M. Lederlin

Bronchial measurements in patients with asthma: comparison of quantitative thin-section CT findings with those in healthy subjects and correlation with pathologic findings.

PURPOSE To analyze and compare computed tomographic (CT) bronchial measurements in patients with asthma and healthy subjects and to correlate bronchial morphometric parameters with functional data and immunohistologic markers of airway remodeling and inflammation. MATERIALS AND METHODS This retrospective study was approved by the institutional review board; patient informed consent was not required. CT and pulmonary function tests were performed in 27 patients separated into two groups: 15 patients with asthma (three men; mean age, 43.1 years +/- 5.3 [standard error of mean]) and 12 healthy subjects (10 men; mean age, 45.0 years +/- 5.4). Endobronchial biopsies were performed in 11 subjects. Bronchial cross-sectional wall area (WA) and lumen area (LA) were measured by using validated software, and wall thickness (WT), total area (TA), WA/LA ratio, and WA/TA ratio were computed. Slope and maximal local slope of each parameter along bronchial generations were calculated. RESULTS Patients with asthma demonstrated significantly lower LA, TA, and WA and higher WA/LA and WA/TA ratios than healthy subjects downward from the fourth bronchial generation. Correlations existed between slope and maximal local slope of WA/LA and/or WA/TA ratios and functional data reflecting bronchial obstruction (r = 0.46-0.58, P = .001-.025), subepithelial membrane thickness (r = 0.67-0.69, P = .019-.023), smooth muscle layer area (r = 0.75, P = .007), subepithelial layer area (r = 0.81, P = .002), and infiltration of the bronchial wall by inflammatory cells (r = 0.67-0.86, P = .049-.003). CONCLUSION Axial reconstructions with orthogonal measurements along the airways enabled by three-dimensional segmentation methods are able to demonstrate significant changes in bronchial morphometry, predicting airflow limitation in asthma, and may have a role in the noninvasive measurement of airway remodeling.

Dual-energy CT perfusion and angiography in chronic thromboembolic pulmonary hypertension: diagnostic accuracy and concordance with radionuclide scintigraphy

ObjectivesTo evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) perfusion and angiography versus ventilation/perfusion (V/Q) scintigraphy in chronic thromboembolic pulmonary hypertension (CTEPH), and to assess the per-segment concordance rate of DECT and scintigraphy.MethodsForty consecutive patients with proven pulmonary hypertension underwent V/Q scintigraphy and DECT perfusion and angiography. Each imaging technique was assessed for the location of segmental defects. Diagnosis of CTEPH was established when at least one segmental perfusion defect was detected by scintigraphy. Diagnostic accuracy of DECT perfusion and angiography was assessed and compared with scintigraphy. In CTEPH patients, the per-segment concordance between scintigraphy and DECT perfusion/angiography was calculated.ResultsFourteen patients were diagnosed with CTEPH and 26 with other aetiologies. DECT perfusion and angiography correctly identified all CTEPH patients with sensitivity/specificity values of 1/0.92 and 1/0.93, respectively. At a segmental level, DECT perfusion showed moderate agreement (κ = 0.44) with scintigraphy. Agreement between CT angiography and scintigraphy ranged from fair (κ = 0.31) to slight (κ = 0.09) depending on whether completely or partially occlusive patterns were considered, respectively.ConclusionsBoth DECT perfusion and angiography show satisfactory performance for the diagnosis of CTEPH. DECT perfusion is more accurate than angiography at identifying the segmental location of abnormalities.Key Points• Chronic thromboembolic pulmonary hypertension (CTEPH) is potentially treatable by surgery.• Dual-energy computed tomography (DECT) allows angiography and perfusion using a single acquisition.• Both DECT perfusion and angiography showed satisfactory diagnostic performance in CTEPH.• DECT perfusion was more accurate than angiography in identifying segmental abnormalities.

Correlation of radio- and histomorphological pattern of pulmonary adenocarcinoma.

Recently, a novel classification system based on tumour architecture and with high prognostic impact has been proposed for pulmonary adenocarcinomas (ADCs). For imaging-based prediction of histological ADC subtypes and, thus, prognosis, it is of paramount importance to investigate the correlations of radio- and histomorphological parameters. Associations between histomorphological ADC growth patterns (lepidic, acinar, papillary, micropapillary and solid) and data from pre-operative assessment by computed tomography (CT) imaging of 174 resected pulmonary ADCs were analysed. Margin configuration as well as solidity/ground glass opacity of an ADC was associated with distinct histomorphological ADC growth patterns. Solid-predominant ADCs usually had smooth margins and were also solid in CT scans, while lepidic-predominant ADCs had no predominant margin pattern, were located in the periphery, showed a positive bronchogram and were frequently associated with solidity/ground glass opacity. In addition, nonspherical tumour growth was a negative predictor of overall and disease-specific patient survival. We defined CT morphological parameters that were associated with histomorphological growth patterns of pulmonary ADCs. These data may form the basis for the development of future prognostic algorithms in the palliative setting, which include an integrated evaluation of biopsy histomorphology and CT scan morphology of nonresectable pulmonary ADC.

