PURPOSE/AIM The purpose of this exhibit is: 1. Review normal cardiac chamber size and morphology ... more PURPOSE/AIM The purpose of this exhibit is: 1. Review normal cardiac chamber size and morphology based on evidence based review of multi-modality literature. 2. Provide guidance for the radiologist for routine nongated thoracic CT in the evaluation of abnormal cardiac size and morphology. CONTENT ORGANIZATION 1. Introduction: Difficulty in evaluating cardiac chamber size and morphology on routine thoracic CT. 2. Pathophysiology of abnormal cardiac chamber size and morphology. 3. Review of evidence based review of multi-modality literature. a. Comparison between echo, MRI, and gated thoracic CT to determine cardiac chamber size. 4. Guidelines for application to routine nongated thoracic CT. a. Upper limits of normal. b. Correlation to cross-sectional imaging. 5. Sample cases. SUMMARY The major teaching points of this exhibit are: 1. Evaluation of abnormal cardiac chamber size and morphology is difficult on routine axial nongated thoracic CT. 2. Review of normal measurements and wall ...
PURPOSE Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon but devastating comp... more PURPOSE Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon but devastating complication of acute pulmonary embolism (PE). Pulmonary thromboendarterectomy (PTE) is often curative with excellent long term outcomes, but as the procedure carries with it significant risk, identifying good candidates for surgery pre-operatively is crucial. At our institution, preoperative evaluation includes catheter pulmonary angiography with digital subtraction (DSA) to gauge clot burden and assess the potential impact PTE may have. 64-slice multi-detector CT has allowed for CT pulmonary angiograms (CTPA) which provide non-invasive volumetric evaluation of the pulmonary vessels. Our study compares the predictive value of CTPA with DSA as they relate to surgically accessible thrombus. METHOD AND MATERIALS CT and DSA examinations for patients who underwent PTE were retrospectively evaluated. Each examination was analyzed by two independent readers who assessed the central (main and desce...
PURPOSE/AIM To better understand the thoracic outlet syndrome by correlating CT, MRI, EMG, clinic... more PURPOSE/AIM To better understand the thoracic outlet syndrome by correlating CT, MRI, EMG, clinical history to the final diagnosis at time of surgery CONTENT ORGANIZATION Thoracic outlet syndrome is an often misdiagnosed, poorly understood disease entity, which deserves further attention in the radiology literature. We review brachial plexus anatomy as relevant to neurological or vascular syndromes that can occur in light of the newer imaging tehcniques now available in 2013. In particular, we focus on correlating surgical findings to imaging (CT ,MRI) and clinical and electrophysiological data. Examples of negative MRI exams which have positive findings at time of surgery will be discussed. Anatomical variations such has fibrous bands, anomalous vascular, osseous or muscular structures which contribute to presumed symptomology will be presented. Role of dynamic or positional MRI or CT will be delineated. Use of low radiation CT in dynamic evaluation of visualized bone and vascular ...
Time-resolved contrast-enhanced magnetic resonance angiography (CE-MRA) provides contrast dynamic... more Time-resolved contrast-enhanced magnetic resonance angiography (CE-MRA) provides contrast dynamics in the vasculature and allows vessel segmentation based on temporal correlation analysis. Here we present an automated vessel segmentation algorithm including automated generation of regions of interest (ROIs), cross-correlation and pooled sample covariance matrix analysis. The dynamic images are divided into multiple equal-sized regions. In each region, ROIs for artery, vein and background are generated using an iterative thresholding algorithm based on the contrast arrival time map and contrast enhancement map. Region-specific multi-feature cross-correlation analysis and pooled covariance matrix analysis are performed to calculate the Mahalanobis distances (MDs), which are used to automatically separate arteries from veins. This segmentation algorithm is applied to a dual-phase dynamic imaging acquisition scheme where low-resolution time-resolved images are acquired during the dynami...
Journal of cardiovascular translational research, 2010
Current imaging methods have focused on evaluation of myocardial anatomy and function. However, s... more Current imaging methods have focused on evaluation of myocardial anatomy and function. However, since myocardial metabolism and function are interrelated, metabolic myocardial imaging techniques, such as positron emission tomography, single photon emission tomography, and magnetic resonance spectroscopy present novel opportunities for probing myocardial pathology and developing new therapeutic approaches. Potential clinical applications of metabolic imaging include hypertensive and ischemic heart disease, heart failure, cardiac transplantation, as well as cardiomyopathies. Furthermore, response to therapeutic intervention can be monitored using metabolic imaging. Analysis of metabolic data in the past has been limited, focusing primarily on isolated metabolites. Models of myocardial metabolism, however, such as the oxygen transport and cellular energetics model and constraint-based metabolic network modeling, offer opportunities for evaluation interactions between greater numbers of...
