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Key Clinical Message: Complex presentations of MCS patients may necessitate a multidisciplinary approach involving HF cardiologists, CT surgeons, advanced cardiac imagers, and interventional cardiologists in order to define the optimal management strategy. Left ventricle assist devices (LVADs) provide life‐sustaining treatment for patients with terminal heart failure, but their intricacy allows for complications. One complication is LVAD outflow graft obstruction due to the graft's intraluminal thrombus or extraluminal compression. It may be treated endovascularly with stenting. We report an endovascular stenting of an outflow tract in HVAD™ (HeartWare Inc.) due to a pseudoaneurysm causing compression and kinking stenosis. [ABSTRACT FROM AUTHOR]

Governments of numerous countries implemented school closures to contain the COVID-19 pandemic. Several investigations have shown the negative impact of social-distancing policies and school closures on children worldwide. Recently, research also demonstrated adverse effects on adults' well-being. The development of children is strongly affected by their parent's emotional state. The present study aimed to examine parental stress levels caused by a short period of homeschooling in December 2020 in Germany. A structured survey was set up and distributed randomly via social media and parent associations. We observed a significant increase in stress and concerns. Family conflicts significantly increased, social isolation was feared, and powerlessness and helplessness ascended. Risk factors were parental education levels, parental working time, and teaching features like the frequency of feedback, correction, and accessibility. [ABSTRACT FROM AUTHOR]

Background: Deep inferior epigastric perforator and muscle sparing transverse rectus abdominis muscle flaps are commonly used flaps for autologous breast reconstruction. CT-angiography allows to analyse the perforator course preoperatively. Our aim was to compare the different aspects of perforator anatomy in the most detailed study. Methods: CT-angiographies of 300 female patients with autologous breast reconstruction of 10 years were analysed regarding the anatomy of the deep inferior epigastric artery and every perforator. Results: Overall, 2260 perforators were included. We identified correlations regarding the DIEA branching point and number of perforators and their intramuscular course. The largest perforator emerged more often from the medial branch of the DIEA than the smaller perforators (70% (416/595) vs. 54% (878/1634), p < 0.001) and more often had a direct connection to the SIEV (large 67% (401/595) vs. small 39% (634/1634), p < 0.01). Medial row perforators were larger than the laterals (lateral 1.44 mm ± 0.43 (n = 941) vs. medial 1.58 mm ± 0.52 (n = 1304) (p < 0.001)). The larger and more medial the perforator, the more likely it was connected to the SIEV: perforators with direct connection to the SIEV had a diameter of 1.65 mm ± 0.53 (n = 1050), perforators with indirect connection had a diameter of 1.43 ± 0.43 (n = 1028), perforators without connection had a diameter of 1.31 mm ± 0.37 (n = 169) (p < 0.001). Medial perforators were more often directly connected to the SIEV than lateral perforators (medial 56% (723/1302) vs. lateral 35% (327/941), p < 0.001). A lateral perforator more often had a short intramuscular course than medial perforators (69% (554/800) vs. 45% (474/1055), p < 0.001), which was also more often observed in the case of a small perforator and a caudal exit of the rectus sheath. Conclusion: The largest perforator emerges more often from the medial branch of the DIEA and frequently has a direct connection to the SIEV, making medial row perforators ideal for DIEP flap transplantation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Delayed-onset muscle soreness (DOMS) is one of the most common reasons for impaired muscle performance in sports. However, little consensus exists regarding which treatments may be most effective, and the underlying mechanisms are poorly understood. OBJECTIVES: To investigate the influence of compression garments on the development of DOMS, focusing on changes in muscle perfusion and muscle stiffness. METHODS: In this controlled laboratory study with repeated measures, muscle perfusion and stiffness, calf circumference, muscle soreness, passive ankle dorsiflexion, and creatine kinase levels were assessed in participants before (baseline) a DOMS-inducing eccentric calf exercise intervention and 60 hours later (follow-up). After DOMS induction, a sports compression garment (18-21 mmHg) was worn on 1 randomly selected calf until follow-up, while the contralateral calf served as an internal control. Muscle perfusion was assessed using contrast-enhanced ultrasound (peak enhancement and wash-in area under the curve), while muscle stiffness was assessed using acoustic radiation force impulse (shear-wave velocities). A magnetic resonance imaging scan of both lower legs was also performed during the follow-up testing session to characterize the extent of exercise-induced muscle damage. Comparisons were made between limbs and overtime. RESULTS: Shear-wave velocity values of the medial gastrocnemius showed a significant interaction between time and treatment (P = .006), with the noncompressed muscle demonstrating lower muscle stiffness values at follow-up compared to baseline or to the compressed muscle. No significant differences in soleus muscle stiffness were noted between limbs or over time, as was the case for muscle perfusion metrics (peak enhancement and wash-in area under the curve) for the medial gastrocnemius and soleus muscles. Further, compression had no significant effect on passive ankle dorsiflexion, muscle soreness, calf circumference, or injury severity, per magnetic resonance imaging. CONCLUSION: Continuous wearing of compression garments during the inflammation phase of DOMS may play an important role in regulating muscle stiffness; however, compression garments have no significant effects on intramuscular perfusion or other common clinical assessments. [ABSTRACT FROM AUTHOR]

