Base-to-apex gradient pattern of cardiac impairment identified on myocardial T1 mapping in cardiac amyloidosis

Late gadolinium enhancement imaging by cardiac magnetic resonance imaging (CMR) is the most reliable method for identifying cardiac involvement in patients with amyloidosis, and myocardial T1 mapping is a novel CMR technique that enables the noninvasive detection and quantification of myocardial amyloid burden. Although, base-to-apex gradient patterns of impairment in patients with cardiac amyloidosis have been reported on myocardial strain analysis using echocardiography, we could not find any other reports to demonstrate that myocardial T1 mapping on CMR can clearly identify a base-to-apex gradient pattern of cardiac impairment in a patient with cardiac amyloidosis. Keywords: Cardiac amyloidosis, Myocardial T1 mapping, Myocardial extracellular volume, Base-to-apex gradien

Advanced parametric imaging for evaluation of Crohn's disease using dual-energy computed tomography enterography

We describe a case of small bowel Crohn's disease in which dual-energy computed tomography enterography using dual-layer spectral detector scanner contributed to quantitative assessment, and provided a higher degree of confidence pertaining to the diagnosis. Dual-layer spectral detector computed tomography enables retrospective analysis including virtual monochromatic imaging, iodine mapping, and determining the effective atomic number Z with routine scan protocols. These advanced parametric dual-energy imaging holds promising potential as an imaging biomarker for diagnosis, risk-stratification, monitoring of disease progression and therapy, and outcome prediction. Keywords: Crohn's disease, CT enterography, Dual-energy C

Basal septal perforator vein mimicking the “late iodine enhancement” in delayed phase cardiac CT for myocardial scar assessment

Delayed-phase cardiac CT is a useful tool for scar detection, based on differences in the volume of distribution of iodine. Although it covers the entire heart, provides uniform, high isotropic spatial resolution, and therefore may be useful for detecting small late iodine enhancement (LIE), we need to correctly differentiate small LIE and pseudo-lesions mimicking LIE. In this case report, we demonstrate basal septal perforator vein mimicking LIE in delayed phase cardiac CT. Left ventricular myocardium includes not only septal vein and artery but also capillaries, arterio- and venoluminal vessels, and sinusoids, etc. which connect to septal veins. To avoid misinterpretations of myocardial LIE on the delayed phase images, we need to understand those anatomical features. Keywords: Delayed iodine CT, Late iodine enhancement, Myocardial infarction, Myocardial scar, Septal perforator vei

Pulmonary arterial hypertension associated with portal hypertension: Noninvasive comprehensive assessment using computed tomography

Pulmonary arterial hypertension associated with portal hypertension, known as portopulmonary hypertension (PoPH) is one of the important and serious pulmonary complications in patients with portal hypertension. Although there are a large number of patients with portal hypertension due to mainly liver cirrhosis, the number of cases diagnosed with PoPH are far fewer because the causes of dyspnea in patients with cirrhosis are diverse and the disease entity of PoPH is poorly recognized by clinicians. We report here the case with PoPH suggested and assessed comprehensively by dual energy computed tomography (CT) including high-resolution pulmonary CT angiography, pulmonary perfusion imaging, myocardial late iodine enhancement imaging, and myocardial extracellular volume analysis. This refined CT imaging protocol can be used in conjunction with standard chest evaluation and offers a practical and useful approach for the noninvasive “one-stop shop” evaluation of PoPH