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BACKGROUND: Sex differences in the calculation of coronary heart disease risk have been analysed extensively. However, data on coronary plaque morphology diverge. We analysed plaque characteristics in patients with suspected coronary artery disease (CAD) and defined prognostic factors using coronary computed tomography angiography (CCTA). METHODS: A total of 6,050 consecutive patients underwent CCTA and were enrolled in the registry. Patients with known CAD were excluded. The patients were propensity score matched (1:1 male:female) for age and known coronary risk factors. Coronary arteries were evaluated for stenosis, plaque types (non-calcified, mixed and calcified) and high-risk plaque features (napkin-ring sign, low-attenuation plaque, spotty calcifications, positive remodelling). Clinical follow-up was performed. RESULTS: A total of 1,050 patients (525 female, 525 male) in matched cohorts were selected for analysis. CCTA showed significantly higher calcium scores for males (mean 180.5 vs 67.8 AU, pâ¯< 0.0001) and a higher rate of CAD (66.0% vs 34.1%, pâ¯< 0.0001). In a total of 16,800 segments, males had significantly more plaques (861 vs 752, pâ¯< 0.0001) with a significantly larger proportion of calcified plaques, while females had more mixed and non-calcified plaques (33.5% vs 24.4%, pâ¯= 0.006 and 24.1% vs 13.6%, pâ¯= 0.22, respectively). After a mean follow-up of 5.6 years, major adverse cardiac event (MACE) rate was 5.3% in male and 1.9% in female patients (pâ¯< 0.05). The relative odds ratio for high-risk plaque features to predict MACE was higher in females. CONCLUSION: Based on a higher relative risk for women with high-risk plaque features, the findings of our study support the increased importance of a differentiated qualitative plaque analysis to improve the risk stratification for both sexes.
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To quantify myocardial edema by using a T2 relaxometry approach with a dual-contrast turbo spin-echo (dcTSE) sequence in patients with acute myocarditis regarding focal late gadolinium enhancement (LGE) burden. CMR T2 relaxometry was performed in 39 patients (age 41 ± 19 years; 36% women) with LGE in a typical myocarditis pattern and in ten healthy volunteers (age 46 ± 12; 60% woman). dcTSE sequence (echo time 29 and 75 ms, respectively) was used for T2 mapping, analysis were performed on the basis of region of interest (ROI). Myocardial T2 relaxation times (T2 RT) in patients-ROI with focal LGE were significantly (p < 0.001) higher than T2 RT in patients-ROI without apparent LGE pattern (65 ms (IQR 36-95) vs. 60 ms (IQR 26-88), respectively). T2 RT in healthy volunteers [55 ms (IQR 35-71)] were significantly lower than in patients ROI with or without focal LGE-pattern (p < 0.001, respectively). T2 RT assessed by dcTSE are significantly higher in patients segments with and without focal LGE compared to normal controls, supporting a global myocardial inflammatory process in acute myocarditis. Furthermore, this quantitative T2-mapping approach highlights the potential to identify patients with diffuse myocarditis.
Assuntos
Meios de Contraste/administração & dosagem , Edema Cardíaco/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador , Imagem Cinética por Ressonância Magnética/métodos , Meglumina/análogos & derivados , Miocardite/diagnóstico por imagem , Compostos Organometálicos/administração & dosagem , Doença Aguda , Adolescente , Adulto , Idoso , Edema Cardíaco/patologia , Edema Cardíaco/fisiopatologia , Feminino , Humanos , Masculino , Meglumina/administração & dosagem , Pessoa de Meia-Idade , Miocardite/patologia , Miocardite/fisiopatologia , Miocárdio/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Função Ventricular Esquerda , Adulto JovemRESUMO
OBJECTIVES: To prospectively evaluate image quality (IQ) and radiation dose of dual-source cardiac computed tomography (CCTA) using different imaging protocols. METHODS: CCTA was performed in 150 patients using the retrospective ECG-gated spiral technique (rECG) the prospective ECG-gated technique (pECG), or the prospective ECG-gated technique with systolic imaging and automated tube voltage selection (pECGsys). IQ was rated using a 16-segment coronary artery model. Techniques were compared for overall IQ, IQ of the large and the small coronary artery segments. Effective dose was used for comparison of radiation dose. RESULTS: Overall IQ and IQ of the large segments showed no differences between the groups. IQ analysis of the small segments showed lowered IQ in pECGsys compared to rECG (p = 0.02), but not to pECG (p = 0.6). Effective dose did not differ significantly between rECG and pECG (p = 0.13), but was significantly lower for pECGsys (p < 0.001 vs. rECG and pECG). CONCLUSION: Radiation dose of dual-source CCTA in heart transplant recipients is significantly reduced by using prospective systolic scanning and automated tube voltage selection, while overall IQ and IQ of the large coronary segments are maintained. IQ appears to be lower compared to retrospective techniques with regard to small coronary segments. KEY POINTS: ⢠Cardiac computed tomography angiography is useful for cardiac allograft vasculopathy assessment. ⢠Despite elevated heart rate, dose reduction in cardiac computed tomography is possible. ⢠Prospective systolic gating and automated tube voltage selection enable 50 % dose reduction.
