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The role of sternal torsion (ST) in patients with pectus excavatum (PEX) is unknown. We evaluated the relationship between ST and both chest malformation and cardiac compression (CC) indexes.We included consecutive patients with PEX who underwent chest computed tomography and cardiac magnetic resonance (CMR) to define surgical candidacy. Malformation indexes included the Haller index (HI), correction index (CI), and ST. CC and the tricuspid to mitral annulus width ratio were evaluated using CMR.One-hundred and sixteen patients were included, with a mean HI of 5.8 ± 3.6 and a mean CI of 35.8 ± 18.0%. ST was significantly related to malformation indexes, being patients with absence of ST those showing the lowest HI (p = 0.048) and CI (p = 0.002). Right-sided ST was significantly related to the CC classification (p = 0.0001), and the tricuspid/mitral annulus width ratio was significantly lower among these patients (absence 0.98 ± 0.15, left-sided 0.91 ± 0.10, right-sided 0.80 ± 0.15, p 0.0001). A significant inverse relationship between ST degrees and the tricuspid/mitral ratio was also identified (r = -0.47, p 0.0001).We identified a significant relationship between ST and both chest malformation and CC indexes; the absence of ST being identified as a marker of an overall more benign phenotype.Study of diagnostic test.Level II.

Purpose Image acquisition protocols and reports in patients with pectus excavatum (PEX) differ significantly from routine examinations, and no imaging modality can enable a comprehensive assessment of PEX severity and cardiac impact within a single examination. We therefore attempt to establish recommendations about preoperative imaging in patients with PEX. Method Chest computed tomography (CT), stress echocardiography (Echo), and cardiac magnetic resonance (CMR) allow the evaluation of specific information regarding structural and functional characteristics of vital importance to assess surgical candidacy and define surgical strategies. We sought to provide a multidisciplinary state of the art document involving thoracic surgeons, radiologists, and cardiologists; to establish recommendations about the variables to be included in the reports of the imaging examinations performed in patients with PEX. Results We provide recommendations for preoperative image acquisition and analysis, aimed at the assessment of the severity of the chest wall deformity (CT); the site of maximum cardiac compression, extent of increased interventricular dependence, and presence of pericardial effusion (CMR); and the effect of PEX on the functional capacity and exercise-related systolic and/or diastolic function, and tricuspid annulus compression (Echo). Conclusions This multidisciplinary state of the art document involving thoracic surgeons, radiologists, and cardiologists provides recommendations about preoperative imaging for patients with PEX.

Aims Previous studies have demonstrated diverse cardiac manifestations in patients with pectus excavatum (PEX), although mostly addressing morphological or physiological impact as separate findings. Using multimodality imaging, we evaluated the impact of PEX on cardiac morphology and function according to the site of maximum compression, and the effect of exertion and breathing. Methods and results All patients underwent chest computed tomography, cardiac magnetic resonance (CMR), and stress echocardiography (echo) in order to establish surgical candidacy. We evaluated diastolic function and trans-tricuspid gradient during stress (echo); and systolic function and respiratory-related septal wall motion abnormalities (CMR). Patients were classified according to the site of cardiac compression as type 0 (without cardiac compression); type 1 (right ventricle); and type 2 [right ventricle and atrioventricular (AV) groove]. Fifty-nine patients underwent multimodality imaging, with a mean age of 19.5 ± 5.9 years. Compared with a sex and age matched control group, peak exercise capacity was lower in patients with PEX (8.4 ± 2.0 METs vs. 15.1 ± 4.6 METs, P Conclusions The present study demonstrated that patients with PEX, particularly those with compression affecting the right ventricle and AV groove, manifest diverse cardiac abnormalities that are mostly related to exertion, inspiration, and diastolic function.

Computed tomography virtual hysterosalpingography (CT-VHSG) is not exempt from the possibility of diagnostic errors, either by omission or by misinterpretation of the imaging findings. To minimize them and preserve the diagnostic potential and validity of the method, it is essential to be aware of potential pitfalls that may be present in the CT-VHSG exams. Most of them can be prevented or avoided by performing the procedure with adequate preparation and an appropriate standardized technique.

Computed tomography virtual hysterosalpingography is a novel radiographic technique for evaluating the female reproductive system. Based on a CT volumetric data of the pelvic region, this diagnostic procedure combines the advantages of multidetector CT and the capabilities of the X-ray hysterosalpingography for an exhaustive and complete evaluation of the gynecologic system in a single study.

Tubal factor infertility represents the most common cause of infertility in women. Most cases are due to salpingitis and consequent pelvic-peritoneal adhesions secondary to previous or persistent infections. Computed tomography virtual hysterosalpingography (CT-VHSG) offers reliable information of the fallopian tubes based on the high temporal and spatial resolution of the method. Variable slab-thickness MIP images and three-dimensional MIP views accurate depict the fallopian tube anatomy, morphology and patency in a single imaging study.

The uterus is a hollow, pear-shaped dynamic female reproductive organ. CT-VHSG is a non-invasive study with low-radiation dose and short examination time that gives objective, accurate, and also measurable anatomical information of the cervix, uterine cavity, uterine wall and external outline of the uterus.

CT-VHSG exams constitute an excellent noninvasive diagnostic alternative for the evaluation of the neck and cervical canal anatomy. Sagittal MPR allows the determination of the cervical-uterine angle between the lower uterine segment and the cervical canal, the measurement of caliber and length of the cervical canal, as well as the identification of pathologies.

