- 作者列表："Palmisano A","Benedetti G","Faletti R","Rancoita PMV","Gatti M","Peretto G","Sala S","Boccia E","Francone M","Galea N","Basso C","Del Maschio A","De Cobelli F","Esposito A
:Background Hyperemia is a key component of acute myocarditis (AM). Early gadolinium uptake because of myocardial hyperemia may be quantified by using T1 mapping. Purpose To evaluate the value of early enhanced T1 shortening for the diagnosis of acute myocarditis. Materials and Methods Study participants suspected of having AM and healthy control (HC) participants were prospectively enrolled from September 2016 to May 2019. Participants underwent 1.5-T cardiac MRI including Lake Louise criteria, T2 mapping, native T1, and extracellular volume, with the addition of early enhanced T1 mapping (2 minutes after intravenous administration of 0.15 mmol/kg gadobutrol). Color-coded maps of the percentage of T1 shortening from precontrast to early postcontrast were generated. Optimal early T1 shortening cut-off value and its diagnostic performance in the identification of acute myocarditis were calculated. Results Forty-five study participants with AM (median age, 40 years; interquartile range [IQR], 20-46 years; 22 women) diagnosed according to multidisciplinary clinical evaluation, electrocardiography, laboratory test, echocardiography, cardiac MRI, and coronary CT and/or invasive angiography. Findings were confirmed by endomyocardial biopsy in 64% (29 of 45) of participants. MRI parameters were compared with 19 HC participants (median age, 39 years; IQR, 28-46 years; seven women). Median early T1 shortening was 75% (IQR, 72%-78%) in participants with AM versus 65% (IQR, 61%-66%) in HC participants (P < .001). Early T1 shortening showed high diagnostic performance (area under the receiver operating characteristic curve [AUC], 0.97; 95% confidence interval [CI]: 0.94, 1.00) and excellent interobserver reproducibility (intraclass correlation coefficient: 0.98; 95% CI: 0.96, 1.00). Early T1 shortening of 70% or greater identified acute myocarditis with 93% sensitivity, 100% specificity, and 95% diagnostic accuracy. Early T1 shortening had better diagnostic performance than late percentage T1 shortening (AUC, 0.97 vs 0.90, respectively; P = .03) and extracellular volume (AUC, 0.97 vs 0.88, respectively; P = .046), and similar to native T1 (AUC, 0.97 vs 0.93, respectively; P = .63) and T2 mapping (AUC, 0.97 vs 0.97, respectively; P > .99). Conclusion In this proof-of-concept study, percentage of T1 shortening at early enhanced T1 mapping showed high accuracy for the diagnosis of acute myocarditis. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by De Cecco and Monti in this issue.
: 背景: 充血是急性心肌炎 (AM) 的关键组成部分。由于心肌充血导致的早期钆摄取可以通过使用T1映射来定量。目的探讨早期增强T1缩短对急性心肌炎的诊断价值。材料和方法研究从2016年9月至2019年5月，前瞻性纳入疑似AM的参与者和健康对照 (HC) 参与者。参与者接受了1.5-T心脏MRI检查，包括Louise湖标准、T2映射、天然T1和细胞外容积，并加入了早期增强T1映射 (静脉注射0.15 mmol/kg gadobutrol后2分钟).生成了从对比前到对比后早期的T1缩短百分比的彩色编码图。计算最佳早期T1缩短临界值及其在急性心肌炎鉴别中的诊断性能。结果45名研究参与者根据多学科临床评估、心电图、实验室检查、超声心动图、心脏MRI、冠状动脉CT和/或侵入性血管造影诊断为AM (中位年龄，40岁; 四分位距 [IQR]，20-46岁; 22名女性)。结果通过心内膜心肌活检证实了64% (45例中的29例) 的参与者。MRI参数与19名HC参与者进行了比较 (中位年龄，39岁; IQR，28-46岁; 7名女性)。AM患者的中位早期T1缩短为75% (IQR，72%-78%)，HC患者为65% (IQR，61%-66%) (P <.001)。早期T1缩短显示高诊断性能 (受试者工作特征曲线下面积 [AUC]，0.97; 95% 置信区间 [CI]: 0.94，1.00) 和出色的观察者间再现性 (组内相关系数: 0.98; 95% CI: 0.96，1.00)。70% 或更大的早期T1缩短以93% 的敏感性、100% 的特异性和95% 的诊断准确性鉴别出急性心肌炎。早期T1缩短的诊断性能优于晚期百分比T1缩短 (AUC，分别为0.97 vs 0.90; P = .03) 和细胞外体积 (AUC，分别为0.97 vs 0.88; P = .046)，与天然T1相似 (AUC，分别为0.97 vs 0.93; P = .63)和T2映射 (AUC分别为0.97 vs 0.97; P> .99)。结论在该概念验证研究中，早期增强T1映射时T1缩短的百分比显示了诊断急性心肌炎的高准确性。©RSNA，2020在线补充材料可用于本文。另见De Cecco和Monti在本期的社论。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.