Cardiovascular Disease in Women: What the Radiologist Needs to Know.

BACKGROUND: Sex-specific disparities are well documented for cardiovascular disease (CVD). There are differences in physiology and pathophysiology, pain perception, spectrum of disease, risk, therapeutic aspects, prognosis, and outcome. CVD represents a broad spectrum of disorders. This review focuses on cardiovascular and cardiac pathology. METHOD: This review summarizes the current state of the literature on cardiovascular disease in women from a radiological viewpoint. It aims to provide a deeper understanding of these differences and thereby alerts the reader to the potential of CT and MRI for diagnosing CVD in women. Special attention is paid to disparities in the underlying physiological and pathophysiological processes, clinical presentation, and the quality of care to provide a deep understanding of the topic. Cardiovascular and cardiac pathologies with a sex-specific pattern of disease are presented and typical CT and MRI findings are arranged and illustrated with imaging findings. RESULTS AND CONCLUSION: Sex-specific differences are not only sex hormonal in nature but are rooted in the epigenome and encompass a multitude of physiological systems. In fact, cardiovascular disease shows sex-specific characteristics spanning from incidence to clinical presentation, course of disease, and prognosis. This is of significance regarding pretest probabilities, the power of tests, imaging strategies, and interpretation of imaging results. Key sex-specific issues encompass obstructive and non-obstructive coronary artery disease (CAD), microvascular angina, myocardial infarction with non-obstructive CAD, and coronary artery dissection. Sex-specific patterns are also noted in myocardial disease and heart failure such as pregnancy-related heart disease, Takotsubo syndrome, and anthracycline-induced cardiotoxicity. KEY POINTS: · Cardiovascular diseases have sex-specific characteristics.. · Imaging strategies and interpretation of imaging results should be adjusted for women.. · Imaging helps in the improvement of the sex-specific management of cardiovascular disease..

[Interdisciplinary position paper: the value of radiofrequency denervation in the treatment of chronic pain]. / Interdisziplinäres Positionspapier: der Stellenwert der Radiofrequenzdenervierung in der Therapie chronischer Schmerzen.

Radiofrequency denervation has been established for many years as an important minimally invasive procedure for the treatment of chronic pain conditions. Positive experiences of many users for various indications are contrasted by a nonuniform evidence. With meticulous patient selection and correct assessment of the indications a longer term reduction of pain, a reduced need for analgesics and an improvement in the quality of life can be achieved. The aim of this interdisciplinary position paper is to present the value of radiofrequency denervation in the treatment of chronic pain. The summarized recommendations of the expert group are based on the available evidence and on the clinical experiences of Austrian centers that frequently implement the procedure. The position paper contains recommendations on patient selection and proven indications. We discribe safety aspects, complications, side effects and contraindications.

Rheumatoid arthritis: a practical guide to state-of-the-art imaging, image interpretation, and clinical implications.

Rheumatoid arthritis (RA) is a chronic systemic disease of unknown origin that predominantly involves synovial tissue. RA affects 0.5%-1.0% of the global population, with females affected more frequently than males. Early diagnosis and initiation of proper therapy help modify the course of the disease and reduce the degree of severe late sequelae. Radiology plays a key role in diagnosis and management of RA. Currently, magnetic resonance imaging is the best imaging modality because it depicts soft-tissue changes and damage to cartilage and bone even better and at an earlier stage than does computed tomography. Ultrasound and conventional radiography are more readily available but cannot show the entire spectrum of the disease. Diagnosis and differential diagnosis are achieved by identifying certain radiologic parameters, which are also used for grading purposes. The disease does not follow a linear course, especially with the early initiation of potent therapy. Knowledge of the imaging findings enables the radiologist to accurately select the most helpful imaging technique. Familiarity with the pathophysiologic mechanisms of RA, the imaging findings, and the grading systems and a basic knowledge of therapeutic regimens are prerequisites for a tailored diagnostic approach by the radiologist.

Closure of a patent foramen ovale: effective therapy of migraine and occipital stroke.

Whether stroke in a patient with migraine and patent foramen ovale (PFO) is due to PFO or migraine is difficult to decide. In a 33-year-old woman with migraine with aura, a visual field defect developed acutely. Neurological investigation revealed double vision when looking to the left and exaggerated patella tendon reflexes. Since then the patient complained about permanent visual impairment. CT- and MRI-scans of the brain showed a right occipital ischemic stroke. Intensive search for risk factors revealed cigarette smoking and chronic hypovolemia On transesophageal echocardiography an inter-atrial hypermobile septum and a PFO were detected. The patient underwent closure of the PFO by means of an Amplatzer PFO occluder nine weeks after the stroke. Since then she did not experience a further cerebrovascular event or migraine attack. This case shows that in a patient with PFO and migraine with aura, stroke may be attributable to migraine rather than to PFO. Occlusion of the PFO may reduce the frequency and intensity of migraine attacks.

Cross-sectional and functional imaging of the temporomandibular joint: radiology, pathology, and basic biomechanics of the jaw.

The temporomandibular joint (TMJ) is a common site of complaint. Clicking sounds and pain are indicators of a frequent condition called internal derangement, most often affecting females. As a general term, internal derangement describes a structural abnormality within an articulation. The internal derangement of the TMJ is a specific term defined as an abnormal positional and functional relationship between the disk and articulating surfaces. Imaging of the joint is an important element in the diagnostic work-up. Trauma and inflammatory arthritis account for most of the other TMJ problems. A thorough understanding of joint anatomy and normal function is a prerequisite for perceiving abnormalities and making the correct diagnosis. The authors elucidate joint anatomy, correlating cadaveric specimen and anatomic slices with conventional and cross-sectional imaging studies. TMJ biomechanics are illustrated with schematics and animations, and an overview of imaging strategies and techniques is presented. Common abnormalities are described and illustrated, and a brief discussion of therapeutic options is included.