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BackgroundPatients with a congenitally corrected transposition of the great arteries show an increasing incidence of cardiac failure with age. In other systemic right ventricles, such as in dextro-transposition after atrial switch, excessive hypertrophy is a potential risk factor for impaired systolic function. In this trial, we sought to compare systemic function and volumes between patients with congenitally corrected transposition and those with dextro-transposition after atrial switch by using cardiac magnetic resonance imaging.Methods and ResultsA total of 19 patients (nine male) with congenitally corrected transposition and 31 patients (21 male) with dextro-transposition after atrial switch were studied using a 1.5-Tesla scanner. Cine steady-state free-precession sequences in standard orientations were acquired for volumetric and functional imaging. Patient parameters were compared with those of a group of 25 healthy volunteers. Although patients with congenitally corrected transposition were older, they presented with higher right ventricular ejection fractions (p = 0.04) compared with patients with dextro-transposition. Patients with congenitally corrected transposition showed a weak negative correlation between age at examination and systemic ejection fraction (r = −0.18, p = 0.04) but no correlation between right ventricular myocardial mass index and ejection fraction. There was no significant difference in the right ventricular end-diastolic volumes between both patient groups.ConclusionAlthough patients with congenitally corrected transposition had a longer pressure load of the systemic right ventricle, ventricular function was better compared with that in patients with dextro-transposition after atrial switch. The results suggest that the systemic ventricles might have partly different physiologies. One difference could be the post-operative situation after atrial switch, which results in impaired atrial contribution to ventricular filling.

To assess differences in aortic and endoleak enhancement in patients after endovascular aneurysm repair (EVAR) with dynamic computed tomography (CT) angiography.Twenty-one consecutive patients (mean age, 74.5 y ± 6; range, 61-88 y) with endoleaks after EVAR of the abdominal aorta were examined on a second-generation dual-source CT unit with 10 unidirectional scan phases (temporal resolution, 5 s; 80 kV; 120 reference-mAs; z-axis field of view, 283 mm), followed by a venous scan phase. Enhancement was assessed in aorta and endoleaks for all phases by density measurements. The diagnostic reliability of endoleak detection was assessed on a five-point confidence scale.In total, 26 endoleaks (type I, n = 1; type II, n = 25) were detected. The highest detection rate was found in phase 5 (22 s after threshold; P.01 vs other dynamic phases). Mean peak aortic enhancement (560 HU ± 96) was present in an early arterial phase (phase 3, 12 s after threshold), whereas the mean peak endoleak enhancement (398 HU ± 174) for type II endoleaks was present later, in phase 4 (17 s after threshold). Despite perceived high diagnostic confidence in phases 1 and 2 (ie, typical arterial phase of biphasic CT protocol), only 23% and 62% of endoleaks were detected, respectively, whereas peak diagnostic confidence (phases 4 and 5) corresponded well with the maximum endoleak detection rate but decreased significantly in later phases (ie, 6-10).Preliminary dynamic CT angiography results in post-EVAR follow-up revealed notably different peaks of endoleak and aortic enhancement, which are not covered sufficiently by conventional biphasic CT protocols. Phase 5 demonstrated the highest type II endoleak detection rate, with high diagnostic confidence.

Objectives The goal of this study was to assess the diagnostic performance of cardiac magnetic resonance (CMR) compared with endomyocardial biopsy in patients with suspected acute myocarditis (AMC) and chronic myocarditis (CMC). Background Several studies have reported an encouraging diagnostic performance of CMR in myocarditis. However, the comparison of CMR with clinical data only and the use of preselected patient populations are important limitations of the majority of these reports. Methods One hundred thirty-two consecutive patients with suspected AMC (defined by symptoms ≤14 days; n = 70) and CMC (defined by symptoms >14 days; n = 62) were included. Patients underwent cardiac catheterization with left ventricular endomyocardial biopsy and CMR, including T 2 -weighted imaging for assessment of edema, T 1 -weighted imaging before and after contrast administration for evaluation of hyperemia, and assessment of late gadolinium enhancement. CMR results were considered to be consistent with the diagnosis of myocarditis if 2 of 3 CMR techniques were positive. Results Within the total population, myocarditis was the most common diagnosis on endomyocardial biopsy analysis (62.9%). Viral genomes were detected in 30.3% (40 of 132) of patients within the total patient population and significantly more often in patients with AMC than CMC (40.0% vs. 19.4%; p = 0.013). For the overall cohort of patients with either suspected AMC or CMC, the diagnostic sensitivity, specificity, and accuracy of CMR were 76%, 54%, and 68%, respectively. The best diagnostic performance was observed in patients with suspected AMC (sensitivity, 81%; specificity, 71%; and accuracy, 79%). In contrast, diagnostic performance of CMR in suspected CMC was found to be unsatisfactory (sensitivity, 63%; specificity, 40%; and accuracy, 52%). Conclusions The results of this study underline the usefulness of CMR in patients with suspected AMC. In contrast, the diagnostic performance of CMR in patients with suspected CMC might not be sufficient to guide clinical management.

Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) have been developed rapidly in the last decade. Technical improvements and broad availability of modern CT and MRI scanners have led to an increasing and regular use of both diagnostic methods in clinical routine. Therefore, this German consensus document has been developed in collaboration by the German Cardiac Society, German Radiology Society, and the German Society for Pediatric Cardiology. It is not oriented on modalities and methods, but rather on disease entities. This consensus document deals with coronary artery disease, cardiomyopathies, arrhythmias, valvular diseases, pericardial diseases and structural changes, as well as with congenital heart defects. For different clinical scenarios both imaging modalities CT and MRI are compared and evaluated in the specific context.

Previous studies analyzing the relation between time-to-reperfusion, infarct size, microvascular obstruction (MO) and infarct transmurality in patients with ST-elevation myocardial infarction (STEMI) reperfused by primary percutaneous coronary intervention (PCI) reported inconsistent results. Furthermore, it remains unclear, if transmural infarction is associated with adverse clinical outcome. The present study included STEMI patients reperfused by primary PCI (n = 322) within 720 min after symptom-onset undergoing contrast-enhanced magnetic resonance imaging (CMR) at a median of 3 days after the index event [interquartile range (IQR) 2-4]. Patients were subcategorized into tertiles according to time-to-reperfusion. Infarct size and MO were assessed approximately 15 min after gadolinium-injection. Infarct transmurality was assessed by a score with late-enhancement grading as25, 25-50, 51-75 and75% transmurality analyzing all 17 left ventricular segments. Clinical follow-up was performed after 20 months (IQR 13;29). The primary endpoint was defined as a composite of death and congestive heart failure. The median time-to-reperfusion was 230 min (IQR 153;390). Infarct size and MO did not increase significantly with longer time-to-reperfusion (p = 0.16 and p = 0.44, respectively). In contrast to infarct size and MO, the infarct transmurality score progressed significantly with increasing ischemic time (p 0.001). In multivariable logistic regression analysis, time-to-reperfusion was identified as an independent predictor for transmural infarction (p = 0.03). However, transmural infarction was not predictive of the primary composite clinical endpoint (p = 0.22). In conclusion, in STEMI patients reperfused by primary PCI, time-to-reperfusion was an independent predictor for transmural infarction but not for infarct size and MO. However, transmural infarction was not predictive of death and congestive heart failure.

Objectives: The objective of this study was to assess the area at risk (AAR) in ST-segment elevation myocardial infarction with 2 different cardiac magnetic resonance (CMR) imaging methods and to c...

