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Guan X, Yang HJ, Zhang X, Wang N, Han H, Tang R, Hu Z, Youssef K, Vora K, Krishnam MS, Christodoulou AG, Li D, Sharif B, Dharmakumar R. Non-electrocardiogram-gated, free-breathing, off-resonance reduced, high-resolution, whole-heart myocardial T 2 * mapping at 3 T within 5 min. Magn Reson Med 2024; 91:1936-1950. [PMID: 38174593 DOI: 10.1002/mrm.29968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Widely used conventional 2D T2 * approaches that are based on breath-held, electrocardiogram (ECG)-gated, multi-gradient-echo sequences are prone to motion artifacts in the presence of incomplete breath holding or arrhythmias, which is common in cardiac patients. To address these limitations, a 3D, non-ECG-gated, free-breathing T2 * technique that enables rapid whole-heart coverage was developed and validated. METHODS A continuous random Gaussian 3D k-space sampling was implemented using a low-rank tensor framework for motion-resolved 3D T2 * imaging. This approach was tested in healthy human volunteers and in swine before and after intravenous administration of ferumoxytol. RESULTS Spatial-resolution matched T2 * images were acquired with 2-3-fold reduction in scan time using the proposed T2 * mapping approach relative to conventional T2 * mapping. Compared with the conventional approach, T2 * images acquired with the proposed method demonstrated reduced off-resonance and flow artifacts, leading to higher image quality and lower coefficient of variation in T2 *-weighted images of the myocardium of swine and humans. Mean myocardial T2 * values determined using the proposed and conventional approaches were highly correlated and showed minimal bias. CONCLUSION The proposed non-ECG-gated, free-breathing, 3D T2 * imaging approach can be performed within 5 min or less. It can overcome critical image artifacts from undesirable cardiac and respiratory motion and bulk off-resonance shifts at the heart-lung interface. The proposed approach is expected to facilitate faster and improved cardiac T2 * mapping in those with limited breath-holding capacity or arrhythmias.
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Affiliation(s)
- Xingmin Guan
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hsin-Jung Yang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Xinheng Zhang
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
| | - Nan Wang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hui Han
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Richard Tang
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Zhehao Hu
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Khalid Youssef
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Keyur Vora
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mayil S Krishnam
- Department of Radiology, Stanford University, Palo Alto, California, USA
| | - Anthony G Christodoulou
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
| | - Behzad Sharif
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rohan Dharmakumar
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Vora KP, Kumar A, Krishnam MS, Prato FS, Raman SV, Dharmakumar R. Microvascular Obstruction and Intramyocardial Hemorrhage in Reperfused Myocardial Infarctions: Pathophysiology and Clinical Insights From Imaging. JACC Cardiovasc Imaging 2024:S1936-878X(24)00060-3. [PMID: 38613553 DOI: 10.1016/j.jcmg.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 01/10/2024] [Accepted: 02/01/2024] [Indexed: 04/15/2024]
Abstract
Microvascular injury immediately following reperfusion therapy in acute myocardial infarction (MI) has emerged as a driving force behind major adverse cardiovascular events in the postinfarction period. Although postmortem investigations and animal models have aided in developing early understanding of microvascular injury following reperfusion, imaging, particularly serial noninvasive imaging, has played a central role in cultivating critical knowledge of progressive damage to the myocardium from the onset of microvascular injury to months and years after in acute MI patients. This review summarizes the pathophysiological features of microvascular injury and downstream consequences, and the contributions noninvasive imaging has imparted in the development of this understanding. It also highlights the interventional trials that aim to mitigate the adverse consequences of microvascular injury based on imaging, identifies potential future directions of investigations to enable improved detection of disease, and demonstrates how imaging stands to play a major role in the development of novel therapies for improved management of acute MI patients.
