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1.
Radiol Med ; 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32948928

RESUMO

Aortic valve stenosis (AS) is a common valvular heart disease. Recently, transcatheter aortic valve implantation (TAVI) has changed the treatment of severe AS in elderly patients with contraindications to traditional surgical replacement. Echocardiography is conventionally used as the first imaging modality to assess the presence and severity of AS and to provide anatomical and functional information. Nowadays, imaging techniques play a crucial role in the planning of TAVI to define suitable candidates. Computed tomography (CT) is essential to display the anatomy of the aortic valve complex (including aortic annulus, Valsalva sinuses, coronary arteries ostia, sinotubular junction), thoracoabdominal aorta, and vascular access. Cardiac CT may also provide the evaluation of coronary arteries in alternative to conventional coronary angiography. Magnetic resonance imaging may be alternative or supplementary in selected cases, providing detailed information of cardiac function and myocardial wall characteristics. More recently, advanced computer modeling image-based techniques can be used to support the evaluation of the feasibility and safety of TAVI procedures.

2.
Clin Imaging ; 68: 169-174, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32836213

RESUMO

OBJECTIVE: The aim of this study was to retrospectively analyze the outcome of LR-3 and LR-4 without arterial phase hyperenhancement (APHE), and identify which features could predict LR-5 progression on serial Gd-EOB-DTPA-enhanced MRI follow-up. METHODS: Forty-nine cirrhotic patients with 55 LR-3 and 19 LR-4 without APHE were evaluated. Observations were classified as decreased, stable or increased in category at follow-up. Observation size and LI-RADS major and ancillary features were evaluated. RESULTS: Seventeen/fifty-five (31%) LR-3 and 8/19 (42%) LR-4 progressed to LR-5 at follow-up. Baseline LI-RADS major and ancillary features were not significantly different among LR-3 and LR-4. A diameter ≥ 10 mm significantly increased LR-5 progression risk of LR-3 (OR = 6.07; 95% CI: 0.12; 60.28]; P < .001). LR-4 with a diameter ≥ 10 mm more likely become LR-5 at follow-up (OR = 8.95; 95% CI: 0.73; 111.8; P = .083]). CONCLUSION: LR-3 and LR-4 without APHE were often downgraded or remained stable in category on Gd-EOB-DTPA-enhanced MRI follow-up.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32543166

RESUMO

BACKGROUND: Radiomic features are increasingly utilized to evaluate tumor heterogeneity in PET imaging but to date its role has not been investigated for Cho-PET in prostate cancer. The potential application of radiomics features analysis using a machine-learning radiomics algorithm was evaluated to select 18F-Cho PET/CT imaging features to predict disease progression in PCa. METHODS: We retrospectively analyzed high-risk PCa patients who underwent restaging 18F-Cho PET/CT from November 2013 to May 2018. 18F-Cho PET/CT studies and related structures containing volumetric segmentations were imported in the "CGITA" toolbox to extract imaging features from each lesion. A Machine-learning model has been adapted using NCA for feature selection, while DA was used as a method for feature classification and performance analysis. RESULTS: 106 imaging features were extracted for 46 lesions for a total of 4876 features analyzed. No significant differences between the training and validating sets in terms of age, sex, PSA values, lesion location and size (p > 0.05) were demonstrated by the machine-learning model. Thirteen features were able to discriminate FU disease status after NCA selection. Best performance in DA classification was obtained using the combination of the 13 selected features (sensitivity 74%, specificity 58% and accuracy 66%) compared to the use of all features (sensitivity 40%, specificity 52%, and accuracy 51%). Per-site performance of the 13 selected features in DA classification were as follow: T= sensitivity 63%, specificity 83%, accuracy 71%; N= sensitivity 87%, specificity 91% of and accuracy 90%; bone-M= sensitivity 33%, specificity 77% and accuracy 66%. CONCLUSIONS: An artificial intelligence model demonstrated to be feasible and able to select a panel of 18F-Cho PET/CT features with valuable association with PCa patients' outcome.