Board certification in cardiac magnetic resonance imaging can be obtained since 2006 in Germany after a 24-month training period. However, currently only 46 cardiologists in Germany have obtained board certification since 2006 and only 4 cardiologists are authorized to train cardiologists in cardiac magnetic resonance imaging for a 12-month period. A 24-month training period is only granted to radiologists which represents an obstacle for the widespread education of cardiologists in this discipline. This article reviews and compares current recommendations of the European Society of Cardiology, the German Roentgen Society and the Education Curriculum of the German Cardiac Society. Each recommendation proposes three levels of training in cardiac magnetic resonance imaging ranging from 1 month for level 1 and >12 months for professionals corresponding to level 3. Further interdisciplinary efforts are necessary to improve the training in cardiac magnetic resonance imaging.

Myocardial salvage assessed by cardiac magnetic resonance imaging (CMRI) holds promise as a surrogate endpoint in studies comparing different treatment strategies for ST-elevation myocardial infarction (STEMI). The aim of this study was to evaluate the reliability of salvaged myocardium measurements by CMRI. Twenty patients underwent CMRI on 2 consecutive days early after reperfused STEMI to assess the area at risk (AAR) on T2-weighted and final infarct size (IS) on delayed enhancement images. Myocardial salvage index (MSI) was calculated (AAR minus IS). Agreement between scans 1 and 2 for the AAR, IS and MSI were analyzed using Bland-Altman analyses. Inter- and intraobserver reliability were assessed. Paired t testing revealed a trend for a significant difference for MSI between scans 1 and 2 (scan 1: 43.8 ± 22.5; scan 2: 45.5 ± 22.0; P = 0.052). The average difference for AAR and IS between scan 1 and scan 2 was -0.5 (upper limit of agreement 5.4% of left ventricular [LV] volume; lower limit of agreement -6.4%LV) and 0.1%LV (upper limit of agreement 2.3%LV; lower limit of agreement -2.1%LV). The corresponding calculated MSI measurements showed a mean bias of -1.7 (upper limit of agreement 5.5; lower limit of agreement -8.9). Coefficients of repeatability for interobserver variability were 3.6%LV for AAR, 2.4%LV for IS and 5.4 for MSI. Likewise, for intraobserver variability, coefficients of repeatability were 5.0%LV (AAR), 2.4%LV (IS) and 4.8 (MSI). Assessment of myocardial salvage by CMRI shows acceptable reliability. Further validation studies and trials showing the prognostic value of myocardial salvage by CMRI are needed before routine implementation as a surrogate endpoint in STEMI trials.

To evaluate changes of right ventricular (RV) parameters in follow-up examinations after corrected tetralogy of Fallot (TOF) by cardiac magnetic resonance (CMR). CMR was performed twice within 4 years in 45 patients using a 1.5 T scanner. RV-volumes and pulmonary-regurgitant-fractions (PRF) were calculated from standard cine-sequences and flow-sensitive gradient-echo images, respectively. Patients were divided into two groups depending on the post-operative (po) interval (group 1 ≤5 years po; group 2 >5 years po) and subgroups depending on type of surgery (transannular vs. non-transannular). Patient groups were compared among each other and differences between 1st and 2nd CMR were assessed. Furthermore, patients were compared with 25 healthy volunteers. Compared with controls RV-size was increased (group 1: p = 0.007; group 2: p

There are a number of imaging tests that are used in the setting of acute myocardial infarction and acute coronary syndrome. Each has their strengths and limitations. Experts from the European Society of Cardiac Radiology and the North American Society for Cardiovascular Imaging together with other prominent imagers reviewed the literature. It is clear that there is a definite role for imaging in these patients. While comparative accuracy, convenience and cost have largely guided test decisions in the past, the introduction of newer tests is being held to a higher standard which compares patient outcomes. Multicenter randomized comparative effectiveness trials with outcome measures are required.

The aim of this study was to examine the effect of coronary collateral flow before reperfusion on long-term clinical prognosis in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. We studied 235 patients with STEMI within 12 hours after symptom onset. All patients had Thrombolysis In Myocardial Infarction gradeor =1 flow before percutaneous coronary intervention. Collateral flow was graded according to the Rentrop classification. Patients were categorized as having absent or poor collateral flow to the infarct-related artery (group A) or significant flow (group B). In 166 patients there was absent or weak collateral flow (group A), whereas 69 had significant flow (group B). Long-term follow-up was available in 227 patients (97%) at a median of 797 days. Overall, 25 patients died during the follow-up period, 22 patients (13.8%) in group A and 3 patients (4.4%) in group B (p = 0.04). A total of 12 (7.5%) nonfatal recurrent myocardial infarctions occurred in group A compared to 2 (2.9%) in group B (p = 0.18). The combined major adverse cardiovascular event end point (death or nonfatal reinfarction) showed a significantly lower event rate in group B (p = 0.02). Extensive collateral flow at baseline was a significant predictor for a favorable long-term clinical outcome on multivariable analysis after adjustment for established prognostic markers. In conclusion, the presence of a well-developed collateral network before mechanical reperfusion in patients with STEMI is associated with improved long-term survival and lower major adverse cardiovascular event rates.

Improvements in software and hardware have enabled the integration of dual imaging modalities into hybrid systems, which allow combined acquisition of the different data sets. Integration of positron emission tomography (PET) and computed tomography (CT) scanners into PET/CT systems has shown improvement in the management of patients with cancer over stand-alone acquired CT and PET images. Hybrid cardiac imaging either with single photon emission computed tomography (SPECT) or PET combined with CT depicts cardiac and vascular anatomical abnormalities and their physiologic consequences in a single setting and appears to offer superior information compared with either stand-alone or side-by-side interpretation of the data sets in patients with known or suspected coronary artery disease (CAD). Hybrid systems are also advantageous for the patient because of the single short dual data acquisition. However, hybrid cardiac imaging has also generated controversy with regard to which patients should undergo such integrated examination for clinical effectiveness and minimization of costs and radiation dose, and if software-based fusion of images obtained separately would be a useful alternative. The European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC) in this paper want to present a position statement of the institutions on the current roles of SPECT/CT and PET/CT hybrid cardiac imaging in patients with known or suspected CAD.

Aufgrund mehrerer Fehlpositionierungen des Ballons der intraaortalen Ballonpumpe (IABP), die in computertomographischen (CT) Aufnahmen festgestellt wurden, und der daraus folgenden Kompromittierung der Viszeralgefase, fuhrten wir eine systematische Nachbearbeitung der Daten kardiochirurgischer IABP-Patienten mit verfugbaren thorakoabdominalen CT-Aufnahmen durch. Ziel war es, Inzidenz, Ursachen und klinische Relevanz der IABP-Fehllage zu eruieren. Bei 63 von 621 Patienten (10,1%) wurde bei liegender IABP eine thorakoabdominale CT-Aufnahme durchgefuhrt. Dabei wurde unter Berucksichtigung der Beziehung zu den Viszeralarterien die proximale und distale Ballonposition analysiert. Des Weiteren wurden bei allen Patienten die anatomische Distanz zwischen A. subclavia sinistra und Truncus coeliacus (AS-TC) sowie der transverse Aortendurchmesser bestimmt. In 96,8% der Falle war in der Thoraxrontgenaufnahme die proximale Ballonlage korrekt, wobei eine adaquate Lage nach CT-Untersuchung nur in 38,1% vorlag. Bei 61 von 63 Patienten (96,8%) wurde die Kompromittierung mindestens einer Viszeralarterie festgestellt. Die AS-TC-Distanz betrug 241±23 mm. Die Ballonlange lag bei 248±17 mm und korrespondierte in 68,2% der Falle mit einem Missverhaltnis der Anatomie und Ballonlange. Eine Laparotomie, die aufgrund einer Mesenterialischamie durchgefuhrt wurde, war bei 23,8% der Patienten erforderlich. Die Gesamtkrankenhausmortalitat betrug 60,3%. Trotz Einhaltung aktueller Behandlungsleitlinien wurde bei fast allen Patienten eine IABP-Fehllage durch das CT nachgewiesen. Grunde waren eine falsche Positionierung des proximalen Ballonendes, sowie ein Missverhaltnis der Anatomie und Ballonlange. Ballonlangen, die kurzer sind als bislang empfohlen, und bessere Positionierungsstrategien scheinen daher angebracht.

