Magnetic resonance imaging maps of velocity were acquired with a 1.5-T system in 10 subjects in a plane perpendicular to the main pulmonary artery. Velocity images were successively acquired with a ...method developed from Fourier-encoding velocity imaging (FEVI) principles with eight gradient steps and one excitation, and with two-point phase-subtraction mapping. Reconstruction in FEVI was implemented by zero-filling interpolation around the eight gradient steps and then around the four central steps. The methods were compared by using estimates of noise in velocity measurements based on the difference between the experimental map and a smooth fitted map. For the same acquisition time, FEVI with four encoding steps was more precise in velocity measurements than phase mapping. Precision was further increased by the use of eight encoding steps, but acquisition time was doubled.
The evaluation of diastolic function from phase-contrast (PC) Magnetic Resonance (MR) data in clinical routine is not yet established. Thus, our goal was to develop a reproducible process to analyze ...PC data. These developments were used to estimate mitral flow and myocardial velocities from PC data of 40 controls. Besides, the reproducibility was assessed on a sub-group of 20 subjects. Transmitral flow and myocardial patterns were successfully delineated on each cardiac phase, resulting in conventional diastolic parameters, consistent with echocardiographic literature. Moreover, new proposed parameters correlated strongly (r >; 0.8) with those with high prognostic value. Finally, the flow segmentation was reproducible (99.5 ± 2.1% of overlap between two segmentations), and a low inter-operators variability (<;3.65%) in diastolic parameters measurements was obtained. Our technique provides a valuable addition to established cardiac MR tools.
Spontaneous coronary dissection usually occurs in middle-aged women, during pregnancy and postpartum. Proposed management strategies are most often based on invasive procedures such as percutaneous ...transluminal intervention with stenting, or surgical revascularization. We report a case of coronary dissection of the main stem artery occurring after intensive exercise, showing a rapid regression under conservative medical treatment. This case and the review of the literature emphasize that in case of non-occlusive coronary dissection, a conservative approach with a careful follow-up may be a strategy to consider.
Hypertrophic cardiomyopathy and anomalous origin of the coronary arteries are important causes of sudden cardiac death in the young, for which several diagnostic imaging modalities are currently ...available. We report the case of a young sudden cardiac death survivor in whom the unusual coexistence of hypertrophic cardiomyopathy and anomalous origin of the left circumflex artery was demonstrated using 64-slice computed tomography.
The robustness of a segmentation method of the left ventricle on MR images and the accuracy of the computation of significant clinical parameters derived from the segmentation are shown. This is done ...by comparison with manual measurements performed by a cardiologist.
A semi-automatic endocardial contour detection method has been developed on cine CT sequences. A preprocessing relying on a pyramidal thresholding is made, permitting the extraction of a region of ...interest on the first image. A contour detection algorithm is then processed on the whole sequence, grounded on the search of an optimal pathway in the graph.
Background
Severe hypercalcemia (HCM) is a common reason for admission in intensive-care unit (ICU). This case series aims to describe the clinical and biological features, etiologies, treatments, ...and outcome associated with severe HCM. This study included all patients with a total calcemia above 12 mg/dL (3 mmol/L) admitted in two ICUs from January 2007 to February 2017.
Results
131 patients with HCM were included. HCM was related to hematologic malignancy in 58 (44.3%), solid tumors in 29 (22.1%), endocrinopathies in 16 (12.2%), and other causes in 28 (21.3%) patients. 108 (82.4%) patients fulfilled acute kidney injury (AKI) criteria. Among them, 25 (19%) patients required renal replacement therapy (RRT). 51 (38.9%) patients presented with neurological symptoms, 73 (55.7%) patients had cardiovascular manifestations, and 50 (38.1%) patients had digestive manifestations. The use of bisphosphonates (HR, 0.42; 95% CI, 0.27–0.67;
P
< 0.001) was the only treatment significantly associated with a decrease of total calcemia below 12 mg/dL (3 mmol/L) at day 5. ICU and Hospital mortality rates were, respectively, 9.9% and 21.3%. Simplified Acute Physiologic Score (SAPS II) (OR, 1.05; 95% CI 1.01–1.1;
P
= 0.03) and an underlying solid tumor (OR, 13.83; 95% CI 2.24–141.25;
P
= 0.01) were two independent factors associated with hospital mortality in multivariate analysis.
Conclusions
HCM is associated with high mortality rates, mainly due to underlying malignancies. The course of HCM may be complicated by organ failures which are most of the time reversible with early ICU management. Early ICU admission and prompt HCM management are crucial, especially in patients with an underlying solid tumor presenting with neurological symptoms.
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