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Background Infective endocarditis (IE) in patients with adult congenital heart disease (ACHD) remains a diagnostic challenge due to difficulties in detecting endocardial lesions by echocardiography. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) has shown good diagnostic performance in prosthetic valve IE. This study aimed to assess its additional diagnostic value in ACHD-associated IE and to characterize its advantages.Methods and Results:Overall, 22 patients with ACHD and clinical suspicion of IE were retrospectively studied. 18F-FDG PET/CT was performed in addition to conventional assessment based on the modified Duke criteria. The final IE diagnosis was determined by an expert team during a 3-month clinical course, resulting in 18 patients diagnosed with IE. Seven patients (39%) were diagnosed with definite IE only by initial echocardiography. An 18F-FDG PET/CT assessment revealed endocardial involvement in the other 9 patients, resulting in the diagnosis of definite IE in 16 in total (88%). Right-sided endocardial lesions were more common (n=12, 67%) but rarely identified by echocardiography, whereas 18F-FDG PET/CT revealed right-sided lesions in 9 patients. A negative 18F-FDG PET/CT (n=7, 39%) assessment was associated with a native valve IE (71% vs. 0%). In 4 patients who were identified with not-IE, neither echocardiography nor 18F-FDG PET/CT detected any suspicious cardiac involvement. Conclusions In the diagnosis of ACHD-associated IE, characterized by right-sided IE, 18F-FDG PET/CT assessment should be useful.

Coronary computed tomography angiography (CCTA) has low specificity for detecting significant functional coronary stenosis. We developed a new transluminal attenuation gradient (TAG)-derived dynamic CCTA with dose modulation, and we investigated its diagnostic performance for myocardial ischemia depicted by 13N-ammonia positron emission tomography (PET). Data from 48 consecutive patients who had undergone both dynamic CCTA and 13N-ammonia PET were retrospectively analyzed. Dynamic CCTA was continuously performed in mid-diastole for five cardiac cycles with prospective electrocardiography gating after a 10-s contrast medium injection. One scan of the dynamic CCTA was performed as a boost scan for conventional CCTA at the peak phase of the ascending aorta. Absolute TAG values at five phases around the boost scan were calculated. The dynamic TAG index (DTI) was defined as the ratio of the maximum absolute TAG to the standard deviation of five TAG values. We categorized the coronary territories as non-ischemia or ischemia based on the 13N-ammonia PET results. A receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff of the DTI for identifying ischemia. The DTI was significantly higher for ischemia compared to non-ischemia (8.8 ± 3.9 vs. 4.6 ± 2.0, p

Background The latest guidelines recommend early intervention in adult atrial septal defect (ASD) patients with signs of right ventricular (RV) enlargement. However, the criteria of RV enlargement for optimal intervention remain unclear. We investigated the preoperative determinants for normalizing the RV volume after transcatheter closure of ASD in adults.Methods and Results:We retrospectively analyzed 52 ASD patients who underwent transcatheter closure. Cardiac magnetic resonance imaging (CMR) measured RV volume before and 1 year after the closure. The patients were divided into normalized (postoperative RV end-systolic volume index [RVESVI] Conclusions Preoperative RVESVI is an independent predictor for normalization of RV volume at 1 year after transcatheter closure of ASD in adults. Early intervention before RVESVI reaches 75 mL/m2may confer optimal timing for normalizing RV volume.

To evaluate the detectability of AKA on aortic computed tomography angiography (CTA) using ultra-high-resolution computed tomography (UHRCT). Twenty-eight patients were enrolled. They underwent aortic CTA with UHRCT (UHRCTA) and had previously undergone aortic conventional CTA (CCTA). The injection protocol of UHRCTA was the same as that of CCTA. The bolus tracking technique was used. UHRCTA images were reconstructed with adaptive iterative dose reduction (strong) and with forward-projected model-based iterative reconstruction solution. The matrix size and slice thickness on UHRCT were 1024 and 0.25 mm, respectively, and those on conventional CT were 512 and 0.5 or 0.67 mm, respectively. The UHRCTA and CCTA images were visually compared by using four scales. A score of 4 or 3 indicated that the AKA was assessable. In this instance, the contrast-to-noise ratios of each UHRCTA were measured. The exposure dose and signal-to-noise ratios were also investigated. The AKA visualization scores obtained with UHRCTA with forward-projected model-based iterative reconstruction solution were significantly higher than those with adaptive iterative dose reduction (p = 0.018) and CCTA (p = 0.0024). UHRCT can contribute to the better visualization of the AKA on aortic CTA.

To determine the potential impact of on-site CT-derived fractional flow reserve (CT-FFR) on the diagnostic efficiency and effectiveness of coronary CT angiography (CCTA) in patients with obstructive coronary artery disease (CAD) on CCTA. This observational cohort study included patients with suspected CAD who had been randomized to cardiac CT in the CRESCENT I and II trials. On-site CT-FFR was blindly performed in all patients with at least one ≥ 50% stenosis on CCTA and no exclusion criteria for CT-FFR. We retrospectively assessed the effect of adding CT-FFR to the CT protocol in patients with a stenosis ≥ 50% on CCTA in terms of diagnostic effectiveness, i.e., the number of additional tests required to determine the final diagnosis, reclassification of the initial management strategy, and invasive coronary angiography (ICA) efficiency, i.e., ICA rate without ≥ 50% CAD. Fifty-three patients out of the 372 patients (14%) had at least one ≥ 50% stenosis on CCTA of whom 42/53 patients (79%) had no exclusion criteria for CT-FFR. CT-FFR showed a hemodynamically significant stenosis (≤ 0.80) in 27/53 patients (51%). The availability of CT-FFR would have reduced the number of patients requiring additional testing by 57%-points compared with CCTA alone (37/53 vs. 7/53, p

OBJECTIVE The aim of the study was to investigate the feasibility of coronary computed tomography (CT) angiography with a low kilovoltage peak scan and a refined scan timing prediction using a small contrast medium (CM) dose. METHODS In protocol A, 120-kVp scanning and a standard CM dose were used. The scan timing was fixed. In protocol B, 80 kVp and a 60% CM dose were used. The scan timing was determined according to the interval from the CM arrival to the peak time in the ascending aorta. We measured the CT number and recorded the radiation dose. RESULTS Higher CT numbers were observed in the left circumflex (proximal, P = 0.0235; middle, P = 0.0007; distal, P < 0.0001) in protocol B compared with protocol A. The radiation dose in protocol B was significantly lower than in protocol A (2.2 ± 0.9 vs 4.3 ± 1.7 mSv). CONCLUSIONS Low-contrast, low-radiation dose, high-image quality coronary CT angiography can be performed with low kilovoltage peak scanning and a refined scan timing prediction.

