Jing Liu

Myocardial Perfusion Magnetic Resonance Imaging Using Sliding-Window Conjugate-Gradient Highly Constrained Back-Projection Reconstruction for Detection of Coronary Artery Disease

Myocardial perfusion magnetic resonance imaging (MRI) with sliding-window conjugate-gradient highly constrained back-projection reconstruction (SW-CG-HYPR) allows whole left ventricular coverage, improved temporal and spatial resolution and signal/noise ratio, and reduced cardiac motion-related image artifacts. The accuracy of this technique for detecting coronary artery disease (CAD) has not been determined in a large number of patients. We prospectively evaluated the diagnostic performance of myocardial perfusion MRI with SW-CG-HYPR in patients with suspected CAD. A total of 50 consecutive patients who were scheduled for coronary angiography with suspected CAD underwent myocardial perfusion MRI with SW-CG-HYPR at 3.0 T. The perfusion defects were interpreted qualitatively by 2 blinded observers and were correlated with x-ray angiographic stenoses ≥50%. The prevalence of CAD was 56%. In the per-patient analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SW-CG-HYPR was 96% (95% confidence interval 82% to 100%), 82% (95% confidence interval 60% to 95%), 87% (95% confidence interval 70% to 96%), 95% (95% confidence interval 74% to100%), and 90% (95% confidence interval 82% to 98%), respectively. In the per-vessel analysis, the corresponding values were 98% (95% confidence interval 91% to 100%), 89% (95% confidence interval 80% to 94%), 86% (95% confidence interval 76% to 93%), 99% (95% confidence interval 93% to 100%), and 93% (95% confidence interval 89% to 97%), respectively. In conclusion, myocardial perfusion MRI using SW-CG-HYPR allows whole left ventricular coverage and high resolution and has high diagnostic accuracy in patients with suspected CAD.

Predictive value of ankle-brachial index to all-cause mortality and cardiovascular mortality in Chinese patients with chronic kidney disease

BACKGROUNDnTo investigate the predictive value of ankle-brachial index (ABI) for all-cause mortality and cardiovascular mortality in Chinese patients with chronic kidney disease (CKD).nnnPATIENTS AND METHODSn1563 CKD patients were enrolled in the cohort and were followed up for about 3 years in China. CKD was defined as an eGFR less than 60 ml/min/1.73m(2). 573 participants were diagnosed with PAD using ABI <= 0.90. Their average age was 73.4 ±8.2 years.nnnRESULTSnDuring a median follow-up of 38 months, there were 1353 CKD patients with complete data. A total of 313 patients (161 with and 152 without PAD) died during follow-up. 184 deaths (99 with and 85 without PAD) were caused by cardiovascular disease (CVD). All-cause and CVD mortality of CKD patients with PAD was increased 2.2-fold and 2.4-fold compared with CKD patients without PAD. The hazard ratio (HR) of PAD for all-cause and CVD mortality was 2.15 (95 % CI: 1.66 - 2.79) and 2.51 (95 % CI: 1.80 - 3.50) respectively. Mortality of CKD patients significantly increased with decreasing ABI. That of CKD patients with ABI <= 0.4 was the highest (42.9 % and 28.6 %, respectively) in different ABI categories. Relative risks of all-cause and CVD mortality of CKD patients with ABI <= 0.4 were increased 3.479-fold (95 % CI: 2.076 - 5.830) and 4.960-fold (95 % CI: 2.644 - 9.302) respectively compared with those of patients with ABI > 1.0 and <= 1.4. Special models to evaluate the predictive value of ABI to mortality of CKD patients suggested that addition of ABI significantly increased the predictive value of the model for 3-year mortality compared with a model including conventional risk factors alone.nnnCONCLUSIONSnLow ankle-brachial index can predict increased mortality of chronic kidney disease patients. Addition of ankle-brachial index can significantly improve the prediction of 3-year mortality compared with conventional risk factors alone.

