Noriko Oyama

Myocardial imaging with 18F-fluoro-2-deoxyglucose positron emission tomography and magnetic resonance imaging in sarcoidosis

PurposeDespite accumulating reports on the clinical value of 18F-fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET) and magnetic resonance imaging (MRI) in the assessment of cardiac sarcoidosis, no studies have systematically compared the images of these modalities.MethodsTwenty-one consecutive patients with suspected cardiac sarcoidosis underwent cardiac examinations that included 18F-FDG PET and MRI. The association of 18F-FDG PET and MRI findings with blood sampling data such as serum angiotensin converting enzyme levels was also evaluated.ResultsEight of 21 patients were diagnosed as having cardiac sarcoidosis according to the Japanese Ministry of Health and Welfare Guidelines for Diagnosing Cardiac Sarcoidosis. Sensitivity and specificity for diagnosing cardiac sarcoidosis were 87.5 and 38.5%, respectively, for 18F-FDG PET, and 75 and 76.9%, respectively, for MRI. When the 18F-FDG PET and MRI images were compared, 16 of 21 patients showed positive findings in one (n = 8) or both (n = 8) of the two modalities. In eight patients with positive findings on both images, the distribution of the findings differed among all eight cases. The presence of positive findings on 18F-FDG PET was associated with elevated serum angiotensin-converting enzyme levels; this association was not demonstrated on MRI.ConclusionsBoth 18F-FDG PET and MRI provided high sensitivity for diagnosing cardiac sarcoidosis in patients with suspected cardiac involvement, but the specificity of 18F-FDG PET was not as high as previously reported. The different distributions of the findings in the two modalities suggest the potential of 18F-FDG PET and MRI in detecting different pathological processes in the heart.

Differential Impact of Age, Sex, and Hypertension on Aortic Atherosclerosis: The Framingham Heart Study

Objective—The purpose of this study was to investigate the impact of age, sex, and hypertension (HTN) on aortic atherosclerotic burden using cardiovascular MRI (CMR) in a free-living longitudinally followed cohort. Methods and Results—1763 participants (829 M and 934 F; 38 to 88 years of age) of the Framingham Heart Study Offspring cohort underwent CMR of the thoracoabdominal aorta using an ECG-gated 2D T2-weighted black-blood sequence. Of these, 1726 subjects (96%) with interpretable CMR were characterized by sex, age-quartile, and presence or absence of HTN and clinical cardiovascular disease (CVD). Aortic plaque prevalence and volume increased with increasing age in both sexes. For the nonhypertensive (no-HTN) group, plaque was identified in 702 (46%) with greater prevalence in women than in men (P<0.006). HTN was associated with greater aortic plaque burden (P<0.02). The 200 subjects with clinical CVD had greater plaque burden than subjects without CVD (P<0.0001). Conclusions—In this free-living longitudinally followed cohort, subclinical aortic atherosclerosis was seen in nearly half of subjects and increased with advancing age. HTN was associated with increased aortic plaque burden. Among no-HTN subjects, women had greater plaque burden than men. These data suggest that subclinical atherosclerosis is more common in no-HTN women and emphasize the importance of focusing on preventive measures in both sexes.

Rapid estimation of split renal function in kidney donors using software developed for computed tomographic renal volumetry

PURPOSE To evaluate the speed and precision of split renal volume (SRV) measurement, which is the ratio of unilateral renal volume to bilateral renal volume, using a newly developed software for computed tomographic (CT) volumetry and to investigate the usefulness of SRV for the estimation of split renal function (SRF) in kidney donors. METHOD Both dynamic CT and renal scintigraphy in 28 adult potential living renal donors were the subjects of this study. We calculated SRV using the newly developed volumetric software built into a PACS viewer (n-SRV), and compared it with SRV calculated using a conventional workstation, ZIOSOFT (z-SRV). The correlation with split renal function (SRF) using (99m)Tc-DMSA scintigraphy was also investigated. RESULTS The time required for volumetry of bilateral kidneys with the newly developed software (16.7±3.9s) was significantly shorter than that of the workstation (102.6±38.9s, p<0.0001). The results of n-SRV (49.7±4.0%) were highly consistent with those of z-SRV (49.9±3.6%), with a mean discrepancy of 0.12±0.84%. The SRF also agreed well with the n-SRV, with a mean discrepancy of 0.25±1.65%. The dominant side determined by SRF and n-SRV showed agreement in 26 of 28 cases (92.9%). CONCLUSION The newly developed software for CT volumetry was more rapid than the conventional workstation volumetry and just as accurate, and was suggested to be useful for the estimation of SRF and thus the dominant side in kidney donors.