PURPOSE To evaluate the usefulness of magnetic resonance imaging (MRI) to differentiate basal cell adenomas (BCAs) from other parotid tumors. METHOD A total of 136 patients with histologically proven parotid gland tumors (13 BCAs, 66 pleomorphic adenomas [PAs], 30 Warthin tumors [WTs], and 27 parotid cancers [PCs]) who underwent a cervical MRI study between December 2011 and March 2019 were retrospectively enrolled. The MRI findings of the tumors were evaluated by two board-certified radiologists. RESULTS All 13 of the BCAs showed smooth margins, while 19 of the 27 PCs showed irregular margins (p

Objectives: To investigate changes in right ventricular (RV) strain after pulmonary valve replacement (PVR) in repaired tetralogy of Fallot (TOF) by applying a novel postprocessing technique to conventional short-axis cine MRI to measure RV strains before and after PVR.Methods: Twenty-four patients with repaired TOF who underwent PVR and 16 healthy controls were enrolled. Global maximum and minimum principal strains (GPSmax, GPSmin) and global circumferential and longitudinal strains (GCS, GLS) were measured from short-axis cine images reconstructed radially along the long axis. Strain parameters before and after PVR were compared using paired t-tests. One-way ANOVA with Tukey post-hoc analysis was used for comparisons between the before and after PVR groups and the control group. Results: There were no differences in strain parameters before and after PVR. The GPSmax before PVR was lower than that in the control group (P=0.002). Before and after PVR, GCSs were higher and GLSs were lower than those in the control group (before and after GCSs: P=0.002 for both, before and after GLSs: PP=0.0003). Conclusions: RV strains from radially reconstructed short-axis cine images revealed impaired myocardial motion after PVR. When compared to the control group, changes in GCS and GLS in TOF patients before and after PVR might be due to RV remodeling.

PURPOSE: We investigated the impact of model-based iterative reconstruction (MBIR) on 320-detector row computed tomography angiography (CTA) in infants with complex congenital heart disease (CHD). METHODS: Seventy infants with complex CHD who underwent 320-detector row CTA (40 boys and 30 girls; age range, 0–22 months; median age, 60 days) were retrospectively evaluated. First, the images were reconstructed by filtered back projection (FBP), hybrid iterative reconstruction (HIR), or MBIR in 20 cases, and variables were compared among the three iterative reconstruction methods (IR test). Second, the variables were compared between 25 cases scanned using HIR and 25 cases scanned using MBIR, with a 20 standard deviation noise level for both. Attenuation values and contrast-to-noise ratios (CNRs) of the great vessels and heart chambers were calculated. Total dose-length products were recorded for all patients (radiation dose: RD test). RESULTS: In the IR test, the mean CNR values were 4.8±1.3 for FBP, 6.9±1.4 for HIR, and 8.2±1.7 for MBIR (p < 0.0001). The best subjective image qualities in the great vessels and heart chambers were obtained with MBIR. In RD testing, no significant differences between HIR and MBIR in image quality (CNR: HIR, 8.4±2.4; MBIR, 8.3±2.4) were observed. The effective dose was significantly lower for MBIR than for HIR (0.7±0.2 vs. 1.1±0.3 mSv; p < 0.001). CONCLUSION: The MBIR algorithm significantly improved image quality and decreased radiation exposure in 320-row CTA of infants with complex CHD, providing an alternative to FBP or HIR that is both safer and produces better results.

The purpose of this study was to investigate whether the origins and courses of the coronary arteries could be better assessed using ECG-gated dual-source computed tomography (CT) than with echocardiography in neonates with transposition of the great arteries (TGA). A total of 17 neonates within 14 days old who underwent both echocardiography and retrospective ECG-gated coronary CT angiography were retrospectively reviewed. The patients were sedated and intubated during CT examinations, and CT images were obtained with a breath-hold. CT images were reconstructed by multiple cardiac phases, and the coronary artery assessment was performed in the most static phase. Coronary anomalies were classified by Shaher’s classification and validated by surgical findings. CT correctly classified 16 of 17 cases (Shaher type 1: 7, type 2: 4, type 9: 3, type 3: 1, type 4: 2), whereas echocardiography classified only 8 of 17 cases correctly. Dual-source CT had a significantly higher diagnostic ability than echocardiography (p = 0.0078). Dual-source coronary CT angiography has a higher diagnostic ability than echocardiography in the assessment of the origins and courses of the coronary arteries in neonates with TGA.

Objective: We proposed the use of standard two-dimensional (2D) cine MR images with inter-slice interpolation to evaluate three-dimensional (3D) left ventricular (LV) global area strain (GAS), and investigated its clinical applicability by comparing to 2D strains. / Materials and Methods: Twenty-one consecutive patients with ischemic cardiomyopathy (ICM) (63±12 years) and 12 controls without cardiac disease (68±13 years) were retrospectively enrolled. Receiver operating characteristic analysis was performed to determine the optimal cutoff of circumferential strain (CS), radial strain (RS), longitudinal strain (LS), and GAS for detection of patients with LV ejection fraction (LVEF) ≤45%. Comparison of CS, RS, LS, and GAS between controls and ICM patients was analyzed by the Wilcoxon rank-sum test. / Results: The optimal cutoff of GAS has the highest diagnostic performance for detection of patients with LVEF ≤45% [area under the curve (AUC), 0.97; sensitivity, 88%; specificity, 100%] compared to the other 2D strains (CS vs. RS vs. LS; AUC, 0.85 vs. 0.85 vs. 0.73; sensitivity, 75% vs. 100% vs. 50%; specificity, 85% vs. 77% vs. 85%). LS and GAS were significantly greater for controls than ICM patients (LS: -18.6±3.2% vs. -10.1±3.2%, p

We explored the clinical value of low-tube voltage prospective second-generation ECG-triggered 320-row CT angiography in infants with complex CHD (37 male, 23 female, aged 0–2 years). The diagnostic accuracy of 320-row CT in complex CHD was 99.4% for intracardiac cardiovascular malformations, 99.8% for extracardiac cardiovascular malformations, and 100% for other malformations. The average subjective overall image quality score for cardiac structures was 3.7 ± 0.5 points. Second-generation 320-row CT angiography with low-tube voltage and prospective ECG-triggered volume target scanning allows accurate diagnosis of cardiovascular anomalies in infants with complex CHD.

