Anatomical variants and coronary anomalies detected by dual-source coronary computed tomography angiography in North-eastern Thailand

Purpose: Congenital coronary anomalies are uncommon, with an incidence ranging from 0.17% in autopsy cases to 1.2% in angiographically evaluated cases. The recent development of dual-source coronary computed tomography angiography (coronary CTA) allows accurate and noninvasive depiction of coronary artery anomalies. Material and methods: A retrospective study included a total of 924 patients who underwent coronary CTA because of known or suspected coronary artery disease. In each study, coronary artery anomalies (CAs) were investigated. Results: A total of 924 patients (mean age 51.2 ±12.8 years), who underwent dual-source coronary CTA, were studied. The overall prevalence of CAs in our study was 3.7%, with the following distribution: four single coronary artery, 14 anomalous origin from opposite sinus of Valsalva, three absent left main, four high take-off coronary artery, three anomalous left coronary artery from pulmonary artery, and eight coronary artery fistulas. Conclusions: The present study supports the use of coronary CTA as a reliable noninvasive tool for defining anomalous coronary arteries in an appropriate clinical setting and provides detailed three-dimensional anatomic information that may be difficult to obtain with invasive coronary angiography

Reduction of radiation dose for coronary computed tomography angiography using prospective electrocardiography-triggered high-pitch acquisition in clinical routine

Purpose: To evaluate the image quality, radiation exposure, and means of application in a group of patients who underwent coronary computed tomography angiography (CCTA) performed with low-dose prospective electrocardiography (ECG)-triggered acquisition in which a standard sequence was added if the low-dose sequence did not allow reliable exclusion of coronary stenosis with respect to image quality. Material and methods: The present study was approved by the Ethics Committee of the Faculty of Medicine, and informed consent was obtained from all patients. The authors performed a retrospective review of 256 consecutive patients referred for CCTA using dual-source CT scanner (Definition FLASH, Siemens, Germany). CCTA was performed using prospective ECG-triggered high-pitch acquisition. In patients with higher heart rates (> 65 bpm) or in whom irregular heart rates were noted prior to the scan, a subsequent CCTA was performed immediately (double flash protocol). The effective radiation dose was calculated for each patient. All images were evaluated by two independent observers for quality on a four-point scale with 1 being non-diagnostic image quality and 4 being excellent. Results: Mean effective whole-body dose of CCTA was 1.6 ± 0.4 mSv (range, 0.4-5.4) for the entire cardiac examination and 0.9 ± 0.3 mSv (range, 0.4-2.8) for individual prospective ECG-triggered high-pitch CCTAs. In 27 of these patients with higher heart rates or occasional premature ventricular contractions or atrial fibrillation, subsequent CCTAs were performed immediately. The average image quality score was good to excellent with less than 1% unevaluable coronary segments. The double flash protocol resulted in a fully diagnostic CCTA in all cases. Conclusions: The prospective ECG-triggered high-pitch CCTA technique is feasible and promising in clinical routine with good to excellent image quality and minimal radiation dose. The double flash protocol might become a more robust tool in patients with higher heart rates or arrhythmia

Anatomical variants and coronary anomalies detected by dual-source coronary computed tomography angiography in North-eastern Thailand

Purpose: Congenital coronary anomalies are uncommon, with an incidence ranging from 0.17% in autopsy cases to 1.2% in angiographically evaluated cases. The recent development of dual-source coronary computed tomography angiography (coronary CTA) allows accurate and noninvasive depiction of coronary artery anomalies. Material and methods: A retrospective study included a total of 924 patients who underwent coronary CTA because of known or suspected coronary artery disease. In each study, coronary artery anomalies (CAs) were investigated. Results: A total of 924 patients (mean age 51.2 ±12.8 years), who underwent dual-source coronary CTA, were studied. The overall prevalence of CAs in our study was 3.7%, with the following distribution: four single coronary artery, 14 anomalous origin from opposite sinus of Valsalva, three absent left main, four high take-off coronary artery, three anomalous left coronary artery from pulmonary artery, and eight coronary artery fistulas. Conclusions: The present study supports the use of coronary CTA as a reliable noninvasive tool for defining anomalous coronary arteries in an appropriate clinical setting and provides detailed three-dimensional anatomic information that may be difficult to obtain with invasive coronary angiography

