Influence of cardiac phase on myocardial native T1 values by a segmental approach

Funding Acknowledgements Type of funding sources: None. Background. Native T1 values are usually assessed in the end-diastole to minimize motion artifacts while the systolic data acquisition offers the advantage of a thicker myocardium, with reduced partial-volume effects. Higher myocardial T1 values have been detected in diastole at both 1.5T and 3T but the dependence of this difference on myocardial segments or gender has not been fully explored. Aim. We provided a systematic comparison of myocardial native T1 values in diastole and systole, by considering separately myocardial segments and dividing males and females. Methods. Sixty-one healthy subjects (46.0 ± 14.1 years, 32 males) underwent CMR at 1.5T (Signa Artist; GE Healthcare). Three short-axis slices of the left ventricle acquired in diastole and systole using a Modified Look–Locker Inversion Recovery sequence. Image analysis was performed with a commercially available software package. T1 value was assessed in all 16 myocardial segments and global value was the mean. Results. Table 1 shows the comparison between T1 values calculated from maps obtained in diastole and systole. Systolic T1 values were significantly lower in the basal anterolateral segment, in all medium segments except for the medium inferior segment, and in all apical segments. The percentage difference between diastolic and systolic T1 values was considered to compensate for the higher T1 values in females, and a significantly higher value was detected in females for the majority of medium segments, for all apical segments, and for the global value. Conclusion. The diastolic-systolic discrepancy was more pronounced for the females and at the apical level, supporting the hypothesis that, besides the physiologic variations in myocardial blood volume during the cardiac cycle, the partial volume-effect may be a strong additional contributing factor. Native T1 values should be obtained always in the same cardiac phase to avoid a potential bias in the discrimination between healthy and pathologically affected myocardium.

Electroangiographic Correlation of Simultaneous ST-Segment Elevations of Anterior and Inferior Segment: Who Is the Culprit?

Simultaneous ST-segment elevation (SST-SE) in anterior and inferior leads in the setting of ST-segment elevation myocardial infarction is often confounding for a cardiologist and further more challenging is the angiographic localization of the culprit vessel. SST-SE can be fatal as it jeopardizes simultaneously a larger area of myocardium. This phenomenon could be due to “one lesion, one artery,” “two lesions, one artery,” “two lesions, two arteries,” or combinations in two different coronary arteries. We have discussed an index case where we encountered a phenomenon of SST-SE and coronary angiography demonstrated “two lesions, one artery” (proximal occlusion and distal critical diffuse stenoses of the wrap-around left anterior descending [LAD] artery) and “two lesions, two (different coronary) arteries” (previously mentioned stenoses of the LAD artery and critical stenosis of the posterolateral branch of the right coronary arteries). We have also described in brief the possible causes of this phenomena and their electroangiographic correlation of the culprit vessels.

Liquid Based Cytology versus Conventional Cytology for Evaluation of Cervical PAP Smear

The cervix is the narrow inferior segment of the uterus which projects into the vaginal vault. Conventional cervical cytology is a simple, cost effective method that has been in use for more than 50 years and is still a highly effective cervical cancer screening procedure. Liquid-based, thin-layer preparation of cervical cytology specimens was a subsequent modification in technique. The present study was split-sample study was to compare Thin Prep Liquid-based Cytology with Conventional Pap Smear, relying on a laboratory with long term experience of the former. In our study most of the Conventional preparations showed cell overlapping, inflammatory cells, blood and mucus that obscure the epithelial cell morphology which was much reduced in Liquid based preparations.