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Affiliation(s)
- Keyur P Vora
- Krannert Cardiovascular Research Center, Indiana University School of Medicine/IUHealth, Indianapolis, Indiana, USA. https://twitter.com/KeyurVoraMD
| | - Andreas Kumar
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada. https://twitter.com/AndreasKumarMD
| | | | | | | | - Rohan Dharmakumar
- Krannert Cardiovascular Research Center, Indiana University School of Medicine/IUHealth, Indianapolis, Indiana, USA.
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Schilling J, Lin JP, Mankad SV, Krishnam MS, Ning M, Patel PM, Kim CK, Kapoor R, Di Tullio MR, Jung J, Kim JK, Fisher MJ. The 2022 FASEB Virtual Catalyst Conference on the Cardiac Interatrial Septum and Stroke Risk, December 7, 2022. FASEB J 2023; 37:e23122. [PMID: 37606555 DOI: 10.1096/fj.202300897] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/09/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023]
Abstract
There is emerging evidence that the cardiac interatrial septum has an important role as a thromboembolic source for ischemic strokes. There is little consensus on treatment of patients with different cardiac interatrial morphologies or pathologies who have had stroke. In this paper, we summarize the important background, diagnostic, and treatment considerations for this patient population as presented during the Federation of American Societies for Experimental Biology (FASEB) Virtual Catalytic Conference on the Cardiac Interatrial Septum and Stroke Risk, held on December 7, 2022. During this conference, many aspects of the cardiac interatrial septum were discussed. Among these were the embryogenesis of the interatrial septum and development of anatomic variants such as patent foramen ovale and left atrial septal pouch. Also addressed were various mechanisms of injury such as shunting physiologies and the consequences that can result from anatomic variants, as well as imaging considerations in echocardiography, computed tomography, and magnetic resonance imaging. Treatment options including anticoagulation and closure were addressed, as well as an in-depth discussion on whether the left atrial septal pouch is a stroke risk factor. These issues were discussed and debated by multiple experts from neurology, cardiology, and radiology.
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Affiliation(s)
- Jonathan Schilling
- Department of Medicine, University of California, Irvine, California, USA
| | - Jeannette P Lin
- Department of Cardiology, University of California, Los Angeles, California, USA
| | - Sunil V Mankad
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayil S Krishnam
- Department of Radiology, Stanford University, Stanford, California, USA
| | - MingMing Ning
- Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pranav M Patel
- Division of Cardiology, Department of Medicine, University of California, Irvine, California, USA
| | - Chi Kyung Kim
- Department of Neurology, Korea University College of Medicine, Seoul, South Korea
| | - Ruchi Kapoor
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Marco R Di Tullio
- Division of Cardiology, Department of Medicine, Columbia University, New York, New York, USA
| | - Jinman Jung
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Jin Kyung Kim
- Division of Cardiology, Department of Medicine, University of California, Irvine, California, USA
| | - Mark J Fisher
- Departments of Neurology, Anatomy & Neurobiology, and Pathology & Laboratory Medicine, University of California, Irvine, California, USA
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Ho VV, O’Sullivan JW, Collins WJ, Ozdalga E, Bell CF, Shah ND, Krishnam MS, Ozawa MG, Witteles RM. Constrictive Pericarditis Revealing Rare Case of ALH Amyloidosis With Underlying Lymphoplasmacytic Lymphoma (Waldenstrom Macroglobulinemia). JACC Case Rep 2022; 4:271-275. [PMID: 35257101 PMCID: PMC8897150 DOI: 10.1016/j.jaccas.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
We present a case of pericardial amyloidosis with associated lymphoplasmacytic lymphoma in a patient with chronic worsening shortness of breath and cough. This case highlights the wide variation in the presentation of cardiac amyloidosis, and the rare occurrence of clinically significant light-chain and heavy-chain amyloidosis in the pericardium. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Vivian V. Ho
- Stanford University School of Medicine, Stanford, California, USA
- Address for correspondence: Dr. Vivian Ho, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305, USA.