A 64-year-old woman with dizziness and blurry vision underwent an evaluation for a possible strok... more A 64-year-old woman with dizziness and blurry vision underwent an evaluation for a possible stroke with a head-neck CT scan and a transthoracic echocardiogram. The head-neck CT scan was unremarkable, but the echocardiogram was notable for a2.0×2.3 cm heterogeneous echodensity attached to the mitral valve. After a transesophageal echocardiogram and chest CT scan, the mass was determined to be a caseous mitral annular calcification, CMAC. This entity is a rare variant of MAC with an estimated prevalence of 0.068%. Echocardiographic techniques can distinguish CMAC from other intracardiac masses such as tumor, cyst, or abscess. CMAC is associated with cerebrovascular accidents; however, optimal treatment is controversial given the rarity of this clinical finding. Management strategies should be tailored based on the patient’s presentation, risk factors, and overall clinical circumstances.
The goal of this article is to familiarize general radiologists and clinicians (particularly opht... more The goal of this article is to familiarize general radiologists and clinicians (particularly ophthalmologists, neuro-ophthalmologists, neurologists, and neurosurgeons) with the recent introduction of clinical MR imaging scanners operating at a magnetic field strength of 3-T and to compare them with the more common standard scanners operating at 1.5-T. In this study, MR imaging at 3-T was found to offer superior depiction of orbital and intracranial anatomy and pathologic findings. Spin echo, high spatial resolution, T2-weighted, thin-section MR imaging sequences are especially useful and sensitive at 3-T for the evaluation of orbital, ocular, and intracranial anatomy and pathologic findings. The authors din that time-of-flight (TOF) MR angiography at 3-T surpasses the best MR angiography at 1.5-T and that two-dimensional TOF venography and three-dimensional contrast MR venography at 3-T offer superior visualization of intracranial and facial veins as compared with MR venography at 1...
Journal of Vascular and Interventional Radiology, 2012
Figure 1. Scout radiographs taken before intravenous contras (arrows) in patients 1 (a), 2 (b), 3... more Figure 1. Scout radiographs taken before intravenous contras (arrows) in patients 1 (a), 2 (b), 3 (c), and 4 (d). ditor: he use of indwelling peripherally inserted central catheters PICCs) for high-powered contrast medium injection for omputed tomography (CT) scans is an increasingly comon practice. The use of PICCs for this purpose is generlly regarded as safe, as most PICCs have been shown to olerate the high injection speed and volume necessary for ontrast enhancement (1–3). Among possible complicaions, most studies report catheter rupture and few describe he possibility of catheter movement during injection (4). e present four patients who experienced repositioning of ower-rated PICCs during intravenous contrast medium njection for routine CT. The records of four patients who were observed to have ICC movement after contrast medium injection were evalated, for which institutional review board review by our nstitution was not required. All patients had received Xcela
PURPOSE/AIM The purpose of this exhibit is: 1. Review normal cardiac chamber size and morphology ... more PURPOSE/AIM The purpose of this exhibit is: 1. Review normal cardiac chamber size and morphology based on evidence based review of multi-modality literature. 2. Provide guidance for the radiologist for routine nongated thoracic CT in the evaluation of abnormal cardiac size and morphology. CONTENT ORGANIZATION 1. Introduction: Difficulty in evaluating cardiac chamber size and morphology on routine thoracic CT. 2. Pathophysiology of abnormal cardiac chamber size and morphology. 3. Review of evidence based review of multi-modality literature. a. Comparison between echo, MRI, and gated thoracic CT to determine cardiac chamber size. 4. Guidelines for application to routine nongated thoracic CT. a. Upper limits of normal. b. Correlation to cross-sectional imaging. 5. Sample cases. SUMMARY The major teaching points of this exhibit are: 1. Evaluation of abnormal cardiac chamber size and morphology is difficult on routine axial nongated thoracic CT. 2. Review of normal measurements and wall ...
PURPOSE Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon but devastating comp... more PURPOSE Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon but devastating complication of acute pulmonary embolism (PE). Pulmonary thromboendarterectomy (PTE) is often curative with excellent long term outcomes, but as the procedure carries with it significant risk, identifying good candidates for surgery pre-operatively is crucial. At our institution, preoperative evaluation includes catheter pulmonary angiography with digital subtraction (DSA) to gauge clot burden and assess the potential impact PTE may have. 64-slice multi-detector CT has allowed for CT pulmonary angiograms (CTPA) which provide non-invasive volumetric evaluation of the pulmonary vessels. Our study compares the predictive value of CTPA with DSA as they relate to surgically accessible thrombus. METHOD AND MATERIALS CT and DSA examinations for patients who underwent PTE were retrospectively evaluated. Each examination was analyzed by two independent readers who assessed the central (main and desce...
PURPOSE/AIM To better understand the thoracic outlet syndrome by correlating CT, MRI, EMG, clinic... more PURPOSE/AIM To better understand the thoracic outlet syndrome by correlating CT, MRI, EMG, clinical history to the final diagnosis at time of surgery CONTENT ORGANIZATION Thoracic outlet syndrome is an often misdiagnosed, poorly understood disease entity, which deserves further attention in the radiology literature. We review brachial plexus anatomy as relevant to neurological or vascular syndromes that can occur in light of the newer imaging tehcniques now available in 2013. In particular, we focus on correlating surgical findings to imaging (CT ,MRI) and clinical and electrophysiological data. Examples of negative MRI exams which have positive findings at time of surgery will be discussed. Anatomical variations such has fibrous bands, anomalous vascular, osseous or muscular structures which contribute to presumed symptomology will be presented. Role of dynamic or positional MRI or CT will be delineated. Use of low radiation CT in dynamic evaluation of visualized bone and vascular ...
