Alexander Schwarz

Head-to-head comparison of prospectively triggered vs retrospectively gated coronary computed tomography angiography: meta-analysis of diagnostic accuracy, image quality, and radiation dose

BACKGROUNDnIn coronary computed tomography (CT) angiography (CTA) prospective electrocardiography triggering requires less radiation dose than retrospective electrocardiography gating but provides less cardiac phases for interpretation. This meta-analysis presents a concise and comprehensive head-to-head comparison of image quality, diagnostic accuracy, and radiation dose of prospectively triggered coronary CTA vs retrospectively gated CTA in patients with suspected or known coronary artery disease (CAD).nnnMETHODSnIn patients with CAD and without tachyarrhythmia, eligible studies (selected from 4 databases) compared prospectively triggered vs retrospectively gated CTA (performed with ≥64-slice CT or dual-source CT) in 2 groups having approximately similar patient characteristics, scored CTA image quality, and/or assessed how accurately CTA diagnoses ≥50% coronary stenoses compared with catheter angiography and reported the radiation dose. The data were meta-analyzed by random-effects models, with CIs provided in the text.nnnRESULTSnAmong 3,330 patients from 20 included studies, 91.3% of CTAs (segments: 97.8%) had diagnostic quality with prospective triggering and 93.3% of CTAs (segments: 98.4%) with retrospective gating (P > .05). Among 664 patients from 5 studies, the pooled sensitivity/specificity of diagnostic CTAs was 98.7%/91.3% (segment level: 91.3%/97.7%) with prospective triggering and 96.9%/95.8% (segment level: 93.1%/97.6%) with retrospective gating (P > .05). The pooled effective dose was 3.5 mSv with prospective triggering and thus, by a factor of 3.5, lower than the pooled effective dose of retrospective gating, which was 12.3 mSv (P < .01).nnnCONCLUSIONSnIn patients with CAD and without tachyarrhythmia, prospectively triggered coronary CTA provides image quality and diagnostic accuracy comparable with retrospectively gated CTA, but at a much lower radiation dose.

Prevalence and clinical relevance of extracardiac findings at cardiac MRI

To assess the incidence of extracardiac findings in patients undergoing clinical cardiac magnetic resonance imaging (CMRI) of the heart, and to determine the influence of those findings on patient management.

Current perspective of multidetector computed tomography (MDCT) in patients after midface and craniofacial trauma

PURPOSEnThe purpose of the study was to determine the prevalence of fractures and incidental findings (IF) with emphasis on clinical significance.nnnMATERIALS AND METHODSnA total of 784 patients were evaluated by computed tomography. Fractures and IF were registered and classified as significant if they were recommended for additional diagnostics or therapy.nnnRESULTSnFour hundred seventy of 784 patients (60%) sustained a fracture. Significant fractures were found in 694/1213 fractures (57%); nonsignificant fractures were found in 519/1213 (43%) fractures. A total of 972 IF were observed in 464/784 (59%) patients. Significant findings were found in 358/972 findings (37%). There were 1.5 fractures and 1.2 IF per patient.nnnCONCLUSIONnThere is a high prevalence of significant fractures (57%) and IF (37%).

Vascular and extravascular findings on magnetic resonance angiography of the thoracic aorta and the origin of the great vessels

To investigate the presence of relevant vascular and incidental extravascular findings in patients undergoing magnetic resonance angiography (MRA) of the thoracic aorta and origin of the great vessels.

Current role of cardiac and extra-cardiac pathologies in clinically indicated cardiac computed tomography with emphasis on status before pulmonary vein isolation.

PURPOSEnThe aim of this study was to assess the incidence of cardiac and significant extra-cardiac findings in clinical computed tomography of the heart in patients with atrial fibrillation before pulmonary vein isolation (PVI).nnnMATERIALS AND METHODSn224 patients (64u200a±u200a10 years; male 63u200a%) with atrial fibrillation were examined by cardiac 64-slice multidetector CT before PVI. Extra-cardiac findings were classified as significant if they were recommended to additional diagnostics or therapy, and otherwise as non-significant. Additionally, cardiac findings were documented in detail.nnnRESULTSnA total of 724 cardiac findings were identified in 203 patients (91u200a% of patients). Additionally, a total of 619 extra-cardiac findings were identified in 179 patients (80u200a% of patients). Among these extra-cardiac findings 196 (32u200a%) were significant, and 423 (68u200a%) were non-significant. In 2 patients (1u200a%) a previously unknown malignancy was detected (esophageal cancer and lung cancer, local stage, no metastasis). 203 additional imaging diagnostics followed to clarify the significant findings (124 additional CT, costs 38u200a314.69 US dollars). Overall, there were 3.2 cardiac and 2.8 extra-cardiac findings per patient. Extra-cardiac findings appear significantly more frequently in patients over 60 years old, in smokers and in patients with a history of cardiac findings (pu200a<0.05).nnnCONCLUSIONnCardiac CT scans before PVI should be screened for extracardiac incidental findings that could have important clinical implications for each patient.