| | - Jack W. O’Sullivan
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Errol Ozdalga
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Caitlin F. Bell
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Neil D. Shah
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mayil S. Krishnam
- Department of Radiology/Cardiovascular Imaging, Stanford University, Stanford, California, USA
| | - Michael G. Ozawa
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Ronald M. Witteles
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
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Fujitani RM, Chen SL, Lane JS, Krishnam MS. Congenital, meandering transdiaphragmatic aortocaval-right atrial arteriovenous fistula. J Vasc Surg Venous Lymphat Disord 2016; 5:124-125. [PMID: 27987601 DOI: 10.1016/j.jvsv.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/02/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Roy M Fujitani
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, Calif.
| | - Samuel L Chen
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, Calif
| | - John S Lane
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, Calif
| | - Mayil S Krishnam
- Division of Cardiovascular and Thoracic Imaging, Department of Radiology, University of California, Irvine Medical Center, Orange, Calif
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Trattner S, Pearson GDN, Chin C, Cody DD, Gupta R, Hess CP, Kalra MK, Kofler JM, Krishnam MS, Einstein AJ. Standardization and optimization of CT protocols to achieve low dose. J Am Coll Radiol 2014; 11:271-278. [PMID: 24589403 DOI: 10.1016/j.jacr.2013.10.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 10/15/2013] [Indexed: 02/03/2023]
Abstract
The increase in radiation exposure due to CT scans has been of growing concern in recent years. CT scanners differ in their capabilities, and various indications require unique protocols, but there remains room for standardization and optimization. In this paper, the authors summarize approaches to reduce dose, as discussed in lectures constituting the first session of the 2013 UCSF Virtual Symposium on Radiation Safety and Computed Tomography. The experience of scanning at low dose in different body regions, for both diagnostic and interventional CT procedures, is addressed. An essential primary step is justifying the medical need for each scan. General guiding principles for reducing dose include tailoring a scan to a patient, minimizing scan length, use of tube current modulation and minimizing tube current, minimizing tube potential, iterative reconstruction, and periodic review of CT studies. Organized efforts for standardization have been spearheaded by professional societies such as the American Association of Physicists in Medicine. Finally, all team members should demonstrate an awareness of the importance of minimizing dose.
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Affiliation(s)
- Sigal Trattner
- Department of Medicine, Division of Cardiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY
| | - Gregory D N Pearson
- Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY
| | - Cynthia Chin
- Departments of Radiology and Biomedical Engineering, University of California, San Francisco
| | - Dianna D Cody
- Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rajiv Gupta
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Christopher P Hess
- Departments of Radiology and Biomedical Engineering, University of California, San Francisco
| | | | | | | | - Andrew J Einstein
- Department of Medicine, Division of Cardiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY.,Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY
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7
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Chen SL, Krishnam MS, Bosemani T, Dissayanake S, Sgroi MD, Lane JS, Fujitani RM. Geometric changes of the inferior vena cava in trauma patients subjected to volume resuscitation. Vascular 2014; 23:459-67. [PMID: 25298135 DOI: 10.1177/1708538114552665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Dynamic changes in anatomic geometry of the inferior vena cava from changes in intravascular volume may cause passive stresses on inferior vena cava filters. In this study, we aim to quantify variability in inferior vena cava dimensions and anatomic orientation to determine how intravascular volume changes may impact complications of inferior vena cava filter placement, such as migration, tilting, perforation, and thrombosis. METHODS Retrospective computed tomography measurements of major axis, minor axis, and horizontal diameters of the inferior vena cava at 1 and 5 cm below the lowest renal vein in 58 adult trauma patients in pre-resuscitative (hypovolemic) and post-resuscitative (euvolemic) states were assessed in a blinded fashion by two independent readers. Inferior vena cava perimeter, area, and volume were calculated and correlated with caval orientation. RESULTS Mean volumes of the inferior vena cava segment on pre- and post-resuscitation scans were 9.0 cm(3) and 11.0 cm(3), respectively, with mean percentage increase of 48.6% (P < 0.001). At 1 cm and 5 cm below the lowest renal vein, the inferior vena cava expanded anisotropically, with the minor axis expanding by an average of 48.7% (P < 0.001) and 