Aims Early and late microvascular obstruction (MO) assessed by magnetic resonance imaging (MRI) are prognostic markers for combined clinical endpoints after ST-elevation myocardial infarction (STEMI). However, there are only limited data for hard endpoints and no consensus exists which of the two best predicts clinical outcome. Furthermore, it is unclear whether the assessment of MO by MRI adds incremental prognostic information independent of traditional outcome markers. Methods and results STEMI patients reperfused by primary angioplasty ( n = 438)

Fur einen Spezialbereich der Kardiologie, die angeborenen Herzfehler, erfolgte die Implementierung eines telemedizinischen Forschungsnetzwerkes, in dem 16 Zentren bundesweit miteinander kooperieren. Zielvorgabe der Kooperation war die Etablierung standardisierter Untersuchungs- und Auswertetechniken in der kardialen Bildgebung, deren Qualitatsmanagement sowie der Aufbau eines zentralen Auswertelabors und eines Archivs fur Bild- und numerische Daten. Deskriptive Analyse der technischen Implementierungen und der mithilfe dieser Netzwerkstruktur ermoglichten Studienergebnisse. Technisch basiert das Netzwerk auf dem datenschutzkonformen, internetbasierten Versand von Bilddaten, der Erfassung numerischer Daten mithilfe elektronischer Formulare und dem Aufbau eines nationalen PACS-Systems mit klaren Zugriffs- und Qualitatssicherungshierarchien. Durch die Netzwerkstruktur wurden relevante Messunterschiede fur kardiale MRT-Funktionsparameter zwischen den verschiedenen Institutionen eliminiert. Die zentrale Auswertung kardialer MRT-Bilddaten unter Anwendung von „standard operation procedures“ (SOPs) fuhrte zu einem signifikant verbesserten Qualitatsniveau, essenziell fur multizentrische Studien. Die zentrale Bilddatenbank ermoglicht erstmals longitudinale Verlaufsstudien unter Verwendung von standardisierten Bilddaten. Ein bedeutsamer Nutzen ist die Schaffung eines umfangreichen Datenpools fur ansonsten seltene Erkrankungen.

ObjectivesThe aim of this randomized, single-blind, controlled trial was to assess N-acetylcysteine effects on contrast-induced nephropathy and reperfusion injury in ST-segment elevation myocardial infarction patients undergoing primary angioplasty with moderate contrast volumes.BackgroundHigh-dose N-acetylcysteine reduced the incidence of contrast-induced nephropathy in patients with high contrast volumes and reduced reperfusion injury in animal trials.MethodsPatients undergoing primary angioplasty were randomized to either high-dose N-acetylcysteine (2 × 1,200 mg/day for 48 h; n = 126) or placebo plus optimal hydration (n = 125). The 2 primary end points were: 1) the occurrence of >25% increase in serum creatinine level

To retrospectively assess the prevalence and functional relevance of lipomatous metaplasia (LM) of the left ventricle in patients with chronic ischaemic heart disease (CIHD) using cardiac magnetic resonance imaging (cMRI) with steady state free precession (SSFP) sequences.We examined 315 patients (248 male, mean age 63 +/- 10 years) with a history of CIHD by cMRI. Standard SSFP sequences were applied and results were correlated with findings from cardiac catheterisation and computed tomography. In a subgroup of patients with LM (LM+) the functional results were correlated with patients without LM (LM-) as controls matched for age, body mass index, gender and infarct size.Of 315 patients, 36 showed LM. LM+ patients showed a higher tendency to develop aneurysms compared with LM- (31% vs. 17%; not significant), but no differences in ejection fraction or volumetric parameters. LM occurred significantly more often in older infarcts and patients with hyperlipoproteinaemia, while other cardiac risk factors or medication did not have a significant influence on the development of LM.LM is a common finding (11%) in patients with CIHD. LM does not have a significant influence on global cardiac function or ventricular size, but on local function and probably also on the development of left ventricular aneurysms.

A growing number of elderly patients with MR are treated by edge-to-edge repair using the MitraClip system, and accumulating evidence suggests that residual TR remains a predictor of adverse outcome in these patients. The clinical benefit of combined edge-to-edge repair of MR plus TR as compared to

Takotsubo cardiomyopathy (TTC) is an increasingly recognised acute cardiac syndrome, whose underlying pathophysiological mechanisms remain unknown. Inflammation might play a role as this has been shown in endomyocardial biopsies. The aim of this study was to assess inflammatory parameters in patients with TTC using a comprehensive cardiovascular magnetic resonance imaging (CMR) approach.Thirty-seven patients with the suspected diagnosis of TTC underwent CMR. T2-weighted imaging to calculate the oedema ratio, T1-weighted imaging before and after contrast agent administration to calculate the global relative enhancement (gRE), and late gadolinium enhancement (LGE) imaging were performed.In 11 patients CMR revealed the diagnosis of myocardial infarction (n = 7; 19%) or myocarditis (n = 4; 11%) with typical patterns of LGE. In all other patients (n = 26; 70%), no LGE was detected consistent with the diagnosis of TTC. Of these, in 16 patients (62%) both inflammatory markers (oedema ratio and gRE) were elevated with concomitant pericardial effusion, indicating acute inflammation. Follow-up CMR after 3 months showed complete normalisation of left ventricular function and inflammatory parameters in the absence of LGE and pericardial effusion.This CMR study provides further insights into the pathophysiological mechanisms in TTC, supporting the contribution of an inflammatory process in the acute setting.

Takotsubo cardiomyopathy (TTC) mimics symptoms of acute myocardial infarction (MI) with transient left ventricular dysfunction, acute chest pain, electrocardiographic changes and minimal myocardial enzyme release in the absence of significant coronary artery disease. We describe the cases of two postmenopausal women with suspected MI undergoing coronary angiography. Both patients had unobstructed coronary arteries but left ventriculography showed apical ballooning. Delayed enhancement magnetic resonance imaging (MRI) revealed in one patient transmural enhancement in the distribution of a coronary artery compatible with MI and in the other patient no delayed enhancement consistent with viable myocardium and the diagnosis of TTC. Therefore cardiac MRI should be performed in all patients with suspected TTC for further differential diagnosis.

Objectives Different techniques for measuring of perfusion are clinically available, but these are usually applied to healthy brain tissue. Material and methods Five different techniques were used here in 12 patients with brain tumors to investigate the impact of tumor vascularization on the perfusion signal: three qualitative dynamic contrast-enhanced/susceptibility-contrast magnetic resonance imaging (DCE-MRI/DSC-MRI) techniques exploiting T1, T2, T 2 * contrast, and two quantitative techniques, pulsed arterial spin labeling (PASL) and H215O positron emission tomography (H215O-PET). Results In a first approximation, a linear correlation was found between all five imaging modalities regarding the perfusion signal of both, normal brain tissue and tumor. The estimated values for tumor perfusion differed significantly between the techniques (1 = methodical mean in arbitrary units): PASL: 0.83, H215O-PET: 0.62, T1-DCE: 1.73, T2-DCE: 0.69, T 2 * -DSC : 0.89. Conclusions The tumor perfusion values, determined with different techniques are not comparable. The T 2 * -DSC , here applied with contrast agent presaturation of extravascular space, and PASL depict median perfusion most reliably.

