Radiologisen kuvantamisen perusteet

Vertaisarvioitu. Näin tutkin.Kuvantamistutkimusten tarkoituksenmukainen käyttö edellyttää kliinikolta oman alansa kuvantamistutkimusten perustuntemusta ja perehtymistä paikallisiin kuvantamiskäytäntöihin. Lähete radiologiseen kuvantamistutkimukseen toimii konsultaatiopyyntönä, ja lähetetiedot vaikuttavat tutkimuksen ajankohtaan, suunnitteluun, suorittamiseen sekä tulkintaan. Natiivikuvaus ja kaikukuvaus ovat usein hyviä ensivaiheen tutkimuksia, jotka voivat ohjata jatkotutkimuksia ja hoitoa oikeaan suuntaan, vaikkei niiden avulla aina päästäisikään diagnoosiin. Läpivalaisu-, tietokonetomografia (TT)- ja magneettikuvaukset kuuluvat pääosin erikoissairaanhoitoon, ja niistä saa toisiaan täydentävää lisätietoa. Toimenpiteisiin lähetettäessä on tärkeää kertoa potilaalle toimenpiteen kulusta ja huomioida myös veren hyytymiseen vaikuttava lääkitys. Epäselvissä tapauksissa radiologille kannattaa soittaa. Parhaimmillaan kliinikon ja radiologin välinen hyvä yhteistyö parantaa potilaan hoitoketjua ja kohtuullistaa kuvantamisen alati suurenevia kokonaiskustannuksia

Reducing cardiac implantable electronic device-induced artefacts in cardiac magnetic resonance imaging

Objectives Cardiac implantable electronic device (CIED)-induced metal artefacts possibly significantly diminish the diagnostic value of magnetic resonance imaging (MRI), particularly cardiac MR (CMR). Right-sided generator implantation, wideband late-gadolinium enhancement (LGE) technique and raising the ipsilateral arm to the generator during CMR scanning may reduce the CIED-induced image artefacts. We assessed the impact of generator location and the arm-raised imaging position on the CIED-induced artefacts in CMR. Methods We included all clinically indicated CMRs performed on patients with normal cardiac anatomy and a permanent CIED with endocardial pacing leads between November 2011 and October 2019 in our institution (n = 171). We analysed cine and LGE sequences using the American Heart Association 17-segment model for the presence of artefacts. Results Right-sided generator implantation and arm-raised imaging associated with a significantly increased number of artefact-free segments. In patients with a right-sided pacemaker, the median percentage of artefact-free segments in short-axis balanced steady-state free precession LGE was 93.8% (IQR 9.4%, n = 53) compared with 78.1% (IQR 20.3%, n = 58) for left-sided pacemaker (p < 0.001). In patients with a left-sided implantable cardioverter-defibrillator, the median percentage of artefact-free segments reached 87.5% (IQR 6.3%, n = 9) using arm-raised imaging, which fell to 62.5% (IQR 34.4%, n = 9) using arm-down imaging in spoiled gradient echo short-axis cine (p = 0.02). Conclusions Arm-raised imaging represents a straightforward method to reduce CMR artefacts in patients with left-sided generators and can be used alongside other image quality improvement methods. Right-sided generator implantation could be considered in CIED patients requiring subsequent CMR imaging to ensure sufficient image quality.Peer reviewe

Clinical experience of magnetic resonance imaging in patients with cardiac pacing devices : unrestricted patient population

Background Magnetic resonance imaging (MRI) in patients with cardiac pacing devices has become available despite previously being considered absolutely contraindicated. However, most institutional safety protocols have included several limitations on patient selection, leaving MRI unavailable for many patients. Purpose To evaluate the first 1000 MRI examinations conducted on patients with cardiac pacing devices at Helsinki University Hospital for any potential safety hazards and also to evaluate the long-term functionality of the safety protocol in "real-life" clinical practice. Material and Methods A total of 1000 clinically indicated MRI scans were performed with a 1.5-T MRI scanner according to the safety protocol. The following information was collected from the electronic medical record (EMR): patients' date of birth; sex; pacing device generator model; date of MRI scan; date of the latest pacing device generator implantation; and the body region scanned. The EMR of these patients was checked and especially searched for any pacing device related safety hazards or adverse outcomes during or after the MRI scan. Results Only one potentially dangerous adverse event was noted in our study group. In addition, patients with abandoned leads, temporary pacing devices, and newly implanted pacing device generators were scanned successfully and safely. Conclusion MRI scans can be performed safely in patients with cardiac pacing devices if the dedicated safety protocol is followed.Peer reviewe

