Steffen Huber

Serial Native T1 Mapping to Monitor Cardiac Response to Treatment in Light-Chain Amyloidosis

Amyloidosis is a condition in which misfolded proteins form insoluble deposits in the extracellular space of various tissues and organs, leading to interstitial expansion and disruption of structure and function. Light-chain (AL) amyloidosis is caused by an underlying plasma cell dyscrasia; cardiac involvement is common, is present in ≈50% of patients at presentation, and is a principal driver of morbidity and mortality.1 In practice, there has been reliance on ECG and echocardiographic features, as well as serum cardiac biomarkers, such as pro-brain natriuretic peptide and troponin T concentrations, for prognostic purposes and correlation to clinical response to treatment. However, these parameters can be of limited use because of concomitant etiologies for left ventricular (LV) hypertrophy and coexisting renal impairment. T1 relaxation time for hydrogen magnetization in the myocardium, an intrinsic characteristic of tissue, has been studied in a variety of pathologies with diffuse processes, including amyloidosis. Native, also known as noncontrast or precontrast, T1 mapping can be performed without the use of gadolinium-based contrast in patients with significantly reduced glomerular filtration rate. The technique of T1 mapping with cardiovascular magnetic resonance (CMR), in which T1 relaxation times for all pixels in the acquired image of the heart are measured, has been used for purposes of tissue characterization in regards to the diagnosis of cardiac involvement2 and prognosis in AL amyloidosis3 at single time point evaluations. Here we present a case using serial CMR native T1 mapping to assess treatment response of AL amyloidosis in a patient with renal failure. A 60-year-old …

Comparison of multidetector computed tomography angiography and cholangiography performed at 80 and 120 kVp in live liver donors.

Objective The objective of this study was to compare the radiation exposure and image quality of contrast-enhanced multidetector computed tomography angiography (CTA) and computed tomography cholangiography (CTC) performed for living liver donor evaluation using 80 and 120 kVp. Methods Ninety-three potential liver donors who underwent preoperative contrast-enhanced 64 multidetector CTA and CTC were retrospectively divided into 2 groups: at 80 and at 120 kVp. An institutional review board waiver was obtained. Signal-to-noise ratio and contrast-to-noise ratio of the hepatic artery and common bile duct were obtained. The dose-length product was recorded. Image quality and visibility of hepatic artery and biliary tract anatomy were evaluated. Mann-Whitney U test was used for statistical evaluation. Results Mean hepatic artery/common bile duct signal-to-noise ratio was 28.9/28.6 (SD, 14.2/10.0) at 80 kVp and 27.6/25.8 (SD, 8.0/6.2) at 120 kVp (P = 0.61/0.099). Mean hepatic artery/common bile duct contrast-to-noise ratio was 24.8/23.3 (SD, 12.9/8.6) at 80 kVp and 22.2/19.3 (SD, 7.7/5.0) at 120 kVp (P = 0.76/0.005). Mean CTA/CTC dose-length product was 279/281 (SD, 42/52) mGy-cm at 80 kVp and 407/451 (SD, 208/243) mGy-cm at 120 kVp (P = 0.026/0.002). Computed tomography cholangiography image quality and visibility of biliary tract anatomy were not significantly different at 80 versus 120 kVp (all P > 0.13). Computed tomography angiography image quality was significantly lower (P < 0.01), and the noise scores significantly higher (P < 0.01) at 80 versus 120 kVp, but diagnostic. Conclusions Contrast-enhanced CTA and CTC performed at 80 kVp result in comparable image quality and anatomical evaluation with reduced radiation exposure when compared with 120 kVp.

Prostate zonal anatomy correlates with the detection of prostate cancer on multiparametric magnetic resonance imaging/ultrasound fusion–targeted biopsy in patients with a solitary PI-RADS v2–scored lesion

PURPOSE To evaluate the positive predictive value (PPV) of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) assessment method in patients with a single suspicious finding on prostate multiparametric magnetic resonance imaging (mpMRI). PATIENTS AND METHODS A total of 176 patients underwent MRI/ultrasound fusion-targeted prostate biopsy after the detection of a single suspicious finding on mpMRI. The PPV for cancer detection was determined based on PI-RADS v2 assessment score and location. RESULTS Fusion biopsy detected prostate cancer in 60.2% of patients. Of these patients, 69.8% had Gleason score (GS) ≥7 prostate cancer. Targeted biopsy detected 90.5% of all GS≥7 prostate cancer. The PPV for GS≥7 detection of PI-RADS v2 category 5 (P5) and category 4 (P4) lesions was 70.2% and 37.7%, respectively. This increased to 88% and 38.5% for P5 and P4 lesions in the peripheral zone (PZ), respectively. Targeted biopsy did not miss GS≥7 disease compared with systematic biopsy in P5 lesions in the PZ and transition zone. CONCLUSION The PPV of PI-RADS v2 for prostate cancer in patients with a single lesion on mpMRI is dependent on PI-RADS assessment category and location. The highest PPV was for a P5 lesion in the PZ.