Background Familial dilated cardiomyopathy is a highly heterogeneous genetic disease. Thus, identification of disease-causing mutations is a challenging and time-consuming task. Genotype–phenotype associations may alleviate identification of the underlying mutation. Objective The purpose of this study was to investigate cardiac phenotypes within a family harboring a familial dilated cardiomyopathy–related mutation in the gene encoding phospholamban. Methods Complete genetic and clinical analyses were performed in a family with familial dilated cardiomyopathy due to the PLN-R14Del mutation. Family relatives were studied by ECG, Holter ECG, echocardiography, ECG body surface potential mapping, and cardiac magnetic resonance imaging. Results A candidate gene approach resulted in identification of a heterozygous deletion of arginine 14 in the gene encoding phospholamban (PLN-R14Del) segregating with dilated cardiomyopathy in the family pedigree. Mutation carriers suffered from familial dilated cardiomyopathy associated with cardiac death between the ages of 26 and 50 years. Interestingly, all adult mutation carriers revealed strikingly attenuated R amplitudes on standard ECG, regardless of the absence or presence of echocardiographic abnormalities. Gadolinium-enhanced cardiac magnetic resonance imaging showed late enhancement in PLN-R14Del carriers with preserved ejection fraction. Late enhancement was regionally related to areas of most pronounced R-amplitude attenuation as assessed by body surface potential mapping. Conclusion Attenuated R amplitudes were identified as an early ECG phenotype in a family with familial dilated cardiomyopathy due to the PLN-R14Del mutation. All adults harboring PLN-R14Del had attenuated R waves irrespective of echocardiographic abnormalities. The study findings suggest a mutation-related remodeling process preceding ventricular dysfunction.

Coronary artery fistulas are rare acquired or congenital abnormalities leading to a shunt between a coronary artery and one of the cardiac cavities, a main artery, or a vein. This case report describes the combined use of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for the precise anatomical and functional assessment of a right coronary artery (RCA) fistula shunting to the coronary sinus. The RCA itself showed a massively elongated deformation and a maximal aneurysmatic dilatation of 41 mm on MDCT and MRI. The absolute shunt volume calculated by MRI flow measurements at the RCA was 40 ml, which means 37% in relation to the measured LV stroke volume of 109 ml.

To compare the usefulness of gadofluorine M with that of Gadomer in assessment of dysferlin-deficient muscular dystrophy at 7.0-T magnetic resonance (MR) imaging.All experiments were approved by local review boards. SJL/J mice (n = 24) with dysferlin-deficient muscular dystrophy and C57BL/6 control mice (n = 24) were imaged at 12-15 weeks (young) or older than 30 weeks (old) by using dynamic contrast material-enhanced imaging with inversion-prepared steady-state free-precession sequence before, during, and after administration of gadofluorine M at 2 micromol or Gadomer at 4 micromol intravenously. After imaging, regions of interest were determined from the upper extremity and left ventricular chamber; fractional extravascular extracellular volume, v(e), and permeability surface tissue density product, PS rho, were measured by using a two-compartment pharmacokinetic model. The natural history of muscular dystrophy was assessed histologically in 70 mice (seven five-mouse groups each of SJL/J mice and of control mice) at 4-week intervals from 8 to 32 weeks. In addition, three SJL/J mice and three control mice at age 33 weeks were sacrificed, and fluorescence microscopy was performed for visualization of intravenously administered carbocyanine-labeled gadofluorine M in muscle cells. Statistical analysis was performed by using the t test.Gadofluorine M enhancement was significantly greater in skeletal muscle of 30-week-old mice with dysferlin-deficient muscular dystrophy, compared with control mice. Gadofluorine M demonstrated both increased rate of enhancement (PS rho sec(-1) +/- standard error of the mean: 0.004 e(-)(4) +/- 3 vs 0.002 e(-)(4) +/- 3; P.05) and increased level of enhancement (v(e) +/- standard error of the mean: 0.035 +/- 0.004 vs 0.019 +/- 0.004; P.05). Gadomer showed no differential enhancement in the two mouse groups. Histologic examination confirmed the presence of labeled gadofluorine M in muscle cells.Gadofluorine M-enhanced MR imaging may be of value in monitoring dysferlin-deficient muscular dystrophy disease progression in this animal model and could prove to be a useful tool in following the course of chronic muscle diseases in humans.

Aims The apical ballooning syndrome (ABS) is a new diagnostic entity which is increasingly recognized. Precise magnetic resonance imaging (MRI) data are not yet available and there is little evidence for the differential diagnosis of ABS assessed by MRI. Methods and results Between January 2005 and January 2008, 6100 consecutive patients with diagnosis of acute coronary syndrome underwent left heart catheterization. In 59 patients (1.0%), coronary angiography revealed normal coronary arteries, but left ventriculography showed left ventricular dysfunction with apical ballooning. These 59 patients underwent cardiac MRI using a 1.5 T MRI scanner. In 13 patients (22.0%), MRI revealed diagnosis of myocardial infarction, in eight patients (13.6%) diagnosis of myocarditis. In all other 38 (64.4%) patients (36 female, age 73 ± 10 years) with suspected ABS, no delayed enhancement or signs of inflammation were detected. Follow-up MRI after 3 months showed a completely normalized left ventricular ejection in all patients with suspected ABS. Similarly, the end-diastolic volume and end-systolic volume improved at follow-up. Conclusion Cardiac MRI allows differentiating ABS from other rare causes with unobstructed coronary vessels such as myocarditis and coronary emboli with spontaneous lysis. Therefore, cardiac MRI can add valuable information in all patients with suspected ABS for further differential diagnosis.

To retrospectively compare the diagnostic accuracy of three cardiac magnetic resonance (MR) imaging approaches for the detection of histologic and immunohistologic criteria (reference standard) proved myocardial inflammation in patients clinically suspected of having chronic myocarditis (CMC).Cardiac MR imaging was performed in 83 consecutive patients (55 male, 28 female; mean age, 44.8 years +/- 17.7 [standard deviation]) clinically suspected of having CMC, after written informed consent was obtained according to guidelines of the local ethics committee, which approved the study. T2-weighted triple-inversion-recovery imaging to calculate the edema ratio (ER), T1-weighted imaging before and after contrast agent administration to calculate the myocardial global relative enhancement (gRE), and inversion-recovery gradient-echo imaging to evaluate areas of late gadolinium enhancement (LE) were performed. The MR results were correlated with the endomyocardial biopsy (EMB) findings to detect intramyocardial inflammation and cardiotropic viral genomes analyzed at polymerase chain reaction assay. For statistical analyses, receiver operating characteristic analysis and the Wilcoxon test for unpaired data were used because the Kolomogorov-Smirnov test revealed a distribution of data that was different from normality.Intramyocardial inflammation and cardiotropic viral persistence were confirmed at immunohistologic analysis in 48 and 49 of the 83 patients, respectively. The sensitivity, specificity, and diagnostic accuracy of the MR parameters, as compared with the immunohistologic detection of inflammation, were, respectively, 62%, 86%, and 72% for gRE; 67%, 69%, and 68% for ER; and 27%, 80%, and 49% for LE. Cardiac MR-derived gRE, ER, and LE were not associated with polymerase chain reaction proof of viral genomes.In patients clinically suspected of having CMC, increased gRE and ER indicating inflammation were common findings that could be confirmed at immunohistologic analysis, whereas LE had low sensitivity and accuracy. Cardiac MR imaging may be helpful in detecting intramyocardial inflammation noninvasively, but it fails to depict viral persistence.