Hereditary papillary renal cell carcinoma primarily diagnosed in a cervical lymph node: a case report of a 30-year-old woman with multiple metastases

BackgroundPapillary renal cell carcinoma is a rare cancer. Some cases can be attributed to individuals with hereditary renal cell carcinomas usually consisting of the clear cell subtype. In addition, two syndromes with hereditary papillary renal cell carcinoma have been described. One is the hereditary leiomyomatosis and renal cell carcinoma, which is characterized by cutaneous and uterine leiomyomas and renal cell carcinoma mostly consisting of the papillary renal cell carcinoma type II with a worse prognosis.Case presentationWe describe a case of a 30-year-old woman with hereditary leiomyomatosis and renal cell carcinoma syndrome with extensively metastasized papillary renal cell carcinoma, primarily diagnosed in a cervical lymph node lacking leiomyomas at any site.ConclusionPapillary renal cell carcinoma in young patients should be further investigated for a hereditary variant like the hereditary leiomyomatosis and renal cell carcinoma even if leiomyomas could not be detected. A detailed histological examination and search for mutations is essential for the survival of patients and relatives.

Incidental findings in cardiac magnetic resonance imaging: superiority of bSSFP over T1w-HASTE for extra-cardiac findings assessment

Incidental findings are frequent in radiological examinations and may have an impact on further patient management. The aim of this retrospective study was to analyze, which of two thoracic scout sequences is more suitable for detecting incidental extra-cardiac findings at cardiac magnetic resonance imaging (CMRI) with stress perfusion. During a 14-month period clinically indicated stress perfusion CMRI was performed in 97 consecutive patients. For anatomical orientation ECG-triggeredxa0(electrocardiography) T1w-Half-fourier acquisition single-shot turbo spin-echo (HASTE) and balanced steady state free precession (bSSFP) sequences were performed for planning the standard cardiac sequences. Two radiologists independently studied incidental extra-cardiac findings with both sequences and rated the diagnostic confidence of the sequences for this assessment using a multinomial model. Furthermore, the interobserver agreement between the observers was assessed by weighted kappa statistics. Eight patients without incidental findings were excluded. In the other 89 patients a total of 153 incidental extra-cardiac findings were observed. Overall, 47.1% of findings were seen with better diagnostic confidence at bSSFP as opposed to 20.6% at T1w-HASTE. 32.4% of findings were equally well seen with both sequences. Consequently the bSSFP sequence was significantly better in terms of diagnostic confidence for detecting the majority of extra-cardiac incidental findings (Pu2009<u20090.01), whereas a minority of findings was better visible by the HASTE sequence. The weighted kappa statistics was 0.85, indicating good interobserver agreement. Compared with T1w-HASTE, the bSSFP sequence improved the visibility of incidental extra-cardiac findings at stress perfusion CMRI. While all findings were seen on both sequences, bSSFP resulted in improved diagnostic confidence, and the T1w-HASTE sequence provided complementary diagnostic information in only a minority of patients.

Split-Bolus Single-Phase Cardiac Multidetector Computed Tomography for Reliable Detection of Left Atrial Thrombus: Comparison to Transesophageal Echocardiography

PURPOSEnEvaluation of a new cardiac MDCT protocol using a split-bolus contrast injection protocol and single MDCT scan for reliable diagnosis of LA/LAA thrombi in comparison to TEE, optimizing radiation exposure and use of contrast agent.nnnMATERIALS AND METHODSnA total of 182 consecutive patients with drug refractory AF scheduled for PVI (62.6u200a% male, mean age: 64.1u200a±u200a10.2 years) underwent routine diagnostic work including TEE and cardiac MDCT for the evaluation of LA/LAA anatomy and thrombus formation between November 2010 and March 2012. Contrast media injection was split into a pre-bolus of 30u200aml and main bolus of 70u200aml iodinated contrast agent separated by a short time delay.nnnRESULTSnIn this study, split-bolus cardiac MDCT identified 14 of 182 patients with filling defects of the LA/LAA. In all of these 14 patients, abnormalities were found in TEE. All 5 of the 14 patients with thrombus formation in cardiac MDCT were confirmed by TEE.nnnCONCLUSIONnMDCT was 100u200a% accurate for thrombus, with strong but not perfect overall results for SEC equivalent on MDCT.nnnKEY POINTSn•u2007Patients with no filling defect or thrombus in MDCT in the LA/LAA region are unlikely to have thrombus and may undergo PVI without TEE.•u2007Here, the role of an additional TEE in pre-procedural management prior to PVI in patients with AF has to be redefined.•u2007Using a split-bolus injection protocol increases the diagnostic accuracy of thrombus in the LA/LAA region.

Current role and future potential of magnetic resonance cholangiopancreatography with an emphasis on incidental findings

PURPOSEnAim of this study was to investigate the incidence of relevant biliary and extrabiliary findings in patients undergoing magnetic resonance cholangiopancreatography (MRCP).nnnMATERIALS AND METHODSnThree hundred eighty-four patients underwent 1.5-Tesla MRCP, and relevant biliary and extra-biliary findings were identified.nnnRESULTSnFour hundred twenty-two biliary findings were identified in 384 patients (75%; 1.1 per patient). Ninety-five patients were free of any relevant biliary finding (25%). Incidental extrabiliary findings were observed in 763 patients (1.98/patient).nnnCONCLUSIONnMost of the findings can be diagnosed by MRCP, while others require further examination. Interdisciplinary involvement is recommended to optimize clinical categorization, management, and treatment of these incidental findings.

Ovarian dermoid cyst with teeth

A 38-year-old woman presented with long-lasting dull pain that she localised in her left hip. X-ray and MRI of the hip showed a small calcification of the labrum (a ring of cartilage surrounding the acetabulum) and excluded the suspected femoroacetabular impingement (where there is abnormal contact between the acetabulum and the femoral head-neck junction).1 However, X-ray incidentally detected two teeth in the left pelvis (figure 1A, anteroposterior view; B, oblique). In the presented MRI (figure 2) the …