One-stop-shop cardiac MRI at 3.0T for the detection of coronary artery disease

We present one-stop-shop cardiac MRI findings in a 58-year-old male patient with suspected coronary artery disease (CAD) who was scheduled for a primary diagnostic invasive coronary angiography. The patient was instructed to refrain from any beverage or foods containing caffeine, and antianginal medication within 24 hours before the MRI study. n nThe study was performed on a 3.0T whole-body clinical scanner (MAGNETOM Tim Trio, Siemens Healthcare, Erlangen, Germany) equipped with a 12-element cardiac coil. The one-stop-shop cardiac MRI procedure consisted of four major protocols performed in the following order: 1) cine imaging for assessment of left ventricular function; 2) adenosine gadolinium first-pass imaging for assessment of stress perfusion; 3) coronary MRA for assessment of coronary artery anatomy; and 4) delayed enhancement MRI for assessment of myocardial infarction. n nAfter localizer sequences, a FLASH sequence was used for cine imaging. The following sequence parameters were used: TR/TE/flip-angle = 5.00 ms/2.44 ms/13°. The short-axis views were distributed to cover the entire left ventricle and two long-axis views (four- and two-chamber views) were also acquired. Adenosine was then administered intravenously at 140 µg/kg/min with the heart rate and blood pressure monitored. After 3 min of the adenosine infusion, an intravenous bolus injection of 0.05 mmol/kg gadolinium contrast material (Magnevist, Schering, Berlin, Germany) was administered into an antecubital vein on the opposing arm with the use of a power injector (Spectris, Medrad, Indianola, Pennsylvania) at a rate of 4 ml/s, followed by a 20 ml saline flush at 4 ml/s. A SR-Turbo-FLASH sequence was used for perfusion imaging with the following parameters: TR/TE/flip-angle = 2.38/1.14/12°, FOV = 270×360 mm2, matrix = 94×192, spatial resolution = 2.9×1.9×10 mm3, GRAPPA factor = 2, TI = 100 ms, and the number of slices = 3. Whole-heart coronary MRA with additional slow infusion of contrast material (0.15 mmol/kg at 0.3 ml/sec) was acquired after perfusion imaging. A navigator-gated, electrocardiography-triggered, fat saturated, segmented 3D fast low-angle shot sequence [1,2], with the following image parameters was used: TR/TE/flip-angle = 3.0/1.4/20°, readout bandwidth = 610 Hz/pixel, voxel size = 1.3 × 1.3 × 1.3 mm3 interpolated to 0.65 × 0.65 × 0.65 mm3, GRAPPA factor = 2, inversion prepulse delay = 200 ms. Delayed enhancement images were acquired by phase sensitive inversion recovery sequences after coronary MRA for viability study. n nThe total examination time was 33 min. Acquisition time of whole-heart coronary MRA procedure was 9.1 min with a navigator acceptance rate of 34%. Data reformation and analysis were performed on a commercially available workstation (Leonardo, Siemens Healthcare, Erlangen, Germany). Figure 1 shows “one-stop-shop” cardiac MRI images at 3.0T from the 58-year-old male patient with suspected CAD. n n n nFigure 1 n n“One-stop-shop” cardiac MRI images at 3.0T from a 58-year-old male patient with suspected CAD. Perfusion image (A) demonstrates perfusion defects in the mid anteroseptal and inferoseptal segments. Coronary MRA images (B and C) show significant ... n n n nThis work shows the feasibility of a comprehensive protocol one-stop-shop for cardiac MRI at 3.0T. It is possible to complete the cine imaging, perfusion imaging, coronary MRA, and delayed enhancement imaging in a single study within 35 minutes. The major advantage of this approach is that it offers functional studies for the detection of ischemia, tissue characterization for the detection and quantification of myocardial infarction as well as luminal assessment of the coronary arteries in a single noninvasive and radiation free test. This may be extremely useful for better selecting patients to undergo an invasive procedure. n nThe authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [3].

Delayed-enhancement magnetic resonance imaging at 3.0 T using 0.15 mmol/kg of contrast agent for the assessment of chronic myocardial infarction

