Quantitative CT at Follow-Up of COVID-19 Pneumonia: Relationship with Pulmonary Function Tests.

BACKGROUND: The role of quantitative chest computed tomography (CT) is controversial in the follow-up of patients with COVID-19 pneumonia. The aim of this study was to test during the follow-up of COVID-19 pneumonia the association between pulmonary function tests (PFTs) and quantitative parameters extrapolated from follow-up (FU) CT scans performed at least 6 months after COVID-19 onset. METHODS: The study included patients older than 18 years old, admitted to the emergency department of our institution between 29 February 2020 and 31 December 2020, with a diagnosis of COVID-19 pneumonia, who underwent chest CT at admission and FU CT at least 6 months later; PFTs were performed within 6 months of FU CT. At FU CT, quantitative parameters of well-aerated lung and pneumonia extent were identified both visually and by software using CT density thresholds. The association between PFTs and quantitative parameters was tested by the calculation of the Spearman's coefficient of rank correlation (rho). RESULTS: The study included 40 patients (38% females; median age 63 years old, IQR, 56-71 years old). A significant correlation was identified between low attenuation areas% (%LAAs) <950 Hounsfield units (HU) and both forced expiratory volume in 1s/forced vital capacity (FEV1/FVC) ratio (rho -0.410, 95% CIs -0.639--0.112, p = 0.008) and %DLCO (rho -0.426, 95% CIs -0.678--0.084, p = 0.017). The remaining quantitative parameters failed to demonstrate a significant association with PFTs (p > 0.05). CONCLUSIONS: At follow-up, CT scans performed at least 6 months after COVID-19 pneumonia onset showed %LAAs that were inversely associated with %DLCO and could be considered a marker of irreversible lung damage.

Hypovolemic shock due to Wunderlich syndrome (spontaneous renal haemorrhage): a case report and literature review.

Wunderlich syndrome (WS) or spontaneous renal haemorrhage is a rare and life-threatening condition often leading to haemorrhagic shock. WS is characterized by an acute onset of non-traumatic subcapsular and perirenal haematoma formation due to several causes, including neoplasms, cystic rupture, vasculitis, coagulopathies, and infections. The classical presentation includes acute flank or abdominal pain, a palpable flank mass and hypovolemic shock (Lenk's triad). Nausea, vomiting, fever, and haematuria can also be present. Computed tomography angiography is mandatory to localize the source of haemorrhage. Super-selective embolization can be performed to stop bleeding, while surgery is reserved to haemodynamic unstable patients and neoplastic cases. We describe a case of WS in a 79-year-old male patient, who rapidly developed hypovolemic shock requiring urgent nephrectomy.

Are Interstitial Lung Abnormalities a Prognostic Factor of Worse Outcome in COVID-19 Pneumonia?

PURPOSE: To assess the association between interstitial lung abnormalities (ILAs) and worse outcome in patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19)-related pneumonia. MATERIALS AND METHODS: The study included patients older than 18 years, who were admitted at the emergency department between February 29 and April 30, 2020 with findings of COVID-19 pneumonia at chest computed tomography (CT), with positive reverse-transcription polymerase chain reaction nasal-pharyngeal swab for SARS-CoV-2, and with the availability of prepandemic chest CT. Prepandemic CTs were reviewed for the presence of ILAs, categorized as fibrotic in cases with associated architectural distortion, bronchiectasis, or honeycombing. Worse outcome was defined as intensive care unit (ICU) admission or death. Cox proportional hazards regression analysis was used to test the association between ICU admission/death and preexisting ILAs. RESULTS: The study included 147 patients (median age 73 y old; 95% CIs: 71-76-y old; 29% females). On prepandemic CTs, ILA were identified in 33/147 (22%) of the patients, 63% of which were fibrotic ILAs. Fibrotic ILAs were associated with higher risk of ICU admission or death in patients with COVID-19 pneumonia (hazard ratios: 2.73, 95% CIs: 1.50-4.97, P =0.001). CONCLUSIONS: In patients affected by COVID-19 pneumonia, preexisting fibrotic ILAs were an independent predictor of worse prognosis, with a 2.7 times increased risk of ICU admission or death. Chest CT scans obtained before the diagnosis of COVID-19 pneumonia should be carefully reviewed for the presence and characterization of ILAs.