The correlation between bicuspid aortic valve (BAV) disease and aortopathy is not fully defined.This study aimed to prospectively analyze the correlation between functional parameters of the aortic root and expression of aortopathy in patients undergoing surgery for BAV versus tricuspid aortic valve (TAV) stenosis.From January 1, 2012 through December 31, 2014, 190 consecutive patients (63 ± 8 years, 67% male) underwent aortic valve replacement ± proximal aortic surgery for BAV stenosis (n = 137, BAV group) and TAV stenosis (n = 53, TAV group). All patients underwent pre-operative cardiac magnetic resonance imaging to evaluate morphological/functional parameters of the aortic root. Aortic tissue was sampled during surgery on the basis of the location of eccentric blood flow contact with the aortic wall, as determined by cardiac magnetic resonance (i.e., jet sample and control sample). Aortic wall lesions were graded using a histological sum score (0 to 21).The largest cross-sectional aortic diameters were at the mid-ascending level in both groups and were larger in BAV patients (40.2 ± 7.2 mm vs. 36.6 ± 3.3 mm, respectively, p0.001). The histological sum score was 2.9 ± 1.4 in the BAV group versus 3.4 ± 2.6 in the TAV group (p = 0.4). The correlation was linear and comparable between the maximum indexed aortic diameter and the angle between the left ventricular outflow axis and aortic root (left ventricle/aorta angle) in both groups (BAV group: r = 0.6, p0.001 vs. TAV group r = 0.45, p = 0.03, z = 1.26, p = 0.2). Logistic regression identified the left ventricle/aorta angle as an indicator of indexed aortic diameter22 mm/m(2) (odds ratio: 1.2; p0.001).Comparable correlation patterns between functional aortic root parameters and expression of aortopathy are found in patients with BAV versus TAV stenosis.

Pulmonary regurgitation is a common finding in patients after correction of tetralogy of Fallot (TOF). Right ventricular impairment and even ventricular arrhythmia have been ascribed to pulmonary valve insufficiency (PI), which is therefore an important issue in follow-up examinations. To compare PI measured by echocardiography (ECHO) with data provided by cardiac MRI (CMR). We studied 54 selected patients (18 female; median age 14.0 years, range 3.8–53.4 years) after surgical correction of TOF. To quantify pulmonary regurgitant fraction (PRF) by CMR, flow velocity mapping was performed. On Doppler ECHO, length, width and localization of regurgitant flow was measured. The severity of PI was categorized as mild, moderate or severe and compared to the data obtained by CMR. On CMR the mean PRF was 29.2 ± 13.4%. Patients with a transannular patch had a significantly higher PRF (39.9 ± 11.6%) than patients with an intact annular ring (23.6 ± 11.4%). Differentiation by Doppler ECHO between the categories mild, moderate and severe PI was confirmed by significant differences in PRF measured by CMR (mild vs. moderate P

Introduction: Heart Failure with Preserved Ejection Fraction (HFpEF) is an increasing public health problem. To tailor successful treatment strategies it is essential to identify patients’ individual pathologies contributing to HFpEF. Cardiac magnetic resonance (CMR) derived T1-Mapping has been suggested as non-invasive tool to quantify diffuse myocardial fibrosis. Invasive tracings of pressure-volume relations represent the gold-standard for assessing load-independent mechanical diastolic properties of the left ventricle. Hypothesis: Aim of this study was therefore to elucidate the diagnostic performance of T1-Mapping in HFpEF patients by examining the relationship between the extracellular volume fraction (ECV) and invasively measured parameters of diastolic function and to study the potential of ECV to differentiate between different pathomechanisms in HFPEF. Methods: We performed CMR T1-Mapping in 21 patients with HFpEF and 11 patients without heart failure symptoms (further referred to as controls). Pressure volume loops were obtained with a conductance catheter during basal conditions and handgrip exercise. Transient preload reduction was used to extrapolate the diastolic stiffness constant. Results: Patients with HFpEF showed a higher extra cellular volume fraction (p=0.001), an elevated load-independent passive LV stiffness constant - ß (p Within the HFpEF cohort, patients with ECV over median showed higher left ventricular masses (p=0.04) and a higher LV stiffness (p=0.05). ECV < median identified patients with a prolonged active LV relaxation (p=0.008) and a marked hypertensive reaction to exercise due to a pathologic arterial elastance (p=0.05). Conclusions: Diffuse myocardial fibrosis, assessed by CMR derived T1-Mapping independently predicts invasively measured LV stiffness in HFpEF. In addition, ECV helps to non-invasively distinguish the role of impaired active relaxation and passive stiffness and refines characterization of patients, which represents a prerequisite for any successful therapy in the future.

Optimal patient characterization in heart failure with preserved ejection fraction (HFpEF) is essential to tailor successful treatment strategies. Cardiac magnetic resonance (CMR)-derived T1 mapping can noninvasively quantify diffuse myocardial fibrosis as extracellular volume fraction (ECV).This study aimed to elucidate the diagnostic performance of T1 mapping in HFpEF by examining the relationship between ECV and invasively measured parameters of diastolic function. It also investigated the potential of ECV to differentiate among pathomechanisms in HFpEF.We performed T1 mapping in 24 patients with HFpEF and 12 patients without heart failure symptoms. Pressure-volume loops were obtained with a conductance catheter during basal conditions and handgrip exercise. Transient pre-load reduction was used to extrapolate the diastolic stiffness constant.Patients with HFpEF showed higher ECV (p0.01), elevated load-independent passive left ventricular (LV) stiffness constant (beta) (p0.001), and a longer time constant of active LV relaxation (p = 0.02). ECV correlated highly with beta (r = 0.75; p0.001). Within the HFpEF cohort, patients with ECV greater than the median showed a higher beta (p = 0.05), whereas ECV below the median identified patients with prolonged active LV relaxation (p = 0.01) and a marked hypertensive reaction to exercise due to pathologic arterial elastance (p = 0.04). On multiple linear regression analyses, ECV independently predicted intrinsic LV stiffness (β = 0.75; p0.01).Diffuse myocardial fibrosis, assessed by CMR-derived T1 mapping, independently predicts invasively measured LV stiffness in HFpEF. Additionally, ECV helps to noninvasively distinguish the role of passive stiffness and hypertensive exercise response with impaired active relaxation. (Left Ventricular Stiffness vs. Fibrosis Quantification by T1 Mapping in Heart Failure With Preserved Ejection Fraction [STIFFMAP]; NCT02459626).

International audience; BACKGROUND: Fractional flow reserve estimated using computed tomography (FFRCT) might improve evaluation of patients with chest pain. OBJECTIVES: The authors sought to determine the effect on cost and quality of life (QOL) of using FFRCT instead of usual care to evaluate stable patients with symptoms suspicious for coronary disease. METHODS: Symptomatic patients without known coronary disease were enrolled into 2 strata based on whether invasive or noninvasive diagnostic testing was planned. In each stratum, consecutive observational cohorts were evaluated with either usual care or FFRCT. The number of diagnostic tests, invasive procedures, hospitalizations, and medications during 90-day follow-up were multiplied by U.S. cost weights and summed to derive total medical costs. Changes in QOL from baseline to 90 days were assessed using the Seattle Angina Questionnaire, the EuroQOL, and a visual analog scale. RESULTS: In the 584 patients, 74% had atypical angina, and the pre-test probability of coronary disease was 49%. In the planned invasive stratum, mean costs were 32% lower among the FFRCT patients than among the usual care patients (\7,343 vs. \10,734 p \textless 0.0001). In the noninvasive stratum, mean costs were not significantly different between the FFRCT patients and the usual care patients (\2,679 vs. \2,137; p = 0.26). In a sensitivity analysis, when the cost weight of FFRCT was set to 7 times that of computed tomography angiography, the FFRCT group still had lower costs than the usual care group in the invasive testing stratum (\8,619 vs. \ 10,734; p \textless 0.0001), whereas in the noninvasive testing stratum, when the cost weight of FFRCT was set to one-half that of computed tomography angiography, the FFRCT group had higher costs than the usual care group (\2,766 vs. \2,137; p = 0.02). Each QOL score improved in the overall study population (p \textless 0.0001). In the noninvasive stratum, QOL scores improved more in FFRCT patients than in usual care patients: Seattle Angina Questionnaire 19.5 versus 11.4, p = 0.003; EuroQOL 0.08 versus 0.03, p = 0.002; and visual analog scale 4.1 versus 2.3, p = 0.82. In the invasive cohort, the improvements in QOL were similar in the FFRCT and usual care patients. CONCLUSIONS: An evaluation strategy based on FFRCT was associated with less resource use and lower costs within 90 days than evaluation with invasive coronary angiography. Evaluation with FFRCT was associated with greater improvement in quality of life than evaluation with usual noninvasive testing. (Prospective Longitudinal Trial of FFRCT: Outcomes and Resource Impacts [PLATFORM]; NCT01943903).