OBJECTIVEnA recent international, multicenter, double-blinded, randomized trial shows delayed-enhanced magnetic resonance imaging (DE-MRI) using contrast doses of ≥0.2mmol/kg is effective in the detection and assessment of myocardial infarction (MI), and 0.1mmol/kg is not enough; intermediate doses between 0.1 and 0.2mmol/kg have not been tested. The aim of this study was to prospectively test the performance of DE-MRI using 0.15mmol/kg of contrast agent for the detection of MI.nnnMATERIALS AND METHODSnA total of 31 consecutive patients with chronic MI underwent DE-MRI at 3.0T using both 0.15mmol/kg and 0.2mmol/kg of contrast agent in random order and on separate days. Infarction segment and infarction size were compared on DE-MRI images using a 17-segment model. Bland-Altman analysis was used to analyze correlation and agreement between global infarct sizes.nnnRESULTSnDE-MRI showed enhanced myocardium in all the 31 patients with chronic MI. There was no significant difference between the 0.15mmol/kg and 0.2mmol/kg images in all 31 patients based on the infarction segment (7.87±2.72 vs. 7.81±2.64, respectively; p=0.33). There was no significant difference between the infarction size obtained from 0.15mmol/kg acquisition and that from 0.2mmol/kg acquisition (16.3±7.8% vs. 16.4±7.9%, respectively; p=0.87). A strong correlation between the infarction size obtained from 0.15mmol/kg acquisition and that from 0.2mmol/kg acquisition was indicated through Bland-Altman analysis.nnnCONCLUSIONnDE-MRI at 3.0T using 0.15mmol/kg of contrast agent is effective for the assessment of MI.

Characterization of the cardiac venous system in heart failure patients using 256-slice CT

a Yuhuangding Hospital, Yantai, Shandong Province, China b Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China c Beijing Anzhen Hospital, Capital Medical University, Beijing, China d Xijing Hospital, Fourth Military Medical University, China e RuiJin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China

Association between estimated glomerular filtration rate, ankle-brachial index, and recurrent ischemic stroke in a Chinese population of ischemic stroke patients.

BACKGROUNDnVery few studies have examined combined association of estimated glomerular filtration rate (eGFR) and ankle-brachial index (ABI) on recurrent ischemic stroke in patients with ischemic stroke in Chinese populations.nnnPATIENTS AND METHODSnA Chinese population of 1219 ischemic stroke patients was followed up in this six-year prospective study.nnnRESULTSn1080 ischemic stroke patients with complete follow-up data were included in the statistical analysis. A total of 245 ischemic stroke patients (22.7 %) had recurrent ischemic stroke during follow-up. The Incidence of recurrent ischemic stroke was significantly increased with decreasing eGFR levels and that of patients with eGFR < 30 ml/min/1.73m2 was the highest. Hazard ratio (HR) of eGFR < 30 ml/min/1.73m2 to recurrent ischemic stroke was 2.633 (95 % CI: 1.653 - 4.194) compared with that of eGFR ≥ 60 ml/min/1.73m2 after adjusting for other potential confounders using Cox regression analysis. Incidence of recurrent ischemic stroke was significantly increased with simultaneously decreasing eGFR and ABI. The highest percentage (71.4 %) of patients with eGFR < 30 ml/min/1.73m2 and ABI ≤ 0.4 simultaneously had recurrent ischemic stroke during follow-up. HR of eGFR < 30 ml/min/1.73m2 and ABI ≤ 0.4 simultaneously with recurrent ischemic stroke was 9.415 (95 % CI: 3.479 - 25.483) compared with that of eGFR ≥ 60 ml/min/1.73m2 and ABI > 1.0 to ≤ 1.4 respectivelynnnCONCLUSIONSnLow ABI and low eGFR together had synergistic effects on increasing recurrent ischemic stroke of ischemic stroke patients during a long-term follow-up.

CT-guided single high-dose percutaneous acetic acid injection for small hepatocellular carcinoma: A long-term follow-up study

OBJECTIVEnTo evaluate the long-term outcome of CT-guided single high-dose percutaneous acetic acid injection (PAI) for the treatment of small hepatocellular carcinoma (SHCC).nnnMATERIALS AND METHODSnSixty-eight consecutive patients (37 men and 31 women; age 52 ± 16 years) with SHCC have undergone CT-guided single high-dose PAI therapy since December 2000. Complications of high-dose PAI were recorded. Tumour survival and recurrence rates were assessed.nnnRESULTSnAll PAI therapies were successful and no severe complications developed. The average follow-up period was 46 ± 18 months. The overall survival rates at 1, 2, 3, 4 and 5 years were 93%, 82%, 68%, 59% and 51%, respectively. The cumulative local recurrence rates for the main tumour at 1, 2, 3, 4 and 5 years were 18%, 22%, 25%, 28% and 28%, respectively. The cumulative new tumour recurrence rates at 1, 2, 3, 4 and 5 years were 24%, 40%, 43%, 60% and 62%, respectively.nnnCONCLUSIONnCT-guided single high-dose PAI is safe and effective for the treatment of SHCC after long-term follow-up.

