The international journal of cardiovascular imaging最新文献

The use of conventional contrast agents in computed tomography (CT) and magnetic resonance (MR) imaging is often limited in patients with chronic kidney disease (CKD) due to potential nephrotoxicity. Ferumoxytol, originally developed for iron supplementation, has emerged as a promising alternative MR contrast agent that is safer for patients with CKD. This study aims to present our center's experience with ferumoxytol as a contrast agent in CKD patients. We retrospectively reviewed 24 MR imaging studies of the chest, abdomen, and pelvis performed in CKD patients at our center. All patients were deemed suitable for ferumoxytol administration, receiving a dose of 4 mg/kg with post-injection monitoring. The imaging quality of the ascending, descending, suprarenal and infrarenal aortic segments was assessed by three independent observers using a qualitative scoring system (nondiagnostic, poor vascular definition, good vascular definition, and excellent vascular definition). Quantitative analyses, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and heterogeneity index, were also performed. No adverse reactions to ferumoxytol were observed. Of the 72 vascular segments evaluated, 90.8% of the images were rated as excellent vascular definition, and 9.2% were rated as good vascular definition. Inter-observer agreement was substantial (k = 0.647), with no statistically significant differences in ratings between observers. Ferumoxytol is a safe and effective alternative to conventional contrast agents for MR vascular imaging, particularly in patients with renal insufficiency. These findings support its selective use in appropriate clinical scenarios, offering a reliable imaging option for CKD patients.

The CT-derived aortic valve area (AVA CT) ≤ 1.2 cm² suggests severe aortic stenosis (AS) but may not account for annular or body size variations. The valve-to-annulus area ratio (VTAAR) may improve AS severity assessment. This study evaluates AVA CT ≤ 1.2 cm² and VTAAR thresholds in severe AS patients. We retrospectively analyzed consecutive patients who underwent transcatheter aortic valve replacement (TAVR) for severe symptomatic AS at a tertiary center. AVA CT was measured via mid-systolic planimetry, and VTAAR was calculated as AVA CT divided by annular area. Severe AS was determined by Structural Heart Team consensus based on transthoracic echocardiography (TTE) and supplementary imaging. Among 343 patients (mean age 79.7 ± 8.4 years, 55.4% male), AVA CT was ≤ 1.2 cm² in 241 (70.3%) and > 1.2 cm² in 102 (29.7%). Applying a VTAAR cutoff of ≤ 0.3 improved CT sensitivity, identifying severe AS in 307 patients (89.5%) meeting either AVA CT ≤ 1.2 cm² or VTAAR ≤ 0.3. This approach reclassified 62 of 102 patients (61%) with AVA CT > 1.2 cm², with greater sensitivity in those with left ventricular ejection fraction (LVEF) < 50%, mean aortic valve pressure gradient < 40 mmHg, and patients with body surface area (BSA) > 1.95 m². AVA CT ≤ 1.2 cm² alone is not a sensitive marker for severe AS. Adding VTAAR ≤ 0.3 enhances CT's sensitivity, particularly in low gradient AS and large BSA patients. If validated prospectively, these CT metrics could aid AS severity assessment when TTE is inconclusive.

Purpose: To evaluate the clinical manifestations, image characteristics and prognosis of pulmonary artery dissection (PAD) compared with pulmonary hypertension (PH).

Methods: Patients diagnosed with PAD and PH were retrospectively enrolled. The clinical presentation, image characteristics, and hemodynamic parameters of right heart catheterization were compared between the two groups. Kaplan-Meier survival analysis was used to evaluate the prognosis of PAD.

Results: Seventeen patients with PAD (mean age ± SD, 38 ± 11 years; 7 men [41.2%]) and 17 patients with PH matched by age and sex were included in the study. Six patients (35.29%) with PAD presented with acute chest pain, and all patients (100%) in PH group presented with chronic symptoms with statistically significant difference (P = 0.018). The diameter ratio of main pulmonary artery to ascending aorta was 2.16 ± 0.81 in PAD group, which was higher than that of PH group (1.48 ± 0.25, P = 0.008). CT imaging of 17 patients of PAD showed intimal flap and the most common was main pulmonary artery involved (n = 13, 76.5%). Pericardial effusion was more common for PAD patients compared with PH (P = 0.031). Patients with PAD may have an increased risk of death compared with PH patients (P = 0.045), and median survival was about 46 months (95%CI: 0-94).