The value of magnetic resonance imaging in evaluation of myocardial and liver iron overload in a thalassaemia endemic population : a report from Northeastern Thailand

Purpose: Patients with chronic haemolytic anaemia, such as in thalassaemia, require repeated blood transfusions, which leads to iron overload and cellular damage, especially in the heart and liver. Classically, serum ferritin and liver biopsy have been used to monitor patient response to chelation therapy. Magnetic resonance imaging (MRI) has proven to be effective in detecting and quantifying iron in the heart and liver. The aim of the paper is to evaluate the accuracy of the MRI T2* procedure in the assessment of liver iron concentration and myocardial iron overload. Material and methods: In 210 cases of monthly transfused patients, hepatic and myocardial iron overload was measured by multi-breath-hold MRI T2* and compared to serum ferritin (a traditional marker of iron overload). Results: No significant correlation was observed between serum ferritin level and cardiac T2* MRI (p = 0.68, r = 0.06). However, a significant correlation was observed between serum ferritin and liver iron concentration evaluated by MRI (p = 0.04, r = 0.68). Conclusion: Routine evaluation of liver and heart iron content using MRI T2* is suggested to better evaluate the haemosiderosis status in thalassaemic patients

The value of dual-source multidetector-row computed tomography in determining pulmonary blood supply in patients with pulmonary atresia with ventricular septal defect

Background: Primary evaluation of patients with pulmonary atresia with ventricular septal defect (PA-VSD) traditionally relies upon echocardiography and conventional cardiac angiography (CCA). Cardiac angiography is considered the gold standard for delineation of anatomy in children with PA-VSD. Data comparing CCA and dual-source multidetector-row computed tomography angiography (MDCT) in PA-VSD patients is limited. The objective of this study was to test the hypothesis that MDCT is equivalent to CCA for anatomic delineation in these patients. Materials and methods: Twenty-eight patients with PA-VSD underwent CCA and MDCT in close proximity to each other without interval therapy. A retrospective review of these 28 patients was performed. All MDCT data of pulmonary artery morphology, major aortopulmonary collateral arteries (MAPCAs) and type of blood supply (dual vs. single supply) were evaluated by blinded experts and results were compared with CCA. Results: Twenty-eight patients had adequate size right and left pulmonary arteries (21 confluent and 7 non-confluent). Seven patients had complete absence of native pulmonary artery and 3 patients had stenosis of distal branches of pulmonary arteries; all had MAPCAs from descending thoracic aorta and/or subclavian arteries. Sensitivity, specificity, positive and negative predictive value of MDCT for detecting confluent of pulmonary arteries, absence of native pulmonary artery and stenosis of pulmonary arteries were all 100%. Moreover, accuracy of detecting MAPCAs was excellent. Conclusions: These results suggest that MDCT and CCA are equivalent in their ability to delineate pulmonary artery anatomy and MAPCAs. Dual source MDCT provides high diagnostic accuracy in evaluation of pulmonary blood supply in patients with PA-VSD and allows precise characterisation of the condition of pulmonary arteries and MAPCAs which is of paramount importance in managing patients with PA-VSD. (Folia Morphol 2018; 77, 1: 116–122)  

Dokładność diagnostyczna angiografii dwuźródłowej tomografii komputerowej w wykrywaniu zwężeń tętnic wieńcowych bez kontroli rytmu serca w porównaniu z angiografią wieńcową przeprowadzoną metodą inwazyjną