We measured right ventricular (RV) strain by applying a novel postprocessing technique to conventional short-axis cine magnetic resonance imaging in the repaired tetralogy of Fallot (TOF) and investigated whether pulmonary valve replacement (PVR) changes the RV strain. Twenty-four patients with repaired TOF who underwent PVR and 16 healthy controls were enrolled. Global maximum and minimum principal strains (GPSmax, GPSmin) and global circumferential and longitudinal strains (GCS, GLS) were measured from short-axis cine images reconstructed radially along the long axis. Strain parameters before and after PVR were compared using paired t-tests. One-way ANOVA with Tukey post-hoc analysis was used for comparisons between the before and after PVR groups and the control group. There were no differences in strain parameters before and after PVR. The GPSmax before PVR was lower than that in the control group (P = 0.002). Before and after PVR, GCSs were higher and GLSs were lower than those in the control group (before and after GCSs: P = 0.002 for both, before and after GLSs: P P = 0.0003). RV strains from radially reconstructed short-axis cine images revealed unchanged myocardial motion after PVR. When compared to the control group, changes in GCS and GLS in TOF patients before and after PVR might be due to RV remodeling.

To determine added value of permeability MRI in parotid tumor characterization to T2-weighted imaging (T2WI), semi-quantitative analysis of time-intensity curve (TIC), and intra-voxel incoherent motion diffusion-weighted imaging (IVIM-DWI). This retrospective study was approved by the institutional review board, and the informed consent was waived. Sixty-one parotid tumors in 61 patients were examined using T2WI, IVIM-DWI, and permeability MRI. TIC patterns were categorized as persistent, washout, or plateau. Signal intensity ratio of lesion-to-muscle on T2WI, apparent diffusion coefficients (ADCs), D and f values from IVIM-DWI, and Ktrans, kep, Ve, and Vp values from permeability MRI were measured. Multiple comparisons were applied to determine whether any differences among 4 histopathologic types (pleomorphic adenomas, Warthin’s tumors, other benign tumors, and malignant tumors) existed. Diagnostic accuracy was compared before and after modification diagnosis referring to permeability MRI. In a validation study, 60 parotid tumors in 60 patients were examined. ADC and D values of malignant tumors were significantly lower than those of benign tumors other than Warthin’s tumors, but higher than those of Warthin’s tumors. kep and Vp values of Warthin’s tumors were significantly higher than those of malignant tumors. Multivariate analyses showed that TIC pattern, D, and kep values were suitable parameters. McNemar’s test showed a significant increase of sensitivity (11/12, 92%) and specificity (46/49, 94%) with adding kep. The validation study yielded high sensitivity (14/16, 88%) and specificity (41/44, 93%). Permeability MRI offers added value to IVIM-MRI and semi-quantitative TIC analysis of DCE-MRI in characterization of parotid tumors • Permeability MR imaging offers added value in the characterization of parotid gland tumors in combination with semi-quantitative TIC analysis and IVIM analyses with D parameter. • The combination of TIC pattern, D, and k ep might facilitate accurate characterization of parotid gland tumor, thereby avoiding unnecessary surgery for benign tumors or delayed treatment for malignant tumors. • A combination of permeability and diffusion MR imaging can be used to guide the selection of an appropriate biopsy site.

Background Coronary computed tomography angiography (CCTA) accurately rules out coronary artery disease (CAD), but has a limited ability to predict hemodynamically significant CAD. Implementing on-site computed tomography-derived fractional flow reserve (CT-FFR) could improve the clinical value and efficiency of cardiac CT in the diagnostic work-up of patients with stable angina. Purpose To determine the impact of on-site CT-FFR on diagnostic effectiveness, management strategy and downstream invasive coronary angiography (ICA) in patients with suspected CAD. Methods 196 patients (59.1±9.6 years, 47% women) with suspected CAD underwent a CCTA in the CRESCENT I and II trials. On-site CT-FFR analysis was performed in all patients with at least one ≥50% stenosis on CCTA (N=53). We assessed the effect of adding CT-FFR analysis to CCTA in terms of 1) diagnostic effectiveness, i.e. the number of additional tests required to determine the final diagnosis; 2) reclassification of the initial management strategy; 3) ICA efficiency, i.e. ICA rate without ≥50% CAD. Results CT-FFR was calculated in 42/53 (79%) of the eligible patients as it could not be calculated in patients with suspected coronary total occlusion (N=7), severe coronary calcification (N=2), severe CT artefacts (N=1) or missing CT images (N=1). CT-FFR ≤0.80 was present in 27/196 (14%) patients, including 8/196 (4%) patients with high-risk ischemia (CT-FFR ≤0.80 in all three vessels, left main or proximal left anterior descending coronary artery). The final diagnosis was achieved with CT-FFR in an additional 30/196 (15%) patients compared to CT alone (p Conclusion Implementation of CT-FFR has the potential for improved diagnostic effectiveness. Functional reclassification of CAD provides more efficient ICA referral in patients with suspected CAD compared to CTA alone. Acknowledgement/Funding Dutch Heart Foundation [NHS 2014T061 and NHS 2013T071]

Purpose To compare the predictabilities of postoperative pulmonary function after lobectomy for primary lung cancer among counting method, effective lobar volume, and lobar collapsibility. Methods Forty-nine patients who underwent lobectomy for primary lung cancer were enrolled. All patients underwent inspiratory/expiratory CT and pulmonary function tests 2 weeks before surgery and postoperative pulmonary function tests 6–7 months after surgery. Pulmonary function losses (ΔFEV 1.0 and ΔVC) were calculated from the pulmonary function tests. Predictive postoperative pulmonary function losses (ppoΔFEV 1.0 and ppoΔVC) were calculated using counting method, effective volume, and lobar collapsibility. Correlations and agreements between ΔFEV 1.0 and ppoFEV 1.0 and those between ΔVC and ppoΔVC were tested among three methods using Spearman's correlation coefficient and Bland-Altman plots. Results ΔFEV 1.0 and ppoΔFEV 1.0insp-exp were strongly correlated (r=0.72), whereas ΔFEV 1.0 and ppoΔFEV 1.0count and ΔFEV 1.0 and Pred. ΔFEV 1.0eff.vol. were moderately correlated (r=0.50, 0.56). ΔVC and ppoΔVC eff.vol. (r=0.71) were strongly correlated, whereas ΔVC and ppoΔVC count , and ΔVC and ppoΔVC insp-exp were moderately correlated (r=0.55, 0.42). Conclusions Volumetry from inspiratory/expiratory CT data could be useful to predict postoperative pulmonary function after lobectomy for primary lung cancer.