Conclusion: CTPA is valuable in evaluating the intimal flap, extent of the dissection and intraluminal thrombus of PAD. It is necessary to recommend CTPA when patients of PH present with chest pain. Patients with PAD may have an increased risk of death compared with PH patients. The long-term survival outcomes require further investigation with extended follow-up.

This review explores a range of imaging techniques used in the pre-surgical planning of vascular access, including duplex ultrasound (DUS), digital subtraction angiography (DSA), digital subtraction venography (DSV), CO2 Venography, magnetic resonance angiography (MRA), computed tomography angiography (CTA), and Intravascular ultrasound (IVUS). For each modality, we analyze its technical background, applications, advantages and disadvantages, and comparisons with alternative imaging options. DUS is the most widely used imaging modality in pre-surgical planning due to its low cost, non-invasiveness, absence of ionizing radiation and nephrotoxic contrast agents, and comparable accuracy in pre-access mapping with other methods. DSA and DSV have high sensitivity and specificity to visualize the arterial and venous system and are recommended when central vascular stenosis is suspected, or a simultaneous intervention is anticipated. However, their use is limited due to exposure to contrast agents and ionizing radiation. CO2-based contrast agents provide an alternative for end-stage renal disease (ESRD) patients to preserve residual renal function. MRA provides a noninvasive option with no radiation exposure and superior image resolution, yet the high cost and limited availability restrict their widespread clinical use. CTA, with its short acquisition time and high-resolution imaging, is a vital modality in intricate cases. However, radiation and contrast exposure can pose challenges in this patient population. The newer IVUS modality has a superior ability to central venous outflow obstruction compared to DSA and provides more information regarding vascular geometry and anatomy. Each imaging modality has its unique advantages and disadvantages in this patient cohort. The decision to use a particular imaging must be made on a case-to-case basis. However, following KDOQI guidelines, a combination of a patient's medical history, physical examination, and DUS is a widely accepted standard practice in pre-surgical vascular access planning, with other imaging modalities reserved for selected patients.

Transthoracic echocardiography (TTE) is a frequently requested investigation in patients admitted to hospital with various cardiorespiratory symptoms. With increasing life expectancy, these symptoms might be related to other clinical conditions, necessitating early and prompt diagnosis and subsequent management. We thought to broaden the use of the standard TTE to unmask clinically significant extracardiac findings (ECF). We screened the epigastrium, right upper abdominal quadrant, both flanks, and dorsal lung fields in 6468 consecutive inpatients undergoing TTE looking for aortic dilatation, liver pathology, ascites, pleural effusion and suspicious masses. We detected ECFs in 507 (8%) patients. Pleural effusion was the most commonly detected ECF seen in 86% of patients. ECF findings necessitating shift in the management plan were detected in 23% of patients and included large effusions necessitating drainage, malignant tumors (predominately liver metastases) and empyema. We concluded that routine screening of the liver, pleura, peritoneum and abdominal aorta could add an important piece of clinical information, detect pleural effusion, possible malignancies (mainly liver metastases) and aortic dilatation necessitating further assessment and management of hospitalized patients with various cardiopulmonary symptoms.

Despite the significant burden of disease in Indigenous Peoples globally, the validity of computed tomography (CT) coronary artery calcium (CAC) scoring has been poorly described. Thus, we aimed to identify the prevalence and predictive utility of a CT CAC score > 0 in this population. A systematic search was conducted on MEDLINE, EMBASE, CINAHL, Scopus and Web of Science databases from 1990 to 2022. Primary observational studies that reported CT CAC scores and Indigenous ethnicity were included. The primary outcome was the prevalence of a CT CAC score > 0. The secondary outcome was MACE. Eight studies on CT CAC scoring stratified results according to Indigenous ethnicity (n = 30,845 and 1,677 Indigenous). Prevalence of CT CAC score > 0 was higher in Australian First Nations people than non-Indigenous people [adjusted odds ratios (aOR) 2.36, 95% confidence interval (CI) 1.32-4.23; p = 0.004 and aOR 2.76, 95% CI 1.30-5.87; p = 0.008] but not in Native Americans (aOR 0.70, 95% CI 0.42-1.18) or Indigenous Brazilians (aOR 0.96, 95% CI 0.30-3.11). Two studies assessed the interaction of Indigenous ethnicity on the association between CAC > 0 and MACE. Neither found a significant interaction (p = 0.64 and 0.53). From 2431 studies, eight reported CT CAC scores stratified by Indigenous ethnicity. From limited data, prevalence of CT CAC score > 0 was higher in Australian First Nations people compared to non-Indigenous Australians and CT CAC score > 0 was similarly able to predict MACE in Indigenous Peoples. Future research on CT CAC scoring should stratify outcomes according to Indigenous status to better understand its utility.

