Comparison of Measurement Techniques and Response Criteria for MR Imaging Follow-up in Adult Primary Central Nervous System Lymphoma.

BACKGROUND AND PURPOSE: Current guidelines proposed for the measurement of primary central nervous system lymphoma in 2005 have indicated that unidimensional and bidimensional measurements may be used, using the same threshold for response categorization, because no clinical study has evaluated the agreement among the measurement techniques. Hence, our study assessed the agreement among different measurements. MATERIALS AND METHODS: In this retrospective study, primary central nervous system lymphoma lesions were measured with different techniques (longest 1D, axial 1D, 2D, 3D, and the Response Evaluation Criteria in Solid Tumor) on consecutive MR images. Intra- and interobserver correlations were calculated with intraclass correlation coefficients. Correlations between raw measurements and variations in size compared with baseline were evaluated with the Spearman rank correlation, and agreement among response categories was evaluated. RESULTS: A total of 304 examinations obtained in 40 patients was assessed. The intraobserver intraclass correlation coefficient for 3D, 2D, and longest 1D were ≥0.993. The interobserver intraclass correlation coefficient was ≥0.967. The correlations in raw measurements and size variation in comparison with 3D were respectively; 0.99 and 0.98 for 2D; 0.94 and 0.92 for longest 1D; 0.94 and 0.83 for axial 1D; and 0.90 and 0.79 for Response Evaluation Criteria in Solid Tumor. With 20%-30% and 25%-50% thresholds for unidimensional techniques, response categorizations were 95% and 95% for 2D, 92.5% and 90% for the longest 1D, 87.5% and 82.5% for axial 1D, and 90% and 85% for the Response Evaluation Criteria in Solid Tumor. CONCLUSIONS: Both longest 1D and 2D demonstrated excellent correlations with 3D measurements. The longest 1D could be used for the follow-up of primary central nervous system lymphoma. If unidimensional measurements were used, 20% and 30% cutoffs should be used for defining response categorization instead of the current guidelines.

Hemorrhagic infiltration of the aortopulmonary adventitia: A complication of acute aortic dissection.

BACKGROUND: Hemorrhagic infiltration of the common aortopulmonary adventitia is an infrequent complication of acute aortic dissection, most frequently Stanford type A. The radiological interpretation of this finding may be a diagnostic challenge. The objective of this multicenter case series is to review the radiological and pathological findings of hemorrhagic infiltration of the aortopulmonary adventitia secondary to acute aortic dissection, and to describe the pathophysiology underlying this complication. MATERIAL AND METHODS: The study includes 20 cases of aortic dissection with hemorrhagic infiltration of the aortopulmonary adventitia. These are 17 cases with computed tomography (CT) data obtained from 5 academic centers. Three other cases were retrieved through a search of autopsy reports. Clinical, radiological and pathological data were collected. RESULTS: Linear foci of moderately increased attenuation were seen along the wall of the proximal pulmonary arteries in 4 cases on unenhanced CT. Contrast-enhanced CT showed soft-tissue thickening along these walls in all imaging cases, with some degree of narrowing of the lumen of the pulmonary arteries. Peribronchovascular ground-glass opacities or consolidation were present in 4 cases. CONCLUSION: Hemorrhagic infiltration of the common aortopulmonary adventitia is an infrequent complication of acute type A aortic dissection. The radiologist should be aware of its pathophysiology and imaging findings in order to make a prompt diagnosis in an urgent setting.

Can troponin elevation predict worse prognosis in patients with acute pericarditis?

