Multidetector Computed Tomography

IJCS

Case Report

Caseous Necrosis of the Mitral Valve: Imaging Methods Allow the Diagnosis and Prevent Surgery

Rodrigo de Moura Joaquim et al. Edileide de Barros Correia Suéllen Lacerda Bezerra Ibraim Masciarelli Francisco Pinto … Tiago Senra Garcia dos Santos Fabiano de Castro Albrecht

Introduction

Calcification of the mitral annulus (CMA) is defined as a chronic degeneration of the mitral annulus fibrous involving mainly the posterior annulus. It is a common condition in the elderly, especially in women, and is associated with hypertension. Caseous necrosis of the mitral valve (CNMV) is a rare and less known CMA variant with a prevalence of 0.64%, which can reach up to 2.7% in autopsy studies of patients with CMA.^–

On echocardiography, CNMV appears as a large rounded or semilunar echodense mass, with a liquid filling and central echolucency, similar to a periannular tumor.^, The mechanism of liquefaction and caseification are still not well understood, but it is believed to occur due to changes in calcium metabolism.

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Original Article

Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block

Estêvan Vieira Cabeda et al. Andréa Maria Gomes Falcão José Soares Jr. Carlos Eduardo Rochitte … César Higa Nomura Luiz Francisco Rodrigues Ávila José Rodrigues Parga

Abstract

Background:

Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB).

Objective:

To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA) and compare the results with those of single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy.

Methods:

Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution’s ethics committee.

Results:

The patients’ mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001). The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001). In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001).

Conclusion:

The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB.

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Case Report

Multidetector Computed Tomographic Characterization of a Left Atrial Myxoma

Anna Marciniak et al. Ronak Rajani

A 57-year-old woman presented to her local hospital with left arm and leg weakness and was diagnosed with a right-sided stroke. A subsequent transthoracic echocardiogram showed a large, poorly-defined mass within the left atrium, which prompted her transfer to our institute for urgent surgical resection.

As a prelude to surgery, we performed a “tripartite” coronary CT angiogram to assess the coronary anatomy and left atrial mass (). The findings were consistent with a left atrial myxoma and the patient subsequently underwent surgery, where the mass was resected and the diagnosis substantiated ().

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Artigo Original

Myocardial fibrosis in patients with hypertrophic cardiomyopathy and high risk for sudden death

Afonso Akio Shiozaki et al. Tiago Senra Edmundo Arteaga Cristiane Guedes Pita … Martino Martinelli Filho Luis Francisco R. Ávila José Rodrigues Parga Filho Charles Mady Carlos Eduardo Rochitte

BACKGROUND: The stratification of risk for sudden death in hypertrophic cardiomyopathy (HCM) continues to be a true challenge due to the great heterogeneity of this disease’s presentation, as most individuals remain asymptomatic during their entire lives and others present sudden death as first symptom. Recent studies have suggested that myocardial fibrosis may represent an important substrate for the malignant ventricular arrhythmias, that are responsible for the cases of sudden death related to this disease. OBJECTIVE: To assess the prevalence and quantification of myocardial fibrosis (MF) in hypertrophic cardiomyopathy (HCM) patients with implantablecardioverter – defibrillator (ICD) indicated due to their high risk or recovered from cardiac sudden death. METHODS: Twenty-eight HCM patients with ICD were submitted to multidetector computed tomography to assess myocardial fibrosis by delayed enhancement technique. RESULTS: Myocardial fibrosis was present in 96% of these HCM patients with (20.38 ± 15.55 g) comprising 15.96 ± 10.20% of the total myocardial mass. MF was observed in a significantly higher prevalence as compared to other classical risk factors for sudden death. CONCLUSION: It is possible to conclude that there is a high prevalence of myocardial fibrosis in hypertrophic cardiomyopathy patients with high-risk or recovered from cardiac sudden death, like those with clinical indication to implantable cardioverter -defibrillator. The higher prevalence of myocardial fibrosis in comparison to classical risk factors of worse prognosis raise the hypothesis that the myocardial fibrosis may be an important substrate in the genesis of lifethreatening arrhythmias in these high risk HCM population.

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Caseous Necrosis of the Mitral Valve: Imaging Methods Allow the Diagnosis and Prevent Surgery

Introduction

Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Multidetector Computed Tomographic Characterization of a Left Atrial Myxoma

Myocardial fibrosis in patients with hypertrophic cardiomyopathy and high risk for sudden death

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