Software-Based Assessment of Well-Aerated Lung at CT for Quantification of Predicted Pulmonary Function in Resected NSCLC.

Background: To test the agreement between postoperative pulmonary function tests 12 months after surgery (mpo-PFTs) for non-small cell lung cancer (NSCLC) and predicted lung function based on the quantification of well-aerated lung (WAL) at staging CT (sCT). Methods: We included patients with NSCLC who underwent lobectomy or segmentectomy without a history of thoracic radiotherapy or chemotherapy treatment with the availability of PFTs at 12 months follow-up. Postoperative predictive (ppo) lung function was calculated using the resected lobe WAL (the lung volume between −950 and −750 HU) at sCT. The Spearman correlation coefficient (rho) and intraclass correlation coefficient (ICC) were used to the test the agreement between WAL ppo-PFTs and mpo-PFTs. Results: the study included 40 patients (68 years-old, IQR 62−74 years-old; 26/40, 65% males). The WAL ppo-forced expiratory volume in 1 s (FEV1) and the ppo-diffusing capacity of the lung for carbon monoxide (%DLCO) were significantly correlated with corresponding mpo-PFTs (rho = 0.842 and 0.717 respectively; p < 0.001). The agreement with the corresponding mpo-PFTs of WAL ppo-FEV1 was excellent (ICC 0.904), while it was good (ICC 0.770) for WAL ppo-%DLCO. Conclusions: WAL ppo-FEV1 and WAL ppo-%DLCO at sCT showed, respectively, excellent and good agreement with corresponding mpo-PFTs measured 12 months after surgery for NSCLC. WAL is an easy parameter obtained by staging CT that can be used to estimate post-resection lung function for patients with borderline pulmonary function undergoing lung surgery.

Thoracic duct leakage in a patient with Type B-Non-Hodgkin lymphoma treated with transvenous retrograde access embolization: a case report.

Thoracic duct (TD) is the largest lymphatic vessel in the body and drains the lymph at the junction between the left subclavian and jugular veins. Chylothorax (CTX) represents an accumulation of lymphatic fluid in the pleural space. We present a case of a 65 years-old man with an histologically diagnosed mediastinal type B non-Hodgkin Lymphoma, treated with chemo-immunotherapy. CT scan during follow up showed significant left side pleural effusion, amounting to 2.8 litres after drainage. Conservative treatment with low fat parenteral nutrition was started without reduction of drainage output, then lymphangiography (LP) with Lipiodol was performed demonstrating a leak in the distal TD. CTX increased in the following days, and a further LP was performed. Using transvenous retrograde access we catheterized TD at the left subclavian jugular veins using a microcatheter. The leak was treated with multiple conventional and controlled delivery microcroils and cyanoacrylate, obtaining complete embolization without residual leak.

Role of visceral pleural invasion and tumor sizing at CT of resected NSCLC in clinical-radiological and pathological T agreement.

OBJECTIVE: To describe in non-small cell lung cancer (NSCLC) the impact of visceral pleural invasion (VPI) and of tumor sizing assessed at computed tomography (CT) on the agreement between clinical-radiological and pathological T staging and its prognostic value. METHODS: Patients affected by NSCLC treated by surgery in the period from January 2017 to September 2020 were retrospectively evaluated. Exclusion criteria were: (1) baseline CT not performed in our hospital; (2) failure of software segmentation at CT of the primary lesion. Clinical-radiological T (cT) was assessed at baseline CT, evaluating in particular T size by semi-automatic tool and VPI (cVPI) visually. Pathological T (pT) and VPI (pVPI) were recorded by pathological report and obtained after formalin-fixation and eventual elastic stain on surgical specimen. The agreement between cT and pT was evaluated by calculating the weighted kappa by Cohen (κw); the association between progression free survival (PFS) with both cT and pT was assessed by the Cox regression analysis. RESULTS: The study included 84 NSCLC in 82 patients (median age 71 years, IQR 63-76 years; females 22/82, 27%). The agreement between cT and pT was poor (κw 0.302, 95%CI 0.158-0.447). The main causes of disagreement were CT oversizing (21%) and false positive cVPI (29%). A significant association was found between PFS and pT2-T3 (HR 2.75, 95%CI 1.21-6.25, p=0.015) but not with cT2-T3 (not retained in the model). CONCLUSIONS: False positive cVPI and oversizing at CT are causes of disagreement between cT and pT in around one-third of resected NSCLC. PFS was significantly associated with pT but not with cT.