Differentiating pre- and minimally invasive from invasive adenocarcinoma using CT-features in persistent pulmonary part-solid nodules in Caucasian patients

OBJECTIVE To retrospectively investigate the diagnostic value of pre-operative CT-features between pre/minimally invasive and invasive lesions in part-solid persistent pulmonary ground glass nodules in a Caucasian population. MATERIALS AND METHODS Retrospective review of two pre-operative CTs for 31 nodules in 30 patients. There were 10 adenocarcinomas in situ, 1 minimally invasive adenocarcinoma, 20 invasive adenocarcinomas. We analyzed the correlation between histopathology and the following CT-features: maximal axial diameter, maximal orthogonal axial diameter, height, density, size of solid component, air bronchogram, pleural retraction, nodule mass, disappearance rate and their evolution during follow-up. RESULTS In univariate analysis, invasive adenocarcinomas had a higher maximal height, density, solid component size, mass, a lower disappearance rate and presented more often with pleural retraction (p<0.05). After logistic regression performed with the uncorrelated parameters using a method of selection of variables, only the size of solid component remained significant, with 100% sensitivity for invasive adenocarcinoma when larger than 5mm. CONCLUSION Preoperative CT-features can help differentiating in situ and minimally invasive adenocarcinomas from invasive adenocarcinomas in Caucasian patients. A solid component larger than 5mm in diameter had 100% sensitivity for the diagnosis of invasive adenocarcinoma.

Ebstein Anomaly Associated With Left Ventricular Noncompaction

A 56-year-old woman with gradually progressing exertional dyspnea was referred to our hospital. She had a known diagnosis of Ebstein anomaly and patent foramen ovale since childhood. One year previously, she had presented with a transient ischemic attack that was thought to be secondary to a paradoxal embolism through the patent foramen ovale, so an Amplatzer occluder had been implanted. Clinical examination revealed a normal sinus rhythm at 56 bpm and a New York Heart Association class II dyspnea without cyanosis. ECG (Figure 1) showed a first- degree atrioventricular block with a pattern of complete right bundle-branch block. Chest radiography (Figure 2) demonstrated mild cardiomegaly and clear lung fields. Two-dimensional echocardiography showed malposition of the anterior and septal tricuspid valve leaflets with grade 2 tricuspid regurgitation. The atrial septal occluder was in correct position without residual shunt. In …

Bronchial morphometry in smokers: comparison with healthy subjects by using 3D CT.

The assessment of airway dimensions in patients with airway disease by using computed tomography (CT) has been limited by the obliquity of bronchi, the ability to identify the bronchial generation, and the limited number of bronchial measurements. The aims of the present study were (i) to analyze cross-sectional bronchial dimensions after automatic orthogonal reconstruction of all visible bronchi on CT images, and (ii) to compare bronchial morphometry between smokers and nonsmokers. CT and pulmonary function tests were performed in 18 males separated into two groups: 9 nonsmokers and 9 smokers. Bronchial wall area (WA) and lumen area (LA) were assessed using dedicated 3D software able to provide accurate cross-sectional measurements of all visible bronchi on CT. WA/LA and WA/(WA+LA) ratios were computed and all parameters were compared between both groups. Smokers demonstrated greater WA, smaller LA, and consequently greater LA/WA and LA/(WA+LA) ratios than nonsmokers. These differences occurred downward starting at the fourth bronchial generation. 3D quantitative CT method is able to demonstrate significant changes in bronchial morphometry related to tobacco consumption.