30.0% (P = 0.01), respectively, while the major axis changed by only 4.2% (P = 0.11) and 6.6% (P = 0.017), respectively. Cross-sectional area and perimeter at 1 cm below the lowest renal vein expanded by 61.6% (P < 0.001) and 10.7% (P < 0.01), respectively. At 5 cm below the lowest renal vein, the expansion of cross-sectional area and perimeter were 43.9% (P < 0.01) and 10.7% (P = 0.002), respectively. The major axis of the inferior vena cava was oriented in a left-anterior oblique position in all patients, averaging 20° from the horizontal plane. There was significant underestimation of inferior vena cava maximal diameter by horizontal measurement. In pre-resuscitation scans, at 1 cm and 5 cm below the lowest renal vein, the discrepancy between the horizontal and major axis diameter was 2.1 ± 1.2 mm (P < 0.001) and 1.7 ± 1.0 mm (P < 0.001), respectively, while post-resuscitation studies showed the same underestimation at 1 cm and 5 cm below the lowest renal vein to be 2.2 ± 1.2 mm (P < 0.01) and 1.9 ± 1.0 mm (P < 0.01), respectively. CONCLUSIONS There is significant anisotropic variability of infrarenal inferior vena cava geometry with significantly greater expansive and compressive forces in the minor axis. There can be significant volumetric changes in the inferior vena cava with associated perimeter changes but the major axis left-anterior oblique caval configuration is always maintained. These significant dynamic forces may impact inferior vena cava filter stability after implantation. The consistent major axis left-anterior oblique obliquity may lead to underestimation of the inferior vena cava diameter used in standard anteroposterior venography, which may influence initial filter selection.
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Affiliation(s)
- Samuel L Chen
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, Orange, CA
| | - Mayil S Krishnam
- Division of Cardiovascular and Thoracic Imaging, University of California, Irvine, CA
| | | | - Sumudu Dissayanake
- Division of Cardiovascular and Thoracic Imaging, University of California, Irvine, CA
| | - Michael D Sgroi
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, Orange, CA
| | - John S Lane
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, Orange, CA
| | - Roy M Fujitani
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, Orange, CA
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Adibi A, Krishnam MS, Dissanayake S, Plotnik AN, Mohajer K, Arellano C, Ruehm SG. Computed tomography angiography of lower extremities in the emergency room for evaluation of patients with gunshot wounds. Eur Radiol 2014; 24:1586-93. [DOI: 10.1007/s00330-014-3174-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 03/25/2014] [Accepted: 04/02/2014] [Indexed: 11/27/2022]
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9
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Kuoy E, Nguyen CV, Dissanayake SN, Nelson KJ, Abbona PJ, Krishnam MS. Quantitative assessment of LV function and volumes with 3-slice segmentation of cine SSFP short axis images: our experience. J Cardiovasc Magn Reson 2014. [PMCID: PMC4044521 DOI: 10.1186/1532-429x-16-s1-p384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Fujitani RM, Chen SL, Lane JS, Krishnam MS. Congenital, Meandering Transdiaphragmatic Aortocaval-Right Atrial Arteriovenous Fistula. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Chen SL, Bosemani T, Krishnam MS, Lane JS, Fujitani RM. Geometric Changes of the Inferior Vena Cava in Trauma Patients Undergoing Volume Resuscitation: Insight into Dynamic Stresses Placed on Inferior Vena Cava Filters. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Edris A, Patel PM, Krishnam MS, Sengupta PP. Intramyocardial hemorrhage after percutaneous coronary intervention. Echocardiography 2012; 29:E50-1. [PMID: 22283207 DOI: 10.1111/j.1540-8175.2011.01546.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ahmad Edris
- Department of Medicine, UC Irvine Medical Center, Division of Cardiology, Orange, California 92868-3217, USA
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13
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Tomasian A, Malik S, Shamsa K, Krishnam MS. Congenital heart diseases: post-operative appearance on multi-detector CT-a pictorial essay. Eur Radiol 2011; 19:2941-9. [PMID: 19513718 PMCID: PMC2778768 DOI: 10.1007/s00330-009-1474-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Revised: 03/26/2009] [Accepted: 04/20/2009] [Indexed: 11/29/2022]
Abstract
Echocardiography is considered as an initial imaging modality of choice in patients with congenital heart disease (CHD), and magnetic resonance (MR) imaging is preferred for detailed functional information. Multi-detector computed tomography (CT) plays an important role in clinical practice in assessing post-operative morphological and functional information of patients with complex CHD when echocardiography and MR imaging are not contributory. Radiologists should understand and become familiar with the complex morphology and physiology of CHD, as well as with various palliative and corrective surgical procedures performed in these patients, to obtain CT angiograms with diagnostic quality and promptly recognise imaging features of normal post-operative anatomy and complications of these complex surgeries.