International audience; BACKGROUND: Fractional flow reserve (FFR) measured by coronary computed tomography angiography (FFRCT) has been validated against invasive FFR. However, there are no data on how the use of FFRCT affects patient care and outcomes. The aim of this study is to compare standard practice guided by usual care testing to FFRCT-guided management in symptomatic subjects with suspected coronary artery disease (CAD). METHODS: In this prospective nonrandomized trial, symptomatic patients with suspected CAD will be enrolled in 2 consecutive cohorts: a usual care-guided pathway (cohort 1) and an FFRCT-guided pathway (cohort 2). Each cohort is divided into 2 groups according to whether noninvasive or invasive diagnostic testing was planned before enrollment. In all subjects, the patient's clinical team will review all diagnostic test results and determine a treatment strategy. A total sample size of 580 subjects will be enrolled and followed up for 12 months. RESULTS: The primary end point is the comparison of the percentage of patients with planned invasive testing who have a catheterization (invasive coronary angiography) within 90 days from initial assessment, which does not show a significant stenosis (defined as coronary artery stenosis \textgreater50% or invasive FFR \textless/=0.80). Secondary end points include the rate of invasive coronary angiography without obstructive CAD in those with planned noninvasive testing and, in all groups, noninferiority of resource use, quality of life, medical radiation exposure, and major adverse cardiac events up to 365 days of follow-up. CONCLUSIONS: The study compares clinical and economic outcomes based on diagnostic evaluation using FFRCT with that based on standard diagnostic strategies.

Aims Distortion of the terminal portion of the QRS complex (so-called Grade 3 ischaemia, G3I) has been associated with adverse outcomes in ST-elevation myocardial infarction (STEMI) populations. However, the correlation of G3I with infarct size and microvascular injury as defined by cardiac magnetic resonance (CMR) is not well defined. Aim of this study was to assess the relation of G3I with myocardial damage as assessed by CMR and clinical outcomes in STEMI patients. Methods and results We analysed the ECGs of 572 consecutive STEMI patients regarding the presence or absence of G3I. CMR was performed within 1 week after infarction for comprehensive assessment of myocardial damage using a standardized protocol. The primary clinical endpoint was major adverse cardiac events (MACE) within 12 months after infarction. G3I was present in 186 (32%) patients. The presence of G3I was associated with larger infarct size ( P = 0.01), the presence of late microvascular obstruction ( P = 0.05), the presence of intramyocardial haemorrhage ( P = 0.04), and impaired myocardial salvage ( P = 0.01). G3I was associated with a higher incidence of MACE ( P = 0.01) and was identified as an independent predictor of MACE in Cox regression analysis (HR 2.19; 95% CI 1.10 to 4.38, P = 0.03). Conclusion This largest study to date correlating G3I on the admission ECG with CMR markers of myocardial damage demonstrates that G3I is significantly associated with infarct size, impaired myocardial salvage, and reperfusion injury in a reperfused STEMI population. Moreover, G3I was independently associated with MACE. ClinicalTrials.gov NCT00712101.

4D PC-MRI enables the noninvasive measurement of time-resolved, three-dimensional blood flow data that allow quantification of the hemodynamics. Stroke volumes are essential to assess the cardiac function and evolution of different cardiovascular diseases. The calculation depends on the wall position and vessel orientation, which both change during the cardiac cycle due to the heart muscle contraction and the pumped blood. However, current systems for the quantitative 4D PC-MRI data analysis neglect the dynamic character and instead employ a static 3D vessel approximation. We quantify differences between stroke volumes in the aorta obtained with and without consideration of its dynamics.We describe a method that uses the approximating 3D segmentation to automatically initialize segmentation algorithms that require regions inside and outside the vessel for each temporal position. This enables the use of graph cuts to obtain 4D segmentations, extract vessel surfaces including centerlines for each temporal position and derive motion information. The stroke volume quantification is compared using measuring planes in static (3D) vessels, planes with fixed angulation inside dynamic vessels (this corresponds to the common 2D PC-MRI) and moving planes inside dynamic vessels.Seven datasets with different pathologies such as aneurysms and coarctations were evaluated in close collaboration with radiologists. Compared to the experts' manual stroke volume estimations, motion-aware quantification performs, on average, 1.57% better than calculations without motion consideration. The mean difference between stroke volumes obtained with the different methods is 7.82%. Automatically obtained 4D segmentations overlap by 85.75% with manually generated ones.Incorporating motion information in the stroke volume quantification yields slight but not statistically significant improvements. The presented method is feasible for the clinical routine, since computation times are low and essential parts run fully automatically. The 4D segmentations can be used for other algorithms as well. The simultaneous visualization and quantification may support the understanding and interpretation of cardiac blood flow.

We compared in vivo blood flow and pulsatility after different types of Fontan operation using magnetic resonance imaging. A total of 37 consecutive patients (mean age 19±7.9 years, 7.3±3.2 years after Fontan operation), 7 with atriopulmonary anastomosis (APC), 18 with intra-atrial lateral tunnel (LTFO) and 12 with extracardiac Fontan (ECFO) were studied using magnetic resonance phase-contrast velocity mapping. Blood flow (volume flow) in the superior vena cava (SVC), inferior vena cava (IVC) and both pulmonary arteries were measured and a pulsatility index was calculated for each vessel. For all modifications, the blood flow distribution between the SVC and IVC was normal (1 : 2). Patients with APC had a normal pulsatility, a dilated right atrium, partial backward flow in the IVC and physiological blood flow distribution between the pulmonary arteries. LTFO and ECFO patients had no retrograde flow in the IVC, equal blood flow distribution between the pulmonary arteries and very low or absent pulsatility. MRI allows hemodynamic quantification and characterization of various types of Fontan modifications and may be a valuable tool to predict Fontan failure. Despite showing normal pulsatility, patients with APC have right atrial dilatation and partial backward flow in the IVC, demonstrating suboptimal Fontan circulation. LTFO and ECFO both produce unidirectional antegrade flow in the IVC but pulsatility is very low or absent, which may promote poor pulmonary artery growth and increase of pulmonary vascular resistance contributing to late Fontan failure.

Thermotherapy using magnetic nanoparticles (nano cancer therapy) is a new concept of local tumour therapy, which is based on controlled heating of intra-tumoural injected magnetic nanoparticles. The aim of this study was to evaluate the usefulness of PET with a recently introduced amino acid tracer O-(2-[18F]fluoroethyl)-]L-tyrosine (FET) for targeting the nanoparticles implantation.Eleven patients with glioblastoma recurrences underwent MR and FET-PET imaging for planning of the nano cancer therapy. Thereafter, the gross tumour volumes (GTV) were defined, taking into consideration the results of both imaging tools.The MRI-based mean GTV was 24.3 cm3 (range 2.5-59.7) and the PET-based mean GTV 31.9 cm3 (range 5.2-77.9). On the average the MRI identified an additional 8.9 +/- 4.7 cm3 and the FET-PET scan-an additional 16.5 +/- 15.2 cm3 outside of the common GTV (15.4 +/- 11.0 cm3). The mean final GTV accounted to 33.8 cm3 (range, 5.2-77.9). The additional information of FET-PET led to an increase in GTV by 22-286% in eight patients and to a decrease of 23% and 26%, respectively, in two patients. In one patient, the final GTV was defined on the basis of MRI data only.FET-PET adds important information on the actual tumour volume in recurrent glioblastomas and is highly valuable for defining the target volume for the nano cancer therapy.