Single-slice epicardial fat area measurement: do we need to measure the total epicardial fat volume?

PurposeThe aim of this study was to assess a method for measuring epicardial fat volume (EFV) by means of a single-slice area measurement. We investigated the relation between a single-slice fat area measurement and total EFV.Methods and methodsA series of 72 consecutive patients (ages 65 ± 11 years; 36 men) who had undergone cardiac computed tomography (CT) on a 64-slice multidetector scanner with prospective electrocardiographic triggering were retrospectively reviewed. Pixels in the pericardium with a density range from −230 to −30 Hounsfield units were considered fat, giving the per-slice epicardial fat area (EFA). The EFV was estimated by the summation of EFAs multiplied by the slice thickness. We investigated the relation between total EFV and each EFA.ResultsEFAs measured at several anatomical landmarks—right pulmonary artery, origins of the left main coronary artery, right coronary artery, coronary sinus—all correlated with the EFV (r = 0.77–0.92). The EFA at the LMCA level was highly reproducible and showed an excellent correlation with the EFV (r = 0.92).ConclusionThe EFA is significantly correlated with the EFV. The EFA is a simple, quick method for representing the time-consuming EFV, which has been used as a predictive indicator of cardiovascular diseases.

Reduction of Bed Rest Time after Transfemoral Noncardiac Angiography from 4 Hours to 2 Hours: A Randomized Trial and a One-arm Study

PURPOSE To evaluate the feasibility of shortening the bed rest time from 4 hours to 2 hours after transfemoral noncardiac angiography with a 4-F sheath (outer diameter, 1.93 mm), a 5-F sheath (outer diameter, 2.27 mm), and a 4-F catheter. MATERIALS AND METHODS Patients were randomized into two groups, receiving either 2 or 4 hours of bed rest after hemostasis by manual compression of the puncture site. The authors evaluated the frequency of bleeding complications. An interim analysis was performed wherein 40 patients were assigned to each group. After the analysis, a single-arm 2-hour bed rest trial was conducted in an additional 115 procedures. RESULTS In the interim analysis, three of the 40 patients in the 4-hour group and none of the 40 patients in the 2-hour group developed minor bleeding within 2 hours after manual compression (P = .24). After 2 hours of bed rest, no bleeding complication was observed in either group. In the single-arm 2-hour bed rest trial, minor bleeding developed in one of the 115 procedures (0.8%). Through the study, minor bleeding occurred in four of the 195 total procedures (2%), and no major complications developed. The occurrence of a bleeding complication was significantly higher in patients with platelet counts of less than 100 x 10(9)/L than in the other patients (4/67 vs 0/128, P = .01). CONCLUSIONS Two hours of bed rest is feasible for patients undergoing transfemoral noncardiac angiography by using a 4-5-F sheath and/or a 4-F catheter, especially those with a normal platelet count.

Atherosclerotic Biomarkers and Aortic Atherosclerosis by Cardiovascular Magnetic Resonance Imaging in the Framingham Heart Study

Background The relations between subclinical atherosclerosis and inflammatory biomarkers have generated intense interest but their significance remains unclear. We sought to determine the association between a panel of biomarkers and subclinical aortic atherosclerosis in a community‐based cohort. Methods and Results We evaluated 1547 participants of the Framingham Heart Study Offspring cohort who attended the 7th examination cycle and underwent both cardiovascular magnetic resonance imaging (CMR) and assays for 10 biomarkers associated with atherosclerosis: high‐sensitivity C‐reactive protein, fibrinogen, intercellular adhesion molecule‐1, interleukin‐6, interleukin‐18, lipoprotein‐associated phospholipase‐A2 activity and mass, monocyte chemoattractant protein‐1, P‐selectin, and tumor necrosis factor receptor‐2. In logistic regression analysis, we found no significant association between the biomarker panel and the presence of aortic plaque (global P=0.53). Using Tobit regression with aortic plaque as a continuous variable, we noted a modest association between biomarker panel and aortic plaque volume in age‐ and sex‐adjusted analyses (P=0.003). However, this association was attenuated after further adjustment for clinical covariates (P=0.09). Conclusions In our community‐based cohort, we found no significant association between our multibiomarker panel and aortic plaque. Our results underscore the strengths and limitations of the use of biomarkers for the identification of subclinical atherosclerosis and the importance of traditional risk factors.

