Cardiac magnetic resonance imaging for assessment of mitral stenosis before and after percutaneous balloon valvuloplasty in comparison to two- and three-dimensional echocardiography.
- 作者列表："Abdelaziz HM","Tawfik AM","Abd-Elsamad AA","Sakr SA","Algamal AM
BACKGROUND:The experience with cardiac magnetic resonance (CMR) in mitral stenosis (MS) is limited in contrast to mitral regurgitation. PURPOSE:To compare CMR versus 2D and 3D transthoracic (TTE) and 3D transesophgeal (TEE) echocardiography in assessment of rheumatic MS before and after percutaneous balloon mitral valvuloplasty (PBMV). MATERIAL AND METHODS:Twenty consecutive symptomatic patients with MS were evaluated prospectively and independently by CMR, TTE, and TEE pre-PBMV, and by CMR and TTE post-PBMV. Mitral valve area (MVA) was assessed by CMR planimetry, TTE and TEE planimetry, and pressure half time (PHT). Further assessment included trans-mitral velocity, mitral regurgitation (MR), and left atrial (LA) volume. RESULTS:PBMV was successful in 18 patients and failed in two patients (one with MVA <1.5 cm2, one developed severe MR). Pre-PBMV and MVA by CMR, 2D TTE, biplane, 3D TTE, 3D TEE, and PHT were 1.16, 1.16, 1.10, 1.02, 1.05, and 0.99 cm2, respectively. Post-PBMV, a significant increase in MVA was observed (2.15, 2.06, 2.07, 2.04, and 2.03 cm2, respectively). High agreement was observed between CMR and echocardiography before and after PBMV, except for PHT method. CMR significantly underestimated trans-mitral velocity and gradients compared to echocardiography (P<0.001). Before PBMV, mild MR was observed in 11, 12, and 19 patients by 2D TTE, 3D TTE, and CMR. After PBMV, MR was observed in all patients (19 mild, one severe) by all modalities. Echocardiography significantly underestimated LA volume compared to CMR (P<0.001). LA volume decreased significantly after PBMV (P<0.001). CONCLUSION:CMR provides comprehensive assessment of several parameters in MS patients before and after intervention. Agreement with echocardiography is acceptable.
背景: 与二尖瓣反流相比，心脏磁共振 (CMR) 在二尖瓣狭窄 (MS) 中的经验有限。 目的: 比较经皮球囊二尖瓣成形术 (PBMV) 前后经胸 (TTE) 和3D经食管 (TEE) 超声心动图对风湿性MS的评价。 材料和方法: 20名连续有症状的MS患者通过CMR、TTE和TEE在PBMV前以及通过CMR和TTE在PBMV后进行前瞻性独立评估。通过CMR平面测量、TTE和TEE平面测量以及压力半时间 (PHT) 评估二尖瓣面积 (MVA)。进一步评估包括跨二尖瓣速度、二尖瓣反流 (MR) 和左心房 (LA) 体积。 结果: PBMV成功18例，失败2例 (1例MVA <1.5 cm2 cm2，1例出现重度MR)。CMR、2D TTE、双平面、3D TTE、3D TEE和PHT的预PBMV和MVA分别为1.16、1.10、1.02、1.05和0.99 cm2 cm2。PBMV后，观察到MVA的显著增加 (分别为2.15、2.06、2.07、2.04和2.03-cm2)。除PHT法外，PBMV前后CMR与超声心动图的一致性较高。与超声心动图相比，CMR显著低估了经二尖瓣速度和梯度 (P<0.001)。在PBMV之前，通过2D TTE、3D TTE和CMR在11、12和19名患者中观察到轻度MR。在PBMV后，通过所有方式在所有患者 (19例轻度，1例重度) 中观察到MR。与CMR相比，超声心动图显著低估LA体积 (P<0.001)。PBMV后LA体积显著下降 (P<0.001)。 结论: CMR提供了MS患者干预前后几个参数的综合评估。与超声心动图相符。
METHODS:OBJECTIVES:The aim was to evaluate the image quality and sensitivity to artifacts of compressed sensing (CS) acceleration technique, applied to 3D or breath-hold sequences in different clinical applications from brain to knee. METHODS:CS with an acceleration from 30 to 60% and conventional MRI sequences were performed in 10 different applications in 107 patients, leading to 120 comparisons. Readers were blinded to the technique for quantitative (contrast-to-noise ratio or functional measurements for cardiac cine) and qualitative (image quality, artifacts, diagnostic findings, and preference) image analyses. RESULTS:No statistically significant difference in image quality or artifacts was found for each sequence except for the cardiac cine CS for one of both readers and for the wrist 3D proton density (PD)-weighted CS sequence which showed less motion artifacts due to the reduced acquisition time. The contrast-to-noise ratio was lower for the elbow CS sequence but not statistically different in all other applications. Diagnostic findings were similar between conventional and CS sequence for all the comparisons except for four cases where motion artifacts corrupted either the conventional or the CS sequence. CONCLUSIONS:The evaluated CS sequences are ready to be used in clinical daily practice except for the elbow application which requires a lower acceleration. The CS factor should be tuned for each organ and sequence to obtain good image quality. It leads to 30% to 60% acceleration in the applications evaluated in this study which has a significant impact on clinical workflow. KEY POINTS:• Clinical implementation of compressed sensing (CS) reduced scan times of at least 30% with only minor penalty in image quality and no change in diagnostic findings. • The CS acceleration factor has to be tuned separately for each organ and sequence to guarantee similar image quality than conventional acquisition. • At least 30% and up to 60% acceleration is feasible in specific sequences in clinical routine.
METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.
METHODS:OBJECTIVE:The primary purpose of this study was to evaluate the effectiveness of a three-dimensional (3D) software tool (smart planes) for displaying fetal brain planes, and the secondary purpose was to evaluate its accuracy in performing automatic measurements. MATERIAL AND METHODS:This prospective study included singleton fetuses with a gestational age (GA) greater than 18 weeks. Transabdominal two-dimensional ultrasound (2DUS) and 3D smart planes images were respectively used to obtain the basic planes of the fetal brain, with five parameters measured. The images, by either two-dimensional (2D) manual or 3D automatic operation, were reviewed by two experienced sonographers. The agreements between two measurements were analyzed. RESULTS:A total of 226 cases were included. The rates of successful detection by automatic display were as high as 80%. There was substantial agreement between the measurements of the biparietal diameter, head circumference and transcerebellar diameter, but poor agreement between the measurements of cisterna magna and lateral ventricle width. CONCLUSIONS:Smart Planes might be valuable for the rapid evaluation of fetal brain, because it simplifies the evaluation process. However, the technology requires improvement. In addition, this technology cannot replace the conventional manual US scans; it can only be used as an additional approach.