Introduction. The aim of this study was to assess the diagnostic accuracy of dual-source coronary computed tomography angiography (coronary CTA) for evaluation of coronary artery disease (CAD) in daily practice without heart rate control in comparison with invasive coronary angiography (ICA). Material and methods. Forty-five consecutive patients underwent both coronary CTA and invasive coronary angiography (ICA). The mean time span between coronary CTA and ICA was 3 ± 13 days. No beta-blockers were administered prior to the scan. All coronary CTA scans were evaluated for the presence of obstructive coronary stenosis by a blinded expert, and the results were compared with ICA. Results. Coronary CTA with diagnostic image quality in 44 of the overall 45 patients. Two vessels and three segments were non diagnostic on coronary CTA. Therefore, 132 vessels and 608 segments from 45 patients were analysed. In six of seven patients with atrial fibrillation and in all 23 patients with heart rates (HR) > 65 beat per minute, image quality was diagnostic. Mean body mass index was 23.1 ± 6 kg/m2 (range 15–35 kg/m2), mean heart rate during DSCT-CA was 70.3 ± 14.2 bpm (range 47–102 bpm), and mean Agatston score was 46 ± 22 (range 0–928). Overall sensitivity, specificity, positive and negative predictive value for evaluating CAD for detect > 50% luminal narrowing were 86.4%, 96.2%, 76%, and 95.6%, respectively, by segment. Moreover, accuracy for detecting > 70% luminal narrowing was excellent by patient, vessel, and segment. The accuracy to detect patients with coronary stenoses > 50% was not significantly different among patients with HR > 65 bpm and < 65 bpm. Conclusions. Coronary CTA performed by dual-source scanner provides high diagnostic accuracy on per-segment, -vessel and -patient analyses, independent of the HR.Wstęp. Badanie przeprowadzono w celu oceny dokładności angiografii tętnic wieńcowych wykonanej metodą dwuźródłowej tomografii komputerowej (DSCT-CA) w diagnostyce choroby wieńcowej (CAD) w warunkach rzeczywistej praktyki u chorych niestosujących leczenia kontrolującego rytm serca w porównaniu z angiografią wieńcową wykonaną metodą inwazyjną (ICA).Materiał i metody. U 45 kolejnych pacjentów wykonano angiografię tomografii komputerowej (CTA) tętnic wieńcowych oraz ICA. Średni odstęp czasowy między badaniami wynosił 3 ± 13 dni. Przed badaniem chorzy nie przyjmowali beta-adrenolityków. Wszystkie skany uzyskane w badaniu CTA były oceniane pod kątem obecności istotnych zwężeń w tętnicach wieńcowych przez specjalistę nieznającego danych pacjenta, a następnie porównywano wynik z rezultatem badania ICA.Wyniki. Diagnostyczną jakość w badaniu CTA tętnic wieńcowych uzyskano u 44 z 45 chorych. Dwa naczynia i 3 segmenty na obrazie CTA tętnic wieńcowych uznano za niediagnostyczne. Ostatecznie do analizy włączono 132 naczynia i 608 segmentów zobrazowanych u 45 chorych. Jakość obrazów była diagnostyczna u 6 spośród 7 chorych z migotaniem przedsionków i u wszystkich 23 chorych z częstotliwością rytmu serca (HR) wynoszącą ponad 65/min. Średni wskaźnik masy ciała wynosił 23,1 ± 6 kg/m2 (zakres 15–35 kg/m2), średnia częstotliwość HR w trakcie badania DSCT-CA wynosiła 70,3 ± 14,2/min (zakres 47–102), a średni wskaźnik w skali Agatstona — 46 ± 22 (zakres 0–928). Ogólnie czułość i swoistość oraz dodatnia i ujemna wartość predykcyjna w ocenie CAD w wykrywaniu ponad 50-procentowego zwężenia segmentów tętnicy wieńcowej wynosiły odpowiednio 86,4%, 96,2%, 76% i 95,6%. Ponadto stwierdzono wysoką dokładność w wykrywaniu ponad 70-procentowych zwężeń w odniesieniu do pacjentów, naczyń i segmentów. Dokładność w wykrywaniu pacjentów ze zwężeniami tętnic powyżej 50% nie różniła się istotnie między osobami z HR ponad 65/min a osobami, u których HR wynosiła mniej niż 65/min.Wnioski. Badanie CTA tętnic wieńcowych przeprowadzone za pomocą aparatu dwuźródłowego zapewnia wysoką dokładność diagnostyczną w wykrywaniu zwężeń w odniesieniu do segmentów, naczyń wieńcowych i pacjentów, niezależnie od HR