Summary Aim: Comparison of two gated SPECT analysis tools – gated SPECT quantification (GSQ) and emory cardiac toolbox (ECT) – in patients with coronary artery disease (CAD) and severely impaired left ventricular function (preoperative: EF

Purpose To evaluate the signal-to-noise ratio (SNR), precision, and accuracy of phase-contrast flow measurements at 3 T with the help of an in vitro model and to compare the results with data from two 1.5-T scanners. Materials and Methods Using an identical setup of a laminar flow model and sequence parameters, measurements were done at one 3-T and at two 1.5-T systems. Precision, accuracy, and SNR were obtained for velocity encodings ranging from 55 up to 550 cm−1. SNRs were calculated from the magnitude as well as the flow encoded images. Results Precision and accuracy for the in vitro flow model were similarly high in all scanners with no significant difference. For velocity encodings from 55 cm−1 up to 550 cm−1, the SNR in magnitude as well as phase encoded images of the 3-T measurements was approximately 2.5 times higher than the SNR obtained from the two 1.5-T systems. Conclusion Even without optimization for the 3-T environment, flow measurements show the same high accuracy and precision as is known from clinical 1.5-T scanners. The superior SNR at 3 T will allow further improvements in temporal and spatial resolution. This will be of interest for small-size vessels like coronary arteries or for slow diastolic flow patterns. J. Magn. Reson. Imaging 2005;21:604–610. © 2005 Wiley-Liss, Inc.

The aim of this study was to compare CT, MRI and FDG-PET in the prediction of outcome of neoadjuvant radiochemotherapy in patients with locally advanced primary rectal cancer. A total of 23 patients with T3/4 rectal cancer underwent a preoperative radiochemotherapy combined with regional hyperthermia. Staging was performed using four-slice CT (n=23), 1.5-T MRI (n=10), and (18)F-FDG-PET (n=23) before and 2-4 weeks after completion of neoadjuvant treatment. Response criteria were a change in T category and tumour volume for CT and MRI and a change in glucose uptake (standard uptake value) within the tumour for FDG-PET. Imaging results were compared with those of pretherapy endorectal ultrasound and histopathological findings. Histopathology showed a response to neoadjuvant therapy in 13 patients whereas 10 patients were classified as nonresponders. The mean SUV reduction in responders (60+/-14%) was significantly higher than in nonresponders (37+/-31%; P=0.030). The sensitivity and specificity of FDG-PET in identifying response was 100% (CT 54%, MRI 71%) and 60% (CT 80%, MRT 67%). Positive and negative predictive values were 77% (CT 78%, MRI 83%) and 100% (CT 57%, MRI 50%) (PET P=0.002, CT P=0.197, MRI P=0.500). These results suggest that FDG-PET is superior to CT and MRI in predicting response to preoperative multimodal treatment of locally advanced primary rectal cancer.

This study compared different magnetic resonance imaging (MRI) methods with Tl(201) single photon emission computerized tomography (SPECT) and the "gold standard" for viability assessment, functional recovery after coronary artery bypass grafting (CABG). Twenty patients (64+/-7.3 years) with severely impaired left ventricular function (ejection fraction [EF] 28.6+/-8.7%) underwent MRI and SPECT before and 6 months after CABG. Wall-motion abnormalities were assessed by stress cine MRI using low-dose dobutamine. A segment with a nonreversible defect in Tl(201)-SPECT and a delayed enhancement (DE) in an area50% of the entire segment, as well as an end-diastolic wall thickness6 mm, was defined as nonviable. The mean postoperative EF (n=20) improved slightly from 28.6+/-8.7% to 32.2+/-12.4% (not significant). Using the Tl(201)-SPECT as the reference method, end-diastolic wall thickness, MRI-DE, and stress MRI showed high sensitivity of 94%, 93%, and 84%, respectively, but low specificities. Using the recovery of contractile function 6 months after CABG as the gold standard, MRI-DE showed an even higher sensitivity of 99%, end-diastolic wall thickness 96%, stress MRI 88%, and Tl(201)-SPECT 86%. MRI-DE showed advantages compared with the widely used Tl(201)-SPECT and all other MRI methods for predicting myocardial recovery after CABG.

The objective was the evaluation of single photon emission computed tomography (SPECT) with integrated low dose computed tomography (CT) in comparison with a retrospective fusion of SPECT and high-resolution CT and a side-by-side analysis for lesion localisation in patients with neuroendocrine tumours. Twenty-seven patients were examined by multidetector CT. Additionally, as part of somatostatin receptor scintigraphy (SRS), an integrated SPECT-CT was performed. SPECT and CT data were fused using software with a registration algorithm based on normalised mutual information. The reliability of the topographic assignment of lesions in SPECT-CT, retrospective fusion and side-by-side analysis was evaluated by two blinded readers. Two patients were not enrolled in the final analysis because of misregistrations in the retrospective fusion. Eighty-seven foci were included in the analysis. For the anatomical assignment of foci, SPECT-CT and retrospective fusion revealed overall accuracies of 91 and 94% (side-by-side analysis 86%). The correct identification of foci as lymph node manifestations (n=25) was more accurate by retrospective fusion (88%) than from SPECT-CT images (76%) or by side-by-side analysis (60%). Both modalities of image fusion appear to be well suited for the localisation of SRS foci and are superior to side-by-side analysis of non-fused images especially concerning lymph node manifestations.

To evaluate resonant circuits as markers for magnetic resonance (MR) imaging-guided placement of nitinol stents.The study was approved by the institutional animal research committee and complied with National Institutes of Health guidelines for care and use of laboratory animals. Resonant circuits similar to catheter markers used at conventional angiography were placed proximally and distally to a nitinol stent in a stent delivery system. Resonant circuits were tested in vitro and in vivo for signal intensity levels that would enable visualization during MR imaging-guided stent deployment. Experiments were conducted by using real-time imaging with a 1.5-T unit. Stents (n = 9) were deployed in the vena cava (n = 2), abdominal aorta (n = 2), isthmus of the aorta (n = 2), and carotid (n = 2) and iliac (n = 1) arteries in five pigs. After intervention, the site of the stent was investigated with balanced fast field-echo MR imaging and contrast material-enhanced MR angiography. Blood flow velocities were measured in the stent lumen and next to the stent with velocity-encoded cine MR imaging. Level of agreement was determined with Bland-Altman analysis.During all interventions, resonant circuits provided highly visible MR signal that allowed fast and reliable visualization of the stent delivery system. Borders of loaded stents were clearly marked, which allowed precise stent placement in all experiments. Balanced fast field-echo MR imaging and contrast-enhanced MR angiography provided information about immediate postintervention position. Positions depicted on MR images were found accurate at postmortem examination. Results of Bland-Altman analysis showed good agreement between blood flow velocities measured in and next to the stent lumen, with a mean difference of -9 cm/sec +/- 5 (standard deviation).Resonant circuits are well suited for use at deployment of endovascular stents.

Cardiovascular MR imaging often requires high temporal and spatial resolution, especially in order to acquire data about cardiac function. Furthermore, the current results at 1.5 T for coronary artery imaging or plaque imaging are still not satisfying even with the use of the latest technology. Therefore, cardiac imaging inherently demands high signal-to-noise (SNR) and contrast-to-noise ratios (CNR) and hence may benefit from higher magnetic field strengths. However, higher magnetic field strengths do not inevitably improve the image quality for all cardiac imaging techniques as compared with their 1.5 T counterparts. At higher magnetic field strengths one has to cope with increased field inhomogeneities, longer T1, shorter T2* relaxation times and radiofrequency power deposition constraints, which require further methodological developments. Initial studies using 3.0 T whole-body scanners for cardiac imaging revealed that optimized steady-state free precession or spin-echo sequences meet the expected SNR increase at 3.0 T but showed different results for CNR. These results are especially encouraging for cardiac tissue characterization at 3 T together with the evolving parallel imaging techniques. This review focuses on the feasibility of cardiac MR imaging at high magnetic field strengths. The pros and cons of cardiac imaging at 3.0 T vs. 1.5 T are examined and technical solutions are discussed.