5.
Comput Biol Med ; 114: 103424, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31521896

RESUMO

Many studies have shown that epicardial fat is associated with a higher risk of heart diseases. Accurate epicardial adipose tissue quantification is still an open research issue. Considering that manual approaches are generally user-dependent and time-consuming, computer-assisted tools can considerably improve the result repeatability as well as reduce the time required for performing an accurate segmentation. Unfortunately, fully automatic strategies might not always identify the Region of Interest (ROI) correctly. Moreover, they could require user interaction for handling unexpected events. This paper proposes a semi-automatic method for Epicardial Fat Volume (EFV) segmentation and quantification. Unlike supervised Machine Learning approaches, the method does not require any initial training or modeling phase to set up the system. As a further key novelty, the method also yields a subdivision into quartiles of the adipose tissue density. Quartile-based analysis conveys information about fat densities distribution, enabling an in-depth study towards a possible correlation between fat amounts, fat distribution, and heart diseases. Experimental tests were performed on 50 Calcium Score (CaSc) series and 95 Coronary Computed Tomography Angiography (CorCTA) series. Area-based and distance-based metrics were used to evaluate the segmentation accuracy, by obtaining Dice Similarity Coefficient (DSC) = 93.74% and Mean Absolute Distance (MAD) = 2.18 for CaSc, as well as DSC = 92.48% and MAD = 2.87 for CorCTA. Moreover, the Pearson and Spearman coefficients were computed for quantifying the correlation between the ground-truth EFV and the corresponding automated measurement, by obtaining 0.9591 and 0.9490 for CaSc, and 0.9513 and 0.9319 for CorCTA, respectively. In conclusion, the proposed EFV quantification and analysis method represents a clinically useable tool assisting the cardiologist to gain insights into a specific clinical scenario and leading towards personalized diagnosis and therapy.

6.
Gland Surg ; 8(2): 123-132, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31183322

RESUMO

Acute pancreatitis (AP) represents a pancreas inflammation of sudden onset that can present different degrees of severity. AP is a frequent cause of acute abdomen and its complications are still a cause of death. Biliary calculosis and alcohol abuse are the most frequent cause of AP. Computed tomography (CT) and magnetic resonance imaging (MRI) are not necessary for the diagnosis of AP but they are fundamental tools for the identification of the cause, degree severity and AP complications. AP severity assessment is in fact one of the most important issue in disease management. Contrast-enhanced CT is preferred in the emergency setting and is considered the gold standard in patients with AP. MRI is comparable to CT for the diagnosis of AP but requires much more time so it is not usually chosen in the emergency scenario. Complications of AP can be distinguished in localized and generalized. Among the localized complications, we can identify: acute peripancreatic fluid collections (APFC), pseudocysts, acute necrotic collections (ANC), walled off pancreatic necrosis (WOPN), venous thrombosis, pseudoaneurysms and haemorrhage. Multiple organ failure syndrome (MOFS) and sepsis are possible generalized complications of AP. In this review, we focus on CT and MRI findings in local complications of AP and when and how to perform CT and MRI. We paid also attention to recent developments in diagnostic classification of AP complications.

7.
Ann Hematol ; 98(6): 1333-1339, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30891614

RESUMO

We determined the prevalence of incidental extracardiac findings (IEF) at Magnetic Resonance Imaging (MRI) potentially related to anemia and hypoxia in age- and sex-matched populations (N = 318) with thalassemia major (TM) and thalassemia intermedia (TI) enrolled in the Myocardial Iron Overload in Thalassemia network. Overall, IEFs were detected in 33.3% and 25.8% of patients with TI and TM, respectively (P = 0.114). TI and TM patients had elevated but comparable prevalence of renal, splenic and liver cysts, and vertebral hemangiomas while TI patients had a significant higher frequency of extramedullary hematopoiesis (EMH) (15.1% vs 4.4%; P = 0.002). The prevalence of total IEFs increased with advancing age. TI non-transfusion-dependent patients had a significantly lower frequency of renal cysts than TI transfusion-dependent patients (8.8% vs 26.4%; P = 0.005). The prevalence of renal cysts in the thalassemic population was significantly higher than that in the general population (19.2% vs 1.9%; P < 0.0001). Our data on renal cysts indicate a significant higher prevalence of these IEFs compared to the general population, suggesting the role of the inappropriate activation of the hypoxia-inducible factor system linked to the chronic hypoxia. The significant prevalence of IEF in thalassemia patients undergoing MRI for iron quantification should prompt the discussion of the inclusion of IEF in the MRI report.


