Right ventricular scalloping index as cardiac magnetic resonance-derived marker for diagnosis of arrhythmogenic right ventricular cardiomyopathy.

BACKGROUND: The cardiac magnetic resonance (CMR) evaluation of right ventricular (RV) morphologic abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is subjective. Here, we aimed to use a quantitative index, the right ventricular scalloping index (RVSI), to standardize the measurement of RV free wall scalloping and aid in the imaging diagnosis. METHODS: We retrospectively included 15 patients with definite ARVC and 45 age- and sex-matched patients with idiopathic right ventricular outflow tract ventricular arrhythmia (RVOT-VA) as controls. The RVSI was measured from cine images on four-chamber view to evaluate its ability to distinguish between ARVC and RVOT-VA patients. Other cardiac functional parameters including strain analysis were also performed. RESULTS: The RVSI was significantly higher in the ARVC than RVOT-VA group (1.56 ± 0.23 vs 1.30 ± 0.08, p < 0.001). The diagnostic performance of the RVSI was superior to the RV global longitudinal, circumferential, and radial strains, RV ejection fraction, and RV end-diastolic volume index. The RVSI demonstrated high intraobserver and interobserver reliability (intraclass correlation coefficient, 0.94 and 0.96, respectively). RVSI was a strong discriminator between ARVC and RVOT-VA patients (area under curve [AUC], 0.91; 95% CI, 0.82-0.99). A cutoff value of RVSI ≥1.49 provided an accuracy of 90.0%, specificity of 97.8%, sensitivity of 66.7%, positive predictive value (PPV) of 90.9%, and a negative predictive value (NPV) of 89.8%. In a multivariable analysis, a family history of ARVC or sudden cardiac death (odds ratio, 38.71; 95% CI, 1.48-1011.05; p = 0.028) and an RVSI ≥1.49 (odds ratio, 64.72; 95% CI, 4.58-914.63; p = 0.002) remained predictive of definite ARVC. CONCLUSION: RVSI is a quantitative method with good performance for the diagnosis of definite ARVC.

Risk factors for pneumothorax and pulmonary hemorrhage following computed tomography-guided transthoracic core-needle biopsy of subpleural lung lesions.

BACKGROUND: Identifying the risk factors for complications may alert the physicians and help them adjust their plans before performing computed tomography-guided lung biopsies. Reportedly, a pleura-nodule distance longer than 2.0 cm is a strong predictor for pneumothorax and pulmonary hemorrhage. However, the rate and risk factors of biopsy-associated complications in subpleural lesions have not been assessed. This study aimed to identify the risk factors for pneumothorax and pulmonary hemorrhage in subpleural lesions ≤2.0 cm in depth. METHODS: Altogether, 196 patients (196 subpleural lesions, lesion depth: 0.1-2.0 cm) who underwent computed tomography-guided transthoracic core-needle biopsies between March 2017 and November 2017 were retrospectively analyzed. Univariate analysis of risk factors including patient-related, lesion-related, and procedure-related characteristics was performed for pneumothorax ≥1 cm and pulmonary hemorrhage ≥2 cm after the biopsy. Multivariate logistic regression analysis was performed to identify the independent risk factors. RESULTS: Pneumothorax ≥1 cm and pulmonary hemorrhage ≥2 cm were identified in 35 (17.9%) and 32 (16.3%) cases, respectively. In the multivariate analysis, a longer needle path (odds ratio [OR], 1.976; 95% confidence interval [CI], 1.113-3.506; p = 0.020) and low attenuation along the biopsy tract (OR, 3.080; 95% CI, 1.038-9.139; p = 0.043) were predictors of pneumothorax ≥ 1 cm. Ground-glass lesions (OR, 2.360; 95% CI, 1.009-5.521; p = 0.048) and smaller needle-pleura angle (OR, 0.325; 95% CI, 0.145-0.728; p = 0.006) were associated with pulmonary hemorrhage ≥2 cm. CONCLUSION: For subpleural lesions ≤2.0 cm in depth, a puncture route having a shorter needle path and passing through the lung parenchyma with higher attenuation may reduce the risk of biopsy-associated pneumothorax ≥1 cm. A higher needle-pleura angle may reduce the risk of pulmonary hemorrhage ≥2 cm in the short axis.