Relationship Between Ventricular Arrhythmias, Conduction Disorders, and Myocardial Fibrosis in Patients With Systemic Sclerosis.

BACKGROUND: Delayed-enhancement magnetic resonance imaging (DE-MRI) is a noninvasive diagnostic tool able to identify myocardial fibrosis. In patients with scleroderma, its relationship with arrhythmias and conduction disorders has not been fully explored. OBJECTIVES: The aim of this study was to evaluate the possible correlations between ventricular arrhythmias, conduction disorders, and myocardial fibrosis in patients with systemic sclerosis. METHODS: Thirty-six patients with diffuse or limited cutaneous scleroderma underwent 12-lead electrocardiogram (ECG), 24-hour Holter ECG monitoring, transthoracic echocardiography, and cardiac DE-MRI, with gadolinium administration in 33 patients. RESULTS: High-quality DE-MRI scans were obtained in 30 patients. Myocardial fibrosis was detected in 25 patients (83.3%). Eighteen patients (60%) had ventricular arrhythmias or conduction disorders. There was no significant difference in ventricular arrhythmia burden (the total number of premature ventricular contractions [PVCs]/24 hours) (48 ± 304 vs. 69 ± 236, P = 0.97), ventricular arrhythmia severity (couplets, triplets, runs) on Holter ECG, or in the presence of conduction disorders (36% vs. 40%, P = 0.86) between patients with and without myocardial fibrosis. In univariate analysis, diffuse fibrosis was weakly associated with the number of PVCs/24 hours (R = 0.157, P = 0.03). A number of at least 597 PVCs/24 hours had a sensitivity of 60% and a specificity of 92% in predicting the presence of diffuse fibrosis on DE-MRI (area under the curve = 0.640). CONCLUSIONS: Delayed-enhancement magnetic resonance imaging can identify myocardial fibrosis in a high percentage of scleroderma patients. Its presence does not seem to influence the ventricular arrhythmia burden and severity or the presence of conduction disorders, with the exception of diffuse myocardial fibrosis, which modestly influences the total number of PVCs/24 hours.

Neuroendocrine tumor of gallbladder with liver and retroperitoneal metastases and a good response to the chemotherapeutical treatment.

Neuroendocrine carcinoma of the gallbladder is an uncommon disease. We present the case of a 45-year-old woman with a mass located in the gallbladder, whose diagnosis was based on contrast-enhanced ultrasound and magnetic resonance imaging. The tumor involved the liver and retroperitoneum, and was histopathologically confirmed by liver biopsy as a neuroendocrine tumor grade 3. The patient received chemotherapy with good response, followed by surgery with cholecystectomy and partial hepatectomy.

Multi-detector row spiral CT (MDCT) in bowel related non-traumatic abdominal emergencies.

The management of the patients with acute abdomen syndrome requires an accurate and rapid diagnostic. Spiral CT is the investigation of choice in these cases because it is rapid, cost-effective and provides a global perspective of abdominal structures. Also, helical CT offers the possibility to obtain thinner contiguous images and to perform coronal or sagittal reconstruction, as well as the possibility to make the acquisitions during the different vascular phases.

Magnetic resonance imaging of bile and pancreatic ducts: a retrospective study.

PURPOSE: To assess the value of magnetic resonance in the diagnosis of pancreatobiliary ductal system changes. MATERIAL AND METHODS: The study included 103 patients (44 men, 59 women, mean age 57, age range 1 month - 91 years) with pancreatobiliary duct changes. The patients underwent a routine liver and pancreas MR imaging that included a MR cholangiopancreatography sequence. Comparison was made with findings at surgery, endoscopic retrograde cholangiopacreatography performed within 14 days, and follow-up, as a reference standard. RESULTS: The sensitivity, specificity, and accuracy of magnetic resonance for the evaluation of lithiasis were 87%, 90.2% and 89.3% respectively; 100%, 97.8%, and 98%, respectively for cholangitis; 91.6%, 96.7% and 96,1%, for bile ducts tumors; 89.4%, 97.5%, and 96%, for chronic pancreatitis; 92.3%, 97.6%, and 96.6%, for pancreatic tumors; 88.8%, 96.4% and 95.1%, for periampullary stenosis. CONCLUSION: Magnetic resonance is a reliable imaging technique for the evaluation of biliary and pancreatic ducts

CT and MR imaging of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the fifth most common tumor in the world and the incidence is expected to increase in the future due to hepatitis viral infections and increasing cirrhosis incidence. The diagnosis of HCC is no longer based on biopsy especially in cases when curative treatment is possible. The imaging criteria are usually based on the vascular findings of HCC (e.g. early arterial uptake followed by washout in the portovenous and equilibrium phase). However, there are several limitations of the assessment of HCC by using only the vascular criteria. The use of tissue-specific contrast agents, including superparamagnetic iron oxides and hepatobiliary contrast agents, improves lesion detection and characterization. Therefore, an accurate diagnosis of HCC implies, at this moment, a combination of vascular and cellular information. This review focuses on the most important findings provided by the unenhanced and dynamic-enhanced CT and MR images regarding HCC evaluation. We also discuss the various imaging characteristics of HCC at MR imaging after the administration of tissue specific contrast agents.