Imaging decisions (Berlin, Germany)最新文献

Malignant lymphomas represent a diverse range of diseases with exceedingly different behaviour. The common clinical denominator, however, is necessary for correct staging and reliable monitoring of therapy. Many reports on the usefulness of 18F-fluoro-deoxy-glucose positron emission tomography (18F-FDG-PET) in staging and follow-up of lymphomas have been published with very promising results. The aim of this review was to highlight the impact of 18F-FDG-PET with respect to the distinct lymphoma entities. The possible future role of PET/computed tomography (CT) is tersely mentioned. Reviewing the literature regarding 18F-FDG-PET according to the WHO classification of lymphomas found the method to be highly reliable in Hodgkin's lymphoma (HL), and especially useful in therapy monitoring in HL patients. Promising data have also been published on follicular lymphoma in spite of its indolent nature, and for the aggressive diffuse large B-cell lymphoma 18F-FDG-PET should be considered standard in assessment of response. For marginal zone lymphoma, especially its common extranodal variant (mucosa-associated lymphoid tissue lymphoma) 18F-FDG-PET results are varying, and the method cannot be recommended for uncritical widespread use in the clinical practice. For the less common lymphoma entities, only few results could be found, but they were nevertheless promising for mantle cell lymphoma (MCL). More mature data are nevertheless still needed to judge the use of 18F-FDG-PET in MCL.

Wall motion imaging with cardiac magnetic resonance imaging (CMR) provides important functional information about global and regional myocardial function. This review will give an overview of the current state of myocardial wall motion imaging, especially focusing on the clinical role of dobutamine stress CMR in ischaemic heart disease. Dobutamine stress CMR provides functional information on the myocardium under conditions of pharmacologically induced stress. High-dose dobutamine is used for wall motion analysis of the left ventricle. Wall motion abnormalities are indicative of myocardial ischaemia and occur in the ischaemic cascade before the onset of chest pain and ECG abnormalities. As a result of technological advances, dobutamine stress CMR has evolved towards a very accurate cardiac stress test. The current state of dobutamine stress CMR allows us to obtain cine MR images with high spatial and temporal resolution in rest and during stress. The use of myocardial tagging has improved the diagnostic accuracy even further. The addition of first-pass perfusion imaging at peak dose dobutamine might enhance accuracy even more. Besides being able to detect myocardial ischaemia, low-dose dobutamine can be used to assess myocardial viability. With these capabilities, viability, wall motion and myocardial perfusion can be assessed in a single examination. The safety and feasibility of dobutamine stress CMR has been proven. The technique and clinical implications are discussed.

Myocardial perfusion imaging (MPI) using nuclear techniques is a well-established diagnostic tool in the management of patients after acute coronary syndromes (ACS) or acute myocardial infarction (AMI) providing non-invasively information about perfusion and function. Single photon emission computed tomography (SPECT) is routinely applied for MPI allowing the characterization of localization, extent and severity of perfusion abnormalities. Gated SPECT MPI is a technique that can accurately define the individual patient risk among clinically stable survivors of AMI, assessing the total left ventricular (LV) perfusion defect size, the extent of inducible ischaemia and the degree of LV dysfunction. The documented prognostic value of these scintigraphic parameters is of clinical importance to guide decision making in the cardiac patient. Moreover, the cost effectiveness of implemented MPI in the work-up of patients after AMI has been demonstrated. Metabolic imaging with F-18 deoxyglucose positron emission tomography (PET) is currently the most advanced scintigraphic imaging technique developed for in vivo assessment of tissue viability, providing clinical valuable information about the presence and extent of viable myocardium in patients with coronary artery disease. Whether this technique will be valuable for patients with ACS or AMI has not been established, yet. However, PET technology offers fascinating opportunities to investigate the distinct pathophysiological pathways in acute and chronic cardiac disease. Imaging of stunning in Takotsubo cardiomyopathy is an example of how nuclear medicine techniques contribute to the understanding of cardiac disease.

This review article highlights the different approaches of adenosine perfusion techniques and the current clinical status of this technique in the work-up of patients suspected for myocardial ischemia. Different scenarios including stress-perfusion, rest-perfusion and delayed-enhancement are discussed.

