Luba Frank

Cardiovascular MR imaging of conotruncal anomalies.

Conotruncal anomalies are congenital heart defects that result from abnormal formation and septation of the outflow tracts of the heart and great vessels. The major conotruncal anomalies include tetralogy of Fallot, transposition of the great arteries, double-outlet right ventricle, truncus arteriosus, and interrupted aortic arch. Cardiovascular magnetic resonance (MR) imaging is an important modality for the evaluation of patients with these defects. Major advances in cardiovascular MR imaging equipment and techniques allow precise delineation of the cardiovascular anatomy and accurate quantitative assessment of ventricular function and blood flow. The data provided by cardiovascular MR imaging are useful for treatment planning and posttreatment monitoring, supplement information obtained with echocardiography, and in many cases obviate cardiac catheterization.

Chest CT incidentalomas: thyroid lesions, enlarged mediastinal lymph nodes, and lung nodules.

Abstract A computed tomography (CT) incidentaloma is an incidentally detected and previously unsuspected finding or abnormality that is not related to the indication for obtaining the CT examination. The aim of this article is to review the frequency of incidentalomas on chest CT scans, discuss the potential clinical significance of the findings, and suggest guidelines for reporting, further evaluation, and follow-up, with particular focus on thyroid lesions, enlarged mediastinal lymph nodes and lung nodules.

Radiation Risk of Lung Cancer Screening

Lung cancer screening with low dose computed tomography (CT) is the only method ever proven to reduce lung cancer-specific mortality in high-risk current and former cigarette smokers. Radiation exposure from annual screening CT examinations and subsequent CT and nuclear medicine testing to further evaluate positive screening CTs is sometimes raised as a reason to avoid screening and is often misunderstood. With all testing, there are potential benefits and risks. As we sit on the brink of widespread adoption of lung cancer screening CT, we aim to explain why the risks associated with radiation exposure from lung cancer screening are very low and should not be used to avoid screening or dissuade individuals who qualify for screening CT to participate in a lung cancer screening program.

Value of Cardiac Magnetic Resonance Imaging in Patients with Failed Ablation Procedures for Ventricular Tachycardia

Ventricular tachycardia (VT) in patients with cardiomyopathy originates in scar tissue. Intramural or epicardial scar may result in ineffective ablation if mapping and ablation are limited to the endocardium. The purpose of this study was to investigate whether preprocedural magnetic resonance imaging (MRI) is beneficial in patients with failed endocardial VT ablations in determining an appropriate ablation strategy.

Left Atrial Function and Maximum Volume as Determined by MDCT Are Independently Associated with Atrial Fibrillation

RATIONALE AND OBJECTIVES To assess whether left atrial (LA) volume, function, and diameter as determined by multidetector computed tomography (MDCT) are associated with the presence and chronicity of atrial fibrillation (AF). MATERIALS AND METHODS A total of 232 subjects, 156 with AF (43 with chronic and 113 with paroxysmal) and 76 normal subjects, formed the study population. AF subjects underwent MDCT of the pulmonary veins and LA, and normal subjects underwent coronary computed tomography (CT), on which LA volume, function, and diameter were measured. Associations between each MDCT LA parameter and presence and chronicity of AF were assessed using logistic regression analysis. RESULTS The indexed LA maximum volume (odds ratio [OR]=2.42; 95% confidence interval [CI], 1.43-4.08; P=.0009) was significantly associated with chronicity and presence of AF (OR=1.06; 95% CI, 1.03-1.10; P=.0003) after adjustment for traditional risk factors. The LA function was associated with presence of AF (OR=0.93; 95% CI, 0.89-0.97; P=.0005), but not with AF chronicity (OR=1.12; 95% CI, 0.93-1.33; P=.21). CONCLUSIONS Decreased LA function is associated with presence of AF, and increased LA maximum volume is associated with presence and chronicity of AF, independent of traditional risk factors.