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiological Science, UCLA Medical Center, Los Angeles, CA 90095–7206, USA
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UyBico SJ, Wu CC, Suh RD, Le NH, Brown K, Krishnam MS. Lung cancer staging essentials: the new TNM staging system and potential imaging pitfalls. Radiographics 2011; 30:1163-81. [PMID: 20833843 DOI: 10.1148/rg.305095166] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide, with a dismal 5-year survival rate of 15%. The TNM (tumor-node-metastasis) classification system for lung cancer is a vital guide for determining treatment and prognosis. Despite the importance of accuracy in lung cancer staging, however, correct staging remains a challenging task for many radiologists. The new 7th edition of the TNM classification system features a number of revisions, including subdivision of tumor categories on the basis of size, differentiation between local intrathoracic and distant metastatic disease, recategorization of malignant pleural or pericardial disease from stage III to stage IV, reclassification of separate tumor nodules in the same lung and lobe as the primary tumor from T4 to T3, and reclassification of separate tumor nodules in the same lung but not the same lobe as the primary tumor from M1 to T4. Radiologists must understand the details set forth in the TNM classification system and be familiar with the changes in the 7th edition, which attempts to better correlate disease with prognostic value and treatment strategy. By recognizing the relevant radiologic appearances of lung cancer, understanding the appropriateness of staging disease with the TNM classification system, and being familiar with potential imaging pitfalls, radiologists can make a significant contribution to treatment and outcome in patients with lung cancer.
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Affiliation(s)
- Stacy J UyBico
- Department of Radiology, University of California, Los Angeles, CA, USA
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15
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Tomasian A, Lai C, Ruehm S, Krishnam MS. Cardiovascular magnetic resonance and PET-CT of left atrial paraganglioma. J Cardiovasc Magn Reson 2010; 12:1. [PMID: 20047692 PMCID: PMC2817869 DOI: 10.1186/1532-429x-12-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 01/04/2010] [Indexed: 11/30/2022] Open
Abstract
Cardiac paragangliomas are among the rarest primary cardiac tumors. We present a case of left atrial paraganglioma in a patient who presented with symptoms and signs of catecholamine excess in which cardiovascular magnetic resonance in multiple orientations and PET-CT played an important role in the diagnosis and tissue characterization.
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiological Sciences, University of California at Los Angeles, USA
| | - Chi Lai
- Department of Pathology, University of California at Los Angeles, USA
| | - Stefan Ruehm
- Department of Radiological Sciences, University of California at Los Angeles, USA
| | - Mayil S Krishnam
- Department of Radiological Sciences, University of California at Los Angeles, USA
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiology, University of California - Los Angeles, Peter V. Ueberroth Bldg., Suite 3371, 10945 Le Conte Ave., Los Angeles, CA 90095-7206, USA.