Objective: Although musculoskeletal effects in resistance training are well described, little is known about structural and functional cardiac adaption in formerly untrained subjects. We prospectively evaluated whether short term high intensity (resistance) training (HI(R)T) induces detectable morphologic cardiac changes in previously untrained men in a randomized controlled magnetic resonance imaging (MRI) study. Materials and methods: 80 untrained middle-aged men were randomly assigned to a HI(R)T-group (n = 40; 43.5±5.9 years) or an inactive control group (n = 40; 42.0±6.3 years). HI(R)T comprised 22 weeks of training focusing on a single-set to failure protocol in 2–3 sessions/week, each with 10–13 exercises addressing main muscle groups. Repetitions were decreased from 8–10 to 3–5 during study period. Before and after HI(R)T all subjects underwent physiologic examination and cardiac MRI (cine imaging, tagging). Results: Indexed left (LV) and right ventricular (RV) volume (LV: 76.8±15.6 to 78.7±14.8 ml/m2; RV: 77.0±15.5 to 78.7±15.1 ml/m2) and mass (LV: 55.5±9.7 to 57.0±8.8 g/m2; RV: 14.6±3.0 to 15.0±2.9 g/m2) significantly increased with HI(R)T (all p<0.001). Mean LV and RV remodeling indices of HI(R)T-group did not alter with training (0.73g/mL and 0.19g/mL, respectively [p = 0.96 and p = 0.87]), indicating balanced cardiac adaption. Indexed LV (48.4±11.1 to 50.8±11.0 ml/m2) and RV (48.5±11.0 to 50.6±10.7 ml/m2) stroke volume significantly increased with HI(R)T (p<0.001). Myocardial strain and strain rates did not change following resistance exercise. Left atrial volume at end systole slightly increased after HI(R)T (36.2±7.9 to 37.0±8.4 ml/m2, p = 0.411), the ratio to end-diastolic LV volume at baseline and post-training was unchanged (0.47 vs. 0.47, p = 0.79). Conclusion: 22 weeks of HI(R)T lead to measurable, physiological changes in cardiac atrial and ventricular morphologic characteristics and function in previously untrained men. Trial regristration: The PUSH-trial is registered at the US National Institutes of Health (), NCT01766791. [ABSTRACT FROM AUTHOR]

Pulmonary arterial dual-energy (aDE) CT is an established technique for evaluating pulmonary perfusion blood volume (PBV). As DECT protocols are increasingly used for thoraco-abdominal CT, this study assessed image quality and clinical findings in portal–venous phase dual-energy (vDE) CT and compared it to aDE. In 95 patients, vDE-CT was performed using a dual-source scanner (70/Sn150 kV, 560/140 ref.mAs). Pulmonary triggered aDE-CT served as reference (n = 94). PBV was reconstructed using a dedicated algorithm. Mean relative attenuation was measured in the pulmonary trunk, aorta, and segmented lung parenchyma. A distribution ratio (DL) between vessels and parenchyma was calculated to assess the iodine uptake of the lung parenchyma. Subjective overall diagnostic image quality was assessed for PBV images on a five-point Likert scale. Image artifacts were classified into five groups based on scale rating and compared between vDE and aDE. Pathological findings were correlated with the anatomical image datasets. Mean relative attenuation of the lung parenchyma was comparable in both groups (vDE: 23 ± 6 HU and aDE: 22 ± 7 HU), but significantly lower in the vessels of vDE. Therefore, iodine uptake of the lung parenchyma was significantly higher in vDE (DL: 10% vs. 8%, p < 0.01). The subjective overall image quality of the PBV images was comparable (p = 0.5). Rotation and streak artifacts were found in most of the patients (>86%, both p > 0.6). Dual-source artifacts were found in only a few patients in both groups (vDE 5%, aDE 7%, p = 0.5). Recess and subpleural artifacts were increased in vDE (vDE 53/27%, aDE 24/7%, both p < 0.001). Pathological findings were found in 19% of the vDE patients and 59% of the aDE patients. Comparable objective and subjective image quality of lung perfusion can be obtained in vDE and aDE. Iodine uptake of the lung parenchyma is increased in vDE compared to aDE, suggesting an interstitial pooling effect. Knowledge of the different appearances of artifacts will aid in the interpretation of the images. Additional clinical information about the lung parenchyma can be provided by PBV evaluation in vDE. [ABSTRACT FROM AUTHOR]

