Validation of cardiac magnetic resonance tissue tracking in the rapid assessment of RV function: a comparative study to echocardiography.

AIM: To investigate the accuracy of cardiac magnetic resonance (CMR) tissue tracking (CMR-TT) and speckle tracking echocardiography (STE) against CMR determined right ventricular (RV) ejection fraction (RVEF) and to identify an optimal cut-off value for STE and CMR-TT to determine RVEF <45% and compare this to other conventional methods for estimating RVEF in dilated cardiomyopathy (DCM) patients. MATERIALS AND METHODS: Twenty-nine DCM patients were recruited prospectively. CMR and echocardiography were performed within 48 hours and four-chamber views were used for strain analysis. Contoured CMR short axis images provided RVEF. Intraclass correlation coefficient (ICC), bias, levels of agreement, and receiver operating characteristic (ROC) curve analyses were performed. RESULTS: CMR-TT RV free-wall longitudinal strain (FLS) and STE RV global longitudinal strain (GLS) showed the best correlation with RVEF (r=-0.68, r=-0.82, p<0.001 respectively). There was moderate correlation between echocardiography RV GLS and CMR RV FLS (r=0.64, p<0.001). CMR-TT FLS showed excellent intra-observer and interobserver reliability (ICC=0.980; ICC=0.968 respectively). STE GLS correlated better with RVEF than with peak systolic annular velocity (S'; r=0.45), tricuspid annular plane systolic excursion (TAPSE; r=0.56), and fractional area change (FAC; r=0.78). CMR-TT RV FLS had better correlation with RVEF than CMR TAPSE (r=0.69 versus 0.40). ROC analysis demonstrated the optimal cut-off value for CMR-TT RV FLS and STE GLS in detection of RVEF <45% was ≥-24.4% (area under the curve=0.87, 100% sensitivity, 66.7% specificity) and ≥-20.9% (area under the curve=0.88, 100% sensitivity, 60% specificity) respectively. CONCLUSION: CMR-TT FLS and STE GLS showed potential to provide rapid assessment of RV function and had superior correlation with RVEF compared to conventional parameters.

[Needle tract implantation of hepatocellular carcinoma after sonographically guided percutaneous needle biopsy].

We reported a case of hepatocellular carcinoma (HCC) with needle tract implantation of the right thoracic wall, which were strongly suspected to have been caused by percutaneous needle biopsy performed at the former hospital to diagnose HCC in September 2001. He visited our hospital at his age of 68 and underwent transcatheter arterial embolization in February 2002. In November 2007, a right 9th intercostal tumor measuring 20 x 15 mm was found on his computed tomography (CT) scan. He underwent resection of the right thoracic wall tumor in January 2008. Pathological diagnosis of the tumor was well differentiated HCC. Twenty one months after surgery, he remains alive without recurrence.

Micro-explosion cystolithotripsy.

According to the newly established method of micro-explosion lithotripsy, a cystolithotriptor with an explosive catheter, the tip of which was charged with 5 mg. lead azide explosives, was developed. In 3 clinical cases bladder stones from 32 to 65 mm. in diameter were crushed successfully into several fragments by 1 to 8 explosions using the cystolithotriptor. The fragments then were smashed into grains with Young's cystoscope and washed out by aspiration. This success may prove the usefulness of micro-explosion lithotripsy, which also may be introduced for the treatment of calculi in other organs in the future.