Time-resolved contrast-enhanced magnetic resonance angiography (CE-MRA) provides contrast dynamic... more Time-resolved contrast-enhanced magnetic resonance angiography (CE-MRA) provides contrast dynamics in the vasculature and allows vessel segmentation based on temporal correlation analysis. Here we present an automated vessel segmentation algorithm including automated generation of regions of interest (ROIs), cross-correlation and pooled sample covariance matrix analysis. The dynamic images are divided into multiple equal-sized regions. In each region, ROIs for artery, vein and background are generated using an iterative thresholding algorithm based on the contrast arrival time map and contrast enhancement map. Region-specific multi-feature cross-correlation analysis and pooled covariance matrix analysis are performed to calculate the Mahalanobis distances (MDs), which are used to automatically separate arteries from veins. This segmentation algorithm is applied to a dual-phase dynamic imaging acquisition scheme where low-resolution time-resolved images are acquired during the dynami...
Journal of cardiovascular translational research, 2010
Current imaging methods have focused on evaluation of myocardial anatomy and function. However, s... more Current imaging methods have focused on evaluation of myocardial anatomy and function. However, since myocardial metabolism and function are interrelated, metabolic myocardial imaging techniques, such as positron emission tomography, single photon emission tomography, and magnetic resonance spectroscopy present novel opportunities for probing myocardial pathology and developing new therapeutic approaches. Potential clinical applications of metabolic imaging include hypertensive and ischemic heart disease, heart failure, cardiac transplantation, as well as cardiomyopathies. Furthermore, response to therapeutic intervention can be monitored using metabolic imaging. Analysis of metabolic data in the past has been limited, focusing primarily on isolated metabolites. Models of myocardial metabolism, however, such as the oxygen transport and cellular energetics model and constraint-based metabolic network modeling, offer opportunities for evaluation interactions between greater numbers of...
A 64-year-old woman with dizziness and blurry vision underwent an evaluation for a possible strok... more A 64-year-old woman with dizziness and blurry vision underwent an evaluation for a possible stroke with a head-neck CT scan and a transthoracic echocardiogram. The head-neck CT scan was unremarkable, but the echocardiogram was notable for a2.0×2.3 cm heterogeneous echodensity attached to the mitral valve. After a transesophageal echocardiogram and chest CT scan, the mass was determined to be a caseous mitral annular calcification, CMAC. This entity is a rare variant of MAC with an estimated prevalence of 0.068%. Echocardiographic techniques can distinguish CMAC from other intracardiac masses such as tumor, cyst, or abscess. CMAC is associated with cerebrovascular accidents; however, optimal treatment is controversial given the rarity of this clinical finding. Management strategies should be tailored based on the patient’s presentation, risk factors, and overall clinical circumstances.
The goal of this article is to familiarize general radiologists and clinicians (particularly opht... more The goal of this article is to familiarize general radiologists and clinicians (particularly ophthalmologists, neuro-ophthalmologists, neurologists, and neurosurgeons) with the recent introduction of clinical MR imaging scanners operating at a magnetic field strength of 3-T and to compare them with the more common standard scanners operating at 1.5-T. In this study, MR imaging at 3-T was found to offer superior depiction of orbital and intracranial anatomy and pathologic findings. Spin echo, high spatial resolution, T2-weighted, thin-section MR imaging sequences are especially useful and sensitive at 3-T for the evaluation of orbital, ocular, and intracranial anatomy and pathologic findings. The authors din that time-of-flight (TOF) MR angiography at 3-T surpasses the best MR angiography at 1.5-T and that two-dimensional TOF venography and three-dimensional contrast MR venography at 3-T offer superior visualization of intracranial and facial veins as compared with MR venography at 1...
Journal of Vascular and Interventional Radiology, 2012
Figure 1. Scout radiographs taken before intravenous contras (arrows) in patients 1 (a), 2 (b), 3... more Figure 1. Scout radiographs taken before intravenous contras (arrows) in patients 1 (a), 2 (b), 3 (c), and 4 (d). ditor: he use of indwelling peripherally inserted central catheters PICCs) for high-powered contrast medium injection for omputed tomography (CT) scans is an increasingly comon practice. The use of PICCs for this purpose is generlly regarded as safe, as most PICCs have been shown to olerate the high injection speed and volume necessary for ontrast enhancement (1–3). Among possible complicaions, most studies report catheter rupture and few describe he possibility of catheter movement during injection (4). e present four patients who experienced repositioning of ower-rated PICCs during intravenous contrast medium njection for routine CT. The records of four patients who were observed to have ICC movement after contrast medium injection were evalated, for which institutional review board review by our nstitution was not required. All patients had received Xcela
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