For therapeutic decisions regarding uni- or biventricular surgical repair in congenital heart disease (CHD), left ventricular mass (LVM) is an important factor. The aim of this retrospective study was to determine the LVM of infants with CHD in thoracic computed tomography angiographies (CTAs) and to evaluate its usefulness as a prognostic parameter, with special attention paid to hypoplastic left heart (HLH) patients. Manual segmentation of the left ventricular endo- and epicardial volumes was performed in CTAs of 132 infants. LVMs were determined from these volumes and normalized to body surface area. LVMs of patients with different types of CHD were compared to each other using analyses of variances (ANOVA). An LVM cutoff for discrimination between uni- and biventricular repair was determined using receiver operating characteristics. Survival rates were calculated using Kaplan–Meier statistics. Patients with a clinical diagnosis of an HLH had significantly lower mean LVM (21.88 g/m2) compared to patients without applicable disease (50.22 g/m2; p < 0.0001) and compared to other CHDs, including persistent truncus arteriosus, left ventricular outflow tract obstruction, transposition of the great arteries, pulmonary artery stenosis or atresia, and double-outlet right ventricle (all, p < 0.05). The LVM cutoff for uni- vs. biventricular surgery was 33.9 g/m2 (sensitivity: 82.3%; specificity: 73.7%; PPV: 94.9%). In a subanalysis of HLH patients, a sensitivity of 50.0%, specificity of 100%, PPV of 100%, and NPV of 83.3% was determined. Patient survival was not significantly different between the surgical approaches or between patients with LVM above or below the cutoff. LVM can be measured in chest CTA of newborns with CHD and can be used as a prognostic factor. [ABSTRACT FROM AUTHOR]

Delayed-onset muscle soreness (DOMS), an ultrastructural muscle injury, is one of the most common reasons for impaired muscle performance. The purpose of this study was to investigate the influence of sport compression garments on the development of exercise-induced intramuscular edema in the context of DOMS. DOMS was induced in 15 healthy participants. The participants performed a standardized eccentric exercise of the calf muscles. Magnetic resonance imaging (MRI) was performed at baseline and 60h after exercise (T2-weighted signal intensity and T2 relaxation time was evaluated in each compartment and the intramuscular edema in the medial head of the gastrocnemius muscle was segmented). After the exercise, a conventional compression garment (18-21 mmHg) was placed on one randomized calf for 60h. The level of muscle soreness was evaluated using a visual analogue pain scale. T2-weighted signal intensity, T2 relaxation time and intramuscular edema showed a significant interaction for time with increased signal intensities/intramuscular edema in the medial head of the gastrocnemius muscle at follow-up compared to baseline. No significant main effect for compression or interaction between time and limb occurred. Further, no significant differences in the soleus muscle and the lateral head of the gastrocnemius muscle were noted between limbs or over time. After exercise, there was significantly increased muscle soreness in both lower legs in resting condition and when going downstairs and a decreased range of motion in the ankle joint. No significant difference was observed between the compressed and the noncompressed calf. Our results indicate that wearing conventional compression garments after DOMS has been induced has no significant effect on the development of muscle edema, muscle soreness, range of motion and calf circumference. [ABSTRACT FROM AUTHOR]