The virtual computed tomography hysterosalpingography (CT-VHSG) technique allows a complete evaluation of the female reproductive system. Knowledge of normal anatomy and typical imaging findings in normal patients are essential for a correct diagnosis.

PURPOSE: To explore stress echocardiographic findings among patients with pectus excavatum (PEX) and their relationship with malformation severity. MATERIALS AND METHODS: A prospective registry involving consecutive patients with a diagnosis of isolated PEX referred to undergo chest CT and stress echocardiography to evaluate surgical candidacy and/or to define treatment strategies was developed. Malformation indexes were evaluated using chest CT. RESULTS: This study included 269 patients with PEX (19.7 years ± 7.8 [standard deviation]; 245 men) and 35 healthy volunteers (20.7 years ± 6.1; 21 men). Patients with PEX achieved a lower maximal workload (PEX group, 8.2 metabolic equivalents ± 1.7; control group, 11.8 metabolic equivalents ± 5.5; P < .0001). This study identified evidence of abnormal right ventricular diastolic function in 29% of patients with PEX and identified no evidence of this among those in the control group (P < .0001). Healthy controls showed a 37% increment in the tricuspid area during exercise, compared with 4% in patients with PEX (P = .002). Right ventricular systolic function was significantly lower in patients with PEX than in controls, both measured using tricuspid annulus plane systolic excursion (stress, 25.0 mm ± 5.5 vs 35.4 mm ± 3.7; P < .0001), and the tricuspid systolic wave was also smaller (stress, 16.9 cm/sec ± 4.5 vs 20.5 cm/sec ± 3.9; P < .0001). During stress, significant associations were detected between malformation indexes with right ventricular systolic and diastolic findings (P < .05 for all). CONCLUSION: This study identified evidence of diverse adverse functional and morphologic cardiac manifestations in PEX, involving signs of abnormal diastolic and systolic right ventricular function and compression of the atrioventricular groove, which worsened during stress and were related to malformation severity. © RSNA, 2020 An earlier incorrect version of this article appeared online. This article was corrected on October 19, 2020.

Resumen Objetivo Explorar cualitativamente y cuantitativamente el estudio espectral de las lesiones focales hepaticas, comparandolo con la valoracion policromatica habitual de la tomografia de energia simple. Metodo El presente estudio prospectivo incluyo 50 pacientes remitidos para la realizacion de tomografia computada multidetector abdominal con contraste intravenoso, que tuvieran al menos una lesion focal hepatica. La fase portal fue adquirida con energia dual. Se realizaron mediciones densitometricas de las lesiones y del parenquima hepatico circundante, tanto en la adquisicion policromatica basal como en las posteriores reconstrucciones monocromaticas a 40, 70 y 140 keV. Se trazaron las curvas espectrales y se calcularon los indices de doble energia y la relacion contraste-ruido. Por ultimo, se hizo una valoracion subjetiva de la calidad de las imagenes y la detectabilidad lesional. Resultados Las diferencias densitometricas entre los distintos tipos de lesiones (avasculares y vascularizadas) y el higado fueron mayores a bajos niveles energeticos (a la izquierda de la curva espectral) que en la evaluacion policromatica. En la valoracion subjetiva, el nivel energetico de 40keV presento una mayor detectabilidad lesional. Conclusiones El estudio espectral monocromatico mediante tomografia computada de energia dual provee una mayor detectabilidad lesional a 40keV en relacion a la que se dispone con la valoracion policromatica habitual.

Objective To qualitatively and quantitatively explore the spectral study of focal liver lesions, comparing it with the usual polychromatic assessment with single-energy computed tomography. Material and methods We prospectively studied 50 patients with at least one focal liver lesion who were referred for abdominal multidetector computed tomography with intravenous contrast material. The portal phase was acquired with dual energy sources. The density of the lesions and of the surrounding liver parenchyma was measured both in the baseline polychromatic acquisition and in the posterior monochromatic reconstructions at 40 keV, 70 keV, and 140 keV. Spectral curves were traced and the dual-energy indices and contrast-to-noise ratio were calculated. Lastly, the quality of the images and the detectability of the lesions were assessed qualitatively. Results Densitometric differences between the different types of lesions (avascular and vascularized) and the liver were greater at low energy levels (left side of the spectral curve) than in the polychromatic evaluation. In the subjective assessment, the 40 keV energy level had the greatest lesion detectability. Conclusions Monochromatic spectral study with dual-energy computed tomography provides better lesion detectability at 40 keV compared to that provided by the ordinary polychromatic evaluation.

Objetivos: Explorar la utilidad de la tomografía computada de doble energía (TCDE) mediante tecnología de imágenes espectrales gemstone (GSI) y de un software dedicado a la reducción de artefactos de metal (MARS), para la evaluación de tejidos periprotésicos e interpretabilidad diagnóstica de patologías relacionadas con implantes.Materiales y Métodos: Se estudió la densidad ósea, partes blandas y grasa en el tejido periprotésico comparado con tejido control sin implante, utilizando un escáner de alta definición de TCDE-GSI tanto en imágenes policromáticas convencionales (PI) y monocromáticas virtuales (VMSI) con MARS en 80 pacientes con prótesis metálicas en diversas regiones musculo-esqueléticas. Se valoró también la calidad de imagen y la interpretabilidad diagnóstica mediante escala de Likert.Resultados: Con PI se observaron diferencias significativas entre el área periprotésica en los tres tipos de tejidos evaluados respecto a los controles (pConclusiones: La tecnología TCDE tiene la capacidad de reducir los artefactos periprotésicos, logrando un significativo incremento en la capacidad de identificación de tejidos e interpretabilidad diagnóstica de posibles patologías relacionadas con implantes.