To elucidate the utility of PROPELLER for motion artefact reduction on shoulder MRI and to examine the influence of streak artefacts on diagnosis of clinical images.15 healthy volunteers and 48 patients underwent shoulder MRI with/without PROPELLER (coronal oblique proton density-fast spin echo [PD-FSE], sagittal oblique T2-FSE). In a volunteer study, all sequences were performed in both static and exercise-loaded conditions. Two radiologists graded artefacts and delineation of various anatomical structures in the volunteer study and motion and streak artefacts in the clinical study. Mean scores were compared between sequences with/without PROPELLER. In the clinical study, mean scores of motion artefacts were compared with mean scores of streak artefacts. Wilcoxon signed-rank test was used for all comparisons.In both studies, PROPELLER significantly reduced motion artefacts (P0.05). In the volunteer study, it significantly improved delineations in sagittal oblique images in the exercise-loaded condition (P0.05). In the clinical study, streak artefacts appeared dominantly on images with PROPELLER (P0.05), but influenced diagnosis to a lesser extent than motion artefacts.PROPELLER can reduce motion artefacts in shoulder MRI. While it does cause streak artefacts, it affects diagnosis to a lesser extent.

Background Five-megapixel (MP) displays are recommended as soft copy devices for digital mammogram. An 8-MP liquid crystal display (LCD) (two 4-MP displays within one display) might offer the advantage of being able to view biplane mammography more easily than the dual planes of 5-MP LCDs. Purpose To compare detectability of Breast Imaging Reporting and Data System (BI-RADS) category 3 or higher lesions and reading time on mammography between 5- MP and 8-MP LCDs. Material and Methods The mammograms of 240 breasts of 120 patients including 60 breasts with BI-RADS category 3 or higher lesions and 180 breasts with normal or category 2 lesions were enrolled. All bilateral mammograms were displayed on bifacial 5-MP LCDs or an 8-MP LCD (two 4-MP displays within one display). Six radiologists assessed 240 breasts on each display. The observations were analyzed using receiver operating characteristic (ROC) analysis. A jack-knife method was used for statistical analysis. We employed a paired t-test to determine whether any significant differences existed in the reading time between two different displays. A P value Results The mean areas under the ROC curve obtained using 5-MP and 8-MP LCDs were 0.925 and 0.915, respectively, and there was no significant difference ( P = 0.46). There was also no significant difference in the reading time between two types of displays (57.8 min. vs. 51.5 min, P = 0.39). Conclusion The detectability of BI-RADS category 3 or higher lesions and reading time using an 8-MP LCD were comparable to those using a 5-MP LCD.

To investigate the feasibility and accuracy of measurement of the pulmonary to systemic blood flow ratio (Qp/Qs) and defect and rim sizes in secundum atrial septal defects (ASDs) using 256-slice CT, compared to the reference transoesophageal echocardiography (TEE) and right heart catheterization (RHC) measurements. Twenty-three consecutive adult patients with secundum ASDs who underwent retrospective ECG-gated coronary CT angiography (CCTA), TEE and RHC were enrolled in this study. Right ventricular (RV) and left ventricular (LV) stroke volumes (SV) were calculated by biventricular volumetry of CCTA. Qp/Qs-CT was defined as RVSV/LVSV. The sizes of the defect and rim were measured by multi-planar reconstruction CT images. Correlations between Qp/Qs-CT and Qp/Qs–RHC and between the defect diameter obtained by CT and TEE were analyzed by Pearson’s coefficient analysis. Rim sizes by CT and TEE were compared by paired t-test. Qp/Qs-CT was significantly correlated with Qp/Qs-RHC (r = 0.83, p

A 54-year-old woman diagnosed with sarcoidosis based on mediastinal lymph node biopsy underwent conventional contrast material–enhanced chest CT examination without electrocardiographic synchronization to evaluate pulmonary sarcoidosis. Past medical history included prior left total mastectomy for breast cancer (Fig 1, A). CT results demonstrated multiple hypoattenuating masses involving the septum, free walls of both ventricles, and right atrium (Fig 1, B, C). Cardiac metastases were a potential diagnosis; however, the cardiac lesions were similar in appearance to lymph nodes noted in the hilum and mediastinum. Subsequent late gadolinium enhancement MRI results showed abnormal foci of delayed enhancement in both ventricles and the right atrium, corresponding to the lesions on chest CT (Fig 1, D). Fluorine 18 fluorodeoxyglucose PET results showed abnormal uptake in these areas (maximum standardized uptake value, 12.0) (Fig 1, E). Finally, results of endomyocardial biopsy from the right ventricle revealed a granuloma with lymphocytes, demonstrating active sarcoidosis (Fig 1, F). Open in a separate window A, Contrast-enhanced CT image obtained with a delay time of 90 seconds after contrast medium injection at a slice thickness of 5 mm shows hilar and mediastinal lymphadenopathy (arrows). Note the prior left total mastectomy (arrowheads). B and C, Contrast-enhanced CT images demonstrate hypoattenuating foci in the septum, both ventricles, and right atrium (arrows). D, A four-chamber view of late enhancement MRI acquired 10 minutes after injection of gadolinium-based contrast material reveals delayed gadolinium enhancement in the septum, both ventricles, and right atrium (arrows). E, Abnormal fluorine 18 fluorodeoxyglucose (18F-FDG) uptake is observed in the septum, both ventricles, and right atrium on the 18F-FDG PET image (arrows). F, Endomyocardial biopsy specimen obtained from the right ventricle demonstrates granulomas with giant cells. (CD68 immunohistochemical staining; magnification rate, ×400.)