Assuntos
Cistos/epidemiologia , Hemangioma/epidemiologia , Hematopoese Extramedular , Doenças Renais Císticas/epidemiologia , Neoplasias da Coluna Vertebral/epidemiologia , Esplenopatias/epidemiologia , Talassemia/complicações , Adulto , Distribuição por Idade , Anemia/complicações , Transfusão de Sangue , Cistos/diagnóstico por imagem , Cistos/etiologia , Feminino , Hemangioma/diagnóstico por imagem , Hemangioma/etiologia , Humanos , Hipóxia/complicações , Serviços de Informação , Quelantes de Ferro/uso terapêutico , Sobrecarga de Ferro/tratamento farmacológico , Sobrecarga de Ferro/epidemiologia , Sobrecarga de Ferro/etiologia , Itália/epidemiologia , Doenças Renais Císticas/diagnóstico por imagem , Doenças Renais Císticas/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/etiologia , Esplenopatias/diagnóstico por imagem , Esplenopatias/etiologia , Talassemia/sangue , Talassemia/terapia , Adulto Jovem
9.
Insights Imaging ; 10(1): 1, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30684056

RESUMO

The widespread use of imaging examinations has increased the detection of incidental adrenal lesions, which are mostly benign and non-functioning adenomas. The differentiation of a benign from a malignant adrenal mass can be crucial especially in oncology patients since it would greatly affect treatment and prognosis. In this setting, imaging plays a key role in the detection and characterization of adrenal lesions, with several imaging tools which can be employed by radiologists. A thorough knowledge of the imaging features of adrenal masses is essential to better characterize these lesions, avoiding a misinterpretation of imaging findings, which frequently overlap between benign and malignant conditions, thus helping clinicians and surgeons in the management of patients. The purpose of this paper is to provide an overview of the main imaging features of adrenal masses and tumor-like conditions recalling the strengths and weaknesses of imaging modalities commonly used in adrenal imaging.

10.
Diagn Interv Radiol ; 25(1): 35-41, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30644366

RESUMO

PURPOSE: We aimed to assess the association between features of epicardial adipose tissue and demographic, morphometric and clinical data, in a large population of symptomatic patients with clinical indication to cardiac computed tomography (CT) angiography. METHODS: Epicardial fat volume (EFV) and adipose CT density of 1379 patients undergoing cardiac CT angiography (918 men, 66.6%; age range, 18-93 years; median age, 64 years) were semi-automatically quantified. Clinical variables were compared between diabetic and nondiabetic patients to assess potential differences in EFV and adipose CT density. Multiple regression models were calculated to find the clinical variables with a significant association with EFV and adipose CT density. RESULTS: The median EFV in diabetic patients (112.87 mL) was higher compared with nondiabetic patients (82.62 mL; P < 0.001). The explanatory model of the multivariable analysis showed the strongest associations between EFV and BMI (ß=0.442) and age (ß=0.365). Significant yet minor association was found with sex (ß=0.203), arterial hypertension (ß=0.072), active smoking (ß=0.068), diabetes (ß=0.068), hypercholesterolemia (ß=0.046) and cardiac height (ß=0.118). The mean density of epicardial adipose tissue was associated with BMI (ß=0.384), age (ß=0.105), smoking (ß=0.088), and diabetes (ß=0.085). CONCLUSION: In a large population of symptomatic patients, EFV is higher in diabetic patients compared with nondiabetic patients. Clinical variables are associated with quantitative features of epicardial fat.


Assuntos
Tecido Adiposo/anatomia & histologia , Tecido Adiposo/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Pericárdio/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Índice de Massa Corporal , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipercolesterolemia/complicações , Hipercolesterolemia/epidemiologia , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pericárdio/patologia , Estudos Retrospectivos , Fatores de Risco
11.
Eur J Radiol ; 101: 1-7, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29571781

