Noha Behairy

Magnetic resonance imaging in fetal anomalies: What does it add to 3D and 4D US?

OBJECTIVE The objective of our study is to evaluate the contribution of adding MRI findings to sonographic data when assessing fetal anomalies and to determine how this addition may affect the management of pregnancy. STUDY DESIGN We prospectively examined 26 fetuses who had sonographically suspected congenital anomalies over a period of 1 year. 2D/3D and 4D ultrasound, Doppler and magnetic resonant imaging was done for all patients. MRI was done within 1 week following US examination. The maternal age range was 18-39 years. The gestational age range was 15-38 weeks (mean age=29 weeks). Ultrasound and magnetic resonance findings were compared together. RESULTS We reported different types of congenital anomalies including eight cases of isolated central nervous system anomalies, four abdominal, five musculoskeletal anomalies, seven cases of renal anomalies and two cases of Meckel Gruber syndrome. MRI and sonography showed concordant findings in 18 cases. MRI changed the diagnosis in five cases and provided additional information in three cases. Ultrasound was superior to magnetic resonance imaging in three cases. CONCLUSION Our results showed that fetal MR imaging can be used as a complementary modality to US in diagnosing fetal abnormality in which US findings are inconclusive or equivocal.

Can myocardial remodeling be a useful surrogate predictor of myocardial iron load? A 3D echocardiographic multicentric study

The relationship between myocardial iron load and eccentric myocardial remodeling remains an under‐investigated area; it was thought that remodeling is rather linked to fibrosis. This study aims to determine whether or not measures of remodeling can be used as predictors of myocardial iron. For this purpose, 60 patients with thalassemia were studied with 3D echocardiography and myocardial relaxometry (T2*) by Cardiac MRI. 3D derived sphericity index was significantly higher in patients with myocardial iron load. It was correlated with T2* with a 100% sensitivity and specificity (cut‐off value of 0.34) to discriminate between patients with and without myocardial iron overload.

Temporal Changes of Left Ventricular Synchronization Parameters and Outcomes of Cardiac Resynchronization Therapy

Background: Left ventricular dyssynchrony plays an important role in predicting response to cardiac resynchronization therapy (CRT). Methods: Thirty patients underwent CRT implantation. Assessment of left ventricular (LV) dyssynchrony was done through Gated SPECT LV phase analysis. Results: Thirty patients received CRT (mean age 58.7 ± 9.0, 24 males). CRT implantation had a favorable prognosis on cardiac functions (LVEF preimplantation: 26.8 ± 4.7% versus 29.1 ± 6.4% post‐implantation; P = 0.002). Reverse LV remodeling (≥15%) was documented in 19 patients. Temporal changes in LV dyssynchrony parameters were correlated to LV reverse remodeling. Applying ROC curve for LV phase analysis showed that a cutoff value of 152° for histogram bandwidth had a sensitivity of 72.7% and specificity of 63.2% for predicting CRT non‐response status. Also, a cutoff value of 54° for histogram standard deviation had a sensitivity of 81.8% and specificity of 63.2%. Conclusion: Responders of CRT showed improved LV dyssynchrony profiles. Utilizing Gated SPECT LV analysis could provide predictors for CRT non‐response. Reverse LV remodeling is associated with temporal improvements in LV dyssynchrony parameters.

Congenital biscuspid aortic valve in pediatric and early adulthood: Is there a relationship between the valvular leaflet fusion pattern and other functional parameters

Methods One hundered patients between 3 months to 26 years were included in the study. They were 78 males and 22 females. BSA for the patients ranged from 0.45-2.27. All patients were subjected to clinical examination, transthoracic echocardiography and CMR on a 1.5T machine. We recorded the leaflet fusion pattern, presence of AS, AR, pressure gradient, EF, LVEDV, aortic diameter at the annulus, sinus, arch and ascending aorta levels. Associated findings were all recorded.

Delayed myocardial enhancement in pediatric hypertrophic cardiomyopathy: correlation with LV functional and demographic parameters

Background Hypertrophic cardiomyopathy is an important cause of sudden cardiac death throughout life and progressive heart failure. There are limited data on the prognostic significance of fibrosis in patients with HCM specially in the pediatric age group. Our aim was to detect the presence of fibrosis in the pediatric age group and study its correlation with other demographic and LV functional parameter to detect additional risk stratification.

Left ventricular scar impact on left ventricular synchronization parameters and outcomes of cardiac resynchronization therapy

BACKGROUND Left ventricular scar, including global scar and lateral wall, plays an important role in predicting response to cardiac resynchronization therapy (CRT). MATERIALS AND METHODS Thirty patients underwent CRT implantation. Assessment of left ventricular (LV) dyssynchrony was done through Gated SPECT LV phase analysis. Pre-implantation cardiac magnetic resonance (CMR) with late gadolinium enhancement technique to examine LV scar burden. Echocardiographic examination of LV end-systolic volume (LVES) prior to CRT and 6 months later. RESULTS Thirty patients received CRT (mean age 58.7±9.0, 24 males). Reverse LV remodeling (decline ≥15% from baseline VES) was documented in 19 patients. Temporal changes in LV dyssynchrony parameters were correlated to LV reverse remodeling. Applying ROC for predicting CRT non-response showed a cutoff 36.5% of global LV scar burden had a sensitivity of 81.8% and specificity of 68.4%. A cutoff for lateral wall scar burden 40.5% of whole lateral wall had a sensitivity of 72.7% and specificity of 68.4%. CONCLUSION Reverse LV remodeling is associated with temporal improvements in LV dyssynchrony parameters. LV scar had an unfavorable impact on CRT response. Both global and lateral wall scar burden could predict CRT nonresponse status.