ejection fraction, 0.98 for mitral valve area and 0.92 for aortic valve area which means a strong positive association between the results by ECHO and MRI. In all instances, the p-value is <0.00001, suggesting that the test is highly significant. CONCLUSION: In our study echocardiography was found to be the gold standard for the diagnosis of Rheumatic valvular heart disease and the role of MRI remained only complimentary to Echocardiography. However with advanced cardiac software, more advanced techniques, and faster imaging sequences, MRI may become a valuable procedure for investigation and follow-up of patients with valvular heart disease.

Pressure injectors for radiologists: A review and what is new.

Pressure Injectors are used routinely in diagnostic and interventional radiology. Advances in medical science and technology have made it is imperative for both diagnostic as well as interventional radiologists to have a thorough understanding of the various aspects of pressure injectors. Further, as many radiologists may not be fully conversant with injections into ports, central lines and PICCs, it is important to familiarize oneself with the same. It is also important to follow stringent operating protocols during the use of pressure injectors to prevent complications such as contrast extravastion, sepsis and air embolism. This article aims to update existing knowledge base in this respect.

Imaging and interventions in idiopathic intracranial hypertension: A pictorial essay.

Intracranial hypertension is a syndrome of elevated intracranial pressure that can be primary or secondary. The primary form, now termed idiopathic intracranial hypertension (IIH), was in the past a disease of exclusion and imaging played a limited role of excluding organic causes of raised intracranial pressure. However imaging markers have been described with patients with IIH at the orbit, sella and cerebral venous system. We wish to reiterate the characteristic imaging features of this poorly understood disease and also emphasise that stenting of the transverse sinus in select cases of IIH is an efficacious option.

Aneurysmal bone cyst of the calcaneum: an expansile locally destructive lesion.

Aneurysmal bone cyst (ABC) is a benign but locally destructive lesion affection of which in the calcaneum has rarely been reported in the literature. We report an unusual case of ABC of the calcaneum in a 17-year-old-male, who presented with painful ankle swelling with difficulty in walking. Radiology revealed benign cystic calcaneal lesion, without any evidence of fracture. Biopsy was characterized by formation of osteoid along with the presence of ecstatic blood-filled channels, consistent with ABC. However, this being an uncommon site for ABC, histopathology needs to be used to differentiate it from other benign and malignant entities, and a definitive diagnosis warrants clinical and radiological correlation. Most of the ABCs require surgical curetting and bone engraftment of the surgical defect.

Correlation of high sensitivity C-reactive protein and calcific aortic valve disease.

OBJECTIVE: To determine whether a difference exists in the levels of high sensitivity C-reactive protein (Hs-CRP) in patients with and without calcific aortic valve disease (CAVD). PATIENTS AND METHODS: This cross-sectional study consisted of 110 patients who had undergone echocardiographic examination from January 2005 to February 2006 at our institution. Information on demographic variables, coronary risk factors, and medications was obtained. More than 200 patients were excluded on the basis of any evidence of infection, active connective tissue disorder, rheumatoid arthritis, recent episodes of bleeding, acute fractures, bowel obstruction, or acute coronary syndrome or use of corticosteroids, nonsteroidal anti-inflammatory drugs, or antibiotic treatment. The values of Hs-CRP, total cholesterol, and erythrocyte sedimentation rate were included. RESULTS: Of the 110 study subjects, 38 patients had aortic sclerosis, 36 patients had aortic stenosis, and 36 were controls. The mean Hs-CRP level in the control group was significantly lower (4.84 +/- 6.9 mg/L) compared with the levels in the groups with aortic sclerosis (14.9 +/- 19.6 mg/L) and aortic stenosis (13.6 +/- 17.3 mg/L) (P = -.01). No statistically significant difference was found between the patients in the aortic sclerosis and aortic stenosis groups. Among the patients with aortic stenosis, no significant correlation existed between Hs-CRP levels and aortic stenosis severity. CONCLUSIONS: The Hs-CRP seems to have a significant association with CAVD during its early stage. The study findings did not have sufficient evidence to suggest the use of Hs-CRP as a marker of progression of calcific aortic stenosis. The Hs-CRP may have a role in identifying patients in the early stages of CAVD and in whom medical treatment may be beneficial to halt the progression to irreversible aortic valvular calcification and stenosis.