| | - Mayil S. Krishnam
- Department of Radiology, University of California - Los Angeles, Peter V. Ueberroth Bldg., Suite 3371, 10945 Le Conte Ave., Los Angeles, CA 90095-7206 USA
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17
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Krishnam MS, Tomasian A, Malik S, Desphande V, Laub G, Ruehm SG. Image quality and diagnostic accuracy of unenhanced SSFP MR angiography compared with conventional contrast-enhanced MR angiography for the assessment of thoracic aortic diseases. Eur Radiol 2009; 20:1311-20. [PMID: 20013276 PMCID: PMC2861759 DOI: 10.1007/s00330-009-1672-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 08/26/2009] [Accepted: 09/30/2009] [Indexed: 11/28/2022]
Abstract
Objectives The purpose of this study was to determine the image quality and diagnostic accuracy of three-dimensional (3D) unenhanced steady state free precession (SSFP) magnetic resonance angiography (MRA) for the evaluation of thoracic aortic diseases. Methods Fifty consecutive patients with known or suspected thoracic aortic disease underwent free-breathing ECG-gated unenhanced SSFP MRA with non-selective radiofrequency excitation and contrast-enhanced (CE) MRA of the thorax at 1.5 T. Two readers independently evaluated the two datasets for image quality in the aortic root, ascending aorta, aortic arch, descending aorta, and origins of supra-aortic arteries, and for abnormal findings. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were determined for both datasets. Sensitivity, specificity, and diagnostic accuracy of unenhanced SSFP MRA for the diagnosis of aortic abnormalities were determined. Results Abnormal aortic findings, including aneurysm (n = 47), coarctation (n = 14), dissection (n = 12), aortic graft (n = 6), intramural hematoma (n = 11), mural thrombus in the aortic arch (n = 1), and penetrating aortic ulcer (n = 9), were confidently detected on both datasets. Sensitivity, specificity, and diagnostic accuracy of SSFP MRA for the detection of aortic disease were 100% with CE-MRA serving as a reference standard. Image quality of the aortic root was significantly higher on SSFP MRA (P < 0.001) with no significant difference for other aortic segments (P > 0.05). SNR and CNR values were higher for all segments on SSFP MRA (P < 0.01). Conclusion Our results suggest that free-breathing navigator-gated 3D SSFP MRA with non-selective radiofrequency excitation is a promising technique that provides high image quality and diagnostic accuracy for the assessment of thoracic aortic disease without the need for intravenous contrast material.
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Affiliation(s)
- Mayil S Krishnam
- Cardiovascular and Thoracic Imaging, UCI Medical Center, University of California, 333 City Boulevard West, Suite 1405, Irvine, CA 92868, USA.
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Tomasian A, Salamon N, Krishnam MS, Finn JP, Villablanca JP. 3D high-spatial-resolution cerebral MR venography at 3T: a contrast-dose-reduction study. AJNR Am J Neuroradiol 2009; 30:349-55. [PMID: 18945800 DOI: 10.3174/ajnr.a1319] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The effect of various contrast-dose regimens for cerebral MR venography (MRV) has not been previously evaluated at 3T, to our knowledge. Our purpose was to evaluate and compare the diagnostic image quality resulting from half-versus-full-dose contrast regimens for high-spatial-resolution 3D cerebral MRV at 3T. MATERIALS AND METHODS Forty consecutive patients with known or suggested cerebrovascular disease underwent 3D high-spatial-resolution (0.7 x 0.6 x 0.9 mm(3)) cerebral contrast-enhanced MRV (CE-MRV) at 3T, by using an identical acquisition protocol. Patients were assigned to 1 of 2 groups: 1) full-dose (approximately 0.1 mmol/kg), and 2) half-dose (approximately 0.05 mmol/kg). Two readers evaluated the resulting images for overall image quality, venous structure definition, and arterial contamination. Signal intensity-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR) were evaluated in 8 consistent sites. Statistical analysis was performed by using Mann-Whitney U, Wilcoxon signed rank, and t tests and a kappa coefficient. RESULTS Both readers scored venous-structure definition as excellent or sufficient for diagnosis in approximately 90% of segments for the full-dose group (kappa = 0.87) and in approximately 80% of segments for the half-dose group (kappa = 0.85). Delineation grades were significantly lower for small venous segments, including the middle cerebral, septal, superior cerebellar, inferior vermian, posterior tonsillar, and thalamostriate veins in the half-dose group (P < .01). No significant difference existed for arterial contamination grades between the 2 groups (P > .05). SNR and CNR values were lower in the half-dose group (P < .01). CONCLUSIONS At 3T, high-spatial-resolution cerebral MRV can be performed with contrast doses as low as 7.5 mL, without compromising image quality as compared with full-dose protocols, except in the smallest veins, and without compromise of acquisition speed or spatial resolution.