Cardiac Magnetic Resonance Imaging-Based Screening for Cardiac Sarcoidosis in Patients With Atrioventricular Block Requiring Temporary Pacing

Background Some myocardial diseases, such as cardiac sarcoidosis, predispose to complete atrioventricular block. The European Society of Cardiology Guidelines on cardiac pacing in 2021 recommend myocardial disease screening in patients with conduction disorder requiring pacemaker with multimodality imaging, including cardiac magnetic resonance (CMR) imaging. The ability of CMR imaging to detect myocardial disease in patients with a temporary pacing wire is not well documented. Methods and Results Our myocardial disease screening protocol is based on using an active fixation pacing lead connected to a reusable extracorporeal pacing generator (temporary permanent pacemaker) as a bridge to a permanent pacemaker. From 2011 to 2019, we identified 17 patients from our CMR database who underwent CMR imaging with a temporary permanent pacemaker for atrioventricular block. We analyzed their clinical presentations, CMR data, and pacemaker therapy. All CMRs were performed without adverse events. Pacing leads induced minor artifacts to the septal myocardial segments. The extent of late gadolinium enhancement in CMR imaging was used to screen patients for the presence of myocardial disease. Patients with evidence of late gadolinium enhancement underwent endomyocardial biopsy. If considered clinically indicated, also 18-F-fluorodeoxyglucose positron emission tomography and extracardiac tissue biopsy were performed if sarcoidosis was suspected. Eventually, 8 of 17 patients (47.1%) were diagnosed with histologically confirmed granulomatous inflammatory cardiac disease. Importantly, only 1 had a previously diagnosed extracardiac sarcoidosis at the time of presentation with high-degree atrioventricular block. Conclusions CMR imaging with temporary permanent pacemaker protocol is an effective and safe early screening tool for myocardial disease in patients presenting with atrioventricular block requiring immediate, continuous pacing for bradycardia.Peer reviewe

Inter- and Intra-Observer Variability and the Effect of Experience in Cine-MRI for Adhesion Detection

Cine-MRI for adhesion detection is a promising novel modality that can help the large group of patients developing pain after abdominal surgery. Few studies into its diagnostic accuracy are available, and none address observer variability. This retrospective study explores the inter- and intra-observer variability, diagnostic accuracy, and the effect of experience. A total of 15 observers with a variety of experience reviewed 61 sagittal cine-MRI slices, placing box annotations with a confidence score at locations suspect for adhesions. Five observers reviewed the slices again one year later. Inter- and intra-observer variability are quantified using Fleiss’ (inter) and Cohen’s (intra) κ and percentage agreement. Diagnostic accuracy is quantified with receiver operating characteristic (ROC) analysis based on a consensus standard. Inter-observer Fleiss’ κ values range from 0.04 to 0.34, showing poor to fair agreement. High general and cine-MRI experience led to significantly (p < 0.001) better agreement among observers. The intra-observer results show Cohen’s κ values between 0.37 and 0.53 for all observers, except one with a low κ of −0.11. Group AUC scores lie between 0.66 and 0.72, with individual observers reaching 0.78. This study confirms that cine-MRI can diagnose adhesions, with respect to a radiologist consensus panel and shows that experience improves reading cine-MRI. Observers without specific experience adapt to this modality quickly after a short online tutorial. Observer agreement is fair at best and area under the receiver operating characteristic curve (AUC) scores leave room for improvement. Consistently interpreting this novel modality needs further research, for instance, by developing reporting guidelines or artificial intelligence-based methods

Magnetic resonance imaging in patients with cardiac implantable electronic devices : safety and image quality