INTRODUCTION: Myopericarditis are common in clinical practice: up to 15% of acute pericarditis have a significant myocardial involvement as assessed by biological markers. This prospective, bicentric study is aimed at describing a myopericarditis population, the clinical and MRI follow-up, and search for prognosis markers. PATIENTS AND METHODS: Between May 2005 and September 2007, 103 patients hospitalised for acute pericarditis were prospectively enrolled. Physical examination, ECG, echocardiography, biological screening and cardiac MRI, in case of myopericarditis defined as acute pericarditis with troponin I elevation, were performed. Between December 2007 and July 2008, patients were contacted for new clinical and MRI evaluation. RESULTS: Among the initial population of 103 patients admitted for acute pericarditis, 14 myopericarditis and 38 pericarditis were included. Compared with pericarditis, the myopericarditis group was associated with the following features: younger age (34.9 years [95% CI 28.3-41.2]; p=0.01), ST-segment elevation (nine patients between 14; p=0.03), higher troponin I (7.3 microg/L [95% CI 4.4-10.2]; p<10(-4)) and lower systemic inflammation (CRP peak 38.1mg/L [95% CI 7-69.2]; p=0.01). In the case of myopericarditis, infectious etiologies were predominant (12 patients among 14; p=0.002) and patients stayed longer in hospital (5.8 days [95% CI 4.7-6.8]; p=0.01). Follow-up showed no difference in terms of functional status (p=0.3) and global complications (p=0.9) between paired myopericarditis and pericarditis. Nevertheless, cardiac mortality was higher for myopericarditis (p=0.04). MRI follow-up showed myocardial sequelae without clinical impact. CONCLUSION: Myopericarditis significantly distinguished from pericarditis. Three years follow-up showed no difference in terms of global complications but a higher cardiac mortality for myopericarditis. MRI myocardial lesions did not develop into symptomatic sequelae.

Evolution of coronary artery calcifications following kidney transplantation: relationship with osteoprotegerin levels.

We prospectively assessed the evolution of coronary artery calcification (CAC) and osteoprotegerin (OPG) levels after renal transplantation (RT). Eighty-three recipients were followed-up prospectively during 1 year. Blood was collected before (baseline) and after RT for determination of mineral metabolism parameters including OPG. CAC was measured by multidetector computed tomography at transplantation (baseline) and 1 year later. Progression of CAC was defined as a difference between the follow-up square-root transformed volume (SRV) and the baseline SRV >or= 2.5. By multivariate analysis, baseline OPG level, age and low LDL levels were significantly associated with baseline CAC. RT was accompanied by mineral metabolism improvement with a decrease of OPG from 955 [395-5652] to 527 [217-1818] pg/mL and parathyroid hormone from 94 [1-550] to 62 [16-410] pg/mL. Thirty-one percent of patients did not exhibit CAC at baseline. CAC diminished in 14.5%, stabilized in 59.2% and progressed in 26.3% of patients. Baseline CAC was associated with progression (OR 2.92 [1.02-8.36]). No significant association was found between OPG and CAC progression despite a higher baseline OPG level in progressors (1046 [456-3285]) vs. non-progressors (899 [396-5952] pg/mL). CAC at baseline, but not 1 year after RT, is independently associated with baseline OPG; posttransplant CAC progression is predicted by baseline CAC score.

[Intra-cardiac lymphoma with right heart failure: a therapeutic emergency in two patients]. / Lymphome intracardiaque avec insuffisance cardiaque droite: à propos de deux cas.

We report the cases of two patients admitted to the Emergency Department with a clinical picture of right heart failure. An emergency echocardiograph suggested an intra-cardiac tumor which turned out to be a primary intra-cardiac lymphoma in one case, and a diffuse lymphoma principally localised in the heart in the other. Echocardiographic, CT and MRI investigations clarified the sites, as well as anatomical relations and extensions. Histology confirmed the diagnosis, and allowed classification of the lymphoma in order to decide on treatment. A PET scan performed in one patient illustrated the response to treatment. The respective significance of each of these investigations is discussed, in addition to the management. While transthoracic echocardiography remains the key element in the acute management, MRI and PET scans are being used more and more often for determining the character of these lesions, as well as for assisting with therapeutic decisions and for follow-up.

[Myocarditis versus myocardial infarction in diabetic patients: a new role for non invasive imaging]. / Myocardite ou infarctus chez le diabétique: un nouveau rôle pour l'imagerie non invasive.

A young diabetic patient was referred to our institution for clinical symptoms of myopericarditis. Cardiac MRI and MDCT of the coronary arteries were performed successively. They demonstrated an acute myocardial infarction related to a left circumflex coronary artery occlusion which was treated by stent angioplasty. This case suggests that cardiac MR and possibly cardiac MDCT could be proposed in patients with a suspected myopericarditis, especially if diabetes mellitus is associated.

[Section planes for cardiac MRI]. / Plans de coupe en IRM cardiaque.

The recent developments of synchronized cardiac MRI are a unique opportunity for the radiology community to integrate cardiac imaging. This educational aticle aims to help radiologists and technicians to obtain cardiac planes comparable to those of cardiac ultrasound and gated SPECT. Of course, cardiac planes described herein for MRI also apply to multi-detector CT.