Multi-Modality Imaging in Vasculitis.

Systemic vasculitides are a rare and complex group of diseases that can affect multiple organ systems. Clinically, presentation may be vague and non-specific and as such, diagnosis and subsequent management are challenging. These entities are typically classified by the size of vessel involved, including large-vessel vasculitis (giant cell arteritis, Takayasu's arteritis, and clinically isolated aortitis), medium-vessel vasculitis (including polyarteritis nodosa and Kawasaki disease), and small-vessel vasculitis (granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis). There are also other systemic vasculitides that do not fit in to these categories, such as Behcet's disease, Cogan syndrome, and IgG4-related disease. Advances in medical imaging modalities have revolutionized the approach to diagnosis of these diseases. Specifically, color Doppler ultrasound, computed tomography and angiography, magnetic resonance imaging, positron emission tomography, or invasive catheterization as indicated have become fundamental in the work up of any patient with suspected systemic or localized vasculitis. This review presents the key diagnostic imaging modalities and their clinical utility in the evaluation of systemic vasculitis.

Comparison of echocardiographic parameters with cardiac magnetic resonance imaging in the assessment of right ventricular function.

INTRODUCTION: The right ventricle (RV) strain measured by speckle tracking (RVS) is an echocardiographic parameter used to assess RV function. We compared RVS to RV fractional area change (FAC%), tricuspid annular plane systolic excursion (TAPSE) and Doppler tissue imaging-derived peak systolic velocity (S') in the assessment of right ventricular (RV) systolic function measured using cardiac magnetic resonance imaging (MRI). METHODS: We enrolled consecutive patients who underwent cardiac MRI between Jan 2012 and Dec 2017 and a transthoracic echocardiogram (TTE) within 1 month of the MRI with no interval event. Baseline clinical characteristics and MRI parameters were extracted from chart review. Echocardiographic parameters were measured prospectively. TTE parameters including RVS, TAPSE, S', and FAC% were tested for accuracy to identify impaired RV EF (EF < 45% & <30%) using receiver operator curves. RESULTS: The study cohort included 500 patients with mean age 55 years ± 18 and peak tricuspid regurgitation velocity 2.7 ± 1.4 m/s. The area under ROC for RVS was 0.69 (95% CI 0.63-0.75) and 0.78 (95% CI 0.70-0.88) to predict RVEF < 45% & RVEF < 30%, respectively. The RV FAC% had second highest accuracy of predicting RVEF among all the TTE parameters tested in study. CONCLUSION: Right ventricular strain is the most accurate echocardiographic method to detect impaired right ventricular systolic function when using MRI as the gold standard.

Hepatocellular integrity during sevoflurane anesthesia with induced hypotension.

The effect of sevoflurane anesthesia with or without induced hypotension on hepatocellular integrity was studied. Forty adult consented patients scheduled for various urological procedures were allocated randomly to either NTG group (nitroglycerin-induced hypotension) or a control group of twenty patients each. Anesthesia was induced and maintained by fentanyl, sevoflurane & vecuronium in both groups. In NTG group, nitro-glycerin infusion was adjusted to maintain mean arterial pressure (MAP) of 50-65 mm Hg. Specific and sensitive hepatic biomarkers; alpha (alpha) and pi (pi) glutathione S-transferases (GST) and hyaluronic acid (HA), also traditional liver enzymes; aspartate (AST) and alanine (ALT) aminotransferases were measured at: TO (pre-induction), T1, T2, T3 (15, 30 & 60 minutes after MAP stabilization respectively) and T4 (24 hours after anesthesia end). Plasma alpha-GST significantly increased at T3 in control group (p < 0.05) and in NTG group (p < 0.01) compared to TO in same group. In NTG group, hyaluronic acid con-centrations was significantly increased at T1, T2 (p < 0.05) and T3 (p < 0.01) from T0. Compared to control group, alpha- GST & HA concentrations showed significant increases in NTG group at T3 with p < 0.05 then returned back to normal range at T4. But, pi-GST, AST and ALT showed no significant changes throughout the study in both groups.