Diffuse myocardial fibrosis in patient with diabetes mellitus type-II assessed by Cardiac Magnetic Resonance T1 mapping technique

Purpose: Diabetic cardiomyopathy (DCM) can be cause of a progressive dysfunction of ventricular contractility with the evolution to heart failure, independently of ischaemic heart disease or hypertension. Early stages of DCM are asymptomatic and characterized by various degrees of myocardial fibrosis. Our aim is to non-invasively detect myocardial fibrotic infiltration in DM-II patients, to assess its relationship with ventricular function abnormalities and to compared our results with a group of healthy controls. Methods and Materials: 100 patients affected by DM-II (57 man, 43 women) with preserved ventricular function and no history of ischaemic disease and 20 matching controls underwent contrast cardiac MR (CMR) between September 2014 and July 2017. Imaging protocol included: modified Look-Locker sequence before and 20 minutes after a double dose of 0.1 mmol/kg gadoterate meglumine injection; T2-mapping; ventricular function module; tagged-cineMR module and late gadolinium enhanced (LGE) imaging. Native myocardial T1 (nT1) and T2 values, extracellular volume fraction (ECV), ventricular torsion angle and myocardial strain values have been calculated and correlated to glycated haemoglobin (HbA1c) and duration of disease. Pearson Correlation, Mann-Whitney test and unpaired T-test were used for statistical analysis. Results: Patient group had higher nT1 and ECV values compared to controls (1018.29±73.28 ms vs.975±38 ms, 29.2±0.07% vs. 22.8±4.3% respectively, p<0.05 for both), whereas no significant differences occurred in T2 measurements (47.61±2.7ms vs. 47.0±2.8ms respectively, p=0.23). nT1 and ECV correlated with HbA1c (nT1: r2=0.99, p<0.0001; ECV: r2=0,07; p<0.005) and disease duration (nT1: r2=0.99, p<0.0001;ECV: r2=0,70 p<0,001) in DM-II patients. nT1 and ECV correlate positively torsion (nT1: r2=0.31, p<0.001; ECV: r2=0.30;p<0.001) and negatively with strain values in tagged-cineMR analysis (nT1 with global longitudinal and circunferential strain: both r2=-0.97, p<0.0001; ECV: r2=0.63 and r2=0.76, p<0.0001). LGE with ischemic pattern was found in eight patients as marker of silent infarction. Conclusion: In DM-II patients with preserved ventricular function, HbA1c values and disease duration showed a significant correlation to myocardial nT1 and ECV increase, as reflection of diffuse fibrosis, and geometrical modification

Characterization of COVID-19-related lung involvement in patients undergoing magnetic resonance T1 and T2 mapping imaging: a pilot study

Tissue characterization by mapping techniques is a recent magnetic resonance imaging (MRI) tool that could aid the tissue characterization of lung parenchyma in coronavirus disease-2019 (COVID-19). The aim of the present study was to compare lung MRI findings, including T1 and T2 mapping, in a group of n = 11 patients with COVID-19 pneumonia who underwent a scheduled cardiac MRI, and a cohort of healthy controls. MRI scout images were used to identify affected and remote lung regions within the patients’ cohort and appropriate regions of interest (ROIs) were drawn accordingly. Both lung native T1 and T2 values were significantly higher in the affected areas of patients with COVID-19 as compared to the controls (1375 ms vs. 1201 ms, p = 0.016 and 70 ms vs. 30 ms, p &lt; 0.001, respectively), whereas no significant differences were detected between the remote lung parenchyma of the COVID-19 patients and the controls (both p &gt; 0.05). When a larger ROI was identified, comprising the whole lung parenchyma within the image irrespective of the affected and remote areas, the COVID-19 patients still retained higher native T1 (1278 ms vs. 1149 ms, p = 0.003) and T2 values (38 ms vs. 34 ms, p = 0.04). According to the receiver operator characteristics curves, the T2 value of the affected region retained the higher accuracy for the differentiation of the COVID-19 patients against the controls (area under the curve 0.934, 95% confidence interval 0.826–0.999). These findings, possibly driven by the ability of MRI tissue mapping to detect ongoing inflammation in the lungs of patients with COVID-19, suggest that T1 and T2 mapping of the lung is a feasible approach in this clinical scenario

T1 and T2 Mapping in Uremic Cardiomyopathy: An Update

Uremic cardiomyopathy (UC) is the cardiac remodelling that occurs in patients with chronic kidney disease (CKD). It is characterised by a left ventricular (LV) hypertrophy phenotype, diastolic dysfunction and generally preserved LV ejection fraction. UC has a major role mediating the increased rate of cardiovascular events, especially heart failure related, observed in patients with CKD. Recently, the use of T1 and T2 mapping techniques on cardiac MRI has expanded the ability to characterise cardiac involvement in CKD. Native T1 mapping effectively tracks the progression of interstitial fibrosis in UC, whereas T2 mapping analysis suggests the contribution of myocardial oedema, at least in a subgroup of patients. Both T1 and T2 increased values were related to worsening clinical status, myocardial injury and B-type natriuretic peptide release. Studies investigating the prognostic relevance and histology validation of mapping techniques in CKD are awaited

Four-dimensional cardiac computed tomography in mitral valve endocarditis obstructing the left ventricle outflow tract

[No abstract available

Alternatives to surgery for the treatment of myomas

Uterine fibroids are benign neoplasms that can cause distressing symptoms in women during their reproductive age. They are often associated with menorrhagia that can determine anemia or bulk-related symptoms. Different treatment options are available: medical therapy has the goal to treat related symptoms, while semi-invasive or non-invasive uterus-sparing procedures aim to treat symptoms and eventually to determine a reduction in fibroids size. In this review we illustrate the current semi-invasive and totally non-invasive most frequently used uterus sparing procedures available. A review of the literature along with personal experience will offer the readers a panoramic view of these up-to-date treatments to be considered as different possibilities to treat women affected by uterine fibroids looking for uterus conserving non-surgical approach

Circumflex coronary artery-coronary sinus fistula: computed tomography angiography imaging

[No abstract available

Heart and lung fibrosis in a patient with COVID-19-related myocarditis

A COVID-19 patient, in whom pneumonia lesions were first detected by chest computed tomography, was further evaluated by cardiac magnetic resonance (CMR) due to a suspected myocarditis. Beyond heart alterations, CMR revealed peculiar features of affected pulmonary areas in T1 mapping sequences and showed a particular distribution of late gadolinium enhancement in the same regions. The noninvasive assessment of the cellular, fluid, or fibrotic content of lung lesions may provide key information about the underlying pathophysiological pathways in the search of a tailored medical therapy and ventilatory support for COVID-19 patients

Heart and lung involvement detected by native T1 and T2 mapping magnetic resonance imaging in a patient with coronavirus disease-19

A 57-year-old woman was presented to our coronavirus disease-2019 (COVID-19) dedicated coronary care unit following chest pain, fever, and concomitant increased high-sensitivity cardiac troponin