Relationship Between Central and Peripheral Atherosclerosis and Left Ventricular Dysfunction in a Community Population

We aimed to determine the relationships between resting left ventricular (LV) wall motion abnormalities (WMAs), aortic plaque, and peripheral artery disease (PAD) in a community cohort. A total of 1726 Framingham Heart Study Offspring Cohort participants (806 males, 65 ± 9 years) underwent cardiovascular magnetic resonance with quantification of aortic plaque volume and assessment of regional left ventricular systolic function. Claudication, lower extremity revascularization, and ankle–brachial index (ABI) were recorded at the most contemporaneous examination visit. WMAs were associated with greater aortic plaque burden, decreased ABI, and claudication in age- and sex-adjusted analyses (all p < 0.001), which were not significant after adjustment for cardiovascular risk factors. In age- and sex-adjusted analyses, both the presence (p < 0.001) and volume of aortic plaque were associated with decreased ABI (p < 0.001). After multivariable adjustment, an ABI ≤ 0.9 or prior revascularization was associated with a threefold odds of aortic plaque (p = 0.0083). Plaque volume significantly increased with decreasing ABI in multivariable-adjusted analyses (p < 0.0001). In this free-living population, associations of WMAs with aortic plaque burden and clinical measures of PAD were attenuated after adjustment for coronary heart disease risk factors. Aortic plaque volume and ABI remained strongly negatively correlated after multivariable adjustment. Our findings suggest that the association between coronary heart disease and non-coronary atherosclerosis is explained by cardiovascular risk factors. Aortic atherosclerosis and PAD remain strongly associated after multivariable adjustment, suggesting shared mechanisms beyond those captured by traditional risk factors.

Volume-rendering and endocardial views of partially unroofed coronary sinus with 64-slice multidetector CT

We diagnosed unroofed coronary sinus preoperatively by the 3D volume rendering and endocardial views with 64-slice MDCT, and those clearly showed the defect of the roof of the coronary sinus and the relationship with the surrounding structure. MDCT is a good non-invasive tool for the evaluation of unroofed coronary sinus, and the reconstructed endocardial view is useful for preoperative surgical planning.

Apicoaortic Valved Conduit for a Patient with Porcelain Aorta

A 69-year-old woman had severe aortic stenosis with a circumferentially calcified aorta from the ascending aorta to the aortic arch, and moderately impaired left ventricular function. Implantation of an apicoaortic valved conduit was performed as aortic clamping was not feasible. The early results were excellent.

Left Ventricular Asynchrony Caused by an Intramuscular Lipoma Computed Tomographic and Magnetic Resonance Detection

Routine chest x-ray of a 67-year-old woman revealed a mass contiguous with the cardiac silhouette. Echocardiogram located the mass in the anterior wall of the left ventricle. Magnetic resonance (MR) and computed tomography (CT) imaging showed a solitary mass with a clear margin resembling a balloon arising from myocardium of the left ventricle (Figure 1; Figure 2A and 2B). The mass extended from the left ventricular myocardium to the epicardial space. On CT, the nonenhanced mass showed low density with a mean CT value of -120 Hounsfield units (HU), which was compatible with fat. In cardiac MR imaging, the signal intensity of the mass on several pulse sequences was consistent with that of fat (Figure 2A and 2B and Figure 3). For kinetic analysis of the left ventricular wall, cine MR imaging was done. This revealed asynchronic motion of the left ventricle due to the tumor (Movies I and II). The tumor contracted just after the systolic phase of the left ventricle. During contraction, the tumor was first pushed out and appeared constricted just after contraction. On the basis of CT and MR imaging, the lesion was thought to represent a lipoma arising within the myocardium with paracardiac extension. The inner myocardium of the mass was very thin, and surgical debulking was not considered an appropriate option because of the possibility of cardiac rupture.Routine chest x-ray of a 67-year-old woman revealed a mass contiguous with the cardiac silhouette. Echocardiogram located the mass in the anterior wall of the left ventricle. Magnetic resonance (MR) and computed tomography (CT) imaging showed a solitary mass with a clear margin resembling a balloon arising from myocardium of the left ventricle (Figure 1; Figure 2A and 2B). The mass extended from the left ventricular myocardium to the epicardial space. On CT, the nonenhanced mass showed low density with a mean CT value of -120 Hounsfield units (HU), which was compatible …