Hybrid solid-state SPECT/CT left atrial innervation imaging for identification of left atrial ganglionated plexi: Technique and validation in patients with atrial fibrillation.

BACKGROUND: Ablating left atrial (LA) ganglionated plexi (GP), identified invasively by high-frequency stimulation (HFS) during pulmonary vein isolation (PVI), may reduce atrial fibrillation (AF) recurrence. 123I-metaiodobenzylguanidine (123I-mIBG) solid-state SPECT LA innervation imaging (LAII) has the spatial resolution to detect LAGP non-invasively but this has never been demonstrated in clinical practice. METHODS: 20 prospective patients with paroxysmal AF scheduled for PVI underwent 123I-mIBG LAII. High-resolution tomograms, reconstructed where possible using cardiorespiratory gating, were co-registered with pre-PVI cardiac CT. Location and reader confidence (1 [low] to 3 [high]) in discrete 123I-mIBG LA uptake areas (DUAs) were recorded and correlated with HFS. RESULTS: A total of 73 DUAs were identified, of which 59 (81%) were HFS positive (HFS +). HFS + likelihood increased with reader confidence (92% [score 3]). 64% of HFS-negative DUAs occurred over the lateral and inferior LA. Cardiorespiratory gating reduced the number of DUAs per patient (4 vs 7, P = .001) but improved: HFS + predictive value (76% vs 49%); reader confidence (2 vs 1, P = .02); and inter-observer, intra-observer, and inter-study agreement (κ = 0.84 vs 0.68; 0.82 vs 0.74; 0.64 vs 0.53 respectively). CONCLUSIONS: 123I-mIBG SPECT/CT LAII accurately and reproducibly identifies GPs verified by HFS, particularly when reconstructed with cardiorespiratory gating.

The safe practice of CT coronary angiography in adult patients in UK imaging departments.

Computed tomography coronary angiography is increasingly used in imaging departments in the investigation of patients with chest pain and suspected coronary artery disease. Due to the routine use of heart rate controlling medication and the potential for very high radiation doses during these scans, there is a need for guidance on best practice for departments performing this examination, so the patient can be assured of a good quality scan and outcome in a safe environment. This article is a summary of the document on 'Standards of practice of computed tomography coronary angiography (CTCA) in adult patients' published by the Royal College of Radiologists (RCR) in December 2014.

Image reconstruction: Part 1 - understanding filtered back projection, noise and image acquisition.

Image reconstruction is an increasingly complex field in CT. Iterative Reconstruction (IR) is at present an adjunct to standard Filtered Back Projection (FBP) reconstruction, but could become a replacement for it. Due to its potential for scanning at lower radiation doses, IR has received a lot of attention in the medical literature and all vendors offer commercial solutions. Its use in cardiovascular CT has been driven in part due to concerns about radiation dose and image quality. This paper is the first manuscript of a pair. It aims to review the basic principles of CT scanning, to describe image reconstruction using Filtered Back Projection, and to identify the physical processes that contribute to image noise which IR may be able to compensate for. The aim is to enable cardiovascular imagers to understand what happens to the raw data prior to the reconstruction process so they may have a better appreciation of the strengths and weaknesses of the various reconstruction techniques available. The second manuscript of this pair will discuss the various vendor permutations of IR in more detail, including the most recent machine learning based offerings, and critically appraise the current clinical research available on the various IR techniques used in cardiovascular CT.

Streptococcus intermedius masquerading as fungal infective endocarditis.