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Técnicas de Imagem de Sincronização Cardíaca/métodos , Vasos Coronários/diagnóstico por imagem , Transplante de Coração , Complicações Pós-Operatórias/diagnóstico por imagem , Doses de Radiação , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia/métodos , Feminino , Seguimentos , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sístole , Tomografia Computadorizada Espiral/métodos , Adulto JovemRESUMO
PURPOSE: The objectives of this study were to compare sonoelastographic color findings of the perineural area between carpal tunnel syndrome patients and healthy volunteers, and to analyze elastographic findings in that area before and immediately after intracarpal tunnel injection in carpal tunnel syndrome patients. MATERIALS AND METHODS: We studied both hands of 15 healthy volunteers (7 men, 8 women; mean age: 60.1 years, range: 41â-â88 years) and 72 hands from 70 patients with symptomatic carpal tunnel syndrome (24 men, 46 women; mean age: 54.2 years, range: 24â-â83 years). Sonoelastographic color distribution was assessed in the perineural area between the median nerve and adjacent flexor tendons. The color elastograms were graded using the following system: Grade 1 as red (softest), grade 2 as yellow (soft), grade 3 as green (hard), grade 4 as blue (hardest). The patients were treated with corticosteroid injection and were reassessed with sonoelastography immediately after the injection. RESULTS: The median color grading in the perineural area of carpal tunnel syndrome patients was grade 3 (3.1â±â0.3, mean ±â95â% Cl), which was stiffer than that of healthy volunteers (grade 1, 1.9â±â0.4) (p <â0.0001). Immediately after injection, the diffusion of the injected fluid was observed as having a softer appearance (grade 1, 1.4â±â0.2) (pâ<â0.0001). CONCLUSION: The perineural area surrounding the median nerve in carpal tunnel syndrome patients was stiffer than that in healthy volunteers. Diffusion of the injected fluid in the carpal tunnel was seen as a softer finding after injection in real time using sonoelastography.
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Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/tratamento farmacológico , Técnicas de Imagem por Elasticidade/métodos , Aumento da Imagem/métodos , Nervo Mediano/efeitos dos fármacos , Nervo Mediano/diagnóstico por imagem , Mepivacaína/administração & dosagem , Triancinolona Acetonida/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valores de ReferênciaRESUMO
Acute chest pain is a common symptom but triage decisions in these patients remain a challenge. Patient's history, cardiac enzyme levels, or electrocardiograms often are unspecific. Nowadays, multidetector-row computed tomography (CT) currently represents the imaging modality of choice for diagnosing or excluding pulmonary embolism (PE) or acute aortic syndrome (AAS). Furthermore, recent studies have demonstrated advantages for non-invasive imaging of the coronary arteries by CT. The so called triple rule-out CT allows the depiction of the pulmonary arteries, the thoracic aorta, and the coronary arteries within a single examination with a simultaneous attenuation of these three vessel territories. This enables the detection of life-threatening such as PE, AAS and ACS, as well as of non-life-threatening diseases causing acute chest pain.
