Diagnostic value of contrast-enhanced cardiac magnetic resonance in patients with acute coronary syndrome with normal coronary arteries

Purpose: To evaluate retrospectively the diagnostic value of cardiac magnetic resonance (CMR) in patients with acute coronary syndromes (ACS) with normal coronary arteries, without pre-existing comorbidities. Materials and methods: We retrospectively reviewed the contrast-enhanced (CE) CMR images of 143 patients (70 males and 73 females, mean age 63 years, age range 37–87), within a server of 1590 patients, between January 2012 and January 2014. Only patients with ACS (anginal episode lasting at least 30 min) with normal coronary arteries were included, as well as patients with serologic assay of positive troponin I (TnI) and possible changes in ECG, particularly ST elevation. All patients with a history of ACS, or chronic troponin elevation, dyslipidemia, smoking, patients with cardiomyopathies or preexisting comorbidities such as diabetes, hereditary collagenopathies, amyloidosis, sarcoidosis, hemosiderosis or other infiltrative diseases were excluded to avoid possible bias. Results: The CMR LGE pattern attributable to AMI occurred in 40/143 cases (28 %) and in particular involved only a myocardial segment (60 %). The MR pattern of acute myocarditis occurred in 16/143 (11.2 %); in 6/143 cases, Tako-Tsubo cardiomyopathy was present. Eighty-one cases out of 143 presented a CMR with no LGE, parietal edema or morphological alterations (56.6 %). Conclusion: In patients with a first episode of ACS with normal coronary arteries, in the absence of pre-existing comorbidities, CMR has a high negative predictive value, often without significant alterations. In particular, the CMR LGE for AMI is infrequent and has predominantly focal distribution. However, further multidisciplinary studies are needed to define the prognostic value of CMR

Dual energy CT and research of the bone marrow edema: Comparison with MRI imaging

Aims: To evaluate the diagnostic accuracy of the Dual Energy Computed Tomography (DECT) in the research of the bone marrow edema. Methods and Material: The MRI images of 100 patients with episodes of articular and or bone pains with or without traumatic lesion were prospectively evaluated during a period between March 2018 and February 2019. In the presence of bone marrow edema, a DECT was performed. The measurement of the density of the bone marrow edema in the DECT was compared with healthy bone in the same patient by two operators. Result: The DECT and MRI images of 15 patients with bone marrow edema were compared. The mean of pathologic bone marrow edema was 1008.20 (Standard Deviation (SD) 23.00), for healthy bone marrow 947.53 (SD 16.42), and t = 11.75, with a statistical significance P < 0.05 (Statistical significance 95%). The agreement between the measurements of the two radiologists has a statistical significance (P < 0.05). Conclusion: The DECT presents an excellent diagnostic accuracy to detect the bone marrow edema, comparable to MRI. The utility of these recent possibilities is maximum where access to MRI is still very difficult

MRI evaluation of not complicated Tailgut cyst: Case report

INTRODUCTION: The Tailgut cyst (cystic hamartoma) is an uncommon congenital disease of presacral retrorectal space and is embryologically part of some forms of enteric cysts. It is a benign malformation, although cases have been described in neoplastic degeneration. PRESENTATION OF CASE: A caucasian 24 year old female presented shortly after childbirth with hypogastric abdominal discomfort associated with rectal tenderness, bleeding and moderate urinary symptoms for about three weeks. No previous similar episodes were reported. The patient was not suffering from haemorrhoids or inflammatory disease of the gastrointestinal tract. Clinical examination revealed no significant abnormalities or in the perianal area and gluteal surface. Digital rectal examination was suspicious of the presence of a presacral retrorectal mass. However, it could not exclude a trans-sphinteric perianal fistula. There was no fistulous communication with the exterior and the pain seemed to be more pronounced in the rectum. MRI, which has a diagnostic accuracy of 76–100% for the detection of any perianal fistulae, was performed and demonstrated the presence of a retrorectal cystic hamartoma (Tailgut cyst). DISCUSSION: The most common retrorectal space cystic lesions includes epidermoid cysts, dermoid cysts and enteric cysts. It presents with pelvic pain, and sometimes with local abscess, secondary to a sinus cyst. There can also be a communication between Tailgut cyst and fistula; in the absence of primary infection may develop postinflammatory fibrosis. Radiological investigation is carried out by TRUS, CT and MRI. During MRI, on T1-weighted images, the signal intensity may change from hypointense to hyperintense as protein concentration increases, as well as in the case of bleeding. On T2-weighted images, signal intensity of mucinous fluids can decrease from highly hyperintense to hypointense with increasing protein concentration and viscosity. CONCLUSION: MRI is a non-invasive useful imaging investigation with high diagnostic accuracy when a retrorectal cyst is suspected. Despite its rarity, Tailgut cyst should be considered, both for acute complications, like infection or bleeding, and for the risk, however infrequent, of neoplastic degeneration