Cardiac sarcoidosis evaluation and characterization with cardiac magnetic resonance

Funding Acknowledgements Type of funding sources: None. Introduction Sarcoidosis is a multisystemic inflammatory disease, which accounts for substantial morbimortality. Cardiac involvement portends a worse prognosis. A major limitation in the evaluation of cardiac sarcoidosis is that no gold standard clinical diagnostic criteria exists. Cardiac magnetic resonance (CMR) may be indicated in patients with suspected cardiac involvement as a diagnostic and prognostic tool. Purpose The aim of this study was to characterize the features of cardiac involvement of sarcoidosis in patients with stablished diagnosis of the systemic disease, as well as to describe changes observed. Methods A multicenter, 6-years prospective study of all patients with sarcoidosis who performed CMR to evaluate possible cardiac involvement. We followed a protocol to evaluate the left and right ventricles (VE; RV) both anatomically and functionally, T2- weighted STIR sequences to evaluate myocardial edema and presence of late gadolinium enhancement(LGE). Results A total of 20 patients were included. Female patients accounted for 75% of the cases, and the mean age was 53 ± 15 years old. A majority of the patients (90%) had preserved LV (mean LV ejection fraction(EF)63 ± 6%) and RV ejection fraction (mean RV EF 62 ± 7%). Patients observed presented with mean LV end diastolic indexed volume(EDIV) of 72 ± 19 mL/m2 and mean RV EDIV of 63 ± 18mL/m2, with only one patient presenting with LV dilation(LV EDIV 138mL/m2) and two with RV dilation (mean RV EDIV 107 ± 6mL/m2). Possible features of cardiac sarcoidosis were present in 10% (n = 2) of patients. One of them presented with biventricular dilation and severe ejection fraction depression(LV EF 22% and RV EF 28%). LGE was observed in these two patients, with one presenting with an intramyocardial lesion with nodular appearance on the apical inferior segment and the other patient having its distribution characterized with two different patterns: linear appearance on the septal intramyocardium and subepicardial on the basal and mid segments of the inferior wall. On STIR sequences none of the patients presented with hypersignal suggestive of edema. None of them presented with left atrium dilation. Conclusion CMR provides a noninvasive and multidimensional assessment of the heart for evaluation of cardiac sarcoidosis. In our population of patients with sarcoidosis but without established cardiac involvement diagnosis, CMR allowed a 10% increasement on the diagnosis of cardiac sarcoidosis. CMR myocardial fibrosis detection allowed a better stratification of patients with sarcoidosis.

Concomitant of Pulmonary Hydatid Cyst and Aspergilloma: A Rare Coinfection

The coexistence of cystic echinococcosis (CE) and aspergilloma is rather uncommon. Aspergillus species, saprophytic fungi, can colonize pulmonary cavities that are caused by tuberculosis, sarcoidosis, and CE. Infection by Aspergillus is often occurring in immunosuppressed patients. However, coinfection of aspergilloma with pulmonary hydatid cyst is very unusual, especially in an immunocompetent patient with unruptured cyst. Herein, we report a case of lung hydatid cyst coinfected with Aspergillus in a 42-year-old Iranian man from Southern Iran. Chest X-ray and computed tomography (CT) scan showed a circumscribed cystic lesion in the superior and inferior segment of the lower lobes of right and left lungs that suggests hydatid cyst. Radical surgery (lobectomy) was performed for the patient. Histopathological evaluation reconfirmed the classical laminated layer of hydatid cyst. Moreover, the ectocyst layer of the right lung showed the presence of numerous cluster septate hyphae with acute-angled branching, as seen in the morphology of Aspergillus species. DNA was extracted from the cyst, and the ITS1-5.8s-ITS2 region of the fungal agent was amplified. Sequencing and analysis of seminested PCR product revealed that the isolate has the most similarity with Aspergillus niger. Further attention is recommended to control fungal pathogens during pulmonary hydatidosis. The coexistence of aspergilloma should always be kept in mind for the better management of CE.

The Bairn’s Blain- Fibromatosis Colli

Preface Fibromatosis colli is an exceptional, benign neoplasm of infancy constituted by spindle-shaped cells of sternocleidomastoid muscle. Fibromatosis colli emerges within specific sites such as distal or inferior segment of sternocleidomastoid muscle and is accompanied by diffuse enlargement of the muscle. Although nomenclated as “sternocleidomastoid tumour” or “sternocleidomastoid pseudo-tumour of infancy”, the designation is a misnomer, as the condition is non neoplastic although it may be denominated as a congenital fibrotic disorder.