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Dor no Peito/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X , Síndrome Coronariana Aguda/diagnóstico por imagem , Doença Aguda , Algoritmos , Doenças da Aorta/diagnóstico por imagem , Dor no Peito/diagnóstico , Angiografia Coronária , Diagnóstico Diferencial , Eletrocardiografia , Emergências , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , TriagemRESUMO
PURPOSE: Real-time sonoelastography (SE), a newly introduced ultrasound technique, has already shown conclusive results in breast, prostate, and thyroid tumor diagnostics. This study investigated the performance of SE for the differentiation of Achilles tendon alterations of tendinopathy compared to clinical examination and conventional ultrasound (US). MATERIALS AND METHODS: Achilles tendons in 25 consecutive patients with chronic Achilles tendinopathy and 25 healthy volunteers were examined clinically by US and by SE. RESULTS: In the healthy volunteers, SE showed the tendon to be hard (93 %), while distinct softening was found in 57 % of the patients. SE showed more frequent involvement of the distal (64 %) and middle third (80 %) than the proximal third (28 %) of the Achilles tendon. Using SE a mean sensitivity of 94 %, specificity of 99 %, and accuracy of 97 % were found when clinical examination was used as the reference standard. The correlation to US was 0.89. Mild softening was found in 7 % of the healthy volunteers and in 11 % of the patients. CONCLUSION: Our results emphasize that only distinct softening of Achilles tendons is comparable to clinical examination and US findings. However, mild softening might be explained by very early changes in tissue elasticity in the case of Achilles tendinopathy, which should be assessed in follow-up studies.
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Tendão do Calcâneo/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador/métodos , Tendinopatia/diagnóstico por imagem , Adulto , Artrite Reumatoide/diagnóstico por imagem , Transtornos Traumáticos Cumulativos/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Valores de Referência , Sensibilidade e Especificidade , Espondilite Anquilosante/diagnóstico por imagemRESUMO
PURPOSE: Inflammatory processes may increase the urothelial thickness of the renal pyelon. Purpose of the study was to assess sonographic measurement of pyelon wall thickness (PWT) in adult patients with acute pyelonephritis, chronic urinary tract infection (UTI) and indwelling ureteral stents. MATERIALS AND METHODS: Four study groups (acute pyelonephritis n=50, chronic UTI n=10, indwelling ureteral stents n=10, controls n=25) underwent renal ultrasonography (Acuson Seqouia, Mountain View, CA; 6 MHz Transducer). The renal pyelon was imaged in transverse and longitudinal planes. PWT measurements of patients with acute pyelonephritis were repeated after successful antibiotic treatment. RESULTS: Mean PWT in healthy controls was 1.0 mm+/-0.19. In patients with acute pyelonephritis, PWT was significantly increased to 2.9 mm+/-0.89 (p<0.001). PWT decreased significantly after antibiotic treatment to 1.4 mm+/-0.47 (p<0.001). Kidneys with indwelling stents presented with a PWT of 2.7 mm+/-0.68, kidneys with chronic UTI demonstrated a PWT of 2.8 mm+/-0.62. PWT in these patient groups was significantly greater than PWT in healthy volunteers (p<0.001). The interobserver agreement was excellent (p<0.001). CONCLUSION: PWT is a reproducible diagnostic criterion for acute pyelonephritis. Based upon our experience, we suggest a cut-off value of 2.0 mm to distinguish healthy kidneys from those with urothelium thickened by inflammation. PWT cannot be used to distinguish acute pyelonephritis from chronic inflammation of the urothelium.
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Pelve Renal/anatomia & histologia , Pelve Renal/diagnóstico por imagem , Pielonefrite/epidemiologia , Adulto , Antibacterianos/uso terapêutico , Humanos , Inflamação , Valor Preditivo dos Testes , Pielonefrite/tratamento farmacológico , Valores de Referência , Stents , UltrassonografiaRESUMO
The value of ultrasound (US) in the diagnosis of prostate cancer has increased in importance in the past decade, which is mainly related due to the increasing incidence of prostate cancer, the most common malignancy in men. The value of conventional gray-scale US for prostate cancer detection has been extensively investigated. The introduction of US contrast agents has dramatically changed the role of US for prostate cancer detection. Advances in US techniques were introduced to further increase the role of US contrast agents. Although most of these advances in US techniques, which use the interaction of the contrast agent with the transmitted US waves are very sensitive for the detection of microbubbles, are mostly unexplored, in particular for prostate applications. First reports of contrast-enhanced US investigations of blood flow of the prostate have shown that contrast-enhanced US adds important information to the conventional US technique. We present a critical evaluation of the current status of transrectal US imaging for prostate cancer detection. Furthermore, we give background information on US contrast agents and imaging modalities. Early results of contrast-enhanced US suggest the feasibility of the use of US contrast agents to enhance US imaging of the prostate. The application of US contrast agents for the detection and clinical staging of prostate cancer is promising. However, future clinical trials will be needed to determine the promise of contrast-enhanced US of the prostate evolves into clinical application.