RESUMO

OBJECTIVE: To investigate the influence of different CT reconstruction parameters on coronary artery calcium scoring (CACS) values and reclassification of predicted cardiovascular (CV) risk. METHODS: CACS was evaluated in 113 patients undergoing ECG-gated 64-slice CT. Reference CACS protocol included standard kernel filter (B35f) with slice thickness/increment of 3/1.5 mm, and field-of-view (FOV) of 150-180 mm. Influence of different image reconstruction algorithms (reconstructed slice thickness/increment 2.0/1.0-1.5/0.8-3.0/2.0-3.0/3.0 mm; slice kernel B30f-B45f; FOV 200-250 mm) on Agatston score was assessed by Bland-Altman plots and concordance correlation coefficient (CCC) analysis. Classification of CV risk was based on the Mayo Clinic classification. RESULTS: Different CACS reconstruction parameters showed overall good accuracy and precision when compared with reference protocol. Protocols with larger FOV, thinner slices and sharper kernels were associated with significant CV risk reclassification. Use of kernel B45f showed a moderate positive correlation with reference CACS protocol (Agatston CCC = 0.67), and yielded significantly higher CACS values (p < .05). Reconstruction parameters using B30f or B45f kernels, 250 mm FOV, or slice thickness/increment of 2.0/1.0 mm or 1.5/0.8 mm, were associated with significant reclassification of CV risk (p < .05). CONCLUSIONS: Kernel, FOV, slice thickness and increment are major determinants of accuracy and precision of CACS measurement. Despite high agreement and overall good correlation of different reconstruction protocols, thinner slices thickness and increment, and sharper kernels were associated with significant upward reclassification of CV risk. Larger FOV determined both upward and downward reclassification of CV risk.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Idoso , Algoritmos , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco/métodos , Fatores de Risco
12.
Cardiovasc Diagn Ther ; 7(2): 129-150, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28540209

RESUMO

During the last decade coronary computed tomography angiography (CTA) has become the preeminent non-invasive imaging modality to detect coronary artery disease (CAD) with high accuracy. However, CTA has a limited value in assessing the hemodynamic significance of a given stenosis due to a modest specificity and positive predictive value. In recent years, different CT techniques for detecting myocardial ischemia have emerged, such as CT-derived fractional flow reserve (FFR-CT), transluminal attenuation gradient (TAG), and myocardial CT perfusion (CTP) imaging. Myocardial CTP imaging can be performed with a single static scan during first pass of the contrast agent, with monoenergetic or dual-energy acquisition, or as a dynamic, time-resolved scan during stress by using coronary vasodilator agents (adenosine, dipyridamole, or regadenoson). A number of CTP techniques are available, which can assess myocardial perfusion in both a qualitative, semi-quantitative or quantitative manner. Once used primarily as research tools, these modalities are increasingly being used in routine clinical practice. All these techniques offer the substantial advantage of combining anatomical and functional evaluation of flow-limiting coronary stenosis in the same examination that would be beneficial for clinical decision-making. This review focuses on the state-of the-art and future trends of these evolving imaging modalities in the field of cardiology for the physiologic assessments of CAD.

13.
Cardiovasc Diagn Ther ; 7(2): 171-188, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28540212

RESUMO

Myocardial infarction (MI) is a major cause of death and disability worldwide. The incidence is not expected to diminish, despite better prevention, diagnosis and treatment, because of the ageing population in industrialized countries and unhealthy lifestyles in developing countries. Nowadays it is highly requested an imaging tool able to evaluate MI and viability. Technology improvements determined an expansion of clinical indications from coronary plaque evaluation to functional applications (perfusion, ischemia and viability after MI) integrating additional phases and information in the mainstream examination. Cardiac computed tomography (CCT) and cardiac MR (CMR) employ different contrast media, but may characterize MI with overlapping imaging findings due to the similar kinetics and tissue distribution of gadolinium and iodinated contrast media. CCT may detect first-pass perfusion defects, dynamic perfusion after pharmacological stress, and delayed enhancement (DE) of non-viable territories.