Purpose To assess the usefulness of amide proton transfer (APT) imaging in differentiating parotid tumors. Material and methods We retrospectively analyzed 43 histopathologically proven parotid solid tumors with diameters ≥2 cm. Twenty-one tumors were benign and 12 tumors were malignant. Two-dimensional APT imaging was performed using a saturation pulse with a duration of 2 s and a saturation power level of 2 μT. For acquiring Z-spectra, the imaging was repeated at 25 saturation frequency offsets from ω = −6 to +6 ppm with a step of 0.5 ppm as well as one scan acquired far off-resonance (−1560 ppm) for signal normalization. For the APT imaging, the asymmetry analysis at 3.5 ppm downfield from the water signal was calculated. The mean APT signal intensity (SI) was compared between the benign and malignant tumors. Results The mean APT SI was 2.23 ± 0.80 % in the benign tumors and significantly higher at 2.99 ± 0.99 % in the malignant tumors (P = 0.01). A receiver operating curve analysis revealed that the optimal APT SI threshold was 2.40 for distinguishing malignant tumors from benign tumors with an area under the curve of 0.74. The sensitivity, specificity, and accuracy were 83.3%, 61.3%, and 67.4%, respectively. Conclusion The mean APT SI of the malignant parotid tumors was significantly higher than that of the benign parotid tumors.

Congestive hepatopathy and hepatocellular carcinoma is a serious complication after Fontan procedure. Liver fibrosis due to hepatic congestion could occur also in adult patients after repair of tetralogy of Fallot (rTOF). However, the incidence and severity remain unclear.A total of 111 patients with adult congenital heart disease between 2009 and 2016 were enrolled. Liver fibrosis markers and hemodynamic parameters assessed by cardiac magnetic resonance imaging and catheterization were analyzed in 50 rTOF patients having significant pulmonary regurgitation and/or stenosis, 50 Fontan patients and 11 controls.Liver fibrosis markers in patients with rTOF were significantly higher than controls, and tended to be lower than Fontan patients (median, hyaluronic acid: 25.8 vs. 15.9 vs. 40.8, type IV collagen: 129 vs. 113 vs. 166, ng/mL, p 0.05, respectively). Patients with rTOF showed abnormal hyaluronic acid levels more frequently than controls, and less frequently than Fontan patients (22% vs. 0% vs. 38%, respectively, p 0.05). Multivariate analyses indicated a positive association of right atrial pressure with type IV-collagen or hyaluronic acid levels (each, p 0.001, p = 0.003). Abdominal ultrasonography revealed hepatic congestion in 50% of rTOF patients tested. Liver biopsy of the two rTOF patients with highest hyaluronic acid levels showed pathological evidence of moderate and severe (F2 and F3) liver fibrosis and one had combined hepatocellular and cholangiocarcinoma.We first demonstrated elevated liver fibrosis markers in adult patients with rTOF. These levels may help to predict the progressive liver disease as well as consider the timing of pulmonary valve replacement.

To investigate the performance of second-generation 320-row computed tomographic (CT) angiography (CTA) in detecting coronary arteries and identify factors influencing visibility of the coronary arteries in infants with complex congenital heart disease (CHD). Data of 60 infants (aged 0-2 years, median 2 months) with complex CHD who underwent examination using 320-row CTA with low-dose prospective electrocardiogram-triggered volume target scanning were reviewed. The coronary arteries of each infant were assessed using a 0-4-point scoring system based on the number of coronary segments with a visible course. Clinical parameters, the CT value in the ascending aorta, image noise, and the radiation dose were subjected to univariate and multivariate analyses. The mean coronary score for all examinations was 2.6 ± 1.5 points. The mean attenuation in the ascending aorta was 306.7 ± 66.2 HU and the mean standard deviation was 21.7 ± 4.4. The mean effective radiation dose was 1.27 ± 0.39 mSv. Multivariate regression analysis showed significant correlations between coronary score and body weight (p

Purpose. Right ventricular (RV) failure and ventricular dyssynchrony are strong determinants of prognosis in patients with adult congenital heart disease (ACHD). The aim of this study was to investigate the relationship between interventricular dyssynchrony (IVD) using cine-tagged magnetic resonance imaging (MRI) and RV dys- function in ACHD patients. Materials and Methods. Sixty-seven patients with ACHD (38 with repaired tetralogy of Fallot; 22 with atrial septal defect; seven with ventricular septal defect) underwent tagging MRI. Time curves of myocardial circumferential strains for RV and left ventricular (LV) free walls were delivered from short-axis cine-tagging images. Contraction delay between RV and LV free walls was computed by cross-correlation analysis of the two strain time curves and was defined as the IVD time (msec). Results. IVD was significantly greater for patients with RV ejection fraction (RVEF)

The aim of this study was to use T2* cardiac magnetic resonance (CMR) imaging to quantify myocardial iron content in patients with heart failure (HF) and to investigate the relation between iron content, cardiac function, and the cause of HF. CMR data were analyzed from 167 patients with nonischemic and 31 with ischemic HF and 50 patients with normal ventricular function. Short-axis T2* imaging was accomplished using 3-T scanner and multiecho gradient-echo sequence. Myocardial T2* value (M-T2*) was calculated by fitting the signal intensity data for the mid-left ventricular (LV) septum to a decay curve. Patients with nonischemic HF were categorized into patients with LV ejection fraction (LVEF)35% or ≥35%. The relation between nonischemic HF with LVEF35% and the risk for major adverse cardiac events was analyzed by multivariate logistic regression analysis using M-T2* and HF biomarkers. M-T2* was significantly greater for patients with nonischemic HF (LVEF35%: 29 ± 7 ms, LVEF ≥35%: 26 ± 5 ms) than for patients with normal LV function (22 ± 3 ms, p0.0001) or ischemic HF (22 ± 4 ms, p0.001). The odds ratio was 1.21 for M-T2* (p0.0001) and 1.0015 for brain natriuretic peptide (p0.0001) in relation to nonischemic HF with LVEF35%. Furthermore, this value was 0.96 for systolic blood pressure (p = 0.012) and 1.02 for M-T2* (p = 0.03) in relation to the risk for major adverse cardiac events in patients with nonischemic HF. In conclusion, T2* CMR demonstrated the robust relation between myocardial iron deficiency and nonischemic HF. M-T2* is a biomarker that can predict adverse cardiac function in patients with nonischemic HF.