Computed Tomography Texture Analysis of Carotid Plaque as Predictor of Unfavorable Outcome after Carotid Artery Stenting: A Preliminary Study.

Novel biomarkers are advocated to manage carotid plaques. Therefore, we aimed to test the association between textural features of carotid plaque at computed tomography angiography (CTA) and unfavorable outcome after carotid artery stenting (CAS). Between January 2010 and January 2021, were selected 172 patients (median age, 77 years; 112/172, 65% men) who underwent CAS with CTA of the supra-aortic vessels performed within prior 6 months. Standard descriptors of the density histogram were derived by open-source software automated analysis obtained by CTA plaque segmentation. Multiple logistic regression analysis, receiver operating characteristic (ROC) curve analysis and the area under the ROC (AUC) were used to identify potential prognostic variables and to assess the model performance for predicting unfavorable outcome (periprocedural death or myocardial infarction and any ipsilateral acute neurological event). Unfavorable outcome occurred in 17/172 (10%) patients (median age, 79 years; 12/17, 70% men). Kurtosis was an independent predictor of unfavorable outcome (odds ratio, 0.79; confidence interval, 0.65-0.97; p = 0.029). The predictive model for unfavorable outcome including CTA textural features outperformed the model without textural features (AUC 0.789 vs. 0.695, p = 0.004). In patients with stenotic carotid plaque, kurtosis derived by CTA density histogram analysis is an independent predictor of unfavorable outcome after CAS.

Operator-Related Errors and Pitfalls in Dual Energy X-Ray Absorptiometry: How to Recognize and Avoid Them.

Dual-energy X-ray absorptiometry (DXA) is the most common modality for quantitative measurements of bone mineral density. Nevertheless, errors related to this exam are still very common, and may significantly impact on the final diagnosis and therapy. Operator-related errors may occur during each DXA step and can be related to wrong patient positioning, error in the acquisition process or in the scan analysis. The aim of this review is to provide a practical guide on how to recognize such errors in spine and hip DXA scan and how to avoid them, also presenting some of the most common artifacts encountered in clinical practice.

Qualitative and quantitative chest CT parameters as predictors of specific mortality in COVID-19 patients.

PURPOSE: To test the association between death and both qualitative and quantitative CT parameters obtained visually and by software in coronavirus disease (COVID-19) early outbreak. METHODS: The study analyzed retrospectively patients underwent chest CT at hospital admission for COVID-19 pneumonia suspicion, between February 21 and March 6, 2020. CT was performed in case of hypoxemia or moderate-to-severe dyspnea. CT scans were analyzed for quantitative and qualitative features obtained visually and by software. Cox proportional hazards regression analysis examined the association between variables and overall survival (OS). Three models were built for stratification of mortality risk: clinical, clinical/visual CT evaluation, and clinical/software-based CT assessment. AUC for each model was used to assess performance in predicting death. RESULTS: The study included 248 patients (70% males, median age 68 years). Death occurred in 78/248 (32%) patients. Visual pneumonia extent > 40% (HR 2.15, 95% CI 1.2-3.85, P = 0.01), %high attenuation area - 700 HU > 35% (HR 2.17, 95% CI 1.2-3.94, P = 0.01), exudative consolidations (HR 2.85-2.93, 95% CI 1.61-5.05/1.66-5.16, P < 0.001), visual CAC score > 1 (HR 2.76-3.32, 95% CI 1.4-5.45/1.71-6.46, P < 0.01/P < 0.001), and CT classified as COVID-19 and other disease (HR 1.92-2.03, 95% CI 1.01-3.67/1.06-3.9, P = 0.04/P = 0.03) were significantly associated with shorter OS. Models including CT parameters (AUC 0.911-0.913, 95% CI 0.873-0.95/0.875-0.952) were better predictors of death as compared to clinical model (AUC 0.869, 95% CI 0.816-0.922; P = 0.04 for both models). CONCLUSIONS: In COVID-19 patients, qualitative and quantitative chest CT parameters obtained visually or by software are predictors of mortality. Predictive models including CT metrics were better predictors of death in comparison to clinical model.