Regional myocardial motion in patients with mild cognitive impairment: a pilot study

BackgroundCardiovascular disease (CVD) is a risk factor for cognitive impairment in the elderly. Manifestations of subclinical CVDs can be found in patients with cognitive impairment. The aim of the present study was to test the hypothesis that patients with mild cognitive impairment (MCI) have different magnetic resonance imaging (MRI)-derived regional myocardial motion indices compared with healthy controls.MethodsEleven MCI patients (age, 65.5xa0years ±5.9; range, 55–81xa0years old) and 11 sex−/age-matched healthy volunteers were enrolled. All of the participants underwent a head MRI and cardiac MRI. Global cortical atrophy (GCA) was graded on the head MRI. The left ventricular ejection fraction (LVEF) and regional strain, strain rate, displacement and velocity were measured on cine images. The GCA scores, global cardiac function and regional myocardial motion indices were compared between MCI patients and healthy controls using the t-test.ResultsMCI patients had a higher GCA score than healthy controls (pu2009=u20090.048). However, there was no significant difference in LVEF between MCI patients and controls. Compared to healthy controls, MCI patients had a lower peak radial strain (29.1%u2009±u200924.1% vs. 46.4%u2009±u200943.4%, pu2009<u20090.001), lower peak diastolic radial strain rate (3.2u2009±u20092.4xa0s−u20091 vs. 6.0u2009±u20093.0xa0s−u20091, pu2009<u20090.001), lower peak diastolic circumferential strain rate (2.5u2009±u20092.1xa0s−u20091 vs. 3.2u2009±u20092.1xa0s−u20091, pu2009=u20090.002), lower peak systolic radial displacement (4.2u2009±u20092.2xa0mm vs. 5.2u2009±u20093.3xa0mm, pu2009=u20090.002), lower peak diastolic radial velocity (31u2009±u200918xa0mm/s vs. 45u2009±u200933xa0mm/s, pu2009<u20090.001), and lower peak diastolic circumferential velocity (178u2009±u2009124 degree/s vs. 217u2009±u2009131 degree/s, pu2009=u20090.005).ConclusionMRI-derived regional myocardial strain, strain rate and velocity were found to be different between MCI patients and healthy controls. Regional myocardial motion indices have the potential to become novel quantitative imaging biomarkers for representing the risk of neurodegenerative disorders, such as Alzheimer’s disease (AD).

Letter regarding Choudhary et al. "Improving the diagnosis of LV non-compaction with cardiac magnetic resonance imaging"

The excellent paper by Dr. Choudhary et al. highlights the issues surrounding developing a cardiovascular magnetic resonance based semiautomated technique for quantification of non-compacted (NC) and compacted (C) masses and ascertaining their relationships to global and regional left ventricular function [1]. In their study, late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) was performed 10 min after injection of 0.2 mmol/kg of contrast agent at 1.5 T. Their results demonstrate that theNC:C ratio derived from relative signal intensities of myocardium and blood pool improves the ability to detect clinically relevant NC. A previous international, multicenter, double-blinded, randomized trial shows that LGE-CMR at 1.5 T using contrast doses of ≥0.2 mmol/kg is effective [2]. A recent study shows that LGE-CMR at 3.0 T using 0.15 mmol/kg of contrast agent has high agreement compared with LGE-CMR at 3.0 T using 0.2 mmol/kg, and confirms that LGE-CMR at 3.0 T using 0.15 mmol/kg of contrast agent is effective [3]. Lower doses of contrast agent mean a lower cost and decreased side effects in those with severe heart and renal function impairment [4]. In this paper, LGE-

Letter regarding Li et al. “Prognostic impact of late gadolinium enhancement by cardiac magnetic resonance imaging in patients with non-ischaemic dilated cardiomyopathy”

cardiomyopathy and provocable Brugada-like ECG. The description of plakophilin-2 mutation was done in 2007 and it looked like quiet a normal finding in a case of arrhythmogenic cardiomyopathy. Now in the light of the brand-new study it seems that missense mutation in plakophilin-2 causes arrhythmogenic cardiomyopathy and Brugadalike ECG. For all we know this is the first description of arrhythmogenic cardiomyopathy and Brugada syndrome caused by missense mutation in plakophilin-2. In all cases described no one had both — arrhythmogenic cardiomyopathy and Brugada syndrome in one case. References