The detection of ground-glass opacities (GGOs) is an important issue in lung cancer screening with low-dose CT. The iterative reconstruction (IR) technique has the ability to improve the image quality relative to the filtered back projection (FBP) technique with low-dose CT. Our purpose was to investigate the ability to detect GGO in a chest phantom using a low-dose CT and hybrid IR, named iDose. Simulated GGOs in a chest phantom were scanned with 256-section CT at tube current second products of 20, 50, 100, and 200 mAs. Five radiologists visually assessed the detectability of GGOs in the phantom. The contrast-to-noise ratio (CNR) for GGOs was used as an estimate of image quality. Comparison of the detectability and CNR between standard images with 200 mAs-FBP and low-dose images with 20, 50, and 100-mAs FBP/iDose were performed by ANOVA with Dunnett’s and Tukey’s test. The detectability was significantly lower at 20-mAs FBP/iDose and 50-mAs FBP than that at 200-mAs FBP (p < 0.05). There was no significant difference between 50-mAs iDose and 200-mAs FBP and between 100-mAs iDose/FBP and 200-mAs FBP. The CNR was significantly higher on iDose images than that on FBP images at each mAs value. The CNR at 200-mAs FBP was the same as that at 50-mAs iDose (CNR:1.8). The hybrid IR technique and low-dose CT imaging with 50 mAs enabled noise and to maintain the detectability for GGOs in a chest phantom that is equivalent to the reference acquisitions of 200 mAs with FBP.

Quantification of myocardial oxygenation (MO) in heart failure (HF) has been less than satisfactory. This has necessitated the use of invasive techniques to measure MO directly or to determine the oxygen demand during exercise using the cardiopulmonary exercise (CPX) test. We propose a new quantification method for MO using blood-oxygen-level-dependent (BOLD) myocardial T2* magnetic resonance imaging (M-T2* MRI), and investigate its correlation with CPX results.Thirty patients with refractory HF who underwent cardiac MRI and CPX test for heart transplantation, and 24 healthy, age-matched volunteers as controls were enrolled. M-T2* imaging was performed using a 3-Tesla and multi-echo gradient-echo sequence. M-T2* was calculated by fitting the signal intensity data for the mid-left ventricular septum to a decay curve. M-T2* was measured under room-air (T2*-air) and after inhalation of oxygen for 10min at a flow rate of 10L/min (T2*-oxy). MO was defined as the difference between the two values (ΔT2*). Changes in M-T2* at the two conditions and ΔT2* between the two groups were compared. Correlation between ΔT2* and CPX results was analyzed using the Pearson coefficient.T2*-oxy was significantly greater than T2*-air in patients with HF (29.9±7.3ms vs. 26.7±6.0ms, p0.001), whereas no such difference was observed in controls (25.5±4.0ms vs. 25.4±4.4ms). ΔT2* was significantly greater for patients with HF than for controls (3.2±4.5ms vs. -0.1±1.3ms, p0.001). A significant correlation between ΔT2* and CPX results (peak VOΔT2* is increased T2*-oxy is greater in patients with HF, and is correlated with oxygen metabolism during exercise as measured by the CPX test. Hence, ΔT2* can be used as a surrogate marker of MO instead of CPX test.

To use cardiac magnetic resonance imaging (MRI) to investigate the effect of balloon pulmonary angioplasty (BPA) on interventricular dyssynchrony and its associations with ventricular interaction, which impairs LV function in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). This prospective observational study was approved by our institutional review board. Cardiac MRI and right heart catheterization were conducted before BPA sessions and at the follow up after BPA in 20 patients with CTEPH. We measured right ventricular (RV) and left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) using MRI. For the LV and RV free walls, the time to peak (Tpeak) of circumferential strain was calculated as a parameter for interventricular dyssynchrony. Following BPA, the RV-EDV and -ESV were significantly decreased, and the RVEF was significantly increased. Conversely, BPA led to significantly increased LV EDV and SV without changing LVESV. The left-to-right free wall delay (L–R delay) in Tpeak strain decreased from 105 ± 44 ms to 47 ± 67 ms (p

The purpose of this study is to analyze the geometrical characteristics of aortic root and left ventricular (LV) function in aortic stenosis (AS) using 256-slice coronary-computed tomography angiography (CCTA). Retrospective ECG-gated 256-slice CCTA data from 32 patients with tricuspid AS scheduled for aortic valve replacement, and 11 controls were analyzed. Aortic root geometry was measured using multiplanar reconstruction CT images. CCTA data set was transformed into 100 phases/cycle using motion coherence image processing. Systolic shortening (SS, mm/ms) and diastolic relaxation (DR, mm/ms2) in the circumferential and longitudinal directions on time curves of myocardial length were calculated, and were used as estimates of geometric LV function. Comparison of parameters was analyzed by Mann–Whitney U test. Receiver-operating-characteristic (ROC) analysis was performed to determine the optimal cutoff of parameters for differentiating AS patients. Height of the right coronary cusp was significantly lower for AS patients than controls (11.4 ± 2.4 vs. 13.9 ± 2.0 mm/m2, p

To investigate myocardial viability in chronic ischemic heart disease by myocardial perfusion and regional contraction analysis using 256-slice MSCT coronary angiography (CCTA). In 30 patients with prior myocardial infarction (MI), CCTA with retrospective ECG-gating and stress-redistribution thallium-201 SPECT were performed. Using the same raw data as used for CCTA, myocardial perfusion imaging (CT-MPI) was reconstructed at four phases during the cardiac cycle. Mean myocardial attenuation and wall thickness at end-systole and end-diastole were measured in the MI areas depicted by SPECT, and they were compared between viable and non-viable segments categorized by SPECT. End-systolic thickness was significantly greater for viable than for non-viable segments (12.0 ± 3.2 vs. 9.6 ± 3.5 mm, p = 0.0017). There was no difference in end-diastolic thickness. Myocardial attenuation was significantly higher for viable than for non-viable segments in the subendocardium (62 ± 13 vs. 70 ± 11 HU, p = 0.003) and the epicardium (65 ± 13 vs. 80 ± 15 HU, p = 0.0002). The systolic wall thinning and epicardial low-attenuation areas were the indicative findings of CT-MPI for non-viable segments in the prior MI.

Background Spread through air spaces (STAS) is a recently recognized invasive pattern of lung cancer defined as "micropapillary clusters, solid nests, or single cells beyond the edge of the tumor into air spaces." Since STAS has been shown to be a significant prognosticator for the postoperative survival, predicting STAS preoperatively by computed tomography (CT) might help determine the optimum surgical procedures. Methods Information on STAS and preoperative CT was available in 327 patients with resected lung adenocarcinomas. STAS was defined as tumor cells within air spaces in the lung parenchyma beyond the edge of the main tumor. The association of STAS with CT characteristics, such as vascular convergence, ground-glass opacity (GGO), air bronchogram, notch, pleural indentation, spiculation, and cavitation, was analyzed. Results Among the 327 patients with resected adenocarcinoma, 191 (58.4%) were positive for STAS. A univariable analysis demonstrated that STAS-positive adenocarcinomas were significantly associated with a larger radiologic tumor diameter (P = .02), the presence of vascular convergence (P Conclusions The presence of notch and the absence of GGO were independently associated with the STAS phenomenon. These results will prove helpful in identifying STAS-positive adenocarcinoma by CT before surgical resection.