Objective To explore the relationship between ventricular filling curves and the extent of late enhancement on cardiac magnetic resonance imaging (MRI) in patients with hypertrophic cardiomyopathy. Material and methods We retrospectively included consecutive patients with suspected and/or confirmed hypertrophic cardiomyopathy and a control group of patients matched for age and sex who underwent cardiac MRI with evaluation of late enhancement. Among other determinations, we evaluated the following parameters on cine sequences: peak filling rate, time to the first peak filling rate, and filling rate normalized to the filling volume. Results Late enhancement was observed in 29 (73%) of the 40 patients with hypertrophic cardiomyopathy. The normalized peak filling rate was significantly lower in patients with late enhancement (4.9 ± 1.6 in those with hypertrophic cardiomyopathy positive for late enhancement vs. 5.8 ± 2.2 in those with hypertrophic cardiomyopathy negative for late enhancement vs. 6.3 ± 1.5 in controls, p = 0.008) and the time to peak filling was longer in patients with late enhancement (540.6 ± 89.7 ms vs. 505.5 ± 99.3 ms in those with hypertrophic cardiomyopathy negative for late enhancement vs. 486.9 ± 86.3 ms in controls, p = 0.02). When the population was stratified into three groups in function of the normalized peak filling rate, significant differences were observed among groups for age (p = 0.002), mean wall thickness (p = 0.036), and myocardial mass (p = 0.046) and atrial dimensions, whereas no significant differences with respect to late enhancement were seen. Conclusions In patients with hypertrophic cardiomyopathy, we found a significant association between ventricular filling patterns and age, wall thicknesses, and atrial dimensions, but not with the extent of late enhancement. Objetivo Explorar mediante resonancia magnética cardíaca la relación entre las curvas de llenado ventricular y la extensión del realce tardío (RT) en pacientes con miocardiopatía hipertrófica. Material y métodos Se incluyeron de forma retrospectiva pacientes consecutivos con sospecha y/o diagnóstico de miocardiopatía hipertrófica, y un grupo control de pacientes pareados según sexo y edad en quienes se realizó una resonancia magnética cardíaca con valoración de RT. Entre otras determinaciones, se evaluaron mediante secuencias cine: tasa de llenado pico, tiempo a la primera tasa de llenado pico y tasa de llenado pico normalizada al volumen de llenado. Resultados De los 40 pacientes con miocardiopatía hipertrófica, 29 (73%) presentaron RT. Se evidenciaron diferencias significativas respecto a la tasa de llenado pico normalizada (RT positivo 4,9 ± 1,6, vs. RT negativo 5,8 ± 2,2, vs. control 6,3 ± 1,5, p = 0,008) y al tiempo a la tasa de llenado pico (540,6 ± 89,7 ms, vs. 505,5 ± 99,3 ms, vs. 486,9 ± 86,3 ms, p = 0,02). Al estratificar la población en tercios según la tasa de llenado pico normalizada al volumen de llenado se registraron diferencias significativas entre los grupos respecto a la edad (p = 0,002), espesor parietal medio (p = 0,036), masa miocárdica (p = 0,046) y dimensiones auriculares, mientras que no se observaron diferencias significativas respecto al RT. Conclusiones En pacientes con miocardiopatía hipertrófica encontramos una asociación significativa entre patrones de llenado ventricular y edad, espesores parietales y dimensiones auriculares, mientras que no se identificó una relación significativa con la extensión del RT. Fil: De Zan, M.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; Argentina Fil: Carrascosa, P.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; Argentina Fil: Deviggiano, A.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; Argentina Fil: Capunay, C.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; Argentina Fil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; Argentina

Rationale and Objectives We sought to explore the image quality and diagnostic performance of virtual monochromatic imaging derived from dual-energy computed tomography coronary angiography (DE-CTCA) in patients with intermediate to high likelihood of coronary artery disease (CAD) and the influence of calcification. Materials and Methods Consecutive symptomatic patients with suspected CAD referred for invasive coronary angiography who underwent DE-CTCA and a coronary artery calcium scoring before the invasive procedure comprised the study population. Results Sixty-seven patients were included. Image quality was significantly lower at 45 keV reconstructions (mean Likert score 45 keV 3.57 ± 0.6, 65 keV 4.07 ± 0.5, and 85 keV 4.09 ± 0.6; P

Resumen Introduccion y objetivos Se analizaron las diferencias de carga ateroesclerotica observadas entre la coronariografia invasiva y las imagenes monocromaticas virtuales obtenidas con la tomografia computarizada de doble energia. Metodos Se examino con tomografia computarizada de doble energia y se clasifico a 80 pacientes consecutivos remitidos a una coronariografia invasiva segun el grado de carga ateroesclerotica utilizando el indice pronostico de enfermedad coronaria de Duke modificado, la puntuacion de extension de la enfermedad coronaria, la puntuacion de afeccion de segmentos y la puntuacion de estenosis de segmentos. Resultados La media de la puntuacion de afeccion de segmento (8,2 ± 3,9 frente a 6,0 ± 3,7; p Conclusiones La angiografia coronaria con tomografia computarizada de energia dual identifico una carga ateroesclerotica significativamente mayor que la observada con la coronariografia invasiva, en especial por lo que respecta a la afeccion de los segmentos proximales.