Comparison of admission chest computed tomography and lung ultrasound performance for diagnosis of COVID-19 pneumonia in populations with different disease prevalence.

PURPOSE: Chest computed tomography (CT) is considered a reliable imaging tool for COVID-19 pneumonia diagnosis, while lung ultrasound (LUS) has emerged as a potential alternative to characterize lung involvement. The aim of the study was to compare diagnostic performance of admission chest CT and LUS for the diagnosis of COVID-19. METHODS: We included patients admitted to emergency department between February 21-March 6, 2020 (high prevalence group, HP) and between March 30-April 13, 2020 (moderate prevalence group, MP) undergoing LUS and chest CT within 12 h. Chest CT was considered positive in case of "indeterminate"/"typical" pattern for COVID-19 by RSNA classification system. At LUS, thickened pleural line with ≥ three B-lines at least in one zone of the 12 explored was considered positive. Sensitivity, specificity, PPV, NPV, and AUC were calculated for CT and LUS against real-time reverse transcriptase polymerase chain reaction (RT-PCR) and serology as reference standard. RESULTS: The study included 486 patients (males 61 %; median age, 70 years): 247 patients in HP (COVID-19 prevalence 94 %) and 239 patients in MP (COVID-19 prevalence 45 %). In HP and MP respectively, sensitivity, specificity, PPV, and NPV were 90-95 %, 43-69 %, 96-72 %, 20-95 % for CT and 94-93 %, 7-31 %, 94-52 %, 7-83 % for LUS. CT demonstrated better performance than LUS in diagnosis of COVID-19, both in HP (AUC 0.75 vs 0.51; P < 0.001) and MP (AUC 0.85 vs 0.62; P < 0.001). CONCLUSIONS: Admission chest CT shows better performance than LUS for COVID-19 diagnosis, at varying disease prevalence. LUS is highly sensitive, but not specific for COVID-19.

Well-aerated Lung on Admitting Chest CT to Predict Adverse Outcome in COVID-19 Pneumonia.

Background CT of patients with severe acute respiratory syndrome coronavirus 2 disease depicts the extent of lung involvement in coronavirus disease 2019 (COVID-19) pneumonia. Purpose To determine the value of quantification of the well-aerated lung (WAL) obtained at admission chest CT to determine prognosis in patients with COVID-19 pneumonia. Materials and Methods Imaging of patients admitted at the emergency department between February 17 and March 10, 2020 who underwent chest CT were retrospectively analyzed. Patients with negative results of reverse-transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 at nasal-pharyngeal swabbing, negative chest CT findings, and incomplete clinical data were excluded. CT images were analyzed for quantification of WAL visually (%V-WAL), with open-source software (%S-WAL), and with absolute volume (VOL-WAL). Clinical parameters included patient characteristics, comorbidities, symptom type and duration, oxygen saturation, and laboratory values. Logistic regression was used to evaluate the relationship between clinical parameters and CT metrics versus patient outcome (intensive care unit [ICU] admission or death vs no ICU admission or death). The area under the receiver operating characteristic curve (AUC) was calculated to determine model performance. Results The study included 236 patients (59 of 123 [25%] were female; median age, 68 years). A %V-WAL less than 73% (odds ratio [OR], 5.4; 95% confidence interval [CI]: 2.7, 10.8; P < .001), %S-WAL less than 71% (OR, 3.8; 95% CI: 1.9, 7.5; P < .001), and VOL-WAL less than 2.9 L (OR, 2.6; 95% CI: 1.2, 5.8; P < .01) were predictors of ICU admission or death. In comparison with clinical models containing only clinical parameters (AUC = 0.83), all three quantitative models showed better diagnostic performance (AUC = 0.86 for all models). The models containing %V-WAL less than 73% and VOL-WAL less than 2.9 L were superior in terms of performance as compared with the models containing only clinical parameters (P = .04 for both models). Conclusion In patients with confirmed coronavirus disease 2019 pneumonia, visual or software quantification of the extent of CT lung abnormality were predictors of intensive care unit admission or death. © RSNA, 2020 Online supplemental material is available for this article.