Cardiovascular magnetic resonance (CMR) has been studied as an alternative to endomyocardial biopsy (EMB) in orthotopic heart transplant recipients (OHTRs), particularly through breath-hold myocardial T1 and T2 mapping sequences. We aimed to assess the diagnostic performance of the novel free-breathing multiparametric saturation-recovery single-shot acquisition (mSASHA) mapping technique to identify acute cardiac allograft rejection (ACAR) non-invasively against EMB. This retrospective study included n = 21 consecutive OHTRs with suspected ACAR who underwent both a 1.5T CMR scan with mSASHA mapping and an EMB within 5.4 (1.2-14.8) days, and n = 20 healthy controls who underwent CMR with mSASHA mapping. Conventional breath-holding T2-prepared balanced steady-state free precession (T2p-bSSFP) T2 mapping was also acquired. CAR was EMB defined as histological rejection (HR) (acute cellular rejection of ≥ 1 R or acute antibody-mediated rejection of ≥ 1). Overall, n = 21 OHTRs (9 females) with a mean age of 43.2 ± 16.2 years and a median time of 5.4 (1.2-14.8) years since transplantation were included in the study, alongside n = 20 healthy controls. HR was present in n = 9 patients. The HR group showed significantly higher septal mSASHA T2 values compared to the non-HR (n = 12) group (53 ± 6 ms vs. 47 ± 4 ms, p = 0.014). Receiver operator characteristics analysis showed an area under the curve of 0.79 (95% confidence interval 0.59-0.98, p = 0.028) and an optimal cut-off value of 50 ms (sensitivity of 67%, specificity of 75%) for identifying patients with HR using septal mSASHA T2 values. There was at least a moderate correlation of septal and global mSASHA T1 and T2 values (n = 21) with MOLLI T1 (n = 17) and T2p-bSSFP T2 (n = 18) values (r > 0.6, p ≤ 0.003). OHTR patients without HR showed higher septal (T1: 1256 ± 42 ms vs. 1201 ± 46 ms, p = 0.002; T2: 47 ± 4 ms vs. 43 ± 2 ms, p = 0.003) and global mSASHA (T1: 1250 ± 58 ms vs. 1201 ± 45 ms, p = 0.013; T2: 48 ± 5 ms vs. 43 ± 2 ms, p = 0.009) values compared to normal controls (n = 20). In the control group, native mSASHA T1 and T2 values were higher in females (n = 9) than in males. Free-breathing mSASHA T2 mapping may be useful in identifying histological changes associated with ACAR, overcoming the challenges of breath holding and with good diagnostic performance.

Cardiomyopathies are a heterogeneous group of myocardial disorders characterized by mechanical and/or electrical dysfunction, typically occurring without significant coronary artery disease, hypertension, valvular, or congenital heart disease. According to current ESC guidelines, cardiovascular magnetic resonance (CMR) is a class I recommendation for the initial evaluation of patients with suspected cardiomyopathy, given its ability to provide comprehensive morphological and tissue characterization. CMR, however, may be precluded in patients owing to device incompatibility, claustrophobia, or arrhythmia- and motion-related image degradation. In this context, cardiac computed tomography (CCT), traditionally used for assessing coronary artery disease, has emerged as a valuable alternative. Technological advancements have enabled CCT to deliver not only detailed anatomical information but also functional and tissue-specific insights. The recent consensus document from the European Association of Cardiovascular Imaging underscore the expanding clinical applications of CCT, highlighting its potential role in the diagnostic work-up and phenotypic classification of cardiomyopathies. In this review, we summarize the current evidence supporting the use of CCT in patients with suspected cardiomyopathy, outline its clinical strengths and limitations, and discuss emerging developments such as artificial intelligence and radiomics, which could further enhance its diagnostic and prognostic value.