Evaluation of left ventricle diastolic dysfunction in ischemic heart disease by CMR: Correlation with echocardiography and myocardial scarring

Objective: To detect the value of cardiac MR imaging in assessment of left ventricle diastolic function in patients with ischemic heart disease compared to echocardiography and to correlate the degree of dysfunction to the extent of myocardial scarring. Patients and methods: We examined 40 patients with known coronary artery disease. Mean patient’s age was 48 ± 10. All patients were subjected to 2D echocardiography and CMR including transmitral flow and left atrial planimetry. The degree of diastolic dysfunction was detected and correlated with the echocardiographic results and the extent of myocardial scarring. Results: On CMR, 35% of the cases had grade I diastolic dysfunction, 35% showed grade II, 15% had grade III while 15% showed normal diastolic function. CMR showed 94.12% sensitivity, 100% specificity and 95% accuracy. Excellent agreement with echocardiography was detected (Kappa coefficient 0.931). There was a significant correlation between the degree of diastolic dysfunction and the extent of myocardial scarring with Spearman’s correlation coefficient of 0.492 and p = 0.028. Conclusion: CMR has comparative results to echocardiography in assessment of diastolic dysfunction. We found a significant correlation between the degree of diastolic dysfunction and the extent of myocardial scarring

PET/CT in initial staging and therapy response assessment of early mediastinal lymphoma

Objective: To detect accuracy of PET/CT in the initial staging, response after the first line and end of treatment in early mediastinal lymphoma patients compared to contrast CT. Materials and methods: We studied 50 patients with pathologically proven lymphoma with a mean age = 27.5. All patients were at early stage. All patients performed CT and PET/CT for initial staging, after the first course of chemotherapy (after 4–6 weeks) and at the end of treatment (after 2–4 months). Results: PET/CT upstaged 5 cases. At first line of treatment, PET/CT and CECT were agreeable in 32% of cases. PET/CT showed 100% sensitivity, 96.7% specificity, 95% positive predictive value and 100% negative predictive value. At the end of treatment both methods showed a 46% agreement. PET/CT was statistically significant in the follow up of hilar and axillary lymph nodes. PET/CT showed 100% sensitivity and specificity; compared to 62.5% sensitivity and 97.6% specificity for CECT in detection of extra-nodal disease sites. Conclusion: PET/CT proved higher sensitivity and specificity over CECT. The major strength of PET/CT over CECT was its higher ability for detection of extra-nodal sites of lymphoma and excluding active disease in residual nodal mass lesions on follow up

Diagnostic value of fetal MRI in evaluating fetal urinary anomalies

Purpose: To detect the accuracy of fetal MRI in diagnosing urinary tract anomalies in comparison with ultrasonographic findings and fetal outcome. Methods: We examined 30 fetuses with sonographically suspected congenital urinary tract anomalies by 2D/3D ultrasound and MRI. The gestational age range was 18–36 weeks. 43% of the women were in the second trimester. The diagnosis was confirmed by postnatal ultrasound, cystogram and biopsy in born babies and autopsy in still born or abortus fetuses. Results: We found different urinary tract anomalies including: bilateral autosomal recessive polycystic kidney disease (n = 8), unilateral autosomal recessive polycystic kidney disease (n = 1), dilated collecting system (n = 8), renal agenesis (n = 3), bilateral enlarged multicystic dysplastic kidneys (n = 5), unilateral enlarged multicystic dysplastic kidney (n = 4) and renal dysplasia (n = 1). MRI changed the US diagnosis in 6 cases and added information in 4 cases. MRI changed the patient’s management in 3 cases. MRI confirmed US diagnosis in 20 fetuses. Ultrasound was superior to MRI in one case of renal failure. Associated extrarenal anomalies were detected in 9 cases (30%). MRI showed 96% accuracy in diagnosis. Mortality rate reached 56%. Conclusion: Fetal MR imaging may be used as a complementary modality to US in diagnosing inconclusive or equivocal fetal urinary abnormality