Objetivo Explorar las diferencias segmentarias de los espesores parietales (EP) en las miocardiopatias mas prevalentes y en individuos sin cardiopatia estructural por resonancia magnetica cardiaca. Metodo Pacientes mayores de 18 anos referidos a resonancia magnetica cardiaca durante el periodo comprendido entre enero de 2014 y septiembre de 2014, con diagnostico de miocardiopatia hipertrofica, miocardiopatia dilatada idiopatica, miocardiopatia isquemico-necrotica y miocarditis fueron seleccionados retrospectivamente de nuestra base de datos. Resultados Se incluyeron 120 pacientes. El grupo control presento un EP medio de 5.9 ± 1.1 mm, con un indice de espesor relativo de 2.9 ± 0.8. Se identificaron EP significativamente menores en los segmentos apicales tanto en el grupo control (basal 6.7 ± 1.3 vs. medio 6 ± 1.3 vs. apical 4.6 ± 1 mm, p < 0.0001) como en todas las miocardiopatias evaluadas (miocardiopatia hipertrofica: basal 10.5 ± 2.4 vs. medio 10.8 ± 2.7 vs. apical 7.3 ± 3.3 mm, p < 0.0001; miocardiopatia dilatada idiopatica: basal 7.7 ± 1.7 vs. medio 7.6 ± 1.3 vs. apical 5.4 ± 1.3 mm, p < 0.0001; miocardiopatia isquemico-necrotica: basal 7.4 ± 1.7 vs. medio 7.5 ± 1.9 vs. apical 5.5 ± 1.8 mm, p < 0.0001; miocarditis: basal 7.1 ± 1.5 vs. medio 6.4 ± 1.1 vs. apical 5.1 ± 0.8, p < 0.0001). Tambien se evidenciaron diferencias significativas entre hombres y mujeres respecto al EP tanto en el grupo control (6.5 ± 2.1 vs. 5.2 ± 1.7 mm, p < 0.0001), como en la miocardiopatia hipertrofica (10.5 ± 5.3 vs. 8.5 ± 5.7 mm, p < 0.0001) y en la miocarditis (6.6 ± 2 vs. 5.2 ± 1.6 mm, p < 0.0001). Conclusiones En este estudio observacional encontramos un prevalencia relativamente elevada de segmentos comunmente considerados como adelgazados en individuos sin cardiopatia estructural. Ademas, observamos una marcada asimetria y gradiente longitudinal en cuanto a ..

Virtual hysterosalpingography (VHSG) is a noninvasive imaging diagnostic technique that provides high-quality images of the entire female reproductive tract. Based on the capabilities of current multidetector computed tomography, it shows excellent diagnostic performance in comparison with other imaging modalities. The combination of several different imaging reprocessing techniques such as multiplanar reconstructions, maximum-intensity projections, 3D volume-rendering and virtual endoscopy images provides a comprehensive and accurate evaluation of both the female reproductive system and the pelvic anatomy generally. The exam has been used clinically for several years, particularly playing an important role in the evaluation of infertile patients. VHSG has the capability to offer simultaneously information provided by several diagnostic techniques such as conventional X-ray hysterosalpingography, sonohysterography, and magnetic resonance imaging, and it is able to diagnose cervical, uterine cavity, and uterine wall disorders, identify different types of uterine anomalies, and assess tubal patency and the presence of associated pathology. It is an extremely well-tolerated study with a very low radiation exposure.

Computed tomography coronary angiography (CTCA) and cardiac magnetic resonance (CMR) can accurately evaluate coronary and cardiac anatomy with high spatial resolution and without acoustic window limitations. Furthermore, these techniques allow the assessment of the relationship of the vessels with the adjacent structures. Isolated coronary artery anomalies are rare, with an incidence of 0.5–1% of the general population. Most of them are asymptomatic and without clinical relevance. Nevertheless, they can have hemodynamic significance according to their origin and proximal course. It is important to discriminate minor from major coronary anomalies (anomalous origin of a coronary artery from the opposite sinus with inter-arterial course), related to a higher risk of sudden cardiac death.

Low monochromatic energy levels (40 keV) derived from delayed enhancement dual energy cardiac computed tomography (DE-DECT) allow the evaluation of myocardial infarcts (MI) among stable patients, although at the expense of high image noise. We explored whether the application of adaptive statistical iterative reconstruction (ASIR) to 40-keV DE-DECT (unavailable with previous software versions) might improve image quality and detection of MI in stable patients.We prospectively enrolled patients with a history of previous MI, and performed delayed-enhancement cardiac magnetic resonance (DE-CMR) and DE-DECT within the same week. DE-DECT images were reconstructed with 0% and 60% ASIR.MI was identified in 18 (80%) patients with both DE-CMR and DE-DECT. On a per segment basis, we did not identify significant differences regarding the diagnostic performance of DE-DECT with and without ASIR [area under receiver operating characteristic curve 0.86 vs. 0.83, p = 0.10]. The application of ASIR improved the signal-to-noise ratio of DE-DECT with 0% ASIR compared to DE-DECT with 60% ASIR (6.07 ± 2.1 vs. 11.1 ± 4.5, p0.0001). However, qualitative assessment of MI image quality (3.35 ± 1.2, vs. 3.55 ± 1.1, p = 0.10) and diagnostic confidence (4.40 ± 0.9 vs. 4.60 ± 0.8, p = 0.10) were not significantly improved. Using DE-DECT with 60% ASIR, a threshold over 199 HU showed a sensitivity of 67% and a specificity of 92% for the detection of segments with MI.In this study, DE-DECT allowed accurate detection of MI among stable patients compared with DE-CMR, and the application of ASIR improved signal-to-noise ratio of DE-DECT, although the diagnostic performance showed only non-significant improvements.