Infective endocarditis remains an important clinical entity with an incidence of 1.7­10/100 000 person years (Marks et al, 2015). Despite improvements in health care, it still results in significant morbidity and in-hospital mortality approaches 16% (Marks et al, 2015). There are likely multiple causes including late diagnosis, poor response to therapy and the challenges in identifying the causative pathogen and instigating the correct treatment. This is particularly the case for causative organisms that are difficult to culture or identify using routine laboratory methods. An example of this is Streptococcus intermedius, which belongs to the S. milleri group along with other two species (S. anginosus group and S. constellatus). It is a commensal organism that can turn into an opportunistic pathogen (Whiley et al, 1992). It is a rare cause of infective endocarditis and may initially present with abscesses in the liver, spleen or brain which may mimic fungal infection (Woo et al, 2004; Rashid et al, 2007; Tran et al, 2008). Difficulty in identifying this organism has led to the development of molecular testing to aid diagnosis. To the authors' knowledge, there are very few cases in the literature of infective endocarditis caused by S. intermedius that have been confirmed using 16S polymerase chain reaction (Woo et al, 2004). This article describes a patient presenting with S. intermedius infective endocarditis which was diagnosed using this method.

Image reconstruction in cardiovascular CT: Part 2 - Iterative reconstruction; potential and pitfalls.

The use of IR in CT previously has been prohibitively complicated and time consuming, however improvements in computer processing power now make it possible on almost all CT scanners. Due to its potential to allow scanning at lower doses, IR has received a lot of attention in the medical literature and has become a successful commercial product. Its use in cardiovascular CT has been driven in part due to concerns about radiation dose and image quality. This manuscript discusses the various vendor permutations of iterative reconstruction (IR) in detail and critically appraises the current clinical research available on the various IR techniques used in cardiovascular CT.

Synthesis and alpha 2-adrenoceptor antagonist activity of some disulfonamidobenzoquinolizines.

A series of disulfonamidobenzo[a]quinolizines were synthesized and evaluated for their alpha 2- and alpha 1-adrenoceptor antagonist activity on the rat vas deferens and anococcygeus muscle, respectively. N-((2 beta,11b alpha)-1,3,4,6,7,11b-Hexahydro-2H-benzo[a]quinolizin-2-yl)-N- [2-[(methylsulfonyl)amino]ethyl]methanesulfonamide (4) and its N-[2-[(methylsulfonyl)amino]ethyl]ethanesulfonamide (22), N-[2-[(ethylsulfonyl)amino]ethyl]ethanesulfonamide (27), and N-[2-[(methylsulfonyl)amino]ethyl]-4-methylbenzenesulfonamide (30) analogues showed 400-fold or greater selectivity in favor of alpha 2- over alpha 1-adrenoceptor blockade.

Effects of isoprenaline and pilocarpine on salivary glands as assessed by gravimetric and image analysis techniques.

Pigs were given 6 daily injections of isoprenaline or pilocarpine. At necropsy the parotid, submaxillary and sublingual salivary glands were removed and weighed. Histological sections were prepared from several regions of each gland and the cross-sectional area of their acini was measured in treated and control animals by means of a Quantimet Image Analysis System. Both isoprenaline and pilocarpine produced a significant increase in the weight of the parotid and submaxillary glands, which was accompanied by an increase in acinar area. There was no change in the weight of the sublingual gland with either drug, but isoprenaline did induce an increase in the area of sublingual acini. A comparison is made of the changes in weight and structure of the salivary glands as shown by these methods.

Quantitative studies on the development of the bronchi and bronchial glands of the pig from birth to maturity.

Cross-sectional areas of bronchi and bronchial glands of pigs aged from 1 day to 10 months were measured using image analysis. Growth of the bronchial glands was slow for the first month of life, reached a maximum between 1 and 3 months, and slowed again after 5 months. Mucous gland sizes fell into two groups, one included the apical, cardiac and accessory lobes, the other the diaphragmatic lobes. From birth to maturity the percentage increase in mucous gland area of all lobes was very similar. For the anterior lobes, mucous glands and bronchial lumina grew in direct proportion to each other. Up to 1 month of age the bronchial lumina of the diaphragmatic lobes grew but the glands did not. Later, glands and lumina grew in direct proportion. From birth to maturity the percentage increase in bronchial cross-sectional area was similar for all lobes.