Mixing It Up: Coadministration of tPA/DNase in Complicated Parapneumonic Pleural Effusions and Empyema.

Background: A recent randomized controlled trial showed 12 serial doses of tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) is safe and effective in managing complicated parapneumonic pleural effusions and empyema (CPEE). However, this regimen is laborious, requiring trained personnel to open/close the chest tube 8 times daily for 3 days. We present our observational data using a simplified regimen of coadministered tPA/DNase. Materials and Methods: This is a retrospective observational study of patients who received coadministered tPA/DNase for CPEE from January 2012 to April 2015 at the University of Texas Medical Branch. Patient demographics, pleural fluid, radiologic and treatment characteristics, and outcomes were collected. Data are presented as proportions and percentages. Our primary outcome was successful treatment without need of surgery and discharge home alive. Secondary outcomes were dose and length of treatment and hospital stay, treatment complications, and 90-day mortality. Results: The study included 39 patients. All pleural effusions were loculated, 59% macroscopically purulent, 50% had a positive organism in Gram stain, and 40% were culture positive. A median of 6 (interquartile range, 3.5 to 6) doses were coadministered mainly via small bore chest tube (⩽14 Fr in 79%) with a median of 14.5 (interquartile range, 9.5 to 21.5) hospital days. Overall, 85% were successfully treated without need for surgery. Treatment failures occurred in 15%: 3/39 (7%) received surgery; 3/39 (7%) died. Only 1 (2.5%) complication of hemorrhagic pleural effusion resolved after discontinuation of intrapleural treatment. Conclusions: Our study shows intrapleural coadministration of tPA/DNase was effective and safe in management of CPEE.

Pictorial review of cardiac sarcomas and their mimickers

This review aims to present imaging characteristics of cardiac sarcomas, their most important mimickers and benign differential diagnoses in order to avoid potential pitfalls, guide to achieve proper diagnosis, leading to timely and appropriate treatment.

Modern technology: lowering the radiation dose for lung cancer screening

Summary This review will present newer currently available techniques for radiation risk reduction and our model of radiation risk estimation in comparison with available older models, based on calculations of radiation doses on population of atomic bomb survivors.

TU‐EE‐A4‐01: Bismuth Shields Vs. MAs Reduction for Decreased Radiation Dose to Breasts in CT Examinations

Purpose:Bismuth breast shields have been promoted as a means for selectively reducing the radiation dose to the breast by about 30% in CT studies, while maintaining image quality. A study was performed to compare imagenoise and CT number accuracy with the shields to an alternative dose reduction method of employing 30% less mAs. Method and Materials: A humanoid thorax phantom with simulated breasts was imaged on a GE VCT scanner using: 1) a standard lungcancer screening protocol, 2) the same protocol but with a commercial bismuth breast shield, and 3) 30% less mAs without the shield. Regions‐of‐interest (ROIs) were placed in the images and the mean CT numbers and standard deviations of the CT numbers were compared. Results: Relative to the mean CT numbers in images for the standard technique, use of the breast shield resulted in increases of about 9HU, 19HU, 6HU, and 57HU in ROIs in the heart, anterior left lung, posterior left lung, and right breast, respectively. Corresponding changes for 30% mAs reduction were 1HU, −3HU, −2HU, and 0HU. Ratios of the standard deviations of the CT numbers in the dose reduced images to those in the images using the standard technique for the above ROIs were 1.4, 1.2, 0.9, and 1.8 for the breast shield and 1.3, 1.0, 1.0, and 1.2 for 30% mAs reduction. Conclusion: mAs‐reduction is preferred over bismuth breast shields because: 1) mAs‐reduction has much less effect on mean CT numbers, which is important for quantitative studies such as lung density and coronary calcification assessment, 2) noise in the mA‐reduced images is less, and 3) the images do not suffer from streak artifacts arising from the shields. Additional comparisons in images of human subjects undergoing IRB‐approved coronary calcification studies with the breast shield vs. 30% reduced mAs will be presented.