We explored the impact of gender and cardiovascular risk factors (RF) in the distribution and burden of coronary and extra-coronary atherosclerotic plaques among patients undergoing ECG-gated thoracoabdominal computed tomography angiography (CTA) from the supra-aortic trunks to the femoral arteries. We included a consecutive cohort of patients who underwent ECG-gated thoracoabdominal aortic CTA from the supra-aortic trunks to the pubic symphysis. We evaluated the number of coronary segments with plaques [segment-involvement score (SIS)]; and the extra-coronary atherosclerotic plaque burden, comprising the aorta and supra-aortic trunks, iliofemoral arteries, and visceral arteries (extra-coronary SS). A total of 3400 vascular segments were evaluated in 100 patients (mean age 67.0 ± 12.6 years, 66% male). Seventy-two (72%) patients had evidence of atherosclerosis in the coronary tree (coronary SIS ≥ 1), of which 32% was extensive (coronary SIS > 5). Males had a significantly higher prevalence of coronary SIS ≥ 1 [53 (80%), vs. 19 (56%), p = 0.018], and coronary SIS > 5 [24 (36%) vs. 8 (24%), p = 0.035] than females. Extra-coronary SS was similar between genders (males 10.2 ± 5.8 vs. females 9.7 ± 5.4, p = 0.70), irrespective of the location along the different vascular beds. The number of coronary RF was significantly related to the coronary SIS (p = 0.038), and hypertension and diabetes were consistently related to coronary and extra-coronary plaque burden. In the present study involving analysis of multiple vascular beds from the supra-aortic trunks to the femoral arteries, we identified significant sex-related differences in coronary plaque burden, whereas extra-coronary plaque burden was similar between genders irrespective of the vascular bed assessed.

Background Regional fat density assessed by computed tomography (CT) has been suggested as a marker of perivascular adipose tissue inflammation. Dual energy CT (DECT) allows improved tissue characterization compared to conventional CT. Purpose To explore whether DECT might aid regional fat density discrimination. Material and Methods We included patients who had completed a non-enhanced cardiac CT scan, CT coronary angiography (CTCA), and a delayed enhancement CT. Attenuation levels (Hounsfield units [HU]) were assessed at the epicardial, paracardial, visceral, and subcutaneous fat. The number of coronary segments with disease (SIS) was calculated. Results A total of 36 patients were included in the analysis. Twenty-six (72%) patients had evidence of obstructive disease at CCTA and 25 (69%) patients had evidence of previous myocardial infarction. At non-contrast CT, we did not identify significant attenuation differences between epicardial, paracardial, subcutaneous, and visceral fat depots (−110.8 ± 9 HU, vs. −113.7 ± 9 HU, vs. −114.7 ± 8 HU, vs. −113.8 ± 11 HU, P = 0.36). Significant attenuation differences were detected between fat depots at mid and low energy levels, both at CTCA and delayed-enhancement scans ( P Conclusions In this study, regional fat depots amenable to examination during thoracic CT scans have distinctive regional attenuation values. Furthermore, such differences were better displayed using contrast-enhanced monochromatic imaging at low energy levels.

Background: To explore the relationship between coronary and extra-coronary atherosclerotic plaque burden with total and regional fat depots among patients undergoing ECG-gated aortic computed tomography angiography (CTA). Methods: The subjects of this study comprised a cohort of consecutive patients who underwent ECG-gated thoracoabdominal CTA. We assessed the number of coronary segments with plaques (segment-involvement score, SIS); and the extra-coronary atherosclerotic plaque burden, comprising the aorta and supra-aortic trunks, iliofemoral arteries, and visceral arteries (extra-coronary SS). Total and regional fat volume (FV) were calculated. Results: A total of 2700 vascular segments were evaluated in 90 patients. Obese patients (n = 31, 34%) showed similar coronary SIS (p = 0.41) and extra-coronary SS (p = 0.22) than non-obese patients. General body fat measurements were not related to atherosclerotic plaque burden scores, without associations between coronary or extra-coronary plaque burden and BMI (p = 0.68, and p = 0.91), abdominal circumference (p = 0.13, p = 0.89), total body FV (p = 0.50, p = 0.98), or abdominal FV (p = 0.51, p = 0.99). Pericardial FV was related to coronary SIS (p < 0.0001) and extra-coronary SS (p = 0.008), and visceral FV was related to the coronary SIS (p = 0.006) and extra-coronary SS (p = 0.056). Abdominal subcutaneous fat was inversely related to coronary SIS (p = 0.038) and extra-coronary SS (p = 0.010). Pericardial FV was identified as the only independent predictor of extensive coronary [OR 1.020 (95% CI 1.001–1.039), p = 0.036] and extra-coronary [OR 1.018 (95% CI 1.001–1.036), p = 0.035] plaque burden. Conclusions: In the present study, pericardial and visceral fat were associated with an increased atherosclerotic burden, whereas we identified an inverse relationship between subcutaneous abdominal fat and plaque burden. Fil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Diagnóstico Maipú; Argentina Fil: Reynoso, Exequiel. Diagnóstico Maipú; Argentina Fil: Capunay, Carlos. Diagnóstico Maipú; Argentina Fil: Carpio, Jimena. Diagnóstico Maipú; Argentina Fil: Carrascosa, Patricia. Diagnóstico Maipú; Argentina