Pulmonary Insufficiency: Advantage of Pulmonary Regurgitation Volume Versus Pulmonary Regurgitation Fraction in a Congenital Heart Disease Mixed Population.

OBJECTIVE: The objective of this study was to compare the use of pulmonary regurgitation volume (PRV) or indexed PRV (PRVi) with that of pulmonary regurgitation fraction (PRF) in the assessment of patients with pulmonary regurgitation (PR) undergoing cardiac magnetic resonance (CMR) imaging. MATERIALS AND METHODS: CMR of 176 patients with PR were retrospectively evaluated. Their right ventricular diastolic (end-diastolic volume index [EDVi]) and systolic (end-systolic volume index) volume indexes, stroke volume, and ejection fraction were obtained from cine CMR sequences, whereas phase-contrast flow sequences were analyzed to obtain PRV, PRVi, and PRF. Patients were divided into subgroups, according to underlying pathology and according to PR severity. Correlations between PRV or PRF and RV parameters were studied through Spearman ρ, both in the main group and subgroups. Follow-up examinations were analyzed, and correlations between PRV or PRF from the first CMR examination and volume data from the second were calculated. RESULTS: Tetralogy of Fallot was the main setting of PR (98/179). Overall, EDVi strongly correlates with PRV (ρ=0.592, P<0.001) than with PRF (ρ=0.522, P<0.001), and end-systolic volume index strongly correlates with PRV (ρ=0.454, P<0.001) and PRF (ρ=0.406, P <0.001). As regards subgroup analysis, in moderate or severe PR patients, EDVi strongly correlates (P=0.043) with PRV (ρ=0.499, P<0.001) than with PRF (ρ=0.317, P<0.001). Follow-up EDVi correlates with PRV (ρ=0.450, P=0.031), but not with PRF. CONCLUSIONS: Especially when assessing moderate to severe PR, PRV and PRVi may be better indicators of right ventricular dysfunction than PRF. Moreover, PRV may be a predictor of worsening RV dilation.

Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients' management.

BACKGROUND: Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair. MATERIAL AND METHODS: Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as "minor CT findings." The presence of abdominal guarding and/or abdominal pain was considered as "clinical signs." Reference standards included surgically proven BBMI and clinical follow-up. Association was evaluated by the chi-square test. A logistic regression model was used to estimate odds ratio (OR) and confidence intervals (CI). RESULTS: Thirty-four (4.1%) out of 831 patients who sustained blunt abdominal trauma had BBMI at CT. Twenty-one out of thirty-four patients (61.8%) underwent surgical repair; the remaining 13 were treated conservatively. Free fluid had a significant statistical association with surgery (p = 0.0044). The presence of three or more minor CT findings was statistically associated with surgery (OR = 8.1; 95% CI, 1.2-53.7). Abdominal guarding along with bowel wall discontinuity and extraluminal air had the highest positive predictive value (100 and 83.3%, respectively). CONCLUSION: In patients without solid organ injury (SOI), the presence of free fluid along with abdominal guarding and three or more "minor CT findings" is a significant predictor of early surgical repair. The association of bowel wall discontinuity with extraluminal air warrants exploratory laparotomy.

Blood-threshold CMR volume analysis of functional univentricular heart.

PURPOSE: To validate a blood-threshold (BT) segmentation software for cardiac magnetic resonance (CMR) cine images in patients with functional univentricular heart (FUH). MATERIALS AND METHODS: We evaluated retrospectively 44 FUH patients aged 25 ± 8 years (mean ± standard deviation). For each patient, the epicardial contour of the single ventricle was manually segmented on cine images by two readers and an automated BT algorithm was independently applied to calculate end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and cardiac mass (CM). Aortic flow analysis (AFA) was performed on through-plane images to obtain forward volumes and used as a benchmark. Reproducibility was tested in a subgroup of 24 randomly selected patients. Wilcoxon, Spearman, and Bland-Altman statistics were used. RESULTS: No significant difference was found between SV (median 57.7 ml; interquartile range 47.9-75.6) and aortic forward flow (57.4 ml; 48.9-80.4) (p = 0.123), with a high correlation (r = 0.789, p < 0.001). Intra-reader reproducibility was 86% for SV segmentation, and 96% for AFA. Inter-reader reproducibility was 85 and 96%, respectively. CONCLUSION: The BT segmentation provided an accurate and reproducible assessment of heart function in FUH patients.