Recently, several extensive studies have shown that magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices (CIEDs) can be performed safely if a dedicated safety protocol is followed. Still, there is a lack of comprehensive data on MRI safety in certain subgroups of CIED patients, such as patients with epicardial pacing leads and patients requiring temporary pacing. MRI examinations in CIED patients have been performed at Meilahti Helsinki University Hospital (HUH) since 2011 following the HUH’s MRI in CIED patients safety protocol. Patients with abandoned pacing leads and epicardial pacing leads have been permitted in MRI after a case-by-case evaluation. This study aimed to investigate the MRI safety and image quality (IQ) in CIED patients at HUH between November 2011 and October 2019. During the study timeframe, 2338 MRI examinations were performed on CIED patients. Several relevant observations were made. Firstly, the first 1000 MRI scans at HUH were performed safely, and only one potentially catastrophic adverse event was noted. This was due to an unintended change in the pacing mode during MRI in a pacemaker-dependent patient. Secondly, no harm was detected related to MRI in CIED patients with modern (implanted in 2000 or later) functioning epicardial pacing leads. One definite adverse event – a transient elevation of the pacing threshold – related to the MRI was noted in a patient with an old functioning epicardial pacing lead (implanted before the year 2000). Thirdly, this study revealed that cardiac magnetic resonance (CMR) imaging can be performed without adverse events in patients presenting with bradycardic atrioventricular block (AVB) requiring urgent pacing using an active fixation pacing lead connected to an extracorporeal generator (temporary permanent pacemaker [TPPM]). The CMR IQ remained diagnostic, and the myocardial disease screening in this population revealed granulomatous inflammatory cardiac disease in 47.1% of the patients. Lastly, we found that a right-sided generator implantation reduced the CIED-induced artefacts overlaying the left ventricular myocardium on the CMR images compared to a left-sided generator implantation. In patients with a left-sided generator, raising the arm on the side of the generator during the CMR scanning improved the IQ in several sequences compared to an ‘arm-down’ scanning. In conclusion, MRI in CIED patients can be performed safely by following the dedicated safety protocol. Additionally, MRI may be safe in patients with modern functioning epicardial pacing leads. The CMR-based myocardial disease screening in patients with AVB using TPPM is safe, and the IQ remains diagnostic. The arm-raised CMR scanning position may improve the IQ in patients with a left-sided generator.Useat laajat tutkimukset ovat osoittaneet, että sydämentahdistinpotilaiden magneettikuvaus (MK) on turvallista, mikäli sovittua turvallisuustoimintamallia noudatetaan. MK:n turvallisuudesta ei kuitenkaan ole kattavaa tietoa tietyissä alaryhmissä, kuten potilailla, joilla on väliaikainen sydämentahdistin tai sydämen pinnalle asennettavat, epikardiaaliset tahdistinjohdot. Helsingin yliopistollisen sairaalan Meilahden yksikössä tahdistinpotilaiden MK:t aloitettiin marraskuussa 2011 ja turvallisuustoimintamalli luotiin radiologian ja kardiologian yksiköiden läheisessä yhteistyössä. Tässä retrospektiivisessä asiakirjatutkimuksessa selvitimme sydämentahdistinpotilaiden MK:n turvallisuutta ja kuvanlaatua Meilahden yksikössä vuosina 2011–2019. Tarkastelujakson aikana tahdistinpotilaille tehtiin 2338 MK:ta. Havaitsimme, että tahdistinpotilaiden MK:een liittyvät haittatapahtumat ovat harvinaisia, kun turvallisuustoimintamallia noudatetaan. Vain yksi mahdollisesti vaarallinen haittatapahtuma havaittiin ensimmäisen tuhannen MK:n tarkastelussa. Tämä oli tahdistimen asetusten odottamaton muutos MK:n aikana tahdistinriippuvaisella potilaalla. MK:een liittyviä haittatapahtumia ei havaittu myöskään tahdistinpotilailla, joilla oli nykyaikainen, vuonna 2000 tai sen jälkeen, asennettu epikardiaalinen tahdistinjohto. Yhdellä potilaalla, jolla oli vanha, ennen vuotta 2000 asennettu, epikardiaalinen tahdistinjohto, havaittiin ohimenevä tahdistuskynnyksen nousu MK:n jälkeen. Haittatapahtumia ei havaittu sydämen MK:iin liittyen potilailla, joilla oli sydämen hidaslyöntisyyden ja eteis-kammiokatkoksen vuoksi väliaikaisesti asennettu aktiivikiinnitteinen tahdistinjohto ja kehon ulkoinen tahdistingeneraattori. Tässä potilasryhmässä väliaikainen tahdistin ei heikentänyt sydämen MK:n diagnostista arvoa, ja granulomatoottinen tulehduksellinen sydänsairaus todettiin merkittävällä osalla potilaista (47,1 %). Havaitsimme, että sydämen MK:n laatu oli parempi potilailla, joilla on oikeanpuoleinen tahdistingeneraattori verrattuna vasemmanpuoleiseen. Tahdistingeneraattorin siirtäminen etäämmälle sydämestä nostamalla generaattorin puoleinen yläraaja pään viereen sydämen MK:n ajaksi paransi kuvanlaatua potilailla, joilla oli vasemmanpuoleinen generaattori. Yhteenvetona voidaan todeta, että tahdistinpotilaiden MK on turvallista, kun turvallisuustoimintamallia noudatetaan. Lisäksi MK voi olla turvallista potilailla, joilla on nykyaikaiset ehjät, toimivat epikardiaaliset tahdistusjohdot. Tahdistingeneraattorin implantaatiota oikealle voidaan harkita potilaille, jotka tarvitsevat toistuvia sydämen MK:ia. Käsivarren kohottaminen parantaa sydämen MK:n laatua potilailla, joilla on vasemmanpuoleinen generaattori