Transient left ventricular non-apical ballooning syndrome: Diagnosis with multiple imaging modalities

a Service des soins intensifs cardiologiques, hopital cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France b Service de cardiologie, hopital cardiologique du Haut-Leveque, universite Victor-Segalen Bordeaux-2, CHU de Bordeaux, Pessac, France c Unite d’imagerie thoracique et cardiovasculaire, service des soins intensifs cardiologiques, hopital cardiologique du Haut-Leveque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France

Embolisation d'un faux-anévrysme de Rasmussen compliquant une tuberculose active.

es quinze dernières années ont vu une recrudescence des cas de tuberculose en France, notamment chez les sujets migrants qui sont 45 fois plus touchés que la population générale (1). C’est dans cette population que l’on observe les tableaux les plus sévères et le plus de résistances aux antituberculeux classiques. Nous rapportons un cas de tuberculose post-primaire sévère compliquée d’un fauxanévrysme artériel pulmonaire ou fauxanévrysme de Rasmussen. Compte tenu du risque de rupture, ce faux-anévrysme a été traité par vaso-occlusion de l’artère afférente.

Combined Computed Tomography Angiography and Cardiac Magnetic Resonance Imaging for Diagnosis of Acute Myocarditis in a Child with Duchenne Myopathy

An 8-year-old boy with a Duchenne muscular dystrophy was admitted to the hospital with acute constrictive thoracic pain and ST-segment elevation in the inferior chest leads. Serum biochemistry on admission, 10 h after the onset of symptoms, demonstrated an elevated troponin T and NTpro-BNP level of to 63 lg/L [normal for laboratory: 0.00–0.01] and 4106 pg/mL [normal for laboratory: 0–125], respectively. C-reactive protein was not elevated. Transthoracic echocardiography on admission demonstrated lateral, inferobasal, and septobasal hypokinesia with depressed left ventricular function (ejection fraction 40% using the biplane Simpson method). A combined multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) was preferred to selective coronary angiography, as the patient was unable to tolerate general anesthesia because of chronic respiratory failure (commonly present in Duchenne myopathy). A 64-slice CT scan was performed with 2 ECG-gated acquisitions, an initial contrast-enhanced coronary CT angiogram followed 5 min later by a low-dose acquisition. The total radiation dose was 635 mGy cm. There was no abnormality of the coronary arteries; however, there were multiple areas of delayed enhancement demonstrated by late acquisition sequences. The distribution of the areas of delayed enhancement did not match the territory of any coronary artery and strongly suggested the diagnosis of acute myocarditis (Fig. 1). The diagnosis was confirmed by cardiac MRI performed 48 h later. The delayed postgadolinium acquisitions (threedimensional spoiled gradient echo sequence and phasesensitive inversion recuperation sequence) revealed subepicardial enhancement of both septal and lateral walls of the left ventricle (Fig. 2). Acute myocarditis is an inflammatory condition of the heart commonly due to viral infection (although serum serology and blood cultures in the present case were normal), which often causes a diagnostic dilemma due to the nonspecific nature of its clinical presentation. Historically, myocardial biopsy was considered the gold standard diagnostic investigation, performed with selective coronary angiography to exclude coronary artery disease. However, due to its invasive nature, it is not normally performed in the first instance, especially for children. Despite the specific findings of myocardial inflammation seen microscopically, the focal nature of myocarditis (especially in the early phase of the condition) means that a biopsy can give a false-negative result. Friedrich et al. have shown that myocardial inflammation can be both localized and quantified with MRI, even at the early phase of the disease [1]. Additionally, MSCT is noninvasive, fast, and gives a reliable analysis of coronary anatomy and myocardial perfusion. The benefit in pediatric patients is that general anesthesia is not required compared to percutaneous coronary angiography. This case illustrates the benefit of a combined noninvasive imaging strategy using MSCT and MRI to reveal acute myocarditis in a child with a Duchenne muscular dystrophy. X. Iriart (&) G. Vogels CHU de Bordeaux, Cardiopathies Congénitales de l’enfant et de l’adulte, Bordeaux, France e-mail: xavier.iriart@chu-bordeaux.fr

Value of phase-sensitive inversion recovery sequence to perform and analyse late gadolinium enhancement in cardiac amyloidosis.

MOTS CLÉS Amylose ; A 62-year-old man was referred with new onset right heart failure and polyneuropathy. Echocardiography demonstrated severe left ventricular (LV) hypertrophy, with an ejection fraction of 76%. The interventricular septal thickness was 20 mm. On cardiovascular magnetic resonance (CMR), short-axis dark-blood T2-weighted (Fig. 1A) and four chamber steady-state free precession (SSFP) cine (Fig. 1B) sequences showed concentric thickening of the left ventricle and bilateral pleural effusions (Supplemental material). Multi-TI inversion recovery sequence performed 8 min after gadolinium (Gd) injection showed nulling of the myocardium at TI = 160 ms, whereas nulling of the blood pool was observed at TI = 240 ms. Delayed enhancement CMR (DE-CMR) using