1H- and 31P-myocardial magnetic resonance spectroscopy in non-obstructive hypertrophic cardiomyopathy patients and competitive athletes.

PURPOSE: The clinical differentiation between athlete's heart and mild forms of non-obstructive hypertrophic cardiomyopathy (HCM) is crucial. We hypothesized that differences do exist between the myocardial metabolism of patients with non-obstructive HCM and competitive athletes (CAs). Our aim was to evaluate myocardial metabolism with 31P-MRS and 1H-MRS in HCM patients and CAs. MATERIALS AND METHODS: After Ethics Committee approval, 15 CAs and 7 HCM patients were prospectively enrolled. They underwent a 1.5-T cardiac MR including electrocardiographically triggered cine images, single-voxel 1H-MRS and multivoxel 31P-MRS. 1H-MRS was performed after imaging using standard coil with the patient in the supine position; thereafter, 31P-MRS was performed using a dedicated coil, in the prone position. Data were reported as median and interquartile range. Mann-Whitney U test was used. RESULTS: In CAs, left ventricular mass index was 72 (66-83) g/m2, septal thickness 10 (10-11) mm, end diastolic volume index 95 (85-102) ml/m2, end systolic volume index 30 (28-32) ml/m2 and ejection fraction 68% (65-69%); in HCM patients, 81 (76-111) g/m2 (P = 0.052), 18 (15-21) mm (P = 0.003), 73 (58-76) ml/m2 (P = 0.029), 20 (16-34) ml/m2 (P = 0.274) and 68% (55-73%) (P = 1.000), respectively. At 1H-MRS, total lipids were 35 (0-183) arbitrary units (au) for CA and 763 (155-1994) au for HCM patients (P = 0.046). At 31P-MRS, PCr/γATP was 5 (4-6) au for CA and 4 (2-5) au for HCM patients (P = 0.230). Examination time was 20 min for imaging only, 5 min for 1H-MRS and 15 min for 31P-MRS. CONCLUSIONS: We observed a significant increase of myocardial lipids, but a preserved PCr/γATP ratio in the metabolism of HCM patients compared with competitive CAs.

Novel cardiac magnetic resonance biomarkers: native T1 and extracellular volume myocardial mapping.

Cardiac magnetic resonance (CMR) is a non-invasive diagnostic tool playing a key role in the assessment of cardiac morphology and function as well as in tissue characterization. Late gadolinium enhancement is a fundamental CMR technique for detecting focal or regional abnormalities such as scar tissue, replacement fibrosis, or inflammation using qualitative, semi-quantitative, or quantitative methods, but not allowing for evaluating the whole myocardium in the presence of diffuse disease. The novel T1 mapping approach permits a quantitative assessment of the entire myocardium providing a voxel-by-voxel map of native T1 relaxation time, obtained before the intravenous administration of gadolinium-based contrast material. Combining T1 data obtained before and after contrast injection, it is also possible to calculate the voxel-by-voxel extracellular volume (ECV), resulting in another myocardial parametric map. This article describes technical challenges and clinical perspectives of these two novel CMR biomarkers: myocardial native T1 and ECV mapping.

Short-term precision assessment of trabecular bone score and bone mineral density using dual-energy X-ray absorptiometry with different scan modes: an in vivo study.