Background Long COVID occurs at a lower frequency in children and adolescents than in adults. Morphologic and free-breathing phase-resolved functional low-field-strength MRI may help identify persistent pulmonary manifestations after SARS-CoV-2 infection. Purpose To characterize both morphologic and functional changes of lung parenchyma at low-field-strength MRI in children and adolescents with post-COVID-19 condition compared with healthy controls. Materials and Methods Between August and December 2021, a cross-sectional clinical trial using low-field-strength MRI was performed in children and adolescents from a single academic medical center. The primary outcome was the frequency of morphologic changes at MRI. Secondary outcomes included MRI-derived functional proton ventilation and perfusion parameters. Clinical symptoms, the duration from positive reverse transcriptase-polymerase chain reaction test result, and serologic parameters were compared with imaging results. Nonparametric tests for pairwise and corrected tests for groupwise comparisons were applied to assess differences in healthy controls, recovered participants, and those with long COVID. Results A total of 54 participants after COVID-19 infection (mean age, 11 years ± 3 [SD]; 30 boys [56%]) and nine healthy controls (mean age, 10 years ± 3; seven boys [78%]) were included: 29 (54%) in the COVID-19 group had recovered from infection and 25 (46%) were classified as having long COVID on the day of enrollment. Morphologic abnormality was identified in one recovered participant. Both ventilated and perfused lung parenchyma (ventilation-perfusion [V/Q] match) was higher in healthy controls (81% ± 6.1) compared with the recovered group (62% ± 19; P = .006) and the group with long COVID (60% ± 20; P = .003). V/Q match was lower in patients with time from COVID-19 infection to study participation of less than 180 days (63% ± 20; P = .03), 180-360 days (63% ± 18; P = .03), and 360 days (41% ± 12; P < .001) as compared with the never-infected healthy controls (81% ± 6.1). Conclusion Low-field-strength MRI showed persistent pulmonary dysfunction in children and adolescents who recovered from COVID-19 and those with long COVID. Clinical trial registration no. NCT04990531 © RSNA, 2022 Supplemental material is available for this article. See also the editorial by Paltiel in this issue.

Background: There is limited information about perfusion in exercise-induced muscle injuries such as delayed-onset muscle soreness (DOMS) and the effect of compression garments as a therapeutic strategy during the regeneration phase. The purpose of this prospective, explorative study was to evaluate muscle perfusion in DOMS and to assess the effect of compression garments at resting conditions and during DOMS by magnetic resonance (MR) arterial spin labeling (ASL)., Methods: DOMS was induced from 03/2021 to 04/2021 using an eccentric and plyometric exercises targeting the calf muscles in 14 volunteers. A compression garment (21-22 mmHg) was worn during and for 6 h after exercise on one randomized leg. Magnetic resonance imaging (MRI) including ASL of both lower legs was performed before and directly after the exercise as well as after 6 h, and 48 h using a 3 Tesla MRI system. Perfusion analyses of the gastrocnemius muscle (GM) and the tibialis anterior muscle (TA) were performed and results were compared to baseline measurements. T2-weighted images and creatine kinase levels were acquired at baseline and after 48 h., Results: All volunteers presented a successful induction of DOMS in the GM after 48 h. Arterial muscle perfusion in the GM increased from baseline to measurements taken directly after the exercise (4.97±5.59 mL/100 g/min, P<0.001). No significant alteration in perfusion compared to baseline was observed at 6 h (P=0.16) and 48 h (P=1.0) after the induction of DOMS. Compression garments did not elicit a significant alteration in ASL parameters in the GM (P=0.65) or the TA (P=0.05) at any time point. No adverse events occurred during the study., Conclusions: After an initial exercise-associated increase in arterial muscle perfusion, a normalization of blood supply was observed at 6 and 48 h after the exercise intervention inducing DOMS. Wearing a compression garment (21-22 mmHg) during and after the induction of DOMS did not affect muscle perfusion at rest, nor did it have any significant effect on muscle perfusion during the regeneration phase. The results can help to better understand the pathophysiological properties of DOMS and may have implications for diagnostic and therapeutic strategies., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-21-1104/coif). The authors report that this work was funded by Bauerfeind AG, Zeulenroda-Triebes, Germany (No. 3007394). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have no other conflicts of interest to declare., (2022 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Purpose: To compare free-breathing (FB) stress cardiac MRI examinations with the reference standard breath-holding (BH) examination., Materials and Methods: A total of 40 consecutive patients were enrolled prospectively and were examined with 3-T MRI. Functional imaging, perfusion, and late gadolinium enhancement (LGE) sequences were performed in BH and FB by using compressed sensing and in-line motion correction. Left ventricle (LV) and right ventricle (RV) functional parameters in BH and FB examinations were compared by using Bland-Altman plots and linear mixed models. Subjective image quality was assessed with a five-point scale (1 = nondiagnostic, 5 = very good). For perfusion and LGE imaging, diagnostic confidence was rated with a three-point scale (1 = low, 3 = high), and image quality was rated with a five-point scale (1 = nondiagnostic, 5 = very good). The Wilcoxon test was used to compare image quality and diagnostic confidence., Results: Bland-Altman plots showed good agreement for LV and RV functional parameters in BH and FB sequences. Subjective image quality was significantly better with the BH sequences in the LV ( P < .01) but was comparable in the RV ( P > .99). Scanning time was 218 seconds (range, 130-385 seconds) for cine BH and 16 seconds (range, 11-27 seconds) for cine FB. Extent of perfusion defects, LGE, and diagnostic confidence was comparable between groups. Scanning time was 371 seconds (range, 239-502 seconds) for the LGE BH sequence and 189 seconds (range, 122-286 seconds) for the LGE FB sequence., Conclusion: FB adenosine stress cardiac MRI delivers diagnostic image quality and could represent an alternative for use in patients who are unable to meet the demands of multiple BHs and long examination times.© RSNA, 2019., Competing Interests: Disclosures of Conflicts of Interest: C.T. disclosed no relevant relationships. M.W. disclosed no relevant relationships. M.S.M. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is on the Siemens Healthcare speakers bureau; performed educational course administration for Siemens Healthcare. Other relationships: disclosed no relevant relationships. R.H. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is on the Siemens speakers bureau. Other relationships: disclosed no relevant relationships. T.H. disclosed no relevant relationships. M.U. Activities related to the present article: institution received a grant from Siemens Healthineers. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. W.W. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is on the Siemens speakers bureau. Other relationships: disclosed no relevant relationships., (2019 by the Radiological Society of North America, Inc.)