OBJECTIVE The aim of this study was to explore the usefulness of combined virtual monochromatic imaging and metal artifact reduction software (MARS) for the evaluation of musculoskeletal periprosthetic tissue. METHODS Measurements were performed in periprosthetic and remote regions in 80 patients using a high-definition scanner. Polychromatic images with and without MARS and virtual monochromatic images were obtained. RESULTS Periprosthetic polychromatic imaging (PI) showed significant differences compared with remote areas among the 3 tissues explored (P < 0.0001). No significant differences were observed between periprosthetic and remote tissues using monochromatic imaging with MARS (P = 0.053 bone, P = 0.32 soft tissue, and P = 0.13 fat). However, such differences were significant using PI with MARS among bone (P = 0.005) and fat (P = 0.02) tissues. All periprosthetic areas were noninterpretable using PI, compared with 11 (9%) using monochromatic imaging. CONCLUSIONS The combined use of virtual monochromatic imaging and MARS reduced periprosthetic artifacts, achieving attenuation levels comparable to implant-free tissue.

The assessment of myocardial perfusion using single-energy (SE) imaging is influenced by beam-hardening artifacts (BHA). We sought to explore the ability of dual-energy (DE) imaging to attenuate the presence of BHA. Myocardial signal density (SD) was evaluated in 2240 myocardial segments (112 for each energy level) and in 320 American Heart Association segments among the SE group. Compared to DE reconstructions at the best energy level, SE acquisitions showed no significant differences overall regarding myocardial SD or signal-to-noise ratio. The segments most commonly affected by BHA showed significantly lower myocardial SD at the lowest energy levels, progressively normalizing at higher energy levels.

State-of-the-art magnetic resonance angiography with high-field magnetic resonance imaging (MRI) scanners can be used as a reliable alternative to multislice computed tomography angiography and invasive digital angiography for the assessment of the thoracic and abdominal aorta, both in the diagnosis and posttreatment evaluation. Advances in MRI have led to its current role as an alternative and robust diagnostic modality of choice for the assessment of the whole spectrum of aortic disorders.

OBJECTIVE. The objective of our study was to explore whether delayed enhancement dual-energy CT (DECT) allows the detection of myocardial infarcts in stable patients. SUBJECTS AND METHODS. Patients with known or suspected coronary artery disease clinically referred for myocardial perfusion imaging using SPECT were prospectively included. All patients (n = 34) also underwent stress, rest, and delayed enhancement DECT on a DECT scanner. At SPECT, segments with myocardial infarction (MI) were defned as those with a summed rest score of = 2 in two or more consecutive segments, and a diagnosis of MI was supported by wall motion abnormalities, clinical history, and ECG fndings. RESULTS. Segments with MI were identifed in 13 (38%), 15 (44%), and 14 (41%) patients using SPECT, perfusion CT, and delayed enhancement DECT, respectively. When combined SPECT and perfusion CT results were used as the reference standard, delayed enhancement DECT had a sensitivity, specifcity, positive predictive value, and negative predictive value for the detection of MI of 91.7% (95% CI, 62-98%), 86.4% (95% CI, 65-97%), 78.6% (95% CI, 49-95%), and 95.0% (95% CI, 75-100%). At delayed enhancement DECT (40 keV), a signal attenuation higher than 161 HU had a sensitivity of 72% and a specifcity of 79% for the detection of MI on a per-segment basis. The median signal attenuation of myocardial infarcts at 40 keV was 3.0 SDs (interquartile range, 1.3-4.0 SDs) above that of normal myocardium. CONCLUSION. In this study, delayed enhancement DECT allowed the detection of myocardial infarcts in stable patients. Fil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentina. Diagnóstico Maipú; Argentina Fil: Campisi, Roxana. Diagnóstico Maipú; Argentina Fil: Deviggiano, Alejandro. Diagnóstico Maipú; Argentina Fil: de Munain, Maria N. Lopez. Diagnóstico Maipú; Argentina Fil: De Zan, Macarena. Diagnóstico Maipú; Argentina Fil: Capunay, Carlos. Diagnóstico Maipú; Argentina Fil: Carrascosa, Patricia. Diagnóstico Maipú; Argentina

Aims: We sought to explore the relationship between pericardial fat volume (PFV) and both coronary atherosclerosis (CA) extent and severity using coronary artery calcium score (CAC), computed tomography coronary angiography (CTCA), and invasive coronary angiography in patients at high to intermediate likelihood of coronary artery disease (CAD). Methods and results: Patients clinically referred to invasive angiography who underwent CTCA and CAC within 1 month before the procedure comprised the study population. PFV, CAC, atherosclerotic burden indexes [segment involvement score (SIS); segment stenosis score; three-vessel plaque; and any left main plaque], and the invasive angiography-derived CAD index were evaluated independently. A total of 75 patients were included in the study. PFV did not differ between patients with or without obstructive (stenosis .70%) CAD defined by invasive angiography (86.4±31.7 vs. 77.1±42.8 cm3, P = 0.34), although patients with obstructive CAD had significantly higher CAC scores [636.0 (IQR 229.5-1101.0) vs. 206.0 (IQR 0.0-675), P