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Affiliation(s)
- A Tomasian
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, Calif., USA.
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Tomasian A, Lell M, Currier J, Rahman J, Krishnam MS. Coronary artery to pulmonary artery fistulae with multiple aneurysms: radiological features on dual-source 64-slice CT angiography. Br J Radiol 2008; 81:e218-20. [PMID: 18769007 DOI: 10.1259/bjr/64015972] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Coronary artery fistula is a rare vascular anomaly in which there is abnormal communication between the coronary artery and the great vessels or cardiac chambers. We report the case of a 66-year-old man with two separate coronary artery to pulmonary artery fistulas (one of which demonstrated multiple aneurysms), which were diagnosed on dual-source 64-slice coronary CT and reconfirmed by coronary catheter angiography.
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Affiliation(s)
- A Tomasian
- Department of Radiological Sciences, University of California at Los Angeles, 10945 Le Conte Avenue, Los Angeles, CA 90095-7206, USA.
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Singhal A, Tomasian A, Sassani A, Deshpande V, Laub G, Finn JP, Ruehm S, Krishnam MS. 156 Pulmonary vein imaging by 3D non-contrast, free breathing SSFP MR angiography; a novel technique. J Cardiovasc Magn Reson 2008. [DOI: 10.1186/1532-429x-10-s1-a57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Krishnam MS, Tomasian A, Singhal A, Ruehm SG, Finn JP, Gomes A. 1053 Assessment of complex peripheral vascular malformations with highly time-resolved 3D contrast-enhanced MR angiography and single phase high-spatial resolution 3D contrast-enhanced MRA at 3.0 Tesla. J Cardiovasc Magn Reson 2008. [DOI: 10.1186/1532-429x-10-s1-a178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Tomasian A, Salamon N, Lohan DG, Krishnam MS, Villablanca JP, Finn JP. 158 A contrast dose reduction study for 3D high spatial resolution contrast-enhanced magnetic resonance angiography of supra-aortic arteries at 3.0 Tesla. J Cardiovasc Magn Reson 2008. [DOI: 10.1186/1532-429x-10-s1-a59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Tomasian A, Lai C, Finn JP, Gelabert H, Krishnam MS. Cystic adventitial disease of the popliteal artery: features on 3T cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2008; 10:38. [PMID: 18700041 PMCID: PMC2538522 DOI: 10.1186/1532-429x-10-38] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 08/13/2008] [Indexed: 11/16/2022] Open
Abstract
Cystic adventitial disease (CAD) of the popliteal artery is a rare vascular disease of unknown etiology in which a mucin-containing cyst develops in the adventitial layer of the artery. We report the case of a 26-year-old male with CAD of the right popliteal artery diagnosed non-invasively with 3 Tesla cardiovascular magnetic resonance and confirmed on post-operative histopathology.
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Affiliation(s)
- Anderanik Tomasian
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Chi Lai
- Department of Pathology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - J Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Hugh Gelabert
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Mayil S Krishnam
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Suite 3371, Peter V. Ueberroth Bldg, 10945 Le Conte Ave, Los Angeles, CA, 90095-7206, USA
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Habibi R, Krishnam MS, Lohan DG, Barkhordarian F, Jalili M, Saleh RS, Ruehm SG, Finn JP. High-Spatial-Resolution Lower Extremity MR Angiography at 3.0 T: Contrast Agent Dose Comparison Study. Radiology 2008; 248:680-92. [PMID: 18574136 DOI: 10.1148/radiol.2482071505] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Reza Habibi
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Peter V Ueberroth Bldg, Suite 3371, 10945 Le Conte Ave, Los Angeles, CA 90095, USA.