14.
Eur Radiol ; 27(4): 1395-1403, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27456964

RESUMO

OBJECTIVES: Aortic distensibility and pulse-wave velocity (PWV) are under investigation as parameters by which to evaluate the indication for ascending aorta (AA) replacement. The maximum rate of systolic distension (MRSD) was proposed as a new index of aortic elasticity. The aim of this study was to assess the role of aortic elasticity parameters to predict AA growth rates in patients with AA dilation (AAD). METHODS: Magnetic resonance imaging (MRI) was performed annually in 65 patients with AA dilation (median follow-up 17 months; 25-75th percentile; range 12-30 months). A significant increase in AA diameter was defined as a ≥2-mm increase. RESULTS: An increase in AA diameter was found in 42 (68 %) patients (AAD+ group) and absent in 20. Median increase was 0.16 (25-75th percentile; range 0.32-0.7) mm/month. The AAD+ group had a lower MRSD (4.6 ± 2.2 vs 7.4 ± 2.0, p < 0.001) but the same PWV and distensibility. MRSD showed 93.7 % specificity and 75.6 % sensitivity for prediction of increase. Patients with MRSD ≤ 6 had lower progression-free survival times (p < 0.002). After a follow-up of 4.1 years, patients who underwent surgical therapy had lower MRSD and distensibility than others. CONCLUSIONS: MRSD is an index of aorta elastic properties and is a valuable predictor for progression in AAD. KEY POINTS: • MRI-derived parameters of aortic wall elasticity predict progression of ascending aorta dilation. • Maximal rate of systolic distension (MRSD) was the best predictor of progression. • Patients with MRSD ≤ 6 had lower progression-free survival (PFS) times. • Patients who underwent surgical therapy had lower MRSD and distensibility. • MRI-derived parameters identify patients with fast progression of Ascending Aorta Dilation.


Assuntos
Aorta/patologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/patologia , Elasticidade/fisiologia , Imagem por Ressonância Magnética , Aorta/fisiopatologia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Análise de Onda de Pulso , Sensibilidade e Especificidade , Sístole
15.
Radiol Med ; 122(1): 16-21, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27738787

RESUMO

OBJECTIVE: The aim of the study was to compare the atherosclerotic disease in the coronary and carotid arteries in patients who underwent non-invasive imaging for suspected stable coronary artery disease (CAD). MATERIALS AND METHODS: 107 patients (64 men, age 59 ± 12) with atypical chest pain underwent cardiac CT (CCT) and carotid ultrasound (US) on the same day. Severity (obstructive or not-obstructive disease), location, shape, and composition of atherosclerotic plaques in the two districts were evaluated. RESULTS: Patients presented normal coronary arteries in 36 % (n = 38), not-obstructive CAD in 36 % (n = 39), and obstructive CAD in 28 % (n = 30), while had normal carotid arteries in 53 % (n = 57), not-obstructive disease in 44 % (n = 47), and obstructive disease in 3 % (n = 3) (p < 0.05). The coronary plaques were located in 7 % at ostial sites, in 29 % at non-ostial sites, and in 64 % at both locations. The carotid plaques were located at the origin of the internal and external carotid arteries in 56 %, at the bifurcation in 20 %, and at both locations in 24 % (p < 0.05). Coronary plaques were calcified in 25 %, non-calcified in 19 %, and mixed in 56 %; carotid plaques were calcified in 8 %, non-calcified in 8 %, and mixed in 84 % of patients (p < 0.05). CONCLUSION: Atherosclerotic disease presents different imaging findings in the coronary tree and in the carotid district with respect to lesion severity, position along the vessel course, and composition of plaque.


Assuntos
Aterosclerose/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , Técnicas de Imagem de Sincronização Cardíaca , Meios de Contraste , Angiografia Coronária , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Iopamidol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
16.
J Comput Assist Tomogr ; 40(3): 393-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27192500

RESUMO

OBJECTIVE: The aim of our study was to evaluate the diagnostic performance of cardiac computed tomography (CCT) in the evaluation of coronary artery stenosis in patients with ascending aorta aneurysm detected at transthoracic echocardiography. METHODS: We conducted a retrospective analysis of patients with an aneurysm 45 mm or greater at transthoracic echocardiography who underwent CCT from 2012 to 2014 in our hospital. We calculated the sensitivity, specificity, and positive and negative predictive values of CCT for the assessment of coronary artery stenosis (<50% or ≥50% stenosis) in patients who underwent conventional coronary angiography. RESULTS: We included 104 patients (73 men, aged 64 [SD, 10.8] years) in our study. Obstructive coronary artery disease was found in 22.1% of patients. Sensitivity, specificity, and positive and negative predictive values of CCT for detecting significant stenoses were 100%, 98%, and 82% and 100% on a segment-by-segment analysis and 100%, 83%, and 65% and 100% on a per-patient analysis, respectively. CONCLUSIONS: Cardiac computed tomography provides a comprehensive evaluation of ascending aorta aneurysms and coronary artery tree.