Badanie rezonansu magnetycznego serca w wykrywaniu skrzeplin wewnątrzsercowych

Introduction. The aim of our study was to compare the diagnostic accuracy achieved using different magnetic resonance(MR) techniques with the diagnostic accuracy achieved using transthoracic and transoesophageal echocardiographyto detect intracardiac thrombi.Materials and methods. Twenty-four patients with known or suspected intracardiac thrombi were examined using MRimaging and echocardiography. All MR examinations were performed on a 1.5-T MR scanner using dark-blood-preparedhalf-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences, fast imaging steady-state free precession(trueFISP) cine sequences, and inversion recovery gradient-echo fast low-angle shot (inversion recovery turbo FLASH)sequences after injection of 0.2 mmoL/kg of gadolinium diethylene triamine pentaacetic acid (myocardial delayedenhancement).Results. MR imaging and echocardiography revealed 12 thrombi as following: 2 in the right atrium, 1 in the right ventricle,3 in the left atrium, and 6 in the left ventricle. Compared with echocardiography, MR imaging revealed 3 additionalthrombi in the left ventricle; these thrombi were confirmed at surgery. All 15 thrombi appeared as filling defects on earlycontrast-enhanced inversion recovery turbo FLASH MR images. Only 7 thrombi were detected on HASTE images, and 10thrombi were seen on trueFISP images. Four thrombi showed enhancement 10–20 min after contrast material injectionand were characterised as organised clots.Conclusions. The contrast-enhanced inversion recovery turbo FLASH sequences (myocardial delayed enhancement)were superior to dark-blood-prepared HASTE and trueFISP cine MR images in revealing intracardiac thrombi. Comparedwith transthoracic echocardiography, MR imaging was more sensitive for the detection of left ventricular thrombi. Thecharacterisation of thrombi may be used to predict the risk of embolism, which is higher for subacute clots than fororganised thrombi.Wstęp. Celem pracy było porównanie dokładności diagnostycznej różnych technik badania rezonansu magnetycznego (MRI) z dokładnością diagnostyczną echokardiografii przezklatkowej i przezprzełykowej w wykrywaniu skrzeplin wewnątrzsercowych. Materiały i metody. Dwudziestu czterech chorych, u których potwierdzono lub podejrzewano skrzeplinę wewnątrzsercową, poddano badaniom metodami MRI i echokardiografii. Wszystkie badania MRI przeprowadzono za pomocą skanera MR 1,5 T, stosując następujące techniki: szybkie zmodyfikowane sekwencje echa spinowego, tak zwane sekwencje czarnej krwi — HASTE (half-Fourier acquisition single-shot turbo spin-echo); szybkie sekwencje filmowe (cine) trueFISP (fast imaging steady-state free precession) oraz sekwencje echa gradientoweg typu FLAH (fast low-angle shot) z impulsem inwersyjnym po wstrzyknięciu 0,2 mmol/kg mc. kontrastu gadolin–kwas dietylenotriaminopentaoctowy (opóźnione wzmocnienie kontrastowe miokardium). Wyniki. Obecność 12 skrzeplin ujawniono zarówno w badaniach MRI, jak i echokardiograficznych: 2 w prawym przedsionku, 1 w prawej komorze, 3 w lewym przedsionku i 6 w lewej komorze. W porównaniu z echokardiografią badania MRI pozwoliły uwidocznić 3 dodatkowe skrzepliny w lewej komorze. Obecność tych skrzeplin potwierdzono w trakcie zabiegu chirurgicznego. Wszystkie 15 skrzeplin było widocznych jako defekt napełniania komory na obrazach wczesnej fazy wzmocnienia kontrastowego sekwencji turbo FLASH z impulsem inwersyjnym. Na obrazach wykonanych techniką HASTE widocznych było tylko 7 skrzeplin, a na obrazach wykonanych techniką trueFISP — 10 skrzeplin. W przypadku 4 skrzeplin stwierdzono wzmocnienie kontrastowe 10–20 min po podaniu środka kontrastowego i scharakteryzowano je jako skrzepliny zorganizowane. Wnioski. Sekwencje turbo FLASH z impulsem inwersyjnym (opóźnione wzmocnienie kontrastowe miokardium) były bardziej skuteczne w uwidocznianiu skrzeplin wewnątrzsercowych niż obrazy uzyskane techniką ciemnej krwi HASTE i sekwencje cine trueFISP. Badania MRI cechowały się większą czułością w wykrywaniu skrzeplin umiejscowionych w lewej komorze serca. Scharakteryzowanie cech skrzepliny może być przydatne w predykcji ryzyka zatoru, które jest wyższe w przypadku skrzeplin podostrych niż skrzeplin zorganizowanych