Objectives: The aim of this study was to explore the diagnostic performance of dual-energy computed tomography perfusion (DE-CTP) at different energy levels. Methods: Patients with known or suspected coronary artery disease underwent stress and rest DE-CTP and single-photon emission computed tomography. Images were evaluated using monochromatic data, and perfusion defects were initially identified in a qualitative manner and subsequently confirmed using attenuation levels. Results: Thirty-six patients were included. Sensitivity, specificity, positive predictive value, and negative predictive value of DE-CTP for the identification of perfusion defects were 84.1%, 94.2%, 77.3%, and 96.2%, respectively. Perfusion defects showed significantly lower attenuation than normal segments, with the largest differences among low energy levels (sensitivity of 96% and specificity of 98% using a cutoff value ≤ 153 Hounsfield units at 40 keV), progressively declining at the higher levels (P < 0.001). Conclusions: Dual-energy CTP at the lowest energy levels allowed improved discrimination of perfusion defects compared with higher energy levels. Fil: Carrascosa, Patricia. Diagnóstico Maipú, Buenos Aires; Argentina Fil: Deviggiano, Alejandro. Diagnóstico Maipú, Buenos Aires; Argentina Fil: de Zan, Macarena. Diagnóstico Maipú, Buenos Aires; Argentina Fil: Capunay, Carlos. Diagnóstico Maipú, Buenos Aires; Argentina Fil: Campisi, Roxana. Diagnóstico Maipú, Buenos Aires; Argentina Fil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentina

Coronary computed tomography angiography (CCTA) plays an important role in many specific scenarios such as in symptomatic patients with intermediate pretest of coronary artery disease (CAD), as well as in the triage of patients with acute chest pain with TIMI risk ≤2. However, it cannot detect the presence of associated ischemia, which is critical for clinical decision making among patients with moderate to severe stenosis. Although functional information can be obtained with different non-invasive tools, cardiac CT is the unique modality that can perform a comprehensive evaluation of coronary anatomy plus the functional significance of lesions. Myocardial CT perfusion (CTP) can be performed with different approaches such as static and dynamic CTP. In addition, static CTP can be performed using single energy CT (SECT) or dual energy CT (DECT). In this review, we will discuss the technical parameters and the available clinical evidence of static CTP using both SECT and DECT.

We explored whether dual-energy computed tomography (DECT) can allow a significant reduction in iodinated contrast volume during computed tomography angiography (CTA) without hampering image quality or assessibility. We prospectively randomized patients clinically referred to CTA to single energy computed tomography (SECT) with full iodine volume load (group A), DECT with 50 % iodine volume load (group B), DECT with 40 % iodine volume load (group C), and DECT with 30 % iodine volume load (group D); and compared image quality and assessibility. Eighty patients were enrolled and prospectively randomized. The mean age was 61.7 ± 15.0 years and 56 (71 %) patients were male. The demographical characteristics, body mass index, or mean radiation dose did not differ between groups. Significant reductions in total contrast volume were achieved in groups B, C, and D; with mean administrated contrast volumes of 90.3 ± 10.1, 39.5 ± 4.6, 28.3 ± 6.5, and 23.9 ± 6.0 mL, respectively, in groups A to D (p

Economic globalization has led to an international convergence of standards, to the extent that, in recent decades, the International Financial Reporting Standards (IFRS) have become the most used accounting model worldwide, as it has for countries on which this descriptive research is based. This document is the first stage of the research, which main objective is to show the evolution and current characteristics of the accounting model set by the IFRS in Latin America, Spain and Portugal. This is part of the convergence process of worldwide accounting.To this end, this study consists of four parts. In the first one, the process of international accounting harmonization is described in general terms. Meanwhile, in the following paragraphs, this study shows the characteristics and evolution of local accounting standards in Spain, Peru and Argentina, until adopting IFRS or, if it was the case, adopting their standards to these provisions. Finally, in the analysis of each country, there are final thoughts on the process of convergence of the accounting model set by IFRS.