Differentiating Renal Neoplasms From Simple Cysts on Contrast-Enhanced CT on the Basis of Attenuation and Homogeneity

OBJECTIVE The purpose of this study is to compare the attenuation and homogeneity of renal neoplasms with those of cysts on contrast-enhanced CT. MATERIALS AND METHODS A total of 129 renal neoplasms and 24 simple cysts were evaluated. Two readers determined whether each mass was qualitatively heterogeneous or homogeneous. Mean, minimum, and maximum attenuation values were measured. Statistical analysis was performed. RESULTS A total of 116 heterogeneous renal cell carcinomas (RCCs) (99 clear cell, four papillary, four oncocytic, seven chromophobe, and two unclassified RCCs), 13 homogeneous RCCs (10 papillary, two oncocytic, and one chromophobe RCC), and 24 cysts (all of which were homogeneous) were evaluated. All homogeneous RCCs had mean attenuation values of more than 42 HU, whereas renal cysts had mean attenuation values of up to 30 HU (p < 0.001). Two readers qualitatively and identically categorized all RCCs as homogeneous or heterogeneous (κ = 1.0; p < 0.001). CONCLUSION Homogeneous simple renal cysts can have mean attenuation values of up to 30 HU, as determined by contrast-enhanced CT, whereas homogeneous RCCs have mean attenuation values as low as 42 HU, with no overlap occurring between the two groups. These data suggest that further evaluation of a homogeneous renal mass with a mean attenuation value of 30 HU or less on a contrast-enhanced CT scan likely is unwarranted.

Role of MRI in the Use of an Absorbable Hydrogel Spacer in Men Undergoing Radiation Therapy for Prostate Cancer: What the Radiologist Needs to Know

OBJECTIVE Hydrogel spacers have a novel role in the treatment of low- and intermediate-risk prostate cancer with dose-escalated radiation therapy. Given the growing number of patients undergoing treatment with radiation therapy, the use of hydrogel spacers is expected to increase. The purpose of this article is to review what a radiologist needs to know about the imaging of hydrogel spacers, including MRI technique and appearance on CT and MRI. CONCLUSION MRI has a critical role in the evaluation of hydrogel spacer placement and is used to facilitate contouring by the radiation oncologist. The radiologist should be familiar with the imaging appearance of hydrogel spacers on CT and MRI to avoid interpretation pitfalls and errors.

Reverse double inversion-recovery: Improving motion robustness of cardiac T2-weighted dark-blood turbo spin-echo sequence: Motion-Robust Dark-Blood TSE

Cardiac dark‐blood turbo spin‐echo (TSE) imaging is sensitive to through‐plane motion, resulting in myocardial signal reduction.

REPAIRit: Improving Myocardial Nulling and Ghosting Artifacts of 3D Navigator-Gated Late Gadolinium Enhancement Imaging During Arrhythmia: REPAIRit: Improving 3D LGE During Arrhythmia

Cardiac 3D navigator‐gated late gadolinium enhancement (LGE) imaging is important for assessment of left atrial fibrosis, but the image quality is often degraded due to arrhythmia.

Bacillus Calmette–Guérin therapy-induced granulomatous prostatitis on multiparametric magnetic resonance imaging: a case report

Multiparametric magnetic resonance imaging (MRI) has emerged as a diagnostic tool for the detection of prostate cancer. Studies have demonstrated a significant correlation between suspicious MRI lesions and positive prostate biopsy.1,2 Intravesical bacillus Calmette–Guérin (BCG) therapy is routinely performed as a treatment for patients with non-muscle invasive bladder cancer, which may result in granulomatous prostatitis (GP) as a side effect.3–5 Currently, the only way to distinguish GP from prostate cancer is by biopsy confirmation.

A subset of hypertrophic cardiomyopathy patients is predisposed to angulated septum

Background Hypertrophic cardiomyopathy (HCM) is a complex genetic disease with marked morphofunctional heterogeneity. Some HCM patients develop obstructive symptoms later in life, long after cessation of hypertrophic progression. The mechanism underlying this phenomenon is poorly understood. It is known that aorto-septal angulation progresses with age. However, the relationship between age, septal angulation, and HCM subtype has not been explored. In this present study, we examined the relationship between age, aorto-septal angulation and subtypes of HCM. Methods Control normal subjects (n=19) and consecutive HCM patients with apical, concentric, and septal subtypes (n=53) were identified from the MRI database at YaleNew Haven Hospital. Angulated septal angle, the angle between the right septal surface and anterior aortic wall during end systole and diastole, was measured blindly by two readers. Disagreements between two reads >10˚ were excluded. In addition, we further age stratified our cohort of septal subtype (above or below 40 years) to explore differences in the pattern of aorto-septal angle over age. Results Patients with septal, but not apical or concentric subtypes, exhibit more acute angulated septum versus controls in end-systole (p=0.008, 0.326, and 0.167, respectively). The acuity of this angle increased with age in controls (p=0.0009). Interestingly, HCM patients with septal hypertrophy deviated from this pattern, demonstrating early angulation without progression over age (p=0.918). The associations above remained significant in end-diastole.