One-Year Follow-up Study Detects Myocardial Changes with Cardiovascular Magnetic Resonance Tagging in Active Rheumatoid Arthritis

RATIONALE AND OBJECTIVES: To evaluate the effects of 1 year of medical treatment on myocardial function in active rheumatoid arthritis (RA). MATERIALS AND METHODS: Thirty-nine female patients with RA without any known cardiovascular disease underwent a cardiovascular magnetic resonance (CMR) examination before and after 1 year of antirheumatic treatment. The population comprised untreated active early RA (ERA) and chronic RA patients, who were grouped accordingly. The CMR protocol included volumetric determinations, late gadolinium enhancement imaging, myocardial tagging, and native T1 mapping. DAS28-CRP disease activity scores were calculated before and after the treatment. RESULTS: Results are reported as median (quartile 1-quartile 3). Time to peak diastolic filling rate improved in ERA (495 [443-561] ms vs 441 [340-518] ms, P = .018). Peak diastolic mean mid short-axis circumferential strain rate of all six segments was improved (82 [74-91] %/s vs 91 [77-100] %/s, P = .05), particularly in the anterior segment (82 [63-98] %/s vs 86 [77-109] %/s, P = .013). DAS28-CRP decreased in ERA (3.8 [3.2-4.1] vs 1.6 [1.4-2.2], P < .001). In chronic RA, no statistically significant improvement was detected. CONCLUSIONS: Early treatment of active RA is important, as myocardial function detected with CMR tagging improved in ERA in parallel with decreasing inflammatory activity.Peer reviewe

Cardiac magnetic resonance -detected myocardial injury is not associated with long-term symptoms in patients hospitalized due to COVID-19

Peer reviewe

Associations Between Engagement with the BitHabit Digital Lifestyle Intervention and Changes in Type 2 Diabetes Risk Factors

Type 2 diabetes (T2D) can be prevented or delayed through a healthy lifestyle. Digital behavior change interventions (DBCIs) may offer cost-effective and scalable means to support lifestyle changes. This study investigated associations between user engagement with a habit-formation-based DBCI, the BitHabit app, and changes in T2D risk factors over 12 months in 963 participants at risk of T2D. User engagement was characterized by calculating use metrics from the BitHabit log data. User ratings were used as a subjective measure of engagement. The use metrics and user ratings were the strongest associated with improvements in diet quality. Weak positive associations were observed between the use metrics and changes in waist circumference and body mass index. No associations were found with changes in physical activity, fasting plasma glucose, or plasma glucose two hours after an oral glucose tolerance test. To conclude, increased use of the BitHabit app can have beneficial impacts on T2D risk factors, especially on diet quality.Non peer reviewe