Cardiac dysfunction in cancer survivors unmasked during exercise

Introduction: The cardiac dysfunction associated with anthracycline-based chemotherapy cancer treatment can exist sub-clinically for decades before overt presentation. Stress echocardiography, the measurement of left ventricular (LV) deformation and arterial haemodynamic evaluation have separately been used to identify sub-clinical cardiovascular (CV) dysfunction in several patient groups including those with hypertension and diabetes. The purpose of the present cross-sectional study was to determine whether the combination of these techniques could be used to improve the characterisation of sub-clinical CV dysfunction in long-term cancer survivors previously treated with anthracyclines. Materials and methods: Thirteen long-term cancer survivors (36±10 years) with prior anthracycline exposure (11±8 years post-treatment) and 13 age-matched controls were recruited. Left ventricular structure, function and deformation were assessed using echocardiography. Augmentation index was used to quantify arterial haemodynamic load and was measured using applanation tonometry. Measurements were taken at rest and during two stages of low-intensity incremental cycling.Results: At rest, both groups had comparable global LV systolic, diastolic and arterial function (all P>0.05), however longitudinal deformation was significantly lower in cancer survivors (-18±2 v -20±2, P<0.05). During exercise this difference between groups persisted and further differences were uncovered with significantly lower apical circumferential deformation in the cancer survivors (-24±5 v -29±5, -29±5 v 35±8 for first and second stage of exercise respectively, both P<0.05). Conclusion: In contrast to resting echocardiography the measurement of LV deformation at rest and during exercise provides a more comprehensive characterisation of sub-clinical LV dysfunction. Larger studies are required to determine the clinical relevance of these preliminary findings

In vivo Bioimaging as a Novel Strategy to Detect Doxorubicin-Induced Damage to Gonadal Blood Vessels

INTRODUCTION: Chemotherapy may induce deleterious effects in normal tissues, leading to organ damage. Direct vascular injury is the least characterized side effect. Our aim was to establish a real-time, in vivo molecular imaging platform for evaluating the potential vascular toxicity of doxorubicin in mice. METHODS: Mice gonads served as reference organs. Mouse ovarian or testicular blood volume and femoral arterial blood flow were measured in real-time during and after doxorubicin (8 mg/kg intravenously) or paclitaxel (1.2 mg/kg) administration. Ovarian blood volume was imaged by ultrasound biomicroscopy (Vevo2100) with microbubbles as a contrast agent whereas testicular blood volume and blood flow as well as femoral arterial blood flow was imaged by pulse wave Doppler ultrasound. Visualization of ovarian and femoral microvasculature was obtained by fluorescence optical imaging system, equipped with a confocal fiber microscope (Cell-viZio). RESULTS: Using microbubbles as a contrast agent revealed a 33% (P<0.01) decrease in ovarian blood volume already 3 minutes after doxorubicin injection. Doppler ultrasound depicted the same phenomenon in testicular blood volume and blood flow. The femoral arterial blood flow was impaired in the same fashion. Cell-viZio imaging depicted a pattern of vessels' injury at around the same time after doxorubicin injection: the wall of the blood vessels became irregular and the fluorescence signal displayed in the small vessels was gradually diminished. Paclitaxel had no vascular effect. CONCLUSION: We have established a platform of innovative high-resolution molecular imaging, suitable for in vivo imaging of vessels' characteristics, arterial blood flow and organs blood volume that enable prolonged real-time detection of chemotherapy-induced effects in the same individuals. The acute reduction in gonadal and femoral blood flow and the impairment of the blood vessels wall may represent an acute universal doxorubicin-related vascular toxicity, an initial event in organ injury