This study evaluated the use of image fusion in the preoperative staging of neuroendocrine tumors (NET) of the pancreas and the gastrointestinal tract (GIT). Thirty-eight patients suffering from a metastasized NET with location of the primary in the pancreas ( n=15) or the GIT ( n=23) were examined by somatostatin receptor scintigraphy (SRS) and computed tomography (CT). Consecutive image registration and fusion were performed using custom-built software integrated in AVS/Express (Advanced Visual Systems, Waltham, MA, USA). Registration was performed by a voxel-based algorithm based on normalized mutual information. Image fusion was feasible in 36/38 patients. A total of 87 foci were assigned to anatomical regions (e.g. gut, pancreas, liver, lymph node or others) by two independent observers in both SRS and SRS/CT fusion images. The assignments used a binary ranking system (1="definite", 0="not definite"). These results were then retrospectively compared to the classification of the foci, based on postoperative histology or clinical follow-up. Imaging by SRS allowed a definite anatomical assignment in 57% (50/87) and 61% (53/87) of all lesions in the case of observers A and B, respectively. Image fusion improved the topographic assignment to 91% (79/87) and to 93% (81/87). The number classified as "definite" by both observers increased from 54% (47/87) to 86% (77/87). The increase in definite assignments was highly significant for both observers ( P0.0001 for each). In the case of foci classified as liver metastases, image fusion allowed improved assignment to the corresponding liver segment from 45% (18/40) to 98% (39/40) and from 58% (23/40) to 100% (40/40) by observers A and B, respectively. Furthermore, the improved assignment of foci classified as lesions by image fusion was relevant for therapy in 7/36 patients (19%). Therefore, the image fusion technique presented herein appears to be a very useful method for clinical routine.

Die Fontan-Op bewirkt eine akute Volumenentlastung des univentrikularen Herzens mit konsekutiven Veranderungen der Ventrikelgeometrie. Die resultierende postoperative Zunahme des myokardialen Masse-Volumen-Index (MVI) kann die diastolische Funktion und Relaxation des univentrikularen Herzens beeinflussen. In dieser Studie wurde untersucht, ob die durch Magnetresonanztomographie (MRT) errechneten volumetrischen Parameter und mogliche Veranderungen in der Ventrikelgeometrie mit der chronischen Verminderung der Belastbarkeit bei Patienten mit Fontan-Op korrelierten. Wir untersuchten die kardiopulmonale Belastbarkeit von 24 Patienten mit funktionell univentrikularem Herz und erfolgter Fontan-Op im Abstand von 3,63 ± 1,97 Jahren nach Fontan-Op (m = 14, w = 10, Alter: 14,57 ± 9,74 Jahre) mittels einer Fahrrad-Spiroergometrie (Non-Steady-State-Belastung). Die Parameter der Belastung wurden mit den Werten fur MVI, enddiastolische Muskelmasse (EDMM) und endsystolischem Ventrikelvolumen (ESV)—erhoben in einer zeitnah angefertigten MRT-Untersuchung—korreliert. Es wurde eine Leistung von 2,06 ± 0,54 W/kg (60,63 ± 15,75% der Norm) bzw. eine VO2max von 27,41 ± 8,87 ml/min/kg (60,91 ± 19,7% der Norm) erreicht. Es bestand eine positive Korrelation der Belastungsmaxima mit ESV (r2 = 0,2572, p = 0,033) und EDMM (r2 = 0,2544, p = 0,024). Eine Korrelation mit dem MVI lies sich jedoch nicht demonstrieren. Die myokardiale Hypertrophie kann die myokardiale Funktion des univentrikularen Herzens und dadurch auch die korperliche Leistung von Kindern und Erwachsenen mit Fontan-Zirkulation beeinflussen.

Die linksventrikulare Dysfunktion ist der wichtigste Faktor, der die Uberlebensprognose bei koronarer Herzerkrankung (KHK) beeinflusst. Sie ist ebenso der wichtigste Risikofaktor bei Bypass-Operationen im Endstadium der KHK. In der vorliegenden Studie wurde untersucht, wie eine praoperativ bestehende linksventrikulare Dysfunktion das Langzeituberleben nach Bypass-Operation beeinflusst. Am Deutschen Herzzentrum Berlin wurde zwischen 4/1986 und 12/2000 bei 1751 Patienten (1440 Manner/311 Frauen) mit einer linksventrikularen Ejektionsfraktion von 10–30% eine koronare Bypassoperation durchgefuhrt. Das Durchschnittsalter lag bei 59,2 Jahren. Hauptindikation zur Operation war der Nachweis von ischamischem Myokard („hibernating myocardium“) in der Myokardszintigraphie, Echokardiographie und in einigen Fallen in der Magnetresonanztomographie und der Positronenemissionstomographie. Die Operationsletalitat betrug 7,1%. Die aktuarische Uberlebensrate berechnete sich auf 87,6% nach 2 Jahren, auf 76,0% nach 5 und auf 53,3% nach 9 Jahren. 455 Patienten hatten eine linksventrikulare Ejektionsfraktion von 10–20%. Bei ihnen lag die Uberlebensrate nach 2 Jahren bei 79,8%, nach 5 Jahren bei 63,0% und nach 9 Jahren bei 45,7%. Wir folgern, die Koronarchirurgie kann auch bei Patienten mit hochgradig eingeschrankter linksventrikularer Funktion zur Verlangerung der Lebenserwartung genutzt werden. Die Prognose ist gut, wenn ein praoperativer Nachweis eines „hibernating myocardium“ gelingt.

PURPOSE: To assess the new method of 3-dimensional echocardiography in comparison to the "gold standard" MRI as to its ability to calculate left ventricular volumes in patients with congenital heart disease. MATERIALS AND METHODS: Eighteen patients between the ages of 3.9 to 37.3 years (mean: 12.8 +/- 9.7) with a geometrically abnormal left ventricle were examined using a 1.5T scanner with a fast gradient-echo sequence (TR = 14 ms, TE = 2.6 - 2.9 ms, FOV = 300 - 400 mm, flip angle = 20 degrees, matrix = 128 : 256, slice thickness = 5 mm, retrospective gating) in multislice-multiphase technique. Transthoracic 3D-echocardiography was performed with a 3.5 MHz transducer and a Tomtec (Munich, Germany) system for 3D reconstruction. RESULTS: Volume calculation was possible in all patients with 3D-echocardiography, but the muscle mass calculation only succeeded in 11 of 18 patients (61 %) due to inadequate visualization of the entire myocardium. Comparing MRI and 3D-echocardiography, the correlation was r = 0.97 for the end-systolic volumes, r = 0.98 for the end-diastolic volumes, r = 0.79 for the end-systolic muscle mass and r = 0.77 for the end-diastolic muscle mass. The agreement between both methods was considered good for the calculated end-diastolic volumes and sufficient for the calculated end-systolic volumes. The muscle mass calculations showed larger differences especially for the end-systolic mass. Mean intraobserver variability was 18.6 % for end-systolic and 8.3 % for end-diastolic volumes. CONCLUSION: In patients with an abnormal left ventricular configuration due to congenital heart disease, the new method of 3D-echocardiography is sufficient for volume calculations in preselected patients. The high intraobserver variability is still a limitation of transthoracic 3D-echocardiography in comparison to MRI.