Assuntos
Aorta/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Ecocardiografia , Tomografia Computadorizada por Raios X , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
17.
Br J Radiol ; 89(1062): 20150773, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26987374

RESUMO

OBJECTIVE: The aim of the study was to compare epicardial adipose tissue (EAT) characteristics assessed with coronary calcium score (CS) and CT coronary angiography (CTCA) image data sets. METHODS: In 76 patients (mean age 59 ± 13 years) who underwent CS and CTCA owing to suspected coronary artery disease (CAD), EAT was quantified in terms of density (Hounsfield units), thickness and volume. The EAT volume was extracted with a semi-automatic software. RESULTS: A moderate correlation was found between EAT density in CS and CTCA image data sets (-100 ± 19 HU vs -70 ± 24 HU; p < 0.05, r = 0.55). The distribution of EAT was not symmetrical with a maximal thickness at the right atrioventricular groove (14.2 ± 5.3 mm in CS, 15.7 ± 5 mm in CTCA; p > 0.05, r = 0.76). The EAT volume resulted as 122 ± 50 cm(3) in CS and 86 ± 40 cm(3) in CTCA (Δ = 30%, p < 0.05, r = 0.92). After adjustment for post-contrast EAT attenuation difference (Δ = 30 HU), the volume was 101 ± 47 cm(3) (Δ = 17%, p < 0.05, r = 0.92). Based on EAT volume median values, no differences were found between groups with smaller and larger volumes in terms of Agatston score and CAD severity. CONCLUSION: CS and CTCA image data sets may be equally employed for EAT assessment; however, an underestimation of volume is found with the latter acquisition even after post-contrast attenuation adjustment. ADVANCES IN KNOWLEDGE: EAT may be measured by processing either the CS or CTCA image data sets.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Adiposidade , Algoritmos , Feminino , Humanos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
18.
Circ Cardiovasc Imaging ; 8(8): e003230, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26253625

RESUMO

BACKGROUND: Cardiovascular magnetic resonance (CMR) plays a key role in the management of thalassemia major patients, but few data are available in pediatric population. This study aims at a retrospective multiparametric CMR assessment of myocardial iron overload, function, and fibrosis in a cohort of pediatric thalassemia major patients. METHODS AND RESULTS: We studied 107 pediatric thalassemia major patients (61 boys, median age 14.4 years). Myocardial and liver iron overload were measured by T2* multiecho technique. Atrial dimensions and biventricular function were quantified by cine images. Late gadolinium enhancement images were acquired to detect myocardial fibrosis. All scans were performed without sedation. The 21.4% of the patients showed a significant myocardial iron overload correlated with lower compliance to chelation therapy (P<0.013). Serum ferritin ≥2000 ng/mL and liver iron concentration ≥14 mg/g/dw were detected as the best threshold for predicting cardiac iron overload (P=0.001 and P<0.0001, respectively). A homogeneous pattern of myocardial iron overload was associated with a negative cardiac remodeling and significant higher liver iron concentration (P<0.0001). Myocardial fibrosis by late gadolinium enhancement was detected in 15.8% of the patients (youngest children 13 years old). It was correlated with significant lower heart T2* values (P=0.022) and negative cardiac remodeling indexes. A pathological magnetic resonance imaging liver iron concentration was found in the 77.6% of the patients. CONCLUSIONS: Cardiac damage detectable by a multiparametric CMR approach can occur early in thalassemia major patients. So, the first T2* CMR assessment should be performed as early as feasible without sedation to tailor the chelation treatment. Conversely, late gadolinium enhancement CMR should be postponed in the teenager age.