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Krishnam MS, Tomasian A, Lohan DG, Tran L, Finn JP, Ruehm SG. Low-dose, time-resolved, contrast-enhanced 3D MR angiography in cardiac and vascular diseases: correlation to high spatial resolution 3D contrast-enhanced MRA. Clin Radiol 2008; 63:744-55. [PMID: 18555032 DOI: 10.1016/j.crad.2008.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 12/22/2007] [Accepted: 01/03/2008] [Indexed: 11/20/2022]
Abstract
AIM To evaluate the effectiveness of low-dose, contrast-enhanced, time-resolved, three-dimensional (3D) magnetic resonance (MR) angiography (TR-MRA) in the assessment of various cardiac and vascular diseases, and to compare the results with high-resolution contrast-enhanced MRA (CE-MRA). MATERIALS AND METHODS Thirty consecutive patients underwent contrast-enhanced 3D TR-MRA and high spatial resolution 3D CE-MRA for evaluation of cardiac and thoracic vascular diseases at 1.5 T, and neurovascular, abdominal and peripheral vascular diseases at 3T. Gadolinium-based contrast medium was administered at a constant dose of 5 ml for TR-MRA, and 20 ml (lower extremity 30 ml) for CE-MRA. Two readers evaluated image quality using a four-point scale (from 0=excellent to 3=non-diagnostic), artefacts and findings on both datasets. Interobserver variability was tested with kappa coefficient. RESULTS The overall image quality for TR-MRA was in the diagnostic range (median 0, range 0-1; k=0.74). Readers demonstrated important additional dynamic information on TR-MRA in 28 of 30 patients (k=0.84). Confident evaluation of organ perfusion (n=23), arteriovenous malformation/fistula flow patterns (n=7), exclusion of intra-cardiac shunts (n=6), and assessment of stent and conduit patency (n=5) were performed by both readers using TR-MRA. Readers demonstrated fine vascular details with higher confidence in 10 patients on CE-MRA. Using CE-MRA, Reader 1 and 2 depicted anatomical details in 6 and 5 patients, respectively, only on CE-MRA. CONCLUSION Low-dose TR-MRA yields rapid and important functional and anatomical information in patients with cardiac and vascular diseases. Due to limited spatial resolution, TR-MRA is inferior to CE-MRA in demonstrating fine vascular details.
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Affiliation(s)
- M S Krishnam
- Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA 90095-7206, USA.
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Krishnam MS, Suh RD, Tomasian A, Goldin JG, Lai C, Brown K, Batra P, Aberle DR. Postoperative complications of lung transplantation: radiologic findings along a time continuum. Radiographics 2007; 27:957-74. [PMID: 17620461 DOI: 10.1148/rg.274065141] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In the past decade, lung transplantation has become established as an accepted therapy for end-stage pulmonary disease. Complications of lung transplantation that may occur in the immediate or longer postoperative term include mechanical problems due to a size mismatch between the donor lung and the recipient thoracic cage; malposition of monitoring tubes and lines; injuries from ischemia and reperfusion; acute pleural events; hyperacute, acute, and chronic rejection; pulmonary infections; bronchial anastomotic complications; pulmonary thromboembolism; upper-lobe fibrosis; primary disease recurrence; posttransplantation lymphoproliferative disorder; and native lung complications such as hyperinflation, malignancy, and infection. Radiologic imaging--particularly chest radiography, computed tomography (CT), and high-resolution CT--is critical for the early detection, evaluation, and diagnosis of complications after lung transplantation. To enable the selection of an effective and relevant course of therapy and, ultimately, to decrease morbidity and mortality among lung transplant recipients, radiologists at all levels of experience must be able to recognize and understand the imaging manifestations of posttransplantation complications.
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Affiliation(s)
- Mayil S Krishnam
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Peter V. Ueberroth Bldg, Suite 3371, 10945 LeConte Ave, Los Angeles, CA 90095-7206, USA.
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