OBJECTIVES: We estimated the in vivo reproducibility of trabecular bone score (TBS) from dual-energy X-ray absorptiometry (DXA) using different imaging modes to be compared to that of bone mineral density (BMD). METHODS: We enrolled 30 patients for each imaging mode: fast-array, array, high definition. Each patient underwent two DXA examinations with in-between repositioning. BMD and TBS were obtained according to the International Society for Clinical Densitometry guidelines. The coefficient of variation (CoV) was calculated as the ratio between root mean square standard deviation and mean, percent least significant change (LSC) as 2.77 × CoV, reproducibility as the complement to 100% LSC. RESULTS: Fast-array imaging mode resulted in 0.8% CoV and 2.1% LSC for BMD, 1.9% and 5.3% for TBS, respectively; array imaging mode resulted in 0.7% and 2.0% for BMD, 1.9% and 5.2%, for TBS; high-definition imaging mode resulted in 0.7% and 2.0%, for BMD; 2.0% and 5.4% for TBS, respectively. Reproducibility of TBS (95%) was significantly lower than that of BMD (98%) (p < 0.012). Difference in reproducibility among the imaging modes was not significant for either BMD or TBS (p = 0.942). CONCLUSION: While TBS reproducibility was significantly lower than that of BMD, differences among imaging modes were not significant for both TBS and BMD. KEY POINTS: • TBS is an emerging tool for assessing BMD. • TBS reproducibility is lower than that of BMD. • Differences between imaging modes are not significant for either TBS or BMD.

Recoupling of right and left ventricle pump function after surgical ventricle restoration: a cardiac magnetic resonance study.

To evaluate biventricular pump function after surgical ventricle restoration (SVR) using cardiac magnetic resonance (CMR). We retrospectively studied 39 patients who performed 1.5-T CMR before/after SVR acquiring short-axis ECG-gated cine sequences. End-diastolic, end-systolic, and stroke volume indexed to body surface area (EDVI, ESVI, and SVI), ejection fraction (EF), and their modification after SVR (∆) were obtained for right ventricle (RV) and left ventricle (LV). Wilcoxon signed rank test and Spearman correlation coefficient were used; EF reproducibility was estimated. Median LVEF increased from 24% [interquartile range (IQR) 19-31%] before SVR to 34% (IQR 29-43%) after SVR (P < 0.001). Median RVEF remained unchanged from 58% (IQR 48-66%) before SVR to 57% (IR 46-64%) after SVR (P = 0.743). The correlation between LVEF and RVEF was not significant before SVR (r = 0.182; P = 0.266) but significant after SVR (r = 0.445; P = 0.005). The ∆RVEF was positively correlated with ∆LVEF (r = 0.558; P < 0.001). ∆RVSVI was positively correlated with ∆LVSVI (r = 0.502; P = 0.001). LVEF reproducibility before SVR was 97% for both intra- and inter-reader reproducibility; RVEF reproducibility was 96 and 93%, respectively. SVR improved LV function without apparent impact on RV function. After SVR the two ventricles showed a functional recoupling. Reproducibility of CMR EF was excellent for both ventricles.

Segmentation of cardiac magnetic resonance cine images of single ventricle: including or excluding the accessorial ventricle?

Our aim was to compare two different approaches for segmentation of single ventricle (SV) on cardiac magnetic resonance (CMR) cine images. We retrospectively studied 30 consecutive patients (23 males; aged 27 ± 10 years) with a treated SV who underwent 1.5-T CMR using ECG-triggered axial true-FISP, HASTE and cine true-FISP sequences. We classified patients for visceroatrial situs, cardiac axis orientation, ventricular loop, morphology of SV and position of great arteries. One experienced reader segmented cine images twice, firstly including only the systemic ventricle, secondly including both systemic and accessorial ventricles. Ejection fraction (EF), indexed end-diastolic volume (EDVI), end-systolic volume (ESVI), and stroke volume (SVI) were calculated. Data were presented as medians and interquartile intervals. Four patients presented dextrocardia and one patient mesocardia. Two had situs ambiguus with asplenia and one situs ambiguus with polisplenia. Four patients showed right morphology of the SV and three levo-ventricle loop. We found 14 levo-trasposition of great arteries (TGA), 4 levo-malposition of great arteries (MGA), four dextro-MGA, two dextro-TGA, and one inverted vessel position. When segmenting only the systemic ventricle, EDVI (mL/m2) was 65 (50-91), when segmenting both ventricles 76 (58-110) (P < 0.001); ESVI (mL/m2) was 32 (24-45) and 45 (33-60), respectively (P < 0.001); EF (%) was 49 (43-57) and 33 (24-47), respectively (P = 0.003); SVI (mL/m2) was 34 (17-48) and 33 (24-47) (P = 0.070). The inclusion of the accessorial ventricle in the segmentation of SV produce a biased lower EF showing a very low contribution to the pump function.