Assuntos
Cardiomiopatias/diagnóstico , Hemossiderose/diagnóstico , Ferro/análise , Imagem Cinética por Ressonância Magnética , Miocárdio/química , Talassemia beta/complicações , Adolescente , Fatores Etários , Cardiomiopatias/etiologia , Cardiomiopatias/metabolismo , Cardiomiopatias/fisiopatologia , Cardiomiopatias/prevenção & controle , Criança , Meios de Contraste , Feminino , Fibrose , Gadolínio DTPA , Hemossiderose/etiologia , Hemossiderose/metabolismo , Hemossiderose/fisiopatologia , Hemossiderose/prevenção & controle , Humanos , Quelantes de Ferro/uso terapêutico , Itália , Fígado/química , Masculino , Adesão à Medicação , Miocárdio/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Função Ventricular Esquerda , Função Ventricular Direita , Remodelação Ventricular , Talassemia beta/diagnóstico , Talassemia beta/tratamento farmacológico , Talassemia beta/metabolismo
19.
Abdom Imaging ; 40(6): 1700-4, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25761947

RESUMO

PURPOSE: Few studies of renal iron content have been performed with multiecho gradient-echo (ME-GRE) T2* magnetic resonance imaging (MRI). We assessed the feasibility and reproducibility of ME-GRE T2* MRI for measuring regional and global renal T2* values, and established the lower limits of normal in healthy subjects, also correlating the measured values with age and sex. METHODS: Twenty consecutive healthy subjects (13 men and 7 women, mean age 29.1 ± 7.2 years, range 19-42 years) underwent MRI examinations using a 1.5 T magnet and an ME-GRE T2* sequence. For each kidney, T2* was measured in anterior, posterolateral, and posteromedial renal parenchymal regions. The mean T2* value was calculated as the average of the two kidneys T2* values. RESULTS: For the mean kidney T2* value, the coefficients of variation for intra- and inter-operator reproducibility were 1.76% and 6.23%, respectively. The lower limit of normal for the mean kidney T2* value was 31 ms (median 51.39 ± 10.09). There was no significant difference between left and right kidney T2* values (p = 0.578). No significant correlation was found between T2* values and subjects' age or sex. CONCLUSIONS: Renal ME-GRE T2* appears to be a feasible and reproducible technique. The renal T2* values showed no dependence on sex or age.


Assuntos
Sobrecarga de Ferro/diagnóstico , Rim/patologia , Imagem por Ressonância Magnética , Adulto , Fatores Etários , Estudos de Viabilidade , Feminino , Humanos , Aumento da Imagem , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Fatores Sexuais , Adulto Jovem
20.
Radiol Med ; 120(8): 714-22, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25663567

RESUMO

PURPOSE: This study was conducted to assess the role of atrial function by cardiac magnetic resonance (CMR) for the evaluation of diastolic physiology in patients with hypertrophic cardiomyopathy (HCM) compared to healthy controls. MATERIALS AND METHODS: We enrolled 23 consecutive patients affected by HCM and 43 healthy subjects as age-matched control cases (CC). CMR was performed through acquisition of cine steady-state free precession sequences using a 1.5-T scanner. Image postprocessing was carried out using Tracking Tool software. RESULTS: Atrial volumes were significantly higher in patients with HCM compared to CC: maximum atrial volume (p = 0.007) and minimum atrial volume (p = 0.01). A statistically significant difference was also observed in atrial ejection fraction in patients with HCM (p < 0.0001). The atrial volume curves defined as cavity volume over time (dV/t) showed significant differences: early atrial peak emptying rate (PERE) (maximum rate of emptying independent of atrial contraction) in HCM was -146 ± 53 ml/s versus -227 ± 86 ml/s in CC (p < 0.0001); active atrial peak emptying rate (PERA) (maximum rate of emptying secondary to atrial contraction) in HCM was -256 ± 80 ml/s versus -216 ± 104 ml/s in CC (p = 0.05); the atrial PER E/A ratio in HCM was 0.6 ± 0.2 versus 1.05 ± 0.5 in CC (p < 0.0001). CONCLUSIONS: This study demonstrated that in HCM patients with early diastolic dysfunction the parameters of left atrial function assessed by CMR are impaired before the ventricular diastolic indexes such as the early peak filling rate and the active peak filling rate.


Assuntos
Cardiomiopatia Hipertrófica/fisiopatologia , Diástole/fisiologia , Átrios do Coração/fisiopatologia , Imagem Cinética por Ressonância Magnética , Adulto , Estudos de Casos e Controles , Meios de Contraste , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Compostos Organometálicos
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