To evaluate the frequency and the predictive factor of each feeding artery on intra-arterial infusion chemotherapy (IAIC) in primary tongue cancer. We retrospectively evaluated 20 patients who received IAIC for primary tongue cancer. The main and accompanying feeding arteries were identified on super-selective angiography of the branches of the external carotid artery. Tumor diameter, and extension to the contralateral side, tongue extrinsic muscles (TEMs), and lateral mesopharyngeal wall were determined based on magnetic resonance imaging or computed tomography findings. The main feeding artery was the ipsilateral lingual artery (LA) in 15 of the 20 examined tumors and the contralateral LA in the other 5. Ten cancers had only one feeding artery, and multiple feeding arteries were detected in the remaining 10. Tumors >4 cm (n = 9), those with extension to the contralateral side (n = 13), and those with extension to TEMs (n = 15) were supplied by significantly larger numbers of feeding arteries compared to tumors without these features (P = 0.01, 0.049, and 0.02, respectively). The frequency of feeding from the contralateral LA was 64 % (9/14) and 17 % (1/6) in tumors with and without extension to the contralateral side, respectively. Feeding from a facial artery (FA) was not detected in tumors ≤4 cm, while 5 of the 9 (56 %) tumors >4 cm were supplied by a FA (P = 0.01). A careful search for feeding arteries is required, especially in large tumors with extension to the contralateral side or to TEMs.

To find significant parameters to characterise anterior mediastinal solid tumours in adults using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted MRI (DWI), and combined 2-[(18)F]-fluoro-2-deoxy-d-glucose positron-emission tomography/computed tomography (FDG-PET/CT).Forty-eight histologically confirmed anterior mediastinal solid tumours in 48 patients (24 men, 24 women; age range 21-83 years, mean 50.7 years) were examined. The parameters analysed were maximal diameter, presence of capsule/septa on T2-weighted images, time-signal intensity curves (TICs), apparent diffusion coefficient (ADC), and maximum standardised uptake value (SUVmax). Also examined was whether any differences between histological types could be seen in these parameters. In a validation study, 42 anterior mediastinal solid tumours in 42 patients were examined consecutively.The washout pattern on TIC was seen only in thymic epithelial tumours (20/32). SUVmax of lymphoma (mean, 17.9), malignant germ cell tumours (14.2), and thymic carcinomas (15.6) were significantly higher than that of thymomas (6.1). The mean maximal diameter of thymic epithelial tumours was significantly smaller than that of lymphomas (p0.01) and malignant germ cell tumours (p0.05). The validation study also yielded high accuracy (38/42, 91%) in differentiation among the anterior mediastinal solid tumours.The SUVmax, TIC pattern on DCE-MRI, and maximal diameter might be useful to differentiate anterior mediastinal solid tumours in adults.

Background: The purpose of this study was to investigate the utility of total lesion glycolysis (TLG) in 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to predict the response to steroid therapy for cardiac sarcoidosis (CS). Methods: Thirty-six patients with clinically suspected CS who had undergone 18F-FDG PET/CT were retrospectively analysed. Of the 36 patients, 21 were diagnosed as having CS according to Japanese Ministry of Health and Welfare guidelines and divided into 12 responders and 9 non-responders after steroid therapy by the mean follow-up period of 19 months. SUVmax and total lesion glycolysis (TLG) for the left ventricle (LV) on 18F-FDG PET/CT were compared between responders and non-responders using the Wilcoxon test. The predictability of response to steroid therapy was analysed using receiver operating characteristic curve analysis. Results: TLG for the LV wall was significantly higher in non-responders [1082 ± 715 g (mean ± SD)] than in responders (452 ± 385 g, p=0.02), while there was no difference in the SUVmax for the LV wall between the two groups (responders 8.6 ± 2.3 vs. non-responders 11.4 ± 3.8). Use of an optimal TLG cut-off of 1070 g differentiated responders from non-responders with a sensitivity of 100%, a specificity of 55.6%, an accuracy of 81.0% and area under the curve of 0.80. Conclusion: The non-responders to steroid therapy for CS showed a high level of TLG on 18F-FDG PET/CT. TLG of 18F-FDG PET/CT can be a predictor of response to steroid therapy in CS.

The aims of this study were to quantify the geometrical differences in left ventricular (LV) dyssynchrony in patients with heart failure (HF) using cine-tagged MRI, and to investigate the relationship between dyssynchrony and major adverse cardiac events (MACE) in HF.In 67 patients with HF [mean LV ejection fraction (LVEF), 34%], cardiac MRI using a 3-Tesla scanner was performed. The dyssynchrony time between septal and lateral segments (SL-DT) and between basal and apical segments (BA-DT) was computed by cross-correlation analysis of the strain time-curves from the cine-tagged MRI. After receiving optimal medical treatment, all patients were followed-up for a mean period of 27 months. The primary endpoint was MACE that consisted of cardiac death or HF hospitalization or a left ventricular assist device due to refractory pump failure. Multivariate logistic regression analysis was performed to determine the ability of SL-DT, BA-DT, and HF biomarkers to predict MACE.Multivariate logistic regression analysis showed that the odds ratio to predict MACE was 0.935 for LVEF (P = 0.021), 1.016 for BA-DT (P = 0.026), and 0.971 for systolic blood pressure (P = 0.126).The results show that basal-apical dyssynchrony is an independent predictor of MACE in HF patients.