There is a growing consensus to recognize the role of cardiac magnetic resonance (MR) imaging in the diagnosis of myocarditis. The most characteristic finding is the presence of subepicardial enhancing areas in the inferior and lateral walls in delayed-enhanced MR sequences. Segmental wall motion abnormality may be present in the myocardial segments that can be different from those exhibiting the myocardial damage in delayed enhancement sequence. These MR features provide accurate information on the type of myocardial involvement, and probably are able to assess the severity of the disease. Moreover, these MR patterns as well as others may distinguish acute myocarditis from acute myocardial infarct, both on first-pass perfusion images and on delayed-enhancement images. Recent improvements of computerized tomography (CT) make it a challenging method for cardiac MR to assess myocarditis. By providing similar results in terms of myocardial involvement, and by adding information on coronary arteries, ECG-gated MDCT could be a useful alternative non-invasive diagnostic test in the early phase of acute myocarditis.

Life-threatening and prevalent causes of acute chest pain can be ruled out by nuclear medicine techniques. Among them acute coronary syndromes (ACS), acute myocardial infarction (AMI) or suspected pulmonary embolism (PE) are the main indications for the use of nuclear medicine techniques in patients presenting with chest pain to the emergency department (ED). Myocardial perfusion imaging (MPI) using nuclear techniques is a well established diagnostic tool in the management of patients with ACS or AMI providing non-invasively information about perfusion and function. Single photon emission computed tomography (SPECT) is routinely applied for MPI allowing the characterization of localization, extent and severity of perfusion abnormalities. SPECT MPI is accurate and feasible in the clinical settings of patients presenting with chest pain. Pulmonary embolism is a common clinical disorder that is associated with high morbidity and mortality if untreated. Because of the unspecific symptoms commonly observed with the disease confirmation or exclusion of PE needs to be done in many cases admitted to ED. Various diagnostic strategies are available to confirm or rule out PE. Discordance between clinical probability and the results of diagnostic tests require imaging studies. Both lung perfusion and ventilation scintigraphy are safe, feasible and reliable methods enabling to exclude PE in patients with a low clinical probability. In summary, the documented prognostic value of scintigraphic parameters is of clinical importance to guide decision-making in the patient with acute chest pain. Additionally, the cost-effectiveness of nuclear medicine techniques in the work-up of patients with chest pain has been demonstrated.

MSCT coronary angiography may evolve to assess the extent and severity of coronary artery disease in patients with unstable angina or non-ST-segment elevation myocardial infarction. There appears to be no role for MCST-coronary angiography in patients with acute ST-segment elevation myocardial infarction.

This paper reviews the currently existing literature for the use of CT in acute coronary syndrome. Because there is urgent need to a modality that allows to triage patients with this disease some very early reports are already available. CT thereby may rapidly provide valuable information about heart disease as well as about other findings relevant for the differential diagnosis. Patients with negative CT may be discharged earlier than according to the current standard procedure. However, further studies with newer modalities are needed to provide more evidence for the use of CT in this particular cohort of patients.

The evaluation of patients who present to the Emergency Department with chest pain remains challenging, particularly for atypical chest pain. This article discusses imaging techniques that are used in such equivocal cases, including radionuclide perfusion imaging and echocardiography, with emphasis on the potential role of multi-detector computed tomography.

Coronary angiography (CAG) has been the standard method for detection and follow-up of coronary artery disease for years. However, it has a slight but discrete complication rate. With the introduction of multidetector computed tomography (MDCT), the coronary system could be evaluated non-invasively. The limited temporal and spatial resolution of the first MDCT scanners made the examination quality of scanning of patients with high, increasing or irregular heart rates or patients with stents, clips or severely calcified arteries less predictable. The introduction of dual-source computed tomography (DSCT) might constitute a promising new concept for cardiac CT. In this study, we present our first experience with DSCT. We investigated seven patients for different indications with DSCT. Image quality was reliable in all patients despite the presence of high heart rates (up to 105 beats per minute), heavy calcifications and surgical clips. DSCT showed stenoses which were not detected on CAG. Regarding the fact that DSCT not only offers morphological information of the coronary vessel wall and lumen but also delivers all standard functional cardiac parameters, it has true potential as a routine diagnostic tool in the cardiac diagnostic workup. In conclusion, first results of DSCT show high-quality, consistent cardiac and coronary imaging independent of heart rate and patient condition. These features enable a breakthrough in non-invasive cardiac and coronary imaging.