Purpose: To evaluate the ability of magnetic resonance (MR) imaging to induce deoxyribonucleic acid (DNA) damage in patients who underwent cardiac MR imaging in daily routine by using γ-H2AX immunofluorescence microscopy., Materials and Methods: This study complies with the Declaration of Helsinki and was performed according to local ethics committee approval. Informed patient consent was obtained. Blood samples from 45 patients (13 women, 32 men; mean age, 50.3 years [age range, 20-89 years]) were obtained before and after contrast agent-enhanced cardiac MR imaging. MR imaging-induced double-strand breaks (DSBs) were quantified in isolated blood lymphocytes by using immunofluorescence microscopy after staining the phosphorylated histone variant γ-H2AX. Twenty-nine patients were examined with a myocarditis protocol (group A), 10 patients with a stress-testing protocol (group B), and six patients with flow measurements and angiography (group C). Paired t test was performed to compare excess foci before and after MR imaging., Results: The mean baseline DSB level before MR imaging and 5 minutes after MR imaging was, respectively, 0.116 DSB per cell ± 0.019 (standard deviation) and 0.117 DSB per cell ± 0.019 (P = .71). There was also no significant difference in DSBs in these subgroups (group A: DSB per cell before and after MR imaging, respectively, 0.114 and 0.114, P = .91; group B: DSB per cell before and after MR imaging, respectively, 0.123 and 0.124, P = .78; group C: DSB per cell before and after MR imaging, respectively, 0.114 and 0.115, P = .36)., Conclusion: By using γ-H2AX immunofluorescence microscopy, no DNA DSBs were detected after cardiac MR imaging., (© RSNA, 2015)

Background: Radiation exposure occurs in X-ray guided interventional procedures or computed tomography (CT) and γ-H2AX-foci are recognized to represent DNA double-strand breaks (DSBs) as a biomarker for radiation induced damage. Antioxidants may reduce the induction of γ-H2AX-foci by binding free radicals. The aim of this study was to establish a dose-effect relationship and a time-effect relationship for the individual antioxidants on DSBs in human blood lymphocytes., Materials and Methods: Blood samples from volunteers were irradiated with 10 mGy before and after pre-incubation with different antioxidants (zinc, trolox, lipoic acid, ß-carotene, selenium, vitamin E, vitamin C, N-acetyl-L-cysteine (NAC) and Q 10). Thereby, different pre-incubation times, concentrations and combinations of drugs were evaluated. For assessment of DSBs, lymphocytes were stained against the phosphorylated histone variant γ-H2AX., Results: For zinc, trolox and lipoic acid regardless of concentration or pre-incubation time, no significant decrease of γ-H2AX-foci was found. However, ß-carotene (15%), selenium (14%), vitamin E (12%), vitamin C (25%), NAC (43%) and Q 10 (18%) led to a significant reduction of γ-H2AX-foci at a pre-incubation time of 1 hour. The combination of different antioxidants did not have an additive effect., Conclusion: Antioxidants administered prior to irradiation demonstrated the potential to reduce γ-H2AX-foci in blood lymphocytes.