ObjectiveThis study was conducted to determine the differences in the diameter of the thoracic aorta when measured from electrocardiographic (ECG)-gated and nongated computed tomography (CT) angiography. Another aim was to define the difference in the aortic diameter when it is measured at peak systole and end diastole in ECG-gated scans.MethodsThe gated and nongated CT angiograms of 27 patients (mean age, 58 ± 16 standard deviation [SD] years) obtained on a 256-slice multidetector CT scanner were used. The transverse and anteroposterior diameters and the lumen areas were measured at 1, 4, and 8 cm below the origin of the left subclavian artery.ResultsThere was a significant difference in the aortic measurements of diameter between gated and nongated scans found in samples taken at 1, 4, and 8 cm distal to the left subclavian artery (P < .0001). We found a considerable difference between the systolic and diastolic diameters (P < .0001). The maximum change in diameter between systole and diastole was 2.9 ± 0.9 (SD) mm (14.5%, P < .0001) at 1 cm, 5.4 mm (22.6%; median, 1.7 mm; P < .0001) at 4 cm, and 4.4 mm (16.9%; median, 1.3 mm; P < .0001) at 8 cm. There was a significant difference between the transverse and anteroposterior diameters in systole and diastole at all locations (P < .0001): The maximum change in diameter between transverse and anteroposterior diameters in systole was 5.4 ± 1.1 (SD) mm (15.7%, P < .0001) at 1 cm, 5.8 mm (19%; median, 1.4 mm; P < .0001) at 4 cm, and 5 mm (15%; median, 1.02 mm; P < .0001) at 8 cm. There was also a substantial difference between measuring the transverse diameter directly and deriving it from the lumen area (P < .0001).ConclusionsOur results showed an important difference between systolic and diastolic diameters measurements in ECG-gated scans. The standard protocol for measuring aortic diameters in gated scans of the thoracic aorta uses images at end diastole because the lack of wall motion at this time provides better resolution. This is likely to result in undersizing that, in some instances, may threaten stability and the proper seal of the stent graft. The dimensions of the aorta in a gated CT should be measured at peak systole rather than the conventional end diastole used today. Most medical centers use nongated CT or gated CT scans in end diastole to calculate sizes of endografts. In view of our findings, the latter method could result in potential complications.

Introduction and objectives We explored the differences between atherosclerotic burden with invasive coronary angiography and virtual monochromatic imaging derived from dual-energy computed tomography coronary angiography. Methods Eighty consecutive patients referred for invasive coronary angiography underwent dual-energy computed tomography coronary angiography and were categorized according to the atherosclerotic burden extent using the modified Duke prognostic coronary artery disease index, coronary artery disease extension score, segment involvement score, and the segment stenosis score. Results The mean segment involvement score (8.2 ± 3.9 vs 6.0 ± 3.7; P < .0001), modified Duke index (4.33 ± 1.6 vs 4.0 ± 1.7; P = .003), coronary artery disease extension score (4.84 ± 1.8 vs 4.43 ± 2.1; P = .005), and the median segment stenosis score (13.5 [9.0-18.0] vs 9.5 [5.0-15.0]; P < .0001) were significantly higher on dual-energy computed tomography compared with invasive angiography. Dual-energy computed tomography showed a significantly higher number of patients with any left main coronary artery lesion (46 [58%] vs 18 [23%]; P < .0001) and with severe proximal lesions (0.28 ± 0.03 vs 0.26 ± 0.03; P < .0001) than invasive angiography. Levels of coronary artery calcification below and above the median showed a sensitivity, specificity, positive predictive value, and negative predictive value of 100% and 97%; 86% and 50%; 93% and 95%; 100% and 67% for the identification of ≥ 50% stenosis. Conclusions Dual-energy computed tomography coronary angiography identified a significantly larger atherosclerotic burden compared with invasive coronary angiography, particularly involving the proximal segments. Introducción y objetivos Se analizaron las diferencias de carga ateroesclerótica observadas entre la coronariografía invasiva y las imágenes monocromáticas virtuales obtenidas con la tomografía computarizada de doble energía. Métodos Se examinó con tomografía computarizada de doble energía y se clasificó a 80 pacientes consecutivos remitidos a una coronariografía invasiva según el grado de carga ateroesclerótica utilizando el índice pronóstico de enfermedad coronaria de Duke modificado, la puntuación de extensión de la enfermedad coronaria, la puntuación de afección de segmentos y la puntuación de estenosis de segmentos. Resultados La media de la puntuación de afección de segmento (8,2 ± 3,9 frente a 6,0 ± 3,7; p < 0,0001), el índice de Duke modificado (4,33 ± 1,6 frente a 4,0 ± 1,7; p = 0,003), la puntuación de extensión de la enfermedad coronaria (4,84 ± 1,8 frente a 4,43 ± 2,1; p = 0,005) y la mediana de la puntuación de estenosis de segmento (13,5 [9,0-18,0] frente a 9,5 [5,0-15,0]; p < 0,0001) fueron significativamente superiores con la tomografía computarizada de doble energía que con la coronariografía invasiva. La tomografía computarizada de doble energía mostró un número de pacientes con alguna lesión del tronco coronario izquierdo significativamente mayor (46 [58%] frente a 18 [23%]; p < 0,0001) y con lesiones proximales graves (0,28 ± 0,03 frente a 0,26 ± 0,03; p < 0,0001) en comparación con lo observado en la coronariografía invasiva. Los grados de calcificación arterial coronaria por debajo y por encima de la mediana mostraron sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo del 100 y el 97%; el 86 y el 50%; el 93 y el 95% y el 100 y el 67% para la identificación de estenosis ≥ 50%. Conclusiones La angiografía coronaria con tomografía computarizada de energía dual identificó una carga ateroesclerótica significativamente mayor que la observada con la coronariografía invasiva, en especial por lo que respecta a la afección de los segmentos proximales. Fil: Rodriguez Granillo, Gaston Alfredo. Diagnostico Maipú; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentina Fil: Carrascosa, Patricia. Diagnostico Maipú; Argentina Fil: Deviggiano, Alejandro. Diagnostico Maipú; Argentina Fil: Capunay, Carlos. Diagnostico Maipú; Argentina Fil: De Zan, Macarena C.. Diagnostico Maipú; Argentina Fil: Goldsmit, Alejandro. Sanatorio Güemes; Argentina