Cardiac MRI assessment of right ventricular function: impact of right bundle branch block on the evaluation of cardiac performance parameters.

OBJECTIVES: Right ventricular (RV) function represents a prognostic marker in patients with corrected congenital heart disease. In up to 80 % of these patients, right branch bundle block (RBBB) exists and leads to asynchronous ventricular contraction. The aim of this retrospective study was to evaluate the change of RV performance parameters considering delayed RV end-systolic contraction. METHODS: RV volumes of 33 patients were assessed twice: 1) not taking account of RBBB (group I), and 2) considering RBBB (group II). According to the RV ejection fraction (EF) for both groups, RV function was classified in different categories (>50 % = normal, 40-50 % = mildly-, 30-40 % = moderately-, <30 % = severely-reduced). RESULTS: The mean time difference between maximal systolic contraction of the septum and RV free wall was 90.7 ms ± 42.6. Consequently, RV end-systolic volume was significantly decreased in group II (p < 0.001). Accordingly, RV stroke volume and RV EF were significantly higher in group II (p < 0.001). There was also a significant change in the assessment of RV function (p < 0.02). CONCLUSIONS: RBBB induced delayed RV contraction can be detected at CMR. Ignoring the RV physiology in RBBB patients leads to a statistically significant underscoring of RV performance parameters. KEY POINTS: • Right branch bundle block leads to an asynchronous ventricular contraction • In CMR, a delayed right ventricular contraction due to RBBB can be detected • Ignoring RV physiology in RBBB patients leads to underscoring of RV performance.

CEUS in dynamicly assessing blood perfusion of hepatic alveolar echinococcosis in rats / 中国介入影像与治疗学

Objective To evaluate the value of CEUS in dynamicly assessing the blood perfusion of hepatic alveolar echinococcosis (HAE) in rats.Methods The experimentally induced secondary HAE in totally 70 rats were studied at different time periods (gth week,28th week,and 50th week) with CEUS,and compared to pathology results.Results At the 9th week,55 HAE lesions (55/70,78.57％) presented hyperechoic and the rest of 15 HAE lesions (15/70,21.43％)presented mixed echogenicity.The single or multiple vesicular structures were found as pathological feature.At later stages (28th week and 50th week),the size of lesions increased compared to 9th week with more solid structures and the calcifications found in HAE lesions.Microscopically,the fibrous tissues surrounding the lesions gradually thickened and the microvascular accumulation were visible around the lesions.The HAE lesions at the 9th week showed the ring enhancement and central septa enhancement in CEUS.The HAE lesions at the 28th week and 50th week showed combinations of no enhancement,ring enhancement,and central septa enhancement in CEUS.The ratio of edge enhancement to maximum diameter of lesions decreased with the progression (P=0.02).Conclusion The ultrasonographic features in HAE lesions become more complicated with increasing calcifications and enlarged necrosis areas with the progression.The CEUS can reveal the dynamics of blood perfusion of HAE lesions at different stages.

Diagnostic value of separated cystic lesion ultrasound and con-trast-enhanced ultrasound for multi-locular cystic renal cell carci-noma and cysts / 中国肿瘤临床

Objective: To investigate the diagnostic values of separated renal multi-locular cystic lesions color Doppler ultra-sound and contrast-enhanced ultrasound performance in multi-locular cystic renal cell carcinoma and cysts. Methods:A total of 53 pa-tients (54 lesions) with multi-locular cystic renal cell carcinoma and cysts were included in the study. The presence of carcinoma and cysts was confirmed via histopathology and tested using ultrasound. Contrast-enhanced ultrasound was applied in 24 (24 lesions) of the total number of patients, and the receiver operating characteristic (ROC) curve was used to analyze the numbers of separation, thick-ness, and type of blood flow patterns of the lesions. The contrast-enhanced ultrasound characteristics were also analyzed. We analyzed the diagnostic value of the color Doppler ultrasound in the separated renal multilocular cystic lesions and the contrast-enhanced ultra-sound performance in multi-locular cystic renal cell carcinoma and cysts. Results:Based on the analysis of the ROC curves of the sepa-ration number, thickness, and type of the blood flow of the lesions in 53 patients (54 lesions), the diagnostic specificity was relatively higher in the lesions where the separation number was≥5 strips (86%), the thicknesses were>3 and≤4 mm (95%), and blood flow was band-like (86%). The areas under the curve of the three indexes were 0.7621, 0.8331, and 0.7962, respectively, which indicate high diagnostic values. The separation number of 4 strips, the thicknesses of>2 and≤3 mm, and the point-like blood flow could be used as critical values for the diagnosis. The contrast enhancement, enhancement peak, and disappearance were (11.2 ± 3.4), (21.7 ± 3.8), and (32.1±4.0) s in 14 patients with multi-locular cystic renal cell carcinoma and (18.4±4.5), (37.8±8.0), and (51.3±9.0) s in 10 patients with multi-locular renal cysts, with statistically significant differences (t=4.47, t'=5.90, t'=6.31, respectively;P<0.05). Conclusion:The sepa-ration number, thickness, and type of blood flow of lesions have relatively higher specificity in multi-locular renal cysts than in multi-locular cystic renal cell carcinoma. The ROC curves show a high diagnostic value. Contrast-enhanced ultrasound of the lesions helped in the differential diagnosis of multi-locular cystic renal cell carcinoma and renal cysts.

Application of color Doppler ultrasonography in the acute rejection of renal transplantation / 中国医学影像技术

Objective To find the spectacular indexes in the diagnosis of acute rejection of renal transplantation with color Doppler ultrasonography. Methods Forty-two patients with renal rejection were confirmed with percutaneous needle biopsy and 115 patients with stable renal function were confirmed with following-up (>1 year) and clinical examination. The length, width, thickness, cortex thickness and resistive index (RI) of two groups were analyzed statistically. Then the specificity, sensitivity, misdiagnosis rate, false negative rate and consistency rate of renal volume, pyramid swelling, echo weakening, RI＜0.7, RI≥0.7 and RI≥0.8 were calculated. Results The length, width and thickness were statistically different in two groups (P＜0.05). In patients with renal rejection, the marginal blood vessels in renal cortex decreased, and the blood velocity reduced obviously in the diastolic phase and RI increased obviously (P＜0.05). The sensitivity of the above indexes were 55.30%, 55.20%, 42.10%, 57.90%, 31.60%, respectively, while the specificity were 71.30%, 87.10%, 25.70%, 74.20% and 98.20%, respectively. Conclusion Enlargement of renal volume, swelling of renal pyramids, echo weakening and RI increasing are specific indexes for diagnosis of acute rejection of renal transplantation.