Iron deficiency and cardiac sympathetic impairment play a role in the worsening of heart failure, and these two conditions may be linked. The present study aimed to clarify the relationship between myocardial iron deficiency, cardiac sympathetic activity, and major adverse cardiac events (MACE) in patients with dilated cardiomyopathy (DCM). Cardiac T2* MRI for iron deficiency and (123)I-Metaiodobenzylguanidine (MIBG) imaging for cardiac sympathetic activity were performed in 46 patients with DCM. Myocardial T2* value (M-T2*) was calculated by fitting signal intensity data for mid-left ventricular septum to a decay curve using 3-Tesla scanner. (123)I-MIBG washout rate (MIBG-WR) was calculated using a polar-map technique with tomographic data. We analyze the ability of M-T2* and MIBG-WR to predict MACE. MIBG-WR and M-T2* were significantly greater in DCM patients with MACE than in patients without MACE. Receiver-operating-characteristics curve analysis showed that the optimal MIBG-WR and M-T2* thresholds of 35 % and 28.1 ms, and the two combination predict MACE with C-statics of 0.69, 0.73, and 0.82, respectively. Patients with MIBG-WR

To compare 256-slice cardiac computed tomography (CCT) with cardiac magnetic resonance (CMR) imaging to assess right ventricular (RV) function and pulmonary regurgitant fraction (PRF) in patients with repaired tetralogy of Fallot (TOF). Thirty-three consecutive patients with repaired TOF underwent retrospective ECG-gated CCT and 3-Tesla CMR. RV and left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) were measured using CCT and CMR. PRF-CCT (%) was defined as (RVSV − LVSV)/RVSV. PRF-CMR (%) was measured by the phase-contrast method. Repeated measurements were performed to determine intra- and interobserver variability. CCT measurements, including PRF, correlated highly with the CMR reference (r = 0.71–0.96). CCT overestimated RVEDV (mean difference, 17.1 ± 2.9 ml), RVESV (12.9 ± 2.1 ml) and RVSV (4.2 ± 2.0 ml), and underestimated RVEF (−2.6 ± 1.0 %) and PRF (−9.1 ± 2.0 %) compared with CMR. The limits of agreement between CCT and CMR were in a good range for all measurements. The variability in CCT measurements was lower than those in CMR. The estimated effective radiation dose was 7.6 ± 2.6 mSv. 256-slice CCT can assess RV function and PRF with relatively low dose radiation exposure in patients with repaired TOF, but overestimates RV volume and underestimates PRF. • 256-slice CT assessment of RV function is highly reproducible in repaired TOF. • Pulmonary regurgitation can be evaluated by biventricular systolic volume difference. • CT overestimates RV volume and underestimates pulmonary regurgitation, compared with MRI.

Purpose: We propose a new, Myocardial Perfusion Imaging (MPI) with coronary CTA, and investigate the diagnostic ability of subendocardial hypoperfusion for Coronary Artery Disease (CAD) based on degree of coronary stenosis. Methods: In twenty CAD patients, Coronary CTA and Invasive Coronary Angiography (CAG) were performed. CT-Myocardial Perfusion Image (MPI) was reconstructed at 4 cardiac phases (0%, 40%, 60%, and 80% of the R-R interval), applying CT number measured in Hounsfield Unit (HU) as an estimate of perfusion. A myocardial segment with subendocardial low attenuation at endsystole was defined as subendocardial-systolic-hypoperfusion (SSH). Results: Using >50% stenosis on CAG as standard, SSH diagnosed stenotic coronary territories with 63% sensitivity, 82% specificity, and 70% accuracy. Using >75% stenosis on CAG as standard, SSH diagnosed stenotic coronary territories with 73% sensitivity, 80% specificity, and 77% accuracy. The use of the SSH sign led to accurate diagnosis (result of CAG) in 9 of 60 territories (15%), which could not be assessed due to severe coronary calcification. Conclusion: SSH is frequently seen in the stenotic coronary territories. SSH might provide powerful information when the assessment of coronary artery is made difficult by severe calcification.

PURPOSE We investigated possible correlations between apparent diffusion coefficient (ADC) values and prognostic factors of breast cancer. METHODS We retrospectively evaluated 81 patients who underwent magnetic resonance (MR) imaging of the breast and were diagnosed pathologically with invasive ductal carcinoma (IDC) not otherwise specified with invasive foci one cm or larger. We excluded ductal carcinoma in situ and IDC with invasive foci smaller than one cm because small lesions decrease the reliability of signal intensity of diffusion-weighted imaging (DWI). We also excluded special type cancers. We used t-test to compare the mean ADC values of cancers of Stage pT1 (≤2 cm) versus pT2 or 3 (>2 cm), cancers with versus without vascular invasion, axillary lymph node (N)-positive versus N-negative cancers, estrogen receptor (ER)-positive versus ER-negative cancers, and progesterone receptor (PgR)-positive versus PgR-negative cancers. We analyzed correlations between the ADC value with nuclear grade (NG) and human epidermal growth factor receptor 2 (HER2) score by rank test using Spearman's correlation coefficient. RESULTS The mean ADC value was significantly higher for N-positive (n=28; 0.97 ± 0.20 × 10(-3) mm(2)/s) than N-negative cancers (n=53; 0.87 ± 0.17 × 10(-3) mm(2)/s) (P=0.017); significantly lower for ER-positive (n=63; 0.88 ± 0.15 × 10(-3) mm(2)/s) than ER-negative cancers (n=18; 1.01 ± 0.21 × 10(-3) mm(2)/s) (P=0.005); and significantly lower for PgR-positive (n=47; 0.88 ± 0.16 × 10(-3) mm(2)/s) than PgR-negative cancers (n=34; 0.95 ± 0.18 × 10(-3) mm(2)/s) (P=0.048). Tumor size, vascular invasion, NG, and HER2 status showed no significant correlation with ADC values. CONCLUSION ADC values were higher for N-positive and ER-negative breast cancers than N-negative and ER-positive cancers.

Impairment of cardiac sympathetic activity has various detrimental effects on cardiac function. The purpose was to investigate the relationship between left ventricular (LV) dyssynchrony and cardiac sympathetic activity in non-ischemic heart failure (HF).Twenty-seven patients with non-ischemic HF were enrolled. Cardiac sympathetic activity was assessed by heart-to-mediastinum ratio (H/M ratio) on (123)I-Metaiodobenzylguanidine scintigraphy. LV dyssynchrony was assessed by cross-correlation analysis of time curves of myocardial circumferential strains delivered from cine-tagging MR images. Temporal dyssynchrony was defined as contraction delay between septal and lateral segments110 milliseconds. Spatial dyssynchrony was defined as the negative value of the maximum correlation for the two strain time curves.H/M ratio was significantly lower for patients with spatial dyssynchrony compared to patients without (1.8 ± 0.3 vs 2.1 ± 0.3, P.05). There was no difference between patients with and without temporal dyssynchrony (2.0 ± 0.2 vs 2.0 ± 0.3). The incidence of spatial dyssynchrony was significantly higher in patients with H/M ratio2.0 than those whose ratios were ≥2.0 (75% vs 20%, P = .001). There was no difference in the incidence of temporal dyssynchrony between the two groups (17% vs 20%).Impairment of cardiac sympathetic activity was found to be associated with spatial dyssynchrony in patients with non-ischemic HF.